Félix Arnaudin : Chants populaires de la Grande-Lande

Ces deux recueils forment les volumes III et IV de l’ensemble des huit volumes des œuvres complètes de Félix Arnaudin, dont le Parc Régional des Landes de Gascogne a entrepris l’édition. Au magnifique album de photos (quelque trois mille plaques de verre), aux Contes (I), aux Proverbes, Dictons, Devinettes, Formulettes, Prières (II), viennent donc s’ajouter ces deux recueils de chants. Doivent suivre le Dictionnaire de la Grande-Lande, également en deux volumes, dont la parution a été retardé..

Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units

CIAR (Club d'infectiologie en Anesthésie-Réanimation) Study Group: Pr B Allaouchiche (HCL, CHU Lyon), Pr C Arich (CHU Nimes), Pr C Auboyer (CHU St-Etienne), Dr JP Caramella (CHG Nevers), Dr JF Cochard (CHU Bordeaux), Dr A Combes (CHG Meaux), Dr P Courant (CHG Avignon), Dr J Durand-Gasselin (CHG Toulon), Pr J Duranteau (APHP, CHU Bicetre), Dr H Floch (CHU Nantes), Dr F Fraisse (CHG St Denis), Pr M Freysz (CHU Dijon), Dr B Garrigues (CHG Aix-en-Provence), Dr B Georges (CHU Toulouse), Pr F Gouin (APHM, CHU Marseille), Pr L Jacob (APHP, CHU St Louis), Pr P Juvin (APHP, CHU Beaujon), Dr J Keinlen (CHU Montpellier), Dr AM Korinek (APHP, CHU Pitie Salpetriere), Dr C Lamer (Institut Mutualiste Montsouris, Paris), Pr JY Lefrant (CHU Nimes), Dr O Lesieur (CHG La Rochelle), Dr Yazine Mahjoub (CHU Amiens), Pr Y Malledant (CHU Rennes), Pr C Martin (APHM, CHU Marseille), Pr O Mimoz (CHU Poitiers), Pr C Paugam-Burtz (APHP, CHU Beaujon, Clichy), Dr PF Perrigault (CHU Montpellier), Pr T Pottecher (CHU Strasbourg), Pr JL Pourriat (APHP, CHU Hotel Dieu), Dr JF Poussel (CHG Metz), Dr A Rabbat (APHP, CHU Hotel Dieu), Dr J Reignier (CHG La Roche sur Yon), Dr P Sichel (CHG Cherbourg), Dr JP Sollet (CHG Argenteuil), Dr D Thevenin (CHG Lens), Dr G Viquesnel (CHU Caen).International audienceINTRODUCTION: Few studies have addressed the decision-making process of antibiotic therapy (AT) in intensive care unit (ICU) patients. METHODS: In a prospective observational study, all consecutive patients admitted over a one-month period (2004) to 41 French surgical (n = 22) or medical/medico-surgical ICUs (n = 19) in 29 teaching university and 12 non-teaching hospitals were screened daily for AT until ICU discharge. We assessed the modalities of initiating AT, reasons for changes and factors associated with in ICU mortality including a specific analysis of a new AT administered on suspicion of a new infection. RESULTS: A total of 1,043 patients (61% of the cohort) received antibiotics during their ICU stay. Thirty percent (509) of them received new AT mostly for suspected diagnosis of pneumonia (47%), bacteremia (24%), or intra-abdominal (21%) infections. New AT was prescribed on day shifts (45%) and out-of-hours (55%), mainly by a single senior physician (78%) or by a team decision (17%). This new AT was mainly started at the time of suspicion of infection (71%) and on the results of Gram-stained direct examination (21%). Susceptibility testing was performed in 261 (51%) patients with a new AT. This new AT was judged inappropriate in 58 of these 261 (22%) patients. In ICUs with written protocols for empiric AT (n = 25), new AT prescribed before the availability of culture results (P = 0.003) and out-of-hours (P = 0.04) was more frequently observed than in ICUs without protocols but the appropriateness of AT was not different. In multivariate analysis, the predictive factors of mortality for patients with new AT were absence of protocols for empiric AT (adjusted odds ratio (OR) = 1.64, 95% confidence interval (95%CI): 1.01 to 2.69), age ≥60 (OR = 1.97, 95% CI: 1.19 to 3.26), SAPS II score >38 (OR = 2.78, 95% CI: 1.60 to 4.84), rapidly fatal underlying diseases (OR = 2.91, 95% CI: 1.52 to 5.56), SOFA score ≥6 (OR = 4.48, 95% CI: 2.46 to 8.18). CONCLUSIONS: More than 60% of patients received AT during their ICU stay. Half of them received new AT, frequently initiated out-of-hours. In ICUs with written protocols, empiric AT was initiated more rapidly at the time of suspicion of infection and out-of-hours. These results encourage the establishment of local recommendations for empiric AT

A prospective, observational study of fidaxomicin use for Clostridioides difficile infection in France.

