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Biomedical subjects

P Geslin

Publications and source records attributed to P Geslin.

At least 91 records · Page 5Linked to original sources
PubMed1994

Comparative activity of teicoplanin and vancomycin against 400 penicillin susceptible and resistant Streptococcus pneumoniae. The French Study Group.

The MICs of teicoplanin and vancomycin were determined for 400 penicillin-susceptible and -resistant strains of Streptococcus pneumoniae isolated during a multicenter study in 1992. Teicoplanin displayed a four-fold better activity than vancomycin, with modal MICs of these agents being 0.06 and 0.25 micrograms/ml, respectively. These data warrant further studies with teicoplanin in the treatment of pneumococcal infections.

Microbial Sensitivity Tests↗
PubMed1994

Restricted association between biotypes and serotypes within group A streptococci.

Investigating individual variations between different isolates of group A streptococci, we observed a close correlation between biotypes and serotypes in 46 strains from pharyngitis patients. Biotyping, carried out with a commercially available rapid identification gallery, delineated 10 different associations of characteristics, designated biotypes 1 to 10, observed both in the manufacturer's (127 strains) and our personal (98 strains) collections of group A strains. Only the most frequent biotypes (biotypes 1 to 6) were observed in the pharyngitis cohort, but the overall frequencies of the biotypes did not display striking differences compared with the control collections. Serotyping of the pharyngitis strains showed that each M type was restricted to a sole biotype. For example, M types 1, 4, and 28 were found only in biotype 1 and M type 6 was found only in biotype 6 strains. This association was not due to an epidemiologic bias, since it was also observed in a control series consisting of reference strains and isolates from distant countries (the United States and Czech Republic versus France). An exception was for M type 78, which exhibited biotype 3 or biotype 4. Investigation of the heterogeneity of the strains at the DNA level showed no significant variations of the ribotype patterns between strains of different biotypes, confirming that group A streptococci belong to a unique and homogeneous species. This previously undescribed association between serotypes and biotypes is of interest for a rapid and preliminary characterization of strains isolated in individual patients or during an outbreak. A possible pathogenic association of some biotypic characteristics with specific M proteins is envisaged.

Adolescent↗
PubMed1994

Evaluation of human cytomegalovirus latency in alveolar macrophages.

Cytomegalovirus (CMV) pneumonia is a major cause of illness in immunocompromised patients. The sites of human CMV (HCMV) latency are still not clearly defined. The present study was therefore designed to investigate the hypothesis that alveolar macrophages could constitute such a site. DNA extracted from alveolar cells collected by bronchoalveolar lavage and blood mononuclear cells (BMC) from asymptomatic nonimmunocompromised CMV-seropositive and CMV-seronegative patients were investigated. Controls consisted of DNA from a CMV-infected MRC5 cell line, BMC and alveolar macrophages from patients with acute CMV infection. Polymerase chain reaction (PCR) was designed for detection of a 290-bp fragment of the promoter region of the major immediate early gene of HCMV conserved within the various HCMV strains and without homology with the human genome. The limit of detection of the method was evaluated to be one HCMV viral copy per 10(4) cells. HCMV DNA was detected in BMC or alveolar cells of all patients with acute CMV infection. In contrast, no HCMV DNA was detected in alveolar cells and BMC from nonimmunocompromised asymptomatic HCMV-seropositive patients. In conclusion, in the present experiment, no latent HCMV could be detected in alveolar cells collected in nonimmunocompromised asymptomatic CMV-seropositive patients.

Adult↗
PubMed1994

[Recanalization of chronic occlusions and myocardial infarction occurring during reocclusion. Apropos of 2 cases].

Although recent techniques have significantly improved the frequency of disobliteration of chronic occlusions, the potential complications in terms of mortality, emergency bypass surgery and myocardial infarction seem as common as in angioplasty of stenosis. Of these complications, the occurrence of infarction during reocclusion at the site of angioplasty has not been described and even been refuted by some authors. We report two cases of acute infarction, one of which was transmural, occurring during late reocclusion after disobliteration of a chronically occluded artery.

Aged↗
PubMed1994

[Resistance of Streptococcus pneumoniae to penicillin. "Bacteriological" resistance/"clinical" resistance].

