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Alanio A, Snell HM, Cordier C, Desnos-Olivier M, Dellière S, Aissaoui N, Sturny-Leclère A, Da Silva E, Eblé C, Rouveau M, Thégat M, Zebiche W, Lafaurie M, Denis B, Touratier S, Benyamina M, Dudoignon E, Hamane S, Cuomo CA, Dépret F. First Patient-to-Patient Intrahospital Transmission of Clade I Candida auris in France Revealed after a Two-Month Incubation Period. Microbiol Spectr 2022; 10:e0183322. [PMID: 36094221 PMCID: PMC9604096 DOI: 10.1128/spectrum.01833-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 12/31/2022] Open
Abstract
Candida auris is a recently described emerging pathogen in hospital settings. Five genetic clades have been delineated, with each clade being isolated from specific geographic regions. We here describe the first transmission between 2 patients (P0 and P1) of a clade I C. auris strain imported into our burn intensive care unit from the Middle East. The strains have been investigated with whole-genome sequencing, which validated the high similarity of the genomes between isolates from P0 and P1. We repeatedly screened the two patients and contact patients (i.e., other patients present in the same hospital ward at the time of the first positive sample from P0 or P1; n = 49; 268 tests) with fungal culture and a C. auris-specific quantitative PCR assay to assess transmission patterns. We observed that P1 developed C. auris colonization between 41 and 61 days after potential exposure to P0 contamination, despite three negative screening tests as recommended by our national authorities. This study illustrates that transmission of C. auris between patients can lead to long-term incubation times before the detection of colonization. The recommended screening strategy may not be optimal and should be improved in the light of our findings. IMPORTANCE While large outbreaks of C. auris in hospital settings have been described, few clear cases of direct transmission have been documented. We here investigated the transmission of C. auris clade I between two patients with a 41- to 61-day delay between exposure and the development of colonization. This may lead to changes in the recommendations concerning treatment of C. auris cases, as an incubation period of this length is one of the first to be reported.
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Affiliation(s)
- Alexandre Alanio
- Institut Pasteur, Université Paris Cité, CNRS, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR2000, Paris, France
- Laboratoire de parasitologie-mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | | | - Camille Cordier
- Laboratoire de parasitologie-mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Marie Desnos-Olivier
- Institut Pasteur, Université Paris Cité, CNRS, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR2000, Paris, France
| | - Sarah Dellière
- Institut Pasteur, Université Paris Cité, CNRS, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR2000, Paris, France
- Laboratoire de parasitologie-mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | - Nesrine Aissaoui
- Laboratoire de parasitologie-mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Aude Sturny-Leclère
- Institut Pasteur, Université Paris Cité, CNRS, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR2000, Paris, France
| | - Elodie Da Silva
- Laboratoire de parasitologie-mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Cyril Eblé
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Martine Rouveau
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Micheline Thégat
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Widad Zebiche
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Matthieu Lafaurie
- Equipe Opérationnelle d’Hygiène, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Blandine Denis
- Equipe Opérationnelle d’Hygiène, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Touratier
- Service de maladies infectieuses et tropicales, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Benyamina
- Pharmacie centrale, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Département d’anesthésie réanimation, réanimation chirurgicale et centre de traitement des brûlés, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Dudoignon
- Pharmacie centrale, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Département d’anesthésie réanimation, réanimation chirurgicale et centre de traitement des brûlés, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samia Hamane
- Laboratoire de parasitologie-mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | | | - François Dépret
- Université Paris Cité, Paris, France
- Pharmacie centrale, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- Département d’anesthésie réanimation, réanimation chirurgicale et centre de traitement des brûlés, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
