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Biomedical subjects

J Frottier

Publications and source records attributed to J Frottier.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Septicemia of urinary origin. Epidemiology and initial antibiotic treatment].

The SES group was formed by the "Ligue Française pour la Prévention des Maladies Infectieuses" to create a diagnostic and therapeutic expert system on septicemia. 461 cases of septicemia were thus collected from january 1 to december 31, 1985. 83 out of these septicemias had an urinary tract portal of entry, 21 were contracted in hospital. The mean age was 65 +/- 21 years (57 +/- 20 years for the 461 cases NS). There were 46 women and 37 men, i.e., a sex-ratio apposite to that of the overall population of septicemias (p less than 0.001). Au urinary lesion was found in 27 patients (p less than 0.001), a neurological disease in 22 (p less than 0.05), a cardiac disease in 24 (NS). 94 bacteria were isolated (11 polymicrobic septicemias) from the blood cultures: 56 E. coli, 7 Klebsiella, 6 Proteus, 7 Gram positive Cocci. 57 out of the 81 patients whose antibiotherapy was known received single-drug treatment (74%, vs 49% for the whole group, p less than 0.001). The evolution was known in 75 patients, uncomplicated in 57 (fatality rate: 11%). Prognosis did not appear to be influenced by the type of pathogen, or the existence of an urinary abnormality.

Adolescent↗
PubMed1986

[Failure of new beta-lactam antibiotics in the treatment of severe Enterobacter cloacae infections].

In 12 patients infected with an Enterobacter cloacae (E. cl.) initially susceptible to the 3rd generation cephalosporins, we observed the emergence in vivo of variants resistant to most of the new beta-lactam antibiotics (carboxy-penicillins, ureido-penicillins, 3rd generation cephalosporins and aztreonam). These variants remained susceptible to mecillinam and imipenem. The variant emerged under treatment with cefotaxime in 3 cases, with moxalactam in 3 cases, with aztreonam, carbenicillin, and ticarcillin in 1 case each and without treatment in 1 case. An aminoglycoside was combined with the beta-lactam antibiotic in 6 cases. Therapeutic failure was attributed to emergence of the resistant variant in 6 out of 12 cases (with an aminoglycoside in 3 cases, with the beta-lactam antibiotic alone in 3 cases). These case reports underline the importance of bacteriological monitoring of patients infected with E. cl. treated with a beta-lactam antibiotic. The susceptibility to beta-lactam antibiotics of the E. cl. strains isolated during treatment should be systematically retested.

Adult↗
PubMed1986

[Association of bacterial endocarditis and alcoholic cirrhosis in 9 patients].

Ten cases of bacterial endocarditis were observed in cirrhotic patients. In 7 cases, endocarditis was due to group D Streptococcus, 5 of which were Streptococcus D. bovis. Special features were the involvement of tricuspid valve and the involvement of two or more valves in 4 cases. Surgery was necessary in the acute phase in 5 patients: cure was definitely obtained in 8 cases after a particularly long interval. A colonic lesion could have been the portal of entry in some cases. Liver cirrhosis was considered as a predisposing factor for bacterial endocarditis, especially due to group D Streptococcus or to other bacteria of intestinal origin. This is probably related to the frequency of the colonic origin of group D Streptococcus endocarditis. Loss of filter function of the liver may partly explain the features of these forms of endocarditis.

Adult↗
PubMed1985

Clinical and echocardiographic observations in pulmonary valve endocarditis.

Clinical and echocardiographic data from 12 patients with pulmonary valve endocarditis are described. Seven patients had isolated pulmonary endocarditis and in 5 patients other valves were infected (aortic, tricuspid, mitral or all 3). Two patients were heroin addicts and 4 had underlying heart disease (congenital heart disease in 3 and aortic regurgitation in 1 patient). The organisms involved were alpha streptococci in 3 patients (all with underlying heart disease), Staphylococcus aureus in 4, Streptococcus D bovis in 1 patient and Candida guillermondii in 1. M-mode and 2-dimensional echocardiography was performed in 10 patients and revealed vegetations in 8. Pulsed Doppler echocardiography was performed in 6 patients and revealed pulmonary regurgitation in all 6. Seven patients had pulmonary emboli. Four patients underwent surgery. Four patients died, including 1 after cardiac surgery. Five patients, including the patient infected with Candida guillermondii, recovered with antibiotic treatment.

Adolescent↗
PubMed1985

[Air decontamination and preventive antibiotic therapy in orthopedic surgery].

In a private 160-bed orthopedic hospital, the effect of air decontamination and antibiotic prophylaxis on postoperative infections was studied. From 1971 to 1978, 5 016 orthopedic procedures were performed without antibiotic prophylaxis. Postoperative infection rate was 2% with the conventional operating room and 1.9% with the sterile room. The beneficial effect of vertical laminar air flow thus appears doubtful. From 1979 to 1982, prophylactic therapy with a cephalosporin was used for total hip replacements. Rate of postoperative deep infection fell from 3.3% in 811 hip replacements without antibiotics to 0.5% in 1 172 replacements with antibiotic prophylaxis. Our findings suggest that cephalosporin prophylaxis is more effective than vertical laminar air flow for preventing postoperative hospital-acquired infection.

Air Microbiology↗
PubMed1985

[Preventive antibiotic therapy and postoperative infection in orthopedic surgery. 1983 total hip prostheses].

In a previous paper the authors studied the role of aerobio-contamination in the rate of post-operative infections. In the present study, the results of 1,172 total hip prostheses performed between 1979/1982 with prophylactic antibiotics were compared with those obtained in 811 cases performed before 1979 without antibiotics. In the 1979/1982 series, there was 0,5 p. 100 of post-operative infection and in the pre- 1979 series, 3,3 p. 100. During the two periods the peri-operative environment was identical and the surgical technique was the same. The rate of infection in more than 8,000 other surgical procedures performed in the same hospital remained the same. The use of prophylactic antibiotics appears to be a valid approach. They should be used only in high-risk procedures to avoid the selective production of resistant organisms.

Adult↗
PubMed1984

Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases.

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.

Endocarditis, Bacterial↗
PubMed1983

Surgical management of late prosthetic valve endocarditis.

Among 32 patients with late prosthetic valve endocarditis selected from two cooperative retrospective studies, ten had valve replacement: six men and four women, mean age being 48 years, ranging from 23 to 65 years old. An emergency reoperation was undertaken for refractory heart failure in seven out of ten cases, with an average delay of 6.6 days after the beginning of antibiotic therapy. In the other three cases, the operation was carried out at the end of 40 days of antibiotic therapy, once for recurrent endocarditis and twice for severe aortic insufficiency. The most common causative micro organism was the staphylococcus (7 out of 10 cases). The infected prosthetic valves were, in 8 out of the 10 cases, in the aortic position. The outcome was poor as the mortality rate was 60% (6 out of the 7 patients operated on in an emergency). Death was attributed to heart failure with conduction disturbances and severe aortic regurgitation (2 cases), cerebral emboli (2 cases), septicopyemia (2 cases). Four patients of the ten, after a mean follow up of 10 months, are cured without prosthetic valve dysfunction. The extreme gravity of prognosis seems related to the microorganism (staphylococcus), to the delay between the beginning of antibiotic therapy and the onset of the fever, and finally to the extension of destructive lesions under the prosthetic valve implantation base; the reimplantation of the prosthesis on frail and abscessed tissue implies a substantial risk of disinsertion. The indications for systematic early reoperation in cases of severe acute heart failure are discussed.

Adult↗