A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections?

Introduction: Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. Methods: ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients \ 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare related infections and infections caused by unusual pathogens of the urinary tract. Th main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. Results: Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p \ 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCABUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77?6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27?6.44) and Charlson index (aOR 1.11; 95% CI 1.01?1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40?0.93) were less likely to present clinical cure. Conclusion: The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.Funding. This study and the journal’s Rapid Service Fee are sponsored and funded by MSD Spain. The study was also supported by Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0004, RD16/ 0016/0005, RD16/0016/0007, RD16/0016/0010, RD16/0016/0011 and RD16/0016/0015), co-financed by the European Development Regional Fund ‘A way to achieve Europe’ (ERDF), Operative program Intelligent Growth 2014–2020

A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections?

Introduction: Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. Methods: ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. Results: Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77–6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27–6.44) and Charlson index (aOR 1.11; 95% CI 1.01–1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40–0.93) were less likely to present clinical cure. Conclusion: The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure. © 2021, The Author(s)

Le roman comme reflet de la réalité diglossique en Galice

1. Introduction La Galice se présente comme une communauté linguistique diglossique avec deux langues : une langue dominante ou langue A, le castillan, et une langue dominée ou langue B, le galicien. L’usage de l’une ou de l’autre est conditionné socialement dans la plupart des situations communicatives. L’histoire, plusieurs siècles de domination linguistique et d’interdiction du galicien comme langue de la culture, de l’administration et de l’enseignement, ont fini par confiner l’emploi du ..

« Lettres de Galice » de Prosper-Henri Devos, un voyage vers l’Autre, une quête de soi. Analyse d’un voyage d’un ouvrage et de sa traduction

Der Beitrag enthält das Abstract ausschließlich in französischer und englischer Sprache.Prosper-Henri Devos (1889-1914), a writer of Belgian origin, is the author of Lettres de Galice, eight chronicles that recount the author's journey through Galician lands. At first, the article focuses on the analysis of the translation from French into Galician, the translation technique used and the translation problems encountered. Secondlly, the content of the work is analysed as a double exploration of identity, a journey of a bilateral nature. Galicia exists in the history of Devos and the writer's personality is revealed as the encounters take place, as the journey is recounted.Prosper-Henri Devos (1889-1914), écrivain d'origine belge, est l'auteur des Lettres de Galice, huit chroniques qui retracent le parcours de l'auteur en terres galiciennes. Dans un premier temps, l'article se centre sur l'analyse de la traduction du français vers le galicien, la technique de traduction utilisée et les problèmes de traduction rencontrés. Dans un second temps, le contenu de l'œuvre est analysé comme une double exploration identitaire, un parcours à caractère bilatéral. La Galice existe dans l'histoire de Devos et la personnalité de l'écrivain se révèle au fil des rencontres, au fur et à mesure du récit du voyage.La traduction en galicien encourage à son tour ses lecteurs à voyager dans la mémoire de leur pays, tout en étant destinée à rendre au destinataire de la langue cible une copie fidèle de la version original

Écrire en situation bilingue – Volume I

« Écrire en situation bilingue », c’est aussi bien pratiquer le « bilinguisme d’écriture » (qui relève du choix du seul individu) que « écrire en situation diglossique » (c’est-à-dire de l’inégalité socialisée des langues), mais c’est de toute manière œuvrer sur l’hétérogène, alors que les institutions du monde (entre autre la/les littérature/s) se prétendent homogènes. La thématique est envisagée sous trois modalités complémentaires : le « choix » d’une langue d’écriture (choisit-on ? en fonction de quoi ?) ; les stratégies d’écriture bilingue (comment intégrer à un texte deux langues ou plus ?) ; la problématique de la réception (édition, lectorat : quelle diffusion, quel retour, en fonction des choix opérés ?). Le propos est ici, par delà la diversité des terrains et des individus, de tenter de repérer les récurrences, voire les invariants dans la production et la réception de fictions narratives et poétiques. Des Mapuche du Chili aux Chicanos des États-Unis, en passant par l’Argentine et ses élites, par le Paraguay bilingue, ou par les Antilles créolisées ; de l’Algérie et de Tanger à Madagascar, en passant par le Mali ou l’Angola ; des territoires de langue occitane et des Catalognes du nord et du sud, jusqu’en Galice, en passant par le Pays Basque, près d’une vingtaine de langues, écrites ou confinées dans l’oralité, véhiculaires ou vernaculaires, dominantes et dominées, mais méritant toutes le label de « langues de culture », se rencontrent, s’unissent et se télescopent dans le texte de création littéraire, optant pour mimer les conditions sociolinguistiques du réel environnant ou bien pour introduire le lecteur dans un univers imaginaire et fantasmé. Les deux volumes édités se complètent : le volume 1 regroupe 38 textes de communications ; le volume 2, 16 interventions au cours de 3 tables rondes, prononcées au cours du colloque qui s’est tenu à l’Université de Perpignan les 20, 21 et 22 mars 2003