- FHU PROMICE, Paris, France
- INSERM UMR-942, Paris, France
- Réseau INI-CRCT, Nancy, France
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Garcia-Hermoso D, Criscuolo A, Legrande M, Chaouat M, Denis B, Lafaurie M, Rouveau M, Soler C, Mimoun M, Mebazaa A, Dromer F, Brisse S, Bretagne S, Alanio A. Épidémie de mucormycose dans un centre de traitement des brûlés : des biomarqueurs diagnostiques au séquençage complets des souches. J Mycol Med 2015. [DOI: 10.1016/j.mycmed.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3
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Marcade G, Micol JB, Jacquier H, Raskine L, Donay JL, Nicolas-Viaud S, Rouveau M, Ribaud P, Dombret H, Leclercq R, Cambau E. Outbreak in a haematology unit involving an unusual strain of glycopeptide-resistant Enterococcus faecium carrying both vanA and vanB genes. J Antimicrob Chemother 2013; 69:500-5. [DOI: 10.1093/jac/dkt376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Gener G, Dupuy A, Rouveau M, Claisse JP, Casin I, Dubertret L, Morel P, Simon F, Viguier M. [Systematic screening for methicillin-resistant Staphylococcus aureus (MRSA) in the nasal cavities of patients hospitalized in the dermatology departments of the Saint-Louis Hospital]. Ann Dermatol Venereol 2008; 135:815-21. [PMID: 19084690 DOI: 10.1016/j.annder.2008.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 09/12/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In a bid to combat methicillin-resistant Staphylococcus aureus (MRSA) more efficiently in our department, we performed a study to 1) clarify the MRSA carriage rate in patients hospitalized in the department; 2) evaluate the rate of MRSA acquisition during hospitalization; 3) describe the MRSA carrier profile; 4) study the morbidity and mortality associated with MRSA. PATIENTS AND METHODS We conducted a three-month prospective study in all patients hospitalized for more than 24hours in the dermatology department of the Saint-Louis Hospital. Nasal swab cultures were performed on the day of admission, once a week thereafter and on the day of discharge. Clinical and epidemiological data were individually reviewed by means of a standardized questionnaire. RESULTS In 310 patients, the prevalence of nasal MRSA carriage at admission was 6.5%. During hospitalization, 1.9% of our patients became colonized with MRSA. MRSA carriers were significantly older than non-carriers and had been hospitalized more frequently over the previous 12 months, principally in intensive care or in intermediate or long-term care facilities, and erosive and/or ulcerated dermatitis was more common in this population. Of the 27 patients colonized with MRSA, only three had MRSA infections, and these were successfully treated with antibiotics. DISCUSSION The observed rate of MRSA carriage was close to that seen in intensive care units (7%). While systematic screening for MRSA in patients with erosive and/or ulcerated dermatitis would allow detection of twice as many cases of MRSA than the usual screening recommendations, this would be associated with little tangible benefit and high costs, and we therefore decided not to change the usual MRSA screening politic in our dermatology department.
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Affiliation(s)
- G Gener
- Service de dermatologie, université Paris-VII Denis-Diderot, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
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5
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Arlet G, Rouveau M, Philippon A. Substitution of alanine for aspartate at position 179 in the SHV-6 extended-spectrum β-lactamase. FEMS Microbiol Lett 2006. [DOI: 10.1111/j.1574-6968.1997.tb10423.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Nadjar D, Rouveau M, Verdet C, Donay L, Herrmann J, Lagrange PH, Philippon A, Arlet G. Outbreak of Klebsiella pneumoniae producing transferable AmpC-type beta-lactamase (ACC-1) originating from Hafnia alvei. FEMS Microbiol Lett 2000; 187:35-40. [PMID: 10828397 DOI: 10.1111/j.1574-6968.2000.tb09133.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fifty-two strains of Klebsiella pneumoniae producing an AmpC-type plasmid-mediated beta-lactamase were isolated from 13 patients in the same intensive care unit between March 1998 and February 1999. These strains were resistant to ceftazidime, cefotaxime and ceftriaxone, but susceptible to cefoxitin, cefepime and aztreonam. Plasmid content and genomic DNA restriction pattern analysis suggested dissemination of a single clone. Two beta-lactamases were identified, TEM-1 and ACC-1. We used internal bla(ACC-1) primers, to sequence PCR products obtained from two unrelated strains of Hafnia alvei. Our results show that the ACC-1 beta-lactamase was derived from the chromosome-encoded AmpC-type enzyme of H. alvei.
