Search

The increasing use of endovascular aneurysm repair (EVAR) appears to be associated with the burden of vascular endograft infections. Complete stent graft explantation is recommended but leads to significant mortality. This study aimed to assess the technical challenges, complications, and mortality rate following infected endograft explantation.Patients who underwent abdominal aortic endograft explantation for infection at the Bordeaux University Hospital from July 2008 to December 2020 were included retrospectively in this single centre observational study. The diagnosis was established based on the MAGIC criteria. The primary endpoint was 30 day mortality. Secondary endpoints were 90 day and in hospital mortality, survival, and re-infection.Thirty-four patients were included, median age 69 years (interquartile range [IQR] 65, 76), with four (12%) treated as an emergency. The median time from EVAR to explantation was 17.5 months (4.5 - 36.3). In situ reconstruction was carried out with prosthetic grafts in 24 patients (71%, including 23 antimicrobial grafts combining silver and triclosan), and biological grafts in 10 (five femoral veins, four arterial allografts, three bovine patches, one biosynthetic graft). Seventeen aorto-enteric fistulae (AEnF) were addressed with direct repair of the intestinal tract (n = 10/17; 59%) or resection and anastomosis (n = 7/17; 41%). The culture was polymicrobial in 12 patients (35%) and remained sterile in four (12%). The 30 day and in hospital mortality rates were 21% (n = 7) and 27% (n = 9). Twenty-five patients (73%) presented with early post-operative complications, requiring 16 revision procedures (47%). Over a median follow up of 16.2 months (IQR 8.3, 33.6), the mortality rate was 35% (n = 12; 11 aortic related; 32%), with two re-infections (6%), both after biological reconstruction (one for an AEnF).Early morbidity and mortality remain high after complete infected endograft explantation, even in a high volume centre. Comparison with other treatment modalities in large multicentre cohorts might be of interest.

International audience; PURPOSE: Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. MATERIALS AND METHODS: Ancillary study focusing on patients with ICU admission within the ENCEIF cohort, a French prospective observational multicentre study. The primary criteria for outcome was the functional status at hospital discharge, categorized using the Glasgow outcome scale (GOS). Logistic regression model was used to identify risk factors for poor outcome, defined as a GOS ≤ 3. RESULTS: We enrolled 198 ICU patients with IE. HSV was the primary cause (n = 72, 36% of all IE, 53% of IE with microbiological documentation). Fifty-two patients (26%) had poor outcome at hospital discharge, including 22 deaths (11%). Immunodeficiency, supratentorial focal signs on admission, lower cerebrospinal fluid (CSF) white cells count (2 days were independent predictors of poor outcome. CONCLUSION: HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.

Background Campylobacter spp. bacteremia is a severe infection. A nationwide 5-year retrospective study was conducted to characterize its clinical features and prognostic factors. Methods The study included patients with Campylobacter spp. bacteremia diagnosed in 37 French hospitals participating in the surveillance network of the National Reference Center for Campylobacters and Helicobacters, from 1 January 2015 to 31 December 2019. The goal was to analyze the effects of a delay of appropriate antibiotic therapy and other risk factors on 30-day mortality rates, antibiotic resistance, patient characteristics, and prognosis according to the Campylobacter species. Results Among the 592 patients, Campylobacter jejuni and Campylobacter fetus were the most commonly identified species (in 42.9% and 42.6%, respectively). The patients were elderly (median age 68 years), and most had underlying conditions, mainly immunodepression (43.4%), hematologic cancers (25.9%), solid neoplasms (23%), and diabetes (22.3%). C. jejuni and Campylobacter coli were associated with gastrointestinal signs, and C. fetus was associated with secondary localizations. Among the 80 patients (13.5%) with secondary localizations, 12 had endocarditis, 38 vascular, 24 osteoarticular, and 9 ascitic fluid infections. The 30-day mortality rate was 11.7%, and an appropriate antibiotic treatment was independently associated with 30-day survival (odds ratio, 0.47 [95% confidence interval, .24–.93]; P = .03). The median efficient therapy initiation delay was quite short (2 days [interquartile range, 0–4 days]) but it had no significant impact on the 30-day mortality rate (P = .78). Conclusions Campylobacter spp. bacteremia mainly occurred in elderly immunocompromised individuals with variable clinical presentations according to the species involved. Appropriate antimicrobial therapy was associated with improved 30-day survival.

The objective of this retrospective single centre study was to determine whether different enteric reconstruction methods and adjuncts confer a benefit after in situ reconstructions (ISRs) of graft aorto-enteric erosion (AEnE) and fistula (AEnF).Primary endpoints were in hospital mortality and AEnE/F recurrence. Survival was estimated using the Kaplan-Meier method and explanatory factors were searched for using uni- ± multivariable Cox regression analysis. In 2013, a multidisciplinary team meeting was convened and since then the primary operator has always been a senior surgeon.Sixty-six patients were treated for AEnE (n = 38) and AEnF (n = 28, 42%) from 2004 to 2020. All patients with AEnF presented with gastrointestinal bleeding (vs. 0 for AEnE; p.001). Signs of infection were seen in 50 patients (76% [37 for AEnE vs. 13 for AEnF]; p.001). Referrals for endograft infection increased over time (n = 15, 23%; one before 2013 vs. 14 after; p = .002). Most patients underwent complete graft excision (n = 52, 79%) with increasing suprarenal cross clamping (n = 21, 32%; four before 2013 vs. 17 after; p = .015). Complex visceral reconstructions decreased over time (n = 31, 47%; 17 before 2013 vs. 14 after; p = .055), while "open abdomens" (OAs) increased (one before 2013 vs. 22 after; p.001), reducing operating time (p = .012). In hospital mortality reached 42% (n = 28). Estimated survival reached 47.6% (95% confidence interval [CI] 35.0 - 59.1) at one year and 45.6% (95% CI 33.0 - 57.3) at three years and was higher for AEnE than for AEnF (log rank p = .029). AEnE/F recurrence was noted in 12 patients (18%). Older age predicted in hospital mortality in multivariable analysis (p = .034). AEnE/F recurrence decreased with the presence of a primary senior surgeon (vs. junior; p = .003) and OA (1 [4.4%] vs. 11 [26%] for primary fascial closure; p = .045) in univariable analysis.Mortality and recurrence rates remain high after ISR of AEnE/F. Older age predicted in hospital mortality. Primary closure of enteric defects ≤ 2 cm in diameter reduced operating time without increasing the recurrence of AEnF.

