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Bienvenu AL, Leray V, Guichon C, Bourget S, Chapuis C, Duréault A, Pavese P, Roux S, Kahale E, Chaabane W, Subtil F, Maucort-Boulch D, Talbot F, Dode X, Ghesquières H, Leboucher G. ANTIFON-CLIC®, a new clinical decision support system for the treatment of invasive aspergillosis: is it clinically relevant? Ann Pharm Fr 2024; 82:514-521. [PMID: 38000506 DOI: 10.1016/j.pharma.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Invasive aspergillosis (IA) is increasing especially in new groups of patients. Despite advances in management, morbidity and mortality related to IA remain high. Thus, Clinical Decision Support System (CDSS) dedicated to IA are needed to promote the optimal antifungal for each group of patients. PATIENTS AND METHODS This was a retrospective multicenter cohort study involving intensive care units and medical units. Adult patients who received caspofungin, isavuconazole, itraconazole, liposomal amphotericin B, posaconazole, or voriconazole, for the treatment of IA were eligible for enrollment. The primary objective was the concordance between the clinician's prescription and the prescription recommended by the CDSS. The secondary objective was the concordance according to different hospitals, departments, and indications. RESULTS Eighty-eight patients (n=88) from three medical hospitals were included. The overall concordance was 97% (85/88) including 100% (41/41) for center A, 92% (23/25) for center B, and 95% (21/22) for center C. There was no significant difference in concordance among the hospitals (P=0.973), the departments (P=1.000), and the indications (P=0.799). The concordance was 70% (7/10) for isavuconazole due to its use as an empirical treatment and 100% (78/78) for the other antifungals. DISCUSSION The concordance rate was high whatever the hospital, the department, and the indication. The only discrepancy was attributed to the use of isavuconazole as an empirical treatment which is a therapeutic option not included in the CDSS. CONCLUSIONS This new CDSS dedicated to IA is meeting the clinical practice. Its implementation in routine will help to support antifungal stewardship.
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Affiliation(s)
- A-L Bienvenu
- Service pharmacie, groupement hospitalier nord, hospices civils de Lyon, Lyon, France; Univ Lyon, Malaria Research Unit, SMITh, ICBMS UMR 5246, Lyon, France.
| | - V Leray
- Service d'anesthésie-réanimation, groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - C Guichon
- Service d'anesthésie-réanimation, groupement hospitalier nord, Hospices civils de Lyon, Lyon, France
| | - S Bourget
- Service pharmacie, CH de Valence, Valence, France
| | - C Chapuis
- Service de pharmacie, CHU de Grenoble, Grenoble-Alpes, France
| | - A Duréault
- Service des maladies infectieuses, centre hospitalier de Valence, Valence, France
| | - P Pavese
- Service des maladies infectieuses, CHU de Grenoble, Grenoble-Alpes, France
| | - S Roux
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, Lyon, France
| | - E Kahale
- Direction de l'innovation, hospices civils de Lyon, Lyon, France
| | - W Chaabane
- Direction des services numériques, hospices civils de Lyon, Lyon, France
| | - F Subtil
- Service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France
| | - D Maucort-Boulch
- Service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France
| | - F Talbot
- Direction des services numériques, hospices civils de Lyon, Lyon, France
| | - X Dode
- Service pharmacie, groupement hospitalier est, hospices civils de Lyon, Lyon, France
| | - H Ghesquières
- Service d'hématologie, groupement hospitalier sud, hospices civils de Lyon, Lyon, France
| | - G Leboucher
- Service pharmacie, groupement hospitalier nord, hospices civils de Lyon, Lyon, France
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Bienvenu AL, Cour M, Pavese P, Guichon C, Leray V, Chapuis C, Dureault A, Mohkam K, Gallet S, Bourget S, Kahale E, Chaabane W, Subtil F, Maucort-Boulch D, Talbot F, Dode X, Richard JC, Leboucher G. Correlation between antifungal clinical practices and a new clinical decision support system ANTIFON-CLIC® for the treatment of invasive candidiasis: a retrospective multicentre study. J Antimicrob Chemother 2024:dkae118. [PMID: 38656566 DOI: 10.1093/jac/dkae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Invasive candidiasis is still recognized as a major cause of morbidity and mortality. To support clinicians in the optimal use of antifungals for the treatment of invasive candidiasis, a computerized decision support system (CDSS) was developed based on institutional guidelines. OBJECTIVES To evaluate the correlation of this newly developed CDSS with clinical practices, we set-up a retrospective multicentre cohort study with the aim of providing the concordance rate between the CDSS recommendation and the medical prescription (NCT05656157). PATIENTS AND METHODS Adult patients who received caspofungin or fluconazole for the treatment of an invasive candidiasis were included. The analysis of factors associated with concordance was performed using mixed logistic regression models with department as a random effect. RESULTS From March to November 2022, 190 patients were included from three centres and eight departments: 70 patients from centre A, 84 from centre B and 36 from centre C. Overall, 100 patients received caspofungin and 90 received fluconazole, mostly (59%; 112/190) for empirical/pre-emptive treatment. The overall percentage of concordance between the CDSS and medical prescriptions was 91% (173/190) (confidence interval 95%: 82%-96%). No significant difference in concordance was observed considering the centres (P > 0.99), the department of inclusion (P = 0.968), the antifungal treatment (P = 0.656) or the indication of treatment (P = 0.997). In most cases of discordance (n = 13/17, 76%), the CDSS recommended fluconazole whereas caspofungin was prescribed. The clinical usability evaluated by five clinicians was satisfactory. CONCLUSIONS Our results demonstrated the high correlation between current antifungal clinical practice and this user-friendly and institutional guidelines-based CDSS.
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Affiliation(s)
- Anne-Lise Bienvenu
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, Malaria Research Unit, SMITh, ICBMS UMR 5246, Lyon, France
| | - Martin Cour
- Service de Médecine Intensive-Réanimation, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Patricia Pavese
- Service des Maladies Infectieuses, CHU de Grenoble, Grenoble, France
| | - Céline Guichon
- Service d'Anesthésie-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Véronique Leray
- Service d'Anesthésie-Réanimation, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | | | - Amélie Dureault
- Service des Maladies Infectieuses, CH de Valence, Valence, France
| | - Kayvan Mohkam
- Service d'Hépato-Gastro-Entérologie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Salomé Gallet
- Service des Maladies Infectieuses, CHU de Grenoble, Grenoble, France
| | | | - Elham Kahale
- Direction de l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Wajih Chaabane
- Direction des Services Numériques, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France
| | | | - François Talbot
- Direction des Services Numériques, Hospices Civils de Lyon, Lyon, France
| | - Xavier Dode
- Service Pharmacie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Gilles Leboucher
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
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Volpari V, Gallouche M, Caspar Y, Thiebaut-Bertrand A, Épaulard O, Pavese P, Landelle C, Le Maréchal M. Early picc-line infections in non-neutropenic patients are mainly due to E. coli suggesting that third-generation cephalosporin may be used as a first-line antibiotic therapy. Infect Dis Now 2024; 54:104842. [PMID: 38040246 DOI: 10.1016/j.idnow.2023.104842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To describe the rate of peripherally inserted central catheter (PICC) -associated bloodstream infections, and the pathogens involved. METHODS We prospectively analyzed data collected from all adult patients with a PICC insertion in a hematology unit in a tertiary care center between January 1, 2017 and June 30, 2020. RESULTS A total of 370 PICCs were inserted in 275 patients with hematological malignancies: 54 (15 %) confirmed cases of central-line associated bloodstream infection (CLABSI) were identified. Enterobacteria were the most frequent bacteria identified, involved in 35 % of CLABSIs. Group 1 enterobacteria bacteremia occurred a much shorter time after insertion (median time to CLABSI 16 days) than group 2 or group 3 enterobacteria (median time to CLABSI 64 days, p-value = 0.049). CONCLUSION Among Gram-negative bacilli CLABSI among non-neutropenic patients, E. coli identification was the most frequent and occurred earlier after insertion, suggesting that third-generation cephalosporin may be used as a first-line antibiotic therapy for enterobacteria bacteremia among non-neutropenic patients.
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Affiliation(s)
- Victoria Volpari
- Univ. Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C, UMR 5525, Grenoble, France
| | - Meghann Gallouche
- Univ. Grenoble Alpes, CNRS, MESP TIM-C, UMR 5525, 38000 Grenoble, France; Grenoble Alpes University Hospital, Infection Control Unit, 38000 Grenoble, France
| | - Yvan Caspar
- Bacteriology Laboratory, Institute of Biology and Pathology, CHU de Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, CEA, IBS, 38000 Grenoble, France
| | | | - Olivier Épaulard
- Univ. Grenoble Alpes, Service de Maladies Infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Univ. Grenoble Alpes, Inserm Groupe de Recherche en Infectiologie Clinique, CIC, CHU Grenoble-Alpes, France
| | - Patricia Pavese
- Univ. Grenoble Alpes, Service de Maladies Infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Univ. Grenoble Alpes, Inserm Groupe de Recherche en Infectiologie Clinique, CIC, CHU Grenoble-Alpes, France
| | - Caroline Landelle
- Univ. Grenoble Alpes, CNRS, MESP TIM-C, UMR 5525, 38000 Grenoble, France; Grenoble Alpes University Hospital, Infection Control Unit, 38000 Grenoble, France
| | - Marion Le Maréchal
- Univ. Grenoble Alpes, Service de Maladies Infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, 38000 Grenoble, France.
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Lesens O, Forestier E, Botelho-Nevers E, Pavese P, David G, Nougarede B, Corbin V, Pereira B, Aumeran C, Sauvat L. Comparing ethanol lock therapy versus vancomycin lock in a salvation strategy for totally implantable vascular access device infections due to coagulase-negative staphylococci (the ETHALOCK study): a prospective double-blind randomized clinical trial. Eur J Clin Microbiol Infect Dis 2024; 43:223-232. [PMID: 37993679 DOI: 10.1007/s10096-023-04702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Little is known about efficacy and safety of ethanol lock therapy (ELT) to treat totally implantable venous access device (TIVAD) infections. The objective of this trial was to evaluate the effectiveness and safety profile of a local treatment with ELT without removal for TIVAD infection due to coagulase-negative staphylococci. METHODS We performed a prospective, multicenter, double-blind, randomized clinical trial comparing the efficacy of 40% ELT versus vancomycin lock therapy (VLT) in TIVAD infections due to coagulase-negative staphylococci, complicated or not by bloodstream infection. RESULTS Thirty-one patients were assigned to the ELT group and 30 to the VLT arm. Concomitant bacteremia was present in 41 patients (67.2%). Treatment success was 58.1 % (18 of 31) for the ELT arm and 46.7% (14 of 30) for the VLT arm (p = 0.37). The overall treatment success was 52.5% (32). The risk of treatment failure due to uncontrolled infections, superinfections, and mechanical complications did not differ significantly between participants receiving ELT (13 out of 31 [42%]) and those receiving VLT (16 out of 30 [53%]) with a hazard ratio of 0.70 (p = 0.343; 95% CI [0.34-1.46], Cox model). Catheter malfunctions were significantly more frequent in the ELT arm (11 patients versus 2 in the VLT group, p = 0.01). CONCLUSIONS We found an overall high rate of treatment failure that did not differ between the ELT arm and the VLT arm. TIVAD removal must be prioritized to prevent complications (uncontrolled infections, superinfections, and catheter malfunctions) except in exceptional situations.
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Affiliation(s)
- Olivier Lesens
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
- Centre d'Investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
- Infectious and Tropical Diseases Department, Clermont-Ferrand University Hospital Center, Reference Center for Osteoarticular Infections, Regional Reference Center for Tick-Based Vector Diseases, Genome and Environment Microorganisms Laboratory, Clermont Auvergne University, Clermont-Ferrand, France.
| | - Emmanuel Forestier
- Infectious Disease Department, Metropole Savoie Hospital Center, Chambery, France
| | | | - Patricia Pavese
- Infectious Disease Department, Grenoble University Hospital Center, Grenoble, France
| | - Gary David
- Infectious Disease Department, Villefranche sur Saône Hospital Center, Villefranche sur Saône, France
| | | | - Violaine Corbin
- Infectious and Tropical Diseases Department, Clermont-Ferrand University Hospital Center, Reference Center for Osteoarticular Infections, Regional Reference Center for Tick-Based Vector Diseases, Genome and Environment Microorganisms Laboratory, Clermont Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical Research Direction, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Claire Aumeran
- Infection Control Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Léo Sauvat
- Infection Control Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
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Courjon J, Senneville E, Illes HG, Pavese P, Boutoille D, Daoud FC, Dunkel N, Tattevin P. Effectiveness and safety of dalbavancin in France: a prospective, multicentre cohort study. Int J Antimicrob Agents 2023; 62:106945. [PMID: 37543122 DOI: 10.1016/j.ijantimicag.2023.106945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/04/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Dalbavancin is a lipoglycopeptide antibiotic approved for the treatment of acute bacterial skin and skin structure infections. However, several studies have suggested that it is used mostly for off-label indications. We aimed to describe the use of dalbavancin in patients who received at least one dose of the antibiotic in France. METHODS Prospective, observational, multicentre study conducted in France from September 2018 to April 2020. The primary outcome was the clinical response at 30 days after the last dalbavancin dose. RESULTS A total of 151 patients in 16 centres were included in this study. The main infection sites were bone and joint infections (55.0%), multisite infections (15.9%), and vascular infections (14.6%), and the primary pathogens were coagulase-negative staphylococci (N = 82), Staphylococcus aureus (N = 51), and enterococci (N = 27). Most patients (71.5%) received three previous antibiotic treatments. The number of dalbavancin injections per patient was 1 in 26 patients (17.2%), 2 in 95 patients (62.9%), 3 in 17 patients (11.3%), and more than 3 in 13 patients (8.6%), with a mean cumulative dose of 3089 ± 1461 mg per patient. Among the 129 patients with a complete follow-up, clinical success was achieved in 119 patients (92.2%). At least 1 adverse event was reported in 67 patients (44.4%), including 12 (7.9%) patients with dalbavancin-related adverse events. CONCLUSIONS The results of the study showed that dalbavancin is used mostly for off-label indications and in heavily pretreated patients in France. The clinical response at 30 days after the last dose was favourable in most patients, with a good safety profile.
