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Biomedical subjects

D Guillemot

Publications and source records attributed to D Guillemot.

At least 19 recordsLinked to original sources
PubMed2006

Control of an ACC-1-producing Klebsiella pneumoniae outbreak in a physical medicine and rehabilitation unit.

This article describes an outbreak of ACC-1-producing Klebsiella pneumoniae involving 40 patients. These were mainly men under 40 years old with a spinal cord injury, in a physical medicine and rehabilitation unit. The main risk factors were prolonged hospital stay, multiple-bed rooms, tracheostomy care and assisted defaecation. The outbreak was only controlled after the introduction of rigorous patient placement (i.e. single rooms or cohorting in the same room), while allowing the patients to have free access to the various technical services (e.g. physiotherapy and occupational therapy) and living spaces necessary for re-education.

Adult↗
PubMed2005

Use of avilamycin for growth promotion and avilamycin-resistance among Enterococcus faecium from broilers in a matched case-control study in France.

We assessed the putative link between avilamycin-resistant Enterococcus faecium carriage and avilamycin consumption in broilers. As part of the French programme of monitoring for antimicrobial resistance, broilers sampled at slaughterhouse in 1999 and 2000 and carrying avilamycin-resistant E. faecium were matched by slaughterhouse, slaughter month and production type (free-range, standard, light) with control broilers carrying avilamycin-susceptible strains. History of antibiotics consumption (either for growth promotion or therapeutic purpose) in the broiler flocks sampled was collected from the monitoring programme and consumption of each antibiotic class was screened as a potential risk factor. Avilamycin was a risk factor for avilamycin-resistant E. faecium carriage: OR=2.3.

Abattoirs↗
PubMed2005

Invoices and farmer interviews for vaccine-exposure measurement in turkey-broiler production.

Exposure measurement in pharmaco-epidemiological studies can be based on various sources that do not always concur. However, reliability is an important criterion when selecting the method used to assess exposure and interpreting the results obtained. An analysis based on invoices might be more informative and more accurate to assess vaccines exposure (yes/no) in turkey broiler production than a questionnaire administered to farmers, which is nevertheless more feasible and less time-consuming. We compared the two methods to assess vaccination exposure in 239 turkey broiler flocks reared in 129 farms in 2000-2001. The agreement (crude agreement and kappa) was calculated, and association between discrepancy and farm and flock characteristics was investigated. Marek's-disease vaccine, Newcastle-disease vaccine, turkey haemorrhagic-enteritis vaccine and turkey-rhinotracheitis vaccine exposures were reported on the questionnaire for 2.1, 27.6, 93.0, and 98.3% of flocks, respectively, and for 2.1, 29.3, 89.4, and 86.6%, of invoices for the flocks studied, respectively. A discrepancy was observed in 24.9% of flocks. A discrepancy was observed more frequently in specialised farms without any other animal production (OR = 3.6; CI = 1.5, 8.9) and when the farmer did not know whether vaccination had been performed in the hatchery (OR = 7.1; CI = 2.6, 19.7).

Animals↗
PubMed2005

Penicillin-resistant pneumococcal meningitis: high antibiotic exposure impedes new vaccine protection.

The frequency of meningitis due to penicillin-resistant Streptococcus pneumoniae (PRP) has increased in recent years, making treatment failure more likely. It is currently expected that pneumococcal conjugate vaccines might curb this trend. We investigated this issue using a mathematical model applied to the current prevalence of resistance and antibiotic exposure in the United States and in France. Our main finding was that the level of antibiotic exposure may limit the effect of the vaccine. In relatively low antibiotic exposure environments such as the United States, large-scale vaccination prevents a large part of PRP meningitis cases, whereas in high antibiotic-exposure environments such as France, vaccination alone does not lead to a substantial reduction in PRP meningitis incidence. Our results suggest that antibiotic exposure reduction will remain of primary importance for the control of PRP meningitis despite wide scale use of pneumococcal conjugate vaccines.

Adolescent↗
PubMed2005

Thirty-day mortality of nosocomial systemic bacterial infections according to antibiotic susceptibility in an 800-bed teaching hospital in France.