From January 1988 to December 1992, 143 Streptococcus pneumoniae strains have been isolated at a significant level from 136 patients hospitalized in the pulmonary care unit of CHI Créteil. The clinical presentations were: 83 pneumonia (P), 48 acute bronchitis (B) and 12 colonizations (C). Fourteen strains were found to be penicillin resistant (MIC > 0.125 mg. l-1): 11 P, 2 B, 1 C. Two patients were lost of view after the beginning of the treatment: a pneumonia (Serotype 23F, MIC = 2 mg. l-1) and a bronchitis (Serotype 23F, MIC = 2 mg. l-1). Treatment was pristinamycine for one and amoxicilline alone or associated to clavulanic acid for the other 13. We observed the failure of the treatment in two. A pneumonia (Serotype 23, MIC = 2 mg. l-1) was treated before hospitalization by josamycine (3 days), then cefpodoxime (4 days) and amoxicillin-clavulanic acid (1.5 gr/d during 7 days). Healing was obtained with the increase to 3 gr/d. The other failure was a pneumonia without improvement after 11 days with 3 gr/d of amoxicilline. The treatment was stopped during 5 days and a protected brushing was performed. A Streptococcus Pneumoniae (Serotype 23F, MIC = 8 mg. l-1) was isolated. The clinical status rapidly improved with erythromycine (3 gr/d) to which the strain was susceptible. "Bacteriological" Resistance to penicillin is demonstrated (10 percent in our sample, 17 percent in France during 1991). However amoxicillin to a sufficient dosage is still enough ("Clinical" Resistance < 1 percent in our sample) for the treatment of respiratory infections except when the MIC is at a high level.

Adult↗
PubMed1994

Treatment failure in otitis media: an analysis.

An epidemiological study was conducted in order to monitor the involvement of penicillin-resistant pneumococci (PRP) in treatment failure in acute otitis media (AOM), in an area of France where resistance to antibiotics is high. A total of 293 children presenting to 12 ear, nose and throat (ENT) specialists were included in the study. The mean age of the patients was 15.3 months and most of the children (58.7%) were attending day care centres. Bacteriological sampling demonstrated that in 146 cases (49.8%), no pathogen was present at the time of treatment failure. In the remaining patients Streptococcus pneumoniae was the most frequently recovered pathogen, being isolated from 81/147 (55.1%) of bacteriologically documented cases. Serotype 23F was the predominant strain, representing 53% of all S. pneumoniae isolates recovered. Resistance or reduced susceptibility to the prescribed antibiotic was seen in 70/81 (86.4%) of the S. pneumoniae isolates. In 32 out of 49 children administered a beta-lactam antibiotic, treatment failure involved PRP. Amoxycillin seemed to be the most active oral beta-lactam against these pathogens. The multiresistance of S. pneumoniae poses a serious therapeutic problem and should make myringotomy and bacteriological sampling obligatory in cases of antibiotic treatment failure.

Acute Disease↗
PubMed1993

[Pneumonia caused by resistant pneumococci].

During the last few years, acquired resistance of pneumococci to the main families of normally active antibiotics has appeared. This resistance is now worldwide but unevenly distributed: in Europe, for instance, it predominates in Spain and Hungary. In France, according to the national Registry, resistance to penicillins, which was less than 5 percent in 1988, rose to 16.9 percent in 1991. More than 80 percent of resistant strains are found among 4 stereotypes (6, 9, 19, 23) and more than 50 percent belong to stereotype 23F exclusively. The incidence of penicillin-resistant has been evaluated at 8.5 percent in the year 1991-92. The most significant risk factor is a previous treatment with beta-lactam antibiotics, but some authors also blame frequent pneumonias in the previous year, nosocomial pneumonia, or hospitalization during the previous 3 months. There are no specific clinico-radiological features. The incidence of resistant strains is said to be higher in HIV seropositive subjects. Amoxicillin administered in high doses remains the reference treatment for strains with intermediate susceptibility (minimal inhibitory concentration [MIC] between 0.1 and 1.0 microgram/ml). Strains with a more than 1 microgram/ml MIC require beta-lactam antibiotics such as ceftriaxone, cefotaxime of imipenem in high doses. Pristinamycin still has good in vitro activity on resistant strains. Prevention rests on isolation of infected patients, treatment of healthy carriers and wide prescription of anti-pneumococcus vaccine.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Role of coronary angiography in infarction without Q wave. Results of a prospective angiographic study].

