Bacterial infection profiles in lung cancer patients with febrile neutropenia

<p>Abstract</p> <p>Background</p> <p>The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.</p> <p>Methods</p> <p>We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm³) and fever (temperature > 38.3°C).</p> <p>Results</p> <p>The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. <it>Staphylococcus </it>species (mainly <it>S. aureus</it>) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm³.</p> <p>Conclusion</p> <p>Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.</p

Intérêt de la PCR ARN 16S dans la prise en charge thérapeutique des infections bactériennes

Introduction : Devant l augmentation croissante du recours à la Polymerase Chain Reaction universelle (PCRu) au sein de notre CHU, nous avons voulu analyser l intérêt du résultat de cette technique dans la prise en charge thérapeutique des patients. Matériel et méthodes : Etude rétrospective entre novembre 2008 et décembre 2010 sur toutes les demandes de PCRu du CHU d Amiens qui envoie ses demandes au centre de référence des rickettsioses. Les données recueillies concernaient surtout l évolution de la prise en charge thérapeutique notamment l antibiothérapie, la poursuite d investigations ou non, la réorientation du diagnostic et le délai d obtention des résultats. Résultats : Nous avons inclus 149 patients, 11 indications étaient dans le cadre d endocardites à hémocultures négatives, 95 demandes ont été réalisées dans le but d orienter l antibiothérapie et 49 dans un but diagnostique. Seulement 23 conduites à tenir ont été modifiées par le résultat de la PCRu. 79 demandes réalisées par excès (d autres examens avaient permis une prise en charge optimale), et 48 résultats n ont pas été pris en compte par le clinicien, engendrant un surcoût allant de 17399 à 23008EUR. Le délai médian d obtention des résultats était de 13,7 jours (interquartile [4-21] ; extrêmes [1-53]).Conclusion : Cette étude permet de constater que l envoi extérieur de la PCRu entraîne plusieurs dérives, en partie à cause du délai d obtention des résultats, engendrant un surcoût inutile. Nous avons constaté l importance d une collaboration entre clinicien et biologiste pour optimiser la prise en charge diagnostique.Introduction: Given the increase universal polymerase chain reaction (UPCR) use in our hospital, we wanted to analyze the impact of UPCR results in patient s therapeutic management. Materials and methods: We performed a retrospective study between November 2008 and December 2010 on all requests for PCRU in the university hospital of Amiens which sends requests to the reference center for rickettsia in Marseille. We collected data on the evolution of antibiotic treatment, the existence of further investigation or not, the change of the diagnosis and the delay in obtaining results. Results: We included 149 patients, 11 prescriptions were indicate for endocarditis with negative blood cultures, 95 prescriptions were made in order to guide antibiotic therapy and 49 for diagnostic purposes. Only 23 therapeutic changes were made due to the result of the UPCR. We found 79 prescriptions made by excess (other tests had allowed optimal management), and 48 results were not considered by the clinicians, generating additional costs ranging from 17399 to 23008EUR. The median time to results was 13.7 days (interquartile range [4-21]). Conclusion: This study teaches us that mailing the UPCR in another center causes several abuses, partly due to the delay in obtaining results, creating unnecessary extra costs. We emphasize the importance of collaboration between biologists and clinicians to optimize diagnostic management.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Émergence et trajectoire des controverses entourant l’enseignement de l’histoire au Québec et au Canada

L’article s’intéresse aux débats entourant l’enseignement de l’histoire au Québec et au Canada en puisant dans les écrits qui portent sur les controverses scientifiques et publiques. Il présente l’émergence et l’évolution de controverses au Canada et au Québec de la fin des années 1980 à nos jours. Il propose une réflexion sur les facteurs qui ont fait en sorte que la controverse a été soulevée avec beaucoup plus de force au Québec et qu’elle a mené à des changements significatifs dans les programmes de formation.The article reflects on the recent debates regarding history education in Quebec and Canada by using notions developed in the literature about scientific and public controversies. It presents the emergence and evolution of the controversies in Quebec and Canada from the late 1980s to the present day. It offers a reflection on the main factors that explain why the controversy in Quebec was carried with much more force and why it leads to meaningful changes in the history curriculum.Nuestro artículo se interesa por los debates alrededor de la enseñanza de la historia en Quebec y en Canadá, basándonos en los escritos centrados en las controversias científicas y públicas. Así, presentamos la emergencia y la evolución de controversias en Canadá y en Quebec desde el final de los años 80 hasta la actualidad, proponiendo una reflexión sobre los factores que han contribuido para que la controversia haya tenido más fuerza en Quebec y que ésta haya llevado a modificaciones significativas en los programas de formación escolares

