Romaric Larcher | Université de Montpellier (original) (raw)

Papers by Romaric Larcher

Médecine et Maladies Infectieuses Formation

Antimicrobial resistance and infection control, Mar 21, 2024

Research Square (Research Square), Sep 26, 2022

Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosens... more Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosensitive neurons involved in touch sensation and central neurons affected in ASD share transcriptional regulators. Mutant mice for ASD-associated transcription factors exhibit impaired primary tactile perception, and restoring those genes speci cally in primary sensory neurons rescue some of the anxiety-like behavior and social interaction defects. Interestingly, peripheral mechanosensitive sensory neurons also project to internal organs including the cardio-vascular system, and an imbalance of the cardio-vascular sympatho-vagal regulation is evidenced in ASD and intellectual disability. ASD patients have decreased vagal tone, suggesting dysfunction of sensory neurons involved in cardio-vascular sensing. In light of our previous nding that the ASD-associated Meis2 gene is necessary for normal touch neurons development and function, we investigated here if its inactivation in mouse peripheral sensory neurons also affects cardio-vascular sympatho-vagal regulation and barore ex. Combining echocardiography, pharmacological challenge, blood pressure monitoring and heart rate variability analysis, we found that Meis2 mutant mice exhibited a blunted vagal response independently of any apparent cardiac malformation. These results suggest that defects in primary sensory neurons with mechanosensitive identity could participate in the imbalanced cardio-vascular sympatho-vagal tone found in ASD patients, reinforcing current hypotheses on the role of primary sensory neurons in the etiology of ASD.

Revue de Médecine Interne, Dec 1, 2021

Médecine et maladies infectieuses formation, May 1, 2023

International Journal of Antimicrobial Agents, May 1, 2023

Revue de Médecine Interne, Dec 1, 2013

Revue de Médecine Interne, Jun 1, 2019

Introduction Le syndrome catastrophique des antiphospholipides (CAPS) est considere comme etant l... more Introduction Le syndrome catastrophique des antiphospholipides (CAPS) est considere comme etant la manifestation la plus grave du syndrome des anticorps antiphospholipides (SAPL), et est defini par la survenue simultanee de thromboses dans au moins 3 organes ou tissus. Le diagnostic de CAPS est parfois difficile alors que son identification et son traitement precoce est crucial pour le pronostic des malades. Il existe peu de donnee sur l’interet pronostique des criteres du CAPS chez les malades avec un SAPL admis en reanimation. Nous avons conduit une etude pour evaluer la distribution et le pronostic des criteres du CAPS (certain/probable/pas de CAPS) chez les malades porteurs d’un SAPL et admis en reanimation avec une nouvelle manifestation thrombotique. Patients et methodes Nous avons conduit une etude multicentrique retrospective Francaise, entre janvier 2000 et fevrier 2018 dans 24 services de reanimation, incluant les patients porteurs d’un SAPL admis avec une nouvelle manifestation thrombotique (veineuse, arterielle ou microvasculaire). Resultats 152 episodes chez 134 malades ont ete admis en reanimation pendant la duree de l’etude. L’âge moyen ± SD a l’admission etait de 45,4 ± 15,0 ans avec un ratio femme/homme de 2,5. Le diagnostic de SAPL etait connu a l’admission dans 121 (79,6 %) episodes. Les atteintes cliniques anterieures du SAPL etaient : veineuses 70,4 %, arterielles 43,4 % et obstetricales 38,5 %. Quatre-vingt-quatre malades (55,3 %) avaient une triple positivite biologique du SAPL. Un traitement specifique du SAPL etait prescrit dans 78,3 % des cas avant l’admission, un antiagregant plaquettaire 50 (32,9 %) et/ou un anticoagulant 110 (72,4 %). Le SAPL etait associe au lupus systemique dans 34,2 % des cas. Un facteur declenchant etait rapporte lors de 114 (75,0 %) des episodes. Selon les criteres de definition du CAPS, 11 (7,2 %) avaient un CAPS certain, 60 (39,5 %) un CAPS probable et 81 (35,5 %) pas de CAPS. Nous avons par la suite compare les patients uniques avec un CAPS certain/probable (groupe 1, n = 61) ou pas de CAPS (groupe 2, n = 73). En dehors d’une proportion plus importante de femme dans le groupe des non CAPS (n = 38 (62,3 %) vs n = 58 (79,5 %), p = 0,03), il n’y avait pas de difference pour les caracteristiques demographiques et les caracteristiques cliniques anterieures ou biologiques du SAPL. La frequence du lupus et la proportion de patient avec un diagnostic de SAPL avant l’admission etait similaire entre les deux groupes. La gravite initiale et les comorbidites en reanimation definies par les scores de SOFA, l’IGS2 et de Charlson etaient comparables entre les 2 groupes. La mediane [IQR25-75] du nombre d’organes atteints (4 [3-4] vs 2 [1–3], p Conclusion Dans notre etude, l’identification d’un CAPS en utilisant les criteres de definition n’etait pas associee a la mortalite des SAPL admis en reanimation avec une nouvelle manifestation thrombotique. De nouvelles etudes sont necessaires pour evaluer la pertinence des criteres du CAPS, comme outil diagnostique et pronostique, au sein de cette population.

