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Kaasch AJ, López-Cortés LE, Rodríguez-Baño J, Cisneros JM, Dolores Navarro M, Fätkenheuer G, Jung N, Rieg S, Lepeule R, Coutte L, Bernard L, Lemaignen A, Kösters K, MacKenzie CR, Soriano A, Hagel S, Fantin B, Lafaurie M, Talarmin JP, Dinh A, Guimard T, Boutoille D, Welte T, Reuter S, Kluytmans J, Martin ML, Forestier E, Stocker H, Vitrat V, Tattevin P, Rommerskirchen A, Noret M, Adams A, Kern WV, Hellmich M, Seifert H. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis 2024; 24:523-534. [PMID: 38244557 DOI: 10.1016/s1473-3099(23)00756-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Staphylococcus aureus bloodstream infection is treated with at least 14 days of intravenous antimicrobials. We assessed the efficacy and safety of an early switch to oral therapy in patients at low risk for complications related to S aureus bloodstream infection. METHODS In this international, open-label, randomised, controlled, non-inferiority trial done in 31 tertiary care hospitals in Germany, France, the Netherlands, and Spain, adult patients with low-risk S aureus bloodstream infection were randomly assigned after 5-7 days of intravenous antimicrobial therapy to oral antimicrobial therapy or to continue intravenous standard therapy. Randomisation was done via a central web-based system, using permuted blocks of varying length, and stratified by study centre. The main exclusion criteria were signs and symptoms of complicated S aureus bloodstream infection, non-removable foreign devices, and severe comorbidity. The composite primary endpoint was the occurrence of any complication related to S aureus bloodstream infection (relapsing S aureus bloodstream infection, deep-seated infection, and mortality attributable to infection) within 90 days, assessed in the intention-to-treat population by clinical assessors who were masked to treatment assignment. Adverse events were assessed in all participants who received at least one dose of study medication (safety population). Due to slow recruitment, the scientific advisory committee decided on Jan 15, 2018, to stop the trial after 215 participants were randomly assigned (planned sample size was 430 participants) and to convert the planned interim analysis into the final analysis. The decision was taken without knowledge of outcome data, at a time when 126 participants were enrolled. The new sample size accommodated a non-inferiority margin of 10%; to claim non-inferiority, the upper bound of the 95% CI for the treatment difference (stratified by centre) had to be below 10 percentage points. The trial is closed to recruitment and is registered with ClinicalTrials.gov (NCT01792804), the German Clinical trials register (DRKS00004741), and EudraCT (2013-000577-77). FINDINGS Of 5063 patients with S aureus bloodstream infection assessed for eligibility, 213 were randomly assigned to switch to oral therapy (n=108) or to continue intravenous therapy (n=105). Mean age was 63·5 (SD 17·2) years and 148 (69%) participants were male and 65 (31%) were female. In the oral switch group, 14 (13%) participants met the primary endpoint versus 13 (12%) in the intravenous group, with a treatment difference of 0·7 percentage points (95% CI -7·8 to 9·1; p=0·013). In the oral switch group, 36 (34%) of 107 participants in the safety population had at least one serious adverse event compared with 27 (26%) of 103 participants in the intravenous group (p=0·29). INTERPRETATION Oral switch antimicrobial therapy was non-inferior to intravenous standard therapy in participants with low-risk S aureus bloodstream infection. However, it is necessary to carefully assess patients for signs and symptoms of complicated S aureus bloodstream infection at the time of presentation and thereafter before considering early oral switch therapy. FUNDING Deutsche Forschungsgemeinschaft. TRANSLATIONS For the German, Spanish, French and Dutch translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Department of Medicine, Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Department of Medicine, Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel Cisneros
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Department of Medicine, Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - M Dolores Navarro
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Department of Medicine, Universidad de Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Clinics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, University Clinics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University Medical Centre Freiburg, Freiburg, Germany
| | - Raphaël Lepeule
- Antimicrobial Stewardship Team, Department of Prevention, Diagnosis, and Treatment of Infections, Henri-Mondor University Hospital, Creteil, France
| | - Laetitia Coutte
- Antimicrobial Stewardship Team, Department of Prevention, Diagnosis, and Treatment of Infections, Henri-Mondor University Hospital, Creteil, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Katrin Kösters
- Medical Clinic II-Clinic for Gastroenterology, Hepatology, Neurogastroenterology, Infectious Diseases, Hematology, Oncology and Palliative Medicine, Helios Klinikum Krefeld, Krefeld, Germany
| | - Colin R MacKenzie
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), CIBERINFEC, Barcelona, Spain
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Bruno Fantin
- Internal Medicine Department, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | | | | | - Aurélien Dinh
- Infectious Diseases Department, Raymond-Poincaré University Hospital, Garches, France
| | - Thomas Guimard
- Infectious Diseases Department, CHD Vendée, La Roche-sur-Yon, France
| | - David Boutoille
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, INSERM, Nantes, France
| | - Tobias Welte
- Clinic for Respiratory Medicine and Infectious Diseases, Member of the German Center of Lung Research, Medical School Hannover, Hannover, Germany
| | - Stefan Reuter
- Department of Infectious Diseases and General Internal Medicine, Department of Infection Control, Klinikum Leverkusen, Leverkusen, Germany
| | - Jan Kluytmans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maria Luisa Martin
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d'Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| | - Emmanuel Forestier
- Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Hartmut Stocker
- Klinik für Infektiologie, St Joseph Hospital Berlin Tempelhof, Berlin, Germany
| | - Virginie Vitrat
- Infectious Diseases Unit, Centre Hospitalier d'Annecy Genevois, Epagny Metz-Tessy, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Anna Rommerskirchen
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marion Noret
- French National Network of Clinical Research in Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University Medical Centre Freiburg, Freiburg, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Institute of Translational Research, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
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2
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Hazra A, Zucker J, Bell E, Flores J, Gordon L, Mitjà O, Suñer C, Lemaignen A, Jamard S, Nozza S, Nori AV, Pérez-Barragán E, Rodríguez-Aldama JC, Blanco JL, Delaugerre C, Turner D, Fuertes I, Leiro V, Walmsley SL, Orkin CM. Mpox in people with past infection or a complete vaccination course: a global case series. Lancet Infect Dis 2024; 24:57-64. [PMID: 37678309 DOI: 10.1016/s1473-3099(23)00492-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Since May, 2022, a large global outbreak of human mpox (formerly known as monkeypox) has predominantly affected men who have sex with men. The strain responsible, Clade IIb, has mutated substantially from precursors originating from the 2017-18 outbreak in Nigeria. Immunity to smallpox, another orthopoxvirus, via previous infection or vaccination provides lifelong immunity. However, since the 2022 mpox outbreak, recent clusters were described in individuals with presumed immunity through recent infection or vaccination. We aim to describe the epidemiological and clinical characteristics of mpox in individuals with past infection or vaccination to improve the understanding of this disease in the setting of previous immunity. METHODS In this global case series, international collaborators from nine countries provided data on individuals with PCR-confirmed mpox after documented previous infection or vaccination between May 11, 2022, and June 30, 2023. We excluded cases that could not confirm vaccination status or cases with partial immunisation or any doses received before the current multi-national mpox outbreak (cutoff date May 1, 2022). Data were collected via a case report spreadsheet that reported on dates of infection and vaccination, route of immunisation, demographic characteristics, clinical findings, HIV status, concomitant sexually transmitted infections, and markers of disease severity (mpox severity score system). We describe case epidemiology, clinical course, and mpox severity scores; all analyses were descriptive. FINDINGS We report mpox infections in 37 gay and bisexual men who have sex with men: seven individuals had mpox reinfections, 29 individuals had mpox infections that occurred after two appropriately spaced Modified Vaccinia Ankara-Bavarian Nordic vaccine courses, and one individual had an infection that met the criteria for both reinfection and infection after vaccination. The median age of individuals was 36 years (IQR 30-45; range 21-58). Those with natural immunity after initial infection had a shorter disease course with less mucosal disease upon reinfection than with their initial infection. Infections post-vaccination were characterised by few lesions, little mucosal disease, and minimal analgesia requirements; two people received oral tecovirimat. Overall, there were no deaths, no bacterial superinfections, and all individuals were managed in the ambulatory clinic with one hospital admission for a necrotising neck lesion. INTERPRETATION The epidemiology of people with mpox reinfection or infection post-vaccination was similar to other published cohorts during the 2022 outbreak-predominantly young, sexually active gay and bisexual men who have sex with men. Clinical features and outcomes of repeat infection and infection after vaccination appear to be less clinically severe than those described in 2022 case literature. Specifically, compared with the 2022 case series, these individuals in the present study had fewer confluent lesions, less mucosal involvement, reduced analgesia requirement, and fewer admissions. Natural immunity and vaccine-induced immunity are not fully protective against mpox infection. However, in this small series both disease duration and severity appear to be reduced. FUNDING None.
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Affiliation(s)
- Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA; Howard Brown Health, Chicago, IL, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth Bell
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - John Flores
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | | | - Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Clara Suñer
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Adrien Lemaignen
- Department of Infectious Diseases, University Hospital of Tours, Tours, France
| | - Simon Jamard
- Department of Infectious Diseases, University Hospital of Tours, Tours, France
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Jose Louis Blanco
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain
| | - Constance Delaugerre
- Service de Virologie, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Paris, France
| | - Dan Turner
- Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irene Fuertes
- Dermatology Department, Hospital Clinic, Barcelona, Spain
| | - Viviana Leiro
- Dermatology Department, Hospital Muñiz, Buenos Aires, Argentina
| | - Sharon L Walmsley
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Chloe M Orkin
- Blizard Institute and SHARE Collaborative, Queen Mary University of London, London, UK; Department of Infection and Immunity, Barts Health NHS Trust, London, UK.
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3
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Danneels P, Chabrun F, Picard L, Martinet P, Rezig S, Lorleac'h A, Buzelé R, Beaudron A, Kempf M, Le Moal G, Revest M, Boutoille D, Lemaignen A, Grandiere-Perez L, Nacher M, Dubée V. Enterococcus faecalis endocarditis risk assessment in patients with bacteremia: External validation of the DENOVA score. J Infect 2023; 87:571-573. [PMID: 37683897 DOI: 10.1016/j.jinf.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Pierre Danneels
- Infectious Diseases and Tropical Medicine, University Hospital, Angers, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Floris Chabrun
- Biochemistry and Molecular Biology Laboratory, University Hospital, Angers, France
| | - Léa Picard
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Pauline Martinet
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Schéhérazade Rezig
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Aurélien Lorleac'h
- Infectious Diseases and Tropical Medicine, Groupe Hospitalier Bretagne Sud, Lorient, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Rodolphe Buzelé
- Infectious Diseases and Tropical Medicine, General Hospital, St-Brieuc, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Aurélie Beaudron
- Department of Bacteriology, General Hospital, Le Mans, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Marie Kempf
- Department of Bacteriology, University Hospital, Angers, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Gwenaël Le Moal
- Infectious Diseases and Tropical Medicine, University Hospital, Poitiers, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - David Boutoille
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire, CIC-UIC 1413 INSERM, Centre Hospitalier Universitaire, Nantes, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Adrien Lemaignen
- Infectious Diseases and Tropical Medicine, University Hospital, Tours, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Lucia Grandiere-Perez
- Infectious Diseases and Tropical Medicine, General Hospital, Le Mans, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France
| | - Mathieu Nacher
- Clinical Investigation Center, General Hospital, Cayenne, France
| | - Vincent Dubée
- Infectious Diseases and Tropical Medicine, University Hospital, Angers, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Univ Angers, Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, F-44000 Nantes, France.
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4
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Coulongeat M, Marlet J, Aidoud A, Donati F, Jamard S, Van Der Werf S, Debacq C, Leroy V, Lemaignen A, Munier S, Fougère B. Impact of influenza immunity on the mortality among older adults hospitalized with COVID-19: a retrospective cohort study. Clin Exp Med 2023; 23:4955-4965. [PMID: 37906387 DOI: 10.1007/s10238-023-01203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023]
Abstract
It has been suggested that the outcomes of coronavirus disease 2019 (COVID-19) are better in individuals having recently received an influenza vaccine than in non-vaccinated individuals. We hypothesized that this association depends on the humoral responses against influenza viruses. We aim to assess the relationship between the humoral immunity against influenza and the 3-month all-cause mortality among hospitalized older patients with COVID-19. We performed an exploratory retrospective study of older patients (aged 65 and over) hospitalized for confirmed COVID-19 between November 2020 and June 2021. Previous humoral responses to influenza viruses were assessed using a hemagglutination inhibition assay on routinely collected blood samples. The study's primary outcome was the 3-month all-cause mortality, and the secondary outcomes were severe COVID-19 (oxygen requirement ≥ 6 L/min or ventilatory support) and complications (kidney or heart failure, thrombosis and bacterial infection). In the cohort of 95 patients with COVID-19, immunity against influenza vaccine subtypes/lineages was not significantly associated with 3-month all-cause mortality, with an OR [95%CI] of 0.22 [0.02-1.95] (p = 0.174) for the H1N1pdm09 subtype, 0.21 [0.03-1.24] (p = 0.081) for A/Hong Kong/2671/2019 H3N2 subtype, 1.98 [0.51-8.24] (p = 0.329) for the B/Victoria lineage, and 1.82 [0.40-8.45] (p = 0.437) for the B/Yamagata lineage. Immunity against influenza vaccine subtypes/lineages was also not significantly associated with severity and complication. Immunity against influenza subtypes/lineages included in the 2020-2021 vaccine was not associated with a lower 3-month all-cause mortality among COVID-19 hospitalized patients.Trial registration: The study was approved by a hospital committee with competency for research not requiring approval by an institutional review board (Tours University Medical Center, Tours, France: reference: 2021_015). All patients give the informed consent.
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Affiliation(s)
- Matthieu Coulongeat
- Division of Geriatric Medicine, Tours University Medical Center, 37044, Tours, France.
