Carbapenemase-producing Enterobacteriaceae, U.S. Rivers

Identification of imipenem-resistant Enterobacter asburiae isolates from distant rivers indicates an environmental reservoir for carbapenemase genes

A case of IgE myeloma transformed into IgE-producing plasma cell leukaemia

This is a case report of a challenging diagnosis of IgE monoclonal gammopathy of undetermined significance, which transformed into myeloma, then transformed into IgE-producing plasma cell leukaemia in a 71-year-old male who was followed in Brest, France, from 2015 to 2019. The IgEproducing variant is the rarest sub-type of multiple myeloma, and plasma cell leukaemia is considered to be the rarest and the most aggressive of human monoclonal gammopathies. In November 2015, hypogammaglobulinemia was detected during a systematic check-up. A kappa light chain monoclonal gammopathy was first diagnosed due to an increase of the free kappa/lambda light chains ratio. No monoclonal immunoglobulin was detected by either serum protein electrophoresis (Capillarys 2, Sebia, Issy-les-Moulineaux, France) or immunofixation (Hydrasys 2, Sebia, Issy-les- Moulineaux, France). In June 2018, a blood smear led to the diagnosis of plasma cell leukaemia. A monoclonal peak was detected and identified as IgE-kappa. Analysis of an archival sample taken three years earlier, revealed the presence of a monoclonal IgE, which had been missed at diagnosis. Chemotherapy with bortezomib and dexamethasone was introduced. The patient survived 10 months after the diagnosis of leukaemia. This case shows that an abnormal free light chain ratio should be considered as a possible marker of IgE monoclonal gammopathy even in the absence of a solitary light chain revealed by immunofixation. In addition, the use of an undiluted serum may increase the sensitivity of the immunofixation for the detection of IgE monoclonal gammopathies compared to the 1:3 dilution recommended by the manufacturer

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Parcours d’étudiant.es en médecine intensive réanimation : motivations et représentations pour la spécialité

International audienc

Diversité métabolique au sein de l'espèce Escherichia coli (implications dans les capacités d'adaptation et la virulence)

Nous effectuons une étude de la diversité métabolique de divers isolais de E. coli afin (i) d'établir un lien entre métabolisme et virulence et, (ii) de mieux comprendre la physiopathologie des infections urinaires (IU). Les activités enzymatiques spécifiques d'enzymes du métabolisme central sont mesurées à la phase exponentielle dans 4 milieux pour 5 souches. Une diversité intra espèce du métabolisme et des capacités d'adaptation est mise en évidence. Elle peut être rattachée au phénotype pathogène ou commensal et à la niche. E. coli CFT073, uropathogène, favorise le métabolisme de l'acétate et les voies de biosynthèse dans l'urine. L'évaluation de l'homéostasie redox de 8 souches montre que la phase exponentielle, par rapport à la phase stationnaire de la croissance dans l'urine, est associée à un déséquilibre de l'homéostasie redox. Un stress systémique modifie la composition de l'urine, favorisant la croissance de E. coli qui pourrait participer à la survenue d'IU en réanimation.We carry out a study of the metabolic diversity for some strains of E. coli, in order to (i) point out a link between metabolism and virulence and, (ii) improve our understanding of urinary tract infections (UTI). The specific activity of some enzymes from the central metabolism was measured for 5 strains yielded in 4 mediums. We highlight a metabolic diversity, which could be linked to strain's habitats or pathovars. The uropathogenic strain, E. coli CFT073, favours acetate metabolism and neoglucogenesis during growth in urine. The study of redox homeostasis for 8 E. coli strains shows an unbalance during exponential phase by comparison with stationary phase. A systemic stress, such as a polytraumatism, is responsible for changes in urine composition, which could be a risk factor of UTI occurrence in unwell intensive care patients.PARIS5-BU Méd.Cochin (751142101) / SudocSudocFranceF

Platelet storage duration and its clinical and transfusion outcomes: a systematic review

