Epidemiology and clinical characteristics of Klebsiella spp. meningitis in France.

OBJECTIVES: To describe the epidemiology of Klebsiella spp. meningitis in France with respect to clinical and bacteriological data. METHODS: We performed a four-year multicenter, retrospective, observational study. The primary objective was to provide a clinical description of patients with Klebsiella spp. meningitis. Secondary objectives were to compare community-acquired meningitis and healthcare-associated meningitis and to analyze factors associated with mortality. RESULTS: We enrolled 131 patients with Klebsiella spp. meningitis. Eighty-two (62.6%) infections were reported following neurosurgery. Twenty-eight strains (21.4%) were resistant to third-generation cephalosporins (3GC). The median [IQR] cellularity was 980/mm3 [116-5550], the median protein level was 5.67 [1.62-9] g/L and the median CSF glucose level was 2.5 [0-3.4] mmol/L. The in-hospital mortality rate was 23.6%. Community-acquired meningitis isolates were more frequently susceptible to 3GC than isolates from healthcare-associated meningitis (89.2% versus 72%; P=0.04). Comorbidities reported for patients with community-acquired meningitis were mainly diabetes mellitus and liver cirrhosis. In multivariate analysis, focal neurological disorder at the time of diagnosis was the only factor associated with in-hospital mortality (P=0.01). CONCLUSIONS: Purulent meningitis caused by Klebsiella spp. needs to be considered in patients with community-acquired meningitis and preexisting conditions, as well as in case of meningitis following neurosurgical procedures.

Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints.

The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCAST guidelines v2 (24mm versus 19mm). We assessed its impact on categorization of Enterobacterales recovered from urine samples in emergency departments. A total of 7749 and 2348 strains were tested using the DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpoint was in accordance with the BMD. Using the 24-mm breakpoint, the overall rate of fosfomycin resistance in Enterobacterales increased by three-fold (5.6% vs 18.1%, P<0.01) and reached 2.8% and 86.5% in E. coli and K. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remain appropriate. The accuracy of the methods for routine fosfomycin susceptibility testing should be assessed. The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. coli should be evaluated considering its rate of resistance and recent data reporting low accuracy.

Atherosclerosis knowledge of general practice residents: Diagnosis and management in primary care.

OBJECTIVES: Cardiovascular diseases represent the leading cause of death worldwide. In a previous survey, we have shown that the management of patients with atherosclerosis by general practitioners depends on the locations of the disease. The aim of this survey was to assess general practice residents' (GPR) knowledge on three clinical presentations which are ischemic stroke, coronary artery disease (CAD), and peripheral artery disease (PAD). MATERIALS AND METHODS: Between May 2017 and September 2017, a national self-administered survey that we previously used to assess the GPs' knowledge was emailed to GPRs from French medicine faculties. The questionnaire was composed of three clinical cases dealing with transient ischemic attack (TIA), stable angina (SA) and intermittent claudication (IC). Each clinical case was explored by seven similar questions. The primary endpoint was the number of GPRs who correctly answered 5 of the 7 questions for each clinical case. RESULTS: Five hundred and fifty-three GPRs (10%) answered the questionnaire entirely. There is a significant difference between TIA knowledge (19.9% of correct answers) which is greater than SA knowledge (0.9%) and IC knowledge (0.4%). The diagnosis was correctly done by 525 (94.9%) GPRs for TIA, 513 (92.8%) for SA, and 532 (96.2%) for IC. The main difficulties encountered by the GPRs concerned complementary investigations and treatment. CONCLUSION: As for general practitioners, this study reveals a difference in GPRs' knowledge depending on the location of the atherosclerosis. Considering the results, the improvement of initial training and continuing medical education (CME) in general medicine would be desirable.

Detection of Bartonella in cat scratch disease using a single-step PCR assay kit.

PURPOSE: Bartonella is an increasingly isolated emerging pathogen that can cause severe illness in humans, including cat scratch disease (CSD). The bacteria are difficult to grow and thus many detection methods have been developed, especially molecular. We previously developed a PCR method targeting ribC to identify Bartonella sp. A manufactured kit (RealCycler BART, Progenie Molecular) was commercialised shortly thereafter for the detection of Bartonella infection, including Bartonella henselae. METHODOLOGY: We performed a comparison between this test and our in-house PCR assay on 73 lymphadenopathy samples sent to the laboratory for suspicion of CSD.Results/Key findings. Among the 28 positive samples for Bartonella, 21 were identified by the two PCR assays, and seven by the commercial kit only. CONCLUSION: The performance of this commercial kit suggests that it could be a suitable alternative to our in-house PCR assay, highlighting the importance of the molecular methods used to diagnose CSD.

