Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department.

OBJECTIVES: Urinary tract infections, among the leading causes of antibiotic prescriptions in adult women, are complicated by increasing antibiotic resistance. Current recommendations propose a 7 day treatment with fluoroquinolones or a 10-14 day course of third-generation cephalosporins (3GC). Our aim was to study the efficiency and tolerance of a short 7 day treatment with 3GC in uncomplicated acute pyelonephritis in women aged between 18 and 65 years. PATIENTS AND METHODS: This study was an open, prospective, non-comparative, monocentric pilot study with consecutive patients. We included women between 18 and 65 years old who had been admitted to the emergency department with a diagnosis of acute pyelonephritis. The treatment consisted of 1 g of ceftriaxone injection followed by 6 days of 400 mg of cefixime per day. The primary endpoint was negative urine cultures on day 9. We opted for Fleming's multistage design for this trial. ClinicalTrials.gov number: NCT01390623. RESULTS: Thirty-seven patients were analysed. The bacteriological response consisted of negative urine cultures for all 37 patients on day 9. On day 9, 30 patients were completely asymptomatic, while 7 exhibited clinical improvement though persistence of bladder irritation or flank pain. On day 37, there were no remaining symptoms and no recurrences of urinary tract infection, as noted during the last follow-up visits. CONCLUSIONS: These results suggest that acute pyelonephritis in women could be successfully treated with a short-term course of 1 g of ceftriaxone on the first day followed by 400 mg of cefixime per day for 6 days. These positive results must be confirmed by a non-inferiority study.

[Neurological symptoms due to Mycoplasma pneumoniae infection in nine children]. / Formes neurologiques des infections à Mycoplasma pneumoniae : à propos de neuf cas pédiatriques.

Mycoplasma pneumoniae infection is common in children. Extrapulmonary symptoms usually reveal as neurological symptoms, mainly as encephalitis with significant morbidity and mortality. Various other neurological presentations have also been reported. We describe a cohort of nine children with neurological manifestations due to M. pneumoniae infection, including five cases of encephalitis, one of polyradiculoneuritis, one of ophthalmoplegia, one of optic neuritis, and one of myositis. Progression was variable from ad integrum recovery to severe brain damage. Diagnosis is usually confirmed by PCR and/or serological follow-up, but the latter is still insufficiently used in practice to systematically affirm the diagnosis. Therapeutic management is not clearly defined and long-term progression can be uncertain despite early antibiotic and/or anti-inflammatory treatments.

[Neurological symptoms with Bartonella henselae infection: report on 2 pediatric cases]. / Atteintes neurologiques àBartonella henselae : à propos de 2 cas pédiatriques.

Cat scratch disease (CSD) is usually a benign, self-limited regional lymphadenopathy, caused by Bartonella henselae. However, systemic complications have been described. We report on 2 children who developed neurological symptoms of acute encephalitis or neuroretinitis. Cat scratch disease should be suspected when neurological symptoms of undetermined cause occur in children, whether or not anamnesis is significant.

[Analysis of a severe septic transfusion reaction with standard platelet concentrate]. / Analyse d'un incident bactérien grave transmis par transfusion d'un concentré plaquettaire.

We recently observed a near fatal case of transfusion-transmitted infection with standard platelet concentrate. Streptococcus dysgalactiae subspecies equisimilis was isolated both from donor, residual component container and cultures of the patient's blood. This should question the usefulness of systematic bacterial detection in platelet concentrates, however a lethal accident has occurred recently which escaped bacterial detection. This observation calls for implementation of pathogen inactivation procedures for platelets concentrates.

[Should presumptive meningoencephalitis treatment in adults be active against Mycoplasma pneumoniae?]. / Le traitement de première intention d'une méningoencéphalite de l'adulte doit-il tenir compte de Mycoplasma pneumoniae?

INTRODUCTION: Meningoencephalitis is the most common central nervous system complication caused by Mycoplasma pneumoniae. Its frequency is probably underestimated. OBJECTIVE: The study's aim was to determine the retrospectively incidence of M. pneumoniae meningoencephalitis among other cases of encephalitis diagnosed in infectiology, neurology and ICU at the Clermont-Ferrand University hospital in 2004 and 2005. DESIGN: A case of meningoencephalitis was defined by encephalopathy (altered level of consciousness and/or change in personality), with one or more of the following symptoms: fever, seizure, focal neurological findings, meningitis, electroencephalography or neuroimaging findings consistent with encephalitis. Tumor and hematoma diagnosed by scan were excluded. M. pneumoniae was considered as a possible cause when patients had positive serological test (IgM Elisa) and/or positive PCR results for the CSF. RESULTS: Four (8.3%) patients among 48 cases of encephalitis could have been caused by M. pneumoniae. All except one convulsed initially. Pneumopathy was found in two patients. All received a specific treatment later. Antibiotics seemed to influence evolution in only two patients. These 4 cases appeared during an epidemic between November 2004 and August 2005: 48 hospitalized adults had positive serological test for M. pneumoniae in 2005 and 15 in 2004, whereas the number of tests was the same in 2004 and in 2005. CONCLUSIONS: M. pneumoniae should be investigated as a cause of meningoencephalitis if initial tests are negative, if patients have respiratory symptoms and in case of epidemic. Presumptive treatment of meningoencephalitis should include an antibiotic active against M. pneumoniae.