Overall 30-day mortality among patients with nosocomial bacterial infections was analysed according to antibiotic susceptibility in an 800-bed hospital. Survival analysis identified three factors associated with an increased mortality rate: (1) a longer interval between admission and onset of infection; (2) bacterial resistance; and (3) the severity of the initial illness in the intensive care unit. The increased mortality rate associated with antibiotic resistance was observed for all bacterial species with the exception of Gram-positive cocci, and remained significant or near-significant regardless of the hospital ward.

Anti-Bacterial Agents↗
PubMed2005

[Impact of population exposure on the risk of bacterial resistance].

Exposure of populations to antibiotics is a condition for the emergence and the diffusion of bacteria resistant to antibiotics. Analysis of epidemiological causality between antibiotic exposure and expansion of antibiotic resistance in human pathogens requires the study of the basis for the emergence and the subsequent epidemic spread of the strains. Emergence of antibiotic resistance under the selective pressure of antibiotics is unavoidable. However, the rapidity of the emergence depends on several parameters including the biochemical mechanism and the genetic support of the resistance and on the couple bacteria/antibiotic considered. Several of these parameters may be studied and measured in vitro. In vivo, relationship between antibiotic exposure and risk for infection or colonisation by pneumococci resistant to beta-lactams or macrolides and methicillin-resistant staphylococci are among the best studied models. In particular for pneumococci, quantitative relationship between antibiotic consumption and resistance, including geographical correlations have been shown but do not allow to establish any causality relationship. Overall, there is no doubt on the question of the impact of antibiotic exposure and the risk of antibiotic resistance. However, the quantification of the risks remains to be accurately studied.

Anti-Bacterial Agents↗
PubMed2005

Impact de l'exposition des populations sur le risque de résistance bactérienne.

Exposure of populations to antibiotics is a condition for the emergence and the diffusion of bacteria resistant to antibiotics. Analysis of epidemiological causality between antibiotic exposure and expansion of antibiotic resistance in human pathogens requires the study of the basis for the emergence and the subsequent epidemic spread of the strains. Emergence of antibiotic resistance under the selective pressure of antibiotics is unavoidable. However, the rapidity of the emergence depends on several parameters including the biochemical mechanism and the genetic support of the resistance and on the couple bacteria/antibiotic considered. Several of these parameters may be studied and measured in vitro. In vivo, relationship between antibiotic exposure and risk for infection or colonisation by pneumococci resistant to beta-lactams or macrolides and methicillin-resistant staphylococci are among the best studied models. In particular for pneumococci, quantitative relationship between antibiotic consumption and resistance, including geographical correlations have been shown but do not allow to establish any causality relationship. Overall, there is no doubt on the question of the impact of antibiotic exposure and the risk of antibiotic resistance. However, the quantification of the risks remains to be accurately studied.

Journal Article↗
PubMed2004

Short- and long-term effects of pneumococcal conjugate vaccination of children on penicillin resistance.

Recent observations have shown that wide-scale vaccination with pneumococcal conjugate vaccines was associated with a reduction in invasive disease, supporting the expectation that vaccination could help reduce carriage of Streptococcus pneumoniae and control the spread of resistant strains. However, it is too early to assess whether these effects can be sustained in the long term. Here, we used mathematical modeling to investigate time changes in pneumococcal colonization and resistance induced by conjugate vaccination in an environment where antibiotic exposure is high and resistance is widespread. According to model predictions, vaccination induced a decrease in carriage of vaccine-type pneumococci to very low levels, typically in 10 to 15 years under epidemiologically realistic conditions. Almost simultaneously, non-vaccine-type pneumococci spread in the community. Consequently, while there was a short-term decrease in the overall carriage rate, it was followed after a few years by a renewed, although limited, increase. Vaccination with a heptavalent vaccine did not affect the extent to which antibiotic resistance was selected: in all cases, the distribution of resistance levels peaked at high levels (MIC > 2 microg/ml) after 20 years. With a vaccine optimally designed to include all serotypes currently exhibiting decreased susceptibility to penicillin G, the selection of resistance was slowed down, although not prevented. These results suggest that because of serotype replacement, the effects of vaccination observed today may not be sustained in the long term. As a consequence, vaccination alone may not be successful in controlling selection for resistance in S. pneumoniae.

