Victoire De Lastours

Assistance Publique – Hôpitaux de Paris | AP-HP · Département de Médecine Interne

Introduction Cefiderocol is a siderophore cephalosporin active in vitro against carbapenemase-producing Enterobacterales, including New Delhi metallo-β-lactamases (NDM-1). A significant impact of the size of bacterial inoculum on its efficacy has been described in vitro, the clinical impact of which is unclear. Here, we analyse the inoculum effect...

Background The combination of aztreonam (ATM) and avibactam (AVI) is an attractive option to treat infections caused by extended spectrum β -lactamase plus NDM-1-producing Enterobacteriaceae . Since ATM activity was shown to be severely impacted by an increase in the inoculum size in vitro , we wondered whether ATM-AVI activity could be impaired in...

Background: Currently, diagnosis of bacterial infections is based on culture, possibly followed by the amplification and sequencing (Sanger method) of the 16S rDNA - encoding gene when cultures are negative. Clinical metagenomics (CMg), i.e. the sequencing of a sample's entire nucleic acids, may allow for the identification of bacteria not detected...

Background Anti-Ku are rare antibodies (Ab) directed against heterodimeric DNA-binding proteins and detected in some auto-immune diseases (AIDs). In a first study of 42 anti-Ku positive patients, 2 distinct patterns have been yielded thanks to hierarchical clustering. The 1st group corresponded to patients with elevated creatine kinase (CK) levels...

Background Temocillin is a narrow spectrum β-lactam active against MDR Enterobacterales. Mechanisms of acquired resistance to temocillin are poorly understood. We analysed resistance mechanisms in clinical isolates of Escherichia coli and evaluated their impact on temocillin efficacy in vitro and in a murine peritonitis model. Methods Two sets of...

Background Immune reconstitution inflammatory syndrome (IRIS) affecting the central nervous system (CNS) is associated with poor outcomes. Aims To report on risk factors for CNS-IRIS following tuberculous meningitis (TBM) in HIV-negative patients. Methods In this retrospective multicentre study, all HIV-negative adult patients admitted between...

Escherichia coli is both a highly prevalent commensal and a major opportunistic pathogen causing bloodstream infections (BSI). A systematic analysis characterizing the genomic determinants of extra-intestinal pathogenic vs. commensal isolates in human populations, which could inform mechanisms of pathogenesis, diagnostic, prevention and treatment i...

Objective: Whole genome sequencing (WGS) of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-E. coli) in developing countries is lacking. Here we describe the population structure and molecular characteristics of ESBL-E. coli faecal isolates in rural Southern Niger. Methods: Stools of 383 healthy participants were collected among w...

Objective Objective structured clinical examinations (OSCE) are one of the main modalities of skills’ assessment of medical students. We aimed to evaluate the educational value of the participation of third-year medical students in OSCE as standardized patients. Methods We conducted a pilot OSCE session where third-year students participated in si...

Objectives: Data on the efficacy of vancomycin catheter lock therapy (VLT) for conservative treatment of totally implantable venous access port-related infections (TIVAP-RI) due to CoNS are scarce. The aim of this study was to evaluate the effectiveness of VLT in the treatment of TIVAP-RI due to CoNS in cancer patients. Methods: This prospective...

Erdheim-Chester disease (ECD) is a rare form of L group histiocytosis, accounting for up to 1500 cases to date worldwide, which mainly affects men between their 5th and 7th decade of life. The most frequent manifestations are bone involvement, perirenal infiltration with an evocating appearance of “hairy kidneys”, and a “coated aorta” aspect. Lung...

Background The optimal duration of antimicrobial therapy for urinary tract infections in men remains controversial. Methods To compare 7 days to 14 days total antibiotic treatment for febrile urinary tract infections in men, this multicenter randomized, double-blind placebo-controlled non-inferiority trial enrolled 282 men from 27 centers in Franc...

Colistin is a drug of last resort to treat extreme drug-resistant Enterobacterales, but is limited by dose-dependent toxicity and the emergence of resistance. A recently developed antimicrobial pseudopeptide, Pep16, which acts on the cell membrane, may be synergistic with colistin and limit the emergence of resistance. We investigated Pep16 activit...

Escherichia coli is both a highly prevalent commensal and a major opportunistic pathogen causing bloodstream infections (BSI). A systematic analysis characterizing the genomic determinants of extra-intestinal pathogenic vs. commensal isolates in human populations, which could inform mechanisms of pathogenesis, diagnostics, prevention and treatment...

