Ertapénem intraveineux ou sous-cutané pour le traitement des infections urinaires à entérobactérie sécrétrice de BLSE

Introduction

Ertapenem could be used to treat urinary tract infections (UTI) caused by ESBL producing enterobacteriacae (ESBL-E) and administered subcutaneously.

Method

The authors made a retrospective study on adult patients treated with ertapenem administered intravenously or subcutaneously for UTI caused by ESBL-E, between May 2009 and August 2011 at the Chambery hospital, France.

Results

Twenty-five patients were treated (13 cases of prostatitis, ten of pyelonephritis, two of cystitis) mostly caused by Escherichia coli (24 cases). Subcutaneous injections were administered to 20 patients and 23 were treated through outpatient parenteral antibiotic therapy (OPAT). All patients were cured at the end of the ertapenem therapy. Urine samples collected during treatment for 12 patients were sterile. Three months after the end of the treatment, five patients had relapsed, and six had developed a UTI caused by another bacteria.

Conclusion

Ertapenem administered intravenously or subcutaneously could be an effective treatment for UTI caused by ESBL-E, especially using OPAT.     

Localisation hépatique de la maladie des griffes du chat chez un immunocompétent

Introduction

The cat-scratch disease is a benign inoculation disease and a well-known cause of localized lymphadenopathy. Visceral localizations are rare and occur mostly in immunocompetent patients.

Case

We report the case of a 57-year-old-man with lymphadenopathy of the right arm with hepatic nodules related to a Bartonella henselae infection.

Conclusion

The cat-scratch disease must be screened for in case of hepatic and/or splenic nodules. A cause of immunodeficiency should be investigated.     

Variabilité pharmacocinétique intra-individuelle et traitement antibiotique prolongé

Objective

The authors wanted to assess intraindividual pharmacokinetic variability, with a case of long-term amikacin therapy.

Design

A 92-year-old female patient, weighing 44 kg, with renal failure, was treated by amikacin for 52 days. Her individual pharmacokinetic parameters were assessed 12 times in the course of therapy. The intraindividual variability of key parameters was quantified and compared with published interindividual variability.

Results

Intraindividual volume and clearance variability was measured at about one fourth to one third of the value observed for interindividual variability. Half-life intraindividual variability was almost equivalent to the interindividual variability: 24.5% versus 32%.

Conclusions

The high pharmacokinetic variability observed has important potential clinical consequences. This case illustrates the need to ensure the effectiveness of treatment, to re-evaluate periodically the patient's status in order to take into account the intraindividual variability of pharmacokinetics parameters.     

Les angines aiguës de l’enfant dans la région de Sfax (Tunisie) : épidémiologie et intérêt du test de diagnostic rapide

Objective

The authors studied the epidemiology of pharyngitis in children and evaluated the contribution of a rapid streptococcal test.

Patients and methods

This prospective study was conducted from June 2007 to May 2008 in a primary health care institution (Policlinique de la Caisse Nationale de Sécurité Sociale) in Tunisia. Clinical findings were recorded; throat swabs were performed, and a rapid streptococcal test was made.

Results

Five hundred and four children were included in this study. The mean age was 5 years and 8 months. Culture was positive for group A streptococcus in 166 cases (32.9 %). Group A streptococcus was more frequently isolated in children aged 5 to 8 years. There was no difference in clinical features between groups of streptococcal and non-streptococcal pharyngitis. The sensitivity and specificity of the rapid test were respectively 93.2 and 95.3 %.

Conclusion

Pharyngitis was of bacterial origin in one third of cases; among these, group A streptococcus was the most frequent bacterium. The rapid test is a quick and reliable tool for the diagnosis of pharyngitis and hence an appropriate treatment.     

Incidence,prévalence et facteurs de risque de survenue d’une première complication infectieuse sur chambres à cathéter implantables

Background

Totally implantable venous-access ports (TIVAP) should present less risk of complications than central venous catheters over a long time period.

Aims

Firstly, the study's objective was to assess the prevalence and incidence of a first infectious complication on a TIVAP and secondly, to assess the risk factors associated with this first infection.

