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101. Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia.

Author

Combes A, Luyt C, Fagon J, Wollf M, Trouillet J, Gibert C, Chastre J, and PNEUMA Trial Group

Abstract

The impact of methicillin resistance on morbidity and mortality of patients suffering from severe Staphylococcus aureus infections remains highly controversial. We analyzed a retrospective cohort of 97 patients with methicillin-susceptible and 74 patients with methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy was appropriate for every patient. Patients with methicillin-resistant Staphylococcus aureus VAP were older, had higher disease-severity scores, and had been on mechanical ventilation longer at onset of VAP. Factors associated with 28-day mortality retained by multivariate logistic regression analysis were: age (odds ratio [OR] = 1.05, 95% confidence interval [CI], 1.02-1.08, p = 0.001) and Day 1 organ dysfunctions or infection (ODIN) score (OR = 1.90, 95% CI, 1.31-2.78, p = 0.001), but not methicillin resistance (OR = 1.72, 95% CI, 0.73-4.05, p = 0.22). The percentages of infection relapse or superinfection did not differ significantly between the two patient groups. In conclusion, after controlling for clinical and physiologic heterogeneity between groups, methicillin resistance did not significantly affect 28-day mortality of patients with Staphylococcus aureus VAP receiving appropriate antibiotics. [ABSTRACT FROM AUTHOR]

Published
2004
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104. Circulating immune complexes and severe sepsis: duration of infection as the main determinant.

Author

Pocidalo, Marie-Anne, Gibert, C., Verroust, P., Geniteau, Monique, Adam, Christiane, Madec, Y., Gaudebout, C., and Morelmaroger, Liliane

Subjects
*BACTERIAL diseases, *IMMUNE complexes, *SEPSIS, *SYMPTOMS, *RHEUMATOID factor, *BLOOD diseases
Abstract

The relation between the duration of bacterial infection and circulating immune complexes (CIC) level was evaluated using the Clq binding assay in a group of patients with well defined clinical sepsis. Fifty-four patients with endocarditis and 35 with post-open heart surgery mediastinitis were prospectively studied over a period of 2 years. CIC were detected in 42% of patients studied. Interindividual variations were observed but it was found that the level of CIC increased statistically with time (P<0.001). CIC were statistically linked with cryoglobulinemia (P < 0.001). rheumatoid factor (P < 0.001) and a decreased CH50 (P<0.05). CIC were more frequent in patients with endocarditis (53%) than in patients with mediastinitis (24%). However, when the duration of the infection was taken into account the difference was no longer significant. No relation could be evidenced between the incidence of CIC and clinical symptoms including prognosis and renal signs. In our experience, determination of CIC does not have a critical clinical value. [ABSTRACT FROM AUTHOR]

Published
1982

105. Pharmacokinetics of apalcillin in intensive-care patients: study of penetration into the respiratory tract.

Author

Bergogne-Berezin, E., Pierre, J., Chastre, J., Gibert, C., Heinzel, G., and Akbaraly, J. P.

Abstract

A pharmacokinetic study of apalcillin was performed in 12 patients in an intensive-care unit. All received a single dose of 30 mg/kg in a 30 min infusion followed by 90 mg/kg/day for four days; six patients (group A) were treated by intermittent administration for two days (30 mg/kg in 30 min infusion, three times daily), followed by continuous infusion for the next two days; six other patients (group B) first received continuous infusion followed by intermittent infusion. Serial serum specimens were collected after the first infusion and on the third and fifth days of treatment. Bronchial secretions were taken simultaneously via an endotracheal tube or the tracheostomy cannula, in order to study the penetration of the drug into the respiratory tract. Assays were performed by a microbiological method. A mean serum peak value of 87·1±6·13 mg/1 5 min after the end of the first injection was followed by a slow decrease in serum levels and a residual value of 6·29±3·21 mg/l (8 h). Intermittent administration resulted in a mean serum peak of 79·56±12·35 mg/l whereas after continuous infusion, a steady state of about 30 mg/l was obtained. No significant difference was found between pharmacokinetic parameters for the two groups. In bronchial secretions, a mean peak value of 5·8 mg/l was attained by the second hour. Decreased levels in bronchial secretions measured after three or five days treatment were possibly related to a decrease in inflammation. [ABSTRACT FROM PUBLISHER]

