ABSTRACT
To increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment.
Subject(s)
Sepsis/epidemiology , Staphylococcal Infections/epidemiology , Staphylococcus capitis/isolation & purification , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Catheter-Related Infections/drug therapy , Catheter-Related Infections/epidemiology , Catheter-Related Infections/etiology , Drug Resistance, Multiple, Bacterial , Female , France/epidemiology , Humans , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Male , Sepsis/drug therapy , Sepsis/etiology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , Staphylococcus capitis/drug effectsABSTRACT
Bacillus cereus is the 2nd most frequent bacterial agent responsible for food-borne outbreaks in France and the 3rd in Europe. In addition, local and systemic infections have been reported, mainly describing individual cases or single hospital setting. The real incidence of such infection is unknown and information on genetic and phenotypic characteristics of the incriminated strains is generally scarce. We performed an extensive study of B. cereus strains isolated from patients and hospital environments from nine hospitals during a 5-year study, giving an overview of the consequences, sources and pathogenic patterns of B. cereus clinical infections. We demonstrated the occurrence of several hospital-cross-contaminations. Identical B. cereus strains were recovered from different patients and hospital environments for up to 2 years. We also clearly revealed the occurrence of inter hospital contaminations by the same strain. These cases represent the first documented events of nosocomial epidemy by B. cereus responsible for intra and inter hospitals contaminations. Indeed, contamination of different patients with the same strain of B. cereus was so far never shown. In addition, we propose a scheme for the characterization of B. cereus based on biochemical properties and genetic identification and highlight that main genetic signatures may carry a high pathogenic potential. Moreover, the characterization of antibiotic resistance shows an acquired resistance phenotype for rifampicin. This may provide indication to adjust the antibiotic treatment and care of patients.
Subject(s)
Bacillus cereus/genetics , Bacillus cereus/physiology , Cross Infection/epidemiology , Phenotype , Surveys and Questionnaires , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacillus cereus/drug effects , Child , Child, Preschool , Female , Genetic Variation , Genomics , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young AdultABSTRACT
OBJECTIVE: To compare the effects of nasal continuous positive airway pressure (nCPAP) and conventional oxygen therapy on the clinical signs of respiratory distress and the respiratory muscle workload in acute viral bronchiolitis. DESIGN: Prospective, randomized, monocentric study carried out in the pediatric intensive care unit (PICU) of a university hospital. PATIENTS: Infants <6 months old, admitted to the PICU with severe respiratory syncytial virus bronchiolitis. INTERVENTION: The patients were randomized into two groups for 6 hr. The nCPAP group (n = 10) received 6 cmH(2)O pressure support delivered by a jet flow generator and the control group (n = 9) received an air/oxygen mixture from a heated humidifier. Respiratory distress was assessed by the modified Wood's clinical asthma score (m-WCAS), and inspiratory muscle work was evaluated by calculating the pressure-time product per breath (PTP(insp) /breath) and per minute (PTP(insp) /min) from the esophageal pressure (Pes) recordings. MEASUREMENTS AND MAIN RESULTS: Compared with control condition, nCPAP decreased m-WCAS [-2.4 (1.05) vs. -0.5 (1.3), P = 0.03], PTPes(insp)/breath [-9.7 (5.7) vs. -1.4 (8.2), P = 0.04], PTPes(insp) /min [-666 (402) vs. -116 (352), P = 0.015], and FiO(2) [-7 (10) vs. +5 (15), P = 0.05]. Significant worsening of m-WCAS was only observed in the control group (4/9 vs. 0/10, P = 0.03). CONCLUSIONS: nCPAP rapidly decreased inspiratory work in young infants with acute bronchiolitis. Improvement in the respiratory distress score at 6 hr was proportional to the initial clinical severity, suggesting the importance of rapid nCPAP initiation in the more severe forms of the disease.