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Affiliation(s)
- Johan Courjon
- Université Côte d'Azur, CHU Nice, Nice, France, Infectious Disease Unit, Nice, France.
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | | | - Patricia Pavese
- Infectious Diseases Department, Grenoble Alpes University Hospital, La Tronche, France
| | - David Boutoille
- Department of Infectious Disease and CIC-UIC 1413 INSERM, Nantes University Hospital, Nantes, France
| | | | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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Sette AL, Pavese P, Lesprit P, Maillet M, Bourgeois G, Lutz MF, Baldeyrou M, Mondain V, Suy F, Contejean A, Diamantis S, Poitrenaud D, Touati S, Boussat B, François P. Survey on infectious disease telephone hotlines in primary care: General practitioners' satisfaction and compliance with advice. Infect Dis Now 2023; 53:104775. [PMID: 37634659 DOI: 10.1016/j.idnow.2023.104775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Infectious disease (ID) advice is a major part of antimicrobial stewardship programs. The objective of this study was to assess general practitioners' (GPs)' opinions and compliance with advice given by ID hotlines. PATIENTS AND METHODS This multicenter survey was based on the 7-day assessment of initial advice requested by GPs to a hotline set up by volunteer hospital ID teams to record advice for 3 years. The primary endpoint was the GPs' satisfaction with the advice given by ID specialists. RESULTS Ten ID teams participated in the study and recorded 4138 requests for advice, of which 1325 requests included a proposal for antibiotic therapy and justified a follow-up call at seven days. Only 398 follow-up calls (30%) were carried out because many GPs were not reachable. GPs were very satisfied with ID hotlines: 58% considered them indispensable and 38% very useful. The recommendations provided by ID specialists were followed by GPs in more than 80% of cases. The two main motivations for GPs to call the hotline were to get quick advice (86%) and to receive help in managing a patient (76%). CONCLUSIONS The ID telephone consultations and advice systems for GPs are highly appreciated and are effective in terms of following the recommendations.
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Affiliation(s)
- A-L Sette
- Service d'épidémiologie et évaluation Médicale, Centre Hospitalier Régional de Grenoble-Alpes, France
| | - P Pavese
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional de Grenoble-Alpes, France
| | - P Lesprit
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional de Grenoble-Alpes, France
| | - M Maillet
- Service de Maladies Infectieuses, Centre Hospitalier Annecy-Genevois, Épagny-Metz-Tessy, France
| | - G Bourgeois
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - M-F Lutz
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - M Baldeyrou
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, 35033 Rennes, France
| | - V Mondain
- Service des Maladies Infectieuses et Tropicales, CHU de Nice, Nice, France
| | - F Suy
- Médecine Interne Infectieuse et Tropicale, MiiT médical selarl, Lyon-Villeurbanne, France
| | - A Contejean
- Équipe Mobile d'Infectiologie, APHP, Hôpital Cochin, F-75014, Paris, France
| | - S Diamantis
- Service de Maladies Infectieuses, Groupe Hospitalier Sud Île-de-France, Melun, France
| | - D Poitrenaud
- Maladies Infectieuses et Tropicales, Centre Hospitalier d'Ajaccio, Ajaccio, France
| | - S Touati
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional de Grenoble-Alpes, France
| | - B Boussat
- Service d'épidémiologie et évaluation Médicale, Centre Hospitalier Régional de Grenoble-Alpes, France; Laboratoire TIMC-IMAG, Université de Grenoble-Alpes, France
| | - P François
- Service d'épidémiologie et évaluation Médicale, Centre Hospitalier Régional de Grenoble-Alpes, France; Laboratoire TIMC-IMAG, Université de Grenoble-Alpes, France.
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Vignau C, Le Maréchal M, Saunier C, Caspar Y, Landelle C, Froidure M, Blanc M, Pavese P. External validation of multiple prognosis scores to guide usage of echocardiography in patients with Staphylococcus aureus bacteremia using a prospective cohort. J Infect 2023; 87:e45-e47. [PMID: 37339684 DOI: 10.1016/j.jinf.2023.06.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Clémentin Vignau
- Université Grenoble Alpes, Service de Maladies infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France.
| | - Marion Le Maréchal
- Université Grenoble Alpes, Service de Maladies infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Université Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, 38000 Grenoble, France.
| | - Carole Saunier
- Université Grenoble Alpes, Service de Cardiologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Yvan Caspar
- Laboratoire de Bactériologie, Institut de Biologie et de Pathologie, CHU de Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, CNRS, CEA, IBS, 38000 Grenoble, France
| | - Caroline Landelle
- Université Grenoble Alpes, Service de d'hygiène hospitalière, CHU Grenoble Alpes, 38000 Grenoble, France; Université Grenoble Alpes, CNRS, MESP TIM-C, UMR 5525, 38000 Grenoble, France
| | - Marie Froidure
- Service de maladies infectieuses, Centre Hospitalier Alpes Léman, France
| | - Myriam Blanc
- Université Grenoble Alpes, Service de Maladies infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Patricia Pavese
- Université Grenoble Alpes, Service de Maladies infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Université Grenoble Alpes, Inserm Groupe de recherche en infectiologie clinique, CIC, CHU Grenoble-Alpes, France
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8
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Richarme C, Pavese P, Rubens-Duval B, Seurat O, Le Marechal M, Boisset S. Diagnostic performances and therapeutic impact of the Unyvero Implant and Tissue Infection multiplex PCR in periprosthetic joint infections. Future Microbiol 2023; 18:723-734. [PMID: 37526180 DOI: 10.2217/fmb-2022-0245] [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: 08/02/2023] Open
Abstract
Aim: We evaluated the diagnostic performances of Unyvero Implant and Tissue Infection multiplex PCR (mPCR) (Curetis) and the clinical impact of this PCR on therapeutic decisions. Materials & methods: A mPCR was performed on 33 joint fluids in addition to standard culture. A group of experts analyzed a posteriori the impact of the mPCR in the patient management. Results: The rate of concordance with culture was 74% (20/27). The sensitivity of the PCR was 59% and the specificity 90%. Clinicians would have started an appropriate treatment sooner for six patients (from 2 to 22 days earlier). Conclusion: The PCR would improve the management of 22% of the patients. For other patients, mPCR results have to be completed with the culture.
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Affiliation(s)
- Claire Richarme
- Laboratoire de bactériologie-hygiène hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, 38043, France
| | - Patricia Pavese
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, 38043, France
| | - Brice Rubens-Duval
- Service de chirurgie orthopédique et de traumatologie du sport, Hôpital Sud, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, 38043, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologique, Hôpital Nord, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, 38043, France
| | - Marion Le Marechal
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, 38043, France
| | - Sandrine Boisset
- Laboratoire de bactériologie-hygiène hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, 38043, France
- Institut de Biologie Structurale, Université Grenoble Alpes, CNRS, CEA, Grenoble, 38044, France
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Sette AL, François P, Lesprit P, Vitrat V, Rogeaux O, Breugnon E, Baldeyrou M, Mondain V, Issartel B, Kerneis S, Diamantis S, Poitrenaud D, Boussat B, Pavese P. Infectious disease hotlines to provide advice to general practitioners: a prospective study. BMC Health Serv Res 2023; 23:502. [PMID: 37198604 DOI: 10.1186/s12913-023-09515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Telephone hotlines in infectious diseases (ID) are part of antimicrobial stewardship programs designed to provide support and expertise in ID and to control antibiotic resistance. The aim of the study was to characterize the activity of the ID hotlines and estimate their usefulness for general practitioners (GPs). METHODS This was a multicenter prospective observational study in different French regions. ID teams involved in antimicrobial stewardship with a hotline for GPs were asked to record their advice from April 2019 to June 2022. In these regions, all GPs were informed of the ID hotline's operating procedures. The main outcome was usage rate of the hotlines by GPs. RESULTS Ten volunteer ID teams collected 4138 requests for advice from 2171 GPs. The proportion of GPs using the hotline varied pronouncedly by region, from 54% in the Isere department, to less than 1% in departments with the lowest usage. These differences were associated with the number of physicians in ID teams and with the age of the hotline. These results highlighted the value of working time as a means of ensuring the permanence of expertise. The main reasons for calling were: a diagnostic question (44%); choice of antibiotic (31%). The ID specialist provided advice on antibiotic therapy (43%) or a proposal for specialized consultation or hospitalization (11%). CONCLUSIONS ID hotlines could help to strengthen cooperation between primary care and hospital medicine. However, the deployment and perpetuation of this activity require reflection concerning its institutional and financial support.
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Affiliation(s)
- Anna Luce Sette
- Médecine Générale, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France.
| | - Patrice François
- Service d'épidémiologie et évaluation médicale, Centre Hospitalier Universitaire Grenoble-Alpes, Pavillon Taillefer, La Tronche, 38700, France.
| | - Philippe Lesprit
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble-Alpes, Pavillon Taillefer, La Tronche, France
| | - Virginie Vitrat
- Service de maladies infectieuses, Centre Hospitalier d'Annecy, Annecy, France
| | - Olivier Rogeaux
- Service des maladies infectieuses et tropicales, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Emma Breugnon
- Service de maladies infectieuses, Centre Hospitalier Universitaire de Saint-Etienne, Saint- Etienne, France
| | - Marion Baldeyrou
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Rennes, France
| | - Véronique Mondain
- Maladies Infectieuses, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Bertrand Issartel
- Médecine Interne Infectieuse et Tropicale, MiiT médical selarl, Lyon-Villeurbanne, France
| | - Solen Kerneis
- Equipe Mobile d'Infectiologie, APHP, Hôpital Cochin, Paris, F-75014, France
| | - Sylvain Diamantis
- Service de Maladies infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Delphine Poitrenaud
- Maladies infectieuses et tropicales, Centre Hospitalier d'Ajaccio, Ajaccio, France
| | - Bastien Boussat
- Laboratoire TIMC-IMAG, Université de Grenoble Alpes, Grenoble, France
| | - Patricia Pavese
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble-Alpes, Pavillon Taillefer, La Tronche, France
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10
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Truffot A, Noble J, Dartevel A, Chevalier E, Dard C, Giovannini D, Andreani J, Burrel S, Boutolleau D, Epaulard O, Pavese P, Morand P, Lupo J, Germi R. Fatal HSV-2 primary infection most likely acquired by kidney transplantation: A case report. Int J Antimicrob Agents 2023; 61:106769. [PMID: 36870404 DOI: 10.1016/j.ijantimicag.2023.106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
Herpes simplex virus 2 (HSV-2) rarely causes severe disease, even in solid organ transplant recipients. This paper describes a fatal case of HSV-2 infection, probably transmitted from a donor to a kidney transplant recipient. The donor was seropositive for HSV-2 but not for HSV-1, whereas the recipient was seronegative for both viruses before transplantation, suggesting that the graft was the source of infection. The recipient received valganciclovir prophylaxis due to cytomegalovirus seropositivity. Three months after transplantation, the recipient presented with rapidly disseminated cutaneous HSV-2 infection with meningoencephalitis. The HSV-2 strain was resistant to acyclovir, probably acquired under valganciclovir prophylaxis. Despite early initiation of acyclovir therapy, the patient died. This fatal case of HSV-2 infection, probably transmitted by the kidney graft with acyclovir-resistant HSV-2 from the onset, is uncommon.
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Affiliation(s)
- Aurélie Truffot
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France; Institut de Biologie Structurale, UMR 5075 CEA-CNRS-Université Grenoble-Alpes, Grenoble, France.
| | - Johan Noble
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Anaïs Dartevel
- Médecine intensive et réanimation, CHU Grenoble-Alpes, Grenoble, France
| | - Eloi Chevalier
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Celine Dard
- Human Leukocyte Antigen Laboratory, Etablissement Français du Sang, La Tronche, France
| | - Diane Giovannini
- Service d'anatomopathologie, CHU Grenoble Alpes, Grenoble, France
| | - Julien Andreani
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France
| | - Sonia Burrel
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Virologie, Centre National de Référence Herpèsvirus (laboratoire associé), Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - David Boutolleau
- AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Virologie, Centre National de Référence Herpèsvirus (laboratoire associé), Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Olivier Epaulard
- Service des Maladies Infectieuses, CHU Grenoble Alpes, Grenoble, France
| | - Patricia Pavese
- Service des Maladies Infectieuses, CHU Grenoble Alpes, Grenoble, France
| | - Patrice Morand
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France; Institut de Biologie Structurale, UMR 5075 CEA-CNRS-Université Grenoble-Alpes, Grenoble, France
| | - Julien Lupo
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France; Institut de Biologie Structurale, UMR 5075 CEA-CNRS-Université Grenoble-Alpes, Grenoble, France
| | - Raphaële Germi
- Laboratoire de Virologie, CHU Grenoble Alpes, Grenoble, France; Institut de Biologie Structurale, UMR 5075 CEA-CNRS-Université Grenoble-Alpes, Grenoble, France
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11
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Stahl JP, Canouï E, Bleibtreu A, Dubée V, Ferry T, Gillet Y, Lemaignen A, Lesprit P, Lorrot M, Lourtet-Hascoët J, Manaquin R, Meyssonnier V, Pavese P, Pham TT, Varon E, Gauzit R. SPILF update on bacterial arthritis in adults and children. Infect Dis Now 2023; 53:104694. [PMID: 36948248 DOI: 10.1016/j.idnow.2023.104694] [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: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
In 2020 the French Society of Rhumatology (SFR) published an update of the 1990 recommendations for management of bacterial arthritis in adults. While we (French ID Society, SPILF) totally endorse this update, we wished to provide further information about specific antibiotic treatments. The present update focuses on antibiotics with good distribution in bone and joint. It is important to monitor their dosage, which should be maximized according to PK/PD parameters. Dosages proposed in this update are high, with the optimized mode of administration for intravenous betalactams (continuous or intermittent infusion). We give tools for the best dosage adaptation to conditions such as obesity or renal insufficiency. In case of enterobacter infection, with an antibiogram result "susceptible for high dosage", we recommend the requesting of specialized advice from an ID physician. More often than not, it is possible to prescribe antibiotics via the oral route as soon as blood cultures are sterile and clinical have symptoms shown improvement. Duration of antibiotic treatment is 6 weeks for Staphylococcus aureus, and 4 weeks for the other bacteria (except for Neisseria: 7 days).
