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Desmoulin A, Sababadichetty L, Kamus L, Daniel M, Feletti L, Allou N, Potron A, Leroy AG, Jaffar-Bandjee MC, Belmonte O, Garrigos T, Miltgen G. Adaptive resistance to cefiderocol in carbapenem-resistant Acinetobacter baumannii (CRAB): Microbiological and clinical issues. Heliyon 2024; 10:e30365. [PMID: 38720704 PMCID: PMC11076957 DOI: 10.1016/j.heliyon.2024.e30365] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Determining the best available therapy for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is a challenge. Cefiderocol is an attractive alternative drug effective against many resistance mechanisms in Gram-negative bacteria. However, its place in the treatment of Acinetobacter baumannii infections remains unclear and much debated, with contradictory results. Methods We describe here the case of a 37-year-old man with ventilator-associated bacteraemic CRAB pneumonia in an intensive care unit. He was initially treated with a combination of colistin and tigecycline, and was then switched onto colistin and cefiderocol. We then used a new accessible protocol to test 30 CRAB isolates (OXA-23/OXA-24/OXA-58/NDM-1) for adaptive resistance to cefiderocol (ARC) after exposure to this drug. Results After clinical failure with the initial combination, we noted a significant clinical improvement in the patient on the second combination, leading to clinical cure. No ARC was detected in the two OXA-23 case-CRAB isolates. All NDM-1 CRAB isolates were resistant to cefiderocol in standard tests; the OXA-23, OXA-24 and OXA-58 CRAB isolates presented 84.2 %, 50 % and 0 % ARC, respectively. Conclusions ARC is not routinely assessed for CRAB isolates despite frequently being reported in susceptible isolates (69.2 %). Subpopulations displaying ARC may account for treatment failure, but this hypothesis should be treated with caution in the absence of robust clinical data. The two main findings of this work are that (i) cefiderocol monotherapy should probably not be recommended for OXA-23/24 CRAB infections and (ii) the characterisation of carbapenemases in CRAB strains may be informative for clinical decision-making.
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Affiliation(s)
- Anissa Desmoulin
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Loïk Sababadichetty
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Laure Kamus
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Marion Daniel
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Lucie Feletti
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Nicolas Allou
- Service de Réanimation Polyvalente, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Anaïs Potron
- Centre National de La Résistance Aux Antibiotiques, Laboratoire Associé Pseudomonas et Acinetobacter, CHU Jean Minjoz, Besançon, France
| | - Anne-Gaëlle Leroy
- Laboratoire de Bactériologie, Groupe Hospitalier Sud Réunion, Saint-Pierre, La Réunion, France
| | | | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Thomas Garrigos
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
- Centre Régional en Antibiothérapie de La Réunion, Saint-Denis, La Réunion, France
| | - Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
- Centre Régional en Antibiothérapie de La Réunion, Saint-Denis, La Réunion, France
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Hoarau AOG, Mavingui P, Miltgen G. Comprehensive analysis of antimicrobial resistance in the Southwest Indian Ocean: focus on WHO critical and high priority pathogens. Front Public Health 2024; 12:1357345. [PMID: 38628847 PMCID: PMC11018943 DOI: 10.3389/fpubh.2024.1357345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
The spread of antimicrobial resistance (AMR) is a major global concern, and the islands of the Southwest Indian Ocean (SWIO) are not exempt from this phenomenon. As strategic crossroads between Southern Africa and the Indian subcontinent, these islands are constantly threatened by the importation of multidrug-resistant bacteria from these regions. In this systematic review, our aim was to assess the epidemiological situation of AMR in humans in the SWIO islands, focusing on bacterial species listed as priority by the World Health Organization. Specifically, we examined Enterobacterales, Acinetobacter spp., Pseudomonas spp. resistant to carbapenems, and Enterococcus spp. resistant to vancomycin. Our main objectives were to map the distribution of these resistant bacteria in the SWIO islands and identify the genes involved in their resistance mechanisms. We conducted literature review focusing on Comoros, Madagascar, Maldives, Mauritius, Mayotte, Reunion Island, Seychelles, Sri Lanka, and Zanzibar. Our findings revealed a growing interest in the investigation of these pathogens and provided evidence of their active circulation in many of the territories investigated. However, we also identified disparities in terms of data availability between the targeted bacteria and among the different territories, emphasizing the need to strengthen collaborative efforts to establish an efficient regional surveillance network.
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Affiliation(s)
- Axel O. G. Hoarau
- Université de La Réunion, Processus Infectieux en Milieu Insulaire Tropical, Sainte-Clotilde, La Réunion, France
| | - Patrick Mavingui
- Université de La Réunion, Processus Infectieux en Milieu Insulaire Tropical, Sainte-Clotilde, La Réunion, France
| | - Guillaume Miltgen
- Université de La Réunion, Processus Infectieux en Milieu Insulaire Tropical, Sainte-Clotilde, La Réunion, France
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- Centre Régional en Antibiothérapie (CRAtb) de La Réunion, Saint-Pierre, La Réunion, France
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Sababadichetty L, Miltgen G, Vincent B, Guilhaumon F, Lenoble V, Thibault M, Bureau S, Tortosa P, Bouvier T, Jourand P. Microplastics in the insular marine environment of the Southwest Indian Ocean carry a microbiome including antimicrobial resistant (AMR) bacteria: A case study from Reunion Island. Mar Pollut Bull 2024; 198:115911. [PMID: 38103498 DOI: 10.1016/j.marpolbul.2023.115911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
The increasing threats to ecosystems and humans from marine plastic pollution require a comprehensive assessment. We present a plastisphere case study from Reunion Island, a remote oceanic island located in the Southwest Indian Ocean, polluted by plastics. We characterized the plastic pollution on the island's coastal waters, described the associated microbiome, explored viable bacterial flora and the presence of antimicrobial resistant (AMR) bacteria. Reunion Island faces plastic pollution with up to 10,000 items/km2 in coastal water. These plastics host microbiomes dominated by Proteobacteria (80 %), including dominant genera such as Psychrobacter, Photobacterium, Pseudoalteromonas and Vibrio. Culturable microbiomes reach 107 CFU/g of microplastics, with dominance of Exiguobacterium and Pseudomonas. Plastics also carry AMR bacteria including β-lactam resistance. Thus, Southwest Indian Ocean islands are facing serious plastic pollution. This pollution requires vigilant monitoring as it harbors a plastisphere including AMR, that threatens pristine ecosystems and potentially human health through the marine food chain.
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Affiliation(s)
- Loik Sababadichetty
- Université de La Réunion, UMR ENTROPIE, 15 Avenue René Cassin, CS 92003, 97744 Saint Denis Cedex 9, La Réunion, France; CHU, Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400 Saint-Denis, La Réunion, France
| | - Guillaume Miltgen
- CHU, Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400 Saint-Denis, La Réunion, France; Université de La Réunion, UMR PIMIT Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM 1187, IRD 249, Plateforme de recherche CYROI, 2 rue Maxime Rivière, 97490 Ste Clotilde, La Réunion, France
| | - Bryan Vincent
- CIRAD, UMR040 LSTM, Campus Agro Environnemental Caraïbe, BP 214-97285, Cedex 2 le Lamentin, Martinique, Antilles Françaises, France
| | - François Guilhaumon
- IRD, UMR ENTROPIE, 15 Avenue René Cassin, CS 92003, 97744 Saint Denis Cedex 9, La Réunion, France
| | - Veronique Lenoble
- Université de Toulon, Aix Marseille Université, CNRS, IRD, UMR MIO, 83 Toulon, France
| | - Margot Thibault
- Université de La Réunion, UMR ENTROPIE, 15 Avenue René Cassin, CS 92003, 97744 Saint Denis Cedex 9, La Réunion, France; The Ocean Cleanup, Rotterdam, the Netherlands; CNRS, Université Toulouse III, Laboratoire des Interactions Moléculaires et Réactivité Chimique et Photochimique (IMRCP), UMR 5623, Toulouse, France
| | - Sophie Bureau
- Université de La Réunion, UMR ENTROPIE, 15 Avenue René Cassin, CS 92003, 97744 Saint Denis Cedex 9, La Réunion, France
| | - Pablo Tortosa
- Université de La Réunion, UMR PIMIT Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM 1187, IRD 249, Plateforme de recherche CYROI, 2 rue Maxime Rivière, 97490 Ste Clotilde, La Réunion, France
| | - Thierry Bouvier
- UMR MARBEC, Université Montpellier, CNRS, Ifremer, IRD, Montpellier, France
| | - Philippe Jourand
- IRD, UMR ENTROPIE, 15 Avenue René Cassin, CS 92003, 97744 Saint Denis Cedex 9, La Réunion, France.