Outbreak of colonization and infection with vancomycin-resistant Enterococcus faecium in a French university hospital.

An outbreak of infection with vancomycin-resistant Enterococcus faecium occurred at Hotel-Dieu Hospital (Clermont-Ferrand, France). A case-control study was performed in the infectious diseases and hematology units of the hospital. Urinary catheter use (odds ratio [OR], 12 [95% confidence interval {CI}, 1.5-90]; P<.02), prior exposure to a third-generation cephalosporin (OR, 22 [95% CI, 3-152]; P=.002), and prior exposure to antianaerobials (OR, 11 [95% CI, 1.5-88]; P<.02) were independently predictive of vancomycin-resistant Enterococcus faecium carriage.

[VCA agar (bioMérieux) for selective isolation of vancomycin-resistant Enterococci (VRE) from fecal specimens]. / Utilisation de la gélose VCA3 (bioMérieux) pour l'isolement sélectif des Enterococci résistants à la vancomycine à partir de prélèvements fécaux.

Screening for Vancomycin Resistant Enterococci (VRE) is recommended for preventing nosocomial infections with VRE. The aim of this study was to assess the performance of VCA3 agar (bioMérieux) in VRE isolation from fecal specimens. 220 specimens were cultured on VCA3 agar, which contains vancomycin and in parallel, on CAP agar (Oxoid), which is vancomycin-free. 36 vancomycin resistant enterococci were isolated: 24 isolates of Enterococcus faecium expressed a high-level resistance to vancomycin and 12 isolates of E. gallinarum/casseliflavus exhibited resistance at low-level. The sensitivity of VCA3 appeared greater than that of CAP for VRE isolation: 92% (22/24) vs 79% (19/24) for E. faecium (NS, P>0.05) ; 83% (10/12) vs 50% (6/12) for E. gallinarum/casselliflavus (NS, P>0.05). As expected, initial cultures of multiple gram positive organisms were far more frequent on CAP agar than on VCA3 agar. The isolation rate of vancomycin susceptible gram positive strains was impressively lower on VCA3 medium than on CAP medium. VCA3 agar avoided therefore additional subcultures, useless identification and susceptibility tests. In conclusion, VCA3 medium could be useful for the direct, rapid and selective isolation of VRE from fecal specimens.

Frequency and diversity of Class A extended-spectrum beta-lactamases in hospitals of the Auvergne, France: a 2 year prospective study.

OBJECTIVES: To evaluate the frequency and diversity of extended-spectrum beta-lactamases (ESBLs) produced by Enterobacteriaceae and Pseudomonas aeruginosa in one French region. METHODS: During 2001-2002, all the non-duplicate isolates of P. aeruginosa resistant to ceftazidime and of Enterobacteriaceae intermediate or resistant to ceftazidime and/or cefotaxime and/or aminoglycosides with an AAC(6') I phenotype were collected in nine hospitals of the area. ESBL isoelectric points were determined, bla genes were amplified and sequenced and epidemic isolates were genotyped with ERIC2-PCR. RESULTS: ESBLs were observed in 297 Enterobacteriaceae (0.8%). The most frequent were TEM-3 like (n=152; 51.2%) and TEM-24 (n=115; 38.7%). Four new enzymes were observed, TEM-112 (pI 5.4), TEM-113 (pI 6.3), TEM-114 (pI 5.9) and TEM-126 (pI 5.4). Other TEMs were TEM-8, TEM-12, TEM-16, TEM-19, TEM-20, TEM-21, TEM-29 and TEM-71. The other ESBLs were SHV-4, SHV-5 and SHV-12, CTX-M-1, CTX-M-3, CTX-M-14 and CTX-M-15. In 37 P. aeruginosa (0.7%) only one ESBL was observed, PER-1. Five epidemic strains were detected, Serratia marcescens TEM-3 and four observed in several hospitals, Enterobacter aerogenes TEM-24, Citrobacter koseri TEM-3, Proteus mirabilis TEM-3 and P. aeruginosa PER-1. CONCLUSION: ESBL frequency was lower than in 1998, and CTX-M-type frequency higher (2.1% of ESBLs in 2001, 4.9% in 2002). This long-term survey detected new sporadic enzymes (TEM-112, TEM-113, TEM-114 and TEM-126) and interhospital epidemic strains while avoiding any overestimation of ESBL frequency that may otherwise have occurred because of acute epidemics.

Clinical characteristics and outcome of patients with invasive pneumococcal disease, Puy-de-Dôme, France, 1994-1998.

