Bacteremic community-acquired infections due to Klebsiella pneumoniae: clinical and microbiological presentation in New Caledonia, 2008–2013

SummaryObjectivesTo provide data on severe bacteremic community-acquired infections due to Klebsiella pneumoniae in New Caledonia.MethodsAll patients admitted with bacteremic community-acquired infections due to K. pneumoniae at the only tertiary medical center in New Caledonia, from 2008 to 2013, were included retrospectively in this study. Clinical and microbiological characteristics were analyzed, as well as risk factors for mortality.ResultsThe characteristics of 119 patients were analyzed. The most common clinical presentation was urinary tract infection (40 cases, 33%), followed by pneumonia (28 cases, 23%), deep abscesses (15 cases, 13%), liver abscess (12 cases, 9%), meningitis in (five cases, 4%), and endophthalmitis (two cases, 1%). Multiple localizations were reported in 18 cases (15%) and isolated bacteremia was reported in 22 cases (18%). The overall mortality rate was 22% (26/119) and the mortality rate in the intensive care unit was 33% (14/42). Renal impairment, chronic liver disease, pneumonia, and isolated bacteremia were independent risk factors for mortality.ConclusionsK. pneumoniae is a dominant cause of severe community-acquired bacteremic infection in New Caledonia. Physicians should be aware of the poor prognosis of any patient with a bacteremic K. pneumoniae infection and should monitor patients presenting with risk factors closely

Développement et évaluation d'une technique sérologique western-blot pour le diagnostic des candidoses invasives

LYON1-BU Santé (693882101) / SudocSudocFranceF

Necrotizing soft-tissue infections in New Caledonia: Epidemiology, clinical presentation, microbiology, and prognostic factors

Background/Objectives: Necrotizing soft-tissue infections (NSTIs) are severe and rapidly progressive infectious conditions. We herein describe the clinical characteristics, microbiology, and prognosis factors of NSTIs in New Caledonia. Methods: All patients admitted for confirmed NSTIs at the only surgical facility in New Caledonia from January 2008 to July 2013 were retrospectively included. Factors associated with mortality were analyzed by multivariate risk regression. Results: Over the period under review, 67 patients were studied (annual incidence rate, 6.1/year/100,000 inhabitants). The overall mortality rate was 24%. Melanesian people (n = 47; 70%) were more affected than other ethnic groups (n = 20; 30%; p = 0.001). The mean age was 54 years, and men were predominantly affected (n = 46; 69%). The most common comorbidity reported was diabetes mellitus (n = 24; 36%). Nonsteroidal anti-inflammatory intake prior to admission was reported in 14 cases (21%). Lower limbs were the most commonly affected anatomical sites (n = 36; 54%). At least one pathogen was identified in 31 cases (46%), whereas polymicrobial flora was found in 26 cases (39%). No bacteria were isolated in 10 cases (15%). Streptococcus pyogenes was the most frequently isolated bacterium (n = 21; 32%). Factors associated with mortality were use of norepinephrine [odds ratio (OR) 25.6; 95% confidence interval (CI) 4.8–135.8] and presence of two comorbidities (OR 8.6; 95% CI 1.7–42.3). Conclusion: NSTIs are particularly frequent in New Caledonia. Local health care workers should have a high index of suspicion for the disease to initiate surgical and medical treatments early

Peritoneal fluid culture and antibiotic treatment in patients with perforated appendicitis in a Pacific Island

Little data on the usefulness of microbiological samples in appendicular peritonitis (AP) are available. The objectives of the study were to document the clinical value of systematic peritoneal swabbing in complicated appendicitis, to establish whether they influence postoperative outcome, and to help to optimize empirical preoperative treatment. Charts of all consecutive patients undergoing appendicectomy for acute perforated appendicitis were analyzed over a 7-year period from 2005 to 2011 in a tertiary hospital in New Caledonia. From prospectively recorded data, microbiological culture results, and sensitivity of isolates were obtained in relation to histopathological findings and infective morbidity. Overall, 144 cases including 47 (33%) children and 97 (67%) adults with perforated appendicitis were included in the study. Fifty-one (35%) had generalized peritonitis treated laparoscopically in 30 (59%) cases. Peritoneal fluid samples yielded a positive culture in 104 (74%) patients. The most commonly recovered species were Escherichia coli (81%), Streptococcus milleri group (12%), and Pseudomonas aeruginosa (12%). Postoperative infectious complications occurred in 32 (22%) including intra-abdominal abscess (n = 20) and wound infection (n = 12). Probabilist antibiotic regimen was less often suitable in children than in adults (p = 0.003). Infectious complications occurred more often in cases with an unsuitable antibiotic regimen after culture results compared with a suitable antibiotic regimen before culture results (p = 0.01). Although antibiotic use may be considered as an adjunct to surgical intervention of AP, the appropriate use of preoperative antibiotics and modifications according to culture results are essential to prevent infectious complications

