Hip Joint Infections Caused by Multidrug-Resistant Enterobacterales Among Patients With Spinal Cord Injury: Experience of a Reference Center in the Greater Paris Area.

Background: We aimed to describe the management and treatment of hip joint infections caused by multidrug-resistant Enterobacterales among patients with spinal cord injury (SCI). Methods: We included all hip joint infections associated with grade IV decubitus ulcers caused by extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales treated in a reference center for bone and joint infections over 9 years in a retrospective study. Results: Seventeen SCI patients with ischial pressure ulcers breaching the hip capsule (mean age 52 ± 15 years) were analyzed. In 16 patients, paraplegia was secondary to trauma and 1 was secondary to multiple sclerosis. Infections were mostly polymicrobial (n = 15; 88.2%), notably caused by Klebsiella pneumoniae (n = 10) and Staphylococcus aureus (n = 10). The carbapenemases identified were exclusively OXA-48-type (n = 3) including 2 isolates coexpressed with ESBL-PE within the same bacterial host. Multidrug-resistant Enterobacterales were commonly resistant to fluoroquinolones (n = 12; 70.6%). Most therapies were based on carbapenems (n = 10) and combination therapies (n = 13). Median duration of treatment was 45 (6-60) days. Of 17 cases of hip joint infections, 94.1% (n = 16) benefited from a femoral head and neck resection. Infection control was initially achieved in 58.8% (n = 10) of cases and up to 88.2% after revision surgeries, after a median follow-up of 3 (1-36) months. Conclusions: Hip infections among SCI patients caused by multidrug-resistant Enterobacterales are often polymicrobial and fluoroquinolones-resistant infections caused by Klebsiella pneumoniae and S aureus, highlighting the need for expert centers with pluridisciplinary meetings associating experienced surgeons, clinical microbiologists, and infectious disease specialists.

Essential Oil of Deverra tortuosa Aerial Parts: Detailed Chemical Profile, Allelopathic, Antimicrobial, and Antioxidant Activities.

Essential oils (EOs) are a promising group of natural products of the aromatic plants due to their various biological effects such as allelopathic, antioxidant, antimicrobial activities. The present study aimed to construct the detailed chemical profile of the EO derived from Deverra tortuosa aerial parts along with assessing its allelopathic, antimicrobial, and antioxidant potentialities. The EO was extracted by hydrodistillation and analyzed via gas chromatography-mass spectrometry (GC/MS). The allelopathic activity of the EO was assessed against the germination and seedling growth of the weed Chenopodium murale. Also, the EO was tested against five microbes. The antioxidant activity was determined using the free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS). The GC/MS analysis of EO revealed the presence of 86 compounds with a preponderance of oxygenated sesquiterpenes and monoterpene hydrocarbons. Widdrol, ß-phellandrene, piperitol, cubedol, α-terpinene, (E)-10-heptadecen-8-ynoic acid methyl ester, citronellyl tiglate, and m-cymene were the major compounds. A comparative profile was established between the EOs constituents of our study with the documented EOs of D. tortuosa and the other Deverra species around the world via agglomerative hierarchical clustering (AHC) and principal components analysis (PCA). The EO showed a substantial allelopathic activity against C. murale, as well as it showed considerable antimicrobial and antioxidant activities. Thereby, the EO of D. tortuosa could be considered as a promising environmental-friendly bioherbicide against weeds. Also, it could be integrated into food preservation due to its potent antimicrobial and antioxidant activities. However, further study is recommended for more characterization of the major compounds and evaluation of their activities, either singular or synergistic, and assess their efficiency and biosafety.

Purification of soybean cupins and comparison of IgE binding with peanut allergens in a population of allergic subjects.

Identification, purification and characterization of allergens is crucial to the understanding of IgE-mediated disease. Immunologic and structural studies with purified allergens is essential for understanding relative immunogenicity and cross-reactivity. In this work, the complex soybean 7S vicilins (Gly m 5) with three subunits and 11S legumins (Gly m 6) with five subunits were purified and characterized along with purified peanut allergens (Ara h 1, 2, 3, and 6) by label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS). Individual subjects plasma IgE binding was tested from subjects allergic to soybeans and or peanuts by immunoblotting, ImmunoCAP™ and ISAC™ ImmunoCAP chip, comparing these soybean proteins with those of purified peanut allergens; vicilin (Ara h 1), 2S albumin (Ara h 2 and Ara h 6) and 11S globulin (Ara h 3). Results show differences between methods and subjects demonstrating the complexity of finding answers to questions of cross-reactivity.

Clinical and microbiological features associated with group B Streptococcus bone and joint infections, France 2004-2014.

