A. Cometta - Academia.edu (original) (raw)
Papers by A. Cometta
Revue médicale suisse, 2007
Revue médicale suisse, 2014
Revue médicale suisse, 2010
Revue médicale suisse, 2004
La neutropenie consecutive a une chimiotherapie se complique souvent d'une infection. Chez le... more La neutropenie consecutive a une chimiotherapie se complique souvent d'une infection. Chez les patients neutropeniques, l'administration precoce d'une antibiotheraple empirique des l'apparition d'un etat febrile constitue la pierre angor laire de la prise en charge et diminue drastiquement la mortalite liee a l'infection. L'analyse de la reponse clinique a l'antibiotheraple des patients neutropeniques febriles a montre que l'on pouvait differencier ceux a haut risque de ceux a bas risque de complications infectleuses. Chez les patients a bas risque, des regimes antibiotiques oraux se sont reveles aussi efficaces que les traitements antibiotiques intraveineux. A la suite de la simplification des traitements antibiotiques, des patients neutropeniques febriles consideres a bas risque de complications pourraient etre traites sur une base ambulatoire. Des etudes en cours permettront de determiner la securite, les avantages et limites de ce nouveau mode de prise en charge.
Revue médicale de la Suisse romande, 2003
This case report describes a patient with a pyelonephritis due to a fluoroquinolone-resistant E. ... more This case report describes a patient with a pyelonephritis due to a fluoroquinolone-resistant E. coli. The prevalence and the risk factor associated with the resistance of E. coli to fluoroquinolones have been assessed from recently published data. Several studies performed in patients with urinary tract infections have shown that the increase of fluoroquinolone-resistant strains was associated with an increased prescription of these antibiotics. Indiscriminate use of fluoroquinolones, in particular for respiratory tract infections, may lead to the dissemination of resistant strains among the general population.
Schweizerische medizinische Wochenschrift
The benefits of oral prophylaxis for neutropenia have remained controversial up to now. We evalua... more The benefits of oral prophylaxis for neutropenia have remained controversial up to now. We evaluated retrospectively the effect of antibiotic prophylaxis with ciprofloxacin and penicillin on the prevention of bacterial infections in 112 cases of prolonged neutropenia in adult patients treated for haematological malignancies. 41 patients received prophylaxis between December 1993 and November 1994 while 71 patients did not receive prophylaxis between December 1994 and November 1995. There were no significant differences between groups in age, sex, type or stage of haemopathy, type of chemotherapy and duration of neutropenia. The antibiotic prophylaxis reduced the number of overall infections (p = 0.05) and the number of gram-negative bacteraemias (p = 0.02). The median time to the onset of fever, the duration of fever, the duration of antibiotic treatment, the duration of hospitalization or admission to the intensive care unit, the number of serious complications or death were not in...
Journal of Infection Prevention, 2021
The recent increase of migration to Europe represents a risk of increased the prevalence of multi... more The recent increase of migration to Europe represents a risk of increased the prevalence of multidrug-resistant (MDR) bacteria. We conducted a cross-sectional study among asylum seekers admitted at two hospitals in Switzerland. Of the 59 patients included, 9 (14%) were colonised by a MDR bacteria, including 5 (8.5%) methicilin-resistant Staphylococcus aureus (MRSA) and 4 (6.8%) extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. No patient carried both ESBL-producing bacteria and MRSA. None of the patients carried a vancomycin-resistant Enterococcus (VRE) or a carbapenem-resistant Enterobacteriaceae (CRE). Colonisation with MDR bacteria was not associated with hospitalisation abroad or recent arrival in Switzerland. Whole genome sequencing analysis allowed us to exclude transmission between patients. The prevalence of MDR bacteria carriage is moderate among asylum seekers in western Switzerland. Further surveillance studies are necessary to determine if there is a ...
