Background Septic shock is a major cause of intensive care unit (ICU) admission among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, yet data on its epidemiology and prognosis remain limited. Research Question We aimed to describe outcomes, identify independent prognostic factors, and explore associations that may inform early management. Study Design and Methods We performed a multicenter retrospective cohort study including allo-HSCT recipients admitted to the ICU with septic shock between 2015 and 2020. Results Among 1,164 allo-HSCT recipients hospitalized in ICU, 38% (n=444) were admitted for septic shock. The median SOFA score was 8 (IQR, 6-11). Microbiological documentation was obtained in 62% (n=261), including fungal pathogens in 17% (n=74). The respiratory tract was the most common infection source (43%, n=180). Invasive mechanical ventilation and renal replacement therapy were required in 64% (n=284) and 32% (n=143), respectively. Mortality at 90 days and 3 years was 63% (n=280) and 81% (n=350).In the extended Cox model, fungal documentation (HR 1.78 [95% CI, 1.19-2.67], p=0.005), SOFA score (HR 1.07 [95% CI, 1.02-1.13], p=0.007), and neutropenia (HR 3.94 [95% CI, 1.18-13.1], p=0.026) were independently associated with 90-day survival. In a 48-hour landmark analysis, early aminoglycoside use was associated with higher 90-day survival (HR 0.46 [95% CI, 0.33-0.64], p<0.001). However, time-varying analyses indicated a non-constant association over time. Age ≥ 56 years (HR 1.36, [95% CI, 0.99-1.87]), GvHD type, and early bacterial documentation (HR 0.90, [95% CI, 0.64-1.26]) were not associated with 90-day survival. Interpretation Septic shock after allo-HSCT carries a high mortality (63% at 90 days), largely driven by host-related factors and initial illness severity. The association between aminoglycoside use and outcome is complex, does not support a straightforward causal interpretation, and warrants further prospective evaluation.
OBJECTIVE:Chronic wounds, such as venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs), remain a major healthcare challenge, particularly in France, where their management is complex and resource-intensive. Technology lipido-colloid nano-oligosaccharide factor (TLC-NOSF) dressings have demonstrated the ability to modulate the wound microenvironment, inhibit excessive matrix metalloproteinase activity and accelerate healing. Despite strong evidence and national recommendations, their use in routine practice remains limited. The STARTLIFE study aimed to generate additional real-life evidence on the effectiveness of TLC-NOSF dressings in VLUs and DFUs across diverse care settings. METHOD:STARTLIFE was a prospective, multicentre, non-interventional French observational study. TLC-NOSF dressings (UrgoStart Plus Border/Pad, UrgoStart Contact, Laboratoires Urgo, France) were used according to clinical practice. The primary endpoint was complete healing within 12 weeks; secondary outcomes included wound healing progression and dressing performance. RESULTS:From June 2022-July 2024, 229 VLUs and 138 DFUs were included at 53 French sites. Among patients with VLUs, 44.5% achieved complete healing after 72 days, with a median healing time of 60 days. In patients with DFUs, 36.8% achieved complete closure after 78 days, with a median healing time of 64 days. Earlier initiation of TLC-NOSF treatment was associated with better outcomes in both groups. Both patient and clinician satisfaction with comfort and efficacy were high. CONCLUSION:The findings of the STARTLIFE study provide real-life evidence demonstrating the effectiveness, safety and high acceptability of TLC-NOSF dressings in the management of VLUs and DFUs when associated with appropriate standard of care. The diverse range of TLC-NOSF dressings supports personalised wound care and reinforces its use as a first-line intervention throughout the healing process.
