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Biomedical subjects

C Cornette

Publications and source records attributed to C Cornette.

At least 19 recordsLinked to original sources
PubMed2006

[Surveillance of antimicrobial resistance and antimicrobial use in a university-affiliated hospital: implementation of a computerized system].

UNLABELLED: After half a century of antibiotic use, the increasing problem of the emergence and spread of antimicrobial-resistant pathogens has created a problem of public health. The causes of this problem are multifactorial, but the excessive and inappropriate use of antimicrobials is the principal cause. The current guidelines for the control of antimicrobial resistance in hospitals recommend the implementation of a surveillance system of antimicrobial use and antimicrobial resistance data. AIM OF THE STUDY: The objective of our project was to develop a computerised tool to survey the antibiotic consumption data and the antimicrobial resistance. MATERIALS AND METHODS: We have collected antimicrobial resistance data from the software of the bacteriology laboratory, antibiotic use data from the pharmacy and demographical data from the hospital's admission department. These data were integrated in a database server and available with a web application. Antimicrobial resistance data of 15 major microorganisms were extracted and expressed as a frequency with elimination of repeats by using time criteria (7, 14 or 28 days). Antibiotic use data were converted into defined daily doses (DDD) and expressed per 1000 patient-days. RESULTS: Data are available for consultation in the form of tables or graphs per unit, type of units (medicine, surgery, pediatrics, intensive care units) or in the whole hospital. The system allows the confrontation on the same graph of antimicrobial resistance and antibiotic use data. CONCLUSION: Our surveillance system constitutes a needed prerequisite to the implementation of a global strategy of antibiotic use improvement in our hospital.

Anti-Infective Agents↗
PubMed2004

Relationship between glycopeptide use and decreased susceptibility to teicoplanin in isolates of coagulase-negative staphylococci.

To investigate the relationship between glycopeptide use and decreased susceptibility to teicoplanin in coagulase-negative staphylococci (CNS) isolates, data on teicoplanin susceptibility and glycopeptide use from existing microbiology laboratory and pharmacy databases were collected for the period between July 2000 and March 2001. Pooled data for the entire study period were first used to analyse associations. Univariate analysis showed that the incidence of CNS with decreased susceptibility to teicoplanin was significantly correlated with the use of glycopetides, particularly with vancomycin use. This association was confirmed by multivariate analysis. This study suggests that variations in antimicrobial resistance are related to variations in antimicrobial use in the model of CNS with decreased susceptibility to teicoplanin, thus confirming the usefulness of restricting antimicrobial prescribing as a means of controlling resistance.

Anti-Bacterial Agents↗
PubMed2001

Cost-effectiveness of urinary dipsticks to screen asymptomatic catheter-associated urinary infections in an intensive care unit.

OBJECTIVE: To assess the cost-effectiveness of urinary dipsticks (UDs) to screen asymptomatic catheterized patients for quantitative urine. DESIGN: Prospective comparison of UD with quantitative urine culture (QUC) (reference technique) and cost-effectiveness analysis performed from the hospital's perspective. SETTING: Medical intensive care unit (ICU) of the Besançon University Hospital (France). PATIENTS AND PARTICIPANTS: All consecutive, asymptomatic, catheterized patients. INTERVENTIONS: Urinary dipsticks (Multistix 8-SG) were analyzed by the reflectance spectrophotometric method (Clinitek 50). Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of four combinations of the leukocyte (L) test pad and the nitrite (N) test pad were calculated: L and N, L or N, L alone and N alone. A micro-costing technique was used to determine the direct medical cost of each strategy. The calculated cost-effectiveness ratio was the incremental cost-effectiveness (ICE) ratio. MEASUREMENTS AND RESULTS: Three hundred thirty-nine urine samples taken from 144 patients were analyzed. The incidence of asymptomatic catheter-associated urinary tract infections (CAUTIs) was 31.3% (> or =10(5) organisms/ml). The L or N combination was the best detector of asymptomatic CAUTI: Se=87.2%, Sp=61.6%, PPV=30.6% and NPV=96.1%. The cost of QUC strategy and UD strategy was EUR 21.5 and EUR 12.6 per test, respectively. The ICE ratio of QUCs was EUR 69.5 per case of detected CAUTI. CONCLUSION: The UD is a cost-effective test for screening asymptomatic catheterized patients for quantitative urine culture in a medical ICU.

Cost-Benefit Analysis↗
PubMed2001

Risk factors for catheter-associated bacteriuria in a medical intensive care unit.

In a prospective study including 137 consecutive catheterised patients in a medical intensive care unit, the following variables were analysed as possible risk factors for catheter-associated bacteriuria, defined as a quantitative culture with > or = 10(5) organisms/ml: age, sex, simplified acute and physiologic score at admission, duration of catheterisation, diabetes mellitus, immunosuppression, neurologic disorders and prior systemic antibiotic exposure during hospitalisation. The frequency of catheter-associated bacteriuria was 30.7%. By multivariate analysis, female sex (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.9-13.5; P=0.001) and a duration of catheterisation >11 days (OR, 19.4; 95% CI, 5.5-68.7; P=0.0001) were risk factors for catheter-associated bacteriuria, and prior antibiotic exposure was a protective factor (OR, 0.06; 95% CI, 0.019-0.21; P=0.0001).

Adult↗
PubMed2000

Clinical and molecular epidemiology of hospital Enterococcus faecium isolates in eastern France. Members of Réseau Franc-Comtois de Lutte contr les Infections Nosocomiales.

We carried out a surveillance study of Enterococcus faecium isolates in the Franche-Comtéregion of France over three years. Clinical and epidemiological strains were characterized by antibiotype and genotype (pulsed field gel electrophoresis, PFGE). Three case-control studies were performed to identify risk factors for colonization/infection with three defined resistant phenotypes (amoxycillin, high-level gentamicin and high-level kanamycin). The crude incidence of colonization/infection was 0.156%, and 68.8% of cases were classified as hospital-acquired. Incidence did not differ according to the type of hospitalization (middle term or acute care). The urinary tract was the major site of infection. Resistance rates were: 45.8% (amoxycillin), 18.7% (high-level gentamicin), 61.4% (high-level kanamycin) and 3.1% (vancomycin). No isolate produced b-lactamase and one isolate carried the vanA gene. PFGE revealed two major epidemic patterns each including resistant strains isolated in different hospitals and during different periods in the study. Previous antimicrobial treatment was not identified as a risk factor for colonization/infection with any resistant phenotype. Despite the low frequency of vancomycin-resistant isolates in this study, resistant strains were widely disseminated and had characteristics enabling them to persist and spread. If these strains acquired the vanA gene, the risk of an outbreak would be large. So, the prevalence of vancomycin-resistant E. faecium in hospitals should be carefully monitored in the future.

Adult↗
PubMed1999

[Antibiotic therapy of febrile neutropenic patients: prospective study at a hematologic department].

OBJECTIVES: Many antibiotics have been studied in clinical trials in neutropenic patients with fever. Few have been evaluated in the everyday clinical setting. The aim of our study was to analyze the antibiotic strategy used in an adult hematology unit after guidelines had been set up. METHODS: A prospective study was conducted by a pharmacy team not directly working with the prescribing unit. Parameters recorded were drug use, treatment duration and reasons for changing successive drugs. Bacterial ecology data were analyzed. RESULTS: Seventy-four patients were included in the study. Mean treatment duration was 14.8 days and was related to degree of neutropenia: 10 days in case of short neutropenia and 16.2 days for prolonged neutropenia. The most frequent first intention prescription was for non-anti-pseudomonas fl-lactams plus tobramycin, modifications made were: substitution with an anti-pseudomonas fl-lactam and introduction of a glycopeptide as second or third intention drugs. Imipenem and fluoroquinolones were used little. Mean duration of each regimen was 4 days. Initial treatment was generally empirical (7% of the prescriptions were based on documented susceptibility data). The highest rate of bacteriological data (20%) was obtained during the first intention regiment (42% coagulase-negative staphylococci, 14% Pseudomonas aeruginosa). The main reason for changing antibiotics was persistent or renewed fever. No bacterial caused deaths were recorded. No multiresistant Gram negative bacilli were selected. DISCUSSION: Reasonable use of antibiotics is possible in neutropenic patients with fever. First intention anti-pseudomonas fl-lactams and glycopeptides are not indispensable in most of these patients. An analysis of practice in the everyday clinical setting is required for optimal use of antibiotics.

Adult↗
PubMed1999

[Incomplete prescription: a potential medication error].

