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1. Trends in the relation between hyperglycemia correction and active Charcot neuroarthropathy: results from the EPICHAR study

Author

Dured Dardari, Sophie Schuldiner, Carole-Anne Julien, Georges Ha Van, Jocelyne M’Bemba, Muriel Bourgeon, Ariane Sultan, Marc Lepeut, Sylvie Grandperret-Vauthier, Florence Baudoux, Maud François, Sylvaine Clavel, Jacques Martini, Julien Vouillarmet, Paul Michon, Myriam Moret, Arnaud Monnier, Vaneva Chingan-Martino, Vincent Rigalleau, Isabelle Dumont, Laurence Kessler, Ionela Stifii, Benjamin Bouillet, Pierre Bonnin, Amal Lemoine, Enrique Da Costa Correia, Marie Martine Bonello Faraill, Marie Muller, Marie Cazaubiel, Mohammed Zakarya Zemmache, Agnes Hartemann, Laboratoire de Biologie de l'Exercice pour la Performance et la Santé (LBEPS), Université d'Évry-Val-d'Essonne (UEVE)-Université Paris-Saclay-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA), Centre Hospitalier Sud Francilien, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de diabétologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), CHU Roubaix, Service de Génétique Biologique, Histologie Biologie du Développement et de la reproduction, Centre Hospitalier Régional universitaire Jean Minjoz (Service de Génétique Biologique, Histologie Biologie du Développement et de la reproduction, Centre Hospitalier Régional universitaire Jean Minjoz), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hôpital Claude Huriez [Lille], CHU Lille, Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Hôtel-Dieu [Paris], Service Diabétologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hôpital Louis Pradel [CHU - HCL], CHU Pointe-à-Pitre/Abymes [Guadeloupe], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Les Hôpitaux Universitaires de Strasbourg (HUS), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Agro Dijon, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Hôpital Lucien Hussel Vienne [Vienne, France] (HLHV), Centre Hospitalier de Vichy (CH Vichy), Hôpital Archet 2 [Nice] (CHU), Hôpital Michallon, Centre Hospitalier de Tourcoing, and BESPIM

Subjects
Male, HbA1c, MESH: Glycated Hemoglobin, Endocrinology, Diabetes and Metabolism, MESH: Diabetic Neuropathies / epidemiology, Cohort Studies, Diabetic Neuropathies, Diabetes complications, Diagnosis, MESH: Diabetes Mellitus, Type 2 / complications, Humans, Aged, MESH: Hyperglycemia / complications, Glycated Hemoglobin, MESH: Aged, MESH: Humans, Middle Aged, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, MESH: Male, MESH: Middle aged, Diabetes Mellitus, Type 2, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Hyperglycemia, MESH: Cohort studies, Neuroarthropathy, Female, MESH: Female, MESH: Diabetic Neuropathies / etiology
Abstract

IntroductionThe pathophysiology of Charcot neuroarthropathy (CN) remains unclear. There are a number of hypotheses but these are not exclusive. In its clinical presentation, this complication intersects with the semiology of diabetic-induced neuropathy, such as peripheral hypervascularization and the appearance of arteriovenous shunt. The EPICHAR study is as yet an unpublished cohort of people living with diabetes complicated by CN (in active or chronic phase). Based on the findings of the EPICHAR study, this study aimed to investigate whether a reduction in the rate of hyperglycemia accompanies the onset of an active phase of CN.Research design and methodsHemoglobin A1c (HbA1c) levels were assessed 3 months (M3) and 6 months (M6) before the diagnosis of active CN (M0).Results103 patients living with diabetes and presenting active CN were included between January and December 2019 from the 31 centers participating in this study (30 in France and 1 in Belgium). The mean age of the participants was 60.2±12.2 years; the vast majority were men (71.8%) living with type 2 diabetes (75.5%). Mean HbA1c levels significantly declined between M6 (median 7.70; Q1, Q3: 7.00, 8.55) and M3 (median 7.65; Q1, Q3: 6.90, 8.50) (p=0.012), as well as between M6 and M0 (median 7.40; Q1, Q3: 6.50, 8.50) (p=0.014). No significant difference was found between M3 and M0 (p=0.072).ConclusionsA significant reduction in HbA1c levels seems to accompany the onset of the active phase of CN.Trial registration numberNCM03744039.

