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Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.8 % in 2001, 39.6 % en 2007. These data are similar to the French national data over the same period.

Seven hundred and ninety six strains of pneumococcus were collected in the Centre region, from 15 laboratories, between 1st April 1999 and 31st of March 2000. Data were processed, using 4th dimension software, and concerned age, file number, consultation/hospitalisation, sample type, susceptibility to oxacillin (5 micrograms), results of the E-test for benzylpenicillin, amoxicillin, cefotaxime and results of the routine disc diffusion test. Strains with reduced susceptibility to benzylpenicillin (PRSP) were collected by the co-ordinating centre to perform MICs by the reference agar dilution test and serotyping. Out of 796 strains, 450 strains (56.7%) were categorised as PRSP and 400 of them were studied by the co-ordinating centre. Forty two percent of the samples originated from lungs, followed by 19.5% from blood samples, 15% from ear pus (85.7% PRSP) and 2.5% from CSF. Thirty nine percent of the patients were female. 36.6% were children under sixteen (70.1% PRSP) and 62.4% were adults (49.2% PRSP). Out of 400 PRSP 106 (26.5%) were characterised as resistant and 294 (73.5%) as intermediate to benzylpenicillin. Compared to the agar dilution test, 90% of the PRSP studied by E-test had a MIC value for benzylpenicillin within +/- 1 dilution. Thirty six strains of PRSP were resistant to amoxicillin (9% of the PRSP) and 10 (2.5% of the PRSP) to cefotaxime. Serotyping was done on 375 strains. The serotypes encountered were the following: 23 (26.9%), 14 (22.1%), 19 (19.5%), 6 (12.8%), 9 (9.9%) and 15 (5.1%).

Patients admitted in cardiac surgery and cardiac ICU at the Clinic Saint-Gatien (Tours) are screened for MRSA at the entrance by nasal swab and culture on blood agar and selective chromogenic medium made by addition of cefoxitin: BBL CHROMagar MRSA-II BD (result obtained at Day +1). We wanted to assess the molecular biology techniques available to obtain a result at day 0 for the majority of patients and to define an economic and practical strategy for the laboratory.We studied four molecular biology techniques: Cepheid GeneXpert (Cepheid) GeneOhm (BD), LightCycler (Roche) and Hyplex (I2A). Upon reception, nasal swabs were treated by culture, considered as reference, and one of the techniques of molecular biology, according to the manufacturer's notice. We conducted four studies between April 2008 and February 2009 to obtain a significant sample for each of them.By screening we mean a method that allows us to exclude MRSA carriage for patients waiting for surgery, and not to change patient management: for example, lack of isolation measures specific to entrance, no modification of antibiotic prophylaxis during surgery and no isolation measures in the immediate postoperative period.The criteria we considered for this evaluation were: (1) technician time: time to perform one or a series of sample(s) n=10 or more (about 2h for all techniques except GeneXpert 75min), level of skilled competences (no specific training for GeneXpert); (2) results: turnaround time (all molecular biology techniques), ease of reading and results interpretations (no specialized training required for GeneXpert), failure or not (12% of failure of internal controls for GeneOhm); (3) economic: cost for one or a series of sample(s) (n=10 or more), if we considered X as the reference culture cost (10 X Hyplex and LightCycler, 20 X and 40 X for GeneXpert GeneOhm); (4) NPV: 100% for GeneXpert and LightCycler.At same sensitivity, no technique, including culture, can solve alone our problem, which is: (1) get results at day 0 for batch of samples (n10): all molecular biology techniques; (2) beyond 10 samples: LightCycler (Roche) automated or Hyplex (I2A) manual; (3) when the result at day 1 is sufficient, the use of chromogenic agar with a reading of less than 18h as BBL CHROMagar MRSA II (BD) remains the most economical; (4) to be sure that a patient admitted at Day 0, even at night's emergency, is not carrier of MRSA: only Cepheid GeneXpert technology (IL). Furthermore, Cepheid GeneXpert (IL) allows performing several tests in parallel. The rapidity of this system can help control the transmission and make better use of antibiotics.

Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.8 % in 2001, 39.6 % en 2007. These data are similar to the French national data over the same period.

Seven hundred and ninety six strains of pneumococcus were collected in the Centre region, from 15 laboratories, between 1st April 1999 and 31st of March 2000. Data were processed, using 4th dimension software, and concerned age, file number, consultation/hospitalisation, sample type, susceptibility to oxacillin (5 micrograms), results of the E-test for benzylpenicillin, amoxicillin, cefotaxime and results of the routine disc diffusion test. Strains with reduced susceptibility to benzylpenicillin (PRSP) were collected by the co-ordinating centre to perform MICs by the reference agar dilution test and serotyping. Out of 796 strains, 450 strains (56.7%) were categorised as PRSP and 400 of them were studied by the co-ordinating centre. Forty two percent of the samples originated from lungs, followed by 19.5% from blood samples, 15% from ear pus (85.7% PRSP) and 2.5% from CSF. Thirty nine percent of the patients were female. 36.6% were children under sixteen (70.1% PRSP) and 62.4% were adults (49.2% PRSP). Out of 400 PRSP 106 (26.5%) were characterised as resistant and 294 (73.5%) as intermediate to benzylpenicillin. Compared to the agar dilution test, 90% of the PRSP studied by E-test had a MIC value for benzylpenicillin within +/- 1 dilution. Thirty six strains of PRSP were resistant to amoxicillin (9% of the PRSP) and 10 (2.5% of the PRSP) to cefotaxime. Serotyping was done on 375 strains. The serotypes encountered were the following: 23 (26.9%), 14 (22.1%), 19 (19.5%), 6 (12.8%), 9 (9.9%) and 15 (5.1%).

714 pneumococcus were listed from 14 laboratories between the 1 June 1997 and the 31 May 1998. Data capture was done on Epi info software and concerned age, file number, consultation/hospitalization, sample type, susceptibility to oxacilline (5 micrograms), the results of the E-test for penicillin G, amoxicillin, cefotaxime and the results of the routine disk diffusion susceptibility method. Strains with reduced susceptibility to penicillin G (PRSP) were collected by the coordinating center to perform MICs by the reference method of agar dilution and serotyping. Over 714 strains, 45.7% of the samples originated from lungs, followed by 22% for blood samples, 14% for ear pus and 2.3% for CSF. 34% of the patients were female. 36.7% were children under 16 (57.8% PRSP) and 63.3% were adults (41% PRSP). 338 strains (47.3%) were determined as PRSP and 293 of them were studied by the coordinating center. 81 of the 293 PRSP (27.7%) were resistant et 212 (72.3%) were intermediate to penicillin G. 81% of the PRSP studied had a CMI value for penicillin G within +/- 1 log2 dilution. 20 strains of PRSP were resistant for amoxicillin (6.8% of the PRSP) and two (0.7% of the PRSP) for cefotaxime. 289 serotyping were done, most met serotypes were 23 (25%), 14 (23%). The least met was 15 (2.4%). These results let assess the epidemiology of pneumococcus in our region.

Un malade est porteur d'une arthroplastie depuis plus de 2 ans : rage de dents, infection aigue, nettoyage au " Karcher". Quand faut-il arreter les antibiotiques ? L'etat de surface de l'implant doit probablement avoir un role car slime et biofilm protegent les bacteries. L'urgence du nettoyage avant 72 heures est primordiale. Les donnees experimentales ont montre que l'association : Rifampicine/ Fluoroquinolones etait utile mais devait durer 8 a 12 semaines en cas de staphylocoques. Certaines situations autorisent un traitement dit " suppressif" au long cours de plus de six mois. Il n'y a pas de vrais criteres de guerison : le dosage de la pro calcitonine semble contributif, et la ponction. Le bon critere de guerison est l'absence de rechute a plus de deux ans.

URIFAST Es et Es Plus (International Microbio, Signes, France) are rapid antimicrobial susceptibility testing method in broth medium without using an automatic reader. A screening assay (URIFAST Quatro 1C ou URIFAST Twin 1C) is performed with a 4 or 9 antimicrobial agents with a concentration c' below the low critical concentration (c) defined by the Comité de l'Antibiogramme de la Société Française de Microbiologie (CA-SFM). When a bacterial strain is presumed resistant, an antimicrobial susceptibility test with the two critical concentrations (CA-SFM) can be performed with 5 or 10 antimicrobial agents antibiotiques (URIFAST Twin ABG ou URIFAST ABG). 140 strains of Enterobacteriaceae from urinary tract infections; E. coli (n = 94), P. mirabilis (n = 13), K. pneumoniae (n = 4), K. oxytoca (n = 6), C. diversus (n = 3), P. vulgaris (n = 1), M. morganii (n = 3), C. freundii (n = 4), E. aerogenes (n = 2), E. cloacae (n = 5) and S. marcescens (n = 5); were isolated with CPS ID2 (bioMérieux, Marcy l'Etoile, France). URIFAST results were compared to Rapid ATB Ur et ATB Ur results obtained after reading with ATB expression (bioMerieux). For each discrepancy, the minimal inhibitory concentration (MIC) by agar dilution was used as the reference method. Agreement obtained were 98.57% with Quatro 1C, 98.40% with Twin 1C, 98.14% with Twin ABG and 98.39% with ABG. 94% of beta-lactams susceptible Enterobacteriaceae were detected by the screening tray with the antimicrobial agent concentration c'. URIFAST Es et Es Plus are standardized and easy-to-use methods. Because of their good performances, the URIFAST methods can be used to test antimicrobial susceptibility for Enterobacteriaceae from urinary tract infections.

Assessment of the informative value of 8 immunological tests: sero-agglutination (Wright and Rose Bengale), indirect immunosorbent assay, counter immuno electrophoresis, ELISA IgG, IgM and IgA, and particle counting immunoassay (PACIA) has been performed among the results of serum of 209 patients. The patients were divided in four groups: 71 who already had brucellosis, 18 Yersinia infections, 12 Tularemia and 108 free of desease. The informative capacities of a positive result of counter immuno electrophoresis (Protein antigen Brucellin-INRA Tours-Nouzilly) is higher than others reactions and can be proposed as a confirmatory test of brucellosis. Among others techniques, 4 were found to be more sensitive: Elisa IgA (se = 97.6) and IgG (se = 90.1), IFI (se = 91.5) and Rose Bengale (se = 85.9) and can be proposed as screening test for medical diagnosis or epidemiological survey. Many cross-reactions were observed specially with Yersinia enterocolitica even with new serological methods.

The structure and dynamic properties of water in porous Vycor glass of 40 Å mean pore diameter, as well as their changes with temperature, were studied by dielectric relaxation spectroscopy and dc conductivity measurements. The mobility of water moledules in the pores was reduced compared with that of bulk water by a factor which decreased with increasing water content. A significant fraction of water in the first monolayer is transformed to a glassy state at about 170 K. The formation of water clusters around primary hydration sites started at about 0.02 g(H2O)/g (dry sample) where a transition to long-range connectivity amiong ater molecules was observed. © 1994.

For the evaluation of immunological tests during an epidemiological survey and of vaccination with the PI brucellin vaccine, in an occupationally exposed environment, a sample group of 354 subjects was studied. The vaccinal strategy was based on the outcome of a skin test for hypersensitivity: the PS brucellin test. In this framework, the serological status and evolution of individuals with positive or negative reactions to this test were analysed. Sera were studied using the buffered antigen test, indirect fluorescence immunoassay and Wright's agglutination test, as well as by PACIA and ELISA techniques with assay of IgG, IgA and IgM antibodies. The PS test, which was pivotal in this study, was compared with the lymphoblastic transformation test. One prominent aspect of this evaluation was the establishment of conventional prognostic indices for the PS and serology. The PS is definitely shown to be a convenient, reliable tool for screening. Although it does not generate sensitivity it may modify the serological status of both positive and negative individuals.

