Systematic cultures of drain tips or drainage fluids for the early detection of surgical site infections (SSIs) are controversial. To examine the association between the results of systematic drain ...tip or drainage fluid cultures and the occurrence of SSIs in clean or clean-contaminated surgery. Searches were performed in the PubMed, and Cat.inist databases for observational studies published before 31st March 2017. Studies reporting results of drain tip or drainage fluid systematic cultures and SSIs after clean or clean-contaminated surgeries were included, and meta-analyses were performed. Seventeen studies, including 4390 patients for drain tip cultures and 1288 for drainage fluid cultures, were selected. The pooled negative predictive values were high (99%, 95% confidence interval (CI) 98–100 for drain tip cultures and 98%, 95% CI 94–100 for drainage fluid cultures). The positive predictive values were low (11%, 95% CI 2–24 for drain tip cultures and 12%, 95% CI 3–24 for drainage fluid cultures). The sensitivities were low (41%, 95% CI 12–73 for drain tip cultures and 37%, 95% CI 16–60 for drainage fluid cultures). The specificities were high (93%, 95% CI 88–96) for drain tip cultures and moderate (77%, 95% CI 54–94) for drainage fluid cultures. Systematic cultures of drain tips or drainage fluids appear not to be relevant, because their positive predictive values were low in the prediction of SSIs.
Aims
The aim of this study was to evaluate the effect of valve surgery (VS) in infective endocarditis (IE) on 5-year mortality and to evaluate whether conflicting results reported by previous studies ...could be due to differences in their methodological approaches.
Methods and results
Four hundred and forty-nine patients with a definite left-sided IE were selected from a prospective, population-based study. Association between VS and 5-year mortality was examined with a Cox model. To determine the impact of different methodological approaches, we also analysed the relationship between VS and mortality in our database, according to each method used in the five previous studies. Valve surgery was performed in 240 patients (53%). It was associated with an increase in short-term mortality within the first 14 post-operative days; adjusted hazard ratio (HR), 3.69; 95% confidence interval (CI), 2.17-6.25; P < 0.0001 and a decrease in long-term mortality (adjusted HR, 0.55; 95% CI, 0.35-0.87; P = 0.01). At least 188 days of follow-up were required for VS to provide an overall survival advantage. When applying each study's method to our database, we obtained results similar to those reported.
Conclusion
Previous conflicting results appear to be related to differences in statistical methods. When using appropriate models, we found that VS was significantly associated with reduced long-term mortality.
To diagnose invasive fungal infections, the detection of (1 → 3)-β-
d
-glucan in serum has shown variable specificity, depending on the targeted population. Several circumstances for false-positive ...results of beta-glucan tests have been identified, among which are severe bacterial infections. In this study, we measured (1 → 3)-β-
d
-glucan by the Fungitell test in the serum of 62 patients (one serum sample tested per patient) for whom invasive fungal infection was not suspected: 19 control subjects and 43 patients with bacteraemia. The test was interpretable for 58 sera: all 19 control subjects had negative beta-glucan test; among the 39 bacteraemic patients, we report 16 false-positive results. For the 22 patients undergoing bacteraemia due to Gram-negative bacilli, we observed 13 false-positive results (59%). Among the 17 patients with bloodstream infection involving Gram-positive cocci, three false-positive tests were recorded, but none in the eight cases of
Streptococcus pneumoniae
bacteraemia. Statistical analysis showed that beta-glucan levels were significantly higher in patients with Gram-negative bacilli bloodstream infection in comparison to those with bacteraemia due to Gram-positive cocci. These results were independent from other previously described causes for false-positive beta-glucan tests. These data might help physicians to interpret positive beta-glucan detection when an invasive fungal infection is suspected, especially for patients with bacterial infections.
