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Roger PM, Lesselingue D, Gérard A, Roghi J, Quint P, Un S, Chincholle A, Assi A, Bouchard O, Javaudin V, Denes E. Antibiotic Consumption 2017-2022 in 30 Private Hospitals in France: Impact of Antimicrobial Stewardship Tools and COVID-19 Pandemic. Antibiotics (Basel) 2024; 13:180. [PMID: 38391566 PMCID: PMC10886305 DOI: 10.3390/antibiotics13020180] [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: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Our aim was to determine the impact of antimicrobial stewardship tools (ASTs) and the COVID-19 pandemic on antibiotic consumption (AC). We used the national software Consores® to determine AC in DDD/1000 days of hospitalization from 2017 to 2022 in voluntary private hospitals in France. The ASTs considered were: 1. internal guidelines; 2. the list of antibiotics with restricted access; 3. the presence of an antibiotic referent or 4. an ID specialist; and 5. proof of an annual meeting on antimicrobial resistance. Institutions with dedicated units for COVID-19 patients were specified. In 30 institutions, the total AC varied from (means) 390 to 405 DDD/1000 DH from 2017 to 2022. Fluoroquinolones and amoxicillin/clavulanate consumption decreased from 50 to 36 (p = 0.003) and from 112 to 77 (p = 0.025), respectively, but consumption of piperacillin/tazobactam increased from 9 to 21 (p < 0.001). Over the study period, 10 institutions with ≤2 AST had lower AC compared to 20 institutions with ≥3 AST (p < 0.01). COVID-19 units opened in 10 institutions were associated with a trend toward higher macrolide consumption from 15 to 25 from 2017 to 2020 (p = 0.065) and with an acceleration of piperacillin/tazobactam consumption from 2020 to 2022 (p ≤ 0.003). Antibiotic consumption in 30 private hospitals in France was inversely related to the number of AST. The COVID-19 pandemic was associated with limited impact on AC, but special attention should be paid to piperacillin/tazobactam consumption.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Clinique Les Fleurs, 332 ave F. Mistral, 83110 Ollioules, France
- Cellule Recherche et Enseignement, Groupe Elsan, Territoire Provence Alpes-Côte d'Azur, 83110 Ollioules, France
| | - Diane Lesselingue
- Pharmacie, Clinique Jeanne d'Arc, 7 rue N. Saboly, 13200 Arles, France
| | - Anouk Gérard
- Pharmacie, Clinique Bouchard, 77 rue Dr Escat, 13006 Marseille, France
| | - Jacques Roghi
- Pharmacie, Clinique St Michel, Pl 4 Sept av Orient, 83100 Toulon, France
| | - Pauline Quint
- Pharmacie, Clinique Inkermann, 84 Rte d'Aiffres, 79000 Niort, France
| | - Sophie Un
- Pharmacie, Hôpital Privé Océane, 11 rue Dr J. Audic, 56000 Vannes, France
| | - Agnès Chincholle
- Pharmacie, Centre Médico-Chirurgical du Mans, 28 rue Guetteloup, 72100 Le Mans, France
| | - Assi Assi
- Infectiologie, Clinique Les Fleurs, 332 ave F. Mistral, 83110 Ollioules, France
| | - Odile Bouchard
- Infectiologie, Clinique Rhône Durance, 1750 ch Lavarin, 84000 Avignon, France
| | - Véronique Javaudin
- Hygiène, Centre Chirurgical Montagard, 23 bd Gambetta, 84000 Avignon, France
| | - Eric Denes
- Infectiologie, Polyclinique de Limoges, Site Chénieux, 18 rue du Général Catroux, 87000 Limoges, France
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Roger PM, Assi F, Denes E. Prosthetic joint infections: 6 weeks of oral antibiotics results in a low failure rate. J Antimicrob Chemother 2024; 79:327-333. [PMID: 38113529 DOI: 10.1093/jac/dkad382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/21/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Need for parenteral administration and total duration of antibiotic therapy for prosthetic joint infection (PJI) are debated. We report our PJI management, in which outpatient care is privileged. METHODS This was a retrospective multicentre cohort study of PJI managed from January 2017 to Jun 2021. Microbial diagnosis was based on surgical samples. Surgical procedures and antibiotic treatments were reported. Chronic PJI was defined by a course >1 month. Oral antibiotic therapy (OAT) was defined by exclusive use of oral antibiotics or by ≤3 days of parenteral treatments. Management failure was defined by clinical and/or microbial relapse of PJI over 24 months after surgical treatment. RESULTS One hundred and seventy-two patients from 13 institutions were included: 103 were male (60%) and mean age was (±SD): 73 ± 12 years. Sites for PJI were mainly hip (50%) and knee (35%), being chronic infections in 70 cases (41%). The main bacterial genus in monomicrobial infections was Staphylococcus spp. (60%). We recorded 41 (24%) implant exchanges. An OAT was prescribed in 76 cases (44%), and the median (range) course for parenteral route was 6 days (4-180) for 96 cases. Median (range) duration of antimicrobials was 42 days (21-180). Management failure was observed in 7/76 (9.2%) cases treated with OAT and 15/96 (15.6%) treated with prolonged parenteral therapy. In multivariate analysis, risk factors for failure were a knee PJI [adjusted OR (95% CI) = 3.27 (1.27-8.40)] and a polymicrobial infection [4.09 (1.46-11.49)]. CONCLUSIONS OAT for 6 weeks for PJI was associated with a low rate of management failure.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Clinique Les Fleurs, Ave Frédéric Mistral, Ollioules, France
- Cellule Recherche et Enseignement, Groupe Elsan, Territoire Provence Alpes-Côte d'Azur, Ollioules, France
| | - Frédéric Assi
- Infectiologie, Clinique Les Fleurs, Ave Frédéric Mistral, Ollioules, France
| | - Eric Denes
- Infectiologie, Polyclinique de Limoges-Site Chénieux, 18 rue du Général Catroux, Limoges, 87000, France
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Deluzarches P, Poli E, Barrière G, Denes E. Use of a Porous Alumina Antibiotic-Loaded Ceramic to Treat Bone Defect and Bone Infection After Road Trauma. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202206000-00009. [PMID: 35727902 PMCID: PMC10566846 DOI: 10.5435/jaaosglobal-d-21-00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/07/2021] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
To describe the use of a porous alumina ceramic loaded with antibiotics for the reconstruction of bilateral tibial fractures in a patient who presented with bone loss and infection after a motorcycle road injury. A 70-year-old man presented open fractures of his both tibiae (proximal involvement on the right side and diaphyseal on the left side). After initial treatment with multiple débridements and the placement of bilateral external fixators, he had bone loss to both tibiae and had developed infections of both legs with multiple organisms identified (Stenotrophomonas maltophilia, Enterobacter cloacae, and Pseudomonas aeruginosa). We used a porous alumina ceramic, designed according to the defects to fill. This ceramic was loaded with antibiotics (gentamicin and vancomycin). The goal was to obtain locally high concentrations of antibiotics to eradicate bacteria that could have remain in the surgical wound. Ceramic parts were placed 4 months after the trauma. Local antibiotic concentrations largely exceeded the pharmacological parameters for antibiotics efficacy. External fixators were removed 3 months after implantation. After a follow-up of more than 1 year, there is no relapse of infection, and the patient resumed walking while ceramic parts were left in place and that bone started colonizing ceramic parts. This ceramic that combines strength and the possibility of antibiotic loading allows thinking of new ways to treat infected fractures with bone loss. Indeed, its mechanical strength provides primary stability, and antibiotics make it possible to secure implantation in an infected area.
