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1.
C. Duployez C. Loïez C. Cattoen F. Wallet A. Vachée 《Médecine et maladies infectieuses》2019,49(1):47-53
Objectives
Temocillin was introduced in 2015 in the French guidelines for the treatment of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae urinary tract infections. Little susceptibility data is available. We investigated the in vitro activity of temocillin against ESBL-producing Enterobacteriaceae isolated from samples of cytobacteriological examinations of urine.Material and methods
Susceptibility testing was performed on 157 ESBL-producing E. coli and 95 ESBL-producing K. pneumoniae strains using the disk diffusion method. MICs of resistant strains were measured with the Etest method.Results
Using current breakpoints, 71.3% of E. coli strains and 77.9% of K. pneumoniae strains were classified as susceptible. However, diameter and MIC breakpoints vary by country, and we reported discordance of clinical categorization between diameters and MIC determination for some strains. The measure of diameters was also sometimes difficult because of contaminating colonies within the inhibition zone.Conclusion
We highlighted difficulties related to the determination of temocillin susceptibility, such as culture of resistant colonies in the inhibition zone and discordance of clinical categorizations obtained with the disk diffusion method or the Etest method. Overall, 42% of tested Enterobacteriaceae had a diameter or MIC close to the current breakpoints; thus, it is necessary to determine the MIC for these strains before considering the clinical use of this molecule. 相似文献2.
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Carl Llor Almudena Pérez Eugenia Carandell Anna García-Sangenís Javier Rezola Marian Llorente Salvador Gestoso Francesc Bobé Miguel Román-Rodríguez Josep M. Cots Silvia Hernández Jordi Cortés Marc Miravitlles Rosa Morros 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(1):32-39
Introduction
Community-acquired pneumonia (CAP) is treated with penicillin in some northern European countries.Objectives
To evaluate whether high-dose penicillin V is as effective as high-dose amoxicillin for the treatment of non-severe CAP.Design
Multicentre, parallel, double-blind, controlled, randomized clinical trial.Setting
31 primary care centers in Spain.Participants
Patients from 18 to 75 years of age with no significant associated comorbidity and with symptoms of lower respiratory tract infection and radiological confirmation of CAP were randomized to receive either penicillin V 1.6 million units, or amoxicillin 1000 mg three times per day for 10 days.Main measurements
The main outcome was clinical cure at 14 days, and the primary hypothesis was that penicillin V would be non-inferior to amoxicillin with regard to this outcome, with a margin of 15% for the difference in proportions. EudraCT register 2012-003511-63.Results
A total of 43 subjects (amoxicillin: 28; penicillin: 15) were randomized. Clinical cure was observed in 10 (90.9%) patients assigned to penicillin and in 25 (100%) patients assigned to amoxicillin with a difference of ?9.1% (95% CI, ?41.3% to 6.4%; p = .951) for non-inferiority. In the intention-to-treat analysis, amoxicillin was found to be 28.6% superior to penicillin (95% CI, 7.3–58.1%; p = .009 for superiority). The number of adverse events was similar in both groups.Conclusions
There was a trend favoring high-dose amoxicillin versus high-dose penicillin in adults with uncomplicated CAP. The main limitation of this trial was the low statistical power due to the low number of patients included. 相似文献5.
H. Gouze I. Padovano E. Salomon M. de Laroche C. Duran A. Felter R. Carlier M. Breban A. Dinh 《Médecine et maladies infectieuses》2019,49(1):54-58
Objectives
Veillonella parvula is an anaerobic Gram-negative coccus rarely involved in bone and joint infections.Patients and method
We report the case of a Veillonella parvula vertebral osteomyelitis (VO) in a female patient without any risk factor.Results
The 35-year-old patient was immunocompetent and presented with Veillonella parvula VO. She was admitted to hospital for inflammatory lower back pain. The discovertebral sample was positive for Veillonella parvula. Literature data on Veillonella VO is scarce. Reported cases usually occurred in immunocompromised patients. Diagnosis delay can be up to four months. Patients are usually afebrile. Outcome with antimicrobial treatment alone is favorable in half of cases. Other patients must undergo surgery.Conclusions
Veillonella VO may occur in immunocompetent patients and have a clinical spectrum of mechanical lower back pain. 相似文献6.
