Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldw... more Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. Among the 771 enrolled patients (median age 66 years, IQR [52.0–79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%...
Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for s... more Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft tissue infections (SSTI), but real-life use is not well-known. We aimed to describe all first prescriptions in France over an 18-month period. We performed a retrospective study on all adult patients who received at least one dose of dalbavancin from July 1st, 2017 to September 31st, 2018. Data were collected thanks to a standard questionnaire. Failure was defined as: persistent or reappearance of signs of infection; and/or switch to suppressive antibiotic treatment; and/or death from infection. We included 75 patients from 29 French hospitals. Main indications were bone and joint infections (BJIs) (64.0%), endocarditis (25.3%), and SSTIs (17.3%). Main bacteria involved were: Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%); and coagulase-negative staphylococci (CNS) (44.4%). Median MICs for staphylococci to vancomycin and dalbavancin ranged from 0.875 mg/L to 2.0 mg/L, and 0.040 mg/L to 0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. Main treatment regimens for dalbavancin were a weekly 2-dose regimen (1500mg each) in 38 (53.2%) cases, and a single-dose regimen (1500mg) in 13 (18.3%) cases. Overall, at the patients' last visit, clinical cure was observed in 54/72 patients, while failure was found in 14/72 patients. First uses of dalbavancin in France were mostly off-label. Most of them were due to BJIs, and often as rescue therapy for severe infections. Even in off-label situations, dalbavancin seems safe and effective.
Ocular involvement by Candida albicans is rare and may present as endogenous endophthalmitis or c... more Ocular involvement by Candida albicans is rare and may present as endogenous endophthalmitis or choroiditis. It occurs in the context of C. albicans septicemia, in the context of intensive care unit hospitalization or intravenous drug use. We report two cases referred to our department with different characteristics, background, diagnostic modalities and different courses. A 37-year-old woman, with a history of intravenous drug use, presented with C. albicans endophthalmitis. Intravenous combination antifungal therapy was begun, but vitrectomy and intravitreal amphotericin B were performed due to worsening of the endophthalmitis. The second case was a 53-year-old man who was hospitalized in the intensive care unit for C. albicans septicemia with a left macular chorioretinitis. Intravenous antifungal therapy was initiated and allowed regression of the ocular lesion. Our cases illustrate both types of ophthalmic involvement by candidiasis requiring different treatments with well-descr...
Micafungin is effective for the treatment of candidemia and aspergillosis as well as for prophyla... more Micafungin is effective for the treatment of candidemia and aspergillosis as well as for prophylaxis against Candida and Aspergillus in patients receiving stem cell transplantation ([Denning et al., 2006], [Ostrosky-Zeichner et al., 2005] and [Van Burik et al., 2004]). An approach to ...
IntroductionNitrofurantoin is commonly used in the treatment of urinary tract infection and may c... more IntroductionNitrofurantoin is commonly used in the treatment of urinary tract infection and may cause a potential severe complication: interstitial lung diseases.
Diagnostic Microbiology and Infectious Disease, 2017
The value of blood cultures after bone biopsy in diabetic foot osteomyelitis was assessed through... more The value of blood cultures after bone biopsy in diabetic foot osteomyelitis was assessed through a prospective monocentric study. Blood cultures tested positive in 15.8% of patients. Risk factors were male gender, higher CRP levels, Streptococcus sp.-positive bone culture, and pre-existing valvulopathy.
