The purpose of this paper is to describe the impact of exposure to influenza on hospitalizations and deaths in the elderly residents of long-term care facilities (LTCFs). An observational, longitudinal, prospective, multicenter, cohort study collected influenza and influenza-like cases, diseases, hospitalizations, and deaths of dependant elderly residents of French LTCFs during the 2004–2005 seasonal influenza epidemic. A total of 8,041 residents of 98 participating LTCFs were included. The mean age was 85 ± 9 years; 93% were vaccinated against influenza and 64% of the residents were exposed to influenza during the epidemic. Exposure to influenza increased both the all-cause risk of hospitalization (9.2% of the residents exposed vs. 7.4% of the residents not exposed) (relative risk, RR [95% confidence interval, CI] = 1.24 [1.05; 1.47]) and the all-cause risk of death (5.8% vs. 4.3%) (RR [95% CI] = 1.36 [1.10; 1.70]). Exposure to influenza increased the risks of death and hospitalization. Additional measures should be taken to avoid influenza exposure and apply recommendations more thoroughly in the particularly susceptible population of elderly LTCF residents.

OBJECTIVE:Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. METHODS:During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. RESULTS:Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07-17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% (p<0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral (p<0.0001). CONCLUSION:This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting.

Several studies in children showed at the paediatric emergency hospital the interest of influenza rapid diagnostic tests (IRDT) in this disease for which the clinical diagnosis is difficult in children. The purpose of this prospective study carried out in ambulatory paediatric setting was to evaluate impact of the IRDT in the assumption of responsibility of children suspected of Influenza infection. Thirty paediatricians (14 without IRDT, 16 with IRDT) included 602 children between 2004 and 2005. The influenza was confirmed by IRDT in 54% of the cases. Among the 13 symptoms or signs recorded, only 4 - chills (61.6 vs 48.4%), cough (89.8 vs 71.1%), rhinorrhea (97.9 vs 86.2%), and anorexia (50.3 vs 34.8%) - were significantly more frequent (P <= 0.01) for patients avec with positive IRDT However, the difference is not sufficient to be contributive. The paediatricians using IRDT prescribed with positive test more oseltamivir (68.5 vs 1.9%, P < 0.0001). The antibiotic prescription was overall low (9.5% with IRDT vs 3.9% without IRDT P = 0,008), and primarily when the result of IRDT was negative (15.7% if IRDT- vs 4.3% if IRDT+, P = 0.0003). This study confirms the difficulty of clinical diagnosis, and shows the interest of IRDT for the diagnosis of influenza and consequently to improve the management of influenza in children in ambulatory paediatric setting. (C) 2007 Elsevier Masson SAS. Tous droits reserves.

Pregnant woman have an increased risk of respiratory complications and hospitalization related to influenza. The flu, like any systemic infection, may also be responsible for uterine contractions constituting a threat of miscarriage or premature labor according to gestational age at which it occurs.There is no specific recommendation regarding the management of influenza-like illness in pregnant women, but a nasopharyngeal sample can be performed in the presence of respiratory or general symptoms occurring during an epidemic to search influenza and establish if a specific treatment with oseltamivir (Tamiflu®). Surveillance in hospital or intensive care unit may be necessary.Vaccination against influenza provides a satisfactory immunity in pregnant women and reduces the risk of respiratory complications. Transplacental passage of maternal antibody protects newborns who are more likely to have severe influenza infection and because the vaccine cannot be administered before the age of 6 months. The available data show good tolerance influenza vaccination performed during pregnancy.Since 2012, vaccination against seasonal influenza is recommended for pregnant women, whatever the stage of pregnancy at the time of the vaccination campaign.La femme enceinte a un risque accru de complications respiratoires et d'hospitalisation liées à la grippe. La grippe, comme toute infection systémique, peut également être responsable de contractions utérines constituant une menace de fausse couche ou d'accouchement prématuré selon l'âge gestationnel auquel elle survientIl n'existe pas de recommandation spécifique concernant la prise en charge d'un syndrome grippal chez la femme enceinte ; toutefois, un prélèvement nasopharyngé peut être réalisé en présence de signes généraux ou respiratoires survenant en période épidémique afin de rechercher le virus grippal et le cas échéant instituer un traitement spécifique par oseltamivir (Tamiflu®). La surveillance en milieu hospitalier et, en cas de signes de gravité, la prise en charge en unité de soins intensifs peuvent être nécessaires.La vaccination contre la grippe confère une immunité satisfaisante chez la femme enceinte et réduit le risque de complications respiratoires. Le passage transplacentaire des anticorps maternels assure une protection aux nouveau-nés et nourrissons chez qui la grippe est plus grave et la vaccination ne peut être administrée avant l'âge de six mois. Les données disponibles montrent une bonne tolérance de la vaccination grippale réalisée en cours de grossesse.Depuis 2012, la vaccination contre la grippe saisonnière est recommandée chez la femme enceinte quel que soit le terme de la grossesse au moment de la campagne vaccinale.