B. Davido R. Batista H. Fessi H. Michelon L. Escaut C. Lawrence M. Denis C. Perronne J. Salomon A. Dinh 《Médecine et maladies infectieuses》2019,49(3):214-218
Objective
A rapid and worrying emergence of vancomycin-resistant enterococci (VRE) gut colonization is occurring worldwide and may be responsible for outbreaks, especially in healthcare facilities. While no efficient decolonization strategies are recommended, we assessed fecal microbiota transplantation (FMT) to eradicate VRE colonization.Patients and method
Our main objective was to measure the impact of FMT on decolonization of VRE carriers, confirmed by at least two consecutive negative rectal swabs at one-week interval during a 3-month follow-up period. Patients received no antibiotic prior to the FMT.Results
After a month only three patients remained colonized with VRE. Decolonization was associated with 87.5% (n = 7) of success after three months as only one patient remained colonized.Conclusion
Our first results confirm that the FMT seems to be safe, with an impact on VRE colonization over time that may help control outbreaks. 相似文献7.
Impact of mandatory vaccination extension on infant vaccine coverages: Promising preliminary results
R. Cohen J. Gaudelus B. Leboucher J.-P. Stahl F. Denis D. Subtil P. Pujol H. Lepetit L. Longfier A. Martinot 《Médecine et maladies infectieuses》2019,49(1):34-37
Objective
In France infant vaccines protecting against 11 diseases have changed from a recommended to a mandatory status for all children born on or after January 1, 2018. Using the Vaccinoscopie survey, we measured the impact of this new vaccination policy on vaccine coverage rates (VCRs) and on mothers’ perception of vaccination.Methods
Online survey with 1000 mothers of 0- to 11-month-old infants.Results
VCRs for at least one dose at the age of 6 months strongly progressed for diseases that previously did not meet Public Health objectives (+8 points for Hepatitis B and +31 points for meningococcal C vaccines). Mothers were more favorable to mandatory vaccination and better informed in 2018 than in 2017.Conclusion
These first results showed a positive impact of the extension of mandatory vaccination on mothers’ opinion regarding vaccination and on infant VCRs. 相似文献8.
G. Gault A. Fischer E. Nicand F. Burelle A. Burbaud J.L. Koeck 《Médecine et maladies infectieuses》2019,49(1):38-46
Objectives
To measure vaccine coverage among adolescents aged 16–18 years who participated in the National Defense Preparation Day in the Aquitaine region using the free electronic immunization record.Patients and methods
We considered adolescents aged 16–18 years who participated in the National Defense Preparation Day in the Aquitaine region from April to October 2013. All participants received a letter explaining how to create an electronic immunization record. Those records were then validated by checking data against the copies of the vaccination cards brought by participants on the day they attended. Vaccination coverage was estimated for eight vaccinations according to the cumulative number of doses registered and vaccines recommended during childhood.Results
Among the 18,714 participants, 9636 agreed to create an electronic immunization record of which 2781 were validated. Vaccination coverage was ? 90% for tuberculosis, diphtheria-tetanus-poliomyelitis, measles-mumps-rubella, and Haemophilus influenzae type B, and ? 90% for pertussis, hepatitis B, meningococcal C disease, and human papillomavirus. These coverage rates were close to those reported in other available sources.Conclusion
Our study calls attention to the insufficient vaccination of adolescents for pertussis, HBV, meningococcal C disease, and HPV. The absence of a system that routinely provides the vaccination status of this population is a major public health issue in France. The use of an electronic immunization record was innovative, but this tool is not extensively used in the general population and has been evaluated by Santé publique France (the French national public health agency). 相似文献9.
