[Mycologic surveillance of the environment for preventive invasive aspergillosis. Proposals for standardization of the methodologies and implementation]. / Surveillance mycologique de l'environnement pour la prévention de l'aspergillose invasive. Propositions de standardisation des méthodologies et des modalités d'application.

A MAJOR RISK: The infection of immunodepressed patients by Aspergillus-type fungi increases morbidity and mortality, particularly in hematology units or during solid organ transplantation. Although present diagnostic means benefit from the progress over the last years, they remain limited and chemoprophylaxis protocols have still not demonstrated significant efficacy. THE NEED FOR RECOMMENDATIONS: Today, the handling of environmental risks is the only strategy that has proved its efficacy and usefulness. On the basis of administrative recommendations and data from the literature, a multicentric and pluri-disciplinary task force, grouping clinicians, microbiologists and hygienists, has assessed different methods and has proposed recommendations for the standardization and optimization of fungal surveillance of the environment.

Emergence of multidrug-resistant Enterobacter cloacae: nosocomial outbreak or change of microbial ecology?

Frequent selection of mutants resistant to extended and broad spectrum cephalosporins in Enterobacter cloacae is observed in hospital. As we noticed an unusual number of isolates of these strains and to answer the question arose whether these Enterobacter had a common source, we retrospectivally studied 56 strains collected in 11 wards of the hospital. Using PFGE with Spe 1 restriction analysis we identified a prevalent clone (11 patients) dispatched in 8 wards. We also obviously proved cross-contamination patients to patients with other clones. PFGE allow us to point out that clonal Enterobacter cloacae has taken place in our hospital, even if there is no real outbreak. A reinforcement of basic hygienic measures and a control of antibiotics prescription seemed very important to jugulate the sudden increase of multiresistant Enterobacter cloacae prevalence.

[Utilization of Bichrolatex albicans test for the rapid identification of Candida albicans in blood culture bottles in fungemia: preliminary results from a multicenter study]. / Utilisation du réactif Bichrolatex albicans pour l'identification rapide de Candida albicans dans les flacons d'hémoculture au cours des fongémies: résultats préliminaires d'une étude multicentrique.

In patients with fungemia, reliable and rapid identification of the causative organism has a large impact on treatment decisions. The Bichrolatex albicans test (Fumouze, Levallois-Perret, France) allows rapid identification of Candida albicans in colonies. Its usefulness for identifying C. albicans in liquid blood culture media was evaluated using a previously published protocol. Ninety-seven blood culture bottles from 86 fungemia episodes in 13 study centers were studied. C. albicans contributed 52% of the fungemia episodes, whereas C. glabata and C. tropicalis contributed 15% and 11.5%, respectively. The 48 bottles containing a yeast other than C. albicans were all negative by the Bichrolatex albicans test. Of the remaining 48 bottles, which were positive for C. albicans, 33 produced marked to moderate agglutination and 15 were negative. In one case of mixed fungemia (C. albicans plus C. glabata), weak agglutination was seen. Sensitivity of the test was 69%, negative predictive value was 76%, specificity was 100%, and positive predictive value was 100%. Because of its limited sensitivity, the Bichrolatex albicans test cannot be recommended as a confirmation test for C. albicans fungemia. In contrast, the specificity and positive predictive value of the test are excellent.

Absence of peliosis hepatis in patients receiving testosterone enanthate.

Fifty-two autopsies of patients who had undergone hemodialysis and had received testosterone enanthate, were reviewed for evidence of peliosis hepatis and liver neoplasms. Eight (15%) pathologic liver were isolated. No peliosis, adenoma or hepatoma was identified. These findings suggest that, unlike the 17-alpha derivatives of testosterone, testosterone enanthate is not associated with morphologic changes in the liver.

Renal arterial infusion of cyclophosphamide in dogs.

Cyclophosphamide, a nitrogen mustard derivative, has been reported to induce antidiuresis in man and water diuresis in dogs. In order to determine whether the drug acts directly on the kidney, we have infused the drug into one renal artery of hydropenic dogs and compared the responses with those observed following i.v. administration. Renal artery infusion of two different doses in ten dogs induced no unilateral or bilateral, hemodynamic or excretory responses. Intravenous administration of similar doses (16 mg/min for 120 to 160 min) in five dogs induced a progressive increase in the clearance of para-aminohippurate (PAH) (P less than 0.05), creatinine and urea (P less than 0.01), and a natriuresis and kaliuresis (P less than 0.05). The excretion of phosphate increased but was not statistically significant. There was a significant decrease (P less than 0.01) in the clearance of free water. The lack of response to intrarenal infusion of a drug which acts systemically to alter renal function is unusual. Possible explanations are inactivation of drug by renal tissue or rapid excretion by the kidney. In either case, removal rate must approximate renal blood flow in order to prevent the systemic response to the drug.