Non-Q wave myocardial infarction is associated with a high recurrence rate of ischaemic events (angina and infarction). The artery responsible for the infarction is usually patent but stenosed and seems to be the cause of these complications. This prospective multicenter series of 66 patients treated by Heparin, Aspirin, Diltiazem and undergoing coronary angiography during the hospital period studied the artery responsible for the infarction and the value of coronary angiography in this setting. Several conclusions were drawn from the results: the precise diagnosis of the artery responsible for the infarct may be difficult (14%); the left circumflex artery or one of its branches is often implicated (47%); non-Q wave infarction is a various and heterogeneous group, including: infarctions located on small branch arteries, "warning" ischaemic episodes in the left anterior descending artery territory. definitive infarction of the left circumflex artery territory; nevertheless, this group is an intermediate state between Q wave infarction and unstable angina (low occlusion rate 26% and angiographic lesional appearances similar to those of unstable angina); early coronary angiography (48-72 h) seems to be useful to improve prevention of ischaemic recurrences by adequate revascularisation.

Adult↗
PubMed1993

[Thallium 201 myocardial scintigraphy and left branch block. Comparative value of exercise test and dipyridamole test].

Stress Thallium 201 myocardial scintigraphy in patients with left bundle branch block often shows reversible septal perfusion defects even in the absence of coronary artery disease. This phenomenon seems more common when the patients have tachycardia. With the working hypothesis that dipyridamole stress testing, which does not greatly increase the heart rate, would be more appropriate than exercise stress testing to unmask coronary artery disease in this condition, the authors compared the results of two Thallium 201 scintigraphies performed after exercise and then after dipyridamole under the same conditions three weeks later, in 67 patients with complete left bundle branch block. Scintigraphy showed one or more reversible perfusion defects in 64/67 patients after exercise but only 32/67 patients after dipyridamole (p < 0.001). There was poor uptake in the septal region in 59 patients (88%) after exercise and in 25 patients (37%) after dipyridamole (p < 0.001). The specificity was evaluated in 23 patients estimated to have no coronary artery disease. If only unequi vocal perfusion defects were considered, the specificity after dipyridamole was higher than that after exercise, increasing from: 35% to 83% for septal defects (p < 0.01); 65% to 96% for anterior wall defects (p < 0.05); 61% to 87% for inferior wall defects (p < 0.05); 57% to 91% for apical defects (p < 0.01); 17% to 83% overall (p < 0.001). Lower values but with a comparable difference were observed when all forms of hypofixation (even minimal) were taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Value of radionuclide ventriculography and magnetic resonance imaging in the diagnosis of constrictive pericarditis].

In suggestive clinical presentations, the diagnosis of constrictive pericarditis is confirmed by the haemodynamic findings of impaired ventricular filling (diastole). In this study of 15 patients with pure constrictive pericarditis, the diagnosis value of two non-invasive techniques little used in this indication until now was examined: radionuclide ventriculography (RV) and magnetic resonance imaging (MRI). The RV provides a "functional" diagnosis through the analysis of global and segmental left ventricular filling whilst MRI provides anatomical details of the pericardial thickening. Diastolic dysfunction on RV presented as an increased early diastolic filling time as shown by a shortening of the interval to third filling T1/3R (p < 0.0001), an increased peak diastolic E wave velocity (p < 0.01) and early onset (p < 0.001), increased one third (FR 1/3) and mid (FR 1/2) diastolic filling fractions (p < 0.01) and of the E wave velocity to maximal systolic ejection velocity (S) ration (p < 0.01). The atrial contribution to filling in end diastole decreased (NS). Asynchronous filling, shown by dispersion of the times of onset of segmental early diastolic E peak velocities (delta tE) or of one third diastolic filling delta T1/3R, decreased. Seven patients underwent MRI. Pericardial thickening was present in all patients. The pericardium varied from 6 to 14 mm thick (normal 2.5 +/- 0.7 mm), without any systolo-diastolic variation. The thickening was seen as a dark low intensity signal, indicating the fibro-calcific character of the tissues. Sagittal and coronal views clearly demonstrated the non-uniformity of pericardial thickening.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Sudden death and cardiac insufficiency].

The relationship between the incidence of ventricular arrhythmias and sudden death in chronic cardiac failure is, in fact, true as arrhythmias are mainly related to the severity of left ventricular dysfunction. If sudden death in subjects without cardiac failure is usually attributed to arrhythmia, in chronic cardiac failure it is often the result of sudden collapse, the mechanism of which is not well known. The distinction between sudden and non-sudden death therefore loses much of its value.

Arrhythmias, Cardiac↗
PubMed1993

[In vitro antibacterial activity of pristinamycin against penicillin resistant Streptococcus pneumoniae].