[Bacterial flora in blepharitis]. / La flore bactérienne dans les blépharites.

INTRODUCTION: Blepharitis has multiple, poorly defined origins. The goal of this study was to investigate the bacterial flora present in patients affected with blepharitis in comparison with healthy subjects, so as to understand the role of bacterial etiologies in blepharitis. MATERIALS AND METHODS: Fifty-four patients with blepharitis and 50 healthy controls participated in this study. Swabs were obtained and analyzed qualitatively and quantitatively for bacteria. A subgroup of 16 people (9 with blepharitis and 7 controls) also were investigated for Demodex. RESULTS: The percentages of the positive cultures and the number of colonies/case were clearly higher for patients with blepharitis in comparison with healthy controls. Bacteria were isolated for 81% of cases versus 38% for controls, with a mean of 39 colonies versus 4.4 colonies for controls. Corynebacterium sp. were the most common microorganisms isolated from patients with blepharitis (53.7% for cases versus 18% for controls, P<0.01), and the bacterial load was 15 times higher (37.4 col/case versus 2.6 col/case). C. macginleyi was the most common Corynebacteria (33% versus 6%, P<0.01). S. epidermidis: 35.1% versus 16% (P=0.02) with 11.3 col/case versus 1.6 col/case. S. aureus: 13% versus 0% (P=0.01) with 24.7 col/case versus 0. We did not find a significant difference for Propionibacterium acnes: 14.8% versus 14% with 4.7 col/case versus 5.1 col/case, or for Demodex, with 22.2% versus 28.6%. CONCLUSION: Corynebacterium sp. and especially C. macginleyi seem to participate actively in the physiopathology of blepharitis. S. epidermidis and S. aureus also remain associated with this pathology.

[Emerging uropathogens: Point for urologists and biologists]. / Mise au point : les uropathogènes émergents.

INTRODUCTION: Technological advances during the last years in bacterial identification by molecular biology and mass spectrometry, or Matrix Assisted Laser Desorption Ionisation-Time of Flight (MALDI-TOF) have allowed identifying new bacteria involved in urinary tract infections. The purpose of this review is to familiarize clinicians with these bacteria so that they can look at a particular target population and help biologists to suspect and identify them. METHOD: A bibliographic research was performed using the Medline database concerning the keywords Aerococcus, Actinobaculum, Alloscardovia, Trueperella. RESULTS: If Aerococcus sp. is now well known, Actinobaculum sp., Alloscardovia sp. and Trueperella sp. remain rarely isolated and unknown from clinicians. Importance of these germs could be underestimated because of the identifying and isolation difficulties which existed beforehand. They are particularly found in a population of elderly people with underlying conditions or urological risk factors of urinary tract infection. Actinobaculum schaalii is also found more frequently in young children. CONCLUSION: Aerococcus sp. et A. schaalii are true uropathogens not to be underestimated. Further studies are still needed to confirm the specific involvement of Trueperella and Alloscardovia in urinary diseases.

[Failure of vacuum extractions: risk factors, maternal and fetal issues]. / Échecs d'extraction par ventouse obstétricale: facteurs de risque, conséquences maternelles et fœtales.

OBJECTIVES: Determine cases which are at risk of vacuum extraction failure as well as maternal and foetal issues depending on the delivery outcome. MATERIAL AND METHODS: It was a retrospective study comparing 147 vacuum failures, from January 2002 to December 2010, with a control group randomly composed of 526 successful vacuum extractions. The outcomes were high risk situations of vacuum failure, maternal and neonatal morbidity depending on the delivery method (caesarean section or other instrumental extraction). RESULTS: The global vacuum failure rate was 3.3 %. During labour, we identified several situations at risk of vacuum extraction failure: cephalhematomas prior to extraction (P<0.001), deflexion attitude (P<0.001), posterior variety (P<0.001), entering above the inlet strait (P<0.001), occiput posterior delivery (P<0.001), fœtal weight greater than 3500g (P=0.023). Neonatals consequency were more Apgar score below 7 at five minutes life (P=0.007), fœtal acidosis (pH<7,20) (P=0.032), neonatal resuscitation (P<0.001), and craniofacial damages (P<0.001). CONCLUSION: Many dystocic situations occurring during labour require intense care when practicing vacuum extraction since they more frequently result in failure. In case of vacuum extraction failure, immediate adaptation to extra-uterine life seems to be more difficult for new-born babies.

