Adéquation de l'antibiothérapie probabiliste dans les bactériemies nosocomiales néonatales

Introduction : Le traitement probabiliste des bactériémies nosocomiales néonatales ne fait pas l'objet d'un consensus. Il est à l'origiine de très nombreuses prescriptions d'antibiothérapie à large spectre motivées par la crainte d'une évolution rapidement défavorable. C'est un facteur de risque d'émergence de bactéries multirésistantes. Nous avons étudié l'adéquation de l'antibiothérapie dans les bactériémies nosocomiales. Type d'étude : rétrospective, monocentrique, menée entre 2004 et 2006. Matériel et méthodes : Nous avons répertorié toutes les antibiothérapies concernant les bactériémies nosocomiales de notre service sur une période de 3 ans (2004-2006). Nous avons évalué l'intérêt de la colonisation du nouveau-né la semaine précédant l'infection pour adapter le spectre de l'antibiothérapie probabiliste. La surveillance de la colonisation dans les trois semaines suivant la colonisation permettait de rechercher l'émergence de germes multi-résistants. Résultats : Nous avons répertorié 73 épisodes de bactériémies nosocomiales chez 61 nouveaux-nés. Les staphylocoques coagulase négative (SCN) réprésentaient 60% des bactériémies et étaient majoritairement méticilline-résistants. On note trois cas de choc septique à staphylocoque coagulase négative dont deux ont entraîné le décès. Les SA sont tous sensibles à la vancomycine. L'antibiothérapie probabiliste était exactement adaptée au germe dans 16% des cas. Dans la majorité des cas, on traitait par excès. On note un cas d'inadéquation du traitement par défaut pour une bactériémie à E. coli BLSE ayant entraîné le décès. L'adéquation du germe à la colonisation est faible (55%) et fait courir le risque d'un traitement inadapté des infections à bacille gram négatif. Conclusion : La colonisation ne paraît pas être un élément discriminant pertinant. Il paraît difficile de remettre en cause l'usage probabiliste de la vancomycine en première intention. Il est nécessaire d'élaborer des consensus en matière d'antibiothérapie probabiliste des infections nosocomiales néonatales.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Rare Variants in Complement Gene in C3 Glomerulopathy and Immunoglobulin-Mediated Membranoproliferative GN

International audienceBackground C3 glomerulopathy and idiopathic immunoglobulin-mediated membranoproliferative GN (Ig-MPGN) are rare complement-mediated kidney diseases. Inherited forms of C3 glomerulopathy/Ig-MPGN are rarely described. Methods Three hundred ninety-eight patients with C3 glomerulopathy ( n =296) or Ig-MPGN ( n =102) from a national registry were screened for three complement genes: factor H ( CFH ), factor I ( CFI ), and C3 . Patients with rare variant (minor allele frequency <0.1%) were included. Epidemiologic, clinical, and immunologic data at diagnosis and kidney outcomes of patients were retrospectively collected. Results Fifty-three different rare variants, including 30 (57%), 13 (24%), and ten (19%) in CFH , CFI , and C3 variants, were identified in 66/398 (17%) patients. Thirty-eight (72%) variants were classified as pathogenic, including 20/30 (66%) and 11/13 (84%) variants in CFH and CFI , respectively, impairing synthesis of factor H or factor I regulators. Fifteen of 53 (27%) variants were of unknown significance. At diagnosis, 69% of patients were adult (median age of 31 years). With the exception of biologic stigma of thrombotic microangiopathy, which was more frequent in patients with CFI variants (5/14 [36%] versus 1/37 [3%] and 0% in the CFH group and C3 group, respectively, P < 0.001), the clinical and histologic features were similar among the three variants groups. The kidney outcome was poor regardless of the age at onset and treatment received. Sixty-five percent (43/66) of patients with rare variant reach kidney failure after a median delay of 41 (19–104) months, compared with 28% (55/195) after a median delay of 34 (12–143) months in the nonvariant group. Among 36 patients who received a kidney transplant, 2-year recurrence was frequent, occurring in 39% (12/31), without difference between variant groups, and led to graft failure in three cases. Conclusions In our cohort, 17% of C3 glomerulopathy/Ig-MPGN cases were associated with rare variants in the CFH , CFI , or C3 genes. In most cases, a quantitative deficiency in factor H or factor I was identified. The presence of a rare variant was associated with poor kidney survival. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_11_08_CJN0000000000000252.mp

Acute tubulointerstitial nephritis with or without uveitis: a novel form of post-acute COVID-19 syndrome in children

International audienceMultiorgan sequelae of coronavirus disease 2019 (COVID-19) beyond the acute phase of infection are increasingly described as clinical experience expands. In children, acute COVID-19 appears to be generally asymptomatic or mild. Yet, the multisystem inflammatory syndrome in children (MIS-C) may be a severe postinfectious complication following exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 During the first pandemic year, we observed a striking increase in the incidence of acute tubulointerstitial nephritis (aTIN) without or with uveitis (TINUs) among children. Causes of aTIN include drugs, infections, and systemic diseases, but often remain undetermined. The rare TINUs syndrome associating aTIN and uveitis is considered to result from a still ill-characterized immune-mediated process. The observed increased incidence of idiopathic aTIN/TINUs prompted us to examine whether SARS-CoV-2 might be the initial trigger