Methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to glycopeptides (GISA) in 63 French general hospitals.

Clinical isolates of methicillin-resistant Staphylococcus aureus (n = 1070) collected from 63 French general hospitals during June 2000 (n = 1070) were screened initially for reduced susceptibility to glycopeptides (GISA) on brain-heart infusion agar containing teicoplanin 6 mg/L. Glycopeptide MICs were determined for the 145 isolates that grew on the screening plates. Of the 1070 isolates, 1.4% were GISA on Mueller-Hinton agar, and 2.9% by Etest with a high inoculum, while 0.7% and 2.9% were GISA by vancomycin and teicoplanin population analysis profiles, respectively. Most isolates were resistant to gentamicin and rifampicin or fosfomycin or fusidic acid, as determined by disk diffusion. Pulsed-field gel electrophoresis of the 31 GISA isolates identified four clones, with dissemination of one predominant clone. In these French hospitals there was a low incidence of GISA and hetero-GISA.

A parent as a vector of Salmonella brandenburg nosocomial infection in a neonatal intensive care unit.

A newborn baby was admitted to the Neonatal Intensive Care Unit (NICU) of St Germain en Laye Hospital (France) because of premature birth. On day 12, he contracted gastroenteritis due to Salmonella brandenbourg. The salmonellosis led to a septic shock syndrome with a brief cardiopulmonary arrest. He was treated with intravenous ceftriaxone and gentamicin, and the evolution was favorable. Microbiological investigations revealed that the mother was the vector for this nosocomial infection. S. brandenbourg was isolated from the feces of the baby, despite recent recommendations on managing stool specimens from patients hospitalized for more than three days: according to these recommendations, these stools should be processed for viruses and Clostridium difficile toxin only.

Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE) in Northern France: a five-year multicentre incidence study.

In order to measure the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and of Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE), and to evaluate the impact of the national guidelines for multidrug-resistant bacteria (MDRB) prevention in hospitals of Northern France, a multicentre study was conducted for three months every year starting in 1996, in volunteer hospital laboratories. All clinical specimens positive for MRSA and ESBLE were prospectively surveyed. During the five-year surveillance period, the overall proportion of MRSA was 38.4% in the 28,534 strains of S. aureus, and that of ESBLE was 11.4% in the 6121 strains of Klebsiella pneumoniae and 47.7% in the 2353 strains of Enterobacter aerogenes. The overall incidence rates of clinical specimens positive for MRSA, ESBL-K. pneumoniae and E. aerogenes were 0.84. 0.05 and 0.12/1000 hospital-days (HD), respectively. In the 23 hospitals that participated in the survey every year, the proportion and incidence of ESBLE decreased. Hence, despite recommendations as for isolation precautions, MRSA remains poorly controlled and requires more effective measures.

[Primary Neisseria meningitidis arthritis of the knee without meningitis: contribution of synovial fluid culture in blood-culture vial]. / Monoarthrite du genou à Neisseria meningitidis sans méningite: apport de la culture du liquide articulaire en flacon d'hémoculture.

INTRODUCTION: Primary meningococcal arthritis is a rare form of meningococcal disease. It occurs as an isolated acute purulent arthritis without meningitis, and presence of Neisseria meningitidis in articular fluid. We report a new case of typical primary meningococcal arthritis. EXEGESIS: A previously healthy 23-year-old female patient was admitted for purpuric lesions of the legs. At admission, conscience was normal and symptoms of meningitis were absent. During the 2nd day of hospitalisation, a warm and painful effusion in the right knee appeared. Aspiration from the right knee yielded a purulent fluid. N. meningitidis was isolated from a blood-culture vial inoculated with the synovial fluid, while blood cultures remained sterile. Anti-biotherapy was initiated as soon as microbiological diagnosis was established. The patient was symptom-free 1 month later. CONCLUSION: We emphasize the fact that agar cultures of the synovial fluid remained sterile, while N. meningitidis grew in a blood-culture vial. We suggest that diagnosis of primary meningococcal arthritis may be underestimated when inappropriate culture media are used.

[Fulminant streptococcal gangrene of the lower limbs]. / Gangrène streptococcique fulminante des membres inférieurs.

A 58 year old woman with Cushing's disease was admitted to hospital for acute ischaemia of the lower limbs due to fulminant streptococcal gangrene (necrosing fasciitis). A group A beta-haemolytic Streptococcus was isolated from the cutaneous lesions and the blood cultures. Despite antibiotic therapy and medical resuscitation, the patient died within 12 hours of her admission in a state of irreversible collapse. This gangrenous cellulitis, in which a hypersensitivity reaction plays a part in the pathophysiology, is a rare disease which is fatal in one half of cases. The diagnosis is based on a very marked alteration in the general state, the characteristics of the cutaneous lesions and, most importantly, the isolation of group A haemolytic Streptococci, which should be performed early so as to allow wide surgical excision, which remains the principal therapeutic measure, as rapidly as possible.

[Rectovaginal colonization by group B streptococcus]. / Colonisation recto-vaginale par le streptocoque du groupe B.

The influence of various factors, including age, pregnancy, contraceptive methods, menstrual cycle and use of vaginal tampons, on rectal and vaginal colonization with group B streptococci was investigated in 81 women, 25 of whom were pregnant. The organism was found more frequently in the anus (22.2%) than in the vagina (16%) or the pharynx (2.4%). The colonization rate was higher in women younger than 20, and higher in non pregnant (30%) than in pregnant (12%) women. It was also higher during the first phase of the menstrual cycle (45.4%) than during the second phase (21.8%). No significant difference was observed between users and non-users of intrauterine devices, oral contraceptives and vaginal tampons.

[Incidence of acquired infection in the surgical departments of 5 hospitals]. / Incidence des infections acquises dans les services de chirurgie de cinq hôpitaux.

A program for monitoring nosocomial infections was implemented in the surgical units of five hospitals. The overall incidence of infections after clean surgery varied from 6.6% to 15% depending on the units. Surgical wound infections were in the 2.8 to 5% range, which corresponded to 30-66% of nosocomial infections. The main septic complication of surgery in 2 of the 5 units was urinary tract infection, with an incidence of 1.6 to 7.8%. Bacteriaemia complicating urinary tract infections and intravenous catheter infections accounted for 4% to 16% of all infections. Staphylococcus aureus was responsible for 40 to 77% of surgical wound infections and Escherichia coli for 30 to 50% of urinary tract infections. After a 4-5 months period of monitoring, the incidence of nosocomial infections was reduced by 32 to 68% depending on individual units.

[Bacteriostatic and bactericidal effect of penicillins, cephalosporins, aminoglycosides and ampicillin plus gentamicin compared to trimethoprim plus sulfamethoxazole on "Listeria monocytogenes" (author's transl)]. / Action bactériostatique et bactéricide comparée des pénicillines, céphalosporines, aminosides et des associations ampicilline-gentamicine et triméthoprime-sulfaméthoxazole sur Listeria monocytogenes.

The bacteriostatic effect of penicillins and old and new cephalosporins was studied on ten strains of Listeria monocytogenes. Their bactericidal effects were studied in relation to time and concentration of antibiotics. If the betalactamines are bactericidal after 48 h only, they can be distinguished by their MBC/MIC ratio. Cephalosporins have a smaller ratio (8 to 32/200) than penicillin and ampicillin; the new cephalosporins have not improved the bactericidal effect of the oldest. The association trimethoprim plus sulfamethoxazole was equivalent to ampicillin plus gentamicin.

Interaction between piperacillin and pefloxacin or amikacin on the selection of resistant mutants of Pseudomonas aeruginosa.

