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Grimaldi D, Legriel S, Pichon N, Colardelle P, Leblanc S, Canouï-Poitrine F, Salem OBH, Muller G, de Prost N, Herrmann S, Marque S, Baron A, Sauneuf B, Messika J, Dior M, Creteur J, Bedos JP, Boutin E, Cariou A. Ischemic injury of the upper gastrointestinal tract after out-of-hospital cardiac arrest: a prospective, multicenter study. Crit Care 2022; 26:59. [PMID: 35287719 PMCID: PMC8919548 DOI: 10.1186/s13054-022-03939-9] [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: 11/29/2021] [Accepted: 03/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity.
Methods Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal ischemic injury using multivariate regression analysis. We also compared the outcomes (organ failure during ICU stay and neurological status at hospital discharge) of the three groups of patients. Results Among the 214 patients included in the analysis, 121 (57%, 95% CI 50–63%) had an upper gastrointestinal ischemic lesion, most frequently on the fundus. Ischemic lesions were severe in 55/121 (45%) patients. In multivariate regression, higher adrenaline dose during cardiopulmonary resuscitation (OR 1.25 per mg (1.08–1.46)) was independently associated with increased odds of severe upper gastrointestinal ischemic lesions; previous proton pump inhibitor use (OR 0.40 (0.14–1.00)) and serum bicarbonate on day 1 (OR 0.89 (0.81–0.97)) were associated with lower odds of ischemic lesions. Patients with severe lesions had a higher SOFA score during the ICU stay and worse neurological outcome at hospital discharge. Conclusions More than half of the patients successfully resuscitated from OHCA had upper gastrointestinal tract ischemic injury. Presence of ischemic lesions was independently associated with the amount of adrenaline used during resuscitation. Patients with severe lesions had higher organ failure scores during the ICU stay and a worse prognosis. Clinical Trial RegistrationNCT02349074. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03939-9.
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Affiliation(s)
- D Grimaldi
- Department of Intensive Care CUB-Erasme, Route de Lennik, 808, Université Libre de Bruxelles (ULB), 1070, Brussels, Belgium. .,AfterROSC Network Group, Paris, France.
| | - S Legriel
- AfterROSC Network Group, Paris, France.,Medico-Surgical Intensive Care Unit, Versailles Hospital, Le Chesnay, Paris, France
| | - N Pichon
- AfterROSC Network Group, Paris, France.,Medico-surgical Intensive Care Unit, General Hospital Center, Brive-la-Gaillarde, France
| | - P Colardelle
- Gastroenterology, C.H. Versailles, Le Chesnay, France
| | - S Leblanc
- Gastroenterology, APHP, Hôpital Cochin, Paris, France
| | - F Canouï-Poitrine
- Unité de Recherche Clinique (URC Mondor), Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), University Paris Est Creteil, Créteil, France
| | - O Ben Hadj Salem
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), University Paris Est Creteil, Créteil, France.,Intensive Care Unit, Centre Hospitalier Intercommunal Meulan - Les Mureaux, Meulan en Yvelines, France
| | - G Muller
- AfterROSC Network Group, Paris, France.,Intensive Care Unit, Centre Hospitalier Intercommunal Meulan - Les Mureaux, Meulan en Yvelines, France.,ICU, Centre Hospitalier Régional Orleans, Orléans, France
| | - N de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri-Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France.,Université Paris-Est Créteil Val de Marne, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - S Herrmann
- Gastro-enterology, Centre Hospitalier Régional d'Orleans, Orléans, France
| | - S Marque
- ICU, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - A Baron
- Gastroenterology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - B Sauneuf
- AfterROSC Network Group, Paris, France.,ICU, Chpc - Centre Hospitalier Public Du Cotentin : Hospital Louis Pasteur, Cherbourg-en-Cotentin, France
| | - J Messika
- APHP.Nord-Université de Paris, Medico-surgical ICU, Hôpital Louis Mourier, Colombes, France.,INSERM, PHERE UMRS 1152, Université de Paris, Paris, France
| | - M Dior
- DMU ESPRIT, Department of Gastroenterology, AP-HP, Hopital Louis Mourier, 92700, Colombes, France
| | - J Creteur
- Department of Intensive Care CUB-Erasme, Route de Lennik, 808, Université Libre de Bruxelles (ULB), 1070, Brussels, Belgium
| | - J P Bedos
- Medico-Surgical Intensive Care Unit, Versailles Hospital, Le Chesnay, Paris, France
| | - E Boutin
- Unité de Recherche Clinique (URC Mondor), Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), University Paris Est Creteil, Créteil, France
| | - A Cariou
- AfterROSC Network Group, Paris, France.,Medical Intensive Care Unit, Cochin University Hospital (APHP), Paris, France; University of Paris - Medical School, Paris, France.,University of Paris - Medical School, Paris, France
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2
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Bedos JP, Daikos G, Dodgson AR, Pan A, Petrosillo N, Seifert H, Vila J, Ferrer R, Wilson P. Early identification and optimal management of carbapenem-resistant Gram-negative infection. J Hosp Infect 2020; 108:158-167. [PMID: 33290816 DOI: 10.1016/j.jhin.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carbapenem resistance in Gram-negative bacteria is associated with severe infections in the hospital setting. No uniform screening policy or agreed set of criteria exists within the EU to inform treatment decisions for infections caused by carbapenem-resistant Gram-negative bacteria. AIM To develop a range of consensus statements to survey experts in carbapenem resistance, to identify potential similarities and differences across the EU and across specialties. METHODS The survey contained 43 statements, covering six key topics relating to carbapenem-resistant organisms: microbiological screening; diagnosis; infection control implementation; antibiotic stewardship; use of resources; and influencing policy. FINDINGS In total, 136 survey responses were received (66% infectious disease specialists, 18% microbiologists, 11% intensive care specialists, 4% other/unknown) from France, Germany, Greece, Italy, Spain, and the UK. High, or very high, levels of agreement were seen for all 43 consensus statements, indicating good alignment concerning early identification and optimal management of infection due to carbapenem-resistant organisms. CONCLUSION We offer the following recommendations: (1) screening is required when a patient may have been exposed to the healthcare system in countries/hospitals where carbapenem-resistant organisms are endemic; (2) rapid diagnostic tools should be available in every institution; (3) all institutions should have a specific policy for the control of carbapenem-resistant organisms, which is routinely audited; (4) clear strategies are required to define both appropriate and inappropriate use of carbapenems; (5) priority funding should be allocated to the management of infections due to carbapenem-resistant organisms; and (6) international co-operation is required to reduce country-to-country transmission of carbapenem-resistant organisms.
