Subcutaneous teicoplanin in staphylococcal bone and joint infections.

OBJECTIVE: We aimed to describe the use of subcutaneous teicoplanin as an alternative for the treatment of staphylococcal bone and joint infections. METHODS: A retrospective multicentric cohort (2002-2015) was conducted with patients receiving subcutaneous teicoplanin for a staphylococcal bone and joint infection. RESULTS: Forty patients were assessed. A median loading dose of 9.4 mg/kg/12h (IQR, 6.1-13.1) was administered to 35 patients, subcutaneously for 18 of them. Thirteen of these patients received three injections per week. No excess risk of failure was identified. The trough level was not significantly different between the various routes (p=0.462), and was significantly higher if the loading dose was≥9 mg/kg/injection (p<10-3). CONCLUSION: The use of subcutaneous teicoplanin seems to be acceptable as an alternative to other routes of administration for antibiotics.

Disseminated Penicillium marneffei infection associated with human immunodeficiency virus: a report of two cases and a review of 35 published cases.

Penicillium marneffei, a dimorphic fungus that is endemic in southeast Asia, causes deep-seated infection in humans and rodents. About 20 cases have been reported among the local populations of China, Thailand, and Hong Kong, and 35 cases have now been described in patients infected with the human immunodeficiency virus (HIV). We present a review of the literature and report two additional cases. Both immunocompromised and apparently immunocompetent hosts tend to develop disseminated, symptomatic infection. HIV-infected patients having travelled to southeast Asia and presenting with fever, skin lesions, hepatomegaly, adenopathies, or lung disease should be investigated for Penicillium marneffei infection. The diagnosis is based on the demonstration of the organism in clinical specimens. Treatment with amphotericin B or itraconazole is generally successful, but maintenance therapy is warranted for patients with an underlying immunodeficiency.

Foscarnet induction therapy for cytomegalovirus retinitis in AIDS: comparison of twice-daily and three-times-daily regimens.

We have evaluated the effects of induction therapy with foscarnet 100 mg/kg b.i.d. via i.v. infusion in 60 AIDS patients with cytomegalovirus (CMV) retinitis and compared the findings with those in 37 such patients receiving a foscarnet induction regimen of 60 mg/kg t.i.d. via i.v. infusion. Induction therapy was given for at least 3 weeks, with the treatment period being extended in cases of slow resolution of retinitis. There was no significant difference between response rates in the two groups, with ophthalmologic response being observed in 52 (96%) of 54 evaluable b.i.d. patients and 33 (97%) of 34 evaluable t.i.d. patients over mean durations of therapy of 26 and 27 days, respectively; complete and partial responses were observed in 91 and 6%, respectively, of b.i.d. patients and 85 and 12%, respectively, of t.i.d. patients. Foscarnet was discontinued because of adverse events in 3 (3%) of 97 patients, with treatment being stopped in 2 patients because of renal insufficiency and in 1 patient because of an acute neurologic disorder. Serum creatinine concentrations increased significantly in both the b.i.d. group (from 82 to 98 mumol/L, p less than 0.01) and the t.i.d. group (from 73 to 122 mumol/L, p less than 0.001), with the difference between increases not being statistically significant. Serum creatinine concentrations greater than 200 mumol/L were observed in two b.i.d. patients and four t.i.d. patients; in four cases, concomitant medications or conditions contributed to renal impairment. Hypocalcemia of less than 1.75 mmol/L occurred in 18% of b.i.d. patients and 28% of t.i.d. patients during treatment (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of an outbreak of methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides in a French hospital.

Staphylococcus aureus isolates were screened for reduced susceptibility to glycopeptides with an initial glycopeptide agar screening test, followed by confirmation of the strains thus identified by two Etest strip techniques and population analysis. This procedure detected 48 methicillin-resistant S. aureus (MRSA) isolates with reduced susceptibility to glycopeptides from 24 patients among 883 MRSA isolates tested. The dissemination of a single clone was confirmed by pulsed-field gel electrophoresis.

Adverse cutaneous reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.

