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Chevalerias M, Coiffier G, Darrieutort-Laffite C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Le Thuaut A, Bart G, Le Goff B. Association between radiographic and functional outcome in vertebral osteomyelitis SPONDIMMO, a 6-month prospective multicenter cohort. Joint Bone Spine 2023; 90:105600. [PMID: 37330001 DOI: 10.1016/j.jbspin.2023.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to describe radiographic and functional evolution over 6 months in a large cohort of VO patients. METHODS We prospectively recruited patients with VO from 2016 to 2019 in 11 French centers. X-rays were performed at baseline, 3 months, and 6 months to assess progression using structural and static criteria. Functional impairment was evaluated using the Oswestry Disability Index (ODI) at 3 months and 6 months. RESULTS Two hundred and twenty-two patients were included. Mean age was 67.8±14 years, mostly men (67.6%). After 3 months, there was a significant increase in vertebral fusion (16.4% vs 52.7%), destruction of vertebral bodies (10.1% vs 22.8%), and of all the static features (frontal angulation (15.2% vs 24.4%), segmental (34.6% vs 56%) and regional (24.5% vs 41%) kyphosis). From 3 to 6 months, among the different X-ray abnormalities, only the complete fusion progressed significantly (16.6% vs 27.2%). Median ODI showed significant improvement from 3 to 6 months (24, IQR [11.5-38] vs 16, IQR [6-34]). At 6 months, 14.1% of the patients had a severe disability, 2% a major disability. The persistence of vertebral destruction at 6 months was associated with a higher ODI (16, IQR [7.5-30.5] vs 27, IQR [11.5-44.5]). No differences in radiological progression were observed with immobilization using a rigid brace. CONCLUSION Our study demonstrates structural and static radiographic progression after 3 months. Only the complete fusion progressed over the long-term. Functional impairment was associated with persistence of vertebral destruction.
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Affiliation(s)
| | | | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH de Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD de Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Hoppe
- Department of Rheumatology, CHU d'Angers, Angers, France
| | | | - Lydie Khatchatourian
- Department of Internal Medicine and Infectious Disease, CH de Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of Research, Methodology and Biostatistics Platform, CHU de Nantes, Nantes, France
| | - Géraldine Bart
- Department of Rheumatology and Internal Medicine, Percy Military Training Hospital, Paris, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU de Nantes, Nantes, France
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Gueguen M, Khatchatourian L, Lohéac C, Dorval I, Mercier M, Le Calloch R, Mahé K, Rizcallah MJ, Hutin P, Fangous MS, Saidani N, Le Clech L. The humoral response of mRNA COVID-19 vaccine in hematological diseases: the HEMVACO study. Infect Dis Now 2022; 52:280-285. [PMID: 35667558 PMCID: PMC9164434 DOI: 10.1016/j.idnow.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/22/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022]
Abstract
Objectives The HEMVACO study evaluated the humoral response after mRNA anti-SARS-CoV-2 vaccination in an hematological cohort. Methods HEMVACO was a prospective, multicentric study registered in ClinicalTrials.gov, number NCT04852796. Patients received two or three doses of BNT162b2 vaccine or mRNA-1273 vaccine. The SARS-CoV-2 TrimericS IgG titers were measured 1, 3, 6 and 12 months after the second dose. Results Only 16 patients (11.6%) were naive of hematological treatment and 77 patients (55.8%) were on active treatment for hemopathy. Among the 138 analyzed patients, positive antibody titer at 1 month was obtained in 68.1% of patients with mean serology at 850±883 BAU/ml. Risk factors for vaccine failure were anti-CD20 therapy (OR = 111[14.3-873]; P < 0.001), hypogammaglobulinemia under 8 g/L (OR = 2.49[1.05-5.92]; P = 0.032) and lymphopenia under 1.5G/L (OR = 2.47[1.18-5.17]; P = 0.015). Anti-CD20 therapy induced no anti-SARS-CoV-2 seroconversion (96%). Seventy-eight patients (56.5%) received a third dose and could reach the SARS-CoV-2 TrimericS IgG titer of high-risk patients (P = 0.54). The median titer at 379 BAU/ml distinguished two groups of vaccine response (99±121 BAU/ml versus 1,109±678 BAU/ml). Conclusion Vaccination should be performed before anti-CD20 therapy if the hemopathy treatment can be delayed. Administration of the third vaccine dose was interesting for patients with suboptimal response, defined by a 379 BAU/ml titer in our study.
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Affiliation(s)
- M Gueguen
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France
| | - L Khatchatourian
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France
| | - C Lohéac
- Department of Nephrology, Hospital Centre Cornouaille Quimper, France
| | - I Dorval
- Laboratory, Hospital Centre Cornouaille Quimper, France
| | - M Mercier
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Bretagne Atlantique Vannes, France
| | - R Le Calloch
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France
| | - K Mahé
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France
| | - M J Rizcallah
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France; Department of Nephrology, Hospital Centre Cornouaille Quimper, France; Laboratory, Hospital Centre Cornouaille Quimper, France; Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Bretagne Atlantique Vannes, France; Department of Hematology, Hospital Centre Cornouaille Concarneau, France
| | - P Hutin
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France; Department of Nephrology, Hospital Centre Cornouaille Quimper, France; Laboratory, Hospital Centre Cornouaille Quimper, France; Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Bretagne Atlantique Vannes, France; Department of Hematology, Hospital Centre Cornouaille Concarneau, France
| | - M S Fangous
- Laboratory, Hospital Centre Cornouaille Quimper, France
| | - N Saidani
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France
| | - L Le Clech
- Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Cornouaille Quimper, France; Department of Nephrology, Hospital Centre Cornouaille Quimper, France; Laboratory, Hospital Centre Cornouaille Quimper, France; Department of Internal Medicine, Infectious Diseases and Hematology, Hospital Centre Bretagne Atlantique Vannes, France; Department of Hematology, Hospital Centre Cornouaille Concarneau, France.
