Erysipelas of the right arm due to Bordetella trematum: a case report

Background

Bordetella trematum is unknown to most clinicians and microbiologists. However, this Gram-negative opportunistic bacterium can be responsible for ulcer superinfection but also bacteremia and sometimes death by septic shock.

Case report

We report the case of erysipelas due to B. trematum with bacteremia in an immunocompromised 88-year-old Caucasian patient.

Conclusion

In immunocompromised patients, unusual microbial agents such as B. trematum can be responsible for cutaneous and systemic infections, requiring specific antibiotic therapy. Therefore, clinicians should be aware of the need for specific bacterial identification such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16S ribosomal RNA sequencing in the context of atypical evolution of erysipelas in such patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13256-021-02896-1.

Practice guidelines for intramuscular injection in mental health: A delphi method

Introduction

Intramuscular injections (IMI) remain a frequent practice in mental health. The available guidelines for IMI in mental health only focus on the technical side of the practices. Moreover, no recent update has been performed to improve practice of IMI in mental health

Objectives

To assess a formalized consensus agreement regarding the best practice concerning IMI in mental health and to develop practice guidelines.

Methods

A two-round Delphi method was used. The scientific committee consisted in one psychiatrist, one orthopaedic surgeon, one infection control practitioner, one hospital pharmacist, one mental health nurse, one nurse exploring care relationship and one nurse educator. From literature review, each expert proposed specific recommendations. The panel experts were asked to rate the appropriateness and the applicability in current practice of each recommendation on a 9-point Likert scale. Panel members were recruited in five mental health institutions. The first round questionnaire was emailed to each respondent on February 2020 and the second one on June. Propositions were considered appropriate and applicable in current practice if the median was >=7. Agreement among experts were judged by the statistical measure of the Interpercentile Range

Results

From the first round, 46 recommendations were retained by 49 nurses. 27 propositions were retained after this second round by 32 nurses. The scientific committee added 12 other recommendations because of their importance in the literature and clinical practice.

Conclusions

This study provides consensus-based recommendations on IMI in mental health. Nursing staff need to be educated about the new guidelines from both the theoretical and clinical perspectives

Disclosure

No significant relationships.

The levonorgestrel intrauterine system for prevention of endometrial cancer in women with obesity: A cost-effectiveness study

OBJECTIVE

To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity.

METHODS

A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars (CAD) per year of life saved. One-way and two-way sensitivity analyses were performed.

RESULTS

The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than $66,400 CAD ($50,000 US dollars) per year of life saved. The strategy becomes cost-effective if the LNG-IUS is inserted at age 57 (strategy #2), at age 52 for strategy #3, at age 51 for strategy #4 and at age 45 for strategy #5, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality.

CONCLUSION

The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity.

Accurate Measurement of the Electron Antineutrino Yield of ^{235}U Fissions from the STEREO Experiment with 119 Days of Reactor-On Data

We report a measurement of the antineutrino rate from the fission of ^{235}U with the STEREO detector using 119 days of reactor turned on. In our analysis, we perform several detailed corrections and achieve the most precise single measurement at reactors with highly enriched ^{235}U fuel. We measure an IBD cross section per fission of σ_{f}=(6.34±0.06[stat]±0.15[sys]±0.15[model])×10^{-43}  cm^{2}/fission and observe a rate deficit of (5.2±0.8[stat]±2.3[sys]±2.3[model])% compared to the model, consistent with the deficit of the world average. Testing ^{235}U as the sole source of the deficit, we find a tension between the results of lowly and highly enriched ^{235}U fuel of 2.1 standard deviations.

Determinants of doctors' antibiotic prescriptions for patients over 75 years old in the terminal stage of palliative care

INTRODUCTION

Notwithstanding high prevalence of presumably bacterial infections in elderly persons (EP) in palliative care (PC), there exists no recommendation on the role of antibiotic therapy (ABP) in this type of situation.

