To characterize and compare resistance trends in clinical Escherichia coli isolates from humans, food-producing animals (poultry, cattle and swine) and pets (dogs and cats).
Antibiogram results ...collected between January 2014 and December 2017 by MedQual the French surveillance network for antimicrobial resistance (AMR) in bacteria isolated from the community and RESAPATH (the French surveillance network for AMR in bacteria from diseased animals) were analysed, focusing on resistance to antibiotics of common interest to human and veterinary medicine. Resistance dynamics were investigated using generalized additive models.
In total, 743 637 antibiograms from humans, 48 170 from food-producing animals and 7750 from pets were analysed. For each antibiotic investigated, the resistance proportions of isolates collected from humans were of the same order of magnitude as those from food-producing animals or pets. However, resistance trends in humans differed from those observed in pets and food-producing animals over the period studied. For example, resistance to third-generation cephalosporins and fluoroquinolones was almost always below 10% for both humans and animals. However, in contrast to the notable decreases in resistance observed in both food-producing animals and pets, resistance in humans decreased only slightly.
Despite several potential biases in the data, the resistance trends remain meaningful. The strength of the parallel is based on similar data collection in humans and animals and on a similar statistical methodology. Resistance dynamics seemed specific to each species, reflecting different antibiotic-use practices. These results advocate applying the efforts already being made to reduce antibiotic use to all sectors and all species, both in human and veterinary medicine.
The coronavirus disease-2019 (COVID-19) pandemic has imposed unforeseen and unprecedented constraints on emergency departments (EDs). In this study, we detail the organizational and managerial tools ...recently implemented among 5 academic EDs in a French region particularly affected by COVID-19 and analyze how EDs responded to the COVID-19-related disease burden during different phases of the epidemic. Initially, they focused on the early detection of suspected cases by identifying 3 predominant COVID-19 syndromes. During this diagnostic process, patients were placed in respiratory isolation (facial mask before triage) and droplet isolation (ED rooms). A 3-level strategy for triage, clinical pathways in the EDs, and the organization of hospital spaces was based on the real-time polymerase chain reaction (RT-PCR) COVID-19 positivity rate, with ED strategies adapted to the exigencies of each level. This crisis demonstrated hospitals' adaptability and capacity to mobilize in the face of new risks, with hospitals and EDs coordinating their management to reallocate resources, optimize interoperability, and rethink patient pathways. This report on their processes may assist hospitals and EDs in areas currently spared by the new variants.
Abstract
Background
Ciprofloxacin is an antibiotic used in osteoarticular infections owing to its very good bone penetration. Very few pharmacokinetic data are available in this population.
...Objectives
To investigate oral ciprofloxacin population pharmacokinetics in adult patients treated for osteoarticular infections and propose guidance for more effective dosing.
Methods
A retrospective population-pharmacokinetic analysis was performed on 92 consecutive hospitalized patients in the orthopaedic department. Ciprofloxacin plasma samples were obtained on one or two occasions during treatment. Plasma concentration was measured using ultra-performance liquid chromatography system coupled with tandem mass spectrometry. Data analysis was performed using a non-linear mixed-effect approach via Monolix 2019R2.
Results
A total of 397 plasma samples were obtained with 11.5% and 41.6% of patients being below the therapeutic target for Gram-negative and staphylococcal infections, respectively. Ciprofloxacin pharmacokinetics were best described by a two-compartment model with a first-order absorption. Ciprofloxacin apparent plasma clearances and volumes of distribution were dependent on patients’ fat-free mass according to the allometric rule. Elimination clearance was also positively related to renal function through the modification of diet in renal disease equation (MDRD) and rifampicin co-administration. When patients are co-treated with rifampicin, ciprofloxacin dosage should be increased by 50% to 60%.
Conclusions
This study showed that free-fat mass was a better size predictor than total body weight for ciprofloxacin clearance and volumes terms. Moreover, both MDRD and rifampicin status were significant predictors of individual ciprofloxacin clearance. Our study suggests that individual adjustment of ciprofloxacin dose in osteoarticular infections with less-susceptible bacteria might be indicated to reach required efficacy targets.
Background
The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma ...exacerbation (SAE) in adult and pediatric patients.
Results
The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/−) and 7 a low level of evidence (GRADE 2+/−). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines.
