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Ducloyer JB, Deltour JB, Le Meur G, Weber M. [Intravitreal injections: Guidelines, methods and medicolegal issues]. J Fr Ophtalmol 2023:S0181-5512(23)00447-3. [PMID: 37838497 DOI: 10.1016/j.jfo.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/21/2023] [Indexed: 10/16/2023]
Abstract
Intravitreal injection (IVI) of a drug allows for immediate intraocular concentrations of active ingredients higher than those obtained by intravenous injection while reducing the risk of systemic side effects. Today, IVI's play a central role in the treatment of many vitreoretinal diseases. With the aging of the population and the advent of vascular endothelial growth factor (VEGF) antagonists, their indications have increased exponentially, creating structural, organizational and economic difficulties. IVI is now one of the most widely performed medical procedures in industrialized countries, and its indications are expected to expand further in the near future with the development of new molecules. Although the overall safety of this practice is proven, an IVI exposes the patient to a 0.05 % risk of endophthalmitis, the consequences of which are often dramatic. This article details the current recommendations, in particular regarding asepsis and antisepsis, and proposes a typical sequence for performing an IVI.
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Affiliation(s)
- J-B Ducloyer
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - J-B Deltour
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - G Le Meur
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - M Weber
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Sentilhes L, Schmitz T, Madar H, Bouchghoul H, Fuchs F, Garabédian C, Korb D, Nouette-Gaulain K, Pécheux O, Sananès N, Sibiude J, Sénat MV, Goffinet F. [The cesarean procedure: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. Gynecol Obstet Fertil Senol 2023; 51:7-34. [PMID: 36228999 DOI: 10.1016/j.gofs.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify procedures to reduce maternal morbidity during cesarean. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane and EMBASE databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 27 questions, there was agreement between the working group and the external reviewers on 26. The level of evidence of the literature was insufficient to provide a recommendation on 15 questions. Preventing hypothermia is recommended to increase maternal satisfaction and comfort (weak recommendation) and to reduce neonatal hypothermia (strong recommendation). The quality of the evidence of the literature did not allow to recommend the skin disinfectant to be used nor the relevance of a preoperative vaginal disinfection nor the choice between the use or nonuse of an indwelling bladder catheterization (if micturition takes place 1 hour before the cesarean section). The Misgav-Ladach technique or its analogues should be considered rather than the Pfannenstiel technique to reduce maternal morbidity (weak recommendation) bladder flap before uterine incision should not be performed routinely (weak recommendation), but a blunt (weak recommendation) and cephalad-caudad extension of uterine incision (weak recommendation) should be considered to reduce maternal morbidity. Antibiotic prophylaxis is recommended to reduce maternal infectious morbidity (strong recommendation) without recommendation on its type or the timing of administration (before incision or after cord clamping). The administration of carbetocin after cord clamping does not significantly decrease the incidence of blood loss>1000 ml, anemia, or blood transfusion compared with the administration of oxytocin. Thus, it is not recommended to use carbetocin rather than oxytocin in cesarean. It is recommended that systematic manual removal of the placenta not to be performed (weak recommendation). An antiemetic should be administered after cord clamping in women having a planned cesarean under locoregional anaesthesia to reduce intraoperative and postoperative nausea and vomiting (strong recommendation) with no recommendation regarding choice of use one or two antiemetics. The level of evidence of the literature was insufficient to provide any recommendation concerning single or double-layer closure of the uterine incision, or the uterine exteriorization. Closing the peritoneum (visceral or parietal) should not be considered (weak recommendation). The quality of the evidence of the literature was not sufficient to provide recommendation on systematic subcutaneous closure, including in obese or overweight patients, or the use of subcuticular suture in obese or overweight patients. The use of subcuticular suture in comparison with skin closure by staples was not considered as a recommendation due to the absence of a consensus in the external review rounds. CONCLUSION In case of cesarean, preventing hypothermia, administering antiemetic and antibiotic prophylaxis after cord clamping are the only strong recommendations. The Misgav-Ladach technique, the way of performing uterine incision (no systematic bladder flap, blunt cephalad-caudad extension), not performing routine manual removal of the placenta nor closure of the peritoneum are weak recommendations and may reduce maternal morbidity.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, université Paris Diderot, AP-HP, Paris, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - F Fuchs
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, Montpellier, France
| | - C Garabédian
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - D Korb
