Reliability of Pseudomonas aeruginosa semi-automated rep-PCR genotyping in various epidemiological situations.

The purpose of this study was to evaluate the possibility of using a semi-automated repetitive DNA sequences-based polymerase chain reaction (rep-PCR) for typing Pseudomonas aeruginosa isolates. rep-PCR profiles obtained by the DiversiLab system of 84 P. aeruginosa isolates from distinct epidemiological situations were obtained. rep-PCR groupings were in good agreement with the origin of these isolates. Linked rep-PCR profiles were observed for isolates recovered from a same family of cystic fibrosis (CF) patients, for the etiological agents of clustered cases of nosocomial infections, and for some isolates recovered from a same hospital room. rep-PCR and pulsed-field gel electrophoresis SpeI restricted genomic DNA (PFGE-SpeI) profiles were compared. In a few instances, rep-PCR revealed genetic divergences among isolates of a same group of PFGE-SpeI profiles. These divergences could reflect genetic drifts among closely related isolates, as illustrated by those observed between clinical and environmental isolates of a same group of PFGE-SpeI profiles. The interpretation of such differences will require further studies, but the rep-PCR analysis of P. aeruginosa diversity appeared to be an appropriate method to investigate infra-specific genetic relatedness.

[Results of 4 years of microbiological testing of bronchoscopes]. / Endoscopes bronchiques: bilan de quatre années de contrôles microbiologiques.

INTRODUCTION: In the context of reducing endoscopy-related infectious risk and new national guidelines on microbiological samples from bronchoscopy, the results of a surveillance program set up in a hospital center were analyzed. METHODS: Over 4 years, scheduled samples were taken from disinfected bronchoscopes. Bacteriology and mycology tests were used to search for microorganisms. The results were interpreted as falling within three levels: target, alert, and action. Factors that could explain the contamination were studied: age of the bronchoscope, number of uses per year, brand, and model. RESULTS: Out of 96 scheduled samples taken, the compliance rate for the period was 83% and increased (p=0.06) over the 4 years. We identified 15 Pseudomonas (six aeruginosa and nine other species), one Stenotrophomonas, one enterobacterium, and two filamentous fungi. None of the factors studied had a significant effect on sample contamination. CONCLUSION: The microbiological surveillance of bronchoscopes is an indispensable part of the quality assurance of bronchoscope maintenance. It can lead to maintenance of the bronchoscope when a noncompliant result is found.

A neonatal specialist with recurrent methicillin-resistant Staphylococcus aureus (MRSA) carriage implicated in the transmission of MRSA to newborns.

This study reports an investigation of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization involving 17 newborns in the neonatal unit of a teaching hospital. A neonatal specialist colonized with MRSA that eventually became mupirocin-resistant was implicated as a recurrent source of transmission of MRSA to newborns.

[Epidemiology and clinical characteristics of childhood parapneumonic empyemas]. / Epidémiologie et caractéristiques cliniques des complications suppuratives des pneumonies de l'enfant.

UNLABELLED: Several studies have reported an increasing incidence of childhood parapneumonic empyemas in various countries. AIM OF THE STUDY: The aim of our study was to estimate the annual incidence of complicated community-acquired pneumonias in children during a 9-year period in a French area and to describe the epidemiological and clinical characteristics of these complications. POPULATION AND METHODS: We have listed the children from 28 days to 15 years old, hospitalized in the 2 children hospitals of the Isere district for a community-acquired pneumonia complicated with a pleural empyema or a pulmonary abscess from 1995 to 2003. RESULTS: During the study period, 90 children were hospitalized for a complicated pneumonia including 83 pleural empyemas and 7 isolated lung abscess. The average number of cases was 4 per year from 1995 to 1998 then increased since 1999 to reach 34 cases in 2003, according to a linear model (P<0,001). The incidence of the complicated pneumonia, plotted to the paediatric population of the area has gone up from 0.5 per 100000 to 13 per 100000 children between 1995 and 2003. CONCLUSION: The incidence of the complicated pneumonias in children increased since 1999 in a French area. Additional investigations are necessary to identify the causes of this increase.

