Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.

Comparison of hepatitis C virus serotyping and genotyping in French patients.

BACKGROUND: Hepatitis C virus (HCV) serotyping has been proposed as an alternative assay to determine the respective genotype as it is more rapid, simple and less expensive than polymerase chain reaction (PCR) based typing methods. OBJECTIVES: A serotyping assay was compared with a genotyping assay to determine the infecting hepatitis C virus type in chronically HCV infected patients eligible for interferon therapy. STUDY DESIGN: An enzyme immunoassay (HC01, Murex) was tested to identify HCV types 1, 2 and 3 specific antibodies in 134 PCR-positive sera from chronically infected patients which had been previously genotyped by a reverse hybridization assay (INNO-LiPA HCV I, Innogenetics). Respectively nine and seven sera were from HIV-seropositive and hemodialysis patients. Unreactive sera and those with discrepant results were retested by a new version (HC02) extended to types 4, 5 and 6. RESULTS: The distribution frequency of HCV genotypes was subtype 1a, 16.4%; subtype 1b, 46.3%; subtype 2a, 7.5%; subtype 3a, 20.9%; type 4, 4.5%; type 5, 0.7%; and co-infections, 3.7%. Among all the patients, 95% were of type 1, 2 or 3. The antibody reactivities of hemodialysis (1/7; P < 0.05) and HIV-seropositive patients (4/9; P = 0.06) were lower than for the patients seen at the hepatology unit (87/118). For these latter patients, the serotyping assay was interpretable in 71% and concordant in 64% of the samples with the genotyping assay. Out of the 84 samples with interpretable results, 75 sera were correctly serotyped (89% specificity). The two mixed results obtained by serotyping did not correspond to genotype co-infections (n = 3) and reciprocally. Six discrepancies were ruled out by the new assay, but the 2 untypeable sera remained unsolved, and four out of six sera with genotype 4 were serotyped as type 5. CONCLUSIONS: Serotyping could be an attractive approach if the reactivity was improved and the subtyping possible.

Enzyme electrophoresis, sero- and subtyping, and outer membrane protein characterization of two Neisseria meningitidis strains involved in laboratory-acquired infections.

Two cases of laboratory-acquired infections due to Neisseria meningitidis were suspected to have occurred in two French hospitals. The first case occurred shortly, i.e., 3 days, after one strain had been handled by a laboratory technician, and the link between this strain and the strain causing meningitis was easily established. In the second case, infection occurred 3 weeks after 10 strains had been handled by a technician. In this case, it was necessary to use high-resolution markers in order to establish the link between the infecting strain and 1 of the 10 strains handled. The antigenic formulae of the two infecting strains (serogroup:serotype:subtype) were, respectively, C:NT:P1.12 and B:2a:P1.2. Outer membrane protein profile analysis and multilocus enzyme electrophoresis unequivocally confirmed the identity of the respective strains.

[Pharmacokinetics of ofloxacin administered orally in elderly subjects with bronchial or urinary tract infections]. / Pharmacocinétique de l'ofloxacine administrée par voie orale chez le sujet âgé atteint d'infections bronchiques ou urinaires.

The pharmacokinetics of ofloxacin orally administered were investigated at the steady-state in sixteen elderly patients older than 65 years. Patients with either urinary tract of respiratory tract mild infectious were divided into two age-dependent groups A and B. Group A: eight patients (65-80 years) received 200 mg of ofloxacin by the oral route every 12 hours and group B: eight patients older than 80 years, received 200 mg of ofloxacin by the oral route every 24 hours. The pharmacokinetic study was performed on treatment day 5. Plasmatic levels and urinary excretion of ofloxacin during 12 or 24 hours were assayed by means of high pressure liquid chromatography. Wide variations in plasma ofloxacin concentrations were observed within each group (Cmax range, group A: 1.9-9.2 mg/l, group B: 1.6-10.0 mg/l). Similar variability was observed for ofloxacin elimination parameters (CI/F, renal CI(R)/F) and half-life. In contrast, within-group and between-group differences in the volume of distribution adjusted for weight were not significant (group A: 1.22 +/- 0.44 l.kg; group B: 1.49 +/- 0.53 l.kg), but these values were approximately half those observed in the young adult. Plasmatic [CI/F] and renal clearance [CI(R)/F] of ofloxacin were correlated with creatinine clearance in both groups and in the overall population studied. Then the overall population was classified in terms of creatinine clearance [group 1: greater than 50 ml/min; group 2: less than or equal to 50 (minimum 20) ml/min]. The pharmacokinetics of ofloxacin in the elderly are characterized by a decrease in the volume of distribution and in plasmatic and renal clearances.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diffusion of ofloxacin in infected ascitic fluid]. / Diffusion de l'ofloxacine dans l'ascite infectée.

