Tunis, Tunisia
Tunis, Tunisia

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PubMed | Joseph Fourier University, Service de Bacteriologie., Service de Medecine Interne, University of Paris Descartes and 3 more.
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2016

Syphilis remains a significant public health problem. We conducted a prospective study to define more precisely the clinical and biological characteristics of patients with neurosyphilis (NS), and we assessed the diagnostic value of nested polymerase chain reaction (PCR) testing for Treponema pallidum in cerebrospinal fluid (CSF) samples.From 2001 to 2013, we included 40 patients (90% men; 45% infected with human immunodeficiency virus) with NS, defined as syphilis with neurological and/or ophthalmological symptoms and CSF abnormalities.Thirty patients (75%) had early, 5 (12.5%) had late, and 5 had meningovascular NS. Twenty-four patients (80%) with early NS had ophthalmological symptoms, 14 (47%) had neurological symptoms, and 8 (26%) had both. All patients with meningovascular NS had only neurological symptoms. All patients with late NS had neurological symptoms, and 2 (40%) also had ocular symptoms. Ophthalmological symptoms were present in 65% of all patients with NS, and neurological symptoms in 60%. Seventeen patients (42.5%) had CSF white blood cell counts >20/L (mean, 57/L), and 27 (67.5%) had high CSF protein levels (>0.5 g/L; mean value, 1 g/L). CSF PCR results were positive in 42%, and CSF VDRL results in 30%. The nested PCR assay had an overall sensitivity of 42.5%, a specificity of 97%, a positive predictive value of 77%, and a negative predictive value of 86%.Early NS is the most frequent presentation, with an overrepresentation of polymorphous ophthalmological symptoms. PCR is highly specific and of potential value when used with other biological parameters.


Garraffo A.,Service de pediatrie generale | Marguet C.,Service de pediatrie generale | Checoury A.,Service de pediatrie generale | Boyer S.,Service de bacteriologie | And 3 more authors.
Medecine et Maladies Infectieuses | Year: 2014

Objective: We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population. Methods: We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record. Results: One hundred and ten patients (73 girls), 11 days to 12 years of age, were included in 10 months. Ninety-six percent presented with pyelonephritis, associated to uropathy for 25%. Escherichia coli was predominant (78%), followed by Proteus spp. and Enterococcus spp. The antibiotic resistance rate of E.coli was high and close to that reported for adults with complicated UTIs: amoxicillin 60%, amoxicillin-clavulanate 35%, cefotaxim 5%, trimethoprim-sulfametoxazole 26%, nalidixic acid 9%, ciprofloxacin 7%, gentamycin 1%, nitrofurantoin and fosfomycin 0%. The antibiotic exposure in the previous 12 months involved 62 children (56%) most frequently with β-lactams (89%) for a respiratory tract infection (56%). A clear relationship between exposure and resistance was observed for amoxicillin (71% vs. 46%), first generation (65% vs. 46%) and third generation (9% vs. 3%) cephalosporins, or trimethoprim-sulfamethoxazole (36% vs. 15%). However, antibiotic exposure could not account alone for the results, as suggested by the 7% of ciprofloxacin resistance, observed without any identified previous treatment. Conclusion: Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved (previous antibiotic therapies and fecal-oral or mother-to-child transmission). © 2013 Elsevier Masson SAS.


Chauny J.-V.,Service de Pharmacie | Chauny J.-V.,University of Paris Descartes | Lorrot M.,Service de Pediatrie Generale | Lorrot M.,University Paris Diderot | And 7 more authors.
Pediatric Infectious Disease Journal | Year: 2012

We report 6 pediatric cases of tuberculosis caused by Mycobacterium tuberculosis and treated them with levofloxacin or moxifloxacin in the mother-child unit of a university hospital in France between 2005 and 2011. We assess the clinical efficacy and safety of fluoroquinolones and the benefit-risk ratio for their use as second-line antituberculosis drugs in children and adolescents. © 2012 by Lippincott Williams & Wilkins.


