Be careful about MICs to amoxicillin for patients with Streptococci-related infective endocarditis.

BACKGROUND: A variety of microorganisms can cause infective endocarditis (IE), with Staphylococci and Streptococci accounting for the majority of cases. Streptococci are a common cause of community-acquired IE but few studies have focused on this subgroup of endocarditis. METHODS: A retrospective multicentre study was conducted between 2012 and 2017 in 12 hospital centres in France. Data were extracted from the local diagnosis-related group database and matched with microbiological results. After identification, the records were retrospectively analysed. RESULTS: A total of 414 patients with streptococcal endocarditis were included. The patients were predominantly male (72.8%) and the median age was 73.2 years (interquartile range [IQR] 61.3-80.9). The majority of patients (70.6%) had native valve endocarditis. Embolic complications were seen in 38.8% of patients. Viridans group Streptococci (VGS) and bovis-equinus group Streptococci (BGS) accounted for 52.4% and 34.5% of isolated strains, respectively. Minimum inhibitory concentrations (MICs) of amoxicillin were <0.125, 0.125-2 and >2 mg/L for 59.6%, 27% and 1% of isolates, respectively. In-hospital mortality for patients with Streptococci-related IE was 17.8%. In multivariate analysis, the only factor associated with in-hospital mortality was MIC for amoxicillin between 0.25 and 2 mg/L (P = 0.04; OR = 2.23 [95% confidence interval (CI) 1.03-4.88]) whereas performance of cardiac surgery for IE was a protective factor (P = 0.001, OR = 0.23 [95% CI 0.1-0.56]). CONCLUSIONS: IE remains a serious and deadly disease despite recent advances in diagnosis and treatment. Adaptation of antibiotic doses to MICs for amoxicillin and surgery may improve patient outcome.

Fusobacterium nucleatum infections: clinical spectrum and bacteriological features of 78 cases.

PURPOSE: Few series describe the clinical spectrum of Fusobacterium spp. infections. Among them, fewer discuss F. nucleatum, even though there are many clinical cases. METHODS: We performed a retrospective study over 8 years (from 2007 to 2014) in Limoges University Hospital, France, to assess clinical and bacteriological aspects of infections due to F. nucleatum. RESULTS: Eighty-one patients with F. nucleatum positive cultures were included in this study, irrespective of sample origin. Abscesses (n = 43), bacteraemia (n = 18) and bone infections (n = 8) were the most common types of infections, Abscesses were found in various organs (mostly skin, brain, pleura, liver). Co-morbidities were found in 38 patients (47 %) with neoplasia, diabetes, and alcoholism and history of smoking. There were more neoplasms in patients with bacteraemia than in patients with abscesses (p = 0.007). In 51 cases (65.4 %), infection was polymicrobial, either during bacteraemia or abscesses. Main associations were with Streptococcus spp., Peptostreptococcus spp. and/or Prevotella spp. The sources of infection, when found, were either dental or gastrointestinal. All isolates were susceptible to penicillin, clindamycin and metronidazole. CONCLUSIONS: Infections involving F. nucleatum are uncommon and potentially severe, with many abscesses requiring surgery. Bacteraemia was mainly associated with co-morbidities such as cancer. Polymicrobial infections were very common and there is probably interaction and/or synergy between F. nucleatum and some other commensal bacteria to cause infections and abscesses.

Campylobacter fetus infections.

BACKGROUND: Campylobacter fetus infections usually occur in immunodepressed patients or patients presenting with diabetes mellitus or cancer. They rarely cause diarrhea but frequently cause bacteremia or vascular diseases. The therapeutic management is not well codified and fluoroquinolone resistance is continuously increasing. METHODS: We conducted a retrospective study of C. fetus infections from January 2007 to August 2013 at the Limoges teaching hospital. The infections were defined by at least 1 bacteriological sample positive for C. fetus. RESULTS: Twenty patients were included (15 men), with an average age of 73 years (43-91). Sixteen presented with cancer, 12 with solid cancer including 9 of the urinary tract, and 9 patients with hematologic diseases. Five patients presented with diabetes mellitus, 9 with isolated bacteremia, 3 with cellulitis, and 3 with septic arthritis. The diagnosis was made by blood cultures for 17 patients. Twenty percent of the isolates were resistant to amoxicillin and 30% to fluoroquinolones. The therapeutic regimens and the treatment duration were quite different. The outcome was unfavorable for 3 patients whose implanted port had not been removed and 1 with subdural hematoma infection. 1 patient died. CONCLUSIONS: C. fetus infection occurs in case of underlying diseases, most frequently promoting urinary tract cancer. Fluoroquinolones must not be used without susceptibility testing and catheters should be removed.

[Perilunar dislocations of the carpus. Value of surgical treatment]. / Luxations périlunaires du carpe. Intérêt du traitement chirurgical.

Between 1980 and 1990, 60 patients presenting with 62 peri-lunar dislocations of the carpus have been surgically treated. One case was a subluxation of the scaphoid and 61 were posterior perilunar dislocations, among them were 32 grade I, 23 grade II, 4 grade III, 2 unknown grade according to the Witvoët and Allieu scale. In 36 cases the scaphoid was fractured in 5 were associated a fracture of the scaphoid and a scapho-lunar dislocation. 48 cases have been reviewed after a 31 month follow-up average. The result was satisfactory in 83 per cent of these cases, unsatisfactory results being observed in cases of delayed surgery or incomplete reduction. In 36 cases a dynamic radiological examination was available after a 36 month follow-up average. 27 wrists were stable, 9 were not (7 D.I.S.I., 2 V.I.S.I.) 8 of these were related to unsatisfactory reductions. Diagnosis was delayed in 10 cases which ended with less satisfactory results. The authors think that conservative treatment is not adequate, they propose different surgical procedures according to the possible association of a fracture of the scaphoid.

[Cross-forearm replantation in bilateral amputation]. / Replantation croisée d'avant-bras dans une amputation bilatérale.

We report the case of a 27-year-old patient who sustained a traumatic amputation of his 4 limbs. For the right upper limb, the site of amputation was at the level of the upper third of the forearm. For the left upper limb, the site of amputation was at the level of the Cower third of the forearm. In both cases, the loss of soft tissue was so extensive that hand replantation was impossible in the initial position. In such an unusual case, replantation of the right hand to the left side was attempted in this young patient. Osteosynthesis of the radius to the ulna in supination was performed, and arteries, veins, nerves and tendons were repaired. The other segments of amputated limbs were debrided and cleaned. Within a year, protective sensibility was restored in the replanted hand, but intrinsic muscles were paralysed. Secondarily, transfer of thumb opposition and capsulorrhaphy at the level of the metacarpophalangeal joints of long fingers were performed in order to provide a useful key-grip between the three first fingers.