1
|
Drusch S, Neumann A, Michelon H, Pépin M, Zureik M, Herr M. Do Proton Pump Inhibitors Reduce Upper Gastrointestinal Bleeding in Older Patients with Atrial Fibrillation Treated with Oral Anticoagulants? A Nationwide Cohort Study in France. Drugs Aging 2024; 41:65-76. [PMID: 38114724 PMCID: PMC10769917 DOI: 10.1007/s40266-023-01085-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are largely used in older adults and data are needed in off-label indications, such as the prevention of upper gastrointestinal bleeding (UGIB) in patients receiving oral anticoagulants (OACs). This study aimed to assess whether PPIs reduce the risk of UGIB in patients initiating oral anticoagulation. METHODS We conducted a longitudinal study based on the French national health database. The study population included 109,693 patients aged 75-110 years with a diagnosis of atrial fibrillation who initiated OACs [vitamin K antagonist (VKA) or direct OAC (DOAC)] between 2012 and 2016. We used multivariable Cox models weighted by inverse of probability of treatment to estimate the adjusted hazard ratio (aHR) of UGIB between PPI users and nonusers over a 6- and 12-month follow-up. RESULTS PPI users represented 23% of the study population (28% among VKA initiators and 17% among DOAC initiators). The mean age (83 ± 5.3 years) and proportion of women (near 60%) were similar between groups. The risk of UGIB in the first 6 months after initiation of OAC decreased by 20% in PPI users compared with PPI nonusers [aHR6 months = 0.80, 95% confidence interval (CI) 0.65-0.98], but was not significantly modified when the follow-up was extended to 12 months (aHR12 months = 0.90, 95% CI 0.76-1.07), with a stronger effect among patients treated with vitamin K antagonists (aHR6 months = 0.73, 95% CI 0.58-0.93; aHR12 months = 0.81, 95% CI 0.67-0.99). CONCLUSIONS This study suggests that PPIs were associated with reduced risk of gastrointestinal bleeding after initiation of oral anticoagulation in older patients with atrial fibrillation, particularly within 6 months after initiation of an antivitamin K antagonist.
Collapse
Affiliation(s)
- Solene Drusch
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis, France.
- Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, UVSQ, Inserm, Montigny-le-Bretonneux, France.
| | - Anke Neumann
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis, France
| | - Hugues Michelon
- Pharmacy Department, Sainte-Périne Hospital, GHU AP-HP, University of Paris-Saclay, Paris, France
| | - Marion Pépin
- Geriatrics Department, Ambroise Paré Hospital, GHU AP-HP, University of Paris-Saclay, Boulogne-Billancourt, France
- Clinical Epidemiology, University of Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Mahmoud Zureik
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis, France
- Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, UVSQ, Inserm, Montigny-le-Bretonneux, France
| | - Marie Herr
- Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, UVSQ, Inserm, Montigny-le-Bretonneux, France
- Epidemiology and Public Health department, Raymond Poincaré Hospital, GHU AP-HP, University of Paris-Saclay, Garches, France
| |
Collapse
|
2
|
Drusch S, Le Tri T, Ankri J, Michelon H, Zureik M, Herr M. Potentially inappropriate medications in nursing homes and the community older adults using the French health insurance databases. Pharmacoepidemiol Drug Saf 2023; 32:475-485. [PMID: 36424189 DOI: 10.1002/pds.5575] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/29/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Potentially inappropriate medications (PIMs) have become a major issue in improving prescribing practices and reducing the risk of adverse drug events in older people. However, very few studies have compared exposition to PIMs controlling for differences in demographic and health between nursing home residents (NHRs) and community-dwelling older adults (CDOAs). This study aimed to assess the prescribing pattern of PIMs between NHRs and CDOAs. METHODS We conducted a cross-sectional study over three months in 2019 using the French Health Insurance databases. The study population included 274 971 NHRs and 4 893 721 CDOAs aged 75 years or over. The prevalence ratio (PR) between NHRs and CDOAs of 17 PIM indicators, based on the Beers and STOPP criteria lists, was assessed using multivariable robust Poisson regression adjusted for age, sex, diseases, and polypharmacy. RESULTS During the study period, 54% of NHRs and 29% of CDOAs received at least one PIM. After adjustment, the prevalence of PIMs was 33% higher among NHRs compared to CDOAs (aPR = 1.33; 95% CI [1.33-1.34]). NHRs received PIMs related to benzodiazepines (aPR = 1.43; 95% CI [1.42-1.43]), anticholinergic drugs (aPR = 1.29; 95% CI [1.27-1.31]), and at least three central nervous system-active drugs (aPR = 1.94; 95% CI [1.92-1.96]) more frequently. Prevalence of PIMs related to non-steroidal anti-inflammatory drugs (aPR = 0.50; 95% CI [0.48-0.52]) and long-acting benzodiazepines (aPR = 0.84; 95% CI [0.82-0.85]) was lower among NHRs. CONCLUSION The NHRs were at greater risk for PIM than CDOAs, although differences exist according to the category of PIMs. As the population is aging, it is essential to promote and evaluate interventions in NHs and the community to enhance medication optimization.
