Multidisciplinary management of patients presenting with Lyme disease suspicion.

OBJECTIVE: The teaching hospital of Nancy, France, implemented a specific multidisciplinary care pathway (French acronym AMDPL) to improve the management of patients presenting with Lyme borreliosis (LB) suspicion. We aimed to assess the first year of activity of this care pathway. PATIENTS AND METHODS: We included all patients managed in the AMDPL pathway from November 1, 2016 to October 31, 2017. The first step was a dedicated Lyme disease consultation with an infectious disease specialist. Following this consultation, the LB diagnosis was either confirmed and adequate treatment was prescribed, or a differential diagnosis was established and patients received adequate management, or further investigations were required and patients were offered multidisciplinary management as part of a day hospitalization. RESULTS: A total of 468 patients were included. LB diagnosis was confirmed in 15% of patients (69/468), 49% of patients received a differential diagnosis, and 26% (122/468) of patients had the LB diagnosis ruled out without receiving any other diagnosis. CONCLUSIONS: This is to our knowledge the first multidisciplinary center implemented in France for the management of patients presenting with LB suspicion related to polymorphous signs and symptoms. Several diagnoses could be confirmed or corrected, although some symptoms and complaints could not be explained. This cohort could improve our knowledge of LB and its differential diagnoses.

Reducing surgical site infection incidence through a network: results from the French ISO-RAISIN surveillance system.

Surgical-site infections (SSIs) are a key target for nosocomial infection control programmes. We evaluated the impact of an eight-year national SSI surveillance system named ISO-RAISIN (infection du site opératoire - Réseau Alerte Investigation Surveillance des Infections). Consecutive patients undergoing surgery were enrolled during a three-month period each year and surveyed for 30 days following surgery. A standardised form was completed for each patient including SSI diagnosis according to standard criteria, and several risk factors such as wound class, American Society of Anesthesiologists (ASA) score, operation duration, elective/emergency surgery, and type of surgery. From 1999 to 2006, 14,845 SSIs were identified in 964,128 patients (overall crude incidence: 1.54%) operated on in 838 participating hospitals. The crude overall SSI incidence decreased from 2.04% to 1.26% (P<0.001; relative reduction: -38%) and the National Nosocomial Infections Surveillance system (NNIS)-0 adjusted SSI incidence from 1.10% to 0.74% (P<0.001; relative reduction: -33%). The most significant SSI incidence reduction was observed for hernia repair and caesarean section, and to a lesser extent, cholecystectomy, hip prosthesis arthroplasty, and mastectomy. Active surveillance striving for a benchmark throughout a network is an effective strategy to reduce SSI incidence.

Overview of diagnostic and detection methods for legionellosis and Legionella spp.

Since 1977, the diagnostic tools for Legionnaires' disease have been based on culture and serological investigations. Both methods require considerable time to produce results and have 'low' to 'reasonable' sensitivity. Since the introduction of urinary antigen tests in the mid 1990s, underdiagnosis has diminished and mortality has declined, thanks to early diagnosis. To obtain the most accurate diagnosis, culture, serological investigation, and urinary antigen testing should all be performed. In the last decade, advances in polymerase chain reaction technology allowed the development of assays detecting Legionella nucleic acids in clinical and environmental samples. Thus far, only widely varying results with relatively small series have been reported. Furthermore, these assays which are still labour intensive and complicated are not yet practicable for the average medical and/or environmental microbiological laboratory.

Trends of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae-producing extended-spectrum beta-lactamase (ESBLE) in eastern France: a three-year multi-centre incidence study.

The objective of this study was to describe trends for the years 2004 to 2006 in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae-producing extended-spectrum beta-lactamase (ESBLE) in a large hospital network (70 hospitals in eastern France). The incidence of MRSA per 1,000 patient-days decreased significantly from 0.55 in 2004 to 0.45 in 2006. This trend was observed in medicine and surgery units, whereas MRSA incidence was stable in intensive care, paediatric and obstetric units. The incidence of blood cultures positive for MRSA remained stable at 0.04 per 1,000 patient-days. Conversely, the incidence of ESBLE increased significantly from 0.04 in 2004 to 0.08 in 2006. This increase was caused by the spread of ESBLE-producing Escherichia coli. The mean consumption of alcohol-based gel and solution (ABS), expressed in litres per 1,000 patient-days, was 3.3 in 2002, 4.5 in 2003, 5.4 in 2004 and 6.4 in 2005. There was no association between the consumption of ABS and MRSA incidence. These findings suggest that the French recommendations for the control of multi-drug-resistant bacteria (MDRB) have been effective in reducing, or at least stabilising, the incidence of MRSA in an international context of general increase. However, the diffusion of ESBLE-producing E. coli is a matter of concern and should be carefully monitored.

Bacteremia caused by a novel species of Sphingobacterium.

A Gram-negative rod was isolated from the blood cultures of an 84-year-old man with foot cellulitis. The bacterium was first identified as Sphingobacterium spiritivorum on the basis of standard assimilation tests. However, sequencing analysis of its 16S rRNA genes and whole genome hybridization studies with other related bacteria showed that this isolate belongs to a so far undescribed species of Sphingobacterium, close to S. mizutae. This bacterium was susceptible to most of the antibiotics tested, including glycopeptides, but was resistant to aminoglycosides and polymyxins. Treatment with amoxicillin-clavulanate cured the infection.

Low-density lipoprotein ability to generate lipoperoxides in healthy subjects: variations according to age.

