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1.
Transfus Clin Biol ; 18(1): 26-35, 2011 Feb.
Artigo em Francês | MEDLINE | ID: mdl-21310643

RESUMO

PURPOSE OF THE STUDY: Transfusion transmitted bacterial infection is an adverse reaction occurring in a patient during blood transfusion and due to the presence of bacteria in the blood component. For each transfusion transmitted bacterial infection suspicion, clinical and biological investigations should allow to either affirm the accountability of the transfused product in the occurrence of the infection (accountability score 4) or exclude it (accountability score 0). However, among 60,175 adverse reaction sheets extracted from the French e-FIT database (AFSSAPS), 143 are classified as transfusion transmitted bacterial infection diagnosis and 97 of them show a score of accountability 2 (possible). This study aims to analyze these 97 adverse reaction sheets and search for the reasons that led the haemovigilance network actors not to refine the degree of accountability in line with an exclusion or a confirmation of transfusion origin. METHOD: During collective reading sessions, each adverse reaction sheet among the 97 extracted was re-analyzed with an accountability criteria grid, built beforehand, and proposed in the technical guide sheet for transfusion transmitted bacterial infection (e-Fit AFSSAPS). RESULTS: Among the 97 analyzed adverse reaction sheets with a score accountability of 2: 12.4 % were considered as "non-analysable"; 54% were reclassified in another diagnosis category: non haemolytic febrile reaction (n=12), unknown diagnosis (n=17); patient infection before transfusion (n=23); blood component's "smear" (n=9); retrograde contamination of blood component (n=5). Finally, only 18.5% adverse reaction sheets (n=18) were maintained with a true diagnosis of transfusion transmitted bacterial infection an accountability score of 2. These cases were in agreement with those described in number 2, 3 or 4 in the annex sheet "Fiche Technique TTBI". 70% of adverse reaction sheets reclassified under another diagnosis as transfusion transmitted bacterial infection had been declared between 2000 and 2004. In order to improve transfusion transmitted bacterial infection suspicions diagnosis approach and to guide the French haemovigilance network in the investigations following a transfusion transmitted bacterial infection suspicion, the group propose recommendations after each adverse reaction sheets category analysis. CONCLUSION: The improvement measures taken as part of the French haemovigilance declaration framework allowed to perfect the data quality of transfusion transmitted bacterial infection. Progresses are still to be made to improve clinical and biological declaration, in order to precise the accountability of a blood component in the occurrence of an adverse transfusion transmitted bacterial infection effect. Tracking transfusion transmitted bacterial infection notifications by a group of experts at the national level is still recommended.


Assuntos
Bacteriemia/transmissão , Segurança do Sangue , Bases de Dados Factuais , Notificação de Doenças/estatística & dados numéricos , Reação Transfusional , Bacteriemia/sangue , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias/genética , Bactérias/isolamento & purificação , Transfusão de Componentes Sanguíneos/efeitos adversos , Prática Clínica Baseada em Evidências/normas , Controle de Formulários e Registros , França , Genótipo , Humanos , Melhoria de Qualidade , Estudos Retrospectivos , Responsabilidade Social
2.
Int J Microbiol ; 2010: 150464, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21052490

RESUMO

We studied 138 glycopeptide-resistant enterococci (GRE) strains, consisting of 131 glycopeptide-resistant Enterococcus faecium (GREfm) and 7 glycopeptide-resistant Enterococcus faecalis (GREfs). The GREfm strains were resistant to penicillin, ampicillin, vancomycin, and teicoplanin, while the GREfs strains were only resistant to vancomycin and teicoplanin. The van A gene was the only glycopeptide determinant present in all GRE isolates investigated. Genes coding for Hyl and Hyl+ Esp were detected in 39 (29.8%) and 92 (70.2%) of the 131 GREfm isolates, respectively. Three of the 7 GREfs were positive for gelE+asa 1 genes, 3 for gel E gene, and 1 for asa 1 gene. The genetic relationship between the 138 GRE was analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). GREfm isolates were clustered in a single genogroup (pulsotype A), and GREfs were clustered in six genogroups (pulsotypes B-G). Among the isolates investigated by MLST, only 18 PCR products were sequenced (12 E. faecium and 6 E. faecalis), and 9 sequence types (STs) were identified.