Published
1984

106. Epidemiological Survey of a Major Outbreak of Nosocomial Legionellosis.

Author

GUIGUET, M, PIERRE, J, BRUN, P, BERTHELOT, G, GOTTOT, S, GIBERT, C, and VALLERON, A J

Abstract

Forty-seven nosocomial cases of legionellosis due to serogroup 1 were diagnosed in one major outbreak from November 1982 to March 1983 in a 960-bed teaching hospital. Contaminated water was considered to be a possible source of infection because, during that period, monthly samples were found to be positive with averages of 10 CFU/1. After chlorination of hot water associated with flushing of outlets, nearly all samples taken in the next two years were found to be negative. A case-control study was performed to examine potential risk factors. Three groups of controls were randomly selected among eligible patients: In a multivariate analysis, only three clinical factors were found to be associated with legionellosis patients: malignant illness (relative risk, RR = 3.5), presence of an ultimately fatal disease (RR = 2.6), and exposure to corticosteroids prior to admission (RR = 7.9). Investigations of in-hospital exposures suggest that during this nosocomial outbreak diagnostic or therapeutic respiratory procedures had not increased the risk of illness. Although the epidemiological association between water contamination and disease remains unclear, the eradication of L. from the identified supply seems to have been effective in preventing disease in this hospital. [ABSTRACT FROM PUBLISHER]

Published
1987
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107. Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients.

Author

Chastre, Jean, Fagon, Jean-Yves, Soler, Paul, Fichelle, Anika, Dombret, Marie-Christine, Huten, Denis, Hance, Allan J., Gilbert, Claude, Chastre, J, Fagon, J Y, Soler, P, Fichelle, A, Dombret, M C, Huten, D, Hance, A J, and Gibert, C

Subjects
BRONCHOALVEOLAR lavage, FAT embolism, BONE injuries
Abstract

Objective: To evaluate the usefulness of bronchoalveolar lavage in establishing the diagnosis of the fat embolism syndrome in trauma patients with long-bone fractures.Design: Case series.Setting: Referral hospital.Patients: Eighteen trauma patients with long-bone fractures, including 5 with definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 8 with no clinical evidence of the syndrome. Control groups included 9 patients without previous trauma who developed the adult respiratory distress syndrome for various reasons and 15 normal volunteers.Measurements and Main Results: Each patient had fiber-optic bronchoscopy with bronchoalveolar lavage, and the percentage of lavage cells containing intracellular fat droplets stained with oil red 0 were determined. In the five patients with definite fat embolism syndrome, light microscopic study of bronchoalveolar cells stained with oil red 0 showed many large intracellular fat droplets (mean percentage of cells containing fat droplets, 63%; range, 31% to 82%), whereas less than 2% of cells recovered by lavage from trauma patients with no clinical evidence of the syndrome, from patients with the adult respiratory distress syndrome, or from normal volunteers contained such inclusions. Use of the same technique in the five patients with possible fat embolism syndrome permitted the immediate identification of three patients in whom this diagnosis was later confirmed by subsequent autopsy or clinical follow-up.Conclusions: The identification of fat droplets within cells recovered by bronchoalveolar lavage in trauma patients may be a rapid and specific method for establishing the diagnosis of the fat embolism syndrome. [ABSTRACT FROM AUTHOR]

Published
1990
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109. Pneumococcal endocarditis.

Author

Wolff, M., Regnier, B., Witchitz, S., Gibert, C., Amoudry, C., and Vachon, F.

Abstract

Among 369 patients with native valve infective endocarditis observed during a 14-year period, 17 were related to S. pneumoniae. Fourteen of them were observed in the last 7 years. At the time of admission 13 exhibited purulent meningitis, 6 of them being comatose. An apparent portal of entry was present in 13 patients including Pneumonia (n = 11) and otitis media (n = 2). Major alcoholism was present in 6 cases. The mean delay between the onset of fever and the discovery of the cardiac murmur was 15 days (range 1 to 60). Twelve patients exhibited congestive heart failure with acute pulmonary oedema in 9. The aortic valve was involved in 12 and the mitral valve in 7 (in 2 patients both mitral and aortic valves were involved). Myocardial and/or annular abscesses were found in 7 patients. Nine patients underwent surgical procedure (3 died) whereas 6 comatose patients were not operated on and died. The overall mortality was 59%. Although antibiotics are effective, the severity of anatomical lesions leads to prompt surgical treatment. The high mortality is mainly due to purulent meningitis. [ABSTRACT FROM PUBLISHER]

Published
1984
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111. Diagnosis of nosocomial pneumonia in intensive care unit patients

Author

Gibert C, Y. Domart, Jean-Yves Fagon, and Jean Chastre

Subjects
Microbiology (medical), Mechanical ventilation, Cross Infection, medicine.medical_specialty, medicine.diagnostic_test, Critically ill, business.industry, medicine.medical_treatment, Bacterial pneumonia, Pneumonia, General Medicine, medicine.disease, Intensive care unit, law.invention, Intensive Care Units, Infectious Diseases, Medical microbiology, Bronchoalveolar lavage, law, medicine, Protected specimen brush, Humans, Intensive care medicine, business
Abstract

The optimal technique for diagnosing nosocomial bacterial pneumonia in critically ill patients cared for in the intensive care unit remains unclear, especially in the subgroup of patients requiring mechanical ventilation. An important advance has been the development of the protected specimen brush technique. We and others have demonstrated that secretions obtained using this technique and evaluated by quantitative cultures are useful in distinguishing patients with and without pneumonia. However, this procedure has important limitations in that results are not available immediately and in that a few false negative or false positive results may be observed. Recently, the use of bronchoalveolar lavage has been suggested to be of value in establishing the diagnosis of pneumonia, since the cells and liquid recovered can be examined microscopically immediately after the procedure and are also suitable for quantitative culture. We believe that microscopic identification of bacteria within cells recovered by lavage may provide a sensitive and specific means for early and rapid diagnosis of pneumonia in this setting and that the lavage technique can be conveniently incorporated into a protocol along with the quantitative culture of samples obtained using the protected specimen brush. This combination will probably improve the overall accuracy of diagnosis while allowing the administration of prompt empiric antimicrobial therapy in the majority of patients with pneumonia.

