Analyse des pratiques de la réunion de concertation pluridisciplinaire « endocardite infectieuse » : 177 dossiers présentés en 2017 au CHU de Clermont-Ferrand

CONTEXTE L’endocardite infectieuse est associée à un pronostic sévère avec un taux de mortalité de 30 % à 1 an. Les dernières recommandations européennes mettent la réunion de concertation pluridisciplinaire (RCP) « endocardite infectieuse » au coeur de sa prise en charge. OBJECTIF L’objectif est d’analyser les pratiques de la RCP « endocardite infectieuse ». MÉTHODES Cette étude rétrospective unicentrique analyse les dossiers de patients présentés en réunion de RCP « endocardite infectieuse » en 2017 et hospitalisés ou transférés au CHU de Clermont Ferrand. RÉSULTATS Cent soixante-dix-sept patients ont été inclus dans cette étude. La RCP a identifié 78 patients avec le diagnostic d’endocardite dont 20 dossiers avaient la mention d’endocardite probable/possible. Soixante-dix-neuf patients n’avaient pas au final d’endocardite. La mortalité globale des patients à 2 ans dans le groupe endocardite est de 16 %. La relecture des échographies en RCP a permis de confirmer le diagnostic d’endocardite pour 7 patients et de l’infirmer pour 10. Après relecture des images, 10 résultats d’ETO restaient douteux pour la confirmation du diagnostic. Dans le groupe endocardite, le contrôle de l’atteinte valvulaire par échographie était proposé pour 75 des patients (77,5%) ayant une endocardite. L’indication d’une chirurgie cardiaque était posée pour 34 patients (34,7%) mais récusée pour 5,3% des patients ayant une endocardite. La proposition d’examens paracliniques supplémentaires était faite pour 114 patients (64,4%). Leurs résultats ont permis de confirmer le diagnostic d’endocardite pour 13 patients et de l’infirmer pour 9 patients. Concernant le suivi des endocardites, une consultation était prévue avec un infectiologue et/ou cardiologue pour 78 patients (79,6%). CONCLUSION Cette étude analyse les pratiques de la RCP « endocardite » au CHU de Clermont-Ferrand pour apporter des propositions d’amélioration concrètes

Coûts associés au parcours de soins informels pour les patients avec suspicion de la borréliose de Lyme

International audienceObjectives: to compare the direct and indirect medical costs of patients with suspected Lyme borreliosis according to whether or not they had used an informal care pathway. Patients and methods: We retraced the care pathways of participating patients by a prospective questionnaire survey and a retrospective analysis of care records. Direct and indirect costs were estimated using a micro-costing method from different perspectives. We compared the costs of patients who had consulted a “Lyme Doctor” (informal care pathway) with those who had only used the formal care pathway. Non-parametric tests were used to test the significance of the differences between the two groups of patients. Results: Of 103 eligible patients, 49 (including 12 who used an informal health care pathway) agreed to be investigated. Five expenditures items supported entirely by patients were significantly higher for patients following an informal care pathway: productivity loss (3 041 ± 6 580 versus 194 ± 1 177 euros, p=0.01), alternative therapies (3 484 ± 7 308 versus 369 ± 956 euros), biological tests sent abroad (571 ± 1 415 versus 17 ± 92 euros, p<0.01), self-medication (918 ± 1 998 versus 133 ± 689, p=0.02) and transport (3 094 ± 3 456 versus 1 123 ±1 903 p=0.01). Conclusions: From the patient's standpoint, the informal care pathway involving consultation with a Lyme Doctor is far more expensive than the formal care pathway. More specificallay, the patient has to bear the costs of alternative treatments and repeated non-recommended examinations

Biofilm-coated microbeads and the mouse ear skin: An innovative model for analysing anti-biofilm immune response in vivo.

Owing to its ability to form biofilms, Staphylococcus aureus is responsible for an increasing number of infections on implantable medical devices. The aim of this study was to develop a mouse model using microbeads coated with S. aureus biofilm to simulate such infections and to analyse the dynamics of anti-biofilm inflammatory responses by intravital imaging. Scanning electron microscopy and flow cytometry were used in vitro to study the ability of an mCherry fluorescent strain of S. aureus to coat silica microbeads. Biofilm-coated microbeads were then inoculated intradermally into the ear tissue of LysM-EGFP transgenic mice (EGFP fluorescent immune cells). General and specific real-time inflammatory responses were studied in ear tissue by confocal microscopy at early (4-6h) and late time points (after 24h) after injection. The displacement properties of immune cells were analysed. The responses were compared with those obtained in control mice injected with only microbeads. In vitro, our protocol was capable of generating reproducible inocula of biofilm-coated microbeads verified by labelling matrix components, observing biofilm ultrastructure and confirmed in vivo and in situ with a matrix specific fluorescent probe. In vivo, a major inflammatory response was observed in the mouse ear pinna at both time points. Real-time observations of cell recruitment at injection sites showed that immune cells had difficulty in accessing biofilm bacteria and highlighted areas of direct interaction. The average speed of cells was lower in infected mice compared to control mice and in tissue areas where direct contact between immune cells and bacteria was observed, the average cell velocity and linearity were decreased in comparison to cells in areas where no bacteria were visible. This model provides an innovative way to analyse specific immune responses against biofilm infections on medical devices. It paves the way for live evaluation of the effectiveness of immunomodulatory therapies combined with antibiotics

Borréliose de Lyme

National audienceLYME BORRELIOSIS. Lyme borreliosis (LB) is the most common vector-borne disease in the Northern Hemisphere, caused by the bacterium Borrelia burgdorferi sensu lato, transmitted to humans by a bite of ticks Ixodes. Prevention is based on simple measures to evict ticks, and on their rapid extractionin the event of a bite. The diagnosis of LB is based on 3 arguments: an exposure to tick bites; clinically compatible symptoms (cutaneous, neurological or rheumatological manifestations, +/- functional symptoms such as fatigue or polyarthromyalgia), evolving in 3 stages (early localized or erythema migrans, early or late disseminated LB); a positive two-tier serological test (ELISA +/- Western-Blot). Serology can be negative for the first 6 weeks, without excluding the diagnosis. Since serology can remain positive for life, evolution is only evaluated clinically. LB treatment is mainly based on doxycycline for 14 to 28 days, depending on the clinical stage and manifestations, without demonstrated interest in prolonging it, even if symptoms persist. Nonetheless their management is crucial as often responsible for medical wandering. Attentive listening to the patient is essential. The prognosis of LB in the medium-term is favorable, especially if they beneficiate of an early management.La borréliose de Lyme est la principale zoonose vectorielle en France. Elle est due à la bactérie Borrelia burgdorferi sensu lato, transmise lors d’une piqûre de tique infectée du genre Ixodes. Son diagnostic repose sur un trépied diagnostique, parfois incomplet. La prévention consiste en la protection contre les piqûres de tiques, et leur extraction rapide en cas de piqûre. Le traitement repose principalement sur la doxycycline

Sotrovimab therapy elicits antiviral activities against Omicron BQ.1.1 and XBB.1.5 in sera of immunocompromised patients [letter]

International audienc