[Acute streptococcal sore throats in children, state of the present situation. Interview with Pr. E Bingen by Marie Solignac].
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Acute Disease↗
Biomedical subjects
E Bingen
Publications and source records attributed to E Bingen.
[Group B streptococcus and high level resistance to aminoglycosides: therapeutic implications for neonates].
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Aminoglycosides↗
[Pathogenic bacteria in cystic fibrosis].
Since the CF gene identification in 1989 and despite the improvement of our knowledge in the physiopathology of the disease, bronchopulmonary infection determines the vital prognosis. Following Staphylococcus aureus infection, patients are colonized or colonized by Pseudomonas aeruginosa, greatly involved in the pulmonary deterioration. Other bacteria may be involved Burkholderia cepacia, Stenotrophomonas maltophilia, Alcaligenes sp. Intensive antibiotic treatment of primocolonisation helps to prevent or delay chronic colonisation. Chronic colonization needs a rational long term antibiotic strategy to prevent the occurrence of multiresistant germs; antibiotic cures are performed every 3 or 4 months before pulmonary exacerbation symptoms.
Anti-Bacterial Agents↗
[National surveillance of bacterial meningitis in children].
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Child↗
Persistent bacteremia in rabbit fetuses despite maternal antibiotic therapy in a novel intrauterine-infection model.
The effect of optimized maternal therapy by bactericidal agents was evaluated in a reproducible rabbit model of Escherichia coli maternofetal infection simulating human pharmacokinetics. Intravenous antibiotic therapy was begun in the pregnant rabbit 12 h after bacterial intrauterine inoculation, using a computer-controlled pump to simulate human pharmacokinetics of ceftriaxone (1 g/day) associated or not with gentamicin (3 mg/kg of body weight/day). Data were compared for fetal survival, quantitative blood cultures, fetal histology in treated versus untreated groups, and maternal and fetal antibiotic concentrations in plasma in treated animals. Antibiotic therapy led to dramatic improvement in maternal outcome (100% survival versus 100% death in the untreated group in association with maternal septicemia). Fetal survival also improved, with the two-drug combination providing a more potent effect. After 3 days of treatment, 32% of fetuses survived with one-drug therapy and 62% with two-drug therapy (Yates corrected chi(2), P < 0.05). In untreated animals, bacterial counts in blood cultures increased rapidly during the first 24 h up to 8.1 +/- 0.5 log CFU/ml, but remained relatively constant at all times with antibiotic treatment: 4.5 +/- 0.7 log CFU/ml at the start of treatment and 6.2 +/- 0.4 and 5.2 +/- 0.9 log CFU/ml after 72 h for one- and two-drug therapy, respectively (data are means +/- standard deviations). The failure of animals to be cured after 3 days of treatment was not due to an inadequate concentration of ceftriaxone, as the residual level in fetal serum at sacrifice was more than 1000 times the MIC of the microbe. Unexpectedly, inflammation in fetal lung decreased in the treated group after as little as 24 h of antibiotic therapy, despite persistent bacteremia. Although maternal outcome improved and drug concentrations were above the MIC, the treatment did not achieve sterilization of fetuses in utero for this rabbit E. coli maternofetal infection. However, fetal survival showed some improvement, and the histologic features of lung inflammation were reduced.
Animals↗
[Role of pneumococcus in pediatric infectious pathology].
Streptococcus pneumoniae is the most common bacterial cause of invasive and non-invasive infections in children of less than two years. The high level of resistance to penicillin and other antimicrobial agents observed particularly in France is responsible of the difficulties concerning the treatment of acute otitis media and meningitis due to S. pneumoniae. Potential positive consequences of the implementation of pneumococcal conjugate vaccine may include prevention of invasive diseases and prevention of spread of the drug resistant-strains.
Drug Resistance, Bacterial↗
[Therapeutic approaches in children immunized with vaccine Prevenar].
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Acute Disease↗
The Yersinia high-pathogenicity island is highly predominant in virulence-associated phylogenetic groups of Escherichia coli.
The high-pathogenicity island (HPI) present in pathogenic Yersinia and encoding the siderophore yersiniabactin, has recently been identified in the asnT tRNA region of various Escherichia coli pathotypes, especially those responsible for bacteremia and urosepsis. Most E. coli strains causing such extra-intestinal infections belong to phylogenetic groups B2 and D. In this study we investigated (i) the distribution and localization of HPI among the different E. coli phylogenetic groups, using the ECOR reference collection; and (ii) the prevalence of HPI among a set of 124 phylogenetically characterized E. coli strains responsible for neonatal meningitis. Ninety-three percent of the ECOR strains belonging to groups B2 and D harbored HPI. In contrast, the island was present in 32% and 25% of strains belonging to groups A and B1, respectively, which are considered to be non-pathogenic. HPI was found in 100% of the neonatal meningitis strains, 13 of which belonged to groups A and B1, suggesting that HPI might contain virulent factors required for the development of neonatal meningitis. Moreover, we observed for the first time that HPI can be inserted in a site different from the asnT tRNA region.
