Hospital surveillance predicts community pneumococcal antibiotic resistance in Vietnam.

BACKGROUND: In Vietnam, Streptococcus pneumoniae is a leading cause of disease, including meningitis. Antibiotics are available without physician prescription at community pharmacies and rates of antibiotic non-susceptibility are high. Appropriate treatment and antibiotic stewardship need to be informed by surveillance data. OBJECTIVES: To report community-based pneumococcal antibiotic susceptibility testing data from children enrolled in a pneumococcal conjugate vaccine trial in Ho Chi Minh City [the Vietnam Pneumococcal Project (ViPP)] and compare these with published hospital-based data from the nationwide Survey of Antibiotic Resistance (SOAR) to determine whether hospital surveillance data provide an informative estimate of circulating pneumococcal resistance. METHODS: Pneumococcal isolates from 234 nasopharyngeal swabs collected from ViPP participants at 12 months of age underwent antibiotic susceptibility testing using CLSI methods and the data were compared with SOAR data. RESULTS: Antibiotic susceptibility testing identified penicillin-non-susceptible pneumococci in 93.6% of pneumococcus-positive ViPP swabs (oral, non-meningitis breakpoints). Non-susceptibility to erythromycin, trimethoprim/sulfamethoxazole, clindamycin and tetracycline also exceeded 79%. MDR, defined as non-susceptibility to three or more classes of antibiotic, was common (94.4% of swabs). Low or no resistance was detected for ceftriaxone (non-meningitis breakpoints), ofloxacin and vancomycin. Antibiotic non-susceptibility rates in ViPP and SOAR were similar for several antibiotics tested. CONCLUSIONS: A very high proportion of pneumococci carried in the community are MDR. Despite wide disparities in population demographics between ViPP and SOAR, the non-susceptibility rates for several antibiotics were comparable. Thus, with some qualification, hospital antibiotic susceptibility testing data in Vietnam can inform circulating pneumococcal antibiotic non-susceptibility in young children, the group at highest risk of pneumococcal disease, to guide antibiotic prescribing and support surveillance strategies.

[Fractures of the frontal sinus. Therapeutic indications]. / Fractures du sinus frontal. Indications thérapeutiques.

Attitudes towards therapy of frontal sinus fractures, in the Plastic and Maxillofacial Surgical Department of the Foch Medical-Surgical Unit, are discussed. Only those fractures with displacement, a possible cause of complications, are envisaged, the conduct adopted being described in detail as a function of the wall affected. Treatment should be directed along the following lines: --A harmonious frontal outline can be obtained by osteosynthesis of the bone fragments if certain conditions are fulfilled, or by a bone graft. --The sinus cavity should be excluded and filled by spongy grafts when an anterior wall graft is inserted. --Neurosurgical explorations are necessary if a posterior wall defect provides a threat to the meninges, followed by cranialization and obturation of the nasofrontal canal. --Physiological drainage must be ensured for the sinus cavity, particularly in inferior wall fractures.