Biomedical subjects

B Dunais

Publications and source records attributed to B Dunais.

15 recordsLinked to original sources

PubMed2006

[Influenza vaccination coverage rate in children with underlying chronic disorders in 7 French pediatric wards].

UNLABELLED: In France, annual influenza vaccination is recommended and free of charge for children with chronic disease (chronic lung, heart or kidney disease, diabetes, haemoglobinopathy, immune deficiency). The national goal is to reach 75% influenza vaccination coverage by 2008, but data on coverage in high risk children are limited. OBJECTIVES: To estimate the influenza vaccination coverage in children with an underlying chronic health condition in the Paris region, during in- or out-patient visit at hospital. METHODS: A multicentre cross-sectional descriptive study was carried out over 2 months before the 2004-2005 flu vaccination campaign in 7 French paediatric hospitals (Paris region). Inclusion criteria for this survey were: children aged 6 months to 18 years, with an underlying chronic disease requiring annual influenza vaccination, with a vaccination card available, so as to check their vaccination status. Reasons for non vaccination were recorded. RESULTS: Data from 239 children were analysed. 56% of patients were males (mean age: 8.1 years). Two patients had 2 separate underlying chronic disorders; 69% had a haemoglobinopathy, 16.3% had a chronic respiratory disease, and 7.5% had diabetes. The influenza vaccination rate for 2003-2004 was 43.7% (haemoglobinopathy: 55.5%; chronic respiratory diseases: 12.8%). This rate increased from 20.4% to 43.7% between 1999 and 2003. Less than 16% of parents remembered having received a voucher for free vaccination from the National Health Insurance Agency. CONCLUSION: Efforts are still needed to achieve the 2008 objectives of 75% coverage.

Adolescent↗

PubMed2005

In vitro selection of mutants of Streptococcus pneumoniae resistant to macrolides and linezolid: relationship with susceptibility to penicillin G or macrolides.

OBJECTIVES: To evaluate the rate of acquisition of resistance to linezolid and macrolides in Streptococcus pneumoniae isolates with different levels of susceptibility to penicillin and erythromycin. MATERIALS AND METHODS: Thirty strains of S. pneumoniae were tested by serial passages in subinhibitory concentrations of each antibiotic by the spiral method. The four copies of the 23S rRNA rrl gene of parent strains and linezolid-resistant mutants were amplified and sequenced. RESULTS: The rate of acquisition of macrolide resistance did not differ when C-14 and C-16 macrolides were tested. Resistance to linezolid in strains susceptible to penicillin and erythromycin was difficult to produce. For mutants with low-level resistance to linezolid the cut-off value of the MIC was between 6 and 8 mg/L depending on the strain. All linezolid-resistant mutants displayed a mutation in 2-4 copies of the 23S rRNA rrl gene, mainly the G2576U mutation (27/30) with an additional C2610U mutation observed in certain mutants. Two new mutations were also noted, namely C2612A and C2571G. In three linezolid-resistant mutants no mutation was identified within the studied domain, suggesting another mechanism of resistance. CONCLUSIONS: Linezolid resistance in pneumococcal strains susceptible to penicillin and macrolides was more difficult to obtain than with macrolides. Increased resistance to these agents may therefore influence the clinical use of linezolid.

Acetamides↗

PubMed2005

In the era of highly active antiretroviral therapy, why are HIV-infected patients still admitted to hospital for an inaugural opportunistic infection?

