30 research outputs found
Infectious aetiologies of severe acute chest syndrome in sickle-cell adult patients, combining conventional microbiological tests and respiratory multiplex PCR
No full textInternational audienceAcute chest syndrome (ACS) is the most serious complication of sickle cell disease. The pathophysiology of ACS may involve lower respiratory tract infection (LRTI), alveolar hypoventilation and atelectasis, bone infarcts-driven fat embolism, and in situ pulmonary artery thrombosis. One of the most challenging issues for the physicians is to diagnose LRTI as the cause of ACS. The use of a respiratory multiplex PCR (mPCR) for the diagnosis of LRTI has not been assessed in sickle-cell adult patients with ACS. To describe the spectrum of infectious aetiologies of severe ACS, using a diagnostic approach combining conventional tests and mPCR. A non-interventional monocenter prospective study involving all the consecutive sickle-cell adult patients with ACS admitted to the intensive care unit (ICU). Microbiological investigation included conventional tests and a nasopharyngeal swab for mPCR. Altogether, 36 patients were enrolled, of whom 30 (83%) had complete microbiological investigations. A bacterial microorganism, mostly Staphylococcus aureus (n = 8), was identified in 11 patients. There was no pneumonia-associated intracellular bacterial pathogen. A respiratory virus was identified in six patients. Using both conventional tests and nasopharyngeal mPCR, a microbiological documentation was obtained in half of adult ACS patients admitted to the ICU. Pyogenic bacteria, especially S. aureus, predominated
Short and long-term outcomes of <i>Streptococcus pyogenes</i> pneumonia managed in the intensive care unit
No full textImpacts of the COVID-19 pandemic on sepsis incidence, etiology and hospitalization costs in France: a retrospective observational study
No full textAbstract Background Sepsis is a serious medical condition that causes long-term morbidity and high mortality, annually affecting millions of people worldwide. The COVID-19 pandemic may have impacted its burden. This study aimed to estimate the impact of the COVID-19 pandemic on sepsis incidence, etiology and associated hospitalization costs in metropolitan France. Methods This retrospective observational study used data drawn from a cohort of hospitalized sepsis patients in France’s national healthcare database. Sepsis was identified through both explicit International Classification of Diseases 10th revision (ICD-10) codes (E-sepsis) and implicit codes (I-sepsis). Participants included all patients aged 15 years or older hospitalized with E-sepsis or I-sepsis in metropolitan France between January 1, 2018, and December 31, 2022. Patient and hospital stay characteristics were described by sepsis type (E-sepsis, I-sepsis) and overall. The distribution of sepsis etiology was estimated for each year. Annual incidence rates were estimated overall and by sepsis type and etiology. Total and median per-stay hospitalization costs were calculated. Results The total age- and sex-standardized sepsis incidence rate per 100,000 increased slightly from 2018 (446, 95% CI 444.2 to 447.7) to 2020 (457, 95% CI 455.1 to 458.6) and then decreased in 2022 (382, 95% CI 380.2 to 383.7) (p <.0001). Incidence rates decreased for both E-sepsis and bacterial sepsis during the pandemic period, whereas I-sepsis incidence increased in 2020 and 2021, associated with a marked increase in viral sepsis and co-infections (p <.0001 for E- and I-sepsis). Viral sepsis represented about 10% of all sepsis cases during the pandemic, but only about 1% prior to the pandemic. Total sepsis-associated hospitalization costs and extra medication costs increased during the pandemic. Characteristics of patients and their hospital stays were overall stable over the five-year study period. Conclusions The COVID-19 pandemic led to a higher burden of sepsis in French hospitals and an increase in hospital stay costs. Critically, our study highlights the need for introducing more explicit viral sepsis codes within the ICD classification system and for achieving a consensus on its definition in order to robustly estimate sepsis incidence
Risks Related to the Use of Non-Steroidal Anti-Inflammatory Drugs in Community-Acquired Pneumonia in Adult and Pediatric Patients
