Tropheryma whipplei associated with diarrhoea in young children.

Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for <1 week and 3241 children (1444 female and 1797 male, from 22 days to 6 years old) without diarrhoea. Specific quantitative real-time PCR was performed to detect the presence of T. whipplei and of two enteric pathogens Clostridium difficile and Giardia duodenalis. Tropheryma whipplei was significantly more common in children with diarrhoea (22/555, 4%) than without (56/3241, 1.7%; p 0.001). Neither C. difficile nor G. duodenalis showed this association. For C. difficile, 39 of 531 (7.3%) children with diarrhoea were positive versus 184 of 3119 (5.9%) of children without diarrhoea (p 0.25). For G. duodenalis, 2 of 529 (0.37%) children with diarrhoea were positive versus 5 of 3119 (0.16%) children without diarrhoea (p 0.26). Tropheryma whipplei was found more commonly in autumn. Tropheryma whipplei is significantly associated with diarrhoea in children, suggesting that the bacterium may be a cause of acute diarrhoea.

Provision and consumption of alcohol-based hand rubs in European hospitals.

Hand hygiene is considered to be the most effective way of preventing microbial transmission and healthcare-associated infections. The use of alcohol-based hand rubs (AHRs) is the reference standard for effective hand hygiene. AHR consumption is a valuable surrogate parameter for hand hygiene performance, and it can be easily tracked in the healthcare setting. AHR availability at the point of care ensures access to optimal agents, and makes hand hygiene easier by overcoming barriers such as lack of AHRs or inconvenient dispenser locations. Data on AHR consumption and availability at the point of care in European hospitals were obtained as part of the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) study, a framework 7 project funded by the European Commission. Data on AHR consumption were provided by 232 hospitals, and showed median usage of 21 mL (interquartile range (IQR) 9-37 mL) per patient-day (PD) at the hospital level, 66 mL/PD (IQR 33-103 mL/PD) at the intensive-care unit (ICU) level, and 13 mL/PD (IQR 6-25 mL/PD) at the non-ICU level. Consumption varied by country and hospital type. Most ICUs (86%) had AHRs available at 76-100% of points of care, but only approximately two-thirds (65%) of non-ICUs did. The availability of wall-mounted and bed-mounted AHR dispensers was significantly associated with AHR consumption in both ICUs and non-ICUs. The data show that further improvement in hand hygiene behaviour is needed in Europe. To what extent factors at the national, hospital and ward levels influence AHR consumption must be explored further.

Epidemiological investigation of a human leptospirosis case reported in a suburban area near Marseille.

Leptospirosis has been re-emerging in both developed and developing countries, including in Europe, where the phenomenon has notably been associated with urban transmission. In this work, we describe an epidemiological investigation that demonstrated a case of human infection due to peri-urban transmission of Leptospira interrogans serovar icterohaemorrhagiae in southeastern France.

Increased incidence of acute parvovirus B19 infections in Marseille, France, in 2012 compared with the 2002-2011 period.

Human parvovirus B19 occurs worldwide and causes mild or asymptomatic disease in the form of cyclic local epidemics usually occurring in late winter and early summer. In 2012, a dramatic increase in cases was observed in the Public hospitals system of Marseille, with a total of 53 cases reported. Here, we describe the characteristics of this outbreak and compare it with the local epidemiology of B19V infections observed during the 2002-2011 period.

Q fever and pregnancy: disease, prevention, and strain specificity.

The link between fetal morbidity and Q fever and the necessity of long-term antibiotics for Coxiella burnetii infection during pregnancy have been recently questioned in the Netherlands, where the clone responsible for the Q fever outbreak harbors the QpH1 plasmid. In this context, we assessed pregnancy outcomes according to antibiotic administration in a new series and compared the plasmid type between isolates associated with abortion and other clinical isolates to determine if there is a link between genotype and abortion in humans. All French patients who received a diagnosis of Q fever during pregnancy at the French National Referral Centre for Q Fever from 2006 through July 2011 were included. On the other hand, the plasmid types of 160 clinical isolates, including seven isolates from patients who experienced an abortion, were compared. The differences between the QpDV and QpH1 plasmid sequences were analyzed. Acute Q fever was a cause of fetal morbidity, and the absence of long-term cotrimoxazole therapy was associated with fetal death (p < 0.0001). Genotypic analysis showed that the QpDV plasmid was more frequent in isolates associated with abortion (p = 0.03). A comparison of the plasmid sequences revealed that four QpDV proteins had no direct counterparts in QpH1, with two whose functions were not present in QpH1. The different obstetrical morbidity of C. burnetii relative to different geographical areas could be related to strain specificity, possibly based on differences in plasmid sequences, or to a failure of public health authorities to detect early miscarriages.

