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1. Screening of hepatitis E in patients presenting for acute neurological disorders

Author

Aude Belbézier, Alban Deroux, Françoise Sarrot-Reynauld, Barbara Colombe, Annick Bosseray, Claire Wintenberger, Perrine Dumanoir, Maxime Lugosi, Isabelle Boccon-Gibod, Vincent Leroy, Maxime Maignan, Roselyne Collomb-Muret, Damien Viglino, Mathieu Vaillant, Lorella Minotti, Emeline Lagrange, Olivier Epaulard, Chantal Dumestre-Perard, Sébastien Lhomme, Julien Lupo, Sylvie Larrat, Patrice Morand, Carole Schwebel, Antoine Vilotitch, Jean-Luc Bosson, and Laurence Bouillet

Subjects
Hepatitis E, Neurological disorder, Acute hepatitis, Hepatitis, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Introduction: Hepatitis E virus (HEV) infection has been reported to be associated with neurological disorders. However, the real prevalence of acute hepatitis E in those diseases is still unknown. We determined the prevalence of anti-HEV IgM antibody in a population with acute non-traumatic, non-metabolic, non-vascular neurological injury. Method: A registry was created in Grenoble Hospital University from 2014 to 2018 to collect data on patients with acute (

Published
2020
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2. Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak

Author

Elena Charpentier, Cécile Garnaud, Claire Wintenberger, Sébastien Bailly, Jean-Benjamin Murat, John Rendu, Patricia Pavese, Thibault Drouet, Caroline Augier, Paolo Malvezzi, Anne Thiébaut-Bertrand, Marie-Reine Mallaret, Olivier Epaulard, Muriel Cornet, Sylvie Larrat, and Danièle Maubon

Subjects
Pneumocystis jirovecii, pneumocystosis, pneumonia, disease outbreaks, infectious diseases, high-throughput nucleotide sequencing, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

Pneumocystis jirovecii is a major threat for immunocompromised patients, and clusters of pneumocystis pneumonia (PCP) have been increasingly described in transplant units during the past decade. Exploring an outbreak transmission network requires complementary spatiotemporal and strain-typing approaches. We analyzed a PCP outbreak and demonstrated the added value of next-generation sequencing (NGS) for the multilocus sequence typing (MLST) study of P. jirovecii strains. Thirty-two PCP patients were included. Among the 12 solid organ transplant patients, 5 shared a major and unique genotype that was also found as a minor strain in a sixth patient. A transmission map analysis strengthened the suspicion of nosocomial acquisition of this strain for the 6 patients. NGS-MLST enables accurate determination of subpopulation, which allowed excluding other patients from the transmission network. NGS-MLST genotyping approach was essential to deciphering this outbreak. This innovative approach brings new insights for future epidemiologic studies on this uncultivable opportunistic fungus.

Published
2017
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3. Ultrasonography helps emergency physician identify the best lumbar puncture site under the conus medullaris

Author

Line Dussourd, Batistin Martinon, Clara Candille, Carole Paquier, Claire Wintenberger, Perrine Dumanoir, Anais Plazanet, Damien Viglino, and Maxime Maignan

Subjects
Ultrasonography, Lumbar puncture, Emergency, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Ultrasonography – assisted lumbar puncture helps physicians identify traditional anatomical landmarks. However, it could help to overcome the anatomical dogmas and thus identify the best interspinous space under the medullary cone. Methods Traditional anatomical landmarks were reported on a tracing paper in patients with an indication for lumbar puncture. Then, ultrasonography was used to locate the optimal interspinous level defined as the widest subarachnoid space located below the conus medullaris. Primary endpoint was the distance between traditional and ultrasound landmarks. Results Fifty-seven patients were included. Seven emergency physicians practiced the procedure. The median absolute distance between traditional anatomical landmarks and ultrasound marking was 32 [interquartile (IQR) 27 – 37] mm. The inter-spinous space identified in the two procedures was different in 68% of the cases. Conclusions Ultrasound not only allows us to better identify anatomical structures before lumbar puncture, but it also allows us to choose a site of puncture different from recommendations.

Published
2017
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4. Fatal Measles without Rash in Immunocompetent Adult, France

Author

Julien Lupo, Sylvain Bernard, Claire Wintenberger, Monique Baccard, Astrid Vabret, Denise Antona, Jean-François Timsit, and Patrice Morand

Subjects
measles, acute respiratory distress syndrome, rash, death, France, viruses, Medicine, Infectious and parasitic diseases, RC109-216
Published
2012
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5. Description of an influenza outbreak in a French university hospital and risk factors of nosocomial influenza

Author

Alexis Bocquet, Claire Wintenberger, Bruno Lina, Patricia Pavese, Caroline Landelle, Jean-Luc Bosson, Laurence Bouillet, Meghann Gallouche, Patrice Morand, Julien Lupo, and Marie-Reine Mallaret

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Hospitalized patients, 030106 microbiology, Influenza season, Disease Outbreaks, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, Medical microbiology, Risk Factors, Influenza, Human, medicine, Humans, 030212 general & internal medicine, Aged, Aged, 80 and over, Cross Infection, Influenza outbreak, business.industry, Infant, General Medicine, Odds ratio, Middle Aged, University hospital, Infectious Diseases, Child, Preschool, Emergency medicine, Single room, Female, Observational study, France, business
Abstract

Our objective was to evaluate risk factors of nosocomial influenza (NI) in an university hospital during the 2015/2016 influenza season. All hospitalized patients with influenza-like illness associated with laboratory confirmation by polymerase chain reaction were included in a prospective observational study. We identified 44 cases (19%) of NI among the 233 cases of influenza: 38/178 (21%) in adults and 6/55 (11%) in children. Among adults, hospitalization in a double or multi-occupancy room was independently associated with NI (adjusted Odds Ratio, 3.42; 95% CI, 1.29-9.08; p = 0.013). The results of the study underline the importance of single room to prevent NI.

Published
2020
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6. Screening of hepatitis E in patients presenting for acute neurological disorders

Author

Sébastien Lhomme, Chantal Dumestre-Pérard, Vincent Leroy, Lorella Minotti, Emeline Lagrange, Patrice Morand, Jean-Luc Bosson, M. Lugosi, Claire Wintenberger, Roselyne Collomb-Muret, Aude Belbézier, Maxime Maignan, Damien Viglino, Françoise Sarrot-Reynauld, Sylvie Larrat, Perrine Dumanoir, Isabelle Boccon-Gibod, Alban Deroux, Carole Schwebel, A. Bosseray, Antoine Vilotitch, Mathieu Vaillant, Julien Lupo, Laurence Bouillet, Olivier Epaulard, B. Colombe, Clinique de médecine interne, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre Hospitalier Universitaire [Grenoble] (CHU), Pôle Psychiatrie et Neurologie [Grenoble], Service d'immunologie [CHU Grenoble], CHU de Grenoble, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Virologie [Toulouse], CHU Toulouse [Toulouse], Département de virologie [Grenoble], Institut de biologie structurale (IBS - UMR 5075), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA), Radiopharmaceutiques biocliniques (LRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Translational Innovation in Medicine and Complexity / Recherche Translationnelle et Innovation en Médecine et Complexité - UMR 5525 (TIMC ), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP ), Université Grenoble Alpes (UGA), Biologie du Cancer et de l'Infection (BCI ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Virologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble - UMR 5525 (TIMC-IMAG)

Subjects
0301 basic medicine, Male, viruses, Neurological disorder, medicine.disease_cause, Serology, Hepatitis, 0302 clinical medicine, Hepatitis E virus, Seroepidemiologic Studies, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030212 general & internal medicine, Prospective Studies, Acute hepatitis, MESH: Acute Disease / epidemiology, Adult, Aged, Aged, 80 and over, Brachial Plexus Neuritis / epidemiology, Female, France / epidemiology, Guillain-Barre Syndrome / epidemiology, Hepatitis Antibodies / blood, Hepatitis E / blood, Hepatitis E / diagnosis, Hepatitis E / epidemiology, Hepatitis E / immunology, Hepatitis E virus / immunology, Humans Immunoglobulin M / blood, Middle Aged, Nervous System Diseases / epidemiology, Nervous System Diseases / immunology, RNA, Viral / blood, Reverse Transcriptase Polymerase Chain Reaction, Transaminases / blood, Young Adult, education.field_of_study, lcsh:Public aspects of medicine, virus diseases, General Medicine, Hepatitis E, 3. Good health, Infectious Diseases, Acute Disease, RNA, Viral, France, medicine.medical_specialty, 030106 microbiology, Population, Guillain-Barre Syndrome, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Internal medicine, medicine, Seroprevalence, Brachial Plexus Neuritis, Humans, lcsh:RC109-216, Hepatitis Antibodies, education, Transaminases, business.industry, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, medicine.disease, Immunoglobulin M, Elevated transaminases, Nervous System Diseases, business
Abstract

International audience; Introduction: Hepatitis E virus (HEV) infection has been reported to be associated with neurological disor-ders. However, the real prevalence of acute hepatitis E in those diseases is still unknown. We determinedthe prevalence of anti-HEV IgM antibody in a population with acute non-traumatic, non-metabolic,non-vascular neurological injury.Method: A registry was created in Grenoble Hospital University from 2014 to 2018 to collect data onpatients with acute (

Published
2020
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7. Proposal for shorter antibiotic therapies

Author

Lionel Piroth, Yves Pean, R. Cohen, Eric Bonnet, Sylvain Diamantis, Benoit Guery, B. Castan, P. Lesprit, E. Varon, R. Gauzit, F. Vuotto, L. Maulin, C. Strady, Jean-Paul Stahl, E. Peju, and Claire Wintenberger

Subjects
0301 basic medicine, medicine.medical_specialty, Pediatrics, Time Factors, medicine.drug_class, Treatment duration, 030106 microbiology, Antibiotics, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Respiratory tract infections, business.industry, Public health, Bacterial Infections, medicine.disease, Drug Utilization, Anti-Bacterial Agents, Infectious Diseases, Infective endocarditis, Bacteremia, Practice Guidelines as Topic, Bacterial meningitis, business, Febrile neutropenia
Abstract

Objectives Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections. Methods Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website. Results The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables. Conclusion This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.

Published
2017
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8. Grouped Cases of Pulmonary Pneumocystosis After Solid Organ Transplantation: Advantages of Coordination by an Infectious Diseases Unit for Overall Management and Epidemiological Monitoring

Author

Claire Wintenberger, Olivier Epaulard, Boubou Camara, Caroline Augier, Marie-Reine Mallaret, Paolo Malvezzi, Patricia Pavese, Eléna Charpentier, Danièle Maubon, Laurence Bouillet, and John Rendu

Subjects
0301 basic medicine, Microbiology (medical), Pediatrics, medicine.medical_specialty, Genotype, Epidemiology, 030106 microbiology, Pneumocystis carinii, Pneumocystis pneumonia, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Pulmonary pneumocystosis, Humans, Medicine, 030212 general & internal medicine, Intensive care medicine, Genotyping, Cross Infection, Lung, business.industry, Transmission (medicine), Pneumonia, Pneumocystis, Organ Transplantation, medicine.disease, Bacterial Typing Techniques, Infectious Diseases, medicine.anatomical_structure, Epidemiological Monitoring, Multilocus sequence typing, France, business, Multilocus Sequence Typing
Abstract

OBJECTIVETo determine the origin of grouped cases of Pneumocystis pneumonia in solid-organ transplant recipients at our institution.DESIGNA case series with clinical examinations, genotyping, and an epidemiological survey.SETTINGA university hospital in France.PATIENTSWe report 12 solid-organ transplant recipients with successive cases of Pneumocystis pneumonia that occurred over 3 years; 10 of these cases occurred in a single year.METHODSWe used molecular typing of P. jirovecii strains by multilocus sequence typing and clinical epidemiological survey to determine potential dates and places of transmission.RESULTSBetween May 2014 and March 2015, 10 solid-organ transplant recipients (5 kidney transplants, 4 heart transplants, and 1 lung transplant) presented with Pneumocystis pneumonia. Molecular genotyping revealed the same P. jirovecii strain in at least 6 patients. This Pneumocystis strain was not identified in control patients (ie, nontransplant patients presenting with pulmonary pneumocystosis) during this period. The epidemiological survey guided by sequencing results provided information on the probable or possible dates and places of contamination for 5 of these patients. The mobile infectious diseases unit played a coordination role in the clinical management (adaptation of the local guidelines) and epidemiological survey.CONCLUSIONOur cardiac and kidney transplant units experienced grouped cases of pulmonary pneumocystosis. Genotyping and epidemiological surveying results suggested interhuman contamination, which was quickly eliminated thanks to multidisciplinary coordination.Infect Control Hosp Epidemiol 2017;38:179–185

Published
2016
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9. Hepatitis E Virus in Acute Non-Traumatic, Non-Vascular Neurological Injury: A French Monocentric Prospective Study

Author

aude belbézier, Alban Deroux, Françoise Sarrot-Reynauld, Barbara Colombe, Annick Bosseray, Claire Wintenberger, Perrine Dumanoir, Maxime Lugosi, Isabelle Boccond-Gibod, Vincent Leroy, Maxime Maignan, Roselyne Collomb-Muret, Damien Viglino, Mathieu Vaillant, Emeline Lagrange, Olivier Epaulard, Chantal Dumestre-Perard, Julien Lupo, Sylvie Larrat, Patrice Morand, Carole Schwebel, Antoine Vilotitch, Jean-Luc Bosson, and Laurence Bouillet

Published
2018
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10. Hepatitis E Virus in Acute Non-Traumatic, Non-Vascular Neurological Injury: A French Monocentric Prospective Study

Author

Claire Wintenberger, Maxime Maignan, Damien Viglino, Olivier Epaulard, Sylvie Larrat, Carole Schwebel, Françoise Sarrot-Reynauld, B. Colombe, Chantal Dumestre-Pérard, Lorella Minotti, Emeline Lagrange, Isabelle Boccond-Gibod, Alban Deroux, Maxime Lugosi, Laurence Bouillet, Perrine Dumanoir, Patrice Morand, A. Bosseray, Roselyne Collomb-Muret, Vincent Leroy, Jean-Luc Bosson, Julien Lupo, Antoine Vilotitch, Mathieu Vaillant, and Aude Belbézier

Subjects
medicine.medical_specialty, Neurological injury, Hepatitis E virus, business.industry, Non traumatic, Internal medicine, Medicine, business, Prospective cohort study, medicine.disease_cause
Published
2018
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11. Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak1

Author

Patricia Pavese, Sébastien Bailly, Claire Wintenberger, Cécile Garnaud, Caroline Augier, Anne Thiebaut-Bertrand, Sylvie Larrat, Thibault Drouet, Marie-Reine Mallaret, Olivier Epaulard, Danièle Maubon, Eléna Charpentier, John Rendu, Paolo Malvezzi, Muriel Cornet, Jean-Benjamin Murat, Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Thérapeutique Recombinante Expérimentale (TIMC-IMAG-TheREx), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique de médecine interne, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Laboratoire Adaptation et pathogénie des micro-organismes [Grenoble] (LAPM), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), INSERM U836, équipe 4, Muscles et pathologies, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Biochimie et Génétique Moléculaire, CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, Service des Maladies Infectieuses, CHU Grenoble, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Clinique Universitaire d'Hématologie [La Tronche, Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Unité d'hygiène Hospitalière, Department of infectious diseases, Institut de biologie structurale (IBS - UMR 5075 ), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), and Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)

Subjects
Male, 0301 basic medicine, transplants, Epidemiology, multilocus sequence typing, Pneumocystis carinii, Pneumocystis pneumonia, Disease Outbreaks, Genotype, Pneumocystosis, high-throughput nucleotide sequencing, Child, Pneumocystis jirovecii, Phylogeny, ComputingMilieux_MISCELLANEOUS, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, biology, Pneumonia, Pneumocystis, Middle Aged, 3. Good health, Infectious Diseases, NGS, Child, Preschool, Synopsis, Female, MLST, Adult, Microbiology (medical), Adolescent, 030106 microbiology, Sensitivity and Specificity, DNA sequencing, pneumocystosis, respiratory infections, Young Adult, 03 medical and health sciences, medicine, pneumonia, Humans, Genotyping, Aged, Polymorphism, Genetic, Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak, Computational Biology, Infant, Outbreak, biology.organism_classification, medicine.disease, Virology, Case-Control Studies, Multilocus sequence typing, next-generation sequencing, fungi
Abstract

Pneumocystis jirovecii is a major threat for immunocompromised patients, and clusters of pneumocystis pneumonia (PCP) have been increasingly described in transplant units during the past decade. Exploring an outbreak transmission network requires complementary spatiotemporal and strain-typing approaches. We analyzed a PCP outbreak and demonstrated the added value of next-generation sequencing (NGS) for the multilocus sequence typing (MLST) study of P. jirovecii strains. Thirty-two PCP patients were included. Among the 12 solid organ transplant patients, 5 shared a major and unique genotype that was also found as a minor strain in a sixth patient. A transmission map analysis strengthened the suspicion of nosocomial acquisition of this strain for the 6 patients. NGS-MLST enables accurate determination of subpopulation, which allowed excluding other patients from the transmission network. NGS-MLST genotyping approach was essential to deciphering this outbreak. This innovative approach brings new insights for future epidemiologic studies on this uncultivable opportunistic fungus.

Published
2017
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12. Hépatite E dans les troubles neurologiques non traumatiques et non vasculaires : étude prospective française monocentrique

Author

M. Maignan, M. Lugosi, Claire Wintenberger, E. Lagrange, Belbezier, P. Dumanoir, B. Colombe, M. Vaillant, Sylvie Larrat, Laurence Bouillet, and Alban Deroux

Subjects
Gastroenterology, Internal Medicine
Abstract

Introduction Le virus de l’hepatite E fut decrit comme associe a differents troubles neurologiques aigus. La prevalence reelle de l’hepatite E dans ces maladies n’est pas encore connue. L’objectif de notre etude est de determiner la prevalence de l’hepatite E dans les troubles neurologiques aigus non vasculaires, non traumatiques. Patients et methodes Cette etude, transversale, prospective fut realisee de 2014 a 2018 dans l’hopital universitaire de Grenoble (Isere, France). Une serologie hepatite E avec dosage des anticorps type immunoglobuline fut realisee chez les patients hospitalises durant cette periode presentant des troubles neurologiques aigus non traumatiques et non vasculaires. Les patients etaient eligibles s’ils etaient hospitalises et presentaient des manifestations neurologiques aigues definies comme des deficits sensitivomoteurs, des crises d’epilepsie febriles, une confusion febrile, des mouvements anormaux ou des symptomes neuromusculaires intermittents. Les patients souffrants d’encephalopathie, d’accident vasculaire cerebral ou de traumatismes etaient exclus. Parmi 210 patients eligibles, 4 ont refuse de participer, 5 n’ont pas ete testes et 42 ont ete exclus. Le diagnostic de trouble neurologique non traumatique, non vasculaire fut realise chez 159 patients. Nous avons mesure la prevalence de l’hepatite E chez les patients souffrant de troubles neurologiques aigus non traumatiques, non vasculaires et compare cette prevalence a celle des donneurs de sang issus de la meme zone geographique. Cette prevalence fut calculee par l’equipe de Mansuy et al. et publiee en 2016 dans Hepatology. Resultats Onze des 159 patients avec troubles neurologiques aigus non traumatiques, non vasculaires presentaient une infection recente par le virus de l’hepatite E (6,9 %, IC95 % [3,5–12]). Six patients avaient une charge virale serique positive, et 2 une charge virale positive dans les selles. Trois patients avaient une infection associee (un patient presentait une infection a Listeria monocytogenes, une patiente une infection a varicella-zoster virus et un a cytomegalovirus). Une elevation des transaminases etait observee chez 64 % des patients avec une hepatite E et 24 % des patients sans hepatite E (p = 0,011), une cholestase etait notee chez 64 % et 28 % respectivement (p = 0,005). Les patients souffrant de syndrome de Parsonage–Turner associe a l’hepatite E presentaient frequemment une forme bilaterale (p Conclusion Dans cette etude prospective, 6,9 % des patients avec un trouble neurologique aigu non traumatique, non vasculaire presentaient une infection aigue par le virus de l’hepatite E. La serologie de l’hepatite E devrait etre realisee devant tout trouble neurologique aigu non traumatique, non vasculaire. La cytolyse hepatique peut etre absente.

Published
2018
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13. Impact d’un diagnostic virologique de grippe sur la consommation d’antibiotiques

Author

Claire Wintenberger, Marie Reine Mallaret, D. Gantz, C. Giner, Jérôme Fauconnier, Caroline Landelle, C. Terreaux Masson, Hugo Terrisse, Jean Luc Bosson, and Patricia Pavese

Subjects
Infectious Diseases
Abstract

Introduction Les infections respiratoires basses sont une cause frequente d’hospitalisation. La place des antibiotiques dans la prise en charge des syndromes viraux est limitee, or on trouve dans la litterature des pourcentages eleves de prescriptions d’antibiotiques. Notre objectif etait d’evaluer l’impact de la mise en evidence d’un virus respiratoire sur la consommation d’antibiotiques. Materiels et methodes Une etude retrospective cas-temoin a ete realisee dans un centre hospitalier universitaire parmi des patients adultes hospitalises pour syndrome grippal d’origine communautaire du 05/12/16 au 12/03/17. Les patients presentant un prelevement mettant en evidence une surinfection bacterienne, ainsi que ceux juges a haut risque infectieux ou presentant un etat clinique grave necessitant une admission dans un service de reanimation ont ete exclus. Resultats Parmi les 612 patients inclus ayant un prelevement respiratoire analyse par PCR, 204 patients ayant une PCR grippe positive (cas) et 408 patients ayant une PCR grippe negative (temoins) ont ete compares. Les pourcentages de prescriptions d’antibiotiques etaient eleves dans les deux groupes sans difference significative entre les cas et temoins (74 vs 72 %, p = 0,633), mais il y avait significativement plus de prescriptions de dose unique (11 vs 5 %, p = 0,017), moins d’associations d’antibiotiques (23 vs 34 %, p = 0,016) et des durees d’antibiotherapies significativement plus courtes (6 vs 6 jours, p = 0,01) dans le groupe cas versus temoin. Les prescriptions d’antibiotiques etaient majoritairement debutees en pre-PCR dans les deux groupes (90 % vs 85 %, p = 0,183), alors que les prescriptions d’oseltamivir etaient moins frequemment debutes en pre-PCR (50 % vs 66 %). Pour ce qui est des facteurs influencant la poursuite ou non d’une antibiotherapie, d’apres l’analyse multivariee, l’obtention d’un resultat positif de PCR grippe etait significativement associee a l’arret de l’antibiotherapie en post-PCR, tandis qu’un âge et une valeur de CRP eleves etaient associes a une poursuite du traitement. La presence de comorbidites n’influencait pas significativement l’arret ou la poursuite de l’antibiotherapie. Conclusion L’obtention d’un diagnostic virologique de grippe aide a l’arret des antibiotherapies initiees en probabiliste mais l’impact sur la consommation globale d’antibiotiques n’a pas ete demontre. L’acces a une PCR multiplex identifiant de maniere precise le micro-organisme en cause, l’elaboration de recommandations specifiques au niveau de notre etablissement ainsi qu’un avis infectiologique systematique sont des moyens qui pourraient permettre de diminuer les prescriptions inappropriees d’antibiotiques, mais il serait egalement interessant d’agir en amont par une identification plus rapide du pathogene, qui pourraient eviter des prescriptions probabilistes.

Published
2019
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14. Suspicion de méningite : évaluation de la prise en charge aux urgences

Author

Patrice François, Patricia Pavese, Sabine Lautaret, Françoise Carpentier, Claire Wintenberger, Elodie Sellier, and Stéphane Gennai

Subjects
Gynecology, medicine.medical_specialty, business.industry, Medicine, General Medicine, business
Abstract

Introduction : La meningite bacterienne est une urgence diagnostique et therapeutique grevee d'une importante morbi-mortalite. Notre objectif principal etait d'evaluer la prise en charge des suspicions de meningites dans un service d'accueil des urgences (SAU) les mois suivants l'actualisation des recommandations. Materiel et methode : Il s'agissait d'une etude retrospective observationnelle realisee entre le 1er janvier et le 30 juin 2009 au SAU du CHU de Grenoble. Ont ete inclus 68 patients de plus de 15 ans et trois mois, suspects de meningite (fievre dans les 24 heures precedent l'admission accompagnee d'au moins un signe meninge ou neurologique) et beneficiant d'une ponction lombaire (PL) dans les 48 heures suivant leur admission. Deux infectiologues independants ont evalue les prises en charge, apres lecture du dossier medical des urgences, des resultats biologiques et du compte-rendu final d'hospitalisation. Resultats : Le delai median de realisation de la PL etait de 5,5 heures [3,7-8,9], celui d'administration des antibiotiques de 6 heures [3,3-8,75]. La prescription de lactates etait stable au cours des 6 mois d'etude (p=0.58) ; celle de procalcitonine augmentait de maniere significative (p=0,02). La realisation d'un scanner avant la PL augmentait nettement le delai de prelevement du LCR (p < 0,001), sans toutefois impacter sur les delais de prescription et d'administration des antibiotiques. Pour les patients atteints de meningite bacterienne, le choix des molecules, posologies et voies d'administration, les delais de realisation de la PL et d'administration des antibiotiques, etaient estimes conformes. Conclusion : Nos delais de prise en charge sont proches de ceux retrouves dans la litterature. Neanmoins, nous devons chercher a les reduire conformement a la Conference de consensus. Cela implique tous les acteurs de soins, la formation des personnels et la realisation de protocoles (prise en charge therapeutique, indication de scanner avant ponction lombaire).

Published
2013
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15. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study

Author

Odile Fremin-Batteux, Juliette Clarissou-Philippe, Benoît Jauhlac, Severine Guyetand, Jacques Gasnault, Corinne Haioun, Liamine Aissaoui, Marie-Christine Pages, Marie-Pierre Fos, Christian Rose, Didier Hubert, Marie-Rose Rothe, N. Bouziges, Benoît Huc, François Devianne, Sabine Bidart, Anne Forest, Kevin Bertrand, Mohamed Eldeghedy, Annick Verhaeghe, Caroline Malderet, Anne Bertrou, Bernard Guerquin, Catherine Duche, Muriel Archambaud, Rabea Cotteret, Olivier Toullalan, Yves Devaux, Smail Bergheul, Valérie Sivadon-Tardy, Pierre-Gilles Merville, Geneviève Blanchard-Marche, Didier Raoult, Bernard Hory, Florence Richardin, Evelyne Belle, Mohamed Menouar, K Guitteaud, Mohamad Mohty, Ambroise Montcriol, Max Laurin, Aurélia Picard, Jean-Paul Mira, Marie-Charlotte Chopin, Richard Bonnet, Michel Wolff, Sébastien Maillez, Jeanne Maugein, Véronique Leblond, Nicola Walid, Bernard Gauche, Mathieu Evillard, Hassen Jeddi, Anne Bourlet, Isabelle Grawey, Thierry Jault, Sandrine Hiret, Valerie Gaborieau, Véronique Boin-Gay, An Kim, Thierry Constans, Jean-François Gaide, Martine Giraud, Eric Meaudre Desgouttes, Alain Fur, Abdallah Maakaroun, Olivier Matray, Bertrand Maubert, Frédérique Péchinot, Aurelie Garbi, Claire Delbrouck, Benoît Grandclerc, Vincent Cadiergue, Hervé Lécuyer, Bernadette Grignon, Thierry Bensaid, Nicole Constantin, Yannick Chevalier, Hassène Rahmani, Thierry Levent, Joelle Desliers, Florence Van de Velde, Xavier Adhoute, Clara Andriau, Christophe Charasse, Rémi Vatan, Benoît Martha, Alain Lecis, Didier Albert, Romain Jacobs, Hélène Lefranc, Christian Martin, Nasseur Rezgui, Bertrand Pigeon, Catherine Le Henaff, Dominique Cassignard, Françoise Cotes, Eric Pujade Lauraine, Jean-François Gattault, Nicole Ferreira-Maident, Noémie Jourde-Chiche, Hélène Garrec, Olivier Darchen, Carole Schwebel, Marie-Christine Bezian, Patrick Daoud, Tsouria Becaid, Simone Laluque, David Broche, Christine Boisselier, Pascale Martres, Sarah Hammami, Brigitte Olivier, Jean-Marie Nkunzimana, Eric Monlun, Isabelle Marterl-Lafay, Marion Carboni, Marie-Françoise Mattei, Sandrine Castelin, Isabelle Barillot, Marie-Noelle Cufi, Thomas Kaiser, Catherine Herry, Pascal Hutin, Jean-Pierre Bronowicki, Bernard Branger, Pierre Thomas, Elie Zagdoun, Anne Goquelin, Ziad Assaf, Ingrid Croquet, Bruno Pozzetto, Thomas Similowski, Anne-Isabelle Briere, Marie-Thérèse Albertini, Mariam Blaka, Christelle Tassot, Anne Gaschet, Jean-Philippe Lavigne, Antoine Pujol, Philippe Colombat, Edouard Devaud, Hana Talabani-Boizot, François Barière, Anne-Marie Cordier, Philippe Gueudet, Georges Simon, Anne-Sophie Lipovac, Françoise Bandaly, Anne Beauplet-Lepage, Sylvie Prince, Charlotte Jouzel, Jean-Luc Deboutin, Patrick Zavadil, Louis Puybasset, Marie-Cécile Petit, Loïc Guillevin, Kamel Touati, Christophe Ntalu Nkato, Sylvie Carette, Jacques Vaucel, Chantal Delasalle, Marine Gross Goupil, Laurent Gutmann, Christiane Payen, Annick Barboteau, Firouzé Bani-Sadr, Christophe Legendre, Philippe Roulier, Elie Azria, Ibrahim Farah, Isabelle Rouquette-Vincent, Anne-Sophie Erena-Penet, Philippe Labadie, Eric Josien, Aicha Derragui, Mathieu Legrand, Odile Beyne-Rauzy, Jean-Marc Nabholtz, Marie-Joelle Demarcq, Olivier Garosi, Michel Deiber, Fabrice Chaix, Bertrand Souweine, Anne Collignon, Gisèle Renard, Mickael Jego, Gilles Bernardin, Anne Allart, Jocelyn Barrier, Marc Vasse, Philippe Ménager, Marc Wurmser, Abderkader Ouazir, Olivier Gontieron, Yvon Berland, Sébastien Trouiller, David Leysenne, Christophe Ozanon, Fanny Autret, Tahar Saghi, Loïc Dopeux, Sophie Benoit-Coustou, T. Fraisse, Christine Maillard, Karine Nikodijevic, Georges Kaltenbach, Angéline Jamet, Philippe Aucher, Julie Bottero, Marie-Claude Piffaut, Marianne Besnard, Florence Courillon, Marie Bonfils, Christine Ghevaert, Marie Destors, Eliette Jeanmaire, Franck Zerbib, Manuel-Luis Gameiro, T Prazuck, Laurent Mandin, Olivier Guisset, Marguerite Fines, Toufik Feddal, Agnès Jouffret, Louis Mesnard, Thomas Bourrée, Hasinrina Razafimahefa, Sylvestre Tigaud, Vincent Estève, Philippe Malherbe, Jean-Michel Salord, Pascal Adam, Bertrand Rozec, Michel Fuillet, Olivier Lemenand, Denis Quinsat, Ana Danalaché, Véronique Vialette, François Brosset, Patrick Messner Pellenc, Nicolas Heisel, Edouard Girard, Régine Martin, Olivier Garesslin, Catherine Mille, Alexandre Gascon, Marc Nicolino, Laurence Mouly, Claire Fabre, Bénédicte Ponceau, Marie-Etiennette Emeriau, Pascal Cathebras, Bérangère Bernardaud, Michèle Pérouse de Montclos, O. Arsene, Karine Grenet, Yazdan Yazdanpanah, Sten De Witte, Anne Scemla, Laurence Bouillet, Christophe Burucoa, Vincent Loffeier, Séverine Visentin, Luc Desfrere, Miloud Arabi, Frédérique Costa, Sylvie Lechat, Ali Chekroun, Raymond Ruimy, Marie, Jérôme Bizet, Xavier Nassif, Baihas Dib, Patrick Bert-Marcaz, Laurent Martin Lefèvre, Nicholas Sedillot, Blandine Cattier, Emilie Boidin, Daniel Sondag, Aude Bourrouillou, Alain Noirot, Franck Desemerie, Fréderic Heluwaert, Catherine Tamalet, Marc G. Berger, Jean-Daniel Lelièvre, Dominique Perotin, Abdelkader Bemrah, Alain Lozniewski, Bernard Borstein, Hanna Eid, Diana Suatean, Virginie Mignaut, Jean-Claude N'guyen, Valérie Le Goff, Laurent Teillet, Christophe Rolland, Gwenaël Alfonsi, Florence Lachenal, Philippe Bossi, Yves Botreau, Florence Doucet Populaire, Henry Jardel, Nicolas Gallo, Elias Jabre-Sikias, Michel Dupon, Hélène Brihier, Isabelle Patry, Alexandre Leclercq, Bernadette Tourrand, Christophe Roussel, Jean-Emmanuel Kurtz, Bénédicte Paindaveine, Simon Elhadad, Richard Sanchez, Eric Sgro, Pierre Berger, Valérie Murbach, Anne Holstein, Florence Martin, Taoufik Merabet, Amélie Benbara, Milagros Ferreyra, Laure Esposito, Pierre Delobel, Antoine Andremont, Marc Bourlière, Carole-Anne Boudy, Jean-Baptiste Gaulthier, Laurent Tacchini, Olivier Marpeau, Sonia Tesseydre, Marie-Pierre Coulhon, Nathalie Hodee, Marie-Chrsitine Conroy, Pierre Weinbreck, Roland Leclercq, Laurent Souply, Christian Bidault, Annie Elbez, Marie-Annick Lebreton, Patrick Brisou, Agnès Ferroni, Jean-Louis Pourriat, Nadia Anguel, Christian Noel, Philippe Jouvencel, Eric Pichard, Xavier Martin, Mathieu Coste, Pierre Zuber, Catherine Neuwirth, Jean-Pierre Hacot, Paul Aye, Jérôme Guinard, Yves Pean, Jean-Christophe Dengo, Fabrice Petassou, Didier Viole, Thierry Messiaen, Jean Beytout, Philippe Petitjean, Ferdinand Savare, Patrice Cuvillier, Sophie Coignard, Hélène Anglaret, Nassim Kamar, Elisabeth Chachaty, Karine Guimard, Louis Braem, Hacene Fezoui, Pierre Martin, Jean-Paul Viard, Claire Larroche, Nicolai Claudiu-Plesa, Thierry Benoit-Cattin, Olivier Moquet, Thierry Pasdeloup, David Rosay, Rodolphe Jean, Jean-Bernard Mariette, Marc Debouverie, Hervé Peltier, Mustapha Terki, Jacques Daleas, Valérie Dattin-Dorrière, Michel Vergnaud, Emmanuel Grimprel, Sylvène Rosselli, Jean-Marc Didier, Pierre Faurie, Luc Frimat, Aziza Mandjee, Sabine Etchemendy, Pierre Tissières, Jean Nakhleh, Sylvie Mariette, Christian Perronne, Bruno Carbonne, Nathalie Houssiaux-Maisonneuve, Tristan Ferry, S Beague, Anthony Sebban, Marie-Thérèse Hili, Jean-Michel De Kermadec, Lucien Brasme, Gilles Blaison, Caroline Garandeau, Jean-Pierre Sollet, Laurent Tronchon, Thierry Samson, Julien Gesquière, Nicolas Ettahar, Alain Créange, Etienne Laurens, Véronique Equy, Fréderic Bart, Bernard Bouffandeau, Christine Vaillant, Valerie Pesque, Jean-Marc Lalot, Marc Levy, Michel Kaidomar, Mihaela Saplacan, Sterenn Yvenou, Marie-Isabelle Steibach, Emmanuelle Cambau, Agnès Riche, François Fourrier, François Raffi, Mélissa Lalu, Henri Bérard, Danielle Clave, Jean-Claude Mouries, Martine Porcheron, Jean Cabalion, Richard Lamarca, Nathalie Canu, Jean-Baptiste Roseau, Annabelle Stoclin, Luca Luminitan Elena Lupean, Rémi Gebeile, Celia Salanoubat, Carole Marmouset, Pierre Bigot, Anne-Laure Breton, Pierre Kalfon, Colette Vincent, Sophie Marty, Olivier Tandonnet, Alexis Redor, Xavier Valette, Ourida Aoudia, Jacques-Arnaud Seyrig, Bertrand Beaune, Hugues Aumaitre, Georges Pinon, Yann Leveneur, Sylvie Charachon, Raoul Herbrecht, Henriette de Valk, Gary David, Julien Pouyanne, Marc Dommergues, Majed Al Chaar, Véronique Blanc-Amrane, Pascale Guillarmé Grossmann, Bruno Abraham, Yves Morel, Philippe Suel, Denis Sautereau, Olivier Guilloy, Tu Anh Tran, Frédéric Laurent, Zahir Amoura, Jacques-Olivier Bay, Zoubida Elharie-Heraux, Joyce Sibony-Prat, Bernard Guillois, Dominique Rohmer-Heitz, Audrey Barrelet, Jérémie Courouble, Jean-Paul Herry, Daniel Vittecoq, Annie Vermesch-Langlin, Jean Auroux, Claude Aubert, Thierry Harvey, Ghislaine Lamoine-Gimet, J. Riahi, Florence Soraudeau, Bachar Al-Jalaby, Caroline Périsson, Khélifa Ayouz, Florence Cardot, François Maillet, Alain Goux, Théophile Magna, Bertille de Barbeyrac, Adrien May, Dominique Andreotti, Olivier Jonquet, Hélène Dumouchel, Didier Thibaud, Philippe Morlat, Pascal Chevalet, Pascal Ancelin, Guy Chambreuil, Cécile Le Boterff, Anne Ceriez, Olivier Detante, B Pangon, Claude C.A. Bernard, Vincent Cailleaux Pierre-Etienne Cailleux, Jordi Miatello, Pierre-Yves le Berruyer, Sylvain Kouaho, Michel Briaud, Hélène Delaby, Patrick Herbecq, Christine Segonds, Véronique Jault, Pascale Brunel, Christine Dussopt, Jean Thore, Jean-Marc Thouret, Jean-Marc Kerleau, François Le Baron, Slavius Matica, Sophie Leautez-Nainville, Matthieu Pecquet, Laurent Bret, Yacine Sedjelmaci, Pierre Metton, Habiboulaye Diallo, Jany Rey Zermati, Arnaud Delahaye, Hélène Chaussade, Laurent Mandelbrot, Emilie Bessede, Olivier Casanovas, Paul Pierrot, Annick Legras, Dominique Lauque, Hélène Gatti, Jean Catineau, Ebutu Likose, Gilles Capellier, Eric Kibbrecht, Freddy Thibaut, Patrick Valadier, Chantal Lemble, Joël Gaudelus, Joelle Mellier, Joëlle Brochen, Emmanuel Gascou, Stéphane Bonacorsi, Stéphanie Bannier, Bruno Fantin, Didier Raffenot, Valérie Revel, Hakim Amroun, Huguette Negrery, Anne-Laure Fauchais, Paul Mercury, Michel Chuzeville, Christian Zumbo, Nicolas Després, Pascal Roblot, Jérôme Pasche, Jean Claude Boufetteau, Jocelyne Caillon, Julien Boileau, V. Rabier, Benjamin Manéglier, Emilie Jourdes, Franck Ceppa, Christine Recule, Nicolas Degand, Benoît Henry, Thierry Baranger, Dominique Pateron, Agnès Pélaquier, Gérard Bouchet, Hélène Fiette, Ozel Guiden, Dana Ranta, Etienne Ruppé, Nabil Chiouk, Jacques Breuil, Dominique Leduc, Véronique Loustaud, Hervé Métenier, Michel Durand, Isabelle Mahé, Leila Karaoui, Marie-José Collus, Mehran Monchi, Olivier Belmonte, Romain Blondet, Jacques Thierry, Karine Humbert, Gilles Salama, Marie-Noelle Heurtaux, Cécile Goujard, Bruno Sivery, Martial Boisseau, Redouane Dahoumane, Pierre Delour, Christian Niels Meyer, Anne Faudon-Gibelin, Gérard Poulain, Roger-Charles Luciani, J.-C. Souquet, Olivier Grossi, François Vandenesch, Sylvain Mermont, Jacques Bronner, Sonia Dahan, Paul Marzouk, Pascal Pouedras, Noureddine Djafari, François-Xavier Caroli-Bosc, Jean-François Dessin, Brigitte Gruffat, Armelle Morin-Fatome, Sylvie Thoinet, Bano Konate, Jean-Winoc Decousser, Claire Poyart, Patrick Plessis, Olivier Millet, Vincent Cattoir, Françoise Geffroy, Manica Vasseur, Pierre Carli, Isabelle Citony, Christian Richard, Nicolas Sigur, Patrick Marthelet, Luwawu Mbimba, Pierre Feugier, Philippe Sauder, Hama Djerad, Evelyne Bourgerette, Hanen Chahtour, Adrien Lemaignen, Dominique Bechade, Patrick Ochocki, Antoine Vieillard Baron, Dominique Astruc, Marie-Pierre Moiton, Nicolas Dubois, Sylvie Ledru, Corinne Seknazi, Hélène Poupet, Jean-Philippe Brieux, Gérard Barthélémy, Aihem Yehia, Louis-Jean Couderc, Ahmed, Françoise Rigaux, Yohann N'guyen, Philippe Bethery, Damien Corberand, Etienne Auvray, Paul-Louis Woerther, Christian Combe, Sophie Delesalle, Jean-Marie Piala, Faraj Al Freijat, Philippe Juvin, Malcolm Lemyze, Hyacine Rey, Claire Larible, Noel Milpied, Lémia Zgarni, Julia Gaillard, Agnès Juven, Paola Otean, Adrien Melis, André Pechinot, Olivier Bouchaud, Olivier Chassin, Pierre Hausfater, Asma Trabelsi-Jnifen, Vincent Grobost, Didier Lemery, Pierre Soury, Françoise Brevet, Jacques Tankovic, Dominique Sansot, Jean Louis Salomon, Charlotte Cordonnier, Brigitte Lamy, Antoine Maisonneuve, Dominique Pressac, Claude Rémy, Rodolphe Sobesky, Stéphanie Cognet, Pierre Cougoul, Didier Jan, Dominique Perrotin, Cécile Hombrouk-Alet, Thierry André, Gilbert Pochmalicki, Serge Girard, Vincent Zerr, Guillaume Cadiot, Claudine Lasbasses, Michel Slama, Abderrazak El Yamani, Sophie Brovedani, Jean Armengaud, Romain Hernu, Géraldine Mascade, Aurélien Lorléa'ch, Ali Akkari, Mathieu Tourdjman, Christopher Payan, Eric Jullian, Nathalie Fonsale, Frédéric Riehl, Paul Strock, Geneviève Grise, Philippe Mottaz, Christian Floriot, Marie-Noëlle Ungeheuer, Denis Caillot, Arnaud Chalvon-Demersay, Catherine Branger, Stanislas Bruley des Varannes, Marc Paccalin, Marie-Pierre Danjean, Alexandre Mebazaa, Xavier Brunet, Roland De Varax, Laurence Delhoustal, Sophie Haro, Bruno Chabanon-Pouget, Isabelle Goidin, Dominique Chudersky, Corinne Costes, Delphine Chatellier, Maud Gelez, Damien Dassant, Pascal Joly, Jean-Michel Arnal, Zakaria Hamitou, Philippe Rondepierre, Carole Pignon, Valérie Crombe, Amanda Lopes, Chrystelle Kemenar, Olivia Raulin, Anne-Cécile Hochart, Sandrine Gérart Pons, Valérie Zeller, Guillermo Reyes Ortega, Mathilde Guérin, Audrey Migraine Bouvagnet, Florence Eboue, Isabelle Loury-Lariviere, Sophie Leotard, Suzanne Lima, Marie Kassis, Jean-Luc Donay, Jean-Pierre Audié, Guillaume Cartron, Arnaud Ribier, Fanny Buron, Mirela Tuca, Marius Semenescu, Arnaud Serre, Vincent Quentin, Denise Bouyssou-Destriau, Violaine Bresson, Christine Chandesris Joséphine Chapalain-Cagnon, Eric Cua, Henri Courtade, François Bénézit, Sébastien Lamache, Philippe Bonnefoy, Francis Schneider, Richard Monarchi, Adeline Schendel, Paramasiven Mootien, Ghislaine Gardes, Pierre-François Westeel, Jean-François Magny, François Caron, Jocelyn Michon, Didier Eyer, Isabelle Ronda, Pierre-Yves Robillard, Frédéric Renou, Anna Faucher, Jean-Robert Harlé, Anne Debernardi, Grégory Akerman, Benoît Fontenel, Pierre Hourdebaigt-Larrusse, Marie-Noëlle Adam, Aude Lessene, Abdelkader Hrichi, François Blot, Athéna Le Pierres, Romain Lemarie, Françoise Granier, Véronique Tardy, Marc Gatfosse, Pierre-Marie Roger, François Goupil, Saïd Aberrane, Franck Bernardi, Isabelle Plantier, Nathalie Funakoshi, Jean-Gilles Delecalle, Patricia Barbut, Jacques Reynes, Christophe Roy, Sophie Perreve, Michel Garre, David Ribes, Cyrille Ede, Jean-Claude Dausset, Francis Duchene, Jean Caussin, Michelle Becker-Schneider, Gilles Berthelot, Damien Dupont, Jean-Michel Gillot, Aurélie Messager, Jean-Marie Pannecouck, Jean-Christian Roussel, Alain Reynaud, Sylvie Cariou, Anne Dao, François Guillemot, Martin Martinot, Patrick Casali, Anne-Sophie Poirier, Aissa Kerchache, Necera Sakek, Eric Porthault, Christophe Decoene, Chantal Ache-Papillon, Brigitte Bicais, Jean-Claude Feugier, Thierry Masseron, Charles Marty-Ane, Daniele Goldgran Toledano, Jean-Christophe Dubus, Damien du Cheyron, Dominique Decré, Jean-Loup Pennaforte, Ahmed Tigaizin, Bernard Vache, Eric Oswald, Claire Moulinoux, Anne-Christine Jaouen, Caroline Charlier, Anne-Laure Virlouvet, Ali Kara, Jean-Luc Sicsic, Sylvie Goffart, Mathieu Zuber, Claudine Fèbre, Olivier Lortholary, Mathieu Dupont, Annie Vessieres, Thierry Helvadjian, Thomas Signouret, Cedric Daupin, Sandrine Essouri, Jean-Louis Jacob, Pascal Boileau, Caroline Blazejewski, Quentin Lepiller, Juan-Pablo Maureira, Eddy Lebas, Christophe Deschamps, Amévi Ananivi, Clovis Foguem, Daniel Adoue, Abdourahim Chamouine, Alain Michault, Bruno Guérin, Olivier Baud, Clara Vinci, Thierry Weitten, Jean-Marc Eychene, Marie Froidure, Julien Obiols, Patricia Roussellier, Marc Lecuit, André Cabié, Saskia Foucart, Karim Belhadj, Michel Cingotti, Bruno Dumoulard, Jean Puyhardy, Etienne Danquechin Dorval, Lucile Mendes-Martin, Enrique Casalino, Luc Jarrige, Fabien Lambiotte, Philippe Masson, Mohammed Mansouria, Pierre Thouvenot, Katy Jeannot, Martine Nyunga, Valérie Macci, Florent Masia, Claire Briere de la Hosseraye, Wassila Anteur, André Sommabère, Marie-Claude Germain, Isabelle Arnault, Bernard Carbonelle, Philippe Devos, Daniel Protar, Tiphaine Gaillart, Ludovic Lassel, Laurence Hamou-Plotkine, David Trystram, Thierry Bureau, Olivier Collard, Fanny Vuotto, Sophie Malhiere, Frederique Canis, Gillles Plainfosse, Catherine Lechiche, Bertrand Lassere, Martine Chouraqui, Jean Baptiste Michot, Fethi Radhouane-Khanjari, Carole Barbier, Pascal Bonitchi, Abdelaziz Benkhelil, Odile Salmon, Laurent Damaj Gandhi, Bertrand Minguet, Michel Wagner, Odile Falguières, Zahr-Eddine Ali Chaouche, Eric Zaoui, Isabelle Guichard, Bernard Huttin, Apollinaire Karirisi, Gaël Cinquetti, Christophe Plane, Lionel Rostaing, Yanne Henry-Andrieu, Daniel Re, Virginie Verrier, Pascal Bolot, Michel De Biasi, Laurence Vrigneaud, Mathilde Turpin, Marie-Claude Demachy, Etienne Roussel, Michèle Blancs, Olivier Join-Lambert, Yves Ville, Thierry Granger, Gilles Hilbert, Virginie Medeau, Daniel Villers, Benoit Pilmis, François Gouraud, Emmanuel Ardiet, Catherine Heyraud-Blanchet, Alain Devidas, Hélène Dieye, Julie Cremniter, Jean-François Bergmann, Rozenn Le Berre, Virginie Leguen, Daniel Royer, Gilles Le Maout, Christian Harou, Sylvie Gabriel-Soléan, Yves Regouby, Martine Pestel-Caron, Patrick Brunet, David Boutoille, Emmanuelle Bonnin, Patrice Coulon, Marc Sullice, Marianne Barbieux, Gilles Cambonie, Joëlle Tricoire, Marie-Nadège Bachelier, Delphine Briend, Céline Ramanantsoa, Nathalie Bednarek, Didier Lebreton, Julien Lagrandeur, Damien M'Bey, Philippe Audeguy, Elie Saliba, Lena Damaj, Hassan Fallouh, Pascal Couturier, Fabrice Prévost, Yves Domart, Marie-Odile Lafforgue, Anne Le Du, C. Beuscart, Pierre Guillet, Fabrice Larrazet, Marie-Hélène Hausermann, Henri Robert, Nicolas Fanjaud, François Goehringer, Thomas Bachelot Philippe Badia, Jean-Michel Coulaud, Cristel Fissore Magdelein, Renaud Defebvre, Anne-Sohie Moreau, Johan Courjon, Gilles Salles, Michel Mialon, Silvia Iacobelli, Emmanuelle Bille, Marie-Christine Barbier, Yves Aubard, Patrice Badila, Jean-Philippe Rasigade, Alban Deroux, Evelyne Lecaillon-Thibon, Michel Godin, Abdelmajid Djeffal, Viorica Badurescu, Meriem Canitrot, Pierre Blanchard, Antoine Legros, Laurence Got, Françoise Duluc, Mylène M. Maury, Gilles Dassieu, Nordine Khodeir, Jean-Marie Duez, Mathieu Morincomme, Jérôme Lacroix, Mathieu Revest, Koffi Blewoussi, Isabelle Barazer, Françoise Poitevin, Camille Seignovert, Stéphanie Honore Bouakline, Anne Heidt, Brigitte Malbruny, Julien Desblache, Christian Cattoen, Eric Jaunait, Bruno Chaminade, Claude Bazin, Jonathan Chelly, Anne Pottier, Alain Schmitt, Alain Tissot, Karim Dadoun, P. Rebattu, Claudine Contamin, Arnaud Guerard, Nathalie Ravet, Sandrine Khalifa-Thellier, Marlène Chatron, Gaëlle Dörr, Hélène Biessy, Emmanuel Forestier, Bruno Devaux, Jean-Jacques Grelaud, Xavier Tchenio, Marie-Cécile Ploy, Jérémie Violette, Michèle Burdin, Lionel Falchero, Dominique Jacomy, Jean-Christophe Rozé, Damien Labarriere, Stéphane Leroux, Corinne Meregnani, Assia Ferhat Carre, Paul Orode, Jean-Gabriel Paul, Catherine Godon, Agnès Vinay, Régine Barraduc, Dominique Dallay, Alexandre Ampère, Anne-Gaelle Kervegant, Guillaume Louart, Dominique Beal Ardisson, Francoise Leonetti, Jean-Yves Baril, Stéphanie Haiat, Bincy Darre, Jérôme Bay, Yvan Gauthier, Sylvie Radenne, Pierre-Yves Gueugniaud, Philippe Ravaud, Luc Landraud, Guillaume Ranchon, Loïc Chimot, Véronique Duval, Ilhem Agha-Mir, Sabine Camiade, Estelle Wafo, Jean-Patrick Laporte, Mariam Roncato-Saberane, Camille Bron, Patrice Laudat, Samir Kennouche, Nawel Afroukh, Dominique Neri, Hakim Kherouf, Yoar Hichri, Pierre-Edouard Bollaert, Gwenaelle Vary, Denis Castaing, Christine Lefort, Sébastien Rouget, René Robert, Christelle Guillet-Caruba, Catherine Simonin, Alain Vighetto, Severine Cabasson, Alain Brusset, Alexandra Doloy, Christel Cherlet, Ahmed Rouidi, Marina Salvucci, Réginald Pordes, René-Gilles Patrigeon, Emmanuelle Dupre-Narlet, Jacques Minet, Fethi Taleb, Anne-Marie Colingorski, Tahar Hadou, Sylvain Diamantis, Isabelle Glorieux, Thierry May, Jean-Claude Colombani, Anne Berth-Farges, Nicole Desplaces, Renaud de Tayrac, Elisabeth Walter, Fabienne Lorge, Pascal Reboul, Nathalie Dournon, Laurence Estépa, Marie-Lina Toubia, Mathilde Flahault, Thierry Delacour, Dominique Hurel, Hélinoro Andriamaneo, Cécile Bébéar, Denis Grasset, Miloud Serier, Oléna Orléva, Nadine Dubroca, Hervé Gentilhomme, Jean-Luc Baudel, Isabelle Lavenu, Salim Smati, Carlo Saroufim, Eric Placidi, Albert Sotto, Benoît Libeau, Hélène Leroy, François Golfier, Christophe Dollon, Laurence Desnoulez, Eric Barre, Daniel Cohen, Pascal Priollet, Thierry Marsepoil, Benoît Lionnet, Jacques Tebib, Pascale Penn, Antoine Bouissou, Christian Roth, Olivier Martinet, Anna Schmitt, Nathalie Fruleux, Fouzia Radaoui, Jean-Marc Lessinger, Virginie Morando, Jean-Jacques Maillet, Christophe Fruchart, François Boué, François Goffinet, Franck Lellouche, Martin Demarchi, Alain Geissler, Jean-Charles Picaud, David Assouline, Patricia Brazille, Philippe Guimier, Marie-Françoise Dabysing, Bruno Delpeuch, Vanessa Tran, Guy Gengembre, Delphine Deligne, Dominique Vodovar, Yvan Touze, Sabrina Parent, Anne Decoster, Camille Dewitte, Emmanuel Weiss, Thierry Lambert, Thomas Guimard, Vincent Caille, Claude Guérin, Françoise Evreux, Geneviève Barjon, Basile Ondze, Damien Fournier, Olivia Bandin, Sophie Mignart, Henri Demontclos, Didier Perez, Jacques Croize, Nicole Desbois-Nogard, Guenièvre Imbert, Clarisse Dupin, Khalid Ridah, Marie-Christine Varin, Guillaume Arlet, Edith De Clareuil, Marie-Line Eustache, Patricia Le Pimpec, Louise Fortin, Eugène Ngami, Fabrice Mihout, Cecilia Esnault, Vincent Bouden, Véronique Annaix, Yves Poinsignon, Aurélien Lorchleac'h, Jean-Marc Degreff, Marie Garofano, Renaud Mesnage, Anne-Marie Roque-Afonso, Alain Chevailler, Stéphane Hominal, Thierry Charbonnier, Adrianna Bildea, Fabien Fily, Benjamin Davido, Emmanuel Rassiat, Assi Assi, Stéphanie Brunet, Hervé Jacquier, Catherine Claise, Annie Durand, Yannick Monceau, Pierre Blanc, Jean-Marie Sire, Yves Sucin, Jean-Pierre Zarski, Nathalie Bronet, Ingrid Lafon, Philippe Rey, Jacques Markarian, Eric Sennevile, Olivier Wink, Guilène Barnaud, Anne-Sophie Peultier, Sabine Taylor, Rim Savatier, Patrick Valayer, Claude Negrier, Selim Jennane, Edouard Begon, Laura Hyerle, Delphine Bridoux, Claire Daurel, Benoît Dalle, Mathilde Lescat, Philippe Stolidi, Elodie Perrodeau, Xavier Heches, Pierre Castelnau, Philippe Bray, Jean-Claude Texier, Serge Rossignol, Maud Brung-Lefebvre, Jean-François Subra, Jean-Marie Delarbre, Morgane Schneerson, Guyro Jang, Mona Mehri, Nathalie Landgraf, Pierre-Marie Girard, Armand Goll, Zaineb Bekguesmia, Christophe Clement, Michel Collet, Vincent Maze, Amine Benjelloul, Solène Durliat-Ellie, Vincent Letouzey, François Schmitt, Valérie Martinez, Sarah Watson, Abderrezak Bouasria, François Barbier, Raphael Lauretta, Mirana Razafimahery, Cristina Sirbu, Patrick Malherbe, Anne Wuillai, Ludovic Lesecq, Philippe Gaudard, Serge Houssaye, Jacques Monsegu, Gilles Rival, Chantal Chaplain, Jean-Didier Grangé, Oana Zamfiri, Florence Nguyen-Khac, Marc Portneuf, Jean-Michel Pawlotsky, Delphine Bonnet, Laurent Traissac, Sophie Hamon-Charles, Didier Dreyfuss, Louis Bernard, Laurence Detourmignies, Olivier Martineau, François Pettinelli, Marc Zandecki, Michel Dreyfus, Alain Chapelle, Sébastien Sabbat, Anne-Sophie Labussiere, Jean-Louis Gaillard, Chloé Plouzeau-Jayle, Patrick Zoveda, Véronique Leflon, Marie Levy, Aurélie Labé, Bruno Soulie, Raoul Jacques Bensaude, Hecham Moussa, Sylviane Catteu, Nathalie Biron, Loïc Masson, Georges Mourad, Nejla Aissa, Dragos Ciocan, Hubert De Boysson, Jean-Luc Bouyer, Patrick Yeni, Thierry-Pascal Zame, Caroline Thomas, François Cavalié, Laurence Koulmann, Christophe Rioux, Olivier Barraud, François Bricaire, Marguerite Le Poulain, Marie-Noelle Noulard, René Thomas, Guy Semet, Laurent Mosser, Olivier Marret, Brigitte Rivière, Vincent Jarlier, Jean-Philippe Coindre, Marc Villemain, Martin Pierre, Yacine Benkaci, Philippe Chiron, Hoang Vu-Thien, Jérôme Gournay, Andrea Labaune-Kiss, Brigitte Lauzanne, Fanny Lemercier, Souad Silhadi, Imad Kansau, Christophe Poncelet, Olivier Baldesi, Francis Thuet, Olivier Leroy, Aurore Lamberet, Camille Petit Hoang, Sophie Micheli, Ayman Abokasem, Hakima Nesrine, Pierre Lureau, Christian Chidiac, Vincent Piriou, Fabien Zoulim, Dieudonné Nicobaharaye, Anne Tixier, Isabelle Matheron, Soumeth Abasse, Victoria Cacheux, Serge Herson, Christine Fuhrmann, Olivier Proost, Bernard Bedock, Olivier Rogeaux, Mostapha Hajjar, Anne Reverseau, René Courcol, Françoise Carmagnol, Yves Guénard, Céline Ménard, Bouchra Lamia, Bruno Lemmens, Damien Bouhour, L. Lequen, Gaëlle Baty, Cédric Bouet, Dominique Guerrot, Stéphane Blanc, Catherine Chirouze, Anne-Hélène Reboux, A. Vachée, Gregory Taurin, Myriam Mein-Bottini, Jean-Pierre Belot, Alain Lafeuillade, Patricia Gabez-Therou, Philippe Labrousse, Bernard Jarrousse, Philippe Noto, Vincent Brunot, Philippe Condominas, Marion Challier, Béatrice Berçot, Delphine Anuset, Mélanie Daval Cote, François Bernasconi, Y. Costa, Chandrah Goburdhun, Bernard Gressier, Alban Michaud-herbst, Franck Charlier, Moussa Hecham, Luc Boulain, Hélène Corneloup, Alix Greder Belan, Nicolas Boussekey, Claire-Antoinette Dupuy, Yannick Rouquet, Benoit Renard, Benifla Jl, Etienne Javouhey, Michèle Granier, Marie-Christine Jaffarbandjee, Emilie Piet, Benoît Bergues, Claire Malbrunot, Catherine Tiry, Philippe Mérigot, Mouna Ben Soltana, Chantal Roure Sobas, Florian Radenac, Yves Thomas, Agathe Blaise, Sylvie De Martino, Laurence Legout, Gabriel Choukroun, Jean-François Muir, Peggy Dupretz, Patrick Dupont, François Guichart, Julie Jean, Jean-Michel Descamps, Bernard Kittschke, Anne Gruson, Gerard Viquesnel, Marie Keller, Pascal Chavanet, Françis Vallet, Yvan Vaschalde, Jean-Luc Hanouz, Gerard Lina, Françoise Loison, Simon Vincent, Jean-Paul Thellier, Moncef Afi, Dominique Zagozda, Hélène Sokeng-Affoule, Marc Le Bideau, Jean-François Loriferne, Alain Gravet, Sophie Deprecq, Tarik Naceur, Severine Mielczarek, René-Jean Bensadoun, Bernard Karkous, Yves Bléher, Jocelyne Poulain, Véronique Goulet, Laurence Nicolet, Sophie Arista, Antônio Lúcio Teixeira, Jean-François Schved, Laurent Nicolet, Claire Lecomte, Faiza Benddif-Fin, Michel Aumersier, Laurence Burc-Struxiano, Maxime Thouvenin, Samia Harbi, Mathieu Detave, Catherine Rebeyrotte, Jean-Paul Kisterman, Bruno Berdin, Pascal Vincent, Laurent Argaud, Elisabeth Parisi-Duchene, Geneviève Julienne, Fernanda Farto-Bensasson, Georges-Fabrice Blum, Sad Gaizi, Tali-Anne Szwebel, Raphaël Lepeule, Marie-Thérèse Climas, Anne-Françoise Dillies, Amar Boudhane, Umberto Simeoni, Pierre-François Dequin, Gérard Oliviero, Alain Gourlaouen, Caroline Piau, Marie-France Lutz-Murphy, Benoît Claude, Jean-Paul Aubry, Nadine Dubosc-Marchenay, Kamilla Chraibi, Emmanuelle Heusse, Sylvain Le Chevallier, Nathalie Brieu, Farid Sifaoui, Lorraine Letranchant, Hélène Durox, Jean-Pierre Lagasse, Adel Ghedira, Xavier Roubert, Fatma Magdoud, Hélène Jean-Pierre, Etienne Carbonelle, Olivier Dereeper, Lionel Carbillon, Christophe Billy, Mélanie Roblin, Marie-José Kodzin, Philippe Niel, Solène Makdessi, Matteo Vassallo, Maryse Archambaud, Fabian Haccourt, Didier Blaise, Stéphane Bourgeois, Elena Marcu, Charles Kubiak, Brisse Castel, François Guinet, Marie Pouzoullic, Frédérique Nathan-Bonnet, Vincent Gendrin, Céline Becherrawy, Aline Secher, Pierre Abgueguen, Clarence Eloy, Jean-Marc Tourani, Frédéric Klapczynski, Bernard Montmasson, Philippe Real, Joanna Pofelski, Yves Welker, Karim Krechiem, Eric Caumes, Martine Elena-Daumas, Christophe Saigne, Gilles Hittinger, Chantal Delesalle, Jonathan Messika, Fabrice Lesage, Daniela Pop, Daniel Coetmeur, Renato Colamarino, Chetaou Mahaza, Patrick Plésiat, Isabelle Fredenucci, Mylène Baret, Guy Mager, Pascale Chavel, Isabelle Labourdette, Anne-Claude Menguy, Nicolas Fortineau, Ludovic Le Sec, Valérie Gauduchon, Francis Barraud, Nicolas Letellier, Didier Vincent, Janine Frey, Philippe Riegel, Michel Pavic, Jean-Luc Fabre, Jean-Pierre Fauchart, Alain Goudeau, Stéphanie Husson-Wetzel, Philippe Eymerit, Mohamed Camara, Nathalie Seta, Elisabeth Carole Ngo Bell, Philippe Repellin, Laurent Alric, Vincent Leroy, Françoise Delisle Mizon, Jean-Philippe Emond, Marie-Françoise Borie, Lise Crémet, Wladimir Chelle, Elisabeth Brottier-Mancini, Bernard Garrigues, Claire Letellier, Loïc Geffray, Frédéric Méchaï, Julien Bador, Benoit Guery, Alain-Charles Fouilhoux, Corinne Dagada, Pierre Duhaut, Julien Goustille, Arnaud Sément, Francis Carcenac, Isabelle Girard-Buttaz, Claire Chapuzet, Fabienne Jouatte, Bruno Riou, Fabrice Hayoun, Chloé Di Meglio, Youssef Ali, Michel Leneveu, Nathalie Montagne, Yves Garcera, Audrey Moustache, Pierre-Eric Danin, Geneviève Le Lay, Dominique Courouge-Dorcier, Isabelle Worcel, Emmanuel Morelon, Vincent Pestre, Jean-Pierre Vilque, Jean-Christophe Paquet, Lucien Bodson, Anne-Marie Forest, Fabrice Pierre, Christian Pommier, Fabien Dutasta, Pierre Fournel, Stéphanie Courtois, Elodie Dubois, Serge Vanden Einjden, Patrick Honderlick, Pascal Richette, Fabienne Tamion, Véronique Chassy, Richard Megbemado, Anne-Marie Le Reste, Bernard Simian, Henri Osman, Anthony Texier, Badih Ayach, François Simon, Jean-Michel Filloux, Béatrice Dubourdieu, Jean-Claude Semet, Sarah Kubab, Tawfiq Henni, Patrick Dudeffant, Delphine Hequet, Olivier Mimoz, Marc Auburtin, Amélie Chabrol, Mickael Bonnan, Caroline Léonnet, Claire Wintenberger, Serge Ilunga, Patrice Lanba, Sophie Rosello, Alexandre Damage, Flore Bouche, Michel Thibault, Frederic Faibis, Chantal Dhennain, Jean-Philippe Talarmin, Armelle Lamour, Remi Boussier, Fabien Garnier, Marie-Laure Brival, Nourredine Hedjem, Philippe Vande-perre, Raphaël Coint, Jean-Claude Reveil, Eva Weinbronn, Emmanuelle Lavalard, Alexandra Fille, Françoise Le Turdu, Lionel Leroux, Jean-Yves Lefrant, Jean Berthet, Radia Bouaziz, Alain Ravaud, Sylvaine Rousseau, Yacine Merrouche, Alain Le Coustumier, Bertrand Guider, Gisèle Dewulf, Jean-Marc Faucheux, Jacques Piquet, Franck Leibinger, Charles Cerf, Robin Stephan, Jean-Philippe Redonnet, Jean-Paul Stahl, Ella Dzeing, Simona Pavel, Guy Vernet, Ghada Hatem, Samer Kayal, Jacques Deschamps, Dominique Descamps, Marion Levast, Marc Bouiller, Sylvie Dargere, Claire Dingremont, Stéphane Gaudry, François Maillot, Sylvie Odent, Nathalie Cervantes, Hélène Zanaldi, Laurence Gachassin, Olivier Ruyer, David Patin, Benoît Cazenave, Pascal Jacquier, Michelle Boyer, Béatrice Berteaux, Virginie Zarrouk, Jacques Bor, Isabelle Legoff, Hélène Albinet, Florence Rousseau, Gilles Pialoux, Guenaelle Salaun-Beretta, Alexandra Moura, Véronique Vernet Garnier, Didier Lepelletier, Pierre-Alexandre Hauss, Joëlle Belaisch-Amart, Didier Lepeletier, Jacob Xavier, Aline Nare, Annie Motard-Picheloup, Alain Améri, Bertrand Lioger, Jean-Valère Malfuson, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Listeria - National Reference Center Listeria (CNRL), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria (CC-OMS / WHO-CC), Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Département de Médecine interne [Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Biologie des Infections - Biology of Infection, Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources (ICAReB), Institut Pasteur [Paris] (IP), Infectious Disease Department [Saint Maurice], Agence Nationale de la Santé Publique [Saint-Maurice] (ANSP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, MONALISA study group, Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency., ROZIER, marie-Claire, CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections (CNRL), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria - Biologie des Infections (CCOMS), CHU Pitié-Salpêtrière [APHP], Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections ( CNRL ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre collaborateur de l'OMS (CCOMS) des Listeria ( CCOMS ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Biologie des Infections, Institut Pasteur [Paris]-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources ( ICAReB ), Agence Nationale de la Santé Publique [Saint-Maurice] ( ANSP ), Assistance Publique - Hôpitaux de Paris, Assistance publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Paris 5 ( UPD5 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris]-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)

