Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia

<p>Abstract</p> <p>Background</p> <p>Patients with <it>Enterobacter </it>community-acquired pneumonia (EnCAP) were admitted to our intensive care unit (ICU). Our primary aim was to describe them as few data are available on EnCAP. A comparison with CAP due to common and typical bacteria was performed.</p> <p>Methods</p> <p>Baseline clinical, biological and radiographic characteristics, criteria for health-care-associated pneumonia (HCAP) were compared between each case of EnCAP and thirty age-matched typical CAP cases. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with ENCAP. Their outcome was also compared.</p> <p>Results</p> <p>In comparison with CAP due to common bacteria, a lower leukocytosis and constant HCAP criteria were associated with EnCAP. Empiric antibiotic therapy was less effective in EnCAP (20%) than in typical CAP (97%) (p < 0.01). A delay in the initiation of appropriate antibiotic therapy (3.3 ± 1.6 vs. 1.2 ± 0.6 days; p < 0.01) and an increase in duration of mechanical ventilation (8.4 ± 5.2 vs. 4.0 ± 4.3 days; p = 0.01) and ICU stay were observed in EnCAP patients.</p> <p>Conclusions</p> <p>EnCAP is a severe infection which is more consistent with HCAP than with typical CAP. This retrospectively suggests that the application of HCAP guidelines should have improved EnCAP management.</p

BMC Cancer

Background: The exhaustive collection of new sarcoma cases and their second histologic review offer a unique opportunity to study their incidence and time trends in France according to the major subtypes. Methods: Data were collected from population-based cancer registries covering 22% of the French population. Crude and world age-standardized incidence rates (ASR) were estimated according to anatomic, histological and genetic groups, age and sex over the 2010–2013 period. Results: Time trends in incidence were calculated by the annual percent change over the 2000–2013 period. During the most recent period (2010–2013), 3942 patients with sarcoma were included. The ASR of soft-tissue and bone sarcomas, and gastro-intestinal stromal tumors (GIST) were 2.1, 1.0 and 0.6, respectively. For the four most frequent histological subtypes (unclassified, leiomyosarcoma, GIST and liposarcoma), the ASR ranged from 0.4 to 0.7. ASRs were 1.9 for complex genomic and 1.3 for recurrent translocation sarcomas. The time-trend analysis showed a significant increase of sarcoma incidence rate between 2000 and 2005, which stabilized thereafter. Incidence rates increased for four histological subtypes (GIST, chondrosarcoma, myxofibrosarcoma, solitary fibrous tumors) and decreased for three (leiomyosarcomas, Kaposi sarcoma and fibrosarcoma). Conclusion: To our knowledge, this study is the first to investigate sarcoma incidence based on a systematic pathological review of these cancers and on the updated sarcoma classifications. Due to the paucity of literature on sarcomas, future studies using data from population-based cancer registries should consider a standardized inclusion criterion presented in our study to better describe and compare data between countries

BMJ Open

INTRODUCTION: Sarcomas are rare tumours of connective tissue. The exact overall incidence of sarcomas is unknown due to diagnostic difficulties and the various histological subtypes (over 80 subtypes). However, the apparent increasing incidence of sarcomas suggests environmental causes such as pesticides. Except for some specific factors (ie, ionising radiation, vinyl chloride, dioxin and genetic predispositions) the scientific knowledge on the aetiology of sarcomas is sparse and inconsistent. France is a particularly appropriate country to set up a study investigating the causes of sarcoma occurrence due to the French organisation in treatment and care of sarcoma patients, which is highly structured and revolved around national expert networks. The main objective of the ETIOlogy of SARcomas (ETIOSARC) project is to study the role of lifestyle, environmental and occupational factors in the occurrence of sarcomas among adults from a multicentric population-based case-control study. METHODS AND ANALYSIS: Cases will be all incident patients (older than 18 years) prospectively identified in 15 districts of France covered by a general population-based cancer registry and/or a reference centre in sarcoma's patient care over a 3-year period with an inclusion start date ranging from February 2019 to January 2020 and histologically confirmed by a second review of the diagnosis. Two controls will be individually matched by sex, age (5 years group) and districts of residence and randomly selected from electoral rolls. A standardised questionnaire will be administered by a trained interviewer in order to gather information about occupational and residential history, demographic and socioeconomic characteristics and lifestyle factors. At the end of the interview, a saliva sample will be systematically proposed. This study will permit to validate or identify already suspected risk factors for sarcomas such as phenoxyherbicides, chlorophenol and to generate new hypothesis to increase our understanding about the genetic and environmental contributions in the carcinogenicity process. ETHICS AND DISSEMINATION: The present study is promoted by the French National Institute of Health and Medical Research (identification number C17-03). This study received National French Ethic committee (CPP Sud Mediterrannee I) approval (identification number 18-31) and French Data Protection Authority (CNIL) approval (identification number 918171). Results of this study will be published in international peer-reviewed journals. Technical appendix, statistical code and dataset will be available in the Dryad repository when collection data are completed. TRIAL REGISTRATION NUMBER: NCT03670927