Oxidized low-density lipoproteins (LDLs) are recognized to be involved in atherosclerosis development. Since the plasma oxidized LDL assay is inadequate because of the short half-lives of LDLs, measurement of the in vitro ability of LDLs to generate lipoperoxides (LDL-GLs) has been preferred. The present study displays a profile of LDL-GLs in a group of 175 healthy subjects, using a method to measure thiobarbituric acid-reactive substances. We have observed an increased LDL-GL level according to age.

[Free radicals and HIV infection]. / Radicaux libres et infection par le VIH.

In HIV infected patients, the increase of the concentration of free radicals is related to: a depletion of protective system (glutathione peroxidase, superoxide dismutase, vitamin E, selenium ...), and an increased production of free radicals (superoxide anion, hydrogen peroxide, hydroxil radical) consecutive to the activation of lymphocytes and phagocyting cells, the chronic inflammation, the increased polyinsatured fatty acids concentration and lipoperoxidation, and direct or indirect effect of several pathologic agents including Mycoplasma sp. This free radical excess could impair cell membranes and generate apoptosis, the main cause of lymphocytes CD4+ depletion. After a brief review of the free radicals synthesis pathway, their potential deleterious effects and the protective systems, the role of free radicals in the pathogenesis of HIV infection are discussed in regard to data reported in the literature.

[Influence of visible interferences on biochemical assays realised on Au 5231, AU 5223 (Olympus) and CL 7200 (Shimadzu)]. / Influence des interférences visibles sur les dosages de biochimie réalisés sur AU 5231, AU 5223 (Olympus) et CL 7200 (Shimadzu).

The impact of the major interferents (hemolysis, bilirubin, turbidity), on the quality of biochemical tests, was evaluated on multiparametric analysers (CL 7200 Shimadzu, Japan/Ciba-Corning, France; AU 5231 and AU 5223 Olympus, Japan/bioMérieux, France), according to the SFBC instructions. Interferences were detected in 33 cases upon 165 tests realized, that is to say 20% of the performed analysis. Turbidity was the most frequent cause of interference (7.8%), followed by hemolysis (8.5%) and bilirubin (3.6%). The use of a sample blank, a bireagent, the change of reagent, the change of the secondary wavelength or the modification of the measurement times, allowed us to reduce more than 80% of the interferences. Only three interferences remained: hemolysis upon the measurement of TGO and potassium, and bilirubin upon the measurement of creatinine. For these parameters, a suitable note using the Olympus factors (semi quantitative expression of the importance of the three interferents) is reported on the answer sheet.

Measurement of plasma testosterone by gas chromatography-negative-ion mass spectrometry using pentafluoropropionic derivatives.

Plasma testosterone was measured by gas chromatography-negative-ion chemical ionisation mass spectrometry (GC-MS). The testosterone was extracted from plasma using home-made Extrelut columns and diethyl ether elution. It was quantified as the pentafluoropropionate (PFP) derivative by selected-ion monitoring at m/z 560 (testosterone) and 563 (d3-testosterone), accounting for about 34% of the total ion. The characteristics of the method were: extraction recovery about 95%; linearity over the range 1.7-71.5 nmol l-1 with linear regression equation y = 1.41x + 0.0217, r = 0.999; detection limit 3.5 fmol injected with a signal-to-noise ratio of 7.4; within-day variation, 3% for GC-MS, and 5.8% for the whole process; day-to-day coefficient of variation, 6.6-11%, depending on the concentrations. There was a good correlation between the results obtained by GC-MS and RIA (r = 0.994), but the GC-MS values were significantly lower (p < 0.05) than those obtained by RIA.

[In vivo bactericidal effect of ciprofloxacin, ofloxacin and pefloxacin against Staphylococcus aureus]. / Etude de l'activité bactéricide in vivo de la ciprofloxacine, de l'ofloxacine et de la péfloxacine vis-à-vis de Staphylococcus aureus.

The bactericidal activity of ciprofloxacin, ofloxacin, pefloxacin, against methicillin sensitive S. aureus (2 different strains) was studied on a model of infected fibrin clots inserted subcutaneously in rabbit. The quinolones were delivered intravenously, as a single daily dose of 100 mg/kg/day. The bactericidal activity was evaluated by determining for various time points (1 h, 2 h, 6 h, 12 h, and 24 h after the infusion of the antibiotics), viable organisms in the dissolved clots. This study shows that: 1) No significant difference appears between the quinolones studied. 2) The in vivo early bactericidal activity of quinolones against S. aureus appears to be better than oxacillin but lesser than oxacillin-netilmicin combination.

[In vivo bactericidal activity of an oxacillin-netilmicin combination against Staphylococcus aureus. Influence of the rhythm of netilmicin administration]. / Etude de l'activité bactéricide in vivo de l'association oxacilline-nétilmicine vis-à-vis de Staphylococcus aureus. Influence du rythme d'administration de la nétilmicine.

The bactericidal activity of two regimens of netilmicin (8 mg/kg/day) given intravenously once a day (od) or thrice daily (tid) both alone and in combination with oxacillin (200 mg/kg/day) was compared using a model of fibrin clots infected with a strain of Staphylococcus aureus (10(7) CFU/g) sensitive to methicillin and netilmicin (clinical isolate) and implanted subcutaneously in rabbit. This study shows that: 1) Netilmicin given alone as both single and divided doses results in early bacterial killing but does not exert a bactericidal effect after 24 hours because of a significant late increase of the number of bacterial. 2) The netilmicin-oxacillin combinations are more bactericidal at 1 h, 2 h and 24 h than oxacillin alone (P less than 0.001). 3) The oxacillin-netilmicin combination appears to be better for bacterial killing when netilmicin is given thrice daily (P less than 0.001). It is hard to draw a clinical inference from such an experimental study but it seems that 8-hour divided doses intervals should be better for administration of netilmicin than single daily dose during the acute period of staphylococcal infections.