Our objective was to make a focus on the methods for rapid diagnosis of bacteremia by genomic identification. We also aimed to evaluate the interest of using them in the laboratory practice. The ...different methods currently available have been presented according to their technologic approach. It is also possible to classify these methods according to the data provided, only bacterial and/or resistance gene identification or also bacterial susceptibility to antibiotics. In case of mono-microbial blood cultures, the performances recorded with these methods are very good as compared to the subcultures on agar media. Nevertheless, they are better for identifications (>90%) than for susceptibility to antibiotics (>80%). Numerous studies demonstrated the positive impact of these methods for decreasing the time necessary to the prescription of an appropriate antimicrobial treatment. However, it is noteworthy that an appropriate organization of the laboratory and a strategy of antimicrobial stewardship in the hospital are necessary. Concurrently, the impact on the patient outcome has not been clearly demonstrated. Lastly, few medico-economic studies have been reported. However, as these methods have a substantial cost, their utilization strategy must be economically viable.
During the last decade, Acinetobacter baumannii (AB) has been increasingly responsible for infections occurring in three particular contexts (in terms of patients and environment). Community AB ...pneumonia is severe infections, mainly described around the Indian Ocean, and which mainly concern patients with major co-morbidities. AB is also responsible for infections occurring among soldiers wounded in action during operations conducted in Iraq or Afghanistan. Lastly, this bacterium is responsible for infections occurring among casualties from natural disasters like earthquakes and tsunamis. Those infections are often due to multidrug-resistant strains, which can be implicated in nosocomial outbreaks when patients are hospitalized in a local casualty department or during their repatriation thereafter. The source of the contaminations which lead to AB infections following injuries (warfare or natural disasters) is still poorly known. Three hypotheses are usually considered: a contamination of wounds with environmental bacteria, a wound contamination from a previous cutaneous or oropharyngeal endogenous reservoir, or hospital acquisition. The implication of telluric or agricultural primary reservoirs in human AB infections is a common hypothesis which remains to be demonstrated by further specifically designed studies.
Depuis une dizaine d’années, Acinetobacter baumannii (AB) est de plus en plus impliqué dans des infections survenant dans des contextes particuliers (en termes de patients et d’environnement). Trois types de situations sont rencontrés. Les pneumopathies communautaires à AB sont des infections graves, principalement décrites autour de l’océan Indien, et qui touchent le plus souvent des patients présentant d’importantes comorbidités. AB est également impliqué dans des infections survenant chez des militaires blessés lors d’opérations en Afghanistan ou en Irak. Enfin, cette bactérie est responsable d’infections chez les survivants de catastrophes naturelles (séismes ou tsunamis). Ces infections sont souvent dues à des souches multirésistantes aux antibiotiques qui peuvent être à l’origine d’épidémies nosocomiales lors de l’hospitalisation des patients infectés, au moment de leur prise en charge locale en urgence ou de leur rapatriement. Les sources de contamination à l’origine des infections à AB consécutives à des traumatismes (conflits ou catastrophes naturelles) sont difficiles à identifier. Trois hypothèses sont en général retenues : une contamination par des bactéries d’origine environnementale au moment des traumatismes, contamination des blessures à partir d’un foyer de colonisation endogène cutané ou nasopharyngé préalable, ou acquisition nosocomiale au cours des différentes hospitalisations intervenues tout au long de la prise en charge des patients. L’implication de réservoirs primaires telluriques ou agricoles dans des infections humaines à AB est une hypothèse souvent soulevée mais qui reste à démontrer par des études réalisées dans ce but.