No full textInternational audienceNon-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate symptoms during community-acquired pneumonia (CAP), while neither clinical data nor guidelines encourage this use. Experimental data suggest that NSAIDs impair neutrophil intrinsic functions, their recruitment to the inflammatory site, and the resolution of inflammatory processes after acute pulmonary bacterial challenge. During CAP, numerous observational data collected in hospitalized children, hospitalized adults, and adults admitted to intensive care units (ICUs) support a strong association between pre-hospital NSAID exposure and a delayed hospital referral, a delayed administration of antibiotic therapy, and the occurrence of pleuropulmonary complications, even in the only study that has accounted for a protopathic bias. Other endpoints have been described including a longer duration of antibiotic therapy and a greater hospital length of stay. In all adult series, patients exposed to NSAIDs were younger and had fewer comorbidities. The mechanisms by which NSAID use would entail a complicated course in pneumonia still remain uncertain. The temporal hypothesis and the immunological hypothesis are the two main emerging hypotheses. Current data strongly support an association between NSAID intake during the outpatient treatment of CAP and a complicated course. This should encourage experts and scientific societies to strongly advise against the use of NSAIDs in the management of lower respiratory tract infections
Bacterial coinfection in critically ill COVID-19 patients with severe pneumonia
No full textInternational audienceSevere 2019 novel coronavirus infectious disease (COVID-19) with pneumonia is associated with high rates of admission to the intensive care unit (ICU). Bacterial coinfection has been reported to be rare. We aimed at describing the rate of bacterial coinfection in critically ill adult patients with severe COVID-19 pneumonia. All the patients with laboratory-confirmed severe COVID-19 pneumonia admitted to the ICU of Tenon University-teaching hospital, from February 22 to May 7th, 2020 were included. Respiratory tract specimens were obtained within the first 48 h of ICU admission. During the study period, 101 patients were referred to the ICU for COVID-19 with severe pneumonia. Most patients (n = 83; 82.2%) were intubated and mechanically ventilated on ICU admission. Overall, 20 (19.8%) respiratory tract specimens obtained within the first 48 h. Staphylococcus aureus was the main pathogen identified, accounting for almost half of the early-onset bacterial etiologies. We found a high prevalence of early-onset bacterial coinfection during severe COVID-19 pneumonia, with a high proportion of S. aureus. Our data support the current WHO guidelines for the management of severe COVID-19 patients, in whom antibiotic therapy directed to respiratory pathogens is recommended. Keywords Coronavirus disease 2019 • Bacterial coinfection • Staphylococcus aureus • Intensive care unit • Pneumonia Abbreviations COVID 19 Coronavirus infectious disease ICU Intensive care unit SAPSII Simplified acute physiology score SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 SOFA Sequential Organ Failure Assessmen
Trends in hospitalisations for lower respiratory infections after the COVID-19 pandemic in France
No full textInternational audienceObjectives: We aimed to evaluate the impact of the pandemic and post-pandemic periods on hospital admissions for LRTI, with a focus on patients with chronic respiratory disease (CRD). Methods: From July 2013 to June 2023, monthly numbers of adult hospitalisations for LRTI (excluding SARS-CoV-2) were extracted from the French National Hospital Discharge Database. They were modelled by regressions with autocorrelated errors. Three periods were defined: (1) early pandemic and successive lockdowns; (2) gradual lifting of restrictions and widespread SARS-CoV-2 vaccination; (3) withdrawal of restriction measures. Results: Pre-pandemic incidence was 96 (90.5 to 101.5) per 100,000 population. Compared with the pre-pandemic period, no more seasonality and significant reductions were estimated in the first two periods: −43.64% (−50.11 to −37.17) and −32.97% (−39.88 to −26.05), respectively. A rebound with a positive trend and a seasonal pattern was observed in period 3. Similar results were observed for CRD patients with no significant difference with pre-pandemic levels in the last period (−9.21%; −20.9% to 1.67%), albeit with differential changes according to the type of CRD. Conclusions: COVID-19 pandemic containment measures contributed to changes in LRTI incidence, with a rapid increase and return to a seasonal pattern after their lifting, particularly in patients with CRD
A Severe COVID-19 Pneumonia Revealing a Lepidic Adenocarcinoma: A Diagnostic Challenge During the Pandemic Period
No full textInternational audienc
