The LAUsanne STAPHylococcus aureus ENdocarditis (LAUSTAPHEN) score: A prediction score to estimate initial risk for infective endocarditis in patients with S. aureus bacteremia

IntroductionInfective endocarditis (IE) is a common complication of Staphylococcus aureus bacteremia (SAB). The study aimed to develop and validate a prediction score to determine IE risk among SAB.MethodsThis retrospective study included adults with SAB (2015–2021) and divided them into derivation and validation cohorts. Using the modified 2015 European Society of Cardiology modified Duke Criteria for definite IE, the LAUSTAPHEN score was compared to previous scores.ResultsAmong 821 SAB episodes, 419 and 402 were divided into derivation and validation cohorts, respectively. Transthoracic and transoesophageal echocardiography (TOE) were performed in 77.5 and 42.1% of episodes, respectively. Definite IE was diagnosed in 118 episodes (14.4%). Derivation cohort established that cardiac predisposing factors, such as cardiac implantable electronic devices, prolonged bacteremia ≥48 h, and vascular phenomena were independently associated with IE. In addition to those parameters, native bone and joint infections were used to constitute the LAUSTAPHEN score. LAUSTAPHEN and VIRSTA scores misclassified <4% of IE cases as low risk. Misclassification using POSITIVE and PREDICT scores was >10%. The number of TOEs required to safely exclude IE were 66.9 and 51.6% with VIRSTA and LAUSTAPHEN, respectively.DiscussionLAUSTAPHEN and VIRSTA scores exhibited the lowest misclassification rate of IE cases to the low-risk group. However, the number of patients requiring TOE was higher for VIRSTA than for LAUSTAPHEN

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

La question de l'union de l'âme et du corps à partir de la pensée de Descartes (âme-corps, méditation, méthode)

Dans l'œuvre de Descartes, à partir de la distinction réelle de l'âme et du corps, la question de leur union se pose dans les domaines de la médecine, de la morale et de la méthode. La méthode cartésienne trouve son fondement et sa justification dans l'entreprise métaphysique, où la méditation méthodique se révèle discipline et exercice de soi. Ainsi la question de la conduite de sa vie est le point central de la philosophie cartésienne. La connaissance de la distinction et l'épreuve de l'union de l'âme et du corps se joignent dans une sagesse, dans la mesure où " ce sont les mêmes hommes qui pensent et qui ont des corps ".LYON3-Bibliothèques (693872102) / SudocLYON-ENS LSH (693872305) / SudocLYON-BIU-LSH (693872101) / SudocSudocFranceF

IMMUNO-MODULATION PAR THERAPIE GENIQUE CELLULAIRE DE L'ARTHRITE EXPERIMENTALE AU COLLAGENE

LA POLYARTHRITE RHUMATOIDE, RHUMATISME INFLAMMATOIRE CHRONIQUE ABOUTISSANT A UNE DESTRUCTION ARTICULAIRE, EST CARACTERISEE PAR UN DESEQUILIBRE DE LA BALANCE DES CYTOKINES EN FAVEUR DES CYTOKINES PRO-INFLAMMATOIRES ET UNE DEREGULATION DES MECANISMES DE L'APOPTOSE CONDUISANT A UNE HYPERPROLIFERATION SYNOVIALE. NOTRE TRAVAIL AVAIT POUR OBJECTIF D'APPLIQUER LE CONCEPT DE THERAPIE GENIQUE CELLULAIRE UTILISANT DES GENES DE MOLECULES POTENTIELLEMENT ANTI-INFLAMMATOIRES, DANS UN MODELE MURIN DE LA POLYARTHRITE RHUMATOIDE L'ARTHRITE EXPERIMENTALE AU COLLAGENE (AEC). APRES AVOIR MIS EN EVIDENCE LA RECONNAISSANCE INTER-ESPECE DE L'IL-10 MURINE PAR LE RECEPTEUR DE TYPE II HUMAIN (HIL-1RII), RECEPTEUR LEURRE DE LA CYTOKINE, NOUS AVONS DEMONTRE L'INTERET THERAPEUTIQUE DE CE RECEPTEUR DANS L'AEC EN INOCULANT DES KERATINOCYTES HUMAINS TRANSFECTES PAR L'ADNC DE L'HIL-1RII. CETTE GREFFE A PERMIS D'INHIBER LES SIGNES CLINIQUES ET HISTOLOGIQUES DE L'AEC. PAR LA SUITE, NOUS AVONS DEMONTRE QUE LA CO-TRANSFECTION DES GENES DU LIGAND DE FAS ET DE L'IL-4 MURINE DANS LES CELLULES CHO AVANT LEUR ADMINISTRATION POTENTIALISE LES EFFETS BENEFIQUES DE CETTE CYTOKINE DANS L'AEC. L'AMELIORATION EST ASSOCIEE A UNE ACCUMULATION DES POLYNUCLEAIRES AU SITE D'INJECTION ALORS QUE LEUR NOMBRE CHUTE EN PERIPHERIE, SUGGERANT UN MECANISME D'APOPTOSE DE POLYNUCLEAIRES FAS + IMPLIQUES DANS LES MANIFESTATIONS INFLAMMATOIRES DE L'AEC. ENFIN, DANS LE BUT DE CONTOURNER LE REJET DES CELLULES XENOGENIQUES ET DE CIBLER LA REPONSE AUTO-IMMUNE, NOUS AVONS UTILISE COMME VECTEURS CELLULAIRES DES CELLULES PRESENTATRICES D'ANTIGENES SYNGENIQUES CHARGEES AVEC L'ANTIGENE, LE COLLAGENE II. NOUS AVONS AINSI FAIT LA PREUVE DE L'EFFICACITE DE TRAITEMENTS AU MOMENT DE L'IMMUNISATION PAR UN HYBRIDOME B OU DES MACROPHAGES TRANSFECTES PAR LE GENE DE L'IL-4 ET PRESENTANT LES PEPTIDES DU COLLAGENE II POUR INHIBER L'INFLAMMATION ARTICULAIRE AU COURS DE L'AEC.PARIS7-Bibliothèque centrale (751132105) / SudocSudocFranceF

Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study

S. aureus bacteremia is associated with high mortality. The aim was to identify predictors of mortality among patients with S. aureus bacteremia and evaluate the role of early source control. This retrospective study was conducted at the Lausanne University Hospital, Switzerland. All episodes of S. aureus bacteremia among adult patients from 2015 to 2021 were included. During the study period, 839 episodes of S. aureus bacteremia were included, of which 7.9% were due to methicillin-resistant isolates. Bacteremias were related to bone or joint infections (268; 31.9%), followed by bacteremia of unknown origin (158; 18.8%), proven endocarditis (118; 14.1%) and lower-respiratory tract infections (79; 9.4%). Overall 28-day mortality was 14.5%. Cox multivariate regression model showed that Charlson comorbidity index > 5 (P < 0.001), nosocomial bacteremia (P 0.019), time to blood culture positivity ≤ 13 h (P 0.004), persistent bacteremia for ≥ 48 h (P 0.004), sepsis (P < 0.001), bacteremia of unknown origin (P 0.036) and lower respiratory tract infection (P < 0.001) were associated with 28-day mortality, while infectious diseases consultation within 48 h from infection onset (P < 0.001) was associated with better survival. Source control was warranted in 575 episodes and performed in 345 episodes (60.0%) within 48 h from infection onset. Results from a second multivariate analysis confirmed that early source control (P < 0.001) was associated with better survival. Mortality among patients with S. aureus bacteremia was high and early source control was a key determinant of outcome. Infectious diseases consultation within 48 h played an important role in reducing mortality

The LAUsanne STAPHylococcus aureus ENdocarditis (LAUSTAPHEN) score: A prediction score to estimate initial risk for infective endocarditis in patients with S. aureus bacteremia

INTRODUCTION: Infective endocarditis (IE) is a common complication of Staphylococcus aureus bacteremia (SAB). The study aimed to develop and validate a prediction score to determine IE risk among SAB. METHODS: This retrospective study included adults with SAB (2015–2021) and divided them into derivation and validation cohorts. Using the modified 2015 European Society of Cardiology modified Duke Criteria for definite IE, the LAUSTAPHEN score was compared to previous scores. RESULTS: Among 821 SAB episodes, 419 and 402 were divided into derivation and validation cohorts, respectively. Transthoracic and transoesophageal echocardiography (TOE) were performed in 77.5 and 42.1% of episodes, respectively. Definite IE was diagnosed in 118 episodes (14.4%). Derivation cohort established that cardiac predisposing factors, such as cardiac implantable electronic devices, prolonged bacteremia ≥48 h, and vascular phenomena were independently associated with IE. In addition to those parameters, native bone and joint infections were used to constitute the LAUSTAPHEN score. LAUSTAPHEN and VIRSTA scores misclassified 10%. The number of TOEs required to safely exclude IE were 66.9 and 51.6% with VIRSTA and LAUSTAPHEN, respectively. DISCUSSION: LAUSTAPHEN and VIRSTA scores exhibited the lowest misclassification rate of IE cases to the low-risk group. However, the number of patients requiring TOE was higher for VIRSTA than for LAUSTAPHEN

Impact of selective reporting of antibiotic susceptibility testing results on meropenem prescriptions for the treatment of Pseudomonas aeruginosa infections after 2020 EUCAST criteria update: an observational study in a university hospital

