Search

Mycobacterial infections, both tuberculosis and nontuberculous, are more common in patients with haematological malignancies and haematopoietic stem cell transplant recipients than in the general population-although these infections remain rare. Mycobacterial infections pose both diagnostic and therapeutic challenges. The management of mycobacterial infections is particularly complicated for patients in haematology because of the many drug-drug interactions between antimycobacterial drugs and haematological and immunosuppressive treatments. The management of mycobacterial infections must also consider the effect of delaying haematological management. We surveyed the management practices for latent tuberculosis infection (LTBI) in haematology centres in Europe. We then conducted a meticulous review of the literature on the epidemiology, diagnosis, and management of LTBI, tuberculosis, and nontuberculous mycobacterial infections among patients in haematology, and we formulated clinical guidelines according to standardised European Conference on Infections in Leukaemia (ECIL) methods. In this Review, we summarise the available literature and the recommendations of ECIL 8 for managing mycobacterial infections in patients with haematological malignancies.

International audience; PURPOSE: Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. MATERIALS AND METHODS: Ancillary study focusing on patients with ICU admission within the ENCEIF cohort, a French prospective observational multicentre study. The primary criteria for outcome was the functional status at hospital discharge, categorized using the Glasgow outcome scale (GOS). Logistic regression model was used to identify risk factors for poor outcome, defined as a GOS ≤ 3. RESULTS: We enrolled 198 ICU patients with IE. HSV was the primary cause (n = 72, 36% of all IE, 53% of IE with microbiological documentation). Fifty-two patients (26%) had poor outcome at hospital discharge, including 22 deaths (11%). Immunodeficiency, supratentorial focal signs on admission, lower cerebrospinal fluid (CSF) white cells count (2 days were independent predictors of poor outcome. CONCLUSION: HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.

Introduction Better understanding how hospital staff members (HSMs), including HCWs, were contaminated by SARS-CoV-2 during the first wave can help refining the control measures, in the context of the current second wave in Europe. Methods From March 5th to May 10th 2020, the infectious diseases unit at Raymond-Poincare teaching Hospital opened a weekday consultation dedicated to HSMs for a PCR testing. While in the waiting room, HSMs were offered to complete a questionnaire on their potential risk exposure to SARS-CoV-2. Results Of the 200 HSMs screened, 70 were positive. Ninety-nine HSMs (including 86 HCWs) completed the questionnaire of whom 28 cases positive. In the multivariable analysis among healthcare workers, age ≥ 44 years-old (aOR = 5.2, 95%CI [1.4-22.5]), not using a facemask systematically when caring for a patient (aOR = 13.9, 95%CI [1.8-293.0]), were significantly associated with SARS-CoV-2 infection. Conversely, working in a ward dedicated to COVID-19 patients (aOR = 0.7, 95%CI [0.2-3.2]) was not significantly associated with SARS-CoV-2 infection. Regarding community related exposures occurring in and outside the hospital among the HSMs, participation to meetings inside the hospital without wearing a facemask (aOR = 21.3, 95%CI [4.5-143.9]) and participation to private gathering (aOR = 10, 95%CI [1.3-91.0]) were significantly associated with SARS-CoV-2 infection. Conclusions Our results support the effectiveness of barrier precautions, underline that in-hospital contaminations not related to patient care may occur, and that part of the contaminations may be related to exposures in the community. Better protecting HCWs against COVID-19 and thereby ensuring workforces is crucial to fight the current second wave of the epidemic.

Resume Les mycobacteries non tuberculeuses (MNT) representent une menace recente pour les patients atteints de mucoviscidose. La mucoviscidose est une pathologie liee a un deficit mendelien, au niveau du gene cftr, codant la proteine cystic fibrosis transmembrane conductance regulator (CFTR). Il existe un lien privilegie entre mucoviscidose et MNT. En effet, l’incidence des infections pulmonaires a MNT a augmente au cours de ces dernieres annees, avec notamment deux MNT predominantes : Mycobacterium avium complex et le complexe Mycobacterium abscessus. La prise en charge clinique, le diagnostic biologique et les aspects therapeutiques sont complexes. L’alteration preexistante des fonctions respiratoires des patients atteints de mucoviscidose, la presence dans l’environnement des MNT, rendent difficile l’imputabilite des MNT isolees dans les expectorations des patients. La multi-resistance aux antibiotiques des MNT isolees rend egalement difficile le traitement de ces infections. Il n’existait pas jusqu’a aujourd’hui de recommandations nationales et internationales concernant la prise en charge des patients atteints de mucoviscidose presentant une infection a MNT. Deux publications recentes regroupant a la fois la prise en charge diagnostique, clinique et therapeutique presentent des avis d’experts qui permettront a l’avenir de mieux apprehender l’impact des MNT dans l’alteration des fonctions ventilatoires des patients atteints de mucoviscidose.

