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Quénéhervé L, Trang-Poisson C, Fantou A, Flamant M, Durand T, Bouguen G, Bregeon J, Oullier T, Amil M, Dewitte M, Bardot S, Blandin S, Braudeau C, Vibet MA, Josien R, Neunlist M, Bourreille A. Confocal laser endomicroscopy as predictive biomarker of clinical and endoscopic efficacy of vedolizumab in ulcerative colitis: The DETECT study. PLoS One 2024; 19:e0298313. [PMID: 38564601 PMCID: PMC10986992 DOI: 10.1371/journal.pone.0298313] [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] [Received: 02/09/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS In patients with ulcerative colitis (UC), no biomarker is available to help the physician to choose the most suitable biotherapy. The primary objective of this pilot study was to assess the feasibility of identification of α4β7- and TNF-expressing cells, to predict the response to vedolizumab using confocal laser endoscopy (CLE). METHODS Patients with moderate-to-severe UC, naïve of biotherapy, received vedolizumab. Clinical evaluation was performed at each infusion. Endoscopic evaluation was performed before inclusion and at week 22. Fresh colonic biopsies were stained using FITC-labelled vedolizumab and Alexa fluor-labelled adalimumab and ex vivo dual-band CLE images were acquired. Blood samples were collected to measure trough concentrations of vedolizumab and to determine absolute counts of T and B cells subpopulations, NK cells and monocytes. RESULTS Nineteen patients were enrolled in the study and received at least one dose of vedolizumab. Clinical remission and endoscopic improvement were observed in 58% of whom 5 patients (45%) had an endoscopic subscore of 0. In terms of clinical response and remission, endoscopic improvement and histologic response, FITC-conjugated vedolizumab staining tended to be higher in responder patients compared to non-responders at week 22. A threshold value of 6 positive FITC-vedolizumab staining areas detected by CLE seemed informative to discriminate the responders and non-responders. The results were similar in terms of clinical remission and endoscopic improvement with a sensitivity of 78% and a specificity of 85% (p = 0.05). Trough concentrations and blood immune cells were not associated with responses to vedolizumab. CONCLUSION This pilot study demonstrate that dual-band CLE is feasible to detect α4β7- and TNF-expressing cells. Positive α4β7 staining seems to be associated with clinical and endoscopic remission in UC patients treated by anti-α4β7-integrin, subject to validation by larger-scale studies. Clinical-trial.gov: NCT02878083.
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Affiliation(s)
- Lucille Quénéhervé
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Caroline Trang-Poisson
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Aurélie Fantou
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Mathurin Flamant
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Tony Durand
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Guillaume Bouguen
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Jérémy Bregeon
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Thibauld Oullier
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Morgane Amil
- CHD La Roche-Sur-Yon, Hepato-gastroentérologie, La Roche-Sur-Yon, France
| | - Marie Dewitte
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Stéphanie Bardot
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Stéphanie Blandin
- Nantes Université, UMS BioCore, Inserm US16—UAR CNRS 3556, Nantes, France
| | - Cécile Braudeau
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Marie-Anne Vibet
- CHU Nantes, Methodology and Biostatistics Department, Direction de la Recherche Clinique et de l’Innovation, Nantes, France
| | - Régis Josien
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Michel Neunlist
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Arnaud Bourreille
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
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Osmola M, Chapelle N, Vibet MA, Bigot-Corbel E, Masson D, Hemont C, Jirka A, Blin J, Tougeron D, Moussata D, Lamarque D, Josien R, Mosnier JF, Martin J, Matysiak-Budnik T. Iron and Vitamin B12 Deficiency in Patients with Autoimmune Gastritis and Helicobacter pylori Gastritis: Results from a Prospective Multicenter Study. Dig Dis 2024; 42:145-153. [PMID: 38198775 DOI: 10.1159/000535206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Iron and vitamin B12 deficiencies are common in patients with atrophic gastritis, but there are limited data on the prevalence of these deficiencies in different types of atrophic gastritis. METHODS This multicenter, prospective study assessed micronutrient concentrations in histologically confirmed autoimmune gastritis (AIG, n = 45), Helicobacter pylori-related non-autoimmune gastritis (NAIG, n = 109), and control patients (n = 201). A multivariate analysis was performed to determine factors influencing those deficiencies. RESULTS The median vitamin B12 concentration was significantly lower in AIG (367.5 pg/mL, Q1, Q3: 235.5, 524.5) than in NAIG (445.0 pg/mL, Q1, Q3: 355.0, 565.0, p = 0.001) and control patients (391.0 pg/mL, Q1, Q3: 323.5, 488.7, p = 0.001). Vitamin B12 deficiency was found in 13.3%, 1.5%, and 2.8% of AIG, NAIG, and control patients, respectively. Similarly, the median ferritin concentration was significantly lower in AIG (39.5 ng/mL, Q1, Q3: 15.4, 98.3 ng/mL) than in NAIG (80.5 ng/mL, Q1, Q3: 43.6, 133.9, p = 0.04) and control patients (66.5 ng/mL, Q1, Q3: 33.4, 119.8, p = 0.007). Iron deficiency and iron deficiency adjusted to CRP were present in 28.9% and 33.3% of AIG, 12.8% and 16.5% of NAIG, and 12.9% and 18.4% of controls, respectively. Multivariate analysis demonstrated that AIG patients had a higher risk of developing vitamin B12 deficiency (OR: 11.52 [2.85-57.64, p = 0.001]) and iron deficiency (OR: 2.92 [1.32-6.30, p = 0.007]) compared to control patients. Factors like age, sex, and H. pylori status did not affect the occurrence of vitamin B12 or iron deficiency. CONCLUSION Iron and vitamin B12 deficiencies are more commonly observed in patients with AIG than in those with NAIG or control patients. Therefore, it is essential to screen for both iron and vitamin B12 deficiencies in AIG patients and include the treatment of micronutrient deficiencies in the management of atrophic gastritis patients.
