1
|
Brau F, Papin M, Batard E, Abet E, Frampas E, Le Thuaut A, Montassier E, Le Bastard Q, Le Conte P. Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial. Scand J Trauma Resusc Emerg Med 2024; 32:15. [PMID: 38409086 PMCID: PMC10895715 DOI: 10.1186/s13049-024-01182-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Abdominal pain is common in patients visiting the emergency department (ED). The aim of this study was to assess the diagnostic contribution of point-of-care ultrasound (POCUS) in patients presenting to the ED with acute abdominal pain. METHODS We designed an interventional randomized, controlled, open label, parallel-group, trial in two French EDs. We included adult patients presenting to the ED with acute abdominal pain. Exclusion criteria were a documented end-of-life, an immediate need of life-support therapy and pregnant or breast-feeding women. Patients were randomized in the experimental group (i.e., workup including POCUS) or control group (usual care). The primary objective of the study was to assess the added value of POCUS on diagnostic pathway in the ED, according to the diagnostic established a posteriori by an adjudication committee. The primary endpoint was the proportion of exact preliminary diagnosis between the 2 groups. The preliminary diagnosis made after clinical examination and biological results with POCUS (intervention arm) or without POCUS (usual care) was considered exact if it was similar to the adjudication committee diagnosis. RESULTS Between June 2021 11th and June 2022 23th, 256 patients were randomized, but five were not included in the primary analysis, leaving 125 patients in the POCUS group and 126 patients in the usual care group (130 women and 121 men, median [Q1-Q3] age: 42 [30;57]). There was no difference for exact diagnosis between the two groups (POCUS 70/125, 56% versus control 78/126 (62%), RD 1.23 [95% CI 0.74-2.04]). There was no difference in the accuracy for the diagnosis of non-specific abdominal pain nor number of biological or radiological exams. Diagnostic delays and length of stay in the ED were also similar. CONCLUSIONS In this trial, systematic POCUS did not improve the rate of diagnostic accuracy in unselected patients presenting to the ED with acute abdominal pain. However, as it was a safe procedure, further research should focus on patients with suspected etiologies where POCUS is particularly useful. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov on 2022/07/20 ( https://clinicaltrials.gov/study/NCT04912206?id=NCT04912206&rank=1 ) (NCT04912206).
Collapse
Affiliation(s)
- François Brau
- Service des urgences, Centre Hospitalier Départemental, La Roche-Yon, France
| | - Mathilde Papin
- Service Des Urgences, Centre Hospitalier Universitaire, 44035, Nantes Cedex 01, France
| | - Eric Batard
- Service Des Urgences, Centre Hospitalier Universitaire, 44035, Nantes Cedex 01, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Emeric Abet
- Service de Chirurgie Digestive, Centre Hospitalier Départemental, La Roche-Yon, France
| | - Eric Frampas
- Faculté de Médecine, Nantes Université, Nantes, France
- Service de Radiologie, Centre Hospitalier Universitaire, Nantes, France
| | - Aurélie Le Thuaut
- Plateforme de Méthodologie et Biostatistique, electriqueDirection de la Recherche Et de L'Innovation, Centre Hospitalier Universitaire, Nantes, France
| | - Emmanuel Montassier
- Service Des Urgences, Centre Hospitalier Universitaire, 44035, Nantes Cedex 01, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Quentin Le Bastard
- Service Des Urgences, Centre Hospitalier Universitaire, 44035, Nantes Cedex 01, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Le Conte
- Service Des Urgences, Centre Hospitalier Universitaire, 44035, Nantes Cedex 01, France.
- Faculté de Médecine, Nantes Université, Nantes, France.
| |
Collapse
|
2
|
Ishnaiwer M, Le Bastard Q, Naour M, Zeman M, Dailly E, Montassier E, Batard E, Dion M. Efficacy of an inulin-based treatment on intestinal colonization by multidrug-resistant E. coli: insight into the mechanism of action. Gut Microbes 2024; 16:2347021. [PMID: 38685762 PMCID: PMC11062366 DOI: 10.1080/19490976.2024.2347021] [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: 12/15/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
Inulin, an increasingly studied dietary fiber, alters intestinal microbiota. The aim of this study was to assess whether inulin decreases intestinal colonization by multidrug resistant E. coli and to investigate its potential mechanisms of action. Mice with amoxicillin-induced intestinal dysbiosis mice were inoculated with extended spectrum beta-lactamase producing E. coli (ESBL-E. coli). The combination of inulin and pantoprazole (IP) significantly reduced ESBL-E. coli fecal titers, whereas pantoprazole alone did not and inulin had a delayed and limited effect. Fecal microbiome was assessed using shotgun metagenomic sequencing and qPCR. The efficacy of IP was predicted by increased abundance of 74 taxa, including two species of Adlercreutzia. Preventive treatments with A. caecimuris or A. muris also reduced ESBL-E. coli fecal titers. Fecal microbiota of mice effectively treated by IP was enriched in genes involved in inulin catabolism, production of propionate and expression of beta-lactamases. They also had increased beta-lactamase activity and decreased amoxicillin concentration. These results suggest that IP act through production of propionate and degradation of amoxicillin by the microbiota. The combination of pantoprazole and inulin is a potential treatment of intestinal colonization by multidrug-resistant E. coli. The ability of prebiotics to promote propionate and/or beta-lactamase producing bacteria may be used as a screening tool to identify potential treatments of intestinal colonization by multidrug resistant Enterobacterales.
Collapse
Affiliation(s)
- Murad Ishnaiwer
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, Nantes, France
- College of Applied Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Quentin Le Bastard
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, Nantes, France
- Emergency Department, CHU Nantes, Nantes, France
| | | | - Michal Zeman
- Veterinary Research Institute, Brno, Czech Republic
| | - Eric Dailly
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, Nantes, France
- CHU Nantes, Clinical Pharmacology Department, Nantes, France
| | - Emmanuel Montassier
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, Nantes, France
- Emergency Department, CHU Nantes, Nantes, France
- Center for Research in Transplantation and Translational Immunology, Nantes Université, Inserm, CHU Nantes, Nantes, France
| | - Eric Batard
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, Nantes, France
- Emergency Department, CHU Nantes, Nantes, France
| | - Michel Dion
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, Nantes, France
| |
Collapse
|
3
|
Amimer S, Le Bastard Q, Berranger C, Batard E, Le Conte P. Abdominal point-of-care ultrasound for the exclusion of bowel obstruction: prospective multicentre observational study. Eur J Emerg Med 2023; 30:298-299. [PMID: 37387633 DOI: 10.1097/mej.0000000000001030] [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: 07/01/2023]
Affiliation(s)
- Sylvain Amimer
- Service des Urgences, Centre Hospitalier de Saint-Nazaire, Saint-Nazaire
| | - Quentin Le Bastard
- Service des Urgences, Centre Hospitalier Universitaire
- Faculté de Médecine, Nantes Université
| | | | - Eric Batard
- Service des Urgences, Centre Hospitalier Universitaire
- Faculté de Médecine, Nantes Université
| | - Philippe Le Conte
- Service des Urgences, Centre Hospitalier Universitaire
- Faculté de Médecine, Nantes Université
| |
Collapse
|
4
|
Bezabih YM, Bezabih A, Dion M, Batard E, Teka S, Obole A, Dessalegn N, Enyew A, Roujeinikova A, Alamneh E, Mirkazemi C, Peterson GM, Bezabhe WM. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac048. [PMID: 35668909 PMCID: PMC9160884 DOI: 10.1093/jacamr/dlac048] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives The widespread intestinal carriage of ESBL-producing Escherichia coli (ESBL E. coli) among both patients and healthy individuals is alarming. However, the global prevalence and trend of this MDR bacterium in healthcare settings remains undetermined. To address this knowledge gap, we performed a comparative meta-analysis of the prevalence in community and healthcare settings. Methods Our systematic review included 133 articles published between 1 January 2000 and 22 April 2021 and indexed in PubMed, EMBASE or Google Scholar. A random-effects meta-analysis was performed to obtain the global pooled prevalence (community and healthcare settings). Subgroup meta-analyses were performed by grouping studies using the WHO regions and 5 year intervals of the study period. Results We found that 21.1% (95% CI, 19.1%–23.2%) of inpatients in healthcare settings and 17.6% (95% CI, 15.3%–19.8%) of healthy individuals worldwide carried ESBL E. coli in their intestine. The global carriage rate in healthcare settings increased 3-fold from 7% (95% CI, 3.7%–10.3%) in 2001–05 to 25.7% (95% CI, 19.5%–32.0%) in 2016–20, whereas in community settings it increased 10-fold from 2.6% (95% CI, 1.2%–4.0%) to 26.4% (95% CI, 17.0%–35.9%) over the same period. Conclusions The global and regional human intestinal ESBL E. coli carriage is increasing in both community and healthcare settings. Carriage rates were generally higher in healthcare than in community settings. Key relevant health organizations should perform surveillance and implement preventive measures to address the spread of ESBL E. coli in both settings.
Collapse
Affiliation(s)
- Yihienew M. Bezabih
- Arsi University College of Health Sciences, University Road, Asella, ET 0193, Ethiopia
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA, USA
- Corresponding author. E-mail: ; @myihienew
| | | | - Michel Dion
- University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances Laboratory, Nantes, France
| | - Eric Batard
- University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances Laboratory, Nantes, France
- CHU Nantes, Emergency Department, Nantes, France
| | - Samson Teka
- Marshall University School of Medicine, Huntington, WV, USA
| | - Abiy Obole
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | - Noah Dessalegn
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA, USA
| | | | - Anna Roujeinikova
- Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Endalkachew Alamneh
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Corinne Mirkazemi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | | |
Collapse
|
5
|
Javaudin F, Bémer P, Batard E, Montassier E. Impact of Phage Therapy on Multidrug-Resistant Escherichia coli Intestinal Carriage in a Murine Model. Microorganisms 2021; 9:microorganisms9122580. [PMID: 34946183 PMCID: PMC8708983 DOI: 10.3390/microorganisms9122580] [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: 11/09/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The growing resistance of bacteria to antibiotics is a major global public health concern. An important reservoir of this resistance is the gut microbiota. However, limited data are available on the ability of phage therapy to reduce the digestive carriage of multidrug-resistant bacteria. MATERIALS AND METHODS Four novel lytic phages were isolated in vitro for efficacy against an extended-spectrum beta-lactamase-producing (ESBL) Escherichia coli strain also resistant to carbapenems through a carbapenemase OXA-48. The first step was to develop models of ESBL E. coli digestive carriage in mice. The second step was to test the efficacy of an oral and rectal phage therapy (a cocktail of four phages or microencapsulated phage) to reduce this carriage. RESULTS The two most intense models of digestive carriage were obtained by administering amoxicillin (0.5 g·L-1) continuously in the drinking water (Model 1) or pantoprazole (0.1 g·L-1) continuously in the drinking water, combined with amoxicillin (0.5 g·L-1), for the first 8 days (Model 2). Oral administration of the phage cocktail to Model 1 resulted in a transient reduction in the concentration of ESBL E. coli in the faeces 9 days after the bacterial challenge (median = 5.33 × 108 versus 2.76 × 109 CFU·g-1, p = 0.02). In contrast, in Model 2, oral or oral + rectal administration of this cocktail did not alter the bacterial titre compared to the control (area under the curve, AUC, 3.49 × 109; 3.41 × 109 and 3.82 × 109 for the control, oral and oral + rectal groups, respectively; p-value > 0.8 for each two-by-two group comparison), as well as the administration of an oral microencapsulated phage in Model 1 (AUC = 8.93 × 109 versus 9.04 × 109, p = 0.81). CONCLUSIONS Oral treatment with amoxicillin promoted digestive carriage in mice, which was also the case for the addition of pantoprazole. However, our study confirms the difficulty of achieving efficacy with phage therapy to reduce multidrug-resistant bacterial digestive carriage in vivo.