3.
Pathol Biol (Paris) ; 58(1): 11-7, 2010 Feb.
Artigo em Francês | MEDLINE | ID: mdl-19892479

RESUMO

BACKGROUND: Stenotrophomonas maltophilia (Smalto) is a prominent nosocomial pathogen, commonly isolated in the hospital environment. Multiple Smalto nosocomial outbreaks have been linked to contaminated water sources. This study aimed to develop a medium able to ease healthcare environment Smalto isolation. METHODS: Financed, from March 2007 to June 2008, by a university hospital of Amiens' clinical research program, this study allowed Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) development. SM2i is constituted of Mueller Hinton agar (MH), maltose, DL-methionine, bromothymol blue. The mixture sterilized is refreshed at 50 degrees C, its pH adjusted to 7.1, and render selective by addition of vancomycin, imipenem and amphotericin B. Then, SM2i agar is sunk into 90 cm diameter Petri dish dated and stored at 4 degrees C for 4 weeks. SM2i is developed using Pasteur Institute culture type collection (CIP) strains of Smalto, Burkholderia cepacia, Pseudomonas aeruginosa (Psa) and a Smalto strain of our hygiene laboratory collection. It was validate on Psa imipenem-resistant and Enterococcus faecium vancomycin-resistant strains, then, tested on cold water first jet and faucet cotton-swabs samples. SM2i tests were made in comparison with the MH agar, MH agar plus four paper disks loaded 10 microg of imipenem and Cetrimed agar. Its sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, accuracy, likehood-ratio (LR) and Youden index have been determined. RESULTS: SM2i agar is better in culturing Smalto test-strains. On SM2i, Smalto colonies are smooth, round, greeny, olive or lime green, have a green olive centre with a peripheral lighter or a dark green centre with an olive green suburb surrounded by a blue halo. SM2i is a selective, specific, predictive, accurate medium to search for Smalto in healthcare environment. In 122 pairs of cold water first jet and taps cotton-swabs samples, Smalto was isolated from 14.8% of water samples, 10.7% of cotton-swabs samples. It was isolated alone in 6.6% of water samples and 2.5% of swab samples. Thus, smalto has biocontaminated 17.2% of cold water taps. Compared to MH agar, SM2i sensitivity, specificity, PPV, NPV, accuracy, LR were 100, 100, 100, 100, 100% and infinity, and 87.5, 100, 100, 98.1, 98.4% and infinity for water and cotton-swabs samples respectively. CONCLUSION: SM2i is a selective, specific, predictive medium which can allow easily isolating and identifying accurately Smalto in environmental samples. Its evaluation on clinical samples is on going.


Assuntos
Infecção Hospitalar/microbiologia , Meios de Cultura/farmacologia , Infecções por Bactérias Gram-Negativas/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Ágar , Técnicas Bacteriológicas , Meios de Cultura/química , Contaminação de Equipamentos , Humanos , Indicadores e Reagentes , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Stenotrophomonas maltophilia/efeitos dos fármacos , Stenotrophomonas maltophilia/crescimento & desenvolvimento , Microbiologia da Água
4.
Pathol Biol (Paris) ; 58(2): e1-5, 2010 Apr.
Artigo em Francês | MEDLINE | ID: mdl-19892487

RESUMO

BACKGROUND: Pseudomonas aeruginosa (Psa) and Stenotrophomonas maltophilia (Smalto) are major opportunistic waterborne pathogens causing hospital-acquired infections. This study aimed to assess the biocontamination level of cold water used in Amiens' university hospital wards, from March to June 2008. METHODS: We cultivated 122 pairs of cold water first jet and taps cotton-swabs on Cetrimide agar for Psa, on Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) for Smalto, on Mueller Hinton agar used as isolation medium reference for both, 48h at 30 degrees C. Data analysed with Epi-Info 6.04dFr were compared with chi(2) test, significant at p<.05. RESULTS: Psa and Smalto were isolated in 26.2 and 14.8% of water samples and in 21.3 and 10.7% of swab samples respectively. They were associated in 11.5% of water samples and 5% of swab samples. Psa was alone in 13.1% of water samples and 7.4% of swab samples whereas Smalto was found in 6.6% of water and 2.5% of swabs. Psa and Smalto were isolated from 14.8% of water samples and 8.2% of swab samples of the same tap. Finally, respectively 35.2 and 17.2% of the cold water taps were biocontaminated by Psa and Smalto. In fact, microbiologic water taps contamination risk was two-fold higher for Psa than for Smalto, p<.001, without variation between wards. CONCLUSION: Sm2i and Cetrimide are suited and efficient medium respectively for Smalto and Psa isolation. Cold-water samples are sufficient for waterborne pathogens biocontamination risk appraisal. Our results urged healthcare workers on efficient water fittings microbiologic risk control to prevent healthcare associated waterborne infections, notably due to Psa and Smalto.


Assuntos
Infecções por Bactérias Gram-Negativas/prevenção & controle , Hospitais Universitários , Infecções por Pseudomonas/prevenção & controle , Pseudomonas aeruginosa/isolamento & purificação , Stenotrophomonas maltophilia/isolamento & purificação , Microbiologia da Água , Poluição da Água , Técnicas Bacteriológicas , Infecção Hospitalar/prevenção & controle , Meios de Cultura , Contaminação de Equipamentos , França , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Quartos de Pacientes , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Medição de Risco , Gestão da Segurança , Engenharia Sanitária/instrumentação , Stenotrophomonas maltophilia/crescimento & desenvolvimento , Abastecimento de Água
5.
Pathol Biol (Paris) ; 56(7-8): 461-6, 2008.
Artigo em Francês | MEDLINE | ID: mdl-18842353