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Affiliation(s)
- Malgorzata Osmola
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland,
| | - Nicolas Chapelle
- IMAD, Hepato-Gastroenterology and Digestive Oncology, Hôtel Dieu, University Hospital of Nantes, Nantes, France
- INSERM U1064 CRTI, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
| | | | - Edith Bigot-Corbel
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Biochemistry, University Hospital of Nantes, Nantes, France
| | - Damien Masson
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Biochemistry, University Hospital of Nantes, Nantes, France
| | - Caroline Hemont
- Department of Immunology, University Hospital of Nantes, Nantes, France
| | - Adam Jirka
- IMAD, Hepato-Gastroenterology and Digestive Oncology, Hôtel Dieu, University Hospital of Nantes, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
| | - Justine Blin
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Biochemistry, University Hospital of Nantes, Nantes, France
- INSERM U1235 TENS, Nantes, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Driffa Moussata
- Department of Hepato-Gastroenterology, University Hospital of Tours, Tours, France
| | - Dominique Lamarque
- Department of Hepato-Gastroenterology, Ambroise-Paré Hospital, AP-HP, Paris Saclay University, UVSQ, INSERM, Infection Inflammation, Paris, France
| | - Regis Josien
- INSERM U1064 CRTI, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Immunology, University Hospital of Nantes, Nantes, France
| | - Jean-François Mosnier
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Pathology, University Hospital of Nantes, Nantes, France
| | - Jérôme Martin
- INSERM U1064 CRTI, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Immunology, University Hospital of Nantes, Nantes, France
| | - Tamara Matysiak-Budnik
- IMAD, Hepato-Gastroenterology and Digestive Oncology, Hôtel Dieu, University Hospital of Nantes, Nantes, France
- INSERM U1064 CRTI, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
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Gaborit B, Vanhove B, Lacombe K, Guimard T, Hocqueloux L, Perrier L, Dubee V, Ferre V, Bressollette C, Josien R, Thuaut AL, Vibet MA, Jobert A, Dailly E, Ader F, Brouard S, Duvaux O, Raffi F. Effect of Swine Glyco-humanized Polyclonal Neutralizing Antibody on Survival and Respiratory Failure in Patients Hospitalized With Severe COVID-19: A Randomized, Placebo-Controlled Trial. Open Forum Infect Dis 2023; 10:ofad525. [PMID: 37942459 PMCID: PMC10629360 DOI: 10.1093/ofid/ofad525] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
Background We evaluated the safety and efficacy of XAV-19, an antispike glyco-humanized swine polyclonal neutralizing antibody in patients hospitalized with severe coronavirus disease 2019 (COVID-19). Methods This phase 2b clinical trial enrolled adult patients from 34 hospitals in France. Eligible patients had a confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 within 14 days of onset of symptoms that required hospitalization for low-flow oxygen therapy (<6 L/min of oxygen). Patients were randomly assigned to receive a single intravenous infusion of 2 mg/kg of XAV-19 or placebo. The primary end point was the occurrence of death or severe respiratory failure between baseline and day 15. Results Between January 12, 2021, and April 16, 2021, 398 patients were enrolled in the study and randomly assigned to XAV-19 or placebo. The modified intention-to-treat population comprised 388 participants who received full perfusion of XAV-19 (199 patients) or placebo (189 patients). The mean (SD) age was 59.8 (12.4) years, 249 (64.2%) individuals were men, and the median time (interquartile range) from symptom onset to enrollment was 9 (7-10) days. There was no statistically significant decrease in the cumulative incidence of death or severe respiratory failure through day 15 in the XAV-19 group vs the placebo group (53/199 [26.6%] vs 48/189 [25.4%]; adjusted risk difference, 0.6%; 95% CI, -6% to 7%; hazard ratio, 1.03; 95% CI, 0.64-1.66; P = .90). In the safety population, adverse events were reported in 75.4% of 199 patients in the XAV-19 group and in 76.3% of 190 patients in the placebo group through D29. Conclusions Among patients hospitalized with COVID-19 requiring low-flow oxygen therapy, treatment with a single intravenous dose of XAV-19, compared with placebo, did not show a significant difference in terms of disease progression at day 15.
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Affiliation(s)
- Benjamin Gaborit
- Nantes Université, CHU Nantes, INSERM, Department of Infectious Diseases, Nantes, France
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | | | - Karine Lacombe
- INSERM, AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Thomas Guimard
- Infectious Diseases and Emergency Department, Centre Hospitalier de La Roche sur Yon, La Roche sur Yon, France
| | | | - Ludivine Perrier
- Nantes Université, CHU Nantes, Sponsor Department, Direction de la Recherche et de l’Innovation, Nantes, France
| | - Vincent Dubee
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
- Univ Angers, Nantes Université, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, Angers, France
| | - Virginie Ferre
- Nantes Université, CHU Nantes, Virology Laboratory, Nantes, France
| | | | - Régis Josien
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- Nantes Université, CHU Nantes, Laboratoire d’Immunologie, CIMNA, Nantes, France
| | - Aurélie Le Thuaut
- Nantes Université, CHU Nantes, Sponsor Department, Direction de la Recherche et de l’Innovation, Nantes, France
- Nantes Université, CHU Nantes, Plateforme de Méthodologie et Biostatistique, Direction de la Recherche et de l’Innovation, Nantes, France
| | - Marie-Anne Vibet
- Nantes Université, CHU Nantes, Sponsor Department, Direction de la Recherche et de l’Innovation, Nantes, France
- Nantes Université, CHU Nantes, Plateforme de Méthodologie et Biostatistique, Direction de la Recherche et de l’Innovation, Nantes, France
| | - Alexandra Jobert
- Nantes Université, CHU Nantes, Sponsor Department, Direction de la Recherche et de l’Innovation, Nantes, France
- Nantes Université, CHU Nantes, UMR 1246 MethodS in Patients-centered outcomes and HEalth Research,” SPHERE, Nantes, France
| | - Eric Dailly
- Nantes Université, CHU Nantes, Clinical Pharmacology Department, Nantes, France
| | - Florence Ader
- CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, Université Lyon, Lyon, France
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Sophie Brouard
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | | | - François Raffi
- Nantes Université, CHU Nantes, INSERM, Department of Infectious Diseases, Nantes, France
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Chapelle N, Martin J, Osmola M, Hémont C, Leroy M, Vibet MA, Tougeron D, Moussata D, Lamarque D, Bigot-Corbel E, Masson D, Blin J, Josien R, Mosnier JF, Matysiak-Budnik T. Serum pepsinogens can help to discriminate between H. pylori-induced and auto-immune atrophic gastritis: Results from a prospective multicenter study. Dig Liver Dis 2023; 55:1345-1351. [PMID: 37085439 DOI: 10.1016/j.dld.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/16/2023] [Accepted: 03/20/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Serum pepsinogen (PG) testing is recommended by the European guidelines for diagnosis of chronic atrophic gastritis (CAG). However, wide variations in diagnostic performances are observed, due to the differences in the extent of gastric atrophy, and possibly in its origin (Helicobacter pylori-, autoimmune (AIG)). AIM To analyze the diagnostic performances of PGs testing according to these different parameters, using enzyme-linked-immunosorbent serologic assay (ELISA) and chemiluminescent immunoassay (CLEIA). METHODS Serum samples from patients having undergone gastroscopy with biopsies in five French centers were collected prospectively. Sensitivity (Se), specificity (Sp), and Area Under Curve were analyzed according to the extent and origin of CAG. RESULTS Overall, 344 patients (156 males [45%]; mean age 58.8 [±14.2] years) were included, among whom 44 had AIG. Diagnostic performances of PG I for the detection of corpus CAG were excellent, with Se and Sp of 92.7% and 99.1% for ELISA and 90.5% and 98.2% for CLEIA, respectively. For AIG, corresponding values were 97.7% and 97.4% for ELISA, and 95.6% and 97.1% for CLEIA. In multivariate analysis, PG levels were associated with the auto-immune origin (p<0.001) but not with the extent of the atrophic gastritis. CONCLUSIONS Pepsinogens are highly efficient for the diagnosis of corpus-limited CAG and allow to discriminate AIG from H. pylori-induced gastritis.
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Affiliation(s)
- Nicolas Chapelle
- IMAD, Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Nantes, France; Université de Nantes, Inserm, CHU Nantes, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
| | - Jérôme Martin
- Université de Nantes, Inserm, CHU Nantes, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France; CHU Nantes, Laboratoire d'Immunologie, Center for Immuno Monitoring Nantes-Atlantique (CIMNA), F-44000 Nantes, France
| | - Malgorzata Osmola
- Department of Hematology, Transplantation and Internal Medicine, Medical University, Warsaw, Poland
| | - Caroline Hémont
- CHU Nantes, Laboratoire d'Immunologie, Center for Immuno Monitoring Nantes-Atlantique (CIMNA), F-44000 Nantes, France
| | - Maxime Leroy
- Department of Biostatistics, CHU de Nantes, France
| | | | - David Tougeron
- Department of Hepato-Gastroenterology, Poitiers University Hospital and University of Poitiers, Poitiers, France
| | - Driffa Moussata
- Department of Hepato-Gastroenterology, University Hospital of Tours, France
| | - Dominique Lamarque
- Department of Hepato-Gastroenterology, Ambroise-Paré Hospital, AP-HP, Paris Saclay University, UVSQ, INSERM, Infection and Inflammation, Paris, France
| | - Edith Bigot-Corbel
- Department of Biochemistry, University Hospital of Nantes, Nantes, France
| | - Damien Masson
- Department of Biochemistry, University Hospital of Nantes, Nantes, France
| | - Justine Blin
- Department of Biochemistry, University Hospital of Nantes, Nantes, France
| | - Régis Josien
- Université de Nantes, Inserm, CHU Nantes, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France; CHU Nantes, Laboratoire d'Immunologie, Center for Immuno Monitoring Nantes-Atlantique (CIMNA), F-44000 Nantes, France
| | | | - Tamara Matysiak-Budnik
- IMAD, Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Nantes, France; Université de Nantes, Inserm, CHU Nantes, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France.