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Sarsiat L, Garrigos T, Houhamdi L, Dauwalder O, Kuli B, Braunberger E, Belmonte O, Fournier PE, Miltgen G. Case series of 12 Bartonella quintana endocarditis from the Southwest Indian Ocean. PLoS Negl Trop Dis 2023; 17:e0011606. [PMID: 37676863 PMCID: PMC10508605 DOI: 10.1371/journal.pntd.0011606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Bartonella spp. are fastidious bacteria frequently identified as the cause of blood culture-negative (BCN) endocarditis. However, Bartonella infections are difficult to diagnose in routine laboratory testing and their incidence is probably underestimated. We investigated the epidemiological and clinical features of Bartonella endocarditis cases diagnosed between 2009 and 2021 on Reunion Island (Southwest Indian Ocean). METHOD We retrospectively included all patients diagnosed with Bartonella endocarditis at Reunion Island University Hospital during this period. Endocarditis was diagnosed on the basis of microbiological findings, including serological tests (IFA) and PCR on cardiac valves, and the modified Duke criteria. We used then the multispacer typing (MST) method to genotype the available Bartonella strains. FINDINGS We report 12 cases of B. quintana endocarditis on Reunion Island (83.3% in men, median patient age: 32 years). All the patients originated from the Comoros archipelago. The traditional risk factors for B. quintana infection (homelessness, alcoholism, exposure to body lice) were absent in all but two of the patients, who reported head louse infestations in childhood. Previous heart disease leading to valve dysfunction was recorded in 50% of patients. All patients underwent cardiac valve surgery and antimicrobial therapy with a regimen including doxycycline. All patients presented high C-reactive protein concentrations, anemia and negative blood cultures. The titer of IgG antibodies against Bartonella sp. exceeded 1:800 in 42% of patients. Specific PCR on cardiac valves confirmed the diagnosis of B. quintana endocarditis in all patients. Genotyping by the MST method was performed on four strains detected in preserved excised valves and was contributive for three, which displayed the MST6 genotype. CONCLUSIONS Bartonella quintana is an important cause of infective endocarditis in the Comoros archipelago and should be suspected in patients with mitral valve dysfunction and BCN from this area.
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Affiliation(s)
- Ludivine Sarsiat
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Thomas Garrigos
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
| | - Linda Houhamdi
- CNR des Rickettsies, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
| | - Olivier Dauwalder
- Plateau de Microbiologie Moléculaire Spécialisé et de Séquençage, Institut des Agents Infectieux, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France
| | - Barbara Kuli
- Service de Maladies Infectieuses, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Eric Braunberger
- Service de Chirurgie Cardio-thoracique, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Pierre-Edouard Fournier
- CNR des Rickettsies, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
- UMR Vecteurs—Infections Tropicales et Méditerranéennes (VITROME), Université d’Aix-Marseille, IRD, AP-HM, SSA, IHU-Méditerranée Infection, Marseille, France
| | - Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
- Centre Régional en Antibiothérapie (CRAtb) de La Réunion, France
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Combe A, Kovacs D, de Mangou A, Miltgen G, Traversier N, Belmonte O, Simon O, Vidal C, Coolen-Allou N, Allyn J, Allou N. Impact of the COVID-19 pandemic on severe non-SARS-CoV-2 community-acquired pneumonia in Reunion Island: a multicenter retrospective observational study, 2016-2021. Sci Rep 2023; 13:14013. [PMID: 37640709 PMCID: PMC10462684 DOI: 10.1038/s41598-023-40791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
The Coronavirus 2019 (COVID-19) pandemic has had a considerable impact on the incidence of severe community-acquired pneumonia (CAP) worldwide. The aim of this study was to assess the early impact of the COVID-19 pandemic in the Reunion Island. This multicenter retrospective observational study was conducted from 2016 to 2021 in the hospitals of Reunion Island. The incidence of severe non-SARS-CoV-2 CAP, microorganisms, characteristics and outcomes of patients hospitalized in intensive care unit were compared between the pre-COVID-19 period (January 1, 2016 to February 29, 2020) and the early COVID-19 period (March 1, 2020 to October 31, 2021). Over the study period, 389 patients developed severe non-SARS-CoV-2 CAP. The incidence of severe non-SARS-CoV-2 CAP significantly decreased between the two periods (9.16 vs. 4.13 cases per 100,000 person-years). The influenza virus was isolated in 43.5% patients with severe non-SARS-CoV-2 CAP in the pre-COVID-19 period and in none of the 60 patients in the early COVID-19 period (P < 0.0001). The only virus that did not decrease was rhinovirus. Streptococcus pneumoniae was the most frequently isolated bacterial microorganism, with no significant difference between the two periods. In Reunion Island, the COVID-19 pandemic led to a significant decrease in the incidence of influenza, which likely explains the observed decrease in the incidence of severe non-SARS-CoV-2 CAP. The pandemic had no impact on the incidence of other viral and bacterial severe non-SARS-CoV-2 CAP. Monitoring influenza incidence is crucial now that COVID-19 control measures have been removed.
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Affiliation(s)
- Agathe Combe
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - David Kovacs
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Axel de Mangou
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Guillaume Miltgen
- Microbiology, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Nicolas Traversier
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Olivier Belmonte
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Olivier Simon
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Pierre, Reunion Island, France
| | - Charles Vidal
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Nathalie Coolen-Allou
- Respiratory Medicine, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
| | - Jérôme Allyn
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France
- Clinical Informatic Department, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, Reunion Island, France
| | - Nicolas Allou
- Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Reunion Island, France.
- Clinical Informatic Department, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, Reunion Island, France.
- Hôpital Felix Guyon, Réanimation Polyvalente, Bellepierre, 97405, Saint-Denis, France.
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Garrigos T, Grimal A, Badell E, Traversier N, Picot S, Lignereux A, Ramiandrisoa M, Ben Cimon C, Jaffar-Bandjee MC, Gbaguidi-Haore H, Toubiana J, Brisse S, Miltgen G, Belmonte O. Emerging Corynebacterium diphtheriae Species Complex Infections, Réunion Island, France, 2015-2020. Emerg Infect Dis 2023; 29:1630-1633. [PMID: 37486209 PMCID: PMC10370861 DOI: 10.3201/eid2908.230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Clinical, epidemiologic, and microbiologic analyses revealed emergence of 26 cases of Corynebacterium diphtheriae species complex infections on Réunion Island, France, during 2015-2020. Isolates were genetically diverse, indicating circulation and local transmission of several diphtheria sublineages. Clinicians should remain aware of the risk for diphtheria and improve diagnostic methods and patient management.