Several studies in children showed at the paediatric emergency hospital the interest of influenza rapid diagnostic tests (IRDT) in this disease for which the clinical diagnosis is difficult in children. The purpose of this prospective study carried out in ambulatory paediatric setting was to evaluate impact of the IRDT in the assumption of responsibility of children suspected of Influenza infection. Thirty paediatricians (14 without IRDT, 16 with IRDT) included 602 children between 2004 and 2005. The influenza was confirmed by IRDT in 54% of the cases. Among the 13 symptoms or signs recorded, only 4 - chills (61.6 vs 48.4%), cough (89.8 vs 71.1%), rhinorrhea (97.9 vs 86.2%), and anorexia (50.3 vs 34.8%) - were significantly more frequent (P </= 0.01) for patients avec with positive IRDT. However, the difference is not sufficient to be contributive. The paediatricians using IRDT prescribed with positive test more oseltamivir (68.5 vs 1.9%, P < 0.0001). The antibiotic prescription was overall low (9.5% with IRDT vs 3.9% without IRDT, P = 0,008), and primarily when the result of IRDT was negative (15.7% if IRDT(-) vs 4.3% if IRDT(+), P = 0.0003). This study confirms the difficulty of clinical diagnosis, and shows the interest of IRDT for the diagnosis of influenza and consequently to improve the management of influenza in children in ambulatory paediatric setting.

OBJECTIVE:To describe in real-life conditions the flu therapeutic management, motivations to prescribe or not NAI (General Practitioners' (GPs) characteristics, decisional factors) and treated patients' course.DESIGN:A prospective, longitudinal, pharmacoepidemiological study involved 305 GPs in France during 2002-2003 winter epidemic peak. All patients>or=1 year old, with a clinical diagnostic of flu were included.RESULTS:One hundred and eighty-five GPs (150 NAI prescribing and 30 non-prescribing physicians) have included at least 1 patient. Prescribing physicians were the best informed on flu and NAI. 660 patients were analysed (250 NAI+ and 410 NAI-). 66% of NAI+ and 40% of NAI- attended to a consultation within 24 h (P<0.001). 31% of NAI+ and 20% of NAI- had a visit at home (P=0.002). Among the patients without complication at inclusion (N=585), 3% of NAI+ received an antibiotherapy vs 13% of NAI- (P<0.001). 43% of the patients had a sick leave, shorter for the NAI+ than NAI- (respectively, 3.7+/-1.7 vs 4.2+/-1.7 days, p=0.017). NAI was taken within 3 hours (median) after prescription by the 78% of the patients who returned their diary cards. The NAI+ patients had a faster improvement of symptoms than NAI- (within 24 h, respectively: 18 vs 5%, P<0.001) and they returned faster to routine activities (within 48 h, respectively: 27 vs 11%, P<0.001).CONCLUSIONS:This study evidenced the good use of NAI by the physicians. It confirms their therapeutic efficacy in real-life conditions and suggests their prescription allows decreasing antibiotic co-prescriptions and sick leaves duration, profits to consider in NAI benefit/risk ratio.

