Xavier Duval

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (206)1169.76 Total impact

  • La Revue de Médecine Interne 06/2015; 36. DOI:10.1016/j.revmed.2015.03.245 · 1.32 Impact Factor
  • Medecine Nucleaire 05/2015; 39(3). DOI:10.1016/j.mednuc.2015.03.007 · 0.16 Impact Factor
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    ABSTRACT: To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE). All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France. SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%). SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.
    PLoS ONE 05/2015; 10(5):e0127385. DOI:10.1371/journal.pone.0127385 · 3.53 Impact Factor
  • X. Duval, F. Rouzet
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    ABSTRACT: Infective endocarditis (IE) is a rare and severe disease whose diagnosis is challenging. Extracardiac manifestations of the disease, occurring in 30 to 80% of patients, impact on the prognosis. Their detection help to support the diagnosis when this one is doubtful and may lead to alter the therapeutic plan. FDG PET/CT allows to detect secondary septic locations in IE with a high sensitivity. In addition, it offers the possibility to provide both cardiac and extracardiac locations in a single scan. Radiolabelled leukocytes SPECT is very specific of infection. Its diagnostic value has been evidenced in native and prosthetic valve endocarditis. The optimal diagnostic strategy, tailored to the patient, remains to be established.
    Medecine Nucleaire 04/2015; 39(3). DOI:10.1016/j.mednuc.2015.03.194 · 0.16 Impact Factor
  • Clinical Infectious Diseases 03/2015; 61(1). DOI:10.1093/cid/civ244 · 9.42 Impact Factor
  • Diabetes & Metabolism 03/2015; 41:A21-A22. DOI:10.1016/S1262-3636(15)30076-8 · 2.85 Impact Factor
  • Diabetes & Metabolism 03/2015; 41:A57-A58. DOI:10.1016/S1262-3636(15)30213-5 · 2.85 Impact Factor
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    ABSTRACT: Infectious agents associated with community-acquired pneumonia (CAP) are understudied. This study attempted to identify viruses from the upper respiratory tract in adults visiting emergency departments (ED) for clinically suspected CAP. Adults with suspected CAP enrolled in the ESCAPED study (impact of computed tomography on CAP diagnosis) had prospective nasopharyngeal (NP) samples studied by multiplex PCR (targeting 15 viruses and 4 intracellular bacteria). An adjudication committee composed of infectiologists, pneumologists, radiologists blinded to PCR results reviewed patient records, including computed tomography and day 28 follow-up to categorize final diagnostic probability as definite, probable, possible, or excluded CAP. Among the 254 patients enrolled, 78 (31%) had positive PCR, which detected viruses in 72/254 (28%) and intracellular bacteria in 8 (3%) patients. PCR was positive in 44/125 (35%) patients with definite CAP and 21/83 (25%) patients with excluded CAP. The most frequent organisms were influenza virus A/B in 27 (11%), rhinovirus in 20 (8%), coronavirus in 7 (3%), respiratory syncytial virus in 7 (3%) and Mycoplasma pneumoniae in 8 (3%) of 254 patients. Proportion of rhinovirus was higher in patients with excluded CAP compared to other diagnostic categories ( P =0.01). No such difference was observed for influenza virus. Viruses seem common in adults attending ED with suspected CAP. A concomitant clinical, radiological and biological analysis of the patient's chart can contribute to either confirm their role, or suggest upper respiratory tract infection or shedding. Their imputability and impact in early management of CAP deserves further studies. Copyright © 2015. Published by Elsevier Ltd.
