Épidémiologie des patients porteurs d’entérobactéries sécrétrices de bêtalactamase à spectre élargi (EBLSE), à l’admission

Objective

The incidence of extended-spectrum beta-lactamase-producing enterobacteria (ESBLE) has regularly increased over the last few years. However, little is known about epidemiology of ESBLE carriers in France. The objective of this study was to determine the ESBLE carriers or infected patients profile, identified within 48 hours following hospital admission.

Design

This retrospective study included all patients admitted in 2006 and 2007 at the Necker–Enfants-Malades (NEM) teaching hospital, carrying or infected with ESBLE isolated within 48 hours following admission. The pediatric and adult populations were compared.

Results

There was no significant difference between pediatric and adult populations. Escherichia coli and Klebsiella pneumoniae were the two main species isolated, accounting respectively for 59.6 and 21.1 % of the 114 isolated strains. Among the 114 analyzed files, 24 patients (21 %) were known to be EBLSE carriers, 37 (32 %) were transferred from another hospital, including 16 from another country. Concerning the 54 (47 %) other patients, five (4 %) came from a country with high prevalence, and 44 (39 %) were treated for a chronic illness. Only five patients (4 %) carrying ESBLE did not have any usual risk factor for multidrug resistance (MDR) bacterial carriage.

Conclusions

In our study, 4 % of patients carrying ESBLE admitted had no usual risk factor for MDR bacteria. Targeted screening of previous carriers, patients with chronic illness, transferred patients, or patients coming from country with high prevalence, would help to limit the spread of ESBLE.     

La ghréline : seule hormone orexigène connue

Ghrelin is a 28-amino acid acylated peptide predominantly produced by the stomach peripherally as well as the pituitary and the hypothalamus in the brain. Originally discovered as the endogenous ligand of the orphan growth hormone secretagogue receptor, it is also involved in the regulation of food intake and body weight. Ghrelin is the first known orexigenic hormone. Human plasma ghrelin levels sharply increase before and decrease after every meal. Plasma ghrelin levels correlate negatively with the magnitude of energy stores. Obesity is characterized by low ghrelin plasma concentration, conversely patients suffering anorexia or cachexia display high levels. Weight loss triggers an increase in ghrelin levels while the opposite is observed during weight gain. The role for ghrelin in the regulation of appetite and body weight is mediated, at least in part, via the activation of neurons in the hypothalamus that coexpress neuropeptide Y (NPY) and agouti-related protein (AgRP), two anabolic neuropeptides. Ghrelin appears as the hormone that coordinates GH secretion and food intake to assure an optimal growth and a steady energy balance. Due to its role in the regulation of body weight, ghrelin holds promise as a target for both medical and surgical approaches to obesity treatment.     

Homéostasie énergétique et métabolisme glucido-lipidique : pourquoi deux substrats différents ?

Two nutrient families mainly ensure covering human energy needs: carbohydrates and lipids, even if proteins are also involved, while in a particular way. Paradoxically, energy storage is mainly based on lipid deposition in adipose tissue. Carbohydrate oxidation represents a substantial part of energy metabolism, while human beings cannot synthesize glucose from lipids. In fact, the respective properties of these two families of substrates are very complementary, in term of metabolism and energy supply, according to metabolic status, either physiological or pathological. Each of these substrates could represent an advantage or a disadvantage depending on rate and/or efficiency of ATP synthesis. The comparison between these two pathways with their respective characteristics is particularly interesting when considering the today's diseases related to excess of nutrient supply of either carbohydrates and or lipids.     

Bactériémies à Kluyvera : à propos d’une épidémie dans un CHU au Maroc

Kluyvera Spp is an enterobacterium rarely isolated in medical microbiology, an opportunistic pathogen the clinical significance of which remains unclear. Four strains of Kluyvera Spp were isolated for the first time in the Ibn Rochd Teaching Hospital microbiology laboratory. These strains were isolated in hemocultures of four patients hospitalized in the same medical ward, at the same time, and presenting with bacteriemia. An antibiotic susceptibility study allowed identifying the wild phenotype in the first isolate, the three next isolates had acquired resistance to trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ciprofloxacin, and produced broad-spectrum betalactamase. The epidemiological investigation in the patients’ environment made after isolating the fourth strain was negative. The four patients evolved uneventfully without antibiotic treatment. This raises the question of the real pathogenic capacity of these strains, their epidemic power, and their ability to acquire resistance.     

Évaluation des dépenses énergétiques et des apports énergétiques conseillés pour les enfants et les adolescents sportifs de haut niveau de performance

In spite of the impact of nutrition on growth and sport performance, data on energy expenditure (EE) of athletic children and adolescents are scarce, and no RDA are available. Dietary records are known to underestimate EE and requirements. Therefore, energy RDA have beeen elaborated using a factorial method from the results of 7-day-activity records in 200 elite athletic adolescents, boys and girls practicing soccer, basketball, handball, rugby, 1 to 5km races, triathlon, pole vaulting, judo. The energy costs of the various activities were drawn from our data and the literature, and adjusted in concert with coaches. The proposed RDA are tabulated according to body weight and duration of sport activities, and are valid for groups of peer athletes.     