OBJECTIVE

To describe the determinants of antibiotic prescription by general practitioners (GP) and by doctors practicing in institutions (DPI) for patients>75 years, in end-of-life situations in PC.

METHOD

Descriptive investigation by anonymous self-administered questionnaire disseminated in France by e-mail.

RESULTS

A total of 301 questionnaires analyzed: 113 GP, 188 DPIs. The latter were mainly geriatricians (69, 36.6%) and infectologists/internists (41, 21.8%). Sixty-three (55,75%) GPs and 144 (78.7%) DPIs stated that they had prescribed antibiotics. Practice in "EHPAD" retirement homes or intensive care was often associated with non-prescription of antibiotics. Age, PC training and number of patients monitored bore no influence. Family involvement in decision-making was more frequent for GPs than for DPIs. The main purpose of antibiotic therapy was to relieve different symptoms (fever, respiratory congestion, functional urinary signs). Most of the doctors (81%) had previously encountered complications (allergy, adverse effect), which represented the main causes of treatment discontinuation.

CONCLUSION

Antibiotic use in end-of-life EPs in PC seems frequent. In accordance with the principle of beneficence, its goal of often symptom-related; that said, in the absence of scientific data, antibiotic prescription in end-of-life situations should be individualized in view of observing the other ethical caregiving principles (beneficence, non-maleficence, justice, patient autonomy) and re-evaluated daily.

On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents

OBJECTIVES

During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program.

METHODS

To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program.

RESULTS

The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors.

CONCLUSIONS

The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.

Impact of individual social deprivation on environmental risk perception by French pregnant women

Background

Individual social deprivation (ISD) can have significant impact on the life conditions. However, few studies explored the impact of ISD on the preventive behaviors adopted by pregnant women (PW) in relation to exposure of chemicals.

AIM

This study aims to describe the link between ISD and the perception of chemical and environmental risks.

Methods

A cross-sectional survey was performed among PW present in maternity hospitals in Auvergne (France). Face-to-face interviews with a standardized questionnaire were used to collect anonymously the data (socio-demographic characteristics, smoking behaviors, perception of environmental risks (PER Score based on Likert scale ranking from 0 to 10), individual social deprivation (by EPICES score)). Statistical analysis (univariate analysis - logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

300 PW (29±5 years old) were included. The majority of PW reported being aware of the risks associated with chemicals. The PER Score is estimated at 6.3±1.8. It was significantly associated with parity and trimester of pregnancy, and inversely linked to age of PW. The EPICES Score was 19.9 ±17.8 (rank: 0-85). With a precariousness threshold of 30, only a quarter of the PW were in a precarious situation. The EPICES Score was inversely related to age, smoking behaviors, and environmental risks perception. The criterion of choice of everyday products was linked to the EPICES score. 'Organic products' were mainly used by PW with EPICES Score < 30 (not precarious).

Conclusions

The weight of social determinisms on environmental sensitivity highlights the need for targeted prevention. The role of health professionals in prevention and environmental health promotion is essential, especially to detect women of low socioeconomic status who may not be sensitive to media messages and prevention campaigns disseminated by health authorities.

Key messages

Perinatal health professionals must have a major role in environmental health promotion, especially for pregnant women with individual social deprivation. Perception of chemicals and environmental risks was inversely linked to the individual social deprivation (EPICES score) in this French PW population.

Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm³. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

Water-soluble carbohydrates in Patzkea paniculata (L.): a plant strategy to tolerate snowpack reduction and spring drought in subalpine grasslands