Revue de Médecine Interne, Jun 1, 2019

Intensive Care Medicine, Feb 1, 2023

Revue de Médecine Interne, Dec 1, 2021

Journal for ImmunoTherapy of Cancer, May 1, 2023

Background Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last dec... more Background Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening. Methods We conducted a multicenter cross-sectional retrospective study with the aim of better characterizing ICI-related myocarditis. Myocarditis diagnosis was based on the recent consensus statement of the International Cardio-Oncology Society. Results Twenty-nine patients were identified, from six different referral centers. Most patients (55%) were treated using anti-programmed-death 1, rather than ICI combination (35%) or anti-programmed-death-ligand 1 (10%). Transthoracic echocardiography was abnormal in 52% of them, and cardiac magnetic resonance showed abnormal features in 14/24 patients (58%). Eleven patients (38%) were classified as severe. Compared with other patients, they had more frequently pre-existing systemic autoimmune disease (45% vs 6%, p=0.018), higher troponin level on admission (42-fold the upper limit vs 3.55-fold, p=0.001), and exhibited anti-acetylcholine receptor autoantibodies (p=0.001). Seven patients (24%) had myocarditis-related death, and eight more patients died from cancer progression during followup. Twenty-eight patients received glucocorticoids, 10 underwent plasma exchanges, 8 received intravenous immunoglobulins, and 5 other immunosuppressants. ICI rechallenge was performed in six patients, with only one myocarditis relapse. Discussion The management of ICI-related myocarditis may be challenging and requires a multidisciplinary approach. Prognostic features are herein described and may help to allow ICI rechallenge for some patients with smoldering presentation, after an accurate evaluation of benefit-risk balance. ⇒ Early detection of ICI-related myocarditis through a multidisciplinary approach may improve the management of oncology patients. Identification of prognostic factors for severity may also allow ICI rechallenge in some cases, after an accurate evaluation of benefit-risk balance.

Scientific Reports, Nov 23, 2022

Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosens... more Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosensitive neurons involved in touch sensation and central neurons affected in ASD share transcriptional regulators. Mutant mice for ASD-associated transcription factors exhibit impaired primary tactile perception and restoring those genes specifically in primary sensory neurons rescues some of the anxiety-like behavior and social interaction defects. Interestingly, peripheral mechanosensitive sensory neurons also project to internal organs including the cardiovascular system, and an imbalance of the cardio-vascular sympathovagal regulation is evidenced in ASD and intellectual disability. ASD patients have decreased vagal tone, suggesting dysfunction of sensory neurons involved in cardio-vascular sensing. In light of our previous finding that the ASD-associated Meis2 gene is necessary for normal touch neuron development and function, we investigated here if its inactivation in mouse peripheral sensory neurons also affects cardio-vascular sympathovagal regulation and baroreflex. Combining echocardiography, pharmacological challenge, blood pressure monitoring, and heart rate variability analysis, we found that Meis2 mutant mice exhibited a blunted vagal response independently of any apparent cardiac malformation. These results suggest that defects in primary sensory neurons with mechanosensitive identity could participate in the imbalanced cardio-vascular sympathovagal tone found in ASD patients, reinforcing current hypotheses on the role of primary sensory neurons in the etiology of ASD. Autism Spectrum Disorder (ASD) is the consequence of a neurodevelopmental defect affecting different nervous system structures and characterized by many diverse phenotypic manifestations including aberrant social interactions, repetitive behaviors, and restrictive interest. In addition, 90% of ASD patients are estimated to present sensory processing deficits, and an inability to elaborate appropriate behavioral responses due to impaired sound, touch, and sight perception 1. This defective sensory perception can lead to an altered functional "vagal brake" associated with defective behavioral flexibility to stress 2. A large number of genes have been associated with ASD and are believed to be involved in various stages of building neuronal architecture, from neurogenesis to neurites outgrowth, synaptogenesis, and synaptic

