Infections urinaires communautaires de la femme de 15 à 65 ans: sensibilité aux antibiotiques de E. coli en fonction des antécédents: étude AFORCOPI–BIO 2003

OBJECTIVES

A multicenter study was implemented in order to determine the distribution and antibiotic susceptibility patterns of strains isolated from 15 to 65 year old female patients with community-acquired urinary tract infections.

PATIENTS AND METHODS

From October to December 2003, 11 French private laboratories consecutively collected 420 clinical strains with medical data. Minimal inhibitory concentrations of antibiotics on E. coli were determined using the agar dilution method in a coordinating center and interpretation followed the recommendations of the Comité de l'antibiogramme de la Société française de microbiologie.

RESULTS

Escherichia coli was the most prevalent pathogen (80%) followed by Proteus mirabilis (4%), Klebsiella spp (2%), other Enterobacteriaceae (4%), Enterococcus spp (3%), Staphylococcus aureus (2%), Staphylococcus saprophyticus (2%), and Streptococcus agalactiae (2%). The susceptibility of E. coli strains was 61% for amoxicillin (AMX), 93% for nalidixic acid (NAL), 97% for norfloxacin (NOR) and ciprofloxacin (CIP), 77% for cotrimoxazole (SXT), 99% for fosfomycin, gentamicin and cefotaxime. The susceptibility of E. coli was lower in case of previous treatment with beta-lactam antibiotics for AMX (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). In the same way, previous treatment with quinolones was associated with decreased susceptibility for NAL (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02).

CONCLUSIONS

In 2003, fluoroquinolones, third generation cephalosporins, aminoglycosides, and fosfomycin kept a good activity on E. coli collected from community-acquired urinary tract infections in 15 to 65 years old female patients in France.

Arthrite sans urétrite: penser au gonocoque

INTRODUCTION

Septic arthritis caused by Neisseria gonorrhoeae is mono or pauciarticular. They represent a nonrare cause of arthritis in sexually active adults. He is necessary to think of it even in the absence of urethritis.

EXEGESIS

We report the case of gonococcal arthritis without urethritis in a young man associated with positive synovial fluid culture and negative blood cultures.

CONCLUSION

Prompt recognition and treatment of this disease results in cure without aftereffects. The finding of penicillin-resistant organisms reinforces recent recommendations that advanced-generation cephalosporin must be used as initial therapy.

[Pasteurella dagmatis spondylodiscitis in a diabetic patient]

INTRODUCTION

Healthy pets contact are able to induce unusual and severe diseases.

CLINICAL CASE

This case reports the medical history of a dorsal spondylodiscitis in a diabetic patient admitted for a chronic wound of his toes. He had a long-standing history of regular consumption of alcohol and tobacco. Blood bottles and biopsy of intervertebral disc infected discovered Pasteurella dagmatis, commonly colonizing the oropharynx of healthy dogs and cats. In this case, licking of his injured toe by his dog was the likely source of entry of the organism.

DISCUSSION

We found no identical cases in the medical literature. Diabetes mellitus and other immunocompromised disorders justify to change behaviours toward domestic animals.

Épidémie de leishmaniose cutanée chez des militaires de retour de mission en Guyane

BACKGROUND

An outbreak of cutaneous leishmaniasis occurred among 71 soldiers who had participated in various missions during a 4-month's period in French Guiana. The aims of this study were (i) to describe outbreak and (ii) to determine risk factors of cutaneous leishmaniasis.

METHODS

All patients were hospitalised. Cutaneous lesions were biopsied and cultured for species identification. Individual information was collected by a physician or a nurse, using on a standardised, anonymous chart. Data were processed with EpiInfo 6.04 and SAS.

RESULTS

Mean age of the 71 soldiers was about 25.9 years (19-37 years). Twelve soldiers presented 56 lesions due to Leishmania (Viannia) guyanensis (attack rate = 16.9 for 100). Among 56 lesions, 13 lesions were localized on the trunk, usually an unexposed body area. Logistic regression highlighted military exercises in the forest during a high risk period of leishmaniasis transmission (OR = 11.2; p < 0.01), and the young age (OR = 1.33; p = 0.04). Vector control measures were not statistically significant.

CONCLUSION

Military authorities should restrict deep forest activities during periods of high risk transmission. Vector control measures are essential. Officers should motivate their soldiers and supervise vector control measures. As ecotourism is developing, tourists as well as workers staying in deep forest must be informed of the risk and about vector control measures.

First identification of the causative agent of visceral leishmaniasis in Djibouti: Leishmania donovani

The first identification of the Leishmania species responsible for visceral leishmaniasis in Djibouti is described. Four strains, obtained from three autochthonous cases, were identified by starch-gel electrophoresis and iso-enzyme analysis of 15 enzymatic systems. The strains were found to belong to two newly recognized zymodemes of L. donovani: MON-268 and MON-287.