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Bonnelye J, Lancien U, Poinas A, Vibet MA, Dreno B. Long-term benefits of a therapeutic make-up consultation for patients with various facial dermatoses. Eur J Dermatol 2023; 33:419-425. [PMID: 37823493 DOI: 10.1684/ejd.2023.4534] [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] [Indexed: 10/13/2023]
Abstract
BACKGROUND Therapeutic make-up has previously been proven to be efficacious in improving the quality of life of patients with facial dermatoses, but its efficacy has only been assessed in the short term (less than one month). OBJECTIVES This study aimed to determine whether the effect of therapeutic make-up on patients' quality of life persists in the longer term, i.e., after one year. MATERIALS & METHODS This study included 53 patients who benefited from a therapeutic make-up consultation in the context of various facial dermatoses (pigmentation disorders, scars, acne, rosacea, eczema, adverse events of chemotherapy, etc.). Patients were asked to complete a quality-of-life questionnaire to obtain the Skindex score at baseline, and one month (M1) and one year (M12) after the first consultation. The difference in scores between baseline and M12 was calculated and Student's t-test was used to assess the significance of the values. RESULTS Our results showed a significant difference (p<0.001) with an improvement in quality-of-life score by more than 10% between baseline and M12, for all the dimensions of the score (Emotion, Symptoms and Functioning). Based on the subgroup analysis, this score particularly improved for patients suffering with acne or rosacea (p=0.009) and scars (p=0.43), as well as for younger patients (<30 years old) (p=0.009). CONCLUSION This is the first study to demonstrate a persistent long-term effect of therapeutic make-up on the quality of life of patients with facial dermatoses.
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Affiliation(s)
- Julia Bonnelye
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, F-44000 Nantes, France
| | - Ugo Lancien
- Plastic, Reconstructive, and Aesthetic Surgery Unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France
| | - Alexandra Poinas
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, F-44000 Nantes, France
| | - Marie-Anne Vibet
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, F-44000 Nantes, France
| | - Brigitte Dreno
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, F-44000 Nantes, France
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Osmola M, Hemont C, Chapelle N, Vibet MA, Tougeron D, Moussata D, Lamarque D, Bigot-Corbel E, Masson D, Blin J, Leroy M, Josien R, Mosnier JF, Martin J, Matysiak-Budnik T. Atrophic Gastritis and Autoimmunity: Results from a Prospective, Multicenter Study. Diagnostics (Basel) 2023; 13:diagnostics13091599. [PMID: 37174990 PMCID: PMC10178247 DOI: 10.3390/diagnostics13091599] [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: 02/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Despite a global decrease, gastric cancer (GC) incidence appears to be increasing recently in young, particularly female, patients. The causal mechanism for this "new" type of GC is unknown, but a role for autoimmunity is suggested. A cascade of gastric precancerous lesions, beginning with chronic atrophic gastritis (CAG), precedes GC. To test the possible existence of autoimmunity in patients with CAG, we aimed to analyze the prevalence of several autoantibodies in patients with CAG as compared to control patients. Sera of 355 patients included in our previous prospective, multicenter study were tested for 19 autoantibodies (anti-nuclear antibodies, ANA, anti-parietal cell antibody, APCA, anti-intrinsic factor antibody, AIFA, and 16 myositis-associated antibodies). The results were compared between CAG patients (n = 154), including autoimmune gastritis patients (AIG, n = 45), non-autoimmune gastritis patients (NAIG, n = 109), and control patients (n = 201). ANA positivity was significantly higher in AIG than in NAIG or control patients (46.7%, 29%, and 27%, respectively, p = 0.04). Female gender was positively associated with ANA positivity (OR 0.51 (0.31-0.81), p = 0.005), while age and H. pylori infection status were not. Myositis-associated antibodies were found in 8.9% of AIG, 5.5% of NAIG, and 4.4% of control patients, without significant differences among the groups (p = 0.8). Higher APCA and AIFA positivity was confirmed in AIG, and was not associated with H. pylori infection, age, or gender in the multivariate analysis. ANA antibodies are significantly more prevalent in AIG than in control patients, but the clinical significance of this finding remains to be established. H. pylori infection does not affect autoantibody seropositivity (ANA, APCA, AIFA). The positivity of myositis-associated antibodies is not increased in patients with CAG as compared to control patients. Overall, our results do not support an overrepresentation of common autoantibodies in patients with CAG.
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Affiliation(s)
- Malgorzata Osmola
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Caroline Hemont
- Department of Immunology, University Hospital of Nantes, 44093 Nantes, France
| | - Nicolas Chapelle
- Institut des Maladies de l'Appareil Digestif (IMAD), Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Hôtel Dieu, Place Alexis Ricordeau, CEDEX 1, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
| | - Marie-Anne Vibet
- Department of Biostatistics, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, Poitiers University Hospital, University of Poitiers, 86000 Poitiers, France
| | - Driffa Moussata
- Department of Hepato-Gastroenterology, University Hospital of Tours, 37044 Tours, France
| | - Dominique Lamarque
- Department of Hepato-Gastroenterology, Ambroise-Paré Hospital, AP-HP, Paris Saclay University, University of Versailles Saint-Quentin-en-Yvelines, Institut National de la Santé et de la Recherche Médicale (INSERM), Infection and Inflammation, 91190 Paris, France
| | - Edith Bigot-Corbel
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Biochemistry, University Hospital of Nantes, 44093 Nantes, France
| | - Damien Masson
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Biochemistry, University Hospital of Nantes, 44093 Nantes, France
| | - Justine Blin
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Biochemistry, University Hospital of Nantes, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1235 the Enteric Nervous System in Gut and Brain Disorders (TENS), 44300 Nantes, France
| | - Maxime Leroy
- Department of Biostatistics, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - Regis Josien
- Department of Immunology, University Hospital of Nantes, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
| | - Jean-François Mosnier
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
- Department of Pathology, University Hospital of Nantes, 44093 Nantes, France
| | - Jérôme Martin
- Department of Immunology, University Hospital of Nantes, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
| | - Tamara Matysiak-Budnik
- Institut des Maladies de l'Appareil Digestif (IMAD), Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Hôtel Dieu, Place Alexis Ricordeau, CEDEX 1, 44093 Nantes, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1064 Centre de Recherche Translationnelle en Transplantation et Immunologie (CR2TI), 44093 Nantes, France
- Faculty of Medicine, University of Nantes, 44300 Nantes, France
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Masson L, Barbé L, Henaff F, Ahmed T, Le Moullac-Vaidye B, Peltier C, Marchand SS, Scherdel P, Vibet MA, Ruvoën-Clouet N, Elenga N, Imbert-Marcille BM, Gras-Le Guen C, Le Pendu J. Extent of the protection afforded by histo-blood group polymorphism against rotavirus gastroenteritis in metropolitan France and French Guiana. Front Microbiol 2023; 14:1141652. [PMID: 36970669 PMCID: PMC10036354 DOI: 10.3389/fmicb.2023.1141652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
Human rotaviruses attach to histo-blood group antigens glycans and null alleles of the ABO, FUT2 and FUT3 genes seem to confer diminished risk of gastroenteritis. Yet, the true extent of this protection remains poorly quantified. Here, we conducted a prospective study to evaluate the risk of consulting at the hospital in non-vaccinated pediatric patients according to the ABO, FUT2 (secretor) and FUT3 (Lewis) polymorphisms, in Metropolitan France and French Guiana. At both locations, P genotypes were largely dominated by P [8]-3, with P [6] cases exclusively found in French Guiana. The FUT2 null (nonsecretor) and FUT3 null (Lewis negative) phenotypes conferred near full protection against severe gastroenteritis due to P [8]-3 strains (OR 0.03, 95% CI [0.00–0.21] and 0.1, 95% CI [0.01–0.43], respectively in Metropolitan France; OR 0.08, 95% CI [0.01–0.52] and 0.14, 95%CI [0.01–0.99], respectively in French Guiana). Blood group O also appeared protective in Metropolitan France (OR 0.38, 95% CI [0.23–0.62]), but not in French Guiana. The discrepancy between the two locations was explained by a recruitment at the hospital of less severe cases in French Guiana than in Metropolitan France. Considering the frequencies of the null ABO, Secretor and Lewis phenotypes, the data indicate that in a Western European population, 34% (95% CI [29%; 39%]) of infants are genetically protected against rotavirus gastroenteritis of sufficient severity to lead to hospital visit.
