Survey of the antimicrobial resistance of Helicobacter pylori in France in 2018 and evolution during the previous 5 years.

BACKGROUND AND OBJECTIVES: Surveillance of Helicobacter pylori resistance to antibiotics was carried out in France in 2014, 2016, and 2018. We report here the results of the 2018 survey as well as the evolution over the 5-year period. MATERIALS AND METHODS: In this observational study, gastric biopsies were obtained by 62 gastroenterologists randomly selected in 5 regions of France and sent to a central laboratory where culture, antimicrobial susceptibility testing, and a real-time PCR were performed in order to detect H pylori and its mutations associated with clarithromycin resistance. RESULTS AND CONCLUSION: During the year 2018, 951 patients were included: 55.3% women, mean age: 52.4 years ± 15.7, 71.6% born in France. Among them, 359 patients were H pylori positive by both culture and real-time PCR, and 7 more by PCR only. There were 244 naive patients, 110 previously treated patients, and unknown for 5. Primary resistance to clarithromycin was 20.9% [16.3-26.4], to levofloxacin 17.6% [13.4-22.9], and to metronidazole 58.6% [52.3%-64.6%]. Secondary resistance for these antibiotics was 56.4%, 22.7%, and 87.3%, respectively. There was no resistance to amoxicillin and tetracycline and very low resistance to rifampicin (1.2%) in both naive and treated patients. Primary resistance to clarithromycin decreased from 22.2% to 20.3% between 2014 and 2016, and appears to be stable since then. This can be linked to a stable consumption of macrolides over the 3-year time period. Primary levofloxacin resistance was relatively stable while metronidazole resistance increased. Interestingly, in both naive and treated patients, amoxicillin and rifampicin resistance were rare.

A new kit to detect Campylobacter species in stool specimens: the Orion GenRead Campylobacter®.

Campylobacter enteritis is the most frequent bacterial enteritis including in children. Its diagnosis suffers from the lack of sensitivity and delayed result of culture. Our aim was to test a new PCR-derived method for Campylobacter diagnosis in comparison to a composite reference. Patients presenting to the emergency ward of our hospital with enteric symptoms during the 2016 summer season were included. In addition to culture, an ELISA and an in-house real-time PCR were performed, as well as the new method (Orion GenRead Campylobacter) on all stool specimens. The composite reference used to consider a case positive for Campylobacter was either culture positive and in case of negative culture both the ELISA and real-time PCR positive. One hundred fifty patients were included, 64 being infants or children. There were 29 cases positive by the composite reference, with 19 of the 64 children (29.7%) and 10 of the 86 adults (11.6%). If performed alone, culture would have missed six cases. The Orion GenRead Campylobacter detected all the positives by the composite reference but also 12 cases negative by the composite reference (sensitivity 100%, specificity 90.1%). Given the characteristics of the new method, it can be used as a screening method for Campylobacter detection.

Prophylaxis and management of wound infections after elective colorectal surgery: a survey of the American Society of Colon and Rectal Surgeons membership.

BACKGROUND: Postoperative wound infections are a widespread and costly problem, especially in colorectal surgery. Despite their prevalence, there are few data regarding appropriate management and prevention strategies. MATERIALS AND METHODS: In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial to gather evidence in order to support data-driven protocol development, an e-mail survey was sent to the membership of the American Society of Colorectal Surgeons to assess current attitudes and practices pertaining to prevention and management of wound infections. RESULTS: Most respondents estimated that the wound infection rate in their own patients was much lower than commonly reported in the literature. Use of evidence-based perioperative strategies for reducing wound infection, such as the use of a wound protector, hyperoxygenation, and implementation of the Surgical Care Improvement Project guidelines, were far from universal. Management strategies varied widely, without apparent rational basis. CONCLUSION: Based on the practices and beliefs in the surgical community, it is our hope that a multi-institutional study can be carried out to objectify best practices in both the effective and cost-effective management of this common condition and to reduce the wide variation in the treatment of surgical site infections.

The gap in laparoscopic colorectal experience between colon and rectal and general surgery residency training programs.

PURPOSE: In this article, we review the laparoscopic experience of general surgery and colorectal residency training programs in the United States during the past 5 and 12 years, respectively. The purpose of this study was to determine whether an adequate experience was being provided, and at what level of training, to safely and effectively perform advanced laparoscopy. METHODS: General Surgery Operative Reports from the training years 2000 to 2004 were obtained from the Accreditation Council for Graduate Medical Education. Similarly, colorectal operative performance logs from the training years 1994 to 2005 were obtained from the American Board of Colon and Rectal Surgery. RESULTS: From 2000 to 2004, basic and advanced laparoscopic cases (as designated by the Accreditation Council for Graduate Medical Education) have increased from 10.1 to 12.2 percent and 2.1 to 3.7 percent, respectively. Within this period, the number of laparoscopic colon cases/resident/career has increased from 1.8 to 4.6. The percentage of cases performed laparoscopically increased from 3.9 to 22.5 percent from 1993-1994 to 2004-2005 training years. From 1993 to 2001, the average number of laparoscopic cases/resident increased from 6.3 to 16.1. In 2004, the average number of cases/resident increased to 45.3. Of this number, 30 were colon, 9.4 were rectal, and the remaining 5.9 were miscellaneous colorectal procedures. CONCLUSIONS: Learning curves for laparoscopic colectomy are reported in the range of 20 to 60 cases. Based on the most recent data reviewed, colon and rectal resident experience is tending toward this threshold. Recent general surgery graduates may be lacking the appropriate volume to reach proficiency in laparoscopic colorectal surgery.

Mesenteric venulitis in a 71-year-old man after acute appendicitis.

Mesenteric inflammatory veno-occlusive disease (MIVOD) is a clinicopathological entity recently described for a case series of patients with intestinal ischemia of unknown etiology. MIVOD is characterized as a venulitis with lymphocytic, necrotizing, or mixed granulomatous morphology. The disease seems to be self-limiting with resolution of symptoms after surgical resection. We describe a 71-year-old man who developed focal intestinal ischemia in the postoperative period after laparoscopic appendectomy. At re-exploration, a 20-cm segment of grossly ischemic jejunum was identified and resected. The excised specimen demonstrated early ischemic mucosal injury and necrotizing mesenteric venulitis with thrombosis, consistent with verso-occlusive disease. The etiology of this rare vasculitis is currently unknown. We present our case report, which is followed by a review of the literature of MIVOD.

Intramuscular myxomas: a clinicopathologic study with emphasis on surgical management.

Intramuscular myxomas (IMs) are rare myxoid tumors named for their abundance of noncollagenous mucinous stroma. IMs are benign tumors characterized by a paucity of cells, diminished vascularity, and minimal mitotic figures. The objectives of this study were to examine clinicopathologic features of IM and to discuss clinical management of these unusual soft tissue tumors. A 10-year retrospective study at Orlando Regional Medical Center was conducted from May 1993 to May 2003. A case report of a 48-year-old male with a right gluteal mass is presented. Four cases with histologically confirmed diagnosis of intramuscular myxoma were reported. Three patients presented with lesions of the lower extremity and one with an extrafascial IM of the eighth rib. One of the lower extremity cases was shown to be cellular myxoma, a recently characterized subtype of IM. All cases were treated with at least marginal excision of the mass. There have been no known recurrences. Our findings are consistent with described characteristics for IM with respect to anatomic location and gross and microscopic appearance. As it may be unreliable to differentiate IM from malignant myxoid tumors preoperatively, we favor excision with wide margins in the surgical management of these tumors.