OBJECTIVES: To identify factors related to delayed testing, and delayed or interrupted care-seeking or treatment uptake, among HIV-infected patients. DESIGN: HIV-infected patients hospitalized for an opportunistic infection (OI) cases were included in a prospective study and compared with controls matched by age and sex who had regular follow-up and treatment. Patients were asked to complete a questionnaire about their therapeutic itinerary and their socioeconomic, psychological and medical characteristics. RESULTS: Seventy patients were matched with 140 controls. According to their therapeutic itinerary prior to admission, cases were subdivided into four groups among which three will be more particularly studied: nontested patients (NT) (24%; n=17), known HIV-infected patients with no medical follow-up (NF) (30%; n=21); and noncompliant patients (NC) (36%, n=25). Characteristics of NT and NF patients included a predominantly sexual mode of contamination (P=0.01), continuing occupational activity (P=0.01) despite a low mean Karnofsky index (P=0.001) and unfavourable virological and immunological parameters. NT patients displayed a low degree of anxiety, and lacked awareness concerning risk of contamination and HIV-related symptoms. HIV-status announcement (P=0.04) and the benefits of medical follow-up (P=0.05) were less favourably perceived by NF patients than by controls, and were associated with a high degree of anxiety in NF patients. NC patients had a weaker commitment to follow-up and treatment, and more frequent treatment discontinuation associated with a higher rate of interruption of follow-up in a context of social difficulties. CONCLUSIONS: Patients ignorant of their HIV status, patients NF and NC have very specific characteristics. More appropriate approaches are needed regarding screening and access to care in order to reduce the incidence of delayed care-seeking.

AIDS-Related Opportunistic Infections↗

PubMed2004

[Type of child care and nasopharyngeal S. pneumoniae and H. influenzae carriage in children in the Alpes-Maritimes].

OBJECTIVE: To compare the prevalence rates of nasopharyngeal carriage of Streptococcus pneumoniae (SP) and of SP with diminished susceptibility to penicillin (PDSP) according to two types of day care, i.e. children in group day-care (GDC) and those attended by a child minder (CM) before and after the implementation of a local public health campaign promoting prudent antibiotic use in pediatric care. METHODS: Two cross sectional studies were conducted in each care setting in 1999, 2000 and 2002, on a random sample of children. RESULTS: Initial prevalence rates for SP before the campaign were 54% in the GDC group in 1999 and 34% in the CM group in 2000, with 63% and 52% PDSP, respectively. In 2002 theses rates were 58 and 33% for SP (p<10(-5)) and 64 and 53% for PDSP, respectively. The proportion of children who received antibiotics decreased in both care settings between the two surveys, from 47 to 37% in the CM group (p=0.03) and from 60 to 51% in the GDC group (p=0.03). CONCLUSION: These results are in favor of the child minder setting and also illustrate the positive impact of a public health campaign on the frequency of antibiotic prescriptions.

Anti-Bacterial Agents↗

PubMed2003

[Diagnosis of a metastatic valvular tumor in a living patient].

INTRODUCTION: The discovery of an endocardial mass always raises the question of its nature. Infectious endocarditis is the most frequent cause, but others diagnoses must be considered. EXEGESIS: We report a case of endocardial metastasis originating from an upper respiratory tract epidermoid carcinoma in a 48-years-old man. The diagnosis was established while the patient was alive, and survival at the time of writing is 8 months. This case report provides an opportunity for discussion of the differential diagnosis when confronted with an endocardial tumor, i.e. bacterial endocarditis, non-bacterial thrombotic endocarditis, primary cardiac tumors, metastatic osteogenic sarcoma and Libman-Sachs endocarditis. CONCLUSION: Non bacterial thrombotic endocarditis and valvular metastasis should be considered upon discovery of a valvular tumor, in the context of neoplastic disease. The prognosis of endocardial metastasis is poor, but early diagnosis and appropriate management should eventually prolong survival.

Antimetabolites, Antineoplastic↗

PubMed2003

Relevance and complications of intravenous infusion at the emergency unit at Nice university hospital.

