La Prise en charge de la leptospirose au service des urgences du CHU de Pointe à Pitre-Abymes [Guadeloupe] (mise en évidence d'un test diagnostique)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pertinence de la prescription des culots globulaires en urgence (études au service d accueil des urgences du CHU de Pointe-à-Pitre)

Il s agit d évaluer la pertinence des indications des culots globulaires (CGR) prescrits en urgence au service d accueil des urgences (SAU) du CHU de Pointe-à-Pitre par rapport aux recommandations publiées par l AFSSAPS en 2002. Le SAU de Pointe-à-Pitre est parmi les trois principaux prescripteurs de CGR du CHU. Deux études ont été menées. Une étude observationnelle prospective sur 7 mois et demi des prescriptions de CGR en urgence et un audit de connaissances en transfusion, au SAU. Une grille d évaluation a été établie à partir des recommandations. Un algorithme décisionnel a été mis en place pour l anémie aigue. Pour l audit de connaissances un questionnaire a été remis aux médecins du SAU et aux internes de médecine générale. 78 prescriptions en urgence ont été analysées. L âge moyen des patients est 63 ans. Il y a 54 UR et 24 UVI/UV. Les causes médicales dominent avec 42 % d anémies, 31 % d hémorragies digestives non traumatiques et seulement 17 % de traumatismes. Le taux d hémoglobine pré-transfusionnel moyen est 6,5 g/dL (max 14,2 ; min 1,2 g/dL), il y a des signes de mauvaise tolérance clinique dans 67 % des cas. 93 % des CGR commandés ont été transfusés. Pour l audit de connaissances : 56 médecins ont été audités dont 54 internes. 89 % ne savent pas citer les trois degrés d urgence, 57 % transfusent en-dessous de 7 g/dL en l absence d antécédents. 70 % déclarent prescrire une transfusion au moins une fois par mois. Les indications sont pertinentes selon les recommandations dans 92 % des cas. Des lacunes au niveau des connaissances médicales et de la traçabilité des informations dans le dossier médical ont été mises en évidence.The aim of this study is to evaluate the appropriateness of emergency-released red blood cells (RBC) transfusion in the emergency department (ED) of the University Hospital of Pointe-à-Pitre (UH) from the AFSSAPS guidelines published in 2002. ED of Pointe-à-Pitre is among the top three prescribers RBC in the UH. A 7 and a half months prospective observational study of RBC prescriptions and a knowledge audit were conducted in the ED. A data grid was established on the guidelines. A decision algorithm was developed for acute anemia. For auditing knowledges in transfusion, a questionnaire was distributed to doctors and to general practice students. 78 emergency prescriptions were analyzed. The mean age of patients is 63 years. There are 54 simple emergency-releases and 24 vital emergency-releases. Medical causes dominate with 42% of anemia, 31% of nontraumatic gastrointestinal bleeding and only 17% of trauma. The mean pre-transfusion hemoglobin is 6.5 g/dL (14.2 g/dL max, 1.2 g/dL min), there are signs of poor clinical tolerance in 67% of cases. 93% of RBC units ordered were transfused. For the knowledge audit : 56 doctors were audited including 54 students. 89% are unable to name the three degrees of emergency-release, 57% transfuse below 7 g/dL in the absence of medical history. 70% prescribe a transfusion at least once a month. The indications are relevant according to the guidelines in 92% of cases. A deficiency in medical knowledge and traceability in medical records were highlightedABYMES-CHRUPPA-BU (971202102) / SudocSudocFranceF

Emergence of a Novel Lineage and Wide Spread of a blaCTX-M-15/IncHI2/ST1 Plasmid among Nosocomial Enterobacter in Guadeloupe

Between April 2018 and August 2019, a total of 135 strains of Enterobacter cloacae complex (ECC) were randomly collected at the University Hospital Center of Guadeloupe to investigate the structure and diversity of the local bacterial population. These nosocomial isolates were initially identified genetically by the hsp60 typing method, which revealed the clinical relevance of E. xiangfangensis (n = 69). Overall, 57/94 of the third cephalosporin-resistant strains were characterized as extended-spectrum-β-lactamase (ESBL) producers, and their whole-genome was sequenced using Illumina technology to determine the clonal relatedness and diffusion of resistance genes. We found limited genetic diversity among sequence types (STs). ST114 (n = 13), ST1503 (n = 9), ST53 (n = 5) and ST113 (n = 4), which belong to three different Enterobacter species, were the most prevalent among the 57 ESBL producers. The blaCTXM-15 gene was the most prevalent ESBL determinant (56/57) and was in most cases associated with IncHI2/ST1 plasmid replicon carriage (36/57). To fully characterize this predominant blaCTXM-15/IncHI2/ST1 plasmid, four isolates from different lineages were also sequenced using Oxford Nanopore sequencing technology to generate long-reads. Hybrid sequence analyses confirmed the circulation of a well-conserved plasmid among ECC members. In addition, the novel ST1503 and its associated species (ECC taxon 4) were analyzed, in view of its high prevalence in nosocomial infections. These genetic observations confirmed the overall incidence of nosocomial ESBL Enterobacteriaceae infections acquired in this hospital during the study period, which was clearly higher in Guadeloupe (1.59/1000 hospitalization days) than in mainland France (0.52/1,000 hospitalization days). This project revealed issues and future challenges for the management and surveillance of nosocomial and multidrug-resistant Enterobacter in the Caribbe

Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units

International audienceTo increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment