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1. Evidence of Sexual Transmission of Extended-Spectrum β-Lactamase–Producing Enterobacterales: A Cross-sectional and Prospective Study

Author

Laure Surgers, Thibault Chiarabini, Guilhem Royer, Hayette Rougier, Mélanie Mercier-Darty, Dominique Decré, Nadia Valin, Paul-Louis Woerther, Jean-Winoc Decousser, Pierre-Marie Girard, Karine Lacombe, Anders Boyd, Infectious diseases, APH - Methodology, APH - Global Health, Services des Maladies Infectieuses et Tropicales [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hôpital Henri Mondor, Analyse Bio-Informatique pour la Génomique et le Métabolisme (LABGeM), Génomique métabolique (UMR 8030), Genoscope - Centre national de séquençage [Evry] (GENOSCOPE), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université d'Évry-Val-d'Essonne (UEVE)-Centre National de la Recherche Scientifique (CNRS)-Genoscope - Centre national de séquençage [Evry] (GENOSCOPE), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université d'Évry-Val-d'Essonne (UEVE)-Centre National de la Recherche Scientifique (CNRS), Institut de médecine et d'épidémiologie appliquée [AP-HP Hôpital Bichat-Claude Bernard] (IMEA), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Henri Mondor, Centre d'Immunologie et des Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Dynamic Microbiology - EA 7380 (DYNAMIC), École nationale vétérinaire - Alfort (ENVA)-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES)-Université Paris-Est (UPE)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and CHU Henri Mondor [Créteil]

Subjects
Male, Microbiology (medical), antibiotic resistance, MESH: Escherichia coli, [SDV]Life Sciences [q-bio], MESH: beta-Lactamases, virus diseases, HIV Infections, MESH: HIV Infections, beta-Lactamases, sexual transmission, MESH: Sexual and Gender Minorities, Sexual and Gender Minorities, Cross-Sectional Studies, Enterobacterales, Infectious Diseases, Escherichia coli, Prevalence, Humans, Female, epidemiology, Prospective Studies, Homosexuality, Male, carriage
Abstract

Background Extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) represent a major threat to public health. Little is known on their potential for sexual transmission. Methods We recruited individuals at a sexually transmitted infection and human immunodeficiency virus (HIV) outpatient clinic in Paris, France, in whom we evaluated the prevalence of ESBL-E intestinal carriage and, among those testing positive, the proportion with clearance 6 months thereafter. We compared carriage prevalence between groups using logistic regression adjusted for age, geographic origin, travel outside Europe, and antibiotic use in the past 6 months. Results A total of 2157 individuals participated, of whom 226 (10.5%) were ESBL-E carriers. The proportions of ESBL-E carriers varied across sexual groups and were as follows: HIV-negative men who have sex with men (MSM) and who were on preexposure prophylaxis (PrEP), 16.3% (41 of 251); HIV-negative MSM not on PrEP, 9.7% (47 of 487); HIV-positive MSM, 12.2% (61 of 500); HIV-negative men who have sex exclusively with women, 10.0% (44 of 439); and HIV-negative women who have sex with men, 6.9% (n = 33 of 480). After adjustment, ESBL-E prevalence was significantly higher in HIV-negative MSM on PrEP (P Conclusion ESBL-E carriage is more frequent in MSM undergoing PrEP or living with HIV and with increasing number of sexual partners. More research is warranted to understand the consequences of ESBL-E carriage in these populations and how transmission can be reduced.

Published
2022

2. Outbreak of OXA-48-producing Enterobacterales in a haematological ward associated with an uncommon environmental reservoir, France, 2016 to 2019

Author

Sarah Jolivet, Mohamad Mohty, Rémy A. Bonnin, Cyril Gouot, Laurent Dortet, Eolia Brissot, Xavier Vuillemin, Jeanne Couturier, Frédéric Barbut, Marine Adam, Didier Nesa, Unité de contrôle, d'épidémiologie et de prévention des infections (CEPI), Groupe Henri Mondor-Albert Chenevier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie et pharmacotoxicologie placentaire humaine : Microbiote pré & post natal (3PHM - UMR-S 1139), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Unité d'hygiène et de lutte contre les infections nosocomiales [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service d'hématologie clinique et de thérapie cellulaire [CHU Saint-Antoine], Centre International des greffes [CHU Saint-Antoine] (EBMT), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), French National Reference Center for Antibiotic Resistance: Carbapenemase producing Enterobacteriaceae [Le Kremlin-Bicêtre], Gestionnaire, HAL Sorbonne Université 5, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)

Subjects
0301 basic medicine, Veterinary medicine, medicine.medical_specialty, reservoir, toilet, Epidemiology, 030106 microbiology, beta-Lactamases, Disease Outbreaks, 03 medical and health sciences, 0302 clinical medicine, Bacterial Proteins, Cronobacter sakazakii, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Virology, Enterobacterales, Water environment, Escherichia coli, Infection control, Medicine, Humans, 030212 general & internal medicine, Toilet Facilities, Disease Reservoirs, Toilet, Cross Infection, Infection Control, biology, outbreak, business.industry, Transmission (medicine), carbapenemase-producing Enterobacterales, Public Health, Environmental and Occupational Health, Enterobacteriaceae Infections, Outbreaks, Outbreak, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, 6. Clean water, Hospitals, 3. Good health, Citrobacter freundii, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, bacteria, France, business, Water Microbiology
Abstract

The hospital water environment, including the wastewater drainage system, is increasingly reported as a potential reservoir for carbapenemase-producing Enterobacterales (CPE). We investigated a persistent outbreak of OXA-48 CPE (primarily Citrobacter freundii) in a haematological ward of a French teaching hospital by epidemiological, microbiological and environmental methods. Between January 2016 and June 2019, we detected 37 new OXA-48 CPE-colonised and/or ‑infected patients in the haematological ward. In October 2017, a unit dedicated to CPE-colonised and/or ‑infected patients was created. Eleven additional sporadic acquisitions were identified after this date without any obvious epidemiological link between patients, except in one case. Environmental investigations of the haematological ward (June–August 2018) identified seven of 74 toilets and one of 39 drains positive for OXA-48 CPE (seven C. freundii, one Enterobacter sakazakii, one Escherichia coli). Whole genome comparisons identified a clonal dissemination of OXA-48-producing C. freundii from the hospital environment to patients. In addition to strict routine infection control measures, an intensive cleaning programme was performed (descaling and bleaching) and all toilet bowls and tanks were changed. These additional measures helped to contain the outbreak. This study highlights that toilets can be a possible source of transmission of OXA-48 CPE.

Published
2021

3. Combined use of a broad-panel respiratory multiplex PCR and procalcitonin to reduce duration of antibiotics exposure in patients with severe community-acquired pneumonia (MULTI-CAP): a multicentre, parallel-group, open-label, individual randomised trial conducted in French intensive care units

Author

Guillaume, Voiriot, Muriel, Fartoukh, Isabelle, Durand-Zaleski, Laurence, Berard, Alexandra, Rousseau, Laurence, Armand-Lefevre, Charlotte, Verdet, Laurent, Argaud, Kada, Klouche, Bruno, Megarbane, Juliette, Patrier, Jean-Christophe, Richard, Jean, Reignier, Carole, Schwebel, Bertrand, Souweine, Yacine, Tandjaoui-Lambiotte, Tabassome, Simon, Jean-François, Timsit, Saad, Nseir, CarMeN, laboratoire, Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de recherche clinique en économie de la santé [Paris] (URC Eco), Délégation de la Recherche Clinique et de l’Innovation [Paris] (DRCI), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche Clinique de l’Est Parisien [CHU Saint-Antoine] (URC-EST), Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (CHNO)-CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Direction de la Recherche Clinique et de l'Innovation [AP-HP] (DRCI), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de microbiologie [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Nord Val de Seine, Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Lariboisière-Fernand-Widal [APHP], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Hôpital de la Croix-Rousse [CHU - HCL], Centre hospitalier universitaire de Nantes (CHU Nantes), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes (UGA), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Avicenne [AP-HP], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), MULTI-CAP study group: Keyvan Razazi, Jean Dellamonica, Jean-Christophe Navellou, Pierre-Francois Dequin, Pierre-Edouard Bollaert, Marc Gainnier, Julien Bohe, Eric Maury, Saad Nseir., Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP]

Subjects
Adult, adult thoracic medicine, [SDV]Life Sciences [q-bio], Intensive Care, COVID-19, respiratory infections, Pneumonia, diagnostic microbiology, Anti-Bacterial Agents, molecular diagnostics, [SDV] Life Sciences [q-bio], Intensive Care Units, Humans, Multiplex Polymerase Chain Reaction, Procalcitonin, adult intensive & critical care
Abstract

International audience; INTRODUCTION: At the time of the worrying emergence and spread of bacterial resistance, reducing the selection pressure by reducing the exposure to antibiotics in patients with community-acquired pneumonia (CAP) is a public health issue. In this context, the combined use of molecular tests and biomarkers for guiding antibiotics discontinuation is attractive. Therefore, we have designed a trial comparing an integrated approach of diagnosis and treatment of severe CAP to usual care. METHODS AND ANALYSIS: The multiplex PCR and procalcitonin to reduce duration of antibiotics exposure in patients with severe-CAP (MULTI-CAP) trial is a multicentre (n=20), parallel-group, superiority, open-label, randomised trial. Patients are included if adult admitted to intensive care unit for a CAP. Diagnosis of pneumonia is based on clinical criteria and a newly appeared parenchymal infiltrate. Immunocompromised patients are excluded. Subjects are randomised (1:1 ratio) to either the intervention arm (experimental strategy) or the control arm (usual strategy). In the intervention arm, the microbiological diagnosis combines a respiratory multiplex PCR (mPCR) and conventional microbiological investigations. An algorithm of early antibiotic de-escalation or discontinuation is recommended, based on mPCR results and the procalcitonin value. In the control arm, only conventional microbiological investigations are performed and antibiotics de-escalation remains at the clinician's discretion. The primary endpoint is the number of days alive without any antibiotic from the randomisation to day 28. Based on our hypothesis of 2 days gain in the intervention arm, we aim to enrol a total of 450 patients over a 30-month period. ETHICS AND DISSEMINATION: The MULTI-CAP trial is conducted according to the principles of the Declaration of Helsinki, is registered in Clinical Trials and has been approved by the Committee for Protection of Persons and the National French Drug Safety Agency. Written informed consents are obtained from all the patients (or representatives). The results will be disseminated through educational institutions, submitted to peer-reviewed journals for publication and presented at medical congresses. TRIAL REGISTRATION NUMBER: NCT03452826; Pre-results.

Published
2021

4. More than just teddy bears: Unconventional transmission agents in the operating room

Author

Alexandre Hardy, V. Sabatier, O. Rosello, B. Salauze, Frédéric Barbut, Raphaël Vialle, Service de pédiatrie orthopédique [CHU Trousseau], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], and Service des thérapies innovantes pour les maladies musculo-squelettiques [CHU Trousseau]

Subjects
Male, medicine.medical_specialty, Operating Rooms, Adolescent, Population, Statistical difference, Toys, Pediatric spine, Plush, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Acinetobacter ursingii, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Nosocomial infections, medicine, Humans, Surgical Wound Infection, 030212 general & internal medicine, education, Child, 030222 orthopedics, education.field_of_study, Bacteriological Techniques, Cross Infection, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, biology, Bacteria, Transmission (medicine), business.industry, Fomite, Infant, biology.organism_classification, 3. Good health, Play and Playthings, Teddy bear, Child, Preschool, Pediatrics, Perinatology and Child Health, Orthopedic surgery, Colony count, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Infection
Abstract

International audience; INTRODUCTION: Surgical site infection (SSI) following orthopedic surgery can have a substantial impact on patients and families. The rate remains high, ranging from 0.5% to 8.5% in pediatric spine surgery. It is common to allow children to bring a teddy bear (or similar toy) to the surgical ward to help reduce the stress of surgery. We hypothesize that despite their known benefits for children, teddies would increase the bacterial load in the surgical room.METHODS: A blinded descriptive study was conducted from June 2015 to September 2016. The study included children entering the hospital through the emergency ward for a traumatic cause requiring surgery. Patients admitted for infectious problems and those who had been hospitalized less than 6 months before the inclusion date were excluded. A picture of the teddy was taken and stored in a blind fashion. The AFNOR (Association française de normalisation) standardized rules for bacteriological surface control and the ISO/DIS 14698 protocol were strictly followed. Two independent observers performed blind bacteriologic analyses of the teddy bears with bacteria identification and colony counts. Photos of the teddy bears were then analyzed by two blinded, independent observers: one doctor and one parent from outside the hospital. Cleanliness and fluffiness of the toy was evaluated using a numeric scale.RESULTS: Bacteria were identified on 100% of the 53 teddies included. The mean number of bacteria was 182.5±49.8 CFU/25 cm2. Eight teddies (15.1%) tested positive for potential pathogenic bacteria (two staphylococcus aureus, one acinetobacter ursingii, four acinetobacter baumannii, one pseudomonas stutzeri). Three teddies (5.7%) tested positive for fungi. The median cleanliness score was 2 (interquartile range (IQR)=1) if rated by the doctor and 2 (IQR=1) if rated by the parent. No statistical difference was found between these two values in the global teddy bear population. We found no any statistical link between the number of CFUs and the cleanliness scores given by the doctor. The median fluffiness score given by the parent was 2 (IQR=1). Looking at the correlative CFUs, we found a statistically significant difference between each stage of fluffiness with a higher stage showing higher CFU (P

Published
2018

5. Persistence of blaCMY-2-producing Proteus mirabilis in two gull colonies at a 1-year interval in Southern France

Author

Sylvain Godreuil, Salim Aberkane, Jérôme Solassol, Marion Vittecoq, Hélène Jean-Pierre, Alix Pantel, Fabrice Compain, Nicolas Bouzinbi, Dominique Decré, Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM), Virulence bactérienne et maladies infectieuses (VBMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Hydrosciences Montpellier (HSM), and Institut national des sciences de l'Univers (INSU - CNRS)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
0301 basic medicine, Microbiology (medical), Ecology, [SDV]Life Sciences [q-bio], 030106 microbiology, Immunology, Zoology, SXT/R391 integrative and conjugative element, Biology, biology.organism_classification, Microbiology, Proteus mirabilis, Persistence (computer science), Persistence, 03 medical and health sciences, Gulls, 030104 developmental biology, bla(CMY-2), Immunology and Allergy, Interval (graph theory), 14. Life underwater, France, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2017

6. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study

Author

Jean-Luc Baudel, Naïke Bigé, Jacques Tankovic, Claire Pichereau, Simon Bourcier, Hafid Ait-Oufella, Arnaud Galbois, Eric Maury, Guillaume Leblanc, Vincent Dubée, Geoffroy Hariri, Pierre-Yves Boëlle, HAL UPMC, Gestionnaire, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Galien Paris-Sud (IGPS), and Université Paris-Sud - Paris 11 (UP11)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)

Subjects
0301 basic medicine, Carbapenem, Pediatrics, medicine.medical_specialty, Community-acquired pneumonia, 030106 microbiology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, law, Antibiotics, medicine, polycyclic compounds, Intensive care unit, Risk factor, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Extended-spectrum beta-lactamases, business.industry, Research, Retrospective cohort study, Third-generation cephalosporins, Amoxicillin, medicine.disease, 3. Good health, Pneumonia, Amikacin, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

