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Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Exclusive Oral Antibiotic Treatment for Hospitalized Community-Acquired Pneumonia: A Post-Hoc Analysis of a Randomized Clinical Trial. Clin Microbiol Infect 2024:S1198-743X(24)00237-4. [PMID: 38734138 DOI: 10.1016/j.cmi.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). METHODS In this post-hoc analysis of a RCT on patients hospitalized for CAP (PTC trial) comparing 3-day versus 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). Choice of route and molecule was left to the physician in charge. The main outcome was failure at 15 days after first antibiotic intake, defined as temperature>37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to route of administration was evaluated through logistic regression. Inverse probability treatment weighting (IPTW) with a propensity score model was used to adjust for non-randomization of treatment route and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC versus 3GC treatments, or intravenous versus oral AMC, patients with multi-lobar infection, patients aged ≥ 65 years old, and patients with CURB65 scores of 3-4). RESULTS We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. Failure rate at Day 15 was not significantly different among patients treated with initial intravenous versus oral treatment (25/93 (26.9%) versus 28/107 (26.2%), aOR 0.973 (95%CI 0.519-1.823), p=0.932). Failure rates at Day 15 were not significantly different among the subgroup populations. CONCLUSIONS Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT01963442.
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Affiliation(s)
- Aurélien Dinh
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France; Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France.
| | - Clara Duran
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, APHP, Paris, France
| | - Frédérique Bouchand
- Pharmacy department, Raymond-Poincaré University Hospital, APHP Paris Saclay, Garches, France
| | - Laurène Deconinck
- Infectious disease department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious disease department, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | | | - Guillaume Mellon
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal medicine, Lariboisière University Hospital, APHP, Paris, France
| | | | - Daniel Benhamou
- Pneumology department, Rouen University Hospital, Rouen, France
| | | | | | - Bertrand Renaud
- Emergency department, Cochin University Hospital, APHP, Paris, France
| | | | - José Labarère
- Quality of care unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Chaytee J, Dinh A, D’Anglejan E, Bouchand F, Jaffal K, Duran C, Le Gall C. Digital health for remote home monitoring of patients with COVID-19 requiring oxygen: a cohort study and literature review. Front Med (Lausanne) 2024; 10:1255798. [PMID: 38356737 PMCID: PMC10864516 DOI: 10.3389/fmed.2023.1255798] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/31/2023] [Indexed: 02/16/2024] Open
Abstract
Background The clinical course and outcome of COVID-19 vary widely, from asymptomatic and mild to critical. Elderly patients and patients with comorbidities are at increased risk of respiratory failure and oxygen requirements. Due to the massive surge, the pandemic has created challenges for overwhelmed hospitals. Thus, the original home management of COVID-19 patients requiring oxygen and remote monitoring by a web app and a nurse at home were implemented in our center. We aimed to evaluate the outcome of patients with COVID-19 requiring oxygen who benefited from home remote monitoring management. Methods We performed a retrospective cohort study on all COVID-19 patients requiring oxygen (< 5 L/min) who consulted from October 2020 to April 2021 at our emergency department and were managed with home remote monitoring by a web app and an in-home nurse. We also carried out a literature review of studies on COVID-19 patients requiring oxygen with remote monitoring. Results We included 300 patients [184 (61.3%) male patients, median age 51 years]. The main comorbidities were cardiovascular disease (n = 117; 39.0%), diabetes mellitus (n = 72; 24.0%), and chronic respiratory disease (n = 32; 10.7%). Among the 28 (9.3%) patients readmitted to the hospital, 6 (1.9%) were hospitalized in the intensive care unit, and 3 (0.9%) died. In the multivariable analysis, risk factors for unplanned hospitalization were chronic respiratory failure (odds ratio (OR) =4.476, 95%CI 1.565-12.80), immunosuppression (OR = 3.736, 95%CI 1.208-11.552), and short delay between symptoms onset and start of telemonitoring (OR = 0.744, 95%CI 0.653-0.847). In the literature review, we identified seven other experiences of remote monitoring management. Mortality rate and unplanned hospitalization were low (maximum 1.9 and 12%, respectively). Conclusion Our study confirms the safety of home remote monitoring of patients with COVID-19 who require oxygen, as well as our literature review. However, patients with chronic respiratory failure and immunosuppression should be closely monitored.
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Affiliation(s)
- Johann Chaytee
- Emergency Department, Victor Dupouy Hospital, Argenteuil, France
| | - Aurélien Dinh
- Infectious Disease Department, Raymond-Poincaré Hospital, AP-HP Paris Saclay University, Garches, France
| | - Emma D’Anglejan
- Infectious Disease Department, Raymond-Poincaré Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond-Poincaré Hospital, AP-HP Paris Saclay University, Garches, France
| | - Karim Jaffal
- Infectious Disease Department, Raymond-Poincaré Hospital, AP-HP Paris Saclay University, Garches, France
| | - Clara Duran
- Infectious Disease Department, Raymond-Poincaré Hospital, AP-HP Paris Saclay University, Garches, France
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Dinh A, D'anglejan E, Leliepvre H, Bouchand F, Marmouset D, Dournon N, Mascitti H, Genet F, Herrmann JL, Chaussard H, Duran C, Noussair L. Short Antibiotic Treatment Duration for Osteomyelitis Complicating Pressure Ulcers: A Quasi-experimental Study. Open Forum Infect Dis 2023; 10:ofad088. [PMID: 36923117 PMCID: PMC10009872 DOI: 10.1093/ofid/ofad088] [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: 01/11/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Background Osteomyelitis-complicating pressure ulcers are frequent among patients with spinal cord injuries (SCIs), and the optimal management is unknown. In our referral center, the current management is debridement and flap coverage surgeries, followed by a short antibiotic treatment. We aimed to evaluate patients' outcomes a year after surgery. Methods We performed a quasi-experimental retrospective before/after study on SCI patients with presumed osteomyelitis associated with perineal pressure ulcers. We included all patients who underwent surgery with debridement and flap covering, followed by effective antibiotic treatment, between May 1, 2016, and October 30, 2020. The effective antimicrobial treatment duration included the 10 days leading up to January 1, 2018 (before period), and the 5 to 7 days after (after period). We also compared the efficacy of 5-7-day vs 10-day antibiotic treatment and performed uni- and multivariable analyses to identify factors associated with failure. Results Overall, 415 patients were included (77.6% male patients; mean age ± SD, 53.0 ± 14.4 years). Multidrug-resistant organisms (MDROs) were involved in 20.7% of cases. Favorable outcomes were recorded in 69.2% of cases: 117/179 (65.3%) in the 10-day treatment group vs 169/287 (71.9%) in the 5-7-day treatment group (P = .153). The only factor associated with failure in the multivariate analysis was a positive culture from suction drainage (odds ratio, 1.622; 95% CI, 1.005-2.617; P = .046). Effective treatment duration >7 days and intraoperative samples negative for MDROs were not associated with better outcomes (P = .153 and P = .241, respectively). Conclusions A treatment strategy combining surgical debridement and flap covering, followed by 5 to 7 days of effective antibiotic treatment seems safe.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Emma D'anglejan
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Helene Leliepvre
- Physical Medicine and Rehabilitation, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Frédérique Bouchand
- Pharmacy, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Damien Marmouset
- Orthopaedics Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Nathalie Dournon
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Hélène Mascitti
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - François Genet
- Physical Medicine and Rehabilitation, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Jean-Louis Herrmann
- Microbiological Laboratory, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Haude Chaussard
- Orthopaedics Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Clara Duran
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Latifa Noussair
- Microbiological Laboratory, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
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Jaffal K, Bouchand F, Lawrence C, Mascitti H, Duran C, Annane D, Dinh A. Antibiotic Consumption and Bacterial Resistance Rates in Hospitalized COVID-19 Patients: A Retrospective Study During the 3 First Surges. Open Forum Infect Dis 2022; 10:ofac680. [PMID: 36628056 PMCID: PMC9825195 DOI: 10.1093/ofid/ofac680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
In our hospital, during COVID-19 pandemic, overall consumption of antibiotics increased during the three first surges, mainly due to ICU prescription However, antibiotic consumption decreased in the Infectious Diseases Department. Rates of ESBL Enterobacterales remained stable.
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Affiliation(s)
- Karim Jaffal
- Infectious Disease Department, University Hospital Raymond-Poincaré, Paris Saclay University, Assistance Publique–Hôpitaux de Paris, Garches, France
| | - Frédérique Bouchand
- Pharmacy, University Hospital Raymond-Poincaré, Paris Saclay University, Assistance Publique–Hôpitaux de Paris, Garches, France
| | - Christine Lawrence
- Microbiological Department, University Hospital Raymond-Poincaré, Paris Saclay University, Assistance Publique–Hôpitaux de Paris, Garches, France
| | - Hélène Mascitti
- Infectious Disease Department, University Hospital Raymond-Poincaré, Paris Saclay University, Assistance Publique–Hôpitaux de Paris, Garches, France
| | - Clara Duran
- Infectious Disease Department, University Hospital Raymond-Poincaré, Paris Saclay University, Assistance Publique–Hôpitaux de Paris, Garches, France
| | - Djillali Annane
- Intensive Care Unit, University Hospital Raymond-Poincaré, Paris Saclay University, Assistance Publique–Hôpitaux de Paris, Garches, France
| | - Aurélien Dinh
- Correspondence: Aurélien Dinh, MD, PhD, Infectious Disease Department, University Hospital Raymond-Poincaré, AP-HP Paris Saclay University, 104 Bd R. Poincaré, 92380 Garches, France ()
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Dinh A, Massol J, Duran C, Bouchand F, Dortet L. Le céfidérocol. Méd Intensive Réa 2022. [DOI: 10.37051/mir-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Le céfidérocol intraveineux commercialisé sous le nom de Fetcroja® est la première céphalosporine de type sidérophore mise sur le marché. Elle a été approuvée pour le traitement des infections sévère à Bacille Gram négatif (BGN) résistant lorsque les options thérapeutiques sont limitées selon l’HAS. En effet, in vitro, le céfidérocol est stable vis-à-vis des 4 types de β-lactamase de la classification d’Ambler, y compris les métallo-β-lactamases, et démontre une excellente activité vis-à-vis de la plupart des BGN, y compris les souches multi-résistantes.
Dans divers essais randomisés réalisés en double aveugle, le céfiderocol a montré une non- infériorité par rapport à l'imipenème/cilastatine pour le traitement des infections urinaires compliquées, et versus le méropénème au cours des pneumonies associées aux soins.
Au cours d'un essai s'intéressant uniquement aux pathogènes résistants aux carbapénèmes, le céfidérocol a montré une activité comparable au meilleur traitement disponible, mais un déséquilibre de mortalité dans le bras céfidérocol. Par ailleurs, le céfidérocol semble avoir une bonne tolérance et peu d'effets indésirables dans les essais randomisés.
Le céfidérocol est donc une nouvelle molécule attractive étant donné son spectre en particulier sur les BGN multi-résistants et représente une nouvelle option thérapeutique dans les situations complexes.
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Bessis S, Dinh A, Gautier S, Davido B, Levy J, Lawrence C, Lot AS, Bensmail D, Rech C, Farcy-Afif M, Bouchand F, de Truchis P, Herrmann JL, Barbot F, Orlikowski D, Moine P, Perronne C, Josseran L, Prigent H, Annane D. A Restructured Hospital Into a One-Building Organization for COVID-19 Patients: A Resilient and Effective Response to the Pandemic. Front Public Health 2022; 10:709848. [PMID: 35685762 PMCID: PMC9170938 DOI: 10.3389/fpubh.2022.709848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is a unique crisis challenging healthcare institutions as it rapidly overwhelmed hospitals due to a large influx of patients. This major event forced all the components of the healthcare systems to adapt and invent new workflows. Thus, our tertiary care hospital was reorganized entirely. During the cruising phase, additional staff was allocated to a one-building organization comprising an intensive care unit (ICU), an acute care unit, a physical medicine and rehabilitation unit, and a COVID-19 screening area. The transfer of patients from a ward to another was more efficient due to these organizations and pavilion structure. The observed mortality was low in the acute care ward, except in the palliative unit. No nosocomial infection with SARS-CoV-2 was reported in any other building of the hospital since this organization was set up. This type of one-building organization, integrating all the components for comprehensive patient care, seems to be the most appropriate response to pandemics.
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Affiliation(s)
- Simon Bessis
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Aurélien Dinh
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- *Correspondence: Aurélien Dinh
| | - Sylvain Gautier
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Public Health, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Benjamin Davido
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Jonathan Levy
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christine Lawrence
- Microbiology Laboratory and Hygiene, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne-Sophie Lot
- Department of Medical Informatics, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Djamel Bensmail
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Célia Rech
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Muriel Farcy-Afif
- Department of Pharmacy, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Frédérique Bouchand
- Department of Pharmacy, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre de Truchis
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Louis Herrmann
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Microbiology Laboratory and Hygiene, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Frédéric Barbot
- INSERM CIC1429, Clinical Investigation Center, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - David Orlikowski
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- INSERM CIC1429, Clinical Investigation Center, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Moine
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Intensive Care Unit, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christian Perronne
- Department of Infectious Diseases, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Loïc Josseran
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Public Health, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hélène Prigent
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Department of Physiology, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Djillali Annane
- UFR Simone Veil, Paris-Saclay University, Montigny-le-Bretonneux, France
- Intensive Care Unit, Raymond-Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
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Mascitti H, Dinh A, Duran C, Bouchand F, Tourte M, Rouveix E, Bourgault-Villada I. Risk factors for unplanned surgery among patients hospitalized for non-purulent cellulitis. Infect Dis Now 2022; 52:318-320. [DOI: 10.1016/j.idnow.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/21/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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Davido B, Saleh-Mghir A, Rottman M, Jaffal K, Salomon E, Bouchand F, Lawrence C, Bauer T, Herrmann JL, De Truchis P, Noussair L, Cremieux AC. Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area. Int J Antimicrob Agents 2021; 59:106497. [PMID: 34906675 DOI: 10.1016/j.ijantimicag.2021.106497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/05/2022]
Abstract
Antibiotic treatment of native osteomyelitis caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a challenge. Limited epidemiological and outcome data are available. This retrospective cohort study included osteomyelitis patients with ESBL-PE infections treated in a reference centre for bone and joint infections (BJIs) between 2011-2019. Twenty-nine patients with native BJI (mean age, 44.4 ± 15.7 years) were analysed. Fifteen cases were paraplegic patients with ischial pressure sores breaching the hip capsule. Other cases included eight other hip infections, four tibial infections and two foot infections. Infections were mostly polymicrobial (n = 23; 79.3%), including Staphylococcus aureus (n = 13; 8 methicillin-resistant). Klebsiella pneumoniae (n = 13) was the most frequent ESBL-producing species identified, followed by Escherichia coli (n = 10), including 3 E. coli/K. pneumoniae co-infections, and Enterobacter spp. (n = 9). ESBL-PE were rarely susceptible to fluoroquinolones (n = 4; 13.8%). Most therapies were based on carbapenems (n = 22) and combination therapies (n = 19). The median duration of treatment was 41 (5-60) days. Primary control of the infection was achieved in 62.1% (18/29) of cases and up to 86.2% after second look surgeries, after a median follow-up of 6 (1-36) months. Infection with ESBL-producing K. pneumoniae was associated with failure (P = 0.001), whereas age, infection location, prior colonisation and antimicrobial therapy were not found to be predictors of outcome. ESBL-PE native BJIs are often polymicrobial and fluoroquinolone-resistant infections caused by K. pneumoniae, highlighting the need for expert centres with pluridisciplinary meetings with experienced surgeons.
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Affiliation(s)
- B Davido
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France.
| | - A Saleh-Mghir
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - M Rottman
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - K Jaffal
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - E Salomon
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - F Bouchand
- Pharmacie Hospitalière, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - C Lawrence
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - T Bauer
- Service d'Orthopédie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - J L Herrmann
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - P De Truchis
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - L Noussair
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - A C Cremieux
- Service de Maladies Infectieuses, Université Paris Nord, Hôpital Saint-Louis, AP-HP, Paris, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
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Klezovich-Bénard M, Bouchand F, Rouveix E, Goossens PL, Davido B. Management and characteristics of patients suffering from Clostridiodes difficile infection in primary care. Eur J Gen Pract 2021; 27:320-325. [PMID: 34755587 PMCID: PMC8583832 DOI: 10.1080/13814788.2021.1998447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is rising and increases patient healthcare costs due to extended hospitalisation, tests and medications. Management of CDI in French primary care is poorly reported. Objectives To characterise patients suffering from CDI, managed in primary care and describe their clinical outcomes. Methods Retrospective observational study based on survey data among 500 randomly selected General Practitioners (GPs) surveyed in France from September 2018 to April 2019. GPs were asked to complete a multiple-choice questionnaire for each reported patient presenting a CDI. Responses were analysed according to clinical characteristics. Treatment strategies were compared according to the outcome: recovery or recurrent infection. Results Participation rate was 8.6% (n = 43/500) with two incomplete questionnaires. Data from 41 patients with an actual diagnosis of CDI were analysed. Recovery was observed in 61% of patients with a confirmed diagnosis of CDI. In the recovery group, this was exclusively a primary episode, most patients (72%) had no comorbidities, were significantly younger (p = 0.02) than the ones who relapsed and 92% were successfully treated with oral metronidazole. Duration of diarrhoea after antimicrobial treatment initiation was significantly shorter in the recovery group (≤ 48 h) (p = 0.03). Cooperation with hospital specialists was reported in 28% of the recovery group versus 87.5% of the recurrent group (p = 0.0003). Overall, GPs managed successfully 82.9% of cases without need of hospital admission. Conclusion GPs provide relevant ambulatory care for mild primary episodes of CDI using oral metronidazole. Persistent diarrhoea despite an appropriate anti-Clostridiodes regimen should be interpreted as an early predictor of relapse.
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Affiliation(s)
- Maria Klezovich-Bénard
- Département de Médecine Générale, l'Université de Versailles Saint Quentin en Yvelines, France
| | - Frédérique Bouchand
- Pharmacie Hospitalière, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Elisabeth Rouveix
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | | | - Benjamin Davido
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
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Dinh A, Duran C, Ropers J, Bouchand F, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Guillemot D, Renaud B, Claessens YE, Labarère J, Aegerter P, Bedos JP, Crémieux AC. Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2129566. [PMID: 34652445 PMCID: PMC8520128 DOI: 10.1001/jamanetworkopen.2021.29566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Failure of treatment is the most serious complication in community-acquired pneumonia (CAP). OBJECTIVE To assess the potential risk factors for treatment failure in clinically stable patients with CAP. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis assesses data from a randomized clinical trial on CAP (Pneumonia Short Treatment [PTC] trial) conducted from December 19, 2013, to February 1, 2018. Data analysis was performed from July 18, 2019, to February 15, 2020. Patients hospitalized at 1 of 16 centers in France for moderately severe CAP who were clinically stable at day 3 of antibiotic treatment were included in the PTC trial and analyzed in the per-protocol trial population. INTERVENTIONS Patients were randomly assigned (1:1) on day 3 of antibiotic treatment to receive β-lactam (amoxicillin-clavulanate [1 g/125 mg] 3 times daily) or placebo for 5 extra days. MAIN OUTCOMES AND MEASURES The main outcome was failure at 15 days after first antibiotic intake, defined as a temperature greater than 37.9 °C and/or absence of resolution or improvement of respiratory symptoms and/or additional antibiotic treatment for any cause. The association among demographic characteristics, baseline clinical and biological variables available (ie, at the first day of β-lactam treatment), and treatment failure at day 15 among the per-protocol trial population was assessed by univariate and multivariable logistic regressions. RESULTS Overall, 310 patients were included in the study; this secondary analysis comprised 291 patients (174 [59.8%] male; mean [SD] age, 69.6 [18.5] years). The failure rate was 26.8%. Male sex (odds ratio [OR], 1.74; 95% CI, 1.01-3.07), age per year (OR, 1.03; 95% CI, 1.01-1.05), Pneumonia Severe Index score (OR, 1.01; 95% CI, 1.00-1.02), the presence of chronic lung disease (OR, 1.85; 95% CI, 1.03-3.30), and creatinine clearance (OR, 0.99; 95% CI, 0.98-1.00) were significantly associated with failure in the univariate analysis. When the Pneumonia Severe Index score was excluded to avoid collinearity with age and sex in the regression model, only male sex (OR, 1.92; 95% CI, 1.08-3.49) and age (OR, 1.02; 95% CI, 1.00-1.05) were associated with failure in the multivariable analysis. CONCLUSIONS AND RELEVANCE In this secondary analysis of a randomized clinical trial, among patients with CAP who reached clinical stability after 3 days of antibiotic treatment, only male sex and age were associated with higher risk of failure, independent of antibiotic treatment duration and biomarker levels. Another randomized clinical trial is needed to evaluate the impact of treatment duration in populations at higher risk for treatment failure.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
- Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit, Institut Pasteur, Paris, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, APHP, Paris, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond-Poincaré University Hospital, APHP Paris Saclay, Garches, France
| | - Benjamin Davido
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Laurène Deconinck
- Infectious Disease Department, Bichat University Hospital, APHP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious Disease Department, Marne La Vallée Hospital, Grand Hôpital de l'Est Francilien, Marne La Vallée, France
| | | | - Guillaume Mellon
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine, Lariboisière University Hospital, APHP, Paris, France
| | | | - Daniel Benhamou
- Pneumology Department, Rouen University Hospital, Rouen, France
| | | | | | - Didier Guillemot
- Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit, Institut Pasteur, Paris, France
| | - Bertrand Renaud
- Emergency Department, Cochin University Hospital, APHP, Paris, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Roquefeuil L, Lawrence C, Dinh A, Bravo P, Villart M, Davido B, Bouchand F. Analyse des consommations locales d’antibiotiques durant la première vague épidémique de COVID-19 (mars–avril 2020) dans un hôpital de référence. Infect Dis Now 2021. [PMCID: PMC8327560 DOI: 10.1016/j.idnow.2021.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Matériels et méthodes Résultats Conclusion
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Bouchand F, Leplay C, Guimaraes R, Fontenay S, Fellous L, Dinh A, Deconinck L, Sénard O, Matt M, Michelon H, Perronne C, Salomon J, Villart M, Izedaren F, Pottier S, Barbot F, Orlikowski D, Vaugier I, Davido B. Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial. Int J Clin Pract 2021; 75:e14282. [PMID: 33915011 DOI: 10.1111/ijcp.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the impact of a care bundle including medication reconciliation at discharge by a pharmacist versus standard of care, on continuity of therapeutic changes between hospital and primary care and outcome of patients, within 1 month after discharge. METHODS Randomised controlled trial in 120 adult patients with at least one chronic disease and three current medications before admission, hospitalised in an infectious disease department of a tertiary hospital and discharged home. Patients were randomly assigned (1:1) to receive a discharge care bundle including medication reconciliation, counselling session and documentation transfer to primary care physician (PCP) (intervention group) or standard of care (control group). Primary outcome was the proportion of in-hospital prescription changes, not maintained by the PCP, 1 month after discharge. Secondary outcome measures included the proportion of patients experiencing early PCP's consultation, hospital readmissions or adverse reactions within 1-month postdischarge and cost of discharge prescriptions. RESULTS Baseline characteristics were comparable between the two groups. One month after discharge, the proportion of in-hospital prescription changes, not maintained by the PCP, was 11% in the intervention group versus 24% in the control group (P = .007). The median delay before PCP's consultation was longer in the intervention group (30.5 vs 19.5 days, P = .013), there were fewer patients readmitted to hospital (3.4% vs 20.7%, P = .009, odds ratio (OR) = 0.13 [0.02-0.53]) and fewer patients who suffered from adverse drug reaction (7.0% vs 22.8%, P = .04, OR = 0.26 [0.07-0.78]). CONCLUSION This care bundle resulted in the reduction of treatment changes between hospital discharge and primary care.