Abstract Background Platelets (PLTs) are usually stored for up to 5 days prior to transfusion, although in some blood services the storage period is extended to 7 days. During storage, changes occur in both PLT and storage medium, which may lead to PLT activation and dysfunction. The clinical significance of these changes remains uncertain. Methods We performed a systematic review to assess the association between PLT storage time and clinical or transfusion outcomes in patients receiving allogeneic PLT transfusion. We searched studies published in English between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed and the Cochrane Libraries. Results Of the 18 studies identified, five included 4719 critically ill patients (trauma, post-cardiac surgery and a heterogeneous population of critically ill patients) and 13 included 8569 haematology patients. The five studies in critically ill patients were retrospective and did not find any association between PLT storage time when PLTs were stored for up to 5 days and mortality. There was also no association between older PLTs and sepsis in the two largest studies (n = 4008 patients). Of the 13 studies in haematology patients, seven analysed prolonged storage time up to 6.5 or 7 days. Administration of fresh PLTs (less than 2 or 3 days) was associated with a significant increase in corrected count increment (CCI) compared to older PLTs in seven of the eight studies analysing this outcome. One single centre retrospective study found an increase in bleeding events in patients receiving older PLTs. Conclusions PLT storage time does not appear to be associated with clinical outcomes, including bleeding, sepsis or mortality, in critically ill patients or haematology patients. The freshest PLTs (less than 3 days) were associated with a better CCI, although there was no impact on bleeding events, questioning the clinical significance of this association. However, there is an absence of evidence to draw definitive conclusions, especially in critically ill patients

Interactions entre systèmes de production apicoles et systèmes d'élevage dans des paysages agropastoraux : une approche par les ressources florales

International audienceFrom columns to “save the bees” to calls to “conciliate beekeeping and agriculture”, agriculture is often pointed out as responsible for pollinators decline and the beekeeping sector difficulties. At the same time, agriculture, as a major factor of landscape constitution, is an unavoidable lever to solve these very issues, namely through the floral resources it shapes. However, knowledge about the impact of agropastoral farming systems on floral resources for beekeeping is still scarce. How do various livestock farming system contribute to the construction of floral resources in agropastoral landscapes? What are the consequences of this construction for various beekeeping-farming systems?In order to answer these questions, we led an agrarian diagnostic in a middle mountain massif of southern France. We identified various livestock farming systems and beekeeping farming systems, and their respective impact on and dependence to floral resources. This led us to reveal livestock-beekeeping farming systems technical-economical interactions at various spatio-temporal scales: •cultivation practices (choose of cropped species, irrigation, fertilization, mowing) in the short term,•“open” landscapes maintenance in the medium term•land intensification and land abandonment in the long termBeekeeping farming systems have adapted to changes in floral resources and to the global changing beekeeping conditions. They did so by adapting their uses of traditional floral resources or by shifting to new ones. Accounting for floral resources and beekeeping farming systems dynamics is helpful to inform agropastoral landscapes management, in order to elicit beekeepers and farmers cohabitation.D'éditoriaux pour "sauver les abeilles" en appels à "concilier apiculture et agriculture", l'agriculture est souvent pointée du doigt comme responsable du déclin des pollinisateurs d'une part, et des difficultés du secteur apicole d'autre part. D'un autre côté, en tant que contributrice majeure à la construction des paysages, l'agriculture est un levier incontournable pour résoudre ces difficultés, notamment par le biais des ressources florales qu'elle façonne. Toutefois, nos connaissances sur l'influence des systèmes de production agropastoraux sur les ressources florales utiles à l'apiculture sont encore limitées. Comment les différents systèmes d'élevage contribuent-ils à la production de ressources florales dans les paysages agropastoraux ? Comment les différents systèmes de production apicoles s'accomodent-ils des ressources florales ainsi générées à l'échelle des paysages ? Pour répondre à ces questions, nous avons mené un diagnostic agraire sur un massif de moyenne montagne dans le Massif Central. Nous avons identifié différents systèmes de production, apicoles et agropastoraux, ainsi que leurs impacts et usages des ressources florales. Nous mettons ainsi en en évidence les interactions technico-économiques entre systèmes de production apicoles et agropastorales à différentes échelles spatio-temporelles : •celle des systèmes de culture (choix des espèces cultivées, irrigation, fertilisation, pâturage) à court terme•celle des paysages, notamment le maintien de paysages "ouverts, à moyen terme•celle de la double dynamique d'intensification / déprise à long terme. Les systèmes de production apicoles se sont adaptés aux changements dans les ressources florales, dans un contexte de changement global des condition d'exercice de l'apiculture. Cette adaptation est passée par des modification de l'usage des ressources florales historiques ainsi que par l'usage de nouvelles ressources. La prise en compte des ressources florales et des dynamiques des systèmes de production apicoles, est nécessaire pour imaginer une meilleure cohabitation entre apiculture et élevage à l'échelle des territoires

