Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France.

Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.

Refractory Microascus Bronchopulmonary Infection Treated with Olorofim, France.

We report 3 cases of successful treatment of Microascus spp. bronchopulmonary infection in a multiple-traumatized patient and 2 lung transplant recipients in France. We emphasize the promising use of olorofim antifungal therapy in a rising context of intrinsically less-susceptible respiratory infections caused by mold.

Rapid identification of fungi from respiratory samples by Bruker Biotyper matrix-assisted laser desorption/ionisation time-of-flight using ID-FUNGI plates.

Identification of moulds is crucial for the clinical management of patients. The goal of this study was to evaluate the new ID-FUNGI plate (IDFP) for the identification of moulds by MALDI Biotyper. IDFP was compared with Sabouraud with gentamicin and chloramphenicol plate (SAB) for the identification of 80 moulds from respiratory samples and eight reference strains. With the direct transfer method, species identification rose from 6% with SAB to 68% with IDFP using score cut-off 2 and from 20 to 75% using cut-off 1.7 (p < 0.001). Our study highlights that the new IDFP improves mycological diagnostic and workflow in laboratories.

Low Central Nervous System Posaconazole Concentrations during Cerebral Phaeohyphomycosis.

Posaconazole diffusion has been documented in various organs, which contrasts with the scarce data available for the human central nervous system (CNS). We analyzed posaconazole concentrations in plasma and multiple CNS specimens taken from a patient who received posaconazole because of cerebral phaeohyphomycosis. Low posaconazole concentrations were obtained in CNS specimens, with sample-to-plasma ratios between 5% and 22%. This case highlights the role of neurosurgery during cerebral phaeohyphomycoses, even those caused by posaconazole-susceptible black fungi.

Evaluation of the mycobacteria MBT kit for identification of nontuberculous mycobacteria by MALDI-TOF Biotyper (Bruker).

Identification of mycobacteria is crucial for clinical management of patients. The new MBT Mycobacteria kit from the Easy MycoEx protocol (Bruker) is used for the identification of mycobacteria by MALDI Biotyper. The Easy MycoEx protocol was compared to the MycoEx protocol (1) for identification of various mycobacterial isolates collected from samples in 2021, (2) for prospective identification on primary culture during 2 periods. For 44 isolates in MGIT broth, identification rates were high and similar for both protocols (98% vs 95% at cut-off 1.6 and 91% vs 82% at cut-off 1.8). For 42 mycobacteria on Coletsos agar, identification rates were 88% versus 90% at cut-off 1.6 and 76% for both protocols at cut-off 1.8. For slow-growing mycobacteria in MGIT, reproducibility of deposit results was superior with Easy MycoEx. No difference of score was observed between 2 protocols performed on primary culture. Clinical laboratories can easily implement the Easy MycoEx protocol.

Impact of EUCAST rapid antimicrobial susceptibility testing (RAST) on management of Gram-negative bloodstream infection.

OBJECTIVES: During bloodstream infections, reducing the time to antimicrobial susceptibility testing is crucial to initiation of early appropriate antibiotic therapy. For Gram-negative infections, a phenotypic approach remains necessary. Rapid antimicrobial testing (RAST) is a recently developed phenotypic EUCAST method. The goal of this study was to evaluate the accuracy and clinical impact of RAST. PATIENTS AND METHODS: From September 2020 to August 2021, Gram-negative episodes with positive blood culture detected in the morning were included in the RAST group. Categorical agreement of RAST with conventional antimicrobial testing on strains was determined. To assess antibiotic management and patient outcomes, the RAST group was compared with a control group (CG) with positive blood culture detected in the afternoon for which overnight antimicrobial testing was performed. RESULTS: The RAST group included 61 episodes from 61 patients, while the CG group included 49 episodes from 48 patients. While RAST performed on 41 E. coli, 11 K. pneumoniae and 9 P. aeruginosa strains highlighted 99.3 % of categorical agreement, 7.4 % of unreadable zones and 9.4 % of technical uncertainty area at 4 h incubation were also reported. For the RAST group, effective antibiotic therapy was prescribed in 100 % of patients on the day of positive blood culture (day 1) vs 88 % in CG (p = 0,007). As for beta-lactams on day 1, RAST led to 9 escalations and 6 de-escalations. Mortality and length of hospital stay did not significantly differ between the two groups. CONCLUSION: RAST improves management of antibiotic therapy in patients with Gram-negative sepsis.

