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Moreau J, Noël T, Point K, Tewes F, Deroche L, Clarhaut J, Fitton-Ouhabi V, Perraud E, Marchand S, Buyck JM, Brunet K. Pan-azole-resistant Meyerozyma guilliermondii clonal isolates harbouring a double F126L and L505F mutation in Erg11. Mycoses 2024; 67:e13704. [PMID: 38429226 DOI: 10.1111/myc.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Meyerozyma guilliermondii is a yeast species responsible for invasive fungal infections. It has high minimum inhibitory concentrations (MICs) to echinocandins, the first-line treatment of candidemia. In this context, azole antifungal agents are frequently used. However, in recent years, a number of azole-resistant strains have been described. Their mechanisms of resistance are currently poorly studied. OBJECTIVE The aim of this study was consequently to understand the mechanisms of azole resistance in several clinical isolates of M. guilliermondii. METHODS Ten isolates of M. guilliermondii and the ATCC 6260 reference strain were studied. MICs of azoles were determined first. Whole genome sequencing of the isolates was then carried out and the mutations identified in ERG11 were expressed in a CTG clade yeast model (C. lusitaniae). RNA expression of ERG11, MDR1 and CDR1 was evaluated by quantitative PCR. A phylogenic analysis was developed and performed on M. guilliermondii isolates. Lastly, in vitro experiments on fitness cost and virulence were carried out. RESULTS Of the ten isolates tested, three showed pan-azole resistance. A combination of F126L and L505F mutations in Erg11 was highlighted in these three isolates. Interestingly, a combination of these two mutations was necessary to confer azole resistance. An overexpression of the Cdr1 efflux pump was also evidenced in one strain. Moreover, the three pan-azole-resistant isolates were shown to be genetically related and not associated with a fitness cost or a lower virulence, suggesting a possible clonal transmission. CONCLUSION In conclusion, this study identified an original combination of ERG11 mutations responsible for pan-azole-resistance in M. guilliermondii. Moreover, we proposed a new MLST analysis for M. guilliermondii that identified possible clonal transmission of pan-azole-resistant strains. Future studies are needed to investigate the distribution of this clone in hospital environment and should lead to the reconsideration of the treatment for this species.
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Affiliation(s)
- Jérémy Moreau
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
| | - Thierry Noël
- Université de Bordeaux, CNRS, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France
| | - Kévin Point
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
| | - Frédéric Tewes
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
| | - Luc Deroche
- CHU de Poitiers, Service de Virologie, Poitiers, France
| | - Jonathan Clarhaut
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
- CHU de Poitiers, Service de Toxicologie-Pharmacocinétique, Poitiers, France
| | - Valérie Fitton-Ouhabi
- Université de Bordeaux, CNRS, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France
| | - Estelle Perraud
- CHU de Poitiers, Service de Parasitologie et Mycologie Médicale, Poitiers, France
| | - Sandrine Marchand
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
- CHU de Poitiers, Service de Toxicologie-Pharmacocinétique, Poitiers, France
| | - Julien M Buyck
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
| | - Kévin Brunet
- Université de Poitiers, INSERM U1070 PHAR2, Poitiers, France
- CHU de Poitiers, Service de Parasitologie et Mycologie Médicale, Poitiers, France
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Deroche L, Aranzana-Climent V, Rozenholc A, Prouvensier L, Darnaud L, Grégoire N, Marchand S, Ploy MC, François B, Couet W, Barraud O, Buyck JM. Characterization of Pseudomonas aeruginosa resistance to ceftolozane-tazobactam due to ampC and/or ampD mutations observed during treatment using semi-mechanistic PKPD modeling. Antimicrob Agents Chemother 2023; 67:e0048023. [PMID: 37695298 PMCID: PMC10583683 DOI: 10.1128/aac.00480-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