Two warm Neptunes transiting HIP 9618 revealed by TESS and Cheops

peer reviewedHIP 9618 (HD 12572, TOI-1471, TIC 306263608) is a bright (G = 9.0 mag) solar analogue. TESS photometry revealed the star to have two candidate planets with radii of 3.9 ± 0.044 R (HIP 9618 b) and 3.343 ± 0.039 R (HIP 9618 c). While the 20.77291 d period of HIP 9618 b was measured unambiguously, HIP 9618 c showed only two transits separated by a 680-d gap in the time series, leaving many possibilities for the period. To solve this issue, CHEOPS performed targeted photometry of period aliases to attempt to recover the true period of planet c, and successfully determined the true period to be 52.56349 d. High-resolution spectroscopy with HARPS-N, SOPHIE, and CAFE revealed a mass of 10.0 ± 3.1M for HIP 9618 b, which, according to our interior structure models, corresponds to a 6.8 ± 1.4 per cent gas fraction. HIP 9618 c appears to have a lower mass than HIP 9618 b, with a 3-sigma upper limit of 50 d, opening the door for the atmospheric characterization of warm (Teq < 750 K) sub-Neptunes

Antibiotic consumption in hospitals : description, Adjustment criteria and Relationship with Antibiotic Policy

La maitrise de la résistance bactérienne et l’utilisation prudente des antibiotiques à l’hôpital constituent des enjeux majeurs pour les autorités de santé dans tous les pays européens. Toutefois, les connaissances en matière de consommation des antibiotiques et de politique de bon usage des antibiotiques dans les établissements sont limitées. Dans ce contexte, le travail de cette thèse permet de donner une meilleure vision de la consommation des antibiotiques dans les pays européens à partir des données de surveillance disponibles. Il apporte également des cibles d’amélioration de la prescription des antibiotiques et identifie plusieurs indicateurs de qualité pour mener à bien une politique de bon usage des antibiotiques. De plus, ce travail utilise le modèle des hôpitaux français pour identifier des critères d’ajustement de la consommation des antibiotiques facilement disponibles qui sont essentiels à mettre en œuvre pour établir des comparaisons entre les différents hôpitaux. Il s’intéresse également à la relation entre la politique de bon usage des antibiotiques dans les hôpitaux et une moindre consommation des antibiotiques. En conclusion, les données de surveillance de la consommation des antibiotiques ont donc permis de répondre à plusieurs hypothèses de recherche et de dégager de nouveaux axes de réflexions.The control of bacterial resistance and the prudent use of antibiotics in hospitals are major challenges for health authorities in all European countries. However, little is known regarding antibiotic consumption and antibiotic policies in hospitals. In this context, this thesis provides insight into the antibiotic consumption using available survey databases. It also identifies targets for quality improvement and several quality indicators which are essencial to carry out a prudent use antibiotic policy. Moreover, the model of French hospitals was used to explore easily available adjustment criteria for the antibiotic consumption which are crucial to implement comparisons between different types of hospitals. This work brings light onto the relationship between the antibiotic policy and a low level of antibiotic use in French hospitals. In conclusion, survey databases have enabled us to answer several research assumptions and to generate new horizons of reflection

