This paper presents a ship inventory routing and scheduling problem with undedicated compartments (sIRPSP-UC). The objective of the problem is to find a minimum cost solution while satisfying a number of technical and physical constraints within a given planning horizon. In this problem, we identify four sub-problems that need to be decided simultaneously: route selections, ship selection, loading, and unloading activity procedures. To solve this problem, first, we developed a mixed integer linear programming model. We then developed a one-step greedy heuristic, and then based on this heuristic, we propose a set of heuristics. Each heuristic has a combination of rules for each sub-problem. A number of problem instances are used to compare the solutions of the two approaches. We applied selected good combinations of rules to solve each problem using the heuristic approach. The results show that 8 out 12 of the considered problem instances have no gap with MILP solution solved using LINGO. We also find that the average gap is 1.96%. In contrast when we consistently use the same combination for all iterations, there are no dominant combinations of heuristics that can find good solutions for all the problem instances.

Le traitement des infections à mycobactéries atypiques est entrepris après identification précise de la mycobactérie et enquête sur son rôle pathogène. L'apparition de l'épidémie de SIDA a totalement modifié l'aspect de ces infections qui sont beaucoup plus fréquentes au cours du SIDA que dans la population générale. L'infection à M. kansasii doit être traitée durant 12 mois après négativation bactériologique par l'association isoniazide, rifampicine et éthambutol. L'infection à M. xenopi est résistante à la plupart des traitements antituberculeux. Des essais sont en cours, utilisant de nouvelles quinolones, de nouvelles ansamycines et de nouveaux macrolides. Le traitement des infections à M. avium intracellulare, responsables chez les patients atteints de SIDA de mycobactérioses disséminées, est particulièrement difficile. La clofazimine, de nouveaux macrolides comme la clarithromycine, des nouvelles quinolones, l'amikacine et des dérivés de la rifampicine sont actuellement testés. Les autres infections à mycobactéries sont rares et les traitements, peu codifiés, ne sont qu'inconstamment efficaces contre la plupart de ces mycobactéries.The treatment of non tuberculous mycobacteria was initiated after complete identification of the responsible agent. The responsability of mycobacteria in disease had to be established in each case for mycobacteria other than M. tuberculosis. M. kansasii infections are treated during 12 months after bacteriological clearance by an combination of rifampicin, isoniazid and ethambutol. M. xenopi infections are resistant to major antituberculous drugs. Studies using new quinolones, new ansamycines and new macrolides are ongoing. M. avium intracellulare is the responsible agent of subcutaneous, nodes and lung infections in immunocompetent subject. In HIV infected patients M. avium is the responsible agent of disseminated disease. The association of rifabutin isoniazid, clofazimine and ethambutol recommanded has no established efficacy. New drugs as clarithromycin, a new macrolid, fluoroquinolones, ansamycines, amikacine and others are tested to efficacy with promising results for several of them. Other mycobacterial diseases were unfrequent, and most of the potential pathogenic mycobacteria are not susceptible to antimycobacterial agents.

Vibrio cholerae serogroups O1 or O139 are the aetiological agents of cholera. The pathogenicity of non-O1, non-O139 V. cholerae is less well known. These worldwide bacteria are responsible for gastrointestinal infections or, more rarely, bacteraemia in patients with an underlying disease, leading to life-threatening complications. We report a case of non-O1, non-O139 V. cholerae bacteraemia due to a haemolytic strain in a cirrhotic patient. Early antibiotherapy allowed a good outcome. The aim of this case report is to underline the virulence of non-choleragenic Vibrio strains, possibly linked to haemolysin production, and the potential danger of consuming undercooked seafood or exposing wounds to sea water in cirrhotic patients.

Congenital tuberculosis (TB) remains a rare disease but is fatal if untreated. Early detection is difficult because of the non-specific nature of the symptoms in TB during pregnancy and infancy. This report summarizes a case of congenital TB in a very premature infant, born at 25 weeks gestation. Miliary TB was diagnosed in the mother when the neonate was 20 days old. Antituberculous therapy allowed a rapid improvement in the mother. The infant died at 27 days old. A Beijing genotype strain of Mycobacterium tuberculosis was isolated both in the mother, from pulmonary and urine specimens, and in the infant, from peritoneal fluid.

