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The taxonomy modification of Propionibacterium sp. with the description of new species, especially Cutibacterium namnetense, raises the question of species distribution in routine clinical samples. We performed a retrospective study during 3 years before the implementation of MALDI-TOF. Two hundred sixty-nine isolates were included in the study. MALDI-TOF identification, 16S rRNA, and new developed gyrB partial sequencings were performed. The most representative species was C. acnes in 88% of the cases, regardless of the origin of the clinical sample. Eventually, we identified three C. namnetense strains, representing a 1.1% prevalence over the period of time, including two bone infections. MALDI-TOF databases should be regularly updated to incorporate new species. gyrB sequencing constitutes a both easy and relevant method to identify Cutibacterium sp. especially C. namnetense, a new player in bone infections.

A 10-year retrospective study of Propionibacterium/Cutibacterium-positive samples gathered from hospitalized patients was conducted at Nantes University hospital. A total of 2728 Propionibacterium/Cutibacterium-positive samples analyzed between 2007 and 2016 were included. Due to the implementation of MALDI-TOF identification in 2013, most non-Cutibacterium acnes isolates were identified a second time using this technology. Over that period, Cutibacterium acnes remained the most predominant species accounting for 91.5% (2497/2728) of the isolates, followed by Cutibacterium avidum (4.2%, 115/2728) and Cutibacterium granulosum (2.4%, 64/2728). Regarding the origin of samples, the orthopaedic department was the main Cutibacterium sample provider representing 51.9% (1415/2728) of all samples followed by the dermatology department (11.5%, 315/2728). Samples were recovered from various tissue locations: 31.5% (858/2728) from surgery-related samples such as shoulder, spine or hip replacement devices and 19.1% (520/2728) from skin samples. MALDI-TOF method revealed misidentification before 2013. Cutibacterium avidum was falsely identified as C. granulosum (n = 33). Consequently, MALDI-TOF technology using up-to-date databases should be preferred to biochemical identification in order to avoid biased species identification. Regarding antibiotic resistance, 14.7% (20/136) of C. acnes was resistant to erythromycin. 4.1% (41/1005) of C. acnes strains, 17.9% (12/67) of C. avidum strains and 3.6% (1/28) of C. granulosum strains were found resistant to clindamycin.

International audience; We estimate the impact of French town hall elections held in mid-March 2020 on the mortality of 163,000 male candidates aged above 60. Their excess mortality during March and April was similar to the general population. We compare candidates in cities with two candidate lists to those in cities with only one list, as elections are more intense in contacts in the former group. We also use a regression discontinuity design and investigate mortality in 2020 depending on how candidates fared in the 2014 election. We cannot detect any causal effect of active participation in the 2020 elections on mortality.

Resume Introduction Les mycobacteries atypiques (MA) sont responsables d’adenites cervico-faciales, dont l’incidence semble en augmentation. L’objectif est d’en decrire les caracteristiques cliniques, microbiologiques et therapeutiques. Materiel et methodes Etude retrospective monocentrique recensant les cas entre janvier 2008 et decembre 2017 au CHU de Nantes, France. Les criteres d’inclusion etaient : âge Resultats De 2008 a 2017, 49 patients ont ete inclus, d’âge median 28 mois (6–141 mois). Le delai median de confirmation diagnostique etait de 2,1 mois (0,7–6 mois). Les localisations etaient sous mandibulaires dans 45 % des cas, cervicales et parotidiennes dans 33 et 16 % des cas. Les principaux signes cliniques etaient un nodule ferme (70 %), violace (59 %), non douloureux (83 %), sans fievre (88 %). Les especes identifiees etaient : Mycobacterium avium (n = 26), M. lentiflavum (n = 13), M. intracellulare (n = 7), M. malmoense (n = 2), M. scrofulaceum (n = 1). Une antibiotherapie etait prescrite dans 77 % des cas. Discussion Il s’agit de la deuxieme plus grande cohorte francaise d’adenites a MA de l’enfant, confirmee microbiologiquement. La presentation la plus frequente etait un nodule sous mandibulaire ferme, violace et indolore. L’emergence de M. lentiflavum observee dans notre etude n’est pas retrouvee dans les grandes series europeennes avant 2014 mais apparait dans les series plus recentes. L’influence de l’arret de la vaccination par le BCG sur l’incidence des adenites a mycobacteries atypiques, n’est pas demontrable dans notre etude en raison du manque de donnees avant 2007. Conclusion L’adenite a MA est un diagnostic a ne pas meconnaitre chez le jeune enfant devant une tumefaction cervico-faciale violacee indolore.

