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Vacheron CH, Lambert A, Fauvernier M, Vassal O, Wallet F, Bakrin N, Vaudoyer D, Kepenekian V, Passot G, Glehen O, Piriou V, Friggeri A. Troponin measurement for risk stratification after cytoreductive surgery. Br J Surg 2021; 108:e297-e298. [PMID: 34136898 DOI: 10.1093/bjs/znab195] [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: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022]
Abstract
Several studies have raised interest in the use of postoperative troponin levels to stratify risk of postoperative morbidity and mortality. In this study, postoperative troponin concentration after cytoreductive surgery (with or without hyperthermic intraoperative intraperitoneal chemotherapy) was associated with severe postoperative complications, and enhanced the predictive capability of a multivariable model focusing on postoperative complications.
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Affiliation(s)
- C-H Vacheron
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospice Civils de Lyon, Pierre-Bénite, France.,Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - A Lambert
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospice Civils de Lyon, Pierre-Bénite, France
| | - M Fauvernier
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - O Vassal
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospice Civils de Lyon, Pierre-Bénite, France
| | - F Wallet
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospice Civils de Lyon, Pierre-Bénite, France
| | - N Bakrin
- Département de Chirurgie Viscérale, Centre Hospitalier Lyon-Sud, Hospice Civil de Lyon, Pierre-Bénite, France
| | - D Vaudoyer
- Département de Chirurgie Viscérale, Centre Hospitalier Lyon-Sud, Hospice Civil de Lyon, Pierre-Bénite, France
| | - V Kepenekian
- Département de Chirurgie Viscérale, Centre Hospitalier Lyon-Sud, Hospice Civil de Lyon, Pierre-Bénite, France
| | - G Passot
- Département de Chirurgie Viscérale, Centre Hospitalier Lyon-Sud, Hospice Civil de Lyon, Pierre-Bénite, France
| | - O Glehen
- Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France
| | - V Piriou
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospice Civils de Lyon, Pierre-Bénite, France.,Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France
| | - A Friggeri
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospice Civils de Lyon, Pierre-Bénite, France.,Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France
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2
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Lepape A, Machut A, Gerbier-Colomban S, Kuczewski E, Rasigade JP, Timsit JF, Vanhems P, Wallet F, Savey A, Friggeri A. Automated surveillance in French ICUs: is it feasible? Results from a survey in French ICUs participating in a surveillance network. J Hosp Infect 2021; 115:1-4. [PMID: 34048849 DOI: 10.1016/j.jhin.2021.05.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
A survey was undertaken to evaluate the level of computerization in intensive care units (ICUs) within a French network dedicated to the surveillance of healthcare-associated infections, antimicrobial use (AMU) and antimicrobial resistance (AMR) in ICUs (REA-REZO). Ninety-eight ICUs responded, and patient records were computerized in 57%, antimicrobial prescriptions were computerized in 59% and AMR epidemiology was computerized in 72%. AMU and AMR feedback was provided to the ICU itself for 77% and 65% of ICUs, respectively, and feedback was provided to the national surveillance for 79% and 65% of ICUs, respectively. This study suggests that the level of computerization in ICUs requires further improvement.
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Affiliation(s)
- A Lepape
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, REA-REZO Surveillance Network, Infections and Antibiotic Resistance in ICU, Saint Genis Laval, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Critical Care, Pierre-Bénite, Lyon, France; Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases, Centre International de Recherche en Infectiologie, INSERM, Lyon, France.
| | - A Machut
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, REA-REZO Surveillance Network, Infections and Antibiotic Resistance in ICU, Saint Genis Laval, Lyon, France; CPIAS Auvergne-Rhône-Alpes, Hospices Civils de Lyon, Hôpital Henry Gabrielle, Saint Genis Laval, Lyon, France
| | - S Gerbier-Colomban
- Hospices Civils de Lyon, Centre Hospitalier Edouard Herriot, Service Hygiène, Epidémiologie et Prévention, Lyon, France
| | - E Kuczewski
- Hospices Civils de Lyon, Centre Hospitalier Edouard Herriot, Service Hygiène, Epidémiologie et Prévention, Lyon, France
| | - J-P Rasigade
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Institut des Agents Infectieux, Lyon, France; Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases, Centre International de Recherche en Infectiologie, INSERM, Lyon, France
| | - J-F Timsit
- AP-HP, Bichat Claude Bernard University Hospital, Medical and Infectious Diseases Intensive Care Unit, Paris, France; University Sorbonne Paris Nord, Paris, France
| | - P Vanhems
- Hospices Civils de Lyon, Centre Hospitalier Edouard Herriot, Service Hygiène, Epidémiologie et Prévention, Lyon, France; Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases, Centre International de Recherche en Infectiologie, INSERM, Lyon, France
| | - F Wallet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Critical Care, Pierre-Bénite, Lyon, France; Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases, Centre International de Recherche en Infectiologie, INSERM, Lyon, France
| | - A Savey
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, REA-REZO Surveillance Network, Infections and Antibiotic Resistance in ICU, Saint Genis Laval, Lyon, France; CPIAS Auvergne-Rhône-Alpes, Hospices Civils de Lyon, Hôpital Henry Gabrielle, Saint Genis Laval, Lyon, France; Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases, Centre International de Recherche en Infectiologie, INSERM, Lyon, France
| | - A Friggeri
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Critical Care, Pierre-Bénite, Lyon, France; Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases, Centre International de Recherche en Infectiologie, INSERM, Lyon, France
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3
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Bitker L, Dhelft F, Chauvelot L, Frobert E, Folliet L, Mezidi M, Trouillet-Assant S, Belot A, Lina B, Wallet F, Richard JC. Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure. Ann Intensive Care 2020; 10:167. [PMID: 33301059 PMCID: PMC7725883 DOI: 10.1186/s13613-020-00783-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/03/2020] [Accepted: 11/25/2020] [Indexed: 01/08/2023] Open
Abstract
Background Protracted viral shedding is common in hospitalized patients with COVID-19 pneumonia, and up to 40% display signs of pulmonary fibrosis on computed tomography (CT) after hospital discharge. We hypothesized that COVID-19 patients with acute respiratory failure (ARF) who die in intensive care units (ICU) have a lower viral clearance in the respiratory tract than ICU patients discharged alive, and that protracted viral shedding in respiratory samples is associated with patterns of fibroproliferation on lung CT. We, therefore, conducted a retrospective observational study, in 2 ICU of Lyon university hospital. Results 129 patients were included in the study, of whom 44 (34%) died in ICU. 432 RT-PCR for SARS-CoV-2 were performed and 137 CT scans were analyzed. Viral load was significantly higher in patients deceased as compared to patients alive at ICU discharge (p < 0.001), after adjustment for the site of viral sampling and RT-PCR technique. The median time to SARS-CoV-2 negativation on RT-PCR was 19 days [CI95 %:15–21] in patients alive at ICU discharge and 26 days [CI95 %:17-infinity] in non-survivors at ICU discharge. Competitive risk regression identified patients who died in ICU and age as independent risk factors for longer time to SARS-CoV-2 negativation on RT-PCR, while antiviral treatment was independently associated with shorter time. None of the CT scores exploring fibroproliferation (i.e., bronchiectasis and reticulation scores) were significantly associated with time to SARS-CoV-2 negativation. Conclusions Viral load in respiratory samples is significantly lower and viral shedding significantly shorter in ICU survivors of COVID-19 associated acute respiratory failure. Protracted viral shedding is unrelated to occurrence of fibrosis on lung CT.
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Affiliation(s)
- L Bitker
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, 69621, Lyon, France
| | - F Dhelft
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, 69621, Lyon, France
| | - L Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - E Frobert
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, 69007, Lyon, France.,Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, National Reference Center for Respiratory Viruses, Department of Virology, Infective Agents Institute, North Hospital Network, Lyon, France; Virpath Laboratory, International Center of Research in Infectiology, INSERM U1111, CNRS-UMR 5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon, Université Claude Bernard, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - L Folliet
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - M Mezidi
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - S Trouillet-Assant
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, 69007, Lyon, France.,Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - A Belot
- National Referee Centre for Rheumatic AutoImmune and Systemic Diseases in childrEn (RAISE), Lyon, France.,Pediatric Nephrology, Rheumatology, Dermatology Unit, Hospices Civils de Lyon, Pierre-Bénite, France
| | - B Lina
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Team Virpath, 69007, Lyon, France.,Laboratoire de Virologie, Institut des Agents Infectieux, Hospices Civils de Lyon, National Reference Center for Respiratory Viruses, Department of Virology, Infective Agents Institute, North Hospital Network, Lyon, France; Virpath Laboratory, International Center of Research in Infectiology, INSERM U1111, CNRS-UMR 5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon, Université Claude Bernard, Lyon, France.,Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - F Wallet
- Service de Réanimation Polyvalente, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - J C Richard
- Service de Médecine Intensive Réanimation, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Université de Lyon, Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, 69621, Lyon, France.
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4
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Duployez C, Wallet F, Rouzé A, Nseir S, Kipnis E, El Kalioubie A, Dessein R, Loïez C, Le Guern R. Spontaneous decolonization during hospitalization in intensive care unit patients colonized by extended-spectrum beta-lactamase-producing Enterobacterales. J Hosp Infect 2020; 106:500-503. [PMID: 32745588 DOI: 10.1016/j.jhin.2020.07.029] [Citation(s) in RCA: 2] [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: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022]
Abstract
This study aimed to analyse the frequency of occurrence of spontaneous decolonization in intensive care unit patients colonized by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) in order to assess the added value of continuing weekly ESBL-E rectal carriage screening in these patients. In total, 49,468 weekly rectal screening samples taken from 20,846 patients over 12 years were included. Among the 4280 ESBL-E carriers, only 109 patients (2.5%) could be considered decolonized at the end of their hospitalization with at least three consecutive negative samples. Overall, 7957 samples (16.1%) were requested for patients already identified as ESBL-E carriers. Avoiding unnecessary weekly screening following positive ESBL-E colonization results could decrease nursing and laboratory work loads.
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Affiliation(s)
- C Duployez
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019, UMR 9017, Centre for Infection and Immunity of Lille, Lille, France
| | - F Wallet
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019, UMR 9017, Centre for Infection and Immunity of Lille, Lille, France
| | - A Rouzé
- CHU Lille, Critical Care Centre, Lille, France
| | - S Nseir
- CHU Lille, Critical Care Centre, Lille, France
| | - E Kipnis
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019, UMR 9017, Centre for Infection and Immunity of Lille, Lille, France
| | | | - R Dessein
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019, UMR 9017, Centre for Infection and Immunity of Lille, Lille, France
| | - C Loïez
- CHU Lille, Laboratoire de Bactériologie-Hygiène, Lille, France
| | - R Le Guern
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019, UMR 9017, Centre for Infection and Immunity of Lille, Lille, France.
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5
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Tetart M, Kyheng M, Wallet F, Le Rouzic O, Wallaert B, Prevotat A. Impact d’Achromobacter xylosoxidans sur la fonction ventilatoire de patients adultes atteints de mucoviscidose. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.045] [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: 10/27/2022]
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Barth C, Soares M, Toffart AC, Timsit JF, Burghi G, Irrazabal C, Pattison N, Tobar E, Almeida BF, Silva UV, Azevedo LC, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Salluh J, Azoulay E, Lemiale V. Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs). Ann Intensive Care 2018; 8:80. [PMID: 30076547 PMCID: PMC6076209 DOI: 10.1186/s13613-018-0426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/16/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. Methods A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. Results Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4–12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11–16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07–0.81]; p = 0.020). Conclusion This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors’ characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.
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Affiliation(s)
- C Barth
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A C Toffart
- Inserm, u 823, Institut A Bonniot, Grenoble, France
| | - J F Timsit
- Medical ICU, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazabal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - B F Almeida
- ICU, Hospital A. C. Camargo, São Paulo, Brazil
| | - U V Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos, Brazil
| | - L C Azevedo
- ICU, Hospital Sírio Libanês, São Paulo, Brazil
| | - A Rabbat
- Thoracic ICU, Hôpital Cochin, Paris, France
| | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris, France
| | - A Parrot
- Medical ICU, Hôpital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France
| | - F Blot
- ICU, Institut Gustave Roussy, Villejuif, France
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - J Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Lemiale
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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Loïez C, Duployez C, Wallet F. A promising new test to detect Streptococcus pneumoniae urinary antigen. Med Mal Infect 2017; 47:494-497. [DOI: 10.1016/j.medmal.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
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8
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Sanges S, Wallet F, Blondiaux N, Theis D, Vérin I, Vachée A, Dessein R, Faure K, Viget N, Senneville E, Leroy O, Maury F, Just N, Poissy J, Mathieu D, Prévotat A, Chenivesse C, Scherpereel A, Smith G, Lopez B, Rosain J, Frémeaux-Bacchi V, Hachulla E, Hatron PY, Bahuaud M, Batteux F, Launay D, Labalette M, Lefèvre G. Diagnosis of primary antibody and complement deficiencies in young adults after a first invasive bacterial infection. Clin Microbiol Infect 2017; 23:576.e1-576.e5. [DOI: 10.1016/j.cmi.2017.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/28/2017] [Accepted: 02/04/2017] [Indexed: 01/29/2023]
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9
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Baranzelli A, Loïez C, Bervar JF, Scherpereel A, Wallet F. The snake raiser lung: An unusual cause of Salmonella enterica subspecies arizonae pneumonia. Med Mal Infect 2017; 47:424-425. [PMID: 28602385 DOI: 10.1016/j.medmal.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/24/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Affiliation(s)
- A Baranzelli
- Service de pneumologie, CHRU de Lille, université de Lille 2, 59037 Lille cedex, France
| | - C Loïez
- Laboratoire de bactériologie-hygiène, centre de biologie pathologie, boulevard du Pr-Leclercq, 59037 Lille cedex, France
| | - J F Bervar
- Service de pneumologie, CHRU de Lille, université de Lille 2, 59037 Lille cedex, France
| | - A Scherpereel
- Service de pneumologie, CHRU de Lille, université de Lille 2, 59037 Lille cedex, France
| | - F Wallet
- Laboratoire de bactériologie-hygiène, centre de biologie pathologie, boulevard du Pr-Leclercq, 59037 Lille cedex, France.
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10
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Duployez C, Loïez C, Ledoux G, Armand S, Jaillette E, Wallet F. A fatal endocarditis case due to an emerging bacterium: Moraxella nonliquefaciens. IDCases 2017; 8:12-13. [PMID: 28271043 PMCID: PMC5328914 DOI: 10.1016/j.idcr.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/09/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 11/27/2022] Open
Abstract
Moraxella nonliquefaciens is a Gram-negative coccobacillus considered as a commensal organism from the upper respiratory tract, with low pathogenic potential. The phenotypical conventional identification is difficult and the matrix-assisted laser desorption/ionization time-of-flight technology has increased the resolution of identification of this bacterium. We report a fatal case of endocarditis due to M. nonliquefaciens whose identification was confirmed by 16S rRNA, and we review the literature on this pathogen in endocarditis.
