BACKGROUND:Ventilator-associated pneumonia (VAP) is a prevalent nosocomial infection in intensive care units (ICUs) with significant impacts on patient outcomes and healthcare costs. Multiplex PCR could allow for personalized empirical treatment of VAP and optimize antibiotic therapy. METHODS:This multicenter retrospective study analyzed culture-positive VAP cases from January 2016 to March 2021 across 12 ICUs in France. The prevalence of non-targeted bacteria was evaluated according to the bacterial species included in the BioFire® FilmArray® Pneumonia Panel (FAPPP), and associated risk factors were identified. A non-targeted bacteria was defined as a bacterial species isolated during VAP, not included in the FilmArray panel, but considered by the clinician in the final antibiotic therapy. RESULTS:Among 332 patients with 385 culture-positive VAP episodes, non-targeted pathogens were observed in 23% of cases (87/385) and represented 21% (110/534) of isolated bacteria (After excluding bacteria with low pathogenicity, the rate of VAP with a non-targeted bacterium was 21%). The most common non-targeted bacteria identified were Stenotrophomonas maltophilia (22%), Citrobacter koseri, and Hafnia alvei. Gram stain results poorly correlated with definitive cultures (42% of concordance). The proportion of culture-positive VAP with non-targeted bacteria varied significantly between ICUs, ranging from 12 to 37%, (p = 0.013). Polymicrobial culture-positive VAP had a twofold higher risk of non-targeted bacteria (47% vs. 25%, p < 0.001). In the multivariate analysis, in-ICU antibiotic exposure was associated with a twofold increased risk of non-targeted bacteria (25.3% vs. 12.9%, p = 0.042), and age over 70 years was associated with a threefold increased risk (p = 0.027). Among the 48 culture-positive VAP cases with ineffective empiric treatment, Pseudomonas aeruginosa (22%), Stenotrophomonas maltophilia (14%), and Enterobacter cloacae complex (8%) were the most frequent bacteria. Additionally, 67% of the culture-positive VAP cases with ineffective empirical antibiotic therapy involved targeted bacteria, of which 59% could have received effective empirical antibiotic therapy if panel results had been available, according to bacterial species identification and current guidelines. CONCLUSIONS:A significant rate of culture-positive VAP cases with non-targeted bacteria was observed in this study, raising concerns about the interpretation of FAPPP results. Only positive FAPPP results may assist clinicians in the early personalization of antibiotic therapy for VAP.
Background: Preserving meniscal tissue is a major priority in young, physically active patients. Extensive meniscal defects may result in exercise pain and premature osteoarthritis. ACTIfitTM is a synthetic meniscal substitute that may improve short-term functional scores via biological integration with meniscal tissue regeneration. However, long-term data on the lifespan and chondroprotective effect of this newly formed tissue are lacking. The primary objective of this study was to assess the biological integration of ACTIfitTM based on magnetic resonance imaging (MRI) findings. The secondary objective was to evaluate long-term clinical outcomes. Hypothesis: The ACTIfitTM meniscal substitute undergoes biological integration over time, suggesting chondroprotective potential. Materials and methods: A 2014 report by Baynat et al. described the 2-year clinical and radiological outcomes of 18 patients after ACTIfitTM implantation at the Clermont-Tonnerre military teaching hospital (Brest, France). The patients had chronic knee pain of at least 6 months' duration after failure of primary meniscal surgery with segmental meniscal defects. Mean age was 34.0 +/- 7.9 years. A concomitant procedure was performed in 13 (60%) patients, including osteotomy in 8 and ligament reconstruction in 5. For the current study, the clinical and radiological follow-up was at least 8 years. Assessments were with the Genovese grading scale for substitute morphology on MRI scans, International Cartilage Research Society (ICRS) score for osteoarthritis progression, and Lysholm score for clinical outcome. Failure was defined as total substitute resorption (Genovese morphology grade 1) or revision surgery with implant removal, conversion to meniscus allografting, or arthroplasty.Results: MRI scans were available for 12 (66%) patients. The reason for not having long-term MRI scans was surgery for substitute removal or arthroplasty in 3 of the remaining 6 patients. Complete implant resorption (Genovese grade 1) was noted in 7/12 (58%) patients and osteoarthritis progression to ICRS grade 3 in 4/12 (33%) patients. At last follow-up, the mean Lysholm score was significantly improved vs. baseline (79 +/- 15 vs. 55 +/- 13, P = 0.005).Conclusion: The frequency of complete ACTIfitTM resorption 8 years after implantation was high. This finding argues against ability of this substitute to induce the regeneration of durable meniscal tissue with a chondroprotective effect. The clinical outcome score was significantly improved at last follow-up. However, no conclusions can be drawn regarding the effectiveness of ACTIfitTM given the high frequency of concomitant surgical procedures. Level of evidence: IV, retrospective observational cohort (c) 2023 Elsevier Masson SAS. All rights reserved.
El mal de los transportes, o cinetosis, es un problema antiguo pero que sigue estando de actualidad en un mundo en el que la movilidad aún es ineludible. Los simuladores (como las imágenes inmersivas en 3D) y los viajes espaciales han aumentado aún más el número de situaciones favorables para el desarrollo del cuadro. La cinetosis se produce por un conflicto sensorial originado por una discordancia entre el movimiento y los esquemas esperados. Se trata de una afección difícil de estudiar porque la presentación clínica es profusa y diversa según las personas, el modo de transporte y las condiciones observadas. Existen muchas soluciones terapéuticas, farmacológicas o no, que presentan en cada caso ventajas o inconvenientes que requieren adaptarse a cada situación.