Journal of global antimicrobial resistance, Dec 1, 2022

Gatherings like the Hajj involving many people who travel from different parts of the world repre... more Gatherings like the Hajj involving many people who travel from different parts of the world represent a risk for the acquisition and dissemination of infectious diseases. In this study, acquisition of multidrugresistant (MDR) Salmonella spp. in 2013 Hajj pilgrims from Marseille, France, was investigated. In total, 267 rectal swabs were collected from 129 participants before their departure and after their return from the pilgrimage as well as during the pilgrimage from patients with diarrhoea. Samples were screened for the presence of Salmonella using quantitative real-time PCR and culture. Whole-genome sequencing was performed to characterise one of the isolates, and the mechanism leading to colistin resistance was investigated. Six post-Hajj samples and one sample collected during a diarrhoea episode in Hajj were positive for Salmonella by real-time PCR, with five Salmonella enterica belonging to several serotypes recovered by culture, whereas no pre-Hajj sample was positive. Two of the isolates belonged to the epidemic Newport serotype, were resistant to cephalosporins, gentamicin and colistin, and harboured the bla CTX-M-2 gene and a 12-nucleotide deletion in the pmrB gene leading to colistin resistance. This study shows that pilgrims acquired Salmonella bacteria, including a novel MDR clone, during the Hajj pilgrimage. This calls for more improved public health surveillance during Hajj because Salmonella is one of the most common diarrhoea-causing bacteria worldwide. Therefore, returning pilgrims could disseminate MDR bacteria worldwide upon returning to their home countries.

Antimicrobial Resistance & Infection Control

Backgroung Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regress... more Backgroung Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regression (DR) models can correlate antimicrobial consumption (AMC) with AMR and predict future trends to help implement antimicrobial stewardship programs (ASPs). Main body We carried out a systematic review of the literature up to 2023/05/31, searching in PubMed, ScienceDirect and Web of Science. We screened 641 articles and finally included 28 studies using a DR model to study the correlation between AMC and AMR at a hospital scale, published in English or French. Country, bacterial species, type of sampling, antimicrobials, study duration and correlations between AMC and AMR were collected. The use of β-lactams was correlated with cephalosporin resistance, especially in Pseudomonas aeruginosa and Enterobacterales. Carbapenem consumption was correlated with carbapenem resistance, particularly in Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Fluoroquinolone use w...

Cancers

The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This... more The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This study aimed to compare the incidence of PICC-related bloodstream infections (PICCR-BSIs) in cancer patients treated with chemotherapy and in noncancer patients. We performed a secondary analysis from a retrospective, single-center, observational cohort. The PICCR-BSI incidence rates in cancer and noncancer patients were compared after 1:1 propensity-score matching. Then, the factors associated with PICCR-BSI were assessed in a Cox model. Among the 721 PICCs (627 patients) included in the analysis, 240 were placed in cancer patients for chemotherapy and 481 in noncancer patients. After propensity-score matching, the PICCR-BSI incidence rate was 2.6 per 1000 catheter days in cancer patients and 1.0 per 1000 catheter days in noncancer patients (p < 0.05). However, after adjusting for variables resulting in an imbalance between groups after propensity-score matching, only the number of P...