This study describes the clinical and microbiological features associated with group B Streptococcus (GBS) bone and joint infections (BJIs). It was a retrospective analysis of adult cases of GBS BJIs reported to the French National Reference Center for Streptococci from January 2004 to December 2014. Clinical data and GBS molecular characteristics are reported. Strains were collected from 163 patients. The most frequent comorbidities were: solid organ cancer (n = 21, 21%) and diabetes mellitus (n = 20, 20%). The main infection sites were knee (47/155 = 30%) and hip (43/155 = 27%), and occurred on orthopedic devices in 71/148 cases (48%). CPS III (n = 47, 29%), Ia (n = 26, 16%) and V (n = 40, 25%) were predominant. Resistance to erythromycin, clindamycin and tetracycline was detected in 55/163 (34%), 35/163 (21%) and 132/163 (81%) strains, respectively. The most frequent sequence types were ST-1 (n = 21, 25%), ST-17 (n = 17, 20%) and ST-23 (n = 11, 13%). The rate of resistance to erythromycin was 0% for ST-17 strains, 52% (n = 11) for ST-1 and 44% (n = 7) for ST-23 (p < 0.001). GBS bone and joint infections predominantly occur in patients aged >50 years and/or with comorbidities such as cancer and diabetes mellitus. CPS type distribution and MLST are very similar to that of other adult GBS invasive infections.

Implementation of a simple innovative system for postprescription antibiotic review based on computerized tools with shared access.

BACKGROUND: Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance. AIM: To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital. METHODS: An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum ß-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions. The data [patient, antibiotic(s), prescription start date, etc.] were registered on an AMT spreadsheet with shared access, where the microbiologist's opinion on the drug choice, based on available microbiology results, was entered. When the microbiologist and pharmacist did not approve the antibiotic prescribed, a same-day alert was generated and sent to the IDS. That alert led the IDS to re-evaluate the treatment. FINDINGS: From 2012 to 2014, 2106 targeted antibiotic prescriptions were reviewed. Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the IDS. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was <30 min/day for each AMT member. This system allowed correct use of targeted antibiotics for 91.8% of prescriptions, but had no significant impact on targeted antibiotic consumption. CONCLUSION: This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limited misuse of broad-spectrum antibiotics.

Chikungunya associated with cutaneous ulcerations.

Chikungunya is a viral infection commonly causing fever and arthralgias, sometimes accompanied with myalgias and rash. We report a 72-year-old woman presenting with a 3-month history of painful cutaneous ulcerations on both legs, and discuss the cutaneous features associated with chikungunya.

Myasthenia gravis with cutaneous polyarteritis nodosa.

Cutaneous polyarteritis nodosa presents with typical cutaneous lesions of polyarteritis nodosa without visceral involvement at the time of diagnosis. We report a 32-year-old woman with a 12-year history of myasthenia gravis under immunosuppressive treatment, who presented with tender, erythematous nodules 20 mm in diameter on her shins. A diagnosis of cutaneous polyarteritis nodosa was made, based on the clinical and histopathological findings. Myasthenia gravis, an antibody-mediated disease, is occasionally accompanied by other autoimmune diseases, but we found no previous report in the literature associating it with polyarteritis nodosa.

Protective effects of the antioxidant Ginkgo biloba extract and the protease inhibitor aprotinin against Leiurus quinquestriatus venom-induced tissue damage in rats

Oxidative stress and proteases have been implicated in several diseases and extensive evidence indicates that antioxidants and protease inhibitors help prevent organ functional damage. Leiurus quinquestriatus (LQQ) scorpion venom causes cellular injuries that may lead to multiple organ failure. Thus, the capability of the antioxidant "natural standardized extract of Gingko biloba leaves (Gin, EGb 761)" and the non-selective protease inhibitor, aprotinin, in ameliorating venom-induced biochemical alterations indicative of cellular injury and oxidative stress was studied to determine their effectiveness in protecting rats from venom-evoked cellular damages. Thus, in this study, rats were treated with LQQ venom (0.3mg.kg-1, subcutaneously) alone or after Gin (150mg.kg-1, orally, daily for 2 weeks before venom) and/or aprotinin (Apr, 46000 KIU.kg-1, intraperitoneally, 30 min before venom). Control groups were injected with saline or treatment modalities. Lungs and hearts were excised after decapitating rats (n=8/group) 60 min after venom injection and the following activities were measured: reduced glutathione (GSH), malondialdehyde (MDA) - an index of lipid peroxidation, glutathione peroxidase (GPx), glucose-6-phosphate dehydrogenase (G6PD), and lactate dehydrogenase (LDH). Our findings demonstrate that LQQ venomsignificantly elevated GSH (p 0.05 vs. control), MDA (p 0.05), G6PD (p 0.05), and LDH activities (p 0.001) in hearts of envenomed rats. The venom also elevated MDA (p 0.05 vs. control) and reduced GSH and GPx (p 0.05) in the lungs of envenomed rats. In general, pretreatment with EGb761 attenuated LQQ venom-evoked increases in GSH (p 0.05 vs. venom), MDA in rat hearts and lungs (p 0.05 vs. venom), plus LDH in the heart (p 0.01). Aprotinin alone significantly reduced the venom-elicited increase in G6PD and LDH activities and the decrease in GPx levels (p 0.05). In general, these protective effects of EGb761 on GSH, MDA (p 0.01 vs. venom) and LDH (p 0.001) in the heart and/or lung were potentiated when combined with aprotinin. We concluded that the effectiveness of EGb761 and Apr in ameliorating venom-evoked biochemical changes indicative of necrosis and free radical generation point out the involvement of oxidative stress and proteases in venom-evoked cellular damages seen in this study in isolated rat hearts and lungs.

