A prospective, observational study of fidaxomicin use for Clostridioides difficile infection in France.

To describe the characteristics, management and outcomes of hospitalised patients with Clostridioides difficile infection (CDI) treated with and without fidaxomicin. This prospective, multicentre, observational study (DAFNE) enrolled hospitalised patients with CDI, including 294 patients treated with fidaxomicin (outcomes recorded over a 3-month period) and 150 patients treated with other CDI therapies during three 1-month periods. The primary endpoint was baseline and CDI characteristics of fidaxomicin-treated patients. At baseline, the fidaxomicin-treated population included immunocompromised patients (39.1%) and patients with severe (59.2%) and recurrent (36.4%) CDI. Fidaxomicin was associated with a high rate of clinical cure (92.2%) and low CDI recurrence (16.3% within 3 months). Clinical cure rates were ≥90% in patients aged ≥65 years, those receiving concomitant antibiotics and those with prior or severe CDI. There were 121/296 (40.9%) patients with adverse events (AEs), 5.4% with fidaxomicin-related AEs and 1.0% with serious fidaxomicin-related AEs. No fidaxomicin-related deaths were reported. Fidaxomicin is an effective and well-tolerated CDI treatment in a real-world setting in France, which included patients at high risk of adverse outcomes.Trial registration: Description of the use of fidaxomicin in hospitalised patients with documented Clostridium difficile infection and the management of these patients (DAFNE), NCT02214771, www.ClinicalTrials.gov

Étude du polymorphisme de séquence nucléique des gènes impliqués dans la réponse stringente chez <i>Legionella pneumophila</i>

Mémoire de DES (Diplôme d’Études Spécialisées) tenant lieu de thèse d'exerciceLa légionellose est une infection pulmonaire émergente. Legionella pneumophila est le principal agent pathogène mais présente une hétérogénéité de virulence. Il serait donc intéressant de définir un marqueur de virulence. Nous étudions ici la variabilité des gènes relA, rpoS et spoT, impliqués dans la réponse stringente de Legionella pour évaluer le pouvoir discriminant de leur distribution allélique selon des critères de virulence. RpoS et spoT sont étudiés chez L. pneumophila Paris, Lens et Philadelphia. RelA est séquencé chez 14 souches supplémentaires. Ces gènes présentent une séquence conservée. RelA possède 8 allèles pour 17 souches testées. Leur distribution est corrélée aux pulsotypes mais ne permet pas de séparer les isolats cliniques des environnementaux. Au total, relA possède un pouvoir discriminant intéressant mais la mise en place d'un modèle permettant la caractérisation phénotypique des souches semble nécessaire à la validation d'un marqueur génique de virulence

Étude du polymorphisme de séquence nucléique des gènes impliqués dans la réponse stringente chez legionella pneumophila 11

La légionellose est une infection pulmonaire émergente. Legionella pneumophila 1 est le principal agent pathogène mais présente une hétérogénéité de virulence. Il serait donc intéressant de définir un marqueur de virulence. Nous étudions ici la variabilité des gènes relA, rpoS et spoT, impliqués dans la réponse stringente de Legionella pour évaluer le pouvoir discriminant de leur distribution allélique selon des critères de virulence. RpoS et spoT sont étudiés chez L. pneumophila Paris, Lens et Philadelphia. RelA est séquencé chez 14 souches supplémentaires. Ces gènes présentent une séquence conservée. RelA possède 8 allèles pour 17 souches testées. Leur distribution est corrélée aux pulsotypes mais ne permet pas de séparer les isolats cliniques des environnementaux. Au total, relA possède un pouvoir discriminant intéressant mais la mise en place d'un modèle permettant la caractérisation phénotypique des souches semble nécessaire à la validation d'un marqueur génique de virulence.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Assessment of Residual Moisture and Maintenance of Sterility in Surgical Instrument Sets after Sterilization.

International audienceGood sterilization practices include discarding items containing residual moisture after steam sterilization. In this small laboratory study, however, the presence of residual water did not appear to compromise the sterility of surgical instruments in 2 commonly used types of packaging during routine storage after steam sterilization

Rouxiella chamberiensis gen. nov., sp. nov., a new Enterobacteriaceae isolated from parenteral nutrition bags.