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Affiliation(s)
- J P Stahl
- Université Grenoble Alpes, Maladies Infectieuses, 38700, France.
| | - E Canouï
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
| | - A Bleibtreu
- Maladies Infectieuseset Tropicales, Hôpital Pitié Salpêtrière, AP-HP Sorbonne Université, Paris France
| | - V Dubée
- Maladies Infectieuses et Tropicales, CHU d'Angers, Angers, France
| | - T Ferry
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - Y Gillet
- Urgences et Réanimation Pédiatrique, Hospices Civils de Lyon, Université Claude Bernard Lyon, France
| | - A Lemaignen
- Maladies Infectieuses, CHRU de Tours, Université de Tours, 37044, France
| | - P Lesprit
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - M Lorrot
- Pédiatrie Générale et Equipe Opérationnelle d'Infectiologie, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Pitié), Hôpital Armand Trousseau AP-HP Sorbonne Université, Paris France
| | | | - R Manaquin
- Maladies Infectieuses et Tropicales, GHSR , CHU de La Réunion, CRAtb La Réunion, Saint-Pierre, 97410, FRANCE
| | - V Meyssonnier
- Centre de Référence des Infections Ostéo-articulaires, GH Diaconesses Croix Saint-Simon, 75020, Paris, France; Service de Médecine Interne Générale, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - P Pavese
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - T-T Pham
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - E Varon
- Centre National de Référence des Pneumocoques, CRC-CRB, Centre Hospitalier Intercommunal de Créteil, 94000, Créteil, France
| | - R Gauzit
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
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12
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Launay O, Cachanado M, Luong LB, Ninove L, Lachâtre M, Ghezala IB, Bardou M, Schmidt-Mutter C, Lacombe K, Laine F, Allain JS, Botelho-Nevers E, Tavolacci MP, Chidiac C, Pavese P, Dussol B, Priet S, Deplanque D, Touati A, Curci L, Konate E, Hamouda NB, Besbes A, Nubret E, Capelle F, Berard L, Rousseau A, Tartour E, Simon T, Lamballerie XD, Felten R, SURGERS L. 1954. Immunogenicity against SARS CoV-2 ancestral strain and variants of two new COVID-19 recombinant adjuvanted vaccines compared to BNT162b2 as a third dose following two doses of BNT162b2: a single-blinded multicenter randomized controlled trial. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1580] [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] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
New adjuvanted recombinant protein vaccines against coronavirus disease 2019 (COVID-19) as heterologous boosters could maximize the benefits of vaccination against SARS CoV-2.
Methods
In this randomized, single-blinded, multicenter trial, adults who had received two doses of Pfizer-BioNTech mRNA vaccine (BNT162b2) 3–7 months before were randomly assigned to receive a boost of BNT162b2, Sanofi/GSK SARS-CoV-2 adjuvanted recombinant protein MV D614 (monovalent parental formulation) or SARS-CoV-2 adjuvanted recombinant protein MV B.1.351 vaccine (monovalent Beta formulation). The primary endpoint was the percentage of subjects with a ≥ 10-fold increase in neutralizing antibody titers for the Wuhan (D614) and B.1.351 (Beta) SARS-CoV-2 viral strains between D0 and D15.
Results
The percentages of participants whose neutralizing antibody titers against the Wuhan (D614) SARS-CoV-2 strain increased by a factor ≥ 10 between Day 0 and Day 15 was 55.3% (95% CI 43.4-66.7) in MV(D614) group (n=76), 76.1% (64.5-85.4) in MV(Beta) group (n=71) and 63.2% (51.3-73.9) in BNT162b2 group (n=76). These percentages were 44.7% (33.3-56.6), 84.5% (74.0-92.0) and 51.3% (39.6-63.0) for the B.1.351 (Beta) viral strain, respectively. Higher neutralizing antibodies rates against Delta and Omicron BA.1 variants were also elicited after Sanofi/GSK MV(Beta) vaccine compared to the other vaccines. Comparable reactogenicity profile was observed the three vaccines. Table 1.Characteristics of patients at inclusion (per-protocol population).Figure 2.Neutralizing antibodies against D614 (wild-type; Wuhan) SARS-CoV-2 and variants Beta, Delta and Omicron BA.1 at D0, D15 and D28 after the boost dose (“post D3”)with Sanofi/GSK-D614, Sanofi/GSK-B.1.351 or BNT162b2 (per-protocol population); dotted line represents the positivity threshold.Figure 4.Rates and grades of severity of solicited adverse events reported from D0 to D7 by participants from the three randomized groups of the safety population (G1, Sanofi/GSK-D614; G2, Sanofi/GSK-B.1.351; G3, BNT162b2) according to the Toxicity Grading Scale for Healthy Adult and Adolescent Volunteers Enrolled in Preventive Vaccine Clinical Trials (Modified FDA scale/September 2007)
Conclusion
All three vaccines boosted antibodies and neutralizing response after BNT162b2 initial course. Heterologous boosting with the Sanofi/GSK SARS-CoV-2 adjuvanted recombinant protein vaccine B.1.351 (Beta formulation) provided higher neutralizing antibodies response rates against variants, including Omicron BA.1, compared with the mRNA BNT162b2 vaccine.
Disclosures
Odile Launay, MD, PhD, AstraZeneca: Financial|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Johnson & Johnson: Advisor/Consultant|Johnson & Johnson: Grant/Research Support|MD: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Data safety monitoring board|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data safety monitoring board Liem Binh Luong, MD, Pfizer: Advisor/Consultant|Pfizer: Honoraria Karine Lacombe, MD, PhD, Gilead: Advisor/Consultant|Janssen: Grant/Research Support|MSD: Grant/Research Support|ViiV Healthcare: Grant/Research Support Elisabeth Botelho-Nevers, MD, PHD, Janssen: Board Member|Pfizer: Board Member|Sanofi Pasteur: Board Member.
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Affiliation(s)
- Odile Launay
- Université Paris Cité; Inserm F-CRIN , I-REIVAC; Assistance Publique Hôpitaux de Paris, Paris, Ile-de-France , France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Liem Binh Luong
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Laetitia Ninove
- Unité des Virus Emergents, UVE : Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection , 13005, Marseille, France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Marie Lachâtre
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Inès Ben Ghezala
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital , Dijon , France ; , France, Dijon, Bourgogne , France
- F-CRIN, I REIVAC/COVIREIVAC , Dijon , France ; , France, Dijon, Bourgogne , France
| | - Marc Bardou
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital , Dijon , France ; , France, Dijon, Bourgogne , France
- F-CRIN, I REIVAC/COVIREIVAC , Dijon , France ; , France, Dijon, Bourgogne , France
| | - Catherine Schmidt-Mutter
- CIC Inserm 1434, Hôpitaux Universitaires de Strasbourg , France ; , France, Strasbourg, Alsace , France
- F-CRIN, I REIVAC/COVIREIVAC , France ; , France, Strasbourg, Alsace , France
| | - Karine Lacombe
- Sorbonne Inserm UMR-S1136, Hôpital St Antoine , AP-HP, Paris , France ; , France, Paris, Ile-de-France , France
- F-CRIN, I REIVAC/COVIREIVAC , AP-HP, Paris , France ; , France, Paris, Ile-de-France , France
| | - Fabrice Laine
- INSERM, CIC1414 , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
- F-CRIN, I REIVAC/COVIREIVAC , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
| | - Jean-Sébastien Allain
- INSERM, CIC1414 , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
- F-CRIN, I REIVAC/COVIREIVAC , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
| | - Elisabeth Botelho-Nevers
- Service d’infectiologie , CIC1408, Inserm, CHU de Saint-Etienne, 42055 Saint-Etienne , France ; , France, Saint Etienne, Auvergne , France
- F-CRIN, I REIVAC/COVIREIVAC , CIC1408, Inserm, CHU de Saint-Etienne, 42055 Saint-Etienne , France ; , France, Saint Etienne, Auvergne , France
| | - Marie-Pierre Tavolacci
- Normandie Univ , UNIROUEN, U1073, CHU Rouen, and CIC-CRB 1404, F-76000 Rouen , France ; , France, Rouen, Haute-Normandie , France
- F-CRIN, I REIVAC/COVIREIVAC , UNIROUEN, U1073, CHU Rouen, and CIC-CRB 1404, F-76000 Rouen , France ; , France, Rouen, Haute-Normandie , France
| | - Christian Chidiac
- 13. Maladies Infectieuses, GHN Croix Rousse, Hospices Civils de Lyon, UFR de Médecine et Maïeutique Lyon Sud Université Claude Bernard Lyon1, Université de Lyon , CIRI PHE3ID, Inserm U1111 UMR5308 - ENS Lyon; F-CRIN, I REIVAC/COVIREIVAC, France, Lyon, Rhone-Alpes , France
| | - Patricia Pavese
- Maladies infectieuses et tropicales , CHU de Grenoble Alpes , France ; , France, Grenoble, Rhone-Alpes , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , CHU de Grenoble Alpes , France ; , France, Grenoble, Rhone-Alpes , France
| | - Bertrand Dussol
- CIC 14-09, INSERM - Aix Marseille Université – Hôpitaux Universitaires de Marseille; Inserm, F-CRIN, I REIVAC/COVIREIVAC , France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Stéphane Priet
- Unité des Virus Émergents, UVE: Aix Marseille Univ , IRD 190, INSERM 1207, Marseille, France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Dominique Deplanque
- Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d’investigation clinique , F-59000 Lille , France ; , France, Lille, Nord-Pas-de-Calais , France
- F-CRIN, I REIVAC/COVIREIVAC , F-59000 Lille , France ; , France, Lille, Nord-Pas-de-Calais , France
| | - Amel Touati
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Laureen Curci
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Eleine Konate
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Nadine Ben Hamouda
- Service d’Immunologie Biologique, APHP, Hôpital Européen Georges Pompidou , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
- PARCC, INSERM U970, Université de Paris , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
| | - Anissa Besbes
- Service d’Immunologie Biologique, APHP, Hôpital Européen Georges Pompidou , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
- PARCC, INSERM U970, Université de Paris , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
| | - Eunice Nubret
- APHP, Direction de la Recherche Clinique et de l’Innovation (DRCI) , Paris, France, Paris, Ile-de-France , France
| | - Florence Capelle
- Département des Essais Cliniques de l’AGEPS, DRCI-APHP , Paris, France, Paris, Ile-de-France , France
| | - Laurence Berard
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Eric Tartour
- Service d’Immunologie Biologique, APHP, Hôpital Européen Georges Pompidou , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
- PARCC, INSERM U970, Université de Paris , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Xavier De Lamballerie
- Unité des Virus Émergents, UVE: Aix Marseille Univ , IRD 190, INSERM 1207, Marseille, France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Renaud Felten
- Inserm CIC 1434, CHU Strasbourg, Strasbourg, F-CRIN, I REIVAC/COVIREIVAC , Strasbourg, Alsace , France
| | - Laure SURGERS
- Sorbonne Université, IPLESP Inserm UMR-S1136, Hôpital St Antoine , AP-HP, Paris, France - F-CRIN, I REIVAC/COVIREIVAC, Paris, Ile-de-France , France
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Launay O, Cachanado M, Luong Nguyen LB, Ninove L, Lachâtre M, Ben Ghezala I, Bardou M, Schmidt-Mutter C, Lacombe K, Laine F, Allain JS, Botelho-Nevers E, Tavolacci MP, Chidiac C, Pavese P, Dussol B, Priet S, Deplanque D, Touati A, Curci L, Konate E, Ben Hamouda N, Besbes A, Nubret E, Capelle F, Berard L, Rousseau A, Tartour E, Simon T, de Lamballerie X. Immunogenicity and Safety of Beta-Adjuvanted Recombinant Booster Vaccine. N Engl J Med 2022; 387:374-376. [PMID: 35767474 PMCID: PMC9258749 DOI: 10.1056/nejmc2206711] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Fabrice Laine
- Centre Hospitalier Universitaire (CHU) Rennes, Rennes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eunice Nubret
- Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Eric Tartour
- Hôpital Européen Georges Pompidou, Paris, France
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Bienvenu AL, Pavese P, Leboucher G, Berger P, Roux S, Charmillon A, Foroni L, Menotti J, Lebeaux D, Mayan R, Mondain V, Robin C, Lesprit P, Alfandari S, Kernéis S. Practical checklist for implementation of antifungal stewardship programmes. J Med Microbiol 2022; 71. [PMID: 35771615 DOI: 10.1099/jmm.0.001560] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction. Antifungal stewardship programmes are needed in healthcare facilities to limit the overuse or misuse of antifungals, which are responsible for an increase in antifungal resistance.Hypothesis/Gap Statement. Core recommendations for antifungal stewardship were published by the Mycoses Study Group Education and Research Consortium, while the Centers for Disease Control and Prevention (CDC) provided a Core Elements of Hospital Antibiotic Stewardship Programs checklist. The recommendations offer global core elements for best practices in antifungal stewardship, but do not provide a framework for the implementation of antifungal stewardship programmes in healthcare facilities.Aim. In line with the recommendations, it is of the utmost importance to establish a practical checklist that may be used to implement antifungal stewardship programmes.Methodology. The practical checklist was established by a national consensus panel of experts involved in antifungal stewardship activities. A preliminary checklist was sent to all experts. The final document was approved by the panel after discussion and the resolution of any disagreements by consensus.Results. The final checklist includes the following items: leadership support; actions to support optimal antifungal use; actions to monitor antifungal prescribing, use and resistance; and an education programme.Conclusion. This antifungal stewardship checklist offers opportunities for antifungal resistance containment, given that antifungal stewardship activities promote the optimal use of antifungals.