RESUMO

The diagnosis of cat scratch disease (CSD) associated adenitis relies classically on the association of clinical, epidemiological and bacteriological criteria. The polymerase chain reaction (PCR) looks like a more competitive diagnostic trial than serology. We evaluated the sensitivity, specificity and predictive positive and negative values of serology in routine diagnosis of CSD. A retrospective study over five years was led among patients presenting a suspicion of CSD and having a serology and/or a PCR. The Gold standard for diagnosis was PCR. The serological tests of Bartonella henselae was performed once in 482 patients, of which 2% (11 out of 482) were positive, and twice in only 39 patients (8%). The PCR diagnosis method for B. henselae was performed in biopsy of specimen lymph nodes in 28 patients and 14 out of 28 were positive. In nine patients, the diagnosis was exclusively made by PCR. Among the 14 patients whose PCR was negative, two had a positive serology and in three others patients, the serology was not performed. The sensitivity of serology was 35%, this confirms the low sensitivity of the serology in the CSD diagnosis. The diagnosis was confirmed in 56% of cases where PCR was performed. This led us to propose to perform systematically the PCR test for B. henselae in case of adenitis possibly associated with CSD.


Assuntos
Anticorpos Antibacterianos/sangue , Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/diagnóstico , Linfonodos/microbiologia , Reação em Cadeia da Polimerase , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Animais , Bartonella henselae/genética , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/microbiologia , Gatos/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
6.
Med Mal Infect ; 38(9): 465-70, 2008 Sep.
Artigo em Francês | MEDLINE | ID: mdl-18718729

RESUMO

UNLABELLED: The main characteristics of clindamycin are adequate for treatment of osteoarticular infections (OAI): good bone diffusion, broad spectrum of antibacterial activity and oral use. METHOD: A number of 61 patients was included in an observational retrospective study of efficacy and tolerance. RESULTS: Prosthetic infections accounted for 50.8% of the cases and chronic osteitis for 36.1%. The causative micro-organisms were Staphylococci (72.2%) and Streptococci (15.3%); 86.5% of these strains were susceptible to erythromycin, 9.6% were erythromycin resistant and susceptible to lincomycin. Clindamycin was associated with either ofloxacine, rifampicin, or teicoplanin in 88.5% and the average course duration was 101 days. A surgical procedure was performed in 84% of cases. Complete cure was obtained in 91.1% at 18 months of follow up. Only one cutaneous rash and one Clostridium difficile-associated diarrhea occurred. The other adverse effects were gastrointestinal in 36%, cutaneous in 6.6%, and hematological in 1.6%, but did not lead to discontinuation of therapy. CONCLUSION: Clindamycin can be used in OAI in association with or as an alternative to rifampicin, fluoroquinolones, or glycopeptides according to microbiological data.


Assuntos
Antibacterianos/uso terapêutico , Doenças Ósseas/tratamento farmacológico , Doenças Ósseas/microbiologia , Clindamicina/uso terapêutico , Artropatias/tratamento farmacológico , Artropatias/microbiologia , Osteíte/tratamento farmacológico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Doenças Ósseas/etiologia , Clindamicina/administração & dosagem , Diarreia/induzido quimicamente , Quimioterapia Combinada , Tolerância a Medicamentos , Feminino , Humanos , Artropatias/etiologia , Masculino , Pessoa de Meia-Idade , Ofloxacino/uso terapêutico , Osteíte/etiologia , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Rifampina/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Teicoplanina/uso terapêutico
7.
J Clin Microbiol ; 46(3): 1037-44, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18234876

RESUMO

Sixty-two clinical isolates of Enterobacter aerogenes resistant to expanded-spectrum cephalosporins were collected between July 2003 and May 2005. Among these isolates, 23 (37.1%) were imipenem (IPM) susceptible, and 39 (62.9%) were IPM insusceptible, of which 89.7% (35/39) were resistant and 10.3% (4/39) were intermediate. Isolate genotypes were compared by pulsed-field gel electrophoresis. Of 62 isolates, 48 belonged to epidemic pulsotype A (77.4%). This pulsotype included 37.5% and 58.4% of beta-lactam phenotypes b and a, respectively. Nine isolates (14.5%) belonged to pulsotype E, which included 22.3% and 77.7% of phenotypes b and a, respectively. The beta-lactamases with pIs of 5.4, 6.5, 8.2, and 8.2 corresponded to extended-spectrum beta-lactamases (ESBLs) TEM-20, TEM-24, SHV-5, and SHV-12, respectively. Of 39 IPM-insusceptible E. aerogenes isolates, 26 (66.6%) were determined to be metallo-beta-lactamase producers, by using a phenotypic method. Of these isolates, 24 harbored a bla(IMP-1) gene encoding a protein with a pI of >9.5, and two carried the bla(VIM-2) gene encoding a protein with a pI of 5.3, corresponding to beta-lactamases IMP-1 and VIM-2, respectively. The remaining 13 (33.4%) isolates were negative for the bla(IMP-1) and bla(VIM-2) genes but showed an alteration of their outer membrane proteins (OMPs). Ten of these isolates produced the two possible OMPs (32 and 42 kDa), with IPM MICs between 8 and 32 microg/ml, and three others produced only a 32-kDa OMP with IPM MICs >32 microg/ml. This work demonstrates that, in addition to resistance to expanded-spectrum cephalosporins, IPM resistance can occur in ESBL-producing E. aerogenes isolates by carbapenemase production or by the loss of porin in the outer membrane.