Introduction.-Le syndrome de Goodpasture est une pathologie auto-immune rare responsable d'un syn... more Introduction.-Le syndrome de Goodpasture est une pathologie auto-immune rare responsable d'un syndrome pneumo rénal. L'atteinte du système nerveux central (SNC) est inhabituelle en l'absence anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA) associés. Patients et méthodes.-Un homme de 57 ans, est hospitalisé pour l'exploration d'une insuffisance rénale rapidement progressive, la créatininémie passant de 91 mol/L à 519 mol/L en sept jours. Le sédiment urinaire retrouve une hématurie microscopique associée une protéinurie à 1,9 g/g. Le bilan biologique retrouve un syndrome inflammatoire (CRP 355 mg/L), et une anémie normochrome arégénérative à 9,8 g/L. Seuls, les anticorps anti-MBG sont fortement positifs (> 8 technique Bioplex, titre à 1280 en immunofixation). Devant ce tableau de glomérulonéphrite rapidement progressive, une biopsie rénale est réalisée. L'examen histologique objective une glomérulonéphrite extracapillaire atteignant 80 % glomérules. L'immunofixation retrouve une fixation IgG linéaires des membranes basales glomérulaires. Le diagnostic de maladie de Goodpasture est porté. Un traitement a immédiatement débuté par échanges plasmatiques, bolus de cyclophosphamide et prednisone. À j21 post-biopsie, il est mis en évidence un syndrome cérébelleux statique défini par une marche ébrieuse, un élargissement du polygone de sustentation et une danse des tendons sans aggravation à la fermeture des yeux. Le taux d'anticorps anti MBG est alors en augmentation : 6,7 (Bioplex) contre 5,1 et un titre à 160 (immunofixation) contre quarante-quatre jours plus tôt. L'imagerie par résonance magnétique encéphalique met en évidence en séquence FLAIR des hypersignaux de la substance blanche périventriculaire compatible avec des lésions de vascularités. Le traitement spécifique de la maladie de Goodpasture associé à la rééducation fonctionnelle a permis dans notre cas une très nette amélioration de la marche qu'il effectue désormais sans aide. Le taux d'anticorps a diminué de manière progressive pour devenir indétectable à six mois (< 0,8 Bioplex, < 5). Le patient n'a
France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles i... more France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases of measles were confirmed by serologic testing and/or reverse transcription polymerase chain reaction. The cohort consisted of 21 male and 15 female patients, with a median age of 29.2 years (25thY75th interquartile range EIQR^, 27.2Y34.2 yr) and a median Simplified Acute Physiology Score (SAPS II) of 13 (IQR, 9Y18). Among the 26 patients whose measles vaccination status was documented, none had received 2 injections. One patient had developed measles during childhood. Underlying comorbid conditions included chronic respiratory disease in 9 patients, immunosuppression in 7 patients, and obesity in 3 patients, while measles affected 5 pregnant women. Respiratory complications induced by measles infection led to ICU admission in 32 cases, and measles-related neurologic complications led to ICU admission in 2 cases. Two patients were admitted due to concurrent respiratory and neurologic complications. Bacterial superinfection of measles-related airway infection was suspected in 28 patients and was documented in 8. Four cases of community-acquired pneumonia, 6 cases of ventilator-associated pneumonia, 1 case of tracheobronchitis, and 2 cases of sinusitis were microbiologically substantiated. Of 11 patients who required mechanical ventilation, 9 developed acute respiratory distress syndrome (ARDS). Among the patients with ARDS, extraalveolar air leak complications occurred in 4 cases. Five patients died, all of whom were severely immunocompromised. On follow-up, 1 patient had severe chronic respiratory failure related to lung fibrosis, and 2 patients had mild lower limb paraparesis along with bladder dysfunction, both of which were ascribable to measlesinduced encephalitis and myelitis. Among the 5 pregnant patients, the course of measles infection was uneventful, albeit 1 patient underwent emergent cesarean delivery because of fetal growth restriction. Measles is a disease with protean and potentially deceptive clinical manifestations, especially in the immunocompromised patient. Measlesassociated pneumonitis and its complications, and less commonly postinfectious encephalomyelitis, are the main source of morbidity and mortality. In contrast with the usually benign course of the disease in immunocompetent patients, measles occurring in immunocompromised patients gives rise to lethal complications including ARDS, with or without bacterial superinfection. Other patients potentially at high risk for severe measles are young adults and pregnant women. Measles pneumonitis may predispose to air leak disease in patients using mechanical ventilation. To date, vaccination remains the most potent tool to control measles infection. (Medicine 2013;92: 257Y272) Abbreviations: ADEM = acute disseminated encephalomyelitis; ARDS = acute respiratory distress syndrome, CAP = communityacquired pneumonia, CDC = Centers for Disease Control and Prevention, CFU = colony-forming units, chest CT = thoracic computed tomography, CK = creatinine kinase, CNS = central nervous system, CSF = cerebral spinal fluid, ECMO = extracorporeal membrane oxygenation, EEG = electroencephalogram, FLAIR = fluidattenuated inversion recovery, HIV = human immunodeficiency virus, ICU = intensive care unit, IgG = immunoglobulin G, IgM = immunoglobulin M, IQR = interquartile range, IVIG = intravenous immunoglobulin, MIBE = measles inclusion body encephalitis, MRI = magnetic resonance imaging, MSSA = methicillinsensitive Staphylococcus aureus, MV = measles virus, NO = inhaled nitric oxide, NSAID = nonsteroidal antiinflammatory drug, PIE = postinfectious encephalitis and/or myelitis, RT-PCR = reverse transcription polymerase chain reaction, SAPS II = Simplified Acute Physiology Score, VAP = ventilator-associated pneumonia, WHO = World Health Organization.
