Targeted mupirocin-based decolonization for Staphylococcus aureus carriers and the subsequent risk of mupirocin resistance in haemodialysis patients - a longitudinal study over 20 years.

Mupirocin-based decolonization of Staphylococcus aureus carriers undergoing haemodialysis is not widely implemented due to concerns of mupirocin resistance. In our haemodialysis unit, a strategy combining universal S. aureus screening with targeted mupirocin-based decolonization was introduced two decades ago. In this study of haemodialysis patients, mupirocin resistance was assessed in blood and colonizing S. aureus isolates during two periods. Mupirocin resistance in S. aureus was infrequent in both blood and colonizing isolates. Furthermore, in the years 2003-2021, a decreasing trend in the annual rate of S. aureus bloodstream infections was observed. Targeted mupirocin-based decolonization of S. aureus carriers undergoing haemodialysis is a sustainable measure for preventing healthcare-associated infections.

Underlying disease for percutaneous endoscopic gastrostomy tube placement predicts short- and long-term mortality.

Background: PEG (percutaneous endoscopic gastrostomy) is a well established endoscopic procedure for enteral feeding. However, patients with a shorter life expectancy will not benefit from PEG tube placement. Furthermore, some specific evolving diseases will never benefit from PEG. The aim of the study focuses on short and long term mortality rates after PEG tube placement in a referral gastroenterology centre (Geneva University Hospital). 219 patients were enrolled in this study. Patients and methods: All patients scheduled for a PEG procedure between January 2011 and December 2014 were included. Nine patient parameters were collected for further analysis as well as the main underlying disease requiring PEG tube placement. Patients were subsequently divided into 4 groups according to underlying disease: Group 1) swallowing disorders of neurologic origin; Group 2) swallowing disorders associated with upper digestive tract neoplasia ; Group 3) nutritional support for a non GI reason ; Group 4) Other. Results: 219 patients had undergone a PEG tube placement. 33 patients died within 60 days after the procedure. After one year, 71 patients died. Global survival was 870 days. The nutritional support group had the better survival rate with 1276 days compared to the swallowing groups and others. The multivariate analysis has highlighted the underlying disease as the only associated parameter with short and long term mortality. Conclusions: PEG tube placement is associated with high short and long term mortality depending on the underlying disease. We outlined the potential role of PEG tube insertion as a supportive transient approach for nutritional support.

[Surgical strategy for early stage carcinoma of the esophagus]. / Chirurgische Strategie bei Frühkarzinomen des Ösophagus.

Early stage carcinomas of the esophagus are histologically differentiated into adenocarcinomas and squamous cell carcinomas and subdivided into mucosal (m1-3) and submucosal (sm1-3) carcinomas depending on the infiltration depth. While the prevalence of lymph node metastases in mucosal carcinomas is very low, the probability of lymph node metastases increases from submucosal infiltration with increasing depth. According to the current German S3 guidelines endoscopic resection is the recommended treatment strategy for mucosal adenocarcinoma without histological risk factors (lymphatic invasion [L1], venous invasion [V1], poorly differentiated [>G2], microscopic residual disease [R1] at the deep resection margin). For superficial submucosal infiltration (sm1) without histological risk factors endoscopic resection can also be carried out, whereby in this case the guidelines make a stronger recommendation for esophagectomy. For squamous cell carcinoma endoscopic resection is indicated for an infiltration depth up to middle layer mucosal carcinoma (m2) without histological risk factors. Outside of these criteria an esophageal resection should always be carried out. The surgical gold standard is a subtotal abdominothoracic esophagectomy with two-field lymphadenectomy. Alternative procedures are total esophagectomy in proximal esophageal carcinoma and transhiatal extended gastrectomy for carcinoma of the cardia. Limited proximal or distal esophageal resections can be performed in proximal or distal mucosal carcinoma without the possibility of endoscopic resection; however, partial resections are not superior in terms of functional results and are not oncologically equivalent due to limited lymphadenectomy. Minimally invasive procedures show good oncological results and reduce the morbidity of radical esophagectomy. Reduced morbidity might be an argument for surgical resection in borderline cases between endoscopic and surgical resection.

Pathology and Virus Distribution in the Lung and Lymphoid Tissues of Pigs Experimentally Inoculated with Three Distinct Type 1 PRRS Virus Isolates of Varying Pathogenicity.

