To predict at an early phase the clinical course and outcome of nosocomial Staphylococcus aureus bacteremia, the APACHE II score at onset of bacteremia was calculated in 99 patients. A ΔAPACHE II ...score (i.e., the difference between this score and one calculated for the day before the bacteremia) was also determined. This ΔAPACHE II score was highly significantly correlated with clinical course (P < .001) and outcome (P < .001). The risk of a complicated clinical course and of dying from S. aureus bacteremia is determined at the very onset of bacteremia, and this risk can best be assessed by calculating the ΔAPACHE II score. Furthermore, a positive correlation was found between ΔAPACHE II scores and the level of serum opsonic activity (P = .003) toward S. aureus. Therefore, the complicated clinical course of S. aureus bacteremia is not due to a relative lack of specific opsonins.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
The molecular epidemiology of
Pseudomonas aeruginosa infection in cystic fibrosis (CF) siblings was analysed by DNA fingerprinting using arbitrary primed polymerase chain reaction. A total of 306 ...strains collected from six pairs of siblings over a period of 20–126 months (median 64) was studied. Fifty-four different
P. aeruginosa genotypes were recognized. Two out of six pairs of siblings were ultimately colonized by identical strains, and it was shown that a single
P. aeruginosa clone can persist in an individual patient for over ten years. No overlap in
P. aeruginosa genotypes was encountered between families, whereas in all families at least transient cross-colonization with the same genotype was observed. This finding demonstrates that
P. aeruginosa cross-infection or acquisition of the same strain from an identical environmental source exists within the family situation, but does not always result in a long-term colonization by identical genotypes in all family members suffering from CF.
L'épidémiologie moléculaire des infections à
Pseudomonas aeruginosa a été analysée chez des frères et sœurs atteints de maladie fibrokystique, à l'aide d'une réaction d'amplification génique avec amorce arbitraire. Six paires d'enfants — chaque paire appartenant à une même fratrie — sont à l'origine des 306 souches étudiées, collectées sur une période de 20 à 126 mois (médiane 64). Cinquante-quatre génotypes différents de
P. aeruginosa ont été reconnus. Deux des six paires d'enfants ont été finalement colonisées par des souches identiques, et la persistance d'une même souche a pu être mise en évidence chez un même individu sur une période de plus de 10 ans. Aucun chevauchement de génotype n'a été rencontré entre les différentes familles, alors que dans toutes les familles des colonisations croisées au moins passagères ont été observées. On peut conclure de ces observations que l'infection croisée à
P. aeruginosa ou l'acquisition d'une même souche à partir du même environnement existe dans un cadre familial, mais ne résulte pas forcément en une colonisation à long terme par des génotypes identiques chez les membres d'une même fratrie atteints de fibrose kystique.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Paroxysmal nocturnal hemoglobinuria (Marchiafava-Micheli disease) is a rare acquired clonal disorder of the hematopoietic stem cell. Its most frequent clinical manifestations are hemolytic crisis and ...the most serious are venous thrombosis of the mesenteric, hepatic, portal or cerebral territories. Arterial cerebral infarctions are extremely rare. We report and comment on a case of multiple strokes occurring during an hemolytic crisis and despite effective long-term anticoagulation treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In studying the anti-mannan antibodies longitudinally in serial serum samples of three immunocompromised patients, it was observed that anti-mannan antibodies started to increase shortly after the ...moment that cultures of deep-tissue sites became positive with Candida albicans. The mean anti-mannan antibody titers determined in a group of 36 immunocompromised patients with invasive candidiasis increased within two weeks after the probable onset of invasive candidiasis. In contrast, anti-mannan antibody levels in serial serum samples of 14 immunocompromised patients who were only colonized with C. albicans remained stable or decreased over time. The HA test measuring the anti-mannan antibodies was 64% sensitive and 89% specific in determining invasive candidiasis. In contrast, antibodies specific for candidal cytoplasmic antigens or enolase alone were of little value in confirming invasive candidiasis in these immunocompromised patients.
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BFBNIB, FZAB, GIS, IJS, KILJ, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The pharmacokinetics and penetration into suction blister fluid of meropenem was investigated after intermittent (10 mg/kg/6 h) and during continuous infusion (10 mg/kg/6 h) in eight healthy male ...volunteers in a crossover fashion. Concentrations in serum, urine and blister fluid were determined by a HPLC method. The pharmacokinetic parameters in serum (+/- S.D.) T1/2 beta, AUC and clearance after the third dose of intermittent infusion were 62.7 (11.4) min, 43.5 (7.1) mg.h/L and 292.1 (36.8) mL/min respectively. The penetration in blister fluid was rapid and good, with a AUC ratio blister fluid/serum of 84.7 (11.4)%. During continuous infusion, from 12 to 18 h after the start of the infusion, the mean concentration in serum was 6.3 (0.7, S.D.) mg/L and in blister fluid 5.4 (0.7, S.D.) mg/L. The clearance was 338.3 (45.6) mL/min for serum. Urinary recovery was 61.6 (8.7)% after intermittent and 61.9 (6.9)% after continuous infusion.
To estimate the treatment and health care costs of HIV infection or AIDS in France during the era of highly active antiretroviral therapy (HAART).
We used a clinical database of HIV-infected patients ...to calculate the resource use and cost of care for different stages of HIV infection. Costs were incorporated into a computer-based, probabilistic simulation model of the natural history and treatment of HIV infection to estimate the lifetime cost of treating patients with HIV disease.
A northern France HIV clinical cohort.
1232 HIV-infected patients followed from January 1994 through July 1998.
In the absence of an AIDS-defining event, the average total cost of care ranged from 670 euros (1 euro=US $1.19) per person-month in the highest CD4 stratum (>500/microl) to 1060 euros per person-month in the lowest CD4 stratum (< or = 50/microl). The mean cost of care was estimated at 3370 euros per person-month during the initial months around the occurrence of an AIDS-defining event; at 1750 euros per person-month during the period spanning from 2 months after the diagnosis of specific AIDS-defining event to 1 month prior to death; and at 13010 euros per person-month in the final month prior to death. If clinical management of HIV infection began at a CD4 cell count of 378/microl, as in this cohort, the discounted lifetime cost of treating an HIV-infected French patient was estimated at 214000 euros. The undiscounted costs were 309000 euros over a projected life expectancy of 16.4 years.
The cost of HIV disease varies widely depending upon the stage of illness. These estimates of stage-specific and lifetime costs of HIV care will assist health policy planners in assessing the burden of disease in the era of HAART and projecting future resource requirements.
IFN alpha has both antiviral and immunostimulating properties. The ANRS086 Primoferon A Study evaluated in 12 patients with primary HIV infection the tolerance and efficacy of an early and transient ...administration of pegylated IFN alpha, in addition to highly active antiretroviral therapy. Tolerance was good, and this regimen allowed the early control of HIV replication and rapid decay of the viral reservoir. These results support the initiation of comparative studies with pegylated INF alpha in primary HIV infection.
Synchronization of estrus in ewes using a GnRH analog Castonguay, F. (Agriculture et Agroalimentaire, La Pocatiere (Canada). Ferme de Recheche sur le Mouton); Dufour, J.J; Laforest, J.P ...
19/Dec
Conference Proceeding
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