[Monitoring of antibiotic resistance of gram negative anaerobes]. / Surveillance de la résistance aux antibiotiques des anaérobies stricts à Gram négatif.

MATERIAL AND METHOD: Using an agar reference method (Norma M11-A5, National Committee for Clinical and Laboratory Standards) the minimal inhibitory concentrations of nine antibiotics were determined for 376 anaerobic strains. The following strains were investigated: 254 Bacteroides fragilis group (including 143 B. fragilis), 122 other gram-negative anaerobes (Bacteroides spp., Prevotella, Fusobacterium, Porphyromonas, Suterella, Desulfomonas, Veillonella). RESULTS: In the B. fragilis group resistance rates were: coamoxyclav 2.8%, ticarcillin 27.5%, ticarcillin-clavulanic acid 1.9%, piperacillin-tazobactam 1.9%, cefoxitin 6.2%, imipenem 0.8%, clindamycin 28.3%, respectively. Based on previous studies, resistance to imipenem remained low in 2003 and was only observed for B. fragilis. Resistance to clindamycin was maintained around 25%. No metronidazole resistance was observed, but decreased susceptibility was found for B. fragilis, B. merdae and Prevotella, as in 4.3% of gram-negative anaerobes. DISCUSSION: This study confirms the high resistance rate of gram-negative anaerobes to clindamycin, the efficient activity of imipenem, beta-lactam/beta-lactamase inhibitor combinations and metronidazole. However, reduced metronidazole susceptibility seems to be increasing.

Prognostic factors in adult community-acquired bacterial meningitis: a 4-year retrospective study.

The aim of this 4-year, observational, single-center study was to identify prognostic factors and evaluate the need for intensive care in cases of bacterial meningitis. During the study period, 60 cases of adult bacterial meningitis were identified. Fifty-one patients were transferred to the intensive care unit at various times during their hospital stay. In the multivariate analysis, factors significantly associated with the need for mechanical ventilation and/or vasopressive drugs included comorbidity and a Glasgow coma score of less than 12 at hour 6 following presentation. The results indicate patients with a decreased level of consciousness, neurological deficit or comorbidity should be admitted to the intensive care unit at an early stage of illness. When patients lack these criteria 6 h following presentation, admission to the medical ward is reasonable.

[Reservoirs and transmission of Pseudomonas aeruginosa in intensive care unit]. / Réservoirs et transmission de Pseudomonas aeruginosa en réanimation médicale.

OBJECTIVE: The authors had for aim to study reservoirs and transmission of Pseudomonas aeruginosa in an intensive care unit. DESIGN: A 6-month prospective descriptive study was made on water samples, samples from hands of health care workers, and clinical samples. P. aeruginosa strains were compared by pulsed-field gel electrophoresis. RESULTS: Among the 211 patients hospitalized during the study, 14 (6.6%) were infected by P. aeruginosa. Out of 494 water samples, 80 were contaminated by P. aeruginosa. The regularly disinfected water taps were more rarely contaminated than the others (P<10(-5)). Out of 140 hand samples, one showed contamination from an infected patient. CONCLUSIONS: aeruginosa cross transmission was observed during this study. We should follow strict hygienic precautions such as wearing gloves and performing thorough alcoholic rub disinfection. Water taps are often contaminated and require regular disinfection.

Antibiotic resistance among anaerobic Gram-negative bacilli: lessons from a French multicentric survey.

Temporal changes of antibiotic susceptibilities among anaerobes in France are followed in our laboratory since 1992. For Bacteroides strains, resistance increased from 1992 to 1998 for amoxicillin-clavulanic acid, cefotetan and clindamycin. The present study evaluates the situation in 2000 for 434 Gram-negative anaerobic clinical isolates (obtained from 9 large university hospitals) by testing amoxicillin and ticarcillin alone or combined with clavulanic acid, cefoxitin, cefotetan, imipenem, clindamycin and metronidazole (using the NCCLS-approved method for MIC determination. The main genera tested included Bacteroides (359 strains of the fragilis group), Prevotella (40 strains), Fusobacterium (23 strains) and miscellaneous species (8 strains). Resistance rates within the B. fragilis group were: amoxicillin-clavulanic acid 5.6%, ticarcillin 33%, ticarcillin-clavulanic acid 2%, cefoxitin 13%, cefotetan 44%, clindamycin 33%, imipenem 1% and metronidazole <1%, respectively. Only one strain of B. fragilis was resistant to metronidazole (MIC=64 mg/L); due to the presence of the nimA gene on the chromosome. Resistance to imipenem or metronidazole was only found among the B. fragilis species. These two former drugs excepted, B. fragilis was less resistant to antibiotics than the other species. beta-lactamase production was detected for 357/359 strains of the fragilis group, 26/40 stains of Prevotella and 3/23 strains of Fusobacterium. Dynamic changes of antibacterial resistance are occurring within the B. fragilis group: decreased resistance to amoxicillin-clavulanic acid, ticarcillin-clavulanic acid, imipenem while resistance for cefoxitin, cefotetan, clindamycin continues to increase. Regular antibiotic surveys are needed as a source of information to guide the empirical therapy of anaerobic infections.

[Comparative in vitro activity of cefepime: multicenter study in Aquitaine]. / Activité in vitro comparée du céfépime: étude multicentrique en Aquitaine.

Over a 6 month-period (1st January to 30th June 1995), the results of antibiotic susceptibility testing routinely performed for beta-lactams against enterobacteria, Pseudomonas aeruginosa, and Acinetobacter in 7 laboratory hospitals of Aquitaine, have been collected and divided in susceptibility profiles. A total of 9269 strains (7323 enterobacteria, 1667 P. aeruginosa, 279 Acinetobacter) have been examined. On the whole, cefepime (91,5%) and ceftazidime (91,7%) were the most active cephalosporins, followed by cefpirome (87,9%) and cefotaxime (80,4%); imipenem was the most active beta-lactam agent (97,4%). When the strains were divided according to their susceptibility profiles, the advantage of cefepime was shown to be related to its excellent activity against enterobacteria: all strains susceptible to cefotaxime and ceftazidime (CTX/CAZ-S) were susceptible to cefepime, as were most of the strains with an intermediate susceptibility or resistant to these drugs (CTX/CAZ-I/R, approximately 5% of the enterobacteria). The latter strains exhibited a phenotype corresponding either to the overproduction of their chromosomal cephalosporinase (approximately 20% of the species belonging to group 3) or to the synthesis of an extended spectrum beta-lactamase (19% of the strains of Klebsiella pneumoniae). Cefepime was active against 93% of the derepressed mutants of enterobacteria, including 3 imipenem resistant isolates of Enterobacter. CAZ-S strains of P. aeruginosa (84%) were usually susceptible to cefepime (80%), as were 6% of the CAZ-I/R strains. CAZ-S strains of A. baumannii (16.3%) were generally susceptible to cefepime (83%), as were 3.2% of the CAZ-I/R strains.

[Aortic aneurysms due to Yersinia enterocolitica: three new cases and a review of the literature]. / Anévrismes aortiques a Yersinia enterocolitica: trois nouveaux cas et revue de la littérature.

We report three cases of mycotic aortic aneurysms due to Yersinia enterocolitica. In all cases, serogroups are O:9. The three patients more than 70 year-old men with immunodeficiency underlying conditions allowing bacterial graft (neoplasia, diabetes mellitus, dysimmunitary syndrome, hematologic diseases). The six cases of the literature were clinically, biologically and epidemiologically similar. The strains of Y enterocolitica responsible for septicemia are especially serogroups O:9. This is probably due to particular virulence factors in this serogroup (phagocytosis resistance gene: yopH, ypkA et yop E) (yop: Yersinia outer membrane proteins). The presence of a pYV plasmid (plasmid yersinia virulence), found in Yersinia pathogen strains, lead to bacterial proliferation in the tissues. The authors discuss pathophysiological mechanisms involved in arterial bacterial graft following an Y. enterocolitica infection.

[In vitro activity of vancomycin and teicoplanin against gram-positive cocci]. / Activité in vitro de la vancomycine et de la teicoplanine sur les cocci gram+.

The activities of vancomycin and teicoplanin against 148 strains of Gram-positive cocci were tested using agar diffusion and liquid microdilution MIC determination. Tested strains included 84 staphylococci, 32 S. aureus, 52 coagulase-negative staphylococci (CNS), 52 enterococci, and 12 streptococci. Most strains (136) were susceptible to both agents, with inhibition diameters of 17 mm or more. MRSA strains exhibited lower geometric MIC means with teicoplanin (0.90 micrograms/ml) than with vancomycin (1.79 micrograms/ml); this difference was found for methicillin-susceptible S. aureus strains (1.07 and 1.38 micrograms/ml for teicoplanin and vancomycin, respectively). In contrast, methicillin-susceptible and methicillin-resistant strains of CNS exhibited similar MICs (1.60 micrograms/ml approximately). Enterococci were more susceptible to teicoplanin (MIC 0.25 micrograms/ml) than to vancomycin (MIC 1.35 micrograms/ml). Both vancomycin and teicoplanin were thus found to be consistently effective against Gram-positive cocci; however, teicoplanin proved more effective than vancomycin against enterococci and methicillin-resistant S. aureus strains and may therefore be a valuable therapeutic alternative for these multiresistant organisms.

[Seroepidemiologic study of sexually transmitted diseases caused by Chlamydia trachomatis in Casablanca (Morocco)]. / Enquête séro-épidémiologique sur les MST a Chlamydia trachomatis a Casablanca (Maroc).

Screening 579 sera specimens obtained in Casablanca (Morocco) we have performed a retrospective seroepidemiological survey with regard to the prevalence of Chlamydia trachomatis involved in genital tract infections. The surveyed populations are divided into 3 groups: 177 patients affected with sexually transmitted diseases (STD), 319 reference patients, 83 maghrebian patients affected with STD but living in France. The study was performed by the indirect microimmunofluorescence technique. The prevalence of Chlamydia trachomatis ranging from 50% in the moroccan reference groupe to about 70% among patients with STD both in Morocco and Bordeaux indicates that Chlamydia trachomatis takes a significant part in STD observed in moroccan populations.

Isolation of a urease positive thermophilic variant of Campylobacter lari from a patient with urinary tract infection.

An unusual campylobacter strain, a urease positive thermophilic variant of Campylobacter lari, was isolated from the urine of a patient with urinary tract infection who was hospitalized because of cirrhosis and haemorrhage. The strain was isolated from urine specimens on three separate occasions. A significant serological response to the organism was also detected. This is the first documented case of extra-intestinal infection due to this group of organisms.

[Treatment of peritonitis under continuous ambulatory peritoneal dialysis using intraperitoneal ceftazidime]. / Traitement des péritonites en dialyse péritonéale ambulatoire continue par la ceftazidime intrapéritonéale.

Management of peritonitis related to chronic ambulatory peritoneal ceftazidime. In 15 patients under CAPD, 22 cases of bacterial peritonitis were observed with clinical manifestation in 14. The mean cell count in peritoneal dialysis fluid was 3 580/mm3 with 3 040/mm3 polymorphonuclear leukocytes. Causative pathogens were: Staphylococcus in 11 cases, Streptococcus in 3, Sarcines in 2, Corynebacterium in 2, Micrococcus varians in 1, Gram negative in 3. First choice treatment was a intraperitoneal injection of 1 g of ceftazidime every 48 hours, 54.5% of patients recovered within 5 days. Failures were due to 4 Staphylococcus aureus, 3 Staphylococcus epidermidis, 1 Sarcine, 1 Streptococcus liquefaciens, 1 Corynebacterium hofmanii. Mean ceftazidime concentrations 48 hours after the intraperitoneal injection were 35 mg/l (range = 14-54 mg/l) in serum and 5.5 mg/l (E: 2.8,8 mg/l) in dialysate. These concentrations in dialysate, are not greater than most of ceftazidime'S CMI for susceptible bacteria. A single daily intraperitoneal injection of ceftazidime is desirable.

[Treatment of peritonitis in continuous ambulatory peritoneal dialysis with intraperitoneal ceftriaxone]. / Traitement des péritonites en dialyse péritonéale continue ambulatoire par la ceftriaxone intrapéritonéale.

In 16 patients under CAPD, 29 cases of bacterial peritonitis were observed, with clinical manifestations in 23. The mean cell count in peritoneal dialysis fluid was 5608/mm3 with 4991/mm3 polymorphonuclear, Leukocytes Causative pathogens were Staphylococcus in 14 cases, Streptococcus in 6, Bacillus in one, Enterobacteria in 5, Pseudomonas aeruginosa in 1 and Moraxella in 1. Three cultures were negative. First choice treatment was a daily intraperitoneal injection of 1 g of ceftriaxone. 79.3% of patients recovered within 5 days. Failure were due to a Methicillin-resistant Staphylococcus epidermidis in one case, a Streptococcus faecalis in two cases, and a Staphylococcus aureus in three observations, which two were responsible of abscess round catheter peritoneal. Mean ceftriaxone concentrations 24 hours after the intraperitoneal injection were 50.6 mg/l (range: 3.3-141 mg/l) in serum and 58.1 mg/l (range: 4.3-180 mg/l) in dialysate. These concentrations are greater than most of ceftriaxone's MICs for susceptible bacteria, a finding that confirm the value of treatment with a single daily intraperitoneal injection of ceftriaxone.

[Treatment of peritonitis due to continuous ambulatory peritoneal dialysis using a single daily intraperitoneal dose of 1g cefotiam]. / Traitement des péritonites en dialyse péritonéale continue ambulatoire par une dose unique quotidienne de 1g de céfotiam par voie intrapéritonéale.

Peritonitis remains the main complication of CAPD. This study demonstrates that most cases can be successfully treated with cefotiam. In 17 patients under CAPD, 33 cases of bacterial peritonitis were observed, with clinical manifestations in 28. The mean cell count in peritoneal dialysis fluid was 2 820/mm3, with 2 200/mm3 polymorphonuclear leukocytes. Causative pathogens were Staphylococcus in 18 cases, Streptococcus in 4, Stomatococcus mucilaginous in 1, Corynebacterium J.K. in 1, Enterobacter in 3, Acinetobacter in 3 and Pseudomonas in 2. Two cultures were negative. First choice treatment was a daily intraperitoneal injection of 1 g cefotiam. 68.80% of patients recovered within 6 days. Failures were due to a methicillin-resistant Staphylococcus epidermidis in 3 cases, a relapsing Stomatococcus mucilaginous infection in 1, a Streptococcus faecalis in 1, an Acinetobacter in 3 and a Pseudomonas in 2. Mean cefotiam concentrations 24 hours after the intraperitoneal injection were 9.4 +/- 7.0 micrograms/ml (range 1.3-26.4 micrograms/ml) in serum and 3.4 +/- 3.3 micrograms/ml (range 0.4-12.2 micrograms/ml) in dialysate. These concentrations are greater than most of cefotiam's MICs for susceptible bacteria, a finding that confirms the value of treatment with a single daily intraperitoneal injection of cefotiam.