Seasonality in Gram-negative and healthcare-associated infections.

To assess seasonal variations in Gram-negative and healthcare-associated infections (HCAIs), a literature search was performed with combinations of the keywords 'seasonality', 'seasonal variations', 'Gram-negative bacilli', 'infections', 'nosocomial infections', and 'health care associated infections', to retrieve articles published in English in peer-reviewed journals from 1 January 1970 to 29 February 2012. Seasonality was demonstrated for infections, mostly bloodstream infections (BSIs), caused by Acinetobacter spp., Escherichia coli, Enterobacter cloacae, Klebsiella spp., and Pseudomonas aeruginosa, with higher rates of infection during the summer months in North America, Europe, the Middle East, Australia, and Asia. Correlations were observed between temperature increase and rates of BSI for Acinetobacter spp., P. aeruginosa, E. coli, Klebsiella pneumoniae, and extended-spectrum ß-lactamase-producing Enterobacteriaceae. A significant correlation between lower urinary tract infections and higher temperature and decreased relative humidity could explain the seasonality of some BSIs. Regarding HCAI, seasonality is intrinsically present in most viral respiratory and gastrointestinal infections, because viruses are introduced into hospitals during seasonal community outbreaks. Other HCAIs subject to seasonal variations include surgical wound infections, with winter peaks in the USA and summer peaks in Finland, central-line-associated BSIs in haematology/oncology paediatric outpatients, and dialysis-associated peritonitis. In summary, seasonal variations have been shown for infections caused by many Gram-negative bacilli, as well as for a few HCAIs, but many studies remain to be performed in order to better understand the mechanisms of these variations.

Obesity-associated gut microbiota is enriched in Lactobacillus reuteri and depleted in Bifidobacterium animalis and Methanobrevibacter smithii.

BACKGROUND: Obesity is associated with increased health risk and has been associated with alterations in bacterial gut microbiota, with mainly a reduction in Bacteroidetes, but few data exist at the genus and species level. It has been reported that the Lactobacillus and Bifidobacterium genus representatives may have a critical role in weight regulation as an anti-obesity effect in experimental models and humans, or as a growth-promoter effect in agriculture depending on the strains. OBJECTIVES AND METHODS: To confirm reported gut alterations and test whether Lactobacillus or Bifidobacterium species found in the human gut are associated with obesity or lean status, we analyzed the stools of 68 obese and 47 controls targeting Firmicutes, Bacteroidetes, Methanobrevibacter smithii, Lactococcus lactis, Bifidobacterium animalis and seven species of Lactobacillus by quantitative PCR (qPCR) and culture on a Lactobacillus-selective medium. FINDINGS: In qPCR, B. animalis (odds ratio (OR)=0.63; 95% confidence interval (CI) 0.39-1.01; P=0.056) and M. smithii (OR=0.76; 95% CI 0.59-0.97; P=0.03) were associated with normal weight whereas Lactobacillus reuteri (OR=1.79; 95% CI 1.03-3.10; P=0.04) was associated with obesity. CONCLUSION: The gut microbiota associated with human obesity is depleted in M. smithii. Some Bifidobacterium or Lactobacillus species were associated with normal weight (B. animalis) while others (L. reuteri) were associated with obesity. Therefore, gut microbiota composition at the species level is related to body weight and obesity, which might be of relevance for further studies and the management of obesity. These results must be considered cautiously because it is the first study to date that links specific species of Lactobacillus with obesity in humans.

