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Sobhani I, Itti E, Luciani A, Baumgaertner I, Layese R, André T, Ducreux M, Gornet JM, Goujon G, Aparicio T, Taieb J, Bachet JB, Hemery F, Retbi A, Mons M, Flicoteaux R, Rhein B, Baron S, Cherrak I, Rufat P, Le Corvoisier P, de'Angelis N, Natella PA, Maoulida H, Tournigand C, Durand Zaleski I, Bastuji-Garin S. Colorectal cancer (CRC) monitoring by 6-monthly 18FDG-PET/CT: an open-label multicentre randomised trial. Ann Oncol 2019; 29:931-937. [PMID: 29365058 PMCID: PMC5913635 DOI: 10.1093/annonc/mdy031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 12/14/2022] Open
Abstract
Background [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18FDG-PET/CT) has high sensitivity for detecting recurrences of colorectal cancer (CRC). Our objective was to determine whether adding routine 6-monthly 18FDG-PET/CT to our usual monitoring strategy improved patient outcomes and to assess the effect on costs. Patients and methods In this open-label multicentre trial, patients in remission of CRC (stage II perforated, stage III, or stage IV) after curative surgery were randomly assigned (1 : 1) to usual monitoring alone (3-monthly physical and tumour marker assays, 6-monthly liver ultrasound and chest radiograph, and 6-monthly whole-body computed tomography) or with 6-monthly 18FDG-PET/CT, for 3 years. A multidisciplinary committee reviewed each patient’s data every 3 months and classified the recurrence status as yes/no/doubtful. Recurrences were treated with curative surgery alone if feasible and with chemotherapy otherwise. The primary end point was treatment failure defined as unresectable recurrence or death. Relative risks were estimated, and survival was analysed using the Kaplan–Meier method, log-rank test, and Cox models. Direct costs were compared. Results Of the 239 enrolled patients, 120 were in the intervention arm and 119 in the control arm. The failure rate was 29.2% (31 unresectable recurrences and 4 deaths) in the intervention group and 23.7% (27 unresectable recurrences and 1 death) in the control group (relative risk = 1.23; 95% confidence interval, 0.80–1.88; P = 0.34). The multivariate analysis also showed no significant difference (hazards ratio, 1.33; 95% confidence interval, 0.8–2.19; P = 0.27). Median time to diagnosis of unresectable recurrence (months) was significantly shorter in the intervention group [7 (3–20) versus 14.3 (7.3–27), P = 0.016]. Mean cost/patient was higher in the intervention group (18 192 ± 27 679 € versus 11 131 ± 13 €, P < 0.033). Conclusion 18FDG-PET/CT, when added every 6 months, increased costs without decreasing treatment failure rates in patients in remission of CRC. The control group had very close follow-up, and any additional improvement (if present) would be small and hard to detect. ClinicalTrials.gov identifier NCT00624260
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Affiliation(s)
- I Sobhani
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France; Department of Gastroenterology, APHP-Hôpital Henri Mondor, Créteil, France.
| | - E Itti
- Department of Nuclear Medicine, APHP-Hôpital Henri Mondor, Créteil, France
| | - A Luciani
- Department of Medical Imaging, APHP-Hôpital Henri Mondor, Créteil, France
| | - I Baumgaertner
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | - R Layese
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France; CEpiA Clinical Epidemiology and Ageing Un, EA7376, Université Paris-Est (UPEC), A-TVB DHU, IMRB, Créteil, France
| | - T André
- Sorbonnes University and Department of Medical Oncology, APHP-Hôpital St Antoine, Paris, France
| | - M Ducreux
- Department of Gastrointestinal Oncology, Institut Gustave Roussy, Villejuif, France
| | - J-M Gornet
- Department of Gastroenterology, APHP-Hôpital St Louis, Paris, France
| | - G Goujon
- Department of Gastroenterology, APHP-Hôpital Bichat, Paris, France
| | - T Aparicio
- Department of Gastroenterology, APHP-Hôpital Avicenne, Paris, France
| | - J Taieb
- Department of Gastrointestinal Oncology, APHP-Hôpital Européen Georges Pompidou, Paris, France
| | - J-B Bachet
- Department of Gastroenterology and Medical Informatics, APHP-Hôpital Pitié-Salpêtrière, Paris, France
| | - F Hemery
- Department of Medical Informatics, APHP-Hôpital Henri Mondor, Créteil, France
| | - A Retbi
- Sorbonnes University and Department of Medical Oncology, APHP-Hôpital St Antoine, Paris, France
| | - M Mons
- Department of Gastrointestinal Oncology, Institut Gustave Roussy, Villejuif, France
| | - R Flicoteaux
