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1. The natriuretic peptide receptor agonist osteocrin disperses Pseudomonas aeruginosa biofilm

Author

Melissande Louis, Ali Tahrioui, Courtney J. Lendon, Thomas Clamens, Jérôme Leprince, Benjamin Lefranc, Eric Kipnis, Teddy Grandjean, Emeline Bouffartigues, Magalie Barreau, Florian Defontaine, Pierre Cornelis, Marc G.J. Feuilloley, Nicholas J. Harmer, Sylvie Chevalier, and Olivier Lesouhaitier

Subjects
Biofilm, Natriuretic peptides, Osteocrin, h-NPR-C, Bacterial adaptation, Bacterial sensor, Biotechnology, TP248.13-248.65, Microbiology, QR1-502
Abstract

Biofilms are highly tolerant to antimicrobials and host immune defense, enabling pathogens to thrive in hostile environments. The diversity of microbial biofilm infections requires alternative and complex treatment strategies. In a previous work we demonstrated that the human Atrial Natriuretic Peptide (hANP) displays a strong anti-biofilm activity toward Pseudomonas aeruginosa and that the binding of hANP by the AmiC protein supports this effect. This AmiC sensor has been identified as an analog of the human natriuretic peptide receptor subtype C (h-NPRC). In the present study, we evaluated the anti-biofilm activity of the h-NPRC agonist, osteocrin (OSTN), a hormone that displays a strong affinity for the AmiC sensor at least in vitro. Using molecular docking, we identified a pocket in the AmiC sensor that OSTN reproducibly docks into, suggesting that OSTN might possess an anti-biofilm activity as well as hANP. This hypothesis was validated since we observed that OSTN dispersed established biofilm of P. aeruginosa PA14 strain at the same concentrations as hANP. However, the OSTN dispersal effect is less marked than that observed for the hANP (−61% versus −73%). We demonstrated that the co-exposure of P. aeruginosa preformed biofilm to hANP and OSTN induced a biofilm dispersion with a similar effect to that observed with hANP alone suggesting a similar mechanism of action of these two peptides. This was confirmed by the observation that OSTN anti-biofilm activity requires the activation of the complex composed by the sensor AmiC and the regulator AmiR of the ami pathway. Using a panel of both P. aeruginosa laboratory reference strains and clinical isolates, we observed that the OSTN capacity to disperse established biofilms is highly variable from one strain to another. Taken together, these results show that similarly to the hANP hormone, OSTN has a strong potential to be used as a tool to disperse P. aeruginosa biofilms.

Published
2023
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2. Antibiotic-related gut dysbiosis induces lung immunodepression and worsens lung infection in mice

Author

Rodrigue Dessein, Marvin Bauduin, Teddy Grandjean, Rémi Le Guern, Martin Figeac, Delphine Beury, Karine Faure, Christelle Faveeuw, Benoit Guery, Philippe Gosset, and Eric Kipnis

Subjects
Antibiotics, Dysbiosis, Pseudomonas aeruginosa, Murine model, Flt3-ligand, Fecal microbial transplant, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Gut dysbiosis due to the adverse effects of antibiotics affects outcomes of lung infection. Previous murine models relied on significant depletion of both gut and lung microbiota, rendering the analysis of immune gut-lung cross-talk difficult. Here, we study the effects of antibiotic-induced gut dysbiosis without lung dysbiosis on lung immunity and the consequences on acute P. aeruginosa lung infection. Methods C57BL6 mice received 7 days oral vancomycin-colistin, followed by normal regimen or fecal microbial transplant or Fms-related tyrosine kinase 3 ligand (Flt3-Ligand) over 2 days, and then intra-nasal P. aeruginosa strain PAO1. Gut and lung microbiota were studied by next-generation sequencing, and lung infection outcomes were studied at 24 h. Effects of vancomycin-colistin on underlying immunity and bone marrow progenitors were studied in uninfected mice by flow cytometry in the lung, spleen, and bone marrow. Results Vancomycin-colistin administration induces widespread cellular immunosuppression in both the lung and spleen, decreases circulating hematopoietic cytokine Flt3-Ligand, and depresses dendritic cell bone marrow progenitors leading to worsening of P. aeruginosa lung infection outcomes (bacterial loads, lung injury, and survival). Reversal of these effects by fecal microbial transplant shows that these alterations are related to gut dysbiosis. Recombinant Flt3-Ligand reverses the effects of antibiotics on subsequent lung infection. Conclusions These results show that gut dysbiosis strongly impairs monocyte/dendritic progenitors and lung immunity, worsening outcomes of P. aeruginosa lung infection. Treatment with a fecal microbial transplant or immune stimulation by Flt3-Ligand both restore lung cellular responses to and outcomes of P. aeruginosa following antibiotic-induced gut dysbiosis.

Published
2020
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3. Pseudomonas aeruginosa Biofilm Dispersion by the Human Atrial Natriuretic Peptide

Author

Mélissande Louis, Thomas Clamens, Ali Tahrioui, Florie Desriac, Sophie Rodrigues, Thibaut Rosay, Nicholas Harmer, Suraya Diaz, Magalie Barreau, Pierre‐Jean Racine, Eric Kipnis, Teddy Grandjean, Julien Vieillard, Emeline Bouffartigues, Pierre Cornelis, Sylvie Chevalier, Marc G. J. Feuilloley, and Olivier Lesouhaitier

Subjects
ami pathway, antibiotics, bacterial adaptation, bacterial sensor, biofilm dispersion, hANP, Science
Abstract

Abstract Pseudomonas aeruginosa biofilms cause chronic, antibiotic tolerant infections in wounds and lungs. Numerous recent studies demonstrate that bacteria can detect human communication compounds through specific sensor/receptor tools that modulate bacterial physiology. Consequently, interfering with these mechanisms offers an exciting opportunity to directly affect the infection process. It is shown that the human hormone Atrial Natriuretic Peptide (hANP) both prevents the formation of P. aeruginosa biofilms and strongly disperses established P. aeruginosa biofilms. This hANP action is dose‐dependent with a strong effect at low nanomolar concentrations and takes effect in 30–120 min. Furthermore, although hANP has no antimicrobial effect, it acts as an antibiotic adjuvant. hANP enhances the antibiofilm action of antibiotics with diverse modes of action, allowing almost full biofilm eradication. The hANP effect requires the presence of the P. aeruginosa sensor AmiC and the AmiR antiterminator regulator, indicating a specific mode of action. These data establish the activation of the ami pathway as a potential mechanism for P. aeruginosa biofilm dispersion. hANP appears to be devoid of toxicity, does not enhance bacterial pathogenicity, and acts synergistically with antibiotics. These data show that hANP is a promising powerful antibiofilm weapon against established P. aeruginosa biofilms in chronic infections.

Published
2022
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4. Brief summary of French guidelines for the prevention, diagnosis and treatment of hospital-acquired pneumonia in ICU

Author

Marc Leone, Lila Bouadma, Bélaïd Bouhemad, Olivier Brissaud, Stéphane Dauger, Sébastien Gibot, Sami Hraiech, Boris Jung, Eric Kipnis, Yoann Launey, Charles-Edouard Luyt, Dimitri Margetis, Fabrice Michel, Djamel Mokart, Philippe Montravers, Antoine Monsel, Saad Nseir, Jérôme Pugin, Antoine Roquilly, Lionel Velly, Jean-Ralph Zahar, Rémi Bruyère, Gérald Chanques, ADARPEF, and GFRUP

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The French Society of Anaesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit. The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. Results The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, post-operative and paediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Conclusions HAP should be prevented by a standardised multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram-negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli.

Published
2018
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5. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

Author

Maïté Garrouste-Orgeas, Cécile Flahault, Léonor Fasse, Stéphane Ruckly, Nora Amdjar-Badidi, Laurent Argaud, Julio Badie, Amélie Bazire, Naike Bige, Eric Boulet, Lila Bouadma, Cédric Bretonnière, Bernard Floccard, Alain Gaffinel, Xavier de Forceville, Hubert Grand, Rebecca Halidfar, Olfa Hamzaoui, Mercé Jourdain, Paul-Henri Jost, Eric Kipnis, Audrey Large, Alexandre Lautrette, Olivier Lesieur, Virginie Maxime, Emmanuelle Mercier, Jean Paul Mira, Yannick Monseau, Erika Parmentier-Decrucq, Jean-Philippe Rigaud, Antoine Rouget, François Santoli, Georges Simon, Fabienne Tamion, Nathalie Thieulot-Rolin, Marina Thirion, Sandrine Valade, Isabelle Vinatier, Christel Vioulac, Sebastien Bailly, and Jean-François Timsit

Subjects
ICU diary, Intensive care unit, Stress disorders, post-traumatic, Family, Anxiety, Medicine (General), R5-920
Abstract

Abstract Background Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient’s story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death. Methods A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary. Discussion This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay. Trial registration ClinicalTrial.gov, ID: NCT02519725 . Registered on 13 July 2015.

Published
2017
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6. Inflammasomes in Tissue Damages and Immune Disorders After Trauma

Author

Perrine Bortolotti, Emmanuel Faure, and Eric Kipnis

Subjects
inflammasome, trauma, DAMP, inflammation, immunosuppression, Immunologic diseases. Allergy, RC581-607
Abstract

Trauma remains a leading cause of death worldwide. Hemorrhagic shock and direct injury to vital organs are responsible for early mortality whereas most delayed deaths are secondary to complex pathophysiological processes. These processes result from imbalanced systemic reactions to the multiple aggressions associated with trauma. Trauma results in the uncontrolled local and systemic release of endogenous mediators acting as danger signals [damage-associated molecular patterns (DAMPs)]. Their recognition by the innate immune system triggers a pro-inflammatory immune response paradoxically associated with concomitant immunosuppression. These responses, ranging in intensity from inappropriate to overwhelming, promote the propagation of injuries to remote organs, leading to multiple organ failure and death. Some of the numerous DAMPs released after trauma trigger the assembly of intracellular multiprotein complexes named inflammasomes. Once activated by a ligand, inflammasomes lead to the activation of a caspase. Activated caspases allow the release of mature forms of interleukin-1β and interleukin-18 and trigger a specific pro-inflammatory cell death termed pyroptosis. Accumulating data suggest that inflammasomes, mainly NLRP3, NLRP1, and AIM2, are involved in the generation of tissue damage and immune dysfunction after trauma. Following trauma-induced DAMP(s) recognition, inflammasomes participate in multiple ways in the development of exaggerated systemic and organ-specific inflammatory response, contributing to organ damage. Inflammasomes are involved in the innate responses to traumatic brain injury and contribute to the development of acute respiratory distress syndrome. Inflammasomes may also play a role in post-trauma immunosuppression mediated by dysregulated monocyte functions. Characterizing the involvement of inflammasomes in the pathogenesis of post-trauma syndrome is a key issue as they may be potential therapeutic targets. This review summarizes the current knowledge on the roles of inflammasomes in trauma.

Published
2018
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7. Distinct immune response in two MERS-CoV-infected patients: can we go from bench to bedside?

Author

Emmanuel Faure, Julien Poissy, Anne Goffard, Clement Fournier, Eric Kipnis, Marie Titecat, Perinne Bortolotti, Laura Martinez, Sylvain Dubucquoi, Rodrigue Dessein, Philippe Gosset, Daniel Mathieu, and Benoit Guery

Subjects
Medicine, Science
Abstract

One year after the occurrence of the first case of infection by the Middle East Respiratory Syndrome coronavirus (MERS-CoV) there is no clear consensus on the best treatment to propose. The World Health Organization, as well as several other national agencies, are still working on different clinical approaches to implement the most relevant treatment in MERS-CoV infection. We compared innate and adaptive immune responses of two patients infected with MERS-CoV to understand the underlying mechanisms involved in the response and propose potential therapeutic approaches. Broncho-alveolar lavage (BAL) of the first week and sera of the first month from the two patients were used in this study. Quantitative polymerase chain reaction (qRTPCR) was performed after extraction of RNA from BAL cells of MERS-CoV infected patients and control patients. BAL supernatants and sera were used to assess cytokines and chemokines secretion by enzyme-linked immunosorbent assay. The first patient died rapidly after 3 weeks in the intensive care unit, the second patient still recovers from infection. The patient with a poor outcome (patient 1), compared to patient 2, did not promote type-1 Interferon (IFN), and particularly IFNα, in response to double stranded RNA (dsRNA) from MERS-CoV. The absence of IFNα, known to promote antigen presentation in response to viruses, impairs the development of a robust antiviral adaptive Th-1 immune response. This response is mediated by IL-12 and IFNγ that decreases viral clearance; levels of both of these mediators were decreased in patient 1. Finally, we confirm previous in vitro findings that MERS-CoV can drive IL-17 production in humans. Host recognition of viral dsRNA determines outcome in the early stage of MERS-CoV infection. We highlight the critical role of IFNα in this initial stage to orchestrate a robust immune response and bring substantial arguments for the indication of early IFNα treatment during MERS-CoV infection.