To describe the characteristics, management and outcomes of hospitalised patients with Clostridioides difficile infection (CDI) treated with and without fidaxomicin. This prospective, multicentre, observational study (DAFNE) enrolled hospitalised patients with CDI, including 294 patients treated with fidaxomicin (outcomes recorded over a 3-month period) and 150 patients treated with other CDI therapies during three 1-month periods. The primary endpoint was baseline and CDI characteristics of fidaxomicin-treated patients. At baseline, the fidaxomicin-treated population included immunocompromised patients (39.1%) and patients with severe (59.2%) and recurrent (36.4%) CDI. Fidaxomicin was associated with a high rate of clinical cure (92.2%) and low CDI recurrence (16.3% within 3 months). Clinical cure rates were ≥90% in patients aged ≥65 years, those receiving concomitant antibiotics and those with prior or severe CDI. There were 121/296 (40.9%) patients with adverse events (AEs), 5.4% with fidaxomicin-related AEs and 1.0% with serious fidaxomicin-related AEs. No fidaxomicin-related deaths were reported. Fidaxomicin is an effective and well-tolerated CDI treatment in a real-world setting in France, which included patients at high risk of adverse outcomes.Trial registration: Description of the use of fidaxomicin in hospitalised patients with documented Clostridium difficile infection and the management of these patients (DAFNE), NCT02214771, www.ClinicalTrials.gov

Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs), medical and surgical wards between 2009 and 2013

Antibiotiques chez le patient insuffisant rénal : actualisation des adaptations posologiques à la pratique clinique en infectiologie

Antibiotic prescription in chronic kidney disease patients poses a twofold problem. The appropriate use of antibacterial agents is essential to ensure efficacy and to prevent the emergence of resistance, and dosages should be adapted to the renal function to prevent adverse effects. SiteGPR is a French website for health professionals to help with prescriptions to chronic kidney disease patients. A working group of infectious disease specialists and nephrology pharmacists reviewed the indications, dosing regimens, administration modalities, and dose adjustments of antibiotics marketed in France for patients with renal failure. Data available on the SiteGPR website and detailed in the present article aims to provide an evidence-based update of infectious disease recommendations to health professionals managing patients with chronic kidney disease

Chitosan and cyclodextrin polymer based sponge for the treatment of diabetic foot infections

Les infections du pied diabétique sont la complication la plus fréquente nécessitant l’hospitalisation des patients atteints de diabète. Ces infections sont la conséquence de plusieurs complications liées à l’hyperglycémie chronique. C’est aussi l’évènement le plus commun amenant à une amputation des extrémités. Elles sont associées à une morbi-mortalité très élevée,particulièrement quand l’os est infecté. Leur prise en charge est lourde, longue avec un risque de rechute important. Leur traitement repose sur des actes chirurgicaux, des soins infirmiers et une antibiothérapie par voie systémique. Les artériopathies dont souffrent les patients diabétiques et les tissus nécrosés mal vascularisés entourant les plaies engendrent une mauvaise pénétrance des antibiotiques au site infecté, avec de possible sélections de résistances bactériennes. Ces infections sont donc particulièrement difficiles à soigner. Dans ce contexte, l’objectif de ce travail est de développer un dispositif médical pour la libération locale d’antibiotiques. Ce dispositif consiste en une éponge conçue à base de deux polyélectrolytes, obtenue par lyophilisation. Le chitosan est un polymère cationique en condition acide et le polymère de cyclodextrines est anionique et résulte d’une réaction de réticulation entre les cyclodextrines et l’acide citrique. Les cyclodextrines sont des molécules cages capables de former des complexes d’inclusion avec des principes actifs. Ces complexes permettent de libérer les médicaments de façon prolongée. Les éponges sont imprégnées dans des solutions d’antibiotiques et sont destinées à être implantées dans la lésion infectée. La libération locale permet d’augmenter les concentrations au niveau de la plaie sans risque de toxicité pour l’organisme et évite l’émergence de bactéries résistantes.Diabetic foot infections are the most common complication requiring hospitalization ofpatients with diabetes. These infections are the result of many complications related to chronichyperglycemia. They often result in extremities amputation and are associated with a high morbimortality,especially when bone is infected. Their treatment is based on surgical procedures, nursingcare and systemic antibiotic therapy for several weeks, with a significant risk of relapse. Because of abasic low blood flow and diabetic foot infections damages, blood supply is decreased causing a lowantibiotic diffusion in the infected site and possible bacterial resistance selections. Therefore, they are particularly difficult to treat. In this context, the objective of this work is to develop a medical devicefor a local antibiotics release. We designed a sponge based on two polyelectrolytes (chitosan andcylodextrin polymer) and obtained by freeze-drying. Chitosan is a cationic polymer under acid condition and the cyclodextrin polymer is anionic and results from the crosslinking reaction between cyclodextrins and citric acid. Cyclodextrins are molecular cages able to form inclusion complexes with drugs, leading to an extended release. Sponges are impregnated in antibiotics solutions and are intended to be implanted in the infected lesion. Local release increases concentrations in the wound without risks of toxicity to the body and prevents the emergence of resistant bacteria