SARS-CoV-2 infection: advocacy for training and social distancing in healthcare settings.

This article reports the observed rate of infection with severe acute respiratory syndrome coronavirus-2 in healthcare workers (HCWs) who worked on wards dedicated to care of patients with coronavirus disease 2019 (COVID-19) compared with HCWs who worked on non-COVID-19 wards. The infection rate was significantly higher among HCWs who worked on non-COVID-19 wards (odds ratio 2.3, P=0.005), illustrating the need to strengthen social distancing measures and training.

Carbapenemase-producing Acinetobacter baumannii: An outbreak report with special highlights on economic burden.

OBJECTIVE: We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up. METHODS: We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data. RESULTS: Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A. baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit - including specific area for cohorting of patients and dedicated staff - at the beginning of the outbreak, the estimated cost would have been $189,046. CONCLUSION: Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak.

Decolonization of Staphylococcus aureus carriage.

Staphylococcus aureus nasal colonization is a well-known independent risk factor for infection caused by this bacterium. Screening and decolonization of carriers have been proven effective in reducing S. aureus infections in some populations. However, a gap remains between what has been proven effective and what is currently done. We aimed to summarize recommendations and current knowledge of S. aureus decolonization to answer the following questions: Why? For whom? How? When? And what are the perspectives?

Preventing healthcare-associated infections: Residents and attending physicians need better training in advanced isolation precautions.

OBJECTIVE: Compliance with advanced isolation precautions (IPs) is crucial to reduce healthcare-associated infections. Our aim was to evaluate physician's knowledge and attitudes related to IPs. METHODS: An online questionnaire was sent to our hospital's physicians (attending physicians and residents). RESULTS: A total of 111 physicians completed the questionnaire: 60 (54%) attending physicians and 51 (46%) residents. Overall, respondents had a poor knowledge of the three types of IPs, especially droplet precautions (13 correct answers, 11.7%) and airborne IP (17 correct answers, 16.3%). We observed a statistically significant difference between attending physicians and residents for the type of IP to prescribe to a patient presenting with multidrug-resistant urinary infection: 44 residents (86%) gave the correct answer vs 42 attending physicians (70%), P=0.04. Physicians (both residents and attending physicians) who were already familiar with the dedicated webpage available on the hospital's intranet (n=40) obtained a score of 4.75/10 (±2.0) compared with 4.03/10 (±1.7) for those who had never used that tool (n=71). The difference was statistically significant (P=0.04). The average score for both residents and attending physicians was 4.3/10 (±1.9, range: 1-10). Attending physicians' and residents' scores were 4/10 (±1.8) and 4.5/10 (±1.9), respectively, but the difference was not statistically significant (P=0.14). CONCLUSION: Physicians' knowledge of IPs was insufficient. Improvement in medical training is needed. The use of a dedicated webpage on hospitals' intranet could help physicians acquire better knowledge on that matter.

Molecular dynamics of Staphylococcus aureus nasal carriage in Hajj pilgrims.

During the 2012 Hajj season, the risk of acquisition of Staphylococcus aureus nasal carriage in a cohort of French pilgrims was 22.8%, and was statistically associated with the acquisition of viral respiratory pathogens (p 0.03). The carriage of S. aureus belonging to the emerging clonal complex 398 significantly increased following the pilgrimage (p < 0.05).

Delta-toxin production deficiency in Staphylococcus aureus: a diagnostic marker of bone and joint infection chronicity linked with osteoblast invasion and biofilm formation.

Biofilm formation, intra-osteoblastic persistence, small-colony variants (SCVs) and the dysregulation of agr, the major virulence regulon, are possibly involved in staphylococcal bone and joint infection (BJI) pathogenesis. We aimed to investigate the contributions of these mechanisms among a collection of 95 Staphylococcus aureus clinical isolates from 64 acute (67.4%) and 31 chronic (32.6%) first episodes of BJI. The included isolates were compared for internalization rate, cell damage and SCV intracellular emergence using an ex vivo model of human osteoblast infection. Biofilm formation was assessed in a microbead immobilization assay (BioFilm Ring test). Virulence gene profiles were assessed by DNA microarray. Seventeen different clonal complexes were identified among the screened collection. The staphylococcal internalization rate in osteoblasts was significantly higher for chronic than acute BJI isolates, regardless of the genetic background. Conversely, no differences regarding cytotoxicity, SCV emergence, biofilm formation and virulence gene distribution were observed. Additionally, agr dysfunction, detected by the lack of delta-toxin production using whole-cell matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) analysis (n = 15; 15.8%), was significantly associated with BJI chronicity, osteoblast invasion and biofilm formation. These findings provide new insights into MSSA BJI pathogenesis, suggesting the correlation between chronicity and staphylococcal osteoblast invasion. This adaptive mechanism, along with biofilm formation, is associated with agr dysfunction, which can be routinely assessed by delta-toxin detection using MALDI-TOF spectrum analysis, possibly providing clinicians with a diagnostic marker of BJI chronicity at the time of diagnosis.

Kinetic study of compost liquor nitrification.

This study is a first kinetic approach about the compost liquor treatment by activated sludge. This industrial wastewater is highly loaded in organic and nitrogen compounds (COD≈12,000 mg L(-1) and NH(4)(+)-N≈4,000 mg L(-1)). The possibility of its treatment in an urban WWTP is studied measuring ammonia oxidation rate with non-acclimated sludge to the industrial effluent. Compost liquor appears as an inhibitor substrate. The ammonia oxidation rate can be modelled by the Haldane model: U(MAX)=0.180 d(-1), K(S)=12.0 mgN.L(-1) and K(I)=26.0 mgN.L(-1). The ammonia oxidation rate also follows for a synthetic substrate which has the same pollutant load as the real substrate. In this case, the ammonia oxidation rate can be modelled by the Monod model: U(MAX)=0.073 d(-1) and K(S)=4.3 mgN.L(-1). This result confirms that the ammonia oxidising bacteria are inhibited by the real wastewater. The following-up of nitrate production shows also the inhibition of nitrite oxidising bacteria. The compost liquor treatment seems not possible in an urban WWTP (<50,000 p.e.). That's why a specific WWTP is recommended and an acclimation step of activated sludge is essential.