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Affiliation(s)
- J P Bedos
- Intensive Care Unit, Centre Hospitalier De Versailles, Le Chesnay, France
| | - G Daikos
- First Department of Propaedeutic Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - A R Dodgson
- Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Public Health Laboratory, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - A Pan
- Division of Infectious Diseases, ASST di Cremona, Cremona, Italy
| | - N Petrosillo
- Clinical and Research Infectious Disease Department and Infectious Disease Unit, National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy.
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
| | - J Vila
- Department of Clinical Microbiology, Hospital Clínic, ISGlobal, Universitat de Barcelona, Barcelona, Spain
| | - R Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P Wilson
- Department of Microbiology and Virology, University College London Hospitals, London, UK
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3
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Tran-Dinh A, Neulier C, Amara M, Nebot N, Troché G, Breton N, Zuber B, Cavelot S, Pangon B, Bedos JP, Merrer J, Grimaldi D. Impact of intensive care unit relocation and role of tap water on an outbreak of Pseudomonas aeruginosa expressing OprD-mediated resistance to imipenem. J Hosp Infect 2018; 100:e105-e114. [PMID: 29857026 DOI: 10.1016/j.jhin.2018.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem (PA-OprD). AIM The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before and after an incidental relocation of the ICU. The role of tap water as a route of contamination for colonization/infection of patients with PA-OprD was assessed as a secondary aim. METHODS A single-centre, observational, before/after comparison study was conducted from October 2013 to October 2015. The ICU was relocated at the end of October 2014. All P. aeruginosa-positive samples isolated from patients hospitalized ≥48 h in the ICU were included. Tap water specimens were collected every three months in the ICU. PA-OprD strains isolated from patients and tap water were genotyped using pulse-field gel electrophoresis. FINDINGS A total of 139 clinical specimens of P. aeruginosa and 19 tap water samples were analysed. The proportion of PA-OprD strains decreased significantly from 31% to 7.7% after the relocation of the ICU (P = 0.004). All PA-OprD clinical specimens had a distinct genotype. Surprisingly, tap water was colonized with a single PA-OprD strain during both periods, but this single clone has never been isolated from clinical specimens. CONCLUSION Relocation of the ICU was associated with a marked decrease in P. aeruginosa strains resistant to imipenem. The polyclonal character of PA-OprD strains isolated from patients and the absence of tap-water-to-patient contamination highlight the complexity of the environmental impact on the endogenous colonization/infection with P. aeruginosa.
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Affiliation(s)
- A Tran-Dinh
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France; Département d'anesthésie et de réanimation chirurgicale, 75018, Centre Hospitalier de Bichat, Paris, France.
| | - C Neulier
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - M Amara
- Service de Biologie, Unité de microbiologie, 78157, Centre Hospitalier De Versailles, Le Chesnay, France
| | - N Nebot
- Service de pharmacie, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - G Troché
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - N Breton
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - B Zuber
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - S Cavelot
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - B Pangon
- Service de Biologie, Unité de microbiologie, 78157, Centre Hospitalier De Versailles, Le Chesnay, France
| | - J P Bedos
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - J Merrer
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - D Grimaldi
- Département de réanimation, CUB-Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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4
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Llitjos JF, Daviaud F, Grimaldi D, Legriel S, Georges JL, Guerot E, Bedos JP, Fagon JY, Charpentier J, Mira JP. Ilio-psoas hematoma in the intensive care unit: a multicentric study. Ann Intensive Care 2016; 6:8. [PMID: 26782681 PMCID: PMC4717128 DOI: 10.1186/s13613-016-0106-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Background
Clinical features and outcomes of patients with spontaneous ilio-psoas hematoma (IPH) in intensive care units (ICUs) are poorly documented. The objectives of this study were to determine epidemiological, clinical, biological and management characteristics of ICU patients with IPH. Methods
We conducted a retrospective multicentric study in three French ICUs from January 2006 to December 2014. We included IPH diagnosed both at admission and during ICU stay. Surgery and embolization were available 24 h a day for each center, and therapeutic decisions were undertaken after pluridisciplinary discussion. All IPHs were diagnosed using CT scan. Results During this period, we identified 3.01 cases/1000 admissions. The mortality rate of the 77 included patients was 30 %. In multivariate analysis, we observed that mortality was independently associated with SAPS II (OR 1.1, 95 % CI [1.013–1.195], p = 0.02) and with the presence of hemorrhagic shock (OR 67.1, 95 % CI [2.6–1691], p = 0.01). We found IPH was related to anticoagulation therapy in 56 cases (72 %), with guideline-concordant reversal performed in 33 % of patients. We did not found any association between anticoagulant therapy type and outcome. Conclusion We found IPH is an infrequent disease, with a high mortality rate of 30 %, mostly related to anticoagulation therapy and usually affecting the elderly. Management of anticoagulation-related IPH includes a high rate of no reversal of 38 %.
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Affiliation(s)
- J F Llitjos
- Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France.
| | - F Daviaud
- Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - D Grimaldi
- Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - S Legriel
- Intensive Care Unit, Hôpital de Versailles - Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - J L Georges
- Cardiology, Hôpital de Versailles - Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - E Guerot
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France.,Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - J P Bedos
- Intensive Care Unit, Hôpital de Versailles - Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - J Y Fagon
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France.,Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - J Charpentier
- Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France
| | - J P Mira
- Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, 15 rue de l'Ecole de Médecine, 75006, Paris, France
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5
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Alfandari S, Robert J, Péan Y, Rabaud C, Bedos JP, Varon E, Lepape A, Bru JP, Gauzit R. Antibiotic use and good practice in 314 French hospitals: The 2010 SPA2 prevalence study. Med Mal Infect 2015; 45:475-80. [PMID: 26612602 DOI: 10.1016/j.medmal.2015.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to assess antibiotic prescriptions to identify potential targets for improvement. METHODS We conducted a point prevalence survey (November 2010) of antibiotic use in 314 voluntary hospitals recruited by the French Infectious Diseases Society (SPILF) and the National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials (ONERBA). Data were entered online, immediately analyzed and exported. RESULTS The prevalence of antibiotic use was 19.5% (9059/46,446patients). A higher prevalence was observed in the infectious disease (58.4%), hematology (58%), and intensive care (48.7%) units. The three most frequently used antibiotic classes were aminopenicillins (23.8%), fluoroquinolones (17.9%), and 3rd-generation cephalosporins (16.7%). A monotherapy was prescribed to 64% of patients. The reasons for the antibiotic prescription were written in the medical records of 74% of patients and 62% were consistent with the local guidelines. CONCLUSION Our results are similar to that of other studies. Various local targets for improvement have been identified to help hospitals define a better antibiotic stewardship.