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Affiliation(s)
- Philippe Deluzarches
- From the Orthopedic Department, Henri Mondor Hospital, Aurillac, France (Deluzarches); the Research & Development Department, I.Ceram, Limoges, France (Poli, and Barriere); and the Infectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France (Denes)
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Denes E, El Balkhi S, Fiorenza F. Local Argyria due to Silver-Coated Megaprosthesis. Am J Med 2022; 135:e116. [PMID: 35134368 DOI: 10.1016/j.amjmed.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Eric Denes
- Infectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France.
| | | | - Fabrice Fiorenza
- Orthopedic Surgery Department, Limoges Teaching Hospital, Limoges, France
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Sixt T, Aho S, Chavanet P, Moretto F, Denes E, Mahy S, Blot M, Catherine FX, Steinmetz E, Piroth L. Long-term prognosis following vascular graft infection: a 10-year cohort study. Open Forum Infect Dis 2022; 9:ofac054. [PMID: 35281705 PMCID: PMC8907415 DOI: 10.1093/ofid/ofac054] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/19/2021] [Accepted: 01/26/2022] [Indexed: 11/14/2022] Open
Abstract
Background Vascular graft infection (VGI) remains a severe disease with high mortality and relapse rates. We performed a retrospective single-center cohort study to highlight factors associated with long-term all-cause mortality in patients with vascular graft infection. Methods All patients hospitalized in our facility over 10 years for VGI were included. VGI was defined by the presence of a vascular graft or an aortic stent graft (stent or fabric), associated with 2 criteria among clinical, biological, imaging, or microbiological elements in favor of VGI. The primary outcome was all-cause mortality. Empirical antibiotic therapy was considered as appropriate when all involved pathogens were susceptible in vitro to the antibiotics used. The surgical strategy was defined as nonoptimal when the graft was not removed in a late-onset surgery (>3 months) or no surgery was performed. Results One hundred forty-six patients were included. Empirical antibiotic therapy was administered in 98 (67%) patients and considered appropriate in 55 (56%) patients. Surgery was performed in 136 patients (96%) and considered as optimal in 106 (73%) patients. In multivariable analysis, appropriate empirical antibiotic therapy was associated with a lower probability of mortality (hazard ratio, 0.47 [95% confidence interval, .30–.79]; P = .002). Long-term survival did not differ according to whether the surgical strategy was considered optimal or not (log-rank = 0.66). Conclusions Appropriate empirical antibiotic therapy is a cornerstone of the management of VGI. Whenever possible, antibiotics must be associated with optimal surgical management. However, surgery could potentially be avoided in comorbid patients who are treated with appropriate antibiotics.
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Affiliation(s)
- T Sixt
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - S Aho
- Hospital Epidemiology and Infection Control Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - P Chavanet
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM CIC 1432, module plurithématique, University of Burgundy, Dijon, France
| | - F Moretto
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - E Denes
- Infectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France
| | - S Mahy
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - M Blot
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM CIC 1432, module plurithématique, University of Burgundy, Dijon, France
| | - F X Catherine
- Infectious Diseases Department, Chalon sur Saône Hospital, Chalon sur Saône, France
| | - E Steinmetz
- Cardiovascular and Thoracic Surgery Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - L Piroth
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM CIC 1432, module plurithématique, University of Burgundy, Dijon, France
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Ly KH, Costedoat-Chalumeau N, Liozon E, Dumonteil S, Ducroix JP, Sailler L, Lidove O, Bienvenu B, Decaux O, Hatron PY, Smail A, Astudillo L, Morel N, Boutemy J, Perlat A, Denes E, Lambert M, Papo T, Cypierre A, Vidal E, Preux PM, Monteil J, Fauchais AL. Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study. J Clin Med 2022; 11:jcm11020386. [PMID: 35054081 PMCID: PMC8779072 DOI: 10.3390/jcm11020386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.
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Affiliation(s)
- Kim-Heang Ly
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
- Correspondence: ; Tel.: +33-55-5055-8076
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin University Hospital, Internal Medicine Department, Referral Centre for Rare Autoimmune and Systemic Diseases, 75014 Paris, France; (N.C.-C.); (N.M.)
| | - Eric Liozon
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Stéphanie Dumonteil
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Jean-Pierre Ducroix
- Department of Internal Medicine, Amiens University Hospital, 80054 Amiens, France; (J.-P.D.); (A.S.)
| | - Laurent Sailler
- Department of Internal Medicine, CHU Toulouse-Purpan, CEDEX, 31059 Toulouse, France; (L.S.); (L.A.)
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 75020 Paris, France;
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, 14033 Caen, France; (B.B.); (J.B.)
| | - Olivier Decaux
- Department of Internal Medicine CHU de Rennes, 35000 Rennes, France; (O.D.); (A.P.)
| | - Pierre-Yves Hatron
- Department of Internal Medicine, CHU Claude Huriez, 59000 Lille, France; (P.-Y.H.); (M.L.)
| | - Amar Smail
- Department of Internal Medicine, Amiens University Hospital, 80054 Amiens, France; (J.-P.D.); (A.S.)
| | - Léonardo Astudillo
- Department of Internal Medicine, CHU Toulouse-Purpan, CEDEX, 31059 Toulouse, France; (L.S.); (L.A.)
| | - Nathalie Morel
- AP-HP, Cochin University Hospital, Internal Medicine Department, Referral Centre for Rare Autoimmune and Systemic Diseases, 75014 Paris, France; (N.C.-C.); (N.M.)
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, 14033 Caen, France; (B.B.); (J.B.)
| | - Antoinette Perlat
- Department of Internal Medicine CHU de Rennes, 35000 Rennes, France; (O.D.); (A.P.)
| | - Eric Denes
- Department of Infectious Diseases, CHU Limoges, CEDEX, 87042 Limoges, France; (E.D.); (A.C.)
| | - Marc Lambert
- Department of Internal Medicine, CHU Claude Huriez, 59000 Lille, France; (P.-Y.H.); (M.L.)
| | - Thomas Papo
- Department of Internal Medicine, Paris Diderot University, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 75018 Paris, France;
| | - Anne Cypierre
- Department of Infectious Diseases, CHU Limoges, CEDEX, 87042 Limoges, France; (E.D.); (A.C.)
| | - Elisabeth Vidal
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Pierre-Marie Preux
- Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges University Hospital, CEDEX, 87042 Limoges, France;
| | - Jacques Monteil
- Department of Nuclear Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France;
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
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Denes E, Alain J, Lenoir I. Finger osteitis due to Yokenella regensburgei in an immunocompetent patient. Infect Dis Now 2021; 52:177-178. [PMID: 34838773 DOI: 10.1016/j.idnow.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Eric Denes
- Infectious diseases department, ELSAN Polyclinique de Limoges, Limoges, France.
| | - Jérome Alain
- Orthopedic surgery department, ELSAN Polyclinique de Limoges, Limoges, France
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Denes E, Lanoé M, Salomé F. Acute Renal Failure in Patients with Indwelling Double-J Stents: It Is Not Always a Device Dysfunction, Think Fungus Balls. Surg Infect (Larchmt) 2021; 22:1099. [PMID: 34242529 DOI: 10.1089/sur.2021.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eric Denes
- Infectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France
| | - Matthieu Lanoé
- Urology Surgery Department, ELSAN Polyclinique de Limoges, Limoges, France
| | - Franck Salomé
- Urology Surgery Department, ELSAN Polyclinique de Limoges, Limoges, France
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Abstract
BACKGROUND Bacterial prostatitis can be difficult to treat as more and more bacteria are resistant to fluoroquinolone and/or Sulfamethoxazole-Trimethoprim which are the antibiotics of choice. Fosfomycin-Trometamol which is registered for uncomplicated urinary tract infections can be an option when other treatments can't be used. OBJECTIVE To describe a case of prostatitis cured using a prolonged course of Fosfomycin-Trometamol. Patient: A 67 years-old man with a chronic bacterial prostatitis, with recurrences for more than 3 years, due to E. coli was treated with Fosfomycin-Trometamol 3g once a day for a week followed by 3 months of the same dose every two days. Prostatitis was clinically and bacteriologically cured and no relapse occurred after 6 months of follow-up. CONCLUSION Fosfomycin-Trometamol can be a good option for the treatment of bacterial prostatitis when other antibiotics can't be used either for resistance or allergy.
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Affiliation(s)
- Eric Denes
- Infectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France
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Denes E, Fiorenza F, Armendariz M, Martin C. Case Report: CD8+ T-Lymphocyte Deficit: A Prerequisite for Pasteurella spp. Infection? Front Med (Lausanne) 2021; 8:668976. [PMID: 33987195 PMCID: PMC8110698 DOI: 10.3389/fmed.2021.668976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Immunity against Pasteurella spp. is not well-known for humans. Methods: We've tested T CD8+ lymphocytes in a patient with a chronic prosthetic joint infection due to Pasteurella spp. to search for a deficit which could have favored her infection. As this deficit was found, we've searched for such a deficit in other patients with Pasteurella spp. Infections, either acute or subacute. Results: Eight patients were tested and all had a persistent T CD8+ lymphocytes deficit. This is striking as these cells are involved in the response to this type of infection in animal models. Conclusion: The authors suggest that a deficit in CD8+ T lymphocytes can be one of the causes for the onset of infections with P. multocida.
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Affiliation(s)
- Eric Denes
- Infectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France
| | - Fabrice Fiorenza
- Orthopaedic Surgery Department, Limoges Teaching Hospital, Limoges, France
| | - Mateo Armendariz
- Orthopaedic Surgery Department, Limoges Teaching Hospital, Limoges, France
| | - Christian Martin
- Bacteriology Laboratory, Limoges Teaching Hospital, Limoges, France
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Denes E. Temporal and spatial concomitance of exanthema and dysesthesia in a patient with SARS-cov-2 infection. Brain Behav Immun Health 2020; 9:100165. [PMID: 33111131 PMCID: PMC7582041 DOI: 10.1016/j.bbih.2020.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/11/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Eric Denes
- Infectious Diseases Department, ELSAN Polyclinique de Limoges, 18 Rue Du Général Catroux, 87000, Limoges, France
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Denes E, Tricard J, Chermat A, El Balkhi S, Bertin F. Utilisation d’une céramique chargée en antibiotique pour le traitement des destructions sternales post-médiastinites et outrepasser les résistances bactériennes. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.218] [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: 10/23/2022]
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Tricard J, Chermat A, Denes E, Bertin F. Antibiotic-loaded ceramic sternum for sternal replacement in a patient with deep sternal wound infection. Interact Cardiovasc Thorac Surg 2020; 29:973-975. [PMID: 31365090 DOI: 10.1093/icvts/ivz182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/12/2022] Open
Abstract
A 68-year-old man presented with destruction of his sternum after cardiac surgery. Classical management with multiple debridements, vacuum dressings and antibiotics failed. A replacement of his sternum was performed using an antibiotic-loaded porous alumina ceramic sternum. Despite the infected wound, the ceramic sternum did not get infected due to the high antibiotic concentration obtained locally. Two years after the surgery, no relapse occurred and the pulmonary function tests improved.
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Affiliation(s)
- Jeremy Tricard
- Thoracic and Cardiovascular Surgery Department, Limoges teaching Hospital, Limoges, France
| | - Anaëlle Chermat
- Thoracic and Cardiovascular Surgery Department, Limoges teaching Hospital, Limoges, France
| | - Eric Denes
- R&D Department, I.Ceram, Limoges, France.,Infectious Diseases Department, Clinic Chénieux, Limoges, France
| | - François Bertin
- Thoracic and Cardiovascular Surgery Department, Limoges teaching Hospital, Limoges, France
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Denes E, Bertin F, Barraud O, El Balkhi S. Mediastinitis due to highly resistant bacteria treated with the help of locally delivered antibiotics to optimize local antibiotic concentrations. Clin Microbiol Infect 2020; 26:1099-1100. [PMID: 32120040 DOI: 10.1016/j.cmi.2020.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
- E Denes
- R&D Department, I.Ceram, Limoges, France; Infectious Diseases Department, Limoges Polyclinique, France.
| | - F Bertin
- Thoracic Surgery Department, CHU Limoges, Limoges, France
| | - O Barraud
- Bacteriology-Virology-Hygiene Department, CHU Limoges, Limoges, France
| | - S El Balkhi
- Pharmacology-Toxicology and Pharmacovigilance Department, CHU Limoges, Limoges, France
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Abstract
Background After its destruction during refractory deep sternal wound infection (DSWI), current sternum reconstructions mainly rely on muscle flaps technique, but such technique have pitfalls and limits. To tackle the limited possibilities to use device implantation because of the risk of infection, we developed a self-protected device allowing its implantation in an infected area. Methods We used gentamicin alone or in combination with vancomycin loaded in a porous ceramic sternum to replace sternums destroyed during DSWI. The aim was to mechanically replace the sternum and to secure the implantation by killing the remaining bacteria in the wound thanks to the loaded antibiotic. Results This device was implanted in four infected patients during DWSI with sternal dehiscence. No complication occurred during surgeries, and wound healing was obtained quickly. Local antibiotic concentrations largely exceeded the ones needed for their efficacy while no antibiotic was found in the blood. All patients are well-being. However previously unknown gentamicin resistant bacteria, present in the surgical wound at the time of positioning, required sternal implant removal for one patient after 19 months. For all patients, pulmonary function tests (PFT) improved after implantation. Conclusions The ceramic sternum played its role consolidating the thoracic cage without stiffening. The antibiotic loaded in the sternum allowed a secure implantation, killing bacteria before the colonization of the implant even in this infected area. These four implantations are promising for patients with sternal destruction after DSWI.
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Affiliation(s)
- Jeremy Tricard
- Thoracic and Cardiovascular Surgery Department, Limoges Teaching Hospital, Limoges, France
| | - Anaëlle Chermat
- Thoracic and Cardiovascular Surgery Department, Limoges Teaching Hospital, Limoges, France
| | | | - Eric Denes
- R&D Department, I.Ceram, Limoges, France.,Infectious Diseases Department, Polyclinique de Limoges, Limoges, France
| | - François Bertin
- Thoracic and Cardiovascular Surgery Department, Limoges Teaching Hospital, Limoges, France
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Abstract
Alumina (Al2O3) ceramic is widely used for medical devices and its biocompatibility is well known and is reported in articles and textbooks. However, finding proof of this assertion gathered over more than 40 years can be challenging. We performed a literature review about alumina biocompatibility to compile data from the literature. We searched for articles on the biocompatibility of alumina in relation to the ISO 10993-1 International Standard, which defines the biocompatibility of biomaterials. For every biological effect listed in the norm, such as cytotoxicity, sensitization, implantation, and genotoxicity, in vitro and in vivo tests in animals and humans did not reveal any abnormal biological response. Proof for the the well-known biocompatibility of alumina is summarized in this review.
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Sunder S, Grammatico-Guillon L, Lemaignen A, Lacasse M, Gaborit C, Boutoille D, Tattevin P, Denes E, Guimard T, Dupont M, Fauchier L, Bernard L. Incidence, characteristics, and mortality of infective endocarditis in France in 2011. PLoS One 2019; 14:e0223857. [PMID: 31652280 PMCID: PMC6814232 DOI: 10.1371/journal.pone.0223857] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives We assessed the determinants of mortality in infective endocarditis (IE), using the national hospital discharge databases (HDD) in 2011. Methods IE stays were extracted from the national HDD, with a definition based on IE-related diagnosis codes. This definition has been assessed according to Duke criteria by checking a sample of medical charts of IE giving a predictive positive value of 86.1% (95% confidence interval (CI): 82.7% - 89.5%). The impact of heart valve surgery on survival has been studied if performed during the initial stay, and over the year of follow-up. Risk factors of in-hospital mortality were identified using logistic regression model for the initial stay and Cox Time-dependent model for the 1-year mortality. Results The analysis included 6,235 patients. The annual incidence of definite IEs was 63 cases/million residents. Staphylococci and Streptococci were the most common bacteria (44% and 45%, respectively). A valvular surgery was performed in 20% of cases, but substantial variations existed between hospitals. The in-hospital mortality was 21% (ranging 12% to 27% according to the region of patients), associated with age>70, chronic liver disease, renal failure, S. aureus, P. aeruginosa or candida infection and strokes whereas valvular surgery, a native valve IE or intraveinous drug use (right heart IE) were significantly protective for an initial death. The same factors were associated with the one-year mortality, except for valvular surgery which was associated with a 1.4-fold higher risk of death during the year post IE. Conclusion We reported a high IE incidence rate. Valvular surgery was considerably less frequent in this study than in the previous published data (near 50%) whereas mortality was similar. Surgery was associated with higher survival if undergone within the initial stay. There were significant regional differences in frequency of surgery but it did not impact mortality.
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Affiliation(s)
- S. Sunder
- CH de Niort, Service des Maladies Infectieuses et Tropicale, Niort, France
| | - L. Grammatico-Guillon
- CHRU de Tours, Unité d’Épidémiologie des données cliniques, EpiDcliC, Tours, France
- Unité Inserm 1259, Université de tours, Tours, France
- * E-mail:
| | - A. Lemaignen
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - M. Lacasse
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - C. Gaborit
- Unité Inserm 1259, Université de tours, Tours, France
| | - D. Boutoille
- CHU de Nantes, Service des Maladies Infectieuses et Tropicales, Nantes, France
| | - P. Tattevin
- CHU de Rennes, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - E. Denes
- CHU de Limoges, Service des Maladies Infectieuses et Tropicales, Limoges, France
| | - T. Guimard
- CH de La Roche sur Yon, Service des Maladies Infectieuses, La Roche sur Yon, France
| | - M. Dupont
- CH de Saint Malo, Service des Maladies Respiratoires et Infectieuses, Saint Malo, France
| | - L. Fauchier
- Equipe d’accueil EA 1275, Université de Tours, Tours, France
- CHRU de Tours, Service de cardiologie, Tours, France
| | - L. Bernard
- CHRU de Tours, Unité d’Épidémiologie des données cliniques, EpiDcliC, Tours, France
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
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Poli E, Ouk TS, Barrière G, Lévèque G, Sol V, Denes E. Does low hydroxyl group surface density explain less bacterial adhesion on porous alumina? Orthop Traumatol Surg Res 2019; 105:473-477. [PMID: 30612953 DOI: 10.1016/j.otsr.2018.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bacterial adhesion depends on surface materials. Recently it was suggested that ceramic-on-ceramic bearings could be less prone to infection than other bearings. We examined the possibility that porous alumina ceramic could be less susceptible to bacterial adhesion. HYPOTHESIS As hydroxyl groups (OH) on material surface are a major factor governing the surface properties (for example: adsorption, first non-specific step of bacterial adhesion), we hypothesized that alumina had lower OH group density than other material. Thus, we asked (i) if bacterial adhesion was lower on alumina than on titanium alloy, stainless steel and polyethylene and (ii) if OH group density was also lower on alumina. MATERIAL AND METHODS We performed (i) in vitro bacterial cultures on porous alumina, titanium, stainless steel and polyethylene using Staphylococcus aureus and Pseudomonas aeruginosa, known to adhere to surfaces. Bacterial cultures were done 3 times in duplicate for each material and each strain. Colony Forming Units (CFU) per cm2 were measured; (ii) Neutral red reagent helped obtaining OH density estimates using spacer arms. UV-visible spectrophotometry method with Neutral red test, reproduced twice for each surface, provided μg/cm2 measurements of OH density. RESULTS There was significantly less P. aeruginosa adherent on porous alumina (2.25×104 CFU/cm2) than on titanium (4.27×105 CFU/cm2, p=0.01), on stainless steel (2.44×105 CFU/cm2, p=0.02) and on polyethylene (7.29×105 CFU/cm2, p<0.001). S. aureus was significantly less adherent on porous alumina (3.22×105 CFU/cm2) than on polyethylene (5.23×106 CFU/cm2, p=0.01), but there was no difference with titanium (1.64×106 CFU/cm2, p=0.08) and stainless steel (1.79×106 CFU/cm2, p=0.1). There was significantly lower Neutral red grafted on porous alumina (0.09μg/cm2) than on titanium (8.88μg/cm2, p<0.0001), on stainless steel (39.8μg/cm2, p=0.002) and on polyethylene (4.5μg/cm2, p<0.01). However, no correlation was found between bacterial adherence and OH group density. DISCUSSION Bacterial adherence on porous alumina was lower than on other bearings. Although there were less surface OH groups on porous alumina, we failed establishing a statistical correlation between bacterial adherence and OH group density. LEVEL OF EVIDENCE IV, in vitro study.
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Affiliation(s)
- Evelyne Poli
- R&D Department, I.Ceram, 1 rue Columbia, 87068 Limoges, France
| | - Tan-Sothea Ouk
- Laboratoire PEIRENE, EA 7500, Limoges University, 87000 Limoges, France
| | | | | | - Vincent Sol
- Laboratoire PEIRENE, EA 7500, Limoges University, 87000 Limoges, France
| | - Eric Denes
- R&D Department, I.Ceram, 1 rue Columbia, 87068 Limoges, France.
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Bertin F, Deluche E, Tricard J, Piccardo A, Denes E. First case of sternum replacement with a bioceramic prosthesis after radio-induced sarcoma. ACTA ACUST UNITED AC 2018; 25:e351-e353. [PMID: 30111981 DOI: 10.3747/co.25.4020] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To date, no "gold standard" technique has been developed for sternum replacement in cases of radioinduced sarcoma, which is a rare and aggressive disease. Current techniques rely on metallic prostheses, meshes, or bone grafts-procedures that that are associated with several complications. We therefore tried a new solution that might simplify and optimize this surgery. Methods We used a porous alumina ceramic prosthesis (Ceramil: i.ceram, Limoges, France) that has several interesting characteristics, such as osseointegration, biocompatibility, radiolucency, and high mechanical strength. Results We report the first case of sternal replacement surgery involving the implantation of a ceramic prosthesis after radio-induced sternal sarcoma. In 2005, a 54-year-old woman was diagnosed with local breast cancer for which she underwent all appropriate treatment. Ten years later, she developed radio-induced sarcoma of the sternum. A complete sternal replacement was performed on 24 April 2015, with no postoperative complications. Imaging by 18F-flurodeoxyglucose positron-emission tomography-computed tomography performed 26 months after the surgery showed no local recurrence. The patient seems to have fully recovered and has resumed normal activity. Conclusions This new technique is promising. For the first time, we highlight the feasibility, safety, and efficacy of sternal replacement using a porous alumina ceramic prosthesis.
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Affiliation(s)
- F Bertin
- Department of Cardiothoracic Surgery, University Hospital
| | - E Deluche
- Department of Medical Oncology, University Hospital, and
| | - J Tricard
- Department of Cardiothoracic Surgery, University Hospital
| | - A Piccardo
- Department of Cardiothoracic Surgery, University Hospital
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Denes E, Fiorenza F, Bertin F, El Balkhi S. Administration locale osseuse d’antibiotique via une céramique d’alumine poreuse. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.225] [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: 11/29/2022]
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Matt M, Denes E, Weinbreck P. Infectious sacroiliitis: Retrospective analysis of 18 case patients. Med Mal Infect 2018; 48:383-388. [PMID: 29692328 DOI: 10.1016/j.medmal.2018.02.001] [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: 09/25/2016] [Revised: 01/30/2017] [Accepted: 02/05/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few infectious sacroiliitis reports are available in the literature. There is no standard clinical presentation, and diagnosis and treatments are therefore usually delayed. We aimed to describe this infection. METHODS We performed a single-center retrospective study of patients hospitalized in the infectious diseases unit of the Limoges University Hospital from January 1, 2006 to January 31, 2016. We included all patients presenting with infectious monoarthritis of native sacroiliac joint. Clinical, biological, bacteriological, radiological, and therapeutic characteristics were collected. RESULTS A total of 18 patients were enrolled. The sex ratio was 1.25. Mean age was 39.6years (17-69years). The average progression time at diagnosis was 17.9days (1-110days). The mean hospital stay was 16.2days (3-35days). Temperature at admission was 38.8°C (37-40°C). Identified bacteria were methicillin-susceptible Staphylococcus aureus in 83.3% of cases (n=15), Proteus mirabilis (n=1), and Streptococcus dysgalactiae (n=1). Thirty-two (88.9%) of the 36 imaging examinations were consistent with the diagnosis. The survival rate was 100% at the end of the six-month follow-up. CONCLUSION Infectious sacroiliitis is a complex pathology requiring precise clinical examination for a rapid diagnosis. The outcome is usually favorable.
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Affiliation(s)
- M Matt
- Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Marti-Luther-King, 87042 Limoges cedex, France.
| | - E Denes
- Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Marti-Luther-King, 87042 Limoges cedex, France
| | - P Weinbreck
- Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Marti-Luther-King, 87042 Limoges cedex, France
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Abstract
CONTEXT: To date, there is no gold standard technique for sternum replacement. Current techniques rely on metallic prosthesis, meshes and bars, or bone grafts. However, they have several pitfalls. AIMS: The aim of this article is to report the results of sternal replacement with a porous alumina ceramic sternum. SETTINGS AND DESIGN: Surgeries were performed in two teaching hospitals in France. METHODS: We designed a porous alumina ceramic prosthesis which possesses interesting characteristics for this surgery such as great biocompatibility, a certain level of bacterial resistance, radiolucency, and compatibility with radiotherapy. The implant is stitched to the ribs with suture thread and does not require osteosynthesis material. RESULTS: Six patients with a mean age of 60.6 years received this prosthesis. Indication was tumor in five cases and mediastinitis in one case. The mean follow-up is 20 months (3–37 months). No major complication occurred and healing was fine for all patients. Patients did not complain of breathing discomfort or pain related to the prosthesis. CONCLUSIONS: This new technique is promising even if there are only six patients in this study.
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Affiliation(s)
- François Bertin
- Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France
| | - Alessandro Piccardo
- Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France
| | - Eric Denes
- Department of R and D, I.Ceram, Limoges, France
| | - Gonzagues Delepine
- Department of Cardiothoracic Surgery, Reims Teaching Hospital, Reims, France
| | - Jeremy Tricard
- Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France
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Bertin F, Tricard J, Eveno C, Denes E, Piccardo A. P-159POROUS ALUMINA CERAMIC STERNUM AS AN OPTION FOR STERNAL REPLACEMENT: A REPORT OF 7 CASES. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.159] [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: 11/15/2022] Open
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Sunder S, Lemaignen A, Gaborit C, Boutoille D, Tattevin P, Denes E, Guimard T, Dupont M, Grammatico-Guillon L, Bernard L. Épidémiologie et déterminants de la prise en charge des endocardites infectieuses en France en 2011. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.158] [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: 11/16/2022]
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Lemaignen A, Ghout I, Dinh A, Gras G, Fantin B, Zarrouk V, Carlier R, Loret JE, Denes E, Greder A, Lescure FX, Boutoille D, Tattevin P, Issartel B, Cottier JP, Bernard L. Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis: A case-control study. Medicine (Baltimore) 2017; 96:e6387. [PMID: 28538361 PMCID: PMC5457841 DOI: 10.1097/md.0000000000006387] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Severe neurological deficit (SND) is a rare but major complication of pyogenic vertebral osteomyelitis (PVO). We aimed to determine the risk factors and the variables associated with clinical improvement for SND during PVO.This case-control study included patients without PVO-associated SND enrolled in a prospective randomized antibiotic duration study, and patients with PVO-associated SND managed in 8 French referral centers. Risk factors for SND were determined by logistic regression.Ninety-seven patients with PVO-associated SND cases, and 297 controls were included. Risk factors for SND were epidural abscess [adjusted odds ratio, aOR 8.9 (3.8-21)], cervical [aOR 8.2 (2.8-24)], and/or thoracic involvement [aOR 14.8 (5.6-39)], Staphylococcus aureus PVO [aOR 2.5 (1.1-5.3)], and C-reactive protein (CRP) >150 mg/L [aOR 4.1 (1.9-9)]. Among the 81 patients with PVO-associated SND who were evaluated at 3 months, 62% had a favorable outcome, defined as a modified Rankin score ≤ 3. No factor was found significantly associated with good outcome, whereas high Charlson index [adjusted Hazard Ratio (aHR) 0.3 (0.1-0.9)], low American Spinal Injury Association (ASIA) impairment scale at diagnosis [aHR 0.4 (0.2-0.9)], and thoracic spinal cord compression [aHR 0.2 (0.08-0.5)] were associated with poor outcome. Duration of antibiotic treatment was not associated with functional outcome.SND is more common in cervical, thoracic, and S. aureus PVO, in the presence of epidural abscess, and when CRP >150 mg/L. Although neurological deterioration occurs in 30% of patients in early follow-up, the functional outcome is quite favorable in most cases after 3 months. The precise impact of optimal surgery and/or corticosteroids therapy must be specified by further studies.
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Affiliation(s)
- Adrien Lemaignen
- Department of Infectious Diseases, University Hospital of Tours, Francois Rabelais University, Tours
| | - Idir Ghout
- Clinical Research Unit, University Hospital A. Paré, APHP, Boulogne
| | - Aurélien Dinh
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches
| | - Guillaume Gras
- Department of Infectious Diseases, University Hospital of Tours, Francois Rabelais University, Tours
| | - Bruno Fantin
- Department of Internal Medicine, University Hospital Beaujon, APHP, Clichy
| | - Virginie Zarrouk
- Department of Internal Medicine, University Hospital Beaujon, APHP, Clichy
| | - Robert Carlier
- Radiology Department, Neuro-musculoskeletal Pole, University Hospital R Poincaré, APHP, Versailles University, Paris-Saclay UMR 1179, Garches
| | | | - Eric Denes
- Department of Infectious Diseases, University Hospital of Limoges, Limoges
| | - Alix Greder
- Department of Infectious Diseases, Mignot Hospital, Versailles
| | | | - David Boutoille
- Department of Infectious Diseases, Hotel-Dieu University Hospital, Nantes
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes
| | | | - Jean-Philippe Cottier
- Department of Neuroradiology, University Hospital of Tours, Francois Rabelais University, Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, University Hospital of Tours, Francois Rabelais University, Tours
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Denes E, Barrière G, Poli E, Lévêque G. Commentary: Bioceramics and Scaffolds: A Winning Combination for Tissue Engineering. Front Bioeng Biotechnol 2017; 5:15. [PMID: 28337435 PMCID: PMC5340796 DOI: 10.3389/fbioe.2017.00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
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Le Coustumier EM, Denes E, Martin C, Weinbreck P. [Nocardiosis: A retrospective case series of 19 patients]. Rev Med Interne 2016; 38:81-89. [PMID: 27659745 DOI: 10.1016/j.revmed.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/20/2016] [Revised: 07/16/2016] [Accepted: 08/16/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. METHODS A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. RESULTS Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. CONCLUSION Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
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Affiliation(s)
- E M Le Coustumier
- Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Service de médecine interne A et polyclinique, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - E Denes
- Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - C Martin
- Laboratoire de bactériologie-virologie-hygiène, centre de biologie et recherche en santé, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - P Weinbreck
- Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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Denes E, Ducroix-Roubertou S, Matt M, Cypierre A, Genet-Villéger C, Pinet P, Durox H, Weinbreck P. IOA-02 - Sacro-iléite infectieuses. à propos de 18 cas. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30411-5] [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: 11/26/2022]
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Denes E, Barraud O. Fusobacterium nucleatum infections: clinical spectrum and bacteriological features of 78 cases. Infection 2016; 44:475-81. [PMID: 26783023 DOI: 10.1007/s15010-015-0871-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/31/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Few series describe the clinical spectrum of Fusobacterium spp. infections. Among them, fewer discuss F. nucleatum, even though there are many clinical cases. METHODS We performed a retrospective study over 8 years (from 2007 to 2014) in Limoges University Hospital, France, to assess clinical and bacteriological aspects of infections due to F. nucleatum. RESULTS Eighty-one patients with F. nucleatum positive cultures were included in this study, irrespective of sample origin. Abscesses (n = 43), bacteraemia (n = 18) and bone infections (n = 8) were the most common types of infections, Abscesses were found in various organs (mostly skin, brain, pleura, liver). Co-morbidities were found in 38 patients (47 %) with neoplasia, diabetes, and alcoholism and history of smoking. There were more neoplasms in patients with bacteraemia than in patients with abscesses (p = 0.007). In 51 cases (65.4 %), infection was polymicrobial, either during bacteraemia or abscesses. Main associations were with Streptococcus spp., Peptostreptococcus spp. and/or Prevotella spp. The sources of infection, when found, were either dental or gastrointestinal. All isolates were susceptible to penicillin, clindamycin and metronidazole. CONCLUSIONS Infections involving F. nucleatum are uncommon and potentially severe, with many abscesses requiring surgery. Bacteraemia was mainly associated with co-morbidities such as cancer. Polymicrobial infections were very common and there is probably interaction and/or synergy between F. nucleatum and some other commensal bacteria to cause infections and abscesses.
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Affiliation(s)
- E Denes
- Infectious Diseases Department, CHU Limoges, 87000, Limoges, France.
| | - O Barraud
- University of Limoges, UMR_S 1092, 87000, Limoges, France
- INSERM, U1092, 87000, Limoges, France
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Limoges, 87000, Limoges, France
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Gagnard JC, Hidri N, Grillon A, Jesel L, Denes E. Moraxella osloensis, an emerging pathogen of endocarditis in immunocompromised patients? Swiss Med Wkly 2015; 145:w14185. [PMID: 26376092 DOI: 10.4414/smw.2015.14185] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report two cases of endocarditis due to Moraxella osloensis. Only one previous case of such infection has been described. These infections occurred in immunocompromised patients (B-cell chronic lymphocytic leukaemia and kidney graft associated with Hodgkin's disease) and both patients had a favourable outcome with a complete cure of their infectious endocarditis. This bacterium could be an emerging pathogen revealed by MALDI-TOF. Indeed, its characterisation within the Moraxella group by use of biochemistry-based methods is difficult. Moreover, this strain could be particularly involved in immunocompromised patients.
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Affiliation(s)
| | - Nadia Hidri
- Bacteriology Laboratory, Limoges Teaching Hospital, France
| | - Antoine Grillon
- Bacteriology Laboratory, Strasbourg Teaching Hospital, France
| | - Laurence Jesel
- Cardiology Department, Strasbourg Teaching Hospital, France
| | - Eric Denes
- CHU Dupuytren, 2 Ave Martin Luther King, LIMOGES, FRANCE
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Nicolas A, Babakhanyan A, Denes E, Leone N, Vazeille F, Dallocchio A. P-517 – Antibiothérapie pédiatrique inadaptée en pratique courante. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30692-8] [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: 10/23/2022]
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32
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Bousquet P, Mons F, Bedu A, Domelier M, Grine J, Ponthier L, Mallet E, Guigonis V, Garnier F, Denes E. P-535 – Intérêt du contrôle des hémocultures dans les bactériémies à staphylocoque coagulase négative (SCN). Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30710-7] [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: 10/23/2022]
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33
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Denes E, Camilleri Y, Fiorenza F, Martin C. First case of osteomyelitis due to Erysipelothrix rhusiopathiae: pubic osteomyelitis in a gored farmer. Int J Infect Dis 2014; 30:133-4. [PMID: 25462176 DOI: 10.1016/j.ijid.2014.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 10/26/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022] Open
Abstract
We report the first proven case of osteomyelitis due to Erysipelothrix rhusiopathiae. This infection occurred almost 20 years after traumatic inoculation of the bacterium, when the patient was gored by one of his cows. Diagnosis was made by bone biopsies, and treatment included rifampicin and levofloxacin for 3 months.
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Affiliation(s)
- E Denes
- Infectious Diseases Department, Limoges Teaching Hospital, France.
| | - Y Camilleri
- Radiology Department, Limoges Teaching Hospital, France
| | - F Fiorenza
- Orthopaedics Surgery Department, Limoges Teaching Hospital, France
| | - C Martin
- Bacteriology Laboratory, Limoges Teaching Hospital, France
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34
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Denes E, Pinet P, Cypierre A, Durox H, Ducroix-Roubertou S, Genet C, Weinbreck P. Spectrum of advice and curbside consultations of infectious diseases specialists. Med Mal Infect 2014; 44:374-9. [PMID: 25149269 DOI: 10.1016/j.medmal.2014.07.012] [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: 02/24/2014] [Revised: 05/30/2014] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Curbside consultation (CC) of infectious diseases specialists for advice is very frequent but the corresponding workload has rarely been assessed. This activity is mostly oral (phone or direct contact) and poorly quantifiable because it is not charged. We had for aim to evaluate this activity in a French teaching hospital. METHODS We recorded all CCs given during a 2.5-year period, from mid-2011 to the end of 2013. RESULTS During the study period, 6789 CCs were recorded (2715 per year), or slightly more than 10 per day. These CCs were divided in 676 travel recommendations and 6113 for other reasons. They were mostly given by phone (77.4%). Most demands came from our hospital (61.4%), followed by community family physicians and specialist (27.1%), other local hospitals (6.5%) and clinics (4.3%). All the departments in our hospital consulted us for advice at least once and answers were mainly given by phone (70.1%) and at bedside (30.5%). The answers were principally advice (50.8%), modification of antibiotic prescription (22.9%), initiation of antibiotic course (14.8%), maintaining the same treatment (6.2%), and stopping antibiotics (4.3%). CCs accounted for 20% of clinical work for 1 physician. If the CCs in our hospital had been paid, our department would have received an additional 77,000€ in revenue. CONCLUSION This curbside activity is very important and time-consuming for infectious diseases specialists, but it is currently not acknowledged or rewarded.