Background Temocillin is a β-lactam that is not hydrolysed by ESBLs Objectives To describe the real-life use of temocillin, to assess its effectiveness in infections caused by ESBL-producing Enterobacterales, and to identify risk factors for treatment failure. Methods Retrospective multicentric study in eight tertiary care hospitals in the Greate...

Introduction La tuberculose neuroméningée (TNM) est une forme rare mais sévère d’infection à Mycobacterium tuberculosis. Son traitement repose sur une antibiothérapie prolongée et une corticothérapie à haute dose de courte durée. La TNM peut se compliquer d’une réaction paradoxale (RP) sous traitement. Les RP, bien décrites chez les patients VIH ou...

Introduction Vancomycin prescription modalities remain non-consensual. We examined and evaluated the vancomycin prescription habits of infectious disease specialists in France. Methods Through an anonymized online questionnaire sent to members of the French Infectious Diseases Society, detailed information on vancomycin prescription modalities was...

Twenty-five patients with reflux cholangitis (RC) defined as acute cholangitis (AC) with normal abdominal imaging occurring > 3 months after bilioenteric anastomosis were described and compared to 116 AC patients with biliary obstruction (tumoral, lithiasis). RC episodes occurred a median 4.5 months after surgery; 18 (72%) had recurrent RC (n ≥ 3)....

Objective Whole genome sequencing (WGS) of extended-spectrum β-lactamase-producing Escherichia coli (ESBL- E. coli ) in developing countries is lacking. Here we describe the population structure and molecular characteristics of ESBL- E. coli faecal isolates in rural Southern Niger. Methods Stools of 383 healthy participants were collected among wh...

The COVID-19 pandemic has led health schools to cancel many on-site training and exams. Teachers were looking for the best option to carry out online OSCEs, and Zoom was the obvious choice since many schools have used it to pursue education purposes. Methods: We conducted a feasibility study during the 2020–2021 college year divided into six pilot...

Background: The impact of the variant of concern (VOC) Alpha on the severity of COVID-19 has been debated. We report our analysis in France. Methods: We conducted an exposed/unexposed cohort study with retrospective data collection, comparing patients infected by VOC Alpha to contemporaneous patients infected by historical lineages. Participants...

Résumé Introduction Malgré les recommandations nationales, la couverture vaccinale des soignants reste faible. L’objectif de ce travail était d’analyser l’attitude et les croyances du personnel soignant en Médecine Interne vis-à-vis de la vaccination antigrippale. Méthodes Les soignants de deux services universitaires de Médecine Interne d’Île de...

Bone and joint infections (BJIs) are complex infections that require precise microbiological documentation to optimize antibiotic therapy. Currently, diagnosis is based on microbiological culture, sometimes complemented by amplification and sequencing of the 16S rDNA gene. Clinical metagenomics (CMg), that is, the sequencing of the entire nucleic a...

Escherichia coli is an important cause of bloodstream infections (BSI), which is of concern given its high mortality and increasing worldwide prevalence. Finding bacterial genetic variants that might contribute to patient death is of interest to better understand infection progression and implement diagnostic methods that specifically look for thos...

Background Three healthy volunteers carried similar quinolone-resistant E. coli (QREC) (pulsed field gel electrophoresis profiles) in their gut before and after 14 days ciprofloxacin treatment. Given the intensity of the selective pressure and the mutagenic properties of quinolones, we determined whether these strains had evolved at the phenotypic...

Escherichia coli is an important cause of bloodstream infections (BSI), which is of concern given its high mortality and increasing worldwide prevalence. Finding bacterial genetic variants that might contribute to patient death is of interest to better understand its mechanism and implement diagnostic methods that specifically look for those factor...

Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Baye...

Background Alternative treatments are needed against NDM-1-producing Escherichia coli. Colistin (COL) and fosfomycin (FOS) often remain active in vitro but selection of resistant mutants is frequent if used separately. We determined whether the combination of colistin and fosfomycin may be useful to treat infections with NDM-1-producing E. coli wit...

Importance Failure of treatment is the most serious complication in community-acquired pneumonia (CAP). Objective To assess the potential risk factors for treatment failure in clinically stable patients with CAP. Design, Setting, and Participants This secondary analysis assesses data from a randomized clinical trial on CAP (Pneumonia Short Treatm...

