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Monard C, Bianchi N, Kelevina T, Altarelli M, Schneider A. Epidemiology and outcomes of early versus late septic acute kidney injury in critically ill patients: A retrospective cohort study. Anaesth Crit Care Pain Med 2024; 43:101332. [PMID: 38043859 DOI: 10.1016/j.accpm.2023.101332] [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: 04/27/2023] [Revised: 09/26/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND It was recently proposed to distinguish early from late sepsis-associated acute kidney injury (SA-AKI). We aimed to determine the relative frequency of these entities in critically ill patients and to describe their characteristics and outcomes. METHODS We included in this retrospective cohort study all adult patients admitted for sepsis in a tertiary ICU between 2010 and 2020. We excluded those on chronic dialysis or without consent. We extracted serum creatinine, hourly urinary output, and clinical and socio-demographic data from medical records until day 7 or ICU discharge. AKI presence and characteristics were assessed daily using KDIGO criteria. We compared patients with early (occurring within 2 days of admission) or late (occurring between day 2 and day 7) SA-AKI. We conducted sensitivity analyses using different definitions for early/late SA-AKI. RESULTS Among 1835 patients, 1660 (90%) fulfilled SA-AKI criteria. Of those, 1610 (97%) had early SA-AKI, and 50 (3%) had late SA-AKI. Similar proportions were observed when only considering AKI with elevated sCr (71% vs. 3%), severe AKI (67% vs. 6%), or different time windows for early SA-AKI. Compared with early SA-AKI patients, those with late SA-AKI were younger (median age [IQR] 59 [49-70] vs. 69 [58-76] years, p < 0.001), had lower Charlson comorbidity index (3 [1-5] vs. 5 [3-7], p < 0.001) and lower SAPSII scores (41 [34-50] vs. 53 [43-64], p < 0.001). They had similar (24% vs. 26%, p = 0.75) in-hospital mortality. CONCLUSIONS AKI is almost ubiquitous in septic critically ill patients and present within two days of admission. The timing from ICU admission might not be relevant to distinguish different phenotypes of SA-AKI. ETHICS APPROVAL Ethics Committee Vaud, Lausanne, Switzerland (n°2017-00008).
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Affiliation(s)
- Céline Monard
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nathan Bianchi
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Tatiana Kelevina
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Marco Altarelli
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
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Monard C, Rimmelé T, Blanc E, Goguillot M, Bénard S, Textoris J. Economic burden of in-hospital AKI: a one-year analysis of the nationwide French hospital discharge database. BMC Nephrol 2023; 24:343. [PMID: 37990296 PMCID: PMC10664266 DOI: 10.1186/s12882-023-03396-8] [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: 07/05/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Although Acute Kidney Injury (AKI) incidence is increasing worldwide, data investigating its cost are lacking. This population-wide study aimed to describe the characteristics and costs of hospital stays with, and without AKI, and to estimate the AKI-associated increases in costs and length of stay (LOS) in three subgroups (major open visceral surgery (MOV), cardiovascular surgery with extracorporeal circulation (CVEC), and sepsis). METHODS All hospital stays that occurred in France in 2018 were included. Stay and patient characteristics were collected in the French hospital discharge database and described. Medical conditions were identified using the 10th International Classification of Diseases and the medical acts classification. In each subgroup, the adjusted increase in cost and LOS associated with AKI was estimated using a generalized linear model with gamma distribution and a log link function. RESULTS 26,917,832 hospital stays, of which 415,067 (1.5%) with AKI, were included. AKI was associated with 83,553 (19.8%), 7,165 (17.9%), and 15,387 (9.2%) of the stays with sepsis, CVEC, and MOV, respectively. Compared to stays without AKI, stays with AKI were more expensive (median [IQR] €4,719[€2,963-€7782] vs. €735[€383-€1,805]) and longer (median [IQR] 9[4-16] vs. 0[0-2] days). AKI was associated with a mean [95%CI] increase in hospitalization cost of 70% [69;72], 48% [45;50], and 68% [65;70] in the sepsis, CVEC, and MOV groups respectively, after adjustment. CONCLUSION This study confirms the major economic burden of in-hospital AKI in a developed country. Interventions to prevent AKI are urgently needed and their cost should be balanced with AKI-related costs.
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Affiliation(s)
- Céline Monard
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
- EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1, Biomérieux, Hospices Civils de Lyon, Lyon, France.
| | - Thomas Rimmelé
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1, Biomérieux, Hospices Civils de Lyon, Lyon, France
| | - Esther Blanc
- SA, Global Medical Affairs, bioMerieux, Marcy-L'Étoile, France
| | | | | | - Julien Textoris
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- SA, Global Medical Affairs, bioMerieux, Marcy-L'Étoile, France
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Abraham P, Monard C, Lamblin A, Schneider A, Rimmelé T. Hemoperfusion in Burns. Contrib Nephrol 2023; 200:160-168. [PMID: 37290418 DOI: 10.1159/000527709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/23/2022] [Indexed: 06/10/2023]
Abstract
Patients with severe thermal injury require urgent specialized care in burn units. These units assure good coordination of a bundle of care including fluid resuscitation, nutritional support, respiratory care, surgical care and wound care, infection prevention, and rehabilitation. When severely injured, burn patients present a systemic inflammatory response syndrome, associated with a dysregulated immune homeostasis. This complex host response exposes patients to prolonged hospitalization with suppressed immune function, increased susceptibility to secondary infections, longer organ support, and increased mortality. To date, several strategies, such as hemoperfusion techniques, have been developed to mitigate immune activation. We propose herein a review of the immune response to burn injury and the rationale and potential applications of extracorporeal blood purification techniques such as hemoperfusion for burn patients' management.