A double ampC (AmpCG183D) and ampD (AmpDH157Y) genes mutations have been identified by whole genome sequencing in a Pseudomonas aeruginosa (PaS) that became resistant (PaR) in a patient treated by ceftolozane/tazobactam (C/T). To precisely characterize the respective contributions of these mutations on the decreased susceptibility to C/T and on the parallel increased susceptibility to imipenem (IMI), mutants were generated by homologous recombination in PAO1 reference strain (PAO1- AmpCG183D, PAO1-AmpDH157Y, PAO1-AmpCG183D/AmpDH157Y) and in PaR (PaR-AmpCPaS/AmpDPaS). Sequential time-kill curve experiments were conducted on all strains and analyzed by semi-mechanistic PKPD modeling. A PKPD model with adaptation successfully described the data, allowing discrimination between initial and time-related (adaptive resistance) effects of mutations. With PAO1 and mutant-derived strains, initial EC50 values increased by 1.4, 4.1, and 29-fold after AmpCG183D , AmpDH157Y and AmpCG183D/AmpDH157Y mutations, respectively. EC50 values were increased by 320, 12.4, and 55-fold at the end of the 2 nd experiment. EC50 of PAO1-AmpCG183D/AmpDH157Y was higher than that of single mutants at any time of the experiments. Within the PaR clinical background, reversal of AmpCG183D, and AmpDH157Y mutations led to an important decrease of EC50 value, from 80.5 mg/L to 6.77 mg/L for PaR and PaR-AmpCPaS/AmpDPaS, respectively. The effect of mutations on IMI susceptibility mainly showed that the AmpCG183D mutation prevented the emergence of adaptive resistance. The model successfully described the separate and combined effect of AmpCG183D and AmpDH157Y mutations against C/T and IMI, allowing discrimination and quantification of the initial and time-related effects of mutations. This method could be reproduced in clinical strains to decipher complex resistance mechanisms.
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Affiliation(s)
- Luc Deroche
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
- CHU de Poitiers, Département des agents infectieux, Poitiers, France
- Université de Limoges, Inserm U1092, Limoges, France
| | | | | | - Laure Prouvensier
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
- CHU de Poitiers, Laboratoire de Toxicologie et de Pharmacocinétique, Poitiers, France
| | - Léa Darnaud
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
| | - Nicolas Grégoire
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
- CHU de Poitiers, Laboratoire de Toxicologie et de Pharmacocinétique, Poitiers, France
| | - Sandrine Marchand
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
- CHU de Poitiers, Laboratoire de Toxicologie et de Pharmacocinétique, Poitiers, France
| | - Marie-Cécile Ploy
- Université de Limoges, Inserm U1092, Limoges, France
- CHU de Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, Limoges, France
| | - Bruno François
- Université de Limoges, Inserm U1092, Limoges, France
- CHU Limoges, Service de Réanimation Polyvalente, Limoges, France
- Inserm CIC 1435, CHU Limoges, Limoges, France
| | - William Couet
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
- CHU de Poitiers, Laboratoire de Toxicologie et de Pharmacocinétique, Poitiers, France
| | - Olivier Barraud
- Université de Limoges, Inserm U1092, Limoges, France
- CHU de Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, Limoges, France
- Inserm CIC 1435, CHU Limoges, Limoges, France
| | - Julien M. Buyck
- Université de Poitiers, PHAR2, Inserm U1070, Poitiers, France
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Deroche L, Bellecave P, David R, Ouattara E, Garcia M, Roblot F, Boinot L, Faucher JF, Rejasse A, Gschwind G, Malvy D, Filleul L, Rogez S, Lévêque N, Lafon ME. One year of SARS-CoV-2 circulation in the Nouvelle-Aquitaine region, February 2021-2022, France. Front Microbiol 2023; 14:1176575. [PMID: 37577437 PMCID: PMC10420073 DOI: 10.3389/fmicb.2023.1176575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background Since 2021, 3 variants of concern (VOC) have spread to France, causing successive epidemic waves. Objectives To describe the features of Alpha, Delta and Omicron VOC circulation in the Nouvelle-Aquitaine region, France, between February 2021 and February 2022. Study design Data from the three university hospitals (UH) of Nouvelle-Aquitaine were used to describe regional SARS-CoV-2 circulation (RT-PCR positive rates and identified VOC) as well as its consequences (total number of hospitalizations and admissions in intensive care unit). They were analyzed according to the predominant variant and compared with national data. Results A total of 611,106 SARS-CoV-2 RT-PCR tests were performed in the 3 Nouvelle-Aquitaine UH during the study period. The 37,750 positive samples were analyzed by variant-specific RT-PCR or whole-genome sequencing. In 2021, Alpha VOC was detected from week 5 until week 35. Delta became the most prevalent variant (77.3%) in week 26, reaching 100% in week 35. It was replaced by Omicron, which was initially detected week 48, represented 77% of positive samples in week 52 and was still predominant in February 2022. The RT-PCR positive rates were 4.3, 4.2, and 21.9% during the Alpha, Delta and Omicron waves, respectively. The ratio between intensive care unit admissions and total hospitalizations was lower during the Omicron wave than during the two previous waves due to the Alpha and Delta variants. Conclusion This study highlighted the need for strong regional cooperation to achieve effective SARS-CoV-2 epidemiological surveillance, in close association with the public health authorities.
