Disseminated papulopustular eruption due to Mycobacterium fortuitum in an immunocompetent patient.
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Humans↗
Biomedical subjects
T Fosse
Publications and source records attributed to T Fosse.
Bacteroides fragilis group infections in HIV-infected patients. The Bacteroides Study Group.
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AIDS-Related Opportunistic Infections↗
Effects of combined topical metronidazole and mechanical treatment on the subgingival flora in deep periodontal pockets in cuspids and bicuspids.
The Effect on the subgingival microflora of a single topical administration of a 95% collagen and 5% metronidazole device in combination with debridement was investigated in 30 adult periodontitis patients in comparison with mechanical treatment alone. For each patient, plaque samples from test and control sites in cuspids and bicuspids were collected for culture and enumeration of total anaerobically cultivable bacteria (TA), black-pigmented anaerobes (BPA), and Actinobacillus actinomycetemcomitans (Aa). Spirochetes and fusiforms were quantified by direct microscopic examination after Giemsa staining. A decrease was observed for all parameters, and a significant difference in comparison with the control group was found for fusiforms. After treatment, a lower number of Aa positive sites were observed in the test group (13/25). These results show that a single application of topical metronidazole seems to be effective as adjunctive antimicrobial treatment in adult periodontitis.
Administration, Oral↗
Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. A French multicenter study.
BACKGROUND: Although Clostridium difficile is the main agent responsible for nosocomial diarrhea in adults, its prevalence in stool cultures sent to hospital microbiology laboratories is not clearly established. OBJECTIVES: To determine the prevalence of C difficile in inpatient stools sent to hospital microbiology laboratories and to assess the relationship between serotypes and toxigenicity of the strains isolated and the clinical data. METHODS: From January 18, 1993, to July 31, 1993, the presence of C difficile was systematically investigated in a case-control study on 3921 stool samples sent for stool culture to 11 French hospital microbiology laboratories. The prevalence of C difficile in this population (cases) was compared with that of a group of 229 random hospital controls matched for age, department, and length of stay (controls). Stool culture from controls was requested by the laboratory although not prescribed by the clinical staff. Serotype and toxigenesis of the strains isolated were compared. RESULTS: The overall prevalence of C difficile in the cases was twice the prevalence in the controls (9.7% vs 4.8%; P < .001) and was approximately 4 times as high in diarrheal stools (ie, soft or liquid) as in normally formed stools from controls (11.5% vs 3.3%; P < .001). The strains isolated from diarrheal stools were more frequently toxigenic than those isolated from normally formed stools. Serogroup D was never toxigenic, and its proportion was statistically greater in the controls than in the cases (45% vs 18%; chi 2 = 5.2; P < .05). Conversely, serogroup C was isolated only from the cases. Clostridium difficile was mainly found in older patients ( > 65 years), suffering from a severe disabling disease, who had been treated with antibiotics and hospitalized for more than 1 week in long-stay wards or in intensive care. CONCLUSIONS: This multicenter period prevalence study clearly supports the hypothesis of a common role of C difficile in infectious diarrhea in hospitalized patients. Disease associated with C difficile should therefore be systematically evaluated in diarrheal stools from inpatients.
Anti-Bacterial Agents↗
Antibiotic susceptibility in aerobic gram-negative bacilli isolated in intensive care units in 39 French teaching hospitals (ICU study).
