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:In order to better establish a prevention strategy based on mupirocin, we evaluated nasal carriage of Staphylococcus aureus in haemodialysis patients over a 15 month period.METHODS:Search for Staphylococcus aureus in the nasal cavities was made every 2 months in 92 chronic dialysis patients. These patients were divided into 3 groups according to the nature of the carriage: non-permanent, intermittent or permanent.RESULTS:Among the 80 patients retained for analysis, there were 27.5% with intermittent carriage and 11.25% with permanent carriage. Factors which appeared to protect against carriage were rural residence and home self-dialysis.CONCLUSION:Repeated long-term search for nasal carriage of Staphylococcus aureus has provided reliable data for each patient and gave information on the effects of epidemiological conditions and health care structures.

Objectives: In order to better establish a prevention strategy based on mupirocin, we evaluated nasal carriage of Staphylococcus aureus in haemodialysis patients over a 15 month period. Methods: Search for Staphylococcus aureus in the nasal cavities was made every 2 months in 92 chronic dialysis patients, These patients were divided into 3 groups according to the nature of the carriage: non-permanent, intermittent or permanent. Results: Among the 80 patients retained for analysis, there were 27.5% with intermittent carriage and 11.25% with permanent carriage, Factors which appeared to protect against carriage were rural residence and home self-dialysis. Conclusion: Repeated long-term search for nasal carriage of Staphylococcus aureus has provided reliable data for each patient and gave information on the effects of epidemiological conditions and health care structures.

This observation reports a clinical failure of teicoplanin in a patient with a nosocomial respiratory tract infection caused by a methicillin-resistant Staphylococcus aureus. The infection occurred in a non-university hospital where teicoplanin is infrequently used. The strain exhibited intermediate susceptibility to teicoplanin with a MIC of 8 mg/l, but was susceptible to vancomycin, with a MIC of 2 mg/l. Recovery was achieved by switching from teicoplanin to vancomycin.

The authors report fungal contamination of the water delivery system in one of their dialysis centers. They emphasize the insufficiency of the legal recommendations for water analysis, as well as the economical and logistical consequences of this type of contamination. Finally, they suggest disinfection procedures allowing eradication of fungi.

The authors report fungal contamination of the water delivery system in one of their dialysis centers. They emphasize the insufficiency of the legal recommendations for water analysis, as well as the economical and logistical consequences of this type of contamination. Finally, they suggest disinfection procedures allowing eradication of fungi.

Since the more frequent use of highly permeable membranes and bicarbonate dialysate, hypersensitivity reactions are more often described during hemodialysis and raise the question of the entry of pyrogens from dialysate towards blood due to high permeability of membranes and to possible backfiltration. During dialysis sessions with such membranes, authors observed a severe collapse in a patient on bicarbonate fluid and a repeated Quincke's edema in another on acetate fluid. After exclusion of other causes of such hypersensitivity accidents, they discuss the role of bacterial contamination of dialysis fluid. They analyse the phenomenons of bidirectional high permeability and of backfiltration linked to these new membranes. They recall the different causes of dialysate contamination and give some means of avoiding these inconveniences which expose on one hand to acute severe reactions and on the other are prejudicial in the long term for the patients because of interleukin 1 production.

Les auteurs rapportent un cas de kyste dermoïde ovarien, siège d'un abcès à Salmonella typhi chez une femme de 48 ans. Elle arrivait du Cambodge après 4 ans de séjour dans un camp de réfugiés. Les causes de cette localisation inhabituelle de Salmonella typhi sont présentées et discutées.

Resume Les auteurs decrivent un cas inhabituel d'infection focale par Pasteurella multocida . Leur malade, diabetique et hemodialyse, a developpe, a la suite d'une morsure de son chat au dos de la main droite, un phlegmon allant jusqu'a un delabrement profond. La guerison a ete obtenue grâce a la chirurgie, l'antibiotherapie specifique par cyclines et les soins locaux.