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Affiliation(s)
- Lydie Masson
- Department of Pediatrics, University Hospital of Nantes, Nantes, France
| | - Laure Barbé
- Nantes Université, Inserm, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, Nantes, France
| | - Fanny Henaff
- Department of Pediatrics, Centre Hospitalier Andrée Rosemon, Cayenne, France
| | - Tasnuva Ahmed
- Nantes Université, Inserm, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, Nantes, France
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | - Cécile Peltier
- Center for Research in Transplantation and Translational Immunology, Inserm, Nantes Université, Nantes, France
| | - Sarah S Marchand
- Virology Department, University Hospital of Nantes, Nantes, France
| | - Pauline Scherdel
- Clinical Investigation Center (CIC004), Inserm, University Hospital of Nantes, Nantes, France
| | - Marie-Anne Vibet
- Clinical Research Department, University Hospital of Nantes, Nantes, France
| | - Nathalie Ruvoën-Clouet
- Nantes Université, Inserm, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, Nantes, France
- Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation, Oniris, Nantes, France
| | - Narcisse Elenga
- Department of Pediatrics, Centre Hospitalier Andrée Rosemon, Cayenne, France
| | - Berthe-Marie Imbert-Marcille
- Center for Research in Transplantation and Translational Immunology, Inserm, Nantes Université, Nantes, France
- Virology Department, University Hospital of Nantes, Nantes, France
| | | | - Jacques Le Pendu
- Nantes Université, Inserm, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, Nantes, France
- *Correspondence: Jacques Le Pendu,
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8
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Poupon C, Poirier M, Blum Y, Lagarrigue S, Parléani C, Vibet MA, Winer N. Difference in Pap test uptake between women who have sex with women and other women in France: A comparative survey of 2032 women. Prev Med Rep 2022; 30:101990. [PMID: 36193090 PMCID: PMC9525892 DOI: 10.1016/j.pmedr.2022.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 10/26/2022] Open
Abstract
The elimination of cervical cancer has been a priority of the World Health Organization since 2018. The number of these cancers induced by the human papillomavirus (HPV) could be drastically reduced through vaccination and regularly screening by Pap tests. Guidelines for cervical cancer screening apply to all women, including those who have sexual relations with women (WSW), as HPV can be transmitted during sex between two women. As far as we know, our study is the first that compare the Pap test rate between WSW and other women in France. We developed an 18-item questionnaire available on the internet for 15 days and finally analyzed the responses of 2032 women. Based on their responses about their self-definition of their sexual orientation and their sexual behavior, we classified them into three groups of women: exclusive WSW, mixed WSW, and non-WSW. For each question, we tested the statistical differences in responses between these three groups. Our study shows in a large sample representative of the French population that exclusive WSW undergo Pap tests significantly less often than either mixed WSW or non-WSW. Among the exclusive WSW, 28.9 % had never had a Pap test, compared with 9 % of the mixed WSW and 3.1 % of non-WSW (p < 0,001). The responses to our questionnaire contribute to an understanding of this disparity and thus help to envision solutions for better care of all women, regardless of their sexual orientation; this point is crucial for prevention of cervical cancer.
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Affiliation(s)
- Camille Poupon
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Maud Poirier
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Yuna Blum
- Univ Rennes, CNRS, INSERM, IGDR (Institut de Génétique et Développement de Rennes) - UMR6290, ERL U1305, 35000 Rennes, France
| | | | - Cécile Parléani
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Marie-Anne Vibet
- Methodology and Biostatistics Platform, Direction of Research and Innovation, University Hospital of Nantes, France
| | - Norbert Winer
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS).,Department of Gynaecology and Obstetrics, University Hospital of Nantes, NUN INRAE PhAN, UMR 1280, F-44000, France
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9
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Espitia O, Robin O, Hersant J, Roncato C, Théry A, Vibet MA, Gautier G, Raimbeau A, Lapébie FX. Inter and intra-observer agreement of arterial wall contrast-enhanced ultrasonography in giant cell arteritis. Front Med (Lausanne) 2022; 9:1042366. [DOI: 10.3389/fmed.2022.1042366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
ObjectiveThe aim of this study was to analyze inter- and intra-observer agreement for contrast-enhanced ultrasonography (CEUS) for monitoring disease activity in Giant Cell Arteritis (GCA) in the wall of axillary arteries, and common carotid arteries.MethodsGiant cell arteritis patients have CEUS of axillary arteries and common carotid. These images were rated by seven vascular medicine physicians from four hospitals who were experienced in duplex ultrasonography of GCA patients. Two weeks later, observers again rated the same images. GCA patients were recruited in from December 2019 to February 2021. An analysis of the contrast of the ultrasound images with a gradation in three classes (grade 0, 1, and 2) was performed. Grade 0 corresponds to no contrast, grade 1 to moderate wall contrast and grade 2 to intense contrast. A new analysis in 2 classes: positive or negative wall contrast; was then performed on new series of images.ResultsSixty arterial segments were evaluated in 30 patients. For the three-class scale, intra-rater agreement was substantial: κ 0.70; inter-rater agreement was fair: κ from 0.22 to 0.27. Thirty-four videos had a wall thickness of less than 2 mm and 26 videos had a wall thickness greater than 2 mm. For walls with a thickness lower than 2 mm: intra-rater agreement was substantial: κ 0.69; inter-rater agreement was fair: κ 0.35. For walls with a thickness of 2 mm or more: intra-rater agreement was substantial: κ 0.53; inter-rater agreement was fair: κ 0.25. For analysis of parietal contrast uptake in two classes: inter-rater agreement was fair to moderate: κ from 0.35 to 0.41; and for walls with a thickness of 2 mm or more: inter-rater agreement was fair to substantial κ from 0.22 to 0.63.ConclusionThe visual analysis of contrast uptake in the wall of the axillary and common carotid arteries showed good intra-rater agreement in GCA patients. The inter-rater agreement was low, especially when contrast was analyzed in three classes. The inter-rater agreement for the analysis in two classes was also low. The inter-rater agreement was higher in two-class analysis for walls of 2 mm thickness or more.
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10
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Guillotin F, Poulain C, Gaborit B, Bouras M, Cinotti R, Lakhal K, Vourc’h M, Rozec B, Asehnoune K, Vibet MA, Riche VP, Gibaud SA, Crémet L, Roquilly A. Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study. Front Cell Infect Microbiol 2022; 12:804611. [PMID: 35493730 PMCID: PMC9043525 DOI: 10.3389/fcimb.2022.804611] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/14/2022] [Indexed: 01/23/2023] Open
Abstract
ObjectivesTo investigate the potential impact of the syndromic multiplex FilmArray® Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP).MethodsRespiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio.ResultsThe predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p<0.0001) and 2 [2-3.25] days in the recommendations-based simulation (p<0.0001). Treatment failure was predicted in 3% of cases with FAPP results versus observed in 11% in real-life (p=0.08) and 6% with recommendations-based simulation (p=0.37). The incremental cost-effectiveness ratio was 1 121 € [-7021; 6794] to avoid one day of non-optimized antimicrobial therapy.ConclusionsOur results suggest that using FAPP in patients with VHAP has the potential to reduce the use of broad-spectrum antimicrobial therapy without increasing the risk of microbial treatment failure.