    Clinical Microbiology and Infection 02/2015; 21(6). DOI:10.1016/j.cmi.2015.02.014 · 5.20 Impact Factor
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    ABSTRACT: In a context of controversy about influenza antiviral treatments, this study assessed primary health care physicians' prescription of neuraminidase inhibitors (NIs) in France during pandemic and seasonal influenza between 2009 and 2013. This observational study, using data recorded in three national databases, estimated the rate of NIs' prescription among influenza like-illness (ILI) patients seen in GPs' and paediatricians' consultations, and determined factors associated with this prescription according to a multivariate analysis. NIs' delivery by pharmacists was also evaluated. Rates of NIs' prescription were estimated to 61.1% among ILI patients with a severe influenza risk factor seen in GPs' consultation during the A(H1N1)pdm2009 pandemic versus an average rate of 25.9% during the three following seasonal influenza epidemics. Factors associated with NIs' prescription were a chronic disease in patients under 65 years (OR, 14.85; 95%CI, 13.00-16.97) and in those aged 65 and older (OR, 7.54; 5.86-9.70), an age ≥ 65 years in patients without chronic disease (OR, 1.35; 1.04-1.74), a pregnancy (OR, 10.63; 7.67-15.76), obesity (OR, 4.67; 3.50-6.22), and a consultation during the pandemic A(H1N1)pdm2009 (OR, 3.19; 2.93-3.48). The number of antiviral treatments delivered by pharmacists during the A(H1N1)pdm2009 pandemic was 835 per 100 000 inhabitants, and an average of 275 per 100 000 inhabitants during the three following seasonal influenza epidemics. Although physicians seem to follow the recommended indications for NIs in primary health care practice, this study confirms the low rate of NIs prescription to ILI patients with a severe influenza risk factor, especially during seasonal epidemics.
    Antiviral therapy 02/2015; DOI:10.3851/IMP2945 · 3.14 Impact Factor
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    ABSTRACT: A major deleterious side effect of glucocorticoids is skin atrophy. Glucocorticoids activate the glucocorticoid and the mineralocorticoid (MR) receptor, both present in epidermis. We hypothesized that glucocorticoid-induced epidermal atrophy may be related to inappropriate occupancy of MR by glucocorticoids. We evaluated whether epidermal atrophy induced by the topical glucocorticoid clobetasol could be limited by co-administration of MR antagonist. In cultured human skin explants, the epidermal atrophy induced by clobetasol was significantly limited by MR antagonism (canrenoate, eplerenone). Blockade of the epithelial sodium channel ENaC by phenamil was also efficient, identifying a role of MR-ENaC cascade in keratinocytes, acting through restoration of clobetasol-induced impairment of keratinocyte proliferation. In the SPIREPI randomized double-blind controlled trial, gels containing clobetasol, the MR antagonist spironolactone, both agents or placebo were applied on four zones of the forearms of 23 healthy volunteers for 28 days. Primary outcome was histological thickness of the epidermis with clobetasol alone or clobetasol+spironolactone. Spironolactone alone did not affect epidermis thickness but co-application of clobetasol and spironolactone limited significantly clobetasol-induced atrophy and was well tolerated. Altogether these findings identify MR as a factor regulating epidermal homeostasis and suggest that topical MR blockade could limit glucocorticoid-induced epidermal atrophy.Journal of Investigative Dermatology accepted article preview online, 10 February 2015. doi:10.1038/jid.2015.44.
    Journal of Investigative Dermatology 02/2015; DOI:10.1038/jid.2015.44 · 6.37 Impact Factor
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    ABSTRACT: Aortic valve stenosis (AS) is a progressive disease, but the impact of baseline AS haemodynamic or anatomic severity on AS progression remains unclear. In 149 patients (104 mild AS, 36 moderate AS and 9 severe AS) enrolled in 2 ongoing prospective cohorts (COFRASA/GENERAC), we evaluated AS haemodynamic severity at baseline and yearly, thereafter, using echocardiography (mean pressure gradient (MPG)) and AS anatomic severity using CT (degree of aortic valve calcification (AVC)). After a mean follow-up of 2.9±1.0 years, mean MGP increased from 22±11 to 30±16 mm Hg (+3±3 mm Hg/year), and mean AVC from 1108±891 to 1640±1251 AU (arbitrary units) (+188±176 AU/year). Progression of AS was strongly related to baseline haemodynamic severity (+2±3 mm Hg/year in mild AS, +4±3 mm Hg/year in moderate AS and +5±5 mm Hg/year in severe AS (p=0.01)), and baseline haemodynamic severity was an independent predictor of haemodynamic progression (p=0.0003). Annualised haemodynamic and anatomic progression rates were significantly correlated (r=0.55, p<0.0001), but AVC progression rate was also significantly associated with baseline haemodynamic severity (+141±133 AU/year in mild AS, +279±189 AU/year in moderate AS and +361±293 AU/year in severe AS, p<0.0001), and both baseline MPG and baseline AVC were independent determinants of AVC progression (p<0.0001). AS progressed faster with increasing haemodynamic or anatomic severity. Our results suggest that a medical strategy aimed at preventing AVC progression may be useful in all subsets of patients with AS including those with severe AS and support the recommended closer follow-up of patients with AS as AS severity increases. COFRASA (clinicalTrial.gov number NCT 00338676) and GENERAC (clinicalTrial.gov number NCT00647088). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Heart (British Cardiac Society) 02/2015; 101(12). DOI:10.1136/heartjnl-2014-307154 · 6.02 Impact Factor