In situ reconstruction (ISR) with autologous veins is the preferred method in infectious native aortic aneurysms (INAA) or vascular (endo)graft infection (VGEI). However, access to biological substitutes can prove difficult and lacks versatility. This study evaluates survival and freedom from reinfection after ISR of INAA/VGEI using the Antimicrobial InterGard Synergy graft combining silver and triclosan.From February 2014 to April 2020, 86 Antimicrobial grafts were implanted for aortic infection. The diagnosis of INAA/VGEI and reinfection was established based on the MAGIC criteria. Survival was analyzed using the Kaplan-Meier method and log-rank p-values.The Antimicrobial graft was implanted in 32 cases of INAA, 28 of VGI, and 26 of VEI. Median age was 69.0 (IQR: 62.0;74.0), with a history of coronary artery disease (n=21; 24.4%), chronic kidney disease (n=11; 12.8%), cancer (n=21; 24.4%), and immunosuppression (n=27; 31.4%). Imaging showed infiltration (n=14; 16.3%), air (n=10; 11.6%), and rupture (n=16; 18.6% including 22 aorto-enteric fistulae (AEnF)). Symptoms included fever (n=37; 43.0%), shock (n=11; 12.8%), and pain (n=47; 54.7%). Repair was undertaken through a midline laparotomy in 75 cases (87.2%) and coeliac cross-clamping in 19 (22.1%), supra-renal in 26 (30.2%), plus celiac trunk (n=3), mesenteric (n=5), renal (n=13) or hypogastric (n=4) artery reconstruction and omental flap coverage (n=41; 48.8%). For AEnF, the gastrointestinal tract was repaired using direct suture (n=14; 16.3%) or resection-anastomosis (n=8; 9.3%). Causative organisms were identified in 74 patients (86.0%), with polymicrobial infection in 32 (37.2%) and fungal co-infection in 7 (8.1%). Thirty-day and in-hospital mortality were 14.0% and 22.1% (n=12 and 19 respectively, 3 INAA (9.4%), 7 VGI (25.0%) and 9 VEI (34.6%)). Seventy patients (81.4%) had a post-operative complication, 44 (51.2%) of whom returned to the operative room. The 1 and 2-year survival rates were 74.0% (95%CI: 63.3-82.1) and 69.8% (95%CI: 58.5-78.5). Survival was significantly better for INAA vs VGEI (p=.01) and worse for AEnF (p=.001). Freedom from reinfection was 97.2% (95%CI: 89.2-99.3) and 95.0% (95%CI: 84.8-98.4) with 6 reinfections (7.0%) requiring 2 radiological/6 surgical drainage and 2 graft removals. Primary patency was 88.0% (95%CI: 78.1-93.6) and 79.9% (95%CI: 67.3-88.1) with no significant difference between INAA and VGEI (p=.16).ISR of INAA or VGEI with the Antimicrobial graft showed encouraging early mortality, comparable to the rates found in femoral vein (9-16%) and arterial allograft (8-28%) studies, as well as mid-term reinfection. The highest in-hospital mortality was noted for VEI including nearly 50% of AEnF.

We conducted a retrospective (2006-2017) study ofOf 137Half of the clinical samples that grew

Background Determining the etiology of aortitis is often challenging, in particular to distinguish infectious aortitis (IA) and noninfectious aortitis (NIA). This study aims to describe and compare the clinical, biological, and radiological characteristics of IA and NIA and their outcomes. Methods A multicenter retrospective study was performed in 10 French centers, including patients with aortitis between 1 January 2014 and 31 December 2019. Results One hundred eighty-three patients were included. Of these, 66 had IA (36.1%); the causative organism was Enterobacterales and streptococci in 18.2% each, Staphylococcus aureus in 13.6%, and Coxiella burnetii in 10.6%. NIA was diagnosed in 117 patients (63.9%), mainly due to vasculitides (49.6%), followed by idiopathic aortitis (39.3%). IA was more frequently associated with aortic aneurysms compared with NIA (78.8% vs 17.6%, P < .001), especially located in the abdominal aorta (69.7% vs 23.1%, P < .001). Crude and adjusted survival were significantly lower in IA compared to NIA (P < .001 and P = .006, respectively). In the IA cohort, high American Society of Anesthesiologists score (hazard ratio [HR], 2.47 [95% confidence interval {CI}, 1.08–5.66]; P = .033) and free aneurysm rupture (HR, 9.54 [95% CI, 1.04–87.11]; P = .046) were significantly associated with mortality after adjusting for age, sex, and Charlson comorbidity score. Effective empiric antimicrobial therapy, initiated before any microbial documentation, was associated with a decreased mortality (HR, 0.23, 95% CI, .08–.71]; P = .01). Conclusions IA was complicated by significantly higher mortality rates compared with NIA. An appropriate initial antibiotic therapy appeared as a protective factor in IA.

Objectives To describe the characteristics of patients with a positive urethral sample for Haemophilus spp. Material and methods We performed a retrospective study from January 2018 to July 2019 at the Bordeaux university hospital (France) of all urethral samples positive for Haemophilus spp. Results Haemophilus spp. was isolated in 10 urethral samples from nine patients. The mean age was 33.8 years. Most patients reported having unprotected sex. Haemophilus parainfluenzae was isolated in nine samples, and Haemophilus influenzae in one sample. Antibiotic susceptibility tests were performed in five samples; Haemophilus spp. was always resistant to amoxicillin and tetracycline. One patient had persistent symptoms after treatment for a multidrug-resistant Haemophilus parainfluenzae strain. Conclusion Haemophilus spp. is a rare pathogen of urethritis. Its responsibility should be considered in case of persistent symptoms. The emergence of multidrug-resistant Haemophilus spp. is becoming problematic.

