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Resume Cette etude menee entre 1997 et 2003 en Bretagne sur les pneumocoques responsables d'infections invasives, evalue la sensibilite aux antibiotiques et les serogroupes des souches isolees de bacteriemies, de meningites et d'otites chez les enfants et les adultes. En 2003, 62 % des souches sont de sensibilite diminuee a la penicilline, 11 % sont resistantes. La prevalence des souches resistantes a l'erythromycine atteint 63 %. Ces taux de resistances sont les plus importants dans la population infantile. Les serogroupes 14 et 19 sont les plus frequents, surtout parmi les enfants. L'emergence notable du serogroupe 19 pourrait etre due a l'utilisation du vaccin conjugue heptavalent introduit en France en 2001. La surveillance des pneumocoques reste necessaire pour detecter les serogroupes emergents et les resistances.

Resume Treize laboratoires bretons ont collecte 832 souches de Streptococcus pneumoniae en 1999 chez 312 (37,5 %) femmes et 518 (62,2 %) hommes hospitalises ou consultants. Cette population comprenait 255 (30,6 %) enfants. Cent quatre-vingt-huit (22,6 %) souches ont ete isolees d’hemocultures, 16 (1,9 %) de LCR, 449 (54 %) de prelevements pulmonaires qu’ils soient proteges (8,1 %) ou non (45,9 %) et 88 (10,6 %) de pus d’otite moyenne aigue. La diminution de la sensibilite a la penicilline G (PSDP) a ete mesuree par un disque d’oxacilline 5 μg selon les recommandations du CA-SFM. Les CMI de la penicilline G, de l’amoxicilline et du cefotaxime ont ete mesurees sur une partie des PSDP par la methode de dilution en gelose. Soixante-cinq pour-cent (546/832) des pneumocoques sont des PSDP, 33,5 % des PSDP sont resistants a la penicilline G, 2,2 % sont resistants a l’amoxicilline et 0,2 % au cefotaxime. L’activite de l’erythromycine, de la tetracycline et du cotrimoxazole, determinee par diffusion en gelose, confirme l’association de la resistance a ces antibiotiques aux PSDP. Le serotypage des PSDP retrouve les types predominants 23 (23,7 %), 14 (23,5 %) et souligne l’augmentation de frequence du type 19 (19,1 %). Dans notre region, l’augmentation constante des PSDP (1993–1994 : 28,5 % ; 1997 : 56,4 % ; 1999 : 65,6 %) pourrait peut-etre etre expliquee par l’analyse des donnees sociologiques et demographiques specifiques.

Resume Les auteurs rapportent le cas d'une reinfection d'ascite a pneumocoque resistant a la penicilline (PRP) apres traitement par amoxicilline. Les similitudes microbiologiques et genetiques des deux souches isolees suggerent qu'elles derivent d'un meme clone et supportent l'hypothese d'une rechute de l'infection au niveau peritoneal. L'amoxicilline aux doses habituelles semble insuffisante pour eradiquer le PRP du site infectieux dans l'infection spontanee d'ascite des cirrhotiques. L'action des nouvelles fluoroquinolones reste a evaluer.

Resume L'evolution de la diminution de sensibilite de Streptococcus pneumoniae aux β-lactamines est suivie, en France, par le Centre National de Reference du Pneumocoque (CNRP). Les resultats d'une enquete regionale retrospective, effectuee dans 13 Centres hospitaliers, ont ete compares aux donnees nationales du CNRP, puis analyses par centre. Le taux moyen de resistance a la penicilline du pneumocoque dans cette region est comparable aux donnees du CNRP (13 %). L'etude montre egalement une nette difference de sensibilite selon que les souches sont considerees invasives (5,5 % de PRP) provenant d'hemocultures, LCR, prelevement bronchique protege ou non-invasives (18,6 %). Une relation entre PRP et recrutement pediatrique est mise en evidence (33 % de PRP chez les enfants). Une heterogeneite de resultats est constatee dans les differents centres incitant a discuter des biais possibles tels que le type des prelevements recus, le recrutement de patients et les methodes d'etude de la sensibilite. Les resultats de cette etude devraient inciter a un suivi epidemiologique homogene local afin de guider les choix therapeutiques.

At this time, many antibiotics have decreased activity against Streptococcus pneumoniae, a major agent of infectious disease. In this study, we evaluated antibiotic susceptibility and serogroups of strains isolated from bacteraemia, meningitis and acute otitis media in adults and children over the 1997-2003 period in Brittany, France. In 2003, 62% of the isolates were not susceptible to penicillin and 11% were fully resistant. The prevalence of erythromycin resistance was 63%. Resistance rates were higher among isolates recovered from children than adults. Serogroups 19 and 14 were the most frequently isolated, especially the 19 one among children. The emergence of this serogroup might be a consequence of the use of heptavalent conjugate vaccine introduced in 2001 in France. Future surveillance after vaccination will be needed to detect emerging serogroups and resistance among S. pneumoniae.