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Affiliation(s)
- Paul Abraham
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Céline Monard
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Antoine Lamblin
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Antoine Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,
- EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France,
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Bianchi NA, Altarelli M, Monard C, Kelevina T, Chaouch A, Schneider AG. Identification of an optimal threshold to define oliguria in critically ill patients: an observational study. Crit Care 2023; 27:207. [PMID: 37254158 DOI: 10.1186/s13054-023-04505-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The relevance of current consensus threshold to define oliguria has been challenged by small observational studies. We aimed to determine the optimal threshold to define oliguria in critically-ill patients. METHODS Cohort study including adult patients admitted within a multi-disciplinary intensive care unit between January 1st 2010 and June 15th 2020. Patients on chronic dialysis or who declined consent were excluded. We extracted hourly urinary output (UO) measurements along with patient's characteristics from electronic medical records and 90-day mortality from the Swiss national death registry. We randomly split our data into a training (80%) and a validation (20%) set. In the training set, we developed multivariable models to assess the relationship between 90-day mortality and the minimum average UO calculated over time windows of 3, 6, 12 and 24 h. Optimal thresholds were determined by visually identifying cut-off values for the minimum average UO below which predicted mortality increased substantially. We tested models' discrimination and calibration on the entire validation set as well as on a subset of patients with oliguria according to proposed thresholds. RESULTS Among the 15,500 patients included in this analysis (training set: 12,440, validation set: 3110), 73.0% (95% CI [72.3-73.8]) presented an episode of oliguria as defined by consensus criteria (UO < 0.5 ml/kg/h for 6 h). Our models had excellent (AUC > 85% for all time windows) discrimination and calibration. The relationship between minimum average UO and predicted 90-day mortality was nonlinear with an inflexion point at 0.2 ml/kg/h for 3 and 6 h windows and 0.3 ml/kg/h for 12 and 24 h windows. Considering a threshold of < 0.2 ml/kg/h over 6 h, the proportion of patients with an episode of oliguria decreased substantially to 24.7% (95% CI [24.0-25.4]). Contrary to consensus definition, this threshold identified a population with a higher predicted 90-day mortality. CONCLUSIONS The widely used cut-off for oliguria of 0.5 ml/kg/h over 6 h may be too conservative. A cut-off of 0.2 ml/kg/h over 3 or 6 h is supported by the data and should be considered in further definitions of oliguria.
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Affiliation(s)
- Nathan Axel Bianchi
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marco Altarelli
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland
| | - Céline Monard
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland
| | - Tatiana Kelevina
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland
| | - Aziz Chaouch
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Antoine Guillaume Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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von Groote T, Meersch M, Romagnoli S, Ostermann M, Ripollés-Melchor J, Schneider AG, Vandenberghe W, Monard C, De Rosa S, Cattin L, Rahmel T, Adamzik M, Parise D, Candela-Toha A, Haaker JG, Göbel U, Bernard A, Lumlertgul N, Fernández-Valdes-Bango P, Romero Bhathal I, Suarez-de-la-Rica A, Larmann J, Villa G, Spadaro S, Wulf H, Arndt C, Putensen C, García-Álvarez R, Brandenburger T, Siniscalchi A, Ellerkmann R, Espeter F, Porschen C, Sadjadi M, Saadat-Gilani K, Weiss R, Gerss J, Kellum J, Zarbock A. Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): study protocol for an international, prospective, randomised controlled multicentre trial. BMJ Open 2023; 13:e070240. [PMID: 36972972 PMCID: PMC10069589 DOI: 10.1136/bmjopen-2022-070240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Previous studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation. METHODS AND ANALYSIS The BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage. ETHICS AND DISSEMINATION The BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Münster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research. TRIAL REGISTRATION NUMBER NCT04647396.
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Affiliation(s)
- Thilo von Groote
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Melanie Meersch
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence; Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospitals NHS Trust, London, London, UK
| | | | | | - Wim Vandenberghe
- Department of Intensive Care Medicine, Universiteit Gent, Gent, Belgium
| | - Céline Monard
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Lyon, Rhône-Alpes, France
| | - Silvia De Rosa
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital of Vicenza, Vicenza, Veneto, Italy
- Department of Intensive Care Medicine, Centre for Medical Sciences, CISMed, University of Trento, Trento, Trentino-Alto Adige, Italy
| | - Lucia Cattin
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital of Vicenza, Vicenza, Veneto, Italy
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Michael Adamzik
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Diego Parise
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Angel Candela-Toha
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Jan Gerrit Haaker
- Department of Anesthesiology and Intensive Care, St Franziskus-Hospital Münster GmbH, Munster, Nordrhein-Westfalen, Germany
| | - Ulrich Göbel
- Department of Anesthesiology and Intensive Care, St Franziskus-Hospital Münster GmbH, Munster, Nordrhein-Westfalen, Germany
| | - Alice Bernard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, University of Tübingen, Tubingen, Baden-Württemberg, Germany
| | - Nuttha Lumlertgul
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospitals NHS Trust, London, London, UK
- Division of Nephrology, Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Bangkok, Thailand
| | | | - Irene Romero Bhathal
- Department of Anaesthesiology and Intensive Care Medicine, Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalunya, Spain
| | - A Suarez-de-la-Rica
- Department of Anesthesiology and Critical Care, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Department of Anaesthesiology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jan Larmann
- Department of Anaesthesia, Heidelberg University Hospital, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence; Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, St. Anne's Archbishop Hospital, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Hinnerk Wulf
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | - Christian Arndt
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | - Christian Putensen
- Department of Anesthesiology and Surgical Intensive Care Medicine, Division of Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Raquel García-Álvarez
- Department of Anesthesia and Intensive Care, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Timo Brandenburger
- Anesthesiology and Critical Care Medicine, Heinrich Heine University Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Antonio Siniscalchi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia-Romagna, Italy
| | - Richard Ellerkmann
- Department of Anesthesiology, Intensive Care, Pain Medicine and Palliative Care Medicine, Hospital Dortmund, Dortmund, Germany
| | - Florian Espeter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Christian Porschen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Mahan Sadjadi
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Khaschayar Saadat-Gilani
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Raphael Weiss
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Munster, Nordrhein-Westfalen, Germany
| | - John Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
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Monard C, Abraham P, Schneider A, Rimmelé T. New Targets for Extracorporeal Blood Purification Therapies in Sepsis. Blood Purif 2023; 52:1-7. [PMID: 35717943 DOI: 10.1159/000524973] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
As highlighted by the last international consensus definition for sepsis and septic shock (sepsis-3), sepsis comes from a complex relationship between a pathogen and a dysregulated host response. To date, the treatment of sepsis is based on antimicrobial treatment, source control, and organ support. Extracorporeal blood purification therapies have been proposed as adjuvant therapies to modulate the dysregulated inflammatory response. These therapies aim mostly at removing inflammatory mediators (cytokines) and endotoxins from the blood. However, so far, they failed to clearly demonstrate an improvement in patient survival when evaluated in randomized trials. Recently, new devices directly targeting the primary determinants of sepsis, e.g., the pathogen itself and the host immune cells, have been developed. This short review aimed at presenting new blood purification devices that have recently been developed to target pathogens and immune cells. For each, we will present the mechanism of action of the therapy and discuss the related literature.
