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Goutelle S, Jullien V, Bru JP, Cattoir V, Gauzit R, Lesprit P, Lina G, Schramm F, Canoui E, Lepeule R. Defining standard and high dosages for β-lactam agents administered by intermittent, prolonged or continuous infusion: a PK/PD simulation study. J Antimicrob Chemother 2023; 78:2762-2769. [PMID: 37796958 DOI: 10.1093/jac/dkad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The new definitions of antimicrobial susceptibility categories proposed by EUCAST in 2020 require the definition of standard and high dosages of antibiotic. For injectable β-lactams, standard and high dosages have been proposed for short-infusion regimens only. OBJECTIVES To evaluate dosages for β-lactams administered by prolonged infusion (PI) and continuous infusion (CI). METHODS Monte Carlo simulations were performed for seven injectable β-lactams: aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, piperacillin and temocillin. Various dosage regimens based on short infusion, PI or CI were simulated in virtual patients. Pharmacokinetic (PK) profiles and PTAs were obtained based on reference population PK models, as well as PK/pharmacodynamic targets and MIC breakpoints proposed by EUCAST. Alternative dosage regimens associated with PTA values similar to those of recommended dosages up to the breakpoints were considered acceptable. RESULTS Adequate PTAs were confirmed for most EUCAST short-infusion dosage regimens. A total of 9 standard and 14 high dosages based on PI (3 to 4 h) or CI were identified as alternatives. For cefepime and aztreonam, only PI and CI regimens could achieve acceptable PTAs for infections caused by Pseudomonas spp.: 2 g q8h as PI of 4 h or 6 g/24 h CI for cefepime; 2 g q6h as PI of 3 h or 6 g/24 h CI for aztreonam. CONCLUSIONS These alternative standard and high dosage regimens are expected to provide antibiotic exposure compatible with new EUCAST definitions of susceptibility categories and associated MIC breakpoints. However, further clinical evaluation is necessary.
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Affiliation(s)
- Sylvain Goutelle
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Service de Pharmacie, Lyon, France
- Univ Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
- Univ Lyon, Université Claude Bernard Lyon 1, ISPB-Faculté de Pharmacie de Lyon, Lyon, France
| | - Vincent Jullien
- Unité Fonctionnelle de Pharmacologie, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, Bondy, F-93140, France
- Département de Pharmacologie, Université Sorbonne Paris Nord, Bobigny, F-93000, France
| | - Jean-Pierre Bru
- Service des Maladies Infectieuses, Centre Hospitalier Annecy Genevois, Pringy Cedex 74374, France
| | - Vincent Cattoir
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, Rennes, F-35033, France
| | - Rémy Gauzit
- Infectiologie Transversale, CHU Cochin, AP-HP, Paris, 75014, France
| | - Philippe Lesprit
- Service des Maladies Infectieuses, CHU Grenoble Alpes, La Tronche, F-38700, France
| | - Gérard Lina
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon and Equipe Pathogénie des Staphylocoques, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Frédéric Schramm
- Laboratory of Bacteriology, FMTS-CHRU Strasbourg, University of Strasbourg, Strasbourg, F67000, France
| | - Etienne Canoui
- Equipe mobile d'infectiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Centre-Cochin, Paris, F75014, France
| | - Raphael Lepeule
- Unité Transversale de Traitement des Infections, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, F-94010, France
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2
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Gauzit R, Kabir-Ahmadi M, Thompson N, Pea F, Tattevin P. Safety of high loading doses of teicoplanin: POSY-TEICO, a prospective, multicentre, observational study. Int J Antimicrob Agents 2023; 62:106940. [PMID: 37524134 DOI: 10.1016/j.ijantimicag.2023.106940] [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: 12/08/2022] [Revised: 06/22/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Teicoplanin is used for treating infections caused by Gram-positive bacteria. The POSY-TEICO study assessed the safety of a high loading dose (HLD) of teicoplanin (12 mg/kg twice daily) in a real-world setting. METHODS This prospective study was conducted across six countries in Europe and enrolled adults prescribed HLD of teicoplanin between 2016 and 2019. The primary objective was to determine the incidence of nephrotoxicity following HLD of teicoplanin over loading dose period. An independent clinical adjudication committee (ICAC) assessed all study outcomes related to nephrotoxicity. RESULTS The study included 300 patients (males, 68.3%), with a mean age of 63.1 years and median teicoplanin treatment duration of 16 days (interquartile range: 9-38). The number of patients with bone and joint infection, infective endocarditis, and other severe infections was 176, 36, and 80, respectively. During the loading dose period, 41 (13.8%) patients received 3 HLDs and 246 (82.8%) received ≥4 HLDs. Overall, 28 (11.0%) patients (95% CI, 7.4-15.5) experienced nephrotoxicity during loading, and 10 (6.9%) patients (95% CI, 3.4-12.4) during maintenance dose periods. The number of patients who experienced nephrotoxicity certainly or possibly related to teicoplanin according to the ICAC was 20 (7.9%; 95% CI, 4.9-11.9), 8 (5.6%; 95% CI, 2.4-10.7) and 33 (12.4%; 95% CI, 8.7-16.9) across three study periods. CONCLUSIONS HLD of teicoplanin had an acceptable safety profile in patients treated for bone and joint infection, infective endocarditis, and other severe infections, and no increased risk of nephrotoxicity was observed. However, patients should be closely monitored when HLDs are administered.
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Affiliation(s)
- Rémy Gauzit
- Infectiologie Transversale, Réanimation Ollier, CHU Cochin, Paris, France.
| | | | - Naomi Thompson
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, United Kingdom
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
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3
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Stahl JP, Canouï E, Bleibtreu A, Dubée V, Ferry T, Gillet Y, Lemaignen A, Lesprit P, Lorrot M, Lourtet-Hascoët J, Manaquin R, Meyssonnier V, Pavese P, Pham TT, Varon E, Gauzit R. SPILF update on bacterial arthritis in adults and children. Infect Dis Now 2023; 53:104694. [PMID: 36948248 DOI: 10.1016/j.idnow.2023.104694] [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: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
In 2020 the French Society of Rhumatology (SFR) published an update of the 1990 recommendations for management of bacterial arthritis in adults. While we (French ID Society, SPILF) totally endorse this update, we wished to provide further information about specific antibiotic treatments. The present update focuses on antibiotics with good distribution in bone and joint. It is important to monitor their dosage, which should be maximized according to PK/PD parameters. Dosages proposed in this update are high, with the optimized mode of administration for intravenous betalactams (continuous or intermittent infusion). We give tools for the best dosage adaptation to conditions such as obesity or renal insufficiency. In case of enterobacter infection, with an antibiogram result "susceptible for high dosage", we recommend the requesting of specialized advice from an ID physician. More often than not, it is possible to prescribe antibiotics via the oral route as soon as blood cultures are sterile and clinical have symptoms shown improvement. Duration of antibiotic treatment is 6 weeks for Staphylococcus aureus, and 4 weeks for the other bacteria (except for Neisseria: 7 days).
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Affiliation(s)
- J P Stahl
- Université Grenoble Alpes, Maladies Infectieuses, 38700, France.
| | - E Canouï
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
| | - A Bleibtreu
- Maladies Infectieuseset Tropicales, Hôpital Pitié Salpêtrière, AP-HP Sorbonne Université, Paris France
| | - V Dubée
- Maladies Infectieuses et Tropicales, CHU d'Angers, Angers, France
| | - T Ferry
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - Y Gillet
- Urgences et Réanimation Pédiatrique, Hospices Civils de Lyon, Université Claude Bernard Lyon, France
| | - A Lemaignen
- Maladies Infectieuses, CHRU de Tours, Université de Tours, 37044, France
| | - P Lesprit
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - M Lorrot
- Pédiatrie Générale et Equipe Opérationnelle d'Infectiologie, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Pitié), Hôpital Armand Trousseau AP-HP Sorbonne Université, Paris France
| | | | - R Manaquin
- Maladies Infectieuses et Tropicales, GHSR , CHU de La Réunion, CRAtb La Réunion, Saint-Pierre, 97410, FRANCE
| | - V Meyssonnier
- Centre de Référence des Infections Ostéo-articulaires, GH Diaconesses Croix Saint-Simon, 75020, Paris, France; Service de Médecine Interne Générale, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - P Pavese
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - T-T Pham
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - E Varon
- Centre National de Référence des Pneumocoques, CRC-CRB, Centre Hospitalier Intercommunal de Créteil, 94000, Créteil, France
| | - R Gauzit
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
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4
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Stahl JP, Castan B, Bonnet E, Bru JP, Cohen R, Diamantis S, Faye A, Hitoto H, Issa N, Lesprit P, Maulin L, Poitrenaud D, Raymond J, Strady C, Varon E, Verdon R, Vuotto F, Welker Y, Gauzit R. Utilization of macrolides: State of the art 2022 Spilf and GPIP. Infect Dis Now 2022; 52:252-266. [DOI: 10.1016/j.idnow.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Gauzit R, Castan B, Bonnet E, Bru JP, Cohen R, Diamantis S, Faye A, Hitoto H, Issa N, Lebeaux D, Lesprit P, Maulin L, Poitrenaud D, Raymond J, Strady C, Varon E, Verdon R, Vuotto F, Welker Y, Stahl JP. Anti-infectious treatment duration: The SPILF and GPIP French guidelines and recommendations. Infect Dis Now 2021; 51:114-139. [PMID: 34158156 DOI: 10.1016/j.idnow.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Affiliation(s)
- R Gauzit
- Infectiologie transversale, CHU Cochin, AP-HP, 75014 Paris, France.
| | - B Castan
- Maladies infectieuses et tropicales, CHG, 24000 Périgueux, France
| | - E Bonnet
- Équipe Mobile d'Infectiologie, Hôpital Joseph-Ducuing, Clinique Pasteur, 31300 Toulouse, France
| | - J P Bru
- Maladies Infectieuses, CH Annecy-Genevois, 74374 Pringy, France
| | - R Cohen
- Unité petits nourrissons, CHI, 94000 Créteil, France
| | - S Diamantis
- Maladies Infectieuses et Tropicales, groupe hospitalier Sud Île-de-France, 77000 Melun, France
| | - A Faye
- Pédiatrie Générale et maladies infectieuses, Hôpital Robert-Debré, Université de Paris, AP-HP, 75019 Paris, France
| | - H Hitoto
- Maladies Infectieuses et Tropicales, CH, 72037 Le Mans, France
| | - N Issa
- Réanimation médicale et maladies infectieuses, Hôpital Saint-André, CHU, 33000 Bordeaux, France
| | - D Lebeaux
- Université de Paris, 75006 Paris, France; Microbiologie, Unité Mobile d'Infectiologie, HEGP, AP-HP, 75015 Paris, France
| | - P Lesprit
- Unité transversale d'hygiène et d'infectiologie, Service de Biologie Clinique, Hôpital Foch, 92150 Suresnes, France
| | - L Maulin
- Maladies Infectieuses et tropicales, CHIAP, 13616 Aix-en-Provence, France
| | - D Poitrenaud
- Unité fonctionnelle d'Infectiologie Régionale, CH Ajaccio, 20303 Ajaccio, France
| | - J Raymond
- Bactériologie, Centre Hospitalier Bicêtre, 94270 Kremlin-Bicêtre, France
| | - C Strady
- Cabinet d'infectiologie, Groupe Courlancy, 51100 Reims, France
| | - E Varon
- Laboratoire de Biologie Médicale et Centre National de Référence des Pneumocoques, CHIC, 94000 Créteil, France
| | - R Verdon
- Maladies Infectieuses et Tropicales, CHU, 14033 Caen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, GRAM 2.0, 14000 Caen, France
| | - F Vuotto
- Maladies Infectieuses, CHU, Hôpital Huriez, 59000 Lille, France
| | - Y Welker
- Maladies Infectieuses, CHI, 78100 Saint-Germain-en-Laye, France
| | - J P Stahl
- Infectiologie, CHU Grenoble Alpes, 38043 Grenoble, France
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6
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Diamantis S, Dawudi Y, Cassard B, Longuet P, Lesprit P, Gauzit R. Home intravenous antibiotherapy and the proper use of elastomeric pumps: Systematic review of the literature and proposals for improved use. Infect Dis Now 2021; 51:39-49. [PMID: 33576336 DOI: 10.1016/j.medmal.2020.10.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/28/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022]
Abstract
Over several decades, the economic situation and consideration of patient quality of life have been responsible for increased outpatient treatment. It is in this context that outpatient antimicrobial treatment (OPAT) has rapidly developed. The availability of elastomeric infusion pumps has permitted prolonged or continuous antibiotic administration by dint of a mechanical device necessitating neither gravity nor a source of electricity. In numerous situations, its utilization optimizes administration of time-dependent antibiotics while freeing the patient from the constraints associated with infusion by gravity, volumetric pump or electrical syringe pump and, more often than not, limiting the number of nurse interventions to one or two a day. That much said, the installation of these pumps, which is not systematically justified, entails markedly increased OPAT costs and is liable to expose the patient to a risk of therapeutic failure or adverse effects due to the instability of the molecules utilized in a non-controlled environment, instability that necessitates close monitoring of their use. More precisely, a prescriber must take into consideration the stability parameters of each molecule (infusion duration, concentration following dilution, nature of the diluent and pump temperature). The objective of this work is to evaluate the different means of utilization of elastomeric infusion pumps in intravenous antibiotic administration outside of hospital. Following a review of the literature, we will present a tool for optimized antibiotic prescription, in a town setting by means of an infusion device.
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Affiliation(s)
- S Diamantis
- Service des maladies infectieuses et tropicales, groupe hospitalier Sud Île-de-France, 270, boulevard Marc-Jacquet, 77000 Melun, France.
| | - Y Dawudi
- Service des maladies infectieuses et tropicales, groupe hospitalier Sud Île-de-France, 270, boulevard Marc-Jacquet, 77000 Melun, France
| | - B Cassard
- Service de pharmacie hospitalière, groupe hospitalier Sud Île-de-France, Melun, France
| | - P Longuet
- Équipe mobile d'antibiothérapie, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - P Lesprit
- Unité transversale d'hygiène et d'infectiologie, service de biologie clinique, hôpital Foch, Suresnes, France
| | - R Gauzit
- Équipe mobile d'infectiologie, réanimation Ollier, hôpital Cochin AP-HP, Paris, France
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7
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Contejean A, Leporrier J, Canouï E, Alby-Laurent F, Lafont E, Beaudeau L, Parize P, Lecieux F, Greffet A, Chéron G, Gauzit R, Fourgeaud J, L'Honneur AS, Tréluyer JM, Charlier C, Casetta A, Frange P, Leruez-Ville M, Rozenberg F, Lortholary O, Kernéis S. Comparing Dynamics and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 Transmissions Among Healthcare Workers of Adult and Pediatric Settings in Central Paris. Clin Infect Dis 2021; 72:257-264. [PMID: 33501952 PMCID: PMC7454459 DOI: 10.1093/cid/ciaa977] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 05/22/2020] [Accepted: 07/09/2020] [Indexed: 01/10/2023] Open
Abstract
Background Health-care workers (HCW) have paid a heavy toll to the coronavirus disease-19 (COVID-19) outbreak. Routes of transmission remain to be fully understood. Methods This prospective study compared a 1,500-bed adult and a 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. From February 24th until April 10th, 2020, all symptomatic HCW were screened for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on a nasopharyngeal swab. HCW screened positive were questioned on their profession, symptoms, occupational and non-occupational exposures to SARS-CoV-2. Results Among 1344 HCW tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no death were reported. Most HCW (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on March 23rd, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment (PPE) for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric setting, respectively (p=0.0022). In the adult setting, HCW more frequently reported exposure to COVID-19 patients without PPE (25% versus 15%, p=0.046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period. Conclusion Universal masking, reinforcement of hand hygiene, and PPE with medical masks for patients’ care allowed protection of HCW and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.
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Affiliation(s)
- Adrien Contejean
- Université de Paris, Faculté de Médecine, Paris, France.,Equipe Mobile d'Infectiologie, Assistance Publique-Hôpitaux de Paris, APHP.CUP, Hôpital Cochin, Paris, France
| | - Jérémie Leporrier
- Service de maladies infectieuses et tropicales, Assistance Publique-Hôpitaux de Paris, IHU Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - Etienne Canouï
- Equipe Mobile d'Infectiologie, Assistance Publique-Hôpitaux de Paris, APHP.CUP, Hôpital Cochin, Paris, France
| | - Fanny Alby-Laurent
- Université de Paris, Faculté de Médecine, Paris, France.,Service de maladies infectieuses et tropicales, Assistance Publique-Hôpitaux de Paris, IHU Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - Emmanuel Lafont
- Université de Paris, Faculté de Médecine, Paris, France.,Service de maladies infectieuses et tropicales, Assistance Publique-Hôpitaux de Paris, IHU Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - Lauren Beaudeau
- Equipe Mobile d'Infectiologie, Assistance Publique-Hôpitaux de Paris, APHP.CUP, Hôpital Cochin, Paris, France
| | - Perrine Parize
- Service de maladies infectieuses et tropicales, Assistance Publique-Hôpitaux de Paris, IHU Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - Fabienne Lecieux
- Service de santé au travail, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Agnès Greffet
- Service de santé au travail, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
| | - Gérard Chéron
- Université de Paris, Faculté de Médecine, Paris, France.,Service d'urgences pédiatriques, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
| | - Rémy Gauzit
- Equipe Mobile d'Infectiologie, Assistance Publique-Hôpitaux de Paris, APHP.CUP, Hôpital Cochin, Paris, France
| | - Jacques Fourgeaud
- Laboratoire de virologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France.,EHU 7328 PACT, Institut Imagine, Université de Paris, Faculté de Médecine, Paris, France
| | - Anne-Sophie L'Honneur
- Service de virologie, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Jean-Marc Tréluyer
- Département de soins intensifs pédiatriques, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France.,Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris, Faculté de Médecine, Paris, France.,Département de pharmacologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Caroline Charlier
- Université de Paris, Faculté de Médecine, Paris, France.,Service de maladies infectieuses et tropicales, Assistance Publique-Hôpitaux de Paris, IHU Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - Anne Casetta
- Equipe opérationnelle d'hygiène hospitalière, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Pierre Frange
- EHU 7328 PACT, Institut Imagine, Université de Paris, Faculté de Médecine, Paris, France.,Laboratoire de microbiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
| | - Marianne Leruez-Ville
- Laboratoire de virologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France.,EHU 7328 PACT, Institut Imagine, Université de Paris, Faculté de Médecine, Paris, France
| | - Flore Rozenberg
- Université de Paris, Faculté de Médecine, Paris, France.,Service de virologie, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, Paris, France.,Service de maladies infectieuses et tropicales, Assistance Publique-Hôpitaux de Paris, IHU Imagine, Hôpital Necker-Enfants malades, Paris, France.,Institut Pasteur, Molecular Mycology Unit, National Reference Centre for Invasive Mycoses and Antifungals, CNRS UMR 2000, Paris, France
| | - Solen Kernéis
- Equipe Mobile d'Infectiologie, Assistance Publique-Hôpitaux de Paris, APHP.CUP, Hôpital Cochin, Paris, France.,Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France.,Université de Paris, INSERM, IAME, Paris, France
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8
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Arias P, Strazzulla A, Depontfarcy A, Chakvetadze E, Flateau C, Gauzit R, Magere C, Le mener C, Richard E, Diamantis S. Évolution départementale de la consommation d’antibiotiques des médecins généralistes selon des indicateurs de prescriptions. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.033] [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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9
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Contejean A, Jaffrelot L, Benaboud S, Treluyer J, Grignano E, Willems L, Gauzit R, Bouscary D, Hirt D, Kerneis S. Un modèle pharmacocinétique du méropénème chez le patient traité pour une hémopathie maligne. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Contejean A, Jaffrelot L, Benaboud S, Tréluyer JM, Grignano E, Willems L, Gauzit R, Bouscary D, Gana I, Boujaafar S, Kernéis S, Hirt D. A meropenem pharmacokinetics model in patients with haematological malignancies. J Antimicrob Chemother 2020; 75:2960-2968. [DOI: 10.1093/jac/dkaa275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/19/2020] [Indexed: 02/03/2023] Open
Abstract
Abstract
Background
Optimal dosing of antibiotics is critical in immunocompromised patients suspected to have an infection. Data on pharmacokinetics (PK) of meropenem in patients with haematological malignancies are scarce.
Objectives
To optimize dosing regimens, we aimed to develop a PK population model for meropenem in this population.
Methods
Patients aged ≥18 years, hospitalized in the haematology department of our 1500 bed university hospital for a malignant haematological disease and who had received at least one dose of meropenem were eligible. Meropenem was quantified by HPLC. PK were described using a non-linear mixed-effect model and external validation performed on a distinct database. Monte Carlo simulations estimated the PTA, depending on renal function, duration of infusion and MIC. Target for free trough concentration was set at >4× MIC.