Subjects
Bacteremia/epidemiology/mortality, 0301 basic medicine, Male, Pediatrics, bacteraemia, Infectious Disease Transmission, [SDV]Life Sciences [q-bio], Bacteremia, France/epidemiology, Infant, Newborn, Diseases, Foodborne Diseases, Meningoencephalitis, Pregnancy, Risk Factors, Vertical, Medicine, Listeriosis, Prospective Studies, Pregnancy Complications, Infectious, Prospective cohort study, ddc:618, diabetes, alcoholism, Hazard ratio, Foodborne Diseases/microbiology, immuno suppressive therapies, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Hospitalization, Infectious Diseases, isolates, Population Surveillance, Female, France, Listeria monocytogenes/classification/isolation & purification, Cohort study, Adult, medicine.medical_specialty, 030106 microbiology, Notifiable disease, Listeriosis/diagnosis/epidemiology/microbiology, Context (language use), macromolecular substances, 03 medical and health sciences, Humans, study, Aged, [ SDV ] Life Sciences [q-bio], business.industry, Public health, cirrhosis, Infant, Newborn, Infant, Diseases/epidemiology/microbiology, HIV, Mandatory Reporting, Newborn, medicine.disease, Listeria monocytogenes, infection, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious/epidemiology/microbiology, Meningoencephalitis/epidemiology/microbiology/mortality, Observational study, business, prognostic, mellitus
Abstract

