Background: Nursing homes for older adults have concentrated large numbers of severe cases and deaths for COVID-19. Methods: Point seroprevalence study of nursing homes to describe the demography and characteristic of SARS-CoV-2 IgG-positive residents and staff. Results: Clinical information and blood samples were available for 9,332 residents (mean age 86.7 ± 8.1 years, 76.4% women) and 10,614 staff (mean age 45.6 ± 11.5, 86.2% women). Up to 84.4% of residents had frailty, 84.9% co-morbidity and 69.3% cognitive impairment; 65.2% of workers were health-aides. COVID-19 seroprevalence was 55.4% (95% CI, 54.4–56.4) for older adults and 31.5% (30.6–32.4) for staff. In multivariable analysis frailty of residents was related with seropositivity (OR: 1.19, p = 0.02). In the case of staff, age > 50 years (2.10, p < 0.001), obesity (1.19, p = 0.01), being a health-aide (1.94, p < 0.001), working in a center with high seroprevalence in residents (3.49, p < 0.001), and contact with external cases of COVID-19 (1.52, p < 0.001) were factors associated with seropositivity. Past symptoms of COVID-19 were good predictors of seropositivity for residents (5.41, p < 0.001) and staff (2.52, p < 0.001). Conclusions: Level of dependency influences risk of COVID-19 among residents. Individual and work factors, and contacts outside the nursing home are associated with COVID-19 exposure in staff members. It is key to strengthen control measures to prevent the introduction of COVID-19 into care facilities from the community.

PurposeThe aim of the present study is to examine cell wall and septum thickening of methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and methicillin- and linezolid-resistant S. aureus (MLRSA) isolates by transmission electron microscopy to correlate the association of resistance mechanisms with major changes in the morphology of membrane or septum.Materials and methodsMSSA, MRSA, and MLRSA strains obtained from clinical samples of an outbreak that occurred in 2010 at the Intensive Care Unit of our Hospital were thawed and sown at 37°C in blood agar overnight. After that, they were washed, pelleted, and treated with a fixer solution. Pellets were dehydrated and finally embedded in resin. Transmission electron microscopy was used to characterize cell wall and septum thickening in all isolates. The comparison between the measurements obtained for each group was performed by a Kruskal–Wallis test and a post hoc Dunn–Bonferroni’s pairwise comparison method.ResultsDifferences in cell wall and septum thickness were statistically significant (P<0.001 and P<0.001, respectively) between the three groups. Moreover, significant differences were detected in wall and septum thickness between the MSSA and MRSA strains (P<0.001 and P<0.001, respectively) and between the MSSA and MLRSA strains (P<0.001 and P<0.001, respectively) but not between the MRSA and MLRSA strains (P=0.386 and P=0.117).ConclusionIn this analysis, we correlate the resistance mediated by alterations in the cell membrane of S. aureus (methicillin-resistant, for example) with a greater thickness of the wall or septum. The resistance added to linezolid did not determine significant changes in the characteristics of the wall or septum with respect to those strains resistant only to methicillin.

The activity of plazomicin and clinically relevant aminoglycosides was tested against 346 extended-spectrum-␤-lactamase/AmpC-producing Escherichia coli urinary isolates, and the results were correlated with the presence of aminoglycoside-modifying enzymes (AMEs). Data showed that plazomicin was very active against all ESBL/AmpCproducing E. coli urinary isolates. Its activity was not related to the AME genes studied.KEYWORDS AMEs, ESBL, Escherichia coli, plazomicin, aminoglycosides E scherichia coli strains producing extended-spectrum ␤-lactamases (ESBLs) have emerged as major global pathogens, primarily associated with urinary tract infections (1). These strains possess plasmids that carry genes conferring resistance to multiple antibiotic classes (2). As a result, therapeutic options against these ␤-lactamresistant E. coli infections are extremely limited.Aminoglycoside resistance in Gram-negatives is mainly conferred by production of aminoglycoside-modifying enzymes (AMEs) (3). Genes encoding AMEs are located on mobile genetic elements along with other resistance determinants, resulting in multidrug-resistant (MDR) isolates (3). Plazomicin is a next-generation aminoglycoside modified to evade AMEs. The compound is currently under clinical development for the treatment of complicated urinary tract infections (cUTIs) and acute pyelonephritis as a single agent (4,5).In this study, we evaluated the activity of plazomicin and clinically relevant aminoglycosides against 346 ESBL/AmpC-producing E. coli urinary isolates. The presence of four AME genes was also investigated, and the relationship between the AME genes detected and the resistance phenotype found was determined.The isolates were obtained prospectively during 2013 at the Hospital Clínico San Carlos (Madrid, Spain). Only one isolate per patient was included. PCR characterization (6, 7) showed 302 ESBL producers and 44 AmpC producers.MICs of gentamicin, tobramycin, amikacin, and plazomicin were determined by the agar dilution method. MICs of plazomicin were also determined by the broth microdilution method (8). Antimicrobial agents were obtained from their respective manufacturers. Plazomicin was supplied from Achaogen (South San Francisco, CA). The results were interpreted according the guidelines of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (9).All isolates resistant to at least one of the aminoglycosides studied were tested by PCR for the presence of AME genes. Sets of primers for the following genes were