Évolution de la résistance aux antibiotiques de 1997 à 2005 à la Réunion

Objective

The groupe hospitalier Sud Reunion (GHSR) is a 1130-bed hospital center, located on the Reunion Island, (Indian Ocean). We studied the profiles of antibiotic resistance in 2005, and compared those with previous data collected in 1997–1998, and with Metropolitan France and European data.

Material and methodology

All bacteriological strains isolated from diagnostic samples in 2005 were analyzed according to CA-SFM recommendations.

Results

Since 1997, the rates of resistance to enterobacteria (betalactam, aminoside, quinolone, trimethoprim-sulfamethoxazole), Pseudomonas aeruginosa (ticarcillin, amikacin, ciprofloxacin, fosfomycin), Acinetobacter baumanii (amikacin) has decreased significantly. The rate of methicillin-resistant Staphylococcus aureus (1997: 3.6 %, 2005: 13.4 %) has increased but less than in Metropolitan France. The rate of Streptococcuspneumonia with decreased susceptibility to penicillin has increased (1997: 25.5 %, 2005: 42.9 %), as for Haemophilusinfluenzae which present an important increase of betalactam resistance (1997: 15.5 %, 2005: 37.8 %).

Conclusion

By comparing our data to 1997 and Metropolitan French data, it seems that the GHSR has managed to protect its hospital-based microbial ecology. However, community germs showed increasing resistance, probably because of an increasing antibiotic pressure, but with resistance rates often inferior to Metropolitan French ones.     

Comment évaluer les compléments alimentaires à visée cosmétique ?

Relations between skin and ageing, hydratation and sun were mainly targeted by cosmeto-foods. For each of these relation, in vitro and in vivo techniques exist in cosmetology to evaluate benefits of products under development. In a legal way, these cosmeto-foods depend on French food complement legislation. It is thus subjected to no preliminary marketing authorization. These products evaluation may carry out after marketing by the french safety and food agency (AFSSA). Nutritionnists members of AFSSA ask for a scientific justification of allegations advanced by firms developing these products. Knowing techniques used in cosmetology allows an objective evaluation and permit to require a proof level in adequacy with the advanced allegations.     

Méningites bactériennes : facteurs associés au délai d’instauration d’une antibiothérapie adaptée aux urgences

Objectives

We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.

Methods

Our retrospective observational study (2009–2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.

Results

We included 31 adults presenting with ABM; 29 (93.5%) received ceftriaxone or cefotaxime in the emergency department. Indications for corticosteroids and brain imaging complied with guidelines in respectively 71.0% and 83.9% of cases. The median delays (IQR) were: admission/lumbar puncture (LP), 2h43 [1h09–5h57]; admission/antimicrobials, 3h21 [1h34–5h11]. The indication of suspected ABM in the admission letter was associated with earlier LP (P = 0.01), and was almost significantly associated also with faster initiation of adequate antibiotic therapy (P = 0.05).

Conclusions

Suspicion of ABM mentioned in the admission letter was associated to a better management in the emergency department.     

Altérations hormonales et métaboliques lors du travail en horaires décalés

The development of nocturnal socio-professional activities has followed the expansion of artificial lighting, a characteristic of the modern world. Currently, a fifth of the active population work in shifted schedules or during night. The psychological, relational and social repercussions of this shift are obvious and well demonstrated. These situations are also associated with various health problems : sleep and vigilance disturbances, digestive disorders, metabolic abnormalities and cardiovascular morbidity. From 20% to 50% of the night-workers cease their night occupation invoking health problems. If the origin of these abnormalities is not univocal, different data indicate that shift-work led to a desynchronization of the circadian rhythms, source of hormonal and metabolic disturbances that may partly explain the clinical disorders. All occurs as if the circadian system of these subjects was in a phase of compromise between the requirements of their night activity and the maintenance, at least during the weekend, of a social and family diurnal activity. The debt of sleep frequently observed in these subjects may also play a role, which underlines the interactions between sleep and nutrition.     

Actualités épidémiologiques de la leishmaniose viscérale en Tunisie

Objective

Visceral leishmaniasis is an important health problem in Tunisia. The aim of this study was to update the epidemiological and clinical features of the disease.

Design

We performed a retrospective systematic sampling of epidemiological and clinical data collected from the medical records of 1,096 cases of visceral leishmaniasis diagnosed between 1996 and 2006 all over the country.

Results

The mean annual incidence of cases was 99.6 cases/year. The mean annual incidence rate was 1.04 cases/100,000 inhabitants, showing an important increase compared to former studies. As expected, children under 5 years (866 cases) were the most affected with a mean annual incidence rate of 9.6 cases/100,000 (p < 0.001). The geographical distribution of cases revealed the spreading of the disease from the Northern parts of the country to the Central and even to Southern ones. Rural cases (65.3%) were significantly more numerous than urban ones (34.7%), p < 0.001. The sex ratio was 1.03. The diagnostic delay (average of 54 days) was considerably shortened during the study period compared to previous reports, and explains the decrease of the lethality rate (2.9%).