Algorithms↗
PubMed2004

Nasal airway ion transport is linked to the cystic fibrosis phenotype in adult patients.

BACKGROUND: This study was conducted to determine whether the major nasal airway ion transport abnormalities in cystic fibrosis (that is, defective cAMP regulated chloride secretion and basal sodium hyperabsorption) are related to the clinical expression of cystic fibrosis and/or to the genotype. METHODS: Nasal potential difference was measured in 79 adult patients with cystic fibrosis for whom clinical status, respiratory function, and CFTR genotype were determined. RESULTS: In univariate and multivariate analysis, patients with pancreatic insufficiency were more likely to have low responses to low chloride (odds ratio (OR) 8.6 (95% CI 1.3 to 58.5), p = 0.03) and isoproterenol (OR 11.2 (95% CI 1.3 to 93.9), p = 0.03) solutions. Similarly, in univariate and multivariate analysis, patients with poor respiratory function (forced expiratory volume in 1 second <50% of predicted value) were more likely to have an enhanced response to amiloride solution (OR 3.7 (95% CI 1.3 to 11.0), p = 0.02). However, there was no significant relationship between nasal potential difference and the severity of the genotype. CONCLUSIONS: Nasal epithelial ion transport in cystic fibrosis is linked to the clinical expression of the disease. The pancreatic status appears to be mostly related to the defect in epithelial chloride secretion whereas the respiratory status is mostly related to abnormal sodium transport and the regulatory function of the CFTR protein.

Adult↗
PubMed2003

Clinical and microbiological epidemiology of Streptococcus pneumoniae bacteremia in eight French counties.

OBJECTIVE: To describe the incidence of pneumococcal bacteremia not associated with infection of the central nervous system, investigate the susceptibility of bacterial isolates to beta-lactams, evaluate risk factors for antibiotic resistance, and determine factors predicting patient outcome. METHODS: Over a period of 1 year, 919 Streptococcus pneumoniae isolates were collected from 919 patients with bacteremia in eight French counties. Their clinical and microbiological features were recorded. Univariate and multivariate analyses were used to determine risk factors for penicillin-non-susceptible pneumococcal bacteremia and predictors of fatal outcome. RESULTS: Of the 919 patients in the study, 27% were infected with penicillin-non-susceptible pneumococci (PNSP): 17.8% of the isolates were intermediate to penicillin, 7.2% were resistant to penicillin, 16% were intermediate to amoxicillin, and 11% were intermediate to cefotaxime; no PNSP were resistant to either of the last two antibiotics. The most common PNSP serotypes isolated were 14 (41%) and 23 (24%). A statistically significant relationship between PNSP infection and age below 5 years or above 60 years in the different counties was observed by univariate and multivariate analysis. Gender, origin of bacteremia, co-morbidity, immunodeficiency, previous hospitalization and nosocomial infection were not predisposing factors associated with PNSP. The mortality rate was 20.6%: there was no increase in mortality among patients with PNSP bacteremia. Age was the strongest risk factor for mortality, but immunodeficiency also seemed to have had an impact on mortality. Clinical outcome was more closely related to clinical conditions than to the susceptibility status of S. pneumoniae. CONCLUSION: Among cases of bacteremia, 27% were caused by PNSP, but this level varies according to the counties and the age of the patients. Infection-related mortality was high, but there was no increase related to penicillin G non-susceptibility of the infecting strain.

Adolescent↗
PubMed2003

Bacterial resistance to penicillin G by decreased affinity of penicillin-binding proteins: a mathematical model.

Streptococcus pneumoniae and Neisseria meningitidis have very similar mechanisms of resistance to penicillin G. Although penicillin resistance is now common in S. pneumoniae, it is still rare in N. meningitidis. Using a mathematical model, we studied determinants of this difference and attempted to anticipate trends in meningococcal resistance to penicillin G. The model predicted that pneumococcal resistance in a population similar to that of France might emerge after 20 years of widespread use of beta-lactam antibiotics; this period may vary from 10 to 30 years. The distribution of resistance levels became bimodal with time, a pattern that has been observed worldwide. The model suggests that simple differences in the natural history of colonization, interhuman contact, and exposure to beta-lactam antibiotics explain major differences in the epidemiology of resistance of S. pneumoniae and N. meningitidis.

