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1.
Med Mal Infect ; 46(8): 429-435, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27609596

ABSTRACT

OBJECTIVES: Prescribing antibiotics for COPD exacerbations is not easy. Procalcitonin (PCT) is a useful biomarker that helps reduce the rate of antibiotic therapies. However, its proper cut-off levels are often unknown. We aimed to assess the impact of a PCT-based algorithm to guide antibiotic therapy prescription in COPD exacerbations. METHODS: We conducted an observational, retrospective, and before/after study. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation. We then analyzed the rate of antibiotic prescriptions and the number of PCT tests prescribed before and after the introduction of a protocol validated by previous high-power studies. The primary endpoint was the rate of antibiotic prescriptions. RESULTS: A total of 124 patients before protocol and 121 patients after protocol were included. Antibiotic prescriptions decreased by 41% after protocol introduction (59% vs. 35%, P<0.001), with no increase in morbidity and mortality at Day 30. Compliance with protocol was complete in 60% of cases and partial (no PCT guidance to discontinue antibiotics) in 8% of cases. Both antibiotic duration (8.3 days vs. 8.7 days) and length of hospital stay (8.5 days vs. 8.3 days, P=0.78) did not change. CONCLUSION: Hospital physicians are already using PCT-based algorithm to guide antibiotic prescription in COPD exacerbations. Disseminating information on the appropriate PCT cut-off level to use to decide whether or not to initiate antibiotics is effective. Its proper use should be clarified to reduce antibiotic prescriptions to these overexposed patients.


Subject(s)
Algorithms , Anti-Bacterial Agents/therapeutic use , Calcitonin/blood , Drug Prescriptions/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/drug therapy , Aged , Aged, 80 and over , Antimicrobial Stewardship , Biomarkers/blood , Disease Progression , Emergency Medicine , Female , France , Guideline Adherence , Hospitalization/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Inappropriate Prescribing/prevention & control , Internship and Residency , Length of Stay/statistics & numerical data , Male , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/therapy , Retrospective Studies
2.
Arch Pediatr ; 19(5): 497-500, 2012 May.
Article in French | MEDLINE | ID: mdl-22463954

ABSTRACT

Liver abscess in the pediatric population remains uncommon in developed countries, except in cases of septicemia or in children with major debilitating diseases, granulocyte dysfunction, or immunosuppression. Although much is known about the etiopathogenesis of liver abscess, the gold standard of investigations and treatment is still debatable in developing countries. We report the case of a 6-year-old child living in Reunion Island, with no medical history, presenting with right and pyretic abdominal pain in the right upper quadrant. Ultrasound and CT scan showed a large hypodense nonenhanced area in segment IV. Final diagnosis was, by exclusion, pyogenic liver abscess based on negative serology, recent liver lesion, and normal tumor test results, even if blood culture remained negative. No percutaneous puncture was done because of positive outcome after 4 days of antibiotics. Treatment consisted in three intravenous antibiotics (ceftriaxone, aminoxide, and metronidazole) until complete biological normalization. Ultrasound remained normal 3 months later. Even if liver abscess is uncommon in developing countries, the diagnosis must be raised in cases of isolated liver tumor with fever. Management in the nonimmunosuppressed child must be discussed associating parenteral antibiotic therapy, percutaneous drainage, or surgery in very uncommon cases, according to the liver location and first day's progression. Etiological investigation such as colonoscopy in adults must be adapted to pediatric data.


Subject(s)
Liver Abscess , Child , Female , Humans , Liver Abscess/diagnosis , Liver Abscess/drug therapy
3.
Bull Soc Pathol Exot ; 104(2): 142-6, 2011 May.
Article in French | MEDLINE | ID: mdl-21509521

ABSTRACT

From July 6 to September 29, 2009, 380 patients were seen as out-patients for flu-like illness, and 355 files (253 women and 102 men) were available for retrospective analysis. Mean age was 32 years. 158 patients, including 22 with A(H1N1)2009 influenza had underlying medical conditions: pregnancy (N = 87), asthma (N = 37), obesity (N = 17). Most frequent symptoms of A(H1N1)2009 influenza patients were fever (97% of the patients), cough (94%), rhinorrhea (59%), myalgia (56%), headache (36%). A nasopharyngeal swab for influenza virus detection by PCR was performed on 118 patients including 27 pregnant women. 44 patients, including 40 A(H1N1)2009 influenza cases were tested positive. 21 patients were referred to the emergency department for further tests or treatment and 31 patients were admitted as in-patients. 20 pregnant women were referred for further obstetrical monitoring; none presented with respiratory failure or foetal distress. None of the patients were admitted to the ICU or died.


