The usefulness of two quantitative real-time PCR assays (qrt-PCRmip targeting Legionella pneumophila, and qrt-PCR16S targeting all Legionella species) performed on lower respiratory tract (LRT) samples for diagnostic and prognostic purposes in 311 patients hospitalized for community-acquired pneumonia (CAP) in Rhône-Alpes (France) was evaluated. The Now Legionella urinary antigen test (UAT) from Binax (Portland, ME, USA) was used as a reference test. Samples were divided into two groups. Group A included 255 CAP patients admitted to Chambery hospital in 2005 and 2006. The Now Legionella UAT was positive in 14 patients. Sensitivities, specificities, positive predictive and negative predictive values for both qrt-PCR tests were 63.6, 98.7, 77.7 and 97.4%, respectively. Group B included 56 consecutive legionellosis patients diagnosed during a 4-year period (2003-2006) at the Grenoble University Hospital. The qrt-PCR16S and qrt-PCRmip displayed a sensitivity of 82.14 and 80.4%, respectively. Among the 70 legionellosis cases, L. pneumophila serogroup 1 was isolated in 15; qrt-PCRmip was positive in another 36, suggesting L. pneumophila infection, whereas the Legionella species involved could not be determined in the remaining 19 cases. The Legionella burden in LRT samples at the time of admission was determined in 46 patients using qrt-PCR16S tests, 44 for qrt-PCR mip groups A and B patients. It varied from 1.9 to 8.35 log(10) DNA copies/mL of LRT sample for qrt-PCR16S and from 1.9 to 8.11 log(10) DNA copies/mL of sample for qrt-PCRmip. High bacterial loads in LRT samples at hospital admission were significantly associated with higher Fine classes, the need for hospitalization in an intensive care unit and for prolonged hospitalization.

Introduction In the context of reducing endoscopy-related infectious risk and new national guidelines on microbiological samples from bronchoscopy, the results of a surveillance program set up in a hospital center were analyzed. Methods Over 4 years, scheduled samples were taken from disinfected bronchoscopes. Bacteriology and mycology tests were used to search for microorganisms. The results were interpreted as falling within three levels: target, alert, and action. Factors that could explain the contamination were studied: age of the bronchoscope, number of uses per year, brand, and model. Results Out of 96 scheduled samples taken, the compliance rate for the period was 83% and increased (p=0.06) over the 4 years. We identified 15 Pseudomonas (six aeruginosa and nine other species), one Stenotrophomonas, one enterobacterium, and two filamentous fungi. None of the factors studied had a significant effect on sample contamination. Conclusion The microbiological surveillance of bronchoscopes is an indispensable part of the quality assurance of bronchoscope maintenance. It can lead to maintenance of the bronchoscope when a noncompliant result is found.

In the context of reducing endoscopy-related infectious risk and new national guidelines on microbiological samples from bronchoscopy, the results of a surveillance program set up in a hospital center were analyzed.Over 4 years, scheduled samples were taken from disinfected bronchoscopes. Bacteriology and mycology tests were used to search for microorganisms. The results were interpreted as falling within three levels: target, alert, and action. Factors that could explain the contamination were studied: age of the bronchoscope, number of uses per year, brand, and model.Out of 96 scheduled samples taken, the compliance rate for the period was 83% and increased (p=0.06) over the 4 years. We identified 15 Pseudomonas (six aeruginosa and nine other species), one Stenotrophomonas, one enterobacterium, and two filamentous fungi. None of the factors studied had a significant effect on sample contamination.The microbiological surveillance of bronchoscopes is an indispensable part of the quality assurance of bronchoscope maintenance. It can lead to maintenance of the bronchoscope when a noncompliant result is found.