OBJECTIVE: According to the American Society of Health System Pharmacists, an incomplete or imprecise medial order comprises a prescription error. Such errors have potential consequences in terms of mortality, morbidity, prolonged hospital stay and, finally, in health care expenditure. The aim of this study was to determine the rate of incomplete prescriptions observed in a university hospital setting and identify the causes of such imprecisions. METHODS: A prospective analysis of prescriptions for oral medicines ordered by an internal medicine unit of a university hospital was conducted on a daily basis by a pharmaceutical team immediately after the orders were written. A complete prescription was defined as one with the following information: unit dose, formulation, number of doses per day, hour of administration, particular instructions for use. RESULTS: Among the 241 prescription lines analyzed during a 20 day period, 131 (54.2%) were incomplete. The number of doses per day was missing for 7.9%, unit dose for 6.2%, particular instructions for 4.9% and the formulation for 2.9%. DISCUSSION: These findings demonstrated the lack of quality of the prescriptions studied. A treatment scheme totally incompatible with quality prescriptions and a poor understanding of prescription quality were the most probable causes. These two elements reflect the gap between the outdated organizational scheme currently in use and appropriate implementation of the hospital drug distribution circuit.

Drug Prescriptions↗
PubMed1999

Medication errors at the administration stage in an intensive care unit.

OBJECTIVE: To assess the type, frequency and potential clinical significance of medication-administration errors. DESIGN: Prospective study using the observation technique as described by the American Society of HealthSystem Pharmacists but eliminating the disguised aspect. SETTING: Medical intensive care unit (ICU) in a university hospital. PATIENTS AND PARTICIPANTS: 2009 medication administration interventions by nurses. INTERVENTIONS: Pharmacist-performed observation of preparation and administration of medication by nurses, comparison with the original medical order and comparison with the data available in the literature. MEASUREMENTS AND RESULTS: 132 (6.6% of 2009 observed events) errors were detected. Their distribution is as follows: 41 dose errors, 29 wrong rate, 24 wrong preparation technique, 19 physicochemical incompatibility, 10 wrong administration technique and 9 wrong time errors. No fatal errors were observed, but 26 of 132 errors were potentially life-threatening and 55 potentially significant. CONCLUSION: According to this first observation-based study of medication administration errors in a European ICU, these errors were due to deficiencies in the overall organisation of the hospital medication track, in patient follow-up and in staff training.

France↗
PubMed1998

Removal of piperacillin in critically ill patients undergoing continuous venovenous hemofiltration.

OBJECTIVE: Continuous hemofiltration is now widely used in the intensive care unit. Our study aimed to assess the removal of piperacillin under continuous hemofiltration and to define a suitable dosage regimen of administration. DESIGN: Prospective study of blood and ultrafiltrate concentrations of piperacillin to assess the pharmacokinetics of the antibiotic. SETTING: The medical intensive care unit of a teaching hospital. PATIENTS: Ten patients were included in the study. Six patients were receiving their first dose of piperacillin (group 1) and four had already been treated for 2 to 6 days (group 2). The mean Simplified Acute Physiology II score was 74 +/- 6 (SEM), and the number of organ failures was 3.6 +/- 0.3 (range 3 to 5). Renal failure was related to septic shock in seven patients and to cardiogenic shock in three patients. Seven patients were anuric. Hepatic dysfunction was present in four of the ten patients. INTERVENTIONS: Patients were treated with continuous venovenous hemofiltration using a hollow polysulfone capillary fiber. Piperacillin (4 g) was injected intravenously over 20 mins. Arterial blood and ultrafiltrate were sampled immediately before the injection and then every hour until 8 hrs after injection time. Piperacillin concentrations were assayed using high performance liquid chromatography. MEASUREMENTS AND MAIN RESULTS: In group 1, the mean serum peak concentration of piperacillin was in the normal range (125 +/- 21 mg/L), but trough values were higher (48 +/- 8 mg/L) than in normal subjects. In group 2, trough values before the injection were increased in all patients (188 +/- 71 mg/L). At T1, blood peak concentration reached 470 +/- 127 mg/L. A small amount of piperacillin was retrieved from the ultrafiltrate. The elimination half-life was 5.1 +/- 1.4 and 4.8 +/- 1.4 hrs in groups 1 and 2, respectively. CONCLUSIONS: Piperacillin was not removed to a significant extent during continuous hemofiltration. Further, in the intensive care unit, patients in shock with multiple organ failure such as liver failure might behave differently from patients with stable end-stage renal disease. A 4-g dose of piperacillin twice a day is recommended in such patients.

Aged↗
PubMed1989

Decreased serum TBG concentration in the face of normal T4-binding capacity in patients on hemodialysis.

