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Raffetin A, Puppo C, Chahour A, Belkasmi A, Baux E, Patrat-Delon S, Caraux-Paz P, Rivière J, Gallien S. Lyme borreliosis and medical wandering: what do patients think about multidisciplinary management? A qualitative study in the context of scientific and social controversy. BMC Infect Dis 2024; 24:344. [PMID: 38519907 PMCID: PMC10958838 DOI: 10.1186/s12879-024-09194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/05/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION To answer to patients' medical wandering, often due to "unexplained symptoms" of "unexplained diseases" and to misinformation, multidisciplinary care centers for suspected Lyme borreliosis (LB), such as the 5 Tick-Borne Diseases (TBDs) Reference Centers (TBD-RC), were created a few years ago in France, the Netherlands and Denmark. Our study consisted of a comprehensive analysis of the satisfaction of the patients managed at a TBD-RC for suspected LB in the context of scientific and social controversy. METHODS We included all adults who were admitted to one of the TBD-RC from 2017 to 2020. A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains, including 2 free-text items: "What points did you enjoy?" and "What would you like us to change or to improve?". In the current study, the 2 free-items were analyzed with a qualitative method called reflexive thematic analysis within a semantic and latent approach. RESULTS The answer rate was 61.3% (349/569) and 97 distinctive codes from the 2-free-text items were identified and classified into five themes: (1) multidisciplinarity makes it possible to set up quality time dedicated to patients; (2) multidisciplinarity enables seamless carepaths despite the public hospital crisis compounded by the COVID-19 pandemic; (3) multidisciplinarity is defined as trust in the team's competences; (4) an ambivalent opinion and uncertainty are barriers to acceptance of the diagnosis, reflecting the strong influence of the controversy around LB; and (5) a lack of adapted communication about TBDs, their management, and ongoing research is present. CONCLUSION The multidisciplinary management for suspected LB seemed an answer to medical wandering for the majority of patients and helped avoid misinformation, enabling better patient-centered shared information and satisfaction, despite the context of controversy.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France.
- EpiMAI Research Unity, Laboratory of Animal Health, Anses-National Veterinary School of Alfort, 7 Av. du Général de Gaulle, 94700, Maisons-Alfort, France.
- DYNAMIC Research Unity, UPEC-Anses, 8 Rue du Général Sarrail, 94000, Créteil, France.
| | - Costanza Puppo
- Department of Psychology, University Lyon II, France, UMR 1296, 86 Rue Pasteur, 69007, Lyon, France
| | - Amal Chahour
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France
| | - Assia Belkasmi
- Department of Public Health, University of Versailles Saint-Quentin en Yvelines, 55 Avenue de Paris, 78000, Versailles, France
| | - Elisabeth Baux
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Eastern Region, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France
| | - Solène Patrat-Delon
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Western Region, University Hospital of Rennes, 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France
| | - Julie Rivière
- EpiMAI Research Unity, Laboratory of Animal Health, Anses-National Veterinary School of Alfort, 7 Av. du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Sébastien Gallien
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France
- DYNAMIC Research Unity, UPEC-Anses, 8 Rue du Général Sarrail, 94000, Créteil, France
- Department of Infectious Diseases, Tropical Medicine and Immunology, University Hospital Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
