Olivier Lortholary

Université Paris-Sorbonne - Paris IV, Lutetia Parisorum, Île-de-France, France

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Publications (629)2246.86 Total impact

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    ABSTRACT: Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challenges remain for the diagnosis or management of nocardiosis. This opportunistic infection affects 0.04 to 3.5 % of patients with solid organ or hematopoietic stem cell transplantation, depending on the organ transplanted, cytomegalovirus (CMV) infection, corticosteroids dose and calcineurin inhibitors level. Nocardiosis diagnosis relies on appropriate clinical, radiological and microbiological workup that includes the sampling of an accessible involved site and molecular microbiology tools. In parallel, extensive clinical and radiological evaluations are mandatory, including brain imaging, even in the absence of neurological signs. In transplanted patients, differential diagnosis is challenging, with co-infections reported in 20 to 64 % of cases. As the antibiotic susceptibility pattern varies among species, the antimicrobial regimen before species identification should rely on the association of antibiotics active on all species of Nocardia. Bactericidal antibiotics are required in cases of severe or disseminated disease. Furthermore, in transplant recipients, combination therapy is difficult to manage because of cumulative toxicity and interactions with immunosuppressive agents. Because of a high recurrence rate, antibiotic therapy should be prescribed for 6 to 12 months.
    European Journal of Clinical Microbiology 11/2013; · 3.02 Impact Factor
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    ABSTRACT: We developed and validated quantitative bioanalytical liquid chromatography-tandem mass spectrometry assay for the protein kinase inhibitor, midostaurin. Plasma samples were pre-treated using a protein precipitation with methanol containing midostaurin-d5 as an internal standard. After centrifugation, 5μL of the supernatant was injected into the chromatographic system. The system consisted of a 3.5μm particle bonded octadecyl silica column, with gradient elution using a mixture of 0.1% (v/v) formic acid in acetonitrile and 10mM ammonium formate in water with 0.1% formic acid. The analyte was quantified using the selected reaction-monitoring mode of a triple quadrupole mass spectrometer equipped with a heated electrospray interface. The assay was validated in a 75-2500ng/mL calibration range. For quality control, within-day and between-day precisions were 1.2-2.8%, and 1.2-6.9%, respectively. The β-expectation tolerance limit (accuracy) met the limits of acceptance ±15% (±20% for the LLQ). The drug was sufficiently stable under all relevant analytical conditions. The assay has successfully been used to assess drug levels for therapeutic drug monitoring in patients presenting advanced systemic mastocytosis and treated with the promising midostaurin.
    Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 11/2013; 944C:175-181. · 2.78 Impact Factor
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    ABSTRACT: Background Deep dermatophytosis is a severe and sometimes life-threatening fungal infection caused by dermatophytes. It is characterized by extensive dermal and subcutaneous tissue invasion and by frequent dissemination to the lymph nodes and, occasionally, the central nervous system. The condition is different from common superficial dermatophyte infection and has been reported in patients with no known immunodeficiency. Patients are mostly from North African, consanguineous, multiplex families, which strongly suggests a mendelian genetic cause. Methods We studied the clinical features of deep dermatophytosis in 17 patients with no known immunodeficiency from eight unrelated Tunisian, Algerian, and Moroccan families. Because CARD9 (caspase recruitment domain-containing protein 9) deficiency has been reported in an Iranian family with invasive fungal infections, we also sequenced CARD9 in the patients. Results Four patients died, at 28, 29, 37, and 39 years of age, with clinically active deep dermatophytosis. No other severe infections, fungal or otherwise, were reported in the surviving patients, who ranged in age from 37 to 75 years. The 15 Algerian and Tunisian patients, from seven unrelated families, had a homozygous Q289X CARD9 allele, due to a founder effect. The 2 Moroccan siblings were homozygous for the R101C CARD9 allele. Both alleles are rare deleterious variants. The familial segregation of these alleles was consistent with autosomal recessive inheritance and complete clinical penetrance. Conclusions All the patients with deep dermatophytosis had autosomal recessive CARD9 deficiency. Deep dermatophytosis appears to be an important clinical manifestation of CARD9 deficiency. (Funded by Agence Nationale pour la Recherche and others.).
    New England Journal of Medicine 10/2013; · 51.66 Impact Factor
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    ABSTRACT: To report the long-term safety data of certolizumab pegol (CZP) in rheumatoid arthritis (RA) accumulated as of 30 November 2011. Data from 10 completed randomised controlled trials (RCT) of CZP in RA and several open-label extensions (OLE) were pooled across all doses. Reported adverse events (AE) occurred between the first dose and 84 days after the last dose. All deaths, serious infectious events (SIE) and malignancies were reviewed by external experts, classified according to predefined rules, and validated by an external steering committee. Incidence rates (IR) and event rates (ER) per 100 patient-years (PY) are presented. 4049 RA patients who received CZP were included in the safety pooling; total exposure 9277 PY, mean exposure 2.1 years (range 0.04-7.6). SIE, most frequently pneumonia (IR 0.73/100 PY), were the most common serious AE, occurring more frequently in CZP compared to placebo-treated patients in RCT (IR 5.61/100 PY vs 1.35/100 PY, odds ratio (OR) 4.35, 95% CI 0.65 to 29.30). SIE rates were lower in the CZP-treated population including OLE (ER 4.33/100 PY). 44 patients developed tuberculosis (IR 0.47/100 PY), 39 from high endemic regions. 58 deaths occurred in CZP-exposed patients (IR 0.63/100 PY) and 70 developed malignancies excluding non-melanoma skin cancer (IR 0.76/100 PY), including five lymphomas (IR 0.05/100 PY). No new or unexpected safety signals associated with CZP emerged in this updated long-term safety analysis. While SIE rates were higher for CZP than for placebo in RCT, the rate decreased with continued exposure to CZP. These rates are consistent with data previously reported for CZP and other tumour necrosis factor inhibitors.
    Annals of the rheumatic diseases 10/2013; · 8.11 Impact Factor
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    ABSTRACT: Invasive fusariosis has been associated with a poor prognosis. Although recent series have reported improved outcomes, defining optimal therapies remains controversial. The objective of this study was to evaluate changes in the outcome of invasive fusariosis. We retrospectively analysed 233 cases of IF from 11 countries, comparing demographics, clinical findings, treatment and outcome in two periods: 1985-2000 (period 1) and 2001-2011 (period 2). Most patients (92%) had haematological disease. Primary treatment with deoxycholate amphotericin B was more frequent in period 1 (63% vs. 30%, p<0.001), while voriconazole (32% vs. 2%, p<0.001) and combination therapies (18% vs. 1%, p<0.001) were more frequent in period 2. The 90-day probability of survival in periods 1 and 2 was 22% and 43%, respectively (p<0.001). In period 2, the 90-day probability of survival was 60% with voriconazole, 53% with a lipid formulation of amphotericin B, and 28% with deoxycholate amphotericin B (p=0.04). Variables associated with poor prognosis (death 90 days after the diagnosis of fusariosis) by multivariable analysis were: receipt of corticosteroids (hazard ratio [HR] 2.11, 95% CI 1.18 - 3.76, p=0.01), neutropenia at end of therapy (HR 2.70, 95% CI 1.57 - 4.65, p<0.001), and receipt of deoxycholate amphotericin B (HR 1.83, 95% CI 1.06 - 3.16, p=0.03). Treatment practices have changed over the last decade, with an increased use of voriconazole and combination therapies. There has been a 21% increase in survival rate in the last decade. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 10/2013; · 4.58 Impact Factor
  • B Denis, O Lortholary
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    ABSTRACT: Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime.