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Affiliation(s)
- Anne-Lise Bienvenu
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, Malaria Research Unit, SMITh, ICBMS UMR 5246, Lyon, France
| | - Patricia Pavese
- Service des Maladies Infectieuses, CHU de Grenoble, Grenoble, France
| | - Gilles Leboucher
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Pierre Berger
- Infectiologie, Institut Paoli Calmettes, Marseille, France
| | - Sandrine Roux
- Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon
| | | | - Luc Foroni
- Omédit, ARS Auvergne-Rhône-Alpes, Lyon, France
| | - Jean Menotti
- Service de Mycologie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - David Lebeaux
- Maladies Infectieuses et Tropicales, Hôpital Européen Georges-Pompidou, Paris, France
| | - Rémi Mayan
- Infectiologie, Ramsay Sante, Clinique Belharra, Bayonne, France
| | | | - Christine Robin
- Service d'hématologie clinique et de thérapie cellulaire, APHP, Hôpital Henri Mondor, Créteil, France
| | - Philippe Lesprit
- Service des Maladies Infectieuses, CHU de Grenoble, Grenoble, France
| | - Serge Alfandari
- Service de Réanimation et Maladies Infectieuses, CH Dron, Tourcoing, France
| | - Solen Kernéis
- Equipe de Prévention du Risque Infectieux, Hôpital Bichat, Paris, France
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15
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Wackenheim C, Le Maréchal M, Pluchart H, Gavazzi G, Blanc M, Caspar Y, Pavese P. Dalbavancin in clinical practice: a particular place for the elderly? Eur J Clin Microbiol Infect Dis 2022; 41:977-979. [PMID: 35471751 DOI: 10.1007/s10096-022-04427-2] [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: 03/02/2021] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
We investigate dalbavancin efficiency and tolerance among elderly in Grenoble-Alpes 32 university hospital. Among the 65 patients who received dalbavancin, 51% (33) were considered as old. Patients presented mainly bones and joint infections (52%), surgical site infection 34 (31%), and infective endocarditis (IE) (8%). Clinical cure was confirmed for 79% of old 35 patients at 1, 3, and 6 months. Six adverse events (9%) were reported after 36 dalbavancin's administration, but each time in combination with other antibiotics. 37 Dalbavancin had a significant effectiveness and safety profile and represents a real 38 therapeutic option in the management of deep and complex infections of elderly patients.
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Affiliation(s)
- Chloé Wackenheim
- Infectious Diseases Department, CH Alpes Léman, Contamine-sur-Arve, France.
| | - Marion Le Maréchal
- Infectious Diseases Department, CHU de Grenoble Alpes, Grenoble, France. .,Groupe de Recherche en Infectiologie Clinique (GRIC), CIC, CHU Grenoble Alpes, Grenoble, France.
| | - Hélène Pluchart
- Pharmacy Department, CHU de Grenoble Alpes, Grenoble, France.
| | - Gaëtan Gavazzi
- Groupe de Recherche en Infectiologie Clinique (GRIC), CIC, CHU Grenoble Alpes, Grenoble, France. .,Geriatric Medicine Department, CHU de Grenoble Alpes, Grenoble, France.
| | - Myriam Blanc
- Infectious Diseases Department, CHU de Grenoble Alpes, Grenoble, France.
| | - Yvan Caspar
- Groupe de Recherche en Infectiologie Clinique (GRIC), CIC, CHU Grenoble Alpes, Grenoble, France. .,Bacteriology Laboratory, Institute of Biology and Pathology, CHU de Grenoble Alpes, Grenoble, France.
| | - Patricia Pavese
- Infectious Diseases Department, CHU de Grenoble Alpes, Grenoble, France. .,Groupe de Recherche en Infectiologie Clinique (GRIC), CIC, CHU Grenoble Alpes, Grenoble, France.
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16
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Boussat B, Cazzorla F, Le Marechal M, Pavese P, Mounayar AL, Sellier E, Gaillat J, Camara B, Degano B, Maillet M, Courtois X, Bouisse M, Seigneurin A, François P. Incidence of Avoidable 30-Day Readmissions Following Hospitalization for Community-Acquired Pneumonia in France. JAMA Netw Open 2022; 5:e226574. [PMID: 35394509 PMCID: PMC8994128 DOI: 10.1001/jamanetworkopen.2022.6574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Rates of 30-day readmissions following hospitalization for pneumonia are used to publicly report on hospital performance and to set financial penalties for the worst-performing hospitals. However, the rate of avoidable readmission following hospitalization for pneumonia is undefined. OBJECTIVE To assess how often 30-day readmissions following hospitalization for community-acquired pneumonia (CAP) are avoidable. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed the results of an independent review of readmissions following hospitalization for CAP within 30 days among patients discharged from 2 large hospitals in France in 2014. Structured clinical records including clinical information (ie, baseline characteristics, physical examination, laboratory findings, x-ray or computed tomography scan findings, discharge plan, and treatments) for both index and readmission stays were independently reviewed by 4 certified board physicians. All consecutive adult patients hospitalized in 2014 with a diagnosis of CAP in our 2 eligible hospitals were eligible. All analyses presented were performed in March 2021. MAIN OUTCOMES AND MEASURES Avoidable readmission within 30 days of discharge from index hospitalization. The likelihood that a readmission was avoidable was quantified using latent class analysis based on the independent reviews. A readmission was considered avoidable if Bayes posterior probability exceeded 50%. RESULTS The total analytical sample consisted of 1150 index hospital stays with a diagnosis of CAP, which included 651 (56.6%) male patients. The median (IQR) age for all patients was 77.8 (IQR, 62.7-86.4) years. Out of the 1150 index hospital stays, 98 patients (8.5%) died in hospital, and 108 (9.4%) unplanned readmissions were found. Overall, 15 readmissions had a posterior probability of avoidability exceeding 0.50 (13.9% of the 108 unplanned readmissions; 95% CI, 8.0%-21.9%). The median (IQR) delay between the hospital discharge index and readmission was considerably shorter when readmission was deemed avoidable (4 [6-21] days vs 12 [2-18] days; P = .02). CONCLUSIONS AND RELEVANCE Only a small number of readmissions following hospitalization for CAP were deemed avoidable, comprising less than 10% of all readmissions. Shorter time interval between hospitalization discharge and readmission was associated with avoidability.
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Affiliation(s)
- Bastien Boussat
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, Grenoble, France
- Laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, Université Grenoble-Alpes, France
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Fabiana Cazzorla
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, Grenoble, France
| | | | - Patricia Pavese
- Service des maladies infectieuses, CHU Grenoble-Alpes, Grenoble, France
| | | | - Elodie Sellier
- Service d’information médicale, CHU Grenoble-Alpes, Grenoble, France
| | - Jacques Gaillat
- Service d’information et d’évaluation médicale, Centre hospitalier Annecy-Genevois, Épagny-Metz-Tessy, France
| | - Boubou Camara
- Service de pneumologie, CHU Grenoble-Alpes, Grenoble, France
| | - Bruno Degano
- Service de pneumologie, CHU Grenoble-Alpes, Grenoble, France
| | - Mylène Maillet
- Service des maladies infectieuses, Centre hospitalier Annecy-Genevois, Épagny-Metz-Tessy, France
| | - Xavier Courtois
- Service d’information et d’évaluation médicale, Centre hospitalier Annecy-Genevois, Épagny-Metz-Tessy, France
| | - Magali Bouisse
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, Grenoble, France
| | - Arnaud Seigneurin
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, Grenoble, France
- Laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, Université Grenoble-Alpes, France
| | - Patrice François
- Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, Grenoble, France
- Laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, Université Grenoble-Alpes, France
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17
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Epaulard O, Buisson M, Nemoz B, Maréchal ML, Terzi N, Payen JF, Froidure M, Blanc M, Mounayar AL, Quénard F, Pierre I, Pavese P, Germi R, Grossi L, Larrat S, Poignard P, Lupo J. Persistence at one year of neutralizing antibodies after SARS-CoV-2 infection: Influence of initial severity and steroid use. J Infect 2021; 84:418-467. [PMID: 34687831 PMCID: PMC8527702 DOI: 10.1016/j.jinf.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 10/25/2022]
Affiliation(s)
- Olivier Epaulard
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France.
| | - Marlyse Buisson
- UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Benjamin Nemoz
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Marion Le Maréchal
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Nicolas Terzi
- Service de Médecine Intensive et Réanimation, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Jean-François Payen
- Département d'anesthésie et Réanimation, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Marie Froidure
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Myriam Blanc
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Anne-Laure Mounayar
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Fanny Quénard
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Isabelle Pierre
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Patricia Pavese
- Service des Maladies Infectieuses, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France
| | - Raphaele Germi
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Laurence Grossi
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Sylvie Larrat
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Pascal Poignard
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Julien Lupo
- Groupe de Recherche en Infectiologie Clinique CIC-1406, Inserm - CHUGA - Université Grenoble Alpes, Grenoble, France; UMR 5075 - CEA-CNRS-UGA, Institut de Biologie Structurale, Grenoble, France; Laboratoire de Virologie, Center Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
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18
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Landoas A, Cazzorla F, Gallouche M, Larrat S, Nemoz B, Giner C, Le Maréchal M, Pavese P, Epaulard O, Morand P, Mallaret MR, Landelle C. SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study. Antimicrob Resist Infect Control 2021; 10:114. [PMID: 34353356 PMCID: PMC8339707 DOI: 10.1186/s13756-021-00984-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures.
Methods We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period. Results Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12–42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively. Conclusions The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected. Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).
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Affiliation(s)
- A Landoas
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - F Cazzorla
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - M Gallouche
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Grenoble, France
| | - S Larrat
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - B Nemoz
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS/CEA, Institut de Biologie Structurale (IBS), HIV and persistent viral infections, Grenoble, France
| | - C Giner
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - M Le Maréchal
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - P Pavese
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - O Epaulard
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - P Morand
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS/CEA, Institut de Biologie Structurale (IBS), HIV and persistent viral infections, Grenoble, France
| | - M-R Mallaret
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Grenoble, France
| | - C Landelle
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France. .,Grenoble Alpes University/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Grenoble, France. .,Hospital Hygiene Department, Pavilion E - Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.
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19
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Portais A, Le Marechal M, Nemoz B, Dartevel A, Rigault G, Pavese P, Pierre I, Terzi N. Measles-associated pneumonia in an immunocompromised patient: Persistent shortcomings in vaccination guidelines. Infect Dis Now 2021; 51:316-318. [PMID: 33934814 PMCID: PMC8078873 DOI: 10.1016/j.idnow.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Portais
- Infectiologie, CHU Grenoble-Alpes, 38000 Grenoble, France.
| | - M Le Marechal
- Infectiologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - B Nemoz
- Microbiologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - A Dartevel
- Médecine intensive et reanimation, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - G Rigault
- Médecine intensive et reanimation, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - P Pavese
- Infectiologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - I Pierre
- Infectiologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - N Terzi
- Médecine intensive et reanimation, CHU Grenoble-Alpes, 38000 Grenoble, France
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20
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Ponderand L, Pavese P, Maubon D, Giraudon E, Girard T, Landelle C, Maurin M, Caspar Y. Evaluation of Rapid Sepsityper® protocol and specific MBT-Sepsityper module (Bruker Daltonics) for the rapid diagnosis of bacteremia and fungemia by MALDI-TOF-MS. Ann Clin Microbiol Antimicrob 2020; 19:60. [PMID: 33298064 PMCID: PMC7727196 DOI: 10.1186/s12941-020-00403-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/28/2020] [Indexed: 12/11/2022] Open
Abstract
During bloodstream infections, rapid adaptation of empirical treatment according to the microorganism identified is essential to decrease mortality. The aim of the present study was to assess the microbiological performances of a new rapid version of the Sepsityper® kit (Bruker Daltonics) allowing identification of bacteria and yeast by MALDI-TOF mass spectrometry directly from positive blood cultures in 10 min and of the specific MBT-Sepsityper module for spectra analysis, designed to increase identification performance. Identification rates were determined prospectively on 350 bacterial and 29 fungal positive blood cultures, and compared to conventional diagnostic method. Our rapid diagnosis strategy (Rapid Sepsityper® protocol: one spot with and one without formic acid extraction step) combined to MBT-Sepsityper module provided 65.4%, 78.9% and 62% reliable identification to the species level of monomicrobial positive blood cultures growing respectively Gram-positive, Gram-negative bacteria or yeast. Importantly, identification rates of Gram-positive bacteria were higher in anaerobic than in aerobic bottles (77.8% vs 22.2%; p = 0.004), if formic acid extraction step was performed (60.8% vs 39.2%; p = 1.8e−6) and if specific MBT-Sepsityper module was used (76.2% vs 61.9%, p = 0.041) while no significant differences were observed for Gram-negative bacteria. For yeasts identification, formic acid extraction step improved rapid identification rate by 37.9% while the specific MBT-Sepsityper module increased overall performances by 38%, providing up to 89.7% reliable identification if associated with the standard Sepsityper® protocol. These performances, associated with a reduce turnaround time, may help to implement a rapid identification strategy of bloodstream infections in the routine workflow of microbiology laboratories.
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Affiliation(s)
- Léa Ponderand
- Laboratoire de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Patricia Pavese
- Service de Médecine Infectieuse et Tropicale, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France
| | - Danièle Maubon
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France.,Laboratoire de Parasitologie Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France
| | - Emmanuelle Giraudon
- Laboratoire de Parasitologie Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France
| | - Thomas Girard
- Laboratoire de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France
| | - Caroline Landelle
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France
| | - Max Maurin
- Laboratoire de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Yvan Caspar
- Laboratoire de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, 38000, Grenoble, France. .,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France. .,Laboratoire de Bactériologie-Hygiène Hospitalière, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, CS10217, 38043, Grenoble Cedex 9, France.
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21
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Bryant S, Almahmoud I, Pierre I, Bardet J, Touati S, Maubon D, Cornet M, Richarme C, Maurin M, Pavese P, Caspar Y. Evaluation of Microbiological Performance and the Potential Clinical Impact of the ePlex ® Blood Culture Identification Panels for the Rapid Diagnosis of Bacteremia and Fungemia. Front Cell Infect Microbiol 2020; 10:594951. [PMID: 33324578 PMCID: PMC7726344 DOI: 10.3389/fcimb.2020.594951] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
Molecular rapid diagnostic assays associated with antimicrobial stewardship have proven effective for the early adaptation of empiric therapy in bloodstream infections. The ePlex® BCID (GenMark Diagnostics) Panels allow identification of 56 bacteria and fungi and 10 resistance genes in 90 min directly from positive blood cultures. We prospectively evaluated 187 sepsis episodes at Grenoble University Hospital and retrospectively analyzed the cases to measure the potential clinical impact of the ePlex BCID results. Identification of all pathogens was obtained for 164/187 (88%) bloodstream infections with 100% detection of antimicrobial resistance genes (17 blaCTX-M , 1 vanA, and 17 mecA genes). Only 15/209 (7%) strains were not covered by the panels. Sensitivity for detection of micro-organisms targeted by the RUO BCID-GP, BCID-GN, and BCID-FP Panels was respectively 84/84 (100%), 103/107 (96%), and 14/14 (100%). Interestingly, accurate identification of all pathogens was achieved in 15/17 (88%) polymicrobial samples. Retrospective analysis of medical records showed that a modification of antimicrobial treatment would have been done in 45% of the patients. Treatment modifications would have been an optimization of empiric therapy, a de-escalation or an escalation in respectively 16, 17, and 11% of the patients. Moreover, 11% of the samples were classified as contaminants or not clinically relevant and would have led to early de-escalation or withdrawal of any antibiotic. Detection of resistance genes in addition to identification alone increased escalation rate from 4 to 11% of the patients. Absence of the ePlex result was considered a lost opportunity for therapy modification in 28% of patients.
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Affiliation(s)
- Sabrina Bryant
- Laboratoire de bactériologie-hygiène hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Iyad Almahmoud
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Isabelle Pierre
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Bardet
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Saber Touati
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Daniele Maubon
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Muriel Cornet
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Claire Richarme
- Laboratoire de bactériologie-hygiène hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Max Maurin
- Laboratoire de bactériologie-hygiène hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Patricia Pavese
- Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Yvan Caspar
- Laboratoire de bactériologie-hygiène hospitalière, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
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22
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Mounayar AL, Francois P, Pavese P, Sellier E, Gaillat J, Camara B, Degano B, Maillet M, Bouisse M, Courtois X, Labarère J, Seigneurin A. Development of a risk prediction model of potentially avoidable readmission for patients hospitalised with community-acquired pneumonia: study protocol and population. BMJ Open 2020; 10:e040573. [PMID: 33177142 PMCID: PMC7661353 DOI: 10.1136/bmjopen-2020-040573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION 30-day readmission rate is considered an adverse outcome reflecting suboptimal quality of care during index hospitalisation for community-acquired pneumonia (CAP). However, potentially avoidable readmission would be a more relevant metric than all-cause readmission for tracking quality of hospital care for CAP. The objectives of this study are (1) to estimate potentially avoidable 30-day readmission rate and (2) to develop a risk prediction model intended to identify potentially avoidable readmissions for CAP. METHODS AND ANALYSIS The study population consists of consecutive patients admitted in two hospitals from the community or nursing home setting with pneumonia. To qualify for inclusion, patients must have a primary or secondary discharge diagnosis code of pneumonia. Data sources include routinely collected administrative claims data as part of diagnosis-related group prospective payment system and structured chart reviews. The main outcome measure is potentially avoidable readmission within 30 days of discharge from index hospitalisation. The likelihood that a readmission is potentially avoidable will be quantified using latent class analysis based on independent structured reviews performed by four panellists. We will use a two-stage approach to develop a claims data-based model intended to identify potentially avoidable readmissions. The first stage implies deriving a clinical model based on data collected through retrospective chart review only. In the second stage, the predictors comprising the medical record model will be translated into International Classification of Diseases, 10th revision discharge diagnosis codes in order to obtain a claim data-based risk model.The study sample consists of 1150 hospital stays with a diagnosis of CAP. 30-day index hospital readmission rate is 17.5%. ETHICS AND DISSEMINATION The protocol was reviewed by the Comité de Protection des Personnes Sud Est V (IRB#6705). Efforts will be made to release the primary study results within 6 months of data collection completion. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02833259).
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Affiliation(s)
| | - Patrice Francois
- Medical Assessment, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Patricia Pavese
- Infectious Diseases, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Elodie Sellier
- Medical Information, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Jacques Gaillat
- Medical Information and Assessment, Annecy Genevois Hospital Centre, Epagny Metz-Tessy, Rhône-Alpes, France
| | - Boubou Camara
- Pneumology Department, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Bruno Degano
- Pneumology Department, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Mylène Maillet
- Infectious Diseases, Annecy Genevois Hospital Centre, Epagny Metz-Tessy, Rhône-Alpes, France
| | - Magali Bouisse
- Medical Assessment, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
| | - Xavier Courtois
- Medical Information and Assessment, Annecy Genevois Hospital Centre, Epagny Metz-Tessy, Rhône-Alpes, France
| | - José Labarère
- Medical Assessment, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
- BCM, Laboratoire TIMC-IMAG, La Tronche, Rhône-Alpes, France
| | - Arnaud Seigneurin
- Medical Assessment, CHU Grenoble Alpes, Grenoble, Rhône-Alpes, France
- BCM, Laboratoire TIMC-IMAG, La Tronche, Rhône-Alpes, France
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Forget V, Fauconnier J, Boisset S, Pavese P, Vermorel C, Bosson JL, Saragaglia D, Tonetti J, Mallaret MR, Landelle C. Risk factors for Staphylococcus aureus surgical site infections after orthopaedic and trauma surgery in a French university hospital. Int J Hyg Environ Health 2020; 229:113585. [PMID: 32781428 DOI: 10.1016/j.ijheh.2020.113585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/14/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Surgical site infections (SSI) after orthopaedic surgery are responsible for reduced quality of life, increased length of hospital stay and costs. The most commonly identified organism is Staphylococcus aureus but risk factors for S. aureus SSI are not well-known. The aim of this study was to evaluate the incidence rate trend of S. aureus SSI over the years and risk factors of these infections in a French University Hospital. METHODS SSI rates were expressed as cumulative incidence rates per year. A case-control study nested within a prospective cohort of patients undergoing orthopaedic or trauma surgery from January 1st, 2012 to April 30th, 2015 was performed. Cases were patients with S. aureus SSI; controls were patients without SSI. Risk factors of S. aureus SSI were identified by univariate and multivariable analysis. RESULTS Of 7438 interventions, 50 (0.7%) S. aureus SSI were identified, without significant increase by years. A total of 46 S. aureus SSI was matched to 91 controls. Risk factors for S. aureus SSI were smoking (odds-ratio (OR) = 8.4, 95%CI 1.2-59.6) and National Nosocomial Infections Surveillance System score (NNISS) ≥1 (OR = 5.8, 95%CI 1.8-19.1). Having 1 or 2 preoperative antiseptic showers (OR = 0.3, 95%CI 0.1-0.7) was a protective factor. CONCLUSION The rate of S. aureus SSI is not negligible after orthopaedic and trauma surgery. It seems imperative to strengthen smoking cessation recommendations, and to recall the importance of preoperative antiseptic showers. Systematic screening and decolonization for S. aureus carriage before orthopaedic and trauma surgery could be a means to prevent these infections.
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Affiliation(s)
| | - Jérôme Fauconnier
- Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Medical Information, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Sandrine Boisset
- Bacteriology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Patricia Pavese
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Céline Vermorel
- Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Jean-Luc Bosson
- Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, South Teaching Hospital, Grenoble Alpes University Hospital, Grenoble, France
| | - Jérôme Tonetti
- Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie-Reine Mallaret
- Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Infection Control Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Landelle
- Univ Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Infection Control Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France.
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24
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Dinh A, Duran C, Pavese P, Khatchatourian L, Monnin B, Bleibtreu A, Denis E, Etienne C, Rouanes N, Mahieu R, Bouchand F, Davido B, Lotte R, Cabaret P, Camou F, Chavanet P, Assi A, Limonta S, Lechiche C, Riou R, Courjon J, Illes G, Lacassin-Beller F, Senneville E. French national cohort of first use of dalbavancin: A high proportion of off-label use. Int J Antimicrob Agents 2019; 54:668-672. [PMID: 31400471 DOI: 10.1016/j.ijantimicag.2019.08.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 06/24/2019] [Revised: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft-tissue infections (SSTIs), but its real-life use is not well known. The aim of this study was to describe all first prescriptions in France over an 16-month period. A retrospective study on all adult patients receiving at least one dose of dalbavancin from 1 June 2017 to 31 September 2018 was performed (75 patients from 29 French hospitals). Data were collected via a standard questionnaire. Failure was defined as persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment, and/or death from infection. The main indications were bone and joint infection (BJI) (64.0%), endocarditis (25.3%), and SSTI (17.3%). The main bacteria involved were Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%), and coagulase-negative staphylococci (44.4%). Median minimum inhibitory concentrations (MICs) for staphylococci to vancomycin and dalbavancin ranged from 0.875-2.0 mg/L and 0.032-0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. The main treatment regimens for dalbavancin were a two-dose regimen (1500 mg each) in 38 cases (50.7%) and a single-dose regimen (1500 mg) in 13 cases (17.3%). Overall, at the patient's last visit, clinical cure was observed in 54/68 patients, whilst failure was observed in 14/68 patients. First use of dalbavancin in France was mostly off-label. Most were due to BJI, often as rescue therapy for severe infections. Even in off-label situations, dalbavancin appears safe and effective.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France.
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France
| | - Patricia Pavese
- Infectious Disease Unit, University Hospital of Grenoble, Grenoble, France
| | | | - Boris Monnin
- Infectious Disease Department, University Hospital of Montpellier, Montpellier, France
| | - Alexandre Bleibtreu
- Infectious Disease Unit, La Pitié-Salpétrière University Hospital, AP-HP, Paris, France
| | - Eric Denis
- Infectious Disease Unit, Hospital of Antibes, Antibes, France
| | - Cédric Etienne
- Infectiologie transversale, Hospital of Grasse, Grasse, France
| | - Nicolas Rouanes
- Infectious Disease Unit, Hospital of Périgueux, Périgueux, France
| | - Rafael Mahieu
- Infectious Disease Unit, University Hospital of Angers, Angers, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd. Raymond Poincaré, 92380 Garches, France
| | - Romain Lotte
- Bacteriology Laboratory, University Hospital of Nice, Nice, France
| | - Philippe Cabaret
- Antimicrobial Stewardship Team, Saint Philibert-Saint Vincent de Paul Hospitals, GHICL, Lille, France
| | - Fabrice Camou
- Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Pascal Chavanet
- Infectious Disease Department, University Hospital of Dijon, Dijon, France
| | - Assi Assi
- Antimicrobial Stewardship Team, Les Fleurs Clinic, Toulon, France
| | - Silvia Limonta
- Infectious Disease Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Raphaëlle Riou
- Infectious Disease Unit, Hotel-Dieu University Hospital, Nantes, France
| | - Johan Courjon
- Infectious Disease Unit, University Hospital of Nice, Nice, France
| | - Gabriela Illes
- Infectious Disease Unit, Hospital of Mont-de-Marsan, Mont-de-Marsan, France
| | | | - Eric Senneville
- Infectious Disease Unit, Hospital of Tourcoing, Tourcoing, France
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25
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Dinh A, Duran C, Pavese P, Monnin B, Riou R, Lechiche C, Courjon J, Lacassin-Beller F, Senneville E, Dalbavancine G. Utilisation de la Dalbavancine en vie réelle : cohorte nationale. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Andry F, Pierre I, Recule C, Caspar Y, Landelle C, Epaulard O, Pavese P. Épidémiologie et devenir des patients avec des hémocultures rendues positives une fois sortis de l’hôpital : étude rétrospective sur une année. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Amsilli M, Epaulard O, Brion JP, Pavese P, Letoublon C, Pelloux I, Maurin M. Hepatic Brucelloma Diagnosis and Long-Term Treatment, France. Emerg Infect Dis 2019; 25:1021-1023. [PMID: 31002052 PMCID: PMC6478221 DOI: 10.3201/eid2505.180613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a case of hepatic brucelloma in France. This diagnosis may be suspected in any patient who has a liver abscess after traveling to a brucellosis-endemic area. Brucella spp. may be detected by PCR in the liver tissue or suppuration. Abscess drainage and prolonged antimicrobial therapy help achieve healing.
