Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. CEMIC (French-Belgian Study Club of Infectious Diseases in Cancer).

A total of 1051 bacteremic episodes (782 patients) were prospectively recorded in 10 cancer centers (9 French, 1 Belgian), with: patient's age (mean 53, range 1-89 years), underlying cancer, neutropenia (< 1000 neutrophils/microliters; 233), signs and symptoms, type of i.v. line (percutaneous central: 534; peripheral: 228; central implanted: 304), treatment, blood culture system, number of positive blood culture bottles/total obtained, time to growth. Of all episodes, 23.2% occurred within 48 h of admission. The patients were receiving systemic antibiotics at sampling (on AB) in 34.6% of cases. The 1147 pathogens isolated (86 polymicrobial) were: E. coli (10.7%), Klebsiella-Enterobacter-Serratia (6.1%), other enterobacteriaceae (2.2%), Pseudomonas aeruginosa (4.8%), other nonfermenters (4.7%), coagulase-negative staphylococci (CNS, 40.8%), Staphylococcus aureus (9.9%), streptococci (5.4%), enterococci (2.2%), anaerobes (3.4%), yeasts (3.5%), and other bacteria (6.9%). The CDC (Centers for Disease Control) criteria (1988) were used to assess significance: group 1: pathogenic species (616 episodes; 59%); group 2: clinical signs and isolation of a "contaminant" species (47; 4.5%); group 3: as in group 2 with an i.v. line and empiric antibiotic treatment (181 episodes including 176 CNS; 17%); group 4: non-significant (207 episodes including 203 CNS; 20%). Groups 1-3, in which the episodes were considered to be significant (844 episodes; 80%) were compared with non-significant episodes (Fisher). Significant differences (P < or = 0.05) were seen in time to growth (median growth within 24 h vs 48 h), fever (86% vs 54%), chills (40% vs 3%), hypotension (10% vs 2%), septic shock (9% vs 1%), polymicrobial etiology (10% vs 0.5%), and initiation of empiric antibiotic treatment (71% vs 4%). Bacteremic episodes of CDC groups 1, 3 and 4 were further studied in episodes with a single isolate as a doubtful clinical significance (482 episodes) and episodes with > or = 2 bottles positive of probable clinical significance (569 episodes; 54%). In group 1 (218 doubtful, 398 probably significant episodes) significant differences were seen in chills (36% vs 52%), shock (7% vs 13%), polymicrobial (8% vs 17%), initiation of empiric antibiotic treatment (60% vs 72%); in group 3 (87 doubtful, 94 probably significant) in time to growth delay; in group 4 (177 doubtful, 30 probably significant) in proportion with implanted catheter (26% vs 52%), fever (62% vs 10%), and time to growth. This study confirms the predominant role of Gram-positive cocci in bacteremia occurring in cancer patients.

[Incidence of nosocomial infections in an cancer center: clinical and bacteriologic data]. / Incidence des infections nosocomiales dans un centre anticancéreux: données cliniques et bactériologiques.

Over a 5 month period, a study of the incidence of nosocomial infections (NI) was carried out in the Léon Bérard Oncology Center (Lyons). It comprised 1,551 patients classified in groups according to the site of origin of the underlying malignancy. The respective frequency of the different types of nosocomial infections and the responsible agents was evaluated in each group and the incidence was calculated per day of hospitalization. The overall incidence of NI was 11.29 per 1,000 patient-days, with a maximal value of 20.04 for patients suffering from lymphomas. The most frequently encountered infections were bacteremias (22.7%), followed by urinary tract infections (20.8%) and wound infections (20.5%). The most frequent causative agents of NI were Escherichia coli (25.8%), Pseudomonas aeruginosa (13.9%), Staphylococcus aureus (9.8%) and Staphylococcus epidermidis (9.8%). The latter micro-organism together with Escherichia coli were the most frequent causative agents of bacteremias. Even though cancer patients are particularly prone to developing infections, the incidence of NI could be reduced thanks to a program of control and surveillance of infectious episodes during hospitalization.

