Infections de prothèses vasculaires (Etude rétrospective, descriptive de 78 patients admis entre le 01.01.2006 et le 31.03.2012 dans les services de chirurgie vasculaire et d'infectiologie des Hôpitaux Universitaires de Strasbourg)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

COVID-19 Epidemic:: Regional Organization Centered on Nursing Homes

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Improving the diagnosis of invasive aspergillosis by the detection of Aspergillus in broncho-alveolar lavage fluid Comparison of non-culture-based assays

International audienceObjectives This study aimed to evaluate new tools to diagnose invasive aspergillosis (IA) directly from broncho-alveolar lavage (BAL) samples.Methods All consecutive patients with suspected IA who underwent bronchoscopy with BAL were prospectively included. Mycological culture and ELISA detection of galactomannan (GM) were performed on BAL. Two in-house and two marketed PCR assays were used on BAL DNA extracts to detect Aspergillus species. Susceptibility testing was performed after culture; marketed PCR assays detected mutations in the CYP51A gene associated to resistance.Results Within 3 years, 1555 BAL samples were processed, including 413 samples from 387 immunosuppressed patients. IA diagnosis was no-IA, possible, probable or proven IA in 326, 23, 37 and 1 patients, respectively. PCR assays sensitivity for Aspergillus detection ranged from 61% to 74%, below GM (87%), but contrasting with 47% for cultures. Combining PCR to EORTC/MSG criteria increased the sensitivity to 100%. Interestingly, tests performance in non-hematological patients ranged from 60% to 75%, and were higher than in hematological patients, and those with prior exposure to antifungals. All 16 isolates of Aspergillus fumigatus were susceptible; PCR did not detect any resistance marker in the 37 A. fumigatus PCR-positive samples.Conclusion The molecular detection of Aspergillus directly in BAL samples greatly improved the diagnosis of IA, particularly in non-hematological patients. (C) 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved

COVID-19 vaccine hesitancy among healthcare workers

International audienceObjective: To characterize healthcare workers' (HCWs) intention to receive the COVID-19 vaccine by thebeginning of the vaccine campaign in France. Methods: Data were collected on a self-administered questionnaire through the website of a tertiary carecenter (February 9-18, 2021). Results: Among 1,965 respondents, 1,436 (73.1%), 453 (23.1%), and 76 (3.9%) declared themselves infavor, hesitant, or against the COVID-19 vaccine: < 60% of auxiliary nurses and technicians intended to bevaccinated, as compared to 60-79% of nurses and support staff, and > 80% of medical staff. On multivariateanalysis, age, occupation, flu vaccine history, and controversy over the AstraZeneca vaccine tolerabilitywere independently associated with COVID-19 vaccine intention. Conclusions: Patterns of vaccine hesitancy related to the COVID-19 and influenza vaccines are similaramong HCWs. Media communication on vaccine side effects have a dramatic effect on vaccine hesitancy. Efforts are requested to inform HCWs about the risk/benefit balance of COVID-19 vaccines

2020 French recommendations on the management of septic arthritis in an adult native joint

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Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia

International audienceBackground : Improving timeliness of pathogen identification is crucial to allow early adaptation of antibiotic therapy and improve prognosis in patients with pneumonia. We evaluated the relevance of a new syndromic rapid multiplex PCR test (rm-PCR) on respiratory samples to guide empirical antimicrobial therapy in adult patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP).MethodsThis retrospective multicenter study was conducted in four French university hospitals. Respiratory samples were obtained from patients with clinical and radiological signs of pneumonia and simultaneously tested using conventional microbiological methods and the rm-PCR. A committee composed of an intensivist, a microbiologist, and an infectious diseases specialist retrospectively assessed all medical files and agreed on the most appropriate antimicrobial therapy for each pneumonia episode, according to the results of rm-PCR and blinded to the culture results. The rm-PCR-guided antimicrobial regimen was compared to the empirical treatment routinely administered to the patient in standard care.ResultsWe included 159 pneumonia episodes. Most patients were hospitalized in intensive care units (n=129, 81%), and episodes were HAP (n=68, 43%), CAP (n=54, 34%), and VAP (n=37, 23%). Conventional culture isolated >= 1 microorganism(s) at significant level in 95 (60%) patients. The syndromic rm-PCR detected at least one bacteria in 132 (83%) episodes. Based on the results of the rm-PCR, the multidisciplinary committee proposed a modification of the empirical therapy in 123 (77%) pneumonia episodes. The modification was a de-escalation in 63 (40%), an escalation in 35 (22%), and undetermined in 25 (16%) patients. In microbiologically documented episodes (n=95), the rm-PCR increased appropriateness of the empirical therapy to 83 (87%), as compared to 73 (77%) in routine care.ConclusionsUse of a syndromic rm-PCR test has the potential to reduce unnecessary antimicrobial exposure and increase the appropriateness of empirical antibiotic therapy in adult patients with pneumonia

Utility of hyposmia and hypogeusia for the diagnosis of COVID-19

International audience[No abstract available