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See detailPerinatal Group B Streptococcal Disease : Prevention strategies
Melin, Pierrette ULg

Conference (2006, February)

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See detailSelection of resistance during sequential use of preferential antibiotic classes
Damas, Pierre ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Intensive Care Medicine (2006), 32

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU ... [more ▼]

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU with three separated subunits of eight, eight, and ten beds. PATIENTS AND PARTICIPANTS: The study examined the 1,721 patients with a length of stay longer than 2 days. INTERVENTIONS: Three different antibiotic regimens were used sequentially over 2 years as first-choice empirical treatment: cephalosporins, fluoroquinolone, or a penicillin-beta-lactamase inhibitor combination. Each regimen was applied for 8 months in each subunits of the ICU, using "latin square" design. RESULTS: We treated 731 infections in 546 patients (32% of patients staying more than 48 h). There were 25.5 ICU-acquired infections per 1,000 patient-days. Infecting pathogens and colonizing bacteria were found in 2,739 samples from 1,666 patients (96.8%). No significant change in global antibiotic susceptibility was observed over time. However, a decrease in the susceptibility of several species was observed for antibiotics used as the first-line therapy in the unit. Selection pressure of antibiotics and occurrence of resistance during treatment was documented within an 8-month rotation period. CONCLUSIONS: Antibiotic use for periods of several months induces bacterial resistance in common pathogens [less ▲]

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See detailKilling Kinetics of Group B Streptococci for Penicillin in Combination with Gentamicin
Melin, Pierrette ULg; Lorquet, Sophie ULg; Hayette, Marie-Pierre ULg et al

in Sriprakash, Kabada S (Ed.) "Streptococci: New Insights into an Old Enemy", Proceedings of the XVI Lancefield International Symposium on Streptococci and Streptococcal Diseases (2006)

In vitro synergism and killing kinetics studies of penicillin in combination with gentamicin were performed with group B streptococci recently isolated in Belgium. The expected accelerated killing was not ... [more ▼]

In vitro synergism and killing kinetics studies of penicillin in combination with gentamicin were performed with group B streptococci recently isolated in Belgium. The expected accelerated killing was not observed when compared with penicillin alone. D 2005 Elsevier B.V. All rights reserved. [less ▲]

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See detailSérologie infectieuse: interprétation des résultats et pièges à éviter
Huynen, Pascale ULg; Hayette, Marie-Pierre ULg; Melin, Pierrette ULg et al

in Revue Médicale de Liège (2006), 61(12), 827-833

In Medical Microbiology, in addition to the direct methods of indentification of infectious agentss, the serologic indirect techniques by quantification of antibodies have extremely useful in infectiology ... [more ▼]

In Medical Microbiology, in addition to the direct methods of indentification of infectious agentss, the serologic indirect techniques by quantification of antibodies have extremely useful in infectiology, for the diagnosis and the therapeutic or vaccination follow-up as well as for epidemiologic enquiries, serodiagnosis methods have significantly improved. Meanwhile, results may reveal hard to interpret, especially when are tries to specify the time of the beginning of an infection. The results require in the majority of the cases to be compared on two subsequent serum samples, to observe a possible increase in antibodies level. In addition, the infectious serology results may not be considered as the only element of final diagnosis. In all cases, they have to be interpreted and challenged against the clinical context. [less ▲]

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See detailProspective survey of digestive tract colonization with enterobacteriaceae that produce ESBLs in intensive care units
Christiaens, Geneviève ULg; Ciccarella, Y.; Damas, Pierre ULg et al

in Journal of Hospital Infection (2006), 62(3), 386-388

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See detailComparison of the Sensititre YeastOne and Fungitest methods with the NCCLS M27-A2 reference method for antifungal susceptibility testing of yeasts
Hayette, Marie-Pierre ULg; Kondarowski, E.; Melin, Pierrette ULg et al

Poster (2005, December)

Background: The recent introduction of Sensititre YeastOne, a colorimetric microdilution method that includes new antifungal agents has opened the field to MIC’s determination by an easy-to-perform method ... [more ▼]

