Facteurs de risque de décès à 28 jours des patients cirrhotiques admis en réanimation pour sepsis sévère ou choc septique

Introduction: determinants of mortality of septic shock patients with liver cirrhosis is poorly known. Methods: Multicenter observational study including all patients with liver cirrhosis admitted in ICU for severe sepsis or septic shock between 1997 and 2014 in the OUTCOMEREA database. Patients with liver transplantation were excluded. A Cox model censored at 28 days Cox model was used to identify risk factors of mortality.Résults: 228 patients with liver cirrhosis were included. Cirrhosis was followed by gastro-enterologists in 42% (n=91). The main source of infection was lung 38% (n=86). Patients were transferred from Emergency department in 52% (n=118) and from hepato-gastro-enterology in 16% (n=36). 28 days Mortality rate was 51% (IC95% 45-58). Risk factors independently associated with mortality at 28 days were women HR: 1.72 (IC95%: 1.12-2.6, p=0.01), Child-Pugh score unreferenced HR: 2.28 (IC95%: 1.33-5.37, pConclusion: severity of organ dysfunctions is the main element associated with mortality. Six important characteristics, independent of the management, present in the first two days of ICU stay can identified.Introduction : les facteurs de risque de mortalité des patients cirrhotiques admis en réanimation pour sepsis sévère ou choc septique sont mal connus.Méthodes : tous les patients enregistrés comme cirrhotiques dans la base de données OUTCOMEREA et admis pour sepsis sévère ou choc septique ont été inclus. Un modèle de Cox censuré à 28 jours a été utilisé pour identifier les facteurs de risque de mortalité.Résultats : 228 patients cirrhotiques ont été admis pour sepsis sévère ou choc septique. 118 patients (52%) étaient admis via un service d'urgences et 36 patients (16%) étaient transférés d'hépato-gastro-entérologie. La mortalité à 28 jours était de 51% (IC95% 45-58). Les facteurs de risque indépendamment associés à la mortalité à 28 jours étaient le sexe (femme) (HR : 1.72 ; IC95% [1.12-2.6], p=0.01), un score Child-Pugh non référencé (HR : 2.28 ; IC95% [1.33-5.37], pConclusion : la gravité des dysfonctions d'organe reste le principal facteur associé à la mortalité. Plusieurs facteurs de risque indépendants de la prise en charge peuvent être identifiés à l'admission

[Assessment of the transobturator male sling by a pelvic MRI].

International audiencePURPOSE: To evaluate the usefulness of MRI to assess the anatomical and functional relationships between the transobturator male sling Advance(®) and the uretral sphincter, in patients treated for postprostatectomy urinary incontinence. PATIENTS: For 12 patients treated for postprostatectomy urinary incontinence using the transobturator male sling Advance(®), a pelvic real-time MRI was performed between 1 and 3 months postoperatively. A comparison between pre- and postoperative MRI was performed in eight patients. The static sequences studied the anatomical relationships between the sling and the uretral sphincter, as well as the impact on the location of the vesico-uretral anastomosis. The dynamic sequences by coughing looked for the existence of an uretral sphincter mobility. Finally, the voiding sequences studied the impact of the sling on the uretral lumen during the micturition. RESULTS: The position of the sling was always visible, located at a median distance of 5mm from the posterior wall of the uretra. On transverse sections, the angles between the transobturator arms and the horizontal line between the ischial tuberosities varied from 28 to 59 degrees. The vesico-uretral anastomosis location was not modificated between pre and postoperative MRI. On the preop sequences by coughing, four patients had uretral mobility, which didn't exist on postop sequences. To finish, the seven patients who were able to void during MRI, had micturition without uretral stenosis. CONCLUSION: Pelvic MRI was a useful tool to assess the positioning of the sling and the relationships with the uretral sphincter. When correctly positioned, the sling was retro-uretrally and no urethral stenosis was visible during the micturition

Community-acquired infection caused by the uncommon hypervirulent Klebsiella pneumoniae ST66-K2 lineage

International audienceKlebsiella pneumoniae (Kp) reference strain Kp52.145 is widely used in experimental Klebsiella pathophysiology. Since 1935, only one other strain of the same sublineage (sequence type ST66, capsular serotype K2) was isolated (AJ210, Australia). Here, we describe a community-acquired invasive infection caused by a ST66-K2 Kp strain in France. Four hypermucoviscous Kp isolates responsible for acute otitis media, meningitis, bacteraemia and bacteriuria, respectively, were obtained from a patient with a history of chronic alcoholism and diabetes mellitus, and infected with HIV. The isolates were characterized by phenotypic and genomic methods. The four genetically identical ST66-K2 isolates presented a full antimicrobial susceptibility profile, including to ampicillin, corresponding to a single strain (SB5881), which was more closely related to AJ210 (135 SNPs) than to Kp52.145 (388 SNPs). Colibactin and yersiniabactin gene clusters were present on the integrative and conjugative element ICE Kp 10 in the chromosome. The two plasmids from Kp52.145 were detected in SB5881. In addition to carrying genes for virulence factors RmpA, aerobactin and salmochelin, plasmid II has acquired in SB5881, the conjugation machinery gene cluster from plasmid I. We report the first case of community-acquired infection caused by a hypervirulent ST66-K2 Kp strain in Europe. This demonstrates the long-term persistence of the high-virulence and laboratory model ST66-K2 sublineage. The combination of a conjugative apparatus and major virulence genes on a single plasmid may contribute to the co-occurrence of hypervirulence and multidrug resistance in single Kp strains

Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation.

