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

Le coût des centrales nucléaires ; essai de comparaison entre la France et les Etats-Unis

La comparaison, même grossière, des coûts d'investissement des centrales nucléaires que l'on trouve dans la littérature concernant la France et les Etats-Unis ne peut être abordée sans une certaine réflexion. Alors qu'aux Etats-Unis ces montants correspondent à la dépense totale en monnaie courante, en France ils ne s'appliquent qu'à une évaluation destinée à justifier la réalisation au niveau de la planification nationale, en comparant sa rentabilité à celle de réalisations de nature différente (centrales au charbon, installations hydrauliques ou énergies nouvelles), sur des bases « normatives » (ou pseudo-fictives). Les auteurs montrent comment une comparaison est cependant possible : l'écart d'un facteur voisin de 2 entre les montants trouvés dans la littérature provient de la prise en compte des habitudes comptables différentes et des conséquences de l'inflation observée actuellement

A propos d'une radiation infrarouge très intense dans la lumière du ciel nocturne

Les auteurs rappellent qu'ils ont été les premiers à observer, dans le ciel nocturne, la radiation 1,04 μ ; ils discutent son identification et les conditions de son émission

Electron optics

Electron Optics, Second English Edition, Part I: Optics is a 10-chapter book that begins by elucidating the fundamental features and basic techniques of electron optics, as well as the distribution of potential and field in electrostatic lenses. This book then explains the field distribution in magnetic lenses; the optical properties of electrostatic and magnetic lenses; and the similarities and differences between glass optics and electron optics. Subsequent chapters focus on lens defects; some electrostatic lenses and triode guns; and magnetic lens models. The strong focusing lenses and pri

Management and outcome of bloodstream infections: a prospective survey in 121 French hospitals (SPA-BACT survey)

Oliver Robineau,1 Jérome Robert,2 Christian Rabaud,3 Jean-Pierre Bedos,4 Emmanuelle Varon,5 Yves Péan,6 Rémy Gauzit,7 Serge Alfandari8 On behalf of the Société de Pathologie Infectieuse de Langue Française (SPILF), the Observatoire National de l’Épidémiologie de la Résistance Bactérienne aux Antibiotiques (ONERBA), and the Surveillance de la Prescription des Antibiotiques (SPA) Group 1Infectious Disease Department, Dron Hospital, Univ Lille, Tourcoing, 2Sorbonne University, UPMC Univ Paris 06, CR7, CIMI, Team E13 (Bacteriology), Paris, 3Infectious Disease Department, Nancy University Hospital, Nancy, 4Intensive Care Unit, Henri Mignot Hospital, Le Chesnay, 5Bacteriology Laboratory, HEGP, 6Observatoire National de L’epidémiologie de la Résistance Bactérienne aux Antibiotiques (OneRBa), 7Intensive Care Unit, Cochin Hospital, APHP, Paris, 8Intensive Care Unit, Dron Hospital, Tourcoing, France Background: Bloodstream infections (BSIs) are severe infections that can be community or hospital acquired. Effects of time to appropriate treatment and impact of antimicrobial management team are discussed in terms of outcome of BSI. We sought to evaluate the impact of initial BSI management on short-term mortality. Patients and methods: A prospective, multicenter survey was conducted in 121 French hospitals. Participants declaring BSI during a 1-month period were included consecutively. Data on patient comorbidities, illness severity, BSI management, and resistance profile of bacterial strains were collected. Predictors of 10-day mortality were identified by multivariate regression for overall BSI, health care-related and hospital-acquired BSI. Results: We included 1,952 BSIs. More than a third of them were hospital acquired (39%). Multidrug resistance was identified in 10% of cases, mainly in health care-related BSI. Empirical therapy and targeted therapy were appropriate for 61% and 94% of cases, respectively. Increased 10-day mortality was associated with severe sepsis, septic shock, increasing age, and any focus other than the urinary tract. Decreased mortality was associated with receiving at least one active antibiotic within the first 48 hours. Intervention of antimicrobial management team during the acute phase of BSI was associated with a decreased mortality at day 10 in the overall population and in health care-related BSI. Conclusion: Optimizing BSI management by increasing rapidity of appropriate treatment initiation may decrease short-term mortality, even in countries with low rate of multidrug-resistant organisms. Early intervention of antimicrobial management team is crucial in terms of mortality. Keywords: mortality, bloodstream infections, antimicrobial management team, community-acquired infection, health care-related infectio

Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies

International audienc

Enquête SPA2 de prévalence et de bon usage des anti-infectieux dans 314 hôpitaux français en 2010

International audienceObjectivesWe aimed to assess antibiotic prescriptions to identify potential targets for improvement.MethodsWe conducted a point prevalence survey (November 2010) of antibiotic use in 314 voluntary hospitals recruited by the French Infectious Diseases Society (SPILF) and the National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials (ONERBA). Data were entered online, immediately analyzed and exported.ResultsThe prevalence of antibiotic use was 19.5% (9059/46,446patients). A higher prevalence was observed in the infectious disease (58.4%), hematology (58%), and intensive care (48.7%) units. The three most frequently used antibiotic classes were aminopenicillins (23.8%), fluoroquinolones (17.9%), and 3rd-generation cephalosporins (16.7%). A monotherapy was prescribed to 64% of patients. The reasons for the antibiotic prescription were written in the medical records of 74% of patients and 62% were consistent with the local guidelines.ConclusionOur results are similar to that of other studies. Various local targets for improvement have been identified to help hospitals define a better antibiotic stewardship.ObjectifsÉvaluer les prescriptions antibiotiques afin de proposer des pistes d’amélioration.MéthodesNous avons réalisé une enquête de prévalence de l’antibiothérapie, en novembre 2010, dans 314 hôpitaux volontaires recrutés par les réseaux de la SPILF et de l’ONERBA. Les données étaient saisies en ligne avec une analyse instantanée et un export des données.RésultatsLa prévalence de l’antibiothérapie était de 19,5 % (9059/46 446patients). Elle était plus élevée en maladies infectieuses (58,4 %), hématologie (58 %) et réanimation (48,7 %). Les trois classes les plus fréquentes étaient les aminopénicillines (23,8 %), les fluoroquinolones (17,9 %) et les céphalosporines de 3e génération (16,7 %). Une monothérapie était utilisée dans 64 % des cas. Le motif de la prescription était noté dans le dossier médical dans 74 % des cas et était conforme aux recommandations locales dans 62 %.ConclusionsCes résultats sont similaires à ceux d’autres enquêtes. Des possibilités d’amélioration sur des critères locaux permettent aux établissements d’orienter leurs politiques d’amélioration de la prescription