Results
Overall, 88 patients (181 samples) were included, 66 patients (75%) were in aplasia and median Modification of Diet in Renal Disease (MDRD) CLCR was 117 mL/min/1.73 m2 (range: 35–359). Initial meropenem dosing regimen ranged from 1 g q8h to 2 g q8h over 30 to 60 min. A one-compartment model with first-order elimination adequately described the data. Only MDRD CLCR was found to be significantly associated with CL. Only continuous infusion achieved a PTA of 100% whatever the MIC and MDRD CLCR. Short duration of infusion (<60 min) failed to reach an acceptable PTA, except for bacteria with MIC < 0.25 mg/L in patients with MDRD CLCR below 90 mL/min/1.73 m2.
Conclusions
In patients with malignant haematological diseases, meropenem should be administered at high dose (6 g/day) and on continuous infusion to reach acceptable trough concentrations.
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Affiliation(s)
- A Contejean
- Service d’Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Equipe mobile d’infectiologie, AP-HP, Centre Université de Paris—Cochin, Paris, France
| | - L Jaffrelot
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
| | - S Benaboud
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
| | - J -M Tréluyer
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
- CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - E Grignano
- Service d’Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Université de Paris, Faculté de Médecine, Paris, France
| | - L Willems
- Service d’Hématologie, AP-HP, Hôpital Cochin, Paris, France
| | - R Gauzit
- Equipe mobile d’infectiologie, AP-HP, Centre Université de Paris—Cochin, Paris, France
| | - D Bouscary
- Service d’Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Université de Paris, Faculté de Médecine, Paris, France
| | - I Gana
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
| | - S Boujaafar
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
| | - S Kernéis
- Université de Paris, Faculté de Médecine, Paris, France
- Equipe mobile d’infectiologie, AP-HP, Centre Université de Paris—Cochin, Paris, France
| | - D Hirt
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
- INSERM, U1018, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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11
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Hadjadj J, Yatim N, Barnabei L, Corneau A, Boussier J, Smith N, Péré H, Charbit B, Bondet V, Chenevier-Gobeaux C, Breillat P, Carlier N, Gauzit R, Morbieu C, Pène F, Marin N, Roche N, Szwebel TA, Merkling SH, Treluyer JM, Veyer D, Mouthon L, Blanc C, Tharaux PL, Rozenberg F, Fischer A, Duffy D, Rieux-Laucat F, Kernéis S, Terrier B. Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients. Science 2020; 369:718-724. [PMID: 32661059 PMCID: PMC7402632 DOI: 10.1126/science.abc6027] [Citation(s) in RCA: 1959] [Impact Index Per Article: 489.8] [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: 05/03/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by distinct patterns of disease progression that suggest diverse host immune responses. We performed an integrated immune analysis on a cohort of 50 COVID-19 patients with various disease severity. A distinct phenotype was observed in severe and critical patients, consisting of a highly impaired interferon (IFN) type I response (characterized by no IFN-β and low IFN-α production and activity), which was associated with a persistent blood viral load and an exacerbated inflammatory response. Inflammation was partially driven by the transcriptional factor nuclear factor-κB and characterized by increased tumor necrosis factor-α and interleukin-6 production and signaling. These data suggest that type I IFN deficiency in the blood could be a hallmark of severe COVID-19 and provide a rationale for combined therapeutic approaches.
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Affiliation(s)
- Jérôme Hadjadj
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, F-75015 Paris, France.,Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France
| | - Nader Yatim
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France.,Institut Pasteur, Laboratory of Dendritic Cell Immunobiology, INSERM U1223, Department of Immunology, F-75015 Paris, France
| | - Laura Barnabei
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, F-75015 Paris, France
| | - Aurélien Corneau
- Sorbonne Université, UMS037, PASS, Plateforme de cytométrie de la Pitié-Salpêtrière CyPS, F-75013 Paris, France
| | - Jeremy Boussier
- Institut Pasteur, Laboratory of Dendritic Cell Immunobiology, INSERM U1223, Department of Immunology, F-75015 Paris, France
| | - Nikaïa Smith
- Institut Pasteur, Laboratory of Dendritic Cell Immunobiology, INSERM U1223, Department of Immunology, F-75015 Paris, France
| | - Hélène Péré
- Université de Paris, INSERM, U970, PARCC, F-75015 Paris, France.,Service de Microbiologie, AP-HP, APHP-CUP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Bruno Charbit
- Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015 Paris, France
| | - Vincent Bondet
- Institut Pasteur, Laboratory of Dendritic Cell Immunobiology, INSERM U1223, Department of Immunology, F-75015 Paris, France
| | | | - Paul Breillat
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France
| | - Nicolas Carlier
- Department of Pulmonology, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France
| | - Rémy Gauzit
- Equipe Mobile d'Infectiologie, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France
| | - Caroline Morbieu
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France
| | - Frédéric Pène
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, F-75006 Paris, France.,Service de Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France
| | - Nathalie Marin
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France
| | - Nicolas Roche
- Department of Pulmonology, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France.,Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, F-75006 Paris, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France
| | - Sarah H Merkling
- Institut Pasteur, Insect-Virus Interactions Unit, UMR 2000, CNRS, Paris, France
| | - Jean-Marc Treluyer
- Université de Paris, Pharmacologie et Evaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte EA7323, F-75006 Paris, France.,Recherche Clinique et Pharmacologie, AP-HP, APHP-CUP, Hôpitaux Cochin Necker, F-75014 Paris, France
| | - David Veyer
- Service de Microbiologie, AP-HP, APHP-CUP, Hôpital Européen Georges Pompidou, F-75015 Paris, France.,Université de Paris and Sorbonne Université, INSERM, Centre de Recherche des Cordeliers, Functional Genomics of Solid Tumors (FunGeST), F-75006 Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France.,Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, F-75006 Paris, France
| | - Catherine Blanc
- Sorbonne Université, UMS037, PASS, Plateforme de cytométrie de la Pitié-Salpêtrière CyPS, F-75013 Paris, France
| | | | - Flore Rozenberg
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, F-75006 Paris, France.,Service de Virologie, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France
| | - Alain Fischer
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, F-75015 Paris, France.,Department of Paediatric Immuno-Haematology and Rheumatology, AP-HP, APHP.CUP, Hôpital Necker, F-75015 Paris, France.,Collège de France, Paris, France
| | - Darragh Duffy
- Institut Pasteur, Laboratory of Dendritic Cell Immunobiology, INSERM U1223, Department of Immunology, F-75015 Paris, France.,Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015 Paris, France
| | - Frédéric Rieux-Laucat
- Université de Paris, Imagine Institute Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, F-75015 Paris, France
| | - Solen Kernéis
- Equipe Mobile d'Infectiologie, Hôpital Cochin, AP-HP, APHP-CUP, F-75014 Paris, France.,Université de Paris, INSERM, IAME, F-75006 Paris, France.,Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015 Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, F-75014 Paris, France. .,Université de Paris, INSERM, U970, PARCC, F-75015 Paris, France
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12
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Diamantis S, Longuet P, Lesprit P, Gauzit R. Terms of use of outpatient parenteral antibiotic therapy. Infect Dis Now 2020; 51:14-38. [PMID: 32574696 DOI: 10.1016/j.medmal.2020.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- S Diamantis
- Service des maladies infectieuses et tropicales, groupe hospitalier Sud Île-de-France, Melun, France
| | - P Longuet
- Équipe mobile d'antibiothérapie, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - P Lesprit
- Unité transversale d'hygiène et d'infectiologie, service de biologie clinique, hôpital Foch, Suresnes, France
| | - R Gauzit
- Équipe mobile d'infectiologie, réanimation Ollier, hôpital Cochin, AP-HP, Paris, France.
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13
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Bru J, Alfandari S, Bleibtreu A, Chavanet P, Gauzit R, Lescure X, Lesprit P, Tattevin P. Carbapenems versus beta-lactam/beta-lactamase inhibitors to treat ESBL-producing Enterobacteriaceae infections. Med Mal Infect 2020; 50:313-315. [DOI: 10.1016/j.medmal.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
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14
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Strazzulla A, Bokobza S, Ombandza E, Kherallah K, Hommel S, Draidi R, Bonutto C, Zamponi DB, Gauzit R, Diamantis S. Impact of an Antimicrobial Stewardship Program on Resistance to Fluoroquinolones of Urinary Enterobacteriaceae Isolated From Nursing Home Residents: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1322-1326. [PMID: 32199718 DOI: 10.1016/j.jamda.2020.01.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study investigated the impact of an antimicrobial stewardship program on fluoroquinolone (FLQ) resistance in urinary Enterobacteriaceae isolated from residents of 3 French nursing homes. DESIGN A multicentric retrospective before-and-after study was conducted. SETTING AND PARTICIPANTS All the first urinary Enterobacteriaceae isolates obtained from nursing home residents were included. Two time frames were analyzed: 2013-2015 and 2016-2017. METHODS The antimicrobial stewardship program started in 2015 and was based on (1) 1-day training for use of an "antimicrobial stewardship kit for nursing homes;" and (2) daily support and training of the coordinating physician by an antibiotic mobile team (AMT) in 2 of 3 nursing homes. RESULTS Overall, 338 urinary isolates were analyzed. Escherichia coli was the most frequent species (212/338, 63%). A significant reduction of resistance to ofloxacin was observed between 2013-2015 and 2016-2017 in general (Δ = -16%, P = .004) and among isolates obtained from patients hospitalized in the county nursing home with AMT support (Δ = -28%, P < .01). A nonstatistically significant reduction in ofloxacin resistance was also observed in the hospital nursing home with AMT support (Δ = -18%, P = .06). CONCLUSIONS AND IMPLICATIONS Our antimicrobial stewardship program resulted in a decrease in resistance to FLQ among urinary Enterobacteriaceae isolated from nursing home residents. The support of an AMT along with continuous training of the coordinating physician seems to be an important component to ensure efficacy of the intervention.
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Affiliation(s)
- Alessio Strazzulla
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France; Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France.
| | | | | | | | | | - Raouf Draidi
- Antibiotic Mobile Team, Hospital of Provins, France
| | | | - Dominique Bonnet Zamponi
- Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique, Paris, France
| | - Rémy Gauzit
- Antibiotic Mobile Team, Cochin University Hospital, Paris, France
| | - Sylvain Diamantis
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France
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15
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat J. Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med 2019; 38:549-562. [DOI: 10.1016/j.accpm.2019.02.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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16
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Macheda G, Luc A, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies. Med Mal Infect 2019; 49:456-462. [PMID: 31351803 DOI: 10.1016/j.medmal.2019.07.005] [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] [Received: 07/09/2018] [Revised: 08/31/2018] [Accepted: 07/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018. METHODS We conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations. RESULTS We included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P<0.001). Guidelines used by participants displayed fixed durations for 77% (123/160) of cases in 2018 versus 21% (35/165) in 2016. Almost all respondents (89%, 131/160) declared they were aware of the 2017 SPILF's proposal. CONCLUSION The release of guidelines promoting shorter durations of antibiotic therapy seems to have had a favourable impact on practices of specialists giving advice on antibiotic prescriptions.
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Affiliation(s)
- G Macheda
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
| | - A Luc
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France
| | - G Béraud
- Médecine interne et maladies infectieuses, CHU de Poitiers, 86021 Poitiers, France; Centre de recherche du CHU de Québec, université Laval, hôpital Saint-Sacrement, chemin Sainte-Foy, Québec, Canada; Hasselt university, interuniversity institute for biostatistics and statistical bioinformatics, Censtat, Hasselt, Belgium
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 20303 Ajaccio, France
| | - R Gauzit
- Équipe mobile d'infectiologie, université Paris Descartes, hôpitaux universitaires Paris centre-site Cochin, AP-HP, 75014 Paris, France
| | - P Lesprit
- Hôpital Foch, 92151 Suresnes, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France
| | - N Thilly
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France
| | - C Pulcini
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France.
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17
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Canouï E, Chahwakilian A, Poupet H, Chedhomme F, Boully C, Gauzit R, Batista R, Kernéis S. Impact d’un programme multidisciplinaire de bon usage des antibiotiques en contexte gériatrique. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Fromentin M, Ameto T, Gile B, Gauzit R, Baillard C, Mullaert J. Duodénopancreatectomie céphalique et modalités d’antibioprophylaxie une étude comparative. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Macheda G, Dyar OJ, Luc A, Beovic B, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Are infection specialists recommending short antibiotic treatment durations? An ESCMID international cross-sectional survey. J Antimicrob Chemother 2019; 73:1084-1090. [PMID: 29346568 DOI: 10.1093/jac/dkx528] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the current practice and the willingness to shorten the duration of antibiotic therapy among infection specialists. Methods Infection specialists giving at least weekly advice on antibiotic prescriptions were invited to participate in an online cross-sectional survey between September and December 2016. The questionnaire included 15 clinical vignettes corresponding to common clinical cases with favourable outcomes; part A asked about the antibiotic treatment duration they would usually advise to prescribers and part B asked about the shortest duration they were willing to recommend. Results We included 866 participants, mostly clinical microbiologists (22.8%, 197/863) or infectious diseases specialists (58.7%, 507/863), members of an antibiotic stewardship team in 73% (624/854) of the cases, coming from 58 countries on all continents. Thirty-six percent of participants (271/749) already advised short durations of antibiotic therapy (compared with the literature) to prescribers for more than half of the vignettes and 47% (312/662) chose shorter durations in part B compared with part A for more than half of the vignettes. Twenty-two percent (192/861) of the participants declared that their regional/national guidelines expressed durations of antibiotic therapy for a specific clinical situation as a fixed duration as opposed to a range and in the multivariable analysis this was associated with respondents advising short durations for more than half of the vignettes (adjusted OR 1.5, P = 0.02). Conclusions The majority of infection specialists currently do not advise the shortest possible duration of antibiotic therapy to prescribers. Promoting short durations among these experts is urgently needed.
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Affiliation(s)
- Gabriel Macheda
- CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Oliver J Dyar
- Karolinska Institutet, Department of Public Health Sciences, Global Health - Health Systems and Policy, Stockholm, Sweden
| | - Amandine Luc
- CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France
| | - Bojana Beovic
- University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Guillaume Béraud
- CHU de Poitiers, Médecine Interne et Maladies Infectieuses, Poitiers, France.,Centre de recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, Chemin Sainte-Foy (Québec), Canada.,Hasselt University, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Censtat, Hasselt, Belgium
| | - Bernard Castan
- CH Ajaccio, Unité fonctionnelle d'infectiologie régionale, Ajaccio, France
| | - Rémy Gauzit
- AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, Équipe mobile d'infectiologie, Paris, France
| | | | - Pierre Tattevin
- CHU de Rennes, hôpital Pontchaillou, Maladies infectieuses et réanimation médicale, Rennes, France
| | - Nathalie Thilly
- CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - Céline Pulcini
- CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
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20
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Castan B, Gauzit R, Tattevin P. Gestion des pénuries d’antibiotiques en réanimation. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0101] [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: 11/20/2022]
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21
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Robineau O, Robert J, Rabaud C, Bedos JP, Varon E, Péan Y, Gauzit R, Alfandari S. Management and outcome of bloodstream infections: a prospective survey in 121 French hospitals (SPA-BACT survey). Infect Drug Resist 2018; 11:1359-1368. [PMID: 30214256 PMCID: PMC6124465 DOI: 10.2147/idr.s165877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Bloodstream infections (BSIs) are severe infections that can be community or hospital acquired. Effects of time to appropriate treatment and impact of antimicrobial management team are discussed in terms of outcome of BSI. We sought to evaluate the impact of initial BSI management on short-term mortality. Patients and methods A prospective, multicenter survey was conducted in 121 French hospitals. Participants declaring BSI during a 1-month period were included consecutively. Data on patient comorbidities, illness severity, BSI management, and resistance profile of bacterial strains were collected. Predictors of 10-day mortality were identified by multivariate regression for overall BSI, health care-related and hospital-acquired BSI. Results We included 1,952 BSIs. More than a third of them were hospital acquired (39%). Multidrug resistance was identified in 10% of cases, mainly in health care-related BSI. Empirical therapy and targeted therapy were appropriate for 61% and 94% of cases, respectively. Increased 10-day mortality was associated with severe sepsis, septic shock, increasing age, and any focus other than the urinary tract. Decreased mortality was associated with receiving at least one active antibiotic within the first 48 hours. Intervention of antimicrobial management team during the acute phase of BSI was associated with a decreased mortality at day 10 in the overall population and in health care-related BSI. Conclusion Optimizing BSI management by increasing rapidity of appropriate treatment initiation may decrease short-term mortality, even in countries with low rate of multidrug-resistant organisms. Early intervention of antimicrobial management team is crucial in terms of mortality.
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Affiliation(s)
- Oliver Robineau
- Infectious Disease Department, Dron Hospital, Univ Lille, Tourcoing,
| | - Jérome Robert
- Sorbonne University, UPMC Univ Paris 06, CR7, CIMI, Team E13 (Bacteriology), Paris
| | | | | | | | - Yves Péan
- Observatoire National de L'epidémiologie de la Résistance Bactérienne aux Antibiotiques (OneRBa)
| | - Rémy Gauzit
- Intensive Care Unit, Cochin Hospital, APHP, Paris
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Alviset S, Canouï E, Blanc K, Garelli E, Nesci J, Marey J, Poupet H, Gauzit R, Alifano M, Kerneis S. Empyème postopératoire après pneumonectomie : incidence, documentation microbiologique et pronostic. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.114] [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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Arias P, Tebano G, Depontfarcy A, Gauzit R, Magere C, Diamantis S. Définition des profils de prescription d’antibiotiques des médecins généralistes selon le volume et l’impact écologique. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Senneville E, Sotto A, Subtil D, Trivalle C, Merens A, Etienne M. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect 2018; 48:327-358. [PMID: 29759852 DOI: 10.1016/j.medmal.2018.03.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/24/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- F Caron
- Maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Normandie, CHU de Rouen, 76000 Rouen, France
| | - T Galperine
- Infection Control Program, Geneva University Hospitals, Switzerland
| | - C Flateau
- Immunologie clinique et maladies infectieuses, centre hospitalier Henri-Mondor, 94000 Créteil, France
| | - R Azria
- Cabinet de médecine générale, 95510 Vetheuil, France
| | - S Bonacorsi
- Service de microbiologie, hôpital Robert-Debré, université Paris Diderot, AP-HP, 75019 Paris, France
| | - F Bruyère
- Urologie, CHU deTours, 37000 Tours, France
| | - G Cariou
- Urologie, centre hospitaler Diaconesses, 75012 Paris, France
| | - E Clouqueur
- Gynécologie, CHRU de Lille, 59000 Lille, France
| | - R Cohen
- Néonatologie, centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - T Doco-Lecompte
- Maladies infectieuses, hôpitaux universitaires de Genève, Genève, Switzerland
| | - E Elefant
- Centre de référence sur les agents tératogènes, hôpital Armand-Trousseau, Groupe hospitalier Est, AP-HP, 75012 Paris, France
| | - K Faure
- Maladies infectieuses, CHRU de Lille, 59000, France
| | - R Gauzit
- Réanimation, CHU de Cochin, AP-HP, 75014 Paris, France
| | - G Gavazzi
- Clinique de médecine gériatrique, CHU de Grenoble-Alpes, 38700 La Tronche, France
| | - L Lemaitre
- Radiologie, CHRU de Lille, 59000 Lille, France
| | - J Raymond
- Microbiologie, université Paris Descartes, CHU de Cochin, 75014 Paris, France
| | - E Senneville
- Maladies infectieuses, CHRU de Lille, 59000 Lille, France
| | - A Sotto
- Maladies infectieuses, hôpital universitaire Carémeau, 30000 Nîmes, France
| | - D Subtil
- Gynécologie-obstétrique, CHRU Lille, 59000 Lille, France
| | - C Trivalle
- Gérontologie, hôpital Paul-Brousse, 94800 Villejuif, France
| | - A Merens
- Microbiologie, hôpital Inter-armées Begin, 94160 Saint-Mandé, France
| | - M Etienne
- Maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Normandie, CHU de Rouen, 76000 Rouen, France.
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Muller A, Bertrand X, Rogues AM, Péfau M, Alfandari S, Gauzit R, Dumartin C, Gbaguidi-Haore H. Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study. Antimicrob Resist Infect Control 2018; 7:11. [PMID: 29387345 PMCID: PMC5778631 DOI: 10.1186/s13756-018-0302-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs), medical and surgical wards between 2009 and 2013. Methods This ward-level multicentre retrospective study was based on data from French antibiotic and multidrug-resistant bacteria surveillance networks in healthcare facilities. Antibiotic use was expressed in defined daily doses per 1000 patient-days. Factors associated with the reduction in carbapenem use (yes/no) over the study period were determined from random-effects logistic regression model (493 wards nested within 259 healthcare facilities): ward characteristics (type, size…), ward antibiotic use (initial antibiotic use [i.e., consumption of a given antibiotic in 2009], initial antibiotic prescribing profile [i.e., proportion of a given antibiotic in the overall antibiotic consumption in 2009] and reduction in the use of a given antibiotic between 2009 and 2013) and regional ESBL-PE incidence rate in acute care settings in 2011. Results Over the study period, carbapenem consumption in ICUs (n = 85), medical (n = 227) and surgical wards (n = 181) was equal to 73.4, 6.2 and 5.4 defined daily doses per 1000 patient-days, respectively. Release of guidelines was followed by a significant decrease in carbapenem use within ICUs and medical wards, and a slowdown in use within surgical wards. The following factors were independently associated with a higher probability of reducing carbapenem use: location in Eastern France, higher initial carbapenem prescribing profile and reductions in consumption of fluoroquinolones, glycopeptides and piperacillin/tazobactam. In parallel, factors independently associated with a lower probability of reducing carbapenem use were ICUs, ward size increase, wards of cancer centres, higher initial third-generation cephalosporin (3GC) prescribing profile and location in high-risk regions for ESBL-PE. Conclusions Our study suggests that a decrease in 3GCs in the overall antibiotic use and the continuation of reduction in fluoroquinolone use, could allow reducing carbapenem use, given the well-demonstrated role of 3GCs and fluoroquinolones in the occurrence of ESBL-PE. Thus, antibiotic stewardship programs should target wards with higher 3GC prescription proportions to reduce them.
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Affiliation(s)
- Allison Muller
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France
| | - Xavier Bertrand
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France
| | - Anne-Marie Rogues
- 3University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Muriel Péfau
- 4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Serge Alfandari
- Gustave Dron Hospital, Infectious Diseases Department, F-59208 Tourcoing, France
| | - Rémy Gauzit
- 6AP-HP, Cochin University Hospital, Infectious Diseases Department, F-75014 Paris, France
| | - Catherine Dumartin
- 3University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Houssein Gbaguidi-Haore
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, 3 Bd Fleming, 25030, Besançon, Cedex, France
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Gaume M, Marie-Hardy L, Larousserie F, Lavielle M, Roux C, Leclerc P, Paugam A, Archambeau D, Eyrolle L, Gauzit R, Lortholary O, Anract P, Epelboin L, Salmon D. [Erratum to "Histoplasma capsulatum bone and joint infection" [Med. Mal. Infect. 47 (2017) 554-557]]. Med Mal Infect 2017; 48:81. [PMID: 29274666 DOI: 10.1016/j.medmal.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Gaume
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - L Marie-Hardy
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - F Larousserie
- Département de pathologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - M Lavielle
- Département de rhumatologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - C Roux
- Département de rhumatologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Leclerc
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Paugam
- Département de parasitologie-mycologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - D Archambeau
- Département d'anesthésie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - L Eyrolle
- Département d'anesthésie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - R Gauzit
- Département de maladies infectieuses, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - O Lortholary
- Département de maladies infectieuses, hôpital Necker, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Anract
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - L Epelboin
- Infectious Diseases Department, centre hospitalier Andrée-Rosemon, Cayenne, France
| | - D Salmon
- Département de maladies infectieuses, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
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Kernéis S, Leprince C, Archambeau D, Eyrolle L, Leclerc P, Poupet H, Loubinoux J, Gauzit R, Salmon D, Launay O, Poyart C, Anract P, Morand PC. Impact of Sequential Culture Results on Diagnosis and De-Escalation of the Antibiotic Regimen in Joint and Bone Infections. Surg Infect (Larchmt) 2017; 18:910-914. [PMID: 28972874 DOI: 10.1089/sur.2017.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND According to existing guidelines, orthopedic specimens collected in joint and bone infections (JBI) in our institution are cultured on several media sets and incubated for two, seven, and 14 days. The optimal timing for de-escalation of the first-line antibiotic combination according to the culture results needs to be defined. METHODS Single-center, retrospective analysis of all adult patients with a first documented episode of JBI between May 2012 and April 2013. RESULTS Ninety patients were included, 51 males (57%), median age 58 y (range 18-87 y), with prosthesis infection in 62 cases (69%). Rapidly growing pathogens (Staphylococcus aureus [n = 36] and Enterobacteriaceae [n = 12]) usually were diagnosed within two days, whereas coagulase-negative staphylococci (n = 25) and Propionibacterium acnes (n = 13) generally were identified after seven days (p < 10-5). Positive culture results at day 2 fit with definitive microbiological diagnosis in 95% of cases, and prolonged incubation led to the identification of additional micro-organisms in only four of 76 patients (5%) with day-2-positive cultures. Conversely, for those with negative two-day culture (n = 14), the seven-day culture allowed identification of less virulent pathogens in eight cases (57%). CONCLUSIONS Our results suggest that, in JBI, de-escalation of the empirical antibiotic regimen can be based on micro-organisms identified on the two-day culture set. The impact of such a strategy on clinical outcomes, antibiotic consumption, and costs needs to be assessed in larger studies.
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Affiliation(s)
- Solen Kernéis
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,2 Department of Infectious Diseases, hôpital Cochin , Paris, France
| | - Cécile Leprince
- 3 Department of Bacteriology, hôpital Cochin , Paris, France
| | | | - Luc Eyrolle
- 4 Department of Intensive Care, hôpital Cochin , Paris, France
| | - Philippe Leclerc
- 5 Department of Orthopedic Surgery, Assistance Publique-Hôpitaux de Paris, hôpital Cochin , Paris, France
| | - Hélène Poupet
- 3 Department of Bacteriology, hôpital Cochin , Paris, France
| | - Julien Loubinoux
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,3 Department of Bacteriology, hôpital Cochin , Paris, France
| | - Rémy Gauzit
- 2 Department of Infectious Diseases, hôpital Cochin , Paris, France .,4 Department of Intensive Care, hôpital Cochin , Paris, France
| | - Dominique Salmon
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,2 Department of Infectious Diseases, hôpital Cochin , Paris, France
| | - Odile Launay
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,2 Department of Infectious Diseases, hôpital Cochin , Paris, France
| | - Claire Poyart
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,3 Department of Bacteriology, hôpital Cochin , Paris, France
| | - Philippe Anract
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,5 Department of Orthopedic Surgery, Assistance Publique-Hôpitaux de Paris, hôpital Cochin , Paris, France
| | - Philippe C Morand
- 1 Université Paris Descartes , Sorbonne Paris Cité, Faculté de Médecine, Paris, France .,3 Department of Bacteriology, hôpital Cochin , Paris, France
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28
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Gaume M, Marie-Hardy L, Larousserie F, Lavielle M, Roux C, Leclerc P, Paugam A, Archambeau D, Eyrolle L, Gauzit R, Lortholary O, Anract P, Epelboin L, Salmon D. [Histoplasma capsulatum bone and joint infection]. Med Mal Infect 2017; 47:554-557. [PMID: 28919390 DOI: 10.1016/j.medmal.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/31/2016] [Accepted: 05/31/2017] [Indexed: 11/26/2022]
Affiliation(s)
- M Gaume
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - L Marie-Hardy
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - F Larousserie
- Département de pathologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - M Lavielle
- Département de rhumatologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - C Roux
- Département de rhumatologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Leclerc
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Paugam
- Département de parasitologie-mycologie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - D Archambeau
- Département d'anesthésie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - L Eyrolle
- Département d'anesthésie, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - R Gauzit
- Département de maladies infectieuses, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - O Lortholary
- Département de maladies infectieuses, hôpital Necker, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Anract
- Département de chirurgie orthopédique, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
| | - L Epelboin
- Infectious Diseases Department, centre hospitalier Andrée-Rosemon, Cayenne, France
| | - D Salmon
- Département de maladies infectieuses, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, Paris, France
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29
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Castan B, Bonnet É, Gauzit R, Lesprit P, Poitrenaud D, Wintenberger C. [Can the duration of antibiotic therapy be reduced without impairing its efficacy?]. Rev Prat 2017; 67:703-707. [PMID: 30512759] [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: 06/09/2023]
Affiliation(s)
- Bernard Castan
- Unité fonctionnelle d'infectiologie régionale, hôpital Eugénie, Ajaccio, France
| | - Éric Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph- Ducuing, Toulouse, France
| | - Rémy Gauzit
- Infectiologie transversale, hôpital Cochin, Paris, France
| | | | - Delphine Poitrenaud
- Unité fonctionnelle d'infectiologie régionale, hôpital Eugénie, Ajaccio, France
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30
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kerneis S, Leroy J, Lescure X, Meyssonnier V, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: A 2017 update]. Med Mal Infect 2017; 47:439-442. [PMID: 28781198 DOI: 10.1016/j.medmal.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, CH Ajaccio, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, CH de Tourcoing, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses et tropicales, CH Sud Île-de-France, 77011 Melun, France
| | - R Gauzit
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - S Kerneis
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - J Leroy
- ARLIN BFC/PRIMAIR, service d'hygiène hospitalière et service de maladies infectieuses, CHRU de Besançon, 25030 Besançon, France
| | - X Lescure
- IAME UMR 1137 Inserm, service de maladies infectieuses et tropicales, AP-HP, hôpital Bichat-Claude Bernard, faculté Paris Diderot, 75018 Paris, France
| | - V Meyssonnier
- CRIOAC, médecine interne, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - V Mondain
- Service des maladies infectieuses, CHU de Nice, Nice, France
| | - P Pavese
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - C Rabaud
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | - J P Stahl
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 35033 Rennes, France
| | - F Roblot
- Service de médecine interne, maladies infectieuses et tropicales et Inserm U1070, CHU de Poitiers, 86021 Poitiers, France
| | - C Pulcini
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France.
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Canouï E, Gauzit R, Alviset S, Bruneau A, Hays C, Launay O, Batista R, Kernéis S. Réévaluation des carbapénèmes dans la vraie vie : la conformité est-elle médecin-dépendante ? Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Diamantis S, Beziz D, Bonnet-zamponi D, Armaingaud D, Ombandza E, Pitsch A, Aufaure S, Tangre I, Tubach F, Gauzit R. Antibiorésistance des entérobactéries isolées d’ECBU réalisés dans huit établissements pour personnes âgées dépendantes (EHPAD) en France. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Wintenberger C, Guery B, Bonnet E, Castan B, Cohen R, Diamantis S, Lesprit P, Maulin L, Péan Y, Peju E, Piroth L, Stahl JP, Strady C, Varon E, Vuotto F, Gauzit R. Proposal for shorter antibiotic therapies. Med Mal Infect 2017; 47:92-141. [PMID: 28279491 DOI: 10.1016/j.medmal.2017.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/30/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections. METHODS Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website. RESULTS The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables. CONCLUSION This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.
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Affiliation(s)
- C Wintenberger
- Département de médecine interne, CHU de Grenoble Alpes, 38043 Grenoble, France
| | - B Guery
- Service de maladies infectieuses, CHU vaudois et université de Lausanne, Lausanne, Switzerland
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, hôpital Eugenie, boulevard Rossini, 20000 Ajaccio, France
| | - R Cohen
- IMRB-GRC GEMINI, unité Court Séjour, université Paris Est, Petits Nourrissons, centre hospitalier intercommunal de Créteil, ACTIV France, 40, avenue de Verdun, 94000 Créteil, France
| | - S Diamantis
- Service de maladies infectieuses et tropicales, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - P Lesprit
- Infectiologie transversale, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - L Maulin
- Centre hospitalier du Pays-d'Aix, avenue de Tamaris, 13616 Aix-en-Provence, France
| | - Y Péan
- Observatoire national de l'épidémiologie de la résistance bactérienne aux antibiotiques (ONERBA), 10, rue de la Bonne-Aventure, 78000 Versailles, France
| | - E Peju
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - L Piroth
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - J P Stahl
- Infectiologie, université, CHU de Grenoble Alpes, 38043 Grenoble, France
| | - C Strady
- Cabinet d'infectiologie, clinique Saint-André, groupe Courlancy, 5, boulevard de la Paix, 51100 Reims, France
| | - E Varon
- Laboratoire de microbiologie, hôpital européen Georges-Pompidou, 75908 Paris cedex 15, France
| | - F Vuotto
- Service de maladies infectieuses, CHU vaudois et université de Lausanne, Lausanne, Switzerland
| | - R Gauzit
- Réanimation et infectiologie transversale, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Robert J, Péan Y, Alfandari S, Bru JP, Bedos JP, Rabaud C, Gauzit R. Application of guidelines for aminoglycosides use in French hospitals in 2013-2014. Eur J Clin Microbiol Infect Dis 2017; 36:1083-1090. [PMID: 28070748 DOI: 10.1007/s10096-016-2892-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
In 2011, the French Agency for Safety of Health Products issued guidelines underlining the principles of proper aminoglycosides' use. The aim of the survey was to evaluate adherence to these guidelines two years after their issue. Characteristics of patients receiving aminoglycosides were recorded by voluntary facilities during a 3-month survey in 2013-2014. The modalities of aminoglycosides treatment were analysed by comparison with the French guidelines. A total of 3,323 patients were included by 176 facilities. Patients were mainly hospitalized in medical wards (33.0%), and treated for urinary-tract infections (24.7%). Compliance regarding the clinical indication and the daily aminoglycosides dose was observed in 65.2% and 62.9% of the cases, respectively. A 30-min once-daily IV administration was recorded in 62.5% of the cases. Aminoglycosides treatment duration was appropriate (≤5 days) for 93.6% of the patients. When considering the four criteria together, 23.2% of the patients had a treatment regimen aligned with the guidelines. Requests for measurements of peak and trough AG serum concentrations matched the guidelines in 24.9% and 67.4% of the cases, respectively. Two years after guidelines issue, aminoglycosides use remains unsatisfactory in French health-care facilities. Efforts should be made for guidelines promotion, especially regarding the issue of underdosing.
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Affiliation(s)
- J Robert
- Centre d'Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bacteriology), Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM, U1135, 75013, Paris, France. .,AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Bacteriology and Hygiene, 75013, Paris, France. .,Laboratoire de Bactériologie-Hygiène, Faculté de Médecine Pierre et Marie Curie (UPMC Paris 6), 91 Boulevard de l'hôpital, 75634, Paris 13, France.
| | - Y Péan
- Observatoire National de l'Epidémiologie de la Résistance Bactérienne aux Antibiotiques (ONERBA), Paris, France
| | - S Alfandari
- Service de Réanimation et Maladies Infectieuses, CH Gustave Dron, Tourcoing, France
| | - J-P Bru
- Infectious Diseases Department, CH de la Région d'Annecy, Annecy, France
| | - J-P Bedos
- Intensive Care Unit, CH Henri Mignot de Versailles, Le Chesnay, France
| | - C Rabaud
- Infectious Diseases Department, CHU de Nancy, Nancy, France
| | - R Gauzit
- Intensive care Unit, CHU Cochin, APHP, Paris, France
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kernéis S, Leroy J, Lescure FX, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: What's new?]. Med Mal Infect 2016; 46:403-405. [PMID: 27856081 DOI: 10.1016/j.medmal.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 27, avenue Impératrice-Eugénie, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, centre hospitalier Tourcoing, 155, rue du Président-Coty, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - R Gauzit
- Réanimation Ollier, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Kernéis
- Fédération d'infectiologie, université Paris Descartes, UMR 1181, Institut Pasteur, hôpital Cochin, AP-HP, 75014 Paris, France
| | - J Leroy
- PRIMAIR (Programme régional interdisciplinaire pour la maîtrise de la résistance aux anti-infectieux) ARLin B-FC, service d'hygiène hospitalière de maladies infectieuses, CHU de Besançon, 3, boulevard A.-Fleming, 25030 Besançon, France
| | - F X Lescure
- Service des maladies infectieuses et UMR 1137, Inserm, faculté de Paris Diderot, hôpital Bichat-Claude-Bernard, AP-HP, 5, rue Thomas-Mann, 75013 Paris, France
| | - V Mondain
- Infectiologie, hôpital de L'Archet, CHU de Nice, 4, avenue Reine-Victoria, 06003 Nice, France
| | - P Pavese
- Maladies infectieuses, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Rabaud
- Fédération française d'infectiologie (CNP-FFI), 30, boulevard Pasteur, 75014 Paris, France
| | - J P Stahl
- Maladies infectieuses, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, Inserm U 835, université Rennes-I, hôpital Pontchaillou, rue du Thabor, 35000 Rennes, France
| | - F Roblot
- Service de médecine interne et maladies infectieuses, Inserm U1070, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Pulcini
- Service de maladies infectieuses et Tropicales, université de Lorraine, EA 4360 APEMAC, hôpitaux de Brabois, CHRU de Nancy, 54511 Vandœuvre-Lès-Nancy cedex, France.
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Fascia P, Dumartin C, Giard M, Gauzit R, Cauterman M, Yvars S, Savez A. PADS 1-01 - « Les antibios, juste ce qu’il faut » : une campagne nationale hospitalière. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Longuet P, Lecapitaine AL, Cassard B, Batista R, Gauzit R, Lesprit P, Haddad R, Vanjak D, Diamantis S. Preparing and administering injectable antibiotics: How to avoid playing God. Med Mal Infect 2016; 46:242-68. [PMID: 27112521 DOI: 10.1016/j.medmal.2016.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
The emergence of bacterial resistance and the lack of new antibiotics in the pipeline represent a public health priority. Maximizing the quality of antibiotic prescriptions is therefore of major importance in terms of adequate preparation and administration modalities. Adequate preparation prevents the inactivation of antibiotics and is a prerequisite to maximizing their efficacy (taking into account the pharmacokinetic/pharmacodynamic relationship) and to minimizing their toxicity. Many antibiotic guidelines address the choice of drugs and treatment duration but none of them exclusively address preparation and administration modalities. These guidelines are based on the available literature and offer essential data for a proper antibiotic preparation and administration by physicians and nurses. They may lead to a better efficacy and to a reduced antibiotic resistance. Such guidelines also contribute to a proper use of drugs and improve the interaction between inpatient and outpatient care for a better overall management of patients.
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Affiliation(s)
- P Longuet
- Équipe mobile d'antibiothérapie, centre hospitalier V, Dupouy, Argenteuil, France
| | - A L Lecapitaine
- Service de médecine interne et maladies infectieuses, hôpital Robert-Ballanger, Aulnay-sous-Bois, France
| | - B Cassard
- Service de pharmacie, hôpital de Melun, Melun, France
| | - R Batista
- Service de pharmacie, hôpital Cochin, AP-HP, Paris, France
| | - R Gauzit
- Service de réanimation thoracique, hôpital Cochin, AP-HP, Paris, France.
| | - P Lesprit
- Service de biologie clinique, hôpital Foch, Suresnes, France
| | - R Haddad
- Service de pharmacie, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - D Vanjak
- Unité de contrôle de l'infection, institut Curie, Paris, France
| | - S Diamantis
- Service de médecine interne et maladies infectieuses, hôpital de Melun, Melun, France
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Alfandari S, Robert J, Péan Y, Rabaud C, Bedos JP, Varon E, Lepape A, Bru JP, Gauzit R. Antibiotic use and good practice in 314 French hospitals: The 2010 SPA2 prevalence study. Med Mal Infect 2015; 45:475-80. [PMID: 26612602 DOI: 10.1016/j.medmal.2015.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to assess antibiotic prescriptions to identify potential targets for improvement. METHODS We conducted a point prevalence survey (November 2010) of antibiotic use in 314 voluntary hospitals recruited by the French Infectious Diseases Society (SPILF) and the National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials (ONERBA). Data were entered online, immediately analyzed and exported. RESULTS The prevalence of antibiotic use was 19.5% (9059/46,446patients). A higher prevalence was observed in the infectious disease (58.4%), hematology (58%), and intensive care (48.7%) units. The three most frequently used antibiotic classes were aminopenicillins (23.8%), fluoroquinolones (17.9%), and 3rd-generation cephalosporins (16.7%). A monotherapy was prescribed to 64% of patients. The reasons for the antibiotic prescription were written in the medical records of 74% of patients and 62% were consistent with the local guidelines. CONCLUSION Our results are similar to that of other studies. Various local targets for improvement have been identified to help hospitals define a better antibiotic stewardship.
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Affiliation(s)
- S Alfandari
- Service de réanimation et des maladies infectieuses, centre hospitalier Dron, 59208 Tourcoing, France.
| | - J Robert
- Bactériologie et hygiène, hôpitaux universitaires de la Pitié-Salpêtrière - Charles-Foix, AP-HP, 75013 Paris, France
| | - Y Péan
- Observatoire national de l'épidémiologie de la résistance bactérienne aux antibiotiques (ONERBA), 75006 Paris, France
| | - C Rabaud
- Service des maladies infectieuses, CHU, 54511 Nancy, France
| | - J P Bedos
- Service de réanimation, centre hospitalier Henri-Mignot, 78157 Le Chesnay, France
| | - E Varon
- Laboratoire de bactériologie, HEGP, 75908 Paris, France
| | - A Lepape
- Service de réanimation, hôpital Sud, 69495 Lyon, France
| | - J P Bru
- Service des maladies infectieuses, centre hospitalier de la région d'Annecy, 74374 Annecy, France
| | - R Gauzit
- Service d'anesthésie-réanimation chirurgicale, CHU Cochin, AP-HP, 75679 Paris, France
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Gauzit R, Pean Y, Alfandari S, Bru JP, Bedos JP, Rabaud C, Robert J. Carbapenem use in French hospitals: A nationwide survey at the patient level. Int J Antimicrob Agents 2015; 46:707-12. [PMID: 26508585 DOI: 10.1016/j.ijantimicag.2015.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/31/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to evaluate the characteristics of carbapenem use in French healthcare settings in order to guide future actions. Healthcare facilities voluntarily participated in a nationwide cross-sectional survey in 2011. Medical data and reasons for carbapenem treatment (CPR) and discontinuation were recorded for all patients treated with carbapenems. A total of 2338 patients were recorded by 207 facilities. The median duration of CPR was 8 days, and 31.4% of patients received CPR for >10 days. An antibiotic consultant was involved in the initial choice of CPR in 36.8% of cases. CPR was chosen on an empirical (EP) basis for 1229 patients (52.6%), mainly because of severe sepsis (48.6%) or a perceived risk of bacterial resistance (33.7%). Among EP patients, de-escalation was more frequent in the case of intervention of an antibiotic consultant (35.1%) than without intervention (22.9%) (P<0.01). Among the 1109 patients receiving CPR initially based on bacteriological results, 607 (54.7%) had ESBL-producing Enterobacteriaceae and 397 (35.8%) had Gram-negative bacilli susceptible to at least one β-lactam other than carbapenems or to fluoroquinolones. Among the latter, de-escalation was performed in 59 cases (14.9%). The intervention of an antibiotic consultant did not favour de-escalation in this group. In conclusion, carbapenems are frequently used for treating suspected or confirmed multidrug-resistant bacteria, and overall CPR duration is long. De-escalation is frequently not implemented despite isolates being susceptible to other drugs. More frequent antibiotic consultant intervention may help to decrease carbapenem use in the case of EP treatment.
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Affiliation(s)
- Rémy Gauzit
- Intensive Care Unit, CHU Cochin, AP-HP, Paris, France
| | - Yves Pean
- Observatoire National de l'Épidémiologie de la Résistance Bactérienne aux Antibiotiques (ONERBA), Paris, France
| | - Serge Alfandari
- Infectious Diseases Department, CH Gustave Dron, Tourcoing, France
| | - Jean-Pierre Bru
- Infectious Diseases Department, CH de la Région d'Annecy, Annecy, France
| | - Jean-Pierre Bedos
- Intensive Care Unit, CH André Mignot de Versailles, Le Chesnay, France
| | | | - Jérôme Robert
- Sorbonne Universités, UPMC Univ. Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), F-75013 Paris, France; AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Bacteriology and Hygiene, F-75013 Paris, France.
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Pulcini C, Alfandari S, Ballereau F, Bonnet E, Bruneel F, Castan B, Chidiac C, Cohen R, Descamps D, Doco-Lecompte T, Gauzit R, Guéry B, Jarlier V, Lesprit P, Marcelin AG, Molina JM, Rabaud C, Riché A, Salmon-Céron D, Senneville E, Stahl JP, Tattevin P, Varon E, Roblot F. [European Antibiotic Awareness Day: What is new in France?]. Med Mal Infect 2015; 45:345-7. [PMID: 26411783 DOI: 10.1016/j.medmal.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Affiliation(s)
- C Pulcini
- Université de Lorraine, université Paris Descartes, EA 4360 APEMAC, France; Service de maladies infectieuses et tropicales, CHU de Nancy, Nancy, France.
| | | | | | - E Bonnet
- Hôpital Ducuing, Toulouse, France
| | - F Bruneel
- Service de réanimation, CH de Versailles, Le Chesnay, France
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, CH d'Ajaccio, Ajaccio, France
| | - C Chidiac
- Service de maladies infectieuses et tropicales, hôpital de la Croix Rousse, CHU de Lyon, Lyon, France
| | - R Cohen
- CH de Créteil, Créteil, France
| | - D Descamps
- Laboratoire de virologie, infections antimicrobials modelling evolution (IAME), Inserm UMR 1137, université Paris Diderot, Sorbonne Paris Cité, GH Bichat-Claude-Bernard, Paris, France
| | | | | | | | - V Jarlier
- CHU Pitié-Salpêtrière, Paris, France
| | - P Lesprit
- Hôpital Foch, infectiologie transversale, Suresnes, France
| | | | | | - C Rabaud
- Service de maladies infectieuses et tropicales, CHU de Nancy, Nancy, France
| | - A Riché
- CH de Angoulême, Angoulême, France
| | | | | | - J P Stahl
- CHU et université de Grenoble, Grenoble, France
| | | | - E Varon
- Hôpital européen Georges-Pompidou, Paris, France
| | - F Roblot
- CHU de Poitiers, Poitiers, France
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Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM, Laterre PF, Misset B, Bru JP, Gauzit R, Sotto A, Brigand C, Hamy A, Tuech JJ. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med 2015; 34:117-30. [PMID: 25922057 DOI: 10.1016/j.accpm.2015.03.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Intra-abdominal infections are one of the most common gastrointestinal emergencies and a leading cause of septic shock. A consensus conference on the management of community-acquired peritonitis was published in 2000. A new consensus as well as new guidelines for less common situations such as peritonitis in paediatrics and healthcare-associated infections had become necessary. The objectives of these Clinical Practice Guidelines (CPGs) were therefore to define the medical and surgical management of community-acquired intra-abdominal infections, define the specificities of intra-abdominal infections in children and describe the management of healthcare-associated infections. The literature review was divided into six main themes: diagnostic approach, infection source control, microbiological data, paediatric specificities, medical treatment of peritonitis, and management of complications. The GRADE(®) methodology was applied to determine the level of evidence and the strength of recommendations. After summarising the work of the experts and application of the GRADE(®) method, 62 recommendations were formally defined by the organisation committee. Recommendations were then submitted to and amended by a review committee. After 2 rounds of Delphi scoring and various amendments, a strong agreement was obtained for 44 (100%) recommendations. The CPGs for peritonitis are therefore based on a consensus between the various disciplines involved in the management of these patients concerning a number of themes such as: diagnostic strategy and the place of imaging; time to management; the place of microbiological specimens; targets of empirical anti-infective therapy; duration of anti-infective therapy. The CPGs also specified the value and the place of certain practices such as: the place of laparoscopy; the indications for image-guided percutaneous drainage; indications for the treatment of enterococci and fungi. The CPGs also confirmed the futility of certain practices such as: the use of diagnostic biomarkers; systematic relaparotomies; prolonged anti-infective therapy, especially in children.
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Affiliation(s)
- Philippe Montravers
- Département d'anesthésie-réanimation, CHU Bichat-Claude-Bernard, AP-HP, université Paris VII Sorbonne Cité, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Hervé Dupont
- Pôle anesthésie-réanimation, CHU d'Amiens, 80054 Amiens, France
| | - Marc Leone
- Département d'anesthésie-réanimation, CHU Nord, 13915 Marseille, France
| | | | - Paul-Michel Mertes
- Service d'anesthésie-réanimation, CHU de Strasbourg, Nouvel Hopital Civil, BP 426, 67091 Strasbourg, France
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Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM, Laterre PF, Misset B, Bru JP, Gauzit R, Sotto A, Brigand C, Hamy A, Tuech JJ. Prise en charge des infections intra-abdominales. Anesthésie & Réanimation 2015. [DOI: 10.1016/j.anrea.2014.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tattevin P, Cremieux AC, Rabaud C, Gauzit R. Efficacy and Quality of Antibacterial Generic Products Approved for Human Use: A Systematic Review. Clin Infect Dis 2013; 58:458-69. [DOI: 10.1093/cid/cit769] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Dupuy AM, Philippart F, Péan Y, Lasocki S, Charles PE, Chalumeau M, Claessens YE, Quenot JP, Guen CGL, Ruiz S, Luyt CE, Roche N, Stahl JP, Bedos JP, Pugin J, Gauzit R, Misset B, Brun-Buisson C. Role of biomarkers in the management of antibiotic therapy: an expert panel review: I - currently available biomarkers for clinical use in acute infections. Ann Intensive Care 2013; 3:22. [PMID: 23837559 PMCID: PMC3708786 DOI: 10.1186/2110-5820-3-22] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [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: 05/13/2013] [Accepted: 06/03/2013] [Indexed: 12/11/2022] Open
Abstract
In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine currently available literature on the potential role of biomarkers to improve antimicrobial prescribing, by answering three questions: 1) Which are the biomarkers available for this purpose?; 2) What is their potential role in the initiation of antibiotic therapy?; and 3) What is their role in the decision to stop antibiotic therapy? To answer these questions, studies reviewed were limited to recent clinical studies (<15 years), involving a substantial number of patients (>50) and restricted to controlled trials and meta-analyses for answering questions 2 and 3. With regard to the first question concerning routinely available biomarkers, which might be useful for antibiotic management of acute infections, these are currently limited to C-reactive protein (CRP) and procalcitonin (PCT). Other promising biomarkers that may prove useful in the near future but need to undergo more extensive clinical testing include sTREM-1, suPAR, ProADM, and Presepsin. New approaches to biomarkers of infections include point-of-care testing and genomics.
