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Moisset H, Rio J, Benhard J, Arnoult F, Deconinck L, Grall N, Iung B, Lescure X, Rouzet F, Suc G, Hoen B, Hobson CA, Duval X. Evaluation of the Specificity of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Classification for Infective Endocarditis. Clin Infect Dis 2024; 78:930-936. [PMID: 38330172 DOI: 10.1093/cid/ciae034] [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: 06/02/2023] [Revised: 06/29/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The 2023 Duke-ISCVID (International Society of Cardiovascular Infectious Diseases) classification is a new diagnostic tool for infective endocarditis, updating the 2000 modified Duke and the 2015 European Society for Cardiology (ESC) classifications. In comparison, its sensitivity is higher; however, its specificity remains to be evaluated and compared to that of the 2 other classifications in endocarditis suspected patients. METHODS We retrospectively collected the characteristics of patients hospitalized in Bichat University's Hospital, Paris, in 2021, who had been evaluated for clinical suspicion of endocarditis, have had at least a transthoracic echocardiography, 2 pairs of blood cultures, 3-month follow-up and in whom endocarditis diagnosis was finally rejected. All patients were classified by 2000 modified Duke, 2015 ESC and 2023 Duke-ISCVID, as though the endocarditis diagnosis had not been rejected. RESULTS In total, 130 patients' charts were analyzed. Mean age was 62 years, 84 (64.6%) were male, 39 (30.0%) had prosthetic cardiac valve or valve repair, 21 (16.2%) cardiac implanted electronic device, and 30 (23.1%) other cardiac conditions. Overall, 5, 2, and 5 patients were falsely classified as definite endocarditis with the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID classifications, respectively. The corresponding specificities were 96.2% (95% confidence interval [CI] [90.8%, 98.6%]), 98.5% (95% CI [93.9%, 99.7%]), and 96.2% (95% CI [90.8%, 98.6%]). The rates of possible endocarditis were of 38%, 35%, and 35% in the 3 classifications, respectively. CONCLUSIONS The 2023 Duke-ISCVID classification is highly specific for ruling out the diagnosis of definite infective endocarditis in patients who had been evaluated for IE.
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Affiliation(s)
- Hugo Moisset
- Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Paris Cité University, Paris, France
| | - Julien Rio
- Paris Cité University, Paris, France
- Center of Clinical Investigations, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Inserm CIC 1425, Paris, France
| | - Johan Benhard
- Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Paris Cité University, Paris, France
| | - Florence Arnoult
- Department of Physiology, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Laurene Deconinck
- Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Nathalie Grall
- Microbiology Laboratory, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Bernard Iung
- Paris Cité University, Paris, France
- Cardiology Department, Bichat-Claude Bernard University Hospital, AP-HP, LVTS U1148, Université Paris-Cité, Paris, France
| | - Xavier Lescure
- Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Paris Cité University, Paris, France
- Inserm, UMR-1137, IAME, Paris, France
| | - François Rouzet
- Paris Cité University, Paris, France
- Nuclear Medicine Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Laboratory for Vascular Translational Science, Inserm U1148, Paris, France
| | - Gaspard Suc
- Cardiology Department, Bichat-Claude Bernard University Hospital, AP-HP, LVTS U1148, Université Paris-Cité, Paris, France
| | - Bruno Hoen
- Infectious Diseases Department, Nancy University Hospital, Brabois Hospitals Vandoeuvre-lès-Nancy, France
| | - Claire Amaris Hobson
- Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Paris Cité University, Paris, France
| | - Xavier Duval
- Paris Cité University, Paris, France
- Center of Clinical Investigations, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Inserm CIC 1425, Paris, France
- Inserm, UMR-1137, IAME, Paris, France
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Garofoli N, Joly V, Le Pluart D, Hobson CA, Beaumont AL, Lariven S, Grall N, Para M, Yazdanpanah Y, Lescure FX, Peiffer-Smadja N, Deconinck L, Thy M. Enterococcal endocarditis management and relapses. JAC Antimicrob Resist 2024; 6:dlae033. [PMID: 38449516 PMCID: PMC10915900 DOI: 10.1093/jacamr/dlae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Enterococcus faecalis is the third micro-organism causing endocarditis and is associated with a significant relapse rate. The objective of this study was to describe the management of patients with Enterococcus faecalis endocarditis (EE) and its implication for relapses. Methods We conducted a monocentric, retrospective analysis of all patients hospitalized for EE including endocarditis or infection of cardiac implantable electronic device defined by the modified ESC 2015 Duke criteria in a referral centre in Paris, France. Results Between October 2016, and September 2022, 54 patients with EE were included, mostly men (n = 40, 74%) with a median age of 75 [68-80] years. A high risk for infective endocarditis (IE) was found in 42 patients (78%), including 14 (26%) previous histories of IE, and 32 (59%) histories of valvular cardiac surgery. The aortic valve was the most frequently affected (n = 36, 67%). Combination therapy was mainly amoxicillin-ceftriaxone during all the curative antibiotic therapy duration (n = 31, 57%). Surgery was indicated for 40 patients (74%), but only 27 (50%) were operated on, mainly due to their frailty. Among the 17 deaths (32%), six (11%) happened during the first hospitalization for EE. A suppressive antibiotic treatment was initiated in 15 (29%) patients, mostly because of not performing surgery. During the 6-year study period an EE relapse occurred in three (6%) patients. Conclusions EE is a worrying disease associated with a high risk of relapse and significant mortality. Suppressive antibiotic therapy could be a key treatment to limit the occurrence of relapses.
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Affiliation(s)
| | - Véronique Joly
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Diane Le Pluart
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Claire Amaris Hobson
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Anne-Lise Beaumont
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sylvie Lariven
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nathalie Grall
- Bacteriology Laboratory, Hôpital Bichat—Claude-Bernard, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Marylou Para
- Cardiology Department, Hôpital Bichat—Claude-Bernard, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Yazdan Yazdanpanah
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - François-Xavier Lescure
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Nathan Peiffer-Smadja
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Michael Thy
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France
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d'Humières C, Delavy M, Alla L, Ichou F, Gauliard E, Ghozlane A, Levenez F, Galleron N, Quinquis B, Pons N, Mullaert J, Bridier-Nahmias A, Condamine B, Touchon M, Rainteau D, Lamazière A, Lesnik P, Ponnaiah M, Lhomme M, Sertour N, Devente S, Docquier JD, Bougnoux ME, Tenaillon O, Magnan M, Ruppé E, Grall N, Duval X, Ehrlich D, Mentré F, Denamur E, Rocha EPC, Le Chatelier E, Burdet C. Perturbation and resilience of the gut microbiome up to 3 months after β-lactams exposure in healthy volunteers suggest an important role of microbial β-lactamases. Microbiome 2024; 12:50. [PMID: 38468305 DOI: 10.1186/s40168-023-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 12/20/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Antibiotics notoriously perturb the gut microbiota. We treated healthy volunteers either with cefotaxime or ceftriaxone for 3 days, and collected in each subject 12 faecal samples up to day 90. Using untargeted and targeted phenotypic and genotypic approaches, we studied the changes in the bacterial, phage and fungal components of the microbiota as well as the metabolome and the β-lactamase activity of the stools. This allowed assessing their degrees of perturbation and resilience. RESULTS While only two subjects had detectable concentrations of antibiotics in their faeces, suggesting important antibiotic degradation in the gut, the intravenous treatment perturbed very significantly the bacterial and phage microbiota, as well as the composition of the metabolome. In contrast, treatment impact was relatively low on the fungal microbiota. At the end of the surveillance period, we found evidence of resilience across the gut system since most components returned to a state like the initial one, even if the structure of the bacterial microbiota changed and the dynamics of the different components over time were rarely correlated. The observed richness of the antibiotic resistance genes repertoire was significantly reduced up to day 30, while a significant increase in the relative abundance of β-lactamase encoding genes was observed up to day 10, consistent with a concomitant increase in the β-lactamase activity of the microbiota. The level of β-lactamase activity at baseline was positively associated with the resilience of the metabolome content of the stools. CONCLUSIONS In healthy adults, antibiotics perturb many components of the microbiota, which return close to the baseline state within 30 days. These data suggest an important role of endogenous β-lactamase-producing anaerobes in protecting the functions of the microbiota by de-activating the antibiotics reaching the colon. Video Abstract.
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Affiliation(s)
- Camille d'Humières
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Microbial Evolutionary Genomics, Paris, 75015, France
| | - Margot Delavy
- Institut Pasteur, Université Paris Cité, INRAE, USC2019, Unité Biologie Et Pathogénicité Fongiques, Paris, F-75015, France
| | - Laurie Alla
- Université Paris-Saclay, INRAE, MetaGenoPolis, Jouy-en-Josas, F-78350, France
| | - Farid Ichou
- ICANomics, Foundation of Innovation in Cardiometabolism and Nutrition (IHU ICAN), Paris, F-75013, France
| | - Emilie Gauliard
- Sorbonne Université, INSERM U938, Centre de Recherche Saint-Antoine, Paris, F-75012, France
| | - Amine Ghozlane
- Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics Hub, Paris, F-75015, France
| | - Florence Levenez
- Université Paris-Saclay, INRAE, MetaGenoPolis, Jouy-en-Josas, F-78350, France
| | - Nathalie Galleron
- Université Paris-Saclay, INRAE, MetaGenoPolis, Jouy-en-Josas, F-78350, France
| | - Benoit Quinquis
- Université Paris-Saclay, INRAE, MetaGenoPolis, Jouy-en-Josas, F-78350, France
| | - Nicolas Pons
- Université Paris-Saclay, INRAE, MetaGenoPolis, Jouy-en-Josas, F-78350, France
| | - Jimmy Mullaert
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- AP-HP, Département d'Epidemiologie, Biostatistique and Recherche Clinique, Hôpital Bichat, Paris, F-75018, France
| | | | | | - Marie Touchon
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Microbial Evolutionary Genomics, Paris, 75015, France
| | - Dominique Rainteau
- Sorbonne Université, INSERM U938, Centre de Recherche Saint-Antoine, Paris, F-75012, France
| | - Antonin Lamazière
- Sorbonne Université, INSERM U938, Centre de Recherche Saint-Antoine, Paris, F-75012, France
| | - Philippe Lesnik
- INSERM UMR-S 1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, F-75013, France
- ICANomics, Foundation of Innovation in Cardiometabolism and Nutrition (IHU ICAN), Paris, F-75013, France
| | - Maharajah Ponnaiah
- ICANomics, Foundation of Innovation in Cardiometabolism and Nutrition (IHU ICAN), Paris, F-75013, France
| | - Marie Lhomme
- ICANomics, Foundation of Innovation in Cardiometabolism and Nutrition (IHU ICAN), Paris, F-75013, France
| | - Natacha Sertour
- Institut Pasteur, Université Paris Cité, INRAE, USC2019, Unité Biologie Et Pathogénicité Fongiques, Paris, F-75015, France
| | - Savannah Devente
- Dipartimento di Biotecnologie Mediche, Università di Siena, Siena, I-53100, Italy
| | - Jean-Denis Docquier
- Dipartimento di Biotecnologie Mediche, Università di Siena, Siena, I-53100, Italy
| | - Marie-Elisabeth Bougnoux
- Institut Pasteur, Université Paris Cité, INRAE, USC2019, Unité Biologie Et Pathogénicité Fongiques, Paris, F-75015, France
- AP-HP, Unité de Parasitologie-Mycologie, Service de Microbiologie Clinique, Hôpital Necker-Enfants-Malades, Paris, F-75015, France
| | | | - Mélanie Magnan
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
| | - Etienne Ruppé
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- AP-HP, Laboratoire de Bactériologie, Hôpital Bichat, Paris, F-75018, France
| | - Nathalie Grall
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- AP-HP, Laboratoire de Bactériologie, Hôpital Bichat, Paris, F-75018, France
| | - Xavier Duval
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- AP-HP, Centre d'Investigation Clinique, INSERM CIC 1425, Hôpital Bichat, Paris, F-75018, France
| | - Dusko Ehrlich
- Université Paris-Saclay, INRAE, MetaGenoPolis, Jouy-en-Josas, F-78350, France
- University College London, Institute for Neurology, London, UK
| | - France Mentré
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- AP-HP, Département d'Epidemiologie, Biostatistique and Recherche Clinique, Hôpital Bichat, Paris, F-75018, France
| | - Erick Denamur
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France
- AP-HP, Laboratoire de Génétique Moléculaire, Hôpital Bichat, Paris, F-75018, France
| | - Eduardo P C Rocha
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Microbial Evolutionary Genomics, Paris, 75015, France
| | | | - Charles Burdet
- Université Paris Cité, IAME, INSERM, Paris, F-75018, France.
- AP-HP, Département d'Epidemiologie, Biostatistique and Recherche Clinique, Hôpital Bichat, Paris, F-75018, France.
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Vivant AL, Marchand E, Janvier B, Berthe T, Guigon E, Grall N, Alliot F, Goutte A, Petit F. Wild fish from a highly urbanized river (Orge, France) as vectors of culturable Enterobacterales resistant to antibiotics. Can J Microbiol 2024; 70:63-69. [PMID: 38063167 DOI: 10.1139/cjm-2023-0121] [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] [Indexed: 02/02/2024]
Abstract
This study shows how wild fishes from urbanized rivers could be involved in the spread of antibiotic-resistant Enterobacterales. Antibiotic resistance profiles and molecular detection of clinical integron (IntI1) were carried out on 105 Enterobacterales isolated from 89 wildfish (skin or gut) belonging to 8 species. The proportion of isolates resistant to at least one antibiotic was independent of fish species and reached 28.3% within the Escherichia coli (E. coli) population and 84.7% in the non-E.coli Enterobacterales. Bacteria involved in nosocomial infections were isolated, such as E. coli, Klebsiella, and Enterobacter, as well as the environmental bacteria (Lelliottia, Butiauxella, and Kluyvera).
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Affiliation(s)
- Anne-Laure Vivant
- Université Rouen Normandie, Université Caen Normandie, CNRS, M2C, UMR, 6143 Rouen, France
| | - Etienne Marchand
- Université Rouen Normandie, Université Caen Normandie, CNRS, M2C, UMR, 6143 Rouen, France
- Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris, France
| | - Benjamin Janvier
- Université Rouen Normandie, Université Caen Normandie, CNRS, M2C, UMR, 6143 Rouen, France
| | - Thierry Berthe
- Université Rouen Normandie, Université Caen Normandie, CNRS, M2C, UMR, 6143 Rouen, France
- Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris, France
| | - Elodie Guigon
- Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris, France
- EPHE, PSL Research University, Sorbonne University, CNRS, UMR METIS, Paris, France
| | - Nathalie Grall
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
- Service de bactériologie, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Fabrice Alliot
- Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris, France
- EPHE, PSL Research University, Sorbonne University, CNRS, UMR METIS, Paris, France
| | - Aurélie Goutte
- Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris, France
- EPHE, PSL Research University, Sorbonne University, CNRS, UMR METIS, Paris, France
| | - Fabienne Petit
- Université Rouen Normandie, Université Caen Normandie, CNRS, M2C, UMR, 6143 Rouen, France
- Sorbonne Université, CNRS, EPHE, PSL, UMR METIS, Paris, France
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Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P. Toxic Shock Syndrome: A Literature Review. Antibiotics (Basel) 2024; 13:96. [PMID: 38247655 PMCID: PMC10812596 DOI: 10.3390/antibiotics13010096] [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: 12/14/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin-1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease.
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Affiliation(s)
- Enora Atchade
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
| | - Christian De Tymowski
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- INSERM UMR 1149, Immunoreceptor and Renal Immunopathology, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Nathalie Grall
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- Bacteriology Department, Bichat Claude Bernard Hospital, AP-HP, Paris Cité University, 75018 Paris, France
- INSERM UMR 1137 Infection, Antimicrobials, Modelling, Evolution, 75018 Paris, France
| | - Sébastien Tanaka
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- INSERM, UMR 1188, Diabetes Atherothrombosis Réunion Océan Indien (DéTROI), la Réunion University, 97400 Saint-Denis de la Réunion, France
| | - Philippe Montravers
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- INSERM UMR 1152 ANR 10—LABX-17, Pathophysiology and Epidemiology of Respiratory Diseases, 75018 Paris, France
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Montravers P, Grall N, Kantor E, Augustin P, Boussion K, Zappella N. Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999-2019. World J Emerg Surg 2023; 18:58. [PMID: 38115142 PMCID: PMC10729506 DOI: 10.1186/s13017-023-00528-1] [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: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Temporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT). METHODS This retrospective monocentric analysis (1999-2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO. RESULTS A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time. CONCLUSIONS We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO.
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Affiliation(s)
- Philippe Montravers
- Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France.
- UFR Paris Nord, Université Paris Cité, 75006, Paris, France.
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018, Paris, France.
| | - Nathalie Grall
- INSERM UMR 1137 IAME, Université Paris Cité, 75018, Paris, France
- Department of Bacteriology, AP-HP, Hôpital Bichat, 75018, Paris, France
| | - Elie Kantor
- Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France
| | - Pascal Augustin
- Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France
| | - Kevin Boussion
- Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France
| | - Nathalie Zappella
- Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France
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Lafaurie M, Chevret S, Fontaine JP, Mongiat-Artus P, de Lastours V, Escaut L, Jaureguiberry S, Bernard L, Bruyere F, Gatey C, Abgrall S, Ferreyra M, Aumaitre H, Aparicio C, Garrait V, Meyssonnier V, Bourgarit-Durand A, Chabrol A, Piet E, Talarmin JP, Morrier M, Canoui E, Charlier C, Etienne M, Pacanowski J, Grall N, Desseaux K, Empana-Barat F, Madeleine I, Bercot B, Molina JM, Lefort A. Antimicrobial for 7 or 14 Days for Febrile Urinary Tract Infection in Men: A Multicenter Noninferiority Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Clin Infect Dis 2023; 76:2154-2162. [PMID: 36785526 DOI: 10.1093/cid/ciad070] [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: 11/18/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The optimal duration of antimicrobial therapy for urinary tract infections (UTIs) in men remains controversial. METHODS To compare 7 days to 14 days of total antibiotic treatment for febrile UTIs in men, this multicenter randomized, double-blind. placebo-controlled noninferiority trial enrolled 282 men from 27 centers in France. Men were eligible if they had a febrile UTI and urine culture showing a single uropathogen. Participants were treated with ofloxacin or a third-generation cephalosporin at day 1, then randomized at day 3-4 to either continue ofloxacin for 14 days total treatment, or for 7 days followed by placebo until day 14. The primary endpoint was treatment success, defined as a negative urine culture and the absence of fever and of subsequent antibiotic treatment between the end of treatment and 6 weeks after day 1. Secondary endpoints included recurrent UTI within weeks 6 and 12 after day 1, rectal carriage of antimicrobial-resistant Enterobacterales, and drug-related events. RESULTS Two hundred forty participants were randomly assigned to receive antibiotic therapy for 7 days (115 participants) or 14 days (125 participants). In the intention-to-treat analysis, treatment success occurred in 64 participants (55.7%) in the 7-day group and in 97 participants (77.6%) in the 14-day group (risk difference, -21.9 [95% confidence interval, -33.3 to -10.1]), demonstrating inferiority. Adverse events during antibiotic therapy were reported in 4 participants in the 7-day arm and 7 in the 14-day arm. Rectal carriage of resistant Enterobacterales did not differ between both groups. CONCLUSIONS A treatment with ofloxacin for 7 days was inferior to 14 days for febrile UTI in men and should therefore not be recommended. CLINICAL TRIALS REGISTRATION NCT02424461; Eudra-CT: 2013-001647-32.
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Affiliation(s)
- Matthieu Lafaurie
- Department of Infectious Diseases, Hôpital Saint-Louis-Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France; Université Paris Diderot, Inserm S 717
| | | | | | - Victoire de Lastours
- Department of Internal Medicine, Hôpital Beaujon, AP-HP, Clichy, France
- Infection Antimicrobials Modelling Evolution (IAME) Research Group, UMR 1137, Université Paris Cité et Inserm, Paris, France
| | - Lélia Escaut
- Department of Infectious Diseases, Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Stéphane Jaureguiberry
- Department of Infectious Diseases, Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Louis Bernard
- Department of Infectious Diseases, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Franck Bruyere
- Department of Urology, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Caroline Gatey
- Department of Internal Medicine, Hôpital Antoine Béclère, AP-HP, Clamart, France
| | - Sophie Abgrall
- Université Paris-Saclay, Inserm U1018, Le Kremlin-Bićtre, France
| | - Milagros Ferreyra
- Department of Infectious Diseases, Centre Hospitalier de Perpignan, Perpignan, France
| | - Hugues Aumaitre
- Department of Infectious Diseases, Centre Hospitalier de Perpignan, Perpignan, France
| | - Caroline Aparicio
- Department of Internal Medicine, Hôpital Lariboisière, AP-HP, Paris, France
| | - Valérie Garrait
- Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Vanina Meyssonnier
- Department of Internal Medicine and Infectious Diseases, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | | | - Amélie Chabrol
- Department of Infectious Diseases, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Emilie Piet
- Department of Infectious Diseases, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Jean-Philippe Talarmin
- Department of Infectious Diseases, Centre Hospitalier Intercommunal de Cornouaille, Quimper, France
| | - Marine Morrier
- Department of Infectious Diseases, Centre Hospitalier Départemental de la Roche sur Yon, La Roche sur Yon, France
| | - Etienne Canoui
- Mobile Infectious Diseases Team, Hôpital Cochin, AP-HP, France
| | - Caroline Charlier
- Mobile Infectious Diseases Team, Hôpital Cochin, AP-HP, France
- Université Paris-Cité Hospital, AP-HP; French National Reference Center Listeria, Biology of Infection Unit, Inserm U1117, Institut Pasteur, France
| | - Manuel Etienne
- Department of Infectious Diseases, Hôpital Charles Nicolle, Rouen, France
| | - Jerome Pacanowski
- Department of Infectious Diseases, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Nathalie Grall
- Infection Antimicrobials Modelling Evolution (IAME) Research Group, UMR 1137, Université Paris Cité et Inserm, Paris, France
- Department of Bacteriology, Hôpital Bichat, AP-HP, Paris, France
| | - Kristell Desseaux
- Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Florence Empana-Barat
- Clinical Trial Department, Agence Générale des Équipements et Produits de Santé, AP-, Paris, France
| | | | - Béatrice Bercot
- Infection Antimicrobials Modelling Evolution (IAME) Research Group, UMR 1137, Université Paris Cité et Inserm, Paris, France
- Department of Microbiology, Hôpital Saint-Louis-Hôpital Lariboisière, AP-HP, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hôpital Saint-Louis-Hôpital Lariboisière, AP-HP, Paris, France; Université Paris Cité, Inserm UMR 941, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Hôpital Beaujon, AP-HP, Clichy, France
- Infection Antimicrobials Modelling Evolution (IAME) Research Group, UMR 1137, Université Paris Cité et Inserm, Paris, France
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8
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Goulenok T, Seurat J, Selle ADL, Jullien V, Leflon-Guibout V, Grall N, Lescure FX, Lepeule R, Bertrand J, Fantin B, Burdet C, Lefort A. Pharmacokinetic Interaction between Rifampicin and Clindamycin in Staphylococcal Osteoarticular Infections. Int J Antimicrob Agents 2023:106885. [PMID: 37302771 DOI: 10.1016/j.ijantimicag.2023.106885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
The oral combination of clindamycin and rifampicin is relevant for the treatment of staphylococcal osteoarticular infections (SOAI). However, rifampicin induces CYP3A4, suggesting a pharmacokinetic (PK) interaction with clindamycin with unknown PK/pharmacodynamic (PD) consequences. OBJECTIVES To quantify clindamycin PK/PD markers before and during rifampicin co-administration in OAI. METHODS Patients with SOAI were included (NCT02782078). After an initial intravenous antistaphylococcal treatment, oral therapy was started with clindamycin (600 or 750 mg tid), followed by the addition of rifampicin 36 hours after. Population PK analysis was performed using the SAEM algorithm. PKPD markers were compared with and without rifampicin co-administration, each patient being his own control. RESULTS In 19 patients, Clindamycin Median (min-max) through concentrations were 2.7 (0.3-8.9) and <0.05 (<0.05-0.3) mg/L, before and during rifampicin administration, respectively. Rifampicin co-administration increased clindamycin clearance by a factor 16 and reduced the AUC0-8h /MIC by a factor 15 (p<0.005). We simulated clindamycin plasma concentration for 1000 individuals, without and with rifampicin. Against a susceptible S. aureus strain with a clindamycin MIC of 0.0625 mg/L, more than 80% of individuals would reach all the proposed PKPD targets without co-administration of rifampicin, even with a low clindamycin dose. For the same strain, when rifampicin was co-administered, the probability to reach clindamycin PKPD targets dropped to 1% to have a %fT>MIC = 100% and to 6% to achieve an AUC0-24/MIC > 60, even with high dose of clindamycin. CONCLUSION Rifampicin co-administration with clindamycin has high impact on clindamycin exposure and PKPD targets in SOAI, which could result in clinical failures, even for a fully susceptible strain.
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Affiliation(s)
- T Goulenok
- Département de Médecine Interne, Hôpital Bichat-Claude Bernard, GHU APHP Nord, Université de Paris, France.
| | - J Seurat
- Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France
| | - A de La Selle
- Département de Médecine Interne, Hôpital Beaujon, Clichy, GHU APHP Nord, Université de Paris, France
| | - V Jullien
- Université Sorbonne Paris Nord, UF de Pharmacologie, hôpital Jean Verdier, 93141 Bondy, France
| | - V Leflon-Guibout
- Service de Microbiologie, Hôpital Beaujon, Clichy, GHU APHP Nord, Université de Paris, France
| | - N Grall
- Service de Bactériologie, Hôpital Bichat-Claude Bernard GHU APHP Nord, Université de Paris, France; Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France
| | - F X Lescure
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard GHU APHP Nord, Université de Paris, France; Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France
| | - R Lepeule
- Unité transversale de traitement des infections, Assistance Publique des Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, Université Paris Est Créteil, 94000 Creteil, France
| | - J Bertrand
- Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France
| | - B Fantin
- Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France
| | - C Burdet
- Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France; Département d'Épidémiologie, Biostatistique et Recherche Clinique, Hôpital Bichat-Claude Bernard GHU APHP Nord, Université de Paris, France
| | - A Lefort
- Département de Médecine Interne, Hôpital Beaujon, Clichy, GHU APHP Nord, Université de Paris, France; Université Paris Cité, INSERM 1137, IAME, Paris F-75018, France
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9
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Tran-Dinh A, Tir I, Tanaka S, Atchade E, Lortat-Jacob B, Jean-Baptiste S, Zappella N, Boudinet S, Castier Y, Mal H, Mordant P, Ben Abdallah I, Bunel V, Messika J, Armand-Lefèvre L, Grall N, Montravers P. Impact of Culture-Positive Preservation Fluid on Early Morbidity and Mortality After Lung Transplantation. Transpl Int 2023; 36:10826. [PMID: 36846604 PMCID: PMC9945515 DOI: 10.3389/ti.2023.10826] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
The prevalence, risk factors and outcomes associated with culture-positive preservation fluid (PF) after lung transplantation (LT) are unknown. From January 2015 to December 2020, the microbiologic analyses of PF used to store the cold ischaemia-placed lung graft(s) of 271 lung transplant patients were retrospectively studied. Culture-positive PF was defined as the growth of any microorganism. Eighty-three (30.6%) patients were transplanted with lung grafts stored in a culture-positive PF. One-third of culture-positive PF were polymicrobial. Staphylococcus aureus and Escherichia coli were the most frequently isolated microorganisms. No risk factors for culture-positive PF based on donor characteristics were identified. Forty (40/83; 48.2%) patients had postoperative pneumonia on Day 0 and 2 (2/83; 2.4%) patients had pleural empyema with at least one identical bacteria isolated in culture-positive PF. The 30-day survival rate was lower for patients with culture-positive PF compared with patients with culture-negative PF (85.5% vs. 94.7%, p = 0.01). Culture-positive PF has a high prevalence and may decrease lung transplant recipient survival. Further studies are required to confirm these results and improve understanding of the pathogenesis of culture-positive PF and their management.
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Affiliation(s)
- Alexy Tran-Dinh
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
- INSERM UMR 1148 LVTS, Université de Paris, Paris, France
| | - Imane Tir
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Sébastien Tanaka
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
- Réunion Island University, INSERM U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de la Réunion, France
| | - Enora Atchade
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Brice Lortat-Jacob
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Sylvain Jean-Baptiste
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Nathalie Zappella
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Sandrine Boudinet
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Yves Castier
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
| | - Hervé Mal
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Pierre Mordant
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Paris Transplant Group, Paris, France
| | - Iannis Ben Abdallah
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
| | - Vincent Bunel
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Jonathan Messika
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
- Paris Transplant Group, Paris, France
| | - Laurence Armand-Lefèvre
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Bactériologie, Paris, France
- INSERM UMR 1137 IAME, Université de Paris, Paris, France
| | - Nathalie Grall
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Bactériologie, Paris, France
- INSERM UMR 1137 IAME, Université de Paris, Paris, France
| | - Philippe Montravers
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
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10
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Sandot A, Grall N, Rodier T, Bunel V, Godet C, Weisenburger G, Tran-Dinh A, Montravers P, Mordant P, Castier Y, Eloy P, Armand-Lefevre L, Mal H, Messika J. Risk of Bronchial Complications After Lung Transplantation With Respiratory Corynebacteria. Results From a Monocenter Retrospective Cohort Study. Transpl Int 2023; 36:10942. [PMID: 36936442 PMCID: PMC10014466 DOI: 10.3389/ti.2023.10942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
Corynebacterium spp. are associated with respiratory infections in immunocompromised hosts. A link with bronchial complications after lung transplantation (LTx) has been suggested. We aimed to assess the link between respiratory sampling of Corynebacterium spp. and significant bronchial complication (SBC) after LTx. We performed a single center retrospective study. Inclusion of LTx recipients with at least one respiratory Corynebacterium spp. sample (July 2014 to December 2018). Subjects were matched to unexposed LTx recipients. Primary outcome was SBC occurrence after Corynebacterium spp. isolation. Secondary outcomes were Corynebacterium spp. persistent sampling, chronic lung allograft dysfunction (CLAD) onset and all-cause mortality. Fifty-nine patients with Corynebacterium spp. sampling with 59 without isolation were included. Corynebacterium spp. identification was not associated with SBC occurrence (32.4% vs. 21.6%, p = 0.342). Previous SBC was associated with further isolation of Corynebacterium spp. (OR 3.94, 95% CI [1.72-9.05]). Previous SBC and corticosteroids pulses in the last 3 months were the only factors associated with increased risk of Corynebacterium spp. isolation in multivariate analysis. Corynebacterium spp. sampling was significantly associated with CLAD onset (27.1% vs. 6.9%, p = 0.021). Corynebacterium spp. isolation was not associated with SBC but with higher risk of CLAD. Whether CLAD evolution is affected by Corynebacterium spp. eradication remains to be investigated.
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Affiliation(s)
- Adèle Sandot
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
| | - Nathalie Grall
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Thomas Rodier
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
| | - Vincent Bunel
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Cendrine Godet
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Gaëlle Weisenburger
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Alexy Tran-Dinh
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Département d’Anesthésie et Réanimation, Paris, France
| | - Philippe Montravers
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Département d’Anesthésie et Réanimation, Paris, France
| | - Pierre Mordant
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France
| | - Yves Castier
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France
| | - Philippine Eloy
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
| | - Laurence Armand-Lefevre
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Hervé Mal
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
| | - Jonathan Messika
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- Paris Transplant Group, Paris, France
- *Correspondence: Jonathan Messika,
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11
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Garé M, Thy M, Deconinck L, Grall N, Yazdanpanah Y, Joly V. Réactivation de tuberculose après traitement immunomodulateur pour une infection sévère à SARS-CoV-2. Médecine et Maladies Infectieuses Formation 2022. [PMCID: PMC9771745 DOI: 10.1016/j.mmifmc.2022.12.003] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Nous rapportons deux cas de réactivation tuberculeuse après COVID-19 sous corticostéroïdes et tocilizumab. Ils ont présenté une lymphopénie, des signes cliniques limités, des signes radiologiques inhabituels mais des prélèvements microbiologiques positifs. Le dépistage de l'infection tuberculeuse latente (ITL) étant inapproprié dans ce contexte, il faudrait discuter de la traiter systématiquement chez des patients les plus à risque en cas de traitement immunomodulateur.
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Affiliation(s)
- Mathilde Garé
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France,Auteur correspondant
| | - Michael Thy
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
| | - Laurène Deconinck
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
| | - Nathalie Grall
- Service de Microbiologie, Hôpital Bichat, APHP, Paris, France
| | - Yazdan Yazdanpanah
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
| | - Véronique Joly
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
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12
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Tran-Dinh A, Guiot M, Tanaka S, Lortat-Jacob B, Atchade E, Zappella N, Mordant P, Castier Y, Mal H, Weisenburger G, Messika J, Grall N, Montravers P. Bacteraemia Is Associated with Increased ICU Mortality in the Postoperative Course of Lung Transplantation. Antibiotics (Basel) 2022; 11:antibiotics11101405. [PMID: 36290063 PMCID: PMC9598225 DOI: 10.3390/antibiotics11101405] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia. Forty-six bacteria were isolated from 45 bacteraemic patients in 33/303 (10.9%) patients during the postoperative ICU stay. Staphylococcus aureus (17.8%) was the most frequent bacteria, followed by Pseudomonas aeruginosa (15.6%) and Enterococcus faecium (15.6%). Multidrug-resistant bacteria accounted for 8/46 (17.8%) of the isolates. The most common source of bacteraemia was pneumonia (38.3%). No pre- or intraoperative risk factor for bacteraemia was identified. Recipients who experienced bacteraemia required more renal replacement therapy, invasive mechanical ventilation, norepinephrine support, tracheotomy and more days of hospitalization during the ICU stay. After adjustment for age, sex, type of LT procedure and the need for intraoperative ECMO, the occurrence of bacteraemia was associated with a higher mortality rate in the ICU (aOR = 3.55, 95% CI [1.56–8.08], p = 0.003). Bacteraemia is a major source of concern for lung transplant recipients.
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Affiliation(s)
- Alexy Tran-Dinh
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1148 LVTS, Université Paris Cité, 75018 Paris, France
- Correspondence: ; Tel.: +33-1-40-25-83-55
| | - Marion Guiot
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Sébastien Tanaka
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM U1188 Diabetes Atherothrombosis Réunion Indian OCean (DéTROI), CYROI Plateform, Réunion Island University, 97744 Saint-Denis de la Réunion, France
| | - Brice Lortat-Jacob
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Enora Atchade
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Nathalie Zappella
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Pierre Mordant
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
| | - Hervé Mal
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
- Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Gaelle Weisenburger
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
- Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Jonathan Messika
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
- Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- Paris Transplant Group, 75018 Paris, France
| | - Nathalie Grall
- Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1137 IAME, Université Paris Cité, 75018 Paris, France
| | - Philippe Montravers
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
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13
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Delavy M, Burdet C, Sertour N, Chatelier EL, Doquier JD, Volant S, Ghozlane A, Grall N, Duval X, Mentré F, Duffy D, D'Enfert C, Bougnoux ME. S10.3c Clinical studies provide new insights on the association between the microbiota and host resistance to Candida albicans intestinal colonization. Med Mycol 2022. [PMCID: PMC9511560 DOI: 10.1093/mmy/myac072.s10.3c] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
S10.3 The mycobiome characterization: future perspectives or just a trend?, September 24, 2022, 10:30 AM - 12:00 PM
Objectives
Candida albicans is both a harmless commensal intestinal yeast in healthy individuals and a harmful opportunistic pathogen in immunocompromised patients, causing life-threatening invasive candidiasis. C. albicans intestinal overgrowth is a prerequisite for intestinal translocation, which is at the root of invasive candidiasis. Therefore, to prevent invasive candidiasis in immunocompromised patients, it is necessary to curb intestinal C. albicans overgrowth. However, little is known of the role of bacterial species of the microbiota in dampening C. albicans intestinal colonization.
We aimed to decipher the influence of the bacterial and fungal intestinal microbiota on C. albicans gut colonization in healthy individuals in whom their microbiota was modified or not by antibiotic treatment.
Methods
We studied two cohorts of healthy individuals: the first cohort included 22 volunteers for which fecal samples were collected before, during and after a 3-day regimen of third-generation cephalosporin antibiotics. The second cohort gathered 1000 healthy individuals for which a single fecal sample was collected. We quantified C. albicans carriage using a specific quantitative PCR approach. We monitored the antibiotic effect on the composition of the fungal microbiota—the so called mycobiota—in the gut of the individuals up to 180 days post-antibiotic exposure, using both the qPCR data and ITS1 targeted metagenomic. We also monitored the level of fecal β-lactamase activity, which is known to modulate the intensity of post-cephalosporin intestinal dysbiosis. Finally, to identify potential C. albicans inhibiting bacteria, we used MaAsLin2 to search for associations between C. albicans levels and bacterial species abundance, deduced from shotgun metagenomics data obtained from all individuals and annotated at the species level.
Results
A very high level of C. albicans carriage was observed in both cohorts, with a prevalence of 95.2% and 83.1% in the first and second cohort, respectively. Yet, the quantity of C. albicans DNA detected varied greatly between subjects. The mycobiota composition was significantly altered by antibiotics and the fungal load was increased both at short and long term. Particularly, C. albicans abundance was increased but with wide inter-subject variations. A part of these variations was explained by changes in the levels of endogenous fecal β-lactamase activity, with subjects characterized by a low increase of β-lactamase activity displaying a higher increase of C. albicans levels. Finally, using shotgun metagenomics data, we identified a first set of 50 bacterial and archaeal species whose abundance inversely correlated with C. albicans abundance.
Conclusion
These results (1) bring a new understanding of C. albicans overgrowth in healthy individuals, (2) lead to the identification of microbial signatures with a potential key role in controlling C. albicans gut colonization, and finally (3) show for the first time that changes in endogenous fecal β-lactamase activity is a key factor for C. albicans overgrowth in the gut after antibiotic exposure. Taken together, these results open the way for new intervention strategies to curb C. albicans intestinal overgrowth.
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Affiliation(s)
- Margot Delavy
- Institut Pasteur , Université Paris Cité, Fungal Biology and Pathogenicity Unit, Paris , France
| | - Charles Burdet
- Université Paris Cité , IAME, INSERM, Paris , France
- Assistance Publique des Hôpitaux de Paris (APHP) , Hôpital Bichat, Departement of Epidemiology, Biostatistic and Clinical Research, Paris , France
| | - Natacha Sertour
- Institut Pasteur , Université Paris Cité, Fungal Biology and Pathogenicity Unit, Paris , France
| | | | | | - Stevenn Volant
- Institut Pasteur , Université de Paris, Bioinformatics and Biostatistics Hub, Paris , France
| | - Amine Ghozlane
- Institut Pasteur , Université de Paris, Bioinformatics and Biostatistics Hub, Paris , France
| | | | - Xavier Duval
- Université Paris Cité , IAME, INSERM, Paris , France
- INSERM Clinical Investigation Center 1425 , Paris , France
| | - France Mentré
- Université Paris Cité , IAME, INSERM, Paris , France
- Assistance Publique des Hôpitaux de Paris (APHP) , Hôpital Bichat, Departement of Epidemiology, Biostatistic and Clinical Research, Paris , France
| | - Darragh Duffy
- Institut Pasteur , Université Paris Cité, Immunobiology of Dendritic Cells laboratory, Paris , France
| | - Christophe D'Enfert
- Institut Pasteur , Université Paris Cité, Fungal Biology and Pathogenicity Unit, Paris , France
| | - Marie-Elisabeth Bougnoux
- Institut Pasteur , Université Paris Cité, Fungal Biology and Pathogenicity Unit, Paris , France
- Assistance Publique des Hôpitaux de Paris (APHP) , Hôpital Necker-Enfants-Malades, Service de Microbiologie Clinique, Unité de Parasitologie-Mycologie, Paris , France
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14
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De Castro N, Mechaï F, Bachelet D, Canestri A, Joly V, Vandenhende M, Boutoille D, Kerjouan M, Veziris N, Molina JM, Grall N, Tattevin P, Laouénan C, Yazdanpanah Y. Treatment with a three-drug regimen for pulmonary tuberculosis based on rapid molecular detection of isoniazid resistance: a non-inferiority randomized trial (FAST-TB). Open Forum Infect Dis 2022; 9:ofac353. [PMID: 35949399 PMCID: PMC9356674 DOI: 10.1093/ofid/ofac353] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The rationale behind the use of ethambutol in the standard tuberculosis treatment is to prevent the emergence of resistance to rifampicin in case of primary resistance to isoniazid. We evaluated whether early detection of isoniazid resistance using molecular testing allows the use an ethambutol-free regimen. Methods FAST-TB, a phase 4, French, multicenter, open-label, non-inferiority trial, compared 2 strategies: (1) polymerase chain reaction (PCR)-based detection of isoniazid and rifampicin resistance at baseline using Genotype MTBDRplus version 2.0 followed by ethambutol discontinuation if no resistance was detected (PCR arm) and (2) a standard 4-drug combination, pending phenotypic drug-susceptibility results (C arm). Adult patients with smear-positive pulmonary tuberculosis were enrolled. The primary endpoint was the proportion of patients with treatment success defined as bacteriological or clinical cure at the end of treatment. A non-inferiority margin of 10% was used. Results Two hundred three patients were randomized, 104 in the PCR arm and 99 in the C arm: 26.6% were female, median age was 37 (interquartile range, 28–51) years, 72.4% were born in Africa, and 5.4% were infected with human immunodeficiency virus. Chest x-ray showed cavities in 64.5% of the cases. Overall, 169 patients met criteria of treatment success: 87 of 104 (83.7%) in the PCR arm and 82 of 99 (82.8%) in the C arm with a difference of +0.8% (90% confidence interval, −7.9 to 9.6), meeting the noninferiority criteria in the intention-to-treat population (P = .02). Conclusions In a setting with low prevalence of primary isoniazid resistance, a 3-drug combination with isoniazid, rifampicin, and pyrazinamide, based on rapid detection of isoniazid resistance using molecular testing, was noninferior to starting the recommended 4-drug regimen.
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Affiliation(s)
| | - F Mechaï
- AP-HP Hôpital Avicenne , Bobigny , France
| | - D Bachelet
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | | | - V Joly
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | - M Vandenhende
- Hôpital Saint-André - CHU de Bordeaux , France
- Université Bordeaux , Bordeaux , France
| | - D Boutoille
- CHU Nantes , Nantes , France
- Centre d'Investigation Clinique, Unité d'Investigation Clinique 1413 INSERM , Nantes , France
| | | | - N Veziris
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris) , UMR 1135 , France
- AP-HP Hôpital Saint-Antoine, Centre National de Référence des Mycobactéries , Paris , France
| | - JM Molina
- APHP Hôpital Saint-Louis , Paris , France
- Université de Paris , Paris , France
| | - N Grall
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | - P Tattevin
- CHU de Rennes , Rennes , France
- Université de Rennes , France
| | - C Laouénan
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | - Y Yazdanpanah
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
- Université de Paris , Paris , France
- Inserm , IAME UMR 1137 INSERM, Paris , France
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15
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Guk J, Bridier‐Nahmias A, Magnan M, Grall N, Duval X, Clermont O, Ruppé E, d'Humières C, Tenaillon O, Denamur E, Mentré F, Guedj J, Burdet C. Modeling the bacterial dynamics in the gut microbiota following an antibiotic‐induced perturbation. CPT Pharmacometrics Syst Pharmacol 2022; 11:906-918. [PMID: 35583200 PMCID: PMC9286716 DOI: 10.1002/psp4.12806] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Recent studies have highlighted the importance of ecological interactions in dysbiosis of gut microbiota, but few focused on their role in antibiotic‐induced perturbations. We used the data from the CEREMI trial in which 22 healthy volunteers received a 3‐day course of ceftriaxone or cefotaxime antibiotics. Fecal samples were analyzed by 16S rRNA gene profiling, and the total bacterial counts were determined in each sample by flux cytometry. As the gut exposure to antibiotics could not be experimentally measured despite a marked impact on the gut microbiota, it was reconstructed using the counts of susceptible Escherichia coli. The dynamics of absolute counts of bacterial families were analyzed using a generalized Lotka–Volterra equations and nonlinear mixed effect modeling. Bacterial interactions were studied using a stepwise approach. Two negative and three positive interactions were identified. Introducing bacterial interactions in the modeling approach better fitted the data, and provided different estimates of antibiotic effects on each bacterial family than a simple model without interaction. The time to return to 95% of the baseline counts was significantly longer in ceftriaxone‐treated individuals than in cefotaxime‐treated subjects for two bacterial families: Akkermansiaceae (median [range]: 11.3 days [0; 180.0] vs. 4.2 days [0; 25.6], p = 0.027) and Tannerellaceae (13.7 days [6.1; 180.0] vs. 6.2 days [5.4; 17.3], p = 0.003). Taking bacterial interaction as well as individual antibiotic exposure profile into account improves the analysis of antibiotic‐induced dysbiosis.
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Affiliation(s)
- Jinju Guk
- Université de Paris, IAME, INSERM Paris France
| | | | | | - Nathalie Grall
- Université de Paris, IAME, INSERM Paris France
- AP‐HP, Hôpital Bichat, Laboratoire de Bactériologie Paris France
| | - Xavier Duval
- Université de Paris, IAME, INSERM Paris France
- AP‐HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425 Paris France
| | | | - Etienne Ruppé
- Université de Paris, IAME, INSERM Paris France
- AP‐HP, Hôpital Bichat, Laboratoire de Bactériologie Paris France
| | - Camille d'Humières
- Université de Paris, IAME, INSERM Paris France
- AP‐HP, Hôpital Bichat, Laboratoire de Bactériologie Paris France
| | | | - Erick Denamur
- Université de Paris, IAME, INSERM Paris France
- AP‐HP, Hôpital Bichat, Laboratoire de Génétique Moléculaire Paris France
| | - France Mentré
- Université de Paris, IAME, INSERM Paris France
- Département d'Épidémiologie AP‐HP, Hôpital Bichat, Biostatistique et Recherche Clinique Paris France
| | | | - Charles Burdet
- Université de Paris, IAME, INSERM Paris France
- Département d'Épidémiologie AP‐HP, Hôpital Bichat, Biostatistique et Recherche Clinique Paris France
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16
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Montravers P, Esposito-Farèse M, Lasocki S, Grall N, Veber B, Eloy P, Seguin P, Weiss E, Dupont H. Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial. J Antimicrob Chemother 2021; 76:3303-3309. [PMID: 34458922 PMCID: PMC8598293 DOI: 10.1093/jac/dkab307] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background Therapeutic failure is a frequent issue in the management of post-operative peritonitis. Objectives A post hoc analysis of the prospective, multicentre DURAPOP trial analysed the risk factors for failures in post-operative peritonitis following adequate source control and empirical antibiotic therapy in critically ill patients. Patients and methods Overall failures assessed post-operatively between Day 8 and Day 45 were defined as a composite of death and/or surgical and/or microbiological failures. Risk factors for failures were assessed using logistic regression analyses. Results Among the 236 analysed patients, overall failures were reported in 141 (59.7%) patients, including 30 (12.7%) deaths, 81 (34.3%) surgical and 95 (40.2%) microbiological failures. In the multivariate analysis, the risk factors associated with overall failures were documented piperacillin/tazobactam therapy [adjusted OR (aOR) 2.10; 95% CI 1.17–3.75] and renal replacement therapy on the day of reoperation (aOR 2.96; 95% CI 1.05–8.34). The risk factors for death were age (aOR 1.08 per year; 95% CI 1.03–1.12), renal replacement therapy on reoperation (aOR 3.95; 95% CI 1.36–11.49) and diabetes (OR 6.95; 95% CI 1.34–36.03). The risk factors associated with surgical failure were documented piperacillin/tazobactam therapy (aOR 1.99; 95% CI 1.13–3.51), peritoneal cultures containing Klebsiella spp. (aOR 2.45; 95% CI 1.02–5.88) and pancreatic source of infection (aOR 2.91; 95% CI 1.21–7.01). No specific risk factors were identified for microbiological failure. Conclusions Our data suggest a predominant role of comorbidities, the severity of post-operative peritonitis and possibly of documented piperacillin/tazobactam treatment on the occurrence of therapeutic failures, regardless of their type.
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Affiliation(s)
- Philippe Montravers
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude-Bernard, GHU Nord, APHP, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1152-ANR10-LABX-17, Paris, France
| | - Marina Esposito-Farèse
- INSERM CIC-EC 1425, CHU Bichat-Claude-Bernard, GHU Nord, APHP, Paris, France.,Unité de Recherche Clinique, CHU Bichat-Claude-Bernard, GHU Nord, Université de Paris, Paris, France
| | | | - Nathalie Grall
- Université de Paris, Paris, France.,Department of Bacteriology, CHU Bichat-Claude-Bernard Hospital, Paris, France.,INSERM UMR 1137, IAME, Paris, France
| | - Benoit Veber
- Pole Anesthésie-Réanimation, CHU de Rouen, Rouen, France
| | - Philippine Eloy
- Département d'Epidémiologie Biostatistiques et Recherche Clinique, CHU Bichat-Claude-Bernard, GHU Nord, APHP, Paris, France.,INSERM, Centre d'Investigations Cliniques-Epidémiologie Clinique 1425, CHU Bichat-Claude-Bernard, Paris, France
| | | | - Emmanuel Weiss
- Université de Paris, Paris, France.,DAR, CHU Beaujon, Clichy, France.,INSERM UMR S1149 CHU Bichat-Claude-Bernard, Paris, France
| | - Herve Dupont
- DAR, CHU d'Amiens, Amiens, France.,SSPC-UR UPJV 7518, Université de Picardie Jules Vernes, Amiens, France
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17
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Féron F, de Ponfilly GP, Potier L, Gauthier DC, Salle L, Laloi-Michelin M, Munier AL, Jacquier H, Vidal-Trécan T, Julla JB, Carlier A, Abouleka Y, Venteclef N, Grall N, Mercier F, Riveline JP, Senneville É, Gautier JF, Roussel R, Kevorkian JP. Reliability and Safety of Bedside Blind Bone Biopsy Performed by a Diabetologist for the Diagnosis and Treatment of Diabetic Foot Osteomyelitis. Diabetes Care 2021; 44:2480-2486. [PMID: 34475028 DOI: 10.2337/dc20-3170] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Bone biopsy (BB) performed by a surgeon or an interventional radiologist is recommended for suspicion of osteomyelitis underlying diabetic foot ulcer (DFU). To facilitate its practice, we developed a procedure allowing bedside blind bone biopsy (B4) by a diabetologist. RESEARCH DESIGN AND METHODS We conducted a three-step observational study consisting of a feasibility and safety phase (phase 1) to assess the success and side effects of B4, a validity phase (phase 2) to compare DFU outcomes between positive (B4+) and negative (B4-) bone cultures, and a performance phase (phase 3) to compare B4 with the conventional surgical or radiological procedure basic bone biopsy (B3). Primary end points were the presence of bone tissue (phase 1) and complete DFU healing with exclusive medical treatment at 12 months (phases 2 and 3). RESULTS In phase 1, 37 consecutive patients with clinical and/or radiological suspicion of DFU osteomyelitis underwent B4. Bone tissue was collected in all patients with few side effects. In phase 2, a B4+ bone culture was found in 40 of 79 (50.6%) participants. Among B4+ patients, complete wound healing after treatment was 57.5%. No statistical difference was observed with patients with B4- bone culture not treated with antibiotics (71.8%, P = 0.18). In phase 3, the proportion of patients with positive BB was lower in B4 (40 of 79, 50.6%) than in B3 (34 of 44, 77.3%, P < 0.01). However, complete healing was similar (64.6% vs. 54.6%, P = 0.28). No difference in rate of culture contamination was observed. CONCLUSIONS B4 is a simple, safe, and efficient procedure for the diagnosis of DFU osteomyelitis with a similar proportion of healing to conventional BB.
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Affiliation(s)
- Florine Féron
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Gauthier Péan de Ponfilly
- Department of Microbiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Louis Potier
- Department of Diabetes, Endocrinology, and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,Cordeliers Research Centre, INSERM, Immunity and Metabolism in Diabetes Laboratory, Sorbonne University, Université de Paris, Paris, France
| | - Diane-Cécile Gauthier
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Laurence Salle
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marie Laloi-Michelin
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Anne-Lise Munier
- Department of Infectious Disease, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Hervé Jacquier
- Department of Microbiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Tiphaine Vidal-Trécan
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean-Baptiste Julla
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,Cordeliers Research Centre, INSERM, Immunity and Metabolism in Diabetes Laboratory, Sorbonne University, Université de Paris, Paris, France
| | - Aurélie Carlier
- Department of Diabetes, Endocrinology, and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Yawa Abouleka
- Department of Diabetes, Endocrinology, and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nicolas Venteclef
- Cordeliers Research Centre, INSERM, Immunity and Metabolism in Diabetes Laboratory, Sorbonne University, Université de Paris, Paris, France
| | - Nathalie Grall
- Department of Microbiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Frédéric Mercier
- Department of Surgery, Parc Monceau International Clinic, Paris, France
| | - Jean-Pierre Riveline
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,Cordeliers Research Centre, INSERM, Immunity and Metabolism in Diabetes Laboratory, Sorbonne University, Université de Paris, Paris, France
| | - Éric Senneville
- Department of Infectious Disease, Gustave Dron Hospital, Tourcoing, France
| | - Jean-François Gautier
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,Cordeliers Research Centre, INSERM, Immunity and Metabolism in Diabetes Laboratory, Sorbonne University, Université de Paris, Paris, France
| | - Ronan Roussel
- Department of Diabetes, Endocrinology, and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,Cordeliers Research Centre, INSERM, Immunity and Metabolism in Diabetes Laboratory, Sorbonne University, Université de Paris, Paris, France
| | - Jean-Philippe Kevorkian
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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18
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Tanaka S, Thy M, Tashk P, Ribeiro L, Lortat-Jacob B, Hermieu JF, Zappella N, Rozencwajg S, Snauwaert A, Atchade E, Grall N, Assadi M, Tran-Dinh A, Montravers P. Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study. Eur J Clin Microbiol Infect Dis 2021; 41:109-117. [PMID: 34625886 PMCID: PMC8732959 DOI: 10.1007/s10096-021-04354-8] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022]
Abstract
Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.
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Affiliation(s)
- Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France. .,French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Réunion Island University, Saint-Denis de La Réunion, France.
| | - Michael Thy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France.,EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Paris Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Parvine Tashk
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Lara Ribeiro
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of General and Visceral Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Brice Lortat-Jacob
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Jean-François Hermieu
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Urology, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Sacha Rozencwajg
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France
| | - Aurelie Snauwaert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Enora Atchade
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Grall
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM), IAME, UMR 1137, Paris, France
| | - Maksud Assadi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France.,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France.,Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, ANR10-LABX-17, Paris, France
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19
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Dinh A, Hallouin-Bernard MC, Davido B, Lemaignen A, Bouchand F, Duran C, Even A, Denys P, Perrouin-Verbe B, Sotto A, Lavigne JP, Bruyère F, Grall N, Tavernier E, Bernard L. Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial. Clin Infect Dis 2021; 71:3128-3135. [PMID: 31867616 DOI: 10.1093/cid/ciz1207] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/17/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalizations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis (ie, the alternate weekly administration of 2 antibiotics) in preventing R-UTIs. METHODS Randomized (1:1), open-label, superiority-controlled trial compared WOCA prophylaxis to no prophylaxis (control) for 6 months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome was incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes were number of febrile UTIs, number of hospitalizations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal, and nasal microbiota. RESULTS Forty-five patients were either allocated to the WOCA group (n = 23) or the control group (n = 22). Median (IQR) incidence of symptomatic antibiotic-treated UTIs was 1.0 (0.5-2.5) in the WOCA group versus 2.5 (1.2-4.0) (P = .0241) in the control group. No febrile UTIs were recorded in the WOCA group versus 9 (45.0%) (P < .001) in the control group. The median number of additional antibiotic treatment was 0.0 (IQR, 0.0-2.0) versus 3.0 (2.0-5.0) (P = .004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed. CONCLUSIONS WOCA is efficient and well tolerated in preventing R-UTIs in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures. CLINICAL TRIALS REGISTRATION NCT01388413.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | | | - Benjamin Davido
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Adrien Lemaignen
- Department of Infectious Diseases, Bretonneau University Hospital, Tours, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Alexia Even
- Department of Urology, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Pierre Denys
- Department of Urology, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, Saint-Jacques Hospital, University Hospital of Nantes, Nantes, France
| | - Albert Sotto
- Department of Infectious Diseases, Caremeau University Hospital, Nîmes, France
| | | | - Franck Bruyère
- Department of Urology, Bretonneau University Hospital, Tours, France
| | - Nathalie Grall
- Microbiology Laboratory, Bichat-Claude Bernard University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elsa Tavernier
- Clinical Investigation Centre INSERM 1415, Bretonneau University Hospital, Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, Bretonneau University Hospital, Tours, France
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20
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Boussion K, Zappella N, Grall N, Ribeiro-Parenti L, Papin G, Montravers P. Epidemiology, clinical relevance and prognosis of staphylococci in hospital-acquired postoperative intra-abdominal infections: an observational study in intensive care unit. Sci Rep 2021; 11:5884. [PMID: 33723332 PMCID: PMC7960962 DOI: 10.1038/s41598-021-85443-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/24/2021] [Indexed: 12/29/2022] Open
Abstract
The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Patients with S-HAIs were compared to nS-HAIs patients. Overall, 380 patients were analyzed, including 87 (23%) S-HAI patients [29 Staphylococcus aureus (Sa-HAIs) and 58 coagulase-negative staphylococci (CoNS-HAIs)]. The clinical characteristics did not differ between the S-HAI and nS-HAI patients. Adequacy of empirical anti-infective therapy was achieved less frequently in the staphylococci group (54 vs 72%, respectively, p < 0.01). The 90-day (primary endpoint) and one-year mortality rates did not differ between these groups. The S-HAI patients had decreased rates of postoperative complication (p < 0.05). The adjusted analysis of the clinical outcomes reported a decreased frequency of surgical complications in the staphylococci group (OR 0.43, 95% CI [0.20–0.93], p = 0.03). While the trends toward decreased morbidity criteria were observed in S-HAI patients, the clinical outcomes were not different between the CoNS-HAI and Sa-HAI patients. In summary, our data are not substantial enough to conclude that staphylococci exhibit no pathogenicity in HAIs.
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Affiliation(s)
- Kévin Boussion
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Zappella
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Grall
- Hôpitaux de Paris, Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1137, IAME, Paris, France
| | - Lara Ribeiro-Parenti
- Hôpitaux de Paris, Department of General, Esogastric and Bariatic Surgery, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, Paris, France.,Inserm UMR1149, Paris, France
| | - Grégory Papin
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Philippe Montravers
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France. .,Université de Paris, Paris, France. .,INSERM UMR1152, ANR-10-LABX-17, Paris, France.
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21
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Thy M, Tanaka S, Tran-Dinh A, Ribeiro L, Lortat-Jacob B, Donadio J, Zappella N, Ben-Rehouma M, Tashk P, Snauwaert A, Atchade E, Grall N, Montravers P. Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients. Front Med (Lausanne) 2021; 7:609497. [PMID: 33748150 PMCID: PMC7969649 DOI: 10.3389/fmed.2020.609497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction: Recent studies described the threat of emerging multidrug-resistant (MDR) bacteria in intensive care unit (ICU) patients, but few data are available for necrotizing skin and soft tissue infections (NSTI). In a cohort of ICU patients admitted for NSTI, we describe the dynamic changes of microbial population during repeated surgeries. Materials and Methods: This retrospective study compiled consecutive cases admitted for the management of severe NSTI. Clinical characteristics, NSTI features, morbidity and mortality data were collected. The microbiological characteristics of surgical samples obtained during initial surgery were compared with those obtained during the first reoperation, including persistence of initial pathogens and/or emergence of microorganisms. Risk factors for emergence of microorganisms and MDR bacteria were assessed by univariable and multivariable analyses. Results: Among 100 patients {63% male, 58 years old [interquartile ratio (IQR) 50–68]} admitted for NSTI, 54 underwent reoperation with a median [IQR] delay of 3 (1–7) days. Decreased proportions of susceptible strains and emergence of Gram-negative bacteria, including Pseudomonas aeruginosa, staphylococci and enterococci strains, were reported based on the cultures of surgical specimen collected on reoperation. On reoperation, 22 (27%) of the isolated strains were MDR (p < 0.0001 vs. MDR bacteria cultured from the first samples). Broad-spectrum antibiotic therapy as first-line therapy was significantly associated with a decreased emergence of microorganisms. Adequate antibiotic therapy from the initial surgery did not modify the frequency of emergence of microorganisms (p = 0.79) and MDR bacteria (p = 1.0) or the 1-year survival rate. Conclusion: The emergence of microorganisms, including MDR bacteria, is frequently noted in NSTI without affecting mortality.
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Affiliation(s)
- Michael Thy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Paris Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, UFR Denis Diderot, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Lara Ribeiro
- Université de Paris, UFR Denis Diderot, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of General and Visceral Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Brice Lortat-Jacob
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Julia Donadio
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Orthopedic Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Mouna Ben-Rehouma
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Paris-Saclay University, French Institute of Health and Medical Research, INSERM UMR 1195, Le Kremlin-Bicêtre, France
| | - Parvine Tashk
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Aurelie Snauwaert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Enora Atchade
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Grall
- Université de Paris, UFR Denis Diderot, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM), IAME, UMR 1137, Paris, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, UFR Denis Diderot, Paris, France.,French Institute of Health and Medical Research (INSERM) U1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France
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22
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Bleibtreu A, Dortet L, Bonnin RA, Wyplosz B, Sacleux SC, Mihaila L, Dupont H, Junot H, Bunel V, Grall N, Razazi K, Duran C, Tattevin P, Dinh A. Susceptibility Testing Is Key for the Success of Cefiderocol Treatment: A Retrospective Cohort Study. Microorganisms 2021; 9:microorganisms9020282. [PMID: 33573148 PMCID: PMC7911443 DOI: 10.3390/microorganisms9020282] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 01/19/2023] Open
Abstract
Cefiderocol is a novel siderophore cephalosporin, which has proven in vitro activity against carbapenem-resistant (CR) Gram-negative pathogens and stability towards all carbapenemases. The aim of this study was to describe the first cases of prescriptions and the efficacy of cefiderocol for compassionate use in the 2 months following its access in France. We performed a national retrospective study of all patients who received at least one dose of cefiderocol from 2 November 2018 to 5 November 2019. We collected clinical characteristics and outcome through a standard questionnaire. Bacterial isolates from 12 patients were centralized and analyzed in the French National Reference Center for Antimicrobial Resistance, and sequenced using Illumina technology. Finally, 13 patients from 7 French university hospitals were included in the study. The main type of infection treated by cefiderocol was respiratory tract infections (RTI, n = 10). The targeted bacteria were Pseudomonas aeruginosa (n = 12), including carbapenemase-producing P. aeruginosa (n = 9), Acinetobacter baumannii (n = 2), Klebsiella pneumoniae (n = 1), and Enterobacter hormaechei (n = 1). Overall, of the 12 patients whose samples were analyzed, 5 P. aeruginosa strains were not susceptible to cefiderocol (4 categorized as resistant and 1 as intermediate) according to Clinical and Laboratory Standards Institute (CLSI) breakpoints. If considering susceptible strains, the cure rate was 6/7, while being 0/5 among not-susceptible strains. This study underlines the necessity to test strains in adequate conditions.
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Affiliation(s)
- Alexandre Bleibtreu
- Infectious Disease Unit, La Pitié-Salpétrière University Hospital, AP-HP, University of Paris, 75013 Paris, France;
| | - Laurent Dortet
- Microbiology Laboratory, Bicêtre University Hospital, AP-HP Paris Saclay University, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.); (L.M.)
- Associate French National Center for Antimicrobial Resistance, 94275 Le Kremlin-Bicêtre, France
| | - Remy A. Bonnin
- Microbiology Laboratory, Bicêtre University Hospital, AP-HP Paris Saclay University, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.); (L.M.)
- Associate French National Center for Antimicrobial Resistance, 94275 Le Kremlin-Bicêtre, France
| | - Benjamin Wyplosz
- Infectious Disease Unit, Bicêtre University Hospital, AP-HP Paris Saclay University, 94270 Le Kremlin-Bicêtre, France;
| | - Sophie-Caroline Sacleux
- Intensive Care Unit, Paul Brousse Hospital, AP-HP Paris Saclay University, 94800 Villejuif, France
| | - Liliana Mihaila
- Microbiology Laboratory, Bicêtre University Hospital, AP-HP Paris Saclay University, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.); (L.M.)
| | - Hervé Dupont
- Intensive Care Unit, Amiens University Hospital, 80054 Amiens, France;
| | - Helga Junot
- Pharmacy Department, La Pitié-Salpétrière University Hospital, AP-HP, University of Paris, 75013 Paris, France;
| | - Vincent Bunel
- Pneumology Department, Bichât University Hospital, AP-HP, University of Paris, 75018 Paris, France;
| | - Nathalie Grall
- IAME, INSERM, University of Paris, 75870 Paris, France;
- Microbiology Laboratory, Bichât University Hospital, AP-HP, University of Paris, 75018 Paris, France
| | - Keyvan Razazi
- Intensive Care Unit, Henri Mondor University Hospital, AP-HP, 94010 Créteil, France;
| | - Clara Duran
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, 92380 Garches France;
| | - Pierre Tattevin
- Infectious Disease and Intensive Care Unit, Pontchaillou University Hospital, 35000 Rennes, France;
| | - Aurélien Dinh
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, 92380 Garches France;
- Correspondence: ; Tel.: +33-147104432
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23
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Roux P, Josselin LB, Grall N, Dumonceau O, Leport C. [Recurrent urinary tract infections in men: how to avoid antibiotics]. Rev Prat 2020; 70:1053-1057. [PMID: 33739641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Pascal Roux
- Maison d'accueil spécialisée Francis-de-Pressensé, Saint-Denis, France
| | - Le Bel Josselin
- Département de médecine générale, université de Paris, UMR 1137, Inserm, IAME, Paris, France
| | - Nathalie Grall
- Service de bactériologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Catherine Leport
- Service des maladies infectieuses et tropicales, IAME - UMR 1137, université Paris-Diderot et Inserm, site Bichat.Unité Coordination du risque épidémique et biologique, Paris, France
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24
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Logre E, Enser M, Tanaka S, Dubert M, Claudinon A, Grall N, Mentec H, Montravers P, Pajot O. Amikacin pharmacokinetic/pharmacodynamic in intensive care unit: a prospective database. Ann Intensive Care 2020; 10:75. [PMID: 32514769 PMCID: PMC7276966 DOI: 10.1186/s13613-020-00685-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background Aminoglycosides have a concentration-dependent therapeutic effect when peak serum concentration (Cmax) reaches eight to tenfold the minimal inhibitory concentration (MIC). With an amikacin MIC of 8 mg/L, the Cmax should be 64–80 mg/L. This objective is based on clinical breakpoints and not on measured MIC. This study aimed to assess the proportion of patients achieving the pharmacokinetic/pharmacodynamic (PK/PD) target Cmax/MIC ≥ 8 using the measured MIC in critically ill patients treated for documented Gram-negative bacilli (GNB) infections. Methods Retrospective analysis from February 2016 to December 2017 of a prospective database conducted in 2 intensive care units (ICU). All patients with documented severe GNB infections treated with amikacin (single daily dose of 25 mg/kg of total body weight (TBW)) with both MIC and Cmax measurements at first day of treatment (D1) were included. Results are expressed in n (%) or median [min–max]. Results 93 patients with 98 GNB-documented infections were included. The median Cmax was 55.2 mg/L [12.2–165.7] and the median MIC was 2 mg/L [0.19–16]. Cmax/MIC ratio ≥ 8 was achieved in 87 patients (88.8%) while a Cmax ≥ 64 mg/L was achieved in only 38 patients (38.7%). Overall probability of PK/PD target attainment was 93%. No correlation was found between Cmax/MIC ratio and clinical outcome at D8 and D28. Conclusion According to PK/PD parameters observed in our study, single daily dose of amikacin 25 mg/kg of TBW appears to be sufficient in most critically ill patients treated for severe GNB infections.
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Affiliation(s)
- Elsa Logre
- CH Argenteuil, réanimation polyvalente, 69 rue du Lieutenant-Colonel Prudhon, Argenteuil, France.
| | - Maya Enser
- CH Argenteuil, réanimation polyvalente, 69 rue du Lieutenant-Colonel Prudhon, Argenteuil, France
| | - Sébastien Tanaka
- CHU Bichat, réanimation chirurgicale, Paris, France.,INSERM UMR1188 Diabète - Athérothrombose - Thérapies Réunion Océan Indien (DéTROI), Saint-Denis de la Réunion, Université de la Réunion, Réunion, France
| | - Marie Dubert
- CHU Bichat, maladies infectieuses et tropicales, Paris, France
| | | | | | - Hervé Mentec
- CH Argenteuil, réanimation polyvalente, 69 rue du Lieutenant-Colonel Prudhon, Argenteuil, France
| | | | - Olivier Pajot
- CH Argenteuil, réanimation polyvalente, 69 rue du Lieutenant-Colonel Prudhon, Argenteuil, France
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25
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Rousseau B, Hilmi M, Khati I, Turpin A, Andremont A, Burdet C, Grall N, Vidal J, Bousquet PJ, Le Bihan C. Impact of antibiotics (ATB) on the recurrence of resected colorectal cancer (CRC): Results of EVADER-1 a nation-wide pharmacoepidemiologic study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4106] [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] [Indexed: 11/20/2022] Open
Abstract
4106 Background: Recent studies suggest that ATB increase the overall risk of CRC incidence through disruption of gut microbiota. Impact of ATB on the risk of CRC recurrence after curative resection remains unknown. Methods: Using the French nation-wide Institut National du Cancer (INCa – Système National des Données de Santé) database of cancer patients, all newly diagnozed localized CRC patients resected between 01/2012 and 12/2014 were involved. The perioperative ATB intake (6 month before until 1 year after surgery) was classified according to the spectrum, doses and period of use. The primary endpoint was 3-year Disease-Free Survival (3-DFS), stratified on chemotherapy (chemo) administration (yes/no), and assessed using multivariate Cox models. Results: Out of 219,884 CRC patients, the present study included 36,640 patients: male 53%, age≥75 years 39%, left colon/rectal 59%, exposure to chemo 44%, at least one ATB intake 74%. At 3-years, 29% of patients had recurred and 18% had died. In multivariate analysis, in patients not receiving chemo, ATB intake as an out-patient was significantly associated with better 3-DFS [HR (one ATB only) = 0.88 (0.82-0.94)]. This effect remained in the same range whatever the number of ATB or cumulative exposure to ATB. In patients receiving chemo, ATB intake as an out-patient had a significant detrimental effect on 3-DFS [HR (one ATB only) = 1.15 (1.08-1.23)], increasing with the number of ATB [HR (≥5 ATB) = 1.54 (1.39-1.71)] and longer exposure [HR ( > 30 days) = 1.39 (1.31-1.48)]. Penicillin A, quinolones and ATB combinations were associated with worse 3-DFS. The timing of ATB intake related to chemo revealed that the strongest deleterious effect was observed when ATB were taken during chemo [HR = 1.64 (1.53-1.75)]. No difference in the mean number of chemo cycle was observed comparing patients receiving ATB or not. Conclusions: This nation-wide study is the first to suggest that ATB modulate 3-DFS in resected CRC with a differential impact according to chemo exposure. Importantly, ATB intake with chemo is detrimental in a dose- and time-dependent manner suggesting that dysbiosis of gut microbiota during adjuvant chemo might increase risk of recurrence.
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Affiliation(s)
| | | | - Ines Khati
- Public Health and Healthcare Division, French National Cancer Institute INCa, Boulogne-Billancourt, France
| | | | | | - Charles Burdet
- AP-HP, Bichat Hospital, Department of Epidemiology, Biostatistics and Clinical Research, Paris, France
| | - Nathalie Grall
- AP-HP Microbiology Laboratory, Bichat-Claude Bernard University Hospital, Paris, France
| | - Joana Vidal
- Medical Oncology Hospital del Mar, Barcelona, Spain
| | - Philippe Jean Bousquet
- Public Health and Healthcare Division, French National Cancer Institute INCa, Boulogne-Billancourt, France
| | - Christine Le Bihan
- Public Health and Healthcare Division, French National Cancer Institute INCa, Boulogne-Billancourt, France
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Pierre-Audigier C, Talla C, Alame-Emane AK, Audigier B, Grall N, Ruimy R, Andremont A, Cadet-Daniel V, Sola C, Takiff H, Gicquel B, Vray M, Armand-Lefevre L. Tuberculosis trends in a hot-spot region in Paris, France. Int J Tuberc Lung Dis 2020; 24:428-435. [DOI: 10.5588/ijtld.19.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Tuberculosis (TB) incidence is declining overall in France, but not in Paris where some areas remain relative hot spots for TB.OBJECTIVES: To obtain a better knowledge of local TB epidemiology in order to facilitate control measures.DESIGN: Analysis
of demographic data of TB patients diagnosed at the Bichat-Claude Bernard Hospital from 2007 to 2016, with spoligotyping of Mycobacterium tuberculosis complex isolates.RESULTS: During the study period, 1096 TB patients were analysed. The incidence of TB diagnosis was stable,
averaging 115 patients per year, predominantly males (71%), foreign-born (81%), with pulmonary TB (77%) and negative HIV serology (88%). The mean age of foreign-born TB patients decreased over the study period, most significantly in recent arrivals in France, whose average age decreased by
two years (P = 0.001). The time period between arrival in France and being diagnosed with active TB decreased annually significantly by 0.75 years (P = 0.02). The proportion of L4.6.2/Cameroon and L2/Beijing sub-lineages increased annually by 0.7% (P < 0.05). Multi-drug
resistant strains, representing 4% of all strains, increased annually by 0.75% (P = 0.03)CONCLUSION: The number of TB patients remained high in northern Paris and the surrounding suburbs, suggesting the need for increased control measures.
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Affiliation(s)
- C. Pierre-Audigier
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center
for Chronic Disease Control, Shenzhen, 518054, China
| | - C. Talla
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - A-K. Alame-Emane
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - B. Audigier
- Statistic Study Group, Ecole Polytechnique, Palaiseau
| | - N. Grall
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne Paris
Cité F-75018, Paris
| | - R. Ruimy
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, Laboratoire de Bactériologie, Centre Hospitalo-Universitaire, Nice
| | - A. Andremont
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne
Paris Cité F-75018, Paris
| | | | - C. Sola
- Institute for Integrative Biology of the Cell (I2BC), CEA, Centre national de la Recherche scientifique, Université Paris Sud, Université Paris Saclay, Gif-sur-Yvette, France
| | - H. Takiff
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China, Instituto Venezolano de Investigaciones Cientificas (IVIC), Caracas,
Venezuela
| | - B. Gicquel
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - M. Vray
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - L. Armand-Lefevre
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne
Paris Cité F-75018, Paris
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27
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Dubert M, Visseaux B, Birgy A, Mordant P, Metivier AC, Dauriat G, Fidouh N, Yazdanpanah Y, Grall N, Castier Y, Mal H, Thabut G, Lescure FX. Late viral or bacterial respiratory infections in lung transplanted patients: impact on respiratory function. BMC Infect Dis 2020; 20:176. [PMID: 32093612 PMCID: PMC7041086 DOI: 10.1186/s12879-020-4877-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background Respiratory infections are a major threat for lung recipients. We aimed to compare with a monocentric study the impact of late viral and bacterial respiratory infections on the graft function. Methods Patients, who survived 6 months or more following lung transplantation that took place between 2009 and 2014, were classified into three groups: a viral infection group (VIG) (without any respiratory bacteria), a bacterial infection group (BIG) (with or without any respiratory viruses), and a control group (CG) (no documented infection). Chronic lung allograft dysfunction (CLAD) and acute rejection were analysed 6 months after the inclusion in the study. Results Among 99 included lung recipients, 57 (58%) had at least one positive virological respiratory sample during the study period. Patients were classified as follows: 38 in the VIG, 25 in the BIG (among which 19 co-infections with a virus) and 36 in the CG. The BIG presented a higher initial deterioration in lung function (p = 0.05) than the VIG. But 6 months after the infection, only the VIG presented a median decrease of forced expiratory volume in 1 s; − 35 mL (IQR; − 340; + 80) in the VIG, + 140 mL (+ 60;+ 330) in the BIG and + 10 (− 84;+ 160) in the CG, p < 0.01. Acute rejection was more frequent in the VIG (n = 12 (32%)), than the BIG (n = 6 (24%)) and CG (n = 3 (8%)), p < 0.05, despite presenting no more CLAD (p = 0.21). Conclusions Despite a less severe initial presentation, single viral respiratory infections seem to lead to a greater deterioration in lung function, and to more acute rejection, than bacterial infections.
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Affiliation(s)
- Marie Dubert
- AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, 46 Rue Henri Huchard, F-75018, Paris, France.
| | - Benoit Visseaux
- INSERM, IAME, UMR 1137, F-75018, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Hôpital Bichat, Laboratoire de virologie, F-75018, Paris, France
| | - André Birgy
- INSERM, IAME, UMR 1137, F-75018, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Hôpital Robert Debré, Laboratoire de microbiologie, F-75019, Paris, France
| | - Pierre Mordant
- AP-HP, Hôpital Bichat, Service de chirurgie thoracique, F-75018, Paris, France
| | | | - Gaelle Dauriat
- AP-HP, Hôpital Bichat, Service de pneumologie, F-75018, Paris, France
| | - Nadhira Fidouh
- AP-HP, Hôpital Bichat, Laboratoire de virologie, F-75018, Paris, France
| | - Yazdan Yazdanpanah
- AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, 46 Rue Henri Huchard, F-75018, Paris, France.,INSERM, IAME, UMR 1137, F-75018, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | - Nathalie Grall
- INSERM, IAME, UMR 1137, F-75018, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Hôpital Bichat, Laboratoire de microbiologie, F-75018, Paris, France
| | - Yves Castier
- AP-HP, Hôpital Bichat, Service de chirurgie thoracique, F-75018, Paris, France
| | - Hervé Mal
- AP-HP, Hôpital Bichat, Service de pneumologie, F-75018, Paris, France
| | - Gabriel Thabut
- AP-HP, Hôpital Bichat, Service de pneumologie, F-75018, Paris, France
| | - François-Xavier Lescure
- AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, 46 Rue Henri Huchard, F-75018, Paris, France. .,INSERM, IAME, UMR 1137, F-75018, Paris, France. .,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.
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28
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Augustin P, Tanaka S, Tran-Dinh A, Parenti Ribeiro L, Arapis K, Grall N, Al Qarni A, Montravers P. Outcome and Adequacy of Empirical Antibiotherapy in Post-Operative Peritonitis: A Retrospective Study. Surg Infect (Larchmt) 2019; 21:284-292. [PMID: 31770083 DOI: 10.1089/sur.2019.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Empirical antibiotherapy (EA) should target all bacteria in post-operative peritonitis (PP). Nevertheless, recent studies failed to prove a link between adequacy of EA and prognosis of PP. We sought to confirm this loss of association between adequate EA and prognosis and to analyze the evolution of patients' characteristics and antimicrobial strategies. Methods: This is was retrospective study. Patients with a positive fungal culture were excluded. The cohort was divided into two time periods. Data of survivors and non-survivors were compared within each time period. Differences between the two periods were assessed. A multivariable analysis searched for parameters associated with a higher hospital mortality rate. Results: Two hundred fifty-one patients were included, with 92 patients in the first period (P1) and 152 patients in the second period (P2). Inadequate EA was associated with a worse outcome only in P1. The multivariable analysis in the whole cohort showed that inadequate EA was associated with a higher mortality rate. When the differences noticed between the two periods were entered in the model (presence of resistant gram-positive cocci and EA comprising glycopeptides), inadequate EA was no longer associated with worse outcome. In P1, the most severe patients had more resistant bacteria, hence, had a higher rate of inadequate EA. This artifact disappeared in P2, during which broader antibiotherapies with triple EA were more often prescribed for the most severe patients. Conclusion: This study showed that the link between inadequate EA and outcome of patients with PP was at least partly artifactual in older studies.
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Affiliation(s)
- Pascal Augustin
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sebastien Tanaka
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexy Tran-Dinh
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lara Parenti Ribeiro
- Service de Chirurgie digestive, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kostantinos Arapis
- Service de Chirurgie digestive, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nathalie Grall
- Laboratoire de Microbiologie, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Adel Al Qarni
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Press Sorbonne Cité, Paris, France.,INSERM UMR 1152, Paris, France
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29
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Calais J, Touati A, Grall N, Laouénan C, Benali K, Mahida B, Vigne J, Hyafil F, Iung B, Duval X, Lepage L, Le Guludec D, Rouzet F. Diagnostic Impact of
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F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and White Blood Cell SPECT/Computed Tomography in Patients With Suspected Cardiac Implantable Electronic Device Chronic Infection. Circ Cardiovasc Imaging 2019; 12:e007188. [DOI: 10.1161/circimaging.117.007188] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background:
Cardiac implantable electronic devices (CIEDs) chronic infection diagnosis is challenging because the clinical presentation is frequently misleading and echocardiography may be inconclusive. The aim of this study was to evaluate the diagnostic value of
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F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and radiolabeled white blood cells single photon emission CT/CT in a cohort of patients who underwent both scans for suspicion of CIED infection and inconclusive routine investigations.
Methods:
Forty-eight consecutive patients with suspicion of CIED infection who underwent both
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F-fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT in a time span ≤30 days were retrospectively included. The final diagnosis of CIED infection by the endocarditis expert team was based on the modified Duke-Li classification at the end of follow-up.
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F-Fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT scans were independently analyzed blinded to the patients’ medical record.
Results:
In the overall study population, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were respectively 80%, 91%, 80%, and 91% for
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F-fluorodeoxyglucose positron emission tomography/CT and 60%, 100%, 100%, and 85% for white blood cell single photon emission CT/CT. Addition of a positive nuclear imaging scan as a major criterion markedly improved the Duke-Li classification at admission. Semiquantitative parameters did not allow to discriminate between definite and rejected CIED infection. Prolonged antibiotic therapy before imaging tended to decrease the sensitivity for both techniques.
Conclusions:
Nuclear imaging can improve the diagnostic performances of the Duke-Li score at admission in a selected population of patients with suspected CIED infection, particularly when the infection was initially graded as possible. Whenever possible, imaging should be performed before or early after antibiotic initiation.
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Affiliation(s)
- Jérémie Calais
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
| | - Aziza Touati
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
| | - Nathalie Grall
- INSERM, UMR 1137 (IAME), Paris, France (N.G., C.L., X.D.)
- Microbiology Laboratory (N.G.), AP-HP, Bichat Hospital, Paris, France
| | - Cédric Laouénan
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM, UMR 1137 (IAME), Paris, France (N.G., C.L., X.D.)
- Department of Biostatistics (C.L.), AP-HP, Bichat Hospital, Paris, France
| | - Khadija Benali
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Besma Mahida
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Jonathan Vigne
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Fabien Hyafil
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Bernard Iung
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- Department of Cardiology (B.I.), AP-HP, Bichat Hospital, DHU FIRE, Paris, France
| | - Xavier Duval
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM, UMR 1137 (IAME), Paris, France (N.G., C.L., X.D.)
- INSERM, Clinical Investigation Centre, Bichat (X.D.)
| | - Laurent Lepage
- Department of Cardiac surgery (L.L.), AP-HP, Bichat Hospital, DHU FIRE, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - François Rouzet
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
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Perrineau S, Lachâtre M, Lê MP, Rioux C, Loubet P, Fréchet-Jachym M, Gonzales MC, Grall N, Bouvet E, Veziris N, Yazdanpanah Y, Peytavin G. Long-term plasma pharmacokinetics of bedaquiline for multidrug- and extensively drug-resistant tuberculosis. Int J Tuberc Lung Dis 2019; 23:99-104. [DOI: 10.5588/ijtld.18.0042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S. Perrineau
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris
| | - M. Lachâtre
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris
| | - M. P. Lê
- Infection, Antimicrobiens, Modelisation, Evolution, Unité mixte de recherche 1137, Institut national de la santé et de la recherche médicale (INSERM), Paris, Service de Pharmacologie-Toxicologie, Hôpital Bichat-Claude
Bernard, AP-HP, Paris
| | - C. Rioux
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris
| | - P. Loubet
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, Infection, Antimicrobiens, Modelisation,
Evolution, Unité mixte de recherche 1137, Institut national de la santé et de la recherche médicale (INSERM), Paris
| | | | - M. Cervantes Gonzales
- Infection, Antimicrobiens, Modelisation, Evolution, Unité mixte de recherche 1137, Institut national de la santé et de la recherche médicale (INSERM), Paris, Département d'Épidémiologie,
Biostatistique et Recherche clinique
| | - N. Grall
- Université Paris Diderot, Sorbonne Paris Cité, Paris, Infection, Antimicrobiens, Modelisation, Evolution, Unité mixte de recherche 1137, Institut national de la santé et de la recherche médicale (INSERM), Paris,
Laboratoire de Microbiologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris
| | - E. Bouvet
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris
| | - N. Veziris
- Département de Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires de l'Est Parisien, AP-HP
Paris, Centre d'Immunologie et des Maladies Infectieuses équipe 13, Sorbonne Université, INSERM Unité 1135, Paris, France
| | - Y. Yazdanpanah
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, Infection, Antimicrobiens,
Modelisation, Evolution, Unité mixte de recherche 1137, Institut national de la santé et de la recherche médicale (INSERM), Paris
| | - G. Peytavin
- Université Paris Diderot, Sorbonne Paris Cité, Paris, Infection, Antimicrobiens, Modelisation, Evolution, Unité mixte de recherche 1137, Institut national de la santé et de la recherche médicale (INSERM), Paris,
Service de Pharmacologie-Toxicologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris
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Burdet C, Loubet P, Le Moing V, Vindrios W, Esposito-Farèse M, Linard M, Ferry T, Massias L, Tattevin P, Wolff M, Vandenesch F, Grall N, Quintin C, Mentré F, Duval X, Lescure FX. Efficacy of cloxacillin versus cefazolin for methicillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa): study protocol for a randomised, controlled, non-inferiority trial. BMJ Open 2018; 8:e023151. [PMID: 30173161 PMCID: PMC6120654 DOI: 10.1136/bmjopen-2018-023151] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a common and severe disease responsible for approximately 65 000 deaths every year in Europe. Intravenous antistaphylococcal penicillins (ASP) such as cloxacillin are the current recommended antibiotics. However, increasing reports of toxicity and recurrent stock-outs of ASP prompted healthcare providers to seek for alternative antibiotic treatment. Based on retrospective studies, cefazolin, a first-generation cephalosporin, is recommended in patients at risk of severe ASP-associated toxicity.We hypothesised that cefazolin has a non-inferior efficacy in comparison to cloxacillin, with a better safety profile for the treatment of MSSA bacteraemia. METHODS AND ANALYSIS The CloCeBa trial is an open-label, randomised, controlled, non-inferiority trial conducted in academic centres throughout France. Eligible patients are adults with MSSA bacteraemia without intravascular device or suspicion of central nervous system infection. Patients will be randomised (1:1) to receive either cloxacillin or cefazolin by the intravenous route, for the first 14 days of therapy. The evaluation criteria is a composite criteria of negative blood cultures at day 5, survival, absence of relapse and clinical success at day 90 after randomisation. Secondary evaluation criteria include both efficacy and safety assessments. Three ancillary studies are planned to describe the epidemiology of β-lactamase encoding genes, the ecological impact and pharmacokinetic/pharmacodynamic parameters of cefazolin and cloxacillin. Including 300 patients will provide 80% power to demonstrate the non-inferiority of cefazolin over cloxacillin, assuming 85% success rate with cloxacillin and taking into account loss-to-follow-up, with a 0.12 non-inferiority margin and a one-sided type I error of 0.025. ETHICS AND DISSEMINATION This protocol received authorisation from the ethics committee Sud-Est I on 13 November 2017 (2017-87-PP)and French National Agency for Medicines and Health Products (170661A-43). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03248063 and 2017-003967-36.
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Affiliation(s)
- Charles Burdet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat Claude Bernard—Département d’Epidémiologie, Biostatistiques et recherche Clinique, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Paul Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat Claude Bernard—Service de maladies infectieuses, Assistance Publique—Hopitaux de Paris, Paris, France
| | | | - William Vindrios
- Hôpital Bichat Claude Bernard—Service de maladies infectieuses, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Marina Esposito-Farèse
- Hôpital Bichat Claude Bernard—Unité de recherche Clinique, Assistance Publique—Hopitaux de Paris, Paris, France
- Inserm CIC 1425, Centre d’Investigation Clinique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Morgane Linard
- Hôpital Bichat Claude Bernard—Département d’Epidémiologie, Biostatistiques et recherche Clinique, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Hopital de la Croix-Rousse, Lyon, France
| | - Laurent Massias
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat Claude Bernard—Laboratoire de toxicologie, Assistance Publique—Hopitaux de Paris, Paris, Île-de-France, France
| | - Pierre Tattevin
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France
| | - Michel Wolff
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat Claude Bernard—Service de réanimation médicale et infectieuse, Assistance Publique—Hopitaux de Paris, Paris, France
| | | | - Nathalie Grall
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat lLaude Bernard—Laboratoire de bactériologie, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Caroline Quintin
- Hôpital Bichat Claude Bernard—Unité de recherche Clinique, Assistance Publique—Hopitaux de Paris, Paris, France
| | - France Mentré
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat Claude Bernard—Département d’Epidémiologie, Biostatistiques et recherche Clinique, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Xavier Duval
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Inserm CIC 1425, Centre d’Investigation Clinique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - François-Xavier Lescure
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
- Hôpital Bichat Claude Bernard—Service de maladies infectieuses, Assistance Publique—Hopitaux de Paris, Paris, France
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Gras J, De Castro N, Montlahuc C, Champion L, Scemla A, Matignon M, Lachâtre M, Raskine L, Grall N, Peraldi MN, Molina JM. Clinical characteristics, risk factors, and outcome of tuberculosis in kidney transplant recipients: A multicentric case-control study in a low-endemic area. Transpl Infect Dis 2018; 20:e12943. [DOI: 10.1111/tid.12943] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/05/2018] [Accepted: 05/28/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Julien Gras
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Saint Louis; Paris France
| | - Nathalie De Castro
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Saint Louis; Paris France
| | - Claire Montlahuc
- Service de Biostatistiques et Information médicale; Hôpital Saint Louis APHP; Paris ECSTRA Team; UMR 1153 INSERM; Université Paris Diderot; Sorbonne Paris Cité; Paris France
| | - Laure Champion
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Bichat; Paris France
| | - Anne Scemla
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Necker Enfants Malades; Paris France
| | - Marie Matignon
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Henri Mondor; Créteil France
| | - Marie Lachâtre
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Bichat; Paris France
| | - Laurent Raskine
- Service de bactériologie; APHP-Hôpital Lariboisière; Paris France
| | - Nathalie Grall
- Laboratoire de microbiologie; APHP-Hôpital Bichat; INSERM; IAME; UMR 1137; Paris France
| | - Marie Noëlle Peraldi
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Saint Louis; Paris France
- Université Paris Diderot-Paris VII; Paris France
| | - Jean Michel Molina
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Saint Louis; Paris France
- Université Paris Diderot-Paris VII; Paris France
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Tanaka S, Geneve C, Tebano G, Grall N, Piednoir P, Bronchard R, Godement M, Atchade E, Augustin P, Mal H, Castier Y, Montravers P, Desmard M. Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation. BMC Pulm Med 2018; 18:43. [PMID: 29506501 PMCID: PMC5836426 DOI: 10.1186/s12890-018-0605-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/30/2017] [Accepted: 02/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU after LT between 2006 and 2012. Methods Three situations were described: colonization determined in donors and recipients, pneumonia and tracheobronchitis during the first 28 postoperative days. Severity score, demographic, bacteriologic and outcome data were collected. Results 26% of donors and 31% of recipients were colonized. 92% of recipients developed BRI, including at least one episode of pneumonia in 19% of recipients. Only 21% of recipients developed BRI with an organism cultured from the donor’s samples, while 40% of recipients developed BRI with their own bacteria cultured before LT. Purulent sputum appears to be an important factor to discriminate tracheobronchitis from pneumonia. When compared to patients with tracheobronchitis, those with pneumonia had longer durations of mechanical ventilation (13 [3–27] vs 3 [29], p = 0.0005) and ICU stay (24 [16–34] vs 14 [9-22], p = 0.002). Pneumonia was associated with higher 28-day (11 (32%) vs 9 (7%), p = 0.0004) and one-year mortality rates (21 (61%) vs 24 (19%), p ≤ 0.0001). Conclusions These data confirm the high frequency of BRI right from the early postoperative period and the poor prognosis of pneumonia after LT.
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Affiliation(s)
- Sebastien Tanaka
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France.
| | - Claire Geneve
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Gianpiero Tebano
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Grall
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France.,AP-HP, CHU Bichat-Claude Bernard Laboratoire de Microbiologie, Paris, France
| | - Pascal Piednoir
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Régis Bronchard
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Mathieu Godement
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Enora Atchade
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Pascal Augustin
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Herve Mal
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France.,INSERM, UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Yves Castier
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France.,APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France.,Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Mathieu Desmard
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France.,Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
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Delory T, Ferrand H, Grall N, Casalino E, Lafarge M, Melot B, Hajage D, Charpentier C, Aubier M, Tubach F, Bouvet E, Gault N, Yazdanpanah Y. Score for pulmonary tuberculosis in patients with clinical presumption of tuberculosis in a low-prevalence area. Int J Tuberc Lung Dis 2017; 21:1272-1279. [DOI: 10.5588/ijtld.17.0353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES: To develop a diagnostic predictive model for the identification of patients with presumptive pulmonary tuberculosis (PTB) at high risk for active disease and those requiring nucleic acid amplification (NAAT) testing and/or preventive respiratory isolation in low-incidence,
high-income countries.DESIGN: A 1:1 case-control study was conducted in consecutive immunocompetent patients with presumed PTB hospitalised between 2009 and 2012 in Paris, France. Cases were defined as individuals with culture-confirmed PTB, regardless of smear result. Those with presumed
PTB and three smear- and culture-negative samples were selected as controls. A score was derived using conditional logistic regression. Internal validity of the score was assessed using the bootstrap method.RESULTS: A total of 354 patients were included in the analysis (177 cases, 177
controls). Among the 177 cases, 74 (42%) were smear-negative but culture-positive. Factors independently associated with PTB were age <50 years (adjusted OR [aOR] 4.7, 95%CI 1.8–12), diabetes (aOR 3.2, 95%CI 1.1–9.8), absence of cough with or without sputum (aOR 3.7, 95%CI 1.7–8.3),
fever >15 days (aOR 3.5, 95%CI 1.3–9.5), apical infiltration without cavity (aOR 3.4, 95%CI 1.4–8.5) and cavitation or miliary pattern (aOR 19.7, 95%CI 7.6–51.1). Score C-index was 0.84 (95%CI 0.79–0.88). Calibration for the overall population (P = 0.770)
and in smear-negative patients (P = 0.980) was appropriate. A score of 3.3 had 90% sensitivity, 50% specificity and 79% (IQR 28–95) median probability of PTB.CONCLUSIONS: This score could be used to build an algorithm to determine the need for respiratory isolation and/or NAAT use in PTB disease.
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Affiliation(s)
| | - H. Ferrand
- APHP, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - N. Grall
- Service de Bactériologie, Paris, France
| | - E. Casalino
- Service d'Accueil des Urgences, Paris, France
| | | | - B. Melot
- APHP, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - D. Hajage
- Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris, France
| | - C. Charpentier
- Service de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - M. Aubier
- Service de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - F. Tubach
- Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris
| | - E. Bouvet
- APHP, Service de Maladies Infectieuses et Tropicales, France
| | - N. Gault
- Assistance Publique-Hôpitaux de Paris (APHP), Département Epidémiologie et Recherche Clinique, Hôpital Bichat-Claude Bernard, Paris, France; Centre d'Investigation Clinique 1425-EC, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables, Paris , Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Y. Yazdanpanah
- APHP, Service de Maladies Infectieuses et Tropicales, France
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Ruppé E, Burdet C, Grall N, de Lastours V, Lescure FX, Andremont A, Armand-Lefèvre L. Impact of antibiotics on the intestinal microbiota needs to be re-defined to optimize antibiotic usage. Clin Microbiol Infect 2017; 24:3-5. [PMID: 28970162 DOI: 10.1016/j.cmi.2017.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 12/22/2022]
Affiliation(s)
- E Ruppé
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France.
| | - C Burdet
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Département of d'Epidémiologie, Biostatistiques et Recherche Clinique, Paris, France
| | - N Grall
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - V de Lastours
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Beaujon, Equipe Mobile d'Antibiothérapie, Clichy, France
| | - F-X Lescure
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Service des Maladies Infectieuses, Paris, France
| | - A Andremont
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - L Armand-Lefèvre
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
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Loubet P, Burdet C, Vindrios W, Grall N, Wolff M, Yazdanpanah Y, Andremont A, Duval X, Lescure FX. Cefazolin versus anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bacteraemia: a narrative review. Clin Microbiol Infect 2017; 24:125-132. [PMID: 28698037 DOI: 10.1016/j.cmi.2017.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/27/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anti-staphylococcal penicillins (ASPs) are recommended as first-line agents in methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Concerns about their safety profile have contributed to the increased use of cefazolin. The comparative clinical effectiveness and safety profile of cefazolin versus ASPs for such infections remain unclear. Furthermore, uncertainty persists concerning the use of cefazolin due to controversies over its efficacy in deep MSSA infections and its possible negative ecological impact. AIMS The aim of this narrative review was to gather and balance available data on the efficacy and safety of cefazolin versus ASPs in the treatment of MSSA bacteraemia and to discuss the potential negative ecological impact of cefazolin. SOURCES PubMed and EMBASE electronic databases were searched up to May 2017 to retrieve available studies on the topic. CONTENTS Although described in vitro and in experimental studies, the clinical relevance of the inoculum effect during cefazolin treatment of deep MSSA infections remains unclear. It appears that there is no significant difference in rate of relapse or mortality between ASPs and cefazolin for the treatment of MSSA bacteraemia but these results should be cautiously interpreted because of the several limitations of the available studies. Compared with cefazolin, there is more frequent discontinuation for adverse effects with ASP use, especially because of cutaneous and renal events. No study has evidenced any change in the gut microbiota after the use of cefazolin. IMPLICATIONS Based on currently available studies, there are no data that enable a choice to be made of one antibiotic over the other except in patients with allergy or renal impairment. This review points out the need for future prospective studies and randomized controlled trials to better address these questions.
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Affiliation(s)
- P Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - C Burdet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Département d'épidémiologie, biostatistique et recherche clinique, Paris, France
| | - W Vindrios
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - N Grall
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Bactériologie, Paris, France
| | - M Wolff
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de réanimation médicale et infectieuse, Paris, France
| | - Y Yazdanpanah
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - A Andremont
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Bactériologie, Paris, France
| | - X Duval
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Centre d'Investigation Clinique, Paris, France
| | - F-X Lescure
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France.
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Grall N, Lazarevic V, Gaïa N, Couffignal C, Laouénan C, Ilic-Habensus E, Wieder I, Plesiat P, Angebault C, Bougnoux ME, Armand-Lefevre L, Andremont A, Duval X, Schrenzel J. Unexpected persistence of extended-spectrum β-lactamase-producing Enterobacteriaceae in the faecal microbiota of hospitalised patients treated with imipenem. Int J Antimicrob Agents 2017; 50:81-87. [PMID: 28499958 DOI: 10.1016/j.ijantimicag.2017.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
Imipenem is active against extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) but favours the intestinal emergence of resistance. The effects of imipenem on intestinal microbiota have been studied using culture-based techniques. In this study, the effects were investigated in patients using culture and metagenomic techniques. Seventeen hospitalised adults receiving imipenem were included in a multicentre study (NCT01703299, http://www.clinicaltrials.gov). Most patients had a history of antibiotic use and/or hospitalisation. Stools were collected before, during and after imipenem treatment. Bacterial and fungal colonisation was assessed by culture, and microbiota changes were assessed using metagenomics. Unexpectedly, high colonisation rates by imipenem-susceptible ESBL-E before treatment (70.6%) remained stable over time, suggesting that imipenem intestinal concentrations were very low. Carriage rates of carbapenem-resistant Gram-negative bacilli (0-25.0%) were also stable over time, whereas those of yeasts (64.7% before treatment) peaked at 76.5% during treatment and decreased thereafter. However, these trends were not statistically significant. Yeasts included highly diverse colonising Candida spp. Metagenomics showed no global effect of imipenem on the bacterial taxonomic profiles at the sequencing depth used but demonstrated specific changes in the microbiota not detected with culture, attributed to factors other than imipenem, including sampling site or treatment with other antibiotics. In conclusion, culture and metagenomics were highly complementary in characterising the faecal microbiota of patients. The changes observed during imipenem treatment were unexpectedly limited, possibly because the microbiota was already disturbed by previous antibiotic exposure or hospitalisation.
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Affiliation(s)
- N Grall
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France.
| | - V Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - N Gaïa
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - C Couffignal
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Biostatistique, F-75018 Paris, France
| | - C Laouénan
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Biostatistique, F-75018 Paris, France
| | - E Ilic-Habensus
- AP-HP, Hôpital Bichat, INSERM CIC 1425, F-75018 Paris, France
| | - I Wieder
- AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - P Plesiat
- Laboratoire de Bactériologie EA4266, Faculté de Médecine-Pharmacie, Université de Franche-Comté, Besançon, France
| | - C Angebault
- AP-HP, Hôpital Necker-Enfants Malades, Unité de Parasitologie-Mycologie, Service de Microbiologie, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, F-75015 Paris, France
| | - M E Bougnoux
- AP-HP, Hôpital Necker-Enfants Malades, Unité de Parasitologie-Mycologie, Service de Microbiologie, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, F-75015 Paris, France
| | - L Armand-Lefevre
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - A Andremont
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - X Duval
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, INSERM CIC 1425, F-75018 Paris, France
| | - J Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Bacteriology, Geneva University Hospitals, Geneva, Switzerland
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Poirier C, Dinh A, Salomon J, Grall N, Andremont A, Bernard L. Prevention of urinary tract infections by antibiotic cycling in spinal cord injury patients and low emergence of multidrug resistant bacteria. Med Mal Infect 2016; 46:294-9. [DOI: 10.1016/j.medmal.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/15/2015] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
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Collarino R, Vergeylen U, Emeraud C, Latournèrie G, Grall N, Mammeri H, Messika-Zeitoun D, Vallois D, Yazdanpanah Y, Lescure FX, Bleibtreu A. Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description. New Microbes New Infect 2016; 13:40-2. [PMID: 27408740 PMCID: PMC4927642 DOI: 10.1016/j.nmni.2016.06.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/02/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022] Open
Abstract
Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis.
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Affiliation(s)
- R Collarino
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - U Vergeylen
- Cardiology Departments, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - C Emeraud
- Bacteriology Departments, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - G Latournèrie
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - N Grall
- Bacteriology Departments, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - H Mammeri
- Bacteriology Departments, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - D Messika-Zeitoun
- Cardiology Departments, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - D Vallois
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - Y Yazdanpanah
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - F-X Lescure
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
| | - A Bleibtreu
- Infectious and Tropical Diseases Department, University Hospital Bichat-Claude Bernard, APHP, Paris, France
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Perrineau S, Lachâtre M, Le M, Rioux C, Fréchet-Jachym M, Grall N, Bouvet E, Veziris N, Yazdanpanah Y, Gilles P. MYCOBACT-15 - Pharmacocinétique plasmatique de la bédaquiline lors du traitement des tuberculoses MDR/XDR. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gras J, De Castro N, Bérot V, Lachatre M, Champion L, Raskine L, Molina J, Montlahuc C, Grall N, Peraldi M. MYCOBACT-11 - Caractéristiques des tuberculoses chez les patients transplantés rénaux dans un CHU entre 2004 et 2015 : à propos de 15 cas. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Montravers P, Augustin P, Grall N, Desmard M, Allou N, Marmuse JP, Guglielminotti J. Characteristics and outcomes of anti-infective de-escalation during health care-associated intra-abdominal infections. Crit Care 2016; 20:83. [PMID: 27052675 PMCID: PMC4823898 DOI: 10.1186/s13054-016-1267-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/16/2016] [Indexed: 12/26/2022]
Abstract
Background De-escalation is strongly recommended for antibiotic stewardship. No studies have addressed this issue in the context of health care-associated intra-abdominal infections (HCIAI). We analyzed the factors that could interfere with this process and their clinical consequences in intensive care unit (ICU) patients with HCIAI. Methods All consecutive patients admitted for the management of HCIAI who survived more than 3 days following their diagnosis, who remained in the ICU for more than 3 days, and who did not undergo early reoperation during the first 3 days were analyzed prospectively in an observational, single-center study in a tertiary care university hospital. Results Overall, 311 patients with HCIAI were admitted to the ICU. De-escalation was applied in 110 patients (53 %), and no de-escalation was reported in 96 patients (47 %) (escalation in 65 [32 %] and unchanged regimen in 31 [15 %]). Lower proportions of Enterococcus faecium, nonfermenting Gram-negative bacilli (NFGNB), and multidrug-resistant (MDR) strains were cultured in the de-escalation group. No clinical difference was observed at day 7 between patients who were de-escalated and those who were not. Determinants of de-escalation in multivariate analysis were adequate empiric therapy (OR 9.60, 95 % CI 4.02–22.97) and empiric use of vancomycin (OR 3.39, 95 % CI 1.46–7.87), carbapenems (OR 2.64, 95 % CI 1.01–6.91), and aminoglycosides (OR 2.31 95 % CI 1.08–4.94). The presence of NFGNB (OR 0.28, 95 % CI 0.09–0.89) and the presence of MDR bacteria (OR 0.21, 95 % CI 0.09–0.52) were risk factors for non-de-escalation. De-escalation did not change the overall duration of therapy. The risk factors for death at day 28 were presence of fungi (HR 2.64, 95 % CI 1.34–5.17), Sequential Organ Failure Assessment score on admission (HR 1.29, 95 % CI 1.16–1.42), and age (HR 1.03, 95 % CI 1.01–1.05). The survival rate expressed by a Kaplan-Meier curve was similar between groups (log-rank test p value 0.176). Conclusions De-escalation is a feasible option in patients with polymicrobial infections such as HCIAI, but MDR organisms and NFGNB limit its implementation.
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Affiliation(s)
- Philippe Montravers
- Département d'Anesthésie Réanimation, APHP, CHU Bichat-Claude Bernard, Paris, France. .,Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.
| | - Pascal Augustin
- Département d'Anesthésie Réanimation, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Nathalie Grall
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France.,Laboratoire de Microbiologie, AP-HP, CHU Bichat-Claude Bernard, Paris, France
| | - Mathieu Desmard
- Département d'Anesthésie Réanimation, APHP, CHU Bichat-Claude Bernard, Paris, France.,Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Nicolas Allou
- Département d'Anesthésie Réanimation, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Jean-Pierre Marmuse
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,Service de Chirurgie Générale, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Jean Guglielminotti
- Département d'Anesthésie Réanimation, APHP, CHU Bichat-Claude Bernard, Paris, France.,Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France
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Tebano G, Geneve C, Tanaka S, Grall N, Atchade E, Augustin P, Thabut G, Castier Y, Montravers P, Desmard M. Epidemiology and risk factors of multidrug-resistant bacteria in respiratory samples after lung transplantation. Transpl Infect Dis 2016; 18:22-30. [DOI: 10.1111/tid.12471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/23/2015] [Accepted: 09/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- G. Tebano
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - C. Geneve
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - S. Tanaka
- Service de Réanimation; Centre Hospitalier Victor Dupouy; Argenteuil France
| | - N. Grall
- Laboratoire de Microbiologie; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - E. Atchade
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - P. Augustin
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - G. Thabut
- Service de Pneumologie B et Transplantation Pulmonaire; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
- Physiopathologie et Epidémiologie des Maladies Respiratoires; Université Paris Diderot Sorbonne Cite; Inserm UMR1152; Paris France
| | - Y. Castier
- Physiopathologie et Epidémiologie des Maladies Respiratoires; Université Paris Diderot Sorbonne Cite; Inserm UMR1152; Paris France
- Service de Chirurgie Thoracique et Vasculaire; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
| | - P. Montravers
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
- Physiopathologie et Epidémiologie des Maladies Respiratoires; Université Paris Diderot Sorbonne Cite; Inserm UMR1152; Paris France
| | - M. Desmard
- Département d'Anesthésie Réanimation; Université Paris Diderot Sorbonne Cite; APHP; CHU Bichat-Claude Bernard; Paris France
- Service de Réanimation; Centre Hospitalier Sud Francilien; Corbeil-Essonnes France
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Alqarni A, Augustin P, Snauwaert A, Guivarch E, Benrehouma M, Geneve C, Grall N, Arapis K, Montravers P. Prognosis of bacteremic patients during postoperative peritonitis. Intensive Care Med Exp 2015. [PMCID: PMC4797005 DOI: 10.1186/2197-425x-3-s1-a120] [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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Grall N, Barraud O, Wieder I, Hua A, Perrier M, Babosan A, Gaschet M, Clermont O, Denamur E, Catzeflis F, Decré D, Ploy MC, Andremont A. Lack of dissemination of acquired resistance to β-lactams in small wild mammals around an isolated village in the Amazonian forest. Environ Microbiol Rep 2015; 7:698-708. [PMID: 25858231 DOI: 10.1111/1758-2229.12289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/31/2015] [Indexed: 06/04/2023]
Abstract
In this study, we quantitatively evaluated the spread of resistance to β-lactams and of integrons in small rodents and marsupials living at various distances from a point of antibiotic's use. Rectal swabs from 114 animals were collected in Trois-Sauts, an isolated village in French Guiana, and along a 3 km transect heading through the non-anthropized primary forest. Prevalence of ticarcillin-resistant enterobacteria was 36% (41/114). Klebsiella spp., naturally resistant to ticarcillin, were found in 31.1% (23/73) of animals from the village and in an equal ratio of 31.7% (13/41) of animals trapped along the transect. By contrast Escherichia coli with acquired resistance to ticarcillin were found in 13.7% (10/73) of animals from the village and in only 2.4% (1/41) of those from the transect (600 m from the village). There was a huge diversity of E. coli and Klebsiella pneumoniae strains with very unique and infrequent sequence types. The overall prevalence of class 1 integrons carriage was 19.3% (22/114) homogenously distributed between animals from the village and the transect, which suggests a co-selection by a non-antibiotic environmental factor. Our results indicate that the anthropogenic acquired antibiotic resistance did not disseminate in the wild far from the point of selective pressure.
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Affiliation(s)
- Nathalie Grall
- INSERM, IAME, UMR 1137, F-75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
- Laboratoire de Microbiologie, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Olivier Barraud
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Limoges, Limoges, France
- INSERM, U1092, Limoges, France
- Univ Limoges, UMR-S1092, Limoges, France
| | - Ingrid Wieder
- Laboratoire de Microbiologie, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Anna Hua
- Laboratoire de Microbiologie, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Marion Perrier
- Laboratoire de Microbiologie, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Ana Babosan
- Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpital Saint-Antoine, F-75012, Paris, France
| | - Margaux Gaschet
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Limoges, Limoges, France
| | - Olivier Clermont
- INSERM, IAME, UMR 1137, F-75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | - Erick Denamur
- INSERM, IAME, UMR 1137, F-75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
| | - François Catzeflis
- CNRS UMR-5554, Institut des Sciences de l'Evolution, Univ Montpellier-2, Montpellier, France
| | - Dominique Decré
- Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpital Saint-Antoine, F-75012, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, Team E13, Paris, France
| | - Marie-Cécile Ploy
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Limoges, Limoges, France
- INSERM, U1092, Limoges, France
- Univ Limoges, UMR-S1092, Limoges, France
| | - Antoine Andremont
- INSERM, IAME, UMR 1137, F-75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France
- Laboratoire de Microbiologie, AP-HP, Hôpital Bichat, F-75018, Paris, France
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Ferrand H, Delory T, Grall N, Gault N, Melot B, Bouvet E, Yazdanpanah Y. K-05: Élaboration d’un score prédictif de tuberculose (TB) pulmonaire chez des patients suspects de tuberculose : une étude cas-témoins. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70210-0] [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: 11/30/2022]
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Gravey F, Galopin S, Grall N, Auzou M, Andremont A, Leclercq R, Cattoir V. Lincosamide resistance mediated by lnu(C) (L phenotype) in a Streptococcus anginosus clinical isolate. J Antimicrob Chemother 2013; 68:2464-7. [PMID: 23812683 DOI: 10.1093/jac/dkt255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Unique resistance to lincosamides (L phenotype) due to the production of nucleotidyltransferases (Lnu) is uncommon among Gram-positive bacteria. The aim of the study was to characterize the L phenotype in a clinical isolate of the Streptococcus milleri group. METHODS The strain UCN93 was recovered from neonatal specimens and from the mother's vaginal swab. Identification was confirmed by sequencing of the sodA gene. Antimicrobial susceptibility testing was carried out by the disc diffusion method, while MICs were determined using the agar dilution method. Screening for lnu(A), lnu(B), lnu(C) and lnu(D) genes was performed by PCR. Genetic environment and support were determined by thermal asymmetric interlaced PCR and PCR mapping. The transfer of lincomycin resistance was also attempted by conjugation. RESULTS UCN93 was unambiguously identified as Streptococcus anginosus. It was susceptible to all tested antibiotics, except lincomycin (MIC, 8 mg/L) and tetracycline (2 mg/L). The lnu(C) gene was found to be responsible for the L phenotype. It was shown that lnu(C) was associated with a gene coding for a transposase within a structure similar to the transposon MTnSag1, described once in Streptococcus agalactiae. Since MTnSag1 was found to be mobilized by Tn916 and S. anginosus UCN93 harboured a Tn916 transposon, several attempts at transfer were performed but they all failed. The lnu(C)-containing genetic element was inserted into a chromosomal intergenic sequence of S. anginosus. CONCLUSIONS Since lnu(C) has been detected in only one S. agalactiae clinical isolate so far, this is its second description among clinically relevant streptococci.
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Affiliation(s)
- François Gravey
- CHU de Caen, Service de Microbiologie & CNR de la Résistance aux Antibiotiques (laboratoire associé 'entérocoques et résistances particulières des bactéries à Gram positif'), F-14033 Caen, France
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Grall N, Chachaty E, Sayah-Jeanne S, de Gunzburg J, Andremont A. O012: Can DAV132, a medical device targeting an adsorbent to the late ileum, decrease significantly the impact of antibiotics on the fecal microbiota? Antimicrob Resist Infect Control 2013. [PMCID: PMC3687688 DOI: 10.1186/2047-2994-2-s1-o12] [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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Bille E, Dauphin B, Leto J, Bougnoux ME, Beretti JL, Lotz A, Suarez S, Meyer J, Join-Lambert O, Descamps P, Grall N, Mory F, Dubreuil L, Berche P, Nassif X, Ferroni A. MALDI-TOF MS Andromas strategy for the routine identification of bacteria, mycobacteria, yeasts, Aspergillus spp. and positive blood cultures. Clin Microbiol Infect 2011; 18:1117-25. [PMID: 22044600 DOI: 10.1111/j.1469-0691.2011.03688.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
All organisms usually isolated in our laboratory are now routinely identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) using the Andromas software. The aim of this study was to describe the use of this strategy in a routine clinical microbiology laboratory. The microorganisms identified included bacteria, mycobacteria, yeasts and Aspergillus spp. isolated on solid media or extracted directly from blood cultures. MALDI-TOF MS was performed on 2665 bacteria isolated on solid media, corresponding to all bacteria isolated during this period except Escherichia coli grown on chromogenic media. All acquisitions were performed without extraction. After a single acquisition, 93.1% of bacteria grown on solid media were correctly identified. When the first acquisition was not contributory, a second acquisition was performed either the same day or the next day. After two acquisitions, the rate of bacteria identified increased to 99.2%. The failures reported on 21 strains were due to an unknown profile attributed to new species (9) or an insufficient quality of the spectrum (12). MALDI-TOF MS has been applied to 162 positive blood cultures. The identification rate was 91.4%. All mycobacteria isolated during this period (22) were correctly identified by MALDI-TOF MS without any extraction. For 96.3% and 92.2% of yeasts and Aspergillus spp., respectively, the identification was obtained with a single acquisition. After a second acquisition, the overall identification rate was 98.8% for yeasts (160/162) and 98.4% (63/64) for Aspergillus spp. In conclusion, the MALDI-TOF MS strategy used in this work allows a rapid and efficient identification of all microorganisms isolated routinely.
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Affiliation(s)
- E Bille
- Assistance Publique-Hôpitaux de Paris, Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
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Grall N, Livny J, Waldor M, Barel M, Charbit A, Meibom KL. Pivotal role of the Francisella tularensis heat-shock sigma factor RpoH. Microbiology (Reading) 2009; 155:2560-2572. [PMID: 19443547 DOI: 10.1099/mic.0.029058-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Francisella tularensis is a highly infectious pathogen that infects animals and humans to cause the disease tularemia. The primary targets of this bacterium are macrophages, in which it replicates in the cytoplasm after escaping the initial phagosomal compartment. The ability to replicate within macrophages relies on the tightly regulated expression of a series of genes. One of the most commonly used means of coordinating the regulation of multiple genes in bacteria consists of the association of dedicated alternative sigma factors with the core of the RNA polymerase (RNAP). In silico analysis of the F. tularensis LVS genome led us to identify, in addition to the genes encoding the RNAP core (comprising the alpha1, alpha2, beta, beta' and omega subunits), one gene (designated rpoD) encoding the major sigma factor sigma(70), and a unique gene (FTL_0851) encoding a putative alternative sigma factor homologue of the sigma(32) heat-shock family (designated rpoH). Hence, F. tularensis represents one of the minority of bacterial species that possess only one or no alternative sigma factor in addition to the main factor sigma(70). In the present work, we show that FTL_0851 encodes a genuine sigma(32) factor. Transcriptomic analyses of the F. tularensis LVS heat-stress response allowed the identification of a series of orthologues of known heat-shock genes (including those for Hsp40, GroEL, GroES, DnaK, DnaJ, GrpE, ClpB and ClpP) and a number of genes implicated in Francisella virulence. A bioinformatic analysis was used to identify genes preceded by a putative sigma(32)-binding site, revealing both similarities to and differences from RpoH-mediated gene expression in Escherichia coli. Our results suggest that RpoH is an essential protein of F. tularensis, and positively regulates a subset of genes involved in the heat-shock response.
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Affiliation(s)
- Nathalie Grall
- INSERM, U570, Unit of Pathogenesis of Systemic Infections, F-75015 Paris, France.,Université Paris Descartes, Faculté de Médecine Necker-Enfants Malades, F-75015 Paris, France
| | - Jonathan Livny
- Channing Laboratories, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA
| | - Matthew Waldor
- Howard Hughes Medical Institute, 4000 Jones Bridge Road, Chevy Chase, MD 20815-6789, USA.,Channing Laboratories, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA
| | - Monique Barel
- INSERM, U570, Unit of Pathogenesis of Systemic Infections, F-75015 Paris, France.,Université Paris Descartes, Faculté de Médecine Necker-Enfants Malades, F-75015 Paris, France
| | - Alain Charbit
- INSERM, U570, Unit of Pathogenesis of Systemic Infections, F-75015 Paris, France.,Université Paris Descartes, Faculté de Médecine Necker-Enfants Malades, F-75015 Paris, France
| | - Karin L Meibom
- INSERM, U570, Unit of Pathogenesis of Systemic Infections, F-75015 Paris, France.,Université Paris Descartes, Faculté de Médecine Necker-Enfants Malades, F-75015 Paris, France
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