- Department of Gastroenterology, APHP-Hôpital St Louis, Paris, France
| | - B Rhein
- Department of Medical Informatics, Centre Hospitalier d'Intercommunal de Créteil, Créteil, France
| | - S Baron
- Department of Gastroenterology, APHP-Hôpital Avicenne, Paris, France
| | - I Cherrak
- Department of Gastrointestinal Oncology, APHP-Hôpital Européen Georges Pompidou, Paris, France
| | - P Rufat
- Department of Gastroenterology and Medical Informatics, APHP-Hôpital Pitié-Salpêtrière, Paris, France
| | - P Le Corvoisier
- Clinical Investigations Centre, APHP-Hôpital Henri Mondor, Créteil, France
| | - N de'Angelis
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | - P-A Natella
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France
| | - H Maoulida
- Healthcare Economics Research Unit, APHP, Paris, France, France
| | - C Tournigand
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | | | - S Bastuji-Garin
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France; CEpiA Clinical Epidemiology and Ageing Un, EA7376, Université Paris-Est (UPEC), A-TVB DHU, IMRB, Créteil, France
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Amarsy R, Guéret D, Benmansour H, Flicoteaux R, Berçot B, Meunier F, Mougari F, Jacquier H, Pean de Ponfilly G, Clermont O, Denamur E, Teixeira A, Cambau E. Determination of Escherichia coli phylogroups in elderly patients with urinary tract infection or asymptomatic bacteriuria. Clin Microbiol Infect 2019; 25:839-844. [PMID: 30648603 DOI: 10.1016/j.cmi.2018.12.032] [Citation(s) in RCA: 12] [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: 08/28/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Distinguishing between urinary tract infection (UTI) and asymptomatic bacteriuria (ABU) is difficult in the geriatric population since specific symptoms are often lacking. Escherichia coli is the most frequent UTI pathogen in this population but also a common urine colonizer. We hypothesized that detecting E. coli phylogroups B2 or D, which were previously associated with virulent strains responsible for extra-intestinal infections outside elderly patients, could help in distinguishing UTI from ABU. METHODS Consecutive cases of E. coli bacteriuria diagnosed in hospitalized patients >75 years old during 3 months were investigated for E. coli phylogroups. Multiplex PCR was used to search for several virulence genes as previously described. Characteristics of UTI and ABU cases, assessed retrospectively according to definitions and geriatric expertise, were compared. RESULTS Out of 233 bacteriuria cases, 60 were assessed to be UTI and 163 to be ABU, with 10 cases unclassified. E. coli strains belonging to the phylogroups B2 and D were significantly more frequent in UTI (48/60, 80%) than in ABU (101/163, 62%) by univariate and multivariate analyses (OR 3.05, 1.44-6.86, p 0.005). Out of all the host and bacterial characteristics studied, falls (p 0.032), comorbidities (p 0.041), and altered autonomy evaluated by a low activity of daily living score (p 0.027) were also associated with UTI using univariate and multivariate analysis. CONCLUSIONS Determination of the E. coli phylogroup, in addition to some host characteristics, can help to distinguish UTI from ABU in elderly patients with bacteriuria. If this hypothesis is confirmed by prospective studies, then inappropriate use of antibiotics may be reduced in ABU cases.
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Affiliation(s)
- R Amarsy
- APHP, Groupe Hospitalier Lariboisière-Fernand Widal, Equipe Opérationnelle d'Hygiène, Paris, France; Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - D Guéret
- Service de SSR Gériatrique, Centre Hospitalier de la Côte Fleurie, Equemauville, France
| | - H Benmansour
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - R Flicoteaux
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, France; ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Centre (CRESS), Paris, France
| | - B Berçot
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - F Meunier
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - F Mougari
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - H Jacquier
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - G Pean de Ponfilly
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - O Clermont
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - E Denamur
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - A Teixeira
- Service de Gériatrie, Hôpitaux Universitaires Saint Louis Lariboisière Fernand, Paris, France
| | - E Cambau
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France.
