'Leptotrichia amnionii' is an underestimated fastidious inhabitant of the vaginal flora that can cause upper genital tract infections when predisposing factors are present. We describe here what is believed to be the first reported case of early onset meningitis due to 'L. amnionii' in a neonate with intrauterine growth retardation. The outcome was favourable after cefotaxime treatment. Case reportA 23-year-old primigravida woman was admitted to the Teaching Hospital of Amiens (Amiens, France) for preterm labour (PTL) at 29 weeks of gestation and intrauterine growth retardation, which were attributed to alcoholism, smoking and gestational hypertension. Pelvic examination revealed cervical dilatation and apparently intact membranes. The patient was afebrile and haemodynamically stable, had no abdominal pain, and had a leukocyte count of 9.5610 3 cells ml 21 . Serological testing of maternal blood for syphilis, human immunodeficiency virus, hepatitis B, Toxoplasma gondii and rubella was negative. The PTL was treated with nifedipine as a tocolytic (10 mg every 15 min during the first hour followed by 20 mg every 12 h).At this time, a sample taken from the cervix and vaginal exudate showed the presence of abundant Gram-negative rods that did not grow under aerobic conditions, which was in agreement with bacterial vaginosis. The patient was treated with amoxicillin (50 mg kg 21 per day) for 7 days. One week after completing treatment, her testof-cure vaginal culture yielded an Escherichia coli isolate producing penicillinase. A co-amoxiclav treatment was carried out for the next 7 days (50 mg kg 21 per day).At 37 weeks gestation, a 1630 g live-born girl was delivered by spontaneous vaginal delivery with Apgar scores of 2 (1 min), 6 (5 min) and 8 (10 min). The total body length and the cranial circumference were 42 cm and 31.5 cm, respectively. The intrauterine growth retardation was homogeneous. There was no suspicion of materno-fetal infection on clinical grounds. No sample was taken from the infant and the amniotic fluid at delivery. During admission, the mother was never febrile and did not complain of abdominal tenderness or chills. She was discharged 2 days after delivery without further complications. At a 6-week follow-up, she remained well, with no signs of infection.After an uneventful observation period, the baby deteriorated at day 6 being febrile (39.1 u C) and hypotonic. On examination, her respiratory rate was 48 breaths min 21 , and her heart rate was 180 beats min 21 . She had no focal neurological signs. Her anterior fontanelle was full but not bulging. Cranial ultrasonography findings were normal. The rest of the systemic examination was unremarkable. Laboratory findings revealed a white blood cell count of 10.1610 3 cells ml 21 , a C-reactive protein level of 108 mg l 21 and a blood glucose level of 5 mmol l 21 . Lumbar puncture revealed cerebrospinal fluid (CSF) that was cloudy with 1450 white blood cells ml 21 (98 % polymorphonuclear leukocytes and 2 % mononuclear cells), an elevated concentratio...
Although carbapenemase-producing Enterobacteriaceae (CPE) have become a serious public health issue, their detection remains challenging. The aim of this study was to implement a test based on imipenem hydrolysis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS), using 65 strains producing or not a carbapenemase. Then, we compared its performance to that of the Rapidec Carba NP test using 20 additional strains. The MS-based test effectively discriminated between CPE and other non-carbapenem-susceptible strains compared to the Rapidec Carba NP test (sensitivity 100% and 92%, specificity 94% and 92%, respectively). The MS-based test gave less difficulty in interpretation than the colorimetric Rapidec Carba NP test. MALDI-ToF gave a result in less than one hour and limited the use of expensive molecular assays. In conclusion, the hydrolysis test based on MALDI-ToF MS can detect clinically relevant CPE isolates in routine practice. This technology, also described to screen for carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii complex strains, also seems to be interesting in routine practice for these pathogens.
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