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Affiliation(s)
- Frédérique Bouchand
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Céline Leplay
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Ricardo Guimaraes
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Sarah Fontenay
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Lesly Fellous
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Aurélien Dinh
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Laurène Deconinck
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Olivia Sénard
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Morgan Matt
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Hugues Michelon
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Christian Perronne
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Jérôme Salomon
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Maryvonne Villart
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Fatima Izedaren
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Sandra Pottier
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Frédéric Barbot
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - David Orlikowski
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Isabelle Vaugier
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Benjamin Davido
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
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Rigon A, Dehache L, Bravo P, Ribeiro V, Duran C, Dinh A, Bourgault-Villada I, Villart M, Bouchand F, Mascitti H. Rôle de la pharmacie dans l’investigation allergologique des patients ayant présenté un exanthème en cours d’hospitalisation pour COVID-19. Revue Française d'Allergologie 2021. [PMCID: PMC8111406 DOI: 10.1016/j.reval.2021.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Les manifestations cutanées observées chez les patients COVID-19 sont multiples et fréquentes : engelures, exanthème, urticaire, purpura, eczéma. Chez les patients recevant des antiinfectieux et présentant ces symptômes compatibles avec des réactions d’hypersensibilités retardées (HSR), le diagnostic de toxidermie est systématiquement évoqué. Méthodes À partir de la cohorte bicentrique des patients présentant des manifestations cutanéo-muqueuses au cours du COVID-19 nous décrirons la démarche collaborative entre les services de médecine et la pharmacie hospitalière et l’étude de faisabilité des préparations magistrales de patch tests, prick-tests et tests IDR. Résultats Parmi la cohorte de 59 patients hospitalisés pour une pneumonie COVID-19 en mars 2020, 68 % avait des atteintes cutanées (exanthèmes dans 80 %) ; 23 des 40 patients présentant des manifestations cutanées (58 %) avaient reçu au moins un antiinfectieux (hydroxychloroquine [HCQ], azithromycine [AZT], spiramycine [SPR], amoxicilline [AMX] et/ou ceftriaxone [CFX]). Une revue complète de la littérature a été réalisée et les PUI réalisant ce type de tests ont été contactées pour déterminer les concentrations non irritantes, dilutions optimales, nature des diluants, vérification de la texture, choix des contrôles positifs et négatifs, conditionnement le plus approprié et évaluation des moyens humains et matériels nécessaires. Quinze fiches de fabrication ont été rédigées. La pharmacie a élaboré des tests épicutanés dosés à 30 % dans de la vaseline à partir des formes orales (HCQ, AZT) ; 10 % (lyophilistas) ou 30 % (solutions) dans vaseline pour les solutions injectables (AMX, CFX et SPR). Les prick-tests et les tests IDR en seringues ont été préparés en conditions stériles, à partir des formes injectables (AMX, CFX et SPR). Les tests cutanés seront réalisés à 1 an de l’épisode (mars 2021) : résultats à venir. Conclusion Ce travail a favorisé le travail pluridisciplinaire entre les services. Les résultats des tests allergologiques permettront d’identifier les HSR allergiques qui contre-indiqueront la réintroduction des molécules et la meilleure compréhension des atteintes dermatologiques observées chez les patients atteints de COVID-19.
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Mascitti H, Bonsang B, Rigon A, Bravo P, Bouchand F, Villart M, Malot C, Jacob L, Chokron E, Yaprat Karabulut C, Duran C, Le Gal A, Matt M, Emile J, Dinh A, Bourgault-Villada I. Première série de cas de DRESS syndrome au cours d’une pneumonie sévère COVID-19. Revue Française d'Allergologie 2021. [PMCID: PMC8111425 DOI: 10.1016/j.reval.2021.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Lors de la première vague de COVID-19, les praticiens ont largement prescrit l’association hydroxychloroquine (HCQ) – azythromycine (AZM). Méthodes Nous rapportons une série de 3 cas de DRESS certains, selon le score REGISCAR, chez des patients atteints de pneumonies COVID-19 sévères. Résultats Le premier patient a 58 ans, est diabétique, hypertendu et obèse. Il présente à J20 du début des symptômes de COVID-19 un exanthème maculo papuleux diffus, œdème du visage, adénomégalies supra centimétriques et une hyperéosinophilie à 0,74 G/L ; à J15 d’un traitement par ceftriaxone (CTX), AZM et HCQ. La deuxième patiente a 76 ans, est diabétique, hypertendue et atteinte d’une SEP. Elle présente à 1 mois du début de sa pneumonie COVID-19 ; et à 21 jours post-prises de CTX, AZM et HCQ une éruption cutanée sévère compatible avec un DRESS. Elle a présenté une hyperéosinophilie concomitante à 0,65 G/L avant traitement par dermocorticoides. Le troisième patient a 56 ans et aucune comorbidité. Il présente à J3 du début des symptômes de COVID-19 un volumineux œdème du visage et des lésions érythémateuses maculopapuleuses purpuriques ; à J8 d’un traitement antipaludéens et AINS. Pour chacun d’entre eux, la biopsie cutanée appuie le diagnostic de DRESS ; les PCR sanguines HHV6, EBV, CMV, VIH, VHB, VHC, parvovirus B19 sont négatives ; et l’évolution a été lentement favorable avec un blanchiement complet de la peau en plus de 15 jours d’application de Clobetasol. Discussion Le DRESS syndrome est une toxidermie rare qui peut-être fatale. Aucun cas de toxidermie type DRESS n’avait été rapportée jusqu’à ce jour dans un contexte de COVID-19. Moins d’une dizaine de cas de DRESS ont été rapportés dans la littérature avec l’un ou l’autre des traitements par HCQ ou AZM. Les réactivations virales sont classiquement décrites avec HHV6 ou d’autres herpes virus (EBV, CMV), mais aucune de ces réplications virales classiques n’ont été objectivées chez nos patients qui étaient atteints de formes actives sévères d’infections par le SARS-CoV-2, probablement réplicatif. L’implication du SARS-CoV-2 est supposée ici. Conclusion Il s’agit ici de la première série de cas de DRESS certains chez des patients atteints de formes sévères de COVID-19.
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Rempenault C, Pagis V, Noussair L, Berbescu S, Duran C, Bouchand F, de Laroche M, Salomon E, Nich C, Bauer T, Rottman M, Davido B, Matt M, Dinh A. Treatment of bone and joint infections by ceftazidime/avibactam and ceftolozane/tazobactam: a cohort study. J Glob Antimicrob Resist 2021; 25:282-286. [PMID: 33933698 DOI: 10.1016/j.jgar.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/20/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Ceftazidime/avibactam (C/A) and ceftolozane/tazobactam (C/T) are two novel antibacterials with known efficacy against Gram-negative bacteria (GNB). We aimed to describe the efficacy and safety of surgical management combined with C/A or C/T treatment for bone and joint infections (BJIs). METHODS We conducted an observational, bicentric study of patients treated with C/A or C/T for a BJI between May 2016 and June 2019. Failure was defined as the need for unplanned additional antibiotic treatment or orthopaedic surgery, or death due to the BJI up to the patient's latest visit. RESULTS Overall, 15 patients were included. Nine patients were treated with C/A, mainly for polymicrobial BJI due to multidrug-resistant (MDR) bacteria (Enterobacteriaceae, n = 7). Six patients were male, the median age was 66 years and the median Charlson comorbidity index (CCI) was 5. It was the first septic episode at the site in 3/9 patients. The cure rate was 7/9 (median follow-up, 272 days). Two patients showed C/A-related confusion. Five patients were treated with C/T for BJI involving MDR Pseudomonas aeruginosa. Four patients were male, the median age was 53 years and the median CCI was 2. All patients had previous septic episodes at the infection site. The cure rate was 3/5 (median follow-up, 350 days). One patient was successfully treated by C/T then C/A for multistage spondylodiscitis. CONCLUSION In our experience, C/A and C/T are two effective and safe options, even as salvage treatment for BJI due to MDR-GNB despite the absence of label, however more data are warranted.
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Affiliation(s)
- Claire Rempenault
- Rheumatology Department, University Hospital of Montpellier, Montpellier, France; Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Valentine Pagis
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Latifa Noussair
- Clinical Microbiology Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Simona Berbescu
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Marine de Laroche
- Infectious Disease Unit, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Elsa Salomon
- Clinical Microbiology Unit, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Christophe Nich
- Orthopedic Surgery, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Thomas Bauer
- Orthopedic Surgery, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Martin Rottman
- Clinical Microbiology Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Morgan Matt
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France.
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Dinh A, Hallouin-Bernard MC, Davido B, Lemaignen A, Bouchand F, Duran C, Even A, Denys P, Perrouin-Verbe B, Sotto A, Lavigne JP, Bruyère F, Grall N, Tavernier E, Bernard L. Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial. Clin Infect Dis 2021; 71:3128-3135. [PMID: 31867616 DOI: 10.1093/cid/ciz1207] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/17/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalizations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis (ie, the alternate weekly administration of 2 antibiotics) in preventing R-UTIs. METHODS Randomized (1:1), open-label, superiority-controlled trial compared WOCA prophylaxis to no prophylaxis (control) for 6 months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome was incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes were number of febrile UTIs, number of hospitalizations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal, and nasal microbiota. RESULTS Forty-five patients were either allocated to the WOCA group (n = 23) or the control group (n = 22). Median (IQR) incidence of symptomatic antibiotic-treated UTIs was 1.0 (0.5-2.5) in the WOCA group versus 2.5 (1.2-4.0) (P = .0241) in the control group. No febrile UTIs were recorded in the WOCA group versus 9 (45.0%) (P < .001) in the control group. The median number of additional antibiotic treatment was 0.0 (IQR, 0.0-2.0) versus 3.0 (2.0-5.0) (P = .004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed. CONCLUSIONS WOCA is efficient and well tolerated in preventing R-UTIs in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures. CLINICAL TRIALS REGISTRATION NCT01388413.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | | | - Benjamin Davido
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Adrien Lemaignen
- Department of Infectious Diseases, Bretonneau University Hospital, Tours, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Alexia Even
- Department of Urology, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Pierre Denys
- Department of Urology, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, Saint-Jacques Hospital, University Hospital of Nantes, Nantes, France
| | - Albert Sotto
- Department of Infectious Diseases, Caremeau University Hospital, Nîmes, France
| | | | - Franck Bruyère
- Department of Urology, Bretonneau University Hospital, Tours, France
| | - Nathalie Grall
- Microbiology Laboratory, Bichat-Claude Bernard University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elsa Tavernier
- Clinical Investigation Centre INSERM 1415, Bretonneau University Hospital, Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, Bretonneau University Hospital, Tours, France
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17
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Dinh A, Ropers J, Duran C, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Makhloufi S, Mellon G, de Lastours V, Bouchand F, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Perronne C, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet 2021; 397:1195-1203. [PMID: 33773631 DOI: 10.1016/s0140-6736(21)00313-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired pneumonia who were stable after 3 days of treatment. METHODS We did this double-blind, randomised, placebo-controlled, non-inferiority trial (the Pneumonia Short Treatment [PTC]) in 16 centres in France. Adult patients (aged ≥18 years) admitted to hospital with moderately severe community-acquired pneumonia (defined as patients admitted to a non-critical care unit) and who met prespecified clinical stability criteria after 3 days of treatment with β-lactam therapy were randomly assigned (1:1) to receive β-lactam therapy (oral amoxicillin 1 g plus clavulanate 125 mg three times a day) or matched placebo for 5 extra days. Randomisation was done using a web-based system with permuted blocks with random sizes and stratified by randomisation site and Pneumonia Severity Index score. Participants, clinicians, and study staff were masked to treatment allocation. The primary outcome was cure 15 days after first antibiotic intake, defined by apyrexia (temperature ≤37·8°C), resolution or improvement of respiratory symptoms, and no additional antibiotic treatment for any cause. A non-inferiority margin of 10 percentage points was chosen. The primary outcome was assessed in all patients who were randomly assigned and received any treatment (intention-to-treat [ITT] population) and in all patients who received their assigned treatment (per-protocol population). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT01963442, and is now complete. FINDINGS Between Dec 19, 2013, and Feb 1, 2018, 706 patients were assessed for eligibility, and after 3 days of β-lactam treatment, 310 eligible patients were randomly assigned to receive either placebo (n=157) or β-lactam treatment (n=153). Seven patients withdrew consent before taking any study drug, five in the placebo group and two in the β-lactam group. In the ITT population, median age was 73·0 years (IQR 57·0-84·0) and 123 (41%) of 303 participants were female. In the ITT analysis, cure at day 15 occurred in 117 (77%) of 152 participants in the placebo group and 102 (68%) of 151 participants in the β-lactam group (between-group difference of 9·42%, 95% CI -0·38 to 20·04), indicating non-inferiority. In the per-protocol analysis, 113 (78%) of 145 participants in the placebo treatment group and 100 (68%) of 146 participants in the β-lactam treatment group were cured at day 15 (difference of 9·44% [95% CI -0·15 to 20·34]), indicating non-inferiority. Incidence of adverse events was similar between the treatment groups (22 [14%] of 152 in the placebo group and 29 [19%] of 151 in the β-lactam group). The most common adverse events were digestive disorders, reported in 17 (11%) of 152 patients in the placebo group and 28 (19%) of 151 patients in the β-lactam group. By day 30, three (2%) patients had died in the placebo group (one due to bacteraemia due to Staphylococcus aureus, one due to cardiogenic shock after acute pulmonary oedema, and one due to heart failure associated with acute renal failure) and two (1%) in the β-lactam group (due to pneumonia recurrence and possible acute pulmonary oedema). INTERPRETATION Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These findings could allow substantial reduction of antibiotic consumption. FUNDING French Ministry of Health.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France.
| | - Jacques Ropers
- Clinical research unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Clara Duran
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Laurène Deconinck
- Infectious Disease Department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious Disease Department, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | | | - Sabrina Makhloufi
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Guillaume Mellon
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Victoire de Lastours
- Internal Medicine Department, Beaujon University Hospital, AP-HP, University of Paris, Clichy, France
| | - Frédérique Bouchand
- Pharmacy, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | | | - Jean-Emmanuel Kahn
- Internal Medicine Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine Department, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | | | - Daniel Benhamou
- Pneumology Department, Bois-Guillaume University Hospital, Rouen, France
| | | | - Marie-Christine Dombret
- Pneumology Department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Bertrand Renaud
- Emergency Department, Cochin University Hospital, AP-HP, Paris Centre University, Paris, France
| | - Christian Perronne
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1169 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
| | - Anne-Claude Crémieux
- Infectious Disease Department, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
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de Laroche M, Fellous L, Salomon E, Saadeh D, Duran C, Bouchand F, Lequintrec JL, Teillet L, Gaillard JL, Seridi Z, Michelon H, Dinh A. Bloodstream infections in older population: epidemiology, outcome, and impact of multidrug resistance. Eur J Clin Microbiol Infect Dis 2021; 40:1665-1672. [PMID: 33694038 DOI: 10.1007/s10096-021-04212-7] [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: 11/22/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Bloodstream infections (BSIs) among older patients are frequent with high rate of mortality. Infections with multidrug-resistant organisms (MDRO) are associated with higher mortality than with susceptible microorganisms. We aimed to evaluate the prevalence of MDRO infection during BSI in older population and the factors associated with unfavorable outcome. This study is a retrospective cohort of all BSI episodes occurring among older patients (> 65yo), from April 1, 2010, to December 31, 2016, in a French university hospital for geriatric medicine. A total of 255 BSI episodes were analyzed. Mean age was 86.3±6.5 years, and sex ratio (M/F) was 0.96. Main comorbidities were orthopedic device (26.7%), active neoplasia (24.3%), and diabetes mellitus (18.4%). Main primary sites of infection were urinary tract infections (56.9%), respiratory tract infections (10.6%), intra-abdominal infections (7.1%), and skin and soft tissue infections (4.7%). Main bacteria identified were Escherichia coli (45.1%), Staphylococcus aureus (14.1%), enterococci (10.7%), coagulase-negative staphylococci (CoNS) (5.5%), and streptococci (5.1%). MDROs were involved in 17.2% of BSI (gram-negative bacilli: 9.0%; CoNS: 4.3%; and methicillin-resistant S. aureus (MRSA): 3.9%). The main factor associated with MDRO BSI was colonization with MDRO (OR=6.29; 95%CI=2.9-14.32). Total mortality was 18.4% and significantly higher in case of initial severity (OR=3.83; 95%CI=1.75-8.38), healthcare-associated infection (OR=5.29; 95%CI=1.11-25.30), and MRSA BSI (OR=9.16; 95%CI=1.67-50.16). BSI due to MDRO is frequent in older population and is strongly associated with carriage of MDRO. Healthcare-associated BSI, severe episodes, and BSI due to MRSA are associated with unfavorable outcome. In these cases, a broad-spectrum antibiotic should be promptly initiated.
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Affiliation(s)
- Marine de Laroche
- Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Lesly Fellous
- Pharmacy Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Elsa Salomon
- Microbiology Laboratory, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Danielle Saadeh
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Clara Duran
- Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Jean-Laurent Lequintrec
- Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Laurent Teillet
- Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France.,Geriatric Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Microbiology Laboratory, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Zineb Seridi
- Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Hugues Michelon
- Pharmacy Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France.,Pharmacy Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aurélien Dinh
- Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France. .,Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, 104 Bd R. Poincaré, 92380, Garches, France.
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19
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Mascitti H, Bonsang B, Dinh A, Assan F, Perronne V, Leblanc T, Duran C, Bouchand F, Matt M, Le Gal A, N'guyen Van Thanh J, Lanore A, Jacob L, Kiavue N, Siméon S, Bessis S, de Truchis P, Landowski S, Davido B, Moreau F, Rameix-Welti MA, Gault E, Gaillard JL, Roux AL, Sivadon-Tardy V, Salomon E, El Sayed F, Carlier R, Emile JF, Perronne C, Bourgault-Villada I. Clinical Cutaneous Features of Patients Infected With SARS-CoV-2 Hospitalized for Pneumonia: A Cross-sectional Study. Open Forum Infect Dis 2020; 7:ofaa394. [PMID: 33204745 PMCID: PMC7650967 DOI: 10.1093/ofid/ofaa394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/25/2020] [Indexed: 12/29/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a current pandemic worldwide. This virus can reach all organs and disturbs the immune system, leading to a cytokine storm in severe forms. We aimed to report cutaneous features among coronavirus disease 2019 (COVID-19) hospitalized patients. Methods We performed a cross-sectional study on 1 given day among all patients hospitalized in acute care for COVID-19 and included all patients with cutaneous features. Follow-up 48 hours later was obtained. Results Among 59 adult patients hospitalized on the day of the study in an infectious diseases ward for SARS-CoV-2 infection who were confirmed by molecular assay and/or radiological findings (computed tomography scan), 40 were included. Several cutaneous manifestations were found: macular exanthema (80%), face edema (32%), livedo (13%), urticarial rash (8%), purpura (5%), oral lichenoid lesions (33%), and conjunctivitis (18%). Cutaneous biopsy was performed in 17 patients. Histological findings showed mast cell hyperplasia (100%), superficial perivascular infiltrate of lymphocytes (94%), and superficial edema (47%) consistent with capillary leak. Conclusions Various dermatological signs can be encountered during COVID-19. A macular rash was the most frequent. All cutaneous features could be related to a vascular leak process.
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Affiliation(s)
- Hélène Mascitti
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Benjamin Bonsang
- Department of Pathological Anatomy and Cytology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Aurélien Dinh
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Florence Assan
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Véronique Perronne
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Thibault Leblanc
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Clara Duran
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Bouchand
- Department of Pharmacy, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Morgan Matt
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aurélie Le Gal
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Julia N'guyen Van Thanh
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aymeric Lanore
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Louis Jacob
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Nicolas Kiavue
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Soline Siméon
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Simon Bessis
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Pierre de Truchis
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Stéphanie Landowski
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Moreau
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Marie-Anne Rameix-Welti
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Elyanne Gault
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Anne-Laure Roux
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Valérie Sivadon-Tardy
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Elsa Salomon
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Faten El Sayed
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Robert Carlier
- Department of Radiology, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Jean-François Emile
- Department of Pathological Anatomy and Cytology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Christian Perronne
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Isabelle Bourgault-Villada
- Department of Dermatology and Immunology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
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20
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Davido B, Noussair L, Saleh-Mghir A, Salomon E, Bouchand F, Matt M, Lawrence C, Bauer T, Herrmann JL, Perronne C, Gaillard JL, Rottman M, Dinh A. Case series of carbapenemase-producing Enterobacteriaceae osteomyelitis: Feel it in your bones. J Glob Antimicrob Resist 2020; 23:74-78. [PMID: 32882450 DOI: 10.1016/j.jgar.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/18/2020] [Revised: 07/20/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Limited data have been reported regarding osteomyelitis due to carbapenemase-producing Enterobacteriaceae (CPE), including co-infections with extended-spectrum β-lactamase (ESBL)-producing micro-organisms. METHODS We conducted a retrospective study in a reference centre for bone and joint infections from 2011 to 2019 among patients infected with CPE. RESULTS Nine patients (mean age 46.8 ± 16.6 years), including three with infected implants, were identified. Infections were mostly polymicrobial (n = 8/9), including Staphylococcus aureus (n = 6/9). CPE were mainly OXA-48-type, associated with ESBL-producing Enterobacteriaceae (n = 8/9), of which 5/9 isolates were Klebsiella pneumoniae. Control of the infection was achieved in seven cases. CONCLUSIONS CPE osteomyelitides are essentially polymicrobial and fluoroquinolone-resistant infections, highlighting the need for efficient surgery with implant removal.
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Affiliation(s)
- B Davido
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France.
| | - L Noussair
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - A Saleh-Mghir
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - E Salomon
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - F Bouchand
- Pharmacie Hospitalière, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - M Matt
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - C Lawrence
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - T Bauer
- Service d'Orthopédie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - J L Herrmann
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - C Perronne
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - J L Gaillard
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - M Rottman
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - A Dinh
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
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21
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Siméon S, Dortet L, Bouchand F, Roux AL, Bonnin RA, Duran C, Decousser JW, Bessis S, Davido B, Sorriaux G, Dinh A. Compassionate Use of Cefiderocol to Treat a Case of Prosthetic Joint Infection Due to Extensively Drug-Resistant Enterobacter hormaechei. Microorganisms 2020; 8:microorganisms8081236. [PMID: 32823796 PMCID: PMC7464826 DOI: 10.3390/microorganisms8081236] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 67-year old man with a right knee prosthetic joint infection due to extensively drug-resistant Enterobacter hormaechei. The resistance phenotype was due to the overproduction of the intrinsic cephalosporinase (ACT-5) associated with the production of three acquired β-lactamases (CTX-M-15, TEM-1B and OXA-1), and a putative membrane decreased permeability. He was first treated with colistin-tigecyclin due to adverse drug reactions; treatment was switched to cefiderocol for a 12-week antibiotic duration, with a favorable outcome.
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Affiliation(s)
- Soline Siméon
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | - Laurent Dortet
- Microbiology laboratory, Bicêtre Hospital, AP-HP, UMR 1184, Team Resist, INSERM, Paris-Saclay University, Faculty of Medicine, French National Reference Center for Antibiotic Resistance: Carbapenemase producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.)
| | - Frédérique Bouchand
- Pharmacy, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France;
| | - Anne-Laure Roux
- Microbiology laboratory, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France;
| | - Rémy A. Bonnin
- Microbiology laboratory, Bicêtre Hospital, AP-HP, UMR 1184, Team Resist, INSERM, Paris-Saclay University, Faculty of Medicine, French National Reference Center for Antibiotic Resistance: Carbapenemase producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.)
| | - Clara Duran
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | - Jean-Winoc Decousser
- Department of Bacteriology and Infection Control, Henri Mondor University Hospital, AP-HP, 94000 Créteil, France;
- EA 7380 Dynamyc, University Paris-Est Créteil (UPEC), Ecole nationale vétérinaire d’Alfort (EnvA), Faculty of Medecine, 94000 Créteil, France
| | - Simon Bessis
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | - Benjamin Davido
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | | | - Aurélien Dinh
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
- Correspondence:
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Davido B, Boussaid G, Vaugier I, Lansaman T, Bouchand F, Lawrence C, Alvarez JC, Moine P, Perronne V, Barbot F, Saleh-Mghir A, Perronne C, Annane D, De Truchis P. Impact of medical care, including use of anti-infective agents, on prognosis of COVID-19 hospitalized patients over time. Int J Antimicrob Agents 2020; 56:106129. [PMID: 32755653 PMCID: PMC7396133 DOI: 10.1016/j.ijantimicag.2020.106129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
Patients with COVID-19 pneumonia are at risk of transfer to the intensive care unit or death We observed a decrease of ICU admission over time during the epidemic Better management of oxygen therapy and possibly use of anti-infective agents explained those results
Introduction The effect of anti-infective agents in COVID-19 is unclear. The impact of changes in practice on prognosis over time has not been evaluated. Methods Single center, retrospective study in adults hospitalized in a medicine ward for COVID-19 from March 5th to April 25th 2020. Patient characteristics were compared between two periods (before/after March 19th) considering French guidelines. The aim of the study was to evaluate how medical care impacted unfavorable outcome, namely admission to intensive care unit (ICU) and/or death. Results A total of 132 patients were admitted: mean age 59.0±16.3 years; mean C-reactive protein (CRP) level 84.0±71.1 mg/L; 46% had a lymphocyte count <1000/mm3. Prescribed anti-infective agents were lopinavir-ritonavir (n=12), azithromycin (AZI) (n=28) and AZI combined with hydroxychloroquine (HCQ) (n=52). There was a significant decrease in ICU admission, from 43% to 12%, between the two periods (P<0.0001). Delays until transfer to ICU were similar between periods (P=0.86). Pulmonary computerized tomography (CT)-scans were performed significantly more often with time (from 50% to 90%, P<0.0001), and oxygen-dependency (53% vs 80%, P=0.001) and prescription of AZI±HCQ (from 25% to 76%, P<0.0001) were also greater over time. Multivariate analyses showed a reduction of unfavorable outcome in patients receiving AZI±HCQ (hazard ratio [HR]=0.45, 95% confidence interval [CI: 0.21-0.97], P=0.04), particularly among an identified category of individuals (lymphocyte ≥1000/mm3 or CRP ≥100 mg/L). Conclusion The present study showed a significant decrease in admission to ICU over time, which was probably related to multiple factors, including a better indication of pulmonary CT-scan, oxygen therapy, and a suitable prescription of anti-infective agents.
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Affiliation(s)
- Benjamin Davido
- Maladies Infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France.
| | - Ghilas Boussaid
- Université Paris-Saclay, UVSQ, Erphan, 78000, Versailles, France
| | - Isabelle Vaugier
- Centre d'Investigation Clinique (Inserm CIC 1429), Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Thibaud Lansaman
- Rééducation fonctionnelle, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Frédérique Bouchand
- Pharmacie Hospitalière, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Christine Lawrence
- EOH, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Jean-Claude Alvarez
- Pharmaco-toxicologie, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Pierre Moine
- Réanimation médicale, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Véronique Perronne
- Maladies Infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Frédéric Barbot
- Centre d'Investigation Clinique (Inserm CIC 1429), Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Azzam Saleh-Mghir
- Maladies Infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Christian Perronne
- Maladies Infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Djillali Annane
- Réanimation médicale, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Pierre De Truchis
- Maladies Infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches, France
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Hamon A, El Sayed F, Bouchand F, Davido B, Duran C, Coggia M, Javerliat I, Dinh A. [Coxiella burnetii infection of endovascular aortic graft]. Med Mal Infect 2020; 50:620-623. [PMID: 32113867 DOI: 10.1016/j.medmal.2020.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/27/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Affiliation(s)
- A Hamon
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France
| | - F El Sayed
- Service de microbiologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne Billancourt, France
| | - F Bouchand
- Service de pharmacie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - B Davido
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France
| | - C Duran
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France
| | - M Coggia
- Service de chirurgie vasculaire, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne Billancourt, France
| | - I Javerliat
- Service de chirurgie vasculaire, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne Billancourt, France
| | - A Dinh
- Service de maladies infectieuses, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré 92380 Garches, France.
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Coudert M, Pépin M, de Thezy A, Fercot E, Laycuras M, Coudert AL, Duran C, Bouchand F, Davido B, Le Crane M, Denis B, Muller F, Gourdon M, Peng CL, Mahamdia R, Mekerta Z, Seridi Z, Gaillard JL, Leichowski L, Moulias S, Rottman M, Sivadon-Tardy V, Teillet L, Dinh A. Présentation clinique et performance de la bandelette urinaire pour le diagnostic d’infection urinaire en population gériatrique. Rev Med Interne 2019; 40:714-721. [DOI: 10.1016/j.revmed.2019.06.010] [Citation(s) in RCA: 1] [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: 01/26/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
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Deconinck L, Dinh A, Nich C, Tritz T, Matt M, Senard O, Bessis S, Bauer T, Rottman M, Salomon J, Bouchand F, Davido B. Efficacy of cotrimoxazole (Sulfamethoxazole-Trimethoprim) as a salvage therapy for the treatment of bone and joint infections (BJIs). PLoS One 2019; 14:e0224106. [PMID: 31622440 PMCID: PMC6797119 DOI: 10.1371/journal.pone.0224106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/04/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Cotrimoxazole (Sulfamethoxazole-Trimethoprim, SXT) has interesting characteristics for the treatment of bone and joint infection (BJI): a broad spectrum of activity with adequate bone diffusion and oral and intravenous formulations. However, its efficacy and safety in BJIs are poorly documented and its use remains limited. Methods We conducted a retrospective study in 2 reference centers for BJIs from 2013 to 2018 among patients treated with SXT for a BJI. Data were collected from patient’s medical charts. Outcomes and adverse events were evaluated at day (D)7, D45 and D90. Results We analyzed 51 patients with a mean age of 60 ± 20 (SD) years of which 76% presented with an orthopedic device infection (ODI). Gram-negative bacilli (GNB) were involved in 47% of BJIs (n = 24). Moreover, they were often polymicrobial infections (41%). Doses of SXT ranged from 800/160mg bid (61%; n = 31) to 800/160mg tid (39%; n = 20). Median SXT treatment duration was 45 days (IQR 40–45). SXT was part of a dual therapy in 84% of patients (n = 43), associated mainly with fluoroquinolones (n = 17) or rifampicin (n = 14). Outcome was favorable at D7 in 98% (n = 50), at D45 in 88.2% (n = 45) and at D90 in 78.4% (n = 40). The second agent combined with SXT was not an independent factor of favorable outcome (p = 0.97). Adverse events were reported in 8% (n = 4) of patients, with a median of 21 days (IQR 20–30) from SXT initiation and led to discontinuation (n = 3). Conclusion SXT appears to be effective for treatment of BJIs as a salvage therapy, even in GNB or polymicrobial infection, including ODI. Further data are needed to confirm SXT efficacy as an alternative oral regimen in BJIs.
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Affiliation(s)
- Laurene Deconinck
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Aurélien Dinh
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Christophe Nich
- Service d’Orthopédie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Thomas Tritz
- Pharmacie Hospitalière, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Morgan Matt
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Olivia Senard
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Simon Bessis
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Thomas Bauer
- Service d’Orthopédie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Martin Rottman
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Jérome Salomon
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Frédérique Bouchand
- Pharmacie Hospitalière, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - Benjamin Davido
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
- * E-mail:
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, AP-HP, Versailles Saint-Quentin University, Garches
| | - Benjamin Davido
- Infectious Diseases Unit, AP-HP, Versailles Saint-Quentin University, Garches
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches
| | - Clara Duran
- Infectious Diseases Unit, AP-HP, Versailles Saint-Quentin University, Garches
| | - Jacques Ropers
- Clinical Research Unit, Ambroise Paré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt
| | - Anne-Claude Crémieux
- Infectious Disease Department, Saint-Louis Teaching Hospital, AP-HP, Diderot Paris University, France
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Dinh A, Davido B, Duran C, Bouchand F, Bernard L. Antibiotic prophylaxis approaches for urinary tract infections. Lancet Infect Dis 2019; 18:1065. [PMID: 30303098 DOI: 10.1016/s1473-3099(18)30501-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France.
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Hôpitaux de Paris, Versailles Saint-Quentin University, 92380 Garches, France
| | - Louis Bernard
- Internal Medicine and Infectious Diseases Department, Bretonneau Hospital, University Hospital of Tours, Tours, France
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Fellous L, Davido B, Leplay C, Randuineau P, Bouchand F. Electronic Pharmaceutical Record: A tool to avoid medication errors at hospital admission. Presse Med 2019; 48:999-1000. [DOI: 10.1016/j.lpm.2019.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 07/04/2019] [Accepted: 08/14/2019] [Indexed: 11/25/2022] Open
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Dinh A, Duran C, Pavese P, Khatchatourian L, Monnin B, Bleibtreu A, Denis E, Etienne C, Rouanes N, Mahieu R, Bouchand F, Davido B, Lotte R, Cabaret P, Camou F, Chavanet P, Assi A, Limonta S, Lechiche C, Riou R, Courjon J, Illes G, Lacassin-Beller F, Senneville E. French national cohort of first use of dalbavancin: A high proportion of off-label use. Int J Antimicrob Agents 2019; 54:668-672. [PMID: 31400471 DOI: 10.1016/j.ijantimicag.2019.08.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft-tissue infections (SSTIs), but its real-life use is not well known. The aim of this study was to describe all first prescriptions in France over an 16-month period. A retrospective study on all adult patients receiving at least one dose of dalbavancin from 1 June 2017 to 31 September 2018 was performed (75 patients from 29 French hospitals). Data were collected via a standard questionnaire. Failure was defined as persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment, and/or death from infection. The main indications were bone and joint infection (BJI) (64.0%), endocarditis (25.3%), and SSTI (17.3%). The main bacteria involved were Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%), and coagulase-negative staphylococci (44.4%). Median minimum inhibitory concentrations (MICs) for staphylococci to vancomycin and dalbavancin ranged from 0.875-2.0 mg/L and 0.032-0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. The main treatment regimens for dalbavancin were a two-dose regimen (1500 mg each) in 38 cases (50.7%) and a single-dose regimen (1500 mg) in 13 cases (17.3%). Overall, at the patient's last visit, clinical cure was observed in 54/68 patients, whilst failure was observed in 14/68 patients. First use of dalbavancin in France was mostly off-label. Most were due to BJI, often as rescue therapy for severe infections. Even in off-label situations, dalbavancin appears safe and effective.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France.
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France
| | - Patricia Pavese
- Infectious Disease Unit, University Hospital of Grenoble, Grenoble, France
| | | | - Boris Monnin
- Infectious Disease Department, University Hospital of Montpellier, Montpellier, France
| | - Alexandre Bleibtreu
- Infectious Disease Unit, La Pitié-Salpétrière University Hospital, AP-HP, Paris, France
| | - Eric Denis
- Infectious Disease Unit, Hospital of Antibes, Antibes, France
| | - Cédric Etienne
- Infectiologie transversale, Hospital of Grasse, Grasse, France
| | - Nicolas Rouanes
- Infectious Disease Unit, Hospital of Périgueux, Périgueux, France
| | - Rafael Mahieu
- Infectious Disease Unit, University Hospital of Angers, Angers, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France
| | - Romain Lotte
- Bacteriology Laboratory, University Hospital of Nice, Nice, France
| | - Philippe Cabaret
- Antimicrobial Stewardship Team, Saint Philibert-Saint Vincent de Paul Hospitals, GHICL, Lille, France
| | - Fabrice Camou
- Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Pascal Chavanet
- Infectious Disease Department, University Hospital of Dijon, Dijon, France
| | - Assi Assi
- Antimicrobial Stewardship Team, Les Fleurs Clinic, Toulon, France
| | - Silvia Limonta
- Infectious Disease Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Raphaëlle Riou
- Infectious Disease Unit, Hotel-Dieu University Hospital, Nantes, France
| | - Johan Courjon
- Infectious Disease Unit, University Hospital of Nice, Nice, France
| | - Gabriela Illes
- Infectious Disease Unit, Hospital of Mont-de-Marsan, Mont-de-Marsan, France
| | | | - Eric Senneville
- Infectious Disease Unit, Hospital of Tourcoing, Tourcoing, France
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Randuineau P, Bouchand F, Matt M, Villart M, Davido B, Nich C, Dinh A. Efficacité et tolérance de la rifampicine dans le traitement des infections ostéo-articulaires. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.225] [Citation(s) in RCA: 1] [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] [Indexed: 11/30/2022]
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Matt M, Pagis V, Duran C, Bouchand F, Noussair L, de Laroche M, Roux A, Rottman M, Davido B, Dinh A. Infections ostéo-articulaires : utilisation de ceftolozane-tazobactam et ceftazidime-avibactam, expérience monocentrique. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.228] [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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Dinh A, Duran C, Bouchand F, Salomon J, Davido B. Fecal Microbiota Transplantation Is a New Effective Weapon to Fight Multidrug-Resistant Bacteria, but Harmonization and More Data Are Needed. Clin Infect Dis 2019; 65:1425-1426. [PMID: 28595295 DOI: 10.1093/cid/cix538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, R. Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Garches
| | - Clara Duran
- Infectious Disease Unit, R. Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Garches
| | - Frédérique Bouchand
- Pharmacy Department, R. Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Garches
| | - Jérôme Salomon
- Infectious Disease Unit, R. Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Garches.,UMR 1181, INSERM, Institut Pasteur, Paris, France
| | - Benjamin Davido
- Infectious Disease Unit, R. Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Garches
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Senard O, Bouchand F, Deconinck L, Matt M, Fellous L, Rottman M, Perronne C, Dinh A, Davido B. Efficacy of cefoxitin for the treatment of urinary tract infection due to extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates. Ther Adv Infect Dis 2019; 6:2049936118811053. [PMID: 30891241 PMCID: PMC6416675 DOI: 10.1177/2049936118811053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/15/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Cefoxitin has a good in vitro activity and stability in resistance to hydrolysis by extended-spectrum beta-lactamases and is a good candidate for the treatment of urinary tract infection. However, data are scarce regarding its use in clinical practice. Methods We conducted a retrospective study from September 2014 to November 2017, in a tertiary care hospital in Garches (France). We gathered all prescriptions of cefoxitin for urinary tract infection due to extended-spectrum beta-lactamase isolates. We compared the clinical outcomes between Escherichia coli and Klebsiella pneumoniae extended-spectrum-beta-lactamase-producing isolates after a 90-day follow-up. When available, we assessed whether cefoxitin-based regimen was associated with an emergence of resistance. Results The treatment of 31 patients with a mean age of 60 ± 18 years was analyzed. We observed a clinical cure of 96.7% (n = 30/31) at day 30 and of 81.2% (n = 13/16) and 85.7% (12/14) at day 90 for extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae isolates, respectively (p = 0.72). No adverse events were reported. One patient who relapsed carried a Klebsiella pneumoniae isolate that became intermediate to cefoxitin in the follow-up. Conclusion In a period of major threat with a continuous increase of extended-spectrum beta-lactamase obliging to a policy of carbapenem-sparing regimens, it seems detrimental to deprive physicians of using cefoxitin for extended-spectrum beta-lactamase Enterobacteriaceae for the treatment of urinary tract infection while our data show its efficacy.
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Affiliation(s)
- Olivia Senard
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Frédérique Bouchand
- Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Laurene Deconinck
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Morgan Matt
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Lesly Fellous
- Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Martin Rottman
- Laboratoire de Microbiologie, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Christian Perronne
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Aurélien Dinh
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Benjamin Davido
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
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Dinh A, Davido B, Duran C, Bouchand F, Gaillard JL, Even A, Denys P, Chartier-Kastler E, Bernard L. Urinary tract infections in patients with neurogenic bladder. Med Mal Infect 2019; 49:495-504. [PMID: 30885540 DOI: 10.1016/j.medmal.2019.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 05/02/2018] [Revised: 09/04/2018] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
Urinary tract infections (UTIs) in patients with neurogenic bladder are a major public health issue due to their high incidence and major consequences. Despite their frequency and potential severity, their physiopathology and management are poorly known. We provide a narrative literature review on the epidemiology, physiopathology, diagnostic criteria, microbiology, antimicrobial management, and prevention. UTIs among patients with neurogenic bladder are associated with high morbidity and healthcare utilization. Risk factors for UTI among this population are: indwelling catheter, urinary stasis, high bladder pressure, and bladder stones. Their diagnosis is a major challenge as clinical signs are often non-specific and rare. A urinary sample should be analyzed in appropriate conditions before any antibiotic prescription. According to most guidelines, a bacterial threshold≥103CFU/ml associated with symptoms is acceptable to define UTI in patients with neurogenic bladder. The management of acute symptomatic UTI is not evidence-based. A management with a single agent and a short antibiotic treatment of 10 days or less seems effective. Antibiotic selection should be based on the patient's resistance patterns. Asymptomatic bacteriuria should not be treated to avoid the emergence of bacterial resistance. Regarding preventive measures, use of clean intermittent catheterization, intravesical botulinum toxin injection, and prevention using antibiotic cycling are effective. Bacterial interference is promising but randomized controlled trials are needed. Large ongoing cohorts and randomized controlled trials should soon provide more evidence-based data.
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Affiliation(s)
- A Dinh
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France.
| | - B Davido
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - C Duran
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - F Bouchand
- Pharmacie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - J-L Gaillard
- Laboratoire de microbiologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - A Even
- Service de neuro-urologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - P Denys
- Service de neuro-urologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital Pitié Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - L Bernard
- Département des maladies infectieuses et tropicales, hôpital Bretonneau, université F.-Rabelais, 37000 Tours, France
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Davido B, Bouchand F, Dinh A. Re: ‘Are third-generation cephalosporins associated with a better prognosis than amoxicillin-clavulanate in patients hospitalized in the medical ward for community-onset pneumonia?’ by Batard, et al. Clin Microbiol Infect 2018; 24:1222-1223. [DOI: 10.1016/j.cmi.2018.07.004] [Citation(s) in RCA: 1] [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: 07/06/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022]
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Mascitti H, Duran C, Nemo EM, Bouchand F, Câlin R, Descatha A, Gaillard JL, Lawrence C, Davido B, Barbier F, Dinh A. Factors associated with bacteraemia due to multidrug-resistant organisms among bacteraemic patients with multidrug-resistant organism carriage: a case control study. Antimicrob Resist Infect Control 2018; 7:116. [PMID: 30288256 PMCID: PMC6162938 DOI: 10.1186/s13756-018-0412-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Infections caused by multidrug-resistant organisms (MDRO) are emerging worldwide. Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathogens. This question is especially essential among MDRO carriers. We aim to determine the occurrence of MDRO bacteraemia among bacteraemic patients colonized with MDRO, and the associated factors with MDRO bacteraemia among this population. Methods We performed a retrospective monocentric study among MDRO carriers hospitalized with bacteraemia between January 2013 and August 2016 in a French hospital. We compared characteristics of patients with MDRO and non-MDRO bacteraemia. Results Overall, 368 episodes of bacteraemia were reviewed; 98/368 (26.6%) occurred among MDRO carriers. Main colonizing bacteria were extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (40/98; 40.8%), ESBL-producing Klebsiella pneumoniae (35/98; 35.7%); methicillin-resistant Staphylococcus aureus (26/98; 26.5%) and multidrug-resistant Pseudomonas aeruginosa (PA) (12/98; 12.2%). There was no significant difference considering population with MDRO bacteraemia vs. non-MDRO bacteraemia, except for immunosuppression [OR 2.86; p = 0.0207], severity of the episode [OR 3.13; p = 0.0232], carriage of PA [OR 5.24; p = 0.0395], and hospital-acquired infection [OR 2.49; p = 0.034]. In the multivariate analysis, factors significantly associated with MDRO bacteraemia among colonized patient were only immunosuppression [OR = 2.96; p = 0.0354] and the hospital-acquired origin of bacteraemia [OR = 2.62; p = 0.0427]. Conclusions According to our study, occurrence of bacteraemia due to MDRO among MDRO carriers was high. Factors associated with MDRO bacteraemia were severity of the episode and hospital-acquired origin of the bacteraemia. Thus, during bacteraemia among patients colonized with MDRO, if such characteristics are present, broad-spectrum antimicrobial treatment is recommended.
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Affiliation(s)
- Hélène Mascitti
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Clara Duran
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Elisabeth-Marie Nemo
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Frédérique Bouchand
- 2Pharmacy department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Ruxandra Câlin
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Alexis Descatha
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Jean-Louis Gaillard
- 3Microbiological laboratory, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Christine Lawrence
- 3Microbiological laboratory, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - Benjamin Davido
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
| | - François Barbier
- Intensive care unit, Orléans Hospital, 14 Avenue de l'Hôpital, 45067 Orléans, France
| | - Aurélien Dinh
- 1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France
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Davido B, Moussiegt A, Dinh A, Bouchand F, Matt M, Senard O, Deconinck L, Espinasse F, Lawrence C, Fortineau N, Saleh-Mghir A, Caballero S, Escaut L, Salomon J. Germs of thrones - spontaneous decolonization of Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) in Western Europe: is this myth or reality? Antimicrob Resist Infect Control 2018; 7:100. [PMID: 30123500 PMCID: PMC6090624 DOI: 10.1186/s13756-018-0390-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022] Open
Abstract
Background In France, Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) are considered as Extensively Drug-Resistant (XDR) bacteria. Their management requires reinforcement of hospital’s hygiene policies, and currently there is few consistent data concerning the spontaneous decolonization in XDR colonized patients. Our aim is to study the natural history of decolonization of XDR carriers over time in a hospital setting in a low prevalence country. Material and methods Retrospective multicenter study over 2 years (2015–2016) in 2 different tertiary care hospital sites and units having an agreement for permanent cohorting of such XDR carriers. We gathered the type of microorganisms, risk factors for colonization and rectal swabs from patient’s follow-up. We also evaluated patient care considering isolation precautions. Results We included 125 patients, aged 63+/−19y, including 72.8% of CRE (n = 91), 24.8% of VRE (n = 31) and 2.4% (n = 3) co-colonized with CRE and VRE. CRE were mainly E. coli (n = 54), K. pneumoniae (n = 51) and E. cloacae (n = 6). Mechanisms of resistance were mainly OXA-48 (n = 69), NDM-1 (n = 11), OXA-232 (n = 8) and KPC (n = 3). Prior antibiotic therapy was reported in 38.4% (n = 48) of cases. Conversely, 17.6% (n = 22) received antibiotics during follow-up. Spontaneous decolonization occurred within the first 30 days in 16.4% (n = 19/116) of cases and up to 48.2% after day-90 with a median follow-up of 96 days (0–974). We estimated that XDR carriage was associated with a larger care burden in 13.6% (n = 17) of cases, especially due to a prolongation of hospitalization of 32.5 days (15–300). Conclusions Our study shows that spontaneous decolonization is increasing over time (up to 48.2%). We can regret that only few patients underwent screening after 1 year, emphasizing the need for more monitoring and prospective studies.
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Affiliation(s)
- Benjamin Davido
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Aurore Moussiegt
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Aurélien Dinh
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Frédérique Bouchand
- 2Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Morgan Matt
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Olivia Senard
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Laurene Deconinck
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Florence Espinasse
- 3Hygiène Hospitalière, Hôpital Universitaire Ambroise-Paré, AP-HP, 92210 Boulogne-Billancourt, France
| | - Christine Lawrence
- 4Hygiène Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Nicolas Fortineau
- 5Laboratoire de Microbiologie, Hôpital Universitaire Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Azzam Saleh-Mghir
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | | | - Lelia Escaut
- 7Maladies Infectieuses, Hôpital Universitaire Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Jérome Salomon
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
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Davido B, Senard O, Bouchand F, Deconinck L, Matt M, Fellous L, Rottman M, Perronne C, Dinh A. Efficacité de la céfoxitine dans les infections urinaires (IU) à E . coli et K . pneumoniae BLSE. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.257] [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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Matt M, Nich C, Geffrier A, Deconinck L, Davido B, Senard O, Bouchand F, Duran C, Rottman M, Dinh A. Intérêt d’un test de détection de l’infection ostéoarticulaire par l’alpha-défensine lors des reposes de prothèse orthopédique avec antécédent septique. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.215] [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: 10/14/2022]
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Bouchand F, Randuineau P, Leplay C, Matt M, Deconinck L, Sénard O, Villart M, Perronne C, Davido B, Dinh A. Contrôle des antibiothérapies de plus de 7 jours dans un hôpital universitaire et évaluation de l’impact clinique. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.044] [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: 10/14/2022]
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Falcou L, Davido B, Even A, Bouchand F, Salomon J, Sotto A, Denys P, Dinh A. [Original strategy for prevention of recurrent symptomatic urinary tract infections in patients with neurogenic bladder: Bacterial interference, state of the art]. Prog Urol 2018; 28:307-314. [PMID: 29699855 DOI: 10.1016/j.purol.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/08/2018] [Accepted: 03/14/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Urinary tract infection (UTI) is the most common complication in patients with neurogenic bladder. The long-term use of antibiotic drugs induces an increase in antimicrobial resistance and adverse drug reactions. Bacterial interference is a new concept to prevent recurrent UTI which consists in a bladder colonization with low virulence bacteria. We performed a literature review on this emerging therapy. MATERIALS AND METHODS Literature review of bacterial interference to prevent symptomatic urinary tract infection in neurological population. RESULTS Seven prospectives study including 3 randomized, double-blind and placebo controlled trial were analyzed. The neurological population was spinal cord injured in most cases. The bladder colonization was performed with 2 non-pathogen strains of Escherichia coli: HU 2117 and 83972. At 1 month, 38 to 83% of patients were colonized. Mean duration of colonization was 48.5 days to 12.3 months. All studies showed that colonization might reduce the number of urinary tract infections and is safe with absence of serious side effects. CONCLUSION Bacterial interference is a promising alternative therapy for the prevention of recurrent symptomatic urinary tract infections in neurogenic patients. This therapy should have developments for a daily use practice and for a long-term efficacy.
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Affiliation(s)
- L Falcou
- Unité d'urodynamique, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 92380 Garches, France
| | - B Davido
- Unité de maladies infectieuses, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - A Even
- Unité d'urodynamique, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 92380 Garches, France
| | - F Bouchand
- Pharmacie, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 92380 Garches, France
| | - J Salomon
- Unité de maladies infectieuses, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - A Sotto
- Service de maladies infectieuses, CHU de Nîmes, 30189 Nîmes, France
| | - P Denys
- Unité d'urodynamique, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 92380 Garches, France
| | - A Dinh
- Unité d'urodynamique, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 92380 Garches, France; Unité de maladies infectieuses, hôpital universitaire R.-Poincaré, UVSQ, AP-HP, 104, boulevard R.-Poincaré, 92380 Garches, France.
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Davido B, Lawrence C, Dinh A, Bouchand F. Back to the Future with the Use of Penicillin in Penicillin-Susceptible Staphylococcus aureus (PSSA) Bacteremia. Am J Med 2018; 131:e155. [PMID: 29555039 DOI: 10.1016/j.amjmed.2017.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Benjamin Davido
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Christine Lawrence
- Microbiologie, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
| | - Aurélien Dinh
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France
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Dinh A, Fessi H, Duran C, Batista R, Michelon H, Bouchand F, Lepeule R, Vittecoq D, Escaut L, Sobhani I, Lawrence C, Chast F, Ronco P, Davido B. Clearance of carbapenem-resistant Enterobacteriaceae vs vancomycin-resistant enterococci carriage after faecal microbiota transplant: a prospective comparative study. J Hosp Infect 2018; 99:481-486. [PMID: 29477634 DOI: 10.1016/j.jhin.2018.02.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 12/07/2017] [Accepted: 02/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE) carriage are increasing worldwide. Faecal microbiota transplantation (FMT) appears to be an attractive option for decolonization. This study aimed to evaluate CRE vs VRE clearance by FMT among carriers. METHODS A multi-centre trial was undertaken on patients with CRE or VRE digestive tract colonization who received FMT between January 2015 and April 2017. Adult patients with CRE or VRE colonization, confirmed by three consecutive rectal swabs at weekly intervals, including one in the week prior to FMT, were included in the study. Patients with immunosuppression or concomitant antibiotic prescription at the time of FMT were excluded. Successful decolonization was determined by at least two consecutive negative rectal swabs [polymerase chain reaction (PCR) and culture] on Days 7, 14, 21 and 28, and monthly for three months following FMT. RESULTS Seventeen patients were included, with a median age of 73 years [interquartile range (IQR) 64.3-79.0]. Median duration of carriage of CRE or VRE before FMT was 62.5 days (IQR 57.0-77.5). One week after FMT, three of eight patients were free of CRE colonization and three of nine patients were free of VRE colonization. After three months, four of eight patients were free of CRE colonization and seven of eight patients were free of VRE colonization. Qualitative PCR results were concordant with culture. Six patients received antibiotics during follow-up, three in each group. No adverse events were reported. CONCLUSION CRE and VRE clearance rates were not significantly different in this study, possibly due to the small sample size, but a trend was observed. These data should be confirmed by larger cohorts and randomized trials.
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Affiliation(s)
- A Dinh
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France.
| | - H Fessi
- Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Batista
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - H Michelon
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Lepeule
- Antimicrobial Stewardship Unit, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - D Vittecoq
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Kremlin-Bicêtre, France
| | - L Escaut
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Kremlin-Bicêtre, France
| | - I Sobhani
- Gastro-enterology Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - C Lawrence
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Chast
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - P Ronco
- Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France
| | - B Davido
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
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Dinh A, Demay O, Rottman M, Gaudot F, Bougnoux ME, Bouchand F, Coignard H, Rouzaud C, Davido B, Duran C, Nich C. Case of femoral pseudarthrosis due to Scedosporium apiospermum in an immunocompetent patient with successful conservative treatment and review of literature. Mycoses 2018; 61:400-409. [PMID: 29274090 DOI: 10.1111/myc.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/11/2017] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
Abstract
Scedosporium apiospermum is a ubiquitous filamentous fungus, commonly found in soil, sewage and polluted waters. It is rarely pathogenic but can cause a broad spectrum of clinical diseases, which can be localised or disseminate to distant organs. The disseminated form of the disease is mostly seen among immunocompromised patients. However, some rare cases of disseminated disease have been reported in immunocompetent individuals. Treatment of these infections is challenging because of their natural resistance to many antifungal agents. Here, we report the case of a 57-year-old immunocompetent patient diagnosed with femoral pseudarthrosis due to S. apiospermum, despite having no obvious clinical sign of infection. Previously, the patient had undergone four iterative femoral surgeries following a road traffic accident which occurred 20 years before. During its last surgery for pseudarthrosis, no clinical or biological signs of infection were present. Per operative samples tested positive for S. apiospermum. The patient was successfully treated with oral voriconazole during 6 months with an excellent tolerance. We also provide a review of literature on bone and joint infections due to Scedosporium spp. (S. apiospermum, Scedosporium boydii and Scedosporium aurantiacum), discussing the evolution of their management and outcome which seems to improve since the use of voriconazole.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Olivier Demay
- Orthopaedic Surgery Department, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Martin Rottman
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Fabrice Gaudot
- Orthopaedic Surgery Department, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | | | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Hélène Coignard
- Infectious Diseases Department, Necker Teaching Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Claire Rouzaud
- Infectious Diseases Department, Necker Teaching Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Benjamin Davido
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Christophe Nich
- Orthopaedic Surgery Department, Raymond Poincaré Teaching Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
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Dinh A, Duran C, Davido B, Lagrange A, Sivadon-Tardy V, Bouchand F, Beauchet A, Gaillard JL, Beaune S, Salomon J, Grenet J. Cost effectiveness of pneumococcal urinary antigen in Emergency Department: a pragmatic real-life study. Intern Emerg Med 2018; 13:69-73. [PMID: 27988829 DOI: 10.1007/s11739-016-1586-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/30/2016] [Indexed: 01/23/2023]
Abstract
Community-acquired pneumonia (CAP) is frequent and can be life-threatening. Streptococcus pneumoniae is the main bacteria involved, and is susceptible to penicillin A. Rapid microbiological diagnosis could then help reduce the antimicrobial spectrum. The pneumococcal urinary antigen (PUA) test is fast and easy to perform, but its impact on antimicrobial prescription and cost-effectiveness in emergency departments (ED) is not well known. We performed a pragmatic real life retrospective study in an adult ED to assess its usefulness: proportion of positive results, impact on antimicrobial prescriptions and cost-effectiveness. Over 3 years (from January 1st 2012 to December 31st 2014), 979 PUA tests were reutilized in our ED among 1224 patients who consulted for CAP; 51 (5.2%) were positive. Among them, 10 led to a modification of the antimicrobial treatment, but only 7 (14.3%) were in accordance with the results. The total cost of a PUA test is 27€. As only 7 PUA tests led to appropriate antimicrobial modification, we deemed that 972 had no impact, and the potential cost savings, if the test had not been used, would have been 26,244 € (972 × 27) during 3 years, that is 8748 € per year. Thus, it seems that the PUA test should not be generally used in the ED considering its low rate of positivity and the difficulties for physicians to adapt antibiotic treatment accordingly. This attitude change in utilization would lead to substantial cost savings.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
| | - Clara Duran
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Aurore Lagrange
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Valérie Sivadon-Tardy
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Frédérique Bouchand
- Pharmacy Department, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Alain Beauchet
- IT Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Sébastien Beaune
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jérôme Salomon
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Julie Grenet
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
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Davido B, Bouchand F, Dinh A, Perronne C, Villart M, Senard O, Salomon J. Reinforcement of an antimicrobial stewardship task force aims at a better use of antibiotics of last resort: the COLITIFOS study. Int J Antimicrob Agents 2017; 50:142-147. [DOI: 10.1016/j.ijantimicag.2017.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/05/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
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Dinh A, Duran C, Davido B, Bouchand F, Deconinck L, Matt M, Sénard O, Guyot C, Levasseur AS, Attal J, Razazi D, Tritz T, Beauchet A, Salomon J, Beaune S, Grenet J. Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department. J Hosp Infect 2017; 97:288-293. [PMID: 28698021 DOI: 10.1016/j.jhin.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/16/2017] [Accepted: 07/04/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Antimicrobial stewardship programmes (ASPs) have been effective in optimizing antibiotic use for inpatients. However, an emergency department's fast-paced clinical setting can be challenging for a successful ASP. AIM In April 2015, an ASP was implemented in our emergency department and we aimed to determine its impact on antimicrobial use for outpatients. METHODS This was a single-centre study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016). For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24h) were evaluated by an infectious disease specialist and an emergency department physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified. FINDINGS Before and after ASP, 34,671 and 35,925 consultations were registered at our emergency department, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (P < 0.0001). There were 484 (62.9%) and 271 (46.7%) (P < 0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliance included unnecessary antimicrobial prescriptions, 197 (25.6%) vs 101 (17.4%) (P<0.0005); inappropriate spectrum, 108 (14.0%) vs 54 (9.3%) (P=0.008); excessive treatment duration, 87 (11.3%) vs 53 (9.1%) (P>0.05); and inappropriate choices, 11 (1.4%) vs 15 (2.6%) (P>0.05). CONCLUSION The implementation of an ASP markedly decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.
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Affiliation(s)
- A Dinh
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France.
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - B Davido
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - L Deconinck
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - M Matt
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - O Sénard
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - C Guyot
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - A-So Levasseur
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - J Attal
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - D Razazi
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - T Tritz
- Pharmacy Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Garches, France
| | - A Beauchet
- Medical Informatic Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Garches, France
| | - J Salomon
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - S Beaune
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - J Grenet
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
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Bouchand F, Truchard E, Sigonney F, Rottman M, Lotfi N, Villart M, Nich C, Dinh A. La prescription des anti-infectieux après décisions collégiales dans un Centre de référence des infections ostéoarticulaires (CRIOA) : une étape à risque d’erreur médicamenteuse. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.121] [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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49
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Bouchand F, Leplay C, Davido B, Matt M, Villart M, Salomon J, Dinh A. Impact d’une alerte systématique de réévaluation des antibiothérapies de plus de 7 jours par un infectiologue dans un hôpital universitaire. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prendki V, Sergent P, Barrelet A, Oziol E, Beretti E, Berlioz-Thibal M, Bouchand F, Dauchy FA, Forestier E, Gavazzi G, Ronde-Oustau C, Stirnemann J, Dinh A. Efficacy of indefinite chronic oral antimicrobial suppression for prosthetic joint infection in the elderly: a comparative study. Int J Infect Dis 2017; 60:57-60. [PMID: 28526565 DOI: 10.1016/j.ijid.2017.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND During prosthetic joint infection (PJI), surgical management is sometimes impossible and indefinite chronic oral antimicrobial suppression (ICOAS) may be the only option. The outcomes of elderly patients who benefited from ICOAS with strictly palliative intent were evaluated. METHODS A national retrospective cohort study was performed in France, involving patients aged >75 years with a PJI who were managed with planned life-long ICOAS from 2009 to 2014. Patients who experienced an event were compared to those who did not. An event was defined as a composite outcome in patients undergoing ICOAS, including local or systemic progression of the infection, death, or discontinuation of antimicrobial therapy because of an adverse drug reaction. RESULTS Twenty-one patients were included, with a median age of 85 years (interquartile range 81-88 years). Eight of the 21 patients experienced an event: one had an adverse drug reaction, three had systemic progression of sepsis, and two had local progression. Two of the 21 patients died. No death was related to ICOAS or infection. There was no significant difference between the population with an event and the population free of an event with regard to demographic, clinical, and microbiological characteristics (p>0.05). CONCLUSIONS ICOAS appeared to be an effective and safe option in this cohort.
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Affiliation(s)
- V Prendki
- Internal Medicine and Rehabilitation Unit, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - P Sergent
- Department of Orthopaedics and Traumatology, Jean Minjoz University Hospital, Besançon, France
| | - A Barrelet
- Division of Infectious Diseases Unit, Le Chesnay, France
| | - E Oziol
- Internal Medicine Unit, Béziers Hospital, Béziers, France
| | | | - M Berlioz-Thibal
- Department of Orthopaedics and Traumatology, University Hospital of Nantes, Nantes, France
| | - F Bouchand
- Pharmacy, Raymond Poincaré University Hospital, AP-HP, Garches, France
| | - F A Dauchy
- Division of Infectious Diseases, University Hospital of Bordeaux, Bordeaux, France
| | - E Forestier
- Infectious Diseases Unit, Chambéry Hospital, Chambéry, France
| | - G Gavazzi
- Division of Infectious Diseases, University Hospital of Grenoble - University Clinic of Geriatric Medicine, Grenoble, France
| | - C Ronde-Oustau
- Division of Infectious Diseases, University Hospital of Strasbourg, Strasbourg, France
| | - J Stirnemann
- Internal Medicine and Rehabilitation Unit, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - A Dinh
- Division of Infectious Diseases Unit, Raymond Poincaré University Hospital, AP-HP, Garches, France.
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