Porcine reproductive and respiratory syndrome (PRRS) continues to be the most economically important disease of swine worldwide. The appearance of highly pathogenic PRRS virus (PRRSV) strains in Europe and Asia has raised concerns about this disease and initiated increased efforts to understand the pathogenesis. In this study, we have compared the pathology and the virus distribution in tissues of pigs experimentally inoculated with three different genotype 1 PRRSV isolates. Sixty 5-week-old pigs were inoculated intranasally with a) the Lelystad virus (LV), b) a field strain from the UK causing respiratory clinical signs (UK) or c) a highly pathogenic strain from Belarus (BE). Sixteen animals were mock-infected and used as controls. The animals were euthanized at 3, 7 and 35 days post-infection (dpi), and lung and lymphoid tissues collected for histopathological examination and PRRSV detection by immunohistochemistry (IHC). Histopathological lesions consisted of interstitial pneumonia with mononuclear cell infiltrates in the lungs, lymphoid depletion, apoptosis and follicular hyperplasia in the spleen, lymph nodes and tonsil and lymphoid depletion in the thymus. Porcine reproductive and respiratory syndrome virus was detected mainly in monocytes-macrophages. BE-infected animals showed the highest pathological scores and the highest presence of virus at 3 and 7 dpi, followed by the UK field strain and then LV. Moderate lesions were observed at 35 dpi with lesser detection of PRRSV by IHC in each infected group. The highly pathogenic BE strain induced more severe pathology in both lungs and lymphoid organs of pigs compared with the classic field isolate and the prototype LV. The increased severity of pathology was in correlation with the presence of a higher number of PRRSV-infected cells in the tissues.

[Achalasia: which treatment to choose in 2015?]. / Achalasie: queulle thérapie choisir en 2015 ?

Achalasia is a rare disorder, whose diagnostic Gold standard is high-resolution cesophageal manometry. The proposed treatment must take into account the patient's health condition and the type of achalasia determined by HRM. Heller's laparoscopic myotomy and pneumatic dilation are the first line treatments for most of the patients, whereas Botulinum toxin injections and pharmacologic therapy are only indicated for patients with a high surgical risk who cannot undergo first line treatments. Peroral endoscopic myotomy (POEM) is a recent and promising endoscopic technique reserved for expert endoscopy centers, whose exact role is still to be determined by randomized prospective studies. Oesophagectomy has only a marginal role in rare patients with extremely advanced achalasia or at risk of neoplastic degeneration.

Emergence of highly pathogenic porcine reproductive and respiratory syndrome (HP-PRRS) in medium-scale swine farms in southeastern Cambodia.

Since 2006, reports from China and Viet Nam have alerted of an emergent highly pathogenic variant of porcine reproductive and respiratory syndrome virus (HP-PRRSV) in that region. The frequent occurrence of outbreaks in these countries puts Cambodian pig farms at high risk of infection, but no study had been conducted to investigate the presence of HP-PRRS in Cambodian farms. We investigated the presence of HP-PRRS in medium-scale (semi-commercial) swine farms in the Cambodian southeastern region. Specifically, one province bordering Viet Nam (Takeo) was selected due to the concentration of most semi-commercial farms in that province. A cross-sectional study was carried out, between July and September 2010 to assess whether the prevalence of infection in these farms was indicative of recent spread of PPRSV and to identify risk factors for infection. The number of farms to be sampled was established using methods for Lot Quality Assurance Surveys (LQAS), in order to achieve a pre-established ability to discriminate between two different prevalence settings. The target population comprised all semi-commercial farms in Takeo province from which a random sample of 35 farms was selected. Selected farms were visited and questionnaires administered to gather information on farm characteristics and husbandry practices. Blood samples from individual pigs were collected in each of the study farms and tested for PRRSV, along with a number of other swine respiratory pathogens in order to investigate potential interactions. Our results showed that the virus was already present in Takeo semi-commercial pig population (LQAS herd prevalence ≥85%) at the time of sampling. The presence of sows in the farm and farm density were significantly associated (P<0.05) with the introduction and the presence of PRRS - but this was an unadjusted association as small sample size precluded multivariate analysis. Spatiotemporal description of the supposed pattern of infection revealed that the 1st farms infected were closely located to major national and provincial roads, connecting the Cambodian capital Phnom Penh to Viet Nam.

Re-emergence of a genetic outlier strain of equine arteritis virus: Impact on phylogeny.

Equine arteritis virus (EAV) is the causative agent of equine viral arteritis (EVA), a respiratory and reproductive disease of equids, which is notifiable in some countries including the Great Britain (GB) and to the OIE. Herein, we present the case of a persistently infected stallion and the phylogenetic tracing of the virus strain isolated. Discussing EAV occurrence and phylogenetic analysis we review features, which may aid to harmonise and enhance the classification of EAV.

[Self-expanding metallic stent in malignant colonic obstruction]. / Place de la prothèse métallique colique dans l'obstruction tumorale.