Collapse
Affiliation(s)
- Solene Drusch
- EPI-PHARE, Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance, Saint-Denis, France
- UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, Montigny le Bretonneux, France
| | - Thien Le Tri
- EPI-PHARE, Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance, Saint-Denis, France
| | - Joel Ankri
- UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, Montigny le Bretonneux, France
| | - Hugues Michelon
- Pharmacy Department, Sainte-Périne Hospital, AP-HP, University of Paris-Saclay, Paris, France
| | - Mahmoud Zureik
- EPI-PHARE, Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance, Saint-Denis, France
- UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, Montigny le Bretonneux, France
| | - Marie Herr
- UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, University of Paris-Saclay, Montigny le Bretonneux, France
- Epidemiology and Public Health Department, AP-HP, University of Paris-Saclay, Paris, France
| |
Collapse
|
3
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Michelon H, Souchu H, Chauvron-Defilippi B, Lecoeur A, Villart M, Denis M. Subcutaneous pantoprazole in an elderly, palliative care patient. BMJ Support Palliat Care 2022; 12:e187-e188. [PMID: 31462422 DOI: 10.1136/bmjspcare-2019-001916] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/15/2019] [Indexed: 11/04/2022]
Abstract
Proton pump inhibitors (PPIs) have become the agents of choice for acid-related diseases. In some clinical situations, PPI therapy by oral or intravenous route may be difficult especially among elderly and patients in palliative care. Off-label PPI subcutaneous injection could be the last alternative to improve patient relief, despite limited published data. We report a case of linitis plastica, peritoneal carcinomatosis and occlusive syndrome who suffered from painful regurgitations which rapidly improved after subcutaneous pantoprazole. No related adverse effects were observed during PPI therapy. Despite some limitations, this report suggests that off-label subcutaneous pantoprazole could be an interesting alternative route when intravenous infusion may be difficult or harmful for elderly and patients in palliative care. Nevertheless, clinical safety and efficiency data on larger populations are needed to validate this use in such population.
Collapse
Affiliation(s)
- Hugues Michelon
- Pharmacy Department, Site Sainte-Périne, AP-HP, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| | - Hélène Souchu
- Palliative Care Unit, Site Sainte-Périne, AP-HP, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| | - Bénédicte Chauvron-Defilippi
- Palliative Care Unit, Site Sainte-Périne, AP-HP, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| | - Anne Lecoeur
- Pharmacy Department, Site Ambroise Paré, AP-HP, Hôpitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France
| | - Maryvonne Villart
- Pharmacy Department, Site Sainte-Périne, AP-HP, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| | - Michel Denis
- Palliative Care Unit, Site Sainte-Périne, AP-HP, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| |
Collapse
|
5
|
Ble O, Bensmail D, Pérennou D, Parratte B, Joseph PA, Boyer FC, Michelon H, Lansaman T, Levy J. Management of antithrombotics for intramuscular injection of botulinum toxin for spasticity. A survey of real-life practice in France. Ann Phys Rehabil Med 2021; 64:101467. [PMID: 33316432 DOI: 10.1016/j.rehab.2020.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Ozoua Ble
- Department of Physical and Rehabilitation Medicine, Raymond Poincaré Hospital, APHP, University Paris-Saclay, 92380 Garches, France.
| | - Djamel Bensmail
- U1179 Neuromuscular Handicap, Inserm, University of Versailles-St-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Dominic Pérennou
- Department of Physical and Rehabilitation Medicine, Grenoble University Hospital, South Hospital, 38130 Echirolles, France
| | - Bernard Parratte
- Department of Physical and Rehabilitation Medicine, CHRU Jean Minjoz, Besançon-Franche-Comté University, 25000 Besançon, France
| | - Pierre-Alain Joseph
- Department of Physical and Rehabilitation Medicine, CHU de Bordeaux, 33000 Bordeaux, France
| | - François-Constant Boyer
- Department of Physical and Rehabilitation Medicine, University of Reims, CHU de Reims, 51100 Reims, France
| | - Hugues Michelon
- Pharmacy Department, Raymond Poincaré Hospital, APHP, University Paris-Saclay, 92380 Garches, France
| | | | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
de Laroche M, Fellous L, Salomon E, Saadeh D, Duran C, Bouchand F, Lequintrec JL, Teillet L, Gaillard JL, Seridi Z, Michelon H, Dinh A. Bloodstream infections in older population: epidemiology, outcome, and impact of multidrug resistance. Eur J Clin Microbiol Infect Dis 2021; 40:1665-1672. [PMID: 33694038 DOI: 10.1007/s10096-021-04212-7] [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: 11/22/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Bloodstream infections (BSIs) among older patients are frequent with high rate of mortality. Infections with multidrug-resistant organisms (MDRO) are associated with higher mortality than with susceptible microorganisms. We aimed to evaluate the prevalence of MDRO infection during BSI in older population and the factors associated with unfavorable outcome. This study is a retrospective cohort of all BSI episodes occurring among older patients (> 65yo), from April 1, 2010, to December 31, 2016, in a French university hospital for geriatric medicine. A total of 255 BSI episodes were analyzed. Mean age was 86.3±6.5 years, and sex ratio (M/F) was 0.96. Main comorbidities were orthopedic device (26.7%), active neoplasia (24.3%), and diabetes mellitus (18.4%). Main primary sites of infection were urinary tract infections (56.9%), respiratory tract infections (10.6%), intra-abdominal infections (7.1%), and skin and soft tissue infections (4.7%). Main bacteria identified were Escherichia coli (45.1%), Staphylococcus aureus (14.1%), enterococci (10.7%), coagulase-negative staphylococci (CoNS) (5.5%), and streptococci (5.1%). MDROs were involved in 17.2% of BSI (gram-negative bacilli: 9.0%; CoNS: 4.3%; and methicillin-resistant S. aureus (MRSA): 3.9%). The main factor associated with MDRO BSI was colonization with MDRO (OR=6.29; 95%CI=2.9-14.32). Total mortality was 18.4% and significantly higher in case of initial severity (OR=3.83; 95%CI=1.75-8.38), healthcare-associated infection (OR=5.29; 95%CI=1.11-25.30), and MRSA BSI (OR=9.16; 95%CI=1.67-50.16). BSI due to MDRO is frequent in older population and is strongly associated with carriage of MDRO. Healthcare-associated BSI, severe episodes, and BSI due to MRSA are associated with unfavorable outcome. In these cases, a broad-spectrum antibiotic should be promptly initiated.
