Prevalence of extended-spectrum beta-lactamase producing Escherichia coli in community-onset urinary tract infections in France in 2013.

OBJECTIVES: We sought to assess the importance of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae in urinary tract infections in outpatients in France. METHODS: Retrospective laboratory based survey analysing susceptibility patterns of Escherichia coli and Klebsiella pneumoniae isolates providing from urines collected from outpatients during three months in 2013. RESULTS: Four hundred and ninety-nine laboratories collected data on 51,643 E. coli and 3495 K. pneumoniae isolates. The overall proportion of ESBL-producing E. coli was 3.3%. The proportion was higher for males (4.8%) than for females (3.0%) and increased with age: 2% for patients <20 years to 5.4% for those aged >80 years. More than 95% of isolates we susceptible to cefixime, fosfomycin, and nitrofurantoin. In nursing homes, the ESBL-producing E. coli proportion was 12.1%. For K. pneumoniae, the proportion of ESBL-positive isolates was 6.6%, and this proportion increased with age. Data from 2010 collected from a subset of the network showed that the ESBL-producing E. coli proportion was 2.0%. CONCLUSION: ESBL-producing isolates were rather frequent in urines in French outpatients in 2013. Males and persons residing in nursing homes were at higher risk of ESBL-positive infection. Despite the increase in ESBL-positive isolates, the susceptibility to antibiotics used to treat cystitis remains high.

[Screening and diagnosis of gestational diabetes. Evaluation of the methodological quality of the guidelines of the Haute Autorité de Santé, of the American Diabetes Association, and of the World Health Organisation]. / Dépistage et diagnostic du diabète gestationnel: évaluation de la qualité méthodologique des avis de la Haute autorité de santé, de l'American diabetes association et de l'Organisation mondiale de la santé

We critically appraised the methodological quality of the clinical practice guideline (CPG) published by the Haute autorité de santé (HAS) about screening and diagnosis of gestational diabetes, and we compared its quality with that of two other CPGs, i.e. that of the American diabetes association (ADA) and that of the World health organisation (WHO). According to the AGREE criteria, HAS and ADA have produced CPGs that have approximately got the same levels of quality. Both these CPGs obtain AGREE scores that are better than those of WHO. Although the CPG of the HAS suffers from a few methodological drawbacks, regarding more particularly stakeholder involvement (AGREE domain n degrees 2), applicability (AGREE domain n degrees 5) and editorial independence (AGREE domain n degrees 6), this CPG summarises, and allows to compare most, if not all, other CPGs available with each other, with their possible benefits or harms, which may be useful for professionals involved in the care of the patient.

[Practice guidelines: let us sort them]. / Guides de pratique clinique: trions-les.

A growing number of clinical practice guidelines (CPG) is published. This is understandable because CPG are the corner stone in the evaluation of professional practices (EPP). One cannot deny that EPP is necessary. However, in order for the EPP to reach their objectives, which are to use our resources better and to improve health-care, CPG at our disposal should be of good quality, both in their form and in their content. This is not always the case. What is more, health-care professionals are often not properly trained to distinguish "good" from "not so good" CPG. In this context, the Société française de biologie clinique has created a working group on "CPG and Evidence-Based Laboratory Medicine (EBLM)". One of the main objectives of our group is to publish critical appraisals of CPG on a regular basis in the Annales de Biologie Clinique (ABC). Thus, the ABC will follow the example set by other medical journals, for example in France: Prescrire. We will more particularly appraise CPGs in relation with laboratory medicine. In this first article, we describe the methods that we will use in order to distinguish "good" from "not so good" CPG. Just like Prescrire as well as like many others, our first tool will be the AGREE instrument, which is quite consensual at an international level. The AGREE tool makes it possible to appraise quite easily, and in a reproducible way, the methodological quality of CPG. We also briefly discuss the more complicated methods that can be used to make judgments about the content of CPG, bearing in mind that equity, patients' autonomy, balancing risks and benefits, are the four universal principles of medical ethics, that is of good medicine, that is of EB(L)M.

