Prevalence of multidrug-resistant bacteria colonisation among asylum seekers in western Switzerland.

The recent increase of migration to Europe represents a risk of increased the prevalence of multidrug-resistant (MDR) bacteria. We conducted a cross-sectional study among asylum seekers admitted at two hospitals in Switzerland. Of the 59 patients included, 9 (14%) were colonised by a MDR bacteria, including 5 (8.5%) methicilin-resistant Staphylococcus aureus (MRSA) and 4 (6.8%) extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. No patient carried both ESBL-producing bacteria and MRSA. None of the patients carried a vancomycin-resistant Enterococcus (VRE) or a carbapenem-resistant Enterobacteriaceae (CRE). Colonisation with MDR bacteria was not associated with hospitalisation abroad or recent arrival in Switzerland. Whole genome sequencing analysis allowed us to exclude transmission between patients. The prevalence of MDR bacteria carriage is moderate among asylum seekers in western Switzerland. Further surveillance studies are necessary to determine if there is a risk of dissemination of pathogens into the local population.

[Prevention of health care associated infections and bacterial resistance : guidance for good practice]. / Lutte contre les infections nosocomiales et les résistances bactériennes : quelques conseils de bonne pratique.

Despite improvement of infection control measures during the last 20 years, incidence of health care associated infections (HAI) remains high. HAI, also known as nosocomial infections, are mainly due to susceptible bacteria. However, resistant bacteria are responsible for some of them. In Switzerland, methicillin resistant Staphylococcus aureus incidence is decreasing but enterobacteriaceae producing extended spectrum beta-lactamase are increasing. In addition, emerging resistance challenges such as vancomycin-resistant enterococci or carbapenemase-producing bacteria were observed occasionally during recent years. Physicians in charge of hospitalized patients should know and apply good practice measures to prevent HAI and reduce the emergence and spread of multidrug resistant bacteria.

Malgré l'amélioration des mesures de contrôle de l'infection ces vingt dernières années, l'incidence des infections associées aux soins (IAS) reste importante. Les IAS, aussi appelées infections nosocomiales, sont en majorité dues à des germes sensibles aux antibiotiques, mais parfois des germes résistants sont en cause. Si, en Suisse, les staphylocoques dorés résistant à la méticilline sont en baisse, les entérobactéries productrices de bêtalactamases à spectre étendu sont à la hausse. De plus, des problématiques émergentes telles que les entérocoques résistant à la vancomycine ou les bactéries productrices de carbapénémases ont été notées sporadiquement ces dernières années. Les médecins doivent connaître et appliquer les mesures de prévention des IAS, et celles visant à limiter l'émergence et la dissémination des résistances bactériennes.

Development of a duplex real-time PCR for the detection of Rickettsia spp. and typhus group rickettsia in clinical samples.

Molecular diagnosis using real-time polymerase chain reaction (PCR) may allow earlier diagnosis of rickettsiosis. We developed a duplex real-time PCR that amplifies (1) DNA of any rickettsial species and (2) DNA of both typhus group rickettsia, that is, Rickettsia prowazekii and Rickettsia typhi. Primers and probes were selected to amplify a segment of the 16S rRNA gene of Rickettsia spp. for the pan-rickettsial PCR and the citrate synthase gene (gltA) for the typhus group rickettsia PCR. Analytical sensitivity was 10 copies of control plasmid DNA per reaction. No cross-amplification was observed when testing human DNA and 22 pathogens or skin commensals. Real-time PCR was applied to 16 clinical samples. Rickettsial DNA was detected in the skin biopsies of three patients. In one patient with severe murine typhus, the typhus group PCR was positive in a skin biopsy from a petechial lesion and seroconversion was later documented. The two other patients with negative typhus group PCR suffered from Mediterranean and African spotted fever, respectively; in both cases, skin biopsy was performed on the eschar. Our duplex real-time PCR showed a good analytical sensitivity and specificity, allowing early diagnosis of rickettsiosis among three patients, and recognition of typhus in one of them.

[Immunocompromised HIV patient with lymphadenopathy and fever]. / Adénopathies et fièvre chez une patiente VIH positive.