International audience; BackgroundThird-generation cephalosporins (3GCs) are recommended for empirical antibiotic therapy of community-acquired pneumonia (CAP) in patients requiring ICU admission. However, their extensive use could promote the emergence of extended-spectrum beta-lactamases-producing Enterobacteriaceae. Our aim was to assess whether the use of 3GCs in patients with CAP requiring ICU admission was justified.MethodsWe assessed all patients with CAP who required ICU admission during a 7-year period. We recorded empirical and definitive antibiotic therapies and susceptibility of causative pathogens. Amoxicillin, amoxicillin/clavulanate (A/C) susceptibilities as well as amikacin susceptibility of A/C-resistant strains were recorded.ResultsFrom January 2007 to March 2014, 391 patients were included in the study. Empirical 3GCs were used in 215 patients (55%). Among 267 patients with microbiologically documented CAP (68%), 241 received a beta-lactam as definitive therapy, and of those, 3CGs were chosen for 43 patients (18%). Amoxicillin or A/C was active against isolated pathogens in 159 patients (66%), while 39 patients (16%) required a beta-lactam with a broader spectrum than 3GCs. Ninety-four per cent of A/C-resistant strains were amikacin susceptible.ConclusionsIn ICU patients with CAP, 3GCs given on an empirical basis are changed, according to microbiological documentation, for another beta-lactam in 82% of cases especially to A/C in the absence of resistance risk factor. In patients evidencing risk factors for A/C-resistant strains infection, 3GCs or antipseudomonal beta-lactams including carbapenem associated with amikacin in the most severe patients seem a relevant empirical antibiotic therapy. This strategy could decrease 3GCs’ use.

Published
2017

7. Clostridium difficile infection in acute flares of inflammatory bowel disease: A prospective study

Author

Anne Bourrier, Julien Kirchgesner, Isabelle Nion-Larmurier, Valérie Lalande, Sylvie Rajca, Jacques Cosnes, Laurent Beaugerie, Cécilia Landman, Harry Sokol, Philippe Seksik, Frédéric Barbut, Microorganismes, Molécules Bioactives et Physiopathologie Intestinale (LBM-E4), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), MICrobiologie de l'ALImentation au Service de la Santé (MICALIS), Institut National de la Recherche Agronomique (INRA)-AgroParisTech, Departement Hospitalo- Universitaire - Inflammation, Immunopathologie, Biothérapie [Paris] (DHU - I2B), CHU Pitié-Salpêtrière [APHP]-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Gastroentérologie et nutrition [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Service de microbiologie [CHU Saint-Antoine], GRC-2 Epidiff, Université Pierre et Marie Curie - Paris 6 (UPMC), National reference laboratory for clostridium difficile, Université Pierre et Marie Curie - Paris 6 (UPMC)-AP-HP - Hôpital Saint-Antoine, CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Pierre et Marie Curie - Paris 6 (UPMC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), French society of gastroenterology (FARE grant), Biocodex, HAL-UPMC, Gestionnaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and Université Pierre et Marie Curie - Paris 6 (UPMC)-CHU Pitié-Salpêtrière [APHP]

Subjects
0301 basic medicine, Male, Multivariate analysis, Databases, Factual, genetic structures, Inflammatory bowel disease, Polymerase Chain Reaction, Immunoenzyme Techniques, Feces, 0302 clinical medicine, Prospective Studies, Young adult, Prospective cohort study, Aged, 80 and over, education.field_of_study, Gastroenterology, Clostridium difficile, Middle Aged, Ulcerative colitis, 3. Good health, 030211 gastroenterology & hepatology, Female, France, Adult, medicine.medical_specialty, Adolescent, Population, Crohn, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, education, Aged, Hepatology, business.industry, Clostridioides difficile, Diagnostic Tests, Routine, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, Inflammatory Bowel Diseases, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 030104 developmental biology, Logistic Models, Immunology, Multivariate Analysis, Clostridium Infections, business, Complication
Abstract

International audience; ObjectivesClostridium difficile infection (CDI) is a common complication in inflammatory bowel disease (IBD) and has been associated with poor IBD outcome. The aims of our study were to look for predictive factors of CDI in patients hospitalized for IBD flare and to evaluate a rapid testing strategy in this population.MethodsConsecutive patients hospitalized for IBD flare in Saint-Antoine Hospital (Paris, France) were prospectively tested for CDI with a defined strategy involving rapid testing and reference methods. Risk factors for CDI were investigated and performances of diagnostic tests were evaluated.ResultsC. difficile testing was performed at admission in 461 hospitalizations for IBD flare. CDI was diagnosed in 35 cases (7.6%) and non-toxigenic C. difficile was identified in 10 cases (2.2%). In multivariate analysis, UC phenotype was associated with CDI (OR 2.2, 95% CI 1.03–4.6, p = 0.047). Glutamate dehydrogenase (GDH) test had a 97.1% sensitivity and a 100% negative predictive value for CDI diagnosis but a positive predictive value of 79.1%. Enzyme immunoassay (EIA)-based toxin detection (C. Diff Quik Chek complete®, Alere) had a poor sensitivity and diagnosis was rescued by toxin PCR in 100% of cases.ConclusionCDI is frequent in patients hospitalized for IBD flare. Clinical parameters do not help for the diagnosis and rapid testing should be performed in all patients. Currently, a negative result of an EIA-based toxin search associated with a positive GDH test cannot rule out a CDI and should not delay initiation of specific treatment in case of severe symptoms or high presumption.