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28
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Gallouche M, Pavese P, Pierre I, Mallaret MR, Stahl JP, Landelle C. Reply to 'Searching for the best agent for antibiotic prophylaxis in patients undergoing transcatheter aortic valve implantation'. J Hosp Infect 2018; 100:459-461. [PMID: 30171887 DOI: 10.1016/j.jhin.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M Gallouche
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - P Pavese
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - I Pierre
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - M R Mallaret
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France
| | - J P Stahl
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - C Landelle
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France.
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29
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Lesens O, Ferry T, Forestier E, Botelho-Nevers E, Pavese P, Piet E, Pereira B, Montbarbon E, Boyer B, Lustig S, Descamps S. Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study. Eur J Clin Microbiol Infect Dis 2018; 37:1949-1956. [PMID: 30083889 DOI: 10.1007/s10096-018-3330-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022]
Abstract
To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan-Meier method was 76.2 [95% CI 68-83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69-0.88]; p < 0.001) and combination therapy including rifampin (HR 0.08 [0.018-0.36]; p = 0.001) were independently associated with success, whereas active smoking was independently associated with failure (HR 3.6 [1.09-11.84]; p = 0.036). When the analysis was restricted to patients with early infection onset (< 3 months), early acute infection was also predictive of a better prognosis (HR 0.25 [0.09-0.7]; p = 0.009). Failure was not associated with time from prosthesis insertion to debridement, nor with duration of symptoms > 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI.
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Affiliation(s)
- O Lesens
- Service des Maladies Infectieuses et Tropicales, Hôpital Gabriel Montpied, CRIOAc, CHU, Clermont-Ferrand, France.
- Laboratoire Microorganismes: Génome Environnement (LMGE) UMR 6023, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - T Ferry
- Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - E Forestier
- Service de Maladies Infectieuses, CH Métropole Savoie, Chambéry, France
| | - E Botelho-Nevers
- Service d'Infectiologie, CIC1408-Inserm, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint Etienne, 42055, Saint-Etienne, France
| | - P Pavese
- Service de Maladies Infectieuses, CHU Grenoble Alpes, Grenoble, France
| | - E Piet
- Service d'Infectiologie, CH Annecy Genevois, 74000, Annecy, France
| | - B Pereira
- CHU Clermont-Ferrand, DRCI-Biostatistique, Clermont-Ferrand, France
| | - E Montbarbon
- Service d'Orthopédie-Traumatologie, CH Metropole Savoie, Chambéry, France
| | - B Boyer
- Service Orthopédie, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint-Etienne, Saint-Etienne, France
| | - S Lustig
- Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - S Descamps
- Université Clermont- Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178, Aubiere, France
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30
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Gennai S, Ortiz S, Boussat B, François P, Pavese P. Evaluation of ceftriaxone prescriptions in the emergency department of a university hospital: an urgent need for improvement and alternative therapy. Eur J Clin Microbiol Infect Dis 2018; 37:2063-2068. [PMID: 30069616 DOI: 10.1007/s10096-018-3339-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/20/2018] [Indexed: 12/01/2022]
Abstract
To evaluate the relevance of ceftriaxone prescriptions in an emergency department of a university hospital and suggest whenever possible an antibiotic alternative with a lower ecological impact. All ceftriaxone prescriptions in the first complete week of each month during the year 2016, in the emergency department of the Grenoble university hospital, have been analyzed by an IDS referent in antibiotic prescriptions. Ceftriaxone prescription was considered appropriate if justified (an antibiotic must be used), relevant (ceftriaxone is a good choice), and adapted (in terms of dose, route, and period of administration), regardless of a potential antibiotic association, consistent with international recommendations. We considered patient outcome regarding the quality of initial prescription. Additionally, alternatives were suggested for relevant prescriptions. We included 327 patients, of which ceftriaxone prescriptions were not appropriate in 37.6% of cases: 13.5% were not justified, 12.8% not relevant, and 11.3% not adapted. The main factors associated with unjustified prescriptions were urinary, dermatological, and less frequent infection sites (p < 0.001). The main factors associated with irrelevant prescriptions were patients carrying multi-resistant bacteria (p = 0.002) or already following an antibiotic prescription at emergency department admission (p = 0.024). Antibiotic prescriptions were poorly adapted in patients with a creatinine rate over 150 μmol/L (p < 0.001) and septic shocks (p = 0.032). No difference was found concerning the hospital length of stay comparing appropriate initial prescriptions to inappropriate ones. However, alternatives with lower ecological impact were suggested in 55.2% of relevant prescriptions. In emergency departments, it is crucial to preserve ceftriaxone, selecting better indications and considering alternatives.
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Affiliation(s)
- Stéphane Gennai
- Emergency Department, Grenoble University Hospital, La Tronche, France. .,Emergency Department, Reims University Hospital, Reims, France.
| | - Stéphanie Ortiz
- Emergency Department, Grenoble University Hospital, La Tronche, France
| | - Bastien Boussat
- Quality of Care Unit, Grenoble University Hospital, La Tronche, France
| | - Patrice François
- Quality of Care Unit, Grenoble University Hospital, La Tronche, France
| | - Patricia Pavese
- Department of Infectious Diseases, Grenoble University Hospital, La Tronche, France
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Champey J, Mourey C, Francony G, Pavese P, Gay E, Gergele L, Manet R, Velly L, Bruder N, Payen JF. Strategies to reduce external ventricular drain-related infections: a multicenter retrospective study. J Neurosurg 2018; 130:1-6. [PMID: 29932377 DOI: 10.3171/2018.1.jns172486] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/02/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEVarious strategies have been proposed to reduce the incidence of external ventricular drain (EVD)-related infections. The authors retrospectively studied the impact of EVD care management on EVD-related infections at 3 French university hospital intensive care units.METHODSBetween 2010 and 2014, 462 consecutive adult patients with no evidence of a preexisting CSF infection received EVDs as part of their care at one of the following sites: Grenoble (221 patients), Saint-Etienne (130 patients), and Marseille (111 patients). Written protocols describing the EVD placement procedure, management, and removal were implemented at the 3 sites. Daily CSF sampling and intraventricular administration of antibiotics prior to EVD removal were performed at the Grenoble site only. EVD-related infection was considered for any confirmed ventriculostomy-related infection (VRI) and ventriculitis. VRI was defined as one or more positive CSF cultures or Gram stain with CSF pleocytosis and biochemical abnormalities. Ventriculitis was defined as CSF pleocytosis and biochemical abnormalities with degradation of neurological status and fever.RESULTSA total of 6945 EVD days were observed in the entire population. In the Grenoble cohort, the mean cumulative incidence of EVD-related infections was significantly lower than that in the 2 other cohorts: 1.4% (95% CI 0.0%-2.9%) versus 9.2% (95% CI 4.2%-14.2%) and 7.2% (95% CI 2.4%-12.0%) at Saint-Etienne and Marseille, respectively (p < 0.01). Accounting for the duration of external ventricular drainage at each site, the risk for EVD-related CSF infections was significantly higher at Saint-Etienne and Marseille than at Grenoble, with ORs of 15.9 (95% CI 3.6-71.4, p < 0.001) and 10.0 (95% CI 2.2-45.5, p = 0.003), respectively.CONCLUSIONSThese findings indicate that it is possible to attain a low incidence of EVD-related infections, provided that an EVD care bundle, which can include routine daily CSF sampling, is implemented and strongly adhered to.
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Affiliation(s)
| | | | | | | | | | | | | | - Lionel Velly
- 6Pôle Anesthésie Réanimation, CHU La Timone, Marseille
| | | | - Jean-François Payen
- 1Pôle Anesthésie Réanimation
- 7Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; and
- 8INSERM, U1216, Grenoble, France
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Charpentier E, Garnaud C, Wintenberger C, Bailly S, Murat JB, Rendu J, Pavese P, Drouet T, Augier C, Malvezzi P, Thiébaut-Bertrand A, Mallaret MR, Epaulard O, Cornet M, Larrat S, Maubon D. Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak1. Emerg Infect Dis 2018; 23:1237-1245. [PMID: 28726611 PMCID: PMC5547796 DOI: 10.3201/eid2308.161295] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pneumocystis jirovecii is a major threat for immunocompromised patients, and clusters of pneumocystis pneumonia (PCP) have been increasingly described in transplant units during the past decade. Exploring an outbreak transmission network requires complementary spatiotemporal and strain-typing approaches. We analyzed a PCP outbreak and demonstrated the added value of next-generation sequencing (NGS) for the multilocus sequence typing (MLST) study of P. jirovecii strains. Thirty-two PCP patients were included. Among the 12 solid organ transplant patients, 5 shared a major and unique genotype that was also found as a minor strain in a sixth patient. A transmission map analysis strengthened the suspicion of nosocomial acquisition of this strain for the 6 patients. NGS-MLST enables accurate determination of subpopulation, which allowed excluding other patients from the transmission network. NGS-MLST genotyping approach was essential to deciphering this outbreak. This innovative approach brings new insights for future epidemiologic studies on this uncultivable opportunistic fungus.
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Gallouche M, Barone-Rochette G, Pavese P, Bertrand B, Vanzetto G, Bouvaist H, Pierre I, Schmitt D, Fauconnier J, Caspar Y, Recule C, Picot-Guéraud R, Stahl JP, Mallaret MR, Landelle C. Incidence and prevention of infective endocarditis and bacteraemia after transcatheter aortic valve implantation in a French university hospital: a retrospective study. J Hosp Infect 2017; 99:94-97. [PMID: 29191610 DOI: 10.1016/j.jhin.2017.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/19/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication. Among 326 patients who underwent TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11 (3.4%) cases of bacteraemia were identified. No cases of IE were linked to the intervention; one was due to Staphylococcus aureus despite a screening and targeted decolonization strategy. This underscores the need for randomized studies to evaluate the benefit and cost-effectiveness of this policy.
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Affiliation(s)
- M Gallouche
- Hospital Hygiene Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - G Barone-Rochette
- Cardiology Unit, Grenoble Alpes University Hospital, Grenoble, France; INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Toulouse, France
| | - P Pavese
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - B Bertrand
- Cardiology Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - G Vanzetto
- Cardiology Unit, Grenoble Alpes University Hospital, Grenoble, France; INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, Toulouse, France
| | - H Bouvaist
- Cardiology Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - I Pierre
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - D Schmitt
- Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - J Fauconnier
- Medical Information Department, Grenoble Alpes University Hospital, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France
| | - Y Caspar
- Bacteriology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - C Recule
- Bacteriology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - R Picot-Guéraud
- Interhospital Network for Prevention of Nosocomial Infections, Grenoble Alpes University Hospital, Grenoble, France
| | - J P Stahl
- Infectious Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - M R Mallaret
- Hospital Hygiene Unit, Grenoble Alpes University Hospital, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France
| | - C Landelle
- Hospital Hygiene Unit, Grenoble Alpes University Hospital, Grenoble, France; University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France.
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kerneis S, Leroy J, Lescure X, Meyssonnier V, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: A 2017 update]. Med Mal Infect 2017; 47:439-442. [PMID: 28781198 DOI: 10.1016/j.medmal.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, CH Ajaccio, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, CH de Tourcoing, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses et tropicales, CH Sud Île-de-France, 77011 Melun, France
| | - R Gauzit
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - S Kerneis
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - J Leroy
- ARLIN BFC/PRIMAIR, service d'hygiène hospitalière et service de maladies infectieuses, CHRU de Besançon, 25030 Besançon, France
| | - X Lescure
- IAME UMR 1137 Inserm, service de maladies infectieuses et tropicales, AP-HP, hôpital Bichat-Claude Bernard, faculté Paris Diderot, 75018 Paris, France
| | - V Meyssonnier
- CRIOAC, médecine interne, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - V Mondain
- Service des maladies infectieuses, CHU de Nice, Nice, France
| | - P Pavese
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - C Rabaud
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | - J P Stahl
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 35033 Rennes, France
| | - F Roblot
- Service de médecine interne, maladies infectieuses et tropicales et Inserm U1070, CHU de Poitiers, 86021 Poitiers, France
| | - C Pulcini
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France.
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35
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Caspar Y, Maillet M, Pavese P, Francony G, Brion JP, Mallaret MR, Bonnet R, Robin F, Beyrouthy R, Maurin M. mcr-1 Colistin Resistance in ESBL-Producing Klebsiella pneumoniae, France. Emerg Infect Dis 2017; 23:874-876. [PMID: 28418313 PMCID: PMC5403025 DOI: 10.3201/eid2305.161942] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report intestinal carriage of an extended-spectrum β-lactamase−producing Klebsiella pneumoniae strain with high-level resistance to colistin (MIC 24 mg/L) in a patient in France who had been hospitalized for fungal meningitis. The strain had the mcr-1 plasmid gene and an inactivated mgrB gene, which are associated with colistin resistance.