[Community-acquired urinary tract infections in 15 to 65 years old female patients in France. Susceptibility of E. coli according to history: AFORCOPI-BIO network 2003]. / Infections urinaires communautaires de la femme de 15 à 65 ans: sensibilité aux antibiotiques de E. coli en fonction des antécédents: étude AFORCOPI-BIO 2003.

OBJECTIVES: A multicenter study was implemented in order to determine the distribution and antibiotic susceptibility patterns of strains isolated from 15 to 65 year old female patients with community-acquired urinary tract infections. PATIENTS AND METHODS: From October to December 2003, 11 French private laboratories consecutively collected 420 clinical strains with medical data. Minimal inhibitory concentrations of antibiotics on E. coli were determined using the agar dilution method in a coordinating center and interpretation followed the recommendations of the Comité de l'antibiogramme de la Société française de microbiologie. RESULTS: Escherichia coli was the most prevalent pathogen (80%) followed by Proteus mirabilis (4%), Klebsiella spp (2%), other Enterobacteriaceae (4%), Enterococcus spp (3%), Staphylococcus aureus (2%), Staphylococcus saprophyticus (2%), and Streptococcus agalactiae (2%). The susceptibility of E. coli strains was 61% for amoxicillin (AMX), 93% for nalidixic acid (NAL), 97% for norfloxacin (NOR) and ciprofloxacin (CIP), 77% for cotrimoxazole (SXT), 99% for fosfomycin, gentamicin and cefotaxime. The susceptibility of E. coli was lower in case of previous treatment with beta-lactam antibiotics for AMX (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). In the same way, previous treatment with quinolones was associated with decreased susceptibility for NAL (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). CONCLUSIONS: In 2003, fluoroquinolones, third generation cephalosporins, aminoglycosides, and fosfomycin kept a good activity on E. coli collected from community-acquired urinary tract infections in 15 to 65 years old female patients in France.

[Prevalence of community-acquired methicillin-résistant Staphylococcus aureus]. / Etude de la prévalence de la résistance à la méthicilline chez Staphylococcus aureus communautaire.

OBJECTIVE: The authors had for aim to assess the prevalence of community-acquired methicillin-resistant Staphylococcus aureus in France. METHOD: Two hundred fifty-four strains identified in 1,079 nasal samples from voluntary individuals were analyzed in 2002. An antibiogram (especially measuring the inhibition diameter of cefoxitine) and screening by oxacillin (6 mug/ml) allowed the identification of strains resistant to betalactams. The resistant phenotype was confirmed by amplification of the mecA gene by PCR. The distribution of strains was compared to the resistance to various antibiotics and especially to cotrimoxazole, macrolides, aminosides, and the mechanisms of resistance were determined. RESULTS: Eleven methicillin-resistant strains were detected in 254 carriers (4.33%), or 1% of the total population studied. CONCLUSION: Complementary tests (detection of the Panton-Valentine toxin, pulsed field electrophoresis) will be necessary to finish strain characterization. It can already be stated that compared to previous studies, community-acquired MRSA carriage is weak in France.

[Genital infections in women, in community practice. Comparison of two studies, 1987 and 2002]. / Les infections génitales chez la femme en pratique de ville Enquêtes Aforcopi-BIO. Comparaison des résultats 1987 et 2002.

One thousand eight hundred and thirty-six clinical and biological cervico-vaginal flora samples from genital infections in women observed in community practice in 1987 were compared to 368 samples collected in 2001. The diagnosis of sexually transmitted infection (STI) was rarely made. Nonetheless, examining these samples made it possible either to prescribe a specific treatment for a confirmed infection (chlamydia, trichonomiasis, candidiasis, gonococci, vaginosis), or to modify a long-term treatment that was often ineffective and sometimes badly tolerated. Not all vulvar itching, associated or not with pelvic pain, is caused by mycosis. Treatment based on a syndromic approach was often ineffective, because clinical symptoms, whether isolated or associated, even when they were suggestive of an etiology, presented only a minor positive predictive value (the PPV for the association ichting + pelvic pain was only 10% for chlamydia, but 45% for candidiasis). The diagnosis of vaginosis, suggested for the past 10 years as an improvement in the diagnosis of vulvo-vaginitis, was made in only 13% of the cases. The only significant difference in our two studies was a lower number of cases of gonococci, chlamydiae, and ureaplasms in 2001, the settings having remained identical, except for a lower number of patients in 2001.