Complete excision in patients with aortic vascular graft and endograft infections (VGEIs) is a significant undertaking, and many patients never undergo definitive treatment. Knowing their fate is important to be able to assess the risks of graft excision vs alternative strategies. This study analyzed their life expectancy and sepsis-free survival.VGEIs were diagnosed according to the Aortic Graft Infection (MAGIC) criteria, and patients turned down for graft removal from November 2006 to December 2020 were included. Primary endpoints were aortic-related and sepsis-free survival estimated using the Kaplan-Meier method. A Cox proportional hazards regression analysis was used to compute the hazard ratio (HR) and 95% confidence interval (CI) as estimates of survival without sepsis.Seventy-four patients were included, with a median age of 71 years (range, 63-79 years). The index aortic repair was either open (n = 33; 44.6%), endovascular (n = 19; 25.7%), or hybrid (n = 22; 29.7%). Causative organisms were identified in 56 patients (75.7%). At presentation, 26 patients (35.1%) required salvage surgery, open (n = 22; 29.7%) or endovascular (n = 8; 10.8%), and 17 radiological drainage (23.0%). During follow-up, eight required drainage and 11 (14.9%) graft removal (five complete). Infectious complications included pseudoaneurysms (n = 14; 18.9%), rupture (n = 9; 12.2%), gastro-intestinal bleeding (n = 13; 17.6%), septic embolisms (n = 4; 5.4%), and thrombosis (n = 12; 16.2%). In-hospital mortality was 20.3% (n = 15), freedom from aortic-related death and overall survival was 77.1% (95% CI, 65.2%-85.3%) and 70.4% (95% CI, 58.3%-79.7%) at 1 year, and 61.7% (95% CI, 46.1%-74.0%) and 43.1% (95% CI, 29.2%-56.3%) at 5 years. Sepsis recurrence occurred in 37 patients (50.0%). Seven (16.3%) developed acquired antimicrobial resistance. Malnutrition (HR, 3.3; 95% CI, 1.4-7.6; P = .005), hemorrhagic shock at presentation (HR, 2.9; 95% CI, 1.0-8.2; P = .048), aorto-enteric fistulae (HR, 3.3; 95% CI, 1.3-8.4; P = .011), fungal coinfection (HR, 3.5; 95% CI, 1.2-11.5; P = .030), and infection with resistant micro-organisms (HR, 3.1; 95% CI, 1.1-8.3; P = .023) were significantly associated with worse survival without sepsis.In-hospital and aortic-related mortality were significant, but with salvage surgery and antibiotic therapy, the median survival was 3 years. Sepsis recurrence remained frequent, and further procedures were needed. These outcomes should be considered when graft excision is proposed. Known predictors of adverse outcomes should become important points for discussion in multidisciplinary team meetings.

Background New diagnostic tools have been developed to improve the diagnosis of infectious encephalitis. Using a prospective cohort of encephalitis patients, our objective was to identify possible clusters of patients with similar patterns among encephalitis of unknown cause (EUC) and to describe to what extent a patient’s initial presentation may be predictive of encephalitis etiology, particularly herpes simplex virus (HSV) and varicella-zoster virus (VZV). Methods The National Cohort of Infectious Encephalitis in France is an ongoing prospective cohort study implemented in France in 2016. Patients who present with documented or suspected acute infectious encephalitis were included. Focusing on the variables that describe the initial presentation, we performed a factor analysis of mixed data (FAMD) to investigate a pattern of association between the initial presentation of a patient and the etiologic pathogen. Results As of 1 August 2018, data from 349 patients were analyzed. The most frequent pathogens were HSV (25%), VZV (11%), tick-borne encephalitis virus (6%), Listeria (5%), influenza virus (3%), and EUC (34%). Using the FAMD, it was not possible to identify a specific pattern related to the group of EUC. Age, temporal or hemorrhagic lesions, and cerebral spinal fluid lymphocytosis were significantly associated with HSV/VZV encephalitis. Conclusions No initial clinical/imaging/biology pattern was identified at admission among EUC, despite the improvement in diagnostic tools. In this context, the recommendation for a universal, early, probabilistic, initial treatment against HSV and VZV is still relevant, regardless of the initial clinical presentation of the encephalitis.

International audience; We report 5 cases of vascular Q fever complicated by polymicrobial superinfection in patients who had no risk factors for acute Q fever. Q fever was diagnosed by serologic and molecular assays for Coxiella burnetii. We confirmed additional infections using conventional graft cultures.

Bartonella alsatica is a wild rabbit pathogen causing bacteremia rarely reported in humans, with only three cases published so far, including one lymphadenitis and two endocarditis cases. Here, we report the case of a 66-year-old man who suffered from acute renal failure due to a membranoproliferative glomerulonephritis. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) showed diffuse FDG uptake around the aortobifemoral graft with no indication of infection. A white blood cell scan showed an accumulation of labeled neutrophils on the left femoral part of the graft. The patient underwent surgery and an abscess around the left iliac part of the graft was found intraoperatively. Intraoperative samples were all negative, but 16S rRNA gene-based PCR was positive, and the sequence was positioned among the Bartonella species cluster. Specific PCRs targeting groEL/hsp60, rpoB and gltA genes were performed and led to the identification of B. alsatica. Accordingly, indirect immunofluorescence serological analyses were positive for Bartonella henselae and Bartonella quintana. The patient had a history of regularly hunting wild rabbits. He was treated with 100 mg of doxycycline twice a day for six months and his renal function significantly improved with no sign of persistent infection. This case highlights the contribution of serology assays and molecular-based methods in prosthetic vascular graft infection diagnosis.