Introduction La dialyse péritonéale (DP) représente 11 % des techniques de suppléance des patients atteints de maladie rénale chronique terminale. La péritonite de dialyse péritonéale (PDP) est la première cause d’arrêt de la DP et une de ses complications les plus sévères. Le but de cette étude est de caractériser les prescriptions d’antibiothérapie (PAB), et les comparer aux référentiels émis par l’International Society for Peritoneal Dialysis (ISPD). Matériels et méthode Pour cette étude rétrospective, les données ont été extraites à partir de l’application de gestion de dossier patient informatisé DxCare par le logiciel Business Object. La sélection a été faite sur les patients hospitalisés en néphrologie bénéficiant d’une antibiothérapie par voie intrapéritonéale (VIP) ou voie intraveineuse (VIV) avec mention « par VIP ». Résultats et discussion De 2019 à 2024, l’étude a inclus 26patients avec un diagnostic de PDP, d’âge moyen 66±17ans (61,5 % hommes) et de poids moyen 72,8±13,4kg. 73,1 % des patients avaient une clinique évocatrice et 76,9 % un liquide de DP trouble. La cellularité intrapéritonéale (CIP) moyenne d’entrée était de 3416±3131 cellules/mm 3, dont 75,5 %±21,1 de polynucléaires neutrophiles.Au total, 18patients (69,2 %) avaient une identification microbiologique, dont 61,1 % étaient monobactériennes. Sur 33 micro-organismes (MO) identifiés, 42,4 % étaient des bactéries à Gram positif, dont 18,2 % de staphylocoques à coagulase négative, 54,5 % des bactéries à Gram négatif et 3,1 % des mycobactéries.Les traitements probabilistes étaient 88,5 % des bithérapies, dont 82,6 % par ceftazidime et vancomycine, 3,8 % des monothérapies, et 7,7 % des trithérapies ; 100 % des patients étaient traités par VIP, dont 84,6 % par VIP seule ; 80,9 % traités à une posologie de référence.Les traitements documentés bénéficiaient à 73,1 % d’une adaptation d’antibiothérapie, dont 36,8 % ont nécessité un changement de voie. 46,2 % étaient des monothérapies, 46,2 % des bithérapies et 7,7 % des trithérapies. 92,3 % des patients étaient traités par VIP, dont 70,8 % par VIP seule, 3,8 % par VIV seule, et 3,8 % par voie per os seule.La durée moyenne de séjour était de 11±7,7J et la durée moyenne d’antibiothérapie de 17,7±4,7J. La PDP s’est résolue pour 69,2 % des patients ; 15,2 % ont eu une récidive dont 7,7 % au même MO, 7,7 % un retrait de cathéter et 3,8 % sont décédés. Conclusion L’ISPD propose la prise en charge probabiliste d’une PDP par une bi-antibiothérapie à large spectre et une durée d’antibiothérapie recommandée de 14 à 21jours, ce qui correspond à nos résultats. Au total, 81 % des PAB n’ont pas été prescrites selon leur protocole d’administration par VIP il serait intéressant de rappeler aux prescripteurs l’existence de ces protocoles et leur disponibilité dans DxCare. Le céfépime a été prescrit en traitement après documentation pour 4 patients, mais aucune ligne de prescription par VIP n’a été relevée et la création d’un protocole VIP céfépime sera prochainement proposée à l’équipe médicale.
Life-saving for people with type 1 or insulin-deprived diabetes for other causes, needed for people with type 2 diabetes or diabetes of other origin for which glucose control is not achievable without it, insulin therapy has shown a dramatic evolution during the last 30 years. The multiple-daily insulin injection regimens almost only use fast-acting and long-acting insulin analogues, according to a standard-of-care basal-bolus scheme. The initiation of insulin therapy in type 2 diabetes electively promotes the use of a long-acting insulin analogue. Using premix combinations of a fast-acting analogue and NPH insulin becomes obsolete. The treatment by insulin pumps which uses only fast-acting analogues has shown a major development in type 1 diabetes, amplified during the recent 5 years by the availability of automated insulin delivery systems.
Identifying risk factors for transitioning from suicidal ideation to suicide attempts is crucial for improving suicide prevention strategies. Many existing risk factors fail to differentiate between those who attempt suicide and those who only experience suicidal thoughts. This study aimed to prospectively examine risk factors for suicide attempt over a one-year follow-up period in patients with mood disorders and current suicidal ideation, stratified by their history of lifetime suicide attempt. A cohort of 679 hospital-based patients with mood disorders and current suicidal ideation was assessed. Sociodemographic and clinical data, including depression severity, psychological pain, and suicidal ideation, were collected. Multivariate analyses and Cox proportional hazard models identified risk factors for suicide attempts. Among patients with a history of suicide attempt (n = 440), 20.2 % attempted suicide during follow-up. Significant risk factors included comorbid anxiety disorders (OR = 2.11; 95 % CI = [1.24, 3.70]) and higher levels of maximum suicidal ideation (OR = 1.19; 95 % CI = [1.04, 1.40]). Among those without a prior attempt (n = 239), 9.6 % attempted suicide, with younger age (OR = 0.93; 95 % CI = [0.87, 0.97]) and an interaction between psychological pain and suicidal ideation (OR = 2.08; 95 % CI = [1.31, 3.58]) as key predictors. High suicidal ideation levels were a common risk factor, regardless of attempt history. Suicidal ideation and associated risk factors, particularly anxiety and psychological pain, should be addressed through evidence-based and person-centered pharmacological, psychotherapeutic, and psychosocial strategies to help prevent suicidal behavior.
