Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases.Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609.

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Staphylococcus aureus is a major cause of nosocomial and community-acquired infections. The predominance of two capsular polysaccharides, types 5 and 8, on the surface of clinical isolates led to the development of a conjugate vaccine (StaphVAX) based on capsular polysaccharides types 5 and 8 conjugated to a carrier protein.We have studied the capsular phenotypes and genotypes of 195 isolates representative of all clinical syndromes that encompassed both hospital and community-acquired infections. These isolates were mainly detected in France between January 2001 and December 2004. In this population, most of clinical isolates (87%) expressed either capsular polysaccharide type 5 (42%) or 8 (45%), whereas 13% were nontypeable by the serotyping method with antibodies specific to capsular polysaccharide type 5 or 8. These 26 nontypeable strains were further serotyped and were demonstrated to express the cell wall surface antigen 336, a polyribitol phosphate N-acetylglucosamine, which resembles cell wall teichoic acid. Among methicillin-resistant Staphylococcus aureus (MRSA) strains, we found a predominance of serotype 5 for 64% of strains, whereas MSSA isolates were predominantly capsular serotype 8 (60%). All S. aureus clinical isolates included in the present study have been investigated by PCR method, demonstrating that all isolates carried either the cap5 or the cap8 locus.

We conducted a prospective multicenter study of methicillin-resistant Staphylococcus aureus (MRSA) isolates, including the first five consecutive clinical isolates, collected between September 2006 and February 2007 in 23 hospitals located throughout France (Fig. 1). The 111 isolates were tested for their antibiotic susceptibility patterns and were extensively characterized by screening for drug resistance and agr alleles, multilocus sequence typing (ST), staphylococcal cassette chromosome mec (SCCmec) typing, spa typing, and PCR profiling of 21 toxin genes. Clones were designated by their ST followed by their SCCmec type (I to VI). The Lyon clone ST8-IV or ST8-IV variant (n ‫؍‬ 77; 69.4%) was widely distributed. Four minor clones were also detected, namely, the "classical" Pediatric clone ST5-IV (n ‫؍‬ 9; 8.1%), the "new" Pediatric clone ST5-VI (n ‫؍‬ 8; 7.2%), the clone Geraldine ST5-I truncated (n ‫؍‬ 7; 6.3%), and the European clone ST80-IV (n ‫؍‬ 4; 3.6%). The six other isolates were related to five rare clones. Relative to that of other European countries, the situation in France is marked by the predominance of a specific major clone and the worrying emergence of minor clones with enhanced virulence and new antibiotic susceptibility profiles.

Clinical microbiology has always been a slowly evolving and conservative science. The sub-field of bacteriology has been and still is dominated for over a century by culture-based technologies. The integration of serological and molecular methodologies during the seventies and eighties of the previous century took place relatively slowly and in a cumbersome fashion. When nucleic acid amplification technologies became available in the early nineties, the predicted "revolution" was again slow but in the end a real paradigm shift did take place. Several of the culture-based technologies were successfully replaced by tests aimed at nucleic acid detection. More recently a second revolution occurred. Mass spectrometry was introduced and broadly accepted as a new diagnostic gold standard for microbial species identification. Apparently, the diagnostic landscape is changing, albeit slowly, and the combination of newly identified infectious etiologies and the availability of innovative technologies has now opened new avenues for modernizing clinical microbiology. However, the improvement of microbial antibiotic susceptibility testing is still lagging behind. In this review we aim to sketch the most recent developments in laboratory-based clinical bacteriology and to provide an overview of emerging novel diagnostic approaches.

Candida auris is an emerging antifungal resistant yeast species causing nosocomial and invasive infections, emphasising the need of improved diagnostics and epidemiological typing methods. We show that MALDI-TOF VITEK-MS followed by amplified length polymorphisms allows for accurate species identification and subsequent epidemiological characterisation of strains encountered during potential outbreaks.