Published
2014
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8. Monitoring in the Intensive Care

Author

Eric Kipnis, Davinder Ramsingh, Maneesh Bhargava, Erhan Dincer, Maxime Cannesson, Alain Broccard, Benoit Vallet, Karim Bendjelid, and Ronan Thibault

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient’s hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined “goal directed therapy.” On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings.

Published
2012
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9. Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial

Author

Audrey De Jong, Anne Bignon, François Stephan, Thomas Godet, Jean-Michel Constantin, Karim Asehnoune, Aude Sylvestre, Juliette Sautillet, Raiko Blondonnet, Martine Ferrandière, Philippe Seguin, Sigismond Lasocki, Amélie Rollé, Pierre-Marie Fayolle, Laurent Muller, Emmanuel Pardo, Nicolas Terzi, Séverin Ramin, Boris Jung, Paer-Selim Abback, Philippe Guerci, Benjamine Sarton, Hadrien Rozé, Claire Dupuis, Joel Cousson, Marion Faucher, Virginie Lemiale, Bernard Cholley, Gerald Chanques, Fouad Belafia, Helena Huguet, Emmanuel Futier, Elie Azoulay, Nicolas Molinari, Samir Jaber, AUDREY DE JONG, ANNE BIGNON, FRANÇOIS STEPHAN, THOMAS GODET, JEAN-MICHEL CONSTANTIN, KARIM ASEHNOUNE, AUDE SYLVESTRE, JULIETTE SAUTILLET, RAIKO BLONDONNET, MARTINE FERRANDIERE, PHILIPPE SEGUIN, SIGISMOND LASOCKI, AMELIE ROLLE, PIERRE-MARIE FAYOLLE, LAURENT MULLER, EMMANUEL PARDO, NICOLAS TERZI, SEVERIN RAMIN, BORIS JUNG, PAER-SELIM ABBACK, PHILIPPE GUERCI, BENJAMINE SARTON, HADRIEN ROZE, CLAIRE DUPUIS, JOEL COUSSON, MARION FAUCHER, VIRGINIE LEMIALE, BERNARD CHOLLEY, GERALD CHANQUES, FOUAD BELAFIA, HELENA HUGUET, EMMANUEL FUTIER, CLAUDINE GNIADEK, AURELIE VONARB, ALBERT PRADES, CARINE JAILLET, XAVIER CAPDEVILA, JONATHAN CHARBIT, THIBAUT GENTY, SAIDA REZAIGUIA-DELCLAUX, AUDREY IMBERT, CATHERINE PILORGE, ROMAN CALYPSO, ASTRID BOUTEAU-DURAND, MICHEL CARLES, HOSSEN MEHDAOUI, BERTRAND SOUWEINE, LAURE CALVET, MATTHIEU JABAUDON, BENJAMIN RIEU, CLARA CANDILLE, FLORIAN SIGAUD, BEATRICE RIU, LAURENT PAPAZIAN, SABINE VALERA, DJAMEL MOKART, LAURENT CHOW CHINE, MAGALI BISBAL, CAMILLE POULIQUEN, JEAN-MANUEL DE GUIBERT, MAXIME TOURRET, DAMIEN MALLET, MARC LEONE, LAURENT ZIELESKIEWICZ, JEANNE COSSIC, MONA ASSEFI, ELODIE BARON, CYRIL QUEMENEUR, ANTOINE MONSEL, MATTHIEU BIAIS, ALEXANDRE OUATTARA, ELINE BONNARDEL, SIMON MONZIOLS, MARTIN MAHUL, JEAN-YVES LEFRANT, CLAIRE ROGER, SABER BARBAR, FABIEN LAMBIOTTE, PIEHR SAINT-LEGER, CATHERINE PAUGAM, JULIEN POTTECHER, PIERRE-OLIVIER LUDES, LUCIE DARRIVERE, MARC GARNIER, ERIC KIPNIS, GILLES LEBUFFE, MATTHIAS GAROT, JEREMY FALCONE, BENJAMIN CHOUSTERMAN, MAGALI COLLET, ETIENNE GAYAT, JEAN DELLAMONICA, WILLY-SERGE MFAM, EVELINA OCHIN, MOHAMED NEBLI, NEJLA TILOUCHE, BENJAMIN MADEUX, DAVID BOUGON, YASSIR AARAB, FANNY GARNIER, ELIE AZOULAY, NICOLAS MOLINARI, and SAMIR JABER

Subjects
Pulmonary and Respiratory Medicine
Published
2023
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10. Progressive in vivo development of resistance to cefiderocol in Pseudomonas aeruginosa

Author

Mustafa Sadek, Rémi Le Guern, Eric Kipnis, Philippe Gosset, Laurent Poirel, Rodrigue Dessein, and Patrice Nordmann

Subjects
Microbiology (medical), Infectious Diseases, General Medicine
Abstract

We report in vivo development of cefiderocol (FDC) resistance among four sequential Pseudomonas aeruginosa clinical isolates ST244 recovered from a single patient, without exposure to FDC, which raises concern about the effectiveness of this novel drug. The first recovered P. aeruginosa isolate (P-01) was susceptible to FDC (2 μg/mL), albeit this MIC value was higher than that of a wild-type P. aeruginosa (0.12–0.25 μg/ml). The subsequent isolated strains (P-02, P-03, P-04) displayed increasing levels of FDC MICs (8, 16, and 64 μg/ml, respectively). Those isolates also showed variable and gradual increasing levels of resistance to most β-lactams tested in this study. Surprisingly, no acquired β-lactamase was identified in any of those isolates. Whole-genome sequence analysis suggested that this resistance was driven by multifactorial mechanisms including mutational changes in iron transporter proteins associated with FDC uptake, ampC gene overproduction, and mexAB-oprM overexpression. These findings highlight that a susceptibility testing to FDC must be performed prior to any prescription.

Published
2022
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12. Colonization resistance against multi-drug-resistant bacteria: a narrative review

Author

Rodrigue Dessein, Y. Karaca, R. Le Guern, P. Gosset, Eric Kipnis, Sarah Stabler, Karine Faure, Emmanuel Faure, Teddy Grandjean, and Muriel Pichavant

Subjects
Microbiology (medical), biology, Multi drug resistant bacteria, business.industry, medicine.drug_class, Exogenous bacteria, Antibiotics, General Medicine, Colonisation resistance, Gut flora, Antimicrobial, biology.organism_classification, digestive system, Anti-Bacterial Agents, Gastrointestinal Microbiome, Microbiology, Infectious Diseases, Pharmaceutical Preparations, Drug Resistance, Multiple, Bacterial, Dysbiosis, Humans, Antimicrobial stewardship, Medicine, Colonization, business
Abstract

Summary Colonization resistance by gut microbiota is a fundamental phenomenon in infection prevention and control. Hospitalized patients may be exposed to multi-drug-resistant bacteria when hand hygiene compliance among healthcare workers is not adequate. An additional layer of defence is provided by the healthy gut microbiota, which helps clear the exogenous bacteria and acts as a safety net when hand hygiene procedures are not followed. This narrative review focuses on the role of the gut microbiota in colonization resistance against multi-drug-resistant bacteria, and its implications for infection control. The review discusses the underlying mechanisms of colonization resistance (direct or indirect), the concept of resilience of the gut microbiota, the link between the antimicrobial spectrum and gut dysbiosis, and possible therapeutic strategies. Antimicrobial stewardship is crucial to maximize the effects of colonization resistance. Avoiding unnecessary antimicrobial therapy, shortening the antimicrobial duration as much as possible, and favouring antibiotics with low anti-anaerobe activity may decrease the acquisition and expansion of multi-drug-resistant bacteria. Even after antimicrobial therapy, the resilience of the gut microbiota often occurs spontaneously. Spontaneous resilience explains the existence of a window of opportunity for colonization of multi-drug-resistant bacteria during or just after antimicrobial therapy. Strategies favouring resilience of the gut microbiota, such as high-fibre diets or precision probiotics, should be evaluated.

Published
2021
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14. Answer to January 2022 Photo Quiz

Author

Kevin Sermet, Eric Kipnis, Claire Duployez, Frédéric Wallet, Rodrigue Dessein, and Rémi Le Guern

Subjects
Microbiology (medical), Photo Quiz
Published
2022

15. Influence of bacterial resistance on mortality in intensive care units: a registry study from 2000 to 2013 (IICU Study)

Author

M. Aupée, S. Glorion, J. L. Gérard, V. Bonnet, Jean-Luc Hanouz, Eric Kipnis, M.O. Fischer, Hervé Dupont, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Réanimations [CHU Amiens-Picardie], CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Lille, Service d'Anesthésie - Réanimation Chirurgicale [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, and Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)

Subjects
Adult, Male, Microbiology (medical), Cross infection, medicine.medical_specialty, medicine.drug_class, [SDV]Life Sciences [q-bio], Registry study, Antibiotics, Antibiotic resistance, Intensive care, Internal medicine, Drug Resistance, Bacterial, Epidemiology, medicine, Humans, Prospective Studies, Aged, Aged, 80 and over, Cross Infection, Bacteria, Icu mortality, business.industry, Bacterial Infections, General Medicine, Length of Stay, Middle Aged, Survival Analysis, Intensive Care Units, Infectious Diseases, Female, France, business
Abstract

International audience; Background: Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. Aim: To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. Methods: The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. Findings: The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant microorganisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 +/- 26 vs 29 +/- 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. Conclusion: Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient. (C) 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Published
2019
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16. Healthcare Associated Pneumonia in Intensive Care Unit

Author

Sami Hraiech, Jean-Ralph Zahar, Sébastien Gibot, Charles-Edouard Luyt, Antoine Roquilly, Gerald Chanques, Djamel Mokart, Lila Bouadma, Marc Leone, Dimitri Margetis, Fabrice Michel, Rémi Bruyère, Yoann Launey, Philippe Montravers, O. Brissaud, Stéphane Dauger, Saad Nseir, Antoine Monsel, Belaid Bouhemad, Lionel Velly, Jérôme Pugin, Eric Kipnis, Boris Jung, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut Hospitalier Universitaire Méditerranée Infection (IHU AMU), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'anesthésie réanimation chirurgicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service d'anesthésiologie et soins intensifs [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CIC Lille, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Biologie du Développement de Marseille (IBDM), Aix Marseille Université (AMU)-Collège de France (CdF)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation - soins continus (Centre hospitalier de Bourg-en-Bresse), Centre Hospitalier de Bourg-en-Bresse, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]

Subjects
[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Emergency Nursing, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 030228 respiratory system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Emergency Medicine, Medicine, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, 030212 general & internal medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2019
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17. Vascular Endothelial Damage in the Pathogenesis of Organ Injury in Severe COVID-19

Author

Antoine Rauch, Guillaume Lefèvre, Alain Duhamel, Anne Bauters, Eric Kipnis, Natacha Rousse, Senna Staessens, Pauline Varlet, Sophie Susen, Annabelle Dupont, Julien Labreuche, Bart Staels, Morgan Caplan, Flavien Vincent, Julien Poissy, Marc Lambert, Mickael Rosa, Mouhamed Moussa, Simon F. De Meyer, Julien Goutay, Karine Faure, Fanny Lassalle, Delphine Corseaux, Delphine Garrigue, Emmanuelle Jeanpierre, and Peter J. Lenting

Subjects
0301 basic medicine, Male, Pathology, medicine.medical_specialty, Endothelium, Critical Care, Multiple Organ Failure, 030204 cardiovascular system & hematology, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Tissue factor pathway inhibitor, medicine, Humans, Complement Activation, Liver injury, business.industry, SARS-CoV-2, Microcirculation, COVID-19, Thrombosis, Neutrophil extracellular traps, Immune dysregulation, Liver Failure, Acute, Middle Aged, medicine.disease, Complement system, Nucleosomes, 030104 developmental biology, medicine.anatomical_structure, Respiratory failure, Cytokines, Tumor necrosis factor alpha, Female, Endothelium, Vascular, Cardiology and Cardiovascular Medicine, business, Respiratory Insufficiency, Biomarkers
Abstract

Objective: Whether endotheliopathy only mirrors coronavirus disease 2019 (COVID-19) severity or plays an intrinsic role in microvascular thrombosis and organ failure remains unanswered. We assessed whether markers of endothelial damage and immune dysregulation were associated with organ failure, thrombus formation, and death. Approach and Results: Markers of endothelial damage (VWF:Ag [von Willebrand factor antigen], PAI-1 [plasminogen activator inhibitor-1], syndecan-1, TFPI [tissue factor pathway inhibitor], and soluble thrombomodulin), complement activation (C5a and C5b-9), cytokines (IL [interleukin]-6, TNF [tumor necrosis factor]-α, and IL-2R), and neutrophil extracellular traps (cell-free DNA, nucleosomes, and myeloperoxidase-DNA) were measured at intensive care unit admission in 82 patients with COVID-19. We also analyzed the histological composition of thrombi collected in critically ill living patients successfully weaned from extracorporeal membrane oxygenation. Beside respiratory failure, VWF:Ag, PAI-1, TFPI, and syndecan-1 were independently associated with liver injury and multiorgan failure development, underlining the direct role of endotheliopathy in organ failure. Nucleosomes were also associated with liver injury, multiorgan failure, and death which occurred in 38%, 60%, and 27% of patients, respectively. Moreover, dysregulated immune response including cytokines, complement, and neutrophil extracellular traps was associated with markers of endothelial damage, respiratory failure, and liver injury. COVID-19 thrombi retrieved from extracorporeal membrane oxygenation circuitry contained accumulation of neutrophils, VWF, and significantly higher amount of neutrophil extracellular traps when compared with non-COVID-19 thrombi. Conclusions: We provide new associative data supporting that endotheliopathy and dysregulated immune responses are involved in respiratory and liver failure through microvascular damage in patients with severe COVID-19.

Published
2021

18. Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia

Author

Charles Tacquard, Alexandre Mansour, Alexandre Godon, Julien Godet, Julien Poissy, Delphine Garrigue, Eric Kipnis, Sophie Rym Hamada, Paul Michel Mertes, Annick Steib, Mathilde Ulliel-Roche, Bélaïd Bouhemad, Maxime Nguyen, Florian Reizine, Isabelle Gouin-Thibault, Marie Charlotte Besse, Nived Collercandy, Stefan Mankikian, Jerrold H. Levy, Yves Gruel, Pierre Albaladejo, Sophie Susen, Anne Godier, P. Albaladejo, N. Blais, F. Bonhomme, A. Borel-Derlon, A. Cohen, J.-P. Collet, E. de Maistre, P. Fontana, D. Garrigue Huet, A. Godier, Y. Gruel, A. Godon, B. Ickx, S. Laporte, D. Lasne, J. Llau, G. Le Gal, T. Lecompte, S. Lessire, J.H. Levy, D. Longrois, S. Madi-Jebara, A. Mansour, M. Mazighi, P. Mismetti, P.E. Morange, S. Motte, F. Mullier, N. Nathan, P. Nguyen, G. Pernod, N. Rosencher, S. Roullet, P.M. Roy, S. Schlumberger, P. Sié, A. Steib, S. Susen, C.A. Tacquard, S. Testa, A. Vincentelli, P. Zufferey, CHU Strasbourg, CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Centre Hospitalier Universitaire [Grenoble] (CHU), Unité de Glycobiologie Structurale et Fonctionnelle (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Duke University [Durham], University Hospital of Strasbourg (Hopitaux Universitaires de Strasbourg-Direction de la Recherche Clinique et des Innovations), Université de Rennes (UR), Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Santé et de la Recherche Médicale (INSERM), and Jonchère, Laurent

Subjects
BMI, body mass index, [SDV]Life Sciences [q-bio], VTE, venous thromboembolism, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Interquartile range, 030212 general & internal medicine, anticoagulation, Original Research, Incidence (epidemiology), Hazard ratio, INR, international normalized ratio, Vitamin K antagonist, IPTW, inverse probability treatment weighting, ICU, intensive care unit, 3. Good health, Pulmonary embolism, [SDV] Life Sciences [q-bio], Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.drug_class, Critical Illness, Low molecular weight heparin, HPA, high dose prophylactic anticoagulation, 03 medical and health sciences, Internal medicine, medicine, Humans, CRRT, continuous renal replacement therapy, UFH, unfractionated heparin, APTT, activated partial thromboplastin time, Blood Coagulation, thrombosis, DOAC, direct oral anticoagulant, business.industry, SARS-CoV-2, Anticoagulants, COVID-19, Retrospective cohort study, VKA, vitamin K antagonist, medicine.disease, bleeding, HR, hazard ratio, LMWH, low molecular weight heparin, OR, odds ratio, 030228 respiratory system, COPD, chronic obstructive pulmonary disease, TC, thrombotic complication, business, ECMO, extracorporeal membrane oxygenation
Abstract

International audience; BACKGROUND: Because of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent. RESEARCH QUESTION: What is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC? STUDY DESIGN AND METHODS: All consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight. RESULTS: Of 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75). INTERPRETATION: High-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results.

Published
2021
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19. Classification and Regression Trees for Bacterial Vaginosis Diagnosis in Pregnant Women Based on High-Throughput Quantitative PCR

Author

Rodrigue Dessein, Teddy Grandjean, Gilles Brabant, Damien Subtil, Marvin Bauduin, Rémi Le Guern, Eric Kipnis, Aurore Loquet, Claire Duployez, CCSD, Accord Elsevier, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Institut de Microbiologie [CHRU Lille], Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Saint Vincent de Paul de Lille, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Lille, Santé Publique : épidémiologie et qualité des soins (EA 2694), Faculté de Médecine Henri Warembourg - Université de Lille-Centre d'Etudes et de Recherche en Informatique Médicale [Lille] (CERIM), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), and Groupe Hospitalier de l'Institut Catholique de Lille (GHICL)

Subjects
0301 basic medicine, Adult, medicine.medical_specialty, Real-Time Polymerase Chain Reaction, Asymptomatic, Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Humans, Pregnancy, Obstetrics, business.industry, Vaginosis, Bacterial, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, female genital diseases and pregnancy complications, 3. Good health, 030104 developmental biology, Real-time polymerase chain reaction, 030220 oncology & carcinogenesis, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Molecular Medicine, Regression Analysis, Female, Nugent score, Pregnant Women, Bacterial vaginosis, medicine.symptom, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business
Abstract

International audience; Bacterial vaginosis (BV) diagnosis in pregnancy is based on the Nugent score, which consists of semiquantitation of bacterial morphotypes. Limited data exist concerning molecular-based diagnosis in asymptomatic pregnant women. Using high-throughput quantitative PCR, 34 microorganisms were screened in asymptomatic pregnant women and compared with the Nugent score. Three-hundred and four vaginal samples had a Nugent score

Published
2021
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20. 2021 adaptation of the editorial policy of Anaesthesia Critical Care and Pain Medicine (ACCPM)

Author

Arthur James, Sylvain Ausset, Antoine G. Schneider, Emmanuel Lorne, Matthieu Boisson, Anaïs Caillard, Ruth Landau, Patrice Forget, Sorin J. Brull, Eric Kipnis, O. Brissaud, Morgan Le Guen, Francis Veyckemans, Antoine Rocquilly, Nicolas Mongardon, Sacha Rozencwajg, Lionel Bouvet, Marc-Olivier Fischer, Jean-Yves Lefrant, Alice Blet, Sophie Hamada, Armelle Nicolas-Robin, Sophie Bastide, Mark J. Peters, Hervé Quintard, Philippe Cuvillon, Jason A. Roberts, Frédéric J. Mercier, Anne Godier, Jean-Stéphane David, Xavier Capdevila, Matthieu Biais, Romain Pirracchio, Du Bin, Philippe Richebé, Arthur Le Gall, Olivier Joannes-Boyau, Kerstin Kolodzie, Jordi Rello, Paul Zetlaoui, Per-Arne Lönnqvist, Denis Frasca, Osama Abou Arab, Aude Carillon, Tomoko Fujii, Hervé Bouaziz, Thomas Clavier, Christophe Dadure, Sébastien Kerever, Stéphanie Sigaut, Matthieu Legrand, Rosanna Njeim, Dean Gopalan, Fanny Vardon Bounes, and Dan Benhamou

Subjects
medicine.medical_specialty, Critical Care, business.industry, Pain medicine, MEDLINE, Pain, General Medicine, Critical Care and Intensive Care Medicine, Anesthesiology and Pain Medicine, Anesthesiology, Medicine, Humans, Anesthesia, Adaptation (computer science), business, Intensive care medicine, Editorial Policies
Published
2021

21. High incidence of postoperative infections after pancreaticoduodenectomy: A need for perioperative anti-infectious strategies

Author

Gilles Lebuffe, R. Le Guern, C. Delpierre, Perrine Bortolotti, François-René Pruvot, Stéphanie Truant, Xavier Lenne, M. El Amrani, Eric Kipnis, A. Bignon, Le Guern, Rémi, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Institut de Microbiologie [CHRU Lille], Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 (GRITA), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 (CANTHER), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, and Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)

Subjects
medicine.medical_specialty, Cephalic pancreaticoduodenectomy, medicine.drug_class, medicine.medical_treatment, Antibiotics, 030230 surgery, Gastroenterology, Bile colonization, Pancreaticoduodenectomy, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, medicine, Humans, Surgical Wound Infection, Antibiotic prophylaxis, Prospective cohort study, business.industry, Incidence, Retrospective cohort study, Perioperative, Antibiotic Prophylaxis, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 3. Good health, Infectious Diseases, Antimicrobial prophylaxis, 030220 oncology & carcinogenesis, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, High incidence, Perioperative infection, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business, Complication, Surgical site infection
Abstract

Objectives Postoperative infections occur frequently after pancreaticoduodenectomy, especially in patients with bile colonization. Recommendations for perioperative anti-infectious treatment are lacking, and clinical practice is heterogenous. We have analyzed the effects of bile colonization and antibiotic prophylaxis on postoperative infection rates, types and therapeutic consequences. Methods Retrospective observational study in patients undergoing pancreaticoduodenectomy with intraoperative bile culture. Data on postoperative infections and non-infectious complications, bile cultures and antibiotic prophylaxis adequacy to biliary bacteria were collected. Results Among 129 patients, 53% had a positive bile culture and 23% had received appropriate antibiotic prophylaxis. Postoperative documented infection rate was over 40% in patients with or without bile colonization, but antibiotic therapy was more frequent in positive bile culture patients (77% vs. 57%, P = 0,008). The median duration of antibiotic therapy was 11 days and included a broad-spectrum molecule in 42% of cases. Two-thirds of documented postoperative infections involved one or more bacteria isolated in bile cultures, which was associated with a higher complication rate. While bile culture yielded Gram-negative bacilli (57%) and Gram-positive cocci (43%), fungal microorganisms were scarce. Adequate preoperative antibiotic prophylaxis according to bile culture was not associated with reduced infectious or non-infectious complication rates. Conclusion Patients undergoing pancreaticoduodenectomy experience a high rate of postoperative infections, often involving bacteria from perioperative bile culture when positive, with no preventive effect of an adequate preoperative antibiotic prophylaxis. Increased postoperative complications in patients with bile colonization may render necessary a perioperative antibiotic treatment targeting bile microorganisms. Further prospective studies are needed to improve the anti-infectious strategy in these patients.

Published
2021
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22. Bacteremia Due to Kosakonia cowanii in a Preterm Neonate

Author

Eric Kipnis, Rodrigue Dessein, Claire Duployez, Marie-Eve Edun-Renard, Rémi Le Guern, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Le Guern, Rémi, Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, and Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)

Subjects
Cefepime, medicine.medical_treatment, Context (language use), Gut flora, Microbiology, 03 medical and health sciences, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intensive care, Medicine, 030212 general & internal medicine, 030304 developmental biology, Bacteriological Techniques, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, 0303 health sciences, Kosakonia cowanii, biology, business.industry, Enterobacter, biology.organism_classification, medicine.disease, 3. Good health, Infectious Diseases, Amikacin, Bacteremia, Pediatrics, Perinatology and Child Health, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Prematurity, business, Central venous catheter, medicine.drug
Abstract

Objective Low-birthweight infants admitted to neonatal intensive care units are at high risk of hospital-acquired infections by opportunistic pathogens. The gut microbiota of preterm neonates lacks commensal bacteria providing a barrier against pathogens. We report a case of bacteremia due to Kosakonia cowanii in a preterm neonate. Case Report A female baby of 680 g was delivered through a cesarean-section at 28 weeks of gestation due to intrauterine growth retardation and fetal rhythm abnormalities. On day 27, two blood cultures grew gram-negative bacilli in a context of functional ileus. No reliable identification could be obtained using matrix assisted laser desorption ionization-time of flight, biochemical reactions with the VITEK 2 GN ID card, or 16S rDNA sequencing. K. cowanii was finally identified by gyrB sequencing. The source of infection may have been either the central venous catheter or translocation from the gut microbiota. Evolution was favorable after 14 days of cefepime (combined with amikacin for 5 days) and central venous catheter removal. Conclusion K. cowanii is a member of the Enterobacteriaceae family that was recently reclassified from the Enterobacter genus. Human infections due to K. cowanii are scarce and have mainly been associated with traumatic inoculation from plants or transient gut colonization. K. cowanii may be an underestimated opportunistic pathogen in susceptible populations such as preterm neonates.

Published
2020
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23. Antibiotic-related Gut Dysbiosis Induces Lung Immunodepression and Worsens Lung Infection

Author

Rodrigue Dessein, Marvin BAUDUIN, Teddy GRANDJEAN, Rémi LE GUERN, Martin FIGEAC, Delphine BEURY, Karine FAURE, Christelle FAVEEUW, Benoit GUERY, Philippe GOSSET, and Eric KIPNIS

Subjects
respiratory system
Abstract

BackgroundGut dysbiosis due to the adverse effects of antibiotics affects outcomes of lung infection. Previous murine models relied on significant depletion of both gut and lung microbiota, rendering the analysis of immune gut-lung cross-talk difficult.Here we study the effects of antibiotic-induced gut dysbiosis without lung dysbiosis on lung immunity and the consequences on acute P. aeruginosa lung infection.MethodsC57BL6 mice were administered 7 days oral vancomycin-colistin, modulated or not by fecal microbial transplant or exogenous hematopoietic cytokine, Fms-related tyrosine kinase 3 ligand (Flt3-Ligand), followed by intranasal P. aeruginosa strain PAO1. Gut and lung microbiota were studied by next-generation sequencing, and lung infection outcomes were studied at 24h. Effects of vancomycin-colistin on underlying immunity and bone marrow progenitors were studied in uninfected mice by flow cytometry in the lung, spleen, and bone marrow.ResultsVancomycin-colistin administration induces widespread cellular immunosuppression in both lung and spleen, decreases circulating hematopoietic cytokine Flt3-Ligand, and depresses dendritic cell bone marrow progenitors leading to worsening of P. aeruginosa lung infection outcomes (bacterial loads, lung injury and survival). Reversal of these effects by fecal microbial transplant shows that these alterations are related to gut dysbiosis. Recombinant Flt3-Ligand reverses the effects of antibiotics on subsequent lung infection. ConclusionsThese results show that gut dysbiosis strongly impairs monocyte/dendritic progenitors and lung immunity, worsening outcomes of P. aeruginosa lung infection. Treatment with a fecal microbial transplant or immune stimulation by Flt3-Ligand both restore lung cellular responses to and outcomes of P. aeruginosa following antibiotic-induced gut dysbiosis.

Published
2020
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24. Coagulation biomarkers are independent predictors of increased oxygen requirements in COVID‐19

Author

Julien Goutay, Emmanuelle Jeanpierre, Julien Poissy, Antoine Rauch, Marc Lambert, Sophie Susen, Morgan Caplan, Karine Faure, Leslie Charbonnier, Alain Duhamel, Fanny Lassalle, Julien Labreuche, Eric Kipnis, Aurelien Rohn, Annabelle Dupont, Peter J. Lenting, Delphine Garrigue, Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires (RNMCD - U1011), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Hémostase, Inflammation, Thrombose (HITH - U1176 Inserm - CHU Bicêtre), Université Paris-Sud - Paris 11 (UP11)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Glycobiologie Structurale et Fonctionnelle (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), ANR-16-IDEX-0004,ULNE,ULNE(2016), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Université de Lille, LillOA, ULNE - - ULNE2016 - ANR-16-IDEX-0004 - IDEX - VALID, and Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD)

Subjects
Male, [SDV]Life Sciences [q-bio], Comorbidity, 030204 cardiovascular system & hematology, Fibrinogen, Gastroenterology, Body Mass Index, 0302 clinical medicine, Patient Admission, Risk Factors, hemic and lymphatic diseases, Prevalence, Medicine, Platelet, Prospective Studies, Letter to the Editor, 2. Zero hunger, biology, Age Factors, Venous Thromboembolism, Hematology, Middle Aged, Thrombosis, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Coagulation, Female, Original Article, France, medicine.drug, circulatory and respiratory physiology, medicine.medical_specialty, SARS‐CoV2, Risk Assessment, Letter to the Editors, 03 medical and health sciences, Sex Factors, Von Willebrand factor, Internal medicine, Diabetes mellitus, von Willebrand Factor, Humans, Blood Coagulation, Factor VIII, business.industry, Oxygen Inhalation Therapy, Anticoagulants, COVID-19, Original Articles, medicine.disease, Oxygen, SARS-CoV2, biology.protein, Metabolic syndrome, business, Body mass index, Biomarkers
Abstract

International audience; Background :Hypercoagulability seems to contribute to SARS-CoV-2 pneumonia pathogenesis. However, age and metabolic syndrome are potential confounders when assessing the value of coagulation biomarkers’ prediction of COVID-19 outcomes. We assessed whether coagulation biomarkers, including factor VIII (FVIII) and von Willebrand factor (VWF) levels, measured at time of admission, were predictive of COVID-19 adverse outcomes irrespective of age and major comorbidities associated with metabolic syndrome.Methods :Blood was sampled at admission in 243 adult COVID-19 patients for analysis of coagulation biomarkers including FVIII and VWF on platelet-poor plasma. The association between baseline C-reactive protein (CRP), activated partial thromboplastin time ratio, prothrombin time ratio, D-dimers, fibrinogen, FVIII, VWF antigen (VWF:Ag), and FVIII/VWF:Ag ratio levels and adverse outcomes (increased oxygen requirements, thrombosis, and death at day 30) was assessed by regression analysis after adjustment on age, sex, body mass index (BMI), diabetes, and hypertension.Results :In univariable regression analysis increased CRP (subdistribution hazard ratio [SHR], 1.68; 95% confidence interval [CI], 1.26-2.23), increased fibrinogen (SHR, 1.32; 95% CI, 1.04-1.68), and decreased FVIII/VWF:Ag ratio (SHR, 0.70; 95% CI, 0.52-0.96) levels at admission were significantly associated with the risk of increased oxygen requirement during follow-up. Leucocytes (SHR, 1.36; 95% CI, 1.04-1.76), platelets (SHR,1.71; 95% CI, 1.11-2.62), D-dimers (SHR, 2.48; 95% CI, 1.66-3.78), and FVIII (SHR, 1.78; 95% CI, 1.17-2.68) were associated with early onset of thrombosis after admission. After adjustment for age, sex, BMI, hypertension, and diabetes, these associations were not modified.Conclusion :Coagulation biomarkers are early and independent predictors of increased oxygen requirement in COVID-19 patients.

Published
2020
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25. Malignant Leakage After Sleeve Gastrectomy: Endoscopic and Surgical Approach

Author

Jean-Baptiste Cazauran, Camille Marciniak, Robert Caiazzo, François Pattou, Julien Branche, Magalie Devienne, Maud Robert, Ninon Wallach, Eric Kipnis, Gregory Baud, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Élevages et territoires (UR ETCF), Centre national du machinisme agricole, du génie rural, des eaux et forêts (CEMAGREF), Hôpital Claude Huriez [Lille], CHU Lille, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), and Université Lille Nord (France)

Subjects
Gastric Fistula, Reoperation, Sleeve gastrectomy, Poor prognosis, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Fistula, [SDV]Life Sciences [q-bio], Gastric bypass, Gastric Bypass, Peritonitis, 030209 endocrinology & metabolism, Anastomotic Leak, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Gastrectomy, Medicine, Humans, Chronic, Retrospective Studies, Nutrition and Dietetics, Surgical approach, medicine.diagnostic_test, business.industry, medicine.disease, 3. Good health, Surgery, Endoscopy, Management, Obesity, Morbid, Stenosis, 030211 gastroenterology & hepatology, Laparoscopy, business, Leakage
Abstract

PURPOSE: Gastric leak occurs after sleeve gastrectomy (SG) in 2% of cases. Most staple-line disruptions (SLD) can be successfully treated with first-line endoscopic procedures. Less favorable situations may lead to more complex therapeutic strategies, like conversion to Roux-en-Y gastric bypass (RYGBP). The aim of our study is to predict the factors of endoscopic treatment failure and to assess the safety of conversion to RYGBP. METHODS: We included all patients treated in two centers of academic excellence (n = 100) between 2013 and 2017 who had a malignant SLD after SG. A "malignant" leakage met one of the following poor prognosis criteria suggested in the literature: unsuccessfully treated by the first-line endoscopic treatment; generalized peritonitis; anatomical anomalies; gastro-cutaneous or gastro-pleural fistula (GCF/GPF); or chronic leaks (\textgreater 4 weeks). RESULTS: No deaths occurred during the follow-up (20 ± 12 months). The endoscopy reported an anatomically abnormal gastric tube in 35 (35%) patients (stenosis [n = 21 (21%)], twist [n = 9 (9%)], or both [n = 5 (5%)]). We could maintain the SG in place in 92% of cases without stenosis, twist, or GCF/GPF. Conversion to RYGBP due to leakage was necessary in 37 (37%) patients. Stenosis, twist, or GCF/GPF significantly prevented healing in multivariate analysis (respectively: p = 0.020, OR = 0.17, and p \textless 0.001, OR = 0.07-logistic regression). CONCLUSION: Endoscopy is the treatment of choice for the management of chronic leaks after SG. The association of anatomical anomalies and GCF/GPF should lead to consideration of conversion to RYGBP.

Published
2020
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26. Association of transcription factor 7-like 2 gene (TCF7L2) polymorphisms with stress-related hyperglycaemia (SRH) in intensive care and resulting outcomes: The READIAB study

Author

A. Bignon, A. Elbaz, C. Vanbaelinghem, H. Abi Rached, Sébastien Preau, M. Jourdain, Eric Kipnis, Hélène Behal, François Machuron, Laurent Robriquet, Emmanuelle Jaillette, A. Ben Hamou, Alain Duhamel, S. Espiard, D. Du Cheyron, Fabienne Tamion, François Pattou, Arnaud Jannin, Benoit Voisin, Jean-Charles Preiser, Saad Nseir, Damien Thellier, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Unité de Glycobiologie Structurale et Fonctionnelle UMR 8576 (UGSF), Université de Lille-Institut National de la Recherche Agronomique (INRA)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation médicale [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de réanimation médicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Hôpital Provo, Centre Hospitalier Tourcoing, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Recherche translationnelle sur le diabète - U 1190 (RTD), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), and Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
Adult, Blood Glucose, Male, medicine.medical_specialty, Critical Care, Genotype, endocrine system diseases, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], education, 030209 endocrinology & metabolism, Type 2 diabetes, 030204 cardiovascular system & hematology, Logistic regression, Polymorphism, Single Nucleotide, law.invention, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Stress-related hyperglycaemia, law, Intensive care, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Genetic Predisposition to Disease, Intensive care unit, Prospective Studies, TCF7L2 polymorphism, Alleles, business.industry, Long-term mortality, Incidence (epidemiology), Diabetes, General Medicine, Middle Aged, medicine.disease, 3. Good health, Hyperglycemia, Cohort, Female, business, Transcription Factor 7-Like 2 Protein, TCF7L2
Abstract

International audience; Objective :The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose ≥ 11 mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. Methods :This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012–2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for < 48 h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded.Main results :The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB–G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P = 0.078): OR(per one T copy): 1.24, 95% CI: 0.98–1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P = 0.026), but was no longer significant at 1 year (P = 0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43–3.06; P < 0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32–2.28; P < 0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07–4.20; P = 0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71–2.96; P = 0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P = 0.72) or 1 year (P = 0.64).Conclusion :This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development.

Published
2020
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27. Clinical relevance of Clostridium bacteremia: An 8-year retrospective study

Author

Karine Faure, Marie Titecat, Claire Duployez, Rodrigue Dessein, Rémi Le Guern, Eric Kipnis, Caroline Loïez, Emmanuel Faure, Frédéric Wallet, Perrine Bortolotti, Sarah Stabler, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Bactériologie-Hygiène [CHRU Lille], Institut de Microbiologie [CHRU Lille], Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Univ. Lille, CHU Lille., Le Guern, Rémi, Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, and Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)

Subjects
Adult, Male, medicine.medical_specialty, Multivariate analysis, Clostridium perfringens, Clinical significance, Bacteremia, Clostridium infections, Hypothermia, Microbiology, Cohort Studies, 03 medical and health sciences, Clostridium, Blood culture contamination, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Medicine, Humans, Mortality, 030304 developmental biology, Aged, Retrospective Studies, 0303 health sciences, biology, 030306 microbiology, business.industry, Mortality rate, Retrospective cohort study, Middle Aged, Antimicrobial, biology.organism_classification, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 3. Good health, Anti-Bacterial Agents, Anaerobic bacteria, Infectious Diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business
Abstract

International audience; Clostridium spp. are recovered from 25% of the blood culture positive with anaerobes. However, the clinical relevance of Clostridium bacteremia has been controverted in the literature, particularly for C. perfringens. We aimed to evaluate the clinical relevance of Clostridium bacteremia, either due to C. perfringens or other Clostridium species, and to identify the risk factors of mortality in these patients. A retrospective cohort study was conducted from January 2010 to April 2018. All the patients with at least one blood culture positive with any Clostridium species were included. Eighty-one patients with a least one blood culture positive with any Clostridium species were included. Seventy patients (86.4%) fulfilled the criteria for clinically relevant bacteremia. Bacteremia due to C. perfringens tended to be less clinically relevant than other Clostridium species but this was not statistically significant (76% vs 91.2%, P = 0.09). In case of clinically relevant bacteremia, the 30-day mortality rate was 31.4%. In multivariate analysis, adequate empiric antimicrobial therapy was significantly associated with survival (P = 0.03). In conclusion, bacteremia due to C. perfringens or other Clostridium species is usually clinically relevant. This finding was also supported by an improved survival at 30 days when adequate empiric antimicrobial therapy was administered.

Published
2020
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28. Spontaneous decolonization during hospitalization in intensive care unit patients colonized by extended-spectrum beta-lactamase-producing Enterobacterales

Author

Saad Nseir, Eric Kipnis, A. El Kalioubie, Anahita Rouzé, Rodrigue Dessein, Caroline Loïez, Frédéric Wallet, R. Le Guern, Claire Duployez, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Pôle de Biologie Pathologie Génétique [CHU Lille], Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Université de Lille, CNRS, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 [CIIL], Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576, 425779|||Centre Hospitalier Régional Universitaire [Lille] [CHRU Lille], Recherche translationnelle : relations hôte-pathogènes - EA 7366, Centre d'Infection et d'Immunité de Lille (CIIL) - U1019 - UMR 9017, and Le Guern, Rémi

Subjects
Male, Microbiology (medical), medicine.medical_specialty, 2019-20 coronavirus outbreak, Frequency of occurrence, colonization, extended-spectrum beta-lactamase, infection control, critical care, contact precautions, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, 030501 epidemiology, beta-Lactamases, law.invention, 03 medical and health sciences, Enterobacteriaceae, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Enterobacterales, Humans, Infection control, Medicine, Aged, Retrospective Studies, Cross Infection, 0303 health sciences, 030306 microbiology, business.industry, Enterobacteriaceae Infections, Rectum, General Medicine, Middle Aged, Intensive care unit, 3. Good health, Hospitalization, Intensive Care Units, Infectious Diseases, Carriage, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Carrier State, Beta-lactamase, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, business
Abstract

International audience; This study aimed to analyse the frequency of occurrence of spontaneous decolonization in intensive care unit patients colonized by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) in order to assess the added value of continuing weekly ESBL-E rectal carriage screening in these patients. In total, 49,468 weekly rectal screening samples taken from 20,846 patients over 12 years were included. Among the 4280 ESBL-E carriers, only 109 patients (2.5%) could be considered decolonized at the end of their hospitalization with at least three consecutive negative samples. Overall, 7957 samples (16.1%) were requested for patients already identified as ESBL-E carriers. Avoiding unnecessary weekly screening following positive ESBL-E colonization results could decrease nursing and laboratory work loads.

Published
2020
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29. Une voie originale pour une voix originale

Author

Jean-Michel Constantin, Thomas Fuchs-Buder, Antoine G. Schneider, Jean-Stéphane David, Jason A. Roberts, Souhayl Dahmani, Vincent Laudenbach, Jean-François Brichant, Eric Kipnis, Olivier Joannes-Boyau, Jean-Pierre Tourtier, Emmanuel Lorne, Karim Asehnoune, Christophe Dadure, Alexandre Ouattara, Jean-Luc Hanouz, Laurie Tran, Emmanuel Marret, Thomas Geeraerts, Silvain Ausset, Romain Pirracchio, Philippe Cuvillon, Jean-Yves Lefrant, Anne Godier, Sébastien Pierre, Matthieu Biais, Xavier Capdevila, Thomas Lescot, Matthieu Legrand, Pierre Beaulieu, Beny Charbit, Morgan Le Guen, and Nicolas Mongardon

Subjects
Anesthesiology and Pain Medicine
Published
2019
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30. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

Author

Audrey Large, Eric Boulet, Fabienne Tamion, Jean-Philippe Rigaud, Jean Paul Mira, Marina Thirion, Olivier Lesieur, Isabelle Vinatier, Eric Kipnis, Paul-Henri Jost, Jean-François Timsit, Virginie Maxime, Lila Bouadma, Nathalie Thieulot-Rolin, Cécile Flahault, Sandrine Valade, Rebecca Halidfar, Cédric Bretonnière, Nora Amdjar-Badidi, Emmanuelle Mercier, Amélie Bazire, Christel Vioulac, Julio Badie, Yannick Monseau, Alexandre Lautrette, Mercé Jourdain, Hubert Grand, Stéphane Ruckly, Alain Gaffinel, François Santoli, Léonor Fasse, Sébastien Bailly, Olfa Hamzaoui, Georges Simon, Antoine Rouget, Xavier Forceville, Maité Garrouste-Orgeas, Erika Parmentier-Decrucq, Bernard Floccard, Laurent Argaud, and Naïke Bigé

Subjects
Time Factors, Health Status, health care facilities, manpower, and services, Medicine (miscellaneous), Anxiety, Hospital Anxiety and Depression Scale, Medical Records, law.invention, Stress Disorders, Post-Traumatic, ICU diary, Study Protocol, 0302 clinical medicine, Cost of Illness, law, Surveys and Questionnaires, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, Depression (differential diagnoses), lcsh:R5-920, Narration, Depression, Syndrome, Intensive care unit, Icu admission, Intensive Care Units, Mental Health, Research Design, Family Relations, France, medicine.symptom, lcsh:Medicine (General), post-traumatic, medicine.medical_specialty, Critical Care, Patients, 03 medical and health sciences, Memory, Intervention (counseling), medicine, Humans, In patient, Family, Intensive care medicine, Stress syndrome, business.industry, 030208 emergency & critical care medicine, Stress disorders, Quality of Life, business
Abstract

Background Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient’s story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death. Methods A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary. Discussion This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay. Trial registration ClinicalTrial.gov, ID: NCT02519725. Registered on 13 July 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2283-y) contains supplementary material, which is available to authorized users.

Published
2017
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31. The human NAIP-NLRC4-inflammasome senses the Pseudomonas aeruginosa T3SS inner-rod protein

Author

Marion Thepaut, Laura Monlezun, B. Guery, Eric Faudry, Eric Kipnis, Rodrigue Dessein, Teddy Grandjean, Anne Boucher, Université de Lille, Pathogenèse bactérienne et réponses cellulaires (PBRC), Biologie du Cancer et de l'Infection (BCI ), Institut National de la Santé et de la Recherche Médicale (INSERM)-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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), 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), and Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV)

Subjects
0301 basic medicine, Inflammasomes, THP-1 Cells, Interleukin-1beta, medicine.disease_cause, [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, Type three secretion system, Mice, 0302 clinical medicine, NLRC4, Type III Secretion Systems, Immunology and Allergy, Toll-like receptor, biology, Chemistry, Caspase 1, NOD-like receptor, Inflammasome, General Medicine, Neuronal Apoptosis-Inhibitory Protein, Innate Immunity, Salmonella enterica, Pseudomonas aeruginosa, Intercellular Signaling Peptides and Proteins, medicine.drug, Immunology, Microbiology, 03 medical and health sciences, Pathogen-associated microbial pattern, medicine, Animals, Humans, Pseudomonas Infections, Nod-like receptor, Macrophages, Calcium-Binding Proteins, Pathogen-Associated Molecular Pattern Molecules, biology.organism_classification, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Immunity, Innate, Toll-Like Receptor 2, CARD Signaling Adaptor Proteins, Toll-Like Receptor 4, 030104 developmental biology, bacteria, NAIP, Carrier Proteins, 030215 immunology
Abstract

While NLRC4-dependent sensing of intracellular Gram-negative pathogens such as Salmonella enterica serovar typhimurium is a beneficial host response, NLRC4-dependent sensing of the Pseudomonas aeruginosa type 3 secretion system (T3SS) has been shown to be involved in pathogenicity. In mice, different pathogen-associated microbial patterns are sensed by the combination of the NLRC4-inflammasome with different neuronal apoptosis inhibitory proteins (NAIPs). NAIP2 is involved in sensing PscI, an inner-rod protein of the P. aeruginosa T3SS. Surprisingly, only a single human NAIP (hNAIP) has been found. Moreover, there is no description of hNAIP-NLRC4 inflammasome recognition of T3SS inner-rod proteins in humans. Here, we show that the P. aeruginosa T3SS inner-rod protein PscI and needle protein PscF are both sensed by the hNAIP-NLRC4 inflammasome in human macrophages and PBMCs from healthy donors, allowing caspase-1 and IL-1β maturation and resulting in a robust inflammatory response. TLR4 and TLR2 are involved in redundantly sensing these two T3SS components.

Published
2017
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32. Clostridium ventriculi bacteremia following acute colonic pseudo-obstruction: A case report

Author

Malo Penven, Rémi Le Guern, Laure Marceau, Rodrigue Dessein, Perrine Bortolotti, Eric Kipnis, Agnès Wacrenier, Sophian Messaadi, Maud Fauquembergue, Karine Faure, Emmanuel Faure, Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de Pathologie [CHU Lille], Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de Microbiologie [CHRU Lille], Univ. Lille, CHU Lille., We thank Antonino Bongiovanni of the BICeL Facility for access to systems and technical advice. We thank Teddy Grandjean for technical help., and Le Guern, Rémi

Subjects
Male, Ogilvie syndrome, Perforation (oil well), Colonic Pseudo-Obstruction, Bacteremia, Microbiology, Sarcina ventriculi, 03 medical and health sciences, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, Humans, 030304 developmental biology, Aged, Clostridium, 0303 health sciences, Obligate, 030306 microbiology, business.industry, Clostridium ventriculi, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, digestive system diseases, Infectious Diseases, ANAEROBIC COCCUS, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Clostridium Infections, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business
Abstract

International audience; Clostridium ventriculi (formerly Sarcina ventriculi) is a Gram-positive, obligate anaerobic coccus. Human infections due to this bacterium have rarely been reported, its involvement in the development of gastric ulcers and perforation has been suggested. We present a case of bacteremia due to C. ventriculi following acute colonic pseudo-obstruction.

Published
2019
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33. Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study

Author

Eric Kipnis, Arthur Durand, André Vincentelli, Christophe Decoene, Guillaume Gantois, Slimane Ait-Ouarab, Antoine Lamer, Guillaume Leroy, Brandt Caroline, Julien Labreuche, Mouhamed Moussa, Liu Vincent, Emmanuel Robin, Delphine Deblauwe, Olivier Joulin, and Benoit Vallet

Subjects
Male, medicine.medical_specialty, Risk Assessment, pCO2, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, immune system diseases, 030202 anesthesiology, law, Internal medicine, Cardiopulmonary bypass, Clinical endpoint, Medicine, Humans, Prospective Studies, Cardiac Surgical Procedures, Prospective cohort study, Hypoxia, Aged, Univariate analysis, Cardiopulmonary Bypass, Receiver operating characteristic, business.industry, 030208 emergency & critical care medicine, Carbon Dioxide, Middle Aged, Prognosis, Cardiac surgery, Oxygen, Intensive Care Units, Anesthesiology and Pain Medicine, Treatment Outcome, Cardiology, Biomarker (medicine), Female, Blood Gas Analysis, business, Biomarkers
Abstract

Background Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. Objectives We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. Design A prospective, observational cohort study. Setting Single-centre, academic hospital cardiovascular ICU. Patients We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. Main outcome measures The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. Results MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P Conclusion After cardiac surgery with cardiopulmonary bypass, ΔPCO2 measured 2 h after ICU admission was the only dysoxia biomarker independently associated with MPC, but with limited performance. Trial registration ClinicalTrials.gov, NCT03107572.

Published
2019

34. Impact of the Timing of Antibiotic Administration on Digestive Colonization with Carbapenemase-Producing Enterobacteriaceae in a Murine Model

Author

Karine Faure, Eric Kipnis, Teddy Grandjean, Guillaume Millot, Martin Figeac, Aurore Loquet, Rémi Le Guern, Rodrigue Dessein, Marvin Bauduin, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Plateforme de génomique fonctionnelle et structurelle [Lille], Institut pour la recherche sur le cancer de Lille [Lille] (IRCL)-Université de Lille, Droit et Santé, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), and Le Guern, Rémi

Subjects
medicine.drug_class, Klebsiella pneumoniae, Antibiotics, Microbial Sensitivity Tests, Gut flora, beta-Lactamases, Microbiology, 03 medical and health sciences, Mice, Bacterial Proteins, Enterobacteriaceae, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Antimicrobial stewardship, Infection control, Animals, Pharmacology (medical), Colonization, Experimental Therapeutics, 030304 developmental biology, Pharmacology, 0303 health sciences, Infection Control, biology, 030306 microbiology, business.industry, Enterobacteriaceae Infections, Clindamycin, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, 3. Good health, Anti-Bacterial Agents, Gastrointestinal Microbiome, Disease Models, Animal, Infectious Diseases, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, business, medicine.drug
Abstract

While antibiotic use is a risk factor of carbapenemase-producing Enterobacteriaceae (CPE) acquisition, the importance of timing of antibiotic administration relative to CPE exposure remains unclear. In a murine model of gut colonization by New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Klebsiella pneumoniae , a single injection of clindamycin within at most 1 week before or after CPE exposure induced colonization persisting up to 100 days.

Published
2019
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35. Early management of severe pelvic injury (first 24 hours)

Author

Pascal Incagnoli, Fréderic Rongieras, Tobias Gauss, Clément Buléon, Delphine Garrigue, Jean-Luc Hanouz, Jacques Choukroun, Eric Kipnis, Isabelle Plenier, Anatole Harrois, François Régis Desfemmes, Jean Stephane David, Xavier Combes, Pierre Bouzat, Elodie Brunel, Sylvain Ausset, Xavier Bobbia, Benoît Vivien, Jacques Bessereau, Julien Brun, Jean Paul Beregi, Alain Puidupin, Service d'anesthésie-réanimation, Hospices Civils de Lyon, centre hospitalier Lyon Sud, Direction centrale du service de santé des armées, École du Val de Grâce (EVDG), Service de Santé des Armées, Service de radiologie et d'imagerie médicale, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Assistance publique des Hôpitaux de Marseille, SAMU 13, pôle RUSH, CHU de la Timone, Division anesthésie-réanimation douleur urgences, Pôle anesthésie-réanimation, Grenoble Alpes Trauma Centre, Service d'anesthésie-réanimation, hôpital Purpan, CHU Toulouse [Toulouse], Service Réanimation médico-chirurgicale [CH Le Mans], Centre Hospitalier Le Mans (CH Le Mans), Hôpital Bellepierre, SAMU 974, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Service de chirurgie urologique, Hôpital d'instruction des Armées du Val de Grace, Service d'accueil des urgences vitales chirurgicales, CHRU de Lille, Service de chirurgie de l'urgence, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique des Hôpitaux Paris, hôpital Beaujon, servie d'anesthésie-réanimation, réanimation chirurgicale, Hôpitaux Universitaires Paris Nord Val de Seine, Service d'anesthésie-réanimation, reanimation chirurgicale, Assistance publique des Hôpitaux Paris, CHU de Bicêtre, Pôle d'anesthésie-réanimation, and CHRU de Lille, réanimation chirurgicale

Subjects
medicine.medical_specialty, Critical Care, Population, Critical Care and Intensive Care Medicine, Pelvis, Fractures, Bone, 03 medical and health sciences, BIOMECANIQUE, [SPI]Engineering Sciences [physics], 0302 clinical medicine, PELVIC TRAUMA, PREHOSPITAL SETTING, Health care, Humans, Medicine, Anesthesia, TRAUMA NETWORK, education, 030222 orthopedics, education.field_of_study, Trauma Severity Indices, business.industry, General surgery, ARTERIAL EMBOLIZATION, SEVERITY CRITERIA, [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], 030208 emergency & critical care medicine, General Medicine, Guideline, Evidence-based medicine, medicine.disease, 3. Good health, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Pelvic fracture, Wounds and Injuries, Abdomen, Professional association, business, Trauma surgery
Abstract

Objective Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients. To date, in France, there are no guidelines issued by healthcare authorities or professional societies that address this subject. Design A consensus committee of 22 experts from the French Society of Anaesthesia and Intensive Care Medicine (Societe Francaise d’Anesthesie et de Reanimation; SFAR) and the French Society of Emergency Medicine (Societe Francaise de Medecine d’Urgence; SFMU) in collaboration with the French Society of Radiology (Societe Francaise de Radiologie; SFR), French Defence Health Service (Service de Sante des Armees; SSA), French Society of Urology (Association Francaise d’Urologie; AFU), the French Society of Orthopaedic and Trauma Surgery (Societe Francaise de Chirurgie Orthopedique et Traumatologique; SOCFCOT), and the French Society of Digestive Surgery (Societe Francaise de Chirurgie digestive; SFCD) was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently from any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Methods Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE® methodology. Results The SFAR Guideline panel provided 22 statements on prehospital and hospital management of the unstable patient with pelvic fracture. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, 11 have a high level of evidence (Grade 1 ± ), 11 have a low level of evidence (Grade 2 ± ). Conclusions Substantial agreement exists among experts regarding many strong recommendations for management of the unstable patient with pelvic fracture.

Published
2019
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36. Rationalizing antimicrobial therapy in the ICU: a narrative review

Author

Etienne Ruppe, Jorge I. F. Salluh, Kevin B. Laupland, Jesús Rodríguez-Baño, Jan J. De Waele, Eric Kipnis, José Artur Paiva, Fabio Silvio Taccone, Emmanuel Weiss, François Barbier, Andre Kallil, Matteo Bassetti, Olaf L. Cremer, Marin H. Kollef, George L. Daikos, and Jean-François Timsit

Subjects
medicine.medical_specialty, Quality management, medicine.drug_class, Antibiotics, Antibiotic stewardship, Antimicrobial resistance, Carbapenem, Critical illness, Empirical therapy, Outcome, Sepsis, Anti-Infective Agents, Antimicrobial Stewardship, Humans, Intensive Care Units, Medical Overuse, Risk Factors, Rationalization, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Health care, medicine, Dosing, Intensive care medicine, business.industry, 030208 emergency & critical care medicine, medicine.disease, Antimicrobial, Regimen, 030228 respiratory system, Narrative review, business
Abstract

The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.

Published
2019

37. Compliance with evidence-based clinical management guidelines in bleeding trauma patients

Author

Benoît Tavernier, Elodie Drumez, M. Bacus, Sophie Susen, Antoine Rauch, D. Garrigue-Huet, A. Guidat, Anne Godier, and Eric Kipnis

Subjects
Adult, Male, medicine.medical_specialty, Evidence-based practice, Hemorrhage, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, medicine, Humans, 030212 general & internal medicine, Patient compliance, Intensive care medicine, Retrospective Studies, Evidence-Based Medicine, business.industry, Mortality rate, 030208 emergency & critical care medicine, Retrospective cohort study, Odds ratio, Middle Aged, Confidence interval, Compliance (physiology), Anesthesiology and Pain Medicine, Emergency medicine, Wounds and Injuries, Female, France, Guideline Adherence, business
Abstract

Background In 2007, the multidisciplinary European Task Force for Advanced Bleeding Care in Trauma published guidelines for the management of the bleeding trauma patient. The present study aimed to assess compliance with the European guidelines during the first 24 h in a level I trauma centre and to determine whether compliance impacts mortality. Methods This was a retrospective study of consecutive bleeding trauma patients referred to a university hospital in France between 2010 and 2014. A reference document was developed on the basis of the European guidelines to transform the guidelines pragmatically into 22 objectively measurable criteria. We measured per-patient and per-criterion compliance rates and assessed the impact of guideline compliance on mortality. Results A total of 121 bleeding trauma patients were included. The median (interquartile range) per-patient compliance rate was 75 (65–82)% and the per-criterion compliance rate 64 (57–81)%. Mortality rates were 18 and 32% at 24 h and 30 days, respectively. After adjusting for injury severity, per-patient compliance rates were associated with decreased mortality at 24 h (odds ratio per 10% increase in patient compliance score, 0.43; 95% confidence interval 0.26–0.71; P = 0.0001) and at 30 days (odds ratio per 10% increase in patient compliance score, 0.47; 95% confidence interval 0.31–0.72; P = 0.0004). Conclusions We found that compliance with protocols based on European guidelines impacts trauma outcome, because patient compliance was associated with survival. Further work is needed to improve adherence to these guidelines, with ongoing monitoring to ensure best practice and optimal patient outcome.

Published
2016
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38. Chronic post-thyroidectomy pain: Incidence, typology, and risk factors

Author

Gilles Lebuffe, Grégoire Andrieu, Robert Caiazzo, Eric Kipnis, Jean-Michel Wattier, François Pattou, CIC CHU ( Lille)/inserm, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 (GRITA), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Recherche translationelle relations hôte-pathogènes

Subjects
Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Anxiety, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030202 anesthesiology, Surveys and Questionnaires, Humans, Medicine, Anesthesia, Prospective Studies, Prospective cohort study, Aged, Cervical Plexus, Pain Measurement, Pain, Postoperative, business.industry, Incidence, Incidence (epidemiology), Cervical plexus, Thyroidectomy, Chronic pain, Nerve Block, General Medicine, Middle Aged, medicine.disease, Surgery, Anesthesiology and Pain Medicine, Neuropathic pain, Nerve block, Female, France, Chronic Pain, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

International audience; Chronic postoperative pain exists in varying degrees for every type of surgery. An evaluation of the incidence, the typology and predictive factors of chronic pain was carried out at 3 and 6months after thyroidectomy. A prospective observational study, having included each of the patients prior to their thyroidectomy, was carried out over 12months. The patients used an 11-point numerical rating scale (NRS), a neuropathic pain screening questionnaire (DN4), an evaluation scale for anxiety and for the need for information related to anaesthesia and surgery (APAIS), a questionnaire describing pain (QDSA) and a questionnaire evaluating neuropathic pain (NPSI) before surgery and at three and six months later. Three hundred and four patients were included. The questionnaires were completed by 251 patients (57 males and 194 females) at 3 and 6months (82%). At 3months, 31 out of 251 (12%) patients mentioned a DN4≥3; at 6months, this rate dropped to 23 out of 251 (9%). The average intensity of chronic postoperative pain remained low to moderate. Levels of anxiety and the need for information were higher in patients with postoperative pain at 3 and 6months. In contrast, the number of intraoperative procedures using a bilateral superficial cervical plexus block (BSCPB) was lower in patients with DN4≥3. Multivariate analysis demonstrated that the type of anaesthesia procedure interfered with the risk of delayed pain after thyroidectomy. The presence of a DN4≥3 was nearly three-fold greater in patients without BSCPB (OR 2.647, CI=1.198-5.848).

Published
2016
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39. Fréquence des acrosyndromes chez les patients avec infection sévère à SARS-CoV-2 en réanimation

Author

C. Fievet, Eric Kipnis, E. Drumez, F. Dezoteux, Julien Poissy, Delphine Staumont-Sallé, S. Buche, A.S. Moreau, Alain Duhamel, B. Mille, and Daniel Mathieu

Subjects
Gynecology, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Dermatology, Pseudo-engelure, P085, medicine, SARS CoV 2, business, Acrosyndrome, COVID 19, Réanimation
Abstract

Introduction De nombreuses manifestations cliniques dermatologiques ont ete rapportees durant la pandemie mondiale de la COVID-19. Parmi elles, des phenomenes d’acrosyndromes ont ete decrits, principalement chez des patients suspects d’infection par SARS-Cov-2 mais asymptomatiques ou pauci-symptomatiques. Peu d’etudes se sont interessees a ces manifestations chez les patients admis en reanimation. Notre objectif etait donc d’evaluer la frequence instantanee des manifestations acrales cutanees chez les patients severes atteints de la COVID19 admis en reanimation. Materiel et methodes Nous avons realise une etude observationnelle et prospective, realisee du 5 au 6 mai 2020. Tout patient adulte hospitalise en reanimation au CHU de Lille dans le cadre de la COVID19 etait inclus et beneficiait d’un examen systematique du tegument par un dermatologue senior. Resultats Au total, 39 patients ont ete examines (34 hommes, 5 femmes) avec un âge moyen de 60,6 ans. Aucun patient n’avait presente de symptome dermatologique au debut de la maladie. La duree mediane d’hospitalisation en reanimation etait de 35 jours [21-41] ; 35 patients (90 %) avaient recu un support ventilatoire par intubation oro-tracheale et 21 (54 %) un support circulatoire par amines vasopressives. Nous avons observe des manifestations cutanees acrales chez 11 patients (28 %) : lesions necrotiques (5/11, 45 %), bulles hemorragiques (3/11, 27 %), livedo (1/11, 9 %), erosions (1/11, 9 %), hemorragies sous ungueales (2/11, 18 %). Un patient presentant a la fois des lesions necrotiques et des erosions cutanees. Aucun patient ne presentait de manifestations a type d’engelure ou pseudo-engelure. Il n’y avait pas de difference significative entre les patients avec et sans manifestation acrale concernant la duree d’hospitalisation et les complications thromboemboliques, les symptomes initiaux, et les caracteristiques de base des patients excepte l’IMC moyen plus bas chez les patients avec manifestations acrales. La duree moyenne de la maladie etait significativement plus longue et davantage de medicaments vasoactifs ont ete administres aux patients presentant des manifestations cutanees acrales, suggerant une gravite plus elevee de la maladie dans ce groupe et pouvant etre en lien avec les manifestations observees. Discussion Nous rapportons une serie de manifestations cutanees acrales chez seulement 28 % des patients pris en charge en reanimation au moment de l’etude. Ces manifestations sont variees et peu specifiques. Aucune manifestation a type d’engelure n’etait observee contrairement aux patients suspects de formes pauci ou asymptomatiques et inconstamment confirmees sur le plan serologique ou moleculaire. Sur le plan physiopathologique, plusieurs hypotheses sont avancees comme une reponse immune antivirale de type interferon. Des etudes sont necessaires afin de mieux comprendre les mecanismes a l’origine de ces manifestations.

Published
2020

40. Tetraphenylethylene-based glycoclusters with aggregation-induced emission (AIE) properties as high-affinity ligands of bacterial lectins

Author

Anne Imberty, Eric Kipnis, Shuay Abdullayev, Emilie Gillon, Marion Donnier-Maréchal, Rodrigue Dessein, Yoann Pascal, Meng-Qi Fu, Sébastien Vidal, Marvin Bauduin, Xiao-Peng He, Chimie Organique 2-Glycochimie (CO2GLYCO), Institut de Chimie et Biochimie Moléculaires et Supramoléculaires (ICBMS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut de Chimie du CNRS (INC)-École Supérieure Chimie Physique Électronique de Lyon-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut de Chimie du CNRS (INC)-École Supérieure Chimie Physique Électronique de Lyon-Centre National de la Recherche Scientifique (CNRS), Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), East China University of Science and Technology, Centre de Recherches sur les Macromolécules Végétales (CERMAV ), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Lyon-Université de Lyon-École Supérieure de Chimie Physique Électronique de Lyon (CPE)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre de Recherches sur les Macromolécules Végétales [2016-2019] (CERMAV [2016-2019]), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Lille 2 - Faculté de Médecine, and Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
[CHIM.ORGA]Chemical Sciences/Organic chemistry, 010405 organic chemistry, Organic Chemistry, Oligosaccharides, Tetraphenylethylene, 010402 general chemistry, Ligands, 01 natural sciences, Biochemistry, Fluorescence, Combinatorial chemistry, 0104 chemical sciences, chemistry.chemical_compound, Spectrometry, Fluorescence, chemistry, Stilbenes, [CHIM]Chemical Sciences, Spectrophotometry, Ultraviolet, Physical and Theoretical Chemistry, Aggregation-induced emission, Adhesins, Bacterial
Abstract

International audience; Tetraphenylethylene (TPE) is fluorescent through aggregation induced emission (AIE) in water. Herein, TPE was used as the core of glycoclusters that target the bacterial lectins LecA and LecB of Pseudomonas aeruginosa. Synthesis of these TPE-based glycoclusters was accomplished by using azide-alkyne "click" chemistry. The AIE properties of the resulting glycoclusters could be readily verified, but imaging could not be pursued due to the overlap of the fluorescence signals from cells and bacteria. Nonetheless, the glycoclusters displayed nanomolar affinities toward LecA and LecB. Further evaluation in a cell-based anti-adhesive assay highlighted a limited decrease in adhesion (20%) for the fucosylated glycocluster. This confirmed that these TPE-based glycoclusters are indeed LecA and LecB high-affinity ligands. Nevertheless, the hypotheses involving their application in imaging or anti-adhesive therapy could not be verified.

Published
2018
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41. Impact of Centralized Management of Bariatric Surgery Complications on 90-day Mortality

Author

Gregory Baud, Robert Caiazzo, Guillaume Clément, Eric Kipnis, Gilles Lebuffe, François Pattou, Fanelly Torres, Benoît Dervaux, Xavier Lenne, Guelareh Dezfoulian, CIC CHU ( Lille)/inserm, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Recherche translationnelle sur le diabète - U 1190 (RTD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Rennes 2 (UR2), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier [Valenciennes, Nord], Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 (GRITA), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Recherche translationelle relations hôte-pathogènes, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Rennes (UNIV-RENNES), and Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille

Subjects
Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], MEDLINE, Bariatric Surgery, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Humans, Medicine, 030212 general & internal medicine, Retrospective Studies, business.industry, Centralized management, Retrospective cohort study, Middle Aged, 3. Good health, Surgery, Multicenter study, 030220 oncology & carcinogenesis, Centralized Hospital Services, Female, France, business
Abstract

International audience; BACKGROUND AND AIMS: The potential benefit of the centralization of Bariatric surgery (BS) remains debated. The aim of this study was to evaluate the impact on 90-day mortality of an innovative organization aiming at centralizing the care of severe postoperative complications of BS. STUDY DESIGN: The centralization of care for postoperative complication after BS was implemented by French Authorities in 2013 in the Nord-Pas-de-Calais Region, France. This unique formalized network (OSEAN), coordinated by 1 tertiary referral center, enrolled all regional institutions performing bariatric surgery. Data were extracted from the medico-administrative database providing information on all patients undergoing BS between 2009 and 2016 in OSEAN (n = 22,928) and in Rest of France (n = 288,942). The primary outcome was the evolution of 90-day mortality before and after the implementation of this policy. Rest of France was used as a control group to adjust the results to improvement with time of BS outcomes. RESULTS: The numbers of primary procedure and reoperations increased similarly before and after 2013 within OSEAN and in Rest of France. The 90-day mortality rate became significantly lower within OSEAN than in the rest of France after 2013 (0.03% vs 0.08%, P < 0.01). This difference was confirmed in multivariate analysis after adjustment to the procedure specific mortality (P < 0.04). The reduction of 90-day mortality was most visible for sleeve gastrectomy. CONCLUSION: The implementation of centralized care for early postoperative complications after BS in OSEAN was associated with reduced 90-day mortality. Our results indicate that this reduction was not due to a lower incidence of complications but to the improvement of their management.

Published
2018
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42. Pneumonies associées aux soins de réanimation

Author

Antoine Roquilly, Olivier Brissaud, Eric Kipnis, Philippe Montravers, Sami Hraiech, Gerald Chanques, Rémi Bruyère, Jean-Ralph Zahar, Jérôme Pugin, Djamel Mokart, Marc Leone, Fabrice Michel, Lila Bouadma, Stéphane Dauger, Sébastien Gibot, Charles-Edouard Luyt, Dimitri Margetis, Saad Nseir, Antoine Monsel, Belaid Bouhemad, Lionel Velly, Yoann Launey, Boris Jung, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Hôpital Bichat - Claude Bernard, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Pôle de réanimation pédiatrique (CHU de Bordeaux), CHU de Bordeaux Pellegrin [Bordeaux], Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies (PROTECT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département Anesthésie-Réanimation, Hôpital Roger Salengro, CHRU de Lille, Hôpital Roger Salengro, CHRU de Lille, Lille, France, Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Anesthésie Réanimation [Rennes], CHU Pontchaillou [Rennes], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance Publique - Hôpitaux de Marseille (APHM), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Département d'Anesthésie Réanimation, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Immunologie - Immunopathologie - Immunothérapie (I3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service des Soins Intensifs [Genève], Université de Genève = University of Geneva (UNIGE)-Hôpitaux Universitaires de Genève (HUG), Hôpital Universitaire de Genève = University Hospitals of Geneva (HUG), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Avicenne [AP-HP], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation - soins continus (Centre hospitalier de Bourg-en-Bresse), Centre Hospitalier de Bourg-en-Bresse, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Genève (UNIGE)-Hôpitaux Universitaires de Genève (HUG), and Hôpital Universitaire de Genève

Subjects
Gynecology, medicine.medical_specialty, Intensive care units, business.industry, 030208 emergency & critical care medicine, 3. Good health, Healthcare-associated pneumonia, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Healthcare associated, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, 030212 general & internal medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract

Resume La Societe francaise d’anesthesie et de reanimation et la Societe de reanimation de langue francaise ont publie des recommandations se concentrant sur les pneumonies associees aux soins de reanimation. Le but de ces seize experts francophones etait de produire un cadre permettant une meilleure prise de decision pour les medecins reanimateurs. Ces recommandations sont liees a trois sujets precis (la prevention, le diagnostique et le traitement) chez quatre types de patients (BPCO, neutropenie, postoperation et pediatrique). L’analyse litteraire et la formulation des recommandations ont ete conduites selon le systeme GRADE. Une recherche litteraire extensive a ete conduite sur 10 ans sur les publications indexees sur les bases de donnees Cochrane et Pubmed. Les pneumonies associees aux soins doivent etre evitees grâce a une approche multimodale standardisee et en utilisant la decontamination digestive la ou la prevalence des bacteries multi resistantes aux medicaments etait inferieure a 20 %. Le diagnostique se base sur l’evaluation clinique et les analyses microbiologiques. En l’absence de facteurs de risques pour les bacteries multi resistantes, de bacille a gram-negatif non-fermentant et/ou d’une mortalite accrue (choc sceptique, defaillance organique), la monotherapie est fortement recommandee. Apres documentation microbiologique, il est recommande de reduire le spectre et de preferer la monotherapie pour l’antibiotherapie des pneumonies associees aux soins de reanimation, y compris les bacilles a gram-negatif non-fermentant.

Published
2018
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43. Draft Genome Sequences of Two Carbapenemase-Producing Klebsiella pneumoniae Strains Isolated from Blood Cultures

Author

Eric Kipnis, Rémi Le Guern, Marvin Bauduin, Rodrigue Dessein, Karine Faure, Teddy Grandjean, Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 [CIIL], and Le Guern, Rémi

Subjects
0301 basic medicine, biology, Klebsiella pneumoniae, Genome Sequences, 030106 microbiology, Carbapenemase producing, biology.organism_classification, Genome, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 3. Good health, Microbiology, 03 medical and health sciences, Resistant bacteria, 030104 developmental biology, Immunology and Microbiology (miscellaneous), [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Genetics, Colonization, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Molecular Biology, ComputingMilieux_MISCELLANEOUS
Abstract

Carbapenemase-producing Klebsiella pneumoniae represents an emerging public health issue. Here, we present the draft whole-genome sequences of K. pneumoniae clinical strains KPL0.1 (OXA-48 carbapenemase) and KPL0.2 (NDM-1 carbapenemase)., Carbapenemase-producing Klebsiella pneumoniae represents an emerging public health issue. Here, we present the draft whole-genome sequences of K. pneumoniae clinical strains KPL0.1 (OXA-48 carbapenemase) and KPL0.2 (NDM-1 carbapenemase). These genome sequences should help in investigating pathophysiological mechanisms of digestive colonization or infection with these highly resistant bacteria.