OBJECTIVE: Evaluation of the distribution and antibiotic susceptibility of the aerobic gram-negative bacilli (AGNB) isolated from patients in intensive care units (ICU study). DESIGN AND SETTING: Microbiological study carried out in 1991 in 39 teaching hospitals. A standardized method was used to determine the minimum inhibitory concentrations of 12 antibiotics against 3366 strains of AGNB (close to 100 strains per hospital) during a period of 3 months. RESULTS: The 2773 initial strains (i.e., the first AGNB isolate for a given species and a given patient) were mainly isolated from the respiratory tract (34.4%), urinary tract (23%), or blood (9.6%) and were mainly Pseudomonas aeruginosa (22.9%), Escherichia coli (22%), Acinetobacter (9.7%), and Klebsiella pneumoniae (8.3%). E. coli was prominent in urine and blood and P. aeruginosa in the respiratory tract. Overall, the rate of susceptibility of AGNB was 58 to 65% to piperacillin, cefotaxime, and gentamicin; 69 to 75% to aztreonam, tobramycin, and ciprofloxacin; 83% to ceftazidime; and 91% to imipenem. The overall rates of susceptibility were higher for the initial strains isolated from blood than for those from the urinary or respiratory tracts, mostly reflecting differences in species distribution. Susceptibility rates were lower for the 593 repeat strains (i.e., all the subsequent isolates for a given species and a given patient) than for the initial strains, mostly due to the higher proportion of resistant species (P. aeruginosa 45.9%) but also due to the difference in susceptibility rates for some species-antibiotic combinations. Concomitant resistance (i.e., resistance to several antibiotics due to independent mechanisms of resistance) was marked between beta-lactams and aminoglycosides or quinolones, particularly in P. aeruginosa and K. pneumoniae. CONCLUSIONS: Rates of resistance in AGNB as a whole and in particular species (P. aeruginosa, Klebsiella), as well as frequency of concomitant resistance found in the French ICU study, were higher than those found in ICU studies conducted with the same methodology in Belgium, The Netherlands, and Germany, which may reflect differences in case mix.
Bacteria, Aerobic↗
Topical metronidazole as an adjunct to subgingival debridement in the treatment of chronic periodontitis.
The purpose of this study was to evaluate the clinical effects of a single application of a 5% metronidazole collagen device in periodontal pockets deeper than 5 mm, in association with debridement and without reinforcement of home care and hygiene as practiced by the patient at any time. Pocket depth, attachment level, bleeding on probing, gingival index and plaque index were assessed at baseline, and on days 15, 30 and 90. Analysis of data from 28 patients indicated that both debridement and metronidazole therapy decreased pocket depth, bleeding on probing and gingival index, but results were significantly better with metronidazole. These results indicate that topical metronidazole provides an effective adjunctive treatment of advanced periodontitis.
Adult↗
[Multifactorial analysis of the phenotypes for beta-lactams of 1044 Escherichia coli strains].
1,044 E. coli strains were randomly collected by the beginning of 1992. Their susceptibility for seven beta-lactam antibiotics: amoxycillin, augmentin, ticarcillin, claventin, cephalothin, cefoxitin and cefotaxime, was studied routinely by the agar diffusion method. The datas were analyzed by the CERIB multifactorial analysis package which yields to homogeneous populations. This analysis showed four well defined populations: 1) 588 strains (56.4%) susceptible to all antibiotics; 2) 410 strains (39.3%) present a penicillinase phenotype; 3) 11 strains (1.05%) are cephalosporinase producer; 4) 7 strains (0.67%) were identified as producing an extended-spectrum beta-lactamase. The remaining strains: 28 (2.68%) had a reduced susceptibility to all antibiotics, which suggests the combination of few resistance mechanisms or other hypothesis.
Anti-Bacterial Agents↗
[Cerebral nocardiosis. Severity seems to be a function of the delay for diagnosis].
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Adult↗
[Iodized polyvidone (betadine) and prevention of postoperative infection. A multicenter study].
A multicentre study of a new preparation of povidone iodine (5% betadine) was carried out on 150 patients undergoing cataract surgery. Pre-operatively the eye was prepared by daubing the peri-ocular skin and a two-minute instillation into the conjunctival fornices. No other antiseptic was applied. Tolerance to the product was evaluated in all the patients: clinical evaluation postoperatively and during a 60-day follow-up period confirmed that the preparation was harmless to the eye. Microbiological investigations (comprising conjunctival swabbing, bacterial culture and count of the bacterial species isolated, before and after application of the product) performed on 60 patients showed a significant fall in the number of colonies after treatment.
Administration, Topical↗
[Infectious diarrhea in the adult].
