Clinical Features and Risk Factors for Atazanavir (ATV)-Associated Urolithiasis: A Case-Control Study

International audienceObjectivesClinical features and risk factors for atazanavir (ATV)-associated urolithiasis have not been fully investigated.MethodsWe reviewed all cases of ATV-containing urolithiasis identified by infrared spectrophotometry among HIV-infected patients over a 5-year period to describe their clinical features and outcome. A case-control study was performed to identify risk factors associated with ATV-associated urolithiasis using univariate and multivariate logistic regression analyses.Results30 cases of ATV-associated urolithiasis were analyzed. Patients were mostly men (87%), median age: 45.5 years, median CD4 cell count: 443 cells/µL and 97% had plasma HIV RNA level <50 cp/mL. Median time between the initiation of ATV-containing regimen and the diagnosis of urolithiasis was 3.1 years. Patients presented with flank pain in 90% and macroscopic hematuria in 82.6%, 34% had renal dysfunction and 44.8% needed ureteroscopic treatment. In univariate analysis, chronic hepatitis C, a history of urolithiasis, prior use of indinavir, ATV duration, undetectable plasma HIV RNA, use of ritonavir as a booster and serum free bilirubin level were associated with ATV-urolithiasis. Multivariate models retained serum free bilirubin level (OR: 2.31, p<0.02) and either ATV duration (OR:  = 1.42, p = <0.03) or a history of urolithiasis (OR = 4.79, p<0.02) when adjusting on serum free bilirubin level as risk factors associated with urolithiasis.ConclusionsATV-containing urolithiasis are associated with frank clinical symptoms and may require surgical intervention. A high serum bilirubin level, a long exposure to ATV and a history of urolithiasis are risk factors for this rare adverse event

INTERET DE LA SCINTIGRAPHIE AUX LEUCOCYTES MARQUES POUR LE DIAGNOSTIC DES INFECTIONS OSTEO-ARTICULAIRES

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Mucormycose pulmonaire chez un allogreffé de moëlle (à propos d'un cas et revue de la littérature)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Mécanique et division cellulaire - Contrôle temporel de l'abscission [Mechanics and cell division Temporal control of abscission]

International audienc

Méningites herpétiques (à propos de 18 observations)

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Incidence, risk factors and outcome of multi-drug resistant Acinetobacter baumannii nosocomial infections during an outbreak in a burn unit

Background: Multidrug-Resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in burn units. We aimed to study the incidence, risk factors and outcome of MR-AB infections in a burn unit (BU). Methods: A prospective study was conducted from April to November, 2014 during an outbreak in a BU in Paris. Weekly surveillance cultures were performed to determine MR-AB colonization. MR-AB nosocomial infections, discharge or death without MR-AB infection were considered as competing events. To identify risk factors for MR-AB infection, baseline characteristics and time-dependent variables were investigated in univariate analyses using Cox models. Results: Eighty-six patients admissions were analyzed during the study period. Among them, 15 (17%) acquired MR-AB nosocomial infection. Median time to infection was 22 days (interquartile range: 10–26 days). Cumulative incidence of MR-AB infections was 15% at 28 days (95% CI = 8–24). Risk factors for MR-AB infection in univariate analysis were SAPS II (Hazard Ratio (HR):1.08; 95% CI:1.05–1.12; P < 0.0001) and ABSI (Abbreviated Burn Severity Index) scores (HR:1.32; 95% CI:1.12–1.56; P = 0.001), MR-AB colonization (HR:10.2; 95%CI:2.05–50.3; P = 0.004), invasive procedures (ventilation, arterial and/or venous catheter) (P = 0.0001) and ≥2 skin grafts (HR:10.2; 95% CI:1.76–59.6; P = 0.010). MR-AB infection was associated with an increased risk of death (HR: 7.11; 95%CI: 1.52–33.2; P = 0.013) and longer hospital stay with a median estimated increase of 10 days (IQR: 6; 14). Conclusions: Incidence of MR-AB nosocomial infection was high during this outbreak, and was associated with prolonged hospitalization and increased risk of death. High patient severity scores, prior MR-AB colonization, invasive procedures and repeated skin grafts were associated with an increased risk of nosocomial infection. Keywords: Acinetobacter baumannii, Antibiotic resistance, Infection, Risk factors, Burn

Utility of anaerobic bottles for the diagnosis of bloodstream infections

International audienceBACKGROUND:Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI).METHODS:We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied.RESULTS:A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient.CONCLUSIONS:Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia

Temocillin versus carbapenems for urinary tract infection due to ESBL-producing Enterobacteriaceae: a multicenter matched case-control study.

International audienceObjectives: We aim to compare the efficacy of temocillin to carbapenems for ESBL-E UTI.Methods: We conducted a multicenter retrospective case-control study of adults with ESBL-E UTI between January-2015 and October-2019. Cases received temocillin ≥50% of the effective antibiotic therapy duration. Control exclusively received carbapenem. They were statistically matched (1:1 ratio) on period, sex, and age. The clinical cure at the end of antibiotic therapy was analyzed using conditional logistic regression.Results: We matched 72 temocillin cases to 72 carbapenem controls. Most (67%) were male, aged 69.4-years in median, 81 (56%) were immunocompromised, including 44 (31%) solid organ transplant recipients (SOT). There was no difference between cases and controls for baseline characteristics and microorganisms involved: K.pneumoniae in 59 (41%), E.coli in 57 (40%), and Enterobacter spp. in 24 (17%). The median time from admission to effective antibiotic therapy was 0-days [0-2]. Among cases, first-line antibiotic therapy (≤72 hours) was temocillin in 6 (8%) and carbapenems in 39 (54%). Temocillin was given at the median daily dose of 4g [2], [3], [4], after 3-days [2], [3], [4], [5] of carbapenems. Patients received temocillin for 81% [70-93] of the effective antibiotic course duration during 11-days [8], [9], [10], [11], [12], [13], [14]. The effective antibiotic duration was similar in cases and controls (p-value=0.067). Clinical cure at the end of the antibiotic therapy was 94% (68/72) in cases versus 99% (71/72) in controls (p-value=0.206), without difference among immunocompromised and SOT patients (p-value>0.050).Conclusions: Temocillin effectively relays beta-lactams, including carbapenems, to treat (complicated) ESBL-E UTI. Its efficacy is consistent among kidney transplant recipients