Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients.

RATIONALE: The occurrence of ventilator-associated pneumonia (VAP) is linked to the aspiration of contaminated pharyngeal secretions around the endotracheal tube. Tubes with cuffs made of polyurethane rather than polyvinyl chloride or with a conical rather than a cylindrical shape increase tracheal sealing. OBJECTIVES: To test whether using polyurethane and/or conical cuffs reduces tracheal colonization and VAP in patients with acute respiratory failure. METHODS: We conducted a multicenter, prospective, open-label, randomized study in four parallel groups in four intensive care units between 2010 and 2012. A cohort of 621 patients with expected ventilation longer than 2 days was included at intubation with a cuff composed of cylindrical polyvinyl chloride (n = 148), cylindrical polyurethane (n = 143), conical polyvinyl chloride (n = 150), or conical polyurethane (n = 162). We used Kaplan-Meier estimates and log-rank tests to compare times to events. MEASUREMENTS AND MAIN RESULTS: After excluding 17 patients who secondarily refused participation or had met an exclusion criterion, 604 were included in the intention-to-treat analysis. Cumulative tracheal colonization greater than 10(3) cfu/ml at Day 2 was as follows (median [interquartile range]): cylindrical polyvinyl chloride, 0.66 (0.58-0.74); cylindrical polyurethane, 0.61 (0.53-0.70); conical polyvinyl chloride, 0.67 (0.60-0.76); and conical polyurethane, 0.62 (0.55-0.70) (P = 0.55). VAP developed in 77 patients (14.4%), and postextubational stridor developed in 28 patients (6.4%) (P = 0.20 and 0.28 between groups, respectively). CONCLUSIONS: Among patients requiring mechanical ventilation, polyurethane and/or conically shaped cuffs were not superior to conventional cuffs in preventing tracheal colonization and VAP. Clinical trial registered with clinicaltrials.gov (NCT01114022).

Esophageal tuberculosis in a patient on maintenance dialysis: advantages of interferon-gamma release assay.

Patients with chronic renal failure have a higher risk of developing tuberculosis compared to the general population, and especially extra-pulmonary tuberculosis. This pathology is often difficult to diagnose and requires a combination of multidisciplinary examinations. The confirmation of the diagnosis is important in order to quickly match the treatment with the pathology. We report a patient with primary esophageal tuberculosis for whom the interferon gamma release assay facilitated a timely diagnosis.

Streptococcus sinensis: an emerging agent of infective endocarditis.

The identification by conventional methods of viridans streptococcal species, which are rarely encountered clinically, requires confirmation by genomic methods. We characterized a strain of Streptococcus sinensis responsible for infective endocarditis by sequencing both the 16S rRNA and the manganese-dependent superoxide dismutase genes.

Severe group a streptococcus infection after thyroidectomy: report of three cases and review.

BACKGROUND: Group A Streptococcus (GAS) is an uncommon cause of infection after clean surgery in non-pregnant adults. METHODS: Report of three cases and review of the literature. results: For the first time in France, severe GAS infections were observed in three patients who underwent thyroidectomy at three hospitals. Two of them developed streptococcal toxic shock syndrome. CONCLUSION: Better knowledge of physiopathologic mechanisms would help in the detection and prevention of severe GAS infections.

Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study.

BACKGROUND: Enteroviruses are the most frequent cause of acute meningitis and are seen increasingly in sepsis-like disease and fever without source in the paediatric population. Detection of enterovirus in cerebrospinal fluid (CSF) specimens by PCR is the gold standard diagnostic test. Our aim was to assess a method of detecting enterovirus in blood specimens by PCR. METHODS: We did a prospective, multicentre, observational study at 35 French paediatric and emergency departments in 16 hospitals. We recruited newborn babies (aged ≤28 days) and infants (aged >28 days to ≤2 years) with fever without source, sepsis-like disease, or suspected meningitis, and children (aged >2 years to ≤16 years) with suspected meningitis, who were admitted to a participating hospital. We used a standardised form to obtain demographic, clinical, and laboratory data, which were anonymised. Enterovirus PCR testing was done in blood and CSF specimens. FINDINGS: Between June 1, 2015, and Oct 31, 2015, and between June 1, 2016, and Oct 31, 2016, we enrolled 822 patients, of whom 672 had enterovirus PCR testing done in blood and CSF specimens. Enterovirus was detected in 317 (47%) patients in either blood or CSF, or both (71 newborn babies, 83 infants, and 163 children). Detection of enterovirus was more frequent in blood samples than in CSF specimens of newborn babies (70 [99%] of 71 vs 62 [87%] of 71; p=0·011) and infants (76 [92%] of 83 vs 62 [75%] of 83; p=0·008), and was less frequent in blood samples than in CSF specimens of children (90 [55%] of 163 vs 148 [91%] of 163; p<0·0001). Detection of enterovirus was more frequent in blood samples than in CSF specimens of infants aged 2 years or younger with fever without source (55 [100%] of 55 vs 41 [75%] of 55; p=0·0002) or with sepsis-like disease (16 [100%] of 16 vs nine [56%] of 16; p=0·008). Detection of enterovirus was less frequent in blood than in CSF of patients with suspected meningitis (165 [67%] of 246 vs 222 [90%] of 246; p<0·0001). INTERPRETATION: Testing for enterovirus in blood by PCR should be an integral part of clinical practice guidelines for infants aged 2 years or younger. This testing could decrease the length of hospital stay and reduce exposure to antibiotics for low-risk patients admitted to the emergency department with febrile illness. FUNDING: University Hospital Clermont-Ferrand.

