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Introduction Elderly residents of nursing homes (NHs) and long-term care units (LTCUs) have been shown to have a high risk of mortality and morbidity in cases of SARS-CoV-2 infection. The objective of this study was to examine the kinetics of neutralizing antibodies (NAbs) directed against the SARS-CoV-2 virus in residents of the NH and LTCU units of our University Hospital who were identified with positive serology after the first epidemic outbreak. Materials and Methods The participants included were sampled every three months for qualitative serological testing, as well as quantitative testing by neutralization tests using retroviral particles containing the S glycoprotein of SARS-CoV-2. Vaccination using the Comirnaty (Pfizer BNT162b2) vaccine begun before the last serological follow-up. Results The median NAb titer in June 2020 was 80 [40; 60] versus 40 [40; 160] three months later, showing a statistically significant decline (p < 0.007), but remained stable between the three- and six-month timepoints (p = 0.867). By nine months after vaccination, we observed a significant difference between vaccinated residents known to have positive serology before vaccination (SERO+, Vacc+) and those vaccinated without having previously shown COVID-19 seroconversion (SERO−, Vacc+), the latter group showing similar titers to the SERO+, Vacc- participants (p=0.166). The median antibody titer in SERO+, Vacc+ patients increased 15-fold following vaccination. Discussion Humoral immunity against SARS-CoV-2 appears to be persistent in elderly institutionalized patients, with a good post-vaccination response by residents who had already shown seroconversion but a notably diminished response by those who were seronegative before vaccination. To evaluate immunity in its entirety and elaborate a sound vaccination strategy, the cellular immune response via T cells specific to SARS-CoV-2 merits analysis, as this response is susceptible to being affected by immunosenescence.

SummaryObjectiveThe objective of this study was to monitor the anti-SARS-CoV-2 antibody response in infected patients.MethodsIn order to assess the time of seroconversion, we used 151 samples from 30 COVID-19 inpatients and monitored the detection kinetics of anti-S1, anti-S2, anti-RBD and anti-N antibodies with in-house ELISAs. We also monitored the presence of neutralizing antibodies in these samples as well as 25 asymptomatic carrier samples using retroviral particles pseudotyped with the spike of the SARS-CoV-2.ResultsWe observed that specific antibodies were detectable in all inpatients two weeks post-symptom onset. The detection of the SARS-CoV-2 Nucleocapsid and RBD was more sensitive than the detection of the S1 or S2 subunits. Neutralizing antibodies reached a plateau two weeks post-symptom onset and then declined in the majority of inpatients. Furthermore, neutralizing antibodies were undetectable in 56% of asymptomatic carriers.ConclusionsOur results raise questions concerning the role played by neutralizing antibodies in COVID-19 cure and protection against secondary infection. They also suggest that induction of neutralizing antibodies is not the only strategy to adopt for the development of a vaccine. Finally, they imply that anti-SARS-CoV-2 neutralizing antibodies should be titrated to optimize convalescent plasma therapy.HighlightsSpecific antibodies are detectable in 100% COVID-19 inpatients two weeks post-symptom onset.The detection of the SARS-CoV-2 Nucleocapsid and Receptor Binding Domain is more sensitive than the detection of the S1 or S2 subunits.Neutralizing antibodies reach a plateau two weeks post-symptom onset and then decline in the majority of inpatients.Neutralizing antibodies are undetectable in the majority of asymptomatic carriers.

Aim To analyze the factors associated with the time to initiating tuberculosis contact investigations in the Somme department, France. Methods All reported tuberculosis cases and all their contacts screened between 2007 and 2011 were retrospectively included. Univariate and multivariate analyses were conducted to determine the factors associated with a “system delay” ≤ 1 month and a “contact delay” ≤ 0 days. Results The mean time between the mandatory notification of a case of tuberculosis and the date set for the contact's screening (system delay) was 35.3 days and the average time between that date and when the contact was actually screened (contact delay) was 12.5 days. In multivariate analysis, a smear-positive sputum sample (OR: 3.68; 95% CI: 1.63–8.30) and a diagnosis at the university hospital (OR: 2.61; 95% CI: 1.14–5.96) were significantly associated with a system delay ≤ 1 month. A smear-positive sputum sample (OR: 1.35; 95% CI: 1.08–1.69), male gender (OR: 1.21; 95% CI: 1.01–1.49), being born in a foreign country (OR: 1.31; 95% CI: 1.02–1.69), being a family member (OR: 1.37; 95% CI: 1.05–1.77), or being another type of close contact of the case (OR: 2.47; 95% CI: 1.81–3.36) were significantly associated with a contact delay ≤ 0 days. Conclusion System and contact delays were longer than recommended, and the factors associated with the lengthening of these delays need to be taken into account.

Background The associated factors contributing to a delay in mandatory tuberculosis notification in the Somme department, France, are not yet known. The objective of this study was to analyze these factors. Methods All reported cases of tuberculosis between 2007 and 2011 were retrospectively included. Univariate and multivariate analyses were conducted to investigate the factors associated with a short time to notification, i.e., ≤48 h. Results Between 2007 and 2011, a total of 175 cases of tuberculosis were reported to the Somme Regional Health Agency. Of the 145 (83.8%) cases of tuberculosis with at least one pulmonary location, 57.7% had a positive sputum smear. The mean time between the diagnosis of tuberculosis and mandatory notification was 6.1 days. It was 2.6 days for tuberculosis cases with a positive sputum smear versus 8.3 days for cases with a negative sputum smear; 2.0 days for severe cases and 6.3 days for simpler forms. In multivariate analysis, only a positive sputum smear was significantly associated with a short time to mandatory notification (OR 2.44; 95%CI 1.18–5.00; P = 0.02). Conclusion The time to mandatory notification is longer than recommended. Better collaboration between the parties involved in tuberculosis control and their continuing medical education could reduce this delay in the Somme department.

The biopsies of prostate are the reference examination to assert the diagnosis of prostate cancer. Even if the urinary infectious complications are rare thanks to the systematic oral antibiotic prophylaxis, they may still be serious. The SPILF (Society of Infectious Pathology and French language) published in 2014, an important increase of the resistances in fluoroquinolones for Escherichia coli (3 to 25%), whereas this is the most bacterium frequently found in the urinary infections (70-80%). The objectives of this study were to estimate the indicence of the febrile urinary tract infections after prostate needle biopsy and to define the ecology and the profile of E. coli's resistance.A total of 466 transrectal ultrasound-guided needle prostate biopsy were included in the study from 2012 to 2015. All the patients were taken care according to the recommendations of the AFU (Ouzzane et al., 2011). We estimated, for all the inclusive patients, if they had presented a clinic sign of urinary infection like fever or burning which suggestive of an urinary infection, and having a urines and blood culture, in the next 30 days the realization of the medical exam.Among 466 realized biopsies, seven patients developed a febril urinary tract infection (1.5%) [prostatitis (n=6), orchitis (n=1)]. Five infections to E. coli were identified; two were resistant for fluoroquinolones (40%). No germ was able to be identified for two patients.The infectious complications post-biopsy of prostate are rare (1.5%). E. coli is the germ most frequently identified with 40% of resistance with fluoroquinolones.4.

International audience; The worldwide burden of hepatitis C virus (HCV) infection is a major public health concern. New direct antiviral agents (DAAs) have revolutionised the management of HCV infection, with eradication rates higher than 90%. However, their high cost has precluded their widespread use, leading to restrictive conditions of prescription in many countries. DAAs have been available to all people living in France who are infected with HIV for 2 years (fi rst via temporary authorisation and then via marketing authorisations) regardless of their liver fi brosis stage.

International audience; BACKGROUND: The combination of one non-nucleoside reverse transcriptase inhibitor (NNRTI) with two nucleoside reverse transcriptase inhibitors is a validated first-line antiretroviral (ARV) therapy. The once-daily combination of lamivudine, tenofovirDF and nevirapine has not been evaluated in a clinical trial. METHODS: Randomized, open-label, multicentre, non-inferiority trial comparing lamivudine, tenofovirDF and nevirapine once daily (Group 2) with zidovudine/lamivudine and nevirapine twice daily (Group 1), in naive HIV-1-infected patients with a CD4 count

The hepatitis C virus (HCV) neutralizing antibody (nAb) response in 37 subjects with HCV monoinfection and 37 HCV-infected subjects with well-controlled human immunodeficiency virus (HIV) infection was evaluated using a focus reduction neutralization assay. HCV nAb levels were retrospectively studied in both groups of patients, who were matched on the basis of sex, age, and HCV genotype. The mean HCV nAb level (+/- standard deviation) among coinfected patients (1.613+/-0.416) was significantly less than that among monoinfected patients (1.912+/-0.578) (P= .013). Lower HCV nAb titers in coinfected patients could help worsen the outcome of HCV infection. These results favor starting HCV therapy as soon as possible in coinfected patients.

International audience; BackgroundAn epidemic of measles broke out in France in 2008. We designed a retrospective study focusing on adults hospitalized for measles in 2010/2011.MethodsA case was any patient aged more than 15 years, hospitalized (September 2010 to September 2011) with a typical rash or a biological diagnosis. Data was collected with standardized questionnaires in participating hospitals.ResultsFour hundred and sixty cases were reported: sex-ratio (M/F) = 0.93, median age 26 years (σ = 8.8). Twenty-nine cases were severe (6.5%), 27 of which hospitalized in an ICU. Three hundred and twelve (68%) cases had elevated serum transaminases (EST), 155 (34%) cases had pneumonia, 34 (7%) cases had elevated serum creatinin (ESC), four (0.9%) cases had elevated serum amylase and lipase (ESAL), and three (0.7%) cases had neurological symptoms. One hundred and four (23%) patients presented simultaneously with EST and pneumonia. One patient presenting with severe pneumonia died (0.2%). One hundred and ten (24%) patients received antibiotics during a median seven days.ConclusionMeasles can present as various syndromes in adults and be responsible for a high burden during outbreaks. The immediate outcome is favorable in most patients. Long-term outcome needs further investigations to identify possible late complications.; ContexteUne épidémie de rougeole est survenue en France, de 2008 à 2011. Nous avons mené une étude rétrospective, sur les adultes hospitalisés pour rougeole.MéthodesUn cas était un patient âgé de plus de 15 ans, hospitalisé (septembre 2010 à septembre 2011) présentant un rash typique ou un diagnostique biologique. Les données ont été recueillies grâce à un questionnaire standardisé, dans les centres hospitaliers participants.RésultatsQuatre cent soixante cas ont été recueillis: sex-ratio (M/F) = 0,93, âge médian 26 ans (σ = 8,8). Vingt-neuf cas ont été graves (6,5 %), dont 27 hospitalisés en soins intensifs. 312 (68 %) cas ont présenté des transaminases sériques élevées, 155 (34 %) cas ont présenté une pneumonie, 34 (7 %) cas avaient une créatininémie élevée, quatre (0,9 %) cas avaient des amylasémies et lipasémies élevées, et trois (0,7 %) cas avaient des symptômes neurologiques. Cent quatre (23 %) patients ont présenté simultanément des transaminases élevées et une pneumonie. Une patiente avec une pneumonie grave est décédée (0,2 %). Cent dix (24 %) patients ont reçu une antibiothérapie pendant une durée médiane de sept jours.ConclusionLa rougeole de l’adulte peut se présenter sous des formes cliniques variées et peut être un important fardeau de santé publique en cas d’épidémie. Le pronostic immédiat est favorable chez la plupart des patients. Un suivi à long terme est cependant nécessaire afin d’identifier de possibles complications tardives.

Background In France, the human papillomavirus vaccine is routinely recommended for 14-year-old females and a “catch-up” vaccination should be offered to female adolescents who are between 15 and 23 years of age. Currently, few studies are available on the coverage rates in France. The aim of this study was to evaluate the coverage of the human papillomavirus vaccine and compliance with the vaccination scheme in Picardy, between 2009 and 2010, and to analyze the socioeconomic factors possibly influencing this coverage. Methods We selected a female population that was affiliated with the national health insurance organization, living in the Picardy region of France, and aged between 14 and 23 years on 31st December 2010. Results The coverage rate in the study population with at least one dose of vaccine was 16.8%. A complete vaccination scheme (three doses) was observed in less than 38.9% of them, so only 6.5% of this population had received the complete vaccination. Higher rates of coverage and compliance were observed in girls 14 years of age (65.5%) and if the prescriber was a gynecologist or pediatrician (respectively, 44.7% and 48.1%). There is a negative correlation between coverage and compliance and the percentage of single-parent families and immigrant families by canton area of Picardy. The economic cost of an inappropriate scheme was 1.3 million euros for Picardy in 2009. Conclusion Coverage and compliance rates of human papillomavirus vaccines in Picardy appear to be low. This study suggests that health authorities in Picardy should provide communication and action campaigns to improve these results.

Lymph node tuberculosis (LNTB) is the most frequent form of extra-pulmonary tuberculosis (TB). Randomised, controlled trials have convincingly demonstrated that 6 months of chemotherapy is sufficient for most drug-susceptible LNTB. We performed a retrospective, multicentric study from 1997 to 2010 to describe factors associated with prolonged anti-tuberculosis treatment in patients with LNTB. Of 126 patients diagnosed with LNTB, 22 (17.5%) were human immunodeficiency virus (HIV) infected. The median treatment duration was 9 months (interquartile range, 6-12). Treatment was significantly longer in patients with HIV (P0.01), additional sites of TB (P0.01) or weight loss (P = 0.04). Factors independently associated with excessively lengthy treatment were HIV co-infection and the presence of other TB foci.

Purpose: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners' (GPs') office and identify barriers to and drivers for better practice. Materials and Methods: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. Results: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%), treat wounds (10%), fit intrauterine devices (18%) or perform injections (18%). The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7), inspection by the health authorities (4.8) and the fear of legal action (4.4). Conclusions: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.

