Background There is emerging evidence for enhanced blood coagulation in coronavirus 2019 (COVID-19) patients, with thromboembolic complications contributing to morbidity and mortality. The mechanisms underlying this prothrombotic state remain enigmatic. Further data to guide anticoagulation strategies are urgently required. Methods We used viscoelastic rotational thromboelastometry (ROTEM) in a single-center cohort of 40 critically ill COVID-19 patients. Results Clear signs of a hypercoagulable state due to severe hypofibrinolysis were found. Maximum lysis, especially following stimulation of the extrinsic coagulation system, was inversely associated with an enhanced risk of thromboembolic complications. Combining values for maximum lysis with D-dimer concentrations revealed high sensitivity and specificity of thromboembolic risk prediction. Conclusions The study identifies a reduction in fibrinolysis as an important mechanism in COVID-19-associated coagulopathy. The combination of ROTEM and D-dimer concentrations may prove valuable in identifying patients requiring higher intensity anticoagulation.

ObjectivesThe objective of these recommendations is to highlight the importance of infection prevention and control in ultrasound (US), including diagnostic and interventional settings.MethodsReview of available publications and discussion within a multidisciplinary group consistent of radiologists and microbiologists, in consultation with European patient and industry representatives.RecommendationsGood basic hygiene standards are essential. All US equipment must be approved prior to first use, including hand held devices. Any equipment in direct patient contact must be cleaned and disinfected prior to first use and after every examination. Regular deep cleaning of the entire US machine and environment should be undertaken. Faulty transducers should not be used. As outlined in presented flowcharts, low level disinfection is sufficient for standard US on intact skin. For all other minor and major interventional procedures as well as all endo-cavity US, high level disinfection is mandatory. Dedicated transducer covers must be used when transducers are in contact with mucous membranes or body fluids and sterile gel should be used inside and outside covers.ConclusionsGood standards of basic hygiene and thorough decontamination of all US equipment as well as appropriate use of US gel and transducer covers are essential to keep patients safe.Main messages • Transducers must be cleaned/disinfected before first use and after every examination. • Low level disinfection is sufficient for standard US on intact skin. • High level disinfection is mandatory for endo-cavity US and all interventions. • Dedicated transducer covers must be used for endo-cavity US and all interventions. • Sterile gel should be used for all endo-cavity US and all interventions.

The genus Dietzia has only been established fairly recently. The Gram morphology and colony appearance of the species of this genus is remarkably similar to Rhodococcus equi. In the absence of simple, accurate methods for their identification, Dietzia spp. might have been misidentified as a Rhodococcus spp. and/or considered to be contaminants only. This MiniReview is designed to summarize current evidence on the clinical significance of Dietzia species, to consider their potential role as human pathogens, and to outline approaches that can be used to accurately classify and identify members of the genus, with the overall aim of alerting the medical microbiological community to a little known genus that contains clinically significant organisms.

Use of molecular biology technique increased the laboratory rate of identifying the pathogen by 20%, confirming the technique is very useful for the endophthalmitis specimen. Samples of both aqueous and vitreous should be collected and stored at -20 degrees C for PCR at the time of the diagnostic taps.

Erythromycin A, the first macrolide, was introduced in the 1950s and after years of clinical experience it still remains a commonly relied upon antibiotic. In the past, pharmacodynamic characteristics of macrolides beyond antimicrobial action such as anti-inflammatory and immune-modulating properties have been of scientific and clinical interest. The function of erythromycin as a prokinetic agent has also been investigated for a range of gastrointestinal motility disorders and more recently within the context of critically ill patients. Prokinetic agents are drugs that increase contractile force and accelerate intraluminal transit. Whilst the anti-inflammatory action may be a desirable side effect to its antibiotic action, using erythromycin A merely for its prokinetic effect alone raises the concern about promoting emergence of macrolide resistance. The objectives of this review article are: (i) to briefly summarize the modes and epidemiology of macrolide resistance, particularly in respect to that found in the Streptococcus species (a potential reservoir for the dissemination of macrolide resistance on the critical care unit); (ii) to discuss in this context the evidence for conditions promoting bacterial resistance against macrolides; and (iii) to assess the potential clinical benefit of using erythromycin A as a prokinetic versus the risks of promoting emergence of macrolide resistance in the clinical setting. We conclude, that in view of the growing weight of evidence demonstrating the potential epidemiological impact of the increased use of macrolides upon the spread of resistance, versus a lack of sufficient and convincing evidence that erythromycin A is a superior prokinetic agent to potential alternatives in the critically ill patient population, at this stage we do not advocate the use of erythromycin A as a prokinetic agent in critically ill patients unless they have failed all other treatment for impaired gastrointestinal dysmotility and are intolerant of metoclopramide. Further large and methodologically robust studies are needed to ascertain the effectiveness of erythromycin A and other alternative agents in the critically ill.

An actinomycete isolated from an immunocompetent patient suffering from confluent and reticulated papillomatosis was characterized using a polyphasic taxonomic approach. The organism had chemotaxonomic and morphological properties that were consistent with its assignment to the genus Dietzia and it formed a distinct phyletic line within the Dietzia 16S rRNA gene tree. It shared a 16S rRNA gene sequence similarity of 98.3 % with its nearest neighbour, the type strain of Dietzia cinnamea, and could be distinguished from the type strains of all Dietzia species using a combination of phenotypic properties. It is apparent from genotypic and phenotypic data that the organism represents a novel species in the genus Dietzia. (Mayilraj, et al., 2006), D. natronolimnaea from a moderately saline and alkaline East African soda lake (Duckworth et al., 1998) and D. psychralcaliphila was isolated from a drain pool of a fish-egg-processing plant (Yumoto et al., 2002). Species of the genus Dietzia have been reported as potential human pathogens in an immunocompetent patient (Pidoux et al., 2001) and in immunocompromised patients (BemerMelchior et al., 1999;Yassin et al., 2006).The aim of the present investigation was to determine the taxonomic position of an actinomycete that had been isolated from the skin of an immunocompetent patient with confluent and reticulated papillomatosis and presumptively assigned to the genus Dietzia (Natarajan et al., 2005). The isolate was the subject of a polyphasic taxonomic investigation which showed that it warrants recognition as a novel species of the genus Dietzia.Strain N 1280 T was isolated from skin scrapings from a patient suffering from confluent and reticulated papillomatosis, as described by Natarajan et al. (2005). The organism was maintained on glucose-yeast extract agar (GYEA; Gordon & Mihm, 1962) at room temperature and as glycerol suspensions (20 %, v/v) at 220 u C. Biomass required for chemotaxonomic and 16S rRNA gene sequence analyses was obtained by growing the novel strain in shake flasks of glucose-yeast extract (GYE) brothThe GenBank/EMBL/DDBJ accession number for the 16S rRNA gene sequence of strain N 1280T is AY643401.

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