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Raffetin A, Chahour A, Schemoul J, Paoletti G, He Z, Baux E, Patrat-Delon S, Nguala S, Caraux-Paz P, Puppo C, Arias P, Madec Y, Gallien S, Rivière J. Acceptance of diagnosis and management satisfaction of patients with "suspected Lyme borreliosis" after 12 months in a multidisciplinary reference center: a prospective cohort study. BMC Infect Dis 2023; 23:380. [PMID: 37280565 DOI: 10.1186/s12879-023-08352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Because patients with a "suspicion of Lyme borreliosis (LB)" may experience medical wandering and difficult care paths, often due to misinformation, multidisciplinary care centers were started all over Europe a few years ago. The aim of our study was to prospectively identify the factors associated with the acceptance of diagnosis and management satisfaction of patients, and to assess the concordance of the medical health assessment between physicians and patients 12 months after their management at our multidisciplinary center. METHODS We included all adults who were admitted to the Tick-Borne Diseases Reference Center of Paris and the Northern Region (TBD-RC) (2017-2020). A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains and 13 items rated between 0 (lowest) and 10 (highest grade): (1)Reception; (2)Care and quality of management; (3)Information/explanations given to the patients; (4)Current medical condition and acceptance of the final diagnosis; (5)Overall appreciation. Factors associated with diagnosis acceptance and management satisfaction at 12 months were identified using logistic regression models. The concordance of the health status as assessed by doctors and patients was calculated using a Cohen's kappa test. RESULTS Of the 569 patients who consulted, 349 (61.3%) answered the questionnaire. Overall appreciation had a median rating of 9 [8;10] and 280/349 (80.2%) accepted their diagnoses. Patients who were "very satisfied" with their care paths at TBD-RC (OR = 4.64;CI95%[1.52-14.16]) had higher odds of diagnosis acceptance. Well-delivered information was strongly associated with better satisfaction with the management (OR = 23.39;CI95%[3.52-155.54]). The concordance between patients and physicians to assess their health status 12 months after their management at TBD-RC was almost perfect in the groups of those with confirmed and possible LB (κ = 0.99), and moderate in the group with other diagnoses (κ = 0.43). CONCLUSION Patients seemed to approve of this multidisciplinary care organization for suspected LB. It helped them to accept their final diagnoses and enabled a high level of satisfaction with the information given by the doctors, confirming the importance of shared medical decisions, which may help to reduce health misinformation. This type of structure may be useful for any disease with a complex and controversial diagnosis.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France.
- EpiMAI Research Unity, Laboratory of Animal Health, Ecole Nationale Vétérinaire d'Alfort, Anses-National Veterinaty School of Alfort, Maison-Alfort, France.
- DYNAMIC Research Unity, UPEC-Anses, Créteil, France.
| | - Amal Chahour
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Julien Schemoul
- Department of Rheumatology, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Giulia Paoletti
- Department of Psychiatry, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Zhuoruo He
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
- Department of Public Health, University of Paris Saclay, Saclay, France
| | - Elisabeth Baux
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Eastern Region, Brabois Hospital, University Hospital of Nancy, Nancy, France
| | - Solène Patrat-Delon
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Western Region, University Hospital of Rennes, Rennes, France
| | - Steve Nguala
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Costanza Puppo
- Department of Psychology, Lumière University Lyon II, UMR 1296, Lyon, France
| | - Pauline Arias
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases Unit, Institut Pasteur, University of Paris, Paris, France
| | - Sébastien Gallien
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
- DYNAMIC Research Unity, UPEC-Anses, Créteil, France
- Department of Infectious Diseases, UH Henri Mondor, Créteil, France