The purpose of the present study was to evaluate the survival and freedom from reinfection for patients with infected native aortic aneurysms (INAAs) treated with in situ revascularization (ISR), using either open surgical repair (OSR) or endovascular aneurysm repair (EVAR), and to identify the predictors of outcome.Patients with INAAs who had undergone ISR from January 2005 to December 2020 were included in the present retrospective single-center study. The diagnosis of INAAs required a combination of two or more of the following criteria: (1) clinical presentation, (2) laboratory results, (3) imaging findings, and (4) intraoperative findings. The primary endpoint was 30-day mortality. The secondary endpoints were in-hospital mortality, estimated survival, patency, and freedom from reinfection using the Kaplan-Meier method. The predictive factors for adverse outcomes were evaluated using the Mann-Whitney U test or the Fisher exact test and multivariate regression analysis.A total of 65 patients (53 men [81.5%]; median age, 69.0 years; interquartile range, 61.5-75.0 years) were included, 31 (47.7%) were immunocompromised, 60 were symptomatic (92.3%), and 32 (49.2%) had presented with rupture, including 3 aortocaval fistulas (4.6%) and 12 aortoenteric fistulas (18.5%). The most common location was infrarenal (n = 39; 60.0%). Of the 65 patients, 55 (84.6%) had undergone primary OSR with ISR, 3 (4.6%) had required EVAR as a bridge to OSR, and 8 (12.3%) had undergone EVAR as definitive treatment. The approach was a midline laparotomy for 44 patients (67.7%), mostly followed by reconstruction and aortic-aortic bypass (n = 28; 40.6%) and the use of a silver and triclosan Dacron graft (n = 30; 43.5%). Causative organisms were identified in 55 patients (84.6%). The 30-day and in-hospital mortality rates were 6.2% (n = 4) and 10.8% (n = 7). The median follow-up was 33.5 months (interquartile range, 13.6-62.3 months). The estimated 1- and 5-year survival rates were 79.7% (95% confidence interval [CI], 67.6%-87.7%) and 67.4% (95% CI, 51.2%-79.3%). The corresponding freedom from reinfection rates were 92.5% (95% CI, 81.1%-97.1%) and 79.4% (95% CI, 59.1%-90.3%). On multivariate analysis, in-hospital mortality increased with uncontrolled sepsis (P .0001), rapidly expanding aneurysms (P = .008), and fusiform aneurysms (P = .03). The incidence of reinfection increased with longer operating times (P = .009).The selective use of ISR and OSR combined with targeted antimicrobial therapy functioned reasonably well in the treatment of INAAs, although larger, prospective, multicenter studies with appropriately powered comparative cohorts are necessary to confirm our findings and to determine the best vascular substitute and precise role of EVAR as a bridge to OSR or definitive treatment.

Patients in hemodialysis on central venous catheter as vascular access are at risk of infections. Catheter-related bloodstream infection is one of the most serious catheter-complications in hemodialysis patients. Its clinical and microbiological diagnosis is challenging. The implementation of empiric antibiotic therapy is based on old recommendations proposing the combination of a molecule targeting methicillin-resistant Staphylococcus aureus and a betalactamin active on P. aeruginosa, and also adapting this probabilistic treatment by carrying out a microbiological register on a local scale, which is rarely done. In our hemodialysis center at Bordeaux University Hospital, an analysis of the microorganisms causing all catheter-related bloodstream infection over the period 2018-2020 enabled us to propose, in agreement with the infectious disease specialists, an adapted probabilistic antibiotic therapy protocol. This approach allowed us to observe a low incidence of meticillinoresistance of Staphylococcus. For catheters inserted more than 6 months ago, we observed no Staphylococcus, no multi-resistant Pseudomonas, and only 2% of Enterobacteria resistant to cephalosporins. A frequent updating of the microbiological epidemiology of catheter-related bloodstream infection, in partnership with the infectious diseases team in each hemodialysis center, allowing an adaptation of the probabilistic antibiotic therapy, and seems to have a good feasibility. This strategy might favor the preservation of microbial ecology on an individual and collective scale in maintenance hemodialysis patients.

International audience; We describe the fourth cases of arterial aneurysm consecutive to Capnocytophaga canimorsus infection in a 77-year-old man. The infection occurred after a dog bite. He presented fever. The thoracic-abdominal computed tomography angiography revealed aneurysms on the abdominal aorta, left common femoral artery, and left popliteal artery. The diagnosis was performed by a blood culture positive for Capnocytophaga canimorsus. The outcome was favorable with surgery and antibiotic therapy.

Background Measles remains endemic worldwide, despite current vaccination recommendations, and is associated with high morbidity and mortality rates. We describe all cases hospitalized in Bordeaux University Hospital (BUH), the starting point of a national significant measles outbreak in 2017–2018. Methods In this retrospective study, we included all patients hospitalized in BUH from September 1, 2017, to May 31, 2018. Inclusion criteria were age >1 year, clinical symptoms, and biological confirmation by measles immunoglobulin M or measles reverse transcription polymerase chain reaction positivity. Results We included 171 patients. Most patients were immunocompetent; only 19% had preexisting medical histories. Most patients had rash and fever (97%), but some cases were atypical and difficult to diagnose. Köplik’s spots were reported in 66 cases (38%). The most frequent biological markers were blood inflammation markers (96%) and lymphopenia (81%). Unexpectedly, we found hyponatremia ( Conclusions During the BUH outbreak, measles was often complicated and sometimes atypical. Vaccination coverage was dramatically insufficient. We also describe vaccination failure cases that must be better investigated.

Objectives: Vascular graft infections (VGIs) are severe and require prolonged adequate antimicrobial therapy. However, up to 45% of conventional cultures are negative. Sonication and genus specific PCRs for microbiological diagnosis of VGI was evaluated. Methods: Samples were prospectively obtained from explanted vascular grafts in Bordeaux University Hospital. Conventional bacterial cultures with and without prior sonication of samples were performed. A genus specific PCR assay panel, targeting the most frequent bacteria involved in VGI (Staphylococcus, Streptococcus, Enterococcus, and Enterobacteriaceae), was also applied to sonicate fluids. The performance of these three diagnostic strategies was compared. Results: Forty-five patients (118 samples) were included between July 2014 and October 2015. Six patients had no infection and 39 had a VGI. Sensitivities of graft culture, sonicate fluid culture, and genus specific PCR were 85.7%, 89.7%, and 79.5%, respectively. Specificities were 100%, 100%, and 83.3%, respectively. Sonicate fluid culture was positive for five graft samples (from four patients) with negative culture without sonication. Four VGIs were detected by PCR only (3 patients had previously received antibiotics). For 15 patients with positive graft cultures, PCR identified at least one additional bacterium compared with culture, thus 30 additional bacteria for all included patients. By combining sonicate fluid culture and PCR, a microbiological diagnosis was obtained for all patients with VGI. Conclusions: There was no statistical difference between performances of culture with and without sonication and genus specific PCR. However, combining sonicate fluid cultures and PCR may be the best strategy for microbiological diagnostic of VGI.

Many clinical manifestations can be related to Tropheryma whipplei infection. We report a Tropheryma whipplei limbic encephalitis developed as a relapse of classical Whipple’s disease. This case is to the best of our knowledge the first proof of the effective brain–blood barrier crossing of both doxycycline and hydroxychloroquine as demonstrated by direct concentration monitoring on brain biopsy.

International audience; Objectives. - Limited data on Mycoplasma genitalium infection has been reported among PrEP users. The aim of this study was to estimate the prevalence and macrolide resistance of M. genitalium infection among enrollees in a French PrEP program. Patients and methods. - M. genitalium infection screening was systematically and prospectively proposed to patients of the Bordeaux PrEP program (between January 2016 and February 2017). Macrolide resistance was evaluated in M. genitalium-positive patients. Results. - Among 89 clients, M. genitalium infection prevalence was 10% (mainly asymptomatic) with a high rate of macrolide resistance (58%). Conclusions. - Because of a high level of macrolide resistance, a systematic search for M. genitalium macrolide resistance associated-mutations may be recommended in PrEP users before initiating the antibiotic therapy.

Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography integrated with computed tomography (A retrospective single centre study was conducted on patients undergoing WBC scan andThirty-nine patients were included, of whom 15 had PVGI. Antibiotic treatment was started before nuclear imaging for 16 patients, including nine patients with a PVGI. The 96 grafts of these patients were analysed, and 19 were infected. The diagnostic value of the WBC scan was significantly higher thanThe WBC scan has a better diagnostic value than

Introduction La rougeole reste une infection virale potentiellement severe, endemique dans le monde malgre les campagnes de vaccination. Nous decrivons les cas hospitalises au CHU de Bordeaux, point de depart d’une nouvelle epidemie de grande ampleur en 2017–2018 en France. Materiels et methodes De facon retrospective, nous avons inclus tous les patients hospitalises au CHU de Bordeaux du 1er septembre 2017 au 31 mai 2018. Les criteres d’inclusion etaient un âge superieur a 1 an, des signes cliniques compatibles avec la rougeole et une confirmation biologique du diagnostic par serologie (IgM positives) et/ou par PCR. Les virus etaient ensuite sequences pour genotypage (centre de reference). Resultats Cent-soixante et onze patients ont ete inclus, dont 125 adultes et 46 enfants. L’âge moyen etait de 22,7 ans et le sex-ratio 1/1. La duree moyenne d’hospitalisation etait de 4,9 jours. La plupart des patients (98,5 %) presentaient une eruption cutanee febrile, avec pourtant une errance diagnostique au debut de l’epidemie. Une toux etait presente dans 88 % des cas (151) avec une catarrhe oculo-nasale dans 65 % des cas (112). Le signe de Koplik etait probablement sous-diagnostique avec une frequence rapportee de 38,5 % (soit 66 patients). Les signes biologiques les plus frequents etaient un syndrome inflammatoire biologique (73 %), une lymphopenie (65 %) et une thrombopenie (32 %). De facon inhabituelle, une hyponatremie ( Soixante-cinq patients (38 %) ont presente une forme jugee grave : 47 pneumopathies, 54 hepatites, 7 keratites bilaterales et 10 formes neurologiques, dont un syndrome de Guillain Barre et une encephalite a inclusions chez une adolescente immunodeprimee, decedee dans les suites. Au total, 8 patients ont ainsi necessite une hospitalisation prolongee en soins intensifs. Sur ces cas hospitalises potentiellement severes, 136 patients (80 %) n’etaient pas correctement vaccines (moins de deux injections), parmi lesquels 28 soignants. A noter, 49 patients ont developpe une authentique infection rougeoleuse malgre des IgG positives (vaccination prealable ou antecedent viral). Conclusion La rougeole reste actuellement frequente dans le monde et les formes graves ne sont pas rares, y compris en France : 171 hospitalisations dont 65 pour formes graves sont decrites dans cette epidemie bordelaise. La population francaise reste sous-vaccinee ; neanmoins, cette vaccination pourrait etre insuffisante dans certains cas (IgG + ) qui seront detailles dans un autre travail.

Data on the occurrence of STIs among men who have sex with men (MSMs) who access pre-exposure prophylaxis (PrEP) in France are lacking, especially about Mycoplasma genitalium (Mgen). We previously reported on the prevalence of STIs in a population who completed 1 year of PrEP at the Bordeaux University Hospital; prevalence of Mgen was 11% (9/89) in this study.1 Here, we report findings from a prospective study conducted in …

Objectives Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro- d -glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) and white blood cell (WBC) scan for the diagnosis of PVGI were compared. Methods A retrospective single centre study was conducted on patients undergoing WBC scan and 18F-FDG PET/CT for a suspected PVGI between April 2013 and June 2016 at the Bordeaux University Hospital, France. The diagnostic value of both imaging tests was assessed for all grafts, using receiver operating characteristic (ROC) curve analysis. Images were independently interpreted by two nuclear medicine physicians blinded to the patients’ clinical and other imaging data. Results Thirty-nine patients were included, of whom 15 had PVGI. Antibiotic treatment was started before nuclear imaging for 16 patients, including nine patients with a PVGI. The 96 grafts of these patients were analysed, and 19 were infected. The diagnostic value of the WBC scan was significantly higher than 18F-FDG PET/CT (ROC AUC = 0.902, 95% CI 0.824–0.980, and 0.759, CI 95% (0.659–0.858), respectively, p = .0071). Interobserver agreement was good for 18F-FDG PET/CT and excellent for WBC scan (kappa value of 0.76, 95% CI 0.62–0.9, and 0.97, 95% CI 0.92–1, respectively). Only one patient had a false negative 18F-FDG PET/CT result under antibiotic therapy. Conclusion The WBC scan has a better diagnostic value than 18F-FDG PET/CT for PVGI diagnosis.