The effects of a sodium and a calcium channel blocker on lethality of mice injected with the yellow scorpion (Leiurus quinquestriatus) venom

Scorpion venom toxins generally produce similar effects by mainly acting on sodium channels, and to a lesser extent, on potassium, calcium, and chloride channels. This leads to increased release of neurotransmitters and mediators, resulting in a cascade of pathological events, involving the central nervous system, the autonomic nervous system, the cardiovascular and the respiratory system, eventually leading to death. The objective of this paper was to discover whether a sodium channel blocker, lidocaine, or a calcium channel blocker, verapamil, would prolong the survival of mice injected with the venom from the common yellow scorpion Leiurus quinquestriatus quinquestriatus (LQQ). For this purpose, mice were divided into 2 groups, each injected with a different venom dose (250 or 300 µg.kg-1, s.c.). Subgroups (n=10) from each group were given venom alone; different doses of lidocaine (4, 10, 15, or 20 mg.kg-1); or several doses of verapamil (0.01, 0.03, 0.1, 0.3, or 1 mg.kg-1). All doses of lidocaine and verapamil were intravenously administered 3 minutes before, 1, 5, and 15 minutes after venom injection. Percent surviving after 24 hours was recorded in addition to the time of death. In general, lidocaine significantly prolonged survival at the dose of 10 mg.kg-1 (P<0.05 and P<0.01, versus low and high dose of venom, respectively) or 15 mg.kg-1 (P<0.01 and P<0.001, versus low and high dose of venom, respectively; Covariance Wilcoxon survival statistics), especially when injected before the venom or in the early stages of envenomation. On the other hand, in all doses administered, verapamil was either toxic or showed non-significant results. Lidocaine, the sodium channel blocker, appears to play an important role in the protection from lethality of mice injected with LQQ venom, and significantly prolonged the survival time of mice whether injected before or in the early stages of envenomation.(AU)

Sunscreen sensitization: a 5-year study.

The purpose of this study was to evaluate the prevalence of sunscreen contact allergy and/or contact photoallergy in 370 patients with suspected photodermatitis. Patch and photopatch tests were performed using the French Society of Photodermatology (SFPD) standard series. A total of 57 cases of contact allergy and/or photocontact allergy to sunscreens were diagnosed (15.4%). Amongst these, 27 reactions were related to oxybenzone and 14 to isopropyl dibenzoylmethane. These results, obtained from January 1990 to December 1994, confirm that, given the high frequency of photosensitization cases, a large part of the battery of photopatch tests should be dedicated to sunblocks.

[Photosensitive prurigo in AIDS]. / Prurigo photodéclenché au cours du SIDA.

INTRODUCTION: A case of photosensitive prurigo during AIDs is reported. This is the second case in the literature. We discuss the relations between HIV infection and photodermatoses. OBSERVATIONS: A woman, known to be HIV seropositive from 1990, developed during the spring 1990 a prurigo on light exposed areas who received the next year. A photobiological investigation was performed, showing a polymorphic light eruption induced by UVB. DISCUSSION: Patients infected with HIV have a high prevalence of UV radiation responsive skin diseases. On the other hand, UVA radiations, UVB and UVC have been shown to induce activation and replication of HIV. PUVA therapy and UVB therapy have shown their efficacity in the treatment of many photodermatoses associated with HIV infection, without any worsening of the illness. Many questions are not yet solved in the relationship between HIV and photosensitivity and the photobiological investigation should be more frequently done.