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Affiliation(s)
- C Duployez
- CHU Lille, Service de Bactériologie-Hygiène, Centre de Biologie-Pathologie, F 59000 Lille, France
| | - C Loïez
- CHU Lille, Service de Bactériologie-Hygiène, Centre de Biologie-Pathologie, F 59000 Lille, France
| | - G Ledoux
- CHU Lille, Service de Réanimation, Centre de Réanimation, F 59000 Lille, France
| | - S Armand
- CHU Lille, Service de Bactériologie-Hygiène, Centre de Biologie-Pathologie, F 59000 Lille, France
| | - E Jaillette
- CHU Lille, Service de Réanimation, Centre de Réanimation, F 59000 Lille, France
| | - F Wallet
- CHU Lille, Service de Bactériologie-Hygiène, Centre de Biologie-Pathologie, F 59000 Lille, France
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11
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Demoule A, Clavel M, Rolland-Debord C, Perbet S, Terzi N, Kouatchet A, Wallet F, Roze H, Vargas F, Guerin C, Dellamonica J, Jaber S, Brochard L, Similowski T. Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial. Intensive Care Med 2016; 42:1723-1732. [PMID: 27686347 DOI: 10.1007/s00134-016-4447-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 03/20/2016] [Accepted: 07/05/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that tailors the level of assistance delivered by the ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation. METHODS A multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units. Patients were randomly assigned to NAVA or PSV. The primary outcome was the probability of remaining in a partial ventilatory mode (either NAVA or PSV) throughout the first 48 h without any return to assist-control ventilation. Secondary outcomes included asynchrony index, ventilator-free days and mortality. RESULTS In the NAVA and PSV groups respectively, the proportion of patients remaining in partial ventilatory mode throughout the first 48 h was 67.2 vs. 63.3 % (P = 0.66), the asynchrony index was 14.7 vs. 26.7 % (P < 0.001), the ventilator-free days at day 7 were 1.0 day [1.0-4.0] vs. 0.0 days [0.0-1.0] (P < 0.01), the ventilator-free days at day 28 were 21 days [4-25] vs. 17 days [0-23] (P = 0.12), the day-28 mortality rate was 15.0 vs. 22.7 % (P = 0.21) and the rate of use of post-extubation noninvasive mechanical ventilation was 43.5 vs. 66.6 % (P < 0.01). CONCLUSIONS NAVA is safe and feasible over a prolonged period of time but does not increase the probability of remaining in a partial ventilatory mode. However, NAVA decreases patient-ventilator asynchrony and is associated with less frequent application of post-extubation noninvasive mechanical ventilation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02018666.
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Affiliation(s)
- A Demoule
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013, Paris, France.
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
| | - M Clavel
- Réanimation Polyvalente, Hôpital Dupuytren, Limoges, France
| | - C Rolland-Debord
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - S Perbet
- Réanimation Médico-Chirurgicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- R2D2 EA-7281, Université d'Auvergne, Clermont-Ferrand, France
| | - N Terzi
- INSERM U1042, Université Grenoble-Alpes, HP2, 38000, Grenoble, France
- Service de Réanimation Médicale, CHU Grenoble Alpes, 38000, Grenoble, France
| | - A Kouatchet
- Service de Réanimation Médicale et Médecine Hyperbare, CHU d'Angers, Angers, Angers, France
| | - F Wallet
- Réanimation Médicale et Chirurgicale, Centre Hospitalier Lyon-Sud, Lyon, France
- Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - H Roze
- Anesthésie et Réanimation, CHU de Bordeaux, Pessac, France
| | - F Vargas
- Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France
| | - C Guerin
- Réanimation Médicale, Hôpital de la Croix Rousse, Lyon, France
| | - J Dellamonica
- Réanimation Médicale, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice, France
- INSERM 1065 Team 3 C3 M, Nice, France
| | - S Jaber
- Anesthésie et Réanimation, Hôpital Saint-Eloi, Montpellier, France
- Montpellier School of Medicine, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - L Brochard
- Keenan Research Centre and Li Ka Shing Institute, Saint-Michael's Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - T Similowski
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Duployez C, Loiez C, Cattoen C, Descamps D, Wallet F, Vachée A. In vitro susceptibility to mecillinam of Escherichia coli strains isolated from the urine of pregnant women. Med Mal Infect 2016; 46:436-441. [PMID: 27609597 DOI: 10.1016/j.medmal.2016.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/04/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Pivmecillinam is a safe beta-lactam for use in pregnancy. It has been widely used for the treatment of lower urinary tract infections (UTIs) in the Nordic countries where its efficacy, minor impact on the microbiota, and low level of resistance among the Escherichia coli strains have been proven. However, susceptibility data related to E. coli involved in asymptomatic bacteriuria and lower UTIs in pregnant women is lacking. We aimed to support the 2015 recommendations issued by the French Infectious Diseases Society (SPILF) on gestational UTI, with a particular focus on pivmecillinam. MATERIAL AND METHODS Antimicrobial susceptibility testing was performed by 12 hospitals with a maternity department on 235 E. coli strains isolated from the urine of pregnant women. Susceptibility to mecillinam was tested by disk diffusion method using the 2015 recommendations of the antibiogram committee of the French microbiology society (CA-SFM). RESULTS Global susceptibility to mecillinam was 86.4%. Susceptibility to mecillinam was 96.5% for strains susceptible to amoxicillin-clavulanic acid and 38.7% for resistant strains. All six extended-spectrum beta-lactamase-producing E. coli strains were susceptible to mecillinam. CONCLUSION Given the efficacy and safety of pivmecillinam during pregnancy, it may be used for the documented treatment of asymptomatic bacteriuria and acute cystitis in pregnant women. It also represents an alternative for the treatment of multidrug-resistant bacterial infections.
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Affiliation(s)
- C Duployez
- Centre hospitalier universitaire, institut de microbiologie, 59037 Lille cedex, France.
| | - C Loiez
- Centre hospitalier universitaire, institut de microbiologie, 59037 Lille cedex, France.
| | - C Cattoen
- Centre hospitalier de Valenciennes, laboratoire de microbiologie, 59322 Valenciennes cedex, France.
| | - D Descamps
- Centre hospitalier de Béthune, laboratoire de biologie, 62408 Béthune cedex, France.
| | - F Wallet
- Centre hospitalier universitaire, institut de microbiologie, 59037 Lille cedex, France.
| | - A Vachée
- Centre hospitalier de Roubaix, laboratoire de biologie, 59100 Roubaix, France.
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- Réseau de microbiologistes du Nord-Pas-de-Calais, Nord-Pas-de-Calais, France
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Ledoux G, Six S, Lawson R, Labreuche J, Blazejewski C, Wallet F, Duhamel A, Nseir S. Impact of a targeted isolation strategy at intensive-care-unit-admission on intensive-care-unit-acquired infection related to multidrug-resistant bacteria: a prospective uncontrolled before-after study. Clin Microbiol Infect 2016; 22:888.e11-888.e18. [PMID: 27451941 DOI: 10.1016/j.cmi.2016.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/13/2016] [Revised: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 12/17/2022]
Abstract
Isolation of patients with multidrug resistant (MDR) bacteria is recommended to reduce cross-transmission of these bacteria. However, isolation of critically ill patients has several negative side effects. Therefore, we hypothesized that a targeted isolation strategy, based on the presence of at least one risk factor for MDR bacteria, would be not inferior to a systematic isolation strategy at intensive-care unit (ICU) admission. This prospective before-after study was conducted in a mixed ICU, during two 12-month periods, separated by a 1-month 'wash-out' period. During the before period, isolation was systematically performed in all patients at admission. During the after period, isolation was only performed in patients with at least one risk factor for MDR bacteria at admission. During the two periods, routine screening for MDR bacteria was performed at ICU admission, and isolation prescription was modified after receipt of screening result. Primary outcome was the percentage of patients with ICU-acquired infection (ICUAI) related to MDR bacteria, measured from ICU admission until ICU discharge or day 28, whatever happens first. A total of 1221 patients were included. No significant difference was found in ICUAI related to MDR bacteria (85 of 585 (14.5%) vs. 84 of 636 (13.2%) patients, risk difference, -1.3%, 95% confidence interval [-5.2 to 2.6%]) between the two periods, confirming the non-inferiority hypothesis. Our results suggest that targeted isolation of patients at ICU admission is not inferior to systematic isolation, regarding the percentage of patients with ICUAI related to MDR bacteria. Further randomized controlled multicentre studies are needed to confirm our results.
