Temocillin against Enterobacteriaceae isolates from community-acquired urinary tract infections: low rate of resistance and good accuracy of routine susceptibility testing methods.

Background: Temocillin is an old 'revived' antibiotic that may play an important role in the treatment of febrile urinary tract infection (UTI). Data regarding its activity against current Enterobacteriaceae isolates as well as the performance of routine susceptibility testing methods are, however, scarce. Objectives: To determine the MICs of temocillin for Enterobacteriaceae strains reflecting the current epidemiology and to analyse the accuracy of three commercial methods. Methods: Enterobacteriaceae isolates causing community-acquired UTI were prospectively collected from September 2015 to January 2017 in two French centres. Temocillin MIC was determined by agar dilution (AD) as the reference method and then compared with: (i) susceptibility testing by disc diffusion; (ii) MIC determination by Etest; and (iii) MIC estimation by the Vitek 2 automated system. Results: A total of 762 Enterobacteriaceae were analysed comprising 658 (86.4%) Escherichia coli and 37 (4.9%) ESBL-producing isolates. Susceptibility rate assessed by AD was 99.6% according to the 8 mg/L clinical breakpoint and was significantly lower against the ESBL-producing isolates than the non-ESBL-producing isolates (94.6% versus 99.9%, P < 0.01). The MIC50 and MIC90 for the total set were 3 and 6 mg/L, respectively. According to the 8 mg/L clinical breakpoint, the major error rate was <1% for disc diffusion and Etest, and significantly higher for Vitek 2 (4.3%, P < 0.01), but still low. No very major error was noticed. Conclusions: Temocillin showed a high level of activity against Enterobacteriaceae from community-acquired UTI and good to excellent reliability of routine methods for susceptibility testing in such a setting.

Meningococcal carriage during a clonal meningococcal B outbreak in France.

The aim of this study performed in Normandy, France, was to analyze the pharyngeal meningococcal carriage at the peak of a clonal meningococcal B outbreak, which was subsequently controlled using an outer membrane vesicle vaccination. This cross-sectional study included randomly selected subjects aged 1-25 years. Carriers and non carriers were compared using unconditional logistic regression. Among the 3,522 volunteers, there were 196 (standardized rate: 6.46 %) Neisseria meningitidis carriers, of which there were only five with the outbreak strain (B:14:P1.7,16/ST-32; standardized rate: 0.18 %). From the multivariate analysis, older age, smoking, higher degree of socialization, and social deprivation appear to favor the carriage of all the strains included. Prior antibiotic treatment up to 12 months before swabbing, even with ß-lactam, was protective against carriage. Our data indicate a low overall meningococcal carriage rate with a surprising protective effect of prior antibiotic exposure. The observed low carriage rate of the epidemic strain (B:14:P1.7,16/ST-32) contrasts with the high incidence of invasive meningococcal diseases (IMD) due to this strain. Hence, our data underline the high virulence of the strain and suggest a low level of natural immunity of the population against this strain. Although highly resource-consuming, carriage studies are helpful in guiding the implementation of control measures of IMD, such as mass vaccination or chemoprophylaxis.

[Surgical-site infections following varicose vein surgery according to a continuous series of 408 interventions in a teaching hospital]. / Infections du site opératoire sur ablation de varices d'après une série continue de 408 interventions réalisées dans un centre hospitalier universitaire.

OBJECTIVE: To determine the incidence of surgical-site infections (SSI) following varicose vein surgery in the vascular surgery ward of a French teaching hospital. PATIENTS AND METHODS: A prospective surveillance of SSI was conducted during one year, with a 30-day postoperative follow-up. SSI cases were identified by using the definitions of the Centers for Disease Control (CDC, USA). Data acquisition and analysis were performed with the Epi-Info 6.04 software (CDC). RESULTS: Three quarters of the 408 included interventions were characterized by a NNIS score equal to 0. All patients underwent a hair removing practice before intervention. Hair removing methods were very heterogeneous and often not in accordance with national recommendations (e.g. mechanic shaving for 44.6% of patients). The incidence of SSI was 1.2% (95% confidence interval=[0.2-2.2]). All infections were identified after hospital discharge. Four infected patients out of five presented obesity or excess weight, and two patients had diabetes mellitus. The mean age of infected patients was significantly higher than non-infected ones (70.4 years versus 52.0; p<0.01). All SSI had consequences like rehospitalization, reintervention, or antimicrobial therapy. CONCLUSION: According to our results, SSI following varicose vein surgery are scarce and mainly concerned high-risk patients. However, in an aim of prevention, it seems necessary to homogenize hair removing methods in this ward.

