A study of 257 French invasive pneumococci isolated between 2000 and 2002 showed high rates of nonsusceptibility to penicillin and macrolides (50%), contrasting with a low frequency of resistance to amoxicillin or levofloxacin (<1%) and tolerance to vancomycin (0%). The genetic homogeneity of some serogroups, including serogroup 1, enhanced the risk of epidemiological changes.

OBJECTIVE To assess trends in the susceptibility to beta-lactam agents and to fluoroquinolones of clinically relevant Enterobacteriaceae isolated over a 3-year period in 14 French hospital laboratories. METHODS During the second quarter of 1996, 1997 and 1998, 180 consecutive non-duplicate isolates of Enterobacteriaceae were collected in each center. Sixteen beta-lactams and four quinolones were tested by the disk diffusion method. In addition, the double-disk synergy test was used to screen for the production of extended-spectrum beta-lactamase (ESBL). RESULTS Totals of 2507, 2312 and 2506 clinical isolates were obtained in each period, respectively. The distribution of Enterobacteriaceae species according to clinical specimens and wards was similar in each study period. No significant variation in the susceptibility rates to beta-lactams and fluoroquinolones was observed, except in Klebsiella pneumoniae and Enterobacter aerogenes. The prevalence of ESBL-producing isolates decreased from 18% to 9% in the former, while it increased from 32% to 54% in the latter. At the same time, the susceptibility to ofloxacin and pefloxacin increased for K. pneumoniae (P < 0.003) and cephalosporinase-producing species (P < 0.05), except Enterobacter spp. CONCLUSION Over the 3-year study period beta-lactams and fluoroquinolones remained highly active against Enterobacteriaceae clinical isolates, with the exception of E. aerogenes, probably as a result of the dissemination of multiresistant clones in French hospitals.

Objectives - From July 1997 to June 1998, 15 microbiological laboratories, set up as a regional survey unit in Alsace, collected S. pneumoniae strains to assess their susceptibility to antibiotic agents.Method - The strains were isolated from various clinical samples (blood cultures, pulmonary samples, cerebrospinal fluid, otitis media).Results - 599 strains were collected and the prevalence of Pneumococci with a Decreased Susceptibility to Penicillin G (PDSP) reached 32.9% (197 strains, MIC > 0.06 mg/L) but included a very small percentage of high level resistance strains to penicillin G (10 strains with MIC > 1 mg/L). Amoxicillin and cefotaxime remained active (3 and 0 resistant strains, respectively). The percentage of DPSP was much higher in the isolates of children (45.3%) than in those of adults (28.2%). The PDSP were rather resistant to erythromycin (76.6%), cotrimoxazole (65.2%), and fosfomycin (18.4%). Among PDSP, the most prevalent serotypes were 23, 14, and 9.Conclusion - This epidemiological survey allowed to assess the local impact of pneumocaccal resistance to antibiotics thanks to extensive collection and study. (C) 2000 Editions scientifiques et medicales Elsevier SAS.

Neisseria meningitidis is a well-known pathogenic agent responsible for clinical infections of which the two most common are meningitis and acute meningococcemia. A case of acute meningococcemia due to N. meningitidis in a young male is reported. The chemoprophylaxis, microbiological diagnosis, and pathogenesis of this condition are discussed.

We analyzed the data collected during a nationwide survey of cryptococcosis (1985-1993). We first checked the quality of the survey. The stability of its completeness (approximately 50%) and its representativity were assessed by the capture-recapture method after we cross-checked our data on cryptococcosis (as a presenting manifestation of AIDS) against those of the national registry of AIDS. Of the 1,057 cases of cryptococcosis (1,013 patients), 827 (86%) involved patients with AIDS. The increasing number of cases of human immunodeficiency virus (HIV)-related cryptococcosis over time paralleled the AIDS epidemic except for a higher male-to-female ratio. Malignancies (32%), organ transplantation (19%), and corticosteroid therapy (33%) were the main predisposing conditions in 163 patients without AIDS. Cryptococcal meningitis more frequently occurred in patients with AIDS than in HIV-negative patients (P < 10(-6)). Among the 413 isolates available for serotyping, 410 were Cryptococcus neoformans variety neoformans (including 20.5% of serotype D). Three isolates of the variety gattii (serotype B) were recovered from patients without AIDS.

C. difficile est maintenant largement reconnu comme le principal agent de diarrhées nosocomiales ou associées à l'antibiotiques, en particulier chez les malades à risque qu'ils soint âgés ou que leurs défenses immunitaires soient amoindries.

Les auteurs rapportent une étude multicentrique dans 16 hôpitaux généraux sur la résistance à la Péfloxacine par la technique de l'antibiogramme classique (diffusion). Les souches intermédiaires et résistantes ont été regroupées. L'étude porte sur 3939 souches étudiées entre octobre 1985 et juin 1986. La résistance est la suivante : 5,4 % (0,8 à 20 %) chez les souches de S. aureus méti S ; 32 % (10 à 66 %) chez les souches de S. aureus méti R ; 14,3 % (0 à 28,5 %) chez les souches de Proteus indole positif ; 13,4 % (0 à 57 %) chez les souches d'Enterobacter ; 18 % (11 à 50%) chez les souches de Citrobacter ; 63,5 % (7,6 à 90 %) chez les souches de Serratia ; 65,8 % (30 à 75 %) chez les souches de Providencia ; 63,9 % (0 à 88,6 %) chez les souches d'Acinetobacter ; 58,9 % (25,6 à 91 %) chez les souches de P. aeruginosa.