The aim of the study was to assess whether an isolated positive catheter culture is predictive of... more The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. Retrospective clinical study between 2000 and 2007. Intensive care unit of a university hospital. All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active antibiotic therapy was active if at least one of the antibiotics administered was effective against the selected pathogenic microorganism of the positive catheter culture. None. The end point of the study was the ratio of the number of subsequent bloodstream infections to that of selected pathogenic microorganisms isolated from positive catheter culture 30 days after catheter removal. A total of 138 isolated positive catheter cultures for 149 selected pathogenic micro-organisms was included in the study. Only two cases (1.3%) of subsequent bloodstream infection were evidenced, one resulting from Escherichia coli and the other from Staphylococcus epidermidis. The incidence of subsequent bloodstream infection did not differ with regard to the presence or absence of active antibiotics at catheter removal: zero of 23 vs. two of 121 (p = 1), respectively. Our results suggest that the risk of subsequent bloodstream infection in intensive care unit patients when the Brun-Buisson technique is used to define isolated positive catheter culture is low.
The aim of the study was to assess whether an isolated positive catheter culture is predictive of... more The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. Retrospective clinical study between 2000 and 2007. Intensive care unit of a university hospital. All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active anti...
Quel dépistage de la tuberculose avant mise sous biothérapie ? Commentaire de l'article intitulé ... more Quel dépistage de la tuberculose avant mise sous biothérapie ? Commentaire de l'article intitulé « Place des tests à l'interféron (IGRAs) dans le dépistage de la tuberculose latente (TBL) avant prescription d'agents anti-TNF : le point » par Lioté et al ଝ
Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldw... more Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. Among the 771 enrolled patients (median age 66 years, IQR [52.0–79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%...
Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for s... more Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft tissue infections (SSTI), but real-life use is not well-known. We aimed to describe all first prescriptions in France over an 18-month period. We performed a retrospective study on all adult patients who received at least one dose of dalbavancin from July 1st, 2017 to September 31st, 2018. Data were collected thanks to a standard questionnaire. Failure was defined as: persistent or reappearance of signs of infection; and/or switch to suppressive antibiotic treatment; and/or death from infection. We included 75 patients from 29 French hospitals. Main indications were bone and joint infections (BJIs) (64.0%), endocarditis (25.3%), and SSTIs (17.3%). Main bacteria involved were: Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%); and coagulase-negative staphylococci (CNS) (44.4%). Median MICs for staphylococci to vancomycin and dalbavancin ranged from 0.875 mg/L to 2.0 mg/L, and 0.040 mg/L to 0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. Main treatment regimens for dalbavancin were a weekly 2-dose regimen (1500mg each) in 38 (53.2%) cases, and a single-dose regimen (1500mg) in 13 (18.3%) cases. Overall, at the patients' last visit, clinical cure was observed in 54/72 patients, while failure was found in 14/72 patients. First uses of dalbavancin in France were mostly off-label. Most of them were due to BJIs, and often as rescue therapy for severe infections. Even in off-label situations, dalbavancin seems safe and effective.
Ocular involvement by Candida albicans is rare and may present as endogenous endophthalmitis or c... more Ocular involvement by Candida albicans is rare and may present as endogenous endophthalmitis or choroiditis. It occurs in the context of C. albicans septicemia, in the context of intensive care unit hospitalization or intravenous drug use. We report two cases referred to our department with different characteristics, background, diagnostic modalities and different courses. A 37-year-old woman, with a history of intravenous drug use, presented with C. albicans endophthalmitis. Intravenous combination antifungal therapy was begun, but vitrectomy and intravitreal amphotericin B were performed due to worsening of the endophthalmitis. The second case was a 53-year-old man who was hospitalized in the intensive care unit for C. albicans septicemia with a left macular chorioretinitis. Intravenous antifungal therapy was initiated and allowed regression of the ocular lesion. Our cases illustrate both types of ophthalmic involvement by candidiasis requiring different treatments with well-descr...