Published
2017

8. Primary osteomyelitis caused by an NDM-1-producing K. pneumoniae strain of the highly virulent sequence type 23

Author

Isabelle Podglajen, Nathalie Genel, Astrid Ramahefasolo, Fabrice Compain, Marie Gominet, Dominique Decré, David Lebeaux, Alexis Vandenberghe, Structures bactériennes impliquées dans la modulation de la résistance aux antibiotiques, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR58-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Paris Descartes - Paris 5 (UPD5), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), HAL-UPMC, Gestionnaire, Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -IFR58-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Université Paris Descartes - Paris 5 ( UPD5 ), Centre d'Immunologie et de Maladies Infectieuses ( CIMI ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP]

Subjects
0301 basic medicine, Epidemiology, 030106 microbiology, Immunology, Virulence, Biology, Microbiology, 03 medical and health sciences, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Virology, Drug Discovery, medicine, Letter to the Editor, Sequence (medicine), [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [ SDV.MHEP.ME ] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Strain (chemistry), Osteomyelitis, K pneumoniae, General Medicine, medicine.disease, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Infectious Diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Parasitology
Abstract

International audience; Hypervirulent variant of Klebsiella pneumoniae (hvKP) is characterized by its hypermucoviscosity and its capacity to cause invasive community-acquired infections in previously healthy young individuals. The most common clinical presentation is a pyogenic liver abscess with metastatic spread, while various other invasive infections have been reported. Strains of hvKP belong predominantly to the capsular serotypes K1 and K22 and their genetic background seems to differ from that of multidrug-resistant (MDR) isolates. The most commonly encountered sequence types (STs) among hvKP include ST23 (associated with serotype K1), ST25, ST65, ST86, ST375 and the recently emerging ST380.

Published
2017

9. Fecal Carriage of Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases in Hospitalized Patients and Healthy Community Volunteers in Burkina Faso

Author

Abdoul-Salam Ouédraogo, Sylvain Godreuil, Nicolas Bouzinbi, Christian Carrière, Philippe Van de Perre, Aimée Kissou, Salim Aberkane, Soufiane Sanou, Hélène Jean-Pierre, Boubacar Nacro, Dominique Decré, Armel Poda, Rasmata Ouédraogo, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Pathogénèse et contrôle des infections chroniques (PCCI), Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre Hospitalier Universitaire de Montpellier ( CHU Montpellier ), Centre d'Immunologie et de Maladies Infectieuses ( CIMI ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Université de Montpellier (UM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)

Subjects
0301 basic medicine, Male, Klebsiella pneumoniae, Antibiotics, Gene Expression, antibiotics, molecular characterization, Feces, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, genes, Escherichia coli Infections, Phylogeny, biology, Enterobacteriaceae Infections, 3. Good health, Anti-Bacterial Agents, Hospitalization, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Fluoroquinolones, Microbiology (medical), Adult, medicine.drug_class, 030106 microbiology, Immunology, enzymes, beta-Lactams, Microbiology, beta-Lactam Resistance, beta-Lactamases, 03 medical and health sciences, Enterobacteriaceae, Multiplex polymerase chain reaction, Burkina Faso, Enterobacter cloacae, medicine, Escherichia coli, Humans, Agar diffusion test, Pharmacology, Case-control study, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, Klebsiella Infections, Carriage, ESBL, Case-Control Studies, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Multiplex Polymerase Chain Reaction
Abstract

International audience; Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) have been described worldwide, but few reports focused on Burkina Faso. To assess the prevalence of digestive carriage of such bacteria in the community and in the hospital, 214 fecal samples, 101 from healthy volunteers and 113 from hospitalized patients without digestive pathology, were collected in Bobo Dioulasso, Burkina Faso economic capital, during July and August 2014. Stool samples were screened using ESBL agar plates. Strains were identified by mass spectrometry using the Biotyper MALDI-TOF. ESBL production was confirmed with the double-disc synergy test. Susceptibility was tested using the disk diffusion method on Müller-Hinton agar. The main ESBL genes were detected using multiplex PCR and bidirectional gene sequencing. Escherichia coli phylogenetic groups were identified using a PCR-based method. During the study period, prevalence of subjects with fecal ESBL-PE was 32% (69/214), 22% among healthy volunteers and 42% among inpatients. All but two ESBL, CTX-M-15 and ESBL-PE, were mostly E. coli (78%). Among the 60 ESBL-producing E. coli strains, 26% belonged to phylogenetic group D, 23.3% to group A, 20% to group B1, 6.6% to group B2, and 3.3% to the ST131 clone. Univariate analysis showed that history of hospitalization and previous antibiotic use were risk factors associated with ESBL-PE fecal carriage. In Burkina Faso, the prevalence of both healthy subjects from the community and hospitalized patients with fecal ESBL-PE is alarmingly high. This feature should be taken into consideration by both general practitioners and hospital doctors with regard to empirical treatments of infections, notably urinary tract infections.