- Division of Geriatric Medicine, University Hospital Center of ORLEANS, 45100, Orléans, France.
| | - Julien Marlet
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, Tours, France
- INSERM U1259, Université de Tours, 37044, Tours, France
| | - Amal Aidoud
- Division of Geriatric Medicine, Tours University Medical Center, 37044, Tours, France
- Tours University, EA4245 Transplantation, Immunologie, Inflammation, Tours, France
| | - Flora Donati
- Institut Pasteur, Université Paris Cité, CNRS UMR3569, Unité de Génétique Moléculaire Des Virus À ARN, 75015, Paris, France
- Institut Pasteur, CNR Virus Des Infections Respiratoires, 75015, Paris, France
| | - Simon Jamard
- Service de Maladies Infectieuses Et Tropicales (SMIT), Centre Hospitalier Universitaire de Tours, 37044, Tours, France
| | - Sylvie Van Der Werf
- Institut Pasteur, Université Paris Cité, CNRS UMR3569, Unité de Génétique Moléculaire Des Virus À ARN, 75015, Paris, France
- Institut Pasteur, CNR Virus Des Infections Respiratoires, 75015, Paris, France
| | - Camille Debacq
- Division of Geriatric Medicine, Tours University Medical Center, 37044, Tours, France
| | - Victoire Leroy
- Division of Geriatric Medicine, Tours University Medical Center, 37044, Tours, France
- Centre Mémoire Ressources Et Recherche (CMRR), Centre Hospitalier Universitaire de Tours, 37044, Tours, France
- Education, Ethics, Health (EA 7505), Tours University, 37044, Tours, France
| | - Adrien Lemaignen
- Service de Maladies Infectieuses Et Tropicales (SMIT), Centre Hospitalier Universitaire de Tours, 37044, Tours, France
| | - Sandie Munier
- Institut Pasteur, Université Paris Cité, CNRS UMR3569, Unité de Génétique Moléculaire Des Virus À ARN, 75015, Paris, France
- Institut Pasteur, CNR Virus Des Infections Respiratoires, 75015, Paris, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Medical Center, 37044, Tours, France
- Education, Ethics, Health (EA 7505), Tours University, 37044, Tours, France
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5
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Sebillotte M, Boutoille D, Declerck C, Talarmin JP, Lemaignen A, Piau C, Revest M, Tattevin P, Gousseff M. Non-HACEK gram-negative bacilli endocarditis: a multicentre retrospective case-control study. Infect Dis (Lond) 2023; 55:599-606. [PMID: 37353977 DOI: 10.1080/23744235.2023.2226212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) caused by non-HACEK gram-negative bacilli (GNB) is poorly characterised and may be emerging as a consequence of medical progress. METHODS We performed an observational retrospective case-control study. Cases were non-HACEK GNB IE, definite or possible (modified Duke criteria), diagnosed in adults between 2007 and 2020 in six French referral hospitals. Two controls were included for each case (IE due to other bacteria, matched by sites and diagnosis date). RESULTS Non-HACEK GNB were identified in 2.4% (77/3230) of all IE during the study period, with a mean age of 69.2 ± 14.6 years, and a large male predominance (53/77, 69%). Primary pathogens were Escherichia coli (n = 33), Klebsiella sp. (n = 12) and Serratia marcescens (n = 9), including eight (10%) multidrug-resistant GNB. Compared to controls (n = 154: 43% Streptococcus sp., 41% Staphylococcus sp. and 12% Enterococcus sp.), non-HACEK GNB IE were independently associated with intravenous drug use (IVDU, 8% vs. 2%, p = .003), active neoplasia (15% vs. 6%, p = .009), haemodialysis (9% vs. 3%, p = .007) and healthcare-associated IE (36% vs. 18%, p = .002). Urinary tract was the main source of infection (n = 25, 33%) and recent invasive procedures were reported in 29% of cases. Non-HACEK GNB IE were at lower risk of embolism (31% vs. 47%, p = .002). One-year mortality was high (n = 28, 36%). Comorbidities, particularly malignant hemopathy and cirrhosis, were associated with increased risk of death. CONCLUSIONS Non-HACEK GNB are rarely responsible for IE, mostly as healthcare-associated IE in patients with complex comorbidities (end-stage renal disease, neoplasia), or in IVDUs.
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Affiliation(s)
- Marine Sebillotte
- Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - David Boutoille
- Maladies Infectieuses, CIC 1413 INSERM, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, Nantes, France
| | - Charles Declerck
- Maladies Infectieuses, Hôpital Larrey, Centre Hospitalier Universitaire, Angers, Angers, France
| | | | - Adrien Lemaignen
- Maladies Infectieuses, EA 7505 Education-Ethics-Health, Hôpital Bretonneau, Centre Hospitalier Universitaire, Tours, Tours, France
| | - Caroline Piau
- Bactériologie, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - Matthieu Revest
- Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - Pierre Tattevin
- Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - Marie Gousseff
- Maladies infectieuses, Centre Hospitalier Bretagne-Atlantique, Vannes, France
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Coustillères F, Renault V, Corvec S, Dupieux C, Simões PM, Lartigue MF, Plouzeau-Jayle C, Tande D, Lamoureux C, Lemarié C, Chenouard R, Laurent F, Lemaignen A, Bémer P. Clinical, Bacteriological, and Genetic Characterization of Bone and Joint Infections Involving Linezolid-Resistant Staphylococcus epidermidis: a Retrospective Multicenter Study in French Reference Centers. Microbiol Spectr 2023; 11:e0419022. [PMID: 37133395 PMCID: PMC10269892 DOI: 10.1128/spectrum.04190-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/09/2023] [Indexed: 05/04/2023] Open
Abstract
The choice of the best probabilistic postoperative antibiotics in bone and joint infections (BJIs) is still challenging. Since the implementation of protocolized postoperative linezolid in six French referral centers, linezolid-resistant multidrug-resistant Staphylococcus epidermidis (LR-MDRSE) strains were isolated in patients with BJI. We aimed here to describe clinical, microbiological, and molecular patterns associated with these strains. All patients with at least one intraoperative specimen positive for LR-MDRSE between 2015 and 2020 were included in this retrospective multicenter study. Clinical presentation, management, and outcome were described. LR-MDRSE strains were investigated by MIC determination for linezolid and other anti-MRSA antibiotics, characterization of genetic determinants of resistance, and phylogenetic analysis. Forty-six patients (colonization n = 10, infection n = 36) were included in five centers, 45 had prior exposure to linezolid, 33 had foreign devices. Clinical success was achieved for 26/36 patients. Incidence of LR-MDRSE increased over the study period. One hundred percent of the strains were resistant to oxazolidinones, gentamicin, clindamycin, ofloxacin, rifampicin, ceftaroline, and ceftobiprole, and susceptible to cyclins, daptomycin, and dalbavancin. Susceptibility to delafloxacin was bimodal. Molecular analysis was performed for 44 strains, and the main mutation conferring linezolid resistance was the 23S rRNA G2576T mutation. All strains belonged to the sequence type ST2 or its clonal complex, and phylogenetic analysis showed emergence of five populations corresponding geographically to the centers. We showed the emergence of new clonal populations of highly linezolid-resistant S. epidermidis in BJIs. Identifying patients at risk for LR-MDRSE acquisition and proposing alternatives to systematic postoperative linezolid use are essential. IMPORTANCE The manuscript describes the emergence of clonal linezolid-resistant strains of Staphylococcus epidermidis (LR-MDRSE) isolated from patients presenting with bone and joint infections. Incidence of LR-MDRSE increased over the study period. All strains were highly resistant to oxazolidinones, gentamicin, clindamycin, ofloxacin, rifampicin, ceftaroline, and ceftobiprole, but were susceptible to cyclins, daptomycin, and dalbavancin. Susceptibility to delafloxacin was bimodal. The main mutation conferring linezolid resistance was the 23S rRNA G2576T mutation. All strains belonged to the sequence type ST2 or its clonal complex, and phylogenetic analysis showed emergence of five populations corresponding geographically to the centers. LR-MDRSE bone and joint infections seem to be accompanied by an overall poor prognosis related to comorbidities and therapeutic issues. Identifying patients at risk for LR-MDRSE acquisition and proposing alternatives to systematic postoperative linezolid use become essential, with a preference for parenteral drugs such as lipopeptids or lipoglycopeptids.
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Affiliation(s)
- François Coustillères
- Service des Maladies Infectieuses, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
| | - Victor Renault
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
| | - Stéphane Corvec
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
| | - Céline Dupieux
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
| | - Patricia Martins Simões
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
| | - Marie Frédérique Lartigue
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
| | - Chloé Plouzeau-Jayle
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Poitiers, France
| | - Didier Tande
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Brest, France
| | - Claudie Lamoureux
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Brest, France
| | - Carole Lemarié
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Angers, France
| | - Rachel Chenouard
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Angers, France
| | - Frédéric Laurent
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
| | - Adrien Lemaignen
- Service des Maladies Infectieuses, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
| | - Pascale Bémer
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
| | - the CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest) Study Team
- Service des Maladies Infectieuses, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Poitiers, France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Brest, France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Angers, France
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7
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Dorel M, Albert R, Bot AL, Caillault L, Lalanne S, Tattevin P, Verdier MC, Lemaignen A, Revest M. Amoxicillin therapeutic drug monitoring for endocarditis: a comparative study (EI-STAB). Int J Antimicrob Agents 2023; 62:106821. [PMID: 37088439 DOI: 10.1016/j.ijantimicag.2023.106821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION International guidelines recommend high doses of beta-lactams for most infective endocarditis (IE). Therapeutic drug monitoring (TDM) is increasingly used to adjust the dose based on plasma concentrations, although no comparative study supports these practices. We aimed to evaluate the benefit of amoxicillin TDM during IE. METHODS An observational retrospective cohort study of all adults treated with high-dose amoxicillin for enterococcal or streptococcal IE was conducted in two referral centers. We compared patients with, or without TDM. The primary outcome was mean daily amoxicillin dose. RESULTS We enrolled 206 streptococcal (n=140, 68%) or enterococcal (n=66, 32%) IE, on native valve (n=129, 63%) or prosthetic valve (n=77, 37%). There were 154 men (75%), mean age was 70 ± 14 years, valvular surgery was performed in 81/206 (39%) patients, and in-hospital mortality was 8% (17/206). All patients in the TDM group and the vast majority of them in the other group received amoxicillin as continuous infusion. Amoxicillin TDM was performed for 114 patients (55.3%), with a mean of 4.7 +/- 2.3 measures per patient, a mean plasma steady-state concentration of 41.2 +/- 19 mg/L, most (82/114, 72%) being within the therapeutic target (20-80 mg/L). Mean amoxicillin dose was lower in patients with TDM (10.0 +/- 3.3 g/day vs 11.3 +/- 2.0 g/day in patients without TDM, P=0.003). CONCLUSION Amoxicillin TDM was associated with a reduction in daily doses, with no impact on adverse events and prognosis. Individualized treatment of IE through TDM may contribute to decreased use of antibiotics.
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Affiliation(s)
- Marie Dorel
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France
| | - Robin Albert
- Infectious Diseases and Tropical Medicine Unit, CHRU de Tours, Tours, France
| | - Audrey Le Bot
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France
| | - Leila Caillault
- Internal Medicine Unit, CHU Rennes, 35033 Rennes Cedex, France
| | - Sébastien Lalanne
- Univ Rennes, Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France; University of Rennes, Inserm, BRM, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, F-3500 Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France
| | - Adrien Lemaignen
- Infectious Diseases and Tropical Medicine Unit, CHRU de Tours, Tours, France; University of Tours, Tours, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France; University of Rennes, Inserm, BRM, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, F-3500 Rennes, France.
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8
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Danneels P, Hamel JF, Lemaignen A, Cattoir V, Dubée V. Reply to Cuervo et al and Horinouchi et al. Clin Infect Dis 2023; 76:1525-1528. [PMID: 36527727 DOI: 10.1093/cid/ciac956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | - Adrien Lemaignen
- Infectious Diseases and Tropical Medicine, Tours University Hospital
| | - Vincent Cattoir
- Department of Bacteriology
- National Reference Center for Enterococci, Pontchaillou University Hospital, Rennes, France
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9
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Stahl JP, Canouï E, Bleibtreu A, Dubée V, Ferry T, Gillet Y, Lemaignen A, Lesprit P, Lorrot M, Lourtet-Hascoët J, Manaquin R, Meyssonnier V, Pavese P, Pham TT, Varon E, Gauzit R. SPILF update on bacterial arthritis in adults and children. Infect Dis Now 2023; 53:104694. [PMID: 36948248 DOI: 10.1016/j.idnow.2023.104694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
In 2020 the French Society of Rhumatology (SFR) published an update of the 1990 recommendations for management of bacterial arthritis in adults. While we (French ID Society, SPILF) totally endorse this update, we wished to provide further information about specific antibiotic treatments. The present update focuses on antibiotics with good distribution in bone and joint. It is important to monitor their dosage, which should be maximized according to PK/PD parameters. Dosages proposed in this update are high, with the optimized mode of administration for intravenous betalactams (continuous or intermittent infusion). We give tools for the best dosage adaptation to conditions such as obesity or renal insufficiency. In case of enterobacter infection, with an antibiogram result "susceptible for high dosage", we recommend the requesting of specialized advice from an ID physician. More often than not, it is possible to prescribe antibiotics via the oral route as soon as blood cultures are sterile and clinical have symptoms shown improvement. Duration of antibiotic treatment is 6 weeks for Staphylococcus aureus, and 4 weeks for the other bacteria (except for Neisseria: 7 days).