Diversity of Mycobacterium avium subsp. hominissuis mycobacteria causing lymphadenitis, France.

The knowledge of Mycobacterium avium complex (MAC) genotypes responsible for lymphadenitis is limited. We retrospectively characterized all of the MAC isolates made in our laboratory in the last 18 years by sequence-based identification and genotyping, and compared the clinical and laboratory data for lymphadenitis-associated and non-lymphadenitis-associated MAC isolates. Of 67 MAC-infected patients, 25 lymphadenitis patients were significantly younger than 42 non-lymphadenitis patients, while the male/female ratio did not significantly differ between the two groups. Cervical topography found in 76.5% of lymphadenitis patients was significantly more frequent in non-immunocompromised patients (p=0.04). M. avium subsp. hominissuis was identified in 53 patients (24 lymphadenitis, 29 non-lymphadenitis), M. colombiense in six patients (five non-lymphadenitis, one lymphadenitis), M. intracellulare in four non-lymphadenitis patients, and M. chimaera in three non-lymphadenitis patients, while negative controls remained negative. M. hominissuis was significantly associated with lymphadenitis (p=0.03). M. hominissuis isolates yielded 15 genotypes in 29 non-lymphadenitis isolates (molecular diversity, 0.622) versus 11 genotypes in 24 lymphadenitis isolates (molecular diversity, 0.578), demonstrating a non-significant lower diversity of M. hominissuis isolates cultured from lymphadenitis. The genotypes did not correlate with the clinical features. These data suggest the presence of several environmental reservoirs for M. hominissuis causing lymphadenitis in France.

Impact of diagnostic procedures on patient management and hospitalization cost during the 2000 and 2005 enterovirus epidemics in Marseilles, France.

Enteroviruses are frequent aetiological agents of central nervous system infections in humans. In 2000 and 2005, two large outbreaks of Echovirus 30 (a member of species human enterovirus B) were observed in the University Hospitals of Marseilles (France). Between the two epidemics, the diagnostic protocols for enterovirus infection were modified, moving from viral cultures and classic RT-PCR in 2000 to real-time RT-PCR in 2005. We compared some viral and epidemiological characteristics of the 2000 and 2005 outbreaks with special attention to diagnostic procedures and to the subsequent clinical management of patients. Despite similar virological and epidemiological characteristics during both outbreaks, our results show that real-time RT-PCR techniques used in 2005 noticeably shortened the period of time necessary to deliver diagnostic results and suggest that this was associated with a decrease in the duration of hospitalization for positive cases. In conclusion, this study suggests that the improvement of enterovirus diagnosis had a major financial impact on the management of the 2005 epidemic in Marseilles and may constitute an interesting example of how new diagnostic methods in microbiology can be self-financed through improvement in patient management.

Growth-promoting effects of single-dose intragastrically administered probiotics in chickens.

1. Live body weight gain (WG) and food conversion efficiency (FCE) were measured over a 4-week period in chicks (female, Kabir strain), inoculated intragastrically at one week of age with either a single dose (1 ml) of 10(7) live bacterial cells of Lactobacillus fermentum (LBF) or a strain of Lactobacillus spp. (LB), named Autruche 4 (A4), suspended in 1 ml of phosphate-buffered saline (PBS, pH 7.0); controls (n = 10) were inoculated only with PBS. The same commercial chicken feed was used throughout the 4-week experiment. 2. Compared with the control group, WG to 8 and 21 d, and also liver weight, were significantly greater in LBF and A4 treatments and FCE improved in both of the experimental groups. Compared with the A4 treatment group, WG was significantly higher and FCE improved in the LBF-treated group. The effects of A4 treatment on chicks were similar to those in an earlier pilot experiment using the same methodology but with 1-week-old female chicks (Kabir) inoculated with either the A4 strain or strain of LB named Autruche 5. 3. It is concluded that a single dose of Lactobacillus fermentum or Lactobacillus spp. (Autruche 4) administered intragastrically improves WG and FCE of broiler chicks.

Almond oil implicated in a Staphylococcus capitis outbreak in a neonatal intensive care unit.

OBJECTIVE: To develop an effective outbreak-control strategy by identifying the source and modes of transmission of Staphylococcus capitis in a 60-bed neonatal intensive care unit (NICU). STUDY DESIGN: We conducted a study among neonates hospitalized during the outbreak (June 2000 through November 2003). All cases of S. capitis colonization or infection detected by clinical samples during the outbreak were included. The molecular analysis of the isolated was assessed by pulsed-field electrophoresis. We reported the description of the outbreak and the measures taken during this investigation. RESULT: Thirty-three patients were colonized or infected by S. capitis. Mean gestational age was 28.5+/-4.4 weeks of gestation, mean birth weight was 1068+/-637.3 g and the mean length of hospital stay was 77.9+/-35.9 days. We observed that positive S. capitis cultures were over-represented in six beds of the NICU. Because S. capitis is known to thrive in lipid media, we cultured samples from the almond oil bottles assigned to these beds. S. capitis strain recovered from one of the almond oil sample was genetically identical to the strain recovered from the cases. CONCLUSION: Almond oil is an unusual reservoir infection. Control policy allowed prompt institution of measures that were successful in ending the outbreak.

Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome.

Q fever is a zoonotic disease caused by Coxiella burnetii. Polymorphic, the disease may present as an acute or chronic infection. Vascular infections are the second most common form of chronic Q fever, following endocarditis. Herein, we studied the outcome of 30 new cases of aortic infection caused by C. burnetii using uni- and multivariate analyses. The outcome of ten cases previously reported by our team was also updated. Of these 40 patients, 32 had a follow-up of >or=3 years. Among them, the overall mortality was of 25% (8/32). Vascular rupture was significantly and independently (multivariate P=0.03) associated with a lethal issue, whereas vascular surgery was significantly associated with recovery (uni- and multivariate P<0.01). Our findings demonstrate the critical importance of surgery in the management of C. burnetii vascular infections.

Role of hospital stay and antibiotic use on Pseudomonas aeruginosa gastrointestinal colonization in hospitalized patients.

The prospective cohort study presented here assessed the risk factors associated with Pseudomonas aeruginosa gastrointestinal colonization (PAGIC) in 933 patients hospitalized in five different wards in a French university hospital. A total of 195 patients were colonized. By logistic regression, hospitalization in an intensive care unit and length of hospital stay were independent risk factors. A significant association was observed between fluoroquinolone use and PAGIC caused by an ofloxacin-resistant strain (p < 0.0001), imipenem use and PAGIC caused by an imipenem-resistant strain (p < 0.0002) and ceftazidime use and PAGIC caused by a ceftazidime-resistant strain (p < 0.02). The ecological impact of antibiotic use is of great clinical relevance and clinicians should consider antimicrobial resistance in order to limit the development and dissemination of resistant microorganisms.

Risk-factors for gastrointestinal colonisation with resistant Enterobacteriaceae among hospitalised patients: a prospective study.

This study assessed the incidence of gastrointestinal colonisation by resistant Enterobacteriaceae among hospitalised patients, and identified risk-factors for ceftazidime and ofloxacin resistance. A prospective cohort study was performed in five wards in a French teaching hospital during a 2-year period. Patients hospitalised for > 48 h were enrolled between 17 April 2000 and 30 April 2002. A rectal swab was taken at admission, then once-weekly and/or on the day of discharge. In total, 933 patients were investigated and 585 amoxycillin-resistant isolates were obtained. Resistance rates for ceftazidime and ofloxacin were 9.4% and 4.8%, respectively. Multivariate analysis indicated that previous hospitalisation (p < 0.004) and exposure to amoxycillin-clavulanate (p < 0.003) and ceftriaxone (p < 0.002) were associated significantly with ceftazidime resistance. Hospitalisation in the urology ward (p < 0.02) and previous exposure to fluoroquinolones (p < 0.01) were the two independent risk-factors associated with ofloxacin resistance. The results of the study confirmed that antibiotic use selected resistant Enterobacteriaceae from the gut flora. Resistance was observed mostly in patients with previous antibiotic exposure and previous hospitalisation in wards with a high antibiotic selection pressure.

