Background & Aims
Hepatitis B Virus (HBV) DNA during chronic infection can reach levels at which mother‐to‐child (MTC) transmission frequently occurs despite passive‐active immunization of newborns. ...Hepatitis D Virus (HDV) RNA can reach high levels, we assessed HBV/HDV MTC co‐transmission.
Methods
Monocentric retrospective study (registered in ClinicalTrials.gov (NCT02044055)), after informed consent in HBV/HDV co‐infected women pregnant between 01/01/2004 and 01/01/2015 in Paris, France. The children were tested when 24 months of age or older.
Results
Twenty‐two (3%) of 742 HBV infected women, HDV co‐infected, gave birth to 54 children during the study period. HBV DNA was above 5 Log10 I.U/mL in 10 pregnancies previous any treatment, with HDV RNA of less than 2.3 Log10 I.U/mL. HDV RNA was above 5 Log10 I.U/mL in eight pregnancies previous any treatment, with HBV DNA of less than 1.5 Log10 I.U/mL. Inverse patterns of HBV DNA and HDV RNA were observed in 17 of 35 (49%) pregnancies: 13 (76%) received no HBV treatment; four (24%) were treated. HBV DNA was under 5 Log10 I.U/mL in 46 of the 50 assessed women (92%) at birth. Of the 36 assessed children, given passive‐active immunization, 24 (66%) were protected, 10 (28%) were neither infected nor protected, one was chronically HBV infected, and one had a past HBV infection. HDV Ab was negative in the 36 children.
Conclusions
These results suggest that HBV/HDV MTC co‐transmission is exceptional. Studies are needed, mainly in developing countries.
•We report and analyse all multi-resistant Acinetobacter baumannii (MR-AB) infections in patients hospitalized in a burn unit from April to November 2014 in a prospective observational study.•We ...found that among 86 patients admitted to the ward, 15 acquired MR-AB nosocomial infection with a median time of 22 days.•Risk factors for MR-AB infection were SAPS II and ABSI scores, MR-AB colonization, invasive procedures and ≥2 skin grafts.•MR-AB infection was associated with an increased risk of death and a longer hospital stay.•Surveillance cultures should be performed to identify colonized patients in whom the risk of MR-AB infection is widely increased.•As it seems difficult to limit the number of skin grafts or invasive procedures needed to manage severely burned patients, prevention of MR-AB colonization remains critical.•This study is, to our knowledge, the first prospective study on the subject, which is a great asset.
Multidrug-Resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in burn units. We aimed to study the incidence, risk factors and outcome of MR-AB infections in a burn unit (BU).
A prospective study was conducted from April to November, 2014 during an outbreak in a BU in Paris. Weekly surveillance cultures were performed to determine MR-AB colonization. MR-AB nosocomial infections, discharge or death without MR-AB infection were considered as competing events. To identify risk factors for MR-AB infection, baseline characteristics and time-dependent variables were investigated in univariate analyses using Cox models.
Eighty-six patients admissions were analyzed during the study period. Among them, 15 (17%) acquired MR-AB nosocomial infection. Median time to infection was 22days (interquartile range: 10–26 days). Cumulative incidence of MR-AB infections was 15% at 28days (95% CI=8–24). Risk factors for MR-AB infection in univariate analysis were SAPS II (Hazard Ratio (HR):1.08; 95% CI:1.05–1.12; P<0.0001) and ABSI (Abbreviated Burn Severity Index) scores (HR:1.32; 95% CI:1.12–1.56; P=0.001), MR-AB colonization (HR:10.2; 95%CI:2.05–50.3; P=0.004), invasive procedures (ventilation, arterial and/or venous catheter) (P=0.0001) and ≥2 skin grafts (HR:10.2; 95% CI:1.76–59.6; P=0.010). MR-AB infection was associated with an increased risk of death (HR: 7.11; 95%CI: 1.52–33.2; P=0.013) and longer hospital stay with a median estimated increase of 10days (IQR: 6; 14).
