Faisabilité du traitement endovasculaire en phase aiguë des infarctus cérébraux (expérience strasbourgeoise à propos des 55 premiers patients)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Susceptibility of Escherichia coli to the amoxycillin-clavulanate combination: which recommendations should be used to provide relevant information to clinicians?

International audienceThis study compared MIC distributions of amoxycillin-clavulanate obtained with NCCLS and French (Comite de l'Antibiogramme de la Societe Francaise de Microbiologie; CA-SFM) methodologies for Escherichia coli isolates from urine that were non-susceptible to amoxycillin-clavulanate by the disk diffusion method. With the NCCLS and CA-SFM methods, 74% and 13%, respectively, of these isolates were susceptible to amoxycillin-clavulanate. Therefore, the apparent relatively poor efficacy of amoxycillin-clavulanate against E. coli in French hospitals probably reflects a methodological difference rather than a localised resistance problem. This implies that amoxycillin-clavulanate could be used as an alternative to fluoroquinolones for treatment of E. coli urinary tract infections. Susceptibility tests for amoxycillin-clavulanate should be standardised worldwide

[Two efflux systems expressed simultaneously in clinical Pseudomonas aeruginosa].

International audienceActive efflux systems MexAB-OprM and MexXY were found to be overexpressed simultaneously in 12 multiresistant clinical isolates of Pseudomonas aeruginosa. Nine of these strains (agrZ mutants) harbored mutations in gene mexZ, the product of which down-regulates expression of operon mexXY. Eight of the 12 strains exhibited mutations in genes known to control transcription of operon mexAB-oprM, such as mexR (four nalB mutants) or PA3721 (three nalC mutants). One strain was a nalB/nalC double mutant. For MexAB-OprM as well as for MexXY, no clear correlation could be established between (i) the types of mutations, (ii) the over-expression levels of genes mexA or mexX, and (iii) the resistance levels to effluxed antibiotics. Finally, three and four isolates overproduced MexXY (agrW mutants) or MexAB-OprM (nalD mutants), respectively, without any mutation in the known regulator genes. These data show that clinical isolates are able to broaden their drug resistance profiles by coexpressing two Mex efflux pumps and suggest the existence of additional regulators for MexAB-OprM and MexXY

Re: ‘Microbiological epidemiology depending on time to occurrence of prosthetic joint infection’ by Triffault-Fillit et al.

International audienc

Patient and bacterial determinants involved in symptomatic urinary tract infection caused by Escherichia coli with and without bacteraemia.

International audienceRisk-factors for bacteraemia were determined in a case-control study of patients with Escherichia coli urinary tract infection. Cases were defined as patients with E. coli urinary source bacteraemia, and controls were chosen from among patients with E. coli urinary tract infection without bacteraemia. Patient characteristics were collected prospectively and the bacterial traits were determined. The phylogenetic background and virulence factors of E. coli isolates did not differ between cases and controls. In multivariate analysis, being female and having a urinary catheter were significantly less prevalent among patients with urinary source bacteraemia than among patients with uncomplicated urinary tract infection

[Evaluation of antibiotic prescription in a French university hospital]

International audienceOBJECTIVE: The aim of this study was to evaluate antibiotic prescription in a French university hospital. DESIGN: Our hospital participated in an international European Surveillance of Antimicrobial Consumption (ESAC) project study, including a longitudinal survey of monthly antibiotic use between 1998 and 2005, and a point prevalence study in 2006. All patients in the hospital on the day of survey were included in the study. Antibiotic treatments were assessed according to local antibiotic guidelines. RESULTS: Between 1998 and 2005, antibiotic use increased from 551.9 to 628.5 defined daily doses per 1000 patient-days. This increase was linked to the increase of penicillin and fluoroquinolone consumption. In the point prevalence survey, 251 (27.0%) of the 930 included patients received one or several antibiotics for a total of 395 antibiotic prescriptions. Community-acquired infections were the first indication of treatment (41.8% of prescriptions), hospital-acquired infections accounted for 34.9% of prescriptions, surgical and medical antibiotic prophylaxis for 22.4%. The assessment of antibiotic prescriptions showed that 73.7% of them were in conformity with local recommendations. CONCLUSIONS: This type of study is relevant to identify critical points of inadequate antibiotic use so as to suggest corrective measures to prescribers

Are antibiotic-resistant Pseudomonas aeruginosa isolated from hospitalised patients recovered in the hospital effluents?

International audiencePrevious reports have studied the presence of antibiotic-resistant Pseudomonas aeruginosa strains in hospital wastewater without determination of their clonal relationship with the clinical strains of this species. The objectives of this study were to quantify the presence of P. aeruginosa in wastewater of our hospital, to determine their antibiotic-resistance profile and to potentially trace clinical antibiotic-resistant strains from patients to wastewater. Specimens were taken at the end of the wastewater network of our hospital just before the reject in the collective network of the town. Two specimens were taken each Monday during 12 weeks. All P. aeruginosa isolates recovered from hospitalised patients during the study period were collected. Genotyping of both clinical and wastewater isolates was determined by using pulsed-field gel electrophoresis (PFGE). The antibiotic-resistance profile of wastewater isolates was different from that of clinical isolates. The mechanisms involved in antibiotic resistance were different according to the origin of the isolates (wastewater versus human isolates). There was no common PFGE pattern in antibiotic-resistant P. aeruginosa from humans and wastewater. This study suggests that the risk of spread of antibiotic resistance in hospital wastewater is limited

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

[In Process Citation].

International audienc

Appropriateness of aminoglycoside prescriptions in a French university hospital.

International audienceAminoglycosides are a major class of antibiotics. Their use is particularly interesting in the treatment of severe infections but their toxicity is well known. They are mostly prescribed combined with other agents and as first-line treatments. We aimed to assess the appropriateness of aminoglycoside prescriptions in a French university hospital on the basis of the latest French recommendations published in 2011.We conducted a prospective study between January 17th and February 4th, 2014 to assess prescription modalities of aminoglycosides on the basis of the following criteria: indication, duration of treatment, dosing schedule, administration modalities, and drug level monitoring. Prescriptions were then compared to the 2011 national guidelines.A total of 68 consecutive prescriptions were analyzed and only 47.8% complied with guidelines. Most physicians complied with recommendations, particularly with the indication for severe infections (95.6%), the administration of a single daily dose (92.6%), and the slow intravenous infusion (30minutes) administration (84%). However, physicians tended to prescribe lower doses than recommended (40.3%), especially to patients presenting with renal insufficiency, and drug level monitoring was not optimal.Although new and accurate national recommendations were recently published, aminoglycoside prescription is still not optimal, in particular for dosing and plasma concentration monitoring