International audience; Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (

Published
2016
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16. CD-ROM continuous medical education model for the management of urinary tract infections in family practice

Author

Elodie Sellier, M. Coulouma, Patrice François, Jean-Paul Stahl, Claire Wintenberger, and Patricia Pavese

Subjects
Male, Medical education, business.industry, media_common.quotation_subject, Best practice, Middle Aged, Session (web analytics), Test (assessment), Presentation, CD-ROM, Infectious Diseases, Continuing medical education, Intervention (counseling), Urinary Tract Infections, Humans, Medicine, Education, Medical, Continuing, Female, Prospective Studies, Family Practice, business, media_common, Qualitative research
Abstract

Objectives This study had for aim to assess the acceptability of a model for continuing medical education, to improve the implementation of best practice recommendations for family practice. The training focused on the management of community acquired urinary tract infections in adults. The secondary objective was to identify barriers in the implementation of these best practice recommendations. Methods We conducted a prospective qualitative study. The intervention included an initial knowledge test, an audio-visual CD-ROM presentation, and a second knowledge test. After the session, family practitioners (FP) were asked to answer a face-to-face questionnaire in order to give their opinion on the training session. Ten FP, working in the Savoie and Isere sub-divisions in France, were included. Results All FP were satisfied with the e-learning training session. The element of the session, they best appreciated, was the audio-visual presentation. The comparison between initial and second test results showed a non-significant improvement of knowledge (P = 0.07). The barriers, most frequently mentioned for knowledge and use of best practice recommendations, were: lack of time, content unfit for family practice, habits, and the very broad field of expertise required. Conclusion FP accepted this model of continuing medical education. E-learning seems relevant to improve the implementation of best practice recommendations in family practice.

Published
2012
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17. Outcome of central venous catheter-related bacteraemia according to compliance with guidelines: experience with 91 episodes

Author

Olivier Epaulard, Patricia Pavese, J.P. Brion, Claire Wintenberger, V. Hincky-Vitrat, Jean-Paul Stahl, C. Recule, and Patrice François

Subjects
Adult, Male, Microbiology (medical), Catheterization, Central Venous, medicine.medical_specialty, Pediatrics, Adolescent, medicine.medical_treatment, Bacteremia, Hospitals, University, Young Adult, Humans, Medicine, Sampling (medicine), Major complication, Child, Aged, Aged, 80 and over, business.industry, Guideline compliance, General Medicine, Middle Aged, University hospital, Anti-Bacterial Agents, Conservative treatment, Catheter, Treatment Outcome, Infectious Diseases, Child, Preschool, Practice Guidelines as Topic, Emergency medicine, Positive blood culture, Female, France, Guideline Adherence, business, Central venous catheter
Abstract

Infection is a major complication associated with the use of central venous catheters. Guidelines for medical management of catheter-related bacteraemia have been published, but no study has assessed the appropriateness of physician practices.To assess medical practices in cases of central venous catheter-related bacteraemia (CRB) in a university hospital.Cases were recorded over a period of 12 months and their management was evaluated. All cases of positive blood cultures based on central venous catheter sampling were analysed, and episodes of CRB were determined in this group of patients. Medical management and patient outcome were analysed independently by two physicians.In all, 187 cases of positive blood culture were recorded and 91 cases of CRB were analysed. Systemic antimicrobial therapy was optimal in 56% of the episodes. In 51 episodes, catheter salvage was attempted, for 29 with an indication in agreement with the guidelines but without antibiotic-lock therapy in 20 episodes. The overall medical management was appropriate in 41.8% of the episodes. The overall cure rate was 72.5%. CRB-related death occurred in 5.5% of the episodes. Cure was associated with guideline compliance (P = 0.03) and with adaptation of systemic antimicrobial therapy (P 0.01). Conservative treatment success was associated with compliance with the guidelines for the indication (P = 0.01).Medical management of CRB did not closely adhere to international guidelines. CRB outcome was associated with the appropriateness of this management, particularly when conservative treatment was attempted.

Published
2012
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18. Apport du séquençage nouvelle génération au typage MLST de Pneumocysits jirovecii , dans le cadre d’une épidémie chez des patients transplantés d’organe solide

Author

Eléna Charpentier, Danièle Maubon, Jean-Benjamin Murat, Cécile Garnaud, Sébastien Bailly, Patricia Pavese, Thibault Drouet, Paolo Malvezzi, Caroline Augier, Anne Thiebaut-Bertrand, Claire Wintenberger, Muriel Cornet, Olivier Epaulard, Marie-Reine Mallaret, Sylvie Larrat, and John Rendu

Subjects
Infectious Diseases
Abstract

Le typage par multilocus sequence typing (MLST) permet une caracterisation genotypique precise et reproductible des souches, mais les performances du sequencage Sanger (Sseq) pour la detection de souches minoritaires sont limitees. Or, les infections a differentes souches (infections mixtes) sont frequentes au cours des pneumonies a Pneumocystis jirovecii (PCP). Le sequencage nouvelle generation (NGS) permet la mise en evidence a la fois des populations minoritaires et majoritaires. Dans ce travail, nous avons etudie l’apport du NGS pour le typage MLST des souches issues de cas groupes (cluster) de PCP chez des patients transplantes d’organe solide (TOS). Trente-deux patients presentant une PCP au CHU Grenoble-Alpes entre 2012 et 2015 ont ete inclus. Parmi eux, 12 TOS (rein, cœur, foie, poumons) appartenaient a un cluster observe entre mai 2014 et aout 2015 et 20 patients, epidemiologiquement non relies entre eux, representaient le groupe controle. Une strategie MSLT a trois loci ( mtLSU , CYTB , SOD ) a ete adoptee, comprenant, pour des contraintes techniques liees au sequencage NGS, de nouvelles amorces permettant l’obtention d’amplicons d’environ 750 pb. Les souches de 12 des 32 patients ont egalement ete analysees par Sseq en parallele. Les genotypes obtenus ont ete nommes arbitrairement car il n’existait pas d’etudes prealables utilisant des amplicons etendus de 750 pb. Parmi les 12 TOS, 5 partageaient un meme genotype majoritaire (C2a), regroupant 3 patients transplantes renaux, un patient transplante cardiaque et un patient double transplante renal et cardiaque. Ce genotype C2a n’a pas ete retrouve dans le groupe controle. Toutes populations confondues, la proportion d’infections mixtes etait plus elevee avec le NGS (65 %) qu’avec le Sseq (25 %). Si seule la population controle (hors cluster) etait consideree, cette proportion d’infection mixtes augmentait a 85 %. Le NGS a revele des infections avec plus de deux souches (53 %), et la presence de souches minoritaires, parmi lesquelles le genotype C2a. Une carte de transmission a confirme la probable acquisition nosocomiale de PCP. Un sixieme patient qui presentait la souche C2a sous forme minoritaire a ete inclus dans la carte de transmission. Les sequences etendues de mtLSU ont revele 4 nouveaux polymorphismes augmentant significativement le pouvoir discriminant de ce locus. En conclusion, et comme attendu dans ce contexte de PCP, le NGS surpasse les capacites du Sseq pour la detection d’infections mixtes et permet de preciser la carte de transmission. L’utilisation d’un amplicon etendu a 750 bp pour le locus mtLSU est interessante pour augmenter le pouvoir discriminant du schema MLST. Ce travail ouvre de nouvelles perspectives pour les futures etudes epidemiologiques de ce champignon non cultivable.