Collapse
Affiliation(s)
- Marine de Laroche
- Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Lesly Fellous
- Pharmacy Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Elsa Salomon
- Microbiology Laboratory, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Danielle Saadeh
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Clara Duran
- Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Jean-Laurent Lequintrec
- Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Laurent Teillet
- Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France.,Geriatric Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Microbiology Laboratory, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Zineb Seridi
- Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Hugues Michelon
- Pharmacy Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France.,Pharmacy Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aurélien Dinh
- Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France. .,Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, 104 Bd R. Poincaré, 92380, Garches, France.
| |
Collapse
|
8
|
Michelon H, Larabi IA, Lemoine J, Alvarez JC, Genevée A, Lillo-Lelouet A, Azouvi P, Lefèvre-Dognin C, Paquereau J. Atropine-induced toxicity after off-label sublingual administration of eyedrop for sialorrhoea treatment in neurological disabled patients. Br J Clin Pharmacol 2021; 87:3364-3369. [PMID: 33521988 DOI: 10.1111/bcp.14757] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022] Open
Abstract
Sialorrhea is a troublesome and disabling symptom defined by the unintentional loss of saliva from the mouth, usually associated with swallowing disorders. Today there is no consensus about the management of sialorrhoea, but off-label use of ophthalmic atropine eyedrop administered sublingually may offer benefits, despite limited safety data. We report 2 cases of atropine overdose after sublingual administration illustrating that atropine can expose to severe adverse effects when administered sublingually. The noncompartmental pharmacokinetic study of atropine performed in 1 patient highlighted that systemic absorption of sublingual atropine was effective (Cmax [1 h] = 2.2 ng mL-1 ; approximately) after a single dose of 1 mg.
Collapse
Affiliation(s)
- Hugues Michelon
- Service de Pharmacie, Hôpital Sainte-Périne, APHP. Université Paris-Saclay, Paris, France.,Service de Pharmacie, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| | - Islam Amine Larabi
- Service de Pharmacologie - Toxicologie, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| | - Jérôme Lemoine
- Unité de Soins de Rééducation Post-Réanimation, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| | - Jean-Claude Alvarez
- Service de Pharmacologie - Toxicologie, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| | - Anne Genevée
- Unité de Soins de Rééducation Post-Réanimation, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| | - Agnès Lillo-Lelouet
- Centre Régional de Pharmacovigilance de Paris, Hôpital Européen Georges Pompidou, AP-HP.Centre - Université de Paris, Paris, France
| | - Philippe Azouvi
- Unité de Soins de Rééducation Post-Réanimation, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| | - Clémence Lefèvre-Dognin
- Unité de Soins de Rééducation Post-Réanimation, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France.,Unité de Soins Prolongés Complexes, Hôpital Sainte-Périne, APHP. Université Paris-Saclay, Paris, France
| | - Julie Paquereau
- Unité de Soins de Rééducation Post-Réanimation, Hôpital Raymond Poincaré, APHP. Université Paris-Saclay, Garches, France
| |
Collapse
|
9
|
Michelon H, Astruc-Bellag A, Ongaro C, Rodrigues L, Croitor C. [Automation of the medication circuit to ensure patient safety]. Soins Gerontol 2021; 26:30-34. [PMID: 33894912 DOI: 10.1016/j.sger.2021.01.010] [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: 11/29/2022]
Abstract
The medication circuit is a complex, transversal and risky process. It involves interdependent clinical and logistical stages. Its automation and computerisation are real levers for securing the patient's medication management and optimising the organisation of care. It allows care staff to free up precious time to provide care, particularly in geriatrics.
