Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. A French multicenter study.

BACKGROUND: Although Clostridium difficile is the main agent responsible for nosocomial diarrhea in adults, its prevalence in stool cultures sent to hospital microbiology laboratories is not clearly established. OBJECTIVES: To determine the prevalence of C difficile in inpatient stools sent to hospital microbiology laboratories and to assess the relationship between serotypes and toxigenicity of the strains isolated and the clinical data. METHODS: From January 18, 1993, to July 31, 1993, the presence of C difficile was systematically investigated in a case-control study on 3921 stool samples sent for stool culture to 11 French hospital microbiology laboratories. The prevalence of C difficile in this population (cases) was compared with that of a group of 229 random hospital controls matched for age, department, and length of stay (controls). Stool culture from controls was requested by the laboratory although not prescribed by the clinical staff. Serotype and toxigenesis of the strains isolated were compared. RESULTS: The overall prevalence of C difficile in the cases was twice the prevalence in the controls (9.7% vs 4.8%; P < .001) and was approximately 4 times as high in diarrheal stools (ie, soft or liquid) as in normally formed stools from controls (11.5% vs 3.3%; P < .001). The strains isolated from diarrheal stools were more frequently toxigenic than those isolated from normally formed stools. Serogroup D was never toxigenic, and its proportion was statistically greater in the controls than in the cases (45% vs 18%; chi 2 = 5.2; P < .05). Conversely, serogroup C was isolated only from the cases. Clostridium difficile was mainly found in older patients ( > 65 years), suffering from a severe disabling disease, who had been treated with antibiotics and hospitalized for more than 1 week in long-stay wards or in intensive care. CONCLUSIONS: This multicenter period prevalence study clearly supports the hypothesis of a common role of C difficile in infectious diarrhea in hospitalized patients. Disease associated with C difficile should therefore be systematically evaluated in diarrheal stools from inpatients.

Study of nuclear mannosyl-transferase: lipids intermediates.

Mannosyl-transferase of rat liver nuclei catalyzed the transfer of mannose, from GDP-mannose, to endogeneous lipids and proteins. Two solubility-different glycolipids were characterized: a mannosyl-phosphoryl-dolichol and an oligosaccharide-lipid. The labeling of the two lipids was consistent with a role in mannose transfer to nuclear glycoproteins, but not according to the Lennarz' scheme.

[The importance of Lancefield Group B streptococci (S. agalactiae) in gynaecology and obstetrics (author's transl)]. / Importance de streptocoque du groupe B de Lancefield (S. agalactiae) en gynécologie-obstétrique.

A bacteriological study of 10,962 vaginal swabs has made it possible to work out the percentage of women who are carriers of Group B streptococci in their vaginas. The count varies between 9.43 and 17.25 per cent according to the different populations that were studied. Serotyping of the strains of 1,030 vaginal specimens was carried out and it was found that serotypes II and III predominated. We have been able to study 27 strains responsible for infection in the early neonatal period such as septicaemia or meningitis at the same time as we were studying the vaginal flora. The distribution of the serotypes illustrates a predominance of types 1c and III in 70 per cent of cases. Contamination between the mother and the child is obvious but in 95 per cent of cases the strain isolated in the infected child was of the same serotype as that which was isolated in the mother. Group B streptococci are still very sensitive to antibiotics and particularly to the penicillins. It does seem to us to be unrealistic to treat with antibiotics prophylactically in pregnancy. On the other hand careful attention to the newborn and careful bacteriological study of multiple specimens taken from the skin and the orifices gives easy screening for the germ and the possibility of treating infants that are grossly contaminated.

[Evolution of antibiotic resistance of Streptococcus pneumoniae: results of Alsace observatory in 2005]. / Evolution de la sensibilité de Streptococcus pneumoniae aux antibiotiques: résultats de l'observatoire du pneumocoque Alsace (année 2005).

OBJECTIVES: Between 1st January 2005 and 31st December 2005, 232 strains of Streptococcus pneumoniae were collected in the Alsace county from participating laboratories (one from university hospital, 7 from general hospitals and 12 private laboratories) to assess their susceptibility to penicillin and evaluated serogroups of strains. METHOD: The coordinating centre performed MICs by the reference agar dilution test, interpreted according to CA-SFM breakpoints. Others antibiotics (erythromycin, cotrimoxazole, tetracycline...) were tested by agar diffusion, ATB-PNEUMO gallery or VITEK gallery (BioMérieux, France) by each participating laboratory. Data were processed, using 4th dimension software. RESULTS: Strains were collected from 151 blood samples, 38 ear pus, 11 cerebrospinal fluids, 8 pleural liquids and 24 representative pulmonary samples. The prevalence of pneumococci with decreased susceptibility to penicillin G (PDSP) is 35.1% (pulmonary samples excluded). The rate of PNSP decreases for all types of samples compared with other years of surveillance 2003 (44.0%). The rate of blood samples decreases for first time between the creation of Pneumococcal Observatory. The high-level resistance tend to decrease and began low. The PDSP are rather resistant to erythromycin, cotrimoxazole and fosfomycin. Among the PDSP, the most prevalent serotypes were 14, 19, 6 and 9. CONCLUSION: Among pneumococcal strains, the rate of PDSP tend however to decrease in 2005 compared with 2003. The rate stays inferior to the observed rates in other French counties where the same decreasing is described.

[Activity of seven antimicrobial agents against "Bacteroides fragilis" (author's transl)]. / Activité de sept antibiotiques sur Bacteroides fragilis.

One hundred and fifty-two strains of Bacteroides fragilis were tested by agar dilution technique against 7 antimicrobial agents. Metronidazole at 1 microgram/ml and chloramphenicol at 8 microgram/ml inhibited all the strains tested. Cefoxitin at 32 microgram/ml and carbenicillin at 128 microgram/ml were active against nearly all strains. On the other hand, only 92% of the strains of B. fragilis were inhibited by clindamycin at 4 microgram/ml. Erythromycin and tetracycline were less active against B. fragilis.

[Rate of isolation of "C. difficile" from stools of hospitalized patients: susceptibility of 75 strains (author's transl)]. / Fréquence d'isolement de Clostridium difficile dans les selles de malades hospitalisés: sensibilité aux antibiotiques des souches isolées.

Seventy-five strains of Clostridium difficile were recovered from 1,276 stools from patients. Fifty-six of these strains were found to be toxigenic. The rate of isolation of C. difficile was high in culture of stools from patients in surgical intensive care units and in pediatrics units. The susceptibility of these isolates to 13 antimicrobial agents was tested by agar dilution technics. Vancomycin, metronidazole, penicillin and ampicillin at 4 micrograms/ml inhibited all the strains. Cefoxitin, cefotaxim and lincomycin were never active against C. difficile. Only 13.3% of the strains were inhibited by clindamycin at 4 micrograms/ml.

[Effect of pH on bacteria in early log phase]. / Influence du pH sur des bactéries en phase de croissance

The bacteria harvested in the early log phase lyse when they are submitted to a pH above 10. The peptidoglycan is not degraded in these conditions. Thus, the authors used these properties to extract the peptidoglycan from several gram negative and gram positive bacteria.

[Bacterial adjuvants in cell mediated immunity. Recent data]. / Les adjuvants bactériens de l'immunité à médiation cellulaire. Données récentes

Only some bacterial adjuvants are able to stimulate cell-mediated immunity. It has been shown recently that this property is due to a cell-wall component, the peptidoglycan. The relevance of these findings to tumor immunity has been discussed.