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Affiliation(s)
- J P Stahl
- Université Grenoble Alpes, Maladies Infectieuses, 38700, France.
| | - E Canouï
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
| | - A Bleibtreu
- Maladies Infectieuseset Tropicales, Hôpital Pitié Salpêtrière, AP-HP Sorbonne Université, Paris France
| | - V Dubée
- Maladies Infectieuses et Tropicales, CHU d'Angers, Angers, France
| | - T Ferry
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - Y Gillet
- Urgences et Réanimation Pédiatrique, Hospices Civils de Lyon, Université Claude Bernard Lyon, France
| | - A Lemaignen
- Maladies Infectieuses, CHRU de Tours, Université de Tours, 37044, France
| | - P Lesprit
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - M Lorrot
- Pédiatrie Générale et Equipe Opérationnelle d'Infectiologie, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Pitié), Hôpital Armand Trousseau AP-HP Sorbonne Université, Paris France
| | | | - R Manaquin
- Maladies Infectieuses et Tropicales, GHSR , CHU de La Réunion, CRAtb La Réunion, Saint-Pierre, 97410, FRANCE
| | - V Meyssonnier
- Centre de Référence des Infections Ostéo-articulaires, GH Diaconesses Croix Saint-Simon, 75020, Paris, France; Service de Médecine Interne Générale, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - P Pavese
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - T-T Pham
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - E Varon
- Centre National de Référence des Pneumocoques, CRC-CRB, Centre Hospitalier Intercommunal de Créteil, 94000, Créteil, France
| | - R Gauzit
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
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10
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Tinévez C, Lehours P, Ranc AG, Belaroussi Y, Velardo F, Dubois D, Neuwirth C, Pailhoriès H, Dorel M, Hery-Arnaud G, Join-Lambert O, Gras E, Corvec S, Codde C, Fournier D, Boijout H, Doat V, Bouard L, Lagneaux AS, Pichon M, Couzigou C, Letellier C, Lemaignen A, Bille E, Bérard X, Caradu C, Webster C, Neau D, Cazanave C, Puges M. Multicenter Retrospective Study of Vascular Infections and Endocarditis Caused by Campylobacter spp., France. Emerg Infect Dis 2023; 29:484-492. [PMID: 36823023 PMCID: PMC9973684 DOI: 10.3201/eid2903.221417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The incidence of campylobacteriosis has substantially increased over the past decade, notably in France. Secondary localizations complicating invasive infections are poorly described. We aimed to describe vascular infection or endocarditis caused by Campylobacter spp. We included 57 patients from a nationwide 5-year retrospective study on Campylobacter spp. bacteremia conducted in France; 44 patients had vascular infections, 12 had endocarditis, and 1 had both conditions. Campylobacter fetus was the most frequently involved species (83%). Antibiotic treatment involved a β-lactam monotherapy (54%) or was combined with a fluoroquinolone or an aminoglycoside (44%). The mortality rate was 25%. Relapse occurred in 8% of cases and was associated with delayed initiation of an efficient antimicrobial therapy after the first symptoms, diabetes, and coexistence of an osteoarticular location. Cardiovascular Campylobacter spp. infections are associated with a high mortality rate. Systematically searching for those localizations in cases of C. fetus bacteremia may be warranted.
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11
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Courjon J, Dinh A, Lemaignen A, Senneville E, Robineau O, Carles M. Comment on: Dalbavancin in Gram-positive periprosthetic joint infections. J Antimicrob Chemother 2023; 78:561. [PMID: 36527681 DOI: 10.1093/jac/dkac417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Johan Courjon
- Université Côte d'Azur, CHU Nice,, Infectious Diseases unit, 151 Route de St Antoine, 06200 Nice, France
| | - Aurélien Dinh
- Infectious Diseases Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, 104 bd Raymond Poincaré, 92380 Garches, France
| | - Adrien Lemaignen
- Infectious Diseases unit, Centre Hospitalier Régional Universitaire de Tours, Boulevard Tonnellé 37000 Tours, France
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, 155 Rue du Président Coty, 59200 Tourcoing, France
| | - Olivier Robineau
- Infectious Diseases Department, Gustave Dron Hospital, 155 Rue du Président Coty, 59200 Tourcoing, France
| | - Michel Carles
- Université Côte d'Azur, CHU Nice,, Infectious Diseases unit, 151 Route de St Antoine, 06200 Nice, France
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12
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Collercandy N, Thorey C, Diot E, Grammatico-Guillon L, Thillard EM, Bernard L, Maillot F, Lemaignen A. When to investigate for secondary hyperhidrosis: data from a retrospective cohort of all causes of recurrent sweating. Ann Med 2022; 54:2089-2101. [PMID: 35903938 PMCID: PMC9455328 DOI: 10.1080/07853890.2022.2102675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Identification of underlying diseases is crucial for secondary hyperhidrosis management, but data are lacking to guide appropriate investigation.Objective: To describe aetiologies of recurrent sweating in a hospital setting and the diagnostic performance parameters of their respective clinical/biological features.Patients and Methods: We performed a monocentric evaluative study in a tertiary care centre. Patients with recurrent generalised sweating were selected via the Clinical Data Warehouse (CDW) by screening all electronic hospital documents from the year 2018 using a keyword-based algorithm. All in and out-patients aged ≥ 18 years having reported recurrent sweating for at least 2 weeks in 2018 were included, with a minimum one-year follow-up after symptoms' onset.Results: A total of 420 patients were included. Over 130 different aetiologies were identified; 70 patients (16.7%) remained without diagnosis. Solid organ cancers (14.3% with 13 lung cancers), haematologic malignancies (14.0% with 35 non-Hodgkin's lymphomas) and Infectious Diseases (10.5% including 13 tuberculosis) were the most frequent diagnoses. Other aetiologies were gathered into inflammatory (16.9%) and non-inflammatory (27.6%) conditions. To distinguish non-inflammatory and undiagnosed hyperhidrosis from other causes, fever had a specificity of 94%, impaired general condition a sensitivity of 78%, and C-reactive protein (CRP) > 5.6 mg/l a positive predictive value of 0.86. Symptoms' duration over 1 year was in favour of non-infectious and non-malignant causes (94% specificity).Conclusions: We identified fever, impaired general condition, duration, and CRP as helpful orientation parameters to assess the need for complementary explorations for hyperhidrosis. The study provides a diagnostic algorithm for the investigation of recurrent sweating.KEY MESSAGESIn a hospital setting, malignancies and infections are the most frequently associated diseases, but 1/5 remain without diagnosis.Fever is a specific but not sensitive sign to distinguish inflammatory conditions.Over 1 year duration of symptoms significantly reduce the probability of malignancy or infection as the underlying diagnosis.
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Affiliation(s)
- Nived Collercandy
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France.,Service de Médecine interne et Immunologie clinique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Camille Thorey
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Elisabeth Diot
- Service de Médecine interne et Immunologie clinique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Service d'Information Médicale, Epidémiologie et Economie de la Santé (SIMEES, Centre de données cliniques), Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - Eve Marie Thillard
- Centre Régional de Pharmacovigilance et d'Information sur le Médicament, Centre Val de Loire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Louis Bernard
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - François Maillot
- Service de Médecine interne et Immunologie clinique, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - Adrien Lemaignen
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
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13
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Coulongeat M, Polisset N, Poitau F, Laurent E, Fougère B, Lemaignen A. Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department. Heliyon 2022; 8:e11630. [PMID: 36411926 PMCID: PMC9674905 DOI: 10.1016/j.heliyon.2022.e11630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective To evaluate the level of agreement between experts from several disciplines on the indication for antibiotic therapy for a bacterial infection in older patients presenting at an ED, and to describe the characteristics of the infections. Methods Based on comprehensive medical records, three experts (a geriatrician, an emergency physician (EP), and an infectious disease specialist (IDS)) determined independently and then jointly whether a patient presenting at the ED had a bacterial infection requiring antibiotic therapy. Inter-expert agreement was expressed as a fixed-marginal Fleiss’ kappa (κ). Results Of the 444 medical records included, the consensus meeting found that 114 (25.7%) had an indication for antibiotics, 327 (73.6%) did not have an indication, and 3 could not be classified. The overall level of agreement was 85.2%, and κ[95%CI] was 0.64 [0.57–0.72] (p < 0.001). The level of agreement between the geriatrician and the IDS (89.41%, κ0.73, 95%CI [0.62–0.85] (p < 0.001)) was higher than that between the geriatrician and the EP (83.56%, κ0.62, 95%CI [0.51–0.73] (p < 0.001)) and between the IDS and the EP (82.66%, κ0.59, 95%CI [0.48–0.70] (p < 0.001)). The levels of agreement between the final adjudication, was higher for the geriatrician, and IDS respectively 94.1% (κ0.85, 95%CI [0.74–0.97] (p < 0.001) and 94.4% (κ0.86, 95%CI [0.74–0.97] (p < 0.001)). 114 (25.7%) patients had a bacterial infection (mostly lung infections (n = 55, 48.2%) and urinary tract infections (n = 25, 21.9%)), and 28 patients (6.3%) had a viral infection. Conclusion Our results highlighted substantial agreement between members of a multidisciplinary expert panel. Experts from different disciplines showed substantial agreement in deciding on the requirement of antibiotics The level of inter-expert agreement depended on the physicians' medical specialties Most of the bacterial infections were lung infections and urinary tract infections This study is the first step towards to better identification of infections with an atypical presentation of infections
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14
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Danneels P, Hamel JF, Picard L, Rezig S, Martinet P, Lorleac’h A, Talarmin JP, Buzelé R, Guimard T, Le Moal G, Brochard-Libois J, Beaudron A, Letheulle J, Codde C, Chenouard R, Boutoille D, Lemaignen A, Bernard L, Cattoir V, Dubée V. Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse. Clin Infect Dis 2022; 76:281-290. [PMID: 36124844 PMCID: PMC9839190 DOI: 10.1093/cid/ciac777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Enterococcus faecalis infective endocarditis (EFIE) is characterized by a higher frequency of relapses than other infective endocarditis. The role of the treatment on its occurrence remains poorly understood. The aim of this study was to investigate whether the antibiotic regimen could impact the risk of relapse in EFIE. MATERIALS This was a multicenter retrospective study of patients diagnosed with definite EFIE between 2015 and 2019 in 14 French hospitals. The primary endpoint was the occurrence of relapses within the year following endocarditis diagnosis. As death was a competing risk for relapse, Fine and Gray models were used for studying risk factors and impact of treatment. RESULTS Of the 279 patients included, 83 (29.7%) received the amoxicillin-gentamicin (A-G) combination, 114 (40.9%) amoxicillin-ceftriaxone (A-C), 63 (22.6%) A-G and A-C (A-G/A-C) sequentially, 9 (3.2%) amoxicillin (A), and 10 received other treatments. One-year-relapse rate was 9.3% (26 patients). Relapse occurred after a median delay of 107 days from EFIE diagnosis; 6 occurred after 6 months, and 6 were diagnosed by blood cultures in asymptomatic patients. In multivariate analysis, surgery during treatment was a protective factor against one-year relapse and death.The cumulative incidence of relapse 1 year after endocarditis was 46.2% for patients treated with amoxicillin, 13.4% with A-G, 14.7% with A-C, and 4.3% with A-G/A-C (P≥.05 in multivariate analysis). CONCLUSIONS Relapses after treatment of EFIE are frequent, frequently asymptomatic, and may occur more than 6 months after the initial episode.
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Affiliation(s)
- Pierre Danneels
- Infectious Diseases and Tropical Medicine, Angers University Hospital, Angers, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | | | - Léa Picard
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Schéhérazade Rezig
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Pauline Martinet
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Aurélien Lorleac’h
- Infectious Diseases and Tropical Medicine, Groupe Hospitalier Bretagne Sud, Lorient, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Jean-Philippe Talarmin
- Infectious Diseases and Tropical Medicine, Cornouaille Hospital, Quimper, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Rodolphe Buzelé
- Infectious Diseases and Tropical Medicine, Saint-Brieuc General Hospital, Saint-Brieuc, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Thomas Guimard
- Infectious Diseases and Tropical Medicine, Vendée Departmental Hospital, La Roche Sur Yon, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Gwenaël Le Moal
- Infectious Diseases and Tropical Medicine, Poitiers University Hospital, Poitiers, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Julia Brochard-Libois
- Infectious Diseases and Tropical Medicine, Saint Nazaire General Hospital, St-Nazaire, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Aurélie Beaudron
- Department of Bacteriology, Le Mans General Hospital, Le Mans, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Julien Letheulle
- Service de médecine polyvalente, Centre Hospitalier de Laval, Laval, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Cyrielle Codde
- Infectious Diseases and Tropical Medicine, Limoges University Hospital, Limoges, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Rachel Chenouard
- Department of Bacteriology, Angers University Hospital, Angers, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - David Boutoille
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire, CIC-UIC 1413 INSERM, Centre Hospitalier Universitaire de Nantes, Nantes, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Adrien Lemaignen
- Infectious Diseases and Tropical Medicine, Tours University Hospital, Tours, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Louis Bernard
- Infectious Diseases and Tropical Medicine, Tours University Hospital, Tours, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Vincent Cattoir
- Department of Bacteriology, Pontchaillou University Hospital, Rennes, France,National Reference Center for Enterococci, Pontchaillou University Hospital, Rennes, France,INSERM unit U1230, University of Rennes 1, Rennes, France
| | - Vincent Dubée
- Correspondence: V. Dubée, Infectious Diseases and Tropical Medicine, University Hospital. 4, Rue Larrey, 49100 Angers, France ()
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15
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Bonnet I, Haddad E, Guglielmetti L, Bémer P, Bernard L, Bourgoin A, Brault R, Catho G, Caumes E, Escaut L, Fourniols E, Fréchet-Jachym M, Gaudart A, Guillot H, Lafon-Desmurs B, Lanoix JP, Lanotte P, Lemaignen A, Lemaire B, Lemaitre N, Michau C, Morand P, Mougari F, Marigot-Outtandy D, Patrat-Delon S, Perpoint T, Piau C, Pourcher V, Zarrouk V, Zeller V, Veziris N, Jauréguiberry S, Aubry A. Clinical Features and Outcome of Multidrug-Resistant Osteoarticular Tuberculosis: A 12-Year Case Series from France. Microorganisms 2022; 10:microorganisms10061215. [PMID: 35744731 PMCID: PMC9229793 DOI: 10.3390/microorganisms10061215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
The optimal treatment for osteoarticular infection due to multidrug-resistant tuberculosis strains (MDR-OATB) remains unclear. This study aims to evaluate the diagnosis, management and outcome of MDR-OATB in France. We present a case series of MDR-OATB patients reviewed at the French National Reference Center for Mycobacteria between 2007 and 2018. Medical history and clinical, microbiological, treatment and outcome data were collected. Twenty-three MDR-OATB cases were reported, representing 3% of all concurrent MDR-TB cases in France. Overall, 17 were male, and the median age was 32 years. Six patients were previously treated for TB, including four with first-line drugs. The most frequently affected site was the spine (n = 16). Bone and joint surgery were required in 12 patients. Twenty-one patients (91%) successfully completed the treatment with a regimen containing a mean of four drugs (range, 2-6) for a mean duration of 20 months (range, 13-27). Overall, high rates of treatment success were achieved following WHO MDR-TB treatment guidelines and individualized patient management recommendations by the French National TB Consilium. However, the optimal combination of drugs, duration of treatment and role of surgery in the management of MDR-OATB remains to be determined.
