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Daptomycin (DAP) represents an interesting alternative to treat methicillin-resistant Staphylococcus aureus (MRSA) infections. Different mechanisms of DAP resistance have been described; however, in vivo-acquired resistance is uncharacterized. This study described the phenotypic and genotypic evolution of MRSA strains that became resistant to DAP in two unrelated patients with bacteremia under DAP treatment, in two hospitals in the South of France. DAP MICs were determined using broth microdilution method on the pairs of isogenic (DAP-S/DAP-R) S. aureus isolated from bloodstream cultures. Whole genome sequencing was carried out using Illumina MiSeq Sequencing system. The two cases revealed DAP-R acquisition by MRSA strains within three weeks in patients treated by DAP. The isolates belonged to the widespread ST5 (patient A) and ST8 (patient B) lineages and were of spa-type t777 and t622, respectively. SNP analysis comparing each DAP-S/DAP-R pair confirmed that the isolates were isogenic. The causative mutations were identified in MprF (Multiple peptide resistance Factor) protein: L826F (Patient A) and S295L (Patient B), and in Cls protein: R228H (Patient B). These proteins encoded both proteins of the lipid biosynthetic enzymes. The resistance to DAP is particularly poorly described whereas DAP is highly prescribed to treat MRSA. Our study highlights the non-systematic cross-resistance between DAP and glycopeptides and the importance of monitoring DAP MIC in persistent MRSA bacteremia. [ABSTRACT FROM AUTHOR]

Penelope, Nausicaa, Ariadne, Sappho, Aspasia, Olympias, so many names of well-known female figures who have long served as the backdrop for the history of the Greeks without really questioning their own history. What about today? To answer I propose to follow my experience, that of a teacher-researcher at the university in France since the 1970s. This contribution built from a personal journey does not claim to be a synthesis of teaching and research on the history of women and gender in ancient history, but only one perspective among others. It describes the passage from a history of women to a history of gender, then to a mixed history which develops today in history of the ancient worlds, Greek and Roman. [ABSTRACT FROM AUTHOR]

Early diagnosis and treatment of meningitis and encephalitis is essential for reducing both their morbidity and mortality. The FilmArray® Meningitis/Encephalitis (FA-M/E) panel is a recently available molecular tool allowing the simultaneous detection of 14 pathogens in about one hour. We evaluated its routine use over a 13-month period at Nîmes University Hospital, France. Cerebrospinal fluid (CSF) specimens were prospectively analyzed, independently of cell count; results were retrospectively analyzed and positive results compared to clinical and microbiological data. Among the 708 patients included (734 CSF samples), 89 (12.6%) had a positive FA-M/E panel, 71 (80%) for a viral pathogen and 18 (20%) for a bacterial pathogen. Enterovirus and HHV-6 were the main detected pathogens. Mean time-to-results was 1h46mn. Four non-clinically relevant results were detected (3 HHV-6 and 1 Haemophilus influenzae) on the basis of inconsistent clinical and/or biological data, and/or after visualization of melting curves. No CSF pleocytosis was observed in 11% of the patients with a positive FA-M/E panel. For the 18 patients with a positive FA-M/E panel for a bacterial pathogen, five (28%) had CSF samples showing a positive Gram stain allowing an early diagnosis of bacterial infection and 67% had CSF displaying a positive culture. Altogether the panel detected 5 cases of bacterial M/E (29%) not diagnosed by culture. Despite undeniable advantages, mainly ease of use, quick result availability, and an extremely low rate of invalid results, measures should be implemented to limit false-positive results due to contamination and a careful interpretation based on the overall data for each patient is required. [ABSTRACT FROM AUTHOR]

