Currently, contact precautions are recommended for patients colonized or infected with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Recent studies have challenged this ...strategy. This study aimed to assess the rate of ESBL-PE faecal carriage among hospitalized patients according to type of hospital ward, and to identify risk factors associated with carriage.
A point prevalence study was conducted in five different types of hospital ward medical, surgical, intensive care unit (ICU), after care and rehabilitation, and geriatric in eight French hospitals. All patients included in the study provided a fresh stool sample.
In total, 554 patients were included in the study, with a median age of 73 years (range 60–82 years). The overall faecal carriage rate of ESBL-PE was 17.7%. The most frequently encountered species among ESBL-PE was Escherichia coli (71.4%), followed by Klebsiella pneumoniae (14.3%). Risk factors associated with ESBL-PE faecal carriage on univariate analysis were: living in the Paris region (P<0.01) and hospitalization on a geriatric ward (P<0.01). Interestingly, the cumulative duration of hospital stay before screening was not associated with a significantly higher prevalence of ESBL-PE carriage, regardless of ward type. The ESBL-PE colonization rate was much higher for patients hospitalized on geriatric wards (28.1%) and ICUs (21.7%) compared with those for patients hospitalized on surgical wards (14.8%), medical wards (12.8%) or aftercare and rehabilitation (11.2%).
The overall prevalence of ESBL-PE faecal carriage was 17.7%, with only 21% of patients identified previously as carriers. The delay between admission and screening was not associated with an increase in ESBL-PE faecal carriage.
Meticillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA) are responsible for outbreaks in intensive care units. MSSA infections have the same morbidity and mortality rate as MRSA ...infections but are studied less often. Whole-genome sequencing (WGS) is used increasingly for outbreak monitoring, but still requires specific installation and trained personnel to obtain and analyse the data.
To evaluate the workflow and benefits of EpiSeq solution (bioMérieux, Marcy l’Etoile, France) in exploring the increased incidence of S. aureus bloodstream infections in a neonatal intensive care unit (NICU).
Four S. aureus bacteraemia isolates and 27 colonization isolates obtained between January and July 2016 were submitted to the ‘all in one solution’ EpiSeq WGS, quality data assessment, multi-locus sequence typing (MLST), spa typing, virulome and resistome characterization, and phylogenetic tree construction. More in-depth analyses were performed (whole-genome MLST and whole-genome single nucleotide polymorphism (wgSNP) with BioNumerics software (Applied Maths, Sint-Martens-Latem, Belgium).
Nine different sequence types and 13 different spa types were found among the 31 isolates studied. Among those isolates, 11 (seven patients) were ST146 spa type t002, five (four patients) were ST30 and four (four patients) were ST398. The 11 ST146 isolates had a maximum of seven pairwise SNP differences.
Use of EpiSeq solution allowed fast demonstration of the polyclonal profile of the MSSA population in neonates, and enabled the suspicion of a global outbreak to be ruled out. However, wgSNP analysis showed the transmission and persistence of one sequence type for over six months in the NICU, and enabled the infection control team to adapt its response.
Linezolid is an antimicrobial agent for the treatment of multiresistant Gram-positive infections. We assessed the impact of linezolid on the microbiota and the emergence of resistance and ...investigated its relationship with plasma pharmacokinetics of the antibiotic. Twenty-eight patients were treated for the first time with linezolid administered orally (n = 17) or parenterally (n = 11) at 600 mg twice a day. Linezolid plasma pharmacokinetic analysis was performed on day 7. Colonization by fecal enterococci, pharyngeal streptococci, and nasal staphylococci were assessed using selective media with or without supplemental linezolid. The resistance to linezolid was characterized. The treatment led to a decrease of enterococci, staphylococci, and streptococci in the fecal (P = 0.03), nasal, and pharyngeal (P < 0.01) microbiotas. The appearance of resistant strains was observed only in enterococci from the fecal microbiota between the 7th and 21st days of treatment in four patients (14.3%). The resistance was mainly due for the first time to the mutation G2447T in the 23S rRNA gene. No pharmacokinetic parameters were significantly different between the patients, regardless of the appearance of resistance. The emergence of linezolid resistance during treatment was observed only in the intestinal microbiota and unrelated to pharmacokinetic parameters. However, colonization by Gram-positive bacteria was reduced as a result of treatment in all microbiotas.
•Geographical origin and socioeconomic deprivation were not associated with severe forms of COVID-19 after attendance to hospital emergency department.•Hydrocortisone had a strong protective impact ...on the occurrence of severe forms of COVID-19.
Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors.
Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March–April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively.
Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions>25% at admission (aHR: 2.2 95% CI: 1.3–3.5) and higher peak CRP levels and acute kidney failure (aHR: 2.0 1.2–3.3) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 0.3–0.8).