Collapse
Affiliation(s)
| | | | | | | | - Chrystelle Croitor
- Unité de soins prolongés complexes, hôpital Sainte-Périne, groupe hospitalier universitaire Paris-Saclay, Assistance publique- Hôpitaux de Paris, 11 rue Chardon-Lagache, 75016 Paris, France
| |
Collapse
|
10
|
Annane D, Heming N, Grimaldi-Bensouda L, Frémeaux-Bacchi V, Vigan M, Roux AL, Marchal A, Michelon H, Rottman M, Moine P. Eculizumab as an emergency treatment for adult patients with severe COVID-19 in the intensive care unit: A proof-of-concept study. EClinicalMedicine 2020; 28:100590. [PMID: 33173853 PMCID: PMC7644240 DOI: 10.1016/j.eclinm.2020.100590] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [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: 07/01/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Complement pathway inhibition may provide benefit for severe acute respiratory illnesses caused by viral infections such as COVID-19. We present results from a nonrandomized proof-of-concept study of complement C5 inhibitor eculizumab for treatment of severe COVID-19. METHODS All patients (N = 80) with confirmed SARS-CoV-2 infection and severe COVID-19 admitted to our intensive care unit between March 10 and May 5, 2020 were included. Forty-five patients were treated with standard care and 35 with standard care plus eculizumab through expanded-access emergency treatment. The prespecified primary outcome was day-15 survival. Clinical laboratory values and biomarkers, complement levels, and treatment-emergent serious adverse events (TESAEs) were also assessed. FINDINGS At day 15, estimated survival was 82.9% (95% CI: 70.4%‒95.3%) with eculizumab and 62.2% (48.1%‒76.4%) without eculizumab (log-rank test, P = 0.04). Patients treated with eculizumab experienced a significantly more rapid decrease in lactate, blood urea nitrogen, total and conjugated bilirubin levels and a significantly more rapid increase in platelet count, prothrombin time, and in the ratio of arterial oxygen tension over fraction of inspired oxygen versus patients treated without eculizumab. Eculizumab-associated changes in complement levels, laboratory values, and biomarkers were consistent with terminal complement inhibition, reduced hypoxia, and decreased inflammation. TESAEs of special interest occurring in >5% of patients treated with/without eculizumab were ventilator-associated pneumonia (51%/24%), bacteremia (11%/2%), gastroduodenal hemorrhage (14%/16%), and hemolysis (3%/18%). INTERPRETATION Findings from this proof-of-concept study suggest eculizumab may improve survival and reduce hypoxia in patients with severe COVID-19. Randomized studies evaluating the efficacy and safety of this treatment approach are needed. FUNDING Programme d'Investissements d'Avenir: ANR-18-RHUS60004.
Collapse
Affiliation(s)
- Djillali Annane
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, 104 Boulevard Raymond Poincaré, Garches 92380, France
| | - Nicholas Heming
- Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, Garches, France
| | - Lamiae Grimaldi-Bensouda
- Clinical Research Unit AP-HP, Paris-Saclay, Hôpital Raymond Poincaré, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, CESP Anti-Infective Evasion and Pharmacoepidemiology Team, F-78180 Montigny-Le-Bretonneux, France
| | - Véronique Frémeaux-Bacchi
- Laboratory of Immunology, Georges-Pompidou European Hospital (APHP), Invasive Bacterial Infection Unit and National Reference Center for Meningococci, Pasteur Institute, Centre de Recherche des Cordeliers, Paris, France
| | - Marie Vigan
- Clinical Research Unit, AP-HP, Paris-Saclay, Hôpital Raymond Poincaré, Garches, France
| | - Anne-Laure Roux
- Department of Microbiology and Innovative Biomarkers Platform, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, Garches, France
| | - Armance Marchal
- Laboratory of Immunology, Georges-Pompidou European Hospital (APHP), Paris, France
| | - Hugues Michelon
- Pharmacy Department, Hôpital Raymond Poincaré (APHP), University Paris Saclay, Garches, France
| | - Martin Rottman
- Department of Microbiology and Innovative Biomarkers Platform, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, Garches, France
| | - Pierre Moine
- Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, Garches, France
| | - for the Garches COVID 19 Collaborative Group
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, 104 Boulevard Raymond Poincaré, Garches 92380, France
- Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, Garches, France
- Clinical Research Unit AP-HP, Paris-Saclay, Hôpital Raymond Poincaré, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, CESP Anti-Infective Evasion and Pharmacoepidemiology Team, F-78180 Montigny-Le-Bretonneux, France
- Laboratory of Immunology, Georges-Pompidou European Hospital (APHP), Invasive Bacterial Infection Unit and National Reference Center for Meningococci, Pasteur Institute, Centre de Recherche des Cordeliers, Paris, France
- Clinical Research Unit, AP-HP, Paris-Saclay, Hôpital Raymond Poincaré, Garches, France
- Department of Microbiology and Innovative Biomarkers Platform, Hôpital Raymond Poincaré (APHP), Laboratory of Infection & Inflammation – U1173, School of Medicine Simone Veil, University Versailles Saint Quentin – University Paris Saclay, INSERM, Garches, France
- Laboratory of Immunology, Georges-Pompidou European Hospital (APHP), Paris, France
- Pharmacy Department, Hôpital Raymond Poincaré (APHP), University Paris Saclay, Garches, France
| |
Collapse
|
11
|
Michelon H, Bouabdallah-Perrin L, Singh S, Touratier S, Loustalot M, Bleibtreu A, Pain J, Wyplosz B, Junot H, Dinh A. Utilisation de la témocilline : étude de cohorte. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.094] [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]
|
12
|
Michelon H, Pons‐Peyneau C, Gourdon M, Le Dastumer B, Teillet L, Herr M. Off‐label use of midazolam in older inpatients: analysis of prescribing practices in a French hospital (MIDnight study). Fundam Clin Pharmacol 2020; 34:515-517. [DOI: 10.1111/fcp.12532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/18/2019] [Accepted: 01/06/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Hugues Michelon
- Service de Pharmacie Hôpitaux Universitaires Paris Ile‐de‐France Ouest, site Hôpital Sainte‐Périne, AP‐HP Paris France
| | - Cécile Pons‐Peyneau
- Service de Gériatrie Hôpitaux Universitaires Paris Ile‐de‐France Ouest, site Hôpital Sainte‐Périne, AP‐HP Paris France
| | - Mathilde Gourdon
- Service de Gériatrie Hôpitaux Universitaires Paris Ile‐de‐France Ouest, site Hôpital Sainte‐Périne, AP‐HP Paris France
| | - Bruno Le Dastumer
- Service de Gériatrie Hôpitaux Universitaires Paris Ile‐de‐France Ouest, site Hôpital Sainte‐Périne, AP‐HP Paris France
| | - Laurent Teillet
- Service de Gériatrie Hôpitaux Universitaires Paris Ile‐de‐France Ouest, site Hôpital Sainte‐Périne, AP‐HP Paris France
| | - Marie Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université de Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- Département Hospitalier d'Epidémiologie et de Santé Publique Hôpitaux Universitaires Paris Ile‐de‐France Ouest, site Hôpital Sainte Périne, AP‐HP Paris France
| |
Collapse
|
13
|
Belissa E, Vallet T, Laribe-Caget S, Chevallier A, Chedhomme FX, Abdallah F, Bachalat N, Belbachir SA, Boulaich I, Bloch V, Delahaye A, Depoisson M, Wojcicki AD, Gibaud S, Grancher AS, Guinot C, Lachuer C, Lechowski L, Leglise P, Mahiou A, Meaume S, Michel C, Michelon H, Orven Y, Perquy I, Piccoli M, Rabus M, Ribemont AC, Rwabihama JP, Trouvin JH, Ruiz F, Boudy V. Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues. BMC Geriatr 2019; 19:344. [PMID: 31810442 PMCID: PMC6898963 DOI: 10.1186/s12877-019-1337-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population. Methods An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively. Results Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men. Conclusion This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.
