Prevalence and risk factors of bacterial vaginosis during the first trimester of pregnancy in a large French population-based study.

OBJECTIVES: Bacterial vaginosis is a risk factor for preterm delivery. Its prevalence and risk factors in Europe are not well known. Our objective was to assess both in early pregnancy. STUDY DESIGN: As part of the PREMEVA randomized controlled trial, this population-based study included 14,193 women screened before 14 weeks' gestation for bacterial vaginosis in the 160 laboratories of the Nord-Pas-de-Calais region in France. Bacterial vaginosis was defined by a Nugent score ≥ 7. Data were collected about maternal tobacco use, age, education, and history of preterm birth. We estimated the prevalence of bacterial vaginosis and used a multilevel logistic regression model to identify significant risk factors for it. RESULTS: Among the 14,193 women assessed before 14 weeks' gestation, the prevalence of bacterial vaginosis was 7.1% (95% CI: 6.6-7.5%). In the multivariate analysis, smoking during pregnancy tobacco (adjusted OR: 1.38; 95% CI: 1.19-1.60), maternal age 18-19 years (adjusted OR: 1.40; 95% CI: 1.01-1.93), and educational level (completed only primary school: adjusted OR: 1.77; 95% CI: 1.35-2.31; completed only secondary school: adjusted OR: 1.27; 95% CI: 1.10-1.48) were independent risk factors for bacterial vaginosis. History of preterm delivery was not an independent risk factor of bacterial vaginosis: adjusted OR: 1.15; 95% CI: 0.90-1.47. CONCLUSION: In a large sample of women in their first trimester of pregnancy in France, the prevalence of bacterial vaginosis was lower than rates reported in other countries, but risk factors were similar: young age, low level of education, and tobacco use during pregnancy. These results should be considered in future strategies to reduce preterm delivery.

Development of an animal model to study meshes used in genital prolapse surgery.

OBJECTIVE: The objective was to develop an animal model using bacterial inoculation to evaluate tissue integration and tolerance to meshes used in genital prolapse surgery. STUDY DESIGN: We placed three different meshes under the abdominal skin of 120 Wistar rats: a polypropylene monofilament non-coated mesh (Parietene), a polypropylene monofilament collagen-coated mesh (Ugytex) and a polyethylene terephthalate mesh (Mersuture). We performed bacterial inoculation just after implantation with 1 ml of 10(7) colonies forming unit (CFU) of Staphylococcus epidermidis or Escherichia coli. Rats were sacrificed 7, 14, 60, and 90 days after intervention. We used polarised light microscopy to analyse the collagen deposition and organisation. We quantified the inflammation cells. Bacterial analysis and quantification of the explanted meshes were performed. The exact Fisher's test and Kruskal-Wallis test were used for statistics. RESULTS: We did not find any significant difference between inoculated or non-inoculated meshes in terms of collagen deposition. The scarring process seemed stable at day 90. Tissue integration was best with the polypropylene meshes, which allowed the development of a well-organised, mature connective tissue. Inflammatory reaction was higher in inoculated meshes, but only at day 7. At day 90, we found a high number of macrophages and multinuclear cells around all the meshes. There was no significant difference between prostheses that had been inoculated and those that had not with regard to positive bacterial culture. Quantification of bacterial colonies decreased with time. CONCLUSION: In this animal model, we did not find any clinically related difference in infection and tissue integration between the meshes used in genital prolapse. Such experimental studies must be carried out whenever new prostheses become available before their use is validated in common practice.

[Self-collected vaginal swabs to diagnosis bacterial vaginosis during pregnancy: A pilot study]. / Autoprélèvement vaginal à la recherche d'une vaginose bactérienne pendant la grossesse: étude pilote.

