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The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCAST guidelines v2 (24mm versus 19mm). We assessed its impact on categorization of Enterobacterales recovered from urine samples in emergency departments. A total of 7749 and 2348 strains were tested using the DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpoint was in accordance with the BMD. Using the 24-mm breakpoint, the overall rate of fosfomycin resistance in Enterobacterales increased by three-fold (5.6% vs 18.1%, P0.01) and reached 2.8% and 86.5% in E. coli and K. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remain appropriate. The accuracy of the methods for routine fosfomycin susceptibility testing should be assessed. The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. coli should be evaluated considering its rate of resistance and recent data reporting low accuracy.

Les péritonites sont une complication majeure et grave en termes de morbi-mortalité chez les patients traités par dialyse péritonéale. Leur diagnostic microbiologique est compliqué tant au point vu de la détection des agents étiologiques des péritonites que de l’interprétation des cultures positives. De nombreux micro-organismes peuvent être à l’origine de cette infection ; germes « classiques » comme les staphylocoques à coagulase négative ou les entérobactéries, mais également des bactéries « atypiques », de culture ou de détection plus fastidieuse. Pour mettre en évidence les bactéries responsables, des techniques de biologie moléculaire et de culture peuvent être mises en place. La biologie moléculaire (particulièrement la recherche universelle (ADNr 16s)) permet d’identifier d’éventuels germes atypiques, mais ne permet pas la réalisation d’un antibiogramme. La culture des liquides de dialyse péritonéale reste donc le « gold-standard » pour le diagnostic de ces infections. Celle-ci doit être néanmoins optimisée pour abaisser son seuil de sensibilité. Le diagnostic étiologique des péritonites chez les patients traités par dialyse péritonéale peut être difficile, mais la microbiologie moderne combinée à une discussion bactério-clinique permet l’identification du germe responsable de l’infection dans la très grande majorité des cas. Abstract Peritonitis is a major and serious complication in terms of morbi-mortality for patients treated with peritoneal dialysis. Their microbiological diagnosis is challenging for both the detection of the etiological agents and in interpreting positive cultures. Many microorganisms can cause this infection; usual micro-organisms such as coagulase-negative staphylococci or Enterobacteriaceae, but also ‘atypical’ bacteria, which culture or detection, is more tedious can be found. To identify the responsible bacteria, molecular biology and culture techniques can be set up. Molecular biology (particularly the sequencing of the universal 16s rDNA gene) makes it possible to identify atypical agents, but antimicrobial susceptibility testing cannot be performed following these technics. The culture of peritoneal dialysis fluids remains the ‘gold-standard’ for the diagnosis of these infections. Nevertheless this must be optimized to enhance its sensitivity. The etiological diagnosis of peritonitis in patients treated with peritoneal dialysis may be difficult, but modern microbiology combined with a bacterioclinical discussion allow the identification of the microorganism responsible for the infection in the great majority of the cases., Bulletin de la Dialyse à Domicile, Vol. 1 No 1 (2018): Bulletin de la Dialyse à Domicile

Lyme disease is the most common vector-borne disease in the Northern Hemisphere. Skin is a key organ in the disease, since it is the key interface where host cells, pathogen, skin microbiota and vector interact early during pathogen transmission. We developed a late lyme borreliosis model on mice. This model allowed us to develop a specific detection method of Borreliella proteins in the mouse skin by SRM-MS that might be used to develop a human diagnosis of disseminated Lyme disease. In a second part, we analysed the relationship between skin microbiota, resident skin cells (keratinocytes and fibroblasts), in the presence or absence of Borreliella. The secretome of three commensals bacteria, S. epidermidis, P. acnes and C. striatum was shown to have a synergistic activity with Borreliella in pro-inflammatory gene expressions by keratinocytes and fibroblasts. P. acnes and C. striatum secretomes were also able to inhibit partially the inflammatory response of keratinocytes that might help the transmission/dissemination of the pathogen.; La maladie de Lyme est la maladie à transmission vectorielle la plus répandue de l’hémisphère Nord. La peau est un organe clef dans cette maladie, car c’est à cet endroit qu’interagissent les cellules de l’hôte, le pathogène, le microbiote cutané et le vecteur. Nous avons développé un modèle murin d’infection disséminée de borréliose de Lyme, qui nous a permis de développer une méthode spécifique de détection de protéines de Borreliella dans le tissu cutané murin par SRM-MS, pouvant aboutir à une méthode de diagnostic chez l’homme. Dans un deuxième temps, nous nous sommes intéressés aux relations entre le microbiote cutané, les cellules résidentes de la peau, kératinocytes et fibroblastes, avec Borreliella. Les sécrétomes de trois bactéries commensales, S. epidermidis, P. acnes et C. striatum possèdent un effet synergique sur l’expression de gènes inflammatoires par les kératinocytes et les fibroblastes. Les sécrétomes de P. acnes et de C. striatum se sont également montrés capables d’inhiber une partie de la réponse inflammatoire des kératinocytes, pouvant aider le pathogène lors de la transmission/dissémination précoce.

In vector-borne diseases, the skin plays an essential role in the transmission of vector-borne pathogens between the vertebrate host and blood-feeding arthropods and in pathogen persistence. Borrelia burgdorferi sensu lato is a tick-borne bacterium that causes Lyme borreliosis (LB) in humans. This pathogen may establish a long-lasting infection in its natural vertebrate host where it can persist in the skin and some other organs. Using a mouse model, we demonstrate that Borrelia targets the skin regardless of the route of inoculation, and can persist there at low densities that are difficult to detect via qPCR, but that were infective for blood-feeding ticks. Application of immunosuppressive dermocorticoids at 40 days post-infection (PI) significantly enhanced the Borrelia population size in the mouse skin. We used non-targeted (Ge-LC-MS/MS) and targeted (SRM-MS) proteomics to detect several Borrelia-specific proteins in the mouse skin at 40 days PI. Detected Borrelia proteins included flagellin, VlsE and GAPDH. An important problem in LB is the lack of diagnosis methods capable of detecting active infection in humans suffering from disseminated LB. The identification of Borrelia proteins in skin biopsies may provide new approaches for assessing active infection in disseminated manifestations.

Lyme disease is the most common vector-borne disease in the Northern Hemisphere. Skin is a key organ in the disease, since it is the key interface where host cells, pathogen, skin microbiota and vector interact early during pathogen transmission. We developed a late lyme borreliosis model on mice. This model allowed us to develop a specific detection method of Borreliella proteins in the mouse skin by SRM-MS that might be used to develop a human diagnosis of disseminated Lyme disease. In a second part, we analysed the relationship between skin microbiota, resident skin cells (keratinocytes and fibroblasts), in the presence or absence of Borreliella. The secretome of three commensals bacteria, S. epidermidis, P. acnes and C. striatum was shown to have a synergistic activity with Borreliella in pro-inflammatory gene expressions by keratinocytes and fibroblasts. P. acnes and C. striatum secretomes were also able to inhibit partially the inflammatory response of keratinocytes that might help the transmission/dissemination of the pathogen., La maladie de Lyme est la maladie à transmission vectorielle la plus répandue de l’hémisphère Nord. La peau est un organe clef dans cette maladie, car c’est à cet endroit qu’interagissent les cellules de l’hôte, le pathogène, le microbiote cutané et le vecteur. Nous avons développé un modèle murin d’infection disséminée de borréliose de Lyme, qui nous a permis de développer une méthode spécifique de détection de protéines de Borreliella dans le tissu cutané murin par SRM-MS, pouvant aboutir à une méthode de diagnostic chez l’homme. Dans un deuxième temps, nous nous sommes intéressés aux relations entre le microbiote cutané, les cellules résidentes de la peau, kératinocytes et fibroblastes, avec Borreliella. Les sécrétomes de trois bactéries commensales, S. epidermidis, P. acnes et C. striatum possèdent un effet synergique sur l’expression de gènes inflammatoires par les kératinocytes et les fibroblastes. Les sécrétomes de P. acnes et de C. striatum se sont également montrés capables d’inhiber une partie de la réponse inflammatoire des kératinocytes, pouvant aider le pathogène lors de la transmission/dissémination précoce.

International audience; In Lyme borreliosis, the skin is the key site for bacterial inoculation by the infected tick and for cutaneous manifestations. We previously showed that different strains of Borrelia burg-dorferi sensu stricto isolated from tick and from different clinical stages of the Lyme borrelio-sis (erythema migrans, and acrodermatitis chronica atrophicans) elicited a very similar transcriptional response in normal human dermal fibroblasts. In this study, using whole transcriptome microarray chips, we aimed to compare the transcriptional response of normal human dermal fibroblasts stimulated by 3 Borrelia burgdorferi sensu lato strains belonging to 3 main pathogenic species (B. afzelii, B. garinii and B. burgdorferi sensu stricto) in order to determine whether " species-related " inflammatory pathways could be identified. The three Borrelia strains tested exhibited similar transcriptional profiles, and no species-specific fingerprint of transcriptional changes in fibroblasts was observed. Conversely , a common core of chemokines/cytokines (CCL2, CXCL1, CXCL2, CXCL6, CXCL10, IL-6, IL-8) and interferon-related genes was stimulated by all the 3 strains. Dermal fibroblasts appear to play a key role in the cutaneous infection with Borrelia, inducing a homogeneous inflammatory response, whichever Borrelia species was involved.