Time to intestinal clearance of carbapenemase-producing Enterobacterales in hospital patients: a longitudinal retrospective observational cohort study.

BACKGROUND: Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone to discontinue isolation precautions for CPE patients in hospitals. This study aimed to evaluate the time to spontaneous CPE-IC and identify its potential associated risk factors. METHODS: This retrospective cohort study was carried out between January 2018 and September 2020 on all patients in a 3200-bed teaching referral hospital with confirmed CPE intestinal carriage. CPE-IC was defined as at least three consecutive CPE-negative rectal swab cultures without a subsequent positive result. A survival analysis was performed to determine the median time to CPE-IC. A multivariate Cox model was implemented to explore the factors associated with CPE-IC. RESULTS: A total of 110 patients were positives for CPE, of whom 27 (24.5%) achieved CPE-IC. Median time to CPE-IC was 698 days. Univariate analysis showed that female sex (P=0.046), multiple CPE-species in index cultures (P=0.005), Escherichia coli or Klebsiella spp. (P=0.001 and P=0.028, respectively) were significantly associated with the time to CPE-IC. Multivariate analysis highlighted that identification of E. coli carbapenemase-producing or CPEs harbouring ESBL genes in index culture extended the median time to CPE-IC, respectively (adjusted hazard ratio (aHR) = 0.13 (95% confidence interval: 0.04-0.45]; P=0.001 and aHR = 0.34 (95% confidence interval: 0.12-0.90); P=0.031). CONCLUSION: Intestinal decolonization of CPE can take several months to years to occur. Carbapenemase-producing E. coli are likely to play a key role in delaying intestinal decolonization, probably through horizontal gene transfer between species. Therefore, discontinuation of isolation precautions in CPE-patients should be considered with caution.

[Update of clinical findings in cobalamin deficiency: personal data and review of the literature]. / Manifestations hématologiques de la carence en vitamine B12: données personnelles et revue de la littérature.

PURPOSE: During last decades, several progresses have been made in the diagnosis of cobalamin (vitamin B12) deficiency. Routine used of cobalamin standardized assays have potentially modified the frequency and the type of hematologic abnormalities. CURRENT KNOWLEDGE AND KEY POINTS: Current studies on cobalamin deficiency, including more precise definitions and the description of new etiologies of cobalamin deficiency in adults, as the food-cobalamin malabsorption syndrome, show that hematological abnormalities are generally incomplete compared to historical descriptions of megaloblastic anemia. Nevertheless, they include severe manifestations in 10% of the patients: pancytopenia, severe anemia (hemoglobin < 6 g/dl) or hemolytic anemia and pseudo thrombotic microangiopathy related to cobalamin deficiency. These studies also show the efficacy of new treatment modalities including oral cobalamin administration. PROSPECTS AND PROJECTS: Future studies will confirm these data with the routine use of the new cobalamin assay: holotranscobalamin and validate the usefulness of oral cobalamin therapy.

[Risk factors for nosocomial Clostridium difficile diarrhoea in an infectious and tropical diseases department]. / Facteurs de risque de diarrhée nosocomiale à Clostridium difficile dans un service de maladies infectieuses et tropicales.

FOREWORD: Clostridium difficile associated diarrhea (CDAD) accounts for 25% of all cases of diarrhea occurring in hospital. Infectious diseases departments are considered as presenting with an important risk of CDAD because of the large quantity of antibiotics used. OBJECTIVES AND METHOD: The authors made a prospective study in the first 6 months of 2001, in order to identify the risk factors of CDAD in their department. One hundred and fifty-two patients hospitalized for at least 6 days were included in this study. The studied factors were: age, mean number of days of hospitalization (MDH), antibiotic therapy, WHO scale of reduced mobility of patients, recent hospitalization (less than 3 months before). RESULTS: MDH was 36 (IC95%: 23-48). Beta-lactam antibiotics were found as significant risk factors, as reported in the literature. However, age and a recent hospitalization were not related to the CDAD as described in the literature. A reduced mobility of patients was identified as a significant risk factor for developing a CDAD in our department.

Effect of peracetic acid and aldehyde disinfectants on biofilm.

The effects of two aldehyde (Cidex, Endosporine) and four peracetic acid (PAA) (Nu Cidex, Anioxyde 1000, Hydraseptic, Peralkan) disinfectants on an Escherichia coli biofilm model were studied. The biofilm was prepared in glass tubes, and evaluated indirectly using a colourimetric method. The ability of the disinfectants to fix or remove the biofilm from tubes was determined by their detergent activity (DA). The two aldehyde derivatives and two of the PAA (Nu Cidex, Anioxyde 1000) agents fixed the biofilm. However, the effects of Hydraseptic and Peralkan were equivalent to the control (sterile water). Regardless of their disinfectant activity, PAA agents display different DAs that could be used to select the weakest biofilm-fixing agents. Users should be concerned about the efficiency of the cleaning stage of medical devices, and when choosing a PAA product, non-fixing ability should be considered in addition to antimicrobial activity.

[Is there a link between the food-cobalamin malabsorption and the pernicious anemia?]. / Existe-t-il un lien entre les non-dissociations de la vitamine B12 et la maladie de Biermer?

BACKGROUND: A relation between food-cobalamin malabsorption and pernicious anemia has been suggested, particularly in the event of food-cobalamin malabsorption related to hypochlorhydric atrophic gastritis. STUDY DESIGN: This work describes three cases of well-documented cobalamin deficiency related to food-cobalamin malabsorption in three women aged 56, 82 and 68 Years who had atrophic gastritis (not associated with Helicobacter pylori infection) and later developed authentic pernicious anemia. CONCLUSIONS: This work illustrates the potential relation between these two disorders responsible for cobalamin deficiency.

Effectiveness of detergent-disinfecting agents on Escherichia coli 54127 biofilm.

Detergent-disinfecting agents (dD) are used daily for cleaning reused medical devices. We have devised a simple method to test dD detergent activity (DA) using an E. coli 54127 biofilm prepared in haemolysis glass tubes, which are cleaned with test dD, according to supplier's recommendations. Crystal violet 0.05% is used to colour the residual biofilm after dD (or tap water control) application. The biofilm quantification was made indirectly by measuring the absorbance of crystal violet at 585 nm. A measure of the detergent effectiveness called DA was calculated as the percentage reduction of colour from a tap water control. Fifteen products including enzymatic and non-enzymatic dDs were evaluated. Most enzymatic dDs gave a high DA, as did some non-enzymatic products. Thus, the view that enzymatic dDs are more effective than non-enzymatic dDs, put forward by some manufacturers, should be regarded with caution. The DA determination should help infection control teams choose, within the wide range of products available on the market, the most effective dD based on both its detergent and disinfecting activity.