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See detailNEONATAL INVASIVE GROUP B STREPTOCOCCAL (GBS) INFECTIONS IN EUROPE
MELIN, Pierrette ULg; Berner, Reinhard; Afshar, Baharak et al

Poster (2011, September)

Objectives: To describe clinical characteristics and capsular type of GBS isolates responsible of invasive infections in infants from Belgium, Bulgaria, Czech-Republic, Denmark, Germany, Italy, Spain and ... [more ▼]

Objectives: To describe clinical characteristics and capsular type of GBS isolates responsible of invasive infections in infants from Belgium, Bulgaria, Czech-Republic, Denmark, Germany, Italy, Spain and United Kingdom, representing one of the main objectives of the DEVANI (DEsign of a Vaccine Against Neonatal Infections) project. Methods: Surveillance of invasive GBS infections in infants was performed from mid-2008 through December 2010. For each case, a standardized case report form was filled. Samples from cases were processed using local procedures. GBS isolates were characterised in national central labs using standardised type-specific (Ia, Ib-IX) latex agglutination and molecular typing methods. Results: Data on 188 infants with invasive infection were analysed: 144 (60.6%) early onset diseases (EOD) and 74 (39.4%) late onset diseases (LOD). In EOD, mean/median ages at onset were 14/0 hours and the male:female ratio was 1.25. The predominant manifestation at onset was respiratory distress (42% cases); 83% cases were associated with sepsis/bacteremia, 15% with pneumonia and 6% with meningitis. Late-prenatal screening cultures were obtained from 51% of cases’ mothers and only half of these were positive for GBS. Non-elective C-section, intrapartum fever and rupture of membrane (>18h) were more frequent in EO-cases’ mothers versus healthy babies’ GBS-positive mothers. The major serotypes were III (43%), V (21%) and Ia (18%). In LOD, mean/median ages at onset were 42/34 days and the male:female ratio was 0.9. The predominant characteristic at onset was fever (62% cases); 70% cases were associated with sepsis and 30% with meningitis. Very rare manifestations were osteomyelitis and cellulitis. Serotype III was highly predominant (80.6%) followed mainly by Ia (12.5%). Death rates were 4.7/1.5% in EOD/LOD. Conclusions: Clinical presentations were associated with age at onset of infection. Serotype III predominated in neonatal infections. Prenatal screening was not universal neither sensitive. Study funded through the European Commission Seventh Framework. [less ▲]

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See detailPili genes pattern in Group B streptococci from newborn infections and pregnant women in Europe (DEVANI Project)
Imperi, Monica; Rinaudo, Daniela; Creti, Roberta et al

Poster (2011, September)

Objectives Evaluation of the presence and expression of genes coding for pili in a collection of group B streptococcci (GBS) isolated from newborn infection and pregnant women in the course of the DEVANI ... [more ▼]

Objectives Evaluation of the presence and expression of genes coding for pili in a collection of group B streptococcci (GBS) isolated from newborn infection and pregnant women in the course of the DEVANI (Design of a Vaccine Against Neonatal Infection) project. Methods GBS isolates from pregnant women (PW) and cases of newborn infection (NI) were collected in 8 European countries (Belgium, Bulgaria, Czech Republic, Denmark, Germany, Italy, Spain, United Kingdom) during 2009/10 under the auspices of DEVANI. Total no. of strains examined was 1078 and 192 from PW and NI, respectively. Isolates were screened by multiplex PCR and FACS analysis to evaluate respectively gene presence and surface-exposure of pili. Results The most common gene patterns found were PI-2a alone, PI 1+2a and PI 1+2b, while the PI-2b gene alone was very rare. The most prominent result was that a majority of isolates from NI carried the PI-1+2b gene pattern, while the most common pattern among PW was PI-1+2a. Most of analyzed strains express at least one pilus on their surface. Conclusions All isolates contained at least one gene coding for pili. When present pili 2a and 2b were highly surface exposed. [less ▲]

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See detailSeverity of ICU-acquired pneumonia according to infectious microorganisms
DAMAS, Pierre ULg; LAYIOS, Nathalie ULg; SEIDEL, Laurence ULg et al

in Intensive Care Medicine (2011), 37(7), 1128-35

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See detailGBS colonization and screening in pregnancy: how does it work in Europe?
MELIN, Pierrette ULg