eThe integration of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) in clinical microbiology has revolutionized species identification of bacteria, yeasts, and molds. However, beyond straightforward identification, the method has also been suggested to have the potential for subspecies-level or even type-level epidemiological analyses. This minireview explores MALDI-TOF MS-based typing, which has already been performed on many clinically relevant species. We discuss the limits of the method's resolution and we suggest interpretative criteria allowing valid comparison of strain-specific data. We conclude that guidelines for MALDI-TOF MS-based typing can be developed along the same lines as those used for the interpretation of data from pulsed-field gel electrophoresis (PFGE). Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has recently been integrated into the routine diagnostic workflow of many industrial, pharmaceutical, and medical microbiology laboratories. It has already been thoroughly evaluated for the identification of clinically relevant bacterial species, including anaerobes, Gram-positive rods and cocci, Enterobacteriaceae, and miscellaneous Gram-negative (including nonfermentative) rods, with adequate to excellent results (1, 2).Species identification, however, is only a first step in the diagnostic workflow. The ability to quickly and reliably distinguish or "type" related bacterial isolates is essential for bacterial transmission studies and larger-scale epidemiological surveillance projects. "Conventional" phenotyping methods, such as multiple-susceptibility testing, phage typing, serotyping, biochemical typing, and several others, have been important contributors to our understanding of the epidemiology of community-and health careassociated infections. However, these methods all have practical limitations which render them largely unsuitable for comprehensive bacterial population analyses as well as for scientifically less ambitious but critical infection surveillance. Furthermore, most phenotypic methods have been developed for individual bacterial taxa and are not transferable to other taxa without considerable adaptation.Hence, over the past 2 decades, phenotyping has been largely replaced by "molecular" genotyping. Clonal reproduction by binary fission imprints the evolutionary history of the organism in genotypic markers amenable to analysis by nucleic acid-mediated methods. However, in practice, the ease with which recombination, transfection, and transformation can take place in bacteria necessitates that data from multiple genetic markers are analyzed in defining a "precise" genotype and even then there is no guarantee that an adequate natural taxonomy will be derived. Polyphasic taxonomy currently uses combinations of different phenotypic and/or genotypic data sets to define genera, species, and entities at or below the subspecies level. Still, all these approaches remain time-consuming and relatively...

d; POLE Pharma Consulting, Breganzona, Switzerland e The objective of this research was to extend the Vitek MS fungal knowledge base version 2.0.0 to allow the robust identification of clinically relevant dermatophytes, using a variety of strains, incubation times, and growth conditions. First, we established a quick and reliable method for sample preparation to obtain a reliable and reproducible identification independently of the growth conditions. The Vitek MS V2.0.0 fungal knowledge base was then expanded using 134 well-characterized strains belonging to 17 species in the genera Epidermophyton, Microsporum, and Trichophyton. Cluster analysis based on mass spectrum similarity indicated good species discrimination independently of the culture conditions. We achieved a good separation of the subpopulations of the Trichophyton anamorph of Arthroderma benhamiae and of anthropophilic and zoophilic strains of Trichophyton interdigitale. Overall, the 1,130 mass spectra obtained for dermatophytes gave an estimated identification performance of 98.4%. The expanded fungal knowledge base was then validated using 131 clinical isolates of dermatophytes belonging to 13 taxa. For 8 taxa all strains were correctly identified, and for 3 the rate of successful identification was >90%; 75% (6/8) of the M. gypseum strains were correctly identified, whereas only 47% (18/38) of the African T. rubrum population (also called T. soudanense) were recognized accurately, with a large quantity of strains misidentified as T. violaceum, demonstrating the close relationship of these two taxa. The method of sample preparation was fast and efficient and the expanded Vitek MS fungal knowledge base reliable and robust, allowing reproducible dermatophyte identifications in the routine laboratory. D ermatophytes in the genera Epidermophyton, Microsporum, and Trichophyton are usually characterized and identified by cultural and morphological characters and physiological tests or, more recently, by sequencing (1). Morphological identification is time-consuming and complex, usually requiring expert mycological knowledge, while sequencing is comparatively expensive and at least 2 to 3 days elapse before sequencing results are available.Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is a reliable technique for the identification and typing of microbial pathogens such as bacteria (2-7), yeasts (8-10), and filamentous fungi, including dermatophytes (7,(11)(12)(13)(14)(15)(16)(17). Recent studies confirm that this technique may be very attractive for dermatophyte identification (18-22). In one study, the rate of correct identification of isolates belonging to the T. mentagrophytes complex was 89% (19), and in others, the overall rates of successful identification of dermatophyte species reached 95.8% (18), 97.8% (21), and 99.3% (20), demonstrating the potential of MALDI-TOF MS to replace classical identification methods. The technique has now also been used for the direct identification of dermatophytes in c...