Heterogeneous disease progression and treatment response in a C3HeB/FeJ mouse model of tuberculosis

Mice are the most commonly used species for non-clinical evaluations of drug efficacy against tuberculosis (TB). Unlike commonly used strains, C3HeB/FeJ mice develop caseous necrosis in the lung, which might alter the representation of drug efficacy in a way that is more like human TB. Because the development of such pathology requires time, we investigated the effect of infection incubation period on the activity of six drugs in C3HeB/FeJ and BALB/c mice. Mice were aerosol infected and held for 6, 10 or 14 weeks before receiving therapy with rifampin (RIF), rifapentine (RPT), pyrazinamide (PZA), linezolid (LZD), sutezolid (PNU) or metronidazole (MTZ) for 4-8 weeks. Outcomes included pathological assessments, pH measurements of liquefied caseum and assessment of colony-forming unit (CFU) counts from lung cultures. Remarkable heterogeneity in the timing and extent of disease progression was observed in C3HeB/FeJ mice, largely independent of incubation period. Likewise, drug efficacy in C3HeB/FeJ mice was not affected by incubation period. However, for PZA, LZD and PNU, dichotomous treatment effects correlating with the presence or absence of large caseous lesions were observed. In the case of PZA, its poor activity in the subset of C3HeB/FeJ mice with large caseous lesions might be explained by the pH of 7.36±0.09 measured in liquefied caseum. This study highlights the potential value of C3HeB/FeJ mice for non-clinical efficacy testing, especially for investigating the interaction of lesion pathology and drug effect. Careful use of this model could enhance the bridging of non-clinical results with clinical outcomes

Cytomegalovirus-Associated Gianotti-Crosti Syndrome in 28-Year-Old Immunocompetent Patient

Gianotti-Crosti syndrome is a cutaneous eruption that occurs rarely in adults. It mostly concerns pediatric population and immunocompromised patients. Cytomegalovirus has already been described as one etiology of Gianotti-Crosti acrodermatitis in children and bone-marrow transplanted patients. Here, we present a Cytomegalovirus-associated Gianotti-Crosti syndrome in a 28-year-old immunocompetent female patient diagnosed in CHU Amiens-Picardie (Amiens, France). This type of case has never been shared in literature before. This rare complication of Cytomegalovirus infection indirectly led to disruption of anticoagulant treatment and thromboembolic incident that could have been fatal

Measuring the prevalence of aspiration pneumonia in view of improving the relevance of antibiotic prescription of antibiotics: A retrospective, observational study

International audiencePurposeAspiration pneumonia (AP) has significant incidence and impact on mortality. However, data about clinical diagnosis criteria are scarce. We aimed to evaluate according to predefined criteria the prevalence of true AP and its impact on antibiotic stewardship.MethodsRetrospective study of patients whose main diagnosis was AP hospitalized at Amiens University Hospital in 2018. We first defined diagnostic criteria of certainty for pneumonia and aspiration. AP was then classified according to degree of certainty.ResultsAmong 862 cases of AP, its diagnosis was certain, likely, probably in excess, certainly in excess or absent in 2 % (n = 17), 3 % (n = 26), 50.5 % (n = 433), 23.1 % (n = 198) and 21.4 % (n = 183) respectively. Irrelevant use of amoxicillin-clavulanic acid and metronidazole was found in 27 % and 13 % of cases, respectively.ConclusionsThe diagnosis of AP is frequently excessive, and diagnostic tools are urgently needed to improve antibiotic stewardship