Eighty-five children were diagnosed with culture-confirmed nontuberculous mycobacterial cervical lymphadenitis within the MYCOMED surveillance network from 2004 to 2013. The mean incidence sharply increased from 0.57 to 3.7 per 100,000 children per year, after the discontinuation of mandatory bacillus Calmette and Guérin immunization in 2007. Cases were documented as Mycobacterium avium (62.3%), Mycobacterium intracellulare (15.3%) and Mycobacterium lentiflavum (12.9%). Outcome was favorable in all, with or without surgery or antimycobacterial treatment.

After rifampin and levofloxacin treatment for a Staphylococcus aureus bone infection, a pyogenic granuloma due to a newly described Cutibacterium species, C. namnetense developed on the tibia former external fixator. This rifampin resistant bacterium, selected during treatment, harbored a mutation in the rpoB gene. This case illustrates the possible in vivo selection of resistant mutant most likely due to the bacterial burden and therefore the importance of adequate bone infection treatment.

Staphylococcus aureus is one of the main etiologies of bone and device-related infections. Treatment of these orthopedic infections combines mostly rifampicin with other antibiotics. The recurrence or failure rate after fusidic acid/rifampicin treatment remains low (

Background Mycobacterial infection is the most common cause of cervical granuloma, implicating either a tuberculous or a non-tuberculous mycobacterium (NTM). NTM is a ubiquitous organism, found in soil, water, food, etc. The most frequently implicated is Mycobacterium avium -intracellular. Most authors agree that NTM is increasingly isolated, due to a decrease in vaccination rates. Initial diagnosis is difficult and management is not clearly codified. Methods A retrospective study conducted in the University Hospital of Nantes, France, between 2005 and 2014, included all patients treated for head and neck NTM lymphadenitis. The research was conducted on the database of the institution's bacteriology department. Population, history, symptoms and diagnostic features were noted. Treatment, surgical complications, adverse reactions to antibiotics, patient adherence, antibiotic therapy duration, time to remission and prognosis were analyzed. Results Between 2005 and 2014, 30 patients were diagnosed with head and neck NTM lymphadenitis: 17 female, 13 male; mean age at diagnosis, 4.5 years. Locations were submandibular ( n = 16), parotid, ( n = 7), cervical ( n = 5), parapharyngeal ( n = 4) and, for 1 patient, in the auricle concha. Eight patients received first-line surgical treatment, which was effective in 75% of cases, 2 patients requiring additional antibiotic therapy. Twenty-two patients were treated with first-line antibiotherapy, which was effective in 90% of cases. There were no relapses at a mean 32 weeks’ follow-up. Conclusions Total resection of all affected nodes and infiltrated subcutaneous fatty tissue is the treatment of choice. Drug therapy (including at least a macrolide) seems indicated only in case of incomplete resection or if surgery would entail functional and/or esthetic risk. Increased incidence, since BCG vaccination was stopped, will continue to confront the practitioner with an infantile disease in which management must be multidisciplinary.

Resume Introduction L’infection a mycobacterie est la cause la plus commune de granulome cervical : elle peut etre due a une mycobacterie, tuberculeuse ou non, appelee mycobacterie atypique (MA). Les MA sont des organismes ubiquitaires retrouves dans la terre, l’eau, les aliments… La plupart des infections sont dues au Mycobacterium avium -intracellulaire. La plupart des auteurs considerent que l’incidence d’isolement des MA augmente, a cause d’une diminution dans le taux de vaccination. Le diagnostic initial est difficile et la prise en charge therapeutique n’est pas clairement codifiee. Methodes Etude retrospective au CHU de Nantes entre 2005 et 2014 portant sur l’ensemble des patients traites pour une MA cervico-faciale. La recherche a ete menee sur la base des donnees du service de bacteriologie. Une evaluation de la population, des antecedents, de la symptomatologie et des elements diagnostiques a ete effectuee. Le traitement, les complications chirurgicales, les effets indesirables lies a l’antibiotherapie, l’observance des patients, la duree de l’antibiotherapie, le delai de guerison et le pronostic ont ete analyses. Resultats Entre 2005 et 2014, 30 patients ont eu un diagnostic de MA cervico-faciale, 17 filles et 13 garcons. L’âge moyen au moment du diagnostic etait de 4,5 ans. Les localisations etaient sub-mandibulaires ( n = 16), parotidiennes ( n = 7), cervicales ( n = 5), parapharyngee ( n = 1) et de la conque ( n = 1). Huit patients ont eu un traitement chirurgical premier, efficace dans 75 % des cas, 2 patients ont necessite une antibiotherapie complementaire. Vingt-deux patients ont ete traites en premiere intention par une antibiotherapie, efficace a 90 %. Aucune rechute n’a ete observee au delai moyen de 32 semaines. L’augmentation du nombre de cas semble correlee a l’arret de la vaccination BCG. Conclusion L’excision complete de tous les ganglions atteints et de la graisse sous-cutanee infiltree est le traitement de choix. Le traitement medicamenteux (au minimum antibiotherapie par macrolide) ne se justifie que si l’excision ne peut etre complete ou presente un risque fonctionnel et/ou esthetique. L’incidence accrue depuis l’arret de la vaccination BCG confrontera le praticien a une pathologie infantile qui exige une gestion pluridisciplinaire.

