Management of an Acinetobacter baumannii outbreak in an intensive care unit.

INTRODUCTION: Acinetobacter baumannii is a ubiquitous pathogen resistant to desiccation and responsible for healthcare-associated infections (HAI), especially in intensive care units (ICU) where it is responsible for 5-10% of HAIs. An A. baumannii outbreak occurred in the ICU of the University Hospital of Angers, France. OBJECTIVES: To describe the A. baumannii outbreak and to evaluate the control measures taken. The secondary objective was to evaluate the impact of the electronic alert system on the incidence of multidrug resistance to antibiotics. METHODS: We performed a descriptive study of A. baumannii carriers during the outbreak. Case contacts and carriers were described using the epidemic curve and a case synopsis table. RESULTS: From August 2011 to September 2013, 49 patients presenting with an extended-spectrum beta-lactamase-producing A. baumannii infection were identified: thirty-four were colonized and 15 were infected. No death was due to the outbreak. Measures taken were: geographical and technical isolation of patients, dedicated team implementation, contact precaution implementation including hand hygiene measures, appropriate use of gloves, and reinforcement of bio-cleaning procedures. CONCLUSION: Some patients were re-admitted to hospital while still being carriers; this could explain epidemic peaks. The immersion mission of the hygiene nurse contributed to answering healthcare workers' queries and led to a better cooperation between the ICU and the hygiene team.

Bioassays and field immersion tests: a comparison of the antifouling activity of copper-free poly(methacrylic)-based coatings containing tertiary amines and ammonium salt groups.

This paper focuses on the activity spectrum of three dimethylalkyl tertiary amines as potential active molecules and the corresponding ammonium salt-based antifouling (AF) paints. Bioassays (using marine bacteria, microalgae and barnacles) and field tests were combined to assess the AF activity of coatings. Bioassay results demonstrated that the ammonium salt-based paints did not inhibit the growth of microorganisms (except the dimethyldodecylammonium-based coatings) and that the tertiary amines were potent towards bacteria, diatoms, and barnacle larvae at non-toxic concentrations (therapeutic ratio, LC50/EC50, <1). The results from field tests indicated that the ammonium salt-based coatings inhibited the settlement of macrofouling and the dimethylhexadecylammonium-based coatings provided protection against slime in comparison with PVC blank panels. Thus, results from laboratory assays did not fully concur with the AF activity of the paints in the field trial.

[Acute COPD exacerbations in women: EABPCO-CPHG study by the College of general hospital pneumologists]. / Les exacerbations aiguës de BPCO chez la femme : étude EABPCO-CPHG du Collège des pneumologues des hôpitaux généraux.

INTRODUCTION: Emerging evidence suggests that gender differences exist in the prevalence, susceptibility, severity and response to the treatment of COPD. This article compares the characteristics of acute exacerbation in male and female patients hospitalized for acute chronic obstructive pulomnary disease (COPD) exacerbation. METHODS: This observational study collected data from 1,824 patients admitted to the pneumology department in 68 general hospitals between October 2006 and June 2007. RESULTS: The 423 (23.2%) women were younger than the men (69.1 versus 70.6 years; p=0.016) and more frequently non-smokers (14.4% versus 4.2%; p<0.0001). Before the acute exacerbation, they more frequently reported asthma (18% versus 11.6%; p=0.0006) or bronchiectasis (10.4% versus 5.9%; p=0.002). They also more often presented consciousness disorders (6.4% versus 3.9%; p=0.033) and desaturation (SpO2<90%: 50.4% versus 42%; p=0.002) during acute exacerbation and their hypercapnia was more severe (50.7 versus 46.5mmHg; p<0.0001). During hospitalization, they were more frequently ventilated (23.9 versus 17.1%; p=0.002). There was no difference in the mortality between the sexes (1.4% versus 2.8%; p=0.11). Age and smoking behavior were closely related in the female patients: the smokers were younger (62.5 years) than the ex-smokers (73.7 years) or non-smokers (78.1 years). Of the six women who died during hospitalization, two were smokers and four ex-smokers. In addition, four were over 80 years old. CONCLUSION: The women hospitalized for acute COPD exacerbation differed from the men with respect to risk factors, steady-state COPD severity and exacerbation severity.

[Patent and occult intra-alveolar hemorrhage in leptospirosis]. / Hémorragies intra-alvéolaires patentes et occultes au cours des leptospiroses.

PURPOSE: Pulmonary involvement (PI) is common in leptospiral infection, usually characterized by hemoptysis and diffuse bilateral infiltrates on chest radiographs. Alveolar haemorrhage (AH) has already been proved by autopsy and some case-reports with fiberoptic bronchoscopy (FB) and bronchoalveolar lavage (BAL). The purpose of this study was 1/to evaluate the incidence of AH in leptospirosis 2/to define the impact of BAL on the early diagnosis of the infection. PATIENTS AND METHODS: FB with BAL were performed in 23 consecutive patients with leptospirosis (13 patients with patent signs of PI: group 1, 10 patients without: group 2). AH was defined by a percentage of siderophages > or = 20% and/or a Golde score > 100 and/or an haemorrhagic aspect of BAL fluid. Culture tests were performed on specific medium. RESULTS: We diagnosed AH in all patients of group 1 and in 7 patients of group 2. Filaments were seen in 6 specimens of BAL fluid, initially thought to be leptospires, but culture tests were negative. CONCLUSION: AH is identified in all cases of leptospirosis with PI. Occult AH often occurs to patients without any respiratory symptom. Physicians should consider leptospiral infection in the differential diagnosis of AH. Culture-tests for leptospirosis in BAL do no help in diagnosing leptospirosis.

[Analysis of the results obtained in fertilization in vitro according to the degree and type of teratospermia]. / Analyse des résultats obtenus en fécondation in vitro selon le degré et le type de tératospermie.

The aim of this study was to evaluate the consequences of sperm morphology abnormalities on fertilization capacity. We selected 115 couples who consulted for in vitro fertilization at the Salengro Maternity Ward (Lille, France). Teratospermia was > 40% in all. The mean rate of cleavage was 23% and was significantly lower than in a population which had had in vitro fertilization for a tube indication (63%, p < or = 0.001). In addition, this level was significantly correlated with teratospermia (p < or = 0.05). The ROC method demonstrated that above the threshold of 74% teratospermia, fertilization decreases significantly. We distinguished several types of abnormal morphology and demonstrated a weak correlation between head abnormalities and the rate of cleavage, a stronger correlation between abnormalities of the intermediary piece and rate of cleavage and finally the absence of any correlation between flagella abnormalities and the rate of fertilization. Teratospermia is therefore an important factor in evaluating fertilization capacity. A better selection of normal spermatoids could improve the chance of success in cases of male sterility.

[The incidence of atypical pulmonary mycobacterium infections in Reunion before the era of acquired immunodeficiency syndrome (AIDS)]. / Incidence des mycobactérioses pulmonaires atypiques à la Réunion avant l'ère du Syndrome d'immunodépression acquise (SIDA).

The authors analyzed cases of pulmonary non-tuberculous mycobacterial infection observed in the Reunion Island between 1979 and 1986, before any reported case of AIDS in the Island. Isolation of non tuberculous mycobacteria from bronchopulmonary specimens was estimated at 21.4% among all positive cultures (n = 971). The analysis of clinical and biological data from 791 different patients with a positive culture concluded to the responsibility of a non tuberculous mycobacteria in 117 (14.8%); among these 117, only 10 (8.5%) were considered as pathogen. Species repartition, antituberculous drug sensitivity and clinical out come are discussed.

[Severe pulmonary mycobacteriosis caused by Mycobacterium simiae]. / Mycobactériose pulmonaire grave à Mycobacterium simiae.

We report a case of pulmonary mycobacterial infection due to Mycobacterium simiae followed between 1968 and 1985 and leading to unilateral pulmonary destruction. Formal bacteriological proof was obtained by culturing from the pneumonectomy specimen. None of the usual features of immunosuppression were found. This is the first case suffering from this germ described in this part of the world.