Current Opinion in Infectious Diseases, 1997
Acute myeloid leukemia (AML) is frequently encountered in elderly patients (> 65) whereas most... more Acute myeloid leukemia (AML) is frequently encountered in elderly patients (> 65) whereas most myelosuppressive chemotherapy protocols are restricted to younger patients. We retrospectively reviewed the 21 patients older than 65 (median age: 70, range: 66-86) hospitalized in our leukemia unit for recently diagnosed AML between 1. 1. 1988 and 31. 3. 1993. 16 had de novo AML (n-AML) and 5 had AML secondary to myelodysplastic syndromes (s-AML). Induction therapy consisted of cytarabine and either daunorubicine or mitoxantrone at conventional dosage in 18/21 patients. Early consolidation therapy was given to 14/21 patients and consisted of m-AMSA and VP-16 in 11 of them. The response to, and toxicity from, myelosuppressive chemotherapy was different according to the type of AML. In patients with n-AML a complete remission (CR) was obtained in 63% (10/16) and only 19% (3/16) died of MCT-related toxicity. In contrast, only 1/5 patients with s-AML achieved CR while 4/5 died of toxicity....
Chemotherapy-related neutropenia is frequently complicated by infections. In granulocytopenic can... more Chemotherapy-related neutropenia is frequently complicated by infections. In granulocytopenic cancer patients, the early empiric administration of broad-spectrum antibiotics is the cornerstone of the management and has dramatically decreased the infection-related mortality. Several intravenous antibiotic regimens have been shown to be effective and well tolerated, especially monotherapies with broad-spectrum beta-lactams. The analysis of the outcome of febrile neutropenic patients has allowed the differentiation of those at high risk from those at low risk of infectious complications. In low risk patients, oral antibiotic regimens have been shown as effective as intravenous regimens. Running studies will allow to determine the advantages and limits of an outpatient management
European Respiratory Journal, 2004
Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumo... more Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumonia (CAP). The current authors assessed whether oral levofloxacin treatment of patients with severe CAP, followed-up for 30 days, would save money. Over a 12-month period, 129 hospitalised patients with severe non-intensive care unit CAP were randomly assigned to receive either oral levofloxacin or sequential antibiotic treatment. Direct and indirect costs were compared over a 30-day period from several perspectives. CAP resolved in 71 out of 77 oral levofloxacin (92%) and in 34 out of 37 sequential antibiotic treatment patients (92%). Patients9 characteristics, treatment duration, hospital length of stay and mortality were similar in both groups. Drug acquisition costs were 1.7-times smaller in oral levofloxacin patients, who were less often transferred to rehabilitation centres, but they used more physicians9 visits during follow-up and their total costs were lower. As only a minority of patients was still active, inability to work and, hence, indirect costs were similar in both groups. In this study, oral levofloxacin for severe non-intensive care unit community-acquired pneumonia was equally effective as sequential antibiotic treatment, but did not lead to major costs savings except for drug acquisition costs. External factors linked with patients9 characteristics and/or medical practice are likely to play a role and should be addressed.
Until recently, aminoglycoside antibiotics were the cornerstone for the treatment of severe infec... more Until recently, aminoglycoside antibiotics were the cornerstone for the treatment of severe infections. The rationale for using combination therapy containing beta-lactams and aminoglycosides was not only to broaden the antimicrobial spectrum but also to achieve enhanced bacterial killing by synergism and to prevent the emergence of antibiotic resistance. However, with the advent of new potent broad-spectrum and highly bactericidal antibiotics, the necessity of combining beta-lactams with aminoglycosides should be reassessed. This review questions the use of aminoglycosides in three severe infections frequently observed in intensive care units, nosocomial pneumonia, nosocomial sepsis and severe diffuse peritonitis. A review of the literature suggests that the addition of an aminoglycoside to a broad-spectrum beta-lactam does not improve the outcome in nosocomial pneumonia and severe diffuse peritonitis. However, the lack of large prospective studies in severe sepsis or septic shock ...