| | - Julie Rivière
- EpiMAI Research Unity, Laboratory of Animal Health, Ecole Nationale Vétérinaire d'Alfort, Anses-National Veterinaty School of Alfort, Maison-Alfort, France
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Naudion P, Raffetin A, Zayet S, Klopfenstein T, Baux E, Martinot M, Piroth L, Caumes E, Chirouze C, Bouiller K. Positive intrathecal anti-Borrelia antibody synthesis: what are the implications for clinical practice? Clinical features and outcomes of 138 patients in a French multicenter cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:441-452. [PMID: 36806057 DOI: 10.1007/s10096-023-04574-0] [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: 10/18/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
We aimed to describe the clinical characteristics, management, and residual symptoms (RS) in patients with definite and possible Lyme neuroborreliosis (LNB). We conducted a retrospective French multicenter cohort study (2010-2020). Cases of LNB were defined as clinical manifestations attributed to LNB and a positive Borrelia-specific intrathecal antibody index (AI) ("possible" LNB) and with pleocytosis ("definite" LNB). Risk factors of RS were determined using a logistic regression model. We included 138 adult patients with a positive AI. Mean age was 59.5 years (± 14.7). The median duration of symptoms before diagnosis was 1.0 [0.5-4.0] months. The most frequent manifestation was radicular pain (n = 79, 57%). Complete cerebrospinal fluid (CSF) leukocyte analysis was available in 131 patients, of whom 72 (55%) had pleocytosis. Patients with definite LNB had a shorter duration of symptoms (median 1.0 [0.5-2.6] vs. 3.0 [0.6-7.0] months, p < 0.01) and more radicular pain (74% vs 44%, p < 0.01) than patients with possible LNB. At the last visit (median duration of follow-up: 70 [30-175] days), 74/124 patients (59.7%) reported RS, mostly radicular pain (n = 31, 25%). In multivariate analysis, definite LNB (OR = 0.21 [0.05-0.931], p = 0.039) and duration of symptoms less than 3 months (OR = 0.04 [0.01-0.37], p = 0.005) were protective factors against RS at last follow-up. Our study highlights the challenges of LNB management, especially for patients with a positive AI without pleocytosis, questioning whether LB is still ongoing or not. Early diagnosis and treatment are important to improve outcomes and to lower potential RS.
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Affiliation(s)
- Pauline Naudion
- Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France
| | - Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center, Paris and Northern Region, General Hospital of Villeneuve-Saint-Georges, 40 Allée de La Source, 94 190, Villeneuve-Saint-Georges, France. .,Research Unity of EpiMAI (USC Anses), Ecole Nationale Vétérinaire de Maisons-Alfort, Maisons-Alfort, France. .,European Study Group for Lyme Borreliosis (ESGBOR), Basel, Switzerland. .,EA 7380 Dynamyc, Université Paris-Est Créteil, Ecole Nationale Vétérinaire d'Alfort, USC Anses, Créteil, France.
| | - Souheil Zayet
- Department of Infectious Diseases, General Hospital of Nord Franche-Comté, Belfort, France
| | - Timothée Klopfenstein
- Department of Infectious Diseases, General Hospital of Nord Franche-Comté, Belfort, France
| | - Elisabeth Baux
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | - Martin Martinot
- Department of Infectious Diseases, General Hospital of Colmar, Colmar, France
| | - Lionel Piroth
- Department of Infectious Diseases, University Hospital of Dijon, Dijon, France
| | - Eric Caumes
- Department of Infectious Diseases, University Hospital of Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie Et de Santé Publique, Paris, France
| | - Catherine Chirouze
- Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France.,UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000, Besançon, France
| | - Kevin Bouiller
- Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France. .,European Study Group for Lyme Borreliosis (ESGBOR), Basel, Switzerland. .,UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000, Besançon, France.