An outbreak of methicillin-resistant Staphylococcus aureus surgical-site infections initiated by a healthcare worker with chronic sinusitis.

An investigation was performed following two methicillin-resistant Staphylococcus aureus surgical-site infections in a 946-bed French general hospital. The investigation revealed that the outbreak involved 7 patients in 2 surgical wards and that infections were probably contracted in the operating theater from a healthcare worker suffering from chronic sinusitis.

Reproducibility of protected specimen brush and bronchoalveolar lavage conserved at 4 degrees C for 48 hours.

OBJECTIVE: Protected specimen brush (PSB) and bronchoalveolar lavage (BAL) are proposed in combination to optimize antimicrobial treatment. Nevertheless, they are only validated for immediate laboratory processing. This study was therefore conducted to determine whether 48 h conservation at a mere 4 degrees C enables good culture reproducibility for both PSB and BAL. DESIGN AND SETTING: Prospective study, evaluation of a conservation procedure for PSB and BAL, from February 1994 to February 1995, in the 12 bed ICU of a general hospital (938 beds). SAMPLES: Ninety-nine PSB and 86 BAL samples, obtained from 100 bronchoscopic procedures, were analyzed. Thresholds were 10(3) and 10(4) cfu/ml for PSB and BAL, respectively. MEASUREMENTS AND RESULTS: Qualitative comparison between the immediate and 48 h procedures were, for PSB, specificity 100%, sensitivity 78%, positive predictive value 100%, negative predictive value 84% and overall accuracy 90%; and for BAL: 100%, 89%, 100%, 89% and 94%. Lowered 10(2) and 10(3) cfu/ml thresholds at the 48 h procedure for PSB and BAL reduce the false negatives from 10 to 3 and 5 to 1, respectively. Microorganism results were comparable for PSB and BAL ( r = 0.63 and 0.67), especially for the most resistant strains: Staphylococcus, Enterobacteriaceae and Pseudomonas. However, there was a decrease in the Neisseria and Haemophilus group ( p < 0.01). CONCLUSION: There is a good culture reproducibility for both PSB and BAL after 48 h conservation at 4 degrees C, especially with lowered thresholds; this technique is therefore appropriate for routine use.

[Prevalence of latent tuberculosis infection among health care workers from the emergency department of Meaux hospital using an interferon gamma release assay]. / Étude de la prévalence de l'infection tuberculeuse chez le personnel soignant du service des urgences du centre hospitalier de Meaux par dosage de l'interféron gamma.

OBJECTIVE: To determine the prevalence of the latent tuberculosis infection (LTBI) among health care workers (HCW) of the emergency ward of Meaux hospital, by comparing it with two witnesses units: the orthopaedic surgery ward (referral service to low risk) and the respiratory ward (referral service to high risk). METHODS: From July to December 2008, on a voluntary basis, anonymised blood samples of any HCW of the three departments were carried out by the occupational health service. Determination of interferon gamma was released by the test "QuantiFERON-TB Gold" (QFT). RESULTS: Of the 137 eligible subject sampled, 16 had a positive QFT test: nine in the emergency ward, six in the respiratory ward and one in the orthopaedic surgery ward. The proportion of HCW with a positive QFT test was not significantly different between the three wards. DISCUSSION: This study shows that HCWs of the emergency ward of the Meaux hospital are not working in a department where the risk of LTBI is high. CONCLUSION: Our study shows that, in a territory of health where the incidence of the tuberculosis disease is superior to the national average, the emergency department of Meaux hospital does not belong to an area at high risk of LTBI. It underlines the interest of QFT test for the screening of LTBI among vaccinated persons.