Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

We studied the prevalence and species distribution of nontuberculous mycobacteria (NTM) in relation to age in 385 patients with cystic fibrosis (CF) (mean age ؎ standard deviation [range], 12.0 ؎ 6.1 [1 to 24] years; sex ratio, 0.53) attending three Parisian centers. The overall prevalence of NTM in sputum was 8.1% (31 out of 385). The following NTM were isolated (n ‫؍‬ 33): Mycobacterium abscessus (n ‫؍‬ 13, 39.4%), Mycobacterium avium complex (MAC) (n ‫؍‬ 7, 21.2%), Mycobacterium gordonae (n ‫؍‬ 6, 18.2%), and other (n ‫؍‬ 7, 21.2%). Sixteen patients met the American Thoracic Society microbiological criteria for NTM infection, including 11 patients positive for M. abscessus, 4 for MAC, and 1 for MAC and Mycobacterium kansasii. The overall prevalence of NTM was significantly lower in patients under 15 years old than for patients equal to or more than 15 years old (4.8 versus 14.9%, respectively; P ‫؍‬ 0.001). M. abscessus was isolated at all ages, while MAC was not recovered before 15 years (prevalence of 0.0 and 5.2% in patients aged 1 to 14 and 15 to 24, respectively; P ‫؍‬ 0.001).Since 1990, an increasing number of studies have reported the recovery of nontuberculous mycobacteria (NTM) from the respiratory tract of patients with cystic fibrosis (CF) (1,12,13,16). In a recent multicenter study carried out in the United States using standardized bacteriological methods, the overall prevalence of NTM in sputum (percent of patients with at least one positive NTM culture) was 13%, ranging from 7 to 24% depending on the center (16). Mycobacterium avium complex (MAC) (72%) and Mycobacterium abscessus (16%) were the most common species. Other NTM (Mycobacterium gordonae, Mycobacterium kansasii, Mycobacterium lentiflavum, Mycobacterium peregrinum) were much rarer. About 20% of the culture-positive subjects met the American Thoracic Society (ATS) microbiological criteria for NTM pulmonary disease (2); most of these patients were positive for MAC or M. abscessus.Paradoxically, although we know that CF children are vulnerable to bacterial infections from birth, most previous studies on NTM in CF have been conducted in populations mostly or exclusively composed of adults (1, 13, 16). For example, only patients who were 10 years or older were recruited in the multicenter United States study cited above, and the mean age Ϯ standard deviation (SD) was 21 Ϯ 9 years (16). Very few case series involving children with CF have been carried out, and those that have been done mainly used inadequate culture and species identification techniques. However, although imperfect, these studies suggest some differences in the epidemiology of NTM between pediatric and adult CF populations. One of the most intriguing differences is the apparent propensity of CF children to be infected with rapidly growing mycobacteria (RGM). In 1980, Boxerbaum reported that 8 out of 430 CF children were infected with RGM: 6 with organisms referred to as Mycobacterium chelonei (now the M. chelonaeabscessus group) and two with M. fortuitum (4). M. chelonei in...

In order to identify the source of infection by Pseudomonas aeruginosa in patients with cystic fibrosis (CF), systematic genotyping of isolates is necessary. Multiple-locus variable-number tandem-repeat (VNTR) analysis (MLVA) was used to survey the sources of P. aeruginosa infections in a French (Paris, France) pediatric CF center. Between January 2004 and December 2006, 108 patients ages 2 to 21 years who were regularly monitored at the center provided sputum for culture. P. aeruginosa was detected in 46 children, 17 of whom had primary colonization. A total of 163 isolates were recovered. MLVA was improved from a previously published method by the addition of new, informative, and easily typeable markers. Upon genotyping with 15 VNTRs, a total of 39 lineages composed of indistinguishable or closely related isolates, were observed. One of them corresponds to "clone C," which is widely distributed in Europe, and another corresponds to reference strain PA14. Six patients were colonized with two different strains, and the remaining 40 patients were colonized with a single strain. Strains from seven lineages were shared by at least two and up to four patients among a total of 20 patients. The study demonstrates that MLVA is an efficient, easy, and rapid molecular method for epidemiological surveillance for P. aeruginosa infection. The resulting data and strain genetic profiles can be queried on http://bacterial-genotyping.igmors.u-psud.fr.

Outbreaks caused by Enterobacteriaceae isolates producing extended-spectrum ␤-lactamases (ESBL) in neonatal wards can be difficult to control. We report here an extensive outbreak in a neonatal ward with a case of meningitis caused by an ESBL-producing Escherichia coli strain. Between 24 March and 29 April 2009, among the 59 neonates present in the ward, 26 neonates with ESBL-producing E. coli rectal colonization were detected (44%). One of the colonized neonates developed meningitis with a favorable outcome after treatment combining imipenem, gentamicin, and ciprofloxacin. Despite strict intensification of hygiene and isolation procedures for more than 1 month, ward closure to new admissions was necessary to control the outbreak. Randomly amplified polymorphic DNA and pulsed-field gel electrophoresis analysis performed on 31 isolates recovered from 26 neonates and two mother's milk samples showed a clonal strain. ESBL PCR assays indicated that the strain harbored a TEM-52 ESBL encoded by an IncI1 replicon. Phylogenetic analysis by multilocus sequence typing showed that the strain belonged to rare phylogenetic group C, which is closely related to group B1 but appears as group A by the triplex PCR phylogrouping method. The strain harbored the virulence genes fuyA, aer, and iroN and was virulent in a mouse model of septicemia. This work indicates the high potential of colonization, transmission, and virulence of some ESBL-producing E. coli clones.With Streptococcus agalactiae, Escherichia coli is one of the two most common bacterial species frequently responsible of neonatal infections (34). E. coli is the second leading cause of neonatal bacterial meningitis in industrial countries, and recent studies suggest that extraintestinal pathogenic E. coli isolates belong mainly to phylogenetic group B2 (2, 6). An increased rate of E. coli ampicillin resistance after the initiation of intrapartum antimicrobial prophylaxis was previously reported (5, 34). However, most of the E. coli isolates remained susceptible to extended-spectrum cephalosporins (ESC), but currently, extended-spectrum ␤-lactamases (ESBL) are becoming an increasingly important cause of resistance to ESC in E. coli, frequently involving the CTX-M-type enzymes (29). In 2008, Boyer-Mariotte et al. reported one case of fatal neonatal meningitis caused by a CTX-M-15-producing E. coli strain (7). Emergence of ESBL-producing Enterobacteriaceae is a major problem, since the choice of drugs for antimicrobial treatment is limited; moreover, such strains have been increasingly implicated in nosocomial outbreaks in neonatal intensive care units (11,23,33,35). While the spread of CTX-M-type ESBL in the family Enterobacteriaceae, especially in E. coli, has been described worldwide (11,13,15,17), the spread of TEM-type ESBL has been less frequently reported (8, 9). We report here a case of neonatal meningitis caused by a TEM-52 ESBL-producing E. coli strain within a serious outbreak among neonates with rectal colonization and the characteristics of the strain. MATERIA...