Effect of the Aeration Strategy on NOB Suppression in Activated Sludge and Biofilm in a Hybrid Reactor with Nitrification/Denitrification

The purpose of the study was to analyse the impact of aeration strategies defined by the changes in the duration of aerated sub-phases, the ratio between non-aerated and aerated sub-phase times (R), and dissolved oxygen concentrations (DO) on the suppression of nitrite-oxidizing bacteria (NOB) in activated sludge and biofilm developing in a hybrid reactor with nitrification/denitrification. The primary factor causing NOB suppression both in biofilm and in activated sludge was an increase in the R-value (from 0 to 1/4 and from 1/4 to 1/3). After reducing the DO from 3 to 2 mg O2/L, there were no changes in the frequency of NOB occurrence, and no reduction in the nitrite oxidation rate was recorded. The abundance of Comammox bacteria was considerably affected by the change from continuous to intermittent aeration. Activated sludge showed a substantial increase in the quantity of clade A and B, whereas the quantity considerably decreased in biofilm.

Intensive Care Antifungal Stewardship Programme Based on T2Candida PCR and Candida Mannan Antigen: A Prospective Study

Non-culture-based biomarkers may improve diagnosis and antifungal treatment (AFT) of invasive candidiasis (IC). We evaluated an antifungal stewardship programme (AFSP) in a prospective intensive care unit (ICU) study, which included T2Candida and Candida mannan antigen (MAg) screening of patients with sepsis and a high risk of IC. Patients with non-neutropenic sepsis and a high risk of IC from two large tertiary ICUs were prospectively included, during a one-year period. IC was classified as proven, likely, possible or unlikely. The AFSP, diagnostic values of T2Candida and MAg, and the consumption of antifungals were evaluated. An amount of 219 patients with 504 T2Candida/MAg samples were included. IC was classified as proven in 29 (13.2%), likely in 7 (3.2%) and possible in 10 (5.5%) patients. Sensitivity/specificity/PPV/NPV values, comparing proven/likely versus unlikely IC, were 47%/100%/94%/90% for BC alone, 50%/97%/75%/90% for T2Candida alone, and 39%/96%/67%/88% for MAg alone. For the combination of T2Candida/MAg taken ≤3 days after AFT initiation, sensitivity/specificity/PPV/NPV was 70%/90%/63%/93%. T2Candida/MAg contributed to early (<3 days) AFT initiation in 13%, early AFT discontinuation in 25% and abstaining from AFT in 24% of patients. No reduction in overall use of AFT during the study period compared with the previous year was observed. An AFSP based on T2Candida and MAg screening contributed to a reduction of unnecessary treatment, but not overall AFT use. The diagnostic performance of T2Candida was lower than previously reported, but increased if T2Candida was combined with MAg.