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Hossain SI, de Goër de Herve J, Hassan MS, Martineau D, Petrosyan E, Corbin V, Beytout J, Lebert I, Durand J, Carravieri I, Brun-Jacob A, Frey-Klett P, Baux E, Cazorla C, Eldin C, Hansmann Y, Patrat-Delon S, Prazuck T, Raffetin A, Tattevin P, Vourc'h G, Lesens O, Nguifo EM. Exploring convolutional neural networks with transfer learning for diagnosing Lyme disease from skin lesion images. Comput Methods Programs Biomed 2022; 215:106624. [PMID: 35051835 DOI: 10.1016/j.cmpb.2022.106624] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Lyme disease which is one of the most common infectious vector-borne diseases manifests itself in most cases with erythema migrans (EM) skin lesions. Recent studies show that convolutional neural networks (CNNs) perform well to identify skin lesions from images. Lightweight CNN based pre-scanner applications for resource-constrained mobile devices can help users with early diagnosis of Lyme disease and prevent the transition to a severe late form thanks to appropriate antibiotic therapy. Also, resource-intensive CNN based robust computer applications can assist non-expert practitioners with an accurate diagnosis. The main objective of this study is to extensively analyze the effectiveness of CNNs for diagnosing Lyme disease from images and to find out the best CNN architectures considering resource constraints. METHODS First, we created an EM dataset with the help of expert dermatologists from Clermont-Ferrand University Hospital Center of France. Second, we benchmarked this dataset for twenty-three CNN architectures customized from VGG, ResNet, DenseNet, MobileNet, Xception, NASNet, and EfficientNet architectures in terms of predictive performance, computational complexity, and statistical significance. Third, to improve the performance of the CNNs, we used custom transfer learning from ImageNet pre-trained models as well as pre-trained the CNNs with the skin lesion dataset HAM10000. Fourth, for model explainability, we utilized Gradient-weighted Class Activation Mapping to visualize the regions of input that are significant to the CNNs for making predictions. Fifth, we provided guidelines for model selection based on predictive performance and computational complexity. RESULTS Customized ResNet50 architecture gave the best classification accuracy of 84.42% ±1.36, AUC of 0.9189±0.0115, precision of 83.1%±2.49, sensitivity of 87.93%±1.47, and specificity of 80.65%±3.59. A lightweight model customized from EfficientNetB0 also performed well with an accuracy of 83.13%±1.2, AUC of 0.9094±0.0129, precision of 82.83%±1.75, sensitivity of 85.21% ±3.91, and specificity of 80.89%±2.95. All the trained models are publicly available at https://dappem.limos.fr/download.html, which can be used by others for transfer learning and building pre-scanners for Lyme disease. CONCLUSION Our study confirmed the effectiveness of even some lightweight CNNs for building Lyme disease pre-scanner mobile applications to assist people with an initial self-assessment and referring them to expert dermatologist for further diagnosis.
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Affiliation(s)
- Sk Imran Hossain
- Université Clermont Auvergne, CNRS, ENSMSE, LIMOS, F-63000 Clermont-Ferrand, France
| | - Jocelyn de Goër de Herve
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, 63122 Saint-Genès-Champanelle, France; Université de Lyon, INRAE, VetAgro Sup, UMR EPIA, F-69280 Marcy l'Etoile, France
| | - Md Shahriar Hassan
- Université Clermont Auvergne, CNRS, ENSMSE, LIMOS, F-63000 Clermont-Ferrand, France
| | - Delphine Martineau
- Infectious and Tropical Diseases Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Evelina Petrosyan
- Infectious and Tropical Diseases Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Violaine Corbin
- Infectious and Tropical Diseases Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean Beytout
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, CNRS 6023 Laboratoire Microorganismes: Génome Environnement (LMGE), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Lebert
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, 63122 Saint-Genès-Champanelle, France; Université de Lyon, INRAE, VetAgro Sup, UMR EPIA, F-69280 Marcy l'Etoile, France
