21 research outputs found
Pseudomonas aeruginosa prosthetic joint-infection outcomes: Prospective, observational study on 43 patients
ObjectivesAnalysis the outcomes of Pseudomonas aeruginosa prosthetic joint infection (PJI), and of their clinical and microbiological characteristics, surgical strategies and antibiotic treatments.MethodsMonocenter cohort study in a Bone-and-Joint-Infection Referral Center (08/2004 to 10/2018) including all consecutive P. aeruginosa PJIs. Data were extracted from the prospective database, including the following events: relapses, new PJIs, related deaths.ResultsMedian [IQR]: among the 43 patients included (28 females; 72 [63â80] years old; 27 hip, 15 knee, and 1 shoulder PJIs), 29 (67%) had underlying comorbidities, 12 (28%) had previously been treated for another PJI and 9 (21%) had undergone previous surgeries for their P. aeruginosa PJI. Eleven (26%) PJIs were polymicrobial, 16 (37%) strains were wild type, 8 (19%) ciprofloxacin-resistant. PJIs were classified as late chronic (n = 33), early postoperative (n = 9) or acute hematogenous infection (n = 1). Forty patients underwent surgery: 27 one-stage and 5 two-stage exchanges, 3 debridement and implant retention, and 5 other surgical strategies. Antibiotic treatments were: 29 received 41 [37â43] days of combination therapy (IV anti-pseudomonal ÎČ-lactam and 3â5 days of amikacin, then ÎČ-lactam and oral ciprofloxacin), followed by oral ciprofloxacin for a total of 12 weeks; 10 received only IV antibiotics for 83 [77â86] days, including 37 [32â46] days of combination therapy; 49 days of ceftazidime alone for 1. During follow-up lasting 33 [24â64.5] months, 2 relapses, 3 new PJIs, and 2 related deaths occurred. Thirty-three (82%) patients and 93% of those managed with one-stage exchange experienced no event.ConclusionOutcomes of our cohortâs P. aeruginosa PJIsâpredominantly monomicrobial, chronic, ciprofloxacin-susceptible, treated with one-stage exchange and prolonged IV antibioticsâwere 82% favorable
Rifampicin mono-resistant tuberculosis in France: a 2005â2010 retrospective cohort analysis
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
Epidémiologie de la tuberculose et de la résistance aux antituberculeux
Tuberculosis (TB) control is a major global public health issue. We used existing surveillance systems in two countries with different epidemiological profiles of tuberculosis (France and China) to evaluate patient management and antituberculosis drug resistance. In France, we first analyzed primary isoniazid monoresistance according to birth cohorts, demonstrating higher resistance rates among cohorts of young patients born in France. This result suggests recent transmission of such strains in France. Data currently available in the networks do not allow for further analysis to explain this increase (i.e. parental origins, exposure type, circulation of a particular clonal strain). In a second work, we showed that rifampin monoresistance incidence rate was very low (<1%), that its management was heterogeneous, and its treatment success rate not satisfactory. We suggest to implement a program identical to the one established for the management of multidrug resistant TB. In China, using a regional surveillance network, we confirmed that cough and belonging to a vulnerable population were risk factors for delayed diagnosis. The training of healthcare workers and patient's access to healthcare must be improved. Surveillance networks are key tools for collecting data, permitting the establishment of indicators of epidemiological TB characteristics, the basis of tuberculosis control programsLe contrĂŽle de la tuberculose est un enjeu majeur de SantĂ© Publique dans le monde. Nous avons utilisĂ© les systĂšmes de surveillance mis en place dans deux pays de profil Ă©pidĂ©miologique de la tuberculose diffĂ©rent (France et Chine) pour Ă©tudier la prise en charge des malades et la rĂ©sistance aux antituberculeux. En France, nous avons analysĂ© la mono-rĂ©sistance primaire Ă l'isoniazide selon les cohortes de naissance et montrĂ© des taux de rĂ©sistance plus Ă©levĂ©s parmi les cohortes de jeunes patients nĂ©s en France. Ceci suggĂšre une transmission rĂ©cente de ces souches en France. Les donnĂ©es disponibles actuellement dans les rĂ©seaux ne permettent pas d'analyser plus prĂ©cisĂ©ment les causes de cette augmentation (origine des parents, type d'exposition, circulation d'un clone particulier ...). Pour ce qui concerne la mono-rĂ©sistance Ă la rifampicine, son incidence est trĂšs faible (<1%). Nous avons montrĂ© que sa prise en charge est trĂšs hĂ©tĂ©rogĂšne et que le taux de succĂšs thĂ©rapeutique peut ĂȘtre amĂ©liorĂ©. Une rĂ©flexion identique Ă celle qui a eu lieu pour les cas multi rĂ©sistants doit ĂȘtre mise en place. En Chine, en utilisant un rĂ©seau rĂ©gional, nous avons confirmĂ© que la toux et l'appartenance Ă des populations vulnĂ©rables Ă©taient des facteurs de risque de diagnostic tardif. La formation mĂ©dicale et l'accĂšs aux structures de soins doivent ĂȘtre amĂ©liorĂ©s. Les rĂ©seaux de surveillance sont des outils clĂ©s pour collecter des donnĂ©es permettant de fournir des indicateurs sur les caractĂ©ristiques Ă©pidĂ©miologiques de la tuberculose sur lesquels vont se baser les programmes de lutte contre la tuberculos
La choroïdite multifocale périphérique idiopathique (une entité ophtalmologique proche de la sarcoïdose ?)