• An optimization framework for aerospace CFRP waste supply chain is developed. • The deployment and design phase are modelled. • The recycling routes involve Grinding, Pyrolysis, Supercritical Water and Microwave processes. • A bicriteria approach is based on cost and environmental (GWP) objectives. • A mix of technologies will be involved in deployment phase. • The methodology can be replicated in other contexts. This paper presents a modelling framework for the deployment and design of aerospace CFRP (Carbon Fibre Reinforced Polymer) waste supply chain. The problem involves a multi-period Mixed Integer Linear Programming (MILP) formulation considering ε-constraint, lexicographic techniques and Multiple Criteria Decision Making (MCDM) tools. The methodology has been applied to a case study of France. In this model, the deployment of new recycling sites (Grinding, Pyrolysis, Supercritical Water, Microwave) is established. The system is optimised by bi-criteria optimisation including an economic objective based on cost minimisation or Net Present Value (NPV) maximisation and an environmental one (minimisation of Global Warming Potential). The potential for economic acceptability of recycled carbon fibres is assessed through a levelized cost derived from the supply chain total cost and the profitability via NPV with a range of various CFRP prices. The results show that the compromise strategy for both economic and environmental objectives leads to centralised configurations at the regions close to significant waste sources. The cooperation in the recovery system is needed to minimise cost and maximise profit. The improvement of recycling technology permits to achieve the compromise solution for both economic and environmental objectives. The results also highlight that a mix of technologies will be involved in deployment phase and that the answer is not straightforward due to the complexity of the system. The methodology is yet generic enough to be replicated in other contexts considering the upgrade of process database. [ABSTRACT FROM AUTHOR]

An innovative resource flow optimization model is proposed that aims at helping decision makers to choose the best resource management policies at national and international scales. This model has been developed and validated on French copper cycle, but can easily be extended to any country or metal. A mathematical formulation of all the in- and outflows of the resource, as well as stocks in the technosphere and waste management, including recycling, has been developed. The complexity of resource cycle led to the introduction of 47 decision variables and resulted in a Mixed-Integer Non-Linear Programming formulation. The resource cycle efficiency has been assessed through four indicators regarding costs, greenhouse gas emissions, energy consumption and resource losses. The NSGA II genetic algorithm methodology has been selected as an optimization strategy. Monobjective optimizations have firstly been conducted for each of the four criteria: the results showed that very different management strategies are needed depending on the targeted criteria. Multiobjective optimizations have thus been conducted coupled with the decision support tool TOPSIS to find an optimal compromise solution. As expected, the selected solution highlights the importance of developing a recycling channel for Waste from Electrical and Electronic Equipment in France. • A model for multi-objective optimization of copper management in France has been developed. • Cost, environmental impacts, energy consumption and losses all along copper cycle have been chosen as optimization criteria. • Increasing the recycling rate of Waste from Electrical and Electronic Equipment should be a priority in France. [ABSTRACT FROM AUTHOR]

New consumer awareness is shifting industry towards more sustainable practices, creating a virtuous cycle between producers and consumers enabled by eco-labelling. Eco-labelling informs consumers of specific characteristics of products and has been used to market greener products. Eco-labelling in the food industry has yet been mostly focused on promoting organic farming, limiting the scope to the agricultural stage of the supply chain, while carbon labelling informs on the carbon footprint throughout the life cycle of the product. These labelling strategies help value products in the eyes of the consumer. Because of this, decision makers are motivated to adopt more sustainable models. In the food industry, this has led to important environmental impact improvements at the agricultural stage, while most other stages in the Food Supply Chain (FSC) have continued to be designed inefficiently. The objective of this work is to define a framework showing how carbon labelling can be integrated into the design process of the FSC. For this purpose, the concept of Green Supply Chain Network Design (GSCND) focusing on the strategic decision making for location and allocation of resources and production capacity is developed considering operational, financial and environmental (CO 2 emissions) issues along key stages in the product life cycle. A multi-objective optimization strategy implemented by use of a genetic algorithm is applied to a case study on orange juice production. The results show that the consideration of CO 2 emission minimization as an objective function during the GSCND process together with techno-economic criteria produces improved FSC environmental performance compared to both organic and conventional orange juice production. Typical results thus highlight the importance that carbon emissions optimization and labelling may have to improve FSC beyond organic labelling. Finally, CO 2 emission-oriented labelling could be an important tool to improve the effects eco-labelling has on food product environmental impact going forward. [ABSTRACT FROM AUTHOR]