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Munier AL, Biard L, Rousseau C, Legrand M, Lafaurie M, Lomont A, Donay JL, de Beaugrenier E, Flicoteaux R, Mebazaa A, Mimoun M, Molina JM. Incidence, risk factors, and outcome of multidrug-resistant Acinetobacter baumannii acquisition during an outbreak in a burns unit. J Hosp Infect 2017; 97:226-233. [PMID: 28751010 DOI: 10.1016/j.jhin.2017.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multidrug-resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in a burns unit. AIM To study the incidence, risk factors and outcome of MR-AB colonization during an outbreak. METHODS A prospective study was conducted from April to November 2014 in a burns unit in Paris. Weekly surveillance cultures of patients and their environment were performed. MR-AB acquisition, discharge, or death without MR-AB colonization were considered as competing events. To identify risk factors for colonization, baseline characteristics and time-dependent variables were investigated in univariate and multivariate analyses using Cox models. MR-AB strains were genotypically compared using multi-locus sequence typing. FINDINGS Eighty-six patients were admitted in the burns unit during the study period. Among 77 patients without MR-AB colonization at admission, 25 (32%) acquired MR-AB with a cumulative incidence of 30% at 28 days (95% CI: 20-40). Median time to MR-AB acquisition was 13 days (range: 5-34). In multivariate analysis, risk factors for MR-AB acquisition were ≥2 skin graft procedures performed [hazard ratio (HR): 2.97; 95% confidence interval (CI): 1.10-8.00; P = 0.032] and antibiotic therapy during hospitalization (HR: 4.42; 95% CI: 1.19-16.4; P = 0.026). A major sequence type of MR-AB (ST2) was found in 94% and 92% of patients and environmental strains, respectively, with all strains harbouring the blaOXA-23 gene. MR-AB colonization increased length of hospitalization (HR: 0.32; 95% CI: 0.17-0.58; P = 0.0002) by a median of 12 days. CONCLUSION A high incidence of MR-AB acquisition was seen during this outbreak with most strains from patients and their environment belonging to single sequence type. MR-AB colonization was associated with more skin graft procedures, antibiotic use, and prolonged hospitalization.
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Affiliation(s)
- A-L Munier
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
| | - L Biard
- Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - C Rousseau
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - M Legrand
- Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France; INSERM U942, France
| | - M Lafaurie
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - A Lomont
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - J-L Donay
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - E de Beaugrenier
- Pharmacy Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - R Flicoteaux
- Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - A Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - M Mimoun
- Plastic Surgery Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - J-M Molina
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
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Lafaurie M, Lepeule R, Deslastours V, Lefort A, Celeste T, Flicoteaux R. Activité de référents en infectiologie : intérêt d’une fiche informatisée partagée dans plusieurs centres hospitaliers. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Righi L, Amarsy R, Picat MQ, Thuillier M, Cambau E, Raskine L, Chevret S, Flicoteaux R. Monitoring antimicrobial resistance (AMR) using CUSUM control charts. Eur J Clin Microbiol Infect Dis 2017; 36:1519-1525. [PMID: 28315144 DOI: 10.1007/s10096-017-2961-4] [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: 01/20/2017] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Abstract
We evaluated the use of the Cumulative Summation (CUSUM) control chart methodology for detection of an excessive increase in antimicrobial-resistant (AMR) bacteria acquisition. We used administrative, clinical and bacteriological data from all 157,570 patients hospitalized for at least 48 h from January 1, 2010 to December 31, 2015 in a 654-bed university teaching hospital in Paris, France. Monthly computed CUSUM were evaluated for the detection of out-of-control situations, defined as incidence rates of acquired AMR bacterial colonization exceeding acceptable thresholds at the hospital and ward levels (based on six selected wards) for AMR bacteria overall and Extended-spectrum beta-lactamases Enterobacteriaceae (ESBL-E) and Methicillin-resistant Staphylococcus aureus (MRSA), specifically. During the study period, 1,403 samples of acquired AMR bacteria were identified including 1,129 ESBL-E and 151 MRSA. The incidence rate of acquired AMR bacteria was stable at the hospital and the wards level. When based on AMR bacteria overall, CUSUM alarms were triggered at the hospital level and at the ward level in four units. For ESBL-E, CUSUM tests generated alarms at the hospital level and for the same four wards, and for MRSA, CUSUM tests detected out-of-control situations in all the wards. The CUSUM approach appears complementary with hospital infection control strategies currently in practice and appears of interest in common practice as a simple tool for AMR surveillance.