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Affiliation(s)
- S Alfandari
- Service de réanimation et des maladies infectieuses, centre hospitalier Dron, 59208 Tourcoing, France.
| | - J Robert
- Bactériologie et hygiène, hôpitaux universitaires de la Pitié-Salpêtrière - Charles-Foix, AP-HP, 75013 Paris, France
| | - Y Péan
- Observatoire national de l'épidémiologie de la résistance bactérienne aux antibiotiques (ONERBA), 75006 Paris, France
| | - C Rabaud
- Service des maladies infectieuses, CHU, 54511 Nancy, France
| | - J P Bedos
- Service de réanimation, centre hospitalier Henri-Mignot, 78157 Le Chesnay, France
| | - E Varon
- Laboratoire de bactériologie, HEGP, 75908 Paris, France
| | - A Lepape
- Service de réanimation, hôpital Sud, 69495 Lyon, France
| | - J P Bru
- Service des maladies infectieuses, centre hospitalier de la région d'Annecy, 74374 Annecy, France
| | - R Gauzit
- Service d'anesthésie-réanimation chirurgicale, CHU Cochin, AP-HP, 75679 Paris, France
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6
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Bouglé A, Max A, Mongardon N, Grimaldi D, Pène F, Rousseau C, Chiche JD, Bedos JP, Vicaut E, Mira JP. Protective effects of FCGR2A polymorphism in invasive pneumococcal diseases. Crit Care 2012; 16. [PMCID: PMC3504810 DOI: 10.1186/cc11696] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - A Max
- Hôpital Cochin, Paris, France
| | | | | | - F Pène
- Hôpital Cochin, Paris, France
| | - C Rousseau
- Institut Cochin, INSERM U1016/CNRS UMR8104, Paris, France
| | | | - JP Bedos
- Hôpital André Mignot, Le Chesnay, France
| | - E Vicaut
- Hôpital Lariboisière, Paris, France
| | - JP Mira
- Hôpital Cochin, Paris, France
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7
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Bruneel F, Veziris N, Chevret S, Wolff M, Bedos JP. Retrospective review of Pneumocystis jirovecii pneumonia in a French intensive care unit (1994–2000). Int J STD AIDS 2009; 20:441-2. [DOI: 10.1258/ijsa.2009.009107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- F Bruneel
- Intensive Care Unit, Versailles Hospital Center, Le Chesnay
- Intensive Care Unit, Bichat Claude-Bernard Hospital, Paris, France
| | - N Veziris
- Mycobacteria National Reference Center, Pitie Salpetriere Hospital
- Intensive Care Unit, Bichat Claude-Bernard Hospital, Paris, France
| | - S Chevret
- Biostatistics Department, Saint Louis Hospital
| | - M Wolff
- Intensive Care Unit, Bichat Claude-Bernard Hospital, Paris, France
| | - JP Bedos
- Intensive Care Unit, Versailles Hospital Center, Le Chesnay
- Intensive Care Unit, Bichat Claude-Bernard Hospital, Paris, France
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8
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Bedos JP. [Which partner for the betalactam agent in empiric combined therapy? I Fluoroquinolone]. Ann Fr Anesth Reanim 2004; 23:636-8. [PMID: 15234734 DOI: 10.1016/j.annfar.2004.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- J P Bedos
- Département d'anesthésie-réanimation, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay, France.
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9
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Affiliation(s)
- J P Bedos
- Service de réanimation, centre hospitalier de Versailles, hôpital Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
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10
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Decousser JW, Pina P, Ghnassia JC, Bedos JP, Allouch PY. First report of clinical and microbiological failure in the eradication of glycopeptide-intermediate methicillin-resistant Staphylococcus aureus carriage by mupirocin. Eur J Clin Microbiol Infect Dis 2003; 22:318-9. [PMID: 12736798 DOI: 10.1007/s10096-003-0929-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J W Decousser
- Department of Hospital Health, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay Cedex, France.
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11
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Eloy O, Tabella C, Harzic M, Pina P, Allouch P, Pangon B, Bedos JP, Ghnassia JC. [Detection of circulating Candida albicans mannan and antimannan antibodies: useful for diagnosis of deep seated candidiasis]. Ann Biol Clin (Paris) 2002; 60:711-4. [PMID: 12446238] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
In deep seated candidiasis, only 40% of blood cultures are positive. The aim of the study was to investigate circulating Candida albicans mannan and anti-mannan antibodies as a possible help for the diagnosis of deep seated candidiasis. We have compared the results to the detection of IgM by Elisa and antibodies by immunoflourescence. The best tests, in accord to their sensitivity and specificity, are the mannan antigenemia (43% and 100%) and IgM (86% and 100%) and have to be used together.
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Affiliation(s)
- O Eloy
- Service de microbiologie, Hôpital André Mignot, 177 rue de Versailles, 78157 le Chesnay, France
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12
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Bruneel F, Gachot B, Wolff M, Bedos JP, Regnier B, Danis M, Vachon F. [Blackwater fever]. Presse Med 2002; 31:1329-34. [PMID: 12355996] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
DEFINITION Blackwater fever is a clinical entity characterized by acute intravascular hemolysis classically occuring after the re-introduction of quinine in long-term residents in Plasmodium falciparum endemic areas and repeatedly using the product. CLINICAL PROFILE The symptomatology appears brutally with emission of porto-colored urine, icterus, pallor, nausea, fever and acute renal failure. The hemolytic-like anemia is immediately severe. Parasitemia is mild or absent. The mechanism of renal failure is tubular necrosis. QUININE AND SIMILAR MOLECULES Well known at the start of the 20th century, blackwater fever has become exceptional since 1950, when quinine was replaced by chloroquine. The disease reappeared in 1990, following the re-utilization of quinine because of resistance to chloroquine. Thereafter, several cases have been described with halofantrine and mefloquine, two new molecules similar to quinine (amino-alcohol family). The physiopathogenesis of the disease is not well known, however it would appear that the concomitance of a double sensitivization of the red blood cells to the P. falciparum red blood cells and to the amino-alcohols is necessary to provoke the hemolysis. EVOLUTION The severity of the clinical picture often requires initial management in intensive care unit. Nowadays, however, prognosis is good and the disease usually regresses without after effects.
