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PubMed | La Source Hospital, University of Limoges, CNR Institute of Neuroscience, Laboratoire Of Bacteriologie Virologie Hygiene and 15 more.
Type: | Journal: Antimicrobial agents and chemotherapy | Year: 2016

The objective of this study was to perform an inventory of the ESBL-producing Enterobacteriaceae isolates responsible for infections in French hospitals, and to assess the mechanisms associated with ESBL diffusion.200 non-redundant ESBL-producing Enterobacteriaceae strains isolated from clinical samples were collected during a multi-centric study performed in 18 representative French hospitals. Antibiotic resistance genes were identified by PCR and sequencing experiments. The clonal relatedness between isolates was investigated by the Diversilab system. ESBL-encoding plasmids were compared by PCR-based-replicon-typing and plasmid-multi-locus-sequence-typing.CTX-M-15, CTX-M-1, CTX-M-14 and SHV-12 were the most prevalent ESBLs (8 to 46.5%). The three CTX-M-type EBSLs were significantly observed in Escherichia coli (37.1%, 24.2% and 21.8% respectively), and CTX-M-15 was the predominant ESBL in Klebsiella pneumoniae (81.1%). SHV-12 was associated with ESBL-encoding Enterobacter cloacae strains (37.9%). qnrB, aac(6)-Ib-cr and aac (3)-II genes were the main plasmid-mediated resistance genes, with prevalence varying between 19.5 and 45% according to the ESBLs. Molecular typing did not identify wide clonal diffusion. Plasmid analysis suggested the diffusion of few numbers of ESBL-encoding plasmids, especially in K. pneumoniae and E. cloacae However, the ESBL-encoding genes were observed in different plasmid replicons according to the bacterial species.The prevalence of ESBL subtypes is different according to the Enterobacteriaceae species. Plasmid spread is a key determinant of this epidemiology and the link observed between the ESBL-encoding plasmids and the bacterial host explain the differences observed in the Enterobacteriaceae species.


Bourlet T.,Jean Monnet University | Bourlet T.,Laboratoire Of Bacteriologie Virologie Hygiene | Memmi M.,Jean Monnet University | Saoudin H.,Laboratoire Of Bacteriologie Virologie Hygiene | And 2 more authors.
Expert Review of Molecular Diagnostics | Year: 2013

Nuclear acid testing is more and more used for the diagnosis of infectious diseases. This paper focuses on the use of molecular tools for HIV screening. The term 'screening' will be used under the meaning of first-line HIV molecular techniques performed on a routine basis, which excludes HIV molecular tests designed to confirm or infirm a newly discovered HIV-seropositive patient or other molecular tests performed for the follow-up of HIV-infected patients. The following items are developed successively: i) presentation of the variety of molecular tools used for molecular HIV screening, ii) use of HIV molecular tools for the screening of blood products, iii) use of HIV molecular tools for the screening of organs and tissue from human origin, iv) use of HIV molecular tools in medically assisted procreation and v) use of HIV molecular tools in neonates from HIV-infected mothers. © 2013 Informa UK Ltd.


Rudler M.,University Pierre and Marie Curie | Rousseau G.,University Pierre and Marie Curie | Benosman H.,University Pierre and Marie Curie | Massard J.,University Pierre and Marie Curie | And 4 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2012

Background Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients. Aim To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis. Methods We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients. Results A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87). Conclusions Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol. © 2012 Blackwell Publishing Ltd.


PubMed | University of Reims Champagne Ardenne, Reims University Hospital Center, Chirurgie maxillo faciale and Laboratoire Of Bacteriologie Virologie Hygiene
Type: Journal Article | Journal: Annales de chirurgie plastique et esthetique | Year: 2016

Children represent a population at risk, because of their short size, their naivety and their attraction to animals. The face and hands are the most specific locations in young children. Wounds are often multiple. In more than half the cases, the child knows the animal, which are dogs and cats by frequency argument. The bite episode occurs mostly when the child is alone with the pet without direct supervision, while playing or stroking the animal. As in all bites, pediatric lesions are infectious, functional and aesthetic emergencies, but the goal of this work was primarily to make a point on principles of surgical management of animal bites in children, highlighting pediatric specificities. Animal bites require psychological, anesthetic and surgical treatment, adapted to the child, in a specialized structure. Hospitalization and general anesthesia are more frequent in children. Any suspicion of mistreatment (and/or abuse) should lead to the childs hospitalization, even if wounds do not justify monitoring in a surgical environment. Emergency surgery is essential to limit functional and aesthetic consequences. The healing capacities of the child and the frequent lack of co-morbidity allow a conservative surgical treatment with suture, repositioning skin flaps and controlled healing in the first place. Immobilization, drainage, and antibiotics will complete the surgery. The healing process, however, leads to a specific management during scar remodeling phase and growth. Psychological care of the child and parents should not be forgotten, and has to start at the same time as surgical treatment at in acute phase.


PubMed | Hopital Robert Ballanger, CNR Institute of Neuroscience, Center Hospitalier Of Versailles, CEA DAM Ile-de-France and Laboratoire Of Bacteriologie Virologie Hygiene
Type: Case Reports | Journal: Transfusion | Year: 2016

Transfusion-transmitted bacterial infection (TTBI) is still one of the most feared complications of blood transfusion.We report a fatal case involving an 8-year-old child with congenital dyskeratosis complicated by severe aplastic anemia who was regularly transfused with platelet (PLT) concentrates for 5 years. The patient received an apheresis PLT concentrate (APC) on Day 0 due to thrombocytopenia complicated by mucocutaneous hemorrhage. Thirty minutes after the start of the transfusion, bradycardia and dyspnea appeared, quickly followed by chills, nausea, vomiting, headache, and hyperthermia. TTBI was suspected and the patient was immediately treated with intravascular antibiotherapy. On Day 3, the patient developed severe acute respiratory distress syndrome leading to death on Day 7. Patient blood cultures and APC cultures were both positive for Citrobacter koseri.The donor was a 19-year-old woman. She had previously given blood. No infectious symptom was reported during the medical interviews before and after the donation and no postdonation information was received. On the day of the donation (Day -2), her white blood cell count was 5.83 10The isolates from the donors blood cultures, the APC bag, the attached tube, and the donors nasal sample all gave identical profiles; they were thus identified as the same strain and the TTBI was confirmed.


Batalla A.-S.,Service de medecine interne et des maladies infectieuses | Benito D.,Service de medecine interne et des maladies infectieuses | Baumard S.,Service de medecine interne et des maladies infectieuses | Brodard V.,Laboratoire Of Bacteriologie Virologie Hygiene | And 3 more authors.
Medecine et Maladies Infectieuses | Year: 2011

Objective: The objective of this study was to compare epidemiological, clinical, and biological data of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) primary infections in immunocompetent adults, admitted in the infectious disease department of the Reims Teaching Hospital between 2000 and 2005. Patients and methods: Inclusion criteria were the presence of anti-VCA IgM antibodies or the presence of CMV specific IgM antibodies and the absence of any other positive serology. Differences in reported percentage were compared with a Khi 2 test or Fischer's exact test, when appropriate. Continuous variables were compared with the Mann-Whitney Test. Results: There were no significant changes over the years in the numbers of EBV (n = 32) and CMV (n = 20) primary infections. The patient's mean age was 22.7. years (14-48. years) in EBV primary infections and 38.6. years (13-66. years) in CMV primary infections (P< 0.01). The clinical variables significantly associated with primary EBV infection were sore throat and cervical lymphadenopathy (P< 0.01). Arthromyalgia and respiratory manifestations were less frequent in EBV primary infection (P< 0.01). The biological variables significantly associated with EBV primary infection were a marked alanine aminotransferase elevation and a marked lymphocytosis with atypical lymphocytes (P< 0.001). Thrombopenia was less frequently associated with EBV primary infection (P< 0.001). Conclusion: Clinical and biological presentations of EBV and CMV primary infections were similar. The simultaneous serologic diagnosis of these two infections remains necessary to provide a specific diagnosis, for the most efficient patient care. © 2010 Elsevier Masson SAS.


Guillard T.,Reims University Hospital Center | Guillard T.,University of Reims Champagne Ardenne | Guillard T.,University Paris Diderot | Moret H.,Reims University Hospital Center | And 8 more authors.
Diagnostic Microbiology and Infectious Disease | Year: 2011

Plasmid-mediated quinolone resistance genes in clinical strains cannot be detected by phenotypic traits but require gene detection. We developed a multiplex real-time polymerase chain reaction (PCR) assay using high-resolution melting master mix with ResoLight dye to detect qnr genes and a simplex real-time PCR assay using SYBR Green I to detect qepA genes. Using qnr-positive and qepA1-positive control strains, the ResoLight method was able to rapidly identify qnrA, qnrB, qnrS, qnrC, and qnrD genes; the SYBR Green I method identified qepA genes. Among 118 extended spectrum beta-lactamase-producing Enterobacteriaceae isolates, the 2 new assays efficiently detected and identified qnr in 9 strains, but no qepA gene. To our knowledge, this is the first study describing the detection of all 5 qnr and qepA genes using real-time PCR. The 2 tests constitute a significant step forward for screening for plasmid quinolone resistance genes in clinical strains. © 2011 Elsevier Inc.


Cattoir V.,Laboratoire Of Bacteriologie Virologie Hygiene | Cattoir V.,Caen University Hospital Center | Gilibert A.,Laboratoire Of Bacteriologie Virologie Hygiene | Le Glaunec J.-M.,Laboratoire Of Bacteriologie Virologie Hygiene | And 3 more authors.
Annals of Clinical Microbiology and Antimicrobials | Year: 2010

Background: Pseudomonas aeruginosa is responsible for numerous bloodstream infections associated with severe adverse outcomes in case of inappropriate initial antimicrobial therapy. The present study was aimed to develop a novel quantitative PCR (qPCR) assay, using ecfX as the specific target gene, for the rapid and accurate identification of P. aeruginosa from positive blood cultures (BCs).Methods: Over the period August 2008 to June 2009, 100 BC bottles positive for gram-negative bacilli were tested in order to evaluate performances of the qPCR technique with conventional methods as gold standard (i.e. culture and phenotypic identification).Results: Thirty-three strains of P. aeruginosa, 53 strains of Enterobactericaeae, nine strains of Stenotrophomonas maltophilia and two other gram-negative species were isolated while 3 BCs were polymicrobial including one mixture containing P. aeruginosa. All P. aeruginosa clinical isolates were detected by qPCR except a single strain in mixed culture. Performances of the qPCR technique were: specificity, 100%; positive predictive value, 100%; negative predictive value, 98.5%; and sensitivity, 97%.Conclusions: This reliable technique may offer a rapid (<1.5 h) tool that would help clinicians to initiate an appropriate treatment earlier. Further investigations are needed to assess the clinical benefit of this novel strategy as compared to phenotypic methods. © 2010 Cattoir et al; licensee BioMed Central Ltd.


Atroun T.,Unite Neurovasculaire | Varvat J.,Unite Neurovasculaire | Exbrayat S.,Unite Neurovasculaire | Cazorla C.,Service des Maladies Infectieuses et Tropicales | And 3 more authors.
Pratique Neurologique - FMC | Year: 2013

Ischemic stroke has many etiologies but in 30% of patients the mechanism remains unknown, leading to a search for rare causes. We report the case of a 64-year-old man with no known vascular risk factor. The patient was a hiker who presented isolated phasic disorders leading to the diagnosis of a transient ischemic attack (TIA). The etiological search remained negative excepting for the frail irregular aspect of the left sylvian artery implicated in the symptoms. The patient then developed vertigo without any MRI signs of a vascular event. Lyme serology, in both blood and CSF samples enabled the diagnosis of neuroborreliosis to which the TIA was secondarily attributed due to the vasculitis of the left sylvian artery. Antibiotic therapy provided cure. Lyme disease is a rare cause of stroke but should always be entertained as a possible diagnosis since there is a curative treatment. © 2013 Elsevier Masson SAS. All rights reserved.


PubMed | Laboratoire Of Bacteriologie Virologie Hygiene, National Influenza Center South of France, University of Lyon and École Centrale Lyon
Type: Journal Article | Journal: PloS one | Year: 2014

D222G/N substitutions in A(H1N1)pdm09 hemagglutinin may be associated with increased binding of viruses causing low respiratory tract infections and human pathogenesis. We assessed the impact of such substitutions on the balance between hemagglutinin binding and neuraminidase cleavage, viral growth and in vivo virulence.Seven viruses with differing polymorphisms at codon 222 (2 with D, 3 G, 1 N and 1 E) were isolated from patients and characterized with regards hemagglutinin binding affinity (Kd) to -2,6 sialic acid (SA-2,6) and SA-2,3 and neuraminidase enzymatic properties (Km, Ki and Vmax). The hemagglutination assay was used to quantitatively assess the balance between hemagglutinin binding and neuraminidase cleavage. Viral growth properties were compared in vitro in MDCK-SIAT1 cells and in vivo in BALB/c mice. Compared with D222 variants, the binding affinity of G222 variants was greater for SA-2,3 and lower for SA-2,6, whereas that of both E222 and N222 variants was greater for both SA-2,3 and SA-2,6. Mean neuraminidase activity of D222 variants (16.0 nmol/h/10(6)) was higher than that of G222 (1.7 nmol/h/10(6) viruses) and E/N222 variants (4.4 nmol/h/10(6) viruses). The hemagglutination assay demonstrated a deviation from functional balance by E222 and N222 variants that displayed strong hemagglutinin binding but weak neuraminidase activity. This deviation impaired viral growth in MDCK-SIAT1 cells but not infectivity in mice. All strains but one exhibited low infectious dose in mice (MID50) and replicated to high titers in the lung; this D222 strain exhibited a ten-fold higher MID50 and replicated to low titers. Hemagglutinin-neuraminidase balance status had a greater impact on viral replication than hemagglutinin affinity strength, at least in vitro, thus emphasizing the importance of an optimal balance for influenza virus fitness. The mouse model is effective in assessing binding to SA-2,3 but cannot differentiate SA-2,3- from SA-2,6- preference, nor estimate the hemagglutinin-neuraminidase balance in A(H1N1)pdm09 strains.

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