[Which betalactam antibiotic use as a marker of multiresistance in Pseudomonas aeruginosa?]

The determination of an indicating antibiotic for multiresistance, as methicillin in staphylococci, can be useful for Pseudomonas aeruginosa. Until now, the majority of the hygienists used ticarcillin, ceftazidim or imipenem in their investigations as markers of multiresistance for this species. Piperacillin has never been proposed for this purpose. To evaluate this choice, 2098 non-repetitive P. aeruginosa strains collected from 15 teaching hospitals in 1997-1999 were analysed, for eight antibiotics (ticarcillin, piperacillin, ceftazidim, imipenem, tobramycin, amikacin, ciprofloxacin, fosfomycin) according (i) to the results of the minimal inhibiting concentrations obtained by dilution in Mueller-Hinton agar, (ii) to their susceptibility following the criteria of Comité de l'antibiogramme de la Société Française de Microbiologie and (iii) to the determination of the mechanisms of resistance to the beta-lactam antibiotics. The low rates of sensitivity to the beta-lactam antibiotics, aminoglycosides, ciprofloxacin and fosfomycin were more frequent for piperacillin-resistant strains than for ceftazidim-resistant ones. Resistance to the other beta-lactam antibiotics are poor markers of multiresistance. In the light of the presented data, piperacillin seems to be, among the beta-lactam antibiotics, the best candidate as a marker of multiresistance for P. aeruginosa, followed by ceftazidim. This multiresistance is mainly found in strains overproducing AmpC cephalosporinase or transferable beta-lactamases. These mechanisms are well detected by resistance to piperacillin.

[Extreme obesity in Prader-Willi Syndrome (PWS)]

INTRODUCTION

Prader-Willi Syndrome (PWS) belong to genetic obesities and we report a caricatural observation.

DEVELOPMENT

The early onset of (PWS) is characterised by a severe neonatal hypotonia with poor suck reflex--which may lead to tube feeding--and poor weight gain. Later appears insatiable appetite, morbid obesity associated with short stature, dysmorphic syndrome with small hands and behavioural disorders. Although diagnosis is based on clinical features, it must be confirmed by genetic test looking for the characteristic deletion of the chromosome 15q11-q13 region. PWS is the first example in humans of genetic imprinting.

CONCLUSION

Today, the challenge in PWS is it early management which may authorise Growth Hormone administration.

[Clinical and biological surveillance of envenomed patients]

Faced with an envenomation, the problem is to take sufficiently rapidly the decision to administer the only effective treatment--immunotherapy--, to know which antivenom to choose and how long to administrate it. If the snake is not identified, symptoms and initial development give information on the type of venom. It is convenient to classify the symptoms according to four clinical types: i) the cobra syndrome with a potentially fatal evolution within two to ten hours and which resembles an Elapid bite, ii) the viper syndrome associating bleeding and inflammation, which can be due either to a viper, pit viper or, in Australia, to Elapids, iii) disturbance of blood circulating functions and iv) disturbance of other live functions. Between the third to the half of snakebite victims present no envenomation. Severe envenomations must be monitored in an intensive care unit, with experience in emergency management and monitoring of patients with major life-threatening conditions. Throughout the world, snakebites induce more than 100,000 deaths every year. Schematically, the emergency may be considered in terms of seconds for blood circulation disorders, minutes for respiratory paralysis, and hours for the coagulopathy.

[Antibiotic sensitivity of Salmonella isolated in army hospitals between 1998-1999]

OBJECTIVES

Monitor the evolution in France of antibiotic sensitivity of non-typhoid salmonella isolated in fecal cultures conducted in army hospital laboratories.

METHODS

A prospective study was performed from January 1998 to December 1999 in all the biology departments of the 11 army hospitals in France. All the non-repetitive strains were sent to an official center for serotyping and determination of the minimum inhibiting concentrations, by dilution in Mueller Hinton's gelose. The antibiotics currently used in treatment were tested and interpretation endpoints followed the recent recommendations of the Antibiogram committee of the French society of microbiology. Identification of beta-lactamase was conducted by iso-electric focalization and polymerization by chain reaction (PCR). For Salmonella Typhimurium, research for the specific resistance locus of the DT104 clone was made using PCR.

RESULTS

Two hundred and twenty-two non-repetitive salmonella strains were isolated. The principle serotypes found were: Salmonella Enterididis (23.9%), S. Typhimurium (21.2%) and S. Hadar (10.8%). All the strains were sensitive to ciprofloxacin and cefotaxim, whereas one third exhibited reduced sensitivity to aminopenicillin. Depending on the serotype, Typhimurium and Hadar serotypes exhibited significantly lesser sensitivity to aminopenicillin, nalidixic acid and tetracycline. For S. Typhimurium, resistance is related to the diffusion of the multiresistant DT104 clone, which involves half of the strains of this serotype. For S. Hadar, 18 out of 24 strains (75%) were resistance to nalidixic acid, and 5 of them exhibited reduced resistance to ciprofloxacin. There was no difference in sensitivity to antibiotics between the strains responsible for diarrhea and those isolated in systematic examinations for capacity to work in the food trade (respectively 54 and 46% of strains).