Micafungin is effective for the treatment of candidemia and aspergillosis as well as for prophyla... more Micafungin is effective for the treatment of candidemia and aspergillosis as well as for prophylaxis against Candida and Aspergillus in patients receiving stem cell transplantation ([Denning et al., 2006], [Ostrosky-Zeichner et al., 2005] and [Van Burik et al., 2004]). An approach to ...
IntroductionNitrofurantoin is commonly used in the treatment of urinary tract infection and may c... more IntroductionNitrofurantoin is commonly used in the treatment of urinary tract infection and may cause a potential severe complication: interstitial lung diseases.
Diagnostic Microbiology and Infectious Disease, 2017
The value of blood cultures after bone biopsy in diabetic foot osteomyelitis was assessed through... more The value of blood cultures after bone biopsy in diabetic foot osteomyelitis was assessed through a prospective monocentric study. Blood cultures tested positive in 15.8% of patients. Risk factors were male gender, higher CRP levels, Streptococcus sp.-positive bone culture, and pre-existing valvulopathy.
Introduction.-Le syndrome de Goodpasture est une pathologie auto-immune rare responsable d'un syn... more Introduction.-Le syndrome de Goodpasture est une pathologie auto-immune rare responsable d'un syndrome pneumo rénal. L'atteinte du système nerveux central (SNC) est inhabituelle en l'absence anticorps anti-cytoplasme des polynucléaires neutrophiles (ANCA) associés. Patients et méthodes.-Un homme de 57 ans, est hospitalisé pour l'exploration d'une insuffisance rénale rapidement progressive, la créatininémie passant de 91 mol/L à 519 mol/L en sept jours. Le sédiment urinaire retrouve une hématurie microscopique associée une protéinurie à 1,9 g/g. Le bilan biologique retrouve un syndrome inflammatoire (CRP 355 mg/L), et une anémie normochrome arégénérative à 9,8 g/L. Seuls, les anticorps anti-MBG sont fortement positifs (> 8 technique Bioplex, titre à 1280 en immunofixation). Devant ce tableau de glomérulonéphrite rapidement progressive, une biopsie rénale est réalisée. L'examen histologique objective une glomérulonéphrite extracapillaire atteignant 80 % glomérules. L'immunofixation retrouve une fixation IgG linéaires des membranes basales glomérulaires. Le diagnostic de maladie de Goodpasture est porté. Un traitement a immédiatement débuté par échanges plasmatiques, bolus de cyclophosphamide et prednisone. À j21 post-biopsie, il est mis en évidence un syndrome cérébelleux statique défini par une marche ébrieuse, un élargissement du polygone de sustentation et une danse des tendons sans aggravation à la fermeture des yeux. Le taux d'anticorps anti MBG est alors en augmentation : 6,7 (Bioplex) contre 5,1 et un titre à 160 (immunofixation) contre quarante-quatre jours plus tôt. L'imagerie par résonance magnétique encéphalique met en évidence en séquence FLAIR des hypersignaux de la substance blanche périventriculaire compatible avec des lésions de vascularités. Le traitement spécifique de la maladie de Goodpasture associé à la rééducation fonctionnelle a permis dans notre cas une très nette amélioration de la marche qu'il effectue désormais sans aide. Le taux d'anticorps a diminué de manière progressive pour devenir indétectable à six mois (< 0,8 Bioplex, < 5). Le patient n'a
France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles i... more France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases of measles were confirmed by serologic testing and/or reverse transcription polymerase chain reaction. The cohort consisted of 21 male and 15 female patients, with a median age of 29.2 years (25thY75th interquartile range EIQR^, 27.2Y34.2 yr) and a median Simplified Acute Physiology Score (SAPS II) of 13 (IQR, 9Y18). Among the 26 patients whose measles vaccination status was documented, none had received 2 injections. One patient had developed measles during childhood. Underlying comorbid conditions included chronic respiratory disease in 9 patients, immunosuppression in 7 patients, and obesity in 3 patients, while measles affected 5 pregnant women. Respiratory complications induced by measles infection led to ICU admission in 32 cases, and measles-related neurologic complications led to ICU admission in 2 cases. Two patients were admitted due to concurrent respiratory and neurologic complications. Bacterial superinfection of measles-related airway infection was suspected in 28 patients and was documented in 8. Four cases of community-acquired pneumonia, 6 cases of ventilator-associated pneumonia, 1 case of tracheobronchitis, and 2 cases of sinusitis were microbiologically substantiated. Of 