P. Mariani-Kurkdjian

Escherichia coli O104:H4 south-west France, June 2011

Comment on: nCharacterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. [Lancet Infect Dis. 2011]

Early Detection of Colonization by VIM-1-Producing Klebsiella pneumoniae and NDM-1-Producing Escherichia coli in Two Children Returning to France

ABSTRACT Rapid identification of metallo-β-lactamase-producing Gram-negative species is crucial for the timely implementation of infection control measures. We describe two pediatric cases in which colonization by VIM-1- and New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae was rapidly detected by phenotypic and genotypic methods. Phenotypic methods can be useful for routine detection of carbapenemase production.

Characterization of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli Strains Involved in Maternal-Fetal Colonization: Prevalence of E. coli ST131

ABSTRACT Maternal-fetal Escherichia coli infections, such as neonatal bacteremia and meningitis, are important causes of morbidity and mortality. From 2006 to 2010, we studied newborns and their mothers who were colonized with E. coli in a French hospital in order to document (i) the epidemiology and genetic characteristics of extended-spectrum-beta-lactamase (ESBL)-producing E. coli strains, (ii) the prevalence of associated virulence genes, (iii) the prevalence of clone sequence type 131 (ST131), and (iv) the genetic relationship among ESBL-producing strains. Among the 2,755 E. coli cultures recovered from vaginal or neonatal samples, 68 were ESBL producers (2.46%). We found a wide diversity of ESBL genes, with the majority being bla CTX-M-14, bla CTX-M-1, and bla CTX-M-15, distributed among the 4 main phylogenetic groups. Genes encoding virulence factors were found in 90.7% of the isolates, with ≥2 virulence genes present in 76% of cases. The prevalence of ST131 among ESBL-producing E. coli isolates was 9.4% (6/64). Five of these 6 ST131 isolates possessed bla CTX-M-15 enzymes (and also were resistant to quinolones), and one possessed bla CTX-M-2 enzymes. Two possessed virulence genes, suggesting the presence of pathogenicity island IIJ96 (PAI IIJ96)-like domains. Pulsed-field gel electrophoresis (PFGE) revealed a high level of genomic diversity overall, except for 3 closely related isolates belonging to clonal group ST131. Repetitive PCR showed that the six ST131 isolates were closely related to ST131 control strains (>95% similarity). This study shows a high prevalence of ESBL-producing E. coli strains and clonal group ST131 in the French maternal-fetal population. These results suggest a widespread distribution of ESBL enzymes in the community and highlight the early transmission between mothers and neonates. These findings are worrisome, especially for this particularly vulnerable population.

Evolving microbiology of complicated acute otitis media before and after introduction of the pneumococcal conjugate vaccine in France

We compare the microbiology of otopathogens causing recurrent acute otitis media (AOM) or AOM treatment failure in 600 children during 2000 to 2008 before and after the introduction of 7-valent pneumococcal conjugate vaccine (PCV-7). Streptococcus pneumoniae predominated before PCV-7 introduction and during 2007 to 2008, whereas Haemophilus influenzae predominated during 2005 to 2006. S. pneumoniae 19A became the most frequent serotype after PCV-7 introduction.

Semi-automated rep-PCR for rapid differentiation of major clonal groups of Escherichia coli meningitis strains

DiversiLab, a semi-automated repetitive-sequence-based PCR (rep-PCR) device, is a highly integrated platform designed for rapid bacterial genotyping. Here, we evaluated the capacity of the DiversiLab system to determine the genetic relatedness of Escherichia coli neonatal meningitis (ECNM) strains and to identify clonal groups. We analyzed 80 isolates representative of the diversity of ECNM strains in Europe and North America and 52 E. coli reference (ECOR) strains belonging to phylogenetic groups A, D, and B2. All the strains had previously been characterized by means of multilocus sequence typing (MLST). The DiversiLab dendrogram clustered all but 8 of the strains according to their phylogenetic groups. After defining a rep-PCR type complex (RPTc) based on an average similarity threshold of 95% between rep-PCR types, we observed excellent agreement between RPTc and sequence type complexes (STc) in groups D and B2. In group A, rep-PCR typing was more discriminative than MLST, dividing the 25 ECOR group A strains into 19 RPTc, compared to only 10 STc. In the highly virulent clonal group B2(1), mainly composed of O1, O2, O18, and O45:K1 strains, the DiversiLab system individualized a particular subgroup of O2:K1 strains. In addition, among O18:K1 strains the system identified a particular genetic background associated with pathogenicity island II(J96)-like domains. Thus, the DiversiLab system is a rapid and powerful tool for identifying and discriminating clonal groups among ECNM strains.