OBJECTIVE: Insertion of peripheral venous catheters (PVCs) is current practice within the hospital environment and particularly in the emergency department (ED). This simple yet invasive technique may result in venous thrombosis, infection or mechanical complications. We conducted a prospective study at the Nice University Hospital ED in order to determine the frequency, relevance and complications of peripheral venous cannulation. PATIENTS AND METHODS: Fourteen 24 h periods were surveyed over the months of May and June 2000, during which 2515 patients over 16 years of age attended the unit. Demographic and medical data were recorded for every patient who received a PVC. These patients were followed at 12 h intervals until the catheter was removed. Reasons for PVC, time left in place, and eventual complications were recorded. Justification for PVC was evaluated upon arrival at the ED, upon exiting the ED and in some cases within the hospital ward. RESULTS: Six hundred and thirty of 2515 patients (25%) received a PVC (290 women (46%) and 340 men (54%); meanage 58 years). Indication for the PVC was considered unjustified in 24.8% of cases upon arrival at the ED, and 33.8% upon leaving the ED. Upon admission in a hospital ward after passing through the ED, out of 318 patients, the PVC was left in place for no reason in 63 (20%). Overall, 390 PVCs were followed until the time of their removal. Mean duration of IV infusion was 28 h. Among these 390 patients, 62 (15.9%) developed complications, of which 54 (13.6%) had thrombophlebitis and 9 (2.3%) developed local infection. Mean duration of PVC left in place for patients with complications was 50 h vs 25 h for patients with no complications (P<0.001). CONCLUSION: Insertion of a PVC is common practice especially in EDs. The excessive use of this procedure leads to extra cost and iatrogenic complications. A renewed definition of its indication and raised awareness among hospital staff concerning the risks involved with this standard procedure should result in less use of PVC and fewer complications.

Catheterization, Peripheral↗

PubMed2002

Changing trends in pregnancy outcome among HIV-infected women between 1985 and 1997 in two southern French university hospitals.

OBJECTIVES: To analyze risk factors for pregnancy outcome among HIV-infected women before and after introduction of AZT prophylaxis in 1994. STUDY DESIGN: A prospective, two-center observational study conducted from 1 January 1985 to 31 December 1997. PATIENTS: Pregnant HIV-infected women followed in one of the obstetrics units during the study period. MAIN OUTCOME MEASURES: pregnancy outcome (normal delivery, ectopic pregnancy, spontaneous abortion, voluntary termination of pregnancy (TOP) according to year of pregnancy, age at pregnancy professional status, marital status, ethnic origin, mode of contamination, stage of disease, partner's human immunodeficiency virus (HIV) status and prior pregnancy. RESULTS: One thousand one hundred and three pregnancies among 937 HIV-infected women were studied. Mean age of patients was 28.1 +/- 4.9 years. Pregnancy outcomes were distributed as follows: 473 normal deliveries, 589 TOP, 9 ectopic pregnancies and 32 spontaneous abortions. The proportion of TOP decreased from 59.4% before 1994 to 37.5% from 1994 (P < 0.001). In univariate analysis, mode of transmission, marital status, ethnic origin, partner's HIV status and prior pregnancy were also significantly correlated with pregnancy outcome. However, after adjustment by logistic regression for each period (before and after 1994), mode of transmission no longer appeared to influence pregnancy outcome. CONCLUSION: Effective prevention of mother-to-child transmission of HIV infection appears to have influenced HIV-infected women's decisions on continuing their pregnancy to term. Incidence of voluntary TOP has decreased significantly after introduction of AZT.

Abortion, Induced↗

PubMed2002

Consensual treatment of plasmodium falciparum malaria does not lead to adequate quinine blood concentrations.

Since 1996, we have a common protocol in the Infectious Diseases Department and the Intensive Care Unit for the administration of quinine in case of Plasmodium falciparum malaria. Patients were classified as uncomplicated form of malaria (UFM) or severe form of malaria (SFM) according to WHO criteria, adding parasitemia >5% as a criteria of SFM. Treatment of SFM should consist of a 4 h infusion of 16 mg/kg quinine-base loading dose, followed by 8 mg/kg every 8 h. Patients with UFM receive quinine-base, 8 mg/kg every 8 h. A therapeutic index of 10-15 mg/l was considered adequate. Hypoglycemia and cardiotoxicity were the two main adverse effects of quinine to be investigated. In order to verify that these modalities for quinine administration are associated with adequate quinine blood concentrations, we have reviewed the pharmacological data and the occurrence of adverse effects. Between April 1996 and December 2000, 95 patients were hospitalised: 25 with SFM and 70 with UFM: 78/95 patients (82%) received adequate treatment and 26/95 (28%) of the patients presented an overdosage of quinine. Six severe adverse effects were observed, even in case of adequate quinine administration. Consensual treatment of malaria does not confer adequate quinine blood concentrations, and toxic effects are still common.

Animals↗

PubMed2001

Ventricular patch endocarditis caused by Propionibacterium acnes: advantages of gallium scanning.