We investigated the ability of three pathogens (Burkholderia multivorans, Burkholderia cenocepacia, and Pseudomonas aeruginosa) involved in chronic bacterial infections in the CF lung to form biofilm in the presence of mucin. Previously Landry et al. (2006) have shown that P. aeruginosa developed larger aggregates when grown on mucin compared to when grown on glass. We investigated the differences in biofilm-biomass (BFBM) for a total of fifty isolates belonging to all three species when grown in vitro in the presence of porcine stomach mucin Type III. Our results showed that on average biofilm formation by P. aeruginosa (n = 22) was significantly higher than biofilm formation by either B. multivorans (n = 11) or B. cenocepacia (n = 17) (p< 0.0001). Further investigations within members of B. cenocepacia demonstrated that members of the recA type-IIIA (n = 6) formed on average significantly higher BFBM than other B. cenocepacia isolates (n = 11) (p< 0.0001). Further comparison of the average BFBM formation for isolates belonging to the highly problematic ET-12 clonal complex (n = 4) and isolates belonging to P. aeruginosa (n = 22) demonstrated that members of the ET12 clonal complex formed on average comparable BFBM as isolates belonging to P. aeruginosa (p< 0.79). This study demonstrates that members of P. aeruginosa form on average significantly higher BFBM compared to members belonging either to B. multivorans or B. cenocepacia. However, members of the ET-12 clonal complex were observed to form on average higher BFBM than other members of B. cenocepacia and comparable BFBM production of P. aeruginosa when grown in vitro.

The incidence of nontuberculous mycobacteria (NTM) pulmonary diseases in HIV-negative patients was studied prospectively from January 1, 2001 to December 31, 2003 by 32 sentinel sites distributed throughout France. In total, 262 patients who yielded NTM isolates from respiratory clinical specimens, met the bacteriological, radiological and clinical criteria established by the American Thoracic Society for NTM respiratory disease. Among the 262 NTM isolates, 234 were slow-growing mycobacteria (125 Mycobacterium avium-intracellulare complex (MAC), 66 M. xenopi, 34 M. kansasii) and 28 were rapidly growing mycobacteria (25 M. abscessus complex). In the Paris area, M. xenopi was the most frequently isolated species, followed by MAC. Most patients (>50%), except those with M. kansasii, had underlying predisposing factors such as pre-existing pulmonary disease or immune deficiency. Asthenia, weight loss, chronic cough and dyspnoea were the most common clinical symptoms. The classical radiological appearance of NTM infections was indistinguishable from that observed in patients with pulmonary tuberculosis. In summary, the incidence of nontuberculous mycobacteria pulmonary infections in HIV-negative patients was estimated at 0.74, 0.73 and 0.72 cases per 100,000 inhabitants in 2001, 2002 and 2003, respectively.

At this time. many antibiotics have decreased activity against Streptococcus pneumoniae, a major agent of infectious disease. In this study, we evaluated antibiotic susceptibility and serogroups of strains isolated from bacteraemia, meningitis and acute otitis media in adults and children over the 1997-2003 period in Brittany, France. In 2003, 62% of the isolates were not susceptible to penicillin and 11% were fully resistant. The prevalence of erythromycin resistance was 63%. Resistance rates were higher among isolates recovered from children than adults. Serogroups 19 and 14 were the most frequently isolated, especially the 19 one among children. The emergence of this serogroup might be a consequence of the use of heptavalent conjugate vaccine introduced in 2001 in France. Future surveillance after vaccination will be needed to detect emerging serogroups and resistance among S. pneumoniae. (c) 2005 Elsevier SAS. Tous droits reserves.

At this time, many antibiotics have decreased activity against Streptococcus pneumoniae, a major agent of infectious disease. In this study, we evaluated antibiotic susceptibility and serogroups of strains isolated from bacteraemia, meningitis and acute otitis media in adults and children over the 1997-2003 period in Brittany, France. In 2003, 62% of the isolates were not susceptible to penicillin and 11% were fully resistant. The prevalence of erythromycin resistance was 63%. Resistance rates were higher among isolates recovered from children than adults. Serogroups 19 and 14 were the most frequently isolated, especially the 19 one among children. The emergence of this serogroup might be a consequence of the use of heptavalent conjugate vaccine introduced in 2001 in France. Future surveillance after vaccination will be needed to detect emerging serogroups and resistance among S. pneumoniae.