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Pluart AL, Coiffier G, Darrieutort-Lafitte C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Thuaut AL, Goff BL, Bart G. Spine immobilization and neurological outcome in Vertebral Osteomyelitis. SPONDIMMO, a prospective multicentric cohort. Joint Bone Spine 2021; 89:105333. [PMID: 34954077 DOI: 10.1016/j.jbspin.2021.105333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of our study was to describe spine immobilization in a multicentric cohort of vertebral osteomyelitis (VO), and evaluate its association with neurological complications during follow-up. METHODS We prospectively included patients from 2016 to 2019 in 11 centers. Immobilization, imaging, and neurological findings were specifically analyzed during a 6-month follow-up period. RESULTS 250 patients were included, mostly men (67.2%, n=168). Mean age was 66.7 ± 15 years. Diagnosis delay was 25 days. The lumbo-sacral spine was most frequently involved (56.4%). At diagnosis, 25.6% patients (n=64) had minor neurological signs and 9.2% (n=23) had major ones. Rigid bracing was prescribed for 63.5% (n=162) of patients, for a median of 6 weeks, with variability between centers (p<0.001). The presence of epidural inflammation and abscess on imaging was associated with higher rates of rigid bracing prescription (OR 2.33, p=0.01). Frailness and endocarditis were negatively associated with rigid bracing prescription (OR 0.65, p<0.01, and OR 0.42, p<0.05, respectively). During follow up, new minor or major neurological complications occurred in respectively 9.2% (n=23) and 6.8% (n=17) of patients, with similar distribution between immobilized and non-immobilized patients. CONCLUSION Spine immobilization prescription during VO remains heterogeneous and seems associated inflammatory lesions on imaging but negatively associated with frailness and presence of endocarditis. Neurological complications can occur despite rigid bracing. Our data suggest that in absence of any factor associated with neurological complication spine bracing might not be systematically indicated. We suggest that spine immobilization should be discussed for each patient after carefully evaluating their clinical signs and imaging findings.
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Affiliation(s)
| | - Guillaume Coiffier
- Department of Rheumatology, CHU Rennes, Rennes, France; Department of Rheumatology, GHT Rance-Emeraude, CH Dinan/Saint-Malo, France
| | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Kremlin-Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Lydie Khatchatourian
- Department of internal medicine and infectious disease, CH Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of research, Methodology and Biostatistics platform, CHU Nantes, Nantes, France
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Gueguen L, Loheac C, Saidani N, Khatchatourian L. Membranous nephropathy following anti-COVID-19 mRNA vaccination. Kidney Int 2021; 100:1140-1141. [PMID: 34419553 PMCID: PMC8376522 DOI: 10.1016/j.kint.2021.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Lorraine Gueguen
- Department of Nephrology, Cornouaille Hospital Quimper, Quimper, France.
| | - Charlotte Loheac
- Department of Nephrology, Cornouaille Hospital Quimper, Quimper, France
| | - Nadia Saidani
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
| | - Lydie Khatchatourian
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
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5
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Cloarec E, Gloaguen A, Saidani N, Khatchatourian L. « Et si nous vaccinions directement dans les services? » Évaluation de la tolérance du vaccin AztraZeneca chez les soignants sur la première semaine de campagne vaccinale. Infect Dis Now 2021. [PMCID: PMC8327576 DOI: 10.1016/j.idnow.2021.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Dans ce contexte de crise sanitaire, la vaccination est un enjeu majeur pouvant permettre le contrôle de la pandémie liée au SARS-CoV-2. Dès janvier 2021, les professionnels de santé (PDS) de plus de 50 ans ou avec facteurs de risque sont devenus éligibles aux vaccins à ARNm. L’autorisation de mise sur le marché du vaccin AztraZeneca (AZ) a permis d’étendre l’indication vaccinale à tous les PDS début février 2021. Matériels et méthodes La vaccination AZ a débuté dans notre établissement le 09/02/2021 et s’est initialement organisée dans plusieurs services considérés à risque afin d’optimiser l’offre vaccinale. Les cadres de chaque unité ont recensé les soignants volontaires à la vaccination et un binôme IDE/médecin s’est déplacé dans chaque service afin d’effectuer la consultation médicale et la vaccination. Un premier recensement des effets secondaires post-vaccinaux a spontanément été réalisé par les cadres devant les nombreux symptômes rapportés dans les 24 h suivant l’injection, puis complété par les IDE du centre de vaccination sur appel des PDS vaccinés. Résultats Du 09 au 12/02/21, 144 soignants ont été vaccinés avec l’AZ dont 107 femmes (74 %). L’âge médian était de 38 ans [22-58]. Parmi eux, on dénombrait 26% de médecins/internes, 48 % IDE/IADE, 13 % d’AS, 9 % de sages-femmes/auxiliaires puéricultrices et 13 % d’autres catégories. Les principaux services concernés étaient l’oncologie (7,6 %), l’hématologie-maladies infectieuses (5,6 %), la médecine polyvalente (7,6 %), les urgences/SMUR (22,9 %), la réanimation (13,2 %), la rhumatologie-pneumologie (6,3 %), la gastro-entérologie (4,2 %), le pôle mère-enfant (18,1 %). Les données de tolérance ont pu être recueillies chez 127 soignants (88 %). Seulement 27 vaccinés (21 %) n’ont présenté aucun symptôme post-vaccinal. Les principaux symptômes décrits étaient : fièvre (41 %), frissons (35 %), asthénie (34 %), courbatures (37 %), céphalées (31 %), douleurs au site d’injection (9 %) et troubles digestifs (6 %). Ces symptômes semblaient plus fréquents chez les femmes (82 % vs 71 %) (OR 1,86 [IC 95 % 0,75-4,61], p = 0,18), et étaient significativement plus élevés chez les PDS de moins de 35 ans (90% vs 72%) (OR 3,46 [IC 95% 1,21-9,86], p = 0,02). Ces effets secondaires ont généré 7 arrêts de travail. Une soignante a été prise en charge au SAU 4 jours après la vaccination pour un tableau de dyspnée progressive dont le lien avec la vaccination n’a pas été définitivement établi. Conclusion Si l’idée de vacciner directement dans les services semblait séduisante afin de pouvoir vacciner rapidement les soignants les plus exposés au SARS-CoV-2, la tolérance modérée de ce vaccin a donné lieu à la suspension de la campagne organisée dans les unités afin d’éviter un nombre trop important d’arrêts de travail sur la même période. Elle s’est secondairement mise en place de manière échelonnée au centre de vaccination Covid-19 de l’établissement. Même si les symptômes systémiques observés ont été fréquents, ils restent cependant superposables aux données de tolérance issues des études cliniques du vaccin AZ.
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Martinet P, Khatchatourian L, Saidani N, Fangous MS, Goulon D, Lesecq L, Le Gall F, Guerpillon B, Corre R, Bizien N, Talarmin JP. Hypermetabolic pulmonary lesions on FDG-PET/CT: Tularemia or neoplasia? Infect Dis Now 2021; 51:607-613. [PMID: 34242840 DOI: 10.1016/j.idnow.2021.06.307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pulmonary tularemia is a rare and little-known disease, whose clinical and radiological presentation can be confused with those of much more frequent pathologies, such as lung cancer or B-cell lymphoma (46,000 and 5,000 new cases respectively per year in France). Furthermore, PET/CT is a powerful tool for the diagnosis of malignancies or the exploration of fever of unknown origin. The objective of this study was to describe the characteristics of pulmonary tularemia and to determine whether its PET/CT aspect could help distinguish it from neoplasia. METHODS Retrospective observational study collecting all pulmonary tularemia cases for which a PET/CT was performed between 2016 and 2020. RESULTS Twenty-seven cases of pulmonary tularemia were analyzed. The sex ratio was 4.4, and the median age was 60 years. Clinical manifestations were mainly represented by fever (n=23), arthralgia (n=7) and cough (n=6). PET/CT revealed intensely hypermetabolic mediastinal adenopathies in all cases, associated with parenchymal (n=20) or pleural (n=6) lesions, suggesting neoplastic pathology in 15 patients. Cytopuncture or lymph node biopsy was performed in 16 patients, revealing non-specific adenitis (n=8), necrotic epithelio-gigantocellular granuloma (n=3), or were non-contributory (n=5). All patients reported significant environmental exposure. The outcome was favorable for all patients, spontaneously for 8 of them and after antibiotic therapy with either doxycycline or ciprofloxacin for the other 19. CONCLUSIONS Depending on the epidemiological setting, pulmonary tularemia may be considered an alternative diagnosis to lung cancer, lymphoma, or tuberculosis, in the presence of infectious symptoms and hypermetabolic pulmonary lesions and mediastinal lymphadenopathies on PET/CT.
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Affiliation(s)
- Pauline Martinet
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Lydie Khatchatourian
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Nadia Saidani
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Marie-Sarah Fangous
- Department of Microbiology, Centre Hospitalier de Cornouaille, Quimper, France
| | - Dorothée Goulon
- Department of Nuclear Medicine, Centre Georges Charpak, Quimper, France
| | - Ludovic Lesecq
- Department of Infectious Diseases, Clinique Saint Michel, Quimper, France
| | - Florence Le Gall
- Department of Microbiology, Centre Hospitalier de Cornouaille, Quimper, France
| | - Brice Guerpillon
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Romain Corre
- Department of Pulmonary Diseases, Centre Hospitalier de Cornouaille, Quimper, France
| | - Nicolas Bizien
- Department of Pulmonary Diseases, Centre Hospitalier de Cornouaille, Quimper, France
| | - Jean-Philippe Talarmin
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France.
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Asquier-Khati A, Deschanvres C, Boutoille D, Lefebvre M, Le Turnier P, Gaborit B, Lakhal K, Buffenoir K, Khatchatourian L, Asseray N. Switch from parenteral to oral antibiotics for brain abscesses: a retrospective cohort study of 109 patients. J Antimicrob Chemother 2021; 75:3062-3066. [PMID: 32699907 DOI: 10.1093/jac/dkaa285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Brain abscess is one of the most serious diseases of the CNS and is associated with high morbidity and mortality. With regard to the lack of data supporting an optimal therapeutic strategy, this study aimed to explore the prognostic factors of brain abscess, putting emphasis on the impact of therapeutic decisions. METHODS We retrospectively included patients hospitalized for brain abscess during a period of 13 years. Comorbidities (Charlson scale), clinical presentation, microbiology culture, radiological features and therapeutic management were collected. Glasgow Outcome Scale (GOS) at 3 months and length of hospital stay were, respectively, the main and the secondary outcomes. Logistic regression was used to determine factors associated with outcome independently. RESULTS Initial Glasgow Coma Scale (GCS) ≤14 and comorbidities (Charlson scale ≥2) were associated with poor neurological outcome while oral antibiotic switch was associated with better neurological outcome. Oral switch did not appear to be associated with an unfavourable evolution in the subset of patients without initial neurological severity (GCS >14) on admission. Duration of IV regimen and time to oral switch were associated with the length of inpatient stay. CONCLUSIONS This study confirms the role of GCS and comorbidities as prognostic factors and presents reassuring data regarding the safety of oral switch for the antibiotic treatment of brain abscesses. Oral switch could prevent catheter-induced iatrogenic complications and allow a higher quality of life for patients.
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Affiliation(s)
| | | | | | | | | | | | - Karim Lakhal
- Intensive Care Unit, CHU Laënnec, Nantes, France
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8
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Martinet P, Khatchatourian L, Saidani N, Fangous M, Le Gall F, Lesecq L, Bizien N, Goulon D, Talarmin J. Et si ce n’était pas un cancer ? À propos de 13 cas de tularémie pulmonaire. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.421] [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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9
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Lécuyer R, Boutoille D, Khatchatourian L, Ducloyer JB, Gibaud S, Raffi F, Gaborit B. Listeria Endophthalmitis Cured With Linezolid in an Immunocompetent Farmer Woman: Hazard of a Sweep of a Cow's Tail. Open Forum Infect Dis 2020; 6:ofz459. [PMID: 32377543 PMCID: PMC7194287 DOI: 10.1093/ofid/ofz459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022] Open
Abstract
We report the first case of an unexpected exogenous Listeria monocytogenes endophthalmitis in a previously healthy woman after a cow’s tail’s sweep, successfully treated with surgery and linezolid. It is the first case carried out with linezolid to treat Listeria endophthalmitis. Therefore, it may challenge the requirement for intravenous antibiotics for long-term treatment.
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Affiliation(s)
- Romain Lécuyer
- Infectious Diseases Department, Hotel-Dieu Hospital and INSERM Clinical Investigation Center, Nantes University Hospital, Nantes, France.,Equipe d'Accueil 3826 Thérapeutiques Cliniques et Expérimentales des Infections, University of Nantes, Nantes, France
| | - David Boutoille
- Infectious Diseases Department, Hotel-Dieu Hospital and INSERM Clinical Investigation Center, Nantes University Hospital, Nantes, France.,Equipe d'Accueil 3826 Thérapeutiques Cliniques et Expérimentales des Infections, University of Nantes, Nantes, France
| | - Lydie Khatchatourian
- Infectious Diseases Department, Hotel-Dieu Hospital and INSERM Clinical Investigation Center, Nantes University Hospital, Nantes, France
| | - Jean-Baptiste Ducloyer
- Department of Ophthalmology, Hotel-Dieu Hospital, Nantes University Hospital, Nantes, France
| | - Sophie Gibaud
- Department of Bacteriology and Hygiene, Hotel-Dieu Hospital, Nantes University Hospital, Nantes, France
| | - François Raffi
- Infectious Diseases Department, Hotel-Dieu Hospital and INSERM Clinical Investigation Center, Nantes University Hospital, Nantes, France
| | - Benjamin Gaborit
- Infectious Diseases Department, Hotel-Dieu Hospital and INSERM Clinical Investigation Center, Nantes University Hospital, Nantes, France.,Equipe d'Accueil 3826 Thérapeutiques Cliniques et Expérimentales des Infections, University of Nantes, Nantes, France
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10
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Gaborit BJ, Tessoulin B, Lavergne RA, Morio F, Sagan C, Canet E, Lecomte R, Leturnier P, Deschanvres C, Khatchatourian L, Asseray N, Garret C, Vourch M, Marest D, Raffi F, Boutoille D, Reignier J. Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study. Ann Intensive Care 2019; 9:131. [PMID: 31776705 PMCID: PMC6881486 DOI: 10.1186/s13613-019-0604-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 07/26/2019] [Accepted: 11/13/2019] [Indexed: 01/11/2023] Open
Abstract
Background Pneumocystis jirovecii pneumonia (PJP) remains a severe disease associated with high rates of invasive mechanical ventilation (MV) and mortality. The objectives of this study were to assess early risk factors for severe PJP and 90-day mortality, including the broncho-alveolar lavage fluid cytology profiles at diagnosis. Methods We prospectively enrolled all patients meeting pre-defined diagnostic criteria for PJP admitted at Nantes university hospital, France, from January 2012 to January 2017. Diagnostic criteria for PJP were typical clinical features with microbiological confirmation of P. jirovecii cysts by direct examination or a positive specific quantitative real-time polymerase chain reaction (PCR) assay. Severe PJP was defined as hypoxemic acute respiratory failure requiring high-flow nasal oxygen with at least 50% FiO2, non-invasive ventilation, or MV. Results Of 2446 respiratory samples investigated during the study period, 514 from 430 patients were positive for P. jirovecii. Of these 430 patients, 107 met criteria for PJP and were included in the study, 53 (49.5%) patients had severe PJP, including 30 who required MV. All patients were immunocompromised with haematological malignancy ranking first (n = 37, 35%), followed by solid organ transplantation (n = 27, 25%), HIV-infection (n = 21, 20%), systemic diseases (n = 13, 12%), solid tumors (n = 12, 11%) and primary immunodeficiency (n = 6, 8%). By multivariate analysis, factors independently associated with severity were older age (OR, 3.36; 95% CI 1.4–8.5; p < 0.05), a P. jirovecii microscopy-positive result from bronchoalveolar lavage (BAL) (OR, 1.3; 95% CI 1.54–9.3; p < 0.05); and absence of a BAL fluid alveolitis profile (OR, 3.2; 95% CI 1.27–8.8; p < 0.04). The 90-day mortality rate was 27%, increasing to 50% in the severe PJP group. Factors independently associated with 90-day mortality were worse SOFA score on day 1 (OR, 1.05; 95% CI 1.02–1.09; p < 0.001) whereas alveolitis at BAL was protective (OR, 0.79; 95% CI 0.65–0.96; p < 0.05). In the subgroup of HIV-negative patients, similar findings were obtained, then viral co-infection were independently associated with higher 90-day mortality (OR, 1.25; 95% CI 1.02–1.55; p < 0.05). Conclusions Older age and P. jirovecii oocysts at microscopic examination of BAL were independently associated with severe PJP. Both initial PJP severity as evaluated by the SOFA score and viral co-infection predicted 90-day mortality. Alveolitis at BAL examination was associated with less severe PJP. The pathophysiological mechanism underlying this observation deserves further investigation.
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Affiliation(s)
- Benjamin Jean Gaborit
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France. .,EA 3826, Laboratory of Clinical and Experimental Therapeutics of Infections, IRS2-Nantes Biotech, Nantes, France.
| | - Benoit Tessoulin
- Service d'Hématologie, University Hospital, INSERM, U1232, Université de Nantes, Nantes, France
| | - Rose-Anne Lavergne
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, University Hospital, Nantes, France
| | - Florent Morio
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, University Hospital, Nantes, France
| | | | - Emmanuel Canet
- Medical Intensive Care, University Hospital, Nantes, France
| | - Raphael Lecomte
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | - Paul Leturnier
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | - Colin Deschanvres
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | - Lydie Khatchatourian
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | - Nathalie Asseray
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | | | - Michael Vourch
- Medical Intensive Care, University Hospital, Nantes, France
| | | | - François Raffi
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, Hôtel-Dieu University Hospital, University Hospital of Nantes and CIC 1413, INSERM, 1 Place Alexis-Ricordeau, 44000, Nantes, France.,EA 3826, Laboratory of Clinical and Experimental Therapeutics of Infections, IRS2-Nantes Biotech, Nantes, France
| | - Jean Reignier
- Medical Intensive Care, University Hospital, Nantes, France
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11
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Dinh A, Duran C, Pavese P, Khatchatourian L, Monnin B, Bleibtreu A, Denis E, Etienne C, Rouanes N, Mahieu R, Bouchand F, Davido B, Lotte R, Cabaret P, Camou F, Chavanet P, Assi A, Limonta S, Lechiche C, Riou R, Courjon J, Illes G, Lacassin-Beller F, Senneville E. French national cohort of first use of dalbavancin: A high proportion of off-label use. Int J Antimicrob Agents 2019; 54:668-672. [PMID: 31400471 DOI: 10.1016/j.ijantimicag.2019.08.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft-tissue infections (SSTIs), but its real-life use is not well known. The aim of this study was to describe all first prescriptions in France over an 16-month period. A retrospective study on all adult patients receiving at least one dose of dalbavancin from 1 June 2017 to 31 September 2018 was performed (75 patients from 29 French hospitals). Data were collected via a standard questionnaire. Failure was defined as persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment, and/or death from infection. The main indications were bone and joint infection (BJI) (64.0%), endocarditis (25.3%), and SSTI (17.3%). The main bacteria involved were Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%), and coagulase-negative staphylococci (44.4%). Median minimum inhibitory concentrations (MICs) for staphylococci to vancomycin and dalbavancin ranged from 0.875-2.0 mg/L and 0.032-0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. The main treatment regimens for dalbavancin were a two-dose regimen (1500 mg each) in 38 cases (50.7%) and a single-dose regimen (1500 mg) in 13 cases (17.3%). Overall, at the patient's last visit, clinical cure was observed in 54/68 patients, whilst failure was observed in 14/68 patients. First use of dalbavancin in France was mostly off-label. Most were due to BJI, often as rescue therapy for severe infections. Even in off-label situations, dalbavancin appears safe and effective.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France.
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France
| | - Patricia Pavese
- Infectious Disease Unit, University Hospital of Grenoble, Grenoble, France
| | | | - Boris Monnin
- Infectious Disease Department, University Hospital of Montpellier, Montpellier, France
| | - Alexandre Bleibtreu
- Infectious Disease Unit, La Pitié-Salpétrière University Hospital, AP-HP, Paris, France
| | - Eric Denis
- Infectious Disease Unit, Hospital of Antibes, Antibes, France
| | - Cédric Etienne
- Infectiologie transversale, Hospital of Grasse, Grasse, France
| | - Nicolas Rouanes
- Infectious Disease Unit, Hospital of Périgueux, Périgueux, France
| | - Rafael Mahieu
- Infectious Disease Unit, University Hospital of Angers, Angers, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France
| | - Romain Lotte
- Bacteriology Laboratory, University Hospital of Nice, Nice, France
| | - Philippe Cabaret
- Antimicrobial Stewardship Team, Saint Philibert-Saint Vincent de Paul Hospitals, GHICL, Lille, France
| | - Fabrice Camou
- Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Pascal Chavanet
- Infectious Disease Department, University Hospital of Dijon, Dijon, France
| | - Assi Assi
- Antimicrobial Stewardship Team, Les Fleurs Clinic, Toulon, France
| | - Silvia Limonta
- Infectious Disease Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Raphaëlle Riou
- Infectious Disease Unit, Hotel-Dieu University Hospital, Nantes, France
| | - Johan Courjon
- Infectious Disease Unit, University Hospital of Nice, Nice, France
| | - Gabriela Illes
- Infectious Disease Unit, Hospital of Mont-de-Marsan, Mont-de-Marsan, France
| | | | - Eric Senneville
- Infectious Disease Unit, Hospital of Tourcoing, Tourcoing, France
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12
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Guillemette L, Dozias G, Harry M, Briand T, Khatchatourian L, Saidani N, Talarmin J, Partant C. Consultations pharmaceutiques pour les patients sous antibiothérapie au long cours dans le cadre des Infections Ostéo-Articulaires (IOA). Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.133] [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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13
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Asquier-Khati A, Deschanvres C, Boutoille D, Lakhal K, Buffenoir K, Khatchatourian L, Asseray N. Abcès cérébraux à pyogènes : facteurs pronostiques et intérêt du relais des antibiotiques par voie orale au sein d’une cohorte rétrospective de 109 patients. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Allavena C, Volteau C, André-Garnier E, Guimard T, Hall N, Khatchatourian L, Morrier M, Billaud E, Rodallec A, Reliquet V, Jovelin T, Le Guen L, Perré P, Grégoire M, Raffi F. Switching from abacavir/lamivudine plus nevirapine to abacavir/lamivudine/dolutegravir in virologically controlled HIV-infected adults (SWAD study). Med Mal Infect 2018; 49:505-510. [PMID: 30583867 DOI: 10.1016/j.medmal.2018.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/05/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The metabolic pathways of dolutegravir suggest a potential predator effect of nevirapine on dolutegravir pharmacokinetics and switching from a nevirapine- to a dolutegravir-containing regimen could lead to a lower and suboptimal exposure to dolutegravir several weeks after the switch in case of persistent inducer effect. PATIENTS AND METHOD Prospective, pilot, single-arm, open-label, non-comparative, bicentric study to evaluate the pharmacokinetics, virologic outcomes, safety, and patient satisfaction of switching from abacavir/lamivudine and nevirapine to a single tablet of abacavir/lamivudine/dolutegravir. The primary endpoint was the maintenance of virologic suppression (HIV-1 RNA<50 copies/mL) at week 12. Secondary endpoints were virologic suppression at week 48, safety and tolerability, patient satisfaction, and pharmacokinetic interaction between nevirapine and dolutegravir. Fifty-three adults on stable abacavir/lamivudine and nevirapine regimen for a median duration of 6years and virologically suppressed for 9.6years were included. RESULTS Dolutegravir reached steady state by week 4/week 12 when expected by day 5/day 10. All subjects maintained plasma HIV-RNA˂50 copies/mL at week 12 and week 48. Abacavir/lamivudine/dolutegravir was well-tolerated, with two cases of serious adverse events deemed unrelated to study drugs (coronary syndrome in both cases), and one discontinuation for renal impairment at week 24 with a slight improvement after dolutegravir discontinuation. Level of treatment satisfaction remained high after the switch. CONCLUSION The transient predator effect of nevirapine on dolutegravir had no clinical consequences after switching from nevirapine to dolutegravir, neither on safety nor maintenance of virologic suppression. It also had no consequences on patient satisfaction.
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Affiliation(s)
- C Allavena
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France; Inserm UIC 1413, CHU de Nantes, 44000 Nantes, France.
| | - C Volteau
- Plateforme de biométrie, CHU de Nantes, 44000 Nantes, France
| | - E André-Garnier
- Inserm UIC 1413, CHU de Nantes, 44000 Nantes, France; Service de virologie, CHU de Nantes, 44000 Nantes, France
| | - T Guimard
- Service de médecine interne, CHD Vendée, 85000 La Roche-sur-Yon, France
| | - N Hall
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France
| | - L Khatchatourian
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France
| | - M Morrier
- Service de virologie, CHU de Nantes, 44000 Nantes, France
| | - E Billaud
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France; Inserm UIC 1413, CHU de Nantes, 44000 Nantes, France
| | - A Rodallec
- Inserm UIC 1413, CHU de Nantes, 44000 Nantes, France; Service de virologie, CHU de Nantes, 44000 Nantes, France
| | - V Reliquet
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France; Inserm UIC 1413, CHU de Nantes, 44000 Nantes, France
| | - T Jovelin
- COREVIH Pays de la Loire, CHU de Nantes, 44000 Nantes, France
| | - L Le Guen
- Service de virologie, CHU de Nantes, 44000 Nantes, France
| | - P Perré
- Service de médecine interne, CHD Vendée, 85000 La Roche-sur-Yon, France
| | - M Grégoire
- Service de pharmacologie clinique, CHU de Nantes, 44000 Nantes, France; EA 3826 thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44000 Nantes, France
| | - F Raffi
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France; Inserm UIC 1413, CHU de Nantes, 44000 Nantes, France
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15
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Raffi F, Hanf M, Ferry T, Khatchatourian L, Joly V, Pugliese P, Katlama C, Robineau O, Chirouze C, Jacomet C, Delobel P, Poizot-Martin I, Ravaux I, Duvivier C, Gagneux-Brunon A, Rey D, Reynes J, May T, Bani-Sadr F, Hoen B, Morrier M, Cabie A, Allavena C. Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen. J Antimicrob Chemother 2018; 72:3425-3434. [PMID: 28961719 DOI: 10.1093/jac/dkx300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023] Open
Abstract
Objectives We investigated the risk of virological rebound in HIV-1-infected patients achieving virological suppression on first-line combined ART (cART) according to baseline HIV-1 RNA, time to virological suppression and type of regimen. Patients and methods Subjects were 10 836 adults who initiated first-line cART (two nucleoside or nucleotide reverse transcriptase inhibitors + efavirenz, a ritonavir-boosted protease inhibitor or an integrase inhibitor) from 1 January 2007 to 31 December 2014. Cox proportional hazards models with multiple adjustment and propensity score matching were used to investigate the effect of baseline HIV-1 RNA and time to virological suppression on the occurrence of virological rebound. Results During 411 436 patient-months of follow-up, risk of virological rebound was higher in patients with baseline HIV-1 RNA ≥100 000 copies/mL versus <100 000 copies/mL, in those achieving virological suppression in > 6 months versus <6 months, and lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. Baseline HIV-1 RNA >100 000 copies/mL was associated with virological rebound for ritonavir-boosted protease inhibitors but not for efavirenz or integrase inhibitors. Time to virological suppression >6 months was strongly associated with virological rebound for all regimens. Conclusions In HIV-1-infected patients starting cART, risk of virological rebound was lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. These data, from a very large observational cohort, in addition to the more rapid initial virological suppression obtained with integrase inhibitors, reinforce the positioning of this class as the preferred one for first-line therapy.
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Affiliation(s)
- François Raffi
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- INSERM CIC 1413, Nantes University Hospital, Nantes, France.,INSERM UMR 1181 B2PHI, Versailles Saint Quentin University, Institut Pasteur, Villejuif, France
| | - Tristan Ferry
- Infectious and Tropical Diseases Department, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Lydie Khatchatourian
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Véronique Joly
- Infectious Diseases Department, Hôpital Bichat, AP-HP, Paris, France.,National Institute of Health and Medical Research (INSERM) IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France
| | - Christine Katlama
- Department of Infectious Diseases, Assistance publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France.,Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Unité Mixte de Recherche en Santé 1136, Inserm, Paris and Université Pierre et Marie Curie Paris 06, Sorbonne Universités, Paris, France
| | - Olivier Robineau
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Catherine Chirouze
- Infectious Diseases Department, University Hospital of Besançon, UMR CNRS 6249, University of Bourgogne-Franche Comté, Besançon, France
| | - Christine Jacomet
- Infectious Diseases Department, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Delobel
- INSERM, UMR1043, Toulouse and Université Toulouse III Paul Sabatier, Toulouse, France.,Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, Toulouse, France
| | - Isabelle Poizot-Martin
- Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Immuno-Hematology Clinic, Marseille, France.,Inserm U912 (SESSTIM), Marseille, France
| | - Isabelle Ravaux
- Department of Infectious Diseases, Aix-Marseille University, APHM, Hôpital de La Conception, Marseille, France
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Centre, Paris, France.,Medical Centre of Pasteur Institut, Necker-Pasteur Infectiology Centre, Paris, France.,EA7327, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - David Rey
- Centre for HIV Infection Care, Strasbourg, France
| | - Jacques Reynes
- Infectious Diseases Department, UMI233 INSERM U1175, Montpellier University Hospital, Montpellier, France
| | - Thierry May
- Department of Infectious Diseases, University Hospital Centre, Nancy, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology Reims Teaching Hospitals, University of Reims, Reims, France
| | - Bruno Hoen
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Point-á-Pitre, France.,Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Marine Morrier
- Departement of Infectious Diseases, CHD Vendee, La Roche sur yon, France
| | - André Cabie
- Infectious Diseases Department, University Hospital of Martinique, Fort-de-France, France
| | - Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
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16
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Takoudju E, Bémer P, Touchais S, Asseray N, Corvec S, Khatchatourian L, Serandour N, Boutoille D. Bacteriological relevance of linezolid vs. vancomycin in postoperative empirical treatment of osteoarticular infections: a retrospective single-center study. Int J Antimicrob Agents 2018; 52:663-666. [PMID: 29751119 DOI: 10.1016/j.ijantimicag.2018.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/18/2018] [Accepted: 04/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2015, our center replaced vancomycin with linezolid for the postoperative empirical treatment of osteoarticular infections (OAI). OBJECTIVES To assess the bacteriological relevance of linezolid for orthopedic postoperative probabilistic antibiotic therapy. METHODS Analysis of an observational cohort of patients empirically treated with a combination of linezolid and piperacillin/tazobactam during the immediate postoperative stage for an OAI between July 1st 2015 and July 1st 2016, in a French reference center. RESULTS Seventy-seven of 126 patients who received a probabilistic postoperative combination of linezolid with piperacillin/tazobactam had microbiological proof of infection. Sixty-six of 77 OAI involved material, including an osteosynthesis in 45 cases (68%) and prosthesis in 21 cases (32%). Infection was due to Gram-positive bacteria in 62 cases (80.5%), mostly S. aureus (n=32, 41.6%), and S. epidermidis (n=14, 18.2%) accounting for 74.2% of Gram-positive bacteria. Among 14 OAI due to S. epidermidis, 11 (78.6%) were due to methicillin-resistant strains. All the S. aureus and S. epidermidis strains were susceptible to linezolid (MICs ≤ 4 mg/L), except in one patient previously treated with linezolid who was infected with a linezolid-resistant S. epidermidis strain (MIC > 256 mg/L). CONCLUSION Linezolid can be used empirically in postoperative antibiotic therapy of OAI before obtaining definitive microbial results. Although linezolid resistance is rare in this population, previous oxazolidinone treatment should be documented before initiation of probabilistic postoperative treatment to highlight potential linezolid resistance.
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Affiliation(s)
- E Takoudju
- Bacteriology-Hospital Hygiene Unit, Nantes University Hospital, Nantes, France
| | - P Bémer
- Bacteriology-Hospital Hygiene Unit, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - S Touchais
- Department of Orthopedic Surgery, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - N Asseray
- Infectious Diseases Department, Nantes University Hospital, CIC UIC 1413 INSERM, CHU Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - S Corvec
- Bacteriology-Hospital Hygiene Unit, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - L Khatchatourian
- Infectious Diseases Department, Nantes University Hospital, CIC UIC 1413 INSERM, CHU Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - N Serandour
- Pharmacy Department, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - D Boutoille
- Infectious Diseases Department, Nantes University Hospital, CIC UIC 1413 INSERM, CHU Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France.
