[Tigecycline: CMI 50/90 towards 1766 Gram-negative bacilli (3rd generation cephalosporins resistant enterobacteriaceae), Acinetobacter baumannii and Bacteroides fragilis group, University Hospital - Montpellier, 2008-2011]. / Tigécycline : CMI 50/90 vis-à-vis de 1766 bacilles à Gram-négatif (entérobactéries résistantes aux céphalosporines de troisième génération), Acinetobacter baumannii et Bacteroides du groupe fragilis, CHU - Montpellier, 2008-2011.

Tigecycline is a new glycylcyclin with a wide spectre including multi-resistant bacteria. Our laboratory tests in routine the in vitro activity of the TGC towards clinically significant isolates of 3rd generation cephalosporins resistant enterobacteriaceae (EC3R), Acinetobacter baumannii and Bacteroides fragilis group (BFG). The objective of this study is to describe the in vitro activity of TGC against these strains isolated between 2008 and 2011 in the university hospital of Montpellier. In this study period, 1070 isolates EC3R including 541 extended spectrum ß-lactamase-producers (ESBL) strains, 47 isolates of A. baumannii including 40 multi-resistant isolates and 645 isolates of BFG were tested. Minimum inhibitory concentrations (MIC) were determined using the E-test method. TGC was active against 86.2% of EC3R with a MIC 90 less or equal to 1mg/L (Escherichia coli being the most sensitive species). A. baumannii and BFG were also inhibited at low concentrations of TGC with a MIC 90 less or equal to 2mg/L respectively for 47% and 84.2% of the isolates. Our study confirms the activity of TGC against the EC3R including ESBL-producers strains. The relevance of the therapeutic use of TGC on the BFG isolates with a MIC greater than 2mg/L should be better documented. Often prescribed in therapeutic impasse, the proper use of TGC would require: clarifying the threshold of sensitivity for some species (i.e., A. baumannii, Bacteroides fragilis group); a better understanding of correlation between in vitro and in vivo activity.

[The assessment of autonomy in elderly people]. / Evaluation de l'autonomie de la personne âgée.

The assessment of autonomy in elderly people relies on various instruments that aim to evaluate and follow up patients, to measure the burden of care for the medical staff, or to properly distribute health budgets. In this article, we describe 3 clinical scales traditionally employed by gerontologists and specialists in geriatric rehabilitation. We intentionally left out generic scales such as the Barthel index and the Functional Independence Measure, which are well known by physiatrists. The Katz index is a scale of Activities of Daily Living, and the Lawton test is a scale of Instrumental Activities of Daily Living. We paid special attention to the AGGIR classification, which is the actual legal instrument for evaluating dependency in elderly in France, and whose first application is health resources management.

Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA.

MNA is a simple and accurate way to assess the nutritional status in routine practice, and is suitable for systematic use and large epidemiologic studies. The purpose of this study was to evaluate the difference in the nutritional status of elderly patients hospitalized in different types of care in the same hospital, and to evaluate its relationship with risk factors. Nutritional status was evaluated in 918 elderly patients hospitalized in acute care (AC) (n=299), sub-acute care (SAC) (n=196) or long-term care (LTC) (n=423), using the MNA (Mini-Nutritional Assessment), a nutritional assessment tool including 18 items grouped in 4 domains, within the first 48 h after admission (all subjects) and at the end of hospitalization (AC, SAC). More patients were rated in the "malnourished" class in SAC (32.5%) than in AC (24.5%) and LTC (24. 7%). Retrospective analysis showed that the initial nutritional status was linked to the type of care and the nature of underlying pathology. The nutritional status on arrival was worse in patients in SAC, and better in those in LTC (p = 0.005). This is probably due to a difference in the kind of patients hospitalized. The nutritional status was worse in patients suffering from infectious disease, stroke, dementia and traumatic injuries, and, conversely, better in patients suffering from cardiopathy, metabolic and gastro-intestinal (except cancerous) diseases (p < 0.0001). Prospective analysis showed that duration of hospitalization was the only variable found to be linked to an improvement of nutritional status. The MNA is a rapid, effective and cheap tool for the assessment of nutritional status and moreover for evaluation of the mortality risk of patients admitted into AC and SAC.

[Calcification of the pectineal ligament. An usual radiological imaging in pediatrics]. / Calcification du ligament pectiné. Une image radiologique d'observation courante en gériatrie.

OBJECTIVES: Since its first description several years ago in the elderly subject, calcification of the Cooper ligament is often considered as a rare anecdotal phenomenon. We present the radiographic presentation which is often not well known. METHODS: Two experienced radiologists examined independently a series of 100 consecutive X-rays of the pelvis performed in a population of elderly subjects (mean age 84.4 +/- 9.2), looking for calcification of the Cooper ligament. RESULTS: Calcification of the Cooper ligament was observed on 7 of the 100 images of the pelvis. There was no significant difference in age, sex, or reason for ordering the examination between subjects with calcification and those without calcifications. Arterial calcifications were observed at an equal frequency. The usual aspect of the Cooper ligament was a fine opaque line following along the upper border of the iliopectinate crest. Oblique views visualized the calcification better. The line of calcification was either continuous of fragmented and was bilateral in all 7 cases. CONCLUSION: These images are apparently of no pathological significance. Clinicians should however be aware of the radiographic presentation in order to avoid confusion with visceral calcification or periosteal deposits.