Published
1989

112. Liste des auteurs

Author

Abadie, Y., Abou-Ayache, R., Adhoum, A., Adib-Conquy, M., Adnet, F., Ait Hssain, A., Albanese, J., Alquier, P., Amstutz, P., Anglicheau, D., Annane, D., Annat, G., Ansart, S., Antoun, S., Anxionnat, R., Appéré de Vecchi, C., Argaud, L., Arich, C., Arrault, X., Arrivé, L., Asfar, P., Attaix, D., Aumeran, C., Auneau, J.-C., Ayem, M.-L., Azoulay, E., Barbar, S., Barnoud, D., Baron, D., Barouk, D., Barraud, D., Barry, B., Barthélémy, A., Bastien, O., Baud, F., Baudin, F., Bauwens, M., Bazin, C., Beague, S., †Beaufrère, B., Bedock, B., Bedon-Carte, S., Bédos, J.-P., Bédry, R., Bégueret, H., Belaouchi, F., Belle, E., Benali, A., Bengler, C., Benyamina, M., Bernardin, G., Berré, J., Bertrand, J.-C., Bilbault, P., Binoche, A., Biour, M., Bismuth, C., Blackwell, F., Blanc, P.-L., Blanchard, E., Bleichner, G., Blettery, B., Blivet, S., Blot, F., Bobin, S., Boccheciampe, N., Bohé, J., Boiteau, R., Boncompain-Gérard, M., Bonmarchand, G., Bonnaud, I., Bonnet, N., Bouadma, L., Bouchet, M.-F., Bouffandeau, B., Boulain, T., Boulard, G., Boulétreau, P., Boulo, M., Bourgoin, A., Boussat, S., Boussuges, A., Boyer, A., Bracard, S., Briand, E., Bridoux, F., Brivet, F., Brocas, E., Brochard, L., Bruder, N., Bruel, C., Brun-Buisson, C., Bruneel, F., Brun-Vézinet, F., Bumsel, F., Camou, F., Camus, C., Camus, Y., Canaud, B., Cannesson, M., Capellier, G., Capron, F., Carbonell, N., Cariou, A., Carlet, J., Carpentier, F., Carrat, F., Carrat, X., Cartier, F., Cary, E., Castaing, Y., Castelain, V., Cavaillon, J.-M., Cha, O., Chambrier, C., Chambrin, M.-C., Chanard, J., Chapplain, J.-M., Charbonneau, P., Chastre, J., Chaumoitre, K., Chemla, D., Chenine, L., Chevrolet, J.-C., Chiche, J.-D., Chiras, J., Chopin, C., Chouchane, N., Choukroun, M.-L., Clair, B., Clavier, B., Clec'h, C., Cluzel, P., Cochereau, I., Cohadon, F., Cohen, Y., Combe, C., Combes, A., Cordonnier, C., Coriat, P., Corne, P., Coulange, M., Cros, A.-M., Crozier, S., Dailland, P., Danel, V., Darmon, M., Darnal, E., David, S., de Cagny, B., De Deyne, C., De Jonghe, B., Decousus, H., Deklunder, G., Delabranche, X., Delafosse, B., Delahaye, A., Delarue, J., de Montalembert, M., Demoule, A., Dequin, P.-F., Deray, G., Deriaz, H., Descamps, J.-M., Devictor, D., Deye, N., Dhainaut, J.-F., di Costanzo, J., Diehl, J.-L., Dingemans, G., Djibré, M., Doise, J.-M., Dolz, M., Donati, S.Y., Dreyfuss, D., Drizenko, A., Du Cheyron, D., Ducloy-Bouthors, A.-S., Dugernier, T., Duguet, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eckert, Ph., Edouard, D., El Esper, N., Essig, M., Esteban, C., Eurin, B., Fagon, J.-Y., Faisy, C., Fangio, P., Fartoukh, M., Faurisson, F., Favarel-Garrigues, J.-C., Feihl, F., Ferrand, E., Ferry, T., Fialon, P., Fischer, E., Flamant, M., Flamens, C., Flesch, F., Folscheid, D., Forget, A.-P., Fourel, D., Fournier, A., Fournier, G., Fourrier, F., François, B., Francoz, C., Frat, J.-P., Frederic, M., Friedlander, G., Frossard, J.-L., Gabinski, C., Gainnier, M., Gajdos, P., Gamelin, L., Garo, B., Garot, J., Garré, M., Garrouste-Orgeas, M., Gastinne, H., Gbikpi-Benissan, G., †Gehanno, P., Gelas, P., Genestal, M., Gerbeaux, P., †Gibert, C., Gibot, S., Girault, C., Girot, M., Goarin, J.-P., Godeau, B., Goetghebeur, D., Goldgran-Toledano, D., Gonzalez, F., Goulenok, C., †Goulon, M., Grimaldi, D., Grosdidier, G., Gruson, D., Guenoun, T., Guérin, C., Guérin, J.-M., Guérot, E., Guervilly, C., Gueye, P., Guglielminotti, J., Guiavarch, M., Guidet, B., Guyomarc'h, S., Hallynck, C., Hamzaoui, O., Haniez, F., Harlay, M.-L., Harrois, A., Harry, P., Hasselmann, M., Hattab, A., Hébuterne, X., Heng, A.-É., Hertig, A., Hervé, P., Hilbert, G., Himbert, D., Holzapfel, L., Hommel, S., Houhou, N., Houillier, P., Hours, S., Hurel, D., Ichaï, P., Isnard-Bagnis, C., Jacobs, F., Jaffrelot, M., Jaffuel, S., Janvier, G., Jardel, B., Jardin, F., Jarrin, I., Jars-Guincestre, M.-C., Joly, L.-M., Joly-Guillou, M.-L., Jonquet, O., Joseph, T., Jourdain, M., Journois, D., Jung, B., Kahn, D., Kanfer, A., Karie-Guigues, S., Kerlan, V., Khalil, A., Koffel, J.