Antibiotic susceptibility and mechanisms of erythromycin resistance in clinical isolates of Streptococcus agalactiae: French multicenter study.

Among 126 Streptococcus agalactiae isolates collected in 10 French laboratories in 1999, 27 (21.4%) had macrolide resistance related to the presence of erm(B) (11 strains), erm(A) subclass erm(TR) (10 strains), and mef(A) genes (2 strains) and the presence of combinations of erm(B) and erm(A) genes or mef(A) genes (3 strains).

[Urinary tract infection in an urban population: etiology and antibiotic sensitivity as a function of patient history]. / Infections urinaires en pratique de ville: étiologies et sensibilité aux antibiotiques en fonction des antécédents. l'AFORCOPI-BIO. Association pour la Formation Continue en Pathologie Infectieuse des Biologistes.

OBJECTIVE: The aim of this study was to explore the relationship between etiological factors, bacterial isolates and Escherichia coli susceptibility to antibiotics in ambulatory patients with urinary tract infection. PATIENTS AND METHODS: A prospective study was conducted in 13 private medical laboratories in France in March 1998. Data were collected on 658 cases involving 679 strains in ambulatory patients with urinary tract infections. Data on age, gender, catheter insertion within the 7 preceding days, and history of hospitalization, urinary infection and antibiotic treatment during the 6 preceding months were recorded. The distribution of the bacterial isolates and Eschericha coli sensitivity to ciprofloxacin, cotrimoxazole, and gentamycin were studied. RESULTS: E. coli was most frequently isolated in women, in patients with no catheter or without a history of antibiotic treatment, hospitalization or urinary infection. There was no difference in E. coli sensitivity according to sex and age in women. In patients with prior antibiotic treatment, all the tested antibiotics except gentamycin were significantly less active. In case of prior hospitalization, the E. coli isolates were more resistant to amoxicillin, quinolones, cotrimoxazole and gentamycin. The level of E. coli suceptibility rose as the delay since hospitalization or urinary infection increased. CONCLUSION: Ambulatory patients comprise a heterogeneous population requiring particular attention to correctly adapt therapeutic strategies.

Fluoroquinolone resistance in the hospital versus outpatient setting.

The Lomefloxacin International Surveillance Trial (LIST) is an in vitro testing program specifically designed to assess the antimicrobial activity of lomefloxacin against a wide range of clinical isolates from hospitals, clinics, and laboratories worldwide. Lomefloxacin was used as a representative quinolone to assess susceptibility patterns of fresh clinical isolates for new fluoroquinolones. Between June 1989 and December 1990, hospitals and clinics in France contributed zone-diameter data (5 mug disk) on approximately 45 000 clinical isolates. Data were collected by a processing center in the USA and were analyzed to identify susceptibility patterns by region and by country in addition to identifying trends in high-grade fluoroquinolone resistance. This analysis showed that an unusual and widespread pattern of fluoroquinolone resistance was observed for isolates tested at tertiary-care centers in France. In order to assess whether high levels of fluoroquinolone usage in these centers might be responsible for this level of resistance, a group of six French Community Clinics was added to the testing program in 1990. From May 1990 until April 1991, these clinics contributed data on almost 4500 strains to the testing program. In most cases, there was little or no difference between susceptibility patterns obtained in French Community Clinics and University Hospitals. The only statistically significant difference noted was for Staphylococcus aureus: only 70% of French University Hospital strains were susceptible to lomefloxacin compared with 92% of Community Clinic strains (p<0.05). This result is in agreement with other studies of new fluoroquinolones carried out in the USA and worldwide. Many of the fluoroquinolone-resistant strains of Staphylococcus aureus were also resistant to methicillin and other anti-bacterial drugs.

[Frequency and antibiotic susceptibility of bacteria responsible for urinary infections in private practice from 1986 to 1990. Results of 5398 samples]. / Fréquence et sensibilité des germes isolés des infections urinaires en pratique de ville de 1986 à 1990. Bilan sur 5,398 prélèvements.