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Affiliation(s)
- Isabelle Bonnet
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Elie Haddad
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lorenzo Guglielmetti
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Pascale Bémer
- Department of Bacteriology, University Hospital, CHU Nantes, 44000 Nantes, France;
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Anne Bourgoin
- Service de Virologie et Mycobactériologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Rachel Brault
- Service de Rhumatologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Gaud Catho
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lélia Escaut
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
| | - Eric Fourniols
- Service de Chirurgie Orthopédique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne-Université, 75013 Paris, France;
| | - Mathilde Fréchet-Jachym
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Alice Gaudart
- Service de Bactériologie, Centre Hospitalier Universitaire de Nice, 06000 Nice, France;
| | - Hélène Guillot
- Service de Médecine Interne, Hôpital Robert Ballanger, 93600 Aulnay-sous-Bois, France;
| | - Barthélémy Lafon-Desmurs
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France;
| | - Jean-Philippe Lanoix
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d’Amiens-Picardie, 80054 Amiens, France;
| | - Philippe Lanotte
- Service de Bactériologie, Centre Hospitalier Universitaire de Tours, 37000 Tours, France;
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Bénédicte Lemaire
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Nadine Lemaitre
- Service de Bactériologie, Centre Hospitalier Universitaire d’Amiens-Picardie, 59200 Tourcoing, France;
| | - Christophe Michau
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Saint-Nazaire, 44606 Saint-Nazaire, France;
| | - Philippe Morand
- Service de Bactériologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France;
| | - Faiza Mougari
- Service de Bactériologie, Hôpital Lariboisière, AP-HP, Nord-Université de Paris, 75018 Paris, France;
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Solène Patrat-Delon
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Caroline Piau
- Service de Bactériologie, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Nord-Université de Paris, 92110 Clichy, France;
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, 75020 Paris, France;
| | - Nicolas Veziris
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Service de Bactériologie, Hôpitaux Saint-Antoine, Tenon, Trousseau, Rothschild, AP-HP, 75012 Paris, France
| | - Stéphane Jauréguiberry
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Alexandra Aubry
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
- Correspondence:
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16
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Collercandy N, Thorey C, Diot E, Thillard E, Grammatico-Guillon L, Bernard L, Maillot F, Lemaignen A. Quand suspecter une hyperhydrose secondaire : données d’une cohorte rétrospective de sueurs récurrentes. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Halimi JM, Thoreau B, von Tokarski F, Bauvois A, Gueguen J, Goin N, Barbet C, Cloarec S, Mérieau E, Lachot S, Garot D, Lemaignen A, Gyan E, Perrotin F, Pouplard C, Maillot F, Gatault P, Sautenet B, Rusch E, Frémeaux-Bacchi V, Vigneau C, Bayer G, Fakhouri F. What is the impact of blood pressure on neurological symptoms and the risk of ESKD in primary and secondary thrombotic microangiopathies based on clinical presentation: a retrospective study. BMC Nephrol 2022; 23:39. [PMID: 35057750 PMCID: PMC8781095 DOI: 10.1186/s12882-022-02672-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/05/2022] [Indexed: 12/26/2022] Open
Abstract
Abstract
Background
The impact of blood pressure on neurological symptoms and risk of end-stage kidney disease (ESKD) is unknown in primary and secondary thrombotic microangiopathies (TMAs).
Methods
We measured baseline systolic (SBP) and diastolic (DBP) BP in consecutive 563 patients with adjudicated primary and secondary TMAs, and assessed its association with the risk of ESKD.
Results
Normal BP, grade 1, 2 and 3 hypertension were present in 243 (43.1%), 132 (23.4%), 101 (17.9%) and 88 (15.6%), respectively.
Significant BP differences were noted in relation to the cause of TMA: highest BP values were found in patients with atypical hemolytic-uremic syndrome (aHUS), pregnancy, transplantation and auto-immune-related TMAs. Normal BP or grade 1 hypertension was found in 17/18 (94.4%) patients with thrombotic thrombocytopenic patients (only 1/18 (5.6%) had a SBP value>150 mmHg). In contrast, BP values could not differentiate isolated “essential” malignant hypertension (MH) from MH associated with aHUS (isolated MH (n=15): BP (median (IQR)): 220 (182-249)/132 (101-150) mmHg; MH with aHUS (n=5): BP: 223 (196-245)/131 (111-144) mmHg).
The risk of vigilance disturbances (6.9%, 15.0%, 25.0%, respectively), epileptic seizures (1.5%, 4.0%, 12.5%, respectively) and posterior reversible encephalopathy syndrome (0.76%, 2.97%, 6.82%, respectively) increased with increasing baseline BP values from grade 1 to grade 3 hypertension.
ESKD occurred in 35/563 (6.2%) patients (1.23%, 2.27%, 11.9% and 19.3% of patients with normal BP, grade 1, 2 and 3 hypertension, respectively). As compared to patients with normal BP (<120/139 mmHg), grade 1, grade 2 and grade 3 hypertension were associated with a greater risk of ESKD in univariate (OR: 1.91 [0.83-4.40], 13.2 [3.56-48.9] and 34.8 [9.31-130], respectively) and multivariate (OR: 0.89 [0.30-2.69], 7.00 [1.57-31.3] and 19.7 [4.53-85.2], respectively) analyses. The association between BP and the risk of ESRD was unchanged after adjustment on eculizumab use (OR: 3.46 [1.41-8.49], 17.7 [4.44-70.0] and 70.6 [8.61-579], respectively). Patients with MH, regardless of its cause, had a greater risk of ESKD (OR: 26.4 [10.0-69.8] vs other patients).
Conclusions
Baseline BP differs in primary and secondary TMAs. High BP reduces the neurological tolerance of TMAs and is a powerful independent risk factor of ESKD, even after adjustment on TMA’s cause.
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18
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Nasri I, Ramdani Y, Lemaignen A, Ferreira-Maldent N, Bigot A, Boucaud A, Maillot F, Audemard-Verger A. [Multiple liver lesions]. Rev Med Interne 2021; 43:57-58. [PMID: 34922782 DOI: 10.1016/j.revmed.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Affiliation(s)
- I Nasri
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - Y Ramdani
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France; Service de maladies infectieuses, CHRU Tours, Tours, France
| | - A Lemaignen
- Service de maladies infectieuses, CHRU Tours, Tours, France; Université de Tours, Tours, France
| | - N Ferreira-Maldent
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - A Bigot
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - A Boucaud
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France
| | - F Maillot
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France; Service de maladies infectieuses, CHRU Tours, Tours, France
| | - A Audemard-Verger
- Service de médecine interne et immunologie, université de Tours, CHRU, Tours, France; Service de maladies infectieuses, CHRU Tours, Tours, France.
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19
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Maisons V, Desoubeaux G, Coustillères F, Lemaignen A, Chesnay A, Doman M, Lanternier F, Bernard L, Lacasse M. Intricate isavuconazole therapy of a subcutaneous nodule caused by Alternaria infectoria in a heart transplant recipient. J Mycol Med 2021; 32:101235. [PMID: 34954620 DOI: 10.1016/j.mycmed.2021.101235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023]
Abstract
Invasive fungal infections have appeared to be increasingly emergent in immunocompromised patients, especially in solid organ transplant (SOT) recipients. The Alternaria genus encompasses more than 80 dematiaceus species. Among them, Alternaria alternata and Alternaria infectoria are the most frequent isolated as responsible for infection in humans. To our knowledge, we report the first case of a heart transplant recipient suffering from subcutaneous nodule caused by Alternaria infectoria and who was treated with isavuconazole. Despite all the promises of this new azole drug, one should keep in mind the potential great variability of the inter-individual responses for such complex patients. We demonstrate herein how it can be challenging to manage Alternaria infection in SOT recipients. More comprehensive studies and recommendations are expected in the context of Alternaria infections.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie et d'Immunologie Clinique, CHU Bretonneau, CHRU Tours, France.
| | - Guillaume Desoubeaux
- Service de Parasitologie-Mycologie-Médecine tropicale, CHRU Tours, Tours, France
| | | | - Adrien Lemaignen
- Service de Médecine Interne - Maladies Infectieuses, CHRU Tours, Tours, France
| | - Adelaïde Chesnay
- Service de Parasitologie-Mycologie-Médecine tropicale, CHRU Tours, Tours, France
| | - Marc Doman
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, APHP, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, APHP, Paris, France
| | - Louis Bernard
- Service de Médecine Interne - Maladies Infectieuses, CHRU Tours, Tours, France
| | - Marion Lacasse
- Service de Médecine Interne - Maladies Infectieuses, CHRU Tours, Tours, France
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20
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak 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D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Tinévez C, Velardo F, Ranc AG, Dubois D, Pailhoriès H, Codde C, Join-Lambert O, Gras E, Corvec S, Neuwirth C, Melenotte C, Dorel M, Lagneaux AS, Pichon M, Doat V, Fournier D, Lemaignen A, Bouard L, Patoz P, Hery-Arnaud G, Lemaitre N, Couzigou C, Guillard T, Recalt E, Bille E, Belaroussi Y, Neau D, Cazanave C, Lehours P, Puges M. Retrospective multicentric study on Campylobacter spp. bacteremia in France: the Campylobacteremia study. Clin Infect Dis 2021; 75:702-709. [PMID: 34849656 DOI: 10.1093/cid/ciab983] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Campylobacter spp. bacteremia is a severe infection. A nationwide 5-year retrospective study was conducted to characterize its clinical features and prognostic factors. METHODS Patients diagnosed with Campylobacter spp. bacteremia in 37 French hospitals participating in the surveillance network of the National Reference Center for Campylobacter and Helicobacter were included from January 1, 2015, to December 31, 2019. The goal was to analyze the effects of a delay of appropriate antibiotic therapy and other risk factors on 30-day mortality, antibiotic resistance, patient characteristics and prognosis according to the Campylobacter species. FINDINGS Among the 592 patients, Campylobacter jejuni and Campylobacter fetus were the most commonly identified species (42.9 and 42.6%, respectively). The patients were elderly (median age 68 years), and most had underlying conditions, mainly immunodepression (43.4%), hematologic malignancies (25.9%), solid neoplasms (23%) and diabetes (22.3%). C. jejuni and Campylobacter coli were associated with gastrointestinal signs, and C. fetus was associated with secondary localizations. Among the 80 patients (13.5%) with secondary localizations, 12 had endocarditis, 38 vascular, 24 osteo-articular and 9 ascitic fluid infections. The thirty-day mortality rate was 11.7%, and an appropriate antibiotic treatment was independently associated with 30-day survival (odds ratio [OR]=0.47, 95% CI [0.24-0.93], p=0.03). The median efficient therapy initiation delay was quite short (2 days, IQR [0-4]) but it had no significant impact on 30-day mortality (p=0.78). INTERPRETATION Campylobacter spp. bacteremia mainly occurred in elderly immunocompromised individuals with variable clinical presentations according to the species involved. Appropriate antimicrobial therapy was associated with improved 30-day survival.
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Affiliation(s)
- Claire Tinévez
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
| | - Fanny Velardo
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, F-33000 Bordeaux, France
| | - Anne-Gaëlle Ranc
- CHU de Lyon Sud, Bacteriology Department, F-69310 Pierre-Bénite, France
| | - Damien Dubois
- CHU de Toulouse, Bacteriology Department, F-31059 Toulouse, France
| | | | - Cyrielle Codde
- CHU de Limoges, Infectious and Tropical Diseases Department, F-87000 Limoges, France
| | | | - Emmanuelle Gras
- Hôpital Européen Georges-Pompidou, Infectious and Tropical Diseases Department, F-75015 Paris, France
| | - Stéphane Corvec
- CHU de Nantes, Bacteriology Department, F-44093 Nantes, France
| | | | - Cléa Melenotte
- CHU de Marseille, Bacteriology Department, F-13005 Marseille, France
| | - Marie Dorel
- CHU de Rennes, Infectious Diseases and Intensive Care Department, F-35033 Rennes, France
| | | | - Maxime Pichon
- CHU de Poitiers, Infectious Agents Department, Bacteriology, F-86021 Poitiers, France
| | - Violaine Doat
- CH Pierre Oudot, Biology Department, F-38300 Bourguoin-Jallieu, France
| | - Damien Fournier
- CHU de Besançon, Bacteriology Department, F-25000 Besançon, France
| | - Adrien Lemaignen
- CHRU de Tours, Infectious and Tropical Diseases Department, F-37000 Tours, France
| | - Leslie Bouard
- CHD Vendée, Biology Department, F-85000 La Roche-Sur-Yon, France
| | - Pierre Patoz
- CH de Tourcoing, Biology Department, F-59208 Tourcoing, France
| | | | - Nadine Lemaitre
- CHU d'Amiens, Bacteriology Department, F-80000 Amiens, France
| | | | - Thomas Guillard
- CHU de Reims, Bacteriology Department, F-51092 Reims, France
| | - Elise Recalt
- CHU de Strasbourg, Bacteriology Department, F-67200 Strasbourg, France
| | - Emmanuelle Bille
- CH Necker-Enfants malades, Bacteriology Department, F-75015 Paris, France
| | - Yaniss Belaroussi
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, F-33000 Bordeaux, France
| | - Didier Neau
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
| | - Charles Cazanave
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
| | - Philippe Lehours
- CHU de Bordeaux, National Reference Center for Campylobacter and Helicobacter, Bacteriology Department, F-33000 Bordeaux, France.,Univ. Bordeaux, INSERM, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, 33076, Bordeaux, France
| | - Mathilde Puges
- CHU de Bordeaux, Infectious and Tropical Diseases Department, F-33000 Bordeaux, France
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Lemoine L, Le Brun C, Maillot F, Thorey C, Boucaud A, Lemaignen A, Bigot A. Dual Ureaplasma parvum arthritis: a case report of U. parvum septic arthritis following contralateral reactive arthritis in an immunosuppressed patient. BMC Infect Dis 2021; 21:1117. [PMID: 34715803 PMCID: PMC8556906 DOI: 10.1186/s12879-021-06733-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background Ureaplasma parvum is usually part of the normal genital flora. Rarely can it cause invasive infections such as genitourinary infections, septic arthritis, or meningitis. Case presentation Here we present the first description of chronic ureterocystitis in a 56-year-old immunocompromised patient, complicated first by reactive arthritis and secondarily by contralateral septic arthritis due to U. parvum infection. U. parvum was detected in synovial fluid and in a urine sample. Treatment consisted of double-J stenting and targeted antibiotic therapy. Evolution showed resolution of urinary symptoms and clinical improvement of arthritis despite functional sequelae. Conclusions Given the high prevalence of U. parvum colonisation, this diagnosis should remain a diagnosis of exclusion. However, because of the difficulty in detecting this microorganism, it should be considered in unexplained subacute urethritis or arthritis, including reactive arthritis, especially in immunosuppressed patients. Real-time PCR positivity in the absence of a differential diagnosis should not be overlooked. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06733-0.