Published
2022

2. Costs associated with community acquired pneumonia in France

Author

Patrick Petitpretz, Pierre Bonnin, Henri Laurichesse, J. Gaillat, Jean-Damien Ricard, Christian Chidiac, Bruno Detournay, Grèce Saba, Luiz Flavio Andrade, Gérard de Pouvourville, Jonathan Messika, and Hajnal-Gabriela Illes

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Pediatrics, Multivariate analysis, 030106 microbiology, Economics, Econometrics and Finance (miscellaneous), Context (language use), Young Adult, 03 medical and health sciences, 0302 clinical medicine, Community-acquired pneumonia, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Hospital Costs, health care economics and organizations, Average cost, Aged, Aged, 80 and over, Health economics, Descriptive statistics, business.industry, Health Policy, Pneumonia, Length of Stay, Middle Aged, medicine.disease, Community-Acquired Infections, Hospitalization, Emergency medicine, Pneumococcal pneumonia, Female, France, business
Abstract

Pneumocost is a prospective study that aimed at documenting the costs of the management of patients hospitalized with a pneumococcal pneumonia and the post-discharge costs during a 6-month period in the French context. Billing data were used to document hospital costs. Resource use during the follow-up period was collected through phone interviews at month 1, 3 and 6. Descriptive statistics and multivariate analyses were performed. We used generalized linear models with log-link functions to estimate parameters associated with hospital and follow-up costs of patients. Five hundred twenty-four patients were enrolled in 40 public centers from October 2011 to April 2014. Average age was 63 (SD 17); 55.0% of them were male. Average length of stay was 15 days (SD 23). Average cost of stay for the French Sickness Fund was €7293 (SD €7363). Average cost of follow-up was €1242 (SD €3000) and decreased steadily through time. When controlling for patient’s socioeconomic characteristics, severity of disease and hospital stay, results showed a concave relationship between hospital costs and age. Obesity, the severity of the disease and comorbidities were associated with constantly increasing inpatient costs. Concerning follow-up costs, we found the same concave relationship with age, while gender, a history of pneumonia and severity of the disease were the most important predictors of high costs after discharge. Pneumocost is the first French study providing a robust estimation of the cost of managing invasive pneumococcal pneumonia in the French context.

Published
2017

3. Health related quality of life in patients with community-acquired pneumococcal pneumonia in France

Author

Grèce Saba, Luiz Flavio Andrade, Hajnal-Gabriela Illes, Patrick Petitpretz, Jonathan Messika, Bruno Detournay, Pierre Bonnin, Gérard de Pouvourville, Henri Laurichesse, J. Gaillat, Christian Chidiac, Jean-Damien Ricard, ESSEC Business School, Essec Business School, Ecologie et Evolution des Microorganismes (EEM), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des Maladies Infectieuses, Centre Hospitalier de la Région d'Annecy (Pringy), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Immunité infection vaccination (I2V), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-IFR128-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des Maladies Infectieuses et Tropicales [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, and ESSEC