Background: Acinetobacter pittii is a nosocomial pathogen rarely involved in community-acquired infections. We report for the first time that A. pittii can be responsible for cavitary community-acquired pneumonia and study its virulence, and discuss its pathogenesis and treatment options.Case Presentation: A 45-year-old woman with a history of smoking and systemic lupus was admitted to Nimes University Hospital (France) with coughing and sputum lasting for three weeks. Thoracic CT scanner showed cavitary pneumonia. Broncho-alveolar lavage cultures found community-acquired Acinetobacter calcoaceticus-baumannii complex. The clinical outcome was favourable after twenty-one days of antimicrobial treatment by piperacillin/tazobactam and amikacin then cefepime. Multilocus sequence typing (MLST) analyses identified an A. pittii ST249. Despite the atypical clinical presentation with an unexpected partial destruction of lung parenchyma, we found very low virulence potential of the A. pittii strain with nematode killing assays and biofilm formation test. The median time required to kill 50% of the nematodes was 7 ± 0.3 days for A. pittii ST249, 7 ± 0.2 days for A. baumanii NAB ST2 and 8 ± 0.2 days for E. coli OP50, (p > 0,05). A. pittii ST249 showed significantly slower biofilm formation than A. baumanii NAB ST2: BFI = 8.83 ± 0.59 vs 3.93 ± 0.27 at 2 h (p < 0.0001), BFI = 6.3 ± 0.17 vs 1.87 ± 0.12 at 3 h (p < 0.0001) and BFI = 3.67 ± 0.41 vs 1.7 ± 0.06 after 4 h of incubation (p < 0.01).Conclusions: Community-acquired A. pittii should be considered as possible cause of sub-acute cavitary pneumonia particularly in a smoking and/or immunocompromised patient despite its low virulence potential. [ABSTRACT FROM AUTHOR]

A model of copper scrap management at country level is proposed, taking all copper scrap collection streams into account, with their associated environmental impacts and costs. The method is applied to the treatment of printed wiring boards (PWB) in France. Considering the initial physical properties and composition of this scrap, seven flowsheets are constructed for the production of refined copper. Then, depending on the number of PWB treated in each processing chain, the production rate, energy consumption, operating cost and environmental impacts are evaluated. Three bi-objective optimizations are conducted based on the NSGA II multi-objective genetic algorithm: production versus energy consumption, production versus operating cost and production versus environmental impacts. Pareto fronts are obtained for each optimization, giving the set of non-dominated solutions. Then the decision support tool TOPSIS is used to find the best compromise solution for waste management. [ABSTRACT FROM AUTHOR]

