Classification, diagnosis, and approach to treatment for angioedema: Consensus report from the Hereditary Angioedema International Working Group

Angioedema is defined as localized and self-limiting edema of the subcutaneous and submucosal tissue, due to a temporary increase in vascular permeability caused by the release of vasoactive mediator(s). When angioedema recurs without significant wheals, the patient should be diagnosed to have angioedema as a distinct disease. In the absence of accepted classification, different types of angioedema are not uniquely identified. For this reason, the European Academy of Allergy and Clinical Immunology gave its patronage to a consensus conference aimed at classifying angioedema. Four types of acquired and three types of hereditary angioedema were identified as separate forms from the analysis of the literature and were presented in detail at the meeting. Here, we summarize the analysis of the data and the resulting classification of angioedema. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Évaluation des pratiques professionnelles (le bon usage des hémocultures au centre hospitalier universitaire de Grenoble)

Le but de cette étude prospective était d évaluer le bon usage des hémocultures au Centre Hospitalier Universitaire de Grenoble. La première partie a évalué la réalisation pratique (renseignement des bons, volume de sang prélevé). La seconde partie a apprécié le bon usage proprement dit sur toute l'hospitalisation des patients inclus lors de la première phase (indication, nombre d hémocultures, délai entre les différentes séries, traitement anti-infectieux réalisé). L évaluation a porté sur 260 patients. Le volume de sang prélevé était insuffisant dans 63% des cas. Le nombre d hémocultures prélevées était inadapté pour 61% des patients. Enfin, l'antibiothérapie était conforme pour seulement 68% des patients après récéption d'un résultat d hémoculture positive. En conclusion, l utilisation des hémocultures est loin d être optimale. La Commission des Anti-Infectieux envisage d implémenter un guide de bon usage des hémocultures afin d améliorer ces pratiques professionnelles.The aim of this prospective study was to assess blood culture practice in a University Hospital. First, we evaluated collecting procedure (technical realisation) through information available at the laboratory : blood culture indication or antibiotic therapy precised, blood volume cultured. Secondly, we assessed blood culture practice : indication, number of sets per patient, antibiotic treatments prescribed. The study included 260 patients. Inadequate blood volume was inoculated in 63%. Number of blood cultures was inadequate in 61%. In case of positive blood cultures, antibiotherapy was adequate in only 68% after receiving culture and antibiogram results. In conclusion, blood culture quality is poor in the Grenoble University Hospital. This study will be the start point to implement a blood culture practice guideline and to try to improve clinical outcome in bacteremia and fungemiaGRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prospective study of telephone calls to a hotline for infectious disease consultation: analysis of 7,863 solicited consultations over a 1-year period

International audienceTo respond to the increasing requests of non-infectious disease physicians for access to infectious diseases expertise, a hotline was created in the infectious diseases consultation (IDC) unit of the Grenoble university-affiliated hospital (GUH). This study describes the patterns of solicited consultations provided by the hotline during a 1-year period. We conducted a prospective study of consecutive solicited IDCs requested by physicians in 2008. A total of 7,863 consultations were requested by physicians over 1 year; 4,407 (56.0%) by ambulatory physicians, 2,933 (37.3%) by GUH physicians, and 523 (6.7%) by physicians in public or private hospitals. The majority of consultations were requested via cell phone (58.7%). The main reasons for requesting a consultation were related to antimicrobial treatment for hospital-based physicians and prophylaxis for ambulatory physicians ( < 0.001). Recommendations to perform diagnostic or monitoring tests were less frequent in ambulatory medicine (16%) than in the GUH (59%) or other hospitals (63%,  < 0.001). The route of consultation for patients with nosocomial infections was more likely to be formal ( < 0.001). The activity of the IDC hotline attests to an important need for such expertise consultation, both in hospitals and in ambulatory medicine

Appropriateness of blood culture testing parameters in routine practice. Results from a cross-sectional study.

International audienceWe aimed to assess the appropriateness of routine blood culture testing parameters and antimicrobial therapy for patients with suspected bloodstream infection. We conducted a cross-sectional study of blood cultures registered in the microbiological laboratory at a university-affiliated hospital from 4 to 15 June 2007. Using a structured implicit chart review, two infectious disease specialists assessed the appropriateness of the testing parameters and antimicrobial therapy. Overall, 2,696 blood culture bottles were collected from 260 patients during their stay, including 955 bottles that were evaluated during the study period. The indication of fungal and bacterial blood cultures was rated as appropriate for 75% (95% confidence interval [CI], 65-83) and 91% (95% CI, 87-95) of patients. Only 45% (95% CI, 39-52) of patients had an adequate number of blood cultures (i.e., two to four). An optimal volume of blood (i.e., ≥10 mL) was inoculated in 13% (95% CI, 11-15) of adult bottles. Empirical antimicrobial therapy was appropriate for 60% (95% CI, 43-76) of patients with positive blood cultures. There is room for improvement regarding routine blood culture testing parameters and antimicrobial therapy. The effectiveness of multifaceted interventions in altering the appropriateness of blood culture parameters deserves further research