We describe what we believe to be the first documented case of Mycobacterium goodii infection in Europe. It is also the second documented report of a pacemaker pocket surgical site infection caused by M. goodii. Although rarely involved in such infections, rapidly growing mycobacteria should be recognized during conventional bacteriological investigations and further identified by molecular tools to provide adequate therapy. In the present case, antimicrobial therapy with doxycycline without removal of the pacemaker was successful.

Documentation of Helicobacter pylori infection and eradication is important, prompting some clinicians and pathologists to request ancillary stains on all gastric samples that do not demonstrate H. pylori on initial histologic review. Studies evaluating the utility of ancillary stains in patients with minimal inflammation are lacking. We used Giemsa, Warthin-Starry, acridine orange, and immunohistochemical stains to search for organisms in 56 patients with biochemical evidence of H. pylori infection (positive Campylobacter-like organism test) and gastric mucosal samples interpreted to be H pylori negative by hematoxylin and eosin (H&E). We correlated the findings with severity of inflammation and patients' histories of medication use. Nineteen (34%) patients had histologically normal mucosae, 22 (39%) had chronic inflammation with or without focal activity, and 15 (27%) had chemical gastropathy. Fifty (89%) cases were negative for H. pylori with additional stains, and 6 contained bacteria that were detected with all 4 ancillary stains and on retrospective review of H&E-stained sections that also showed chronic inflammation. Eleven (20%) patients were taking proton pump inhibitors, and 4 (7%) had previously received H. pylori eradication therapy. We conclude that H&E stains demonstrate H. pylori in most infected patients, so preemptive stain requests are largely unnecessary. Failure to identify bacteria by H&E evaluation generally reflects their absence in biopsy material, even among Campylobacter-like organism test--positive patients. However, organisms may be overlooked in patients with mild inflammation and in those receiving proton pump inhibitor or antibiotic therapy, so one should consider ordering ancillary stains to enhance detection of bacteria in these settings.

Among the six species characterized within the genus Ochrobactrum, Ochrobactrum anthropi and Ochrobactrum intermedium are currently reported as opportunistic pathogens in humans. Since the species identification is mainly based on 16S rDNA analysis, the aim of this study was to search for other characteristics useful for Ochrobactrum species discrimination. Ribotyping, morphological and biochemical analyses, and antimicrobial susceptibility testing were performed for a panel of 35 clinical isolates, first identified to the species level using 16S rDNA sequencing. Type and reference strains of five Ochrobactrum species were comparatively analysed. Commercial identification systems such as API 20NE and VITEK 2 were tested for their ability to identify Ochrobactrum anthropi and to detect other members of the genus Ochrobactrum. An improved protocol for the identification of Ochrobactrum spp. by routine medical microbiology practices is proposed: isolation of a non-fastidious non-fermenting oxidase-positive Gram-negative rod resistant to all beta-lactams except imipenem indicates the genus Ochrobactrum, and the API 20NE system confirms the genus identification for most strains, whereas the VITEK 2 system using ID-GNB cards was less powerful. Urease activity, the mucoidy of the colonies, growth at 45 degrees C on tryptic soy agar, and susceptibility to colistin, tobramycin and netilmicin should be considered as differential characteristics for identification of O. anthropi and O. intermedium to the species level. However, definitive identification depends on genotyping methods.