The emergence of carbapenemase-producing Gram-negative bacilli is a worldwide problem. To date, no study has evaluated the prevalence of faecal carriage of carbapenemase-producing and carbapenem-resistant Gram-negative bacilli (CR GNB) in France. From 1 February to 30 April 2012, we conducted a prospective, multicentre study in three University Hospitals and four General Hospitals in the south of France. The carriage of carbapenemase-producing Enterobacteriaceae (CPE) and other CR GNB was screened by both cultivation on chromID® CARBA and chromID® OXA-48 media (bioMérieux) and molecular tools [multiplex polymerase chain reaction (PCR) and NucliSENS EasyQ® KPC (bioMérieux)]. The genetic relationship between isolates was assessed by rep-PCR (DiversiLab, bioMérieux) or multilocus sequence typing (MLST). The prevalences of CR GNB and carbapenemase-producing bacteria were 2.4 % (27/1,135) and 0.4 % ( n = 5), respectively. Two strains corresponded to OXA-23-producing Acinetobacter baumannii and belonged to the widespread sequence type (ST) 2/international clone II, whereas one strain was an ST15 OXA-48-producing Klebsiella pneumoniae. Two OXA-48-producers were detected exclusively by PCR. This first French study revealed the very low dissemination of carbapenemase-producing bacteria in patients attending hospitals in southern France during a non-outbreak situation. However, the increasing description of epidemic cases in this area must reinforce the use of hygiene procedures to prevent diffusion of these multidrug-resistant microorganisms. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the presence of oxyiminocephalosporin-resistant (OCR) Gram-negative bacilli and extended-spectrum β-lactamase (ESBL)-producing isolates in stool specimens obtained from paediatric patients hospitalised for acute diarrhoea. We conducted a prospective, multicentre study over a period of 6 months in seven hospitals in the south of France. Samplings were carried out from infants admitted for acute diarrhoea with no previous antibiotic treatment in the last week. Bacteria in stool specimens were screened for the presence of OCR Gram-negative bacilli on Drigalski agar supplemented with ceftazidime and ESBL CHROMagar® media, and confirmed by the Rosco tablets test. Genetic detection was performed by the Check MDR® microarray and by polymerase chain reaction (PCR) and sequencing with bacterial DNA extracted from isolates. The presence of OCR enterobacteria was markedly high (177/1,118 patients, 15.2 %), with an important community origin (66.1 %). The majority of multidrug-resistant (MDR) bacteria were Enterobacter cloacae (106, 59.9 %) and Escherichia coli (61, 34.5 %). The prevalence of ESBL and CTX-M producers represented 5.2 and 4.3 % of the isolates, respectively. The main proportion of these ESBL carriers was found in children less than 1 year of age (53.4 %). One carbapenemase (IMP-1) was detected. The study revealed the wide dissemination of MDR bacteria in infants attending hospitals in the south of France during a non-outbreak situation, in particular, the spread of cefotaximase and the detection of a carbapenemase. This worrisome situation must reinforce the use of hygiene procedures and appropriate antibiotics to control the emergence and spread of OCR organisms. [ABSTRACT FROM AUTHOR]

This study performs a quantitative description of the copper life cycle at the scale of France from 2000 to 2009 with special focus on waste streams. The approach is based on substance flow analysis and includes data reconciliation. The model takes into account the relationships between economic system, resource consumption, product manufacturing, waste generation and pollution, thus broadening the traditional scope of process systems engineering. The more important results concern waste management since France exports most of its collected copper wastes because there is no industry for recycling low-grade scrap. The paper shows the interest of using substance flow analysis methodology coupled with data reconciliation to obtain a precise cartography of a substance flow inside a large area. Indeed, statistic data from institutional organisms and industries may vary from one source to the other, and the utilization of the redundancy of information is an efficient tool for obtaining more precise data. Moreover, the dynamic analysis allows modelling the stock evolution with more accuracy than in previous studies. Finally, the results are compared with existing values for other countries or continents, and some perspectives concerning the use of copper in France are given. [ABSTRACT FROM AUTHOR]

• A design framework for Hydrogen and Methane Supply Chains is developed. • Power-to-Gas concepts are coupled with Steam Methane Reforming. • Carbon dioxide sources stem mainly from methanization and gasification processes. • Renewable hydrogen from PtG can be competitive with SMR through a carbon tax. • Renewable methane contribution needs to be assessed in terms of additional flexibility provided to the network. This work presents a methodological design framework for Hydrogen and Methane Supply Chains (HMSC). An innovative approach is to focus on Power-to-Hydrogen (PtH) and Power-to-Methane (PtM) concepts, and their interactions with other technologies, and energy carriers (i.e., Steam Methane Reforming – SMR, and natural gas). The overall objective of this work is to perform single objective and multi-objective optimizations for HMSC design to provide effective support for deployment scenarios. The methodological framework developed is based on a Mixed Integer Linear Programming (MILP) approach with augmented ε-constraint implemented in the GAMS environment according to a multi-period approach (2035-2050). Several available energy sources (wind, PV, hydro, national power grid, and natural gas) for hydrogen production through electrolysis and SMR are included. Carbon dioxide sources stem mainly from methanization and gasification processes, which are used to produce methane through methanation. The objective to be minimised in the single optimization approach is the total annual cost considering the externality of greenhouse gas emissions through the carbon price for the whole HMSC over the entire period studied. The multi-objective optimization includes as objectives the total annual cost, greenhouse gas emissions, and the total methane production from methanation. The Levelized Cost of Energy (LCOE), and the greenhouse gas emissions for each energy carrier are also computed. The results show that renewable hydrogen from PtG can be competitive with SMR through the implementation of carbon prices below 0.27 €/kgCO 2. In the case of synthetic methane, the available resources can meet the demand through PtG, and even if synthetic methane for natural gas network injection is thus far from competitive with natural gas, power-to-gas technologies have the potential to decarbonize the fossil economy and achieve a circular economy through CO 2 recovery. [Display omitted] [ABSTRACT FROM AUTHOR]