Collapse
Affiliation(s)
- François Javaudin
- MiHAR Laboratary, EE1701, University of Nantes, 44200 Nantes, France; (P.B.); (E.B.); (E.M.)
- Emergency Department, Nantes University Hospital, 44000 Nantes, France
- Correspondence:
| | - Pascale Bémer
- MiHAR Laboratary, EE1701, University of Nantes, 44200 Nantes, France; (P.B.); (E.B.); (E.M.)
- Department of Bacteriology, Nantes University Hospital, 44000 Nantes, France
| | - Eric Batard
- MiHAR Laboratary, EE1701, University of Nantes, 44200 Nantes, France; (P.B.); (E.B.); (E.M.)
- Emergency Department, Nantes University Hospital, 44000 Nantes, France
| | - Emmanuel Montassier
- MiHAR Laboratary, EE1701, University of Nantes, 44200 Nantes, France; (P.B.); (E.B.); (E.M.)
- Emergency Department, Nantes University Hospital, 44000 Nantes, France
| |
Collapse
|
6
|
Affiliation(s)
| | - Delphine Douillet
- Emergency Department, CHU Angers
- Collège de Médecine d'Urgence des Pays de la Loire, Nantes, France
| | - Céline Longo
- Emergency Department, CHU Nantes, Nantes
- Collège de Médecine d'Urgence des Pays de la Loire, Nantes, France
| | - Joël Jenvrin
- Emergency Department, CHU Nantes, Nantes
- Collège de Médecine d'Urgence des Pays de la Loire, Nantes, France
| | | |
Collapse
|
7
|
Ishnaiwer M, Bezabih Y, Javaudin F, Sassi M, Bemer P, Batard E, Dion M. In vitro and in vivo activity of new strains of Bacillus subtilis against ESBL-producing Escherichia coli: an experimental study. J Appl Microbiol 2021; 132:2270-2279. [PMID: 34679216 DOI: 10.1111/jam.15329] [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: 06/07/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
AIMS The gastro-intestinal tract is a major reservoir of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli. Bacillus spores may be used as probiotics to decrease digestive colonization by ESBL-E. coli. Our aim was to assess the in vitro and in vivo activity of new Bacillus strains against ESBL-E. coli. METHODS AND RESULTS We screened the in vitro activity of 50 Bacillus strains against clinical isolates of ESBL-E. coli and selected B. subtilis strains CH311 and S3B. Both strains decreased ESBL-E. coli titers by 4 log10 CFU L-1 in an in vitro model of gut content, whereas the B. subtilis CU1 strain did not. In a murine model of intestinal colonization by ESBL-E. coli, CH311 and S3B did not decrease fecal titers of ESBL-E. coli. Ten sequences of putative antimicrobial peptides were identified in the genomes of CH311 and S3B, but not in CU1. CONCLUSIONS Two new B. subtilis strains showed strong in vitro activity against ESBL-E. coli. SIGNIFICANCE AND IMPACT OF STUDY Despite strong in vitro activities of new B. subtilis strains against ESBL-E. coli, intestinal colonisation was not altered by curative Bacillus treatment even if their spores proved to germinate in the gut. Thus, this work underlines the importance of in vivo experiments to identify efficient probiotics. The use of potential antimicrobial compounds identified by genome sequencing remains an attractive alternative to explore.
Collapse
Affiliation(s)
| | | | - François Javaudin
- MiHAR Lab, EE1701, University of Nantes, Nantes, France.,Emergency Department, CHU Nantes, Nantes, France
| | - Mohamed Sassi
- Inserm, BRM [Bacterial Regulatory RNAs and Medicine] - UMR_S 1230, Université de Rennes 1, Rennes, France
| | - Pascale Bemer
- MiHAR Lab, EE1701, University of Nantes, Nantes, France.,Department of Bacteriology, University Hospital, CHU Nantes, Nantes, France
| | - Eric Batard
- MiHAR Lab, EE1701, University of Nantes, Nantes, France.,Emergency Department, CHU Nantes, Nantes, France
| | - Michel Dion
- MiHAR Lab, EE1701, University of Nantes, Nantes, France
| |
Collapse
|
8
|
Léaute P, Pettinotti O, Pes P, Meresse-Prost L, Toulgoat F, Le Conte P, Batard E. Justification des demandes de tomodensitométrie aux urgences. Ann Fr Med Urgence 2021. [DOI: 10.3166/afmu-2021-0331] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La justification des demandes de tomodensitométrie (TDM) faites aux urgences est mal connue. Notre objectif était d’évaluer la justification des demandes de TDM dans un service d’urgences adultes.
Méthodes : La justification des demandes de scanner a été mesurée prospectivement de deux façons complémentaires. L’adéquation aux recommandations a été évaluée pour l’ensemble des demandes de TDM par confrontation à une liste préétablie de syndromes et d’hypothèses diagnostiques. La pertinence des demandes a été évaluée par un comité d’experts sur la base du dossier médical des urgences pour 100 de ces dossiers.
Résultats : Les 273 TDM incluses concernaient le crâne (52%), l’abdomen (17%), le thorax (11%) ou une autre localisation (20%). Elles étaient en adéquation avec les recommandations dans 215 cas (79%). Pour 100 dossiers analysés par le comité d’experts, la pertinence a été adjugée à l’unanimité pour 95 cas ; 67 TDM (71%) ont été jugées pertinentes. La concordance entre l’adéquation aux recommandations et la pertinence évaluée par le comité d’expert était faible (kappa, 0,27, intervalle de confiance à 95%, de 0,06 à 0,47). Le seul facteur associé significativement à la pertinence était l’opinion du clinicien en charge du patient que la TDM ne pouvait pas être reportée (OR=6,7 avec IC95% [1,6-28,1], p=0,01).
Conclusion : La proportion des demandes de TDM qui ne sont pas en adéquation avec les recommandations et la proportion de demandes non pertinentes sont élevées. Elles suggèrent que le nombre de TDM demandées par les services d’urgences pourrait être diminué.
Collapse
|
9
|
Lemoine L, Le Bastard Q, Batard E, Montassier E. An Evidence-Based Narrative Review of the Emergency Department Management of Acute Hyperkalemia. J Emerg Med 2021; 60:599-606. [PMID: 33423833 DOI: 10.1016/j.jemermed.2020.11.028] [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] [Received: 08/19/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The normal range for potassium is within narrow limits. Hyperkalemia is an electrolyte disorder that frequently affects patients in the emergency department (ED), and can result in significant morbidity and mortality if not identified and treated rapidly. OBJECTIVE This article provides an evidence-based narrative review of the management of hyperkalemia, with focused updates for the emergency clinician. METHODS We searched in MEDLINE, EMBASE, Web of Science, and Scopus databases for articles in English published in peer-reviewed journals and indexed up until May 2020. We used multiple search terms, including hyperkalemia, potassium, acute hyperkalemia, emergency department, dyskalemia, potassium disorders, kidney disease, epidemiology, electrolyte disturbance, severe hyperkalemia, and emergency management. DISCUSSION In the ED, interventions aimed to protect patients from the immediate dangers of elevated serum potassium are divided into the following: stabilizing cardiac membrane potentials, reducing serum potassium levels through shift from the extracellular fluid to intracellular fluid, and elimination of potassium through excretion via urinary or fecal excretion. Calcium is widely recommended to stabilize the myocardial cell membrane, but additional research is necessary to establish criteria for use, dosages, and preferred solutions. Redistribution of potassium ions from the bloodstream into the cells is based on intravenous insulin or nebulized β2-agonists. CONCLUSIONS Hyperkalemia is a frequent electrolyte disorder in the ED. Because of the risk of fatal dysrhythmia due to cardiac membrane instability, hyperkalemia is a medical emergency. There is a lack of scientific evidence on the optimal management of hyperkalemia and more research is needed to establish optimal strategies to manage acute hyperkalemia in the emergency department.
Collapse
Affiliation(s)
- Loic Lemoine
- Department of Emergency Medicine, Nantes University Hospital, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Nantes, France
| | - Quentin Le Bastard
- Department of Emergency Medicine, Nantes University Hospital, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Nantes, France; Microbiota, Hôtes, Antibiotiques et Résistances Laboratory, Université de Nantes, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, Nantes University Hospital, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Nantes, France; Microbiota, Hôtes, Antibiotiques et Résistances Laboratory, Université de Nantes, Nantes, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, Nantes University Hospital, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Nantes, France; Microbiota, Hôtes, Antibiotiques et Résistances Laboratory, Université de Nantes, Nantes, France
| |
Collapse
|
10
|
Le Bastard Q, Chapelet G, Birgand G, Hillmann BM, Javaudin F, Hayatgheib N, Bourigault C, Bemer P, De Decker L, Batard E, Lepelletier D, Montassier E. Gut microbiome signatures of nursing home residents carrying Enterobacteria producing extended-spectrum β-lactamases. Antimicrob Resist Infect Control 2020; 9:107. [PMID: 32665016 PMCID: PMC7359458 DOI: 10.1186/s13756-020-00773-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The prevalence of extended beta-lactamase producing Enterobacteriaceae (ESBL-E) has been constantly increasing over the last few decades. These microorganisms that have acquired broad antibiotic resistance are now common human pathogens. Changes in the gut microbiome, induced by antibiotics or other drugs, enable expansion of these microorganisms, but the mechanisms are not yet fully understood. OBJECTIVES The main objective was to identify specific bacteria and functional pathways and genes characterizing the gut microbiome of nursing home residents carrying ESBL-E, using metagenomics. SUBJECTS AND METHODS We included 144 residents living in two different nursing homes. All fecal samples were screened for ESBL-E and gut microbiome was characterized using shallow shotgun metagenomic DNA sequencing. RESULTS Ten nursing home residents were colonized by ESBL-E, namely Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae species, and were compared to non-carriers. We found that ESBL-E carriers had an alteration in within-sample diversity. Using a bootstrap algorithm, we found that the gut microbiome of ESBL-E carriers was depleted in butyrate-producing species, enriched in succinate-producing species and enriched in pathways involved in intracellular pH homeostasis compared to non-carriers individuals. Several energy metabolism pathways were overrepresented in ESBL-E carriers suggesting a greater ability to metabolize multiple microbiota and mucus layer-derived nutrients. CONCLUSIONS The gut microbiome of ESBL-E carriers in nursing homes harbors specific taxonomic and functional characteristics, conferring an environment that enables Enterobacteriaceae expansion. Here we describe new functional features associated with ESBL-E carriage that could help us to elucidate the complex interactions leading to colonization persistence in the human gut microbiota.
Collapse
Affiliation(s)
- Quentin Le Bastard
- MiHAR lab, Université de Nantes, 44000, Nantes, France.
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France.
| | - Guillaume Chapelet
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Pole de gérontologie clinique, Nantes University Hospital, 44000, Nantes, France
| | - Gabriel Birgand
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Regional Infection Control Centre, Pays de la Loire, Nantes, France
| | - Benjamin M Hillmann
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - François Javaudin
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France
| | | | - Céline Bourigault
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - Pascale Bemer
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - Laure De Decker
- Pole de gérontologie clinique, Nantes University Hospital, 44000, Nantes, France
| | - Eric Batard
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France
| | - Didier Lepelletier
- MiHAR lab, Université de Nantes, 44000, Nantes, France
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - Emmanuel Montassier
- MiHAR lab, Université de Nantes, 44000, Nantes, France.
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France.
| |
Collapse
|
11
|
Leforestier A, Vibet MA, Gentet N, Javaudin F, Le Bastard Q, Montassier E, Batard E. Modeling the risk of fluoroquinolone resistance in non-severe community-onset pyelonephritis. Eur J Clin Microbiol Infect Dis 2020; 39:1123-1127. [DOI: 10.1007/s10096-020-03830-x] [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] [Received: 12/21/2019] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
|
12
|
Lemoine L, Le Bastard Q, Masson D, Javaudin F, Batard E, Montassier E. Incidence of hyperkalemia in the emergency department: a 10-year retrospective study. Intern Emerg Med 2020; 15:727-728. [PMID: 31396921 DOI: 10.1007/s11739-019-02159-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 06/11/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Loïc Lemoine
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
| | - Quentin Le Bastard
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
- MiHAR Lab, Université de Nantes, 44000, Nantes, France
| | - Damien Masson
- Department of Biochemistry, Nantes University Hospital, 44000, Nantes, France
| | - François Javaudin
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
- MiHAR Lab, Université de Nantes, 44000, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
- MiHAR Lab, Université de Nantes, 44000, Nantes, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France.