M. Lagree S. Bontemps R. Dessein F. Angoulvant F. Madhi A. Martinot R. Cohen F. Dubos 《Médecine et maladies infectieuses》2018,48(3):193-201
Objective
To evaluate clinical practices for ESBL-producing urinary tract infection (UTI) in France.Methods
We performed an observational, retrospective, cross-sectional, hospital-based study in 22 pediatric departments of university or secondary care hospitals. We collected data of the last five patients presenting with ESBL-producing UTI in 2012 and the physicians’ therapeutic approach to two case vignettes of acute non-septic ESBL-producing pyelonephritis (7-month-old girl) and cystitis (30-month-old girl). The adequacy of the therapeutic decision was analyzed by a panel of independent infectious disease experts.Results
A total of 80 case patients of ESBL-producing UTI were collected: 54 with acute pyelonephritis (mean age: 28 months, female: 66%), of whom 98% received an intravenous ESBL-adapted antibiotic treatment and 55% a two-drug antibiotic therapy. Carbapenems were used in 56% of cases and aminoglycosides in 36%. Of the 26 cystitis patients (mean age: 5 years, female: 73%), 85% were treated with antibiotics, including three intravenously (carbapenems = 2). For the case vignettes, physicians (n = 85) would have treated the pyelonephritis patient with carbapenems (76%) and/or aminoglycosides (68%); 71% would have used a two-drug antibiotic treatment. The cystitis patient would have been treated intravenously by 29% of physicians; 8% would have used a two-drug antibiotic treatment, 16% would have prescribed carbapenems, and 11% aminoglycosides. Antibiotic treatments were deemed appropriate in 37% of cases.Conclusions
Antimicrobial treatment for ESBL-producing UTI greatly varies, and carbapenems are excessively prescribed. Specific guidelines for ESBL infections are required. 相似文献10.
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Objectives
Trimethoprim has been recently included in the French guidelines for the treatment of urinary tract infections, but no epidemiological data supports its use. We aimed to determine the trimethoprim susceptibility of Escherichia coli isolates responsible for community-acquired urinary tract infections in women of childbearing age.Materials and methods
We conducted a national prospective survey. A total of 350 strains of E. coli isolated from urines in 35 laboratories were included. Antibiotic susceptibility testing was performed in each laboratory.Results
We reported a susceptibility rate of 78%, and a similar clinical categorization between trimethoprim and cotrimoxazole for 97.4% of isolates. We pointed out an association between resistance to trimethoprim and other antibiotic classes.Conclusion
The results support trimethoprim as a second-line therapy based on antibiotic susceptibility testing results. We confirm that trimethoprim and cotrimoxazole susceptibility rates are very close. 相似文献12.
C. Jacquet F. Goehringer E. Baux J.A. Conrad M.O. Ganne Devonec J.L. Schmutz G. Mathey H. Tronel T. Moulinet I. Chary-Valckenaere T. May C. Rabaud 《Médecine et maladies infectieuses》2019,49(2):112-120
Objective
The teaching hospital of Nancy, France, implemented a specific multidisciplinary care pathway (French acronym AMDPL) to improve the management of patients presenting with Lyme borreliosis (LB) suspicion. We aimed to assess the first year of activity of this care pathway.Patients and methods
We included all patients managed in the AMDPL pathway from November 1, 2016 to October 31, 2017. The first step was a dedicated Lyme disease consultation with an infectious disease specialist. Following this consultation, the LB diagnosis was either confirmed and adequate treatment was prescribed, or a differential diagnosis was established and patients received adequate management, or further investigations were required and patients were offered multidisciplinary management as part of a day hospitalization.Results
A total of 468 patients were included. LB diagnosis was confirmed in 15% of patients (69/468), 49% of patients received a differential diagnosis, and 26% (122/468) of patients had the LB diagnosis ruled out without receiving any other diagnosis.Conclusions
This is to our knowledge the first multidisciplinary center implemented in France for the management of patients presenting with LB suspicion related to polymorphous signs and symptoms. Several diagnoses could be confirmed or corrected, although some symptoms and complaints could not be explained. This cohort could improve our knowledge of LB and its differential diagnoses. 相似文献13.