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17
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Raffi F, Hanf M, Ferry T, Khatchatourian L, Joly V, Pugliese P, Katlama C, Robineau O, Chirouze C, Jacomet C, Delobel P, Poizot-Martin I, Ravaux I, Duvivier C, Gagneux-Brunon A, Rey D, Reynes J, May T, Bani-Sadr F, Hoen B, Morrier M, Cabie A, Allavena C. Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen. J Antimicrob Chemother 2017; 72:3502. [PMID: 29121210 DOI: 10.1093/jac/dkx383] [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: 11/12/2022] Open
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Lavergne RA, Kandel-Aznar C, Khatchatourian L, Garcia-Hermoso D, Jeddi F, Boutoille D, Morio F, Le Pape P. Emmonsia pasteuriana : une cause rare d’infection fongique chez l’immunodéprimé. J Mycol Med 2017. [DOI: 10.1016/j.mycmed.2017.04.025] [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] [Indexed: 10/18/2022]
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Eschapasse E, Khatchatourian L, Biron C, Brochard J, Raffi F, Lefevre M, Boutoille D. Deux cas d’anémies hémolytiques auto-immunes inaugurales de tuberculose pulmonaire bacillifère. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.253] [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: 10/19/2022]
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Brochard J, Khatchatourian L, Woaye-Hune P, Biron C, Lefebvre M, Denis-Musquer M, Grange P, Dupin N, Raffi F. Immune reconstitution inflammatory syndrome presenting as secondary syphilis with polymorphous erythema and knee arthritis. J Eur Acad Dermatol Venereol 2017; 31:e381-e382. [DOI: 10.1111/jdv.14196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Brochard
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - L. Khatchatourian
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - P. Woaye-Hune
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - C. Biron
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - M. Lefebvre
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - M. Denis-Musquer
- Department of Pathology; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - P. Grange
- Faculté de Médecine; INSERM; Institut Cochin U1016; Laboratoire de Dermatologie-CNR Syphilis and AP-HP; Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca; Service de Dermatologie-Vénéréologie; Université Sorbonne Paris Descartes; Paris France
| | - N. Dupin
- Faculté de Médecine; INSERM; Institut Cochin U1016; Laboratoire de Dermatologie-CNR Syphilis and AP-HP; Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca; Service de Dermatologie-Vénéréologie; Université Sorbonne Paris Descartes; Paris France
| | - F. Raffi
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
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Khatchatourian L, Le Bourgeois A, Asseray N, Biron C, Lefebvre M, Navas D, Grégoire M, Gaborit B, Raffi F, Boutoille D. Correction of myelotoxicity after switch of linezolid to tedizolid for prolonged treatments. J Antimicrob Chemother 2017; 72:2135-2136. [DOI: 10.1093/jac/dkx097] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fouasson-Chailloux A, Metayer B, Menu P, Khatchatourian L, Glemarec J, Dauty M. Total hip arthroplasty infection due to Mycobacterium bovis , after BCG therapy. Ann Phys Rehabil Med 2016. [DOI: 10.1016/j.rehab.2016.07.250] [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: 11/28/2022]
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Bernaud C, Khatchatourian L, Rodallec A, Hall N, Perre P, Morrier M, Pineau S, Jovelin T, André-Garnier E, Raffi F, Allavena C. Optimizing the virological success of tenofovir DF/FTC/rilpivirine in HIV-infected naive and virologically suppressed patients through strict clinical and virological selection. Infect Dis (Lond) 2016; 48:754-9. [PMID: 27389932 DOI: 10.1080/23744235.2016.1194528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Tenofovir DF/FTC/rilpivirine (TDF/FTC/RPV) is a single tablet regimen considered as safe and efficacious in HIV population as long as food requirements, concomitant PPI administration, and compromised antiviral activity have been carefully reviewed. We evaluated TDF/FTC/RPV in a real-life setting with focus on clinical and virological outcomes. METHODS OCEAN II is a prospective, two-centre observational study. From September 2012 to December 2013, antiretroviral-naive patients with HIV RNA <100,000 copies/mL or wishing to switch for simplification were considered for TDF/FTC/RPV. A systematic review of potential obstacles to TDF/FTC/RPV administration was undertaken during a multidisciplinary meeting, including DNA genotyping to detect archived RPV and/or NRTI-associated resistance mutations if historical RNA resistance testing was lacking. RESULTS TDF/FTC/RPV was considered for 480 patients, however was not offered to 194 patients (40%), mainly because of risk of insufficient virological efficacy, issues on adherence, patient refusal, meal constraint, or PPI therapy. A total of 286 patients (269 in maintenance; 17 ART-naive) received TDF/FTC/RPV. After a median follow-up of 30 months, virological failure occurred in five patients (1.7%) without the emergence of resistance mutations. Discontinuation of TDF/FTC/RPV occurred in 98 patients, due to adverse events in 43 patients (44%) and non-safety reasons in 55 patients (56%). No grade three-fourth adverse events occurred. CONCLUSION In this real-life experience, cohort consisting primarily of virologically suppressed patients, TDF/FTC/RPV usually maintained virologic suppression. Discontinuation of therapy because of intolerability was due to mild adverse events. Strict clinical and virological screening probably explained the low rate of virological failure.
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Affiliation(s)
- Camille Bernaud
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France
| | - Lydie Khatchatourian
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France
| | - Audrey Rodallec
- b CHU Hôtel-Dieu, Virology Department , Nantes University Hospital , Nantes , France
| | - Nolwenn Hall
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France
| | - Philippe Perre
- c CHD Vendée, Internal Medicine Department , La Roche sur Yon , France
| | - Marine Morrier
- c CHD Vendée, Internal Medicine Department , La Roche sur Yon , France
| | - Solène Pineau
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France ;,d COREVIH Pays de la Loire , Nantes University Hospital , Nantes , France
| | - Thomas Jovelin
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France ;,d COREVIH Pays de la Loire , Nantes University Hospital , Nantes , France
| | | | - François Raffi
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France
| | - Clotilde Allavena
- a CHU Hôtel-Dieu, Infectious Diseases Department , Nantes University Hospital , Nantes , France
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Riaudel T, Khatchatourian L, Chevalet P, Pichierri S, Mussini JM, Berrut G. Inflammatory myopathy presenting as head drop. Age Ageing 2013; 42:132. [PMID: 22832378 DOI: 10.1093/ageing/afs095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Typhaine Riaudel
- Geriatric Medicine, Hôpital Bellier, Nantes University Hospital, Nantes, France.
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Khatchatourian L, Decrocq C, Connault J, Ponge T, Mussini J, Hamidou M, Agard C. La myosite interstitielle des mollets, mode de révélation d’une maladie de Crohn. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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