Management of an outbreak of invasive Kingella kingae skeletal infections in a day care center.

BACKGROUND: Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak. METHOD: Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center. RESULTS: We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively. CONCLUSION: Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.

Characterization of a multidrug-resistant Klebsiella pneumoniae ST607-K25 clone responsible for a nosocomial outbreak in a neonatal intensive care unit.

PURPOSE: Multidrug-resistant Klebsiella pneumoniae strains are regularly involved in hospital outbreaks. This study describes an ESBL-producing K. pneumoniae clone (ST607-K25) responsible for a nosocomial outbreak in a neonatal intensive care unit. METHODOLOGY: Fourteen strains isolated from 13 patients were included. Antimicrobial susceptibility testing was performed by the agar diffusion method. A clonal link was first investigated by fingerprinting (ERIC-PCR and REP-PCR) then confirmed by MLST. Characterization was performed by molecular detection and identification of several drug resistance and virulence determinants. RESULTS: All strains expressed the same antibiotype, combining ESBL production, fluoroquinolones and aminoglycoside resistance, except for one which remained susceptible to fluoroquinolones. Fingerprinting methods confirmed the clonal link and MLST identified a ST607 clone. Molecular investigations revealed: (I) genes encoding for two narrow-spectrum beta-lactamases (SHV-1 and TEM-1) and an ESBL (CTX-M-15); (II) absence of any chromosomal mutation in quinolone resistance-determining- regions (QRDR) of gyrA/gyrB and parC/parE genes; (III) genes encoding for three plasmid-mediated quinolone-resistance (PMQR) determinants: oqxAB (14/14), aac(6')-Ib-cr (14/14) and qnrB (13/14); (IV) production of a K25 capsule; and (V) carriage of three genes encoding for virulence factors: mrkD (type 3 fimbriae) (14/14), ybts (yersiniabactin) (12/14) and entB (enterobactin) (14/14). CONCLUSION: We described a multidrug-resistant Kp ST607 clone responsible for a nosocomial outbreak in vulnerable and premature newborns. Molecular investigations allowed us to identify several resistance factors responsible for ESBL production (CTX-M-15) and quinolone resistance (three PMQR determinants). The detection of a gene (ybtS) belonging to the high-pathogenicity island yersiniabactin could partly explain its high colonization and diffusion potential.

Limited efficacy of nontreponemal test combined with treponemal test in the initial syphilis screening algorithm.

PURPOSE: Various syphilis screening algorithms have been proposed and are now used by many clinical laboratories following the introduction of automated treponemal tests (TTs). In France, the diagnosis of syphilis is based on a TT combined with a nontreponemal test (NTT). The objective of this study was to evaluate the diagnostic impact of NTT on initial syphilis screening at the Amiens University Hospital between January 2013 and December 2016. METHODOLOGY: Serum samples sent for syphilis testing were analysed using a treponemal enzyme immunoassay (Siemens IMMULITE 2000 Syphilis Screen) combined with a nontreponemal test. Enzyme immunoassay (EIA)-reactive and/or nontreponemal-reactive samples were titrated to endpoint using the Treponema pallidum particle agglutination test (TPHA). Complementary tests, such as line immunoassay, and medical charts were reviewed to categorize reactive samples into positive or negative syphilis contacts. RESULTS: Among 15 523 initial screening samples, 148 samples (0.95 %) were reactive with the combined TT and NTT, and 335 (2.16 %) and 66 (0.42 %) were reactive with TT or NTT only. Analysis of the 66 discordant results between TT and NTT showed that only 4 sera were reactive with a second-line TPHA, but these results were not confirmed by line immunoassay and patient characteristics. CONCLUSION: The results of this study show that the combination of NTT and TT for initial screening does not provide any diagnostic gain, but represents additional laboratory work time.

Late recurrence of an osteoarticular infection caused by Klebsiella pneumoniae in a child.

Klebsiella pneumoniae is an opportunistic pathogen in neonates. A 23-day-old newborn developed septic arthritis of the right hip due to an ESBL-producing strain. A recurrence on the knee was observed at 4 years of age. A molecular investigation confirmed the clonal link of the strains responsible for the two infections and allowed us to identify virulence factors.

Multicenter performance evaluation of the Unyvero IAI cartridge for detection of intra-abdominal infections.

Intra-abdominal infections (IAIs) are one of the most common type of infections in patients with sepsis and an important cause of death in intensive care units. Early detection and treatment are necessary to reduce patient complications and improve outcomes. The Unyvero IAI Application (Curetis GmbH) is the first automated assay to rapidly and simultaneously identify a large panel of bacteria, fungi, toxins, and antibiotic resistance markers directly from IAI-related samples. The assay was evaluated in four European clinical laboratories in comparison to routine microbiological practices. A total of 300 clinical samples were tested with an overall sensitivity of 89.3% and specificity of 99.5%, while time to results was reduced by an average of about 17 h compared to identification (ID) results and 41 h compared to full antibiotic susceptibility testing (AST) results. The Unyvero IAI was able to detect additional microorganisms compared with culture, in particular anaerobes, with most detections confirmed by sequencing. The most frequent resistance markers detected were mecA/mecC (n = 25), aacA4 (n = 20), and blaCTX-M (n = 17) and carbapenemase genes were identified in nine specimens. Further studies are now required to determine the clinical impact of this new rapid test which could play a role in the successful treatment of IAI.

Comparison of MALDI-ToF MS with the Rapidec Carba NP test for the detection of carbapenemase-producing Enterobacteriaceae.

Although carbapenemase-producing Enterobacteriaceae (CPE) have become a serious public health issue, their detection remains challenging. The aim of this study was to implement a test based on imipenem hydrolysis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS), using 65 strains producing or not a carbapenemase. Then, we compared its performance to that of the Rapidec Carba NP test using 20 additional strains. The MS-based test effectively discriminated between CPE and other non-carbapenem-susceptible strains compared to the Rapidec Carba NP test (sensitivity 100% and 92%, specificity 94% and 92%, respectively). The MS-based test gave less difficulty in interpretation than the colorimetric Rapidec Carba NP test. MALDI-ToF gave a result in less than one hour and limited the use of expensive molecular assays. In conclusion, the hydrolysis test based on MALDI-ToF MS can detect clinically relevant CPE isolates in routine practice. This technology, also described to screen for carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii complex strains, also seems to be interesting in routine practice for these pathogens.

Place of diagnostic tools in the identification of Anaerobiospirillum succiniciproducens bacteraemia.

Anaerobiospirillum succiniciproducens is a rare but potentially lethal pathogen. We report a case of A. succiniciproducens bloodstream infection in a 55-year-old man hospitalized for pelvic trauma. The strain was identified by 16sRNA sequencing after several failures of identification by MALDI-TOF MS. The strain was susceptible to beta-lactam antibiotics and ciprofloxacin, but resistant to macrolides and clindamycin. Identification tools must be improved to enhance our knowledge on this rare pathogen and to define optimal therapy.

[Bronchial carcinoma and intensive care]. / Cancer bronchopulmonaire et réanimation.

INTRODUCTION: Lung cancer is a disease with a poor prognosis. Therapeutic innovations in oncology and the optimisation of intensive care patient management have improved the prognosis of lung cancer presenting with acute life-threatening respiratory or cardiac emergencies. OBSERVATION: We reported on the case of a patient with lung cancer presenting with mildly abundant haemoptysis, who was hospitalised in intensive care. After multidisciplinary discussion, the patient was intubated following recurrent haemorrhage that resulted in respiratory failure. The outcome was favourable. Four months later, this patient was still alive and autonomous. DISCUSSION: After years of pessimism, the medical literature has revealed an improvement in lung cancer patients' survival. Respiratory failure and shock are the main reasons for admission to the intensive care unit. The mortality risk factors depend more on acute conditions than on the underlying lung cancer. The patient's admission must be made before multiorgan failure occurs, along with the implementation of non invasive therapies. The use of intensive care as a bridge to overcome an acute event is a possible means of caring for the patient. CONCLUSION: Consideration of the acute event is important when deciding whether to hospitalise a patient with lung cancer in intensive care. An early admission, if indicated, is desirable. The course in the first 72hours provides a good estimation of the patient's prognosis and helps to achieve better treatment.

[What treatment for a patient of PS 2-3 with stage IV non-small cell lung cancer?]. / Quel traitement pour un patient de PS-2/3 ayant un cancer bronchique non à petites cellules (CBNPC) de stade IV?

Patients with poor performance status (PS) and advanced lung cancer have been underrepresented in clinical trials. As a consequence, the management of these patients in clinical practice is often empirical. Recent data indicate that patients with advanced non-small cell lung cancer (NSCLC) and a PS of 2 tend to benefit from first line chemotherapy with respect to symptom improvement and perhaps overall survival. Whether single-agent or combination chemotherapy is preferable remains debatable. In previously treated patients with NSCLC, EGFR tyrosine kinase inhibitors produced a substantial rate of clinical benefit and led to an improvement in survival compared with placebo in studies that included a significant percentage of patients with poor PS.