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Biomedical subjects

L Fleury

Publications and source records attributed to L Fleury.

10 recordsLinked to original sources
PubMed2002

Epidemiology of invasive aspergillosis in France: a six-year multicentric survey in the Greater Paris area.

Invasive aspergillosis is the most prevalent mould infection. An epidemiological surveillance network was set up in 18 teaching hospitals in Paris and the Greater Paris area. Prospective surveillance was conducted between 1994 and 1999. Between 1994 and 1997 cases were categorized as proven or probable aspergillosis and then the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria were used. The authors analysed 621 cases (115 proven, 506 probable). No seasonal variation was found. Haematological disorders (73%) including stem-cell transplantation (36%), solid-organ transplantations (10%) and AIDS (9%) were the main underlying conditions. The crude mortality was 63%. Incidence of IA was 8% (CI(95): 6.5-9.5) in acute myelocytic leukaemia and 6.3% (CI(95): 4.3-8.3) in acute lymphocytic leukaemia. Incidence was 12.8% (CI(95): 10.8-14.8) following allogeneic stem-cell transplantation and 1.1% (CI(95): 0.7-1.5) following autologous stem-cell transplantation. In solid-organ recipients incidence ranged from 11% following heart-lung transplantation and small bowel to 0.4% following kidney transplantation. Incidence in HIV infected patients ranged from 0.02 to 0.13% per annum. This large series confirmed that patients with haematologic disorders and transplantations are the most at risk for IA.

Adolescent↗
PubMed2000

Nonclassical photon statistics in single-molecule fluorescence at room temperature

The fluorescence of single terrylene molecules in a crystalline host is investigated at room temperature by scanning confocal optical microscopy. Photon arrival times are analyzed in terms of interphoton time distributions, second order correlation functions, and the variance of the photon number probability distribution. Antibunching at short times and bunching behavior for longer times is observed, associated with sub- and super-Poissonian statistics, respectively. A rate-equation analysis of the molecular level populations indicates an accelerated reverse intersystem crossing.

Journal Article↗
PubMed2000

[Development of a predictive model for respiratory isolation of patients suspected of having pulmonary tuberculosis].

INTRODUCTION: As numerous nosocomial outbreaks of pulmonary tuberculosis have been reported during the last two decades, prompt identification and effective isolation of contagious patients should be made a priority in tuberculosis control policies. There is a need to develop a predictive model which would allow prompt recognition and isolation of smear-positive patients. CURRENT KNOWLEDGE AND KEY POINTS: Various authors have attempted to improve the respiratory isolation policies for patients suspected of having pulmonary tuberculosis. A French multicenter prospective study of 211 patients suspected of having pulmonary tuberculosis established that: 1) the current respiratory isolation policy of suspected pulmonary tuberculosis needs improvement (sensitivity = 71.4%; i.e., 28.6% of smear-positive patients are admitted without isolation) and 2) better interpretation of clinical and radiological data available on patient admission could improve the adequacy of respiratory isolation. Univariate analysis showed that predictive factors of pulmonary tuberculosis were chest X-rays (P < 0.00001), symptoms (P = 0.0004), age (mean: 40.8 years for TB vs. 47.5 for non-TB, P = 0.04), HIV infection (10.6% vs. 28.7%, P = 0.01), immigrant (72% vs. 55%, P = 0.03) and BCG status (P = 0.025), while multivariate analysis demonstrated that chest X-ray pattern (P < 0.00001), HIV infection (P = 0.002) and symptoms (P = 0.009) were independent predictive factors. FUTURE PROSPECTS AND PROJECTS: From these data, a model was proposed and evaluated in the derivation cohort using the receiver operating characteristics (ROC) curve. We retrospectively studied the predictive model in two populations different from the one from which it was derived. The model would have improved sensitivity of the respiratory isolation policy from 71.4% (current respiratory isolation policy) to 82.4% and 91.1%, respectively. Prospective, multicenter studies are requested to establish the value of such a predictive model in improving the respiratory isolation policy for patients suspected of having pulmonary tuberculosis.

Cohort Studies↗
PubMed2000

Nosocomial bacteremia in HIV patients: the role of peripheral venous catheters.

A retrospective case-control study compared 40 human immunodeficiency virus (HV)-infected patients with 43 nosocomial bacteremias (NB) to 77 HIV-infected patients without NB. Presence of a peripheral venous catheter (PVC) was associated with occurrence of NB and was significantly more frequent in NB without an identified source. PVCs probably are an underestimated source of NB in HIV-infected patients.

Adult↗
PubMed1999

Cost of antimicrobial treatment for nosocomial infections based on a French prevalence survey.

An estimate of the antibiotic cost of nosocomial infections (NI) was made in a university hospital group based on data collected in adult inpatients enrolled in the French national prevalence survey in 1996. Among the 6839 study patients, 636 (9.3%) presented with at least one NI, of these, data on antimicrobial treatment were available for 480. The overall daily antibiotic cost was estimated between FF 49,439 and 103,526, resulting in FF 103 to 216 per infected patient. The most expensive antibiotic treatment was prescribed in intensive care patients, for pneumonia for device-related NI, or for multi-resistant bacterial infections. Non-documented NI represented about 20% of the overall antibiotic cost. Beta-lactam antibiotics, especially third generation cephalosporins, and parenteral fluoroquinolones were the most expensive antimicrobial drugs. The cost of antibiotic treatment for NI represents a significant part of hospital expenditure that should be reduced by better control of highly expensive prescriptions.