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Affiliation(s)
- Céline Monard
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France.,EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Paul Abraham
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Antoine Schneider
- Adult Intensive Care Unit and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France.,EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
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Monard C, Bianchi N, Poli E, Altarelli M, Debonneville A, Oddo M, Liaudet L, Schneider A. Cytokine hemoadsorption with CytoSorb ® in post-cardiac arrest syndrome, a pilot randomized controlled trial. Crit Care 2023; 27:36. [PMID: 36691082 PMCID: PMC9869834 DOI: 10.1186/s13054-023-04323-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hemoadsorption (HA) might mitigate the systemic inflammatory response associated with post-cardiac arrest syndrome (PCAS) and improve outcomes. Here, we investigated the feasibility, safety and efficacy of HA with CytoSorb® in cardiac arrest (CA) survivors at risk of PCAS. METHODS In this pilot randomized controlled trial, we included patients admitted to our intensive care unit following CA and likely to develop PCAS: required norepinephrine (> 0.2 µg/kg/min), and/or had serum lactate > 6 mmol/l and/or a time-to-return of spontaneous circulation (ROSC) > 25 min. Those requiring ECMO or renal replacement therapy were excluded. Eligible patients were randomly allocated to either receive standard of care (SOC) or SOC plus HA. Hemoadsorption was performed as stand-alone therapy for 24 h, using CytoSorb® and regional heparin-protamine anticoagulation. We collected feasibility, safety and clinical data as well as serial plasma cytokines levels within 72 h of randomization. RESULTS We enrolled 21 patients, of whom 16 (76%) had out-of-hospital CA. Median (IQR) time-to-ROSC was 30 (20, 45) minutes. Ten were assigned to the HA group and 11 to the SOC group. Hemoadsorption was initiated in all patients allocated to the HA group within 18 (11, 23) h of ICU admission and conducted for a median duration of 21 (14, 24) h. The intervention was well tolerated except for a trend for a higher rate of aPTT elevation (5 (50%) vs 2 (18%) p = 0.18) and mild (100-150 G/L) thrombocytopenia at day 1 (5 (50%) vs 2 (18%) p = 0.18). Interleukin (IL)-6 plasma levels at randomization were low (< 100 pg/mL) in 10 (48%) patients and elevated (> 1000 pg/mL) in 6 (29%). The median relative reduction in IL-6 at 48 h was 75% (60, 94) in the HA group versus 5% (- 47, 70) in the SOC group (p = 0.06). CONCLUSIONS In CA survivors at risk of PCAS, HA was feasible, safe and was associated with a nonsignificant reduction in cytokine plasma levels. Future trials are needed to further define the role of HA after CA. Those studies should include cytokine assessment to enrich the study population. TRIAL REGISTRATION NCT03523039, registered 14 May 2018.
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Affiliation(s)
- Céline Monard
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nathan Bianchi
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Elettra Poli
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Marco Altarelli
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Anne Debonneville
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Thoracic Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Mauro Oddo
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Medical Directorate, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Lucas Liaudet
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
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Abraham P, Monard C, Schneider A, Rimmelé T. Extracorporeal Blood Purification in Burns: For Whom, Why, and How? Blood Purif 2023; 52:17-24. [PMID: 35738240 PMCID: PMC9909620 DOI: 10.1159/000525085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
Patients with serious thermal burn injuries require immediate and specialized care in order to minimize morbidity and mortality. Optimal fluid resuscitation, nutritional support, pulmonary care, burn wound care, and infection control practices represent key aspects of patient care in burn centers. When severely burned, the patient usually presents a systemic inflammatory response syndrome, soon balanced by a counter anti-inflammatory response syndrome. These may lead to immune dysregulation/exhaustion favoring infectious complications that dramatically impair the prognosis of burn patients. This narrative review provides an overview of the main concepts, current understanding, and potential applications of extracorporeal blood purification techniques for burn patient management. Current understanding of burn patients' immune responses is reported. Hypotheses and data on the potential value of immunoregulation are reviewed. Finally, how extracorporeal blood purification may be of interest in this specific population is discussed.