Published
2016

10. Extended-spectrum beta-lactamase − producing enterobacteriaceae in the intensive care unit: acquisition does not mean cross-transmission

Author

Georges Offenstadt, Dominique Decré, Frédéric Barbut, Jean-Luc Baudel, Naïke Bigé, Astrid Lemire, Claire Pichereau, Mikael Alves, Hafid Ait-Oufella, Eric Maury, Dimitri Margetis, Bertrand Guidet, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de microbiologie [CHU Saint-Antoine], and HAL UPMC, Gestionnaire

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, 030106 microbiology, Antibiotics, Biology, Polymerase Chain Reaction, beta-Lactamases, law.invention, 03 medical and health sciences, 0302 clinical medicine, Medical microbiology, Enterobacteriaceae, law, Internal medicine, polycyclic compounds, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Aged, Cross Infection, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Incidence (epidemiology), Enterobacteriaceae Infections, Rectum, DNA, Middle Aged, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, Intensive care unit, Anti-Bacterial Agents, 3. Good health, Intensive Care Units, Infectious Diseases, Transmission (mechanics), Carriage, Parasitology, Beta-lactamase, bacteria, Female, beta-lactamase, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Research Article, ESBL-E
Abstract

Background In intensive care unit (ICU), infection and colonization by resistant Gram-negative bacteria increase costs, length of stay and mortality. Extended-spectrum beta-lactamase − producing Enterobacteriaceae (ESBL-E) is a group of pathogens increasingly encountered in ICU setting. Conditions that promote ESBL-E acquisition are not completely understood. The increasing incidence of infections related to ESBL-E and the unsolved issues related to ESBL-E cross-transmission, prompted us to assess the rates of referred and acquired cases of ESBL-E in ICU and to assess patient-to-patient cross-transmission of ESBL-E using a multimodal microbiological analysis. Methods During a 5-month period, all patients admitted to a medical ICU were tested for ESBL-E carriage. A rectal swab was performed at admission and then twice a week until discharge or death. ESBL-E strains were analyzed according to antibiotic susceptibility pattern, rep-PCR (repetitive-element Polymerase chain reaction) chromosomal analysis, and plasmid PCR (Polymerase chain reaction) analysis of ESBL genes. Patient-to-patient transmission was deemed likely when 2 identical strains were found in 2 patients hospitalized simultaneously in the ICU. Results Among the 309 patients assessed for ESBL-E carriage on admission, 25 were found to carry ESBL-E (importation rate: 8 %). During follow-up, acquisition was observed among 19 of them (acquisition rate: 6.5 %). Using the multimodal microbiological approach, we found only one case of likely patient-to-patient ESBL-E transmission. Conclusions In unselected ICU patients, we found rather low rates of ESBL-E referred and acquired cases. Only 5 % of acquisitions appeared to be related to patient-to-patient transmission. These data highlight the importance of jointly analyzing phenotypic profile and molecular data to discriminate strains of ESBL-E. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1489-z) contains supplementary material, which is available to authorized users.

Published
2016

11. High Prevalence of SXT/R391-Related Integrative and Conjugative Elements Carrying bla CMY-2 in Proteus mirabilis Isolates from Gulls in the South of France

Author

Jérôme Solassol, Salim Aberkane, Abdoul-Salam Ouédraogo, Nathalie Brieu, Alix Pantel, Chloé Dupont, Jean-Philippe Lavigne, Chrislène Laurens, Sylvain Godreuil, Dominique Decré, Christian Carrière, Marion Vittecoq, Fabrice Compain, François Renaud, Nicolas Bouzinbi, Hélène Jean-Pierre, Service de Biopathologie [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Hydrosciences Montpellier (HSM), Institut national des sciences de l'Univers (INSU - CNRS)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre de recherche de la Tour du Valat, Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Virulence bactérienne et maladies infectieuses (VBMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier du Pays d'Aix, Centre d'Immunologie et des Maladies Infectieuses (CIMI), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
0301 basic medicine, Charadriiformes, Veterinary medicine, 030106 microbiology, Zoology, beta-Lactamases, Epidemiology and Surveillance, Feces, 03 medical and health sciences, Prevalence, Animals, Humans, Pharmacology (medical), Proteus mirabilis, Pharmacology, High prevalence, biology, Chromosome Mapping, Chromosomes, Bacterial, biology.organism_classification, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Conjugation, Genetic, Genetic structure, embryonic structures, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, France
Abstract

The genetic structures involved in the dissemination of bla CMY-2 carried by Proteus mirabilis isolates recovered from different gull species in the South of France were characterized and compared to clinical isolates. bla CMY-2 was identified in P. mirabilis isolates from 27/93 yellow-legged gulls and from 37/65 slender-billed gulls. It was carried by a conjugative SXT/R391-like integrative and conjugative element (ICE) in all avian strains and in 3/7 human strains. Two clinical isolates had the same genetic background as six avian isolates.

Published
2016

12. A rare cause of subcutaneous crepitation

Author

Zhao, Lin-Pierre, Tankovic, Jacques, Decré, Dominique, Maury, Eric, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de microbiologie [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and HAL-UPMC, Gestionnaire

Subjects
Klebsiella pneumoniae, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Cystitis, Peritonitis, urologic and male genital diseases, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; A 66-year-old diabetic man presented with fever, hypotension, lower abdominal pain, hematuria and supra pubic crepitation. Abdominal CT scan revealed gas in bladder wall, and pre bladder space (Fig A), The patient was referred to the operating room where surgical findings confirmed bladder rupture requiring conservative surgery. Urine, blood cultures and operative samples grew with a cefotaxime sensitive Klebsiella pneumoniae gas producing strain (Fig B and C). The patient recovered progressively and was discharged from ICU six weeks later.