[Streptococcus pneumoniae cellulitis in a diabetic patient]. / Dermohypodermite cervicale à Streptococcus pneumoniae chez un patient diabétique.

Pneumococcal cellulitis is an uncommon infection. Head, neck, and trunk are usually affected in patients with hematological malignancies and lupus erythematosus. Limb cellulitis is frequently observed in patients with diabetes mellitus, drug abusers, or alcoholics. Patients present with septic shock most of the time. Surgical treatment is necessary in 50% of the cases. The outcome is usually favorable. We describe the case of a 72-year-old alcoholic patient with diabetes mellitus presenting with cellulitis and septic shock. Serotype 19 Streptococcus pneumoniae with abnormal susceptibility to penicillin (MIC: 0.75 mg/l) was isolated from cellulitis and in blood culture. The evolution was favorable after itavenous antibiotherapy combining ceftriaxone(DCI) (2 g/j), metronidazole(DCI) (1 g/j), and ciprofloxacin(DCI).

[A severe form of Chryseobacterium indologenes pneumonia in an immunocompetent patient]. / Une forme sévère de pneumopathie à Chryseobacterium indologenes chez l'immunocompétent.

We report a case of severe pneumonia due to Chryseobacterium indologenes in an immunocompetent patient. Chryseobacterium indologenes (formerly Flavobacterium indologenes) are saprophytic Gram-negative rods widely distributed in damp environment. Many sites of infection were described in the literature. These infections are always severe sometimes associated to multiple organ failure. The evolution is usually favorable with antibiotic treatment. Bacteria characteristically grow as yellow-pigmented colonies. They are naturally resistant to many antimicrobial agents. They are usually susceptible to piperacillin(DCI) alone or combined with tazobactam(DCI), ceftazidime(DCI), cefepime(DCI), fluoroquinolones(DCI), rifampin(DCI) and cotrimoxazole(DCI), but the in vitro susceptibility to these antibiotics should be systematically tested. Nevertheless, the optimum antibiotic treatment for Chryseobacterium-related infections remains to be established. In the case we report, the diagnosis was made according to the results of bronchial sample bacterial culture. This case report underlines the need for specific management of patients infected with this species.

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.

Improved identification of Staphylococcus aureus using a new agglutination test. Results of an international study.

A new reagent for the identification of Staphylococcus aureus, SLIDEX STAPH-KIT, operates on the principle of a latex and red blood cell combination agglutination: red blood cells are coated with fibrinogen for the detection of clumping factor, and latex particles are sensitized with anti-S. aureus serotype 18 monoclonal antibody for the detection of protein A and antigen 18. French strains belonging to serotype 18 are methicillin-resistant. The performance of this reagent was compared with STAPHYSLIDE and STAPHAUREX in Europe (France, Germany, Italy), in the United States and in Japan using 548 methicillin-resistant S. aureus strains, 392 methicillin-sensitive S. aureus strains, and 441 non-aureus staphylococci. The specificity of the three reagents was equivalent (98.8% for SLIDEX STAPH-KIT, 99.1% for STAPHYSLIDE, 98.1% for STAPHAUREX). SLIDEX STAPH-KIT (97.3%) was more sensitive than STAPHYSLIDE (93.5%) and STAPHAUREX (89.7%) for all S. aureus strains due to a higher rate of identified methicillin-resistant S. aureus strains.

Comparative in vitro activity of penicillin G, levofloxacin, moxifloxacin, telithromycin, pristinamycin, quinupristin-dalfopristin and linezolid against ofloxacin-intermediate and -resistant Streptococcus pneumoniae.

Screening by ofloxacin disk was carried out on 1158 strains of Streptococcus pneumoniae in order to investigate the in vitro bacteriostatic activity of penicillin G, levofloxacin, moxifloxacin, telithromycin, linezolid, pristinamycin and quinupristin-dalfopristin against ofloxacin-intermediate and -resistant S. pneumoniae strains. It was concluded that these new antimicrobial agents could be useful for the treatment of pneumococcal infections caused by penicillin-sensitive and -resistant S. pneumoniae, and would represent a valid therapeutic option for patients allergic to beta-lactams, should they prove to be potent in vivo.