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Hao-Min Cheng Ling-Jan Chiou Tzu-Ching Chen Shih-Hsien Sung Chen-Huan Chen Hui-Chu Lang 《Health policy (Amsterdam, Netherlands)》2019,123(2):229-234
Objective
To evaluate the cost-effectiveness of using drugeluting stents (DES) compared to bare-metal stents (BMS) for coronary heart disease (CHD).Data sources/study setting
Data were obtained from the National Health Insurance Longitudinal Health Insurance Database, which contains claims data for 1,000,000 beneficiaries. The data were randomly sampled from all beneficiaries.Study design
A retrospective claims data analysis.Data collection/extraction methods
Patients with stable coronary heart disease who underwent coronary stent implantation from 2007 to 2008 were recruited and followed to the end of 2013. After a 2:1 propensity score matched by gender, age, stent number, and the Charlson comorbidity index (CCI), 852 patients with 568 stents in the BMS group and 284 stents in the DES group were included. The cumulative medical costs for both matched groups were estimated with the Kaplan-Meier Sample Average (KMSA), and then the incremental cost-effectiveness ratio (ICER) was estimated.Principal findings
The ICER of DES vs. BMS was NT$ 663,000 per cardiovascular death averted and NT$ 238,394 per cardiovascular death or coronary event averted in five years from the insurer perspective.Conclusion
Percutaneous coronary intervention (PCI) with DES was a more cost-effective strategy than PCI with BMS for CHD patients during the five-year follow-up. 相似文献15.
J. Gaudelus R. Cohen B. Leboucher J.P. Stahl F. Denis P. Pujol L. Longfier A. Martinot 《Médecine et maladies infectieuses》2019,49(3):180-186
Objectives
Meningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMD C), mainly through herd immunity. The Vaccinoscopie survey helps follow vaccination coverage rates (VCRs) of children.Methods
This annual survey is based on a self-administered online questionnaire. In 2017, 4500 mothers of children completed the questionnaire and reported all vaccinations recorded in their child's health record.Results
MenC vaccination was deemed indispensable or useful by 77% to 84% of mothers. The main barrier mentioned by mothers considering the vaccination useless/not very useful, was fear of adverse effects. VCR was estimated at 77% among 24-35-month-old infants, 79% among 6-year-old children, and 50% among 14-15-year-old adolescents. VCR strongly varied depending on the physician's advice for vaccination and on the type of follow-up. Six months after publication of the new French vaccine calendar in April 2017, with a MenC vaccine recommendation for all 5-month-old infants, 43% of infants had received a dose at 6 months of age.Conclusions
VCRs are insufficient to reach herd immunity. Between 2011 and 2017 more than 100 deaths could have been avoided in France if optimal VCRs had been achieved. Faced with this vaccine strategy failure, the new vaccine recommendation at 5 months of age seems well-accepted. This recommendation and the implementation of infant mandatory vaccination in 2018 should have a major impact on IMD C incidence in this age group. 相似文献16.
A.E. Njom Nlend K. Nguedou Marcelle P. Koki Ndombo A. Brunelle Sandié 《Revue d'épidémiologie et de santé publique》2019,67(3):163-167
Background
Cameroon has adopted the option B+ for the prevention of mother-to-child transmission (MTCT) program of HIV in August 2014 in order to eradicate MTCT of HIV.Objective
To analyze in routine life settings, efficacy of option B+ for PMTCT and associate factors.Methods
We conducted a cross-sectional study over a 6-month period in the ESSOS hospital center. Study population comprised HIV-positive mothers and their infants aged 0–24 months. Variables included were : moment of HIV maternal testing, timing of commencement of maternal antiretroviral therapy (ART) and self-reported adherence to ART. Efficacy was measured through early and late MTCT rate and associated factors.Results
We included 200 mothers and 124 infants. Under option B+, the rate of transmission was at 4.20% at 6 weeks and 5.83% at 12 months. The rate of HIV transmission in breastfed infants stood at 3.7%. In unadjusted analysis, bottle-feeding, term at birth, early screening and management during pregnancy were associated with lower risk of HIV transmission. After adjustment, term at delivery after 37 weeks adjusted odds ratio (AOR) [0.059; (0.0061; 0.56)] was protective; while lack of prophylaxis was among HIV-exposed infants emerged as the main factor associated with residual transmission of HIV [AOR 117.23 ; (3.55 ; 3874.9)].Conclusion
In this setting of Yaoundé, routine option B+ posted laudable results at 12 months even amongst breastfed children and should therefore be made sustainable. 相似文献17.