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Affiliation(s)
- F Bruneel
- Clinique de réanimation des maladies infectieuses, Hôpital Bichat-Claude Bernard, Paris.
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Zahar JR, Azoulay E, Klement E, De Lassence A, Lucet JC, Regnier B, Schlemmer B, Bedos JP. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med 2001; 27:513-20. [PMID: 11355119 PMCID: PMC7095425 DOI: 10.1007/s001340000849] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To clarify the patterns of pulmonary tuberculosis (TB) that should result in a high index of suspicion, to increase the chances of early therapy and to identify predictors of 30-day mortality. PATIENTS AND METHODS Retrospective, 7-year study in two medical intensive care units (ICUs). All patients admitted with pulmonary TB were enrolled. Clinical and laboratory data at admission and events within 48 h of admission were collected. Predictors of 30-day mortality were identified by univariate and multivariate analysis. RESULTS The study included 99 patients with a median age of 41 years. Immunodeficiency was present in 60 patients, including 38 with AIDS. Fifty-nine patients had pulmonary TB alone, 22 also had extrapulmonary TB and 18 had miliary. All 99 patients were admitted for acute respiratory failure, some also with shock (20), neurologic disorders (18) or acute renal failure (10). Mechanical ventilation was needed in 50 patients; 22 patients met criteria for acute respiratory distress syndrome (ARDS). The 30-day mortality rate was 26.2%. Four factors independently predicted mortality: a time from symptom onset to treatment of more than 1 month (OR, 3.49; CI, 1.20-10.20), the number of organ failures (OR, 3.15; CI, 1.76-5.76), a serum albumin level above 20 g/l (OR, 3.96; CI, 1.04-15.10), and a larger number of lobes involved on chest radiograph (OR, 1.83; CI, 1.12-2.98). CONCLUSION Delayed clinical suspicion and treatment of active pulmonary TB with respiratory failure may contribute to the persistently high mortality rates in ICU patients with these diseases.
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Affiliation(s)
- J R Zahar
- Intensive Care Department, Bichat Claude-Bernard Hospital, University Paris 7, 46 rue Henri Huchard, 75018 Paris, France.
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Eloy O, Vauloup C, Thérond P, Pina P, Allouch P, Pangon B, Bedos JP, Ghnassia JC. [Procalcitonin level in deep-seated Candida infections]. Ann Biol Clin (Paris) 2001; 59:502-5. [PMID: 11470651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- O Eloy
- Service de microbiologie, Hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay
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15
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Mourvillier B, Bedos JP. [Soft tissue infections by anaerobic bacteria. Etiology, diagnosis, treatment]. Rev Prat 2001; 51:319-24. [PMID: 11265431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- B Mourvillier
- Service de réanimation médico-chirurgicale, hôpital André-Mignot, centre hospitalier de Versailles, Le Chesnay 78157
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16
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Pina P, Marliere C, Vandenesch F, Bedos JP, Etienne J, Allouch PY. An outbreak of Staphylococcus aureus strains with reduced susceptibility to glycopeptides in a French general hospital. Clin Infect Dis 2000; 31:1306-8. [PMID: 11073773 DOI: 10.1086/317464] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe the isolation of Staphylococcus aureus isolates with glycopeptide heteroresistant subpopulation from 15 patients (11 with colonizations and 4 with infections) in a French hospital. Non of the patients were previously treated with glycopeptides. The 15 isolates belonged to 2 different pulsotypes unrelated to other methicillin-resistant S. aureus isolates from the same hospital.
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Affiliation(s)
- P Pina
- Centre Hospitalier de Versailles, Le Chesnay, France
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17
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Veber B, Souweine B, Gachot B, Chevret S, Bedos JP, Decre D, Dombret MC, Dureuil B, Wolff M. Comparison of direct examination of three types of bronchoscopy specimens used to diagnose nosocomial pneumonia. Crit Care Med 2000; 28:962-8. [PMID: 10809267 DOI: 10.1097/00003246-200004000-00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare direct examination of bronchial aspirate and plugged telescopic catheter specimens (PTC) with infected cell counts in bronchoalveolar lavage (BAL) specimens for the diagnosis of nosocomial pneumonia. DESIGN Prospective study of critically ill patients. SETTING Intensive care unit in a university hospital. PATIENTS A total of 64 patients hospitalized for >48 hrs with suspected nosocomial pneumonia. INTERVENTIONS Fiberoptic bronchoscopy with bronchial aspirate and quantitative protected specimen brush, PTC, and BAL cultures. PTC and bronchial aspirate specimens were Gram-stained. BAL specimens for infected cell counts were examined as described previously in the literature. MEASUREMENTS AND MAIN RESULTS Nosocomial pneumonia was diagnosed by the medical staff based on all available clinical, radiologic, laboratory test, and microbiological data and on the course before and after appropriate therapy. A total of 71% of patients were ventilated, and 70.1% were receiving antibiotics. Nosocomial pneumonia was diagnosed in 54% of the cases. On direct examination, sensitivity (Se) and specificity (Sp) of bronchial aspirate specimens were Se, 82% and Sp, 60%; of BAL with 5% infected cells, Se, 56% and Sp, 100%; of BAL with 3% infected cells, Se, 74% and Sp, 96%; of PTC specimens, Se, 65% and Sp, 76%; and of PTC specimens plus BAL with 3% infected cells, Se, 83% and Sp, 78%. BAL with 3% infected cells was significantly better for predicting nosocomial pneumonia than direct examination of bronchial aspirate or PTC specimens (p = .0012). When the BAL showed 3% infected cells, neither direct examination of bronchial aspirate nor direct examination of PTC specimens was useful (p = .24 and p = .38, respectively). Combined use of direct examination of PTC specimens plus BAL with 3% infected cells markedly improved sensitivity. The total cost of each procedure was taken into account for the final evaluation. CONCLUSIONS Our data suggest that BAL with 3% infected cells is currently the only test whose predictive value for nosocomial pneumonia is sufficiently high to be of use for guiding the initial choice of antimicrobial class while waiting for quantitative culture results.