Pristinamycin, a member of streptogramin family, is the association of two groups (components I and pristinamycin II A) which have a high synergistic activity. Given the increasing rates of penicillin resistance in Streptococcus pneumoniae in many countries, and in particular of strains exhibiting multiple resistance to commonly used antibiotics, it was interesting to study the in vitro activity of pristinamycin against penicillin resistant S. pneumoniae (47 strains) and compare it with that of erythromycin. All strains were isolated from otitis media. Minimal inhibitory concentrations (MICs) were determined by an agar dilution technique using Mueller-Hinton medium supplemented with 5% horse blood. An inoculum of 10(4)-10(5) CFU per spot was delivered by a Steers replicator. This study showed that, among the 47 penicillin resistant strains, 29 (61.7%) were resistant to erythromycin but none of them were resistant to pristinamycin. The good in vitro activity of pristinamycin against S. pneumoniae could be of particular interest in cases of infections with multiresistant strains.

Dose-Response Relationship, Drug↗
PubMed1993

[Antibiotherapy as first choice in infectious meningitis].

The choice of antibiotics in bacterial meningitis must integrate several parameters. i) The bacterial epidemiology of community acquired meningitis: Haemophilus influenzae (Hi) Neisseria meningitidis (Nm), Streptococcus pneumoniae (Sp) represents more than 95% of cases; ii) The increase of antibiotic bacterial resistance, particularly preoccupying for Sp; iii) The microbiological properties and pharmacokinetics of antibiotics, especially their penetration in CSF: the concentrations achieved must be several times higher than the MBC. In fact, CSF is not favourable to the antibiotic activity; iv) The results of clinical comparative trials; v) The contribution of animal models to the knowledge of meningitis physiopathology. Third generation cephalosporins (cefotaxime, ceftriaxone) satisfy this objective for Hi, Nm, and penicillin sensitive strains of Sp. For penicillin resistant Sp, no treatment can achieve antibiotic CSF concentrations higher than ten times the MBC. An increase in dosage of cephalosporins, the use of an other regimen (Vancomycin or imipenem) and antibiotic association (rifamycin, fosfomycin) are needed.

Anti-Bacterial Agents↗
PubMed1992

Antimicrobial resistance in Streptococcus pneumoniae: an epidemiological survey in France, 1970-1990.

The antimicrobial resistance of Streptococcus pneumoniae was surveyed in 1970-1990 at Saint Joseph and Broussais hospitals in Paris (3,279 isolates) and in 1984-1990 at the National Reference Center for Pneumococci (NRCP) in Créteil (8,128 isolates). All isolates were tested for susceptibility and serotyped. At St. Joseph and Broussais hospitals, the rate of resistance to tetracycline increased from 14% in 1970 to 46.5% in 1978 and then decreased to approximately 20% in 1988-1990. Resistance to chloramphenicol appeared in 1972; its frequency remained at less than 10% until 1990. Resistance to macrolides was first detected in 1976, increased to 20% in 1984, and reached 29% in 1990. Among strains submitted to the NRCP, resistance to penicillin (MIC, greater than or equal to 0.1 mg/L) remained infrequent (less than or equal to 1.1%) between 1984 and 1986 but then increased steadily, reaching 12% in 1990. The frequency of high-level resistance to penicillin (MIC, greater than 1 mg/L) among penicillin-resistant pneumococci increased from 13% in 1988 to 48% in 1990. Compared with other serotypes, the penicillin-resistant serotype isolated most frequently (23F, 49.3%) was more often highly resistant to penicillin and was more often multiresistant.

Drug Resistance, Microbial↗
PubMed1992

Analysis of DNA restriction fragment length polymorphism extends the evidence for breast milk transmission in Streptococcus agalactiae late-onset neonatal infection.

Analysis of restriction fragment length polymorphism (RFLP) of total DNA and of ribosomal DNA (ribotyping) was used to document four cases of Streptococcus agalactiae mother-to-infant transmission potentially associated with ingestion of infected mother's milk. Twenty strains were analyzed. Ten strains were mother-baby pairs, five from the milk of five mothers, four from their neonates with late-onset infection, and one from a colonized neonate. All mothers had early postpartum mastitis. Ten unrelated strains were studied for comparison. In each case, the two strains of each mother-baby pair produced identical RFLP patterns of total DNA. The 10 unrelated strains generated 10 different patterns, one of which, though, was observed in one of the mother-baby pairs. Ribotyping was less discriminative than total DNA RFLP analysis (6 different patterns vs. 13). These data extend the evidence for breast milk transmission in S. agalactiae late-onset neonatal infection.

Breast Feeding↗