| | - Jonas Durand
- Tous Chercheurs Laboratory, UMR 1136 'Interactions Arbres Micro-Organismes', INRAE, Centre INRAE Grand Est-Nancy, F-54280 Champenoux, France
| | | | - Annick Brun-Jacob
- Tous Chercheurs Laboratory, UMR 1136 'Interactions Arbres Micro-Organismes', INRAE, Centre INRAE Grand Est-Nancy, F-54280 Champenoux, France
| | - Pascale Frey-Klett
- INRAE, US 1371 Laboratory of Excellence ARBRE, Centre INRAE Grand Est-Nancy, Champenoux F-54280, France
| | - Elisabeth Baux
- Infectious Diseases Department, University Hospital of Nancy, Nancy, France
| | - Céline Cazorla
- Infectious Disease Department, University Hospital of Saint Etienne, Saint-Etienne, France
| | - Carole Eldin
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Yves Hansmann
- Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires, 67000 Strasbourg, France
| | - Solene Patrat-Delon
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Thierry Prazuck
- Department of Infectious and Tropical Diseases, CHR Orléans, Orléans, France
| | - Alice Raffetin
- Tick-Borne Diseases Reference Center, North region, Department of Infectious Diseases, Hospital of Villeneuve-Saint-Georges, 40 allée de la Source, 94190 Villeneuve-Saint-Georges; ESGBOR, European Study Group for Lyme Borreliosis
| | - Pierre Tattevin
- Department of Infectious Diseases and Intensive Care Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Gwenaël Vourc'h
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, 63122 Saint-Genès-Champanelle, France; Université de Lyon, INRAE, VetAgro Sup, UMR EPIA, F-69280 Marcy l'Etoile, France
| | - Olivier Lesens
- Infectious and Tropical Diseases Department, CRIOA, CHU Clermont-Ferrand, Clermont-Ferrand, France; UMR CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Université Clermont Auvergne, Clermont-Ferrand, France
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Demotier S, Limelette A, Charmillon A, Baux E, Parent X, Mestrallet S, Pavel S, Servettaz A, Dramé M, Muggeo A, Wynckel A, Gozalo C, Taam MA, Fillion A, Jaussaud R, Trenque T, Piroth L, Bani-Sadr F, Hentzien M. Incidence, associated factors, and effect on renal function of amoxicillin crystalluria in patients receiving high doses of intravenous amoxicillin (The CRISTAMOX Study): A cohort study. EClinicalMedicine 2022; 45:101340. [PMID: 35295665 PMCID: PMC8919213 DOI: 10.1016/j.eclinm.2022.101340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Amoxicillin crystalluria (AC), potentially responsible for acute kidney injury (AKI), is reported more and more frequently in patients treated with high doses of intravenous amoxicillin (HDIVA). The main objective of this study was to evaluate AC incidence in these patients. The secondary objectives were to identify factors associated with AC and to evaluate its impact on the risk of AKI. METHODS This multicentre, observational, cohort study was conducted between Mar 18, 2014 and Aug 16, 2019 in Dijon, Nancy, and Reims University Hospitals as well as Châlon-sur-Saône, Charleville-Mézières, and Troyes general hospitals in France. Adult patients (≥18 years) treated with HDIVA and having been tested for AC at least once during treatment were included. Clinical, biological, and therapeutic characteristics of the patients were collected. A univariable mixed logistic regression model assessed the factors associated with AC. A multivariable Cox model with AC as a time-dependent variable assessed the prognostic factors for AKI. ClinicalTrials.gov number: NCT02853292. FINDINGS Of the 112 included patients, 27 (24.1%, 95% CI [16.2-32.0]) developed at least one episode of AC within a mean of 5.1 days. The factors associated with its occurrence were the concomitant use of angiotensin converting enzyme (ACE) inhibitors (OR=4.6, 95% CI [2.2-9.3], p<0.0001) and the decrease of urinary pH (OR=2.1 for one pH point decrease, 95% CI [1.2-3.7], p=0.009). 20 patients (17.9%) presented with AKI, within a mean time of 10.9 days. The main factor associated with the occurrence of AKI was the occurrence of AC (aHR=7.4, 95% CI [2.5-22.2], p=0.0003). INTERPRETATION AC occurred in a quarter of patients treated with HDIVA and was highly prognostic of AKI. FUNDING None.