CONCLUSION

Non-typhoid salmonella are frequently isolated in diarrhea of infectious origin. The increasing resistance to antibiotics is primarily related to the diffusion of the DT104 clone, regarding S. Typhimurium and to the increase in resistance to quinolone, regarding S. Hadar.

Effect of beta-lactam antibiotics on the in vitro development of resistance in Pseudomonas aeruginosa

OBJECTIVE

To investigate whether stepwise selection of resistance mutations may mirror the continued bacterial exposure to antibiotics that occurs in the clinical setting.

METHODS

We examined the in vitro development of resistance to a number of commonly used antibiotics (cefepime, cefpirome, ceftazidime, cefotaxime, piperacillin and imipenem) in Pseudomonas aeruginosa, a significant nosocomial pathogen. Stepwise resistance was assessed by serial passage of colonies located nearest to the inhibition zone on antibiotic-containing gradient plates.

RESULTS

The lowest frequencies of spontaneous resistance mutations were found with cefepime and imipenem; these drugs also resulted in the slowest appearance of resistance of spontaneous resistance mutations. In five wild-type P. aeruginosa strains, cefepime-selected isolates required a mean of 30 passages to reach resistance; resistance occurred more rapidly in strains selected with other cephalosporins. P. aeruginosa strains that produced beta-lactamase or non-enzymatic resistance generally developed resistance more rapidly than wild-type strains. For most strains, resistance to all antibiotics except imipenem correlated with increased levels of beta-lactamase activity. Cross-resistance of cephalosporin-selected resistant mutants to other cephalosporins was common. Cephalosporin-resistant strains retained susceptibility to imipenem and ciprofloxacin.

CONCLUSIONS

From our in vitro study, we can conclude that the rate of development of resistance of P. aeruginosa is lower with cefepime compared with other cephalosporines.

[Sensitivity to antibiotics of bacteria from nosocomial infections. Evolution in resuscitation services of military hospitals]

OBJECTIVE

The aim of this study, conducted in the French Military hospitals, was to monitor the course of the antimicrobial sensibility of bacteria isolated from nosocomial infection in intensive care units.

PATIENTS AND METHODS

A prospective study has been conducted from January to December 1998 in all the intensive care units of the French Army. All the non-repetitive strains isolated from nosocomial infection were collected and sent to a reference centre. Antimicrobial susceptibility was determined by the agar dilution method. Beta-lactamase were identified by iso-electro-focalisation. Antibiotics choice and interpretative criteria were those of the "Comité Français de l'Antibiogramme de la Société Française de Microbiologie".

RESULTS

A total of 849 strains are included in this study. Pseudomonas aeruginosa was the most frequently isolated bacterium (20%) followed by Escherichia coli (19%) Staphylococcus aureus (15%), coagulase-negative Staphylococci (CoNS) (11%) and Enterococci (7%). Imipenem was the most effective antibiotic against enterobacteriaceae (336 isolates; 100% susceptibility). Gentamicin (92%), amikacin (92%) third generation cephalosporins (83%), aztreonam (83%) and ciprofloxacin (78%) were also very effective. Resistance to III generation cephalosporins was correlated with an extended spectrum beta-lactamase (BLSE) in 36% of cases. This BLSE could be associated with an over production of the constitutive cephalosporinase. The most frequent species producing BLSE were Enterobacter aerogenes (75% of BLSE) and Klebsiella pneumoniae (17%). Among the 172 P. aeruginosa isolated, antimicrobial susceptibility were respectively: 71% for imipenem, 62%: tobramycin, 60%: amikacin 59%: ciprofloxacin 59% piperacillin + tazobactam, 55% piperacillin, 53%: ceftazidime and 44% for ticarcillin. Seventy per cent of the 96 CoNS and 50.2% of the 126 S. aureus isolated were resistant to methicillin. A strain of S. aureus and 2 CoNS strains had intermediate resistance to teicoplanin. Twenty per cent of the 59 Enterococci strains isolated were resistant to aminopenicillins (10/11 strains of E. faecium), and 9% presented a high level of resistance to gentamicine. One strain of E. faecium was resistant to vancomycin.

CONCLUSION

The evolution of the susceptibility to antibiotics in intensive care units reflects the antibiotic pressure and level of cross-transmission. High rates of meticillin-resistance among staphylococci, of resistance to beta-lactams antibiotics among P. aeruginosa and of ciprofloxacin among Enterobacteriaceae are shown in this study. The implementation of appropriate strategies for surveillance and prevention is necessary.