Les bactéries du genre Neisseria sont des cocci Gram négatif aérobies. Elles entraînent principalement des infections méningées et génito-urinaires, mais également des endophtalmies. Ce cas clinique décrit le premier cas, à notre connaissance, d'endophtalmie aiguë à Neisseria cinerea post-chirurgie de la cataracte. Le patient, âgé de 72 ans et sans antécédent particulier (notamment non immunodéprimé), a présenté une endophtalmie aiguë (baisse d'acuité visuelle, douleur et rougeur) 4 jours après une chirurgie de cataracte de l'œil gauche non compliquée. Il a consulté et a été pris en charge 2 jours plus tard. Une analyse microbiologique a été réalisée par cultures (hémocultures pédiatriques) et PCR (extraction de l'ADN, amplification de l'ADN 16S puis séquençage). Le tableau clinique initial, d'emblée très sévère, comportait une acuité visuelle réduite aux perceptions lumineuses, un hypopion à 1,8 mm, une membrane cyclitique et une perte de la lueur pupillaire. Le patient a été traité par injections intravitréennes de ceftazidime et vancomycine, associées à une antibiothérapie générale par lévofloxacine et pipéracilline. Une vitrectomie a été réalisée 3 jours après l'admission en l'absence d'amélioration. L'analyse microbiologique a permis d'identifier, sur les cultures et la PCR, une souche de Neisseria cinerea sensible aux antibiotiques utilisés (résistance naturelle à la vancomycine). L'évolution a été péjorative (phtyse). Neisseria cinerea étant une bactérie commensale de la sphère oropharyngée chez l'homme, la contamination a pu être per ou post-opératoire. L'évolution péjorative malgré une sensibilité aux aminosides, aux fluoroquinolones et aux beta-lactamines pourrait être liée au délai de prise en charge. Il s'agit du premier cas rapporté d'endophtalmie aiguë post-chirurgie de la cataracte liée à un Neisseria cinerea.

Objective. - Analyze the microbiological quality of reconstituted milk formulas and the surface hygiene in a hospital infant formula room, in the context of a worldwide emergence of Enterobacter sakazakii infections.Material and methods. - Over 3.5 years, monthly samples of reconstituted milk formulas as well as quarterly infant formula room surface samples were taken for bacteriological analysis.Results. - Of the 156 formulas analyzed, 54 carried microorganisms but no pathogenic bacteria. The presence of Bacillus species was found in 54% of the formulas for premature infants and in 19% of the other formulas (significant difference). Bacteria, probably brought by operators during reconstitution of the powdered formulas, were found in four of 156 samples (two negative-coagulase staphylococcus, one alpha-hemolytic streptococcus, and one Clostridium bifermentans). Surfaces were studied using 117 samples divided into 11 series: 4.3% of the points carried pathogenic bacteria (Enterobacter cloacae, Pseudomonas fluorescens, Bulhkholderia cepacia, Staphylococcus aureus).Discussion. - The presence of Bacillus species should be analyzed thoroughly so as to differentiate Bacillus cereus from other nonpathogenic species. The microbiological analysis techniques used for reconstituted infant formulas can be simplified.Conclusion. - The quality of the infant formulas seems satisfactory. Hygiene practices provide good microbiological quality in reconstituted infant milk formulas. Microbiological monitoring of these preparations and the infant formula room surfaces is an important aspect of the quality assurance policy, which makes it possible to take corrective measures when an unsatisfactory result is found. (C) 2007 Elsevier Masson SAS. Tons droits reserves.

The microbiological study identifies the bacterial spectrum after surgery, in acute, delayed-onset, or chronic endophthalmitis. DNA amplification of eubacterium-specific sequences in DNA extracted from ocular samples is a new tool for the etiological diagnosis of endophthalmitis. The most successful way to identify bacteria in endophthalmitis is the association of conventional cultures and panbacterial PCR on vitreous samples. Both techniques are complementary. The efficacy of these new molecular techniques should modify our future therapeutic strategies.