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Affiliation(s)
- Lea Lemoine
- Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, 2 Boulevard Tonnellé, Tonnellé, France. .,Faculty of Medicine of Tours, François Rabelais University, 10 Boulevard Tonnellé, Tours, France.
| | - Cecile Le Brun
- Department of Bacteriology-Virology-Hygiene, University Hospital of Tours, 2 Boulevard, Tonnellé, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, 2 Boulevard Tonnellé, Tonnellé, France.,UMR INSERM 1253, 10 Boulevard Tonnellé, Tours, France.,Faculty of Medicine of Tours, François Rabelais University, 10 Boulevard Tonnellé, Tours, France
| | - Camille Thorey
- Department of Infectiology, University Hospital of Tours, 2 Boulevard Tonnellé, Tonnellé, France
| | - Annaelle Boucaud
- Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, 2 Boulevard Tonnellé, Tonnellé, France.,Faculty of Medicine of Tours, François Rabelais University, 10 Boulevard Tonnellé, Tours, France
| | - Adrien Lemaignen
- Department of Infectiology, University Hospital of Tours, 2 Boulevard Tonnellé, Tonnellé, France.,Faculty of Medicine of Tours, François Rabelais University, 10 Boulevard Tonnellé, Tours, France
| | - Adrien Bigot
- Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, 2 Boulevard Tonnellé, Tonnellé, France
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Poupin P, N'Diaye D, Chaumier F, Lemaignen A, Bernard L, Fougère B. Management of COVID-19 in a French Nursing Home: Experiences from a Multidisciplinary Mobile Team. J Frailty Aging 2021; 10:363-366. [PMID: 34549253 PMCID: PMC8067781 DOI: 10.14283/jfa.2021.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for multidisciplinary collaboration to help manage outbreaks when they occur. Method In April 2020, Tours University Medical Center created a multidisciplinary mobile team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious disease experts, and palliative care specialists. Results On April 8th, 2020, the first intervention took place in a 100 residents nursing home with a total of 18 confirmed cases among 26 symptomatic residents and five deaths. The nursing home staffs’ main requests were a multidisciplinary approach, consensus decision-making, and the dissemination of information on disease management. Conclusion Three lessons emerged from this collaboration: (i) intensify collaborations between hospitals and nursing homes, (ii) limit disease transmission through the use of appropriate hygiene measures, broad screening, and the isolation of sick residents and sick employees, and (iii) provide sufficient human resources.
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Affiliation(s)
- P Poupin
- Pierre Poupin, MD, Division of Geriatric Medicine, Tours University Medical Center, Tours, France, E-mail: , Phone: +33-643-166-637
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24
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Sebillotte M, Boutoille D, Declerck C, Talarmin J, Lemaignen A, Piau C, Tattevin P, Gousseff M. Endocardites à bacilles Gram négatif non HACEK : étude rétrospective multicentrique cas-témoins. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Hobson CA, Desoubeaux G, Carvalho-Schneider C, Destrieux C, Cottier JP, Garot D, Le Brun C, Maakaroun Z, Lemaignen A, Bailly É, Bernard L. Challenging diagnosis of chronic cerebral fungal infection: Value of (1→3)-ß-D-glucan and mannan antigen testing in cerebrospinal fluid and of cerebral ventricle puncture. Med Mycol 2021; 59:74-80. [PMID: 32470986 DOI: 10.1093/mmy/myaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1→3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.
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Affiliation(s)
- Claire A Hobson
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Guillaume Desoubeaux
- Department of Parasitology and Mycology, University Hospital of Tours, France.,CEPR INSERM U1100 / Team 3
| | | | - Christophe Destrieux
- Department of Neuro-surgery, University Hospital of Tours, France.,UMR1253, iBrain, INSERM, Tours, France
| | - Jean-Philippe Cottier
- UMR1253, iBrain, INSERM, Tours, France.,Department of Neuro-imaging, University Hospital of Tours, France
| | - Denis Garot
- Intensive Care Unit, University Hospital of Tours, France
| | - Cécile Le Brun
- Department of Microbiology, University Hospital of Tours, France
| | - Zoha Maakaroun
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Adrien Lemaignen
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Éric Bailly
- Department of Parasitology and Mycology, University Hospital of Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, University Hospital of Tours, France
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Lacasse M, Inyambo K, Lemaignen A, Mennecart M, Gensburger S, Valentin AS, Bernard L, Fougère B. Erysipelas of the right arm due to Bordetella trematum: a case report. J Med Case Rep 2021; 15:365. [PMID: 34253232 PMCID: PMC8276433 DOI: 10.1186/s13256-021-02896-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/10/2021] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- M Lacasse
- Geriatric Department, Tours University Hospital, Tours, France. .,Infectious Diseases Unit, Tours University Hospital, Tours, France.
| | - K Inyambo
- Geriatric Department, Tours University Hospital, Tours, France
| | - A Lemaignen
- Infectious Diseases Unit, Tours University Hospital, Tours, France
| | - M Mennecart
- Geriatric Department, Tours University Hospital, Tours, France
| | - S Gensburger
- Geriatric Department, Tours University Hospital, Tours, France
| | - A S Valentin
- Bacteriology Department of Tours University Hospital, Tours, France
| | - L Bernard
- Infectious Diseases Unit, Tours University Hospital, Tours, France
| | - B Fougère
- Geriatric Department, Tours University Hospital, Tours, France
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27
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Dellière S, Peiffer-Smadja N, João-Lopes M, Cevik M, Pichon M, Bleibtreu A, Schweitzer V, Last K, Ferreira TG, Lemaignen A, Barac A. Aims and challenges of building national trainee networks in clinical microbiology and infectious disease disciplines. Future Microbiol 2021; 16:687-695. [PMID: 34227395 DOI: 10.2217/fmb-2021-0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Trainees represent the medical practice of tomorrow. Interactions and collaborations at the early stage in career will strengthen the future of our specialties, clinical microbiology and infectious diseases. Trainee networks at the national level help access the best education and career opportunities. The aim of this collaborative white paper between the Trainee Association of European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and four national trainee networks is to discuss the motivation for building such networks and offer guidance for their creation and sustainability even during a health crisis.
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Affiliation(s)
- Sarah Dellière
- Université de Paris, Service de Parasitologie-Mycologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Nathan Peiffer-Smadja
- Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Maria João-Lopes
- Infectious & Tropical Diseases Department, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal
| | - Muge Cevik
- Division of Infection & Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK
| | - Maxime Pichon
- Infectious Agents Department, CHU de Poitiers, Bacteriology & Infection Control Laboratory, Poitiers, France; Université de Poitiers, U1070 INSERM, Pharmacologie des Agents Anti-Infectieux, Poitiers, France
| | - Alexandre Bleibtreu
- Infectious & Tropical Diseases Departement, Pitié Salpêtrière hospital, APHP-SU, Paris, France
| | - Valentijn Schweitzer
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Katharina Last
- Institute of Medical Microbiology & Hygiene, Saarland University, Homburg/Saar, Germany
| | - Théo G Ferreira
- Université de Paris, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Université de Tours, Tours, France
| | - Aleksandra Barac
- Clinic for Infectious & Tropical Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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Renard L, Lemaignen A, Desoubeaux G, Bakhos D. Case Report: Progressive Dysphonia and Dysphagia due to Laryngeal Leishmaniasis. Am J Trop Med Hyg 2021; 105:458-460. [PMID: 34125697 DOI: 10.4269/ajtmh.20-1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/03/2021] [Indexed: 11/07/2022] Open
Abstract
Laryngeal leishmaniasis is an unusual form of the disease. We report the case of a patient who consulted for dysphonia and dysphagia in a context of asthenia and weight loss. The patient had lesions that were suggestive of laryngeal cancer but were revealed to be leishmaniasis by histopathology examination and polymerase chain reaction. Treatment with amphotericin B and miltefosine permitted complete resolution of the lesions and no recurrence during the 18-month follow-up period.
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Affiliation(s)
- Laura Renard
- CHU de Tours, Service ORL et Chirurgie Cervico-Faciale, Tours, France
| | - Adrien Lemaignen
- CHU de Tours, Service de Maladies Infectieuses, Tours, France.,Faculté de Médecine de Tours, Université François-Rabelais de Tours, CHRU de Tours, Tours, France
| | - Guillaume Desoubeaux
- Faculté de Médecine de Tours, Université François-Rabelais de Tours, CHRU de Tours, Tours, France.,Service de Parasitologie, Mycologie et Médecine Tropicale. Tours, France
| | - David Bakhos
- CHU de Tours, Service ORL et Chirurgie Cervico-Faciale, Tours, France.,Faculté de Médecine de Tours, Université François-Rabelais de Tours, CHRU de Tours, Tours, France.,Service de Parasitologie, Mycologie et Médecine Tropicale. Tours, France
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29
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Dinh A, Hallouin-Bernard MC, Davido B, Lemaignen A, Bouchand F, Duran C, Even A, Denys P, Perrouin-Verbe B, Sotto A, Lavigne JP, Bruyère F, Grall N, Tavernier E, Bernard L. Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial. Clin Infect Dis 2021; 71:3128-3135. [PMID: 31867616 DOI: 10.1093/cid/ciz1207] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/17/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalizations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis (ie, the alternate weekly administration of 2 antibiotics) in preventing R-UTIs. METHODS Randomized (1:1), open-label, superiority-controlled trial compared WOCA prophylaxis to no prophylaxis (control) for 6 months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome was incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes were number of febrile UTIs, number of hospitalizations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal, and nasal microbiota. RESULTS Forty-five patients were either allocated to the WOCA group (n = 23) or the control group (n = 22). Median (IQR) incidence of symptomatic antibiotic-treated UTIs was 1.0 (0.5-2.5) in the WOCA group versus 2.5 (1.2-4.0) (P = .0241) in the control group. No febrile UTIs were recorded in the WOCA group versus 9 (45.0%) (P < .001) in the control group. The median number of additional antibiotic treatment was 0.0 (IQR, 0.0-2.0) versus 3.0 (2.0-5.0) (P = .004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed. CONCLUSIONS WOCA is efficient and well tolerated in preventing R-UTIs in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures. CLINICAL TRIALS REGISTRATION NCT01388413.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | | | - Benjamin Davido
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Adrien Lemaignen
- Department of Infectious Diseases, Bretonneau University Hospital, Tours, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Alexia Even
- Department of Urology, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Pierre Denys
- Department of Urology, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, Saint-Jacques Hospital, University Hospital of Nantes, Nantes, France
| | - Albert Sotto
- Department of Infectious Diseases, Caremeau University Hospital, Nîmes, France
| | | | - Franck Bruyère
- Department of Urology, Bretonneau University Hospital, Tours, France
| | - Nathalie Grall
- Microbiology Laboratory, Bichat-Claude Bernard University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elsa Tavernier
- Clinical Investigation Centre INSERM 1415, Bretonneau University Hospital, Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, Bretonneau University Hospital, Tours, France
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30
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Martins C, Peiffer-Smadja N, Thill P, Osei L, Sotto A, Bleibtreu A, Lemaignen A. Reform of the third cycle of medical studies: One year after, what is the record concerning infectious diseases? Infect Dis Now 2021; 51:576-579. [PMID: 33870887 DOI: 10.1016/j.idnow.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 01/14/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - P Thill
- CHU d'Amiens, Amiens, France
| | | | | | - A Bleibtreu
- Hôpital de la Pitié Salpêtrière, AP-HP, France
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Von Tokarski F, Hobson C, Lartigue MF, Lemaignen A, Lioger B. Streptococcus pyogenes necrotizing soft tissue infection following glucose monitoring with FreeStyle Libre device. QJM 2021; 114:58-59. [PMID: 32277817 DOI: 10.1093/qjmed/hcaa123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Von Tokarski
- Department of Infectious Diseases and Internal Medicine, University Hospital of Tours, Francois Rabelais University, Tours, France
| | - C Hobson
- Department of Infectious Diseases and Internal Medicine, University Hospital of Tours, Francois Rabelais University, Tours, France
| | - M-F Lartigue
- Service de Bactériologie Virologie et Hygiène Hospitalière, University Hospital of Tours, Francois Rabelais University, Tours, France
| | - A Lemaignen
- Department of Infectious Diseases and Internal Medicine, University Hospital of Tours, Francois Rabelais University, Tours, France
| | - B Lioger
- Department of Internal Medicine, Hospital of Blois, Mail Pierre Charlot, Blois 41000, France
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Bouiller K, Catho G, Le Maréchal M, Gras J, Hentzien M, Peiffer-Smadja N, Bessis S, Cabon M, Dubee V, Lemaignen A, Thy M, Martins C, Thill P, Osei L. The role of infectious disease trainees during the first wave of the COVID-19 pandemic: A national survey. Infect Dis Now 2021; 51:215-217. [PMID: 33495762 PMCID: PMC7816620 DOI: 10.1016/j.idnow.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/29/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Kevin Bouiller
- Service de maladies Infectieuses, Centre Hospitalier Universitaire Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besancon, France
| | - Gaud Catho
- Service de Prévention et Contrôle de l'Infection, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Marion Le Maréchal
- Service de maladies Infectieuses, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julien Gras
- Service de maladies Infectieuses, Hôpital Saint-Louis, Assistance-publique Hôpitaux de Paris, Paris, France
| | - Maxime Hentzien
- Service de médecine interne, maladies infectieuses, immunologie clinique, Robert Debré University Hospital, Reims, France
| | - Nathan Peiffer-Smadja
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance-publique Hôpitaux de Paris, Paris, France
| | - Simon Bessis
- Service de maladies infectieuses et tropicales, Hôpital Raymond-Poincaré - Assistance publique hôpitaux de Paris (AP-HP), France
| | - Mathieu Cabon
- Hôpital d'Instruction des Armées, Bégin, Saint Mandé, France
| | - Vincent Dubee
- Service des Maladies Infectieuses et Tropicales, CHU, Angers, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau, CHRU de Tours, France
| | - Michael Thy
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Capucine Martins
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Pauline Thill
- Service Des Maladies Infectieuses, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Lindsay Osei
- Service de Maladies Infectieuses et Tropicales, CHU, Martinique
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Lemaignen A, Bernard L, Marmor S, Ferry T, Grammatico-Guillon L, Astagneau P. Epidemiology of complex bone and joint infections in France using a national registry: The CRIOAc network. J Infect 2020; 82:199-206. [PMID: 33352213 DOI: 10.1016/j.jinf.2020.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/29/2020] [Accepted: 12/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES In France, a network of reference centers for bone and joint infections (BJI) was created in 2008, focused on the management of complex BJI (previous failure, difficult-to-treat microorganisms, heavy comorbidities or surgical procedures). A national registry was implemented from 2012, collecting decisions advised in periodic multidisciplinary meetings. We present here an epidemiological overview. METHODS All consecutive adult patients presented from 2014 to 2019 in 23/30 reference centers were included in this cohort. Characteristics of patients, BJI, and medico-surgical management advice were described. RESULTS 27,483 individual patients were included, corresponding to 28,365 distinct infectious episodes, which 17,328 were complex. Median age was 65 years, with 62% of men, 1/3 patients presented more than 2 comorbidities. Prosthetic joint infections (PJI) represented 42% of all BJIs (11,812 episodes). Staphylococcus aureus, coagulase-negative staphylococci and polymicrobial PJI represented 26%, 25% and 16% respectively. DAIR (debridement, antibiotics and implant retention) was proposed for 3,157 (27%), whereas one-stage and two-stage revision for 3,683 (31%) and 1,764 (15%). An antibiotic treatment was advised in 10,493 episodes (87%), with combination therapy in 88%. CONCLUSION This national network allows an optimized management of complex BJIs. Its cohort is a unique opportunity to draw up a detailed epidemiological picture and to follow the trends of these infrequent infections.