Collapse
Affiliation(s)
- Emilie Belissa
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Thibault Vallet
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Sandra Laribe-Caget
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Alain Chevallier
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - François-Xavier Chedhomme
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Fattima Abdallah
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Nathalie Bachalat
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Sid-Ahmed Belbachir
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Imad Boulaich
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Vanessa Bloch
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Anne Delahaye
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Mathieu Depoisson
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Amélie Dufaÿ Wojcicki
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Stéphane Gibaud
- Centre Hospitalier de l'Ouest Vosgien, 1280 avenue division Leclerc, 88300, Neufchâteau, France
| | - Anne-Sophie Grancher
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Caroline Guinot
- Hôpital Fernand Widal, Groupe Hospitalier Universitaire Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, 75010, Paris, France
| | - Celia Lachuer
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Laurent Lechowski
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Patrick Leglise
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Abdel Mahiou
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Sylvie Meaume
- Hôpital Rothschild, Groupe Hospitalier Universitaire Est Parisien, AP-HP, 5 rue Santerre, 75012, Paris, France
| | - Corinne Michel
- Hôpital René Muret, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, AP-HP, avenue du Dr Schaeffner, 93270, Sevran, France
| | - Hugues Michelon
- Hôpital Sainte Périne, Groupe Hospitalier Universitaire Paris Ile-de-France Ouest, AP-HP, 11 rue Chardon Lagache, 75016, Paris, France
| | - Yann Orven
- Hôpital Vaugirard, Groupe Hospitalier Universitaire Paris Ouest, AP-HP, 10 rue Vaugelas, 75015, Paris, France
| | - Ines Perquy
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Matthieu Piccoli
- Hôpital Broca, Groupe Hospitalier Universitaire Paris Centre, AP-HP, 54-56 rue Pascal, 75013, Paris, France
| | - Maïté Rabus
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Annie-Claude Ribemont
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Paul Rwabihama
- Hôpital Joffre Dupuytren, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, 1 rue Eugène Delacroix, 91210, Draveil, France
| | - Jean-Hugues Trouvin
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France
| | - Fabrice Ruiz
- ClinSearch, 110 avenue Pierre Brossolette, 92240, Malakoff, France
| | - Vincent Boudy
- Département Recherche et Développement Pharmaceutique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer à Moulin, 75005, Paris, France.
| |
Collapse
|
14
|
Michelon H, Tardivel M, Dinh A, Alvarez JC, Salomon E, Le Quintrec JL, Hirt D, Davido B. Efficacy and safety of subcutaneous administration of ceftazidime as a salvage therapy in geriatrics: a case report. Fundam Clin Pharmacol 2019; 34:521-524. [PMID: 31709583 DOI: 10.1111/fcp.12520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/13/2019] [Revised: 09/30/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
Ceftazidime is a third-generation cephalosporin used for the treatment of Gram-negative bacteria only approved for parenteral use by intravenous and intramuscular route. In some clinical situations, off-label subcutaneous injection could be a salvage route for the administration of antibiotics, especially in geriatrics, despite the paucity of evidence about efficacy and safety. We report a case of a successful and well-tolerated subcutaneous ceftazidime therapy in a 90-year-old woman for the treatment of an acute urinary tract infection caused by Pseudomonas aeruginosa with therapeutic drug monitoring data.
