Molecular epidemiology and antimicrobial susceptibility profiles of methicillin-resistant Staphylococcus aureus blood culture isolates: results of the Quebec Provincial Surveillance Programme.

The objectives of this study were to characterize methicillin-resistant Staphylococcus aureus (MRSA) blood culture isolates and to determine their relative importance in both nosocomial and community-acquired infections. A total of 535 MRSA blood culture isolates were analysed. In vitro susceptibility to 14 agents was determined. The genes nuc, mecA and coding for PVL toxin were identified by PCR. All isolates were characterized by PFGE or spa typing to assess their genomic relationships. Most MRSA isolates were retrieved from nosocomial bloodstream infections (474, 89%) and were of the CMRSA2 genotype. Healthcare-associated (HA)-MRSA bloodstream infections were associated with older age (70-89 years, P = 0·002) and most often secondary to central line infections (P = 0·005). Among MRSA strains associated with community-acquired (CA)-MRSA, 28·8% were isolated in intravenous drug users. CA-MRSA genotypes were more frequently found in young adults (20-39 years, P < 0·0001) with skin/soft tissue as the primary sources of infection (P = 0·006). CMRSA10 genotype was the predominant CA-MRSA strain. All MRSA isolates were susceptible to doxycycline, tigecycline, trimethoprim/sulfamethoxazole and vancomycin. Both the presence of the genes coding for PVL toxin (89·8%) and susceptibility to clindamycin (86·5%) were predictive of CA-MRSA genotypes. Whereas in the USA, HA-MRSA have been replaced by USA300 (CMRSA10) clone as the predominant MRSA strain type in positive blood cultures from hospitalized patients, this phenomenon has not been observed in the province of Quebec.

Childhood trauma and personality disorder in 43 women with panic disorder.

Among 43 women with panic disorder (38 with agoraphobia), 23 reported histories of childhood sexual abuse associated with high incidence of other early adverse experiences. The finding that subjects reporting childhood sexual and physical abuse were more likely to receive an Axis II diagnosis than those who did not confirms prior work.

MMPI indices of childhood trauma among 110 female outpatients.

This study investigated MMPI characteristics of adult female outpatients in a behavior therapy clinic (N = 110). Those reporting histories of childhood sexual or physical abuse or both differed from those who did not on global Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) indices of psychopathology and on Scales F, K, L, 4, 7, and 8. Subjects reporting abuse also reported high rates of other early traumas: witnessing family violence, parental alcohol abuse, and parental divorce. Physical abuse history was the best predictor of adult maladjustment as assessed by the MMPI. Findings suggest the potential utility of the MMPI for assessing long-range trauma effects and highlight the importance of considering multiple early-risk factors for the development of psychological disturbance.

The Psychological Maltreatment Inventory: development of a measure of psychological maltreatment in childhood for use in adult clinical settings.

Development of a 25-item Psychological Maltreatment Inventory, based on five categories of psychological maltreatment found in the literature on child development, is described. Two major factors emerged from a factor analytic study of the responses of 118 clinical outpatients. Reported childhood experiences of Emotional Neglect and Hostile Rejection were related to several measures of psychological dysfunction among adult outpatients.

[Complications and contraindications of corticotherapy]. / Complications et contre-indications de la corticothérapie

In a review of the classical complications of corticotherapy the aouthors tried, in the light of the literature, to take into consideration the ideas received as compared with the numerical conclusions of statistical studies on large series. Then they presented the patient treated with corticoids, faced with the surgical intervention. They tried to demonstrate that adrenal insufficiency, if present, is only exceptional and that all of the incidents, observed during and immediately after surgery must not be attributed to it.

[Preparation of the patient for reoperation]. / Préparation du malade à la réintervention

The preparation of patients for reintervention should aim at the correction of: - states of shock and collapse, found in one out of three patients; - hydroelectrolytic disturbances (sodium depletion, hypochloremia, dyskaliemia); - and finally, re-establishment of the acid-base balance.

[Infectious problems in reoperations in abdominal surgery. Apropos of 104 operations]. / Problèmes infectieux dans les réinterventions en chirurgie abdominale. A propos de 104 interventions

Analysis of the problems with infection in a series of 104 reinterventions, enables one to accentuate the importance of infestation from intraperitoneal foci (70 p. 100 of the cases). Extra-peritoneal entry pathways are difficult to prove. Septicemia is found in one out of every three cases. In certain cases, preventive treatment of the extra-peritoneal entry pathways must be opposed to the effectiveness of the surgical act in the eradication of septic foci.

[Evaluation of 1200 venous catheterizations in reanimation]. / Bilan de plus de 1200 cathétérismes veineux en réanimation

The authors present a series of 1247 venous catheterizations during resuscitation, the latter being carried out under particularly strict aseptic conditions. This series contains especially: - 364 internal jugular catheterizations; - 223 subclavian catheterizations; - 130 femoral catheterizations. The total number of days of infusion is 6300, of which 3,619 were of prolonged parenteral feeding. 79.5 p. 100 of the catheters cultured proved to be sterile; in the case of those cultures which were positive, 6.5 p. 100 were due to pathogenic organisms, 13.9 p. 100 were due to saprophytes. On the whole, 7 septicemies of venous origin (0.56 p. 100 of all of the catheterizations) were observed. The détailed study of each route shows that the frequency of cultures of pathogen positive catheters is practically the same in all cases. On the other hand, the frequency of cultures of catheters positive with saprophytes is evidently higher for the internal jugular vein; this being particularly true in the male where the role of the beard as a contaminating factor is evoked. The importance of asepsis in the procedure of putting venous catheters in place and in their maintenance seems to be welle demonstrated by the results presented.

[Antidepressives and anesthesia]. / Anti-dépresseurs et anesthésie

Anesthesia and anti-depressors have a bad name: is their reputation justified? In the opinion of the Anesthesiologist, it is justified in a large part concerning the IMAO, because there is no absolutely secure solution in large scale surgery. On the other hand, the value of accidents must be reset in its proper place. Only the hypertensive increase is very worrying, not so the drop in tension, and it is often the therapeutical gesture which induces the catastrophe. As far as the tricyles are concerned, they never lead to real problems, if we are aware of the treatment to be applied.

[General anesthesia for electroshock therapy]. / Anesthésie générale pour sismothérapie

Those are a few reflexions to be pondered by psychiatrists, to remind them what are the dangers connected with anesthesia for electroshock-therapy. Some of those risks are well-known: inhalation of gastric liquids, recess in ventilation. Others are somehow more obscure: hyperkalemia, extended curarization after injection of succinylcholine. The risk is therefore still present: to know it is to be ready to face it.