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Affiliation(s)
- G Ledoux
- CHU Lille, Centre de Réanimation, Lille, France
| | - S Six
- CHU Lille, Centre de Réanimation, Lille, France
| | - R Lawson
- CHU Lille, Centre de Réanimation, Lille, France
| | - J Labreuche
- CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - C Blazejewski
- CH de Dunkerque, Service de réanimation polyvalente, Dunkerque, France
| | - F Wallet
- CHU Lille, Centre de Biologie et de Pathologie, Lille, France
| | - A Duhamel
- CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France; Université Lille, Medical School, Lille, France
| | - S Nseir
- CHU Lille, Centre de Réanimation, Lille, France; Université Lille, Medical School, Lille, France.
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Filali A, Barrailler S, Boulo M, Aissi E, Wallet F, Leroy O, Van Grunderbeeck N. ENDO-02 -Infections cardiaques à Streptococcus pneumoniae : une série de 21 cas. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30371-7] [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: 11/24/2022]
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Wallet F, Maucort Boulch D, Malfroy S, Ledochowski S, Bernet C, Kepenekian V, Passot G, Vassal O, Piriou V, Glehen O, Friggeri A. No impact on long-term survival of prolonged ICU stay and re-admission for patients undergoing cytoreductive surgery with HIPEC. Eur J Surg Oncol 2016; 42:855-60. [PMID: 27061789 DOI: 10.1016/j.ejso.2016.03.004] [Citation(s) in RCA: 6] [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: 11/10/2015] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) are promising new approaches of peritoneal metastases. However these surgical procedures are associated with a high morbidity rate thus intensive care (IC) management following serious complications may be warranted for these patients. The impact of the prolonged IC stay or re-admission on long-term survival remains unknown. METHODS We retrospectively analysed 122 consecutive HIPEC procedures over a one year period (2010-2011) in a single academic hospital. We analysed complications that would lead to prolonged stay or re-admission into ICU and analysed long term follow-up in patients whether they required intensive care (ICU group) or not (Control group). RESULTS ICU group represented 26.2% of the cohort mainly due to septic or haemorrhagic shock. Among them acute kidney injury and respiratory failure were present in 50% and 47% respectively. Cohort overall mortality rate was of 5.7%. Patients were followed for 4 years and survival analysis was performed adjusting for main confounding factors in a Cox survival model. Survival was not different between groups, with a median survival of 38 months [32; 44] vs. 33 months [26; 39] in the ICU group and Control group respectively. CONCLUSION Prolonged stay or re-admission into ICU does not seem to statistically impact long term prognosis of patients undergoing CRS with HIPEC.
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Affiliation(s)
- F Wallet
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France; Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, France.
| | - D Maucort Boulch
- Université de Lyon, Lyon, France; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, F-69100, France
| | - S Malfroy
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - S Ledochowski
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - C Bernet
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - V Kepenekian
- Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France
| | - G Passot
- Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France
| | - O Vassal
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - V Piriou
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France
| | - O Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Université Lyon 1, EMR 3738, Pierre Bénite, France
| | - A Friggeri
- Critical Care and Anaesthesiology Department, CHU Lyon Sud, University Lyon 1, Pierre Benite, France; Laboratoire des Pathogènes Emergents, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, France
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16
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Freymond N, Perrot E, Regal O, Fayet JM, Ragué P, Mottard N, Wallet F. [Patient's course requiring NIPPV in Centre Hospitalier Lyon-Sud]. Rev Pneumol Clin 2016; 72:35-40. [PMID: 25727659 DOI: 10.1016/j.pneumo.2014.12.002] [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] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/03/2014] [Indexed: 06/04/2023]
Abstract
Non-invasive positive pressure ventilation (NIPPV) has become a major therapeutic of acute respiratory failure. Thanks to technical progress, its use has become widespread in intensive care units and now in emergency and pneumology departments, for indications recognized and validated as decompensation of chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema. Patients with this conditions transit in the hospital, from the emergency or pulmonology departments, sometimes through intensive care units. Knowledge of the NIPPV, its indications, contraindications, terms of use and surveillance requires trained teams. This training covers not only the technical but also the hardware, multiple ventilation modes, and interfaces. Other indications being evaluated, such as ventilation in the perioperative period, also require coordination between different actors. The establishment of a specific group of thinking and working around the NIPPV is clearly needed, allowing teams of hospital (emergency department, intensive care unit, pulmonology, anesthesia) to work together. This work deals with different areas: training, equipment, condition of receiving patients in the different services within the constraints of personnel and equipment. In this article, we trace the point of view of each of the professionals in this group and some of the actions implemented.
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Affiliation(s)
- N Freymond
- Service de pneumologie, pavillon médical, centre hospitaliser Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - E Perrot
- Service de pneumologie, pavillon médical, centre hospitaliser Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - O Regal
- Service d'accueil des urgences, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - J M Fayet
- Service d'accueil des urgences, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - P Ragué
- Service de réanimation, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - N Mottard
- Service de réanimation, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - F Wallet
- Service de réanimation, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
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Demoule A, Clavel M, Rolland-Debord C, Perbet S, Terzi N, Kouatchet A, Wallet F, Guerin C, Roze H, Vargas F, Dellamonica J, Jaber S, Similowski T. Comparison of neurally adjusted ventilatory assist and pressure support ventilation during the early phase of weaning from mechanical ventilation - a randomised controlled study. Intensive Care Med Exp 2015. [PMCID: PMC4798043 DOI: 10.1186/2197-425x-3-s1-a410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Ulrich M, Frimat M, Titcat M, Jacobsoone-Ulrich A, El Fallah S, Vandenbussche C, Lemoine C, Lionet A, Wallet F, Lebas C, Hazzan M, Noël C. Nocardiose disséminée en transplantation rénale : intérêt des β-d-glucanes. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.437] [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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Kempf M, Varon E, Lepoutre A, Gravet A, Baraduc R, Brun M, Chardon H, Cremniter J, Croizé J, Dalmay F, Demachy MC, Fosse T, Grelaud C, Hadou T, Hamdad F, Koeck JL, Luce S, Mermond S, Patry I, Péchinot A, Raymond J, Ros A, Segonds C, Soullié B, Tandé D, Vergnaud M, Vernet-Garnier V, Wallet F, Gutmann L, Ploy MC, Lanotte P. Decline in antibiotic resistance and changes in the serotype distribution of Streptococcus pneumoniae isolates from children with acute otitis media; a 2001-2011 survey by the French Pneumococcal Network. Clin Microbiol Infect 2014; 21:35-42. [PMID: 25636925 DOI: 10.1016/j.cmi.2014.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 06/09/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
Abstract
Streptococcus pneumoniae is an important cause of acute otitis media (AOM). The aim of this study was to evaluate trends in antibiotic resistance and circulating serotypes of pneumococci isolated from middle ear fluid of French children with AOM during the period 2001-2011, before and after the introduction of the PCV-7 (2003) and PCV-13 (2010) vaccines. Between 2001 and 2011 the French pneumococcal surveillance network analysed the antibiotic susceptibility of 6683 S. pneumoniae isolated from children with AOM, of which 1569 were serotyped. We observed a significant overall increase in antibiotic susceptibility. Respective resistance (I+R) rates in 2001 and 2011 were 76.9% and 57.3% for penicillin, 43.0% and 29.8% for amoxicillin, and 28.6% and 13.0% for cefotaxime. We also found a marked reduction in vaccine serotypes after PCV-7 implementation, from 63.0% in 2001 to 13.2% in 2011, while the incidence of the additional six serotypes included in PCV-13 increased during the same period, with a particularly high proportion of 19A isolates. The proportion of some non-PCV-13 serotypes also increased between 2001 and 2011, especially 15A and 23A. Before PCV-7 implementation, most (70.8%) penicillin non-susceptible pneumococci belonged to PCV-7 serotypes, whereas in 2011, 56.8% of penicillin non-susceptible pneumococci belonged to serotype 19A. Between 2001 and 2011, antibiotic resistance among pneumococci responsible for AOM in France fell markedly, and PCV-7 serotypes were replaced by non-PCV-7 serotypes, especially 19A. We are continuing to assess the impact of PCV-13, introduced in France in 2010, on pneumococcal serotype circulation and antibiotic resistance.
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Affiliation(s)
- M Kempf
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - E Varon
- Centre National de Référence des Pneumocoques (CNRP), AP-HP HEGP, Paris, France
| | - A Lepoutre
- Institut de Veille Sanitaire (InVS), Saint Maurice, France
| | - A Gravet
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - R Baraduc
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - M Brun
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - H Chardon
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - J Cremniter
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - J Croizé
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - F Dalmay
- CHU Limoges, UFRCB, Limoges, France
| | - M-C Demachy
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - T Fosse
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - C Grelaud
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - T Hadou
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - F Hamdad
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - J-L Koeck
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - S Luce
- CHU Limoges, UFRCB, Limoges, France
| | - S Mermond
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - I Patry
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - A Péchinot
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - J Raymond
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - A Ros
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - C Segonds
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - B Soullié
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - D Tandé
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - M Vergnaud
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - V Vernet-Garnier
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - F Wallet
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - L Gutmann
- Centre National de Référence des Pneumocoques (CNRP), AP-HP HEGP, Paris, France
| | - M-C Ploy
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France
| | - P Lanotte
- French pneumococcal surveillance network 'Observatoires Régionaux du Pneumocoque', CHU Limoges, Limoges, France.
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Soares M, Toffart AC, Timsit JF, Burghi G, Irrazábal C, Pattison N, Tobar E, Almeida BFC, Silva UVA, Azevedo LCP, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Tejera D, Salluh JIF, Azoulay E. Intensive care in patients with lung cancer: a multinational study. Ann Oncol 2014; 25:1829-1835. [PMID: 24950981 DOI: 10.1093/annonc/mdu234] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs. PATIENTS AND METHODS Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality. RESULTS Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge. CONCLUSIONS ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
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Affiliation(s)
- M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
| | | | - J-F Timsit
- Medical Intensive Care Unit (ICU), Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazábal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London; ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | | | - U V A Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos
| | | | | | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris
| | - A Parrot
- Medical ICU, APHP-Hopital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon
| | - F Blot
- ICU, Gustave Roussy, Villejuif
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - D Tejera
- ICU, Hospital de Clínicas, Montevideo, Uruguay
| | - J I F Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, Saint-Louis Teaching Hospital, Paris, France
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Abstract
We report the case of a 55-year-old man without significant medical history admitted to the ICU for a progressive paralysis mimicking life-threatening tetanus. Evolution with classical tetanus treatment was negative, with the need for ventilator support and worsening condition being life threatening. Uncommon evolution revealed a rare glycin antibody-associated hyperekplexia (progressive encephalomyelitis with rigidity syndrome). Patient dramatically improved with immunosuppressive therapy including plasmatic exchanges, cyclophasmid and high dose corticoid infusions. Intensivists should be aware of this very rare syndrome whose treatment is the opposite of tetanus while presentation is very close. Optimal and treatment could lead to prolonged survival.
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Affiliation(s)
- F Wallet
- Service de réanimation médicale, hôpital de la Croix-Rousse, CHU de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - A Didelot
- Service de neurologie, hôpital neurologique, CHU de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - B Delannoy
- Service de réanimation médicale, hôpital de la Croix-Rousse, CHU de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - V Leray
- Service de réanimation médicale, hôpital de la Croix-Rousse, CHU de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Guerin
- Service de réanimation médicale, hôpital de la Croix-Rousse, CHU de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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Houdouin V, Pouessel G, Angoulvant F, Brouard J, Derelle J, Fayon M, Ferroni A, Gangneux JP, Hau I, Le Bourgeois M, Lorrot M, Menotti J, Nathan N, Vabret A, Wallet F, Bonacorsi S, Cohen R, de Blic J, Deschildre A, Gandemer V, Pin I, Labbe A, Le Roux P, Martinot A, Rammaert B, Dubus JC, Delacourt C, Marguet C. Erratum à l’article « Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois » [Arch. Pediatr. 21(4) (2014) 418–423]. Arch Pediatr 2014. [DOI: 10.1016/j.arcped.2014.05.022] [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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Robert J, Pantel A, Merens A, Lavigne JP, Nicolas-Chanoine MH, Brieu N, Vrain A, Scanvic A, Porcheret H, Garnier P, Bertrand X, Descamps D, Hombrouck C, Soullie B, Heym B, de Montclos H, Garrec H, Levast M, Mendes-Martins L, Decousser JW, Huet C, Bert F, Herzig V, Klein JP, Nebbad B, Hendricx S, Verhaeghe A, Lafaurie C, Lanselle C, Elsayed F, Carrer A, Drieux-Rouzet L, Evreux F, Varache C, Wallet F, Martin C, Le-Bris JM, Moulhade MC, Deville E, Menouni O, Jean-Pierre H, Pierrot P, Delarbre JM, Coude B, Foca M, Degand N, Prots L, Pantel A, Adam MN, Laurens E, Raskine L, Laouira S, Arlet G, Sanchez R, Peuchant O, Grau V, Laurent C, De-Champs C, Vachee A, Harriau P, Merens A, Belmonte O, Michel G, Henry C, Picot S, Glatz I, Gueudet T, Honderlick P, Cavalie L, Galinier JL, Patoz P, van-der-Mee-Marquet N, Haguenoer E, Canis F, Kassis-Chikhany N, Le-Garrec Y. Incidence rates of carbapenemase-producing Enterobacteriaceae clinical isolates in France: a prospective nationwide study in 2011-12. J Antimicrob Chemother 2014; 69:2706-12. [DOI: 10.1093/jac/dku208] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Cattoen C, Descamps D, Vachée A, Wallet F. F-03: Bactériémies à Escherichia coli producteurs de BLSE dans le Nord – Pas-de-Calais : caractéristiques des patients, sensibilité aux antibiotiques, prise en charge thérapeutique. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70160-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] [Indexed: 11/25/2022]
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Houdouin V, Pouessel G, Angoulvant F, Brouard J, Derelle J, Fayon M, Ferroni A, Gangneux JP, Hau I, Le Bourgeois M, Lorrot M, Menotti J, Nathan N, Vabret A, Wallet F, Bonacorsi S, Cohen R, de Blic J, Deschildre A, Gandemer V, Pin I, Labbe A, Le Roux P, Martinot A, Rammaert B, Dubus JC, Delacourt C, Marguet C. Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois. Arch Pediatr 2014; 21:418-23. [DOI: 10.1016/j.arcped.2014.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/16/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Passot G, Bakrin N, Garnier L, Roux A, Vaudoyer D, Wallet F, Gilly F, Glehen O, Cotte E. Intraperitoneal vascular endothelial growth factor burden in peritoneal surface malignancies treated with curative intent: The first step before intraperitoneal anti-vascular endothelial growth factor treatment? Eur J Cancer 2014; 50:722-30. [DOI: 10.1016/j.ejca.2013.11.005] [Citation(s) in RCA: 7] [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: 08/30/2013] [Revised: 10/28/2013] [Accepted: 11/02/2013] [Indexed: 12/21/2022]
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Titécat M, Senneville E, Wallet F, Dezèque H, Migaud H, Courcol RJ, Loïez C. Bacterial epidemiology of osteoarticular infections in a referent center: 10-year study. Orthop Traumatol Surg Res 2013; 99:653-8. [PMID: 23988422 DOI: 10.1016/j.otsr.2013.02.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 11/07/2012] [Revised: 01/25/2013] [Accepted: 02/07/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of osteoarticular infections combines surgical treatment with antibiotic therapy. For some teams the immediate postoperative regimen requires at least partly wide-spectrum probabilistic treatment while waiting for the microbiological results. This protocol exposes the patient to the selection of resistant bacteria and the hospital unit to a modification of its bacterial ecology. The objective of this study was to retrospectively describe the microbial epidemiology of the Traumatology and Orthopaedics Department of the Lille University Hospital over 10 years (2002-2011). MATERIALS AND METHODS The bacterial species isolated in culture of osteoarticular samples were listed, after removing any duplicates. The antibiotics retained for follow-up were those used in treatment of these infections as well as those recognized as markers of resistance. For Gram-positive species, the antibiotics considered were methicillin, rifampicin, fluoroquinolones, glycopeptides, and linezolid; for the Gram-negative species, cefotaxime, cefepime, imipenem, and fluoroquinolones were considered. RESULTS Of the 5006 strains isolated between 2002 and 2011, Gram-positive cocci accounted for more than 71%; Staphylococcus aureus 27%, and coagulase-negative staphylococci (CoNS) 54%. Contrary to S. aureus, resistance to methicillin, fluoroquinolones, and teicoplanin significantly increased in CoNS, reaching 44%, 34%, and 22%, respectively, of the strains in 2011. The proportion of streptococcal and enterococcal infections remained stable, a mean 7.4% and 5.3%, respectively, per year. Enterobacteria (12.5% of the isolates) were producers of extended-spectrum beta-lactamase in 7.8% of the cases. Pseudomonas aeruginosa was involved in 3.6% of the infections, and 12% of the strains remained resistant to ceftazidime. Propionibacterium acnes accounted for 5.8% of the bacteria isolated and showed few antibiotic resistance problems. DISCUSSION Stability in the distribution and the susceptibility of different bacterial species was noted over this 10-year period. Although the evolution of S. aureus resistance was favourable, the resistance of CoNS specially to methicillin and glycopeptides increased. LEVEL OF EVIDENCE Level IV. Retrospective cohort study.
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Affiliation(s)
- M Titécat
- Institut de microbiologie, CHU de Lille, 59037 Lille, France; Université de Lille Nord de France, Lille, France
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Botterel F, Cabaret O, Wallet F, Wallaert B, Decousser JW, Bruce K, Delhaes L. Colonisation microbienne respiratoire des patients atteints de mucoviscidose : comparaison de la culture avec les techniques de RFLP, clonage et séquençage à haut débit. J Mycol Med 2013. [DOI: 10.1016/j.mycmed.2013.07.018] [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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Darien M, Wallet F, Schoeffler M, Tassin C, Lieutaud T, Piriou V. Profil et motivations des étudiants inscrits à un diplôme universitaire en 2011. ACTA ACUST UNITED AC 2012; 31:840-5. [DOI: 10.1016/j.annfar.2012.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
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Delhaes L, Monchy S, Fréalle E, Hubans C, Salleron J, Leroy S, Prevotat A, Wallet F, Wallaert B, Dei-Cas E, Sime-Ngando T, Chabe M, Viscogliosi E. 100 The airway microbiota in cystic fibrosis: a complex and dynamic biological community and implications for therapeutic management. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60270-7] [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: 11/25/2022]
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Legout L, Sarraz-Bournet B, D'Elia P, Devos P, Pasquet A, Caillaux M, Wallet F, Yazdanpanah Y, Senneville E, Haulon S, Leroy O. Characteristics and prognosis in patients with prosthetic vascular graft infection: a prospective observational cohort study. Clin Microbiol Infect 2012; 18:352-8. [DOI: 10.1111/j.1469-0691.2011.03618.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [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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Wallet F, Tassin C, Perdrix JP, Piriou V. Les revues de morbimortalité : faut-il privilégier la qualité à la quantité ? ACTA ACUST UNITED AC 2011; 30:869-70. [DOI: 10.1016/j.annfar.2011.10.006] [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: 11/29/2022]
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Flandreau G, Bourdin G, Leray V, Bayle F, Wallet F, Delannoy B, Durante G, Vincent B, Barbier J, Burle JF, Passant S, Richard JC, Guerin C. Management and Long-Term Outcome of Patients With Chronic Neuromuscular Disease Admitted to the Intensive Care Unit for Acute Respiratory Failure: A Single-Center Retrospective Study. Respir Care 2011; 56:953-60. [DOI: 10.4187/respcare.00862] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wallet F, Lunel A, Cassar E, Tassin C, Lieutaud T, Golfier F, Piriou V. [An unusual endometritis]. J Gynecol Obstet Hum Reprod 2011; 40:166-168. [PMID: 20926206 DOI: 10.1016/j.jgyn.2010.08.007] [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: 03/09/2010] [Revised: 08/20/2010] [Accepted: 08/26/2010] [Indexed: 05/30/2023]
Abstract
We report a case of pyometra without any related risk factor. This leads to a severe septic shock. Evolution was successful because of quick surgical management. We report literature management of such infection. Although pyometra is an uncommon disease, it should be kept in mind as delayed management may lead to fatal outcome.
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Affiliation(s)
- F Wallet
- Service d'anesthésie réanimation médicale et chirurgicale, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2010; 17:1201-8. [PMID: 21054665 DOI: 10.1111/j.1469-0691.2010.03420.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this prospective cohort study was to determine whether admission to an intensive care unit (ICU) room previously occupied by a patient with multidrug-resistant (MDR) Gram-negative bacilli (GNB) increases the risk of acquiring these bacteria by subsequent patients. All patients hospitalized for >48 h were eligible. Patients with MDR GNB at ICU admission were excluded. The MDR GNB were defined as MDR Pseudomonas aeruginosa, Acinetobacter baumannii and extended spectrum β-lactamase (ESBL) -producing GNB. All patients were hospitalized in single rooms. Cleaning of ICU rooms between two patients was performed using quaternary ammonium disinfectant. Risk factors for MDR P. aeruginosa, A. baumannii and ESBL-producing GNB were determined using univariate and multivariate analysis. Five hundred and eleven consecutive patients were included; ICU-acquired MDR P. aeruginosa was diagnosed in 82 (16%) patients, A. baumannii in 57 (11%) patients, and ESBL-producing GNB in 50 (9%) patients. Independent risk factors for ICU-acquired MDR P. aeruginosa were prior occupant with MDR P. aeruginosa (OR 2.3, 95% CI 1.2-4.3, p 0.012), surgery (OR 1.9, 95% CI 1.1-3.6, p 0.024), and prior piperacillin/tazobactam use (OR 1.2, 95% CI 1.1-1.3, p 0.040). Independent risk factors for ICU-acquired A. baumannii were prior occupant with A. baumannii (OR 4.2, 95% CI 2-8.8, p <0.001), and mechanical ventilation (OR 9.3, 95% CI 1.1-83, p 0.045). Independent risk factors for ICU-acquired ESBL-producing GNB were tracheostomy (OR 2.6, 95% CI 1.1-6.5, p 0.049), and sedation (OR 6.6, 95% CI 1.1-40, p 0.041). We conclude that admission to an ICU room previously occupied by a patient with MDR P. aeruginosa or A. baumannii is an independent risk factor for acquisition of these bacteria by subsequent room occupants. This relationship was not identified for ESBL-producing GNB.
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Affiliation(s)
- S Nseir
- Intensive Care Unit, Calmette Hospital, University Hospital of Lille, Lille, France.
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Prévotat A, Leroy S, Perez T, Wallet F, Wallaert B. [Tolerance and efficacy of ceftazidime in combination with aztreonam for exacerbations of cystic fibrosis]. Rev Mal Respir 2010; 27:449-56. [PMID: 20569877 DOI: 10.1016/j.rmr.2010.03.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 10/29/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antibiotic therapy for acute pulmonary exacerbations in patients with cystic fibrosis is usually chosen based on the results of antimicrobial susceptibility. This can be difficult when bacteria are multiresistant. The objective of this retrospective study was to evaluate the tolerance and efficiency of ceftazidime and aztreonam combination (+/-tobramycin, +/-ciprofloxacin) in the treatment of acute exacerbations in cystic fibrosis patients who were chronically colonized with multiresistant P. aeruginosa. PATIENTS Seventeen severe patients, with FEV(1)=1070+/-66 mL and BMI=18+/-0.6 kg/m(2), who had chronic colonisation with P. aeruginosa with intermediate sensitivity or resistance to ceftazidime and aztreonam, were studied between June 2003 and March 2007. Oxygen saturation, dyspnoea, weight, FEV(1), FVC, and tolerance were evaluated before and after antibiotic courses. RESULTS Forty-two courses of treatment, administered between June 2003 and March 2007 were studied: Patients increased their FEV(1) and FVC (p=0.01). One antibiotic course was stopped after four days because of cutaneous side effects. The median delay until the next exacerbation was 101+/-10 days. These courses were compared with other combinations of antibiotics that the patients had received before. The combination of ceftazidime and aztreonam was more effective in patients receiving less than four courses per year for acute pulmonary exacerbation. CONCLUSION In chronically P. aeruginosa colonised cystic fibrosis patients, ceftazidime and aztreonam combination (+/-tobramycin, +/-ciprofloxacin) is well tolerated and efficient. This treatment suggests a clinical and functional benefit is possible, even in patients with severe disease.
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Affiliation(s)
- A Prévotat
- CRCM adultes, service de pneumologie et immuno-allergologie, hôpital Calmette, CHRU de Lille, boulevard du Professeur Leclercq, 59037 Lille, France.
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Berend M, Jahandiez V, Wallet F, Hacquard H, Tronc F, David JS. [Management of tracheobronchial ruptures]. ACTA ACUST UNITED AC 2010; 29:491-3. [PMID: 20558028 DOI: 10.1016/j.annfar.2010.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Accepted: 05/11/2010] [Indexed: 11/19/2022]
Abstract
We report the case of a 25-year-old man who suffered a severe trauma with a complete rupture and separation of the right main bronchus. The patient presented on the scene with respiratory distress and severe hypoxemia. At the admission in the trauma resuscitation unit, the CT scan and fiberoptic examination confirmed the diagnosis of right main bronchus rupture. Selective fiberoptic intubation of the left main bronchus was done and the patient was sent to the operating theater for urgent thoracotomy. During thoracotomy, profound arterial oxygen desaturation requested the right main bronchus being intubated by the surgeon under the control of view and separate lung ventilation, until the end of the bronchus suture. Surgery allowed the patient to survive. He was then discharged alive from the hospital at day 36. Severe tracheobronchial rupture may be rapidly associated with major respiratory distress and severe hypoxemia that necessitate specialised care in referring centre. Initial orientation of these patients appears to be as important that airway and hypoxemia management.
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Affiliation(s)
- M Berend
- Département d'anesthésie-réanimation-urgences, centre hospitalier Lyon-Sud, Hospices civils de Lyon, Pierre-Bénite, France
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Wallet F, Nseir S, Baumann L, Herwegh S, Sendid B, Boulo M, Roussel-Delvallez M, Durocher AV, Courcol RJ. Preliminary clinical study using a multiplex real-time PCR test for the detection of bacterial and fungal DNA directly in blood. Clin Microbiol Infect 2009; 16:774-9. [PMID: 19689465 DOI: 10.1111/j.1469-0691.2009.02940.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Early diagnosis of sepsis, rapid identification of the causative pathogen(s) and prompt initiation of appropriate antibiotic treatment have a combined impact on mortality due to sepsis. In this observational study, a new DNA-based system (LightCycler SeptiFast (LC-SF) test; Roche Diagnostics) allowing detection of 16 pathogens at the species level and four groups of pathogens at the genus level has been evaluated and compared with conventional blood cultures (BCs). One hundred BC and LC-SF results were obtained for 72 patients admitted to the intensive-care unit over a 6-month period for suspected sepsis. Microbiological data were compared with other biological parameters and with clinical data. The positivity rate of BCs for bacteraemia/fungaemia was 10%, whereas the LC-SF test allowed detection of DNA in 15% of cases. The LC-SF performance, based on its clinical relevance, was as follows: sensitivity, 78%; specificity, 99%; positive predictive value, 93%; and negative predictive value, 95%. Management was changed for four of eight (50%) of the patients because organisms were detected by the LC-SF test but not by BC. LC-SF results were obtained in 7-15 h, in contrast to the 24-72 h required for BC. According to the LC-SF results, initial therapy was inadequate in eight patients, and antibiotic treatment was changed. Our results suggest that the LC-SF test may be a valuable complementary tool in the management of patients with clinically suspected sepsis.
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Affiliation(s)
- F Wallet
- Pôle de Microbiologie, Centre Hospitalier Universitaire de Lille, Faculte de Medicine de Lille, France
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Perbet S, Wallet F, Le Manach Y, Chaine A, Langeron O. Intubation orotrachéale puis abord transitoire sous-mental des voies aériennes pour chirurgie maxillofaciale traumatologique en urgence. ACTA ACUST UNITED AC 2009; 28:604-5. [DOI: 10.1016/j.annfar.2009.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marion-Audibert AM, Schoeffler M, Wallet F, Duperret S, Mabrut JY, Bancel B, Pere-Verge D, Wander L, Souquet JC. Acute fatal pulmonary embolism during cyanoacrylate injection in gastric varices. ACTA ACUST UNITED AC 2008; 32:926-30. [DOI: 10.1016/j.gcb.2008.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 07/26/2008] [Accepted: 07/28/2008] [Indexed: 12/13/2022]
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Viale JP, Wallet F, Schoeffler M, Robert MO, Workineh S, Duperret S. [Low tracheal rupture management]. Ann Fr Anesth Reanim 2008; 27:757-758. [PMID: 18760894 DOI: 10.1016/j.annfar.2008.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Schoeffler M, Wallet F, Robert M, Tramoni G, Workineh S, Viale J, Duperret S. Élévation de troponine I à coronarographie normale chez un patient porteur d’une myopathie de Duchenne. ACTA ACUST UNITED AC 2008; 27:345-7. [DOI: 10.1016/j.annfar.2008.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 01/08/2008] [Indexed: 11/26/2022]
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Roussel-Delvallez M, Caillaux M, Cattöen C, Decoster A, Descamps D, Graveline N, Hendricx S, Menouar M, Noulard M, Paul J, Pelletier M, Rolland C, Samaille S, Vachée A, Vasseur M, Verhaeghe A, Delpierre F, Wallet F, Courcol R. Prévalence de la résistance d’Escherichia coli isolés de prélèvements d’origine urinaire ou gastro-intestinale vis-à-vis de l’association amoxicilline-acide clavulanique et de divers antibiotiques. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1294-5501(07)88769-3] [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: 10/22/2022]
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Wallet F, Chatain G, Ceruse P, Marcotte G, Gueugniaud PY, Piriou V. [Transorbital fiberoptic intubation: a predictable difficult intubation in cephalic surgery]. ACTA ACUST UNITED AC 2006; 25:773-6. [PMID: 16707242 DOI: 10.1016/j.annfar.2006.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 02/22/2006] [Indexed: 12/20/2022]
Abstract
Management of the difficult adult airway is a crucial problem in anaesthesia. It is the first cause of anaesthetic mortality and morbidity. We report here the case of a patient who could only be intubated through the orbital cavity. We discuss our technique of intubation compared to the other rare procedures described in the literature. We also focus on our anaesthetic protocol and the interest of preserving spontaneous ventilation for intubation. Use of short acting anaesthetic drugs can help to achieve such conditions.
