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Streptococcus pneumoniae is an important cause of acute otitis media (AOM). The aim of this study was to evaluate trends in antibiotic resistance and circulating serotypes of pneumococci isolated from middle ear fluid of French children with AOM during the period 2001-2011, before and after the introduction of the PCV-7 (2003) and PCV-13 (2010) vaccines. Between 2001 and 2011 the French pneumococcal surveillance network analysed the antibiotic susceptibility of 6683 S. pneumoniae isolated from children with AOM, of which 1569 were serotyped. We observed a significant overall increase in antibiotic susceptibility. Respective resistance (I+R) rates in 2001 and 2011 were 76.9% and 57.3% for penicillin, 43.0% and 29.8% for amoxicillin, and 28.6% and 13.0% for cefotaxime. We also found a marked reduction in vaccine serotypes after PCV-7 implementation, from 63.0% in 2001 to 13.2% in 2011, while the incidence of the additional six serotypes included in PCV-13 increased during the same period, with a particularly high proportion of 19A isolates. The proportion of some non-PCV-13 serotypes also increased between 2001 and 2011, especially 15A and 23A. Before PCV-7 implementation, most (70.8%) penicillin non-susceptible pneumococci belonged to PCV-7 serotypes, whereas in 2011, 56.8% of penicillin non-susceptible pneumococci belonged to serotype 19A. Between 2001 and 2011, antibiotic resistance among pneumococci responsible for AOM in France fell markedly, and PCV-7 serotypes were replaced by non-PCV-7 serotypes, especially 19A. We are continuing to assess the impact of PCV-13, introduced in France in 2010, on pneumococcal serotype circulation and antibiotic resistance.

e Teicoplanin is a key drug for the treatment of multiresistant staphylococcal bone and joint infections (BJI), yet can only be administered via a parenteral route. The objective of this study was to evaluate the safety and tolerability of subcutaneous (s.c.) teicoplanin for that indication over 42 days. Thirty patients with Gram-positive cocci BJI were included. Once the target of 25 to 40 mg/liter trough serum concentration was achieved, treatment was switched from an intravenous to an s.c. route. No discontinuation of teicoplanin related to injection site reaction and no severe local adverse event were observed. On multivariate analysis, better tolerability was observed at the beginning of treatment, in patients over 70 years old, and for dosages less than 600 mg. In conclusion, we recommend s.c. administration of teicoplanin when needed.T he use of a glycopeptide (teicoplanin or vancomycin) for 6 to 12 weeks is recommended to treat infection due to Grampositive bacteria, most commonly involved in bone and joint infections (BJI), when the isolated strain is resistant to several class of antibiotics (1). Teicoplanin, generally preferred over vancomycin because of lower nephrotoxicity and longer elimination halflife (2, 3), has a marketing authorization exclusively for intramuscular (i.m.) or intravenous (i.v.) administration; the painful i.m. route is not routinely used, and long-term daily i.v. administration usually requires placement of a central venous catheter or an implantable chamber (1), which constitutes an invasive procedure and exposes the patient to the risk of mechanical, infectious, and thrombotic complications (4, 5).The efficacy and nephrotoxicity of teicoplanin depend on plasma levels, and a trough serum concentration (C min ) between 25 and 40 mg/liter appears to achieve the best benefit/risk balance (2, 6, 7).When teicoplanin is needed, subcutaneous (s.c.) administration should offer several advantages: preservation of peripheral veins, absence of implantable device-related complications, easier outpatient management, reduction of health care costs, and possibly improved patient comfort.Few clinical studies demonstrated comparable efficacy of the s.c. route to the i.v. route (8, 9). However, the tolerability of treatment administered for more than 2 weeks has not been evaluated.We therefore conducted a prospective open-label study to evaluate the tolerability of s.c. teicoplanin for the treatment of BJI and the usefulness of drug concentration monitoring in dosage adjustments.( This study was conducted at the Amiens University Hospital (France) from March 2013 to June 2015, the institutional ethics review board of which provided ethics approval. The primary objective was to evaluate the tolerability at the injection site of subcutaneous teicoplanin for the treatment of BJI. Each evaluation was scored according to the Common Terminology Criteria for Adverse Events (CTCAE) (10). The secondary objective was to analyze the usefulness of teicoplanin dosage in maintaining its C min within a therap...

Sixty-two clinical isolates of Enterobacter aerogenes resistant to expanded-spectrum cephalosporins were collected between July 2003 and May 2005. Among these isolates, 23 (37.1%) were imipenem (IPM) susceptible, and 39 (62.9%) were IPM insusceptible, of which 89.7% (35/39) were resistant and 10.3% (4/39) were intermediate. Isolate genotypes were compared by pulsed-field gel electrophoresis. Of 62 isolates, 48 belonged to epidemic pulsotype A (77.4%). This pulsotype included 37.5% and 58.4% of ␤-lactam phenotypes b and a, respectively. Nine isolates (14.5%) belonged to pulsotype E, which included 22.3% and 77.7% of phenotypes b and a, respectively. The ␤-lactamases with pIs of 5.4, 6.5, 8.2, and 8.2 corresponded to extended-spectrum ␤-lactamases (ESBLs) TEM-20, TEM-24, SHV-5, and SHV-12, respectively. Of 39 IPM-insusceptible E. aerogenes isolates, 26 (66.6%) were determined to be metallo-␤-lactamase producers, by using a phenotypic method. Of these isolates, 24 harbored a bla IMP-1 gene encoding a protein with a pI of >9.5, and two carried the bla VIM-2 gene encoding a protein with a pI of 5.3, corresponding to ␤-lactamases IMP-1 and VIM-2, respectively. The remaining 13 (33.4%) isolates were negative for the bla IMP-1 and bla VIM-2 genes but showed an alteration of their outer membrane proteins (OMPs). Ten of these isolates produced the two possible OMPs (32 and 42 kDa), with IPM MICs between 8 and 32 g/ml, and three others produced only a 32-kDa OMP with IPM MICs >32 g/ml. This work demonstrates that, in addition to resistance to expanded-spectrum cephalosporins, IPM resistance can occur in ESBL-producing E. aerogenes isolates by carbapenemase production or by the loss of porin in the outer membrane.Enterobacter aerogenes has recently emerged as an important hospital pathogen (13). The prevalence of this bacterial species has increased considerably since the introduction of extendedspectrum cephalosporins into clinical practice (18). Various resistance mechanisms have been described in this species, such as extended-spectrum ␤-lactamases (ESBLs), plasmidmediated production (21), and hyperproduction of the Bush group 1 chromosomally mediated cephalosporinases (32). Although these enzymes are specifically characteristic of some Enterobacter spp., the appearance of similar plasmid-mediated ␤-lactamases in Klebsiella pneumoniae and Escherichia coli raises concerns about the spread of resistance (21, 32). For both ESBL-producing and AmpC-producing isolates, carbapenems are the only ␤-lactam agents active against both resistance mechanisms. Data from previous studies have shown that both ESBL and AmpC ␤-lactamase producers had reduced susceptibility to imipenem (IPM) due to either carbapenemhydrolyzing enzymes (carbapenemase) (30), decreased membrane permeability due to loss of porin in the outer membrane (14, 39), or active efflux (27).The IPM resistance of ESBL-producing E. aerogenes strains was observed for the first time at Amiens University Hospital (A.U.H.) in 2002. To determine whether the strains were epidem...

We saw an increase in this condition related to emergence of Streptococcus pneumoniae serotype 23B.