The match between the real-life therapeutic management of chronic hepatitis B (CHB) in HIV-infected patients and the recommendations that existed at the time has never been assessed on a case-by-case basis.A total of 73 HBV-HIV coinfected patients, 34 of whom were first followed in 2003-2005 and 39 in 2006-2008 (before and after the 2005 European Consensus Conference on the treatment of chronic viral hepatitis in HIV coinfected patients), were included. All the data were retrospectively collected from their first visit to October 2008 through a standardised questionnaire.Baseline HBV DNA quantification and/or liver histology were missing in 44.1 and 28.2% of cases before and after 2005, respectively (p = 0.16). The observed management significantly differed from the recommendations for the whole population (p = 0.009), for the 2003-2005 group (p = 0.02), and tended to differ for the 2006-2008 group (p = 0.07). Therapeutic management of CHB was in accordance with the recommendations in 27 (57.4%) cases, with a higher rate of untreated patients in the 2003-2005 group, and a high rate of patients on dual therapy in both groups despite the fact that HBV therapy was not recommended.Even though global management of HBV-HIV coinfected patients is improving, baseline evaluation of CHB though necessary is still often insufficient. The strong rationale for early dual anti-HIV and anti-HBV therapy, and the reality of everyday clinical practice, bring support to the recent simplification of the recommendations widening the use of tenofovir and emtricitabine in HBV-HIV coinfected patients, irrespective of immunological, virological, or histological considerations.

Non tuberculous mycobacteria (NTM), unlike tuberculous mycobacteria, are not strictly human pathogens. The diagnosis of infection and the choice of treatment remain difficult.Evidence of a NTM in a pulmonary sample is not synonymous with infection. The diagnosis depends on the association of clinical, radiological and microbiological factors. If a NTM is isolated from a respiratory sample, the probability of infection depends on the species. The main NTMs responsible for pulmonary infection in France are Mycobacterium avium intracellulare, Mycobacterium xenopi, Mycobacterium kansasi and Mycobacterium abscessus. Their management is difficult and poorly understood. Treatment is well established for M. avium intracellulare and M. kansasii, with combinations of clarithromycin-rifampicin-ethambutol and isoniazid-rifampicin-ethambutol respectively. For M. xenopi, the optimal treatment is not known and a combination of clarithromycin-rifampicin-ethambutol, with moxifloxacin as an alternative, is currently recommended. In general, treatment is prolonged and often associated with problems of tolerance.The management of NTM infection, taking into account of the increase in patients "at risk", is an important issue. Further studies are needed to improve the criteria for infection and to find the optimal therapeutic combinations.

Lymph node infection is the most frequent localization of extrapulmonary tuberculosis. However, there is still no consensus on the length of antimicrobial treatment.We conducted a retrospective study in the Department of infectious diseases and internal medicine in the Amiens Teaching Hospital, France. All patients diagnosed with lymph node tuberculosis between 1998 and 2007 were included; some patients presented with bi- or multifocal tuberculosis. The aim of the study was a practice analysis.We studied 48 medical records, 16 were excluded for lack of more than 40% of data or because lymph node tuberculosis was non-active. The mean age of the 32 patients included was 49 years. The mean duration of treatment was 10.9 months (standard deviation 2.6, median 11, range 6-18). There was no statistical age difference between subgroups (lymph node tuberculosis versus multifocal tuberculosis). There was no significant difference between the 6-month treatment group and the 9-month treatment group in term of clinical response. One relapse was diagnosed, eight patients (25%) were lost to follow-up at 1 year after treatment. DISCUSSION AND REVIEW: No reliable published data was found as to the optimal duration of treatment. A high quality clinical trial should be carried out to suggest a consensus.

Resume La survenue d'une evolution defavorable lors d'infections des voies respiratoires inferieures, n'est pas due tant a l'agent infectieux, qu'au terrain sous-jacent. Grand âge, immunosuppression et autre terrain debilite, quel que soit l'agent causal, entrainent plus souvent des complications gravissimes aigues, voire la mort. Le principal facteur de gravite d'une pneumopathie communautaire, sur un terrain debilite, est le retard a l'instauration d'une antibiotherapie, couvrant pneumoccoque, staphylocoque aureus et bacilles G-.

Background: Owing to its low incidence, the management of Mycobacterium xenopi pulmonary infections is not clearly defined. A multicentre retrospective study was performed to describe the features of the disease and to evaluate its prognosis. Methods: All patients with M xenopi satisfying the 1997 ATS/IDSA criteria from 13 hospitals in north-east France (1983–2003) were included in the study. Clinical, radiological and bacteriological characteristics and data on the management and outcome were collected. Results: 136 patients were included in the analysis, only 12 of whom presented with no co-morbidity. Three types of the disease were identified: (1) a classical cavitary form in patients with pre-existing pulmonary disease (n = 39, 31%); (2) a solitary nodular form in immunocompetent patients (n = 41, 33%) and (3) an acute infiltrate form in immunosuppressed patients (n = 45, 36%). 56 patients did not receive any treatment; the other 80 patients received first-line treatment containing rifamycin (87.5%), ethambutol (75%), isoniazid (66.2%), clarithromycin (30%) or fluoroquinolones (21%). After a follow-up of 36 months, 80 patients (69.1%) had died; the median survival was 16 months (range 10–22). Two independent prognostic factors were found: the acute infiltrate form was associated with a bad prognosis (hazard ratio 2.6, p = 0.001) and rifamycin-containing regimens provided protection (hazard ratio 0.325, p = 0.006). Clarithromycin-containing regimens did not improve the prognosis. Conclusions: In contrast to recent guidelines, this study showed three different types of the disease (cavitary, nodular or diffuse infiltrate forms) with a different prognosis. In order to improve survival, all patients with M xenopi infection should be treated with a rifamycin-containing regimen. The usefulness of clarithromycin remains to be evaluated.

