Gut injury is a severe and unpredictable illness related to the increased cell death of intestinal epithelial cells (IECs). Excessive IEC apoptotic cell death during the pathophysiological state entails chronic inflammatory diseases. This... more
Gut injury is a severe and unpredictable illness related to the increased cell death of intestinal epithelial cells (IECs). Excessive IEC apoptotic cell death during the pathophysiological state entails chronic inflammatory diseases. This investigation was undertaken to assess the cytoprotective action and underlying mechanisms of polysaccharides from Tunisian red alga, Gelidium spinosum (PSGS), on H2O2-induced toxicity in IEC-6 cells. The cell viability test was initially carried out to screen out convenient concentrations of H2O2 and PSGS. Subsequently, cells were exposed to 40 µM H2O2 over 4 h in the presence or absence of PSGS. Findings revealed that H2O2 caused oxidative stress manifested by over 70% cell mortality, disturbed the antioxidant defense, and increased the apoptotic rate in IEC-6 cells (32% than normal cells). Pretreatment of PSGS restored cell viability, especially when used at 150 µg/mL and normal cell morphology in H2O2-callenged cells. PSGS also equally sustaine...
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BACKGROUND During the COVID-19 pandemic, there has been an increase in workload, as well as greater vigilance and compliance at work. Healthcare workers must perform their duties while facing the fear of COVID-19, which can trigger and/or... more
BACKGROUND During the COVID-19 pandemic, there has been an increase in workload, as well as greater vigilance and compliance at work. Healthcare workers must perform their duties while facing the fear of COVID-19, which can trigger and/or aggravate stress. This study aimed to obtain the determinant factors of stress among healthcare workers during the pandemic by emphasizing the change in the psychosocial situation at the hospital. METHODS This cross-sectional study was conducted from January to March 2021 using an online questionnaire consisting of personal and occupational questionnaires, as well as the validated stressor and stress questionnaires using validity and reliability tests (Cronbach’s alpha 0.8 and 0.9). For the multivariate analysis, multiple logistic regression was used to identify the determinant factors (p<0.05). Data were analyzed using SPSS software version 20 (IBM Corp., USA). RESULTS Determinant factors of the occurrence of moderate–severe stress were the alt...
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Aims/IntroductionFrench Guiana has a high prevalence of metabolic diseases, which are risk factors for gestational diabetes mellitus. Despite routine screening for gestational diabetes, treatment is still challenging because of health... more
Aims/IntroductionFrench Guiana has a high prevalence of metabolic diseases, which are risk factors for gestational diabetes mellitus. Despite routine screening for gestational diabetes, treatment is still challenging because of health inequalities and different cultural representations of disease and pregnancy. This study was conducted to assess the role of early and universal GDM screening on obstetrical and neonatal complications in a socially deprived population.Materials and MethodsA prospective study was conducted, in the level III maternity in French Guiana. Of 2136 deliveries, 223 had gestational diabetes mellitus, 110 of whom were followed-up for 6 month to detail their social and laboratory parameters.ResultsThe prevalence of gestational diabetes in French Guiana (Cayenne Hospital) was estimated at 10.3%. The study population was very precarious with 70% of patients on welfare (universal health coverage or state medical assistance). The following obstetrical complications w...
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IntroductionCeliac disease is a pathology which is rarely associated with thrombosis complications. Cerebral vascular thrombosis has never been described in patients with a celiac disease.
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THE AIM of the study was to type Serratia marcescens responsible for nosocomial outbreaks in an intensive care unit in Sfax -Tunisia. The relatedness between S. marcescens isolates was studied by Pulsed field gel electrophoresis (PFGE).... more
THE AIM of the study was to type Serratia marcescens responsible for nosocomial outbreaks in an intensive care unit in Sfax -Tunisia. The relatedness between S. marcescens isolates was studied by Pulsed field gel electrophoresis (PFGE). We included 56 strains of Serratia marcescens isolated from patients hospitalized in the intensive care unit during 2003 and 2004. Seven epidemiological unrelated strains of Serratia marcescens were also tested. Samples from environment and hands of the nursing and medical staff were collected and cultured to identify the source of contamination. All strains showed a wild type of antimicrobial susceptibility. PFGE typing revealed that three different clones were present. None of the cultures taken from hands of unit staff and from environmental samples yielded positive results for S. marcescens. We have confirmed the presence of three consecutive outbreaks caused by three genetically unrelated bacterial clones of Serratia marcescens in the intensive ...