Bacterial Proteins↗
PubMed2001

Better control of antibiotic resistance.

This text summarizes the conclusions of the French Working Party to Promote Research to Control Bacterial Resistance, initiated by the French Institute for Public Health Surveillance. The goal was to identify and prioritize the research areas most pertinent to the evolution of antibiotic resistance. The working group was part of a nationwide consultation of experts in the field of bacterial resistance and was coordinated with 2 other groups addressing (1) the use and surveillance of resistance to antibiotics and (2) the control and prevention of resistance to antibiotics. The proposals were discussed at a meeting held on 13 January 1999 by a large group of French microbiologists and clinicians who specialize in infectious diseases. The expert panel stressed that the determinants of evolution of antimicrobial resistance and the possibility of reversing this evolution are not completely known or understood. It emphasized the need for efforts to anticipate emergence of new resistances, to analyze the consequences of bacterial resistance, to develop rapid tests for determination of susceptibility to antibiotics, and to develop new antibiotics.

Animals↗
PubMed1999

[Development of pharmaco-epidemiology in France].

A new scientific discipline: Progress in scientific knowledge, advances in therapeutic innovation, the development of new drugs and the continuing need for optimal drug use impose a new approach to the rational assessment of public health needs and the risks and benefits of therapeutic intervention. In the near future, a new scientific discipline, pharmaceutical epidemiology, will play a leading role. France seems to be a bit behind other western countries in this area. Goal setting: The objectives of industrial firms do not necessarily cover all aspects of the overall goals of society. If the scientific community leaves the development and implementation of pharmaceutical epidemiology in the hands of industrial firms alone, they risk seeing its field of action limited to industrial objectives. The goals of this new discipline must be defined within an unbiased framework aimed at meeting the needs of society in general. Organization: The development of pharmaceutical epidemiology as an integral part of medical research requires a clear definition of its objectives, methods, working hypotheses and time and human allocations. In this context, pharmaceutical epidemiology should be organized within the University and scientific settings currently contributing to scientific research in France (INSERM, CNRS, ORSTOM, etc.). Creating favorable conditions: A pharmaceutical epidemiology network with adequate human and material resources is needed. The wide range of needs expressed by existing institutions (Drug Agency, Prescription and Drug Use Observatory, industrial firms, the national health insurance system, physician and pharmacist associations) pleads for a nationally organized project working in the public domain.

Drug Prescriptions↗
PubMed1999

Estimation of the prevalence of orally treated diabetes in France using a pharmacoepidemiologic approach: comparison between 1981 and 1992.

PURPOSE: Non-insulin-dependent diabetes may become a public health problem in the next decade, given the increasing life expectancy of populations and because the baby-boom generation will reach the age at risk. Moreover a modification of the diagnostic criteria may increase the number of diabetic patients. We studied the evolution of diabetes prevalence. METHODS: A non-specific household survey, performed every 10 years was used. Patients who bought an oral antidiabetic drug during these studies were classified as diabetics. RESULTS: In 1980-81 and 1991-92 the crude diabetes prevalences were not significantly different even if there was a trend to increase (1.27% and 1.41%, respectively). When the 1980-81 prevalence was standardized to the age distribution of the 1991-92 sample, the trend disappeared (prevalence 1980-81:1.35%). CONCLUSION: There was no increase in an individual's risk of diabetes. However the crude prevalence tended to increase because of the changing age structure of the population. On-going studies are needed to follow the prevalence of diabetes during the next decade.

Journal Article↗
PubMed1999

Antibiotic use in humans and bacterial resistance.

As with any public health problem, the evolution of antibacterial resistance must be viewed from a perspective of risk, and analysed in terms of probabilities within the populations. It is necessary to be able to predict the risk of antibacterial resistance, in the future, and two main strategies have recently been developed in mathematical models that may help to evaluate these risks. It is also important to understand how antibiotics are used and how their use affects the evolution of antibacterial resistance. Understanding the epidemiology of antibacterial resistance will enable us to develop preventive strategies to limit existing resistance and to avoid the emergence of new strains of resistant bacteria.

Anti-Bacterial Agents↗