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Affiliation(s)
- Sophie Demotier
- Service de Médecine Interne— Maladies infectieuses, Immunologie Clinique. Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Anne Limelette
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Alexandre Charmillon
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire Brabois, Vandoeuvre-lès-Nancy, France
| | - Elisabeth Baux
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire Brabois, Vandoeuvre-lès-Nancy, France
| | - Xavier Parent
- Laboratoire de Biochimie, Hôpitaux Civils de Colmar, Colmar, France
| | - Stéphanie Mestrallet
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Intercommunal Nord-Ardennes, Charleville-Mézières, France
| | - Simona Pavel
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier, Troyes, France
| | - Amélie Servettaz
- Service de Médecine Interne— Maladies infectieuses, Immunologie Clinique. Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Moustapha Dramé
- Département de Recherche Clinique et Innovation, Centre Hospitalier Universitaire Pierre Zobda-Quitman, Fort-de-France, France
| | - Anaelle Muggeo
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Alain Wynckel
- Service de Néphrologie, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Claire Gozalo
- Laboratoire de Pharmacologie-Toxicologie, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Malak Abou Taam
- Pôle antalgie, anesthésie, rhumatologie, médicaments des addictions, Direction Médicale Médicament 2, ANSM, Saint-Denis, France
| | - Aurélie Fillion
- Service de Maladies Infectieuses, Centre Hospitalier William Morey, Chalon-sur-Saône, France
| | - Roland Jaussaud
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Brabois, Vandoeuvre-lès-Nancy, France
| | - Thierry Trenque
- Centre Régional de Pharmacovigilance et de Pharmacoépidémiologie, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Lionel Piroth
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire François Mitterand, Dijon, France
| | - Firouze Bani-Sadr
- Service de Médecine Interne— Maladies infectieuses, Immunologie Clinique. Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Maxime Hentzien
- Service de Médecine Interne— Maladies infectieuses, Immunologie Clinique. Centre Hospitalier Universitaire Robert Debré, Reims, France
- Corresponding author: Dr Maxime Hentzien, Service de Médecine Interne—Maladies infectieuses, Immunologie Clinique, Centre Hospitalier Universitaire Robert Debré, Avenue du général Koenig, 51092 Reims Cedex, France, Phone number: 0033 3 26 78 71 89 or 0033 6 07 85 01 77, Fax number: 0033 3 26 78 40 90
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Rabaud C, Goehringer F, Fall E, Peter L, Dufournaud M, Baux E, Balan M, Rotonda C, Machado J, Tarquinio C. Suspicion de maladie de Lyme : déterminants et conséquences psychologiques. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.359] [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: 10/23/2022]
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Baux E, Aissa N, Pulcini C, May T, Lozniewski A, Rabaud C, Hénard S. BU-34 - Impact d’une antibiothérapie alternative aux carbapénèmes sur la mortalité dans le traitement des infections urinaires fébriles à eblse. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30358-4] [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: 11/28/2022]
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Kimmoun A, Baux E, Das V, Terzi N, Talec P, Asfar P, Ehrmann S, Geri G, Grange S, Anguel N, Demoule A, Moreau AS, Azoulay E, Quenot JP, Boisramé-Helms J, Louis G, Sonneville R, Girerd N, Ducrocq N, Agrinier N, Wahl D, Puéchal X, Levy B. Outcomes of patients admitted to intensive care units for acute manifestation of small-vessel vasculitis: a multicenter, retrospective study. Crit Care 2016; 20:27. [PMID: 26812945 PMCID: PMC4729170 DOI: 10.1186/s13054-016-1189-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/14/2016] [Indexed: 11/25/2022]
Abstract
Background The outcomes of patients admitted to the intensive care unit (ICU) for acute manifestation of small-vessel vasculitis are poorly reported. The aim of the present study was to determine the mortality rate and prognostic factors of patients admitted to the ICU for acute small-vessel vasculitis. Methods This retrospective, multicenter study was conducted from January 2001 to December 2014 in 20 ICUs in France. Patients were identified from computerized registers of each hospital using the International Classification of Diseases, Ninth Revision (ICD-9). Inclusion criteria were (1) known or highly suspected granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis (respectively, ICD-9 codes M31.3, M30.1, and