Serum TBG concentrations were evaluated in 34 patients on regular hemodialysis. Mean serum TBG level measured by two different radioimmunoassays was markedly decreased (1.24 +/- 0.08 mg/dl - normal limits 1.6-2.4 mg/dl). Twenty-seven (79%) patients had values below 1.6 mg/dl, which contrasted in 21 of them with a lack of reciprocal elevation of T3RU values. By contrast, T4-binding capacity of TBG measured in 14 patients with low TBG concentration was normal, suggesting that the low TBG values were an artefact resulting from an altered immunoreactivity of the protein. In 2 patients with low TBG while on hemodialysis, TBG levels increased significantly after renal transplantation. This suggests that the "low TBG syndrome" (altered immunoreactivity in the face of normal T4-binding capacity) observed in patients on chronic hemodialysis is a consequence of uremia.

Adolescent↗
PubMed1986

Effects of iodide and thyroxine on iodine-deficient mouse thyroid: a morphological and functional study.

The effects of iodide and thyroxine (T4) on female mice fed a low iodine diet (LID) for 8 weeks were analysed by morphological, stereological and biochemical methods. Iodide was given at a dose of 10 micrograms/day (HID) or 1 microgram/day (MID), either alone or together with daily injections of 1 microgram T4 for 8 or 40 days. With HID, the thyroid weight and the numbers of follicles and cells remained higher than in controls, although cell necrosis occurred. Colloid volume increased and iodine was stored within the gland: a colloid goitre with non-functioning follicles was produced. With MID, the glands resumed an almost normal appearance. With T4 and LID, progressive normalization occurred, but after 40 days thyroid weight and numbers of follicles and cells remained higher than in controls. Glandular iodine content slowly increased and reached control value. The proportions of 125I-labelled tri-iodothyronine (T3) and T4 in thyroglobulin were reduced. With T4 and HID, the glands resumed a normal appearance. Neither necrosis nor folliculoneogenesis was noted. The proportions of 125I-labelled T3 and T4 in thyroglobulin were reduced, but T3 and T4 serum levels were higher than with HID. With T4 and MID, a normal state was obtained as early as day 8. After 40 days the gland was morphologically and functionally inactive. In conclusion, the association of T4 and iodide seems to be the best way to obtain a rapid and complete involution of thyroid hyperplasia. The administration of T4 prevents the deleterious effects of an excess of iodine on follicular cells, and causes the gland to enter a slow-functioning state.

Animals↗
PubMed1985

Morphological and functional changes during thyroid hyperplasia and involution in C3H mice: effects of iodine and 3,5,3'-triiodothyronine during involution.

Involution of thyroid hyperplasia was induced in mice by discontinuing a goitrogenic treatment (low iodine diet plus 0.25% propylthiouracil for 10 days) and returning either to a moderate iodine diet (MID; 1 microgram I/day) alone or associated with T3 administration (1 microgram/day) or to a high iodine diet (HID; 10 micrograms I/day) alone or associated with T3 treatment. Thyroid involution was studied by morphological, stereological, and biochemical methods after 2, 4, 6, and 8 days of involution. Age-paired, HID-fed animals were used as controls. When the involution was induced by MID, the glands resumed a normal morphological aspect. The synthesis and secretion of T3 were highly stimulated on day 2, but decreased thereafter. Plasma T4 levels reached a plateau at 50% of the control value from days 2-8. The administration of T3 together with MID accelerated the involution of hyperplasia and colloid accumulation in the follicular lumina. The synthesis and secretion of T3 and T4 remained lower than those in controls. When the involution was induced by HID, the thyroid weight remained higher than that in controls or in any involuting groups. The number of follicles and epithelial cells as well as the glandular thyroglobulin content were twice the control values. A Wolff-Chaikoff effect was evident on day 4, and hypothyroidism persisted. When HID was supplemented with T3 treatment, glandular weight and morphology were normal, but the Wolff-Chaikoff effect occurred earlier. In conclusion, the iodine dose given after a goitrogenic treatment must be carefully controlled; a high but physiological dose can have deleterious effects, whereas a small dose is beneficial. T3 prevents the deleterious effects of HID, but the thyroid enters a resting state.

Animals↗
PubMed1985

[Modifications of the hepatotoxicity of cocaine on Swiss mice by various inhibitors].

Cocaine (50 mg/kg i. p.) in phenobarbital-treated mice induces hepatotoxicity. Treatment with SKF 525A, diazinon or diethylmaleate 30 minutes prior to cocaine demonstrates a metabolite responsibility for this trouble. However this metabolite reacts only weakly with glutathione and does not produce lipid peroxidation as measured by the thiobarbituric acid reaction.