Subject(s)
Epidemics , Influenza A Virus, H1N1 Subtype , Influenza, Human/epidemiology , Outpatient Clinics, Hospital/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/complications , Influenza, Human/virology , Male , Middle Aged , Nasopharynx/virology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Respiratory Distress Syndrome/etiology , Reunion/epidemiology , Young Adult
4.
Pathol Biol (Paris) ; 58(1): 18-24, 2010 Feb.
Article in French | MEDLINE | ID: mdl-19864085

ABSTRACT

AIM OF THE STUDY: The antibiotic resistance of enterobacteriacae knows a worldwide worrying evolution with an increase of the extended spectrum betalactamases (ESBL) that spread into the community. Few publications describe this problem in the Indian Ocean area. The aim of this study is first to identify in Félix Guyon Hospital (Reunion Island) the emergent antibiotics resistance for enterobacteriaceae between 1997/1998 and 2006/2007 periods, at second, to update the prophylactic and therapeutic measures for handling the risk linked to multiresistant enterobacteriaceae in our hospital and third, to assess the risk in Reunion Island and especially at the community level. METHODS: The antibiotic susceptibility of 7814 enterobacteriaceae strains collected among patients, during 1997/1998 and 2006/2007 periods, were analysed as well as the consumption of the third generation cephalosporins, imipenem and fluoroquinolones. RESULTS: Within a span of time of 10 years, an important increase (+57 %) of the resistance prevalence of enterobacteriaceae is observed. The resistance by the ESBL production mechanism is predominant especially for Enterobacter cloacae and Escherichia coli. An important use of broad spectrum antibiotics is correlated with this resistance evolution. CONCLUSION: The emergence of ESBL-producing enterobacteriaceae in our hospital is impairing both therapeutic and health care. It requires a much better control of antibiotics prescriptions and therefore, an important multidisciplinary implication. A proof molecular analysis would allow to evaluate the risk more precisely, especially at the community level.


Subject(s)
Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/drug effects , beta-Lactam Resistance/genetics , beta-Lactamases/isolation & purification , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Cephalosporin Resistance/genetics , Cephalosporinase/genetics , Cephalosporinase/metabolism , Cross Infection/epidemiology , Drug Utilization , Enterobacteriaceae/enzymology , Enterobacteriaceae/genetics , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/epidemiology , Fluoroquinolones/pharmacology , Fluoroquinolones/therapeutic use , Humans , Imipenem/pharmacology , Imipenem/therapeutic use , Retrospective Studies , Reunion/epidemiology , Substrate Specificity , beta-Lactamases/genetics
5.
Med Mal Infect ; 40(3): 172-4, 2010 Mar.
Article in French | MEDLINE | ID: mdl-19616394

ABSTRACT

INTRODUCTION: The cat-scratch disease is a benign inoculation disease and a well-known cause of localized lymphadenopathy. Visceral localizations are rare and occur mostly in immunocompetent patients. CASE: We report the case of a 57-year-old-man with lymphadenopathy of the right arm with hepatic nodules related to a Bartonella henselae infection. CONCLUSION: The cat-scratch disease must be screened for in case of hepatic and/or splenic nodules. A cause of immunodeficiency should be investigated.


Subject(s)
Bartonella henselae , Cat-Scratch Disease/diagnosis , Liver Diseases/diagnosis , Liver Diseases/microbiology , Cat-Scratch Disease/complications , Humans , Immunocompetence , Male , Middle Aged
6.
Rev Med Interne ; 28(4): 263-5, 2007 Apr.
Article in French | MEDLINE | ID: mdl-17196308

ABSTRACT

PURPOSE: Prolonged intermittent fevers are frequently seen in internal medicine and they constitute a real diagnosis challenge. Infection, auto-immune disease and neoplasy are the most common causes. EXEGESIS: We report here a 48 year-old man with a prolonged intermittent fever. At first, all his assessments were negative and it's only secondary, as clinical and biological disturbances occur that the diagnosis of adenocarcinoma of the ampulla has been done. CONCLUSION: Neoplasms represent a rare cause of intermittent prolonged fever, but we must always keep them in mind. In this case, any specific symptom was initially present to end up quickly to the solution.


