Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT.

OBJECTIVE: To compare the efficacy and tolerability of a new ionic silver alginate matrix (Askina Calgitrol Ag) with that of a standard silver-free alginate dressing (Algosteril). METHOD: Patients with locally infected chronic wounds (pressure ulcers, venous or mixed aetiology leg ulcers, diabetic foot ulcers) or acute wounds were eligible for this prospective, open-label, controlled and randomised trial. Patients were randomised to receive one of the two dressings for a two-week period. Criteria of efficacy were based on the evolution, from day 1 to day 15, of local signs of infection using a clinical score ranging from 0 to 18, and the evolution of the bacteriological status for each wound. The latter was determined by (blind) bacteriological examinations of results obtained from two biopsies performed at days 1 and 15. A three-point scale (deterioration, unchanged, improvement) was also used. Acceptability, usefulness and tolerance were also assessed. RESULTS: Forty-two patients (20 women and 22 men, 68.9 +/- 18.8 and 66.5 +/- 15.7 years old respectively) were randomly assigned to receive either Askina Calgitrol Ag (n=20) or Algosteril (n=22). Most had chronic wounds such as pressure ulcers (57%) or venous or mixed aetiology leg ulcers and diabetic foot ulcers (29%); few had acute wounds (14%). Clinical scores of infection were comparable in both groups at inclusion, 8.9 +/- 2.4 and 8.6 +/- 3.2 in the Askina Calgitrol Ag group and the Algosteril group respectively (not significant), but decreased significantly in both groups at day 15, 3.8 +/- 2.9 in the Askina Calgitrol Ag group (p=0.001) and 3.8 +/- 3.4 in the Algosteril group (p=0.007). There was no significant difference between the two groups at day 15. Although there was also no significant difference in bacteriological status between the treatment groups, a trend in favour of Askina Calgitrol Ag was found for the relative risk of improvement, especially in patients who were not treated with antibiotics either at the beginning of the study or during it. No differences between groups were observed regarding local tolerance, acceptability and usefulness of the dressings. CONCLUSION: The regression of local signs of infection, local tolerance, acceptability and usefulness were similar for the two dressings. However, Askina Calgitrol Ag improved the bacteriological status of the wounds. Further trials are required to show that it has a positive impact on the healing process.

[The search for Yersinia enterocolitica in vegetables treated by a cold line in school cafeterias in Montpellier]. / Recherche de Yersinia enterocolitica dans des légumes traités par la chaîne de froid des restaurants scolaires de Montpellier.

From 134 samples of raw or cooked vegetables taken in two points of a cold line we isolated 19 strains of Yersinia enterocolitica, 3 of Y. intermedia 3 of Y. kristensenii. None of them belongs to serotypes usually pathogenic for man. The raw vegetables are most contaminated. Y. kristensenii and Y. intermedia were isolated especially from samples of green salad. The used method was a cold enrichment at 4 degrees C followed by a potassium hydroxyde treatment. The activity of 16 antimicrobial drugs was studied by the disk diffusion test at 28 degrees C. All strains were sensitive to aminoglycosides, minocycline, colistine and cotrimoxazole. The results obtained with chloramphenicol and beta-lactam antibiotics vary in terms of species and/or biotypes.

[Community acquired pneumonias in the region of Montpellier. Increase of pneumococci with reduced sensitivity to penicillins]. / Pneumonies communautaires dans la région de Montpellier. Augmentation des pneumocoques de sensibilité diminuée aux pénicillines.

OBJECTIVES: Bacteriological data indicate that there is an increased incidence of Streptococcus pneumoniae strains with an intermediate sensitivity to penicillin. The goals of the present study was i) to investigate the profile of sensitivity of Streptococcus pneumoniae isolated from patients with bacterial pneumonia in the area of Montpellier and ii) to compare this profile with the findings of the national center registry to better appreciate geographical specificity. METHODS: Fifty-six patients with bacterial pneumonia were enrolled into the study. From September 1989 to March 1994, we performed bacterial sampling including blood cultures, protected brushes and bronchoalveolar lavage specimens. We examined the antibiotic sensitivity of the germs which were isolated. All patients were followed using clinical and radiological criteria. RESULTS: A precise bacteriological diagnosis was established in 83.6% of the population. Streptococcus pneumoniae was found in 47.2% of the samples. In 19%, the strains displayed an intermediate sensitivity to penicillin. All patients recovered. CONCLUSION: We found a higher rate of resistance to penicillin in Montpellier than the common rate of the national reference center in France. The location of Montpellier closed to the Spanish border might, at least in part, explain this difference.