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Affiliation(s)
- Luc Deroche
- Virology Laboratory, CHU Poitiers, Poitiers, France
| | | | - Romain David
- Virology Laboratory, CHU Bordeaux, Bordeaux, France
| | - Eric Ouattara
- Medical Information Analysis and Coordination Unit (UCAIM-DIM), Medical Information Department, Bordeaux University Hospital, Bordeaux, France
| | - Magali Garcia
- Virology Laboratory, CHU Poitiers, Poitiers, France
- LITEC UR15560, Université de Poitiers, Poitiers, France
| | - France Roblot
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France
- INSERM U1070, Université de Poitiers, Poitiers, France
| | - Laurence Boinot
- Service d’Information Médicale, CHU Poitiers, Poitiers, France
| | - Jean-François Faucher
- Tropical Infectious Diseases Department, Limoges University Hospital, Limoges, France
| | - Aurélie Rejasse
- Medical Information Department, Limoges University Hospital, Limoges, France
| | - Guillaume Gschwind
- Medical Information Department, Limoges University Hospital, Limoges, France
| | - Denis Malvy
- Department of Infectious and Tropical Diseases, CHU Bordeaux, Bordeaux, France
- UMR Inserm 1219/IRD, University of Bordeaux, Bordeaux, France
| | - Laurent Filleul
- Regional Office-Nouvelle Aquitaine, Santé publique France, Bordeaux, France
| | - Sylvie Rogez
- Virology Laboratory, CHU Limoges, Limoges, France
| | - Nicolas Lévêque
- Virology Laboratory, CHU Poitiers, Poitiers, France
- LITEC UR15560, Université de Poitiers, Poitiers, France
| | - Marie-Edith Lafon
- Virology Laboratory, CHU Bordeaux, Bordeaux, France
- CNRS UMR 5234, University of Bordeaux, Bordeaux, France
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Deroche L, Buyck J, Cateau E, Marchand S, Brunet K. Draft Genome Sequence of the Rhinocladiella similis Clinical Isolate CBS 149759. Mycopathologia 2023:10.1007/s11046-023-00715-3. [PMID: 37022620 DOI: 10.1007/s11046-023-00715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/08/2023] [Indexed: 04/07/2023]
Abstract
Rhinocladiella similis is a melanized fungi involved in chromoblastomycosis. R. similis genome has never been sequenced, therefore we propose the first draft genome of R. similis.
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Affiliation(s)
- Luc Deroche
- INSERM U1070, Poitiers, France
- Université de Poitiers, Faculté de Médecine Et Pharmacie, Poitiers, France
- Service de Virologie, Département Des Agents Infectieux, CHU de Poitiers, Poitiers, France
| | - Julien Buyck
- INSERM U1070, Poitiers, France
- Université de Poitiers, Faculté de Médecine Et Pharmacie, Poitiers, France
| | - Estelle Cateau
- Université de Poitiers, Faculté de Médecine Et Pharmacie, Poitiers, France
- Service de Mycologie-Parasitologie, Département Des Agents Infectieux, CHU de Poitiers, Poitiers, France
| | - Sandrine Marchand
- INSERM U1070, Poitiers, France
- Université de Poitiers, Faculté de Médecine Et Pharmacie, Poitiers, France
- Service de Toxicologie Et de Pharmacocinétique, CHU de Poitiers, Poitiers, France
| | - Kévin Brunet
- INSERM U1070, Poitiers, France.
- Université de Poitiers, Faculté de Médecine Et Pharmacie, Poitiers, France.
- Service de Mycologie-Parasitologie, Département Des Agents Infectieux, CHU de Poitiers, Poitiers, France.
