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Resume Contexte L’hypercholesterolemie familiale (HF) est une maladie genetique frequente qui expose a une atherosclerose precoce, en particulier coronaire. Cependant, l’HF reste encore meconnue des cardiologues et est largement sous-diagnostiquee en France. Elle doit etre suspectee pour des taux de LDL cholesterol (LDLc) ≥ 1,9 g/L en l’absence de traitement. Objectif L’objectif de cette etude multicentrique retro- et prospective etait de preciser la prevalence des patients admis en USIC avec un taux eleve de LDLc et l’impact sur leur suivi lipidique personnel et familial. Methodes Analyse retrospective de tous les bilans lipidiques preleves a l’admission en USIC dans 4 centres en 2017. Analyse descriptive des caracteristiques demographiques, des motifs d’hospitalisation et du statut coronaire des patients consecutifs avec taux de LDLc ≥ 1,9 g/L (4,9 mmol/L). Suivi prospectif a un an portant sur le traitement hypocholesterolemiant, le suivi biologique et l’existence d’un depistage familial de l’HF. Resultats Un dosage de lipides a ete realise chez 2172 patients et 108 (5 %) avaient un taux de LDLc ≥ 1,9 g/L (âge moyen 64 ± 14 ans, hommes 51 %). L’hospitalisation etait liee a un syndrome coronaire aigu dans 78 % des cas et une cardiopathie non ischemique dans 22 %. Un traitement hypocholesterolemiant etait prescrit chez 9 % des patients a l’entree et 84 % a la sortie, par fortes doses de statine. Au suivi a un an, 20 % n’avaient pas controle leur LDLc, la statine avait ete diminuee (36 %) ou arretee (7 %) chez 43 %. Au moins un relatif du premier degre (fratrie ou enfants) avait eu un dosage de cholesterol dans 37 % des cas, et l’exploration genetique a ete realisee chez 3 patients. Conclusions Le depistage de l’HF en USIC necessite le calcul systematique du score DUTCH chez les patients a risque dont le taux de LDLc est superieur a 1,9 g/L, ce critere biologique n’etant pas suffisant en soi. Cette etude montre qu’il existe une marge importante d’optimisation de la prise en charge therapeutique et de l’exploration familiale chez les patients a risque d’HF depistes en USIC.

Familial hypercholesterolemia (FH) is a frequent genetic disorder that leads to premature atherosclerosis and coronary artery disease. However, knowledge of FH by cardiologists is weak, and FH remains underdiagnosed in France. FH should be suspected when low-density lipoprotein cholesterol (LDLc) levels exceed 1.9g/L (4.9mmol/L) without lipid lowering therapy.This multicenter retro- and prospective observational study aimed at estimating the prevalence of high LDLc levels in patients admitted in coronary care units, and the impact for the personal and familial follow-up for lipid status.Retrospective analysis of all plasma lipid measurements performed at admission in coronary care unit of 4 hospitals in 2017. Retrospective analyses of demographic, clinical, and coronary data of consecutive patients with LDLc levels≥1.9g/L. Prospective 1 year follow-up focused on lipid levels, treatments, and personal and familial screening for FH.Lipid measurement has been performed in 2172 consecutive patients, and 108 (5%) had LDLc level≥1.9g/L (mean age 64±14 years, men 51%). The primary cause of the hospitalisation was acute coronary syndrome (78%), and 22% of patients were free off coronary artery disease. Lipid lowering therapy was present in 9% of patients at admission, and 84% at discharge, with high statins regimen. At 1-year follow-up, control of LDLc level was not performed in 20% of patients, and statin dose was decreased (36%) or withdrawn (7%) in 43%. Lipid measurement has been performed in at least one first degree relative in 37% of patients, and genetic exploration has been done for 3 patients.Screening of FH in CCU should be routinely performed using the Dutch Score when LDLc is above 1.9g/L. Individual and familial management of patients at high risk for FH screened in CCU should be optimized, both for diagnosis and therapeutic purposes.

