In 1999, in Rhône-Alpes region, in a survey of resistance to antibiotics of Streptococcus pneumoniae, 35 cases of meningitis were observed. A retrospectic questionnary was sent to each participant. ...MICs to Penicillin, Amoxicillin and Cefotaxime were determined with ATB-PNEUMO gallery or E-test and by disk diffusion for the other antibiotics. The results were interpreted according to the recommendations of the CA-SFM. Mean age was 38.1 years (range : 1 month -78 years) and sex-ratio 2/5. Eight patients had previously received antibiotics, 22 patients had risk factors and 23 were transferred in intensive care unit. The patients received C3G + glycopeptide in 15 of 16 children and in 13/19 adults according to the consensus recommendations. Diagnostic was made on the direct examination of CSF in 83%, and blood cultures was positive in 74.3% of cases. The percentage of PRP was 48.6% with 17.1% of intermediate-amoxicilline and 14.3% intermediate-cefotaxime strains. Resistance to trimethoprim-sulfamethoxazole was 45.7%, to chloramphenicol 30% and to fosfomycin 6.9%. All the strains were susceptible to rifampicin and vancomycin. Among the 17 PRP strains, 7 were belonging to serotype 6 (6 in children). The clinical outcome was fatal in 7 male cases (20%), without risk factors in 3 children and 6 of 7 strains were susceptible to penicillin. Six patients (17%) had auditive and/or neurologic sequellaes. This study shows that nearly 50% of strains isolated in meningitis, in Rhône-Alpes region, were not susceptible to penicillin, and confirms the frequency of sequellaes while the mortality is not related with the resistance of strains to the antibiotics.
En 1999, en région Rhône-Alpes, dans le cadre de la surveillance de la résistance de
S. pneumoniae aux antibiotiques, 35 méningites ont été répertoriées. Un questionnaire rétrospectif a été adressé à ...chaque participant. Les CMI à la pénicilline, l’amoxicilline et le céfotaxime déterminées à l’aide de la galerie ATB-PNEUMO® ou E-test® et les antibiogrammes ont été interprétés selon les recommandations du CA-SFM. Soixante-trois pour cent des méningites ont été observées en automne/hiver. L’âge médian était de 38,1 ans (extrêmes : 1 mois–78 ans), le sex-ratio M/F à 2/5. Huit patients avaient reçu des antibiotiques dans les 15 jours précédents ; 22 patients présentaient des facteurs de risque (4 brèches, 3 OMA…) ; 23 patients ont été transférés en réanimation. Les traitements antibiotiques ont été une C3G + glycopeptide chez 15 des 16 enfants et chez 13 des 19 adultes conformément aux recommandations de consensus. Le diagnostic a été fait sur l’examen direct du LCR dans 83 % des cas. Les hémocultures étaient positives dans 74,3 % des cas. Le pourcentage de PSDP était de 48,6 %, avec 17,1 % de souches intermédiaires à l’amoxicilline et 14,3 % au céfotaxime. La résistance au triméthoprime-sulfaméthoxazole était de 45,7 %, au chloramphénicol de 30 % et à la fosfomycine de 6,9 %. Toutes les souches étaient sensibles à la rifampicine et à la vancomycine. Parmi les 17 PSDP, 7 souches appartenaient au sérotype 6 dont 6 chez les enfants. L’évolution a été marquée par 7 décès (20 %), tous de sexe masculin, sans facteur de risque chez les 3 enfants ; 6 souches sur 7 étaient péni-S. Six patients (17 %) ont eu des séquelles auditives et/ou neurologiques. Cette étude montre que presque la moitié des souches isolées de méningites, en région Rhône-Alpes, sont de sensibilité diminuée à la pénicilline et confirme la fréquence des survenues de séquelles qui, comme les décès, ne sont pas liés à la résistance des souches aux antibiotiques.
In 1999, in Rhône-Alpes region, in a survey of resistance to antibiotics of
Streptococcus pneumoniae, 35 cases of meningitis were observed. A retrospectic questionnary was sent to each participant. MICs to Penicillin, Amoxicillin and Cefotaxime were determined with ATB-PNEUMO gallery or E-test and by disk diffusion for the other antibiotics. The results were interpreted according to the recommendations of the CA-SFM. Mean age was 38.1 years (range : 1 month –78 years) and sex-ratio 2/5. Eight patients had previously received antibiotics, 22 patients had risk factors and 23 were transfered in intensive care unit. The patients received C3G + glycopeptide in 15 of 16 children and in 13/19 adults according to the consensus recommendations. Diagnostic was made on the direct examination of CSF in 83%, and blood cultures was positive in 74.3% of cases. The percentage of PRP was 48.6% with 17.1% of intermediate-amoxicilline and 14.3% intermediate-cefotaxime strains. Resistance to trimethoprim-sulfamethoxazole was 45.7%, to chloramphenicol 30% and to fosfomycin 6.9%. All the strains were susceptible to rifampicin and vancomycin. Among the 17 PRP strains, 7 were belonging to serotype 6 (6 in children). The clinical outcome was fatal in 7 male cases (20%), without risk factors in 3 children and 6 of 7 strains were susceptible to penicillin. Six patients (17%) had auditive and/or neurologic sequellaes. This study shows that nearly 50% of strains isolated in meningitis, in Rhône-Alpes region, were not susceptible to penicillin, and confirms the frequency of sequellaes while the mortality is not related with the resistance of strains to the antibiotics.
A 62-year-old patient was scheduled for coronary artery bypass surgery because of tritroncular coronary artery disease. The early postoperative period was uncomplicated until the 10th postoperative ...day when purulent fluid appeared from the sternal wound. Cultures of blood, wound and mediastinal tissues yielded Streptococcus pneumoniae with decreased susceptibility to penicillin G. Despite prompt surgical debridement and appropriate antibiotics, a septic shock with multiorgan failure occurred and the patient died on the 19th postoperative day. Although Streptococcus pneumoniae is uncommonly implicated in postoperative mediatinitis, it frequently leads to multiple organ failure and death.
The diagnosis of severe mitral stenosis with left atrial thrombus was rectified at valvular replacement in a 48-year old immuno-competent man who was a cat owner. The mass in the left atrium was, in ...fact, a large endocarditic vegetation. Pre- and postoperative blood cultures were negative as was culture of the excised mitral valve. The diagnosis of infectious endocarditis (IE) due to Bartonella Henselae was made from a positive serological test (1600) and identification of the germ by genetic amplification. Antibiotic therapy was continued for 6 months and the patient was cured with a follow-up of 4 years. Bartonella Henselae IE is very rare (14 reported cases) and affects mainly the aortic valve, often giving rise to very large vegetations which, in half the cases, are complicated by systemic emboli. Germs like Batonella are sensitive to most antibiotics, especially the aminosides and macrolides. In Bartonella Henselae IE, valve replacement is the rule (13 out of 14 cases) and the prognosis is usually good. Sero-diagnosis of Bartonellosis should be part of the systematic investigation of all blood culture negative IE.
Infective endocarditis due to Staphylococcus capitis Lina, B; Celard, M; Vandenesch, F ...
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America,
07/1992, Letnik:
15, Številka:
1
Report
Objectif –
Déterminer l'état de la résistance du pneumocoque en 1999 dans la région Rhône-Alpes.
Patients et méthodes –
Mille huit cent treize souches de
Streptococcus pneumoniae (64,5 % adultes, ...35,5 % enfants) ont été collectées par 31 laboratoires. La sensibilité à l'oxacilline des souches isolées en situation pathogène a été mesurée (normes du CA-SFM). Pour toutes les souches de sensibilité diminuée à la pénicilline G (PSDP), les CMI à la pénicilline G, l'amoxicilline et au céfotaxime ont été déterminées (E-test ou ATB-Pneumo). Le centre coordinateur a contrôlé la CMI ainsi que le sérotypage des souches de PSDP.
Résultats –
La prévalence des PSDP était de 40,5 %. Parmi les 9,4 % de résistants, 63,3 % étaient intermédiaires à l'amoxicilline et 0,8 % résistants au céfotaxime. La résistance à l'érythromycine, tétracycline, cotrimoxazole, chloramphénicol, pristinamycine, rifampicine et fosfomycine était de 42 %, 27,4 %, 37,9 %, 19,2 %, 1,4 %, 0,6 % et 8 %. La multirésistance chez les PSDP était de : 70,7 % à l'érythromycine, 72 % à cotrimoxazole, 45 % à tétracycline, 32,8 % au chloramphénicol, 1,8 % à la pristinamycine et 0,4 % à la rifampicine. Les PSDP de sérotypes 14 (23,8 %) étaient les plus fréquents, puis les sérotypes 6 (16 %), 23 (15,7 %), 19 (11 %), et 15 (2,8 %).
Discussion –
Depuis 1997 les PSDP augmentent (29,5 % versus 40,5 %), les souches résistantes à l'amoxicilline sont encore peu fréquentes (2 %) et celles résistantes au céfotaxime (0,3 %) sont maintenant isolées.
Objective –
The authors wanted to determine the state of pneumococcus resistance in the Rhône-Alpes region, in 1999.
