Comparison of prognostic factors between bacteraemic and non-bacteraemic critically ill immunocompetent patients in community-acquired severe pneumococcal pneumonia: a STREPTOGENE sub-study.

BACKGROUND: The presence of bacteraemia in pneumococcal pneumonia in critically ill patients does not appear to be a strong independent prognostic factor in the existing literature. However, there may be a specific pattern of factors associated with mortality for ICU patients with bacteraemic pneumococcal community-acquired pneumonia (CAP). We aimed to compare the factors associated with mortality, according to the presence of bacteraemia or not on admission, for patients hospitalised in intensive care for severe pneumococcal CAP. METHODS: This was a post hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France between 2008 and 2012 for pneumococcal CAP. Patients were divided into two groups based on initial blood culture (positive vs. negative) for Streptococcus pneumoniae. The primary outcome was hospital mortality, which was compared between the two groups using odds ratios according to predefined variables to search for a prognostic interaction present in bacterial patients but not non-bacteraemic patients. Potential differences in the distribution of serotypes between the two groups were assessed. The prognostic consequences of the presence or not of initial bi-antibiotic therapy were assessed, specifically in bacteraemic patients. RESULTS: Among 614 included patients, 274 had a blood culture positive for S. pneumoniae at admission and 340 did not. The baseline difference between the groups was more frequent leukopaenia (26% vs. 14%, p = 0.0002) and less frequent pre-hospital antibiotic therapy (10% vs. 16.3%, p = 0.024) for the bacteraemic patients. Hospital mortality was not significantly different between the two groups (p = 0.11). We did not observe any prognostic factors specific to the bacteraemic patient population, as the statistical comparison of the odds ratios, as an indication of the association between the predefined prognostic parameters and mortality, showed them to be similar for the two groups. Bacteraemic patients more often had invasive serotypes but less often serotypes associated with high case fatality rates (p = 0.003). The antibiotic regimens were similar for the two groups. There was no difference in mortality for patients in either group given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. CONCLUSION: Bacteraemia had no influence on the mortality of immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, regardless of the profile of the associated prognostic factors

Epidémiologie comparée des candidémies en réanimation chez le sujet non neutropénique

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric).

Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Societe de Reanimation de Langue Francaise (SRLF) and the Societe Francaise d'Anesthesie et de Reanimation (SFAR) to set up a panel of experts from various disciplines. These experts met for the first time at the end of 2012 and have since met regularly to issue the following 67 recommendations, according to the rigorous GRADE methodology. Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria

Elevated Plasma Levels of sRAGE Are Associated With Nonfocal CT-Based Lung Imaging in Patients With ARDS A Prospective Multicenter Study

International audienceBACKGROUND: During ARDS, CT can reveal two distinct lung imaging patterns, focal or non-focal, with different responses to positive end-expiratory pressure, recruitment maneuvers, and prone position. Nevertheless, their association with plasma biomarkers and their distinct functional/pathobiological mechanisms are unknown. The objective of this study was to characterize focal and nonfocal patterns of lung CT-based imaging with plasma markers of lung injury. METHODS: A prospective multicenter cohort study involving 119 consecutive patients with ARDS. Plasma biomarkers (soluble form of the receptor for advanced glycation end product [sRAGE], plasminogen activator inhibitor-1, soluble intercellular adhesion molecule-1, and surfactant protein-D) were measured within 24 h of ARDS onset. Lung CT scan was performed within the first 48 h to assess lung morphology. RESULTS: Thirty-two (27%) and 87 (73%) patients had focal and nonfocal ARDS, respectively. Plasma levels of sRAGE were significantly higher in nonfocal ARDS, compared with focal ARDS. A cut-off of 1,188 pg/mL differentiated focal from nonfocal ARDS with a sensitivity of 94% and a specificity of 84%. Nonfocal patterns were associated with higher 28- and 90-day mortality than focal patterns (31% vs 12%, P = .038 and 46% vs 21%, P = .026, respectively). Plasma levels of plasminogen activator inhibitor-1 were significantly higher in nonfocal ARDS. There was no difference in other biomarkers. CONCLUSIONS: Plasma sRAGE is associated with a nonfocal ARDS. Such novel findings may suggest a role for RAGE pathway in an underlying endotype of impaired alveolar fluid clearance and stimulate future research on the association between ARDS phenotypes and therapeutic responses

Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study.