[Travelers' knowledge of vaccines. A survey including 400 people having consulted an international vaccination center]. / Connaissances des voyageurs à propos des vaccins. Enquête auprès de 400 personnes consultantes d'un centre de vaccinations internationales.

UNLABELLED: The authors conducted a survey in an international vaccination centre. The aim of the study was to assess the travelers' knowledge of vaccines and to check their health record to determine the vaccination rate. We used a self-administered questionnaire and added vaccination certificates to the document. RESULTS: Most of the travelers knew about complications due to vaccinations, but ignored their contraindications. Knowledge decreased over the age of thirty. The travelers agreed with antihepatitis B vaccination and only 10% mentioned the risk of multiple sclerosis. The list of compulsory vaccinations and their schedule were well-known but some of the travelers ignored their vaccine status and said they trusted their general practitioner. Only 40% of people over 20years of age were able to present their national or international vaccination certificate, a reason for underestimating the vaccination rate. CONCLUSION: It would be necessary to have a "World Health Organization" type vaccination certificate available for all French people over 20years of age, while improving the smart health card and training practitioners to better inform their patients about vaccinations.

Predictive value of oral colonization by Candida yeasts for the onset of a nosocomial infection in elderly hospitalized patients.

The incidence of nosocomial yeast infections has increased markedly in recent decades, especially among the elderly. The present study was therefore initiated not only to determine the predictive value of oral colonization by yeasts for the onset of a nosocomial Candida infection in elderly hospitalized patients (> 65 years), but also to clarify the factors that promote infection and to establish a relationship between the intensity of oral carriage and the onset of yeast infection. During this prospective cohort study, 256 patients (156 women and 100 men with a mean age of 83 +/- 8 years) were surveyed for yeast colonization or infection. Samples were collected every 4 days from day 0 to day 16 from four sites in the mouth, and intrinsic and extrinsic factors that might promote infection were recorded for each patient. Pulsed field gel electrophoresis was performed on Candida albicans isolates from all infected patients. Poor nutritional status was observed in 81 % of the patients and hyposalivation in 41 %. The colonization level was 67 % on day 0 (59 % C. albicans) and a heavy carriage of yeasts (> 50 c.f.u.) was observed for 51 % of the patients. The incidence of nosocomial colonization reached 6.9 % on day 4 (6.1 % on day 8 and 2.7 % on day 12), and that of nosocomial infection was 3.7 % on day 4 (6.8 % on day 8, 11.3 % on day 12 and 19.2 % on day 16). Of the 35 patients infected, 57 % were suffering from oral candidiasis. The principal risk factors for colonization were a dental prosthesis, poor oral hygiene and the use of antibiotics. The risk factors for infection, in addition to those already mentioned for colonization, were endocrine disease, poor nutritional status, prolonged hospitalization and high colony counts. Genotyping revealed person-to-person transmission in two patients. Thus, this study demonstrates a significant association between oral colonization and the onset of yeast infections in elderly hospitalized patients. Therefore, oral samples should be collected at admission and antifungal treatment should be administered in cases of colonization, especially in patients presenting a heavy carriage of yeasts. Genotyping of the strains confirmed the possibility of person-to-person transmission.

[A new case of bat rabies in France]. / Un nouveau cas de rage chez les chauves-souris en France.

INTRODUCTION: Bat rabies represents an emerging zoonosis in Europe and the only endemic cause of rabies in France. CASE RECORD: A 29 year-old woman was bitten at the hand by a bat. The diagnosis of bat rabies was positive and the viral strain was an European Bat Lyssavirus 1a. A combination of rabies vaccine and human rabies immune globulin was provided to the patient. DISCUSSION: Any direct contact with a bat must be avoided. In case of exposure to bats, the postexposure treatment must associate the rabies vaccine and human rabies immune globulin because of antigenic diversity of Lyssavirus circulating in bat species.

Nosocomial Candida albicans acquisition in a geriatric unit: epidemiology and evidence for person-to-person transmission.