Bacterial Outer Membrane Proteins↗
Genotypic characterization of Pseudomonas aeruginosa strains recovered from patients with cystic fibrosis after initial and subsequent colonization.
Chronic infection by Pseudomonas aeruginosa (PA) in patients with cystic fibrosis (CF) is preceded by a period of colonization and acute infection. Early aggressive antibiotic treatment of initial colonisation may prevent or at least delay chronic pulmonary infection. We initiated treatment with a combination of IV beta-lactam tobramycin, followed by nebulized colistin when PA was first isolated from patients with CF. Subsequent serial PA isolates obtained from these colonized CF patients were characterized by means of molecular methods to determine whether they were genetically related to the initial strain. Initial colonization was eradicated in all 19 patients. All patients reacquired PA within 3-25 months during the 3 years of follow-up. Fourteen patients acquired a new PA strain with a distinct genotypic profile, suggesting a new source of contamination. Five patients had two PA isolates with identical genotypes, suggesting either previous undetected respiratory tract colonization or a persistent environmental source of contamination.
Administration, Inhalation↗
Clonal relationships among penicillin-susceptible, multiresistant serotype 6B Streptococcus pneumoniae isolates recovered in Greece and France.
In January 1996 the emergence of penicillin-susceptible, multiresistant serotype 6B Streptococcus pneumoniae isolates resistant to chloramphenicol, tetracycline, erythromycin, clindamycin and trimethoprim-sulfamethoxazole was observed in young carriers in the city of Patras, located in the southwestern region of Greece. Later, a significant spread of pneumococci with this unusual phenotype was noted in carriers living in various other areas of the country. Using restriction fragment length polymorphism of the ribosomal RNA genes, clonal relationships were found between these Greek strains and serotype 6B penicillin-susceptible, multiresistant pneumococci isolated in France between January 1992 and September 1996. The French and Greek isolates appear to have a common ancestry.
Carrier State↗
[Treatment of acute group A beta-hemolytic streptococcal tonsillitis in children with a 5-day course of josamycin].
MATERIAL AND METHODS: In this randomized open study, 325 children aged two to 15 years with acute tonsillitis and a positive test of GA beta H streptococcal antigen were treated with josamycin 50 mg.kg-1.day-1 b.i.d for 5 days, or penicillin 50,000 to 100,000 IU/day t.i.d for 10 days. Clinical assessments and throat cultures for GA beta HS isolation were performed at the inclusion visit (V1), at the end of treatment visit (V2: day 12 for all patients) and at the follow-up visit (V3: day 30). In case of positive GA beta HS culture, the bacterial DNA by RFLP was performed to differentiate between the persistence (presence of original strain at V2), relapse (eradication at V2 and acquisition of same strain at V3) and reinfection (eradication at V2 and acquisition of different strain at V3). RESULTS: Two hundred and twenty-three patients were included in the bacteriological and clinical criteria per protocol analysis. At V2, eradication rates were comparable: 82% in josamycin and 80% in penicillin patients; clinical cure rates were 90% and 89%. At V3, relapse of GAS assessed only on clinically and bacteriologically cured patients at V2 occurred in 12% of josamycin patients and 12.8% of penicillin patients. Tolerance was good; 14% and 10% of josamycin and penicillin patients respectively experienced an adverse event. CONCLUSION: In this non-inferiority study, the efficacy of a 5-day course of josamycin is comparable to reference treatment in GA beta HS tonsillitis in children.
Acute Disease↗
[Meningococcal purpura fulminans: untoward result of genetic polymorphism?].
Despite significant progress in intensive care medicine, the mortality of septic shock has not changed in recent years. Early recognition of subtle signs in favor of meningococcal sepsis, early antibiotic treatment, and aggressive hemodynamic support remains the cornerstone of therapy of severe meningococcal shock in children. Recent work has emphasized the role of genetic polymorphisms in various systems to explain the most severe cases: anti-inflammatory cytokine profile IL-10/TNF-alpha, elevated levels of plasminogen activator inhibitor type-1, variants of the gene for mannose-binding lectin complement pathway. This may explain the disillusionment of pediatric intensivists, and the general failure of immunotherapy for sepsis. Reasonable hope lies upon new meningococcal vaccines.
Child↗
[Assessment of the use of aminoglycosides at a pediatrics hospital].