Intensive Care Medicine

In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with sign... more In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

La Revue de Médecine Interne, 2019

La Revue de Médecine Interne, 2013

Médecine et Maladies Infectieuses Formation

Antimicrobial resistance and infection control, Mar 21, 2024

Research Square (Research Square), Sep 26, 2022

Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosens... more Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosensitive neurons involved in touch sensation and central neurons affected in ASD share transcriptional regulators. Mutant mice for ASD-associated transcription factors exhibit impaired primary tactile perception, and restoring those genes speci cally in primary sensory neurons rescue some of the anxiety-like behavior and social interaction defects. Interestingly, peripheral mechanosensitive sensory neurons also project to internal organs including the cardio-vascular system, and an imbalance of the cardio-vascular sympatho-vagal regulation is evidenced in ASD and intellectual disability. ASD patients have decreased vagal tone, suggesting dysfunction of sensory neurons involved in cardio-vascular sensing. In light of our previous nding that the ASD-associated Meis2 gene is necessary for normal touch neurons development and function, we investigated here if its inactivation in mouse peripheral sensory neurons also affects cardio-vascular sympatho-vagal regulation and barore ex. Combining echocardiography, pharmacological challenge, blood pressure monitoring and heart rate variability analysis, we found that Meis2 mutant mice exhibited a blunted vagal response independently of any apparent cardiac malformation. These results suggest that defects in primary sensory neurons with mechanosensitive identity could participate in the imbalanced cardio-vascular sympatho-vagal tone found in ASD patients, reinforcing current hypotheses on the role of primary sensory neurons in the etiology of ASD.

Revue de Médecine Interne, Dec 1, 2021

Médecine et maladies infectieuses formation, May 1, 2023

International Journal of Antimicrobial Agents, May 1, 2023

Revue de Médecine Interne, Dec 1, 2013

Revue de Médecine Interne, Jun 1, 2019

Introduction Le syndrome catastrophique des antiphospholipides (CAPS) est considere comme etant l... more Introduction Le syndrome catastrophique des antiphospholipides (CAPS) est considere comme etant la manifestation la plus grave du syndrome des anticorps antiphospholipides (SAPL), et est defini par la survenue simultanee de thromboses dans au moins 3 organes ou tissus. Le diagnostic de CAPS est parfois difficile alors que son identification et son traitement precoce est crucial pour le pronostic des malades. Il existe peu de donnee sur l’interet pronostique des criteres du CAPS chez les malades avec un SAPL admis en reanimation. Nous avons conduit une etude pour evaluer la distribution et le pronostic des criteres du CAPS (certain/probable/pas de CAPS) chez les malades porteurs d’un SAPL et admis en reanimation avec une nouvelle manifestation thrombotique. Patients et methodes Nous avons conduit une etude multicentrique retrospective Francaise, entre janvier 2000 et fevrier 2018 dans 24 services de reanimation, incluant les patients porteurs d’un SAPL admis avec une nouvelle manifestation thrombotique (veineuse, arterielle ou microvasculaire). Resultats 152 episodes chez 134 malades ont ete admis en reanimation pendant la duree de l’etude. L’âge moyen ± SD a l’admission etait de 45,4 ± 15,0 ans avec un ratio femme/homme de 2,5. Le diagnostic de SAPL etait connu a l’admission dans 121 (79,6 %) episodes. Les atteintes cliniques anterieures du SAPL etaient : veineuses 70,4 %, arterielles 43,4 % et obstetricales 38,5 %. Quatre-vingt-quatre malades (55,3 %) avaient une triple positivite biologique du SAPL. Un traitement specifique du SAPL etait prescrit dans 78,3 % des cas avant l’admission, un antiagregant plaquettaire 50 (32,9 %) et/ou un anticoagulant 110 (72,4 %). Le SAPL etait associe au lupus systemique dans 34,2 % des cas. Un facteur declenchant etait rapporte lors de 114 (75,0 %) des episodes. Selon les criteres de definition du CAPS, 11 (7,2 %) avaient un CAPS certain, 60 (39,5 %) un CAPS probable et 81 (35,5 %) pas de CAPS. Nous avons par la suite compare les patients uniques avec un CAPS certain/probable (groupe 1, n = 61) ou pas de CAPS (groupe 2, n = 73). En dehors d’une proportion plus importante de femme dans le groupe des non CAPS (n = 38 (62,3 %) vs n = 58 (79,5 %), p = 0,03), il n’y avait pas de difference pour les caracteristiques demographiques et les caracteristiques cliniques anterieures ou biologiques du SAPL. La frequence du lupus et la proportion de patient avec un diagnostic de SAPL avant l’admission etait similaire entre les deux groupes. La gravite initiale et les comorbidites en reanimation definies par les scores de SOFA, l’IGS2 et de Charlson etaient comparables entre les 2 groupes. La mediane [IQR25-75] du nombre d’organes atteints (4 [3-4] vs 2 [1–3], p Conclusion Dans notre etude, l’identification d’un CAPS en utilisant les criteres de definition n’etait pas associee a la mortalite des SAPL admis en reanimation avec une nouvelle manifestation thrombotique. De nouvelles etudes sont necessaires pour evaluer la pertinence des criteres du CAPS, comme outil diagnostique et pronostique, au sein de cette population.