Adolescent↗
PubMed1999

Efficacy of prevention by high-efficiency particulate air filtration or laminar airflow against Aspergillus airborne contamination during hospital renovation.

OBJECTIVE: To evaluate efficacy of laminar airflow facilities plus high-efficiency particulate air (HEPA) filtration and HEPA filtration alone in preventing environmental Aspergillus contamination during hospital renovation. To show the usefulness of environmental surveillance to facilitate protection of patients at risk for invasive pulmonary aspergillosis. DESIGN: Prospective sampling of air and surfaces for Aspergillus conidia during 2-year period. SETTING: A hematological department adjacent to building renovation at a university hospital. RESULTS: 1,047 air samples and 1,178 surface samples were collected from January 1996 to December 1997. Significantly more air samples were positive for Aspergillus species during the period of building renovation than during the periods before and after renovation in a unit without a protected air supply adjacent to the building work area (51.5% vs 31.7%; odds ratio [OR], 2.3; 95% confidence interval [CI95], 1.4-3.7; P<.001). A major increase in the frequency of positive air samples was also found in another adjacent unit that was protected with HEPA filtration alone (from 1.8% to 47.5%; OR, 48.9; CI95, 12-229; P<10(-7)). In addition, in this unit, the mean count of Aspergillus conidia in positive air samples increased significantly during construction (4 colony-forming units [CFU]/m3 to 24.7 CFU/m3; P=.04) and the proportion of positive surface samples showed a significant increase during renovation (from 0.4% to 9.7%; OR, 28.3; CI95, 3.4-623; P=10(-4)). However, none of 142 air samples collected during renovation in the area protected with laminar airflow plus HEPA filtration showed Aspergillus conidia. In a unit distant from the building renovation site, the results of air and surface samples were not affected by renovation. CONCLUSION: This study showed a strong association between building renovation and an increase in environmental Aspergillus contamination. Results confirmed the high efficacy of laminar airflow plus HEPA filtration and a high air-change rate. Although filtration with HEPA was effective during normal conditions, it alone was unable to prevent the rise of Aspergillus contamination related to building renovation. This study emphasized the necessity of an environmental survey of airborne contamination related to construction, to facilitate prevention of nosocomial aspergillosis outbreaks. A standardized protocol for aerobiological surveillance is needed.

Air Microbiology↗
PubMed1999

The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model.

STUDY OBJECTIVE: To improve the respiratory isolation policy for patients with suspected pulmonary tuberculosis (TB). DESIGN: Prospective, descriptive, French multicenter study. SETTING: Emergence of nosocomial outbreaks of TB. PATIENTS: All consecutive patients admitted with suspicion of pulmonary TB. MEASUREMENTS AND RESULTS: Medical history, social factors, symptoms, and chest radiograph (CXR) pattern (symptoms and CXR both scored as typical of pulmonary TB, compatible, negative, or atypical) were obtained on admission. Serial morning sputa were collected. Of the 211 patients, 47 (22.3%) had culture-proven pulmonary TB, including 31 (14.7%) with a positive smear. Mean age was 46.2 years; 52 patients were HIV positive (24.6%). The sensitivity of the respiratory isolation policy was 71.4%, specificity was 51.7%, negative predictive value (NPV) was 88.2%, and positive predictive value (PPV) was 26.3%. On univariate analysis, predictive factors of culture-proven pulmonary TB were CXR (p < 0.00001), symptoms (p = 0.0004), age (mean, 40.8 years for TB patients vs 47.5 years for non-TB patients; p = 0.04), absence of HIV infection (89.4% vs 71.3%; p = 0.01), immigrant status (72% vs 55%; p = 0.03), and bacillus Calmette-Guérin status (p = 0.025). On multivariate analysis, CXR pattern (p < 0.00001), HIV infection (p = 0.002), and symptoms (p = 0.009) remained independently predictive. Based on these data, a model was proposed using a receiver operating characteristics curve. In the derivation cohort, the sensitivity and NPV of the model in detecting smear-positive pulmonary TB would have been 100%. The specificity and PPV would have been 48.4% and 25%, respectively. The model performed less well when evaluated on two retrospective groups, but its sensitivity remained above that of the current respiratory isolation policy (91.1% and 82.4% for the retrospective groups vs 71.1% for the current policy). CONCLUSIONS: Improved interpretation of clinical and radiologic data available on patient admission could improve adequacy of respiratory isolation. A prediction model is proposed.

BCG Vaccine↗
PubMed1995

Preparation and characterization of dipalmitoylphosphatidylcholine liposomes containing interleukin-2.

Human recombinant interleukin-2 (IL-2) has been associated or mixed with small unilamellar vesicles prepared from dipalmitoylphosphatidylcholine (DPPC). Whatever the mode of IL-2 introduction, a considerable proportion of the added protein was associated with the liposomes, as determined by gel filtration and ultrafiltration/centrifugation, suggesting that IL-2 can interact with the lipid bilayer as well as being entrapped within the aqueous phase. Moreover, IL-2 prevented the aggregation/fusion of the vesicles at 4 degrees C. Liposome-associated protein was partially protected from digestion by pepsin, especially at the C-terminal, since no fluorescence emission from the tryptophan in this region was detected in the resulting peptides after separation by HPLC. Such systems could constitute a sustained release form of IL-2 for immunotherapy.

1,2-Dipalmitoylphosphatidylcholine↗