Resume La biologie moleculaire fait maintenant partie inherente de l’arsenal diagnostique. Porte par les developpements en virologie medicale, l’ensemble de la microbiologie medicale semble ne plus pouvoir deroger a la biologie moleculaire devant les potentiels services rendus au patient. De meme, une automatisation permettant de degager du temps afin d’ameliorer la prise en charge des prelevements positifs doit apporter egalement cette efficience. Mais il reste la encore un peu de chemin a parcourir.

The in vitro activity of cefoxitin and imipenem was compared for 43 strains of the Mycobacterium abscessus complex, mostly isolated from cystic fibrosis patients. The MICs of imipenem were lower than those of cefoxitin, although the number of imipenem-resistant strains was higher according to the CLSI breakpoints. Strain comparisons indicated that the MICs of cefoxitin were significantly higher for Mycobacterium bolletii than for M. abscessus. The MICs of both β-lactams were higher for the rough morphotype than for the smooth morphotype. The clinical impact of the in vitro difference between the activity of imipenem and that of cefoxitin remains to be determined.

We report a microbiological process for the documentation of prosthetic joint infection (PJI). Intraoperative periprosthetic tissue samples from 92 consecutive patients undergoing revision surgery for PJI were submitted to mechanized beadmill processing: specimens were aseptically collected in polypropylene vials, filled with sterile water and glass beads and submitted to mechanized agitation with a beadmill. The documentation rate of PJI following culture on solid and liquid media was 83.7% and the contamination rate 8.7%. Final documentation was obtained after overnight culture for 51.9% of cases and with 7 days of broth culture for all documented cases.

A study was performed to compare matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS), linked to a recently engineered microbial identification database, and two rapid identification (ID) automated systems, BD Phoenix (Becton Dickinson Diagnostic Systems, France) and VITEK-2 (bioMérieux, Marcy L'Etoile, France), for the ID of coagulase-negative staphylococci (CoNS). Two hundred and thirty-four clinical isolates of CoNS representing 20 species were analyzed. All CoNS isolates were characterized by sodA gene sequencing, allowing interpretation of the ID results obtained using the respective database of each apparatus. Overall correct ID results were obtained in 93.2%, 75.6% and 75.2% of the cases with the MALDI-TOF-MS, Phoenix and VITEK-2 systems, respectively. Mis-ID and absence of results occurred in 1.7% and 5.1% of the cases with MALDI-TOF-MS, in 23.1% and 1.3% with the Phoenix, and in 13.7% and 0.9% with the VITEK-2 systems, respectively. In addition, with the latter automate, 10.3% of the IDs were proposed with remote possibility. When excluding the CoNS species not included in the databases of at least one of the three systems, the final percentage of correct results, Mis-ID and absence of ID were 97.4%, 1.3% and 1.3% with MALDI-TOF-MS, 79%, 21% and 0% with the Phoenix, and 78.6%, 10.3% and 0.9% with the VITEK-2 system, respectively. The present study demonstrates the robustness and high sensitivity of our microbial identification database used with MALDI-TOF-MS technology. This approach represents a powerful tool for the fast ID of clinical CoNS isolates.

Summary M. abscessus is the most common rapidly growing mycobacterium (RGM) pathogenic for man. It is by far the leading RGM causing lung infections in patients with an underlying disease (cystic fibrosis, COPD, bronchial dilatation), but also in healthy subjects free of lung disease. M. abscessus is also the most common RGM found in bronchial secretions in patients with cystic fibrosis. Besides their frequency, M. abscessus lung infections are generally true lung infections using the criteria established by the American Thoracic Society (ATS). The genome of the typical strain of M. abscessus has been sequenced and now provides means for molecular studies of the species with construction of deletion mutants. In addition, M. abscessus has a characteristic genotypic and phenotypic heterogeneity. M. abscessus, which was long considered to be a sub-species of M. chelonae, is now considered to be a complex including M. abscessus species stricto senso, M. bolletii and M. massiliense. Molecular identification being the only reliable identification method for M. abscessus, the study of different identification targets evidenced the mosaic makeup of some isolates, raising questions about the speciation process within the complex. Regarding the phenotype of M. abscessus sensu lato, two morphotypes can be described on solid media: the smooth (S) and the rough (R) morphotype. This heterogeneity is correlated with variable virulence, some isolates only being associated with true mycobacterial disease, these strains commonly displaying an R morphotype. The biochemical basis underlying the S and R phenotypes remain obscure, but recent studies shows that the R morphotype is associated with a small or highly diminished capacity for these bacteria to produce glycopeptidolipid (GPL) surface molecules. These recent data show that the R variants induce hyperproduction of TNF by murine macrophages in culture but also that the activation pathway leading to this process involves TLR2 receptors. The host response has been studied in mice. In this model, mycobacteria are typically controlled by the T cell compartment. An original humoral immune response has been demonstrated in the control of the emergence of rough strains. The study of the interaction between M. abscessus and other cell or animal models presenting a CFTR−/− or ΔF508 phenotype will be useful in understanding the specific sensitivity of children with cystic fibrosis to this mycobacterium.

Resume Objectif Les patients presentant des troubles neurologiques et cognitifs chroniques, apres morsure de tiques et malgre un traitement antibiotique adapte a la maladie de Lyme et bien conduit, posent d’importants problemes diagnostiques et therapeutiques. L’objectif etait de mieux evaluer les troubles par un bilan etiologique et de retentissement rigoureux. Methodologie Nous avons realise un bilan etiologique standardise comprenant un examen clinique, un bilan biologique et serologique, des examens d’imagerie et de neurophysiologie, une etude du liquide cephalorachidien et un bilan detaille des fonctions cognitives. Resultats Les resultats observes sur une cohorte hospitaliere de 30 patients etaient pauvres en termes d’examens cliniques et biologiques. Des anomalies significatives etaient cependant observees : hyper proteinorachie (64 %), hypersignaux en sequence flair a l’imagerie cerebrale par resonance magnetique (41 %) et perturbations des potentiels evoques visuels et somesthesiques evoquant des lesions du systeme nerveux central (47 %). Le bilan des fonctions cognitives montrait des troubles de l’attention, des difficultes de mise et de maintien en memoire de l’information chez 100 % des patients. Conclusions Ce bilan a permis d’objectiver des troubles jusque-la subjectifs et de proposer un bilan standardise permettant de suivre l’evolution des patients dans une perspective d’innovations therapeutiques.

Resume Introduction Le depistage et le traitement des personnes presentant une infection tuberculeuse (TB-infection) latente a haut risque de progression vers la tuberculose active (TB-maladie) sont deux elements majeurs des plans de lutte antituberculeuse, en France et dans de nombreuses regions du monde. Si la mise en evidence des bacilles tuberculeux est l’examen essentiel dans la confirmation du diagnostic de la TB-maladie, il n’existe pas de test indiscutable pour le diagnostic de la TB-infection latente. Etat des connaissances L’aide au diagnostic de la TB infection repose actuellement sur le degre de positivite du Test Cutane a la Tuberculine (TCT), ce dernier presente differentes limites operationnelles et logistiques qui en limite son utilite. Une nouvelle approche apparait de fait de la disponibilite de deux tests biologiques, presentes sous forme de Kit (QuantiFERON-TB ® et TSPOT-TB ® ), qui mesurent la production in vitro d’Interferon gamma (IFN- γ ) par les cellules mononuclees sanguines stimulees par des antigenes (ESAT-6 et CFP10) specifiques du complexe M. tuberculosis . Cette revue analyse les differentes etudes publiees, faites avec un nombre variable de patients, qui ont evalue les valeurs diagnostiques de ces deux tests biologiques en comparaison avec le TCT. Ces etudes demontrent des valeurs de specificite similaires pour ces deux tests biologiques, mais statistiquement plus elevees que celle du TCT en particulier dans des populations vaccinees par le BCG. Par ailleurs, leurs valeurs de sensibilite sont au moins equivalentes a celles du TCT, et dans certaines etudes ces valeurs seraient superieures avec l’un des tests (T-SPOT-TB ® ). Enfin, plusieurs etudes chez des sujets contacts ont ete realisees afin d’evaluer la concordance entre ces tests biologiques et le TCT. Le point essentiel est la tres bonne correlation entre la positivite des tests biologiques et le degre d’exposition. Ces tests presentent en plus des avantages operationnels majeurs par rapport au TCT : la realisation en un seul temps, les resultats obtenus en 24 heures, l’absence de divergence inter- et intra-observateur, et la detection d’une potentielle immunodepression. Perspectives Cependant, ces deux tests biologiques presentent actuellement encore plusieurs limites qui sont soulignees : une sensibilite incomplete dans la TB-maladie severe, des donnees partielles chez les sujets immunodeprimes et chez les enfants, une absence de validation comme temoin de risque de TB-maladie ulterieure, une absence de distinction entre TB-infection latente et TB-maladie. De nombreuses etudes cliniques, en France et de par le monde, sont en cours de realisation pour reduire ces limites permettant d’inscrire au mieux ces tests dans l’aide au diagnostic dans la tuberculose. Conclusions Ces deux tests biologiques devraient dans un avenir proche remplacer ou completer le TCT dans l’aide au diagnostic des TB infections latentes recentes permettant d’inscrire au mieux ces tests dans les arbres de decision du plan national de la lutte antituberculeuse.

Rapid and sensitive detection of Mycobacterium tuberculosis complex (MTB) directly on clinical respiratory specimens is essential for a correct management of patients suspected of tuberculosis. For this purpose PCR-based kits are available to detect MTB in respiratory specimen but most of them need at least 4 hours to be completed. New methods, based on TRC method (TRC: Transcription Reverse transcription Concerted--TRCRapid M. Tuberculosis--Tosoh Bioscience, Tokyo, Japon) and dedicated monitor have been developed. A new kit (TRC Rapid M. tuberculosis and Real-time monitor TRCRapid-160, Tosoh Corporation, Japan) enabling one step amplification and real-time detection of MTB 16S rRNA by a combination of intercalative dye oxazole yellow-linked DNA probe and isothermal RNA amplification directly on respiratory specimens has been tested in our laboratory. 319 respiratory specimens were tested in this preliminary study and results were compared to smear and culture. Fourteen had a positive culture for MTB. Among theses samples, smear was positive in 11 cases (78.6%) and TRC process was positive in 8 cases (57.1%). Overall sensitivity of TRC compared to smear positive samples is 73%. Theses first results demonstrated that a rapid identification of MTB was possible (less than 2 processing hours for 14 specimens and about 1 hour for 1 specimen) in most cases of smear positive samples using ready to use reagents for real time detection of MTB rRNA in clinical samples. New pretreatment and extraction reagents kits to increase the stability of the sputum RNA and the extraction efficiency are now tested in our laboratory.

Resume Introduction Mycobacterium tuberculosis , agent de la tuberculose, reste un organisme pathogene capable d’infecter un grand nombre d’individus, et de resister a la reponse immune de l’hote infecte. Les acteurs principaux de cette reponse immune sont les cellules presentatrices d’antigenes comme les cellules dendritiques, les macrophages et les lymphocytes T. Etat des connaissances L’etude comparative des interactions entre M. tuberculosis et les cellules presentatrices d’antigene a permis de montrer que les cellules dendritiques ne permettent pas la croissance intracellulaire de M. tuberculosis , a la difference de ce que l’on observe dans les macrophages. Un compartiment intracellulaire hostile cree les conditions d’une bacteriostase. M. tuberculosis st internalise en se liant a un recepteur des cellules dendritiques de type lectine (DC-SIGN). Perspectives Ce recepteur reconnait des composes sucres que l’on retrouve a la surface de la paroi de M. tuberculosis . Ce lien sucres-lectine pourrait compenser le lien composes bacteriens-recepteur de type Toll, inhibant partiellement la reaction inflammatoire protectrice, ou compensant une reaction inflammatoire excessive. Conclusions Ce lien favoriserait egalement la persistance de la bacterie a l’etat quiescent dans les cellules dendritiques, et l’adaptation reciproque de l’hote et de la bacterie au cours du temps.

Resume De nombreuses approches diagnostiques, principalement moleculaires et serologiques, ont ete developpees dans le seul but d’ameliorer le diagnostic rapide de la tuberculose. La qualite de l’extraction d’ADN, la presence d’inhibiteurs d’amplification genique, le choix de la cible ainsi que la qualite de l’operateur representent les elements principaux intervenant sur la sensibilite de l’amplification genique. Le choix d’antigenes specifiques de Mycobacterium tuberculosis pour la mise au point d’un test serologique Elisa, et notamment le choix d’antigenes glycolipidiques, non proteiques, a considerablement ameliore l’efficacite du diagnostic serologique de la tuberculose.

Mycobacterium tuberculosis and Mycobacterium bovis, the causative agents of human and bovine tuberculosis, have been reported to express a range of surface and secreted glycoproteins, although only one of these has been subjected to detailed structural analysis. We describe the use of a genetic system, in conjunction with lectin binding, to characterize the points of attachment of carbohydrate moieties to the polypeptide backbone of a second mycobacterial glycoprotein, antigen MPB83 from M. bovis. Biochemical and structural analysis of the native MPB83 protein and derived peptides demonstrated the presence of 3 mannose units attached to two threonine residues. Mannose residues were joined by a (1 --> 3) linkage, in contrast to the (1 --> 2) linkage previously observed in antigen MPT32 from M. tuberculosis and the (1 --> 2) and (1 --> 6) linkages in other mycobacterial glycolipids and polysaccharides. The identification of glycosylated antigens within the M. tuberculosis complex raises the possibility that the carbohydrate moiety of these glycoproteins might be involved in pathogenesis, either by interaction with mannose receptors on host cells, or as targets or modulators of the cell-mediated immune response. Given such a possibility characterization of mycobacterial glycoproteins is a step toward understanding their functional role and elucidating the mechanisms of mycobacterial glycosylation.

Interactions between dendritic cells (DCs) and Mycobacterium tuberculosis, the etiological agent of tuberculosis, most likely play a key role in anti-mycobacterial immunity. We have recently shown that M. tuberculosis binds to and infects DCs through ligation of the DC-specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) and that M. tuberculosis mannose-capped lipoarabinomannan (ManLAM) inhibits binding of the bacilli to the lectin, suggesting that ManLAM might be a key DC-SIGN ligand. In the present study, we investigated the molecular basis of DC-SIGN ligation by LAM. Contrary to what was found for slow growing mycobacteria, such as M. tuberculosis and the vaccine strain Mycobacterium bovis bacillus Calmette-Guérin, our data demonstrate that the fast growing saprophytic species Mycobacterium smegmatis hardly binds to DC-SIGN. Consistent with the former finding, we show that M. smegmatis-derived lipoarabinomannan, which is capped by phosphoinositide residues (PILAM), exhibits a limited ability to inhibit M. tuberculosis binding to DC-SIGN. Moreover, using enzymatically demannosylated and chemically deacylated ManLAM molecules, we demonstrate that both the acyl chains on the ManLAM mannosylphosphatidylinositol anchor and the mannooligosaccharide caps play a critical role in DC-SIGN-ManLAM interaction. Finally, we report that DC-SIGN binds poorly to the PILAM and uncapped AraLAM-containing species Mycobacterium fortuitum and Mycobacterium chelonae, respectively. Interestingly, smooth colony-forming Mycobacterium avium, in which ManLAM is capped with single mannose residues, was also poorly recognized by the lectin. Altogether, our results provide molecular insight into the mechanisms of mycobacteria-DC-SIGN interaction, and suggest that DC-SIGN may act as a pattern recognition receptor and discriminate between Mycobacterium species through selective recognition of the mannose caps on LAM molecules.

Background: The aim of this study was to determine whether tuberculosis (TB) treatment and follow-up is a feasible option for patients without primary health coverage when free access to health care and drug delivery is provided on an outpatient basis. Methods: We conducted a retrospective analysis of patient characteristics, treatment modalities, and evolution up to 9 months of follow-up at Saint-Louis Hospital, Paris, France. Results: TB patients without (n=44) compared to those with (n=49) primary health coverage at diagnosis tended to be younger and more frequently homeless (P