PURPOSE: To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). METHODS: Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. RESULTS: Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets /= 2 (4.58; 1.61-13), age > 65 years (2.92; 1.49-5.74), lactates > 4 mmol/L (2.41; 1.27-4.56), male gender and septic shock (2.23; 1.30-3.83 for each), invasive mechanical ventilation (1.78; 1-3.19), and bilateral pneumonia (1.59; 1.02-2.47). Women with platelets </= 100 x 10(9)/L had the highest mortality risk (adjusted OR, 7.7; 2.8-21). CONCLUSIONS: In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality

Study of isospin diffusion from 40,48^{40,48}Ca+40,48+^{40,48}Ca experimental data at Fermi energies: direct comparisons with transport model calculations

This article presents an investigation of isospin equilibration in cross-bombarding $^{40,48}$Ca$+^{40,48}$Ca reactions at $35$ MeV/nucleon, by comparing experimental data with filtered transport model calculations. Isospin diffusion is studied using the evolution of the isospin transport ratio with centrality. The asymmetry parameter $\delta=(N-Z)/A$ of the quasiprojectile (QP) residue is used as isospin-sensitive observable, while a recent method for impact parameter reconstruction is used for centrality sorting.A benchmark of global observables is proposed to assess the relevance of the antisymmetrized molecular dynamics (AMD) model, coupled to GEMINI++, in the study of dissipative collisions. Our results demonstrate the importance of considering cluster formation to reproduce observables used for isospin transport and centrality studies.Within the AMD model, we prove the applicability of the impact parameter reconstruction method, enabling a direct comparison to the experimental data for the investigation of isospin diffusion.For both, we evidence a tendency to isospin equilibration with an impact parameter decreasing from $9$ to $3$ fm, while the full equilibration is not reached.A weak sensitivity to the stiffness of the equation of state employed in the model is also observed, with a better reproduction of the experimental trend for the neutron-rich reactions

Study of isospin diffusion from 40,48^{40,48}Ca+40,48+^{40,48}Ca experimental data at Fermi energies: direct comparisons with transport model calculations

This article presents an investigation of isospin equilibration in cross-bombarding $^{40,48}$Ca$+^{40,48}$Ca reactions at $35$ MeV/nucleon, by comparing experimental data with filtered transport model calculations. Isospin diffusion is studied using the evolution of the isospin transport ratio with centrality. The asymmetry parameter $\delta=(N-Z)/A$ of the quasiprojectile (QP) residue is used as isospin-sensitive observable, while a recent method for impact parameter reconstruction is used for centrality sorting.A benchmark of global observables is proposed to assess the relevance of the antisymmetrized molecular dynamics (AMD) model, coupled to GEMINI++, in the study of dissipative collisions. Our results demonstrate the importance of considering cluster formation to reproduce observables used for isospin transport and centrality studies.Within the AMD model, we prove the applicability of the impact parameter reconstruction method, enabling a direct comparison to the experimental data for the investigation of isospin diffusion.For both, we evidence a tendency to isospin equilibration with an impact parameter decreasing from $9$ to $3$ fm, while the full equilibration is not reached.A weak sensitivity to the stiffness of the equation of state employed in the model is also observed, with a better reproduction of the experimental trend for the neutron-rich reactions

Study of isospin diffusion from 40,48^{40,48}Ca+40,48+^{40,48}Ca experimental data at Fermi energies: direct comparisons with transport model calculations