Pseudomonas aeruginosa mutants were selected with piperacillin, pefloxacin, amikacin and the combinations pefloxacin-piperacillin and amikacin-piperacillin. With amikacin and the piperacillin-amikacin combination no mutants were selected. With piperacillin (1-32 x MIC) mutants resistant to carboxypenicillins, ureidopenicillins, monobactam and cephalosporins were selected. With pefloxacin, three different types of mutant were observed which showed different patterns of cross-resistance to pefloxacin, sulphonamides, imipenem, piperacillin and other beta-lactam antibiotics. With the pefloxacin-piperacillin association, mutants similar to one of the types selected by pefloxacin alone and resistant to both of the selective antibiotic were predominantly obtained. No mutants were selected with this combination if one of the antibiotics was used at a concentration equal to its MIC for the wild type strain and the other at concentrations above 4 x MIC. Since the association of piperacillin and pefloxacin was only moderately bactericidal against the predominantly cross-resistant mutant selected, the concentration of these antibiotics may have to be carefully controlled to prevent the emergence of such mutants.

[Bactericidal speed of ceftriaxone and cefotaxime on 18 strains of Haemophilus influenzae]. / Vitesse de bactéricidie de la ceftriaxone et du céfotaxime sur dix-huit souches d'Haemophilus influenzae.

The bactericidal effect of ceftriaxone and cefotaxime was studied by killing curves on 18 Haemophilus influenzae at 2, 4, 6 and 24 h. The MIC of ceftriaxone are between 0.0012 and 0.015 mg/l. The MIC of cefotaxime are between 0.006 and 0.03 mg/l. The MBC of ceftriaxone are between 0.0012 and 0.03 mg/l. The MBC of cefotaxime are between 0.006 and 0.03 mg/l. The bactericidal effect was studied at the concentration of 0.06 mg/l; at this concentration we obtained a reduction of 4 log 10 for 3 strains in 6 hours by both drugs. In 24 h, 16 stains give a 99.99% of killing for ceftriaxone and 18 strains for cefotaxime. Our results do not show a significant difference in the bactericidal effect of the two drugs on Haemophilus.

Activity of CI-960 alone and in combination with amoxycillin against Listeria monocytogenes, and comparison with other quinolones.

In-vitro activity of CI-960 against seven strains of Listeria monocytogenes was compared to that of other fluoroquinolones. MICs/MBCs were: ciprofloxacin and sparfloxacin: 0.5-2/1-4 mg/L;PD 131628: 0.125-0.5/0.25-2 mg/L; CI-960: 0.06-0.25/0.25-0.5 mg/L. At 4 h, CI-960 (4 x MIC) reduced the inoculum (log10 cfu) by 2.88 +/- 0.61 compared with 1.78 +/- 0.48 for ciprofloxacin, 1.5 +/- 0.46 for sparfloxacin, and 1.35 +/- 0.47 for PD 131628 (P < 0.05). At 24 h, the bactericidal effects were similar (-4 log10 cfu). The amoxycillin/CI-960 (8 x MIC) combination was bactericidal, without emergence of resistant mutants.

Alteration of PBP 3 entails resistance to imipenem in Listeria monocytogenes.

A mutant with decreased susceptibility to imipenem (IpR) was selected in vitro from a susceptible clinical isolate of Listeria monocytogenes (IpS). IpR exhibited decreased susceptibility to penicillin G (4 x MIC) and imipenem (16 x MIC) and increased susceptibility to cefotaxime (0.25 x MIC). Electrophoretic profiles of membrane proteins and penicillin-binding proteins (PBPs) were identical in the two strains; each strain had five PBPs with molecular masses of ca. 97, 83.3, 81, 77.1, and 42.6 kilodaltons. A decreased affinity of PBP 3 for penicillin G and imipenem (10-fold) was observed in IpR. In contrast, the affinity of PBP 3 for cefotaxime in IpR was increased twofold and correlated with the decreased MIC of this drug. From these findings and competition experiments with different beta-lactam antibiotics, we conclude that the alteration of PBP 3 is responsible for the decreased susceptibility of IpR to penicillin and imipenem and that PBP 3 might be an essential target of beta-lactam antibiotics in L. monocytogenes.