The main characteristics of clindamycin are adequate for treatment of osteoarticular infections (OAI): good bone diffusion, broad spectrum of antibacterial activity and oral use.A number of 61 patients was included in an observational retrospective study of efficacy and tolerance.Prosthetic infections accounted for 50.8% of the cases and chronic osteitis for 36.1%. The causative micro-organisms were Staphylococci (72.2%) and Streptococci (15.3%); 86.5% of these strains were susceptible to erythromycin, 9.6% were erythromycin resistant and susceptible to lincomycin. Clindamycin was associated with either ofloxacine, rifampicin, or teicoplanin in 88.5% and the average course duration was 101 days. A surgical procedure was performed in 84% of cases. Complete cure was obtained in 91.1% at 18 months of follow up. Only one cutaneous rash and one Clostridium difficile-associated diarrhea occurred. The other adverse effects were gastrointestinal in 36%, cutaneous in 6.6%, and hematological in 1.6%, but did not lead to discontinuation of therapy.Clindamycin can be used in OAI in association with or as an alternative to rifampicin, fluoroquinolones, or glycopeptides according to microbiological data.

The purpose of this report is to describe a case of febrile hypereosinophilic syndrome in a traveler three weeks after returning from a sightseeing trip to Guinea. Laboratory testing demonstrated an inflammatory response syndrome and hepatic cytolysis. Parasite serology led to suspicion of toxocariasis that was treated using albendazole. Follow-up tests at two months showed the presence of Schistosoma mansoni eggs in stools despite negative standard serodiagnostic testing (hemagglutination). Secondarily Western blot testing of serum samples at one, two and 14 months after returning from Guinea continued to show only protein bands specific to toxocariasis with no bands specific to bilhariziasis. These findings provide further evidence of the limitations of serological testing for detection of bilharziasis in travelers and the difficulty of diagnosis. Guinea is a high-risk tourist destination. Intestinal and urinary bilharziasis are endemic over three-fourths of country. Travelers planning even short stays in areas where bilharziasis is endemic should be advised on preventive measures.

To assess the incidence and risk factors for severe liver toxicity in human immunodeficiency virus (HIV) infected patients on anti-tuberculosis treatment and the impact of patients' characteristics and concomitant medications instituted during the first week of antituberculosis treatment.HIV-infected patients referred to six French hospitals between 1 January 1992 and 31 December 2004, with confirmed or 'presumptive' tuberculosis (TB). Liver toxicity was studied during the first 2 months of TB treatment.During the 12 years of the study period, 144 patients were enrolled. Severe liver toxicity developed in 15 (10.7%). The median time to development of liver toxicity was 14 days. In the univariate analysis, high baseline bilirubin levels (P = 0.004), CD4 cell counts between 50 and 100 cells/mm3 (P = 0.022) and the use of fluconazole (P = 0.0005) were associated with liver toxicity. In the multivariate analysis, independent risk factors were abnormal baseline alanine aminotransferase (ALT) (P = 0.028) and bilirubin levels (P = 0.033) and the use of fluconazole (P = 0.008).Severe liver toxicity is frequent, and occurs early in the course of anti-tuberculosis treatment. ALT and bilirubin levels should be closely monitored during the first month of treatment, especially in patients with high baseline ALT or bilirubin levels. We suggest caution when prescribing fluconazole and anti-tuberculosis drugs concomitantly, although this needs to be confirmed and further investigated.

Study the health-care associated infection risk due to Extended-Spectrum Betalactamases Producing Escherichia coli (ESBL Esc) isolated from diagnostic samples.Descriptive, longitudinal and prospective study of 104 diagnostic isolates of ESBL Esc, one per patient, identified in Amiens university hospital between February 1999 and December 2005. Patients (sex, age, contamination risk factor, antecedent hospitalization) and microbiological data were progressively collected, entered into EPI INFO 6.04dFr software (ENSP, France) database, and compared using the chi-square test and Wilcoxon rank sum test, as appropriate. A p value of less than 0.05 was considered significant.Diagnostic ESBL Esc isolates raised, per 1000 isolates of Esc, from 1.2 in 1999 to 6 in 2005. Global and acquired isolates number of ESBL Esc varied from 7 and 3 in 2002 to 25 and 19 in 2003 (P=0.22). ESBL Esc global and acquired incidence per 10(5) patient-days were, 0.8 and 0.6 in 1999 and 4.99 and 3.4 in 2005 (P10(-6)), but rose from 0.6 acquired isolate in 2002 to 3.9 in 2003 (P=0.002). ESBL Esc, isolated from urines, stools, pulmonary, blood and surgical site samples of patients of/=65 years aged (68.3%), were imipenem and latamoxef sensitive. Their acquisition risk factors found were hospitalization during the last 6 month period (40/104) and transfer from other institutions (20/104).ESBL Esc isolates, among ESBL-producing Enterobacteriaceae, constitute an escalating health-care associated risk in our institution. The research at admission time of ESBL-producing Enterobacteriaceae, mainly in acute geriatric wards, strict isolation precaution and hand hygiene observance, rational antibiotic usage, are the key actions to control their cross transmission. Nonetheless, other studies are needed to determine whether we are in front of an ESBL Esc new clone emergence.

Streptococcus pneumoniae primary peritonitis is rare. The diagnosis is uneasy and the treatment is not standardised.We report a single case of S. pneumoniae primary peritonitis needing surgical treatment.S. pneumoniae primary peritonitis can be medically treated. Surgery is needed in case of sepsis, associated digestive injuries or failure of medical treatment.

To study the circumstances of diagnosis, the supporting factors, the bacteriology, and the therapeutic management of peritonsillar abscesses (quinsy).This was a retrospective study over a period of 10 years in 98 patients hospitalized in an ENT and Head and Neck Surgery department for peritonsillar abscess.Ninety percent of cases of peritonsillar abscesses complicated angina. Forty-nine percent of patients had no previous antibiotic therapy, 9% had a previous history of peritonsillar abscess, 62% were treated in the emergency department, and fever was present in 64% of cases. The diagnosis was clinical in 98% of cases. The average hospitalization stay lasted 2 days. Sixty-five percent of patients had one needle aspiration of the abscess, 35% had surgical drainage with local anaesthesia. The needle aspiration was negative in 14% of cases. In 29% of cases one bacterium was identified. The patients were completely cured in 10 days. Forty-five percent of patients underwent tonsillectomy at a later date.The progression of peritonsillar abscess is favorable in 2-3 days since a local therapeutic act (needle aspiration or drainage) is done associated with an antibiotic and corticoid treatment that is initially intravenous. An emergency tonsillectomy can be proposed in cases of recurrent tonsillitis or peritonsillar abscess.

Methicillin-resistant Staphylococcus aureus (MRSA) constitute the most important multiresistant bacteria (MRB) recovered in French hospitals. Our objective was to measure these MRSA diffusion in our hospital to evaluate the MRB control programme which had been implemented in the beginning of 1999. This study was conducted in a teaching hospital containing 1800 beds, from February 1999 to January 2001. All MRSA isolated in clinical samples were included. Duplicates (same bacteria in the same patient) were excluded. The detection of methicillin-resistance was performed at 30 degrees C, by disk diffusion method. Incidence densities were determined with their 95% confidence interval (CI 95%). Their evolution by four-month period was evaluated with the chi-square test for trend. During the two-year period, 866 MRSA were isolated. The global incidence was 0,88 per 1000 patient-days (PD) (IC 95% = left open bracket 0,83-0,93 right open bracket ). For cases acquired in our hospital the incidence was 0,66 per 1000 PD, whereas it was 0,26 per 1000 PD for imported cases. Concerning the evolution of incidences, no significant trend was observed for global incidence. The incidence of acquired MRSA decreased during the first year, but increased thereafter. The incidence of imported MRSA increased with a significant trend (p10(-5)). The number of these imported MRSA isolated in our hospital was twice fold higher in 2000. This study emphasizes an important actual problem : the increase of patient colonization pressure at the time of admission in hospitals. This increase, which can be due in part to a community transmission, is responsible for a reduction of the efficacy of MRSA control programmes.

French Guyana is an endemic area for American cutaneous leishmaniasis. At the start, the initial red lesion may be mistaken for a whitlow. Twenty percent of developed forms exhibit a sporotrichosis pattern. The notion of travel to an endemic area is very important for diagnosis. We report the case of a young man from French Guyana presenting with a cutaneous lesion of the finger. After numerous surgical treatments for a "whitlow", the final diagnosis of leishmaniasis was difficult because of local-complications and cutaneous rearrangement. Erroneous initial orientation in a unit unaware of tropical diseases can forestall appropriate care of the patients. Epidemiological, clinical and therapeutic data on American tegument leishmaniasis are discussed.