[Titers of antibodies binding the complement detected in a healthy population against 32 antigens. A basis of interpretation for routine serology?]. / Titres d'anticorps fixant le complément détectés dans une population saine vis-à-vis de trente-deux antigènes. Une base d'interprétation pour la sérologie de routine?

Is it possible to interpret the serological results when we cannot test better than one sample? Concerning complement fixation we tried to answer investigating the prevalence of 32 antigens in 150 blood donors. Antibodies titers distribution is given. A table synthesizes "normal" values and probabilities of "pathological" results.

[Increase in cases of tuberculosis (bacteriologically detected) in children in the Montpellier area, in 1979 and 1980]. / Augmentation des cas de tuberculose (détectés bactériologiquement) chez l'enfant dans la région de Montpellier en 1979 et 1980.

From 1973 to 1980 the authors recorded the rates of detection of Mycobacterium tuberculosis in their laboratory. From 1973 to 1978 this rate in samples from children was low, never reaching 6 %, and nearly constant. In the last two years (1979 and 1980) the rate more than doubled. These results are analyzed and discussed according to the age and nationality of patients. The distribution of the various clinical forms is given. The study of BCG status confirms well-known data : either the patients had never been vaccinated or the tuberculin tests had not been regularly checked.

[Isolation of Streptococcus pneumoniae from genital samples. Discussion of its pathogenic role]. / Isolement de Streptococcus pneumoniae dans les prélèvements génitaux. Discussion du rôle pathogène.

Within an eleven month period (September 1984 to July 1985) fourteen Streptococcus pneumoniae were isolated from varied genital samples (vaginal secretions, IUD, placentas, sperms). The possible carriage and the pathogenicity of pneumococcus are examined. The outbreak of several pooled cases last year, pose a difficult problem.

[Use of Autobac system in the study of the bacteriostatic effect of combinations of antibiotics (author's transl)]. / Application du système Autobac à l'étude de l'activité bactériostatique des associations d'antibiotiques.

After determining the LSI80 (light scattering index 80) concentration X and Y of two antibiotics for a given bacteria by an automated light scatter photometric method, we use the same process to test the bacteriostatic effect of all the combinations between the values 2X, X, X/2, X/4, X/8 and 2Y, Y, Y/2, Y/4, Y/8. The results read on the light scatter photometer are interpreted: --approximatealy by means of a simplified schematic diagram; --more precisely by drawing three curves: we begin with two inhibiton curves in order to determine the LSI50 concentrations (CLSI50) of each antibiotic, isolted and in the presence of defined concentrations of the complementary antibiotic; then from these CLSI50 we draw the bacteriostatic effect curve of the combination. When the LSI50 effect of the combination occurs with less than 50% of the CLSI50 of each isolated antibiotic, the combination is synergistic. It is antagonist if the bacteriostase is obtained with more than 100% of the CLSI50 of each isolated antibiotic. The intermediate percentages determine the indifferent effects. The additive effects come to an equilateral hyperbola passing through the points 50%-50%, 25%-75%. The Autobac system allows inoculum standardization, very simplified handlihg and automatic reading. It takes only 9 h to handle the complete process, including the determinations of the CLSI80 and the study of the combination. There is a high correlation between the results obtained and those given by the Patte and Chabbert "carre method".

Case report and review of septicemia due to Serratia ficaria.

Serratia ficaria was first described in 1979 as part of the fig tree ecosystem (P.A.D. Grimont, F. Grimont, and M. P. Starr, Curr. Microbiol. 2:277-282, 1979). Since then, it has been isolated from clinical specimens from a few human patients (C. Bollet, J. Freney, P. de Micco, F. Grimont, and P.A.D. Grimont, Méd. Mal. Infect. 20:97-100, 1990; J.A. Brouillard, W. Hansen, and A. Compere, J. Clin. Microbiol. 19:902-904, 1984; H. Darbas, H. Jean-Pierre, G. Boyer, and M. Riviere, Méd. Mal. Infect. 23:269-270, 1993; V.J. Gill, J.J. Farmer, III, P.A.D. Grimont, M.A. Asbury, and C.L. McIntosh, J. Clin. Microbiol. 14:234-236, 1981; F.D. Pien and J.J. Farmer III, South. Med. J. 76:1591-1592, 1983; C. Richard, J. de Coquet, and C. Suc, Méd. Mal. Infect. 19:45-47, 1989), but the pathogenicity of S. ficaria was always questionable. We are reporting the case of an aged cancer patient who developed S. ficaria septicemia. The habitat of this organism and its potential role as a pathogen are discussed.

[Course of the resistance of Staphylococcus aureus to pefloxacin. A study based on 782 strains isolated in 1985 and 1986]. / Evolution de la résistance des Staphylococcus aureus à la péfloxacine. Etude portant sur 782 souches isolées en 1985 et 1986.

We studied the evolution of the resistance of Staphylococcus aureus to pefloxacin during 1985 and 1986 in eight hospital units. The pefloxacin resistant Staphylococcus aureus, which amounted to 8.9% in 1985 reached 27% in 1986. They are found mainly among the methicillin-resistant Staphylococcus. There is no obvious relationship between this resistance and the consumption of pefloxacin in each of the units.

[In vitro activity of glycopeptides on 114 coagulase-negative staphylococci: problems with the teicoplanin diffusion test, "alert" parameters indicating need for MIC determination]. / Activité in vitro des glycopeptides sur 114 staphylocoques à coagulase négative: problèmes du test en diffusion pour la teicoplanine, paramètres "d'alerte" incitant au contrôle de la CMI.

The activity of vancomycin (Va) and teicoplanin (Tc) against 114 coagulase-negative staphylococci (CNS) strains was evaluated by disk-diffusion and agar dilution minimal inhibitory concentration (MIC) determination. Results were analysed by species and methicillin-resistance (MR) status. MICs for Va were in the susceptible range (< 4 mg/l) for all strains, with inhibition zone diameters of 17 mm or more in every case. MICs for teicoplanin were 8 or 16 mg/l for 19 CNS strains (including 18 with MR) of which 14 yielded an inhibition zone diameter of 17 mm or more (false susceptibility). Parameters which should lead to MIC determination for Tc regardless of disk diffusion findings include the species (S. haemolyticus), methicillin resistance, Tc zone diameter, and an at least 3 mm difference between the Va and Tc zone diameters.

[Prevention of septicemia caused by gastrointestinal tract organisms in patients with granulopenia. Comparison of three gastrointestinal tract decontamination treatments]. / Prévention des septicémies d'origine digestive chez les granulopéniques: comparaison de trois traitements de décontamination digestive.

Three gastrointestinal tract decontamination regimens were tested in patients with granulopenia: vancomycin 250 mg, tobramycin 75 mg, and colistin 1 million international units (regimen A); vancomycin 125 mg, tobramycin 75 mg, and colistin 1 million IU (regimen B); and colistin 1 million IU (regimen C); nystatin was added to all three regimens. Effectiveness was evaluated by stool organism counts and blood cultures to detect bacterial translocation (passage of bacteria from the intestinal tract to the bloodstream). Regimen C proved insufficiently effective. Regimen A was found to be poorly tolerated by the digestive mucosa. Regimen B was the best treatment since the low dosage of vancomycin proved effective. Nystatin satisfactorily eliminated yeasts.

Bronchoalveolar lavage for diagnosing bacterial pneumonia in mechanically ventilated patients.

To assess the usefulness of BAL in diagnosing bacterial pneumonia in mechanically ventilated patients, 80 BAL fluid samples obtained from 72 patients with lung infiltrates were studied using the following parameters: infected cell count (polymorphonuclear leukocytes or macrophages with intracellular organisms), microscopic examination of stained smears, and quantitative culture with the determination of the simplified bacterial index (SBI) and the predominant species index (PSI). Of the 80 BAL samples studied, 56 were performed under antibiotic therapy. Bacterial pneumonia was the final diagnosis in 28 cases. The SBI is the sum of the whole numbers of each bacterial concentration expressed as a common logarithm. The PSI is the whole number of the predominant microorganism's concentration expressed as a common logarithm. The discriminative value of each test was assessed using a receiver operating characteristic (ROC) curve, whereby the possibility of establishing a cutoff value used to discriminate between the presence or absence of pneumonia is evaluated. The percentage of infected cells was higher in the pneumonia group (8.8 +/- 18.1 versus 0.4 +/- 1.1%, p < 10(-3), but no cutoff value could be proposed. Under microscopic examination, the presence of bacteria was noted with a significantly greater frequency in the pneumonia group (sensitivity 67.8% and specificity 82.7%). A total of 58 BAL samples were positive when cultured. The SBI was significantly higher in the pneumonia group (6.5 +/- 2.9 versus 1.6 +/- 1.7, p < 10(-4).(ABSTRACT TRUNCATED AT 250 WORDS)

[Activity of ethambutol, isoniazid and rifampicin on Corynebacterium urealyticum and Corynebacterium jeikeium]. / Activité de l'éthambutol, de l'isoniazide et de la rifampicine sur Corynebacterium urealyticum et Corynebacterium jeikeium.

Because corynebacteria and mycobacteria have walls of similar composition, it was of interest to test the effects on resistant corynebacteria of two agents with anti-wall effects, i.e., ethambutol (EMB) and isoniazid (INH). Rifampicin was also studied to extend previous data and clarify conflicting results in the literature. INH was not active in levels achieved in vivo with standard dosages. The minimal inhibitory concentration (MIC) of EMB was under serum levels for only three of 78 strains. All minimal bactericidal concentration (MBCs) were greater than serum levels. With RIF, 59% of strains were susceptible and 19.2% exhibited intermediate susceptibility as defined by the French Committee on Antimicrobial Susceptibility Testing. CMI and CMB distributions were heterogeneous, suggesting a possible acquired heterogeneous resistance to RIF.

Prosthetic joint infection due to Veillonella dispar.

Described here is the first report of a monomicrobial joint infection caused by Veillonella dispar that resulted in loosening of a prosthesis. This clinical case shows that Veillonella spp. should not be disregarded as contaminant organisms, particularly when they are isolated in pure culture from clinical specimens involving cases of septic arthritis.

TEM-24 produced by four different species of Enterobacteriaceae, including Providencia rettgeri, in a single patient.

Four species of members of the family Enterobacteriaceae harboring extended-spectrum beta-lactamase (ESBL) were recovered in a single patient hospitalized in an intensive care unit. Among these isolates, we describe for the first time an ESBL-producing Providencia rettgeri strain. Bacteria from the same species were shown to be genetically related by pulsed-field gel electrophoresis analysis. These strains produced the same TEM derivative ESBL, characterized as TEM-24. This enzyme had the peculiarity of being encoded by a large conjugative plasmid of 180 kb, never previously described for such an ESBL.

Serratia ficaria: a misidentified or unidentified rare cause of human infections in fig tree culture zones.

Serratia ficaria, an enterobacterium involved in the fig tree ecosystem, has been isolated from human clinical samples in rare instances, and its role as a pathogen is unclear. In 7 years, we have isolated S. ficaria from seven patients; it was the only pathogen in 4 patients, including a patient with septicemia described previously and three patients with gallbladder empyemas described in the present report. From March 1995 to July 1997, the incidence of biliary infections due to S. ficaria was 0.7%. We discuss the digestive carriage of this bacterium and its epidemiology with respect to the fig tree life cycle. Since fig trees grow around the Mediterranean as well as in the United States (California, Louisiana, Hawaii), S. ficaria should be more frequently isolated. In our experience, various strains have been misidentified or unidentified by commercial systems. Incorrect identification could be an additional explanation for the paucity of reported cases. S. ficaria produces nonpigmented, lactose-negative colonies which give off a potatolike odor. This odor is the primary feature of S. ficaria and must prompt reexamination of the identifications proposed by commercial systems. We tested 42 novel strains using three commercial systems: Vitek gram-negative identification (GNI) cards and API 20E and ID 32E strips (bioMérieux, Marcy-l'Etoile, France). The percentages of positivity that we have obtained were lower than those published previously for the following characteristics: lipase, gelatinase, DNase, and rhamnose. The best system for the recognition of S. ficaria is ID 32E, which correctly identified 27 of 42 strains. The API 20E system gave correct identifications for only two strains. S. ficaria was not present in the Vitek GNI card system database.

[Sensitivity curves of multiply resistant corynebacteria JK and D2]. / Vitesses de bactéricidie chez les corynébactéries JK et D2 multirésistantes.

Corynebacteria groups JK and D2 are opportunistic pathogens. They are sometimes responsible for severe infections, especially in immunocompromised patients. They are resistant to many antibiotics. Under these conditions it seemed important to discover which antibiotics among those regularly active, have a killing effect, what their bactericidal speed is, and how they react to combination with other antibiotics. Glycopeptids have a killing effect within 24 hours. Pristinamycin, rifampin, fusidic acid, when active, are bacteriostatic. Their combination with vancomycin is indifferent but in one case the combination vancomycin + rifampin is synergistic.

[A 2-year evaluation of antibacterial serology adapted to the diagnosis of reactive arthritis (168 cases)]. / Bilan de deux ans de sérologie anti-bactérienne adaptée au diagnostic des arthrites réactionnelles (168 dossiers).

The diagnosis of reactive arthritis requires the identification of a trigger infection. Since 1984 we have carried out a series of serological tests that we have called "serology of reactive arthritis": they aim at detecting antibodies against the most common infectious agents in this particular pathology. This serology is essentially based on the complement-fixation test. Here we report the results obtained over a period of two years, comparing them with clinical and biological data: 168 cases have been studied. They include to two groups of patients: group A reassembling seronegative spondylarthropathies and including reactive arthritis (N = 104), and group B with patients suffering from a typical rheumatic affection usually having no relation to spondylarthropathies (N = 64). We propose for each antigen a level of positivity from which the presence of antibodies can be taken into consideration as part of the diagnosis. With reference to these levels we have obtained a significant relationship to recent antecedents (genito-urinary and intestinal), to the presence of IgM circulating immune complexes and to the precocity of the serological tests. The contribution of this type of serology to the recognition of reactive arthritis has been studied together with the other diagnosis factors of the diseases. We have been able to show significant rates of antibodies in more than 50% of the cases. The negative results and limits of this serodiagnosis are discussed.

[A 3-year evaluation of systematic research on Salmonella, Shigella, Campylobacter and Yersinia at a Montpellier hospital]. / Bilan de trois années de recherche systématique de Salmonella, Shigella, Campylobacter et Yersinia dans un hôpital montpelliérain.

This work aims at assessing the prevalence of four bacterial genus that are the most frequently involved in infectious diarrhoea, among patients usually kept apart from this type of pathology (there is not a department of Digestive Tract Diseases, of Infectious Diseases, of Pediatry). Among 3.626 stools received in our laboratory from 1.163 patients, 12 strains of Campylobacter, 11 strains of Salmonella and only one strain of Yersinia were isolated. No strain of Shigella was found. Of the 12 strains of Campylobacter, 6 were found in patients in the department of Hematology. The effect of Campylobacter upon immunocompromised hosts and/or during decontamination of the digestive tract is discussed. Of the 11 strains of Salmonella that were isolated, we didn't notice any actual predominance of one of the species. Finally the scarcity of Yersinia in spite of twofold patterns of enriching is commented upon.