Decline in antibiotic resistance and changes in the serotype distribution of Streptococcus pneumoniae isolates from children with acute otitis media; a 2001-2011 survey by the French Pneumococcal Network.

Streptococcus pneumoniae is an important cause of acute otitis media (AOM). The aim of this study was to evaluate trends in antibiotic resistance and circulating serotypes of pneumococci isolated from middle ear fluid of French children with AOM during the period 2001-2011, before and after the introduction of the PCV-7 (2003) and PCV-13 (2010) vaccines. Between 2001 and 2011 the French pneumococcal surveillance network analysed the antibiotic susceptibility of 6683 S. pneumoniae isolated from children with AOM, of which 1569 were serotyped. We observed a significant overall increase in antibiotic susceptibility. Respective resistance (I+R) rates in 2001 and 2011 were 76.9% and 57.3% for penicillin, 43.0% and 29.8% for amoxicillin, and 28.6% and 13.0% for cefotaxime. We also found a marked reduction in vaccine serotypes after PCV-7 implementation, from 63.0% in 2001 to 13.2% in 2011, while the incidence of the additional six serotypes included in PCV-13 increased during the same period, with a particularly high proportion of 19A isolates. The proportion of some non-PCV-13 serotypes also increased between 2001 and 2011, especially 15A and 23A. Before PCV-7 implementation, most (70.8%) penicillin non-susceptible pneumococci belonged to PCV-7 serotypes, whereas in 2011, 56.8% of penicillin non-susceptible pneumococci belonged to serotype 19A. Between 2001 and 2011, antibiotic resistance among pneumococci responsible for AOM in France fell markedly, and PCV-7 serotypes were replaced by non-PCV-7 serotypes, especially 19A. We are continuing to assess the impact of PCV-13, introduced in France in 2010, on pneumococcal serotype circulation and antibiotic resistance.

Diagnosis and follow-up of genital chlamydial infection by direct methods and by detection of serum IgG, IgA and secretory IgA.

PURPOSE: To determine the prevalence of Chlamydia trachomatis infection in a high-risk population by direct and indirect methods and to evaluate the diagnosis of secretory immunoglobulin A (sIgA). PATIENTS AND METHODS: Urethral or endocervical specimens from 78 patients (48 females and 30 males) were examined by cell culture, direct fluorescence assay, PCR Cobas Amplicor (Roche Molecular Diagnostics), and sIgA was detected by the recombinant lipopolysaccharide (LPS)-enzyme-linked immunoassay (rELISA). Serum from each patient was also obtained and analysed for the presence of IgG and IgA antibody by in-house microimmunofluorescence (MIF) and by the rELISA method (Medac, Hamburg, Germany). RESULTS: The overall C. trachomatis prevalence determined by direct methods was 28%. The detection of sIgA antibodies was significantly higher in the group of patients with a positive direct detection (50%) than in the group of negative direct detection (10.7%). The Chlamydia-specific IgA antibodies were detected by the rELISA in 40.9 and 53.6% of group I (positive direct detection) and group II patients (negative direct detection), respectively. The species-specific IgA antibodies were detected by the MIF method in 18.2 and 16.1% of group I and II patients, respectively. Chlamydia genus-specific IgG antibodies were detected by the rELISA in 86.4 and 83.9% of group I and group II patients and, C. trachomatis specific IgG were present in 81.8 and 73.2% of group I and group II patients, respectively, as assessed by the MIF test. CONCLUSION: Combining the positive direct methods and/or positive sIgA antibody results from cervical or urethral specimens had an indication of current C. trachomatis infection.

[The diagnosis of cat-scratch-disease-associated adenitis: diagnostic value of serology and polymerase chain reaction]. / Le diagnostic microbiologique des adénites associées à la maladie des griffes du chat : place de la sérologie et de l'amplification génique.

The diagnosis of cat scratch disease (CSD) associated adenitis relies classically on the association of clinical, epidemiological and bacteriological criteria. The polymerase chain reaction (PCR) looks like a more competitive diagnostic trial than serology. We evaluated the sensitivity, specificity and predictive positive and negative values of serology in routine diagnosis of CSD. A retrospective study over five years was led among patients presenting a suspicion of CSD and having a serology and/or a PCR. The Gold standard for diagnosis was PCR. The serological tests of Bartonella henselae was performed once in 482 patients, of which 2% (11 out of 482) were positive, and twice in only 39 patients (8%). The PCR diagnosis method for B. henselae was performed in biopsy of specimen lymph nodes in 28 patients and 14 out of 28 were positive. In nine patients, the diagnosis was exclusively made by PCR. Among the 14 patients whose PCR was negative, two had a positive serology and in three others patients, the serology was not performed. The sensitivity of serology was 35%, this confirms the low sensitivity of the serology in the CSD diagnosis. The diagnosis was confirmed in 56% of cases where PCR was performed. This led us to propose to perform systematically the PCR test for B. henselae in case of adenitis possibly associated with CSD.

Successive emergence of extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacter aerogenes isolates in a university hospital.