Infectious Disease Clinics of North America, 1991
Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, th... more Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, the amelioration of the underlying conditions, the correction of predisposing factors, the drainage of abscesses, the removal of infected foreign bodies, and adequate supportive care are also of paramount importance for curing the infection and should not be neglected. Beginning in the late 1960s, most of the clinical work on gram-negative infections has focused on the evaluation of new antibiotics. Numerous studies have shown that early, appropriate antibiotic treatment of gram-negative bacteremia significantly improved patients' outcomes and prevented the development of septic shock. Prescribing standard doses of antibiotics does not necessarily mean that therapeutic levels will be reached in all patients, and relapses of infections or breakthrough bacteremias can occur in patients with subinhibitory serum levels of antibiotics. The monitoring of serum concentrations of antibiotic is therefore recommended in critically ill septic patients. Whereas initial studies on the antibiotic treatment of gram-negative bacteremia were carried out in nonneutropenic patients, more recent clinical investigations have been performed almost exclusively in cancer patients with neutropenia. Studies conducted in the 1970s and 1980s among these patients have shown the following: (1) early empirical therapy reduced the mortality of gram-negative bacteremia; (2) therapy with a combination of two antibiotics, be it an extended spectrum penicillin plus an aminoglycoside or a third-generation cephalosporin, has significantly improved patients' outcomes; and (3) triple-drug combinations (i.e., a penicillin plus a cephalosporin plus an aminoglycoside) are not superior to combinations of beta-lactams and aminoglycosides. For the treatment of gram-negative bacteremia, clinicians today have a choice between well-established antibiotic combinations and broad-spectrum single-agent therapy with third-generation cephalosporins or carbapenem antibiotics. Although recent studies suggested that monotherapy could be as effective as combination therapy for the empirical treatment of fever in the neutropenic host, no definitive study has so far unquestionably demonstrated the equivalence of these treatments in patients with gram-negative bacteremias, especially those caused by P. aeruginosa, or in patients with adverse prognostic conditions, such as persistent and profound granulocytopenia. This literature should however be reviewed with great caution. Indeed, only a minority of studies have included a sufficient number of patients to confidently assess the impact of therapy on patients' outcomes. Obviously, small studies can have a significant risk of type II errors, that is, making false-negative conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)
New England Journal of Medicine, 1992
Infections and their sequelae are a major cause of death among patients admitted to the surgical ... more Infections and their sequelae are a major cause of death among patients admitted to the surgical intensive care unit (ICU). Studies of passive immunotherapy with standard intravenous immune globulin and hyperimmune globulin directed against gram-negative core lipopolysaccharide to prevent gram-negative infections and their serious systemic complications have had equivocal results in such patients. We performed a double-blind study to assess the efficacy of standard immune globulin and core-lipopolysaccharide hyperimmune globulin in preventing infections in surgical patients at high risk. The patients received standard immune globulin (400 mg per kilogram of body weight), hyperimmune globulin (400 mg per kilogram), or placebo (25 percent albumin, 8 ml per kilogram) weekly, for a maximum of four doses while in the ICU. A total of 352 patients were enrolled, and 329 could be evaluated. The number of patients in whom infections developed was significantly lower in the group receiving standard immune globulin than in the placebo group (36 of 109 vs. 53 of 112 patients, P = 0.03), as was the incidence of pneumonia (15 vs. 30 cases, P = 0.04), especially pneumonia due to gram-negative bacteria (5 vs. 16 cases, P = 0.02). The number of days spent in the ICU and the total days spent in the hospital were lower in the standard immune globulin group (medians of 2 and 7.5 days fewer; P = 0.02 and 0.06, respectively). In contrast, the hyperimmune globulin had no detectable prophylactic effect on infections (50 of 108 patients, with 25 cases of pneumonia). The rate of systemic infections and shock was similar in the three study groups, and hospital mortality did not differ significantly among them. Intravenous immune globulin given prophylactically to selected high-risk patients in the surgical ICU can reduce the incidence of infection. Core-lipopolysaccharide hyperimmune globulin is not effective in preventing gram-negative infections and their systemic complications.