Revue de Médecine Interne, Jun 1, 2019

Intensive Care Medicine, Feb 1, 2023

Revue de Médecine Interne, Dec 1, 2021

Journal for ImmunoTherapy of Cancer, May 1, 2023

Background Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last dec... more Background Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening. Methods We conducted a multicenter cross-sectional retrospective study with the aim of better characterizing ICI-related myocarditis. Myocarditis diagnosis was based on the recent consensus statement of the International Cardio-Oncology Society. Results Twenty-nine patients were identified, from six different referral centers. Most patients (55%) were treated using anti-programmed-death 1, rather than ICI combination (35%) or anti-programmed-death-ligand 1 (10%). Transthoracic echocardiography was abnormal in 52% of them, and cardiac magnetic resonance showed abnormal features in 14/24 patients (58%). Eleven patients (38%) were classified as severe. Compared with other patients, they had more frequently pre-existing systemic autoimmune disease (45% vs 6%, p=0.018), higher troponin level on admission (42-fold the upper limit vs 3.55-fold, p=0.001), and exhibited anti-acetylcholine receptor autoantibodies (p=0.001). Seven patients (24%) had myocarditis-related death, and eight more patients died from cancer progression during followup. Twenty-eight patients received glucocorticoids, 10 underwent plasma exchanges, 8 received intravenous immunoglobulins, and 5 other immunosuppressants. ICI rechallenge was performed in six patients, with only one myocarditis relapse. Discussion The management of ICI-related myocarditis may be challenging and requires a multidisciplinary approach. Prognostic features are herein described and may help to allow ICI rechallenge for some patients with smoldering presentation, after an accurate evaluation of benefit-risk balance. ⇒ Early detection of ICI-related myocarditis through a multidisciplinary approach may improve the management of oncology patients. Identification of prognostic factors for severity may also allow ICI rechallenge in some cases, after an accurate evaluation of benefit-risk balance.

Scientific Reports, Nov 23, 2022

Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosens... more Recent understanding of Autism Spectrum Disorder (ASD) showed that peripheral primary mechanosensitive neurons involved in touch sensation and central neurons affected in ASD share transcriptional regulators. Mutant mice for ASD-associated transcription factors exhibit impaired primary tactile perception and restoring those genes specifically in primary sensory neurons rescues some of the anxiety-like behavior and social interaction defects. Interestingly, peripheral mechanosensitive sensory neurons also project to internal organs including the cardiovascular system, and an imbalance of the cardio-vascular sympathovagal regulation is evidenced in ASD and intellectual disability. ASD patients have decreased vagal tone, suggesting dysfunction of sensory neurons involved in cardio-vascular sensing. In light of our previous finding that the ASD-associated Meis2 gene is necessary for normal touch neuron development and function, we investigated here if its inactivation in mouse peripheral sensory neurons also affects cardio-vascular sympathovagal regulation and baroreflex. Combining echocardiography, pharmacological challenge, blood pressure monitoring, and heart rate variability analysis, we found that Meis2 mutant mice exhibited a blunted vagal response independently of any apparent cardiac malformation. These results suggest that defects in primary sensory neurons with mechanosensitive identity could participate in the imbalanced cardio-vascular sympathovagal tone found in ASD patients, reinforcing current hypotheses on the role of primary sensory neurons in the etiology of ASD. Autism Spectrum Disorder (ASD) is the consequence of a neurodevelopmental defect affecting different nervous system structures and characterized by many diverse phenotypic manifestations including aberrant social interactions, repetitive behaviors, and restrictive interest. In addition, 90% of ASD patients are estimated to present sensory processing deficits, and an inability to elaborate appropriate behavioral responses due to impaired sound, touch, and sight perception 1. This defective sensory perception can lead to an altered functional "vagal brake" associated with defective behavioral flexibility to stress 2. A large number of genes have been associated with ASD and are believed to be involved in various stages of building neuronal architecture, from neurogenesis to neurites outgrowth, synaptogenesis, and synaptic