Sixty-two clinical isolates of Enterobacter aerogenes resistant to expanded-spectrum cephalosporins were collected between July 2003 and May 2005. Among these isolates, 23 (37.1%) were imipenem (IPM) susceptible, and 39 (62.9%) were IPM insusceptible, of which 89.7% (35/39) were resistant and 10.3% (4/39) were intermediate. Isolate genotypes were compared by pulsed-field gel electrophoresis. Of 62 isolates, 48 belonged to epidemic pulsotype A (77.4%). This pulsotype included 37.5% and 58.4% of beta-lactam phenotypes b and a, respectively. Nine isolates (14.5%) belonged to pulsotype E, which included 22.3% and 77.7% of phenotypes b and a, respectively. The beta-lactamases with pIs of 5.4, 6.5, 8.2, and 8.2 corresponded to extended-spectrum beta-lactamases (ESBLs) TEM-20, TEM-24, SHV-5, and SHV-12, respectively. Of 39 IPM-insusceptible E. aerogenes isolates, 26 (66.6%) were determined to be metallo-beta-lactamase producers, by using a phenotypic method. Of these isolates, 24 harbored a bla(IMP-1) gene encoding a protein with a pI of >9.5, and two carried the bla(VIM-2) gene encoding a protein with a pI of 5.3, corresponding to beta-lactamases IMP-1 and VIM-2, respectively. The remaining 13 (33.4%) isolates were negative for the bla(IMP-1) and bla(VIM-2) genes but showed an alteration of their outer membrane proteins (OMPs). Ten of these isolates produced the two possible OMPs (32 and 42 kDa), with IPM MICs between 8 and 32 microg/ml, and three others produced only a 32-kDa OMP with IPM MICs >32 microg/ml. This work demonstrates that, in addition to resistance to expanded-spectrum cephalosporins, IPM resistance can occur in ESBL-producing E. aerogenes isolates by carbapenemase production or by the loss of porin in the outer membrane.

[Streptococcus pneumoniae meningitis in Amiens Hospital between 1990 and 2005. Bacteriological characteristics of strains isolated]. / Les méningites à Streptococcus pneumoniae au CHU d'Amiens de 1990 à 2005. Aspects bactériologiques des souches isolées.

Streptococcus pneumoniae is actually the first most likely organism to cause meningitis in children 2 months to 2 years old and in adults older than 65 years. From January 1990 to December 2005, 72 cases of S. pneumoniae-positive cerebrospinal fluid culture were indexed in our hospital. Among the 72 cases, 25 came from children, and 60% of these came from children under two years of age and 47 came from adults whose the mean age was 55 years. The first penicillin-resistant S. pneumoniae (PNSP) meningitis was identified in 1993. The susceptibility to penicillin of pneumococcal isolates causing meningitis varied according to time; until 1995, 25% of the strains were PNSP, then from 1996 to 2005, 50% of strains were PNSP. The overall prevalence of non-susceptible was 34.7% (25/72). Among the 25 PNSP, 21 were intermediate to penicillin G and four of them were resistant. Among children, seven PNSP meningitis were indexed and one of them was resistant. The antimicrobial MICs of amoxicillin and cefotaxim varied from 0.064 to 1 mg/l and from 0.016 to 0.5 mg/l respectively. Among adults, 18 PNSP meningitis were indexed. Three strains were penicillin-resistant. The antimicrobial MICs of amoxicillin varied from 0.064 to 2 mg/l. Nine strains of 18 PNSP had cefotaxim MIC>/=0.5 mg/l and, four of them had MIC 1 mg/l. None amoxicillin and cefotaxim-resistant strain was isolated. Serotyping of all strains was performed in the Reference Center. Serotypes 6B, 9V and 19 were the most frequent in child and serotypes 6B, 23F, 19, 9, 4 were the most frequent in adult. So, all serotypes were represented.

[Performance of different methods of oxacillin resistance detection in atypic strains of Staphylococcus aureus]. / Performances des différentes méthodes de détection de la résistance à l'oxacilline de souches atypiques de Staphylococcus aureus.

Seventy-three of aminoglycoside-susceptible methicillin-resistant Staphylococcus aureus (AS-MRSA) and 12 kanamycin-tobramycin-resistant methicillin-susceptible S. aureus (KTR-MSSA) isolates were phenotypically and genotypically examined for methicillin susceptibility. The AS-MRSA profile represents 8.3% of MRSA strains and the KTR-MSSA profile represents 1.38% of MSSA strains. The diffusion method using the 5 microg oxacillin and 30 microg cefoxitin discs on Mueller-Hinton Agar (MHA) with and without NaCl, the incubation at 35 degrees C or 30 degrees C for 24 or 48 hours respectively, and the determining oxacillin MICs by E-test (AES, Combourg, France) were performed and used as phenotypic methods. We also used the mecA gene PCR which was considered as the "gold standard" for methicillin resistance detection, and the Slidex MRSA Detection (bioMérieux) that detect the presence of mecA gene product (PBP 2a). To increase the level of PBP 2a expression, the 30 microg cefoxitin disc was used as an inducer. All the AS-MRSA strains (100%) were detected by the cefoxitin disc in all conditions and by the oxacillin disc on MHA with 2% of NaCl at 35 degrees C. Without NaCl, the sensitivity fell to 97,2% by oxacillin disc. The oxacillin MICs for these isolates ranged from 2 to 128 mg/l. The mecA gene determinant and its product PBP 2a were detected in all AS-MRSA strains. All KTR-MSSA strains were phenotypically methicillin-susceptible and oxacillin MICs were below or borderline of breakpoint (< or =2 mg/l). The mecA gene determinant and its product were detected in one strain which was considered to be the most heterogeneous of those tested.

