Elizabethkingia anophelis outbreak in France.

OBJECTIVE: We report an outbreak of Elizabethkingia anophelis infections in France. To the best of our knowledge, this is the first outbreak described in Europe. METHODS: Each E. anophelis-positive microbiological sample was considered a case. All patients were hospitalized in an infectious diseases unit. Clinical, environmental, and microbiological investigations (MALDI-TOF mass spectrometry, PCR, E-test) were performed for each case. RESULTS: Twenty cases were reported from September 2020 to September 2021, mainly community-acquired infections, responsible for nine deaths. The phylogenetic analysis showed a clonal origin and excluded nosocomial transmission. Despite the analysis of multiple environmental specimens, no source of contamination was identified. All strains were highly resistant to cefotaxime, ceftazidime, and imipenem. CONCLUSIONS: Clinicians and microbiologists should be aware of this multidrug-resistant bacterium, capable of causing severe infections. Most strains showed the lowest minimum inhibitory concentration values for cotrimoxazole and ciprofloxacin, making them the best choice for empirical antibiotic therapy.

Relapse of Enterococcus hirae prosthetic valve endocarditis.

Enterococcus hirae, a gram-positive bacterium, is a rare isolate in clinical specimens. We report an unusual case of a relapse of prosthetic valve endocarditis due to E. hirae 6 months after the initial episode. Clonal relationship was proven by genomic analysis.

Should we reconsider cefazolin for treating staphylococcal meningitis? A retrospective analysis of cefazolin and cloxacillin cerebrospinal fluid levels in patients treated for staphylococcal meningitis.

OBJECTIVES: To assess the meningeal penetration of cefazolin and cloxacillin in individuals treated for methicillin-susceptible staphylococcal meningitis. METHODS: We retrospectively identified individuals treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a validated assay of liquid chromatography coupled with mass spectrometry at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific PCR). Medical charts were retrospectively reviewed to collect microbiological and clinical data, and to assess therapeutic success. RESULTS: Among the 17 included individuals, eight (47%) were treated with cefazolin and nine (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 g (range 6-12 g) and 12 g (range 10-13 g), respectively. Cefazolin and cloxacillin were mainly administered by continuous infusion. Eleven individuals (65%) were men, median (interquartile range (IQR)) age was 54 years (50; 70), 14 (82%) had postoperative meningitis and 3 (18%) had haematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 mg/L (2.1; 5.2) and 0.66 mg/L (0.5; 0.9) for cefazolin and cloxacillin groups, respectively. Cloxacillin was discontinued in two individuals for therapeutic failure. CONCLUSIONS: Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate that should be properly evaluated in this indication.

Candida endocarditis: role of new antifungal agents.

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report seven cases, which occurred during a period of 1 year in western France. Six cases were because of Candida albicans, and one pacemaker endocarditis was because of Candida parapsilosis. All patients were men and presented risk factors for candidaemia. Of the six patients with valvular involvement, five received caspofungin and two had surgical valve replacement. Three patients treated with caspofungin antifungal therapy without valve replacement were cured from endocarditis. Antifungal and surgical strategies are discussed, in particular, the possible role of new antifungal therapies and long-term suppression therapy without surgery. One patient died in the acute phase of endocarditis, three patients died of causes unrelated to infective endocarditis and three patients had a favourable outcome.

Electrochemical reduction of a bridging imide: generation of ammonia at a dimolybdenum tris(mu-thiolate) site

The electrochemical reduction of the imide complex [Mo2(cp)2(mu-SMe)3(mu-NH)]+ (1+) has been investigated in THF and MeCN electrolytes by cyclic voltammetry, controlled-potential electrolysis and coulometry. In the absence of free protons, the electrochemical reduction produces the amide derivative [Mo2(cp)2(mu-SMe)3(mu-NH2)] (2) after consumption of 1 Fmol(-1) of 1+. In THF in the presence of acid, the reduction of 1+ occurs through a two-electron process. The presence of acid also results in the shift of the equilibrium between 1+ and amide dication 2(2+) (MeCN electrolyte) or induces an isomerisation of the imide ligand (THF electrolyte). This allows the electrolysis to be conducted at a potential 600 mV less negative than the reduction potential of 1+. Controlled-potential electrolyses in the presence of acid (2 equiv HTsO) produce the ammine derivative. Ammonia is released from these compounds either by coordination of the solvent (MeCN electrolyte) or by the binding of chloride to the ammine-tosylate complex (electrolyses in THF in the presence of acid and chloride). The final products, isolated almost quantitatively (>95%), are [Mo2(cp)2(mu-SMe)3(MeCN)2]+ and [Mo2(cp)2(mu-SMe)3(mu-Cl)], respectively.

[Contribution of molecular biology and Aspergillus galactomannan antigen assay for the diagnosis of histoplasmosis]. / Contribution de la biologie moléculaire et de l'antigénémie galactomannane aspergillaire au diagnostic de l'histoplasmose.

We report a case of a pulmonary histoplasmosis in an HIV-positive patient usually living in Cambodia, with a positive Aspergillus galactomannan antigenemia resulting from a cross-reaction, that decreased after antifungal therapy. We discuss the potential interest of the detection of fungal DNA by PCR and Aspergillus galactomannan antigenemia for the diagnosis of histoplasmosis, especially in countries where Histoplasma capsulatum antigen testing is not available.