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Affiliation(s)
- Florian Guillotin
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- *Correspondence: Florian Guillotin, ; Antoine Roquilly,
| | - Cécile Poulain
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Benjamin Gaborit
- Service de Maladies Infectieuses et Tropicales et CIC 1413, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Raphaël Cinotti
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Karim Lakhal
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Mickael Vourc’h
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Service d’ Anesthésie-Réanimation, Hôpital Nord Laënnec, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
| | - Marie-Anne Vibet
- Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Valéry-Pierre Riche
- Cellule Innovation - Département Partenariat et Innovation - Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Sophie-Anne Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU de Nantes, Nantes, France
| | - Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU de Nantes, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Anesthesie Réanimation, INSERM, Center for Research in Transplantation and Translational Immunology, Nantes, France
- *Correspondence: Florian Guillotin, ; Antoine Roquilly,
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11
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Gaborit B, Vanhove B, Vibet MA, Le Thuaut A, Lacombe K, Dubee V, Ader F, Ferre V, Vicaut E, Orain J, Le Bras M, Omnes A, Berly L, Jobert A, Morineau-Le Houssine P, Botturi K, Josien R, Flet L, Degauque N, Brouard S, Duvaux O, Poinas A, Raffi F. Evaluation of the safety and efficacy of XAV-19 in patients with COVID-19-induced moderate pneumonia: study protocol for a randomized, double-blinded, placebo-controlled phase 2 (2a and 2b) trial. Trials 2021; 22:199. [PMID: 33750432 PMCID: PMC7942514 DOI: 10.1186/s13063-021-05132-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Early inhibition of entry and replication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a very promising therapeutic approach. Polyclonal neutralizing antibodies offers many advantages such as providing immediate immunity, consequently blunting an early pro-inflammatory pathogenic endogenous antibody response and lack of drug-drug interactions. By providing immediate immunity and inhibiting entry into cells, neutralizing antibody treatment is of interest for patient with COVID-19-induced moderate pneumonia. Convalescent plasma to treat infected patients is therefore a relevant therapeutic option currently under assessment (CORIMUNO-PLASM NCT04324047). However, the difficulties of collecting plasma on the long term are not adapted to a broad use across all populations. New polyclonal humanized anti-SARS-CoV2 antibodies (XAV-19) developed by Xenothera and administered intravenous. XAV-19 is a heterologous swine glyco-humanized polyclonal antibody (GH-pAb) raised against the spike protein of SARS-CoV-2, blocking infection of ACE-2-positive human cells with SARS-CoV-2. METHODS Pharmacokinetic and pharmacodynamic studies have been performed in preclinical models including primates. A first human study with another fully representative GH-pAb from Xenothera is ongoing in recipients of a kidney graft. These studies indicated that 5 consecutive administrations of GH-pAbs can be safely performed in humans. The objectives of this 2-step phase 2 randomized double-blinded, placebo-controlled study are to define the safety and the optimal XAV-19 dose to administrate to patients with SARS-CoV-2 induced moderate pneumonia, and to assess the clinical benefits of a selected dose of XAV-19 in this population. DISCUSSION This study will determine the clinical benefits of XAV-19 when administered to patients with SARS-CoV-2-induced moderate pneumonia. As a prerequisite, a first step of the study will define the safety and the dose of XAV-19 to be used. Such treatment might become a new therapeutic option to provide an effective treatment for COVID-19 patients (possibly in combination with anti-viral and immunotherapies). Further studies could later evaluate such passive immunotherapy as a potential post-exposure prophylaxis. TRIAL REGISTRATION ClinicalTrials.gov NCT04453384 , registered on 1 July 2020, and EUDRACT 2020-002574-27, registered 6 June 2020.
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Affiliation(s)
- Benjamin Gaborit
- CHU Nantes, Department of Infectious Disease, Clinical Investigation, Nantes, France
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
| | | | | | | | - Karine Lacombe
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Vincent Dubee
- CHU Angers, Service de Maladies Infectieuses et Tropicales, Angers, France
| | - Florence Ader
- Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, F-69007 Lyon, France
- Département des Maladies infectieuses et tropicales, Hospices Civils de Lyon, F-69004 Lyon, France
| | - Virginie Ferre
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
- CHU Nantes, Virology Laboratory, Nantes, France
| | - Eric Vicaut
- APHP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, Paris, France
| | - Jéremie Orain
- CHU Nantes, Department of Infectious Disease, Clinical Investigation, Nantes, France
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
| | - Morgane Le Bras
- CHU Nantes, Department of Infectious Disease, Clinical Investigation, Nantes, France
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
| | - Anne Omnes
- CHU Nantes, Sponsor Department, Nantes, France
| | | | | | - Pascale Morineau-Le Houssine
- CHU Nantes, Department of Infectious Disease, Clinical Investigation, Nantes, France
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
| | - Karine Botturi
- CHU Nantes, Partnership and Innovation Department, Nantes, France
| | - Régis Josien
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
- CHU Nantes, Laboratoire d’Immunologie, Nantes, France
| | | | - Nicolas Degauque
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France
| | - Sophie Brouard
- Nantes Université, CHU Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
- CHU Nantes, Nantes Université, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France
| | | | - Alexandra Poinas
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
| | - François Raffi
- CHU Nantes, Department of Infectious Disease, Clinical Investigation, Nantes, France
- CHU Nantes and Inserm, Clinical Investigation Centre CIC1413, Nantes, France
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12
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Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sébille V, Leone M. Implementation of French recommendations for the prevention and the treatment of hospital-acquired pneumonia: a cluster-randomized trial. Clin Infect Dis 2020; 73:e1601-e1610. [PMID: 32970811 DOI: 10.1093/cid/ciaa1441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) for can improve the outcomes of patients in intensive care units (ICUs). METHODS This study was conducted at 35 ICUs in 30 hospitals. We included consecutive adult patients hospitalized in ICUs for three days or more. After a three-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a three-month cluster-randomized trial. We randomly assigned ICUs to either audit and feedback (intervention group) or participation to a national registry (control group). The primary outcome was the duration of ICU stay. RESULTS Among 1,856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measure of compliance was 47(38-56)% in the intervention group and 42(25-53)% in the control group (p=0.001). As compared to the baseline period, the ICU length of stay was reduced by 3.2 days in the intervention group (p=0.07) and by 2.8 days in the control group (p=0.02). The duration of ICU stay was 7 (5-14) in the control group and 9 (5-20) days in the intervention group (p=0.10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from ICU in the control group was 1.17 (95% CI, 0.69 to 2.01; p=0.10). CONCLUSIONS The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes.