Journal of global antimicrobial resistance, Dec 1, 2022

Gatherings like the Hajj involving many people who travel from different parts of the world repre... more Gatherings like the Hajj involving many people who travel from different parts of the world represent a risk for the acquisition and dissemination of infectious diseases. In this study, acquisition of multidrugresistant (MDR) Salmonella spp. in 2013 Hajj pilgrims from Marseille, France, was investigated. In total, 267 rectal swabs were collected from 129 participants before their departure and after their return from the pilgrimage as well as during the pilgrimage from patients with diarrhoea. Samples were screened for the presence of Salmonella using quantitative real-time PCR and culture. Whole-genome sequencing was performed to characterise one of the isolates, and the mechanism leading to colistin resistance was investigated. Six post-Hajj samples and one sample collected during a diarrhoea episode in Hajj were positive for Salmonella by real-time PCR, with five Salmonella enterica belonging to several serotypes recovered by culture, whereas no pre-Hajj sample was positive. Two of the isolates belonged to the epidemic Newport serotype, were resistant to cephalosporins, gentamicin and colistin, and harboured the bla CTX-M-2 gene and a 12-nucleotide deletion in the pmrB gene leading to colistin resistance. This study shows that pilgrims acquired Salmonella bacteria, including a novel MDR clone, during the Hajj pilgrimage. This calls for more improved public health surveillance during Hajj because Salmonella is one of the most common diarrhoea-causing bacteria worldwide. Therefore, returning pilgrims could disseminate MDR bacteria worldwide upon returning to their home countries.

Antimicrobial Resistance & Infection Control

Backgroung Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regress... more Backgroung Antimicrobial resistance (AMR) is on the rise worldwide. Tools such as dynamic regression (DR) models can correlate antimicrobial consumption (AMC) with AMR and predict future trends to help implement antimicrobial stewardship programs (ASPs). Main body We carried out a systematic review of the literature up to 2023/05/31, searching in PubMed, ScienceDirect and Web of Science. We screened 641 articles and finally included 28 studies using a DR model to study the correlation between AMC and AMR at a hospital scale, published in English or French. Country, bacterial species, type of sampling, antimicrobials, study duration and correlations between AMC and AMR were collected. The use of β-lactams was correlated with cephalosporin resistance, especially in Pseudomonas aeruginosa and Enterobacterales. Carbapenem consumption was correlated with carbapenem resistance, particularly in Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii. Fluoroquinolone use w...

Cancers

The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This... more The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This study aimed to compare the incidence of PICC-related bloodstream infections (PICCR-BSIs) in cancer patients treated with chemotherapy and in noncancer patients. We performed a secondary analysis from a retrospective, single-center, observational cohort. The PICCR-BSI incidence rates in cancer and noncancer patients were compared after 1:1 propensity-score matching. Then, the factors associated with PICCR-BSI were assessed in a Cox model. Among the 721 PICCs (627 patients) included in the analysis, 240 were placed in cancer patients for chemotherapy and 481 in noncancer patients. After propensity-score matching, the PICCR-BSI incidence rate was 2.6 per 1000 catheter days in cancer patients and 1.0 per 1000 catheter days in noncancer patients (p < 0.05). However, after adjusting for variables resulting in an imbalance between groups after propensity-score matching, only the number of P...

Intensive Care Medicine

In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with sign... more In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

La Revue de Médecine Interne, 2019

La Revue de Médecine Interne, 2013