Assuntos
Proteínas de Bactérias/biossíntese , Resistência às Cefalosporinas , Enterobacter aerogenes/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Hospitais Universitários , beta-Lactamases/biossíntese , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Proteínas da Membrana Bacteriana Externa/química , Proteínas da Membrana Bacteriana Externa/metabolismo , Proteínas de Bactérias/genética , Enterobacter aerogenes/efeitos dos fármacos , Enterobacter aerogenes/enzimologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , França/epidemiologia , Humanos , Focalização Isoelétrica , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Porinas/análise , Análise de Sequência de DNA , beta-Lactamases/genética
8.
J Neurol Neurosurg Psychiatry ; 79(2): 147-51, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17911183

RESUMO

BACKGROUND AND OBJECTIVE: Many patients with brain infarction (BI) lack traditional risk factors, suggesting that other factors (including infectious agents) might contribute to stroke risk. We investigated Chlamydia pneumoniae infection in a large cohort of patients with BI according to aetiological subtypes and carotid atherosclerosis. METHODS: We measured serum IgG and IgA to C. pneumoniae by microimmunofluorescence in 483 BI cases and 483 controls matched for age, sex and centre. IgG > or = 1/32 and IgA > or = 1/24 were considered positive. Cases with BI proven by magnetic resonance imaging were consecutively recruited and were classified into aetiological subtypes. Carotid atherosclerosis (intima-media thickness, plaques, stenosis) was evaluated by duplex ultrasonography in all subjects following the same method and with central reading. RESULTS: C. pneumoniae IgG seropositivity was not associated with BI (adjusted odds ratio (OR) 1.10, 95% confidence interval (CI) 0.80-1.51) and did not increase the risk of any aetiological subtype. Overall, C. pneumoniae IgA was not associated with BI (adjusted OR 1.54, 95% CI 0.84-2.81), but there was a significant interaction with hypertension. IgA seropositivity increased the BI risk in patients without hypertension (adjusted OR 2.79, 95% CI 1.15 to 6.74). When stratifying BI into subtypes, IgA seropositivity increased the risk of BI of unknown cause, but without significant heterogeneity. There was neither association with atherothrombotic, lacunar and cardioembolic BI nor with carotid intima-media thickness, carotid plaques or stenosis. CONCLUSIONS: We found no evidence that C. pneumoniae seropositivity is associated with carotid atherosclerosis and BI, regardless of aetiological subtype; but it might be associated with an increased risk of BI in normotensive patients.


Assuntos
Anticorpos Antibacterianos/sangue , Infarto Encefálico/imunologia , Estenose das Carótidas/imunologia , Infecções por Chlamydophila/imunologia , Chlamydophila pneumoniae/imunologia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Idoso , Pressão Sanguínea , Infarto Encefálico/diagnóstico , Estenose das Carótidas/diagnóstico , Estudos de Casos e Controles , Infecções por Chlamydophila/diagnóstico , Estudos de Coortes , Feminino , Humanos , Hipertensão/complicações , Hipertensão/imunologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
9.
Pathol Biol (Paris) ; 55(8-9): 446-52, 2007 Nov.
Artigo em Francês | MEDLINE | ID: mdl-17905533

RESUMO

Streptococcus pneumoniae is actually the first most likely organism to cause meningitis in children 2 months to 2 years old and in adults older than 65 years. From January 1990 to December 2005, 72 cases of S. pneumoniae-positive cerebrospinal fluid culture were indexed in our hospital. Among the 72 cases, 25 came from children, and 60% of these came from children under two years of age and 47 came from adults whose the mean age was 55 years. The first penicillin-resistant S. pneumoniae (PNSP) meningitis was identified in 1993. The susceptibility to penicillin of pneumococcal isolates causing meningitis varied according to time; until 1995, 25% of the strains were PNSP, then from 1996 to 2005, 50% of strains were PNSP. The overall prevalence of non-susceptible was 34.7% (25/72). Among the 25 PNSP, 21 were intermediate to penicillin G and four of them were resistant. Among children, seven PNSP meningitis were indexed and one of them was resistant. The antimicrobial MICs of amoxicillin and cefotaxim varied from 0.064 to 1 mg/l and from 0.016 to 0.5 mg/l respectively. Among adults, 18 PNSP meningitis were indexed. Three strains were penicillin-resistant. The antimicrobial MICs of amoxicillin varied from 0.064 to 2 mg/l. Nine strains of 18 PNSP had cefotaxim MIC>/=0.5 mg/l and, four of them had MIC 1 mg/l. None amoxicillin and cefotaxim-resistant strain was isolated. Serotyping of all strains was performed in the Reference Center. Serotypes 6B, 9V and 19 were the most frequent in child and serotypes 6B, 23F, 19, 9, 4 were the most frequent in adult. So, all serotypes were represented.