Conclusion
The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
Abstract Background Ciprofloxacin is an antibiotic used in osteoarticular infections owing to its very good bone penetration. Very few pharmacokinetic data are available in this population. ...Objectives To investigate oral ciprofloxacin population pharmacokinetics in adult patients treated for osteoarticular infections and propose guidance for more effective dosing. Methods A retrospective population-pharmacokinetic analysis was performed on 92 consecutive hospitalized patients in the orthopaedic department. Ciprofloxacin plasma samples were obtained on one or two occasions during treatment. Plasma concentration was measured using ultra-performance liquid chromatography system coupled with tandem mass spectrometry. Data analysis was performed using a non-linear mixed-effect approach via Monolix 2019R2. Results A total of 397 plasma samples were obtained with 11.5% and 41.6% of patients being below the therapeutic target for Gram-negative and staphylococcal infections, respectively. Ciprofloxacin pharmacokinetics were best described by a two-compartment model with a first-order absorption. Ciprofloxacin apparent plasma clearances and volumes of distribution were dependent on patients’ fat-free mass according to the allometric rule. Elimination clearance was also positively related to renal function through the modification of diet in renal disease equation (MDRD) and rifampicin co-administration. When patients are co-treated with rifampicin, ciprofloxacin dosage should be increased by 50% to 60%. Conclusions This study showed that free-fat mass was a better size predictor than total body weight for ciprofloxacin clearance and volumes terms. Moreover, both MDRD and rifampicin status were significant predictors of individual ciprofloxacin clearance. Our study suggests that individual adjustment of ciprofloxacin dose in osteoarticular infections with less-susceptible bacteria might be indicated to reach required efficacy targets.
Trichoderma longibrachiatum, a filamentous fungus, was recently described as an emerging pathogen in immunocompromised patients. Here, we report the first case, to our knowledge, of isolated invasive ...lung infection by T. longibrachiatum in a patient with hematologic malignancy. The infection mimicked invasive pulmonary aspergillosis and was successfully treated with a combination of voriconazole and caspofungin.
In France, fruit and vegetable productions contribute 2% of the UAA and are characterised by a diversity of cultivated species and cropping systems with contrasting environmental impacts. Facing new ...stakes of implementing horticulture with high environment performance, Inra carries out researches targeting a reduction of the environmental impact of these crops and conc eption of innovative production systems. The main results achieved during the recent years concern optimisation of the management climatic conditions in greenhouses, optimised management of irrigation and fertilisation, creation of varieties with multiple resistance as well as durable management of resistances to pests and diseases, conception of production systems leading to reduced phytosanitary risks. Beyond researches in organic farming, the implementation of integrated pest management in fruit production and, more recently, integrated biological control in greenhouses are main contributions to environment preservation. Present approaches of Inra are more global and target low input production systems with high environmental and economic performances. They require modelling of complex systems and multiple partnerships. To feed and study these questions, Inra reinforces its collaborative structures, especially through Group of Scientific Interest (GIS) such as GIS PICLeg and, soon, GIS Fruits
En France, les productions fruitières et légumières qui occupent moins de 2% de la SAU sont caractérisés par la diversité des espèces cultivées et les multiples systèmes de culture qui peuvent avoir des impacts environnementaux divers. Face aux nouveaux enjeux de développement d’une horticulture sensu lato à haute performance environnementale, l’Inra contribue aux travaux visant à réduire l’impact environnemental de ces cultures et à concevoir des systèmes de culture innovants. Les principaux résultats acquis au cours des dernières années concernent l’optimisation de la gestion du climat sous serre, le raisonnement optimisé de pratiques d’irrigation et de fertilisation, la création de variétés multi résistantes et la gestion durable des résistances aux bio agresseurs, l’élaboration de systèmes de cultures innovants limitant les risques phytosanitaires. Outre les recherches conduites en agriculture biologique, le développement de la protection fruitière intégrée et, plus récemment, de la protection biologique intégrée sous serre constituent des apports importants dans cette démarche de protection de l’environnement. Les approches actuelles de l’Inra sont plus globales et concernent l’étude des systèmes de culture à bas intrants et à hautes performances environnementales et économiques. Elles nécessitent des approches de modélisation des systèmes complexes et des partenariats multiples. Pour nourrir et étudier ces questions, l’Inra renforce ses structures d’interface notamment au travers de Groupements d’Intérêt Scientifique tels que le GIS PIClég et très prochainement le GIS « Fruits »
Cette étude contribue à évaluer les pertes alimentaires en France au sein des filières de fruits, légumes et pomme de terre. Compte tenu du nombre de produits, de la variété des systèmes de ...production et des multiples destinations, l’analyse s’appuie sur 9 productions illustrant la diversité existant au sein de ces trois filières. Des pertes alimentaires potentielles apparaissent tout au long de ces filières, de la parcelle du producteur à l’étal du distributeur, et peuvent être plus ou moins importantes selon les produits (d’environ 5% à plus de 20%). Elles représentent globalement pour l’ensemble des fruits et des légumes 12% de la production disponible au champ. Les trois quarts de ces pertes sont constatés aux premières étapes de la filière, de la récolte à la mise en marché. Leurs principales causes sont la sensibilité des produits aux aléas sanitaires et climatiques, leur périssabilité, l’application de normes règlementaires ou de cahiers des charges exigeants. Les pertes aux stades de la distribution (grossistes et détaillants) représentent le quart restant ; elles sont principalement dues à la manipulation de produits très périssables et surtout à des problèmes de surmaturité liés en partie à une gestion inappropriée des stocks. Ces produits écartés de ces filières sont en majorité épandus dans les parcelles agricoles, et plus occasionnellement orientés vers des plateformes de méthanisation. Pour réduire ou mieux valoriser ces pertes alimentaires, plusieurs leviers d’action peuvent être envisagés à différents niveaux de ces filières, avec pour certaines d’entre elles l’appui de la Recherche et/ou un soutien des politiques publiques.