International audienceParenteral nutrition bags for newborns were found contaminated by a previously undescribed 23 Enterobacteriaceae. The six isolates studied by rrs - (encoding 16S rRNA) and multilocus 24 sequence analysis (MLSA) formed a discrete branch close to genera Ewingella, Rahnella, 25 Yersinia, Hafnia and Serratia. Phenotypically, the new taxon was distinct from these four 26 genera. The new taxon gave positive Voges-Proskauer, Simmons citrate, o-nitrophenyl-β-27 galactoside hydrolysis tests; fermented D-glucose, D-mannitol, L-rhamnose, D-melibiose, L-28 arabinose, D-xylose, and hydrolyzed esculin; did not ferment maltose, trehalose, raffinose, D-29 sorbitol, sucrose and D-cellobiose. The following tests, motility, gas production, urease, 30 gelatinase, and nitrate reduction were also negative. All isolates failed to grow at 37°C. 31 Therefore, the new taxon is proposed as a new species and genus and named Rouxiella 32 chamberiensis gen. nov., sp. nov. The type strain is 130333T (= CIP 110714T = DSM 28324T). 33 The G+C content of the type strain DNA was 53 mol%

<i>Bacillus cereus</i>, a serious cause of nosocomial infections: Epidemiologic and genetic survey

<div><p><i>Bacillus cereus</i> is the 2^nd most frequent bacterial agent responsible for food-borne outbreaks in France and the 3^rd in Europe. In addition, local and systemic infections have been reported, mainly describing individual cases or single hospital setting. The real incidence of such infection is unknown and information on genetic and phenotypic characteristics of the incriminated strains is generally scarce. We performed an extensive study of <i>B</i>. <i>cereus</i> strains isolated from patients and hospital environments from nine hospitals during a 5-year study, giving an overview of the consequences, sources and pathogenic patterns of <i>B</i>. <i>cereus</i> clinical infections. We demonstrated the occurrence of several hospital-cross-contaminations. Identical <i>B</i>. <i>cereus</i> strains were recovered from different patients and hospital environments for up to 2 years. We also clearly revealed the occurrence of inter hospital contaminations by the same strain. These cases represent the first documented events of nosocomial epidemy by <i>B</i>. <i>cereus</i> responsible for intra and inter hospitals contaminations. Indeed, contamination of different patients with the same strain of <i>B</i>. <i>cereus</i> was so far never shown. In addition, we propose a scheme for the characterization of <i>B</i>. <i>cereus</i> based on biochemical properties and genetic identification and highlight that main genetic signatures may carry a high pathogenic potential. Moreover, the characterization of antibiotic resistance shows an acquired resistance phenotype for rifampicin. This may provide indication to adjust the antibiotic treatment and care of patients.</p></div

Correlation clusters of the quantitative variables characterizing each <i>B</i>. <i>cereus</i> strain isolated from patients.

<p>The percentages of variation explained by the principal components (PC1 and PC2) are indicated in brackets. The factors involved in PC1 (Dim1: age of patients and NHE indice) and PC2 (Dim2: HBL indice) are indicated in the variable factor map at the top right of the figure. The strains located inside a colored circle belong to the same cluster, as determined by the hierarchical cluster analysis performed after PCA. Each dot corresponds to a strain. The squares represent the representative value for the cluster.</p

Characteristics of patients or hospital environment displaying <i>B</i>. <i>cereus</i> positive samples.

<p>Characteristics of patients or hospital environment displaying <i>B</i>. <i>cereus</i> positive samples.</p

M13-PCR fingerprint patterns of <i>B</i>. <i>cereus</i> strains showing eight possible cross contaminations between patients/patients or patients/environment.

<p>Top panel, lane 1: 1kb DNA ladder. Lane 2: reference strain <i>B</i>. <i>cereus</i> ATCC14579. Lane 2 to 23: <i>B</i>. <i>cereus</i> strains. Bottom: divergence tree between eight samples obtained by hierarchical clustering based on the matrix of pairwise divergences after WGS data.</p