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Mokrani D, Le Hingrat Q, Thy M, Choquet C, Joly V, Lariven S, Rioux C, Deconinck L, Loubet P, Papo T, Crestani B, Bunel V, Bouadma L, Khalil A, Armand-Lefèvre L, Raynaud-Simon A, Timsit JF, Lescure FX, Yazdanpanah Y, Descamps D, Peiffer-Smadja N. Clinical characteristics and outcomes of Respiratory Syncytial Virus-associated ARF in immunocompetent patients: a seven-year experience at a tertiary hospital in France. J Infect 2024:106180. [PMID: 38759759 DOI: 10.1016/j.jinf.2024.106180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is widely recognized as a cause of acute respiratory failure in infants and immunocompromised patients. However, RSV can also contribute to acute respiratory failure in adults, particularly among the elderly population. The objective of this study was to analyze the clinical characteristics and outcomes of immunocompetent adults hospitalized for RSV infection. METHODS This retrospective study included all immunocompetent adult patients consecutively admitted to a tertiary care hospital with RSV-related acute respiratory failure over a seven-year period (2016 - 2023). Diagnosis of RSV infection was made through nasal swabs or pulmonary samples, with multiplex reverse transcription polymerase chain reaction (RT-PCR). Patients were eligible for inclusion if they required supplemental oxygen therapy for at least 48hours. RESULTS One hundred and four patients met the inclusion criteria. Median age [IQR] was 77 years [67 - 85]. Ninety-seven patients had at least one comorbidity (97/104, 93%). At the time of RSV diagnosis, 67 patients (67/104, 64%) experienced acute decompensation of a pre-existing chronic comorbidity. Antibiotics were started in 80% (77/104) of patients; however, only 16 patients had a confirmed diagnosis of bacterial superinfection. Twenty-six patients needed ventilatory support (26/104, 25%) and 21 were admitted to the intensive care unit (21/104, 20%). The median duration of oxygen therapy [IQR] was 6 days [3 - 9], while the median hospital length of stay [IQR] was 11 days [6 - 15]. The overall mortality rate within one month of hospital admission was 13% (14/104). The sole variables associated with one-month mortality were age and maximum oxygen flow during hospitalisation. CONCLUSION RSV-associated acute respiratory failure affected elderly individuals with multiple comorbidities and was associated with prolonged hospitalization and a high mortality rate.
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Affiliation(s)
- David Mokrani
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Quentin Le Hingrat
- Université de Paris, IAME, UMR 1137, INSERM, Paris, France; Department of Virology, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Michaël Thy
- Université de Paris, IAME, UMR 1137, INSERM, Paris, France; Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France; EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France
| | - Christophe Choquet
- Emergency Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Véronique Joly
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, IAME, UMR 1137, INSERM, Paris, France
| | - Sylvie Lariven
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Rioux
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Paul Loubet
- Department of Infectious and Tropical Diseases, CHU Nîmes, Université de Montpellier, Nîmes, France; VBIC, INSERM U1047, University of Montpellier, Nimes, France
| | - Thomas Papo
- Internal Medicine department, Bichat Hospital, APHP, Université Paris Cité, Paris, France
| | - Bruno Crestani
- Service de Pneumologie A, Hôpital Bichat, 75018-Paris France, APHP Nord-Université Paris Cité, Paris, France; INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France
| | - Vincent Bunel
- INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France; Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Lila Bouadma
- Université de Paris, IAME, UMR 1137, INSERM, Paris, France; Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Laurence Armand-Lefèvre
- Université de Paris, IAME, UMR 1137, INSERM, Paris, France; Service de Bactériologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Agathe Raynaud-Simon
- APHP, Department of Geriatrics, Bichat, Beaujon and Bretonneau hospitals, Paris Cité University
| | - Jean-François Timsit
- Université de Paris, IAME, UMR 1137, INSERM, Paris, France; Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
| | - F-X Lescure
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, IAME, UMR 1137, INSERM, Paris, France
| | - Yazdan Yazdanpanah
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, IAME, UMR 1137, INSERM, Paris, France
| | - Diane Descamps
- Université de Paris, IAME, UMR 1137, INSERM, Paris, France; Department of Virology, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Nathan Peiffer-Smadja
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, IAME, UMR 1137, INSERM, Paris, France
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Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Exclusive Oral Antibiotic Treatment for Hospitalized Community-Acquired Pneumonia: A Post-Hoc Analysis of a Randomized Clinical Trial. Clin Microbiol Infect 2024:S1198-743X(24)00237-4. [PMID: 38734138 DOI: 10.1016/j.cmi.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). METHODS In this post-hoc analysis of a RCT on patients hospitalized for CAP (PTC trial) comparing 3-day versus 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). Choice of route and molecule was left to the physician in charge. The main outcome was failure at 15 days after first antibiotic intake, defined as temperature>37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to route of administration was evaluated through logistic regression. Inverse probability treatment weighting (IPTW) with a propensity score model was used to adjust for non-randomization of treatment route and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC versus 3GC treatments, or intravenous versus oral AMC, patients with multi-lobar infection, patients aged ≥ 65 years old, and patients with CURB65 scores of 3-4). RESULTS We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. Failure rate at Day 15 was not significantly different among patients treated with initial intravenous versus oral treatment (25/93 (26.9%) versus 28/107 (26.2%), aOR 0.973 (95%CI 0.519-1.823), p=0.932). Failure rates at Day 15 were not significantly different among the subgroup populations. CONCLUSIONS Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT01963442.
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Affiliation(s)
- Aurélien Dinh
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France; Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France.
| | - Clara Duran
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, APHP, Paris, France
| | - Frédérique Bouchand
- Pharmacy department, Raymond-Poincaré University Hospital, APHP Paris Saclay, Garches, France
| | - Laurène Deconinck
- Infectious disease department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious disease department, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | | | - Guillaume Mellon
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal medicine, Lariboisière University Hospital, APHP, Paris, France
| | | | - Daniel Benhamou
- Pneumology department, Rouen University Hospital, Rouen, France
| | | | | | - Bertrand Renaud
- Emergency department, Cochin University Hospital, APHP, Paris, France
| | | | - José Labarère
- Quality of care unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Beaumont AL, Mestre F, Decaux S, Bertin C, Duval X, Iung B, Rouzet F, Grall N, Para M, Thy M, Deconinck L. Long-term Oral Suppressive Antimicrobial Therapy in Infective Endocarditis (SATIE Study): An Observational Study. Open Forum Infect Dis 2024; 11:ofae194. [PMID: 38737431 PMCID: PMC11083633 DOI: 10.1093/ofid/ofae194] [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: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Abstract
Background The role of suppressive antimicrobial therapy (SAT) in infective endocarditis (IE) management has yet to be defined. The objective of this study was to describe the use of SAT in an IE referral center and the patients' outcomes. Methods We conducted a retrospective observational study in a French IE referral center (Paris). All patients with IE who received SAT between 2016 and 2022 were included. Results Forty-two patients were included (36 male [86%]; median age [interquartile range {IQR}], 73 [61-82] years). The median Charlson Comorbidity Index score (IQR) was 3 (1-4). Forty patients (95%) had an intracardiac device. The most frequent microorganisms were Enterococcus faecalis (15/42, 36%) and Staphylococcus aureus (12/42, 29%). SAT indications were absence of surgery despite clinical indication (28/42, 67%), incomplete removal of prosthetic material (6/42, 14%), uncontrolled infection source (4/42, 10%), persistent abnormal uptake on nuclear imaging (1/42, 2%), or a combination of the previous indications (3/42, 7%). Antimicrobials were mainly doxycycline (19/42, 45%) and amoxicillin (19/42, 45%). The median follow-up time (IQR) was 398 (194-663) days. Five patients (12%) experienced drug adverse events. Five patients (12%) presented with a second IE episode during follow-up, including 2 reinfections (different bacterial species) and 3 possible relapses (same bacterial species). Fourteen patients (33%) in our cohort died during follow-up. Overall, the 1-year survival rate was 84.3% (73.5%-96.7%), and the 1-year survival rate without recurrence was 74.1% (61.4%-89.4%). Conclusions SAT was mainly prescribed to patients with cardiac devices because of the absence of surgery despite clinical indication. Five (12%) breakthrough second IE episodes were reported. Prospective comparative studies are required to guide this empirical practice.
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Affiliation(s)
- Anne-Lise Beaumont
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Femke Mestre
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Sixtine Decaux
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Chloé Bertin
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
- Center of Clinical Investigations, Inserm, CIC 1425, Bichat Hospital, AP-HP, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - Nathalie Grall
- Bacteriology Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, IAME, INSERM, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Michael Thy
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
- EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
| | - Laurène Deconinck
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
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Garofoli N, Joly V, Le Pluart D, Hobson CA, Beaumont AL, Lariven S, Grall N, Para M, Yazdanpanah Y, Lescure FX, Peiffer-Smadja N, Deconinck L, Thy M. Enterococcal endocarditis management and relapses. JAC Antimicrob Resist 2024; 6:dlae033. [PMID: 38449516 PMCID: PMC10915900 DOI: 10.1093/jacamr/dlae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Enterococcus faecalis is the third micro-organism causing endocarditis and is associated with a significant relapse rate. The objective of this study was to describe the management of patients with Enterococcus faecalis endocarditis (EE) and its implication for relapses. Methods We conducted a monocentric, retrospective analysis of all patients hospitalized for EE including endocarditis or infection of cardiac implantable electronic device defined by the modified ESC 2015 Duke criteria in a referral centre in Paris, France. Results Between October 2016, and September 2022, 54 patients with EE were included, mostly men (n = 40, 74%) with a median age of 75 [68-80] years. A high risk for infective endocarditis (IE) was found in 42 patients (78%), including 14 (26%) previous histories of IE, and 32 (59%) histories of valvular cardiac surgery. The aortic valve was the most frequently affected (n = 36, 67%). Combination therapy was mainly amoxicillin-ceftriaxone during all the curative antibiotic therapy duration (n = 31, 57%). Surgery was indicated for 40 patients (74%), but only 27 (50%) were operated on, mainly due to their frailty. Among the 17 deaths (32%), six (11%) happened during the first hospitalization for EE. A suppressive antibiotic treatment was initiated in 15 (29%) patients, mostly because of not performing surgery. During the 6-year study period an EE relapse occurred in three (6%) patients. Conclusions EE is a worrying disease associated with a high risk of relapse and significant mortality. Suppressive antibiotic therapy could be a key treatment to limit the occurrence of relapses.