This work deals with food loss in the French production chains of fruits, vegetables and potato. The study focuses on nine products representative of the diversity of product categories, production systems and final uses. Potential losses are distributed all along the production chain, in the farmer’s field or orchard up to retail and vary according to the type of product, being comprised between 5 % and more than 20 % overall. For fruits and vegetables as a whole, food loss represents approximately 12 % of the production being ready for harvest in the field or the orchard. Three quarters of these losses are observed at the upstream stages of the chain, from harvest to marketing. These are mainly due to high sensitivity of fruits and vegetables to sanitary problems and unfavorable weather conditions, high perishability, and non-conformity to regulations or to demanding commercial specifications. Food losses at distribution stage (wholesalers and retailers) represent the remaining quarter. They are mainly due to handling of highly fragile commodities with limited shelf-live, and over-ripening problems due to inappropriate stock management. Discarded products are mostly spread on fields, and occasionally directed to anaerobic digestion units. In order to decrease food loss or make better use of it though recycling, several types of action can be considered at different steps of the production chain, with possible support from research projects and/or of public policy.
Cette étude contribue à évaluer les pertes alimentaires en France au sein des filières de fruits, légumes et pomme de terre. Compte tenu du nombre de produits, de la variété des systèmes de ...production et des multiples destinations, l’analyse s’appuie sur 9 productions illustrant la diversité existant au sein de ces trois filières. Des pertes alimentaires potentielles apparaissent tout au long de ces filières, de la parcelle du producteur à l’étal du distributeur, et peuvent être plus ou moins importantes selon les produits (d’environ 5% à plus de 20%). Elles représentent globalement pour l’ensemble des fruits et des légumes 12% de la production disponible au champ. Les trois quarts de ces pertes sont constatés aux premières étapes de la filière, de la récolte à la mise en marché. Leurs principales causes sont la sensibilité des produits aux aléas sanitaires et climatiques, leur périssabilité, l’application de normes règlementaires ou de cahiers des charges exigeants. Les pertes aux stades de la distribution (grossistes et détaillants) représentent le quart restant ; elles sont principalement dues à la manipulation de produits très périssables et surtout à des problèmes de surmaturité liés en partie à une gestion inappropriée des stocks. Ces produits écartés de ces filières sont en majorité épandus dans les parcelles agricoles, et plus occasionnellement orientés vers des plateformes de méthanisation. Pour réduire ou mieux valoriser ces pertes alimentaires, plusieurs leviers d’action peuvent être envisagés à différents niveaux de ces filières, avec pour certaines d’entre elles l’appui de la Recherche et/ou un soutien des politiques publiques.
This work deals with food loss in the French production chains of fruits, vegetables and potato. The study focuses on nine products representative of the diversity of product categories, production systems and final uses. Potential losses are distributed all along the production chain, in the farmer’s field or orchard up to retail and vary according to the type of product, being comprised between 5 % and more than 20 % overall. For fruits and vegetables as a whole, food loss represents approximately 12 % of the production being ready for harvest in the field or the orchard. Three quarters of these losses are observed at the upstream stages of the chain, from harvest to marketing. These are mainly due to high sensitivity of fruits and vegetables to sanitary problems and unfavorable weather conditions, high perishability, and non-conformity to regulations or to demanding commercial specifications. Food losses at distribution stage (wholesalers and retailers) represent the remaining quarter. They are mainly due to handling of highly fragile commodities with limited shelf-live, and over-ripening problems due to inappropriate stock management. Discarded products are mostly spread on fields, and occasionally directed to anaerobic digestion units. In order to decrease food loss or make better use of it though recycling, several types of action can be considered at different steps of the production chain, with possible support from research projects and/or of public policy.
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