Abstract Background We previously reported an increase in meropenem prescriptions for Pseudomonas aeruginosa infections in our hospital after the implementation of the 10th version of the EUCAST breakpoints table for P. aeruginosa in January 2020. As a consequence, antibiotic susceptibility testing results were adapted by masking meropenem for P. aeruginosa isolates susceptible to either ceftazidime, cefepime or piperacillin-tazobactam. We aimed to assess the changes in meropenem prescriptions after the implementation of the selective reporting. Methods In this retrospective single-centre observational study, we analysed antimicrobial therapies prescribed for P. aeruginosa infections after the susceptibility testing results have been made available over three periods: “before EUCAST update”, “after EUCAST update without selective reporting” and “after EUCAST update with selective reporting”, at Lausanne University Hospital, Switzerland. We collected epidemiological, microbiological and clinical data. The primary outcome was the prescription of meropenem to treat P. aeruginosa infections after the release of susceptibility testing results. Secondary outcomes were the use of increased dosage of non-meropenem anti-pseudomonal drugs, and IDs’ consultations rates after the release of susceptibility testing results. Results Among the 457 patients included, 65 (14.2%) received meropenem: 5/148 (3.4%) before EUCAST update, 51/202 (25.3%) after EUCAST update without selective reporting, and 9/107 (8.4%) after EUCAST update with selective reporting. Supervision and counselling from IDs as well as the use of increased dosages of non-carbapenem antibiotics increased in both periods after EUCAST update, compared to the first period, respectively: 40.5% (60/148) versus 61.4% (124/202) versus 51.4% (55/107) (P < 0.001), and 57.9% (84/148) versus 91.1% (183/202) versus 90.7% (97/107) (P < 0.001). Conclusions Selective reporting of antibiotic susceptibility testing results might decrease unnecessary meropenem prescriptions for the treatment of P. aeruginosa infections and could be part of multimodal antibiotic stewardship interventions

Chromosomally Integrated HHV-6: Slow Decrease of HHV-6 Viral Load After Hematopoietic Stem-Cell Transplantation

International audienc

Prevalence of Infective Endocarditis among Patients with <i>Staphylococcus aureus</i> Bacteraemia and Bone and Joint Infections

We aimed to evaluate the occurrence of infective endocarditis (IE) among patients with bone and joint infections (BJIs) and Staphylococcus aureus bacteraemia. This observational study was conducted at Lausanne University Hospital, Switzerland, from 2014 to 2023, and included episodes involving BJI, S. aureus bacteraemia, and cardiac imaging studies. The endocarditis team defined IE. Among the 384 included episodes, 289 (75%) involved native BJI (NBJI; 118 septic arthritis, 105 acute vertebral or non-vertebral osteomyelitis, 101 chronic osteitis), and 112 (29%) involved orthopedic implant-associated infection (OIAI; 78 prosthetic joint infection and 35 osteosynthesis/spondylodesis infection). Fifty-one episodes involved two or more types of BJI, with 17 episodes exhibiting both NBJI and OIAI. IE was diagnosed in 102 (27%) episodes. IE prevalence was 31% among patients with NBJI and 13% among patients with OIAI (p S. aureus bacteraemic patients with NBJI, with notably lower prevalence among those with OIAI

Data_Sheet_1_The LAUsanne STAPHylococcus aureus ENdocarditis (LAUSTAPHEN) score: A prediction score to estimate initial risk for infective endocarditis in patients with S. aureus bacteremia.docx

IntroductionInfective endocarditis (IE) is a common complication of Staphylococcus aureus bacteremia (SAB). The study aimed to develop and validate a prediction score to determine IE risk among SAB.MethodsThis retrospective study included adults with SAB (2015–2021) and divided them into derivation and validation cohorts. Using the modified 2015 European Society of Cardiology modified Duke Criteria for definite IE, the LAUSTAPHEN score was compared to previous scores.ResultsAmong 821 SAB episodes, 419 and 402 were divided into derivation and validation cohorts, respectively. Transthoracic and transoesophageal echocardiography (TOE) were performed in 77.5 and 42.1% of episodes, respectively. Definite IE was diagnosed in 118 episodes (14.4%). Derivation cohort established that cardiac predisposing factors, such as cardiac implantable electronic devices, prolonged bacteremia ≥48 h, and vascular phenomena were independently associated with IE. In addition to those parameters, native bone and joint infections were used to constitute the LAUSTAPHEN score. LAUSTAPHEN and VIRSTA scores misclassified 10%. The number of TOEs required to safely exclude IE were 66.9 and 51.6% with VIRSTA and LAUSTAPHEN, respectively.DiscussionLAUSTAPHEN and VIRSTA scores exhibited the lowest misclassification rate of IE cases to the low-risk group. However, the number of patients requiring TOE was higher for VIRSTA than for LAUSTAPHEN.</p