Antibiotic consumption in hospitals : description, Adjustment criteria and Relationship with Antibiotic Policy

La maitrise de la résistance bactérienne et l’utilisation prudente des antibiotiques à l’hôpital constituent des enjeux majeurs pour les autorités de santé dans tous les pays européens. Toutefois, les connaissances en matière de consommation des antibiotiques et de politique de bon usage des antibiotiques dans les établissements sont limitées. Dans ce contexte, le travail de cette thèse permet de donner une meilleure vision de la consommation des antibiotiques dans les pays européens à partir des données de surveillance disponibles. Il apporte également des cibles d’amélioration de la prescription des antibiotiques et identifie plusieurs indicateurs de qualité pour mener à bien une politique de bon usage des antibiotiques. De plus, ce travail utilise le modèle des hôpitaux français pour identifier des critères d’ajustement de la consommation des antibiotiques facilement disponibles qui sont essentiels à mettre en œuvre pour établir des comparaisons entre les différents hôpitaux. Il s’intéresse également à la relation entre la politique de bon usage des antibiotiques dans les hôpitaux et une moindre consommation des antibiotiques. En conclusion, les données de surveillance de la consommation des antibiotiques ont donc permis de répondre à plusieurs hypothèses de recherche et de dégager de nouveaux axes de réflexions.The control of bacterial resistance and the prudent use of antibiotics in hospitals are major challenges for health authorities in all European countries. However, little is known regarding antibiotic consumption and antibiotic policies in hospitals. In this context, this thesis provides insight into the antibiotic consumption using available survey databases. It also identifies targets for quality improvement and several quality indicators which are essencial to carry out a prudent use antibiotic policy. Moreover, the model of French hospitals was used to explore easily available adjustment criteria for the antibiotic consumption which are crucial to implement comparisons between different types of hospitals. This work brings light onto the relationship between the antibiotic policy and a low level of antibiotic use in French hospitals. In conclusion, survey databases have enabled us to answer several research assumptions and to generate new horizons of reflection

Consommation des Antibiotiques dans les Etablissements de Santé (description, Critères d'Ajustement et Relation avec la Politique de Bon Usage des Antibiotiques)

La maitrise de la résistance bactérienne et l utilisation prudente des antibiotiques à l hôpital constituent des enjeux majeurs pour les autorités de santé dans tous les pays européens. Toutefois, les connaissances en matière de consommation des antibiotiques et de politique de bon usage des antibiotiques dans les établissements sont limitées. Dans ce contexte, le travail de cette thèse permet de donner une meilleure vision de la consommation des antibiotiques dans les pays européens à partir des données de surveillance disponibles. Il apporte également des cibles d amélioration de la prescription des antibiotiques et identifie plusieurs indicateurs de qualité pour mener à bien une politique de bon usage des antibiotiques. De plus, ce travail utilise le modèle des hôpitaux français pour identifier des critères d ajustement de la consommation des antibiotiques facilement disponibles qui sont essentiels à mettre en œuvre pour établir des comparaisons entre les différents hôpitaux. Il s intéresse également à la relation entre la politique de bon usage des antibiotiques dans les hôpitaux et une moindre consommation des antibiotiques. En conclusion, les données de surveillance de la consommation des antibiotiques ont donc permis de répondre à plusieurs hypothèses de recherche et de dégager de nouveaux axes de réflexions.The control of bacterial resistance and the prudent use of antibiotics in hospitals are major challenges for health authorities in all European countries. However, little is known regarding antibiotic consumption and antibiotic policies in hospitals. In this context, this thesis provides insight into the antibiotic consumption using available survey databases. It also identifies targets for quality improvement and several quality indicators which are essencial to carry out a prudent use antibiotic policy. Moreover, the model of French hospitals was used to explore easily available adjustment criteria for the antibiotic consumption which are crucial to implement comparisons between different types of hospitals. This work brings light onto the relationship between the antibiotic policy and a low level of antibiotic use in French hospitals. In conclusion, survey databases have enabled us to answer several research assumptions and to generate new horizons of reflection.BORDEAUX2-Bib. électronique (335229905) / SudocSudocFranceF