An unusual community-acquired invasive and multi systemic infection due to ExoU-harboring Pseudomonas aeruginosa strain: Clinical disease and microbiological characteristics
No full textInternational audienceCommunity-acquired Pseudomonas aeruginosa infections are rare. Most cases involve patients either with underlying immunosuppression or structural chronic lung diseases. We report here an atypical case of a severe community-acquired invasive infection due to a hypervirulent ExoU-producing strain, in an immunocompetent patient
Severe hemoptysis associated with lung cancer in the ICU: recurrence and outcome
No full textAbstract Background Hemoptysis is a life-threatening event in the course of lung cancer (LC). The management of the most severe episodes of hemoptysis include medical measures and vascular interventional radiology (VIR). There are few data on initial clinical and radiological features associated with early bleeding recurrence, and its prognostic significance. Methods A monocenter retrospective study involving patients admitted to the intensive care unit (ICU) between 2009 and 2020 for severe hemoptysis (SH) associated with LC and requiring VIR. Results During the study period, 130 patients (85% males; 59.5 ± 5.3 yrs) with SH and non-small cell (78%) or small-cell (18%) LC were analysed. SH was inaugural in half of cases. A lower respiratory tract infection (LRTI) was microbiologically documented in 39% of cases. All patients received a first-line VIR, including systemic bronchial and non-bronchial arteriography with embolisation (n = 117) and/or pulmonary arterial vaso-occlusion (n = 20). Bleeding recurred in 34% cases, after 1 day [1–3] of initial VIR attempt. Overall, the 28-day, 6-month and 12-month mortality rates were 25.3%, 47.7% and 63%, respectively. Intravenous terlipressin prior to VIR (OR 4.43, p = 0.001) and LRTI (OR 2.93; p = 0.007) were independently associated with bleeding recurrence. Tumoral cavitation (HR 3.37; p = 0.004), Staphylococcus aureus infection (HR 8.3; p = 0.005) and bleeding recurrence (HR 2.68; p = 0.01) were independently associated with one-year mortality. Conclusion Lung cancer-related SH is associated with a high rate of bleeding recurrence and a poor prognosis. The association of Staphylococcus aureus infection with recurrence and mortality raises the potential interest of the administration of antibacterial treatment in that context
Trajectoires de soins des patients atteints de maladies respiratoires chroniques après hospitalisation pour COVID-19
No full textInternational audienceLes maladies respiratoires chroniques (MRC) semblent avoir été impactées de manière différente par la pandémie de COVID-19. En effet, si les patients asthmatiques semblent peu affectés, les patients atteint de BPCO présentent un surrisque d'hospitalisation et de mortalité. L'impact à plus long terme d'une hospitalisation au sein de cette population est inconnu. Notre étude vise à identifier, chez les patients présentant une MRC ayant survécu à une hospitalisation pour COVID-19 durant les deux premières vagues, les trajectoires de soins. MéTHODES: Les données ont été extraite du Système National des Données de Santé. Les patients hospitalisés pour COVID-19, pendant la première et la deuxième vague respectivement de mars à juin 2020 et septembre 2020-janvier 2021, ont été identifiés par des codes CIM-10 spécifiques. L'hospitalisation d'inclusion et l'ensemble des hospitalisations dans les 12 mois précédant ont permis de déterminer la présence d'une MRC. Les trajectoires de soins des patients survivants ont été analysées via une analyse de séquence par ''optimal matching''. RéSULTATS: Au total, 174 177 sur 218 282 patients au total ont survécus à une hospitalisation pour COVID-19. Près de 25% des patients présentaient une MRC, majoritairement la BPCO (19 %). Cinq trajectoires de soins similaires dans les deux vagues ont été identifiées : décès précoce (11 %), décès tardif (5 %), séjour prolongé hospitalier (2 %), retour à domicile avec soins (14 %) et retour à domicile simple (68 %). Comparés aux patients sans recours aux soins hospitalier les patients avec un recours au soin hospitalier post-hospitalisation index pour COVID-19 semblent plus âgés, plus comorbide avec davantage de séjours en réanimation. Les patients ayant un décès post-hospitalier étaient également plus âgés et comorbides. Notre étude souligne la diversité des trajectoires de soins des patients atteints de MRC après une hospitalisation pour COVID-19. Malgré un retour simple à domicile dans 2/3 des cas, une proportion importante de patients nécessite des soins prolongés ou des réadmissions hospitalières, soulignant l'importance d'un suivi post-hospitalisation adapté
