[Abiotrophia related endocarditis: contribution of molecular biology]. / Endocardites liées aux bactéries du genre Abiotrophia: apport de la biologie moléculaire.

BACKGROUND: Former nutritionally-deficient (variant) streptococci were recently separated from other streptococci viridans to constitute a new Abiotrophia genus, subdivided into two species, Abiotrophia defectiva (ex-Streptococcus defectivus) and Abiotrophia adjacens (ex-Streptococcus adjacens). CASE REPORT: A woman was admitted to the hospital because of purpura and fever. Vegetations were shown by trans-esophageal echocardiography. Although blood samples were positive within 24 hours, accurate identification of the morphologically and biochemically streptococcus-like bacteria that had grown remained impossible. Molecular biology technicals permitted to identify Abiotrophia defectiva, ex-Streptococcus defectivus. DISCUSSION: This new genus is important to be identified in clinical practice, because of the increased virulence of these bacteria, when compared with Streptococci viridans. They are also frequently penicillin-resistant. Molecular biology technicals allow precocious diagnosis, and make possible the improvement of the prognosis.

[In vitro kinetics of the activity of fusidic acid and fluoroquinolones combinations against staphylococci according to methicillin-resistance phenotype. Implications for the treatment of osteoarticular infections]. / Etude cinétique de l'activité in vitro des associations acide fusidique-fluoroquinolones a l'égard de staphylocoques, en fonction de leurs phenotypes de résistance à la méticilline. Implications dans le traitement des infections ostéo-articulaires.

The kinetics of the effect of fusidic acid and of two fluoropiperazinyl quinolones (ofloxacin and pefloxacin), used alone or in combination, on ten methicillin-susceptible or methicillin-resistant strains of staphylococci were studied. Little or no bactericidal effects were seen with fusidic acid. With ofloxacin and pefloxacin, the bactericidal effect was delayed and occurred only with high concentrations. Used in combination, fusidic acid and the fluoroquinolones exhibited no synergistic effects and occasionally antagonized each other in vitro. The methicillin-resistance phenotype of organisms had no influence on results.

[Empirical treatment of febrile episodes in granulocytopenic patients with a combination of piperacillin and ofloxacin. Preliminary study]. / Traitement empirique des épisodes fébriles chez les patients granulopéniques par l'association pipéracilline-ofloxacine. Etude préliminaire.

We evaluated the efficacy and toxicity of piperacillin-ofloxacin as an empiric treatment of fever in patients with neutropenia. 24 febrile episodes occurring in 21 patients (mean neutropenia: 204/mm3) were treated. The neutropenia was due to an hematologic malignancy in 6 cases and to chemotherapy in 15 cases. Fever was related to septicemia in 4 cases, urinary tract infection in 1 case, other infectious sites without microbiological documentation in 11 cases, and was of unknown origin in 8 cases. Empirical therapy was started within 24 hours of the occurrence of fever greater than 38.5 degrees C with the combination of intravenous piperacillin (12 g/day in 3 divided doses) and oral ofloxacin (400 mg/day in 2 doses). The overall response rate was 86% (19/22) of evaluable cases, with an immediate success rate (apyrexia within 48 hours) of 46%. Of the 3 failures, one was bacteriologically documented and was due to a multiply resistant strain of Staphylococcus haemolyticus (to which both piperacillin and ofloxacin were resistant). The therapy was clinically well tolerated in all except 3 patients, in whom intolerance to intravenous piperacillin was observed, leading to discontinuation of the drug in 2 cases. More extensive and comparative trials should better determine the place of this piperacillin-ofloxacin combination as first-line treatment of febrile episodes in patients with neutropenia.

[In vitro antibacterial effect of a new oral cephalosporin, cefixime. Results of a multicenter study]. / Activité antibactérienne in vitro d'une nouvelle céphalosporine orale, le céfixime. Résultats d'une étude multicentrique.

Minimal inhibitory concentrations (MIC) of cefixime (CXM) were evaluated by agar dilution against 2,469 bacterial strains isolated in 10 hospitals. For Enterobacteriaceae, MIC 50 and 90% micrograms/ml were respectively: (I) naturally non beta lactamase producing species: E. coli and Shigella 0.25-0.5; Salmonella 0.06-0.25; P. mirabilis 0.008-0.032. (II) chromosomal penicillinase producing species: Klebsiella 0.06-2. (III) chromosomal cephalosporinase producing species: E. cloacae and C. freundii 1-greater than 128; S. marcescens 0.25-16; indole + Proteus 0.06-4; P. stuartii 0.032-0.5. Activity of CXM was not modified against plasmid-mediated penicillinase producing strains, but CXM was inactive on cephalosporinase hyperproducing strains and on broad spectrum beta lactamases producing strains. CXM was inactive on P. aeruginosa (MIC 50 and 90%: 64-128) and on A. baumannii (16-128). Haemophilus and Gonococci, regardless of beta-lactamase production status, and Meningococci were very susceptible to CXM (MIC 0.008-0.12). B. catarrhalis was generally inhibited by 0.03 to 0.5. CXM was poorly active on methicillin susceptible Staphylococci (MIC 50 and 90%: 1-64) and inactive on methicillin resistant strains. Enterococci were generally resistant whereas Streptococci and Pneumococci were inhibited by low concentrations: 0.008 to 1. These antibacterial properties place CXM in excellent position among oral cephalosporins.

