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1. Lyme borreliosis and medical wandering: what do patients think about multidisciplinary management? A qualitative study in the context of scientific and social controversy

Author

Alice Raffetin, Costanza Puppo, Amal Chahour, Assia Belkasmi, Elisabeth Baux, Solène Patrat-Delon, Pauline Caraux-Paz, Julie Rivière, and Sébastien Gallien

Subjects
Lyme borreliosis, Satisfaction, Multidisciplinarity, Shared information, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Introduction To answer to patients’ medical wandering, often due to “unexplained symptoms” of “unexplained diseases” and to misinformation, multidisciplinary care centers for suspected Lyme borreliosis (LB), such as the 5 Tick-Borne Diseases (TBDs) Reference Centers (TBD-RC), were created a few years ago in France, the Netherlands and Denmark. Our study consisted of a comprehensive analysis of the satisfaction of the patients managed at a TBD-RC for suspected LB in the context of scientific and social controversy. Methods We included all adults who were admitted to one of the TBD-RC from 2017 to 2020. A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains, including 2 free-text items: “What points did you enjoy?” and “What would you like us to change or to improve?”. In the current study, the 2 free-items were analyzed with a qualitative method called reflexive thematic analysis within a semantic and latent approach. Results The answer rate was 61.3% (349/569) and 97 distinctive codes from the 2-free-text items were identified and classified into five themes: (1) multidisciplinarity makes it possible to set up quality time dedicated to patients; (2) multidisciplinarity enables seamless carepaths despite the public hospital crisis compounded by the COVID-19 pandemic; (3) multidisciplinarity is defined as trust in the team’s competences; (4) an ambivalent opinion and uncertainty are barriers to acceptance of the diagnosis, reflecting the strong influence of the controversy around LB; and (5) a lack of adapted communication about TBDs, their management, and ongoing research is present. Conclusion The multidisciplinary management for suspected LB seemed an answer to medical wandering for the majority of patients and helped avoid misinformation, enabling better patient-centered shared information and satisfaction, despite the context of controversy.

Published
2024
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2. Acceptance of diagnosis and management satisfaction of patients with 'suspected Lyme borreliosis' after 12 months in a multidisciplinary reference center: a prospective cohort study

Author

Alice Raffetin, Amal Chahour, Julien Schemoul, Giulia Paoletti, Zhuoruo He, Elisabeth Baux, Solène Patrat-Delon, Steve Nguala, Pauline Caraux-Paz, Costanza Puppo, Pauline Arias, Yoann Madec, Sébastien Gallien, and Julie Rivière

Subjects
Lyme borreliosis, Multidisciplinary management, Satisfaction, Concordance, Diagnostic acceptance, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Introduction Because patients with a “suspicion of Lyme borreliosis (LB)” may experience medical wandering and difficult care paths, often due to misinformation, multidisciplinary care centers were started all over Europe a few years ago. The aim of our study was to prospectively identify the factors associated with the acceptance of diagnosis and management satisfaction of patients, and to assess the concordance of the medical health assessment between physicians and patients 12 months after their management at our multidisciplinary center. Methods We included all adults who were admitted to the Tick-Borne Diseases Reference Center of Paris and the Northern Region (TBD-RC) (2017–2020). A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains and 13 items rated between 0 (lowest) and 10 (highest grade): (1)Reception; (2)Care and quality of management; (3)Information/explanations given to the patients; (4)Current medical condition and acceptance of the final diagnosis; (5)Overall appreciation. Factors associated with diagnosis acceptance and management satisfaction at 12 months were identified using logistic regression models. The concordance of the health status as assessed by doctors and patients was calculated using a Cohen’s kappa test. Results Of the 569 patients who consulted, 349 (61.3%) answered the questionnaire. Overall appreciation had a median rating of 9 [8;10] and 280/349 (80.2%) accepted their diagnoses. Patients who were “very satisfied” with their care paths at TBD-RC (OR = 4.64;CI95%[1.52–14.16]) had higher odds of diagnosis acceptance. Well-delivered information was strongly associated with better satisfaction with the management (OR = 23.39;CI95%[3.52–155.54]). The concordance between patients and physicians to assess their health status 12 months after their management at TBD-RC was almost perfect in the groups of those with confirmed and possible LB (κ = 0.99), and moderate in the group with other diagnoses (κ = 0.43). Conclusion Patients seemed to approve of this multidisciplinary care organization for suspected LB. It helped them to accept their final diagnoses and enabled a high level of satisfaction with the information given by the doctors, confirming the importance of shared medical decisions, which may help to reduce health misinformation. This type of structure may be useful for any disease with a complex and controversial diagnosis.