-C., Kopferschmitt, J., Korach, J.-M., Kummerlen, C., L'Her, E., Laaban, J.-P., Laarbaui, F., Labrousse, J., Lacroix, D., Lachérade, J.-C., Lambert, H., Lanceleur, A., Langeron, O., Langevin, B., Lannes, B., Lapostolle, F., Larmignat, P., Laterre, P.-F., Laurent, C.h., Lautrette, A., Lavaux, T., Laxenaire, M.-C., Le Conte, P., Le Corre, B., Le Gall, C., Le Gall, G., Le Gall, J.-R., Le Prado, D., Le Tulzo, Y., Lebranchu, Y., Leclerc, F., Leclerc, X., Leclercq, R., Lefevre, M., Legendre, C., Leger, P., Legras, A., Lellouche, F., Lemaire, F., Lemiale, V., Lemonnier, M.-P., Léon, A., Léone, M., Leprince, P., Leray-Moragues, H., Lerebours, E., Leverve, X., Lévy, B., Lévy, Ph., Leys, D., Lheureux, P., Lienhart, A., Lissac, J., Loirat, P., Loubières, Y., Lucet, J.-C., Lutun, P., Luyt, C.-E., Maillet, J.-M., Mainardi, J.-L., Mancebo, J., Manel, J., Mangiapan, G., Manier, G., Manzon, C., Manzo-Silberman, S., Marek, A., Marit, G., Markowicz, P., Marqué, S., Marquette, C.-H., Marthan, R., Martin, C., Martin, O., Mathien, C., Mathieu, D., Mattéi, M., Maury, E., Maxime, V., Mayaud, C., Mayeur, C., Mazighi, M., Mégarbane, B., Melchior, J.-C., Mélot, C., Mentec, H., Mercat, A., Mertes, P.-M., Meyer, G., Meziani, F., Michelet, C., Micheletti, G., Mignon, A., Mira, J.-P., Mira, L., Mismetti, P., Misset, B., Monchi, M., Monnet, X., Monnier-Cholley, L., Moriconi, M., Morinière, P., Moritz, F., Mortier, E., Mottier, D., Mourvillier, B., Nace, L., Naeije, R., Nicolas, F., Nicolas-Chanoine, M.-H., Nitenberg, A., Nitenberg, G., Nousbaum, J.-B., Noyon, V., Obadia, E., Oger, E., Onimus, Th., Orizet, C., Ould Ahmed, M., Outin, H., Ozier, Y., Page, Y., Paillard, M., Pairault, M., Pajot, O., Papazian, L., Parer, S., Parquin, F., Parrot, A., Pavie, A., Pène, F., Penouil, F., Peraldi, M.-N., Perrin-Gachadoat, D., Perrotin, D., Petitjean, T., Philippart, F., Philit, F., Picard, L., Picart-Jacq, J.-Y., Pichené, C., Pillet, O., Pinsard, M., Plantefeve, G., Pochard, F., Pocidalo, M.-A., Podglajen, I., Pointet, P., Pourrat, O., Prat, G., Préveraud de Vaumas, C., Pruvo, J.-P., Puntous, M., Rabaud, C., Rabbat, A., Rackelboom, T., Racy, E., Raherison, C., Ralec, B., Ramakers, M., Rambaud, L., Rameix, S., Raphaël, J.-C., Ramon, P., Raynard, B., Régnier, B., Renault, A., Revest, M., Reynaert, M.-S., Reynaud, J., Ribaud, P., Ricard, J.-D., Richalet, J.-P., Richard, C., Richard, J.-C.M., Ricome, J.-L., Ricot, J., Ridel, C., Rigolet, A., Robert, D., Robert, R., Roger, I., Rondeau, E., Roques, S., Rossert, J., Roujeau, J.-C., Rozenberg, A., Rugeri, L., Rusterholtz, T., Sab, J.-M., Safran, D., Saïkhali, E., †Sainty, J.-M., Saissy, J.-M., Saliba, F., Samuel, D., Sauder, P., Saumon, G., Savineau, J.-P., Savoye, G., Schabanel, J.-C., Schaeffer, A., Schaller, M.-D., Schiano, P., Schlemmer, B., Schlossmacher, P., Schneider, F., Schneider, S.-M., Schortgen, F., Schwartz, A., Segouin, C., Seguin, Th., Seknadji, P., Serre-Sapin, A.-F., Sharshar, T., Silleran-Chassany, J., Similowski, T., Simonneau, G., Sitbon, O., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Soubrier, S., Soufir, L., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Stéphanazzi, J., Sterkers, G., Straus, C., Subtil, D., Sztrymf, B., Tabah, A., Taboulet, P., Tamion, F., Tardy, B., Tardy-Poncet, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Teboul, J.-L., Tempé, J.-D., Tenaillon, A., Terzi, N., Tesnière, A., Textoris, J., Thabut, D., Thaler, F., Théodore, J., Thierry, A., Thille, A.W., Thirion, M., Thomas, R., Thuong, M., Timsit, J.-F., Tissières, P., Touchard, G., Tournoud, C., Tournoys, A., Tourtier, Y., Tranchant, C., Troché, G., Trouillet, J.-L., Trzeciak, M.-C., Tunon de Lara, J.-M., Ubeaud-Séquier, G., Vachon, F., Valatx, J.-L., Valentin, J.-M., Vallée, F., Vallet, B., Van de Louw, A., Vargas, F., Venet, C., Verdon, R., Vergier, B., Vésin, A., Vial, A., Viale, J.-P., Viau, F., Vieillard-Baron, A., Vignon, P., Villers, D., Vinatier, I., Vincent, B., Vinsonneau, C., Wassermann, D., Wattel, F., Willems, V., Woimant, F., Wysocki, M., Yéni, P., Zahar, J.-R., and Zelter, M.