[Pays de la Loire Pneumococcus Observatory: antimicrobial resistance of Streptococcus pneumoniae in 2007]. / Observatoire régional du pneumocoque en région Pays de la Loire: résistance de Streptococcus pneumoniae aux antibiotiques en 2007.

OBJECTIVES: Between 1st January and 31st December 2007, 331 Streptococcus pneumoniae strains were collected from 20 participating laboratories in the Pneumococcus Network Pays de la Loire county to assess their susceptibility to antibiotics and to evaluate serogroups of strains. METHOD: The coordinating centre performed MICs of penicillin G, amoxicillin and cefotaxime by the reference agar dilution method. Results were interpreted according to CA-SFM breakpoints. Sensitivity to other antibiotics were studied and serotyping of each strain performed. RESULTS: Three hundred and thirty one strains were isolated in 2007. They were collected from 30 cerebrospinal fluids, 239 blood samples, 53 middle ear fluids and nine pleural fluids. The percentage of pneumococci with decreased susceptibility to penicillin G (PDSP) was 39% and was higher in children (51%) than in adults (35%). The PDSP were often multidrug resistants especially with a high percentage of resistance to erythromycin (87.6% versus 8.4% for pneumococci sensitive to penicillin G). Finally, the most prevalent serogroup was the serogroup 19 (29.6% of isolates). CONCLUSION: A decrease of PDSP was observed since 2001 and high-level resistant strains to beta-lactams remain low. The rate of PDSP in Pays de la Loire is in the national average.

[Otologic sequels in velopalatine clefts. Analysis and management]. / Séquelles otologiques dans les fentes palatovélaires. Analyse et prise en charge.

As early as in 1878, medical teams managing children born with a velopalatine cleft had noted the prevalence of middle-ear pathologies largely related to anatomic and inflammatory Eustachian tube dysfunction. The aim of this study was to describe otologic sequels related to a velopalatine cleft and to suggest an adapted management. These sequels are evolving presentations of chronic serous otitis; they worsen the functional prognosis (hypoacousia) and more rarely the vital prognosis (cerebral or infectious complications of cholesteatoma). We must stress the importance of prevention: during the initial management, by Eustachian tube rehabilitation, and by ENT (Ear, Noseand Throat) follow-up allowing to prevent these sequels and to bring hearing to normal as soon as possible, so as to support cognitive development, language skills, and sociofamilial integration of the children.

Radiative proton capture on (6)He.

Radiative capture of protons is investigated as a probe of clustering in nuclei far from stability. The first such measurement on a halo nucleus is reported here for the reaction 6He(p,gamma) at 40 MeV. Capture into 7Li is observed as the strongest channel. In addition, events have been recorded that may be described by quasifree capture on a halo neutron, the alpha core, and 5He. The possibility of describing such events by capture into the continuum of 7Li is also discussed.

Halo structure of (14)Be.

The two-neutron halo nucleus (14)Be has been investigated in a kinematically complete measurement of the fragments ((12)Be and neutrons) produced in dissociation at 35 MeV/nucleon on C and Pb targets. Two-neutron removal cross sections, neutron angular distributions, and invariant mass spectra were measured, and the contributions from electromagnetic dissociation (EMD) were deduced. Comparison with three-body model calculations suggests that the halo wave function contains a large nu(2s(1/2))(2) admixture. The EMD invariant mass spectrum exhibited enhanced strength near threshold consistent with a nonresonant soft-dipole excitation.

Communication Systems Interactive Software (COMSIS): Modeling of Components and its Application to the Simulation of Optical Communication Systems.

comsis, which stands for communication systems interactive software, is a computer-aided-design tool based on a time approach. It allows the design, analysis, and performance optimization of optical transmission systems by use of various optical devices. comsis allows scalar or vectorial simulations, depending on whether the polarization is taken into account. An overview concerning the optical component models is given. A new model of an erbium-doped fiber amplifier allows the user to describe the amplifier through either physical or system parameters by using silicate or fluoride glass fibers or any other material, provided the user can give a file that contains the amplifier's characteristics. The new model of a single-mode fiber allows the user to describe chromatic dispersion through a constant, a function, or a file (given by the user) and to take optionally into account the Kerr and the Raman effects and the polarization-mode dispersion. The simulation tools that are used to characterize the quality of an optical transmission system are also presented. To show the system's full range of capabilities in the optical domain, we describe examples of wavelength-division-multiplexing and soliton-transmission systems.