Introduction L’incidence des encephalites en France se situe entre 0,5 et 1/100 000 habitants. Cette relative rarete fait que tous les praticiens n’ont pas une expertise importante sur cette pathologie. Dans les cas complexes, un appui collegial et multidisciplinaire pour la demarche diagnostique et la gestion des patients peut s’averer utile. Materiels et methodes Un groupe d’experts a ete designe, en fonction des criteres suivants : membres du comite de pilotage de la cohorte encephalite francaise (etude ENCEIF), membres du comite scientifique de la RPC encephalites (organisee par la SPILF), representation des competences cliniques (infectiologie, neurologie, reanimation), microbiologiques (bacteriologie, virologie) et epidemiologiques indispensables. Tout clinicien en charge d’une encephalite complexe peut saisir le groupe au moyen d’une adresse mail dediee ( encephalite.spilf@infectiologie.com ). Une reunion telephonique est alors organisee sous 48 h avec les membres du groupe et le demandeur qui expose son dossier et ses besoins specifiques d’aide au diagnostic etiologique ou a la prise en charge. Une proposition formelle et tracable est alors emise. Un compte rendu est adresse apres la reunion au demandeur. Resultats En 2016, 11 dossiers ont ete soumis au groupe, dont 1 a ete discute en incluant des experts internationaux en raison de sa complexite et sa gravite. Les demandes etaient caracterisees par la diversite et la complexite des questions posees par chaque patient : toutes les competences ont ete necessaires pour la discussion (epidemiologie, valeurs des outils diagnostiques, imagerie, pronostic et prise en charge therapeutique). Dans 9 cas, il s’agissait de patients avec evolution prolongee d’etiologie inconnue au moment de la sollicitation, dans 1 cas d’une possible encephalite a EBV et dans 1 cas, il s’agissait d’une demande parvenue apres le deces brutal du patient. Deux conseils de biopsie cerebrale ont ete donnes dont un a abouti a un diagnostic de lymphome cerebral. Pour 5 patients il a ete considere que l’etiologie la plus probable etait une maladie inflammatoire ou auto-immune, avec conseil de traitement par corticoide ou immunosuppresseur. Pour 3 patients, l’hypothese la plus probable etait une tuberculose. Conclusion Ce centre de ressource semble efficace et utile dans la prise en charge des encephalites se presentant comme infectieuses et permet de reorienter l’hypothese initiale vers des pathologies non infectieuses. La multidisciplinarite apparait indispensable.

Pulmonary disease due to Mycobacterium avium complex (MAC) without evidence of dissemination is uncommon in HIV-infected patients. Five cases were observed over a 2-year period. All patients had AIDS and the median CD4 cell count at the time of presentation was 90 x 10(6)/L. Radiographic patterns included unilobar alveolar infiltrates or diffuse alveolar densities. All patients had a favorable clinical response to antimycobacterial chemotherapy with a median follow-up period of 10 months. MAC should be considered in HIV-infected patients with positive respiratory samples for acid-fast bacilli and pulmonary infiltrates. Patients with such findings in whom presumptive therapy for tuberculosis has failed should receive broad-spectrum antimycobacterial chemotherapy until final identification is available.

Introduction La prise en charge infectiologique des patients blesses medullaires est particuliere en raison du type d’infection (urinaire, pulmonaire, musculosquelettique, neurologique, sur materiel). Ces patients presentent regulierement des infections associees a une bacteriemie pouvant etre : i) recidivante, ii) a bacteries multi-resistantes (BMR), iii) associee a une morbi-mortalite importante. Les donnees de la litterature concernant ce sujet sont pauvres. Materiels et Methodes Nous avons realise une enquete retrospective, a partir de l’ensemble des hemocultures positives (1 hemoculture a un pathogene non saprophyte ou au moins 2 hemocultures concordantes a germe saprophyte) provenant de patients adultes hospitalises paraplegiques ou tetraplegiques. Cette etude a analyse le terrain sous-jacent (co-morbidites et niveau lesionnel neurologique), l’identification microbiologique (et particulierement la notion de BMR), la nature et la gravite de l’infection, les therapeutiques entreprises, et l’evolution a distance des patients. Resultats Sur 10 ans (1998-2008), nous avons recense 249 patients ayant presente 342 episodes de bacteriemies. L’identification microbiologique etait : Staphylococcus aureus ( n = 80 dont 44 meticilline resistants), staphylocoque a coagulase negative ( n = 73 dont 68 meticilline resistants), Escherichia coli ( n = 51; dont 7 BMR), Pseudomonas aeruginosa ( n = 23 ; dont 8 BMR), Klebsiella pneumoniae ( n = 22 don’t 9 BMR), Enterococcus faecalis ( n = 17), Streptococcus sp ( n = 17), Proteus sp ( n = 16) et autres germes ( n = 43). Chez les patients blesses medullaires, 81 bacteriemies etaient a BMR, les principales origines infectieuses etaient urinaires et musculo-squelettiques (escarre). Lors de l’episode de bacteriemie les patients ont presente dans 45 % une infection grave (sepsis severe, choc septique) necessitant la prise en charge en reanimation.