Infectious diarrhoeas are usually divided into two types; toxinogenic and invasive. Invasive diarrhoeas are copious and responsible for dehydration which is the principal clinical sign; mucosal lesions and bacteraemia are absent. The most typical of toxinogenic diarrhoeas is cholera, but enterotoxicogenic E. coli and Aeromonas infections have similar clinical features. In invasive diarrhoeas the responsible microorganisms penetrate into the epithelial cells of the intestine, producing fever and stools that contain blood and mucus. However, some organisms causing invasive diarrhoeas secrete cytotoxins; they include Shigella spp., Salmonella spp, some strains of E. coli, Campylobacter jejuni and Yersinia spp. When diarrhoea occurs in patients under antibiotics pseudomembranous colitis due to the proliferation of Clostridium difficile must be suspected; the diagnosis is suggested by endoscopy and confirmed by bacteriology. Toxic and infectious diarrhoeas due to food are increasingly frequent; they are usually caused by Salmonella spp., but sometimes by Clostridium perfringens or Staphylococcus aureus. In patients with suspected infectious diarrhoea symptomatic treatment combined or not with intestinal antibacterial agents is immediately initiated in most cases; stool cultures are reserved to severe or protracted diarrhoeas. Specimens must be collected under the best conditions and rapidly sent to the laboratory.
Adult↗
[Determination of antibiotype by a computer program. Epidemiological significance and antibiogram-identification correlates].
By means of a computer program disk diffusion diameter were analysed and an antibiotic susceptibility code (antibiotype) was determined for enterobacteriaceae. This code was a 6 figure-number. Each figure summarised susceptibility (susceptible or resistant) to 3 antibiotics. Thus a 18 serial antibiotics was necessary to calculate the 6 figure-code. At least following antibiotics were chosen for their characteristic behavior: amoxycillin, ticarcillin, amoxycillin + clavulanic acid, cephalothin, ticarcillin + clavulanic acid, cefotaxime, gentamycin, tobramycin, amikacin, nalidixic acid, pefloxacin, ciprofloxacin, fosfomycin and colistin. This code allowed three kind of utilisation: epidemiology by comparing biochemical and susceptibility patterns of same isolated species; laboratory control: a data base with main antibiotic susceptibility patterns for each species allowed a rapid compatibility control of biochemical identification with antibiogram. An inconsistent result lead to a checking of biochemical and susceptibility tests or to record a new code in a file to a further enrichment of the data base. Impression of a message depending of the code for a therapeutic purpose.
Drug Resistance, Microbial↗
[In vitro activity of fusidic acid in combination with various antibiotics against Staphylococcus epidermidis].
In vitro antibacterial activity of fusidic acid (FUC) in combination with cefotaxime (CTX), imipenem (IMP), gentamicin (GEN), amikacin (AKN), rifampin (RIF), fosfomycin (FOS), vancomycin, pefloxacin (PEF) was studied against 19 presumably pathogen meti-R Staphylococcus epidermidis strains. The study was carried out by means of a microtiter checkerboard method (FICs index, 19 strains) and killing-curves (3 strains). FUC x GEN, FUC x AKN and FUC x IMP combinations were found synergistic with achievable therapeutic concentrations for IMP (MIC in the combination less than 1 microgram/ml) but with higher concentrations for AKN and GEN (greater than or equal to 8 micrograms/ml). FUC x PEF combinations were regularly antagonistic. FUC x RIF, and FUC x FOS combinations showed a modal FIC greater than or equal to 4 but were found respectively additive and synergistic with killing-curve method. Remaining FUC combinations results were variable. FUC resistant mutant frequency, studied for 3 S. epidermidis strains, was similar as S. aureus one's (0.5.10(-7) a 2.5.10(-8)).
Drug Resistance, Microbial↗
[Urinary Corynebacterium group D2 infections. A hospital epidemic and antibiotic sensitivity].
An outbreak of Corynebacterium group D2 urinary tract infections was recently observed at Nice CHR. These infections were characterized by alkaline urine. The five first cases were reported in the same department and the ten other cases were latter observed in different departments. Age average was 79 and all patients had either an intra-vesical catheter of a urinary collector. Among samples of material tested, only one gave a positive culture. The 15 isolates showed a similar identification and antibiotic phenotype. These strains presented a multiple antibiotic resistance: resistance to beta-lactams, aminoglycosides (except streptomycin), erythromycin, chloramphenicol, tetracyclines. All strains were susceptible to rifampin, pristinamycin, fusidic acid and vancomycin.
