Antifungal susceptibility testing practices in mycology laboratories in France, 2018.

A survey of mycology laboratories for antifungal susceptibility testing (AFST) was undertaken in France in 2018, to better understand the difference in practices between the participating centers and to identify the difficulties they may encounter as well as eventual gaps with published standards and guidelines. The survey captured information from 45 mycology laboratories in France on how they perform AFST (number of strains tested, preferred method, technical and quality aspects, interpretation of the MIC values, reading and interpretation difficulties). Results indicated that 86% of respondents used Etest as AFST method, with a combination of one to seven antifungal agents tested. Most of the participating laboratories used similar technical parameters to perform their AFST method and a large majority used, as recommended, internal and external quality assessments. Almost all the participating mycology laboratories (98%) reported difficulties to interpret the MIC values, especially when no clinical breakpoints are available. The survey highlighted that the current AFST practices in France need homogenization, particularly for MIC reading and interpretation.

Can real-time polymerase chain reaction allow a faster recovery of hospital activity in cases of an incidental discovery of carbapenemase-producing Enterobacteriaceae and vancomycin-resistant Enterococci carriers?

BACKGROUND: Detection of faecal carriers of carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE) has become a routine medical practice in many countries. In an outbreak setting, several public health organizations recommend three-weekly rectal screenings to rule-out acquisition in contact patients. This strategy, associated with bed closures and reduction of medical activity for a relatively long time, seems costly. AIM: The objective of this study was to test the positive and negative predictive values of reverse transcription polymerase chain reaction (RT-PCR; GeneXpert®) carried-out at Day 0, compared with conventional three-weekly culture-based rectal screenings, in identifying, among contact patients, those who acquired CPE/VRE. METHODS: A multicentre retrospective study was conducted from January2015 to October2018. All contact patients (CPs) were included identified from index patients (IPs) colonized or infected with CPE/VRE, incidentally discovered. Each CP was investigated at Day 0 by PCR (GeneXpert®), and by the recommended three-weekly screenings. FINDINGS: Twenty-two IPs and 159 CPs were included. An average of 0.77 secondary cases per patient was noted, with a mean duration of contact of 10 days (range 1-64). Among the 159 CPs, 16 (10%) had a CPE/VRE-positive culture during the monitoring period. Rectal screenings were positive at Day 0 (10 patients), Day 7 (two patients), Day 14 (four patients). Thirteen of 16 patients with positive culture had a positive PCR at Day 0. Overall, a concordance of 97.5% (155/159) was observed between the three-weekly screenings and Day 0 PCR results. When performed on CPs at Day 0 of the identification of an IP, PCR (GeneXpert®) allowed the reduction in turnaround time by five to 27 days, compared to three-weekly screenings. Positive predictive value and negative predictive value were 100% and 98%, respectively. CONCLUSIONS: The use of RT-PCR (GeneXpert®) can avoid the three-weekly rectal samplings needed to rule-out acquisition of CPE/VRE.

[Candidemia original diagnosis]. / Diagnostic original d'une candidémie.

We reported here a case of fungemia, which was diagnosed by a globular numeration: peripheral blood smears showed yeast cells, especially in the cytoplasm of neutrophils, with characteristic images of fungal phagocytosis. This test induced a prompt diagnosis of fungal septicaemia and the prescription of adapted treatment, which probably permitted to rescue the patient from a high mortality pathology.

[Update on the susceptibility of streptococci to antibiotics (enterococci and Streptococcus pneumoniae excluded)]. / Actualité sur la sensibilité des streptocoques aux antibiotiques (en dehors des entérocoques et de Streptococcus pneumoniae).