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Affiliation(s)
- E Denes
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - P Pinet
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - A Cypierre
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - H Durox
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - S Ducroix-Roubertou
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - C Genet
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P Weinbreck
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Gagnard JC, Denes E, Pinet P, Ducroix-Roubertou S, Genet-Villéger C, Weinbreck P, Rogez S. A-28: Le raltégravir, en permettant l’accumulation d’ADN viral, est-il en cause dans les charges virales faiblement positives ? Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70111-8] [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: 10/25/2022]
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36
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Denes E, Le Berre R, Le Guyader A, Badra A, Fangous MS, De Moreuil C, Weinbreck P. S-01: Antibiothérapie suppressive et infections intravasculaires. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70326-9] [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: 11/28/2022]
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37
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Genet-Villéger C, Denes E, Ducroix-Roubertou S, Pinet P, Pascual J, Durox H, Weinbreck P. A-17: Les patients séropositifs pour le VIH connaissent-ils leur maladie ? Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70100-3] [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: 11/28/2022]
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38
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Ly K, Liozon E, Denes E, Gondran G, Palat S, Bézanahary H, Nadalon S, Thouy F, Martel C, Vidal-Cathala E, Fauchais AL. Caractéristiques et pronostic à moyen terme des fièvres épisodiques : étude sur une cohorte de 135 patients. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.095] [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: 10/25/2022]
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39
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Denes E, Pinet P, Cypierre A, Durox H, Ducroix-Roubertou S, Genet C, Weinbreck P. COL04-02: Périmètre de la transversalité : à propos de 6 789 avis donnés en CHU. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70055-1] [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: 10/25/2022]
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40
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Cypierre A, Denes E, Barraud O, Jamilloux Y, Jacques J, Durox H, Pinet P, Weinbreck P. Campylobacter fetus infections. Med Mal Infect 2014; 44:167-73. [DOI: 10.1016/j.medmal.2014.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/26/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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41
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Ricard E, Martin C, Bertin P, Denes E. [Kingella Kingae sternoclavicular septic arthritis in an adult]. Med Mal Infect 2014; 44:79-81. [PMID: 24556455 DOI: 10.1016/j.medmal.2013.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/02/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Affiliation(s)
- E Ricard
- Service de rhumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - C Martin
- Service de bactériologie-virologie-hygiène, CHU Dupuytren, 87042 Limoges, France
| | - P Bertin
- Service de rhumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - E Denes
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 87042 Limoges, France
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43
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Cypierre A, Denes E, Sotarith B, Pinet P, Durox H, Genet C, Ducroix-Roubertoux S, Weinbreck P. Une paralysie du membre inférieur gauche non neurologique. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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44
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Boussier R, Rogez S, François B, Denes E, Ploy MC, Garnier F. Two-step bacterial broad-range polymerase chain reaction analysis of heart valve tissue improves bacteriological diagnosis of infective endocarditis. Diagn Microbiol Infect Dis 2013; 75:240-4. [DOI: 10.1016/j.diagmicrobio.2012.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/18/2012] [Accepted: 11/26/2012] [Indexed: 01/16/2023]
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Denes E, Fiorenza F, Saint-Marcoux F, Megherbi M, Dupon M, Weinbreck P. Voriconazole stability in cement spacers. Med Mal Infect 2012; 42:567-8. [PMID: 23044087 DOI: 10.1016/j.medmal.2012.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/31/2012] [Accepted: 07/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
- E Denes
- Department of Infectious Diseases, University Hospital of Limoges, CHU Dupuytren, 2 avenue Martin-Luther-King, 87000 Limoges, France.
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Denes E, Prouzergue J, Ducroix-Roubertou S, Aupetit C, Weinbreck P. Antibiotic prescription by general practitioners for urinary tract infections in outpatients. Eur J Clin Microbiol Infect Dis 2012; 31:3079-83. [PMID: 22722765 DOI: 10.1007/s10096-012-1668-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022]
Abstract
In July 2008, in France, guidelines for antibiotic prescriptions for urinary tract infections (UTIs) were amended. As general practitioners (GPs) treat numerous UTIs, we wanted to evaluate whether they followed these guidelines. In order to do this, we performed a prospective study. The point of call was urinalyses. Using this selection method together with criteria diagnostic for urinalysis, we confirmed that patients presented a UTI. Each GP was contacted. Prescriptions were analysed and compared to the 2008 French guidelines for UTIs. Our study included 185 urinalyses. UTIs diagnosed by GPs were as follows: acute cystitis: 72.4 %, prostatitis: 13.5 %, nephritis: 8.7 % and asymptomatic bacteriuria: 5.4 %. The principal antibiotics used were: quinolone (59.5 %), furan (17.8 %) and cotrimoxazole (6.5 %). Only 20 % of the prescriptions were compliant with the guidelines. The correct antibiotic but not the dose or the duration of prescription was selected in 8.1 % of the prescriptions. For cystitis, inappropriate prescription was associated with an extra cost of 694 <euro>, namely, 7.4 <euro> per treatment. GP prescriptions for UTIs do not follow the guidelines. Even if GPs assert that they are aware of the emergence of resistant strains, it seems that they do not take into account the objective of quinolone restriction, which was one of the backbones of these guidelines.
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Affiliation(s)
- E Denes
- Infectious Diseases Department, Limoges Teaching Hospital, Limoges, France.
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48
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Denes E, Labach C, Durox H, Adoukonou T, Weinbreck P, Magy L, Ranger-Rogez S. Intrathecal synthesis of specific antibodies as a marker of herpes simplex encephalitis in patients with negative PCR. Swiss Med Wkly 2010; 140:w13107. [PMID: 20927686 DOI: 10.4414/smw.2010.13107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND PCR in the cerebrospinal fluid (CSF) has become the sole method used for the diagnosis of herpes simplex encephalitis (HSE). Nevertheless, PCR results may sometimes be false negative, and in this situation other techniques may be useful. METHODS 3 patients hospitalised for meningoencephalitis with fever showed a negative result for herpes simplex virus (HSV) PCR in their CSF. We then performed a detection of intrathecal anti-HSV immunoglobulins (IgGs) in the CSF and analysed their level in relation to those in the serum, compared to albumin. RESULTS We confirmed that IgG synthesis was the direct consequence of an immune system reaction in the 3 patients' CSF. These results were consistent with clinical signs and neurodiagnostic procedures. They prompted us to continue the treatment, which would have been stopped following the negative PCR results. The clinical progression was favourable for all patients. CONCLUSIONS PCR, which many physicians now consider the gold standard for the detection of HSV, may sometimes yield false negative results, i.e. when performed too early after the disease onset or when the viral load is too low. The method described here, although positive a few days after PCR, may prove helpful in the diagnosis of HSE for patients with negative HSV PCR in the CSF.
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Affiliation(s)
- Eric Denes
- Department of Infectious Diseases, CHU Dupuytren, Limoges, France.
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Hamonet J, Verdié-Kessler C, Daviet JC, Denes E, Nguyen-Hoang CL, Salle JY, Munoz M. Evaluation of a multidisciplinary consultation of diabetic foot. Ann Phys Rehabil Med 2010; 53:306-18. [PMID: 20510664 DOI: 10.1016/j.rehab.2010.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a multidisciplinary consultation of diabetic foot in terms of ulcer healing rate and podiatric complications prevention. METHODS A longitudinal observational study was conducted on 78 patients consulting multidisciplinary clinic of diabetic foot between the 1st January 2005 and the 31th December 2006. There were two evaluations: the first one in June 2008, the second one in January 2010, at a medium follow-up of 48 months. RESULTS 30.8% of diabetic patients were addressed in primary prevention, 53.8% for treatment of foot ulcer, and 15.4% in secondary prevention. The global healing rate was 76.19% after a medium follow-up of 29 months, and the recurrence rate at a medium follow-up of 48 months was 9.52%. Healing was achieved in 63.6% of patients with off-loading shoes versus 81.8% of whom with fiberglass cast boot. CONCLUSION Care and follow-up of diabetic patients with foot at risk in multidisciplinary consultation seem to be effective not only in curative treatment, but also in primary and secondary prevention. The economic benefits need to be evaluated.
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Affiliation(s)
- J Hamonet
- Hôpital J.-Rebeyrol, CHU de Limoges, France.
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50
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Doffoel-Hantz V, Reminieras L, Dufauret C, Martin C, Denes E, Jaccard A, Bonnetblanc JM, Sparsa A. Traitement d’une infection réfractaire à Mycobacterium chelonae par clarythromycine et interféron gamma. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.287] [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: 11/26/2022]
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