No effect of vancomycin MIC ≥ 1.5 mg/L on treatment outcome in methicillin-susceptible Staphylococcus aureus bacteraemia

International audience; The vancomycin minimum inhibitory concentration (MIC) has been shown to affect the outcome of methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. In this study, the outcomes of patients with MSSA bacteraemia with a vancomycin MIC ≥ 1.5 mg/L were assessed. A prospective cohort of patients with MSSA bacteraemia in two tertiary-care hospitals was collected. The vancomycin MIC was determined by Etest. Staphylococcus aureus strains were categorised as low (<1.5 mg/L) or high (≥1.5 mg/L) vancomycin MIC. First- and second-line treatments were recorded and classified as optimal, appropriate and inappropriate. The primary endpoint was 30-day mortality. A total o…

Détection et identification de Fusarium spp. dans le réseau hydrique d’un centre hospitalier universitaire

Liver Fat Content in People with Pituitary Diseases: Influence of Serum IGF1 Levels

AbstractNon-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome, and type 2 diabetes. NAFLD is also seen in patients with endocrinopathies. However, the relationship between endocrine diseases and the development of NAFLD is not well known. In this study, we set out to determine whether liver fat content (LFC) was associated with IGF1 levels in people with pituitary diseases (PD). Eighty-nine patients with pituitary diseases and 74 healthy controls were included in this study. LFC was measured using MRI. Hepatic steatosis was defined as LFC&gt;5.5%. Patients with PD were older, and had a higher BMI than healthy controls. LFC was significantly higher…

Profiles and seasonal distribution of airborne fungi in indoor and outdoor environments at a French hospital

International audience; A one-year prospective survey of fungal air contamination was conducted in outdoor air and inside two haematological units of a French hospital. Air was sampled with a portable Air System Impactor. During this period of survey, the mean viable fungal load was 122.1 cfu/m(3) in outdoor air samples, and 4.1 and 3.9 cfu/m(3) in samples from adult and pediatric haematology units, respectively. In outdoor samples, Cladosporium was the dominant genus (55%) while in the clinical units, Penicillium sp. (23 to 25%), Aspergillus sp. (15 to 23%) and Bjerkandera adusta (11 to 13%) were the most frequently recovered airborne fungi. The outdoor fungal load was far higher in autumn…

Dynamics of fungal colonization in a new medical mycology laboratory

International audience; Objective of the study. - Study of the spatio-temporal fungal colonization in a new medical mycology laboratory. Methods. - A 17-month survey of airborne fungal contamination was conducted in a new medical mycology laboratory at a tertiary care university hospital. This survey was implemented at three different periods: before the new premises were occupied (period A), during the move into the new laboratory (period B) and after resumption of the mycological activities in these new premises (period C). Results. - During period A, the airborne fungal load ranged from 2.3 to 6 cfu/m(3). The most frequently recovered airborne fungi were Penicillium spp. (75 to 100%). Du…

N-Acetylaspartate/Creatine and Choline/Creatine Ratios in the Thalami, Insular Cortex and White Matter as Markers of Hypertension and Cognitive Impairment in the Elderly

International audience; Abstract: Our objective was to investigate the influence of hypertension on N-acetylaspartate (NAA) and choline (Cho) ratios in brain tissues in a community-dwelling elderly population. Brain flexibility was also evaluated with regard to the same metabolite ratios. Proton magnetic resonance spectroscopy (MRS) and the Trail Making Test (TMT) were performed in 80 subjects (75.7 +/- 4 years old) from the Three-City Study. Fifty-eight participants had hypertension. The NAA/creatine (Cr) and Cho/Cr ratios were obtained in the insular cortex, the thalami and the deep periventricular white matter. In addition, the B-A score of the TMT was evaluated. Uniand multi-variate ana…

Intravoxel incoherent motion diffusion-weighted imaging in nonalcoholic fatty liver disease: a 3.0-T MR study.

