Infective endocarditis due to Citrobacter koseri in an immunocompetent adult.

Citrobacter koseri (formerly Citrobacter diversus) is a motile gram-negative bacillus usually arising from urinary and gastrointestinal tracts. C. koseri rarely causes infection in immunocompetent patients and, thus far, has been considered an opportunistic pathogen. We report on a 30-year-old man, with no medical past, hospitalized for infective aortic endocarditis due to C. koseri. Four weeks of antibiotherapy led to a full recovery for this patient. However, this case is unusual, as previous history and 1 year of follow-up showed no features of intercurrent immunosuppression. Microbiological diagnosis was based on using 16S rRNA gene sequencing.

[Influence of nutritional status on development of nosocomial pneumonia in case of acute decompensation of chronic obstructive pulmonary diseases]. / Influence de l'état nutritionnel sur la survenue d'une pneumopathie nosocomiale dans les décompensations aiguës des bronchopneumopathies chroniques obstructives.

OBJECTIVE: The aim of this retrospective study was to assess the incidence of nutritional status on the development of nosocomial pneumonia in patients with chronic obstructive pulmonary disease (COPD) suffering an acute episode of respiratory failure requiring ventilatory assistance. PATIENTS AND METHODS: The study included 48 patients with COPD who were hospitalized in an intensive care unit for acute respiratory failure requiring ventilatory assistance. Nutritional status was assessed within 24 hours of admission to the intensive care unit. Body weight, tricipital skin fold, brachial muscle circumference, creatinuria-waist index, plasma levels of albumin, transferrin, transthyretin and retinol-binding protein, the Multitest and lymphocyte counts were recorded. The diagnosis of nosocomial pneumonia was based on recognized criteria: occurrence more than 48 hours after admission, Andrews' criteria for bacterial pneumonia and bacteriological proof. RESULTS: Nineteen of the 48 patients developed nosocomial pneumonia. The nutritional parameters at admission to intensive care were not significantly different between patients who developed nosocomial pneumonia and those who remained free of lung infection. The duration of ventilatory assistance and total stay in the intensive care unit were significantly longer in patients who developed nosocomial pneumonia. CONCLUSION: This study showed that in patients with COPD who undergo ventilatory assistance for acute decompensation, the development of nosocomial pneumonia was not correlated with nutritional status admission.

[Nosocomial Legionnaires' disease in children. Preventive measures]. / Maladies des légionnaires nosocomiale chez l'enfant. Mesures de prévention.

Two immunocompromised children, aged 3 years and 1 1/2 month, developed an hospital-acquired Legionnaire's disease. In one case, Legionella pneumophila serotype 1 was identified by culture in pleural fluid; LP1 was isolated in all the warm water samples in the hospital. Clinical, epidemiological data and laboratory findings are discussed.

[Preoperative skin preparation. A prospective study comparing a depilatory agent in shaving]. / Préparation cutanée à la chirurgie. Etude prospective comparant un agent dépilatoire au rasage.

Two types of pre-operative skin preparation were compared in a prospective randomized study conducted on 100 patients undergoing elective surgery: 51 patients were shaven (group I) and 49 were prepared with a depilatory agent. In all cases skin preparation was performed on the eve of the operation. Bacterial density, measured immediately before surgery by application of a contact agar preparation was 493 +/- 928 CFU in group I and 386 +/- 670 CFU in group II (NS). Bacterial density was less than 25 CFU in a significantly greater number of group II patients (P less than 0.01). On the second postoperative day, the number of scars without any sign of sepsis was significantly greater in group II patients (P less than 0.05). In addition, the depilatory agent proved bactericidal against 3 pathogenic strains (S. aureus, Pseudomonas aeruginosa and E. coli). Depilation with a chemical agent seems to be a satisfactory method of pre-operative skin preparation. It is more rapid than shaving, it can be applied to areas not easily accessible to razors, and it can often be carried out by the patient himself.

[Postoperative infection of fractures of the upper end of the femur]. / Infection post-opératoire des fractures de l'extrémité supérieure du fémur.

This series comprises 74 post-operative infections of fractures of the upper end of the femur, 47 associated with internal fixation and 27 with prostheses. The organisms were different in the 13 men, with a predominance of gram-positive cocci, from those in the 61 women in which the significantly high proportion of gram-negative organisms seemed to be due frequent to soiling of urinary origin. In the 47 internal fixations, local wound toilet gave 29 successful results with union in the normal time. Two patients were not able to be operated on again and died before they could be treated. Sixteen failures, including seven deaths, were due to septic arthritis of the hip. The diagnosis of septic arthritis was difficult, which explains why resection of the head and neck of femur was only made in six cases, five of them successfully. In the 27 prostheses, the best results were obtained by deep wound toilet retaining the prosthesis, with nine successes in ten cases. An acceptable functional result was compatible with a persistent grumbling infection.

[Arthritis of the hip in paraplegic patients. Apropos of 8 cases]. / L'arthrite de hanche chez le paraplégique. A propos de 8 cas.

Eight instances of septic arthritis of the hip were treated in 6 paraplegics. On each occasion the hip had been infected through a nearby ulcer. In 2 cases the diagnosis was only made at operation because signs of a severe infection are not obvious in paraplegics. The radiographs were often misleading, the joint space being either normal or narrowed even before the onset of sepsis. The treatment combined antibiotic therapy with resection of the head and neck stabilized by external fixation for 45 days. The procedure was only successful in 5 cases out of 8 as far as infection was concerned. The resection did not impair ability to sit in this type of patient.

[Tibiotarsal arthrodesis in a septic milieu]. / L'arthrodèse tibio-tarsienne en milieu septique.

The authors have performed 28 ankle fusions for septic causes. There were 23 cases of septic arthritis and 5 severely comminuted compound fractures treated by primary fusion. Arthrodesis was made after wide excision and stabilization by external fixator. In 23 cases secondary bone grafting was done. Only in 13 cases was a satisfactory contact between the bony surfaces obtained. There was no contact at all in 9 cases. The authors have had good experience with the A.L.J. model of external fixator. On 7 occasions, secondary grafting was made using a cortico-cancellous graft with 3 failures. On 6 occasions, the Papineau technique was used with success but healing was slow. Out of 24 patients, the final result was good in 18 with 4 failures of fusion and 3 persistent sinuses. The importance of a wide excision is emphasised leading to the need for the use of external fixation. In cases of skin loss in recent comminuted fractures, the Papineau method is indicated as a primary procedure.

[Seroepidemiology of herpesvirus hominis and cytomegalovirus infections in the first 4 years of life (author's transl)]. / Séro-épidémiologie des infections par l'herpesvirus hominis et le cytomégalovirus au cours des 4 premières années de la vie.

Two hundred children and their mothers were examined when they were 10 months, 2 years and 4 years of age. Anti-cytomegalovirus, anti-Herpesvirus hominis and anti-rubella virus antibodies were titered. The evolution of antibody titers showed that primary infections with cytomegalovirus and Herpesvirus are especially frequent during the first months of life, and that mothers are the principal source of infection. In the group studied, it appeared that country of origin of the parents was the most important socio-economic factor influencing the frequency of infections in children, based upon the large variations of the serum positivity in mothers.