Morocco as a possible source for acquisition of Rhinocladiella mackenziei.

Rhinocladiella mackenziei cerebral phaeohyphomycosis is a rare severe disease that has been typically described in the Middle East. Here, we report 2 cases of R. mackenziei cerebral phaeohyphomycosis in patients from Morocco, diagnosed and treated in France, and raise a concern about the ever-going extension of the area at risk for this devastating invasive fungal infection.

[Optimization of incubation duration of culture media in microbiology]. / Optimisation des durées d'incubation des milieux de culture en microbiologie.

In order to perform biological analysis, clinical laboratories apply the instructions of reagent suppliers. For culture media these instructions are often incomplete and poorly adapted to the variety of clinical samples and micro-organisms. The REMIC can help to overcome these shortcomings. Required time of incubation for culture media are proposed based on the nature of the sample and the type of micro-organism suspected. Nevertheless, they are most often expressed in multiple of 24 hours and they are often considered as minimal by the laboratories. As the samples are inoculated "continuously", while the readings are most often done at a single definite time of the day, we propose a strategy to optimize incubation duration of cultures medium. A time of incubation in the day so-called "limit" is defined. From this, the incubations are stopped or prolonged according to the results of the culture and the direct examination. As the instructions of suppliers of culture media are not adapted, it appears necessary that these suppliers relies on the repositories of professional societies as this is the case for agars medias used for antibiotic susceptibility testing.

[Evaluation of the environmental contamination in microbiology Which strategy to adopt?] / Évaluation de la contamination environnementale en microbiologie Quelle stratégie adopter ?

The culture of micro-organisms exposes to the risk of microbiological contamination at all stages of the analysis: inoculation on culture media, incubation, and observation of cultures. During our accreditation renewal audit, a surveillance point was notified, regarding the lack of consideration of the risk of microbiological contamination. Its mastery mainly relies on cleaning/disinfection operations and their traceability. In addition, several strategies based on environmental sampling or indicators can be performed. We propose a risk analysis in order to present these strategies.

Rapid identification of Escherichia coli colonies from clinical sample inoculated on CHROMagar Orientation media (Becton Dickinson).

CHROMmagar Orientation media (Becton Dickinson) was developed and validated for the culture of urinary samples. It allows a direct identification of E. coli colonies without additional tests. As CHROMmagar Orientation media is superior to non-chromogenic media for the distinction of enterobacterial colonies, it is used for the inoculation of a large variety of samples in clinical laboratories. Direct identification of E. coli colonies cultured from these samples is not validated by the manufacturer. The difference in microbial ecology and the nature of the sample may impact CHROMagar Orientation performances for this use. We evaluated these media for the direct identification of E. coli colonies from 410 samples (excluding urine). Its sensitivity of 99% allows a direct identification of E. coli colonies cultured from a wide variety of samples. On-site testing using a large number of representative samples, allows laboratories to assess agar media performance and adapt their uses. Suppliers who are aware of frequent and non-recommended use of their culture media should perform tests and if conclusive, adapt their technical instructions.

[Contribution and evolution of blood culture quality indicators]. / Apports et perspectives d'évolution des indicateurs qualité de l'hémoculture.

The monitoring of quality indicators, combined with a detailed risk analysis, validates the process of automated blood culture. Here we report the methodology of 5 years monitoring for 5 indicators at the Biology Department of Foch Hospital: volume sampled, proportion of contaminants, proportion of positive blood cultures in each instrument and drawer, epidemiological indicator and proportion of false-positive instrument signals. The results obtained were outside the expected target for the volume sampled and were acceptable for the other indicators. The analysis of these results leads us to discuss the evolution of quality indicators and more particularly the implementation of corrective measures, their periodicity, their relevance as well as the need to refine their results to carry out targeted actions.