Peritoneal fluid culture and antibiotic treatment in patients with perforated appendicitis in a Pacific Island

Background: Little data on the usefulness of microbiological samples in appendicular peritonitis (AP) are available. The objectives of the study were to document the clinical value of systematic peritoneal swabbing in complicated appendicitis, to establish whether they influence postoperative outcome, and to help to optimize empirical preoperative treatment. Methods: Charts of all consecutive patients undergoing appendicectomy for acute perforated appendicitis were analyzed over a 7-year period from 2005 to 2011 in a tertiary hospital in New Caledonia. From prospectively recorded data, microbiological culture results, and sensitivity of isolates were obtained in relation to histopathological findings and infective morbidity. Results: Overall, 144 cases including 47 (33%) children and 97 (67%) adults with perforated appendicitis were included in the study. Fifty-one (35%) had generalized peritonitis treated laparoscopically in 30 (59%) cases. Peritoneal fluid samples yielded a positive culture in 104 (74%) patients. The most commonly recovered species were Escherichia coli (81%), Streptococcus milleri group (12%), and Pseudomonas aeruginosa (12%). Postoperative infectious complications occurred in 32 (22%) including intra-abdominal abscess (n = 20) and wound infection (n = 12). Probabilist antibiotic regimen was less often suitable in children than in adults (p = 0.003). Infectious complications occurred more often in cases with an unsuitable antibiotic regimen after culture results compared with a suitable antibiotic regimen before culture results (p = 0.01). Conclusion: Although antibiotic use may be considered as an adjunct to surgical intervention of AP, the appropriate use of preoperative antibiotics and modifications according to culture results are essential to prevent infectious complications

Isolation of Leptospira from blood culture bottles

International audienceWith the increasing use of real time PCR techniques, Leptospira isolation has mostly been abandoned for the diagnosis of human leptospirosis. However, there is a great value of collecting Leptospira isolates to better understand the epidemiology of this complex zoonosis and to provide the researchers with different isolates. In this study, we have successfully isolated different Leptospira strains from BacT/Alert aerobic blood culture bottles and suggest that this privileged biological material offers an opportunity to isolate leptospires

MCR-1 in ESBL-producing Escherichia coli responsible for human infections in New Caledonia

MCR-1 in ESBL-producing Escherichia coli responsible for human infections in New Caledoni

La surveillance microbiologique des endoscopes comme élément d’assurance qualité au Centre hospitalier territorial de Nouvelle-Calédonie entre 2012 et 2020