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To evaluate the predictive value of pericatheter skin cultures in detecting catheter-related infections in critically-ill patients. Prospective study. Over a 5 months period (from August 1(st) 2001 to December 31 2001), 500 patients were... more
To evaluate the predictive value of pericatheter skin cultures in detecting catheter-related infections in critically-ill patients. Prospective study. Over a 5 months period (from August 1(st) 2001 to December 31 2001), 500 patients were hospitalised, and 108 central venous catheters were prospectively examined. For each catheter, blood cultures, pericatheter skin cultures and semiquantitative culture of the catheter tip were performed. The median duration of catheterization was 8 days (interquartile: 8 days). Catheter was removed because of suspected infection in 54 cases (50%). Systemic catheter-related infection was found in 12 cases (11%) and the responsible organism was a gram-negative rod in 11 cases (92%). The negative predictive values of pericatheter skin cultures in the diagnosis of catheter-related infections and in case of suspected catheter-related infection were 89 and 86%, respectively. These results indicate that the pericatheter skin cultures are not an effective pr...
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We describe a 35-year-old male admitted to the intensive care unit (ICU) for acute exacerbation of chronic obstructive pulmonary disease (COPD). He developed ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas... more
We describe a 35-year-old male admitted to the intensive care unit (ICU) for acute exacerbation of chronic obstructive pulmonary disease (COPD). He developed ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas aeruginosa and was treated with imipenem and colistin without any renal toxicity. The patient was readmitted to the ICU for a 2nd and a 3rd exacerbation of COPD and was again treated with imipenem and colistin. In both episodes, he developed rapid worsening in renal function, which improved following colistin withdrawal. Use of the Naranjo ADR probability scale indicated a probable relationship between the renal failure and the colistin therapy. In addition, the time course of events suggested that colistin was the cause of acute interstitial nephritis in this patient. We conclude that our patient had a possible acute allergic reaction to colistin since the 1st introduction was not associated with any renal toxicity and renal failure was observed on the 1...
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To determine clinical and routine laboratory factors associated with pulmonary edema secondary to scorpion envenomation. Retrospective study covering 13 years (1990-2002) in the medical Intensive Care Unit of a university hospital... more
To determine clinical and routine laboratory factors associated with pulmonary edema secondary to scorpion envenomation. Retrospective study covering 13 years (1990-2002) in the medical Intensive Care Unit of a university hospital (Sfax-Tunisia). 428 patients older than 3 years who were admitted to the intensive care unit for scorpion envenomation were included in this study. Patients were stratified into two groups according to the presence or absence of pulmonary edema as assessed by a medical committee. The mean (+/- SD) age was 17.5 +/- 17.7 years, ranging from 3 to 76 years. The pulmonary edema group included 294 patients (68.7%). A multivariate analysis found the following factors to be correlated with a pulmonary edema: age less than 5 years (p = 0.04), sweating (p = 0.004), agitation (p = 0.01), leukocytes of 25000 cells/mm3 or more (p = 0.02), and a plasma protein concentration of 72 g/L or more (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In addition, a plasma protein concentration of 72 g/L or more predicted the presence of pulmonary edema with a sensitivity of 78% a specificity of 88%, a positive predictive value of 93%, and negative predictive value of 64%. Almost 84% of patients having a respiratory rate of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 breaths/minute associated with agitation and sweating were classified in the pulmonary edema group. This clinical association indicates the presence of pulmonary edema with a specificity of 84.3% and a positive predictive value of 87.5%. In scorpion envenomation patients older than 3 years, the association of a respiratory rate of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 breaths/minute, agitation, sweating, or the presence of high plasma protein concentrations suggest the presence of pulmonary edema.