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Affiliation(s)
- F Wallet
- Service d'anesthésie-réanimation, CHU Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
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Zebouh M, Thomas C, Honderlick P, Lemee L, Segonds C, Wallet F, Husson MO. Étude multicentrique portant sur l'évaluation d'une méthode simplifiée d'analyse bactériologique dans la surveillance des infections bronchiques à Pseudomonas aeruginosa survenant au cours de la mucoviscidose. ACTA ACUST UNITED AC 2005; 53:490-4. [PMID: 16087300 DOI: 10.1016/j.patbio.2005.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 06/29/2005] [Accepted: 06/29/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sputum bacteriological analysis of cystic fibrosis (CF) patients colonised by Pseudomonas aeruginosa is difficult. The bronchial persistence of these bacteria involves phenotypical modifications and the many antibiotic treatments result in emergence of multiresistant strains. The aim of this study is to evaluate a new fast identification and sensitivity testing method of P. aeruginosa and other pathogenic bacteria in sputum of CF patients. It is based on applying a gradient of antibiotic (E-test strip) onto an agar plate inoculated with the sputum. OBSERVATIONS 310 sputum, collected from adults and children colonised by P. aeruginosa, were analysed by this new method. This method allowed a direct reading of the minimal concentration of antibiotic that inhibited the totality of Gram-negative strains and the detection of resistant pathogenic bacteria inside the ellipse of inhibition. Results obtained by this new method were compared with the conventional method for identification and antimicrobial sensitivity. CONCLUSION This new method, studying with CF patient colonised by P. aeruginosa, appears interesting, with a sensibility equal or higher than 89% in detection of the bacteria and their sensitivity to antibiotics. Furthermore it allows a saving of time and simplified results.
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Affiliation(s)
- M Zebouh
- Laboratoire de bactériologie-hygiène, hôpital A.-Calmette, CHRU de Lille, boulevard du Professeur-J.-Leclercq, 59037 Lille cedex, France
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Virecoulon F, Wallet F, Fruchart-Flamenbaum A, Rigot JM, Peers MC, Mitchell V, Courcol RJ. Bacterial flora of the low male genital tract in patients consulting for infertility. Andrologia 2005; 37:160-5. [PMID: 16266393 DOI: 10.1111/j.1439-0272.2005.00673.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [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: 11/28/2022] Open
Abstract
The physiological aerobic bacterial flora of the low male genital tract was determined. This prospective study was performed on 600 semen specimens collected from 543 asymptomatic males consulting for infertility. Semen cultures were sterile in 28.8%, with a polymicrobial flora and/or absence or low titres of Ureaplasma urealyticum in 49.3%, and with one or two aerobic and facultative bacteria > or =1 x 10(3) CFU ml(-1) and/or U. urealyticum with titres > or =10(4) CCU ml(-1) (colour changing units) in 21.8%. In standard aerobic cultures, Gardnerella vaginalis was the most commonly isolated species (26.1%), followed by coagulase-negative staphylococci (15.7%) and Streptococcus anginosus (14.2%). Ureaplasma urealyticum was absent in 84.5% of semen samples, but when recovered, high (> or =10(4) CCU ml(-1)) and low titres (< or =10(3) CCU ml(-1)) were counted in 7.2% and 8.3% respectively. Of 48 patients, the follow-up of semen cultures showed marked variations in time. This study shows that (i) there was no relationship between the bacterial flora and the leucocytospermia; (ii) low titres of U. urealyticum in semen were not associated with a disturbance of the ecosystem; (iii) the critical threshold for U. urealyticum should be raised to > or =10(4) CFU ml(-1) and (iv) a positive semen culture should be repeated before any treatment.
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Affiliation(s)
- F Virecoulon
- Laboratoire de Spermiologie/Histologie-Embryologie et Biologie de la Reproduction, Hôpital A. Calmette, Centre Hospitalier Regional Universitaire de Lille, 59037 Lille Cedex, France
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Verrier A, Souques M, Wallet F. Characterization of exposure to extremely low frequency magnetic fields using multidimensional analysis techniques. Bioelectromagnetics 2005; 26:266-74. [PMID: 15832337 DOI: 10.1002/bem.20075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/11/2022]
Abstract
Our lack of knowledge about the biological mechanisms of 50 Hz magnetic fields makes it hard to improve exposure assessment. To provide better information about these exposure measures, we use multidimensional analysis techniques to examine the relations between different exposure metrics for a group of subjects. We used a combination of a two stage Principal Component Analysis (PCA) followed by an ascending hierarchical classification (AHC) to identify a set of measures that would capture the characteristics of the total exposure. This analysis gives an indication of the aspects of the exposure that are important to capture to get a complete picture of the magnetic field environment. We calculated 44 metrics of exposure measures from 16 exposed EDF employees and 15 control subjects, containing approximately 20,000 recordings of magnetic field measurements, taken every 30 s for 7 days with an EMDEX II dosimeter. These metrics included parameters used routinely or occasionally and some that were new. To eliminate those that expressed the least variability and that were most highly correlated to one another, we began with an initial Principal Component Analysis (PCA). A second PCA of the remaining 12 metrics enabled us to identify from the foreground 82.7% of the variance: the first component (62.0%) was characterized by central tendency metrics, and the second (20.7%) by dispersion characteristics. We were able to use AHC to divide the entire sample (of individuals) into four groups according to the axes that emerged from the PCA. Finally, discriminant analysis tested the discriminant power of the variables in the exposed/control classification as well as those from the AHC classification. The first showed that two subjects had been incorrectly classified, while no classification error was observed in the second. This exploratory study underscores the need to improve exposure measures by using at least two dimensions: intensity and dispersion. It also indicates the usefulness of constructing a typology of magnetic field exposures.
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Affiliation(s)
- A Verrier
- Service Général de Médecine de Contrôle, EDF Gaz de France, Paris, France.
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Abstract
BACKGROUND To determine whether local complications at the site of pacemaker implantation indicate infection of the intravascular part of the lead as well as of the pacemaker pocket. METHODS 105 patients admitted for local inflammatory findings, impending pacemaker or lead exteriorisation, frank pacemaker or lead exteriorisation, or overt infection were studied prospectively. After systematic lead extraction, the initial clinical presentation was related to the results of lead cultures. RESULTS Regardless of the initial presentation, the intravascular parts of the leads gave positive cultures in 79.3% of patients. Additionally, 91.6% of the cultures of the extravascular lead segments were positive, in contrast to 38.1% positivity for wound swab cultures. No clinical observations or laboratory investigations permitted identification of patients with negative lead cultures. In a subgroup of 50 patients with manifestations strictly limited to the pacemaker implantation site, cultures of intravascular lead segments were positive in 72%. Infection recurred in 4/8 patients without complete lead body extraction (50%) v 1/97 patients (1.0%) whose leads were totally extracted (p < 0.001). CONCLUSIONS Local complications at the site of pacemaker implantation are usually associated with infection of the intravascular part of the leads, with a risk of progressing to systemic infection. Such local symptoms should prompt the extraction of leads even in the absence of other infectious manifestations.
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Affiliation(s)
- D Klug
- Department of Cardiology, University of Lille, Lille, France.
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Dumoulard B, Wallet F, Glowacki F, Courcol RJ. [Campylobacter fetus subsp fetus bacteremia in a female patient infected by the hepatitis C virus]. Ann Biol Clin (Paris) 2004; 62:587-9. [PMID: 15355811] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 06/03/2004] [Indexed: 04/30/2023]
Abstract
Campylobacter fetus subsp fetus was identified as an unusual etiologic agent of septicemia in an immuno-compromized patient VHC positive by utilizing a 16S rRNA molecular kit in our hospital's clinical laboratory. This method would appear as a performing approach to identify pathogens when discrepancies exist between phenotypical tests.
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Affiliation(s)
- B Dumoulard
- Laboratoire de bactériologie-hygiène, CHRU, Lille
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