Detection of an outbreak of methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides in a French hospital.

Staphylococcus aureus isolates were screened for reduced susceptibility to glycopeptides with an initial glycopeptide agar screening test, followed by confirmation of the strains thus identified by two Etest strip techniques and population analysis. This procedure detected 48 methicillin-resistant S. aureus (MRSA) isolates with reduced susceptibility to glycopeptides from 24 patients among 883 MRSA isolates tested. The dissemination of a single clone was confirmed by pulsed-field gel electrophoresis.

[Neuromeningeal listeriosis in adults. Clinical aspects and contribution of cotrimoxazole in monotherapy]. / Listériose neuroméningée de l'adulte. Aspects cliniques et apport du cotrimoxazole en monothérapie.

A series of 28 patients suffering from neuromeningeal listeriosis is reported. This disease is consecutive to infection by Listeria monocytogenes--an ubiquitous and opportunistic Gram-positive bacillus--and has become a public health problem: its incidence is increasing and its prognosis is very severe despite the development of new bacteriological identification methods. Human beings are contaminated by food, which explains the frequent outbreaks of epidemics which are widely publicized, the infection being one of the consequences of the unprecedented development of the food industry and the cold food chain. The predominant clinical picture is one of non-specific meningoencephalitis. In about 50 percent of the cases the subjects infected are "immunodepressed" and/or more than 60 years' old. The diagnosis is difficult since the bacteriological identification is delayed (direct examination of the cerebrospinal fluid is rarely positive) and this fluid may be sterile (hence the value of blood cultures). A probability treatment therefore must be initiated before the diagnosis is confirmed if an unfavourable outcome is to be avoided. In Listeria monocytogenes infection cotrimoxazole administered alone seems to be a better antibacterial therapy than the reference ampicillin-aminoside combination.

Influence of mannitol on the penetration of teicoplanin into infected CSF of experimental Staphylococcus aureus meningitis of rabbits.

We investigated the influence to mannitol injections on the teicoplanin penetration into CSF in experimental bacterial meningitis of rabbits. Experimental bacterial meningitis was obtained by intracisternal inoculation of 10(7) cfu of methicillin resistant Staphylococcus aureus. The experimental bacterial meningitis was controlled 18 h later by cisternal puncture. At this time (T0) mannitol (solution for injection 20%) was injected (bolus), at a dosage of 3 ml/kg, into the carotid arteria. Immediately after the previous bolus, teicoplanin was administered through the same line over 5 min, at a dosage of 5 mg/kg. Cerebrospinal fluid was obtained 30 min and 2 h after injection was completed, and serum samples were obtained at the same time. Results were (mg/l) in cerebrospinal fluid: (Table; see text) (* p less than 0.05 comparing the two regimens at T0 + 2 h, and comparing regimen teicoplanin + mannitol infusion at T0 + 30 sec and + 2 h). This is very promising for the treatment of methicillin resistant Staphylococcus aureus bacterial meningitits and should support further investigations.

[Effect of teicoplanin and vancomycin on cerebrospinal fluid proteins of non-infected rabbits after suboccipital injection]. / Effet de la teicoplanine et de la vancomycine sur la protéinorachie du lapin non infecté après injection sous-occipitale.

The IC inoculation of antibiotics into the CSF for therapeutic use could produce biological effects we should consider when analysing samples. To corroborate this assumption, we observed the effect of ICI T and V on the PL of the CSF of non infected rabbits. T and V were ICI as dosage of 1 mg/kg diluted in 0.2 ml of isotonic saline solution (ISS). ISS was also ICI alone. CSF samples were obtained before inoculation from 41 animals (T0) setting the normal PL. Other samples were obtained 2 (T2) and 4 hours (T4) after inoculation. PL were assayed in an Analyser Clinic Automatic (Du Pont). The statistical analysis was performed by the Kolomogorov-Smirnov Test, for comparison of samples from unknown and not necessarily similar distributions. Results were (mg/l) = PL at T0 = 0.20 +/- 0.08. At T2, levels were 0.6 +/- 0.41 (ISS), 0.73 +/- 0.27 (V) and 0.87 +/- 0.44 (T). At T4 they were 0.3 +/- 0.15 (ISS), 0.55 +/- 0.25 (V) and 0.78 +/- (T). Statistical differences (p less than 0.05) were demonstrated at T2 (T, V and ISS vs control at T0), at T4 = V, vs control at T0 but not between the two antibiotics nor between the two antibiotics and ISS, at any time. We conclude that IC inoculation of T and V and ISS increased significantly the CSF PL.

[A case of pleuropneumopathy due to Eikenella corrodens]. / Un cas de pleuropneumopathie à Eikenella corrodens.

We report the observation of a pleuropneumonia due to Eikenella corrodens in a man of 39 years old suffering from diffuse dilatation of the bronchi. This small micro-aerophilic Gram negative bacillus has rarely been implicated as a cause of pneumonia. It appears that it may often be associated with streptococcal infections and that it becomes a pathogen when the immunity is lowered. Its sensitivity to antibiotics is excellent, particularly vis-à-vis bêta-lactams.