Normal pregnancies after treatment of hyperprolactinemia with bromoergocryptine, despite suspected pituitary tumors.

Bromocryptine treatment was administered to 15 patients with amenorrhea and galactorrhea (AG) and to 1 patient with amenorrhea. All of them had increased plasma PRL levels. Of these 16 patients, 4 had a normal sella turcica (ST; group STO), 4 had a slight enlargement (group ST+), and 7 had a clear enlargement of ST (ST++) but no evidence of suprasellar extension. Ovulation was restored in 15 patients by bromocryptine treatment only. In one patient, ovulation resumed only after human pituitary gonadotropin treatment in combination with bromocryptine. There was no correlation between basal prolactinemia, PRL stimulability or suppressibility, the size of ST, or the efficiency of bromocryptine treatment. Every patient with normal LH response to either LRH or clomiphene or both resumed ovulation. Ovulation resumed in 3 patients among the 4 with abnormal LH response to either LRH or clomiphene or both. Among the 14 who desired pregnancy, 13 became pregnant. To date, 12 patients (ST++, 5; ST+, 3; STO, 4) have delivered normal babies. The courses of pregnancy were normal. During pregnancy, no change of ST was noted on lateral and frontal skull x-ray performed in every patient at trimonthly intervals. There was no change in the sellar index in 10 patients after pregnancy, as compared to the pretreatment status. In the presence of a pituitary adenoma or in patients with hyperprolactinemia and amenorrhea and galactorrhea, bromocryptine treatment may cure sterility without pituitary complication during pregnancy.

[Personal experience with salpingoplasty. Apropos of 285 cases]. / Notre expérience de la salpingoplastie. A propos de 285 cas.

285 cases of salpingoplasty are reported and studied. Only 172 patients could be followed up recently. The percentage of pregnancies was 27-7, 20 per cent were intra-uterine pregnancies. The percentage of successful pregnancies was 45-93 if only those patients who were seen again were reviewed. The results are best when the operation is carried out in the most conservative and most anatomically restorative fashion. This fine surgery, which must be carried out so delicately and with such detail, which will appeal more and more to modern technicians using micro-surgery, should stay in the hands of specialists because there is no doubt that the level of success rises with the experience of the operator.

[Significance of pruritus during pregnancy. Relations with the hepatic disorders of gestation]. / Signification du prurit au cours de la grossesse. Relations avec les troubles hépatiques de la gestation

The principal clinical and biological characteristics and the origin of pruritus of pregnancy (p.p.) which occurs in a little more than two pregnancies per thousand are considered in the light of 7 cases. As with recurrent jaundice of pregnancy (r.j.p.), of which pruritus represents a minor analogue, the symptoms occur solely during pregnancy and disappear after delivery. In p.p. signs of cholestasis are seen, more marked than in a normal pregnancy coming to term but less than in icterus gravidarum. The increase in transaminases seen in p.p. and r.j.p. does not occur in normal pregnancy. The two conditions, which may be grouped together under the term hepatogestosis, are benign as far as the mother is concerned but represent a definite and significant risk of prematurity for the child. It is possible to establish a relation between p.p. and/or r.j.p. and the hepatic manifestations associated with oral contraceptives. In both instances a genetic predisposition seems to favour the development of a cholestatic syndrome. A past history of p.p. represents a contraindication to the use of oral contraceptives. Cholestyramine, a bile salt chelator, gives excellent results in persistent p.p.

PIP: 7 cases of pruritus in pregnancy are reported and their laboratory findings compared with a group of normal pregnant women; then pruritus is reviewed with respect to diagnosis, pathogenesis, therapy, and prognosis. The 7 women developed pruritus in 28-38 weeks of typically the 2nd pregnancy, although during oral contraception in 1 woman. The frequency was about 2/1000 pregnancies. Lab findings suggestive of cholestasis included normal prothrombin, elevated transaminaes, alkaline phosphatase, total bilirubin, total cholesterol, and slowed BSP clearance. None of these women had any history of hepatitis, medication, or positive Australia antigen. It is important in diagnosis to rule out infections, toxic or iatrogenic hepatitis, and especially herpes gestationis, which is teratogenic. Pruritus of pregnancy is identical to that seen during oral contraception, i.e., it is a less severe form of cholestatsis than jaundice. It can be treated with cholestyramine, or will regress spontaneously after delivery, but may cause prematurity.

[Injuries to the upper extremities in the newborn diagnosed at birth]. / Les traumatismes du membre supérieur du noveau-né constatés à la naissance

Injuries to the upper limb vary in type. The overall incidence, including the form which is revealed by paralysis, is 2.6 per 1,000 (30 cases in 13,342 deliveries). In 90 per cent of cases it followed a dystocic delivery. The prognosis for these lesions is favourable when the diagnosis is made early and the correct treatment is started in the first days of life. All the same, sequellae are not rare, being in the order of 10 per cent, and this pathological condition should not be considered as a benign one. The pathology of these lesions does not depend only on the second stage of labour, nor entirely on the choice between hysterotomy and vaginal delivery, but equally on the prevention of the birth of large children and on the treatment of maternal obesity, as well as on a better estimation of the size ofthe foetus in utero by the development of measurements of the bi-acromial diameter with the use of ultra-sonic techniques.