BACKGROUND AND DESIGN: Patients with the acquired immunodeficiency syndrome are predisposed to cutaneous drug reactions. The reasons are poorly understood and the circumstances in which such patients can be treated through hypersensitivity are a matter of discussion. We assessed the value of clinical and laboratory parameters for predicting trimethoprim-sulfamethoxazole-induced skin reactions and the effects of continued trimethoprim-sulfamethoxazole therapy in such patients. We retrospectively studied all episodes of nonhypoxemic Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome who were treated with trimethoprim-sulfamethoxazole. RESULTS: No clinical or laboratory parameters were found to be predictive of trimethoprim-sulfamethoxazole-induced cutaneous reactions. Of 38 patients treated with trimethoprim-sulfamethoxazole, 18 (47%) developed cutaneous reactions; these occurred within a median of 11 days (range, 7 to 20 days). Of these 18 patients, 12 (67%) continued to be treated with trimethoprim-sulfamethoxazole through hypersensitivity. Trimethoprim-sulfamethoxazole treatment was continued in 19 (95%) of the 20 patients who did not develop cutaneous reactions (P = .067). The mean duration of trimethoprim-sulfamethoxazole therapy was shorter (18 days) in patients who developed skin reactions than in those who did not (20 days) (P = .016). Noncutaneous side effects accounted for all but one interruption of therapy. CONCLUSION: No clinical or laboratory parameters were found to be predictive of cutaneous reactions. By treating through hypersensitivity, 67% of our patients, who otherwise might have had to stop taking trimethoprim-sulfamethoxazole, were able to continue this essential drug therapy.

[Cholestatic viral hepatitis A in adults. Clinical, biological and histopathological study of 9 cases]. / Hépatite virale A cholestatique de l'adulte. Etude clinique, biologique et histopathologique de 9 cas.

OBJECTIVES: We report here 9 cases of acute viral hepatitis A leading to hospitalization between June 1989 and October 1992. The main feature was a marked and protracted cholestasis. RESULTS: Jaundice lasted an average of 77 +/- 39 days (range: 30-120) and total serum bilirubin concentrations were 265 +/- 184 mumol/L (range: 51-560). IgM anti-HAV was present in the serum for 6.3 +/- 5.5 months (median: 4, range: 2-19). Histopathological examination of the liver was performed in 6 patients and most showed intralobular cholestasis and portal tract inflammation associated with dystrophy and paucity of bile ducts. Acute renal failure was noted in one patient. In three patients, whose pruritus was not relieved by cholestyramine, plasma exchange was an effective therapy. CONCLUSION: These case reports confirm the severity of viral hepatitis A in adults and emphasize the importance of vaccination.

[Tuberculosis and HIV]. / Tuberculose et infection par le virus de l'immunodéficience humaine (VIH).

With the increased number of HIV infected patients, tuberculosis has become more frequent in Europe, USA and particularly in Africa. Impaired immunity, poor life conditions and high prevalence of tuberculosis in the general population facilitate the transmission of the disease. Tuberculosis is often seen early in the course of HIV infection and sometimes reveals the underlying immunodeficiency. Most of these cases are due to reactivation of earlier primo-infection when tuberculosis occurs later in the HIV disease, it may be secondary to a recent contagion. The infection may be localized in the lungs or in extrathoracic sites such as lymph nodes, liver, spleen, blood or meninges. The diagnosis is based on direct visualization of acid fast bacilli in gastric aspirate or BAL, on positive blood cultures or in histological findings which often show atypical granulomatous reaction without marked caseation. The role of the intracutaneous tuberculin test remain questionable as it often proves negative. A positive skin reaction can be useful for the diagnosis of tuberculosis, however, this is rarely observed. An early diagnosis is important in order to improve the prognosis and this justifies the frequent instauration of empiric treatment. The usual quadritherapy is efficacious and when started early permits in most cases a favorable outcome. The duration of treatment is poorly standardized but approaches 9-12 months in most instances. The drugs are not always well tolerated. A life-long maintenance therapy seems to have become necessary and primary prophylaxis might be of interest. The increased occurrence of drug resistant stains adds to the interest of preventing transmission, particularly in the hospital.

[Intracerebral tuberculoma in HIV infection. Epidemiology and contribution of magnetic resonance imaging]. / Tuberculomes intracérébraux au cours de l'infection par le VIH. Epidémiologie et apport de l'imagerie par résonance magnétique.