Summary The etiology of cat scratch disease is a topical issue ; Flavimonas oryzihabitans septicaemias are rare, and are usually suppressed quickly by antibiotics. For these reasons, it seems interesting to report the case of a cat scratch disease complicated by a nosocomial Flavimonas oryzihabitans septicaemia which was hard to check by antibiotherapy.

The aim of this study was to compare methicillin-resistant Staphylococcus aureus strains collected in eight hospitals located in the same region of France (Brittany) over a short period (January 1999–July 2000). Ninety-two isolates of methicillin-resistant S. aureus were characterised by their pulsotype and their antibiotype. Pulsotype analysis permitted the definition of three clusters. Two of them comprised 83% of the studied isolates. Phenotypic analysis showed two major antibiotypes, widespread in Brittany but with a heterogeneous geographic distribution and one antibiotype fitting the definition of glycopeptide intermediate S. aureus . These data argue for the high epidemicity of methicillin-resistant S. aureus among the same region.

Throughout 1999, clinical microbiology laboratories of 13 hospitals in Brittany have recovered Streptococcus pneumoniae isolates in 832 patients, 312 (37.5%) female and 518 (62.2%) male. Two hundred fifty five of them (30.6%) were children. One hundred eighty eight isolates were recovered from blood cultures (22.6%), 16 from CSF (1.9%), 449 from lungs (54%), and 88 from ear exsudates (10.6%).A 5 microgram oxacillin-disk test was used to detect isolates with reduced susceptibility to penicillin G. Determination of MICs of penicillin G, amoxicillin and cefotaxime were then performed by agar dilution method on 402 strains previously categorized resistant or intermediate. Five hundred forty six isolates were PSDP, 33.5% of them were resistant to penicillin G, 2.2% to amoxicillin and 0.2% to cefotaxime. As expected, a decreased susceptibility to beta-lactamins was frequently associated with resistance to macrolides, cotrimoxazole and tetracycline. Among PSDP, the most prevalent serotypes were 23 (23.7%), 14 (23.5%) and 19 (19.1%). In Brittany, the constant rise of PSDP (1993-1994: 28.5%; 1997: 56.4%; 1999: 65.6 %) could be perhaps explain by analysis of social and demographic data.

For 14 months, effects of volume on blood culture with Bactec 9240 are studied. Amongst the 1392 vials sending a signal out, 15.5% are false positive (FP). They stand out as such true positives by that very fact: negative subcultures, higher blood volumes, shorter time for detection, greater number of aerobic vials. Exclusively for FP, blood volume and detection delay are linked. In short, whatever the volume of culture may be, the prevalence of aerobic vial is observed with FP. The best volume of blood for the positive vials is 8 ml. Blood volume for each vial must be distinguished from whole culture volume of blood for each patient. If Bactec 9240 seems to be perfectible, for now, its optimum use should be septic discharge culture of about 30 blood milliliters shared out amongst 2 aerobic vials and 2 anaerobic vials, and incubation time should be kept at 7 days.

Given the difficulty of interpreting the results of aminoglycoside determinations using current methods, we decided to use data processing in order to help practitioners in their prescriptions of these drugs. Our software has numerous advantages. Results can be interpreted even before obtention of the steady-state and whatever the interval between specimen taking and drug administration, which permit different modalities of blood sampling. Data storage enables the operator to make retroactive studies in order to establish better correlation between blood concentrations and side effects. This method gives practitioners the necessary pharmacological data for rapid adjustments in aminoglycosides dosage.

Apparent stationary viscosity, viscoelasticity and thixotropy measured with a Couette viscosimeter have been determined on blood samples stored in eight anticoagulant and/or preservative solutions. All the results as well as those obtained in a previous morphological study show clearly the advantages of the SAG or PAGGS storage processes. It is observed that the rheological parameters of RBC stored in protein poor media are, between the 30 th and 35 th days, identical on CPD at the first week and with that measured in CPD concentrates between second and third week (for a same hematocrit value). We want to emphasize that the erythrocytes stored in these new media retain for a long time their ability to circulate in the capillary system.

By studying the sensitivity to antibiotics of 74 Acinetobacter baumannii strains, four phenotype groups were distinguished. The resistance of one of them (11% of the strains) to imipenem, argues against the therapeutic attitudes that now prevail. From studies on the kinetics of bactericidal activity of antibiotics and there association we propose what should be done in the laboratory to provide help to the physician for the antibiotic choice.