Antimicrobial Agents and Chemotherapy, 1994
Nosocomial pneumonia and sepsis, as well as severe diffuse peritonitis, must be treated early in ... more Nosocomial pneumonia and sepsis, as well as severe diffuse peritonitis, must be treated early in order to prevent complications such as septic shock and organ dysfunctions. With the availability of new broad-spectrum and highly bactericidal antibiotics, the need of combining beta-lactams with aminoglycosides for the treatment of severe infections should be reassessed. A prospective randomized controlled study was performed to compare imipenem monotherapy with a combination of imipenem plus netilmicin in the empiric treatment of nosocomial pneumonia, nosocomial sepsis, and severe diffuse peritonitis. A total of 313 patients were enrolled, and 280 were assessable. The antibiotic treatment was successful in 113 of 142 patients (80%) given the monotherapy and in 119 of 138 patients (86%) given the combination (P = 0.19). The failure rates for the most important type of infection, i.e., pneumonia, were similar in the two groups, as well as the number of superinfections. While creatinine ...
Revue médicale suisse, 2007
Schweizerische medizinische Wochenschrift, 1994
Infectious complications, a major cause of morbidity and mortality after heart transplantation, w... more Infectious complications, a major cause of morbidity and mortality after heart transplantation, were reviewed in 49 heart transplant patients at Lausanne. The follow-up lasted 32 months on average. 43 patients (88%) presented 108 infections (2.20 episodes of infection/patient). 38 severe infections (0.78 episodes/patient) were diagnosed in 27 patients (55%). 2 of the 9 deaths which occurred were due to infection. The viruses, principally of the herpes group, were responsible for 37% of all the infections, and bacteria for 28%. About a third of the viral and bacterial infections were severe. The other documented infections were caused by fungi (13%), which were most often responsible for superficial infections, and rarely by protozoa (5%). Finally, in 17% of infectious episodes, the pathogen could not be identified. Cytomegalovirus was the pathogen the most frequently responsible in severe infections. The highest incidence of infections occurred during the first 2-3 months after tran...
Les problemes rencontres chez la personne âgee lors de traitements antimicrobiens reconnaissent e... more Les problemes rencontres chez la personne âgee lors de traitements antimicrobiens reconnaissent essentiellement une origine pharmacocinetique. Ce changement dans la disposition des medicaments decoule parfois de modifications physiologiques liees au processus du vieillissement mais plus generalement d'alterations physiopathologiques et touche principalement les substances a elimination renale. Le potentiel d'interactions medicamenteuses, dont certaines graves, liees a l'utilisation de certains antiinfectieux doit etre connu.
L'incidence de la meningo-encephalite verno-estivale (MEVE) a plus que double en Suisse au co... more L'incidence de la meningo-encephalite verno-estivale (MEVE) a plus que double en Suisse au cours des dernieres annees. En Suisse romande, plusieurs cas semblent avoir ete acquis en dehors des zones d'endemie connues. Trente patients avec MEVE residant ou ayant declare avoir ete infectes en Suisse romande entre 2000 et 2005 ont ete recenses. Pour un patient, il n'a pas ete possible d'obtenir d'information precise sur le lieu d'acquisition de l'infection et seize patients ont ete infectes dans des foyers d'endemie connus. Parmi les treize patients restants, six ont acquis l'infection sur les rives sud du lac de Neuchâtel et sept dans la plaine de l'Orbe. Nous concluons qu'il existe de nouveaux foyers d'endemie de MEVE dans le nord vaudois. La vaccination devrait etre proposee a la population a risque de ces regions. En plus, il est important que les personnes ayant une activite dans la nature dans ces regions respectent les mesures de pr...