No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.
Background. The emergence of resistance to antibiotics in vivo, particularly in commensal, potentially pathogenic bacteria, is a factor that is key to the future of antibiotics. To better document ...the circumstances favoring the emergence of resistance to linezolid (the first of a new class of antibiotics, the oxazolidinones), we modeled the effect of different regimens of linezolid on Enterococcus faecalis in gnotobiotic mice. Methods. We studied the rate of emergence of linezolid-resistant E. faecalis mutants in the digestive tract of gnotobiotic mice monoassociated with linezolid-susceptible E. faecalis and fed with water containing linezolid (0.5, 0.05, or 0.005 g/L). 23S Ribosomal RNA (rRNA) mutations were characterized by sequencing each of the 4 copies of the rRNA genes individually. Results. Mutants were readily obtained in vivo, but the frequencies, persistence, and type of mutants were all dependent on the linezolid regimen. Mutations conferring resistance, either the G2505A or G2576U mutation, were present in domain V of the 23S rRNA gene of all resistant isolates. Levels of resistance increased with the number of mutated copies of the 23S rRNA gene and with duration of exposure. Conclusion. The antibiotic dose appears to be critical in the dynamics and molecular basis of resistance.
Asymptomatic faecal carriage of Clostridioides difficile has been widely evaluated, but its prevalence across a wide range of clinical departments and related risk factors are not well described. The ...objectives of the PORTADIFF study were to evaluate the prevalence and identifying risk factors leading to asymptomatic carriage of both toxigenic and non-toxigenic C. difficile.
The PORTADIFF study was a 1-day prevalence study carried out in 10 different French hospitals. Adult patients, who agreed to participate, were included in this study and provided a fresh stool sample. C. difficile strains isolated from carriage were characterized by polymerase chain reaction (PCR) detection of tcdA, tcdB, cdtA and cdtB, and PCR ribotyping.
In total, 721 patients were included in this study. The median age was 73 years (range 18–101 years) and the male/female ratio was 1.06. C. difficile (either toxigenic or non-toxigenic strains) was isolated from 79 (11%) patients; 42 (5.8%) strains were toxigenic. The prevalence rates of asymptomatic carriage ranged from 5% on surgical wards to 19% on long-term care wards. The main risk factors associated with asymptomatic carriage were antibiotic treatment within the preceding 3 months (81.8% vs 53.7%; P<0.01), hospitalization within the preceding 2 months (55.8% vs 33%; P<0.01), cumulative duration of hospital stay before study inclusion (mean 50.1 vs 34.5 days; P<0.047), and hospitalization on a ward with high global incidence of C. difficile infection.
Eleven percent of hospitalized patients were asymptomatic carriers of toxigenic or non-toxigenic C. difficile, and may constitute a potential reservoir of C. difficile strains.
Mupirocin is the cornerstone of decolonization regimens, a successful strategy to prevent healthcare-associated staphylococcal infections. Several recent studies have reported alarming results: (i) ...an extending reservoir of mupA, the ancestral mobile resistance gene, among coagulase-negative staphylococci (CoNS); (ii) the emergence of a new resistance gene (mupB); and (iii) a growing number of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA), including highly pathogenic clones. We performed a nationwide prospective study in France to detect such trends among invasive staphylococci.
Between October 2011 and February 2012, 367 MRSA and 708 CoNS invasive isolates were collected from 37 hospitals and analysed centrally. Mupirocin MICs were determined using the broth microdilution method. mupA/B PCR was performed for resistant isolates (MIC >1 mg/L). Genetic relatedness between mupirocin-resistant MRSA isolates was determined by PFGE analysis and related isolates were tested by microarray.
Among MRSA isolates 2.2% (n = 8) were classified as mupirocin resistant; 1.4% (n = 5) showing low-level resistance (MIC ≤256 mg/L) and 0.8% (n = 3) high-level resistance (MIC >256 mg/L). Only the latter isolates carried mupA. A clonal relationship was identified between two mupA-negative MRSA from the same hospital and three mupA-positive MRSA from three distant towns; these three isolates belonged to the Lyon clone. Mupirocin resistance was identified in 10.3% of CoNS, mainly highly resistant mupA-positive isolates (5.6%). The mupB gene was not detected in mupirocin-resistant MRSA or CoNS.