Nicolas-Chanoine M.-H.,Service de Microbiologie | Nicolas-Chanoine M.-H.,University Paris Diderot | Nicolas-Chanoine M.-H.,Institut Universitaire de France | Jarlier V.,Laboratoire Of Bacteriologie Hygiene Hospitaliere | And 11 more authors.
PLoS ONE | Year: 2012

Background: Global dissemination of Escherichia coli producing CTX-M extended-spectrum β-lactamases (ESBL) is a public health concern. The aim of the study was to determine factors associated with CTX-M- producing E. coli infections among patients hospitalised in the Assistance Publique-Hôpitaux de Paris, the largest hospital system in France (23 000 beds), through a prospective case-control-control study. Methods/Principal Findings: From November 2008 to June 2009, 152 inpatients with a clinical sample positive for CTX-M-producing E. coli (cases), 152 inpatients with a clinical sample positive for non ESBL-producing E. coli on the day or within the three days following case detection (controls C1), and 152 inpatients with culture-negative clinical samples since the beginning of hospitalisation and until three days after case detection (controls C2) were included in ten hospitals of the Paris area. Factors studied were related to patient's origin, lifestyle and medical history as well as care during hospitalisation. Those independently associated with CTX-M-producing E. coli were determined. Three independent factors were common to the two case-control comparisons: birth outside of Europe (cases vs C1: OR 1 = 2.4; 95%CI = [1.3-4.5] and cases vs C2: OR 2 = 3.1; 95%CI = [1.4-7.0]), chronic infections (OR 1 = 2.9; 95%CI = [1.3-6.9] and OR 2 = 8.7; 95%CI = [2.0-39.7]), and antibiotic treatment between hospital admission and inclusion (OR 1 = 2.0; 95%CI = [1.0-3.8] and OR 2 = 3.3; 95%CI = [1.5-7.2]). Cases were also more likely to be (i) functionally dependent before hospitalisation than C2 (OR 2 = 7.0; 95%CI = [2.1-23.5]) and (ii) living in collective housing before hospitalisation than C2 (OR 2 = 15.2; 95%CI = [1.8-130.7]) when CTX-M-producing E. coli was present at admission. Conclusion: For the first time, patient's origin and lifestyle were demonstrated to be independently associated with isolation of CTX-M-producing E. coli, in addition to health care-related factors. © 2012 Nicolas-Chanoine et al.


Tritar F.,Service de pneumologie | Daghfous H.,Service de pneumologie | Ben Saad S.,Service de pneumologie | Slim-Saidi L.,Service de bacteriologie
Revue de Pneumologie Clinique | Year: 2015

The emergence of drug-resistant TB in many countries has become a major public health problem and an obstacle to effective tuberculosis control. Multidrug-resistant tuberculosis (MDR-TB), which is most often the result of poor adherence, is a particularly dangerous form of tuberculosis because it is caused by bacilli resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs. Techniques for rapid diagnosis of resistance have greatly improved the care of patients by allowing early treatment which remains complex and costly establishment, and requires skills and resources. The treatment is not standardized but it includes in all cases attack phase with five drugs (there must be an injectable agent and a fluoroquinolone that form the basis of the regimen) for eight months and a maintenance phase (without injectable agent) with a total duration of 20 months on average. Surgery may be beneficial as long as the lesions are localized and the patient has a good cardiorespiratory function. Evolution of MDR-TB treated is less favorable than tuberculosis with germ sensitive. The cure rate varies from 60 to 75% for MDR-TB, and drops to 30 to 40% for XDR-TB. Mortality remains high, ranging from 20 to 40% even up to 70-90% in people co-infected with HIV. © 2014 Elsevier Masson SAS.


PubMed | Service de Bacteriologie and Service de Microbiologie
Type: | Journal: Antimicrobial agents and chemotherapy | Year: 2017

Ceftolozane-tazobactam was tested against 58 multidrug-resistant non-fermenting Gram-negative bacilli (35 Pseudomonas aeruginosa, 11 Achromobacter xylosoxydans and 12 Stenotrophomonas maltophilia) isolated from cystic fibrosis patients and compared to ceftolozane alone, ceftazidime, meropenem and piperacillin-tazobactam. Ceftolozane-tazobactam was the most active agent against P. aeruginosa but was inactive against A. xylosoxydans and S. maltophilia In time-kill experiments ceftolozane-tazobactam had complete bactericidal activity against 2/6 (33%) clinical isolates.


