7 results on '"Xavier Duval"'
Search Results
2. Cerebrovascular complications and outcomes of critically ill adult patients with infective endocarditis
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Thomas Rambaud, Etienne de Montmollin, Pierre Jaquet, Augustin Gaudemer, Eric Mariotte, Sonia Abid, Marylou Para, Claire Cimadevilla, Bernard Iung, Xavier Duval, Michel Wolff, Lila Bouadma, Jean-François Timsit, and Romain Sonneville
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Critical Care and Intensive Care Medicine - Abstract
Background Neurological complications are associated with poor outcome in patients with infective endocarditis (IE). Although guidelines recommend systematic brain imaging in the evaluation of IE patients, the association between early brain imaging findings and outcomes has never been evaluated in critically ill patients. We aimed to assess the association of CT-defined neurological complications with functional outcomes of critically ill IE patients. Methods This retrospective cohort study included consecutive patients with severe, left-sided IE hospitalized in the medical ICU of a tertiary care hospital. Patients with no baseline brain CT were excluded. Baseline CT-scans were classified in five mutually exclusive categories (normal, moderate-to-severe ischemic stroke, minor ischemic stroke, intracranial hemorrhage, other abnormal CT). The primary endpoint was 1-year favorable outcome, defined by a modified Rankin Scale score of 0–3. Results Between 06/01/2011 and 07/31/2018, 156 patients were included. Among them, 87/156 (56%) had a CT-defined neurological complication, including moderate-to-severe ischemic stroke (n = 33/156, 21%), intracranial hemorrhage (n = 24/156, 15%), minor ischemic stroke (n = 29/156, 19%), other (n = 3/156, 2%). At one year, 69 (45%) patients had a favorable outcome. Factors negatively associated with favorable outcome in multivariable analysis were moderate-to-severe ischemic stroke (OR 0.37, 95%CI 0.14 − 0.95) and age (OR 0.94, 95%CI 0.91–0.97). By contrast, the score on the Glasgow Coma Scale was positively associated with favorable outcome (per 1-point increment, OR 1.23, 95%CI 1.08–1.42). Sensitivity analyses conducted in operated patients revealed similar findings. Compared to normal CT, only moderate-to-severe ischemic stroke was associated with more frequent post-operative neurological complications (n = 8/23 (35%) vs n = 1/46 (2%), p Conclusion Moderate-to-severe ischemic stroke had an independent negative impact on 1-year functional outcome in critically ill IE patients; whereas other complications, including intracranial hemorrhage, had no such impact.
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- 2022
3. Hypermetabolism of the spleen or bone marrow is an additional albeit indirect sign of infective endocarditis at FDG-PET
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B. Hoen, Amandine Pallardy, François Goehringer, Besma Mahida, Aurélie Bourdon, François Rouzet, Caroline Boursier, Zohra Lamiral, Nicolas Piriou, Olivier Morel, Véronique Roch, Elodie Chevalier, Pierre-Yves Marie, Xavier Duval, Christine Selton-Suty, Nancyclotep- Experimental Imaging Platform = Plate-forme d'imagerie moléculaire, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Lorraine (UL), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique (CIC 1425), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Services de Maladies Infectieuses et Tropicales [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Nuclear Medicine Department [Hôpital Bichat - Claude Bernard], Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHRU Nancy], Service de Médecine Nucléaire [Nancy], Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de médecine nucléaire [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Médecine Nucléaire [Nantes], Hôpital Laennec, Service de Médecine nucléaire, biophysique, isotopes [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), and Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)
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Male ,medicine.medical_specialty ,Spleen ,[SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,030204 cardiovascular system & hematology ,Gastroenterology ,Malignant disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Bone Marrow ,Fluorodeoxyglucose F18 ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,FDG-PET ,Aged ,Aged, 80 and over ,business.industry ,valvular heart disease ,Endocarditis, Bacterial ,Odds ratio ,Middle Aged ,medicine.disease ,3. Good health ,PET ,medicine.anatomical_structure ,Positron-Emission Tomography ,Infective endocarditis ,Cohort ,Hypermetabolism ,Female ,Bone marrow ,Radiopharmaceuticals ,Infection ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; Purpose: This study aimed at determining the diagnostic implications of indirect signs of infection at FDG-PET-i.e., hypermetabolisms of the spleen and/or bone marrow (HSBM)-when documented in patients with known or suspected infective