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Affiliation(s)
- D Nadjar
- Service de Bactériologie, Hôpital Tenon, Paris, France
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7
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Abstract
The accumulation of infected clots under the silicone septum of the reservoir of venous access ports (VAPs) has been reported. We analyzed the relationship between these deposits and the occurrence of VAP-related bloodstream infections (VAP-BSIs) by (1) evaluating the accuracy of paired quantitative blood cultures for diagnosing VAP-BSI before the removal of the device and (2) assessing the accuracy of cultures of the tip and septum (i.e., the internal lumen of the VAP) for diagnosing VAP-BSI after removal of the device. Over a 16-month period, all VAPs removed were prospectively investigated. Before VAP removal, paired quantitative blood cultures were 77% sensitive and 100% specific and had a positive predictive value of 100% and a negative predictive value of 98% for diagnosing VAP-BSI. After VAP removal, tip culture was only 46% sensitive, whereas septum culture was 93.3% sensitive for confirming the diagnosis of VAP-BSI. Thus infected deposits that accumulate under the VAP septum are the source of VAP-BSI.
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Affiliation(s)
- M C Douard
- Département d'Anesthésiologie, Hôpital Saint Louis, 75475 Paris Cedex 10, France
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8
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Lesprit P, Zagdanski AM, de La Blanchardière A, Rouveau M, Decazes JM, Frija J, Lagrange P, Modaï J, Molina JM. Cerebral tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). Report of 6 cases and review. Medicine (Baltimore) 1997; 76:423-31. [PMID: 9413428 DOI: 10.1097/00005792-199711000-00005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cerebral tuberculosis (TB) was diagnosed in 6 (4%) of 156 HIV-infected patients with TB seen at our institution over 6 years. We describe here the clinical and radiologic features of these cases and of 15 others reported in the literature. Of the 21 patients, 59% were intravenous drug users. Presenting symptoms were fever (76%), confusion (52%), seizures (38%), and headache (38%). Fourteen patients (66%) had previous or active extracerebral TB at presentation. Cranial CT scan showed ring-(62%) or nodular-(24%) enhancing lesions or mixed forms (14%). Among the 12 patients who underwent a brain biopsy, bacteriologic evidence of TB was found in 9. Four patients (19%) died during hospitalization. Among the 17 others who received antituberculous therapy, only 1 developed neurologic sequelae. Five patients also received steroid therapy to control cerebral edema or paradoxical growth of the cerebral mass lesions. TB should be considered as a cause of cerebral mass lesions in HIV-infected patients, especially if tuberculous infection is suspected at other sites.
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Affiliation(s)
- P Lesprit
- Clinique des Maladies Infectieuses, Hôpital Saint-Louis, Paris, France
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9
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Garrouste-Orgeas M, Chevret S, Arlet G, Marie O, Rouveau M, Popoff N, Schlemmer B. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis. Am J Respir Crit Care Med 1997; 156:1647-55. [PMID: 9372689 DOI: 10.1164/ajrccm.156.5.96-04076] [Citation(s) in RCA: 207] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Colonization of the digestive tract has been supposed to be the source of many hospital-acquired infections, especially nosocomial pneumonia. To assess the relationship between oropharyngeal and gastric colonization and subsequent occurrence of nosocomial pneumonia, we prospectively studied 86 ventilated, intensive care unit (ICU) patients. Oropharyngeal or gastric colonizations were detected and quantified on admission and twice weekly during ICU stay. When nosocomial pneumonia was suspected on clinical grounds (new chest X-ray infiltrate and purulent tracheal secretions), diagnosis was assessed on fiberoptic bronchoscopy with quantitative cultures of a protected specimen brush sampling and/or a plugged telescoping catheter sampling yielding > or = 10(3) cfu/ml of at least one microorganism. Bacterial strains responsible for colonization and infection (Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, and Staphylococcus aureus) were compared using pulsed-field electrophoresis. A total of 31 cases (36%) of pneumonia were diagnosed. Oropharyngeal colonization, detected either on admission or from subsequent samples, was a predominant factor of nosocomial pneumonia as compared with gastric colonization. For instance, oropharyngeal colonization with A. baumannii yielded a 7.45-fold estimated increased risk of pneumonia as compared with patients not yet or not identically colonized (p = 0.0004). DNA genomic analysis demonstrated that an identical strain was isolated from oropharyngeal or gastric samples and bronchial samples in all but three cases of pneumonia, due to S. aureus. These findings provide better knowledge of the pathophysiology of nosocomial pneumonia in mechanically ventilated patients.