Background: The recent introduction of Sensititre YeastOne, a colorimetric microdilution method that includes new antifungal agents has opened the field to MIC’s determination by an easy-to-perform method. The aim of this study was to compare this test with the NCCLS M27-A protocol and with Fungitest, a current routine method for yeasts susceptibility testing. Methods: Sensititre YeastOne method (Trek diagnostic), and the NCCLS M27-A2 were performed on 300 yeasts clinical isolates distributed as follow: 125 C. albicans, 273 non-albicans species. Four antifungal agents were tested by the reference method: amphotericine B (AmB), fluconazole (FZ), itraconazole (ITZ), and voriconazole (VOR). The reading of the Sensititre and NCCLS results was visually performed after 24 and 48 h respectively. The Fungitest (Biorad) method was applied on 121 among the 300 isolates and the reading was made after 24 to 48 h incubation time according to the positive control growth. Results: By the NCCLS method, the MICs50/MICs90 (µg/ml) were as follows: 1/2 (AmB); 16/64 (FZ); 0.25/4 (ITZ) and 0.125/2 (VOR). Sensititre vs. NCCLS: The overall agreement within 2 dilutions for AmB, FZ, ITZ and VOR was respectively 54, 82, 80 and 78%. The MICs50/MICs90 were in absolute concordance for VOR by both techniques. Very major errors (%) were recorded as follows: 0.01/0 (AmB with a MIC ≥ 4/8µg/ml for resistant strains respectively), 1.6 (FZ), 3.6 (ITZ) and 2.3 (VOR with a MIC ≥ 8µg/ml for resistant strains). Fungitest vs. NCCLS: The agreement between both methods including minor discrepancies was 98% (AmB), 88% (FZ) and 98% (ITZ). Following the breakpoints given by the manufacturer, very major errors were 6.3% for FZ, 0.03% for ITZ and none for AmB. Conclusions: Sensititre is a convenient alternative to the NCCLS method for yeast susceptibility testing. Fungitest in spite of good correlations must change the breakpoints and include new antifungal agents to be competitive. [less ▲]

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See detailPrevention of perinatal group B streptococcak diseases: update and guidelines
MELIN, Pierrette ULg

in Ducoffre, Geneviève (Ed.) Program and Abstracts book of 2005 Symposium of ISP (2005, November 17)

Face à l’importance et à la gravité des infections périnatales à streptocoques du groupe B (GBS), depuis dix ans, différentes approches préventives ont été proposées. Le point commun est l’administration ... [more ▼]

Face à l’importance et à la gravité des infections périnatales à streptocoques du groupe B (GBS), depuis dix ans, différentes approches préventives ont été proposées. Le point commun est l’administration intraveineuse d’antibiotiques pendant le travail et l’accouchement aux patientes identifiées « à risque » soit par un dépistage de colonisation maternelle pendant la grossesse, soit par la présence de facteurs de risque définis. En 2002, après quelques années d’implémentation et d’adoption des recommandations éditées par le CDC (Centers for Diseases Control and Prevention, Atlanta, USA) en 1996, différentes études ont évalué l’efficacité des alternatives et ont démontré pour différentes raisons, la supériorité du dépistage pendant la grossesse pour l’identification des mères « à risque ». C’est pourquoi, en août 2002, le CDC publiait une version révisée des recommandations en proposant un dépistage universel, c'est-àdire de TOUTES les femmes enceintes. Parallèlement d’autres pays, notamment la France et la Belgique, évaluaient aussi l’efficacité et la faisabilité de différentes stratégies plus ou moins proches de celles du CDC. Depuis juillet 2003, les recommandations belges « Prevention of Perinatal Group B streptococcal Infections. Guidelines from the Belgium Health Council . (SHC. 721) » sont disponibles sur le site du CSH : (http://www.health.fgov.be/CSH_HGR/Francais/Brochures/GBS_2003.pdf et http://www.health.fgov.be/CSH_HGR/Nederlands/Brochures/GBS_2003.pdf). Ces recommandations sont très proches de celles du CDC moyennant quelques adaptations techniques et de prises en charge des nouveau-nés et, qui devraient en améliorer l’efficacité. Ces recommandations belges seront présentées et discutées. L’efficacité optimale attendue de ces recommandations est une réduction de 75% des cas d’infection néonatale précoce confirmés par culture. Pour atteindre cet objectif, la communication et une coordination multidisciplinaires sont indispensables entre le service de gynécologie-obstétrique, le laboratoire, le bloc d’accouchement et le service de néonatologie. [less ▲]

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See detailKilling kinetics of clinical isolates of group B streptococci isolated in Belgium for penicillin alone or in combination with gentamicin
MELIN, Pierrette ULg; Lorquet, Sophie; HAYETTE, Marie-Pierre ULg et al

Poster (2005, September)

BACKGROUND: Associated with high morbidity and mortality, severe GBS infections should be treated with antimicrobial agents alone or in combination characterized by both a good diffusion at the site of ... [more ▼]

BACKGROUND: Associated with high morbidity and mortality, severe GBS infections should be treated with antimicrobial agents alone or in combination characterized by both a good diffusion at the site of infection and a short bactericidal lag time. Penicillin (P) or another blactam used in combination with an aminoglycoside is usually recommended to start the therapy. MICs to gentamicin (G) of GBS recently isolated in Belgium range from 16 to 256 mg/L (> or = MICs of E.faecalis with low level resistance to G, LLR). OBJECTIVES: To investigate in vitro, the potential synergism of P+G on strains of GBS isolated in Belgium. METHODS: According to Etest-AB Biodisk original procedures, for 6 Belgian strains of GBS (G MICs: 16-128 mg/L), we investigated the potential synergism, MICs and time killing curves, between P and G (ratio1:1). In the killing kinetic assays, surviving organisms were enumerated initially and repeatedly after 2, 4, 8 and 20 hours (T2, T4, T8 and T20) at concentrations of P equal to 4 and 16x MICs. Two strains of E.faecalis (1 HighLR and 1 LLR to G) were used as negative and positive control. Each isolate was tested twice. RESULTS: For GBS the P MICs in the combination were within +/- 1 dilution compared with single drug. As expected, P+G produced enhanced killing at T2 and T4 compared with P alone for G LLR E.faecalis and there was no difference for the G HLR E.faecalis. On the contrary, no accelerated killing was observed for any GBS isolate with the combination even for a concentration of 16xMIC of P; moreover for 3 isolates a reduced killing was observed at T2 in the combination tests compared with P alone. CONCLUSION: This limited in vitro testing of the combination P+G compared with P alone for Belgian GBS isolates did not show any synergism or accelerated killing. Moreover the killing was reduced at T2 for half of the isolates. Further evaluation should be performed on these strains with other ratio or other b-lactams as ampicillin in combination with G. [less ▲]

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See detailLe streptocoque du groupe B en clinique antenatale et en salle de travail: un probleme d'attitude systematique
Lorquet, Sophie ULg; Melin, Pierrette ULg; Minon, Jean-Marc et al

in Journal de Gynécologie, Obstétrique et Biologie de la Reproduction (2005), 34(2), 115-27

OBJECTIVES: We wanted to evaluate the compliance to the local recommendations, similar to the CDC (Centers for Disease Control and prevention) recommendations launched in 1996, for the prevention of ... [more ▼]

OBJECTIVES: We wanted to evaluate the compliance to the local recommendations, similar to the CDC (Centers for Disease Control and prevention) recommendations launched in 1996, for the prevention of perinatal group B streptococcal (GBS) disease in the clinical practice of a academic maternity and to identify the causes of missed screening and antibiotic prophylaxis. MATERIALS AND METHODS: Retrospective study of 1249 consecutive pregnancies between 1st January and 31th August 2002. The screening methods for GBS colonisation were the culture of rectovaginal swabs collected between 35 and 37 weeks and/or a rapid antigenic screening performed on a vaginal swab collected at the patient's admission for labor. RESULTS: Rate of global screening was very high (97.8%): 28.8% of antenatal screening versus 90.3% during labor. An appropriate antibiotic prophylaxis was administered to only one-third of positive women when the screening was performed at admission to the labor room, whereas two-thirds of GBS-positive women screened between 35 and 37 weeks received their antibiotic prophylaxis. 2.4%o of the newborns were infected and 2.9% were colonized. Among the different risk factors, intrapartum fever was more often associated with maternal GBS colonisation. The observed sensitivity of the rapide antigenic test was 20.4%. CONCLUSION: Compliance to guidelines is sometimes difficult in the clinical practice of an academic maternity. In our hands the rapid test for GBS screening had low sensitivity. The analysis of these data led to introducing a computerized algorithm in our maternity to improve the prevention of perinatal group B streptococcal disease. [less ▲]

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See detailPerinatal Group B Streptococcal infections
Melin, Pierrette ULg

Conference (2005, February)

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See detailSusceptibility testing of pseudomonas aeruginosa by the Vitek 2 system: A comparison with Etest results
Saegeman, V.; Huynen, Pascale ULg; Colaert, J. et al

in Acta Clinica Belgica (2005), 60(1, JAN-FEB), 3-9

P aeruginona infections need accurate antimicrobial susceptibility data, as treatment mainly relies on antibiotic efficiency in debilitated patients. Vitek 2, a popular automated susceptibility testing ... [more ▼]