Background Familial hypercholesterolemia (FH) is a frequent genetic disorder that leads to premature atherosclerosis and coronary artery disease. However, knowledge of FH by cardiologists is weak, and FH remains underdiagnosed in France. FH should be suspected when low-density lipoprotein cholesterol (LDLc) levels exceed 1.9 g/L (4.9 mmol/L) without lipid lowering therapy. Purpose This multicenter retro- and prospective observational study aimed at estimating the prevalence of high LDLc levels in patients admitted in coronary care units, and the impact for the personal and familial follow-up for lipid status. Methods Retrospective analysis of all plasma lipid measurements performed at admission in coronary care unit of 4 hospitals in 2017. Retrospective analyses of demographic, clinical, and coronary data of consecutive patients with LDLc levels ≥ 1.9 g/L, whatever the reason for hospitalisation. Prospective 1-year follow-up focused on lipid levels, treatments, and personal and familial screening for FH. Results Lipid measurement has been performed in 2172 consecutive patients, and 108 (5%) had LDLc level ≥ 1.9 g/L (mean age 64 ± 14 years, men 51%). The primary cause of the hospitalisation was acute coronary syndrome (78%), and 22% of patients were free off coronary artery disease. Lipid lowering therapy was present in 9% of patients at admission, and 84% at discharge, with high statins regimen. At 1-year follow-up, control of LDLc level was not performed in 20% of patients, and statin dose was decreased (36%) or withdrawn (7%) in 43%. Lipid measurement has been performed in at least one first degree relative in 37% of patients, and genetic exploration has been done for 3 patients only. Conclusions Screening of FH in CCU should be routinely performed using the Dutch Score when LDLc is above 1.9 g/L. Individual and familial management of patients at high risk for FH screened in CCU should be optimized, both for diagnosis and therapeutic purposes.

OBJECTIVES Mupirocin is the cornerstone of decolonization regimens, a successful strategy to prevent healthcare-associated staphylococcal infections. Several recent studies have reported alarming results: (i) an extending reservoir of mupA, the ancestral mobile resistance gene, among coagulase-negative staphylococci (CoNS); (ii) the emergence of a new resistance gene (mupB); and (iii) a growing number of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA), including highly pathogenic clones. We performed a nationwide prospective study in France to detect such trends among invasive staphylococci. METHODS Between October 2011 and February 2012, 367 MRSA and 708 CoNS invasive isolates were collected from 37 hospitals and analysed centrally. Mupirocin MICs were determined using the broth microdilution method. mupA/B PCR was performed for resistant isolates (MIC >1 mg/L). Genetic relatedness between mupirocin-resistant MRSA isolates was determined by PFGE analysis and related isolates were tested by microarray. RESULTS Among MRSA isolates 2.2% (n = 8) were classified as mupirocin resistant; 1.4% (n = 5) showing low-level resistance (MIC ≤256 mg/L) and 0.8% (n = 3) high-level resistance (MIC >256 mg/L). Only the latter isolates carried mupA. A clonal relationship was identified between two mupA-negative MRSA from the same hospital and three mupA-positive MRSA from three distant towns; these three isolates belonged to the Lyon clone. Mupirocin resistance was identified in 10.3% of CoNS, mainly highly resistant mupA-positive isolates (5.6%). The mupB gene was not detected in mupirocin-resistant MRSA or CoNS. CONCLUSIONS This first large national study indicates the need for thorough epidemiological monitoring and a stewardship programme to prevent and detect mupirocin resistance in staphylococci.

resume La creation d'un logiciel multimedia complet integrant la presentation video, la description interactive, le guide de bonne execution des analyses (GBEA) et la simulation de fonctionnement d'un automate de biologie medicale est interessante aussi bien pour le constructeur que pour le biologiste utilisateur. Le fabricant dispose ainsi d'un nouveau mode de communication, universel via Internet, et le biologiste d'un outil gerant aussi bien les tâches fastidieuses du GBEA que la formation des techniciens sur les automates, integrant ainsi le laboratoire au monde virtuel des nouveaux reseaux de communication.