Decline in antibiotic resistance and changes in the serotype distribution of Streptococcus pneumoniae isolates from children with acute otitis media; a 2001-2011 survey by the French Pneumococcal Network.

Streptococcus pneumoniae is an important cause of acute otitis media (AOM). The aim of this study was to evaluate trends in antibiotic resistance and circulating serotypes of pneumococci isolated from middle ear fluid of French children with AOM during the period 2001-2011, before and after the introduction of the PCV-7 (2003) and PCV-13 (2010) vaccines. Between 2001 and 2011 the French pneumococcal surveillance network analysed the antibiotic susceptibility of 6683 S. pneumoniae isolated from children with AOM, of which 1569 were serotyped. We observed a significant overall increase in antibiotic susceptibility. Respective resistance (I+R) rates in 2001 and 2011 were 76.9% and 57.3% for penicillin, 43.0% and 29.8% for amoxicillin, and 28.6% and 13.0% for cefotaxime. We also found a marked reduction in vaccine serotypes after PCV-7 implementation, from 63.0% in 2001 to 13.2% in 2011, while the incidence of the additional six serotypes included in PCV-13 increased during the same period, with a particularly high proportion of 19A isolates. The proportion of some non-PCV-13 serotypes also increased between 2001 and 2011, especially 15A and 23A. Before PCV-7 implementation, most (70.8%) penicillin non-susceptible pneumococci belonged to PCV-7 serotypes, whereas in 2011, 56.8% of penicillin non-susceptible pneumococci belonged to serotype 19A. Between 2001 and 2011, antibiotic resistance among pneumococci responsible for AOM in France fell markedly, and PCV-7 serotypes were replaced by non-PCV-7 serotypes, especially 19A. We are continuing to assess the impact of PCV-13, introduced in France in 2010, on pneumococcal serotype circulation and antibiotic resistance.

[Septicemia, bilateral community acquired pneumonia and empyema due to Burkholderia pseudomallei (mellioidosis) with a favorable outcome following prolonged specific antibiotic therapy]. / Septicémie, pneumopathie bilatérale et pleurésie purulente à Burkholderia pseudomallei (mélioïdose) d'évolution favorable sous antibiothérapie adaptée, prolongée.

INTRODUCTION: Melioidosis is an infectious disease due to Burkholderia pseudomallei (Bp). It is regarded as endemic in southeast Asia and northern Australia. The septicaemic form is a severe illness with a high mortality. The tsunami in 2004 has renewed its current importance. CASE REPORT: A 57 year old man was admitted to hospital with a 2 week history of fever, productive cough and progressive weight loss. On admission he was in septic shock and respiratory failures secondary to a left lower lobe community acquired pneumonia. This progressed to a left sided empyema. Bp was isolated from blood cultures and the pleural pus. Initial intensive therapy with ceftazidime and cotrimoxazole for 4 weeks, followed by cotrimoxazole alone for 20 weeks, led to complete recovery with little residual radiological abnormality. Follow up gave no evidence of relapse but revealed an operable, squamous cell, bronchial carcinoma. CONCLUSION: Melliodosis seems to be an emerging disease in New Caledonia with 10 cases identified since 1999. A favourable climate and possibly an animal reservoir might explain sporadic cases in this region. It is important for the medical profession to be aware of this disease in order to ensure the rapid and correct management of patients whose life is at risk.

[Necrotizing pneumonia due to Gemella morbillorum in an immunocompetent patient]. / Pneumopathie nécrosante à Gemella morbillorum chez un patient immunocompétent.

BACKGROUND: Gemella morbillorum is an anaerobic to aerotolerant Gram positive coccus. It is considered a member of the normal upper respiratory tract flora including the oropharynx and also the gastro-intestinal and female genital tract. However severe infections are reported like endocarditis, septic shock and septic arthritis, more often in immunocompromised hosts. It is an infrequently isolated organism and a rare cause of pulmonary or pleural infections. CASE REPORT: We report a case of necrotizing pneumonia due to Gemella morbillorum in a 45-years-old Melanesian, smoker patient. The presentation was subacute with a four month history of loss of appetite, progressive weight loss and cough without fever. Initial presentation seems to be a malignant disease. The positive diagnosis has been established on the results of BAL fluid and the protected specimen brush samples. It was an immunocompetent patient presenting dental inflammation but not oral infection. Further management included intravenous administration of amoxicillin during two weeks. We recommended oral antibiotic treatment for another six weeks. After two months the patient was reevaluated. The CT scan showed no evidence of persistent infection. The HR CT scan will reveal multiple kystic bronchiectasies not seen on the first CT scan. CONCLUSION: Gm can be found endoscopic samples. Gemella morbillorum can be responsible of community-acquired pneumonia in immunocompetent host.