Determination of HPV type 16 and 18 viral load in cervical smears of women referred to colposcopy.

It has been recognized that human papillomavirus infection is the major causal factor for high-grade cervical lesions. The aim of the study was to evaluate the relationship between HPV 16 and 18 viral loads and cervical status in different age strata. A duplex real time PCR method was devised to determine HPV 16 and 18 viral load per million of human cells using an in house plasmidic construct as a standard of quantification. The 151 cervical scrapes were collected before colposcopic examination from either abnormal cervico-vaginal smear (group 1, 97 patients) or from post treatment clinical follow-up (group 2, 54 patients). In women aged 30-40, the HPV16 viral loads were significantly higher in high-grade squamous intraepithelial lesion than in low-grade squamous intraepithelial lesion in both groups and HPV18 in group 1. In women aged 20-30 of group 1, high HPV viral load was associated in few cases with high-grade squamous intraepithelial lesion or low-grade squamous intraepithelial lesion, and surprisingly in some patients with normal cervix. HPV 16 and 18 viral loads are related to the severity of cervical lesion, and may be useful in the clinical management of cervical lesions. A specific follow-up may be useful for those with high viral load despite normal cervix.

Assessment of ica operon carriage and biofilm production in Staphylococcus epidermidis isolates causing bacteraemia in bone marrow transplant recipients.

The clinical significance of coagulase-negative staphylococci isolated from blood culture is typically assessed on the basis of a combination of clinical and microbiological criteria. However, these criteria are difficult to apply to haematology patients who are highly immunosuppressed and from whom blood cultures are obtained most frequently through a central venous catheter. This study analysed 112 episodes of Staphylococcus epidermidis bacteraemia that occurred in 79 bone marrow transplant recipients. In 73 (65%) episodes, only one blood culture set was positive for S. epidermidis, while 39 (35%) episodes grew S. epidermidis from multiple blood cultures. Nine patients had two or more episodes of bacteraemia with the same strain, as determined by pulsed-field gel electrophoresis (PFGE). The PFGE method also showed that 34 (31%) isolates belonged to seven clusters, indicating the persistence of certain clones in the environment. Of the 109 isolates analysed, 59 (54%) produced biofilm and 91 (83.5%) carried the ica operon. Isolates that produced biofilm were observed to colonise central venous catheters faster than non-biofilm-producing isolates (18 vs. 37 days; p 0.03). No clinical features were associated with carriage of the ica operon, but the ica operon was carried more frequently by the isolates that formed clusters.

Contribution of systematic serological testing in diagnosis of infective endocarditis.

Despite progress with diagnostic criteria, the type and timing of laboratory tests used to diagnose infective endocarditis (IE) have not been standardized. This is especially true with serological testing. Patients with suspected IE were evaluated by a standard diagnostic protocol. This protocol mandated an evaluation of the patients according to the modified Duke criteria and used a battery of laboratory investigations, including three sets of blood cultures and systematic serological testing for Coxiella burnetii, Bartonella spp., Aspergillus spp., Legionella pneumophila, and rheumatoid factor. In addition, cardiac valvular materials obtained at surgery were subjected to a comprehensive diagnostic evaluation, including PCR aimed at documenting the presence of fastidious organisms. The study included 1,998 suspected cases of IE seen over a 9-year period from April 1994 to December 2004 in Marseilles, France. They were evaluated prospectively. A total of 427 (21.4%) patients were diagnosed as having definite endocarditis. Possible endocarditis was diagnosed in 261 (13%) cases. The etiologic diagnosis was established in 397 (93%) cases by blood cultures, serological tests, and examination of the materials obtained from cardiac valves, respectively, in 348 (81.5%), 34 (8%), and 15 (3.5%) definite cases of IE. Concomitant infection with streptococci and C. burnetii was seen in two cases. The results of serological and rheumatoid factor evaluation reclassified 38 (8.9%) possible cases of IE as definite cases. Systematic serological testing improved the performance of the modified Duke criteria and was instrumental in establishing the etiologic diagnosis in 8% (34/427) cases of IE.