[Measurement of the right ventricular ejection fraction during the acute phase of myocardial infarction using 81m krypton infusion. Comparison with the left ejection fraction]. / Mesure de la fraction d'éjection ventriculaire droite à la phase aiguë de l'infarctus du myocarde avec une perfusion de 81m krypton. Comparaison avec la fraction d'éjection gauche.

The right ventricular ejection fraction is rarely measured, as conventional diagnostic methods (radiology, echocardiography) are confronted with the problem of representing the right ventricle as a simple tridimensional geometrical model. This is not necessary with the radio-isotopic techniques. However, all those used for the measurement of right ventricular ejection fraction lead to important methodological problems. We have therefore developed a technique of measuring this parameter with an infusion of 81 m Kr. This radioactive gas is pure gamma-ray emitter with a 13 second period. Dissolved and infused intravenously, it is eliminated during the first passage through the lung. The continuous separation of the generator of 81 m Kr is performed with isotonic dextrose solution which is then infused for a period of 7 minutes. During this time, the activity detected by the scintillation camera inclined in the 30 degrees RAO projection is stored, together with the electrocardiogram in a computer. The precordial radioactivity of the retrocardiac lung tissue is subtracted after injection of 74 MBq of 99 mTc microspheres. A graph of right ventricular activity can then be reconstructed and the right ventricular ejection fraction calculated. The left ventricular ejection fraction is then measured with 99 mTc--labelled RBCs. This method allows the right ventricular ejection fraction to be measured in the RAO projection, the best incidence for the separation of the right atrial from the right ventricular activity without interference from left ventricular activity because of the pulmonary elimination of the Krypton radioactivity. The measurement performed on a large number of cardiac cycles allows a continuous study of the right ventricular ejection fraction. At the end of the infusion there is no circulating radioactivity so that the measurement can be repeated. This technique was used in 17 patients with acute myocardial infarction. In the 7 patients with anterior infarcts reduction of the left ventricular ejection fraction was the predominant finding (21,6 +/- 6,8%). The right ventricular ejection fraction was 34,2 +/- 6,4%. On the other hand, patients with a postero-inferior infarction had little change in left ventricular ejection fraction (59,2 +/- 12%) but those with right ventricular extension of their infarcts had very reduced right ventricular ejection fractions (less than 23%). The measurement of right ventricular ejection fraction with 81 m Kr is a reliable atraumatic method for diagnosing right ventricular infarction by the quantification of its functional impairment.

[Campylobacter pylori: diagnostic value of the urease test during endoscopy]. / Le Campylobacter pylori: valeur diagnostique de l'uréase test pratiqué en salle d'endoscopie.

The aims of this prospective study were a) to evaluate the diagnostic value of the urease test for the detection of C. pylori in gastric biopsy specimens, b) to specify the prevalence of C. pylori in a sample of 74 patients from the Grenoble area undergoing upper gastrointestinal endoscopy, c) to analyze the density of bacteria according to the biopsy site (antrum, body, edges of ulcer), d) to demonstrate any possible correlation between the histologic state of the antral and body mucosa and the presence of C. pylori. An antral biopsy was taken for the urease test during endoscopy. Biopsies were also taken from the body, the antrum and the edges of gastric or duodenal ulcers for bacterial and histologic studies, and urease test in the bacterial laboratory. The sensitivity and the specificity of the urease test during endoscopy varied according to the delay in observation of the color change. They were 0.81 and 0.84, respectively, at 2 h 30. The sensitivity and specificity of the urease test in the bacterial laboratory were 0.67 and 0.95, respectively, for the same delay. The global prevalence of C. pylori was 51 p. 100: it was 42 p. 100 in the absence of ulcer, 67 p. 100 in the presence of gastric ulcer, and 71 p. 100 in the presence of duodenal ulcer (p less than 0.05 compared to the group without ulcer).(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the quality of management of urinary infections in children in ambulatory care]. / Evaluation de la qualité de la prise en charge de l'infection urinaire de l'enfant en médecine ambulatoire.