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Affiliation(s)
- Paul Abraham
- Adult Intensive Care Unit and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,*Paul Abraham,
| | - Céline Monard
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,EA 7426, Pathophysiology of Injury-Induced Immunosuppression (P13), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Antoine Schneider
- Adult Intensive Care Unit and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,EA 7426, Pathophysiology of Injury-Induced Immunosuppression (P13), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
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Monard C, Tresson P, Lamblin A, Benatir F, Taverna XJ, Rimmelé T. Intraoperative extracorporeal blood purification therapy during major septic vascular surgery. Crit Care 2022; 26:404. [PMID: 36575522 PMCID: PMC9795654 DOI: 10.1186/s13054-022-04284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Céline Monard
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Philippe Tresson
- grid.413852.90000 0001 2163 3825Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France ,grid.413852.90000 0001 2163 3825Centre de Référence des Infections Vasculaire Complexes (CRIVasc Network), Hospices Civils de Lyon, Lyon, France
| | - Antoine Lamblin
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Farida Benatir
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Xavier-Jean Taverna
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Rimmelé
- grid.413852.90000 0001 2163 3825Service d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Université Claude Bernard Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
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Tardiveau C, Monneret G, Lukaszewicz AC, Cheynet V, Cerrato E, Imhoff K, Peronnet E, Bodinier M, Kreitmann L, Blein S, Llitjos JF, Conti F, Gossez M, Buisson M, Yonis H, Cour M, Argaud L, Delignette MC, Wallet F, Dailler F, Monard C, Brengel-Pesce K, Venet F. A 9-mRNA signature measured from whole blood by a prototype PCR panel predicts 28-day mortality upon admission of critically ill COVID-19 patients. Front Immunol 2022; 13:1022750. [DOI: 10.3389/fimmu.2022.1022750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Immune responses affiliated with COVID-19 severity have been characterized and associated with deleterious outcomes. These approaches were mainly based on research tools not usable in routine clinical practice at the bedside. We observed that a multiplex transcriptomic panel prototype termed Immune Profiling Panel (IPP) could capture the dysregulation of immune responses of ICU COVID-19 patients at admission. Nine transcripts were associated with mortality in univariate analysis and this 9-mRNA signature remained significantly associated with mortality in a multivariate analysis that included age, SOFA and Charlson scores. Using a machine learning model with these 9 mRNA, we could predict the 28-day survival status with an Area Under the Receiver Operating Curve (AUROC) of 0.764. Interestingly, adding patients’ age to the model resulted in increased performance to predict the 28-day mortality (AUROC reaching 0.839). This prototype IPP demonstrated that such a tool, upon clinical/analytical validation and clearance by regulatory agencies could be used in clinical routine settings to quickly identify patients with higher risk of death requiring thus early aggressive intensive care.
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Teoli J, Amour S, Dananché C, Dauwalder O, Gerbier-Colomban S, Mauranne CC, Zorio V, Monard C, Arnal S, Friggeri A, Lepape A, Guerin C, Rimmelé T, Argaud L, Munier-Marion E, Gustin MP, Vanhems P. Trends in the proportion of resistant bacteria involved in ventilator-associated pneumonia as the first hospital-acquired infection in intensive care units between 2003 and 2016 in Lyon, France. Am J Infect Control 2021; 49:1454-1456. [PMID: 33930517 DOI: 10.1016/j.ajic.2021.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to describe the proportion of multidrug-resistant microorganisms (MDROs) involved in ventilator-associated pneumonia (VAP) as the first hospital-acquired infection in 536 adults with restricted risk factors for MDRO-related infection. We found a significant decrease in the percentage of MDROs involved in VAP between 2003 and 2016 and this percentage increased when VAP occurred after day 10.
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Venet F, Cour M, Rimmelé T, Viel S, Yonis H, Coudereau R, Amaz C, Abraham P, Monard C, Casalegno JS, Brengel-Pesce K, Lukaszewicz AC, Argaud L, Monneret G. Longitudinal assessment of IFN-I activity and immune profile in critically ill COVID-19 patients with acute respiratory distress syndrome. Crit Care 2021; 25:140. [PMID: 33845874 PMCID: PMC8040759 DOI: 10.1186/s13054-021-03558-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the onset of the pandemic, only few studies focused on longitudinal immune monitoring in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) whereas their hospital stay may last for several weeks. Consequently, the question of whether immune parameters may drive or associate with delayed unfavorable outcome in these critically ill patients remains unsolved. METHODS We present a dynamic description of immuno-inflammatory derangements in 64 critically ill COVID-19 patients including plasma IFNα2 levels and IFN-stimulated genes (ISG) score measurements. RESULTS ARDS patients presented with persistently decreased lymphocyte count and mHLA-DR expression and increased cytokine levels. Type-I IFN response was initially induced with elevation of IFNα2 levels and ISG score followed by a rapid decrease over time. Survivors and non-survivors presented with apparent common immune responses over the first 3 weeks after ICU admission mixing gradual return to normal values of cellular markers and progressive decrease of cytokines levels including IFNα2. Only plasma TNF-α presented with a slow increase over time and higher values in non-survivors compared with survivors. This paralleled with an extremely high occurrence of secondary infections in COVID-19 patients with ARDS. CONCLUSIONS Occurrence of ARDS in response to SARS-CoV2 infection appears to be strongly associated with the intensity of immune alterations upon ICU admission of COVID-19 patients. In these critically ill patients, immune profile presents with similarities with the delayed step of immunosuppression described in bacterial sepsis.
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Affiliation(s)
- Fabienne Venet
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France. .,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.
| | - Martin Cour
- Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Thomas Rimmelé
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Sebastien Viel
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.,Immunology Laboratory, Lyon-Sud University Hospital, Hospices Civils de Lyon, 69495, Pierre-Bénite, France
| | - Hodane Yonis
- Medical Intensive Care Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004, Lyon, France
| | - Remy Coudereau
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
| | - Camille Amaz
- Centre d'Investigation Clinique de Lyon (CIC 1407 Inserm), Hospices Civils de Lyon, 69677, Lyon, France
| | - Paul Abraham
- Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Céline Monard
- Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Jean-Sebastien Casalegno
- Virology Laboratory, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004, Lyon, France
| | - Karen Brengel-Pesce
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
| | - Anne-Claire Lukaszewicz
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Guillaume Monneret
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
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Fabri A, Kandara K, Coudereau R, Gossez M, Abraham P, Monard C, Cour M, Rimmelé T, Argaud L, Monneret G, Venet F. Characterization of Circulating IL-10-Producing Cells in Septic Shock Patients: A Proof of Concept Study. Front Immunol 2021; 11:615009. [PMID: 33613540 PMCID: PMC7890231 DOI: 10.3389/fimmu.2020.615009] [Citation(s) in RCA: 13] [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: 10/07/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Sepsis is a worldwide health priority characterized by the occurrence of severe immunosuppression associated with increased risk of death and secondary infections. Interleukin 10 (IL-10) is a potent immunosuppressive cytokine which plasma concentration is increased in septic patients in association with deleterious outcomes. Despite studies evaluating IL-10 production in specific subpopulations of purified cells, the concomitant description of IL-10 production in monocytes and lymphocytes in septic patients' whole blood has never been performed. In this pilot study, we characterized IL-10 producing leukocytes in septic shock patients through whole blood intracellular staining by flow cytometry. Twelve adult septic shock patients and 9 healthy volunteers were included. Intracellular tumor necrosis factor-α (TNFα) and IL-10 productions after lipopolysaccharide stimulation by monocytes and IL-10 production after PMA/Ionomycine stimulation by lymphocytes were evaluated. Standard immunomonitoring (HLA-DR expression on monocytes, CD4+ T lymphocyte count) of patients was also performed. TNFα expression by stimulated monocytes was reduced in patients compared with controls while IL-10 production was increased. This was correlated with a reduced monocyte HLA-DR expression. B cells, CD4+, and CD4- T lymphocytes were the three circulating IL-10 producing lymphocyte subsets in both patients and controls. No difference in IL-10 production between patients and controls was observed for B and CD4- T cells. However, IL-10 production by CD4+ T lymphocytes significantly increased in patients in parallel with reduced CD4+ T cells number. Parameters reflecting altered monocyte (increased IL-10 production, decreased HLA-DR expression and decreased TNFα synthesis) and CD4+ T lymphocyte (increased IL-10 production, decreased circulating number) responses were correlated. Using a novel technique for intracellular cytokine measurement in whole blood, our results identify monocytes and CD4+ T cells as the main IL-10 producers in septic patients' whole blood and illustrate the development of a global immunosuppressive profile in septic shock. Overall, these preliminary results add to our understanding of the global increase in IL-10 production induced by septic shock. Further research is mandatory to determine the pathophysiological mechanisms leading to such increased IL-10 production in monocytes and CD4+ T cells.
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Affiliation(s)
- Astrid Fabri
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Khalil Kandara
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Rémy Coudereau
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Morgane Gossez
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Paul Abraham
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Céline Monard
- Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France.,Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Martin Cour
- Medical Intensive Care Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Thomas Rimmelé
- Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France.,Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France.,Hospices Civils de Lyon-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression", Université Claude Bernard Lyon 1, Villeurbanne, France
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Benech N, Leboucher G, Monard C, Ferry T. Septic shock due to refractory severe clostridioides difficile colitis rapidly resolving after faecal microbiota transplantation. BMJ Case Rep 2020; 13:13/9/e234329. [PMID: 32900719 DOI: 10.1136/bcr-2020-234329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Nicolas Benech
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, Rhône-Alpes, France.,Université Claude Bernard Lyon, Lyon, France
| | - Gilles Leboucher
- Service de Pharmacie Hospitalière, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Céline Monard
- Service de Réanimation Chirurgicale, Pavillon P, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, Rhône-Alpes, France .,Université Claude Bernard Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université́ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
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16
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Monard C, Pehlivan J, Auger G, Alviset S, Tran Dinh A, Duquaire P, Gastli N, d'Humières C, Maamar A, Boibieux A, Baldeyrou M, Loubinoux J, Dauwalder O, Cattoir V, Armand-Lefèvre L, Kernéis S. Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia. Crit Care 2020; 24:434. [PMID: 32665030 PMCID: PMC7359443 DOI: 10.1186/s13054-020-03114-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/29/2020] [Indexed: 01/13/2023]
Abstract
Background Improving timeliness of pathogen identification is crucial to allow early adaptation of antibiotic therapy and improve prognosis in patients with pneumonia. We evaluated the relevance of a new syndromic rapid multiplex PCR test (rm-PCR) on respiratory samples to guide empirical antimicrobial therapy in adult patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP). Methods This retrospective multicenter study was conducted in four French university hospitals. Respiratory samples were obtained from patients with clinical and radiological signs of pneumonia and simultaneously tested using conventional microbiological methods and the rm-PCR. A committee composed of an intensivist, a microbiologist, and an infectious diseases specialist retrospectively assessed all medical files and agreed on the most appropriate antimicrobial therapy for each pneumonia episode, according to the results of rm-PCR and blinded to the culture results. The rm-PCR-guided antimicrobial regimen was compared to the empirical treatment routinely administered to the patient in standard care. Results We included 159 pneumonia episodes. Most patients were hospitalized in intensive care units (n = 129, 81%), and episodes were HAP (n = 68, 43%), CAP (n = 54, 34%), and VAP (n = 37, 23%). Conventional culture isolated ≥ 1 microorganism(s) at significant level in 95 (60%) patients. The syndromic rm-PCR detected at least one bacteria in 132 (83%) episodes. Based on the results of the rm-PCR, the multidisciplinary committee proposed a modification of the empirical therapy in 123 (77%) pneumonia episodes. The modification was a de-escalation in 63 (40%), an escalation in 35 (22%), and undetermined in 25 (16%) patients. In microbiologically documented episodes (n = 95), the rm-PCR increased appropriateness of the empirical therapy to 83 (87%), as compared to 73 (77%) in routine care. Conclusions Use of a syndromic rm-PCR test has the potential to reduce unnecessary antimicrobial exposure and increase the appropriateness of empirical antibiotic therapy in adult patients with pneumonia.