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Affiliation(s)
- B Veber
- Service de réanimation chirurgicale, Hôpital Charles Nicolle, Rouen, France
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18
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Abstract
OBJECTIVE To assess the type and bacteriology of otologic diseases associated with bacterial meningitis in adults. METHOD Retrospective review of 79 patients over an 18-year period. RESULTS Acute otitis media was diagnosed in 32 patients, chronic otitis in 29 (16 with cholesteatoma), and cerebrospinal fluid leak in 18. Streptococcus pneumoniae was a common cause of meningitis-complicating acute otitis media (69%) or cerebrospinal fluid leak (50%), whereas other bacteria or negative cultures were found in the cerebrospinal fluid of patients with chronic otitis. Surgery was performed promptly in 26 patients; four patients died. CONCLUSIONS Early diagnosis of otogenic bacterial meningitis is essential to allow appropriate antimicrobial treatment. Antimicrobials active on gram negative bacilli and anaerobes should be used in patients with chronic otitis. An emergency surgical procedure is required in patients whose neurologic or infectious status fails to improve under antimicrobial treatment.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cerebrospinal Fluid Otorrhea/diagnosis
- Cerebrospinal Fluid Otorrhea/microbiology
- Cerebrospinal Fluid Otorrhea/mortality
- Cerebrospinal Fluid Otorrhea/surgery
- Cholesteatoma, Middle Ear/diagnosis
- Cholesteatoma, Middle Ear/microbiology
- Cholesteatoma, Middle Ear/mortality
- Cholesteatoma, Middle Ear/surgery
- Chronic Disease
- Female
- Humans
- Male
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/microbiology
- Meningitis, Bacterial/mortality
- Meningitis, Bacterial/surgery
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Meningitis, Pneumococcal/mortality
- Microbial Sensitivity Tests
- Middle Aged
- Otitis Media/diagnosis
- Otitis Media/microbiology
- Otitis Media/mortality
- Otitis Media/surgery
- Survival Rate
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Affiliation(s)
- B Barry
- Department of Otorhinolaryngology, Bichat-Claude-Bernard Hospital, Paris, France
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19
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Bedos JP. [Choice of antibiotics in lower respiratory infections: what does pharmacodynamics bring? Data of experimental models]. Presse Med 1998; 27 Suppl 4:19-20. [PMID: 9798481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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20
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Souweine B, Veber B, Bedos JP, Gachot B, Dombret MC, Regnier B, Wolff M. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments. Crit Care Med 1998; 26:236-44. [PMID: 9468159 DOI: 10.1097/00003246-199802000-00017] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether the diagnostic accuracy of bronchoscopy samples in patients with suspected ventilator-associated pneumonia is affected by prior antibiotic treatment given for a previous infection, and/or by antibiotic treatment recently started to treat suspected ventilator-associated pneumonia. DESIGN Study of critically ill patients. SETTING Intensive care unit in a university hospital. PATIENTS Sixty-three episodes of suspected ventilator-associated pneumonia were prospectively evaluated. Based on prior antibiotic treatment, three groups were defined: no antibiotic group (no previous antibiotic treatments), n = 12; current antibiotic group (antibiotic treatment initiated >72 hrs earlier), n = 31; and recent antibiotic group (new antibiotic treatment class started within the last 24 hrs), n = 20. INTERVENTIONS Fiberoptic bronchoscopy with quantitative protected specimen brush cultures, bronchoalveolar lavage cultures, and intracellular organism counts of bronchoalveolar lavage cells. MEASUREMENTS AND MAIN RESULTS The diagnosis of ventilator-associated pneumonia was made in 35 cases, based on histology (n = 2), cavitation (n = 2), blood cultures (n = 4), or outcome under appropriate antibiotic treatment (n = 27). The discriminative value of the tests, based on the area under the receiver operating characteristic curve, was high (> or =0.85) in both current antibiotic treatment and recent antibiotic treatment patients. Sensitivities for a 5% intracellular organism count of bronchoalveolar lavage cells, a protected specimen brush culture threshold of 10(3) colony-forming units (cfu)/mL, and a bronchoalveolar lavage culture threshold of 10(5) cfu/mL were as follows, respectively, in the three groups: 0.71, 0.88, and 0.71 (no antibiotic treatment group); 0.5, 0.77, and 0.83 (current antibiotic group); and 0.67, 0.40, and 0.38 (recent antibiotic group). Specificity was consistently > or =0.9. In the recent antibiotic group, protected specimen brush and bronchoalveolar lavage cultures had lower sensitivities (p < .05), and the best threshold values for these two tests were 10(2) cfu/mL and 10(3) cfu/mL, respectively. CONCLUSIONS After recent introduction of an antibiotic treatment for suspected ventilator-associated pneumonia, protected specimen brush and bronchoalveolar lavage culture thresholds must be decreased to maintain good accuracy. In contrast, current antibiotic treatment prescribed for a prior infectious disease does not modify the diagnostic accuracy of protected specimen brush or bronchoalveolar lavage.
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Affiliation(s)
- B Souweine
- Service de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
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21
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Bruneel F, Bedos JP. [Herpetic encephalitis, Diagnosis, treatment]. Rev Prat 1997; 47:1137-43. [PMID: 9208679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- F Bruneel
- Clinique de réanimation des maladies infectieuses (Pr F. Vachon), groupe hospitalier Bichat-Claude Bernard, Paris
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22
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Dupont H, Timsit JF, Souweine B, Gachot B, Bedos JP, Wolff M. Intra-alveolar hemorrhage following bipedal lymphography. Intensive Care Med 1996; 22:614-5. [PMID: 8814488 DOI: 10.1007/bf01708114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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23
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Azoulay-Dupuis E, Moine P, Bedos JP, Rieux V, Vallee E. Amoxicillin dose-effect relationship with Streptococcus pneumoniae in a mouse pneumonia model and roles of in vitro penicillin susceptibilities, autolysis, and tolerance properties of the strains. Antimicrob Agents Chemother 1996; 40:941-6. [PMID: 8849256 PMCID: PMC163235 DOI: 10.1128/aac.40.4.941] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We used a mouse model of pneumococcal pneumonia to assess the bactericidal effect of increasing doses of amoxicillin (AMX) against clinical strains with various susceptibilities to penicillin. Twelve strains that exhibited similar virulence in mice were selected. Three were penicillin susceptible (PS) (penicillin and AMX MICs = 0.01 to 0.03 microgram/ml), three were intermediately resistant (PIR) (penicillin and AMX MICs = 0.5 to 1 microgram/ml), and six were penicillin resistant (PR) (penicillin and AMX MICs = 1 to 8 micrograms/ml). Leukopenic Swiss mice were infected intratracheally with 10(7) CFU of each strain. Treatment was initiated 3 h after infection and consisted of a single subcutaneous injection of AMX at doses ranging from 2.5 to 10 mg/kg (PS strains), 5 to 100 (PIR strains), and 25 to 3,000 (PR strains). Bacterial killing kinetics were recorded in the lungs over 9 h. The maximal log CFU reduction (Emax) was observed 3 h postinjection. The relation between Emax and log10(dose/MIC) showed two populations. With seven strains (the three PS, the three PIR, and one of the six PR [MICs, penicillin/AMX = 4/1]) a good correlation was observed between Emax and log10(dose/MIC) (r = 0.772; P < 0.02). A bactericidal effect equal to 3.5 log10 CFU was observed at a log10(dose/MIC) = 2. At this ratio, with the five other PR strains, Emax varied from 0.4 to 1.6 log10 CFU. In brain heart infusion medium containing AMX at 50 times the relevant MIC, these five PR strains were tolerant in vitro. Treatment failure with AMX was found in vivo, with tolerant, highly resistant strains.
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Affiliation(s)
- E Azoulay-Dupuis
- Institut National de la Santé et de la Recherche Médicale U13, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
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24
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Simon F, Descamps D, Boucheaud O, Lacassin F, Bedos JP, Dussaix E, Brun-Vézinet F. p24 antigenemia in African patients during primary HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 11:204-5. [PMID: 8556405 DOI: 10.1097/00042560-199602010-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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25
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Abstract
Cerebral aspergillosis carries a mortality rate close to 100%, especially in immunocompromised patients. We describe 3 patients who contracted cerebral aspergillosis after neurosurgery, 2 of whom survived after exhaustive surgical treatment and medical treatment with high doses of amphotericin B (once liposomal), 5-fluorocytosine and itraconazole. We review the few non-fatal cases of cerebral aspergillosis reported. We consider that surgical excision must be complete and repeated if necessary, always in combination with medical treatment.
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Affiliation(s)
- C Darras-Joly
- Clinique de Réanimation des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Paris, France
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26
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Bedos JP, Veber B. [Lower respiratory infections: predictive factors of therapeutic response]. Rev Pneumol Clin 1996; 52 Suppl 2:S47-S50. [PMID: 9033917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J P Bedos
- Clinique de Réanimation des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Paris
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27
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Gachot B, Bedos JP, Veber B, Wolff M, Regnier B. Short-term effects of methylene blue on hemodynamics and gas exchange in humans with septic shock. Intensive Care Med 1995; 21:1027-31. [PMID: 8750129 DOI: 10.1007/bf01700666] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the acute effects of methylene blue (MB), an inhibitor of the L-arginine nitric oxide pathway, in patients with septic shock. DESIGN A prospective, open, single-dose study. SETTING The medical ICU of a university hospital. PATIENTS Six patients with severe septic shock. INTERVENTIONS Complete hemodynamic values were recorded before and 20 min after the infusion of intravenous MB (3 mg kg(-1)). Arterial pressure was then monitored during the next 24 h or until death. MEASUREMENTS AND RESULTS Methylene blue increased the mean arterial pressure from 69.7 +/- 4.5 to 83.7 +/- 5.1 mmHg (p = 0.028) and the mean pulmonary artery pressure, from 34.3 +/- 7.2 to 38.7 +/- 8.0 mmHg (p = 0.023). Systemic vascular resistance index was increased from 703.1 +/- 120.6 to 903.7 +/- 152.2 dyne.s.cm(-5).m(-2) (p = 0.028) and pulmonary vascular resistance index, from 254.6 +/- 96.9 to 342.2 +/- 118.9 dyne.s.cm(-5) .m(-2) (p = 0.027). The PaO2/FIO2 decreased from 229.2 +/- 54.4 to 162.2 +/- 44.1 mmHg (p = 0.028), without significant modification of intrapulmonary shunting. Heart rate, cardiac index, right atrial pressure, DO2, VO2, oxygen extraction and arterial lactate were essentially unchanged. Sequential measurements of arterial pressure demonstrated a return to baseline level in 2-3 h. All but one patients died, three in shock and two in multiple organ failure. CONCLUSIONS MB induces systemic and pulmonary vasoconstriction in patients with septic shock, without significant decrease in cardiac index. The worsening of arterial oxygenation following MB injection may limit its use in patients with the adult respiratory distress syndrome. Larger studies are required to determine whether MB improves the outcome of patients with septic shock.
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Affiliation(s)
- B Gachot
- Clinique de Reanimation des Maladies Infectieuses, Hopital Bichat-Claude Bernard, Paris, France
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28
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Lucet JC, Bailly MP, Bedos JP, Wolff M, Gachot B, Vachon F. Septic shock due to toxoplasmosis in patients infected with the human immunodeficiency virus. Chest 1993; 104:1054-8. [PMID: 8404165 DOI: 10.1378/chest.104.4.1054] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To describe the presentation and clinical course of septic shock due to Toxoplasma gondii in patients infected with the human immunodeficiency virus (HIV). PATIENTS AND METHODS From April 1988 to February 1992, nine HIV-infected patients were admitted because of predominant septic shock (7 patients) or developed septic shock in the ICU (2 patients). The recent CD4+ cell count ranged from 2 to 84 x 10(6)/L. RESULTS The main clinical features were (1) a history of fever for longer than 15 days, with a recent increase to more than 39.5 degrees C; (2) a recent history of dyspnea (< 15 days, 8 cases; < 7 days, 3 cases); and (3) recent onset of thrombocytopenia (6 of 9 cases). All patients were in shock (hyperkinetic profile in 6 of 7; hypokinetic in 1 of 7), and 8 of 9 were in respiratory distress (ratio of PaO2 over fractional concentration of oxygen in the inspired gas of 117 +/- 23; range, 88 to 155). Chest roentgenograms revealed diffuse alveolar infiltrates in six of nine cases. The serum lactate dehydrogenase (LDH) activity was 6,510 +/- 5,080 IU/L (range, 1,010 to 15,450 IU/L). Serologic tests for T gondii were negative in two cases. Toxoplasma gondii was isolated from lung (9/9), bone marrow (5/7), or blood (2/2). One, 3, and 2 patients had brain, ocular, and myocardial involvement, respectively. No other microbial pathogens were isolated. Seven patients died, 5 less than 3 days after admission. CONCLUSION Disseminated toxoplasmosis can cause septic shock in HIV-infected patients. In two cases, the disease was probably a primary infection. The association of high fever, acute dyspnea, recent onset of thrombocytopenia, and a very high level of LDH activity is suggestive of disseminated toxoplasmosis.