Revue médicale suisse, 2007
Revue médicale suisse, 2014
Revue médicale suisse, 2010
Revue médicale suisse, 2004
La neutropenie consecutive a une chimiotherapie se complique souvent d'une infection. Chez le... more La neutropenie consecutive a une chimiotherapie se complique souvent d'une infection. Chez les patients neutropeniques, l'administration precoce d'une antibiotheraple empirique des l'apparition d'un etat febrile constitue la pierre angor laire de la prise en charge et diminue drastiquement la mortalite liee a l'infection. L'analyse de la reponse clinique a l'antibiotheraple des patients neutropeniques febriles a montre que l'on pouvait differencier ceux a haut risque de ceux a bas risque de complications infectleuses. Chez les patients a bas risque, des regimes antibiotiques oraux se sont reveles aussi efficaces que les traitements antibiotiques intraveineux. A la suite de la simplification des traitements antibiotiques, des patients neutropeniques febriles consideres a bas risque de complications pourraient etre traites sur une base ambulatoire. Des etudes en cours permettront de determiner la securite, les avantages et limites de ce nouveau mode de prise en charge.
Revue médicale de la Suisse romande, 2003
This case report describes a patient with a pyelonephritis due to a fluoroquinolone-resistant E. ... more This case report describes a patient with a pyelonephritis due to a fluoroquinolone-resistant E. coli. The prevalence and the risk factor associated with the resistance of E. coli to fluoroquinolones have been assessed from recently published data. Several studies performed in patients with urinary tract infections have shown that the increase of fluoroquinolone-resistant strains was associated with an increased prescription of these antibiotics. Indiscriminate use of fluoroquinolones, in particular for respiratory tract infections, may lead to the dissemination of resistant strains among the general population.
Schweizerische medizinische Wochenschrift
The benefits of oral prophylaxis for neutropenia have remained controversial up to now. We evalua... more The benefits of oral prophylaxis for neutropenia have remained controversial up to now. We evaluated retrospectively the effect of antibiotic prophylaxis with ciprofloxacin and penicillin on the prevention of bacterial infections in 112 cases of prolonged neutropenia in adult patients treated for haematological malignancies. 41 patients received prophylaxis between December 1993 and November 1994 while 71 patients did not receive prophylaxis between December 1994 and November 1995. There were no significant differences between groups in age, sex, type or stage of haemopathy, type of chemotherapy and duration of neutropenia. The antibiotic prophylaxis reduced the number of overall infections (p = 0.05) and the number of gram-negative bacteraemias (p = 0.02). The median time to the onset of fever, the duration of fever, the duration of antibiotic treatment, the duration of hospitalization or admission to the intensive care unit, the number of serious complications or death were not in...
Journal of Infection Prevention, 2021
The recent increase of migration to Europe represents a risk of increased the prevalence of multi... more The recent increase of migration to Europe represents a risk of increased the prevalence of multidrug-resistant (MDR) bacteria. We conducted a cross-sectional study among asylum seekers admitted at two hospitals in Switzerland. Of the 59 patients included, 9 (14%) were colonised by a MDR bacteria, including 5 (8.5%) methicilin-resistant Staphylococcus aureus (MRSA) and 4 (6.8%) extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. No patient carried both ESBL-producing bacteria and MRSA. None of the patients carried a vancomycin-resistant Enterococcus (VRE) or a carbapenem-resistant Enterobacteriaceae (CRE). Colonisation with MDR bacteria was not associated with hospitalisation abroad or recent arrival in Switzerland. Whole genome sequencing analysis allowed us to exclude transmission between patients. The prevalence of MDR bacteria carriage is moderate among asylum seekers in western Switzerland. Further surveillance studies are necessary to determine if there is a ...
Current Opinion in Infectious Diseases, 1997
Acute myeloid leukemia (AML) is frequently encountered in elderly patients (> 65) whereas most... more Acute myeloid leukemia (AML) is frequently encountered in elderly patients (> 65) whereas most myelosuppressive chemotherapy protocols are restricted to younger patients. We retrospectively reviewed the 21 patients older than 65 (median age: 70, range: 66-86) hospitalized in our leukemia unit for recently diagnosed AML between 1. 1. 1988 and 31. 3. 1993. 16 had de novo AML (n-AML) and 5 had AML secondary to myelodysplastic syndromes (s-AML). Induction therapy consisted of cytarabine and either daunorubicine or mitoxantrone at conventional dosage in 18/21 patients. Early consolidation therapy was given to 14/21 patients and consisted of m-AMSA and VP-16 in 11 of them. The response to, and toxicity from, myelosuppressive chemotherapy was different according to the type of AML. In patients with n-AML a complete remission (CR) was obtained in 63% (10/16) and only 19% (3/16) died of MCT-related toxicity. In contrast, only 1/5 patients with s-AML achieved CR while 4/5 died of toxicity....
Chemotherapy-related neutropenia is frequently complicated by infections. In granulocytopenic can... more Chemotherapy-related neutropenia is frequently complicated by infections. In granulocytopenic cancer patients, the early empiric administration of broad-spectrum antibiotics is the cornerstone of the management and has dramatically decreased the infection-related mortality. Several intravenous antibiotic regimens have been shown to be effective and well tolerated, especially monotherapies with broad-spectrum beta-lactams. The analysis of the outcome of febrile neutropenic patients has allowed the differentiation of those at high risk from those at low risk of infectious complications. In low risk patients, oral antibiotic regimens have been shown as effective as intravenous regimens. Running studies will allow to determine the advantages and limits of an outpatient management
European Respiratory Journal, 2004
Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumo... more Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumonia (CAP). The current authors assessed whether oral levofloxacin treatment of patients with severe CAP, followed-up for 30 days, would save money. Over a 12-month period, 129 hospitalised patients with severe non-intensive care unit CAP were randomly assigned to receive either oral levofloxacin or sequential antibiotic treatment. Direct and indirect costs were compared over a 30-day period from several perspectives. CAP resolved in 71 out of 77 oral levofloxacin (92%) and in 34 out of 37 sequential antibiotic treatment patients (92%). Patients9 characteristics, treatment duration, hospital length of stay and mortality were similar in both groups. Drug acquisition costs were 1.7-times smaller in oral levofloxacin patients, who were less often transferred to rehabilitation centres, but they used more physicians9 visits during follow-up and their total costs were lower. As only a minority of patients was still active, inability to work and, hence, indirect costs were similar in both groups. In this study, oral levofloxacin for severe non-intensive care unit community-acquired pneumonia was equally effective as sequential antibiotic treatment, but did not lead to major costs savings except for drug acquisition costs. External factors linked with patients9 characteristics and/or medical practice are likely to play a role and should be addressed.
Until recently, aminoglycoside antibiotics were the cornerstone for the treatment of severe infec... more Until recently, aminoglycoside antibiotics were the cornerstone for the treatment of severe infections. The rationale for using combination therapy containing beta-lactams and aminoglycosides was not only to broaden the antimicrobial spectrum but also to achieve enhanced bacterial killing by synergism and to prevent the emergence of antibiotic resistance. However, with the advent of new potent broad-spectrum and highly bactericidal antibiotics, the necessity of combining beta-lactams with aminoglycosides should be reassessed. This review questions the use of aminoglycosides in three severe infections frequently observed in intensive care units, nosocomial pneumonia, nosocomial sepsis and severe diffuse peritonitis. A review of the literature suggests that the addition of an aminoglycoside to a broad-spectrum beta-lactam does not improve the outcome in nosocomial pneumonia and severe diffuse peritonitis. However, the lack of large prospective studies in severe sepsis or septic shock ...
Infectious Disease Clinics of North America, 1991
Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, th... more Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, the amelioration of the underlying conditions, the correction of predisposing factors, the drainage of abscesses, the removal of infected foreign bodies, and adequate supportive care are also of paramount importance for curing the infection and should not be neglected. Beginning in the late 1960s, most of the clinical work on gram-negative infections has focused on the evaluation of new antibiotics. Numerous studies have shown that early, appropriate antibiotic treatment of gram-negative bacteremia significantly improved patients' outcomes and prevented the development of septic shock. Prescribing standard doses of antibiotics does not necessarily mean that therapeutic levels will be reached in all patients, and relapses of infections or breakthrough bacteremias can occur in patients with subinhibitory serum levels of antibiotics. The monitoring of serum concentrations of antibiotic is therefore recommended in critically ill septic patients. Whereas initial studies on the antibiotic treatment of gram-negative bacteremia were carried out in nonneutropenic patients, more recent clinical investigations have been performed almost exclusively in cancer patients with neutropenia. Studies conducted in the 1970s and 1980s among these patients have shown the following: (1) early empirical therapy reduced the mortality of gram-negative bacteremia; (2) therapy with a combination of two antibiotics, be it an extended spectrum penicillin plus an aminoglycoside or a third-generation cephalosporin, has significantly improved patients' outcomes; and (3) triple-drug combinations (i.e., a penicillin plus a cephalosporin plus an aminoglycoside) are not superior to combinations of beta-lactams and aminoglycosides. For the treatment of gram-negative bacteremia, clinicians today have a choice between well-established antibiotic combinations and broad-spectrum single-agent therapy with third-generation cephalosporins or carbapenem antibiotics. Although recent studies suggested that monotherapy could be as effective as combination therapy for the empirical treatment of fever in the neutropenic host, no definitive study has so far unquestionably demonstrated the equivalence of these treatments in patients with gram-negative bacteremias, especially those caused by P. aeruginosa, or in patients with adverse prognostic conditions, such as persistent and profound granulocytopenia. This literature should however be reviewed with great caution. Indeed, only a minority of studies have included a sufficient number of patients to confidently assess the impact of therapy on patients' outcomes. Obviously, small studies can have a significant risk of type II errors, that is, making false-negative conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)
New England Journal of Medicine, 1992
Infections and their sequelae are a major cause of death among patients admitted to the surgical ... more Infections and their sequelae are a major cause of death among patients admitted to the surgical intensive care unit (ICU). Studies of passive immunotherapy with standard intravenous immune globulin and hyperimmune globulin directed against gram-negative core lipopolysaccharide to prevent gram-negative infections and their serious systemic complications have had equivocal results in such patients. We performed a double-blind study to assess the efficacy of standard immune globulin and core-lipopolysaccharide hyperimmune globulin in preventing infections in surgical patients at high risk. The patients received standard immune globulin (400 mg per kilogram of body weight), hyperimmune globulin (400 mg per kilogram), or placebo (25 percent albumin, 8 ml per kilogram) weekly, for a maximum of four doses while in the ICU. A total of 352 patients were enrolled, and 329 could be evaluated. The number of patients in whom infections developed was significantly lower in the group receiving standard immune globulin than in the placebo group (36 of 109 vs. 53 of 112 patients, P = 0.03), as was the incidence of pneumonia (15 vs. 30 cases, P = 0.04), especially pneumonia due to gram-negative bacteria (5 vs. 16 cases, P = 0.02). The number of days spent in the ICU and the total days spent in the hospital were lower in the standard immune globulin group (medians of 2 and 7.5 days fewer; P = 0.02 and 0.06, respectively). In contrast, the hyperimmune globulin had no detectable prophylactic effect on infections (50 of 108 patients, with 25 cases of pneumonia). The rate of systemic infections and shock was similar in the three study groups, and hospital mortality did not differ significantly among them. Intravenous immune globulin given prophylactically to selected high-risk patients in the surgical ICU can reduce the incidence of infection. Core-lipopolysaccharide hyperimmune globulin is not effective in preventing gram-negative infections and their systemic complications.