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Affiliation(s)
- Céline Monard
- Département d'Anesthésie et Réanimation, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Jonathan Pehlivan
- Service de Réanimation Médicale Infectieuse, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - Gabriel Auger
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, Rennes, France.,CNR de la Résistance aux Antibiotiques (Laboratoire Associé Entérocoques), Rennes, France
| | - Sophie Alviset
- Equipe Mobile d'Infectiologie, APHP, Hôpital Cochin, Centre Université de Paris, Paris, France
| | - Alexy Tran Dinh
- Département d'anesthésie-réanimation, APHP, Hôpital Bichat-Claude Bernard, Université de Paris, Paris, France.,Inserm U 1148 LVTS, Université de Paris, Paris, France
| | - Paul Duquaire
- Département d'Anesthésie et Réanimation, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Nabil Gastli
- Service de Bactériologie, APHP, Hôpital Cochin, Centre Université de Paris, Paris, France
| | - Camille d'Humières
- Service de Bactériologie, APHP Nord, Université de Paris, Hôpital Bichat, Paris, France.,IAME, INSERM, Université de Paris, Paris, France
| | - Adel Maamar
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - André Boibieux
- Equipe mobile d'infectiologie, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Marion Baldeyrou
- Service de Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Julien Loubinoux
- Service de Bactériologie, AP-HP Centre, Hôpital Cochin, Université de Paris, Paris, France
| | - Olivier Dauwalder
- Plateau de Microbiologie 24/24, Institut des Agents Infectieux, Hospices Civils de Lyon, Centre de Biologie et Pathologie Nord, Lyon, France.,INSERM CIRI LYON, Equipe "Pathogénie des Staphylocoques", Lyon, France
| | - Vincent Cattoir
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, Rennes, France.,CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques), Rennes, France.,Unité Inserm U1230, Université de Rennes 1, Rennes, France
| | - Laurence Armand-Lefèvre
- Service de Bactériologie, APHP Nord, Université de Paris, Hôpital Bichat, Paris, France.,IAME, INSERM, Université de Paris, Paris, France
| | - Solen Kernéis
- Equipe Mobile d'Infectiologie, APHP, Hôpital Cochin, Centre Université de Paris, Paris, France. .,IAME, INSERM, Université de Paris, Paris, France.
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17
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Affiliation(s)
- Louis Kreitmann
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Céline Monard
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Dauwalder
- Institut des Agents Infectieux, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France
| | - Marie Simon
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Laurent Argaud
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.
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18
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Waeckel L, Venet F, Gossez M, Monard C, Rimmelé T, Monneret G. Delayed persistence of elevated monocytic MDSC associates with deleterious outcomes in septic shock: a retrospective cohort study. Crit Care 2020; 24:132. [PMID: 32264937 PMCID: PMC7137224 DOI: 10.1186/s13054-020-02857-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/30/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Louis Waeckel
- Immunology Laboratory, Edouard Herriot Hospital, Hospices Civils de Lyon, Pavillon E - 5 place d'Arsonval, 69437, Lyon Cedex 03, France
| | - Fabienne Venet
- Immunology Laboratory, Edouard Herriot Hospital, Hospices Civils de Lyon, Pavillon E - 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France
| | - Morgane Gossez
- Immunology Laboratory, Edouard Herriot Hospital, Hospices Civils de Lyon, Pavillon E - 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France
| | - Céline Monard
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Thomas Rimmelé
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Guillaume Monneret
- Immunology Laboratory, Edouard Herriot Hospital, Hospices Civils de Lyon, Pavillon E - 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.
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19
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Leijte GP, Rimmelé T, Kox M, Bruse N, Monard C, Gossez M, Monneret G, Pickkers P, Venet F. Monocytic HLA-DR expression kinetics in septic shock patients with different pathogens, sites of infection and adverse outcomes. Crit Care 2020; 24:110. [PMID: 32192532 PMCID: PMC7082984 DOI: 10.1186/s13054-020-2830-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/12/2020] [Indexed: 12/29/2022]
Abstract
Background Decreased monocytic (m)HLA-DR expression is the most studied biomarker of sepsis-induced immunosuppression. To date, little is known about the relationship between sepsis characteristics, such as the site of infection, causative pathogen, or severity of disease, and mHLA-DR expression kinetics. Methods We evaluated mHLA-DR expression kinetics in 241 septic shock patients with different primary sites of infection and pathogens. Furthermore, we used unsupervised clustering analysis to identify mHLA-DR trajectories and evaluated their association with outcome parameters. Results No differences in mHLA-DR expression kinetics were found between groups of patients with different sites of infection (abdominal vs. respiratory, p = 0.13; abdominal vs. urinary tract, p = 0.53) and between pathogen categories (Gram-positive vs. Gram-negative, p = 0.54; Gram-positive vs. negative cultures, p = 0.84). The mHLA-DR expression kinetics differed between survivors and non-survivors (p < 0.001), with an increase over time in survivors only. Furthermore, we identified three mHLA-DR trajectories (‘early improvers’, ‘delayed or non-improvers’ and ‘decliners’). The probability for adverse outcome (secondary infection or death) was higher in the delayed or non-improvers and decliners vs. the early improvers (delayed or non-improvers log-rank p = 0.03, adjusted hazard ratio 2.0 [95% CI 1.0–4.0], p = 0.057 and decliners log-rank p = 0.01, adjusted hazard ratio 2.8 [95% CI 1.1–7.1], p = 0.03). Conclusion Sites of primary infection or causative pathogens are not associated with mHLA-DR expression kinetics in septic shock patients. However, patients showing delayed or no improvement in or a declining mHLA-DR expression have a higher risk for adverse outcome compared with patients exhibiting a swift increase in mHLA-DR expression. Our study signifies that changes in mHLA-DR expression over time, and not absolute values or static measurements, are of clinical importance in septic shock patients.