Propionibacterium acnes is a weakly pathogenic commensal of the skin. When isolated from blood cultures it is often considered a contaminant. However, P. acnes may be responsible for severe infections and its role in certain cases of infectious endocarditis has now been definitely established.(1) We report a case of endocarditis due to P. acnes stemming from a ventricular patch and revealed by a gallium 67 scan.

Endocarditis, Bacterial↗

PubMed1999

Epidemiology of bacterial infection during management of open leg fractures.

In a randomised double-blind trial conducted between 1990 and 1994, 616 patients from 43 centres, pefloxacin (group P, 316 patients) and a cefazolin-oxacillin combination (group C, 300 patients) were compared in the prophylaxis of bone infection after grade 1 and 2 open leg fractures. Samples were obtained at emergency, before and during surgery, and from drain aspirates. Antimicrobial susceptibility, slime production and adherence properties of the bacteria were tested. Cultures at emergency and before surgery showed similar distributions of gram-positive and gram-negative bacteria in both groups, while wound closure and infecting isolates showed prevailing gram-positive bacteria in group P and gram-negative bacteria in group C. Positive cultures at each stage were correlated with the occurrence of infection but were not predictive of the infecting species, which were nosocomial bacteria in most cases. Positive cultures at wound closure warn of a higher infection risk. Twenty-one of 316 (6.6%) patients in group P and 24 of 300 (8%) in group C were considered infected within 3 months. The difference is not significant (chi-square test = 0.42; P = 0.51). Infecting strains were isolated from 38 patients (group P, 18; group C, 20). Infecting species, although not predictable, appear to be those escaping the spectrum of the prescribed antimicrobial prophylaxis.

4-Quinolones↗

PubMed1999

Gradient plate method to induce Streptococcus pyogenes resistance.

In recent years, increasing numbers of Streptococcus pyogenes (GAS) strains displaying resistance to macrolides have been reported in Finland, Japan, Asia and Spain. Antibiotic use has been shown to be a risk factor for infection with and carriage of drug-resistant streptococci. The aim of this study was to compare in-vitro development of resistance of streptococci to beta-lactams (penicillin, amoxycillin, cefotiam and cefuroxime) and erythromycin by serial passages in subinhibitory concentrations of antibiotics (subMICs) by gradient plate method. Three clinical strains of GAS were tested. Two were susceptible to erythromycin (MIC = 0.015 mg/L and 0.013 mg/L) and one resistant. Serial passages were performed daily by gradient plate method until a four-fold increase of the MIC was achieved. GAS variants obtained after serial passages in beta-lactams had MICs increased at least four-fold. They remained susceptible to these antibiotics. With erythromycin, final MICs reached intermediate and resistant level. Results obtained in this study with erythromycin are in good correlation with clinical studies showing that prior exposure to macrolides may help to facilitate the emergence of drug-resistant strains of streptococci.

Anti-Bacterial Agents↗

PubMed1999

[Nasopharyngeal carriage of resistance pneumococci in day-care centers in the Alps-Maritimes region].

To provide ongoing information on regional trends of antibiotic resistance prevalence to pneumococci, a cross selectional survey was conducted on a large representative sample of children attending day-care centers. Children were analyzed in spring (n = 378) and autumn (n = 379) for nasopharyngeal carriage. Streptococcus pneumoniae was detected in 149 children (39.4%) in Spring and 204 (59.8%) in Autumn. Half of these isolated strains showed penicillin insensitivity or resistance. A high proportion of children (43.6% in spring and 47.5% in autumn) had been treated with antibiotics during the 3 months prior to sample collection; 21.6% of isolated strains were serotype 6B, 20.1% type 23F, 18.9% type 19A and 19F, 11.5% type 14. Reduced susceptibility was frequently noted in serotype 23F, 14 and 19F, representing 93%, 94% and 46% of identified serotypes, respectively. Acquisition of a strain of PRP was correlated with prescription of antibiotics during the previous three months (p < 0.05). This type of survey on children in day-care centers can contribute to the understanding of regional variations in antibiotic resistance and provide information for epidemiological surveillance.

Animals↗

PubMed1998

New perspectives offered by a French study of antibiotic resistance in day-care centers.

To provide ongoing information on regional trends of antibiotic resistance prevalence to pneumococci, a cross-sectional survey was conducted on a large representative sample of children attending day-care centers. Children were analyzed in spring (n = 379) and autumn (n = 379) for nasopharyngeal carriage. Streptococcus pneumoniae was detected in 149 children (39.4%) in spring and 204 (59.8%) in autumn. Half of these isolated strains showed penicillin insensitivity or resistance. A high proportion of children (43.6% in spring and 47.5% in autumn) had been treated with antibiotics during the 3 months prior to sample collection; 21.6% of isolated strains were serotype 6B, 20.1% type 23F, 18.9% type 19A and 19F, 11.5% type 14. Reduced susceptibility was frequently noted in serotype 23F, 14 and 9V, representing 93, 94 and 83% of identified serotypes, respectively. This type of survey on children in day-care centers can contribute to the understanding of regional variations in antibiotic resistance and provide information for epidemiological surveillance.

Child↗

PubMed1997

Pneumococcal resistance patterns in Europe.

The emergence of Streptococcus pneumoniae strains with decreased susceptibility to penicillin has been reported worldwide over the past 20 years. However, there are striking discrepancies in penicillin susceptibility among various European countries, suggesting that local conditions may affect clonal propagation or de novo selection of resistant strains. In the present study, data on penicillin resistance patterns, antibiotic use and mode of administration, and treatment compliance in five European countries (France, Spain, Germany, Italy, and the UK) were compared. High prevalence rates of penicillin-resistant pneumococci have been reported in Spain and France, where antibiotics are widely prescribed, and overall in Europe, patient compliance with more than 50% of oral antimicrobial prescriptions is inadequate. The low prevalence of penicillin resistance in Germany and the UK coincides with lower antibiotic consumption and better treatment compliance in these countries. Recent attempts to raise public awareness and to restrict and improve indications for antimicrobial agents have resulted in decreased pneumococcal resistance in Hungary and Iceland, suggesting that pneumococcal resistance can be reversed.

Anti-Bacterial Agents↗

PubMedDate not supplied

Intracellular concentration of protease inhibitors in HIV-1-infected patients: correlation with MDR-1 gene expression and low dose of ritonavir.

BACKGROUND: Protease inhibitors (PIs) are substrates for the P-glycoprotein (P-gp/170) encoded by the multi-drug resistance gene (MDR-1). HIV infection is associated with increased expression of P-gp. The role of MDR gene overexpression in clinical pharmacokinetics is not known. METHOD: We determined by HPLC, at trough and peak levels, the current PI concentrations in plasma (P) and in peripheral blood mononuclear cells (PBMCs) (intracellular concentration [IC]) from 49 HIV-infected patients receiving different treatment combinations: nelfinavir ([NFV] n = 12); indinavir ([IDV] n = 10); amprenavir ([APV] n = 5); ritonavir (RTV) 100 bid/IDV 800 mg bid (n = 6); RTV 400 bid/IDV 400 mg bid (n = 3); RTV 100 bid/saquinavir (SQV) 600 mg tid (n = 9); APV 600 bid/RTV 100 mg bid (n = 4). We determined the mean ratio of intracellular/plasma PI concentration for each treatment group. The MDR-1 gene expression was determined by a semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). HIV viral load was simultaneously measured. RESULTS: 49 patients (mean age 41 +/- 8.7 years; mean CD4 cell count 418 [57-972]; mean HIV RNA 2.1 +/- 0.8 log(10)) were included in the study. Patients who overexpressed the MDR-1 gene had significantly lower trough intracellular PI levels (p =.02) or lower intracellular accumulation of PI (p =.042). Patients treated with low-dose RTV in combined regimens with detectable RTV intracellular concentration showed lack of MDR-1 gene expression (p =.01). Patients with HIV RNA < 40 copies/mL had significantly higher RTV intracellular accumulation (p =.029). CONCLUSION: In HIV-infected patients, IC of PI is inversely correlated with MDR-1 gene overexpression. Undetectable viral load was associated with the use of low-dose RTV, probably linked to better intracellular accumulation of the drug. Nevertheless, further investigation is needed to confirm these results.

Adult↗