Urinary tract infections caused by extended-spectrum β-lactamase Escherichia coli (ESBL-EC) are increasing worldwide and are a current concern because treatment options are often limited. This study investigated antimicrobial susceptibility, antimicrobial resistance genes (ARGs), and the biological diversity of urinary ESBL-EC isolates at Cerdanya Hospital, a European cross-border hospital that combines French and Spanish healthcare models. Bacterial identification and susceptibility were determined using the Microscan WalkAway® system and ESBL production was examined by the double-disk synergy method. Isolates were sequenced using the Ion S5™ next-generation sequencing system, with the whole-genome sequences then assembled using SPADEs software and analyzed using PubMLST, ResFinder, FimTyper, PlasmidFinder, and VirulenceFinder. A phylogenetic analysis was performed by constructing an assembly-based core-SNV alignment, followed by a phylogenetic tree constructed using Parsnp from the Harvest suite. All isolates studied were multidrug-resistant and could be classified into 19 different sequence types characterized by a high genetic diversity. The most prevalent ESBL-enzymes were CTX-M-14 and CTX-M-15. High-risk international clones (ST131, ST10, and ST405) were also identified. The results demonstrated the absence of a single predominant clone of ESBL-MDR-EC at Cerdanya Hospital.
Background/Aim: Paraneoplastic syndrome symptoms include isolated involuntary weight loss (IIWL). The differential diagnosis of cancer from other diseases may require a significant number of tests. Tumour markers (TMs) can be used for the diagnosis and stratification of patients according to cancer risk. Patients and Methods: This study included 606 patients (48% females) seen at the rapid diagnostic unit for IIWL. We determined the levels of TMs carcinoembryonic antigen, carbohydrate antigen 19-9, soluble fragments of cytokeratin 19, carbohydrate antigen 15-3, carbohydrate antigen 125, neuron specific enolase, alpha-fetoprotein, prostatic specific antigen using the multiparametric analyser COBAS 601. Two cut-off points were established, the upper reference limit described by the manufacturer and a high cut-off point suggested by Molina et al., to stratify patients according to cancer risk. Results: Patients were classified according to TM levels as follows: I) all TMs below the upper reference limit; II) highest number of TMs between the two cut-offs; III) at least one TM above the higher cut-off. The odds ratio for malignancy was 4.3 for group II and 248 for group III. These results indicate that when at least one TM is above the higher cut-off, neoplasia is highly probable. Conclusion: TM determination allowed to establish cancer risk in patients with IIWL.Many cancer patients do not present specific symptoms or signs when they consult medical services (1, 2). These symptoms, including cachexia, weight loss, and muscle wasting arise from tumour secretion of hormones, peptides or cytokines (3,4) or in case of autoimmune neurological disorders, from immune cross reactivity between malignant and normal host tissues (5,6). Other disorders are due to tumour invasion or compression in surrounding or distant tissues.In some cases, paraneoplastic syndromes are presented before cancer diagnosis and may be used to select patients for more exhaustive tests, in order to perform differential diagnosis with benign diseases.In our country, specialised hospital units have been created to avoid unnecessary delays for patients with these symptoms. The rapid diagnostic unit (RDU) is an ambulatory resource for the study of severe pathologies without the need for hospital admission. It refers to patients with guidesymptoms derived from other hospital services or primary care. Some of the frequent signs that require referral to RDU are constitutional syndrome, wasting syndrome, or isolated involuntary weight loss (IIWL). Between 10 and 30% of patients who arrive at these units present involuntary weight loss as the only sign. In the RDU, they are being prioritized to undergo endoscopies, image tests, blood tests and biopsies in order to reach a diagnosis and start treatment when possible within one month (7-9).
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