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Affiliation(s)
| | - Véronique Joly
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Diane Le Pluart
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Claire Amaris Hobson
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Anne-Lise Beaumont
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sylvie Lariven
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nathalie Grall
- Bacteriology Laboratory, Hôpital Bichat—Claude-Bernard, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Marylou Para
- Cardiology Department, Hôpital Bichat—Claude-Bernard, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Yazdan Yazdanpanah
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - François-Xavier Lescure
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Nathan Peiffer-Smadja
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Michael Thy
- Infectious and Tropical Diseases Department, Bichat—Claude-Bernard Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Cité, Paris, France
- EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France
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El Hatimi S, Erpelding ML, Selton-Suty C, Botros JB, Goehringer F, Berthelot E, Elfarra M, Deconinck L, Para M, Provenchere S, Hoen B, Agrinier N, Duval X, Iung B. Predictive performance of surgical mortality risk scores in infective endocarditis. Eur J Cardiothorac Surg 2024; 65:ezad433. [PMID: 38175782 DOI: 10.1093/ejcts/ezad433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES This observational study aimed to evaluate Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI) surgery score predictive performance in comparison to general (EuroSCORE I, II) and specific (De Feo, PALSUSE) surgical risk scores for infective endocarditis (IE). METHODS The study included patients who underwent surgery for IE during the acute phase at Bichat University Hospital (Paris, France) between 1 January 2006 and 31 December 2016 and at Nancy University Hospital (Nancy, France) between 1 January 2009 and 31 December 2019. Patients with IE complicating percutaneous aortic valve implantations or implantable intra-cardiac devices were excluded. Discrimination and calibration were assessed using receiver operating characteristic curve analysis, calibration curves and the Hosmer-Lemeshow test. RESULTS In-hospital mortality rates were 18% at Bichat and 16% at Nancy. Discrimination was high for all risk scores at Bichat (area under the receiver operating characteristic curve = 0.77 for EuroSCORE I, 0.78 for EuroSCORE II, 0.76 for De Feo score, 0.72 for PALSUSE and 0.73 for AEPEI with 95% confidence interval ranging from 0.67 to 0.83), but lower at Nancy (0.56 for EuroSCORE I, 0.65 for EuroSCORE II, 0.63 for De Feo score, 0.67 for PALSUSE and 0.66 for AEPEI score with 95% confidence interval ranging from 0.47 to 0.75). With Brier score, all scores were adequately calibrated in both populations between 0.129 (De Feo) and 0.135 (PALSUSE) for Bichat and between 0.128 (De Feo) and 0.135 (EuroSCORE I) for Nancy. With the Hosmer-Lemeshow test, the AEPEI score exhibited the best calibration (observed/predicted ratio 1.058 in Bichat, 1.087 in Nancy). CONCLUSIONS This surgical score external validation in 2 large independent populations demonstrated that the AEPEI surgical score had the best predictive performance compared to other prognosis scores. It could be helpful in clinical practice to assist the endocarditis team in decision-making.
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Affiliation(s)
- Safwane El Hatimi
- Cardiology Department, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-Line Erpelding
- Clinical Epidemiology Department, Université de Lorraine CHRU Nancy, INSERM, CIC, Nancy, France
| | | | - Jean-Baptiste Botros
- Cardiology Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - François Goehringer
- Infectious and Tropical Diseases Department, Université de Lorraine CHRU Nancy, Nancy, France
| | - Emmanuelle Berthelot
- Cardiology Department, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mazen Elfarra
- Cardiac Surgery Department, Université de Lorraine CHRU Nancy, Nancy, France
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - Marylou Para
- Cardiac Surgery Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - Sophie Provenchere
- Anaesthesiology Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
| | - Bruno Hoen
- Infectious and Tropical Diseases Department, Université de Lorraine CHRU Nancy, Nancy, France
| | - Nelly Agrinier
- Clinical Epidemiology Department, Université de Lorraine CHRU Nancy, INSERM, CIC, Nancy, France
| | - Xavier Duval
- Infectious and Tropical Diseases Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
- Inserm CIC 1425, IAME, Paris, France
| | - Bernard Iung
- Cardiology Department, Université Paris-Cité, AP-HP, Hôpital Bichat, Paris, France
- Inserm U1148, Laboratory for Vascular Translational Science, Paris, France
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Régis C, Thy M, Mahida B, Deconinck L, Tubiana S, Iung B, Duval X, Rouzet F. Absence of infective endocarditis relapse when end-of-treatment fluorodeoxyglucose positron emission tomography/computed tomography is negative. Eur Heart J Cardiovasc Imaging 2023; 24:1480-1488. [PMID: 37307564 DOI: 10.1093/ehjci/jead138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS In non-operated infective endocarditis (IE), relapse may impair the outcome of the disease. The aim of the study was to evaluate the relationship between end-of-treatment (EOT) fluorodeoxyglucose positron emission tomography/computed tomography FDG-PET/CT results and relapse in non-operated IE either on native or prosthetic valve. METHODS AND RESULTS We included 62 patients who underwent an EOT FDG-PET/CT for non-operated IE performed between 30 and 180 days of antibiotic therapy initiation. Qualitative valve assessment categorized initial and EOT FDG-PET/CT as negative or positive. Quantitative analyses were also conducted. Clinical data from medical charts were collected, including endocarditis team decision for IE diagnosis and relapse. Forty-one (66%) patients were male with a median age of 68 years (57; 80) and 42 (68%) had prosthetic valve IE. End-of-treatment FDG-PET/CT was negative in 29 and positive in 33 patients. The proportion of positive scans decreased significantly compared with initial FDG-PET/CT (53% vs. 77%, respectively, P < 0.0001). All relapses (n = 7, 11%) occurred in patients with a positive EOT FDG-PET/CT with a median delay after EOT FDG-PET/CT of 10 days (0; 45). The relapse rate was significantly lower in negative (0/29) than in positive (7/33) EOT FDG-PET/CT (P = 0.01). CONCLUSION In this series of 62 patients with non-operated IE who underwent EOT FDG-PET/CT, those with a negative scan (almost half of the study population) did not develop IE relapse after a median follow-up of 10 months. These findings need to be confirmed by prospective and larger studies.
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Affiliation(s)
- Claudine Régis
- Nuclear Medicine Department, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
- Department of Medical Imaging, Institut de cardiologie de Montréal, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Michael Thy
- Infectious Disease Department, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
- Université Paris Cité, 45 Rue des Saints-Pères, Paris 75006, France
| | - Besma Mahida
- Nuclear Medicine Department, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
- Laboratory for Vascular Translational Science, Inserm U1148, 46 rue Henri-Huchard, Paris 75018, France
| | - Laurène Deconinck
- Infectious Disease Department, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
| | - Sarah Tubiana
- Université Paris Cité, 45 Rue des Saints-Pères, Paris 75006, France
- Clinical Investigation Center, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
| | - Bernard Iung
- Université Paris Cité, 45 Rue des Saints-Pères, Paris 75006, France
- Laboratory for Vascular Translational Science, Inserm U1148, 46 rue Henri-Huchard, Paris 75018, France
- Cardiology Department, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, 75018, 46 rue Henri-Huchard, Paris 75018, France
| | - Xavier Duval
- Université Paris Cité, 45 Rue des Saints-Pères, Paris 75006, France
- Clinical Investigation Center, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
| | - François Rouzet
- Nuclear Medicine Department, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri-Huchard, Paris 75018, France
- Université Paris Cité, 45 Rue des Saints-Pères, Paris 75006, France
- Laboratory for Vascular Translational Science, Inserm U1148, 46 rue Henri-Huchard, Paris 75018, France
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Bertin C, Tarhini H, Rahi M, Deconinck L, Perrineau S, Merlant M, Ghosn J, Peiffer-Smadja N. Complicated scarring following mpox infection. Br J Dermatol 2023:7128041. [PMID: 37071783 DOI: 10.1093/bjd/ljad126] [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] [Received: 10/14/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/20/2023]
Abstract
We describe two patterns of complicated scarring following mpox lesions. The first was hypertrophic scarring of facial lesions in two patients and the second was a scarring folliculitis on peri-buccal lesions in two patients. The combination of deep dermic inflammation, local super-infection, and scratching may have led to these aesthetic complications.
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Affiliation(s)
- Chloé Bertin
- Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - Hassan Tarhini
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - Mayda Rahi
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - Laurène Deconinck
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - Ségolène Perrineau
- Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - Marie Merlant
- Université Paris Cité, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard
| | - Jade Ghosn
- Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - Nathan Peiffer-Smadja
- Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
- Assistance Publique - Hôpitaux de Paris.Nord - Bichat Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, Paris, France
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8
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Mailhe M, Beaumont AL, Thy M, Le Pluart D, Perrineau S, Houhou-Fidouh N, Deconinck L, Bertin C, Ferré VM, Cortier M, De La Porte Des Vaux C, Phung BC, Mollo B, Cresta M, Bouscarat F, Choquet C, Descamps D, Ghosn J, Lescure FX, Yazdanpanah Y, Joly V, Peiffer-Smadja N. Clinical characteristics of ambulatory and hospitalized patients with monkeypox virus infection: an observational cohort study. Clin Microbiol Infect 2023; 29:233-239. [PMID: 36028090 PMCID: PMC9533921 DOI: 10.1016/j.cmi.2022.08.012] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES A global outbreak of monkeypox virus infections in human beings has been described since April 2022. The objectives of this study were to describe the clinical characteristics and complications of patients with a monkeypox infection. METHODS All consecutive patients with a polymerase chain reaction (PCR)-confirmed monkeypox infection seen in a French referral centre were included. RESULTS Between 21 May and 5 July 2022, 264 patients had a PCR-confirmed monkeypox infection. Among them, 262 (262/264, 99%) were men, 245 (245/259, 95%) were men who have sex with men, and 90 (90/216, 42%) practiced chemsex in the last 3 months. Seventy-three (73/256, 29%) patients were living with human immunodeficiency virus infection, and 120 (120/169, 71%) patients were taking pre-exposure prophylaxis against human immunodeficiency virus infection. Overall, 112 (112/236, 47%) patients had contact with a confirmed monkeypox case; it was of sexual nature for 95% of the contacts (86/91). Monkeypox virus PCR was positive on the skin in 252 patients, on the oropharyngeal sample in 150 patients, and on blood in eight patients. The majority of patients presented with fever (171/253, 68%) and adenopathy (174/251, 69%). Skin lesions mostly affected the genital (135/252, 54%) and perianal (100/251, 40%) areas. Overall, 17 (17/264, 6%) patients were hospitalized; none of them were immunocompromised. Complications requiring hospitalization included cellulitis (n = 4), paronychia (n = 3), severe anal and digestive involvement (n = 4), non-cardia angina with dysphagia (n = 4), blepharitis (n = 1), and keratitis (n = 1). Surgical management was required in four patients. CONCLUSION The current outbreak of monkeypox infections has specific characteristics: it occurs in the men who have sex with men community; known contact is mostly sexual; perineal and anal areas are frequently affected; and severe complications include superinfected skin lesions, paronychia, cellulitis, anal and digestive involvement, angina with dysphagia, and ocular involvement.
