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C Dupeyron

Publications and source records attributed to C Dupeyron.

At least 19 recordsLinked to original sources
PubMed2000

A 5-year epidemiological study of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in a medium- and long-stay neurological unit.

Thirty-eight different strains of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (ESBL Kp), isolated from urine and pus samples of 38 patients hospitalized in a medium- and long-stay neurology department between 1 January 1992 and 31 December 1996, were analysed by antibiotic resistance phenotyping, DNA macrorestriction by pulsed-field electrophoresis and isoelectric focusing of beta-lactamases. An epidemiological survey was conducted to identify risk factors for infection by ESBL Kp in this setting. The 38 isolates were distributed into 13 antibiotypes, three of which predominated (13, six and six isolates). The DNA macrorestriction pattern identified 15 genotypes, four of which predominated (11, six, four and four isolates). A combination of the two typing methods revealed several epidemic clones that emerged consecutively. Two main types of ESBL (SHV-2 and CTX-1) were identified by isoelectric focusing, the former predominating. The case-control study showed that the length of hospital stay, degree of malnutrition and dependency, and urinary sphincter status were the main factors significantly associated with ESBL Kp isolation.

Aged↗
PubMed1998

[False Osler node].

Explore the source record for details and available documents.

Echocardiography, Transesophageal↗
PubMed1998

Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: effect of long-term administration of norfloxacin.

We performed a 5-year retrospective study to evaluate the effect of long-term administration of norfloxacin on the epidemiology of severe hospital-acquired infections in patients with advanced cirrhosis. Sixty-seven episodes of spontaneous bacterial peritonitis and 60 episodes of bacteremia occurred in, respectively, 46 patients (group 1a) and 52 patients (group 1b) who did not receive norfloxacin, while 23 and 17 episodes occurred in 21 patients (group 2a) and 17 patients (group 2b) during or within 10 days after long-term administration of norfloxacin. Enterobacteriaceae were more prevalent in groups 1a and 1b than in the other two groups (P < .001 and P < .01, respectively); conversely, staphylococci were more prevalent in groups 2a and 2b (P < .001 and P < .05, respectively). The rate of staphylococcal resistance to methicillin was 53.6% in groups 1a and 1b and 77.3% in groups 2a and 2b. We conclude that long-term norfloxacin administration to cirrhotic patients reduces the risk of gram-negative infections but increases the risk of severe hospital-acquired staphylococcal infections and of high-level resistance to antibiotics.

Aged↗
PubMed1998

Changes in nature and antibiotic resistance of bacteria causing peritonitis in cirrhotic patients over a 20 year period.

AIM: To assess all clinically and bacteriologically documented episodes of spontaneous bacterial peritonitis diagnosed in a single unit over a 20 year period, to identify changes in the nature and antibiotic resistance of the causative bacteria. SETTING: A specialist liver disease unit in a tertiary care centre. MATERIAL: Cultured ascitic fluid obtained in the course of 240 consecutive episodes of clinically and bacteriologically proven spontaneous bacterial peritonitis. Patient recruitment remained stable during the 20 year period in terms of the number of cirrhotic patients admitted and the severity of their condition. RESULTS: 78.7% of isolates were Enterobacteriaceae (Escherichia coli in 51%) and 19% were Gram positive cocci. Until 1979 all the Enterobacteriaceae had the wild phenotype, compared with only 50% at the end of the study period. Since 1993, 22% of Enterobacteriaceae have been resistant to third generation cephalosporins. Methicillin resistant staphylococci were only isolated after 1989. CONCLUSIONS: Changes in the epidemiology and antibiotic resistance of bacteria causing spontaneous bacterial peritonitis must be monitored for optimal treatment.

Ascitic Fluid↗
PubMed1998

[Oxygen in the field hospitals: current experience in the military health service].

A fifty per cent oxygen ratio locks quite sufficient for putting at sleep war wounded patient. After the present time, every french field surgical structures are equipped with oxygen extractors. Furthermore, those teams have at heir disposal for several years, oxygen generators, working with sodium chlorate candels. Those one can fill oxygen cylinders (3.5 l at 90 or 150 bars), providing pure oxygen, which will ever be essential under exceptional conditions. During war period, the supply difficulties demand to have at disposal two different production capabilities for oxygen administration.

France↗
PubMed1997

[Treatment of severe osteoarticular injuries in under conditions of war].