International audiencePURPOSE: To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy. METHODS AND MATERIALS: From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity. RESULTS: The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods. CONCLUSION: The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity

Clinical and biological clusters of sepsis patients using hierarchical clustering

International audienceBackground Heterogeneity in sepsis expression is multidimensional, including highly disparate data such as the underlying disorders, infection source, causative micro-organismsand organ failures. The aim of the study is to identify clusters of patients based on clinical and biological characteristic available at patients’ admission. Methods All patients included in a national prospective multicenter ICU cohort OUTCOMEREA and admitted for sepsis or septic shock (Sepsis 3.0 definition) were retrospectively analyzed. A hierarchical clustering was performed in a training set of patients to build clusters based on a comprehensive set of clinical and biological characteristics available at ICU admission. Clusters were described, and the 28-day, 90-day, and one-year mortality were compared with log-rank rates. Risks of mortality were also compared after adjustment on SOFA score and year of ICU admission. Results Of the 6,046 patients with sepsis in the cohort, 4,050 (67%) were randomly allocated to the training set. Six distinct clusters were identified: young patients without any comorbidities,admitted in ICU for community acquired pneumonia (n = 1,603 (40%)); young patients without any comorbidities, admitted in ICU for meningitis or encephalitis (n = 149 (4%)); elderly patients with COPD, admitted in ICU for bronchial infection with few organ failures (n = 243 (6%)); elderly patients, with several comorbidities and organ failures (n = 1,094 (27%)); patients admitted after surgery, with a nosocomial infection (n = 623 (15%)); young patients with immunosuppressive conditions (e.g., AIDS, chronic steroid therapy or hematological malignancy) (n = 338 (8%)). Clusters differed significantly in early or late mortality (p < .001), even after adjustment on severity of organ dysfunctions (SOFA) and year of ICU admission. Conclusions Clinical and biological features commonly available at ICU admission of patients with sepsis or septic shock enabled to set up six clusters of patients, with very distinct outcomes. Considering these clusters may improve the care management and the homogeneity of patients in future studies

French coastal network for carbonate system monitoring: The CocoriCO2 dataset

International audienceSince the beginning of the industrial revolution, atmospheric carbon dioxide (CO2) concentrations have risen steadily and have induced a decrease of the averaged surface ocean pH by 0.1 units, corresponding to an increase in ocean acidity of about 30%. In addition to ocean warming, ocean acidification poses a tremendous challenge to some marine organisms, especially calcifiers. The need for long-term oceanic observations of pH and temperature is a key element to assess the vulnerability of marine communities and ecosystems to these pressures. Nearshore productive environments, where a large majority of shellfish farming activities are conducted, are known to present pH levels as well as amplitudes of daily and seasonal variations that are much larger than those observed in the open ocean. Yet, to date, there are very few coastal observation sites where these parameters are measured simultaneously and at high frequency

French coastal network for carbonate system monitoring: the CocoriCO2 dataset

International audienceSince the beginning of the industrial revolution, atmospheric carbon dioxide (CO2) concentrations have risen steadily and have induced a decrease of the averaged surface ocean pH by 0.1 units, corresponding to an increase in ocean acidity of about 30 %. In addition to ocean warming, ocean acidification poses a tremendous challenge to some marine organisms, especially calcifiers. The need for long-term oceanic observations of pH and temperature is a key element to assess the vulnerability of marine communities and ecosystems to these pressures. Nearshore productive environments, where a large majority of shellfish farming activities are conducted, are known to present pH levels as well as amplitudes of daily and seasonal variations that are much larger than those observed in the open ocean. Yet, to date, there are very few coastal observation sites where these parameters are measured simultaneously and at high frequency. To bridge this gap, an observation network was initiated in 2021 in the framework of the CocoriCO2 project. Six sites were selected along the French Atlantic and Mediterranean coastlines based on their importance in terms of shellfish production and the presence of high- and low-frequency monitoring activities. At each site, autonomous pH sensors were deployed, both inside and outside shellfish production areas, next to high-frequency CTD (conductivity–temperature–depth) probes operated through two operating monitoring networks. pH sensors were set to an acquisition rate of 15 min, and discrete seawater samples were collected biweekly in order to control the quality of pH data (laboratory spectrophotometric measurements) as well as to measure total alkalinity and dissolved inorganic carbon concentrations for full characterization of the carbonate system. While this network has been up and running for more than 2 years, the acquired dataset has already revealed important differences in terms of pH variations between monitored sites related to the influence of diverse processes (freshwater inputs, tides, temperature, biological processes). Data are available at https://doi.org/10.17882/96982 (Petton et al., 2023a)