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Affiliation(s)
- Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau, CHRU de Tours, 2, Boulevard Tonnellé, 37044 Tours CEDEX 9, France; Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France.
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau, CHRU de Tours, 2, Boulevard Tonnellé, 37044 Tours CEDEX 9, France
| | - Simon Marmor
- Groupe Hospitalier Diaconesses-Croix Saint Simon, CRIOAc, Paris, France
| | - Tristan Ferry
- Hospices Civils de Lyon, Service de Maladies Infectieuses et Tropicales, Lyon, France
| | - Leslie Grammatico-Guillon
- CHRU de Tours, Unité d'Épidémiologie des données cliniques, EpiDcliC, Tours, France; Unité Inserm 1259, Université de tours, Tours, France
| | - Pascal Astagneau
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France; Centre d'appui pour la prévention des infections associées aux soins (CPIAS), Paris, France
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Peiffer-Smadja N, Ardellier FD, Thill P, Beaumont AL, Catho G, Osei L, Dubée V, Bleibtreu A, Lemaignen A, Thy M. How and why do French medical students choose the specialty of infectious and tropical diseases? A national cross-sectional study. BMC Med Educ 2020; 20:397. [PMID: 33129325 PMCID: PMC7602756 DOI: 10.1186/s12909-020-02317-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Infectious and tropical diseases (ID) physicians are needed now more than ever to tackle existing and emerging global threats. However, in many countries, ID is not recognized as a qualifying specialty. The creation of ID residency in 2017 in France offers the opportunity to know how and why the specialty is chosen by medical students. METHODS We first analyzed the choice of specialty of all French medical students in 2017 and 2018 according to their rank at the national exam that ends medical studies. A web questionnaire was then sent in January 2019 to all ID residents in France (n = 100) to assess the factors influencing their choice of specialty and their career plan. RESULTS We analyzed the choice of 17,087 medical students. ID was the first-chosen specialty with a median national rank of 526/8539, followed by plastic surgery and ophthalmology. The questionnaire was completed by 90% of the French ID residents (n = 100). The most encouraging factors to choose ID were the multi-system approach of the specialty, the importance of diagnostic medicine and having done an internship in ID during medical school. The potential deterrents were the work-life balance, the workload and the salary. CONCLUSIONS The recent recognition of ID as a qualifying specialty in France can be considered a success insofar as the specialty is the most popular among all medical and surgical specialties. Individuals who choose ID are attracted by the intellectual stimulation of the specialty but express concerns about the working conditions and salaries.
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Affiliation(s)
- Nathan Peiffer-Smadja
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France.
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
- Université de Paris, INSERM, IAME, F-75006, Paris, France.
| | | | - Pauline Thill
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Anne-Lise Beaumont
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Gaud Catho
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Lindsay Osei
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Vincent Dubée
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Alexandre Bleibtreu
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Adrien Lemaignen
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Michaël Thy
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance-Publique Hôpitaux de Paris, Paris, France
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Lemaignen A, Grammatico-Guillon L, Astagneau P, Marmor S, Ferry T, Jolivet-Gougeon A, Senneville E, Bernard L. Computerized registry as a potential tool for surveillance and management of complex bone and joint infections in France: French registry of complex bone and joint infections. Bone Joint Res 2020; 9:635-644. [PMID: 33101653 PMCID: PMC7547640 DOI: 10.1302/2046-3758.910.bjr-2019-0362.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The French registry for complex bone and joint infections (C-BJIs) was created in 2012 in order to facilitate a homogeneous management of patients presented for multidisciplinary advice in referral centres for C-BJI, to monitor their activity and to produce epidemiological data. We aimed here to present the genesis and characteristics of this national registry and provide the analysis of its data quality. Methods A centralized online secured database gathering the electronic case report forms (eCRFs) was filled for every patient presented in multidisciplinary meetings (MM) among the 24 French referral centres. Metrics of this registry were described between 2012 and 2016. Data quality was assessed by comparing essential items from the registry with a controlled dataset extracted from medical charts of a random sample of patients from each centre. Internal completeness and consistency were calculated. Results Between 2012 and 2016, 30,607 presentations in MM were recorded corresponding to 17,748 individual patients (mean age 62.1 years (SD 18.4); 10,961 (61.8%) males). BJI was considered as complex for 63% of cases (n = 19,355), and 13,376 (44%) had prosthetic joint infections (PJIs). The controlled dataset, available for 19 centres, included 283 patients. Global consistency and completeness were estimated at 88.2% and 88.9%, respectively, considering missing items in the eCRFs as negative results. Conclusion This national registry is one of the largest prospective databases on BJI and its acceptable data quality parameters allow further use for epidemiological purposes.Cite this article: Bone Joint Res 2020;9(9):635-644.
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Affiliation(s)
- Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Regional University Hospital Centre Tours, Tours, France.,University of Tours, Tours, France.,iPLESP, Paris, France
| | - Leslie Grammatico-Guillon
- Unité d'Épidémiologie des données cliniques, EpiDcliC, Regional University Hospital Centre Tours, Tours, France.,UMR 1259 - MAVIVH, INSERM, Tours, France
| | - Pascal Astagneau
- iPLESP, Paris, France.,Centre d'appui pour la prévention des infections associées aux soins (CPIAS), Paris, France
| | - Simon Marmor
- Service d'Orthopédie, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | | | - Eric Senneville
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, Tourcoing, Nord-Pas-de-Calais, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Regional University Hospital Centre Tours, Tours, France
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Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, Flament T, Ferreira-Maldent N, Bruyère F, Stefic K, Gaudy-Graffin C, Grammatico-Guillon L, Bernard L. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2020; 27:258-263. [PMID: 33031948 PMCID: PMC7534895 DOI: 10.1016/j.cmi.2020.09.052] [Citation(s) in RCA: 422] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023]
Abstract
Objectives To describe the clinical evolution and predictors of symptom persistence during 2 months' follow-up in adults with noncritical coronavirus disease 2019 (COVID-19). Methods We performed descriptive clinical follow-up (day (D) 7, D30 and D60) of 150 patients with noncritical COVID-19 confirmed by real-time reverse transcriptase PCR at Tours University Hospital from 17 March to 3 June 2020, including demographic, clinical and laboratory data collected from the electronic medical records and by phone call. Persisting symptoms were defined by the presence at D30 or D60 of at least one of the following: weight loss ≥5%, severe dyspnoea or asthenia, chest pain, palpitations, anosmia/ageusia, headache, cutaneous signs, arthralgia, myalgia, digestive disorders, fever or sick leave. Results At D30, 68% (103/150) of patients had at least one symptom; and at D60, 66% (86/130) had symptoms, mainly anosmia/ageusia: 59% (89/150) at symptom onset, 28% (40/150) at D30 and 23% (29/130) at D60. Dyspnoea concerned 36.7% (55/150) patients at D30 and 30% (39/130) at D60. Half of the patients (74/150) at D30 and 40% (52/130) at D60 reported asthenia. Persistent symptoms at D60 were significantly associated with age 40 to 60 years old, hospital admission and abnormal auscultation at symptom onset. At D30, severe COVID-19 and/or dyspnoea at symptom onset were additional factors associated with persistent symptoms. Conclusions Up to 2 months after symptom onset, two thirds of adults with noncritical COVID-19 had complaints, mainly anosmia/ageusia, dyspnoea or asthenia. A prolonged medical follow-up of patients with COVID-19 seems essential, whatever the initial clinical presentation.
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Affiliation(s)
- Claudia Carvalho-Schneider
- Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, France.
| | - Emeline Laurent
- Epidémiologie des Données cliniques en Centre-Val de Loire (EpiDcliC), Centre Hospitalier Universitaire de Tours, Tours, France; Equipe de Recherche 'Education Ethique Santé' (EE1 EES), Université de Tours, Tours, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, France
| | - Emilie Beaufils
- Centre Mémoire Ressources et Recherche (CMRR), Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Saïd Laribi
- Service d'urgences et Faculté de Médecine, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Thomas Flament
- Service de Pneumologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Franck Bruyère
- Service d'urologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Karl Stefic
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Tours, Tours, France; Unité INSERM U1259, Université de Tours, Tours, France
| | - Catherine Gaudy-Graffin
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Tours, Tours, France; Unité INSERM U1259, Université de Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Epidémiologie des Données cliniques en Centre-Val de Loire (EpiDcliC), Centre Hospitalier Universitaire de Tours, Tours, France; Unité INSERM U1259, Université de Tours, Tours, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, France
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Marlet J, Petillon C, Ragot E, Abou El Fattah Y, Guillon A, Marchand Adam S, Lemaignen A, Bernard L, Desoubeaux G, Blasco H, Barin F, Stefic K, Gaudy-Graffin C. Clinical performance of four immunoassays for antibodies to SARS-CoV-2, including a prospective analysis for the diagnosis of COVID-19 in a real-life routine care setting. J Clin Virol 2020; 132:104633. [PMID: 32927357 PMCID: PMC7831733 DOI: 10.1016/j.jcv.2020.104633] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 01/13/2023]
Abstract
The sensitivity of evaluated SARS-CoV-2 immunoassays ranged from 95.6% to 97.8%. The specificity was 92.1% for Euroimmun IgG and ≥ 98.9% for Abbott IgG, Wantai Ab and DiaPro confirmation IgG assays. A lack of specificity was observed for low positive Euroimmun IgG results (ratio<5) and inconclusive RT-PCR results. A lack of sensitivity was observed for early serology (<14 days) or late RT-PCR testing (>30 days).
Objectives The aim of the present study was to evaluate the clinical performance of four SARS-CoV-2 immunoassays and their contribution in routine care for the diagnosis of COVID-19, in order to benefit of robust data before their extensive use. Methods The clinical performance of Euroimmun ELISA SARS-CoV-2 IgG, Abbott SARS-CoV-2 IgG, Wantai SARS-CoV-2 Ab ELISA, and DiaPro COVID-19 IgG confirmation were evaluated in the context of both a retrospective and a prospective analysis of COVID-19 patients. The retrospective analysis included plasma samples from 63 COVID-19 patients and 89 control (pre-pandemic) patients. The prospective study included 203 patients who tested either negative (n = 181) or positive (n = 22) by RT-PCR before serology sampling. Results The specificity was 92.1 %, 98.9 %, 100 % and 98.9 % and the sensitivity 14 days after onset of symptoms was 95.6 %, 95.6 %, 97.8 % and 95.6 % for Euroimmun IgG, Abbott IgG, Wantai Ab, and DiaPro IgG confirmation SARS-CoV-2 immunoassays, respectively. The low specificity of Euroimmun IgG (for ratio <5) was not confirmed in routine care setting (98.5 % negative agreement). Serology was complementary to RT-PCR in routine care and lead to identification of false positive (Ct>38, <2 targets detected) and false negative RT-PCR results (>1 month post onset of symptoms). Conclusions Serology was complementary to RT-PCR for the diagnosis of COVID-19 at least 14 days after onset of symptoms. First line serology testing can be performed with Wantai Ab or Abbott IgG assays, while DiaPro IgG confirmation assay can be used as an efficient confirmation assay.
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Affiliation(s)
- Julien Marlet
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France.
| | - Camille Petillon
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
| | - Emma Ragot
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
| | | | - Antoine Guillon
- Service de Réanimation Polyvalente, CHRU de Tours, France; Inserm, U1100, Centre d'Etude des Pathologies Respiratoires, Université de Tours, Tours, France
| | - Sylvain Marchand Adam
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, France
| | - Guillaume Desoubeaux
- Service de Parasitologie et Mycologie - Médecine tropicale, CHRU de Tours, France
| | - Hélène Blasco
- Service de Biochimie et Biologie Moléculaire, CHRU de Tours, France
| | - Francis Barin
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France
| | - Karl Stefic
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France
| | - Catherine Gaudy-Graffin
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France
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Carvalho Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao Tournois C, Bruyère F, Stefic K, Guillon Grammatico L, Bernard L. Suivi clinique à 30 et 60 jours des patients ayant présenté une forme modérée de COVID-19. Med Mal Infect 2020. [PMCID: PMC7441925 DOI: 10.1016/j.medmal.2020.06.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gousseff M, Botelho-Nevers E, Conrad A, Gallay L, Goehringer F, Lemaignen A, Lescure F, Penot P, Salmon D, Pozzetto B. Récurrences symptomatiques de COVID-19 confirmées après guérison clinique d’un premier épisode : rechute, réinfection ou rebond inflammatoire ? Med Mal Infect 2020. [PMCID: PMC7442014 DOI: 10.1016/j.medmal.2020.06.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Bien que, par analogie aux autres coronavirus, la maladie COVID-19 induite par SARS-CoV-2 ait été initialement supposée monophasique et transitoirement immunisante, de rares publications rapportent des patients avec 2e épisode. L’objectif de cette étude est de décrire les caractéristiques cliniques, la séquence moléculaire de détection virale, et le devenir de patients présentant 2 épisodes distincts de COVID-19. Matériels et méthodes Une étude nationale multicentrique rétrospective observationnelle a recensé les patients présentant un 2e épisode aigu symptomatique de COVID-19, défini par au moins un signe clinique majeur typique, et une PCR SARS-CoV-2 positive dans les voies aériennes, après : – au moins 21 jours du début du 1er épisode ; – une phase de guérison clinique (retour à l’état antérieur, ou sortie de soins aigus sans oxygène), sans diagnostic différentiel infectieux, thromboembolique ou inflammatoire. Résultats Onze patients présentant un 2e épisode de COVID-19 après une guérison clinique médiane [étendue] de 10 [3–27] jours ont été recensés, et 2 groupes ont été individualisés. Dans le 1er, 4 soignants sans comorbidités, d’âge médian 32,5 [19–43] ans, potentiellement re-exposés au SARS-CoV- (3 dans des unités de soins COVID, 1 au domicile), ont présenté aux 2 épisodes une maladie modérée suivie en ambulatoire. Dans le 2e groupe, 7 patients comorbides (dont 2 sous chimiothérapie), d’âges médian 73 [54–91] ans, ont été hospitalisés en soins aigus à chaque épisode. Au 1er, 3 patients ont reçu des corticoïdes. Aucune réexposition au SARS-CoV-2 n’a été documentée, et 3 patients sont décédés, dont 2 de syndrome de détresse respiratoire aiguë sans autre cause que le SARS-CoV-2. Au 2e épisode, tous les scanners montraient des signes aigus de COVID-19, 4/9 PCR avaient des « cycle threshold » (CT) < 30, et 1 sur 2 cultures virales pratiquées était positive. La sérologie SARS-CoV-2 après j21 était positive pour 6 patients, et négative pour 3 (du 2e groupe). Conclusion Cette étude exploratoire confirme la possibilité de récurrences de symptômes après guérison clinique d’un premier épisode de COVID-19. La positivité des PCR aux 2e épisodes (de plusieurs gènes ou avec CT bas) et au moins une culture virale positive, sans diagnostic différentiel identifié, sont en faveur d’une origine virale à ces récurrences. Les caractéristiques des 2 groupes de patients suggèrent soit des réinfections, soit des réactivations virales. Un déficit immunitaire relatif cellulaire ou humoral (par épuisement professionnel ou immuno-senescence, ou traitements immunosuppresseurs), pourraient entraver la clairance virale ou l’efficacité immunitaire antivirale contre les réinfections à SARS-CoV-2. De plus larges études épidémiologiques, et immuno-virologiques sont nécessaires pour comprendre la fréquence et le(s) mécanisme(s) de ces récurrences.
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Lauda-Maillen M, Lemaignen A, Puyade M, Catroux M, Le Moal G, Beraud G, El Hajj H, Michaud A, Destrieux C, Bernard L, Rammaert B, Cazenave-Roblot F. Feasibility of early switch to oral antibiotic in brain abscesses and empyema: a multicentre retrospective study. Eur J Clin Microbiol Infect Dis 2020; 40:209-213. [PMID: 32671654 DOI: 10.1007/s10096-020-03904-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- M Lauda-Maillen
- Université de Poitiers, Poitiers, France.
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France.
| | - A Lemaignen
- Université de Tours, Tours, France
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - M Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - M Catroux
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - G Le Moal
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - G Beraud
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - H El Hajj
- Service de Neurochirurgie, CHU de Poitiers, Poitiers, France
| | - A Michaud
- Service de Microbiologie, CHU de Poitiers, Poitiers, France
| | - C Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- Service de Neurochirurgie, CHRU de Tours, Tours, France
| | - L Bernard
- Université de Tours, Tours, France
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - B Rammaert
- Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
- INSERM U1070, Poitiers, France
| | - F Cazenave-Roblot
- Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
- INSERM U1070, Poitiers, France
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Lemaignen A, Bernard L, Tattevin P, Bru JP, Duval X, Hoen B, Brunet-Houdard S, Mainardi JL, Caille A. Oral switch versus standard intravenous antibiotic therapy in left-sided endocarditis due to susceptible staphylococci, streptococci or enterococci (RODEO): a protocol for two open-label randomised controlled trials. BMJ Open 2020; 10:e033540. [PMID: 32665381 PMCID: PMC7365486 DOI: 10.1136/bmjopen-2019-033540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Left-sided infective endocarditis (IE) is a serious infection with a heavy burden for patients and healthcare system. Oral switch after initial intravenous antibiotic therapy may reduce costs and improve patients' discomfort without increasing unfavourable outcomes. We describe the methodology of two simultaneously conducted open-label randomised trials aiming to assess non-inferiority of oral switch as compared with entirely intravenous antibiotic therapy for the treatment of left-sided IE. METHODS AND ANALYSIS Two simultaneous multicentre open-label prospective randomised trials assessing non-inferiority of oral switch during antibiotic treatment as compared with entirely intravenous therapy in patients with left-sided IE are ongoing. One trial is dedicated to left-sided IE caused by multisusceptible staphylococci (Relais Oral Dans le traitement des Endocardites à staphylocoques ou streptOcoques (RODEO)-1) and the other is dedicated to left-sided IE caused by susceptible streptococci or enterococci (RODEO-2). It is planned to randomise 324 patients in each trial after an initial course of at least 10 days of intravenous antibiotic therapy either to continue intravenous antibiotic therapy or to switch to oral antibiotic therapy. The primary outcome is treatment failure within 3 months after the end of antibiotic treatment, a composite outcome defined by all-cause death and/or symptomatic embolic events and/or unplanned valvular surgery and/or microbiological relapse (with the primary pathogen). Secondary outcomes include patient quality of life, echocardiographic outcome, costs and efficiency associated with IE care. Statistical analysis will be performed with a non-inferiority margin of 10% and a one-sided 2.5% type I error. ETHICS AND DISSEMINATION Written informed consent will be obtained from all participants. This study was approved by Tours Research ethics committee (CPP TOURS-Region Centre-Ouest 1, 2015-R26, 23 February 2016). Study findings will be published in peer-reviewed journals and disseminated through presentation at relevant national and international conferences. TRIAL REGISTRATION NUMBER EudraCT Number: 2015-002371-16 and NCT02701608; NCT02701595.
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Affiliation(s)
- Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, Tours, France
- Université de Tours, Faculté de Médecine, PRES Centre-Val de Loire Université, Tours, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Pierre Tattevin
- Service de Maladies Infectieuses et de Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Jean-Pierre Bru
- Service d'infectiologie et de médecine interne, Centre Hospitalier Annecy-Genevois, Epagny Metz-Tessy, Rhône-Alpes, France
| | - Xavier Duval
- INSERM Clinical Investigation Center 1425, IAME 1138, Universite Paris Diderot, Sorbonne Paris-Cité, Paris, Île-de-France, France
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Bruno Hoen
- Service de Maladies Infectieuses et Tropicales, CHRU de Nancy, Vandoeuvre-les-Nancy, France
| | - Solène Brunet-Houdard
- Unité d'Evaluation Médico-Economique, EA7505, Education Ethique, Santé, Centre Hospitalier Régional Universitaire de Tours, Université de Tours, Tours, Centre, France
| | - Jean-Luc Mainardi
- Service de Microbiologie, APHP, Hôpital Européen Georges Pompidou, Paris, France
| | - Agnes Caille
- Unité d'Evaluation Médico-Economique, EA7505, Education Ethique, Santé, Centre Hospitalier Régional Universitaire de Tours, Université de Tours, Tours, Centre, France
- INSERM CIC1415, CHRU de Tours, Tours, France
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42
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Gousseff M, Penot P, Gallay L, Batisse D, Benech N, Bouiller K, Collarino R, Conrad A, Slama D, Joseph C, Lemaignen A, Lescure FX, Levy B, Mahevas M, Pozzetto B, Vignier N, Wyplosz B, Salmon D, Goehringer F, Botelho-Nevers E. Clinical recurrences of COVID-19 symptoms after recovery: Viral relapse, reinfection or inflammatory rebound? J Infect 2020; 81:816-846. [PMID: 32619697 PMCID: PMC7326402 DOI: 10.1016/j.jinf.2020.06.073] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/27/2022]
Abstract
For the first 3 months of COVID-19 pandemic, COVID-19 was expected to be an immunizing non-relapsing disease. We report a national case series of 11 virologically-confirmed COVID-19 patients having experienced a second clinically- and virologically-confirmed acute COVID-19 episode. According to the clinical history, we discuss either re-infection or reactivation hypothesis. Larger studies including further virological, immunological and epidemiologic data are needed to understand the mechanisms of these recurrences.
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Affiliation(s)
- Marie Gousseff
- Service de Medecine interne, Maladies Infectieuses, hematologie, Centre Hospitalier Bretagne Atlantique, 20, boulevard Maurice Guillaudot, 56000 Vannes, France.
| | - Pauline Penot
- Hôpital intercommunal André Grégoire, groupement hospitalier Grand Paris Nord Est, 56, boulevard de la Boissière, 93100 Montreuil, France.
| | - Laure Gallay
- Service Médecine Interne, Pr Hot, INMG CNRS UMR5310 INSERM U1217, Place d'arsonvaal, 69003 Lyon, France.
| | - Dominique Batisse
- Department of Infectious Diseases and Immunology, Cochin-Hôtel-Dieu Hospital, Publique -Hôpitaux de Paris (APHP), University of Paris. 1, place parvis Notre Dame, 75014 Paris, France
| | - Nicolas Benech
- Service des Maladies Infectieuses et Tropicales, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69004 Lyon, France.
| | - Kevin Bouiller
- Department of infectious disease, University Hospital of Besançon, F-25000 Besançon, France; UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France.
| | - Rocco Collarino
- Service des Maladies infectieuses et tropicales, Assistance publique- hôpitaux de Paris, Centre hospitalier universitaire Bicêtre, 78 rue du général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Anne Conrad
- Service des Maladies Infectieuses et Tropicales, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69004 Lyon, France.
| | - Dorsaf Slama
- Department of Infectious Diseases and Immunology, Cochin-Hôtel-Dieu Hospital, Assistance, Publique -Hôpitaux de Paris (APHP), University of Paris. 1, place parvis Notre Dame, 75014 Paris, France
| | - Cédric Joseph
- Service des Maladies Infectieuses et Tropicales, CHU Amiens-Picardie, Place Victor Pauchet 80054 Amiens, France.
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Université de Tours, 2, Boulevard Tonnellé, 37000 Tours, France.
| | - François-Xavier Lescure
- AP-HP, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University, Hospital, Paris, France; University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France. 46 rue Henri Huchard, 75018 Paris, France.
| | - Bruno Levy
- Service de Médecine Intensive et Reanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, and Université de Lorraine, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France. IMRB - U955 - INSERM Equipe n°2 "Transfusion et maladies du globule rouge" EFS Île-de-France, Hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - Bruno Pozzetto
- GIMAP (EA 3064), University of Saint-Etienne, University of Lyon, Faculty of Medicine of Saint-Etienne, 42023 cedex 02 Saint-Etienne, France.
| | - Nicolas Vignier
- Groupe hospitalier Sud Ile de France & INSERM, Institut Pierre Louis d'Épidémiologie et de, Santé Publique (IPLESP), Sorbonne Université, Paris, France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - Benjamin Wyplosz
- Service des Maladies infectieuses et tropicales, Assistance publique- hôpitaux de Paris, Centre hospitalier universitaire Bicêtre, 78 rue du général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Dominique Salmon
- Department of Infectious Diseases and Immunology, Cochin-Hôtel-Dieu Hospital, Assistance, Publique -Hôpitaux de Paris (APHP), University of Paris. 1, place parvis Notre Dame, 75014 Paris, France.
| | - Francois Goehringer
- Service de Maladies Infectieuses et Tropicales, Centre Régional Universitaire de Nancy, Hôpitaux de Brabois, Rue du Morvan, 54511 Vandoeuvre Lés Nancy, France.
| | - Elisabeth Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, 42055 cedex 02 Saint-Etienne, GIMAP (EA 3064), France; University of Saint-Etienne, University of Lyon, Faculty of Medicine of Saint-Etienne, 42023 cedex 02 Saint-Etienne, France.
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43
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Le Hingrat Q, Collin G, Lê M, Peytavin G, Visseaux B, Bertine M, Tubiana R, Karmochkine M, Valin N, Collin F, Lemaignen A, Bernard L, Damond F, Matheron S, Descamps D, Charpentier C. A New Mechanism of Resistance of Human Immunodeficiency Virus Type 2 to Integrase Inhibitors: A 5-Amino-Acid Insertion in the Integrase C-Terminal Domain. Clin Infect Dis 2020; 69:657-667. [PMID: 30383215 DOI: 10.1093/cid/ciy940] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are crucial for the treatment of human immunodeficiency virus (HIV) type 2 infection, due to limited available therapeutic options. Recently, bictegravir has been approved for HIV-1, but no data are currently available for HIV-2. METHODS We assessed the phenotypic susceptibility of 12 HIV-2 clinical isolates, obtained from 2 antiretroviral-naive and 10 antiretroviral-experienced patients, to 5 INSTIs (bictegravir, cabotegravir, dolutegravir, elvitegravir, and raltegravir) at the virological failure of an INSTI-based regimen. The 50% inhibitory concentrations (IC50s) were determined. Phenotypic inhibitory quotients were determined using trough INSTI plasma concentrations. RESULTS Wild-type viruses were susceptible to the 5 INSTIs, with IC50s in the nanomolar range. Bictegravir had a lower IC50 than the other INSTIs on those HIV-2 isolates bearing major, resistance-associated mutations (codons 143, 148, and 155). We identified a new resistance profile-a 5-amino-acid insertion at codon 231 of the HIV-2 integrase (231INS)-in 6 patients at the virological failure of a raltegravir-based regimen. Those patients had adequate raltegravir concentrations, but harbored multiresistant viruses with low genotypic susceptibility scores (median = 1.5). This insertion rendered isolates highly resistant to raltegravir and elvitegravir, and moderately resistant to dolutegravir and cabotegravir. Regarding bictegravir, 2 isolates remained susceptible and 2 had a slight increase in IC50 (3- to 5-fold change). CONCLUSIONS Our results confirm the potency of INSTI on HIV-2 clinical isolates with wild-type integrase. In addition, we identified a new resistance pathway, 231INS, selected in antiretroviral-experienced patients with multiresistant HIV-2 viruses. This highlights the need of close follow-up of those patients initiating an INSTI-based regimen.
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Affiliation(s)
- Quentin Le Hingrat
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Gilles Collin
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Minh Lê
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Pharmacologie, Hôpital Bichat, AP-HP, Hôpital St-Antoine, Paris
| | - Gilles Peytavin
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Pharmacologie, Hôpital Bichat, AP-HP, Hôpital St-Antoine, Paris
| | - Benoit Visseaux
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Mélanie Bertine
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Roland Tubiana
- Service de Maladies Infectieuses, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital St-Antoine, Paris.,Sorbonne Universités, Université Paris 6-Pierre et Marie Curie, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (UMRS 1136), Hôpital St-Antoine, Paris
| | - Marina Karmochkine
- Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Hôpital St-Antoine, Paris
| | - Nadia Valin
- Service de Maladies Infectieuses et Tropicales, Hôpital St-Antoine, Paris
| | - Fidéline Collin
- Bordeaux Population Health Center, UMR 1219, INSERM, AP-HP, Paris, France.,Centre Hospitalier Universitaire de Bordeaux, AP-HP, Paris, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Tours, AP-HP, Paris, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Tours, AP-HP, Paris, France
| | - Florence Damond
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Sophie Matheron
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Diane Descamps
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Charlotte Charpentier
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
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Desoubeaux G, Lemaignen A, Ehrmann S. Reply to the reply to Scientific rationale for inhaled caspofungin to treat Pneumocystis pneumonia: A therapeutic innovation likely relevant to investigate in a near future …. Int J Infect Dis 2020; 95:469-470. [PMID: 32276043 DOI: 10.1016/j.ijid.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Guillaume Desoubeaux
- Université de Tours, INSERM U1100, Centre d'étude des pathologies respiratoires, Tours, France.
| | - Adrien Lemaignen
- CHRU de Tours, Médecine interne & Maladies infectieuses, Tours, France
| | - Stephan Ehrmann
- Université de Tours, INSERM U1100, Centre d'étude des pathologies respiratoires, Tours, France; CHRU de Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep Network, Tours, France
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45
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Desoubeaux G, Nourrisson C, Moniot M, De Kyvon MA, Bonnin V, De La Bretonniére ME, Morange V, Bailly É, Lemaignen A, Morio F, Poirier P. Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit. Emerg Infect Dis 2020; 25:1625-1631. [PMID: 31441425 PMCID: PMC6711236 DOI: 10.3201/eid2509.190311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Microsporidiosis is a fungal infection that generally causes digestive disorders, especially in immunocompromised hosts. Over a 4-day period in January 2018, 3 patients with hematologic malignancies who were admitted to the hematology unit of a hospital in France received diagnoses of Enterocytozoon bieneusi microsporidiosis. This unusually high incidence was investigated by sequence analysis at the internal transcribed spacer rDNA locus and then by 3 microsatellites and 1 minisatellite for multilocus genotyping. The 3 isolates had many sequence similarities and belonged to a new genotype closely related to genotype C. In addition, multilocus genotyping showed high genetic distances with all the other strains collected from epidemiologically unrelated persons; none of these strains belonged to the new genotype. These data confirm the epidemiologic link among the 3 patients and support a common source of infection.
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46
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Sunder S, Grammatico-Guillon L, Lemaignen A, Lacasse M, Gaborit C, Boutoille D, Tattevin P, Denes E, Guimard T, Dupont M, Fauchier L, Bernard L. Incidence, characteristics, and mortality of infective endocarditis in France in 2011. PLoS One 2019; 14:e0223857. [PMID: 31652280 PMCID: PMC6814232 DOI: 10.1371/journal.pone.0223857] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- S. Sunder
- CH de Niort, Service des Maladies Infectieuses et Tropicale, Niort, France
| | - L. Grammatico-Guillon
- CHRU de Tours, Unité d’Épidémiologie des données cliniques, EpiDcliC, Tours, France
- Unité Inserm 1259, Université de tours, Tours, France
- * E-mail:
| | - A. Lemaignen
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - M. Lacasse
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - C. Gaborit
- Unité Inserm 1259, Université de tours, Tours, France
| | - D. Boutoille
- CHU de Nantes, Service des Maladies Infectieuses et Tropicales, Nantes, France
| | - P. Tattevin
- CHU de Rennes, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - E. Denes
- CHU de Limoges, Service des Maladies Infectieuses et Tropicales, Limoges, France
| | - T. Guimard
- CH de La Roche sur Yon, Service des Maladies Infectieuses, La Roche sur Yon, France
| | - M. Dupont
- CH de Saint Malo, Service des Maladies Respiratoires et Infectieuses, Saint Malo, France
| | - L. Fauchier
- Equipe d’accueil EA 1275, Université de Tours, Tours, France
- CHRU de Tours, Service de cardiologie, Tours, France
| | - L. Bernard
- CHRU de Tours, Unité d’Épidémiologie des données cliniques, EpiDcliC, Tours, France
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
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Desoubeaux G, Chesnay A, Mercier V, Bras-Cachinho J, Moshiri P, Eymieux S, De Kyvon MA, Lemaignen A, Goudeau A, Bailly É. Combination of β-(1, 3)-D-glucan testing in serum and qPCR in nasopharyngeal aspirate for facilitated diagnosis of Pneumocystis jirovecii pneumonia. Mycoses 2019; 62:1015-1022. [PMID: 31494981 DOI: 10.1111/myc.12997] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Currently, the biological diagnosis of Pneumocystis jirovecii pneumonia (PjP infection) usually relies on microbiological investigations in bronchial-alveolar lavage fluid (BALF) by conventional staining methods and/or molecular biology. However, bronchial-alveolar lavage is sometimes complicated to manage, especially in weakened patients. Therefore, alternative clinical samples-easier to collect-are warranted in such specific contexts. OBJECTIVE Over a four-year period, diagnostic performance of an original method based on combination of quantitative real-time polymerase chain reaction (qPCR) in nasopharyngeal aspirate (NPA) with measurement of β-(1, 3)-D-glucan antigen (BDG) in serum was prospectively assessed in a single centre. PATIENTS/METHODS Results were compared with those obtained in BALF through direct staining methods and qPCR. True positives were defined by an independent committee based on clinical, radiological and biological data. Overall, 48 individuals with a definitive diagnosis of PjP infection were included, and 48 controls were selected upon matching for age, sex and underlying disease(s). RESULTS qPCR results were strongly correlated between BALF and NPA (P < .0001). Altogether, greater diagnostic performance was achieved when establishing the positive cut-off of BDG antigen at 143 pg/mL. In such conditions, sensitivity of the testing based on either positive BDG measurement or positive qPCR in NPA was then calculated at 93.75%, 95% CI [82.37%-98.40%], and specificity at 97.87%, 95% CI [87.66%-100.00%]. CONCLUSIONS Further validation through multicentre studies is now required, especially for establishing clear cut-offs. However, one could already state that combination of qPCR in the NPA with BDG measurement in serum may be a valuable substitute for BALF examination.
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Affiliation(s)
- Guillaume Desoubeaux
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France.,CEPR - INSERM U1100/Équipe 3, Faculté de Médecine, Université de Tours, Tours, France
| | - Adélaïde Chesnay
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France.,CEPR - INSERM U1100/Équipe 3, Faculté de Médecine, Université de Tours, Tours, France
| | - Victor Mercier
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France
| | - José Bras-Cachinho
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France
| | - Parastou Moshiri
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France
| | - Sébastien Eymieux
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France
| | | | - Adrien Lemaignen
- Médecine interne & Maladies Infectieuses, CHU de Tours, Tours, France
| | | | - Éric Bailly
- Parasitologie, Mycologie, Médecine Tropicale, CHU de Tours, Tours, France
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48
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Périer A, Puyade M, Revest M, Tattevin P, Bernard L, Lemaignen A, Boutoille D, Allal J, Roblot F, Rammaert B. Prognosis of Streptococcus pneumoniae endocarditis in France, a multicenter observational study (2000-2015). Int J Cardiol 2019; 288:102-106. [PMID: 31056415 DOI: 10.1016/j.ijcard.2019.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/18/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is responsible for <2% of infective endocarditis (IE). The aim of this study was to assess the prognosis of pneumococcal IE. METHODS This multicentric observational retrospective study included adult patients presenting with definite S. pneumoniae IE according to modified Dukes criteria from four French university hospitals over a 15-year period, January 2000-December 2015. Survival rate at 90 days and 2 years after diagnosis, appropriateness of antibiotherapy, and pneumococcal vaccination status were determined. Risk factors for mortality were studied by univariate analysis. RESULTS Of 3886 patients admitted with IE during the study period, 50 (1.3%) had pneumococcal IE, mostly males (n = 38, 76%), with a mean age of 60 ± 14 years. Predisposing conditions for IE or for invasive pneumococcal disease (IPD) involved 24% and 78% of the cases, respectively. Only 2 patients were vaccinated against pneumococcus before IE and 13 (26%) after IE. Antimicrobial strategy was in accordance with the 2015 ESC Guidelines in 28%. Cardiac surgery was performed in 56%, and was associated with better survival (p = 0.012). In the 40 patients followed until 2 years, the survival rate was 67%, deaths occurring mostly before 90 days. Age ≥ 65 was a risk factor for mortality (p = 0.011). CONCLUSION Pneumococcal IE remains rare but with a poor prognosis. Resort to surgery is yet to be determined. Predisposing conditions for IPD are the main factors leading to pneumococcal IE. They could be prevented by vaccine coverage improvement.
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Affiliation(s)
- Amandine Périer
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France
| | - Mathieu Puyade
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France
| | - Matthieu Revest
- Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France
| | - Pierre Tattevin
- Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France
| | - Louis Bernard
- Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - Adrien Lemaignen
- Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - David Boutoille
- Université de Nantes, Nantes, France; CHU de Nantes, Service de Maladies Infectieuses, Nantes, France
| | - Joseph Allal
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Cardiologie, Poitiers, France
| | - France Roblot
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France
| | - Blandine Rammaert
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France.
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49
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Gras E, Bailly E, Le Brun C, Lemaignen A, Lanotte P. Borrelia crocidurae tick-borne relapsing fever upon return from Senegal. Med Mal Infect 2019; 49:624-625. [PMID: 31202618 DOI: 10.1016/j.medmal.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/22/2018] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Affiliation(s)
- E Gras
- Service de bactériologie-virologie-hygiène hospitalière, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - E Bailly
- Service de parasitologie-mycologie, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - C Le Brun
- Service de bactériologie-virologie-hygiène hospitalière, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Lemaignen
- Service de médecine interne et maladies infectieuses, Hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - P Lanotte
- Service de bactériologie-virologie-hygiène hospitalière, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours, France; Infectiologie et santé publique, INRA, université de Tours, UMR1282, 37380 Nouzilly, France.
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50
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Martins C, Bleibtreu A, Thill P, Osei L, Peiffer-Smadja N, Lemaignen A. Bilan à 1 an de la mise en place de la réforme du troisième cycle médical. Une Enquête du RéJIF. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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