In subalpine grasslands of the central French Alps, cessation of traditional mowing promotes dominance of Patzkea paniculata (L.) G.H.Loos (Poaceae) tussocks, with high biomass but low fodder quality. Mowing limits P. paniculata abundance through the depletion of its water-soluble carbohydrate (WSC) reserves, which sustain early spring growth initiation. However, the effectiveness of mowing effects is modulated by grassland functional composition, fertilization and climate change, as WSC compounds, and notably fructans, support plant physiological responses to climate stresses such as drought or frost. To characterize the mechanisms underpinning the control of P. paniculata under global change, we tested the effects of climate manipulation (combined snow removal and drought) and management (cutting and fertilization) alone or in combination on P. paniculata WSC storage in assembled grassland communities of varying functional composition. Management and climate treatments individually decreased seasonal fructan storage, with neither additive nor synergic effects between them, primarily due to the dominance of management over climate effects. Fructan amounts were higher in individuals growing in unmanaged exploitative communities compared to unmanaged conservative communities, regardless of climate treatments, but management overrode these differences. Our findings suggest that reduction by combined snow removal and drought of P. paniculata carbon allocation to WSC storage may similarly limit its dominance to that in current mowing practices.

Short communication: Diets supplemented with starch and corn oil, marine algae, or hydrogenated palm oil differently affect selected metabolite concentrations in cow and goat milk

The objective was to investigate the effects of species (cow vs. goat) and of various dietary lipid supplements, known to modulate milk fat content, on selected metabolites and enzymes in milk and to explore their correlations with performance traits. Twelve Holstein cows and 12 Alpine goats, all multiparous and nonpregnant, and at 86 ± 24.9 and 61 ± 1.8 DIM, respectively, were fed a basal diet (45% forage + 55% concentrate) not supplemented (CTL) or supplemented with corn oil plus wheat starch [COS, 5% of diet dry matter (DM)], marine algae powder (MAP, 1.5% of diet DM), or hydrogenated palm oil (HPO, 3% of diet DM) in a replicated 4 × 4 Latin square design with 28-d experimental periods. Intake, milk production and composition, milk fatty acid profile, and plasma metabolite concentrations were previously reported. Concentrations of 9 milk metabolites [β-hydroxybutyrate (BHB), glucose, glucose-6-phosphate, isocitrate, choline, glutamate, urea, cholesterol, and free amino groups] and 2 milk enzyme activities (alkaline phosphatase and lactate dehydrogenase) were measured on d 24 of each experimental period. Dairy performance data showed marked species and diet effects on milk fat content. Irrespective of diet, cow milk was richer in alkaline phosphatase and glucose compared with goat milk (16 and 3 times more, respectively), whereas goat milk had greater urea and glucose-6-phosphate concentrations compared with cow milk (1.9 and 5.3 times more, respectively). In cows, COS decreased milk BHB and choline (-25 and -43%, respectively) compared with CTL, whereas no effects were observed in goats. The COS and MAP diets increased milk isocitrate compared with CTL in cows, but COS decreased isocitrate concentrations in goat milk. Milk choline was correlated with milk fat content in cows (Spearman r, r_S = +0.73) and goats (r_s = +0.58), and lactate dehydrogenase activity was correlated with milk somatic cell count (r_s = +0.66) in cows but not in goats. We provide evidence of different milk metabolite responses according to species and diets. Metabolites and enzymes secreted in milk may be indicators of specificities of lipid metabolism among ruminant species and may contribute to a better understanding of mechanisms regulating milk fat secretion. Changes in the concentrations of some metabolites considered minor components of milk may be valuable diagnostic tools of mammary gland and animal metabolism as well as of milk processing characteristics.

Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement

OBJECTIVES

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in aortic stenosis (AS). Infective endocarditis (IE) in patients with prosthetic heart valves is associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after TAVI are conflicting. We evaluated these issues in patients with percutaneous TAVI vs. isolated surgical AVR (SAVR) at a nationwide level.

METHODS

Based on the administrative hospital discharge database, the study collected information for all patients with aortic stenosis treated with AVR in France between 2010 and 2018.