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Affiliation(s)
- M Garrouste-Orgeas
- Département de Réanimation, Hôpital Saint-Louis et Université Paris VII, France
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10
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Abstract
SHV-6 was previously identified by its susceptibility pattern and biochemical criteria in a clinical isolate of Klebsiella pneumoniae which was resistant to ceftazidime. It contains only a single point difference with the beta laSHV-1 gene as determined by PCR amplification and nucleotide sequencing. This is the result of a single amino acid substitution, Ala for Asp, at position 179. Directed mutagenesis experiments have shown this substitution to confer selective resistance to ceftazidime in the TEM family.
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Affiliation(s)
- G Arlet
- Université Paris VII Denis Diderot, Service de Microbiologie, Hôpital Saint-Louis, Paris, France
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11
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Garrouste-Orgeas M, Marie O, Rouveau M, Villiers S, Arlet G, Schlemmer B. Secondary carriage with multi-resistant Acinetobacter baumannii and Klebsiella pneumoniae in an adult ICU population: relationship with nosocomial infections and mortality. J Hosp Infect 1996; 34:279-89. [PMID: 8971617 DOI: 10.1016/s0195-6701(96)90108-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A one year prospective, observational survey was performed to evaluate the abnormal carriage of multi-resistant Klebsiella pneumoniae and/ or Acinetobacter baumannii, to determine associated risk factors for carriage, and to correlate the abnormal carriage with infectious morbidity and mortality in the intensive care unit (ICU) of a University Hospital. Two hundred and ninety-eight patients who stayed in the ICU > 48h, and were not neutropenic, were studied. Salivary and rectal samples were obtained on admission and weekly until discharge. Out of 265 evaluable patients, 88 (33%) developed oropharyngeal and/or rectal carriage within a median of nine days. Three factors were significantly associated with abnormal carriage: higher 'severity of illness' score on admission, a threefold increase in ICU stay, and the need for mechanical ventilation. K. pneumoniae or A. baumannii accounted for 57/158 (36%) of all ICU-acquired infections (in 46 patients). They were considered as secondary endogenous infections (SEI) in 42 patients who were previously colonized with the same strains, and developed infection within a median of three days (range 0-68 days). Prolonged stay in ICU was the only factor associated with SEI in the carrier population. Mortality was significantly greater in the carrier group (43 vs 25%, P = 0.0006). Post hoc stratification suggested that abnormal carriage only influenced mortality in patients showing a low severity of illness score on admission to ICU. Abnormal carriage was found in the most severely ill patients, predisposed to secondary nosocomial infections, and could influence mortality in the less severely ill.
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Bachelez H, Ducloy G, Pinquier L, Rouveau M, Sibilla J, Dubertret L. Disseminated varioliform pustular eruption due to Mycobacterium avium intracellulare in an HIV-infected patient. Br J Dermatol 1996; 134:801-3. [PMID: 8733397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Severe disseminated infection due to Mycobacterium avium intracellulare, with unusual cutaneous features, is reported in a patient with acquired immunodeficiency syndrome (AIDS). The eruption appeared as disseminated pustular lesions which showed necrotic features and which led to varioliform scarring. Bacterial culture from the skin, blood, and bone marrow, and ultimately from the bronchoalveolar fluid and sputum, was positive for M. avium intracellulare. The patient was successfully treated using a multiple agent anti-mycobacterial regimen including clarithromycin, which appeared to be the most effective drug. This resulted in resolution of the cutaneous and general symptoms. Our patient illustrates the wide spectrum of skin presentations that may be seen with mycobacterial infections in subjects infected with the human immunodeficiency virus (HIV). Clarithromycin is an important agent for the treatment of these severe infections.
