To determine the prevalence and genotypic characteristics of extended-spectrum β-lactamase-producing Enterobacterales (ESBLE) and carbapenemase-producing Enterobacterales (CPE) in nursing homes (NHs) ...in a French region. Risk factors associated with their carriage were also investigated.
A point-prevalence survey was proposed from November 2017 to June 2018 to NHs in the study region. Volunteer residents were screened for ESBLE and CPE carriage. Escherichia coli and Klebsiella pneumoniae isolates were genotyped using multi-locus sequence typing, pulsed-field gel electrophoresis (PFGE) and phylogrouping (for E. coli alone). Collective and individual data were analysed by random-effects logistic regression.
The study was conducted in 18 NHs and included 262 patients. Fifty-two patients (19.8%) carried at least one ESBLE, corresponding to 56 isolates (42 E. coli, 11 K. pneumoniae and three others), while no CPE was detected. The majority (27/42) of ESBL E. coli belonged to phylogroup B2, and ST131 was over-represented in this subset (21/27). PFGE analysis revealed ST131 cross-transmission within NHs. Regarding ESBL K. pneumoniae, nine of 11 isolates belonged to ST663, and PFGE suggested diffusion of the clone in six NHs. Significant individual risk factors for colonization by ESBLE were: use of a shared bathroom, previous antibiotic use and recent history of hospitalization. Significant collective protective factors were proper compliance with glove use and support of the NH by a healthcare facility.
This study shows that NHs in the study region are an important reservoir of ESBLE, whereas no residents were CPE carriers. The control of ESBLE in NHs should focus on antibiotic stewardship and excreta management policies.
Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA) but its effectiveness requires high adherence. We aimed to assess the impacts of the ...spouse's/partner's involvement and the quality of the couple's relationship on CPAP adherence.
In a multicenter prospective study conducted in France, patients reported their subjective views regarding their partner's engagement in their CPAP treatment and the quality of their marital relationship using the Quality of Marriage Index. A hierarchical linear model was built to assess the predictors of CPAP adherence at day 120. Structural equation modeling was performed to evaluate the direct and indirect effects of the spouse's/partner's engagement and the quality of the couple's relationship on CPAP adherence.
The 290 OSA patients were predominantly male (77%), with a median age of 53 years IQR: 46; 62, median BMI: 32 kg/m2 28.6; 35.9 and median apnea + hypopnea index: 43/per hour 33; 58. Independent factors for CPAP adherence at day 120 were the partner's encouragement of CPAP usage and a stable relationship exceeding 30 years, although emotional support or collaboration were not associated with CPAP adherence. Structural equation modeling demonstrated that spouse's/partner's engagement is directly related to CPAP adherence and improvement of symptoms, and that CPAP adherence is a mediator of disease-specific health-related quality of life. Marital quality was a significant moderator of these interactions meaning that a spouse's/partner's engagement improved adherence only when the quality of marriage index was high.
Future research and integrated OSA management should systematically include and document the role of the spouse/partner in CPAP adherence.
•Spouses's/partner's encouragement is an independent factor for CPAP adherence.•A stable relationship of over 30 years is an independent factor for CPAP adherence.•SEM analysis shows partner's engagement to directly affect CPAP adherence.•CPAP adherence is a mediator of disease-specific health-related quality of life.•However, adherence only improves when the quality of marriage index is high.
Hybrid nanoplasmonics is one of the most promising branch of nanophotonics which aims, in particular, to control the energy transfer between donor and acceptor nano-emitters via surface plasmons. ...Recently, an approach of nano-emitters positioning was introduced. It is based on two-photon polymerization of a photosensitive material which contains quantum dots as nano-emitters. This technique allowed for the integration of green quantum dots on plasmonic silver nanowires. In this article, we report on the use of this approach for integrating both green and red quantum dots on silver nanowires. The coupling between nano-emitters and propagating surface plasmons that are supported by the silver nanowires is reported and observed through their scattering at the nanowire ends. For both colors, a parametric study of the distance between the quantum dots and the nanowire extremity shows that precise control of the position of the launching sites enables control of light intensity at the wire end, through surface plasmon propagation length. More interestingly, by integrating two kinds of quantum dots on the same nanowire, we realized an efficient donor-acceptor hybrid nano-system, where green surface plasmons polaritons (from donors) are transformed into red plasmons (from acceptors) at controlled sites of the plasmonic guides, as a result of a frequency conversion of the plasmons polaritons.
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•Integration of two kinds of QDs on the same silver nanowires (Ag-NW) that support propagating surface plasmons polaritons•Demonstration of a clear donor-acceptor dialogue via the Ag NW•Demonstration of SPP down-conversion at controlled sites
We aimed to determine whether serum leptin levels are predictive of the occurrence of healthcare-associated infections (HAIs) in hospitalized older patients. In a prospective cohort, 232 patients had ...available data for leptin and were monitored for HAIs for 3 months. Admission data included comorbidities, invasive procedures, the Mini Nutritional Assessment (MNA), BMI, leptin, albumin and C-reactive protein levels, and CD4 and CD8 T-cell counts. Multivariate logistic regression modelling was used to identify predictors of HAIs. Of the 232 patients (median age: 84.8; females: 72.4%), 89 (38.4%) experienced HAIs. The leptin level was associated with the BMI (
< 0.0001) and MNA (
< 0.0001) categories. Women who experienced HAIs had significantly lower leptin levels than those who did not (5.9 μg/L (2.6-17.7) and 11.8 (4.6-26.3), respectively;
= 0.01; odds ratio (OR) (95% confidence interval): 0.67 (0.49-0.90)); no such association was observed for men. In a multivariate analysis of the women, a lower leptin level was significantly associated with HAIs (OR = 0.70 (0.49-0.97)), independently of comorbidities, invasive medical procedures, and immune status. However, leptin was not significantly associated with HAIs after adjustments for malnutrition (
= 0.26) or albuminemia (
= 0.15)-suggesting that in older women, the association between serum leptin levels and subsequent HAIs is mediated by nutritional status.
Sarcomas are rare but aggressive diseases. Specialized multidisciplinary management is not implemented for all patients in most countries. We investigated the impact of a multidisciplinary tumor ...board (MDTB) presentation before treatment in a nationwide study over 5years.
NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized MDTB, funded by the French National Cancer Institute to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients in France. Patients’ characteristics and follow-up are collected in a database regularly monitored and updated. The management and survival of patients presented to these MDTB before versus after initial treatment were analyzed.
Out of the 12528 patients aged ≥15years, with a first diagnosis of soft tissue and visceral sarcoma obtained between 1 January 2010 and 31 December 2014, 5281 (42.2%) and 7247 (57.8%) were presented to the MDTB before and after the initiation of treatment, respectively. The former group had generally worse prognostic characteristics. Presentation to a MDTB before treatment was associated with a better compliance to clinical practice guidelines, for example, biopsy before surgery, imaging, quality of initial surgery, and less reoperations (all P<0.001). Local relapse-free survival and relapse-free survival were significantly better in patients presented to a MDTB before initiation of treatment, both in univariate and multivariate analysis.
The compliance to clinical practice guidelines and relapse-free survival of sarcoma patients are significantly better when the initial treatment is guided by a pre-therapeutic specialized MDTB.
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