This first large national study indicates the need for thorough epidemiological monitoring and a stewardship programme to prevent and detect mupirocin resistance in staphylococci.
abstract
Vancomycin‐resistant enterococci represent a large reservoir in animals because of the use of avoparcin as a growth promoter in Europe. These strains of animal origin enter the food chain ...and can either colonize the human gut or transfer their resistance genes to the human microbiota. In this study, we compared the transfer of vancomycin resistance from resistant animal Enterococcus faecium to sensitive human Enterococcus faecalis and E. faecium. We analysed these transfers in dibiotic mice and human faecal flora‐associated mice. VanA transfer from animal E. faecium to human E. faecalis occurred in dibiotic mice. The transconjugants appeared rapidly and persisted at levels between 3.0 and 4.0 log10 colony‐forming units g−1 of faeces. In human faecal flora‐associated mice, vanA gene transfer was not detected towards E. faecalis but was possible between E. faecium strains. Our experiments revealed the possibility of vanA transfer from animal E. faecium to human E. faecalis in vitro and in vivo in the intestine of dibiotic mice. However, intraspecies transfer of vanA gene seems more common than interspecies transfer among enterococci.
Linezolid is a synthetic antibiotic, the first available agent in a new class of antibiotic called the oxazolidinones, whose particular mechanism of action consists in inhibiting the initiation of ...protein synthesis. Its spectrum of in vitro and in vivo activity includes staphylococci, streptococci, enterococci, corynebacteria and some anaerobic bacteria (Peptostreptococcus, Clostridium, and Fusobacterium). The first therapeutic results were very encouraging, leading to the marketing of the product in France in 2002. Linezolid is indicated in the treatment of pneumonia and the complicated infections of the skin. Pharmacocinetics studies have shown that linezolid has an excellent bioavailability allowing a fast relay per os. However, failures of treatment under linezolid were reported and resistant strains of staphylococci and enterococci were obtained in vitro and in vivo after therapeutic use of this antibiotic. Changes in the domain V of 23S rRNA were found in the site of fixation, the most frequent was (G out of U) in position 2576 (numbering E. coli). In a context where resistance to traditional treatments in enterococci, pneumococci and S. aureus do not cease to increase, linezolid can be regarded as a therapeutic alternative to treat the infections with Gram-positive cocci.
Dans le cadre des nouvelles missions des CeGIDD, l’offre de dépistage et de prévention s’est diversifiée pour s’adapter à l’augmentation des IST qui est notée chez les jeunes hétérosexuels (HTR) et ...dans la population des hommes ayant des relations sexuelles avec des hommes (HSH). Un dépistage plus large, multisite, adapté aux pratiques sexuelles de chacun semble se justifier.
Un recueil exhaustif des données démographiques, sociales, médicales et des prises de risque à partir de questionnaires entre le 1er janvier et le 31 décembre 2017 a été réalisé. Les sérologies VIH, VHB, VHC et syphilis étaient systématiquement proposées. Un dépistage large des autres IST a été réalisé par PCR couplées Neisseria G. et Chlamydia T., Mycoplasma G. et Trichomonas V. Depuis février 2017, le dépistage est adapté aux pratiques de chaque patient (prélèvement vaginal, 1er jet urinaire et gorge, prélèvement anal le cas échéant), un seul site était effectué auparavant.
Mille six cent trente-quatre personnes ont bénéficié d’un dépistage incluant au moins une PCR. Le sex-ratio H/F était de 1,5. Les personnes HTR représentaient 87,7 % de la file active (n=781 hommes et 652 femmes) et la population des HSH 12,3 % (n=201). L’âge médian était respectivement de 23 et 26 ans chez les femmes et les hommes. Dans la population HSH, il y avait respectivement 15 PCR urinaires positives (n=15/191, soit 7,8 %), 19 PCR gorge positives (n=19/135, soit 14,1 %) et 22 PCR anales positives (n=22/88, soit 25,0 %). Neuf syphilis actives ont été dépistées (n=9/1142), toutes chez des HSH. Dans la population HTR féminine, il y avait respectivement chez les moins de 25 ans : 77 PCR vaginales positives (n=77/375, soit 20,5 %), 3 PCR gorge positives (n=3/149, soit 2,0 %) et 1 PCR anale positive (n=1/14, soit 7,1 %). Chez les 25 ans et plus, il y avait 25 PCR vaginales positives (n=25/260, soit 9,6 %), 2 PCR gorge positives (n=2/121, soit 1,6 %) et 2 PCR anales positives (n=2/13, soit 15,4 %). Dans la population HTR masculine, il y avait respectivement chez les moins de 30 ans : 54 PCR urinaires positives (n=54/519, soit 10,4 %), 3 PCR gorge positives (n=3/94, soit 3,2 %). Chez les 30 ans et plus il y avait 11 PCR urinaires positives (n=11/211, soit 5,2 %), 2 PCR gorge positives (n=2/52, soit 3,8 %).
Notre CeGIDD accueille une population jeune essentiellement concernées par les IST bactériennes. L’intérêt du dépistage multisite est confirmé notamment dans la population HSH et se discute aussi chez les femmes ayant des rapports anaux.
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