771 cases of erysipelas and 52 cases of infectious cellulitis were collected over 3 months in a prospective study carried out in French hospitals. The mean age was 62.7 +/- 19.3 years for the erysipelas patients and 69.7 +/- 16 years for the cellulitis patients. Sex-ratios were respectively 0.92 and 2.7. The infection was mainly localized in the lower limbs in both categories (90.9 p. 100 and 71 p. 100); the upper limbs and the face were more often involved in cellulitis than in erysipelas (13 p. 100 versus 5.2 p. 100 and 10 p. 100 versus 2.5 p. 100). Penicillin G was the initial antimicrobial treatment in 45 p. 100 of the erysipelas cases, whereas amoxicillin-clavulanic acid was used in 32.7 p. 100 of the cellulitis cases. Other antibiotics used were pristinamycin, antistaphylococcal penicillin, and amoxicillin. Combinations of antibiotics were used to treat 50 p. 100 of the cellulitis cases but only 11 p. 100 of the erysipelas cases. Anticoagulants were used in 67.4 p. 100 of the erysipelas cases and in 59.7 p. 100 of the cellulitis cases. Surgery was performed in 52 p. 100 of the cellulitis cases, and hyperbaric oxygen in 4.2 p. 100. The outcome was quite different for the 2 diseases: cure rate without complications reached 86.6 p. 100 for erysipelas, and only 48.1 p. 100 for cellulitis; death rates reached respectively 0.77 p. 100 and 5.7 p. 100, median length of hospitalization 8 days and 21 days, and median length of antibiotic treatment 15 days and 21 days.

The author had for aim to collect data on how general practitioners deal with bacterial hypodermal inflammation.An enquiry on practice and a prospective study were carried out over 3 months.The mean number of cases reached 0.54 per physician over the 3-month period, for a total of 103 cases of bacterial hypodermal infection. The patients'mean age was slightly superior to 60 years, with a high female predominance and a preferential site of infection located in the lower limbs (89.6 p. 100 of the cases). 20 p. 100 of the patients were immediately sent to hospital, mainly because of the importance of local and/or general symptoms, and of the underlying conditions. In home care, antibiotic therapy was almost always oral and consisted in courses of group A penicillin or pristinamycin in over half of the cases, for a mean duration of 12.4 days for erysipelas, and 9.1 days for cases classified as "other type of bacterial hypodermal infection". An anticoagulant treatment was associated in close to 30 p. 100 of the cases, and anti-inflammatory or corticoids agents were prescribed in 17.9 p. 100 of the cases. The cure rate among home care patients reached 89.3 p. 100 and only 3 patients were hospitalized after the initial treatment; these 3 patients had all been given non-steroidal anti-inflammatory agents.

A six-month prospective study of costs associated with antimicrobial therapy in nosocomial bacteremia was conducted from November 1, 1995 to April 30, 1996 in a 1837-bed teaching hospital, with the help of the hospital pharmacists and hospital hygiene unit. Only the costs due to the antimicrobials themselves were taken into account. A total of 238 cases of nosocomial bacteremia occurred during the study period. The total direct cost of antimicrobial therapy was 444,931 French francs (FF), i.e., 6.8% of total expenditures for antimicrobials. Mean cost per case was 1869 FF, and was 2.6-fold higher in the 21 patients with bacteremia due to more than one organism (P = 0.03). CAses with an identifiable portal of entry contributed 75% of the total cost. Portals of entry associated with the highest cost included central venous lines (103,928 FF) and urinary tract infections (50,810 FF). Although 20% of nosocomial bacteremias due to coagulase-negative staphylococci did not lead to antimicrobial therapy, the remaining 80% contributed 40.8% of the total cost, followed by nosocomial bacteremias due to Escherichia coli with 19.7% of the total cost. Thirty-seven patients (15.5%) did not receive specific antimicrobial therapy, for the following reasons: death before treatment initiation, transfer to another hospital, antimicrobial therapy initiated earlier for another infection elsewhere in the body due to a different organism, or other form of treatment. The results of this study highlight the need for prevention.

The purpose of this in vitro study was to compare polymerization of composite resins, as indicated by microhardness, at increasing depths using an argon laser versus a conventional light. For this, a microfill (Silux Plus) and a hybrid (TPH) composite resin were used. Five specimens per group were prepared by injecting composite into a rectangular split Teflon mold 3 x 3 x 8 mm. Specimens were then polymerized by either a 40-second exposure to the conventional visible light (VL) or a 30-, 20-, or 10-second exposure to the argon laser (AL). Specimens were stored in a light-proof container for 24 hours at 37 degrees C, then Knoop hardness was determined. Four measurements were taken for each specimen at depths of 0, 1, 2, 3, and 4 mm from the exposed surface. No significant differences were found in surface hardness for either the microfill or hybrid composite regardless of light source or exposure time. For the microfill composite, at 1, 2, 3, and 4 mm depths, VL40 and AL30 exposures produced comparable hardness, which was significantly greater than that found for AL20 and AL10. At a depth of 4 mm, exposure to VL40 resulted in significantly greater hardness compared to AL20. With AL10 exposure, the composite was too soft to determine hardness. The hybrid composite had comparable hardness to a depth of 3 mm for VL40, AL30 and AL20.