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Deroche L, Buyck J, Cateau E, Rammaert B, Marchand S, Brunet K. Draft Genome Sequence of Kazachstania bovina Yeast Isolated from Human Infection. Mycopathologia 2022; 187:413-415. [PMID: 35829847 DOI: 10.1007/s11046-022-00639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
Kazachstania bovina is a yeast species from the K. telluris complex that has been recently involved in bloodstream infections. While yeast genomes from this complex have already been sequenced, K. bovina genome has not been published yet. Here is the first draft genome of K. bovina (CBS 16326).
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Affiliation(s)
- Luc Deroche
- INSERM U1070, Poitiers, France
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- Département des Agents Infectieux, Service de Virologie, CHU de Poitiers, Poitiers, France
| | - Julien Buyck
- INSERM U1070, Poitiers, France
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Estelle Cateau
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- Département des Agents Infectieux, Service de Mycologie-Parasitologie, CHU de Poitiers, Poitiers, France
- Laboratoire Écologie et Biologie des Interactions, UMR CNRS 7267, Université de Poitiers, Poitiers, France
| | - Blandine Rammaert
- INSERM U1070, Poitiers, France
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - Sandrine Marchand
- INSERM U1070, Poitiers, France
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
- Service de Toxicologie et de Pharmacocinétique, CHU de Poitiers, Poitiers, France
| | - Kévin Brunet
- INSERM U1070, Poitiers, France.
- Faculté de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.
- Département des Agents Infectieux, Service de Mycologie-Parasitologie, CHU de Poitiers, Poitiers, France.
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Damour A, Robin B, Deroche L, Broutin L, Bellin N, Verdon J, Lina G, Leclère FM, Garcia M, Cremniter J, Lévêque N, Bodet C. Phenol-soluble modulins α are major virulence factors of Staphylococcus aureus secretome promoting inflammatory response in human epidermis. Virulence 2021; 12:2474-2492. [PMID: 34516337 PMCID: PMC8451463 DOI: 10.1080/21505594.2021.1975909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Staphylococcus aureus is a skin commensal microorganism commonly colonizing healthy humans. Nevertheless, S. aureus can also be responsible for cutaneous infections and contribute to flare-up of inflammatory skin diseases such as atopic dermatitis (AD), which is characterized by dysbiosis of the skin microbiota with S. aureus as the predominant species. However, the role of major virulence factors of this pathogen such as phenol-soluble modulin (PSM) toxins in epidermal inflammation remains poorly understood. Stimulation of primary human keratinocytes with sublytic concentrations of synthetic and purified PSM α3 resulted in upregulation of a large panel of pro-inflammatory chemokine and cytokine gene expression, including CXCL1, CXCL2, CXCL3, CXCL5, CXCL8, CCL20, IL-1α, IL-1β, IL-6, IL-36γ and TNF-α, while inducing the release of CXCL8, CCL20, TNF-α and IL-6. In addition, using S. aureus culture supernatant from mutants deleted from genes encoding either α-type PSMs or all PSM production, PSMs were shown to be the main factors of S. aureus secretome responsible for pro-inflammatory mediator induction in human keratinocytes. On the other hand, α-type PSM-containing supernatant triggered an intense induction of pro-inflammatory mediator expression and secretion during both topical and basal layer stimulation of an ex vivo model of human skin explants, a physiologically relevant model of pluristratified epidermis. Taken together, the results of this study show that PSMs and more specifically α-type PSMs are major virulence factors of S. aureus inducing a potent inflammatory response during infection of the human epidermis and could thereby contribute to AD flare-up through exacerbation of skin inflammation.