Collapse
Affiliation(s)
- Hugues Michelon
- Service de Pharmacie, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte-Périne, AP-HP, 11 rue Chardon Lagache, Paris, 75016, France
| | - Marie Tardivel
- Service de Médecine Gériatrique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte-Périne, AP-HP, 11 rue Chardon Lagache, Paris, 75016, France
| | - Aurélien Dinh
- Service de Maladies Infectieuses, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, 104 Bd Raymond Poincaré, Garches, 92380, France
| | - Jean-Claude Alvarez
- Service de Pharmacologie - Toxicologie, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, 104 Bd Raymond Poincaré, Garches, 92380, France
| | - Elsa Salomon
- Service de Microbiologie, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Ambroise Paré, AP-HP, 9 avenue Charles de Gaulle, Boulogne-Billancourt, 94104, France
| | - Jean-Laurent Le Quintrec
- Service de Médecine Gériatrique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Site Sainte-Périne, AP-HP, 11 rue Chardon Lagache, Paris, 75016, France
| | - Deborah Hirt
- Service de Pharmacologie Clinique, Groupe Hospitalier Paris Centre, Site Cochin, AP-HP, 27 rue du Faubourg Saint Jacques, Paris, 75014, France
| | - Benjamin Davido
- Service de Maladies Infectieuses, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Raymond Poincaré, AP-HP, 104 Bd Raymond Poincaré, Garches, 92380, France
| |
Collapse
|
15
|
Ruiz F, Keeley A, Léglise P, Tuleu C, Lachuer C, Rwabihama JP, Bachalat N, Boulaich I, Abdallah F, Rabus M, Ribemont AC, Michelon H, Wojcicki AD, Orlu M, Vallet T, Boudy V. Sex Differences in Medicine Acceptability: A New Factor to Be Considered in Medicine Formulation. Pharmaceutics 2019; 11:pharmaceutics11080368. [PMID: 31374869 PMCID: PMC6723034 DOI: 10.3390/pharmaceutics11080368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 12/22/2022] Open
Abstract
Palatability is a recognized driver of medicine acceptability in pediatrics but deemed less relevant in older populations due to sensory decline. Preliminary findings from an observational study implicated palatability problems with one Alzheimer's medicine. Among 1517 observer reports combining multiple measures on medicines uses in patients aged over 64, we focused on two original formulations of memantine (Ebixa®, tablets (n = 25) and oral solution (n = 60)). Evaluations were scored with an acceptability reference framework (CAST), the rodent Brief Access Taste Aversion (BATA) model tested aversiveness. Focusing on women treated with Ebixa® (n = 54), the oral formulation sub-group was classified as "negatively accepted", while the coated tablet was associated with the "positively accepted" cluster. In men, both formulations belonged to the "positively accepted" profile. Using BATA, the original oral solution was categorized as highly aversive/untolerated while solutions of excipients only were well tolerated. Furthermore, the number of licks was significantly lower in female than in male rats. These results revealed that medicine palatability remains important for acceptability in older populations. Moreover, converging results from humans and animal models highlighted that palatability profiles can significantly vary between the sexes. These drivers should be closely considered during drug development to enhance acceptability in this population.
Collapse
Affiliation(s)
- Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France.
| | - Alexander Keeley
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Patrick Léglise
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Catherine Tuleu
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Célia Lachuer
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Jean-Paul Rwabihama
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Nathalie Bachalat
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Imad Boulaich
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Fattima Abdallah
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Maité Rabus
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Annie-Claude Ribemont
- Hôpital Joffre Dupuytren, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 rue Eugène Delacroix, 91210 Draveil, France
| | - Hugues Michelon
- Hôpital Sainte-Périne, Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris (AP-HP), 11 rue Chardon-Lagache, 75016 Paris, France
| | - Amélie Dufaÿ Wojcicki
- Unité de R&D Galénique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer À Moulin, 75005 Paris, France
| | - Mine Orlu
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Vincent Boudy
- Unité de R&D Galénique, Agence Générale des Equipements et Produits de Santé (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), 7 rue du Fer À Moulin, 75005 Paris, France
| |
Collapse
|
16
|
Davido B, Batista R, Fessi H, Michelon H, Escaut L, Lawrence C, Denis M, Perronne C, Salomon J, Dinh A. Fecal microbiota transplantation to eradicate vancomycin-resistant enterococci colonization in case of an outbreak. Med Mal Infect 2019; 49:214-218. [DOI: 10.1016/j.medmal.2018.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/22/2018] [Accepted: 11/06/2018] [Indexed: 11/17/2022]
|
17
|
Dinh A, Fessi H, Duran C, Batista R, Michelon H, Bouchand F, Lepeule R, Vittecoq D, Escaut L, Sobhani I, Lawrence C, Chast F, Ronco P, Davido B. Clearance of carbapenem-resistant Enterobacteriaceae vs vancomycin-resistant enterococci carriage after faecal microbiota transplant: a prospective comparative study. J Hosp Infect 2018; 99:481-486. [PMID: 29477634 DOI: 10.1016/j.jhin.2018.02.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 12/07/2017] [Accepted: 02/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE) carriage are increasing worldwide. Faecal microbiota transplantation (FMT) appears to be an attractive option for decolonization. This study aimed to evaluate CRE vs VRE clearance by FMT among carriers. METHODS A multi-centre trial was undertaken on patients with CRE or VRE digestive tract colonization who received FMT between January 2015 and April 2017. Adult patients with CRE or VRE colonization, confirmed by three consecutive rectal swabs at weekly intervals, including one in the week prior to FMT, were included in the study. Patients with immunosuppression or concomitant antibiotic prescription at the time of FMT were excluded. Successful decolonization was determined by at least two consecutive negative rectal swabs [polymerase chain reaction (PCR) and culture] on Days 7, 14, 21 and 28, and monthly for three months following FMT. RESULTS Seventeen patients were included, with a median age of 73 years [interquartile range (IQR) 64.3-79.0]. Median duration of carriage of CRE or VRE before FMT was 62.5 days (IQR 57.0-77.5). One week after FMT, three of eight patients were free of CRE colonization and three of nine patients were free of VRE colonization. After three months, four of eight patients were free of CRE colonization and seven of eight patients were free of VRE colonization. Qualitative PCR results were concordant with culture. Six patients received antibiotics during follow-up, three in each group. No adverse events were reported. CONCLUSION CRE and VRE clearance rates were not significantly different in this study, possibly due to the small sample size, but a trend was observed. These data should be confirmed by larger cohorts and randomized trials.