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Résumé/Abstract But: Analyser les aspects épidémiologiques et décrire les caractéristiques lésionnelles et évolutives des enfants traumatisés du crâne dans le sud Tunisien. Méthodes: C'est une étude rétrospective, sur une période de... more
Résumé/Abstract But: Analyser les aspects épidémiologiques et décrire les caractéristiques lésionnelles et évolutives des enfants traumatisés du crâne dans le sud Tunisien. Méthodes: C'est une étude rétrospective, sur une période de 8 ans (1997-2004) dans le service de ...
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... Mounir Bouaziz Service de réanimation médicale Hôpital Habib Bourguiba Route el Ain Km 1 3029 Sfax Tunisie bahloulmab@yahoo.fr mounir.bouaziz@rns ... Bahloul M, Bouaziz M, Dammak H, Ben Hamida C, Ksibi H, Rekik N, Chelly H, Teboul JL,... more
... Mounir Bouaziz Service de réanimation médicale Hôpital Habib Bourguiba Route el Ain Km 1 3029 Sfax Tunisie bahloulmab@yahoo.fr mounir.bouaziz@rns ... Bahloul M, Bouaziz M, Dammak H, Ben Hamida C, Ksibi H, Rekik N, Chelly H, Teboul JL, Kallel H. Value of the plasma ...
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Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies... more
Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies infectieuses. Ces territoires sont de plus l’objet de mouvements importants de populations, voyageurs ou migrants, ce qui joue un rôle significatif dans le développement d’épidémies et/ou de pathologies émergentes. Ces pathologies infectieuses dites « tropicales » peuvent nécessiter une prise en charge en réanimation. Nous rapportons ici les principales données récentes concernant ces pathologies (hors infection liée au VIH) ainsi que les stratégies diagnostiques et thérapeutiques, à l’usage des réanimateurs amenés à exercer en zone tropicale AG ou recevant en métropole des patients issus de cette région.
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Background β-lactams are the main antibiotics used against wild-type AmpC-producing Enterobacterales (wtAE). However, they may fail or select AmpC-overproducing mutants. Our aim was to assess factors associated with clinical failure of... more
Background β-lactams are the main antibiotics used against wild-type AmpC-producing Enterobacterales (wtAE). However, they may fail or select AmpC-overproducing mutants. Our aim was to assess factors associated with clinical failure of β-lactams in the treatment of wtAE infection. Methods From September 2017 to December 2020, we prospectively included all consecutive patients treated by definitive β-lactams therapy for wtAE infection in four university ICUs. Clinical failure was defined as inadequate response to antimicrobial therapy leading to death or to the switch for a broader-spectrum antibiotic. Results 177 patients were included and 29.4% progressed to clinical failure. E. cloacae was the most prevalent species (42.4%) and ventilator-associated pneumonia (VAP) was the most frequent wtAE infection (69.5%). Cefepime and cefotaxime were used as definitive antibiotic treatment in 42.9% and 27.7% of patients, respectively. Occurrence of AmpC-overproduction was documented in 5.6% o...
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Background Snakebite (SB) envenoming is an acute emergency requiring an early care delivery. We aimed to search for the time to reach healthcare facilities in various regions of French Guiana (FG) and to assess the impact of time to... more
Background Snakebite (SB) envenoming is an acute emergency requiring an early care delivery. We aimed to search for the time to reach healthcare facilities in various regions of French Guiana (FG) and to assess the impact of time to antivenom (AV) on the correction of coagulation parameters in these patients. Methodology This is a prospective observational study conducted in Cayenne General Hospital between January 1st, 2016, and July 31st, 2022. We included all patients hospitalized for SB envenoming less than 48h after the bite, and receiving antivenom (AV). We assessed the time lapse between SB and medical attention and the time needed to return of the coagulation parameters to normal. Principal findings Overall, 119 patients were investigated, and 48.7% were from remote areas. The median time from SB to AV therapy was 09:15 h (05:32–17:47). The time was longer in patients from remote rural locations. AV was dispensed within the first six hours after the SB in 45 cases (37.8%). T...
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Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French... more
Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey’s incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one ...