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Affiliation(s)
- H Bachelez
- Clinique des Maladies Cutanées, Hôpital Saint-Louis, Paris, France
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14
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Arlet G, Rouveau M, Casin I, Bouvet PJ, Lagrange PH, Philippon A. Molecular epidemiology of Klebsiella pneumoniae strains that produce SHV-4 beta-lactamase and which were isolated in 14 French hospitals. J Clin Microbiol 1994; 32:2553-8. [PMID: 7814497 PMCID: PMC264101 DOI: 10.1128/jcm.32.10.2553-2558.1994] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Preliminary results suggested that the diffusion in France of the SHV-4 extended-spectrum beta-lactamase was probably due to the spread of one single epidemic strain of Klebsiella pneumoniae. In this study, we tested various phenotypic and genotypic markers to compare K. pneumoniae strains producing this enzyme isolated in 14 French hospitals between 1987 and 1989. All of the strains were of the same capsule serotype, K25. Twelve of them were of the same biotype: weak urease activity and no sucrose fermentation. Among the six plasmid profiles observed, one accounted for eight strains. Large plasmids of 170 kb encoding SHV-4 beta-lactamase were present in all strains of K. pneumoniae and could be transferred by conjugation with high frequency to Escherichia coli J53-2 or HB101 from all except one strain. Plasmid EcoRI restriction patterns suggested that these plasmids were closely related and similar to pUD18 encoding SHV-3 beta-lactamase, originally described in France and differing from SHV-4 by one amino acid substitution. Ribotyping with EcoRI and HindIII and genomic fingerprinting with XbaI by pulsed-field gel electrophoresis were concordant and suggested that 12 of the isolates recovered from the 14 hospitals were probably the same strain. Dissemination in France of the SHV-4 extended-spectrum beta-lactamase was thus essentially due to the diffusion of a single K. pneumoniae clone.
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Affiliation(s)
- G Arlet
- Service de Microbiologie, Hôpital Saint-Louis, Paris, France
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15
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Douard MC, Clementi E, Arlet G, Marie O, Jacob L, Schremmer B, Rouveau M, Garrouste MT, Eurin B. Negative catheter-tip culture and diagnosis of catheter-related bacteremia. Nutrition 1994; 10:397-404. [PMID: 7819651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The accuracy of paired quantitative blood cultures (PQtBCs) collected in pediatric Isolator 1.5-ml tubes compared to central venous catheter (CVC) segment cultures (hub and tip) to diagnose catheter-related bacteremia (CRB) was evaluated in 58 bacteremic adult patients. The second aim of this study was to state precisely whether the tip or the hub (or both) of the infected device was the source of the bacteremia in case of significant results of PQtBC. Fifty-eight bacteremic patients with suspected CRB entered the study. In 52 patients, the diagnosis was obtained before CVC removal by PQtBC and was confirmed by CVC segment cultures: CRB in 30 patients, non-catheter-related bacteremia in 22 patients. Six patients had CRB not found by PQtBC. 1) PQtBC is 83% sensitive, 100% specific (negative predictive values 78%, positive predictive values 100%). 2) Sixteen bacteremic patients had authentic hub-related bacteremia (positive hub culture associated with negative tip cultures). When CRB is suspected in bacteremic patients, a negative tip culture cannot exclude the diagnosis of CRB. In all cases, CVC tip culture must be associated either with PQtBC or with hub cultures.
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Affiliation(s)
- M C Douard
- Service d'Anesthesie Reanimation, Hopital Saint-Louis, Paris, France
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16
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David F, Delassence A, Bennaceur A, Rouveau M, Daniel MT. [Corynebacterium diphtheriae septicemia causing bone marrow disease]. Presse Med 1994; 23:492. [PMID: 8022731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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17
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Arlet G, Rouveau M, Fournier G, Lagrange PH, Philippon A. Novel, plasmid-encoded, TEM-derived extended-spectrum beta-lactamase in Klebsiella pneumoniae conferring higher resistance to aztreonam than to extended-spectrum cephalosporins. Antimicrob Agents Chemother 1993; 37:2020-3. [PMID: 8239625 PMCID: PMC188114 DOI: 10.1128/aac.37.9.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A clinical isolate of Klebsiella pneumoniae was more resistant to aztreonam than to cefotaxime and ceftazidime. It produced a clavulanate-susceptible beta-lactamase with an isoelectric point of 6.3 which readily hydrolyzed penicillins, cefotaxime, and ceftazidime, but which hydrolyzed aztreonam poorly. The enzyme was encoded by a gene on a 15-kb plasmid; the gene hybridized with an intragenic DNA probe of blaTEM.