[Determination of the sensitivity of bacteria to antibiotics by an agar diffusion method and use of the API ATB system: a comparative study]. / Détermination de la sensibilité des bactéries aux antibiotiques par méthode de diffusion en gélose et utilisation de galeries API ATB: étude comparative.

130 bacterial strains were studied for their antibiotics sensitivity by an agar diffusion method and using API ATB System: 50 Enterobacteriaceae, 12 other Gram negative bacilli, 48 Staphylococci and 20 Streptococci. The results concurred in 83 p. cent of the cases. Discrepancies were essentially observed for coagulase negative Staphylococci and Streptococci. Strains appeared more resistant by API ATB System than by the agar diffusion method. Discrepancies mostly concerned beta-lactam antibiotic sensitivity for Gram negative bacilli or aminoglycosides and macrolides sensitivity for Staphylococci. They also concerned sulfamides and trimethoprim sensitivity for all bacterial species.

[Prophylactic systemic antibiotherapy with only ceftriaxone in neutropenic patients treated in a protected environment]. / Antibiothérapie systémique prophylactique par ceftriaxone seule chez les patients neutropéniques traités en environnement protégé.

Prophylactic systemic antibiotherapy with ceftriaxone (CRO) alone was tested in aplastic patients receiving total gut decontamination and treated in protected environment. To enter the study, the patients had to be afebrile when their polymorphonuclear (PMN) count fell under 500/cumm. Seventy eight therapeutic aplasias (after allogeneic or autologous bone marrow transplant conditioning regimens or high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 D (11-93 D). Forty-three patients received during 51 aplasias one single injection of CRO per day as soon as PMN count was under 500/cumm. In 23 cases (45%) the patients remained afebrile until the end of aplasia. There were 3 Staphylococcus epidermidis bacteremias (6%), 3 bacteriologically documented fevers (6%) and 1 Cryptococcus septicemia. Twenty-nine of these aplasias were part of a randomized study between group A (prophylactic CRO) and group B (non prophylactic CRO: 27 cases). In group A, there were significantly more aplasias without fever (34.5% vs 4%), and less bacteremias (10% vs 48%). Fever appeared later in group A (mean 12.5 D vs 6 D). No death was recorded during the whole study. Thus, in protected environment, prophylactic systemic antibiotherapy could still lessen the risk of bacterial infections. The side effects and the cost of such a procedure appeared to be diminished by a monoantibiotherapy.

[Comparative activity of habekacin and 4 other aminoglycosides against gram-negative bacilli. Evolution of resistance]. / Activité comparée de l'habékacine et de quatre autres aminosides à l'égard des bacilles Gram négatif. Evolution de la résistance.

The activity of 5 aminoglycosides compounds (habekacin, amikacin, gentamicin, netilmicin and tobramycin) was studied by an agar dilution method, against 235 strains of Enterobacteriaceae and 146 other Gram negative bacilli. 79 to 98% of susceptible strains were observed, according to the aminoglycoside compound. Habekacin and amikacin were the most effective, specially against the more frequently resistant bacteria: Enterobacter, Serratia, Hafnia, Acinetobacter, Pseudomonas aeruginosa. In comparison with a previous study, no evolution was observed in the resistance to aminoglycosides.

[Comparative study of various API galeries for the identification of gram negative bacteria]. / Etude comparative de diverses galeries API pour l'identification des bactéries à Gram négatif.

116 strains of Gram negative bacteria were identified with the use of API ATB 32 GN and Rapid 20 E galeries, in order to evaluate their performance as compared with API 20 E or API NE galeries used as reference. The identification concur (bacterial genus and species) in approximately 80 per cent of the cases. There are only 2 major discrepancies with ABT 32 GN galleries and only one with Rapid 20 E. In other cases, the profile that is obtained only permits identification of the genus but without a sufficient differentiation, requiring a study of additional characteristics or repetition of the test. These galeries enable to solve most routine diagnosis problems due to Gram negative bacteria, with the advantage of Rapid (Rapid 20 E) or automatized reading (ATB 32 GN).

Antibiotic susceptibilities of Listeria: in vitro studies.

Although Listeria is a rather susceptible bacterium, most antibiotics exert a bacteriostatic effect on Listeria monocytogenes. Except for fosfomycin, antibiotic susceptibilities are similar among the species of the genus Listeria. In vitro, bactericidal effect is often achieved by the use of antibiotic combinations. The most commonly used combinations are ampicillin with aminoglycosides. Up until now, there has been no trend towards reduced susceptibility of Listeria to antibiotics.

