A predictive score for the result of carbapenem-resistant Enterobacterales and vancomycin-resistant enterococci screening.

BACKGROUND: The duration of extensively drug-resistant bacteria (XDR) carriage depends on several factors for which the information can be difficult to recover. AIM: To determine whether past screening and clinical results of patients can predict the results of subsequent screening. METHODS: In total, 256 patients were retrospectively included from 10 healthcare centres in France from January 2014 to January 2022. We created a predictive clearance score, ranging from -5 to +7, that included the number of XDR species and the type of resistance detected in the sample, as well as the time from the last positive sample, the number of previous consecutive negative samples, and obtaining at least one negative PCR result in the collection. This score could be used for the upcoming rectal screening of a patient carrying an XDR as soon as the last screening sample was negative. FINDINGS: The negative predictive value was >99% for score ≤0. The median time to achieve XDR clearance was significantly shorter for a score of 0 (443 days (259-705)) than that based on previously published criteria. CONCLUSION: This predictive score shows high performance for the assessment of XDR clearance. Relative to previous guidelines, it could help to lift specific infection prevention and control measures earlier. Nevertheless, the decision should be made according to other factors, such as antimicrobial use and adherence to hand hygiene.

Environmental detection of SARS-CoV-2 in hospital rooms in different wards of a university hospital.

BACKGROUND: Transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can occur through direct, indirect, or close contact with infected people. However, the extent of environmental contamination is unknown. The nature of the relation between patients' symptoms and SARS-CoV-2 environmental shedding remains unclear. The aim of this study was to assess the relationship between patient coronavirus disease 2019 (COVID-19) status and environmental contamination. METHODS: Between May and November 2020, environmental swabs were taken before and after room disinfection at day 7 after symptom onset in a cohort of patients clinically or biologically diagnosed with COVID-19. Twelve surfaces per room were collected in 13 rooms. Sample analysis was performed by reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection [SARS-CoV-2 R-Gene (biomérieux, Marcy l'Etoile, France)]. Clinical data (day of illness, symptoms, RT-PCR results) was collected from the clinical software. RESULTS: Five medical units were included in the study. Of 156 samples collected in 13 rooms, five rooms (38.5%) presented 11 SARS-CoV-2-positive samples. These positive samples were detected on eight different surfaces. There was no association between detection of SARS-CoV-2 and patient age (P=1) or patient symptoms (P=0.3). CONCLUSION: Viral shedding during COVID-19 appears to be unrelated to the presence of symptoms, patient age, and low-value cycle threshold of patient's test. This study supports the evidence for the environmental shedding of SARS-CoV-2 until at least 7 days after symptom onset. It emphasizes the need for strict compliance with contact precautions, hand hygiene, the correct use of personal protective equipment and room disinfection for the routine care of patients with COVID-19.

Economic evaluation of pre-operative shower with antiseptic soap to prevent surgical site infections.

BACKGROUND: A pre-operative shower is recommended before surgery to prevent surgical site infections (SSIs). METHODS: We modelled the occurrence of SSIs and the potential savings for patients undergoing an antimicrobial soap (AS) shower prior to surgery at a French University Hospital level. RESULTS: AS shower prevented 209 SSIs, generating a potential saving of €632,210 per year. Results grouped by type of surgery showed annual savings of €26,537, €20,520 and €14,377 for orthopaedic, gynaecologic and obstetric, and digestive surgery, respectively. CONCLUSIONS: Despite the lack of published data surrounding the efficacy of AS in preventing SSIs, we demonstrated the potential savings and benefits of generalizing AS before surgical interventions.

Biofilms in hospital effluents as a potential crossroads for carbapenemase-encoding strains.