OBJECTIVE: To study the feasibility of a screening for bacterial vaginosis by a self-collected vaginal swab during pregnancy. To measure bacterial vaginosis prevalence in a non-representative sample of women. PATIENTS AND METHODS: A self-collected swab was suggested to 398 women who consulted between 15 and 33 weeks of gestation in three different centres. Gram stain evaluation using Nugent criteria was used for the diagnosis of bacterial vaginosis. RESULTS: Three hundred and forty-one women agreed to take part in the study (86%). The quality of the swabs was satisfactory in 93% of the cases. Concerning the 15 non-interpretable slides, the cellular and bacterial density was too poor, owing to a poor quality or a low vaginal flora. Thirty-one women (9%) had a bacterial vaginosis--Nugent score included between 7 and 10--and this frequency did not vary according to the centre. Thirty-five women (10%) had an intermediate flora--score between 4 and 6--and this result varied from 2 to 12% depending on the centre, but the difference was not significant. DISCUSSION AND CONCLUSION: Self-collected swabs to detect bacterial vaginosis are well accepted by most of pregnant women, and the quality of the swabs seems to be satisfactory. In case vaginal flora is intermediate--between 4 and 6--the interpretation of the slides could be difficult.

[Comparative antibacterial activity of cefotaxime, ceftazidime and cefepime with regard to different strains of Enterobacter aerogenes selected for their resistance to third generation cephalosporins]. / Activité antibactérienne comparative du céfotaxime, de la ceftazidime et du céfépime vis-à-vis de différentes souches d'Enterobacter aerogenes sélectionnées pour leur résistance aux céphalosporines de troisième génération.

After being confronted with the isolation in our laboratory of numerous antibiotic-multiresistant Enterobacter aerogenes strains, we studied the in vitro antimicrobial activity of cefotaxime, ceftazidime, and cefepime alone or in association with sulbactam. For that, we selected 67 isolates according to their low level of susceptibility to cefotaxime. First, we deduced from a synergy test in presence of clavulanic acid and cloxacillin the production of an extended spectrum beta-lactamase (ESBL) and/or an overproduction of a chromosomal cephalosporinase. Three groups of strains were thus defined: one group of ESBL strains, another group of overproducing strains of chromosomal cephalosporinase, and a last group that produced the two types of enzymes. Minimal inhibitory concentrations (MICs) of each cephalosporin alone or in presence of 8 mg/L of sulbactam, gentamicin or amikacin were measured. Our results demonstrated the best activity of cefepime: MICs were low with a value inferior to 4 mg/L independently of the type of beta-lactamase. They were lower than 0.5 mg/L in presence of sulbactam against ESBL-producing strains. The cephalosporins could be used in association with aminoglycosides according to their susceptibility.

[Comparative study of the bactericidal activity of cefepime and cefpirome in association with glycopeptides against Staphylococci sensitive and resistant to methicillin]. / Etude comparative de l'activité bactéricide du céfépime et du cefpirome en association avec les glycopeptides vis-à-vis de staphylocoques sensibles et résistants à la méthicilline.

The aim of this study was to evaluate by a kinetic time-kill method the synergy and bactericidal activity of cefepime and cefpirome in association with vancomycin and teicoplanin against 4 coagulase-positive and 7-negative staphylococci strains. Among these 2 were susceptible to methicillin and 7 resistant. Antibiotic concentrations used for time-kill curves were 0.5 and 1 CMI for glycopeptides and 32 mg/l for cephalosporins. Bactericidal activity was defined as a 3 log10 reduction of the initial inoculum. Cephalosporins at 32 mg/l and teicoplanin at 1 CMI were not bactericidal, while vancomycin at 1 CMI was bactericidal in 24 to 48 h for 3 strains. Cefepime and cefpirome in association with vancomycin were bactericidal against all strains with no secondary regrowth. Bactericidal activity was observed for 6 and 9 strains with the combinations of cefepime-teicoplanin and cefpirome-teicoplanin respectively. In conclusion, despite no significant antistaphylococcal activity of cefepime and cefpirome, their association to glycopeptides improved the bactericidal activity of vancomycin and teicoplanin.

Routine evaluation of BACTEC NR-16A and NR-17A media.