Aged↗
[Infectious endocarditis, complication of mitral valve prolapse].
Among 77 patients with bacterial endocarditis on native valves explored by echocardiography, 12 (7 male, 5 female, mean age: 50 years) presented with mitral valve prolapse. This condition is relatively common, being found in 15.5% of patients with bacterial endocarditis and in 32% of those with mitral valve endocarditis. Two-dimensional TM echocardiography showed the mitral valve prolapse in every case and, in 11/12 cases, a vegetation associated with a varying degree of thickening of the valve due to myxoid degeneration. Although cardiac signs were sometimes minimal. Ten hemocultures were positive: 7 for streptococci, 2 for staphylococci and 1 for Hemophilus para-aphrophilus. Two patients died of cerebral haemorrhage, and there were 2 cases of hemiplegia, 4 cases of transient left ventricular failure and 2 cases of spleen embolism. These findings suggest that prophylactic treatment of bacterial endocarditis should be undertaken in patients with mitral valve prolapse and signs of myxoid degeneration at echocardiography.
Adult↗
[Endocarditis caused by Yersinia enterocolitica serotype 0:8. First case in Europe].
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Aged↗
[Antibiotic combinations and serum concentrations: a study using a computer program].
An original computer program developed to study antibiotic combinations is presented. In vitro combination effects were determined by broth microtiter checkerboard method. Inhibitory and bactericidal concentrations for each antibiotic alone and in combination were registered on a microcomputer (Apple Lisa). The program (Pascal UCSD) allowed to determine FIC and FBC index and a therapeutical index (IFT) based on reduction of concentrations under mean serum levels for the two antibiotics. An IFT less than 1 correlated to a combination of antibiotics with achievable therapeutic levels. More the IFT was low more the combination was effective. This therapeutical index was calculated for various combinations of antibiotic concentrations.
Anti-Bacterial Agents↗
[In vitro study of the effects of an imipenem-fosfomycin combination against clinical strains of Staphylococcus].
In vitro antibacterial activity of imipenem-fosfomycin (IMP-FOS) combinations were studied against 31 clinical isolates of Staphylococcus strains: methicillin susceptible S. aureus (MSSA, 11 strains), methicillin resistant S. aureus (MRSA, 11 strains), methicillin resistant S. epidermidis (MRSE, 9 strains). The study was carried out by means of a microtiter checkerboard method (FICs and FBCs index) and killing-curves (3 strains). Imipenem antibacterial activity was good against MSSA (mean MICs of 0.12 micrograms/ml) but reduced against MRSA (16 micrograms/ml). Fosfomycin was regularly effective (CMI less than or equal to 64 micrograms/ml) against most strains. IMP-FOS combination was strongly synergistic (FIC less than 0.125) against MSSA and still synergistic with achievable therapeutic concentrations against heterogeneous MRSA and MRSE strains (mean FIC of 0.125, MIC in the combination of 1 microgram/ml). The bactericidal activity (FBCs and killing-curves) was limited against homogeneous MRSA and MRSE needing higher concentrations (8 micrograms/ml in the combination). In the 3 cases fosfomycin concentrations in combination remained low (1 to 2 micrograms/ml).
Drug Combinations↗
Metastatic cerebral abscesses due to Hemophilus paraphrophilus.
A patient who had a two-month history of nonspecific inflammatory disease experienced symptoms of raised intracranial pressure and meningitis. Computed tomographic scan showed multiple, small ring-enhancing hypodensities consistent with cerebral abscesses. The infective agent proved to be Hemophilus paraphrophilus, a fastidious, particularly slow-growing organism that was identified on blood cultures. An autopsy disclosed disseminated microabscesses and demonstrated typical pathologic changes of endocarditis complicating mitral valve prolapse.
Brain Abscess↗