    Revue des Maladies Respiratoires 10/2013; 30(8):682-95. · 0.50 Impact Factor
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    ABSTRACT: Surgery and antifungals are the gold standard for rhino-orbito-cerebral mucormycosis (ROCM). The impact of local control on survival of 22 consecutive ROCM adults was studied on day 90: none vs. 75% died, respectively with or without local control (P < .0001). Hence, repeated surgical procedures are recommended to achieve local control of ROCM. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 09/2013; · 4.58 Impact Factor
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    ABSTRACT: Mucormycosis, an emerging fungal infection in solid organ transplant patients, is mostly located in rhino-orbito-cerebral, pulmonary, and cutaneous areas, or disseminated with poor prognosis. A 4-year-old girl with chronic intestinal pseudo-obstruction syndrome underwent a modified multivisceral transplantation, including half of the stomach, the duodeno-pancreas, the small bowel, and the right colon. On postoperative day 5, a digestive perforation was suspected. Surgical exploration found a small necrotic area on the native stomach, which was externally drained. The next day, massive gastric bleeding occurred. During the emergency laparotomy, 2 hemorrhagic ulcers were found and resected from the transplanted stomach. Pathology and fungal culture showed mucormycosis caused by Lichtheimia (formerly Absidia) ramosa in both the transplanted and native stomach. High-dose intravenous liposomal amphotericin B was immediately started. No other site of fungal infection was found. The child recovered, and 3 years after transplantation, is alive and well, off parenteral nutrition. The originality of this case is the very early presentation after transplantation, the unusual site, and the complete recovery after rapid medico-surgical management. The origin of the fungus and treatment are discussed.
    Transplant Infectious Disease 09/2013; · 1.98 Impact Factor
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    ABSTRACT: The mortality associated with invasive fungal infections remains high with that involving rare yeast pathogens other than Candida being no exception. This is in part due to the severe underlying conditions typically predisposing patients to these health-care related infections (most often severe neutropaenia in patients with haematological malignancies), and in part due to the often challenging intrinsic susceptibility pattern of the pathogens that potentially leads to delayed appropriate antifungal treatment. A panel of experts of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG) and the European Confederation of Medical Mycology (ECMM) undertook a data review and compiled guidelines for the diagnostic tests and procedures for detection and management of rare invasive yeast infections. The rare yeast pathogens were defined and limited to the following genus/species: Cryptococcus adeliensis, Cryptococcus albidus, Cryptococcus curvatus, Cryptococcus flavescens, Cryptococcus laurentii and Cryptococcus uniguttulatus (often published under the name Filobasidium uniguttulatum), Malassezia furfur, Malassezia globosa, Malassezia pachydermatis and Malassezia restricta, Pseudozyma spp., Rhodotorula glutinis, Rhodotorula minuta and Rhodotorula mucilaginosa, Sporobolomyces spp., Trichosporon asahii, Trichosporon asteroides, Trichosporon dermatis, Trichosporon inkin, Trichosporon jirovecii, Trichosporon loubieri, Trichosporon mucoides and Trichosporon mycotoxinivorans and ascomycetous ones: Geotrichum candidum, Kodamaea ohmeri, Saccharomyces cerevisiae (incl. S. boulardii) and Saprochaete capitatae (Magnusiomyces (Blastoschizomyces) capitatus formerly named Trichosporon capitatum or Geotrichum (Dipodascus) capitatum) and Saprochaete clavata. Recommendations about the microbiological investigation and detection of invasive infection were made and current knowledge on most appropriate antifungal and supportive treatment reviewed. In addition, remarks about antifungal susceptibility testing were made. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 09/2013; · 4.58 Impact Factor
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    ABSTRACT: Background. Voriconazole long-term therapy is suspected to induce cutaneous squamous cell carcinomas (SCC), as suggested by 18 case reports worldwide and three retrospective studies. Methods. To better characterize the natural history of these potentially voriconazole-associated tumors, a nationwide call for notification of skin cancers and other skin lesions observed between 2002 and 2012 in patients treated by voriconazole was launched in France. A multidisciplinary committee evaluated voriconazole involvement in each case. Results. Nineteen SCC were reported. The committee determined the likelihood of voriconazole involvement as "high" in 15 cases, "intermediate" in 2, and "low" in 2. In the 17 patients with high/intermediate likelihood of voriconazole involvement, the mean time between voriconazole initiation and SCC diagnosis was 39±18 months (range 28-84), and was shorter in transplant recipients (35 vs. 45 months, p<0.05). Cumulative mean duration of voriconazole therapy at SCC diagnosis was 35 months (range 7-63). A multi-step process was noted in 14/17 patients: acute phototoxicity during the first year of voriconazole therapy (mean time 6 months, range 0-18), actinic keratosis (AK) of the same sun-exposed skin area in the second/third year (mean 30 months, range 11-57), followed by SCC during the third year or later. Five cases of AK without SCC and 37 cases of other skin lesions were also reported. Conclusions. Our study suggests that long-term voriconazole prescription may be associated with a multi-step phototoxic process involving acute skin lesions followed by AK then by SCC. Discontinuation of voriconazole should be strongly considered in patients experiencing chronic phototoxicity.
    Clinical Infectious Diseases 09/2013; · 9.37 Impact Factor
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    ABSTRACT: Iatrogenic Cushing's syndrome is an undesirable outcome of glucocorticoids treatment. It can be increased by pharmacologic interactions. Glucocorticoid therapy, given in association with ritonavir or some azole treatments are providers of iatrogenic Cushing's syndrome. We present a patient with common variable immunodeficiency who received seven years of itraconazole therapy for bronchial colonization with Aspergillus in combination with inhaled fluticasone without any Cushing symptoms. After a switch to posaconazole, the patient developed Cushingoid symptoms.
    Antimicrobial Agents and Chemotherapy 08/2013; · 4.57 Impact Factor
  • The Journal of hospital infection 08/2013; · 3.01 Impact Factor
  • Clinical Infectious Diseases 08/2013; 57(4):616-7. · 9.37 Impact Factor
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    ABSTRACT: Mastocytosisis a rare diseaseassociated with chronic symptoms related to mast cell mediator release.Patients with mastocytosis display high level of negative emotionality such as depression and stress sensibility. Brain mast cells are mainly localized in the diencephalon, which is linked to emotion regulatory systems. Negative emotionality has been shown to be associated with telomere shortening. Taken together these observations led us to hypothesize that mast cells activity could be involved in both negative emotionality and telomere shortening in mastocytosis. To demonstrate a possible relationship between negative emotionality in mastocytosis and leukocytes telomere length. Leukocyte telomere length and telomerase activity were measured amongmastocytosispatients and were correlated with perceived stress and depressionassessed by the Beck Depression Inventory revised and the Perceived Stress Scale. Mild-severe depression scores were frequent (78.9%) as well as high perceived stress (42.11%). Telomere length was correlated to perceived stress (r=0.77; p= 0.0001) but not to depression in our population. Patients displaying Wild-type KIT significantly presented higher perceived stress levels. Patients with the D816VC KIT mutation who had high perceived stress scores displayed significantly shorter telomere but not if they had high depression scores. These findings suggest that high perceived stress in mastocytosis could accelerate the rate of leukocytes telomere shortening. Since mastocytosis is, by definition, a mast cell mediated disease; these cells could be involved in this phenomenon. Mechanistic causal relationships between these parameters need to be investigated.
