PubMed Health⌕ Search

Biomedical subjects

M Thibault

Publications and source records attributed to M Thibault.

At least 19 recordsLinked to original sources
PubMed2003

[Significant decrease of rate and incidence of methicillin resistant Staphylococcus aureus in a French general hospital between 1999 and 2001].

In our French general hospital of 1000 hospitalization beds, a specific isolation for multiresistant bacteria (MRB) colonized or infected patients was set up since 1998. To assess the impact of these recommendations, the rate and incidence of methicillin resistant Staphylococcus aureus (MRSA), the most important MRB recovered in French hospitals, were calculated for each year since 1999. All the strains isolated from clinical samples, except duplicates (same bacteria in the same patient), were included. The results were compared with the chi(2)-test. Between 1999 and 2001, 644 strains were isolated. MRSA rate went from 46% in 1999 to 41% in 2000, and to 37% in 2001 (P = 0.007). In the study proposed by the CCLIN Paris-Nord, in April, May and June of each year, the rate of SARM was 52% in 1999, 43% in 2000 then 36% in 2001. The incidence per 100 admissions was 0.73 in 1999, 0.59 in 2000 and 0.54 in 2001 (P = 0.002) and the incidence per 1000 hospitalization days was, respectively, 0.92, 0.74, 0.67 in 1999, 2000 and 2001 (P < 0.001). The significant decrease of the rate and incidence of SARM proved that the isolation policy was effective in our hospital. This decrease was obtained through cooperation between staff members, bacteriologists and hospital nosocomial infection committee members. We know that measures to prevent MRSA cross transmission are very difficult to maintain over a long time and we hope that indicators would not increase next year. The use of alcohol based hand-rub since May 2002 should contribute to maintain this decrease.

France↗
PubMed2001

Efficacy of a swab transport system in maintaining viability of Neisseria gonorrhoeae and Streptococcus pneumoniae.

The efficacy of swab transport systems in maintaining viability of Neisseria gonorrhoeae and Streptococcus pneumoniae is crucial both for establishing definitive diagnosis and for monitoring emerging resistance. We tested the efficacy of a newly modified Amies charcoal swab transport system, the StarSwab SP131X (Starplex Scientific, Inc., Etobicoke, Ontario, Canada), by using a combined total of 31 clinical and American Type Culture Collection stock reference strains of N. gonorrhoeae and S. pneumoniae in 46 suspensions of concentrations ranging from 10(5) to 10(8) CFU/ml. Triplicate swabs per strain held at room temperature for 0, 24, and 48 h were plated without prior vortexing, and their growths were graded. All 31 strains were viable at 0 and 24 h. Gonococcal viability at 48 h varied considerably, even among strains with comparable inoculum sizes, suggesting that viability might be strain dependent and confirming the different structural and growth profiles of gonococcal strains. S. pneumoniae strains showed consistent viability, with all strains recovered at all holding periods. This study demonstrates that the StarSwab SP131X is capable of maintaining the viability of N. gonorrhoeae and S. pneumoniae for at least 24 and 48 h, respectively, and reinforces the need for adequate sampling and for timely processing of specimens to maintain optimum performance.

Culture Media↗
PubMed1999

[Outbreak of methicillin-resistant Staphylococcus aureus in general hospital intensive care unit].

