Gilles Potel

Gilles Potel
Centre Hospitalier Universitaire de Nantes | CHU Nantes · Pôle Urgences

MD,PhD

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414
Publications
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Introduction
Skills and Expertise

Publications

Publications (414)
Article
S. aureus bone infections remain a therapeutic challenge, leading to long and expensive hospitalizations. Systemic antibiotic treatments are inconsistently effective due to insufficient penetration into the infectious site. In an osteomyelitis model, the single local administration of nanoparticle-encapsulated daptomycin allows sterilization of the...
Article
Riassunto Il riscontro o il sospetto di sindrome meningea deve essere oggetto di un’indagine tanto rapida quanto rigorosa, dominata dalla ricerca o dall’esclusione della diagnosi di meningite batterica. In un clima non febbrile, e quando è di esordio molto brutale, si deve sospettare un accidente emorragico, di solito facilmente confermato dalla di...
Article
Full-text available
For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not...
Article
Objective: Staphylococcusaureus is involved in around 20% of nosocomial pneumonia cases. Vancomycin used to be the reference antibiotic in this indication, but new molecules have been commercialized, such as linezolid. Previous studies comparing vancomycin and linezolid were based on models. Comparing their real costs from a hospital perspective w...
Article
L’hyperkaliémie est l’un des désordres hydroélectrolytiques les plus fréquemment rencontrés aux urgences. Les étiologies principales sont l’insuffisance rénale aiguë ou chronique, le diabète et l’insuffisance cardiaque. L’hyperkaliémie aiguë peut être une urgence vitale, car elle est potentiellement létale du fait du risque d’arythmie cardiaque. Sa...
Article
Study objective: Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among p...
Article
Full-text available
Impeding as well as reducing the burden of antimicrobial resistance in Gram negative pathogens is an urgent public health endeavor. Our current antibiotic armamentarium is dwindling while major resistance determinants (e.g. extended-spectrum β-lactamases (ESBLs)) continue to evolve and disseminate around the world. One approach to attack this probl...
Article
Many studies show that the human microbiome plays a critical role in the chronic pathologies of obesity, inflammatory bowel diseases, and diabetes. More recently, the interaction between cancer and the microbiome has been highlighted. Most studies have focused on the gut microbiota because it represents the most extensive bacterial community, and t...
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The aim of this study was to evaluate whether recent systemic anti-inflammatory agents (AIAs) exposure in patients with sore throat managed with or without antibiotic therapy influenced the risk of peritonsillar abscess (PTA). We conducted a multicenter case–control study in 13 French university hospitals in 2009–2012 comparing patients admitted wi...
Article
Résumé Le risque d’une rupture dans l’approvisionnement en cloxacilline intraveineuse conduit à rechercher des alternatives à l’utilisation des pénicillines anti-staphylococciques dans les infections sévères à Staphylococcus aureus sensible à la méticilline. But du travail Examiner les arguments bibliographiques récents plaidant pour une large uti...
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The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009–2012 describing 412 patients. Median age was 29 year (range, 2–84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) ha...
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Background Bacteremia, or bloodstream infection (BSI), is a leading cause of death among patients with certain types of cancer. A previous study reported that intestinal domination, defined as occupation of at least 30 % of the microbiota by a single bacterial taxon, is associated with BSI in patients undergoing allo-HSCT. However, the impact of th...
Article
The availability of medical beds is a daily challenge in all Emergency Departments (EDs). Aim To demonstrate the value of a “dedicated” medical ward, fully integrated in an ED, adapted to the most common medical conditions, requiring limited use of health care resources. Procedure For 15 years, a medical ward fully dedicated to the ED of Nantes Uni...
Article
This study aimed to compare the susceptibility to carbapenems (imipenem, meropenem and doripenem) of clinical strains of Pseudomonas aeruginosa. It also studied whether susceptibility to imipenem or meropenem could predict, reliably, susceptibility to doripenem. Pseudomonal strains were collected from respiratory specimens, half of them from cystic...
Article
Objective: Prosthetic vascular graft infection (PVGI) is an emerging disease, mostly caused by staphylococci, with limited data regarding efficacy of current antistaphylococcal agents. We aimed to assess the efficacy of different antibiotic regimens. Methods: Six different strains of MSSA and MRSA were used. We compared results of minimal biofil...
Article
Objectives: Third-generation cephalosporins and fluoroquinolones are particularly prone to promoting bacterial resistance. Their use in Emergency Departments (EDs) is poorly known. Our objectives were to assess the use of antibacterial agents in French EDs. Methods: This study is a retrospective study of antibiotics delivered to the adult units...
Article
Aims: Third generation cephalosporins (3GC) and fluoroquinolones (FQ) are particularly prone to promote bacterial resistance. Emergency physicians could decrease their use by replacing them with narrow-spectrum antibiotics. Our objectives were to assess the incidence of 3GC and FQ prescriptions in the Emergency Department (ED), and the proportion o...
Article
Résumé La faute caractérisée en droit pénal serait déterminée par le fait d’exposer autrui à un danger en toute connaissance de cause que ce soit par un acte positif ou une abstention grave. Face à la notion de faute caractérisée dans le domaine de la responsabilité médicale, le législateur n’a pas donné de définition précise. C’est pourquoi une an...
Article
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Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of ba...
Article
ECG interpretation is a pivotal skill to acquire during residency, especially for Emergency Department (ED) residents. Previous studies reported that ECG interpretation competency among residents was rather low. However, the optimal resource to improve ECG interpretation skills remains unclear. The aim of our study was to compare two teaching modal...
Data
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Background : Urine cultures are frequently sampled in the Emergency Department. Urine cultures are justified in patients with clinical features suggestive of UTI. However, as urine cultures are sometimes sent by nurses to the microbiology laboratory without prescription by a senior doctor, some tests may be unnecessary. Objective : To assess the r...
Article
Chemotherapy is commonly used as myeloablative conditioning treatment to prepare patients for haematopoietic stem cell transplantation (HSCT). Chemotherapy leads to several side effects, with gastrointestinal (GI) mucositis being one of the most frequent. Current models of GI mucositis pathophysiology are generally silent on the role of the intesti...
Article
Résumé La documentation bactérienne des pneumonies aiguës communautaires (PAC) est le seul moyen permettant de procéder à une désescalade antibiotique au cours d’un traitement le plus souvent initialement probabiliste, ou de corriger une antibiothérapie initiale inefficace. Parmi les moyens les plus utiles, l’examen cyto-bactériologique des crachat...
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Fluoroquinolones and 3rd-generation cephalosporins that are prescribed for pneumonia may be avoided and replaced by a penicillin in some cases. We aimed to determine if the proportion of patients treated for pneumonia with a cephalosporin, a fluoroquinolone or both varies among Emergency Departments (EDs), and to estimate the proportion of avoidabl...
Article
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Non-drug treatments should be systematically associated to the medical analgesic treatment during the terminal phase of cancer. Patient 1, a 23-year-old woman, presented an adenocarcinoma of the rectum, with liver and lung metastases. Pain was initially treated by oral morphine and a combination of pregabalin and amitriptyline. Ketamine and intrath...
Article
Objective: An ECG is pivotal for the diagnosis of coronary heart disease. Previous studies have reported deficiencies in ECG interpretation skills that have been responsible for misdiagnosis. However, the optimal way to acquire ECG interpretation skills is still under discussion. Thus, our objective was to compare the effectiveness of e-learning a...
Article
Abstract Objective. It has been proved that emergency medical dispatch centers (EMDC) save lives by promoting an appropriate allocation of emergency medical service resources. Indeed, optimal dispatcher call duration is pivotal to reduce the time gap between the time a call is placed and the delivery of medical care. However, little is known about...
Conference Paper
Full-text available
Background : Urine cultures are frequently sampled in the Emergency Department. Urine cultures are justified in patients with clinical features suggestive of UTI. However, as urine cultures are sometimes sent by nurses to the microbiology laboratory without prescription by a senior doctor, some tests may be unnecessary. Objective : To assess the...
Conference Paper
Full-text available
To assess the ability of the Pseudomonas aeruginosa Type-III Secretion System (T3SS) to alter the protective interleukin-22 (IL22) response in an acute pneumonia mouse model.
Article
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The aim of this study was to compare ceftolozane with ceftazidime, piperacillin/tazobactam (TZP) and imipenem in an experimental rabbit model of Pseudomonas aeruginosa pneumonia. Efficacy was assessed following 2 days of treatment by total colony counts in different tissues (lung, spleen and blood culture). Mean ± standard deviation pulmonary bacte...
Article
Background Gastrointestinal mucositis is defined as inflammation and/or ulcers of the gastrointestinal tract occurring as a complication of chemotherapy and radiation therapy, and affects about 50% of all cancer patients.AimTo assess the role of gut microbiota in the pathogenesis of gastrointestinal mucositis and the potential for manipulations of...
Article
Epidemiology of severe sepsis in intensive care units is well known and account for 15% of admissions. Hospital mortality is about 30%. Infectious focus is in order of frequency, pulmonary, urinary, digestive, skin and primitive bacteremia. It is less known in Emergency Departments but account for 500,000 annual visits in the United States. Inciden...
Article
Introduction The aim of this study is to analyze the adverse drug events (ADE) frequency for the oral anticoagulant drugs (OAD) in patients visiting the medical emergency department (ED) of the tertiary care hospital of Nantes. Material and Methods Between March 2011 and February 2012, adult patients visiting the medical ED were included during ra...
Article
Background Many adverse drug events (ADEs) are not identified by emergency physicians. Research has been done to study risk factors for ADEs and help emergency physicians diagnose ADEs. However, no research has specifically examined the causes underlying a lack of attribution of ADEs to medications in emergency department (ED) patients. Objective...
Article
Introduction – objectifs Évaluer le rôle des AI dans la survenue d’APA en cas de mal de gorge traité ou non par antibiotique. Matériels et méthodes Étude cas-témoins prospective multicentrique (13 CHU français) comparant les patients admis entre 2009 et 2012 pour APA à un groupe témoin consultant un médecin pour « mal de gorge ». Une analyse uni e...
Conference Paper
Objective To assess the participation in an interactive e-learning, promoting a decreased use of 3rd generation cephalosporins and fluoroquinolones for lower respiratory tract infections, in the emergency department. Methods: The e-learning consisted of a 16-min slide show, one-page take-home messages, 10 optional and interactive multiple choice te...
Article
Full-text available
Pseudomonas aeruginosa infection is a clinically relevant infection involved in pneumonia in ICUs. Understanding the type of immune response initiated by the host during pneumonia would help defining new strategies to interfere with the bacteria pathogenicity. In this setting, the role of natural killer cells remains controversial. We assessed the...
Article
Background. The “ECN” (French Medical Final Exams) represent the last millstone of medical studies in France. The objective of our study was to evaluate the performance of the most commonly used textbooks to prepare this exam. Methods. The 3 most popular types of textbooks were studied: “Collège des Enseignants” considered to be the gold standard b...
Article
Full-text available
Background: Linezolid is considered as a therapeutic alternative to the use of glycopeptides for the treatment of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). Clinical studies reported a potent survival advantage conferred by the oxazolidinone and called into question the use of glycopeptides as first-line therapy. Meth...
Article
Objectifs Les objectifs de cette enquête étaient d’étudier l’épidémiologie des bactéries multirésistantes (BMR) dans la communauté française, incluant tous les patients porteurs d’entérobactéries résistantes aux céphalosporines de troisième génération (ER-C3G), parmi les patients âgés de plus de 65 ans et d’étudier les co-résistances aux antibiotiq...
Article
Fluoroquinolones and third-generation cephalosporins are particularly prone to select bacterial resistance to antibiotics. We aimed to assess the temporal trends of antibiotic use in the emergency department adults unit of an academic hospital between 2002 and 2012. Antibiotic use was converted in defined daily doses (DDD). The total antibiotic con...
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Full-text available
Gastrointestinal disturbances are a side-effect frequently associated with haematological malignancies due to the intensive cytotoxic treatment given in connection with bone marrow transplantation (BMT). However, intestinal microbiota changes during chemotherapy remain poorly described, probably due to the use of culture-based and low-resolution mo...
