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Valenciennes, France

Antimicrobial resistance is an increasing problem in the intensive care unit (ICU), and the persistence of colonization with multidrug-resistant bacteria (MRB) may play an important role in the spreading of these bacteria. The duration of colonization with MRB is not well defined, especially after ICU discharge. The knowledge of MRB persistence in hospitalized and readmitted patients may influence prevention measures. The duration of colonization, and its characterization, may depend on several factors: type of MRB, antibiotic treatment, repeated hospitalizations, sensitivity of the microbiological tests used (cultures, polymerase chain reaction [PCR]). Most of the studies were performed in hospitalized patients colonized with MBR and readmitted to the ICU. These studies show the complexity of factors influencing the duration of colonization and show that median time until MRB clearance may increase to several months. Long-term carriages are reported in several studies for different MRB: MRSA (1–4 years), ESBL-producing enterobacteria (3 years), vancomycin-resistant enterococcal (50 weeks), carbapenem-resistant enterobacteria (1 year), multidrug-resistant Acinetobacter baumannii (42 months). Antibiotics play a major role in the emergence of MRB, and are a risk factor for persistent carriage. © 2015, Société de réanimation de langue française (SRLF) and Springer-Verlag France.

Nahon S.,Center Hospitalier Intercommunal Le Raincy Montfermeil | Hagege H.,Center Hospitalier Intercommunal Of Creteil | Latrive J.P.,Center Hospitalier Of Compiegne | Rosa I.,Center Hospitalier Intercommunal Of Creteil | And 9 more authors.
Endoscopy | Year: 2012

Background and study aims: The mortality rate from upper gastrointestinal bleeding (UGIB) remains high, at 5%-10%. The aim of the current study was to describe the epidemiological characteristics, prognostic factors, and actual practice in a cohort of patients with UGIB admitted to French general hospitals. Methods: From March 2005 to February 2006, a prospective multicenter study was conducted at 53 French hospitals. A total of 3298 patients admitted for UGIB were enrolled consecutively. Patient data were collected up to the date of discharge from hospital. Results: Data were available for 2130 men and 1073 women (mean age 63 ± 18 years), one-third of whom were taking drugs that would increase the risk of UGIB. The two main causes of bleeding were peptic ulcers (38%) and esophagogastric varices (EGV) or portal hypertensive gastropathy (24.5%). Mean Rockall score was 5.0 ± 2.3.Endoscopy was performed on 96% of patients (within 24 hours in 79%), and 66% of those with ulcers and 62.5% of the EGV patients underwent hemostatic therapy when indicated. Rebleeding occurred in 9.9% of the patients, and 8.3% died. Independent predictors of rebleeding were: need for transfusion (odds ratio [OR] 19.1; 95% confidence interval [95%CI] 10.1-35.9); hemoglobin<10g/dL (OR: 1.7; 95%CI 1.1-3.3); Rockall score (OR: 1.4 for each 1 point score increase; 95%CI 1.0-1.9), systolic blood pressure <100mmHg (OR: 1.9; 95%CI 1.4-2.5), and signs of recent bleeding (OR: 2.4; 95%CI 1.7-3.5). Independent predictors of mortality were: Rockall score (OR: 2.8; 95%CI 2.0-4.0), co-morbidities (OR: 3.6 for each additional co-morbidity; 95%CI 2.0-6.3), and systolic blood pressure <100mmHg (OR: 2.1; 95%CI 1.8-2.8). Rockall score, blood pressure and co-morbidities were taken as continuous variables meaning that the OR was 1.4 for every point increase, it was the same for blood pressure. Conclusion: UGIB still occurs mainly as a result of peptic ulcers and portal hypertension in France, and causes significant rates of mortality. There is scope for improvement via better prevention (better use of UGIB-facilitating drugs), endoscopic therapy, and management of co-morbidities. © Georg Thieme Verlag KG Stuttgart · New York.

Benhamed L.,Center Hospitalier Of Valenciennes | Woelffle D.,Center Hospitalier Of Valenciennes
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether adjuvant antifungal therapy is useful after pulmonary surgery for aspergilloma. One hundred and sixteen papers were identified using the search described below, of which 5 papers presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. No paper was greater than level-three evidence. One study compared the outcomes of 72 patients treated for pulmonary aspergilloma (PA) during a 23-year period. Despite no difference being found in outcomes, more complications were seen in the surgery-alone group. Another study included 14 patients treated with amphotericin B alone or with flucytocine. They found no benefit in the treatment of PA by systemic antifungal therapy. One retrospective study reported complete eradication of PA in patients treated with preoperative and postoperative oral itraconazole. One large cohort study reported their outcomes in 256 patients with PA, divided into two groups: Group A (simple aspergilloma, n = 96) and Group B (complex aspergilloma, n = 160) after aggressive surgical treatment and antifungal therapy. They found no difference in the postoperative morbidity between two groups (P = 0.27). A postoperative fungal relapse was found in 2 patients. One retrospective study reported the outcomes and mortality in 61 cases with PA. Thirty-five (60%) patients were treated with antifungal agents, and 15 (25%) patients were treated surgically. Many cases did not respond to antifungal therapy. Nineteen (31%) patients died. We did not find evidence to support the role of adjuvant antifungal therapy following definitive surgical removal of the fungus ball in immunocompetent patients; however, randomized control studies in multiple centres, with new antifungal therapy, are necessary to confirm these preliminary results. © 2014 The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Metzler K.D.,Max Planck Institute for Infection Biology | Fuchs T.A.,Max Planck Institute for Infection Biology | Fuchs T.A.,Harvard University | Nauseef W.M.,University of Iowa | And 6 more authors.
Blood | Year: 2011

The granule enzyme myeloperoxidase (MPO) plays an important role in neutrophil antimicrobial responses. However, the severity of immunodeficiency in patients carrying mutations in MPO is variable. Serious microbial infections, especially with Candida species, have been observed in a subset of completely MPOdeficient patients. Here we show that neutrophils from donors who are completely deficient in MPO fail to form neutrophil extracellular traps (NETs), indicating that MPO is required for NET formation. In contrast, neutrophils from partially MPOdeficient donors make NETs, and pharmacological inhibition of MPO only delays and reduces NET formation. Extracellular products of MPO do not rescue NET formation, suggesting that MPO acts cellautonomously. Finally, NET-dependent inhibition of Candida albicans growth is compromised in MPO-deficient neutrophils. The inability to form NETs may contribute in part to the host defense defects observed in completely MPO-deficient individuals. © 2011 by The American Society of Hematology.

Lemaire A.,Center Hospitalier Of Valenciennes | Plancon M.,Center Hospitalier Of Valenciennes | Bubrovszky M.,Service de Psychiatrie Adulte
Psycho-Oncologie | Year: 2014

Ketamine, a molecule mainly used as an analgesic in supportive oncology in particular in palliative care, turns out to be an excellent fast-acting antidepressant. By acting as an NMDA receptor antagonist, its mechanism of action is complementary to classical and long-acting antidepressants like selective serotonin reuptake inhibitors. These properties offer new perspectives in fast-controlling depression within the development of early palliative care in oncology. © 2014 Springer-Verlag.

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