المؤلفون: Huttner, B.D.^1,2,3 (AUTHOR) benedikt.huttner@hcuge.ch, de Lastours, V.^4,5 (AUTHOR), Wassenberg, M.⁶ (AUTHOR), Maharshak, N.⁷ (AUTHOR), Mauris, A.⁸ (AUTHOR), Galperine, T.¹ (AUTHOR), Zanichelli, V.¹ (AUTHOR), Kapel, N.⁹ (AUTHOR), Bellanger, A.¹⁰ (AUTHOR), Olearo, F.¹ (AUTHOR), Duval, X.^11,12,13 (AUTHOR), Armand-Lefevre, L.^5,14 (AUTHOR), Carmeli, Y.¹⁵ (AUTHOR), Bonten, M.^6,16 (AUTHOR), Fantin, B.^4,5 (AUTHOR), Harbarth, S.^1,2,3 (AUTHOR)

المصدر: Clinical Microbiology & Infection. Jul2019, Vol. 25 Issue 7, p830-838. 9p.

مصطلحات موضوعية: *CLINICAL trials, *ANTIBIOTICS, *ENTEROBACTERIACEAE, *MUPIROCIN, *TRANSPLANTATION of organs, tissues, etc.

مصطلحات جغرافية: PARIS (France), UTRECHT (Netherlands), GENEVA (Switzerland)

مستخلص: Intestinal carriage with extended spectrum β-lactamase Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) can persist for months. We aimed to evaluate whether oral antibiotics followed by faecal microbiota transplantation (FMT) can eradicate intestinal carriage with ESBL-E/CPE. Randomized, open-label, superiority trial in four tertiary-care centres (Geneva (G), Paris (P), Utrecht (U), Tel Aviv (T)). Non-immunocompromised adult patients were randomized 1: 1 to either no intervention (control) or a 5-day course of oral antibiotics (colistin sulphate 2 × 106 IU 4×/day; neomycin sulphate 500 mg 4×/day) followed by frozen FMT obtained from unrelated healthy donors. The primary outcome was detectable intestinal carriage of ESBL-E/CPE by stool culture 35–48 days after randomization (V4). ClinicalTrials.gov NCT02472600. The trial was funded by the European Commission (FP7). Thirty-nine patients (G = 14; P = 16; U = 7; T = 2) colonized by ESBL-E (n = 36) and/or CPE (n = 11) were enrolled between February 2016 and June 2017. In the intention-to-treat analysis 9/22 (41%) patients assigned to the intervention arm were negative for ESBL-E/CPE at V4 (1/22 not receiving the intervention imputed as positive) whereas in the control arm 5/17 (29%) patients were negative (one lost to follow up imputed as negative) resulting in an OR for decolonization success of 1.7 (95% CI 0.4–6.4). Study drugs were well tolerated overall but three patients in the intervention group prematurely stopped the study antibiotics because of diarrhoea (all received FMT). Non-absorbable antibiotics followed by FMT slightly decreased ESBL-E/CPE carriage compared with controls; this difference was not statistically significant, potentially due to early trial termination. Further clinical investigations seem warranted. [ABSTRACT FROM AUTHOR]

المؤلفون: Grall, N.^1,2,3 nathalie.grall@aphp.fr, Lazarevic, V.⁴, Gaïa, N.⁴, Couffignal, C.^1,2,5, Laouénan, C.^1,2,5, Ilic-Habensus, E.⁶, Wieder, I.³, Plesiat, P.⁷, Angebault, C.^8,9, Bougnoux, M.E.^8,9, Armand-Lefevre, L.^1,2,3, Andremont, A.^1,2,3, Duval, X.^1,2,6, Schrenzel, J.^4,10

المصدر: International Journal of Antimicrobial Agents. Jul2017, Vol. 50 Issue 1, p81-87. 7p.

مصطلحات موضوعية: *IMIPENEM, *ENTEROBACTERIACEAE, *BETA lactamases, *ANTIBIOTICS, *METAGENOMICS