Published
2017
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19. La maladie de Whipple : une cause curable d’encéphalite

Author

Brieuc Gestin, Claire Wintenberger, A. Bosseray, B. Colombe, C. Massot, and Sylvie Grand

Subjects
Gynecology, 0303 health sciences, medicine.medical_specialty, biology, 030306 microbiology, business.industry, Whipple Disease, Gastroenterology, biology.organism_classification, medicine.disease, 3. Good health, Tropheryma whipplei, Intestinal malabsorption, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, medicine, 030212 general & internal medicine, Whipple's disease, business, Encephalitis
Abstract

Resume Introduction La maladie de Whipple est une granulomatose systemique rare et de diagnostic parfois difficile. Observation Nous rapportons une observation de maladie de Whipple dont la presentation initiale etait une encephalite aigue. La realisation de multiples prelevements a la recherche d’une maladie de Whipple a conduit au diagnostic, alors que la polymerase chain reaction (PCR) Tropheryma whipplei sur le liquide cephalorachidien etait negative et la biopsie cerebrale stereotaxique recusee. L’evolution sous antibiotherapie adaptee a ete consideree comme « spectaculaire ». Conclusion La maladie de Whipple est une cause rare d’encephalite. Le diagnostic repose sur la realisation de la PCR specifique sur divers prelevements, et sur l’histologie. L’evolution sous antibiotherapie adaptee peut etre tres favorable.

Published
2011
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20. Q fever in the Netherlands - 2007-2010: what we learned from the largest outbreak ever

Author

Peter M. Schneeberger, W. van der Hoek, Jean-Paul Stahl, and Claire Wintenberger

Subjects
medicine.medical_specialty, Time Factors, biology, Transmission (medicine), business.industry, Public health, Zoonosis, Outbreak, Q fever, Coxiella burnetii, biology.organism_classification, medicine.disease, Disease Outbreaks, Natural history, Infectious Diseases, Immunology, Emergency medicine, medicine, Humans, Female, Seroconversion, business, Q Fever, Algorithms, Netherlands
Abstract

Q fever is a zoonosis caused by Coxiella burnetii with a presentation ranging from asymptomatic seroconversion to possibly fatal chronic Q fever. The Netherlands faced an exceptionally large outbreak of Q fever from 2007 to 2010: 4026 human cases were notified, which makes it the largest Q fever outbreak ever reported. This outbreak, because of its size, allowed collecting a wide range of information on the natural history of Q fever, as well as on its transmission and clinical presentation. It also posed unprecedented public healthcare problems, especially for the concomitant management of the epizootic by veterinarian authorities and public health authorities, but also for the management of transmission risk related to blood donation. The need for cost efficient measures emerged rapidly because of the great number of infected individuals or at risk of infection, with a need for guidance on follow-up of acute Q fever patients, screening of pregnant women, or implementation of diagnostic algorithms. The acute outbreak was controlled by drastic veterinarian measures but chronic Q fever will remain a problem for the coming years.

Published
2013

21. À propos de 2 cas de diagnostic fluorescent de paludisme

Author

A. Bocquet, B. Nemoz, C. Dard, Claire Wintenberger, C. Dumestre-Peyrard, and C. Garnaud

Subjects
Gastroenterology, Internal Medicine
Abstract

Introduction En immunofluorescence, un aspect particulier de fluorescence des anticorps anti-nucleaires (AAN) est retrouve dans les cas de paludisme aigu a Plasmodium falciparum ou de splenomegalie palustre hyperimmune. Elle associe une fluorescence diffuse cytoplasmique, une fluorescence perinucleaire et un aspect mouchete du noyau. Observation Mme A., 42 ans, sans antecedents hormis des crises palustres durant l’enfance, presente une fievre, des frissons et une alteration de l’etat general alors qu’elle n’est pas retournee au Cameroun ou n’a pas voyage a l’etranger depuis 4 ans. Son examen clinique est sans particularite avec une absence d’adenomegalie ou d’hepatosplenomegalie. La biologie retrouve alors une anemie a 99 g/L et une thrombopenie a 86 G/L. L’antigenemie P. falciparum est positive mais il n’existe pas de parasitemie. Finalement, une fluorescence atypique des anticorps antinucleaires compatibles avec un paludisme a P. falciparum et la presence de gametocytes permettent de porter le diagnostic. M. C., 27 ans, Guineen d’origine, ayant pour principal antecedent des acces palustres a repetition depuis l’âge de 8 ans, presente un tableau de cephalees febriles, myalgies, nausees et douleurs abdominales. Tableau clinique identique a ces acces palustres anterieurs alors qu’il n’a pas voyage ou n’est pas sorti de France depuis 3 ans. Il ne presente pas de splenomegalie clinique et son bilan biologique retrouve une parasitemie a P. falciparum a 0,6 %. Parallelement, la fluorescence des AAN est typique de celle decrite dans les cas de splenomegalie palustre hyperimmune. Discussion Dans les deux cas presentes, le diagnostic de paludisme a ete difficile a porter compte tenu de l’absence de voyage recent en zone d’endemie palustre, d’autant plus que pour une patiente la parasitemie est negative. La fluorescence particuliere des AAN lors d’une infection a P. falciparum peut donc representer une aide importante au diagnostic. De plus, alors que cette fluorescence a ete essentiellement observee dans des formes de splenomegalie hyperimmune, les deux cas rapportes ne presentent pas ce diagnostic, meme s’il s’agit d’une forme chronique de paludisme. Conclusion La fluorescence particuliere des anticorps antinucleaires peut etre une aide diagnostique importante concernant les cas de paludisme chronique sans la presence obligatoire de splenomegalie palustre hyperimmune associee.

Published
2016
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22. [Suspicion of meningitis: evaluation of the management in the emergency unit]

Author

Sabine, Lautaret, Stéphane, Gennai, Elodie, Sellier, Claire, Wintenberger, Patrice, François, Françoise, Carpentier, and Patricia, Pavese

Subjects
Adult, Male, Humans, Female, Emergencies, Middle Aged, Emergency Service, Hospital, Aged, Meningitis, Bacterial, Retrospective Studies
Abstract

Bacterial meningitis is a diagnosis and therapeutic emergency. It is associated with high morbidity and mortality. The objective was to evaluate the management of suspicion of meningitis in an emergency unit, following the update of recommendations.A retrospective observational study was conducted between 1st January and 30th June 2009 in the emergency unit of Grenoble University Hospital. Inclusion criteria were: patient aged 15 years and 3 months or older with suspicion of meningitis (fever in the last 24 hours with the presence of at least one meningeal or neurological clinical sign), for whom a lombar puncture was realized in the 48 hours following the admission. Two infectious disease specialists independently evaluated the management of these patients in the emergency unit.Sixty-eight patients were included. Median time of the lombar puncture was 5.5 hours after admission [25-75 percentiles, 3.7-8,9]. Median time for antibiotic administration was 6 hours after admission [25-75 percentiles, 3.3-8.75]. Lactate prescription was stable during the study period (P=0.58) whereas procalcitonin prescription increased significantly (P=0.02). The realization of a brain scanner before the lumbar puncture was associated with a significant delay in the realization of the lumbar puncture (P0.001), and was not associated with a delay in the prescription and administration of antimicrobial treatment. According to the infectious disease specialists, an antimicrobial treatment was recommended for 37 patients (54.4%); and 35 of them (94.6%) received an antibiotic in the emergency department. Dosage of ceftriaxone complied with recommendations in 17.8% of cases. A brain scanner was recommended for 33 patients and realized for 25 among them (75.8%). Ten patients (28.6%) had a brain scanner whereas it was not recommended.Time management was in accordance with those found in previous studies, although higher than those recommended. Consequently it should be reduced. All professionals should be concerned. Staff training and writing of protocols are necessary (especially for the treatment and the brain scanner indications).

Published
2011

24. Réhospitalisations à sept jours des patients admis depuis les urgences pour un motif médical : prévalence, caractéristiques et facteurs associés

Author

Manuel, Aldric, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and Claire Wintenberger

Subjects
Réhospitalisation non programmée, Service d’accueil des urgences, Durée de séjour, Qualité des soins, Réhospitalisation précoce, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Seven-day readmission rate (7DR) is a quality of care indicator for the healthcare provided by hospitals. The main objective of this study is to describe the index stays (IS), the related 7DR, and search for risk factors of early readmissions. A retrospective observational study was conducted at Grenoble Alpes teaching hospital in 2017. The patients admitted via the emergency department for medical conditions were included when they met the criteria of the ministerial indicator. The medical and demographic data of the patients and the calendar and organizational characteristics of the stays were collected. The planned or unplanned character of the 7DR was sought. Seven thousand and twenty IS were included, of which 355 (5.06%) were followed by a 7DR. One hundred and fourteen (32%) were planned. Risk factors for an unplanned 7DR were: an age of 75 years or older (57.26% vs. 44.59%, p

Published
2018

25. Description des modalités d’adressage des patients admis dans un service d’accueil des urgences adultes avec un diagnostic final de grippe au cours de l’épidémie 2016-2017

Author

Miallier, Juliette, Cribier, Charles, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), and Claire Wintenberger

Subjects
Médecine générale, Continuité des soins, Grippe, Service d'accueil des urgences, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

AIM: To describe addressing modalities of patients with afterward influenza diagnosis in the adult emergency department of the Grenoble university hospital, and identify patterns in patients’ characteristics and based on time of admission. METHOD: Single-center prospective observational study. Patients with clinical or biological influenza diagnosis were included. We collected patients’ characteristics, addressing modalities and calendar factors. RESULTS: Four hundred and three emergency admissions have led to influenza diagnosis. One hundred and seventeen patients were admitted following medical advice. Patients older than 65 and with at least one clinical criterion for hospitalization were associated with medical addressing (relative risks: 1.52 [IC95% 1.2-3.2] and 2.16 [IC95% 1.7-6]). Weekend or public holidays admissions were associated with medical addressing absence (relative risks: 0,53 [IC95% 0,22-0,63] et 0,74 [IC95% 0,39-0,86]). Medical addressing was associated with afterward hospitalization (p < 0.01). CONCLUSION: During the 2016-2017 winter influenza epidemic, in this center, calendar factors (weekends, public holidays) were associated with less medical addressing before patients’ with influenza diagnosis emergency department admission. These results show the continuity of ambulatory care importance during epidemic periods.; OBJECTIF : Décrire les modalités d’adressage des patients admis au service des urgences adultes du centre hospitalier universitaire de Grenoble avec un diagnostic de grippe posé au décours, et rechercher une association avec les caractéristiques des patients et des facteurs calendaires. METHODE : Etude unicentrique prospective descriptive. Inclusion des patients ayant un diagnostic clinique ou virologique de grippe au décours de leur séjour. Recueil des caractéristiques des patients, des modalités d’adressage et de leur jour d’admission. RESULTATS : Quatre-cent-trois passages aux urgences ont conduit au diagnostic de grippe. Cent-soixante-dix-sept patients étaient adressés suite à un avis médical. Un âge supérieur à 65 ans et le fait de présenter au moins un critère clinique motivant l’hospitalisation étaient associés au fait d’avoir bénéficié d’un adressage médical (risques relatifs : 1,52 [IC95% 1,2-3,2] et 2,16 [IC95% 1,7-6]). Une admission pendant le weekend ou les vacances scolaires était associée au fait de ne pas avoir bénéficié d’adressage médical (risques relatifs : 0,53 [IC95% 0,22-0,63] et 0,74 [IC95% 0,39-0,86]). Le fait d’avoir été adressé par un médecin était associé à une hospitalisation au décours (p < 0,01). CONCLUSION : Au cours de l’épidémie grippale de l’hiver 2016-2017, dans ce centre, des facteurs calendaires (weekends, vacances scolaires) étaient associés à moins d’adressage médical préalable à une admission aux urgences chez les patients ayant un diagnostic de grippe au décours. Ces résultats montrent l’importance de la continuité des soins primaires ambulatoires en période épidémique.

Published
2018

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