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Acute pulmonary embolism (PE) is a life-threatening situation in cancer patients. In this situation, anticoagulant therapy is complex to administer due to the risk of bleeding. Only few studies have been conducted when these patients are admitted to the intensive care unit (ICU). The aim of this study was to assess the association between anticoagulation strategies as well as other factors with 90-day mortality in patients with cancer and PE admitted to ICU. Major bleeding was also evaluated according to the type of anticoagulation. Retrospective study carried out in 4 ICUs in France over a 12-year period (2009–2021). All patients with cancer and PE were included. An overlap propensity score weighting analysis was performed in the subgroup of patients treated with either unfractionated heparins (UFH) alone or low-molecular-weight heparins (LMWH) alone on 90-day mortality and major bleeding. A total of 218 consecutive cancer patients admitted to ICU and presenting PE were included. The 90-day mortality rate was 42 % for the global cohort. After propensity score analysis in the subgroup of patients treated with either "UFH alone" (n = 80) or "LMWH alone" (n = 71), the 90-day mortality was similar in patients treated with UFH alone (42.6 %) vs LMWH alone (39.9 %): OR = 1.124, CI 95 % [0.571–2.214], p = 0.750. There was a significant increased toward major bleeding rates in the "UFH alone" group (25.5 %) as compared to "LMWH alone" group (11.5 %), p = 0.04. In 218 patients admitted to ICU and presenting PE, the 90-day mortality rate was 42 %. Treatment with UFH alone was associated with a mortality comparable to treatment with LMWH alone but it appeared to be more prone to major bleeding. • UFH alone is associated with a mortality comparable to treatment with LMWH alone. • UFH alone seems to be more prone to major bleeding. • Metastatic cancer and thrombocytopenia are independently associated with mortality. • Pulmonary embolism diagnosed in the early postoperative period is associated with a good outcome. [ABSTRACT FROM AUTHOR]

