[Is rapid intrapartum vaginal screening test of group B streptococci (GBS) during partum useful in identifying infants developing early-onset GBS sepsis in postpartum period?]. / Test de dépistage rapide intra partum du portage vaginal de streptocoque du groupe B (SGB) pour le repérage des nouveau-nés à risque d'infection néonatale précoce à SGB. Étude observationnelle analytique dans une maternité de type III.

INTRODUCTION: Group B streptococcus (GBS) is the most common infectious agent responsible for early-onset bacterial sepsis (EOS) in term newborns. French prevention of perinatal GBS disease guidelines recommend screening for maternal vaginal GBS colonization at the 9th month of pregnancy, and use of intrapartum antibiotic prophylaxis (IAP) in case of detected GBS vaginal colonization. Peripheral bacterial sampling (gastric aspiration, ear, or meconium) and measurement of C-reactive protein (CRP) are performed in asymptomatic newborns in case of infectious risk factors and/or incomplete IAP. OBJECTIVE: The aim of this study was to investigate the relation between a rapid intrapartum screening test for GBS during labor in term parturients and infants developing GBS EOS and in comparison to current recommendations. METHODS: We conducted an observational analytic single-center study, with use of a rapid intrapartum GBS screening test, at Toulouse University Hospital. RESULTS: A total of 1416 mother-newborn dyads were prospectively included between 31/01/2012 and 17/08/2012. Vaginal GBS colonization was found at the 9th month of pregnancy in 148 mothers (10.6 %), and 176 mothers (12.5 %) were screened positively at delivery using intrapartum GBS rapid polymerase chain reaction assay (GBS PCR) (P=0.025). No confirmed neonatal GBS EOS was found. Nine infants had suspected GBS EOS because of a positive peripheral bacterial finding and elevated CRP. In these infants, seven pregnant mothers were GBS-positive with GBS PCR assay during labor, and four women were positive on prenatal culture at the 9th month of pregnancy. The diagnostic values of the two tests highlighted a nonsignificant superiority of intrapartum GBS PCR assay (AUC=0.83 [0.68-0.97] vs. 0.67 [0.50-0.84]), (P=0.057). The negative predictive value was improved with intrapartum PCR assay (negative likelihood ratio [LR]: 0.3 [0.1-0.9] vs. 0.6 [0.4-1.1]). Intrapartum GBS PCR assay provided its best positive predictive value in the absence of complete AIP and without other infectious factors (positive LR: 21.3 [15.4-29.5]). CONCLUSION: These results suggest that the intrapartum GBS PCR assay offers a better predictive value of GBS EOS than the usual vaginal culture swab at the 9th month but requires confirmation by large studies.

[Completeness and quality of multidisciplinary team meetings: the example of prostate cancer in the Mid-Pyrenees region]. / Exhaustivité et qualité des réunions de concertation pluridisciplinaire: l'exemple des cancers prostatiques en Midi-Pyrénées.

OBJECTIVES: To determine the completeness of the examination of cancer patient cases in a multidisciplinary team meeting (MDTM), to study the factors that can affect this examination and to assess the quality of the MDTM concerning prostate cancer in Tarn. METHODS: Completeness was estimated by comparing the database of the Tarn cancer registry containing all the inhabitants of this department for whom prostate cancer was diagnosed in 2007 with the list of patients living in Tarn whose cases were discussed during a Midi-Pyrénées MDTM. Determinants of the case discussion in MDTM were studied from data collected in medical records (age, stage at diagnosis, PSA level, Gleason score, treatment). The MDTM quality study (delay in management, whether the case was seen before or after treatment, required elements for MDTM, clinical data, conformity between suggested treatment and guidelines, adequacy between suggested and performed treatments) was based on the MDTM forms retrieved from the DCO and from medical records. RESULTS: Four hundred and fifty-nine patients were re-examined. The pretherapeutic passage rate within three months after diagnosis was 56.2%. The probability of a discussion in MDTM decreased for people over 85 years of age (OR=0.10) compared with the 70-74 year-old people and it increased for the N+M+ (OR=4.23) compared with the T1-T2. Patients for whom radiotherapy was considered were presented more frequently than the others. The MDTM quality was studied based on 220 DCO forms. The patient's physician attended the MDTM in 65% of the cases, 97% of the suggested treatments were consistent with the guidelines and 90% of the performed treatments complied with the suggested treatment. CONCLUSION: The discussion rate in MDTM has not reached the 100% planned by the first "plan cancer" yet, but when a MDTM was carried out, its compliance and adequacy were high. While seniors' cases require interdisciplinarity because of a complicated management, they were less discussed in MDTM.