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Affiliation(s)
- J C Lucet
- Department of Infectious Disease, Bichat-Claude Bernard Hospital, Paris, France
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30
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Azoulay-Dupuis E, Vallee E, Veber B, Bedos JP, Bauchet J, Pocidalo JJ. In vivo efficacy of a new fluoroquinolone, sparfloxacin, against penicillin-susceptible and -resistant and multiresistant strains of Streptococcus pneumoniae in a mouse model of pneumonia. Antimicrob Agents Chemother 1992; 36:2698-703. [PMID: 1336343 PMCID: PMC245531 DOI: 10.1128/aac.36.12.2698] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The increasing emergence of penicillin-resistant and multiresistant strains of Streptococcus pneumoniae may pose a problem in coming years. We therefore compared sparfloxacin, a new fluoroquinolone with improved potency against streptococci, with amoxicillin, the "gold standard" in this setting, and another fluoroquinolone, ciprofloxacin, in a mouse pneumonia model. Their efficacies against penicillin-susceptible (serotype 3), macrolide-resistant (serotype 1), penicillin-resistant (serotype 23), and multiresistant (serotype 6) S. pneumoniae strains were evaluated. Immunocompetent Swiss mice (serotypes 1 and 3) and leukopenic mice (serotypes 6 and 23) were infected by peroral tracheal delivery of 10(4) to 10(6) CFU. Subcutaneous injections of antibiotics were initiated at 6, 18, 48, or 72 h after infection (six injections at 12-h intervals). In the immunocompetent mice, 100% survival was obtained with sparfloxacin (50 mg/kg) and amoxicillin (5 mg/kg) against both penicillin-susceptible and macrolide-resistant strains; ciprofloxacin gave significantly lower survival rates. Two to four injections of sparfloxacin completely cleared bacteria from lungs and blood; the most rapid eradication was achieved with amoxicillin. Sparfloxacin also fully protected leukopenic mice against penicillin-resistant strains. The dose of amoxicillin (50 mg/kg) required to protect mice and eradicate penicillin-resistant and multiresistant strains was 10 times higher than that effective against penicillin-susceptible strains. The microbiological and pharmacokinetic properties of sparfloxacin (e.g., the time during which concentrations exceed the MIC of the test pathogen) accounted for its efficacy against susceptible and resistant strains of S. pneumoniae in this model.
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Affiliation(s)
- E Azoulay-Dupuis
- Institut National de la Santé et de la Recherche Médicale U.13, Hôpital Claude Bernard, Paris, France
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Azoulay-Dupuis E, Bedos JP, Vallée E, Pocidalo JJ. Comparative activity of fluorinated quinolones in acute and subacute Streptococcus pneumoniae pneumonia models: efficacy of temafloxacin. J Antimicrob Chemother 1991; 28 Suppl C:45-53. [PMID: 1664829 DOI: 10.1093/jac/28.suppl_c.45] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We have compared the efficacy of temafloxacin against Streptococcus pneumoniae in experimental murine pneumonia models with that of ofloxacin and ciprofloxacin. Erythromycin and amoxycillin were used as reference agents. Two different strains of mice were used: Swiss mice develop acute pneumonia and die within three to four days, while C57B1/6 mice develop subacute pneumonia and die within eight to ten days. In both cases all animals quickly become bacteraemic. Mice were infected with approximately 10(5) cfu of a virulent S. pneumoniae strain, serotype 3 (P4241), by the intra-tracheal per oral route. In Swiss mice, subcutaneous treatments were initiated early (18 h post-infection) and given every 12 h for 72 h. A 79% cumulative survival rate was obtained in temafloxacin-treated mice (50 mg/kg); a figure not significantly different from those for erythromycin and amoxycillin but far higher than those for ofloxacin and ciprofloxacin (7% survivors). Pulmonary clearance of bacteria was consistent with the survival rates. Complete clearance of bacteria in the lungs and blood was achieved using temafloxacin (50 mg/kg), whereas mice remained bacteraemic even with increased dosages of ofloxacin and ciprofloxacin. In the subacute pneumonia C57B1/6-mice model, the superior efficacy of temafloxacin (compared to ofloxacin and ciprofloxacin) was also seen even when treatment was initiated at late stages of the disease (up to 96 h post-infection). The pharmacokinetics of temafloxacin account for its better efficacy against S. pneumoniae pneumonia relative to the other quinolones.