• Reformulation of the original bi-objective Mixed-Integer Linear Programming model as a bi-level optimization problem. • Development of an adapted solution tool, which is a matheuristic involving a Multi-Objective Evolutionary Algorithm particularly efficient for bi-objective problems (SMS-EMOA) and Linear Programming. • Numerical evaluation of the proposed tool, with an application to the design of the HSC in the Midi-Pyrénées region (southern of France), which demonstrates the benefits of our approach, regarding both solution quality and computational efficiency. This work introduces an efficient tool for the design of sustainable hydrogen supply chains (HSCs), considering both economic and environmental concerns, through an appropriate multi-objective strategy. The original problem, being formulated as a bi-objective mixed-integer linear programming (MILP) problem, takes into consideration the availability of different energy sources, the installation and operation of hydrogen facilities of different sizes and technologies, and the transportation of hydrogen from production units to storage facilities. The area of study is divided into grids which have a specific hydrogen demand that evolves over time, thus a multi-period model of the HSC is considered. In order to overcome the computational burden associated to the solution of large size instances of the resulting problem, we proposed a solution strategy consisting of a hybrid algorithm. The original problem is reformulated into a bi-level optimization problem: the upper level (discrete problem) consists of finding the optimal location for production plants and storage facilities, whereas the lower level (continuous problem) minimizes their corresponding costs associated to transportation and facility operation. A multi-objective evolutionary algorithm is employed for the solution of the bi-objective upper level, whereas the bi-objective lower level is decomposed using a scalarizing function, which is then solved using a linear programming solver. The proposed methodology is validated through the comparison of the true Pareto fronts given by CPLEX with ε -constraint method, for six increasing size instances. Numerical results prove that the proposed hybrid approach produces an accurate approximation of the Pareto-optimal fronts, more efficiently than the exact solution approach. [ABSTRACT FROM AUTHOR]

We characterized 53 OXA-48-producing Klebsiella pneumoniae ( OXA-48-Kp) isolated between 2011 and 2013 in 21 French hospitals. All the isolates were genotyped using MLST and PFGE and the population structure of the species was determined by a nucleotide-based analysis of the entire K. pneumoniae MLST database. Most of the OXA-48-Kp isolates also produced CTX-M-15 and remained susceptible to imipenem and meropenem. The isolates were distributed into 20 STs, of which five were dominant ( ST15, ST101, ST147, ST395 and ST405). All the OXA-48-Kp clustered in the major clade of K. pneumoniae KpI. [ABSTRACT FROM AUTHOR]

• This paper addresses the multi-objective design of a hydrogen supply chais under demand uncertainty. • The potential of genetic algorithms is explored to cope with the multi-objective formulation. • Better compromise solutions are produced than those obtained with ε-constraint MILP approach. • Demand uncertainty has also been modelled using fuzzy concepts. • The robustness of the configuration solutions has been assessed. Hydrogen is currently considered one of the most promising sustainable energy carriers for mobility applications. A model of the hydrogen supply chain (HSC) based on MILP formulation (mixed integer linear programming) in a multi-objective, multi-period formulation, implemented via the ε-constraint method to generate the Pareto front, was conducted in a previous work and applied to the Occitania region of France. Three objective functions have been considered, i.e., the levelized hydrogen cost, the global warming potential, and a safety risk index. However, the size of the problem mainly induced by the number of binary variables often leads to difficulties in problem solution. The first innovative part of this work explores the potential of genetic algorithms (GAs) via a variant of the non-dominated sorting genetic algorithm (NSGA-II) to manage multi-objective formulation to produce compromise solutions automatically. The values of the objective functions obtained by the GAs in the mono-objective formulation exhibit the same order of magnitude as those obtained with MILP, and the multi-objective GA yields a Pareto front of better quality with well-distributed compromise solutions. The differences observed between the GA and the MILP approaches can be explained by way of managing the constraints and their different logics. The second innovative contribution is the modelling of demand uncertainty using fuzzy concepts for HSC design. The solutions are compared with the original crisp models based on either MILP or GA, giving more robustness to the proposed approach. [ABSTRACT FROM AUTHOR]