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Affiliation(s)
- Guus P Leijte
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Rimmelé
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niklas Bruse
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Céline Monard
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Morgane Gossez
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Immunology Laboratory, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Monneret
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Immunology Laboratory, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fabienne Venet
- Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, bioMérieux, Edouard Herriot Hospital, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,Immunology Laboratory, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
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20
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de Roquetaillade C, Kandara K, Gossez M, Peronnet E, Monard C, Cour M, Rimmelé T, Argaud L, Monneret G, Venet F. Intracellular calcium signaling and phospho-antigen measurements reveal functional proximal TCR activation in lymphocytes from septic shock patients. Intensive Care Med Exp 2019; 7:74. [PMID: 31873820 PMCID: PMC6928172 DOI: 10.1186/s40635-019-0287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/11/2019] [Accepted: 12/05/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Charles de Roquetaillade
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Current address: INSERM U942 MArkers in Stressed COndiTions (MASCOT), Hôpital Lariboisière, Lyon Cedex, 03, Paris, France
| | - Khalil Kandara
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 69437, Lyon, France
| | - Morgane Gossez
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 69437, Lyon, France
| | - Estelle Peronnet
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Joint Research Unit HCL-bioMérieux, Hôpital Edouard Herriot, 5 place d'Arsonval, 69003, Lyon, France
| | - Céline Monard
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, 69437, Lyon, France
| | - Martin Cour
- Intensive Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, 69437, Lyon, France
| | - Thomas Rimmelé
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, 69437, Lyon, France
| | - Laurent Argaud
- Intensive Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, 69437, Lyon, France
| | - Guillaume Monneret
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France. .,Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 69437, Lyon, France.
| | - Fabienne Venet
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Edouard Herriot Hospital, 69437, Lyon, France.,Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 69437, Lyon, France
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Schwindenhammer V, Girardot T, Chaulier K, Grégoire A, Monard C, Huriaux L, Illinger J, Leray V, Uberti T, Crozon-Clauzel J, Rimmelé T. oXiris® Use in Septic Shock: Experience of Two French Centres. Blood Purif 2019; 47 Suppl 3:1-7. [PMID: 30982028 DOI: 10.1159/000499510] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). SUMMARY Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74-87] SAPS II quartile and 70 vs. 98% for the [87-163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52-2.45] µg/kg/min; at 48 h it was 0.20 [0.09-1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.
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Affiliation(s)
- Victor Schwindenhammer
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibaut Girardot
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France, .,EA 7426 PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-bioMérieux-Hospices Civils de Lyon, Lyon, France,
| | - Kevin Chaulier
- Intensive Care Unit, L'Hôpital Nord-Ouest, Villefranche-sur-Saône General Hospital, Gleizé, France
| | - Arnaud Grégoire
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Céline Monard
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laetitia Huriaux
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Julien Illinger
- Intensive Care Unit, L'Hôpital Nord-Ouest, Villefranche-sur-Saône General Hospital, Gleizé, France
| | - Véronique Leray
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Uberti
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jullien Crozon-Clauzel
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thomas Rimmelé
- Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,EA 7426 PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-bioMérieux-Hospices Civils de Lyon, Lyon, France
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Abstract
Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club "Cappuccino with Claudio Ronco" at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52.
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Affiliation(s)
- Céline Monard
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France, .,EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France,
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France.,EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Claudio Ronco
- Full Professor of Nephrology, Department of Medicine, University of Padova, Vicenza, Italy.,Director of International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Director of Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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Monard C, Lefèvre M, Subtil F, Piriou V, David JS. Peripherally inserted central catheter with intracavitary electrocardiogram guidance: Malposition risk factors and indications for post-procedural control. J Vasc Access 2018; 20:128-133. [DOI: 10.1177/1129729818781266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To confirm the feasibility of intracavitary electrocardiogram guidance to verify tip’s position during insertion of peripherally inserted central catheter and to identify clinical factors or intracavitary electrocardiogram patterns associated with aberrant tip’s position. Methods: A prospective study was conducted in our university hospital after authorization of the ethics committee. All patients addressed for peripherally inserted central catheter insertion were included and received the insertion using intracavitary electrocardiogram and electromagnetic guidance. Side of insertion and three electrocardiogram factors were collected: visualization of P-wave at baseline (sinusal rhythm), acquisition of the maximal P-wave and the negative deflection. All patients had a systematic post-procedural chest X-ray. One of the investigators assessed all chest X-ray, blinded to the results of intracavitary electrocardiogram, and confirmed whether the tip’s position on chest X-ray matched with the intracavitary electrocardiogram information or if the tip was malpositioned on chest X-ray (mismatch with intracavitary electrocardiogram or aberrant position). Factors associated with malposition were described. Results: From January 2015 to April 2015, 330 patients were eligible, 5 had an uninterpretable chest X-ray, and 14 were non-sinusal at baseline. Our main analysis population included 311 patients. We observed a mismatch between intracavitary electrocardiogram and chest X-ray estimate of the tip’s position in 3 cases (1%) and an aberrant tip’s position occurred in 3 cases (1%). Incidence of malposition was higher in the group of patients with non-sinusal rhythm (14%) and when the catheter was inserted on the left side (7%). Conclusion: This study confirmed the feasibility of intracavitary electrocardiogram for peripherally inserted central catheter positioning and the limits of chest X-ray. Insertion on left side may represent risk factor for aberrant position but our study lacked power to establish a statistical link.
