Search

Background Bone and joint infections (BJIs) due to Streptococcus agalactiae are rare but has been described to increase in the past few years. The objective of this study was to describe clinical features and outcomes of cases of S. BJIs. Methods We conducted a retrospective analysis of adult cases of S. agalactiae BJIs that occurred between January 2009 and June 2015 in a French university hospital. The treatment success was assessed until 24 months after the end of antibiotic treatment. Results Among the 26 patients included, 20 (77%) were male, mean age was 62 years ± 13 and mean Charlson comorbidity index score was 4.9 ± 3.2. Diabetes mellitus was the most common comorbidity (n = 14, 54%). Six had PJI (Prosthetic Joint Infections), five osteosynthesis-associated infections, 11 osteomyelitis and four native septic arthritis. Eleven patients had a delayed or late infection: six with a prosthetic joint infection and five with an internal fixation device infection. Sixteen patients (62%) had a polymicrobial BJI, most commonly with Gram-positive cocci (75%) notably Staphylococcus aureus (44%). Polymicrobial infections were more frequently found in foot infections (90% vs 44%, p = 0.0184). During the two-year follow-up, three patients died (3/25, 12%) and seven (7/25, 28%) had treatment failure. Conclusion Diabetes mellitus was the most common comorbidity. We observed an heterogenous management and a high rate of relapse.

International audience; AIM: We evaluated the performance of Unyvero implant and tissue infections system (ITI) application (Curetis) to diagnose Diabetic Foot Osteomyelitis (DFOM). PATIENTS & METHODS: The study was conducted in the Diabetic Foot reference center of N\ⁱmes University Hospital (France) from 1 December 2016 to 31 May 2017. We compared the Unyvero ITI PCR to conventional culture and alternative molecular approaches. RESULTS: A total of 79 patients with DFOM were included: 177 microorganisms were isolated by culture, 146 detected by PCR, resulting in a concordance level of 66.7% (65.0-68.4). Discrepant results were obtained for 45 samples, with 59 microorganisms being detected by PCR only (18 samples) or by culture only (27 samples). CONCLUSION: Unyvero ITI PCR represents an interesting additional diagnosis solution to manage DFOM.

Aims Nasal carriage of Staphylococcus aureus in diabetic patients may be a risk factor for diabetic foot lesion infections. The aims of this study were to compare the genotypic profiles of S. aureus strains isolated from nares and diabetic foot ulcers (DFUs) using microarray technology. Methods Patients were included if they were admitted for diabetic foot infection (DFI) at any of three diabetology departments of Montpellier and Nimes University Hospitals between 1 September 2010 to 30 June 2012. All S. aureus isolates were analyzed using oligonucleotides arrays; S. aureus resistance and virulence genes were determined and each isolate was affiliated to a clonal complex. Results The prevalence of S. aureus nasal carriage among the 276 included patients was 39.5% ( n =109), while 36.6% ( n =101) had S. aureus at both sites (nares and foot wounds) and, of these patients, 65.3% of patients harboured the same strain at both sites. In addition, the spread of the methicillin-resistant S. aureus (MRSA) ST398 clone in DFI and its tropism for bone were also further confirmed. Conclusion These findings appear to provide new arguments in favour of the systematic detection of nasal S. aureus carriage to anticipate the management of DFI.

OBJECTIVE To extend our previous work on evaluating the use of oligonucleotide arrays to discriminate colonization from infection owing to Staphylococcus aureus in diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS Patients admitted to 14 French diabetic foot departments for a DFU were screened for entry into the study. At admission, ulcers were classified based on clinical examination according to the Infectious Diseases Society of America system. Only patients with monomicrobial culture for S. aureus were included. In persons with an uninfected ulcer, a second wound bacterial specimen was obtained 1 month later. Using oligonucleotide arrays, S. aureus resistance and virulence genes were determined, and each isolate was affiliated to a clonal complex (CC). RESULTS S. aureus was initially isolated from 75 uninfected and 120 infected ulcers; 35 were methicillin resistant. A total of 44 (59%) strains from uninfected DFUs belonged to CC5/CC8 clones vs. 6 (5%) from infected DFUs (P < 0.001). During follow-up, 57 (76%) of uninfected DFUs healed or had a favorable outcome; the strain in 49 (86%) of them belonged to CC5/CC8. Conversely, 18 (24%) had a poor outcome but not a single strain belonged to CC5/CC8 clone. Moreover, lukDE was significantly associated with a favorable outcome of the wound. CONCLUSIONS As suggested by our previous study, the use of DNA arrays appears to be a promising technique that might help distinguishing uninfected from infected wounds, predicting ulcer outcome and then contributing to a more adequate use of antibiotics.