Objective. - To describe in real-life conditions the flu therapeutic management, motivations to prescribe or not NAI (General Practitioners' (GPs) characteristics, decisional factors) and treated patients' course.Design. - A prospective, longitudinal, pharmacoepidentiological study involved 305 GPs in France during 2002-2003 winter epidemic peak. All patients >= 1 year old, with a clinical diagnostic of flu were included.Results. - One hundred and eighty-five GPs (150 NAI prescribing and 30 non-prescribing physicians) have included at least I patient. Prescribing physicians were the best informed on flu and NAI. 660 patients were analysed (250 NAI+ and 410 NAI-). 66% of NAI+ and 40% of NAI- attended to a consultation within 24 It (P < 0.001). 31% of NAI+ and 20% of NAI- had a visit at home (P = 0.002). Among the patients without complication at inclusion (N = 585), 3% of NAI+ received an antibiotherapy vs 13% of NAI- (P < 0.001). 43% of the patients had a sick leave, shorter for the NAI+ than NAI- (respectively, 3.7 +/- 1.7 vs 4.2 +/- 1.7 days, p = 0.017). NAI was taken within 3 hours (median) after prescription by the 78% of the patients who returned their diary cards. The NAI+ patients had a faster improvement of symptoms than NAI- (within 24 h, respectively: 18 vs 5%, P < 0.001) and they returned faster to routine activities (within 48 h, respectively: 27 vs 11%, P < 0.001).Conclusions. - This study evidenced the good use of NAI by the physicians. It confirms their therapeutic efficacy in real-life conditions and suggests their prescription allows decreasing antibiotic co-prescriptions and sick leaves duration, profits to consider in NAI benefit/risk ratio. (c) 2005 Elsevier SAS. Tons droits reserves.

Background. - In emergency department (ED) the prevalence of infectious diseases is high but anti-microbial drugs are misused.Objective. - The authors had for aim to identify antibiotic use, defined either as a first prescription (FP), interruption (IP), replacement (RP),. or continuation (CP) of a previous antibiotic.Methods. - Patients, 18 years of age or more, were included if 1) FP, or IP, or RP, or CP was decided 2) they agree to a telephone follow-up at day 3. They were sorted in 5 categories according to a pre-test evaluation of disease acuteness (PDA) published in 1994, in order to compare them to the standard French EW patient.Results. - From December 11 to December 24, 2000, 33 of the 34 EWs reported 38,859 patients; 21,909 were non-trauma patients and 2,326 (11.2%) who were presumed to be infected were given an antibiotic in 77.3% of the cases. Extrapolated to all 34 EWs, infectious diseases prevalence would be 12.86% of non-trauma patients. The 34 EWs included 1,981 patients, aged 52 24 years. FP was prescribed in 77.3%, RP in 14.5%, CP in 5% and IP in 3.2%. The main infections were respiratory (37.4%), urinary (20.4%), skin (18.6%), and ENT (12%). The major antibiotics used were penicillins (57.2%), fluoroquinolones (20.8%), and 3GC (10.4%). The patients' PDA differed significantly from that of the standard French EW patient (p<10(-4)). One thousand and eighty-nine (55%) were hospitalized. One thousand and eight-hundred-twenty were followed-up, with 1.4% reported dead, 3.9% who did not comply, and 23.2% whose antibiotic therapy was modified by a physician. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.

In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard?Systematic review with meta-analysis of prospective cohort studies.Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis.The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard.Measures of diagnostic accuracy.Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion.This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse.PROSPERO CRD42018095555.

Objectif – Cette étude multicentrique, randomisée et en double aveugle avait pour objectif de comparer l'efficacité de la ceftriaxone à 1 g/jour pendant dix jours versus 1 g/jour pendant cinq jours dans le traitement des pneumonies aiguës communautaires.

AIMS:Midazolam is given intravenously for induction of anaesthesia and conscious sedation and by subcutaneous infusion in patients in palliative care units. The objective of the present study was to determine the absolute bioavailability of subcutaneous midazolam and its pharmacokinetics in young, healthy, male volunteers.METHODS:Eighteen volunteers were given single doses of 0.1 mg kg-1 midazolam i.v. and s.c. after a wash-out period of 7-15 days in an open-label, randomized, cross-over study. Blood samples were collected up to 12 h post-infusion. Plasma concentrations of midazolam and of its two metabolites, 1'-OHM and 4-OHM, were assessed using an h.p.l.c.-MS method (LOQ 0.5 ng ml-1 for each analyte). Vital signs, cardiac parameters and oximetry were monitored. Local tolerance was determined and adverse events were also monitored.RESULTS:After s.c. infusion t(max) and C(max) were 0.51 +/- 0.18 h and 127.8 +/- 29.3 ng ml-1 (mean +/- s.d.), respectively. No statistically significant difference was detected in AUC(0, infinity ) after i.v. and s.c. administration. The mean (+/- s.d.) absolute bioavailability of subcutaneous midazolam was 0.96 (+/- 0.14) (CI 0.84, 1.03). Mean (+/- s.d.) t1/2 was similar after s.c. (3.2 (+/- 1.0) h) and i.v. infusion (2.9 (+/- 0.7) h), although a statistically significant difference was reached (P < 0.05). Mean CL and V of i.v. midazolam were 4.4 +/- 1.0 ml min-1 kg-1 and 1.1 +/- 0.2 l kg-1 (mean +/- s.d.), respectively. Plasma concentrations of 1'-OHM were higher than those of 4-OHM. Few mild and transient adverse events were noted and there were no clinically significant effects on EEG, blood pressure and laboratory parameters.CONCLUSIONS:This study has shown that subcutaneous midazolam has excellent bioavailability and that administration of midazolam by this route could be preferable when the intravenous route is inappropriate.

Objective - Seven hospital lab departments were enrolled in this study in order to update and analyse data on E. coli susceptibility to antibiotics in 1998 and 1999.Material and methods - 1,114 strains were randomly selected for analysis, a large number of which had been obtained from female (65,7%) and elderly patients, and essentially from urinary samples (56%) and blood cultures (23%).Results - It was observed that resistance rates (R+I) were elevated for amoxicillin (44%), ticarcillin (42%), co-amoxiclav (31%) and cephalothin (36%), moderate for nalidixic acid (8%), ciprofloxacin (5%) and gentamicin (2%), and very low for ceftazidime (1%) and ceftriaxone (0.8%); 2 strains only (0.2%) were ESBL producers. Finally, it was noteworthy that pediatry units were providers of strains significantly more resistant to amoxicillin, co-amoxiclav, ticarcillin and cephalothin than strains from other units; no other risk-factor of resistance was detected. While the previous 1 114 randomised strains presented MIC50 and 90 of 0.125 and 0.25 g mu /mL for ceftazidime and 0,03 and 0,06 mug/mL for ceftriaxone, a complementary analysis carried out on a pool of 76 ESBL producers and 137 strains resistant (R+I) to ceftazidime and/or to cefotaxime/cefriaxone (but ESBL-) revealed that these value were increased of 7 to 9 dilutions for the 76 ESBL+ strains and of 5 to 6 for the 137 ESBL- strains in comparison with susceptible strains. Moreover these strains were observed to present elevated rates of co-resistance (R+I) to nalidixic acid, ciprofloxacin and gentamicin: 52%, 37% and 41% respectively for ESBL+ strains and 43%, 21% and 16% respectively for ESBL- strains. (C) 2000 Editions scientifiques ef medicales Elsevier SAS.