Methods

The authors made a longitudinal historical cohort study of patients with a TIVAP in 2003, in the Dijon University Hospital.

Results

Two hundred and nineteen patients (sex-ratio 1.9) were included, with a total follow-up of 92,773 patients-days. Ninety percent of the TIVAP were used for chemotherapy, 5% for antibiotic drug administration, 2% for parenteral nutrition and 3% for other reasons (recurrent blood transfusions, etc.). Overall, 34 (16.3%) out of 209 patients presented with at least one infectious complication, with an incidence rate of 0.37 infection/1,000 patients-days. The 5-year cumulative probability to be free of infectious complication was only 62.8%. In multivariate analysis, only underlying hematological neoplasia (by contrast with solid tumors) was significantly associated to a higher risk of infectious complication.

Conclusions

The infectious risk linked to the use of TIVAP is significant, higher in case of underlying hematological neoplasia and during the first months of use.     

Sensibilité aux antibiotiques des souches de Staphylocoques aureus isolées dans deux hôpitaux universitaires à Rabat,Maroc

Objectives

The aim of this study was to assess the in vitro activity of several antimicrobial agents against Staphylococcus aureus (S. aureus).

Method

This 2 year study was made in two Moroccan teaching hospitals. Four hundred and sixty-one non-repetitive clinical S. aureus strains were isolated and collected from various samples collected in several units between March 2006 and March 2008.The susceptibility of strains was determined by the agar disk diffusion method.

Results

The rate of methicillin resistance was 19.3% for S. aureus isolates. 53.93% of S. aureus strains were resistant to gentamycin, and all strains were susceptible to glycopeptides.

Conclusion

The rate of MRSA was high. Resistance to methicillin is often associated with resistance to gentamycin and fluoroquinolones. Vancomycin and teicoplanin were still effective on S. aureus in the two university hospitals.     

Cent quinze cas de paludisme d’importation à Plasmodium falciparum admis en service d’urgence au CHU de Bordeaux

Objectives

The authors had for objective to evaluate the management of a Plasmodium falciparum malaria in a Bordeaux teaching hospital EU.

Methods

One hundred and fifteen patients with falciparum malaria admitted between January 2004 and October 2006 were retrospectively studied and those with ambulatory treatment were questioned by phone.

Results

Fifty per cent of patients had consulted a community physician prior to admission, and a parasitic test was made for 50 % of these. In seven (27 %) cases the test was wrong. Twenty-seven (87 %) of ambulatory patients were contacted by phone. Eleven (41 %) of these said they were not aware of the potential disease severity. Patients initially treated in ambulatory care and later hospitalized because of their evolution have either insisted to go back home or have been sent home because there was not enough room in the hospital. Hospitalization for at least 24 hours had been indicated for 83 patients (72 %). Twelve patients (10 %) have presented with symptoms of severe malaria. Atovaquone–proguanil was the main therapeutic regimen for inpatients and outpatients (n = 93, 81 %). Twelve (10 %) patients did not undergo follow-up parasitological assessment, 10 ambulatory patients (32 %) and two hospitalized patients (2 %).

Conclusion

An efficient hospital-community network and recent protocols are the best tools to rapidly refer patients to an adapted structure with available trained staff and referent specialist.     

L’hôpital de jour du CHU de Bobo Dioulasso : une structure de référence pour la prise en charge des patients infectés par le VIH au Burkina Faso

Objective

The goal of the study was to assess the activity of a multidisciplinary structure for HIV infected patients, two years after the opening of the day hospital.

Design

A retrospective observational study of the Bobo Dioulasso day-hospital was made using the ESOPE^® (Epiconcept, France) software.

Results

In 2002, 147 patients were followed in the Bobo Dioulasso university hospital, 27 (or 18.5 %) of whom were treated with antiretrovirals. Between 2005, opening of the day-hospital, and 2007, the total number of patients increased by 20 %. The number of patients on antiretrovirals rose from 47 to 70 % in the same time. The rate of patients with waved antiretroviral costs rose from 6 to 53 %. Three hundred and eighty-six patients died between 2002 and 2007. 1450 patients were lost to follow-up between 20002 and 2007.

Conclusions

Two years after its opening, the Bobo Dioulasso day-hospital manages one of the largest HIV cohort in sub-Saharan Africa and has become a reference structure in Burkina Faso. The analysis of this cohort was an opportunity to identify issues concerning HIV patient treatment in 2009.     

Variabilité pharmacocinétique inter- et intra-individuelle lors de traitements par teicoplanine chez les sujets âgés

Objectives

The authors had for aim to assess the inter- and intra-individual variability of teicoplanin pharmacokinetic parameters in geriatric patients.

Methods

A cohort of 90 geriatric patients, treated with teicoplanin, was used to build two models describing the pharmacokinetics of teicoplanin, at the beginning and at the end of treatment respectively.

Results

The inter- and intra-individual variability of parameters were important as shown respectively by the coefficients of variation of pharmacokinetic parameters ranging from 125 to 694% and the half-life change during the treatment (by a factor of three to more than 30) for 60% of patients.

Conclusions

The results revealed that elderly patients presented significant variability, which was only partly explained by the renal function. Therapeutic monitoring of teicoplanin in geriatric patients should be undertaken at the end of the loading dose and repeatedly during the maintenance phase to prevent over- or underexposure.     

Étude de la résistance des souches d’Escherichia coli isolées dans les urines aux fluoroquinolones et aux céphalosporines de troisième génération

Objectives

This study had for objective to assess the frequency of resistance to fluoroquinolones and to third generation cephalosporin in E. coli isolated from urines of consulting and hospitalized patients and to detect the rate of multiresistant E. coli strains.

Design

A retrospective survey was made over 3 years (1^st January 2005 to 31^st December 2007). Eight hundred and nineteen patients presented with UTI confirmed in the Rabat Cheikh Zayd Teaching Hospital.

Results

E. coli was the etiologic agent in 57% of reported UTI. The frequency of E. coli resistance to fluoroquinolones was 27% with a higher rate among hospitalized patients. We found that ten E. coli strains were producing extended-spectrum β-lactamase and resistant to aminosides and fluoroquinolones.

Conclusions

The resistance of E. coli to fluoroquinolones is becoming worrying among consulting and hospitalized patients. Ten strains multiresistant to fluoroquinolones and third generation cephalosporins, probably because of plasmids, were isolated. This increasingly frequent resistance mechanism should lead to a more careful use of first line fluoroquinolones for UTI.     

Lésions cérébelleuses réversibles et neuropathie périphérique induites par le métronidazole

Introduction

Metronidazole is a widely prescribed treatment for amoebic and anaerobic germ infections. Its neurologic toxicity is rare but can be serious.

Case report

We report the case of a 27-year-old male patient, treated with metronidazole for a cerebral abscess. He presented with a cerebellar syndrome and peripheral neuropathy at a cumulative metronidazole dose of 60 g. The MRI aspect of the cerebellar lesions in addition to their reversibility after treatment cessation led to the diagnosis of metronidazole induced neurologic toxicity.

Conclusion

The occurrence of neurologic disorders in patients treated with metronidazole must suggest drug toxicity and lead to cessation of treatment.     

2,3,7,8-Tetrachlorodibezo-p-dioxin exposure and prostate cancer: a meta-analysis of cohort studies

Objective

To perform a meta-analysis of cohort studies and evaluate the association between exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and prostate cancer quantitatively.

Study design

Publications before April 2012 about populations exposed to TCDD were searched in PubMed. Only cohort studies were included. Extraction and quality assessment of included articles was performed independently by two authors using the MOOSE guidelines.

Methods

A total of 17 cohort studies on prostate cancer with information about standardized mortality ratios (SMR), risk ratio (RR), standardized incidence ratios (SIR) and TCDD exposure were included. SMRs and RRs were pooled separately after weighing each study by calculating the inverse of the estimated variance.

Results

Based on the 13 reported SMRs or SIRs, the meta-analysis yielded a meta-SMR of 1.26 (95% confidence interval 1.00–1.57, P = 0.046). The meta-RR, based on four reported RR from four cohorts, was 1.04 (95% confidence interval 0.85–1.28). Begg's funnel plot showed little evidence of publication bias (Egger's test P-value = 0.817).