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Affiliation(s)
- Antoine Roquilly
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Gérald Chanques
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Montpellier, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - Arnaud Foucrier
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Beaujon (AP/HP), Beaujon, France
| | - Brice Fermier
- Intensive Care Unit, Simone Veil Hospital, Blois, France
| | - Hugues De Courson
- Department of Neuro-Critical Care, Pellegrin Hospital, Bordeaux, France
| | - Cedric Carrie
- Surgical and trauma Intensive Care, Pellegrin Hospital, Bordeaux, France
| | - Marc Danguy des Deserts
- Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care, CHU Caen, Caen, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Kevin Lagarde
- Neuroréanimation-Anesthésie Neuroradiologie Interventionnelle, Hôpital Gabriel Montpied, CHU Clermont Ferrand, Clermont-Ferrand, France
| | | | - Sami Blidi
- Intensive Care Unit, Eaubonne Hospital, Eaubonne, France
| | - Achille Sossou
- Department of Anesthesiology and Critical Care, Emile Roux Hospital, Le Puy en Velay, France
| | | | - Celine Monard
- Department of Anesthesiology and Critical Care, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Adrien Oudotte
- Department of Neuro-Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Calypso Mathieu
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
| | - Jeremy Bourenne
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Emergency Intensive Care Unit, Hopital la Timone, Marseille, France
| | - Christian Isetta
- Department of Anesthesiology and Cardiothoracic Intensive Care, Pierre Zobda-Quitman, Martinique, France
| | | | - Karim Lakhal
- Department of Anesthesiology and Critical Care, Guillaume and Rene Laennec Hospital, CHU Nantes, Nantes, France
| | - Armine Rouhani
- Severe Burn Intensive Care Unit, Hotel Dieu, CHU Nantes, Nantes, France
| | - Karim Asehnoune
- Department of Anesthesiology and Critical Care, Hotel Dieu, CHU Nantes, Nantes, France.,Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France
| | - Philippe Guerci
- Surgical Intensive Care Unit, Centre Hospitalier Universitaire, Nancy, France
| | - Alexy Tran Dinh
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Bichat (AP/ HP), Paris, France
| | - Benjamin Chousterman
- Department of Anesthesiology and Critical Care, Severe Burn Unit, Centre Hospitalier Universitaire de Lariboisiere (AP/HP), Paris, France
| | - Alexandru Cupaciu
- Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire de Saint Louis (AP/ HP), Paris, France
| | | | - Remy Bellier
- Neuro-Intensive Care Unit, Centre Hospitalier Universitaire, Poitiers, France
| | - Jonathan Au Duong
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Rangueil Hospital, Centre Hospitalier Universitaire, Toulouse, France
| | - Alexandre Mansour
- Department of Anesthesiology and Critical Care, Pontchaillou Hospital, CHU Rennes, Rennes, France
| | - Jérome Morel
- Department of Anesthesiology and Critical Care, CHU Saint Etienne, Saint Etienne, France
| | - Ghilain Beauplet
- Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg, France
| | - Marie-Anne Vibet
- Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Université de Nantes, Nantes, France.,DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France
| | - Fanny Feuillet
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Véronique Sébille
- DRCI, Plateforme de Méthodologie et de Biostatistique, CHU Nantes, Nantes, France.,UMR INSERM U1246 - SPHERE "methodS in Patient-centered outcomes & HEalth ResEarch" Université de Nantes, Université de Tours, France
| | - Marc Leone
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Critical Care Medicine, Hôpital Nord, Marseille, France
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Crémet L, Gaborit B, Bouras M, Drumel T, Guillotin F, Poulain C, Persyn E, Lakhal K, Rozec B, Vibet MA, Roquilly A, Gibaud S. Evaluation of the FilmArray ® Pneumonia Plus Panel for Rapid Diagnosis of Hospital-Acquired Pneumonia in Intensive Care Unit Patients. Front Microbiol 2020; 11:2080. [PMID: 32983057 PMCID: PMC7477898 DOI: 10.3389/fmicb.2020.02080] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/07/2020] [Indexed: 12/19/2022] Open
Abstract
The FilmArray® Pneumonia plus Panel (FAPP) is a new multiplex molecular test for hospital-acquired pneumonia (HAP), which can rapidly detect 18 bacteria, 9 viruses, and 7 resistance genes. We aimed to compare the diagnosis performance of FAPP with conventional testing in 100 intensive care unit (ICU) patients who required mechanical ventilation, with clinically suspected HAP. A total of 237 samples [76 bronchoalveolar lavages (BALDS) and 82 endotracheal aspirates (ETADS) obtained at HAP diagnosis, and 79 ETA obtained during follow-up (ETATT)], were analyzed independently by routine microbiology testing and FAPP. 58 patients had paired BALDS and ETADS. The positivity thresholds of semi-quantified bacteria were 103–104 CFUs/mL or 104 copies/mL for BAL, and 105 CFUs/mL or copies/mL for ETA. Respiratory commensals (H. influenzae, S. aureus, E. coli, S. pneumoniae) were the most common pathogens. Discordant results for bacterial identification were observed in 33/76 (43.4%) BALDS and 36/82 (43.9%) ETADS, and in most cases, FAPP identified one supplemental bacteria (23/33 BALDS and 21/36 ETADS). An absence of growth, or polybacterial cultures, explained almost equally the majority of the non-detections in culture. No linear relationship was observed between bin and CFUs/mL variables. Concordant results between paired BALDS and ETADS were obtained in 46/58 (79.3%) patients with FAPP. One of the 17 resistance genes detected with FAPP (mecA/C and MREJ) was not confirmed by conventional testing. Overall, FAPP enhanced the positivity rate of diagnostic testing, with increased recognition of coinfections. Implementing this strategy may allow clinicians to make more timely and informed decisions.
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Affiliation(s)
- Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France.,Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France
| | - Benjamin Gaborit
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service de Maladies Infectieuses et Tropicales et CIC 1413, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Thomas Drumel
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Florian Guillotin
- Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Cécile Poulain
- Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Elise Persyn
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Karim Lakhal
- Service de Réanimation en Chirurgie Polyvalente, Pôle Anesthésie-Réanimation, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Service de Réanimation en Chirurgie Cardio-Thoracique et Vasculaire, Pôle Anesthésie-Réanimation, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Marie-Anne Vibet
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Antoine Roquilly
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Sophie Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
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14
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Leforestier A, Vibet MA, Gentet N, Javaudin F, Le Bastard Q, Montassier E, Batard E. Modeling the risk of fluoroquinolone resistance in non-severe community-onset pyelonephritis. Eur J Clin Microbiol Infect Dis 2020; 39:1123-1127. [DOI: 10.1007/s10096-020-03830-x] [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] [Received: 12/21/2019] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
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Quaegebeur A, Brunard L, Javaudin F, Vibet MA, Bemer P, Le Bastard Q, Batard E, Montassier E, Roman F, Llorens P, Salvi F, Galeazzi R, Ortega M, Marco F, Martinez Ortiz de Zarate M, Figueroa Ceron R, Trovato FM, Carpinteri G, Moustafa F, Romaszko JP, Pedersen M, Westh H, Dejaune P, Fihman V, Joost I, Blumel B, Parrilla Ruiz FM, Alvarez Corral G, Bieler D, Bergmann H, Granzer H, Carron PN, Prod’hom G, Greub G, Gonzalez Del Castillo JM, Candel Gonzalez FJ, Juvin ME, Occelli C, Ruimy R, Claret PG, Lavigne JP, Hausfater P, Robert J, Ramacciati N, Mencacci A, Tartaglia D, Rossi L, Ojetti V, Petruzziello C, Fiori B, Bonenfant J, Piau-Couape C, Dejoies L, Garcia-Garcia Á, Cores-Calvo O, Van Den Brand CL, van Veen SQ, Laribi S, Lartigue MF. Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study. J Antimicrob Chemother 2019; 74:3069-3076. [DOI: 10.1093/jac/dkz274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).
Methods
In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.
Results
We included 88242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).
Conclusions
Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.
