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Summary: Isolation of a bacterial strain at the infectious site and determination of the suceptibility profile may help to guide approriate antibiotic treatment. However technical difficulties justify interpretative reading to recognize interferring resistance mechanisms from resistance phenotypes. The aim of this article is to give some examples showing interpretative reading of routine sensitivity test data. [Copyright &y& Elsevier]

Summary: Background: The GPIP/ACTIV (Groupe de Pathologie Infectieuse Pédiatrique and Association Clinique et Thérapeutique Infantile du Val de Marne) set up an active surveillance network to analyze the epidemiological, clinical and biological features of meningococcal meningitis. Methods: French pediatric wards working with 166 microbiology laboratories enrolled all children (0–18 years old) with bacterial meningitis. Risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. Results: Since 2001, 1661 meningococcal meningitis were reported among 3769 (44.1%) bacterial meningitis. Mean age was 4.4- year- old (±4.8, median 2.5) and 2/3 cases occurred in children under 5- year- old (68.8%). Serogroup B (61.3%) is preponderant following by serogroup C (27.0%). 27.5% of children had received an antibiotic treatment 24 hours before lumbar puncture. A shock is reported in 31.0% of cases. No cases of meningococcal meningitis C has been reported in children vaccinated with a conjugate vaccine. Two children vaccinated with MenBvac® vaccine had a meningitis B14:P1.7,16. Global case fatality rate was 6.5% but was higher (9.2%) for serogroup C than for serogroup B (5.9%) (p =0.02). Conclusion: This is among the largest series of microbiologically documented meningococcal meningitis to date (1661 cases). In France, meningococal is responsible for approximately 50 % of meningitis. Effective meningococcal serogroup B vaccine and serogroup C vaccination recommendation could control the burden of meningococal meningitis. [Copyright &y& Elsevier]

Summary: The healthy carrier of Streptococcus pneumoniae (S. pneumoniae) has been studied very little at the national level. With the emergence of antibiotic-resistant strains worldwide, and the emergence of new serotypes, an epidemiological survey is needed before the vaccine can be introduced in Morocco. Objectives: This study''s objective was to determine the prevalence and risk factors of pneumococcal nasopharyngeal carriage in children less than 2years of age in the Marrakech region and to assess the antibiotic susceptibility of the isolates and the serotypes present prior to the introduction of the conjugate pneumococcal vaccine. Patients and methods: From 2008 to 2009, 660 nasopharyngeal samples were collected on children under 2years of age during scheduled visits to dispensaries for routine immunization in the Marrakech region. Results: S. pneumoniae carriage was found in 45.8% of children. Of the 660 samples, 302 strains were isolated. The percentage of pneumococcal strains with reduced susceptibility to penicillin (PRSP) was 34.7%. Among these strains, 87.1% showed low-level resistance and 12.9% high-level resistance. Resistance to amoxicillin was found in 3.3% of the strains and no strains were resistant to cefotaxime. Several risk factors for pneumococcal carriage were identified, the main ones being breastfeeding less than 2 months, the presence of more than one sibling, passive smoking, and low socioeconomic level. The most frequent serotypes were 19F, 6, 14, 23, 18, and 9. The study of the vaccine serotype distribution showed that the theoretical vaccine coverage of the 7 valent vaccines was at 57% for all the isolates. Conclusion: These data show the frequency and the risk factors on nasopharyngeal carriage, and report the status of penicillin resistance of strains carrying children less than 2years of age in the Marrakech region. The fluctuation of circulating serotypes at the national level underscores the importance of epidemiological surveillance carried out before the introduction of the heptavalent vaccine in Morocco. [ABSTRACT FROM AUTHOR]

A 1-year prospective cohort study of all episodes of Escherichia coli bacteraemia in two French university hospitals was conducted to assess simultaneously the influence of host and bacterial determinants on the initial severity and outcome of E. coli sepsis. Clinical data (community-acquired/nosocomial infection, immune status, underlying disease, primary source of infection, severity sepsis scoring and outcome), phylogenetic groups (A, B1, D and B2), nine virulence factors (VFs) ( papC, papGII, papGIII, sfa/foc, hlyC, cnf1, iucC, fyuA and iroN) and the antibiotic susceptibility of isolates were investigated. All VFs except iucC were significantly more prevalent (p <0.05) among the B2 group isolates . The non-B2 isolates were more frequently resistant to antibiotics than were B2 isolates (p <0.05). There were significantly more B2 isolates from immunocompetent than from immunocompromised patients (p <0.05). No bacterial or host determinants influenced the initial severity of sepsis. Multivariate analysis revealed that the presence of papGIII, septic shock at baseline and a non-urinary tract origin of sepsis were associated independently with a fatal outcome (p 0.04, <0.0001 and 0.04, respectively). A factorial analysis of correspondence allowed two populations of isolates to be distinguished: those belonging to the B2 group were associated more frequently with susceptibility to antibiotics, community-acquired infection, a urinary tract origin and immunocompetent hosts; those belonging to the A, B1 or D groups were associated more frequently with resistance to antibiotics, a nosocomial origin, a non-urinary tract source and immunocompromised hosts. Although no influence of host or bacterial determinants on the initial severity of sepsis was detected, bacterial and host determinants both influenced the outcome of E. coli sepsis significantly. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2012; 18: E134-E136 Abstract Kingella kingae arthritis in children is now mainly diagnosed by PCR, which has surpassed conventional culture of joint fluid. As oropharynx colonization is the first step of Kingella kingae invasion, we prospectively investigated the possibility of cultivating it from throat swabs, in children hospitalized for K. kingae arthritis. Throat culture was 5.6-fold more sensitive than joint fluid cultures in isolating K. kingae (66.7% vs. 11.9% respectively, p <0.001) and may be used to perform antibiotic susceptibility testing. [ABSTRACT FROM AUTHOR]