Pancreatic and biliary duct cancers are increasing causes of acute cholangitis (AC). We retrospectively characterize 81 cancer-associated cholangitis (CAC) compared to 49 non-cancer-associated cholangitis (NCAC). Clinical and biological presentations were similar. However, in CAC, antibiotic resistance and inadequate empirical antibiotic therapy we...

With rising antibiotic resistance, alternatives to carbapenems are needed for acute cholangitis (AC). Temocillin reaches high biliary concentrations with limited impact on microbiota. We retrospectively included 140 AC episodes and assessed the efficacy of temocillin using microbiology susceptibility testing from blood cultures. Considering all bac...

To the Editor—We read with great interest the paper by Lipworth et al [1] published in the January 2021 issue of Clinical Infectious Diseases. O-antigen targeted vaccines against Escherichia coli may be useful in reducing morbidity, mortality, and antimicrobial resistance [2]. E. coli serotyping studies to guide vaccine target selection are limited...

Background: Escherichia coli is the leading cause of bloodstream infections, associated with a significant mortality. Recent genomic analyses revealed that few clonal lineages are involved in bloodstream infections and captured the emergence of some of them. However, data on within sequence type (ST) population genetic structure evolution are rare...

Trial enrichment using gut microbiota derived biomarkers by high-risk individuals can improve the feasibility of randomized controlled trials for prevention of Clostridioides difficile infection (CDI). Here, we report in a prospective observational cohort study the incidence of CDI and assess potential clinical characteristics and biomarkers to pre...

Background Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired...

Background Patients with COVID-19 pneumonia have an excess of inflammation and increased concentrations of cytokines including interleukin-1 (IL-1). We aimed to determine whether anakinra, a recombinant human IL-1 receptor antagonist, could improve outcomes in patients in hospital with mild-to-moderate COVID-19 pneumonia. Methods In this multicent...

Purpose Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing n...

Fosfomycin resistance in Escherichia coli results from chromosomal mutations or acquisition of plasmid-mediated genes. Because these mechanisms may be absent in some resistant isolates, we aimed at decipher the genetic basis of fosfomycin resistance in E. coli. Different groups of isolates were studied: fosfomycin-resistant mutants selected in vitr...

Objectives Simulation-based training (SBT) is increasingly used to teach clinical patient-doctor communication skills (CS) to medical students. However, the long-lasting impact of this training has been poorly studied. Methods In this observational study we included all fourth-year undergraduate medical students from a French medical school who un...

Introduction La résistance bactérienne aux carbapénèmes représente actuellement un défi thérapeutique majeur. Un des mécanismes de résistance des entérobactéries aux carbapénèmes est l’expression d’une métallo-β-lactamase (MBL) dont l’activité hydrolytique nécessite du zinc. Notre objectif était d’étudier l’activité de l’acide dimercaptosuccinique...

Background: Carbapenemase-producing Enterobacterales represent a major therapeutic challenge. MBLs, requiring zinc at their catalytic site, could be inhibited by meso-dimercaptosuccinic acid (DMSA), a heavy metal chelator already widely used for treating lead intoxication. Objectives: To evaluate the activity of carbapenems alone or combined wit...

Clinical benefit of carbapenems against carbapenemase-producing Enterobacteriaceae (CPE) remains questioned. MICs of imipenem (IMP) and ertapenem (ERT) against isogenic derivatives of the wild-type strain Escherichia coli CFT073 producing KPC-3, OXA-48 or NDM-1 were 0.25, 2, 16 and 64 mg/L for IMP and 0.008, 0.5, 8 and 64 mg/L, for ERT, respectivel...

Background: The R-GNOSIS (Resistance in Gram-Negative Organisms: Studying Intervention Strategies) WP3 study was the first multicenter randomized clinical trial systematically investigating fecal microbiota transplantation (FMT) for intestinal decolonization of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-...

Background Pyogenic liver abscesses in liver transplant recipient (PLA‐LTR) are a rare disease whose specificities compared with PLA in non‐transplanted patients (PLA‐C) are unknown. Methods A retrospective case‐control study was conducted in a French academic hospital from January 1, 2010 to December 31, 2014. Results Among 176 patients diagnose...

Background: Escherichia coli bloodstream infections (BSIs) account for high mortality rates (5%-30%). Determinants of death are unclear, especially since the emergence of ESBL producers. Objectives: To determine the relative weight of host characteristics, bacterial virulence and antibiotic resistance in the outcome of patients suffering from E....

Objective To assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen. Design Comparative observational study using data collected from routine care. Setting Four French tertiary care centres providing care to patients with covid-19 pneumonia between 12 M...

