Prevalence of extended-spectrum beta-lactamase producing Escherichia coli in community-onset urinary tract infections in France in 2013.

OBJECTIVES: We sought to assess the importance of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae in urinary tract infections in outpatients in France. METHODS: Retrospective laboratory based survey analysing susceptibility patterns of Escherichia coli and Klebsiella pneumoniae isolates providing from urines collected from outpatients during three months in 2013. RESULTS: Four hundred and ninety-nine laboratories collected data on 51,643 E. coli and 3495 K. pneumoniae isolates. The overall proportion of ESBL-producing E. coli was 3.3%. The proportion was higher for males (4.8%) than for females (3.0%) and increased with age: 2% for patients <20 years to 5.4% for those aged >80 years. More than 95% of isolates we susceptible to cefixime, fosfomycin, and nitrofurantoin. In nursing homes, the ESBL-producing E. coli proportion was 12.1%. For K. pneumoniae, the proportion of ESBL-positive isolates was 6.6%, and this proportion increased with age. Data from 2010 collected from a subset of the network showed that the ESBL-producing E. coli proportion was 2.0%. CONCLUSION: ESBL-producing isolates were rather frequent in urines in French outpatients in 2013. Males and persons residing in nursing homes were at higher risk of ESBL-positive infection. Despite the increase in ESBL-positive isolates, the susceptibility to antibiotics used to treat cystitis remains high.

Nationwide survey of extended-spectrum {beta}-lactamase-producing Enterobacteriaceae in the French community setting.

OBJECTIVES: The aim of this study was to assess the prevalence of the extended-spectrum beta-lactamase (ESBL)-producing enterobacteria (ESBLE) in the French community, during a 2006 survey. METHODS: All enterobacteria isolated from urine samples of patients, exhibiting a decreased susceptibility to broad-spectrum cephalosporins, were analysed for their beta-lactamase content (synergy test, isoelectrofocusing, conjugation transfer, PCR amplification and/or cloning experiments and sequencing). Additional co-resistances were investigated by PCR, sequencing and/or cloning. Epidemiological relationship was studied by PFGE for all species and, in addition, for Escherichia coli by the determination of the phylogenetic group, multilocus sequence type (ST) and O25b antigen. Characteristics of CTX-M-producing E. coli carriers were compared with other ESBLE carriers. RESULTS: Seventy-two ESBLE were collected from 71 patients. Most of them expressed a CTX-M enzyme (n = 42, comprising 40 E. coli), with a predominance of CTX-M-15 (n = 24); 10 CTX-M-15-producing E. coli belonged to the same clone (phylogroup B2, ST131, serotype O25b). The 30 remaining strains possessed a TEM- or SHV-type ESBL. In addition, three strains presented unusual co-resistances such as DHA-1 (n = 2), QnrB4 and ArmA. Risk factors for ESBLE acquisition were substantially less frequent when the ESBL was of the CTX-M type, except for prior antimicrobial therapy. Eighteen percent of the patients were considered to have true community-acquired ESBLE; most of them harboured a CTX-M-producing E. coli. CONCLUSIONS: This first nationwide study reports an ESBLE prevalence of 1.1% in the French community setting in 2006, mainly related to the presence of CTX-M-producing E. coli strains; furthermore, unusual co-resistances rarely found in the community setting were occasionally observed, which may threaten future emergence.

Antibiotic resistance rates and phenotypes among isolates of Enterobacteriaceae in French extra-hospital practice.

Antibiotic resistance among members of the family Enterobacteriaceae was prospectively surveyed by eight French private laboratories over a 5-month period in 1999. A total of 2,599 consecutive and nonduplicate strains were collected, mainly (60.9%) from patients in the community. Most strains (82.9%) derived from urine. Escherichia coli was the predominant (73.9%) organism isolated. The overall rates of antibiotic resistance were as follows: amoxicillin, 53.4%; amoxicillin-clavulanic acid, 27.3%; ticarcillin, 44.2%; piperacillin-tazobactam, 3.2%; cephalothin, 29.2%; cefuroxime, 14.7%; cefoxitin, 11.5%; ceftazidime, 3.6%; cefotaxime, 2.8%; cefepime, 0.3%; imipenem, 0.1%; gentamicin (G), 3.8%; tobramycin (T), 5.0%; netilmicin (Nt), 3.7%; amikacin (A), 0.7%; nalidixic acid, 14.3%; ofloxacin, 10.4%; cotrimoxazole, 21.1%; nitrofurantoin, 12.7%; fosfomycin, 5.2%; tetracycline, 50.1%; and colistin, 12.5%. Beta-lactam resistance phenotypes essentially comprised penicillinase production (33.9%), overexpression of chromosomal cephalosporinase (4.6%), and synthesis of inhibitor-resistant TEM/OXA enzymes (1.5%) or extended-spectrum beta-lactamases (1.5%). Aminoglycoside resistance phenotypes consisted of GTNt (93 strains), TNtA (68 strains), GTNtA (14 strains), T (4 strains), GT (3 strains), G (1 strain), and reduced uptake/permeability (3 strains). Most of the nalidixic acid-resistant strains were resistant to ofloxacin (72.8%). Antibiotic resistance rates and phenotypes varied widely according to the bacterial group and the source of the strains. Significantly higher rates were observed in private healthcare centers than in the community, due to a higher proportion of both resistant species and resistant strains. However, multidrug-resistant isolates, including five extended-spectrum beta-lactamase-producing strains, were also recovered from the community.