Subject(s)
Adenocarcinoma/diagnosis , Ampulla of Vater , Common Bile Duct Neoplasms/diagnosis , Fever/etiology , Humans , Male , Middle Aged
7.
Rev Med Interne ; 28(3): 186-7, 2007 Mar.
Article in French | MEDLINE | ID: mdl-17141378

ABSTRACT

INTRODUCTION: The most common presenting features of multiple myeloma are bone pain, anemia, renal failure or hypercalcemia. Bacterial infection as the initial presentation of this desease is rare. CLINICAL CASE: We report the case of a 62-year-old man with pneumococcal septic arthritis of the knee revealing a multiple myeloma. DISCUSSION: Pneumococcal infection should lead to a suspicion of underlying illness and especially the multiple myeloma.


Subject(s)
Arthritis, Infectious/microbiology , Multiple Myeloma/diagnosis , Pneumococcal Infections/etiology , Humans , Immunocompromised Host , Knee/microbiology , Male , Middle Aged
8.
Clin Microbiol Infect ; 12(12): 1151-3, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17121619

ABSTRACT

There is increasing interest concerning the possible impact of anti-tumour necrosis factor (TNF)-alpha therapeutic agents on the emergence of infections. However, these agents do not seem to increase the incidence of adverse infectious events significantly. Published observations concern mostly infections of the urinary and upper respiratory tracts that develop in the setting of co-morbidities, such as anterior or concomitant immunosuppressive treatment. Infliximab appears to increase the risk of tuberculosis, but this effect has not been observed with other anti-TNF-alpha agents. To better characterise the adverse infectious effects associated with these agents, physicians should be encouraged to notify the microbiological data relating to all cases.


Subject(s)
Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Opportunistic Infections/immunology , Tuberculosis/immunology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Arthritis, Rheumatoid/drug therapy , Crohn Disease/drug therapy , Humans , Incidence , Infliximab , Opportunistic Infections/epidemiology , Tuberculosis/epidemiology , Tumor Necrosis Factor-alpha/immunology
9.
Med Mal Infect ; 36(9): 473-5, 2006 Sep.
Article in French | MEDLINE | ID: mdl-17027214

ABSTRACT

BACKGROUND: Severe community acquired pneumonia is a common cause of acute respiratory failure. The influenza virus itself can cause a severe pneumonia and non-respiratory illness. CASE REPORT: A physician developed an acute respiratory failure associated with hemolytic anemia, acute renal failure, and myocarditis. Influenza A infection was diagnosed by screening for antibodies (complement fixation, ELISA Ig A). DISCUSSION: Fulminant influenza pneumonia is a rare clinical presentation of influenza infection and usually has a severe clinical course. Influenza infection is also associated with myositis, myocarditis, acute renal failure, encephalopathy, and hemolytic anemia. Rapid laboratary diagnosis can be made by PCR or immunofluorescence applied directly to respiratory specimens. Antiviral treatment did not prove its efficacy in fulminant Influenza. This case report is an opportunity to stress the importance of seroprophylaxis by parenteral vaccination in exposed occupations.


Subject(s)
Community-Acquired Infections/diagnosis , Influenza, Human/complications , Pneumonia, Viral/diagnosis , Humans , Influenza Vaccines , Influenza, Human/prevention & control , Male , Middle Aged , Pneumonia, Viral/prevention & control
10.
Med Mal Infect ; 36(5): 264-9, 2006 May.
Article in French | MEDLINE | ID: mdl-16762519

ABSTRACT

OBJECTIVE: Our goal was to describe the epidemiological, clinical, and microbiological characteristics of nocardiosis in the Bordeaux teaching hospital, between January 1, 1993 and December 31, 2003. DESIGNS: The retrospective study included patients examined between January 1, 1993 and December 31, 2003 in whom a Nocardia bacterium had been identified from a biological sample. RESULTS: Twenty-four out of 30 Nocardia sp. strains identified during the study period were classified as colonizing strains. 19 patients presented with risk factors for nocardiosis. Nocardia asteroïdes were found in 22 samples, mainly from pulmonary samples. 11 cases of infection due to Nocardia sp. were reported during the study period. Immunosuppression was reported in 7 cases. The clinical forms were not specific. The species incriminated belonged to the N. asteroïdes complex in 8 cases. Treatment consisted in a combination of 2 or 3 molecules including cotrimoxazole for an average duration of 9 months. 9 patients recovered. CONCLUSIONS: The variability of clinical presentation and the lack of standard identification methods delayed the diagnostic. The treatment is not well defined. Clinical strains should be reported to the reference laboratory and prospective studies are necessary.