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Godin C, Bonnet C, Vitrat V, Chidiac C, Boibieux A, Rogeaux O, Forestier E, Issartel B, Pavese P. Activité régionale d’infectiologie transversale : un impact possible sur la médecine générale et le parcours des patients. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.115] [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: 11/24/2022]
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37
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Ara-Somohano C, Bonadona A, Carpentier F, Pavese P, Vesin A, Hamidfar-Roy R, Minet C, Vanzetto G, Schwebel C, Timsit JF. Evaluation of eight biomarkers to predict short-term mortality in patients with acute severe dyspnea. Minerva Anestesiol 2017; 83:824-835. [PMID: 28275223 DOI: 10.23736/s0375-9393.17.10882-5] [Citation(s) in RCA: 10] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Being able to better predict risk and optimal care for patients presenting with acute dyspnea is critical. Prognostic biomarkers are well known: amino-terminal pro-B-type Natriuretic Peptide, troponin, C-reactive protein, procalcitonin. Some were more recently developed: mid-regional pro-A-type natriuretic peptide (Mid Pro-ANP), mid-regional-pro-adrenomedullin (MR-proADM), pro-endothelin, copeptin. The aim of the paper was to evaluate prognostic value of clinical findings and 8 biomarkers in patients with severe acute dyspnea. METHODS We designed a prospective cohort study targeting patients admitted in the Emergency Department and in Intensive Care Unit of a University Hospital. Inclusion criteria were acute dyspnea with SpO2 less than 92% and/or respiratory rate (RR) greater than or equal to 25 bpm. Clinical and biological data, including biomarker levels, were recorded. The contribution of the biomarkers in the prognosis was assessed using AUC-ROC curves and by multiple logistic regression. RESULTS Three hundred and eighty four patients (median age 74 years, 28-day mortality 17%) were enrolled. All biomarkers were available for 317 patients. Main diagnoses were sepsis in 141 cases (36.7%), and acute heart failure in 84 (21.9%) cases. All biomarkers were correlated with prognosis. Pro-ADM (AUC-ROC=0.731; 95% CI: 0.658-0.804) showed the best accuracy. The parameters independently associated with prognosis led to a clinical/biological model with an AUC=0.809 and a good calibration (P (HLchi2)=0.9). Three biomarkers added prognostic information to the model: MR-proADM (P=0.005), copeptin (P=0.006) and troponin (P=0.05). CONCLUSIONS Biomarkers can contribute to determine the day-28 outcome of patients with acute severe dyspnea.
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Affiliation(s)
| | | | | | | | - Aurélien Vesin
- University Joseph Fourier, Integrated Research Center Inserm U1039, "Radiopharmaceutical Bioclinical", Grenoble, France
| | | | | | - Gerald Vanzetto
- University Joseph Fourier, Integrated Research Center Inserm U1039, "Radiopharmaceutical Bioclinical", Grenoble, France.,Cardiovascular Unit, University Hospital, Grenoble, France
| | - Carole Schwebel
- Medical ICU, University Hospital, Grenoble, France.,University Joseph Fourier, Integrated Research Center Inserm U1039, "Radiopharmaceutical Bioclinical", Grenoble, France
| | - Jean-Francois Timsit
- University Joseph Fourier, Integrated Research Center Inserm U1039, "Radiopharmaceutical Bioclinical", Grenoble, France.,AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU, Paris, France.,IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
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38
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kernéis S, Leroy J, Lescure FX, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: What's new?]. Med Mal Infect 2016; 46:403-405. [PMID: 27856081 DOI: 10.1016/j.medmal.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 27, avenue Impératrice-Eugénie, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, centre hospitalier Tourcoing, 155, rue du Président-Coty, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - R Gauzit
- Réanimation Ollier, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Kernéis
- Fédération d'infectiologie, université Paris Descartes, UMR 1181, Institut Pasteur, hôpital Cochin, AP-HP, 75014 Paris, France
| | - J Leroy
- PRIMAIR (Programme régional interdisciplinaire pour la maîtrise de la résistance aux anti-infectieux) ARLin B-FC, service d'hygiène hospitalière de maladies infectieuses, CHU de Besançon, 3, boulevard A.-Fleming, 25030 Besançon, France
| | - F X Lescure
- Service des maladies infectieuses et UMR 1137, Inserm, faculté de Paris Diderot, hôpital Bichat-Claude-Bernard, AP-HP, 5, rue Thomas-Mann, 75013 Paris, France
| | - V Mondain
- Infectiologie, hôpital de L'Archet, CHU de Nice, 4, avenue Reine-Victoria, 06003 Nice, France
| | - P Pavese
- Maladies infectieuses, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Rabaud
- Fédération française d'infectiologie (CNP-FFI), 30, boulevard Pasteur, 75014 Paris, France
| | - J P Stahl
- Maladies infectieuses, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, Inserm U 835, université Rennes-I, hôpital Pontchaillou, rue du Thabor, 35000 Rennes, France
| | - F Roblot
- Service de médecine interne et maladies infectieuses, Inserm U1070, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Pulcini
- Service de maladies infectieuses et Tropicales, université de Lorraine, EA 4360 APEMAC, hôpitaux de Brabois, CHRU de Nancy, 54511 Vandœuvre-Lès-Nancy cedex, France.
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Franko B, Fournier P, Jouve T, Malvezzi P, Pelloux I, Brion JP, Pavese P. Lactobacillus bacteremia: Pathogen or prognostic marker? Med Mal Infect 2016; 47:18-25. [PMID: 27765476 DOI: 10.1016/j.medmal.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/29/2015] [Revised: 01/20/2016] [Accepted: 04/18/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Lactobacillus bacteremia is a rare event and its epidemiology is poorly known. Whether Lactobacillus bacteremia is a contaminant, a risk factor, or a risk marker of death remains an open question. PATIENTS AND METHODS We conducted a retrospective study of patients presenting with Lactobacillus bacteremia (LB), between January 2005 and December 2014, at the Grenoble University Hospital. RESULTS LB was observed in 38 patients (0.34% of all positive blood cultures). Cancer (40%), immunosuppression (37%), and use of central venous devices (29%) were frequently associated with LB. We observed a significant increase with time in the number of Lactobacillus positive blood cultures among all blood cultures performed (P=0.04). LBs were divided into two clinical-biological presentations: secondary bacteremia with a known portal of entry (n=30) and isolated bacteremia (n=8). Case fatality was 31% at D28, 55.2% at 1 year in the secondary bacteremia group, and 12.5% (both at D28 and 1 year) in the isolated bacteremia group. Secondary bacteremia with a known portal of entry was significantly associated with case fatality after adjustment for age, co-infection, cancer, immunosuppression, diabetes, and sex (OR 14.9 [1.04-216] P=0.047) for fatality at one year, but not for D28 fatality (P=0.14). CONCLUSION Lactobacillus bacteremia may be an important marker of disease severity rather than a pathogen, suggesting comorbidities. It should not be considered a contaminant, but should lead physicians to screen for associated infections and underlying diseases.
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Affiliation(s)
- B Franko
- Chronic Granulomatous Disease Diagnosis and Research Centre (CDiReC), Therex-TIMC/Imag, UMR CNRS 5525, UJF-Grenoble 1, CHU de Grenoble, 38043 Grenoble, France; Nephrology Unit, Centre Hospitalier Annecy-Genevois, 74370 Metz-Tessy, France.
| | - P Fournier
- Infectious department, Bacteriology, CHU Grenoble, 38043 Grenoble, France
| | - T Jouve
- Nephrology Unit, CHU Grenoble, 38043 Grenoble, France
| | - P Malvezzi
- Nephrology Unit, CHU Grenoble, 38043 Grenoble, France
| | - I Pelloux
- Infectious department, Bacteriology, CHU Grenoble, 38043 Grenoble, France
| | - J P Brion
- Infectious disease unit, CHU Grenoble, 38043 Grenoble, France
| | - P Pavese
- Infectious disease unit, CHU Grenoble, 38043 Grenoble, France
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40
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Champey J, Pavese P, Bouvaist H, Maillet M, Kastler A, Boussat B, Francois P. Is brain angio-MRI useful in infective endocarditis management? Eur J Clin Microbiol Infect Dis 2016; 35:2053-2058. [PMID: 27599711 DOI: 10.1007/s10096-016-2764-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
In infective endocarditis (IE), brain magnetic resonance imaging (MRI) is helpful to diagnose clinically silent neurological events. We assessed the usefulness of systematic early brain MRI in IE diagnosis and medico-surgical management. Over a period of 1 year, all patients admitted in one of the three hospitals participating in and fulfilling the Duke criteria for definite or possible IE underwent cerebral MRI within 7 days of IE suspicion. Eight panels of experts analyzed the records a posteriori. For each case, one record with and one record without the MRI results were randomly assigned to two panels, which determined the theoretical diagnosis and treatment. Paired comparisons were performed using a symmetry test. Thirty-seven brain MRIs were performed within a median of 5 days after inclusion. MRI was pathological in 26 patients (70 %), showing 62 % microischemia and 58 % microbleeds. The expert advice did not differ significantly between the two evaluations (with or without the MRI results). The therapeutic strategies determined diverged in five cases (13.5 %). Diagnosis differed in two cases (5.4 %), with an upgrading of diagnosis from possible to definite IE using MRI results. Early brain MRI did not significantly affect the IE diagnosis and medico-surgical treatment plan. These results suggest that systematic use of early brain MRI is irrelevant in IE. Further studies are necessary to define whether MRI is mandatory in IE management within a multidisciplinary approach, with particular attention paid to better timing and the subset of patients in whom this imaging examination could be beneficial.
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Affiliation(s)
- J Champey
- Intensive Care Medicine, CHU de Grenoble, BP 218, 38043, Grenoble Cedex 9, France.
| | - P Pavese
- Infectious Disease Department, CHU Grenoble, Grenoble, France
| | - H Bouvaist
- Cardiology Department, CHU Grenoble, Grenoble, France
| | - M Maillet
- Infectious Disease Department, CHU Grenoble, Grenoble, France
| | - A Kastler
- Neuroradiology Department, CHU Grenoble, Grenoble, France
| | - B Boussat
- Public Health Department, CHU Grenoble, Grenoble, France
| | - P Francois
- Public Health Department, CHU Grenoble, Grenoble, France
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Bailly S, Garnaud C, Cornet M, Pavese P, Hamidfar-Roy R, Foroni L, Boisset S, Timsit JF, Maubon D. Impact of systemic antifungal therapy on the detection of Candida species in blood cultures in clinical cases of candidemia. Eur J Clin Microbiol Infect Dis 2016; 35:1023-32. [DOI: 10.1007/s10096-016-2633-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/18/2016] [Indexed: 01/19/2023]
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Van Hollebeke M, Chapuis C, Bernard S, Foroni L, Stahl JP, Bedouch P, Pavese P. Compliance with carbapenem guidelines in a university hospital. Med Mal Infect 2016; 46:72-8. [PMID: 26874673 DOI: 10.1016/j.medmal.2015.10.009] [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: 03/13/2015] [Revised: 08/17/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to evaluate carbapenem prescription compliance with guidelines for nosocomial and community-acquired infections. PATIENTS AND METHODS We conducted a prospective study over a four-month period at our university hospital. We included all adult and pediatric hospitalized patients who had received at least one dose of carbapenem. Data was collected from patients' medical records (hard copy and computerized data; CristalLink software). Compliance with guidelines was assessed by two infectious disease specialists. Assessment criteria included indication, antibiotic choice, dosage, and treatment duration. RESULTS We included 152 patients in the study (65.4% of men). Carbapenem prescription was appropriate for 76.3% of prescriptions. The use of carbapenems was considered appropriate for 73.9% of empirical prescriptions and for 77.8% of documented prescriptions. Non-compliance with guidelines was mainly due to prescriptions for community-acquired infections. Antibiotic de-escalation could not be initiated in 40.3% of patients and was only initiated in 51.7% of patients for whom it could be considered. Although the average treatment duration was 7.5 days, 23.7% of patients received carbapenems for more than 10 days. CONCLUSION These results highlight the need for a strong carbapenem stewardship program in our hospital.
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Affiliation(s)
- M Van Hollebeke
- Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - C Chapuis
- Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - S Bernard
- Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - L Foroni
- Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - J P Stahl
- Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - P Bedouch
- Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - P Pavese
- Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
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Fraison JB, Sève P, Dauphin C, Mahr A, Gomard-Mennesson E, Varron L, Pugnet G, Landron C, Roblot P, Oziol E, Chalhoub G, Galempoix JM, Humbert S, Humbert P, Sbidian E, Grange F, Bayrou O, Cathebras P, Morlat P, Epaulard O, Pavese P, Huong DLT, Zoulim A, Stankovic K, Bachelez H, Smail A, Bachmeyer C, Granel B, Serratrice J, Brinchault G, Mekinian A, Costedoat-Chalumeau N, Bourgarit-Durand A, Puéchal X, Guillevin L, Piram M, Koné-Paut I, Fain O. Kawasaki disease in adults: Observations in France and literature review. Autoimmun Rev 2015; 15:242-9. [PMID: 26631821 DOI: 10.1016/j.autrev.2015.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 11/04/2015] [Accepted: 11/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is a vasculitis that mostly occurs in young children and rarely in adults. We analyzed the characteristics of adult-onset KD (AKD) in France. METHODS We collected retrospective and prospective data for patients with a diagnosis of KD occurring after the age of 18 years. Cases were obtained via various French medical networks and identified from the international literature. RESULTS We included 43 patients of AKD at 26 institution from 1992 to 2015, with mean (SD) age 30 (11) years (range 18-68) and sex ratio (M/F) 1.2; 34 patients met the American Heart Association criteria and 9 were incomplete AKD. The median time to diagnosis was 13 days (interquartile range 8-21). The main symptoms were fever (100%), exanthema (98%), changes in the extremities (91%), conjunctivitis (77%), oral cavity changes (89%), cervical adenitis (55%) and cardiac abnormalities (45%). Overall, 35% of patients showed large-vessel vasculitis: coronary vasculitis (26%) and coronary aneurysm (19%). Treatment was mostly intravenous immunoglobulins (79%) and aspirin (81%). Four patients showed myocardial infarction due to coronary vasculitis, but none were treated with IVIg because of late diagnosis. After a median follow-up of 5 months (range 1-117), persistent aneurysm was noted in 9% of cases. Damage was significantly lower with early treatment than late or no treatment (p=0.01). CONCLUSION Given the high frequency of cardiac involvement and complications in this series of AKD, diagnosis and treatment should not be delayed, and early IVIg treatment seems to improve the outcome.