Published
2023
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3. Incidence, associated factors, and effect on renal function of amoxicillin crystalluria in patients receiving high doses of intravenous amoxicillin (The CRISTAMOX Study): A cohort study

Author

Sophie Demotier, MD, Anne Limelette, MD, Alexandre Charmillon, MD, Elisabeth Baux, MD, Xavier Parent, PharmD, Stéphanie Mestrallet, MD, Simona Pavel, MD, Amélie Servettaz, MD PhD, Moustapha Dramé, MD PhD, Anaelle Muggeo, PharmD PhD, Alain Wynckel, MD, Claire Gozalo, PharmD, Malak Abou Taam, PharmD, Aurélie Fillion, MD, Roland Jaussaud, MD PhD, Thierry Trenque, MD PhD, Lionel Piroth, MD PhD, Firouze Bani-Sadr, MD PhD, and Maxime Hentzien, MD PhD

Subjects
Amoxicillin, crystalluria, acute kidney injury, incidence, cohort study, Medicine (General), R5-920
Abstract

Summary: Background: Amoxicillin crystalluria (AC), potentially responsible for acute kidney injury (AKI), is reported more and more frequently in patients treated with high doses of intravenous amoxicillin (HDIVA). The main objective of this study was to evaluate AC incidence in these patients. The secondary objectives were to identify factors associated with AC and to evaluate its impact on the risk of AKI. Methods: This multicentre, observational, cohort study was conducted between Mar 18, 2014 and Aug 16, 2019 in Dijon, Nancy, and Reims University Hospitals as well as Châlon-sur-Saône, Charleville-Mézières, and Troyes general hospitals in France. Adult patients (≥18 years) treated with HDIVA and having been tested for AC at least once during treatment were included. Clinical, biological, and therapeutic characteristics of the patients were collected. A univariable mixed logistic regression model assessed the factors associated with AC. A multivariable Cox model with AC as a time-dependent variable assessed the prognostic factors for AKI. ClinicalTrials.gov number: NCT02853292. Findings: Of the 112 included patients, 27 (24.1%, 95% CI [16.2-32.0]) developed at least one episode of AC within a mean of 5.1 days. The factors associated with its occurrence were the concomitant use of angiotensin converting enzyme (ACE) inhibitors (OR=4.6, 95% CI [2.2-9.3], p

Published
2022
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4. Methodological Quality Assessment with the AGREE II Scale and a Comparison of European and American Guidelines for the Treatment of Lyme Borreliosis: A Systematic Review

Author

Steve Nguala, Elisabeth Baux, Solène Patrat-Delon, Florian Saunier, Julien Schemoul, Pierre Tattevin, Céline Cazorla, Carole Eldin, Kevin Bouiller, and Alice Raffetin

Subjects
Lyme borreliosis, treatment, guidelines, AGREE II, Medicine
Abstract

Background: Most European and American countries recently updated their guidelines on Lyme borreliosis (LB). The aim of this study was to provide a comparative overview of existing guidelines on the treatment of LB in Europe and America and to assess the methodological quality of their elaboration. Methods: A systematic search was carried out in MEDLINE, Google Scholar, and the national databases of scientific societies from 2014 to 2020. Quality was assessed by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results: Twelve guidelines were included. The scores for the AGREE II domains (median ± IQR) were: overall assessment 100 ± 22, scope and purpose 85 ± 46, stakeholder involvement 88 ± 48, rigour of development 67 ± 35, clarity of presentation 81 ± 36, applicability 73 ± 52 and editorial independence 79% ± 54%. Cohen’s weighted kappa showed a high agreement (K = 0.90, 95%CI 0.84–0.96). Guidelines were quite homogeneous regarding the recommended molecules (mostly doxycycline in the first intention and ceftriaxone in the second intention), their duration (10 to 28 days), and their dosage. The differences were due to the lack of well-conducted comparative trials. The International Lyme and Associated Diseases Society (ILADS) guidelines were the only ones to suggest longer antibiotics based on an expert consensus. Conclusion: European and American guidelines for the treatment of LB were quite homogeneous but based on moderate- to low-evidence studies. Well-conducted comparative trials are needed to assess the best molecules, the optimal duration and the most effective doses.

