Alain Astier
University of Paris
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Featured researches published by Alain Astier.
Clinical Infectious Diseases | 1997
Hélène Aubry-Damon; Patrick Legrand; Christian Brun-Buisson; Alain Astier; Claude-James Soussy; R Leclercq
The spread of methicillin-resistant Staphylococcus aureus (MRSA) in our hospital in the 1980s correlated with increasing acquisition of resistance to antibiotics including gentamicin, rifampin, and fluoroquinolones. During the period 1993-1995, there was a major change in clinical MRSA isolates: the percentage of aminoglycoside-resistant MRSA isolates decreased from 75% to 52%, while the proportion of heterogeneous MRSA strains susceptible to gentamicin, rifampin, and tetracycline increased gradually from 4.9% to 27.5%. We used five epidemiological markers (i.e., antibiotyping, phage typing, pulsed-field gel electrophoresis, and restriction analysis of PCR amplified coagulase and protein A genes) to characterize recent isolates. With use of these techniques, we confirmed the persistence of the aminoglycoside-resistant MRSA clone and identified a clone of erythromycin-susceptible strains among the gentamicin-susceptible isolates and found that the remaining strains were diverse. These changes were due to the introduction of various MRSA strains from outside the hospital, while implementation of infection control measures in 1991 could have led to reduced transmission of the aminoglycoside-resistant MRSA strain. Changes in antibiotic prescribing patterns that resulted in reduced selective pressure from gentamicin may have contributed to the spread of gentamicin-susceptible MRSA strains.
BMJ | 1996
Frédéric J. Baud; Stephen W. Borron; Eric Bavoux; Alain Astier; Jerome R. Hoffman
Cyanide poisoning produces rapid blockade of cellular respiration due to binding to cytochromeaa3, resulting in accumulation of lactate. Lactic acidosis is a recognised hallmark of acute cyanide poisoning in humans.1 2 The time course of lactic acidosis, however, has not been well described in relation to evolving blood cyanide concentrations. We studied the relation of blood cyanide to plasma lactate concentrations in a patient with pure acute cyanide poisoning. A 63 year old man called for help immediately after suicidal ingestion of a single potassium cyanide capsule. He was conscious on arrival of ambulance staff, but apnoea rapidly supervened, followed by cardiac arrest. Cardiopulmonary resuscitation, endotracheal intubation with 100% pure …
Infection Control and Hospital Epidemiology | 1997
Isabelle Durand-Zaleski; Laurent Delaunay; Olivier Langeron; Eric Belda; Alain Astier; Christian Brun-Buisson
OBJECTIVE To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections. DESIGN The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohns disease and intensive-care unit (ICU) patients. The extra cost of using bags was
Clinical Toxicology | 2001
Rafik Bekka; Stephen W. Borron; Alain Astier; Pierre Sandouk; Chantal Bismuth; Frédéric J. Baud
20 per day. The total cost of nosocomial bacteremia was estimated at
Human & Experimental Toxicology | 1996
Alain Astier; Frédéric J. Baud
6,000. The monetary benefits of using TPN bags were
Journal of Chromatography B: Biomedical Sciences and Applications | 1995
Alain Astier; Frédéric J. Baud
6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio. RESULTS Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohns disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from
Annales pharmaceutiques françaises | 2010
C. Bazin; V. Vieillard; Alain Astier; Muriel Paul
90,000 to
Annales pharmaceutiques françaises | 2010
C. Bazin; V. Vieillard; Alain Astier; Muriel Paul
7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from
Drug Development Research | 1999
E. Cauchetier; Hatem Fessi; Y. Boulard; Michèle Deniau; Alain Astier; Muriel Paul
180,000 to
Human & Experimental Toxicology | 1995
P. Chariot; R. Ratiney; F. Le Maguet; V. Fourestié; Alain Astier; R. Gherardi
14,000 if the infection rate was reduced by one third. CONCLUSION The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.