Epidemiology of pediatric community-acquired bloodstream infections in a children hospital in Paris, France, 2001 to 2008

In 2001 to 2008, we documented 483 cases of pediatric community-acquired bacteremia mostly because of Streptococcus agalactiae (< 4 days), Escherichia coli (4 days to 3 months), pneumococci (3 months to 5 years), and Staphylococcus aureus (> 5 years). Pneumococcal conjugate vaccination affected the serotype distribution of pneumococcal bacteremia but not its frequency. Serotype 19A represented 12% and 22% of pneumococci in the prevaccine and vaccine periods, respectively.

Foodborne transmission of sorbitol-fermenting Escherichia coli O157:[H7] via ground beef: an outbreak in northern France, 2011

Sorbitol-fermenting Escherichia coli O157:[H7] is a particularly virulent clone of E.xa0coli O157:H7 associated with a higher incidence of haemolytic uraemic syndrome and a higher case fatality rate. Many fundamental aspects of its epidemiology remain to be elucidated, including its reservoir and transmission routes and vehicles. We describe an outbreak of sorbitol-fermenting E.xa0coli O157:[H7] that occurred in France in 2011. Eighteen cases of paediatric haemolytic uraemic syndrome with symptom onset between 6 June and 15 July 2011 were identified among children aged 6xa0months to 10xa0years residing in northern France. A strain of sorbitol-fermenting E.xa0coli O157:[H7] stx2a eae was isolated from ten cases. Epidemiological, microbiological and trace-back investigations identified multiply-contaminated frozen ground beef products bought in a supermarket chain as the outbreak vehicle. Strains with three distinct pulsotypes that were isolated from patients, ground beef preparations recovered from patients freezers and from stored production samples taken at the production plant were indistinguishable upon molecular comparison. This investigation documents microbiologically confirmed foodborne transmission of sorbitol-fermenting of E.xa0coli O157 via beef and could additionally provide evidence of a reservoir in cattle for this pathogen.

Entérobactéries productrices de bêta-lactamases à spectre étendu

Resume Les beta-lactamases a spectre etendu (BLSE) sont des enzymes qui hydrolysent l’ensemble des penicillines et les cephalosporines a l’exception des cephamycines (cefotixine, cefotetan) du moxalactam et des carbapenemes. Les premieres BLSE derivaient des penicillinases de type TEM ou SHV-1 par mutation ponctuelle. Plus recemment, de nouvelles BLSE non derivees des penicillinases ont emerge : les cefotaximases de type CTX-M et les ceftazidimases de type PER, GES et VEB. La distribution des especes bacteriennes au sein de ces souches a egalement evolue : K. pneumoniae qui representait environ 60 % de ces souches en 1995, n’en represente plus que 20 %. C’est chez Escherichia coli que la progression est la plus nette, passant de moins de 10 % en 1995 a 55 % en 2008. En France, la prevalence des souches d’E. coli resistantes aux cephalosporines de troisieme generation isolees d’hemocultures reste

Congenital malaria in neonates: two case reports and review of the literature

Congenital malaria is uncommon in nonendemic countries. We describe two cases involving neonates hospitalized with fever, anaemia and thrombocytopaenia. Thick and thin blood smears were positive for Plasmodium vivax (P. vivax) and P. ovale, respectively. These two cases were discussed regarding the literature and potential implications of HIV coinfection in the mother.

Infections néonatales à Candida

Resume Les infections neonatales a Candida sont, comme les infections bacteriennes, separees selon leur age de survenue en infections precoces maternofcetales (IMF), en infections tardives primitives et en infections nosocomiales. Les infections a Candida representent moins de 1% des IMF. Leur diagnostic nest quinconstamment orients par des lesions cutandes qui peuvent rester localisees ou saccompagner dune atteinte systemique. Les infections nosocomiales systemiques a Candida sont plus frequentes (7 % des infections nosocomiales chez le premature Lamphotericine B, et son derive lipidique lAmbisome®, reste la molecule de reference pour le traitement des candidoses systemiques; lintroduction plus recente du fluconazole moins toxique et dutilisation plus simple le fait utiliser preferentiellement contre les souches sensibles. Son utilisation prophylactique chez le grand premature colonise a ete proposee.