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Affiliation(s)
- Jean-Baptiste Fraison
- Service de Médecine Interne, Hôpital Saint Louis, AP HP, Université Diderot, France.
| | - Pascal Sève
- Service de Médecine Interne, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, Université de Lyon, France
| | - Claire Dauphin
- Service de Cardiologie, Hôpital Gabriel Montpied, Université de Clermont-Ferrand, France
| | - Alfred Mahr
- Service de Médecine Interne, Hôpital Saint Louis, AP HP, Université Diderot, France
| | | | - Loig Varron
- Service de Médecine Interne, Centre Hospitalier de Montélimar, France
| | - Gregory Pugnet
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, France
| | - Cédric Landron
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, France
| | - Pascal Roblot
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, France
| | - Eric Oziol
- Service de Médecine Interne, Centre Hospitalier de Béziers, France
| | - Gihane Chalhoub
- Service de Médecine Interne, Centre Hospitalier de Metz-Thionville, France
| | - Jean-Marc Galempoix
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, France
| | - Sébastien Humbert
- Service de Médecine Interne, Centre Hospitalier Universitaire de Besançon, France
| | - Philippe Humbert
- Service de Dermatologie, Centre Hospitalier Universitaire de Besançon, University of Franche-Comté, INSERM UMR1098, SFR FED 4234 IBCT, Besançon, France
| | - Emilie Sbidian
- Service de Dermatologie, Hôpital Henri Mondor, AP HP, Université Paris Est, France
| | - Florent Grange
- Service de Dermatologie, Centre Hospitalier Universitaire de Reims, France
| | - Olivier Bayrou
- Service de Dermatologie, Hôpital Tenon, AP HP, Université Pierre et Marie Curie, France
| | - Pascal Cathebras
- Service de Médecine Interne, Centre Hospitalier Universitaire de St Etienne, France
| | - Philippe Morlat
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Bordeaux, France
| | - Olivier Epaulard
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, France
| | - Patricia Pavese
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, France
| | - Du Le Thi Huong
- Service de Médecine Interne 2, Hôpital La Pitié-Salpétrière, AP HP, Université Pierre et Marie Curie, France
| | - Abdelkader Zoulim
- Service de Médecine Interne, Centre Hospitalier Universitaire de Caen, France
| | - Katia Stankovic
- Service de Médecine Interne, Hôpital Tenon, AP HP, Université Pierre et Marie Curie, France
| | - Hervé Bachelez
- Service de Dermatologie, Hôpital Saint Louis, AP HP, Université Diderot, France
| | - Amar Smail
- Service de Médecine Interne, Centre Hospitalier Universitaire d'Amiens, France
| | - C Bachmeyer
- Service de Médecine Interne, Centre Hospitalier de Creil, France
| | | | | | | | - Arsène Mekinian
- Service de Médecine Interne, DHUi2B, Hôpital Saint Antoine, AP HP, Université Pierre et Marie Curie, France
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques et Autoimmunes Rares, AP HP, Université Paris Descartes, France
| | - Anne Bourgarit-Durand
- Service de Médecine Interne, Hôpital Jean Verdier, AP HP, Université Leonard de Vinci, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques et Autoimmunes Rares, AP HP, Université Paris Descartes, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques et Autoimmunes Rares, AP HP, Université Paris Descartes, France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique, Centre de Référence des Maladies Auto-Inflammatoires de l'enfant, Hôpital Bicêtre, AP HP, Université Paris Sud, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique, Centre de Référence des Maladies Auto-Inflammatoires de l'enfant, Hôpital Bicêtre, AP HP, Université Paris Sud, France
| | - Olivier Fain
- Service de Médecine Interne, DHUi2B, Hôpital Saint Antoine, AP HP, Université Pierre et Marie Curie, France
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Champey J, Pavese P, Bouvaist H, Kastler A, Krainik A, Francois P. Value of brain MRI in infective endocarditis: a narrative literature review. Eur J Clin Microbiol Infect Dis 2015; 35:159-68. [PMID: 26585337 PMCID: PMC4724368 DOI: 10.1007/s10096-015-2523-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 10/07/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Abstract
The nervous system is frequently involved in patients with infective endocarditis (IE). A systematic review of the literature was realized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). This study sought to systematically evaluate the published evidence of the contribution of brain magnetic resonance imaging (MRI) in IE. The aim was to identify studies presenting the incidence and type of MRI brain lesions in IE. Fifteen relevant studies were isolated using the Medline, Embase, and Cochrane databases. Most of them were observational studies with a small number of patients. MRI studies demonstrated a wide variety and high frequency of cerebral lesions, around 80 % of which were mostly clinically occult. This review shows MRI’s superiority compared to brain computed tomography (CT) for the diagnosis of neurologic complications. Recent developments of sensitive MRI sequences can detect microinfarction and cerebral microhemorrhages. However, the clinical significance of these microhemorrhages, also called cerebral microbleeds (CMBs), remains uncertain. Because some MRI neurological lesions are a distinctive IE feature, they can have a broader involvement in diagnosis and therapeutic decisions. Even if cerebral MRI offers new perspectives for better IE management, there is not enough scientific proof to recommend it in current guidelines. The literature remains incomplete regarding the impact of MRI on concerted decision-making. The long-term prognosis of CMBs has not been evaluated to date and requires further studies. Today, brain MRI can be used on a case-by-case basis based on a clinician’s appraisal.
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Affiliation(s)
- J Champey
- Medical Intensive Care Department, CHU de Grenoble, BP 218, 38043, Grenoble Cedex 9, France.
| | - P Pavese
- Infectious Diseases Department, CHU de Grenoble, BP 218, 38043, Grenoble Cedex 9, France.
| | - H Bouvaist
- Cardiology Department, CHU Grenoble, Grenoble, France
| | - A Kastler
- Neuroradiology Department, CHU Grenoble, Grenoble, France
| | - A Krainik
- Neuroradiology Department, CHU Grenoble, Grenoble, France
| | - P Francois
- Public Health Department, CHU Grenoble, Grenoble, France
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45
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Champey J, Pavese P, Bouvaist H, Vittoz JP, Tahon F, Eker OF, Goutier S, Recule C, Francois P. Cerebral imaging in infectious endocarditis: A clinical study. Infect Dis (Lond) 2015; 48:235-40. [PMID: 26567595 DOI: 10.3109/23744235.2015.1109704] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Because neurological failure is the most frequent extra-cardiac complication in Infectious Endocarditis (IE), a brain computerised tomography (CT) scan is usually performed. The benefits of magnetic resonance imaging (MRI) have not been clearly established. This study aims to clarify the prevalence and type of cerebral lesions in IE detected using MRI and to compare them with those detected using CT scans. METHODS In the Grenoble University Hospital, patients diagnosed with definite or possible endocarditis according to Duke's criteria were screened from 2010-2012. Brain CT and MRI were performed as soon as possible after diagnosis. RESULTS Of the 62 patients with IE who underwent at least one cerebral imaging within 3 weeks of diagnosis, Streptococcus (29) and Staphylococcus (14) were the main micro-organisms present. Twenty-eight (45%) patients underwent cardiac surgery. Eight (13%) died before discharge. Twenty (32%) had neurological symptoms. A brain CT-scan was performed on 53 (85%) patients and a MRI was performed on 43 (69%) patients. CT was pathological in 26 (49%) patients, whereas 32 (74%) MRI demonstrated abnormalities. The MRI lesions were classified as follows: ischaemia (48%), microbleeds (34%), haemorrhages (16%), abscesses (9%) and microbial aneurysms (4%). Of the 37 patients who underwent both MRI and CT examinations, ischaemia (48% vs 35%) and microbleeds (34%) demonstrated the difference between the two imaging methods. CONCLUSION Through the early diagnosis of cerebral damage, even in asymptomatic cases, MRI may have a role in the IE management, influence any surgical decision and assist in prognosis assessment.
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Affiliation(s)
| | | | | | | | | | - Omer F Eker
- f Neuroradiology Department , CHU Montpellier , France
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46
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Maillet M, Pavese P, Bruley D, Seigneurin A, François P. Is prosthesis retention effective for chronic infections in hip arthroplasties? A systematic literature review. Eur J Clin Microbiol Infect Dis 2015; 34:1495-502. [PMID: 25926304 DOI: 10.1007/s10096-015-2388-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/10/2015] [Indexed: 01/28/2023]
Abstract
The success rate of prosthesis removal as the standard approach to manage chronic infection in hip arthroplasties (HA) is 80-90 %. The effectiveness of prosthesis retention, with or without surgical debridement, to treat patients with chronic HA infection (symptom duration of more than 4 weeks) has not been well established, whereas this strategy is sometimes used in clinical practice. This study aimed to explore the cumulative incidence of failure of chronic HA infections treated with prosthesis retention, with or without debridement. A systematic literature review was conducted in accordance with the methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies concerning patients with chronically infected HA treated with prosthesis retention were included. The primary outcome was the cumulative risk of failure. We searched the MEDLINE, Embase, and Cochrane databases up to April 2014. The database searches provided a total of 1,213 studies for potential inclusion in the review. Six relevant studies were finally identified, corresponding to 29 patients included. Their treatments consisted of prosthesis retention with debridement. This strategy failed for 14 out of these 29 patients after a 1-year follow-up. The failure rate of the prosthesis retention approach associated to debridement for chronic infection in HA is 48.3 % in this review. Debridement and prosthesis retention in association with prolonged antimicrobial treatment may be an advantageous alternative to arthroplasty exchange for frail patients. The difficulty in finding relevant studies illustrates the challenges of interpreting the existing literature for the management of chronic prosthetic joint infection (PJI).
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Affiliation(s)
- M Maillet
- Infectious Diseases Department, Grenoble University Hospital, CHU de Grenoble BP 218, 38043, Grenoble Cedex 9, France,
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47
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Bedouch P, Labarère J, Chirpaz E, Allenet B, Lepape A, Fourny M, Pavese P, Girardet P, Merloz P, Saragaglia D, Calop J, Francois P. Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital. Infect Control Hosp Epidemiol 2015; 25:302-7. [PMID: 15108727 DOI: 10.1086/502396] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.Design:Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.Setting:Orthopedic surgery wards in a 2,200-bed French teaching hospital.Patients:A random sample of 416 patients undergoing THR from January 1999 to December 2000.Results:Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).Conclusion:The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.
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Affiliation(s)
- Pierrick Bedouch
- Unité d'Evaluation Médicale, Centre Hospitalier Universitaire de Grenoble, France
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Fabien L, Foroni L, Brion JP, Maubon D, Stahl JP, Pavese P. [Adequacy of antifungal agents in a teaching hospital: too many inappropriate prescriptions despite training]. Presse Med 2014; 43:e241-50. [PMID: 24972851 DOI: 10.1016/j.lpm.2013.11.029] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/15/2013] [Accepted: 05/14/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess adequacy and conformity of systemic antifungal drugs prescriptions in comparison with local, French, European and international recent guidelines in the Grenoble Teaching Hospital. METHODS Each prescription of itraconazole, liposomal amphotericin B, voriconazole, caspofungin, micafungin, posaconazole and anidulafungin made between February and October 2010 were reviewed by an infectious diseases specialist. Fluconazole prescriptions' were reviewed only for 15 days. RESULTS Two hundred and eight patients received 295 systemic antifungal prescriptions. Most of them had at least one risk factor and immunodeficiency was one of the most common. Antifungal treatment starting, molecules choice, administrations conformity (dosage, administration way) were appropriate in 126 cases on 208 (60.5 %) at the treatment beginning evaluation and in 171 cases on 295 (58 %) at the treatment ending evaluation. Antifungal combinations (9.4 %) were less frequent than in the study carried out in Grenoble teaching hospital in 2007 (16.3 %). Most common non-conformities encountered were use of caspofungin instead of fluconazole, antifungal combinations prescription, administration modalities misguiding. The economy that could have been generated by appropriate prescriptions represented 18 % of the antifungal budget of 2010 in the Grenoble Teaching Hospital. CONCLUSION An improvement was highlighted in the antifungal prescriptions in comparison to the previous study led in 2007 in the Universitary Grenoble Hospital. However, the antifungal use was not optimal and further training is planned.
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Affiliation(s)
- Laetitia Fabien
- Université Joseph-Fourier-Grenoble 1, maladies infectieuses, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France.
| | - Luc Foroni
- Université Joseph-Fourier-Grenoble 1, pharmacie hospitalière, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Jean-Paul Brion
- Université Joseph-Fourier-Grenoble 1, maladies infectieuses, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Danièle Maubon
- Université Joseph-Fourier-Grenoble 1, laboratoire de parasitologie, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Jean-Paul Stahl
- Université Joseph-Fourier-Grenoble 1, maladies infectieuses, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Patricia Pavese
- Université Joseph-Fourier-Grenoble 1, maladies infectieuses, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
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Chumpitazi BFF, Lebeau B, Faure-Cognet O, Hamidfar-Roy R, Timsit JF, Pavese P, Thiebaut-Bertrand A, Quesada JL, Pelloux H, Pinel C. Characteristic and clinical relevance of Candida mannan test in the diagnosis of probable invasive candidiasis. Med Mycol 2014; 52:462-71. [DOI: 10.1093/mmy/myu018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Chiquet C, Khayi H, Puech C, Tonini M, Pavese P, Aptel F, Romanet JP. Atteinte oculaire de la syphilis. J Fr Ophtalmol 2014; 37:329-36. [DOI: 10.1016/j.jfo.2013.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/16/2022]
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