Published
2009
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113. An uncommon Helicobacter isolate from blood: evidence of a group of Helicobacter spp. pathogenic in AIDS patients.

Author

Weir, S C, Gibert, C L, Gordin, F M, Fischer, S H, and Gill, V J

Abstract

An unusual Helicobacter sp. was isolated from the blood of a human immunodeficiency virus (HIV)-infected patient. This organism had spiral morphology, with single amphitrichous flagella, and was negative for hippurate hydrolysis, production of urease, and reduction of nitrate. 16S rRNA gene sequence analysis verified that the isolate was a species of Helicobacter, most closely related to an undescribed Helicobacter-like isolate from Vancouver, British Columbia, Canada, and to Helicobacter westmeadii, a recently described species from Australia. Both organisms had also been isolated from the blood of HIV-infected patients. These blood isolates, along with Helicobacter cinaedi, form a cluster of closely related Helicobacter spp. that may represent an emerging group of pathogens in immunocompromised patients.

Published
1999

116. Pharmacokinetics of teicoplanin in critically ill patients with various degrees of renal impairment

Author

Domart, Y, Pierre, C, Clair, B, Garaud, J J, Regnier, B, and Gibert, C

Abstract

The pharmacokinetics of teicoplanin were studied in 15 adult patients in the acute phase of severe infections caused by gram-positive cocci. All the subjects were given a daily intravenous bolus dose of 6 mg of teicoplanin kg-1 (body weight). The pharmacokinetic study was performed over a 48-h period after injection 4. The subjects were categorized according to their mean creatinine clearances (ml.min-1.kg-1) during the study period: group 1 (n = 3), greater than 1.6; group 2 (n = 6), 0.8 to 1.6; and group 3 (n = 6), 0.15 to 0.8. Mean concentrations of teicoplanin in serum at 1, 24, and 48 h were 33 +/- 8, 9 +/- 3, and 6 +/- 2.5 micrograms.ml-1, respectively. The mean half-lives of the concentration-time curve from 12 to 48 h were 28 +/- 4, 44 +/- 24, and 48 +/- 14 h in groups 1, 2, and 3, respectively (group 3 versus group 1: P less than 0.05). The mean area under the serum concentration-time curve from time zero to 24 h was 344 +/- 92 mg.h.liter-1, and the mean hybrid volume of distribution was 1.09 +/- 0.46 liter.kg-1. These values were similar for the three groups, with a trend for larger areas under the curve in group 3. Creatinine clearance correlated directly with the total body clearance of teicoplanin (r = 0.70) and with the renal clearance of teicoplanin (r = 0.82). However, in critically ill patients, the wide interindividual variations in pharmacokinetic parameters are more relevant than those related to the variations in renal function when creatinine clearance is above 0.30 ml.min-1.kg-1. We concluded that, in such conditions, monitoring of concentrations of teicoplanin in serum is mandatory.