Mantes' hospital polyvalent intensive care unit (ICU) experienced an outbreak episode caused by methicillin resistant Staphylococcus aureus (MRSA). Suspicion of physicians was strengthened by observing the weekly reading of multiresistant germs and the significative increase of MRSA carriers incidence rate, compared with the number of admission in the ICU: 5.5% to 11.3%. This outbreak was surprising: it happened immediately after the installation in a new hospital and the reinforcement of nosocomial infection surveillance (systematic screening of every patient admitted to the I.U.C., his isolation if he presents risk factors to multiresistant germs, increasing of handwashing stations). The overlapping period of hospitalisation concerning the 13 patients being reported as SARM carrier, having the same antibiogram, and the epidemic curve suggested a cross contamination. The index case was a MRSA carrier the day of her admission and have had a recent hospitalisation in a high risk unit. MRSA has always been isolated in nasal swab. Six patients among the thirteen carriers developed an infection and have been treated by vancomycin: two systemic infections and four pulmonary infections. The mortality rate was 33% and only one of them seemed to be directly due to MRSA. Area samples were all negative. The clinical staff have been screened with nasal swab. We identified only one nasal MRSA carrier. The pulsed-field gel electrophoresis study showed that 9/11 which have been analysed were identical. This outbreak brought about staff, more sensibilisation to the nosocomial infection and updating of plain hygien rules leaded to its stop five months later.

Adult↗
PubMed1998

[Multifocal invasive Kingella kingae infection].

CASE REPORT: A 2-year-old child, non immunodeficient, presented with septicemia due to Kingella kingae successively complicated by meningitis, arthritis of one knee and endocarditis. Outcome was favourable after a long and adjusted antibiotherapy, involving in particular for the endocarditis ceftriaxone (100 mg/kg/d) and amikacin (20 mg/kg/d) during 3 weeks, then amoxicillin per os (200 mg/kg/d) during 3 weeks. CONCLUSIONS: Bacteriologic characteristics of the bacteria, the culture of which requires medium base with additional nutrient are reviewed. The tropism of Kingella kingae is essentially osteoarticular and cardiac as shown by the cases reported in the literature. Its susceptibility to antibiotics explains the frequent favourable outcome.

Amikacin↗
PubMed1995

Pharmacology, relative bioavailability, and toxicity of three different oral cyclophosphamide preparations in a randomized, cross-over study.

Thirty-six patients were entered on this study to determine the pharmacology, bioavailability, and toxicity of three different oral formulations of cyclophosphamide (Cytoxan, Endoxan, and an investigational direct compression tablet). Patients were randomized with respect to the order in which they received the different oral cyclophosphamide preparations, and received each one for two weeks followed by a two week washout period. Concurrent chemotherapy was allowed provided it remained constant across all 3 courses of cyclophosphamide. Plasma concentrations of cyclophosphamide and phosphoramide mustard were measured by gas chromatography with electron capture detection. Peak plasma cyclophosphamide concentrations and times to peak plasma cyclophosphamide and phosphoramide mustard preparations were significantly greater for Endoxan than for Cytoxan and the investigational direct compression tablet. Drug area under the concentration-time curve (AUC), bioavailability, and plasma elimination half-life could not be reliably calculated for Endoxan but were similar for Cytoxan and the investigational formulation. Based on AUC comparisons, bioavailability of parent compound (relative to an oral cyclophosphamide solution) was 85% for Cytoxan and 69% for the investigational formulation. This difference was not significant. There were no significant differences between the 3 formulations with respect to any individual type of toxicity, although the investigational formulation tended to be associated with somewhat less overall toxicity (p = 0.08).

Administration, Oral↗
PubMed1990

Nosocomial Serratia marcescens individualized by five typing methods in a regional hospital.

The relationships between 69 isolates obtained from 26 patients who were affected by two Serratia marcescens hospital outbreaks occurring in the urology and postnatal wards, were examined by five typing methods for epidemiological purposes. Serotyping, antibiotic resistance profile and electrophoretic analysis of enzymes identified three groups of isolates, while biotyping and bacteriocin typing identified only two. These surveys allowed us to demonstrate the existence of independent episodes of cross-infection among patients of each ward.

Bacterial Typing Techniques↗
PubMed1990

Vitamin E deficiency and lipoperoxidation during adult respiratory distress syndrome.

Vitamin E (Vit E) is an important component of the lung's defense against oxidant injury. The aim of this study was to determine a) if adult respiratory distress syndrome (ARDS) was associated with a decrease in Vit E plasma level linked to an enhancement of plasma lipoperoxidation, and b) if this Vit E deficiency might be explained by malnutrition and/or a consumption defect. Vit E, lipoperoxides (LP), total lipids, and fatty acid plasma levels were measured in 12 patients with ARDS (PaO2 less than or equal to 60 Torr with FIO2 0.6 on mechanical ventilation). At the onset of ARDS (T0), the decrease in Vit E plasma level was significant (p less than .001) 7.73 +/- 0.54 (n = 12) vs. 11.46 +/- 0.55 mg/L (n = 7) in the control group (healthy subjects breathing room air). A significant (p less than .05) increase in LP was simultaneously observed (4.12 +/- 0.35 [n = 12] vs. 2.94 +/- 0.30 nmol/ml [n = 17]) in the control group. At T0, LP were inversely correlated with Vit E plasma levels (r = .78, p less than .01). Vit E deficiency was associated with low levels of total plasma lipids (3.68 +/- 0.25 g/L) and plasma cholesterol (0.97 +/- 0.07 g/L). Thus, the Vit E/total lipids ratio (2.18 +/- 0.17 mg/g) was always above the accepted normal limit value for this ratio (0.8 mg/g).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Comparative activity of new oral cephalosporins and quinolones against Escherichia coli resistant to ampicillin isolated from urinary specimens].

The activity of eight antibiotics was studied against fifty Escherichia coli strains resistant to ampicilline from positive urine cultures. We compared the in vitro activity and the inhibitory power of urine. Three antimicrobial agents are the most active: pefloxacin, ofloxacin and cefotaxime. Then in activity order: pipemidic acid, cefixime, cefuroxime, amoxicilline-clavulanic acid and cefalotine.

Ampicillin Resistance↗
PubMed1989

[Q fever infectious endocarditis. Apropos of a new case].

We report a case of Coxiella burnetii endocarditis in a 42-year old man presenting with a long-known cardiac murmur and an infectious syndrome of several months duration. The aetiological diagnosis, delayed by the lack of knowledge of a primary Q fever, was established by serology. The infection responded to tetracycline combined with cotrimoxazole, but a valve replacement performed for haemodynamic reasons was followed by serious complications. We remind the readers that Q fever endocarditis must be considered as a possible diagnosis in all cases of endocarditis with negative blood cultures and that specific serological examinations in search of anti-phase I antibodies of the IgA type should be performed as soon as possible, using the indirect immunofluorescence technique. Attention is drawn to the different serological responses of the three clinical types of Q fever infection and to the cellular immunity associated with that disease.

Adult↗
PubMed1988

Human central nervous system and plasma pharmacology of mitoxantrone.

Mitoxantrone 5-6 mg/m2 was administered IV to 10 consenting patients prior to surgical resection of an intracerebral tumor. Plasma pharmacokinetic parameters were calculated and concentration of mitoxantrone in intracerebral tumors was determined. Concentrations of mitoxantrone were also determined in autopsy tissues of one of the patients who expired 192 days after receiving the drug. The plasma pharmacokinetics were best described by a 3 compartment model, with a tl/2 gamma of 4.74 +/- 5.53 h. Mitoxantrone concentrations in the intracerebral tumors were potentially cytotoxic and ranged from 4 to 322 ng/g. In all but one case, mitoxantrone concentration was higher in tumor than in concurrent plasma samples. There was no obvious relation between tumor mitoxantrone concentration and peak plasma mitoxantrone concentration or time from mitoxantrone administration to tumor removal. Low grade gliomas and viable tumors tended to have lower mitoxantrone concentrations than did other tumor types and necrotic tumors. In the patient undergoing autopsy, highest mitoxantrone concentrations were found in liver, thyroid and heart.

Adult↗
PubMed1986

Human autopsy tissue concentrations of mitoxantrone.