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Affiliation(s)
- Anne-Marie Dupuy
- Département de Biochimie, Hopital Lapeyronie CHU Montpellier, France, 371, avenue du doyen Gaston Giraud, 34295 Montpellier Cédex 5, France
| | - François Philippart
- Service de Réanimation polyvalente, Groupe hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France
| | - Yves Péan
- Laboratoire de Microbiologie, Institut Mutualiste Montsouris, 42, Bld Jourdan, 75014 Paris, France
| | - Sigismond Lasocki
- Pôle d’Anesthésie Réanimation, CHU d’Angers, 4 rue Larrey, 49933 Angers Cedex 9, Angers, France
| | - Pierre-Emmanuel Charles
- Service de réanimation médicale, CHU Dijon, Université de Bourgogne, 14 rue Paul Gaffarel, 21970 Dijon, France
- Laboratoire Interactions Muqueuses Agents Pathogènes, EA562, UFR Médecine, Université de Bourgogne, 7 Bd Jeanne d’Arc, 21000 Dijon, France
| | - Martin Chalumeau
- Service de Pédiatrie Générale, CHU Necker Enfants Malades, AP-HP & Université Paris Descartes, 149 rue de Sèvres, 75743 Paris, France
- Inserm, U953 Paris, France
| | - Yann-Eric Claessens
- Département d’Urgences Médicales, Centre Hospitalier Princesse Grace, 1 avenue Pasteur, BP 489, 98012 Principauté de, Monaco
| | - Jean-Pierre Quenot
- Service de réanimation médicale, CHU Dijon, Université de Bourgogne, 14 rue Paul Gaffarel, 21970 Dijon, France
- Centre d’investigation clinique (INSERM CIE 1), 7 Boulevard Jeanne d’Arc, 21079 Dijon, France
| | - Christele Gras-Le Guen
- Clinique Médicale et Service d’Urgences Pédiatriques, Hôpital Mère-Enfant, CHU Nantes, 38 boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - Stéphanie Ruiz
- Pôle d’Anesthésie-Réanimation, Hôpital de Rangueil, CHU de Toulouse, 1, Ave Pr Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Charles-Edouard Luyt
- Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP & Université Pierre et Marie Curie - Paris VI, 4783,– boulevard de l’Hôpital, 75651 Paris Cedex 13, France
| | - Nicolas Roche
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpitaux Universitaires Paris Centre, AP-HP & Université Paris-Descartes, 27 rue du fbg St Jacques, 75679 Paris, France
| | - Jean-Paul Stahl
- Service de maladies infectieuses et tropicales, Université 1 de Grenoble, CHU de Grenoble, BP 217, Boulevard de la Chantourne, 38043 Grenoble, France
| | - Jean-Pierre Bedos
- Service de réanimation, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Jérôme Pugin
- Intensive Care - SIRS Unit, University Hospitals of Geneva, 4 rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Rémy Gauzit
- Unité de réanimation, CHU Hôtel Dieu, AP-HP, Place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - Benoit Misset
- Service de Réanimation polyvalente, Groupe hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France
- Centre de Recherche Clinique, Groupe hospitalier Paris Saint Joseph & Université Paris Descartes, 75014 Paris, France
| | - Christian Brun-Buisson
- Service de Réanimation médicale, Hôpitaux Universitaires Henri Mondor, AP-HP & Université Paris-Est, 94000 Créteil, France
- Inserm U957, Institut Pasteur, Paris, France
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Quenot JP, Luyt CE, Roche N, Chalumeau M, Charles PE, Claessens YE, Lasocki S, Bedos JP, Péan Y, Philippart F, Ruiz S, Gras-Leguen C, Dupuy AM, Pugin J, Stahl JP, Misset B, Gauzit R, Brun-Buisson C. Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy. Ann Intensive Care 2013; 3:21. [PMID: 23830525 PMCID: PMC3716933 DOI: 10.1186/2110-5820-3-21] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/08/2013] [Indexed: 12/13/2022] Open
Abstract
Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that PCT be measured to help predict infection; however, available data are insufficient to decide on initiating antibiotics based on PCT levels. In adult patients suspected of community-acquired LRTI, we suggest withholding antibiotic therapy when the serum PCT level is low (<0.25 ng/mL); in patients having nosocomial LRTI, data are insufficient to recommend initiating therapy based on a single PCT level or even repeated measurements. For children with suspected bacterial meningitis, we recommend using a decision rule as an aid to therapeutic decisions, such as the Bacterial Meningitis Score or the Meningitest®; a single PCT level ≥0.5 ng/mL also may be used, but false-negatives may occur. In adults with suspected bacterial meningitis, we suggest integrating serum PCT measurements in a clinical decision rule to help distinguish between viral and bacterial meningitis, using a 0.5 ng/mL threshold. For ICU patients suspected of community-acquired infection, we do not recommend using a threshold serum PCT value to help the decision to initiate antibiotic therapy; data are insufficient to recommend using PCT serum kinetics for the decision to initiate antibiotic therapy in patients suspected of ICU-acquired infection. In children, CRP can probably be used to help discontinue therapy, although the evidence is limited. In adults, antibiotic discontinuation can be based on an algorithm using repeated PCT measurements. In non-immunocompromised out- or in- patients treated for RTI, antibiotics can be discontinued if the PCT level at day 3 is < 0.25 ng/mL or has decreased by >80-90%, whether or not microbiological documentation has been obtained. For ICU patients who have nonbacteremic sepsis from a known site of infection, antibiotics can be stopped if the PCT level at day 3 is < 0.5 ng/mL or has decreased by >80% relative to the highest level recorded, irrespective of the severity of the infectious episode; in bacteremic patients, a minimal duration of therapy of 5 days is recommended.
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Affiliation(s)
- Jean-Pierre Quenot
- Service de Réanimation médicale, Hôpitaux Universitaires Henri Mondor, AP-HP & Université Paris-Est, 51, av de Lattre de Tassigny, 94000 Créteil, France.
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Gauzit R, Petitjean O. Réponse à la lettre à la rédaction : « Commentaires sur les génériques d’antibiotiques ». Med Mal Infect 2013; 43:36-7. [DOI: 10.1016/j.medmal.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/18/2012] [Indexed: 11/26/2022]
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Boisseau D, Alfandari S, Gauzit R, Rabaud C, Stahl JP. Staphylococcus aureus nasal carriage during the infectious diseases national congress in France. Med Mal Infect 2012; 42:435-9. [PMID: 22959772 DOI: 10.1016/j.medmal.2012.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/11/2012] [Accepted: 07/24/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Screening for (methicillin-sensitive [MSSA] or -resistant [MRSA]) Staphylococcus aureus (SA) nasal carriage in health care workers in contact with fragile patients is a recurrent question. We wanted to assess carriage among infectious diseases healthcare workers. METHODS Voluntary health care workers were recruited during the 2010 Yearly French Congress (Journées Nationales d'Infectiologie, JNI). An anonymous double nasal swab was performed followed by PCR examination (GeneXpert MRSA/SA nasal tests) carried out on the Cepheid stand. Health care workers were also asked to fill in a questionnaire. Results were available 1 hour later but kept anonymous. RESULTS One hundred and fifty-two tests and questionnaires were selected. MRSA was isolated from four health care workers (2.4%). MSSA was isolated from 52 health care workers (34.2%). Sex, clinical activity of health care workers, hospital size, and systematic screening of patients did not affect carriage. CONCLUSIONS The prevalence of MSSA in nasal carriage in France is similar to the European one but the prevalence of MRSA is higher. This raises the question of a targeted decolonization in health care workers.
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Abstract
There are recently published arguments suggesting all generic antibiotic drugs do not present the full reliability needed to claim therapeutic equivalence with branded drugs. The problem is especially crucial for generic intravenous drugs, which do not need any bioequivalence study before they can be marketed. The evaluation of generic antibiotic drug effectiveness yields an important dispersion of results according to antibiotic agents and for the same antibiotic agent all generic drugs are not equivalent. There are differences at all levels: drug components, levels of impurity, pharmacokinetics, pharmacokinetic/pharmacodynamic relationship, in vitro effectiveness, therapeutic effectiveness in experimental models, etc. So that finally, the specifications approved in the initial submission file of a brand name drugs are not always respected by a generic drug. There is also a specific problem of taste and treatment acceptability for pediatric oral antibiotic drugs. Available data on clinical effectiveness is excessively rare. The marketing of a great number of generic drugs of the same specialty is followed by a sometimes very important increase of their use, even in countries where consumption is low. The corollary of this increase in consumption is an increase of resistance, and this is especially true for oral fluoroquinolones. Even if most of this information needs to be verified, it seems necessary to review regulations for marketing authorization of generic antibiotic drugs.
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Affiliation(s)
- R Gauzit
- Unité de réanimation, Hôtel Dieu, place du Parvis-de-Notre-Dame, Paris cedex 04, France.
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Robert J, Péan Y, Varon E, Bru JP, Bedos JP, Bertrand X, Lepape A, Stahl JP, Gauzit R. Point prevalence survey of antibiotic use in French hospitals in 2009. J Antimicrob Chemother 2012; 67:1020-6. [PMID: 22258928 DOI: 10.1093/jac/dkr571] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of a point prevalence survey for monitoring antibiotic use in a voluntary sample of French hospitals. METHODS Demographic and medical data were collected for all inpatients. Additional characteristics regarding antimicrobial treatment, type of infection and microbiological results were collected only for patients receiving antimicrobials. RESULTS Among 3964 patients in 38 hospitals, 343 (8.7%) received antimicrobial prophylaxis and 1276 (32.2%) antimicrobial therapy. The duration of surgical antimicrobial prophylaxis was >1 day in 41 out of 200 (21%) of the cases. Among patients with antimicrobial therapy, 959 (75.2%) received β-lactams (including 34.8% penicillins with β-lactam inhibitors, 22.1% third-generation cephalosporins and 7.8% carbapenems) and 301 (23.6%) received fluoroquinolones (50% orally). A total of 518 (40.6%) patients were treated with more than one drug and 345 (27.2%) were treated for >7 days. Patients treated for hospital-acquired infections (39.2%) were more likely to receive combinations (47.6% versus 34.4%, P < 0.01), carbapenems (14.4% versus 2.6%, P < 0.01), glycopeptides (14.4% versus 3.7%, P < 0.01) and antifungals (17% versus 5.3%, P < 0.01) for a longer duration (7.8 versus 6 days, P < 0.01). Fifty-six patients (4.4%) were treated for >7 days and did not have any microbiological sample drawn. The time allocated for the survey represented 18.3-25.0 h for 100 patients. CONCLUSIONS The data provide directions for further interventions, such as better use of diagnostic tools, decreasing the treatment duration and the use of combinations. In addition, the survey shows that, although cumbersome, it is feasible to improve the representativeness of national data in European surveys.
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Affiliation(s)
- J Robert
- Bacteriology-Hygiene, Université Pierre et Marie Curie, Pitié-Salpêtrière Hospital APHP, Paris, France.
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