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Baclet N, Forestier E, Gavazzi G, Roubaud-Baudron C, Hiernard V, Hequette-Ruz R, Alfandari S, Aumaître H, Botelho-Nevers E, Caraux-Paz P, Charmillon A, Diamantis S, Fraisse T, Gazeau P, Hentzien M, Lanoix JP, Paccalin M, Putot A, Ruch Y, Senneville E, Beuscart JB. One Hundred Explicit Definitions of Potentially Inappropriate Prescriptions of Antibiotics in Hospitalized Older Patients: The Results of an Expert Consensus Study. Antibiotics (Basel) 2024; 13:283. [PMID: 38534718 DOI: 10.3390/antibiotics13030283] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND In geriatrics, explicit criteria for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. OBJECTIVE To produce an expert consensus on explicit definitions of antibiotic-PIPs for hospitalized older patients. METHODS We conducted a Delphi survey involving French experts on antibiotic stewardship in hospital settings. During the survey's rounds, the experts gave their opinion on each explicit definition, and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were adopted. The results were discussed during consensus meetings after each round. RESULTS Of the 155 invited experts, 128 (82.6%) participated in the whole survey: 59 (46%) infectious diseases specialists, 45 (35%) geriatricians, and 24 (19%) other specialists. In Round 1, 65 explicit definitions were adopted and 21 new definitions were suggested. In Round 2, 35 other explicit definitions were adopted. The results were validated during consensus meetings (with 44 participants after Round 1, and 54 after Round 2). CONCLUSIONS The present study is the first to have provided a list of explicit definitions of potentially inappropriate antibiotic prescriptions for hospitalized older patients. It might help to disseminate key messages to prescribers and reduce inappropriate prescriptions of antibiotics.
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Affiliation(s)
- Nicolas Baclet
- CHU Lille, University of Lille, F-59000 Lille, France
- Groupe Hospitalier de l'Institut Catholique (GHICL), Service de Maladies Infectieuses, Université Catholique de Lille, F-59160 Lille, France
| | - Emmanuel Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France
| | - Gaëtan Gavazzi
- Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble-Alpes, GREPI EA7408 Université Grenoble-Alpes, F-38000 Grenoble, France
| | - Claire Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, University of Bordeaux, INSERM 1312 BRIC, F-33000 Bordeaux, France
| | | | | | - Serge Alfandari
- Service Universitaire de Maladies Infectieuses et Tropicales, Hôpital Gustave Dron, F-59200 Tourcoing, France
| | - Hugues Aumaître
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Perpignan, F-66000 Perpignan, France
| | - Elisabeth Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, GIMAP (EA 3064), F-42055 Cedex 02 Saint-Etienne, France
- Faculty of Medicine of Saint-Etienne, University of Saint-Etienne, F-42023 Cedex 02 Saint-Etienne, France
- Faculty of Medicine, University of Lyon, F-69000 Lyon, France
| | - Pauline Caraux-Paz
- Service de Maladies Infectieuses et Tropicales, Hôpital Intercommunal de Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France
| | - Alexandre Charmillon
- CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Grand Est Antibiotic Stewardship Network Coordinator, AntibioEst, F-54000 Nancy, France
| | - Sylvain Diamantis
- Service de Maladies Infectieuses et Tropicales, Hôpital de Melun, F-77000 Melun, France
- Unité de Recherche DYNAMIC, Université Paris-Est Créteil, F-94000 Créteil, France
| | - Thibaut Fraisse
- Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France
| | - Pierre Gazeau
- Service des Maladies Infectieuses et Tropicales, CHRU de Brest, F-29609 Brest Cedex, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, University Hospital of Reims, F-51100 Reims, France
- EA3797-Viellissement Fragilité, Reims Champagne Ardennes University, F-51100 Reims, France
| | - Jean-Philippe Lanoix
- AGIR UR 4294, University Picardie Jules Verne, F-80000 Amiens, France
- Department of Infectious Diseases, Amiens University Hospital, F-80000 Amiens, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU Poitiers, Université Poitiers, F-86000 Poitiers, France
- Centre d'Investigation Clinique CIC 1402, INSERM CHU Poitiers, Université Poitiers, F-86000 Poitiers, France
| | - Alain Putot
- Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, F-74700 Sallanches, France
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires, Université de Bourgogne, F-21000 Dijon, France
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University Hospital, F-67000 Strasbourg, France
| | - Eric Senneville
- Service Universitaire de Maladies Infectieuses et Tropicales, Hôpital Gustave Dron, F-59200 Tourcoing, France
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Rubenstein E, Henneton P, Rivière S, Casanova ML, Broner J, Arnaud E, Oziol E, Quintrec ML, Moranne O, Jorgensen C, Combe B, Bourdin A, Fontaine C, Schiffmann A, Fraison JB, Hallé O, Fraisse T, Veysseyre F, Taieb G, Aerts C, Crampette L, Alovisetti C, Guis L, Mehlal S, Papinaud L, Le Quellec A, Guilpain P, Mahr A. Prevalence of anti-neutrophil cytoplasmic antibody-associated vasculitis in the south of France, using the capture-recapture method. Rheumatology (Oxford) 2023:kead557. [PMID: 37819770 DOI: 10.1093/rheumatology/kead557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of ANCA-associated vasculitis (AAV), ie granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), in Southern France in 2018, and evaluate differences among Europeans and non-Europeans. METHODS This population-based, cross-sectional study used four sources (hospitals, community-based physicians, laboratories, National Health Insurance) to identify adults ≥ 15 years diagnosed with GPA, MPA or EGPA, living in Hérault and Gard in 2018. Cases were defined using the ACR/EULAR classification criteria, and if necessary, the European Medicines Agency algorithm. Prevalence estimates were standardised to the world population and capture-recapture analysis was used to assess the comprehensiveness of the estimation. The influence of geographical origin was evaluated. RESULTS 202 patients were selected, with 86 cases of GPA (42.6%), 85 cases of MPA (42.1%), and 31 cases of EGPA (15.3%). The standardised prevalence estimates per million inhabitants for 2018 were: 103 (95%CI 84 - 125) for AAV, 48 (95%CI 35 - 64) for GPA, 39 (95%CI 28 - 53) for MPA and 16 (95%CI 9 - 26) for EGPA, 36 (95%CI 25 - 50) for anti-PR3 positive AAV, 46 (95%CI 34 - 61) for anti-MPO positive AAV, and 16 (95%CI 9 - 26) for ANCA-negative AAV. The global estimation of comprehensiveness by capture-recapture analysis was 80.5%. The number of AAV cases was higher for non-European residents (P=0.001), particularly for MPA (P<0.0001). CONCLUSION We provide a new estimate of AAV prevalence in France and show a higher prevalence of MPA in non-European patients.
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Affiliation(s)
- Emma Rubenstein
- Department of infectious diseases, Saint-Louis Hospital, Paris, France
| | - Pierrick Henneton
- Department of vascular medicine, Saint-Eloi University Hospital, University of Montpellier, Montpellier, France
| | - Sophie Rivière
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
| | | | - Jonathan Broner
- Department of internal medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Erik Arnaud
- Department of internal medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Eric Oziol
- Department of internal medicine, Béziers Hospital, Béziers, France
| | - Moglie Le Quintrec
- Department of nephrology-transplant, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Olivier Moranne
- Department of nephrology-dialysis-apheresis, Carémeau University Hospital, IDESP, University of Montpellier, Nîmes, France
| | | | | | - Arnaud Bourdin
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | | | - Aurélie Schiffmann
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
- Department of internal medicine, Saint Jean Clinic, Montpellier, France
| | | | - Olivier Hallé
- Department of internal medicine 2, Alès Hospital, Alès, France
| | | | - Frederic Veysseyre
- Department of internal medicine, Saint Jean Clinic, Saint Jean de Vedas, France
| | - Guillaume Taieb
- Department of neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Cécile Aerts
- Department of neurology, Beau Soleil Clinic, Montpellier, France
| | - Louis Crampette
- Department of otorhinolaryngology, Gui de Chauliac University Hospital, Montpellier, France
| | - Caroline Alovisetti
- Department of otorhinolaryngology, Carémeau University Hospital, Nîmes, France
| | - Laurence Guis
- Laboratoire Eurofins Biomnis, Auto-immunité, Ivry sur Seine, France
| | - Souad Mehlal
- Laboratoire Cerba, Biochimie spécialisée, immunologie et pharmacotoxicologie, Saint-Ouen, France
| | | | - Alain Le Quellec
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
| | - Philippe Guilpain
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
- IHU IMMUN4CURE, Saint Eloi University Hospital, Montpellier cedex, France
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy (IRMB), Saint-Eloi University Hospital, Montpellier, France
| | - Alfred Mahr
- ECSTRRA Research Unit, Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
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N'cho-Mottoh MPB, Erpelding ML, Roubaud C, Delahaye F, Fraisse T, Dijos M, Ennezat PV, Fluttaz A, Richard B, Beaufort C, Nazeyrollas P, Brasselet C, Pineau O, Tattevin P, Curlier E, Iung B, Forestier E, Selton-Suty C. The impact of transoesophageal echocardiography in elderly patients with infective endocarditis. Arch Cardiovasc Dis 2023; 116:258-264. [PMID: 37147149 DOI: 10.1016/j.acvd.2023.04.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/25/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. AIM To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. METHODS A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. RESULTS Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE. CONCLUSIONS Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.
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Affiliation(s)
| | - Marie-Line Erpelding
- CHRU of Nancy, Inserm, université de Lorraine, CIC, épidémiologie clinique, 54000 Nancy, France
| | | | | | | | - Marina Dijos
- University Hospital of Bordeaux, 33000 Bordeaux, France
| | | | | | | | | | | | | | | | | | - Elodie Curlier
- University Hospital of Guadeloupe, Les Abymes 97142, France
| | - Bernard Iung
- Bichat-Claude Bernard Hospital, 75018 Paris, France
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Peyriere H, Jacquet J, Peries M, Tribout V, Broche B, Mauboussin J, Makinson A, Perrollaz C, Ferreyra M, Rouanet I, Montoya‐Ferrer A, El‐Majjaoui S, Corriol‐Bonifas F, Fraisse T, Grau F, Laureillard D, Nagot N, Reynes J, Donnadieu‐Rigole H. Chemsex in HIV pre‐exposure prophylaxis users: assessment of mood disorders and addictive behavior. Fundam Clin Pharmacol 2022; 37:639-649. [PMID: 36403123 DOI: 10.1111/fcp.12854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
The assessment of mood disorders and addiction linked to the practice of chemsex is of interest given the psychoactive substances used. The aim of this study was to assess risky sexual and addictive behavior to chemsex and related anxiety/depression symptoms in individuals receiving HIV pre-exposure prophylaxis (PrEP). In this cross-sectional study, all adults presenting for PrEP renewal at French sexual health centers were enrolled from January 2018 to March 2019. Participants completed a questionnaire on chemsex (i.e., the use of psychoactive substances before/during sex), including adapted Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to chemsex addiction (questions of ASSIST were modified to focus on chemsex). Anxiety/depression was assessed with the Hospital Anxiety and Depression Scale. In the last 3 months before enrollment, 39.8% (94/236) of participants reported chemsex. The main psychoactive substances consumed during chemsex were cathinones (74.6%), gamma-hydroxybutyrate (66.3%), and other psychostimulants (60%). The median score of the chemsex-focused ASSIST was 8 [IQR25-75 : 3-15]; 72.2% of participants had a score justifying at least a brief intervention (>4). In multivariate analyses, anxiety and cathinones consumption were associated with an ASSIST score >4: OR 13.65 (95% CI 1.68-662.7), P = 0.0062, and OR 8.468 (95% CI 2.066-43.059), P = 0.0014, respectively. The level of addiction to the practice of chemsex can be difficult to estimate for the user, and the ASSIST makes it possible to evaluate this addiction and to direct the subjects toward specialized consultations of addictology, sexual health, or PrEP renewals. The implementation of the modified ASSIST in these consultations can allow early systematic screening and counseling.
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Affiliation(s)
- Hélène Peyriere
- INSERM U1175/IRD UMI 233 Montpellier University France
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier Montpellier France
| | | | - Marianne Peries
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier Montpellier France
| | - Vincent Tribout
- Sexual Transmitted Infections Center Montpellier University France
| | | | | | - Alain Makinson
- INSERM U1175/IRD UMI 233 Montpellier University France
- Infectious Diseases Department Montpellier University Hospital
| | - Cyril Perrollaz
- Sexual Transmitted Infections Center Montpellier University France
| | | | | | | | | | | | | | - Fanny Grau
- Sexual Transmitted Infections Center, Nimes France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier Montpellier France
| | - Jacques Reynes
- INSERM U1175/IRD UMI 233 Montpellier University France
- Infectious Diseases Department Montpellier University Hospital
| | - Hélène Donnadieu‐Rigole
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier Montpellier France
- Department of Addictology Montpellier University Hospital
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5
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Henri B, Sirvain S, de Wazieres B, Bernard L, Gavazzi G, Forestier E, Fraisse T. [Survey on antibiotic prescription practices for palliative care terminally ill patients of 75 years old and more]. Rev Med Interne 2022; 43:589-595. [PMID: 36064626 DOI: 10.1016/j.revmed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022]
Abstract
Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits. METHOD ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017. RESULTS 220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3%) without statistically significant difference between groups. GP (25%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23%) and GP (18%) reported more urinary tract symptoms than others (11.7%) (P=0.003). Geriatricians (59.6%) declared significantly less urinary analysis than GP (90%) (P=0.0009). 212 doctor (96.4%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9%) significantly more in hospital (121, 89%) than in community (25, 39.1%) (P<0.001). Patient wishes were noted by 30 (46.96%) only GP. CONCLUSION Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.
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Affiliation(s)
- B Henri
- Post-urgences gériatriques, CHU Purpan, 31000 Toulouse, France
| | - S Sirvain
- Court séjour gériatrique, CH Alès-Cevennes, 811 avenue du Dr J goubert, 30100 Ales, France
| | - B de Wazieres
- Service de gériatrie, CHU Caremeau, 30000 Nimes, France
| | - L Bernard
- Service de Maladies Infectieuses, CHU Hôpitaux de Tours, 37000 Tours, France
| | - G Gavazzi
- Service Universitaire de Gériatrie Clinique, CHU de Grenoble, 38000 Grenoble, France
| | - E Forestier
- Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - T Fraisse
- Court séjour gériatrique, CH Alès-Cevennes, 811 avenue du Dr J goubert, 30100 Ales, France.
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6
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Baclet N, Calafiore M, Fregnac C, Gavazzi G, Forestier E, Roubaud-Baudron C, Fraisse T, Alfandari S, Senneville E, Beuscart JB. Explicit definitions of potentially inappropriate prescriptions of antibiotics in hospitalized older patients. Infect Dis Now 2022; 52:214-222. [PMID: 35158094 DOI: 10.1016/j.idnow.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/25/2021] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
Abstract
CONTEXT The use of explicit definitions of potentially inappropriate prescriptions of antibiotics (antibiotic PIPs) might constitute an innovative means to fight against antimicrobial resistance. Explicit definitions of PIPs can reduce the rate of inappropriate prescriptions, but explicit definitions of antibiotic PIPs in geriatric medicine are currently lacking. The objective of the study was to develop explicit definitions of antibiotic PIPs for hospitalized older patients. METHOD We performed a qualitative study of focus groups involving geriatricians and infectious disease specialists. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Transcripts of audio recordings were analyzed in a two-step independent reviewing process. The exact wording of the definitions was validated by a steering committee, an independent expert group, and the focus group participants. RESULTS The four focus groups comprised 28 stakeholders. Our analysis identified 65 explicit definitions of antibiotic PIPs: 47 (73%) concerned misuse, 15 (23%) concerned overuse and three (5%) concerned underuse. Most definitions were related to critically important antibiotics: 11 (17%) for fluoroquinolones, eight (12%) for amoxicillin-clavulanic acid, eight (12%) for cephalosporins, seven (11%) for aminoglycosides, and five (8%) for carbapenems. CONCLUSION To address the public health challenge of antimicrobial resistance, our study generated explicit definitions for antibiotic PIPs in older patients. We intend to refine and to validate these definitions through a national Delphi survey; the resulting consensus might provide key messages for prescribers and open up perspectives for reducing the incidence of antibiotic PIPs.
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Affiliation(s)
- N Baclet
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Lille Catholic Hospitals, Department of Infectious Diseases, F-59160 Lille, France
| | - M Calafiore
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - C Fregnac
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - G Gavazzi
- Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble-Alpes, GREPI EA7408 Université Grenoble-Alpes, F-38000 Grenoble, France
| | - E Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France
| | - C Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, Univ. Bordeaux, INSERM 1053 BaRITOn, F-33000 Bordeaux, France
| | - T Fraisse
- Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France
| | - S Alfandari
- Gustave Dron Hospital, University Department of Infectious Diseases, F-59200 Tourcoing, France
| | - E Senneville
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Gustave Dron Hospital, University Department of Infectious Diseases, F-59200 Tourcoing, France
| | - J-B Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
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Sirvain S, Durand M, Putot A, Forestier E, Gavazzi G, Fraisse T. Antibiotics in end of life: The driving factors. Infect Dis Now 2021; 52:175. [PMID: 34634484 DOI: 10.1016/j.idnow.2021.10.004] [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: 06/20/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Serge Sirvain
- Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France
| | - Mailys Durand
- Service de médecine gériatrique, CHU de Nîmes, Place du Pr R Debré, 30000 Nîmes, France
| | - Alain Putot
- Service de Médecine Interne gériatrique, CHU François-Mitterand, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - Emmanuel Forestier
- Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Gaetan Gavazzi
- Service Universitaire de Gériatrie Clinique, CHU de Grenoble, 38000 Grenoble, France
| | - Thibaut Fraisse
- Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France.
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8
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Durand M, Forestier E, Gras Aygon C, Sirvain S, de Wazières B, Bernard L, Paccalin M, Legout L, Roubaud Baudron C, Gavazzi G, Fraisse T. Determinants of doctors' antibiotic prescriptions for patients over 75 years old in the terminal stage of palliative care. Infect Dis Now 2020; 51:340-345. [PMID: 33075403 DOI: 10.1016/j.medmal.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/31/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Notwithstanding high prevalence of presumably bacterial infections in elderly persons (EP) in palliative care (PC), there exists no recommendation on the role of antibiotic therapy (ABP) in this type of situation. OBJECTIVE To describe the determinants of antibiotic prescription by general practitioners (GP) and by doctors practicing in institutions (DPI) for patients>75 years, in end-of-life situations in PC. METHOD Descriptive investigation by anonymous self-administered questionnaire disseminated in France by e-mail. RESULTS A total of 301 questionnaires analyzed: 113 GP, 188 DPIs. The latter were mainly geriatricians (69, 36.6%) and infectologists/internists (41, 21.8%). Sixty-three (55,75%) GPs and 144 (78.7%) DPIs stated that they had prescribed antibiotics. Practice in "EHPAD" retirement homes or intensive care was often associated with non-prescription of antibiotics. Age, PC training and number of patients monitored bore no influence. Family involvement in decision-making was more frequent for GPs than for DPIs. The main purpose of antibiotic therapy was to relieve different symptoms (fever, respiratory congestion, functional urinary signs). Most of the doctors (81%) had previously encountered complications (allergy, adverse effect), which represented the main causes of treatment discontinuation. CONCLUSION Antibiotic use in end-of-life EPs in PC seems frequent. In accordance with the principle of beneficence, its goal of often symptom-related; that said, in the absence of scientific data, antibiotic prescription in end-of-life situations should be individualized in view of observing the other ethical caregiving principles (beneficence, non-maleficence, justice, patient autonomy) and re-evaluated daily.
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Affiliation(s)
- M Durand
- Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France
| | - E Forestier
- Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - C Gras Aygon
- Département de médecine générale, UFR médecine Montpellier-Nîmes, 34000 Montpellier, France
| | - S Sirvain
- Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France
| | - B de Wazières
- Service de médecine gériatrique, CHU de Nîmes, Place du Pr R Debré, 30000 Nîmes, France
| | - L Bernard
- Service de Maladies Infectieuses, CHU Hôpitaux de Tours, 37000 Tours, France
| | - M Paccalin
- Pôle de Gériatrie, CHU La Milétrie, 86000 Poitiers, France
| | - L Legout
- Service des maladies infectieuses et tropicales, CH Alpes Léman, Contamine sur Arve, France
| | - C Roubaud Baudron
- Pôle de Gérontologie Clinique, Université de Bordeaux, CHU Hôpitaux de Bordeaux, 33000 Bordeaux, France
| | - G Gavazzi
- Service Universitaire de Gériatrie Clinique, CHU de Grenoble, 38000 Grenoble, France
| | - T Fraisse
- Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France.
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- Court séjour gériatrique, CH Alès Cévennes, Avenue du Docteur Jean Goubert, 30100 Alès, France; Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France; Service de médecine gériatrique, CHU de Nîmes, Place du Pr R Debré, 30000 Nîmes, France; Service de Maladies Infectieuses, CHU Hôpitaux de Tours, 37000 Tours, France; Pôle de Gériatrie, CHU La Milétrie, 86000 Poitiers, France; Service des maladies infectieuses et tropicales, CH Alpes Léman, Contamine sur Arve, France; Pôle de Gérontologie Clinique, Université de Bordeaux, CHU Hôpitaux de Bordeaux, 33000 Bordeaux, France; Service Universitaire de Gériatrie Clinique, CHU de Grenoble, 38000 Grenoble, France
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Gavazzi G, Bavelele P, Paccalin M, Aquino J, Roubaud C, Bernard L, Fraisse T, Vittoz J, François P, Forestier E. La vaccination antigrippale modifie t-elle le pronostic des patients âgés hospitalisés atteints de grippe ? Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.392] [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: 11/27/2022]
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10
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Baclet N, Hequette-Ruz R, Calafiore M, Gavazzi G, Forestier E, Roubaud-Baudron C, Fraisse T, Alfandari S, Senneville E, Beuscart JB. Définitions explicites de prescriptions potentiellement inappropriées : nouvelle approche pour le bon usage des antibiotiques. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Forestier E, Roubaud-Baudron C, Fraisse T, Patry C, Gavazzi G, Hoen B, Carauz-Paz P, Moheb-Khosravi B, Delahaye F, Sost G, Paccalin M, Nazeyrollas P, Strady C, Alla F, Selton-Suty C. Comprehensive geriatric assessment in older patients suffering from infective endocarditis. A prospective multicentric cohort study. Clin Microbiol Infect 2019; 25:1246-1252. [PMID: 31055167 DOI: 10.1016/j.cmi.2019.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/11/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim was to describe the impact of infective endocarditis (IE) on functional, cognitive and nutritional statuses, and to estimate the influence of these parameters on surgical management and mortality. METHOD This was a prospective study over 13 months in 14 French hospitals, including patients ≥75 years of age with definite or possible IE. A comprehensive geriatric assessment (CGA) was performed during the first week of hospitalization, including a retrospective estimation of functional status 2 months before hospitalization, and 3 months after. RESULTS A total of 120 patients were included (mean age 83.1 ± 5.0 (75-101) years). IE was associated with a dramatic impairment of functional status between 2 months prior hospitalization and the first geriatric evaluation (90.8% able to walk vs. 35.5% (p < 0.0001), ADL (Activities in Daily Living) 5.0 ± 1.7 vs. 3.1 ± 2.1 (p < 0.0001)). The 19 operated patients (15.8%) had less comorbidities (cumulative illness rating scale geriatric 10.8 ± 8.2 vs. 15.3 ± 7.1 (p 0.0176)), better functional (ADL 5.9 ± 0.4 vs. 4.9 ± 1.8 (p 0.0171) and nutritional (mini nutritional assessment 20.4 ± 5.0 vs. 17.3 ± 6.2 (p 0.0501)) statuses than non-operated patients. Among all infectious, cardiac and geriatric parameters, body mass index (HR 0.9, range 0.8-1, p 0.05) and ADL at the time of the first evaluation (HR 0.7, range 0.6-0.9, p 0.002) were the sole independent predictors of the 3-month (32.5%) and 1-year mortality (42.5%). Three months later, the 57 assessed patients only partially recovered their ADL (3.7 ± 1.9 vs. 5.3 ± 1.4 2 months prior hospitalization and 4.6 ± 1.9 at the first CGA; p < 0.0001). CONCLUSION Functional and nutritional abilities are crucial components that can be accurately explored through a CGA when managing IE in oldest patients.
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Affiliation(s)
- E Forestier
- Infectious Diseases Department, Centre Hospitalier Metropole Savoie, Chambéry, France.
| | - C Roubaud-Baudron
- CHU Bordeaux, Department of Geriatric Medicine, Univ. Bordeaux, F-33000, Bordeaux, France
| | - T Fraisse
- Department of Geriatric Medicine, Centre Hospitalier Alès Cévennes, Alès, France
| | - C Patry
- Department of Geriatrics, Hôpital Bichat - APHP, Paris, France
| | - G Gavazzi
- Department of Geriatric Medicine and GREPI EA 7408, University Hospital of Grenoble-Alpes, Grenoble, France
| | - B Hoen
- Infectious Diseases and Internal Medicine Department and INSERM CIC 1424, University Hospital of Pointe-à-Pitre; Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France
| | - P Carauz-Paz
- Infectious Diseases Department, Centre Hospitalier Intercommunal Lucie et Raymond Aubrac, Villeneuve Saint Georges, France
| | - B Moheb-Khosravi
- Department of Geriatric Medicine, Centre Hospitalier Annecy Genevois, Annecy, France
| | - F Delahaye
- Cardiology Department, Hospices civils de Lyon, Université Claude Bernard Lyon 1, HESPER, EA 7425, Lyon, France
| | - G Sost
- Department of Geriatric Medicine, University Hospital of Rennes, Rennes, France
| | - M Paccalin
- Department of Geriatric Medicine and CIC 1402, University Hospital of Poitiers, Poitiers, France
| | - P Nazeyrollas
- Cardiology Department, University Hospital of Reims, Reims, France
| | - C Strady
- Infectious Diseases Department, Groupe Courlancy, Reims, France
| | - F Alla
- Clinical Epidemiological Center, University Hospital of Nancy, Nancy, France
| | - C Selton-Suty
- Cardiology Department, University Hospital of Nancy, Nancy, France
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Deshayes S, Fellahi S, Bastard J, Launay J, Callebert J, Fraisse T, Buob D, Boffa J, Aouba A, Grateau G, Sokol H, Georgin-Lavialle S. La fièvre méditerranéenne familiale et l’amylose AA s’accompagnent d’une dysbiose : étude transversale sur 60 patients. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Durand M, de Wazieres B, Gavazzi G, Legout L, Bernard L, Forestier E, Fraisse T. Déterminants de la prescription d’antibiotiques chez les personnes âgées en phase terminale de soins palliatifs : enquête nationale de pratiques. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.130] [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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Georgin-Lavialle S, Hentgen V, Stankovic Stojanovic K, Bachmeyer C, Rodrigues F, Savey L, Abbara S, Conan PL, Fraisse T, Delplanque M, Rouet A, Sbeih N, Koné-Paut I, Grateau G. [Familial Mediterranean fever]. Rev Med Interne 2018. [PMID: 29526329 DOI: 10.1016/j.revmed.2018.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Familial Mediterranean Fever (FMF) is the most frequent monogenic auto-inflammatory disease. FMF is an autosomal recessive disease, which affects populations from Mediterranean origin and is associated with MEFV gene mutations encoding for the protein pyrin. Pyrin activation enhances the secretion of interleukin 1 by myelo-monocytic cells. Main features of the disease are acute attacks of serositis mainly located on the abdomen, less frequently on chest and joints, accompanied by fever and biological inflammatory markers elevation. Usually attacks last 1 to 3 days and spontaneously stop. A daily oral colchicine intake of 1 to 2mg/day is able to prevent attack's occurrence, frequency, intensity and duration among most patients. Colchicine is also able to prevent the development of inflammatory amyloidosis, the most severe complication of FMF. This state of the art article will focus on the diagnosis of FMF, the treatment and an update on the pathophysiology including the recent described dominant form of MEFV-associated new auto-inflammatory diseases.
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Affiliation(s)
- S Georgin-Lavialle
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - V Hentgen
- Service de pédiatrie générale, (CEREMAIA), centre hospitalier de Versailles, 179, rue de Versailles, 78150 Le Chesnay, France
| | - K Stankovic Stojanovic
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - C Bachmeyer
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - F Rodrigues
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - L Savey
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - S Abbara
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - P-L Conan
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - T Fraisse
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - M Delplanque
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - A Rouet
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - N Sbeih
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - I Koné-Paut
- Service de rhumatologie pédiatrique, (CEREMAIA), université de Paris Sud, CHU de Bicêtre, Assistance publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France
| | - G Grateau
- Service de médecine interne, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire (CEREMAIA), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Inserm UMRS_933, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Paris 6, Pierre-et-Marie-Curie (UPMC), Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Sbeih N, Hoyeau-Idrissi N, Fraisse T, Launay J, Hentgen V, Hermine O, Canioni D, Amselem S, Giurgea I, Louvrier C, Grateau G, Georgin Lavialle S. Implication des mastocytes dans la fièvre méditerranéenne familiale : une étude prospective sur 50 patients. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.311] [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: 11/27/2022]
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Pages C, Schambach S, Noblet D, Thompson MA, Sirvain S, Fraisse T. [Furosemide induced agranulocytosis in heart failure, what else?]. Presse Med 2017; 46:1115-1117. [PMID: 29110955 DOI: 10.1016/j.lpm.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/08/2017] [Accepted: 06/27/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Christelle Pages
- Centre hospitalier Ales Cevennes, service de court séjour gériatrique aigu, 811, avenue du Dr J.-Goubert, 30100 Ales, France.
| | - Soline Schambach
- Centre hospitalier Ales Cevennes, service de court séjour gériatrique aigu, 811, avenue du Dr J.-Goubert, 30100 Ales, France
| | - Daniel Noblet
- SSR Les cadières, 30340 Saint-Privat des Vieux, France
| | | | - Serge Sirvain
- Centre hospitalier Ales Cevennes, service de court séjour gériatrique aigu, 811, avenue du Dr J.-Goubert, 30100 Ales, France
| | - Thibaut Fraisse
- Centre hospitalier Ales Cevennes, service de court séjour gériatrique aigu, 811, avenue du Dr J.-Goubert, 30100 Ales, France
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Selton-Suty C, Roubaud-Baudron C, Fraisse T, Gavazzi G, Delahaye F, Patry C, Nazeyrollas P, Pineau O, Belle L, Sost G, Iung B, Hoen B, Alla F, Forestier E. P4538Therapeutic and prognostic impact of comprehensive geriatric assessment in elderly patients with infective endocarditis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C. Selton-Suty
- University Hospital of Nancy - Hospital Brabois, Vandoeuvre les Nancy, France
| | | | - T. Fraisse
- Hospital of Alès, Infectious Diseases, Alès, France
| | - G. Gavazzi
- University Hospital of Grenoble, Geriatry, Grenoble, France
| | - F. Delahaye
- Hospital of Alès, Infectious Diseases, Alès, France
| | - C. Patry
- Hospital Bichat-Claude Bernard, Paris, France
| | | | - O. Pineau
- Hospital of Villeneuve St Georges, Villeneuve St Georges, France
| | - L. Belle
- Hospital of Annecy, Annecy, France
| | - G. Sost
- University Hospital of Rennes, Rennes, France
| | - B. Iung
- Hospital Bichat-Claude Bernard, Paris, France
| | - B. Hoen
- University Hospital, Infectious Diseases, Pointe à Pitre, France
| | - F. Alla
- University Hospital of Nancy - Hospital Brabois, Vandoeuvre les Nancy, France
| | - E. Forestier
- Hospital of Chambery, Infectious Diseases, Chambery, France
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Forestier E, Roubaud-Baudron C, Fraisse T, Caraux-Paz P, Gavazzi G, Erpelding M, Hoen B, Duval X, Alla F, Selton-Suty C. Impact des données gériatriques sur la prise en charge thérapeutique et la morbi-mortalité à 3 mois de l’endocardite infectieuse (EI) chez le sujet âgé (étude Elderl-IE). Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.265] [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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Pages C, Fraisse T, Mourlan C, Le Moing V, Sotto A. Évaluation de l’utilisation par les médecins généralistes d’une plaquette sur le bon usage des antibiotiques à destination des patients. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.120] [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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Comarmond C, Jego P, Veyssier-Belot C, Marie I, Mekinian A, Elmaleh-Sachs A, Leroux G, Saadoun D, Oziol E, Fraisse T, Hyvernat H, Thiercein-Legrand MF, Sarrot-Reynauld F, Ferreira-Maldent N, de Menthon M, Goujard C, Khau D, Nguen Y, Monnier S, Michon A, Castel B, Decaux O, Piette JC, Cacoub P. Cessation of oral anticoagulants in antiphospholipid syndrome. Lupus 2017; 26:1291-1296. [DOI: 10.1177/0961203317699285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective To study the outcome of patients with antiphospholipid syndrome (APS) after oral anticoagulant treatment cessation. Methods We performed a retrospective study of patients with APS experiencing cessation of oral anticoagulant and enrolled in a French multicentre observational cohort between January 2014 and January 2016. The main outcome was the occurrence of recurrent thrombotic event after oral anticoagulation cessation. Results Forty four APS patients interrupted oral anticoagulation. The median age was 43 (27–56) years. The median duration of anticoagulation was 21 (9–118) months. Main causes of oral anticoagulant treatment cessation were switch from vitamin K antagonists to aspirin in 15 patients, prolonged disappearance of antiphospholipid antibodies in ten, bleeding complications in nine and a poor therapeutic adherence in six. Eleven (25%) patients developed a recurrent thrombotic event after oral anticoagulation cessation, including three catastrophic APS and one death due to lower limb ischemia. Antihypertensive treatment required at time of oral anticoagulants cessation seems to be an important factor associated with recurrent thrombosis after oral anticoagulant cessation (15.2% in patients with no relapse versus 45.5% in patients with recurrent thrombosis, p = 0.038). Oral anticoagulant treatment was re-started in 18 (40.9%) patients. Conclusion The risk of a new thrombotic event in APS patients who stopped their anticoagulation is high, even in those who showed a long lasting disappearance of antiphospholipid antibodies. Except for the presence of treated hypertension, this study did not find a particular clinical or biological phenotype for APS patients who relapsed after anticoagulation cessation. Any stopping of anticoagulant in such patients should be done with caution.
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Affiliation(s)
- C Comarmond
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
- INSERM UMR 7211, F-75005, Paris, France
- CNRS, UMR 7211, F-75005, Paris, France
| | - P Jego
- Service de Médecine Interne, CHU Rennes, France
| | | | - I Marie
- Service de Médecine Interne, CHU Rouen, France
| | - A Mekinian
- Service de Médecine Interne, CHU Saint-Antoine, Paris, France
| | - A Elmaleh-Sachs
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - G Leroux
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
| | - D Saadoun
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
- INSERM UMR 7211, F-75005, Paris, France
- CNRS, UMR 7211, F-75005, Paris, France
| | - E Oziol
- Service de Médecine Interne, CH Béziers, France
| | - T Fraisse
- Service de Médecine Interne, CH Ales, France
| | - H Hyvernat
- Service de Médecine Interne, CHU Nice, France
| | | | | | | | - M de Menthon
- Service de Médecine Interne, CHU Saint-Louis, Paris, France
| | - C Goujard
- Service de Médecine Interne et d'Immunologie Clinique, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - D Khau
- Service de Médecine Interne, CH Versailles, France
| | - Y Nguen
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - S Monnier
- Service de Médecine Interne, CH Versailles, France
| | - A Michon
- Service de Médecine Intern, CHU Georges Pompidou, Paris, France
| | - B Castel
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - O Decaux
- Service de Médecine Interne, CHU Rennes, France
| | - J-C Piette
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
| | - P Cacoub
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
- INSERM UMR 7211, F-75005, Paris, France
- CNRS, UMR 7211, F-75005, Paris, France
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Roubaud-Baudron C, Forestier E, Fraisse T, Gaillat J, de Wazières B, Pagani L, Ingrand I, Bernard L, Gavazzi G, Paccalin M. Tolerance of subcutaneously administered antibiotics: a French national prospective study. Age Ageing 2017; 46:151-155. [PMID: 28181635 DOI: 10.1093/ageing/afw143] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/15/2016] [Indexed: 11/12/2022] Open
Abstract
Background/ Objective Although poorly documented, subcutaneous (SC) administration of antibiotics is common practice in France especially in Geriatrics Departments. The aim of this study was to determine the tolerance of such a practice. Design Prospective observational multicentre study. Methods Sixty-six physicians accepted to participate from 50 French Infectious Diseases and Geriatrics Departments. From May to September 2014, patients treated at least one day with SC antibiotics could be included. Modalities of subcutaneous administration, occurrence of local and systemic adverse effects (AE) and clinical course were collected until the end of the treatment. Results Two hundred-nineteen patients (83.0 [19–104] yo) were included. Ceftriaxone (n = 163, 74.4%), and ertapenem (n = 30, 13.7%) were the most often prescribed antibiotics. The SC route was mainly used because of poor venous access (65.3%) and/or palliative care (32.4%). Fifty patients (22.8%) experienced at least one local AE that led to an increased hospital stay for two patients (4.0%) and a discontinuation of the SC infusion in six patients (12.0%). A binary logistic regression for multivariate analysis identified the class of antibiotic (p = 0.002) especially teicoplanin and the use of rigid catheter (p = 0.009) as factors independently associated with AE. In over 80% of cases, SC antibiotics were well tolerated and associated with clinical recovery. Conclusions SC administration of antibiotics leads to frequent but local and mild AE. Use of non-rigid catheter appears to be protective against AE. As it appears to be a safe alternative to the intravenous route, more studies are needed regarding efficacy and pharmacokinetics.
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Affiliation(s)
- Claire Roubaud-Baudron
- Pôle de Gérontologie Clinique, Centre Hospitalier Universitaire - Hôpitaux de Bordeaux, Université de Bordeaux, F-33000 Bordeaux, France
| | - Emmanuel Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France
| | - Thibaut Fraisse
- Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France
| | - Jacques Gaillat
- Service de Maladies Infectieuses, Centre Hospitalier Annecy Genevois, F-74000 Annecy, France
| | - Benoit de Wazières
- Médecine Interne Gériatrique, Centre Hospitalier Universitaire de Nîmes, F-30000 Nimes, France
| | - Leonardo Pagani
- Service de Maladies Infectieuses, Centre Hospitalier Annecy Genevois, F-74000 Annecy, France
| | - Isabelle Ingrand
- Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, F-86000 Poitiers, France
- INSERM, CIC 1402, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, F-86000 Poitiers, France
| | - Louis Bernard
- Service de Maladies Infectieuses, Centre Hospitalier Régional Universitaire Bretonneau, F-37000 Tours, France
| | - Gaëtan Gavazzi
- Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble, F-38000 Grenoble, France
| | - Marc Paccalin
- Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, F-86000 Poitiers, France
- Intergroupe SPILF-SFGG
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Fraisse T, Bastard J, Fellahi S, Steichen O, Stankovic K, Avellino V, Hentgen V, Faintuch J, Amselem S, Grateau G, Georgin-Lavialle S. Cytolyse au cours de la fièvre méditerranéenne familiale : étude prospective chez 19 adultes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.052] [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: 10/20/2022]
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Abstract
The incidence of infective endocarditis (IE) rises in industrialized countries. Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients. Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies. Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden. However, the management of IE in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient's functional status and comorbidities. Yet, if IE should be treated according to current recommendations in the healthiest patients, concerns may rise for older patients who suffer from several chronic diseases, especially renal failure, and are on polypharmacy. Treating frailest patients with high-dose intravenous antibiotics during a prolonged hospital stay as recommended for younger patients could also expose them to functional decline and toxic effect. Likewise, the place of surgery according to the aging characteristics of each patient is unclear. The aim of this article is to review the recent data on epidemiology of IE and its peculiarities in the elderly. Then, its management and various therapeutic approaches that can be considered according to and beyond guidelines depending on patient comorbidities and frailty are discussed.
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Affiliation(s)
- Emmanuel Forestier
- Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France
- Correspondence: Emmanuel Forestier, Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, BP 1125, 73011 Chambery Cedex, France, Tel +33 4 7996 5847, Fax +33 4 7996 5171, Email
| | - Thibaut Fraisse
- Acute Geriatric Department, Centre Hospitalier, Alès, France
| | | | | | - Leonardo Pagani
- Infectious Diseases Department, Centre Hospitalier Annecy-Genevois, Annecy, France
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Fraisse T, Fourcade C, Brazes-Sanz J, Koumar Y, Lavigne JP, Sotto A, Laureillard D. A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners. Int J STD AIDS 2015; 27:1005-12. [PMID: 26429893 DOI: 10.1177/0956462415605413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity.
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Affiliation(s)
- Thibaut Fraisse
- Department of Geriatric Medicine, General Hospital, Alès, France
| | - Camille Fourcade
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Yatrika Koumar
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Albert Sotto
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
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Roubaud Baudron C, Forestier E, Fraisse T, Gaillat J, Bernard L, Pagani L, Gavazzi G, Paccalin M. O-046: Tolerance of subcutaneously administered antibiotics: a national, prospective and observational study. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Salles N, Sotto A, Lavigne JP, Dinh A, Bernard L, Fraisse T. [5th symposium of the SPILF-SFGG intergroup (4th of december 2014, Paris)]. Med Mal Infect 2015; 45:308-10. [PMID: 26078012 DOI: 10.1016/j.medmal.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Affiliation(s)
- N Salles
- Service de médecine gériatrique Xavier-Arnozan, groupe hospitalier Sud, avenue de Magellan, 33600 Pessac, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU Caremeau, place du Pr-Robert-Debré, 30029 Nîmes cedex, France
| | - J-P Lavigne
- Laboratoire de microbiologie, CHU Caremeau, place du Pr-Robert-Debré, 30029 Nîmes cedex, France
| | - A Dinh
- Unité des maladies infectieuses, CHU Raymond-Poincaré, hôpitaux universitaires Paris-Île-de-France-Ouest, AP-HP, 92380 Garches, France
| | - L Bernard
- Services des maladies infectieuses, CHU Bretonneau, 37000 Tours, France
| | - T Fraisse
- Court séjour gériatrique aigu, centre hospitalier Alès-Cévennes, 811, avenue du Dr-J.-Goubert, 30100 Alès, France.
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Fraisse T, Trouillier S, Mania A, D’incan M, Ruivard M, Andre M, Aumaître O. Pronostic à long terme des patients avec atteinte digestive sévère du purpura rhumatoïde de l’adulte. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fraisse T, Mania A, Aumaître O, Andre M. Traitement des aphtoses sévères par anti-TNF alpha. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.189] [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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Forestier E, Paccalin M, Roubaud-Baudron C, Fraisse T, Gavazzi G, Gaillat J. Subcutaneously administered antibiotics: a national survey of current practice from the French Infectious Diseases (SPILF) and Geriatric Medicine (SFGG) society networks. Clin Microbiol Infect 2014; 21:370.e1-3. [PMID: 25658521 DOI: 10.1016/j.cmi.2014.11.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/06/2014] [Accepted: 11/15/2014] [Indexed: 11/28/2022]
Abstract
A national survey was performed to explore antibiotic prescription by the subcutaneous (sc) route among French infectious diseases and geriatric practitioners. Among the participating physicians, 367 (96.1%) declared administering sc antibiotics at some point. Ceftriaxone was prescribed sc by all but one, and ertapenem, teicoplanin, aminoglycosides and amoxicillin by 33.2%, 39.2%, 35.1% and 15.3%, respectively. The sc route was resorted to mainly in case of unavailable oral, intravenous or intramuscular routes, especially during palliative care. Pain, skin necrosis and lack of efficacy were the main adverse effects, reported by 70.8%, 12.8% and 19.9% of practitioners, respectively. Further studies are needed to precise the indications, modalities and tolerance of sc antibiotic use.
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Affiliation(s)
- E Forestier
- Service de Maladies Infectieuses, Centre Hospitalier, Chambéry, France.
| | - M Paccalin
- Service de Gériatrie, Centre Hospitalier Universitaire, Poitiers, France
| | - C Roubaud-Baudron
- Pole de Gérontologie clinique, Centre Hospitalier Universitaire, Bordeaux, France
| | - T Fraisse
- Service de Gériatrie, Centre Hospitalier, Alès, France
| | - G Gavazzi
- Service de Gériatrie, Centre Hospitalier Universitaire, Grenoble, France
| | - J Gaillat
- Service de Maladies Infectieuses, Centre Hospitalier, Annecy, France
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Fraisse T, Gras Aygon C, Paccalin M, Vitrat V, De Wazieres B, Baudoux V, Lechiche C, Vicens A, Sotto A, Pagani L, Gaillat J, Forestier E, Gavazzi G. Aminoglycosides use in patients over 75 years old. Age Ageing 2014; 43:676-81. [PMID: 24590569 DOI: 10.1093/ageing/afu023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE to describe aminoglycoside use and nephrotoxicity in patients older than 75 years. DESIGN retrospective multicenter study. SETTING hospital department, rehabilitation, long-term care center. POPULATION patients ≥75 years old treated by aminoglycosides. RESULTS 184 patients, mean age: 84.4 years (range: 75-101). One hundred and twenty-seven patients received other nephrotoxic drug(s). Gentamicin (70%) and amikacin (30%) were used and the once-daily dosing was preferred (92%). Average treatment period was 2.75 (1-10) days for amikacin and 4.4 (1-30) for gentamicin with average dosage 13.5 and 3.5 mg/kg/day, respectively. The monitoring of maximal plasmatic concentration (Cmax) was done in 37 patients, 9 of them had probabilistic treatment. Only one had a Cmax fulfilling the objective of French recommendations (gentamicin >30 mg/l, amikacin >60 mg/l). When infection was documented, the objective of Cmax >10 × minimal inhibitory concentration of the strain was reached for 27%. Minimal plasmatic concentration was checked in 38% of cases, with adequate value (gentamicin <0.5 mg/l, amikacin <2.5 mg/l) for 37%. At the end of aminoglycoside course, 40 patients increased their serum creatinine >25% of the baseline value. In multivariate analysis, this was associated with treatment length ≥3 days and concomitant use of nephrotoxic drugs. CONCLUSION aminoglycosides dosing used in elderly patients probably need therapeutic drug monitoring and dose adjustment. Aminoglycosides are used to treat severe infections. One of the most important side effects is nephrotoxicity in oldest patients. To minimise nephrotoxicity, short treatments are necessary and avoiding others nephrotoxic drugs could be relevant.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Albert Sotto
- CHU Caremeau - Infectious Disease, Nimes, France
| | | | | | | | - Gaëtan Gavazzi
- University Hospital of Grenoble - University Clinic of Geriatric Medicine, BP 217, Grenoble 38043, France
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Fraisse T, Hery L, Samou F, Rieu V, Ruivard M, Buisson A, Tournilhac O, Kahn J, Trouillier S. Éosinophilie majeure révélant une rectocolite hémorragique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gauthier D, Schambach S, Crouzet J, Sirvain S, Fraisse T. Subcutaneous and intravenous ceftriaxone administration in patients more than 75 years of age. Med Mal Infect 2014; 44:275-80. [DOI: 10.1016/j.medmal.2014.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/25/2014] [Accepted: 03/26/2014] [Indexed: 11/24/2022]
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Fraisse T, Courouge-Dorcier D, Aumaitre O, Trouillier S. Une dermatomyosite amyopathique paranéoplasique très atypique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.194] [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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34
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Forestier E, Paccalin M, Roubaud C, Fraisse T, Gavazzi G, Gaillat J. M-10: Administration des antibiotiques par voie sous-cutanée : pratiques rapportées par les infectiologues et les gériatres français. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fraisse T, Gras Aygoin C, de Wazieres B, Paccalin M, Vitrat V, Forestier E, Gaillat J, Gavazzi G. Aminoglycosides use in elderly population: A retrospective observational study in 38 centers in France. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.397] [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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Fraisse T, Makarawiez C, Le Quang C, Le Guenno G, Rieu V, Philippe P, Ruivard M. L’immunocompétence ne protège pas de la toxoplasmmose cérébrale ! : à propos d’un cas. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rami H, Garrido JF, Sirvain S, Fraisse T. Intérêt d’un traitement par imatinib dans la leucémie à éosinophiles du sujet très âgé. À propos d’un cas. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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38
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Fraisse T, Marques M, Castel D. Analyse des pratiques de prise en charge des plaies dans un centre hospitalier. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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39
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Brun A, Julier I, Sirvain S, Fraisse T. Une lésion cérébrale. Rev Med Interne 2012; 33:534-5. [DOI: 10.1016/j.revmed.2011.10.009] [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: 06/22/2011] [Revised: 08/29/2011] [Accepted: 10/09/2011] [Indexed: 11/24/2022]
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40
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Fraisse T, Lachaud L, Sotto A, Lavigne JP, Cariou G, Boiteux JP, Escaravage L, Coloby P, Bruyère F. [Recommendations of the Infectious Disease Committee of the French Association of Urology. Diagnosis, treatment and monitoring candiduria]. Prog Urol 2011; 21:314-21. [PMID: 21514533 DOI: 10.1016/j.purol.2011.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 01/28/2011] [Accepted: 02/03/2011] [Indexed: 11/20/2022]
Abstract
The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60% of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4-14% of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400 mg on day 1 and 200 mg daily for 7 to 14 days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata).
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Affiliation(s)
- T Fraisse
- Service des maladies infectieuses et tropicales, CHU de Nîmes, groupe hospitalo-universitaire Caremeau, place du Professeur-Robert- Debré, 30029 Nîmes, France
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Abstract
OBJECTIVE Candiduria is a common finding in the growing population of very old patients that has not been previously studied. The objective was to study candiduria in the population aged 85 and over, including an estimation of the incidence, factor of acquisition, and evaluation of treatment and mortality. METHODS Retrospective monocentric study. Materials medical charts of patients aged of 85 and over who have candiduria diagnosed at Nimes University Hospital. RESULTS The prevalence of candiduria in the hospitalized very old patients was 8.9%. More than half of strains isolated were C. albicans (59%). Mean age was 89.7 years old with 53 women and 20 men. Urinary catheter (55%) and prior antibiotic use (67%) were commonly found. Fifteen patients with candiduria were treated, consistently with fluconazole. Patients treated had higher Mini Mental Test score than the others. A high C-reactive protein level, Mac Cabe score or Charlson's score >7 were associated with 6 months mortality. CONCLUSION Episodes of candiduria in oldest old were associated with frailty and vulnerability of the patient. The medical decision for antifungal treatment is usually difficult to make but it did not seem to influence mortality.
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Cellier M, Sirvain S, Fraisse T. [Acral lentiginous melanoma: a slow growing tumor of the second finger]. Presse Med 2010; 39:1100-2. [PMID: 20630700 DOI: 10.1016/j.lpm.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 05/20/2010] [Indexed: 11/17/2022] Open
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Fraisse T, Boutet O, Tron AM, Prieur E. Pancreatitis, panniculitis, polyarthritis syndrome: an unusual cause of destructive polyarthritis. Joint Bone Spine 2010; 77:617-8. [PMID: 20599412 DOI: 10.1016/j.jbspin.2010.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2010] [Indexed: 11/26/2022]
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Fraisse T, Brunel AS, Arnaud E, Balducchi JP, Jourdan J, de Wazières B, Sotto A. Manifestations originales au cours de la polychondrite atrophiante : à propos de quatre cas. Rev Med Interne 2008; 29:801-4. [DOI: 10.1016/j.revmed.2008.03.370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 03/29/2008] [Indexed: 01/18/2023]
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Brunel AS, Fraisse T, Lechiche C, Sotto A, Laporte S. [A sexually transmitted peritonitis]. Med Mal Infect 2008; 38:233-4. [PMID: 18339500 DOI: 10.1016/j.medmal.2008.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Revised: 10/06/2007] [Accepted: 01/17/2008] [Indexed: 11/16/2022]
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Marcdargent Fassier A, Gueffier X, Fraisse T, Janelle C, Fassier F. Pont épiphysaire longitudinal déformant du premier métatarsien ou « métatarse delta ». ACTA ACUST UNITED AC 2007; 93:486-93. [PMID: 17878840 DOI: 10.1016/s0035-1040(07)90331-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE OF THE STUDY The longitudinal epiphyseal bracket (LEB) or delta bone is a rare congenital ossification anomaly generally observed in finger or toe phalanges but occasionally in the metatarsus or metacarpus. LEB is initially composed of cartilage forming a bracket linking the proximal and distal epiphyses and causing defective growth of the primary ossification focus. Changes in bone growth secondary to the presence of a LEB would be the cause the angle malformations and length discrepancies observed in these subjects. This raises significant therapeutic problems and repeated surgical interventions when the diagnosis is not established early enough. The clinical presentation of LEB of the first metatarsus is similar to metatarsus adductus or hallux varus primus. The particular aspect on the plain x-ray enables the diagnosis. MATERIAL AND METHODS We operated five feet presenting LEB of the first metatarsus in three children aged on average 23 months (range 8 months to 3 years 10 months). The cartilage bracket was removed, followed by metatarso-phalangeal centromedullary pinning. We studied the course of the angle and length deformities and report outcome at mean follow-up of 4 years 11 months (range 2 years to 3 years 10 months). RESULTS Clinical improvement with correction of the angle deformities was observed in all feet. The length discrepancies did not resolve completely. The degree of correction depended on the age at the time of surgery. DISCUSSION In light of the results obtained in this series and considering the negative prognosis of late surgical management, it would be advisable to obtain a plain x-ray of the foot in all children presenting metatarsus adductus associated with a short first ray.
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Affiliation(s)
- A Marcdargent Fassier
- Service de chirurgie orthopédique, hôpital Saint-Vincent-de-Paul, 74, avenue Denfert-Rochereau, 75014 Paris et Université René-Descartes, Paris V.
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Fraisse T, Brunel A, Arnaud E, Balducchi J, Jourdan J, de Wazieres B, Sotto A. Manifestations originales au cours de la polychondrite atrophiante: à propos de quatre cas. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lechiche C, Fraisse T, Sotto A. Une méningite bien «postérieure». Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.185] [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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Brunel AS, Fraisse T, Lechiche C, Laporte S, Sotto A. Une péritonite sexuellement transmise. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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