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Affiliation(s)
- Céline Monard
- Département d’Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Mathilde Lefèvre
- Département d’Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Université Claude Bernard Lyon 1, Lyon, France
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Vincent Piriou
- Département d’Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Stephane David
- Département d’Anesthésie-Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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Gagey AC, de Queiroz Siqueira M, Monard C, Combet S, Cogniat B, Desgranges FP, Robinson P, Chassard D, Bouvet L. The effect of pre-operative gastric ultrasound examination on the choice of general anaesthetic induction technique for non-elective paediatric surgery. A prospective cohort study. Anaesthesia 2017; 73:304-312. [DOI: 10.1111/anae.14179] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Affiliation(s)
- A.-C. Gagey
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
| | | | - C. Monard
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
| | - S. Combet
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
| | - B. Cogniat
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
| | - F.-P. Desgranges
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
- Department of Anaesthesia; Université Claude Bernard Lyon 1; Villeurbanne France
| | - P. Robinson
- Department of Clinical Research; Hospices Civils de Lyon, Lyon France
| | - D. Chassard
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
- Department of Anaesthesia; Université Claude Bernard Lyon 1; Villeurbanne France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care; Hôpital Femme Mère Enfant; Bron France
- Université Claude Bernard Lyon 1; INSERM, LabTAU UMR1032; Lyon France
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Monard C, Gantner S, Bertilsson S, Hallin S, Stenlid J. Habitat generalists and specialists in microbial communities across a terrestrial-freshwater gradient. Sci Rep 2016; 6:37719. [PMID: 27886241 PMCID: PMC5123577 DOI: 10.1038/srep37719] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022] Open
Abstract
Observations of distributions of microorganisms and their differences in community composition across habitats provide evidence of biogeographical patterns. However, little is known about the processes controlling transfers across habitat gradients. By analysing the overall microbial community composition (bacteria, fungi, archaea) across a terrestrial-freshwater gradient, the aim of this study was to understand the spatial distribution patterns of populations and identify taxa capable of crossing biome borders. Barcoded 454 pyrosequencing of taxonomic gene markers was used to describe the microbial communities in adjacent soil, freshwater and sediment samples and study the role of biotic and spatial factors in shaping their composition. Few habitat generalists but a high number of specialists were detected indicating that microbial community composition was mainly regulated by species sorting and niche partitioning. Biotic interactions within microbial groups based on an association network underlined the importance of Actinobacteria, Sordariomycetes, Agaricomycetes and Nitrososphaerales in connecting among biomes. Even if dispersion seemed limited, the shore of the lake represented a transition area, allowing populations to cross the biome boundaries. In finding few broadly distributed populations, our study points to biome specialization within microbial communities with limited potential for dispersal and colonization of new habitats along the terrestrial-freshwater continuum.
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Affiliation(s)
- C. Monard
- Department of Forest Mycology and Plant Pathology, Uppsala BioCenter, Swedish University of Agricultural Sciences, P.O. Box 7026, SE-75007 Uppsala, Sweden
| | - S. Gantner
- Department of Forest Mycology and Plant Pathology, Uppsala BioCenter, Swedish University of Agricultural Sciences, P.O. Box 7026, SE-75007 Uppsala, Sweden
- Department of Ecology and Genetics, Limnology and Science for Life Laboratory, Uppsala University, Norbyvägen 18D, SE-75236 Uppsala, Sweden
| | - S. Bertilsson
- Department of Ecology and Genetics, Limnology and Science for Life Laboratory, Uppsala University, Norbyvägen 18D, SE-75236 Uppsala, Sweden
| | - S. Hallin
- Department of Forest Mycology and Plant Pathology, Uppsala BioCenter, Swedish University of Agricultural Sciences, P.O. Box 7026, SE-75007 Uppsala, Sweden
| | - J. Stenlid
- Department of Forest Mycology and Plant Pathology, Uppsala BioCenter, Swedish University of Agricultural Sciences, P.O. Box 7026, SE-75007 Uppsala, Sweden
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Monard C, Binet F, Vandenkoornhuyse P. Short-term response of soil bacteria to carbon enrichment in different soil microsites. Appl Environ Microbiol 2008; 74:5589-92. [PMID: 18621864 PMCID: PMC2546630 DOI: 10.1128/aem.00333-08] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 07/05/2008] [Indexed: 11/20/2022] Open
Abstract
The response of bacteria in bulk soil and earthworm casts to carbon enrichment was studied by an RNA stable-isotope probing/terminal restriction fragment length polymorphism strategy with (13)C-labeled glucose and acetate. Both the soil microsite status and the carbon enrichment selected rapidly for different active bacterial communities, which resulted in different degradation kinetics. Our study clearly illustrates the biases that are generated by adding C substrates to detect metabolically active bacteria in soil.
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Affiliation(s)
- C Monard
- CNRS/Université de Rennes 1, UMR 6553 EcoBio, FR2116/FR90 Caren, Campus de Beaulieu, 263 Avenue du Général Leclerc, 35042 Rennes Cedex, France.
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