With the experience obtained in a surgical air borne unit and the long term results in a rear zone hospital, we analyse treatments of bone and joint acute traumas in a field hospital. This injuries appear in a particular context: delayed treatments with little staff and equipment. The surgeon has to be fast with protective measures, debridement of soft tissues, bone stabilisation and vascular repair. We discuss the respective place of each treatment: amputations are dictated by the gravity of the wounds; orthopedic methods are used for the upper limb, for the lower limb they are waiting technics; external fixation stabilizes fastly bone injuries, facilitates transportation and permits delayed reconstruction technics. Indications have to be adapted to circumstances: in a surgical unit with rear evacuation possibility the dramatic choice of amputation is often avoided by external fixator; in a short time mission for civilian populations, amputations are more often used but if conservative treatment is preferred, external fixator must be widely used.

Adolescent↗
PubMed1997

[Abdomino-pelvic-gluteal war injuries. Principles of treatment].

From a series of 316 cases of war wounds, the authors selected those cases in which the entry or exit wound was situated between the iliac crests and the inferior gluteal fold and report a series of 21 wounds (including 17 assault gunshot wounds) involving the perineal, pelvic and/or gluteal regions. Wounds of these regions are characterized by their immediate severity (10% mortality in this series), due to the complexity of combined lesions (urethra, rectum, hip, abdominal and vascular lesions) and the severity of sequelae. This series included 5 anorectal wounds, 5 urethral wounds and 4 hip wounds. Based on this series and a review of the literature, the authors discuss diagnostic problems (risk of missing abdominal penetration, a retroperitoneal rectal wound or an articular wound). Principles of treatments are also described (wide debridement and drainage, systematic colostomy for wounds of the rectum and large soft tissues wounds, systematic cystostomy for bladder and urethral wounds and alignment of urethral wounds whenever possible, articular lavage and immobilization by external fixation of hip wounds).

Abdominal Injuries↗
PubMed1996

Serum and urinary nitrate levels in liver cirrhosis: endotoxemia, renal function and hyperdynamic circulation.

BACKGROUND/AIMS: The relationship between nitric oxide production, endotoxemia, renal function and hyperdynamic circulatory syndrome has not been yet investigated in patients with cirrhosis. METHODS: Serum and urine nitrate, endotoxemia and cardiac index were measured in 59 patients with cirrhosis. RESULTS: Patients with a tense ascites had higher serum nitrate levels than healthy control subjects (39 +/- 7 vs 19 +/- 4 mumol/l, p < 0.01). Patients with mild ascites and without ascites had normal values of nitrate levels. In the group of patients not treated with diuretics (n = 38), creatinine and nitrate clearances were lower in ascitic patients than in nonascitic patients (respectively 0.82 +/- 0.12 vs 1.48 +/- 0.32 ml/s, p < 0.02 and 0.30 +/- 0.07 vs 2.89 +/- 2.04 ml/s, p < 0.05). Endotoxin levels were higher in patients with cirrhosis than in control subjects and paralleled the severity of liver failure (Child A/B/C vs control subjects: 0.056 +/- 0.014/0.064 +/- 0.005/ 0.090 +/- 0.008 vs 0.027 +/- 0.005 Endotoxin Units/ml, p < 0.001). Serum nitrate levels did not correlate with endotoxemia (r = -0.110). On the other hand, levels of orosomucoid, a protein synthesized by the liver in response to a stimulation by cytokines correlated with those of nitrate (respectively r = 0.343, p < 0.01). Hemoglobin levels were negatively correlated with serum nitrate levels (r = -0.328 p < 0.02). Cardiac index was higher in patients than in control subjects and paralleled the degree of liver failure (Child A/B/C vs control subjects: 3.60 +/- 0.25/ 4.10 +/- 0.19/4.47 +/- 0.25 vs 3.15 +/- 0.12 l.min.m2, p < 0.001). Cardiac index did not correlate with serum nitrate levels, urine nitrate excretion and endotoxemia. CONCLUSIONS: Renal impairment accounts for the increased levels of serum nitrate in ascitic patients. A stimulation of nitric oxide production by cytokines may occur but endotoxemia is not involved in such a mechanism. Anemia has a role in nitric oxide activity. Nitric oxide generation assessed by nitrate in serum and urine does not seem to participate in the hyperdynamic circulatory syndrome in patients with cirrhosis.

Analysis of Variance↗
PubMed1996

[Surgical activity at the military health service antenna during the Turquoise operation in Rwanda June-August 1994].

The military health service provided a surgery antenna during the two months of the Turquoise operation in Zaire and Rwanda. During this period, the antenna functioned as a back-up station for the French troop and the local populations subjected to various conditions: Rwanda refugees who had escaped the massacres, subjects wounded by canon shots, war wounds, surgery emergencies in the refugee population. There were 315 operations performed including 33% in children and 70% for lesions of the limbs. The activity during the mission was analyzed on the basis of strategy for surgical diagnosis and treatment under local conditions (lack of complementary examinations, limited number of personnel, disrupted families in the refugee population, no possibility for transfer, major cholera and dysentery epidemic...).