MATERIALS AND METHODS: Three surveys were successively carried out regarding aminoglycoside use: one analysis of amikacine prescriptions in the most prescribing clinical wards and two surveys among nurses and physicians respectively on prescribing, administering and monitoring aminoglycosides. RESULTS: On 43 amikacine prescriptions analyzed in a month, one daily dose infusion in 30 minutes was observed in most of the patients (70%), doses and indications matched most often the official license. Half of patients treated for more than five days had no drug level monitoring. Sample collection by nurses was very erratic making results obtained not interpretable. CONCLUSION: Subsequently, guidelines regarding aminoglycoside use were designed by the interest group, approved by the drug committee and sent to all hospital prescribers and nurses.
Adolescent↗
[Severe neonatal bacterial infections].
The prognosis of septicemic forms of early and late neonatal sepsis is severe with a high rate of mortality especially in premature infants. The evaluation of severity is difficult because of the non specificity of the clinical signs and mortality seems to be a good means of evaluation. A study was conducted in France on the mortality due to infection in neonatal intensive care units and neonatology wards during the third trimester 2000. Among 18 units, the mortality rate was 9.3% of admissions, corresponding to 11 early onset sepsis and 17 nosocomial infections. Death in primitive infections is essentially due to group B streptococci and E. coli with a more important risk in low gestational age infants. The nosocomial infections arise almost only in premature infant. Prognosis of infections due to Staphylococcus coagulase negative staphylococci, most frequent pathogens is good but mortalities rate is higher for enterobacteriacae--40% and for Pseudomonas, 62%.
Bacterial Infections↗
[Virulence factors associated with E. coli neonatal meningitis].
Escherichia coli K1 is the leading cause of gram-negative bacterial meningitis in neonates. It is associated with a mortality rate as high as 40%, and more than half of the survivors have neurologic sequelae. Bacterial meningitis is the result of bacterial translocation from gastrointestinal tract to the blood and from blood to the central nervous system. Successful crossing of the BBB by E. coli K1 requires (a) a high degree of bacteremia and (b) several E. coli determinants contributing to invasion of BMEC such as the K1 capsule, Sfa, Ibe proteins, and CNF1. A better understanding for the molecular basis of E. coli K1 penetration of the BBB could potentially lead to the development of novel therapeutic and preventative strategies for E. coli K1 meningitis.
Blood-Brain Barrier↗
[Hemolytic-uremic syndrome: microbiological aspects].
Escherichia coli O157: H7 became an important pathogen starting in the early 1980s. It has caused epidemics and sporadic cases of often bloody diarrhea which may progress to severe hemolytic and uremic syndrome or thrombotic thrombocytopenia purpura. E. coli O157: H7 is mainly transmitted in food, water and interhuman transmission, but direct animal-to-man transmission has also been documented. E. coli O157: H7 can adhere tightly to the enterocyte brush border (eae gene) and produce verotoxins or Shiga-like toxins and hemolysine (ehxA gene). Diagnosis of E. coli O157: H7 infections is based on evidencing the germ in stools and/or by identifying the genes coding for verotoxins or by serology which increased serum titre of specific antilipopolysaccharide antibodies. Antidiarrheal drugs and antibiotics have little place in the treatment of bloody diarrhea. This public health problem, requires careful identification of animal reservoirs and improved population education in food hygiene.
Animals↗
Genetic and phenotypic characterization of macrolide resistance in group A streptococci isolated from adults with pharyngo-tonsillitis in France.
Three hundred and three strains of group A streptococci (GAS) isolated from adults with pharyngitis were tested to evaluate their phenotype of resistance to macrolides-lincosamides and to search for macrolide resistance genes. MICs of clarithromycin were determined. The overall rate of resistance to both erythromycin and clarithromycin was 9.6%. Constitutive, inducible and M phenotypes of resistance were detected in 4.3, 2 and 3.3% of strains, respectively. All constitutive phenotypes harboured ermB genes, whereas inducible phenotypes had the ermTR gene and M phenotypes had the mefA gene. In France, the current resistance rate of GAS to erythromycin and clarithromycin remains low.
Adenoids↗
In vivo selection of a target/efflux double mutant of Pseudomonas aeruginosa by ciprofloxacin therapy.
We report the emergence after 4 days of ciprofloxacin monotherapy of a double mutant of Pseudomonas aeruginosa overexpressing the multidrug efflux system MexAB-OprM and harbouring a mutation in the gyrB gene. Compared with its initial susceptible counterpart, this mutant exhibited a significant increase in resistance to most of the beta-lactam antibiotics tested (16 x MIC of ticarcillin) and to ciprofloxacin (128 x MIC). Combined ceftazidime and amikacin therapy finally eradicated the resistant isolate and cured the patient of his infection. This case illustrates how strains of P. aeruginosa may develop high levels of fluoroquinolone resistance by combining efflux mechanisms and target alterations.
Adolescent↗