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•Harmonisation des protocoles de préparations pharmaceutiques.•Renforcer les échanges entre les établissements de santé et les officines.•Optimisation de la prise en charge thérapeutique des patients pédiatriques.

•Intérêt du dispositif Impella™ en cardiologie interventionnelle.•Analyse médicoéconomique de dispositifs médicaux coûteux.•Rôle des centres de références au sein d’un groupement hospitalier de territoire.•Optimisation du codage et de la valorisation des séjours•Intérêt de l’analyse pluridisciplinaire.

•Prise en charge chirurgicale de patients avec comorbidités.•Bénéfices des revues de morbi-mortalité et des analyses de matériovigilance.•Risques de l’utilisation du ciment osseux en chirurgie orthopédique.•Assurance qualité et mise en place d’actions correctives•Intérêts de l’analyse pluridisciplinaire.

ABSTRACTBoth intrinsic and acquired resistance to amphotericin B have been documented for Candida lusitaniae. Amphotericin B remains the drug of choice for many critical fungal infections, and the detection of resistance is essential to monitor treatment effectively. The limitations of the National Committee for Clinical Laboratory Standards (NCCLS) reference methodology for detection of amphotericin B resistance are well documented, and several alternative methods have been proposed. Etest assays with RPMI and antibiotic medium 3 (AM3) agar were compared to the NCCLS M27-A broth macrodilution method using AM3 for amphotericin B resistance testing with 49 clinical isolates of C. lusitaniae. The panel included nine isolates with known or presumed resistance to amphotericin B on the basis of in vivo and/or in vitro data. The distribution of amphotericin B MICs by Etest with RPMI ranged from 0.032 to 16 µg/ml and was bimodal. All of the putatively resistant isolates were inhibited by amphotericin B at =0.38 µg/ml and could be categorized as resistant using this breakpoint. Etest with AM3 yielded a broader amphotericin B MIC range (0.047 to 32 µg/ml), and there were six putatively resistant isolates for which MICs were >1 µg/ml. The separation of putatively susceptible and resistant isolates was less obvious. Broth macrodilution with AM3 generated a unimodal distribution of MICs (ranging from 0.032 to 2 µg/ml) and failed to discriminate most of the putatively resistant isolates at both 24 and 48?h. Etest using RPMI and, to a lesser extent, using AM3 provided better discrimination between amphotericin B-resistant and -susceptible isolates of C. lusitaniae.

L’évaluation de la qualité du processus des préparations pharmaceutiques en conformité avec les Bonnes Pratiques de Préparations (BPP) a conduit à l’élaboration d’un outil d’audit et sa réalisation dans les quatre préparatoires de notre CHU.