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Ciguatera fish poisoning (CFP) is one of the most common causes worldwide of marine poisoning associated with fish consumption from tropical areas. Its incidence is underreported. CFP cases seem to increase with grouped cases reported... more
Ciguatera fish poisoning (CFP) is one of the most common causes worldwide of marine poisoning associated with fish consumption from tropical areas. Its incidence is underreported. CFP cases seem to increase with grouped cases reported during summer. Exposure to ciguatoxin, the toxin responsible for CFP with sodium-channel agonistic, cholinergic, and adrenergic activities, may result in a large spectrum of manifestations. We aimed to describe the clinical characteristics, management, and outcome of CFP in Martinique, French West Indies. We conducted an observational retrospective single-center study for six years (October 2012 to September 2018) including all CFP patients managed by the prehospital medical services, admitted to the university hospital emergency department, or declared to the regional health agency. One hundred and forty-nine CFP patients (81females/63males; median age, 46 years [interquartile range, 34-61]) were included. Acute features consisted of general (91%; mai...
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L’OMS classe l’envenimation vipérine comme pathologie négligée. Elle représente un problème de santé publique associé à des taux de mortalité et de morbidité importants. Notre objectif est de faire une mise au point sur les données... more
L’OMS classe l’envenimation vipérine comme pathologie négligée. Elle représente un problème de santé publique associé à des taux de mortalité et de morbidité importants. Notre objectif est de faire une mise au point sur les données récentes de la littérature sur l’épidémiologie et la prise en charge de l’envenimation vipérine en Guyane française. La Guyane est un département français presque entièrement recouvert par une forêt tropicale. Elle abrite une herpétofaune très riche comportant notamment les espèces du genre Bothrops (famille des Viperidae) qui provoquent le plus grand nombre de morsures et d’envenimations. La gestion des envenimations vipérines représente un défi de santé publique. En effet, la plupart des envenimations se produisent dans des zones rurales éloignées où l’accès aux soins est le plus compliqué, avec la présence d’un personnel médical peu formé à la prise en charge et l’indisponibilité de l’antivenin, ce qui constitue une véritable perte de chance pour les p...
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French Guiana (FG) is a French overseas region bordering Brazil and Suriname that is considered endemic for yellow fever (YF); vaccination is compulsory for residents and travellers. In August 2017 and 2018, two sporadic YF cases were... more
French Guiana (FG) is a French overseas region bordering Brazil and Suriname that is considered endemic for yellow fever (YF); vaccination is compulsory for residents and travellers. In August 2017 and 2018, two sporadic YF cases were notified 1 year apart, confirming that sylvatic YF virus circulation is active in the region. YF vaccination coverage should be closely monitored and improved in FG and neighbouring territories and clinicians should be aware of the risk.
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Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about... more
Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about population size and intensive care unit (ICU) bed capacity in the FTA and literature on FTA ICU specificities. Persons living in or visiting the FTA are exposed to specific risks, mainly severe road traffic injuries, envenoming, stab or ballistic wounds, and emergent tropical infectious diseases. These diseases may require specific knowledge and critical care management. However, there are not enough ICU beds in the FTA. Indeed, there are 7.2 ICU beds/100 000 population in Guadeloupe, 7.2 in Martinique, and 4.5 in French Guiana. In addition, seriously ill patients in remote areas regularly have to be transferred, most often by helicopter, resulting in a delay in admission to intensive care. The COVID-19 crisis has shown that the health care system in ...