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Affiliation(s)
- Morgane Mailhe
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Anne-Lise Beaumont
- Infectious and Tropical Diseases Department, Bichat - Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Michael Thy
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Diane Le Pluart
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Ségolène Perrineau
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Nadhira Houhou-Fidouh
- Virology Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Chloé Bertin
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Valentine Marie Ferré
- Virology Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marie Cortier
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Clémentine De La Porte Des Vaux
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bao-Chau Phung
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bastien Mollo
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mélanie Cresta
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Fabrice Bouscarat
- Dermatology Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Choquet
- Emergency Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Diane Descamps
- Virology Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France,Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Jade Ghosn
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France,Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - François-Xavier Lescure
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France,Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Yazdan Yazdanpanah
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France,Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Véronique Joly
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France,Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
| | - Nathan Peiffer-Smadja
- Infectious and Tropical Diseases Department, Bichat – Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France,Université Paris Cité and Université Sorbonne Paris Nord, INSERM, IAME, Paris, France
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9
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Bertin C, Beaumont AL, Merlant M, Mailhe M, Le Pluart D, Deconinck L, Thy M, Cortier M, Garé M, Dollat M, Rahi M, Joly V, Lariven S, Rioux C, Truong A, Deschamps L, Ferré VM, Charpentier C, Lescure FX, Bouscarat F, Descamps V, Yazdanpanah Y, Peiffer-Smadja N. Erythematous maculopapular rash in monkeypox virus infection: A retrospective case series of 30 patients. J Eur Acad Dermatol Venereol 2023; 37:e638-e641. [PMID: 36648134 DOI: 10.1111/jdv.18876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Chloé Bertin
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Anne-Lise Beaumont
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Marie Merlant
- Service de Dermatologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Morgane Mailhe
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Diane Le Pluart
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Laurène Deconinck
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Michael Thy
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Marie Cortier
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Mathilde Garé
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Marion Dollat
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Mayda Rahi
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Véronique Joly
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Sylvie Lariven
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Christophe Rioux
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Audrey Truong
- Service d'anatomopathologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Lydia Deschamps
- Service d'anatomopathologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Valentine Marie Ferré
- Service de Virologie, INSERM, IAME, UMR 1137, AP-HP, Hôpital Bichat Claude Bernard, Université Paris Cité, Paris, France
| | - Charlotte Charpentier
- Service de Virologie, INSERM, IAME, UMR 1137, AP-HP, Hôpital Bichat Claude Bernard, Université Paris Cité, Paris, France
| | - François-Xavier Lescure
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Fabrice Bouscarat
- Service de Dermatologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Vincent Descamps
- Service de Dermatologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Yazdan Yazdanpanah
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
| | - Nathan Peiffer-Smadja
- Department of Infectious and Tropical Diseases, Bichat, Assistance Publique - Hôpitaux de Paris - Claude-Bernard University Hospital, Université Paris Cité, Paris, France
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10
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Thy M, Peiffer-Smadja N, Mailhe M, Kramer L, Ferré VM, Houhou N, Tarhini H, Bertin C, Beaumont AL, Garé M, Le Pluart D, Perrineau S, Rahi M, Deconinck L, Phung B, Mollo B, Cortier M, Cresta M, De La Porte Des Vaux C, Joly V, Lariven S, Rioux C, Somarriba C, Lescure FX, Charpentier C, Yazdanpanah Y, Ghosn J. Breakthrough Infections after Postexposure Vaccination against Mpox. N Engl J Med 2022; 387:2477-2479. [PMID: 36477495 DOI: 10.1056/nejmc2211944] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Mayda Rahi
- Bichat-Claude Bernard Hospital, Paris, France
| | | | - Bao Phung
- Bichat-Claude Bernard Hospital, Paris, France
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11
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Dinh A, Duran C, Singh S, Tesmoingt C, Bouabdallah L, Hamon A, Antignac M, Ourghanlian C, Loustalot MC, Pain JB, Wyplosz B, Junot H, Bleibtreu A, Michelon H, Duran C, Michelon H, Batista R, Singh S, Deconinck L, Tesmoingt C, Bouadballah L, Lafaurie M, Touratier S, de Lastours V, Hamon A, Antignac M, Pacanowski J, Ourghanlian C, Lepeule R, Lebeaux D, Loustalot MC, Calin R, Pain JB, Wyplosz B, Bleibtreu A, Junot H. Real-life temocillin use in Greater Paris area, effectiveness and risk factors for failure in infections caused by ESBL-producing Enterobacterales: a multicentre retrospective study. JAC Antimicrob Resist 2022; 5:dlac132. [PMID: 36601547 PMCID: PMC9798080 DOI: 10.1093/jacamr/dlac132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
Background Temocillin is a β-lactam that is not hydrolysed by ESBLs. Objectives To describe the real-life use of temocillin, to assess its effectiveness in infections caused by ESBL-producing Enterobacterales, and to identify risk factors for treatment failure. Methods Retrospective multicentric study in eight tertiary care hospitals in the Greater Paris area, including patients who received at least one dose of temocillin for ESBL infections from 1 January to 31 December 2018. Failure was a composite criterion defined within 28 day follow-up by persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment and/or death from infection. A logistic regression with univariable and multivariable analysis was performed to identify risks associated with failure. Results Data on 130 infection episodes were collected; 113 were due to ESBL-producing Enterobacterales. Mean age was 65.2 ± 15.7 years and 68.1% patients were male. Indications were mostly urinary tract infections (UTIs) (85.8%), bloodstream infections (11.5%), respiratory tract infections (RTIs) (3.5%) and intra-abdominal infections (3.5%). Bacteria involved were Escherichia coli (49.6%), Klebsiella pneumoniae (44.2%) and Enterobacter cloacae (8.8%). Polymicrobial infections occurred in 23.0% of cases. Temocillin was mostly used in monotherapy (102/113, 90.3%). Failure was found in 13.3% of cases. Risk factors for failure in multivariable analysis were: RTI (aOR 23.3, 95% CI 1.5-358.2) and neurological disease (aOR 5.3, 95% CI 1.5-18.6). Conclusions The main use of temocillin was UTI due to ESBL-producing E. coli and K. pneumoniae, with a favourable clinical outcome. The main risk factor for failure was neurological disease.
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Affiliation(s)
- Aurélien Dinh
- Corresponding author. E-mail: ; @aurdinh, @BleibtreuAlexa1
| | - Clara Duran
- Infectious Disease Department, Raymond-Poincaré Hospital, AP-HP, Université Paris Saclay, Garches, France
| | - Simrandeep Singh
- Pharmacy Department, Cochin Hospital, AP-HP, Centre—Université Paris Cité, Paris, France
| | - Chloé Tesmoingt
- Pharmacy Department, Bichat Hospital, AP-HP, Nord—Université Paris Cité, Paris, France
| | - Laura Bouabdallah
- Pharmacy Department, Saint-Louis Hospital, AP-HP, Nord—Université Paris Cité, Paris, France
| | - Antoine Hamon
- Internal Medicine Department, Beaujon Hospital, AP-HP, Nord—Université Paris Cité, Clichy, France
| | - Marie Antignac
- Pharmacy Department, Saint-Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Clément Ourghanlian
- Pharmacy Department, Henri-Mondor Hospital, AP-HP, HU Henri Mondor, Creteil, France
| | - Marie-Caroline Loustalot
- Pharmacy Department, Hôpital Européen Georges Pompidou, AP-HP, Centre—Université Paris Cité, Paris, France
| | - Jean Baptiste Pain
- Pharmacy Department, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Benjamin Wyplosz
- Tropical and Infectious Disease Department, Bicêtre Hospital, AP-HP, Université Paris Saclay, Kremlin-Bicêtre, France
| | - Helga Junot
- Pharmacy Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Alexandre Bleibtreu
- Infectious Disease Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Hugues Michelon
- Pharmacy Department, Raymond-Poincaré Hospital, AP-HP, Université Paris Saclay, Garches, France
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12
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Garé M, Thy M, Deconinck L, Grall N, Yazdanpanah Y, Joly V. Réactivation de tuberculose après traitement immunomodulateur pour une infection sévère à SARS-CoV-2. Médecine et Maladies Infectieuses Formation 2022. [PMCID: PMC9771745 DOI: 10.1016/j.mmifmc.2022.12.003] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Nous rapportons deux cas de réactivation tuberculeuse après COVID-19 sous corticostéroïdes et tocilizumab. Ils ont présenté une lymphopénie, des signes cliniques limités, des signes radiologiques inhabituels mais des prélèvements microbiologiques positifs. Le dépistage de l'infection tuberculeuse latente (ITL) étant inapproprié dans ce contexte, il faudrait discuter de la traiter systématiquement chez des patients les plus à risque en cas de traitement immunomodulateur.
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Affiliation(s)
- Mathilde Garé
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France,Auteur correspondant
| | - Michael Thy
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
| | - Laurène Deconinck
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
| | - Nathalie Grall
- Service de Microbiologie, Hôpital Bichat, APHP, Paris, France
| | - Yazdan Yazdanpanah
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
| | - Véronique Joly
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, APHP, Paris, France
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13
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d’Humières C, Gaïa N, Gueye S, de Lastours V, Leflon-Guibout V, Maataoui N, Duprilot M, Lecronier M, Rousseau MA, Gamany N, Lescure FX, Senard O, Deconinck L, Dollat M, Isernia V, Le Hur AC, Petitjean M, Nazimoudine A, Le Gac S, Chalal S, Ferreira S, Lazarevic V, Guigon G, Gervasi G, Armand-Lefèvre L, Schrenzel J, Ruppé E. Contribution of Clinical Metagenomics to the Diagnosis of Bone and Joint Infections. Front Microbiol 2022; 13:863777. [PMID: 35531285 PMCID: PMC9069157 DOI: 10.3389/fmicb.2022.863777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Bone and joint infections (BJIs) are complex infections that require precise microbiological documentation to optimize antibiotic therapy. Currently, diagnosis is based on microbiological culture, sometimes complemented by amplification and sequencing of the 16S rDNA gene. Clinical metagenomics (CMg), that is, the sequencing of the entire nucleic acids in a sample, was previously shown to identify bacteria not detected by conventional methods, but its actual contribution to the diagnosis remains to be assessed, especially with regard to 16S rDNA sequencing. In the present study, we tested the performance of CMg in 34 patients (94 samples) with suspected BJIs, as compared to culture and 16S rDNA sequencing. A total of 94 samples from 34 patients with suspicion of BJIs, recruited from two sites, were analyzed by (i) conventional culture, (ii) 16S rDNA sequencing (Sanger method), and (iii) CMg (Illumina Technology). Two negative controls were also sequenced by CMg for contamination assessment. Based on the sequencing results of negative controls, 414 out of 539 (76.7%) bacterial species detected by CMg were considered as contaminants and 125 (23.2%) as truly present. For monomicrobial infections (13 patients), the sensitivity of CMg was 83.3% as compared to culture, and 100% as compared to 16S rDNA. For polymicrobial infections (13 patients), the sensitivity of CMg was 50% compared to culture, and 100% compared to 16S rDNA. For samples negative in culture (8 patients, 21 samples), CMg detected 11 bacteria in 10 samples from 5 different patients. In 5/34 patients, CMg brought a microbiological diagnosis where conventional methods failed, and in 16/34 patients, CMg provided additional information. Finally, 99 antibiotic resistance genes were detected in 24 patients (56 samples). Provided sufficient genome coverage (87.5%), a correct inference of antibiotic susceptibility was achieved in 8/8 bacteria (100%). In conclusion, our study demonstrated that the CMg provides complementary and potentially valuable data to conventional methods of BJIs diagnosis.