Article
Le traitement des infections staphylococciques repose sur l'antibiothérapie et sur la prise en charge des corps étrangers et dispositifs médicaux auxquels ces infections peuvent être associées. Les antibiotiques préférentiels sont les pénicillines M, et les glycopeptides en cas de résistance aux pénicillines M. La résistance de S. aureus aux antibi...
Article
Aim In order to optimize the fully efficient arrival of future physicians in French Emergency Medical Call Centers (EMCs), it is important that a specific pedagogic plan of the initial training is established. That is what we did in our EMC, after the educational needs assessment. Procedure We have interviewed experienced EMC physicians about educa...
Article
Objectifs Conformément au nouveau Plan Antibiotique, MedQual évalue la possibilité d’organiser en Pays-de-la-Loire, un réseau de référents en antibiothérapie afin de répondre aux attentes des professionnels de santé libéraux et des établissements de santé (ES) dépourvus d’infectiologue. Méthodes Une enquête, menée en collaboration avec les antibio...
Article
Full-text available
Little is known about the relation of adverse drug reactions (ADRs) to self-use of medications. The aim of this study was to determine the frequency and severity of ADRs related to self-medication (ADR-SM) among emergency department (ED) patients and to describe their main characteristics. A prospective, cross-sectional, observational study was con...
Article
Dealing with healthcare-associated infections represents a major priority for the public health system. Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, for instance, raises treatment issues and the matter of an alternative to vancomycin, an antibiotic treatment that has been used for decades, is now being addressed. An international c...
Conference Paper
Full-text available
Background: Neutrophils are crucial in the defense against bacteria infection. Type-III secretion system (T3SS) is one of the major virulence factor of Pseudomonas aeruginosa (PA). It includes several exoenzymes (Exo) named S, T, Y and U. Exo can interfere with host cellular mechanisms and induce cell apoptosis once injected into targeted cells. Th...
Article
Background: Transient ischemic attack (TIA) is common and precedes 15% of strokes. TIA should be managed as a time-sensitive illness to prevent a subsequent stroke. However, management of TIA is heterogeneous, with little consensus about its optimal assessment. Objective: The objective of this study was to determine the outcome of patients with...
Article
Spondylarthritis is still viewed as a reaction to infectious agents, as opposed to an infection by persistent bacteria, for several reasons: (a) an infection is considered proven only when the organism can be cultured; (b) no studies have identified dormant bacteria in the tissues targeted by spondylarthritis; (c) the bacterial persistence hypothes...
Conference Paper
Objectif Déterminer la fréquence des prescriptions de céphalosporines de 3e génération (C3G) et de fluoroquinolones dans les infections respiratoires basses aux urgences, et la part évitable de ces prescriptions. Méthodes Série rétrospective de 88 cas adultes de pneumonie communautaire ou d’exacerbation aiguë de BPCO (EABPCO), traités aux urgences...
Article
Background: The difficulty to diagnose community-acquired pneumonia (CAP) and the lack of scientific data regarding the optimal duration of antibiotic therapy are responsible for overprescribing antibiotics. Objective: The authors had for objective to perform a systematic review of the international medical literature on strategies aimed at redu...
Article
Full-text available
This study aimed to evaluate the impact of home-based management of malaria (HBM) strategy on time to treatment and reported presumed malaria morbidity in children aged less than 5 years in Rwanda. The study was carried out in two malaria-endemic rural districts, one where HBM was applied and the other serving as control. In each district, a sample...
Article
To develop the first questionnaire to obtain a complete medication history by documenting self-medication history in adult patients admitted to a medical emergency department (ED). A Questionnaire to document Self-Medicating Behaviours (QSMB) was developed between January and September 2008 (reference period), tested and refined between October and...
Article
Bacteremia remains a major cause of life-threatening complication in patients with cancer. Significant changes in the spectrum of microorganisms isolated from blood culture have been reported in cancer patients over the past years. The aim of our systematic review was to inventory the recent trends in epidemiology and antibiotic resistance of micro...
Article
Throughout the human lifetime, the intestinal microbiota performs vital functions, such as barrier function, metabolic reactions, trophic effects, and maturation of the host's innate and adaptive immune responses. Development of the intestinal microbiota in infants is characterized by rapid and large changes in microbial abundance, diversity, and c...