Patients and method –
One thousand eight hundred and thirteen strains of
S. pneumoniae (Sp) (64.5% adults, 35.5% children) were collected by 31 clinical microbiological laboratories. Susceptibility to oxacillin of the strains (isolated in pathogenic conditions) was measured according to CA-SFM standards. The MICs of penicillin (P), amoxicillin (AMX), and cefotaxime (CTX) were determined (E-test or ATB-Pneumo gallery) for all strains resistant to penicillin G (PRP). The regional coordinating center checked the MIC and serotype of each PRP strain.
Results –
The prevalence of PRP (MIC > 0.06 mg/L) was 40.5%. Resistance (I + R) to ERY, TET, SXT, and C was respectively 42%, 27.4%, 37.9%, and 19.2%. Among the 9.4% of strains resistant to P (MIC > 1 mg/L), 63.3% were intermediate to AMX (0.5 < MIC ⩽ 2 mg/L) and 0.8% resistant to CTX (MIC > 2 mg/L). The multiresistance was frequent in PRP: 70.7% to ERY, 72% to TET, 45% to SXT, 32.8% to C, and only 0.4% to RIF. PRP of serotype 14 (23.8%) were the most frequent, followed by serotypes 6 (16%), 23 (15.7%), 9 (12%), 19 (11%), and 15 (2.8%).
Discussion –
PRP have been increasing since 1997 (29.5% vs. 40.5%), AMX-R strains are still infrequent (2%), and CTX-R strains even though rare (0.3%) are now isolated.
Objective –
The authors wanted to determine the state of pneumococcus resistance in the Rhône-Alpes region, in 1999.
Patients and method –
One thousand eight hundred and thirteen strains of
S. ...pneumoniae (Sp) (64.5% adults, 35.5% children) were collected by 31 clinical microbiological laboratories. Susceptibility to oxacillin of the strains (isolated in pathogenic conditions) was measured according to CA-SFM standards. The MICs of penicillin (P), amoxicillin (AMX), and cefotaxime (CTX) were determined (E-test or ATB-Pneumo gallery) for all strains resistant to penicillin G (PRP). The regional coordinating center checked the MIC and serotype of each PRP strain.
Results –
The prevalence of PRP (MIC > 0.06 mg/L) was 40.5%. Resistance (I + R) to ERY, TET, SXT, and C was respectively 42%, 27.4%, 37.9%, and 19.2%. Among the 9.4% of strains resistant to P (MIC > 1 mg/L), 63.3% were intermediate to AMX (0.5 < MIC ⩽ 2 mg/L) and 0.8% resistant to CTX (MIC > 2 mg/L). The multiresistance was frequent in PRP: 70.7% to ERY, 72% to TET, 45% to SXT, 32.8% to C, and only 0.4% to RIF. PRP of serotype 14 (23.8%) were the most frequent, followed by serotypes 6 (16%), 23 (15.7%), 9 (12%), 19 (11%), and 15 (2.8%).
Discussion –
PRP have been increasing since 1997 (29.5% vs. 40.5%), AMX-R strains are still infrequent (2%), and CTX-R strains even though rare (0.3%) are now isolated.
Objectif –
Déterminer l'état de la résistance du pneumocoque en 1999 dans la région Rhône-Alpes.
Patients et méthodes –
Mille huit cent treize souches de
Streptococcus pneumoniae (64,5 % adultes, 35,5 % enfants) ont été collectées par 31 laboratoires. La sensibilité à l'oxacilline des souches isolées en situation pathogène a été mesurée (normes du CA-SFM). Pour toutes les souches de sensibilité diminuée à la pénicilline G (PSDP), les CMI à la pénicilline G, l'amoxicilline et au céfotaxime ont été déterminées (E-test ou ATB-Pneumo). Le centre coordinateur a contrôlé la CMI ainsi que le sérotypage des souches de PSDP.
Résultats –
La prévalence des PSDP était de 40,5 %. Parmi les 9,4 % de résistants, 63,3 % étaient intermédiaires à l'amoxicilline et 0,8 % résistants au céfotaxime. La résistance à l'érythromycine, tétracycline, cotrimoxazole, chloramphénicol, pristinamycine, rifampicine et fosfomycine était de 42 %, 27,4 %, 37,9 %, 19,2 %, 1,4 %, 0,6 % et 8 %. La multirésistance chez les PSDP était de : 70,7 % à l'érythromycine, 72 % à cotrimoxazole, 45 % à tétracycline, 32,8 % au chloramphénicol, 1,8 % à la pristinamycine et 0,4 % à la rifampicine. Les PSDP de sérotypes 14 (23,8 %) étaient les plus fréquents, puis les sérotypes 6 (16 %), 23 (15,7 %), 19 (11 %), et 15 (2,8 %).
Discussion –
Depuis 1997 les PSDP augmentent (29,5 % versus 40,5 %), les souches résistantes à l'amoxicilline sont encore peu fréquentes (2 %) et celles résistantes au céfotaxime (0,3 %) sont maintenant isolées.