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Affiliation(s)
- Camille d’Humières
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
- INSERM, Université de Paris Cité, IAME, Paris, France
- *Correspondence: Camille d’Humières,
| | - Nadia Gaïa
- Laboratoire de Recherche Génomique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Signara Gueye
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
| | - Victoire de Lastours
- INSERM, Université de Paris Cité, IAME, Paris, France
- AP-HP, Hôpital Beaujon, Service de Médecine Interne, Paris, France
| | | | - Naouale Maataoui
- AP-HP, Hôpital Beaujon, Laboratoire de Bactériologie, Paris, France
| | - Marion Duprilot
- AP-HP, Hôpital Beaujon, Laboratoire de Bactériologie, Paris, France
| | - Marie Lecronier
- AP-HP, Hôpital Beaujon, Service de Médecine Interne, Paris, France
| | | | - Naura Gamany
- AP-HP, Hôpital Beaujon, Service de Médecine Interne, Paris, France
| | - François-Xavier Lescure
- INSERM, Université de Paris Cité, IAME, Paris, France
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Olivia Senard
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Laurène Deconinck
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Marion Dollat
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Valentina Isernia
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | | | | | | | - Sylvie Le Gac
- AP-HP, Hôpital Bichat, Département d’Epidémiologie Biostatistique et Recherche Clinique, Paris, France
| | - Solaya Chalal
- AP-HP, Hôpital Bichat, Département d’Epidémiologie Biostatistique et Recherche Clinique, Paris, France
| | | | - Vladimir Lazarevic
- Laboratoire de Recherche Génomique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | | | | | - Laurence Armand-Lefèvre
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
- INSERM, Université de Paris Cité, IAME, Paris, France
| | - Jacques Schrenzel
- Laboratoire de Recherche Génomique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Etienne Ruppé
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
- INSERM, Université de Paris Cité, IAME, Paris, France
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14
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Husain M, Valayer S, Poey N, Rondinaud E, d'Humières C, Visseaux B, Lariven S, Lescure FX, Deconinck L. Pulmonary bacterial infections in adult patients hospitalized for COVID-19 in standard wards. Infect Dis Now 2021; 52:208-213. [PMID: 34896662 PMCID: PMC8656209 DOI: 10.1016/j.idnow.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/22/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, antibiotic use was very common. However, bacterial co-/secondary infections with coronaviruses remain largely unknown in standard wards. We aimed to investigate the characteristics of pulmonary bacterial infections associated with COVID-19 in hospitalized patients. METHODS A retrospective monocentric observational study was conducted in Bichat hospital, France, between February 26 and April 22, 2020. All patients hospitalized in standard wards with COVID-19 (positive nasopharyngeal PCR and/or typical aspect on CT scan) and diagnosed with pulmonary bacterial infection (positive bacteriological samples) were included. Bacteriological and clinical data were collected from the microbiology laboratories and patient's medical records. RESULTS Twenty-three bacteriological samples from 22 patients were positive out of 2,075 screened samples (1.1%) from 784 patients (2.8%). Bacterial infection occurred within a median of 10 days after COVID-19 onset. Diagnosis of pulmonary bacterial infection was suspected on increase of oxygen requirements (20/22), productive cough or modification of sputum aspect (17/22), or fever (10/22). Positive samples included 13 sputum cultures, one FilmArray® assay on sputum samples, one bronchoalveolar lavage, six blood cultures, and two pneumococcal urinary antigen tests. The most frequent bacteria were Pseudomonas aeruginosa (6/23), Staphylococcus aureus (5/23), Streptococcus pneumoniae (4/23), Enterococcus faecalis (3/23), and Klebsiella aerogenes (3/23). No Legionella urinary antigen test was positive. Four out of 496 nasopharyngeal PCR tests (0.8%) were positive for intracellular bacteria (two Bordetella pertussis and two Mycoplasma pneumonia). CONCLUSIONS Pulmonary bacterial secondary infections and co-infections with SARS-CoV-2 are uncommon. Antibiotic use should remain limited in the management of COVID-19.
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Affiliation(s)
- M Husain
- Infectious and tropical diseases department, Bichat Hospital, Paris, France; Faculty of medicine, University of Paris, Paris, France
| | - S Valayer
- Infectious and tropical diseases department, Bichat Hospital, Paris, France; Faculty of medicine, Sorbonne University, Paris, France
| | - N Poey
- Infectious and tropical diseases department, Bichat Hospital, Paris, France.
| | - E Rondinaud
- Bacteriology department, Bichat Hospital, Paris, France; IAME, UMR 1137, INSERM, University of Paris, Paris, France
| | - C d'Humières
- Bacteriology department, Bichat Hospital, Paris, France; IAME, UMR 1137, INSERM, University of Paris, Paris, France
| | - B Visseaux
- Virology department, Bichat Hospital, Paris, France
| | - S Lariven
- Infectious and tropical diseases department, Bichat Hospital, Paris, France
| | - F X Lescure
- Infectious and tropical diseases department, Bichat Hospital, Paris, France
| | - L Deconinck
- Infectious and tropical diseases department, Bichat Hospital, Paris, France
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15
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Dinh A, Duran C, Ropers J, Bouchand F, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Guillemot D, Renaud B, Claessens YE, Labarère J, Aegerter P, Bedos JP, Crémieux AC. Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2129566. [PMID: 34652445 PMCID: PMC8520128 DOI: 10.1001/jamanetworkopen.2021.29566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Failure of treatment is the most serious complication in community-acquired pneumonia (CAP). OBJECTIVE To assess the potential risk factors for treatment failure in clinically stable patients with CAP. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis assesses data from a randomized clinical trial on CAP (Pneumonia Short Treatment [PTC] trial) conducted from December 19, 2013, to February 1, 2018. Data analysis was performed from July 18, 2019, to February 15, 2020. Patients hospitalized at 1 of 16 centers in France for moderately severe CAP who were clinically stable at day 3 of antibiotic treatment were included in the PTC trial and analyzed in the per-protocol trial population. INTERVENTIONS Patients were randomly assigned (1:1) on day 3 of antibiotic treatment to receive β-lactam (amoxicillin-clavulanate [1 g/125 mg] 3 times daily) or placebo for 5 extra days. MAIN OUTCOMES AND MEASURES The main outcome was failure at 15 days after first antibiotic intake, defined as a temperature greater than 37.9 °C and/or absence of resolution or improvement of respiratory symptoms and/or additional antibiotic treatment for any cause. The association among demographic characteristics, baseline clinical and biological variables available (ie, at the first day of β-lactam treatment), and treatment failure at day 15 among the per-protocol trial population was assessed by univariate and multivariable logistic regressions. RESULTS Overall, 310 patients were included in the study; this secondary analysis comprised 291 patients (174 [59.8%] male; mean [SD] age, 69.6 [18.5] years). The failure rate was 26.8%. Male sex (odds ratio [OR], 1.74; 95% CI, 1.01-3.07), age per year (OR, 1.03; 95% CI, 1.01-1.05), Pneumonia Severe Index score (OR, 1.01; 95% CI, 1.00-1.02), the presence of chronic lung disease (OR, 1.85; 95% CI, 1.03-3.30), and creatinine clearance (OR, 0.99; 95% CI, 0.98-1.00) were significantly associated with failure in the univariate analysis. When the Pneumonia Severe Index score was excluded to avoid collinearity with age and sex in the regression model, only male sex (OR, 1.92; 95% CI, 1.08-3.49) and age (OR, 1.02; 95% CI, 1.00-1.05) were associated with failure in the multivariable analysis. CONCLUSIONS AND RELEVANCE In this secondary analysis of a randomized clinical trial, among patients with CAP who reached clinical stability after 3 days of antibiotic treatment, only male sex and age were associated with higher risk of failure, independent of antibiotic treatment duration and biomarker levels. Another randomized clinical trial is needed to evaluate the impact of treatment duration in populations at higher risk for treatment failure.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
- Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit, Institut Pasteur, Paris, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, APHP, Paris, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond-Poincaré University Hospital, APHP Paris Saclay, Garches, France
| | - Benjamin Davido
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Laurène Deconinck
- Infectious Disease Department, Bichat University Hospital, APHP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious Disease Department, Marne La Vallée Hospital, Grand Hôpital de l'Est Francilien, Marne La Vallée, France
| | | | - Guillaume Mellon
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine, Lariboisière University Hospital, APHP, Paris, France
| | | | - Daniel Benhamou
- Pneumology Department, Rouen University Hospital, Rouen, France
| | | | | | - Didier Guillemot
- Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit, Institut Pasteur, Paris, France
| | - Bertrand Renaud
- Emergency Department, Cochin University Hospital, APHP, Paris, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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16
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Rahi M, Le Pluart D, Beaudet A, Ismaël S, Parisey M, Poey N, Tarhini H, Lescure FX, Yazdanpanah Y, Deconinck L. Sociodemographic characteristics and transmission risk factors in patients hospitalized for COVID-19 before and during the lockdown in France. BMC Infect Dis 2021; 21:812. [PMID: 34388990 PMCID: PMC8361240 DOI: 10.1186/s12879-021-06419-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/07/2021] [Indexed: 12/23/2022] Open
Abstract
Background The efficacy of lockdown in containing the COVID-19 pandemic has been reported in different studies. However, the impact on sociodemographic characteristics of individuals infected with SARS-CoV-2 has not been evaluated. The aim of this study was to describe the changes in sociodemographic characteristics of patients hospitalized for COVID-19 and to compare the transmission risk factors of COVID-19 before and during lockdown in France. Methods An observational retrospective study was conducted in a University Hospital in Paris, France. Data from patients hospitalized for COVID-19 in the Infectious Diseases Department between February 26 and May 11, 2020 were collected. The study population was divided into 2 groups: group A of patients infected before lockdown, and group B of patients infected during lockdown, considering a maximum incubation period of 14 days. Sociodemographic characteristics and transmission risk factors were compared between the 2 groups using Student’s t-test for continuous variables and Chi-2 test or Fisher exact test for categorical variables. Results Three hundred eighty-three patients were included in the study, 305 (79.6%) in group A and 78 (20.4%) in group B. Patients in group A were significantly younger (60.0 versus (vs) 66.5 years (p = 0.03)). The professionally active population was larger in group A (44.3% vs 24.4%). There were significantly more non-French-speaking people in group B (16.7% vs 6.6%, p < 0.01). Most patients from group A had individual accommodation (92.8% vs 74.4%, p < 0.01). Contact with a relative was the main transmission risk factor in both groups (24.6% vs 33.3%, p = 0.16). Recent travel and large gathering were found only in group A. The proportion of people living in disadvantaged conditions, such as homeless people or people living in social housing, was significantly higher in group B (11.5% vs 4.3%, p = 0.03) as was the proportion of institutionalized individuals (14.1% vs 3.0%, p < 0.01). Conclusions In this study conducted in patients hospitalized for COVID-19 in Paris, France, the likelihood of being infected despite the lockdown was higher for people who do not speak French, live in social housing, are homeless or institutionalized. Targeted measures have to be implemented to protect these populations.
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Affiliation(s)
- Mayda Rahi
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Diane Le Pluart
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Alexandra Beaudet
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Sophie Ismaël
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Marion Parisey
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Nora Poey
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Hassan Tarhini
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - François-Xavier Lescure
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
| | - Yazdan Yazdanpanah
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France.
| | - Laurène Deconinck
- Infectious and Tropical Diseases Department
- , Bichat - Claude-Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75018, Paris, France
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17
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Bouchand F, Leplay C, Guimaraes R, Fontenay S, Fellous L, Dinh A, Deconinck L, Sénard O, Matt M, Michelon H, Perronne C, Salomon J, Villart M, Izedaren F, Pottier S, Barbot F, Orlikowski D, Vaugier I, Davido B. Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial. Int J Clin Pract 2021; 75:e14282. [PMID: 33915011 DOI: 10.1111/ijcp.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the impact of a care bundle including medication reconciliation at discharge by a pharmacist versus standard of care, on continuity of therapeutic changes between hospital and primary care and outcome of patients, within 1 month after discharge. METHODS Randomised controlled trial in 120 adult patients with at least one chronic disease and three current medications before admission, hospitalised in an infectious disease department of a tertiary hospital and discharged home. Patients were randomly assigned (1:1) to receive a discharge care bundle including medication reconciliation, counselling session and documentation transfer to primary care physician (PCP) (intervention group) or standard of care (control group). Primary outcome was the proportion of in-hospital prescription changes, not maintained by the PCP, 1 month after discharge. Secondary outcome measures included the proportion of patients experiencing early PCP's consultation, hospital readmissions or adverse reactions within 1-month postdischarge and cost of discharge prescriptions. RESULTS Baseline characteristics were comparable between the two groups. One month after discharge, the proportion of in-hospital prescription changes, not maintained by the PCP, was 11% in the intervention group versus 24% in the control group (P = .007). The median delay before PCP's consultation was longer in the intervention group (30.5 vs 19.5 days, P = .013), there were fewer patients readmitted to hospital (3.4% vs 20.7%, P = .009, odds ratio (OR) = 0.13 [0.02-0.53]) and fewer patients who suffered from adverse drug reaction (7.0% vs 22.8%, P = .04, OR = 0.26 [0.07-0.78]). CONCLUSION This care bundle resulted in the reduction of treatment changes between hospital discharge and primary care.
