Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study.

BACKGROUND: In France, the most severe bone and joint infections (BJI), called "complex" (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification. METHODS: Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients. RESULTS: Inter-expert agreement during one MTM was moderate (κ=0.49), and fair (κ=0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ=0.50, range 0.27-0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ=0.58), it was better between MTMs with professor (κ=0.65) than without (κ=0.51) and with longer median time per case (κ=0.60) than shorter (κ=0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ=0.40). CONCLUSION: The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM.

[1997-2007, 10 years of monitoring the evolution of resistance of Streptococcus pneumoniae to antibiotics in the region Centre; review of the Pneumococcus network]. / 1997-2007, dix ans de suivi de l'évolution de la résistance de Streptococcus pneumoniae aux antibiotiques en région Centre; bilan de l'observatoire du pneumocoque.

Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.8 % in 2001, 39.6 % en 2007. These data are similar to the French national data over the same period.

Severe relapsing erysipelas associated with chronic Streptococcus agalactiae vaginal colonization.

We report a case of severe recurrent erysipelas of the breast due to infection with Streptococcus agalactiae and demonstrate that strains isolated from the skin were closely related to strains isolated from the vagina, which is consistent with the claim that the vagina acts as a reservoir for S. agalactiae isolates that are responsible for erysipelas relapse. Hypervirulence of strains and persistence of a bacterial reservoir may explain why 5 months of prophylaxis with penicillin V (1 million U daily) was necessary to achieve permanent eradication of vaginal carriage and to prevent recurrence of erysipelas caused by S. agalactiae infection.

Virulence and antibiotic susceptibility of Staphylococcus aureus strains isolated from various origins.

We looked for links between the antibiotic susceptibility pattern of Staphylococcus aureus strains, their source and their virulence genes. Forty-four methicillin-sensitive and -resistant S. aureus strains from four antibiogroups were studied by SmaI macrorestriction and PCR detection of ea, eb, tst, lukS-PV and lukF-PV. Genes encoding virulence factors were most prevalent (i) in S. aureus strains originated from skin, (ii) in methicillin-sensitive, quinolone-resistant strains or in methicillin-sensitive multiresistant strains (EMSSA strains), and (iii) in strains with decreased susceptibility or resistance to fusidic acid. This is consistent with the hypothesis that S. aureus antibiotic resistance promoted by local antibiotic treatment also contributes to the emergence of virulence strains.