This study assessed the characteristics of hospital-acquired Acinetobacter calcoaceticus–Acinetobacter baumannii complex bloodstream infections (BSI). From 2010 to 2017, A. calcoaceticus–A. baumannii ...complex BSI were investigated. Of 73 cases, 54.8% were associated with Acinetobacter pittii, 39.7% with Acinetobacter baumannii and 5.5% with Acinetobacter nosocomialis. Multi-drug-resistant isolates were significantly higher in A. baumannii BSI. Thirty-day mortality was no different between A. baumannii or non-baumannii A. calcoaceticus–A. baumannii complex BSI. In contrast with other studies, this study found that most hospital-acquired A. calcoaceticus–A. baumannii complex BSI were associated with non-baumannii A. calcoaceticus–A. baumannii complex species. This study found that these species were important hospital-acquired pathogens, and emphasizes the importance of A. calcoaceticus–A. baumannii complex species identification.
Abstract TP53 deletion or mutation is frequent in B-cell malignancies and is associated with a low response rate. We describe here the p53 landscape in B-cell malignancies, from B-Acute Lymphoblastic ...Leukemia to Plasma Cell Leukemia, by analyzing incidence of gain or loss of function of actors both upstream and within the p53 pathway, namely MYC , RAS , ARF , MDM2 , ATM and TP53 . Abnormalities are not equally distributed and their incidence is highly variable among malignancies. Deletion and mutation, usually associated, of ATM or TP53 are frequent in Diffuse Large B-Cell Lymphoma and Mantle Cell Lymphoma. MYC gain, absent in post-GC malignancies, is frequent in B-Prolymphocytic-Leukemia, Multiple Myeloma and Plasma Cell Leukemias. RAS mutations are rare except in MM and PCL. Multiple Factorial Analysis notes that MYC deregulation is closely related to TP53 status. Moreover, MYC gain, TP53 deletion and RAS mutations are inversely correlated with survival. Based on this landscape, we further propose targeted therapeutic approaches for the different B-cell malignancies.
This study aimed to describe the contamination of sink drains (SDs) with carbapenemase-producing Enterobacterales (CPE) in three intensive care units (ICUs), and to assess the risk of transmission to ...hospitalized patients. All SDs were sampled monthly for CPE screening by culture. Rectal screening for CPE carriage was conducted weekly for hospitalized patients. CPE were isolated from 22% of SD samples. Some SDs remained colonized with the same strain for several months. No CPE acquisition occurred among hospitalized patients during the study. Certain strategies, such as systematic sampling of SDs in ICUs for screening for contamination by CPE, should be discouraged apart from during outbreaks.
La tigécycline (TGC), antibiotique de la famille des glycylcyclines, possède un spectre d’activité sur les bactéries à Gram positif, y compris multirésistantes, et sur la plupart des bactéries à Gram ...négatif, dont les entérobactéries produisant une β-lactamase à spectre étendu (BLSE) et Acinetobacter sp. Son spectre d’activité n’inclut pas Pseudomonas aeruginosa. Le laboratoire de bactériologie du CHU d’Angers participe depuis 2006 au programme mondial de surveillance Tigecycline Evaluation Surveillance Trial (TEST), dont le but est d’évaluer l’efficacité de la TGC et de différents comparateurs vis-à-vis d’agents pathogènes d’origine nosocomiale ou communautaire. L’objectif de cette étude a été d’évaluer l’efficacité de la TGC sur un panel de souches isolées entre 2006 et 2009 au CHU d’Angers. Les concentrations minimales inhibitrices (CMI) des antibiotiques ont été déterminées par dilution en microplaques. Au total, 760 isolats cliniques ont été testés. La TGC présentait une très bonne activité in vitro sur les bactéries à Gram positif, avec 100 % de sensibilité pour toutes les souches testées et cela indépendamment de leur profil de résistance. Concernant les bactéries à Gram négatif, la TGC était active sur 93 % des Enterobacteriaceae, avec des CMI 90 inférieures ou égales à 2mg/L. Parmi les 20 souches produisant une BLSE, toutes étaient sensibles à la TGC. Les bactéries du genre Acinetobacter étaient également inhibées à des concentrations faibles de TGC, avec une CMI 90 de 1mg/L. Ces résultats semblent montrer que la TGC représente une alternative intéressante, notamment dans le traitement des infections à bactéries multirésistantes.