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Affiliation(s)
- Frédérique Bouchand
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Céline Leplay
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Ricardo Guimaraes
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Sarah Fontenay
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Lesly Fellous
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Aurélien Dinh
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Laurène Deconinck
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Olivia Sénard
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Morgan Matt
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Hugues Michelon
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Christian Perronne
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Jérôme Salomon
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Maryvonne Villart
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Raymond-Poincaré, Garches, France
| | - Fatima Izedaren
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Sandra Pottier
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Frédéric Barbot
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - David Orlikowski
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Isabelle Vaugier
- Clinical Investigation Centre 1429, APHP, Hôpital Raymond-Poincaré, Garches, France
| | - Benjamin Davido
- Department of Infectious diseases, APHP, Hôpital Raymond-Poincaré, Garches, France
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18
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Deconinck L, Gschwind R, Petitjean M, Gueye S, Leflon-Guibout V, Maataoui N, Rondinaud E, Suard A, Gallais K, Richaud R, Fuchs A, Iung B, Alkhoder S, Ismaël S, Herrou J, Prié H, Armand-Lefèvre L, d’Humières C, Ruppé E. Endocarditis caused by Thalassospira sp. IDCases 2021; 24:e01109. [PMID: 33948436 PMCID: PMC8080455 DOI: 10.1016/j.idcr.2021.e01109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
Abstract
We report a case of an infective endocarditis caused by a Thalassospira sp. in a 53-year-old man with pre-existing valvular lesions and living in French Polynesia as a fisherman. The strain was identified with DNA-sequecing methods while it was not by mass spectrometry.
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Affiliation(s)
- Laurène Deconinck
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Rémi Gschwind
- INSERM, Université de Paris, IAME, F-75018 Paris, France
| | | | - Signara Gueye
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, F-75018 Paris, France
| | | | - Naouale Maataoui
- INSERM, Université de Paris, IAME, F-75018 Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, F-75018 Paris, France
| | - Emilie Rondinaud
- INSERM, Université de Paris, IAME, F-75018 Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, F-75018 Paris, France
| | - Augustin Suard
- Centre de Cardiologie du Taaone, BP1640 Papeete, Tahiti, French Polynesia
| | - Katell Gallais
- Centre de Cardiologie du Taaone, BP1640 Papeete, Tahiti, French Polynesia
| | - Rainui Richaud
- Centre de Cardiologie du Taaone, BP1640 Papeete, Tahiti, French Polynesia
| | - Adeline Fuchs
- AP-HP, Hôpital Bichat, Service de Cardiologie, F-75018 Paris, France
| | - Bernard Iung
- AP-HP, Hôpital Bichat, Service de Cardiologie, F-75018 Paris, France
- INSERM, Université de Paris, LVTS, F75108 Paris, France
| | - Soleiman Alkhoder
- AP-HP, Hôpital Bichat, Service de Chirurgie Cardiaque et Vasculaire, F-75018 Paris, France
| | - Sophie Ismaël
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Julia Herrou
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Héloïse Prié
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Laurence Armand-Lefèvre
- INSERM, Université de Paris, IAME, F-75018 Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, F-75018 Paris, France
| | - Camille d’Humières
- INSERM, Université de Paris, IAME, F-75018 Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, F-75018 Paris, France
| | - Etienne Ruppé
- INSERM, Université de Paris, IAME, F-75018 Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, F-75018 Paris, France
- Corresponding author at: Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France.
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19
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Gault N, Esposito-Farèse M, Revest M, Inamo J, Cabié A, Polard É, Hulot JS, Ghosn J, Chirouze C, Deconinck L, Diehl JL, Poissy J, Epaulard O, Lefèvre B, Piroth L, De Montmollin E, Oziol E, Etienne M, Laouénan C, Rossignol P, Costagliola D, Vidal-Petiot E. Chronic use of renin-angiotensin-aldosterone system blockers and mortality in COVID-19: A multicenter prospective cohort and literature review. Fundam Clin Pharmacol 2021; 35:1141-1158. [PMID: 33876439 PMCID: PMC8250758 DOI: 10.1111/fcp.12683] [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: 01/07/2021] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 01/09/2023]
Abstract
Aims The role of renin‐angiotensin‐aldosterone system (RAAS) blockers on the course of coronavirus disease 2019 (COVID‐19) is debated. We assessed the association between chronic use of RAAS blockers and mortality among inpatients with COVID‐19 and explored reasons for discrepancies in the literature. Methods and results We included adult hypertensive patients from a prospective nationwide cohort of 3512 inpatients with COVID‐19 up to June 30, 2020. Cox proportional hazard models with various adjustment or propensity weighting methods were used to estimate the hazard ratios (HR) of 30‐day mortality for chronic users versus non‐users of RAAS blockers. We analyzed data of 1160 hypertensive patients: 719 (62%) were male and 777 (67%) were older than 65 years. The main comorbidities were diabetes (n = 416, 36%), chronic cardiac disease (n = 401, 35%), and obesity (n = 340, 29%); 705 (61%) received oxygen therapy. We recorded 135 (11.6%) deaths within 30 days of diagnosis. We found no association between chronic use of RAAS blockers and mortality (unadjusted HR = 1.13, 95% CI [0.8–1.6]; propensity inverse probability treatment weighted HR = 1.09 [0.86‐1.39]; propensity standardized mortality ratio weighted HR = 1.08 [0.79–1.47]). Our comprehensive review of previous studies highlighted that significant associations were mostly found in unrestricted populations with inappropriate adjustment, or with biased in‐hospital exposure measurement. Conclusion Our results do not support previous concerns regarding these drugs, nor a potential protective effect as reported in previous poorly designed studies and meta‐analyses. RAAS blockers should not be discontinued during the pandemic, while in‐hospital management of these drugs will be clarified by randomized trials. NCT04262921.
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Affiliation(s)
- Nathalie Gault
- Centre d'Investigations cliniques-Epidémiologie Clinique 1425, INSERM, Hôpital Bichat, Paris, 75018, France.,Département Epidémiologie Biostatistiques et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, 75018, France
| | - Marina Esposito-Farèse
- Centre d'Investigations cliniques-Epidémiologie Clinique 1425, INSERM, Hôpital Bichat, Paris, 75018, France.,URC Paris Nord, AP-HP DRCI, Hôpital Bichat, Paris, 75018, France
| | - Matthieu Revest
- Service des Maladies Infectieuses et Réanimation Médicale, Univ Rennes, INSERM UMR 1230, Bacterial Regulatory RNA and Medicine, CHU Rennes, Rennes, France
| | - Jocelyn Inamo
- Département de Cardiologie, EA7525, CHU Martinique, Fort-de-France, France
| | - André Cabié
- Inserm CIC 1424, Université des Antilles EA 7524, Service de maladies infectieuses et tropicales, CHU de Martinique, Fort-de-France, France
| | - Élisabeth Polard
- Department of Clinical Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, Rennes, France
| | - Jean-Sébastien Hulot
- PARCC, INSERM, Université de Paris, Paris, 75015, France.,INSERM Centre d'Investigations cliniques-plurithématique 1418 and DMU CARTE, F-CRIN INI-CRCT network, AP-HP, Hôpital Européen Georges-Pompidou, Paris, 751015, France
| | - Jade Ghosn
- Service de Maladie Infectieuses et Tropicales, AP-HP, Hôpital Bichat, Paris, France
| | - Catherine Chirouze
- Service de Maladie Infectieuses et Tropicales, CHU Besançon, Besançon, France
| | - Laurène Deconinck
- Service de Maladie Infectieuses et Tropicales, AP-HP, Hôpital Bichat, Paris, France
| | - Jean-Luc Diehl
- Service de Médecine Intensive Réanimation, Laboratoire de Recherche Biochirurgicale (Fondation Carpentier), AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,UMR_S 1140, Innovations thérapeutiques en Hémostase, Université de Paris, INSERM, Paris, France
| | - Julien Poissy
- Inserm U1285, CHU Lille, Pôle de réanimation, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, CNRS, Lille, France
| | - Olivier Epaulard
- Service de Maladies Infectieuses et Médecine Tropicale, CHU Grenoble Rhône Alpes, Grenoble, France
| | - Benjamin Lefèvre
- Service des Maladies Infectieuses et Tropicales, CHRU Nancy, Université de Lorraine, Nancy, France.,APEMAC, Université de Lorraine, Nancy, France
| | - Lionel Piroth
- Département d'infectiologie, Université de Bourgogne, CHU Dijon Bourgogne, Dijon, France
| | - Etienne De Montmollin
- Service de réanimation médicale et des maladies infectieuses, AP-HP, Hôpital Bichat, Paris, France.,IAME UMR 1137, INSERM, Université de Paris, Paris, France
| | - Eric Oziol
- Service de Médecine Hospitalière, CHU Beziers, Beziers, France
| | - Manuel Etienne
- Service des Maladies Infectieuses et Tropicales, CHU Rouen, Rouen, France
| | - Cédric Laouénan
- Centre d'Investigations cliniques-Epidémiologie Clinique 1425, INSERM, Hôpital Bichat, Paris, 75018, France.,Département Epidémiologie Biostatistiques et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, 75018, France.,IAME UMR 1137, INSERM, Université de Paris, Paris, France
| | - Patrick Rossignol
- Centre d'Investigations cliniques-plurithématique 1433, INSERM U1116, CHRU Nancy, Université de Lorraine, INSERM, Nancy, France.,F-CRIN INI-CRCT network, Nancy, France
| | - Dominique Costagliola
- Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France
| | - Emmanuelle Vidal-Petiot
- Service de Physiologie rénale, AP-HP, Hôpital Bichat, Paris, France.,U1149, INSERM, Université de Paris, Paris, France
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20
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Maillet F, Pourbaix A, le Pluart D, Sirmai L, Postolache SA, Couvelard A, Houhou-Fidouh N, Males L, Deconinck L, Lescure FX. Cytomegalovirus proctitis as a complication of COVID-19 with immunosuppressive treatments. IDCases 2021; 24:e01111. [PMID: 33842207 PMCID: PMC8020601 DOI: 10.1016/j.idcr.2021.e01111] [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: 11/17/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 01/22/2023] Open
Abstract
We report a case of reactivated biopsy-proven cytomegalovirus proctitis complicating the course of severe COVID-19 pneumonia treated with dexamethasone, anakinra and lopinavir/ritonavir. No other contributing factor was found than iatrogenic immunosuppression and COVID-19 immune dysregulation. We draw attention to the immunosuppressive risk when treating severe COVID-19 pneumonia with immunomodulators.