Background: Leptospirosis is an anthropozoonosis that occurs worldwide but is more common in tropical regions. Severe forms may require intensive care unit (ICU) admission. Whether the clinical patterns and outcomes differ between tropical and non-tropical regions with similar healthcare systems is unclear. Our objective here was to address this issue by comparing two cohorts of ICU patients with leptospirosis managed in mainland France and in the overseas French department of Réunion, respectively. Methodology/Principal findings: We compared two retrospective cohorts of patients admitted to intensive care for severe leptospirosis, one from Reunion Island in the Indian Ocean (tropical climate) and the other from metropolitan France (temperate climate). Chi-square and Student's t tests were used for comparisons. After grouping the two cohorts, we also performed multiple correspondence analysis and hierarchical clustering to search for distinct clinical phenotypes. The Réunion and Metropolitan France cohorts comprised 128 and 160 patients respectively. Compared with the Réunion cohort, the metropolitan cohort had a higher mean age (42.5±14.1 vs. 51.4±16.5 years, p<0.001). Severity scores, length of stay and mortality did not differ between the two cohorts. Three phenotypes were identified: hepato-renal leptospirosis (54.5%) characterized by significant hepatic, renal and coagulation failure, with a mortality of 8.3%; moderately severe leptospirosis (38.5%) with less severe organ failure and the lowest mortality rate (1.8%); and very severe leptospirosis (7%) manifested by neurological, respiratory and cardiovascular failure, with a mortality of 30%. Conclusions/Significance: The outcomes of severe leptospirosis requiring ICU admission did not differ between tropical and temperate regions with similar healthcare access, practices, and resources, despite some differences in patient characteristics. The identification of three different clinical phenotypes may assist in the early diagnosis and management of severe leptospirosis. Author summary: This study aims to discern whether there are variations in the clinical manifestations and outcomes of severe Leptospirosis between tropical and non-tropical regions with comparable healthcare infrastructures. Conducted in France, the research scrutinizes the distinctions in patient characteristics, clinical presentations, and prognoses between a tropical area and a temperate one. The analysis reveals minimal discrepancies in patient profiles and clinical patterns across these regions. Additionally, no statistically significant differences were observed regarding the duration of intensive care unit (ICU) or hospital stays, as well as ICU or hospital mortality rates, between the tropical and non-tropical locales. The findings suggest that the clinical features and outcomes of individuals afflicted with severe leptospirosis exhibit substantial uniformity across tropical and temperate regions endowed with similar healthcare resources. This study contributes valuable insights into the understanding of leptospirosis, highlighting the consistency in disease presentation and prognosis irrespective of climatic distinctions, given comparable healthcare capabilities. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii is an opportunistic pathogen that causes nosocomial infections and exhibits multiple antimicrobial resistance. Carbapenems are preferred in the treatment. In recent years, increasing resistance to carbapenems has been reported all over the world. The aim of the study is to investigate the presence of carbapenemases in carbapenem-resistant A. baumannii strains by molecular methods.A total of 77 carbapenem-resistant A. baumannii isolates, obtained from blood samples collected from catheter hubs of patients hospitalized in the intensive care unit at Ondokuz Mayıs University Faculty of Medicine between from January 2021 and September 2022, were examined. Bacterial identification used traditional methods alongside VITEK® MS (bioMérieux, France). Antibiotic resistance profiles were determined following EUCAST standards using the Vitek2 Compact automated system. Additionally, multiplex polymerase chain reaction (PCR) was utilized to investigate the presence of blaOXA 23-like, blaOXA 24-like, blaOXA 51-like, and blaOXA 58-like oxacillinase genes, as well as blaNDM, blaVIM, and blaIMP metallo-beta-lactamase genes. While all 77 A. baumannii isolates were resistant to meropenem, 75 isolates were also resistant to imipenem. In addition, all of the isolates were found to be resistant to ceftazidime, levofloxacin, and ciprofloxacin. Sensitivity to amikacin, gentamicin, and trimethoprim-sulfomethoxazole was 29.8%, 6.4%, and 6.4%, respectively. The blaOXA 51-like gene was found in all A. baumannii strains. The blaOXA 23-like gene was detected in 74 (96%) of the strains, and the blaOXA 24-like gene was detected in 16 (20.7%) strains. blaOXA 58-like, blaNDM, blaVIM, and blaIMP genes were not detected positively in any of the isolates. Oxacillinase-type enzymes, notably blaOXA 51-like, blaOXA 23-like, and blaOXA 24-like genes, primarily contribute to carbapenem resistance in A. baumannii isolates. The blaOXA 58-like gene and metallo-betalactamase metallo-beta-lactamase resistance genes were not found in the strains. These obtained data revealed reveals the necessity of molecular methods in defining the epidemiological relationship of isolates. [ABSTRACT FROM AUTHOR]

We studied 50 patients with invasive nocardiosis treated during 2004-2023 in intensive care centers in France and Belgium. Most (65%) died in the intensive care unit or in the year after admission. Nocardia infections should be included in the differential diagnoses for patients in the intensive care setting. [ABSTRACT FROM AUTHOR]

The situation in France is unique, having a legal framework for continuous and deep sedation (CDS). However, its use in intensive care units (ICU), combined with the withdrawal of life-sustaining therapies, still raises ethical issues, particularly its potential to hasten death. The legalization of assistance in dying, i.e. , assisted suicide or euthanasia at the patient's request, is currently under discussion in France. The objectives of this national survey were first, to assess whether ICU professionals perceive CDS administered to ICU patients as a practice that hastens death, in addition to relieving unbearable suffering, and second, to assess ICU professionals' perceptions of assistance in dying. A national survey with online questionnaires for ICU physicians and nursesaddressed through the French Society of Anesthesiology and Critical Care Medicine. A total of 956 ICU professionals responded to the survey (38% physicians and 62% nurses). Of these, 22% of physicians and 12% of nurses (p < 0.001) felt that the purpose of CDS was to hasten death. For 20% of physicians, CDS combined with terminal extubation was considered an assistance in dying. For 52% of ICU professionals, the current framework did not sufficiently cover the range of situations that occur in the ICU. A favorable opinion on the potential legalization of assistance in dying was observed in 83% of nurses and 71% of physicians (p < 0.001), with no preference between assisted suicide and euthanasia. Our findings highlight the tension between CDS and assisted suicide/euthanasia in the specific context of intensive care and suggest that ICU professionals would be supportive of a legislative evolution. [ABSTRACT FROM AUTHOR]