Identify factors predicting favorable outcome after medical management of valve ring abscesses in order to propose a surveillance schedule for conservative treatment.A multicentric study conducted from July 1989 to February 1996 included 28 patients (mean age 64 +/- 16 years, range 26-83) hospitalized for active endocarditis and valve ring abscesses diagnosed at transthoracic or transesophageal echography. Conservative medical therapy was given because of a decision of the medico-surgical team (n = 9), high surgical risk (n = 12), or patient refusal of surgery (n = 7). Outcome was favourable in 18 patients (Group I) and unfavorable in 10 (Group II) due to death (n = 9) or subsequent surgery (n = 1). Univariate and multivariate analysis were used to determine differences between the groups in terms of clinical and laboratory data.Mean follow-up in Group I was 33 +/- 18 months and 15 +/- 10 months in Group II. Univariate analysis showed significant differences between Group I and II respectively for age (59 +/- 18 yr vs 72 +/- 10, p = 0.04), delay to apyrexia after antibiotics (4.3 +/- 2.8 vs 8.3 +/- 2.4 days, p0.0008), heart failure (5% vs 70%, p = 0.003), grade III or IV valvular regurgitation (5% vs 60%, p0.04), and mean surface area of the abscess (1.5 +/- 1.2 vs 5.4 +/- 6.4 cm2, p0.03). Independent factors at multivariate analysis were by decreasing order: lack of heart failure at admission, delay to apyrexia, abscess surface area, and age. Outcome was favorable (mean follow-up 33 +/- 10 months) in all patients with an abscess surface area1.5 cm2, no signs of heart failure, no grade III or IV valvular regurgitation, apyrexia after less than 8 days on antibiotics and no staphylococcus positive blood culture.Medical management of valve ring abscesses may be indicated in selected patients in care units with rigorous surveillance facilities. Further studies are needed to precisely identify surveillance and treatment criteria.

Central neurological diseases caused by beta-lactamins are usually associated with excessive dosages in patients with renal failure. Two case reports of convulsive encephalopathy in patients treated with ceftazidime, show the absolute necessity of adapted posology, in case of renal dysfunction. In one case, we could follow plasma levels of ceftazidime during hemodialysis, and calculated the pharmacokinetic parameters. We conclude that extra renal epuration is an efficient technique in case of acute ceftazidime intoxication.

Neurological side-effects were a limiting factor with older quinolones. Although they appear to be less frequent with the newer fluoroquinolones, we observed nine such cases at Amiens University Hospital over a four-year period. The patients were six women and three men, with a mean age of 61 years. They received a mean dose of 800 mg/day of pefloxacin. Four had septic shock, one left ventricular failure, and seven had signs of cholestasis (signs of liver failure were absent). Neurological manifestations occurred between 24 hours and seven days after starting treatment and disappeared within 24 to 48 hours of stopping the drug or reducing the dosage. They included myoclonia (3 cases), convulsions (2 cases, one with concomitant theophylline), delirium and agitation (2 cases, one in a patient on steroids) and confusion (3 cases). Plasma drug levels were determined in six patients and were above normal peak levels (10 micrograms/ml) in five. Pefloxacin was measured in the cerebrospinal fluid in two cases (8.7 and 15.0 micrograms/ml). Neurological manifestations during pefloxacin treatment are probably related to overdose (plasma levels were above normal in 5/6 cases), possibly being favoured by cholestasis (7/9 cases) and/or hemodynamic factors (5/9). Symptoms can resolve when the pefloxacin dosage is reduced.

Among 841 autopsies realized between january 1982 and september 1988, by the Pathological the department of Amiens University Hospital the ten patients dead of infectious endocarditis have been autopsied. Macroscopic and microscopic observations have two cases of acute endocarditis and eight of subacute endocarditis. For the two patients dead of acute endocarditis, autopsy affirms the cardiovascular etiology of death. For the eight cases of subacute endocarditis, necropsic findings differs from the germs. In the three cases where the germ is a Staphylococcus aureus, the diagnosis of endocarditis was made before death and the cardiovascular etiology of death was affirmed by autopsy. For the other germs (3 Streptococcus sp, 1 Salmonella typhimurium, and 1 germ unknown), the diagnosis of endocarditis was made by autopsy, but necropsy disclosed the cause of death in only two cases.

This paper describes the process we used in selecting GaAs and InP as the best foreign (non‐CdTe) substrates for metal–organic chemical vapor deposition (MOCVD) growth of CdTe to form hybrid substrates suitable for use as substrates for epitaxial growth of HgCdTe. We describe the MOCVD growth process and give typical characterization results. We carried out a 12 run statistical design experiment to identify the most important parameters which turned out to be the metal–organic pressures and the growth temperature. These hybrid substrates have been used for the growth of HgCdTe by liquid‐phase epitaxy (LPE). Responsivity of 104 V/W is reported for Hg0.7Cd0.3Te with 3.5×1015 donors/cm3 grown on a long wavelength infrared (LWIR) transparent hybrid substrate.