How to: accreditation of blood cultures' proceedings. A clinical microbiology approach for adding value to patient care.

Background: Quality assurance and quality management are driving forces for controlling blood culture best practices but should not be disconnected from the end-point target, i.e. patient value.

[Detection of Staphylococcus aureus resistant to methicillin (MRSA) by molecular biology (Cepheid GeneXpert IL, GeneOhm BD, Roche LightCycler, Hyplex Evigene I2A) versus screening by culture: Economic and practical strategy for the laboratory].

Objectives: Patients admitted in cardiac surgery and cardiac ICU at the Clinic Saint-Gatien (Tours) are screened for MRSA at the entrance by nasal swab and culture on blood agar and selective chromogenic medium made by addition of cefoxitin: BBL CHROMagar MRSA-II BD (result obtained at Day +1). We wanted to assess the molecular biology techniques available to obtain a result at day 0 for the majority of patients and to define an economic and practical strategy for the laboratory.

Techniques: We studied four molecular biology techniques: Cepheid GeneXpert (Cepheid) GeneOhm (BD), LightCycler (Roche) and Hyplex (I2A).

[1997-2007, 10 years of monitoring the evolution of resistance of Streptococcus pneumoniae to antibiotics in the region Centre; review of the Pneumococcus network].

Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.

Legionella anisa, a possible indicator of water contamination by Legionella pneumophila.

Legionella anisa is one of the most frequent species of Legionella other than Legionella pneumophila in the environment and may be hospital acquired in rare cases. We found that L. anisa may mask water contamination by L.

[The Pneumococcal Observatory for the Central Region, 1 April 1999 to 31 March 2000].

Seven hundred and ninety six strains of pneumococcus were collected in the Centre region, from 15 laboratories, between 1st April 1999 and 31st of March 2000. Data were processed, using 4th dimension software, and concerned age, file number, consultation/hospitalisation, sample type, susceptibility to oxacillin (5 micrograms), results of the E-test for benzylpenicillin, amoxicillin, cefotaxime and results of the routine disc diffusion test. Strains with reduced susceptibility to benzylpenicillin (PRSP) were collected by the co-ordinating centre to perform MICs by the reference agar dilution test and serotyping.

[The Pneumococcus Observatory of the Central Region, from June 1, 1997 to May 31, 1998].

714 pneumococcus were listed from 14 laboratories between the 1 June 1997 and the 31 May 1998. Data capture was done on Epi info software and concerned age, file number, consultation/hospitalization, sample type, susceptibility to oxacilline (5 micrograms), the results of the E-test for penicillin G, amoxicillin, cefotaxime and the results of the routine disk diffusion susceptibility method. Strains with reduced susceptibility to penicillin G (PRSP) were collected by the coordinating center to perform MICs by the reference method of agar dilution and serotyping.

[Evaluation of a new and rapid antibiotic sensitivity method testing for Enterobacteriaceae responsible for urinary infections].

URIFAST Es et Es Plus (International Microbio, Signes, France) are rapid antimicrobial susceptibility testing method in broth medium without using an automatic reader. A screening assay (URIFAST Quatro 1C ou URIFAST Twin 1C) is performed with a 4 or 9 antimicrobial agents with a concentration c' below the low critical concentration (c) defined by the Comité de l'Antibiogramme de la Société Française de Microbiologie (CA-SFM). When a bacterial strain is presumed resistant, an antimicrobial susceptibility test with the two critical concentrations (CA-SFM) can be performed with 5 or 10 antimicrobial agents antibiotiques (URIFAST Twin ABG ou URIFAST ABG).

[Informative capacity of 8 serological tests in the diagnosis of human brucellosis].

Assessment of the informative value of 8 immunological tests: sero-agglutination (Wright and Rose Bengale), indirect immunosorbent assay, counter immuno electrophoresis, ELISA IgG, IgM and IgA, and particle counting immunoassay (PACIA) has been performed among the results of serum of 209 patients. The patients were divided in four groups: 71 who already had brucellosis, 18 Yersinia infections, 12 Tularemia and 108 free of desease. The informative capacities of a positive result of counter immuno electrophoresis (Protein antigen Brucellin-INRA Tours-Nouzilly) is higher than others reactions and can be proposed as a confirmatory test of brucellosis.

[Brucellosis among occupationally exposed people: evaluation of immunological tests after vaccination].

For the evaluation of immunological tests during an epidemiological survey and of vaccination with the PI brucellin vaccine, in an occupationally exposed environment, a sample group of 354 subjects was studied. The vaccinal strategy was based on the outcome of a skin test for hypersensitivity: the PS brucellin test. In this framework, the serological status and evolution of individuals with positive or negative reactions to this test were analysed.

[Brucella vaccination in professionally exposed subjects. Prospective study].

This prospective phase IV study on cohort concerns a vaccine made of the phenol-insoluble fraction of Brucella abortus biotype 1 (B19 strain). Three hundred and three professionally exposed subjects entered the study; 161 out of 182 subjects (88.5 percent) with negative response to an intradermal test for detection of previous contamination accepted to be vaccinated.

[Evaluation of Clinitek in the screening and optimisation of the diagnosis of urinary tract infection].

A study was conducted to compare the interest of using Clinitek and leucocytes esterase, blood, nitrites strip Multistix-8 SG (Ames-Bayer Diagnostics) with conventional method (dilution of urine in agar plate) and with automated system (Autobac) as a screening procedure to detect significant bacteriuria. The results are expressed in terms of sensitivity, specificity, predictive value of a negative and positive test. A total of 1303 urine samples were tested of which 730 (56%) were founded negative with Clinitek or conventional urine analysis (Se = 83.

[Evaluation of a screening test for urinary infection].

The interest of using a reagent strip (Multistix-8 SG, Ames, Miles Laboratories) as a screen for urinary tract infection was evaluated in a clinical study involving several sites and 2,183 adult urine specimens of which 340 were infected. The results are expressed in terms of sensitivity, specificity, predictive value of a negative and positive test. The predictive value of a negative test for nitrites in combination with leucocytes (97.

[Human brucellosis in Benin: results of a serological survey among exposed workers].

A serological survey was carried out in Bénin in order to assess the rate of brucellosis infection among exposed workers (workers in slaughtering-houses and breeders). 221 sera were tested with rose Bengale test, Wright sero-agglutination test, indirect immunofluorescence test and counter-immuno electrophoresis (brucelline). The percentage of positive sera among exposed workers is 17,7%.

[Antibiotic sensitivity of bacteria isolated from pathological specimens and utilization of beta-lactams in an orthopedic surgery service].

From 1980 to 1984, computerized data on the sensitivity to the main antibiotics of 1991 strains isolated from clinical specimens were evaluated in relation to beta-lactam use and hospital activity in a unit of orthopedic surgery. No major variations were found in distribution of species throughout the study period, whereas sensitivity to antimicrobial agents changed. From 1980 to 1982, patients had postoperative prophylactic treatment with cephalosporin (cefazolin) for two days; during the same period, 59% of 557 Gram negative organisms were resistant to cefazolin and 31% of Staphylococci were resistant to methicillin (and to other antibiotics).

[Development of the sensitivity to antibiotics in strains of Neisseria gonorrhea isolated in Touraine over a 5-year period].

347 Neisseria gonorrhoeae strains isolated in Touraine, France, from December 1978 to March 1984 were tested for susceptibility to seven antibiotics using an agar dilution method. Percentage of strains with a penicillin G MIC = 0.06 micrograms/ml rose from 58% in 78-80 to 69% in 82-84.

[Antibiotic therapy of pneumopathies in intensive care and protected distal bronchial samples].

Bacteriology was performed on 57 specimens collected by the Wimberley protected catheter bronchoscopy technique (PCB) from 42 ventilated patients with severe head trauma hospitalized in the neurosurgical intensive care unit to determine the etiology of their pneumopathy. All patients had a nasotracheal tube upon arrival at the intensive care unit. For each sample, smears were examined and cultures under aerobic and anaerobic conditions as well as with CO2 were performed.

[Fosfomycin resistance in Staphylococcus saprophyticus and other species of coagulase-negative staphylococci].

Susceptibility of 121 isolates of coagulase-negative staphylococci to two antimicrobial agents, novobiocin and fosfomycin, was determined using the agar dilution method. Isolates included 45 strains of Staphylococcus saprophyticus, 26 strains of S. cohnii and S.

[Postoperative infectious risk in traumatic bone surgery and protocol for antibiotic therapy].

Eleven hundred and sixty eight traumatic cases have been operated on under constant conditions in a conventional operating room with filtered air and positive pressure using absolute filters of 99.999 efficiency. Two hundred and five were submitted to post-operative prophylactic administration of Cephalosporin (Cefazolin) for 2 days.