Incidence of MR-AB nosocomial infection was high during this outbreak, and was associated with prolonged hospitalization and increased risk of death. High patient severity scores, prior MR-AB colonization, invasive procedures and repeated skin grafts were associated with an increased risk of nosocomial infection.
•A carbapenemase NDM-1-producing K. pneumoniae outbreak occurred during COVID-19 epidemic.•The nonoptimal application of bio-cleaning procedures may have contributed to the outbreak.•Workload, ...patient severity and inappropriate glove excessive use may have contributed additionally.
An outbreak of Klebsiella pneumoniae producing the carbapenemase NDM-1 occurred in our ICU during the last COVID-19 wave. Twelve patients were tested positive, seven remained asymptomatic whereas 5 developed an infection. Resistome and in silico multilocus sequence typing confirmed the clonal origin of the strains. The identification of a possible environmental reservoir suggested that difficulties in observing optimal bio-cleaning procedures due to workload and exhaustion contributed to the outbreak besides the inappropriate excessive glove use.
Abstract
Cryptococcal antigen (CrAg) is a capsule polysaccharide antigen that can be detected in the fluids of patients with cryptococcal infections. Cryptococcal Antigen Latex Agglutination System ...(CALAS), enzyme-linked immunosorbent assays (EIA), and lateral flow assay (LFA) are the main methods available. Two main commercial LFA kits are available: CryptoPS (Biosynex, Illkirch Graffenstaden, France) and CrAg LFA (IMMY, Inc. USA). In our lab, we prospectively used CryptoPS as a screening tool in serum for confirmed positive results with CALAS. We investigated the rigor of the CryptoPS test in serum in a multicentric evaluation over 3 years. To improve the specificity of CryptoPS in serum, we additionally implemented and evaluated a pretreatment protocol before CryptoPS testing. A total of 43 serum samples collected from 43 patients were investigated. We found that the CryptoPS assay is hampered by a high rate of false-positive results in serum with a high rate of CryptoPS-positive but CrAg LFA-negative and CALAS-negative sera in patients with no proof of Cryptococcus infection (n = 29). Using a simple pretreatment procedure (5 min incubation at 100°C and centrifugation) we were able to reverse false-positive results, suggesting that there could be interferent material present in the serum. Pretreatment also impacted the CryptoPS results (negative result) in two patients with the cryptococcal disease, one with isolated antigenemia and one with cryptococcal meningitis. Comparing the titers obtained with CALAS and CrAg LFA, we noticed that the titer obtained with CrAg LFA was almost 10-fold higher than those with CALAS. This study showed that Biosynex CryptoPS in serum could give false-positive results even in the absence of cryptococcal disease. These could be reduced by applying an easy pretreatment procedure to the serum before testing, with little but existing impact on the sensitivity.
Large datasets of long-term streamflow measurements are widely used to infer and model hydrological processes. However, streamflow measurements may suffer from what users can consider anomalies, i.e. ...non-natural records that may be erroneous streamflow values or anthropogenic influences that can lead to misinterpretation of actual hydrological processes. Since identifying anomalies is time consuming for humans, no study has investigated their proportion, temporal distribution, and influence on hydrological indicators over large datasets. This study summarizes the results of a large visual inspection campaign of 674 streamflow time series in France made by 43 evaluators, who were asked to identify anomalies falling under five categories, namely, linear interpolation, drops, noise, point anomalies, and other. We examined the evaluators' individual behaviour in terms of severity and agreement with other evaluators, as well as the temporal distributions of the anomalies and their influence on commonly used hydrological indicators. We found that inter-evaluator agreement was surprisingly low, with an average of 12 % of overlapping periods reported as anomalies. These anomalies were mostly identified as linear interpolation and noise, and they were more frequently reported during the low-flow periods in summer. The impact of cleaning data from the identified anomaly values was higher on low-flow indicators than on high-flow indicators, with change rates lower than 5 % most of the time. We conclude that the identification of anomalies in streamflow time series is highly dependent on the aims and skills of each evaluator, which raises questions about the best practices to adopt for data cleaning.