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Malaure C, Hoang S, Bagny K, Tauziède-Espariat A, Garcia-Hermoso D, Kamus L, Traversier N, Miltgen G, Garrigos T. Multifocal cutaneous phaeohyphomycosis caused by Paraconiothyrium cyclothyrioides in an immunocompromised patient: A case report. J Dermatol 2023. [PMID: 36601708 DOI: 10.1111/1346-8138.16706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Célie Malaure
- Department of Bacteriology, University Hospital Centre Félix Guyon, Saint-Denis, France
| | - Stella Hoang
- Department of Infectious Diseases, University Hospital Centre Félix Guyon, Saint-Denis, France
| | - Kelly Bagny
- Department of Dermatology, CHU Félix Guyon, Saint-Denis, France
| | - Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Dea Garcia-Hermoso
- Centre National de la Recherche Scientifique, Centre National de Référence Mycoses Invasives et Antifongiques, Unité de Mycologie Moléculaire, UMR2000, Paris, France
| | - Laure Kamus
- Department of Bacteriology, University Hospital Centre Félix Guyon, Saint-Denis, France.,UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, University of La Réunion, Sainte-Clotilde, France
| | - Nicolas Traversier
- Department of Bacteriology, University Hospital Centre Félix Guyon, Saint-Denis, France
| | - Guillaume Miltgen
- Department of Bacteriology, University Hospital Centre Félix Guyon, Saint-Denis, France.,UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, University of La Réunion, Sainte-Clotilde, France.,Centre Régional en Antibiothérapie (CRATb) de La Réunion, Saint-Denis, France
| | - Thomas Garrigos
- Department of Bacteriology, University Hospital Centre Félix Guyon, Saint-Denis, France.,UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, University of La Réunion, Sainte-Clotilde, France
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de Mangou A, Combe A, Coolen-Allou N, Miltgen G, Traversier N, Belmonte O, Vandroux D, Bohrer M, Cousty J, Caron M, Vidal C, Allyn J, Allou N. Severe community-acquired pneumonia in Reunion Island: Epidemiological, clinical, and microbiological characteristics, 2016–2018. PLoS One 2022; 17:e0267184. [PMID: 35427402 PMCID: PMC9012352 DOI: 10.1371/journal.pone.0267184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/15/2021] [Accepted: 04/04/2022] [Indexed: 12/17/2022] Open
Abstract
Purpose No data are available on severe community-acquired pneumonia (CAP) in the French overseas department of Reunion Island. This is unfortunate as the microorganisms responsible for the disease are likely to differ from those in temperate regions due to a tropical climate and proximity to other islands of the Indian Ocean region. The aim of this study was to assess the epidemiological, clinical, prognosis, and microbiological characteristics of patients with severe CAP in Reunion Island. Materials and methods This retrospective study evaluated all patients with CAP aged >18 years and hospitalized in one of the two intensive care units of Reunion Island between 2016 and 2018. Microorganisms were identified by culture from blood and respiratory samples, multiplex polymerase chain reaction from respiratory samples, urinary antigen tests, and serology. Results Over the study period, 573 cases of severe CAP were recorded, with a mean incidence of 22 per 100,000 person-years. The most frequently isolated microorganism was influenza (21.9%) followed by Streptococcus pneumoniae (12%). The influenza virus was detected in affected patients all year round. Twenty-four patients with severe CAP came from another island of the Indian Ocean region (4.2%), mainly Madagascar (>50%). Two of these patients presented with melioidosis and 4 were infected with Acinetobacter spp. Conclusions Our findings have major implications for the management of severe CAP in tropical regions. The most frequently isolated microorganism in patients with severe CAP in Reunion Island is influenza followed by S. pneumoniae. Physicians should be aware that influenza is the main cause of severe CAP in patients living in or returning from Reunion Island, where this virus circulates all year round.
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Affiliation(s)
- Axel de Mangou
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Agathe Combe
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Nathalie Coolen-Allou
- Respiratory Disease, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Guillaume Miltgen
- Microbiology, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de la Réunion, Saint-Denis, France
| | - Nicolas Traversier
- Microbiology, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Olivier Belmonte
- Microbiology, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - David Vandroux
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Michel Bohrer
- Department of Medical Information, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France
| | - Julien Cousty
- Intensive Care Unit, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre, France
| | - Margot Caron
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Charles Vidal
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
| | - Jérôme Allyn
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
- Clinical Informatic Department, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France
| | - Nicolas Allou
- Intensive Care Unit, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, France
- Clinical Informatic Department, Saint-Denis University Hospital, Saint-Denis, Reunion Island, France
- * E-mail:
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Miltgen G, Martak D, Valot B, Kamus L, Garrigos T, Verchere G, Gbaguidi-Haore H, Ben Cimon C, Ramiandrisoa M, Picot S, Lignereux A, Masson G, Jaffar-Bandjee MC, Belmonte O, Cardinale E, Hocquet D, Mavingui P, Bertrand X. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1254-1262. [PMID: 35194647 PMCID: PMC9047676 DOI: 10.1093/jac/dkac054] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) is a major cause of infections worldwide. An understanding of the reservoirs and modes of transmission of these pathogens is essential, to tackle their increasing frequency. Objectives We investigated the contributions of various compartments (humans, animals, environment), to human colonization or infection with ESBL-Ec over a 3 year period, on an island. Methods The study was performed on Reunion Island (Southwest Indian Ocean). We collected ESBL-Ec isolates prospectively from humans, wastewater and livestock between April 2015 and December 2018. Human specimens were recovered from a regional surveillance system representative of the island’s health facilities. These isolates were compared with those from livestock and urban/rural wastewater, by whole-genome sequencing. Results We collected 410 ESBL-Ec isolates: 161 from humans, 161 from wastewater and 88 from animals. Phylogenomic analysis demonstrated high diversity (100 STs), with different STs predominating among isolates from humans (ST131, ST38, ST10) and animals (ST57, ST156). The large majority (90%) of the STs, including ST131, were principally associated with a single compartment. The CTX-M-15, CTX-M-27 and CTX-M-14 enzymes were most common in humans/human wastewater, whereas CTX-M-1 predominated in animals. Isolates of human and animal origin had different plasmids carrying blaCTX-M genes, with the exception of a conserved IncI1-ST3 blaCTX-M-1 plasmid. Conclusions These molecular data suggest that, despite their high level of contamination, animals are not a major source of the ESBL-Ec found in humans living on this densely populated high-income island. Public health policies should therefore focus primarily on human-to-human transmission, to prevent human infections with ESBL-Ec.
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Affiliation(s)
- Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
- Corresponding author. E-mail:
| | - Daniel Martak
- Service d’Hygiène Hospitalière, CHU Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Benoit Valot
- UMR-CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Laure Kamus
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Thomas Garrigos
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Guillaume Verchere
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Houssein Gbaguidi-Haore
- Service d’Hygiène Hospitalière, CHU Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | | | | | - Sandrine Picot
- Laboratoire de Bactériologie, Groupe Hospitalier Sud Réunion, Saint-Pierre, La Réunion, France
| | - Anne Lignereux
- Laboratoire de Biologie, Centre Hospitalier Ouest Réunion, Saint-Paul, La Réunion, France
| | - Geoffrey Masson
- Laboratoire de Biologie, Groupe Hospitalier Est Réunion, Saint-Benoit, La Réunion, France
| | | | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Eric Cardinale
- Centre de Coopération International en Recherche Agronomique pour le Développement (CIRAD) Océan Indien (Réunion-Mayotte), Sainte-Clotilde, La Réunion, France
- UMR Animal, Santé, Territoires, Risques et Écosystèmes, INRAe 1309, Université de Montpellier, Montpellier, France
| | - Didier Hocquet
- Service d’Hygiène Hospitalière, CHU Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Patrick Mavingui
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Xavier Bertrand
- Service d’Hygiène Hospitalière, CHU Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
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10
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Saïb A, Bouscaren N, Berçot B, Duchateau A, Miltgen G, Rodet R, Wartel G, Andry F, Iacobelli S, Bertolotti A. Prevalence and risk factors for gonococcal infection in Reunion Island. Infect Dis Now 2021; 52:149-153. [PMID: 34920179 DOI: 10.1016/j.idnow.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors for gonococcal infection, and the resistance profile of Neisseria gonorrhoeae (NG) in Reunion Island. PATIENTS AND METHODS All patients who visited the four sexually transmitted infection (STI) clinics of Reunion Island between January 2017 and December 2018 were screened by multiplex polymerase chain reaction. Data on patient characteristics were collected using a self-administered questionnaire (reason for screening, marital status, risk-taking behaviors, place of birth, employment status, type of health care coverage, sexual orientation, number of sexual partners, occurrence of extra-marital relationships, history of STIs, and symptomatology. Precarity was defined as being unemployed and/or receiving universal health insurance). RESULTS The prevalence of NG (n=4289) in the screened population was 2.8% (95% CI [2.3-3.3]). Minors were especially at-risk (4.4% (95% CI [2.6-7])) and especially girls (5.6% (95% CI [3.2-8.9])). The prevalence observed in the homosexual population was 4.0% [2.6-5.9]. Gonococcal infection was asymptomatic in 56 (69%) patients. For all infection sites, the main risk factors were male minors (P=0.019), individuals living in conditions of precarity (P=0.023), individuals co-infected with chlamydia (P<0.001) or syphilis (P<0.001), and individuals of foreign origin (P=0.006). No NG strain was resistant to ceftriaxone. Strains were resistant to penicillin G, ciprofloxacin, and azithromycin in 22% (20/91), 38% (35/91), and 1% (1/91) of cases, respectively. CONCLUSION The prevalence of NG in patients visiting STI clinics in Reunion Island is particularly high among minors. Prevention programs targeting this population should be reinforced and screening should be facilitated in school settings.
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Affiliation(s)
- A Saïb
- CHU Réunion, service des maladies infectieuses - dermatologie, Saint-Pierre, Reunion
| | - N Bouscaren
- Inserm CIC1410, CHU Réunion, Saint-Pierre, Reunion
| | - B Berçot
- Département des agents infectieux, unité fonctionnelle de bactériologie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, Paris, France; Université Paris Diderot, UMR 1137, IAME, Sorbonne-Paris Cité, Paris, France
| | - A Duchateau
- CHU Réunion, service de gynécologie, Saint-Pierre, Reunion
| | - G Miltgen
- CHU Réunion, service de microbiologie, Saint-Denis, Reunion
| | - R Rodet
- CHU Réunion, service des maladies infectieuses, Saint-Denis, Reunion
| | - G Wartel
- CHU Réunion, service des maladies infectieuses, Saint-Denis, Reunion
| | - F Andry
- CHU Réunion, service des maladies infectieuses - dermatologie, Saint-Pierre, Reunion
| | - S Iacobelli
- CHU Réunion, service de néonatalogie, Saint-Pierre, Reunion
| | - A Bertolotti
- CHU Réunion, service des maladies infectieuses - dermatologie, Saint-Pierre, Reunion; Inserm CIC1410, CHU Réunion, Saint-Pierre, Reunion.
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11
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Puech B, Canivet C, Teysseyre L, Miltgen G, Aujoulat T, Caron M, Combe C, Jabot J, Martinet O, Allyn J, Ferdynus C, Allou N. Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia. Ann Intensive Care 2021; 11:160. [PMID: 34825962 PMCID: PMC8626555 DOI: 10.1186/s13613-021-00950-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/04/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia. RESULTS This retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43-73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5-18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01-1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03-1.14, p = 0.002). Appropriate antibiotic therapy, and in particular trimethoprim-sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24-0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28-0.79, p = 0.04). Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5). CONCLUSION In our study, appropriate antibiotic therapy, and in particular trimethoprim-sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia.
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Affiliation(s)
- Bérénice Puech
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France.
| | - Clémence Canivet
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Laura Teysseyre
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Guillaume Miltgen
- Service de Microbiologie, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, France
| | - Thomas Aujoulat
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Margot Caron
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Chloé Combe
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Julien Jabot
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Olivier Martinet
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Jerome Allyn
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
- Département d'Informatique Clinique, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Cyril Ferdynus
- Département d'Informatique Clinique, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
- Département d'Informatique Clinique, Hôpital Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis, France
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12
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Miltgen G, Garrigos T, Cholley P, Deleume M, Allou N, Allyn J, Wilkinson DA, Lugagne N, Belmonte O, Bertrand X, Hocquet D, Mavingui P. Nosocomial cluster of carbapenemase-producing Enterobacter cloacae in an intensive care unit dedicated COVID-19. Antimicrob Resist Infect Control 2021; 10:151. [PMID: 34674756 PMCID: PMC8529563 DOI: 10.1186/s13756-021-01022-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Concomitant prevention of SARS-CoV-2 and extensively drug-resistant bacteria transmission is a difficult challenge in intensive care units dedicated to COVID-19 patients. We report a nosocomial cluster of four patients carrying NDM-1 plasmid-encoded carbapenemase-producing Enterobacter cloacae. Two main factors may have contributed to cross-transmission: misuse of gloves and absence of change of personal protective equipment, in the context of COVID-19-associated shortage. This work highlights the importance of maintaining infection control measures to prevent CPE cross-transmission despite the difficult context and that this type of outbreak can potentially involve several species of Enterobacterales.
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Affiliation(s)
- Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France. .,UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France.
| | - Thomas Garrigos
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Pascal Cholley
- Service d'Hygiène Hospitalière, CHU Jean Minjoz, Besançon, France.,UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Marine Deleume
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Nicolas Allou
- Service de Réanimation Polyvalente, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Jérôme Allyn
- Service de Réanimation Polyvalente, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - David A Wilkinson
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Nathalie Lugagne
- Service d'hygiène hospitalière, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Xavier Bertrand
- Service d'Hygiène Hospitalière, CHU Jean Minjoz, Besançon, France.,UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Didier Hocquet
- Service d'Hygiène Hospitalière, CHU Jean Minjoz, Besançon, France.,UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Patrick Mavingui
- UMR PIMIT, Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
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13
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Miltgen G, Bour M, Allyn J, Allou N, Vedani T, Vuillemenot JB, Triponney P, Martinet O, Lugagne N, Benoit-Cattin T, Dortet L, Birer A, Jaffar-Bandjee MC, Belmonte O, Plésiat P, Potron A. Molecular and epidemiological investigation of a colistin-resistant OXA-23-/NDM-1-producing Acinetobacter baumannii outbreak in the Southwest Indian Ocean Area. Int J Antimicrob Agents 2021; 58:106402. [PMID: 34293453 DOI: 10.1016/j.ijantimicag.2021.106402] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
Dual resistance to colistin and carbapenems is a milestone reached by certain extensively-drug resistant (XDR) Gram-negative bacteria. This study describes the first outbreak of XDR colistin- and carbapenem-resistant OXA-23-/NDM-1-producing Acinetobacter baumannii (CCRAB) in the European overseas territory of Reunion Island (France, Indian Ocean). Between April 2019 and June 2020, 13 patients admitted to the University Hospital of Reunion Island were involved in the outbreak, of whom eight were infected and six died. The first case was traced to a medical evacuation from Mayotte Island (Comoros archipelago). An epidemiological link could be established for 11 patients. All of the collected CCRAB isolates showed the same resistance profile and co-produced intrinsic β-lactamases OXA-69 and ADC-191, together with acquired carbapenem-hydrolysing β-lactamases OXA-23 and NDM-1. A mutation likely involved in colistin resistance was detected in the two-component system PmrAB (D82N in PmrA). All of the isolates were found to belong to STPas1/STOx231 clonal complex and were phylogenetically indistinguishable. Their further characterization by whole-genome sequence analyses (whole-genome multi-locus sequence typing, single nucleotide polymorphisms) provided hints about the transmission pathways. This study pleads for strict application of control and prevention measures in institutions where the risk of imported XDR bacteria is high.
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Affiliation(s)
- Guillaume Miltgen
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France; UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de la Réunion, Sainte-Clotilde, France
| | - Maxime Bour
- Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Jérôme Allyn
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France; Département d'informatique Clinique, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Nicolas Allou
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France; Département d'informatique Clinique, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Thibaut Vedani
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Jean-Baptiste Vuillemenot
- Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France; Laboratoire de Bactériologie, UMR CNRS 6249 Chrono-Environnement, Faculté de Médecine-Pharmacie, Université Bourgogne Franche-Comté, Besançon, France
| | - Pauline Triponney
- Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Olivier Martinet
- Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Nathalie Lugagne
- Service d'Hygiène hospitalière, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | | | - Laurent Dortet
- Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire associé, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
| | - Aurélien Birer
- Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire associé, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Olivier Belmonte
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Patrick Plésiat
- Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France; Laboratoire de Bactériologie, UMR CNRS 6249 Chrono-Environnement, Faculté de Médecine-Pharmacie, Université Bourgogne Franche-Comté, Besançon, France
| | - Anaïs Potron
- Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France; Laboratoire de Bactériologie, UMR CNRS 6249 Chrono-Environnement, Faculté de Médecine-Pharmacie, Université Bourgogne Franche-Comté, Besançon, France.