Comparative evaluation of blood culture using the Vital automated system and the Becton-Dickinson Septi-Chek BHI-S biphasic and Sch bottles.

A comparative study was performed using 1,168 aerobic and anaerobic blood culture pairs from 395 patients, during which 5-10 mL of blood were collected in both Septi-Chek BHI-S biphasic and Septi-Chek Sch bottles (Becton-Dickinson, Meylan, France) and Vital AER and Vital Ana bottles (bioMérieux, Marcy-l'Etoile, France). The bottles were analyzed by using a 7-day protocol for Vital and a 12-day protocol for Septi-Chek. The Vital bottles revealed negative were all subcultured at the end of the protocol. Of the 374 positive Septi-Chek bottles, only 202 bottles gave a positive subculture. Of the 245 positive Vital bottles, 223 bottles led to the isolation of a microorganism. Thirty-five septic episodes were detected by Septi-Chek compared to 38 by the Vital system (only clinically significant isolates were taken into consideration). Four septic episodes were detected by Vital only (one episode implicating coagulase-negative Staphylococcus, one Streptococcus pneumoniae, one Pseudomonas aeruginosa and one Candida albicans, involving a total of 15 bottles). One septic episode implicating Bacteroides fragilis was detected by Septi-Chek only (five bottles). Among the negative Vital bottles, only six bottles gave a positive terminal subculture. This study validates the reliability of the Vital system to detect positive blood cultures.

Detection kinetics for positive blood culture bottles by using the VITAL automated system.

The VITAL system principle is based on homogeneous fluorescence technology. During an 11-month period, a total of 19,706 blood cultures from adult patients hospitalized in various establishments of the Montpellier Teaching Hospital were collected in VITAL bottles, of which 1,939 were declared positive. Only 204 bottles (1.04%) were false positives. The 1,735 true-positive bottles were collected from 130 patients. The final visual control permitted the detection of 10 falsely negative bottles (0.05%), of which 5 contained clinically significant microorganisms from four patients. The kinetics of detection for all microorganisms showed that 66.6% were detected within 24 h, 83.1% within 48 h, 95.5% within 120 h, and 100% within 150 h. No clinical episode would have been missed had a 5-day protocol been used instead of a 7-day protocol. Among the positive bottles, 65.7% were detected by the SLOPE algorithm, 20.1% by the DELTA algorithm, and 14.2% by the THRESHOLD algorithm. This retrospective study of our results shows that a 5-day protocol is sufficient for the detection of septic episodes using the VITAL system.

[Drug interactions: study of 409 prescriptions at the time of discharge from geriatric hospitalization]. / Interactions médicamenteuses: étude de 409 ordonnances établies à l'issue d'une hospitalisation gériatrique.

In order to specify the frequency and the potential consequences of drug interactions in the elderly, we retrospectively analysed 409 discharge prescriptions. The possibility of drug interactions was screened out for each prescription in the software version of the Vidal drug compendium. It appears that prescriptions are mainly adapted to the elderly with respect to posology and pharmacokinetics. Potentially dangerous drug interactions ('contraindicated' or 'unsuitable' associations) were found in 6 per cent of prescriptions; after careful assessment, this frequency decreased to less than 1 per cent. The most common orthoergic side effects were sedation (15 per cent) and hypotension (14.5 per cent). This study points out the multiplicity of criteria to be considered in order to prevent drug interactions, and the gaps in available software.

Ergoloid mesylates ('Hydergine') in the treatment of mental deterioration in the elderly: a 6-month double-blind, placebo-controlled trial.

A double-blind, placebo-controlled trial was carried out in 97 elderly patients with age-related mental deterioration to assess the efficacy of ergoloid mesylates in improving their symptoms. Patients were allocated at random to receive either 4.5 mg ergoloid mesylates per day or a matching placebo tablet and were followed-up for 6 months after the start of treatment. Clinical examinations were performed by the doctor, using the EACG rating scale (a French version of the Sandoz Clinical Assessment Geriatric scale), and by the nurse, using the NOSIE scale, when patients entered the trial and repeated after 2, 4 and 6 months. Changes in the factors (symptom groups) covered by these scales were subjected to statistical analysis. After 6-months' treatment, a statistically significant difference in favour of the ergoloid mesylates group was observed for cognitive deficits (p less than 0.05), anxiety and mood depression (p less than 0.01), unsociability (p less than 0.01), retardation (p less than 0.05) and irritability (p less than 0.001). Treatment was very well tolerated. It was also observed that there was a progressive increase in efficacy throughout the trial; this indicates that treatment with ergoloid mesylates in patients with mental deterioration should be long-term.