About 20% of colorectal cancers are complicated by intestinal obstruction. Self-expanding metallic stents (SEMS) permit desobstruction in over 90% of cases. In palliative setting, employing SEMS reduces hospitalisation time and permanent stoma rate with identical mortality rates compared to surgery. When using SEMS as bridge to surgery, higher primary and lower overall stoma rates are obtained with no significant mortality reduction by now. Of concern, procedure-related bowel perforation is frequent, especially among endoscopists lacking sufficient experience in colonic stenting.

Increased pathogenicity of European porcine reproductive and respiratory syndrome virus is associated with enhanced adaptive responses and viral clearance.

Porcine reproductive and respiratory syndrome (PRRS) is one of the most economically important diseases of swine worldwide. Since its first emergence in 1987 the PRRS virus (PRRSV) has become particularly divergent with highly pathogenic strains appearing in both Europe and Asia. However, the underlying mechanisms of PRRSV pathogenesis are still unclear. This study sets out to determine the differences in pathogenesis between subtype 1 and 3 strains of European PRRSV (PRRSV-I), and compare the immune responses mounted against these strains. Piglets were infected with 3 strains of PRRSV-I: Lelystad virus, 215-06 a British field strain and SU1-bel from Belarus. Post-mortem examinations were performed at 3 and 7 days post-infection (dpi), and half of the remaining animals in each group were inoculated with an Aujeszky's disease (ADV) vaccine to investigate possible immune suppression resulting from PRRSV infection. The subtype 3 SU1-bel strain displayed greater clinical signs and lung gross pathology scores compared with the subtype 1 strains. This difference did not appear to be caused by higher virus replication, as viraemia and viral load in broncho-alveolar lavage fluid (BALF) were lower in the SU1-bel group. Infection with SU1-bel induced an enhanced adaptive immune response with greater interferon (IFN)-γ responses and an earlier PRRSV-specific antibody response. Infection with PRRSV did not affect the response to vaccination against ADV. Our results indicate that the increased clinical and pathological effect of the SU1-bel strain is more likely to be caused by an enhanced inflammatory immune response rather than higher levels of virus replication.

[Can antiplatelet therapy be continued in upper gastrointestinal bleeding?]. / Peut-on poursuivre un traitement antiagrégant en cas d'hémorragie digestive haute?

During a gastro-intestinal bleeding, treatment options regarding antiplatelet agents depend on the indication. In primary prevention, treatment can reasonably be stopped regarding the low expected benefit. In secondary prevention, experts recommend resuming treatment after a five-day interruption. In patients with a coronary stent, the decision is made on a case by case basis and requires close multidisciplinary collaboration between internists, cardiologists and gastroenterologists.

[The role of probiotics in the treatment of inflammatory bowel diseases]. / Place des probiotiques dans le traitement des maladies inflammatoires intestinales.

The intestinal mucosa is the site of a fundamental interaction between a large amount of foreign substances, the immune system and bacteria that colonizes the mucosa. Many gastrointestinal diseases are due to an altered interaction between all these actors, particularly inflammatory bowel diseases. As such probiotics (bacteria providing a benefit to the host) could provide an interesting solution as a therapeutic agent. The evidences supporting such use are limited but there are still some quality randomized controlled trials. The purpose of this review is to discuss the most recent evidences from the literature on the use of probiotics in the treatment of inflammatory bowel diseases.

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB), of submucosal tumors, diffuse esophageal/gastric wall thickening, pancreatic solid masses and cystic-appearing lesions, mediastinal lesions unrelated to lung or esophageal cancer, cancer of the esophagus, stomach, and rectum, lymph nodes of unknown origin, adrenal gland masses, and focal liver lesions. False-positive cytopathological results and needle tract seeding are also discussed. The present Clinical Guideline describes the results of EUS-guided sampling in the different clinical settings, considers the role of this technique in patient management, and makes recommendations on circumstances that warrant its use. A two-page executive summary of evidence statements and recommendations is provided. A separate Technical Guideline describes the general technique of EUS-guided sampling, particular techniques to maximize the diagnostic yield depending on the nature of the target lesion, and sample processing. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling.

[Role of endoscopy in the management of obscure gastrointestinal bleeding]. / Rôle de l'endoscopie dans la prise en charge des saignements digestifs d'origine obscure.