11 patients who required mechanical ventilation, 9 developed acute respiratory distress syndrome (ARDS). Among the patients with ARDS, extraalveolar air leak complications occurred in 4 cases. Five patients died, all of whom were severely immunocompromised. On follow-up, 1 patient had severe chronic respiratory failure related to lung fibrosis, and 2 patients had mild lower limb paraparesis along with bladder dysfunction, both of which were ascribable to measlesinduced encephalitis and myelitis. Among the 5 pregnant patients, the course of measles infection was uneventful, albeit 1 patient underwent emergent cesarean delivery because of fetal growth restriction. Measles is a disease with protean and potentially deceptive clinical manifestations, especially in the immunocompromised patient. Measlesassociated pneumonitis and its complications, and less commonly postinfectious encephalomyelitis, are the main source of morbidity and mortality. In contrast with the usually benign course of the disease in immunocompetent patients, measles occurring in immunocompromised patients gives rise to lethal complications including ARDS, with or without bacterial superinfection. Other patients potentially at high risk for severe measles are young adults and pregnant women. Measles pneumonitis may predispose to air leak disease in patients using mechanical ventilation. To date, vaccination remains the most potent tool to control measles infection. (Medicine 2013;92: 257Y272) Abbreviations: ADEM = acute disseminated encephalomyelitis; ARDS = acute respiratory distress syndrome, CAP = communityacquired pneumonia, CDC = Centers for Disease Control and Prevention, CFU = colony-forming units, chest CT = thoracic computed tomography, CK = creatinine kinase, CNS = central nervous system, CSF = cerebral spinal fluid, ECMO = extracorporeal membrane oxygenation, EEG = electroencephalogram, FLAIR = fluidattenuated inversion recovery, HIV = human immunodeficiency virus, ICU = intensive care unit, IgG = immunoglobulin G, IgM = immunoglobulin M, IQR = interquartile range, IVIG = intravenous immunoglobulin, MIBE = measles inclusion body encephalitis, MRI = magnetic resonance imaging, MSSA = methicillinsensitive Staphylococcus aureus, MV = measles virus, NO = inhaled nitric oxide, NSAID = nonsteroidal antiinflammatory drug, PIE = postinfectious encephalitis and/or myelitis, RT-PCR = reverse transcription polymerase chain reaction, SAPS II = Simplified Acute Physiology Score, VAP = ventilator-associated pneumonia, WHO = World Health Organization.
The aim of the study was to assess whether an isolated positive catheter culture is predictive of... more The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. Retrospective clinical study between 2000 and 2007. Intensive care unit of a university hospital. All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active antibiotic therapy was active if at least one of the antibiotics administered was effective against the selected pathogenic microorganism of the positive catheter culture. None. The end point of the study was the ratio of the number of subsequent bloodstream infections to that of selected pathogenic microorganisms isolated from positive catheter culture 30 days after catheter removal. A total of 138 isolated positive catheter cultures for 149 selected pathogenic micro-organisms was included in the study. Only two cases (1.3%) of subsequent bloodstream infection were evidenced, one resulting from Escherichia coli and the other from Staphylococcus epidermidis. The incidence of subsequent bloodstream infection did not differ with regard to the presence or absence of active antibiotics at catheter removal: zero of 23 vs. two of 121 (p = 1), respectively. Our results suggest that the risk of subsequent bloodstream infection in intensive care unit patients when the Brun-Buisson technique is used to define isolated positive catheter culture is low.
The aim of the study was to assess whether an isolated positive catheter culture is predictive of... more The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. Retrospective clinical study between 2000 and 2007. Intensive care unit of a university hospital. All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active anti...
Quel dépistage de la tuberculose avant mise sous biothérapie ? Commentaire de l'article intitulé ... more Quel dépistage de la tuberculose avant mise sous biothérapie ? Commentaire de l'article intitulé « Place des tests à l'interféron (IGRAs) dans le dépistage de la tuberculose latente (TBL) avant prescription d'agents anti-TNF : le point » par Lioté et al ଝ
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