Introduction : le traitement des infections de prothese de hanche (PTH) et de genou (PTG) par changement de l’implant en un ou deux temps avec antibiotherapie correspond a des procedures complexes qui peuvent etre associees a des complications. La survenue d’evenements indesirables severes (EIS) et leur facteur de risque associes au cours de cette prise en charge a ete cependant peu evaluee. Objectif : l’objectif de notre etude etait la description des EIS lors de la prise en charge medico-chirurgicale des IPA de hanche et de genou, et l’identification des facteurs de risque associes a leur survenue. Patients et methode : Etude retrospective incluant les patients traites pour infection de PTH ou de PTG dans un centre de reference infections osteo-articulaires (CRIOA) avec changement de l’implant en 1 ou 2 temps. L’objectif etait de decrire les EIS de grades ≥3 survenus dans les 6 semaines suivant le debut de prise en charge chirurgicale de l’infection (classification CTCAE ; grade 3 : evenement significatif sans mise en jeu du pronostic vital, grade 4 : mise en jeu du pronostic vital, grade 5 : deces). Resultats : cent dix-huit patients ont ete identifies entre le 1er janvier 2013 et le 31 decembre 2017. L’âge moyen etait de 71 ans (extremes : 43-90 ans) et 66 patients etaient de sexe masculin (55,9 %). Soixante-treize patients (61,9 %) avaient une infection de PTH et 45 patients (38,1 %) une infection de PTG. Les patients avaient les comorbidites suivantes : cardiopathies (n = 47, dont 18 patients sous AVK et 6 sous AOD), immunodepression ou antecedent de neoplasie (n = 37), diabete (n = 18), obesite (n = 16) ou insuffisance renale chronique (n = 8). Nous avons observe 191 evenements indesirables tous grades, dont 71 EIS survenus chez 50 patients (42,3 %). Seize EIS correspondaient a une evolutivite de l’infection. Les 55 EIS restants sont survenus chez 41 patients (34.7 %). Il s’agissait de 47 EIS grade 3 et 8 EIS grade 4. Ces 55 EIS se repartissaient comme suit : 17 saignements necessitant transfusion, 9 de nature cardio-pulmonaire, 7 lies aux antibiotiques, 8 de nature infectieuse sans lien avec l’IOA, 5 insuffisances renales aigues et/ou troubles ioniques, 4 complications mecaniques chirurgicales, 4 EIS neurologiques ou digestifs et 1 EIS hematologique. Les facteurs de risque identifies ont ete la prise en charge en deux temps operatoire, avec un OR a 4,27 IC95 % [1,31-13,92], p = 0,016 et l’obesite avec un OR a 3,49 IC95 % [1,01-11,98], p = 0,047. Conclusion : la survenue d’EIS est frequente dans les 6 semaines suivant un changement de prothese articulaire pour infection et est en relation avec la frequence des comorbidites dans cette population. Les facteurs de risque significativement associes a ces EIS sont l’obesite et le changement prothetique en deux temps operatoire.

Introduction Les infections asymptomatiques a Mycoplasma genitalium (Mg) augmentent chez les HSH, en particulier au niveau rectal. La resistance de Mg aux macrolides est frequente. Dans une etude australienne, apres un traitement sequentiel a base de doxycycline, 95 % des infections genito-urinaires a Mg sensibles aux macrolides etaient gueries. Notre objectif etait d’evaluer differentes strategies therapeutiques, dont le traitement sequentiel, chez les HSH ayant une infection rectale asymptomatique a Mg. Materiels et methodes Les HSH avec une technique d’amplification des acides nucleiques (TAAN, Aptima®, Hologic) anale positive a Mg sans symptomes ont ete inclus prospectivement du 01/11/2017 au 14/09/2018. La recherche de resistance aux macrolides a ete realisee par methode commercialisee (SpeeDx®). Le traitement etait : – en cas de prelevement sensible aux macrolides ou de sensibilite indeterminee (non amplifiable, NA), azithromycine 1,5 g sur 5 j (AZT) ; ou traitement sequentiel par doxycycline 200 mg par jour 7 j, puis AZT 1,5 g sur 5 j, et recherche de Mg par TAAN au 7e jour ; – en cas de resistance aux macrolides, moxifloxacine 400 mg par jour pendant 7 j. L’efficacite du traitement etait definie par une negativation du TAAN a la 5e semaine. Une PCR quantitative ciblant Mg et une recherche de resistance aux macrolides etaient faites a chaque prelevement Mg-positif. Resultats Sur la periode, 28 patients ont ete inclus, 11 etaient infectes par le VIH et 5 ont ete perdus de vue. L’âge moyen etait de 36 ans. Au diagnostic, 14 prelevements etaient sensibles aux macrolides (n = 3) ou NA (n = 11). Sept patients ont ete traites par AZT et 7 par traitement sequentiel. Quatorze echantillons etaient resistants aux macrolides (50 %), 2 patients y avaient ete prealablement exposes. Le traitement a ete efficace chez 70 % des patients (16/23) dont : – 5/6 (83 %) sous AZT (dont 5 NA) ; – 2/6 (33 %) sous traitement sequentiel (dont 6 NA) ; – 9/11 (82 %) sous moxifloxacine, sans resistance a la moxifloxacine en cas d’echec therapeutique. Quatre patients ont developpe une resistance acquise aux macrolides (1 sous AZT, 3 au cours du traitement sequentiel). Conclusion La resistance de Mg aux macrolides chez les HSH est tres elevee (50 %), en particulier chez des patients prealablement exposes. Dans cette etude, le traitement sequentiel n’a pas ete plus efficace que l’AZT seule mais la posologie d’AZT etait plus faible que dans d’autres travaux sur le traitement sequentiel. Il n’a pas ete possible de montrer si la doxycycline permettait de diminuer la charge bacterienne, comme decrit dans certaines autres etudes, en raison du grand nombre de prelevements NA. Notre etude objective la difficulte du traitement des infections anales asymptomatiques a Mg, qu’il n’est plus recommande de traiter.