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14
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Levy Y, Miltgen G, Rousseau A, Lugagne N, Teysseyre L, Traversier N, Desnos-Ollivier M, Allou N, Allyn J. Case Report: Emergence of Candida auris in the Indian Ocean Region. Am J Trop Med Hyg 2020; 104:739-743. [PMID: 33319729 PMCID: PMC7866352 DOI: 10.4269/ajtmh.20-0758] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/27/2020] [Indexed: 12/28/2022] Open
Abstract
Candida auris is an emerging multidrug-resistant yeast that can cause severe infections and spread easily between hospitalized patients, leading to outbreaks in hospital. Here, we report the first four cases of colonization and invasive infection with C. auris reported in the Indian Ocean region. All cases were observed in the French overseas Reunion Island, a very popular destination for European travelers. Three patients had urinary tract or skin colonization, and one had a fatal invasive infection. In three cases, including that of the infected patient, the yeast was not initially identified as C. auris, preventing specific hygiene measures to be implemented as suggested in the December 2016 clinical alert to European healthcare facilities. The infected patient likely acquired C. auris in the intensive care unit from the first colonized patient. This is the first case of C. auris infection and the first potential case of nosocomial transmission of the pathogen to be reported in the French overseas Reunion Island.
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Affiliation(s)
- Yaël Levy
- Réanimation Polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Guillaume Miltgen
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, France
| | | | - Nathalie Lugagne
- CLIN, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Laura Teysseyre
- Réanimation Polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Nicolas Traversier
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
| | - Marie Desnos-Ollivier
- Molecular Mycology Unit, National Reference Center for Invasive Mycoses and Antifungals, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
- Département d’informatique Clinique, Centre Hospitalier Universitaire La Réunion, Saint-Denis Cedex, France
| | - Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France
- Département d’informatique Clinique, Centre Hospitalier Universitaire La Réunion, Saint-Denis Cedex, France
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15
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Gay N, Lugagne N, Miltgen G, Belmonte O, Cardinale E. Reunion Island, a sentinel territory for antimicrobial-resistant bacteria surveillance in the South-Western Indian Ocean: a retrospective survey using hospitalized patient screening, 2015-2017. BMC Public Health 2020; 20:1488. [PMID: 33004028 PMCID: PMC7528459 DOI: 10.1186/s12889-020-09591-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/22/2020] [Indexed: 12/31/2022] Open
Abstract
Background In 2015, antimicrobial resistance was identified as a public health priority for the South-Western Indian Ocean (SWIO) (i.e. Comoros, Madagascar, Mauritius, Mayotte (France), Reunion Island (France), and Seychelles). However, in 2020, colonization rates of antimicrobial-resistant bacteria (ARB) in human populations on most islands in SWIO were still not known and neither hospital nor community colonization rates had been estimated. The aim of this study was to estimate the prevalence of colonization of six ARB groups in hospitalized patients residing in the SWIO territories. The six groups comprise extended-spectrum betalactamase producing Enterobacteriaceae (ESBL-E), carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and both ceftazidime and/or imipenem-resistant Acinetobacter spp. (ACB), and ceftazidime and/or imipenem-resistant Pseudomonas spp. (PSA)). Methods Based on comprehensive hospital laboratory ARB screening data, we provide the first estimation of ARB colonization rates in hospitalized patients residing in SWIO (2015–2017). Using ARB colonization rates in Reunion Island (France) as the reference for estimating odds ratio, we identified at risk patients based on their territory of residence. Results The survey pointed to significantly higher overall ARB colonization rates in patients from Comoros, Madagascar, Mayotte, and Seychelles compared to Reunion Island as the reference. Extended-spectrum betalactamase producing Enterobacteriaceae was found to be the most common ARB group colonizing patients from SWIO territories. The highest MRSA colonization rates were observed in patients from Mayotte and Seychelles. Colonization by carbapenem-resistant Enterobacteriaceae (CRE) was highest in patients from Mauritius. Conclusion These results identify high ARB colonization rates in hospitalized patients from SWIO territories that require further investigation, particularly CRE in Mauritius and MRSA in Seychelles and Mayotte. This study is the first step toward the implementation of a broader regional ARB surveillance system.
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Affiliation(s)
- Noellie Gay
- UMR Animal Santé Territoires Risque Environnement (CIRAD, INRAe, Univ Montpellier), Montpellier, France.
| | - Nathalie Lugagne
- Nosocomial infection Unit, Felix-Guyon University hospital, La Reunion, Saint-Denis, France
| | - Guillaume Miltgen
- Bacteriology laboratory, Felix-Guyon University hospital, La Reunion, Saint-Denis, France.,UMR Processus Infectieux en Milieu Insulaire Tropical (CNRS 9192, INSERM U1187, IRD 249, Univ La Réunion), La Reunion, Saint-Denis, France
| | - Olivier Belmonte
- Bacteriology laboratory, Felix-Guyon University hospital, La Reunion, Saint-Denis, France
| | - Eric Cardinale
- UMR Animal Santé Territoires Risque Environnement (CIRAD, INRAe, Univ Montpellier), Montpellier, France.,Health Monitoring Unit, Indian Ocean Commission, Port-Louis, Mauritius
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16
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Renou A, Miltgen G, Blondé R, Jean F, Allyn J, Allou N. Case Report: Six New Cases of Melioidosis in the Indian Ocean Region: Comoros, Madagascar, Reunion Island. Am J Trop Med Hyg 2020; 103:1844-1845. [PMID: 32876008 DOI: 10.4269/ajtmh.20-0497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Melioidosis is an emerging disease caused by the environmental Gram-negative bacillus Burkholderia pseudomallei. Melioidosis has been reported to be endemic mainly in northern Australia and Southeast Asia. Here, we report the first two cases of melioidosis on the Comorian island of Mayotte. We also describe four cases that occurred over a short period of time in patients who had traveled between Mayotte, Madagascar, and Reunion Island.
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Affiliation(s)
- Amélie Renou
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Guillaume Miltgen
- Bacteriologie, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Renaud Blondé
- Réanimation Polyvalente, Centre Hospitalier de Mayotte, Universitaire Félix Guyon, Saint Denis, France
| | - Fanny Jean
- Pneumologie, Centre Hospitalier Universitaire Saint-Pierre, Saint Pierre, France
| | - Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France
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17
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Jacquier H, Miltgen G, Hoarau D, Kumanski S, Rollot O, Bruniquet S, Ndeikoundam N, Li Pat-Yuen G, Belmonte O, Bercot B, Roquebert B. Molecular epidemiology of Neisseria gonorrhoeae clinical isolates in Reunion and Mayotte. Sex Transm Infect 2020; 96:478-479. [PMID: 32366604 DOI: 10.1136/sextrans-2019-054374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/28/2020] [Accepted: 03/17/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hervé Jacquier
- IAME, INSERM UMR 1137, Université de Paris, Paris, France.,Department of Infectious Agents, French National Reference Center for Bacterial STI, Associated Laboratory for Gonococci, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Guillaume Miltgen
- CNRS 9192, INSERM U1187, IRD 249, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Université de la Réunion, Sainte-Clotilde, Réunion.,Microbiology Laboratory, Felix Guyon University Hospital Center, Saint-Pierre, La Réunion, Réunion
| | - Damien Hoarau
- CNRS 9192, INSERM U1187, IRD 249, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Université de la Réunion, Sainte-Clotilde, Réunion
| | - Sylvain Kumanski
- Department of Infectious Agents, French National Reference Center for Bacterial STI, Associated Laboratory for Gonococci, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | | | - Sandrine Bruniquet
- Microbiology Laboratory, Felix Guyon University Hospital Center, Saint-Pierre, La Réunion, Réunion
| | | | - Ghislaine Li Pat-Yuen
- Microbiology Laboratory, Felix Guyon University Hospital Center, Saint-Pierre, La Réunion, Réunion
| | - Olivier Belmonte
- Microbiology Laboratory, Felix Guyon University Hospital Center, Saint-Pierre, La Réunion, Réunion
| | - Beatrice Bercot
- IAME, INSERM UMR 1137, Université de Paris, Paris, France .,Department of Infectious Agents, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Bénédicte Roquebert
- CNRS 9192, INSERM U1187, IRD 249, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Université de la Réunion, Sainte-Clotilde, Réunion.,Microbiology Laboratory, Felix Guyon University Hospital Center, Saint-Pierre, La Réunion, Réunion
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18
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Miltgen G, Cholley P, Martak D, Thouverez M, Seraphin P, Leclaire A, Traversier N, Roquebert B, Jaffar-Bandjee MC, Lugagne N, Cimon CB, Ramiandrisoa M, Picot S, Lignereux A, Masson G, Allyn J, Allou N, Mavingui P, Belmonte O, Bertrand X, Hocquet D. Carbapenemase-producing Enterobacteriaceae circulating in the Reunion Island, a French territory in the Southwest Indian Ocean. Antimicrob Resist Infect Control 2020; 9:36. [PMID: 32075697 PMCID: PMC7031992 DOI: 10.1186/s13756-020-0703-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/16/2019] [Accepted: 02/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The spread of carbapenemase-producing Enterobacteriaceae (CPE) in the Southwest Indian Ocean area (SIOA) is poorly documented. Reunion Island is a French overseas territory located close to Madagascar and connected with Southern Africa, Indian sub-continent and Europe, with several weekly flights. Here we report the results of the CPE surveillance program in Reunion Island over a six-year period. METHODS All CPE were collected between January 2011 and December 2016. Demographics and clinical data of the carrier patients were collected. We determined their susceptibility to antimicrobials, identified the carbapenemases and ESBL by PCR and sequencing, and explored their genetic relationship using pulsed-field gel electrophoresis and multi-locus sequence typing. RESULTS A total of 61 CPEs isolated from 53 patients were retrieved in 6 public or private laboratories of the island. We found that 69.8% of CPE patients were linked to a foreign country of SIOA and that almost half of CPE cases (47.2%) reached the island through a medical evacuation. The annual number of CPE cases strongly increased over the studied period (one case in 2011 vs. 21 cases in 2016). A proportion of 17.5% of CPE isolates were non-susceptible to colistin. blaNDM was the most frequent carbapenemase (79.4%), followed by blaIMI (11.1%), and blaIMP-10 (4.8%). Autochtonous CPE cases (30.2%) harboured CPE isolates belonging to a polyclonal population. CONCLUSIONS Because the hospital of Reunion Island is the only reference healthcare setting of the SIOA, we can reasonably estimate that its CPE epidemiology reflects that of this area. Mauritius was the main provider of foreign CPE cases (35.5%). We also showed that autochthonous isolates of CPEs are mostly polyclonal, thus unrelated to cross-transmission. This demonstrates the local spread of carbapenemase-encoding genes (i.e. blaNDM) in a polyclonal bacterial population and raises fears that Reunion Island could contribute to the influx of NDM-carbapenemase producers into the French mainland territory.
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Affiliation(s)
- Guillaume Miltgen
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France. .,UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France.
| | - Pascal Cholley
- Laboratoire d'Hygiène Hospitalière, CHRU Jean Minjoz, Besançon, France.,UMR Chrono-Environnement, CNRS 6249, Université de Bourgogne Franche-Comté, Besançon, France
| | - Daniel Martak
- Laboratoire d'Hygiène Hospitalière, CHRU Jean Minjoz, Besançon, France.,UMR Chrono-Environnement, CNRS 6249, Université de Bourgogne Franche-Comté, Besançon, France
| | | | - Paul Seraphin
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Alexandre Leclaire
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Nicolas Traversier
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Bénédicte Roquebert
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France.,UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France.,UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Nathalie Lugagne
- Service d'hygiène hospitalière, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | | | | | - Sandrine Picot
- Laboratoire de Bactériologie, Groupe Hospitalier Sud Réunion, Saint-Pierre, La Réunion, France
| | - Anne Lignereux
- Laboratoire de biologie, Centre Hospitalier Gabriel Martin, Saint-Paul, La Réunion, France
| | - Geoffrey Masson
- Laboratoire de biologie, Groupe Hospitalier Est Réunion, Saint-Benoit, La Réunion, France
| | - Jérôme Allyn
- Service de Réanimation polyvalente. Département d'Informatique clinique, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Nicolas Allou
- Service de Réanimation polyvalente. Département d'Informatique clinique, CHU Félix Guyon, Saint-Denis, La Réunion, France
| | - Patrick Mavingui
- UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, La Réunion, France
| | - Olivier Belmonte
- Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France
| | - Xavier Bertrand
- Laboratoire d'Hygiène Hospitalière, CHRU Jean Minjoz, Besançon, France.,UMR Chrono-Environnement, CNRS 6249, Université de Bourgogne Franche-Comté, Besançon, France
| | - Didier Hocquet
- Laboratoire d'Hygiène Hospitalière, CHRU Jean Minjoz, Besançon, France.,UMR Chrono-Environnement, CNRS 6249, Université de Bourgogne Franche-Comté, Besançon, France
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19
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Teysseyre L, Ferdynus C, Miltgen G, Lair T, Aujoulat T, Lugagne N, Allou N, Allyn J. Derivation and validation of a simple score to predict the presence of bacteria requiring carbapenem treatment in ICU-acquired bloodstream infection and pneumonia: CarbaSCORE. Antimicrob Resist Infect Control 2019; 8:78. [PMID: 31139361 PMCID: PMC6528287 DOI: 10.1186/s13756-019-0529-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/05/2019] [Accepted: 04/28/2019] [Indexed: 12/22/2022] Open
Abstract
Background The recommendations of learned societies mention risk factors for the presence of multidrug resistant bacteria in hospital-acquired infections, but they do not propose a scoring system to guide empiric antibiotic therapy. Our study was aimed at developing a simple score for predicting "the presence of bacteria requiring carbapenem treatment" in ICU-acquired bloodstream infection and pneumonia. Methods Between December 2011 and January 2015, we conducted a retrospective study using a prospectively collected French database of nosocomial infections in the polyvalent intensive care unit of a French university hospital. All patients with ICU-acquired bloodstream infection or pneumonia were included in the study. Bivariate and multivariate analyses were performed to develop the CarbaSCORE, and this score was internally validated. Results In total, 338 patients were analyzed, including 27 patients requiring carbapenem treatment. The CarbaSCORE was composed of four criteria: "presence of bloodstream infection" (as opposed to pneumonia) scored 2 points, "chronic hemodialysis" scored 4 points, "travel abroad in the last 6 months" scored 5 points, and "MDR-colonization or prior use of a β-lactam of class ≥ 3" scored 6 points. Internal validation by bootstrapping showed an area under the receiver operating characteristic curve of 0.81 [0.73-0.89]. Sensitivity was 96% at the 6-point threshold and specificity was 91% at the 9-point threshold. Conclusions The CarbaSCORE is a simple and efficient score for predicting the presence of bacteria requiring carbapenem treatment. Further studies are needed to test this score before it can be used in practice.