- Service de gynécologie obstétrique, hôpital Robert-Debré, université Paris Diderot, AP-HP, Paris, France
| | - K Nouette-Gaulain
- Service d'anesthésie, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - O Pécheux
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - N Sananès
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Strasbourg, Strasbourg, France
| | - J Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP Louis-Mourier, Colombes, France
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP Le Kremlin-Bicêtre, Paris, France
| | - F Goffinet
- Maternité Port-Royal, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris-Descartes, AP-HP, Paris, France
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Héry JC, Champain G, Lombard A, Hulet C, Malherbe M. Relevance of antibiotic prophylaxis in the management of surgical emergency open hand trauma. Hand Surg Rehabil 2021; 41:137-141. [PMID: 34637966 DOI: 10.1016/j.hansur.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
Surgical site infection after emergency hand surgery can cause considerable morbidity and, in the most severe forms, even toxic shock syndrome. Postoperative antibiotic prophylaxis aims to reduce the number of surgical site infections. However, excessive use of antibiotics induces side-effects for patients and antibiotic resistance for society. Contrary to other orthopedic sites, there is no consensus on postoperative antibiotic prophylaxis in open hand trauma beyond analogic reasoning with no proven scientific validity. Our hypothesis was that absence of postoperative antibiotic prophylaxis after open hand trauma surgery does not affect the rate of surgical site infections. A prospective cohort study included 405 patients, operated on in the emergency hand trauma unit without intra- or post-operative antibiotic prophylaxis. Patients were followed up in consultation at 7, 14 and 30 days. Surgical site infection was defined by need for surgery for detersion and flattening, followed by curative antibiotic therapy. The surgical site infection rate was 2.22%. Four patients were lost to follow-up and counted as surgical site infection as originally planned in the worst-case analysis. There were five surgical revisions followed by antibiotic therapy. These results do not differ from those reported in the literature, and thus confirm our hypothesis that postoperative antibiotic prophylaxis is not indicated in open hand trauma management.
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Affiliation(s)
- J-C Héry
- Department of Orthopaedics and Traumatology, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France.
| | - G Champain
- Department of Orthopaedics and Traumatology, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - A Lombard
- Department of Orthopaedics and Traumatology, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - C Hulet
- Department of Orthopaedics and Traumatology, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - M Malherbe
- Department of Orthopaedics and Traumatology, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
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Younsi S, Chemaly P, Fiorina L, Horvilleur J, Lacotte J, Manenti V, Raimondo C, Salerno F, Ait Said M. [Infections in interventional electrophysiology]. Ann Cardiol Angeiol (Paris) 2020; 69:404-410. [PMID: 33071019 DOI: 10.1016/j.ancard.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
The implantation of pacemakers and defibrillators carries the highest risk of infection in interventional electrophysiology. The use of implantable cardiac devices is continually increasing with almost 2 million devices implanted worldwide each year. The recipients' profile may also be associated with an increased risk of infection. Several measures can be implemented to reduce the risk of device-related infection. Systematic antibiotic prophylaxis has proven to be beneficial provided that prescription modalities are respected, especially with respect to the selection of the appropriate molecule and timing of administration prior to the procedure. Despite all the precautions taken during surgery (asepsis, prophylactic antibiotic therapy….) the estimated rate of peri-procedural infection is around 2%. Device related infections are associated with a high rate of morbidity and mortality as well as substantial healthcare costs. Staphylococcus aureus (SA) and epidermidis (SE) are the pathogenic agents involved in most cases. Prevention is crucial given the difficulties in treating such infections because of the near-systematic need to remove the device and antibiotic resistance. Leadless pacemakers and subcutaneous defibrillators are potential alternatives to implantable endocardial devices, albeit with certain limitations. A group of experts has recently issued consensus paper on the prevention, diagnosis and treatment of infections associated with endocardial implantable cardiac devices.
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Affiliation(s)
- S Younsi
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - P Chemaly
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - L Fiorina
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - J Horvilleur
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - J Lacotte
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - V Manenti
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - C Raimondo
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - F Salerno
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - M Ait Said
- ICPS Jacques Cartier, Ramsay Générale de Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France.