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Affiliation(s)
- G Arlet
- Service de Microbiologie, Hôpital Saint-Louis, Paris, France
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18
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Arlet G, Rouveau M, Bengoufa D, Nicolas MH, Philippon A. Novel transferable extended-spectrum beta-lactamase (SHV-6) from Klebsiella pneumoniae conferring selective resistance to ceftazidime. FEMS Microbiol Lett 1991; 65:57-62. [PMID: 1874404 DOI: 10.1016/0378-1097(91)90471-l] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A clinical isolate of Klebsiella pneumoniae sensu lato isolated from throat and a blood culture taken from a neutropenic patient treated for 2 weeks with ceftazidime and vancomycin was resistant to ceftazidime (MIC: 32 micrograms/ml) and moderately susceptible to aztreonam (MIC: 4 micrograms/ml). The isolate contained a plasmid of 180 kb which, when transferred to Escherichia coli by conjugation, conferred resistance to ceftazidime and tetracycline. The transconjugant had decreased susceptibility to ceftazidime (128-fold) and aztreonam (8-fold). Clavulanic acid and sulbactam each inhibited the resistance and clavulanic acid showed a synergistic effect when associated with ceftazidime and aztreonam. An extended-spectrum beta-lactamase with an isoelectric point of 7.6 was detected in the clinical isolates from blood and its transconjugant. This beta-lactamase showed similar substrate and inhibition profiles to SHV-1. In particular it did not hydrolyse ceftazidime. Hybridization with an intragenic probe for SHV-3 indicates that this beta-lactamase is an SHV-type enzyme. We propose that this novel CAZ-type extended-spectrum beta-lactamase be named SHV-6.
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Affiliation(s)
- G Arlet
- Laboratoire de Microbiologie, Hôpital Saint-Louis, Paris, France
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Arlet G, Rouveau M, Bengoufa D, Nicolas M, Philippon A. Novel transferable extended-spectrum β-lactamase (SHV-6) from Klebsiella pneumoniaeconferring selective resistance to ceftazidime. FEMS Microbiol Lett 1991. [DOI: 10.1111/j.1574-6968.1991.tb04712.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Arlet G, Sanson-le Pors MJ, Rouveau M, Fournier G, Marie O, Schlemmer B, Philippon A. Outbreak of nosocomial infections due to Klebsiella pneumoniae producing SHV-4 beta-lactamase. Eur J Clin Microbiol Infect Dis 1990; 9:797-803. [PMID: 2086215 DOI: 10.1007/bf01967377] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
One hundred and fifty-four clinical isolates of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins, aztreonam and amikacin were responsible for an outbreak of nosocomial infections lasting eight months in a university hospital in Paris. This outbreak occurred in the intensive care unit (39 patients), haematology units (8 patients) and surgical and medical units (11 patients). Antibiotic resistant strains were isolated from the urinary tract (48%), wound and drainage fluids (21%), respiratory tract (14%), blood (12%) and stools (5%). High resistance to oxyimino-beta-lactams was mediated by a plasmid-encoded beta-lactamase with an isoelectric point of 7.8 (SHV-4). This CAZ-type enzyme conferred a higher level of resistance to ceftazidime and aztreonam (geometric mean MIC 135 mg/l) than to cefotaxime (geometric mean MIC 14 mg/l). All isolates were of the same biotype (weakly urease positive and no sucrose fermentation). Eight Klebsiella pneumoniae strains isolated in different units and at different times of the outbreak were of the same serotype, had common plasmid patterns and harboured a large self-transferable plasmid of about 180 kilobases encoding resistance to penicillins, oxyimino-beta-lactams, aminoglycosides, tetracycline and trimethoprim. These eight large plasmids had indistinguishable EcoRI restriction patterns. These results suggest that a single strain of Klebsiella pneumoniae was responsible for this outbreak.
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Affiliation(s)
- G Arlet
- Laboratoire de Microbiologie, Hôpital Saint-Louis, Paris, France
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