Évaluer l’intérêt du scanner dans l’exploration des infections de prothèses totales de hanches.Un scanner a été réalisé sur dix sept hanches de quatorze patients présentant une suspicion d’infection de prothèse totale de hanche. Nous recherchons dans les parties molles péri-prothètiques la présence d’abcès, d’épanchements articulaires et de fistules cutanées et au niveau de l’interface os-matériel prothétique, la présence de liserés radio-clairs ou d’érosions osseuses. Nous étudions la faisabilité du scanner malgré les artefacts métalliques générés par les prothèses.Dix hanches sont septiques. Nous retrouvons un abcès dans les parties molles chez huit patients sur dix, associé dans sept cas à un épanchement articulaire suspect de surinfection. Un trajet fistuleux inflammatoire est retrouvé dans huit cas. L’analyse de l’interface osseuse révèle la présence de liserés chez dix patients, dont sept sont septiques et d’érosions chez quatre patients dont deux sont septiques. Les artefacts métalliques ne sont pas un obstacle dans la visualisation des abcès des parties molles.Le scanner permet le diagnostic d’abcès des parties molles au cours des infections de prothèses de hanches. Cet examen permet d’orienter l’intervention chirurgicale ou une surveillance si un traitement médical seul est envisagé.To evaluate the ability of CT imaging to detect infectious lesions in total hip prosthesis.CT was performed in 17 cases of suspected total hip prosthesis infection. Images were reviewed to evaluate for the presence of soft tissue abscess, hip joint effusion or fistula and peri-prosthetic lucency or erosion at bone window setting. The feasibility of CT imaging is assessed with regards to metallic artifacts.Infection was confirmed in 10 hips. A soft tissue abscess was present in 8 of these cases, in association to a joint effusion, presumably septic, in 7 cases. A fistula was identified in 8 cases. A peri-prosthetic lucency was present in 10 cases, 7 of which with infection, and erosions were noted in 4 patients, 2 of which with infection. Metallic artifacts reduced image quality but did not prevent detection of soft tissue abscesses.CT is useful for detection of soft tissue abscesses in patients with infected hip prosthesis. CT is useful for surgical planning or follow-up of patients treated conservatively.

The TEM-24 extended-spectrum -lactamase (ESBL), initially characterized in Klebsiella pneumoniae (3), is currently the predominant ESBL in France (4). This could be related to the spread of a TEM-24-producing Enterobacter aerogenes clone present in most French hospitals (1) but also found in Belgium (5) and Spain (2). TEM-24 enzyme has been recovered from an increasing number of species of the family Enterobacteriaceae (6, 8) and in Pseudomonas aeruginosa (7). In contrast, resistance to expanded-spectrum cephalosporins mediated by ESBLs has never been described in the genus Aeromonas, for which -lactam resistance involves three chromosomally mediated enzymes: a cephalosporinase, a penicillinase, and a carbapenemase (9). We report the first characterization of a TEM-24-producing clinical Aeromonas strain. 16S ribosomal DNA (rDNA) and gyrB sequencing (10) showed that the strain was most closely related to Aeromonas caviae. This strain was recovered together with an ESBL-producing E. aerogenes isolate from the diarrheal feces of a 76-year-old man admitted to Montpellier Hospital for intestinal ischemia. Based on the resistance phenotype observed after the disk diffusion assay, both E. aerogenes and Aeromonas sp. isolates were suspected to produce ceftazidimase-type ESBL and AAC(6 )-I enzyme. Synergy was clearly observed between expanded-spectrum cephalosporins and clavulanate. The resistance phenotype was transferred in Escherichia coli C600 by mating experiments using MuellerHinton agar (Sanofi Diagnostics Pasteur, Marnes-la-Coquette, France) containing ceftazidime (4 g/ml). The MICs of -lactams showed high levels of resistance with the E. aerogenes strain and the two transconjugants for penicillins (64 to 2,048 g/ml), ceftazidime (512 to 1,048 g/ml), and aztreonam (64 to 1,048 g/ml). A low level of resistance or decrease in susceptibility was observed for cefotaxime (4 to 8 g/ml). The Aeromonas sp. strain showed lower resistance levels (penicillins, 8 to 256 g/ml; ceftazidime, 64 g/ml; and aztreonam, 8 g/ml). Clavulanate and tazobactam partially or completely restored the susceptibility to penicillins. ESBL characterization was performed for the two isolates by isoelectric focusing, ESBLencoding gene amplification and sequencing, and plasmid content analysis (6, 7). The ESBLs were focused at a pI of 6.5. The sequence of ESBL-encoding genes shared 100% identity with the blaTEM-24 gene. Plasmids of approximately 180 kb, which displayed similar restriction patterns, were isolated from the two strains and their transconjugants. These results suggested an in vivo transfer of TEM-24-encoding plasmid from E. aerogenes to Aeromonas sp. in the intestinal tract. We have previously reported the transfer of 180-kb TEM24-encoding plasmid from E. aerogenes to Providencia rettgeri CIP 107053 (6) and P. aeruginosa CIP 107051 (7). A comparative study of the restriction profiles obtained for the plasmids recovered from these organisms and from the strains analyzed here revealed similar restriction patterns (Fig. 1). Pulsed-field gel electrophoresis (PFGE) analysis of the E. aerogenes strains isolated in this study and previously (6, 7) revealed that they belong to the TEM-24-producing E. aerogenes clone prevalent in France. This clone had disseminated the same TEM-24-encoding plasmid among various bacterial species for several years. The isolation of a TEM-24-producing Aeromonas sp. strain extends the list of TEM-24-harboring bacteria, and this wide host range is one of the factors responsible for the persistence and spread of the TEM-24-encoding plasmid.

Described here is the first report of a monomicrobial joint infection caused by Veillonella dispar that resulted in loosening of a prosthesis. This clinical case shows that Veillonella spp. should not be disregarded as contaminant organisms, particularly when they are isolated in pure culture from clinical specimens involving cases of septic arthritis.

Two prevalent mechanisms of macrolide resistance are currently described in pneumococci: production of rRNA methylase that modify 23S ribosomal RNA resulting in MLSB phenotype, and an active efflux system resulting in M-phenotype. These two mechanisms are mediated by erm(B) and mef(A) genes respectively. Several studies reported a predominance of mef(A) gene in United-States and Canada. In European countries, erm(B) determinant is prevalent and mef(A)-mediated erythromycin resistance was recently reported in about 10% of strains in Belgium and Italy. In order to evaluate implication of mef(A) gene in pneumococci erythromycin resistance, 160 clinical isolates of S. pneumoniae with low-level of penicillin resistance and resistance to macrolides recovered between April 1999 and April 2000 were collected. These isolates were tested for their macrolide susceptibility by disc diffusion method, 155 showed the MLSB phenotype and 5 the M phenotype. Genotypic analysis was performed by erm(B) and mef(A) specific-mediated PCR: erm(B) gene was detected in 154 isolates, mef(A) gene in 5 isolates, and both genes in one strain. The phenotype seems to be well correlated to the genotyping result except for strain harboring both resistance determinants. Molecular typing of isolates harboring mef(A) gene performed by pulsed-field gel electrophoresis (PFGE) after restriction by Smal shows these strains to be epidemiologically unrelated. Our results show the predominance of the erm(B) gene in erythromycin resistant S. pneumoniae isolates. mef(A)-mediated resistance is effective in Southern France (3.7%) but this rate is the lowest published from European countries.

Several Pseudomonas aeruginosa strains, including one urinary isolate producing an extended-spectrum beta-lactamase TEM-24, were isolated from a long-term-hospitalized woman. Three TEM-24-producing enterobacterial species (Enterobacter aerogenes, Escherichia coli, and Proteus mirabilis) were isolated from the same patient. TEM-24 and the resistance markers for aminoglycosides, chloramphenicol, and sulfonamide were encoded by a 180-kb plasmid transferred by conjugation into E. coli HB101.

ABSTRACT Four species of members of the family Enterobacteriaceae harboring extended-spectrum β-lactamase (ESBL) were recovered in a single patient hospitalized in an intensive care unit. Among these isolates, we describe for the first time an ESBL-producing Providencia rettgeri strain. Bacteria from the same species were shown to be genetically related by pulsed-field gel electrophoresis analysis. These strains produced the same TEM derivative ESBL, characterized as TEM-24. This enzyme had the peculiarity of being encoded by a large conjugative plasmid of 180 kb, never previously described for such an ESBL.

ABSTRACT Serratia ficaria , an enterobacterium involved in the fig tree ecosystem, has been isolated from human clinical samples in rare instances, and its role as a pathogen is unclear. In 7 years, we have isolated S. ficaria from seven patients; it was the only pathogen in 4 patients, including a patient with septicemia described previously and three patients with gallbladder empyemas described in the present report. From March 1995 to July 1997, the incidence of biliary infections due to S. ficaria was 0.7%. We discuss the digestive carriage of this bacterium and its epidemiology with respect to the fig tree life cycle. Since fig trees grow around the Mediterranean as well as in the United States (California, Louisiana, Hawaii), S. ficaria should be more frequently isolated. In our experience, various strains have been misidentified or unidentified by commercial systems. Incorrect identification could be an additional explanation for the paucity of reported cases. S. ficaria produces nonpigmented, lactose-negative colonies which give off a potatolike odor. This odor is the primary feature of S. ficaria and must prompt reexamination of the identifications proposed by commercial systems. We tested 42 novel strains using three commercial systems: Vitek gram-negative identification (GNI) cards and API 20E and ID 32E strips (bioMérieux, Marcy-l’Etoile, France). The percentages of positivity that we have obtained were lower than those published previously for the following characteristics: lipase, gelatinase, DNase, and rhamnose. The best system for the recognition of S. ficaria is ID 32E, which correctly identified 27 of 42 strains. The API 20E system gave correct identifications for only two strains. S. ficaria was not present in the Vitek GNI card system database.