Throughout 1999, clinical microbiology laboratories of 13 hospitals in Brittany have recovered Streptococcus pneumoniae isolates in 832 patients, 312 (37.5%) female and 518 (62.2%) male. Two hundred fifty five of them (30.6%) were children. One hundred eighty eight isolates were recovered from blood cultures (22.6%), 16 from CSF (1.9%), 449 from lungs (54%), and 88 from ear exsudates (10.6%).A 5 mug oxacillin-disk test was used to detect isolates with reduced susceptibility to penicillin G. Determination of MICs of penicillin G, amoxicillin and cefotaxime were then performed by agar dilution method on 402 strains previously categorized resistant or intermediate.Five hundred forty six isolates were PSDP, 33.5% of them were resistant to penicillin G, 2.2% to amoxicillin and 0.2% to cefotaxime.As expected, a decreased susceptibility to beta-lactamins was frequently associated with resistance to macrolides, cotrimoxazole and tetracyclin. Among PSDP, the most prevalent serotypes were 23 (23.7%), 14 (23.5%) and 19 (19.1%).In Brittany, the constante rise of PSDP (1993-1994: 28.5%; 1997: 56.4%; 1999: 65.6%) could be perhaps explain by analysis of social and demographic data. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.

Throughout 1999, clinical microbiology laboratories of 13 hospitals in Brittany have recovered Streptococcus pneumoniae isolates in 832 patients, 312 (37.5%) female and 518 (62.2%) male. Two hundred fifty five of them (30.6%) were children. One hundred eighty eight isolates were recovered from blood cultures (22.6%), 16 from CSF (1.9%), 449 from lungs (54%), and 88 from ear exsudates (10.6%).A 5 microgram oxacillin-disk test was used to detect isolates with reduced susceptibility to penicillin G. Determination of MICs of penicillin G, amoxicillin and cefotaxime were then performed by agar dilution method on 402 strains previously categorized resistant or intermediate. Five hundred forty six isolates were PSDP, 33.5% of them were resistant to penicillin G, 2.2% to amoxicillin and 0.2% to cefotaxime. As expected, a decreased susceptibility to beta-lactamins was frequently associated with resistance to macrolides, cotrimoxazole and tetracycline. Among PSDP, the most prevalent serotypes were 23 (23.7%), 14 (23.5%) and 19 (19.1%). In Brittany, the constant rise of PSDP (1993-1994: 28.5%; 1997: 56.4%; 1999: 65.6 %) could be perhaps explain by analysis of social and demographic data.

Between 1972 and 1989, 63 cases of listeriosis were diagnosed in Brest University Hospital. We did observed that the infection occurs by pluriannual cycle and rather in spring. Neonatal listeriosis, with 37 cases, is always the most common form of the disease. However, the number of listeriosis infection in adults seems to increase since the outset of the eighties, children being rarely sick. The way of contamination in adults is generally unknown; on the contrary, in neonatal forms the mother colonization is nearly always responsible for the disease in newborns, except in cases of hospital acquired infection. Sex is a discriminating factor of L. monocytogenes infection in adults and immunosuppression, a favorising and aggravating one. Isolated meningitidis occurs predominantly in adults, but the prevailing infection in newborns is a disseminated form. In our series, the 4b serotype of L. monocytogenes is widely predominant. The prognosis of the disease is generally good (except in immunocompromised adults) because of the good sensibility to the antibiotics.

La fréquence des infections à Lactobacillus est probablement sous-évaluée, en particulier chez les malades immunodéprimés. Les auteurs rapportent une observation de septicémie à Lactobacillus casei var. rhamnosus chez une malade leucémique en aplasie ayant subi une décontamination intestinale et une antibiothérapie inadaptée. La présence dans les selles de la malade d'un germe ayant exactement les mêmes caractères bactériologiques rend très vraisemblable une translocation du tube digestif vers la circulation sanguine.