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32
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Casalino E, Bouvet E, Bedos JP, Wolff M, Simon F, Vachon F. Acute HIV seroconversion and pneumonitis. AIDS 1991; 5:1143-4. [PMID: 1930782] [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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Azoulay-Dupuis E, Vallée E, Bedos JP, Muffat-Joly M, Pocidalo JJ. Prophylactic and therapeutic activities of azithromycin in a mouse model of pneumococcal pneumonia. Antimicrob Agents Chemother 1991; 35:1024-8. [PMID: 1656849 PMCID: PMC284280 DOI: 10.1128/aac.35.6.1024] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Azithromycin is a new acid-stable 15-membered-ring macrolide that exhibits an extended half-life and excellent tissue distribution, including distribution in the lung. We compared its in vivo activity with that of erythromycin using two models of Streptococcus pneumoniae pneumonia, namely, a model of acute infection in Swiss mice and a model of subacute infection in C57BL/6j mice. Female mice were infected by oral delivery into the trachea of 10(5) CFU of a virulent serotype 3 strain of S. pneumoniae (P 4241). Prophylactic and therapeutic treatments were given orally (p.o.) or subcutaneously (s.c.) by various regimens. In the model of subacute infection, a single dose of azithromycin, 25 mg/kg, given p.o. 7 h before infection protected 92% of the mice, while erythromycin was completely ineffective. In the model of acute infection, a single dose of azithromycin, 50 mg/kg, given s.c. 24 h prior to challenge protected 80% of the mice, whereas only 35% of the mice survived with erythromycin, 50 mg/kg, 1 h before challenge. Therapy, which was studied exclusively in the model of subacute infection, was initiated 48 h postinfection. Two doses of 12.5 mg/kg given p.o. 12 h apart resulted in 80% survival of mice treated with azithromycin versus 7% survival of mice treated with erythromycin. Pulmonary clearance of bacteria was consistent with the survival rates. Two doses (25 mg/kg) of azithromycin given s.c. at 48 and 65 h after infection led to complete clearance of bacteria from the lungs and blood, whereas erythromycin-treated mice remained bacteremic. The pharmacokinetics of azithromycin account for its superior efficacy against S. pneumoniae pneumonia relative to the efficacy of erythromycin.
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Affiliation(s)
- E Azoulay-Dupuis
- Hôpital Claude Bernard, Institut National de la Santé et de la Recherche Médicale U.13, Paris, France
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Bedos JP, Vachon F. [Acute respiratory insufficiency in AIDS: contribution of recent data concerning the role of an adjuvant corticotherapy in the treatment of pneumocystoses]. Rev Prat 1991; 41:728-9. [PMID: 2028215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J P Bedos
- Clinique de réanimation des maladies infectieuses, hôpital Bichat-Claude-Bernard, Paris
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Azoulay-Dupuis E, Bedos JP, Vallée E, Hardy DJ, Swanson RN, Pocidalo JJ. Antipneumococcal activity of ciprofloxacin, ofloxacin, and temafloxacin in an experimental mouse pneumonia model at various stages of the disease. J Infect Dis 1991; 163:319-24. [PMID: 1988515 DOI: 10.1093/infdis/163.2.319] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The efficacy of temafloxacin against Streptococcus pneumoniae in an experimental murine pneumonia model was compared with that of ofloxacin and ciprofloxacin. Erythromycin and amoxicillin were used as reference agents. Subcutaneous administration of antibiotics every 12 h for 3 days was initiated at various times after infection. The cumulative survival rates of mice treated with temafloxacin at 50 mg/kg were 100%, 92%, 81%, and 50% with treatment beginning 18, 48, 72, and 96 h after infection, respectively. The activity of temafloxacin at 50 mg/kg was not significantly different from that of erythromycin and amoxicillin but was superior to that of ofloxacin and ciprofloxacin. The maximum cumulative survival rates of mice treated with ofloxacin and ciprofloxacin at 100 mg/kg were 67% and 50%, respectively, with treatment beginning 18 h after infection. Treatment with ofloxacin and ciprofloxacin at 50 mg/kg 18 h after infection did not significantly increase survival rates compared with those of untreated controls.
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Affiliation(s)
- E Azoulay-Dupuis
- Institut de la Santé et de la Recherche Médicale, Hôpital Claude Bernard, Paris, France
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36
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Bedos JP. [Treatment of acute respiratory insufficiency in AIDS]. Rev Prat 1990; 40:2815-7. [PMID: 2100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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37
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Clair B, Wolff M, Bedos JP, Regnier B, Lebras J, Vachon F. [Adult cerebral malaria. Actual experience of the Infectious Diseases Intensive Care Department at the Claude Bernard Hospital]. Med Trop (Mars) 1990; 50:69-73. [PMID: 2366652] [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
22 cases of adult cerebral malaria were observed between July 1987 and June 1989, either associated or not: parasitemia 5%, consciousness disorders, acute renal failure, thrombocytopenia. Two patients died (9%). Increased frequency of attacks is underlined. They are due to chloroquino-resistant parasite strains, even polychemoresistant, occurred in French speaking Tropical Africa since 1985. Therapeutic strategy is described. The necessity to use increased doses of quinine has been admitted, correlatively underlining importance of strict monitoring of the patients because, in first instance, the risk of hypoglycemia (eased by injecting too quickly high doses of quinine) and of acute pulmonary oedema (eased by too quick perfusions and/or transfusions).
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Affiliation(s)
- B Clair
- Clinique de Réanimation des Maladies Infectieuses, Hôpital Bichat/Claude Bernard, Paris
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Caron F, Bure A, Pangon B, Bedos JP, Vallois JM, Gaudebout C, Carbon C. [A fosfomycin-gentamicin combination in the treatment of experimental endocarditis caused by Klebsiella pneumoniae producing type TEM-3 beta-lactamase]. Pathol Biol (Paris) 1989; 37:1095-7. [PMID: 2691965] [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: 01/02/2023]
Abstract
The authors studied the activity of fosfomycin (FOS) and/or gentamicin (GEN) against a Klebsiella pneumoniae strain resistant to all beta-lactams--except cephamycins and imipenem--by production of a plasmid mediated extended broad-spectrum beta-lactamase-TEM-3, to all aminoglycosides--except gentamicin--by production of a plasmid mediated 6' aminoglycoside acetyltransferase IV, to sulfonamides and to tetracyclines. In vitro, the combination FOS (MIC = MBC = 32 mg/l) + GEN (MIC = MBC = 2) appeared indifferent (FIC = 0.75; FBC = 1). In vivo, on experimental endocarditis in rabbits, FOS alone was ineffective, GEN alone was active but only at high dose regimen, FOS - GEN combination was active as compared with controls. Fosfomycin - gentamicin combination may be an alternative in the therapy of severe infections due to multiresistant Enterobacteriacae.
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Affiliation(s)
- F Caron
- INSERM U.13, Hôpital Claude-Bernard, Service de Médecine Interne, Paris, France
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39
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Bedos JP. [Pneumococcus resistance to antibiotics]. Rev Prat 1989; 39:2155-7. [PMID: 2814286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Perronne C, Leport C, Bedos JP, Zahraoui M, Gehanno P, Himmich H. [Regressive isolated deafness in Mediterranean boutonneuse fever]. Presse Med 1987; 16:1653. [PMID: 2959930] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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