Impact of rapid diagnostic tests on the management of patients presenting with Enterobacteriaceae bacteremia.

OBJECTIVE: Pathogens are usually identified from blood cultures using a two-step procedure: Gram staining on the day of bacterial growth (D0), followed by identification and susceptibility testing the following day (D1). We aimed to evaluate the use of rapid tests performed on D0 in patients presenting with Enterobacteriaceae bacteremia. PATIENTS AND METHODS: Patients with≥1 positive monomicrobial blood culture with Gram staining suggestive of an Enterobacteriaceae were prospectively included. Two successive strategies were evaluated: i) conventional strategy (CS), ii) combination of a rapid identification test and third-generation cephalosporin susceptibility testing (rapid strategy, e.g. RS). RESULTS: Eighty-three patients were included (CS=42; RS=41). Compared with CS, the median delay of identification was significantly shorter with RS (22 hours [20-27] vs. 47 hours [42-53]; P<0.001). Patients in the RS group more frequently received an effective (82.9% vs. 73.8%, P=0.43) and appropriate (70.7% vs. 54.7%, P=0.17) antibiotic therapy on D1. Moreover, all five RS patients infected with a non-susceptible strain received an effective therapy on D1 versus only three of eight CS patients. CONCLUSIONS: Use of rapid testing was associated with a reduced time to result availability. This strategy should be useful to initiate an early effective and appropriate therapy and to improve the care of patients.

[Harvesting thin and semi-thin skin from the scalp: risks and their prevention]. / Le prélèvement de peau mince et semi-épaisse sur le scalp: ses risques et leur prévention.

The complications of raising scalp grafts are dominated by the risks of haemorrhage and alopecia, which can be prevented by careful preparation of the donor site, perfect intraoperative coordination and close surveillance of epithelialisation. The authors report their experience in the Freyming-Merlebach burns unit, with particular emphasis on the value of this technique in children.

[Surgical classification of androgenetic baldness and its therapeutic implications]. / Classification chirurgicale de la calvitie androgénétique et ses implications thérapeutiques.

In order to understand the various operative indications in baldness surgery, we describe a dynamic classification of baldness with practical implications. The most predictive factors of this classification are scalp laxity and the height of the crown.

[Bacteriology of the bile ducts and antibiotic prophylaxis]. / Bactériologie des voies biliaires et antibioprophylaxie.

The gallbladder wall, gallbladder lumen and bile duct intraoperative sampling materials had been examined in 52 patients with an operation on the biliary tract. All patients were treated by only one infusion before operation: 1 g ceftriaxone was given to 26 patients and 2 g ceftriaxone to the 26 others. Bacterial species were isolated on twenty patients. There was no significant difference in infection rate and organism identity between bacterial flora isolated from patients receiving 1 g ceftriaxone and patients receiving 2 g. Isolated germs were enterobacteriaceae (15) streptococci (14) and anaerobic bacteria (8). The mean count of bacteria in bile is 10(4) germs/ml. Half positive sampling materials contains more than one bacterial strain. The bacterial flora isolated from bile has characteristics of mixed flora infection. Ceftriaxone had a good efficacy in antibiotic prophylaxis.