This prospective study, which included 69 patients over a two-month period, was conducted to evaluate the incidence of community-acquired carriage and hospital-acquired yeasts in elderly patients hospitalized in a short stay care unit. Furthermore, possible person-to-person transmission was investigated by means of genotyping the Candida albicans isolates obtained from samples (throat swabs, urine and stools) systematically taken from the patients at different times during the hospitalization and from healthcare workers (throat swabs and handwashes) in the middle of the observation period. This study showed a high prevalence rate of 64% for community-acquired yeast carriage and a 40% incidence rate for hospital- acquired yeasts. Mycological analysis of the samples from the healthcare workers revealed eight of them to be colonized in the oral cavity. In addition, pulsed field gel electrophoresis and mitochondrial DNA analysis of the C. albicans isolates demonstrated person-to-person transmission. This study suggests that regular mycological sampling should be done as hospitalized elderly patients are frequently colonized by yeasts. Likewise, oropharyngeal swabs from healthcare workers may be helpful in this setting.

[Efficiency of hepatitis C virus screening before and after blood transfusion]. / Evaluation médicoéconomique du suivi sérologique péritransfusionnel du virus de l'hépatite C.

UNLABELLED: Efficiency of a viral hepatitis C screening strategy before and after blood transfusion has to be evaluated. METHODS: Four screening strategies were virtually applied to the population of transfused patients at Rouen University Hospital during 1996 and then compared : the first without any systematic HCV screening test; the second with systematic testing both before and 3 months after transfusion; the third with systematic testing both before and 6 months after transfusion ; the last defined as systematic testing before transfusion only. The efficacy (i.e. number of positive tests), the efficiency (i.e. average cost per positive test) and the marginal costs of moving from a strategy to another one were assessed using decision analysis. RESULTS: The efficacy of systematic screening test before transfusion only (361 per positive test), systematic testing both before and three months after (523 per positive test) or six months after (488 per positive test) transfusion was similar, but the efficacy of the strategy without any systematic screening test (385 per positive test) was lower. The systematization of screening test both before, and three months, or 6 months after transfusion lead to a marginal cost of 619 , and 559 per positive test respectively. The systematization of testing before transfusion only lead to a marginal cost of 343 per positive test. Adding systematic testing after transfusion lead to a marginal cost of 5824 per positive test. CONCLUSION: Systematic screening tests before transfusion only can be considered as the most efficient strategy.

[Evaluation of nutritional status in hospitalized aged persons]. / Evaluation de l'état nutritionnel de la personne âgée hospitalisée.

The health status of older people strongly depends on their nutritional status. Hospitalisation is a factor that aggravates protein-energy malnutrition among older people. A descriptive study was completed among 71 subjects over 65 years old and hospitalised in a gerontological internal medicine service. The study used a nutritional evaluation scale called the Mini Nutritional Assessment (MNA). The study showed that 21% of subjects had an acceptable nutritional status, 49% were considered to be "at risk of undernourishment", and 31% were malnourished. A relationship was observed between the MNA score, the degree of autonomy (AGGIR grid), cognitive functions (Mini Mental State: MMS) and the existence of an anxious-depressive state. These elements should be taken into consideration to avoid the aggravation of the nutritional status of older people in the hospital, or to improve it. In addition, certain simple biological exams (albumin, pre-albumin, reactive protein) are necessary to assess the endogenous or exogenous aspect of undernourishment.

[General practitioners' practices and attitudes in regard to suicidal behavior]. / Pratiques et attentes des médecins généralistes à l'égard des conduites suicidaires.

As demonstrated at the recent Consensus Conference on the "suicidal crisis" held by the French Psychiatry Union and the National Agency for the Accreditation and the Evaluation of Care, suicide is recognised as a current public health problem. The general practitioner's role is situated on two levels: in a preliminary stage, the early identification of risk, and in a secondary stage, the provision of care at the time of a suicide attempt and then the provision of on-going follow-up care in partnership with other special services. The study aimed at evaluating general practitioners' practices when encountered with suicidal patients and assessing their management of suicidal behaviour, as well as difficulties met and their expectations. Responses to a questionnaire were received from 290 general practitioners in one regional department in France. The results revealed that two-thirds of the respondents considered the identification of suicidal tendencies as being difficult, in particular with regard to the detection of young people at risk. General hospitals are the most common structures where patients are referred to in the event of a suicide attempt, as a facility that is permanently open and capable of delivering ambulatory care. A majority of the general practitioners expressed the need for training which was focused on methods for the early identification of risk as well as the development of listening skills.