For each year from 1986 to 1990, fourteen private laboratories from all over France collected epidemiological data on germs discovered in urinary infections in France. This retrospective and comparative study covers 5,398 dossiers. The sensitivity of germs in private practice in urinary infections (ampicillin, AM-AC, cephalosporin, ceftriaxone, gentamicin, pipemidic acid, pefloxacin, cotrimoxazol) were analysed. Germ resistance tests carried out by the CMI study in the centre of reference (Pr Thabaut, HIA Bégin) showed variable divergences according to the different antibiogram techniques employed by the private laboratories.

[Frequency of germ isolation from urinary infections in community practice; their sensitivity to 7 antibiotics including a combination of amoxicillin and clavulanic acid. Evaluation on 1611 samples]. / Fréquence d'isolement des germes d'infection urinaire en pratique de ville; leur sensibilité à sept antibiotiques dont l'association amoxicilline-acide clavulanique. Bilan sur 1,611 prélèvements.

A multicenter study including 10 outpatient private laboratories (hospital laboratories excluded) was carried out in France. 1,611 urines samples from patients with UTI were collected during the forth trimester of 1987. The most frequently recovered pathogens were: E. coli (71%), Proteus mirabilis (9%), Staphylococcus coagulase (6%), Klebsiella (6%), Enterobacter (2%). Other sorts (Streptococcus D, Proteus sp, Pseudomonas aeruginosa, Enterobacter sp) were infrequent (less than 1%). The sensitivity of the aerobic Gram-negative bacteria to ampicillin, clavulanic acid-amoxicillin, cephalothin, gentamicin, pipemidic acid, norfloxacin and co-trimoxazole was tested.

[The frequency of isolating urinary infection germs at a community practice and their sensitivity to various antibiotics]. / Fréquence d'isolement de germes d'infection urinaire en pratique de ville et leur sensibilité aux différents antibiotiques.

Nine hundred and thirty one urine's specimens of patients affected by urinary infection have been studied by pathology practising in different towns in France. The most frequently germs retrieved are: Escherichia coli 76%, Proteus mirabilis 12%, Klebsiella 5%, Staphylococcus epidermidis 2%. Were studied Gram negative rods sensibility to ampicillin (A), cephalosporin 1st generation (C), nalidixic acid (Nal), gentamicin (G), norfloxacin (Norf); Gram positive cocci resistance to oxacillin (Oxa), erythromycin (E), pristinamycin (P), gentamicin (G), norfloxacin (Norf). For E. coli: the resistance was 24% A, 2% C1, 0.1% G, 4% Nal, 0.1% Norf. For Klebsiella: the resistance was respectively 96% A, 12% C1, 10% Nal, 18% G., 4% Norf. For P. mirabilis: 11% A, 3% C1, 0% Nal, 9% G, 0% Norf. E. coli strains cephalo R; Gram negative rods Genta R or quinolone R; staphylocoque oxa R or pristina R have been checked by HIA Begin microbiology laboratory. Discrepancies in results have been analysed. This study enabled the participants to improve their bacteriological technic, antibiogramm's reading, results' interpretation.

Male fertility and positive Chlamydial serology. A study of 61 fertile and 82 subfertile men.

In this study, the frequency and titers of serum antibodies to Chlamydia trachomatis in fertile and subfertile subjects and possible correlations between a positive serology and the values of conventional semen parameters were investigated. The subfertile subjects were divided into those without and those with a history of genitourinary infection. No difference was noted between the proportion of seropositive patients in the fertile group (26.2%) as compared with those in the subfertile group with no history of genitourinary infection (27.7%). The percentage of positive tests was significantly increased only in the subfertile group with past genitourinary infection (53.5%). No difference was found between the antibody titers of the fertile and subfertile groups. Only the fertile group had any semen parameter, namely, the volume of the ejaculate, that was significantly different between the seropositive and seronegative patients. In conclusion, three main points should be stressed; the high frequency of serum antibodies to Chlamydia trachomatis in the control subjects and the apparent absence of effects of a positive serology on their fertility; the significant correlation between a past genitourinary infection and the presence of serum antibodies to Chlamydia trachomatis; and the need for a test to assess Chlamydia in semen.