A surveillance program for invasive pneumococcal disease was undertaken in Puyde-Djme, an administrative district of the region Auvergne in France, from 1 January 1994 to 31 December 1998. A total of 214 cases were identified. The annual incidence of invasive pneumococcal disease increased (P=0.04) from 5.5 in 1994 to 9.3 cases per 10(5) person-years in 1998. The highest incidences were for children <2 years of age (59.2 cases per 10(5) person-years) and for adults > or = 65 years (18 cases per 10(5) person-years). Clinical diagnoses, available in 200 patients, included acute pneumonia (62%), meningitis (10%), sepsis without focus (20%), and others (8%). The most frequent chronic medical conditions of the patients included smoking, alcoholism, cardiovascular and pulmonary diseases, and malignancies. Thirty-one percent of the isolates were nonsusceptible to penicillin. Penicillin resistance (MIC > or = 0.1 mg/l) was more frequent (P=0.02) in cancer patients. The overall case-fatality rate was 21.5%. Risk factors for death were age, sex, and underlying diseases of the patients, along with the severity of illness. These population-based findings should convince clinicians to offer pneumococcal vaccine to patients at high risk for invasive pneumococcal disease, thereby increasing vaccination coverage levels in France.

Human and animal epidemic of Yersinia enterocolitica O:9, 1989-1997, Auvergne, France.

Yersinia enterocolitica O:9 infections were reported in Auvergne in 1988 to 1989, while brucellosis due to Brucella abortus was almost eliminated. The serologic cross-reactions between the two bacteria complicated the diagnosis of brucellosis cases. In 1996, human cases of Yersinia enterocolitica O:9 infection were detected, with a peak incidence of 12 cases. Veterinary surveillance could have predicted the emergence of this disease in humans.

Survey of prevalence of extended spectrum beta-lactamases among enterobacteriaceae.

During the first six months of 1990 and 1994 respectively, 3179 and 2721 non-repetitive strains of Enterobacteriaceae were isolated at the teaching hospital of Clermont-Ferrand. Extended-spectrum beta-lactamases were found in 147 isolates, mainly in Klebsiella pneumoniae (n = 73), Enterobacter aerogenes (n = 37) and Proteus mirabilis (n = 15). TEM-3/CTX-1, SHV-4/CAZ-5 and TEM-24/CAZ-6 were the prevalent enzymes. However, the most frequently involved enzyme in 1990 was TEM-3 (48.6%) whereas in 1994 it was SHV-4 (56.0%). Two salient features emerged from this study: the high frequency of TEM-3 production in P. mirabilis and the production of SHV-4 enzyme, heretofore observed solely in K. pneumoniae, in two other species, E. aerogenes and Escherichia coli.

[Detection of pneumococci with reduced susceptibility to penicillin G using the ATB++STREP strip]. / Détection des pneumocoques de sensibilité diminuée à la pénicilline G avec la galerie ATB STREP.

Antibiotic susceptibility of 104 clinical isolates of Streptococcus pneumoniae was routinely tested using ATB STREP strips (Bio-Mérieux), and interpreted with ATB PLUS Expert V 2.3.1 software. In parallel, CMI of penicillin G was determined by Etest, strains with MIC < or = 0.06 mg/l were classified as penicillin susceptible. ATB system proved to be both sensitive and specific for the detection of strains of reduced susceptibility to penicillin G, accurately detecting 70 out of the 71 susceptible strains, and all of the 33 resistant strains. However the level of resistance cannot be deduced from ATB results.

[Detection of beta-lactamases resistant to inhibitors (IRT) by the disk diffusion method]. / Détection des beta-lactamases résistantes aux inhibiteurs (IRT) par la méthode de diffusion.

UNLABELLED: 85 E. coli strains producing various beta-lactamase were studied: TEM low level: n = 11, TEM high level: n = 4, oxacillinase (OXA): n = 5, céphalosporinase (CASE) +/- TEM: n = 5, inhibitor resistant TEM (IRT) n = 50, IRT+TEM: n = 3, IRT+ CASE: n = 7. Their susceptibility to amoxicillin (AMX), amoxicillin+clavulanate (AMC), ticarcillin (TIC), ticarcillin+clavulanate (TCC), piperacillin (PIP), piperacillin+tazobactam (TAZ), mecillinam (MEC), cephalotin (CF), cefoxitin (FOX) et ceftazidime (CAZ) were evaluated by a disk diffusion method, in order to determine the resistance pattern which allows a reliable detection of IRT-producing strains. The phenotype AMX R, TIC R, AMCI/R, TCCI/R et CFS was observed in 46 out of 53 IRT +/- TEM strains, 4/5 of OXA strains and 1/11 of TEM low level strains. A better sensitivity could be obtained by a modification of breakpoints for AMC, TCC and CF, however OXA-producing strains remain indistinguishable from IRT-strains.

[Detection and analysis of cryoglobulins: comparative study of a population of patients and one of healthy controls]. / Détection et analyse des cryoglobulines: étude comparative d'une population de malades et d'une population de témoins sains.

During an 11-month period, 270 cryoglobulins were identified in 735 sera from patients versus 34 in 82 sera from apparently healthy blood donors. Western-blot analysis of the cryoglobulins was performed and cryoglobulin protein content was determined using a colorimetric assay. Comparison of findings in the two groups suggested that a substantial proportion of cryoglobulins identified in the sera of patients are quantitatively and qualitatively indistinguishable from cryoglobulins identified in healthy controls.