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Abstract: To reduce the Legionella-link risk in the several sites of Sud-Francilien Hospital, following a hospital-acquired legionellosis case, a multidisciplinary working group performed an action plan monitored through Legionella pneumophila counts in hot water supply. From 2003 to the first half year 2009, positive points for Legionella pneumophila on the main sites of the hospital decreased from 85.71 to 28.00%, representing a significant reduction of 67.33%. Similar results were observed for three of the four establishments, whereas the last did not describe a pronounced reduction of Legionella pneumophila counts and showed constantly serogroup 1 strains. During this period, investigations of additional cases of legionellosis demonstrated a nosocomial transmission in one case in this last site. Multidisciplinary mobilization in management of Legionella-link risk contributed to these results. [Copyright &y& Elsevier]

Introduction La proportion des entérobactéries productrices de bêta lactamase à spectre étendu (EBLSE) dans les pyélonéphrites (PNA) de l’enfant est de 7 %, en augmentation constante depuis une dizaine d’années. Les alternatives de traitement oral sont restreintes. La synergie cefixime + amoxicilline acide clavulanique (C + AAC) a été démontrée in vitro mais les données d’efficacité clinique sont limitées. Matériels et méthodes Il s’agit d’une étude rétrospective réalisée dans deux services de pédiatrie entre 2013 et 2017, incluant tous les enfants ≤ 15 ans traités par C + AAC pour une PNA à EBLSE résistante aux fluoroquinolones et au cotrimoxazole. Les critères de jugement étaient les taux de succès clinique et microbiologique, définis respectivement par l’absence de nouveau traitement antibiotique pour une rechute de PNA et par la stérilisation de l’ECBU à un mois. Résultats Vingt-trois enfants ont été inclus (11 filles et 12 garçons), l’âge médian était de sept mois [2–14], et 8 enfants présentaient une pathologie urinaire sous-jacente. Les germes étaient dans 91 % des cas un Escherichia coli et 9 % des cas une Klebsiella pneumoniae . Toutes les infections étaient communautaires. Le traitement initial intraveineux a été de 2,5 jours en médiane [2–3] et a consisté en une céphalosporine de troisième génération ( n = 21) (associée pour 15 enfants à l’amikacine), amikacine monothérapie ( n = 1) et imipénème ( n = 1). Une synergie entre C + AAC (CMI de l’association ≤ 1 mg/mL) a été retrouvée sur 21 souches d’EBLSE/23. Tous les enfants ont été traités en relais oral par C + AAC, avec une durée médiane d’antibiothérapie de 10 jours [10–10]. Le succès clinique à un mois était obtenu dans 95 % des cas (22/23 enfants), avec trois rechutes à j26 j53 et j72 respectivement et trois perdus de vue après un mois. Le succès microbiologique était obtenu dans 75 % des cas (15/20 ECBU de contrôle) à 40 jours en médiane [35–56]. Parmi les cinq rechutes microbiologiques, trois correspondent aux échecs cliniques et deux avaient une bactériurie asymptomatique. Trois enfants n’ont pas fait d’ECBU de contrôle mais n’ont jamais présenté de nouvel épisode clinique. Conclusion À notre connaissance, il s’agit de la première étude d’efficacité clinique et microbiologique d’un relais oral par C + AAC dans les PNA à EBLSE de l’enfant. Le taux d’efficacité clinique à 1 mois était de 95 %. Ces résultats sont encourageants et méritent d’être confirmés par une étude prospective multicentrique, chez l’enfant comme chez l’adulte. [ABSTRACT FROM AUTHOR]