RESULTS

A total of 47 553 patients undergoing TAVI and 60 253 patients undergoing isolated SAVR were identified. During a mean follow-up of 2.0 years (median (25th to 75th percentile) 1.2 (0.1-3.4) years), the incidence rates of IE were 1.89 (95% confidence interval (CI) 1.78-2.00) and 1.40 (95% CI 1.34-1.46) events per 100 person-years in unmatched TAVI and SAVR patients, respectively. In 32 582 propensity-matched patients (16 291 with TAVI and 16 291 with SAVR), risk of IE was not different in patients treated with TAVI vs. SAVR (incidence rates of IE 1.86 (95% CI 1.70-2.04) %/year vs 1.71 (95% CI 1.58-1.85) %/year respectively, relative risk (RR) 1.09, 95% CI 0.96-1.23). In these matched patients, total mortality was higher in TAVI patients with IE (43.0% 95% CI 37.3-49.3) than in SAVR patients with IE (32.8% 95% CI 28.6-37.3; RR 1.32, 95% CI 1.08-1.60).

DISCUSSION

In a nationwide cohort of patients with AS, treatment with TAVI was associated with a risk of IE similar to that following SAVR. Mortality was higher for patients with IE following TAVI than for those with IE following SAVR.

Impact of alternative materials to plasticized PVC infusion tubings on drug sorption and plasticizer release

Medical tubings in plasticized polyvinylchloride (PVC) are widely used for the infusion of medications but are known in some cases to cause content-container interactions (drug sorption and plasticizer release). The aim of this study was to assess interactions between drugs and five alternative materials to a reference plasticized PVC intravenous (IV) infusion tubing: three were PVC coextruded with polyethylene (PE), polyurethane (PU) or a thermoplastic elastomer (Styrene-EthyleneButadiene-Styrene (SEBS)) and two were SEBS or thermoplastic olefin (TPO) monolayer tubings. Diazepam and insulin were chosen as respective reference of absorption and adsorption while paracetamol acted as a negative control. The concentration of each drug was quantified with liquid chromatography to evaluate a potential loss after a static contact condition and simulated infusion at 1 mL/h and 10 mL/h dynamic condition by an electric syringe pump. A characterization of each material's surface was performed by Fourier transform infrared spectroscopy in attenuated total reflection mode (ATR-FTIR) and by measurement of surface zeta potential. Plasticizer release was quantified by gas chromatography coupled with mass spectrometry (GC-MS). For all tubings except PVC/PU, no loss of paracetamol was observed in any condition. Diazepam sorption appeared to be less important with PVC/PE, PVC/SEBS, SEBS and TPO tubings than with PVC, but was more important when using PVC/PU tubings. PVC tubings induced the least loss of insulin amongst all the studied materials. Surface analysis by ATR-FTIR highlighted the presence of a plasticizer (that could be attributed to Tris (2-Ethylhexyl) Trimellitate (TOTM)) in the coextruded SEBS layer of PVC/SEBS, which could have influenced drug sorption, probably as a consequence of a migration from the PVC layer. Coextruded PVC/SEBS and PVC/PE presented the lowest zeta potential of all studied materials with respective values of -39 mV and -36 mV and were related to the highest sorption of insulin while PVC/PU with the highest zeta potential (about -9 mV) presented the highest absorption of diazepam. Coextruded layered materials appeared to have a lower plasticizer release than PVC alone. As a conclusion, PVC/PE and thermoplastic elastomers alone or coextruded with PVC could be interesting alternatives to PVC tubings with regards to sorption phenomena and plasticizer release.

Cosmetics and pregnancy: perception of health risk by health professionals and pregnant women

Contex

During pregnancy, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products, including cosmetics. However, both pregnant women (PW) and perinatal health professionals (PHP) know still poorly this source of exposure. AIMS: The PERICOS-Quali Study aims to identify the perception of the risk associated with the use of cosmetics during pregnancy by PHP and PW.

Methodology

A qualitative survey was conducted among PHP and PW in Auvergne (France). The data were collected by semi-structured interviews with the PHP and by focus group with the PW, until saturation of the speeches, by an experienced investigator, with an interview guide. The interviews were recorded, the verbatim was transcribed and subjected to a thematic analysis with the N-VIVO v11 software.