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Affiliation(s)
- Alexia Damour
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France
| | - Brandon Robin
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France
| | - Luc Deroche
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France
| | - Lauranne Broutin
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France.,Laboratoire De Bactériologie, CHU de Poitiers, Poitiers, France
| | - Nicolas Bellin
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France
| | - Julien Verdon
- Laboratoire Ecologie et Biologie des Interactions, UMR CNRS 7267, Université De Poitiers, Poitiers, France
| | - Gérard Lina
- CIRI Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agent Infectieux, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Franck Marie Leclère
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France.,Département de Chirurgie Plastique, Reconstructive et Esthétique, CHU de Poitiers, Poitiers, France
| | - Magali Garcia
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France.,Laboratoire de Virologie et Mycobactériologie, CHU de Poitiers, Poitiers, France
| | - Julie Cremniter
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France.,Laboratoire De Bactériologie, CHU de Poitiers, Poitiers, France
| | - Nicolas Lévêque
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France.,Laboratoire de Virologie et Mycobactériologie, CHU de Poitiers, Poitiers, France
| | - Charles Bodet
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines EA 4331, Université De Poitiers, Poitiers, France
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Broutin L, Deroche L, Michaud A, Le Moal G, Burucoa C, Gayet LE, Plouzeau C, Pichon M. First description of bacteremia caused by Oscillibacter valericigenes in a patient hospitalized for leg amputation. Anaerobe 2020; 64:102244. [PMID: 32712374 DOI: 10.1016/j.anaerobe.2020.102244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Abstract
Initially isolated from the alimentary canal of a Japanese corbicula clam, Oscillibacter valericigenes is a Gram-negative rod, of which culture remains very difficult. Herein we present the first case of bacteremia due to Oscillibacter valericigenes, in humans. A 55-year-old man was hospitalized for clinical management of multiple neglected leg wounds (colonized with maggots) that had occurred during a motorcycle accident. Following radiological confirmation of the bone infection, a transfemoral amputation was performed to limit the risk of extended infection. During hospitalization, before the amputation, the patient experienced fever, biological inflammation justifying the sampling of multiple blood cultures. Anaerobic blood culture was positive after 34 hours, without identification by routine procedure (MALDI-TOF), justifying identification by 16S DNA sequencing. In the absence of possible subculture, antibiotic sensitivity testing could not be performed. A pre-emptive treatment by piperacillin-tazobactam was introduced for 14 days. The evolution was good, except for a local disunion. Complete phylogenic analysis of the clinical strain showed that it significantly differed from the reference strain, which is distantly related to the Clostridia cluster IV. Due to the culture conditions and specialized identification method by sequencing, prevalence of O. valericigenes may be underestimated. Optimization of blood culture procedures and utilization of 16S rRNA gene sequencing are tools needed for identification of rare pathogens that could help to optimize clinical management of infected patients.
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Affiliation(s)
- Lauranne Broutin
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, Poitiers, France
| | - Luc Deroche
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, Poitiers, France
| | - Anthony Michaud
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, Poitiers, France
| | - Gwenaël Le Moal
- University Hospital of Poitiers, Department of Infectious Diseases, CHU, Poitiers, France
| | - Christophe Burucoa
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, Poitiers, France
| | - Louis-Etienne Gayet
- University Hospital of Poitiers, Department of Orthopedic Surgery and Traumatology, CHU, Poitiers, France
| | - Chloé Plouzeau
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, Poitiers, France
| | - Maxime Pichon
- University Hospital of Poitiers, Bacteriology and Infection Control Laboratory, Infectious Agents Department, Poitiers, France.
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8
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Deroche L, Bémer P, Valentin AS, Jolivet-Gougeon A, Tandé D, Héry-Arnaud G, Lemarié C, Kempf M, Bret L, Burucoa C, Corvec S, Plouzeau C. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. J Clin Med 2019; 8:jcm8122113. [PMID: 31810267 PMCID: PMC6947470 DOI: 10.3390/jcm8122113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.
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Affiliation(s)
- Luc Deroche
- Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France; (C.B.); (C.P.)
- Correspondence: or
| | - Pascale Bémer
- Bacteriology-Hospital Hygiene Department, University Hospital of Nantes, Nantes University, F-44000 Nantes, France; (P.B.); (S.C.)
| | - Anne-Sophie Valentin
- Bacteriology-Hospital Hygiene Department, University Hospital of Tours, Tours University, F-37000 Tours, France;
| | - Anne Jolivet-Gougeon
- Univ Rennes, INSERM, University Hospital of Rennes, NUMECAN Institute (Nutrition Metabolisms and Cancer), F-35000 Rennes, France;
| | - Didier Tandé
- Bacteriology-Hospital Hygiene Department, University Hospital of Brest, Brest University, F-29000 Brest, France; (D.T.); (G.H.-A.)