This study describes the clinical and microbiological features associated with group B
Streptococcus
(GBS) bone and joint infections (BJIs). It was a retrospective analysis of adult cases of GBS BJIs ...reported to the French National Reference Center for Streptococci from January 2004 to December 2014. Clinical data and GBS molecular characteristics are reported. Strains were collected from 163 patients. The most frequent comorbidities were: solid organ cancer (
n
= 21, 21%) and diabetes mellitus (
n
= 20, 20%). The main infection sites were knee (47/155 = 30%) and hip (43/155 = 27%), and occurred on orthopedic devices in 71/148 cases (48%). CPS III (
n
= 47, 29%), Ia (
n
= 26, 16%) and V (
n
= 40, 25%) were predominant. Resistance to erythromycin, clindamycin and tetracycline was detected in 55/163 (34%), 35/163 (21%) and 132/163 (81%) strains, respectively. The most frequent sequence types were ST-1 (
n
= 21, 25%), ST-17 (
n
= 17, 20%) and ST-23 (
n
= 11, 13%). The rate of resistance to erythromycin was 0% for ST-17 strains, 52% (
n
= 11) for ST-1 and 44% (
n
= 7) for ST-23 (
p
< 0.001). GBS bone and joint infections predominantly occur in patients aged >50 years and/or with comorbidities such as cancer and diabetes mellitus. CPS type distribution and MLST are very similar to that of other adult GBS invasive infections.
Summary An unusual multi-drug-resistant Pseudomonas aeruginosa (MDR-PA) was isolated in four patients whilst hospitalized in a French teaching hospital between May and August 2011. All four patients ...had undergone an oesophago-gastro-duodenoscopy with the same gastroscope over a five-month period. This endoscope was associated with a culture positive for the MDR-PA. Observations of endoscope reprocessing identified deviations from the agreed processes: insufficient initial cleaning, shortening of the immersion time and brushing time, insufficient channel flushing, and inadequate drying prior to storage. Since withdrawing the gastroscope and institution of strict adherence to the agreed processes, no other MDR-PA cases have been isolated.
Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of ...asymptomatic NC (AsNC) on the management and prognosis of IE.
From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation.
Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality.
The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results.
Streptococcus pneumoniae is an important cause of acute otitis media (AOM). The aim of this study was to evaluate trends in antibiotic resistance and circulating serotypes of pneumococci isolated ...from middle ear fluid of French children with AOM during the period 2001–2011, before and after the introduction of the PCV-7 (2003) and PCV-13 (2010) vaccines. Between 2001 and 2011 the French pneumococcal surveillance network analysed the antibiotic susceptibility of 6683 S. pneumoniae isolated from children with AOM, of which 1569 were serotyped. We observed a significant overall increase in antibiotic susceptibility. Respective resistance (I+R) rates in 2001 and 2011 were 76.9% and 57.3% for penicillin, 43.0% and 29.8% for amoxicillin, and 28.6% and 13.0% for cefotaxime. We also found a marked reduction in vaccine serotypes after PCV-7 implementation, from 63.0% in 2001 to 13.2% in 2011, while the incidence of the additional six serotypes included in PCV-13 increased during the same period, with a particularly high proportion of 19A isolates. The proportion of some non-PCV-13 serotypes also increased between 2001 and 2011, especially 15A and 23A. Before PCV-7 implementation, most (70.8%) penicillin non-susceptible pneumococci belonged to PCV-7 serotypes, whereas in 2011, 56.8% of penicillin non-susceptible pneumococci belonged to serotype 19A. Between 2001 and 2011, antibiotic resistance among pneumococci responsible for AOM in France fell markedly, and PCV-7 serotypes were replaced by non-PCV-7 serotypes, especially 19A. We are continuing to assess the impact of PCV-13, introduced in France in 2010, on pneumococcal serotype circulation and antibiotic resistance.