- MiHAR Lab, Université de Nantes, 44000, Nantes, France.
| |
Collapse
|
13
|
Lemoine L, Le Bastard Q, Masson D, Javaudin F, Batard E, Montassier E. Correction to: Incidence of hyperkalemia in the emergency department: a 10-year retrospective study. Intern Emerg Med 2020; 15:739. [PMID: 31707564 DOI: 10.1007/s11739-019-02221-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In the original publication of the article, the 3rd author name was swapped. The correct author name should read as Damien Masson.
Collapse
Affiliation(s)
- Loïc Lemoine
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
| | - Quentin Le Bastard
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
- MiHAR Lab, Université de Nantes, 44000, Nantes, France
| | - Damien Masson
- Department of Biochemistry, Nantes University Hospital, 44000, Nantes, France
| | - François Javaudin
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
- MiHAR Lab, Université de Nantes, 44000, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France
- MiHAR Lab, Université de Nantes, 44000, Nantes, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, Nantes University Hospital, CHU Nantes, 44000, Nantes, France.
- MiHAR Lab, Université de Nantes, 44000, Nantes, France.
| |
Collapse
|
14
|
Le Bastard Q, Vangay P, Batard E, Knights D, Montassier E. US Immigration Is Associated With Rapid and Persistent Acquisition of Antibiotic Resistance Genes in the Gut. Clin Infect Dis 2019; 71:419-421. [DOI: 10.1093/cid/ciz1087] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Little is known about the effect of human migration on gut microbiome antibiotic resistance gene (ARG) carriage. Using deep shotgun stool metagenomics analysis, we found a rapid increase in gut microbiome ARG richness and abundance in women from 2 independent ethnic groups relocating from Thailand to the United States.
Collapse
Affiliation(s)
- Quentin Le Bastard
- MiHAR Laboratory, Université de Nantes, Nantes, France
- Emergency Department, Nantes University Hospital, Nantes, France
| | - Pajau Vangay
- Bioinformatics and Computational Biology Program, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric Batard
- MiHAR Laboratory, Université de Nantes, Nantes, France
- Emergency Department, Nantes University Hospital, Nantes, France
| | - Dan Knights
- Bioinformatics and Computational Biology Program, University of Minnesota, Minneapolis, Minnesota, USA
- Biotechnology Institute, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emmanuel Montassier
- MiHAR Laboratory, Université de Nantes, Nantes, France
- Emergency Department, Nantes University Hospital, Nantes, France
- EA3826 Thérapeutiques Anti-infectieuses, Institut de Recherche en Santé 2 Nantes Biotech, Medical University of Nantes, Nantes, France
| |
Collapse
|
15
|
Dylis A, Boureau AS, Coutant A, Batard E, Javaudin F, Berrut G, de Decker L, Chapelet G. Antibiotics prescription and guidelines adherence in elderly: impact of the comorbidities. BMC Geriatr 2019; 19:291. [PMID: 31664914 PMCID: PMC6819552 DOI: 10.1186/s12877-019-1265-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/31/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Although the interest of antibiotics is well known, antibiotics prescription is associated with side effect, especially in patients with multiples comorbidities. One way to reduce the incidence of side effects is to respect antibiotics prescriptions guidelines. Our objective was to investigated the factors associated with guidelines adherence in elderly patients with multiples comorbidities. Methods From October 2015 to December 2016, antibiotics prescription and guidelines adherence were analyzed in two post-acute care and rehabilitation services of a 2600-bed, university-affiliated center. Results One hundred and twenty-eight patients were included, fifty-nine (46%) patients had antibiotics prescription according to guidelines. In Multivariable logistic regression analysis, prescription of 2 antibiotics or more (OR = 0.168, 95% IC = 0.037–0.758, p < 0.05), 85 years of age and more (OR = 0.375, 95% IC = 0.151–0.931, p < 0.05) and the Charlson comorbidity index score (OR = 0.750, 95% IC = 0.572–0.984, p < 0.05) were negatively associated with antibiotics prescriptions according to guidelines. Conclusions High comorbidity in the elderly was negatively associated with the guidelines adherence of antibiotiсs prescriptions. These criteria should be considered to optimize antibiotics prescriptions in elderly patients. Electronic supplementary material The online version of this article (10.1186/s12877-019-1265-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anthony Dylis
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Anne Sophie Boureau
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Audrey Coutant
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Eric Batard
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - François Javaudin
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Gilles Berrut
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Laure de Decker
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France.,Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France
| | - Guillaume Chapelet
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France. .,Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France.
| |
Collapse
|
16
|
Quaegebeur A, Brunard L, Javaudin F, Vibet MA, Bemer P, Le Bastard Q, Batard E, Montassier E, Roman F, Llorens P, Salvi F, Galeazzi R, Ortega M, Marco F, Martinez Ortiz de Zarate M, Figueroa Ceron R, Trovato FM, Carpinteri G, Moustafa F, Romaszko JP, Pedersen M, Westh H, Dejaune P, Fihman V, Joost I, Blumel B, Parrilla Ruiz FM, Alvarez Corral G, Bieler D, Bergmann H, Granzer H, Carron PN, Prod’hom G, Greub G, Gonzalez Del Castillo JM, Candel Gonzalez FJ, Juvin ME, Occelli C, Ruimy R, Claret PG, Lavigne JP, Hausfater P, Robert J, Ramacciati N, Mencacci A, Tartaglia D, Rossi L, Ojetti V, Petruzziello C, Fiori B, Bonenfant J, Piau-Couape C, Dejoies L, Garcia-Garcia Á, Cores-Calvo O, Van Den Brand CL, van Veen SQ, Laribi S, Lartigue MF. Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study. J Antimicrob Chemother 2019; 74:3069-3076. [DOI: 10.1093/jac/dkz274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).
Methods
In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.
Results
We included 88242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).
Conclusions
Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.
Collapse
Affiliation(s)
- Alice Quaegebeur
- Lausanne University Hospital, Emergency Department, Lausanne, Switzerland
| | - Loïc Brunard
- CHU Nantes, Emergency Department, Nantes, France
| | - François Javaudin
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Marie-Anne Vibet
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
- CHU Nantes, DRCI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Pascale Bemer
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
- CHU Nantes, Bacteriology and Infection Control, Nantes, France
| | - Quentin Le Bastard
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Eric Batard
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Emmanuel Montassier
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Bachtarzi R, Boureau AS, Mascart C, Batard E, Montassier E, Bémer P, Bourigault C, Berrut G, de Decker L, Chapelet G. <p>Psychoactive drug prescription and urine colonization with extended-spectrum β-lactamase-producing <em>Enterobacteriaceae</em></p>. Infect Drug Resist 2019; 12:1763-1770. [PMID: 31303771 PMCID: PMC6612047 DOI: 10.2147/idr.s200029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background The worldwide dissemination of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has become a major health concern. Previous studies have shown that psychoactive drugs have intrinsic antimicrobial activity and may play a role in the dissemination of antibiotic resistance. The objective of this study was to assess the association between prescriptions for psychoactive drug and urine colonization with ESBL-producing Enterobacteriaceae. Subjects Ninety-five patients were included; 19 cases (urine colonization with an ESBL-producing Enterobacteriaceae) and 76 controls (urine colonization with non ESBL-producing Enterobacteriaceae); and were matched for age and gender. Methods A retrospective 1:4 matched case–control study design was used. All patients colonized with an Enterobacteriaceae isolate in Nantes University Hospital from March to November 2014, were screened before inclusion in the study. Prescriptions data for psychoactive drugs were collected from the electronic medical records. Univariate and multivariate conditional logistic regression analyses were performed. Results Thirty-seven patients (38.9%) were treated with psychoactive drugs, of whom 10 (52.6%) were in the ESBL-producing group and 27 (35.5%) were in the non-ESBL group. Mean (SD) age was 71.2 (23.1) years. In multivariate analyses, previous antimicrobial therapy within 6 months (OR=7.12, 95% CI 1.15–44.18; p=0.035) and previous colonization with an ESBL-producing organism (OR=44.87, 95% CI 1.26–1594.19; p=0.037) were associated with urine colonization with ESBL-producing Enterobacteriaceae. Conclusions Our findings revealed that a history of previous antimicrobial therapy and previous colonization with ESBL-producing organisms are important risk factors in an elderly population. Psychoactive drugs were not associated with urinary carriage of ESBL-producing Enterobacteriaceae. Further studies are required to explore the relationship between psychoactive drugs and colonization with ESBL-producing Enterobacteriaceae.
Collapse
Affiliation(s)
- Raphaële Bachtarzi
- Centre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, NantesF-44000, France
| | - Anne Sophie Boureau
- Centre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, NantesF-44000, France
| | - Charlotte Mascart
- Centre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, NantesF-44000, France
| | - Eric Batard
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), NantesF-44200, France
- Centre Hospitalier Universitaire de Nantes, Emergency Department, NantesF-44000, France
| | - Emmanuel Montassier
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), NantesF-44200, France
- Centre Hospitalier Universitaire de Nantes, Emergency Department, NantesF-44000, France
| | - Pascale Bémer
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), NantesF-44200, France
- Centre Hospitalier Universitaire de Nantes, Bacteriology Department, NantesF-44000, France
| | - Céline Bourigault
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), NantesF-44200, France
| | - Gilles Berrut
- Centre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, NantesF-44000, France
| | - Laure de Decker
- Centre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, NantesF-44000, France
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), NantesF-44200, France
| | - Guillaume Chapelet
- Centre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, NantesF-44000, France
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), NantesF-44200, France
- Correspondence: Guillaume ChapeletCentre Hospitalier Universitaire de Nantes, Clinical Gerontology Department, 1 Place Alexis-Ricordeau, NantesF-44000, FranceTel +33 24 016 5212Fax +33 24 016 5397Email
| |
Collapse
|
18
|
Biron C, Voydeville J, Gaborit B, Juvin M, Batard E, Asseray N, Bretonniere C, Caillon J, Boutoille D, Raffi F. Prise en charge des méningites bactériennes aiguës communautaires au sein d’un CHU : adéquation aux recommandations SPILF-2008. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.084] [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]
|
19
|
Montassier E, Javaudin F, Moustafa F, Nandjou D, Maignan M, Hardouin JB, Annoot C, Ogielska M, Orer PL, Schotté T, Bouget J, Agha Babaei S, Raynal PA, Eche A, Duc AT, Cojocaru RA, Benaouicha N, Potel G, Batard E, Talan DA. Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial. Ann Emerg Med 2019; 74:580-591. [PMID: 30982631 DOI: 10.1016/j.annemergmed.2019.02.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia. METHODS We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes included rates of antibiotic duration less than or equal to 5 days, and clinical success and combined serious adverse outcomes at 30 days in the intention-to-treat population. RESULTS Of 370 eligible patients, 285 (77%) were randomly assigned to either clinical assessment- (n=143) or procalcitonin-guided care (n=142). Median age was 67 years (range 18 to 93 years) and 40% of patients were deemed to have Pneumonia Severity Index class IV or V. Procalcitonin algorithm adherence was 76%. Antibiotic duration was not significantly different between clinical assessment- and procalcitonin-guided groups (median 9 versus 10 days, respectively). Clinical success rate was 92% in each group and serious adverse outcome rates were similar (15% versus 20%, respectively). CONCLUSION Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.
Collapse
Affiliation(s)
- Emmanuel Montassier
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France.
| | - François Javaudin
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Farès Moustafa
- Department of Emergency Medicine, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Demeno Nandjou
- Department of Emergency Medicine, Centre Hospitalier Agen Agen, France
| | - Maxime Maignan
- University Grenoble Alps, Emergency Department and Mobile Intensive Care Unit, Centre Hospitalier UniversitaireGrenoble Alps, Grenoble, France
| | | | - Caroline Annoot
- Department of Emergency Medicine, Centre Hospitalier la Roche sur Yon, la Roche sur Yon, France
| | - Maja Ogielska
- Service de maladies infectieuses, Centre Hospitalier Universitaire Tours, Tours, France
| | - Pascal-Louis Orer
- Department of Emergency Medicine, Assistance Publique Hopitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Thibault Schotté
- Department of Emergency Medicine, Centre Hospitalier Universitaire Angers, Institut Mitovasc, Université d'Angers, Angers, France
| | - Jacques Bouget
- Department of Emergency Medicine, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Syamak Agha Babaei
- Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Pierre-Alexis Raynal
- Department of Emergency Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Paris, France
| | - Antoine Eche
- Department of Emergency Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Hôtel Dieu, Paris, France
| | - Albert Trinh Duc
- Department of Emergency Medicine, Centre Hospitalier Agen Agen, France
| | - Ruxandra-Aimée Cojocaru
- Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France
| | - Nesrine Benaouicha
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Gilles Potel
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, Centre Hospitalier Universitaire, Nantes University Hospital, Nantes, France
| | - David A Talan
- Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Olive View-University of California, Los Angeles Medical Center, Sylmar, California; David Geffen School of Medicine at University of California, Los Angeles.
| |
Collapse
|
20
|
N'Guyen TTH, Bourigault C, Guillet V, Buttes ACGD, Montassier E, Batard E, Birgand G, Lepelletier D. Association between excreta management and incidence of extended-spectrum β-lactamase-producing Enterobacteriaceae: role of healthcare workers' knowledge and practices. J Hosp Infect 2018; 102:31-36. [PMID: 30557588 DOI: 10.1016/j.jhin.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/13/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spread of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in healthcare environments has become a major public health threat in recent years. AIM To assess how healthcare workers (HCWs) manage excreta and the possible association with the incidence of ESBL-PE. METHODS Eight hundred HCWs and 74 nurse-supervisors were questioned through two self-report questionnaires in order to assess their knowledge and practices, and to determine the equipment utilized for excreta management in 74 healthcare departments. Performance on equipment utilized, knowledge and practices were scored as good (score of 1), intermediate (score of 2) or poor (score of 3) on the basis of pre-established thresholds. Linear regression was performed to evaluate the association between HCWs' knowledge/practices and the incidence of ESBL-PE. FINDINGS Six hundred and eighty-eight HCWs (86%) and all nurse-supervisors participated in the survey. The proportions of respondents scoring 1, 2 and 3 were: 14.8%, 71.6% and 17.6% for equipment; 30.1%, 40.6 % and 29.3% for knowledge; and 2.0%, 71.9% and 26.1% for practices, respectively. The single regression mathematic model highlighted that poor practices (score of 3) among HCWs was significantly associated with increased incidence of ESBL-PE (P = 0.002). CONCLUSIONS A positive correlation was found between HCWs' practices for managing excreta and the incidence of ESBL-PE, especially in surgical units. There is an urgent need for development of public health efforts to enhance knowledge and practices of HCWs to better control the spread of multi-drug-resistant bacteria, and these should be integrated within infection control programmes.
Collapse
Affiliation(s)
| | - C Bourigault
- MiHAR Lab, University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - V Guillet
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - A-C Guille des Buttes
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - E Montassier
- MiHAR Lab, University of Nantes, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - E Batard
- MiHAR Lab, University of Nantes, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - G Birgand
- MiHAR Lab, University of Nantes, Nantes, France; Regional Infection Control Centre, Pays de la Loire, Nantes, France
| | - D Lepelletier
- MiHAR Lab, University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
| |
Collapse
|
21
|
|
22
|
Batard E, Javaudin F, Kervagoret E, Caruana E, Le Bastard Q, Chapelet G, Goffinet N, Montassier E. Are third-generation cephalosporins associated with a better prognosis than amoxicillin-clavulanate in patients hospitalized in the medical ward for community-onset pneumonia? Clin Microbiol Infect 2018; 24:1171-1176. [PMID: 29964229 DOI: 10.1016/j.cmi.2018.06.021] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We aimed to assess whether treatment with ceftriaxone/cefotaxime is associated with lower in-hospital mortality than amoxicillin-clavulanate in pati0ents hospitalized in medical wards for community-onset pneumonia. METHODS We conducted a retrospective and multicentre study of patients hospitalized in French medical wards for community-onset pneumonia between 2002 and 2015. Treatments with ceftriaxone/cefotaxime or amoxicillin-clavulanate were defined by their start in the emergency department for a duration of 5 days or more with no other β-lactam. A logistic regression analysis was performed on the overall population, and a propensity score analysis was restricted to patients treated with either ceftriaxone/cefotaxime or amoxicillin-clavulanate. RESULTS 1698 patients (median age, 80 y) were included, of which 716 and 198 were treated with amoxicillin-clavulanate and ceftriaxone/cefotaxime, respectively. In-hospital mortality was 10% (9-12%). In multivariate analysis, factors associated with in-hospital mortality were treatment with ceftriaxone/cefotaxime (aOR 2.9; (1.4-5.7)), pneumonia severity index class 4 or 5 (aOR 7.8 (4.3-15.7)), do-not-resuscitate order (aOR 8.7 (5.2-14.6)) and fluid therapy (aOR 6.3 (2.5-15.1)). The propensity score analysis was performed on 178 patients treated with ceftriaxone/cefotaxime matched with 178 patients treated with amoxicillin-clavulanate; no significant association between treatment with ceftriaxone/cefotaxime and in-hospital mortality was found (OR 1.5 (0.7-3.0)). CONCLUSION In the largest study aiming to compare amoxicillin-clavulanate and ceftriaxone/cefotaxime in community-onset pneumonia, ceftriaxone/cefotaxime was not associated with lower in-hospital mortality than amoxicillin-clavulanate. Our results suggest that ceftriaxone/cefotaxime should not be preferred over amoxicillin-clavulanate for patients hospitalized in medical wards with community-onset pneumonia.
Collapse
Affiliation(s)
- E Batard
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France.
| | - F Javaudin
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France
| | - E Kervagoret
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France
| | - E Caruana
- CHU Nantes, Emergency Department, Nantes, France
| | - Q Le Bastard
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France
| | - G Chapelet
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Clinical Gerontology Department, Nantes, France
| | - N Goffinet
- CHU Nantes, Emergency Department, Nantes, France
| | - E Montassier
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France
| |
Collapse
|
23
|
Allain M, Kuczer V, Longo C, Batard E, Le Conte P. Place de la simulation dans la formation initiale des urgentistes : enquête nationale observationnelle. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction : La simulation apparaît aujourd’hui comme un outil indispensable dans l’apprentissage de compétences médicales techniques et non techniques, tout en respectant le principe éthique suivant : « Jamais la première fois sur le patient ». Actuellement, l’intégration de la simulation dans les programmes de formation des internes de médecine d’urgence est disparate : son cadre demeure à définir devant l’ouverture récente du diplôme d’études spécialisée (DES) de médecine d’urgence à l’automne 2017.
Objectif de l’étude : Cette étude a évalué l’utilisation de la simulation en France dans l’enseignement actuel de la médecine d’urgence, afin d’initier une réflexion sur la place que pourrait avoir ce type d’enseignement pour le DES.
Méthode : Il s’agissait d’une étude observationnelle multicentrique. Un questionnaire a été envoyé par e-mail à l’ensemble des responsables universitaires de France impliqués dans l’enseignement de la médecine d’urgence. Les données ont été colligées dans Excel (Microsoft). Elles étaient à la fois quantitatives et qualitatives et concernaient le cadre, la structuration et le contenu de la formation par la simulation.
Résultats : Vingt-cinq facultés de médecine sur 29 ont répondu au questionnaire. Parmi elles, 23 utilisaient la simulation (soit 92 %), dont 22 la simulation haute fidélité et 21 la simulation procédurale. Arrêt cardiorespiratoire (22), état de choc (21), douleur thoracique et tachycardies (20), traumatisé crânien et traumatisé grave (17) étaient les thématiques majoritairement abordées. Les gestes techniques les plus enseignés étaient : intubation (22), intubation difficile (21), ventilation assistée-contrôlée et voie intraosseuse (18). En médiane, la formation comptait entre deux et trois jours de simulation par année de formation. Par ailleurs, dans 12 centres (soit 52 %), les formateurs avaient un temps professionnel dédié, et 15 centres (soit 65 %) bénéficiaient de personnel salarié. Enfin, seulement 12 centres (52 %) estimaient « plutôt » respecter l’adage « Jamais la première fois sur le patient ».
Discussion : L’utilisation de la simulation dans l’enseignement de la médecine d’urgence est inégale. Les responsables pédagogiques interrogés semblent tomber d’accord quant aux principales thématiques et techniques à aborder. Le développement de la simulation semble souhaité de tous, mais demeure complexe en raison notamment de l’investissement humain et matériel que cela représente. Ces réponses pourraient fournir un axe de réflexion afin d’établir un programme de simulation commun à l’ensemble des facultés.
Collapse
|
24
|
Javaudin F, Leclere B, Segard J, Le Bastard Q, Pes P, Penverne Y, Le Conte P, Jenvrin J, Hubert H, Escutnaire J, Batard E, Montassier E, Gr-RéAC. Prognostic performance of early absence of pupillary light reaction after recovery of out of hospital cardiac arrest. Resuscitation 2018; 127:8-13. [PMID: 29545138 DOI: 10.1016/j.resuscitation.2018.03.020] [Citation(s) in RCA: 28] [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: 02/03/2018] [Revised: 03/02/2018] [Accepted: 03/10/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Loss of pupillary light reactivity (PLR) three days after a cardiorespiratory arrest is a prognostic factor. Its predictive value upon hospital admission remains unclear. Our objective was to determine the prognostic value of the absence of PLR upon hospital admission in patients with out-of-hospital cardiac arrest. METHODS We prospectively included all out-of-hospital cardiac arrests occurring between July 2011 and July 2017 treated by a mobile medical team (MMT) based on data from a French cardiac arrest registry database. PLR was evaluated upon hospital admission and the outcome on day 30. The prognosis was classified as good for Cerebral Performance Category (CPC) 1 or 2, and poor for CPC 3-5 or in case of death. RESULTS Data from 10151 patients was analysed. The sensitivity and specificity of the absence of PLR for a poor outcome were 72.2% (71.2-73.2) and 68.8% (66.7-70.1), respectively. We identified several variables modifying the sensitivity values and the false positive fraction of a factor, ranging from 0.49 (0.35-0.69) for the Glasgow Coma Scale to 2.17 (1.09-2.48) for pupillary asymmetry. Among those living with CPC 1 or 2 on day 30 (n = 1990; 19.6%), 621 (31.2% (29.2-33.3)) had no PLR upon hospital admission. In the multivariate analysis, loss of PLR was associated with a poor outcome (OR = 3.1 (2.7-3.5)). CONCLUSIONS Loss of pupillary light reactivity upon hospital admission is predictive of a poor outcome after out-of-hospital cardiac arrest. However, it does not have sufficient accuracy to determine prognosis and decision making.
Collapse
Affiliation(s)
- F Javaudin
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France.
| | - B Leclere
- University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France; Department of Epidemiology and Medical Evaluation, University Hospital of Nantes, France
| | - J Segard
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France; Department of Emergency Medicine, Hospital of Saint-Nazaire, France
| | - Q Le Bastard
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France
| | - P Pes
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France
| | - Y Penverne
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France
| | - P Le Conte
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France
| | - J Jenvrin
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France
| | - H Hubert
- Public Health Department EA 2694, University of Lille, Lille University Hospital, France
| | - J Escutnaire
- Public Health Department EA 2694, University of Lille, Lille University Hospital, France
| | - E Batard
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France
| | - E Montassier
- Samu 44, Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), Nantes, France
| | - Gr-RéAC
- Research Group on the French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| |
Collapse
|
25
|
Marquet A, Vibet MA, Caillon J, Javaudin F, Chapelet G, Montassier E, Batard E. Is There an Association Between Use of Amoxicillin-Clavulanate and Resistance to Third-Generation Cephalosporins in Klebsiella pneumoniae and Escherichia coli at the Hospital Level? Microb Drug Resist 2018; 24:987-994. [PMID: 29489447 DOI: 10.1089/mdr.2017.0360] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Amoxicillin-clavulanate is extensively used in European hospitals. Whether the hospital use of amoxicillin-clavulanate is associated with nonsusceptibility to third-generation cephalosporins (3GC) in Klebsiella pneumoniae is unknown. Our aim was to assess the relationship between the hospital use of amoxicillin-clavulanate and 3GC nonsusceptibility in K. pneumoniae and Escherichia coli. METHODS Yearly data of antibiotic use and 3GC nonsusceptibility in K. pneumoniae and E. coli were obtained from 33 French hospitals between 2011 and 2016. Decreased susceptibility to 3GC and Extended-Spectrum Beta-Lactamase (ESBL) production were modelled from antibiotic use with linear mixed models on years 2011 to 2015, and validated on year 2016. RESULTS Nonsusceptibility to 3GC increased in K. pneumoniae and E. coli. In a multivariable model that included year and use of 3GC and fluoroquinolones as explanatory variables, amoxicillin-clavulanate use was protective against 3GC nonsusceptibility in K. pneumoniae (incidence rate ratio [IRR], 0.992 [0.988-0.997]), and with ESBL production in K. pneumoniae (IRR, 0.989 [0.985-0.992]). The correlation coefficient between observed and predicted numbers of 3GC-nonsusceptible K. pneumoniae in 2016 was 0.95 (95% confidence interval, 0.89-0.98). There was no significant association between amoxicillin-clavulanate use and 3GC nonsusceptibility in E. coli. CONCLUSION Amoxicillin-clavulanate hospital use was protective against nonsusceptibility to 3GC in K. pneumoniae. Conversely, it was not associated with susceptibility to 3GC in E. coli. To decrease the hospital use of 3GC and fluoroquinolones, and 3GC nonsusceptibility in K. pneumoniae, it may be acceptable to increase the hospital use of amoxicillin-clavulanate. Interventional studies are necessary to confirm this hypothesis.
Collapse
Affiliation(s)
| | - Marie-Anne Vibet
- 2 Laboratoire de Mathématiques Jean Leray, Université de Nantes , Nantes, France
| | - Jocelyne Caillon
- 1 OMEDIT des Pays de la Loire , Nantes, France .,3 Bacteriology and Infection Control, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - François Javaudin
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - Guillaume Chapelet
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France
| | - Emmanuel Montassier
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - Eric Batard
- 1 OMEDIT des Pays de la Loire , Nantes, France .,4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| |
Collapse
|
26
|
Le Bastard Q, Al-Ghalith GA, Grégoire M, Chapelet G, Javaudin F, Dailly E, Batard E, Knights D, Montassier E. Systematic review: human gut dysbiosis induced by non-antibiotic prescription medications. Aliment Pharmacol Ther 2018; 47:332-345. [PMID: 29205415 DOI: 10.1111/apt.14451] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/04/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Global prescription drug use has been increasing continuously for decades. The gut microbiome, a key contributor to health status, can be altered by prescription drug use, as antibiotics have been repeatedly described to have both short-term and long-standing effects on the intestinal microbiome. AIM To summarise current findings on non-antibiotic prescription-induced gut microbiome changes, focusing on the most frequently prescribed therapeutic drug categories. METHODS We conducted a systematic review by first searching in online databases for indexed articles and abstracts in accordance with PRISMA guidelines. Studies assessing the intestinal microbiome alterations associated with proton pump inhibitors (PPIs), metformin, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, statins and antipsychotics were included. We only included studies using culture-independent molecular techniques. RESULTS Proton pump inhibitors and antipsychotic medications are associated with a decrease in α diversity in the gut microbiome, whereas opioids were associated with an increase in α diversity. Metformin and NSAIDs were not associated with significant changes in α diversity. β diversity was found to be significantly altered with all drugs, except for NSAIDs. PPI use was linked to a decrease in Clotridiales and increase in Actinomycetales, Micrococcaceae and Streptococcaceae, which are changes previously implicated in dysbiosis and increased susceptibility to Clostridium difficile infection. Consistent results showed that PPIs, metformin, NSAIDs, opioids and antipsychotics were either associated with increases in members of class Gammaproteobacteria (including Enterobacter, Escherichia, Klebsiella and Citrobacter), or members of family Enterococcaceae, which are often pathogens isolated from bloodstream infections in critically ill patients. We also found that antipsychotic treatment, usually associated with an increase in body mass index, was marked by a decreased ratio of Bacteroidetes:Firmicutes in the gut microbiome, resembling trends seen in obese patients. CONCLUSIONS Non-antibiotic prescription drugs have a notable impact on the overall architecture of the intestinal microbiome. Further explorations should seek to define biomarkers of dysbiosis induced by specific drugs, and potentially tailor live biotherapeutics to counter this drug-induced dysbiosis. Many other frequently prescribed drugs should also be investigated to better understand the link between these drugs, the microbiome and health status.
Collapse
Affiliation(s)
- Q Le Bastard
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - G A Al-Ghalith
- Biotechnology Institute, University of Minnesota, Saint Paul, MN, USA.,Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - M Grégoire
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - G Chapelet
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - F Javaudin
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - E Dailly
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - E Batard
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - D Knights
- Biotechnology Institute, University of Minnesota, Saint Paul, MN, USA.,Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - E Montassier
- MiHAR Lab, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| |
Collapse
|
27
|
Le Conte P, Trewick D, Pes P, Frampas E, Batard E. Acute fissuration of a giant splenic artery aneurysm detected by point-of-care ultrasound: case report. Crit Ultrasound J 2018; 10:5. [PMID: 29392549 PMCID: PMC5794681 DOI: 10.1186/s13089-018-0086-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background Epigastric pain is frequent in Emergency Medicine and remains a challenging situation. Besides benign etiologies such as gastritis or uncomplicated cholelithiasis, it could reveal myocardial infarction or vascular disease. Point-of-care ultrasound (POCUS) could be performed in such situation. Case presentation A healthy 66-year-old man with no previous medical history was admitted to the Emergency Department for a rapid onset epigastric pain. He reported taking non-steroidal anti-inflammatories for 1 week prior to admission. His pain had rapidly subsided and the physical examination was inconclusive. ECG and blood samples were normal. POCUS revealed a vascular mass located between the spleen and the left kidney measuring 80 * 74 mm associated with small amounts of free peritoneal fluid. Computed tomography diagnosed a fissurated giant aneurysm of the splenic artery. The aneurysm was managed emergently by endovascular exclusion by selective splenic artery embolization. The post-intervention course was uneventful and the patient was discharged home 3 days later. The patient has remained free from any complications of the embolization 6 months after the procedure. Conclusion Spontaneously regressive epigastric pain with a normal physical and biology/ECG should not necessarily reassure the physician, in particular if patients have cardiovascular risk factors. A POCUS should be considered for these patients. Electronic supplementary material The online version of this article (10.1186/s13089-018-0086-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - David Trewick
- Service des Urgences, CHU de Nantes, 44093, Nantes, France
| | - Philippe Pes
- Service des Urgences, CHU de Nantes, 44093, Nantes, France
| | - Eric Frampas
- Radiologie centrale, CHU de Nantes, Nantes, France
| | - Eric Batard
- Service des Urgences, CHU de Nantes, 44093, Nantes, France
| | | |
Collapse
|
28
|
Batard E, Vibet MA, Thibaut S, Corvec S, Pivette J, Lepelletier D, Caillon J, Montassier E. Tetracycline use in the community may promote decreased susceptibility to quinolones in Escherichia coli isolates. Eur J Clin Microbiol Infect Dis 2017; 37:271-276. [PMID: 29076047 DOI: 10.1007/s10096-017-3127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
We previously found that the hospital use of tetracyclines is associated with quinolone resistance in hospital isolates of Enterobacteriaceae. Tetracyclines are heavily used in the community. Our aim was to assess whether their use in the community favors quinolone resistance in community isolates of Escherichia coli. Monthly data of community antibiotics use and E. coli quinolone resistance in a 1.3 million inhabitant French area were obtained from 2009 to 2014, and were analyzed with autoregressive integrated moving average (ARIMA) models. Quinolone use decreased from 10.1% of the total antibiotic use in 2009 to 9.3% in 2014 (trend, - 0.016; p-value < 0.0001), while tetracycline use increased from 16.5% in 2009 to 17.1% in 2014 (trend, 0.016; p < 0.0001). The mean (95% confidence interval) monthly proportions of isolates that were non-susceptible to nalidixic acid and ciprofloxacin were 14.8% (14.2%-15.5%) and 9.5% (8.8%-10.1%), respectively, with no significant temporal trend. After adjusting on quinolone use, tetracycline use in the preceding month was significantly associated with nalidixic acid non-susceptibility (estimate [SD], 0.01 [0.007]; p-value, 0.04), but not with ciprofloxacin non-susceptibility (estimate [SD], 0.01 [0.009]; p-value, 0.23). Tetracycline use in the community may promote quinolone non-susceptibility in E. coli. Decreasing both tetracycline and quinolone use may be necessary to fight against the worldwide growth of quinolone resistance.
Collapse
Affiliation(s)
- E Batard
- Microbiotas Hosts Antibiotics bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Benoni-Goullin, 44200, Nantes, France. .,Emergency Department, Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - M-A Vibet
- Laboratoire de Mathématiques Jean Leray, Université de Nantes, Nantes, France
| | - S Thibaut
- Medqual, Centre Ressource en Antibiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - S Corvec
- Bacteriology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - J Pivette
- Medical Department, French Health Insurance Scheme, Nantes, France
| | - D Lepelletier
- Microbiotas Hosts Antibiotics bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Benoni-Goullin, 44200, Nantes, France.,Bacteriology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - J Caillon
- Medqual, Centre Ressource en Antibiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Bacteriology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - E Montassier
- Microbiotas Hosts Antibiotics bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Benoni-Goullin, 44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| |
Collapse
|
29
|
Le Conte P, Thibergien S, Obellianne JB, Montassier E, Potel G, Roy PM, Batard E. Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals. BMC Emerg Med 2017; 17:27. [PMID: 28854874 PMCID: PMC5575926 DOI: 10.1186/s12873-017-0133-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/29/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Sepsis management in the Emergency Department remains a daily challenge. The Surviving Sepsis Campaign (SSC) has released three-hour bundle. The implementation of these bundles in European Emergency Departments remains poorly described. The main objective was to assess the compliance with the Severe Sepsis Campaign 3-h bundle (blood culture, lactate dosage, first dose of antibiotics and 30 ml/kg fluid challenge). Secondary objectives were the analysis of the delay of severe sepsis recognition and description of the population. METHODS In accordance with STROBE statement, we performed a retrospective study in two French University Hospital Emergency Departments from February to August 2015. Patients admitted during the study period were screened using the electronic files of the hospital databases. Patient's files were reviewed and included in the study if they met severe sepsis criteria. Demographics, comorbities, treatments were recorded. Delays from admission to severe sepsis diagnosis, fluid loading onset and antibiotics administration were calculated. RESULTS One hundred thirty patients were included (76 men, mean age 71 ± 14 years). Blood culture, lactate dosage, antibiotics and 30 ml/kg fluid loading were performed within 3 hours in % [95% confidence interval] 100% [96-100%], 62% [54-70%], 49% [41-58%] and 19% [13-27%], respectively. 25 patients out of 130 (19% [13-27%]) fulfilled each criteria of the 3-h bundle. The mean fluid loading volume was 18 ± 11 ml/kg. Mean delay between presentation and severe sepsis diagnosis was 200 ± 263 min, from diagnosis to fluid challenge and first antibiotic dose, 10 ± 27 min and 20 ± 55 min, respectively. CONCLUSION Compliance with SSC 3-h bundle and delay between admission and sepsis recognition have to be improved. If confirmed by other studies, an improvement program might be deployed.
Collapse
Affiliation(s)
| | | | | | | | - Gilles Potel
- Service des urgences, CHU de Nantes, 44035 Nantes cedex 01, France
| | | | - Eric Batard
- Service des urgences, CHU de Nantes, 44035 Nantes cedex 01, France
| |
Collapse
|
30
|
Chapelet G, Boureau AS, Dylis A, Herbreteau G, Corvec S, Batard E, Berrut G, de Decker L. Association between dementia and reduced walking ability and 30-day mortality in patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia. Eur J Clin Microbiol Infect Dis 2017; 36:2417-2422. [PMID: 28801698 DOI: 10.1007/s10096-017-3077-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/20/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
Previous studies have shown controversial results of factors associated with short-term mortality in patients with extended-spectrum beta-lactamase (ESBL)-producing E. coli bacteremia and no research has investigated the impact of the geriatric assessment criteria on short-term mortality. Our objective was to determine whether dementia and walking ability are associated with 30-day mortality in patients with ESBL-producing E. coli bacteremia. All blood bottle cultures, analyzed from January 2008 to April 2015, in the Bacteriology Department of a 2,600-bed, university-affiliated center, Nantes, France, were retrospectively extracted. Factors associated with short-term mortality in patients with ESBL-producing E. coli bacteremia: 140 patients with an ESBL-producing E. coli bloodstream infection were included; 22 (15.7%) patients died within 30 days following the first positive blood bottle culture of ESBL-producing E.coli. In multivariate analysis, a reduced ability to walk (OR = 0.30; p = 0.021), presence of dementia (OR = 54.51; p = 0.040), a high Sepsis-related Organ Failure Assessment (SOFA) score (OR = 1.69; p < 0.001), presence of neutropenia (OR = 12.94; p = 0.049), and presence of a urinary tract infection (OR = 0.07; p = 0.036), were associated with 30-day mortality. Our findings provide new data showing an independent association between 30-day mortality with dementia and reduced walking ability, in patients with ESBL-producing E. coli bacteremia. These criteria should be considered in the therapeutic management of patients with ESBL-producing E. coli bacteremia.
Collapse
Affiliation(s)
- G Chapelet
- EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France. .,Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France. .,Faculté de médecine-Porte 438, 1 rue Gaston Veil, 44035, Nantes cedex 1, France.
| | - A S Boureau
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - A Dylis
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - G Herbreteau
- Bacteriology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - S Corvec
- Bacteriology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - E Batard
- EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - G Berrut
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - L de Decker
- EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France.,Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| |
Collapse
|
31
|
Birgand G, Hayatgheib N, Bémer P, Guilloteau V, Legeay C, Perron S, Chapelet G, Corvec S, Bourigault C, Batard E, Lepelletier D. Multi-drug-resistant Enterobacteriacae carriage in highly exposed nursing homes: prevalence in western France. J Hosp Infect 2017; 97:258-259. [PMID: 28774743 DOI: 10.1016/j.jhin.2017.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/19/2022]
Affiliation(s)
- G Birgand
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, France; Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - N Hayatgheib
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; ONIRIS National Veterinary School (Man-imal One Health Master 2 degree), Nantes, France
| | - P Bémer
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - V Guilloteau
- Infection Control Unit, Chalonnes Hospital Centre, Chalonnes, France
| | - C Legeay
- Infection Control Unit, Angers University Hospital, Angers, France
| | - S Perron
- Infection Control Unit, Saumur Hospital Centre, Saumur, France
| | - G Chapelet
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Gerontologic Department, Nantes University Hospital, Nantes, France
| | - S Corvec
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - C Bourigault
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - E Batard
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - D Lepelletier
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; ONIRIS National Veterinary School (Man-imal One Health Master 2 degree), Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
| |
Collapse
|
32
|
Manoeuvrier G, Bach-Ngohou K, Batard E, Masson D, Trewick D. Diagnostic performance of serum blood urea nitrogen to creatinine ratio for distinguishing prerenal from intrinsic acute kidney injury in the emergency department. BMC Nephrol 2017; 18:173. [PMID: 28545421 PMCID: PMC5445342 DOI: 10.1186/s12882-017-0591-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 02/01/2017] [Accepted: 05/17/2017] [Indexed: 11/11/2022] Open
Abstract
Background The blood urea nitrogen to creatinine ratio (BCR) has been used since the early 1940s to help clinicians differentiate between prerenal acute kidney injury (PR AKI) and intrinsic AKI (I AKI). This ratio is simple to use and often put forward as a reliable diagnostic tool even though little scientific evidence supports this. The aim of this study was to determine whether BCR is a reliable tool for distinguishing PR AKI from I AKI. Methods We conducted a retrospective observational study over a 13 months period, in the Emergency Department (ED) of Nantes University Hospital. Eligible for inclusion were all adult patients consecutively admitted to the ED with a creatinine >133 μmol/L (1.5 mg/dL). Results Sixty thousand one hundred sixty patients were consecutively admitted to the ED. 2756 patients had plasma creatinine levels in excess of 133 μmol/L, 1653 were excluded, leaving 1103 patients for definitive inclusion. Mean age was 75.7 ± 14.8 years old, 498 (45%) patients had PR AKI and 605 (55%) I AKI. BCR was 90.55 ± 39.32 and 91.29 ± 39.79 in PR AKI and I AKI groups respectively. There was no statistical difference between mean BCR of the PR AKI and I AKI groups, p = 0.758. The area under the ROC curve was 0.5 indicating that BCR had no capacity to discriminate between PR AKI and I AKI. Conclusions Our study is the largest to investigate the diagnostic performance of BCR. BCR is not a reliable parameter for distinguishing prerenal AKI from intrinsic AKI.
Collapse
Affiliation(s)
| | - Kalyane Bach-Ngohou
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, Nantes, France
| | - Eric Batard
- Department of Emergency Medicine, CHU Nantes, Nantes, France.,Service des Urgences, CHU Hotel Dieu, 44000, Nantes, France
| | - Damien Masson
- Department of Biology, Laboratory of Clinical Biochemistry, CHU Nantes, Nantes, France
| | - David Trewick
- Department of Emergency Medicine, CHU Nantes, Nantes, France. .,Service des Urgences, CHU Hotel Dieu, 44000, Nantes, France.
| |
Collapse
|
33
|
Chapelet G, Corvec S, Montassier E, Herbreteau G, Berrut G, Batard E, de Decker L. Rapid detection of amoxicillin-susceptible Escherichia coli in fresh uncultured urine: a new tool to limit the use of broad-spectrum empirical therapy of community-acquired pyelonephritis. Int J Antimicrob Agents 2016; 47:486-9. [DOI: 10.1016/j.ijantimicag.2016.04.012] [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] [Received: 02/19/2016] [Revised: 03/25/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
|
34
|
Batard E, Lefebvre M, Aubin GG, Caroff N, Corvec S. High prevalence of cross-resistance to fluoroquinolone and cotrimoxazole in tetracycline-resistant Escherichia coli human clinical isolates. J Chemother 2016; 28:510-512. [DOI: 10.1179/1973947815y.0000000038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
35
|
Montassier E, Al-Ghalith GA, Ward T, Corvec S, Gastinne T, Potel G, Moreau P, De La Cochetiere MF, Batard E, Knights D. Erratum to: Pretreatment gut microbiome predicts chemotherapy-related bloodstream infection. Genome Med 2016; 8:61. [PMID: 27229935 PMCID: PMC4882780 DOI: 10.1186/s13073-016-0321-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Emmanuel Montassier
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France.,Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Gabriel A Al-Ghalith
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA.,Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Tonya Ward
- Biotechnology Institute, University of Minnesota, St. Paul, MN, 55108, USA
| | - Stephane Corvec
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France.,Nantes University Hospital, Microbiology Laboratory, Nantes, France
| | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Gilles Potel
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France
| | - Philippe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie France De La Cochetiere
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France
| | - Eric Batard
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France
| | - Dan Knights
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA. .,Biotechnology Institute, University of Minnesota, St. Paul, MN, 55108, USA.
| |
Collapse
|
36
|
Montassier E, Al-Ghalith GA, Ward T, Corvec S, Gastinne T, Potel G, Moreau P, de la Cochetiere MF, Batard E, Knights D. Pretreatment gut microbiome predicts chemotherapy-related bloodstream infection. Genome Med 2016; 8:49. [PMID: 27121964 PMCID: PMC4848771 DOI: 10.1186/s13073-016-0301-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [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: 01/07/2016] [Accepted: 04/11/2016] [Indexed: 02/07/2023] Open
Abstract
Background Bacteremia, or bloodstream infection (BSI), is a leading cause of death among patients with certain types of cancer. A previous study reported that intestinal domination, defined as occupation of at least 30 % of the microbiota by a single bacterial taxon, is associated with BSI in patients undergoing allo-HSCT. However, the impact of the intestinal microbiome before treatment initiation on the risk of subsequent BSI remains unclear. Our objective was to characterize the fecal microbiome collected before treatment to identify microbes that predict the risk of BSI. Methods We sampled 28 patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic stem cell transplantation (HSCT) prior to administration of chemotherapy and characterized 16S ribosomal RNA genes using high-throughput DNA sequencing. We quantified bacterial taxa and used techniques from machine learning to identify microbial biomarkers that predicted subsequent BSI. Results We found that patients who developed subsequent BSI exhibited decreased overall diversity and decreased abundance of taxa including Barnesiellaceae, Coriobacteriaceae, Faecalibacterium, Christensenella, Dehalobacterium, Desulfovibrio, and Sutterella. Using machine-learning methods, we developed a BSI risk index capable of predicting BSI incidence with a sensitivity of 90 % at a specificity of 90 % based only on the pretreatment fecal microbiome. Conclusions These results suggest that the gut microbiota can identify high-risk patients before HSCT and that manipulation of the gut microbiota for prevention of BSI in high-risk patients may be a useful direction for future research. This approach may inspire the development of similar microbiome-based diagnostic and prognostic models in other diseases. Electronic supplementary material The online version of this article (doi:10.1186/s13073-016-0301-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emmanuel Montassier
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections. Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France.,Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Gabriel A Al-Ghalith
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA.,Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Tonya Ward
- Biotechnology Institute, University of Minnesota, St. Paul, MN, 55108, USA
| | - Stephane Corvec
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections. Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France.,Nantes University Hospital, Microbiology Laboratory, Nantes, France
| | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Gilles Potel
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections. Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France
| | - Phillipe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie France de la Cochetiere
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections. Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France
| | - Eric Batard
- Université de Nantes, EA 3826 Thérapeutiques cliniques et expérimentales des infections. Faculté de médecine, 1 Rue G Veil, Nantes, 44000, France
| | - Dan Knights
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA. .,Biotechnology Institute, University of Minnesota, St. Paul, MN, 55108, USA.
| |
Collapse
|
37
|
Penit A, Bemer P, Besson J, Cazet L, Bourigault C, Juvin ME, Fix MH, Bruley des Varannes S, Boutoille D, Batard E, Lepelletier D. Community-acquired Clostridium difficile infections. Med Mal Infect 2016; 46:131-9. [PMID: 27039068 DOI: 10.1016/j.medmal.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/27/2015] [Revised: 11/25/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the management and treatment of community-acquired C. difficile infections (CDI) and to evaluate family physicians' (FP) knowledge and practice. PATIENTS AND METHODS Observational study from December 2013 to June 2014. All community-acquired CDI case patients diagnosed in the community or at the University Hospital of Nantes were prospectively included. A questionnaire was mailed to 150 FPs of the area of Nantes. RESULTS A total of 27 community-acquired CDI case patients were included (incidence: 7.7 case patients/100,000 inhabitants). Mean age was higher among case patients diagnosed at hospital (69years) compared with those diagnosed in the community (44years). Fifteen patients were treated at home (55%) and 22 received a first-line treatment with metronidazole. Only one patient did not receive any prior antibiotic treatment. Amoxicillin-clavulanic acid was mainly prescribed (68%) for respiratory and ENT infections (40%). Twenty-three patients were cured on Day 7 and three had complications (two deaths). Thirty-one of 47 FPs reported to have already managed CDI patients. Twenty-two FPs reported to usually treat patients with uncomplicated CDI at home, 21 to refer patients to a specialist, and three to hospital. Forty-one FPs reported to prescribe a CD toxin test only after recent antibiotic exposure and 30 when patients are at risk of CDI. CONCLUSION The incidence and impact of community-acquired CDIs may be underestimated and the unjustified use of antibiotics may promote their emergence. FPs are not used to treat CDIs as more than 50% prefer referring patients to hospital or to a specialist.
Collapse
Affiliation(s)
- A Penit
- Pôle de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | - P Bemer
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - J Besson
- Laboratoire d'analyses médicales Biolance, 44000 Nantes, France
| | - L Cazet
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - C Bourigault
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - M-E Juvin
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - M-H Fix
- Pôle de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | | | - D Boutoille
- Service des maladies infectieuses et tropicales, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France
| | - E Batard
- Service d'accueil des urgences, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France
| | - D Lepelletier
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France.
| |
Collapse
|
38
|
Lepelletier D, Pinaud V, Le Conte P, Bourigault C, Asseray N, Ballereau F, Caillon J, Ferron C, Righini C, Batard E, Potel G. Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals. Eur J Clin Microbiol Infect Dis 2016; 35:867-73. [PMID: 26942743 DOI: 10.1007/s10096-016-2609-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009-2012 describing 412 patients. Median age was 29 year (range, 2-84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity.
Collapse
Affiliation(s)
- D Lepelletier
- Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France. .,Medical School, EA 3826, University of Nantes, 44035, Nantes, France.
| | - V Pinaud
- Emergency Department, Nantes University Hospital, 44093, Nantes, France
| | - P Le Conte
- Emergency Department, Nantes University Hospital, 44093, Nantes, France
| | - C Bourigault
- Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France
| | - N Asseray
- Infectious Diseases Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - F Ballereau
- Medqual, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - J Caillon
- Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - C Ferron
- Otorhinolaryngology Department, Nantes University Hospital, 44093, Nantes, France
| | - C Righini
- Otorhinolaryngology Department, Michallon University Hospital, 38000, Grenoble, France
| | - E Batard
- Emergency Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - G Potel
- Emergency Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | | |
Collapse
|
39
|
Montassier E, Gastinne T, Vangay P, Al-Ghalith GA, Bruley des Varannes S, Massart S, Moreau P, Potel G, de La Cochetière MF, Batard E, Knights D. Chemotherapy-driven dysbiosis in the intestinal microbiome. Aliment Pharmacol Ther 2015; 42:515-28. [PMID: 26147207 DOI: 10.1111/apt.13302] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/16/2015] [Accepted: 06/12/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chemotherapy is commonly used as myeloablative conditioning treatment to prepare patients for haematopoietic stem cell transplantation (HSCT). Chemotherapy leads to several side effects, with gastrointestinal (GI) mucositis being one of the most frequent. Current models of GI mucositis pathophysiology are generally silent on the role of the intestinal microbiome. AIM To identify functional mechanisms by which the intestinal microbiome may play a key role in the pathophysiology of GI mucositis, we applied high-throughput DNA-sequencing analysis to identify microbes and microbial functions that are modulated following chemotherapy. METHODS We amplified and sequenced 16S rRNA genes from faecal samples before and after chemotherapy in 28 patients with non-Hodgkin's lymphoma who received the same myeloablative conditioning regimen and no other concomitant therapy such as antibiotics. RESULTS We found that faecal samples collected after chemotherapy exhibited significant decreases in abundances of Firmicutes (P = 0.0002) and Actinobacteria (P = 0.002) and significant increases in abundances of Proteobacteria (P = 0.0002) compared to samples collected before chemotherapy. Following chemotherapy, patients had reduced capacity for nucleotide metabolism (P = 0.0001), energy metabolism (P = 0.001), metabolism of cofactors and vitamins (P = 0.006), and increased capacity for glycan metabolism (P = 0.0002), signal transduction (P = 0.0002) and xenobiotics biodegradation (P = 0.002). CONCLUSIONS Our study identifies a severe compositional and functional imbalance in the gut microbial community associated with chemotherapy-induced GI mucositis. The functional pathways implicated in our analysis suggest potential directions for the development of intestinal microbiome-targeted interventions in cancer patients.
Collapse
Affiliation(s)
- E Montassier
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France.,Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - T Gastinne
- Department of Hematology, Nantes University Hospital, Nantes, France
| | - P Vangay
- Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA
| | - G A Al-Ghalith
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA.,Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA
| | - S Bruley des Varannes
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - S Massart
- Gembloux Agro-Bio Tech, University of Liège, Gembloux, Belgium
| | - P Moreau
- Department of Hematology, Nantes University Hospital, Nantes, France
| | - G Potel
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France
| | - M F de La Cochetière
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, INSERM, Université de Nantes, Nantes, France
| | - E Batard
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France
| | - D Knights
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA.,BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| |
Collapse
|
40
|
Vibet MA, Roux J, Montassier E, Corvec S, Juvin ME, Ngohou C, Lepelletier D, Batard E. Systematic analysis of the relationship between antibiotic use and extended-spectrum beta-lactamase resistance in Enterobacteriaceae in a French hospital: a time series analysis. Eur J Clin Microbiol Infect Dis 2015. [PMID: 26205663 DOI: 10.1007/s10096-015-2437-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The influence of hospital use of antibiotics other than cephalosporins and fluoroquinolones on extended-spectrum beta-lactamase (ESBL) resistance among Enterobacteriaceae is poorly known. Our objective was to explore the association between ESBL and hospital use of various classes of antibacterial agents. The relationship between monthly use of 19 classes of antibacterial agents and incidence of nosocomial ESBL-producing Enterobacteriaceae in a French hospital was studied between 2007 and 2013. Five antibiotic classes were significantly and independently associated with ESBL resistance. Uses of tetracyclines (link estimate ± SE, 0.0066 ± 0.0033), lincosamides (0.0093 ± 0.0029), and other antibacterial agents (0.0050 ± 0.0023) were associated with an increased incidence, while nitrofurantoin (-0.0188 ± 0.0062) and ticarcillin and piperacillin with or without enzyme inhibitor (-0.0078 ± 0.0031) were associated with a decreased incidence. In a multivariate model including 3rd- and 4th-generation cephalosporins, fluoroquinolones, amoxicillin, and amoxicillin-clavulanate, 3rd- and 4th-generation cephalosporins (0.0019 ± 0.0009) and fluoroquinolones (0.0020 ± 0.0008) were associated with an increased ESBL resistance, whereas amoxicillin and amoxicillin-clavulanate were not. Hospital use of tetracyclines and lincosamides may promote ESBL resistance in Enterobacteriaceae. Nitrofurantoin and ticarcillin and piperacillin with or without enzyme inhibitor should be considered as potential alternatives to broad-spectrum cephalosporins and fluoroquinolones to control the diffusion of ESBL resistance.
Collapse
Affiliation(s)
- M-A Vibet
- INSERM, U657 Pharmaco-épidémiologie et évaluation de l'impact des produits de santé sur les populations, Paris, France
| | - J Roux
- EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France
| | - E Montassier
- EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - S Corvec
- EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France
- Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - M-E Juvin
- Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - C Ngohou
- Health Information Management Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - D Lepelletier
- EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France
- Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - E Batard
- EA3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de Médecine, Université de Nantes, 1 rue Gaston Veil, 44000, Nantes, France.
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Nantes, France.
| |
Collapse
|
41
|
Batard E, Lecadet N, Goffinet N, Hardouin JB, Lepelletier D, Potel G, Montassier E. High variability among Emergency Departments in 3rd-generation cephalosporins and fluoroquinolones use for community-acquired pneumonia. Infection 2015; 43:681-9. [PMID: 25998004 DOI: 10.1007/s15010-015-0793-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/29/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Fluoroquinolones and 3rd-generation cephalosporins that are prescribed for pneumonia may be avoided and replaced by a penicillin in some cases. We aimed to determine if the proportion of patients treated for pneumonia with a cephalosporin, a fluoroquinolone or both varies among Emergency Departments (EDs), and to estimate the proportion of avoidable prescriptions. METHODS This was a retrospective study of patients treated for pneumonia in eight French EDs, and subsequently hospitalized in non-ICU wards. Third-generation cephalosporins or respiratory fluoroquinolones were presumed unavoidable if they met both criteria: (1) age ≥65 years or comorbid condition; and (2) allergy or intolerance to penicillin, or failure of penicillin, or previous treatment with penicillin, or for fluoroquinolones only, suspected legionellosis. RESULTS We included 832 patients. Thirty-four percent (95 % CI, 31-38 %) of patients were treated with a cephalosporin, a respiratory fluoroquinolone or both (range among EDs 19-44 %). Four EDs were independent risk factors for prescription of a cephalosporin, a fluoroquinolone or both [adjusted OR, 2.27 (1.64-3.15)], as were immune compromise [aOR 2.54 (1.56-4.14)], antibacterial therapy started before arrival in the ED [aOR 3.32 (2.30-4.81)], REA-ICU class III or IV [aOR 1.93 (1.15-3.23)], PSI class V [aOR 1.49 (1.00-2.20)], fluid resuscitation [aOR 3.98 (2.49-6.43)] and non-invasive ventilation in the ED [aOR, 7.18 (1.7-50.1)]. Treatment with a cephalosporin, a fluoroquinolone or both was avoidable in 67 % (62-73 %) of patients. CONCLUSION Cephalosporins and fluoroquinolones use in pneumonia is highly variable among EDs. The majority of these prescriptions are avoidable. Antibiotic stewardship programs should be implemented to restrict their use in EDs.
Collapse
Affiliation(s)
- Eric Batard
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France. .,Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France.
| | - Nathalie Lecadet
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - Nicolas Goffinet
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - Jean-Benoit Hardouin
- Faculté de Médecine and Pharmacie, Université de Nantes, EA 4275 SPHERE Biostatistics Pharmacoepidemiology and Human Science Research Team, 1 rue Gaston-Veil, 44000, Nantes, France
| | | | - Didier Lepelletier
- Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France.,Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - Gilles Potel
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France.,Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France
| | - Emmanuel Montassier
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France.,Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France
| |
Collapse
|
42
|
Lepelletier D, Batard E, Berthelot P, Zahar JR, Lucet JC, Fournier S, Jarlier V, Grandbastien B. [Carbapenemase-producing enterobacteriae: epidemiology, strategies to control their spread and issues]. Rev Med Interne 2015; 36:474-9. [PMID: 25600328 DOI: 10.1016/j.revmed.2014.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/18/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
The increasing bacterial resistance to antibiotics has become a major public health concern bringing the threat of therapeutic impasses. In this context, control of the spread of highly-resistant bacteria emerging antibiotics (BHRe), such as glycopeptide-resistant enterococci (VRE) and Enterobacteriaceae producing carbapenemases (CPE), is based on a dual strategy of reducing the prescription of antibiotics to limit the pressure selection and preventing the spread from carriers. Prevention strategy is based on three different levels such as standard precautions for all patients with a particular focus on the management of excreta, and additional precautions for BHRe carriers. What makes it difficult is that carriage is usually completely asymptomatic, enterobacteria and enterococci are normal commensal of gut microbiota. Explosive dissemination of Enterobacteriaceae producing extended spectrum beta-lactamases in hospital and community heralds the emergence of CPE whose import by patients with a history of hospitalization in abroad may be the main source of spread in France.
Collapse
Affiliation(s)
- D Lepelletier
- Unité de gestion du risque infectieux, université de Nantes, 6, rue du prof.-Yves-Boquien, 44093 Nantes cedex 01, France; EA3826, thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44035 Nantes, France.
| | - E Batard
- EA3826, thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44035 Nantes, France
| | - P Berthelot
- Unité d'hygiène inter-hospitalière, service des maladies infectieuses et de microbiologie, CHU de Saint-Étienne, 42100 Saint-Étienne, France
| | - J-R Zahar
- Unité de lutte contre les infections nosocomiales, CHU d'Angers, 49100 Angers, France
| | - J-C Lucet
- Unité hospitalière de lutte contre l'infection nosocomiale, groupe hospitalier Bichat-Claude-Bernard, AP-HP, 75877 Paris, France
| | - S Fournier
- CLIN central de l'AP-HP, 75004 Paris, France
| | - V Jarlier
- CLIN central de l'AP-HP, 75004 Paris, France; Laboratoire de bactériologie, hôpital La Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - B Grandbastien
- Unité de lutte contre les infections nosocomiales, service de gestion du risque infectieux, des vigilances et d'infectiologie, CHRU de Lille, 59000 Lille, France
| |
Collapse
|
43
|
Semin-Pelletier B, Cazet L, Bourigault C, Juvin ME, Boutoille D, Raffi F, Hourmant M, Blancho G, Agard C, Connault J, Corvec S, Caillon J, Batard E, Lepelletier D. Challenges of controlling a large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae in a French university hospital. J Hosp Infect 2015; 89:248-53. [PMID: 25601745 DOI: 10.1016/j.jhin.2014.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/31/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
A large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae at Nantes University Hospital was investigated. The index case had no history of travel or hospitalization abroad and had been hospitalized in the internal medicine department for more than one month when the epidemic strain was isolated from a urine sample in June 2013. Seventy-two secondary cases were detected by weekly screening for gastrointestinal colonization during the two phases of the outbreak from June to October 2013 (33 cases) and from November 2013 to August 2014 (39 cases). Spread of the epidemic strain was attributed to the proximity of, and staff movement between, the infectious diseases (32 cases) and the internal medicine (26 cases) departments; 14 secondary cases were also observed in the renal transplant department following the transfer of an exposed patient from the infectious diseases department. Most of the patients (90%) were colonized and no death was linked to the epidemic strain. More than 3000 contact patients were reviewed and 6000 rectal swabs were performed. Initial control measures failed to control the outbreak owing to the late detection of the index case. The late implementation of three successive cohort units, the large number of transfers between wards, and the frequent readmission of cases contributed to the incomplete success of control measures.
Collapse
Affiliation(s)
- B Semin-Pelletier
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - L Cazet
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - C Bourigault
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - M E Juvin
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - D Boutoille
- Infectious Diseases Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France
| | - F Raffi
- Infectious Diseases Department, Nantes University Hospital, Nantes, France
| | - M Hourmant
- Renal Transplant Department, Nantes University Hospital, Nantes, France
| | - G Blancho
- Renal Transplant Department, Nantes University Hospital, Nantes, France
| | - C Agard
- Internal Medicine Department, Nantes University Hospital, Nantes, France
| | - J Connault
- Renal Transplant Department, Nantes University Hospital, Nantes, France
| | - S Corvec
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France
| | - J Caillon
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France
| | - E Batard
- University of Nantes, EA 3826, UFR Medicine School, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - D Lepelletier
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France.
| |
Collapse
|
44
|
Grignon O, Montassier E, Corvec S, Lepelletier D, Hardouin JB, Caillon J, Batard E. Escherichia coli antibiotic resistance in emergency departments. Do local resistance rates matter? Eur J Clin Microbiol Infect Dis 2014; 34:571-7. [DOI: 10.1007/s10096-014-2264-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
|
45
|
Lepelletier D, Pinaud V, Bourigault C, Caillon J, Ferron C, Batard E, Potel G. COL06-02 : Rôle de l’exposition antérieure aux anti-inflammatoires (AI) dans la survenue d’abcès péri-amygdalien (APA) : étude cas-témoins prospective multicentrique. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70065-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
46
|
Montassier E, Batard E, Massart S, Gastinne T, Carton T, Caillon J, Le Fresne S, Caroff N, Hardouin JB, Moreau P, Potel G, Le Vacon F, de La Cochetière MF. 16S rRNA gene pyrosequencing reveals shift in patient faecal microbiota during high-dose chemotherapy as conditioning regimen for bone marrow transplantation. Microb Ecol 2014; 67:690-9. [PMID: 24402367 DOI: 10.1007/s00248-013-0355-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 12/16/2013] [Indexed: 05/11/2023]
Abstract
Gastrointestinal disturbances are a side-effect frequently associated with haematological malignancies due to the intensive cytotoxic treatment given in connection with bone marrow transplantation (BMT). However, intestinal microbiota changes during chemotherapy remain poorly described, probably due to the use of culture-based and low-resolution molecular methods in previous studies. The objective of our study was to apply a next generation DNA sequencing technology to analyse chemotherapy-induced changes in faecal microbiota. We included eight patients with non-Hodgkin's lymphoma undergoing one course of BMT conditioning chemotherapy. We collected a prechemotherapy faecal sample, the day before chemotherapy was initiated, and a postchemotherapy sample, collected 1 week after the initiation of chemotherapy. Total DNA was extracted from faecal samples, denaturing high-performance liquid chromatography based on amplification of the V6 to V8 region of the 16S ribosomal RNA (rRNA) gene, and 454-pyrosequencing of the 16 S rRNA gene, using PCR primers targeting the V5 and V6 hypervariable 16S rRNA gene regions were performed. Raw sequence data were screened, trimmed, and filtered using the QIIME pipeline. We observed a steep reduction in alpha diversity and significant differences in the composition of the intestinal microbiota in response to chemotherapy. Chemotherapy was associated with a drastic drop in Faecalibacterium and accompanied by an increase of Escherichia. The chemotherapy-induced shift in the intestinal microbiota could induce severe side effects in immunocompromised cancer patients. Our study is a first step in identifying patients at risk for gastrointestinal disturbances and to promote strategies to prevent this drastic shift in intestinal microbiota.
Collapse
Affiliation(s)
- Emmanuel Montassier
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, 1 Rue G Veil, 44000, Nantes, France,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Montassier E, Goffinet N, Potel G, Batard E. How to reduce antibiotic consumption for community-acquired pneumonia? Med Mal Infect 2013; 43:52-9. [PMID: 23433607 DOI: 10.1016/j.medmal.2012.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/30/2012] [Accepted: 12/07/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND The difficulty to diagnose community-acquired pneumonia (CAP) and the lack of scientific data regarding the optimal duration of antibiotic therapy are responsible for overprescribing antibiotics. OBJECTIVE The authors had for objective to perform a systematic review of the international medical literature on strategies aimed at reducing antibiotic consumption for CAP. METHODS We performed a Pubmed search using the keywords CAP, antibiotic use, duration of antibiotic therapy, procalcitonin, short-course treatment, and biomarkers. We then made a critical review of the selected articles. RESULTS Our review identified two strategies used to reduce antibiotic consumption for CAP. The first one was based on procalcitonin (PCT) use. This strategy, even though reducing the duration of antibiotic therapy, does not seem optimal since it is associated with longer antibiotic treatment than recommended by the Infectious Diseases Society of America. Moreover, this strategy is associated with an increased cost in biochemical tests. The other strategy is based on a 2-step clinical reassessment: 1) during the first 24 hours of hospitalization, to confirm the diagnosis of CAP and 2) during hospitalization, to shorten the duration of antibiotic therapy according to the patient's clinical status. CONCLUSION Clinical reassessment, currently little studied compared to PCT guidance algorithm, seems to be promising to reduce antibiotic consumption for CAP. Especially since it was never compared to PCT guidance strategy in a randomized clinical trial.
Collapse
Affiliation(s)
- E Montassier
- Service des urgences, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | | | | | | |
Collapse
|
48
|
Crémet L, Corvec S, Batard E, Auger M, Lopez I, Pagniez F, Dauvergne S, Caroff N. Comparison of three methods to study biofilm formation by clinical strains of Escherichia coli. Diagn Microbiol Infect Dis 2013; 75:252-5. [PMID: 23313082 DOI: 10.1016/j.diagmicrobio.2012.11.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/07/2012] [Accepted: 11/21/2012] [Indexed: 01/02/2023]
Abstract
Biofilm formation seems to be a key factor in many bacterial infections, particularly those involving prosthetic implants or urinary catheters, where Escherichia coli is frequently involved. We have determined the ability to form biofilm in vitro of 34 E. coli isolates by 3 different methods (crystal violet staining, BioFilm Ring Test®, and resazurin assay) and tried to correlate biofilm production with phylogenetic background and with the presence of different genes involved in biofilm synthesis. Only 3 isolates (including positive control E. coli ATCC 25922) were classified as strong biofilm producers (1B1, 1D, and 1B2 = control) by the 3 methods, 2 isolates by 2 different methods, and 5 additional isolates by only 1 method. All isolates possessed the csgA gene belonging to the csgABC operon encoding curli, and its regulator csgD. By contrast, only 76% possessed pgaA gene which is part of the pgaABCD operon encoding a polysaccharide adhesin. Interestingly, one of the strong biofilm producers did not harbor pgaA. In the second part, we have selected 5 specific isolates to study the impact of various experimental conditions on biofilm formation. For all these isolates, biofilm production was decreased in anaerobiosis and increased in LB medium compared with brain heart infusion medium, but at various degrees for the different isolates. These results underline the problems encountered in comparing the different published studies using various methods to study biofilm formation in vitro and the great need of standardization.
Collapse
Affiliation(s)
- Lise Crémet
- Service de Bactériologie-Hygiène, CHU de Nantes, 9 quai Moncousu, Nantes Cedex 1, France
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Duchêne E, Montassier E, Boutoille D, Caillon J, Potel G, Batard E. Why is antimicrobial de-escalation under-prescribed for urinary tract infections? Infection 2012; 41:211-4. [PMID: 23124907 DOI: 10.1007/s15010-012-0359-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 10/16/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the frequency of de-escalation in inpatients treated for community-acquired urinary tract infection and the frequency of conditions legitimating not de-escalating therapy. METHODS A retrospective study of inpatients (age >15 years) at a large academic hospital who were empirically treated for urinary tract infections due to Escherichia coli susceptible to at least one of the following antibacterial agents: amoxicillin, co-amoxiclav, and cotrimoxazole. De-escalation was defined as the replacement of the empirical broad-spectrum therapy by amoxicillin, co-amoxiclav, or cotrimoxazole. RESULTS Eighty patients were included. De-escalation was prescribed for 32 of 69 patients for whom it was possible from both a bacteriological and clinical point of view (46 %, 95 % CI, 34-59 %). Initial treatment was switched to amoxicillin (n = 21), co-amoxiclav (n = 2), or cotrimoxazole (n = 8). Thirteen conditions justifying not de-escalating antibacterial therapy were detected in 11 of 48 patients who were not de-escalated (23 %, 95 % CI, 12-37 %): shock, n = 5; renal abscess, n = 1; obstructive uropathy, n = 4; bacterial resistance or clinical contraindication to both cotrimoxazole and β-lactams, n = 3. CONCLUSIONS De-escalation is under-prescribed for urinary tract infections. Omission of de-escalation is seldom legitimate. Interventions aiming to de-escalate antibacterial therapy for UTIs should be actively implemented.
Collapse
Affiliation(s)
- E Duchêne
- Emergency Department, Nantes University Hospital, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | | | | | | | | | | |
Collapse
|
50
|
Montassier E, Batard E, Gueffet JP, Trewick D, Le Conte P. Outcome of Chest Pain Patients Discharged From a French Emergency Department: A 60-day Prospective Study. J Emerg Med 2012; 42:341-4. [DOI: 10.1016/j.jemermed.2010.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/27/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
|