Wiesława Dominika Wranik Dorota Anna Zielińska Liesl Gambold Serperi Sevgur 《Health policy (Amsterdam, Netherlands)》2019,123(2):191-202
Background
Health Technology Assessment is used to support the process of drug appraisal and reimbursement decisions in a variety of health systems. Examples can be found in mature Western countries, such as Canada, and in emerging economies of Central and Eastern Europe, such as Poland. The value of HTA in the process is influenced by the evidence used and the stakeholders involved.Methods
Qualitative interviews with 29 members of two appraisal committees were held in Canada and Poland between July 2017 and March 2018. An a priori thematic framework was applied and supplemented with emergent themes.Results
We report on the results of a core emergent theme – threats identified by respondents to the value of HTA in the formulary process. We classified these into internal threats that arise due to undue influence on the individuals involved in appraisal, and external threats that arise due to undue influence on the production of evidence.Discussion
Findings align with previous evidence regarding political and corporate pressures on the process, and a perception of declining quality of evidence. We contribute to the discussion by highlighting the importance of motivation of experts involved in the appraisal process.Conclusions
The recognition of internal and external threats lays the groundwork for a discussion of policies used to mitigate them. We offer suggestions about potential policy responses. 相似文献18.
F. Gravey G. Loggia A. de La Blanchardière V. Cattoir 《Médecine et maladies infectieuses》2017,47(4):271-278
Objective
Although urinary tract infections are the second leading cause of infections among patients aged above 65 years, data on bacterial epidemiology of urinary specimens in these patients is scarce. Our aim was to describe the main bacterial species found at significant levels in urine specimens of the elderly and to determine their antimicrobial resistance profiles.Methods
From October 2012 to October 2015, all urinary specimens (catheter-related or not) received at the laboratory of microbiology of the university hospital of Caen (France) were retrospectively studied. Results were compared to those of urinary specimens of patients aged 18–64 years. Bacterial identification was performed using MALDI-TOF mass spectrometry and antimicrobial susceptibility testing was performed as per CA-SFM guidelines.Results
Out of 33,302 urine cytobacteriological examinations (UCBE) performed in patients aged above 65 years, 13,450 microorganisms were identified. Escherichia coli was the most frequent species (41.8%) followed by Enterococcus faecalis (9.7%), Pseudomonas aeruginosa (5.7%), Proteus mirabilis (4.6%), and Klebsiella pneumoniae (4.2%). Around 9% of E. coli isolates were resistant to third-generation cephalosporins, including 8.2% by production of extended-spectrum β-lactamase (ESBL). This prevalence was significantly higher than that observed in urinary specimens of patients aged 18–74 years (4.9%, P < 0.001).Conclusion
The bacterial epidemiology of urines collected from the elderly is diverse and significantly different from that of urine specimens of younger patients, with a higher proportion of multidrug-resistant bacteria (particularly ESBL-producing E. coli). 相似文献19.
Background
In 2011, Israel instituted financial incentives as part of a larger program to attract doctors to residency programs in peripheral hospitals.Objective
To explore the impact of these incentives and related changes on the choices of locations for residency training in Israel.Methods
We performed (A) an analysis of administrative data on the location of all new medical residencies in 2005–2014 (B) an internet/phone survey of residents who began specialty training in 2013–2014, with a response rate of 71%.Results
(A) Of all entrants to residency training programs in Israel, those in peripheral hospitals constituted 16–20% in 2005–2010, 19% in 2011, 23% in 2012, and 23% in 2013; the increase consisted predominantly of physicians who were graduates of non-Israeli medical schools (B) About half of all residents in the periphery reported that the incentives contributed to their choice of residency location. About 40% of that group also reported that they had planned already in medical school to practice in the periphery, while 60% of that group (30% of all residents in the periphery) did not have such plans prior to medical school. About 70% of the residents in peripheral hospitals grew up in the periphery; for the southern periphery this was 40% and for the northern periphery this was 80%.Conclusions
The changes instituted in 2011 apparently affected residency location preferences for a non-negligible proportion of young physicians, particularly among those who grew up in the periphery. Policymakers should consider combining targeted incentives with measures to increase the supply of physicians who grew up in the periphery. 相似文献20.
A. Dinh F. Bouchand B. Davido C. Duran P. Denys A. Lortat-Jacob M. Rottman J. Salomon L. Bernard 《Médecine et maladies infectieuses》2019,49(1):9-16