P aeruginona infections need accurate antimicrobial susceptibility data, as treatment mainly relies on antibiotic efficiency in debilitated patients. Vitek 2, a popular automated susceptibility testing method, was compared with Etest to assess its reliability on 150 Belgian P. aeruginonas isolates. Vitek 2 and Etest exhibited a high degree of concordance, but some discrepancies in clinical category were evident for cefepime (high minor and borderline very major error rate) and for piperacillin/tazobactam (high very major error rate). Vitek 2 appears to yield valuable information to the clinician concerning the antimicrobials amikacin, ceftazidime, ciprofloxacin and meropenem, in the setting of pseudomonas infection. For cefepime and piperacillin/tazobactam, a confirmatory testing by means of disk diffusion is worth considering. [less ▲]

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See detailPrevention of perinatal GBS infections: update and guidelines
MELIN, Pierrette ULg

Conference (2004, December 17)

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See detailScreening or not for Group B Streptococci: Screening is necessary
MELIN, Pierrette ULg

Conference (2004, December 09)

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See detailHow many women can benefit from a full intrapartum antibiotic prphylaxis for prevention of perinatal group B streptococcal disease?
MELIN, Pierrette ULg; Lorquet, Sophie; Rodriguez Cuns, Grisel et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 44th Intersciences Conference on Antimicrobial Agents and Chemotherapy (2004, November)

Background: In Belgium as in many Western countries, GBS are still the leading cause of severe perinatal infections. Current guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP ... [more ▼]

Background: In Belgium as in many Western countries, GBS are still the leading cause of severe perinatal infections. Current guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP) administered promptly before delivery to pregnant women colonized with GBS. The risk of vertical GBS transmission to the newborn decreases as the duration of prophylaxis increases. The considered threshold for prophylaxis adequacy is the first dose administered at least 4 hours before delivery. Objective: To evaluate the proportion of pregnant women who could benefit from an adequate IAP for the prevention of GBS perinatal infections. Methods: Between June and October 2003, we recorded in two hospitals the elapse time between admission for labor and delivery. We assumed 5 hours represent a useful threshold to allow admission, revision of chart and administration of adequate IAP. The status of vaginal colonization with GBS was determined by CDC’s recommended culture method with Granada agar added. Results: Among 532 women, 27.3 % delivered within 5 hours after admission for labor. The colonization rate for GBS was 25.6 %. The distribution of elapse time between admission and delivery for GBS colonized pregnant women was not significantly different from non colonized women (p <= 1). Conclusions: 1) With the current prevention strategy, 27.3 % of these pregnant women would not have benefit from adequate prophylaxis 2) These results highlight the importance of an efficient organization to warranty prompt administration of IAP as soon as possible when mandatory. 3) If a rapid intrapartum screening test is used, no delay can be afforded “from ward to bench to bed”. [less ▲]

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See detailReal-Time PCR detection of group B streptococci from pregnant women's vaginal specimens at time of delivery: clinical evaluation
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Lorquet, Sophie et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 44th Intersciences Conference on Antimicrobial Agents and Chemotherapy (2004, November)

Guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP) for pregnant women with a positive prenatal culture-based screening for GBS. To improve this strategy, a rapid screening ... [more ▼]

Guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP) for pregnant women with a positive prenatal culture-based screening for GBS. To improve this strategy, a rapid screening performed at the onset of labor with the IDI-Strep BTM test (IDI), a real time PCR detection (Infectio Diagnostic), may be used. Objective: To evaluate the performance of the IDI to detect GBS from vaginal specimens collected at time of delivery. Methods: Intrapartum vaginal specimens from 923 pregnant women were tested to determine the status of GBS colonization, by CDC’s recommended culture method (including selective LIM broth) with a Granada agar (GR) added as well as by the IDI and the immunologic StrepB OIATM test (OIA), BioStar. The performance of the different methods was compared. Results: GBS were recovered from 16.8% and 23.6% specimens respectively on primary culture plates and overall. The colonization rate for GBS was 18.6 % by IDI and 15.7 % by OIA testing. The sensitivity of IDI for identifying vaginal colonization status at delivery was 92 % or 77.1 % when compared to GR primary cultures or to overall culture results, and for the OIA, it was respectively 65.1 or 52.1 %. The specificity was 99.1 % for IDI and 95.5 % for OIA. The turnaround time for obtaining results was less than one hour for both IDI and OIA. Conclusions: 1) Strep B-IDI test, performed on intrapartum vaginal specimens, yields relevant results rapidly enough to be used as an efficient diagnostic tool for the identification of GBS colonized women, in order to offer IAP really targeted to GBS carriers. 2) By comparison to the prenatal screening-based strategy, the high sensitivity and specificity of IDI would allow a reduction of useless IAP and of missed opportunities. 3) IDI testing might be implemented “in routine” in some hospitals for further clinical and practical evaluation. [less ▲]

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