Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: A descriptive analysis of the Eurobact II study

Background: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. Methods: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients’ characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. Results: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49–2.45). Conclusions: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245. Registered 3 May 2019

Closed-loop multibody kinematic optimization coupled with double calibration improves scapular kinematic estimates in asymptomatic population

Non-invasive methods still need to better estimate scapular kinematics because of soft tissue artifact issue. This study aimed to develop and assess new procedures to estimate scapular kinematics by combining closed kinematic chain optimization and double calibration. Sixteen healthy volunteers performed static postures mimicking analytical and daily living movements. Scapulo-thoracic angles were computed either with a scapula locator (Ref), or with a closed-loop multibody kinematic optimization (Ell) or with double calibration involving linear (DClin), exponential (DCexp) or logarithmic (DClog) correction. Double calibration corrections enforced scapulo-thoracic angles to be the same than those measured with Ref at the end of the movement performed. DClin and DClog significantly (p < 0.01) reduced scapulo-thoracic misorientation for at least the second third of the movement with averaged improvement ranging from 9° to 32°. Moreover, for arm elevation in the sagittal plane, internal rotations and mimicking hair combing, the beneficial effect of DClin and DClog propagates up to half of the movement. To conclude, when a kinematic chain is required, coupling double calibration (using either linear or logarithmic correction), to a closed-loop multibody kinematic optimization is an efficient and fast method in regard with improvement in scapular kinematic estimates in healthy population

Does double calibration coupled with a closed loop multibody kinematic optimization improve scapular kinematic estimates?

45th Congress of the Société de Biomécanique, Metz, France, 26-/10/2020 - 28/10/2020The purpose of this study was to develop and assess a new procedure to estimate scapular kinematics when combining closed kinematic chain algorithm and double calibration

compatibilité en sodium de revêtements durs à base d’aluminures

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0147: Cardiac involvement in hemoglobin SC disease compared to homozygous sickle-cell anemia

BackgroundHemoglobin SC (HbSC) disease and homozygous sickle-cell anemia (SCA) are the most frequent genotypes (accounting for respectively 25% and 70%) of sickle-cell disease. Although the SCA cardiac involvement was well studied, the cardiac remodeling associated to HbSC has never been specifically investigated. The aim of the study was to describe the HbSC cardiac remodeling versus SCA.MethodUsing a case-control design, 61 HbSC (mean age 31.3±10.0 years, 36 women) patients underwent a comprehensive echocardiography and were compared to 61 SCA patients in stable conditions. LV end diastolic volume index and LV ejection fraction were measured by Simpson method. LV mass index, left atrial volume index, septal E/e’ ratio, peak tricuspid regurgitation velocity (TRV) and cardiac index were also measured as recommended. All the parameters were the average of three measures.ResultsBoth LV morphological and diastolic functional parameters differed dramatically between the two groups of patients (table, mean±SD). Moreover, the pulmonary artery systolic pressure as estimated by TRV was lower in HbSC patients.ConclusionsCardiac remodeling is very different in HbSC compared to SCA. Clinical interpretation of echocardiography data should be adjusted to each variant of the disease. Moreover, this study is further evidence that the both genotypes of sickle-cell disease have different organ involvements and should not be pooled in clinical studies. Specific guidelines for follow up of HbSC patients should be established.Abstratct 0147 – TableSCA patients (n=61)HbSC patients (n=61)p valueHeart rate (beats/min)70±1172±100.26LV mass index (g/m²)103±2677±16<0.0001LV end diastolic volume index (ml/m²)92±1964±15<0.0001Cardiac index (L/min/m²)4.2±1.03.1±0.6<0.0001LV ejection fraction (%)60±561±60.88Septal E/e’ ratio10.9±2.47.2±2.1<0.0001Left atrial volume index (ml/m²)51.1±11.933.8±7.5<0.0001Tricuspid regurgitation velocity (m/s)2.57±0.262.26±0.23<0.0001Tricuspid regurgitation velocity>2.5m/s, n(%)34 (56)4 (7)<0.000

Pretest probability of a normal echocardiography: Validation of a simple and practical algorithm for routine use

SummaryBackgroundManagement of increased referrals for transthoracic echocardiography (TTE) examinations is a challenge. Patients with normal TTE examinations take less time to explore than those with heart abnormalities. A reliable method for assessing pretest probability of a normal TTE may optimize management of requests.AimTo establish and validate, based on requests for examinations, a simple algorithm for defining pretest probability of a normal TTE.MethodsIn a retrospective phase, factors associated with normality were investigated and an algorithm was designed. In a prospective phase, patients were classified in accordance with the algorithm as being at high or low probability of having a normal TTE.ResultsIn the retrospective phase, 42% of 618 examinations were normal. In multivariable analysis, age and absence of cardiac history were associated to normality. Low pretest probability of normal TTE was defined by known cardiac history or, in case of doubt about cardiac history, by age>70 years. In the prospective phase, the prevalences of normality were 72% and 25% in high (n=167) and low (n=241) pretest probability of normality groups, respectively. The mean duration of normal examinations was significantly shorter than abnormal examinations (13.8±9.2min vs 17.6±11.1min; P=0.0003).ConclusionA simple algorithm can classify patients referred for TTE as being at high or low pretest probability of having a normal examination. This algorithm might help to optimize management of requests in routine practice

Low-dose corticosteroid therapy for cardiogenic shock in adults (COCCA): study protocol for a randomized controlled trial

Abstract Background Cardiogenic shock (CS) is a life-threatening condition characterized by circulatory insufficiency caused by an acute dysfunction of the heart pump. The pathophysiological approach to CS has recently been enriched by the tissue consequences of low flow, including inflammation, endothelial dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis. The aim of the present trial is to evaluate the impact of early low-dose corticosteroid therapy on shock reversal in adults with CS. Method/design This is a multicentered randomized, double-blind, placebo-controlled trial with two parallel arms in adult patients with CS recruited from medical, cardiac, and polyvalent intensive care units (ICU) in France. Patients will be randomly allocated into the treatment or control group (1:1 ratio), and we will recruit 380 patients (190 per group). For the treatment group, hydrocortisone (50 mg intravenous bolus every 6 h) and fludrocortisone (50 μg once a day enterally) will be administered for 7 days or until discharge from the ICU. The primary endpoint is catecholamine-free days at day 7. Secondary endpoints include morbidity and all-cause mortality at 28 and 90 days post-randomization. Pre-defined subgroups analyses are planned, including: postcardiotomy, myocardial infarction, etomidate use, vasopressor use, and adrenal profiles according the short corticotropin stimulation test. Each patient will be followed for 90 days. All analyses will be conducted on an intention-to-treat basis. Discussion This trial will provide valuable evidence about the effectiveness of low dose of corticosteroid therapy for CS. If effective, this therapy might improve outcome and become a therapeutic adjunct for patients with CS. Trial registration ClinicalTrials.gov, NCT03773822. Registered on 12 December 2018 </jats:sec

Low-dose corticosteroid therapy for cardiogenic shock in adults (COCCA): study protocol for a randomized controlled trial

International audienceBackground Cardiogenic shock (CS) is a life-threatening condition characterized by circulatory insufficiency caused by an acute dysfunction of the heart pump. The pathophysiological approach to CS has recently been enriched by the tissue consequences of low flow, including inflammation, endothelial dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis. The aim of the present trial is to evaluate the impact of early low-dose corticosteroid therapy on shock reversal in adults with CS.Method/design This is a multicentered randomized, double-blind, placebo-controlled trial with two parallel arms in adult patients with CS recruited from medical, cardiac, and polyvalent intensive care units (ICU) in France. Patients will be randomly allocated into the treatment or control group (1:1 ratio), and we will recruit 380 patients (190 per group). For the treatment group, hydrocortisone (50 mg intravenous bolus every 6 h) and fludrocortisone (50 μg once a day enterally) will be administered for 7 days or until discharge from the ICU. The primary endpoint is catecholamine-free days at day 7. Secondary endpoints include morbidity and all-cause mortality at 28 and 90 days post-randomization. Pre-defined subgroups analyses are planned, including: postcardiotomy, myocardial infarction, etomidate use, vasopressor use, and adrenal profiles according the short corticotropin stimulation test. Each patient will be followed for 90 days. All analyses will be conducted on an intention-to-treat basis.Discussion This trial will provide valuable evidence about the effectiveness of low dose of corticosteroid therapy for CS. If effective, this therapy might improve outcome and become a therapeutic adjunct for patients with CS.Trial registration ClinicalTrials.gov , NCT03773822 . Registered on 12 December 201

Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study

International audienceAbstract Background The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Methods Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. Results A total of 1,748 patients were included. Median age was 62.9 [47.4–74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1–6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1–2] deprivations and all had housing deprivation, phenotype D patients had 2 [1–2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2–4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65–1.12); phenotype C (HR, 0.56; 95% CI 0.34–0.93); phenotype D (HR, 1.09; 95% CI 0.78–1.51); phenotype E (HR, 1.20; 95% CI 0.73–1.96). Conclusions In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions