Patient nostril microbial flora: individual-dependency and diversity precluding prediction of Staphylococcus aureus acquisition.

The potential role of a patient's resident microbial flora in the risk of acquiring multiresistant bacteria (MRB) during hospitalization is unclear. We investigated this role by cross-sectional study of 103 patients at risk of acquisition of Staphylococcus aureus (SA), resistant (MRSA) or not (MSSA) to methicillin, recruited in four French hospitals. The flora was analysed by an exhaustive culture-based approach combined with molecular and/or mass-spectrometry-based identification, and SA strain typing. Forty-three of the 53 SA-negative patients at entry were followed for up to 52 weeks: 19 (44.2%) remained negative for SA and 24 (55.8%) became positive, including 19 (79%) who acquired an MSSA, four (17%) who acquired an MRSA and one who acquired both (4%). Fifty-one different species were identified among the 103 patients, of which two, Corynebacterium accolens and Staphylococcus haemolyticus (p = 0.02-0.01), were more prevalent in the absence of SA. However, the same number of patients carrying or not these two species acquired an MSSA/MRSA during follow-up, regardless of antibiotic treatment received. Clustering analysis showed that the microbial flora was highly specific to each patient, and not predictive for acquisition of MSSA/MRSA or not. Patient-specific microbial resident flora is not predictive of SA acquisition.

Avaliação das estruturas secretoras de Ocimum gratissimum var. macrophyllum Briq. (Lamiaceae) após extração dos constituintes voláteis / Evaluation of secretory structures of Ocimum gratissimum var. macrophyllum Briq. (Lamiaceae) after extraction of volatile compounds

O impacto provocado nas estruturas secretoras de folhas adultas de Ocimum gratissimum var. macrophyllum após extração dos componentes voláteis utilizando-se diferentes métodos de extração foi investigado através de microscopia eletrônica de varredura (MEV). Secções transversais do ápice, da nervura central, e da margem mostraram superfície com cutícula estriada, estômatos diacíticos, tricomas tectores simples, filiformes, e glandulares peltados. Os peltados, com estrutura envolta por uma cutícula contendo o exsudado celular, variaram de 60 a 80µm de diâmetro sendo formados por uma porção apical multicelular com disposição radial formada por dois círculos concêntricos com 9 a 16 células. Na região central do ápice do tricoma peltado se identificou a presença de 4 células em forma de vértice dispostas sobre o pedúnculo, sendo esta a região mais externa formada por número variável de células. Os componentes voláteis das folhas adultas foram extraídos por hidrodestilação (HD), destilação-extração simultânea (DES), e solvente (SO). Os dados obtidos evidenciaram que o maior impacto nas estruturas secretoras ocorreu após extração por hidrodestilação quando comparado aos outros métodos utilizados. A porcentagem dos principais constituintes químicos, timol e γ-terpineno variaram de acordo com o método de extração: timol (HD = 25,4%, SO = 18,2%, DES = 54,8%) e γ-terpineno (HD = 38,2%, SO = ausente, DES = 13,7%).

The impact on the secretory structures of mature leaves of Ocimum gratissimum var. macrophyllum, after extraction of the volatile compounds using different extraction methods, was investigated by scanning electron microscopy (SEM). Cross-sections of the apex, the midrib and the margin showed surface with striated cuticle, diacitic stomata, single tector, filiform and glandular peltate trichomes. The peltate trichomes with a structure surrounded by cuticle containing the celllular exudate ranged from 60 to 80µm in diameter and consisted of a multicellular apical portion of radial arrangement formed by two concentric circles with 9 to 16 cells. In the central region of the peltate trichome apex, there were 4 cells in the form of a vertex arranged on the peduncle, and this was the most external region formed by a variable number of cells. The volatile compounds of the mature leaves were extracted by hydrodistillation (HD), simultaneous distillation-extraction (SDE) and solvent (SO). The obtained data evidenced that the major impact on the secretory structures occurred after extraction by hydrodistillation, compared to the other used methods. The percentage of the major chemical constituents, thymol and γ-terpinene, changed according the extraction method: (HD = 25.4%, SO = 18.2%, SDE = 54.8%) and γ-terpinene (HD = 38.2%, SO = absent, SDE = 13.7%).

Identification of clinical coagulase-negative staphylococci, isolated in microbiology laboratories, by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and two automated systems.

A study was performed to compare matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS), linked to a recently engineered microbial identification database, and two rapid identification (ID) automated systems, BD Phoenix (Becton Dickinson Diagnostic Systems, France) and VITEK-2 (bioMérieux, Marcy L'Etoile, France), for the ID of coagulase-negative staphylococci (CoNS). Two hundred and thirty-four clinical isolates of CoNS representing 20 species were analyzed. All CoNS isolates were characterized by sodA gene sequencing, allowing interpretation of the ID results obtained using the respective database of each apparatus. Overall correct ID results were obtained in 93.2%, 75.6% and 75.2% of the cases with the MALDI-TOF-MS, Phoenix and VITEK-2 systems, respectively. Mis-ID and absence of results occurred in 1.7% and 5.1% of the cases with MALDI-TOF-MS, in 23.1% and 1.3% with the Phoenix, and in 13.7% and 0.9% with the VITEK-2 systems, respectively. In addition, with the latter automate, 10.3% of the IDs were proposed with remote possibility. When excluding the CoNS species not included in the databases of at least one of the three systems, the final percentage of correct results, Mis-ID and absence of ID were 97.4%, 1.3% and 1.3% with MALDI-TOF-MS, 79%, 21% and 0% with the Phoenix, and 78.6%, 10.3% and 0.9% with the VITEK-2 system, respectively. The present study demonstrates the robustness and high sensitivity of our microbial identification database used with MALDI-TOF-MS technology. This approach represents a powerful tool for the fast ID of clinical CoNS isolates.

Normal pressure hydrocephalus in the elderly: a treatable cause of dementia?

Although normal pressure hydrocephalus is one of the few remediable causes of dementia, the diagnosis is often not considered in the elderly. Three patients are described who presented to an acute geriatric unit within a six-month period during which normal pressure hydrocephalus was actively sought and treated. Although two made striking initial improvement, the long-term prognosis was poor: complications were frequent, and all three died within two years of operation. This pilot study indicates that normal pressure hydrocephalus may account for a proportion of cases of 'senile' dementia, but that formal controlled studies are required to establish the best means of diagnosis and treatment.