Over the last years, the emergence of resistance to antibiotics has complicated the management of streptococcal infections. The resistance of streptococci to antibiotics is increasing and seems to be linked to the consumption of antibiotics. Resistances to antibiotics have been noted in all species of streptococci and no family of antibiotics is unaffected by resistances. The incidence of resistance to antibiotics varies from one species to another and according to countries. Presently, even though no Streptococcus pyogenes has shown diminished susceptibility to betalactams, this phenomenon has been reported for some strains in the B, C, and G groups, and for up to 56 % of oral streptococci. As for the resistance to macrolides, it reaches as many as 41 % of Streptococcus pyogenes, 46 % of group B streptococci, and 63 % of oral streptococci responsible for severe infections. This evolution is worrying for all streptococci but particularly for oral streptococci which represent a potential reservoir of virulence genes, notably towards Streptococcus pneumoniae. New families of antibiotics as the ketolides or the oxazolidinones appear to be effective in the treatment of streptococcal infections, but it seems that only a policy of control of the consumption of antibiotics could globally decrease the occurrence of resistance.

[Are mydriatic eyedrops dangerous for pre-term infants?]. / Les collyres mydriatiques sont-ils dangereux chez le nouveau-né prématuré ?

The funduscopic examination is essential in neonatology to screen for retinopathy in the pre-term infant. Mydriatic eyedrops, which are used for this examination, are known to induce digestive side effects. We present a case of necrotizing enterocolitis developing in a pre-term infant as a complication of mydriatics. This infant was a girl born at 28 weeks gestation and 5 days, with Down's syndrome, who died on the 44th day of life, due to necrotizing enterocolitis, after instillation of 1 drop of atropine 0.3% in each eye. The chronology of events, the application method, and the clinical symptoms of atropine impregnation argue in favor of a causal relationship between atropine and necrotizing enterocolitis. The review of the literature made on the basis of this observation shows that side effects of mydriatic eyedrops are frequent in pre-term infants and raise the question of atropine hypersensitivity in pre-term infants with Down's syndrome.

Comparison of four commercialized biochemical systems for clinical yeast identification by colour-producing reactions.

We compared the ability of four commercially available yeast identification systems for routine laboratory hospital use: Auxacolor (AUX) (Sanofi Diagnostics Pasteur, Marne-la-Coquette), Fungichrom I (FUC) and Fungifast I Twin (FUF) (International Microbio, Toulon), Api Candida (API) (bioMérieux, Lyon). These systems are based on obtaining a biochemical profile easily defined by colorimetric reactions. We tested 202 yeasts belonging to 19 species which were included or were not included in the manufacturer's data base of the identification systems. Without extra tests, for all the organisms tested, after 24 h of incubation, the percentage of organisms correctly identified was 48% for AUX, 75% for FUC, 77% for FUF and 81% for API. However, if we consider the ratio of the number of correct identifications without extra tests with the number of yeasts included in the manufacturers' data bases (sensitivity) the results increased to 61% for AUX, 81% for FUC, 91% for FUF and 83% for API. These systems are particularly well adapted to medical use, they are simple to set up, interpret, and have very good efficiency for the yeasts most commonly isolated in clinical specimens. The findings reported here indicate that the most favourable results were obtained with FUF and API systems.

[Advantages and limits of the surveillance of nosocomial infections from the microbiology laboratory: experience of Meaux hospital]. / Intérêts et limites de la surveillance des infections nosocomiales à partir du laboratoire de microbiologie : expérience du CHG de Meaux.

To estimate the incidence of nosocomial infections (NI) in our hospital and to increase healthcare professionals' awareness of hygiene, a prospective study was performed between January and December 2002 from the microbiology laboratory data. On 1334 suspicions of NI, corresponding to 1062 patients, sent to the hygiene correspondents in each medical care unit, the infection control team received 853 answers (64% of sendings) with 430 NI validated. The incidence rate of NI validated was 1.7 NI/1000 days of hospitalisation and 1.6 NI/100 inpatients. The NI were predominantly related to urinary tract (47%), bloodstream (14%), and lower respiratory tract (12%). Transmission of these informations to medical information department permitted a valorisation of additional 16,000 ISA points. This prospective study permitted to develop a network of hygiene correspondents in every medical care units. None of the medical care units was unharmed by NI but the exhaustive declaration of NI seems difficult to realise. This study permitted to point out some dysfunctionments in the management of invasive procedures and to improve these practices.