A sensitive high-performance liquid chromatography method was used to measure mitoxantrone in autopsy tissue samples of 11 patients who had received the drug iv 10-272 days antemortem. Mitoxantrone was readily detectable in tissues from all patients. Tissue concentrations were proportional to lifetime cumulative dose of mitoxantrone, and decreased very slowly with time. The thyroid and the liver had the highest mitoxantrone concentrations, followed by the heart. These high cardiac concentrations of mitoxantrone could be partially responsible for the occasional case of cardiotoxicity seen with mitoxantrone. The brain had the lowest mitoxantrone concentrations. Organ mitoxantrone concentrations did not conform to a flow-limited model. Tumor mitoxantrone concentrations varied quite markedly from one site to another in the same patient. Tumors generally had lower mitoxantrone concentrations than did surrounding normal tissues. Mitoxantrone concentrations were consistently highest in intrahepatic tumors and lowest in intracerebral tumors. It is unclear whether the low concentrations in brain tumors were due to a partially intact blood-brain barrier or to the fact that most brain tumors had been irradiated prior to mitoxantrone administration. Further studies are warranted to more fully explore the relationship between human tissue mitoxantrone concentrations and efficacy and toxicity.

Autopsy↗
PubMed1986

[Lipids in the urine after extracorporeal shockwave lithotripsy].

Lipid corpuscles have been found in the urine in about 40 per cent of women (4/10) after extracorporeal shock wave lithotripsy, however this lipuria is very rare in men (1 or 2 per cent of cases) and less pronounced. During three days after treatment, this post-therapeutic lipuria was found to be independent of the age of patients, of the site of the calculi, of their chemical composition or of the number of shock waves administered. This lipuria probably results from the liquefaction of peri-pelvic fat tissue by exothermic reaction. These lipid corpuscles consist mostly of triglycerides and to a lesser extent phospholipids with a very small proportion of cholesterol and fatty acids.

Adult↗
PubMed1983

[Bacterial septicemia in neutropenia patients].

Two hundred bacterial septicemia occurring in neutropenic patients (PMN less than 1,000 microliter) were analyzed. Most of these patients had hematologic malignancies. The underlying disease, the degree of neutropenia the association of septic focus with the bacteremia, the responsive microorganisms and their evolution during hospitalization were studied as prognosis factors. The overall mortality was 32.5 p. 100. The mortality was higher in patients whose granulocyte count was lower than 500 microliter. The occurrence of major septic focus (pulmonary, perineal infection, diarrhea with abdominal distension, ORL, or cutaneous extensive focus) during bacteremia was a highly significant factor of bad prognosis. The mortality of bacteremias with and without major septic focus was respectively 62 p. 100 and 15 p. 100. A study of the distribution of the bacterias was performed in terms of mortality and duration of hospitalization. "Escherichia coli" and gram positive cocci were predominant during the two first days and mortality was then low. After that time, others Gram-negative bacterias appeared, especially "Pseudomonas aeruginosa" and the mortality was increasing until the twentieth day. Therefore, the authors raise the opportunity of antibiotic therapy according to the duration between the beginning of the hospitalization and the occurrence of sepsis in neutropenic patients. The role of the extensive use of a curative antibiotic association using colistine and nalidixic acid between 1974 and 1976 is discussed in the emergence of more gram positive cocci bacteremias between 1976 and 1978 than between 1974 and 1976 in the same intensive care unit.

Agranulocytosis↗
PubMed1981

[In vitro activity of cefotaxime on anaerobes (author's transl)].

The comparative activity of cefotaxime, cefazolin, cefamandole and cefoxitin was studied on 80 strains of anaerobic bacterial species: 14 Clostridia, 60 Bacteroides fragilis, 6 Peptococcus. The new cephalosporins showed an increase in the in vitro activity against Bacteroides fragilis, but their efficacy was still inferior to that of the 5-nitro-imidazole derivatives.

Anaerobiosis↗