Subjects
Male, Time Factors, Lung infection, [SDV]Life Sciences [q-bio], Severity of Illness Index, Health problems, 0302 clinical medicine, Surveys and Questionnaires, Activities of Daily Living, Prospective Studies, 030212 general & internal medicine, Aged, 80 and over, 030503 health policy & services, Age Factors, General Medicine, Middle Aged, CAP, 3. Good health, Community-Acquired Infections, Pneumococcal pneumonia, lcsh:R858-859.7, Female, France, 0305 other medical science, Adult, Quality of life, medicine.medical_specialty, lcsh:Computer applications to medicine. Medical informatics, Young Adult, 03 medical and health sciences, Quality of life (healthcare), EQ-5D, medicine, Humans, In patient, Intensive care medicine, Aged, Health related quality of life, business.industry, Research, Public Health, Environmental and Occupational Health, Pneumonia, Length of Stay, Pneumonia, Pneumococcal, medicine.disease, respiratory tract diseases, Tobit model, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background Community Acquired Pneumococcal Pneumonia is a lung infection that causes serious health problems and can lead to complications and death. The aim of this study was to observe and analyze health related quality of life after a hospital episode for patients with community acquired pneumococcal pneumonia in France. Methods A total of 524 individuals were enrolled prospectively in the study and were followed for 12 months after hospital discharge. Presence of streptococcus pneumoniae was confirmed by microbiological sampling. Quality of life was reported at four different points of time with the EQ-5D-3 L health states using the French reference tariff. Complete data on all four periods was available for 269 patients. We used descriptive and econometric analysis to assess quality of life over time during follow-up, and to identify factors that impact the utility indexes and their evolution through time. We used Tobit panel data estimators to deal with the bounded nature of utility values. Results Average age of patients was 63 and 55% of patients were men. Negative predictors of quality of life were the severity of the initial event, history of pneumonia, smokers, age and being male. On average, quality of life improved in the first 6 months after discharge and stabilized beyond. At month 1, mean utility index was 0.53 (SD: 0.34) for men and 0.45 (SD: 0.34) for women, versus mean of 0.69 (SD: 0.33) and 0.70 (SD: 0.35) at Month 12. “Usual activities” was the dimension the most impacted by the disease episode. Utilities for men were significantly higher than for women, although male patients were more severe. Individuals over 85 years old did not improve quality of life during follow-up, and quality of life did not improve or deteriorated for 34% of patients. We found that length of hospital stay was negatively correlated with quality of life immediately after discharge. Conclusion This study provides with evidence that quality of life after an episode of community acquired pneumococcal pneumonia improves overall until the sixth month after hospital discharge, but older patients with previous history of pneumonia may not experience health gains after the initial episode.

Published
2018

4. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Author

Jean-Ralph Zahar, Philippe Lesprit, Stephane Ruckly, Aurelia Eden, Hitoto Hikombo, Louis Bernard, Stephan Harbarth, Jean-François Timsit, Christian Brun-Buisson, Nejla Aissa, Alain Losniewski, Sandrine Henard, Christian Rabaud, Cécile Janssen, Léonardo Pagani, Stéphane Bland, Jacques Gaillat, Jean Pierre Bru, Pierre Bonnin, Gaelle Clavère, Virginie Vitrat, Laurence Maulin, Luc Quarsaet, Helene Roger, Jean-Baptiste Euzen, Eric Denes, Elodie Couve-Daecon, Catherine Lechiche, Jean-Philippe Lavigne, Véronique Mondain, Celine Pulcini, Veronique Garnier, Dorothée Lambert, Maxime Hentzien, Yohan Nguyen, Jean Paul Talarmin, Pascaline Rameau, Françoise Geffroy, Arnaud Salmon-Rousseau, Vincent Cattoir, Antoine Froissart, Said Aberrane, Laurence Legout, France Roblot, Guillaume Beraud, Patricia Pavese, Olivier Belmonte, Nicolas Traversier, Laurent Bellec, Marie Lagrange-Xelot, Marie-Pierre Moiton, Barbara Kuli, Pascal Longuet, Agnes Scanvic, Lea Colombain, Milagros Ferreyra, Maxime Jean, Etienne Laurens, Matthieu Saada, Hugues Aumaitre, Martine Malet, Frederique Roustant, Vincent LeMoing, Jean-Pierre Helene, Jonathan Theodore, Caroline Garandeau, Jocelyne Caillon, Benjamin Olivero, David Boutoille, Didier Lepelletier, Lucia Grandière-Perez, Aurélie Beaudron, Céline Ramanantsoa, Catherine Varache, Nicolas Varache, Nicolas Crochette, Hikombo Hitoto, Sophie Blanchi, Pascale Penn, Bernard Louis, Dominique Vanjak, Marie-Christine Escande, René-Gilles Patrigeon, Stéphanie Honoré, Audrey Barrelet, Marlène Amara, Jean-Marc Galempoix, Jean-Claude Réveil, Patricia Bucchiotty, Carine Couzigou, Alban LeMonnier, Emilie Boidin, Stephane Sire, Nelly Luizy, Caroline Bronstain, Carolina Fankhauser, Caroline Brossier, Elodie von Dach, Colette Sauve, Marie-Noelle Adam, Laurent Hocqueloux, Laurent Bret, Marie-Hélène André, Régine Barruet, Marion Challier, Andre Cabié, Benoit Roze, Patrick Plesiat, Katy Jeanot, Isabelle Patry, Joséphine Moreau, Catherine Chirouze, Aaron Laurent, Marie-Nadège Bachelier, Guillaume Kac, Nicolas Farthouat, Nicolas Feuillebois, Thomas Guimard, Sandra Bourdon, Sophie Nguyen, Serge Alfandari, Houcine Bentayeb, Mari-Thérèse Albertini, Bruno Marchou, Noémie Gaudré, Damien Dubois, Christelle Guillet-Caruba, Florence Doucet Populaire, Nicolas Fortineau, Leila Escaut, Vincent Fihman, Rémy Gauzit, Josette Raymond, Solene Kerneis, Veronique Leflon-Guibout, Agnes Lefort, Aurelien Dinh, Anne-Laure Roux, Sophie Abgrall, Françoise Jauréguy, Jean-Christophe Lucet, Nathalie Soismier, Amanda Lopes, Emmanuelle Cambau, Veronique Manceron, Guilène Barnaud, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Hôpital Foch [Suresnes], Outcomerea, Centre Hospitalier Saint Jean de Perpignan, Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Faculté de médecine [Genève], Prévention et contrôle des infections (PCI ), Hôpitaux Universitaires de Genève (HUG), Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)

