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Objective Numerous cases of gentamicin underdosing have been described in the literature in the context of sepsis and septic shock in anaesthesia-intensive care units (ICU). A survey of clinical practice was conducted with the aim to rationalise the use of gentamicin in the unit. The secondary objective was to propose a corrective formula for adjusting individual dosage. Methods A single-centre survey was used to determine the initial dose of gentamicin administered, in an anaesthesia-ICU, during the first hours of sepsis/septic shock. An initial retrospective phase allowed focusing on the points of improvement in terms of prescription. A second prospective phase enabled the evaluation of benefits following the implemented changes. Results Fifty-one patients were included during the retrospective phase (2014–2015) and 28 patients during the prospective phase (2016–2017). Out-of-guideline prescriptions significantly decreased between these two study periods (i.e., pulmonary infections decreased from 70.5% to 18%, p

Pseudomonas aeruginosaclinical isolate CY-1, which was resistant to ceftazidime, harbored a conjugative ca. 250-kb plasmid that contained a class 1 integron with two gene cassettes encoding OXA-32, an OXA-2- type β-lactamase, and the aminoglycoside acetyltransferase AAC(6′)Ib9. OXA-32 differed from OXA-2 by an Leu169Ile amino acid substitution (class D numbering). Site-directed mutagenesis established that Ile169 is responsible for resistance to ceftazidime but not to cefotaxime.

Ce travail avait pour objectif de rationaliser les prescriptions d’examens immuno-hematologiques (IH) dans 3 chirurgies: cholecystectomie (CHOL) (cœlioscopie, laparotomie), appendicectomie (APP) (Mac Burney, cœlioscopie), cure de hernie parietale (HERN) (toutes techniques). Le DIM a fourni la liste des patients operes entre 2011 et 2015 (code CCAM) qui a ete confrontee a celle des receveurs extraite du logiciel Cursus (Guyot Walser) et des donnees IH extraites du logiciel Synergy (Technidata). Les dossiers des patients transfuses entre 3 j avant et 15 jours apres la chirurgie ont ete revus. Sur 772 CHOL, 10 ont ete transfuses: 5 CHOL contingentes d’une chirurgie a procedures multiples (CPM), 4 CHOL isolees non programmees, 1 cas de CHOL isolee programmee (plaie de l’artere cystique). Sur 434 APP, 2 ont ete transfusees dans un cadre de CPM. Sur 857 HERN, 6 ont ete transfuses: 2 HERN inscrites dans une CPM, 4 HERN isolees programmees (2 transfusions preoperatoires pour anemie, 2 postoperatoires pour complication d’un traitement anticoagulant). Au final, en dehors des CPM, le risque transfusionnel a ete estime a 0,2 % pour CHOL, 0 % pour APP et 0,5 % pour HERN. Un bilan IH (groupage et RAI) avait ete prescrit dans pres de 100 % des APP, 70 % des CHOL et moins de 10 % des HERN. En decembre 2016, la suppression du bilan IH systematique dans ces 3 chirurgies a ete validee et les prescripteurs concernes–anesthesistes et urgentistes–ont ete informes. Une comparaison entre les chirurgies realisees en 2017 et les 30 derniers actes realises en 2016 montre une reduction des prescriptions de bilan IH en cas d’APP (71 % vs. 17 %– p