Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

<p>Abstract</p> <p>Background</p> <p>There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).</p> <p>Methods</p> <p>The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) – of two French university hospitals.</p> <p>Results</p> <p>The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.</p> <p>Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly <it>E. coli </it>(58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% <it>vs. </it>8%, p < 0.001) and had a higher rate of bacteriological failure (48% <it>vs. </it>19%, p < 0.001).</p> <p>Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001).</p> <p>Conclusion</p> <p>This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.</p

Résistance de bas niveau aux fluoroquinolones par surexpression de l'efflux chez Pseudomonas aeruginosa : conséquences thérapeutiques et détection au laboratoire

International audienceThe aim of this study was (i) to assess the impact of stable overproduction of efflux systems MexAB-OprM and MexXY-OprM on the bacteriostatic activities of fluoroquinolones in clinical Pseudomonas aeruginosa strains and (ii) to find a convenient test for screening isolates with a low level resistance to fluoroquinolones. The minimal inhibitory concentrations (MICs) of ciprofloxacin and levofloxacin were determined for clinical isolates of P. aeruginosa overexpressing MexAB-OprM or MexXY-OprM. Efflux pumps derepression was associated with a modest two- to fourfold increase in resistance to the tested fluoroquinolones. Clinical significance of low level resistance conferred by the efflux mechanism was evaluated with a Monte Carlo simulation with various fluoroquinolone regimens. With this model, low levels of resistance to ciprofloxacin (MIC > or =0.25 mg/L) or levofloxacin (MIC > or =1 mg/L) such as those due to overproduced MexAB-OprM or MexXY-OprM were predicted to result in poor clinical outcomes. Altogether these data strongly suggest that when derepressed MexAB-OprM or MexXY-OprM provides P. aeruginosa with a resistance that may be sufficient to impair the efficacy of single therapy with highly potent fluoroquinolones such as ciprofloxacin and levofloxacin. Routine detection of clinical strains that displayed low-level resistance to fluoroquinolones with a Mueller Hinton agar containing 0.20 mg/L of ciprofloxacin will help clinician in his therapeutical choice

黃牛與荷蘭乳牛換毛期的研究

　　生物受到外在環境極大的影響，特別是身體表面，直接左右於外在環境的部分很多，與生理變化相同、形態上的變化也很顯著。覆蓋的毛髮掌管體溫調節與保護身體的功能，各種動物會依照品種，或者是個體，各自呈現著最適合各自生存環境的狀態。因此，熱帶地區的家畜與溫帶地區的家畜有所不同是極為理所當然的自然現象。與冷熱調節關係密切、依據季節轉變的覆蓋皮毛的換毛狀態亦是如此，不難想見溫帶地區的家畜、與熱帶地區的家畜身上顯現的差異性。本論文即為溫帶產乳牛Holstein與熱帶產牛的黃牛的換毛狀態比較調查。 　　研究內容如下所述。(1)換毛通常進行於春秋二季。不過，會因為品種的不同而有時期上的差異。Holstein在春天的5月開始換毛，秋天的話在10月以後才會開始。換毛最為明顯的時期是6月。黃牛的狀況是在春天的4月，秋天的9月開始換毛。4月中旬過後、以及9月底至10月初是換毛最為明顯的時期。這個換毛狀態也會因為不同個體而有些許的差異性。(2)除了春秋二季的定期換毛以外，每個月多少都會有一些換毛。將新生毛的比例加以平均的話，則可知Holstein在6月有34％，7月有12％，8月有31％的程度。黃牛則是在6月有12％，7月有16％，8月有26％這樣的程度。(3)只要換成夏毛的話，則其中不會混有冬毛。(4)覆蓋毛髮因應氣溫變化而有長度與粗細的不同，冬天細長，夏天粗短。(5) Holstein與黃牛互相比較，則換毛的顯著時期較遲。這是因為在因應氣候的方面，Holstein的反應程度比黃牛來得低。(6)一般而言，夏毛的生存期比冬毛短，夏毛在經過約略5個月之後轉為冬毛，而冬毛則是經過約略7個月後轉為夏毛。(7)髓質在夏天的時候不太發達。封面、書名頁、印記、目次頁 I　緒言 II　研究材料並ニ研究方法 　A）供試動物 　B）供試動物ノ飼養管理 　　i）黄牛ノ状態 　　ii）ホルスタインノ状態 　C）試驗期間及ビ採毛期日 　D）採毛方法 　E）調査方法 III　實驗結果 IV　實驗結果ノ觀察 　A）ホルスタイン 　B）黄牛 　C）ホルスタイント黄牛ノ比較 V　結論 VI　摘要 参【參】考文献 圖表 　（一） 　（二） 圖版、印記、封

Antiretroviral-naive and -treated HIV-1 patients can harbour more resistant viruses in CSF than in plasma

International audienceObjectives: The neurological disorders in HIV-1-infected patients remain prevalent. The HIV-1 resistance in plasma and CSF was compared in patients with neurological disorders in a multicentre study. Methods: Blood and CSF samples were collected at time of neurological disorders for 244 patients. The viral loads were .50 copies/mL in both compartments and bulk genotypic tests were realized. Results: On 244 patients, 89 and 155 were antiretroviral (ARV) naive and ARV treated, respectively. In ARV-naive patients, detection of mutations in CSF and not in plasma were reported for the reverse transcriptase (RT) gene in 2/89 patients (2.2%) and for the protease gene in 1/89 patients (1.1%). In ARV-treated patients, 19/152 (12.5%) patients had HIV-1 mutations only in the CSF for the RT gene and 30/151 (19.8%) for the protease gene. Two mutations appeared statistically more prevalent in the CSF than in plasma: M41L (P ¼ 0.0455) and T215Y (P ¼0.0455). Conclusions: In most cases, resistance mutations were present and similar in both studied compartments. However, in 3.4% of ARV-naive and 8.8% of ARV-treated patients, the virus was more resistant in CSF than in plasma. These results support the need for genotypic resistance testing when lumbar puncture is performed

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence