Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study.

PURPOSE: The recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management. METHODS: A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries. RESULTS: We included 1,156 patients [mean ± standard deviation (SD) age, 59.5 ± 17.7 years; 65 % males; mean ± SD Simplified Acute Physiology Score (SAPS) II score, 50 ± 17] with HA-BSIs, of which 76 % were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7-26] days after hospital admission. Polymicrobial infections accounted for 12 % of cases. Among monomicrobial infections, 58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal and 1.2 % due to strict anaerobes. Overall, 629 (47.8 %) isolates were multidrug-resistant (MDR), including 270 (20.5 %) extensively resistant (XDR), and 5 (0.4 %) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p < 0.001) by country. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95 % confidence interval (95 %CI), 1.07-2.06], uncontrolled infection source (OR, 5.86; 95 %CI, 2.5-13.9) and timing to adequate treatment (before day 6 since blood culture collection versus never, OR, 0.38; 95 %CI, 0.23-0.63; since day 6 versus never, OR, 0.20; 95 %CI, 0.08-0.47). CONCLUSIONS: MDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.

Allergy to betalactam antibiotics in children: results of a 20-year study

Background: 7 - 20% of the childrenreport suspected allergic reactionsto anti-infectious drugs, thebetalactams being the most frequentlyinvolved. Studies based on skin andchallenge tests have shown that 2 -60% (mean: 10 - 15%) of the childrenwith suspected betalactam hypersensitivitywere really allergic to betalactams,and that the likelihood ofbetalactam hypersensitivity increasedwith the severity and/or the earlinessof the reactions. Methods: We reviewedthe records of 1,865 childrenexplored for suspected betalactam hypersensitivitybetween December1990 and July 2009. The objectivewas to confirm or rule-out the diagnosisof betalactam hypersensitivity, toevaluate the diagnostic value of immediateand non-immediate-readingskin tests with betalactams, and to determinerisk factors for betalactamhypersensitivity. In those childrenskin tests were first performed andthen challenges with the suspectedbetalactams were performed in mostchildren with negative skin test results.Results: 1431 children had acomplete allergological work-up. Fifteen-nine per cent of those childrenwere diagnosed allergic to betalactamsby means of skin tests (7.2%),challenge tests (7.7%), and clinicalhistory (0.9%) respectively. Immediatetype betalactam hypersensitivitywas diagnosed in 3.5% and non-immediatetype in 12.4% of the children.Skin tests diagnosed 86% and 31.6%of immediate and non-immediatesensitizations respectively. Cross-reactivityamong betalactams was diagnosedin 76% of the children with immediatehypersensitivity and in14.7% of the children with non-immediatehypersensitivity. The numberof children diagnosed allergic tobetalactams decreased with time betweenthe reaction and the allergologicalwork-up. Finally, age, sex andpersonal atopy were not significantrisk factors for betalactam allergy.Conclusion: This study, in a verylarge number of children, confirmsthat only a few children with suspectedbetalactam hypersensitivityare really allergic to betalactams, andthat the likelihood of betalactam allergyand cross-reactivity with otherbetalactams increases with the severityand/or the earliness of the reactions.We also confirm that immediate-reading skin tests have a good diagnosticvalue, and that the diagnosticvalue of non-immediate-reading skintests is low, the diagnosis of non-immediatehypersensitivity to betalactamsin children beeing mainly basedon challenge tests.

ABD e-News, June 20, 2003

Newsletter for State of Iowa Alcoholic Beverages Division

IDED Tools and Trends, Summer 2002, Issue 20

Newsletter for Ecnonmic Development

28-01-20, Ypres [la cathédrale Saint-Martin en ruines] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57797

Cannes 21-1-20, Miss Ryan [Elisabeth] et Ritchie [Josiah] [contre] Mlle Lenglen [Suzanne] et Albarran [Pierre] [tournoi de lawn-tennis du Carlton-Club de Cannes] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57735

M. Barthou, 17-1-20, Congrès de Versailles : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57681

Général Maud'huy [16-1-20, cour du Sénat, vote préparatoire à l'élection présidentielle] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57669

17-1-20, Congrès de Versailles : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57677

1/2/20, arrivée de [Denis dit] Bertrand, [coureur belge] gagnant du cross de l'Intransigeant [au Bois de Boulogne, pelouse de la Muette] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57832

Arrivée de M. Briand [Aristide] 17-1-20, Congrès de Versailles : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57694

Colombes, 17/2/20, match France contre Pays de Galles [rugby, cérémonie d'avant-match, équipe de France] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58071

Lottery Action, October 7-20, 2002 Vol. 9 no. 19

Newsletter for Iowa Lottery

Lottery Action, October 21-November 3, 2002, Vol. 9, no. 20

Newsletter for Iowa Lottery