Intracerebral tuberculomas, observed in two HIV-infected patients, illustrated the diagnostic and therapeutic problems involved when an intracranial formation is discovered in this clinical situation. Both patients had a history of pulmonary tuberculosis. No preventive treatment had been given and disseminated tuberculosis occurred within a short delay (less than 2 years). A neurological deficiency led to the discovery of intracranial formations. The lack of effect of anti-toxoplasmosis therapy and the simultaneous discovery of tuberculous lesions strongly suggested intracerebral tuberculoma. With antituberculosis treatment, the general signs disappeared rapidly. Magnetic resonance imaging was particularly useful for following the course of the intracerebral lesions with a stereotype structure (confluent polylobular abscesses), for eliminating rapid evolution which would suggest lymphoma, the main differential diagnosis and to indicate corticosteroid treatment due to persistent oedema. Outcome was favourable with anti-tuberculosis therapy and corticosteroids. Intracerebral tuberculomas are rare and should be entertained in patients with tuberculosis when intracerebral abscesses do not respond to antitoxoplasmosis therapy. Magnetic resonance imaging is the most adapted imaging technique for diagnosis and follow-up.

Early antiviral treatment fails to completely prevent herpes-related pain.

OBJECTIVES: Antiviral therapy does not completely relieve herpes zoster (HZ)-related pain, including post-herpetic neuralgia (PHN). The 12-month longitudinal prospective observational ARIZONA study was conducted in primary care in France between November 20, 2006 and September 12, 2008. The ARIZONA study included data from 1358 patients 50 years of age or more, presenting with acute eruptive HZ. This article focuses on the relationship between antiviral therapy and HZ-related pain in this large population. PATIENTS AND METHODS: Six hundred and forty-four family physicians (FPs) consecutively included all patients 50years of age or more presenting with acute HZ in the eruptive phase. The FP documented every patient's demographic and medical characteristics, HZ characteristics, and prescribed drugs at inclusion, and the presence of HZ-related pain on day 15 and at months 1, 3, 6, 9, and 12. RESULTS: One thousand two hundred and fifty-eight (92.6%) of the 1358 included patients (mean 67.7years [SD 10.7]; 62.2% female patients) were given antiviral drugs. The prevalence of HZ-related pain was 43.6%, 27.0%, 11.7%, 8.7%, 7.4%, and 6.0%, on day 15 and at months 1, 3, 6, 9, and 12, respectively. HZ-related pain was at least as frequent in patients treated by antiviral therapy within 72hours following HZ-rash onset as in patients treated later or who did not receive antiviral treatment, and more frequent in patients whose diagnosis was made within 24hours following HZ-rash onset. CONCLUSIONS: Antiviral therapy, even early, does not prevent HZ-related pain and PHN, probably because patients quickly identified and treated were those with severe forms and potentially at high risk of pain. Preventive strategies are thus needed.

[Update on vaccine research. Proceedings of the 15th annual conference on vaccine research organized by the National Foundation for Infectious Diseases]. / Actualités en matière de recherche vaccinale. Compte-rendu de la 15(e) conférence annuelle sur la recherche vaccinale organisée par la National Foundation for Infectious Diseases.

Every year, the National Foundation for Infectious Diseases brings together more than 300 participants to review progress in vaccine research and development and identify the most promising avenues of research. These conferences are among the most important scientific meetings entirely dedicated to vaccine research for both humans and animals, and provide a mix of plenary sessions with invited presentations by acknowledged international experts, parallel sessions, poster sessions, and informal exchanges between experts and young researchers. During the Fifteenth Conference that took place in Baltimore in May 2012, various topics were addressed, including the scientific basis for vaccinology; exploration of the immune response; novel vaccine design; new adjuvants; evaluation of the impact of newly introduced vaccines (such as rotavirus, HPV vaccines); vaccine safety; and immunization strategies. The new techniques of systems biology allow for a more comprehensive approach to the study of immune responses in order to identify correlates of protection and to design novel vaccines against chronic diseases such as AIDS or malaria, against which natural immunity is incomplete.

[Ertapenem administered intravenously or subcutaneously for urinary tract infections caused by ESBL producing enterobacteriacea]. / Ertapénem intraveineux ou sous-cutané pour le traitement des infections urinaires à entérobactérie sécrétrice de BLSE.