Summary: Escherichia coli is both a gastrointestinal tract commensal and a major pathogen. In recent years, E. coli is under fire from the news due to a better understanding of pathogenic factors, outbreaks of infections caused by enterohaemorrhagic strains, and last but not least, the worrying development of antibiotic resistance. Due to the absence of new compounds active against these strains, producing extended-spectrum ß-lactamases (ESBL) and frequently multiresistant to other antibiotics, their emergence will pose therapeutic problems for practitioners of all pediatric specialties. The gold standard treatment for severe infections due to ESBL-E. coli family is the penem classe. The frequent use of penems promotes the emergence of strains resistant to carbapenems. Sparing carbapenems should be a clear objective for non life-threatening infections. [Copyright &y& Elsevier]

Summary: Objective: Delayed cerebrospinal fluid sterilization is defined by a positive second lumbar puncture, recommanded according to the guidelines from the French Consensus Conference of 1996 between the 36th and 48th hours after the beginning of antibiotics prescribed for pneumococcal meningitis. The aim of this study was to analyze specifically delayed cerebrospinal fluid sterilization, identified during the first 5 years of the French observatory of children bacterial meningitis. Patients and methods: The Groupe de Pathologie Infectieuse Pédiatrique (GPIP) and Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV) has set up since the first of January 2001 a descriptive national multicenter network, to determine incidence, main characteristics, and prognosis of bacterial meningitis in children. A questionnaire, available in all pædiatric unit taking care of bacterial meningitis, was completed by a referral doctor. It contained reasons for inclusion in the study, anamnesis, clinical examination, treatment, pneumococcal characteristics, and short term prognosis. Delayed cerebrospinal fluid sterilization were identified, and the analysis of their medical records completed the questionnaire. Results: From 1st January 2001 to 31 December 2005, 616 pneumococcal meningitis were identified. Among them, 442 had a second lumbar puncture, and 8 had delayed cerebrospinal fluid sterilization. The analyis of their medical records were reviewed to describe their characteristics. Two had an osteomeningeal breach, one a ventriculoperitoneal valve. All received previously an antibiotic, and were treated with a curative antibiotic by cephalosporins. Vancomycin was given in 6 cases. The antibiotic was inadapted to the French guidelines for 1 patient. There are 4 vaccine type pneumococci and only 1 strain was resistant to penicillin, and intermediate to cephalosporins. The controlled lumbar puncture was made between 36.5 and 179.4hours after beginning antibiotics. One patient has received a double dose of steroids. Three were in a coma, had convulsions, and were ventilated, none died. One patient has a sequellar paired deafness, two a severe disability, four a normal psychomotor development. Conclusion: The delay of sterilization is a rare situation and represented only 1.8 % of pneumococcal meningitis during the first five years of the observatory. These results suggest that a second lumbar puncture to assess sterilization could be proposed only in cases of unfavourable clinical course, MIC greater than or equal 0.5mg/l to 3GC, risk factors for delayed cerebrospinal fluid sterilization and high bacterial inoculum. [Copyright &y& Elsevier]

Summary: Children empyema pose therapeutic problems for reasons that are not clearly established. The pneumococcus is by far the bacteria most often responsible. There is no clinical study demonstrating the superiority of an antibiotic regimen over another. Even though these studies exist, they would be challenged by the evolution of bacterial resistance that may vary depending on different parameters: antibiotic pressure, vaccination etc. Therefore, it is on the microorganism suspected, the data of bacterial resistance and pharmacokineticspharmacodynamic (Pk / Pd) parameters that lead to antibiotic choice. An analysis of these elements can lead to the following proposals. For pneumococcal empyema, intraveinous 3rd generation cephalosporin at dose of 100mg/kg/day divided 4 injections IV for cefotaxime or 50mg/kg/day in once a day for ceftriaxone. These doses are likely to be doubled in case of pneumococcus resistant to penicillin. Neither fosfomycine or aminoglycosides have a sufficient activity against pneumococcus to be offered in combination. If an association seems useful, the two best candidates are vancomycin and rifampin. For group A streptococcus empyema, clindamycin in association with is certainly the best choice. The recent evolution of resistance to macrolides should lead to check the susceptibility of the bacteria implicated. If S. aureus is susceptible to meticilline (most often), a M penicillin by parenteral route associated with an aminoglycoside is proposed. Fosfomycine can be an alternative to the aminoglycoside. If S. aureus is meticilline resistant, the association vancomycin and rifampicin seems best suited. When no bacteria has been isolated, the choice against pneumococcus resistant seems most appropriate. [Copyright &y& Elsevier]