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Affiliation(s)
- Laura Teysseyre
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, 97405 Saint-Denis cedex, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, 97405 Saint-Denis cedex, France.,INSERM, CIC 1410, F-97410 Saint-Pierre, France
| | - Guillaume Miltgen
- 4Laboratoire de bactériologie, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, cedex, 97405 Saint-Denis, France
| | - Thomas Lair
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, 97405 Saint-Denis cedex, France
| | - Thomas Aujoulat
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, 97405 Saint-Denis cedex, France
| | - Nathalie Lugagne
- 5Comité de Lutte des Infections Nosocomiales, Centre hospitalier universitaire Félix Guyon, La Réunion, Bellepierre, cedex, 97405 Saint-Denis, France
| | - Nicolas Allou
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, 97405 Saint-Denis cedex, France.,6Département d'informatique clinique, Centre hospitalier universitaire Félix Guyon, La Réunion, Bellepierre, cedex, 97405 Saint-Denis, France
| | - Jérôme Allyn
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, La Réunion, Bellepierre, 97405 Saint-Denis cedex, France.,6Département d'informatique clinique, Centre hospitalier universitaire Félix Guyon, La Réunion, Bellepierre, cedex, 97405 Saint-Denis, France
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Abstract
RATIONALE Patients repatriated from foreign hospitals are sources of extensively drug-resistant (XDR) bacteria outbreaks. Thus, an individual benefit potential for the patient opposes a collective ecological risk potential. These ethical issues have not been well studied. PATIENT CONCERNS We report the case of a 74-year-old patient repatriated from Mauritius to the French island of Reunion who presented mesenteric infarction evolving over several days, and who suffered a cardiac arrest before transfer. DIAGNOSES In Reunion Island, a CT-scan revealed a multisegmental enlarged parietal enlargement associated with free peritoneal effusion and a suboccluded aspect of the superior mesenteric artery. INTERVENTIONS Surgical exploration showed a severe mesenteric infarction with peritonitis, and a resection of 120cm of the small intestine was conducted. This patient was infected with a vanA glycopeptide-resistant Enterococcus faecium and a carbapenem-resistant Klebsiella pneumoniae which produced carbapenemases NDM-1 and OXA-181, which required specific care and could have led to a local epidemic. OUTCOMES The patient died after 9 days after being admitted to the ICU. LESSONS Repatriation of critically ill patients from abroad should be considered according to ethical criteria, evaluating, if possible, the expected benefits, and ecological risks incurred. Limiting unnecessary transfers could be an effective measure to limit the spread of XDR bacteria.
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Affiliation(s)
| | | | | | | | - Olivier Belmonte
- Laboratoire de bactériologie, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre
| | | | - Guillaume Miltgen
- Laboratoire de bactériologie, Centre Hospitalier Universitaire La Réunion, Site Félix Guyon, Bellepierre
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, Saint-Denis cedex, France
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21
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Gay N, Leclaire A, Laval M, Miltgen G, Jégo M, Stéphane R, Jaubert J, Belmonte O, Cardinale E. Risk Factors of Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Occurrence in Farms in Reunion, Madagascar and Mayotte Islands, 2016-2017. Vet Sci 2018; 5:vetsci5010022. [PMID: 29473906 PMCID: PMC5876575 DOI: 10.3390/vetsci5010022] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022] Open
Abstract
In South Western Indian ocean (IO), Extended-Spectrum β-Lactamase producing Enterobacteriaceae (ESBL-E) are a main public health issue. In livestock, ESBL-E burden was unknown. The aim of this study was estimating the prevalence of ESBL-E on commercial farms in Reunion, Mayotte and Madagascar and genes involved. Secondly, risk factors of ESBL-E occurrence in broiler, beef cattle and pig farms were explored. In 2016-2017, commercial farms were sampled using boot swabs and samples stored at 4 °C before microbiological analysis for phenotypical ESBL-E and gene characterization. A dichotomous questionnaire was performed. Prevalences observed in all production types and territories were high, except for beef cattle in Reunion, which differed significantly. The most common ESBL gene was blaCTX-M-1. Generalized linear models explaining ESBL-E occurrence varied between livestock production sectors and allowed identifying main protective (e.g., water quality control and detergent use for cleaning) and risk factors (e.g., recent antibiotic use, other farmers visiting the exploitation, pet presence). This study is the first to explore tools for antibiotic resistance management in IO farms. It provides interesting hypothesis to explore about antibiotic use in IO territories and ESBL-E transmission between pig, beef cattle and humans in Madagascar.
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Affiliation(s)
- Noellie Gay
- Animals, Health, Territories, Risks and Ecosystems, Avenue Agropolis, 34398 Montpellier CEDEX 5, France.
| | - Alexandre Leclaire
- Bacteriology laboratory, Félix Guyon Hospital, Saint-Denis, 97400 Reunion, France.
| | - Morgane Laval
- Animals, Health, Territories, Risks and Ecosystems, Avenue Agropolis, 34398 Montpellier CEDEX 5, France.
| | - Guillaume Miltgen
- Bacteriology laboratory, Félix Guyon Hospital, Saint-Denis, 97400 Reunion, France.
- UMR PIMIT, CNRS 9192, INSERM U1187, IRD 249, F-97418 Sainte-Clotilde, La Réunion, France.
| | - Maël Jégo
- Animals, Health, Territories, Risks and Ecosystems, Avenue Agropolis, 34398 Montpellier CEDEX 5, France.
| | - Ramin Stéphane
- Animals, Health, Territories, Risks and Ecosystems, Avenue Agropolis, 34398 Montpellier CEDEX 5, France.
| | - Julien Jaubert
- Bacteriology laboratory, Félix Guyon Hospital, Saint-Denis, 97400 Reunion, France.
| | - Olivier Belmonte
- Bacteriology laboratory, Félix Guyon Hospital, Saint-Denis, 97400 Reunion, France.
| | - Eric Cardinale
- Animals, Health, Territories, Risks and Ecosystems, Avenue Agropolis, 34398 Montpellier CEDEX 5, France.
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Miltgen G, Plésiat P, Mille A, Chatelain P, Fournier D. Detection of carbapenemase activity in Pseudomonas aeruginosa by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). J Microbiol Methods 2018; 145:66-68. [DOI: 10.1016/j.mimet.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/28/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
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Holman AM, Allyn J, Miltgen G, Lugagne N, Traversier N, Picot S, Lignereux A, Oudin C, Belmonte O, Allou N. Surveillance of carbapenemase-producing Enterobacteriaceae in the Indian Ocean Region between January 2010 and December 2015. Med Mal Infect 2017; 47:333-339. [PMID: 28602387 DOI: 10.1016/j.medmal.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to trace the emergence of carbapenemase-producing Enterobacteriaceae (CPE) on Reunion Island, a French overseas territory well suited for the surveillance of CPE emergence in patients from the entire Indian Ocean Region. METHODS This retrospective multicenter study was conducted on Reunion Island between 2010 and 2015. RESULTS A total of 43 CPEs were isolated during the course of the study, in 36 patients (50% in the last year alone). Among these patients, 21 had a link with a foreign country (58%), mainly Mauritius (47.6%). Over the same period, CPEs were isolated from 13 of 1735 (0.7%) repatriated patients to Reunion Island from another country of the Indian Ocean Region. The incidence of isolation of CPEs in the repatriated patients treated in Mauritius was higher (9.2%) than in patients treated in Madagascar or the Comoros Islands (<1%, P<0.001). The most commonly isolated microorganism was Klebsiella pneumoniae (39.5%). The most frequently identified carbapenemase was NDM-1 (81.4%); 100% and 56% of the NDM-1 strains were susceptible to tigecycline and colistin, respectively. In-hospital mortality rate was higher in patients presenting with CPE infection than in patients without CPE infection (75% vs. 25%, P=0.04). CONCLUSION As elsewhere in the world, the number of CPE cases on Reunion Island is on the rise. Most cases involve patients from Mauritius, which justifies screening and isolating CPE in patients from that country.
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Affiliation(s)
- A M Holman
- Réanimation polyvalente, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion
| | - J Allyn
- Réanimation polyvalente, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion
| | - G Miltgen
- Bacteriologie, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion
| | - N Lugagne
- Unité d'hygiène et de lutte contre les infections hospitalières, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion
| | - N Traversier
- Bacteriologie, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion
| | - S Picot
- Bactériologie, centre hospitalier universitaire Sud Réunion, 97410 Saint-Pierre, Réunion
| | - A Lignereux
- Biologie, centre hospitalier Gabriel-Martin, 97460 Saint-Paul, Réunion
| | - C Oudin
- Comité de lutte contre les infections nosocomiales, groupe hospitalier Est Réunion, 97470 Saint-Benoît, Réunion
| | - O Belmonte
- Bacteriologie, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion
| | - N Allou
- Réanimation polyvalente, centre hospitalier universitaire Felix-Guyon, allée des Topazes, 97405 Saint-Denis, Réunion.