Conference (2011, June)

In Europe, as in North America, GBS infections among infants are associated to high morbidity and mortality even if some differences exist between different European countries. During the past two decades ... [more ▼]

In Europe, as in North America, GBS infections among infants are associated to high morbidity and mortality even if some differences exist between different European countries. During the past two decades, major initiatives have been proposed to prevent early onset GBS disease (EOD) and they are still subject of controversy. Several European countries have issued guidelines for the prevention of neonatal GBS diseases, either universal screening-based or risk-based strategy, others have no official guidelines at all. In countries having guidelines, despite considerable efforts and economic resources spent on intrapartum antimicrobial prophylaxis for GBS EOD, cases continue to occur. Among these cases there are a lot of missed opportunities to administer IAP but there are also false negative screening. Therefore in the setting of a maternal GBS-screening program and successful implementation of the strategy, efforts to improve screening for GBS status remain important. The natural reservoir for GBS is the gastrointestinal tract and is likely the source for vaginal colonization. Among pregnant women, GBS carriage rate in the vaginal and rectal flora ranges from 10% up to 30%. Critical factors that influence the accuracy of detecting GBS maternal colonization are the choice of the body sites sampled, the timing of sampling and the use of selective culture media. The evolution of the different culture options to improve the GBS-screening strategy will be reviewed. If the optimal time for performing antenatal cultures is between 35 to 37 weeks’ gestation, as GBS carriage is highly variable, the predictive values of GBS antenatal cultures are not always as good predictors of the maternal GBS status at presentation for delivery as expected. Potential alternative to antenatal GBS-screening culture is the identification of GBS colonization at presentation for delivery. Use of a reliable, sensitive, easy to use rapid test should be cost effective leading to the prevention of more EOGBS cases while reducing the number of unnecessarily IAP. Advances of polymerase chain reaction (PCR) and fluorescence labeling technologies has provided new detection tools for bacterial identification. Therefore, commercialization of rapid detection of GBS through real-time PCR offers the potential for GBS detection among women without prenatal care or those in whom no antenatal culture was collected. However questions of costs and logistics remain unanswered. Could such rapid intrapartum test replace existing screening strategies or could it be used in conjunction with them? Colonizing rates and recommended screening procedures existing through Europe will be reviewed. [less ▲]

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See detailNeonatal Group B Streptococcal Disease: From Pathogenesis to Preventive strategies
MELIN, Pierrette ULg

in Clinical Microbiology & Infection (2011)

Streptococcus agalactiae, or group B streptococcus (GBS), remains the leading cause of neonatal sepsis and meningitis, early onset and late onset diseases (EOD, LOD). Where consensus guidelines to detect ... [more ▼]

Streptococcus agalactiae, or group B streptococcus (GBS), remains the leading cause of neonatal sepsis and meningitis, early onset and late onset diseases (EOD, LOD). Where consensus guidelines to detect and treat intrapartum women with GBS colonization have been widely adopted, incidence of neonatal EOD has dramatically declined. In response to both successful impacts on the incidence of GBS-EOD and analyses of missed opportunities, the first American guidelines for prevention issued in the 90s have since been adapted in several stages to improve their efficacy. In some countries in Europe, nationwide guidelines, whether screening-based or risk-based, for the prevention of neonatal GBS diseases have also been issued and adopted, with the expected impact on incidence of GBS-EOD. In spite of universal screening, in spite of the great progress that has been made, GBS-EOD continues to occur and the GBS burden remains a significant public health issue. Continuous efforts to improve screening for GBS status continue to be important and may be able to take advantage of new rapid diagnostic technologies. The current screening-based strategy for prevention is highly effective but imperfect. Given the challenges, limitations and potential complications of maternal intrapartum prophylaxis, a new approach is still needed. Maternal immunization against GBS is an attractive alternative for the prevention of not only neonatal diseases but also stillbirths and maternal diseases. Vaccines against GBS may likely become the most effective and sustainable long-term preventive strategy. [less ▲]

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See detailAutomatisation en bactériologie: hier, aujourd'hui et demain
MELIN, Pierrette ULg

Scientific conference (2011, April 28)

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See detailInternational External Quality Assurance for Laboratory Identification and Typing of Streptococcus agalactiae (group B streptococci)
Afshar, Baharak; Broughton, Karen; Creti, Roberta et al

in Journal of Clinical Microbiology (2011)

