Etude des signes cliniques associés au diagnostic d’infection urinaire dans un contexte d’examen cytobactériologique des urines positif chez les sujets âgés de plus de 75 ans en médecine ambulatoire à Paris

Urinary tract infection in the elderly is a common cause of consultation in general practice but the diagnosis remain complicated without clear recommandations. The aim of our study was to determinate the clinical signs associated with the diagnosis of urinary tract infection in an ambulatory population over 75 years in Paris. From june to october 2017, bacteriological urinary analysis from patients over 75 years old performed in an ambulatory laboratory were included.The primary objective was to determine clinical signs associated with urinary infections.. Secondary objective were to determinate the incidence of asymptomatic bacteriuria in an ambulatory elderly population, to determinate the bacteriological ecology and to describe the treatment. 98 bacteriological urinary analysis were included for analysis. Urinary burning was the only clinical sign associated with the diagnosis of urinary tract infection (OR 4.12 [1.1-16.1], p=0.04). The incidence of asymptomatic bacteriuria was 13.7%. Escherichia Coli was the main germ found. Treatment guidelines in this particular population were not applied. As conclusion, only urinary burning was associated with the diagnosis of urinary tract infection in an ambulatory population of patients over 75 years in Paris.L’infection urinaire du sujet âgé est un problème fréquent en médecine de ville mais son diagnostic reste compliqué dans cette population sans qu’il existe des recommandations claires. L’objectif de notre étude était de rechercher les signes cliniques associés au diagnostic d’infection urinaire dans un contexte d’ECBU positif chez les sujets de plus de 75 ans en ambulatoire à Paris. De juin à octobre 2017, ont été inclus les patients de plus de 75 ans, ayant un résultat positif d’ECBU pratiqué dans un laboratoire de ville à Paris avec au moins 1 germe identifié. L’objectif principal était de déterminer les signes cliniques associés au diagnostic d’infection urinaire. Les objectifs secondaires étaient de déterminer le taux de colonisation urinaire en ambulatoire, déterminer l’écologie microbiologique et de décrire le type d’antibiothérapie utilisée. Au total, 98 ECBU ont été inclus pour analyse. Les brûlures mictionnelles ont été le seul signe clinique statistiquement associé au diagnostic d’infection urinaire (OR 4.12 [1.1-16.1] avec p=0.04). Aucun signe dit « atypique » n’a été retrouvé dans notre population. Le taux de colonisation urinaire retrouvé a été de 13.7%. Une prédominance d’Eschérichia Coli a été retrouvée dans les ECBU analysés. Les recommandations de prise en charge thérapeutiques dans cette population « à risque de complications » ne sont pas encore parfaitement appliquées. Au total, seules les brûlures mictionnelles sont significativement associées au diagnostic d’infection urinaire dans la population âgée de plus de 75 ans en ambulatoire à Paris

Le signe de Chilaïditi, un piège diagnostique

International audienceUn patient de 85 ans était admis aux urgences pour syndrome confusionnel. On notait dans ses antécédents une maladie de Parkinson (MDP) évoluant depuis 30 ans compliquée de troubles cognitifs avec troubles du comportement sous neuroleptiques et d’une perte d’autonomie, une paralysie phrénique gauche, une bioprothèse aortique

Primary immune responses are negatively impacted by persistent herpesvirus infections in older people: results from an observational study on healthy subjects and a vaccination trial on subjects aged more than 70 years old

International audienceBackground: Advanced age is accompanied by a decline of immune functions, which may play a role in increased vulnerability to emerging pathogens and low efficacy of primary vaccinations in elderly people. The capacity to mount immune responses against new antigens is particularly affected in this population. However, its precise determinants are not fully understood. We aimed here at establishing the influence of persistent viral infections on the naive T-cell compartment and primary immune responsiveness in older adults.Methods: We assessed immunological parameters, related to CD8+ and CD4+ T-cell responsiveness, according to the serological status for common latent herpesviruses in two independent cohorts: 1) healthy individuals aged 19y to 95y (n = 150) and 2) individuals above 70y old enrolled in a primo-vaccination clinical trial (n = 137).Findings: We demonstrate a prevalent effect of age and CMV infection on CD8+ and CD4+ naive T cells, respectively. CMV seropositivity was associated with blunted CD4+ T-cell and antibody responses to primary vaccination.Interpretation: These data provide insights on the changes in adaptive immunity over time and the associated decline in vaccine efficacy with ageing. This knowledge is important for the management of emerging infectious diseases in elderly populations

Corticosteroid Therapy in COVID-19 Associated With In-hospital Mortality in Geriatric Patients: A Propensity Matched Cohort Study

International audienceBackground: Few data are available on the prognosis of older patients who received corticosteroids for COVID-19. We aimed to compare the in-hospital mortality of geriatric patients hospitalized for COVID-19 who received corticosteroids or not. Methods: We conducted a multicentric retrospective cohort study in 15 acute COVID-19 geriatric wards in the Paris area from March to April 2020 and November 2020 to May 2021. We included all consecutive patients aged 70 years and older who were hospitalized with confirmed COVID-19 in these wards. Propensity score and multivariate analyses were used. Results: Of the 1 579 patients included (535 received corticosteroids), the median age was 86 (interquartile range 81-91) years, 56% of patients were female, the median Charlson Comorbidity Index (CCI) was 2.6 (interquartile range 1-4), and 64% of patients were frail (Clinical Frailty Score 5-9). The propensity score analysis paired 984 patients (492 with and without corticosteroids). The in-hospital mortality was 32.3% in the matched cohort. On multivariate analysis, the probability of in-hospital mortality was increased with corticosteroid use (odds ratio [OR] = 2.61 [95% confidence interval (CI) 1.63-4.20]). Other factors associated with in-hospital mortality were age (OR = 1.04 [1.01-1.07], CCI (OR = 1.18 [1.07-1.29], activities of daily living (OR = 0.85 [0.75-0.95], oxygen saturation < 90% on room air (OR = 2.15 [1.45-3.17], C-reactive protein level (OR = 2.06 [1.69-2.51], and lowest lymphocyte count (OR = 0.49 [0.38-0.63]). Among the 535 patients who received corticosteroids, 68.3% had at least one corticosteroid side effect, including delirium (32.9%), secondary infections (32.7%), and decompensated diabetes (14.4%). Conclusions: In this multicentric matched-cohort study of geriatric patients hospitalized for COVID-19, the use of corticosteroids was significantly associated with in-hospital mortality