Published
2021
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5. Benchmarking convolutional neural networks for diagnosing Lyme disease from images.

Author

Sk. Imran Hossain, Jocelyn de Goër de Herve, Md Shahriar Hassan, Delphine Martineau, Evelina Petrosyan, Violaine Corbain, Jean Beytout, Isabelle Lebert, Elisabeth Baux, Céline Cazorla, Carole Eldin, Yves Hansmann, Solene Patrat-Delon, Thierry Prazuck, Alice Raffetin, Pierre Tattevin, Gwenaël Vourc'h, Olivier Lesens, and Engelbert Mephu Nguifo

Published
2021

6. Exploring convolutional neural networks with transfer learning for diagnosing Lyme disease from skin lesion images.

Author

Sk. Imran Hossain, Jocelyn de Goër de Herve, Md Shahriar Hassan, Delphine Martineau, Evelina Petrosyan, Violaine Corbin, Jean Beytout, Isabelle Lebert, Jonas Durand, Irene Carravieri, Annick Brun-Jacob, Pascale Frey-Klett, Elisabeth Baux, Céline Cazorla, Carole Eldin, Yves Hansmann, Solene Patrat-Delon, Thierry Prazuck, Alice Raffetin, Pierre Tattevin, Gwenaël Vourc'h, Olivier Lesens, and Engelbert Mephu Nguifo

Published
2022
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8. Incidence, associated factors, and effect on renal function of amoxicillin crystalluria in patients receiving high doses of intravenous amoxicillin (The CRISTAMOX Study): A cohort study

Author

Sophie Demotier, Anne Limelette, Alexandre Charmillon, Elisabeth Baux, Xavier Parent, Stéphanie Mestrallet, Simona Pavel, Amélie Servettaz, Moustapha Dramé, Anaelle Muggeo, Alain Wynckel, Claire Gozalo, Malak Abou Taam, Aurélie Fillion, Roland Jaussaud, Thierry Trenque, Lionel Piroth, Firouze Bani-Sadr, and Maxime Hentzien

Subjects
General Medicine
Abstract

Amoxicillin crystalluria (AC), potentially responsible for acute kidney injury (AKI), is reported more and more frequently in patients treated with high doses of intravenous amoxicillin (HDIVA). The main objective of this study was to evaluate AC incidence in these patients. The secondary objectives were to identify factors associated with AC and to evaluate its impact on the risk of AKI.This multicentre, observational, cohort study was conducted between Mar 18, 2014 and Aug 16, 2019 in Dijon, Nancy, and Reims University Hospitals as well as Châlon-sur-Saône, Charleville-Mézières, and Troyes general hospitals in France. Adult patients (≥18 years) treated with HDIVA and having been tested for AC at least once during treatment were included. Clinical, biological, and therapeutic characteristics of the patients were collected. A univariable mixed logistic regression model assessed the factors associated with AC. A multivariable Cox model with AC as a time-dependent variable assessed the prognostic factors for AKI. ClinicalTrials.gov number: NCT02853292.Of the 112 included patients, 27 (24.1%, 95% CI [16.2-32.0]) developed at least one episode of AC within a mean of 5.1 days. The factors associated with its occurrence were the concomitant use of angiotensin converting enzyme (ACE) inhibitors (OR=4.6, 95% CI [2.2-9.3], p0.0001) and the decrease of urinary pH (OR=2.1 for one pH point decrease, 95% CI [1.2-3.7], p=0.009). 20 patients (17.9%) presented with AKI, within a mean time of 10.9 days. The main factor associated with the occurrence of AKI was the occurrence of AC (aHR=7.4, 95% CI [2.5-22.2], p=0.0003).AC occurred in a quarter of patients treated with HDIVA and was highly prognostic of AKI.None.

Published
2021

9. La fugue comme 'enfance de l’aventure'

Author

Elisabeth Baux-Pociello

Subjects
Ocean Engineering
Abstract

Das Ausreissen als " Kindheit des Abenteuers" - Die klinische Untersuchung von Dutzenden von ausreissenden und Schulablehnenden Kindern hat es ermöglicht, eine Beständigkeit in der Form dieser städtischen Ausbrechen sowie in den besonderen Familienstrukturen, die dazu geführt haben, hervorzuheben. Während der Kindheit wurde ein Veranlagungsfaktor, eine Art Tropismus, der zur abenteuerlichen Flucht verführt, identifiziert und zwar in der Anwesenheit einer allmächtigen mütterlichen Figur kombiniert mit der labilen väterlichen Figur. Ein Vergleich konnte mit den Biographien einiger grosser Abenteurer (selbst frühzeitige Ausreisser) erstellt werden und dies führte zum Aufbau einer Theorie, wo das Abenteuer eine neue Auslegung findet., Running away as " a forerunner to adventure" - The clinical examination of several dozens of cases of children running away and playing truant has highlighted a certain constancy of form in these urban escapades, as well as the specific family configurations which have brought them about. It can be seen that a factor predisposing to adventurous flight from very early childhood can be directly linked with on omnipotent mother figure and frequently with a weak father figure. A parallel was drawn up with the biographies of certain great adventurers (themselves early runaways) establishing a theory whereby adventure is given a new interpretation., L’examen clinique de plusieurs dizaines de cas d’enfants fugueurs et réfractaires à l’école a permis de dégager une constance de forme, dans ces échappées urbaines, ainsi que dans les configurations familiales particulières qui les ont produites. A été identifié -durant l’enfanceun facteur prédisposant, sorte de tropisme incitant à la fuite aventureuse, dans la présence d’une figure maternelle omnipotente allant de pair avec la fragilité de la figure du père. Un parallèle a pu être établi avec les biographies de certains grands aventuriers (eux-mêmes fugueurs précoces) permettant de construire une Théorie où l’Aventure trouve une nouvelle interprétation., La fuga como "Infancia de la aventura" - El examen clínico de varias decenas de niños fugados y reacios al colegio permitió destacar una constancia de forma en estas escapadas urbanas, así como en las configuraciones familiares particulares que las produjeron. Se identificó "durante la infancia "un factor de predisposición, especie de tropismo incitando a la huida aventurera, en la presencia de una figura materna omnipotente junto con la fragilidad de la figura del padre. Se pudo establecer un paralelismo con las biografías de algunos grandes aventureros (ellos mismos fugados precoces), permitiendo construir una Teoría donde la Aventura encuentra una nueva interpretación., Baux-Pociello Elisabeth. La fugue comme "enfance de l’aventure". In: Agora débats/jeunesses, 11, 1998. L’aventure n’est-elle qu’une mode ? pp. 49-64.

Published
1998
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11. Effect of weight-adjusted intermediate-dose versus fixed-dose prophylactic anticoagulation with low-molecular-weight heparin on venous thromboembolism among noncritically and critically ill patients with COVID-19: the COVI-DOSE trial, a multicenter, randomised, open-label, phase 4 trial

