ABSTRACT
OBJECTIVE: To improve tuberculosis (TB) diagnosis in prison, we evaluate the value of the XpertâMTB/RIF Ultra assay (Xpert) as point-of-care (POC) in a French prison hospital. METHODS: We first validated Xpert use on raw sputum at the referent laboratory. Secondly, trained physicians at the prison hospital performed Xpert tests for each patient presenting TB symptoms. The results were compared with Xpert, microscopic examination, culture and drug susceptibility testing on the corresponding decontaminated specimens. RESULTS: 76 inmates were included in 15 months and 21 were diagnosed with TB. The overall sensitivity, specificity, positive and negative predictive values of Xpert were respectively: 92.3%, 100%, 100% and 98.7% on raw sputum. The efficiency of the molecular POC was confirmed by a concordance of 97% between Xpert findings from the prison hospital and culture results. Delay of microbiological diagnosis was reduced by about 18 days for 13 inmates with smear-negative sputum that avoid the mobilization of major means (escort, transport) to perform fibroscopic samples. Repeated Xpert negative results helped to speed the lifting of inmate isolation. CONCLUSIONS: The implementation of Xpert in prison could optimize the management of incarcerated patients and thus limit the spread of TB among inmates, carers and other staff.
Subject(s)
Antibiotics, Antitubercular , Mycobacterium tuberculosis , Tuberculosis, Pulmonary , Tuberculosis , Antibiotics, Antitubercular/therapeutic use , Humans , Microbial Sensitivity Tests , Mycobacterium tuberculosis/genetics , Point-of-Care Testing , Prisons , Rifampin , Sensitivity and Specificity , Sputum , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapyABSTRACT
Detection of the most frequently bacteria involved in prosthetic joint infection (PJI) is usually performed by conventional cultures. We report a case of early PJI due to Ureaplasma urealyticum, diagnosed by 16S rRNA gene sequence analysis, which highlights the interest of molecular methods if fastidious bacteria are involved in PJI.
Subject(s)
Joint Prosthesis/microbiology , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , RNA, Ribosomal, 16S/genetics , Ureaplasma Infections/diagnosis , Ureaplasma urealyticum/genetics , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , DNA, Bacterial/genetics , Humans , Joint Prosthesis/adverse effects , Male , Microbial Sensitivity Tests , Sequence Analysis , Ureaplasma urealyticum/drug effectsSubject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/genetics , Genes, rRNA/genetics , Linezolid/pharmacology , RNA, Ribosomal, 23S/genetics , Staphylococcus/drug effects , Staphylococcus/genetics , Humans , Microbial Sensitivity Tests/methods , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiologyABSTRACT
We evaluated the benefits of on-demand systematic screening for Chlamydia trachomatis and Neisseria gonorrhoeae using the Xpert CT/NG assay in 589 women attending family planning clinics. The sexually transmitted infection prevalence was 16.5% with 15.1% C. trachomatis and 3.1% N. gonorrhoeae infections. The on-demand test allowed for a quicker management of patients at high risk for sexually transmitted infections.
Subject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Family Planning Services , Gonorrhea/diagnosis , Neisseria gonorrhoeae/isolation & purification , Reagent Kits, Diagnostic/statistics & numerical data , Adolescent , Adult , Ambulatory Care Facilities/statistics & numerical data , Chlamydia Infections/epidemiology , Female , France/epidemiology , Gonorrhea/epidemiology , Humans , Prevalence , Reproducibility of Results , Sensitivity and Specificity , Sexual BehaviorABSTRACT
The Xpert GBS real-time PCR assay for the detection of group B streptococci (GBS) in antepartum screening samples was evaluated on amniotic fluid samples collected from 139 women with premature rupture of membrane at term. When any intrapartum positive result from the Xpert GBS or culture was considered a true positive, the sensitivities of the Xpert GBS and culture were 92.3% and 84.6%, respectively. This assay could enhance exact identification of candidates for intrapartum antibiotic prophylaxis.
Subject(s)
Bacteriological Techniques/methods , Fetal Membranes, Premature Rupture , Molecular Diagnostic Techniques/methods , Pregnancy Complications, Infectious/diagnosis , Real-Time Polymerase Chain Reaction/methods , Streptococcal Infections/diagnosis , Streptococcus agalactiae/isolation & purification , Female , Humans , Pregnancy , Prospective Studies , Streptococcus agalactiae/genetics , Streptococcus agalactiae/growth & developmentABSTRACT
Preoperative samples in the context of complicated appendicitis (CA) are rarely collected, and there is no consensus regarding the optimal antibiotic therapy in children. To help optimize empirical preoperative treatment, we studied clinical and bacteriologic data from a prospective cohort of 93 children with CA in a French hospital. All the bacteria isolated from peritoneal fluids were identified, using phenotypic and/or molecular techniques. The most commonly recovered species were Escherichia coli (71%), Streptococcus group milleri (34%), anaerobes (20%), and Pseudomonas aeruginosa (19%). The association piperacillin-tazobactam is an accurate choice of empirical therapy as it is active against 97% of bacteria. A third-generation cephalosporin with metronidazole in association with an aminoglycoside is a good alternative. Although antibiotic use may be considered as an adjunct to surgical intervention of CA, the appropriate use of preoperative antibiotics is essential and must be constantly reevaluated according to the bacterial epidemiology.