Collapse
Affiliation(s)
- A Dinh
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France.
| | - H Fessi
- Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Batista
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - H Michelon
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Lepeule
- Antimicrobial Stewardship Unit, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - D Vittecoq
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Kremlin-Bicêtre, France
| | - L Escaut
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Kremlin-Bicêtre, France
| | - I Sobhani
- Gastro-enterology Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - C Lawrence
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Chast
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - P Ronco
- Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France
| | - B Davido
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| |
Collapse
|
18
|
Davido B, Batista R, Michelon H, Escaut L, Fessi H, Senard O, Matt M, Deconinck L, De Truchis P, Salomon J, Dinh A. Impact of Fecal Microbiota Transplantation on Digestive Tract Colonization due to Carbapenem-resistant Enterobacteriacae and Vancomycin-resistant Enterococci. Open Forum Infect Dis 2017. [PMCID: PMC5631534 DOI: 10.1093/ofid/ofx163.891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Fecal Microbiota Transplantation (FMT) has proved to be an efficient therapy for recurrent C. difficile infection. Its indication is currently discussed for the decolonization of Multidrug-resistant organisms (MDRO) on the basis of mice experiments. Two recent publications suggest that it could be an efficient strategy for patients colonized with digestive MDRO colonization but few data are available for Carbapenem-Resistant Enterobacteria (CRE) and Vancomycin-Resistant Enterococcus (VRE) colonization.
Methods
We performed a FMT among patients colonized by CRE or VRE documented by at least 3 nonconsecutive positive swabs (including one in the week prior to the FMT).
Procedure: 2 days prior to the FMT, patients received a proton pump inhibitor and a naso-duodenal tube was inserted to perform a bowel lavage with X-prep. FMT was performed with frozen feces from 4 donors previously screened for potential diseases using 5 syringes of 50 cc of feces diluted with saline. Patients were discharged after 24h and benefited of outpatient control swabs (PCR + culture) on day 7, 14, 21, 28 and each month during 3 months in order to assess the decolonization. The study is registered at ClinicalTrials.gov (NCT03029078).
Results
Seventeen individuals were included. Mean age was 69 ± 12.7 (SD) years.
Eight patients were positive for CRE (KPC, OXA48 or NDM-1) and 9 for VRE.
All suffered from severe underlying condition (hemodialysis, dementia, cirrhosis) or chronic wounds. Median functional autonomy scale was evaluated using the French Iso-Resources Groups (GIR)=4/6 IQR[3–6] supporting they were dependent persons.
At 1-month follow-up, 3/8 patients were free from CRE and 5/9 from VRE. At 3-month follow-up, 3/8 patients were still free from CRE whereas 7/8 were free from VRE, considering one death from cirrhosis.
Moreover, one of them received antibiotics during a week for a hospital-acquired infection a long time after FMT. No adverse events were reported.
Conclusion
FMT seems to be an attractive option to eradicate colonization of MDRO, especially for VRE. Limited data are available in the literature to determine response factors. Meanwhile its efficacy is moderate; it provides an alternative solution to quarantine for fragile and frequently hospitalized patients. More data and a controlled trial are required.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
- Benjamin Davido
- Infectious Diseases, Hopital Raymond Poincaré, AP-HP, Garches, France
| | - Rui Batista
- Pharmacy Unit, Hopital Cochin, AP-HP, Paris, France
| | - Hugues Michelon
- Pharmacy Unit, Hopital Raymond Poincaré, AP-HP, Garches, France
| | - Lelia Escaut
- Hopital Kremlin Bicètre, AP-HP, Kremlin Bicètre, France
| | | | - Olivia Senard
- Infectious Diseases, Hôpital Raymond Poincaré-UVSQ, Garches, France
| | - Morgan Matt
- Hopital Raymond Poincaré, AP-HP, Garches, France
| | | | | | - Jérôme Salomon
- Infectious Diseases, Hopital Raymond-Poincaré, AP-HP, Garches, France
| | | |
Collapse
|
19
|
Davido B, Batista R, Michelon H, Lepainteur M, Bouchand F, Lepeule R, Salomon J, Vittecoq D, Duran C, Escaut L, Sobhani I, Paul M, Lawrence C, Perronne C, Chast F, Dinh A. Is faecal microbiota transplantation an option to eradicate highly drug-resistant enteric bacteria carriage? J Hosp Infect 2017; 95:433-437. [PMID: 28237504 DOI: 10.1016/j.jhin.2017.02.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 01/13/2017] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) carriage present a major public health challenge. Decolonization strategies are lacking. We aimed to evaluate the impact of faecal microbiota transplantation (FMT) on a cohort of patients with digestive tract colonization by CRE or VRE. Eight patients were included: six carrying CRE and two colonized by VRE. One month after FMT, two patients were free from CRE carriage, and another patient was free from VRE after three months. In our experience, this strategy is safe.
