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La mise en œuvre du GPS repose sur 3 piliers : (1) gerer l’anemie et l’hemostase, (2) reduire les pertes sanguines, (3) un usage de la transfusion fonde sur des donnees validees. L’interet des programmes de GPS a ete demontre dans la prevention des risques lies a l’anemie et a la transfusion, facteurs de morbi-mortalite et dans la diminution des couts lies a la transfusion. A Brest, des programmes ont ete inities dans plusieurs specialites. Nous rapportons notre experience. Un groupe de travail pilote a ete constitue comprenant des professionnels des reanimations medicale et chirurgicale, chirurgies cardiaque et orthopedique, hematologie, biologie, hemovigilance, unite d’evaluation. Un etat des lieux a ete realise et un plan d’actions global et selon la specialite finalisee. La demarche a ete presentee a la CME par le chef de projet. Resultats (1) la pertinence des bilans pre-operatoires a ete revue et des recommandations ont ete proposees. La diminution du volume des tubes preleves a ete discutee. La prise en charge des anemies pre-operatoires est mise en place en orthopedie. Des appareils de biologie delocalisee sont utilises dans certains secteurs. (2) la reduction des pertes sanguines comprend l’utilisation des cell-saver si besoin, de l’Exacyl ® et l’hemostase chirurgicale. (3) les pratiques evoluent vers la prescription d’un seul CGR au lieu de 2, le fractionnement des delivrances 1 par 1 et des evaluations de la pertinence des transfusions dans tous les secteurs. Au CHRU, la demarche de GPS est bien avancee en chirurgie orthopedique et en cours dans d’autres secteurs. Des evaluations doivent etre menees afin de juger de l’efficacite de ce programme.

Shigellosis, commonly known as bacillary dysentery, is an enterobacterial disease caused by the Shigella genus, which now belongs to the Escherichia tribe, because of their genetic and phenotypic similarities. S. sonnei, flexneri, boydii and dysenteriae differ in their epidemiologic and pathogenic characteristics. S. sonnei is predominant in industrialized countries and causes the mildest disease. S. dysentery is especially dangerous because it occurs in outbreaks, sometimes in catastrophic situations, and has a high mortality rate. Shigellosis typically causes watery diarrhea followed by dysentery. It may be associated with a variety of mild to severe or even life-threatening complications. Shigellosis is a significant public health problem in developing countries where it remains a major cause of diarrhea-related morbidity and mortality, especially among children. Annual cases worldwide are estimated at 160 million. Shigellosis is a highly contagious disease of poor and crowded communities, with fecal-oral (hand-to-mouth) transmission, and an extremely low minimum infectious dose. Multidrug resistance is a serious problem. Ciprofloxacin is the first-line antibiotic, recommended for 3 days. Prevention and control should include personal hygiene, hand washing, sanitation, and water supply. No vaccine is available, but several candidates are currently being evaluated.

Il s’agit d’une femme gabonaise de 24 ans, drepanocytaire homozygote S/S ayant presente une necrose medullaire etendue. Cette derniere est survenue au decours d’une crise vaso-occlusive severe ayant necessite un echange transfusionnel. Les transfusions repetees de produits sanguins labiles ont permis une evolution favorable. Il s’agit ici de decrire une complication rare.

Campylobacter are known to be a cause of enteritidic infections but Campylobacter fetus is more often a cause of systemic infections, mainly in fragilized patients. We report a C. fetus endocarditis. The prognosis seemstobe improved by a prolonged betalactam antibiotic treatment.

Shigellosis, commonly known as bacillary dysentery, is an enterobacterial disease caused by the Shigella genus, which now belongs to the Escherichia tribe, because of their genetic and phenotypic similarities. S. sonnei, flexneri, boydii and dysenteriae differ in their epidemiologic and pathogenic characteristics. S. sonnei is predominant in industrialized countries and causes the mildest disease. S. dysentery is especially dangerous because it occurs in outbreaks, sometimes in catastrophic situations, and has a high mortality rate. Shigellosis typically causes watery diarrhea followed by dysentery. It may be associated with a variety of mild to severe or even life-threatening complications. Shigellosis is a significant public health problem in developing countries where it remains a major cause of diarrhea-related morbidity and mortality, especially among children. Annual cases worldwide are estimated at 160 million. Shigellosis is a highly contagious disease of poor and crowded communities, with fecal-oral (hand-to-mouth) transmission, and an extremely low minimum infectious dose. Multidrug resistance is a serious problem. Ciprofloxacin is the first-line antibiotic, recommended for 3 days. Prevention and control should include personal hygiene, hand washing, sanitation, and water supply. No vaccine is available, but several candidates are currently being evaluated.

Fuente TESIUNAM