The microbiological study identifies the bacterial spectrum after surgery, in acute, delayed-onset, or chronic endophthalmitis. DNA amplification of eubacterium-specific sequences in DNA extracted from ocular samples is a new tool for the etiological diagnosis of endophthalmitis. The most successful way to identify bacteria in endophthalmitis is the association of conventional cultures and panbacterial PCR on vitreous samples. Both techniques are complementary. The efficacy of these new molecular techniques should modify our future therapeutic strategies.

UNLABELLED:Several studies have reported an increasing incidence of childhood parapneumonic empyemas in various countries.AIM OF THE STUDY:The aim of our study was to estimate the annual incidence of complicated community-acquired pneumonias in children during a 9-year period in a French area and to describe the epidemiological and clinical characteristics of these complications.POPULATION AND METHODS:We have listed the children from 28 days to 15 years old, hospitalized in the 2 children hospitals of the Isere district for a community-acquired pneumonia complicated with a pleural empyema or a pulmonary abscess from 1995 to 2003.RESULTS:During the study period, 90 children were hospitalized for a complicated pneumonia including 83 pleural empyemas and 7 isolated lung abscess. The average number of cases was 4 per year from 1995 to 1998 then increased since 1999 to reach 34 cases in 2003, according to a linear model (P<0,001). The incidence of the complicated pneumonia, plotted to the paediatric population of the area has gone up from 0.5 per 100000 to 13 per 100000 children between 1995 and 2003.CONCLUSION:The incidence of the complicated pneumonias in children increased since 1999 in a French area. Additional investigations are necessary to identify the causes of this increase.

Certaines specificites de la bacteriologie medicale font que celle-ci ne beneficie pas encore du meme degre d'automatisation que d'autres disciplines de la biologie medicale. Toutefois, apres l'apparition des « automates » d'hemocultures puis des « automates » d'identification et d'antibiogramme, deux autres secteurs de la bacteriologie medicale ont vu certaines etapes de leur analyse s'automatiser: la cytologie urinaire et la detection des mycobacteries. Si cette automatisation semble inexorablement s'installer, elle ne doit pas faire oublier l'importance de certaines phases conventionnelles de la bacteriologie (microscopie et mise en culture) et l'interet de la biologie moleculaire dans trois domaines: le diagnostic rapide, l'identification de bacteries a croissance lente et l'epidemiologie. Nous presentons dans cet article l'interet et les limites de l'automatisation en bacteriologie en fondant notre propos sur l'experience acquise au sein du laboratoire de bacteriologie du CHU de Grenoble.

This study reports an investigation of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization involving 17 newborns in the neonatal unit of a teaching hospital. A neonatal specialist colonized with MRSA that eventually became mupirocin-resistant was implicated as a recurrent source of transmission of MRSA to newborns.

Pneumococcal cellulitis is an uncommon infection. Head, neck, and trunk are usually affected in patients with hematological malignancies and lupus erythematosus. Limb cellulitis is frequently observed in patients with diabetes mellitus, drug abusers, or alcoholics. Patients present with septic shock most of the time. Surgical treatment is necessary in 50% of the cases. The outcome is usually favorable. We describe the case of a 72-year-old alcoholic patient with diabetes mellitus presenting with cellulitis and septic shock. Serotype 19 Streptococcus pneumoniae with abnormal susceptibility to penicillin (MIC: 0.75 mg/l) was isolated from cellulitis and in blood culture. The evolution was favorable after itavenous antibiotherapy combining ceftriaxone(DCI) (2 g/j), metronidazole(DCI) (1 g/j), and ciprofloxacin(DCI). (C) 2007 Elsevier Masson SAS. Tous droits reserves.

Pneumococcal cellulitis is an uncommon infection. Head, neck, and trunk are usually affected in patients with hematological malignancies and lupus erythematosus. Limb cellulitis is frequently observed in patients with diabetes mellitus, drug abusers, or alcoholics. Patients present with septic shock most of the time. Surgical treatment is necessary in 50% of the cases. The outcome is usually favorable. We describe the case of a 72-year-old alcoholic patient with diabetes mellitus presenting with cellulitis and septic shock. Serotype 19 Streptococcus pneumoniae with abnormal susceptibility to penicillin (MIC: 0.75 mg/l) was isolated from cellulitis and in blood culture. The evolution was favorable after itavenous antibiotherapy combining ceftriaxone(DCI) (2 g/j), metronidazole(DCI) (1 g/j), and ciprofloxacin(DCI).

ABSTRACT Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis is infrequently reported in clinical studies. Five cases of acute postcataract surgery endophthalmitis caused by S. lugdunensis were taken from a multicenter prospective study conducted in four university-affiliated hospitals in France (2004 to 2005). These cases were characterized by severe ocular inflammation occurring with a mean delay of 7.6 days after cataract surgery, severe visual loss (hand motions or less in three cases), and dense infiltration of the vitreous. Each of these patients was initially treated by using a standard protocol with intravitreal (vancomycin and ceftazidime), systemic, and topical antibiotics. Given the severity of the endophthalmitis, even though bacteria were sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in four cases. The final visual prognosis was complicated by severe retinal detachment in three cases. The microbiological diagnosis was reached by using conventional cultures with specific biochemical tests and eubacterial PCR amplification followed by direct sequencing.

We report a case of severe pneumonia due to Chryseobacterium indologenes in an immunocompetent patient. Chryseobacterium indologenes (formerly Flavobacterium indologenes) are saprophytic Gram-negative rods widely distributed in damp environment. Many sites of infection were described in the literature. These infections are always severe sometimes associated to multiple organ failure. The evolution is usually favorable with antibiotic treatment. Bacteria characteristically grow as yellow-pigmented colonies. They are naturally resistant to many antimicrobial agents. They are usually susceptible to piperacillin(DCI) alone or combined with tazobactam(DCI), ceftazidime, cefepime(DCI), fluoroquinolones(DCI), rifampin(DCI) and cotrimoxazole(DCI), but the in vitro susceptibility to these antibiotics should be systematically tested. Nevertheless, the optimum antibiotic treatment for Chryseobacterium-related infections remains to be established. In the case we report, the diagnosis was made according to the results of bronchial sample bacterial culture. This case report underlines the need for specific management of patients infected with this species. (c) 2007 Elsevier Masson SAS. Tous droits reserves.

Certaines specificites de la bacteriologie medicale font que celle-ci ne beneficie pas encore du meme degre d'automatisation que d'autres disciplines de la biologie medicale. Toutefois, apres l'apparition des « automates » d'hemocultures puis des « automates » d'identification et d'antibiogramme, deux autres secteurs de la bacteriologie medicale ont vu certaines etapes de leur analyse s'automatiser: la cytologie urinaire et la detection des mycobacteries. Si cette automatisation semble inexorablement s'installer, elle ne doit pas faire oublier l'importance de certaines phases conventionnelles de la bacteriologie (microscopie et mise en culture) et l'interet de la biologie moleculaire dans trois domaines: le diagnostic rapide, l'identification de bacteries a croissance lente et l'epidemiologie. Nous presentons dans cet article l'interet et les limites de l'automatisation en bacteriologie en fondant notre propos sur l'experience acquise au sein du laboratoire de bacteriologie du CHU de Grenoble.