Detection of methicillin/oxacillin resistance and typing in aminoglycoside-susceptible methicillin-resistant and kanamycin-tobramycin-resistant methicillin-susceptible Staphylococcus aureus.

Eighty-five atypical isolates of Staphylococcus aureus divided into 73 aminoglycoside-susceptible methicillinresistant (AS-MRSA) and 12 kanamycin-tobramycin-resistant methicillin-susceptible (KTR-MSSA) were phenotypically and genotypically examined for methicillin resistance. Among these tests, the diffusion method using the oxacillin and cefoxitin disks on Mueller-Hinton agar with and without NaCl, the incubation at 35 degrees C or 30 degrees C for 24 or 48 hr, respectively, and the determination of oxacillin MICs by E-test were performed. We also examined the presence of the mecA gene by PCR and its product PBP 2a by the Slidex MRSA Detection test after induction by cefoxitin disk. All of the AS-MRSA strains (100%) were detected by the cefoxitin disk in all conditions and by the oxacillin disk on Mueller-Hinton agar with 2% of NaCl at 35 degrees C. Without NaCl, the sensitivity fell to 97.2% by oxacillin disk. The oxacillin MICs for these isolates ranged from 2 to 128 mg/L. The mecA gene determinant and its product PBP 2a were detected in all AS-MRSA strains. All KTR-MSSA strains were phenotypically methicillin-susceptible and oxacillin MICs were below or borderline of breakpoint (< or =2 mg/L). The mecA gene determinant and its product were detected in one strain. Pulsed-field gel electrophoresis (PFGE) was applied and revealed the presence of two major patterns A (36.9%) and B (46.2%) in AS-MRSA isolates and seven patterns in the KTR-MSSA strains.

[Treatment in primary Streptococcus pneumoniae peritonitis in adult: a case report and review of the literature]. / Prise en charge thérapeutique de la péritonite primitive à Streptococcus pneumoniae de l'adulte: étude d'un cas et revue de la littérature.

INTRODUCTION: Streptococcus pneumoniae primary peritonitis is rare. The diagnosis is uneasy and the treatment is not standardised. CASE REPORT: We report a single case of S. pneumoniae primary peritonitis needing surgical treatment. DISCUSSION: S. pneumoniae primary peritonitis can be medically treated. Surgery is needed in case of sepsis, associated digestive injuries or failure of medical treatment.

[Chlamydia trachomatis urogenital infections in women. Best diagnostic approaches]. / Infections urogénitales féminines à Chlamydia trachomatis. Meilleures approches diagnostiques.

Chlamydiae are obligate intracellular bacteria. Chlamydia trachomatis is the most common sexually transmitted disease (STD). The C. trachomatis damaging disease sequelae such as sterility is based on intense and chronic inflammation elicited and maintained by reinfection or persistent infection. The high prevalence of C. trachomatis infection reflects the long and successful adaptation of these organisms to persist in their human host population. The large group of asymptomatically infected persons is not only at risk of serious long-term sequelae but also sustains transmission within communities. C. trachomatis acute infections have been diagnosed by cell culture, direct immunofluorescence, enzyme immunoassay, direct DNA hybridization, and more recently by nucleic acid amplification tests (NAATs). In chronic or persistent chlamydial infections, the level of Chlamydia is very low and bacteria are often not viable. Such infections would be characterized by continuing positive NAATs but only intermittent isolation of viable Chlamydia and positive assays for chlamydial protein antigen. The development of NAATs has been a major advance in the field of chlamydial diagnosis. The use of NAATs associated with serology test is the best diagnosis. The introduction of assays based on amplification of genetic material has subsequently increased the sensitivity of detecting chlamydial infections and offers the opportunity to use non-invasive sampling techniques to screen for infections in asymptomatic subjects. In this article, it was proposed the best diagnosis approaches for detection of acute and chronic infections.

H107, a new aminoglycoside anti-Pseudomonas antibiotic produced by a new strain of Spirillospora.

Spirillospora spp. (strain 719) has been the source of several antibiotics. One of these designated H107 is produced as a trace. Compared with other antibiotics produced by the same strain, it was obtained only from the broth filtrate after precipitation with acetic acid followed by extraction with n-butanol. It was a water soluble metabolite active against Gram-negative bacteria and especially Pseudomonas spp., and was identified as an aminoglycoside compound. This is the first report of aminoglycoside anti-Pseudomonas production by Spirillospora.