Revolutionizing Clinical Microbiology Laboratory Organization in Hospitals with In Situ Point-of-Care

BACKGROUND: Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose. METHODS AND FINDINGS: One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. CONCLUSIONS: The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care

Carbapenem stewardship program in a French university children's hospital

INTRODUCTION: Carbapenems, last-resort antibiotics, are widely used as first-line treatment in patients carrying extended-spectrum beta-lactamases (ESBL) Enterobacteriaceae, including in a pediatric setting. We aimed to implement an antibiotic stewardship program (ASP) to improve the use of carbapenems. METHODS: We implemented an ASP at the Bordeaux Children's University Hospital with 6-month audits on prescribing practice before and after an intervention (revision of antibiotic treatment protocols, a half-day educational session with feedback of the first study period). The number of carbapenem prescriptions was analyzed and two criteria were used to assess conformity of the indication for carbapenem prescription and conformity of the reassessment. A logistic regression was used to assess the overall compliance of carbapenem prescriptions over the two periods adjusted for ESBL carriage. RESULTS: A total of 57 patients were included with 37 carbapenem prescriptions before the intervention and 23 after. Overall carbapenem consumption decreased from 0.54 prescriptions per 100 admissions to 0.32 (p = 0.06). Conformity increased during the study for indication (46-87%, p = 0.004) and for reassessment (48-78%, p = 0.04) and was significantly associated with the second study period, after adjustment for ESBL carriage. CONCLUSION: Our intervention contributed to a significant improvement in the compliance to indications for carbapenem indication and in the reassessment of the prescription

Arch Pediatr

BACKGROUND: Neisseria meningitidis is a virulent bacteria provoking outbreaks of invasive meningococcal disease (IMD) that authorities may try to control with population-based vaccinations. Such campaigns are most often thoroughly followed. We assess the response of poor adherence during a population-based vaccination after a meningococcal B:14:P1.7,16 outbreak. METHODS: Between July, 2012, and April, 2013, six cases including one fatality of invasive meningococcal disease related to N. meningitidis B:14:P1.7,16/ST32 were reported in two neighboring counties. A vaccination campaign with MenBVac((R)) targeting 6911 inhabitants was implemented. People entering the vaccination schedule from January 2014 received 4CMenB. RESULTS: The number of immunized patients proved to be low, with 1721 (24.1%) receiving at least one dose out of 5069 doses administered. However, the incidence of IMD in the zone dramatically fell, with only one purpura fulminans case in June 2014 with a good outcome. The campaign was stopped after 1 year and a 2-year monitoring period was implemented until June, 2016, with no new cases. CONCLUSIONS: This outbreak probably self-terminated in a context of a low incidence of serogroup B IMD during 2014 in France. Poor adherence illustrates the growing vaccine hesitancy in France. Similar campaigns will have to be thoroughly planned and implemented in terms of timing, modalities of injections, and mass communication

"C" trigonocephaly syndrome with diaphragmnatic hernia.

We report on a 6-year-old girl with C-trigonocephaly syndrome and diaphragmatic hernia. She is severely mentally retarded and shows the characteristic findings of this syndrome, including trigonocephaly, unusual facial features, especially intra-oral anomalies, low set and dysplastic ears, cardiac anomaly and neonatal hypotonia. Following our presentation at the 5th European meeting of dysmorphology in Strasbourg, P. Meinecke brought to our attention a case of C-trigonocephaly who died in the neonatal period from complications of a diaphragmatic hernia. Another case of C-trigonocephaly without diaphragmatic hernia was communicated to us by D. Lacombe. We report these three observations and present a review of 26 alleged cases

J Fr Ophtalmol

Summary Purpose To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP. Methods A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included. Results ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at>31 weeks or with BW>1110g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age≤27 weeks and Apgar score at 5minutes≤7. Conclusion In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5minutes as a risk factor for severe ROP requires further studies in order to be confirmed. Résumé Objectif Analyser la prévalence et les facteurs de risques de rétinopathie du prématuré (ROP) et de ROP sévère (nécessitant un traitement). Méthodes Une étude rétrospective a été menée dans une maternité de niveau 3 à Bordeaux, de 2009 à 2015. Quatre cent dix-neuf nourrissons prématurés dont la ROP a été dépistée exclusivement avec la RetCam ont été inclus. Résultats Une ROP a été retrouvée chez 27,68 % des nourrissons. Une ROP de stades 1, 2, 3 et 4 a été retrouvée dans 44 %, 46 %, 9 % et 1 % des sujets, respectivement. Il n’y avait pas de ROP de stade 5. Au total, 6,6 % des nourrissons (28/419) ont été traités par photocoagulation laser exclusive. Aucune injection intra-vitréenne d’anti-VEGF ou de traitement chirurgical n’ont été réalisés. Aucun nourrisson dont le terme était>31SA ou de poids de naissance>1110g n’a nécessité de traitement. En analyse multivariée, les facteurs de risques de développer une ROP étaient un faible poids de naissance, un faible âge gestationnel à la naissance, la durée de ventilation mécanique invasive et un état de choc ou l’utilisation d’amines vasopressives. En analyse multivariée, les facteurs de risques de ROP sévère étaient le sexe masculin, le terme≤27SA et le score d’Apgar à 5minutes≤7. Conclusion Dans notre série sur 6 ans, la ROP a été dépistée avec succès par télémédecine exclusive et aucun traitement chirurgical n’a été nécessaire. Cette étude retrouve les facteurs de risques connus de ROP mais le score d’Apgar à 5minutes comme facteur de risque de ROP sévère nécessite des études ultérieures avant d’être confirmé