Purpose: To present 2 cases of PCR identification of Rhizobium radiobacter in post-operative endophthalmitis. Methods: Microbiological identification was carried out using samples from aqueous humor and/or vitreous. Conventional cultures were performed using a Brain Heart Infusion broth. We used broad-range eubacterial PCR amplification followed by direct sequencing. Results: In both cases, Rhizobium radiobacter was identified using eubacterial PCR and cultures of vitreous from vitreous tap. An 81-year-old female presented an endophthalmitis 4 weeks after an cataract surgery. Inflammation and infection were controlled after 2 intravitreal antibiotic injections and the final visual acuity was of 20/24 at the one-year follow-up exam. A 75-year-old male who underwent a cataract surgery presented an endophthalmitis 9 days after. This patient was treated by 3 intravitreal antibiotic injections and a vitrectomy. The 6-month follow-up exam showed an optic nerve atrophy with a poor visual outcome (20/120). Both patients had an initial marked anterior chamber inflammation with a hypopyon and a severe retinal vasculitis was observed in the second case. Conclusions: Rhizobium radiobacter is a rare pathogen involved in postoperative endophthalmitis. As it is an environmental soil organism, we may assume that the patient's exposure to outdoor environnement and moist soil remains the source of this organism. This gram negative rod is resistant to vancomycin and have an intermediate resistance to most antibiotics used to treat post-operative endophthalmitis. PCR allows a swifter bacterial identification than do cultures and may help choose the most efficient antibiotics.

Nous rapportons un cas de pneumopathie sévère à Chryseobacterium indologenes (anciennement Flavobacterium indologenes) chez une patiente immunocompétente. Chryseobacterium indologenes est un bacille à Gram négatif saprophyte fréquemment retrouvé dans les milieux humides. Diverses infections humaines ont été rapportées dans la littérature. Ces infections sont potentiellement graves, pouvant se compliquer d'une défaillance multiviscérale. L'évolution est habituellement favorable sous antibiothérapie adaptée. Cette bactérie est naturellement résistante à de nombreux antibiotiques. Elle est le plus souvent sensible à la pipéracillineDCI seule ou associée au tazobactamDCI, à la ceftazidimeDCI, au céfépimeDCI, aux fluoroquinolonesDCI, à la rifampicineDCI et au cotrimoxazoleDCI, la sensibilité de ces antibiotiques doit être systématiquement testée in vitro. Le traitement antibiotique optimum des infections liées à cette espèce reste à définir. La bactérie a été isolée sur des prélèvements bronchopulmonaires. Ce cas clinique souligne la spécificité de la prise en charge thérapeutique des patients infectés par cette espèce bactérienne.

We investigated the cross-sectional associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat content with pain conditions in prepubertal children. The participants were a population sample of 439 children aged 6 to 8 years. Sedentary behavior, physical activity, and pain conditions were assessed using questionnaires, cardiorespiratory fitness using maximal cycle ergometer test, and body fat percentage using dual-energy X-ray absorptiometry. The associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat percentage with the risk of pain conditions were analyzed using multivariate logistic regression. Children in the highest sex-specific third of sedentary behavior had 1.95 (95% confidence interval [CI], 1.20–3.17; P = .007 for trend across thirds) times higher odds of any pain than children in the lowest third. Children in the highest sex-specific third of cardiorespiratory fitness had 46% (odds ratio [OR] = .54; 95% CI, .32–.91; P = .019) lower odds of any pain and 50% (OR = .50; 95% CI, .28–.87; P = .015) lower odds of headache than children in the lowest third. Children in the highest sex-specific third of body fat percentage had 44% (OR = .56; 95% CI, .34–.93; P = .023) lower odds of any pain, 49% (OR = .51; 95% CI, .30–.86; P = .011) lower risk of multiple pain, and 48% (OR = .52; 95% CI, .31–.86; P = .010) lower odds of lower limb pain than children in the lowest third. Physical activity was not associated with pain conditions. These findings suggest that prepubertal children with high levels of sedentary behavior, low levels of cardiorespiratory fitness, and low body fat content have increased likelihood of various pain conditions. This information could be used to develop strategies to prevent chronic pain in childhood.Our findings suggest that low cardiorespiratory fitness, high levels of sedentary behavior, and low body fat content are associated with increased likelihood of various pain conditions among prepubertal children. This information could be used to develop strategies to prevent chronic pain in childhood.