We report the results from the first international multicentre external quality assessment (EQA) studies for molecular and serological typing of group B streptococcus (GBS) strains as part of DEVANI ... [more ▼]

We report the results from the first international multicentre external quality assessment (EQA) studies for molecular and serological typing of group B streptococcus (GBS) strains as part of DEVANI (DEsign of a Vaccine Against Neonatal Infections), a pan-European programme. A questionnaire-based surveillance was undertaken amongst eight DEVANI and six non-DEVANI participating laboratories from 13 countries in order to assess their current microbiological procedures for GBS screening, diagnosis and typing. GBS strains from three EQA distributions were characterised using molecular and serological methods based on GBS capsular polysaccharide typing. Participants were asked to test the first distribution using their current serotyping and genotyping methods. Strep-B-Latex agglutination method was the most widely used method with a typeability value of >90%. A multiplex PCR assay for GBS capsular gene typing was also used by two of 14 centres who achieved a typeability value of 93%; this assay only detected 9 of 10 GBS capsular polysaccharide genes. From the second and third EQA studies standardised protocols were prepared for serological and molecular typing of GBS strains based on the Strep-B-Latex agglutination method and a novel multiplex PCR assay which detected all ten GBS capsular types (Ia to IX). These standardised protocols are being used by many European laboratories and as the use of these methods increase, it is imperative to continuously improve and assess laboratory performance and offer training to any laboratories that have technical difficulties. [less ▲]

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See detailInfection néonatale tardive : Méningite à Streptocoque Agalactiae chez un nouveau-né de 19 jours.
Bequet, Emeline ULg; Guffens, Anne; Defontaine, Elizabeth et al

Poster (2011)

Les infections à Streptocoques du groupe B (SGB ou Streptococcus Agalactiae) sont, dans 80% des cas, précoces (< 7jours de vie) et, dans 20% des cas, tardives (> 7 jours de vie). Dans cette seconde ... [more ▼]

Les infections à Streptocoques du groupe B (SGB ou Streptococcus Agalactiae) sont, dans 80% des cas, précoces (< 7jours de vie) et, dans 20% des cas, tardives (> 7 jours de vie). Dans cette seconde catégorie, 35% des infections sont des méningites et engendrent une morbidité importante chez l’enfant. Nous présentons le cas d’un garçon de 19 jours, né à terme par césarienne, ayant développé une méningite à Streptocoques B, avec un dépistage maternel négatif. A l’admission, l’enfant est septique. Un bilan complet met en évidence une méningite à Streptocoque Agalactiae. Une antibiothérapie empirique à base d’Ampicilline 200mg/kg/j, Céfotaxime 100mg/kg/j et Amikacine 15mg/kg/j est initiée. Ce traitement est maintenu 5 jours ; ensuite, poursuite du Céfotaxime en monothérapie pour une durée totale de 14 jours. Les complications précoces (présentes dans 62% des cas) ne sont pas mises en évidence par les différentes explorations réalisées : mesure du périmètre crânien ; échographie transfontanellaire à la recherche d’une hydrocéphalie ou d’abcès cérébraux ; électroencéphalogramme pour exclure des phénomènes paroxystiques. A moyen et long terme, une surveillance clinique, iconographique, ophtalmologique et de l’audiogramme devra être faite afin d’exclure un retard développemental, des troubles sensoriels ainsi qu’une hydrocéphalie, une encéphalomalacie, une atrophie cérébrale ou une porencéphalie. L’incidence des infections précoces à streptocoques B a pu être réduite grâce au dépistage maternel anténatal et à une antibioprophylaxie en cas de positivité du test. Cependant, l’administration perpartale systématique d’antibiotiques ne permet pas de diminuer le nombre et la gravité des infections tardives, la contamination étant, dans ces cas, essentiellement horizontale. Le taux de complications à 5 ans des méningites à SGB est estimé à 49%, ce qui justifie, chez ces enfants, un suivi neuropédiatrique et sensoriel à long terme. [less ▲]