    Brain Behavior and Immunity 07/2013; · 5.61 Impact Factor
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    ABSTRACT: Mastocytosis is a heterogeneous disease characterized by mast cell accumulation in 1 or more organs. Gastrointestinal manifestations of systemic mastocytosis have been previously studied in small cohorts of patients, and no specific histologic description is available. We sought to assess the clinical and pathologic features of gastrointestinal manifestations in patients with mastocytosis. Medical history and gastrointestinal symptoms of patients with mastocytosis (n = 83) were compared with those of matched healthy subjects (n = 83) by means of patient questionnaire. Data were analyzed for epidemiologic, clinical, biological, and genetic factors associated with gastrointestinal symptoms for patients with mastocytosis. A comparative analysis of gastrointestinal histology from patients with mastocytosis (n = 23), control subjects with inflammatory bowel disease (n = 17), and healthy subjects (n = 19) was performed. The following gastrointestinal symptoms occurred more frequently and were more severe in patients with mastocytosis than in healthy subjects: bloating (33% vs 7.2%, P < .0001), abdominal pain (27.3% vs 4.8%, P < .0001), nausea (23% vs 8.4%, P = .02), and diarrhea (33.85% vs 1.2%, P < .0001). Patients with mastocytosis had a significantly higher incidence of personal history of duodenal ulcer (P = .02). Wild-type (WT) c-Kit was associated with diarrhea (P = .03). Specific histologic lesions were present in patients with mastocytosis but were not correlated with clinical symptoms. Gastrointestinal manifestations in patients with mastocytosis are highly prevalent and often severe. Clinical symptoms do not correspond to histologic findings, are nonspecific, and can simulate irritable bowel syndrome.
    The Journal of allergy and clinical immunology 07/2013; · 12.05 Impact Factor
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    ABSTRACT: Current, widely accepted guidelines for the management of HIV-associated cryptococcal meningoencephalitis (CM) recommend amphotericin B combined with flucytosine (5-FC) for ≥2 weeks as the initial induction treatment of choice. However, access to flucytosine in Africa and Asia, where disease burden is greatest, is inadequate at present. While research into identifying effective and well-tolerated antifungal combinations that do not contain flucytosine continues, an ever-increasing body of evidence from in vitro, in vivo and clinical studies points to the benefits of flucytosine in the treatment of CM in both intravenous combinations with amphotericin B and oral combinations with high-dose fluconazole. This article provides an up-to-date review of this evidence, and the current issues and challenges regarding increasing access to this key component of combination antifungal therapy for cryptococcosis.
    Journal of Antimicrobial Chemotherapy 06/2013; · 5.34 Impact Factor
  • The Journal of allergy and clinical immunology 06/2013; · 12.05 Impact Factor
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    ABSTRACT: ABSTRACT RATIONALE: We described legionellosis emergence during tumor necrosis factor (TNF)-α antagonist therapy. OBJECTIVE: Our objective here was to describe the incidence and risk factors of legionellosis associated with TNF-α antagonist use. METHODS: From February 1, 2004 to January 31, 2007, we prospectively collected all cases of legionellosis among French patients receiving TNF-α antagonists in the Research Axed on Tolerance of bIOtherapies (RATIO) national registry. We conducted an incidence study with the French population as a reference and a case-control analysis with 4 controls receiving TNF-α antagonists per case of legionellosis. RESULTS: Twenty-seven cases of legionellosis were reported. The overall annual incidence rate of legionellosis for patients receiving TNF-α antagonists, adjusted for age and sex, was 46.7 (95% confidence interval [95% CI] 0.0-125.7) per 100,000 patient-years. The overall standardized incidence ratio (SIR) was 13.1 (95% CI 9.0-19.1; p<0.0001) and was higher for patients receiving infliximab (SIR 15.3 [95% CI 8.5-27.6; p<0.0001]) or adalimumab (SIR 37.7 [95% CI 21.9-64.9, p<0.0001]) than etanercept (SIR 3.0 [95% CI 1.00-9.2, p=0.06]). In the case-control analysis, exposure to adalimumab (odds ratio [OR] 8.7 [95% CI 2.1-35.1]) or infliximab (OR 9.2 [95% CI 1.9-45.4]) versus etanercept was an independent risk factor for legionellosis. CONCLUSION: The incidence rate of legionellosis for patients receiving TNF-α antagonists is high and the risk is higher for patients receiving anti-TNF-α monoclonal antibodies than soluble TNF-receptor therapy. In case of pneumonia occurring during TNF-α antagonist therapy, specific urine antigen detection should be performed and antibiotic therapy should cover legionellosis.
