First outbreak of community-acquired MRSA USA300 in France: failure to suppress prolonged MRSA carriage despite decontamination procedures.

The first French outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) USA300 clone was investigated. After outbreak investigation, hygiene measures were implemented in all family households and childminders' homes. Several decontamination procedures were performed, which used a combination of topical mupirocin, total body application of chlorhexidine, chlorhexidine gargle (if >6 years old) and a course of antibiotic therapy in cases of infection or decontamination failure. Patients were followed up for MRSA skin and soft tissue infections (SSTIs) and carriage. Strains were characterised by antimicrobial drug resistance profile, pulsed-field gel electrophoresis (PFGE) and DNA microarrays. Between June 2011 and June 2012, six children and six adults among the ten corresponding relatives developed 28 SSTIs. None of the family members, including the index case, had any contact with foreigners or individuals known to have SSTIs. After infection control measures and prolonged decontamination have been implemented with a high adherence, six patients remained sustained CA-MRSA USA300 carriers, including one who developed mupirocin resistance and six who experienced minor CA-MRSA-related SSTIs. A baby was identified as an MRSA carrier 2 months after delivery. CA-MRSA decontamination using mupirocin and chlorhexidine in the community setting may also be a questionable strategy, associated with failure and resistance to both agents. Close monitoring of CA-MRSA SSTIs is required in France and in other European countries where MRSA USA300 has recently emerged. We showed that a closed management based on hygiene measures reinforcement, decolonisation and extended screening may fail to suppress CA-MRSA carriage and subsequent infections.

[Electrocardiographic finding of Osborn's J wave in patients with hypothermia. Description of 2 clinical cases]. / Riscontro elettrocardiografico dell'onda J di Osborn in pazienti affetti da ipotermia. Descrizione di due casi clinici.

Two cases of hypothermia in the elderly are described. The different clinical evolution shows how the concurrent presence of Diabetes Mellitus can be considered as an adverse prognostic factor. It is also confirmed that the Osborn's wave electrocardiographic presence, given up a specific and pathognomonic diagnostic parameter in this disease. The observation that the electrocardiographic J wave can regress after body's temperature normalization suggests the hypothesis that this wave reflects reversible delay of depolarization, or early repolarization.

[Methods of determination of stroke volume from M-mode echocardiogram of the aortic valve and aortic root. A comparative evaluation]. / Metodi di determinazione della gettata sistolica dall'ecocardiogramma M-mode della valvola aortica e della radice aortica. Una valutazione comparativa applicata.

The purpose of this study is to evaluate four methods of determining left ventricular stroke volume (SV) from aortic valve (AV) and aortic root (AR) M-mode echocardiogram (Table I, formulas 1-4); secondly, to study relations between echocardiographic aortic variables and SV. We studied 20 patients (Pts) in our Coronary Unit, 14 men and 6 women; their ages ranged from 38 to 76 (mean 53.4) years. Seventeen Pts had acute myocardial infarction; two Pts had previous myocardial infarction and heart failure; one Pt had dilated cardiomyopathy and heart failure. Three out of the twenty Pts, had mitral insufficiency (Table II, clinical and hemodynamic data). Patients were studied with high quality M-mode echocardiography. Immediately after the examination repeated measurements of cardiac output by thermodilution technique (TD) were carried out, and values of SV calculated (SV-TD). Twenty-five complete procedures were accomplished. The formulas were applied to every patient's echocardiographic data, and results (SV-ECHO) compared with SV-TD (Table III). Echocardiographic variables, whether single or multiple (terms), were also studied with regard to their relation with SV-TD (Table IV). Mean +/- SD value of SV-TD of the study group was 60.3 +/- 24.7 ml; range 22.7 to 108 ml. Mean +/- SD values of SV-ECHO were as follows: Yeh's formula, based on squared mean AV opening and LVET, 56 +/- 22.6 (ml), r = 0.8278, SEE 12.98; Jacobs' formula, based on aortic box planimetry, 68 +/- 32.5 (ml), r = 0.7129, SEE 23.31.(ABSTRACT TRUNCATED AT 250 WORDS)