Assuntos
Meningites Bacterianas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Adulto , Idoso , Amoxicilina/farmacologia , Cefotaxima/farmacologia , Criança , Pré-Escolar , França/epidemiologia , Humanos , Incidência , Meningites Bacterianas/epidemiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Penicilina G/farmacologia , Resistência às Penicilinas/fisiologia , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos
10.
Pathol Biol (Paris) ; 54(8-9): 510-7, 2006.
Artigo em Francês | MEDLINE | ID: mdl-17030458

RESUMO

OBJECTIVES: Study the health-care associated infection risk due to Extended-Spectrum Betalactamases Producing Escherichia coli (ESBL Esc) isolated from diagnostic samples. METHODS: Descriptive, longitudinal and prospective study of 104 diagnostic isolates of ESBL Esc, one per patient, identified in Amiens university hospital between February 1999 and December 2005. Patients (sex, age, contamination risk factor, antecedent hospitalization) and microbiological data were progressively collected, entered into EPI INFO 6.04dFr software (ENSP, France) database, and compared using the chi-square test and Wilcoxon rank sum test, as appropriate. A p value of less than 0.05 was considered significant. RESULTS: Diagnostic ESBL Esc isolates raised, per 1000 isolates of Esc, from 1.2 in 1999 to 6 in 2005. Global and acquired isolates number of ESBL Esc varied from 7 and 3 in 2002 to 25 and 19 in 2003 (P=0.22). ESBL Esc global and acquired incidence per 10(5) patient-days were, 0.8 and 0.6 in 1999 and 4.99 and 3.4 in 2005 (P<10(-6)), but rose from 0.6 acquired isolate in 2002 to 3.9 in 2003 (P=0.002). ESBL Esc, isolated from urines, stools, pulmonary, blood and surgical site samples of patients of>/=65 years aged (68.3%), were imipenem and latamoxef sensitive. Their acquisition risk factors found were hospitalization during the last 6 month period (40/104) and transfer from other institutions (20/104). CONCLUSION: ESBL Esc isolates, among ESBL-producing Enterobacteriaceae, constitute an escalating health-care associated risk in our institution. The research at admission time of ESBL-producing Enterobacteriaceae, mainly in acute geriatric wards, strict isolation precaution and hand hygiene observance, rational antibiotic usage, are the key actions to control their cross transmission. Nonetheless, other studies are needed to determine whether we are in front of an ESBL Esc new clone emergence.


Assuntos
Infecções por Escherichia coli/diagnóstico , Escherichia coli/metabolismo , beta-Lactamases/biossíntese , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Infecções por Escherichia coli/epidemiologia , França , Hospitais Universitários , Humanos , Incidência , Estudos Longitudinais
11.
Pathol Biol (Paris) ; 54(8-9): 447-52, 2006.
Artigo em Francês | MEDLINE | ID: mdl-17030459

RESUMO

Seventy-three of aminoglycoside-susceptible methicillin-resistant Staphylococcus aureus (AS-MRSA) and 12 kanamycin-tobramycin-resistant methicillin-susceptible S. aureus (KTR-MSSA) isolates were phenotypically and genotypically examined for methicillin susceptibility. The AS-MRSA profile represents 8.3% of MRSA strains and the KTR-MSSA profile represents 1.38% of MSSA strains. The diffusion method using the 5 microg oxacillin and 30 microg cefoxitin discs on Mueller-Hinton Agar (MHA) with and without NaCl, the incubation at 35 degrees C or 30 degrees C for 24 or 48 hours respectively, and the determining oxacillin MICs by E-test (AES, Combourg, France) were performed and used as phenotypic methods. We also used the mecA gene PCR which was considered as the "gold standard" for methicillin resistance detection, and the Slidex MRSA Detection (bioMérieux) that detect the presence of mecA gene product (PBP 2a). To increase the level of PBP 2a expression, the 30 microg cefoxitin disc was used as an inducer. All the AS-MRSA strains (100%) were detected by the cefoxitin disc in all conditions and by the oxacillin disc on MHA with 2% of NaCl at 35 degrees C. Without NaCl, the sensitivity fell to 97,2% by oxacillin disc. The oxacillin MICs for these isolates ranged from 2 to 128 mg/l. The mecA gene determinant and its product PBP 2a were detected in all AS-MRSA strains. All KTR-MSSA strains were phenotypically methicillin-susceptible and oxacillin MICs were below or borderline of breakpoint (< or =2 mg/l). The mecA gene determinant and its product were detected in one strain which was considered to be the most heterogeneous of those tested.


Assuntos
Oxacilina/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Antibacterianos/farmacologia , Cefoxitina/farmacologia , Resistência a Meticilina , Testes de Sensibilidade Microbiana , Staphylococcus aureus/classificação
12.
Microb Drug Resist ; 12(3): 177-85, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17002544

RESUMO

Eighty-five atypical isolates of Staphylococcus aureus divided into 73 aminoglycoside-susceptible methicillinresistant (AS-MRSA) and 12 kanamycin-tobramycin-resistant methicillin-susceptible (KTR-MSSA) were phenotypically and genotypically examined for methicillin resistance. Among these tests, the diffusion method using the oxacillin and cefoxitin disks on Mueller-Hinton agar with and without NaCl, the incubation at 35 degrees C or 30 degrees C for 24 or 48 hr, respectively, and the determination of oxacillin MICs by E-test were performed. We also examined the presence of the mecA gene by PCR and its product PBP 2a by the Slidex MRSA Detection test after induction by cefoxitin disk. All of the AS-MRSA strains (100%) were detected by the cefoxitin disk in all conditions and by the oxacillin disk on Mueller-Hinton agar with 2% of NaCl at 35 degrees C. Without NaCl, the sensitivity fell to 97.2% by oxacillin disk. The oxacillin MICs for these isolates ranged from 2 to 128 mg/L. The mecA gene determinant and its product PBP 2a were detected in all AS-MRSA strains. All KTR-MSSA strains were phenotypically methicillin-susceptible and oxacillin MICs were below or borderline of breakpoint (< or =2 mg/L). The mecA gene determinant and its product were detected in one strain. Pulsed-field gel electrophoresis (PFGE) was applied and revealed the presence of two major patterns A (36.9%) and B (46.2%) in AS-MRSA isolates and seven patterns in the KTR-MSSA strains.


Assuntos
Meticilina/farmacologia , Resistência às Penicilinas , Staphylococcus aureus/efeitos dos fármacos , Aminoglicosídeos/farmacologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Meios de Cultura , Eletroforese em Gel de Campo Pulsado , Genótipo , Humanos , Canamicina/farmacologia , Resistência a Meticilina/genética , Testes de Sensibilidade Microbiana/métodos , Oxacilina/farmacologia , Proteínas de Ligação às Penicilinas/genética , Fenótipo , Reação em Cadeia da Polimerase , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Tobramicina/farmacologia
13.
J Infect ; 51(1): 69-76, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15979494

RESUMO

Pneumococcal pneumonia remains a common disease with a high mortality rate. Between 1995 and 2000, we prospectively analyzed 95 consecutive adult cases of community-acquired bacteraemic pneumococcal pneumonia treated in a single centre. The incidence of pneumococcal resistance to penicillin increased from 19 to 50% during the study period. Multivariate analysis showed that only age and recent hospitalization were independently associated with fatal outcome. The proportion of penicillin-resistant strains was slightly but not significantly higher among patients who died before the fourth hospital day than among those who died later. Patients who died before D4 were more likely to have a recent history of hospitalization, cancer and/or chemotherapy. It thus appears that infection by a resistant pneumococcal strain is not in itself a gravity factor in this setting, but that their acquisition is associated with pejorative clinical features.


Assuntos
Bacteriemia/mortalidade , Resistência às Penicilinas , Infecções Pneumocócicas/mortalidade , Pneumonia Pneumocócica/mortalidade , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/microbiologia , Pneumonia Pneumocócica/tratamento farmacológico , Estudos Prospectivos , Resultado do Tratamento
14.
Clin Microbiol Infect ; 11(5): 395-401, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15819867

RESUMO

Between February 1997 and December 2002, 3340 hospitalised patients yielded samples positive for Proteus mirabilis, of whom 45 (1.3%) were colonised/infected by P. mirabilis producing extended-spectrum beta-lactamases (ESBLs). The gross incidence of patients colonised/infected by ESBL-producing P. mirabilis was 1.61/10(5) days of hospitalisation, with 20% of isolates being collected from patients in urology wards, most frequently (53.3%) from urine samples. Seventeen (37.7%) of the 43 isolates were obtained from samples collected within 48 h of hospitalisation, indicating that they were community-acquired. Isoelectric focusing assays and sequencing identified the TEM-24, TEM-92 and TEM-52 ESBLs. Pulsed-field gel electrophoresis revealed eight pulsotypes (I-VIII), with the two most common pulsotypes, IV and VI, comprising ten (23.3%) and 12 (26.6%) isolates, respectively. These pulsotypes were considered to represent epidemic strains and spread in various wards of the hospital.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecções por Proteus/epidemiologia , Proteus mirabilis/genética , beta-Lactamases/genética , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Feminino , França/epidemiologia , Variação Genética , Hospitais Universitários , Humanos , Masculino , Prevalência , Infecções por Proteus/microbiologia , Infecções por Proteus/urina , Proteus mirabilis/efeitos dos fármacos , Proteus mirabilis/isolamento & purificação , Urina/microbiologia
15.
Gynecol Obstet Fertil ; 32(12): 1064-74, 2004 Dec.
Artigo em Francês | MEDLINE | ID: mdl-15589784

