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1.
Sci Rep ; 12(1): 11024, 2022 06 30.
Article in English | MEDLINE | ID: mdl-35773383

ABSTRACT

Severe infections involving Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL + Sa) are increasing. This monocentre, retrospective descriptive cohort assessed clinical characteristics and outcome of paediatric and adult patients admitted for community-acquired PVL + Sa infections to the unique intensive care unit (ICU) on New Caledonia Island. Overall, 72 patients (including 23 children) admitted for acute respiratory failure (42%), sepsis/septic shock (21%), and/or postoperative care (32%) were analysed. Most patients had pulmonary (64%), skin/soft tissue (SSTI) (54%) and/or osteoarticular (38%) infections. Multifocal infections (≥ 2 sites) and bacteraemia were reported in 65% and 76% of the patients, respectively. Methicillin-resistant S. aureus isolates were reported in 61% of adult cases versus 30% in children (p < 0.05). Mechanical ventilation, vasoactive support and source control were administered in 53%, 43% and 58% of the patients, respectively. All paediatric patients received adequate empirical antibiotic therapy versus 30/49 adults (p < 0.001). Adequate documented therapy was obtained ≤ 72 h in 70/72 (97%) patients. Death was only reported in adults (n = 10 (14%)), mainly during pulmonary infection (22%), SSTIs (21%) and bacteraemia (24%)). In summary, in ICU patients from New Caledonia Island the clinical presentation of severe community-acquired PVL + Sa infections seems different from Western European observations with high rates of multifocal infections and methicillin-resistant strains.


Subject(s)
Bacteremia , Bacterial Toxins , Community-Acquired Infections , Methicillin-Resistant Staphylococcus aureus , Soft Tissue Infections , Staphylococcal Infections , Adult , Bacteremia/drug therapy , Bacteremia/epidemiology , Child , Community-Acquired Infections/epidemiology , Exotoxins , Humans , Intensive Care Units , Leukocidins , New Caledonia/epidemiology , Retrospective Studies , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcus aureus
2.
Med Mal Infect ; 50(6): 500-506, 2020 Sep.
Article in English | MEDLINE | ID: mdl-31257062

ABSTRACT

INTRODUCTION: Hypermucoviscous Klebsiella pneumoniae (KP) strains are responsible for complicated bacteremia with multiple septic sites (liver, central nervous system, muscles). We aimed to compare the clinical severity of patients presenting with KP bacteremia based on the hypermucoviscous or non-hypermucoviscous characteristic of the strains. METHODS: Observational retrospective study successively including all patients with KP bacteremia from May 2013 to March 2015 at the tertiary medical center of New Caledonia. The hypermucoviscous characteristic was defined by the string test results and molecular analysis to determine the capsular serotype. RESULTS: A total of 55 bacteremic patients were included in the study; 27% of isolated strains were hypermucoviscous. Hypermucoviscous strains accounted for two-thirds of community-acquired infections (72.5% vs. 33.4%, p=0.01). The rate of intensive care hospitalization was high (hypermucoviscous 46.7%; standard 52.5%) without any difference between the two groups. No significant difference was observed in case fatality (hypermucoviscous 46.7% vs. standard 15%, p=0.07) but patients with hypermucoviscous strains had longer hospital stays (73.5 days versus 50.7 days, p=0.04) and longer persistence of positive blood cultures despite an appropriate treatment (OR 1.41, 95% CI: 1.0-1.96, p=0.045). CONCLUSION: Hypermucoviscous KP bacteremia account for most community-acquired Klebsiella infections in New Caledonia and are associated with longer hospital stay and persistence of positive blood cultures despite the implementation of an appropriate treatment.


Subject(s)
Bacteremia/microbiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/pathogenicity , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Severity of Illness Index
3.
Epidemiol Infect ; 144(6): 1330-7, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26542622

ABSTRACT

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a bacterium endemic in Southeast Asia and northern Australia. In New Caledonia, sporadic cases were first described in 2005; since then, more cases have been identified. To improve our understanding of melioidosis epidemiology in New Caledonia, we compared the local cases and B. pseudomallei isolates with those from endemic areas. Nineteen melioidosis cases have been diagnosed in New Caledonia since 1999, mostly severe and with frequent bacteraemia, leading to three (16%) fatalities. All but one occurred in the North Province. Besides sporadic cases caused by non-clonal strains, we also identified a hotspot of transmission related to a clonal group of B. pseudomallei that is phylogenetically related to Australian strains.


Subject(s)
Bacteremia/epidemiology , Bacteremia/microbiology , Burkholderia pseudomallei/physiology , Melioidosis/epidemiology , Melioidosis/microbiology , Bacteremia/transmission , Bacterial Typing Techniques , Burkholderia pseudomallei/genetics , DNA, Bacterial/genetics , DNA, Bacterial/metabolism , Female , Humans , Male , Melioidosis/transmission , Middle Aged , Multilocus Sequence Typing , New Caledonia/epidemiology , Phylogeny , Sequence Analysis, DNA
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