Published
2018
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44. P2662Prognostic value of postoperative high-sensitivity troponin among patients undergoing fenestrated and/or branched endovascular aortic aneurysm repair

Author

C Brandt, G Gantois, E. Robin, A Hertault, Stéphan Haulon, A Lamer, Eric Kipnis, G Mass, G Leroy, J Sobocinski, Benoît Tavernier, Mouhamed Moussa, S Lecaitel, P Louvel, and S Ait-Ouarab

Subjects
medicine.medical_specialty, Aortic aneurysm repair, business.industry, Internal medicine, High sensitivity troponin, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, Value (mathematics)
Published
2018
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45. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial

Author

Samir Jaber, Catherine Paugam, Emmanuel Futier, Jean-Yves Lefrant, Sigismond Lasocki, Thomas Lescot, Julien Pottecher, Alexandre Demoule, Martine Ferrandière, Karim Asehnoune, Jean Dellamonica, Lionel Velly, Paër-Sélim Abback, Audrey de Jong, Vincent Brunot, Fouad Belafia, Antoine Roquilly, Gérald Chanques, Laurent Muller, Jean-Michel Constantin, Helena Bertet, Kada Klouche, Nicolas Molinari, Boris Jung, Marion Monnin, Jean-Marc Delay, Moussa Cissé, Marie Geniez, Matthieu Conseil, Bruno Souche, Jean Michel Constantin, Eric Noll, Elise Morawiec, Alexandre Robert, Thibaut Triglia, Malika Mechati, Jean-Michel Arnal, Jacques Durand-Gasselin, Didier Demoly, Sami Hraiech, Laurent Papazian, Vincent Gilles, Thomas Rimmelé, Béatrice Riu, Pierre Cougot, Olivier Fourcade, Philippe Seguin, Jonathan Charbit, Xavier Capdevila, Marc Leone, Laurent Zieleskiewicz, Carole Ichai, Jean Christophe Orban, Michael Darmon, Elie Azoulay, Virginie Lemiale, Lara Zafrani, Karim Debbat, Oliver Mimoz, Claude Guérin, Eric Kipnis, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génétique, Reproduction et Développement (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'anesthésie et réanimation chirurgicale, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Clermont-Ferrand, Génétique, Reproduction et Développement - Clermont Auvergne (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Avenue Cheikh Anta Diop, Dakar, Senegal., Anesthesiology, Robert Debré Hospital, PRES Université Nantes Angers Le Mans (UNAM), Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Conservation des espèces, restauration et suivi des populations (CERSP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), sans affiliation, Centre Hospitalier de Toulon-La Seyne, Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Agressions vasculaires et réponses tissulaires, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service de cardiologie [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Pontchaillou [Rennes], Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Service de réanimation, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital St Roch, Département Imagerie et Simulation pour le Contrôle (DISC), Laboratoire d'Intégration des Systèmes et des Technologies (LIST), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France, Laboratoire de Géologie de Lyon - Terre, Planètes, Environnement [Lyon] (LGL-TPE), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Lille 2 - Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
Bicarbonate, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Metabolic alkalosis, law.invention, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, law, Intensive care, Medicine, Humans, 030212 general & internal medicine, Renal replacement therapy, education, Infusions, Intravenous, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Sodium bicarbonate, business.industry, 030208 emergency & critical care medicine, General Medicine, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Hydrogen-Ion Concentration, medicine.disease, Intensive care unit, Survival Analysis, 3. Good health, Renal Replacement Therapy, Intensive Care Units, Intravenous sodium bicarbonate, Sodium Bicarbonate, chemistry, Anesthesia, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Acidosis
Abstract

Summary Background Acute acidaemia is frequently observed during critical illness. Sodium bicarbonate infusion for the treatment of severe metabolic acidaemia is a possible treatment option but remains controversial, as no studies to date have examined its effect on clinical outcomes. Therefore, we aimed to evaluate whether sodium bicarbonate infusion would improve these outcomes in critically ill patients. Methods We did a multicentre, open-label, randomised controlled, phase 3 trial. Local investigators screened eligible patients from 26 intensive care units (ICUs) in France. We included adult patients (aged ≥18 years) who were admitted within 48 h to the ICU with severe acidaemia (pH ≤7·20, PaCO2 ≤45 mm Hg, and sodium bicarbonate concentration ≤20 mmol/L) and with a total Sequential Organ Failure Assessment score of 4 or more or an arterial lactate concentration of 2 mmol/L or more. We randomly assigned patients (1:1), by stratified randomisation with minimisation via a restricted web platform, to receive either no sodium bicarbonate (control group) or 4·2% of intravenous sodium bicarbonate infusion (bicarbonate group) to maintain the arterial pH above 7·30. Our protocol recommended that the volume of each infusion should be within the range of 125–250 mL in 30 min, with a maximum of 1000 mL within 24 h after inclusion. Randomisation criteria were stratified among three prespecified strata: age, sepsis status, and the Acute Kidney Injury Network (AKIN) score. The primary outcome was a composite of death from any cause by day 28 and the presence of at least one organ failure at day 7. All analyses were done on data from the intention-to-treat population, which included all patients who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02476253. Findings Between May 5, 2015, and May 7, 2017, we enrolled 389 patients into the intention-to-treat analysis in the overall population (194 in the control group and 195 in the bicarbonate group). The primary outcome occurred in 138 (71%) of 194 patients in the control group and 128 (66%) of 195 in the bicarbonate group (absolute difference estimate −5·5%, 95% CI −15·2 to 4·2; p=0·24). The Kaplan-Meier method estimate of the probability of survival at day 28 between the control group and bicarbonate group was not significant (46% [95% CI 40–54] vs 55% [49–63]; p=0·09. In the prespecified AKIN stratum of patients with a score of 2 or 3, the Kaplan-Meier method estimate of survival by day 28 between the control group and bicarbonate group was significant (37% [95% CI 28–48] vs 54% [45–65]; p=0·0283). Metabolic alkalosis, hypernatraemia, and hypocalcaemia were observed more frequently in the bicarbonate group than in the control group, with no life-threatening complications reported. Interpretation In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined stratum of patients with acute kidney injury. Funding French Ministry of Health and the Societe Francaise d'Anesthesie Reanimation.

Published
2018
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46. Measure it to manage it: a bevy of ICU quality-of-care indicators

Author

Marc Leone, Eric Kipnis, Université Lille 2 - Faculté de Médecine, Microbes évolution phylogénie et infections (MEPHI), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Faculté de Médecine Henri Warembourg - Université de Lille, and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)

Subjects
0303 health sciences, Measure (data warehouse), Critical Care, 030309 nutrition & dietetics, business.industry, media_common.quotation_subject, General Medicine, Critical Care and Intensive Care Medicine, medicine.disease, Intensive Care Units, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030225 pediatrics, medicine, Humans, Quality (business), Medical emergency, Quality of care, business, ComputingMilieux_MISCELLANEOUS, media_common
Abstract

International audience

Published
2018
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47. Early clindamycin for bacterial vaginosis in pregnancy (premeva): a multicentre, double-blind, randomised controlled trial

Author

Bruno Grandbastien, Rodrigue Dessein, Emma Tilloy, François Goffinet, Jean Louis Plennevaux, Eric Kipnis, Damien Subtil, Catherine Nolf, Karine Faure, Gilles Brabant, David Desseauve, Emmanuelle Joyez, Jean-Charles Dugimont, Marie-Christine Bissinger, Frédérique Canis, Marielle Jousse, Christine Delaeter, Patrick Devos, Anne Personne, Sophie Gautier, Elisabeth Guinard, Pierre-Yves Ancel, Annie Fruchart, Christophe Hacot, Jerome Chantrel, Sylvie Deghilage, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Hôpital Saint Vincent de Paul de Lille, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Centre hospitalier [Valenciennes, Nord], Institut de Microbiologie [CHRU Lille], Pôle de Biologie Pathologie Génétique [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Lille, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Groupe Hospitalier Artois-Ternois Centre Hospitalier d’Arras, Hôpital Claude Huriez [Lille], CHU Lille, Centre Hospitalier de Calais, Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), Université Paris Descartes - Paris 5 (UPD5)-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)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CNRS, Inserm, METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694, Santé publique : épidémiologie et qualité des soins - EA 2694, Troubles cognitifs dégénératifs et vasculaires - U1171, Recherche translationnelle : relations hôte-pathogènes - EA 7366, Troubles cognitifs dégénératifs et vasculaires - U 1171 [TCDV], Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS], Centre hospitalier universitaire de Poitiers [CHU Poitiers], and Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique [CRESS - U1153]

Subjects
Adult, medicine.medical_specialty, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Placebo, Miscarriage, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, Pregnancy, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, medicine, Very Preterm Birth, Humans, 030212 general & internal medicine, Pregnancy Complications, Infectious, 030219 obstetrics & reproductive medicine, Intention-to-treat analysis, business.industry, Clindamycin, Pregnancy Outcome, General Medicine, Vaginosis, Bacterial, medicine.disease, 3. Good health, Anti-Bacterial Agents, Abortion, Spontaneous, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Premature Birth, Female, Bacterial vaginosis, business, medicine.drug
Abstract

International audience; Background: Preterm delivery during pregnancy (

Published
2018
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48. Hospital-acquired pneumonia in ICU

Author

Sébastien Gibot, Antoine Monsel, Belaid Bouhemad, Antoine Roquilly, Lila Bouadma, Boris Jung, Dimitri Margetis, Philippe Montravers, Rémi Bruyère, L. Velly, Djamel Mokart, Saad Nseir, Marc Leone, Charles-Edouard Luyt, Jean-Ralph Zahar, Fabrice Michel, Sami Hraiech, Yoann Launey, O. Brissaud, Jérôme Pugin, Eric Kipnis, Gerald Chanques, Stéphane Dauger, Velly, Lionel, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neuroradiologie, imagerie des urgences [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU de Bordeaux Pellegrin [Bordeaux], AP-HP Hôpital universitaire Robert-Debré [Paris], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Pontchaillou [Rennes], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Immunologie - Immunopathologie - Immunothérapie (I3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Universitaire de Genève = University Hospitals of Geneva (HUG), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Necker - Enfants Malades [AP-HP], Hôpital Avicenne [AP-HP], Centre Hospitalier de Bourg en Bresse, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), and Hôpital Universitaire de Genève

Subjects
medicine.medical_specialty, Clinical Decision-Making, MEDLINE, Healthcare-Associated Pneumonia/drug therapy/epidemiology, Guidelines as Topic, Critical Care and Intensive Care Medicine, Hospital-acquired pneumonia, Cross Infection/diagnosis/microbiology/prevention & control/therapy, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intensive care, Medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Cross Infection, ddc:617, business.industry, Septic shock, The antibiotic, Healthcare-Associated Pneumonia, 030208 emergency & critical care medicine, Multimodal therapy, General Medicine, Guideline, Pneumonia, medicine.disease, Monotherapy, Intensive care unit, 3. Good health, Anti-Bacterial Agents, Anti-Bacterial Agents/therapeutic use, Intensive Care Units, Anesthesiology and Pain Medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, business
Abstract

International audience; The French Society of Anesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit (ICU). The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, postoperative and pediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. HAP should be prevented by a standardized multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli.

Published
2018
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49. Determining the editorial policy of Anaesthesia Critical Care and Pain Medicine (ACCPM)

Author

Matthieu Legrand, Pierre Beaulieu, Jean-Yves Lefrant, Jean-Pierre Tourtier, Beny Charbit, Nicolas Mongardon, Thomas Lescot, Jean-Stéphane David, Xavier Capdevila, Eric Kipnis, Souhayl Dahmani, Sébastien Pierre, Matthieu Biais, Antoine G. Schneider, Karim Asehnoune, Alexandre Ouattara, Christophe Dadure, Jean-François Brichant, Philippe Cuvillon, Anne Godier, Emmanuel Lorne, Emmanuel Marret, Thomas Fuchs-Buder, Sylvain Ausset, Romain Pirracchio, Jason A. Roberts, Vincent Laudenbach, Thomas Geeraerts, Morgan Le Guen, Jean-Michel Constantin, Olivier Joannes-Boyau, Laurie Tran, Jean-Luc Hanouz, Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Amiens-Picardie, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital d'instruction des Armées Percy, Service de Santé des Armées, CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Reims (CHU Reims), Génétique, Reproduction et Développement (GReD), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies (PROTECT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), CHU Toulouse [Toulouse], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Service d'Anesthésie - Réanimation Chirurgicale [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Université Lille 2 - Faculté de Médecine, Université Paris Diderot - Paris 7 (UPD7), Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), University of Queensland [Brisbane], Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Faculté de Médecine Henri Warembourg - Université de Lille, CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Critical Care, Pain medicine, [SDV]Life Sciences [q-bio], MEDLINE, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, medicine, Pain Management, Anesthesia, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, business.industry, 030208 emergency & critical care medicine, General Medicine, Pain management, 3. Good health, Anesthesiology and Pain Medicine, Policy, Publication, Periodicals as Topic, business, Editorial Policies
Abstract

International audience

Published
2018
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50. Erratum to 'Early management of severe pelvic injury (first 24 hours)' [Anaesth Crit Care Pain Med 38 (2019) 199–207. https://doi.org/10.1016/j.accpm.2018.12.003]

Author

Pascal Incagnoli, Alain Puidupin, Sylvain Ausset, Jean-Paul Beregi, Jacques Bessereau, Xavier Bobbia, Julien Brun, Elodie Brunel, Clément Buléon, Jacques Choukroun, Xavier Combes, Jean Stéphane David, François-Régis Desfemmes, Delphine Garrigue, Jean-Luc Hanouz, Isabelle Plénier, Fréderic Rongieras, Benoit Vivien, Tobias Gauss, Anatole Harrois, Pierre Bouzat, and Eric Kipnis

Subjects
Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Published
2019
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