    Chest 06/2013; · 5.85 Impact Factor
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    ABSTRACT: BACKGROUND: Fluoroquinolones are used with increasing frequency in children with a major risk of increasing the emergence of FQ resistance. FQ use has expanded off-label for primary antibacterial prophylaxis or treatment of infections in immune-compromised children and life-threatening multi-resistant bacteria infections. Here we assessed the prescriptions of ciprofloxacin in a pediatric cohort and their appropriateness. METHODS: A monocenter audit of ciprofloxacin prescription was conducted for six months in a University hospital in Paris. Infected site, bacteriological findings and indication, were evaluated in children receiving ciprofloxacin in hospital independently by 3 infectious diseases consultants and 1 hospital pharmacist. RESULTS: Ninety-eight ciprofloxacin prescriptions in children, among which 52 (53.1%) were oral and 46 (46.9%) parenteral, were collected. 45 children had an underlying condition, cystic fibrosis (CF) (21) or an innate or acquired immune deficiency (24). Among CF patients, the most frequent indication was a broncho-pulmonary Pseudomonas aeruginosa infection (20). In non-CF patient, the major indications were broncho-pulmonary (25), urinary (8), intra-abdominal (7), operative site infection (5) and bloodstream/catheter (2/4) infection. 62.2% were microbiologically documented. Twenty-three (23.4%) were considered "mandatory", 48 (49.0%) "alternative" and 27 (27.6%) "unjustified". CONCLUSION: In our university hospital, only 23.4% of fluoroquinolones prescriptions were mandatory in children, especially in Pseudomonas aeruginosa healthcare associated infection. Looking to the ecological risk of fluoroquinolones and the increase consumption in children population we think that a control program should be developed to control FQ use in children. It could be done with the help of an antimicrobial stewardship team.
    BMC Infectious Diseases 05/2013; 13(1):245. · 3.03 Impact Factor
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    ABSTRACT: The clinical and bacteriological consequences of routinely performing highly sensitive bacterial screening of kidney transplant preservation solution (PS) are not known. To evaluate the clinical and microbiological impacts of this strategy, we retrospectively analyzed 200 consecutive kidney allograft recipients from March 2009 to February 2011 for whom PS samples were routinely screened. PS were inoculated into aerobic and anaerobic blood culture bottles, as well as blood agar plates. A rectal swab for extended-spectrum β-lactamase-producing Enterobacteriaceae (EBSL-PE) faecal carriage was also routinely obtained from each patient at admission and every 7 days until hospital discharge. In addition, a standard culture of drain fluid was collected on the day after kidney transplantation. Complete samples and cultures of PS were performed in 165 cases (82.5%), and 62 (37.6%) had positive blood culture results. The most frequent microbial agent isolated was coagulase-negative staphylococci (51.8%). Of these 62 positive samples, only seven (11.3%) were confirmed to contain the same organism by the standard culture method. Drain fluid and PS culture positivity with the same microorganism occurred in only two patients. Of the 62 patients with positive PS cultures, 26 (41.9%) received pre-emptive antibiotic therapy initiated within 48 h post-transplant. During the hospitalization period, patients with a positive PS culture, regardless of whether they received pre-emptive antibiotic therapy, did not exhibit any invasive infections (urinary, blood, peritoneal or wound) related to the microorganisms isolated in the PS. Patients with positive PS cultures who were treated with antibiotic therapy acquired significantly more colonizing ESBL-PE than patients who did not receive antibiotics (53.8% vs. 16.6%; P = 0.01); these patients also developed more clinical infections related to the ESBL-PE (23.1% vs. 5.2%; P < 0.01). The use of antibiotics for patients with positive PS cultures was an independent risk factor for ESBL-PE acquisition in both univariate and multivariate analyses. In conclusion, the use of more sensitive culture methods increases the rate of bacterial contamination of PS and is associated with an increased prescription of antibiotics and increased ESBL-PE carriage and related infections. Therefore, the systematic use of PS blood bottle cultures in kidney transplantation may have no benefit and might increase the rate of ESBL-PE emergence.
