Éditeur(s) : HAL CCSD WB Saunders
Résumé : International audience
BACKGROUND: Environmental surveillance is important in high-risk areas of hospitals to prevent fungal infections in immunosuppressed patients. Conventional culture methods for enumerating environmental fungi are time-consuming. AIM: In this field study, a solid-phase cytometry technique (SPC) and a more conventional culture-based method to quantify fungal contamination of hospital air and surface samples were compared. METHODS: For the air sampling, a liquid cyclone air sampler was used with a flow rate of 300 L/min for 10 min in each of four hospital locations. Surface swabbing was done in two locations, with two different swab types. Samples from all areas were processed by SPC and by culture on malt extract agar. FINDINGS: The mean airborne concentrations of viable fungi determined by SPC were about 1.5-fold higher than the mean concentrations obtained with the culture-based method. These differences for air samples were significant in three hospital environments. No significant difference was observed for surface samples between the two swab types and between the two analytical methods. One of the prominent advantages of SPC was its rapidity in comparison with the culture-based method (5 h versus 5 days). CONCLUSION: In this study, we showed that SPC allows for rapid monitoring of viable fungi in hospital environments. SPC can thus be used to provide an early warning and a rapid implementation of corrective measures. Viable fungi detection may be an important tool to assess infectious risk in wards with immunosuppressed patients.
ISSN: 0195-6701

hal-00874713
https://hal.archives-ouvertes.fr/hal-00874713
DOI : 10.1016/j.jhin.2012.10.004
PUBMED : 23313088

Éditeur(s) : HAL CCSD International Union Against Tuberculosis and Lung Disease
Résumé : International audience
ISSN: 1027-3719

inserm-00864941
http://www.hal.inserm.fr/inserm-00864941
DOI : 10.5588/ijtld.12.0051
PUBMED : 22762431

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Our goal was to determine if the US Environmental Relative Moldiness Index (ERMI) scale might have application in France. Twenty homes in Brittany, north western region of France were classified by inspection as "Moldy" or "Non-Moldy". Dust and air samples were collected (MiTest sampler or Coriolis sampler, respectively) from each home and analyzed by quantitative polymerase chain reaction (QPCR) for the 36 fungi that make-up the ERMI. Inspection and ERMI values provided a consistent assessment for 90% of the homes. Two homes originally classified as "Non-Moldy" were found to fit better into the "Moldy" category based on the QPCR analysis and the ERMI. Dust and air samples analyzed by QPCR provided similar fungal contamination assessments. In conclusion, a metric like the ERMI describes mold burdens in homes on a continuum, as opposed to the frequently used dichotomous approach (moldy vs. non-moldy). Although a larger, random national sampling of French homes is needed, these results suggest that these same 36 fungi may be useful in creating an ERMI for France.
ISSN: 1438-4639

inserm-00817898
http://www.hal.inserm.fr/inserm-00817898
http://www.hal.inserm.fr/inserm-00817898/document
http://www.hal.inserm.fr/inserm-00817898/file/Gangneux-Possible-Application-accepted.pdf
DOI : 10.1016/j.ijheh.2012.06.004

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
ISSN: 1156-5233

hal-00878047
https://hal.archives-ouvertes.fr/hal-00878047
DOI : 10.1016/j.mycmed.2012.07.007

Éditeur(s) : HAL CCSD American Society for Microbiology
Résumé : International audience
Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definite diagnosis relies on parasite DNA detection, but the incidence and burden of disease are ill-known in HIV-negative patients. A three-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, to record the frequency of Toxoplasma DNA detection in ICPs, to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, out of 31,640 PCR performed in ICPs, 610 were positive (323 patients). Blood (n=337), cerebrospinal fluid (n=101) and aqueous humor (n=100) samples were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem-cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV+; the remaining 62% consisted in 72 HSCT, 14 solid-organ transplants, and 26 miscellaneous immunodeficiencies. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and received specific treatment. Overall survival of allo-HSCT patients at two months was better in centers with PCR follow-up than in other centers (p<0.01). This study provides updated data on the frequency of toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide pre-emptive treatment and improve outcome.
ISSN: 0095-1137

hal-01134189
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01134189
DOI : 10.1128/JCM.03282-14
PUBMED : 25762774

