[Community-acquired urinary tract infections in 15 to 65 years old female patients in France. Susceptibility of E. coli according to history: AFORCOPI-BIO network 2003]. / Infections urinaires communautaires de la femme de 15 à 65 ans: sensibilité aux antibiotiques de E. coli en fonction des antécédents: étude AFORCOPI-BIO 2003.

OBJECTIVES: A multicenter study was implemented in order to determine the distribution and antibiotic susceptibility patterns of strains isolated from 15 to 65 year old female patients with community-acquired urinary tract infections. PATIENTS AND METHODS: From October to December 2003, 11 French private laboratories consecutively collected 420 clinical strains with medical data. Minimal inhibitory concentrations of antibiotics on E. coli were determined using the agar dilution method in a coordinating center and interpretation followed the recommendations of the Comité de l'antibiogramme de la Société française de microbiologie. RESULTS: Escherichia coli was the most prevalent pathogen (80%) followed by Proteus mirabilis (4%), Klebsiella spp (2%), other Enterobacteriaceae (4%), Enterococcus spp (3%), Staphylococcus aureus (2%), Staphylococcus saprophyticus (2%), and Streptococcus agalactiae (2%). The susceptibility of E. coli strains was 61% for amoxicillin (AMX), 93% for nalidixic acid (NAL), 97% for norfloxacin (NOR) and ciprofloxacin (CIP), 77% for cotrimoxazole (SXT), 99% for fosfomycin, gentamicin and cefotaxime. The susceptibility of E. coli was lower in case of previous treatment with beta-lactam antibiotics for AMX (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). In the same way, previous treatment with quinolones was associated with decreased susceptibility for NAL (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). CONCLUSIONS: In 2003, fluoroquinolones, third generation cephalosporins, aminoglycosides, and fosfomycin kept a good activity on E. coli collected from community-acquired urinary tract infections in 15 to 65 years old female patients in France.

[Genital infections in women, in community practice. Comparison of two studies, 1987 and 2002]. / Les infections génitales chez la femme en pratique de ville Enquêtes Aforcopi-BIO. Comparaison des résultats 1987 et 2002.

One thousand eight hundred and thirty-six clinical and biological cervico-vaginal flora samples from genital infections in women observed in community practice in 1987 were compared to 368 samples collected in 2001. The diagnosis of sexually transmitted infection (STI) was rarely made. Nonetheless, examining these samples made it possible either to prescribe a specific treatment for a confirmed infection (chlamydia, trichonomiasis, candidiasis, gonococci, vaginosis), or to modify a long-term treatment that was often ineffective and sometimes badly tolerated. Not all vulvar itching, associated or not with pelvic pain, is caused by mycosis. Treatment based on a syndromic approach was often ineffective, because clinical symptoms, whether isolated or associated, even when they were suggestive of an etiology, presented only a minor positive predictive value (the PPV for the association ichting + pelvic pain was only 10% for chlamydia, but 45% for candidiasis). The diagnosis of vaginosis, suggested for the past 10 years as an improvement in the diagnosis of vulvo-vaginitis, was made in only 13% of the cases. The only significant difference in our two studies was a lower number of cases of gonococci, chlamydiae, and ureaplasms in 2001, the settings having remained identical, except for a lower number of patients in 2001.

[Urinary tract infection in an urban population: etiology and antibiotic sensitivity as a function of patient history]. / Infections urinaires en pratique de ville: étiologies et sensibilité aux antibiotiques en fonction des antécédents. l'AFORCOPI-BIO. Association pour la Formation Continue en Pathologie Infectieuse des Biologistes.

OBJECTIVE: The aim of this study was to explore the relationship between etiological factors, bacterial isolates and Escherichia coli susceptibility to antibiotics in ambulatory patients with urinary tract infection. PATIENTS AND METHODS: A prospective study was conducted in 13 private medical laboratories in France in March 1998. Data were collected on 658 cases involving 679 strains in ambulatory patients with urinary tract infections. Data on age, gender, catheter insertion within the 7 preceding days, and history of hospitalization, urinary infection and antibiotic treatment during the 6 preceding months were recorded. The distribution of the bacterial isolates and Eschericha coli sensitivity to ciprofloxacin, cotrimoxazole, and gentamycin were studied. RESULTS: E. coli was most frequently isolated in women, in patients with no catheter or without a history of antibiotic treatment, hospitalization or urinary infection. There was no difference in E. coli sensitivity according to sex and age in women. In patients with prior antibiotic treatment, all the tested antibiotics except gentamycin were significantly less active. In case of prior hospitalization, the E. coli isolates were more resistant to amoxicillin, quinolones, cotrimoxazole and gentamycin. The level of E. coli suceptibility rose as the delay since hospitalization or urinary infection increased. CONCLUSION: Ambulatory patients comprise a heterogeneous population requiring particular attention to correctly adapt therapeutic strategies.

[A car accident. Parallel development of posttraumatic psychiatric pathology in a mother and child]. / Un accident de voiture. Evolution parallèle d'une pathologie psychiatrique post-traumatique de la mère et de l'enfant.

A case of parallel development of a post-traumatic pathological condition in a mother and child is reported. Psychotherapy of the mother's anxiety neurosis allows to understand the child's symptoms as dependent upon maternal phantasies and to underscore the iatrogenic effects of the alleged treatment. The course, over seven years, draws attention to the significance of mother-child relationships as a source of diagnostic error and as a cause of the importance of certain side-effects of barbiturates.