The purpose of this study was to determine whether the BACTEC NR-16A and NR-17A media were more effective than the BACTEC NR-6A and NR-7A media in recovering organisms from the blood of patients undergoing antimicrobial therapy. A total of 986 sets of four blood culture bottles were compared, giving 141, 174, 93, and 104 isolates with BACTEC NR-6A, NR-16A, NR-7A, and NR-17A, respectively. BACTEC NR-6A and NR-7A media recovered 234 isolates, whereas BACTEC NR-16A and NR-17A media recovered 278 isolates. The recovery rate of bacteria when aerobic resin media were used was better than that with conventional aerobic media (P less than 0.001). The mean detection times were 51.5 and 69.7 h with NR-16A and NR-6A, respectively (P less than 0.01), whereas they were 68.2 and 71.3 h with NR-17A and NR-7A, respectively (P greater than 0.05). The small number of anaerobes recovered precluded a statistical comparison of relative recovery for that group of organisms.

Routine evaluation of the nonradiometric BACTEC NR 660 system.

The present study compares the sensitivity, accuracy, and practicability of a nonradiometric blood culture system with those of the standard blood culture system in use in our laboratory. A total of 1,080 sets of four blood cultures bottles were compared, giving 143 positive aerobic-medium associations and 139 positive anaerobic-medium associations. The conventional system recovered 171 isolates, whereas the BACTEC NR 660 system (Johnston Laboratories, Towson, Md.) recovered 155 isolated. There were no significant differences in total isolates with either system (P more than 0.05). The BACTEC NR 660 system recovered a slightly lower number of Serratia marcescens and Streptococcus faecalis but a higher number of Pneumococcus spp. The mean detection times were 55.9 h with the conventional system and 31.6 h with the BACTEC NR 660 system (P less than 0.001). Our results demonstrate that the BACTEC NR 660 system is suitable for routine use.

[Inhibition by "essential" phospholipids of the bactericidal effect of cetylpyridinium chloride on common bacteria. Short communication]. / Durch "essentielle" Phospholipide induzierte Hemmung der bekteriziden Wirkung von Cetylpyridinium-chlorid auf banale Keime. Kurze Mitteilung

The authors examined the conditions under which the bactericidal action of the disinfectant cetylpyridinium chloride (CPC) is neutralized by a dispersion of "essential" phospholipids (EPL). Both gram-positive and gram-negative strains of bacteria were exposed to various concentrations of the quarternary ammonium over different periods of time. Three cultures were prepared for each contact model to check on the effect of either pre-treatment and after-treatment with phospholipids or of CPC-exposure without the addition of phospholipids. The results obtained demonstrate that EPL are able to "receive" gram-negative bacteria like E. coli, P. aerug. and Morax. glucidol. after exposure to lethal concentrations of CPC for 30 min. While the "phenomenon of restoration" depended on the dose of phospholipids applied, the time of expsure to phospholipids proved irrelevant. The stabilisation of bacterial membranes due to EPL is discussed as a possible explanation of the phenomenon of restoration.

[Epidemiology and prevention of tuberculous contamination in bacteriology laboratories. Results of a survey on 23 laboratories]. / Epidémiologie et prévention des contaminations tuberculeuses dans les laboratoires de bactériologie. Résultats d'une enquête effectuée dans 23 laboratoires

The authors have carried out a survey of 23 bacteriology laboratories to investigate tuberculous contaminations which took place from 1967 to 1972 in these laboratories. They have reviewed 20 accidents in 74 technicians who performs searches for tuberculous bacilli, and 29 accidents in the total amount of 379 technicians working in these 23 laboratories. A comparison of these results with the previous published investigations shows a rather high number of cases reported in our country. A review of the possible causes of contaminations leads to suspect bacterial aerosols and to put forward the use of laminar flow enclosures as a prevention. The authors have tested several vertical flow instruments built to different patterns. All three convenient enclosures have an architectural characteristic: their blowing ceiling overhangs the working plane. As these instruments have been under examination for three years in a laboratory where contaminations are very likely to happen, they have obtained interesting results.