Published
2016

13. Clostridium perfringens related spleen gangrene

Author

Jacques Tankovic, Naïke Bigé, Guillaume Dumas, Eric Maury, Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de microbiologie [CHU Saint-Antoine], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), HAL-UPMC, Gestionnaire, CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Clostridium perfringens, 040301 veterinary sciences, Pain medicine, Spleen, Critical Care and Intensive Care Medicine, medicine.disease_cause, 0403 veterinary science, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Anesthesiology, medicine, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Gangrene, business.industry, 04 agricultural and veterinary sciences, medicine.disease, medicine.anatomical_structure, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, business, Gas Gangrene
Abstract

International audience

Published
2017

14. Complete Nucleotide Sequence of the First KPC-2- and SHV-12-Encoding IncX Plasmid, pKpS90, from Klebsiella pneumoniae

Author

Vincent Jarlier, Sylvain Brisse, Dominique Decré, Guillaume Arlet, Lionel Frangeul, Christian Sengelin, Laurence Drieux, Najiby Kassis-Chikhani, Hôpital Paul Brousse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génopole, Institut Pasteur [Paris], Laboratoire de Bactériologie, Faculté de médecine, Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génotypage des Pathogènes et Santé Publique (Plate-forme) (PF8), Service de Bactériologie [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), This work was funded in part by the Université Pierre et Marie Curie, Paris-6, and by a grant from Assistance Publique-Hôpitaux de Paris, contract CRC no. 08007 (KPath)., Institut Pasteur [Paris] (IP), and CHU Saint-Antoine [AP-HP]

Subjects
MESH: Sequence Analysis, DNA, Klebsiella pneumoniae, MESH: Klebsiella pneumoniae, MESH: beta-Lactamases, MESH: Base Sequence, Disease Outbreaks, Hospitals, University, chemistry.chemical_compound, Plasmid, polycyclic compounds, Pharmacology (medical), MESH: Disease Outbreaks, Genetics, 0303 health sciences, MESH: Microbial Sensitivity Tests, Nucleic acid sequence, Anti-Bacterial Agents, 3. Good health, Infectious Diseases, MESH: Klebsiella Infections, MESH: DNA Transposable Elements, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, France, Plasmids, Transposable element, Sequence analysis, Molecular Sequence Data, Microbial Sensitivity Tests, Biology, beta-Lactams, beta-Lactam Resistance, beta-Lactamases, Microbiology, 03 medical and health sciences, Mechanisms of Resistance, MESH: Plasmids, MESH: beta-Lactams, MESH: Anti-Bacterial Agents, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Humans, Gene, 030304 developmental biology, Sequence (medicine), Pharmacology, MESH: Hospitals, University, MESH: Molecular Sequence Data, MESH: Humans, Base Sequence, 030306 microbiology, Sequence Analysis, DNA, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, MESH: beta-Lactam Resistance, Klebsiella Infections, MESH: France, chemistry, DNA Transposable Elements, [INFO.INFO-BI]Computer Science [cs]/Bioinformatics [q-bio.QM], DNA
Abstract

We report the complete nucleotide sequence of the pKpS90 plasmid, carrying the bla KPC-2 and bla SHV-12 genes. This plasmid was isolated from a sequence type 258 (ST258) Klebsiella pneumoniae strain responsible for an outbreak in a French university hospital in 2009. pKpS90 is a 53,286-bp plasmid that belongs to the IncX incompatibility group. pKpS90 consists of a backbone from IncX plasmids, in which the KPC-2-encoding Tn 4401 transposon and a bla SHV-12 -encoding region have been inserted.

Published
2012

15. High prevalence of extended-spectrum ß-lactamase producing enterobacteriaceae among clinical isolates in Burkina Faso

Author

Abdoul-Salam Ouédraogo, Rasmata Ouégraogo, Sylvain Godreuil, Nicolas Bouzinbi, Hélène Jean-Pierre, Salim Aberkane, Boubacar Nacro, Aimée Kissou, Idrissa Sano, Dominique Decré, Firmin Kaboré, Lassana Sangaré, Armel Poda, Hermann Solaré, Mahamadou Sanou, Soufiane Sanou, Christian Carrière, Herrada, Anthony, Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire Souro Sanou [Bobo-Dioulasso] (CHUSS), Centre Hospitalier Universitaire Pédiatrique Charles-de-Gaulle [Ouagadougou, Burkina Faso], Centre Hospitalier Universitaire Yalgado Ouédraogo (CHUYO), Centre d'Immunologie et de Maladies Infectieuses (CIMI), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de microbiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
0301 basic medicine, Male, Clinical samples, Klebsiella pneumoniae, Antibiotics, medicine.disease_cause, 0302 clinical medicine, Medical microbiology, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Odds Ratio, Prevalence, polycyclic compounds, 030212 general & internal medicine, Child, Phylogeny, education.field_of_study, Enterobacteriaceae Infections, Middle Aged, Enterobacteriaceae, 3. Good health, Anti-Bacterial Agents, Infectious Diseases, Child, Preschool, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Inpatient and outpatient, Female, Research Article, Adult, DNA, Bacterial, medicine.medical_specialty, Adolescent, medicine.drug_class, 030106 microbiology, Population, Biology, beta-Lactamases, Microbiology, 03 medical and health sciences, Young Adult, parasitic diseases, Burkina Faso, medicine, Escherichia coli, Humans, Agar diffusion test, education, Aged, Infant, Newborn, Infant, Sequence Analysis, DNA, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, Parasitology, ESBL, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
Abstract