International audience; Objectives The aim was to compare the antimicrobial efficacy of four different grafts: a standard graft (Intergard, IG), an IG graft soaked in rifampicin (IGrif), a silver impregnated graft (Intergard Silver, IGS), and a silver + triclosan impregnated graft (Intergard Synergy, IGSy). Methods This was a seven day in vitro study. The IG, IGrif, IGS, and IGSy grafts were each contaminated separately with the following microorganisms: Staphylococcus epidermidis, Methicillin resistant Staphylococcus aureus (MRSA), Escherichia coli, and Candida albicans from both clinical and American Type Culture Collection (ATCC) origins. The in vitro antimicrobial efficacy was evaluated by time to kill assays at T0, T24h, T48h, T72h, and T168h. Bactericidal activity was defined as >3 log10 reduction factor (logRF). Additionally, Rifampicin, triclosan and silver resistance development were screened. Results As anticipated for the non-antimicrobial IG, all microorganism strains proliferated. The IGSy and the IGS showed a seven day bactericidal efficacy (>3 logRF) for all tested microorganisms. This efficacy was confirmed at all time points for IGSy only, demonstrating faster bactericidal efficacy than IGS. The IGrif demonstrated a seven day bactericidal efficacy against the ATCC MRSA only, while showing no activity against C. albicans and ATCC E. coli. Regarding ATCC S. epidermidis, clinical MRSA and clinical E. coli, IGrif, although bactericidal at earlier time points, lost its antimicrobial efficacy at seven days leading to the emergence of rifampicin resistant mutants in four of six, two of six, and two of six assays, respectively. Mutant strains were also detected in ATCC MRSA in one of six assays. No triclosan or silver resistance has emerged at T7days. Conclusion For all microorganisms tested, the Synergy graft combining silver with triclosan demonstrated a more sustainable and efficient seven day antimicrobial activity than the rifampicin soaked graft. The emergence of rifampicin resistant mutants suggests preference for a Synergy graft over a graft soaked in rifampicin, to prevent or treat an infection when a biological solution is not feasible.

Objectives The aim was to compare the antimicrobial efficacy of the silver impregnated collagen coated polyester vascular graft (IGS) with an identical graft combining silver and triclosan (IGSy). Methods This was an in vitro study. A non-antimicrobial collagen polyester vascular graft served as control (IG). The IG, IGS, and IGSy grafts were contaminated separately with inoculates of each of the following micro-organisms: Staphylococcus epidermidis (SE), methicillin resistant Staphylococcus aureus (MRSA), and Escherichia coli producing extended spectrum beta-lactamase (ESBL-EC) or Candida albicans (CA). MRSA, ESBL-EC, and CA were obtained from retrieved infected grafts. The in vitro antimicrobial efficacies of the contaminated grafts were evaluated by time to kill assays over a 24 hour period in accordance with CLSI Guideline M26-A. All assays were repeated six times. Bacterial survival numbers were obtained at 1, 4, 8, and 24 hours using a standard plate count procedure. Bactericidal activity was defined as a 3 log 10 reduction factor (logRF). To calculate the overall difference in the mean log 10 CFU/mL within 24 hours, a one way ANOVA with a Bonferroni correction was calculated separately for each graft. Results The IG graft showed an increase in the number of viable organisms for the four strains tested. IGSy offered better antimicrobial properties than IGS for both ESBL-EC and MRSA, since only the IGSy graft achieved > 3 logRF and fulfilled the standard criteria for bactericidal activity at 24 hours with 3.78 and 4.08 logRF, respectively. For samples inoculated with SE and CA, both antimicrobial grafts achieved 24 hour bactericidal activity with > 3 logRF. However, for CA the one-way ANOVA analysis demonstrated that the IGSy graft performed differently in terms of speed of antimicrobial action, appearing more active as early as 4 hours following inoculation ( p = .007). Conclusion In the in vitro conditions, the Synergy vascular graft combining silver with triclosan demonstrated better short-term antimicrobial activity than the silver graft for all micro-organisms tested.

Introduction Le pronostic des infections de protheses vasculaires (IPV) est greve d’un taux de mortalite eleve. Un diagnostic fiable et precoce, souvent difficile en particulier dans les IPV latentes est un pre-requis indispensable a l’amelioration de la prise en charge therapeutique de ces infections. Notre etude a compare, chez des patients suspects d’IPV, l’exactitude diagnostique de la tomographie par emission de positons marques au 18F-Fluorodesoxyglucose (18F-FDG TEP) et de la scintigraphie aux leucocytes marques au 99mTc (SLM), toutes deux couplees a la tomodensitometrie. Materiels et methodes Etude prospective monocentrique menee entre avril 2013 et juin 2016. Tous les patients adresses en medecine nucleaire pour une suspicion d’IPV sous-diaphragmatique etaient inclus. Le diagnostic d’IPV etait etabli a la fin du suivi selon les criteres de Fitzgerald. L’exactitude diagnostique des deux examens a ete comparee pour toutes les protheses, avec une double lecture. Trois echelles visuelles differentes ont egalement ete comparees pour l’interpretation de la 18F-FDG TEP, deux echelles precedemment publiees et une echelle elaboree dans le cadre de notre reunion de concertation pluridisciplinaire. Resultats Trente-quatre patients ont ete inclus, 14 presentaient une IPV. Un traitement antibiotique a ete debute avant les examens d’imagerie nucleaire chez 14 patients, dont huit atteints d’IPV. Nous avons analyse 93 protheses vasculaires, dont 18 infectees. En TEP, l’exactitude diagnostique de notre echelle diagnostique semblait etre superieure aux deux autres precedemment publiees (87,1 % contre 72 % et 80,7 %, respectivement, p = 0,017 et 0,32). L’exactitude diagnostique de la SLM etait de 92,5 % [IC 95 % (85,3–96,3)], non significativement superieure a celle de la TEP a 87,1 % [IC 95 % (78,8–92,5)], p = 0,33. Dans le sous-groupe des protheses thrombosees, il n’a pas ete mis en evidence de difference diagnostique significative entre ces deux examens d’imagerie (respectivement 96,9 % et 93,8 %, p = 1). La reproductibilite inter-observateurs etait excellente pour les deux examens. Les valeurs predictives negatives de la TEP et de la SLM etaient excellentes, respectivement 98,5 et 98,6 %. Aucun cas de faux negatif en TEP ou en SLM n’a ete observe dans le sous-groupe des patients sous antibiotiques (comme cela est parfois le cas dans d’autres types d’infection). Conclusion Cette etude confirme les bonnes performances de la TEP et de la SLM dans le diagnostic des IPV. De plus, l’exactitude diagnostique de la SLM semble etre legerement superieure.