International audience; PURPOSE: To compare pure molecular diffusion, D, perfusion-related diffusion, D*, and perfusion fraction, f, determined from diffusion-weighted (DW) magnetic resonance (MR) imaging on the basis of the intravoxel incoherent motion (IVIM) theory in patients with type 2 diabetes with and without liver steatosis. MATERIALS AND METHODS: This prospective study was approved by the appropriate ethics committee, and written informed consent was obtained from all patients. Between December 2009 and September 2011, 108 patients with type 2 diabetes (51 men, 57 women; mean age, 50 years) underwent 3.0-T single-voxel point-resolved proton MR spectroscopy of the liver (segment VII…

Hydro-contamination fongique par Fusarium spp. en milieu hospitalier pendant une période de construction

Épidémiologie de populations de Fusarium oxysporum et F. dimerum en milieu hospitaliers à Dijon et Nancy

Fusarium oxysporum et F. dimerum sont des champignons d'origine tellurique présents dans de nombreux écosystèmes terrestres mais ils ont été récemment détectés dans les systèmes de distribution d'eau de bâtiments hospitaliers1. Une enquête épidémiologique incluant divers bâtiments hospitaliers sur différents sites, des complexes non-hospitaliers et des maisons individuelles a été menée pendant deux ans dans deux villes françaises, Dijon et Nancy. Les champignons ont été détectés seulement dans les canalisations de bâtiments hospitaliers et n'ont pas été détectés dans celles des autres immeubles ni dans l'eau du réseau urbain. Cette distribution surprenante s'explique par une combinaison de …

Adaptation inattendue de populations de Fusarium oxysporum et F. Dimerum au milieu aquatique urbain des conduites d'eau de bâtiments hospitaliers à Dijon et Nancyξ

National audience; Fusarium oxysporum et F. dimerum sont des champignons d'origine tellurique présents dans de nombreux écosystèmes terrestres mais ils ont été récemment détectés dans les systèmes de distribution d'eau de bâtiments hospitaliers. Une enquête épidémiologique incluant divers bâtiments hospitaliers sur différents sites, des complexes non-hospitaliers et des maisons individuelles a été menée pendant 2 ans dans deux villes françaises Dijon et Nancy. Les champignons ont été détectés seulement dans les canalisations de bâtiments hospitaliers et n'ont pas été détectés dans celles des autres immeubles ni dans l'eau du réseau urbain. Cette distribution surprenante s'explique par une c…

Glucagon-like peptide-1 is associated with poor clinical outcome, lipopolysaccharide translocation and inflammation in patients undergoing cardiac surgery with cardiopulmonary bypass.

International audience; Introduction: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with gut barrier dysfunction. Gut barrier dysfunction might be estimated non-invasively by lipopolysaccharide (LPS) plasma concentration. Glucagon-like peptide-1 (GLP-1) is a gut secreted hormone that is a potential marker of mucosal integrity. Our objective was to evaluate GLP-1 as a peri-operative marker of gut barrier dysfunction in patients undergoing cardiac surgery with CPB.Methods: GLP-1, intestinal fatty acid binding protein (I-FABP) and lipopolysaccharide were assayed: at induction, after CPB and 24 h after admission in the intensive care unit. The primary end-point was peri-operat…

Liver methylene fraction by dual- and triple-echo gradient-echo imaging at 3.0T: Correlation with proton MR spectroscopy and estimation of robustness after SPIO administration

Purpose To assess the systematic errors in liver methylene fraction (LMF) resulting from fat–fat interference effects with dual- and triple-echo gradient-recalled-echo Dual/Triple GRE) sequences and to test the robustness of these sequences after iron overloading. Materials and Methods Forty type-2 diabetic patients underwent LMF measurement by 3.0T 1H magnetic resonance spectroscopy (corrected for T1 and T2 decays) as the reference standard and liver fat fraction (%Fat) measurement by four Dual/Triple GRE sequences with 20° and 60° flip angle (α), corrected for T1 recovery. The same four sequences were repeated in eight patients after ferumoxide injection. Corrections for systematic errors…

Résultat et coût de la chimioembolisation hépatique avec des billes chargées chez 21 patients

Resume Objectif L’objectif de notre travail est d’evaluer le resultat et le cout global d’une strategie de traitement des patients atteints d’un carcinome hepatocellulaire (CHC) non resecable non metastatique par chimioembolisation (CHE) avec billes chargees. Patients et methodes L’ensemble des patients traites par CHE avec billes chargees pour un CHC entre janvier 2009 et decembre 2010 dans notre etablissement a ete inclus dans l’etude. Tous les patients etaient traites selon une strategie « a la demande » avec evaluation apres chaque cure de CHE. Resultats Vingt et un patients ont recu en moyenne 1,3 cures. La mediane de temps jusqu’a arret du traitement et la mediane de survie sans progr…

Adaptation of Fusarium oxysporum and Fusarium dimerum to the specific aquatic environment provided by the water systems of hospitals.

SPE IPM MERS EA; International audience; Members of the Fusarium group were recently detected in water distribution systems of several hospitals in the world. An epidemiological investigation was conducted over 2 years in hospital buildings in Dijon and Nancy (France) and in non-hospital buildings in Dijon. The fungi were detected only within the water distribution systems of the hospital buildings and also, but at very low concentrations, in the urban water network of Nancy. All fungi were identified as Fusarium oxysporum species complex (FOSC) and Fusarium dimerum species complex (FDSC) by sequencing part of the translation elongation factor 1- alpha (TEF-1a) gene. Very low diversity was …

Fusarium species recovered from the water distribution system of a French university hospital

Abstract Dijon Hospital is a French tertiary care institution undergoing major renovation, and different microbiological controls revealed the presence of Fusarium spp. in the water distribution system. Because some Fusarium spp. can cause life-threatening opportunistic infections in immunocompromised patients, an 8-month survey was conducted in two hospital sites in order to evaluate the prevalence of the fungi in the water system. In 2 units of one hospital site, 100% of the samples of tap-water were positive, with high concentrations of Fusarium spp. (up to 10 5  cfu/L). In the second hospital site, 94% of samples were positive, but generally with lower concentrations. The analysis of tr…

Adherence to immunomodulatory drugs in patients with multiple myeloma

Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomi…

Result and cost of hepatic chemoembolisation with drug eluting beads in 21 patients.

Abstract Purpose The aim of our study was to assess the results and cost of a treatment strategy involving transarterial chemoembolisation with drug eluting beads (DEB-TACE) in patients with unresectable non-metastatic hepatocellular carcinoma (HCC). Patients and methods This study included all patients treated with DEB-TACE in our hospital between January 2009 and December 2010. All patients received DEB-TACE on demand and were evaluated after each session. Results Twenty-one patients received an average of 1.3 sessions. The median time to treatment discontinuation and median progression-free survival was 181 days and 295 days, respectively. Toxicity caused treatment discontinuation in thr…

Molecular characterization of 39 de novo sSMC: contribution to prognosis and genetic counselling, a prospective study.

Small supernumerary marker chromosomes (sSMCs) are structurally abnormal chromosomes that cannot be characterized by karyotype. In many prenatal cases of de novo sSMC, the outcome of pregnancy is difficult to predict because the euchromatin content is unclear. This study aimed to determine the presence or absence of euchromatin material of 39 de novo prenatally ascertained sSMC by array-comparative genomic hybridization (array-CGH) or single nucleotide polymorphism (SNP) array. Cases were prospectively ascertained from the study of 65,000 prenatal samples [0.060%; 95% confidence interval (CI), 0.042-0.082]. Array-CGH showed that 22 markers were derived from non-acrocentric markers (56.4%) a…

Rapid and sensitive detection of metapneumovirus in clinical specimens by indirect fluorescence assay using a monoclonal antibody.

Human metapneumovirus, with two known genotypes named A and B, is associated with mild respiratory symptoms to severe LRTI in children, high-risk adults and the elderly. Rapid and reliable methods of hMPV detection in clinical samples are essential to implement appropriate care, to better understand the pathology of hMPV and to determine its epidemiology. Respiratory samples from 1,386 patients collected during 2 consecutive years were screened for hMPV using indirect immunofluorescence (IFA) assay with a monoclonal antibody. Forty-three patients tested positive for hMPV by the IFA method. In parallel, the samples were examined with RT-PCR on the F gene. Of these, 41 specimens were RT-PCR p…

Self‐management of immunomodulatory drug treatment in multiple myeloma patients

Objective Immunomodulatory drugs (IMIDs: thalidomide, lenalidomide and pomalidomide) are widely used in patients with multiple myeloma (MM). The aim of our study was to validate a questionnaire to evaluate the self-capacity of MM patients to manage IMID treatment including side effects. Methods We used a method adapted from the recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) to validate a French questionnaire for patients with MM treated with IMIDs. Results The face validity was evaluated in 15 patients and the construct validity in 56 patients. For discriminant validity, two groups were constituted by gender and depending on whether they had a prev…

A Clonal Lineage of Fusarium oxysporum Circulates in the Tap Water of Different French Hospitals.