[Value of enzymuria during antibacterial therapy]. / Valeur de l'enzymurie dans le suivi de la thérapeutique antibactérienne.

Enzymuria is a well known parameter of evaluation of drugs nephrotoxicity, particularly of antibiotics. Alanine aminopeptidase (AAP), gamma-glutamyltransferase (GGT) and N-acetyl-bêta-D-glucosaminidase activities were measured in native urine. This study included 19 patients treated by an association of netilmicin-vancomycin. Enzymuria was measured on 24 hours urines at J0 then every two days during treatment. Enzymuria increased 24 or 48 hours after the beginning of the treatment. The Principal Components Analysis (PCA) of the results of enzymuria, seric urea and creatininemia shows the presence of two groups of responses. The first principal component exhibits two populations: the patients with pathological seric urea and pathological seric creatinine and the others. The PCA does not allow this discrimination using only the results of enzymuria; in contrast, with these results, the patients may be classified by the PCA on the basis of treatment duration. The enzymuria allows the clear identification of nephrotoxic drugs but does not allow the prediction of renal injury or of its aggravation.

[Evaluation of enzymuria as a tracer in nephrotoxicity: results of a multicenter study]. / Evaluation de l'enzymurie comme marqueur de néphrotoxicité: résultats d'une expérience multicentrique.

Urinary excretion of three enzymes of different subcellular location in kidney tissue, alanine aminopeptidase (AAP), gammaglutamyltransferase (GGT), N acetyl-beta-D glucosaminidase (NAG), was carried out in 79 healthy adults and 108 healthy children and in 69 adults with various therapies: antibiotics (32 cases), non steroidal anti-inflammatory drugs (NSAIDs) (22 cases), cisplatinum (12 cases) and cyclosporine (3 cases). A circadian rhythm has been shown in children. In patients treated with antibiotics, the importance and duration of the increased enzymes urinary excretion were variable but the excretion of AAP was always higher than that of GGT and NAG. Short term therapies by NSAIDs were without influence on enzymuria but long term therapies produced a moderate increase of NAG excretion. Enzymuria increased immediately after cisplatinum administration and decreased after each daily dose, except in patients with previously high creatininemia. Cyclosporine induced a slight increase in AAP and NAG excretion. Enzymuria, thus, increased early reflecting a toxic effect of the drug at the cellular level whereas creatininemia increase, marker of renal fonctionnal insufficiency, occurs only occasionally and lately.

[Surface changes of intravenous catheters after antineoplastic chemotherapy]. / Modifications de surface des cathéters veineux après chimiothérapie antinéoplasique.

During long-term venous catheter implantation, septic and thrombotic complications are quite frequent. In the case reported, the failure of systemic and local antibiotic therapy during repeated septicaemia due to Bacillus cereus at the time of intensive chemotherapy led to a scanning electron microscopy study of the used silicone catheter. There were marked changes of the inner surface with a lot of cellular remains, in contrast with the usual non thrombogenic property of the silicone. An in vitro study was carried out with antitumour agents. Duration of exposure and drug concentration were identical to those used in in vivo perfusions. There were marked changes of the inner surface, which could lead to important modifications of the properties of the silicone. The damage depended on the drug. Silicone was slightly sensitive to vicristin and carmustin, but highly sensitive to cisplatin and doxorubicin. The compatibility of catheter material with the drugs used, especially for oncologic chemotherapy, must be tested systematically.

[Isolated increase in the bleeding time: the hemorrhagic risk and therapeutic problems]. / Allongement isolé du temps de saignement: risque hémorragique et problème thérapeutique.

An isolated increase of the bleeding time is rare. In the young, there may exist a history of bleeding disorders such as epistaxis. In middle age, the increased risk of bleeding during surgery is low but real, and depending on the type of surgery. There are many drugs responsible for increased bleeding time; these must be avoided: the principle that one haemostatic defect is often well tolerated whereas two are not is very real. So the management of such patients during surgery must be meticulous and the use of some drugs must be avoided. Careful surgical management with regard to haemostasis undoubtedly allows many patients with this sort of defect to undergo surgery without excessive bleeding. Some treatments are possible (e.g. steroids, DDAVP), but their routine use is not warranted.

[Value of the study of fibrinogen affinity in the identification of Staphylococcus aureus. Results of a multicenter study]. / Valeur de la recherche de l'affinité pour le fibrinogène pour l'identification de Staphylococcus aureus. Résultats d'une étude multicentrique.

The passive haemagglutination reaction for detecting the Staphylococcus aureus fibrinogen affinity was done in a collaborative study. The test was compared to the major tests used in medical microbiology. The test was as efficient as the protein A or coagulase tests. Its simplicity, rapidity and specificity make it a useful tool for the diagnosis of this species.

[Comparison of the results of antibiograms obtained from blood culture broth and after isolation on agar media with the Autobac 1]. / Comparaison des résultats d'antibiogrammes obtenus à partir des bouillons d'hémocultures et après isolement sur milieu gélosé avec l'appareil autobac 1.

The authors compare the results of antibiotic sensitivity tests performed within 4 hours with the aid of the Autobac 1 machine, using blood culture medium and following isolation on agar plates. There was concordance in about 90 p. cent of cases. The first test is not suitable for sensitivity to trimethoprim and the beta-lactamines, as was already observed in the study using the MS-2 machine. The authors discuss the various sources of error and compare the results obtained from the two machines.

[Evaluation of a rapid technic for antibiotic sensitivity testing: reproducibility of minimal inhibitory concentrations routinely estimated with the use of Abbott MS-2 autoanalyzer]. / Evaluation d'une technique rapide d'antibiogramme: reproductibilité des concentrations minimales inhibitrices estimées en routine à l'aide de l'automate Abbott MS-2.

The inter-system reproducibility of the MIC results obtained from the MS-2 automated system of antibiotic sensitivity testing was assessed by a two-stage study. In the first stage, a total of 168 MICs were calculated by the automated system from 134 diverse bacterial strains, selected from routine antibiotic sensitivity testing for their "intermediate" sensitivity to one or more antibiotics. The antibiotic sensitivities were repeated using the same machine, in the same laboratory, on another suspension of the same bacteria. The results of antibiotic sensitivity reported as "intermediate" on the first test were compared to those of the second test; only 19 p. cent of the responses remained "intermediate" and the MICs were comparable between the two tests; 50 p. cent became sensitive and 31 p. cent became resistant (MIC not calculated). In the second stage, 4 strains with stable intermediate sensitivity to 8 antibiotics, as shown by 2 routine sensitivity tests, were tested 33, 48, 44, and 39 times respectively against these antibiotics using various suspensions of the same strain. 394 results were obtained: 92 intermediate results with a MIC (24.4 p. cent), 219 sensitive results (56.3 p. cent) and 83 resistant results (20.2 p. cent). The range of values for the MIC calculated by the automatic system was small, so the MICs are reproducible; but, for 5 of the 8 antibiotics, the responses were both "S" and "R". This suggests that the so-called "Intermediate" zone is in fact a zone of uncertainty where the majority of the MIC results are erroneous.

Evaluation of Salmonella and Shigella identification with the MS2-BID automatic system.

The precision of the Abbott MS-2 system was evaluated for the rapid identification of Salmonella and Shigella strains in 5 hours. The results of 113 strains of Salmonella and 52 strains of Shigella studied showed a total agreement of 68% and 90% respectively with the API 20E method and with sero-agglutination taken as reference. But in 12.40% and 2% of the cases the Salmonella and Shigella strains were not recognised and no warning message was given by the automate. Moreover, during the daily utilisation of the apparatus, the 21 strains labelled Shigella and Salmonella were later shown to belong to other genera. The MS-2 BID system is therefore of limited interest in medical and in food microbiology.