Background: Assessment of T-cell responses to SARS-CoV-2 antigens may be of value to determine long-lasting protection to breakthrough infections or reinfections. Interferon-gamma release assay is a validated method to test cellular immunity in mycobacterial infections and has been proposed for patients with SARS-CoV-2 infection or vaccination. Methods: Quantitative IgG to spike and qualitative IgG to nucleocapsid antigens were determined by chemiluminescence microparticle immunoassay using the Architect® platform (Abbott®), and interferon-gamma release assay against two Qiagen® proprietary mixes of SARS-CoV-2 spike protein (antigen-1 and antigen-2) were performed for a selected group of subjects. Results: A total of 121 subjects in a cloistered institution after a COVID-19 outbreak were studied. IgG-spike levels and interferon-gamma concentration were highest among subjects after two doses of vaccine, followed by patients with a longer history of past COVID-19 and no vaccination. Best cut-off for interferon-gamma assay was 25 IU/μL for all subgroups of individuals and the two sets of SARS-CoV-2 antigens studied. Conclusions: Testing T-cell response may be of clinical utility to determine immunity after exposure to SARS-CoV-2 antigens, with the interferon-gamma concentration of 25 IU/μL as the best cut-off either after infection or vaccination.

These results suggest that bioengineered human oral mucosa substitutes form a well-developed epithelial layer that was very similar to human native tissues. In consequence, the epithelial layer could be fully functional in these oral mucosa substitutes, thus implying that these tissues may have clinical usefulness.

Introduction. The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. Material and methods. We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. Results. The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0). Conclusions. Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection).

Background Indications and outcomes in lumbar spinal fusion for degenerative disease are notoriously heterogenous. Selected subsets of patients show remarkable benefit. However, their objective identification is often difficult. Decision-making may be improved with reliable prediction of long-term outcomes for each individual patient, improving patient selection and avoiding ineffective procedures. Methods Clinical prediction models for long-term functional impairment [Oswestry Disability Index (ODI) or Core Outcome Measures Index (COMI)], back pain, and leg pain after lumbar fusion for degenerative disease were developed. Achievement of the minimum clinically important difference at 12 months postoperatively was defined as a reduction from baseline of at least 15 points for ODI, 2.2 points for COMI, or 2 points for pain severity. Results Models were developed and integrated into a web-app (https://neurosurgery.shinyapps.io/fuseml/) based on a multinational cohort [N = 817; 42.7% male; mean (SD) age: 61.19 (12.36) years]. At external validation [N = 298; 35.6% male; mean (SD) age: 59.73 (12.64) years], areas under the curves for functional impairment [0.67, 95% confidence interval (CI): 0.59–0.74], back pain (0.72, 95%CI: 0.64–0.79), and leg pain (0.64, 95%CI: 0.54–0.73) demonstrated moderate ability to identify patients who are likely to benefit from surgery. Models demonstrated fair calibration of the predicted probabilities. Conclusions Outcomes after lumbar spinal fusion for degenerative disease remain difficult to predict. Although assistive clinical prediction models can help in quantifying potential benefits of surgery and the externally validated FUSE-ML tool may aid in individualized risk–benefit estimation, truly impacting clinical practice in the era of “personalized medicine” necessitates more robust tools in this patient population.

<b><i>Introduction:</i></b> Nursing homes for older adults have been hot spots for SARS-CoV-2 infections and mortality. Factors that facilitate COVID-19 outbreaks in these settings need to be assessed. <b><i>Methods:</i></b> A retrospective cross-sectional study of a cohort of residents and workers in nursing homes taking occasion of a point seroprevalence survey was done in the Community of Madrid. Factors related to outbreaks in these facilities were analyzed. <b><i>Results:</i></b> A total of 369 nursing homes for older adults, making a population of 23,756 residents and 20,795 staff members, were followed from July to December 2020. There were 54.2% SARS-CoV-2 IgG+ results in residents and in 32.2% of workers. Sixty-two nursing homes (16.8%) had an outbreak during the follow-up. Nursing homes with outbreaks had more residents than those without (median number of 81 [IQR, 74] vs. 50 [IQR, 56], <i>p</i> &#x3c; 0.001). Seropositivity for SARS-CoV-2 was lower in facilities with versus without outbreaks, for residents (42.2% [IQR, 55.7] vs. 58.7% [IQR, 43.4], <i>p</i> = 0.002) and for workers (23.9% [IQR, 26.4] vs. 32.8% [IQR, 26.3], <i>p</i> = 0.01). For both residents and staff, the number of infections in outbreaks was larger in centers with lower, as compared with intermediate or high seroprevalence. The size of the facility did not correlate with the number of cases in the outbreak. Taking the incidence of cases in the community as a time-dependent variable (<i>p</i> = 0.03), a Cox analysis (HR [95% CI], <i>p</i>) showed that intermediate or high seroprevalence among residents in the facility was related to a reduction of 55% (0.45 [0.25–0.80], <i>p</i> = 0.007) and 78% (0.22 [0.10–0.48], <i>p</i> &#x3c; 0.001) in the risk of outbreaks, respectively, as compared with low sero­prevalence. Also, as compared with smaller, medium (1.91 [1.00–3.65], <i>p</i> = 0.05) or large centers (4.57 [2.38–8.75], <i>p</i> &#x3c; 0.001) had more respective risk of outbreaks. <b><i>Conclusions:</i></b> The size of the facility and the seroprevalence among residents in nursing homes, and the incidence of infections in the community, are associated with the risk of outbreaks of COVID-19. Facilities with greater proportion of seropositives had smaller number of cases. Monitoring of immunity in nursing homes may help detect those at a greater risk of future cases.