Antimicrobial Agents and Chemotherapy, 1994
Nosocomial pneumonia and sepsis, as well as severe diffuse peritonitis, must be treated early in ... more Nosocomial pneumonia and sepsis, as well as severe diffuse peritonitis, must be treated early in order to prevent complications such as septic shock and organ dysfunctions. With the availability of new broad-spectrum and highly bactericidal antibiotics, the need of combining beta-lactams with aminoglycosides for the treatment of severe infections should be reassessed. A prospective randomized controlled study was performed to compare imipenem monotherapy with a combination of imipenem plus netilmicin in the empiric treatment of nosocomial pneumonia, nosocomial sepsis, and severe diffuse peritonitis. A total of 313 patients were enrolled, and 280 were assessable. The antibiotic treatment was successful in 113 of 142 patients (80%) given the monotherapy and in 119 of 138 patients (86%) given the combination (P = 0.19). The failure rates for the most important type of infection, i.e., pneumonia, were similar in the two groups, as well as the number of superinfections. While creatinine ...
Revue médicale suisse, 2007
Schweizerische medizinische Wochenschrift, 1994
Infectious complications, a major cause of morbidity and mortality after heart transplantation, w... more Infectious complications, a major cause of morbidity and mortality after heart transplantation, were reviewed in 49 heart transplant patients at Lausanne. The follow-up lasted 32 months on average. 43 patients (88%) presented 108 infections (2.20 episodes of infection/patient). 38 severe infections (0.78 episodes/patient) were diagnosed in 27 patients (55%). 2 of the 9 deaths which occurred were due to infection. The viruses, principally of the herpes group, were responsible for 37% of all the infections, and bacteria for 28%. About a third of the viral and bacterial infections were severe. The other documented infections were caused by fungi (13%), which were most often responsible for superficial infections, and rarely by protozoa (5%). Finally, in 17% of infectious episodes, the pathogen could not be identified. Cytomegalovirus was the pathogen the most frequently responsible in severe infections. The highest incidence of infections occurred during the first 2-3 months after tran...
Les problemes rencontres chez la personne âgee lors de traitements antimicrobiens reconnaissent e... more Les problemes rencontres chez la personne âgee lors de traitements antimicrobiens reconnaissent essentiellement une origine pharmacocinetique. Ce changement dans la disposition des medicaments decoule parfois de modifications physiologiques liees au processus du vieillissement mais plus generalement d'alterations physiopathologiques et touche principalement les substances a elimination renale. Le potentiel d'interactions medicamenteuses, dont certaines graves, liees a l'utilisation de certains antiinfectieux doit etre connu.
L'incidence de la meningo-encephalite verno-estivale (MEVE) a plus que double en Suisse au co... more L'incidence de la meningo-encephalite verno-estivale (MEVE) a plus que double en Suisse au cours des dernieres annees. En Suisse romande, plusieurs cas semblent avoir ete acquis en dehors des zones d'endemie connues. Trente patients avec MEVE residant ou ayant declare avoir ete infectes en Suisse romande entre 2000 et 2005 ont ete recenses. Pour un patient, il n'a pas ete possible d'obtenir d'information precise sur le lieu d'acquisition de l'infection et seize patients ont ete infectes dans des foyers d'endemie connus. Parmi les treize patients restants, six ont acquis l'infection sur les rives sud du lac de Neuchâtel et sept dans la plaine de l'Orbe. Nous concluons qu'il existe de nouveaux foyers d'endemie de MEVE dans le nord vaudois. La vaccination devrait etre proposee a la population a risque de ces regions. En plus, il est important que les personnes ayant une activite dans la nature dans ces regions respectent les mesures de pr...