[Evolution of third-generation cephalosporin resistance in Enterobacteriaceae from 2000 to 2008 in a Perpignan hospital]. / Evolution de la résistance des entérobactéries aux céphalosporines de troisième génération de 2000 à 2008 au centre hospitalier de Perpignan.

The aim of this work was to evaluate the evolution of Enterobacteriaceae resistance to third generation cephalosporin (3CG) from 2000 to 2008 at Perpignan hospital. Were observed: the percentage of strains isolated from short stay wards, intensive care unit and medium and long-term care facility. The percentage of strains isolated from: urine, suppuration, tracheal aspiration, and blood have been evaluated. The proportion of Escherichia coli (E. coli) strains among the Enterobacteriaceae strains intermediate (I) or resistant (R) to 3GC was also evaluated.The number of Enterobacteriaceae intermediated (I) or resistant (R) to 3GC increased (402 %).The distribution of species I or R to 3GC has changed, decrease of Klebsielle pneumoniae and Enterobacter aeorogenes species, Escherichia.coli and Enterobacter cloacae became dominant in 2008. We noted the change of isolated species distribution, urines represent the main source of multiresistant Enterobacteriaceae (MRE), 72 % of strains. The profile of patients colonised or infected by MRE has changed. Patients mainly infected with hospital acquirred MRE changed to MRE colonised patients carrying the strain into the hospital. The association of fluorinated quinolone resistance and Extended-Spectrum Beta-Lactamase Enterobacteriaceae represented 51 % in 2000, became stable at 73 % from 2002. The association of fluorinated quinolone resistance and high-level Enterobacteriaceae cephalosporinase has increased from 21 % in 2000 to be stable at 50 % since 2006. The mesures to contain the spread of MRE strains remained inefficient because of outpatients circulation, multiresistant E. coli being community species.

[Comparative susceptibility evolution in Escherichia coli from urinary tract infections in outpatients and inpatients at Perpignan hospital in 2002 and 2004]. / Evolution comparée de la sensibilité de souches de Escherichia coli isolées d'infections urinaires de patients consultant aux urgences et de patients hospitalisés en 2002 et 2004 à l'hôpital de Perpignan.

The medical emergency ward makes a link between outpatients and hospitalized ones, so we can study community bacterial ecology. The antibiotic susceptibility in Escherichia coli strains isolated from urinary tract infections (UTI) of patients consulting at emergency ward of our hospital in 2002 and 2004 was determined and compared with the susceptibility of the same strains isolated from UTI of hospitalized patients on the same period. The antibiotic susceptibility was performed with Microscan (Dade Behring). All bacteria were tested against the following antimicrobial agents: amoxicilline (Amx), l'amoxicilline+clavulanic acid (AMC), nalidixic acid (NA), ciprofloxacine (Cip), cotrimoxazole (SXT), nitrofurantoin (Ft). Susceptibility in E. coli strains isolated from outpatients vary from 58 to 54% for Amx, from 88 to 83% for NA, from 96 to 89% for Cip, from 82 to 79% for SXT, from 94 to 96% for Ft and remains at 60% for AMC from 2002 to 2004. Susceptibility in E. coli strains isolated from hospitalized patients vary from 52 to 47% for Amx, 55 to 53% for AMC, from 79 to 70% for NA, from 87 to 79% for Cip, from 74 to 69% for SXT, from 93 to 92% for Ft. Susceptibility in E. coli strains isolated in the community from UTI outpatients is decreasing and it becomes worrying particularly concerning the fluoroquinolones, therefore empiric treatment of pyelonephritis by fluoroquinolones must be assessed again.

[Endemic heteroresistant glycopeptide intermediate Staphylcoccus aureus (hGISA) comprising unrelated clonal types and not associated with vancomycin therapy]. / Situation endémique à Staphylococcus aureus de sensibilité diminuée aux glycopeptides constituée de clones variés et sans relation avec un traitement à la vancomycine.

The detection of methicillin-resistant S. aureus (SA) (MRSA) refractory to glycopeptides is a serious clinical issue. The prevalence of hetero-resistant GISA (hGISA) strains at H. Maréchal Joffre, France is reported.858 non-repeat SA were isolated during 1999. 367 (43%) of these, from 257 patients, were MRSA (mean incidence 11.9/1000 admissions). All MSRA detected during 1999 were screened for vancomycin (VAN) resistance (BHI+4 mg/l VAN). Isolates recovered were retested using Etest strips (2 McFarland inoculum on BHI) and population analysis profile/area under the curve (PAP-AUC) analysis with hGISA SA Mu3 as a comparator. 58 selected strains were screened for teicoplanin resistance(TEI) using SFM recommended screen (2 McFarland inoculum on MH+5 mg/L TEI) and MIC (0.5 MF inoculum swabbed on MH agar) methods. 188 (51.3%) grew on VAN screen agar (6.1/1000 admissions). 58 strains (7.6%) possessed Etest VAN MIC > 8 mg/l all others being VAN < 8 mg/l. Of these 58 isolates, 10 were stably heterogeneously resistant to both VAN and teicoplanin (MIC > 8 mg/l). PAP-AUC showed 12 strains to have PAP-AUC ratios > 0.95 but < 1.5 (ie. hGISA, not GISA). All 7 isolates defined as hGISA by both Etest and PAP-AUC comprised 1 PFGE clone (< 3 bands difference). Additionally 2 distinct PFGE types were detected among the other 5 hGISA identified PAP-AUC. The 12 hGISAs, were derived from 12 patients with severe underlying disease. None were on glycopeptide therapy prior to hGISA isolation. This is the first report of endemic hGISA, comprising 3 clonal types. The isolation of hVISA seems not to be associated with patient-specific glycopeptide therapies.

Reemergence of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus in France: a phylogenetic approach.

The reemergence of gentamicin-susceptible (Gen(s)) methicillin-resistant Staphylococcus aureus (MRSA) isolates in France between 1992 and 1996 was investigated using a phylogenetic approach (multiprimer randomly amplified polymorphic DNA typing). Eighty-six percent (65 of 85) of the French strains were grouped into one phylogenetic cluster within which all but one Gen(s) strain were grouped into a subcluster. Thus, the reemergence of Gen(s) MRSA strains in France was likely due to the spread of one specific clone which belonged to a cluster comprising most French gentamicin-resistant (Gen(r)) strains. This suggests that the Gen(s) clone has emerged from a Gen(r) strain of this cluster.