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Castan B, Brun JL, Stahl JP, Martin C, Mercier F, Fritel X, Agostini A. [Prevention of postoperative or associated of care pelvic inflammatory diseases. Is there a need for antibiotic prophylaxis for first trimester surgical-induced abortion to prevent pelvic inflammatory diseases? CNGOF good practice points]. Gynecol Obstet Fertil Senol 2020; 48:646-648. [PMID: 32590078 DOI: 10.1016/j.gofs.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Antibiotic prophylaxis is not recommended during surgical induced abortions. Systematic screening for Chlamydia trachomatis and Neisseria gonorrheae infection by polymerase chain reaction (PCR) on a vaginal sample is recommended before any surgical abortion. Moreover, the bacteriological result should be available before the abortion so that antibiotic treatment effective against the identified bacteria, if any, can be proposed before the procedure. The absence of bacteriological result on the day of the abortion must not, however, delay the procedure. If screening is positive for a sexually transmitted infection (STI), and the bacteriological result is only available after the abortion, it is recommended that antibiotic treatment start as soon as possible. The first-line antibiotic treatment is ceftriaxone 500mg in a single dose by the intramuscular route for N. gonorrheae, doxycycline 200mg per day orally for 7 days for C. trachomatis and azithromycin 500mg the first day (D1) then 250mg per day from D2 to D4 orally if Mycoplasma genitalium is detected by multiplex PCR. In case of positive screening, antibiotic treatment of the woman's partner(s) is recommended, adapted to the STI agent(s).
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Affiliation(s)
- B Castan
- Service des maladies infectieuses et tropicales, centre hospitalier de Périgueux, 24000 Périgueux, France
| | - J-L Brun
- Service de chirurgie gynécologique, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France.
| | - J-P Stahl
- Service des maladies infectieuses et tropicales, hôpital Michallon, CHU de Grenoble, 38043 Grenoble, France
| | - C Martin
- Service d'anesthésie-réanimation, hôpital Nord, AP-HM, 13020 Marseille, France
| | - F Mercier
- Service d'anesthésie-réanimation, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - X Fritel
- Service de gynécologie obstétrique, hôpital de la Milétrie, CHU de Poitiers, 86000 Poitiers, France
| | - A Agostini
- Service de gynécologie obstétrique, hôpital de la Conception, AP-HM, 13005 Marseille, France
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El Ouadih Y, Vernhes J, Mulliez A, Berton Q, Al Gahatany M, Traore O, Khalil T, Lemaire JJ. Postoperative empyema following chronic subdural hematoma surgery: Clinically based medicine. Neurochirurgie 2020; 66:365-368. [PMID: 32861684 DOI: 10.1016/j.neuchi.2020.06.132] [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: 04/10/2020] [Revised: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Subdural empyema (SDE) is a rare complication of chronic subdural hematoma (CSDH) surgery. We introduced antibiotic prophylaxis (AP) for this procedure in 2014 following a morbidity-mortality conference (MMC) in our department. We report the results of retrospective data analysis to assess the effect of systematic AP and to identify risk factors for SDE. MATERIAL AND METHODS Two hundred eight patients were recruited between January 2013 and December 2015; 5 were excluded for incomplete data: 107 without and 96 with AP (n=203). SDE was confirmed by clinical examination, imaging and bacteriological analysis. Comparisons between AP-(no cefuroxime) and AP+ (cefuroxime) groups were made with Chi2 test and Student's t-test. RESULTS One empyema was found in each group, indicating that AP had no effect (P=1). The only criterion associated with SDE for these two patients was a greater number of reoperations for CSDH recurrence (P=0.013). DISCUSSION The incidence of postoperative empyema was 1%, similar to the range of 0.2%-2.1% reported in the literature. This rare incidence explains why we found no significant effect of AP. The medical decision taken at the MMC did not help to reduce the rate of postoperative SDE. MMCs can help to define factors associated with adverse surgical events and identify opportunities for improvement. CONCLUSION AP, introduced after an MMC, did not impact SDE rates. In practice, AP should be required only in case of reoperation for CSDH recurrence. However, we still continue to use AP following the MMC considering different parameters discussed in the manuscript.
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Affiliation(s)
- Y El Ouadih
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France; SIGMA Clermont, CNRS, Clermont-Ferrand, France.
| | - J Vernhes
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - A Mulliez
- Service de biostatistiques, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Q Berton
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Al Gahatany
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - O Traore
- Service d'hygiène hospitalière, CHU de Clermont Ferrand, Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France; SIGMA Clermont, CNRS, Clermont-Ferrand, France
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Bey E, Vallée M, Bruyère F; les membres du CIAFU. [Evaluation of French practices in 2019 regarding prevention and treatment of urinary tract infections related to ureteral stent]. Prog Urol 2020; 30:261-6. [PMID: 32234420 DOI: 10.1016/j.purol.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/15/2019] [Accepted: 02/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Urological recommendations never focused on prevention and treatment of urinary tract infections related to endo-ureteral material. METHODS We conducted an evaluation of French professional practices in May 2019 in the aim of highlighting the important heterogeneity of practices using a Survey Monkey inquiry. RESULTS One-hundred-and-seventy-five urologists answered the inquiry, as to say 13% of French urologists. Questions regarding the management of pre-surgical polymicrobial urine sample, medical and surgical management of pyelonephritis on endo-ureteral material and regarding the need to diagnose and treat asymptomatic bacteriuria before endo-ureteral stent removal are the main points a majority of French urologists felt uncomfortable with. CONCLUSION This study evaluated French practices in 2019. The diversity of the answers highlights the need for new recommendations on these subjects of daily practice. Future recommendations should allow their homogenization based on the existing evidence-based data.
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Ramon A, Correia N, Smati M, Malinovsky JM, Bajolet O, Reynaud JP, Perrot P, Bodin F, Francois C. [Proposal of guidelines for antibiotic prophylaxis in plastic, reconstructive, and aesthetic surgery]. ANN CHIR PLAST ESTH 2019; 65:13-23. [PMID: 31831208 DOI: 10.1016/j.anplas.2019.10.001] [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] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In plastic surgery, guidelines about antibiotic prophylaxis are inaccurate and incomplete, due to result the absence of high-level studies on this subject. The main aim is to establish national common recommendations for plastic surgery antibiotic prophylaxis. MATERIALS AND METHODS A working group will discuss and validate a multi-center analysis of practices in three University Hospital Centers compared to an interdisciplinary analysis of recommendations to the French Society of Anaesthesia and Intensive Care Medicine and scientific literature. This working group is composed of plastic surgeon members of the French Society of Aesthetic Reconstructive Plastic Surgery, infectious disease physicians, and anaesthesiologists to define clear and precise antibiotic prophylaxis recommendations. RESULTS Antibiotic prophylaxis with cefazoline (or clindamycine±gentamicine in case of allergy), has been recommended for general surgery with flap or implants, for breast surgery, lipofilling, and rhinoplasty. In other plastic surgery, no antibiotic prophylaxis has been recommended. CONCLUSION We established common recommendations for plastic surgery antibiotic prophylaxis that is the first step to update these recommendations. Now, they can be evaluated in clinical situation to validate them.
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Affiliation(s)
- A Ramon
- Chirurgie plastique, reconstructrice et esthétique, hôpital maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - N Correia
- Chirurgie plastique, reconstructrice et esthétique, hôpital maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - M Smati
- Anesthésie et réanimation, hôpital Maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - J M Malinovsky
- Anesthésie et réanimation, hôpital Maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - O Bajolet
- Équipe opérationnelle d'hygiène, hôpital Maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France
| | - J P Reynaud
- Chirurgie plastique reconstructrice et esthétique, Le jardin du centre - Bât A, 60, rue de l'Acropole, 34000 Montpellier, France
| | - P Perrot
- Chirurgie plastique reconstructrice et esthétique, Hôtel-Dieu, CHU Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Bodin
- Chirurgie plastique, reconstructrice et esthétique, hôpital de Hautepierre, CHU Strasbourg, avenue Molière, 67200 Strasbourg, France
| | - C Francois
- Chirurgie plastique, reconstructrice et esthétique, hôpital maison Blanche, CHU Reims, 45, rue Cognacq Jay, 51100 Reims, France.
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Bouchghoul H. [Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Initial Management]. ACTA ACUST UNITED AC 2020; 48:24-34. [PMID: 31669523 DOI: 10.1016/j.gofs.2019.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate safety of home care, clinical and biological initial examination and effectiveness of prophylactic antibiotic in preventing maternal and neonatal infectious complications in women with term prelabor rupture of membranes. MATERIALS AND METHODS The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS In case of expectant management and low rate of antibiotic prophylaxis coverage, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially when colonized with Group B Streptococcus (GBS) (LE3). Home care is therefore not recommended (Grade C). Studies investigating the initial clinical-biological examination are sparse. The initial examination should search for signs of intra-uterine infection. Repeated digital examination before and during labor is associated with an increased risk of intra-uterine infection (LE3). It is therefore recommended to limit the number of digital examinations before and during labor (Grade C). A GBS-positive vaginal swab is strongly associated with the risk of intra-uterine and neonatal infection (LE3) independently of the type management (induction vs. expectant management) and the mode of induction (oxytocin or prostaglandin) (LE3). When the GBS-positive vaginal swab has not been performed between 34 and 38 weeks, it is recommended to perform it on admission (Professional consensus). The diagnostic performance of the CRP and white blood cell count for the prediction of neonatal infection is low (LE3). If these tests are used, the negative predictive value of the CRP should be preferred (Professional consensus). In case of term prelabor rupture of membranes after 12hours, prophylactic antibiotics could reduce the rate of intra-uterine infection without reducing the risk of neonatal infection (LE3). Their use in term prelabor rupture of membranes after 12hours is therefore recommended (Grade C). When prophylactic antibiotics are indicated, intravenous beta-lactamine is the preferred option (Grade C). CONCLUSION Overall, the current data on initial management of term prelabor rupture of membranes are of low evidence level.
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Ze Ondo C, Pescheloche P, Bessede T, Parier B, Lebacle C, Irani J. [Is it necessary to perform urine culture systematically prior to double J ureteral stent removal?]. Prog Urol 2019; 29:504-509. [PMID: 31387836 DOI: 10.1016/j.purol.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the value of systematic urine culture before ureteric double j removal. MATERIAL AND METHODS This prospective audit was performed to assess the validity of our current clinical practice. A cohort of informed patients without clinical signs of urinary tract infection and without predefined risk factors were programmed for ureteral double j stent removal in an outpatient setting. Urine was sampled for culture immediately before the procedure. Patients had to complete a self-questionnaire 15 days following stent removal, inquiring about tolerance and complications which were to be analyzed according to the culture results. The primary endpoint was the occurrence of febrile urinary tract infection. RESULTS Among the 56 participants, immediate preoperative urine culture revealed colonization in 9 patients (16.1%) and contamination in 6 patients (10.7%). A significant association was found between bacteriuria and double j placement following surgery with urinary tract injury (P<0.02) and diabetes (P<0.009). Two patients had fever including a man with sterile urine and a woman with Staphylococcus Aureus infection. No hospitalization was necessary. Twelve patients reported functional signs with lumbar pain being the most common. There was no significant association between functional signs and patients' clinical characteristics. CONCLUSION This evaluation was not in favor of modifying our protocol of care i.e. the lack of performing neither antibiotic prophylaxis nor systematic urine culture before JJ ureteral stent removal in a selected population. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Ze Ondo
- Service d'urologie du CHU Aristide-Le Dantec, Dakar, Sénégal.
| | - P Pescheloche
- Service d'urologie du CHU Bicetre, Le Kremlin-Bicêtre, France
| | - T Bessede
- Service d'urologie du CHU Bicetre, Le Kremlin-Bicêtre, France
| | - B Parier
- Service d'urologie du CHU Bicetre, Le Kremlin-Bicêtre, France
| | - C Lebacle
- Service d'urologie du CHU Bicetre, Le Kremlin-Bicêtre, France
| | - J Irani
- Service d'urologie du CHU Bicetre, Le Kremlin-Bicêtre, France
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Lauda-Maillen M, Catroux M, Grosset M, Caumes E, Cazenave-Roblot F. [Antibiotic prophylaxis and recurrent non-necrotizing cellulitis of the male external genitalia]. Med Mal Infect 2019; 49:627-9. [PMID: 31375374 DOI: 10.1016/j.medmal.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
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Castan B. [Prevention of postoperative or associated of care pelvic inflammatory diseases: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:451-457. [PMID: 30858077 DOI: 10.1016/j.gofs.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 10/27/2022]
Abstract
Numerous prophylactic antibiotic regimens (PBR) have been evaluated particularly in surgical abortion, hysterosalpingography or caesarean section, but few randomized comparative trials are available. Recommendations for PBR should take into account, expected and demonstrated benefits that reduce the risk of surgical site infection, but also the impact on the microbiota, the risk of bacterial resistance selection, and the overall cost to the community. In addition, antibiotic prophylaxis is not the only one factor to reduce the risk of surgical site infection, such as preventive measures and good hygiene practices.
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Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, hôpital Eugénie, boulevard Rossini, 20000 Ajaccio, France; Coordinateur du groupe des recommandations de la Société de pathologie infectieuse de langue française (SPILF), 21, rue Beaurepaire, 75010 Paris, France.
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Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet JC, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar JR, Caron F, Hermieu JF. [Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. Prog Urol 2018; 28:943-952. [PMID: 30501940 DOI: 10.1016/j.purol.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Egrot
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Dinh
- Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, centre hospitalier régional Bretonneau, 37000 Tours, France
| | - G Birgand
- Centre de prévention des infections associées aux soins, CHU de Nantes, 5, rue du Pr-Boquien, 44000 Nantes, France
| | - F Bruyère
- Service d'urologie, centre hospitalier régional universitaire de Tours, 37000 Tours, France
| | - E Chartier-Kastler
- Médecine Sorbonne Université, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - M Cosson
- Laboratoire BioTIM, école centrale de Lille, université de Lille, CHU de Lille, 59000 Lille, France
| | - X Deffieux
- Service de gynécologie obstétrique, université Paris-Sud, hôpital Antoine-Béclère, groupe hospitalier Sud, AP-HP, 92140 Clamart, France
| | - P Denys
- Service de neuro-urologie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - M Etienne
- Service de maladies infectieuses et tropicales, hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - B Fatton
- Unité d'urogynécologie, groupe hospitalier Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 86000 Poitiers, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - C Lawrence
- Service microbiologie et hygiène, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - L Lenormand
- Service d'urologie, centre fédératif de pelvipérinéologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France
| | - D Lepelletier
- Service bactériologie et hygiène hospitalière, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-C Lucet
- Service de bactériologie, hygiène, virologie, parasitologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - E Marit Ducamp
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - C Pulcini
- Infectious Diseases Department, université de Lorraine, APEMAC, CHRU de Nancy, 54000 Nancy, France
| | - G Robain
- Service de rééducation neurologique, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, CHRU de Lille, 59200 Tourcoing, France
| | - M de Sèze
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex, France
| | - J-R Zahar
- Département de microbiologie, hôpital Avicenne, AP-HP, groupe hospitalier Paris-Seine-Saint-Denis, 93000 Bobigny, France; Unité de recherche Inserm 1137, IAME, université Paris-13, 93000 Bobigny, France
| | - F Caron
- Service des maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - J-F Hermieu
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Schmitz T, Sentilhes L, Lorthe E, Gallot D, Madar H, Doret-Dion M, Beucher G, Charlier C, Cazanave C, Delorme P, Garabedian C, Azria É, Tessier V, Senat MV, Kayem G. [Preterm premature rupture of membranes: CNGOF Guidelines for clinical practice - Short version]. ACTA ACUST UNITED AC 2018; 46:998-1003. [PMID: 30392986 DOI: 10.1016/j.gofs.2018.10.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine management of women with preterm premature rupture of membranes (PPROM). METHODS Bibliographic search from the Medline and Cochrane Library databases and review of international clinical practice guidelines. RESULTS In France, PPROM rate is 2 to 3% before 37 weeks of gestation (level of evidence [LE] 2) and less than 1% before 34 weeks of gestation (LE2). Prematurity and intra-uterine infection are the two major complications of PPROM (LE2). Compared to other causes of prematurity, PPROM is not associated with an increased risk of neonatal mortality and morbidity, except in case of intra-uterine infection, which is associated with an augmentation of early-onset neonatal sepsis (LE2) and of necrotizing enterocolitis (LE2). PPROM diagnosis is mainly clinical (professional consensus). In doubtful cases, detection of IGFBP-1 or PAMG-1 is recommended (professional consensus). Hospitalization of women with PPROM is recommended (professional consensus). There is no sufficient evidence to recommend or not recommend tocolysis (grade C). If a tocolysis should be prescribed, it should not last more than 48hours (grade C). Antenatal corticosteroids before 34 weeks of gestation (grade A) and magnesium sulfate before 32 weeks of gestation (grade A) are recommended. Antibiotic prophylaxis is recommended (grade A) because it is associated with a reduction of neonatal mortality and morbidity (LE1). Amoxicillin, 3rd generation cephalosporins, and erythromycin in monotherapy or the association erythromycin-amoxicillin can be used (professional consensus), for 7 days (grade C). However, in case of negative vaginal culture, early cessation of antibiotic prophylaxis might be acceptable (professional consensus). Co-amoxiclav, aminosides, glycopetides, first and second generation cephalosporins, clindamycin, and metronidazole are not recommended for antibiotic prophylaxis (professional consensus). Outpatient management of women with clinically stable PPROM after 48hours of hospitalization is a possible (professional consensus). During monitoring, it is recommended to identify the clinical and biological elements suggesting intra-uterine infection (professional consensus). However, it not possible to make recommendation regarding the frequency of this monitoring. In case of isolated elevated C-reactive protein, leukocytosis, or positive vaginal culture in an asymptomatic patient, it is not recommended to systematically prescribe antibiotics (professional consensus). In case of intra-uterine infection, it is recommended to immediately administer an antibiotic therapy associating beta-lactamine and aminoside (grade B), intravenously (grade B), and to deliver the baby (grade A). Cesarean delivery should be performed according to the usual obstetrical indications (professional consensus). Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A), even in case of positive vaginal culture for B Streptococcus, provided that an antibiotic prophylaxis has been prescribed (professional consensus). Oxytocin and prostaglandins are two possible options to induce labor in case of PPROM (professional consensus). CONCLUSION Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A).
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Affiliation(s)
- T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - E Lorthe
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; EPIUnit-Institute of Public Health, University of Porto, Rua das Taipas, n(o) 135, 4050-600 Porto, Portugal
| | - D Gallot
- Pôle femme et enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - H Madar
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - M Doret-Dion
- Service de gynécologie obstétrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France
| | - C Charlier
- Service des maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, AP-HP, Paris, France; Université Paris Descartes, 75005 Paris, France; Centre d'infectiologie Necker-Pasteur, Institut IMAGINE, 75015 Paris, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Infections humaines à mycoplasmes et à chlamydiae, université de Bordeaux, USC EA 3671, 33000 Bordeaux, France
| | - P Delorme
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Université Paris Descartes, 75005 Paris, France; DHU risques et grossesse, maternité Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France
| | - C Garabedian
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France; Université de Lille, EA 4489-environnement périnatal et croissance, 59000 Lille, France
| | - É Azria
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Université Paris Descartes, 75005 Paris, France; Maternité Notre Dame de Bon Secours, DHU risques et grossesse, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - V Tessier
- DHU risques et grossesse, maternité Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Collège national des sages-femmes de France, 136, avenue Emile-Zola, 75015 Paris, France
| | - M-V Senat
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - G Kayem
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Service de gynécologie obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
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Doret Dion M, Cazanave C, Charlier C. [Antibiotic prophylaxis in preterm premature rupture of membranes: CNGOF preterm premature rupture of membranes guidelines]. ACTA ACUST UNITED AC 2018; 46:1043-53. [PMID: 30392988 DOI: 10.1016/j.gofs.2018.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyse benefits and risks of antibiotic prophylaxis in the management of preterm premature rupture of membranes. METHODS PubMed and Cochrane Central databases search. RESULTS Streptoccoccus agalactiae (group B streptococcus) and Escherichia coli are the two main bacteria identified in early neonatal sepsis (EL3). Antibiotic prophylaxis at admission is associated with significant prolongation of pregnancy (EL2), reduction in neonatal morbidity (EL1) without impact on neonatal mortality (EL2). Co-amoxiclav could be associated with an increased risk for neonatal necrotising enterocolitis (EL2). Antibiotic prophylaxis at admission in women with preterm premature rupture of the membranes is recommended (Grade A). Monotherapy with amoxicillin, third generation cephalosporin and erythromycin can be used as well as combination of erythromycin and amoxicillin (Professional consensus) for 7 days (GradeC). Shorter treatment is possible when initial vaginal culture is negative (Professional consensus). Co-amxiclav, aminoglycosides, glycopeptides, first and second generation cephalosporin, clindamycin and metronidazole are not recommended (Professional consensus). CONCLUSIONS Antibiotic prophylaxis against Streptoccoccus agalactiae (group B streptococcus) and E. coli is recommended in women with preterm premature of the membranes (Grade A). Monotherapy with amoxicillin, third generation cephalosporin or erythromycin, as well as combination of erythromycin and amoxicillin are recommended (Professional consensus).