Published
1987
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117. Pulmonary disposition of roxithromycin (RU 28965), a new macrolide antibiotic

Author

Chastre, J, Brun, P, Fourtillan, J B, Soler, P, Basset, G, Manuel, C, Trouillet, J L, and Gibert, C

Abstract

The penetration of roxithromycin (RU 28965), an ether oxime derivative of erythromycin, into the cells and fluid lining the epithelial surface of the lower respiratory tract was studied by performing fiber-optic bronchoscopy with bronchoalveolar lavage on eight patients who had received roxithromycin at 300 mg perorally every 12 h for 5 days. The apparent volume of epithelial lining fluid recovered by bronchoalveolar lavage was determined by using urea as an endogenous marker. There was a significant relationship (r = 0.75; P less than 0.02) between roxithromycin levels in plasma and epithelial lining fluid, with a correlation whose slope suggested that the level of drug penetration into the lining fluid was 0.2. Concentrations of the antibiotic in cells recovered by bronchoalveolar lavage (21 +/- 10 micrograms/ml) were 2 and 10 times higher than in plasma (11.4 +/- 5.7 micrograms/ml) and epithelial lining fluid (2.0 +/- 1.7 micrograms/ml), respectively. Thus, when administered perorally in humans, roxithromycin is markedly accumulated by resident alveolar macrophages in concentrations largely exceeding the MBCs of the drug for most facultative intracellular pathogens including Legionella pneumophila, despite low concentrations in the epithelial lining fluid.

Published
1987
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118. Short-Term Prophylactic Antibiotics in Patients Undergoing Prostatectomy: Report of a Double-Blind Randomized Trial with 2 Intravenous Doses of Cefotaxime

Author

Prokocimer, P., Quazza, M., Gibert, C., Lemoine, J.E., Joly, M.L., Dureuil, B., Moulonguet, A., Manuel, C., and Desmonts, J.M.

Abstract

The effect of short-term antibiotic prophylaxis on postoperative infection with 2 injections of cefotaxime begun preoperatively was evaluated in a double-blind, randomized, placebo-controlled trial at 1 center on 181 patients with preoperative sterile urine undergoing transurethral resection (90) or open prostatectomy (91). Antibiotic prophylaxis reduced the number of urinary infections significantly in both groups without altering the level of resistant pathogens. Cefotaxime lowered the incidence of postoperative infection in the early postoperative period from 30 to 4 per cent in the transurethral resection group and from 46 to 4.5 per cent in the open prostatectomy group. A significant difference was found between the 2 treatment groups in the incidence of perioperative bacteremia and postoperative fever. Among the patients undergoing an open prostatectomy a reduced rate of wound infection and a shorter duration of hospital stay were witnessed in the treated group. Thus, short-term chemoprophylaxis by cefotaxime is of benefit in reducing morbidity and hospital cost for prostatectomy by either procedure.

Published
1986
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119. Long-term outcome and quality of life of patients requiring multidisciplinary intensive care unit admission after cardiac operations

Author

Trouillet, J.L., Scheimberg, A., Vuagnat, A., Fagon, J.Y., Chastre, J., and Gibert, C.

Abstract

Patients with organ failure or severe infection after cardiac operations may require prolonged stays in the intensive care unit. This study examined long-term mortality and determined quality of life for surviving patients in this group. This observational cohort study was conducted at Bichat Hospital, Paris, an academic tertiary care center. The study group consisted of 116 consecutive patients who underwent cardiac operations and were transferred to the multidisciplinary intensive care unit between January 1986 and December 1987. Patients referred for mediastinitis were automatically excluded. Respiratory failure (88.8%) and hemodynamic instability (81.9%) were the main causes of transfer; an infection was present in 23.3% of patients at entry into the intensive care unit. Twenty-seven patients (23.3%) died in the intensive care unit. Presurgical New York Heart Association functional class, postoperative bacteremia before admission to the intensive care unit, and severity of illness on admission to the intensive care unit were independent predictors of death in the intensive care unit. After an average follow-up of 81 months (range 70 to 93 months), 69% of the patients alive at transfer from the intensive care unit were still alive. Preoperative New York Heart Association functional class was the only long-term independent prognostic factor. Quality of life, as evaluated by the Nottingham Health Profile, was good for more than 70% of the survivors and was not influenced by any recorded variables, with the exception of age. (J THORAC CARDIOVASC SURG 1996;112:926-34)