Collapse
Affiliation(s)
- B Davido
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Batista
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - H Michelon
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - M Lepainteur
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Lepeule
- Antimicrobial Stewardship Unit, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - J Salomon
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - D Vittecoq
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - L Escaut
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - I Sobhani
- Gastroenterology Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - M Paul
- Pharmacy Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - C Lawrence
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - C Perronne
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Chast
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - A Dinh
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France.
| |
Collapse
|
20
|
Bouchand F, Dinh A, Roux AL, Davido B, Michelon H, Lepainteur M, Legendre B, El Sayed F, Pierre I, Salomon J, Lawrence C, Perronne C, Villart M, Crémieux AC. Implementation of a simple innovative system for postprescription antibiotic review based on computerized tools with shared access. J Hosp Infect 2016; 95:312-317. [PMID: 28108091 DOI: 10.1016/j.jhin.2016.11.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance. AIM To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital. METHODS An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum β-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions. The data [patient, antibiotic(s), prescription start date, etc.] were registered on an AMT spreadsheet with shared access, where the microbiologist's opinion on the drug choice, based on available microbiology results, was entered. When the microbiologist and pharmacist did not approve the antibiotic prescribed, a same-day alert was generated and sent to the IDS. That alert led the IDS to re-evaluate the treatment. FINDINGS From 2012 to 2014, 2106 targeted antibiotic prescriptions were reviewed. Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the IDS. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was <30 min/day for each AMT member. This system allowed correct use of targeted antibiotics for 91.8% of prescriptions, but had no significant impact on targeted antibiotic consumption. CONCLUSION This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limited misuse of broad-spectrum antibiotics.
Collapse
Affiliation(s)
- F Bouchand
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
| | - A Dinh
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - A L Roux
- Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - B Davido
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - H Michelon
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - M Lepainteur
- Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - B Legendre
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - F El Sayed
- Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - I Pierre
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - J Salomon
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - C Lawrence
- Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - C Perronne
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - M Villart
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - A-C Crémieux
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| |
Collapse
|
21
|
Michelon H, Bouchand F, Polito A, Clair B, Annane D. Fatal tramadol-induced multiple organ failure. Therapie 2016; 71:435-7. [DOI: 10.1016/j.therap.2016.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
|
22
|
Lagalle M, Ruet A, Villart M, Azouvi P, Michelon H. Use of psychotropic drugs in physically disabled patients: One-shot prevalence and medical practice assessment in a physical and rehabilitation medicine ward. Ann Phys Rehabil Med 2015; 58:357-8. [PMID: 26585584 DOI: 10.1016/j.rehab.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 12/01/2022]
Affiliation(s)
- M Lagalle
- Service de Pharmacie, Hôpital Raymond-Poincaré, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - A Ruet
- Service de Médecine Physique et de Réadaptation, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - M Villart
- Service de Pharmacie, Hôpital Raymond-Poincaré, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - P Azouvi
- Service de Médecine Physique et de Réadaptation, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - H Michelon
- Service de Pharmacie, Hôpital Raymond-Poincaré, Hôpitaux Universitaires Paris Île-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 104, boulevard R.-Poincaré, 92380 Garches, France.
| |
Collapse
|
23
|
Geets E, Jégousse G, Kertesz B, Lenormand C, Azcarate M, Diard P, Arnould A, Pieplu A, Michelon H, Desbordes M, Genêt F, Paquereau J. Methods of information provision for the 1st therapeutic leave after brain injury – Opinions of patients and carers. Patient Education Program: Hemidom. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.249] [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]
|
24
|
Michelon H, König J, Durrbach A, Quteineh L, Verstuyft C, Furlan V, Ferlicot S, Letierce A, Charpentier B, Fromm MF, Becquemont L. SLCO1B1 genetic polymorphism influences mycophenolic acid tolerance in renal transplant recipients. Pharmacogenomics 2011; 11:1703-13. [PMID: 21142914 DOI: 10.2217/pgs.10.132] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS This study aimed to determine the influence of gene candidates on mycophenolic acid (MPA) response during the first year of renal transplantation. MATERIALS & METHODS A total of 218 renal transplant recipients who received MPA from the first day of transplantation at a fixed dose of 2 g/day were genotyped for ABCB1, ABCC2, UGT2B7, UGT1A9, SLCO1B1, SLCO1B3 and IMPDH1 polymorphisms. Clinical end points were MPA-related adverse drug reactions (ADRs) and acute rejection episodes during the first year post-transplantation. RESULTS After correction for multiple statistical testing, SLCO1B1 (encoding the hepatic uptake transporter OATP1B1) was the only gene associated with MPA-related ADRs, showing a 75% risk reduction in favor of a protective effect of the SLCO1B1*5 allele (p = 0.002). In vitro experiments showed that MPA metabolites MPA-phenyl-glucuronide and MPA-acyl-glucuronide are substrates of OATP1B1. Their transport was decreased in the presence of the variant transporter (OATP1B1*5). CONCLUSION These results suggest for the first time that carriers of the SLCO1B1*5 allele seem to be protected from MPA-related ADRs.
Collapse
Affiliation(s)
- Hugues Michelon
- Pharmacology Department, Univ Paris-Sud, Bicêtre University Hospital, le Kremlin, Bicêtre, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Arzouk N, Michelon H, Snanoudj R, Taburet AM, Durrbach A, Furlan V. Interaction between Tacrolimus and Fumagillin in Two Kidney Transplant Recipients. Transplantation 2006; 81:136-7. [PMID: 16421493 DOI: 10.1097/01.tp.0000189947.55624.74] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Michelon H, Limat S, Woronoff-Lemsi MC. [Cardiovascular drugs. 11/12. Oral anticoagulants]. Soins 2005:53-5. [PMID: 15869237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
|