Alanine Transaminase↗
PubMed1984

Serum thyroglobulin levels in preterm neonates.

Serum thyroglobulin (Tg) levels were determined in preterm neonates. Very high values were found at birth. A significant negative correlation was observed between Tg levels and gestational age. A longitudinal study indicates that a very sharp decrease in Tg levels occurred after birth. Three weeks after birth, the values were close to the values of full-term neonates. These high hTg values could result either from an increased turnover of hTg or from a lower clearance rate of this iodoprotein.

Gestational Age↗
PubMed1984

The thyroid-system function in preterm infants of postmenstrual ages of 31 weeks or less: evidence for a "transient lazy thyroid system".

A prospective study was conducted in order to evaluate thyroid function in 20 healthy and 18 sick preterm infants with postmenstrual ages of 31 weeks or less. The clinical condition of both groups was compared using a "Neonatal Special Care Evolution Score". The effect of thyroid hormone treatment, given from D10 on to the sick infants, was also studied. TSH, thyroid hormone levels (TG, T4, T3, rT3, FT4 and FT3) and TBG were measured by radioimmunoassays at D0, D10, D20, D30 and D40. Healthy preterm infants on D0 have a median TSH level of 22 microU/ml and a high TG level of 200 ng/ml; thereafter, median serum levels decrease to 6 microU/ml and 35 ng/ml respectively. During the same period, median serum T4 is maintained at a low level of about 6-8 micrograms/dl, median serum T3 gradually increases from 80 ng/dl on D0 to 150 ng/dl on D40, and median serum rT3 decreases beyond D10 from a plateau of 200 ng/dl to about 100 ng/dl. In the sick preterm infants before treatment, serum TSH is as in the control group but serum T4, T3 and rT3 on D10 are well below the control values (P = 0.005). In all conditions, there is a significant correlation between serum T4 and FT4, and between serum T3 and FT3. Thyroxine, given to the sick preterm infants from D10 on, brings median serum T4 values closely to the ones of the control group whereas serum levels of TSH and TG are unaffected and similar to those of the healthy preterm infants. Furthermore, thyroxine brings serum rT3 within the range of the control group but leaves median serum T3 at a low level of about 50 ng/dl. On T3 treatment, serum T3 normalizes but rT3 and particularly T4 tend to decline further. In the conditions of this study a significant difference in TBG level is not proven. Although an untreated sick group was not enrolled in the study, thyroid hormone treatment brought the "Neonatal Special Care Evolution Score" of the treated sick infants closer to that of the healthy preterm infants. In the sick preterm infant with failure to thrive on D10, there is an impaired thyroid discharge of T4 in spite of serum TSH values not different from those of the control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1981

The effects of mild iodine deficiency on neonatal thyroid function.

In order to assess neonatal thyroid function in the endemic goitre areas of Greece, T4 and TSH have been measured. Previous studies had shown that in these endemic areas, adults had low T4 but normal TSH values, probably because of an increase in the serum T3 level. In this study, T4 and TSH were measured in dried blood spots from 259 neonates. The fifty-four full-term neonates from the Greek endemic villages had a lower T4 value (8.8 +/- 0.66 micrograms/dl SE) but a higher TSH (15.37 +/- 1.12 mu/l) than the seventy-three full-term neonates from the non-endemic villages (T4:10.0 +/- 0.33 micrograms/dl, TSH:11.93 +/- 0.59 mu/l) or the ninety-eight from Athens (T4:10.0 +/- 0.33 micrograms/dl, TSH:10.96 +/- 0.64 mu/l). Premature neonates, both from Athens and from the endemic areas, have significantly lower T4 and significantly lower TSH values than the full-term ones from the same areas, probably because of the immaturity of the pituitary-thyroidal axis. It is concluded from these observations that (a) Neonates suffer more from the consequences of iodine deficiency than adults. The biochemical hypothyroidism reported here may be relevant to the delayed skeletal maturation previously reported from children of these same areas. This emphasizes the need for correcting even moderate iodine deficiency. (b) The occurrence of non-toxic goitre with normal TSH levels in adults is best explained by assuming that increased TSH stimulation is necessary for goitre formation during neonatal life, but not for goitre maintainance during adulthood. (c) Newborn screening programmes in these areas should take into account the present findings.

Female↗