International audienceBackground. Flexible endoscopes are complex, non-autoclavable devices that must undergo high-level disinfection. The presence of dirt and biofilms can cause infection and promote the spread of resistance to antibiotics. Microbiological monitoring of endoscopes is recommended in France but remains controversial internationally. The objective of this study is to assess the contribution of this surveillance as an element of quality assurance in New Caledonia. Method. We reviewed all the microbiological tests carried out on flexible endoscopes between January 1, 2012 and December 31, 2020 at the Centre Hospitalier Territorial (CHT) in New Caledonia. We assessed the contamination rate and identified the main microorganisms isolated. Results. 605 microbiological endoscope controls were analyzed. A total of 87 samples (14.4%) did not reach the target level. The non-compliance rate varied from 25.0 % to 4.5 % depending on the year. Choledoscopes and echoendoscopes were the most contaminated devices (p = 0.0035). The main microorganisms identified were gram positive bacteria such as coagulase negative staphylococci (n = 122) and Micrococcus sp (n = 97), and gram negative bacteria including Moraxella sp (n = 31) and Pseudomonas (n = 17). Conclusion. This study evaluated the effectiveness of the disinfection of flexible endoscopes used at the CHT. The overall contamination rate (14.4%) is in line with the figures published in various studies. This monitoring makes it possible to identify deviations in the disinfection process and to take corrective measures that guarantee patient safety.Les endoscopes souples sont des appareils complexes non autoclavables qui doivent subir une désinfection de haut niveau. La présence de souillures et de biofilms peut être à l’origine d’infection et favoriser la diffusion de résistances aux antibiotiques. La surveillance microbiologique des endoscopes est recommandée en France mais reste controversée au niveau international. L’objectif de cette étude est d’évaluer l’apport de cette surveillance comme élément d’assurance qualité en Nouvelle Calédonie. Méthode. Nous avons revu l’ensemble des contrôles microbiologiques effectué sur les endoscopes souples entre le 1er janvier 2012 et le 31 décembre 2020 au Centre hospitalier territorial (CHT) de Nouvelle-Calédonie. Nous avons évalué le taux de contamination et identifié les principaux microorganismes isolés. Résultats. Six-cent-cinq contrôles microbiologiques d’endoscopes ont été analysés. Au total, 87 prélèvements (14,4 %) n’atteignaient pas le niveau cible. Le taux de non-conformité variait de 25,0 % à 4,5 % en fonction des années. Les cholédoscopes et les échoendoscopes étaient les appareils (p = 0,0035) les plus contaminés. Les principaux microorganismes identifiés étaient des bactéries gram positives comme les staphylocoques à coagulase négative (n = 122) et Micrococcus sp (n = 97), et des bactéries gram négatives dont Moraxella sp (n = 31) et des Pseudomonas (n = 17). Conclusion. Cette étude a permis d’évaluer l’efficacité de la désinfection des endoscopes souples utilisés au CHT. Le taux global de contamination (14,4 %) est conforme aux chiffres publiés dans différentes études. Cette surveillance permet d’identifier des écarts dans le processus de désinfection et d’apporter les mesures correctives qui garantissent la sécurité des patients

L'identification de l'ennemi

Figure plurielle soumise à des lectures multiples, l’ennemi constitue d’abord un individu ou un groupe qu’il faut identifier pour pouvoir s’en protéger et – éventuellement – le combattre. On observe, entre Révolution française et temps présent, en France, en Europe et dans le monde colonial, une palette de situations variées, mais que réunit une même logique : donner corps et nom, une identité en définitive, à un ennemi nécessaire pour créer ou renforcer le lien dans une société et, si besoin est, justifier une répression plus ou moins violente et radicale d’une catégorie instituée en menace intolérable. Cet « Autre » peut prendre des formes variables – contre-révolutionnaire, syndicaliste rival, opposition démocratique, Congrégation, colonisé, socialiste – en fonction des situations. Mais, par delà les différences de contexte, les enjeux politiques liés à son identification offrent des similitudes dont rendent compte les contributions réunies dans ce numéro de Siècles

Ertapenem Supplemented Selective Media as a New Strategy to Distinguish β-Lactam-Resistant Enterobacterales: Application to Clinical and Wastewater Samples

The increase in carbapenem-resistant Enterobacterales (CRE) is mostly driven by the spread of carbapenemase-producing (CP) strains. In New Caledonia, the majority of carbapenemases found are IMP-type carbapenemases that are difficult to detect on routine selective media. In this study, a culture-based method with ertapenem selection is proposed to distinguish non-CRE, non-CP-CRE, and CP-CRE from samples with very high bacterial loads. Firstly, assays were carried out with phenotypically well-characterized β-lactam-resistant Enterobacterales isolates. Then, this approach was applied to clinical and environmental samples. Presumptive CP-CRE isolates were finally identified, and the presence of a carbapenemase was assessed. In a collection of 27 phenotypically well-characterized β-lactam-resistant Enterobacterales, an ertapenem concentration of 0.5 µg·mL−1 allowed distinguishing CRE from non-CRE. A concentration of 4 µg·mL−1 allowed distinguishing CP-CRE from non-CP-CRE after nine hours of incubation. These methods allowed isolating 18 CP-CRE from hospital effluents, including the first detection of a KPC in New Caledonia. All these elements show that this cost-effective strategy to distinguish β-lactam-resistant Enterobacterales provides fast and reliable results. This could be applied in the Pacific islands or other resource-limited settings, where limited data are available