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Objective: Comparison of treatments initiated during invasive candidiasis in intensive care units with current French guidelines., Study Design: Prospective, observational, French multicenter study (October 2005-May 2006)., Patients and Methods: Selection of patients with Candida species identification and in vitro antifungal susceptibility determination. The empiric treatments instituted before the microbiologic documentation of infection and the curative treatments instituted after identification of the causative Candida and determination of its susceptibility were collected and compared with treatments proposed by the French clinical practice guidelines (2004) for the management of patients with invasive candidiasis., Results: One hundred and eighty-six patients were studied. Invasive candidiasis was due to fluconazole-resistant or susceptible-dose dependent Candida in 18.3% of patients, without any significant influence of a previous treatment with azoles. Empiric and curative treatments were both in accordance with recommendations for 47% of patients. Recommendations were mainly not respected when proposed therapy was amphotericin B that disappeared from therapeutics used in ICU. Finally, 16.9% of episodes of invasive candidiasis, for which fluconazole was the recommended treatment, were due to fluconazole-resistant or susceptible-dose dependent Candida., Conclusion: The support of French ICU physicians to current French guidelines was observed in 47% of cases. The infrequent use of amphotericin B must be emphasized. The nonnegligible incidence of fluconazole-resistant or susceptible-dose dependent Candida sp., particularly in patients without any prior exposition to azole agents, and the inability to predict this resistance should lead to propose a revision of 2004 guidelines.

To measure the prevalence and intensity of pain in hospitalized patients and to assess the quality of pain management, an exhaustive cross-sectional study was conducted in every department in a university hospital. Patients hospitalized for 24 hours or more completed an anonymous self-report questionnaire. Among the 1,475 inpatients, 998 completed the questionnaire. During the 24-hour period prior to our survey, 55% experienced pain. On 100 mm pain intensity measures, the median maximum pain experienced in the 24 preceding hours was 60 mm and the median pain intensity at the time of the survey was 30 mm. Although pain measured at the time of survey disappeared in only 16% of patients, 79% were satisfied with pain management. Despite a high satisfaction level, the prevalence and intensity of pain were very high. This study provided baseline data on pain in a French hospital and led to the implementation of a program for improving pain management.