Background Treatments are urgently needed to prevent respiratory failure and deaths from coronavirus disease 2019 (COVID-19). Hydroxychloroquine (HCQ) has received worldwide attention because of positive results from small studies. Methods We used data collected from routine care of all adults in 4 French hospitals with documented SARS-CoV-2 pneumo...

Background A strategy used by bacterial strains to resist β-lactam antibiotics is the expression of metallo-β-lactamases (MBL) requiring zinc for activity. The use of a zinc chelator may restore carbapenem activity against MBL-producing Enterobacteriaceae. DMSA is a heavy metal chelator approved in humans with a satisfactory safety record. Our obje...

Background Cancer-associated acute cholangitis (CAAC) are becoming more frequent and their characteristics may be changing with the evolution of cancer management. Our aim was to compare clinical, microbiological and outcome characteristics of CAAC to those of cancer-free acute cholangitis (CFAC). Methods All consecutive cases of acute cholangitis...

Background: We report the implementation of a large-scale simulation-based cardiovascular diagnostics course for undergraduate medical students. Methods: A simulation-based course was integrated into the curriculum of second-year medical students (> 400 students/year). The first session aimed at teaching cardiac auscultation skills on mannequins...

Objectives: Intestinal carriage with extended spectrum β-lactamase Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) can persist for months. We aimed to evaluate whether oral antibiotics followed by faecal microbiota transplantation (FMT) can eradicate intestinal carriage with ESBL-E/CPE. Methods: Randomized, open-...

Introduction Escherichia coli est le pathogène le plus fréquemment responsable bactériémies qui sont grevées d’une mortalité de 5 % à 30 %. Le poids relatif des facteurs de risque de décès reste discuté en particulier avec l’émergence mondiale de souches productrices de ß-lactamases à spectre étendu (BLSE). Afin de déterminer le poids des facteurs...

Résumé L’angiocholite est une infection de la bile et des voies biliaires, secondaire dans la majorité des cas à une obstruction des voies biliaires. Les étiologies en sont multiples, dominées par la maladie lithiasique et les néoplasies. Le diagnostic clinique repose sur la triade de Charcot (douleur, fièvre, ictère) mais sa sensibilité insuffisan...

Acute cholangitis is an infection of the bile and biliary tract which in most cases is the consequence of biliary tract obstruction. The two main causes are choledocholithiasis and neoplasia. Clinical diagnosis relies on Charcot's triad (pain, fever, jaundice) but the insufficient sensitivity of the latter led to the introduction in 2007 of a new s...

Background: The overall benefit of surgical management in the acute phase of hematogenous pyogenic vertebral osteomyelitis remains difficult to evaluate because of the balance between potential functional benefit versus complications of surgery. Methods: Between 2000 and 2013, in a tertiary care hospital, we analyzed a cohort of patients with hemat...

The intestinal microbiota is considered to be a major reservoir of antibiotic resistance determinants (ARDs) that could poten-tially be transferred to bacterial pathogens via mobile genetic elements. Yet, this assumption is poorly supported by empirical evidence due to the distant homologies between known ARDs (mostly from culturable bacteria) and...

Introduction Les angiocholites sont des infections potentiellement sévères nécessitant une antibiothérapie probabiliste urgente active notamment sur les entérobactéries. Devant l’augmentation des infections à entérobactéries multirésistantes, comme celles productrices de β-lactamases à spectre élargi (BLSE) et dans un souci d’épargne des carbapénèm...

Introduction Les Infections à Clostridium difficile (ICD) sont à haut risque de récidive, entraînant une morbi-mortalité et des surcoûts importants. La transplantation de micro biote fécal (TMF) a prouvé son efficacité dans le traitement des récidives d’ICD. Récemment, des gélules de selles congelées ont été mises au point, limitant les risques des...

Background: Non-typhoidal salmonellosis (NTS) often occurs in children with sickle-cell disease (SCD) and remains a significant cause of mortality in developing countries. However, there is lack of reports on the clinical presentation, outcome and complications of NTS in adults with SCD. Methods: We performed a chart review between 2006 and 2016 o...

Background: Alternative therapeutic regimens are urgently needed against carbapenemase-producing Enterobacteriaceae. Fosfomycin often remains active against KPC and OXA-48 producers, but emergence of resistance is a major limitation. Our aim was to determine whether the association of temocillin with fosfomycin might be useful to treat KPC- or OXA...