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See detailDiagnosis and Screening for Cytomegalovirus Infection in Pregnant Women in Cuba as Pronostic Markers of Congenital Infection in Newborns: 2007-2008
Kouri, Vivian; Correa, Consuelo B; Verdasquera, Denis et al

in The Pediatrics Infectious Disease Journal (2010), 29(12), 1105-1110

Background: Human cytomegalovirus (HCMV) has established itself as the most significant cause of congenital infection in the developed world. The objective of this research was prenatal identification of ... [more ▼]

Background: Human cytomegalovirus (HCMV) has established itself as the most significant cause of congenital infection in the developed world. The objective of this research was prenatal identification of pregnant women at risk for developing active infection due to HCMV as well as to diagnose congenitally infected newborns. Methods: A diagnostic algorithm based on specific immunoglobulin G (IgG), IgM, and, IgG avidity was used to screen serum from 1131 pregnant women enrolled prospectively from 3 municipalities from Havana City, Cuba during 2007–2008. Qualitative multiplex nested PCR and quantitative real time-based PCR testing for HCMV DNA were performed on urine and saliva specimens from women detected with active infection and from their newborns. Results: Most women were seropositive to HCMV (92.7%), with 2.38% (27 women) having active infection. Primary infection was detected in 20 pregnant women (1.77%) while 7 patients (0.62%) had active nonprimary infection. HCMV DNA was detected in specimens from 9 of the 27 pregnant women by both PCR methods. HCMV congenital infection was diagnosed in 12 (1.06%) of the 26 live children born from 25 mothers with active infection, for a vertical transmission rate of 46.2%. Two fetal deaths were reported from 2 women with active infection; furthermore 2 newborns were symptomatic at birth and 2 showed sequelae during the follow-up done until 6 months age. Conclusions: Mothers with active infection during the pregnancy and with HCMV excretion had significant risks, RR = 1.16 and RR = 1.35, respectively, to have congenitally infected children. [less ▲]

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See detailEUCAST et stratégie antibiotique: impact en pneumologie
Melin, Pierrette ULg

Conference (2010, November 08)

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See detailFilamentous fungi recovered from the water distribution system of a Belgian university hospital
Hayette, Marie-Pierre ULg; Christiaens, Geneviève ULg; Mutsers, Jacques ULg et al

in Medical Mycology (2010), 48(7), 969-974

A study was carried out over a 4-month winter period in order to assess the presence of filamentous fungi in the water distribution system of the University Hospital of Liège. A total of 197 hot and cold ... [more ▼]

A study was carried out over a 4-month winter period in order to assess the presence of filamentous fungi in the water distribution system of the University Hospital of Liège. A total of 197 hot and cold water samples were collected from the main water supply lines and from the taps at three different hospital sites. Overall, filamentous fungi were recovered from 55% and 50% of the main water distribution system and tap water samples, respectively, with a mean of 3.5 ± 1.5 colony forming units per 500 ml water. Nine different genera were identified, all belonging to the Hyphomycetes class. Aspergillus spp. were recovered from 6% of the samples of the water distribution system and A. fumigatus was the most frequently recovered species (66.6%). However, this species was not isolated from water taps. Fusarium spp. was predominant at one site, where it was found in 28% of tap water samples. No Aspergillus spp. but some Fusarium spp. isolates were identified in samples collected from high-risk units. Filters were introduced at the point-of-use in the haematology unit after completion of the study. The findings of the present study confirm the need for further documented studies to evaluate the safety of the hospital water system and to define new preventive measures. [less ▲]

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See detailHCMV seroprevalence and associated risk factors in pregnat women, Havana City, 2007 to 2008
Correa, C. B.; Kouri, V.; Verdasquera, D. et al

in Prenatal Diagnosis (2010), 30(9), 888-92

Objective To prenatally identify pregnant women at risk of developing congenital infection due to human cytomegalovirus (HCMV). Methods One thousand one hundred and thirty-one pregnant women from three ... [more ▼]

Objective To prenatally identify pregnant women at risk of developing congenital infection due to human cytomegalovirus (HCMV). Methods One thousand one hundred and thirty-one pregnant women from three municipalities from Havana City were serologically screened for HCMV infection (IgM/IgG, IgG avidity) from January 2007 to January 2008. Demographical, epidemiological, and clinical variables were correlated to serologic status to identify predictors of seroconversion in pregnancy. Results The majority of women were seropositive to HCMV (92.6%); 27 women (2.4%) developed HCMV active infection during pregnancy, defined by the detection of IgG+ and IgM+ (7 women), IgM+ and IgG− (2 women), and IgG seroconversion (18 women). Susceptibility of active HCMV infection during pregnancy was associated with maternal age <20 years and nulligravidity. Primary infection was detected in 20 pregnant women (1.8%), whereas 7 patients (0.6%) had active non-primary infection. Conclusion Although pregnant women in Cuba have high seroprevalence rates for HCMV, those younger than 20 years and nulligravidae are at risk of acquiring infection during pregnancy. [less ▲]