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Resume Depuis le debut de l’annee 2018, il a ete constate une proliferation croissante et desormais bien documentee d’algues sargasses sur les cotes des iles de la Caraibe dont la Martinique. L’echouage de ces algues brunes constitue non... more
Resume Depuis le debut de l’annee 2018, il a ete constate une proliferation croissante et desormais bien documentee d’algues sargasses sur les cotes des iles de la Caraibe dont la Martinique. L’echouage de ces algues brunes constitue non seulement un desastre environnemental et economique, mais pourrait egalement resulter en un impact sanitaire pour la population malgre le peu de donnees biomedicales disponibles. Apres 48 h d’echouage, en raison de la decomposition de la matiere organique, les algues produisent de grandes quantites de gaz toxiques, dont le sulfure d’hydrogene (H2S) et l’ammoniaque (NH3). La toxicite chez l’homme de l’exposition a de fortes concentrations d’H2S est bien decrite. La gravite des symptomes, dependante des circonstances d’exposition, s’accroit proportionnellement avec les concentrations, entrainant des troubles respiratoires, neurologiques et cardiovasculaires potentiellement fatals, notamment en cas de comorbidites. A l’inverse, les consequences sanitaires d’une exposition chronique ou repetee aux gaz emis par les sargasses en decomposition sont moins bien connues. Ont ete decrits un malaise, une irritation conjonctivale et des voies respiratoires superieures, des troubles digestifs, des cephalees, un syndrome vestibulaire, une perte de memoire et une modification des capacites d’apprentissage. En l’absence de therapeutiques specifiques, la prise en charge est symptomatique. De fait, il faut privilegier les mesures de prevention individuelle. Des donnees preliminaires collectees sur 12 mois par notre groupe de travail Sargasses au CHU de La Martinique ont permis de decrire les caracteristiques cliniques de 154 patients exposes lors des episodes d’echouage des algues en 2018. Les patients se plaignaient surtout de troubles neurologiques non specifiques (80 %), digestifs (77 %), respiratoires (69 %), oculaires (64 %), ORL (53 %) et psychologiques (33 %). Nos donnees soulignent l’importance des actions visant a limiter l’exposition au long terme aux sargasses et aux gaz qu’elles emettent. Il est donc urgent qu’un plan destine a mieux comprendre les consequences sanitaires de cette invasion par les sargasses fasse l’objet de discussions regionales et internationales pour stimuler la recherche.
La septième édition du séminaire annuel de la Commission de la Recherche Translationnelle de la SRLF a permis un nouveau moment d’échange unique entre chercheurs et cliniciens autour des dernières données issues de la recherche... more
La septième édition du séminaire annuel de la Commission de la Recherche Translationnelle de la SRLF a permis un nouveau moment d’échange unique entre chercheurs et cliniciens autour des dernières données issues de la recherche translationnelle en pharmaco-toxicologie. Les études pharmacologiques et toxicologiques, chez les patients en situation critique, se sont longtemps résumées à des mesures de concentrations plasmatiques. Leur interprétation clinique étaient souvent limitées par les méthodes de dosage elles-mêmes, mais aussi par les différents mécanismes conduisant à une variation individuelle de l’absorption, de la distribution, du métabolisme ou de l’élimination des médicaments ou du toxique. Les évolutions récentes des méthodes de dosage, la meilleure compréhension des mécanismes de diffusion et de clairance des médicaments/toxiques dans les tissus ainsi que l’utilisation de techniques innovantes basées sur l’imagerie pharmacologique et les modélisations pharmacocinétiques, ...
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In the world, the impact of environmental conditions on the number of scorpion events was evaluated in North Africa,Middle East, and the Amazonian region but not in Europe. In mainland France, scorpion species described are Buthus... more
In the world, the impact of environmental conditions on the number of scorpion events was evaluated in North Africa,Middle East, and the Amazonian region but not in Europe. In mainland France, scorpion species described are Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) and 4 Euscorpiidae: Euscorpius concinnus (Koch, 1837), Euscorpius italicus (Herbst, 1800), Euscorpius tergestinus (Koch, 1837), and Tetratrichobothrius flavicaudis (De Geer, 1778). We aimed to describe the impact of environmental conduction on the number of scorpion events. For this, a retrospective multi-center study was conducted with data from the French poison control centers files about scorpion events between 1 January 2011 and 31 December 2020. During the study period, 975 incoming calls for scorpion events were recorded and 574 were related to scorpions native to mainland France and Corsica: B. occitanus (n = 86), Euscorpiidae species (n = 222), B. xambeui (n = 1), and undetermined species...
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Background French Guiana (FG) is a French overseas territory where malaria is endemic. The current incidence rate is 0.74‰ inhabitants, and Plasmodium vivax is widely predominating even though Plasmodium falciparum is still present due to... more
Background French Guiana (FG) is a French overseas territory where malaria is endemic. The current incidence rate is 0.74‰ inhabitants, and Plasmodium vivax is widely predominating even though Plasmodium falciparum is still present due to imported cases mainly from Africa. In FG, rapid diagnostic test (SD Malaria Ag P.f/Pan®) is based on the detection of pan-pLDH, PfHRP2, and PfHRP3 antigens, while in South America, the share of deletion of PfHRP2 gene is significantly increasing. Accordingly, the study questions the reliability of RDTs in the Amazonian context. Methods The study is retrospective. It is conducted over 4 years and analysed 12,880 rapid diagnostic tests (RDTs) compared to concomitant Blood Film Tests (BFTs) sampled for malaria diagnosis. Results The global assessment of the accuracy of SD Malaria Ag P.f/Pan® in the diagnostic of malaria shows both Positive and Negative Predictive Values (PPV and NPV) higher than 95%, except for PPV in the diagnosis of malaria to P. fa...