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Affiliation(s)
- L Righi
- Postgraduate School of Public Health, Siena, Italy. .,Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. .,Quality of Care Service, University Hospitals of Geneva, Chemin Thury 3, 1206, Geneva, Switzerland.
| | - R Amarsy
- Infection Control Unit, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,APHP-Lariboisière Hospital, Hopitaux Universitaires Saint Louis-Lariboisière-Fernand Widal, Bacteriology, Paris, France
| | - M-Q Picat
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - M Thuillier
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - E Cambau
- APHP-Lariboisière Hospital, Hopitaux Universitaires Saint Louis-Lariboisière-Fernand Widal, Bacteriology, Paris, France.,Inserm UMR 1137, IAME, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - L Raskine
- Infection Control Unit, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,APHP-Lariboisière Hospital, Hopitaux Universitaires Saint Louis-Lariboisière-Fernand Widal, Bacteriology, Paris, France
| | - S Chevret
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Center (CRESS), Paris, France
| | - R Flicoteaux
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Center (CRESS), Paris, France
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Dermouche M, Flicoteaux R, Chevret S, Velcin J, Tarifht N. Apport des modèles thématiques pour l’aide au codage à partir d’une analyse automatisée des données du compte rendu d’hospitalisation. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.01.026] [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: 10/20/2022] Open
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Righi L, Amarsy-Guerle R, Picat MQ, Benmansour H, Flicoteaux R, Jacquier H, Berçot B, Nante N, Chevret S, Raskine L. Changing epidemiology and impact of resistant bacteria in 2010-2015 in a French Teaching Hospital. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.010] [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: 11/13/2022] Open
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Righi L, Amarsy-Guerle R, Picat MQ, Thuillier M, Nante N, Cambau E, Chevret S, Raskine L, Flicoteaux R. Surveillance of resistant bacteria in a French Hospital in 2010-2015 using cumulative control charts. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.051] [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: 11/13/2022] Open
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Lanoix JP, Gaudry S, Flicoteaux R, Ruimy R, Wolff M. Tuberculosis in the intensive care unit: a descriptive analysis in a low-burden country. Int J Tuberc Lung Dis 2015; 18:581-7. [PMID: 24903796 DOI: 10.5588/ijtld.13.0901] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although tuberculosis (TB) is not a major public health issue in low-burden countries, severe cases are still a matter of concern. OBJECTIVE To assess the risk factors for mortality due to TB in a low-burden setting. DESIGN A retrospective study of 97 patients hospitalised with active TB in the intensive care unit (ICU) of the Bichat-Claude Bernard Hospital, Paris, France, from 2000 to 2009. RESULTS The mean age was 47.4 ± 14.7 years; 40 patients were human immunodeficiency virus (HIV) infected, with a median CD4 cell count of 74 cells/mm(3). The survival analysis showed that 21 patients died during their time in the ICU. The observed risk factors for ICU mortality were organ failure, high Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment scores, and concomitant non-tuberculous infection. In multivariate analysis, only SAPS II score was significantly associated with mortality. CONCLUSION Risk factors identified in this study are different from those in high-burden countries, and were not associated with the site of TB disease. There was no difference in TB presentation between HIV-infected and non-HIV-infected patients, and HIV was not a mortality risk factor. Low-burden countries still experience high death rates due to severe TB.