Venous thrombosis in immunocompetent patients with acute cytomegalovirus infection: a complication that may be underestimated.

In the present study, we retrospectively studied clinical and laboratory findings associated with cytomegalovirus (CMV) infection in immunocompetent patients. We focused on severe CMV infection. Among 38 patients, five had a severe form of infection: one had meningitis, one had symptomatic thrombocytopenia and three had venous thromboses with pulmonary embolism, a rarely described complication. CMV-induced thrombosis has been reported in immunocompromised patients such as transplant recipients and patients with AIDS. Recent case reports have also described thrombotic phenomena in immunocompetent patients with CMV infection. Our study suggests that venous thrombosis during acute CMV infection is an underestimated complication.

Acute cytomegalovirus infection and venous thrombosis: role of antiphospholipid antibodies.

Cytomegalovirus (CMV)-induced thrombosis has been reported in immunocompromised patients, such as transplant recipients and patients with AIDS. Recent cases also describe thrombotic phenomena in immunocompetent patients with CMV infection. Various mechanisms may explain the role of CMV in thrombosis: this virus can damage endothelial cells, activate coagulation factors, and induce production of antiphospholipid (aPL) antibodies. We present a case report of a previously healthy white woman with a pulmonary embolism associated with CMV infection and the presence of aPL antibodies, and we discuss the role of the aPL antibodies associated with CMV infection in the pathogenesis of thrombosis.

Evaluation of a training program for the prevention of lower back pain among hospital employees.

An evaluation of a training program for the prevention of lower back pain (LBP) was conducted over a two-year period in the Regional Hospital of Le Mans, which is located in the west of France and employs 2400 staff. The training program was based on a multidisciplinary approach to worker training in the prevention of LBP and in ergonomic efforts in the workplace. Workers received theoretical training on LBP, patient handling and ergonomics, and on-the-job ergonomics instruction to help them to implement participative ergonomics in their working groups. A cohort of 136 employees attended classes on safe posture and patient handling, then received advice from instructors who observed them while they performed their typical workday tasks.

Nine cases of foodborne botulism type B in France and literature review.

Presented here is an outbreak of nine cases of type B botulism that occurred in France in 2000 followed by a review of the relevant literature. The outbreak resulted from the consumption of home-canned asparagus and required the intubation of six patients. Despite complications, all patients recovered completely. Specific antitoxin treatment was not administered because it is no longer manufactured in France. The literature review covers the epidemiologic data reported from Europe and the USA to date and an assessment of the treatment options for botulism. The usefulness of establishing a European network to provide access to botulism antitoxins is discussed. Although their efficacy is not unanimously accepted, they remain the only specific treatment now known.

Evaluation of an educational low back pain prevention program for hospital employees.

OBJECTIVES: To evaluate the impact of an educational low back pain prevention program in a cohort of hospital employees. METHODS: A cohort of 136 nonclerical hospital employees attended classes on safe postures and patient handling, then received advice by educators who observed them while they performed their typical workday tasks. Each of the subjects in this intervention group was matched on age, sex, and job category with a control. Musculoskeletal complaints and changes in habits during work and recreational activities were evaluated before the intervention (or the corresponding date in the control group) and after two years. RESULTS: In the intervention group, 36% of subjects with low back pain at baseline were free of this symptom at follow-up, whereas only 26% were in the opposite situation. The proportion of subjects with low back pain episodes lasting longer than 30 days increased significantly from baseline to follow-up in the control group (from 30% to 49%) but not in the intervention group. The number of sick leaves longer than 30 days decreased significantly in the intervention group. Only 33% of the intervention group subjects felt the intervention had been helpful; this proportion varied across job categories. CONCLUSION: Our data suggest that differences in job categories should be taken into account when designing educational programs for preventing low back pain. They also indicate that back school programs may be more effective in subjects with a history of low back pain, whereas instruction on safe postures and patient handling may be the best approach in subjects who have not previously experienced low back pain. Observing and providing advice to employees while they are performing their usual duties may be an essential component of low back pain prevention.