International audience; BACKGROUND:Nothing is known about the epidemiology and resistance mechanisms of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) in Burkina Faso. The objective of this study was to determine ESBL-PE prevalence and to characterize ESBL genes in Burkina Faso.METHODS:During 2 months (June-July 2014), 1602 clinical samples were sent for bacteriologic investigations to the microbiology laboratories of the tree main hospitals of Burkina Faso. Isolates were identified by mass spectrometry using a matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) BioTyper. Antibiotic susceptibility was tested using the disk diffusion method on Müller-Hinton agar. The different ESBL genes in potential ESBL-producing isolates were detected by PCR and double stranded DNA sequencing. Escherichia coli phylogenetic groups were determined using a PCR-based method.RESULTS:ESBL-PE frequency was 58 % (179 strains among the 308 Enterobacteriaceae isolates identified in the collected samples; 45 % in outpatients and 70 % in hospitalized patients). The CTX-M-1 group was dominant (94 %, CTX-M-15 enzyme), followed by the CTX-M-9 group (4 %). ESBL producers were more often found in E. coli (67.5 %) and Klebsiella pneumoniae (26 %) isolates. E. coli isolates (n = 202; 60 % of all Enterobacteriaceae samples) were distributed in eight phylogenetic groups (A = 49, B1 = 15, B2 = 43, C = 22, Clade I = 7, D = 37, F = 13 and 16 unknown); 22 strains belonged to the sequence type ST131. No association between a specific strain and ESBL production was detected.CONCLUSIONS:This report shows the alarming spread of ESBL genes in Burkina Faso. Public health efforts should focus on education (population and healthcare professionals), surveillance and promotion of correct and restricted antibiotic use to limit their dissemination.

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16. Which proportion of extended-spectrum beta-lactamase producing strains could be treated by non-carbapenem beta-lactams?

Author

Canoui E, Tankovic J, Bige N, Alves M, and Offenstadt G

Subjects
Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents classification, Anti-Bacterial Agents pharmacology, Cross Infection drug therapy, Cross Infection epidemiology, Cross Infection microbiology, Drug Resistance, Multiple, Bacterial, Enterobacteriaceae enzymology, Enterobacteriaceae genetics, Enterobacteriaceae isolation & purification, Enterobacteriaceae Infections epidemiology, Enterobacteriaceae Infections microbiology, Female, France epidemiology, Humans, Imipenem pharmacology, Imipenem therapeutic use, Intensive Care Units, Male, Microbial Sensitivity Tests, Middle Aged, Retrospective Studies, Substrate Specificity, beta-Lactams pharmacology, Anti-Bacterial Agents therapeutic use, Bacterial Proteins metabolism, Enterobacteriaceae drug effects, Enterobacteriaceae Infections drug therapy, beta-Lactam Resistance genetics, beta-Lactamases metabolism, beta-Lactams therapeutic use
Published
2014
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17. Gram-negative bacteremia: which empirical antibiotic therapy?

Author

Shoai Tehrani M, Hajage D, Fihman V, Tankovic J, Cau S, Day N, Visseaux C, Carbonnelle E, Kouatchet A, Cattoir V, Nhan TX, Corvec S, Jacquier H, Jauréguy F, Le Monnier A, Morand P, and Zahar JR

Subjects
Aged, Cephalosporin Resistance, Community-Acquired Infections drug therapy, Humans, Prospective Studies, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Gram-Negative Bacterial Infections drug therapy
Abstract

Purpose: Given the increasing frequency of cefotaxime-resistant strains, third-generation cephalosporins (3GC e.g. cefotaxime, ceftriaxone) might not be recommended any longer as empirical antibiotic therapy for community-acquired Gram-negative bacteremia (CA-GNB)., Patients and Methods: We conducted a multicenter prospective descriptive study including patients with CA-GNB., Results: Two hundred and nineteen patients were included. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated species in 63% (n=138) and 11% (n=24) of the cases, respectively. The prevalence of cefotaxime-resistance reached 18% (n=39) mostly due to intrinsic resistance (27 cases, 12%). The presence of invasive material (P<0.001), the origin of the patient (Paris region or West of France) (P=0.006), and home health care (P<0.001) were variables predicting resistant GNB. The negative predictive value for resistance in patients with invasive material coming from the West of France, or without invasive material and with home health care was 94%. The positive predictive value for patients with invasive material living in Paris, or without invasive material and with home health care only reached 58 and 54%, respectively., Conclusions: Using 3GC for CA-GNB due to cefotaxime-resistant strains was relatively frequent, ESBL-producing Enterobacteriaceae being rarely involved. Our study highlights the role of local epidemiology; before any changes to first-line antibiotic therapy, local epidemiological data should be taken into account., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Published
2014
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