Fatal nonmeningitic Listeria rhombencephalitis. Report of two cases.

Two cases of rapidly fatal Listeria rhombencephalitis with normal cerebrospinal fluid (CSF) findings occurred in previously healthy adults. The infection presented with nausea and headache followed by fever and signs of lower cranial nerve dysfunction, without associated meningismus, and progressed to death within four and six days of hospitalization. Because of normal CSF findings (including ventricular fluid in one patient) and negative culture results of both blood and CSF, the diagnosis was not suspected. Listeriosis should be considered early in any febrile patient presenting with signs of brain-stem dysfunction, even if CSF findings are normal.

Oxacillin prophylaxis in cerebrospinal fluid shunt procedures: results of a randomized open study in 60 hydrocephalic patients.

A 27-month open randomized trial (October 1981-January 1984) was carried out to study the prophylactic efficacy of antibiotics in 60 hydrocephalic patients being shunted for the first time. The treatment group received oxacillin at a dosage of 200 mg/kg/day by six bolus intravenous injections, beginning with anesthetic induction and continuing for 24 hours after the operations. The minimum postoperative observation was 6 months. Six patients in the control group developed cerebrospinal fluid infections (20%) as compared with only a single patient in the oxacillin group (3.3%); this difference was statistically significant (p less than 0.05). Time of development of cerebrospinal fluid infection was brief (86% at 6 weeks), and as usual staphylococci were the pathogens most frequently implicated. This study would appear to confirm the choice of oxacillin for prevention of meningitis. Nevertheless, the frequency of methicillin-resistant staphylococci, which account for 20% of nosocomial staphylococcal infections, constitutes a limiting factor for such prevention.

[Epidemiology and antimicrobial resistance of Streptococcus pneumoniae strains isolated in Ile de France area during 2001]. / Epidémiologie et résistance aux antibiotiques de Streptococcus pneumoniae en Ile de France en 2001.

OBJECTIVE: The authors wanted to assess the level of Streptococcus pneumoniae antibiotic resistance in Ile de France. METHOD: In 2001, 637 clinical strains of S. pneumoniae were prospectively collected from 32 microbiology laboratories. RESULTS: Fifty one percent of strains were isolated from children under 15 years of age and 49% from adults. In children, 76% of strains came from otitis media, 20% from blood culture, in adults most strains (92%) came from blood culture. The overall prevalence of non-susceptible penicillin pneumococci was 61% higher in children (73%) than in adults (50%). Among the non-susceptible penicillin pneumococci 21.8% were resistant (CMI > 1 mg/l). Strains with decreased susceptibility to amoxicillin and cefotaxime were 38% and 17% respectively. Resistant strains to these two drugs (CMI > 2 mg/l) were rare 2.6% and 0.4% respectively. Among other antimicrobial agents, rate of resistance was 63% to erythromycin, 47% to cotrimoxazole, 40% to tetracycline, and 23% to chloramphenicol. The most frequent serogroups were serogroups 19 and 14, respectively 23% and 18%. Serotypes included in heptavalent vaccine covered 90% of children strains under 2 years of age. CONCLUSIONS: The prevalence of resistance to penicillin was high in children particularly in otitis media pus (76%).

[Prevention of bacterial grafts on revascularization of the arteries of the leg. Apropos of 18 infections in 1000 surgically treated cases]. / Prévention des greffes bactériennes sur revascularisation des artères des membres inférieurs. A propos de 18 infections chez 1000 opérés.

The incidence of vascular and prosthetic infections was compared during two successive periods, each involving approximately 500 surgical acts, a strict protocol of infection prophylaxis being applied during the second period: infection was reduced from 2.7 to 1.5 p. cent (2.3 to 0.5 p. cent after aorto-ilio-femoral grafts). Failure to respond to treatment during the second period occurred under two circumstances: when prophylaxis was insufficient to cover emergency procedures, and when antibiotic therapy was directed against staphylococci only, resulting in persistence of a high level of infections due to Gram-negative bacilli. Analysis of different epidemiological factors, including the germs, the patient, the treating team, and the prosthesis, led to the adoption of numerous specific measures. Their respect implies collective awareness, assisted by analysis of weekly complications and annual results with the involvement of the total team. Prophylactic antibiotic therapy should be of short duration, the antibiotics being selected in reference to the sensitivity of the germs included in the hospital statistics, and of the antibiotic policy which reserves recently developed molecules for curative purposes.

[Which antibiotics should one choose for prophylaxis in vascular surgery?]. / Quel antibiotique choisir pour la prophylaxie en chirurgie vasculaire?

Although the principle and duration of prophylactic antibiotic therapy in prosthetic vascular surgery are fairly widely accepted, the choice of antibiotic is still open to discussion. During two successive periods, identical groups of patients received peri-operative prophylaxis with, during period I (455 cases) oxacillin alone and during period II (537 cases) combined treatment with oxacillin and amikacin. The aim of the study was to evaluate efficacy of the association and to draw general conclusions on choice of antibiotic. The addition of amikacin reduced frequency of infection in elective operations, particularly aorto-ilio-femoral prostheses (0.5% as against 1.24%), but not in operations conducted as emergencies. In addition, frequency of infection due to BGN fell only slightly. Finally, combined therapy with oxacillin-amikacin had 2 disadvantages: impossibility of using these antibiotics for prophylaxis alone as provided for in the protocol, and its high cost. Factors of choice of antibiotic should be: efficacy against germs encountered, which can vary from year to year, rarity of toxic or side effects, good tissue diffusion, the rare need for therapeutic use and a low cost.

[Penicillin-induced encephalopathy]. / Encéphalopathies dues aux bêta-lactamines.

Five cases of encephalopathy due to intravenous penicillin treatment (penicillin G sodium in 4 cases, oxacillin in 1) are reported in 5 uraemic patients. The first abnormalities noted were decreased consciousness and myoclonic jerks (3 cases), followed by seizures and coma (2 cases). Lumbar puncture and cerebral computed tomography gave normal results. Electroencephalograms showed diffuse sharp and slow activities over the brain areas. The diagnosis was confirmed by the high blood levels of the penicillins. Three patients recovered after discontinuation of the drugs; two patients died in status epilepticus and coma resistant to all treatments.

[Multicenter study in actual situations of the activity of an antiseptic in the surgical washing of hands]. / Etude multicentrique en situation réelle de l'activité d'un antiseptique dans le lavage chirurgical des mains.

Results of a collaborative study carried out in three different hospitals by nine surgeons are reported. Activity of a new scrub applied according to a standardized protocol was compared with that of the different scrubs and/or antiseptics customarily used by participating surgeons with their habitual method. Activity of products was evaluated by bacterial counts in gloves. Statistical analysis of results demonstrates the value of this trial design which compares scrubs under real conditions of use.

[In vitro activity of a new 3d-generation cephalosporin, cefodizime, on hospital bacteria]. / Activité in vitro d'une nouvelle céphalosporine de troisième génération, le céfodizime, sur les bactéries hospitalières.

Minimal inhibitory concentrations (MICs) of cefodizime were evaluated by agar dilution for 746 bacterial strains isolated in two hospitals. For enterobacteriaceae MICs ranged from 0.008 micrograms/ml to more than 128 micrograms/ml (mode MIC: 0.25); mode MICs varied across species, ranging from 0.016 micrograms/ml for Proteus mirabilis to 1 microgram/ml for Citrobacter; MICs ranged from 0.12 to 8 for most Enterobacter and from 1 to 64 for Serratia. The rare cefotaxime-resistant strains, most of which were Citrobacter or Enterobacter, also showed resistance to cefodizime. Cefodizime was noticeably less active against Pseudomonas aeruginosa and Acinetobacter, with MICs ranging from 32 to more than 128. Haemophilus sp. and Gonococci, regardless of beta-lactamase-production status, as well as Neisseria meningitidis, were highly susceptible (MIC less than or equal to 0.008-0.016). Cefodizime was moderately active against methicillin-susceptible Staphylococci (MIC: 2 to 16 micrograms/ml) and failed to inhibit methicillin-resistant strains. Enterococci were slightly susceptible or resistant. Whereas the other Streptococci and Pneumococci had low MICs (0.03-0.12). A fairly wide range of MICs was found for anaerobes, with lower values for Clostridium (0.008 to 1) than for Bacteroids (8 to 128 mu g/ml). Our results show that cefodizime has the same properties as other third-generation cephalosporins: cefotaxime-resistant Enterobacteriaceae strains also exhibit resistance to cefodizime.

[Multicenter study of the in vitro effect of imipenem (N-formimidoyl-thienamycin) on hospital bacteria]. / Etude multicentrique de l'activité in vitro de l'imipenem (N. formimidoyl-thiénamycine) sur les bactéries hospitalières.

Minimal inhibitory concentrations (MICs) of imipenem were evaluated by agar dilution for 2 895 bacterial strains isolated in 9 hospitals. Imipenem proved highly active against Enterobacteriaceae, with an MIC less than or equal to 0.25 for 63% of the 1 556 tested strains, less than or equal to 1 for 89.6% and less than or equal to 4 for 99%. The different groups of Enterobacteriaceae exhibited similar mode MICs (0.12 to 0.25), with the exception of Serratia (0.25-0.5), P. mirabilis (0.5), indole-positive Proteus (2), and Providencia (1). MICs of most cefotaxime-resistant strains were within the susceptibility range. Imipenem also exhibited satisfactory activity against P. aeruginosa (mode MIC 1-2) and Acinetobacter sp. (mode MIC: 0.25-0.5). MICs ranged from 0.03 to 4 (mode MIC: 0.5) for Haemophilus sp. and 0.25 to 1 for Gonococci, regardless of beta-lactamase-production status. MICs for Meningococci were less than or equal to 0,06. Methicillin-susceptible Staphylococci had low MICs, ranging from 0.008 to 0.5 (mode MIC : 0.016); MICs for methicillin-resistant strains varied widely, from 0.016 to 64, and were higher after incubation at 30 degrees C. Streptococci, except for Enterococci, and Pneumococci were highly susceptible (usually 0.008-0.03); MICs for Enterococci varied from 0,12 to 32 (mode MIC: 1-2). Except for four C. difficile strains, all tested anaerobic strains were inhibited by concentrations less than or equal to 1 (mode MICs: 0.06 for C. perfringens and 0.03 for B. fragilis).