Author

Zuily, Stéphane, Lefèvre, Benjamin, Sanchez, Olivier, Empis de Vendin, Ombeline, de Ciancio, Guillaume, Arlet, Jean-Benoît, Khider, Lina, Terriat, Béatrice, Greigert, Hélène, Robert, Céline, Louis, Guillaume, Trinh-Duc, Albert, Rispal, Patrick, Accassat, Sandrine, Thiery, Guillaume, Montani, David, Azarian, Réza, Meneveau, Nicolas, Soudet, Simon, Le Mao, Raphaël, Maurier, François, Le Moing, Vincent, Quéré, Isabelle, Yelnik, Cécile, Lefebvre, Nicolas, Martinot, Martin, Delrue, Maxime, Benhamou, Ygal, Parent, Florence, Roy, Pierre-Marie, Presles, Emilie, Goehringer, François, Mismetti, Patrick, Bertoletti, Laurent, Rossignol, Patrick, Couturaud, Francis, Wahl, Denis, Thilly, Nathalie, Laporte, Silvy, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), F-Crin Innovte [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Adaptation, mesure et évaluation en santé. Approches interdisciplinaires (APEMAC), Université de Lorraine (UL), Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHR de Metz-Thionville, Centre Hospitalier Agen-Nérac, Hôpital Bicêtre, Université Paris-Saclay, Centre Hospitalier de Versailles André Mignot (CHV), Department of Cardiology, University Hospital Jean Minjoz, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC), CHU Amiens-Picardie, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), UNEOS, Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Lapeyronie [Montpellier] (CHU), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Lille, CHU Lille, Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpitaux Civils de Colmar, Service d’Hématologie Biologique [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA), CHU d'Angers [Département Urgences], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Université Jean Monnet - Saint-Étienne (UJM), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Service de Chirurgie Vasculaire [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Centre Hospitalier Princesse Grace, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), French Ministry of Health, CAPNET, Grand-Est Region, Grand-Nancy Métropole., and COVI-DOSE investigators: Stéphane Zuily, Francis Couturaud, François Goehringer, Silvy Laporte, Patrick Mismetti, Emilie Presles, Patrick Rossignol, Nathalie Thilly, Denis Wahl, Thomas Lecompte, Emmanuel Oger, Marie-Antoinette Sevestre, Florence Parent, Ygal Benhamou, Pierre-Marie Roy, Tristan Gigante, Morgane Gilg, Pierre-Luc Maclot, Bénédicte Rossignol, Jonathan Udot, Hélène Bouteille, Andréa Buchmuller, Céline Peurière, El Mehdi Siaghy, Valérie Bouaziz, Charlotte Daguin, Benjamin Grosjean, Véronique Saunier, Laurence Verger, Madlyne Jacquot, Nadine Petitpain, Martin Charly, Laurent Tordella, Emilie Presles, Guillaume Baronnet, Elisabeth Baux, Athanase Benetos, Jean-Baptiste Blanvillain, Marie Conrad, Guilhem Courte, Aurélie Cravoisy-Popovic, Virginie Dufrost, Sébastien Gibot, Philippe Guerci, Laure Joly, Antoine Kimmoun, Matthieu Koszutski, Alexandrine Larue, Bruno Levy, Marie-Reine Losser, Mathieu Mattei, Lionel Nace, Emmanuel Novy, Pierre Perez, Jean-Pierre Pertek, Camille Rigaux, Alexis Sauvage, Evelyne Schvoerer, Carine Thivilier, Lev Volkov, Piotr Zieminski, Manil Benlounes, Charles Cheng, Jean-Baptiste de Fréminville, Grégoire Détriché, Emmanuel