This article presents an investigation of isospin equilibration in cross-bombarding $^{40,48}$Ca$+^{40,48}$Ca reactions at $35$ MeV/nucleon, by comparing experimental data with filtered transport model calculations. Isospin diffusion is studied using the evolution of the isospin transport ratio with centrality. The asymmetry parameter $\delta=(N-Z)/A$ of the quasiprojectile (QP) residue is used as isospin-sensitive observable, while a recent method for impact parameter reconstruction is used for centrality sorting.A benchmark of global observables is proposed to assess the relevance of the antisymmetrized molecular dynamics (AMD) model, coupled to GEMINI++, in the study of dissipative collisions. Our results demonstrate the importance of considering cluster formation to reproduce observables used for isospin transport and centrality studies.Within the AMD model, we prove the applicability of the impact parameter reconstruction method, enabling a direct comparison to the experimental data for the investigation of isospin diffusion.For both, we evidence a tendency to isospin equilibration with an impact parameter decreasing from $9$ to $3$ fm, while the full equilibration is not reached.A weak sensitivity to the stiffness of the equation of state employed in the model is also observed, with a better reproduction of the experimental trend for the neutron-rich reactions

Study of isospin diffusion from 40,48^{40,48}Ca+40,48+^{40,48}Ca experimental data at Fermi energies: direct comparisons with transport model calculations

This article presents an investigation of isospin equilibration in cross-bombarding $^{40,48}$Ca$+^{40,48}$Ca reactions at $35$ MeV/nucleon, by comparing experimental data with filtered transport model calculations. Isospin diffusion is studied using the evolution of the isospin transport ratio with centrality. The asymmetry parameter $\delta=(N-Z)/A$ of the quasiprojectile (QP) residue is used as isospin-sensitive observable, while a recent method for impact parameter reconstruction is used for centrality sorting.A benchmark of global observables is proposed to assess the relevance of the antisymmetrized molecular dynamics (AMD) model, coupled to GEMINI++, in the study of dissipative collisions. Our results demonstrate the importance of considering cluster formation to reproduce observables used for isospin transport and centrality studies.Within the AMD model, we prove the applicability of the impact parameter reconstruction method, enabling a direct comparison to the experimental data for the investigation of isospin diffusion.For both, we evidence a tendency to isospin equilibration with an impact parameter decreasing from $9$ to $3$ fm, while the full equilibration is not reached.A weak sensitivity to the stiffness of the equation of state employed in the model is also observed, with a better reproduction of the experimental trend for the neutron-rich reactions

Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia

International audienceAbstract Data on the relationship between antimicrobial resistance and mortality remain scarce, and this relationship needs to be investigated in intensive care units (ICUs). The aim of this study was to compare the ICU mortality rates between patients with ICU-acquired pneumonia due to highly antimicrobial-resistant (HAMR) bacteria and those with ICU-acquired pneumonia due to non-HAMR bacteria. We conducted a multicenter, retrospective cohort study using the French National Surveillance Network for Healthcare Associated Infection in ICUs (“REA-Raisin”) database, gathering data from 200 ICUs from January 2007 to December 2016. We assessed all adult patients who were hospitalized for at least 48 h and presented with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii . The association between pneumonia caused by HAMR bacteria and ICU mortality was analyzed using the whole sample and using a 1:2 matched sample. Among the 18,497 patients with at least one documented case of ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii , 3081 (16.4%) had HAMR bacteria. The HAMR group was associated with increased ICU mortality (40.3% vs. 30%, odds ratio (OR) 95%, CI 1.57 [1.45–1.70], P < 0.001). This association was confirmed in the matched sample (3006 HAMR and 5640 non-HAMR, OR 95%, CI 1.39 [1.27–1.52], P < 0.001) and after adjusting for confounding factors (OR ranged from 1.34 to 1.39, all P < 0.001). Our findings suggest that ICU-acquired pneumonia due to HAMR bacteria is associated with an increased ICU mortality rate, ICU length of stay, and mechanical ventilation duration