[Incidence and clinical characteristics of symptomatic urinary infections in a geriatric hospital]. / Incidence et caractéristiques cliniques des infections urinaires symptomatiques dans un hôpital gériatrique.

UNLABELLED: OBJECTIVES AND SETTINGS: The authors had for aim to study the incidence of symptomatic urinary infections (SUTI) in elderly patients, to describe their clinical and microbiologic characteristics and first-line treatment in a geriatric hospital with 902 beds: 124 in acute care (ACF), 293 in rehabilitation and intermediate-care (RICF), and 485 in long-term-care-facilities (LTCF). METHOD: During two months in 2003, all positive urine cultures detected by the laboratory were sent to the clinician with a questionnaire on clinical signs, diagnosis of SUTI and antibiotic treatment. RESULTS: SUTI was diagnosed in 85 out of 204 positive urine cultures (40%). The incidence of SUTI was 1.86 per 1,000 patient-days (with rates of 2.63, 2.49, 1.41 per 1,000 patients-days for the ACF, RICF, LTCF respectively). For 51 cases (60%) there were only general symptoms, for 24 cases (28.2%) there were only urinary symptoms, and for 10 cases (11.8%) there were both. Escherichia coli and Proteus mirabilis were the main bacterial species involved in 57 and 14% respectively. E. coli strains were 59% resistant to amoxicillin, 55% resistant to amoxicillin-clavulanic acid, and 39% resistant to fluoroquinolones. The main antibiotics were fluoroquinolones, ceftriaxone, and amoxicillin-clavulanate, prescribed respectively in 52.5, 19, and 9% of the cases. CONCLUSION: SUTI was diagnosed in only in 40% of positive urine cultures from elderly patients hospitalized in our hospital. To improve the management of SUTI in this population, we changed our recommendations for diagnosis and treatment.

Epidemiological typing of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates responsible for five outbreaks in a university hospital.

Thirty-seven isolates of extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae implicated in five nosocomial outbreaks (I-V) on three distinct wards of our hospital were compared using capsular typing, biotyping, antibiotyping, enzyme electrophoresis typing and DNA macrorestriction analysis with Xba I resolved by pulsed-field gel electrophoresis. The isolates from each outbreak had common phenotypic and genotypic characteristics indicating that they were related epidemiologically. Isolates from outbreaks I (four patients) and V (13 patients), although they occurred in two different wards (neurology and surgery) and three years apart, produced the same ESBL with a pI of 7.8 (SHV-4) and were of serotype K25. The Xba I patterns were closely related. The isolates of outbreaks II (seven patients), III (four patients) and IV (seven patients), which occurred in a single surgical intensive care unit, produced an ESBL with a pI of 6.3 (TEM-3). Isolates from outbreaks III and IV, which occurred six months apart, were of serotype K68 and had similar Xba I patterns suggesting that the two outbreaks were due to a single strain which persisted endemically in the ward. The isolates from outbreak II were of serotype K62, and had distinct characteristics from the two later outbreaks. The Xba I patterns of the isolates from outbreaks "I and V', II and "III and IV' had Dice similarity coefficients under 40% showing that the three groups were genetically distant. DNA macrorestriction analysis was a useful complement to phenotypic methods for identifying K. pneumoniae strains responsible for outbreaks harbouring a common ESBL.

[Bacterial epidemiology of chronic otitis. Prophylactic and therapeutic deductions]. / Epidémiologie bactérienne de l'otite chronique. Déductions prophylactiques et thérapeutiques.

Antimicrobial sampling was performed in the external auditory canal and in the mastoid cavity when possible in 80 middle ears operated on during the last 15 months. These samplings concerned 20 cholesteatomas. 25 suppurative chronic otitis, 25 non suppurative chronic otitis and 6 miscellaneous. In 20 out of 80 cases (25%), one or several microbial agents were identified: cholesteatomas (35%), suppurative chronic otitis (38%), non suppurative ones (4%) and miscellaneous (16%). In most cases a staphylococcus or a negative gram agent was sensitive to amoxycillin-clavulanique acid. When sampling was performed in the mastoid cavity, the agent was not sensitive to this antibiotic (80% of cases). This study demonstrates that a prophylactic therapy against aerobic and anaerobic agents is necessary in non suppurative chronic otitis whereas the antimicrobial therapy must be adapted in other pathologies.