Bacterial resistance to carbapenem, which is mainly due to the successful dissemination of carbapenemase-encoding genes, has become a major health problem. Few studies have aimed to characterize the level of resistance in the environment, notably in hospital wastewater, which is a likely hotspot for exchange of antibiotic resistance genes. In this work, we looked for the presence of imipenem-resistant bacteria and imipenem in the effluent of the teaching hospital of Clermont-Ferrand, France. Selective growth of bacteria from 14-day old biofilms formed in the pipe sewer showed that 22.1% of the isolates were imipenem-resistant and identified as Aeromonas (n = 23), Pseudomonas (n = 10), Stenotrophomonas (n = 4) and Acinetobacter (n = 1). Fifteen of these strains harbored acquired carbapenemase-encoding genes blaVIM (n = 11), blaOXA-48 (n = 2), blaGES (n = 1), blaNDM (n = 1). All isolates also harbored associated resistances to aminoglycosides, fluoroquinolones and/or tetracyclin. S1-nuclease pulsed-field gel electrophoresis analysis of eight selected isolates showed that four of them harbored one to two plasmids of molecular weight between 48.5 Kb and 194 Kb. In vitro transformation assays evidenced the presence of blaVIM and blaNDM on plasmids with the blaVIM harboring 80 Kb plasmid having conjugative capacity. The predicted environmental concentration of imipenem in the hospital effluent was 3.16 µg/L, suggesting that biofilm bacteria are subjected to sub-MICs of imipenem within the effluent. However, no imipenem molecule was detected in the hospital effluent, probably owing to its instability: in vitro assays indicated that imipenem's biological activity was no longer detectable after 45 h of storage. However, the predictive value of the hazard quotient relative to the development of resistance was >1.0 (HQr = 28.9 ±â€¯1.9), which indicates a possible risk. The presence of carbapenemase-encoding genes in hospital effluent biofilm strains and their ability to transfer are therefore a potential hazard that should not be neglected and points to the need for monitoring antibiotic resistance in hospital wastewater.

[Perimenopausal discovery of endometriomas on ovarian abscess]. / Découverte périménopausique d'un endométriome sur abcès ovarien.

Ovarian abscess is a rare gynaecological diagnosis. The case reported is the one of an unexplained fever with a strong physical alteration during more than 14 days occurring around the menopause, at the age of 54. It has been discovered an ovarian tumour which was, infact, an infected endometrioma. The patient never complained from endometriosis during her reproductive life. She had no other risk factor for ovarian abscess.

A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery.

A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.

Prevention of postoperative hypotension following spinal anesthesia for TURP: a double-blind randomized controlled trial comparing ephedrine with placebo.

Spinal hypotension (SH) is a common side effect of spinal anesthesia and may also occur after the surgical procedure. In this double-blinded, placebo-controlled, randomised clinical trial fifty patients undergoing transurethral prostatectomy under spinal anesthesia received 10 mg of ephedrine IV before being transferred from the operating table into their bed after the procedure, whereas fifty controls received saline IV. The number of per- and postoperative hypotensive episodes and vasopressor use, time delay between the administration of the study medication and the first hypotensive episode, level of spinal blockade at the start of surgery, pre- and postoperative hemoglobine and sodium concentration, cardiovascular co-morbidity and chronic medication were registered. There was no statistically significant difference in the incidence of postoperative hypotension between the two groups, but Poisson regression of the expected number of postoperative hypotensive episodes per patient showed a protective effect of ephedrine (p < 0.05). The occurence of peroperative hypotension was a risk factor for developing postoperative hypotension (p < 0.05). There was no statistically significant relation between age, level of spinal blockade, cardiovascular co-morbidity or biochemical parameters and the risk of developing per- or postoperative hypotension, except for a correlation between preoperative alpha-receptor blocking drugs and peroperative hypotension (p < 0.05). Postoperative hypotension (recorded incidence 31%) was almost as common as peroperative hypotension (recorded incidence 37%) and occurred as late as 190 minutes after the end of surgery. Ephedrine IV at the end of surgery reduced the number of postoperative hypotensive episodes per patient but did not reduce the overall incidence of postoperative SH.

Studies of the ligand binding reaction of adipocyte lipid binding protein using the fluorescent probe 1, 8-anilinonaphthalene-8-sulfonate.