    Transplant International 05/2013; · 3.16 Impact Factor

Publication Stats

12k Citations
2,246.86 Total Impact Points

Institutions

  • 2013–2014
    • Université Paris-Sorbonne - Paris IV
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Nantes
      Naoned, Pays de la Loire, France
    • Hospital for Special Surgery
      New York City, New York, United States
  • 2009–2014
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Nice
      Nice, Provence-Alpes-Côte d'Azur, France
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • St George's, University of London
      Londinium, England, United Kingdom
  • 1993–2014
    • Institut Pasteur
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Paris Saint Joseph
      Lutetia Parisorum, Île-de-France, France
  • 2011–2013
    • Centre Hospitalier Universitaire de Grenoble
      Grenoble, Rhône-Alpes, France
    • Université Libre de Bruxelles
      • Immunobiology Unit
      Brussels, BRU, Belgium
  • 2006–2013
    • Assistance Publique – Hôpitaux de Paris
      • Department of Radiology
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • Radboud University Medical Centre (Radboudumc)
      • Department of Human Genetics
      Nymegen, Gelderland, Netherlands
    • Hôpital Foch
      Lutetia Parisorum, Île-de-France, France
    • University of California, Los Angeles
      • Division of Infectious Diseases
      Los Angeles, California, United States
  • 2009–2012
    • Institut de veille sanitaire
      • Department of Infectious Diseases
      Charenton-le-Pont, Ile-de-France, France
  • 2008–2012
    • University of Houston
      • College of Pharmacy
      Houston, TX, United States
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2006–2012
    • Université Paris Descartes
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2005–2012
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculty of medicine
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Jean-Verdier – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bondy, Île-de-France, France
  • 2008–2011
    • French Institute of Health and Medical Research
      • Unité de Génétique Humaine des Maladies Infectieuses U980
      Paris, Ile-de-France, France
  • 2006–2011
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      Lutetia Parisorum, Île-de-France, France
  • 2000–2011
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 2010
    • Paul Sabatier University - Toulouse III
      Tolosa de Llenguadoc, Midi-Pyrénées, France
    • Hospital Universitário Clementino Fraga Filho
      Rio de Janeiro, Rio de Janeiro, Brazil
    • University of Lyon
      Lyons, Rhône-Alpes, France
    • Centrum kardiovaskulární a transplantační chirurgie
      Brünn, South Moravian, Czech Republic
  • 2008–2010
    • Centre hospitalier Gustave Dron
      Tourcoing, Nord-Pas-de-Calais, France
  • 2005–2009
    • University of Pittsburgh
      • Division of Infectious Diseases
      Pittsburgh, Pennsylvania, United States
  • 2007
    • University of Cologne
      • Department of Internal Medicine
      Köln, North Rhine-Westphalia, Germany
  • 1995–2007
    • Université Paris 13 Nord
      Île-de-France, France
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2004
    • Deaconess Hospital Group Croix Saint - Simon
      Lutetia Parisorum, Île-de-France, France
  • 2002
    • National Institutes of Health
      Maryland, United States
  • 2000–2002
    • Hôpital Raymond-Poincaré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Île-de-France, France
  • 1993–1994
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 1992
    • Institut Curie
      Lutetia Parisorum, Île-de-France, France