Search

Bacterial resistance in community-acquired urinary tract infections (UTIs) is increasing worldwide. Our study aimed to assess the microbiological epidemiology and antimicrobial susceptibility patterns of community-acquired urine bacterial isolates in French Amazonia. Our study is retrospective. It was conducted from January 2015 to December 2019 in the microbiology laboratory of the Cayenne General Hospital (French Guiana). It includes all positive urine samples from adult (> 18 years) outpatients (N = 2,533). Isolated microorganisms were Gram-negative rods in 83.9%, mainly Enterobacterales (98.4%). The main isolated bacteria were Escherichia coli (58.7%) and Klebsiella pneumoniae (13.3%). Among the isolated E. coli, 37.2% were susceptible to amoxicillin, 77.9% to amoxicillin/clavulanic acid, 94.9% to cefotaxime, 78.9% to ofloxacin, and 98.9% to nitrofurantoin. In 106 cases (5.1%), isolated Enterobacterales were extended-spectrum β-lactamase producers (5% of E. coli and 8.9% of K. pneumoniae). Overall, high levels of cross- and co-resistance were registered. The main isolated Gram-positive bacteria was Staphylococcus saprophyticus (28.9%). It was resistant to oxacillin in 52.5% of cases and susceptible to nitrofurantoin in 99.1% of cases. Patients with S. saprophyticus were young women in almost all cases. In conclusion, the most isolated microorganisms from outpatient urinalyses were E. coli and K. pneumoniae. They showed a high resistance rate to amoxicillin, but they were susceptible to the most remaining antibiotics. S. saprophyticus was isolated mainly in young women and was resistant to oxacillin in half of the cases. Interestingly, nitrofurantoin was active against most isolated organisms and can be considered as empirical treatment in uncomplicated UTIs.

Résumé La mission Résilience Dixmude des Armées a réalisé 12 transferts inter-hospitaliers durant la première vague de la crise COVID-19 en 25 jours de patrouilles actives dans l’arc antillais permettant de réduire les pertes de chances des patients COVID+ et non COVID hospitalisés dans les îles du nord et les îles du sud de la Guadeloupe. Le principe de délestage des patients des établissements en double insularité en cas de situation sanitaire exceptionnel doit être retenu et opéré avec des moyens opérationnels adaptés.

Ciguatera fish poisoning (CFP) is one of the most common causes worldwide of marine poisoning associated with fish consumption from tropical areas. Its incidence is underreported. CFP cases seem to increase with grouped cases reported during summer. Exposure to ciguatoxin, the toxin responsible for CFP with sodium-channel agonistic, cholinergic, and adrenergic activities, may result in a large spectrum of manifestations. We aimed to describe the clinical characteristics, management, and outcome of CFP in Martinique, French West Indies. We conducted an observational retrospective single-center study for six years (October 2012 to September 2018) including all CFP patients managed by the prehospital medical services, admitted to the university hospital emergency department, or declared to the regional health agency. One hundred and forty-nine CFP patients (81females/63males; median age, 46 years [interquartile range, 34-61]) were included. Acute features consisted of general (91%; mainly, myalgia pruritus, and asthenia), gastrointestinal (90%; mainly diarrhea, abdominal pain, and nausea), neurological (72%; mainly, paresthesia, dysgeusia, and impairment of hot/cold feeling), and cardiovascular manifestations (22%; bradycardia, hypotension, and heart conduction disorders). Management was supportive. No patient died but symptoms persisted in 40% of the 77 patients with follow-up on day 15. CFP was mainly attributed to the ingestion of trevallies (59%), snappers (13%), and king mackerels (8%) with collective contaminations (71%). Unusual fish (tuna, salmon, and spider conchs) were suspected in rare cases. Ingestion of trevallies was associated with significantly higher persistent symptoms (odds ratio, 3.00; 95% confidence interval, [1.20-8.00]; p=0.03). CFP incidence was 0.67 cases per 10,000 patient-years in Martinique over the study period. To conclude, CFP represents an increasing public health issue in Martinique like in other Caribbean islands. Patients present usual but possibly life-threatening features. The outcome is excellent despite frequently prolonged manifestations.

Background French Guiana (FG) is a French overseas territory where malaria is endemic. The current incidence rate is 0.74‰ inhabitants, and Plasmodium vivax is widely predominating even though Plasmodium falciparum is still present due to imported cases mainly from Africa. In FG, rapid diagnostic test (SD Malaria Ag P.f/Pan®) is based on the detection of pan-pLDH, PfHRP2, and PfHRP3 antigens, while in South America, the share of deletion of PfHRP2 gene is significantly increasing. Accordingly, the study questions the reliability of RDTs in the Amazonian context. Methods The study is retrospective. It is conducted over 4 years and analysed 12,880 rapid diagnostic tests (RDTs) compared to concomitant Blood Film Tests (BFTs) sampled for malaria diagnosis. Results The global assessment of the accuracy of SD Malaria Ag P.f/Pan® in the diagnostic of malaria shows both Positive and Negative Predictive Values (PPV and NPV) higher than 95%, except for PPV in the diagnosis of malaria to P. falciparum (88%). Overall, the concordance rate between RDT and BFT (positive/positive; negative/negative) was 99.5%. The PPV of the RDT in the follow-up of patients diagnosed with P. falciparum was the lowest during the first 28 days. The PPV of the RDT in the follow-up of patients diagnosed with P. vivax was the lowest during the first 21 days. The global sensitivity of SD Malaria Ag P.f/Pan® test was, on average, 96% (88.2–100) for P. falciparum and 93% (90.6–94.2) for P. vivax. The global specificity was 99.8% (99.5–100) for all included species. Conclusion SD Malaria Ag P.f/Pan® is a reliable rapid test used for the first-line diagnosis in remote healthcare centres. The test results should be interpreted in the light of patient’s recent medical history and the date of arrival to FG.

We propose a method to detect early-warning information in relation with subtle changes occurring in the trend of evolution in data time series of the COVID-19 epidemic spread (e.g. daily new cases). The method is simple and easy to implement on laptop computers. It is designed to be able to provide reliable results even with very small amounts of data (i.e. ≈ 10 − 20). The results are given as compact graphics easy to interpret. The data are separated into two subsets: the old data used as control points to statistically define a "trend" and the recent data that are tested to evaluate their conformity with this trend. The trend is characterised by bootstrapping in order to obtain probability density functions of the expected misfit of each data point. The probability densities are used to compute distance matrices where data clusters and outliers are easily visually recognised. In addition to be able to detect very subtle changes in trend, the method is also able to detect outliers. A simulated case is analysed where R0 is slowly augmented (i.e. from 1.5 to 2.0 in 20 days) to pass from a stable damped control of the epidemic spread to an exponentially diverging situation. The method is able to give an early warning signal as soon as the very beginning of the R0 variation. Application to the data of Guadeloupe shows that a small destabilising event occurred in the data near April 30, 2020. This may be due to an increase of R0 ≈ 0.7 around April 13-15, 2020.

Using a stochastic epidemic model explicitly considering the entire population of Guadeloupe (1), we explore the domain of solutions presenting an efficient slowing down of the COVID-19 epidemic spread during the post-containment period. The considered model parameters are the basic reproduction number R0 to simulate the effects of social distancing, the time delay δTq elapsed between the detection of a symptomatic person and her/his placement in quarantine to suppress her/his contagiousness, and the number Na of asymptomatic people tested positively and isolated. We show that acceptable solutions are obtained for a wide range of parameter values. Thanks to a good control of the initial epidemic spread resulting from an early containment and efficient communication by the sanitary and administrative authorities, the present situation corresponds to a pre-epidemic state. The most safe solutions are a combinations of social distancing, numerous testing to perform a systematic isolation of symptomatic patients and guided detection of asymptomatic people in the entourage of localised symptomatic patients.

Predictions on the time-evolution of the number of severe and critical cases of COVID-19 patients in Guadeloupe are presented. A stochastic model is purposely developed to explicitly account for the entire population (≃400000 inhabitants) of Guadeloupe. The available data for Guadeloupe are analysed and combined with general characteristics of the COVID-19 to constrain the parameters of the model. The time-evolution of the number of cases follows the well-known exponential-like model observed at the very beginning of a pandemic outbreak. The exponential growth of the number of infected individuals is controlled by the so-called basic reproductive number,R0, defined as the likely number of additional cases generated by a single infectious case during its infectious periodTI. Because of the rather long duration of infectious period (≃14 days) a high rate of contamination is sustained during several weeks after the beginning of the containment period. This may constitute a source of discouragement for people restrained to respect strict containment rules. It is then unlikely that, during the containment period,R0falls to zero. Fortunately, our models shows that the containment effects are not much sensitive to the exact value ofR0provided we haveR0<0.6. For such conditions, we show that the number of severe and critical cases is highly tempered about 4 to 6 weeks after the beginning of the containment. Also, the maximum number of critical cases (i.e. the cases that may exceed the hospital’s intensive care capacity) remains near 30 whenR0<0.6. For a largerR0= 0.8 a slower decrease of the number of critical cases occurs, leading to a larger number of deceased patients. This last example illustrates the great importance to maintain an as low as possibleR0during and after the containment period. The rather long delay between the beginning of the containment and the appearance of the slowing-down of the rate of contamination puts a particular strength on the communication and sanitary education of people. To be mostly efficient, this communication must be done by a locally recognised medical staff. We believe that this point is a crucial matter of success. Appendix Posterior model assessment with data acquired after April 11, 2020 added in a second version of the paper compares the model predictions with the data acquired from April 12 to May 25 2020, after the construction of the model discussed in the present study. The remarkable agreement between the model predictions and the data may be explained by the good quality of first-hand data used to constrain the model, the ability of the stochastic approach to integrate new information and stability of the sanitary situation due to the respect of the recommendations emitted by medical and administrative authorities by the guadeloupean population.