The fluorescent probe anilinonaphthalene-8-sulfonate binds to adipocyte lipid binding protein at a site that competes with normal physiological ligands, such as fatty acids. Binding to the protein is accompanied by a relatively large increase in fluorescent intensity. To correlate the major change in optical properties and to determine the mechanism of competitive inhibition with fatty acids, the crystal structure of the protein with the bound fluorophore has been determined. In addition, the thermodynamic contributions to the binding reaction have been studied by titration calorimetry. Because the binding site is in a relatively internal position, kinetic studies have also been carried out to determine k(on). The results indicate that binding is not accompanied by any major conformational change. However, the negatively charged sulfonate moiety is not positioned the same as the carboxylate of fatty acid ligands as determined in previous studies. Nonetheless, the binding reaction is still driven by enthalpic effects. As judged by the crystallographic structure, a significant amount of the surface of the fluorophore is no longer exposed to water in the bound state.

The liver fatty acid binding protein--comparison of cavity properties of intracellular lipid-binding proteins.

The crystal and solution structures of all of the intracellular lipid binding proteins (iLBPs) reveal a common beta-barrel framework with only small local perturbations. All existing evidence points to the binding cavity and a poorly delimited 'portal' region as defining the function of each family member. The importance of local structure within the cavity appears to be its influence on binding affinity and specificity for the lipid. The portal region appears to be involved in the regulation of ligand exchange. Within the iLBP family, liver fatty acid binding protein or LFABP, has the unique property of binding two fatty acids within its internalized binding cavity rather than the commonly observed stoichiometry of one. Furthermore, LFABP will bind hydrophobic molecules larger than the ligands which will associate with other iLBPs. The crystal structure of LFABP contains two bound oleate molecules and provides the explanation for its unusual stoichiometry. One of the bound fatty acids is completely internalized and has its carboxylate interacting with an arginine and two serines. The second oleate represents an entirely new binding mode with the carboxylate on the surface of LFABP. The two oleates also interact with each other. Because of this interaction and its inner location, it appears the first oleate must be present before the second more external molecule is bound.

Pasteurella multocida pneumonia with empyema.

We report a case of Pasteurella multocida pneumonia and empyema in an otherwise healthy patient. The most frequently observed human complication with this microorganism is a local wound infection. Only a few cases of pneumonia have been described, and most of the patients were immunodeficient.

Structural characterization of two synthetic catalysts based on adipocyte lipid-binding protein.

Adipocyte lipid-binding protein (ALBP) is a small (14.5 kDa) 10-stranded beta-barrel protein found in mammalian fat cells. The crystal structures of various holo-forms of ALBP have been solved and show the fatty acid ligand bound in a large (approximately 400 A3) cavity isolated from bulk solvent. Examination of the cavity suggests that it would be a good site for the creation of an artificial catalyst, as numerous well defined crystal structures of ALBP are available and past studies have shown the conformation to be reasonably tolerant to modification and mutagenesis. Previous work has shown ALBP to be a good protein scaffold for exploring enantio- and stereoselective reactions; two constructs, ALBP attached to either a pyridoxamine or a phenanthroline group at C117, have been chemically characterized. Both modified proteins have been crystallized and their structures solved and refined. The X-ray models have been used to examine the origin of the chiral selectivity seen in the products. It is apparent that these covalent adducts reduce the internal cavity volume, sterically limiting substrate interactions with the reactive groups, as well as solvent access to potential intermediates in the reaction pathway.

Biochemical and crystallographic analyses of a portal mutant of the adipocyte lipid-binding protein.

