Outcome of patients with diabetes with negative percutaneous bone biopsy performed for suspicion of osteomyelitis of the foot.

AIMS: To assess the outcome of patients with diabetes with suspicion of osteomyelitis of the foot who had undergone a percutaneous bone biopsy that yielded negative microbiological results, with focus on the occurrence of osteomyelitis at the biopsied site. METHODS: Medical charts of adult patients with diabetes with a negative percutaneous bone biopsy were reviewed. Patients' outcome was evaluated at least 2 years after the initial bone biopsy according to wound healing, the results of a new bone biopsy and bone imaging evaluation when applicable. RESULTS: From January 2001 to January 2008, 41 patients with diabetes (30 men/11 women; mean age 58.1 ± 9.6 years; mean diabetes duration 15.8 ± 6.7 years) met study criteria. Osteomyelitis was suspected based on combined clinical and imaging diagnostic criteria. On follow-up at a mean duration of 41.2 ± 22.5 months post-bone biopsy, 16 patients had complete wound healing (39.0%). Of the 25 other patients, 15 had a new bone biopsy performed, six of which yielded positive microbiological results, and among the 10 patients who neither healed nor underwent bone biopsy, comparative radiography of the foot showed a stable aspect of the biopsied site in six of them, for whom the data were available. Finally, osteomyelitis of the foot at the site where the initial bone biopsy had been performed was confirmed during follow-up in six patients (14.6%) and was suspected in four additional patients (9.7%). CONCLUSIONS: The results of the present study suggest that, of patients with diabetes with the suspicion of osteomylelitis and a negative percutaneous bone biopsy, only one out of four will develop osteomyelitis within 2 years of the biopsy.

[Comparison of IRIS IQ ELITE and microscopy for urinalysis and evaluation of performance in predicting outcome of urine cultures]. / Comparaison des résultats de l'automate Iris IQ Elite à l'examen cytologique de l'urine et évaluation des performances de l'automate pour la prédiction de l'infection urinaire.

Since apprearance of reagent strip chemical determinations, different flow cytometers for urine sediments analysis appears (Sysmex UF-100, UF-50 and UF 1000). Recently has been introduced a new analyser (Iris IQ Elite) that analyses urine specimen by microscopy. Five hundred microscopic fields are photographed and analysed. Each particle of the microscopic field is separated and analysed with the software for recognition: Auto Particle Recognition (APR). In most of cases, automatic classification leads to correct results. For abnormal particles, the possibilities of visualisation by the operator permit us to avoid confusion between, for example: red cells and yeasts, spermatozoa and bacillus; that are identified as artefacts in flow cytometer. L'Iris IQ Elite presents a sensitivity of 68%, a specificity of 80%, a predictive positive value of 60% and a negative predictive value of 86% versus urine specimen culture. By combination of differents parameters given by the Iris machine, we can forget 43% of microscopic direct examination and predict the negativity of 32% of culture with a sensitivity and a negative predictive value of 100%.

[Molecular study of a false outbreak of ticarcillin-resistant Pseudomonas aeruginosa infections in a clinical hematology department]. / Etude moléculaire d'une pseudo-épidémie d'infections à Pseudomonas aeruginosa résistant à la ticarcilline dans un service d'hématologie clinique.

Molecular methods for bacterial strain typing are becoming available outside teaching hospitals and large structures. Although it seems reasonable to use conventional markers, most notably the serotype, whenever possible, the limitations of these methods are particularly conspicuous with P. aeruginosa. Combined use of several methods such as quantitative antibiotic susceptibility testing and serotype determination has proved adequate for characterizing P. aeruginosa strains in some cases. In the case of the outbreak reported herein, this approach failed to provide high quality epidemiological data. In contrast, pulsed field gel electrophoresis ruled out epidemic spread of a P. aeruginosa strain in the clinical hematology department.