Characteristics and costs of carbapenemase-producing enterobacteria carriers (2012/2013).

OBJECTIVES: We had for aim to determine the characteristics of carbapenemase-producing enterobacteria (CPE) carriers and to assess the economic impact of isolation measures leading to loss of activity (closed beds, prolonged hospital stays) and additional personnel hours. PATIENTS AND METHODS: We conducted a retrospective study for 2years (2012/2013), in a French general hospital, focusing on CPE carriers with clinical case description. The costs were estimated by comparing the activity of concerned units (excluding the ICU) during periods with CPE carriers or contacts, during the same periods of the year (n-1), plus additional hours and rectal swabs. RESULTS: Sixteen EPC carriers were identified: 10 men and 6 women, 65±10years of age. Seven patients acquired EPC in hospital during 2 outbreaks in 2012. Four patients presented with an infection (peritonitis, catheter infection, and 2 cases of obstructive pyelonephritis) with a favorable outcome. The median length of stay was 21days [4,150]. Six patients died, 1 death was indirectly due to CPE because of inappropriate empiric antibiotic therapy. A decrease in activity was observed compared to the previous year with an estimated 547,303€ loss. The 1779 additional hours cost 63,870€, and 716 screening samples cost 30,931€. The total additional cost was estimated at 642,104€ for the institution. CONCLUSIONS: Specialized teams for CPE carriers and isolation of contact patients, required to avoid/control epidemics, have an important additional cost. An appreciation of their support is needed, as well as participation of rehabilitation units.

Pulmonary tuberculosis due to Mycobacterium microti: a study of six recent cases in France.

Human tuberculosis caused by Mycobacterium microti is rare, but its prevalence and clinical significance may have been underestimated. To the best of our knowledge, 21 cases have been reported in the literature in the last decade. We report six recent pulmonary cases caused by M. microti over a period of 5 years detected in French clinical mycobacteriology laboratories of the hospital network. Our data confirm the potential of M. microti to cause clinical illness in immunocompetent patients. M. microti grew slowly from specimens, delaying the final microbiological diagnosis. Therefore, patients with tuberculosis caused by M. microti could benefit from the use of rapid diagnostic molecular techniques directly on clinical samples. From a review of the literature and this study, a classical antituberculous therapy seems effective in treating patients with M. microti disease.

[Community- and non-community-acquired bacteremia: correlation between empiric antimicrobial therapy and susceptibility of micro-organisms isolated during 2007 in the Ile-de-France microbiologists network]. / Anti-infectieux empiriques dans les 24-48 premières heures des bactériémies des patients hospitalisés dans les hôpitaux du groupe des microbiologistes d'Ile-de-France en 2007.

AIM OF THE STUDY: To estimate the percentage of empirical treatments adapted in the bloodstream infections of community and not community origin and to determine the main circumstances in which this initial treatment is not adapted. PATIENTS AND METHODS: Surveillance of bloodstream infections from the laboratories of microbiology of the eight hospitals of the Ile-de-France network, during year 2007. The study concerned the patients hospitalised in medicine, surgery, obstetrics, intensive care, following care and rehabilitation, day hospitalisation, hospitalisation at home, who presented one or several episodes of bloodstream infections. RESULTS: During year 2007, 2013 bloodstream infections were analysed. Only 63.9% of bloodstream infections had an adapted initial antibiotic treatment. Among this proportion of bloodstream infections, an adapted empirical treatment concerned mainly the community episodes, the urinary tract, the pulmonary tract, or maternal-foetal episodes and the maternity ward and pediatrics. The percentage of adapted treatments was superior in the bloodstream infections where were isolated an Enterobacteriaceae, Streptococcus pneumoniae or other streptococci. On the contrary, only a quarter of bloodstream infections due to an Enterobacteriaceae producing BLSE or to a MRSA had received an adapted empirical treatment. CONCLUSION: Only two-thirds of the patients developing a bloodstream infection received an adapted initial antibiotic treatment. This proportion was even lower when it was not about a community origin, in spite of the frequent administration of several anti-infectious molecules or with wide spectrum.

[Comparison of two ELISA tests to study the seroprevalence of herpes simplex 1 et 2 infection in a maternity near Paris]. / Comparaison de deux techniques Elisa pour l'étude de la séroprévalence de l'infection à herpes simplex 1 et 2 dans une maternité de la région parisienne.

UNLABELLED: The diagnosis of herpes simplex virus (HSV) genital infection is primarily clinical. The primary indication for serodiagnosis is to detect seronegativity in pregnant women at risk of acquiring the HSV virus during the course of their pregnancy. In this study, two ELISA tests were compared for the detection of HSV infection among a population of 307 pregnant women followed at the maternity of a community-based hospital in France (Robert Ballanger hospital in the Seine-Saint-Denis department). The two tests compared were: Test Captia anti-HSV-1 and anti-HSV-2 specifics IgG of Trinity Biotech and the ELISA IgG HerpesSelect 1 and 2 of FOCUS Diagnostics distributed by Eurobio Courtaboeuf, France. RESULTS: Both tests results were similar in terms of population prevalence for HSV-1 and HSV-2 infections (respectively 86.64% and 85.99% for HSV-1; 17.59% and 15.31% for HSV-2). Whereas the prevalence of the HSV-1 virus was described in the literature as being superior to our current results, the prevalence of HSV-2 according to the results of both ELISA tests studied was similar to the one described in previous cohort studies.

[Pleural trichomoniasis due to trichomonas tenax]. / Trichomonase pleurale à Trichomonas tenax.

Thoracic infections due to Trichomonas species often go unrecognised as they are seldom described in the literature. We describe a case that, to our knowledge, is the first reported case of empyema caused by this organism. A 59 year old man with metastatic adenocarcinoma of the lung developed a right pyopneumothorax following treatment with corticosteroids and radiotherapy. The pleural fluid was purulent and fetid, and contained large numbers of Trichomonas tenax amongst a mixed bacterial flora. Pleural drainage and antibiotic therapy with metronidazole, ciprofloxacin and gentalline were instituted immediately, but the patient died 4 days later. Trichomonas tenax is part of the normal oral floral and may on occasions colonize the airways. It can thus become involved during aspiration pneumonia or cause pleural infection following the rupture of a pulmonary abscess. Such infection tends to be associated with concurrent respiratory pathology or with immunodepression. The significance Trichomonas tenax when found in the airways is unclear and their pathogenic role is discussed.