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    ABSTRACT: This phase I, pilot clinical study was designed to evaluate the safety and the pharmacokinetic (PK) profiles of the CIME (Metabolic Identity Card) combination of ten drugs, with a view to its use as a phenotyping cocktail. Ten healthy Caucasian subjects were orally dosed with the CIME combination (caffeine-CYP1A2, repaglinide-CYP2C8, tolbutamide-CYP2C9, omeprazole-CYP2C19, dextromethorphan-CYP2D6, midazolam-CYP3A, acetaminophen-UGT1A1, 6&9 and 2B15, digoxin-P-gp, rosuvastatin-OATP1B1&3 and memantine-active renal transport). Blood was collected over 3 days and on day 7. CIME probes and relevant metabolites were assayed by LC-MS/MS and PK parameters were calculated. Main results were: (1) good safety with reversible mild or moderate adverse effects, (2) an analytical method able to quantify simultaneously the 10 probes and the major metabolites, (3) calculation of PK parameters for all probes in general agreed with published values, and (4) identification of the low CYP2D6 metabolizer. This pilot study showed that the CIME combination was well tolerated and that its pharmacokinetics could be accurately measured in healthy volunteers. This combination can now confidently be checked for sensitivity and specificity and for lack of interaction to be validated as a phenotyping cocktail.
    European Journal of Drug Metabolism and Pharmacokinetics 12/2014; DOI:10.1007/s13318-014-0239-0 · 1.31 Impact Factor
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    ABSTRACT: Echocardiography plays a key role in the diagnosis of infective endocarditis (IE) but can be inconclusive in patients in whom prosthetic valve endocarditis (PVE) is suspected. The incremental diagnostic value of (18)F-FDG PET and radiolabeled leukocyte scintigraphy in IE patients has already been reported. The aim of this study was to compare the respective performance of (18)F-FDG PET and leukocyte scintigraphy for the diagnosis of PVE in 39 patients. (18)F-FDG PET and leukocyte scintigraphy were performed on 39 consecutive patients admitted because of clinically suspected PVE and inconclusive echocardiography results. The results of (18)F-FDG PET and leukocyte scintigraphy were analyzed separately and retrospectively by experienced physicians masked to the results of the other imaging technique and to patient outcome. The final Duke-Li IE classification was made after a 3-mo follow-up. Of the 39 patients, 14 were classified as having definite IE, 4 as having possible IE, and 21 as not having IE. The average interval between (18)F-FDG PET and leukocyte scintigraphy was 7 ± 7 d. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93%, 71%, 68%, 94%, and 80%, respectively, for (18)F-FDG PET and 64%, 100%, 100%, 81%, and 86%, respectively, for leukocyte scintigraphy. Discrepancies between the results of (18)F-FDG PET and leukocyte scintigraphy occurred in 12 patients (31%). In patients with definite IE, 5 had true-positive (18)F-FDG PET results but false-negative leukocyte scintigraphy results. Of these 5 patients, 3 had nonpyogenic microorganism IE (Coxiella or Candida). Of patients for whom endocarditis had been excluded, 6 had true-negative leukocyte scintigraphy results but false-positive (18)F-FDG PET results. These 6 patients had been imaged in the first 2 mo after the last cardiac surgery. The last patient with a discrepancy between (18)F-FDG PET and leukocyte scintigraphy was classified as having possible endocarditis and had positive (18)F-FDG PET results and negative leukocyte scintigraphy results. (18)F-FDG PET offers high sensitivity for the detection of active infection in patients with suspected PVE and inconclusive echocardiography results. Leukocyte scintigraphy offers a higher specificity, however, than (18)F-FDG PET for diagnosis of IE and should be considered in cases of inconclusive (18)F-FDG PET findings or in the first 2 mo after cardiac surgery. © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
    Journal of Nuclear Medicine 12/2014; 55(12):1980-5. DOI:10.2967/jnumed.114.141895 · 5.56 Impact Factor
  • Xavier Duval, Bruno Hoen
    The Lancet 11/2014; 368(9974). DOI:10.1016/S0140-6736(14)62121-8 · 45.22 Impact Factor
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    ABSTRACT: Despite effective highly active antiretroviral treatment, anal cancer incidence has recently strongly increased in HIV-infected population. Treatment strategy in HIV-infected patients does not differ from general population. HIV-infected patients treated by chemo-radiotherapy are exposed to high-grade toxicities and should be closely monitored to deliver the optimal treatment. Close collaboration between oncologist and infectiologist is highly recommended to adjust antiretroviral therapy if necessary.