Child↗
PubMed1995

Methicillin-resistant Staphylococcus aureus subtyping: interest of combined antibiotyping and esterase electrophoretic typing.

Ninety-four methicillin-resistant Staphylococcus aureus isolates (MRSA) were characterized by means of two typing methods, antibiotyping and esterase electrophoretic typing. Antibiotyping, recorded on the basis of susceptibility testing of 13 antimicrobial agents, allowed the description of 18 antibiotypes, four of which comprised 30, 14, 14 and 12 strains respectively. Esterase electrophoretic typing, based on esterase activity against seven synthetic substrates after polyacrylamide-agarose gel electrophoresis, led to the description of 12 electrophoretic types, two of which were predominant with 60 and 20 strains respectively. The combined use of both typing methods yielded 32 combinations, three of which were predominant with 21, 12 and 11 strains respectively. A good differentiation of strains was achieved, particularly when the antibiotype was correlated to the electrophoretic type. Thus, the combination of antibiotyping with esterase electrophoretic typing may be proposed as a well-suited method for the characterization of MRSA strains.

Bacterial Typing Techniques↗
PubMed1995

[Outbreak of infections of Klebsiella pneumoniae with extended spectrum beta-lactamase in a hospital unit with a long and medium stay].

Fourteen extended-spectrum beta-lactamase (ES beta la) Klebsiella pneumoniae strains were isolated from 14 inpatients between February 1993 and February 1994, in a medium- and long-stay neurological unit. For this reason an epidemiological study was begun, based on strain typing and examination of patient files. Strain typing was carried out by two methods (i) the analysis of antibiotic resistance, showing 7 different antibiotypes among the 14 strains studied, (ii) the analysis of esterase and dehydrogenase electrophoretic polymorphism in polyacrylamide-agarose gel. The method was checked by analysing 11 Klebsiella pneumoniae strains with wild phenotype for beta-lactam antibiotics, which were isolated during the same period in the same unit. Simultaneously 6 other strains isolated during the same period in some other units of the hospital were analysed. Nine electrophoretic types were found among the 31 strains (wild and ES beta las). The analysis of the results showed that 8 isolates of the group of 14 ES beta las had the same antibiotype and electrophoretic type. This demonstrates that one epidemic strain was responsible for two outbreaks, the first one in April and the second one in August-September. A case control investigation was carried out to define the risk factors of infection. Files were examined for the 14 infected inpatients and for 20 control inpatients from the same unit during the same period. Statistical analysis was performed with Epi Info software 5 (CDC Atlanta). Length of stay, dependence and malnutrition levels, and urinary sphincter disfunction were the most significant risk factors.

Anti-Bacterial Agents↗
PubMed1994

Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis.

We carried out quantitative culturing of stools from 31 hospitalized alcoholic patients with cirrhosis and ascites, before treatment with 400 mg of norfloxacin per day, weekly for the first month, and then every 2 weeks thereafter for 15 to 229 days (median, 54 days). Members of the family Enterobacteriaceae virtually disappeared from the stools (< 10(2)/g), but treatment had little effect on enterococci. No selection of resistant organisms occurred in 15 patients, but the remaining 16 patients developed fecal organisms resistant to fluoroquinolones between days 14 and 43 of treatment (median, 25 days). Staphylococcus aureus was isolated four times, coagulase-negative Staphylococcus spp. were isolated six times, Citrobacter freundii was isolated four times, Enterobacter cloacae was isolated three times, Klebsiella oxytoca was isolated twice, Proteus rettgeri was isolated once, and untypeable streptococci were isolated six times. Some isolates persisted, while others were transient (one to seven consecutively positive cultures). The MICs of four quinolones (nalidixic acid, norfloxacin, ofloxacin, and ciprofloxacin) were determined by use of experimental microwell strips (ATB CMI; Biomerieux S.A.). All the strains isolated before treatment were susceptible to the four quinolones, with low MICs, whereas those isolated during norfloxacin treatment were highly resistant. Long-term norfloxacin administration thus carries a risk of disturbing the bacterial ecology in these patients, suggesting that digestive decontamination should no longer be prescribed routinely to cirrhotic patients with ascites.

Ascites↗
PubMed1981

[Effect of Gram-negative bacteria on fatty acids].

The gram-negative bacteria investigated exert various effects on fatty acids. P. aeruginosa and A. calcoaceticus catabolize any of the fatty acids tested. S. marcescens is effective upon all fatty acids excepting butyric acid. The long chain fatty acids only are degraded by E. coli, meanwhile the other fatty acids present a bacteriostatic or bactericidal activity on it. The authors propose a simple and original method for testing the capability of degradation of fatty acids by some bacterial species.

Bacteria↗