Conclusions

Visceral leishmaniasis has been present in central Tunisia since the early 1990s. Its incidence and the distribution area have increased. This evolution is probably linked to the development of irrigation and agriculture favorable to the multiplication of vector sandflies and dogs reservoirs of Leishmania infantum.     

Consommation alimentaire et durée d’hémodialyse chez l’insuffisant rénal chronique : corrélation aux paramètres nutritionnels

The aim of this study was to describe food consumption of CRF patients after different hemodialysis duration and to correlate them with some nutritional parameters. Fifty-eight patients divided into three groups: GI: <1 year, GII: 1 to 5 years, GIII: 5 to 13 years of hemodialysis were compared with 22 controls. Reduction of total energy intake by 47% and 30% and protein intake by 49% and 38% was noted in GIII vs GI and GII, respectively. Patients had a dialysis dose (Kt/V) of 0.83±0.35 and a low body mass index. Seventy-seven per cent of patients had hypoalbuminemia (<37g/L). Decreased food consumption involves protein-energy malnutrition and represents a mortality risk.     

Immunosénescence et infections,mythe ou réalité ?

The susceptibility of elderly people to infectious diseases is usually associated to increasing risk factors found in young adults. However, the role of immune function ageing is associated with the decline of immune function but this decline is not homogenous. Some functions such as the cellular immune system are altered but others are enhanced such as innate immunity. The important events of immune ageing are modifications of lymphocyte subsets with accumulation of memory cells, decrease in proliferative response, and a chronic inflammatory state. The chronic antigenic load throughout life is responsible for gaps in the antigenic system with a greater sensitivity to new antigens. These immune system changes are all the more important that diseases are severe and that denutrition is associated. These diseases will speed up the ageing process. The interaction between immunosenescence and pathology is an important phenomenon to consider. This review outlines the immune system changes due to ageing, their relationship with diseases of the aged patient, and the consequences of these modifications on vaccination effectiveness.     

Pose d’une sonde naso-jéjunale au lit du patient combinant l’érythromycine et le décubitus latéral droit

Gastric enteral nutrition is sometimes limited by moderate to severe gastroparesis with high gastric residuals. In these situations, small bowel nutrition is often a good alternative as, most of the time, the small bowel function remain normal.A blind bedside setting up of a nasojejunal feeding tubes is described, combining erythromycin injection and right side decubitus is reported with 94,9 % post-pyloric feeding tubes and 81,3 % beyond Treitz's angle. Technique results are compared with literature data.     

Évaluation de l’antibiothérapie des bactériémies et place d’une équipe mobile pour l’amélioration de la prescription antibiotique

Introduction

Antibiotic management teams (AMTs) are recommended, but they are rarely implemented in France and their activity seldom evaluated.

Objective

The study was made to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSI) and to assess the role of an AMT for improving AT in a 950-bed teaching hospital.

Methods

A prospective analysis was made of all significant BSIs outside ICU in 2008. AT was assessed by the AMT and change was suggested if deemed necessary: effective if at least one prescribed antibiotic was effective in vitro, and appropriate if consistent with local recommendations.

Results

Of 875 +BCs, 560 were significant, 383 were outside ICU and 344 could be evaluated (170 community-acquired, 124 nosocomial, and 50 healthcare-associated [HCA]). The clinical ward has already initiated an effective and appropriate AT in 128 (37%), inappropriate but effective in 104 (30%), and ineffective or absent in 112 (33%) BSIs. The only independent variable associated with ineffective/absent AT was nosocomial and/or HCA BSI (aOR: 2.71; 95%CI: 1.72–4.27; p < 0.001). A recommendation was given and followed in 177/190 (93%) BSIs requiring an intervention. The AMT intervened on the day of the +BC in 256 (84%) cases, the day before the +BC in 12 (4%) cases, and one day later or more in 37 (12%) BSI cases.

Conclusion

Two third of BSIs were not initially treated by appropriate AT, more often in nosocomial BSI. Recommendation provided by the AMT was followed in 93% of cases.     

Évaluation des apports alimentaires d’adolescents obèses et post-obèses : comparaison de la méthode iconographique SU.VI.MAX à la méthode de pesée des aliments

The objectives of this study were 1) to validate the SU.VI.MAX iconographic method against the weighed diet record method to assess food and nutrient intakes in obese and post-obese adolescents, and ; 2) to determine the effects of dietetic education on the precision of this method. Energy and nutrient intakes were determined by both methods in 26 institutionalised obese adolescents over 7-day-periods before the beginning and at the end of a weight-reduction programme, and 4 months later. The mean food, energy, carbohydrate, protein, and lipid intakes as assessed by the two methods were not significantly different, but the limits of agreement between the two methods were high. Obese and post-obese adolescents underestimated intake of their favourite meals (pasta, fried potatoes…) but often overvalued intake of vegetables, milk and hard cheese. The SU.VI.MAX iconographic method is, therefore, a reliable method to assess energy and nutrient intakes of obese and post-obese adolescents in epidemiologic studies, but it is unappropriate for assessment in individuals. In addition, dietetic education resulted in 50% decreases in the mean difference, and in the inter-individual differences in energy intake between the two methods.