ABSTRACT Fusarium oxysporum is typically a soilborne fungus but can also be found in aquatic environments. In hospitals, water distribution systems may be reservoirs for the fungi responsible for nosocomial infections. F. oxysporum was previously detected in the water distribution systems of five French hospitals. Sixty-eight isolates from water representative of all hospital units that were previously sampled and characterized by translation elongation factor 1α sequence typing were subjected to microsatellite analysis and full-length ribosomal intergenic spacer (IGS) sequence typing. All but three isolates shared common microsatellite loci and a common two-locus sequence type (ST). This S…

Absolute Humidity Influences the Seasonal Persistence and Infectivity of Human Norovirus

ABSTRACT Norovirus (NoV) is one of the main causative agents of acute gastroenteritis worldwide. In temperate climates, outbreaks peak during the winter season. The mechanism by which climatic factors influence the occurrence of NoV outbreaks is unknown. We hypothesized that humidity is linked to NoV seasonality. Human NoV is not cultivatable, so we used cultivatable murine norovirus (MNV) as a surrogate to study its persistence when exposed to various levels of relative humidity (RH) from low (10% RH) to saturated (100% RH) conditions at 9 and 25°C. In addition, we conducted similar experiments with virus-like particles (VLPs) from the predominant GII-4 norovirus and studied changes in bin…

Effect of Rotating Auditory Scene on Postural Control in Normal Subjects, Patients With Bilateral Vestibulopathy, Unilateral, or Bilateral Cochlear Implants.

International audience; Objective: The aim of this study was to investigate the impact of a rotating sound stimulation on the postural performances in normal subjects, patients with bilateral vestibulopathy (BVP), unilateral (UCI), and bilateral (BCD cochlear implantees.Materials and Methods: Sixty-nine adults were included (32 women and 37 men) in a multicenter prospective study. The group included 37 healthy subjects, 10 BVP, 15 UCI, and 7 BCI patients. The average of age was 47 +/- 2.0 (range: 23-82). In addition to a complete audiovestibular work up, a dynamic posturography (Multitest Framiral, Grasse) was conducted in silence and with a rotating cocktail party sound delivered by headph…

Contamination des circuits d’alimentation en eau par Fusarium

La decouverte de micromycetes du genre Fusarium dans le reseau hydrique du CHU de Dijon nous a conduit a mettre en place un protocole hospitalier de recherche clinique (PHRC) dont l’objectif a ete de decrire en prospectif, dans le temps et dans l’espace, la contamination par Fusarium dans l’eau de 2 CHU francais (Dijon et Nancy), a des periodes d’activites de restructuration et de construction. Cette etude a ainsi permis de mettre en evidence la presence chronique de Fusarium spp. dans les circuits de distribution de l’eau de certains bâtiments hospitaliers. Nous avons en effet observe que ces micromycetes etaient « installes » dans le reseau, que leur densite de population variait au cours…

Clinical severity and molecular characteristics of circulating and emerging rotaviruses in young children attending hospital emergency departments in France

International audience; Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children <5 years old attending the paediatric emergency units of 16 large hospitals. Rotaviruses were then genotyped by RT-PCR with regard to their outer capsid proteins VP4 and VP7. Genotyping of 4708 RVA showed that G1P[8] strains (62.2%) were predominant. The incidence of G9P[8] (11.5%), G3P[8] (10.4%) and …

Choroidal thickness in glaucoma patients and glaucoma suspects measured by spectral domain coherence optical tomography

Purpose: The aim of our study was to evaluate and compare retro-foveolar choroidal thickness (RFCT) of healthy subjects, individuals with intraocular hypertension, patients with primary open-angle glaucoma (POAG), patients with normal tension glaucoma (NTG) and patients with primary angle-closure glaucoma (PACG) by spectral domain optical coherence tomography (SD-OCT).Methods: Sixty-five healthy eyes, 30 eyes with intraocular hypertension, 90 eyes with POAG, 30 eyes with NTG and 20 eyes with PACG were included in this cross-sectional study. RFCT, foveolar retinal thickness and average retinal nerve fiber layer thickness (RNFL) were measured by SD-OCT (Spectralis HRA-OCT, Heidelberg Engineer…