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Affiliation(s)
- François Maillet
- Infectious Diseases Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
| | - Annabelle Pourbaix
- Infectious Diseases Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
| | - Diane le Pluart
- Infectious Diseases Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
| | - Laura Sirmai
- Hepatogastroenterology Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
| | | | - Anne Couvelard
- Pathology Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
| | | | - Lisa Males
- Radiology Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
| | - Laurène Deconinck
- Infectious Diseases Department, AP-HP Bichat Claude-Bernard Hospital, 75018, Paris, France
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21
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Dinh A, Ropers J, Duran C, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Makhloufi S, Mellon G, de Lastours V, Bouchand F, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Perronne C, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet 2021; 397:1195-1203. [PMID: 33773631 DOI: 10.1016/s0140-6736(21)00313-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired pneumonia who were stable after 3 days of treatment. METHODS We did this double-blind, randomised, placebo-controlled, non-inferiority trial (the Pneumonia Short Treatment [PTC]) in 16 centres in France. Adult patients (aged ≥18 years) admitted to hospital with moderately severe community-acquired pneumonia (defined as patients admitted to a non-critical care unit) and who met prespecified clinical stability criteria after 3 days of treatment with β-lactam therapy were randomly assigned (1:1) to receive β-lactam therapy (oral amoxicillin 1 g plus clavulanate 125 mg three times a day) or matched placebo for 5 extra days. Randomisation was done using a web-based system with permuted blocks with random sizes and stratified by randomisation site and Pneumonia Severity Index score. Participants, clinicians, and study staff were masked to treatment allocation. The primary outcome was cure 15 days after first antibiotic intake, defined by apyrexia (temperature ≤37·8°C), resolution or improvement of respiratory symptoms, and no additional antibiotic treatment for any cause. A non-inferiority margin of 10 percentage points was chosen. The primary outcome was assessed in all patients who were randomly assigned and received any treatment (intention-to-treat [ITT] population) and in all patients who received their assigned treatment (per-protocol population). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT01963442, and is now complete. FINDINGS Between Dec 19, 2013, and Feb 1, 2018, 706 patients were assessed for eligibility, and after 3 days of β-lactam treatment, 310 eligible patients were randomly assigned to receive either placebo (n=157) or β-lactam treatment (n=153). Seven patients withdrew consent before taking any study drug, five in the placebo group and two in the β-lactam group. In the ITT population, median age was 73·0 years (IQR 57·0-84·0) and 123 (41%) of 303 participants were female. In the ITT analysis, cure at day 15 occurred in 117 (77%) of 152 participants in the placebo group and 102 (68%) of 151 participants in the β-lactam group (between-group difference of 9·42%, 95% CI -0·38 to 20·04), indicating non-inferiority. In the per-protocol analysis, 113 (78%) of 145 participants in the placebo treatment group and 100 (68%) of 146 participants in the β-lactam treatment group were cured at day 15 (difference of 9·44% [95% CI -0·15 to 20·34]), indicating non-inferiority. Incidence of adverse events was similar between the treatment groups (22 [14%] of 152 in the placebo group and 29 [19%] of 151 in the β-lactam group). The most common adverse events were digestive disorders, reported in 17 (11%) of 152 patients in the placebo group and 28 (19%) of 151 patients in the β-lactam group. By day 30, three (2%) patients had died in the placebo group (one due to bacteraemia due to Staphylococcus aureus, one due to cardiogenic shock after acute pulmonary oedema, and one due to heart failure associated with acute renal failure) and two (1%) in the β-lactam group (due to pneumonia recurrence and possible acute pulmonary oedema). INTERPRETATION Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These findings could allow substantial reduction of antibiotic consumption. FUNDING French Ministry of Health.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France.
| | - Jacques Ropers
- Clinical research unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Clara Duran
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Laurène Deconinck
- Infectious Disease Department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious Disease Department, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | | | - Sabrina Makhloufi
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Guillaume Mellon
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Victoire de Lastours
- Internal Medicine Department, Beaujon University Hospital, AP-HP, University of Paris, Clichy, France
| | - Frédérique Bouchand
- Pharmacy, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | | | - Jean-Emmanuel Kahn
- Internal Medicine Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine Department, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | | | - Daniel Benhamou
- Pneumology Department, Bois-Guillaume University Hospital, Rouen, France
| | | | - Marie-Christine Dombret
- Pneumology Department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Bertrand Renaud
- Emergency Department, Cochin University Hospital, AP-HP, Paris Centre University, Paris, France
| | - Christian Perronne
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1169 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
| | - Anne-Claude Crémieux
- Infectious Disease Department, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
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22
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Husain M, Valayer S, Poey N, Rondinaud E, D’Humières C, Visseaux B, Deconinck L, Lescure F. Co-infection et surinfection bactérienne chez les patients hospitalisés pour COVID-19: une étude rétrospective monocentrique. Med Mal Infect 2020. [PMCID: PMC7441989 DOI: 10.1016/j.medmal.2020.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Durant la pandémie de COVID-19, la prescription d’antibiotique a été importante. Cependant, les surinfections et co-infections bactériennes associées aux coronavirus sont peu décrites, et concernent principalement les patients de soins intensifs. Matériels et méthodes Une étude observationnelle rétrospective monocentrique a été menée dans notre CHU du 26/02/2020 au 22/04/2020. Ont été inclus tous les patients hospitalisés pour une COVID-19 (PCR respiratoire positive à SARS-CoV-2 ou atteinte scannographique compatible) hors service de réanimation et présentant une infection bactérienne documentée par un prélèvement bactériologique positif parmi: prélèvement respiratoire (ECBC, aspiration bronchique, LBA), hémoculture, antigénurie légionnelle ou pneumocoque, ou PCR nasopharyngée (Bordetella pertussis, Mycoplasma pneumoniae et légionnelle). Les données bactériologiques ont été obtenues par les laboratoires de bactériologie et virologie et les données cliniques recueillies à partir du dossier médical des patients. Résultats Au total, 2710 prélèvements ont été réalisés chez 778 patients hospitalisés: 957 hémocultures, 169 ECBC, 3 aspirations bronchiques, 2 LBA, 537 PCR nasopharyngées, 517 antigénuries légionnelle et 525 antigénuries pneumocoque. Quarante et un prélèvements étaient positifs (1,5 %) dont quatorze ont été considérés comme une colonisation par les cliniciens. Vingt neuf prélèvements positifs (1,1 %) ont été considérés comme pathogènes chez 27 patients (3,5 %): 15 ECBC, 2 aspirations bronchiques, 1 LBA, 7 hémocultures, 2 antigénuries et 4 PCR nasopharyngées. Parmi les 27 patients, 18 (66,7 %) avaient des comorbidités dont 10 (37 %) une pathologie respiratoire chronique. Huit patients (29,6 %) étaient sous traitement immunosuppresseur au long cours et 15 (55,6 %) ont reçu des corticoïdes ou autres traitements immunomodulateurs pour la COVID-19. Le delais entre l’apparition des symptômes de COVID-19 et la survenue de la surinfection bactérienne était en moyenne de 11 jours. Les arguments en faveur d’une surinfection étaient l’augmentation des besoins en oxygène (n = 22, 81,5 %), la toux expectorante (n= 20, 74,0 %) ou la modification de la toux (n = 5, 18,5 %) et la présence de fièvre (n= 5, 18,5 %). Un patient avait un tableau de sepsis. Les pathogènes les plus fréquemment retrouvés nétaient: Pseudomonas aeruginosa (n = 8, 29,6 %), Staphylococcus aureus (n = 5, 18,5 %), Streptococcus pneumoniae (n = 4, 14,8 %) et Enterococcus faecalis (n = 3, 11,1 %). Quatre patients (0,5 %) avaient une co-infection à bactérie intracellulaire: 2 à Bordetella pertussis et 2 à Mycoplasma pneumoniae. Aucune antigénurie légionnelle n’est revenue positive. Conclusion Le taux de surinfections et de co-infections bactériennes dans la COVID-19 semble faible. Ce faible taux est en faveur d’une utilisation limitée des antibiotiques dans la prise en charge de la COVID-19.
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23
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Peiffer-Smadja N, Lucet JC, Deconinck L, Gérard S, Giordano L, Bendjelloul G, Yazdanpanah Y, Lescure FX. Quelles sont les conséquences de l’épidémie COVID-19 sur l’organisation des soins ? Med Mal Infect 2020. [PMCID: PMC7441878 DOI: 10.1016/j.medmal.2020.06.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Le 30/01/2020, l’OMS déclare une urgence de Santé Publique de portée internationale suite à l’épidémie de COVID-19. Les conséquences des épidémies sont nombreuses, aussi bien pour les patients que pour l’ensemble du système de santé. Cette étude a pour but d’évaluer les conséquences de l’épidémie COVID-19 sur l’organisation des soins à l’échelle hospitalière. Matériels et méthodes Nous avons récolté des données sur la réponse épidémique dans un hôpital prenant en charge des patients infectés par le SARS-CoV-2 à l’aide de plusieurs sources : entretiens individuels semi-structurés, périodes d’observation ethnographique in situ et analyse documentaire. Les entretiens ont été réalisés auprès des différents professionnels de l’hôpital. Les différents points de vue et niveaux organisationnels ont été envisagés lors des entretiens à l’aide d’une approche adaptative et itérative. Les entretiens étaient enregistrés, transcrits et codés à l’aide du logiciel NVivo 12. Les données qualitatives ont été analysées par une analyse thématique inductive. Résultats Nous avons réalisé 37 entretiens avec des personnels de santé (infirmier/e/s, médecins, aides-soignant/e/s, manipulateurs radiologiques, cadres de santé) dans plusieurs services (urgences, maladies infectieuses, réanimation, chirurgie cardiaque, équipe d’hygiène) et avec des personnels administratifs (personnel de sécurité, de logistique, de communication et de direction). Nous avons également collecté plus de 100 heures d’observation ethnographique. Concernant la réponse à l’épidémie, nous avons identifié des éléments facilitateurs comme la gestion de cas suspects pour les épidémies antérieures (MERS-CoV et Ebola), la réalisation d’exercices réguliers par l’équipe d’hygiène, et l’existence préalable de protocoles mais aussi des problèmes non anticipés comme la gestion des déchets à risques biologiques, des difficultés à recruter des infirmiers intérimaires ou la pression médiatique et les rumeurs. Les conséquences de l’épidémie ont été directes ; réorganisation du service de maladies infectieuses, de réanimation médicale et de virologie mais également indirectes ; diminution de l’activité de l’équipe mobile d’infectiologie et des activités d’enseignement, inquiétude des patients non concernés et annulation de rendez-vous. Ont été soulignés par les participants l’importance de maintenir la cohésion des équipes entre personnels travaillant auprès de patients infectés par le SARS-CoV-2 et personnels non impliqués, d’intégrer de façon harmonieuse la recherche clinique dans la prise en charge médicale et de réaliser un travail de veille bibliographique en temps réel afin d’actualiser la prise en charge des cas possibles et confirmés. Conclusion L’épidémie COVID-19 a eu de nombreuses conséquences sur l’organisation aussi bien des services médicaux concernés que des services non directement impliqués et des services administratifs. Cette étude permet d’identifier des pistes d’amélioration pour la réponse épidémique.