RESUMO

Chlamydiae are obligate intracellular bacteria. Chlamydia trachomatis is the most common sexually transmitted disease (STD). The C. trachomatis damaging disease sequelae such as sterility is based on intense and chronic inflammation elicited and maintained by reinfection or persistent infection. The high prevalence of C. trachomatis infection reflects the long and successful adaptation of these organisms to persist in their human host population. The large group of asymptomatically infected persons is not only at risk of serious long-term sequelae but also sustains transmission within communities. C. trachomatis acute infections have been diagnosed by cell culture, direct immunofluorescence, enzyme immunoassay, direct DNA hybridization, and more recently by nucleic acid amplification tests (NAATs). In chronic or persistent chlamydial infections, the level of Chlamydia is very low and bacteria are often not viable. Such infections would be characterized by continuing positive NAATs but only intermittent isolation of viable Chlamydia and positive assays for chlamydial protein antigen. The development of NAATs has been a major advance in the field of chlamydial diagnosis. The use of NAATs associated with serology test is the best diagnosis. The introduction of assays based on amplification of genetic material has subsequently increased the sensitivity of detecting chlamydial infections and offers the opportunity to use non-invasive sampling techniques to screen for infections in asymptomatic subjects. In this article, it was proposed the best diagnosis approaches for detection of acute and chronic infections.


Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis , Doença Aguda , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/análise , Infecções por Chlamydia/complicações , Chlamydia trachomatis/genética , Chlamydia trachomatis/imunologia , Chlamydia trachomatis/isolamento & purificação , Doença Crônica , DNA Bacteriano/análise , Feminino , Humanos , Infertilidade/microbiologia , Programas de Rastreamento , Valor Preditivo dos Testes , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/diagnóstico
16.
Pathol Biol (Paris) ; 52(8): 423-8, 2004 Oct.
Artigo em Francês | MEDLINE | ID: mdl-15465258

RESUMO

OBJECTIVES: To identify patient-related risk factors of infection and ways of transmission of extended-spectrum betalactamase (ESBL) producing Serratia marcescens in the paediatric intensive care unit (PICU) of Amiens university hospital (France) between June and July 2002. METHODS: Five cases (four pulmonary infected and one stool contaminated symptom-free neonates) and 35 controls, admitted in the PICU, are included. S. marcescens ESBL analysed are isolated from respiratory tract and faecal samples for cases and urine and pus samples from two non-paediatric other patients. Univariate and multivariate analysis are performed on EPI INFO 6.04 dFr and SPSS 11.0.1. RESULTS: S. marcescens ESBL infections or colonisations rate is 12.5% [4.7-27.6]. The incidence is 8.8 [6.7-11.6] per 1000 hospital-stay days. By univariate analysis, cases and controls don't differ with respect of age, sex, and weight at admission or preterm delivery. Cases don't have more often invasive nursing care than controls. But, they were intubated (P <0.03) and hospitalised (P <0.03) for a longer time than controls. Linear regression analysis showed that duration of intubation was independent predictor of acquisition of S. marcescens ESBL (P <0.008). S. marcescens ESBL strains implicated in pulmonary infections, showed the same pattern of multidrug resistant and ERIC-PCR profile. This clone differs from others isolated from stool or other samples from other hospital wards. CONCLUSION: As S. marcescens cross-colonization appears to be due to lake of hand hygiene and asepsis during invasive nursing care, reinforcing hygiene measures permit to contain the outbreak.


Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Serratia/transmissão , Serratia marcescens , beta-Lactamases/metabolismo , Adolescente , Adulto , Criança , Pré-Escolar , Surtos de Doenças , Fezes/microbiologia , Feminino , França/epidemiologia , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Sistema Respiratório/microbiologia , Serratia marcescens/enzimologia , Serratia marcescens/isolamento & purificação
17.
Clin Microbiol Infect ; 9(5): 360-9, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12848748

RESUMO

OBJECTIVE: To carry out epidemiological typing of clinical isolates of Salmonella enterica serovar Enteritidis by pulsed-field gel electrophoresis (PFGE), random amplified polymorphic DNA (RAPD) and analysis of their antibiotic resistance. METHODS: Over a 12-month period, 44 Salmonella Enteritidis isolates, recovered from 40 patients admitted to the University Hospital Center of Amiens, France and from three outpatients, were characterized by the analysis of phenotypic and genotypic traits and clinical data from medical reports. RESULTS: Forty nontyphoidal salmonellosis episodes were diagnosed in hospitalized patients (34 episodes of gastroenteritis, two episodes of bacteremia not affecting other organs, one episodes of bacteremia plus urinary infection, one episodes of bacteremia plus gastroenteritis, one episodes of chronic colitis plus gastroenteritis and one episode of peritonitis), and three carriers were observed in outpatients. By means of PFGE, RAPD and antibiotic susceptibility patterns 44 isolates were subdivided into 16 clonally related groups. Two of them were predominantly implicated in the course of these infections, being responsible for two successive waves of infection, while the others were encountered sporadically.