M31.7), or anti–glomerular basement membrane antibody disease (ICD-9 codes N08.5X-005 or M31.0+); (2) admission to the ICU for the management of an acute manifestation of vasculitis; and (3) administration of a cyclophosphamide pulse in the ICU or within 48 h before admission to the ICU. The primary endpoint was assessment of mortality rate 90 days after admission to the ICU. Results Eighty-two patients at 20 centers were included, 94 % of whom had a recent (<6 months) diagnosis of small-vessel vasculitis. Forty-four patients (54 %) had granulomatosis with polyangiitis. The main reasons for admission were respiratory failure (34 %) and pulmonary-renal syndrome (33 %). Mechanical ventilation was required in 51 % of patients, catecholamines in 31 %, and renal replacement therapy in 71 %. Overall mortality at 90 days was 18 % and the mortality in ICU was 16 %. The main causes of death in the ICU were disease flare in 69 % and infection in 31 %. In univariable analysis, relevant factors associated with death in nonsurvivors compared with survivors were Simplified Acute Physiology Score II (median [interquartile range] 51 [38–82] vs. 36 [27–42], p = 0.005), age (67 years [62–74] vs. 58 years [40–68], p < 0.003), Sequential Organ Failure Assessment score on the day of cyclophosphamide administration (11 [6–12] vs. 6 [3–7], p = 0.0004), and delayed administration of cyclophosphamide (5 days [3–14] vs. 2 days [1–5], p = 0.0053). Conclusions Patients admitted to the ICU for management of acute small-vessel vasculitis benefit from early, aggressive intensive care treatment, associated with an 18 % death rate at 90 days. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1189-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoine Kimmoun
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France.,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France
| | - Elisabeth Baux
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France.,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Andre Gregoire District Hospital Center, Montreuil, F-93105, France
| | - Nicolas Terzi
- Medical Intensive Care Unit, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Patrice Talec
- Medical Intensive Care Unit, Angers University Hospital, Angers, F-49933, France
| | - Pierre Asfar
- Medical Intensive Care Unit, Angers University Hospital, Angers, F-49933, France
| | - Stephan Ehrmann
- Medical Intensive Care Unit, Bretonneau University Hospital, Tours, F-37044, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin University Hospital, Paris, F-75014, France
| | - Steven Grange
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, 76031, France
| | - Nadia Anguel
- Medical Intensive Care Unit, Kremlin-Bicêtre University Hospital, Paris, F-94275, France
| | - Alexandre Demoule
- Medical Intensive Care Unit and Respiratory Division, Pitié-Salpêtrière University Hospital, Paris, 75013, France
| | - Anne Sophie Moreau
- Medical-Surgical Intensive Care Unit, Lille University Hospital, Lille, F-59000, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Paris, 75010, France
| | - Jean-Pierre Quenot
- Medical Intensive Care Unit, Dijon University Hospital, Dijon, F-21079, France
| | - Julie Boisramé-Helms
- Medical Intensive Care Unit, NHC University Hospital, Strasbourg, F-67091, France
| | - Guillaume Louis
- Medical Intensive Care Unit, Mercy Regional Hospital, Ars-Laquenexy, 57530, France
| | - Romain Sonneville
- Medical Intensive Care Unit, Bichat - Claude-Bernard University Hospital, Paris, 75018, France
| | - Nicolas Girerd
- INSERM CIC1433, Nancy University Hospital, Nancy, 54000, France
| | - Nicolas Ducrocq
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France.,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France
| | - Nelly Agrinier
- INSERM CIC-EC, CIE6, Nancy University Hospital, Nancy, 54000, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-les Nancy, Nancy, 54511, France
| | - Xavier Puéchal
- National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Cochin Hospital, University Paris Descartes, Paris, F-75014, France
| | - Bruno Levy
- Brabois Medical Intensive Care Unit, Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, 54000, France. .,INSERM U1116, Vandoeuvre-les-Nancy, Nancy, France.
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Cabon M, Charbit L, Corriger J, Moulinet T, Mohamed S, Revuz S, Baux E, Deibener J, Kaminsky P. Un cas de syndrome de Sjögren associé à un lymphome T périphérique : le lymphome B n’est pas le seul responsable. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.198] [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: 11/28/2022]
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