In vitro bactericidal activity of amoxicillin, gentamicin, rifampicin, ciprofloxacin and trimethoprim-sulfamethoxazole alone or in combination against Listeria monocytogenes.

The in vitro bactericidal activity of amoxicillin, gentamicin, rifampicin, ciprofloxacin and trimethoprim-sulfamethoxazole alone or in combination was determined against seven strains of Listeria monocytogenes by the killing curve method. Amoxicillin plus gentamicin was the most rapidly bactericidal combination, whereas trimethoprim-sulfamethoxazole was less bactericidal at 6 h but as bactericidal at 24 h. The combination of trimethoprim-sulfamethoxazole with either amoxicillin, ciprofloxacin or rifampicin did not result in antagonism, but the combinations were no more active than trimethoprim-sulfamethoxazole alone. The interaction of amoxicillin with rifampin was fairly antagonistic (1 log10 difference). The combination of amoxicillin and ciprofloxacin, although producing antagonism during the first 6 h, was more active at 24 h than amoxicillin alone and prevented the regrowth observed with ciprofloxacin alone. Ciprofloxacin and rifampicin interacted antagonistically during the first 6 h, and the combination was not very bactericidal (3 log10) but prevented the emergence of mutants, as observed with each drug alone, when used at concentrations greater than the MICs for the strain tested. These regimens merit evaluation in in vivo models of Listeria monocytogenes meningitis.

[Prospective study of rotavirus infection in a maternity unit. Demonstration of a nosocomial infection]. / Etude prospective sur l'infection à rotavirus dans une maternité. Mise en évidence d'une infection nosocomiale.

Eighty-eight children born at the maternity hospital in Saint-Germain-en-Laye between May 24 and June 7, 1983 were followed clinically, with a special supervision concerning stools, weight curves and the way of feeding. Stool samplings looking for Rotavirus were performed in all the children and their mothers, at the 3rd and 6th days of life. No mother was found with Rotavirus infection. In neonates, Rotavirus excretion was significantly related to a slow down in weight curves and the occurrence of diarrhea. All rotaviruses had the same electrophoretype. Breast-feeding had an undeniable protective effect.

[Study of ampicillin sensitivity of 148 strains of Haemophilus influenzae isolated in 2 general hospitals]. / Etude de la sensibilité à l'ampicilline de 148 souches d'Haemophilus influenzae isolées dans deux hôpitaux généraux.

During one year, by disk diffusion, we have studied in two general hospitals, the susceptibility to ampicillin of Haemophilus influenzae isolated from various clinical specimens, CSF (2 strains), blood (1 strain), ears (6 strains), eyes (18 strains), lower respiratory tract specimens (111 strains), genital specimens (7 strains), and various other specimens (3 strains). The beta-lactamase production was researched systematically with a chromogenic test. At all 148 strains of H. influenzae were examined. Drug resistance was observed for 18 strains (12.2%). All strains produced a beta-lactamase. The study of drug resistance of H. influenzae with the regard of the age showed an higher percentage of resistant strains isolated from children than the percentage of resistant strains isolated from adults. From children, 10 out of 50 strains (20%) were resistant to ampicillin, on the other hand 8 out of 98 (8.2%) strains isolated from adults were resistant to ampicillin.

[Antibody coated bacteria in urinary sediment (author's transl)]. / Bactéries urinaires enrobées d'anticorps. Aspect diagnostique et évolutif

The presence of antibody coated bacteria in the urinary sediment was correlated with the infection site in 151 patients. 86 patients were followed regularly and support sequential data. A positive test is noted in most of the chronic pyelonephritis cases in all the prostatitis cases and in some of the chronic infection on bladder disease. In recurrent cystitis the test is generally negative as in acute pyelonephritis seen within 24 hours.