Éditeur(s) : HAL CCSD Taylor & Francis
Résumé : International audience
Portable microbial samplers are useful for detecting microorganisms in the air. However, limited data are available on their performance when sampling airborne biological agents in a routine practice. We compared bacterial and fungal concentrations obtained in field conditions using three impactor samplers with different designs (AES Chemunex Sampl'Air, bioMérieux Air Ideal, and Sartorius AirPort MD8/BACTair). The linearity of mold collection was tested in the range of 100 L to 1000 L, and all the devices had a correlation coefficient higher than 0.95. For optimal comparison of the samplers, we performed experiments in different hospital rooms with varying levels of air biocontamination. Each sampling procedure was repeated to assess reproducibility. No significant difference between the samplers was observed for the mold concentrations on Sabouraud agar, whereas Sampl'Air collected significantly more bacteria on tryptic soy agar than Air Ideal or BACTair at one of the sites. Impactor location in the room was nevertheless associated with the variability observed with the three samplers at the highest microbial concentration levels. On the basis of their performance, autonomy and simplicity of use, these three impactors are suitable for routine indoor evaluation of microbial air contamination.
ISSN: 1545-9624

hal-00874614
https://hal.archives-ouvertes.fr/hal-00874614
DOI : 10.1080/15459624.2013.800955
PUBMED : 23799861

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
OBJECTIVES: Invasive fungal disease (IFD) remains a major concern in patients with haematological conditions. We describe diagnoses, therapeutic management and outcomes in unselected consecutive patients from haematological facilities treated for suspected or documented IFD. METHODS: In this observational prospective study, children/adults with haematological conditions or haematopoietic stem cell transplantation (HSCT) were recruited upon start of non-prophylactic systemic antifungal treatment in 37 French haematological facilities (December 2007 to December 2008). IFD episodes were classified according to the 2008 EORTC/MSG criteria. RESULTS: The cohort included 419 patients (298 adults and 121 children): 88% haematological malignancies, 28% HSCT recipients and 68% neutropenic. Patients had 423 IFD episodes: 21% mycologically documented (59% probable/proven aspergillosis, 32% proven candidiasis and 9% probable/proven other IFD) and 20% classified as possible IFD. The remaining cases were assigned to two groups: febrile neutropenia (34%) and unclassified (25%), 9% of which were classified as possible/probable/proven IFD by day 7. Treatment was thus initiated early in 59% of patients; liposomal amphotericin B and caspofungin were the most common single-agent therapies. The 12 week mortality was 18% for probable/proven aspergillosis, 15% for proven candidiasis, 10% for probable/proven other IFD, 9% for possible IFD, 3% for febrile neutropenia and 12% for unclassified episodes (log rank P = 0.016); it was dependent on age, complete remission of underlying haematological disease and mechanical ventilation. CONCLUSIONS: In this comprehensive sample of haematological patients receiving antifungal treatment, we observe a widespread resort to early therapy and a low mortality rate, including in patients with probable or proven IFD.
ISSN: 0305-7453

hal-00874741
https://hal.archives-ouvertes.fr/hal-00874741
DOI : 10.1093/jac/dks266
PUBMED : 22850692

Éditeur(s) : HAL CCSD
Congrès de la Société Française de Mycologie Médicale
Poitiers, France