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Bothrops lanceolatus is an endemic viperid species in the Lesser Caribbean island of Martinique. Envenomings by this species are characterized by local and systemic effects, among which the development of thrombosis in various organs is... more
Bothrops lanceolatus is an endemic viperid species in the Lesser Caribbean island of Martinique. Envenomings by this species are characterized by local and systemic effects, among which the development of thrombosis in various organs is the most severe complication. An experimental toxicological characterization of this venom was performed using in vivo mouse tests and various in vitro assays. The venom induced lethal, local and systemic hemorrhagic, edema-forming, myotoxic, thrombocytopenic, proteinase and phospholipase A activities. The preclinical efficacy of a batch of monospecific Bothrofav antivenom currently in use in Martinique was assessed. The antivenom was highly effective in the neutralization of all activities tested, in agreement with its described clinical efficacy. This batch of antivenom showed a higher preclinical efficacy as compared to a previous batch used in the past.
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In French Guiana, Bothrops atrox, Bothrops brazili, Bothrops bilineatus, Lachesis muta and Micrurus sp are responsible for most cases of snakebite envenomation. The clinical features in patients suffering from envenomations by viperid... more
In French Guiana, Bothrops atrox, Bothrops brazili, Bothrops bilineatus, Lachesis muta and Micrurus sp are responsible for most cases of snakebite envenomation. The clinical features in patients suffering from envenomations by viperid snakes involve local tissue damage and systemic manifestations, such as hemorrhage, coagulopathies and hemodynamic instability. We report a severe case of envenomation in a patient bitten by a large unidentified pit viper in French Guiana. Due to lack of antivenom, the patient only received symptomatic management. Severe manifestations of local and systemic envenomation developed, and the patient needed multiple debridement procedures and ultimately required a transfemoral amputation. In addition, Aeromonas hydrophila was cultivated from the affected tissue, suggesting that infection contributed to necrotizing fasciitis. This case highlights the clinical features of a severe viperid snakebite envenomation, and illustrates the urgent need to ensure acce...
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This study investigated the clinical epidemiology and resistance mechanisms of Acinetobacter baumannii and characterised the clonal diversity of carbapenem-resistant A. baumannii (CRAB) during an ICU-associated outbreak at Cayenne... more
This study investigated the clinical epidemiology and resistance mechanisms of Acinetobacter baumannii and characterised the clonal diversity of carbapenem-resistant A. baumannii (CRAB) during an ICU-associated outbreak at Cayenne Hospital, French Guiana. All non-duplicate A. baumannii isolates from 2008 to 2014 were tested for antibiotic susceptibility by disk diffusion. Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on CRAB. Of the 441 A. baumannii isolates, most were from males (54.0%) and were detected mainly from the ICU (30.8%) and medicine wards (21.8%). In the ICU, strains were mainly isolated from the respiratory tract (44.1%) and bloodstream (14.0%), whereas in medicine wards they mainly were from wound/drainage (36.5%) and bloodstream (25.0%). A. baumannii showed the greatest susceptibility to piperacillin/tazobactam (92.7%), imipenem (92.5%), colistin (95.6%) and amikacin (97.2%), being lower in the ICU and medicine wards compared with other wards. An outbreak of OXA-23-producing CRAB occurred in the 13-bed ICU in 2010. CRAB strains were more co-resistant to other antimicrobials compared with non-CRAB. Molecular genetics analysis revealed five sequence types [ST78, ST107 and ST642 and two new STs (ST830 and ST831)]. Analysis of PFGE profiles indicated cross-transmissions of CRAB within the ICU, between the ICU and one medicine ward during transfer of patients, and within that medicine ward. This study provides the first clinical and molecular data of A. baumannii from French Guiana and the Amazon basin. The ICU was the highest risk unit of this nosocomial outbreak of OXA-23-producing CRAB, which could subsequently disseminate within the hospital.