Obscure gastrointestinal bleeding is defined as a blood loss in the digestive tract without etiology found at upper digestive endoscopy and colonoscopy. Small bowel lesions, in particular angiodysplasias, are the most frequent cause. Endoscopic examination of the small bowel can be performed using an enteroscope (with or without balloon) or a videocapsule. Videocapsule endoscopy is a minimally invasive procedure, and it allows complete small bowel exploration in 80% of cases (vs. 40-80% with balloon-aided enteroscopy). In practice, videocapsule endoscopy is the first line exam, followed by enteroscopy for biopsy sampling or treatment. In case of completely negative investigations and persistent bleeding, videocapsule endoscopy may be repeated, generally after repeat upper digestive endoscopy and colonoscopy.

[Interventional endoscopic ultrasound: an evolving technique]. / Echoendoscopie interventionnelle: une technique en pleine évolution.

The availability of smaller instruments with larger working channels and higher imaging resolution has led to important development of endoscopic ultrasound (EUS) techniques these past years. From a purely diagnostic instrument, EUS guided fine needle aspiration has become a well recognized technique to acquire tissue in the mediastinum and the upper abdomen, more and more complex therapeutic procedures are now performed. It is now possible to precisely inject therapeutic agents under EUS guidance, drain intraabdominal collections and drain previously inaccessible obstructed pancreatic and bile ducts. The currently accepted indications of interventional endosonography and the technique currently under evaluation will be discussed.

[Endoscopic management of benign biliary strictures]. / Prise en charge endoscopique des sténoses billaires bénignes.

Endoscopic management of benign biliary strictures has significantly changed in recent years. Excluding a malignant etiology remains the first, critical, step; significant progress is being made to increase diagnostic accuracy of bile duct stricture sampling, although negative predictive value does not reach 100%. The currently preferred treatment consists of stricture dilation followed by placement of multiple temporary plastic stents. Drawbacks of this technique include repetition of endoscopic procedures and a small risk of cholangitis. Larger diameter covered self-expandable metal biliary stents seem to be a promising alternative. In this review, we will discuss the various etiologies of benign biliary strictures, their clinical presentation, the diagnostic tools and the endoscopic treatment.

Dynamic differential regulation of innate immune transcripts during the infection of alveolar macrophages by the porcine reproductive and respiratory syndrome virus.

Porcine reproductive and respiratory syndrome virus (PRRSV), an arterivirus, is the etiologic agent of an infectious disease of that name, characterized by respiratory disorders, abortion in pregnant sows and high mortality in piglets, resulting in significant economic losses in the pig industry worldwide. In order to identify whether genetic differences in PRRSV response may exist in pigs, alveolar macrophages were used to assess the progression of the type-I interferon (IFN) transcript response in porcine alveolar macrophages infected by PRRSV. Our results suggest that a dynamic differential regulation of the type-I IFN and chemokine transcripts may operate during the first hours of infection with and entry of the virus in alveolar macrophages, and provide a compelling mechanism for the establishment of PRRSV replication in susceptible cells.

Evidence of bovine immunodeficiency virus (BIV) infection: serological survey in Argentina.

This is the first report of serological evidence for bovine immunodeficiency virus (BIV) infection in Argentina. The analysis was performed in 589 dairy bovine sera samples, applying indirect enzyme-linked immunosorbent assay (I-ELISA) using a synthetic antigen (transmembrane peptide, TM) and Immunofluorescent assay (IFA). In this study, 9 dairy herds from 4 Argentinian provinces were evaluated and 12% of the animals tested positive for BIV. Seven of the 9 herds tested were BIV seropositive and the percentage of BIV seropositive animals in the herds ranged from 2% to 42%. Direct detection of BIV provirus applying nested PCR was not conclusive. Antibody detection against bovine leukemia virus (BLV) in all sera was also performed applying immunodiffusion (ID) assay and 59% resulted seropositive. Statistical analysis of the results was carried out and possible evidence of association between BIV and BLV infection was considered. Future studies should be performed including local field isolates strains of BIV.

Bovine lymphotropic herpesvirus and non-responsive post-partum metritis in dairy herds in the UK.

Bovine lymphotropic herpesvirus (BLHV) was detected for the first time in the UK in December 2005 in a dairy herd suffering from chronic, non-responsive post-partum metritis (NPPM). A small-scale investigation was undertaken in order to determine whether this was an isolated case. Samples of vaginal exudates or vaginal swabs were collected from cows in 13 UK dairy herds with a history of post-partum metritis that had not responded to standard treatment regimes for this condition. Cows in 9/13 herds and 1/13 herds were positive for BLHV and bovine herpesvirus-4, respectively, by pan-herpesvirus polymerase chain reaction. No consistent pattern of infectious agents or nutritional/metabolic factors commonly associated with post-partum metritis was observed at the times of sampling. The detection of BLHV in association with NPPM indicates that further work is warranted to determine the impact this virus has on cattle health.