Bremond-Gignac D.,University of Picardie Jules Verne | Mariani-Kurkdjian P.,Service de Bacteriologie | Beresniak A.,University of Paris Descartes | El Fekih L.,Data Mining International | And 6 more authors.
Pediatric Infectious Disease Journal | Year: 2010

Background: Purulent bacterial conjunctivitis affects all ages with high frequency in newborns and children. In a subset of 150 children included in a large study having enrolled 1043 patients, our aim was to analyze in children, the efficacy and safety of azithromycin 1.5% eye-drops in the treatment of this disease. Methods: This multicenter, randomized, investigator-masked, parallel-group study, included 150 children and adolescents to study safety and compare azithromycin 1.5% eye drops twice daily for 3 days and tobramycin 0.3% 1 drop every 2 hours for 2 days then 4 times daily for 5 days. Out of 150 patients included, 58 had positive cultures and were studied for efficacy. Signs and symptoms were evaluated and cultures obtained at baseline, Days 3 and 9. Primary efficacy variable was the clinical cure (score 0 for bulbar conjunctival injection and purulent discharge) at the test of cure visit (day 9). Results: Both treatments were effective with a clinical and microbiologic cure of more than 80% of children on day 9. Azithromycin therapy provided a greater bacteriologic cure on day 3 than did tobramycin (P < 0.001) and eradicated bacteria that were defined as resistant, using classical antibiogram. No adverse effects were noted on the ocular surface. Conclusions: Azithromycin 1.5% eye drops leads to a rapid clinical and microbiological cure. © 2010 Lippincott Williams & Wilkins.


Philippon A.,Service de Bacteriologie | Slama P.,Independent Researcher | Deny P.,French Institute of Health and Medical Research | Labia R.,Laboratoire University Of Biodiversite Et Decologie Microbienne
Clinical Microbiology Reviews | Year: 2016

For medical biologists, sequencing has become a commonplace technique to support diagnosis. Rapid changes in this field have led to the generation of large amounts of data, which are not always correctly listed in databases. This is particularly true for data concerning class A β-lactamases, a group of key antibiotic resistance enzymes produced by bacteria. Many genomes have been reported to contain putative β-lactamase genes, which can be compared with representative types. We analyzed several hundred amino acid sequences of class A β-lactamase enzymes for phylogenic relationships, the presence of specific residues, and cluster patterns. A clear distinction was first made between dd-peptidases and class A enzymes based on a small number of residues (S70, K73, P107, 130SDN132, G144, E166, 234K/R, 235T/S, and 236G [Ambler numbering]). Other residues clearly separated two main branches, which we named subclasses A1 and A2. Various clusters were identified on the major branch (subclass A1) on the basis of signature residues associated with catalytic properties (e.g., limited-spectrum β-lactamases, extended-spectrum β-lactamases, and carbapenemases). For subclass A2 enzymes (e.g., CfxA, CIA-1, CME-1, PER-1, and VEB-1), 43 conserved residues were characterized, and several significant insertions were detected. This diversity in the amino acid sequences of β-lactamases must be taken into account to ensure that new enzymes are accurately identified. However, with the exception of PER types, this diversity is poorly represented in existing X-ray crystallographic data. © 2015, American Society for Microbiology.


Grange P.A.,University of Paris Descartes | Gressier L.,University of Paris Descartes | Dion P.L.,Center des | Farhi D.,Service de Dermatologie Venereologie | And 10 more authors.
Journal of Clinical Microbiology | Year: 2012

Syphilis diagnosis is based on clinical observation, serological analysis, and dark-field microscopy (DFM) detection of Treponema pallidum subsp. pallidum, the etiological agent of syphilis, in skin ulcers. We performed a nested PCR (nPCR) assay specifically amplifying the tpp47 gene of T. pallidum from swab and blood specimens. We studied a cohort of 294 patients with suspected syphilis and 35 healthy volunteers. Eighty-seven of the 294 patients had primary syphilis, 103 had secondary syphilis, 40 had latent syphilis, and 64 were found not to have syphilis. The T. pallidum nPCR results for swab specimens were highly concordant with syphilis diagnosis, with a sensitivity of 82% and a specificity of 95%. Reasonable agreement was observed between the results obtained with the nPCR and DFM methods (kappa = 0.53). No agreement was found between the nPCR detection of T. pallidum in blood and the diagnosis of syphilis, with sensitivities of 29, 18, 14.7, and 24% and specificities of 96, 92, 93, and 97% for peripheral blood mononuclear cell (PBMC), plasma, serum, and whole-blood fractions, respectively. HIV status did not affect the frequency of T. pallidum detection in any of the specimens tested. Swab specimens from mucosal or skin lesions seemed to be more useful than blood for the efficient detection of the T. pallidum genome and, thus, for the diagnosis of syphilis. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

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