Flammarion, Guillaume Goudot, Amer Hamdan, Raphaël Hindré, Corina Manoli, Emmanuel Messas, Adrien Michon, Tristan Mirault, Jean Pastré, Marie-Aude Penet, Benjamin Planquette, Geoffroy Volle, Rémy Hamdan, Aline Laubriet-Jazayeri, Vincent Petit, Lionel Piroth, Jean Pierre Quenot, Mélissa Saccu, Damien Barraud, Zoé Cavalli, Rostane Gaci, Mathilde Andreu, Laurent Bertoletti, Andréa Buchmuller, Elodie De Magalhaes, Sophie Bulifon, Athénaïs Boucly, Nathan Ebstein, Marc Humbert, Xavier Jaïs, Mitja Jevnikar, Laurent Savale, Andrei Horia Seferian, Charlotte Colin, Timothée Ganem, Mehdi Roumila, Romain Chopard, Matthieu Besutti, Basile Mouhat, Claire Andrejak, Stéphane Dupas, Gaëlle Le Roy, Santhi Samy-Modeliar, Anne Coste, Alexandre Fauche, David Goetghebeur, Christophe Gut-Gobert, Clément Hoffmann, Baptiste Hourmant, Cécile L'hévéder, Emmanuelle Lemoigne, Olivier Nepveu, Raphaël Paret, Gaël Picart, Saïd Azerkan, Chadia Boudaa, Julien Campagne, Peter Eszto, Benoît Godbert, Jean-François Guichard, Marion Heschung, Antoine Legoff, Jacques Mariot, Pascale Martin, Magalie Mercy, Julie Perrin, Stéphane Raymond, Nathalie Vernier, Pierre Fesler, Pierrick Henneton, Cédric Mercuzot, Nathalie Pansu, Lucas Perez, Loïc Andre, Edgar Bakhache, Marie-Charlotte Chopin, Marie Gilbert, Marc Lambert, Mohammad Ryadh Pokeerbux, François Danion, Yves Hansmann, Estelle Rougier, Yvon Ruch, Dominique Stéphan, Axel Ursenbach, Isabelle Connerade, Simon Gravier, Damien Kayser, Jean-Marc Michel, Mahsa Mohseni, Waël Younes, Ruxandra Burlacu, Amanda Lopes, Stéphane Mouly, Kladoum Nassarmadji, Damien Sène, Virginie Siguret, Alain Stepanian, Cédric Annweiler, Antoine Brangier, Vincent Dubee, Samir Henni, Jeanne Hersant, Jocelyne Loison, Léa Kern, Jean-Baptiste Laine, Claire Neveux-Brecheteau, Lucia Perez, Ruben Benainous, Bénédicte Giroux-Leprieur, Marilucy Lopez-Sublet, Saïda Khaled-Jousselin, Yohann Bernard, Amélie Amiot, Jessica Breistroff, Emilie Detry, Kadidiatou Diallo, Agnès Didier, Nathalie Dumont, Julie Egensperger, Aurélie Emmerich, Nelly François, Fanny Gallo, Valérie George, Quentin Gérome, Aurélie Gutehrle, Laure Lehman, Séverine Petit, Vanessa Piard, Maximilien Saint-Gilles, Olivier Terenzi, Amélie Marquette, Hélène Mortelette, Mathilde Audry, Amélie Cransac, Marine Maillard, Anaïs Boyer, Floriana Gallo, Arielle Urbing, Imane Zahaf, Alexandra Byczko, Amina Chaalal, Georgette Berlier, Corinne Bernabe, Souad Bezzeghoud, Caroline Chaudier, Carole Chauvet, Marina Davier, Carine Labruyere, Estelle Perrin, Michaël Pierre, Claire-Annissa Chekirine, Florence Voivret, Ramdane Meftali, Ouaffa Sabri, Anaïs Beulaygue, Julie Gall, Laure Girard, Soumia Haddaoui, Scheherazade Rami, Auriane Couderc, Aude Le Breton, Marie-Line Perruche, Cindy Claudon, Ludivine Roussel, Aude Barnier, Tiphaine Blanchard, Bénédicte Le Gall, Mélanie Pelouin, Anne-Sophie Veillon, Quam Aquereburu, Charlène Delaygue, Zahoua Ait Idir, Jérémy Drugeon, Déborah Dubrulle, Rabah Tezkratt, Anne-Sophie Frantz, Julie Drouaine, Jacqueline Dubois, Magali Eyriey, Elina Haerrel, Mélinda Beaudenon, Mialy Guenet, Thibaud Lecerf, Stéphanie Marechal-Girault, Sami Rehaiem, Romain Simon, Florence Dangeul-Potier, Morgane Goulvent, Souha Fliss, Fadhila Messani, Béatrice Mizejewski, Brigitte Mugnier, Valérie Opderbeck, Brigitte Risse

Subjects
Anticoagulation, Heparin, [SDV]Life Sciences [q-bio], COVID-19, Venous thromboembolism
Abstract

International audience; Background: Venous thromboembolism is a major complication of coronavirus disease 2019 (COVID-19). We hypothesized that a weight-adjusted intermediate dose of anticoagulation may decrease the risk of venous thromboembolism COVID-19 patients.Methods: In this multicenter, randomised, open-label, phase 4, superiority trial with blinded adjudication of outcomes, we randomly assigned adult patients hospitalised in 20 French centers and presenting with acute respiratory SARS-CoV-2. Eligible patients were randomly assigned (1:1 ratio) to receive an intermediate weight-adjusted prophylactic dose or a fixed-dose of subcutaneous low-molecular-weight heparin during the hospital stay. The primary outcome corresponded to symptomatic deep-vein thrombosis (fatal) pulmonary embolism during hospitalization (COVI-DOSE ClinicalTrials.gov number: NCT04373707).Findings: Between May 2020, and April 2021, 1000 patients underwent randomisation in medical wards (noncritically ill) (80.1%) and intensive care units (critically ill) (19.9%); 502 patients were assigned to receive a weight-adjusted intermediate dose, and 498 received fixed-dose thromboprophylaxis. Symptomatic venous thromboembolism occurred in 6 of 502 patients (1.2%) in the weight-adjusted dose group and in 10 of 498 patients (2.1%) in the fixed-dose group (subdistribution hazard ratio, 0.59; 95% CI, 0.22-1.63; P = 0.31). There was a twofold increased risk of major or clinically relevant nonmajor bleeding: 5.9% in the weight-adjusted dose group and 3.1% in the fixed-dose group (P = 0.034).Interpretation: In the COVI-DOSE trial, the observed rate of thromboembolic events was lower than expected in patients hospitalized for COVID-19 infection, and the study was unable to show a significant difference in the risk of venous thromboembolism between the two low-molecular-weight-heparin regimens.

Published
2023
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12. Traitement des entérobactéries productrices de bêta-lactamases à spectre étendu en réanimation

Author

Volkov, Lev, Université de Lorraine (UL), Université de Lorraine, Elisabeth Baux-Pomarès, and Sandrine Hénard

Subjects
Thèse d'exercice de médecine spécialisée, Bêta-lactamases à spectre étendu, Carbapénèmes, Inhibiteurs de la bêta-lactamase, Infections à entérobactéries, Entérobactéries, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

OBJECTIFS: Décrire la mortalité des patients hospitalisés en réanimation et présentant une infection à entérobactérie productrice de bêta-lactamases à spectre étendu (EBLSE) en fonction du traitement par carbapénèmes ou par une antibiothérapie alternative. MÉTHODES: Nous avons effectué une étude rétrospective, descriptive et monocentrique au CHU de Nancy. Les patients âgés de plus de 18 ans, hospitalisés en réanimation et présentant lors de l'admission ou pendant le séjour une infection par une EBLSE entre le 1er janvier 2016 et le 31 mars 2018 étaient inclus. L'objectif principal était le statut vital du patient à la sortie de réanimation. RÉSULTATS: Dans notre étude, 109 patients étaient inclus. Au total, 32 patients (29,4%) étaient décédés pendant le séjour en réanimation. Escherichia coli était la bactérie la plus fréquemment identifiée (41%), suivie de Enterobacter cloacae complex (33%) et de Klebsiella pneumoniae (19%). La pneumonie acquise sous ventilation mécanique (PAVM) et la pneumonie non associée à la ventilation mécanique étaient les sources d'infection les plus fréquentes. Le score IGS II à l'admission était en moyenne de 49,8. Une ventilation mécanique invasive était nécessaire pour 66% des patients. L'utilisation de catécholamine était nécessaire pour 64% des patients. Un état de choc au début de l'infection était présent chez 36,7% des patients. Parmi nos patients, 84 (77,1%) avaient reçu un traitement antibiotique probabiliste dont 22 (26,2%) par une carbapénème et 62 (73,8%) par un traitement alternatif aux carbapénèmes. Quatre-vingt-quinze patients (87,2%) avaient reçu un traitement documenté dont 55 patients (57,9%) par une carbapénème et 40 patients (42,1%) par un traitement alternatif aux carbapénèmes. Lors du séjour en réanimation 32 patients (29,4%) sont décédés. Nous n'avons pas observé de différence statistiquement significative de mortalité entre les patients traités avec une carbapénème et les patients traités avec un traitement alternatif. La mortalité était de 28,3% dans le groupe de patients ayant reçu un traitement probabiliste approprié et de 30,2% dans le groupe de patients ayant reçu un traitement probabiliste non approprié ou n'ayant reçu aucun traitement probabiliste. Une rechute était constatée chez 13 patients (12,1%). CONCLUSION : Les infections à entérobactéries productrices de BLSE chez les patients en réanimation sont associées à une forte mortalité. En raison de la taille de l'échantillon de cette étude rétrospective, aucune différence entre les groupes n'était observée. Par conséquent, une étude plus vaste devrait être réalisée.

Published
2018

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