The objective of this study was to describe the conditions in which urinary tract infections in children are managed by ambulatory medical services and compare the results with recommendations of experts in the field. For a period of one month, we focused on the methods of urine sample collection by observing 149 urinalyses for children under 15 in 13 private medical laboratories. Secondly, we investigated cases involving 26 prescribing physicians in order to assess treatment and additional testing on 28 children whose urine cultures showed significant bacterial growth. Urine samples were collected at home by parents in 72% of the cases, often with defective procedures: improper antisepsis for pre-collection cleansing in 65% of the cases, in 51% of the cases the maximum time lapse between the moment a collection-bag was applied and the moment the filled bag was removed was overrun. Compared with standard techniques, the quality of the samples was deemed questionable in 33% of cases and unacceptable in 41%. Attending physicians diagnosed urinary infections in 22 children. The antibiotic treatment prescribed to these children was apparently insufficient in 40% of the cases. Less than a third of the infected children benefited from a radiologic examination of the urinary tract. This study demonstrates that adherence to rules inherent in managing pediatric urinary infections is less than satisfactory in ambulatory medicine. It appears necessary to improve the quality of urinalysis by inciting laboratories to collect urine samples in laboratory. Physicians should also be better informed of the results of consensus conferences.

[Human salmonellosis and turtles in France]. / Salmonelloses humaines en rapport avec les tortues aquatiques dans le déparement de l'Isère.

Two immunosuppressed children were infected with Salmonella, due to turtles living in water. So we investigated the carriage of Salmonella among those animals. Among the 95 investigated animals, 10 were carrying Salmonella (Arizonae, Rissen, Pomona and Blockley). The water of 6 containers out of 20 contained Salmonella. Comparing our data to others in the litterature, we conclude that human salmonellosis, acquired from turtles are not, by now, a major problem in France. Nevertheless, a number of those animals are carrying Salmonella. So an epidemiological survey is necessary, and immunosuppressed patients should avoid contact with those animals.

[Utilization of a micromethod for the differentiation of Haemophilus biotypes. Relations with serotypes and antibiotypes (author's transl)]. / Utilisation d'une microméthode pour la détermination des biotypes d'Haemophilus. Relations avec les sérotypes et les antibiotypes.

A micromethod utilizing paper discs impregnated with different substrates (Minitek-system) permits differentiation of Haemophilus and their biotypes. Differentiation of biotypes presents an assured advantage: it is the only technic for an exact study of non typable H. influenzae strains and NAD-dependent Haemophilus strains. It is also a complement for study of capsulated H. influenzae. In an epidemiological aspect, this differentiation shows a evident predominance of biotypes I and II for H. influenzae and H. para-influenzae. Except that biotype I includes the larger number of serotypable strains, different serotypes are distributed in the five biotypes of H. influenzae. Likewise none relation has been found between biotypes and antibiotypes.

[Identification of gram-negative aerobic and non-fastidious aero-anaerobic bacilli using the ATB 32 GN system]. / Identification des bacilles à gram négatif aérobies et aéro-anaérobies non exigeants par le système ATB 32 GN.

ATB 32 GN was tested with 279 gram negative non fastidious rods = 188 Enterobacteriaceae and 91 non-enterobacteriaceae. This micro-method included 32 carbon substrate's assimilation tests, read and interpreted automatically after incubation for one or two days at 30 degrees C. 93.5 p. cent of all bacteria are correctly identified (92.5 p. cent of Enterobacteriaceae and 95.6 p. cent of non enteric rods). 2.6 p. cent are misidentified and 3.9 p. cent are unidentified. The results these strains are analysed. This novel system of identification was possible utilised in a medical analysis laboratory.

[Comparison of 2 systems of blood culture: Signal and Bactec]. / Comparaison de deux systèmes d'hémoculture: Signal et Bactec.

Two Bactec bottles (aerobic and anaerobic) and one single bottle Signal were used for detecting bacteremia in 405 patients (47 children and 358 adults). The two blood culture Signal and Bactec aerobic were continuous shaking for up to 24 hours. 10.3 p. cent of patients had positive cultures (62.3 p. cent Gram +, aero-anaerobic bacteria). Nine bacteremia were detected by only one system (4 for signal, 4 for Bactec) 77.1 p. cent of 83 strains were positive on the two systems together, but 7.2 p. cent only in the Bactec and 15.6 p. cent only in the Signal. The delay of growth give an advantage to the Bactec (67 p. cent in 24 hours). The advantages and the disadvantages of the two systems were analysed.