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Affiliation(s)
- J-P Lanoix
- Department of Infectious Diseases, Amiens University Hospital, Amiens, France
| | - S Gaudry
- Intensive Care Department, Bichat-Claude-Bernard University Hospital, Paris, France
| | - R Flicoteaux
- Department of Infectious Diseases, Bichat-Claude-Bernard University Hospital, Paris, France
| | - R Ruimy
- Department of Bacteriology, Bichat-Claude-Bernard University Hospital, Paris, France
| | - M Wolff
- Intensive Care Department, Bichat-Claude-Bernard University Hospital, Paris, France
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Biard L, Bernard R, Porcher R, Bagot M, Chevret S, Flicoteaux R. Monitoring des index de performance avec la méthode CuSum : exemple du suivi de changements organisationnels au sein d’un service de dermatologie. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.01.045] [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: 10/25/2022] Open
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Lê-Leplat C, Briffaut AS, Gomme S, Flicoteaux R, Blachier A, Taright N. Analyse médicalisée des bases PMSI : algorithme de détermination d’une pathologie prépondérante. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.01.098] [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: 11/16/2022] Open
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Troude P, Flicoteaux R, Dozol A, Huchet S, Pavie J, Segouin C. Évaluation de la part d’hospitalisations non programmées dans les services d’un centre hospitalier universitaire parisien. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2011.12.122] [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: 10/28/2022] Open
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Mignot C, Chevret S, Flicoteaux R. Évaluation du coût d’une nouvelle prise en charge : l’exemple des cancers du rein traités par cryothérapie à l’hôpital Saint-Louis (Assistance publique–Hôpitaux de Paris), en 2008. Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.03.054] [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: 10/18/2022] Open
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Tattevin P, Léveiller G, Flicoteaux R, Jauréguiberry S, Le Tulzo Y, Dupont M, Arvieux C, Michelet C. Respiratory Manifestations of Leptospirosis: A Retrospective Study. Lung 2005; 183:283-9. [PMID: 16211464 DOI: 10.1007/s00408-004-2541-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2005] [Indexed: 11/28/2022]
Abstract
We retrospectively reviewed 34 consecutive patients with serologically confirmed leptospirosis admitted during years 1992-2002. Nine patients (26.5%) had respiratory symptoms on admission including cough (n = 4), shortness of breath (n = 4), cyanosis (n = 2), and hemoptysis (n = 1). Six patients had pulmonary radiographic findings including (1) diffuse, ill-defined, ground-glass density (n = 3); (2) diffuse alveolar opacities (n = 2); and (3) small nodular density (n = 1). Male/female ratio was 8/1 and mean age was 47 years. Seven patients reported their exposure source including hunting (n = 2), fishing (n = 2), fresh water swimming (n = 2), and canoeing (n = 1). All patients had fever (mean = 40.1 degrees C). Other common symptoms were headache (n = 4), vomiting (n = 3), and myalgia (n = 3). Biological abnormalities included elevated liver enzymes (n = 8), proteinuria (n = 7), lymphopenia (n = 6), hematuria (n = 5), renal failure (n = 4), anemia (n = 4), and elevated neutrophil count (n = 4). PaO(2 )was measured for 3 patients while they were breathing room air (32, 55, and 66 mmHg). Suspected diagnosis on admission included leptospirosis (n = 2), bacterial pneumonia (n = 2), intoxication, influenza, viral hepatitis, biliary tract lithiasis, and rapidly progressive glomerulonephritis (one patient each). The first serologic testing for leptospirosis was positive for 5 patients (55%). Serovar was presumptively identified for 7 patients: Australis (n = 3), Grippotyphosa (n = 2), and Icterohaemorrhagiae (n = 2). Seven patients were treated with penicillin; two patients received no antibiotics. All patients were cured. In conclusion, patients with leptospirosis may present predominantly with nonspecific pulmonary symptoms. In these patients, leptospirosis must be suspected when there is a potential exposure to rats, especially in case of high-grade fever, myalgia, hepatitis, and renal abnormalities.
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Affiliation(s)
- P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes Cedex, France.
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Tattevin P, Tribut O, Arvieux C, Dupont M, Flicoteaux R, Desbordes L, Le Tulzo Y, Michelet C. Use of high-performance liquid chromatography (HPLC) to monitor beta-lactam plasma concentrations during the treatment of endocarditis. Clin Microbiol Infect 2005; 11:76-9. [PMID: 15649311 DOI: 10.1111/j.1469-0691.2004.01030.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Guidelines recommend high doses of beta-lactams for the therapy of endocarditis. This report describes a retrospective study of 15 endocarditis patients (median age 64 years), treated according to guidelines, whose beta-lactam trough plasma concentrations were measured with high-performance liquid chromatography because of tolerance or efficacy concerns. For amoxycillin, the mean level was 86.8 mg/L (range: 30-212 mg/L); five (45%) patients had concentrations > 1000 x MIC. For cloxacillin, the mean level was 47.9 mg/L (range: 16.7-104 mg/L). The consequences of high and unpredicted beta-lactam trough plasma concentrations for a prolonged period have not yet been thoroughly evaluated.
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Affiliation(s)
- P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
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