Subject(s)
Cross Infection/epidemiology , Nocardia Infections/epidemiology , Nocardia asteroides , Anti-Bacterial Agents/therapeutic use , Cross Infection/microbiology , Drug Therapy, Combination , Female , France , Humans , Immunosuppression Therapy/adverse effects , Lung/microbiology , Male , Middle Aged , Nocardia Infections/transmission , Nocardia asteroides/isolation & purification , Retrospective Studies
11.
Euro Surveill ; 10(11): 222-5, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16371687

ABSTRACT

In August 2004, a case of rabies was diagnosed in a puppy that had been illegally imported from Morocco to Bordeaux (France). Because a great number of people and animals were thought to have come into contact with the puppy, extensive tracing measures were implemented, and an international alert was launched to trace and treat the contacts at risk. One hundred and eighty seven people received post-exposure treatment, eight of whom also received serovaccination, and 57 animals known to have been exposed to the puppy were tested. Six months after the death of the rabid animal, none of the people treated showed any signs of rabies, nor was any secondary animal case reported. The management of this crisis highlights the importance of the role of a rapid alert system at European level. Strict application of sanitary control regulations is essential for animals introduced into EU countries, and all necessary information must be made available to EU residents travelling to rabies enzootic areas.


Subject(s)
Commerce/legislation & jurisprudence , Communicable Disease Control , Contact Tracing , Dog Diseases/transmission , Rabies/veterinary , Zoonoses , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Dogs , Female , France , Humans , Immunoglobulins, Intravenous/therapeutic use , Infant , Internationality , Male , Middle Aged , Rabies/prevention & control , Vaccination
12.
Euro Surveill ; 10(11): 9-10, 2005 Nov.
Article in English | MEDLINE | ID: mdl-29208098

ABSTRACT

In August 2004, a case of rabies was diagnosed in a puppy that had been illegally imported from Morocco to Bordeaux (France). Because a great number of people and animals were thought to have come into contact with the puppy, extensive tracing measures were implemented, and an international alert was launched to trace and treat the contacts at risk. One hundred and eighty seven people received post-exposure treatment, eight of whom also received serovaccination, and 57 animals known to have been exposed to the puppy were tested. Six months after the death of the rabid animal, none of the people treated showed any signs of rabies, nor was any secondary animal case reported. The management of this crisis highlights the importance of the role of a rapid alert system at European level. Strict application of sanitary control regulations is essential for animals introduced into EU countries, and all necessary information must be made available to EU residents travelling to rabies enzootic areas.

13.
Presse Med ; 31(34): 1604-5, 2002 Oct 19.
Article in French | MEDLINE | ID: mdl-12426977

ABSTRACT

INTRODUCTION: The combination of neurofibromatosis type I with hyperparathyroidism is classical but rare. OBSERVATION: Our report is on the original observation of a patient affected with Von Recklinghausen's disease complicated by chronic restrictive breathing deficiency. After an intense breathing decompensation and a spreading convulsive attack, hyperparathyroidism was diagnosed. DISCUSSION: The similarity of the bone lesions seen in type I neurofibromatosis and in hyperparathyroidism strongly suggests a genetic link between these two pathologies. Hence, hyperparathyroidism should be searched for in all patients affected with Von Recklinghausen's disease, since the adjustment of hypercalcemia can lead to partial reversibility of the bone abnormalities.


Subject(s)
Adenoma/complications , Hyperparathyroidism/complications , Neurofibromatosis 1/complications , Parathyroid Neoplasms/complications , Acute Disease , Adenoma/surgery , Adult , Calcium/blood , Calcium/urine , Female , Follow-Up Studies , Humans , Hyperparathyroidism/diagnosis , Hyperparathyroidism/metabolism , Kyphosis/complications , Parathyroid Hormone/blood , Parathyroid Neoplasms/surgery , Phosphorus/blood , Phosphorus/urine , Recurrence , Respiratory Insufficiency/etiology , Scoliosis/complications
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