Intensification agricole et risque de pollution azotée des ressources en eau dans les départements français d'outre-mer insulaires : surveiller en priorité les pratiques agricoles dans les périmètres irrigués

International audienceIntensification agricole et risque de pollution azotée des ressources en eau dans les départements français d'outre-mer insulaires : surveiller en priorité les pratiques agricoles dans les périmètres irrigués Dans les départements français tropicaux insulaires (Guadeloupe, Martinique, Réunion), les roches volcaniques sont entièrement altérables. L'âge et le bilan hydrique déterminent la nature des sols argileux. Dans les zones humides à sols ferrallitiques à halloysite, ou andosols à allophane, l'impact des fertilisations azotées excessives sur les teneurs en nitrates des eaux est faible, pour deux raisons probables : (i) dilution par des flux importants ; (ii) capacité d'échange anionique des andosols. Les seules alertes concernent des cultures intensives, sur des sols jeunes peu propices à l'adsorption des nitrates. Les périmètres irrigués ont permis le développement de cultures intensives, fortement fertilisées sur les vertisols à smectite en zones sèches. Leur irrigation excessive provoque un gonflement et un stress hydrique d'anoxie des cultures, qui entretient une augmentation des fréquences d'arrosage. L'excès d'irrigation peut alors entraîner des solutés en forte concentration. La mosaïque de cultures irriguées et pluviales peu fertilisées expliquerait un impact pourtant modéré sur les nappes. Plusieurs questions de recherche concernent les formes d'azote exportées (nitrates, ammonium, ...), les voies d'exportation (drainage, ruissellement, volatilisation) selon les milieux, la dynamique des ressources en eau souterraines, et les responsabilités respectives de l'agriculture et de l'habitat qui se côtoient. Des pratiques sont préconisées dans les périmètres irrigués, les plus susceptibles d'exporter des nitrates : • fertilisation raisonnée, • pilotage de l'irrigation (THERESA pour les vertisols, tensiomètres pour les sols rigides), • rotations de cultures pluviales et irriguées, pour entretenir la réserve en eau des sols et disperser les « fuites » de nitrate

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Importance Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies.Objectives To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors.Design, Setting, and Participants This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio.Exposure Preoperative S aureus colonization.Main Outcomes and Measures The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models.Results In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs.Conclusions and Relevance In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Rotations culturales et production bananière : destruction des bananeraies et implantation d'une culture fourragère

Une dégradation de la fertilité des sols dans les systèmes intensifs de monoculture bananière est observée actuellement aux Antilles françaises. Ce problème provient des replantations fréquentes et de la mécanisation des nombreuses opérations culturales. Les principaux facteurs de dégradation sont la destruction de la bananeraie qui précède sa replantation et la toxicité des nématocides appliqués pour contrôler les nématodes du bananier. Afin de résoudre ces problèmes, de nouveaux systèmes de culture ont été proposés par le CIRAD-FLHOR reposant sur l'assainissement des sols par des rotations culturales, l'utilisation de matériel végétal sain (vitroplants), l'amélioration des techniques de préparation des terres et la limitation des pratiques culturales susceptibles de dégrader la structure du sol. Ce rapport présente l'évaluation et la mise au point des nouveaux itinéraires techniques préconisés concernant la destruction des bananeraies à l'aide de rotobêches et l'implantation d'une culture de Bracharia en alternance avec le bananier, permettant d'éliminer les nématodes infeodés au bananier; Bracharia n'étant pas une plante hôte des nématodes du bananie

Absence of maribavir penetration into the central nervous system: confirmation by multiple cerebrospinal fluid dosages in a solid organ transplant recipient

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