Aims/hypothesis In 2003, guidelines for management of diabetic foot infection (DFI) were written by the authors’ team according to the guidelines of the International Working Group on the Diabetic Foot. The effects of implementing these guidelines on the microbiology and costs of infected diabetic foot ulcers were assessed. Methods From 2003 to 2007, potential beneficial effects of implementing these guidelines were assessed by comparison over time of bacteriological data (number of bacterial samples, number of microorganisms isolated in cultures, prevalence of multidrug-resistant organisms [MDRO] and colonising flora), and costs related to use of antimicrobial agents and microbiology laboratory workload. Results The study included 405 consecutive diabetic patients referred to the Diabetic Foot Unit for a suspected DFI. From 2003 to 2007, asignificant decrease was observed in the median number of bacteria species per sample (from 4.1 to 1.6), prevalence of MDRO (35.2% vs 16.3%) and methicillin-resistant Staphylococcus aureus (52.2% vs 18.9%) (p

The Internet has become a major source of health information for consumers. Nevertheless the quality of medical information varies widely and is generally poor. Aim This study aimed to evaluate the quality of information delivered on French-speaking Internet about the diabetic foot. Methods Websites were selected using three popular search engines and introducing “foot + diabetes” and “foot + diabetic” as keywords. Two diabetologists independently evaluated the quality of information using a specially created scoring grid (range 0–52) based on acknowledged and published criteria with items relevant to general characteristics of the site and to information content. One hundred and twenty websites were selected but only 27 were included for analysis. Results Agreement between the two raters was close for global score and site content but lower for site characteristics. Averaged global score ranged from 8 to 44. Only five sites were assessed as very advisable with a score higher than 39; in contrast 18 sites were judged as not advisable at all (score lower than 26). Conclusion This study, the first to be devoted to information about the diabetic foot on the Internet, clearly shows the variability and the general poor quality of information delivered by the great majority of French-speaking websites. Regulation organisms are urgently needed for checking and labelling public oriented health information in order to make the Internet a performing tool for patient information.

Introduction Evaluer l’utilite de tests de PCR automatises, rapides (50 min) pour detecter Staphylococcus aureus (et la methicillinoresistance) dans les plaies et le nez chez le diabetique. Patients et methodes 276 adultes diabetiques (72 % d’hommes, âge median : 68,5 ans), ayant une plaie infectee du pied ont ete inclus du 1/09/10 au 30/03/12 dans 3 centres specialises francais. Apres debridement, un prelevement etait realise par ecouvillonnage de la plaie. Un ecouvillonnage nasal etait egalement effectue. Les ecouvillons a deux tetes etaient soient ensemences sur milieux geloses, soient testes sur systeme GeneXpert ® . Les sensibilites (Se), specificites (Sp), valeurs predictives negatives (VPN) et positives (VPP) de ce systeme ont ete determinees avec la culture comme reference. Resultats 462 bacteries ont ete isolees (1,67 bacteries/prelevement). La prevalence du portage de S. aureus etait de 62,7 % au niveau des pieds et 39,5 % au niveau nasal. 101 (36,6 %) patients etaient porteurs de la bacterie dans les 2 sites. La prevalence des staphylocoques methicillinoresistants (SARM) etait de 17 %. Pour la detection de S. aureus dans les plaies par GeneXpert ® , la Se etait de 100 %, la Sp de 93,2 %, VPN et VPP de 100 % et 95,8 %, respectivement. Pour la detection de S. aureus dans le nez, la Se etait de 100 %, la Sp de 97,0 %, et VPN et VPP de 100 % et 95,6 %, respectivement. Aucune difference n’a ete observee pour la detection des SARM. Conclusion Cette etude montre l’importance de S. aureus dans les plaies du pied et le nez des diabetiques. Les performances du systeme GeneXpert apparaissent excellentes. Il est concevable qu’un tel systeme puisse etre implante dans des centres specialises, permettant une utilisation plus raisonnee des antibiotiques.

Objectif Comme une etude pilote avait precedemment montre la presence d’une population de Staphylococcus aureus colonisante appartenant aux complexes clonaux CC5 et CC8 sur les plaies du pied chez le diabetique, le but de la presente etude a ete d’evaluer la prevalence de ces souches en France. Patients et methodes Les patients adultes diabetiques (type 1 et 2), presentant une plaie du pied (grades 1–4; SPILF 2007) avec S. aureus comme seul pathogene ont ete inclus du 1/04/08 au 30/06/10 dans 12 CHU francais. Tous les patients avec plaie de grade 1 (non infectee) ont eu une consultation de suivi dans le mois suivant au cours de laquelle un 2e prelevement a ete effectue. L’origine clonale des souches a ete detectee par biopuces a ADN (StaphyType96®, Alere). Resultats 195 patients ont ete inclus (71% d’hommes, 75 plaies de grade 1) et 223 souches de S. aureus ont ete isolees dont 35 methicillino-resistantes lors de la consultation inaugurale ou de suivi. A l’inclusion, 44 (59%) souches isolees de plaies de grade 1 appartenaient aux clones CC5/CC8 contre 6 (5%) dans les plaies infectees (grades 2–4) (p Conclusion Cette etude demontre l’existence en France d’une population de S. aureus colonisante presente sur les plaies du pied chez le diabetique. L’identification de ces souches permet de distinguer les colonisations (grade 1) des infections (grades 2–4), predire le devenir de la plaie et devrait contribuer a un meilleur usage des antibiotiques dans la prise en charge des plaies du pied chez le diabetique.

But Evaluer l’equilibre metabolique et les modalites de prise en charge (PEC) des diabetiques hospitalises dans un pole medical a orientation vasculaire et metabolique (10 services). Comparer la PEC dans les services non specialises en diabetologie (NSD) (8 services) a celle des 2 services specialises en diabetologie (SD) du meme pole. Patients et Methodes Enquete prospective transversale sur un jour realisee a l’aide d’un questionnaire standardise rempli par des etudiants hospitaliers prealablement formes. Resultats Sur 363 patients hospitalises, 30 % sont diabetiques dont 55 % dans un service NSD : âge moyen 69 ± 11,9 ans, H/F 55/45, BMI non renseigne dans 27,5 % des cas ; 84 % sont DT2, 78,2 % hypertendus et 61 % insulines a l’entree ; HbA1c > 7 % pour 50 % et > 8 % pour 20,5 % d’entre eux mais non dosee chez 43,3 % des patients NSD vs 11,5 % en SD ; Complications liees au diabete presentes a l’entree non connues chez 41 % des patients NSD contre 11,4 % en SD ; recueil tres incomplet pour la retinopathie et l’antecedent de plaie des pieds : + de 50 % ; recherche des complications pas systematique au cours de l’hospitalisation : ECG peu oublie (seulement 17,2 % NSD et 13,4 % SD), mais nephropathie non recherchee dans 93,3 % des cas NSD vs 8,1 % SD et fond d’œil peu realise (NSD 11,5 % vs SD 83,7 %) ; bilan lipidique effectue dans seulement 43,3 % en services NSD contre 79,7 % en SD. Avis du diabetologue sollicite dans les services NSD que dans 15,7 % des cas bien que 85,5 % de ces patients n’aient pas de suivi specialise. Conclusion Cette etude transversale montre : la forte prevalence de la population diabetique dans nos services de Medecine a orientation vasculaire et metabolique ; la difficulte a evaluer la qualite de la PEC du DS selon les recommandations de l’HAS, meme en milieu hospitalo-universitaire. La non remise en question du traitement du diabete malgre un equilibre glycemique particulierement insuffisant dans une population a haut risque vasculaire. Ces resultats plaident pour la mise en place de structures transversales specialisees intra-hospitalieres capables d’assurer une PEC globale du diabetique.

Introduction L’hypothyroidie concerne 2 % de la population feminine et touche environ 0,3 a 2,5 % des femmes enceintes (hypothyroidie averee 0,3-0,7 %, hypothyroidie fruste 2,2-2,5 %). Elle est definie par une TSH ≥ 2,5mU/l, et peut avoir des repercussions notables sur le deroulement de la grossesse, le developpement fœtal et intellectuel de l’enfant. En effet, des etudes ont montre que le quotient intellectuel d’enfants de 9 ans, nes de meres en hypothyroidie moderee pendant la grossesse etait inferieur a celui d’une population temoin. Il n’existe, pourtant, aucun consensus quant au depistage systematique de l’hypothyroidie en debut de grossesse. Le diabete gestationnel est, par ailleurs, une pathologie frequente de la grossesse puisqu’elle concerne 3 a 6 % des femmes enceintes. Patients et methodes L’objectif de ce travail est d’evaluer la prevalence de l’hypothyroidie et des anticorps anti-thyroperoxydase et anti-thyroglobuline dans une population de femmes presentant un diabete gestationnel. Celui-ci a ete diagnostique a partir de la 24e semaine d’amenorrhee (hyperglycemie provoquee orale 75 ou 100 g de glucose) chez 105 femmes âgees de 23 a 45 ans, hospitalisees dans le service de Maladies metaboliques et Endocriniennes du C.H.U. de Nimes. Etaient exclues les patientes ayant des antecedents de dysthyroidie, les grossesses diabetiques, les grossesses gemellaires. L’hypothyroidie etait definie par une TSH ≥ 2,5mU/l (dosage chimiluminescent immunometrique), avec ou sans anomalies des hormones libres (dosage immunoradiometrique). Resultats Dans cette population, l’hypothyroidie est retrouvee dans 26,67 % des cas, avec une prevalence de positivite des anticorps de 4,76 % dans la population globale et de 2,86 % dans le groupe hypothyroidie. La T4 libre n’est retrouvee basse que chez 3 femmes, dont 2 ayant une TSH normale. Conclusion Malgre la faible positivite des anticorps anti-TPO retrouvee, posant la question du mecanisme physiopathologique, la prevalence de l’hypothyroidie est fortement augmentee en cas de diabete gestationnel, necessitant un controle a plus grande echelle et soulevant a nouveau le debat du depistage de l’hypothyroidie au cours de la grossesse.