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24
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Dinh A, Bleibtreu A, Deconinck L, Katlama C, Debuc E, Villie P, Leclert J, Marchand-arvier J, Lescure X, Jourdain P. COVIDOM : une expérience de télémédecine unique pour la gestion du COVID-19. Med Mal Infect 2020. [PMCID: PMC7442052 DOI: 10.1016/j.medmal.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Afin d’éviter l’engorgement du système de soin et de soulager les praticiens ainsi que d’éviter les contaminations hospitalières, le dispositif de télésuivi COVIDOM a été mis en place en urgence à l’échelle de l’Ile de France. Il permet le suivi des patients à domicile atteint du COVID-19. Il s’agit d’une initiative réalisée en partenariat entre l’AP-HP (Assistance des Hôpitaux de Paris), l’ARS (Agence régionale de Santé) et l’URPS (Union régionale des professionnels de santé) Ile-de-France. Nous présentons ce dispositif. Matériels et méthodes Description et évaluation du dispositif COVIDOM déployé en Ile-de-France. Résultats COVIDOM est un dispositif de télésuivi reposant sur des questionnaires renseignés par le patient, atteint de COVID, 1 ou 2 fois par jour ; 7 items étaient renseignés (fréquence cardiaque, dyspnée, fréquence respiratoire, température, malaise, frissons, difficulté au confinement) et généraient des alertes vertes, oranges ou rouges en fonction des seuils définis. Les alertes étaient traitées par un plateau de télésurveillance supervisé par des médecins représentant au total plus de 2 000 personnes sur l’ensemble de la période. Les patients pouvaient être inclus en consultation (de ville ou hospitalière), en sortie d’hospitalisation ou par la régulation du SAMU et étaient suivi 30j au total. Finalement du 9 mars au 8 juin 2020, 70 914 patients ont été inclus par 10 000 médecins, l’âge médian des patients était de 43 ans avec un sexe ratio de 0,71. Au total 266 619 alertes ont été générés dont 22 958 alertes rouges et 243 661 oranges. Au pic de l’épidémie, jusqu’à 10.000 alertes/jour ont été prises en charge par 40 « cellules » de télésurveillance, soit 200 postes de travail 7j/7 de 8 h à 20 h. La capacité de suivi était d’environ 1.200 patients par cellule. Sur le plateau 1.100 intervenants de télésurveillance (ITS) ont été formés : externes médecine/dentaires, professionnels de santé (kiné, pharmaciens, IDE, dentistes, cadres de santé), plus de 990 médecins référents (salariés AP-HP, libéraux, retraités) et enfin plus de 500 bénévoles, ces derniers étaient chargé s de rappeler les patients « non répondants ». Au total, le délai moyen avant prise en charge d’une alerte rouge était de 4,24 minutes et 427 appels SAMU ont été déclenchés par la plateforme, 858 patients ont été hospitalisés et 73 sont décédés. Conclusion COVIDOM est un dispositif efficace et sécurisé, simple aisément transposable et reproductible. Il s’agit de la première expérience de télémédecine de cette envergure deployée dans le cadre d’une pathologie infectieuse aiguë. Il a participé à éviter l’engorgement des structures de soin qui ont pu se consacrer à la prise en charge des patients sévères.
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25
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Garé M, Deconinck L, Dollat M, Heurtaux T, Mutuon P, Secondi C, Rosmorduc P, Yazdanpanah Y, Lariven S. Les étrangers précaires exclus de l’Assurance Maladie en service de maladies infectieuses (EPSAMI) : conséquences médicales et financières. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Dubert M, Visseaux B, Isernia V, Bouadma L, Deconinck L, Patrier J, Wicky PH, Le Pluart D, Kramer L, Rioux C, Le Hingrat Q, Houhou-Fidouh N, Yazdanpanah Y, Ghosn J, Lescure FX. Case report study of the first five COVID-19 patients treated with remdesivir in France. Int J Infect Dis 2020; 98:290-293. [PMID: 32619764 PMCID: PMC7326458 DOI: 10.1016/j.ijid.2020.06.093] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/27/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as the virus responsible for the coronavirus disease 2019 (COVID-19) outbreak worldwide. Data on treatment are scare and parallels have been made between SARS-CoV-2 and other coronaviruses. Remdesivir is a broad-spectrum antiviral with efficient in vitro activity against SARS-CoV-2. Evidence of clinical improvement in patients with severe COVID-19 treated with remdesivir is controversial. The aim of this study was to describe the clinical outcomes and virological monitoring of the first five COVID-19 patients admitted to the intensive care unit of Bichat-Claude Bernard University Hospital, Paris, France, for severe pneumonia related to SARS-CoV-2 and treated with remdesivir. Quantitative reverse transcription PCR was used to monitor SARS-CoV-2 in blood plasma and the lower and upper respiratory tract. Among the five patients treated, two needed mechanical ventilation and one needed high-flow cannula oxygen. A significant decrease in SARS-CoV-2 viral load in the upper respiratory tract was observed in most cases, but two patients died with active SARS-CoV-2 replication in the lower respiratory tract. Plasma samples were positive for SARS-CoV-2 in only one patient. Remdesivir was interrupted before the initialy planned duration in four patients, two because of alanine aminotransferase elevations (3 to 5 normal range) and two because of renal failure requiring renal replacement. This case series of five COVID-19 patients requiring intensive care unit treatment for respiratory distress and treated with remdesivir, highlights the complexity of remdesivir use in such critically ill patients.
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Affiliation(s)
- Marie Dubert
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France.
| | - Benoit Visseaux
- AP-HP. Nord, Virology Department, Bichat-Claude Bernard University Hospital, Paris, France; University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France
| | - Valentina Isernia
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Lila Bouadma
- University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France; AP-HP. Nord, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France
| | - Laurène Deconinck
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Juliette Patrier
- University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France; AP-HP. Nord, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France
| | - Paul-Henri Wicky
- University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France; AP-HP. Nord, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France
| | - Diane Le Pluart
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Laura Kramer
- AP-HP. Nord, Pharmacy Unit, Bichat-Claude Bernard University Hospital, Paris, France
| | - Christophe Rioux
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Quentin Le Hingrat
- AP-HP. Nord, Virology Department, Bichat-Claude Bernard University Hospital, Paris, France; University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France
| | - Nadhira Houhou-Fidouh
- AP-HP. Nord, Virology Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Yazdan Yazdanpanah
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France; University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France
| | - Jade Ghosn
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France; University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France
| | - Francois-Xavier Lescure
- AP-HP. Nord, Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France; University of Paris, French Institute for Health and Medical Research (INSERM), IAME, U1137, Team DesCID, Paris, France
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Visseaux B, Le Hingrat Q, Collin G, Bouzid D, Lebourgeois S, Le Pluart D, Deconinck L, Lescure FX, Lucet JC, Bouadma L, Timsit JF, Descamps D, Yazdanpanah Y, Casalino E, Houhou-Fidouh N. Evaluation of the QIAstat-Dx Respiratory SARS-CoV-2 Panel, the First Rapid Multiplex PCR Commercial Assay for SARS-CoV-2 Detection. J Clin Microbiol 2020; 58:e00630-20. [PMID: 32341142 PMCID: PMC7383528 DOI: 10.1128/jcm.00630-20] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 01/22/2023] Open
Abstract
In the race to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), efficient detection and triage of infected patients must rely on rapid and reliable testing. In this work, we performed the first evaluation of the QIAstat-Dx respiratory SARS-CoV-2 panel (QIAstat-SARS) for SARS-CoV-2 detection. This assay is the first rapid multiplex PCR (mPCR) assay, including SARS-CoV-2 detection, and is fully compatible with a non-PCR-trained laboratory or point-of-care (PoC) testing. This evaluation was performed using 69 primary clinical samples (66 nasopharyngeal swabs [NPS], 1 bronchoalveolar lavage fluid sample [BAL], 1 tracheal aspirate sample, and 1 bronchial aspirate sample) comparing SARS-CoV-2 detection with the currently WHO-recommended reverse transcription-PCR (RT-PCR) (WHO-RT-PCR) workflow. Additionally, a comparative limit of detection (LoD) assessment was performed for QIAstat-SARS and WHO-RT-PCR using a quantified clinical sample. Compatibility of sample pretreatment for viral neutralization or viscous samples with the QIAstat-SARS system were also tested. The QIAstat-Dx respiratory SARS-CoV-2 panel demonstrated a sensitivity comparable to that of the WHO-recommended assay with a limit of detection at 1,000 copies/ml. The overall percent agreement between QIAstat-Dx SARS and WHO-RT-PCR on 69 clinical samples was 97% with a sensitivity of 100% (40/40) and specificity at 93% (27/29). No cross-reaction was encountered for any other respiratory viruses or bacteria included in the panel. The QIAstat-SARS rapid multiplex PCR panel provides a highly sensitive, robust, and accurate assay for rapid detection of SARS-CoV-2. This assay allows rapid decisions even in non-PCR-trained laboratory or point-of-care testing, allowing innovative organization.
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Affiliation(s)
- Benoit Visseaux
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
| | - Quentin Le Hingrat
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
| | - Gilles Collin
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
| | - Donia Bouzid
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service d'Accueil des Urgences, Hôpital Bichat, Paris, France
| | - Samuel Lebourgeois
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
| | - Diane Le Pluart
- Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurène Deconinck
- Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François-Xavier Lescure
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-Christophe Lucet
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lila Bouadma
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-François Timsit
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Diane Descamps
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service de Virologie, Hôpital Bichat, Paris, France
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
| | - Yazdan Yazdanpanah
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Enrique Casalino
- UMR 1137-IAME, Decision Sciences in Infectious Diseases Control and Care (DeSCID), INSERM, Université de Paris, Paris, France
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Service d'Accueil des Urgences, Hôpital Bichat, Paris, France
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Guitton Z, Robineau O, Surgers L, Cheret A, Fontier C, Deconinck L, Bataille P, Bazus H. Éfficacité et tolérance des traitements immunosupresseurs chez les personnes vivant avec le VIH présentant une pathologie auto-immune. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Deconinck L, Robineau O, Valette M, Choisy P, Bocket L, Meybeck A, Ajana F. Clinical impact of tropism testing in a real-life cohort of HIV infected patients: a retrospective observational study. BMC Infect Dis 2019; 19:467. [PMID: 31126239 PMCID: PMC6534926 DOI: 10.1186/s12879-019-4047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 04/29/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The circumstances of prescription of tropism tests clinically relevant in treatment-experienced patients are unclear. METHODS We performed a monocentric retrospective analysis of all tropism tests performed between 2006 and 2015 in HIV-infected patients on antiretroviral therapy (ART) without MVC. The motivation of tropism determination was collected. Factors associated with MVC prescription were determined using logistic regression analysis. RESULTS Five hundred sixty-three tests were performed in experienced patients not receiving MVC. Reasons for tropism performance were: virological failure (44%), side effects or drug-interactions (37%), simplification or sparing strategies (11%), immunological failure (5%), and improvement of neurological diffusion (3%). MVC was prescribed in 110 cases (20%), though 366 tests (65%) revealed a tropism CCR5. MVC was more often prescribed before 2011 (OR 3.65, 95% CI 2.17-6.13) and in patients with multiple previous ART regimens (less than 4 ART regimens compare to more than 10 ART regimens (OR 0.34, 95% CI 0.15-0.74)). CONCLUSIONS In experienced patients not receiving MVC, tropism test prescription should be restricted to patients with virological failure and limited therapeutic options such as patients already treated with a wide range of ART regimens.