Les infections de protheses vasculaires (IPV) sont associees a des taux de mortalite eleves et de diagnostic difficile. Differentes etudes evaluant les performances de la TEP au 18-FDG (TEP) ont ete publiees utilisant cependant souvent des criteres d’interpretation differents. De plus, ces echelles visuelles d’interpretation semblent presenter des insuffisances dans cette pathologie. Nous avons donc compare, a partir d’une etude prospective, les performances de 3 echelles visuelles d’interpretation pour le diagnostic d’IPV. Methodes Etude prospective monocentrique incluant des patients ayant beneficie d’une TEP pour suspicion d’IPV entre avril 2013 et juin 2016 au CHU de Bordeaux. Ont ete exclues les protheses aortiques thoraciques. Le diagnostic d’IPV a ete confirme ou infirme en utilisant les criteres de Fitzgerald a la fin du suivi. La performance de 3 echelles a ete comparee pour chaque prothese, 2 deja publiees dans la litterature (Sah et Fukushi), la 3e a 5 point issue de notre experience. Resultats Trente-quatre patients ont ete inclus, 14 avaient une IPV. Dix-huit des 93 protheses analysees etaient infectees. La sensibilite, specificite, VPP, VPN et l’exactitude etaient, respectivement, pour l’echelle de Sah de 83 %, 69,3 %, 39,5 %, 94,6 %, 72 %, de Fukushi de 66,7 %, 84 %, 50 %, 91,3 %, 80,7 % et pour notre echelle de 94,4 %, 85,3 %, 60,7 %, 98,5 %, 87,1 %. Il existe une difference significative entre les performances de notre echelle et celle de Sah (p = 0,017) mais, meme s’il existe une tendance, il n’y pas de difference significative entre notre echelle et celle de Fukushi (p = 0,32). Il existe cependant une difference significative concernant les protheses thrombosees, notre echelle etant significativement plus performante (p = 0,043). L’accord entre observateurs (1 junior et 1 senior) etait excellent pour notre echelle (K = 0,9) et bon pour les echelles visuelles de Sah (k = 0,78) et Fukushi (k = 0,72). Conclusion Cette etude semble montrer une superiorite de notre echelle d’interpretation visuelle afin de diagnostiquer une infection de prothese vasculaire, notamment en presence de materiel thrombose. Une uniformisation de l’interpretation dans les etudes permettrait une meilleure evaluation des performances de la TEP au 18-FDG.

Introduction Les infections de protheses vasculaires (IPV) sont associees a des taux de mortalite eleves. Le diagnostic est souvent difficile, surtout dans les infections latentes. Pour ameliorer le resultat du traitement medical et chirurgical, un diagnostic precoce et precis est primordial et les criteres de diagnostic reels sont souvent insuffisants. Si la tomographie par emission de positons marquee 18F-fludeoxyglucose (TEP) et la scintigraphie aux leucocytes radiomarques (SLM) ont de bonnes performances dans cette indication, une seule etude et sur une petite serie de patients a, a ce jour, compare les deux examens. Notre etude a pour but de comparer de facon prospective, sur une plus large serie de patient, les performances de la TEP et de la SLM pour le diagnostic d’IPV. Materiel et methodes Etude prospective monocentrique incluant des patients beneficiant d’une SLM et d’une TEP pour suspicion d’IPV entre avril 2013 et juin 2016 au CHU de Bordeaux. Ont ete exclues les protheses aortiques thoraciques. Le diagnostic d’IPV a ete confirme ou non en accord avec les criteres de Fitzgerald a la fin du suivi. La precision des deux examens a ete comparee pour chacune des 93 protheses. Resultats Trente-quatre patients ont ete inclus, 14 avaient une PVGI. Dix-huit des 93 protheses analysees etaient infectees. La sensibilite, specificite, VPP, VPN et exactitude etaient, respectivement, pour la scintigraphie de 94,4 %, 92 %, 73,9 %, 98,6 %, 92,5 % et pour la TEP de 94,4 %, 85,3 %, 60,7 %, 98,5 %, 87,1 %. Il n’y pas de difference significative (p = 0,33). Le SUV max moyen etait de 6,2 (4,9–9,1) pour les protheses infectees et 3,7 (2,1–5,2) pour les protheses non infectees. L’accord entre observateurs (1 senior et 1 junior) etait excellent pour les deux examens (kappa = 0,90 et 0,97). Conclusion Cette etude a mis en evidence d’excellentes performances diagnostiques de la TEP et de la SLM pour le diagnostic d’IPV avec un excellent accord inter observateur. Il n’est pas retrouve dans cette etude comparative de difference significative. L’antibiotherapie ne semble pas influencer les performances de ces deux examens.

Background: aortitis etiological diagnosis is often challenging, particularly between infectious aortitis (IA) and non-infectious aortitis (NIA). This study aims to describe and compare the clinical, biological and radiological characteristics of IA and NIA and their outcomes. Methods: a multicentric retrospective study was performed in 10 French centers, including patients who have been diagnosed with aortitis between January 1st, 2014 and December 31st, 2019. Results: IA was diagnosed in 66 patients, mainly due to Enterobacterales and streptococci in 20% of cases respectively, followed by Staphylococcus aureus and Coxiella burnetii. NIA was diagnosed in 117 patients with a majority of systemic diseases (56.4%, mainly vasculitis) and idiopathic aortitis (39.3%). There were more aortic aneurysms in IA (78.8% vs 17.6% in NIA, p