This study presents a methodological framework for designing a hydrogen supply chain (HSC) utilizing a superstructure that incorporates various alternatives for feedstock, production, storage, transportation, and distribution. The framework features a mixed-integer non-linear mathematical model that includes innovative factors such as power efficiencies, continuous sizing capacities, and time-varying costs of different energy feedstocks related to the learning rate. Furthermore, emerging production technologies such as alkaline electrolysis and proton exchange membrane water electrolysis, along with steam methane reforming with carbon capture, utilization, and storage, are considered. To address the resulting bi-objective optimization problem that aims to minimize both total daily costs and greenhouse gas emissions, a specialized solution strategy based on bi-level decomposition and a matheuristic algorithm is developed. This methodology for designing HSCs is applied to a case study in southern France, demonstrating the effectiveness of the solution technique in approximating the Pareto frontier. By analyzing in detail selected relevant solutions along the Pareto front, insights into the spatial, temporal, and technological deployment of the HSC are gained, enabling decision-makers to make informed choices based on economic and environmental criteria. • Innovative aspects: continuous capacities, learning rates and emergent technologies. • Development of a novel multi-objective Mixed-Integer Non-Linear Programming model. • Ad-hoc strategy using a bi-level reformulation and a matheuristic (MOEAs + LP). • Case study in France and analysis giving insights for the deployment of the HSC. [ABSTRACT FROM AUTHOR]

Introduction: The increase in the population of immunocompromised patients due to advances in management of end-stage diseases and transplants poses challenges in treating infections caused by multi-drug resistant (MDR) pathogens. Cefiderocol (FDC), a siderophore cephalosporin, has shown efficacy against carbapenem-resistant Gram-negative bacteria., Methods: This retrospective multicentre study investigated the real-world use of FDC in 114 immunocompromised adults treated for MDR infections in 12 French hospitals (June 2020-November 2023). Clinical and microbiological outcomes, including infection cure, relapse, as well as mortality, and resistance acquisition, were assessed at days 28 and 90. Antibiotic prescription compliance with current guidelines was investigated., Results: At day 28, clinical success was achieved in 53.3% of cases, and overall mortality was 37.7%, consistent with other studies (33-37%). Infection-related mortality accounted for 25.4%. Relapse occurred in 17.5% of patients by day 28, rising by an additional 9.8% among survivors by day 90. Resistance acquisition was observed in two cases at day 28 (Pseudomonas aeruginosa and Stenotrophomonas maltophilia) and in three additional cases by day 90. FDC was used as monotherapy in 49.1% of cases, with a median treatment duration of 10 days. Nearly 25% of strains collected in FDC-treated patients were susceptible to best-practice alternatives., Conclusion: These findings highlight FDC's utility in difficult-to-treat infections, particularly S. maltophilia, but the high relapse rate and resistance acquisition underscore the need for careful monitoring, adherence to guidelines, and reconsideration of empirical use to prevent resistance and improve outcomes in fragile populations., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SS received travel grants from Shionogi., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