endocarditis (IE).Methods: HSBM were defined by higher mean standardized uptake values comparatively to that of the liver on FDG-PET images from patients with a high likelihood of IE and prospectively included in a multicenter study.Results: Among the 129 included patients, IE was ultimately deemed as definite in 88 cases. HSBM was a predictor of definite IE (P = 0.014; odds ratio (OR) 3.2), independently of the criterion of an abnormal cardiac FDG uptake (P = 0.0007; OR 9.68), and a definite IE was documented in 97% (29/30) of patients showing both HSBM and abnormal cardiac uptake, 78% (7/9) of patients with only abnormal cardiac uptake, 67% (42/63) of patients with only HSBM, and 37% (10/27) of patients with neither one.Conclusion: In this cohort with a high likelihood of IE, HSBM is an additional albeit indirect sign of IE, independently of the criterion of an abnormal cardiac uptake, and could reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease.
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- 2020
4. Infective endocarditis: innovations in the management of an old disease
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Bernard Iung and Xavier Duval
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0301 basic medicine ,medicine.medical_specialty ,Population ,Disease ,030204 cardiovascular system & hematology ,Preoperative care ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Positron Emission Tomography Computed Tomography ,Preoperative Care ,Epidemiology ,Humans ,Medicine ,Cardiac Surgical Procedures ,Antibiotic prophylaxis ,Intensive care medicine ,education ,education.field_of_study ,Endocarditis ,business.industry ,Incidence (epidemiology) ,Antibiotic Prophylaxis ,medicine.disease ,Heart Valves ,Anti-Bacterial Agents ,030104 developmental biology ,Echocardiography ,Heart failure ,Infective endocarditis ,Practice Guidelines as Topic ,Cardiology and Cardiovascular Medicine ,business - Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke–Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke–Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures. Infective endocarditis (IE) is not a common disease, but it has a poor prognosis. In this Review, contemporary findings concerning the epidemiology, diagnosis, therapeutic management and prevention of IE are highlighted, with a particular emphasis on innovations and changes in guidelines.
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- 2019
5. Extracardiac Imaging of Infective Endocarditis
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Xavier Duval and Bernard Iung
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medicine.medical_specialty ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Asymptomatic ,18f fdg pet ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Infective endocarditis ,cardiovascular system ,medicine ,Endocarditis ,In patient ,cardiovascular diseases ,Imaging technique ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
This review analyzes recent studies evaluating the diagnostic and therapeutic impacts of systematic extracardiac imaging techniques in patients with suspected or proven infective endocarditis. Extracardiac imaging techniques are more and more frequently used to establish infective endocarditis (IE) diagnosis in doubtful situations. They also help in evaluating the risk-benefit balance of therapeutic strategies and particularly valvular surgery which is performed in approximately 50% of patients. Latest research underlines the high frequency of asymptomatic lesions found, and a different advantage-disadvantage profile for each of these techniques. Extracardiac imaging techniques are helpful in doubtful situations and may be considered in other situations. Their interest for improving patients’ prognosis remains to be established.
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- 2017
6. 0716. Does intravenous iron induce oxydative stress in critically ill patients? A comparison with healthy volunteers
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Xavier Duval, G. Dufour, Camille Couffignal, Emmanuel Rineau, Fathi Driss, Pascale Piednoir, Clémentine Schilte, and Sigismond Lasocki
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medicine.medical_specialty ,Pediatrics ,Critically ill ,business.industry ,Intravenous iron ,Iron deficiency ,Critical Care and Intensive Care Medicine ,medicine.disease ,medicine.disease_cause ,Gastroenterology ,Internal medicine ,Poster Presentation ,Healthy volunteers ,medicine ,business ,Oxidative stress - Abstract
Anaemia is frequent in critically ill patients. Iron deficiency, secondary to blood losses or prior to admission, is in part responsible for this anaemia. Iron may thus be proposed to critically ill patients (CI). However, iron may promote oxidative stress, which is potentially deleterious. In a mouse model, we previously demonstrated that iron induces less oxidative stress in inflamed mice than in control ones [1], but no data are available in the CI.
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- 2014
7. Oropharyngeal and intestinal concentrations of opportunistic pathogens are independently associated with death of SARS-CoV-2 critically ill adults
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Patrier, Juliette, Villageois-Tran, Khanh, Szychowiak, Piotr, Ruckly, Stéphane, Gschwind, Rémi, Wicky, Paul-Henri, Gueye, Signara, Armand-Lefevre, Laurence, Marzouk, Mehdi, Sonneville, Romain, Bouadma, Lila, Petitjean, Marie, Lamara, Fariza, de Montmollin, Etienne, Timsit, Jean-Francois, Ruppé, Etienne, Abel, Laurent, Abrous, Amal, Andrejak, Claire, Angoulvant, François, Bachelet, Delphine, Bartoli, Marie, Behilill, Sylvie, Beluze, Marine, Bhavsar, Krishna, Cervantes-Gonzalez, Minerva, Chair, Anissa, Charpentier, Charlotte, Chenard, Léo, Chirouze, Catherine, Couffin-Cadiergues, Sandrine, Couffignal, Camille, Debray, Marie-Pierre, Deplanque, Dominique, Descamps, Diane, Diallo, Alpha, da Silva, Fernanda Dias, Dorival, Céline, Duval, Xavier, Eloy, Philippine, Enouf, Vincent, Esperou, Hélène, Esposito-Farese, Marina, Etienne, Manuel, Florence, Aline-Marie, Gaymard, Alexandre, Ghosn, Jade, Gigante, Tristan, Gilg, Morgane, Goehringer, François, Guedj, Jérémie, Houas, Ikram, Hoffmann, Isabelle, Hulot, Jean-Sébastien, Jaafoura, Salma, Kafif, Ouifiya, Khalil, Antoine, Lafhej, Nadhem, Laouénan, Cédric, Laribi, Samira, Le, Minh, Le Hingrat, Quentin, Le Mestre, Soizic, Letrou, Sophie, Levy, Yves, Lina, Bruno, Lingas, Guillaume, Malvy, Denis, Mentré, France, Mouquet, Hugo, Neant, Nadège, Paul, Christelle, Papadopoulos, Aurélie, Petrov-Sanchez, Ventzislava, Peytavin, Gilles, Piquard, Valentine, Picone, Olivier, Rosa-Calatrava, Manuel, Rossignol, Bénédicte, Rossignol, Patrick, Roy, Carine, Schneider, Marion, Su, Richa, Tardivon, Coralie, Timsit, Jean-François, Tubiana, Sarah, van der Werf, Sylvie, Visseaux, Benoit, Wiedemann, Aurélie, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Physiopathologie et pharmacotoxicologie placentaire humaine : Microbiote pré & post natal (3PHM - UMR-S 1139), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Génétique Moléculaire des Virus à ARN - Molecular Genetics of RNA Viruses (GMV-ARN (UMR_3569 / U-Pasteur_2)), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Centre National de Référence des virus des infections respiratoires (dont la grippe) - National Reference Center Virus Influenzae [Paris] (CNR - laboratoire coordonnateur), Institut Pasteur [Paris] (IP)-Université Paris Cité (UPCité), This work was partially supported by the Direction Générale des Armées (project FastGeneII), and French COVID Cohort Study Group Laurent Abel, Amal Abrous, Claire Andrejak, François Angoulvant, Delphine Bachelet, Marie Bartoli, Sylvie Behilill, Marine Beluze, Krishna Bhavsar, Lila Bouadma, Minerva Cervantes-Gonzalez, Anissa Chair, Charlotte Charpentier, Léo Chenard, Catherine Chirouze, Sandrine Couffin-Cadiergues, Camille Couffignal, Marie-Pierre Debray, Dominique Deplanque, Diane Descamps, Alpha Diallo, Fernanda Dias da Silva, Céline Dorival, Xavier Duval, Philippine Eloy, Vincent Enouf, Hélène Esperou, Marina Esposito-Farese, Manuel Etienne, Aline-Marie Florence, Alexandre Gaymard, Jade Ghosn, Tristan Gigante, Morgane Gilg, François Goehringer, Jérémie Guedj, Ikram Houas, Isabelle Hoffmann, Jean-Sébastien Hulot, Salma Jaafoura, Ouifiya Kafif, Antoine Khalil, Nadhem Lafhej, Cédric Laouénan, Samira Laribi, Minh Le, Quentin Le Hingrat, Soizic Le Mestre, Sophie Letrou, Yves Levy, Bruno Lina, Guillaume Lingas, Denis Malvy, France Mentré, Hugo Mouquet, Nadège Neant, Christelle Paul, Aurélie Papadopoulos, Christelle Paul, Ventzislava Petrov-Sanchez, Gilles Peytavin, Valentine Piquard, Olivier Picone, Manuel Rosa-Calatrava, Bénédicte Rossignol, Patrick Rossignol, Carine Roy, Marion Schneider, Richa Su, Coralie Tardivon, Jean-François Timsit, Sarah Tubiana, Sylvie Van Der Werf, Benoit Visseaux, Aurélie Wiedemann.
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Adult ,Staphylococcus aureus ,SARS-CoV-2 ,Critical Illness ,Microbiota ,Resuscitation ,[SDV]Life Sciences [q-bio] ,COVID-19 ,Biomarker ,Critical Care and Intensive Care Medicine ,DNA, Ribosomal ,Anti-Bacterial Agents ,Intensive Care Units ,Humans ,Prospective Studies ,Enterococcus ,Candida - Abstract
Background The composition of the digestive microbiota may be associated with outcome and infections in patients admitted to the intensive care unit (ICU). The dominance by opportunistic pathogens (such as Enterococcus) has been associated with death. However, whether this association remains all throughout the hospitalization are lacking. Methods We performed a single-center observational prospective cohort study in critically ill patients admitted with severe SARS-CoV-2 infection. Oropharyngeal and rectal swabs were collected at admission and then twice weekly until discharge or death. Quantitative cultures for opportunistic pathogens were performed on oropharyngeal and rectal swabs. The composition of the intestinal microbiota was assessed by 16S rDNA sequencing. Oropharyngeal and intestinal concentrations of opportunistic pathogens, intestinal richness and diversity were entered into a multivariable Cox model as time-dependent covariates. The primary outcome was death at day 90. Results From March to September 2020, 95 patients (765 samples) were included. The Simplified Acute Physiology Score 2 (SAPS 2) at admission was 33 [24; 50] and a Sequential Organ Failure Assessment score (SOFA score) at 6 [4; 8]. Day 90 all-cause mortality was 44.2% (42/95). We observed that the oropharyngeal and rectal concentrations of Enterococcus spp., Staphylococcus aureus and Candida spp. were associated with a higher risk of death. This association remained significant after adjustment for prognostic covariates (age, chronic disease, daily antimicrobial agent use and daily SOFA score). A one-log increase in Enterococcus spp., S. aureus and Candida spp. in oropharyngeal or rectal swabs was associated with a 17% or greater increase in the risk of death. Conclusion We found that elevated oropharyngeal/intestinal Enterococcus spp. S. aureus and Candida spp. concentrations, assessed by culture, are associated with mortality, independent of age, organ failure, and antibiotic therapy, opening prospects for simple and inexpensive microbiota-based markers for the prognosis of critically ill SARS-CoV-2 patients.
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- 2022
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