Subjects
Male, 0301 basic medicine, Pediatrics, Bacteremia, Community-Acquired Infections/epidemiology/microbiology, Antibiotic appropriateness, Klebsiella spp, 0302 clinical medicine, Healthcare associated, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Prevalence, Risk of mortality, Medicine, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, beta-Lactamases/secretion, Community onset, ddc:616, Aged, 80 and over, Cross Infection, education.field_of_study, biology, Enterobacteriaceae Infections, General Medicine, Middle Aged, Enterobacteriaceae, 3. Good health, Community-Acquired Infections, Treatment Outcome, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Cross Infection/microbiology, Female, Bacteremia/epidemiology/microbiology, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Population, beta-Lactamases, 03 medical and health sciences, Extended-spectrum β-lactamase, Antibiotic therapy, Enterobacteriaceae/classification/enzymology/isolation & purification, Humans, Risk factor, education, Aged, Enterobacteriaceae Infections/epidemiology/microbiology, business.industry, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, Survival Analysis, Risk factors, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Bacteraemia, business
Abstract

International audience; Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.

Published
2017

5. Ceftaroline for the treatment of prosthetic valve endocarditis due to methicillin-resistant Staphylococcus aureus

Author

Leonardo, Pagani, Pierre, Bonnin, Cécile, Janssen, Emmanuel, Desjoyaux, Virginie, Vitrat, and Jean-Pierre, Bru

Subjects
Heart Valve Prosthesis Implantation, Male, Methicillin-Resistant Staphylococcus aureus, Prosthesis-Related Infections, Treatment Outcome, Frail Elderly, Heart Valve Prosthesis, Humans, Endocarditis, Bacterial, Staphylococcal Infections, Aged, Anti-Bacterial Agents, Cephalosporins
Abstract

The case is described of a frail patient who developed prosthetic valve endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA). Conventional antimicrobial treatments either failed or were contraindicated, and the patient was judged unsuitable for a further valve replacement. A salvage therapy with high doses of a new cephalosporin, ceftaroline, given three times daily was undertaken; subsequently, the patient had not relapsed at two months after completing a six-week course of ceftaroline. Ceftaroline deserves major attention as an alternative choice in difficult-to-treat MRSA endocarditis.

Published
2014

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