    Bulletin du cancer 11/2014; 101(11):1034-1039. DOI:10.1684/bdc.2014.2035 · 0.64 Impact Factor
  • C Chirouze, B Hoen, X Duval
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    ABSTRACT: Historically, infective endocarditis (IE) affected patients with predisposing cardiac conditions and community-acquired bacteremia. Over the past 30 years, significant changes have occurred, regarding microorganisms, underlying valvular heart diseases, portals of entry, and patients' comorbidities. Given these epidemiological changes and unproven prophylaxis efficacy, experts in most countries currently limit antibiotic indications to patients with high-risk cardiac conditions having oral procedures and, in the UK, recommend discontinuing their use altogether. To date, no epidemiological impact on streptococcal IE incidence has been observed. Policy must now address these epidemiological modifications, focus on community-acquired and health care-associated staphylococcal bacteremia prevention, and prompt the adoption of broader and nonexclusively antibiotic-based strategies.
    Current Infectious Disease Reports 11/2014; 16(11):440. DOI:10.1007/s11908-014-0440-y
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    ABSTRACT: A 65 year-old woman was admitted for acute heart failure and severe sepsis revealing definite mitral infective endocarditis with severe regurgitation, complicated by multiple embolisms. Three blood cultures yielded a group G Streptococcus canis strain. Urgent surgery was performed with bioprosthetic valve replacement. Polymerase chain reaction analysis of the valve found S canis DNA. Amoxicillin and gentamicin were given for 2 weeks followed by 4 weeks of amoxicillin alone. She reported contact with a dog without bite. S canis has been reported to cause zoonotic septicemia but to our knowledge, this is the first human case of native valve infective endocarditis. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 11/2014; 30(11):1462.e1-2. DOI:10.1016/j.cjca.2014.07.013 · 3.94 Impact Factor
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    ABSTRACT: Preventive services provided opportunistically by GPs are insufficient. Reasons are most often gathered through GPs' self-reports, rather than through independent observation.
    Family Practice 06/2014; DOI:10.1093/fampra/cmu032 · 1.84 Impact Factor
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    ABSTRACT: Objective Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE. Methods Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors. Results The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p=<0.0001). Conclusions Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated.
    Heart (British Cardiac Society) 06/2014; 100(15). DOI:10.1136/heartjnl-2013-304916 · 6.02 Impact Factor
  • Médecine et Maladies Infectieuses 06/2014; 44(6):52-53. DOI:10.1016/S0399-077X(14)70196-9 · 0.91 Impact Factor

Publication Stats

2k Citations
1,169.76 Total Impact Points


  • 2007–2015
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2005–2015
    • Assistance Publique – Hôpitaux de Paris
      • Department of Cardiology
      Lutetia Parisorum, Île-de-France, France
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 1999–2014
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • Service des Maladies Infectieuses et Tropicales
      Lutetia Parisorum, Île-de-France, France
  • 2012–2013
    • University of Franche-Comté
      Becoinson, Franche-Comté, France
    • University of Zurich
      Zürich, Zurich, Switzerland
    • Unité Inserm U1077
      Caen, Lower Normandy, France
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
  • 2008–2013
    • University of Paris-Est
      La Haye-Descartes, Centre, France
  • 2010–2011
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • French Institute of Health and Medical Research
      • SESSTIM
      Lutetia Parisorum, Île-de-France, France
  • 2005–2007
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      Lutetia Parisorum, Île-de-France, France
  • 1995–2005
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 2001
    • Oregon Health and Science University
      Portland, Oregon, United States