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N Le Saux

Publications and source records attributed to N Le Saux.

10 recordsLinked to original sources
PubMed2001

Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease.

There is increasing evidence that chronic obstructive pulmonary disease (COPD) is associated with chronic inflammation in the airways and lung parenchyma; however, little is known about the inflammatory response during acute COPD exacerbation. The objectives of this study were (1) to determine if inflammatory markers associated with neutrophilic inflammation and activation increase at times of acute COPD exacerbation relative to the clinically stable state, and (2) to determine whether the presence of acute bacterial or viral infection at the time of COPD exacerbation could be correlated with increases in sputum markers of inflammation. Induced sputum was collected from patients with COPD when they were clinically stable, during the time of an acute exacerbation, and 1 mo later. Sputum was analyzed at each time point for soluble markers associated with neutrophilic inflammation; myeloperoxidase (MPO), tumor necrosis factor-alpha (TNF-alpha), and interleukin-8 (IL-8). Serologic assays on acute and convalescent sera were performed for respiratory viruses, and induced sputum was also subject to quantitative bacterial cultures, viral cultures, and polymerase chain reaction (PCR) for detection of respiratory viruses. Fourteen of the 50 patients enrolled in the study met predetermined criteria for an acute COPD exacerbation over the 15-mo study period. TNF-alpha and IL-8 were significantly elevated in the sputum of patients during acute COPD exacerbation compared with when they were clinically stable (p = 0.01 and p = 0.05, respectively). Concentrations of these cytokines declined significantly 1 mo after the exacerbation. Three of 14 patients (21%) had confirmed bacterial or viral respiratory tract infections. Patients with documented infection did not demonstrate greater increases in sputum levels of inflammatory cytokines during exacerbations compared with patients without demonstrable infection. We conclude that markers of airway neutrophilic inflammation increase at the time of acute COPD exacerbation and then decline 1 mo later, and that this acute inflammatory response appears to occur independently of a demonstrable viral or bacterial airway infection.

Adult↗
PubMed2000

Evaluating the benefits of antimicrobial prophylaxis to prevent urinary tract infections in children: a systematic review.

BACKGROUND: The recurrence rate for urinary tract infections in children is estimated at between 30% and 40%. The use of low doses of antibiotics as prophylaxis for recurrent urinary tract infections is common clinical practice. However, prolonged antimicrobial therapy has the potential to contribute to problems of bacterial resistance and antimicrobial side effects. The aim of this review was to systematically examine the available evidence for the effectiveness of this intervention. METHODS: We conducted a literature search of 3 electronic databases for the period 1966 to 1999. We also searched bibliographies from conference proceedings and contacted content experts to ensure completeness of our database. Each trial was evaluated on the basis of the following inclusion criteria: target population (children), intervention (antibiotic v. no antibiotic), outcome (number of urinary tract infections) and study design (randomized controlled trial). Quality was assessed for the studies that met these criteria. RESULTS: Most of the studies identified were case series and cohort studies. Only 6 randomized trials fulfilled the inclusion criteria. All were of low quality (median 2, range 0 to 2 [maximum quality score 5]). Three trials dealt with children who had anatomically normal urinary tracts, and three included children with neurogenic bladder. The rate of infections for patients with normal urinary tracts ranged from 0 to 4.0 per 10 patient-years for the treatment groups and from 4.0 to 16.7 for the control groups. The recurrence rates for patients with neurogenic bladders in 2 trials were 2.9 and 17.1 per 10 patient-years for the treatment groups and 1.5 and 33.0 for the control groups. INTERPRETATION: The available evidence for using antimicrobial prophylaxis to prevent urinary tract infection in children with normal urinary tracts or neurogenic bladder is of low quality. This suggests that the magnitude of any benefit should at best be questioned. The surprising lack of data for children with reflux is of concern. Well-designed trials are needed to optimize the use of antimicrobials in children with recurrent urinary tract infection.

Antibiotic Prophylaxis↗
PubMed1999

Antimicrobial use in febrile children diagnosed with respiratory tract illness in an emergency department.

BACKGROUND: In an era of increasing antibiotic resistance, the prevalence of antibiotic usage and associated factors should be ascertained to optimize their use. We set out to determine the prevalence of antibiotic use in febrile children diagnosed with respiratory tract illnesses at a children's hospital emergency department; to determine how often viral studies were conducted; and to identify patient characteristics associated with antibiotic use. METHODS: We conducted a retrospective study of antibiotic use in febrile children 3 months to 10 years old presenting with respiratory illnesses during two 1-month periods. Patient charts and laboratory tests were reviewed. Antibiotic use was related to diagnosis by logistic regression. RESULTS: A total of 836 patient visits were selected. Antibiotics were prescribed for otitis media in 96% of patients, for pneumonia in 100%, for pharyngitis in 66%, for bronchiolitis in 38%, for reactive airway disease in 24% and for viral or "upper respiratory tract illness" in 14%. For viral illness or upper respiratory tract infection, antibiotic use was associated with a fever duration of >48 h [odds ratio (OR), 3.2; 95% confidence interval (CI) 1.7, 5.9] and having a chest radiograph performed (OR 2.1; 95% CI 1.02, 4.37). Patients with pharyngitis who had a throat swab were less likely to receive an antibiotic (OR 0.08; 95% CI 0.02, 0.4) than those who did not have a swab. In this emergency department antibiotic use for these indications decreased by 11% during the 1997 to 1998 study interval (P < 0.001). CONCLUSION: Antibiotics were commonly prescribed for pharyngitis, bronchiolitis and reactive airway disease, which are conditions principally caused by viruses. Addressing reasons why there is a difference between guidelines and antibiotic use in these conditions may be important.

Anti-Bacterial Agents↗
PubMed1987

Tuberculosis presenting as stridor.

A 40-year-old woman was seen with stridor and mediastinal widening secondary to tuberculous mediastinal lymphadenopathy mimicking neoplasm. Initially, stridor could only be controlled with high-dose corticosteroids, but following initiation of antituberculous chemotherapy corticosteroids were withdrawn successfully and the mediastinal lymphadenopathy resolved.

Adult↗
PubMed1987

Bacillus cereus endophthalmitis.

The authors present a case of a young man with post-traumatic endophthalmitis caused by Bacillus cereus. The clinical course was typical of the panophthalmitis caused by this toxin-producing organism: rapid onset of signs of systemic infection, a corneal ring abscess and eventual loss of the globe requiring enucleation. Studies of experimental rabbit models of the infection have indicated that the most efficacious regimen consists of systemic and topical clindamycin and gentamicin. Successful therapy depends upon immediate systemic administration of these agents when the clinical setting suggests Bacillus cereus infection.

Adult↗
PubMedDate not supplied

Role of ceftriaxone in sexually transmitted diseases.

Ceftriaxone is a third-generation cephalosporin with antibacterial and pharmacokinetic characteristics that make it an excellent choice for the treatment of gonococcal infection and chancroid. Adverse effects are unusual. Clinical efficacy in all reported studies has been excellent. Additional studies are required for further elucidation of the role of ceftriaxone in the treatment of pelvic inflammatory disease and syphilis. Chlamydial infections are not altered by ceftriaxone, and additional treatment is necessary if Chlamydia is present concurrently with Neisseria gonorrhoeae.

Ceftriaxone↗