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Miltgen G, Paillot J, Vanlemmens C, Di Martino V, Heyd B, Millon L, Bellanger AP. Fatal acute respiratory distress by Toxoplasma gondii in a toxoplasma seronegative liver transplant recipient. New Microbiol 2016; 39:160-162. [PMID: 27196559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Abstract
The risk of Toxoplasma gondii infection in solid organ transplant recipients is well known but mainly after heart transplantation. We discuss a case of acute respiratory distress caused by Toxoplasma gondii on Day 32 after liver transplantation. The reported case, which is extremely rare, emphasizes how direct examination and Quantitative Polymerase Chain Reaction (QPCR) in broncholaveolar lavage help to diagnose the infection. Given Trimethoprim/Sulfamethoxazole toxicity, systematic prescription of Toxoplasma gondii chemoprophylaxis is not commonly approved in liver transplantation.
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Affiliation(s)
- Guillaume Miltgen
- Department of Mycology-Parasitology, Jean Minjoz University Hospital, Besançon, France
| | - Jonathan Paillot
- Department of Anaesthesiology and Intensive Care, Jean Minjoz University Hospital, Besançon, France
| | - Claire Vanlemmens
- Department of Gastroenterology and Hepatology, Jean Minjoz University Hospital, Besançon, France
| | - Vincent Di Martino
- Department of Gastroenterology and Hepatology, Jean Minjoz University Hospital, Besançon, France
| | - Bruno Heyd
- Department of Liver Transplantation and Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Laurence Millon
- Department of Mycology-Parasitology, Jean Minjoz University Hospital, Besançon, France
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Perrotti A, Miltgen G, Chevet-Noel A, Durst C, Vernerey D, Bardonnet K, Davani S, Chocron S. Neutrophil gelatinase-associated lipocalin as early predictor of acute kidney injury after cardiac surgery in adults with chronic kidney failure. Ann Thorac Surg 2015; 99:864-9. [PMID: 25595830 DOI: 10.1016/j.athoracsur.2014.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/24/2014] [Accepted: 10/03/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess the utility of neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury (AKI) occurring after cardiac surgery in patients with prior chronic kidney failure. METHODS Patients with preoperative creatinine clearance 60 mL • min(-1) • 1.73 m(-2) or less according to the Cockcroft-Gault formula and scheduled to undergo cardiac surgery were eligible for inclusion. The AKI was defined as an increase in plasma creatinine greater than 50% over preoperative values. Threshold values of NGAL predictive of AKI were determined using receiver operating characteristic curve analysis, and predictive value of NGAL for AKI was evaluated by logistic regression. RESULTS Over a 1-year inclusion period, 166 patients were included. At 6 hours post-surgery, hypertension, occurrence of at least 1 postoperative complication, and NGAL greater than 155 ng/mL were shown to be independent predictors of AKI. NGAL greater than 155 ng/mL at 6 hours was associated with an odds ratio for risk of postoperative AKI of 7.1 [2.7 to 18]. On average, diagnosis of postoperative AKI was made 20 hours earlier using NGAL at 6 hours post-surgery as compared with a diagnosis based on a 50% increase in creatinine over baseline. The threshold for NGAL of 155 ng/mL at 6 hours had a sensitivity of 79% and specificity of 58% for the diagnosis of AKI. CONCLUSIONS Earlier diagnosis of AKI post-surgery based on NGAL assessment makes it possible to initiate appropriate therapy at an earlier stage in this high-risk patient population.
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Affiliation(s)
- Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Guillaume Miltgen
- Department of Biochemistry, University Hospital Jean Minjoz, Besançon, France
| | - Albin Chevet-Noel
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Camille Durst
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Dewi Vernerey
- Department of Methodology and Quality of Life in Oncology Unit, University Hospital Jean Minjoz, Besançon, France
| | - Karine Bardonnet
- Department of Biochemistry, University Hospital Jean Minjoz, Besançon, France
| | - Siamak Davani
- Department of Pharmacology, University Hospital Jean Minjoz, Besançon, France
| | - Sidney Chocron
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
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Juhan C, Haupert S, Miltgen G, Girard N, Dulac P. A new intra arterial rt-PA dosage regimen in peripheral arterial occlusion: bolus followed by continuous infusion. Thromb Haemost 1991; 65:635. [PMID: 1908142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Juhan C, Miltgen G, Barthélémy P, Ayuso D. [Treatment of ilio-femoral venous thromboses with surgical thrombectomy]. Bull Acad Natl Med 1991; 175:643-9; discussion 649-50. [PMID: 1933480] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surgical thrombectomy which has been commonly performed in the past is now abandoned by most teams. Nevertheless some surgeons have gone on performing venous thrombectomies with good results. We have performed venous thrombectomy in 91 acute ilio-femoral vein thrombosis associated with inferior vena cava or superficial vein involvement in respectively 35% and 86% of the cases. The mean estimated age of the clot was 5 days. Ilio-femoral thrombectomy was carried out under general anesthesia using a Fogarty catheter introduced through a common femoral venotomy and the removal of the distal clots by mean of massages maneuver. In case of vena cava involvement, direct caval venotomy was carried out by a right sub-costal approach. A temporary arterio-venous fistula in the groin was associated in 89% and a partial interruption of the vena cava in 55% of the cases. No operative death and no peri-operative pulmonary embolism were observed. Post-operative ilio-femoral vein patency rate was 85% without recurrence after closure of the arterio-venous fistula. A venous thrombectomy in selected cases appears to be more efficient than intra-venous heparin or thrombolytic therapy. Indications of venous thrombectomy are ilio-femoral or ilio-caval vein thrombosis of less than 7 days duration. Patients who are non ambulatory or with limited life expectancy are not likely to benefit from surgery. Venous thrombectomy is not recommended in patients with inflammatory or tumoral pelvic or retroperitoneal lesions, coagulopathies, peripheral arterial or significant heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Juhan
- Service de chirurgie vasculaire, Hôpital Nord, Marseille
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Juhan C, Haupert S, Miltgen G, Dulac P, Girard N, Barthélémy P, Raybaud C. [Intra-arterial thrombolytic therapy of lower limb ischemia]. Bull Acad Natl Med 1990; 174:197-207; discussion 207-9. [PMID: 2372717] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Between 1984 and 1989, 35 patients with recent arterial or graft occlusions have been treated with intra-arterial infusion using sequential association of Urokinase (U.K.) and Lys-Plasminogen. Occlusion was thrombotic in 68.5% of the cases ans embolic in 31.5%, involving 28 native arteries and 7 bypass grafts. The mean duration was 16 days (2 to 90). Continuous infusion of U.K.: 84,000 U.I./H and bolus of Lys-Plasminogen 15 microKatals every 30 minutes were delivered through a catheter embedded into the clot. Intra-venous heparin was always associated. The mean duration of lytic drug infusion was 8 H. Complementary arterial reconstruction by vascular surgery of percutaneous transluminal angioplasty was performed in 23% of the patients. Patients with recent alimentary tract bleeding, hemorragic stroke in the last six months or severe high blood pressures were contra-indicated. Complete lysis was obtained in 23 cases (66%), partial lysis in 7 (20%) and no lysis in 5 (14%). The clinical result was excellent in 24 cases (68.5%), good in 3 (8.5%) and bad in 8 (23%) in which amputation was always necessary. 5 local hematoma (14%) treated by surgery or transfusion and one death (3%) due to neurological complication occurring 24 hours after the end of the procedure were observed. The literature survey has shown that the results of low doses of Streptokinase (S.K.) local infusions were not better, and that higher doses of S.K. or U.K. delivered during a shorter infusion time increased the efficacy of lysis and decreased the rate of hemorragic complications. We have proposed the local thrombolytic treatment to the limb threatening ischemic cases when the traditional medical or surgical techniques where thought to be associated to a high risk of failure or complication. The specific indications are the acute or sub-acute ischemic situation due to atheromatous artery thrombosis, distal or old embolism where the Fogarty catheter is inefficient, and graft thrombosis. Severe acute ischemia with neurologic involvement are not good indications. Local thrombolysis can be successful on arterial occlusion even after one month duration.
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Affiliation(s)
- C Juhan
- Centre hospitalier régional et universitaire de Marseille, Hôpital-Nord, Chemin des Bourrely
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