This prospective phase IV study on cohort concerns a vaccine made of the phenol-insoluble fraction of Brucella abortus biotype 1 (B19 strain). Three hundred and three professionally exposed subjects entered the study; 161 out of 182 subjects (88.5 percent) with negative response to an intradermal test for detection of previous contamination accepted to be vaccinated. Booster injections were given 18 and 36 months after vaccination. Local pain was observed after 45.2 percent of injections and moderate systemic reactions after 5 percent of injections. Seropositivity after primary vaccination reached 80 percent. The booster injection, justified by a major decrease of this rate after 18 months, gave exactly the same response of the thymo-independent type. This vaccinal schedule did not result in detectable hypersensitivity. The clinical effectiveness of the vaccine could not be evaluated accurately because of the insufficient number of subjects. The possibility of subclinical infection in vaccinated subjects calls for wider comparative studies of vaccinated versus non-vaccinated subjects.

A study was conducted to compare the interest of using Clinitek and leucocytes esterase, blood, nitrites strip Multistix-8 SG (Ames-Bayer Diagnostics) with conventional method (dilution of urine in agar plate) and with automated system (Autobac) as a screening procedure to detect significant bacteriuria. The results are expressed in terms of sensitivity, specificity, predictive value of a negative and positive test. A total of 1303 urine samples were tested of which 730 (56%) were founded negative with Clinitek or conventional urine analysis (Se = 83.6%; VPN = 89.6%). Criteria for urinary tract infection were present for 193 samples (14.8%), the predictive value of a negative test for leucocytes, blood or nitrites (99.6%) justifies the use of Clinitek for economical screening of urine. Overall agreement is higher with the results or Clinitek (in few seconds) than with the Autobac (in 4-5 hours) when compared to the conventional method. The authors propose Clinitek as an effective method for screening and optimised urine analysis for urinary tract infection.

Summary A case of non 01 Vibrio cholerae bacteremia in a 65-years-old man is reported. We stress the fact that contamination occurred in Europe. This bacteremia in immuno-compromised patients is frequently fatal.

Summary Susceptibility of 121 isolates of coagulase-negative staphylococci to two antimicrobial agents, novobiocin and fosfomycin, was determined using the agar dilution method. Isolates included 45 strains of Staphylococcus saprophyticus, 26 strains of S. cohnii and S. xylosus, 24 strains of S. epidermidis and 26 strains of S. hominis, S. capitis, S. warneri and S. auricularis. The minimal inhibitory concentration average of fosfomycin for S. saprophyticus differed (p Out of 45 isolates of S. saprophyticus, 42 were resistant to fosfomycin. The results were very heterogeneous with regard to fosfomycin for all of the other coagulase-negative staphylococci. Resistance to fosfomycin, like resistance to novobiocin, could be used as a presumptive test for the identification of S. saprophyticus.

Resume La nature lipopolysaccharidique des antigenes de Brucella utilises dans les techniques serologiques est a l'origine de nombreuses reactions croisees (dont Yersinia enterocolitica). Afin d'apprecier les valeurs diagnostiques respectives de la sero-agglutination de Wright (S.A.W.), l'epreuve a l'antigene tamponne (E.A.T. ou Rose Bengale), la reaction de fixation du complement (F.C.), l'immunofluorescence indirecte (.I.F.I.) et la contre immuno-electrophorese a la Brucelline (C.I.E.), les serums de 214 patients, dont 44 (20 %) proviennent de patients brucellises, ont ete etudies. Les reactions les plus sensibles sont l'I.F.I. (sensibilite = 0,84) et l'E.A.T. (Se = 0,82). Les plus specifiques sont : C.I.E. (specificite = 0,99), I.F.I. (sp = 0,97) et F.C. (sp = 0,98). Les reactions d'agglutination (E.A.T. et S.A.W.) donnent lieu a de nombreuses interferences et les taux d'agglutinations sont voisins que l'infection soit due a Brucella ou a Yersinia enterocololitica 09. Qu'il s'agisse du depistage serologique des patients brucellises (enquete epidemiologique) ou du diagnostic serologique de brucellose, il est necessaire d'associer aux reactions d'agglutinations (E.A.T. ou S.A.W.) des reactions plus specifiques et/ou sensibles comme l'I.F.I., la F.C. ou la C.I.E. a la brucelline.

Resume 14 souches de Staphylococcus saprophyticus , isolees chez des malades atteints d'infection urinaire, ont ete identifiees pendant une periode de 8 mois dans un laboratoire hospitalier de microbiologie clinique. Ces souches representent 5,7 % des bacteries responsables de 333 infections urinaires observees pendant cette periode. Le role pathogene de cette bacterie chez la jeune femme est objective et oppose a celui des autres Staphylococcus isoles chez des malades deja hospitalises, de moyenne d'âge differente et ou ayant subi des explorations instrumentales au niveau du tractus urinaire. L'isolement et l'identification precise de Staphylococcus saprophyticus est indispensable, car sa signification pathologique merite d'etre individualisee tant sur le plan de la pathogenie, que sur ceux de l'epidemiologie, de la clinique, et de la therapeutique.

The transcortin capacity for cortisol (CBC, μg cortisol/100 ml) has been determined by gelfiltration using [1,2-3H]cortisol (De Moor et al. 1962; Doe et al. 1964). There was always 2 to 3% unspecific binding to CBC free plasma (heated to 60°C for 30 minutes) and to pure albumin. The protein binding found in unaltered plasma had to be corrected by subtracting this unspecific radioactivity to calculate the CBC, which had a normal range of 24 ± 8 μg cortisol/100 ml plasma (2 sd, n = 35). Eight states of hyperoestrogenism, 5 hypopituitarisms, 8 acromegalies, 3 congenital adrenal hyperplasias, 2 hirsutisms and 12 Cushing syndromes were tested. As a group only the CBC in hyperoestrogenism was high and outside the normal range. The CBC in two cases of Cushing syndrome and in two cases of acromegaly were low. The CBC has been followed before and under treatment with 2,2(4-chlorophenyl,2-chlorphenyl)1,1-dichlorethane (op'DDD). No significant changes were seen.

Resume Pour preciser l'action du sulfate de protamine sur les lipides circulants, decrite dans nos travaux anterieurs, une revision critique de cette action a ete entreprise sur une nouvelle serie de II sujets hypercholerolestemiques soigneusement selectionnes. presentant des hypercholesterolemies permanentes a serum clair, peu sensibles aux variations du regime alimentaire et habituellement assez stables. Un protocole experimental rigoureux, comportant des controles quotidiens de la lipidemie et la mise en œuvre de techniques differentes, a ete adopte. Il a ainsi ete possible: 1. (1) de faire la part des fluctuations quotidiennes spontanees de la cholesterolemie; 2. (2) de confirmer les diminutions paralleles de la lipidemie totale, de la cholesterolemie et du test phenolique de Kijnkki-, consecutives aux injections intraveineuses de sulfate de protamine, la diminution depassant 15% apres 3 jours pour la cholesterolemie; 3. (3) d'etablir une relation entre l'inactivite de l'une des preparations de sulfate de protamine etudiees et la presence de phenol. Les auteurs attribuent aussi la discordance apparente entre les effets observes et les effets classiquement admis du sulfate de protamine au delai plus long ecoule dans leurs observations outre l'injection et le prelevement sanguin.

Resume Les auteurs rapportent un cas d'endocardite bacterienne a Gemella haemolysans chez un homme de 68 ans sans cardiopathie prealable connue. Les difficultes du diagnostic differentiel avec l'espece Streptococcus morbillorum et les streptocoques du groupe Viridans sont evoquees.

Resume Un cas de septicemie a Lactobacillus acidophilus associe a une pyelonephrite est rapporte chez un malade de 65 ans sans antecedent d'infection urinaire connu. Les auteurs discutent la signification de la presence de Lactobacillus dans les urines.