[Comparison of 2 administration protocols (continuous or discontinuous) of a time-dependent antibiotic, Tazocin]. / Comparaison de deux schémas d'administration (continu ou discontinu) d'un antibiotique temps-dépendant: la Tazocilline.

A predictive parameter of beta-lactam therapeutic efficacy is the time (T > MIC) while antibiotic serum concentrations are above the MIC of suspected bacteriological agents. This led us to carry out a randomised open study to compare the usually used intermittent administration of Tazocin (three injections of 4 g/0.5 g a day) and continuous perfusion of 12 g/1.5 g a day by calculating these T > MIC. Patients from digestive reanimation department were randomised within two arms: continuous or intermittent administration. Sixteen takings of blood were executed over a forty-hour period. After liquid/liquid extraction, piperacillin and tazobactam serum concentrations were determined by HPLC with a reversed phase column (C18) and a UV spectrophotometry detection. Then, from the time-concentration curves we have evaluated the T > MIC for an enterobacteria (MIC = 8 micrograms/mL) and for Pseudomonas (MIC = 16 micrograms/mL). Concerning intermittent administration T > MIC were 74% (c > MICenterobacteria) and 62% (c > MICPseudomonas). These percentages in the continuous arm were 100% (c > MICenterobacteria) and 99% (c > MICPseudomonas). Tazobactam concentrations were low and even undetectable between each injection in the intermittent administration arm. This was not found within the continuous administration arm. In conclusion, for the intermittent administration, we observed some long periods occurring before each injection while antibiotic concentrations were under the MIC of most bacteria. During these same periods tazobactam concentrations were under the efficacy threshold. These periods were not observed within the continuous administration arm.

[Use of the colonization index]. / Utilisation pratique de l'index de colonisation.

In a retrospective study, 2,238 mycologic samples obtained in 1999 from 89 patients hospitalised in an intensive care unit dedicated to digestive diseases were analysed. Feasibility of monitoring fungal colonisation and implications for workload and costs were assessed. From this experience, we confirmed the ability of the Pittet index to identify patients at high risk for Candida infection. Monitoring of Pittet index required a high degree of cooperation between the intensive care unit and the laboratory of mycology, and a precise definition of the modalities of sampling. It entailed a significant increase in costs and workload. A treatment was started whenever a colonisation index > or = 0.5 was associated with severe clinical or biological signs. This involved an increase of the expense of antifungal drugs. The potential benefits could not be evaluated from our study. Direct observation of pseudomycelium in the samples and candiduria were significantly correlated to fungal colonisation.

[Postoperative encephalopathies: thiamine deficiency, an unrecognized etiology]. / Encéphalopathies postopératoires: la carence en thiamine, une étiologie à ne pas méconnaître.

We report the case of a patient who experienced a postoperative Wernicke encephalopathy 8 days after a left hepatectomy performed for metastasis related to a rectal cancer. During the six months before surgery the patient lost 10 kg of weight (15%). Moreover, in the postoperative period the patient received exclusively 5% dextrose solution intravenously. On the 8th postoperative day, an alteration of consciousness, a vertical nystagmus and an ataxia led to consider the diagnosis of thiamine deficiency that was then established by the decrease in the transcetolase activity of the red blood cells. Vitamin B1 supply improved the clinical status rapidly and completely. This observation allows to review aetiologies and clinical forms of thiamine shortage. In addition, it stresses the detection of exposed patients and the prevention methods.