Bone biopsy (BB) performed by a surgeon or an interventional radiologist is recommended for suspicion of osteomyelitis underlying diabetic foot ulcer (DFU). To facilitate its practice, we developed a ...procedure allowing bedside blind bone biopsy (B4) by a diabetologist.
We conducted a three-step observational study consisting of a feasibility and safety phase (phase 1) to assess the success and side effects of B4, a validity phase (phase 2) to compare DFU outcomes between positive (B4+) and negative (B4-) bone cultures, and a performance phase (phase 3) to compare B4 with the conventional surgical or radiological procedure basic bone biopsy (B3). Primary end points were the presence of bone tissue (phase 1) and complete DFU healing with exclusive medical treatment at 12 months (phases 2 and 3).
In phase 1, 37 consecutive patients with clinical and/or radiological suspicion of DFU osteomyelitis underwent B4. Bone tissue was collected in all patients with few side effects. In phase 2, a B4+ bone culture was found in 40 of 79 (50.6%) participants. Among B4+ patients, complete wound healing after treatment was 57.5%. No statistical difference was observed with patients with B4- bone culture not treated with antibiotics (71.8%,
= 0.18). In phase 3, the proportion of patients with positive BB was lower in B4 (40 of 79, 50.6%) than in B3 (34 of 44, 77.3%,
< 0.01). However, complete healing was similar (64.6% vs. 54.6%,
= 0.28). No difference in rate of culture contamination was observed.
B4 is a simple, safe, and efficient procedure for the diagnosis of DFU osteomyelitis with a similar proportion of healing to conventional BB.
Abstract
Objectives
Data on the efficacy of vancomycin catheter lock therapy (VLT) for conservative treatment of totally implantable venous access port-related infections (TIVAP-RI) due to CoNS are ...scarce. The aim of this study was to evaluate the effectiveness of VLT in the treatment of TIVAP-RI due to CoNS in cancer patients.
Methods
This prospective, observational, multicentre study included adults with cancer treated with VLT for a TIVAP-RI due to CoNS. The primary endpoint was the success of VLT, defined as no TIVAP removal nor TIVAP-RI recurrence within 3 months after initiation of VLT. The secondary endpoint was 3 month mortality. Risk factors for VLT failure were also analysed.
Results
One hundred patients were included men 53%, median age 63 years (IQR 53–72). Median duration of VLT was 12 days (IQR 9–14). Systemic antibiotic therapy was administered in 87 patients. VLT was successful in 44 patients. TIVAP could be reused after VLT in 51 patients. Recurrence of infection after completion of VLT occurred in 33 patients, among which TIVAP was removed in 27. Intermittent VLT (antibiotic solution left in place in the TIVAP lumen part of the time) was identified as a risk factor for TIVAP-RI recurrence. At 3 months, 26 deaths were reported; 1 (4%) was related to TIVAP-RI.
Conclusions
At 3 months, success of VLT for TIVAP-RI due to CoNS was low. However, removing TIVAP was avoided in nearly half the patients. Continuous locks should be preferred to intermittent locks. Identifying factors of success is essential to select patients who may benefit from VLT.
Highlights • The impact of fluoroquinolone (FQ) treatment on nasal staphylococci is substantial both in the community and hospitals. • Emergence of FQ resistance in nasal staphylococci is practically ...unavoidable. • A switch in favour of pathogenic and resistant staphylococci species occurs. • Exogenous transmission of resistant strains prevails. • The risk of dissemination and infection by resistant strains is worrisome.