Research Interests: Microbiology, Epidemiology, Medical Microbiology, Medicine, Hospitals, and 15 moreDisease Outbreaks, Humans, Female, Male, French Guiana, Intensive Care Unit, Adult, Colistin, Antimicrobial agents, Carbapenems, Acinetobacter baumannii, Imipenem, Acinetobacter Infections, Beta Lactamases, and Cross Infection
Centers for Disease Control and Prevention built up new surveillance paradigms for the patients on mechanical ventilation and the ventilator-associated events, comprising ventilator-associated conditions and infection-related... more
Centers for Disease Control and Prevention built up new surveillance paradigms for the patients on mechanical ventilation and the ventilator-associated events, comprising ventilator-associated conditions and infection-related ventilator-associated complications. We assess 1) the current epidemiology of ventilator-associated event, 2) the relationship between ventilator-associated event and ventilator-associated pneumonia, and 3) the impact of ventilator-associated event on antimicrobials consumption and mechanical ventilation duration. Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1996-2012). Patients on mechanical ventilation for greater than or equal to 5 consecutive days were classified as to the presence of a ventilator-associated event episode, using slightly modified Centers for Disease Control and Prevention definitions. None. Among the 3,028 patients, 2,331 patients (77%) had at least one ventilator-associated condition, and 869 patients (29%) had one infection-related ventilator-associated complication episode. Multiple causes, or the lack of identified cause, were frequent. The leading causes associated with ventilator-associated condition and infection-related ventilator-associated complication were nosocomial infections (27.3% and 43.8%), including ventilator-associated pneumonia (14.5% and 27.6%). Sensitivity and specificity of diagnosing ventilator-associated pneumonia were 0.92 and 0.28 for ventilator-associated condition and 0.67 and 0.75 for infection-related ventilator-associated complication, respectively. A good correlation was observed between ventilator-associated condition and infection-related ventilator-associated complication episodes, and ventilator-associated pneumonia occurrence: R = 0.69 and 0.82 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The median number of days alive without antibiotics and mechanical ventilation at day 28 was significantly higher in patients without any ventilator-associated event (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Ventilator-associated condition and infection-related ventilator-associated complication rates were closely correlated with antibiotic use within each ICU: R = 0.987 and 0.99, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Ventilator-associated event is very common in a population at risk and more importantly highly related to antimicrobial consumption and may serve as surrogate quality indicator for improvement programs.
Research Interests: Nursing, Medicine, Critical Care Medicine, Complication, Humans, and 15 moreFemale, Pneumonia, Male, Glasgow Coma Scale, Body Mass Index, Clinical Sciences, Apache, Aged, Prevalence, Middle Aged, Mechanical Ventilation, Age Factors, Intensive Care Units, Organ dysfunction scores, and Cross Infection
To report clinical symptoms and outcome of systemic paraphenylene diamine (PPD) intoxication. Our study was retrospective. It was conducted over 6 yrs (1994-2000) in the medical intensive care unit (ICU) of a university hospital and it... more
To report clinical symptoms and outcome of systemic paraphenylene diamine (PPD) intoxication. Our study was retrospective. It was conducted over 6 yrs (1994-2000) in the medical intensive care unit (ICU) of a university hospital and it concerned 19 patients hospitalized for systemic PPD intoxication. The mean age (+/- SD) was 27.9 +/- 16.8 yrs, the sex ratio was about 0.58 and the Simplified Acute Physiology Score (SAPS II) was 30 +/- 27. At admission, clinical symptoms were dominated by cervicofacial edema (79%), chocolate brown colored urine (74%), upper airway tract edema (68.4%), oliguria (36.8%), muscular edema (26.3%) and shock (26.3%). The biological results were dominated by rhabdomyolysis (100%), metabolic acidosis (100%), acute renal failure (ARF) (47.4%) and hyperkalemia (26.3%) (biological disturbances were more pronounced in patients with ARF). The therapies used were gastric lavage (100%), fluid infusion (100%), mechanical ventilation (84.2%), alcalinization (80%), cor...