| | - Geneviève Héry-Arnaud
- Bacteriology-Hospital Hygiene Department, University Hospital of Brest, Brest University, F-29000 Brest, France; (D.T.); (G.H.-A.)
| | - Carole Lemarié
- Bacteriology-Hospital Hygiene Department, University Hospital of Angers, Angers University, F-49000 Angers, France; (C.L.); (M.K.)
| | - Marie Kempf
- Bacteriology-Hospital Hygiene Department, University Hospital of Angers, Angers University, F-49000 Angers, France; (C.L.); (M.K.)
| | - Laurent Bret
- Bacteriology-Hospital Hygiene Department, Hospital of Orléans, F-45000 Orléans, France;
| | - Christophe Burucoa
- Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France; (C.B.); (C.P.)
| | - Stéphane Corvec
- Bacteriology-Hospital Hygiene Department, University Hospital of Nantes, Nantes University, F-44000 Nantes, France; (P.B.); (S.C.)
| | - Chloé Plouzeau
- Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France; (C.B.); (C.P.)
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Deroche L, Plouzeau C, Bémer P, Tandé D, Valentin AS, Jolivet-Gougeon A, Lemarié C, Bret L, Kempf M, Héry-Arnaud G, Corvec S, Burucoa C, Arvieux C, Bernard L. Probabilistic chemotherapy in knee and hip replacement infection: the place of linezolid. Eur J Clin Microbiol Infect Dis 2019; 38:1659-1663. [PMID: 31203474 DOI: 10.1007/s10096-019-03594-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
Abstract
Prosthetic joint infection (PJI) can occur with a wide range of microorganisms and clinical features. After replacement surgery of prosthetic joint, prescription of probabilistic broad-spectrum antimicrobial therapy is usual, while awaiting microbial culture results. The aim of our study was to describe the antibiotic susceptibility of microorganisms isolated from hip and knee PJI. The data were collected to determine the best alternative to the usual combination of piperacillin-tazobactam (TZP) or cefotaxime (CTX) and vancomycin (VAN). Based on a French prospective, multicenter study, we analyzed microbiological susceptibility to antibiotics of 183 strains isolated from patients with confirmed hip or knee PJI. In vitro susceptibility was evaluated: TZP+VAN, TZP+linezolid (LZD), CTX+VAN, and CTX+LZD. We also analyzed resistance to different antibiotics commonly used as oral alternatives. Among the 183 patients with PJI, 62 (34%) had a total knee prosthesis, and 121 (66%) a hip prosthesis. The main identified bacteria were Staphylococcus aureus (32.2% of isolates), coagulase-negative staphylococci (27.3%), Enterobacteriaceae (14.2%), and Streptococcus (13.7%). Infections were polymicrobial for 28 (15.3%) patients. All combinations were highly effective: CTX+VAN, CTX+LZD, TZP+VAN, and TZP+LZD (93.4%, 94%, 98.4%, and 98.9% of all cases respectively). Use of LZD instead of VAN in combination with a broad-spectrum beta-lactam covers almost all of the bacteria isolated in PJI. This association should be considered in probabilistic chemotherapy, as it is particularly easy to use (oral administration and no vancomycin monitoring).
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Affiliation(s)
- Luc Deroche
- Department of Bacteriology, University Hospital of Poitiers, Poitiers, France
| | - Chloé Plouzeau
- Department of Bacteriology, University Hospital of Poitiers, Poitiers, France
| | - Pascale Bémer
- Department of Bacteriology, University Hospital of Nantes, Nantes, France
| | - Didier Tandé
- Department of Bacteriology, University Hospital of Brest, Brest, France
| | | | | | - Carole Lemarié
- Department of Bacteriology, University Hospital of Angers, Angers, France
| | - Laurent Bret
- Department of Bacteriology, Hospital of Orléans, Orléans, France
| | - Marie Kempf
- Department of Bacteriology, University Hospital of Angers, Angers, France
| | | | - Stéphane Corvec
- Department of Bacteriology, University Hospital of Nantes, Nantes, France
| | - Christophe Burucoa
- Department of Bacteriology, University Hospital of Poitiers, Poitiers, France
| | - Cédric Arvieux
- Infectious Diseases Division, University Hospital of Rennes, Rennes, France
| | - Louis Bernard
- Infectious Diseases Division, University Hospital of Tours, Tours, France.
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