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Duboureau H, Achkar K, Stephan R, Schmit JL, Saint F. [Ecology and fluoroquinolon resistance profiles in febrile urinary tract infections (FUTI) after prostate needle biopsy: A retrospective study in 466 biopsies]. Prog Urol 2017; 27:345-350. [PMID: 28478906 DOI: 10.1016/j.purol.2017.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/12/2017] [Accepted: 03/31/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The biopsies of prostate are the reference examination to assert the diagnosis of prostate cancer. Even if the urinary infectious complications are rare thanks to the systematic oral antibiotic prophylaxis, they may still be serious. The SPILF (Society of Infectious Pathology and French language) published in 2014, an important increase of the resistances in fluoroquinolones for Escherichia coli (3 to 25%), whereas this is the most bacterium frequently found in the urinary infections (70-80%). The objectives of this study were to estimate the indicence of the febrile urinary tract infections after prostate needle biopsy and to define the ecology and the profile of E. coli's resistance. METHODS A total of 466 transrectal ultrasound-guided needle prostate biopsy were included in the study from 2012 to 2015. All the patients were taken care according to the recommendations of the AFU (Ouzzane et al., 2011). We estimated, for all the inclusive patients, if they had presented a clinic sign of urinary infection like fever or burning which suggestive of an urinary infection, and having a urines and blood culture, in the next 30 days the realization of the medical exam. RESULTS Among 466 realized biopsies, seven patients developed a febril urinary tract infection (1.5%) [prostatitis (n=6), orchitis (n=1)]. Five infections to E. coli were identified; two were resistant for fluoroquinolones (40%). No germ was able to be identified for two patients. CONCLUSION The infectious complications post-biopsy of prostate are rare (1.5%). E. coli is the germ most frequently identified with 40% of resistance with fluoroquinolones. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- H Duboureau
- Service d'urologie, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Service de pathologie infectieuse, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - K Achkar
- Service d'urologie, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - R Stephan
- Laboratoire de biologie, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - J L Schmit
- Centre hospitalier de Creil, 61000 Creil, France; Service de pathologie infectieuse, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - F Saint
- Service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue René-Laënnec, 80480 Salouël-Amiens, France; Laboratoire HeRVI (EA3801), université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Biobanque de Picardie, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France.
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Khlifi A, Kouira M, Bannour I, Hachani F, Kehila M, Ferhi F, Bouslama A, Ben Jazia K, Fekih M, Khairi H. [What's the optimal time of cesarean section antibiotic prophylaxis, before skin incision or after umbilical cord clamping? A prospective randomized study]. ACTA ACUST UNITED AC 2016; 45:1133-43. [PMID: 27212612 DOI: 10.1016/j.jgyn.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the effect of antibiotics prophylaxis within 30 mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital. MATERIALS AND METHODS We conducted a randomised clinical trial evaluating 279 patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol® 2g) according to their allotment. They were followed up to detect infection up to 30 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version 18.0 using univariate and bivariate analysis. RESULTS The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37 % (A) vs 9.85 % (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2 % [A] vs 8.45 % [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features. CONCLUSIONS Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections.
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Ramel JC, Bron AM, Isaico R, Meillon C, Binquet C, Creuzot-Garcher C. [Incidence of endophthalmitis after intravitreal injection: is antibioprophylaxis mandatory?]. J Fr Ophtalmol 2014; 37:273-9. [PMID: 24655790 DOI: 10.1016/j.jfo.2014.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Endophthalmitis is the most dreaded complication after intravitreal injection. With the rise of antiangiogenics their rate is getting higher each year. The use of antibioprophylaxis is controversial. We tried to evaluate the impact of antibioprophylaxis on intravitreal injection endophthalmitis incidence. METHODS All patients who received intravitreal injections between January 2007 and October 2012 were included in this retrospective study. Until June 2012 all patients had antibiotics the days following the injection. From July 2012 the antibiotic was replaced by an antiseptic immediately after the injection. RESULTS An overall number of 11,450 injections were performed. The overall rate of endophthalmitis was 6/11,450 (0.052%). The incidence of endophthalmitis in the group with antibiotics was 3/10,144 injections (0.03%), 2 were culture proven (0.02%). The incidence in the group without antibiotics was 3/1306 (0.23%). The difference was significant (P=0.024). CONCLUSION The incidence of endophthalmitis post-intravitreal injections seems to be lower when using antibiotics. However, a prospective study is mandatory to draw more robust conclusions.
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Affiliation(s)
- J-C Ramel
- Service d'ophtalmologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France
| | - A-M Bron
- Service d'ophtalmologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France
| | - R Isaico
- Service d'ophtalmologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France
| | - C Meillon
- Service d'ophtalmologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France
| | - C Binquet
- Service d'épidémiologie, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, hôpital Général, CHU de Dijon, 3, rue du Faubourg-Raines, 21000 Dijon, France.
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Pitak-Arnnop P, Pausch NC, Dhanuthai K, Neff A. Oral amoxicillin as antibiotic prophylaxis before dental surgery - "Faux pas" or "dernier cri"? ACTA ACUST UNITED AC 2013; 114:338-40. [PMID: 23992886 DOI: 10.1016/j.revsto.2013.07.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 07/08/2013] [Indexed: 11/18/2022]
Affiliation(s)
- P Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, Research Group for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany.
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