An emergence of multidrug-resistant (MDR) Staphylococcus haemolyticus has been observed in the neonatal intensive care unit (NICU) of Nîmes University Hospital in southern France. A case-control analysis was conducted on 96 neonates, to identify risk factors associated with S. haemolyticus infection, focusing on clinical outcomes. Forty-eight MDR S. haemolyticus strains, isolated from neonates between October 2019 and July 2022, were investigated using routine in vitro procedures and whole-genome sequencing. Additionally, five S. haemolyticus isolates from adult patients were sequenced to identify clusters circulating within the hospital environment. The incidence of neonatal S. haemolyticus was significantly associated with low birth weight, lower gestational age, and central catheter use ( p  < 0.001). Sepsis was the most frequent clinical manifestation in this series (20/46, 43.5%) and was associated with five deaths. Based on whole-genome analysis, three S. haemolyticus genotypes were predicted: ST1 (6/53, 11%), ST25 (3/53, 5.7%), and ST29 (44/53, 83%), which included the subcluster II-A, predominantly emerging in the neonatal department. All strains were profiled in silico to be resistant to methicillin, erythromycin, aminoglycosides, and fluoroquinolones, consistent with in vitro antibiotic susceptibility tests. Moreover, in silico prediction of biofilm formation and virulence-encoding genes supported the association of ST29 with severe clinical outcomes, while the persistence in the NICU could be explained by the presence of antiseptic and heavy metal resistance-encoding genes. The clonality of S. haemolyticus ST29 subcluster II-A isolates confirms healthcare transmission causing severe infections. Based on these results, reinforced hygiene measures are necessary to eradicate the nosocomial transmission of MDR strains.

Objectives: To evaluate the performance of the Accelerate Pheno™ system for the identification and antimicrobial susceptibility testing (AST) of a panel of Gram-negative bacilli (GNB) with different resistance profiles (e.g. penicillinases, ESBLs, cephalosporinase overproduction, carbapenemases, impermeability) directly from positive blood cultures in <7 h., Methods: A panel of 105 clinical strains previously characterized for the presence of β-lactamase-encoding genes was tested. Approximately 100 cfu of each isolate was inoculated into sterile blood culture bottles and incubated in a BD BACTEC™ FX automated system (Becton Dickinson, USA). Positive blood cultures were subjected to parallel testing using the Accelerate Pheno™ system and conventional culture methods [identification of isolated colonies by MALDI-TOF and VITEK® 2 system (bioMérieux, France), and AST by disc diffusion and Etest following EUCAST recommendations]., Results: The overall identification agreement between the Accelerate Pheno™ system and conventional culture methods was 100% (105/105). The overall categorical agreement between the system and culture-based AST was 94.9% (1169/1232), with rates for minor errors of 4.1% (51/1232), major errors 0.3% (4/1232) and very major errors 0.7% (8/1232). The Accelerate Pheno™ system produced AST results indicative of third-generation cephalosporinases (26/26) and carbapenem-resistant strains (52/55)., Conclusions: The Accelerate Pheno™ system is an accurate, sensitive and easy-to-use test for the rapid identification and AST of MDR GNB in bloodstream infections. Given the burden of multidrug resistance, its implementation in the microbiology laboratory could be a useful tool for prompt management of sepsis.

In France, the proportion of episodes of carbapenemase-producing Enterobacteriaceae (CPE) with no recent stay or hospitalisation abroad is increasing. In this study, we investigate epidemiological links between apparently unrelated cases of OXA-48-producing Klebsiella pneumoniae (Kp OXA-48) colonisation or infection. We genotyped detected organisms by repetitive sequence-based PCR, and used a dynamic registry of cases and contacts to cross-reference patients' hospital stays. Between 1 November 2012 and 28 February 2014, 23 Kp OXA-48 cases were detected in a university hospital in Montpellier, of which 15 were involved in three outbreaks: outbreaks I and II occurred in November 2012 and outbreak III in October 2013. Molecular comparison of bacterial strains revealed clonal identity between cases involved in outbreaks II and III and four single cases. Cross-referencing of hospital stays revealed that these single cases and the index case of outbreak III had occupied the same room. Active case search among former occupants of that room found an additional Kp OXA-48 carrier. A clonal strain was isolated from the sink of that room. The epidemiological link between the contaminated room and outbreak II remained undetected. This study is a reminder that environmental reservoirs should be considered as a source of CPE transmission.