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Affiliation(s)
- Alice Quaegebeur
- Lausanne University Hospital, Emergency Department, Lausanne, Switzerland
| | - Loïc Brunard
- CHU Nantes, Emergency Department, Nantes, France
| | - François Javaudin
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Marie-Anne Vibet
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
- CHU Nantes, DRCI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Pascale Bemer
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
- CHU Nantes, Bacteriology and Infection Control, Nantes, France
| | - Quentin Le Bastard
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Eric Batard
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
| | - Emmanuel Montassier
- CHU Nantes, Emergency Department, Nantes, France
- Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Nantes, France
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Cinotti R, Demeure-Dit-Latte D, Mahe PJ, Langlais P, Grillot N, Bouras M, Bourdiol A, Rooze P, Buffenoir K, Perrouin-Verbe B, Vibet MA, Asehnoune K, Roquilly A. Impact of a Quality Improvement Program on the Neurological Outcome of Patients with Traumatic Spinal Cord Injury: A Before-After Mono-Centric Study. J Neurotrauma 2019; 36:3338-3346. [PMID: 30907244 DOI: 10.1089/neu.2018.6298] [Citation(s) in RCA: 5] [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] [Indexed: 11/12/2022] Open
Abstract
Spinal cord injury (SCI) is a major cause of severe disability. This study aims to assess the effectiveness of a quality improvement program on neurological recovery after SCI. Before-after study during two phases was done in one intensive care unit in a university hospital. The quality improvement project comprised protective mechanical ventilation, early tracheostomy in anatomical injury above the sixth cervical vertebra, early enteral nutrition, early mobilization, and active perineal care in adult SCI patients. The primary endpoint was the difference between the American Spinal Injury Association (ASIA) motor score between discharge and intensive care unit (ICU) admission (Delta ASIA). Fifty-seven and 60 patients were included in the control and in the intervention period respectively. The ASIA motor score upon ICU admission was 16 (7-37) before and 11 (2-30) after the implementation (p = 0.30). The implementation phase was associated with lower tidal volumes (p < 0.001), higher positive end-expiratory pressure (p < 0.001), earlier tracheostomy (p = 0.01), earlier enteral nutrition initiation (p < 0.05), earlier mobilization (p < 0.05), and more active perineal care (p < 0.05). The Delta ASIA was +16 [4-32] after versus +6 [0-14] before the intervention (p < 0.05). After adjustment for potential cofounders, the intervention phase was significantly associated with higher Delta ASIA (β coefficient, 11.4; CI95 [1.9-21]; p = 0.01) in multi-variable analysis. No secular time trend unrelated to the intervention was highlighted. One year after trauma, the Delta ASIA was higher in the intervention period than in the control period (+34 [15-60] vs. +11 [0-33]; p < 0.05). After adjustment on potential confounders, an early in-ICU rehabilitation program in SCI patients was associated with higher neurological score upon ICU discharge.
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Affiliation(s)
- Raphaël Cinotti
- Anesthesia and Critical Care Department, Hôpital Laennec, CHU Nantes, Nantes, France
| | | | - Pierre Joachim Mahe
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Paul Langlais
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Nicolas Grillot
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Alexandre Bourdiol
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Paul Rooze
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Kévin Buffenoir
- Department of Neurotraumatology, Hôtel Dieu, CHU Nantes, Nantes, France
| | - Brigitte Perrouin-Verbe
- Physical Medicine and Rehabilitation Department, Hôpital Saint-Jacques, CHU Nantes, Nantes, France
| | - Marie-Anne Vibet
- Laboratory of Mathematics Jean Leray, University of Nantes, Nantes, France
| | - Karim Asehnoune
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France.,Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections," CHU Nantes, Nantes, France
| | - Antoine Roquilly
- Anesthesia and Critical Care Department, Hôtel Dieu, CHU Nantes, Nantes, France.,Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections," CHU Nantes, Nantes, France
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Cheysson F, Vibet MA, Guillemot D, Watier L. Estimation of exposure-attributable fractions from time series: A simulation study. Stat Med 2018; 37:3437-3454. [PMID: 29938833 DOI: 10.1002/sim.7818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 11/06/2022]
Abstract
Burden analysis in public health often involves the estimation of exposure-attributable fractions from observed time series. When the entire population is exposed, the association between the exposure and outcome must be carefully modelled before the attributable fractions can be estimated. This article derives asymptotic convergences for the estimation of attributable fractions for commonly used time series models (ARMAX, Poisson, negative binomial, and Serfling), using for the most part the delta method. For the Poisson regression, the estimation of the attributable fraction is achieved by a Monte Carlo algorithm, taking into account both an estimation and a prediction error. A simulation study compares these estimations in the case of an epidemic exposure and highlights the importance of thorough analysis of the data: When the outcome is generated under an additive model, the additive models are satisfactory, and the multiplicative models are poor, and vice versa. However, the Serfling model performs poorly in all cases. Of note, a misspecification in the form or delay of the association between the exposure and the outcome leads to mediocre estimation of the attributable fraction. An application to the fraction of French outpatient antibiotic use attributable to influenza between 2003 and 2010 illustrates the asymptotic convergences. This study suggests that the Serfling model should be avoided when estimating attributable fractions while the model of choice should be selected after careful investigation of the association between the exposure and outcome.
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Affiliation(s)
- Felix Cheysson
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Marie-Anne Vibet
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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Marquet A, Vibet MA, Caillon J, Javaudin F, Chapelet G, Montassier E, Batard E. Is There an Association Between Use of Amoxicillin-Clavulanate and Resistance to Third-Generation Cephalosporins in Klebsiella pneumoniae and Escherichia coli at the Hospital Level? Microb Drug Resist 2018; 24:987-994. [PMID: 29489447 DOI: 10.1089/mdr.2017.0360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Amoxicillin-clavulanate is extensively used in European hospitals. Whether the hospital use of amoxicillin-clavulanate is associated with nonsusceptibility to third-generation cephalosporins (3GC) in Klebsiella pneumoniae is unknown. Our aim was to assess the relationship between the hospital use of amoxicillin-clavulanate and 3GC nonsusceptibility in K. pneumoniae and Escherichia coli. METHODS Yearly data of antibiotic use and 3GC nonsusceptibility in K. pneumoniae and E. coli were obtained from 33 French hospitals between 2011 and 2016. Decreased susceptibility to 3GC and Extended-Spectrum Beta-Lactamase (ESBL) production were modelled from antibiotic use with linear mixed models on years 2011 to 2015, and validated on year 2016. RESULTS Nonsusceptibility to 3GC increased in K. pneumoniae and E. coli. In a multivariable model that included year and use of 3GC and fluoroquinolones as explanatory variables, amoxicillin-clavulanate use was protective against 3GC nonsusceptibility in K. pneumoniae (incidence rate ratio [IRR], 0.992 [0.988-0.997]), and with ESBL production in K. pneumoniae (IRR, 0.989 [0.985-0.992]). The correlation coefficient between observed and predicted numbers of 3GC-nonsusceptible K. pneumoniae in 2016 was 0.95 (95% confidence interval, 0.89-0.98). There was no significant association between amoxicillin-clavulanate use and 3GC nonsusceptibility in E. coli. CONCLUSION Amoxicillin-clavulanate hospital use was protective against nonsusceptibility to 3GC in K. pneumoniae. Conversely, it was not associated with susceptibility to 3GC in E. coli. To decrease the hospital use of 3GC and fluoroquinolones, and 3GC nonsusceptibility in K. pneumoniae, it may be acceptable to increase the hospital use of amoxicillin-clavulanate. Interventional studies are necessary to confirm this hypothesis.
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Affiliation(s)
| | - Marie-Anne Vibet
- 2 Laboratoire de Mathématiques Jean Leray, Université de Nantes , Nantes, France
| | - Jocelyne Caillon
- 1 OMEDIT des Pays de la Loire , Nantes, France .,3 Bacteriology and Infection Control, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - François Javaudin
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - Guillaume Chapelet
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France
| | - Emmanuel Montassier
- 4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
| | - Eric Batard
- 1 OMEDIT des Pays de la Loire , Nantes, France .,4 Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR) Lab, Institut de Recherche en Santé 2 , Université de Nantes, Nantes, France .,5 Emergency Department, Centre Hospitalier Universitaire de Nantes , Nantes, France
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de Cellès MD, Pons-Salort M, Varon E, Vibet MA, Ligier C, Letort V, Opatowski L, Guillemot D. Interaction of Vaccination and Reduction of Antibiotic Use Drives Unexpected Increase of Pneumococcal Meningitis. Sci Rep 2015; 5:11293. [PMID: 26063589 PMCID: PMC4462765 DOI: 10.1038/srep11293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/11/2015] [Indexed: 01/18/2023] Open
Abstract
Antibiotic-use policies may affect pneumococcal conjugate-vaccine effectiveness. The reported increase of pneumococcal meningitis from 2001 to 2009 in France, where a national campaign to reduce antibiotic use was implemented in parallel to the introduction of the 7-valent conjugate vaccine, provides unique data to assess these effects. We constructed a mechanistic pneumococcal transmission model and used likelihood to assess the ability of competing hypotheses to explain that increase. We find that a model integrating a fitness cost of penicillin resistance successfully explains the overall and age-stratified pattern of serotype replacement. By simulating counterfactual scenarios of public health interventions in France, we propose that this fitness cost caused a gradual and pernicious interaction between the two interventions by increasing the spread of nonvaccine, penicillin-susceptible strains. More generally, our results indicate that reductions of antibiotic use may counteract the benefits of conjugate vaccines introduced into countries with low vaccine-serotype coverages and high-resistance frequencies. Our findings highlight the key role of antibiotic use in vaccine-induced serotype replacement and suggest the need for more integrated approaches to control pneumococcal infections.