Results

12 PHP (5 midwives, 2 general practitioners and 5 obstetricians) and 24 PW were interviewed. PHP and PW considered cosmetics as wellness and body-care products. Furthermore PHP noted that during pregnancy women used more often organic products, moisturizers or anti-stretch marks, and reduced the use of perfumes, deodorants. In the absence of recommandations based on Evidence-Based Medecine, PHP and PW considered the risk related to cosmetics as not major. The PHP (especially midwives) reported giving advice to comfort the pregnant women; their positioning was not to prohibit the use of cosmetics during pregnancy. PW did not identify PHP as reliable sources of information about cosmetics.

Conclusions

PHP are seeking for tools to help them to better advice PW. And PW would like also to have pertinent advices about cosmetics to make a reasoned choice.

Key messages

Health education about use of cosmetics during pregnancy is necessary. Pregnant women and health professionals don’t perceive health risk linked to cosmetics.

Perception of health risk linked to environmental factors by pregnant women

Bacground

Recently, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products during pregnancy. To date, the chemicals, and the risks related, are not well-known, as well by perinatal health professionals (PHP) as by pregnant women (PW). AIMS: to estimate the sensitivity to the environment and the perception of risks related to chemical substances by pregnant women.

Methodology

A descriptive cross-over study was carried out among pregnant women ((followed or hospitalized in different health establishments in Auvergne). The collection of data (socio-demographic characteristics, sensitivity to the environment, use of cosmetics, perception of environmental risks) was carried out by interviewers, using a standardized questionnaire. The statistical analysis (logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

Three hundred questionnaires were analyzed. The sensitivity to the environment is estimated at 6.3 ± 1.7 (scale 0 to 10). For the majority of women, exposure to chemicals is primarily related to the use of cleaning products, DIY products, and gardening products. Food can also be a source of exposure (especially for pesticides). On the other hand, cosmetics are not perceived as products containing chemical substances, with potential risk to health. This vision of chemical substances is related to age, educational level, socio-professional category and sensitivity to the environment. Only 5% (19/300) of PW considered health professionals as referents on chemical substances and environmental problems.

Conclusions

This study highlighted the sensitivity of pregnant women to environmental issues, but a lack of knowledge of chemicals and the risks which they represent for health. It is important to reinforce the information given to pregnant women by perinatal health professionals about healthy behaviors.

Key messages

Pregnant women don’t know all sources of exposure to chemical substances. Training in environmental health must be increased for perinatal health professionals.

Incidence, characteristics, and mortality of infective endocarditis in France in 2011

Objectives

We assessed the determinants of mortality in infective endocarditis (IE), using the national hospital discharge databases (HDD) in 2011.

Methods

IE stays were extracted from the national HDD, with a definition based on IE-related diagnosis codes. This definition has been assessed according to Duke criteria by checking a sample of medical charts of IE giving a predictive positive value of 86.1% (95% confidence interval (CI): 82.7% - 89.5%). The impact of heart valve surgery on survival has been studied if performed during the initial stay, and over the year of follow-up. Risk factors of in-hospital mortality were identified using logistic regression model for the initial stay and Cox Time-dependent model for the 1-year mortality.

Results

The analysis included 6,235 patients. The annual incidence of definite IEs was 63 cases/million residents. Staphylococci and Streptococci were the most common bacteria (44% and 45%, respectively). A valvular surgery was performed in 20% of cases, but substantial variations existed between hospitals. The in-hospital mortality was 21% (ranging 12% to 27% according to the region of patients), associated with age>70, chronic liver disease, renal failure, S. aureus, P. aeruginosa or candida infection and strokes whereas valvular surgery, a native valve IE or intraveinous drug use (right heart IE) were significantly protective for an initial death. The same factors were associated with the one-year mortality, except for valvular surgery which was associated with a 1.4-fold higher risk of death during the year post IE.

Conclusion

We reported a high IE incidence rate. Valvular surgery was considerably less frequent in this study than in the previous published data (near 50%) whereas mortality was similar. Surgery was associated with higher survival if undergone within the initial stay. There were significant regional differences in frequency of surgery but it did not impact mortality.