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See detailAntibiotic consumption and bacterial resistance
ZAOUI, Kuider; MELIN, Pierrette ULg; CHRISTIAENS, Geneviève ULg et al

Conference (2010, June 25)

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See detailGroup B streptococcal Screening, Diagnosis and Clinically Relevant Resistance
Melin, Pierrette ULg

Conference (2010, June 17)

In the setting of a maternal GBS-screening program and successful implementation of the strategy, efforts to improve screening for GBS status remain important. Critical factors that influence the accuracy ... [more ▼]

In the setting of a maternal GBS-screening program and successful implementation of the strategy, efforts to improve screening for GBS status remain important. Critical factors that influence the accuracy of detecting GBS maternal colonization are the choice of culture media, the body sites sampled, and the timing of sampling. The evolution of the different culture options to improve the GBS-screening strategy will be reviewed. Despite efforts related to sampling and culture procedures, false-negative GBS-screening contributing to continuing EOGBS cases and false-positive screening leading to unecessary IAP, occur. As GBS carriage is highly variable, the predictive values of GBS antenatal cultures are not always good predictors of the maternal GBS status at presentation for delivery. Rapid non-cultural GBS screening methods have been developed: antigenic tests are not sensitive enough to replace antenatal screening cultures but available real-time PCR have faired better in the detection of GBS. Real-time PCR tests could improve effectiveness of the screening-based strategy and lead to a further reduction of the incidence of EOGBS disease. However questions of costs and logistics remain unanswered. Either for therapy or for intrapartum chemoprophylaxis, penicillin G for its bactericidal activity and narrow spectrum, remains the agent of choice. But in the true penicillin allergic patients, clindamycin or erythromycin have been recommended as alternative drugs. However, probably as a consequence of the important use of macrolides, related drug resistance among streptococcal isolates is currently recognized in many countries. Epidemiology of resistance to antimicrobial agents will be presented. [less ▲]

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See detailComparative studies for the serodiagnosis of Chlamydophila and Mycoplasma pneumoniae infections
Huynen, Pascale ULg; Goebel, Marie-Rose ULg; Meex, Cécile ULg et al

in ESCMID (Ed.) Abstract book of the 20th ECCMID (2010, April)

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See detailEUCAST et stratégie antibiotique
MELIN, Pierrette ULg

Conference (2010, February 09)

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See detailThe Sanford Guide to Antimicrobial Therapy 22nd edition of the Belgian/Luxembourg Version 2010-2011
independent Belgian/Luxembourg Working Party on Antimicrobial Therapy, SBIMC-BVIKM; MELIN, Pierrette ULg

Book published by SBIMC-BVIKM - Adapted for use by the medical profession in Belgium and Luxembourg by the independent Belgian/Luxembourg Working Party on Antimicrobial Therapy (2010)

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See detailSpectrométrie de masse MALDI-TOF en bactériologie clinique ou comment identifier une bactérie en une minute
Descy, Julie ULg; Meex, Cécile ULg; Melin, Pierrette ULg et al

in Revue Médicale de Liège (2010), 65(Suppl. Synthèse 2010), 29-34

The major application of MALDI-TOTOF mass spectrometry in clinical microbiology is the bacterial identification based on the analysis of all their proteins (ribosomal and membrane-associated proteins ... [more ▼]

The major application of MALDI-TOTOF mass spectrometry in clinical microbiology is the bacterial identification based on the analysis of all their proteins (ribosomal and membrane-associated proteins). This technology allows the identification of most of bacteria within a few minutes. The method is fast, accurate, reliable and cost-effective by comparison to conventional phenotypic techniques. Other applications of MALDI-TOF mass spectrometry are still under development, as the detection of bacterial toxins or resistance mechanisms to antimicrobial agents. [less ▲]

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