The case of a immunocompromised HIV patient with fever and lymphadenopathy discussed in an anatomo-pathological round. This complex clinical case was used as an opportunity to discuss the broad differential diagnosis of fever in an immunocompromized individual with multiples lymphadenopathies. Clinical reasoning leading to the probable diagnosis based on clinical, biological and radiological informations is not only a difficult task for the speaker but also a rich source of learning opportunities for our medical community.

Candida dubliniensis in recurrent polymicrobial tricuspid endocarditis.

This report describes a successful operative case of tricuspid infective endocarditis in an IV drug user. Despite cessation of IV drug use, there were further recurrences. Six different microorganisms with multiple portals of entry were identified, including one episode of fungal endocarditis, To our knowledge, this is the first case of recurrent infective endocarditis involving Candida dubliniensis in an HIV-negative patient.

[Febrile neutropenia]. / Neutropénies fébriles.

Chemotherapy-related neutropenia is frequently complicated by infections. In granulocytopenic cancer patients, the early empiric administration of broad-spectrum antibiotics is the cornerstone of the management and has dramatically decreased the infection-related mortality. Several intravenous antibiotic regimens have been shown to be effective and well tolerated, especially monotherapies with broad-spectrum beta-lactams. The analysis of the outcome of febrile neutropenic patients has allowed the differentiation of those at high risk from those at low risk of infectious complications. In low risk patients, oral antibiotic regimens have been shown as effective as intravenous regimens. Running studies will allow to determine the advantages and limits of an outpatient management.

[Urinary tract infection and fluoroquinolone resistance]. / Infection urinaire et résistance aux fluoroquinolones.

This case report describes a patient with a pyelonephritis due to a fluoroquinolone-resistant E. coli. The prevalence and the risk factor associated with the resistance of E. coli to fluoroquinolones have been assessed from recently published data. Several studies performed in patients with urinary tract infections have shown that the increase of fluoroquinolone-resistant strains was associated with an increased prescription of these antibiotics. Indiscriminate use of fluoroquinolones, in particular for respiratory tract infections, may lead to the dissemination of resistant strains among the general population.

Prophylactic intravenous administration of standard immune globulin as compared with core-lipopolysaccharide immune globulin in patients at high risk of postsurgical infection.

BACKGROUND: Infections and their sequelae are a major cause of death among patients admitted to the surgical intensive care unit (ICU). Studies of passive immunotherapy with standard intravenous immune globulin and hyperimmune globulin directed against gram-negative core lipopolysaccharide to prevent gram-negative infections and their serious systemic complications have had equivocal results in such patients. METHODS: We performed a double-blind study to assess the efficacy of standard immune globulin and core-lipopolysaccharide hyperimmune globulin in preventing infections in surgical patients at high risk. The patients received standard immune globulin (400 mg per kilogram of body weight), hyperimmune globulin (400 mg per kilogram), or placebo (25 percent albumin, 8 ml per kilogram) weekly, for a maximum of four doses while in the ICU. RESULTS: A total of 352 patients were enrolled, and 329 could be evaluated. The number of patients in whom infections developed was significantly lower in the group receiving standard immune globulin than in the placebo group (36 of 109 vs. 53 of 112 patients, P = 0.03), as was the incidence of pneumonia (15 vs. 30 cases, P = 0.04), especially pneumonia due to gram-negative bacteria (5 vs. 16 cases, P = 0.02). The number of days spent in the ICU and the total days spent in the hospital were lower in the standard immune globulin group (medians of 2 and 7.5 days fewer; P = 0.02 and 0.06, respectively). In contrast, the hyperimmune globulin had no detectable prophylactic effect on infections (50 of 108 patients, with 25 cases of pneumonia). The rate of systemic infections and shock was similar in the three study groups, and hospital mortality did not differ significantly among them. CONCLUSIONS: Intravenous immune globulin given prophylactically to selected high-risk patients in the surgical ICU can reduce the incidence of infection. Core-lipopolysaccharide hyperimmune globulin is not effective in preventing gram-negative infections and their systemic complications.