Conclusion

This meta-analysis suggests that exposure to TCDD is associated with increased risk of prostate cancer.     

Surveillance épidémiologique de la rage humaine dans un contexte d’endémie de rage canine en Cote d’Ivoire

Aim

The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.

Patient

A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.

Results

Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients’ were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.

Conclusion

In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.     

Analyse de l’exposition préalable aux anti-inflammatoires et aux antibiotiques d’une cohorte de 34 patients hospitalisés au CHU de Nantes pour phlegmon périamygdalien

Objective

The purpose of this study was to describe the characteristics of patients hospitalized for a peritonsillar abscess over a 1-year period and to evaluate the proportion of patients exposed to anti-inflammatory and antibiotic drugs before hospitalization.

Design

Adult patients hospitalized in the ENT department at the Nantes University Hospital were included in the study during 2006. Data related to prior use of anti-inflammatory and antibiotic drugs, microbiology and treatment was analyzed.

Results

Thirty-four patients were included in the study, 20 (59%) and 21 (62%) patients had been previously exposed to anti-inflammatory and antibiotic drugs, respectively. Half of the patients had received antibiotics despite the negativity of the rapid screening test. All diagnoses were made on pus examination after aspiration. Tonsillectomy was performed only in two cases. A total of 21 bacterial isolates (13 anaerobic and 9 aerobic) were identified. Single bacterial isolates were recovered in 8 infections. The most frequent bacteria were Streptococcus, Fusobacterium, and Prevotella.

Conclusions

Many patients were exposed to both anti-inflammatory and antibiotic drugs, which did not prevent the peritonsillar abscess.     

Défaut de couverture vaccinale pneumococcique chez l’adulte à risque

Objective

This study had for aim to assess pneumococcal vaccination rates in hospitalized patients.

Design

A prospective study was carried out in two medical wards of the Nice University Hospital, France. Patients were included from December 31, 2007 to February 12, 2008.

Results

Hundred and thirty-seven patients, aged 62 ± 20 years, were included. Pneumococcal vaccination was indicated for 62 patients (45 %). Among these 62 patients, 53 (85 %) had not been vaccinated in the previous 5 years, for the following reasons: no medical advice on vaccination (36 cases), no medical consultation in the past years (nine cases), patient opposed to vaccination (two cases), physician opposed to vaccination (one case), miscellaneous (five cases). Among the 53 patients, seven were vaccinated during their hospital stay and 13 were advised to be vaccinated by their general practitioner.

Conclusions

This study highlights a low rate of pneumococcal vaccination in hospitalized patients, mainly due to insufficient counseling from physicians, both in community or in hospital practice.     

Épidémiologie des kystes hydatiques extrapulmonaires : 265 cas en Tunisie

Aim of study

The authors wanted to analyze the epidemiological features of extrapulmonary hydatid cysts and compare their results with those reported in literature.

Methods

Two hundred and sixty-five cases of extrapulmonary hydatid cysts collected from 1990 to 2007 were retrospectively studied.

Results

One hundred and one male and 164 female patients (sex ratio M/F = 0.61 mean age 38.7 years) were included. In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%).

Conclusion

Contrary to published data, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which ranks 3rd. Such unusual results may be due to a selection bias.     

Diagnostic de la tuberculose ganglionnaire périphérique en Tunisie

Objective

The aim of the study was to evaluate the contribution of microbiology, cytology, and anatomopathology in 50 cases of peripheral tuberculous lymphadenitis.

Methodology

Our patients underwent bacteriological tests and cytology and/or histopathology for lymphadenitis.

Results

Ziehl-Neelsen stains and cultures were positive in only 29.7% and 10.8% of cases respectively. The diagnosis was confirmed by cytology in 31.3% of cases (10/32) and by histology in 58.6% of cases (27/46). Granulomas were observed in 46.8% (15/32) of needle aspirates and 76% (35/46) of surgical biopsies.

Conclusion

Our study reveals a weak contribution of conventional microbiological techniques. Cytology remains the procedure of choice in endemic countries. Excisional biopsy may be performed in case of doubt.