[Treatment of Listeria monocytogenes meningoencephalitis with cotrimoxazole in monotherapy]. / Traitement des méningo-encéphalites à Listeria monocytogenes de l'adulte par le cotrimoxazole en monothérapie.

L. monocytogenes meningo-encephalitis are still a therapeutic problem, with most of the time a poor prognosis. In vitro, cotrimoxazole has about the same bactericidal activity as the ampicillin-aminoglycoside combination. So we treated 8 patients with L. M. meningoencephalitis with cotrimoxazole alone, with a mean duration of treatment of 13 days. All patients recovered without sequellae from their infectious episode.

[Comparative study of cefixime versus amoxicillin-clavulanic acid combination in the oral treatment of urinary tract infections in children]. / Etude comparant le céfixime à l'association amoxicilline-acide clavulanique dans le traitement par voie orale des infections urinaires de l'enfant.

BACKGROUND: Acute febrile infections suggestive of pyelonephritis require treatment by broad-spectrum antibiotics capable of reaching significant tissue levels. This study compares efficacy and safety of cefixime with amoxycillin + clavulanic acid in urinary tract infections. POPULATION AND METHODS: Fifty seven children aged 5 months to 14 years treated for urinary tract infection in ten pediatric centres for a period of 10 months had been randomly included in the study. Thirty (22 girls and eight boys) were given cefixime and 27 (24 girls and three boys) amoxycillin-clavulanate. Efficacy was evaluated in only 36 patients whose bacteria were susceptible to both antibiotics (26 pyelonephritis and ten cystitis). RESULTS: Sixteen patients out of the 19 given cefixime recovered vs. 14 out of the 17 given amoxycillin-clavulanate with no significant difference between both groups. Bacteria were more often susceptible to cefixime (100% of cases) than to amoxycillin-clavulanate (69%) (p < or = 0.0001). Safety was good and comparable in both groups. CONCLUSION: Cefixime given per os seems effective and safe in treating urinary tract infections. These results have to be confirmed by further studies.

[Acute Salmonella typhi meningitis in a 25-day-old newborn infant complicated by obstruction of the sylvian artery]. / Méningite aiguë à Salmonella typhi chez un nouveau-né de 25 jours compliquée de l'obstruction de l'artère sylvienne.

UNLABELLED: Acute Salmonella typhi meningitis is rare in neonates, mostly reported from developing countries with poor socioeconomic conditions. CASE REPORT: A male Caucasian newborn presented with acute Salmonella typhi meningitis at the age of 25 days. His parents had traveled across several African countries under rudimentary hygienic conditions a few months before his birth. Despite early and adapted antibiotic therapy (cefotaxime plus netilmycine), the child developed ischemia in the region of the left sylvian artery. CONCLUSION: Salmonella meningitis must be considered while dealing with a sick newborn whose mother has traveled across countries with endemic typhoid.

[Mechanism of antibiotic resistance in bacteria responsible for respiratory infections]. / Mécanismes de résistance aux antibiotiques des bactéries responsables d'infections respiratoires.

Bacterial resistance is both a frequent phenomena and in perpetual evolution; currently it effects all antibiotics. The acquisition of resistance is a result of chromosomal mutations or is a contribution of genetic material either as plasmids or transposons. The principle mechanisms which can be isolated or associated can be grouped together under changes of bacterial permeability which alters the target of the anti-infectious agents; or the synthesis of enzymes which inhibit the activity of the antibiotic. Some micro-organisms such as Staphylococcal aureus, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and certain enterobacteria have developed resistance to varying degrees against the antibiotics initially or more recently introduced which pose, in some cases, very real therapeutic problems. The prescribing doctor should recognise the principle bacterial phenotypes which are resistant, as well as the rules of association of the different antibiotics in order to institute an effective anti-infectious regime, which allows the cure of the patient and limits any introduction of resistance or the selection of resistant mutants.