Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE) in Northern France: a five-year multicentre incidence study

In order to measure the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and of Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLE), and to evaluate the impact of the national guidelines for multidrug-resistant bacteria (MDRB) prevention in hospitals of Northern France, a multicentre study was conducted for three months every year starting in 1996, in volunteer hospital laboratories. All clinical specimens positive for MRSA and ESBLE were prospectively surveyed. During the five-year surveillance period, the overall proportion of MRSA was 38.4% in the 28,534 strains of S. aureus, and that of ESBLE was 11.4% in the 6121 strains of Klebsiella pneumoniae and 47.7% in the 2353 strains of Enterobacter aerogenes. The overall incidence rates of clinical specimens positive for MRSA, ESBL-K. pneumoniae and E. aerogenes were 0.84. 0.05 and 0.12/1000 hospital-days (HD), respectively. In the 23 hospitals that participated in the survey every year, the proportion and incidence of ESBLE decreased. Hence, despite recommendations as for isolation precautions, MRSA remains poorly controlled and requires more effective measures.

[Detection of the phenotypes of resistance of enterobacteriaceae to aminoglycosides with ATB Plus Expert System]

ATB Plus Expert (Biomérieux SA) is an expert system which has been developed to perform an interpretative reading of ATB susceptibility tests. The system was tested on the results obtained for 217 strains of enterobacteriaceae. These strains were selected in order to cover a maximum of bacterial species and resistance mechanisms. The isolates were tested on rapid ATB E, rapid ATB G-, rapid ATB Ur, ATB G- and ATB Ur strips. In parallel, a disc diffusion susceptibility test was performed with 5 discs of aminoglycosides (kanamycin, gentamicin, tobramycin, netilmicin, amikacin) and the interpretation was carried out according to the criteria usually followed. Of the 217 strains tested, 122 showed a resistance phenotype. Only the rapid ATB E strips included kanamycin and allowed the detection of APH(3') phenotypes. Amikacin was not included in the ATB Ur strip, consequently it was impossible to discriminate AAC(3)-II and AAC(6') + AAC(3)-I phenotypes. 12 strains did not grow within 5 hours using the rapid ATB methodology. Not taking into account the problems previously encountered, different phenotypes between the 6 susceptibility tests were found for 16 strains. In 5 cases the expert system detected an anomaly instead of the correct phenotype, and in 3 cases of unknown phenotypes, the answers were variable. In the other cases, the main difficulty was the detection of the isolated resistance to gentamicin (AAC(3)-I phenotype). The expert system automatically corrects the susceptibility test result according to the phenotype observed.

[Laboratory contributions in systemic Candida albicans infections]

The authors have studied Candida albicans' serologies for seven patients in an intensive care unit. The comparison with the clinical evolution and results' laboratory displays an discordance for two cases. For these patients with many risk's factors, the observation of serology seems interesting on a prolonged period.

[Sensitivity of 858 strains of staphylococci to 27 antibiotics]

Susceptibility to 27 antimicrobial agents of 858 strains of staphylococci was determined. Tested strains belonged to the following species: S. epidermidis, S. saprophyticus, S. haemolyticus, S. hominis, S. simulans, S. warneri, S. cohnii, S. xylosus and S. intermedius. The antibiotics were: penicillin G, amoxycillin, augmentin, oxacillin, streptomycin, kanamycin, tobramycin, dibekacin, amikacin, gentamicin, sisomycin, netilmicin, doxycycline, minocycline, chloramphenicol, erythromycin, josamycin, clindamycin, pristinamycin, rifampin, fusidic acid, fosfomycin, trimethoprim, sulfamethoxazole, cotrimoxazole, and vancomycin. The ATB system was used, with the criteria for categorization recommended by the Antibiotic Sensitivity Testing Committee. Penicillin-resistance, that was found in all species, was high for hospital-acquired strains (67 to 75%) but also for some other strains (32% for S. simulans). Oxacillin-resistance varied across species (0% for the least prevalent hospital strains, 6% for S. epidermidis and 28% for S. haemolyticus). All strains were susceptible to vancomycin. For some drugs, resistance was a characteristic of the species: resistance to fosfomycin was often found for S. saprophyticus, S. haemolyticus, S. warneri, S. cohnii, and S. capitis; resistance to trimethoprim was common for S. simulans, and S. haemolyticus. S. haemolyticus was the most resistant species, a fact that justifies routine identification of this pathogen in clinical specimens.

[Rapid ATB staph: 4-hour antibiotic sensitivity test of staphylococci. Description and performance]

Rapid ATB Staph is a method for four-hour antimicrobial susceptibility testing of staphylococci. The equipment and theoretical basis are identical to those already described for rapid testing of enterobacteriaceae. A standardized procedure is required to perform the test. The inoculum should be prepared from a culture no older than 24 hours and accurately standardized at 10(8). Temperature of incubation should be 35 degrees C to 37 degrees C; otherwise growth is delayed by approximately one hour. Time of incubation should not exceed 5 hours. Using these standardized conditions, rapid ATB Staph was compared with the reference agar dilution method for 22 antibiotics. Overall agreement was 96.3%. The rapid system is more sensitive than the reference method fort the detection of netilmicin and amikacin resistance; it is reliable for detecting penicillin resistance, oxacillin resistance and inducible resistance to erythromycin (agreement 96.7%, 94.8% and 98.4% respectively). A Rapid ATB Staph strip containing 15 antibiotics has been designed for routine susceptibility testing.

[Rapid ATB. A new system of antibiotic testing in 4 hours. Description and parameters of variation]

Rapid ATB is a new automated system which performs antibiotic sensitivity testing of Enterobacteriaceae in four hours. It is composed of strips containing dehydrated antibiotics and a medium which ensures rapid bacterial growth, and of the equipment required for standardization of the inoculum, reading of results and interpretation. Strains are classified as susceptible or resistant according to the value of the growth index (IC) which is the ratio of growth in the presence of the antibiotic to growth of a control inoculum. Use of this system requires standardization. The main factors to control are state of the culture used to prepare the inoculum, standardization of the inoculum, incubation temperature (35 to 37 degrees C), and duration of incubation (4 to 5 hours). Variations of these factors usually induce significantly delayed growth. Under well standardized conditions, results are highly reproducible, as proved by testing ten strains ten times each by three investigators.