[Preventive systemic antibiotherapy with ceftriaxone alone in neutropenic patients treated in a protected environment]. / Antibiothérapie systémique prophylactique par ceftriaxone seule chez les malades neutropéniques traités en environnement protégé.

Prophylactic systemic antibiotic therapy with ceftriaxone alone was tested in aplastic patients receiving total gut decontamination and treated in a protected environment. Only patients who were afebrile when their polymorphonuclear (PMN) count fell below 500/cumm were admitted to the study. Seventy-eight episodes of therapeutic aplasia (consecutive to allogeneic or autologous bone marrow transplant conditioning regimens or to high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 days (range 11-93 days). Twenty patients received, during 22 episodes of aplasia, one single injection of ceftriaxone per day as soon as their PMN count was below 500/mm3. In 13 cases (59%) the patients remained afebrile until the end of aplasia, and no bacteriemia was detected. The second part of the study was randomized between group A (prophylactic ceftriaxone: 29 cases) and group B (no prophylactic ceftriaxone: 27 cases). Patients in group A had significantly more episodes of afebrile aplasia (34.5% vs 4%) and less bacteriemias (10% vs 48%) than those in group B. Also fever developed later in group A (mean: 12.5 vs 6 days). No death was recorded throughout the study. Thus, in a protected environment prophylactic systemic antibiotic therapy could still lessen the risk of bacterial infection. Using one single antibiotic seemed to reduce the side-effects and cost of the prophylactic treatment.

[Sensitivity of Pseudomonas aeruginosa to beta-lactam antibiotics. Apropos of 338 strains isolated at the Regional Hospital Center at Nantes in 1984]. / Sensibilité aux bêta-lactamines de Pseudomonas aeruginosa. A propos de 338 souches isolées au Centre Hospitalier Régional de Nantes en 1984.

The MIC of 338 Pseudomonas aeruginosa strains isolated in 1984, in a French hospital, was determined by an agar dilution method, using seven beta-lactam antibiotics: ticarcillin, azlocillin, piperacillin, cefoperazone, ceftriaxone, cefsulodin and ceftazidime. The MIC50-MIC90 were respectively: 32-64, 8-32, 8-16, 8-16, 16-64, 4-16, 2-4 mg/l. Ticarcillin was the most frequently effective compound (95% of the strains were susceptible), 90% of the strains were susceptible to ceftazidime or piperacillin, 87% to azlocillin and 84% to cefsulodin. Cefoperazone and ceftriaxone were much less effective (43% and 19% of the strains, respectively). The study of the resistance patterns showed a higher percentage (80%) of strains susceptible to all the penicillins than the percentage of strains susceptible to cephalosporins, most of them however were susceptible to both cefsulodin and ceftazidime. It also showed the relatively low frequency of resistant strains by inducible cephalosporinase or decreased permeability. Serovar 0.12 was characterized by its multi-resistance to beta-lactam antibiotics.

[Comparative study of first-line ceftriaxone and amikacin in the treatment of severe urinary tract infections in the adult]. / Etude comparative de la ceftriaxone et de l'amikacine en première intention dans le traitement des infections urinaires sévères de l'adulte.

After randomization in 2 groups of 20, 40 adult patients with a severe urinary tract infection (post-urologic surgery, pyelonephritis, prostatitis, neurologic bladder dysfunction, Foley catheter) received as first-line therapy, ceftriaxone (CFX) 1 g/24 h im or amikacin (AMK) 500 mg/24 h im during at least 5 days. The clinical and bacteriological efficiency and the tolerance of the 2 agents are equivalent. In the 2 groups, all patients but one are clinically cured. In the CFX group, 2 patients had resistant organisms (E. cloacae, strepto D) to first-line antibiotic. 48 hours after the beginning and at the end of the treatment, the percentage of urine sterilization was respectively 65 and 88 in the CFX group and 50 in the AMK group. In both groups, 60% of the patients showed negative first-month follow-up urine specimen. Underlying urinary tract pathology contributed to persistence of the original infecting organism, reinfection or relapse; the responsible isolate remained sensitive to the first-line antibiotic.

[Evaluation of the activity of antibiotics against Listeria. Therapeutic perspectives]. / Evaluation de l'activité des antibiotiques sur Listeria. Perspectives thérapeutiques.

The activity of different antibiotics was considered by studying the results reported in literature and during the IXth International Symposium on the Problems of Listeriosis. Listeria susceptibility to antibiotics did not change. Ampicillin was always one of the most effective and used antibiotics against Listeria. The association with an aminoglycoside produced a synergistic effect, which made the bactericidal activity quicker, in vitro as in vivo on animal. More recent molecules like third generation cephalosporins or fluoro-piperazinyl-quinolones had poor activity against Listeria.