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Affiliation(s)
- Matthieu Domenech de Cellès
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, F–75005 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Margarita Pons-Salort
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, F–75005 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Emmanuelle Varon
- AP–HP, Hôpital Européen Georges-Pompidou, Laboratoire de Bactériologie, F–75015 Paris, France
- Centre National de Référence des Pneumocoques, F–75015 Paris, France
| | - Marie-Anne Vibet
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, F–75005 Paris, France
| | - Caroline Ligier
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Véronique Letort
- École Centrale Paris, Laboratoire de Mathématiques Appliquées aux Systèmes, F–92290 Châtenay-Malabry, France
| | - Lulla Opatowski
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Didier Guillemot
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
- AP–HP, Hôpital Raymond-Poincaré, Unité Fonctionnelle de Santé Publique, F–92380 Garches, France
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21
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Roquilly A, Cinotti R, Jaber S, Vourc'h M, Pengam F, Mahe PJ, Lakhal K, Demeure Dit Latte D, Rondeau N, Loutrel O, Paulus J, Rozec B, Blanloeil Y, Vibet MA, Sebille V, Feuillet F, Asehnoune K. Implementation of an evidence-based extubation readiness bundle in 499 brain-injured patients. a before-after evaluation of a quality improvement project. Am J Respir Crit Care Med 2013; 188:958-66. [PMID: 23927561 DOI: 10.1164/rccm.201301-0116oc] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Mechanical ventilation is associated with morbidity in patients with brain injury. OBJECTIVES This study aims to assess the effectiveness of an extubation readiness bundle to decrease ventilator time in patients with brain injury. METHODS Before-after design in two intensive care units (ICUs) in one university hospital. Brain-injured patients ventilated more than 24 hours were evaluated during two phases (a 3-yr control phase followed by a 22-mo intervention phase). Bundle components were protective ventilation, early enteral nutrition, standardization of antibiotherapy for hospital-acquired pneumonia, and systematic approach to extubation. The primary endpoint was the duration of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS A total of 299 and 200 patients, respectively, were analyzed in the control and the intervention phases of this before-after study. The intervention phase was associated with lower tidal volume (P < 0.01), higher positive end-expiratory pressure (P < 0.01), and higher enteral intake in the first 7 days (P = 0.01). The duration of mechanical ventilation was 14.9 ± 11.7 days in the control phase and 12.6 ± 10.3 days in the intervention phase (P = 0.02). The hazard ratio for extubation was 1.28 (95% confidence interval [CI], 1.04-1.57; P = 0.02) in the intervention phase. Adjusted hazard ratio was 1.40 (95% CI, 1.12-1.76; P < 0.01) in multivariate analysis and 1.34 (95% CI, 1.03-1.74; P = 0.02) in propensity score-adjusted analysis. ICU-free days at Day 90 increased from 50 ± 33 in the control phase to 57 ± 29 in the intervention phase (P < 0.01). Mortality at Day 90 was 28.4% in the control phase and 23.5% in the intervention phase (P = 0.22). CONCLUSIONS The implementation of an evidence-based extubation readiness bundle was associated with a reduction in the duration of ventilation in patients with brain injury.
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Affiliation(s)
- Antoine Roquilly
- 1 Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME, University Hospital of Nantes, Nantes, France
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Catherinot E, Roux AL, Vibet MA, Bellis G, Ravilly S, Lemonnier L, Le Roux E, Bernède-Bauduin C, Le Bourgeois M, Herrmann JL, Guillemot D, Gaillard JL. Mycobacterium avium and Mycobacterium abscessus complex target distinct cystic fibrosis patient subpopulations. J Cyst Fibros 2013; 12:74-80. [DOI: 10.1016/j.jcf.2012.06.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/30/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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Catherinot E, Roux AL, Vibet MA, Bellis G, Lemonnier L, Le Roux E, Bernède-Bauduin C, Le Bourgeois M, Herrmann JL, Guillemot D, Gaillard JL. Inhaled therapies, azithromycin and Mycobacterium abscessus in cystic fibrosis patients. Eur Respir J 2012; 41:1101-6. [PMID: 22936714 DOI: 10.1183/09031936.00065612] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cystic fibrosis (CF) patients are at particularly high risk of developing lung disease caused by Mycobacterium abscessus complex (MABSC). Over the last 10 years, changes in CF treatment, with increasing use of inhaled therapies and low-dose azithromycin, have been accompanied by an increase in the prevalence of MABSC infections in CF patients. There is therefore some concern about the role of new CF treatments in the emergence of MABSC infections. We addressed this issue by means of a case-control study including 30 MABSC-positive cases and 60 nontuberculous mycobacteria-negative CF controls matched for age, sex and centre. We also compared practices at the CF centres with the highest prevalence of MABSC with those at the other centres. No positive association was found between MABSC lung disease and the use of inhaled therapies or low-dose azithromycin in the 4 years preceding MABSC isolation. These treatments were not significantly more frequently used at the CF centres with the highest MABSC prevalence rates. In conclusion, there is no evidence for a link between M. abscessus complex lung disease and inhaled therapies or low-dose azithromycin in patients with CF.
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Affiliation(s)
- Emilie Catherinot
- Laboratoire de Microbiologie, Hôpital Raymond Poincaré et Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France
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Ruimy R, Brisabois A, Bernede C, Skurnik D, Barnat S, Arlet G, Momcilovic S, Elbaz S, Moury F, Vibet MA, Courvalin P, Guillemot D, Andremont A. Organic and conventional fruits and vegetables contain equivalent counts of Gram-negative bacteria expressing resistance to antibacterial agents. Environ Microbiol 2010; 12:608-15. [DOI: 10.1111/j.1462-2920.2009.02100.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riquet FB, Blanchard C, Jegouic S, Balanant J, Guillot S, Vibet MA, Rakoto-Andrianarivelo M, Delpeyroux F. Impact of exogenous sequences on the characteristics of an epidemic type 2 recombinant vaccine-derived poliovirus. J Virol 2008; 82:8927-32. [PMID: 18579607 PMCID: PMC2519664 DOI: 10.1128/jvi.00239-08] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 06/09/2008] [Indexed: 11/20/2022] Open
Abstract
Pathogenic circulating vaccine-derived polioviruses (cVDPVs) have become a major obstacle to the successful completion of the global polio eradication program. Most cVDPVs are recombinant between the oral poliovirus vaccine (OPV) and human enterovirus species C (HEV-C). To study the role of HEV-C sequences in the phenotype of cVDPVs, we generated a series of recombinants between a Madagascar cVDPV isolate and its parental OPV type 2 strain. Results indicated that the HEV-C sequences present in this cVDPV contribute to its characteristics, including pathogenicity, suggesting that interspecific recombination contributes to the phenotypic biodiversity of polioviruses and may favor the emergence of cVDPVs.
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Affiliation(s)
- Franck B Riquet
- Unité de Biologie des Virus Entériques, Institut Pasteur, Paris, France
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