Objectives To assess the frequency and diversity of extended spectrum β-lactamases (ESBLs) in the Champagne-Ardenne region France, and to identify genetic elements associated with the blaCTX-M genes. ...Methods During 2004, all the non-duplicate isolates of Pseudomonas aeruginosa and Acinetobacter baumannii resistant to ceftazidime and of Enterobacteriaceae intermediate or resistant to ceftazidime and/or cefotaxime, screening samples excluded, were collected in 10 public hospitals and 3 private clinics. bla genes were sequenced and blaCTX-M environment characterized by PCR mapping. Results In Enterobacteriaceae (138/21 861; 0.6%), ESBLs were predominantly TEM-24 (n = 52; 37.7%) and CTX-M-15 (n = 37; 26.8%). Three new enzymes were identified, CTX-M-61 (CTX-M-1 group), TEM- and SHV-type. A. baumannii (n = 5) produced VEB-1 and P. aeruginosa (n = 2) SHV-2a. ISEcp1 was detected in 22/27 strains, disrupted in 7 of them. The IS903-like element was downstream of blaCTX-M-14 and blaCTX-M-16. ISCR1 was found upstream of blaCTX-M-2 and blaCTX-M-9, and ISCR1 and blaCTX-M-2 were located on a sul1-type class 1 integron. In comparison with 2001–02, ESBL distribution among Enterobacteriaceae showed an increase in CTX-M-type (44.9% vs 3.7% P < 10−7) due to Escherichia coli CTX-M-15 and to the almost total disappearance of TEM-3 (0.9% vs 51.2%). E. coli was the most frequent species (50.0% vs 5.1% in 1998) despite a similar prevalence to that in 1998 (0.5% vs 0.2%). Conclusions A careful detection of blaCTX-M-type spread to other species would help to anticipate clonal endemics such as those observed in Enterobacter aerogenes TEM-24.
We aimed to evaluate factors associated with knowledge of antibiotics and drug resistance.
A questionnaire was handed out by 14 family physicians to their patients between December 20, 2014 and ...April 20, 2015 in Rethel (North-East of France). We conducted a cross-sectional study using a logistical regression model to assess factors associated with antibiotic knowledge. Three criteria were used to assess that knowledge.
Overall, 293 questionnaires were analysed; 48% of patients had received antibiotics in the previous 12 months. Only 44% and 26% gave a correct answer for the statements “Antibiotics are effective against bacteria and ineffective against viruses” and “Antibiotic resistance decreases if the antibiotic use decreases”, respectively. Characteristics such as female sex, age>30 years, high level of education, high professional categories, and having received antibiotic information by the media were associated with high level of knowledge about antibiotics and/or antibiotic resistance. In contrast, having received antibiotic information from family physicians was not associated with good knowledge.
Although media awareness campaigns had an independent impact on a higher public knowledge of antibiotics, the overall public knowledge remains low. It would be necessary to strengthen antibiotic campaigns with clearer information on the relation between the excessive use of antibiotics and the increased risk of antibiotic resistance. Family physicians should be more involved to improve antibiotic knowledge among target groups such as men, young patients, and people from a poor social and cultural background.
Évaluer les facteurs associés aux connaissances des patients sur les antibiotiques et la résistance bactérienne.
Du 20/12/2014 au 20/04/2015, un questionnaire a été distribué dans 14 cabinets médicaux de la ville de Rethel (Ardennes). Dans cette étude transversale analytique, les facteurs associés à la connaissance des antibiotiques ont été identifiés par une régression logistique. Trois critères ont été utilisés pour évaluer le niveau de connaissance.
Au total, 293 patients ont été inclus dans l’étude. Une consommation d’antibiotiques dans l’année était notée dans 48 % des cas. Seulement 44 % et 26 % des patients savaient que les antibiotiques étaient efficaces contre les bactéries et inefficaces contre les virus et que la résistance aux antibiotiques diminuait si la prescription d’antibiotiques diminuait. Le sexe féminin, l’âge>30 ans, le niveau d’étude≥baccalauréat, la profession cadre et/ou profession médicale et les informations reçues dans les médias étaient les caractéristiques des patients indépendamment associées à une bonne connaissance des antibiotiques et/ou des résistances bactériennes alors que les informations reçues du médecin généraliste ne l’étaient pas.
Malgré l’efficacité des campagnes d’information sur l’éducation des patients, la connaissance des antibiotiques reste médiocre. Les campagnes médiatiques devraient donc être intensifiées en étant plus claires sur le lien entre la résistance bactérienne et la consommation d’antibiotiques. Professionnels de santé et notamment médecins généralistes pourraient améliorer la connaissance des antibiotiques au sein des catégories peu informées (hommes, jeunes et personnes avec un faible niveau socioculturel).
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