hal-00676567
https://hal.archives-ouvertes.fr/hal-00676567

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND: We aimed to assess, for the first time, the nature of the indoor air contamination of hospitals. METHODS AND FINDINGS: More than 40 volatile organic compounds (VOCs) including aliphatic, aromatic and halogenated hydrocarbons, aldehydes, alcohols, ketones, ethers and terpenes were measured in a teaching hospital in France, from sampling in six sampling sites--reception hall, patient room, nursing care, post-anesthesia care unit, parasitology-mycology laboratory and flexible endoscope disinfection unit--in the morning and in the afternoon, during three consecutive days. Our results showed that the main compounds found in indoor air were alcohols (arithmetic means ± SD: 928±958 µg/m³ and 47.9±52.2 µg/m³ for ethanol and isopropanol, respectively), ethers (75.6±157 µg/m³ for ether) and ketones (22.6±20.6 µg/m³ for acetone). Concentrations levels of aromatic and halogenated hydrocarbons, ketones, aldehydes and limonene were widely variable between sampling sites, due to building age and type of products used according to health activities conducted in each site. A high temporal variability was observed in concentrations of alcohols, probably due to the intensive use of alcohol-based hand rubs in all sites. Qualitative analysis of air samples led to the identification of other compounds, including siloxanes (hexamethyldisiloxane, octamethyltrisiloxane, decamethylcyclopentasiloxane), anesthetic gases (sevoflurane, desflurane), aliphatic hydrocarbons (butane), esters (ethylacetate), terpenes (camphor, α-bisabolol), aldehydes (benzaldehyde) and organic acids (benzoic acid) depending on sites. CONCLUSION: For all compounds, concentrations measured were lower than concentrations known to be harmful in humans. However, results showed that indoor air of sampling locations contains a complex mixture of VOCs. Further multicenter studies are required to compare these results. A full understanding of the exposure of healthcare workers and patients to complex mixtures of chemical compounds can then be related to potential health outcomes.
ISSN: 1932-6203

hal-00874694
https://hal.archives-ouvertes.fr/hal-00874694
https://hal.archives-ouvertes.fr/hal-00874694/document
https://hal.archives-ouvertes.fr/hal-00874694/file/VOC_Contamination-accepted.pdf
DOI : 10.1371/journal.pone.0055535

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Le groupe de recherche sur les avancées en pneumo-pédiatrie (GRAPP) a élaboré en 2013 des recommandations sur l'utilisation des nouveaux outils diagnostiques dans les infections respiratoires basses de l'enfant de plus de trois mois. Ces recommandations sont présentées ici en un texte court, le texte long est disponible sur le site de la Société française de pédiatrie www.sfpediatrie.com et de la Société pédiatrique de pneumologie et d'allergologie (SP2A) www.sp2a.fr.
ISSN: 0929-693X

hal-00994569
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00994569
DOI : 10.1016/j.arcped.2014.01.004
PUBMED : 24613479

Éditeur(s) : HAL CCSD Oxford University Press (OUP): Policy A1 - Oxford Open Option C
Résumé : International audience
BACKGROUND: Infections of renal grafts with Candida species can induce life-threatening complications in the recipient. METHODS: A 9-year retrospective study involving all of the transplant centers in France was designed to determine the incidence, origin, characteristics, and outcome of graft-site candidiasis that occurred after kidney transplantation. Yeasts cultured from preservation or drainage solutions and graft specimens were recorded. RESULTS: Among 18,617 kidney grafts, 18 recipients corresponding to 12 donors developed culture-confirmed graft-site candidiasis (incidence, 1 case per 1000 grafts) a median of 25 days after the graft procedure. Clinical presentations included 14 cases of renal arteritis (13 were complicated by aneurysm), 1 urinoma, 2 graft site abscesses, and 1 surgical site infection. Candida albicans was involved in 13 cases. A unique C. albicans genotype or a single rare Candida species was involved in each episode. Together with the clinical history, these findings demonstrate that organ contamination followed by transmission to the recipient occurred during recovery. Therapeutic management varied from simple monitoring in 1 case to a combination of surgery (nephrectomy in 9 cases and arterial bypass in 9 cases) and antifungal therapy (14 cases). Overall, 3 of 18 kidney transplant recipients died, and 9 had their graft surgically removed. CONCLUSION: Graft-transmitted candidiasis that ends most often in fungal arteritis is associated with high morbidity and mortality after kidney transplantation and is related to organ contamination during recovery in the donor.
Clinical Infectious Diseases

hal-00676313
https://hal.archives-ouvertes.fr/hal-00676313
DOI : 10.1086/595688
PUBMED : 19090753

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
ISSN: 1156-5233

hal-00878036
https://hal.archives-ouvertes.fr/hal-00878036
DOI : 10.1016/j.mycmed.2012.07.030