INTRODUCTION: Ertapenem could be used to treat urinary tract infections (UTI) caused by ESBL producing enterobacteriacae (ESBL-E) and administered subcutaneously. METHOD: The authors made a retrospective study on adult patients treated with ertapenem administered intravenously or subcutaneously for UTI caused by ESBL-E, between May 2009 and August 2011 at the Chambery hospital, France. RESULTS: Twenty-five patients were treated (13 cases of prostatitis, ten of pyelonephritis, two of cystitis) mostly caused by Escherichia coli (24 cases). Subcutaneous injections were administered to 20 patients and 23 were treated through outpatient parenteral antibiotic therapy (OPAT). All patients were cured at the end of the ertapenem therapy. Urine samples collected during treatment for 12 patients were sterile. Three months after the end of the treatment, five patients had relapsed, and six had developed a UTI caused by another bacteria. CONCLUSION: Ertapenem administered intravenously or subcutaneously could be an effective treatment for UTI caused by ESBL-E, especially using OPAT.

Survey of vaccination policies in French healthcare institutions.

OBJECTIVE: The survey was implemented to describe vaccination policies for healthcare professionals in French healthcare institutions. METHODS: A cross-sectional survey based on questionnaires was sent to occupational physicians and chairpersons of hospital infection prevention and control committees (HIPC) of 38 institutions between November 2010 and January 2011. RESULTS: Twenty-nine occupational physicians and 26 hospital infection prevention and control committees chairpersons (HIPC), from 30 institutions answered (response rate: 79%), 70% of the institutions were university hospitals. Overall, 76% of occupational physicians and 85% of HIPC chairpersons reported that information and awareness campaigns about vaccination recommendations for healthcare professionals were usually conducted in their establishment. Fifty-nine percent of occupational physicians and 31% of HIPC chairpersons reported that they were aware of the vaccine coverage rates of professionals in their institution. The occupational physicians reported that they suggested diphtheria, tetanus, polio, influenza, and acellular pertussis vaccination to all staff at their annual visit in 100%, 97%, and 62% of cases, respectively. Varicella and measles vaccinations were never suggested in 31% and 17% of cases, respectively. Among respondents, 55% of physicians reported that they had already managed a pertussis epidemic, and 42% a measles epidemic, and in both of these cases an awareness campaigns were usually conducted (93% and 96%). CONCLUSIONS: The vaccine coverage rates of healthcare professionals in French healthcare institutions remain insufficiently documented and could be improved.

Quantitative real-time PCR tests for diagnostic and prognostic purposes in cases of legionellosis.

The usefulness of two quantitative real-time PCR assays (qrt-PCRmip targeting Legionella pneumophila, and qrt-PCR16S targeting all Legionella species) performed on lower respiratory tract (LRT) samples for diagnostic and prognostic purposes in 311 patients hospitalized for community-acquired pneumonia (CAP) in Rhône-Alpes (France) was evaluated. The Now Legionella urinary antigen test (UAT) from Binax (Portland, ME, USA) was used as a reference test. Samples were divided into two groups. Group A included 255 CAP patients admitted to Chambery hospital in 2005 and 2006. The Now Legionella UAT was positive in 14 patients. Sensitivities, specificities, positive predictive and negative predictive values for both qrt-PCR tests were 63.6, 98.7, 77.7 and 97.4%, respectively. Group B included 56 consecutive legionellosis patients diagnosed during a 4-year period (2003-2006) at the Grenoble University Hospital. The qrt-PCR16S and qrt-PCRmip displayed a sensitivity of 82.14 and 80.4%, respectively. Among the 70 legionellosis cases, L. pneumophila serogroup 1 was isolated in 15; qrt-PCRmip was positive in another 36, suggesting L. pneumophila infection, whereas the Legionella species involved could not be determined in the remaining 19 cases. The Legionella burden in LRT samples at the time of admission was determined in 46 patients using qrt-PCR16S tests, 44 for qrt-PCR mip groups A and B patients. It varied from 1.9 to 8.35 log(10) DNA copies/mL of LRT sample for qrt-PCR16S and from 1.9 to 8.11 log(10) DNA copies/mL of sample for qrt-PCRmip. High bacterial loads in LRT samples at hospital admission were significantly associated with higher Fine classes, the need for hospitalization in an intensive care unit and for prolonged hospitalization.