Published
1996
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120. Cryoglobulins, circulating immune complexes, and complement activation in cerebral malaria

Author

Adam, C, Géniteau, M, Gougerot-Pocidalo, M, Verroust, P, Lebras, J, Gibert, C, and Morel-Maroger, L

Abstract

A total of 32 patients with Plasmodium falciparum malaria were studied. Of these, 23 had benign infections, and 9 had typical cerebral malaria. Cryoglobulins, circulating immune complexes detected by a C1q-binding assay, and hypocomplementemia were found in eight of nine patients with cerebral malaria. Raised levels of complement component 3 breakdown products (C3d) were found in the seven patients tested. Peak levels of circulating immune complexes and C3d were associated with thrombocytopenia. In contrast, in patients with benign Plasmodium falciparum malaria, cryoglobulins and circulating immune complexes were found only in 3 of 23 patients. Similarly, hypocomplementemia was detected only in 5 of 23 patients. These observations suggest that the intensity of the immune response and of the associated complement activation may be important factors in the pathogenesis of cerebral malaria.

Published
1981
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122. [Pulmonary thromboembolic complications of catheterization using the Swan-Ganz catheter]

Author

Chastre J, Cornud F, abderrezak BOUCHAMA, Viau F, Benacerraf R, and Gibert C

Subjects
Adult, Male, Cardiac Catheterization, Adolescent, Critical Care, Heparin, Thrombosis, Middle Aged, Pulmonary Artery, Radiography, Humans, Female, Jugular Veins, Pulmonary Embolism, Aged
Abstract

Twenty-two adult patients who had required catheterization with a Swan-Ganz catheter and had thrombosis of the internal jugular vein were investigated for pulmonary embolism. In 4 of these, pulmonary embolism was detected by angiography, and 2 patients who died with the catheter in situ had also pulmonary embolism. In 5 out of these 6 patients prophylactic heparin treatment failed to prevent this complication. This study suggests that the Swan-Ganz catheter placement is indicated only when the value of the information to be gained exceeds the potential risk.

Published
1983

123. [Urinary tract obstruction by Candida bezoars, or fungus balls]

Author

Domart Y, Delmas V, Cornud F, abderrezak BOUCHAMA, Chastre J, and Gibert C

Subjects
Bezoars, Male, Radiography, Candidiasis, Humans, Female, Kidney Diseases, Middle Aged, Urinary Tract, Aged
Abstract

Two patients admitted to an intensive care unit for severe bacterial infection develops Candida albicans superinfection with obstruction of the urinary canals by "fungus balls". The development of medico-surgical techniques using antibiotics and immunosuppressive drugs accounts for the increasing incidence of disseminated candidiasis. The kidneys are particularly sensitive to Candida infections. Fungus balls are conglomerates of mycelium which may result in obstruction of the urinary tract. Their clinical, radiological and ultrasonic features, as well as the microbiological and serological diagnostic problems they raise are described. Ultrasonically guided percutaneous nephrostomy is a very interesting technique for the diagnosis of the condition and its local treatment by drainage and lavage with amphotericin B. This antifungal, combined with flucytosine is still used for the systemic treatment of candidiasis.

Published
1986

124. Diagnostic et traitement du paludisme cérébral en zone non endémique

Author

Vachon, F., Carbon, C., and Gibert, C.

Subjects
Adult, Male, Time Factors, Adolescent, Quinine, Plasmodium falciparum, Anemia, Unconsciousness, Acute Kidney Injury, Middle Aged, Prognosis, Hemolysis, Malaria, Diagnosis, Differential, Neurologic Manifestations, Humans, Female, Tracheotomy, Research Article
Published
1974

125. [Bronchial diffusion of new anti-pseudomonal beta-lactams. Clinical significance]

Author

Bergogne-Berezin E, Pierre J, Berthelot G, Kafe H, Even P, Gibert C, Safran D, and Marc STERN

Subjects
Kinetics, Humans, Bronchi, Pseudomonas Infections, beta-Lactams, Anti-Bacterial Agents
Abstract

In treating severe respiratory infections due to Pseudomonas aeruginosa and in patients with cystic fibrosis, new anti-pseudomonal beta-lactams constitute a good alternative to the traditional aminoglycoside antibiotic therapy. Among several criteria for the choice of an antibiotic, estimation of intrabronchial levels is to be taken into account. The authors report the results of the study of a new semi-synthetic penicillin, apalcillin, and two cephalosporins (cefsulodin, ceftazidime), active in vitro against Pseudomonas; their penetration into respiratory secretions was evaluated in 48 patients, intubated, tracheostomized, or undergoing fiberoptic bronchoscopy. Antibiotic concentrations were measured by the microbiological procedure. Bronchial penetration of apalcillin was early and noticeable, reaching a bronchial peak representing 20% of the simultaneous seric concentration. The local levels of cefsulodin and of ceftazidime did not differ from those achieved with cephalosporins studied previously; the bronchial peak reached 5,6 micrograms/ml for both drugs 2 hours after administration; this bronchial level corresponded to 15 to 20% of the serum concentration. The clinical response could not be evaluated due to the severe underlying pathology which compromised the outcome of the disease in the patients of this study. However, at least for apalcillin, a significant correlation was noted between bronchial levels, susceptibility of bacteria isolated in patients, and eradication of susceptible organisms.

Published
1984

127. Prophylaxis of infective endocarditis. Revision of the march 1992 French consensus conference: French recommendations 2002 | Prophylaxie de l'endocardite infectieuse. Révision de la conférence de consensus de mars 1992: Recommandations 2002

Author

Vildé, J. L., Chidiac, C., Byl, B., Choutet, P., Leport, C., Luciani, J., Perronne, C., Pothier, P., Quinet, B., Soussy, C. J., Stahl, J. P., Weinbreck, P., Dosquet, P., Etienne, J., Feki, A., Gibert, C., Michel, P. L., Danchin, N., Duval, X., Brochet, E., Andremont, A., Carlier, G., Christmann, D., Courillon-Mallet, A., Delahaye, F., Ducimetière, P., Mathieu, P., Pichelin, D., Ravery, V., Schabel, C., Sixou, M., Bouvet, A., Briançon, S., Chairay, J. P., Crémieux, A. C., Domart, Y., Habib, G., Hoen, B., Leroy, O., Moreillon, P., Ragot, J. P., Philippe Ravaud, Roche, Y., Strom, B. L., Thomas, D., Meer, J. T. M., Voiriot, P., Acar, C., Aliot, E., Artigou, J. Y., Auboyer, C., Aumaître, O., Aupetit, J. F., Avierinos, C., Bacq, Y., Bassand, J. P., Bastien, P., Becq-Giraudon, B., Bensaïd, J., Bertrand, M., Besnier, J. M., Beytout, J., Blanc, J. J., Bonnet, N., Bonhoure, J. P., Boy-Lefevre, M. L., Brochier, M., Broustet, J. P., Carlet, J., Caron, F., Chanoit, P., Chaptal, P. A., Chapuis, J., Charlemagne, D., Chauvel, C., Coste, P., Couetil, J. P., Daubert, J. C., Davy, C., Mello, G., Decazes, J. M., Delaye, J., Dersot, J. M., Derumeaux, G., Diebold, B., Djiane, P., Doco-Lecompte, T., Drahi, É, Ducardonnet, A., Dupont, B., Duran, D., Durand Gevigney, G., Dureuil, B., Fauchier, J. P., Gaillat, J., Gendrel, D., Grynberg, A., Guillemot, D., and Guize, L.

129. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients

Author

Chastre, J., Viau, F., Brun, P., Pierre, J., Dauge, M. C., abderrezak BOUCHAMA, Akesbi, A., and Gibert, C.

Subjects
Bronchoscopes, Fiber Optic Technology, Humans, Bronchi, Pneumonia, Prospective Studies, Middle Aged, Lung, Respiration, Artificial, Aged, Specimen Handling
Abstract

To determine the relative cultural accuracy of the bronchoscopic protected specimen brush (PSB) in ventilated patients, we compared this method in the same area of the lung with histologic and bacteriologic examinations of pulmonary specimens. The procedures were concluded just after death when the ventilator was still functioning. Samples via the PSB were taken from a branch of the anterior basal bronchus of the left lower lobe, and immediate left thoracotomy was performed to obtain peripheral specimens from the corresponding segment for quantitative cultures. Twenty-six patients were studied; 6 had histologically proved pneumonia. Using quantitative cultures, a correlation was evidenced between PSB and lung cultures, especially in the subgroup of patients who received no antibiotic during the week preceding their death. No pneumonia was observed when PSB cultures isolated no organisms in concentrations greater than 10(3) colony-forming units (cfu) per ml. The PSB cultures at a level of 10(3) cfu/ml identified every patient with histologically proved pneumonia and every microorganism present in concentrations of 10(4) cfu/g or greater in the lungs. Moreover, in the subgroup of patients receiving no antibiotic, only 4 microorganisms were isolated by the PSB in concentrations greater than 10(3) cfu/ml and not found in the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

130. Exploring the potential of co-designed landscapes to promote biological pest control

Author

Sandrine Petit, Alignier, A., Roland Allart, Aviron, S., Hugues Boussard, D Esquerre, P Franck, Gibert, C., Sylvie Ladet, C Lavigne, Lou Lecuyer, M Moncamp, Lucile Muneret, Plantegenest, M., Poggi, S., Benoît Ricci, Rusch, A., Tolle, P., Vialatte, A., Juliette Young, and EL Mjiyad, Noureddine

Subjects
[SDE] Environmental Sciences

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