Salvage Strategy for Long-Term Central Venous Catheter-Associated Staphylococcus aureus Infections in Children

Introduction: Current international guidelines strongly recommend catheter removal in case of S. aureus central line-associated bloodstream infection (CLASBI), but a catheter salvage strategy may be considered in children given age-related specificities. No data is available regarding the outcome of this strategy in children. This study aims to evaluate catheter salvage strategy in children with S. aureus CLABSI, and to determine treatment failure rates and associated risk factors.Methods: We retrospectively analyzed data for all children <18 years having S. aureus CLABSI on a long-term central venous catheter in a tertiary hospital from 2010 to 2014. We defined catheter salvage strategy as a central venous catheter left in place ≥3 days after initiation of empiric treatment for suspected bacteremia, and catheter salvage strategy failure as the persistence or relapse of bacteremia with a S. aureus strain harboring the same antibiotic susceptibility pattern, or the occurrence or the worsening of local or systemic infectious complication between 72 h and 28 days after the first positive blood culture.Results: During the study period, 49 cases of S. aureus CLABSI on long-term central venous catheters were observed in 41 children (including 59% with long-term parenteral nutrition) and 6 (15%) isolates were resistant to methicillin. A catheter salvage strategy was chosen in 37/49 (76%) cases and failed in 12/37 (32%) cases. Initial presence of bloodstream co-infection, serum concentration of vancomycin under the targeted value and inadequate empiric treatment were significantly associated with catheter salvage therapy failure.Conclusions: The catheter salvage strategy of S. aureus CLABSI on a long-term central venous catheter was frequent in the studied hospital and failed only in one third of cases

A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

Objectives Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE. Methods An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%. Results The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions: 1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by . (reference to symptoms, signs, routine labs). 2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment. 3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics. The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life. Conclusions The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes

2021 DORIS definition of remission in SLE: final recommendations from an international task force.

OBJECTIVE: To achieve consensus on a definition of remission in SLE (DORIS). BACKGROUND: Remission is the stated goal for both patient and caregiver, but consensus on a definition of remission has been lacking. Previously, an international task force consisting of patient representatives and medical specialists published a framework for such a definition, without reaching a final recommendation. METHODS: Several systematic literature reviews were performed and specific research questions examined in suitably chosen data sets. The findings were discussed, reformulated as recommendations and voted on. RESULTS: Based on data from the literature and several SLE-specific data sets, a set of recommendations was endorsed. Ultimately, the DORIS Task Force recommended a single definition of remission in SLE, based on clinical systemic lupus erythematosus disease activitiy index (SLEDAI)=0, Evaluator's Global Assessment <0.5 (0-3), prednisolone 5 mg/day or less, and stable antimalarials, immunosuppressives, and biologics. CONCLUSION: The 2021 DORIS definition of remission in SLE is recommended for use in clinical care, education, and research including clinical trials and observational studies

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/)

Des fosses de chasse néolithiques dans des dépressions à la périphérie de Reims (Marne)

International audienc

Évolution spatiale de la Thielle moyenne : de l'intérêt d'utiliser les cartes historiques dans une étude géomorphologique. Approche méthodologique

In the outlet plain of Lake Neuchâtel made of silts and swampy sediments, there are more than forty archaeological sites whose the eponym site Marin-La Tène. To understand the location of these sites, it is necessary to map the geographic evolution of: the shores of Lake Neuchâtel and the bed of the outlet &#34;Thielle moyenne&#34;. But the many developments and the important urbanization of the plain during the last century restrict prospecting methods. The methodology we have chosen is based on the use of old maps (inventory, regressive study and map compiled) to study the evolution of hyrological network since the 16th century

La fantômisation des calcaires lutétiens du Bassin de Paris. Apport des carrières souterraines

Ghost-rock karstification in lutetian limestones of the Paris basin : information from underground quarries. Underground quarries are remarkable sites to observe karstification of limestone massifs. The Lutetian plateaus seem to be hardly karstified, compared to other limestone formations of the Paris Basin. However, in the underground quarries (creutes ) of Valois, Noyonnais, Laonnois and Soissonnais, several forms of paleokarsts and ghost-rock weathering are observed (roots, organ pipes, joints, nuclei), situated on the fracture network of mechanical relaxation of the valleys (lateral spreading). Measurements of colorimetry and calcimetry on samples across a ghost-rock weathering can clearly differentiate limestone, alteration fringe, and alterite. A statistical analysis of vertical joints and spatial organization of the quarries shows that porosity, thickness of limestone, and homogeneity of fades all control ghost-rock karstification. The observations evidence a multiphase karstification of Lutetian limestones on the edge of the valleys and on the sub-surface. Two morphogenetic hypotheses are proposed.Les carrières souterraines sont de remarquables sites d'observation de la karstification des massifs calcaires. Les plateaux lutétiens semblent très peu karstifiés comparés aux autres formations calcaires du bassin de Paris. Cependant, dans les carrières souterraines (creutes) du Valois, du Noyonnais, du Laonnois et du Soissonnais (Picardie), plusieurs formes de paléokarst et de fantômisation (racines, tuyaux d'orgues, joints, noyaux) calées sur la fracturation de détente mécanique des vallées (extension latérale et cambrure de versant) sont observées. Des mesures de colorimétrie et de calcimétrie sur des échantillons prélevés à travers un fantôme de roche permettent de différencier nettement l'encaissant calcaire, la frange d'altération et l'altérite. Une analyse statistique des fissures et de l'organisation spatiale des carrières affectées, montre que la porosité, l'épaisseur de l'encaissant calcaire et l'homogénéité des faciès contrôlent la fantômisation. Ces observations témoignent d'une karstification polyphasée des calcaires lutétiens en bordure des vallées et en sub-surface. Deux hypothèses morphogénétiques sont alors proposées.Devos Alain, Chalumeau Laurent, Fronteau Gilles, Sosson Christelle, Turmel Aurélie, Lejeune Olivier. La fantômisation des calcaires lutétiens du Bassin de Paris. Apport des carrières souterraines. In: Karstologia : revue de karstologie et de spéléologie physique, n°58, 2e semestre 2011. Fantômisation des calcaires lutétiens (Bassin de Paris) pp. 15-28