International audience; We evaluated the Cutibacterium acnes prevalence in prostatic biopsies and characterized the strains at a molecular level. 18 out of 36 biopsies (50%) were sterile after seven days in culture. C. acnes was observed in only two biopsies. Its prevalence was low (5.6%). Finally, the molecular characterization revealed diverse clusters including phylotypes IA1, IB and II.

Objectives To assess the meningeal penetration of cefazolin and cloxacillin in individuals treated for methicillin-susceptible staphylococcal meningitis. Methods We retrospectively identified individuals treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a validated assay of liquid chromatography coupled with mass spectrometry at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific PCR). Medical charts were retrospectively reviewed to collect microbiological and clinical data, and to assess therapeutic success. Results Among the 17 included individuals, eight (47%) were treated with cefazolin and nine (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 g (range 6–12 g) and 12 g (range 10–13 g), respectively. Cefazolin and cloxacillin were mainly administered by continuous infusion. Eleven individuals (65%) were men, median (interquartile range (IQR)) age was 54 years (50; 70), 14 (82%) had postoperative meningitis and 3 (18%) had haematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 mg/L (2.1; 5.2) and 0.66 mg/L (0.5; 0.9) for cefazolin and cloxacillin groups, respectively. Cloxacillin was discontinued in two individuals for therapeutic failure. Conclusions Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate that should be properly evaluated in this indication.

Background: Nine percent of all cases of tuberculosis are bone and joint tuberculosis (BJTB). BJTB occurs in two main forms: spinal (STB) and extraspinal (ESTB). The aim of this study was to compare STB with ESTB in terms of diagnosis, treatment and outcomes. Methods: We collected demographic, clinical, microbiological, treatment duration and outcome data for patients with BJTB in a retrospective multicentre study over a 17-year period. Results: Of the 116 patients included in the study, 69 (59.5%) had STB and 47 (40.5%) had ESTB. The median age was higher in the ESTB group. There were significantly more foreign-born patients in the STB group. The median time for diagnosis was longer for ESTB (6 months) than STB (4 months) (p = 0.017). Magnetic resonance imaging was highly reliable for the diagnosis. Direct examination and histology allowed the diagnosis to be made in more than 80% of cases. The median treatment duration of 12 months, regardless of the type of BJTB, was longer than recommended. A favourable outcome was achieved in 91.9% of cases. Conclusion: The management of BJTB remains challenging. An earlier diagnosis should be more effective, reducing the total duration of treatment and leading to better tolerance.

In vitro occurrence of levofloxacin (LVX) resistance in C. acnes and characterization of its molecular background were investigated. The mutation frequency was determined by inoculation of 10 8 cfu of C. acnes ATCC 11827 (LVX MIC = 0.25 mg/L) on LVX-containing agar plates. The progressive emergence of resistance was studied by a second exposure to increasing LVX concentrations. For mutants, the QRDR regions including the gyrA and parC genes were sequenced and compared to both C. acnes ATCC 11827 and C. acnes KPA171202 reference sequences (NC006085). The importance of the efflux pump system in resistance was investigated by using inhibitors on selected resistant mutants with no mutation in the QRDR. C. acnes growth was observed on LVX-containing plates with mutation frequencies of 3. 8 cfu × 10 −8 (8 × MIC) and 1.6 cfu × 10 −7 (4 × MIC). LVX resistance emerged progressively after one-step or two-step assays. In LVX-resistant isolates, the MIC ranged from 0.75 to >32 mg/L. Mutations were detected exclusively in the gyrA gene. Ten genotypes were identified: G99 C, G99 D, D100N, D100 H, D100 G, S101L, S101W, A102 P, D105 H and A105 G. Mutants S101L and S101W were always associated with a high level of resistance. Mutants with no mutation in the QRDR were more susceptible when incubated with an efflux pump inhibitor (phenyl-arginine β-naphthylamide) only, suggesting, for the first time, the expression of such a system in C. acnes LVX-resistant mutants.