مستخلص: Imipenem is active against extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) but favours the intestinal emergence of resistance. The effects of imipenem on intestinal microbiota have been studied using culture-based techniques. In this study, the effects were investigated in patients using culture and metagenomic techniques. Seventeen hospitalised adults receiving imipenem were included in a multicentre study (NCT01703299, http://www.clinicaltrials.govTest ). Most patients had a history of antibiotic use and/or hospitalisation. Stools were collected before, during and after imipenem treatment. Bacterial and fungal colonisation was assessed by culture, and microbiota changes were assessed using metagenomics. Unexpectedly, high colonisation rates by imipenem-susceptible ESBL-E before treatment (70.6%) remained stable over time, suggesting that imipenem intestinal concentrations were very low. Carriage rates of carbapenem-resistant Gram-negative bacilli (0–25.0%) were also stable over time, whereas those of yeasts (64.7% before treatment) peaked at 76.5% during treatment and decreased thereafter. However, these trends were not statistically significant. Yeasts included highly diverse colonising Candida spp. Metagenomics showed no global effect of imipenem on the bacterial taxonomic profiles at the sequencing depth used but demonstrated specific changes in the microbiota not detected with culture, attributed to factors other than imipenem, including sampling site or treatment with other antibiotics. In conclusion, culture and metagenomics were highly complementary in characterising the faecal microbiota of patients. The changes observed during imipenem treatment were unexpectedly limited, possibly because the microbiota was already disturbed by previous antibiotic exposure or hospitalisation. [ABSTRACT FROM AUTHOR]

المؤلفون: Sangare, S.A.^1,2,3 vieuxsamba@yahoo.fr, Maiga, A.I.^1,3, Guindo, I.^3,4, Maiga, A.⁵, Camara, N.¹, Savadogo, S.⁵, Diallo, S.^3,6, Bougoudogo, F.^3,4, Armand-Lefevre, L.², Andremont, A.², Maiga, I.I.^5,7

المصدر: Medecine & Maladies Infectieuses. Sep2015, Vol. 45 Issue 9, p374-382. 9p.

مصطلحات موضوعية: *BETA lactamases, *ENTEROBACTERIACEAE, *EPIDEMIOLOGICAL research, *BLOOD testing, *PUBLIC health, *LITERATURE reviews

مصطلحات جغرافية: AFRICA

الملخص (بالإنجليزية): Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from many regions of the world. Epidemiological studies are being conducted in Europe, North America, and Asia. No study has however been conducted in Africa to determine the prevalence and distribution of ESBLs on the continent. This literature review aimed at describing the prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures, as well as the ESBL genes involved at the international level. Our focus was mainly on Africa. We conducted a literature review on PubMed. Articles related to our study field and published between 1996 and 2014 were reviewed and entirely read for most of them, while we only focused on the abstracts of some other articles. Relevant articles to our study were then carefully reviewed and included in the review. The prevalence of ESBL-producing Enterobacteriaceae differs from one country to another. The results of our literature review however indicate that class A ESBLs prevail over the other types. We took into consideration articles focusing on various types of samples to assess the prevalence of ESBL-producing Enterobacteriaceae, but information on isolates from blood cultures is limited. The worldwide prevalence of ESBL-producing Enterobacteriaceae has increased over time. Evidence of ESBL-producing Enterobacteriaceae can be found in all regions of the world. Studies conducted in Africa mainly focused on the Northern and Eastern parts of the continent, while only rare studies were carried out in the rest of the continent. [ABSTRACT FROM AUTHOR]

Abstract (French): Résumé Les entérobactéries productrices de bêtalactamases à spectre étendu (BLSE) ont été trouvées partout dans le monde. Des études de surveillance sont présentes en Europe, en Amérique du Nord et en Asie, mais en Afrique, aucune recherche récapitulative montrant la prévalence et la répartition de BLSE n’a été réalisée. Cette revue de la littérature a pour but de décrire la prévalence des entérobactéries BLSE isolées des hémocultures et les gènes BLSE impliqués dans le monde, tout en mettant un accent particulier sur le cas de l’Afrique. Une recherche de la littérature a été effectuée sur PubMed. Les articles publiés sur le domaine entre 1996 et 2014 ont été examinés et lus en texte intégral pour la majorité et seulement les résumés pour d’autres. Dans notre contexte, les articles qui étaient pertinents ont été évalués et inclus dans l’étude. La prévalence des entérobactéries BLSE varie entre les pays. Les BLSE de classe A ont été majoritairement retrouvées. Plusieurs types d’échantillons ont été étudiés pour estimer la prévalence des entérobactéries BLSE, mais le cas particulier des hémocultures reste vraiment limité. À travers le monde, on observe une tendance de la prévalence des entérobactéries BLSE à la hausse au fil des années. Les entérobactéries BLSE sont courantes un peu partout dans le monde. En Afrique, la majorité des études ont été réalisées au Nord et à l’Est. Très peu d’études ont été réalisées sur le reste du continent. [ABSTRACT FROM AUTHOR]