The ofloxacin diffusion was investigated in 13 cirrhotic patients with spontaneous bacterial peritonitis. Plasma and ascitic samples were collected at times H1, H31 and H8 after a first dose of 200 mg per os, in these 13 patients, after 4.5 or 6 days of 200 mg per os each 8 hours in 9 out of them. After the first dose, the plasmatic and ascitic concentrations, measured by High Performance Liquid Chromatography (HPLC), were between 0 and 3.62 mg/l, 0 and 1.95 mg/l respectively. The steady state concentrations are higher than the MIC'S for the organisms most commonly involved, comparable in the plasma and the ascitic fluid is good and suggest the interest of its use in this indication.

[Course of the diffusion of cefotiam in infected ascitic fluid]. / Evolution de la diffusion du céfotiam dans le liquide d'ascite infecté.

The cefotiam (CFT) penetration in infected ascitic fluid was investigated in 12 cirrhotic patients. CFT (1 g every 8 h) was given intravenously and measured by HPLC in plasmatic and ascitic samples. The mean ascitic concentrations (+/- SEM), 1 h, 3 h and 8 h after the first injection (J1) were 14.6 +/- 4.6, 11.8 +/- 3 and 8.4 +/- 2.9 micrograms/ml respectively. These values were 38, 62 and 88% of the corresponding mean plasmatic concentrations and higher than the MIC's for the organisms most commonly involved. The mean plasmatic and ascitic concentrations, a few days later (4.5 or 6 days) (Jn) were not significantly different from the corresponding values at J1. A significant decrease of polymorphonuclear cell count was observed between J1 and Jn. These results suggest that CFT diffusion into ascitic fluid is independent of inflammation and CFT is an adequate antibiotic in cirrhotic patients with infected ascitic fluid.

[Pharmacokinetics of ofloxacin in the elderly (65-85 years) with normal renal function after a single oral dose of 200 mg]. / Pharmacocinétique de l'ofloxacine chez le sujet âge (65 à 85 ans) à fonction rénale normale après prise orale unique de 200 mg.

Ofloxacin is a fluoroquinolone that is mainly eliminated through the kidneys. We studied ofloxacin pharmacokinetics following administration of a single oral 200 mg dose to each of 16 elderly patients (77 +/- 2.4 years). Serum and urine concentrations were assayed using high performance liquid chromatography. Peak serum ofloxacin concentrations were 3.60 (+/- 0.36) micrograms/ml; residual concentrations were 1.33 (+/- 0.15) and 0.62 (+/- 0.10) micrograms/ml at 12 and 24 hours respectively. Urine concentrations approximating 100 micrograms/ml were found up to the 12th hour. As compared to healthy adults, in elderly subjects ofloxacin distribution volume (85.3 +/- 6.3 l) was decreased by 34%, apparent clearance (4.97 +/- 0.53 l/h) was divided by 2.6 and elimination half life (13.3 +/- 1.2 h) was almost doubled. A linear correlation was found between individual apparent ofloxacin clearances and creatinine clearances. In view of these significant changes in ofloxacin pharmacokinetics found in elderly subjects, we advocate reducing the usual dosage by half.

[Use of the API 20E system for rapid identification of Enterobacteriaceae (six hours) (author's transl)]. / Utilisation du système API 20E pour l'identification rapide (six heures) des Enterobacteriaceae.

The authors propose a modification of the method of use of the API 20E system permitting more rapid identification of Enterobacteriaceae within six hours (3 hours preculture and 3 hours incubation on an API 20E plate) it was possible to identify correctly 67% of 192 strains studied at species level and 75.5% studied at generic level. One may note four mistakes (2.1%) of which 3 were minor, (species within the same genus). The construction of a base of numerical data adapted to the technic within six hours would no doubt permit us to reduce the percentage undetermined.