PARIS5-BU MĂ©d.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Epidémiologie de la tuberculose et de la résistance aux antituberculeux
Le contrĂŽle de la tuberculose est un enjeu majeur de SantĂ© Publique dans le monde. Nous avons utilisĂ© les systĂšmes de surveillance mis en place dans deux pays de profil Ă©pidĂ©miologique de la tuberculose diffĂ©rent (France et Chine) pour Ă©tudier la prise en charge des malades et la rĂ©sistance aux antituberculeux. En France, nous avons analysĂ© la mono-rĂ©sistance primaire Ă l isoniazide selon les cohortes de naissance et montrĂ© des taux de rĂ©sistance plus Ă©levĂ©s parmi les cohortes de jeunes patients nĂ©s en France. Ceci suggĂšre une transmission rĂ©cente de ces souches en France. Les donnĂ©es disponibles actuellement dans les rĂ©seaux ne permettent pas d analyser plus prĂ©cisĂ©ment les causes de cette augmentation (origine des parents, type d exposition, circulation d un clone particulier ). Pour ce qui concerne la mono-rĂ©sistance Ă la rifampicine, son incidence est trĂšs faible (<1%). Nous avons montrĂ© que sa prise en charge est trĂšs hĂ©tĂ©rogĂšne et que le taux de succĂšs thĂ©rapeutique peut ĂȘtre amĂ©liorĂ©. Une rĂ©flexion identique Ă celle qui a eu lieu pour les cas multi rĂ©sistants doit ĂȘtre mise en place. En Chine, en utilisant un rĂ©seau rĂ©gional, nous avons confirmĂ© que la toux et l appartenance Ă des populations vulnĂ©rables Ă©taient des facteurs de risque de diagnostic tardif. La formation mĂ©dicale et l accĂšs aux structures de soins doivent ĂȘtre amĂ©liorĂ©s. Les rĂ©seaux de surveillance sont des outils clĂ©s pour collecter des donnĂ©es permettant de fournir des indicateurs sur les caractĂ©ristiques Ă©pidĂ©miologiques de la tuberculose sur lesquels vont se baser les programmes de lutte contre la tuberculoseTuberculosis (TB) control is a major global public health issue. We used existing surveillance systems in two countries with different epidemiological profiles of tuberculosis (France and China) to evaluate patient management and antituberculosis drug resistance. In France, we first analyzed primary isoniazid monoresistance according to birth cohorts, demonstrating higher resistance rates among cohorts of young patients born in France. This result suggests recent transmission of such strains in France. Data currently available in the networks do not allow for further analysis to explain this increase (i.e. parental origins, exposure type, circulation of a particular clonal strain). In a second work, we showed that rifampin monoresistance incidence rate was very low (<1%), that its management was heterogeneous, and its treatment success rate not satisfactory. We suggest to implement a program identical to the one established for the management of multidrug resistant TB. In China, using a regional surveillance network, we confirmed that cough and belonging to a vulnerable population were risk factors for delayed diagnosis. The training of healthcare workers and patient s access to healthcare must be improved. Surveillance networks are key tools for collecting data, permitting the establishment of indicators of epidemiological TB characteristics, the basis of tuberculosis control programsPARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF
Actualités thérapeutiques en orthopédie septique
This article highlights four recent updates in infectious disease in the management of bone and joint infections (BJI). During the first six weeks of treatment of a BJI, with or without orthopedic implant, oral antimicrobial therapy is as effective as intravenous therapy. For periprosthetic joint infections, a randomized control study failed to demonstrate non-inferiority of 6 versus 12 weeks of antibiotic therapy. In diabetic foot osteomyelitis, a 3-week course of antibiotics appears to be non-inferior to a 6-week course. Phage therapy seems promising in adjunctive therapy of complex BJI.Cet article expose quatre nouveautĂ©s thĂ©rapeutiques significatives en orthopĂ©die septique. Durant les six premiĂšres semaines de traitement dâune infection ostĂ©oarticulaire, avec ou sans matĂ©riel, une antibiothĂ©rapie per os est aussi efficace quâune antibiothĂ©rapie intraveineuse. Concernant les arthroplasties infectĂ©es, il nây a pas de preuve suffisante Ă raccourcir le traitement antibiotique Ă moins de douze semaines. Dans les ostĂ©omyĂ©lites de pied diabĂ©tique, une antibiothĂ©rapie de trois semaines semble non infĂ©rieure Ă une thĂ©rapie de six semaines. Finalement, la phagothĂ©rapie est prometteuse dans les infections ostĂ©oarticulaires, particuliĂšrement dans les situations dâĂ©chec des traitements conventionnels
High Rate of Multidrug-Resistant Gram-Negative Bacilli Carriage and Infection in Hospitalized Returning Travelers: a Cross-Sectional Cohort Study
International audienc