To reduce the Legionella-linked risk in the several sites of Sud-Francilien Hospital, following a hospital-acquired legionellosis case, a multidisciplinary working group performed an action plan monitored through Legionella pneumophila counts in hot water supply. From 2003 to the first half year 2009, positive points for Legionella pneumophila in the main sites of the hospital decreased from 85.71 to 28.00%, representing a significant reduction of 67.33%. Similar results were observed for three of the four establishments, whereas the last did not describe a pronounced reduction of Legionella pneumophila counts and showed constantly serogroup 1 strains. During this period, investigations of additional cases of legionellosis demonstrated a nosocomial transmission in one case in this last site. Multidisciplinary mobilization in management of Legionella-linked risk contributed to these results., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Objective: The authors wanted to assess the level of Streptococcus pneumoniae antibiotic resistance in Ile de France., Method: In 2001, 637 clinical strains of S. pneumoniae were prospectively collected from 32 microbiology laboratories., Results: Fifty one percent of strains were isolated from children under 15 years of age and 49% from adults. In children, 76% of strains came from otitis media, 20% from blood culture, in adults most strains (92%) came from blood culture. The overall prevalence of non-susceptible penicillin pneumococci was 61% higher in children (73%) than in adults (50%). Among the non-susceptible penicillin pneumococci 21.8% were resistant (CMI > 1 mg/l). Strains with decreased susceptibility to amoxicillin and cefotaxime were 38% and 17% respectively. Resistant strains to these two drugs (CMI > 2 mg/l) were rare 2.6% and 0.4% respectively. Among other antimicrobial agents, rate of resistance was 63% to erythromycin, 47% to cotrimoxazole, 40% to tetracycline, and 23% to chloramphenicol. The most frequent serogroups were serogroups 19 and 14, respectively 23% and 18%. Serotypes included in heptavalent vaccine covered 90% of children strains under 2 years of age., Conclusions: The prevalence of resistance to penicillin was high in children particularly in otitis media pus (76%).

Introduction: The microorganisms incriminated in severe community-acquired pneumonia hospitalized in intensive care unit are the following: Streptococcus pneumoniae, enterobacteria isolated in aspiration-related pneumonia and less frequently intracellular bacteria in so-called atypical pneumonia (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila)., Case Reports: We report two cases of severe community-acquired pneumonia admitted in intensive care unit and due to Lancefield Group A beta hemolytic streptococcus (Streptococcus pyogenes). Despite the increased incidence of invasive streptococcal infections, this microorganism still has a rare causative role in the pathogenesis of community-acquired pneumonia. The case reports concern two young patients without any significant medical history and with many clinical, radiological and microbiological similarities. However, the prognosis was not the same because of the way the initial management has been provided., Discussion: Group A beta hemolytic streptococcus could be a causative microorganism of severe and possibly fulminating community-acquired pneumonia, even in young and healthy patients as is the case with pneumococcal infections. Medical history, clinical symptoms and radiological signs should be taken into account to evoke the diagnosis and to initiate antibiotherapy early, taking into account that this microorganism is sensitive to Penicillin G.

An automated system for mycobacteria culture, BACTEC 9000 MB, was compared with Lowenstein Jensen culture. On a total of 4,484 pulmonary and extrapulmonary human clinical samples, 126 (2.8%) were positive for mycobacteria on Lowenstein Jensen (LJ) medium; 105 (2.34%) were identified as Mycobacterium tuberculosis and 39 (1.10%) as non tuberculosis mycobacteria. The mean time of detection of Mycobacterium tuberculosis on the 131 positive samples was reduced to approximately ten days with BACTEC 9000 MB compared to the LJ (17.6 versus 27.38 days). Through the results of this comparative study, we confirmed that BACTEC 9000 MB is a more efficient system than LJ for culture detection of all mycobacteria from various sites samples.

Several reports of Yersinia enterocolitica (Ye) post-transfusion septicaemia have been recently published. In order to study the prevalence of Ye contamination of packed red blood cells (PRBC) we performed a post-transfusion control on 1,000 PRBC units. We did not find any Ye contamination. This is in accordance with the rarity of the reported cases. However as they are very serious, a prevention is necessary. As classical bacteriological techniques are not feasible, the only possibility is to decrease the PRBC conservation time and to select blood donors by a careful questioning about recent GI tract disturbances.

The clinical need for rapidly and correctly differentiating pathogenic streptococci into Lancefield groups prompted the development of rapid agglutination techniques by the direct colony method. Pastorex Streptogroupe (Diagnostics Pasteur, France) and Streptex (Wellcome Diagnostics, USA) were tested on 90 streptococcal isolates and compared with the identification obtained by conventional procedures. No cross-reactions were observed with any of the 33 strains of enterococci and of the seven strains representative of other genus among Gram-positive bacteria. When combined with colonial morphology and hemolytic reaction, both Pastorex and Streptex were specific tests for identifying beta-hemolytic streptococci, with Pastorex being slightly faster.