[Antibiotic resistance of Staphylococcus aureus in urban experience: 6 month study in Aquitaine]. / Résistance aux antibiotiques de Staphylococcus aureus en pratique de ville: étude sur six mois en Aquitaine.

Antibiotic resistance of Staphylococcus aureus has been surveyed by eight city laboratories of the Aquitaine area, during a six month-period (january to june 1998). Antibiotic susceptibility testing has been performed by the disk diffusion method, and the results have been collected and analysed using the SIRscan system. After elimination of the redundant strains, a total of 747 isolates has been retained. They were mainly isolated from pus (64%) collected from patients of the community (40%) or hospitalized in 30 private clinics or nursing homes. The percentages of resistant strains (community/institutions) were: benzylpenicillin: 90% (87/92%), oxacillin: 39% (23/50%), kanamycin: 37% (22/47%); gentamicin: 13% (8/16%), tobramycin: 37% (21/47%), amikacin: 21% (13/27%); netilmicin: 6% (5/7%), erythromycin: 33% (30/35%), spiramycin: 72% (77/69%), lincomycin: 24% (17/29%), pristinamycin: 2% (1/2%), tetracycline: 17% (14/19%); pefloxacin: 40% (25/50%), fosfomycin: 9% (6/12%), rifampicin: 10% (7/13%), fusidic acid: 14% (11/15%), cotrimoxazole and vancomycin: 0%. Meticillin-susceptible strains of S. aureus were mostly sensitive to other antibiotics (< or = 6% resistant strains, except for erythromycin: 22%). Among meticillin-resistant S. aureus, heterogeneous strains with a KT phenotype, and various resistance patterns to the remaining antibiotics were predominant (61%), compared to the homogeneous strains with a KTG phenotype and multiresistant to the other antibiotics (32%). The frequencies of resistant strains were highly variable depending on the specimen, the laboratory and the health care institution, except for cotrimoxazole and vancomycin which were always active.

[Urinary tract infection in an urban population: etiology and antibiotic sensitivity as a function of patient history]. / Infections urinaires en pratique de ville: étiologies et sensibilité aux antibiotiques en fonction des antécédents. l'AFORCOPI-BIO. Association pour la Formation Continue en Pathologie Infectieuse des Biologistes.

OBJECTIVE: The aim of this study was to explore the relationship between etiological factors, bacterial isolates and Escherichia coli susceptibility to antibiotics in ambulatory patients with urinary tract infection. PATIENTS AND METHODS: A prospective study was conducted in 13 private medical laboratories in France in March 1998. Data were collected on 658 cases involving 679 strains in ambulatory patients with urinary tract infections. Data on age, gender, catheter insertion within the 7 preceding days, and history of hospitalization, urinary infection and antibiotic treatment during the 6 preceding months were recorded. The distribution of the bacterial isolates and Eschericha coli sensitivity to ciprofloxacin, cotrimoxazole, and gentamycin were studied. RESULTS: E. coli was most frequently isolated in women, in patients with no catheter or without a history of antibiotic treatment, hospitalization or urinary infection. There was no difference in E. coli sensitivity according to sex and age in women. In patients with prior antibiotic treatment, all the tested antibiotics except gentamycin were significantly less active. In case of prior hospitalization, the E. coli isolates were more resistant to amoxicillin, quinolones, cotrimoxazole and gentamycin. The level of E. coli suceptibility rose as the delay since hospitalization or urinary infection increased. CONCLUSION: Ambulatory patients comprise a heterogeneous population requiring particular attention to correctly adapt therapeutic strategies.

Evolution of tumor necrosis factor-alpha serum concentrations in HIV infected individuals treated with zidovudine.

We studied the evolution of Tumor Necrosis Factor-alpha serum concentration (TNF-alpha) and CD4+ lymphocyte counts (CD4+) in a pilot cohort study of HIV-infected patients during the first year of zidovudine therapy. Data on 17 patients remaining asymptomatic during the one-year follow-up period (non progressors) were analysed. Serum samples were obtained at entry and at each follow-up visit (1, 3, 6, 9 and 12 months). TNF-alpha was quantified in pg/ml using a very sensitive radioimmunoassay (Medgenix). All patients had increased TNF-alpha at entry (median: 26.4 pg/ml). TNF-alpha decreased significantly as soon as the first month of therapy (median: 16 pg/ml). A steady state was then observed until Month 6 (median: 17.5 pg/ml), from which a slow increase appeared, without reaching the initial level (median at Month 9: 21.3, at Month 12: 19.8). During the same time, less sustained changes in CD4+ lymphocytes count and beta-2 microglobulin level were observed. The results of this pilot study suggest that, during HIV infection treated course, TNF-alpha could potentially be an additional surrogate marker to CD4+ lymphocyte count.