Tigecycline (TGC), an antibiotic belonging to glycylcyclines, is active against Gram-positive bacteria, including multi-resistant bacteria, and most of the Gram-negative bacteria, including extended spectrum β-lactamase-producers (ESBL) and Acinetobacter sp. TGC is not active on Pseudomonas aeruginosa. The microbiological laboratory from the university hospital of Angers participates in the Tigecycline Evaluation and Surveillance Trial (TEST) since 2006. The objective of this study is to evaluate the effectiveness of TGC and of various comparators against nosocomial and community-acquired pathogens. We also evaluated the effectiveness of TGC on a panel of strains isolated between 2006 and 2009 in the university hospital of Angers. Minimum inhibitory concentrations (MIC) were determined using the microdilution method. A total of 760 clinical strains were tested. TGC had a very good activity against Gram-positive bacteria, with 100 % of susceptibility for all the strains tested, irrespective of their resistance profile. Concerning Gram-negative bacteria, TGC was active against 93 % of Enterobacteriaceae, with a MIC 90 not exceeding 2mg/L. Whole of the 20 strains ESBL-producers tested were susceptible to TGC. Acinetobacter sp. were also inhibited at low concentrations of TGC, with a MIC 90 of 1mg/L. These results suggest that TGC can be a useful therapeutic alternative, especially for infections involving multirésistant bacteria.
Our objective was to study the carriage of Acinetobacter baumannii (AB) in pets in Reunion Island (RI), a French territory in Indian Ocean. Overall, 138 pets were sampled (rectum, mouth, wounds if ...applicable) in 9 veterinary clinics (VC). The prevalence of AB carriage was 6.5% (95%CI; 2.4, 10.6) and 9 carriers were indentified from 4 VC. Hospitalization in a VC and antimicrobial treatment administered within the 15 preceding days were significantly associated with AB carriage (P<0.01 and P<0.05, respectively). Despite the VC in which animals have been sampled were located all around RI, most isolates (8/9) were closely-related (>90% similarity by pulsed-field gel electrophoresis). Additional studies are needed to improve the understanding about interactions between the different reservoirs of AB in RI.
The aim of this work was to evaluate the impact of a teaching method in pharmacokinetics (PK) in terms of satisfaction and performance in the final test of students.
This method consisted of the ...development of a practical problem and a peer-tutored solution by small groups of three or four students. Students enrolled in the second year of pharmaceutical studies had to generate a PK practical problem, to propose a solution and to conduct a peer-tutored solution of the practical problem completed by another student group in a learning-connected classroom. Student's performance was assessed by individual semi-structured interviews and by comparing the scores obtained in the final test with those obtained in previous years.
More than 70% of the students were highly satisfied with the new format of the PK course, especially concerning the development and the design of a practical problem. More than 94% of the students considered that the content of the lecture-based teaching was at least adapted and in accordance with the objectives of the PK course. Students reported very constructive discussions and interactions with peers and the teacher. In addition, students significantly increased their score at the final PK test compared to previous years (53.27±19.10% in 2015-2017 vs. 71.30±13.47% in 2018-2019, P<.0001).
This new method including peer teaching was applied in PK and allowed to significantly increase the performance and the satisfaction of the students in PK.
Sink drains of six intensive care units (ICUs) were sampled for screening contamination with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE). A high prevalence (59.4%) of sink ...drain contamination was observed. Analysing the data by ICU, the ratio ‘number of ESBLE species isolated in sink drains/total number of sink drains sampled’ was highly correlated (Spearman coefficient: 0.87; P = 0.02) with the ratio ‘number of hospitalization days for patients with ESBLE carriage identified within the preceding year/total number of hospitalization days within the preceding year’. Concurrently, the distribution of ESBLE species differed significantly between patients and sink drains.