1. Wendel GD, Stark BJ, Jamison RB, Molina RD, Sullivan TJ. Penicillin allergy and desensitization in serious infections during pregnancy. N Engl J Med 1985;312:1229-32. 2. Finegold SM. Overview of clinically important anaerobes. Clin Infect Dis 1995;20(SuppI2):S205-7. 3. Loewe L, Rosenblatt P, Alture-Werber E. A refractory case of subacute bacterial endocarditis due to Veillonella gazogenes clinically arrested by a combination of penicillin; sodium para-aminohippurate, and heparin. Am Heart J 1946;32:327-38.

All enteroccoci isolated during September 1993 were collected in a Montpellier hospital. 225 strains remained after elimination of identical one. The species were identified by means of rapid ID 32 Strep. Enterococcus faecalis (83.5 % of isolates) predominates in genito-urinary tract and E. faecium (9 % of isolates) in digestive isolates. Based on bacteriological and cytological criteria, we considered 20 % of enterococci (all samples) as pathogenic as well as 95 % of digestive isolates and 8.4 % of urinary strains. Disks diffusion test was used for sensitivity to amoxicillin, piperacillin, gentamicin, kanamycin, vancomycin and teicoplanin. Minimal inhibitory concentrations of two glycopeptides was determined by E-Test. All E. faecalis were sensitive to beta-lactams. 55 % of E. faecium and 3 out of 3 strains of E. gallinarum had reduced sensitivity. High level resistance to aminoglycosides concerned 42.2 % of strains for kanamycin and 11.5 % of strains for gentamicin. High level resistance glycopeptides was not found.

OBJECTIVES:Bacteriological data indicate that there is an increased incidence of Streptococcus pneumoniae strains with an intermediate sensitivity to penicillin. The goals of the present study was i) to investigate the profile of sensitivity of Streptococcus pneumoniae isolated from patients with bacterial pneumonia in the area of Montpellier and ii) to compare this profile with the findings of the national center registry to better appreciate geographical specificity.METHODS:Fifty-six patients with bacterial pneumonia were enrolled into the study. From September 1989 to March 1994, we performed bacterial sampling including blood cultures, protected brushes and bronchoalveolar lavage specimens. We examined the antibiotic sensitivity of the germs which were isolated. All patients were followed using clinical and radiological criteria.RESULTS:A precise bacteriological diagnosis was established in 83.6% of the population. Streptococcus pneumoniae was found in 47.2% of the samples. In 19%, the strains displayed an intermediate sensitivity to penicillin. All patients recovered.CONCLUSION:We found a higher rate of resistance to penicillin in Montpellier than the common rate of the national reference center in France. The location of Montpellier closed to the Spanish border might, at least in part, explain this difference.

Objectives: Bacteriological data indicate that there is an increased incidence of Streptococcus pneumoniae strains with an intermediate sensitivity to penicillin, The goals of the present study was i) to investigate the profile of sensitivity of Streptococcus pneumoniae isolated from patients with bacterial pneumonia in the area of Montpellier and ii) to compare this profile with the findings of the national center registry to better appreciate geographical specificity. Methods: Fifty-six patients with bacterial pneumonia were enrolled into the study, From September 1989 to March 1991, we performed bacterial sampling including blood cultures, protected brushes and bronchoalveolar lavage specimens, We examined the antibiotic sensitivity of the germs which were isolated, All patients were followed using clinical and radiological criteria. Results: A precise bacteriological diagnosis was established in 83.6% of the population, Streptococcus pneumoniae was found in 47.2% of the samples, In 19%, the strains displayed an intermediate sensitivity to penicillin, All patients recovered. Conclusion: We found a higher rate of resistance to penicillin in Montpellier than the common rate of the national reference center in France, The location of Montpellier closed to the Spanish border might, at least in part, explain this difference.

Serratia ficaria was first described in 1979 as part of the fig tree ecosystem (P.A.D. Grimont, F. Grimont, and M. P. Starr, Curr. Microbiol. 2:277-282, 1979). Since then, it has been isolated from clinical specimens from a few human patients (C. Bollet, J. Freney, P. de Micco, F. Grimont, and P.A.D. Grimont, Méd. Mal. Infect. 20:97-100, 1990; J.A. Brouillard, W. Hansen, and A. Compere, J. Clin. Microbiol. 19:902-904, 1984; H. Darbas, H. Jean-Pierre, G. Boyer, and M. Riviere, Méd. Mal. Infect. 23:269-270, 1993; V.J. Gill, J.J. Farmer, III, P.A.D. Grimont, M.A. Asbury, and C.L. McIntosh, J. Clin. Microbiol. 14:234-236, 1981; F.D. Pien and J.J. Farmer III, South. Med. J. 76:1591-1592, 1983; C. Richard, J. de Coquet, and C. Suc, Méd. Mal. Infect. 19:45-47, 1989), but the pathogenicity of S. ficaria was always questionable. We are reporting the case of an aged cancer patient who developed S. ficaria septicemia. The habitat of this organism and its potential role as a pathogen are discussed.

To assess the usefulness of BAL in diagnosing bacterial pneumonia in mechanically ventilated patients, 80 BAL fluid samples obtained from 72 patients with lung infiltrates were studied using the following parameters: infected cell count (polymorphonuclear leukocytes or macrophages with intracellular organisms), microscopic examination of stained smears, and quantitative culture with the determination of the simplified bacterial index (SBI) and the predominant species index (PSI). Of the 80 BAL samples studied, 56 were performed under antibiotic therapy. Bacterial pneumonia was the final diagnosis in 28 cases. The SBI is the sum of the whole numbers of each bacterial concentration expressed as a common logarithm. The PSI is the whole number of the predominant microorganism's concentration expressed as a common logarithm. The discriminative value of each test was assessed using a receiver operating characteristic (ROC) curve, whereby the possibility of establishing a cutoff value used to discriminate between the presence or absence of pneumonia is evaluated. The percentage of infected cells was higher in the pneumonia group (8.8 +/- 18.1 versus 0.4 +/- 1.1%, p < 10(-3), but no cutoff value could be proposed. Under microscopic examination, the presence of bacteria was noted with a significantly greater frequency in the pneumonia group (sensitivity 67.8% and specificity 82.7%). A total of 58 BAL samples were positive when cultured. The SBI was significantly higher in the pneumonia group (6.5 +/- 2.9 versus 1.6 +/- 1.7, p < 10(-4).(ABSTRACT TRUNCATED AT 250 WORDS)

Serratia ficaria, which was described in 1979 by Grimont et al, is closely involved in the ecosystem of figs. Some isolations from human clinical specimens have been reported but the pathogenicity of the bacterium has always been open to question. We report the isolation of S. ficaria from gallbladder empyema fluid and discuss its pathogenicity and susceptibility to antibiotics.

The activity of vancomycin (Va) and teicoplanin (Tc) against 114 coagulase-negative staphylococci (CNS) strains was evaluated by disk-diffusion and agar dilution minimal inhibitory concentration (MIC) determination. Results were analysed by species and methicillin-resistance (MR) status. MICs for Va were in the susceptible range (< 4 mg/l) for all strains, with inhibition zone diameters of 17 mm or more in every case. MICs for teicoplanin were 8 or 16 mg/l for 19 CNS strains (including 18 with MR) of which 14 yielded an inhibition zone diameter of 17 mm or more (false susceptibility). Parameters which should lead to MIC determination for Tc regardless of disk diffusion findings include the species (S. haemolyticus), methicillin resistance, Tc zone diameter, and an at least 3 mm difference between the Va and Tc zone diameters.