Assuntos
Surtos de Doenças , Infecções por Salmonella/epidemiologia , Salmonella enteritidis/isolamento & purificação , Adolescente , Adulto , Idoso , Bacteriemia/epidemiologia , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Primers do DNA , Resistência Microbiana a Medicamentos , Eletroforese em Gel de Campo Pulsado/métodos , Feminino , Hospitalização , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fenótipo , Técnica de Amplificação ao Acaso de DNA Polimórfico/métodos , Infecções por Salmonella/microbiologia , Salmonella enteritidis/classificação , Salmonella enteritidis/genética , Estações do Ano
18.
Clin Microbiol Infect ; 9(4): 315-8, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12667243

RESUMO

Serologic cross-reactivity has been demonstrated between Bartonella quintana and Chlamydia pneumoniae. Therefore, the association between antibodies to C. pneumoniae and coronary heart disease (CHD) as described in the literature may be due to antibodies cross-reacting with B. quintana. To investigate this hypothesis, we evaluated, in a case-control study, the prevalence of C. pneumoniae and B. quintana antibodies among 296 cases with angiographically significant artery lesions and 170 controls without angiographically demonstrable coronary artery disease. The prevalence of C. pneumoniae antibodies was higher among cases than among controls: 69% versus 49% (P < 0.001; OR 1.39; 95% CI (1.55; 3.52)). Multiple logistic regression demonstrated that C. pneumoniae seropositivity is an independent risk factor for CHD (adjusted OR 2.31; 95% CI (1.49; 3.60)). No statistically significant association was demonstrated between B. quintana seropositivity and CHD. Antibodies to both C. pneumoniae and B. quintana were found in nine subjects (seven cases and two controls), suggesting co-infection rather than cross-reactivity.


Assuntos
Bartonella quintana/isolamento & purificação , Infecções por Chlamydophila/microbiologia , Chlamydophila pneumoniae/isolamento & purificação , Doença das Coronárias/microbiologia , Estudos de Casos e Controles , Infecções por Chlamydophila/diagnóstico , Infecções por Chlamydophila/epidemiologia , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , França/epidemiologia , Humanos , Masculino , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Febre das Trincheiras/diagnóstico , Febre das Trincheiras/epidemiologia , Febre das Trincheiras/microbiologia
19.
Pathol Biol (Paris) ; 50(9): 538-43, 2002 Nov.
Artigo em Francês | MEDLINE | ID: mdl-12490416

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) constitute the most important multiresistant bacteria (MRB) recovered in French hospitals. Our objective was to measure these MRSA diffusion in our hospital to evaluate the MRB control programme which had been implemented in the beginning of 1999. This study was conducted in a teaching hospital containing 1800 beds, from February 1999 to January 2001. All MRSA isolated in clinical samples were included. Duplicates (same bacteria in the same patient) were excluded. The detection of methicillin-resistance was performed at 30 degrees C, by disk diffusion method. Incidence densities were determined with their 95% confidence interval (CI 95%). Their evolution by four-month period was evaluated with the chi-square test for trend. During the two-year period, 866 MRSA were isolated. The global incidence was 0,88 per 1000 patient-days (PD) (IC 95% = left open bracket 0,83-0,93 right open bracket ). For cases acquired in our hospital the incidence was 0,66 per 1000 PD, whereas it was 0,26 per 1000 PD for imported cases. Concerning the evolution of incidences, no significant trend was observed for global incidence. The incidence of acquired MRSA decreased during the first year, but increased thereafter. The incidence of imported MRSA increased with a significant trend (p < 10(-5)). The number of these imported MRSA isolated in our hospital was twice fold higher in 2000. This study emphasizes an important actual problem : the increase of patient colonization pressure at the time of admission in hospitals. This increase, which can be due in part to a community transmission, is responsible for a reduction of the efficacy of MRSA control programmes.


Assuntos
Farmacorresistência Bacteriana , Resistência a Múltiplos Medicamentos , Resistência a Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Distribuição de Qui-Quadrado , Feminino , França/epidemiologia , Hospitais de Ensino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Fatores de Tempo
20.
J Hosp Infect ; 52(2): 107-13, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12398076

RESUMO

In order to measure the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and of Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE), and to evaluate the impact of the national guidelines for multidrug-resistant bacteria (MDRB) prevention in hospitals of Northern France, a multicentre study was conducted for three months every year starting in 1996, in volunteer hospital laboratories. All clinical specimens positive for MRSA and ESBLE were prospectively surveyed. During the five-year surveillance period, the overall proportion of MRSA was 38.4% in the 28,534 strains of S. aureus, and that of ESBLE was 11.4% in the 6121 strains of Klebsiella pneumoniae and 47.7% in the 2353 strains of Enterobacter aerogenes. The overall incidence rates of clinical specimens positive for MRSA, ESBL-K. pneumoniae and E. aerogenes were 0.84. 0.05 and 0.12/1000 hospital-days (HD), respectively. In the 23 hospitals that participated in the survey every year, the proportion and incidence of ESBLE decreased. Hence, despite recommendations as for isolation precautions, MRSA remains poorly controlled and requires more effective measures.


Assuntos
Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Vigilância da População , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , beta-Lactamases/metabolismo , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Enterobacteriaceae , França/epidemiologia , Humanos , Incidência , Infecções por Klebsiella/tratamento farmacológico , Resistência a Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação
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