A number of crystallographic studies of the adipocyte lipid-binding protein have established that the fatty acid-binding site is within an internalized water-filled cavity. The same studies have also suggested the existence of a region physically distinct from the fatty acid-binding site which connects the cavity of the protein with the external solvent, hereafter referred to as the portal. In an effort to examine the portal region, we have used site-directed mutagenesis to introduce the mutations V32D/F57H into the murine ALBP cDNA. Mutant protein has been isolated, crystallized, and its stability and binding properties studied by biochemical methods. As assessed by guanidine-HCl denaturation, the mutant form exhibited a slight overall destabilization relative to the wild-type protein under both acid and alkaline conditions. Accessibility to the cavity in both the mutant and wild-type proteins was observed by stopped-flow analysis of the modification of a cavity residue, Cys117, by the sulfhydryl reactive agent 5, 5'-dithiobis(2-nitrobenzoic acid) at pH 8.5. Cys117 of V32D/F57H ALBP was modified 7-fold faster than the wild-type protein. The ligand binding properties of both the V32D/F57H mutant and wild-type proteins were analyzed using a fluorescent probe at pH 6.0 and 8.0. The apparent dissociation constants for 1-anilinonaphthalene-8-sulfonic acid were approximately 9-10-fold greater than the wild-type protein, independent of pH. In addition, there is a 6-fold increase in the Kd for oleic acid for the portal mutant relative to the wild-type at pH 8.0. To study the effect of pH on the double mutant, it was crystallized and analyzed in two distinct space groups at pH 4.5 and 6.4. While in general the differences in the overall main chain conformations are negligible, changes were observed in the crystallographic structures near the site of the mutations. At both pH values, the mutant side chains are positioned somewhat differently than in wild-type protein. To ensure that the mutations had not altered ionic conditions near the binding site, the crystallographic coordinates were used to monitor the electrostatic potentials from the head group site to the positions near the portal region. The differences in the electrostatic potentials were small in all regions, and did not explain the differences in ligand affinity. We present these results within the context of fatty acid binding and suggest lipid association is more complex than that described within a single equilibrium event.

[Hematemesis disclosing hemorrhagic fever with renal syndrome]. / Hématémèse révélatrice d'une fièvre hémorragique avec syndrome rénal.

We report a case of hematemesis as the presenting sign of hemorrhagic fever with renal syndrome. Gastroscopy revealed hemorrhagic gastropathy. Such lesions are a common finding in epidemic nephropathy, the European form of the disease. The occurrence of such lesions could be induced in a direct, cytopathic effect of the virus but seems also to be related to the severity of thrombocytopenia.

Intubating conditions and neuromuscular effects of mivacurium during propofol-alfentanil anaesthesia.

In three groups of 20 patients, anaesthetized with propofol and alfentanil, tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride (0.11, 0.15, and 0.19 mg/kg = 1.5 x ED95, 2 x ED95, and 2.5 x ED95) were assessed. Intubation conditions were found to be clinically acceptable (good or excellent) in 83% of patients. Eighty-two per cent of patients were successfully intubated on the first attempt after 60-90 s. No difference in intubation scores or number of intubation attempts among the three dosage groups were found. We conclude that mivacurium chloride allows smooth intubation in most patients within 60-90 s, even with the lowest dose (0.11 mg/kg), after a propofol-alfentanil induction of anaesthesia. However, because there were a few patients in whom intubating conditions were inadequate at 60-90 s, we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations.

[Association of pseudochylothorax and pleural tuberculosis. Apropos of a case]. / Association pseudochylothorax et tuberculose pleurale. A propos d'une observation.

The authors report a case of pseudochylothorax revealed by pleural tuberculosis. Classically, pseudochylothorax is a late complication of chronical and calcified pleurisy especially sequellae of tuberculosis treated by induced pneumothorax. Treatment consist on thoracentesis or aspiration with frequent remove. Surgical decortication can be useful. Specific chemotherapy is only necessary in the patients in whom tuberculosis is present or never treated with antibiotics.

Physiological consequences of DnaK and DnaJ overproduction in Escherichia coli.

The physiological consequences of molecular chaperone overproduction in Escherichia coli are presented. Constitutive overproduction of DnaK from a multicopy plasmid containing large chromosomal fragments spanning the dnaK region resulted in plasmid instability. Co-overproduction of DnaJ with DnaK stabilized plasmid levels. To examine the effects of altered levels of DnaK and DnaJ in a more specific manner, an inducible expression system for dnaK and dnaJ was constructed and characterized. Differential rates of DnaK synthesis were determined by quantitative Western blot (immunoblot) analysis. Moderate levels of DnaK overproduction resulted in a defect in cell septation and formation of cell filaments, but co-overproduction of DnaJ overcame this effect. Further increases in the level of DnaK terminated culture growth despite increased levels of DnaJ. DnaK overproduction was found to be bacteriocidal, and this effect was also partially suppressed by DnaJ. The bacteriocidal effect was apparent only with cultures which were allowed to enter stationary phase, indicating that DnaK toxicity is growth phase dependent.