The spread of carbapenemase-producing Gram-negative rods is an emerging global problem. This study describes the epidemiologic features of an outbreak caused by an environmental reservoir of OXA-48-producing Klebsiella pneumoniae caused by persistence of the bacteria during 20 months in an intensive care unit in France. This report emphasizes the importance of early environmental screening to interrupt the transmission of carbapenemase-producingEnterobacteriaceae., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

The genetic structures involved in the dissemination of blaCMY-2 carried by Proteus mirabilis isolates recovered from different gull species in the South of France were characterized and compared to clinical isolates. blaCMY-2 was identified in P. mirabilis isolates from 27/93 yellow-legged gulls and from 37/65 slender-billed gulls. It was carried by a conjugative SXT/R391-like integrative and conjugative element (ICE) in all avian strains and in 3/7 human strains. Two clinical isolates had the same genetic background as six avian isolates., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

In February 2011, the CARB-LR group was created as a sentinel laboratory-based surveillance network to control the emergence of carbapenem-resistant Gram-negative bacilli (CR GNB) in a French Southern Region. We report the epidemiological results of a 2-year study. All the Gram-negative bacilli isolates detected in the different labs (hospital and community settings) of a French Southern Region and with reduced susceptibility to ertapenem and/or imipenem were characterised with regard to antibiotic resistance, bla genes content, repetitive sequence-based polymerase chain reaction (rep-PCR) profiles and multilocus sequence typing (MLST). A total of 221 strains were analysed. Acinetobacter baumannii was the most prevalent carbapenemase-producing bacteria, with a majority of OXA-23 producers (n = 37). One isolate co-produced OXA-23 and OXA-58 enzymes. Klebsiella pneumoniae was the most frequent carbapenemase-producing Enterobacteriaceae (CPE) (OXA-48 producer: n = 29, KPC producer: n = 1), followed by Escherichia coli (OXA-48 producer: n = 8, KPC producer: n = 1) and Enterobacter cloacae (OXA-48 producer, n = 1). One isolate of Pseudomonas aeruginosa produced a VIM-1 carbapenemase. A clonal diversity of carbapenemase-producing K. pneumoniae and E. coli was noted with different MLSTs. On the other hand, almost all OXA-23-producing A. baumannii strains belonged to the widespread ST2/international clone II. The link between the detection of CR GNB and a foreign country was less obvious, suggesting the beginning of a local cross-transmission. The number of CR GNB cases in our French Southern Region has sharply increased very recently due to the diffusion of OXA-48 producers.

Objectives: To determine proportions and incidence rates of Enterobacteriaceae producing carbapenemase among those non-susceptible (NS) to carbapenems in France., Methods: From November 2011 to April 2012, 71 laboratories recorded non-duplicate Enterobacteriaceae clinical isolates NS to at least one carbapenem and the total number of isolates of the different species. Carbapenem MICs were determined by broth microdilution and the β-lactamase content by DNA microarray., Results: During the study period, the 71 laboratories identified 133 244 Enterobacteriaceae isolates, of which 846 (0.63%) were NS to at least one carbapenem. Carbapenem-NS isolates accounted for 0.07% (61/90 148) among Escherichia coli isolates, 1.1% (111/10 436) among Klebsiella pneumoniae, 8.2% (492/5971) among Enterobacter cloacae and 4.0% (84/2104) among Enterobacter aerogenes. Among the 541 available carbapenem-NS isolates, 222 (including 63 randomly selected E. cloacae) were further analysed after confirmation of carbapenem non-susceptibility. None of the Enterobacter spp. isolates produced carbapenemase. Among the other species, 28 isolates produced carbapenemases (22 OXA-48, 4 KPC and 2 NDM), accounting for an estimated proportion of carbapenemase-producing isolates of 0.08% for all species, 0.01% for E. coli and 0.27% for K. pneumoniae. The incidence-density rate in the participating hospitals was 0.0041 per 1000 hospital-days and the incidence rate was 0.0027 per 100 admissions., Conclusions: The incidence-density rate of carbapenemase-producing isolates per 1000 hospital-days was low and 30-fold lower than that of carbapenem-NS isolates (0.125) and almost 300-fold lower than that of ESBL-producing isolates (1.104) in these French hospitals., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)