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Affiliation(s)
- Laurène Deconinck
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France.
| | - Olivier Robineau
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Michel Valette
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Philippe Choisy
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Laurence Bocket
- Virology Department, Lille University Hospital, Lille, France
| | - Agnes Meybeck
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Faiza Ajana
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
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Davido B, Senard O, Bouchand F, Deconinck L, Matt M, Fellous L, Rottman M, Perronne C, Dinh A. Efficacité de la céfoxitine dans les infections urinaires (IU) à E . coli et K . pneumoniae BLSE. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Matt M, Nich C, Geffrier A, Deconinck L, Davido B, Senard O, Bouchand F, Duran C, Rottman M, Dinh A. Intérêt d’un test de détection de l’infection ostéoarticulaire par l’alpha-défensine lors des reposes de prothèse orthopédique avec antécédent septique. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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32
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Bouchand F, Randuineau P, Leplay C, Matt M, Deconinck L, Sénard O, Villart M, Perronne C, Davido B, Dinh A. Contrôle des antibiothérapies de plus de 7 jours dans un hôpital universitaire et évaluation de l’impact clinique. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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33
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Davido B, Moussiegt A, Dinh A, Senard O, Deconinck L, Auzel O, Repesse X, Sirol M, Morgan M, Salomon J. Contribution of echocardiography in the diagnosis of definitive infective endocarditis: the infectious disease specialist’s point of view. Eur J Clin Microbiol Infect Dis 2017; 36:2329-2334. [DOI: 10.1007/s10096-017-3064-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/04/2017] [Indexed: 01/22/2023]
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34
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Dinh A, Duran C, Davido B, Bouchand F, Deconinck L, Matt M, Sénard O, Guyot C, Levasseur AS, Attal J, Razazi D, Tritz T, Beauchet A, Salomon J, Beaune S, Grenet J. Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department. J Hosp Infect 2017; 97:288-293. [PMID: 28698021 DOI: 10.1016/j.jhin.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/04/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Antimicrobial stewardship programmes (ASPs) have been effective in optimizing antibiotic use for inpatients. However, an emergency department's fast-paced clinical setting can be challenging for a successful ASP. AIM In April 2015, an ASP was implemented in our emergency department and we aimed to determine its impact on antimicrobial use for outpatients. METHODS This was a single-centre study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016). For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24h) were evaluated by an infectious disease specialist and an emergency department physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified. FINDINGS Before and after ASP, 34,671 and 35,925 consultations were registered at our emergency department, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (P < 0.0001). There were 484 (62.9%) and 271 (46.7%) (P < 0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliance included unnecessary antimicrobial prescriptions, 197 (25.6%) vs 101 (17.4%) (P<0.0005); inappropriate spectrum, 108 (14.0%) vs 54 (9.3%) (P=0.008); excessive treatment duration, 87 (11.3%) vs 53 (9.1%) (P>0.05); and inappropriate choices, 11 (1.4%) vs 15 (2.6%) (P>0.05). CONCLUSION The implementation of an ASP markedly decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.
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Affiliation(s)
- A Dinh
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France.
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - B Davido
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - L Deconinck
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - M Matt
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - O Sénard
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - C Guyot
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - A-So Levasseur
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - J Attal
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - D Razazi
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - T Tritz
- Pharmacy Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Garches, France
| | - A Beauchet
- Medical Informatic Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Garches, France
| | - J Salomon
- Infectious Diseases Unit, Raymond Poincaré University Hospital, Versailles Saint Quentin University, Garches, France
| | - S Beaune
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
| | - J Grenet
- Emergency Department, Ambroise Paré University Hospital, Versailles Saint Quentin University, Boulogne-Billancourt, France
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Matt M, Senard O, Deconinck L, Lawrence C, Dinh A, Godin E, Salomon J, Davido B. État des lieux de la perte de chance liée au cohorting des patients colonisés et/ou infectés à BHRe en secteur dédié de maladies infectieuses. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Deconinck L, Meybeck A, Patoz P, Van Grunderbeeck N, Boussekey N, Chiche A, Delannoy PY, Georges H, Leroy O. Impact of combination therapy and early de-escalation on outcome of ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Infect Dis (Lond) 2017; 49:396-404. [DOI: 10.1080/23744235.2016.1277035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Laurène Deconinck
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Agnès Meybeck
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Pierre Patoz
- Laboratoire de microbiologie, Centre Hospitalier de Tourcoing, Tourcoing, France
| | | | - Nicolas Boussekey
- Service de réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Arnaud Chiche
- Service de réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France
| | | | - Hugues Georges
- Service de réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Olivier Leroy
- Service de réanimation, Centre Hospitalier de Tourcoing, Tourcoing, France
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Robineau O, Deconinck L, Pasquet A, Leroy O. [Not Available]. Rev Prat 2016; 66:e461-e469. [PMID: 30512489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Olivier Robineau
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, Tourcoing, France
| | - Laurène Deconinck
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, Tourcoing, France
| | - Armelle Pasquet
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, Tourcoing, France
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Deconinck L, Robineau O, Valette M, Choisy P, Bocket L, Meybeck A, Ajana F. VIH-21 - Place du tropisme CCR5 pour l’initiation et le maintien du maraviroc chez les patients infectés par le VIH : suivi dans la vraie vie. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Robineau O, Deconinck L, Berthol N, Senneville E, Ajana F. VAC-19 - Statut vaccinal des étudiants externe en médecine en stage dans un service de maladies infectieuses. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Robineau O, Deconinck L, Hulleux T, Baclet V, Valette M, Choisy P, Senneville E, Ajana F. HEP-05 - Prise en charge de l’hépatite C aiguë chez les patients infectés par le VIH : leçons d’une cohorte historique. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Deconinck L, Meybeck A, Pradier M, Patoz P, Melliez H, Senneville E. Community acquired fungemia caused by Candida pulcherrima: diagnostic contribution of MALDI-TOF mass spectrometry. Ann Clin Microbiol Antimicrob 2016; 15:14. [PMID: 26951431 PMCID: PMC4782459 DOI: 10.1186/s12941-016-0129-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-onset candidemia constitute a distinct clinical entity the incidence of which is increasing. Contribution of non-albicans Candida species is rising. CASE PRESENTATION We describe here the first reported case of community acquired fungemia due to Candida pulcherrima. Identification to the species level was performed by MALDI-TOF mass spectrometry. Treatment with fluconazole was successful. CONCLUSION This case confirms the pathogenic role of C. pulcherrima and the contribution of MALDI-TOF mass spectrometry for identification of rare Candida species.
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Affiliation(s)
- Laurène Deconinck
- Centre Hospitalier Dron, Service Universitaire des Maladies Infectieuses et du voyageur, 135 avenue du Président Coty, 59200, Tourcoing, France.
| | - Agnès Meybeck
- Centre Hospitalier Dron, Service Universitaire des Maladies Infectieuses et du voyageur, 135 avenue du Président Coty, 59200, Tourcoing, France.
| | - Maxime Pradier
- Centre Hospitalier Dron, Service Universitaire des Maladies Infectieuses et du voyageur, 135 avenue du Président Coty, 59200, Tourcoing, France.
| | - Pierre Patoz
- Laboratoire de biologie, Centre Hospitalier Dron, 135 avenue du Président Coty, 59200, Tourcoing, France.
| | - Hugues Melliez
- Centre Hospitalier Dron, Service Universitaire des Maladies Infectieuses et du voyageur, 135 avenue du Président Coty, 59200, Tourcoing, France.
| | - Eric Senneville
- Centre Hospitalier Dron, Service Universitaire des Maladies Infectieuses et du voyageur, 135 avenue du Président Coty, 59200, Tourcoing, France.
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Deconinck L, Flateau C, Pichenot M, Morell-Dubois S, Maillard H, Hatron PY, Guery B, Faure K. Antiviral therapy of primary cytomegalovirus infection with vascular thrombosis in immunocompetent adults. Med Mal Infect 2016; 46:87-92. [DOI: 10.1016/j.medmal.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/11/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
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Deconinck L, Yazdanpanah Y, Gilson RJ, Melliez H, Viget N, Joly V, Sabin CA. Time to initiation of antiretroviral therapy in HIV-infected patients diagnosed with an opportunistic disease: a cohort study. HIV Med 2014; 16:219-29. [PMID: 25522796 DOI: 10.1111/hiv.12201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to identify factors associated with the time between opportunistic disease (OD) diagnosis and antiretroviral therapy (ART) initiation in HIV-infected patients presenting for care with an OD, and to evaluate the outcomes associated with any delay. METHODS A multicentre cohort study was undertaken in London, Paris and Lille/Tourcoing. The medical records of patients diagnosed from 2002 to 2012 were reviewed. RESULTS A total of 437 patients were enrolled in the study: 70% were male, the median age was 40 years, 42% were from sub-Saharan Africa, 68% were heterosexual, the median CD4 count was 40 cells/μL, and the most common ODs were Pneumocystis pneumonia (37%), tuberculosis (24%), toxoplasmosis (12%) and Kaposi's sarcoma (11%). Of these patients, 400 (92%) started ART within 24 weeks after HIV diagnosis, with a median time from OD diagnosis to ART initiation of 30 [interquartile range (IQR) 16-58] days. Patients diagnosed between 2009 and 2012 had a shorter time to ART initiation than those diagnosed in earlier years [hazard ratio (HR) 2.07; 95% confidence interval (CI) 1.58-2.72]. Factors associated with a longer time to ART initiation were a CD4 count ≥ 200 cells/μL (HR 0.30; 95% CI 0.20-0.44), tuberculosis (HR 0.40; 95% CI 0.30-0.55) and diagnosis in London (HR 0.62; 95% CI 0.48-0.80). Patients initiating 'deferred' ART (by ≥ 30 days) exhibited no difference in disease progression or immunovirological response compared with patients who had shorter times to ART initiation. Patients in the 'deferred' group were less likely to have ART modifications (HR 0.69; 95% CI 0.48-1.00) and had shorter in-patient stays (mean 14.2 days shorter; 95% CI 8.9-19.5 days) than patients in the group whose ART was not deferred. CONCLUSIONS The time between OD diagnosis and ART initiation remains heterogeneous and relatively long, particularly in individuals with a high CD4 count or tuberculosis or those diagnosed in London. Deferring ART was associated with fewer ART modifications and shorter in-patient stays.
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Affiliation(s)
- L Deconinck
- UCL Research Department of Infection and Population Health, University College London, London, UK; Decision Sciences in Infectious Disease: Prevention, Control, and Care, IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France; Department of Infectious Diseases, Lille School of Medicine, Tourcoing Hospital, Tourcoing, France
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Pichenot M, Morell-Dubois S, Flateau C, Deconinck L, Hatron PY, Lambert M. Acute cytomegalovirus infection as a transient risk factor for thrombosis: Report of three cases and focus on specific coagulation pathways. Thromb Res 2013; 132:145-7. [DOI: 10.1016/j.thromres.2013.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/21/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
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Piette M, Deconinck L, Timperman J, Thomas F, Majelyne W. Correlation between postmortem ethanol levels in the blood and the testicle. A computerized study of 633 determinations. Z Rechtsmed 1982; 88:39-48. [PMID: 7080683 DOI: 10.1007/bf00200734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study emphasizes the value of the presence of ethanol in the testicle. It proves particularly useful in cases where blood and urine are no more present in the body. In 633 cases where blood or urine were still available, a highly positive correlation between the blood, alcohol and the amount of alcohol present in the testicle could be demonstrated, thus confirming the research carried out in the Department of Legal Medicine as far back as 1943. An attempt is further made to assess the possible influence of such factors as putrefaction, submersion or post-traumatic anemia on this correlation.
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