Clay mineral and stable isotope (C, O) data are reported from the upper Sinemurian (Lower Jurassic) of the Cardigan Bay Basin (Llanbedr–Mochras Farm borehole, northwestern Wales) and the Paris Basin ...(Montcornet borehole, northern France) to highlight the prevailing environmental and climatic conditions. In both basins, located at similar palaeolatitudes of 30–35∘ N, the clay mineral assemblages comprise chlorite, illite, illite–smectite mixed layers (R1 I-S), smectite, and kaolinite in various proportions. Because the influence of burial diagenesis and authigenesis is negligible in both boreholes, the clay minerals are interpreted to be derived from the erosion of the Caledonian and Variscan massifs, including their basement and pedogenic cover. In the Cardigan Bay Basin, the variations in the proportions of smectite and kaolinite are inversely related to each other through the entire upper Sinemurian. As in the succeeding Pliensbachian, the upper Sinemurian stratigraphic distribution reveals an alternation of kaolinite-rich intervals reflecting strong hydrolysing conditions and smectite-rich intervals indicating a semi-arid climate. Kaolinite is particularly abundant in the upper part of the obtusum zone and in the oxynotum zone, suggesting more intense hydrolysing conditions likely coeval with warm conditions responsible for an acceleration of the hydrological cycle. In the north of the Paris Basin, the succession is less continuous compared to the Cardigan Bay Basin site, as the oxynotum zone and the upper raricostatum zone are either absent or highly condensed. The clay assemblages are dominantly composed of illite and kaolinite without significant stratigraphic trends, but a smectite-rich interval identified in the obtusum zone is interpreted as a consequence of the emersion of the London–Brabant Massif following a lowering of sea level. Following a slight negative carbon isotope excursion at the obtusum–oxynotum zone transition, a long-term decrease in δ13Corg from the late oxynotum–early raricostatum zones is recorded in the two sites and may precede or partly include the negative carbon isotope excursion of the Sinemurian–Pliensbachian Boundary Event, which is recognised in most basins worldwide and interpreted to signify a late pulse of the Central Atlantic Magmatic Province volcanism.
Late Carboniferous to early Permian organic-rich sedimentary successions of late-orogenic continental basins from the northeastern Massif Central (France) coincide with both the Variscan mountain ...dismantling and the acme of the long-lasting Late Paleozoic Ice Age. Here, we investigate the carbon and nitrogen cycles in the newly dated sedimentary successions of the Decize–La Machine and Autun basins during these geodynamic and climate upheavals. The sedimentary organic matter has been analyzed through Rock-Eval pyrolysis, palynofacies and elemental and isotope geochemistry along cored-wells and outcropping sections, previously accurately defined in terms of paleo-depositional environments. Rock-Eval and palynofacies data have evidenced two origins of organic matter: a phytoplanktonic/bacterial lacustrine origin (Type I organic matter, organic δ
13
C values around −23.5‰), and a terrestrial origin (vascular land plants, Type III organic matter, organic δ
13
C values around −20‰), mixed in the deltaic-lacustrine sediments during background sedimentation (mean organic δ
13
C values around −22‰). Episodes of high organic matter storage, reflected by black shales and coal-bearing deposits (total organic carbon up to 20 and 70%, respectively) are also recognized in the successions, and are characterized by large negative organic carbon isotope excursions down to −29‰. We suggest that these negative isotope excursions reflect secondary processes, such as organic matter remineralization and/or secondary productivity varying under strict local controls, or possibly larger scale climate controls. At times, these negative δ
13
C excursions are paired with positive δ
15
N excursions up to +10‰, reflecting water column denitrification and anammox during lake-water stratification episodes. Together, these isotopic signals (i.e., low sedimentary organic δ
13
C associated with high bulk δ
15
N values) indicate periods of high primary productivity of surface waters, where nitrogen and carbon cycles are spatially decoupled. These local processes on the sedimentary isotope archives may partially blur our ability to directly reconstruct paleoclimate variations in such continental settings using only C and N isotopes. At last, we explore an organic δ
13
C-based mixing model to propose ways to disentangle autochthonous versus allochthonous origin of organic matter in lacustrine continental settings.
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