The Non-Hemostatic Aspects of Transfused Platelets

Platelets transfusion is a safe process, but during or after the process, the recipient may experience an adverse reaction and occasionally a serious adverse reaction (SAR). In this review, we focus on the inflammatory potential of platelet components (PCs) and their involvement in SARs. Recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Blood platelets are involved in inflammation and various other aspects of innate immunity through the release of a plethora of immunomodulatory cytokines, chemokines, and associated molecules, collectively termed biological response modifiers that behave like ligands for endothelial and leukocyte receptors and for platelets themselves. The involvement of PCs in SARs—particularly on a critically ill patient’s context—could be related, at least in part, to the inflammatory functions of platelets, acquired during storage lesions. Moreover, we focus on causal link between platelet activation and immune-mediated disorders (transfusion-associated immunomodulation, platelets, polyanions, and bacterial defense and alloimmunization). This is linked to the platelets’ propensity to be activated even in the absence of deliberate stimuli and to the occurrence of time-dependent storage lesions

Is hypophosphataemia an independent predictor of mortality in critically ill patients with bloodstream infection? A multicenter retrospective cohort study

International audienceObjective: Primary hypobetalipoproteinemia is characterized by LDL-C (low-density lipoprotein cholesterol) concentrations below the fifth percentile. Primary hypobetalipoproteinemia mostly results from heterozygous mutations in the APOB and PCSK9 genes, and a polygenic origin is hypothesized in the remaining cases. Hypobetalipoproteinemia patients present an increased risk of nonalcoholic fatty liver disease and steatohepatitis. Here, we compared hepatic alterations between monogenic, polygenic, and primary hypobetalipoproteinemia of unknown cause. Approach and Results: Targeted next-generation sequencing was performed in a cohort of 111 patients with hypobetalipoproteinemia to assess monogenic and polygenic origins using an LDL-C-dedicated polygenic risk score. Forty patients (36%) had monogenic hypobetalipoproteinemia, 38 (34%) had polygenic hypobetalipoproteinemia, and 33 subjects (30%) had hypobetalipoproteinemia from an unknown cause. Patients with monogenic hypobetalipoproteinemia had lower LDL-C and apolipoprotein B plasma levels compared with those with polygenic hypobetalipoproteinemia. Liver function was assessed by hepatic ultrasonography and liver enzymes levels. Fifty-nine percent of patients with primary hypobetalipoproteinemia presented with liver steatosis, whereas 21% had increased alanine aminotransferase suggestive of liver injury. Monogenic hypobetalipoproteinemia was also associated with an increased prevalence of liver steatosis (81% versus 29%, P <0.001) and liver injury (47% versus 0%) compared with polygenic hypobetalipoproteinemia. Conclusions: This study highlights the importance of genetic diagnosis in the clinical care of primary hypobetalipoproteinemia patients. It shows for the first time that a polygenic origin of hypobetalipoproteinemia is associated with a lower risk of liver steatosis and liver injury versus monogenic hypobetalipoproteinemia. Thus, polygenic risk score is a useful tool to establish a more personalized follow-up of primary hypobetalipoproteinemia patients

Transfusion in the mechanically ventilated patient

Red blood cell transfusions are a frequent intervention in critically ill patients, including in those who are receiving mechanical ventilation. Both these interventions can impact negatively on lung function with risks of transfusion-related acute lung injury (TRALI) and other forms of acute respiratory distress syndrome (ARDS). The interactions between transfusion, mechanical ventilation, TRALI and ARDS are complex and other patient-related (e.g. presence of sepsis or shock, disease severity, and hypervolemia) or blood product-related (e.g. presence of antibodies or biologically active mediators) factors also play a role. We propose several strategies targeted at these factors that may help limit the risks of associated lung injury in critically ill patients being considered for transfusion.SCOPUS: re.jinfo:eu-repo/semantics/publishe