Propionibacterium acnes is now well-known and recognized for its implication in the pathogenesis of acne vulgaris. Here, we report the draft genome sequence of an erythromycin-resistant P. acnes strain isolated from a case of folliculitis of the scalp belonging to phylotype IA1 and sequence type 18 (ST18).

Propionibacterium acnes was previously described as a potential implant-related pathogen. Here, we report the draft genome sequence of four P. acnes strains, isolated from spine material, hip arthroplasty, and knee arthroplasty infections in France belonging to different sequence types (ST18, ST27, and ST36).

In August 2015, a 44-year-old woman and her 17-year-old daughter consulted the Dermatology department, Nantes University Hospital, France, with skin lesions on both legs with no other clinical symptoms (figure 1A). One month before disease onset, the patients had spent 15 days in Thailand. During the trip, they had swam in rivers and lakes and had suffered insect bites. Moreover, they had been in contact with animals, namely during an elephant ride. They did not report any other contact with livestock [...]

Introduction Depuis 10 ans, la technologie MALDI-TOF a revolutionne l’identification bacterienne en routine dans les laboratoires de bacteriologie. Par ailleurs, en deux ans, la taxonomie des Propionibacterium a ete largement revue avec individualisation du genre Cutibacterium, incluant C. acnes, C. granulosum, C. avidum et 2 nouvelles especes recemment decrites : C. humerusii et C. namnetense. L’objectif de cette etude etait de determiner la prevalence de C. namnetense dans la collection du laboratoire avant l’arrivee du MALDI-TOF et d’investiguer les circonstances de l’isolement clinique. Materiels et methodes Nous avons repris les souches identifiees a Propioniobacterium sp. entre 2010 et 2012. Apres isolement, les souches identifiees initialement par des tests et galeries phenotypiques (Api20A) ont ete identifiees par spectrometrie de masse VitekMS et par identification moleculaire par sequencage des genes gyrB et ARN 16S. Resultats Sur les 269 souches dedoublonnees retrouvees (toutes natures de prelevement confondues), 246 etaient identifiees respectivement a C. acnes, 18 a C. granulosum et 5 a Cutibacterium sp. par les techniques phenotypiques. L’identification spectrale revelait 231 C. acnes, 5 C. granulosum, 14 C. avidum, ainsi que 13 echecs d’acquisition de spectre et 6 souches appartenant a un genre different. En revanche, l’identification moleculaire des 262 Cutibacterium sp. confirmait l’identification de 236 C. acnes, 5 C. granulosum, 17 C. avidum, 1 Propionimicrobium lymphophilum et 3 C. namnetense. Aucun C. humerusii n’etait retrouve. Deux des trois C. namnetense avaient ete identifies a C. acnes et l’un etait en echec d’acquisition de spectre. La prevalence de cette nouvelle espece sur cette periode est de 1,1 %. Deux des trois patients presentaient une osteite comme le patient avec la souche initiale (3/3 et 4/4 prelevements positifs, dans les deux cas). Conclusion C. namnetense, decrit en 2016, s’avere rare dans notre collection. Son tropisme osseux necessite une etude prospective multicentrique, d’autant que nous l’avons retrouve prospectivement dans d’autres prelevements, notamment une spondylodiscite. Son caractere pro-inflammatoire reste a confirmer. Par ailleurs, les modifications taxonomiques et l’emergence de nouvelle espece en clinique imposent une actualisation reguliere des bases de donnees du MALDI-TOF.

Escherichia coli is the major commensal aerobic bacterium of the digestive tract of humans and animals, but is also the most frequent human bacterial pathogen. As a consequence, resistance mechanisms carried by this species are of particular concern. One of these mechanisms is the overproduction of the chromosomal AmpC β-lactamase, leading to increased MICs of most β-lactams including third-generation cephalosporins. AmpC overproduction is caused by various mutations in the ampC promoter (–42, –32 and –11) increasing homology with the consensus promoter for RNA polymerase