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•Inserted in a dedicated expert platform, TIVAP is complicated by infection in less than 5% of patients.•Chemotherapy administration through peripheral access in the month before placement is a risk factor for TIVAP-infection.•Radiation therapy of the homolateral chest wall is an avoidable risk factor for TIVAP-infection.•TIVAP-related infection is not associated with one-year mortality in solid tumor patients.

ABSTRACTSixty-two isolates of Enterobacteriaceae(35 Escherichia coliand 27 Klebsiella pneumoniaeisolates) producing CTX-M-type ß-lactamases were collected between March 2000 and June 2003 in different wards of Charles Nicolle Hospital in Tunis (Tunisia). Sequencing identified the blaCTX-M-15determinant in 55 isolates and blaCTX-M-16in 7 isolates. The CTX-M-15-producing strains were isolated in several wards and consisted mainly of two successive clonal groups of E. coliand a major clonal group of K. pneumoniae. The second clonal group of E. colibelonged to phylogenetic group B2 and harbored more virulence factors than the first clonal group. Among the 22 transconjugants or electroporants obtained with selected E. coliand K. pneumoniaeCTX-M-15-producing strains, a predominant plasmid restriction pattern was obtained with 17 isolates. The four CTX-M-16-producing strains of E. coliyielded the same pulsed-field gel electrophoresis (PFGE) pattern, while the three CTX-M-16-producing strains of K. pneumoniaeyielded two different PFGE patterns. All of the CTX-M-16-producing isolates were recovered in the pediatric ward and had the same plasmid restriction pattern.

ABSTRACTFrom whole-cell DNA of an enterobacterial Erwinia persicinareference strain that displayed a penicillinase-related antibiotic-resistant phenotype, a β-lactamase gene was cloned and expressed in Escherichia coli.It encoded a clavulanic-acid-inhibited Ambler class A β-lactamase, ERP-1, with a pI value of 8.1 and a relative molecular mass of ca. 28 kDa. ERP-1 shared 45 to 50% amino acid identity with the most closely related enzymes, the chromosomally encoded enzymes from Citrobacter koseri, Kluyvera ascorbata, Kluyvera cryocrescens, Klebsiella oxytoca, Proteus vulgaris, Proteus penneri, Rahnella aquatilis, Serratia fonticola, Yersinia enterocolitica, and the plasmid-mediated enzymes CTX-M-8 and CTX-M-9. The substrate profile of the noninducible ERP-1 was similar to that of these β-lactamases. ERP-1 is the first extended-spectrum β-lactamase from an enterobacterial species that is plant associated and plant pathogenic.

L’antibiothérapie probabiliste en réanimation obéit au double défi du bénéfice individuel du patient septique grave et du bénéfice collectif en termes d’émergence de résistances acquises. La désescalade antibiotique (AB) diminue la pression de sélection tandis que l’escalade AB en cas de non-adaptation probabiliste améliore le pronostic du patient. Le βLACTA test (BLT) est un test de détection rapide de la résistance aux céphalosporines de 3egénération (C3G) réalisable sur colonies à H24 du prélèvement microbiologique. L’objectif de cette étude est d’évaluer l’intérêt du BLT pour adapter précocement l’AB probabiliste en réanimation.

<it>Objectives</it>: To characterize the β-lactamase gene content of <it>Erwinia rhapontici</it>. <it>Methods</it>: The β-lactamase gene was cloned, sequenced and expressed in <it>Escherichia coli.</it> <it>Results</it>: The cloned gene conferred a resistance pattern of an Ambler class C β-lactamase in <it>E. coli</it>. The AmpC-type enzyme had a pI value of 8.6 and shared 62% amino acid sequence identity with that of <it>Escherichia fergusonii</it>. The <it>ampC</it> gene was associated with a regulatory <it>ampR</it> gene and β-lactamase production was inducible. <it>Conclusions</it>: This work provides further evidence of the molecular heterogeneity of β-lactamases in <it>Erwinia</it> spp. and that plant-pathogenic enterobacterial species may constitute a reservoir of antibiotic resistance genes.