Isabelle Fournel

Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery: Results From the IMACORS Study.

Background:Intra-abdominal infections are frequent and life-threatening complications after colorectal surgery. An early detection could diminish their clinical impact and permit safe early discharge. Objective:This study aimed to find the most accurate marker for the detection of postoperative intra-abdominal infection and the appropriate moment to measure it. Methods:A prospective, observational study was conducted in 3 centers. Consecutive patients undergoing elective colorectal surgery with anastomosis were included. C-reactive protein and procalcitonin were measured daily until the fourth postoperative day. Postoperative infections were recorded according to the definitions of the Centres for Diseases Control. The areas under the receiver operating characteristic curve were analyzed and compared to assess the diagnostic accuracy of each marker. Results: :Five-hundred and one patients were analyzed. The incidence of intra-abdominal infection was 11.8%, with 24.6% of patients presenting at least one infectious complication. Overall mortality was 1.2%. At the fourth postoperative day, C-reactive protein was more discriminating than procalcitonin for the detection of intra-abdominal infection (areas under the ROC curve: 0.775 vs 0.689, respectively, P = 0.03). Procalcitonin levels showed wide dispersion. For the detection of all infectious complications, C-reactive protein was also significantly more accurate than procalcitonin on the fourth postoperative day (areas under the ROC curve: 0.783 vs 0.671, P = 0.0002). Conclusions:C-reactive protein is more accurate than procalcitonin for the detection of infectious complications and should be systematically measured at the fourth postoperative day. It is a useful tool to ensure a safe early discharge after elective colorectal surgery.

Airborne Aspergillus contamination during hospital construction works: Efficacy of protective measures

BACKGROUND The Dijon University Hospital in Dijon, France is involved in a large construction program with heavy truck traffic and a very dusty environment. This study aimed to assess the impact of outdoor hospital construction work on Aspergillus air contamination in the immediate environment of patients at high risk for aspergillosis in the presence of protective measures. METHODS Prospective air and surface sampling (n=1301) was performed in 3 hospital units over a 30-month period. Generalized estimating equations were used to test the relationship between Aspergillus air contamination and the different variables (construction period, air treatment system, and surface contamination). RESULTS Positivity rates of Aspergillus spp varied from 21.1% before construction work to 16.9% during work for air samples (P=.07), and the associated mean fungal load varied from 1.21 colony-forming units (CFU)/m(3) to 0.64 CFU/m(3) (P=.04). In multivariate analysis, only the use of an air treatment system was associated with decreased airborne Aspergillus contamination (P < .0001). No significant difference was observed between the presence or absence of construction work and the proportion of airborne Aspergillus contamination (P=.91) or the Aspergillus fungal load (P=.10). CONCLUSIONS No influence of hospital construction work on airborne Aspergillus contamination was demonstrated when protective measures were taken, including reinforcement of the importance of environmental cleaning.

Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery: A Meta-analysis.

Objective: Intra-abdominal infections (IAIs) after elective colorectal surgery impact significantly the short- and long-term outcomes. In the era of fast-track surgery, they often come to light after discharge from hospital. Early diagnosis is therefore essential. C-reactive protein levels have proved to be accurate in this setting. Procalcitonin has been evaluated in several studies with conflicting results. This meta-analysis aimed to compare the predictive abilities of C-reactive protein and procalcitonin in the occurrence of IAIs after elective colorectal surgery. Methods: This meta-analysis included studies analyzing C-reactive protein and/or procalcitonin levels at postoperative days 2, 3, 4, and/or 5 as markers of intra-abdominal infection after elective colorectal surgery. Methodological quality was assessed by the QUADAS2 tool. The area under the curve summary receiver-operating characteristic was calculated for each day and each biomarker, using a random-effects model in cases of heterogeneity. Results: The meta-analysis included 11 studies (2692 patients). An IAI occurred in 8.9% of the patients. On postoperative day 3, area under the curve was 0.80 (95% CI, 0.76–0.85) for C-reactive protein and 0.78 (95% CI, 0.68–0.87) for procalcitonin. On postoperative day 5, their predictive accuracies were 0.87 (95% CI, 0.80–0.93) and 0.90 (95% CI, 0.82–0.98), respectively. The accuracy of C-reactive protein and procalcitonin did not differ at any postoperative day. Conclusions: Levels of inflammatory markers under the cutoff value between postoperative days 3 and 5 ensure safe early discharge after elective colorectal surgery. Procalcitonin seems not to have added value as compared to C-reactive protein in this setting.

Human metapneumovirus in patients hospitalized with acute respiratory infections: A meta-analysis.

Abstract This meta-analysis aimed to estimate the prevalence of human metapneumovirus (hMPV) infections in patients hospitalized for acute respiratory infection (ARI) and to study factors associated with this prevalence. Medline and ScienceDirect databases were searched for prospective observational studies that screened hospitalized patients with ARI for hMPV by RT-PCR, with data available at December 27, 2014. The risk of bias was assessed regarding participation rate, definition of ARI, description of diagnostic technique, method of inclusion identical for all subjects, standardized and identical sampling method for all subjects, analysis performed according to the relevant subgroups, and presentation of data sources. Random-effect meta-analysis with arcsine transformation and meta-regressions was used. In the 75 articles included, the prevalence of hMPV among hospitalized ARI was 6.24% (95% CI 5.25–7.30). An effect of the duration of the inclusion period was observed (p=0.0114), with a higher prevalence of hMPV in studies conducted during periods of 7–11 months (10.56%, 95% CI 5.97–16.27) or complete years (7.55%, 95% CI 5.90–9.38) than in periods of 6 months or less (5.36%, 95% CI 4.29–6.54). A significant increase in the incidence with increasing distance from the equator was observed (p=0.0384). hMPV should be taken into account as a possible etiology in hospitalized ARI.

Détermination du statut vital par chaînage entre des données hospitalières et les données de mortalité nationales anonymisées

BACKGROUND A subjects vital status is essential for epidemiological studies. This information may be obtained for large numbers of patients with different methods, but these are often expensive. This study was aimed at assessing the performance of patient vital status determination using a record linkage method between hospital data and national mortality data once the information was made anonymous in compliance with French legislation. METHODS All patients hospitalised in the Gustave-Roussy Institute, a cancer center in Villejuif France, were eligible for inclusion if they lived in France (mainland or Overseas Departments). The study cohort included patients admitted for the first time for malignant or suspected malignant-tumor during the period 1998-2000. Nominal data from the Gustave Roussy Institute hospital files as well as from the French National Institute of Statistics and Economic Studies (INSEE) mortality databases were then anonymised using irreversible hash coding. Once anonymised, the Gustave Roussy Institute and INSEE mortality databases were linked using the Jaro probabilistic method. Record linkage involved the following variables: birth name, first given name and birth date, along with the INSEE code of birth place. RESULTS 10,089 patients were included. The linkage record results were very satisfactory for all the patients included; the percentage of those properly classified was 97.2%, sensitivity was 94.8% and specificity 99.5%. The performance of the probabilistic record linkage method on anonymised data was very satisfactory (sensitivity 96.8% and specificity 99.8%) for determining vital status for patients born in France, suffering from cancer and in-patients at the Institute Gustave-Roussy. Results were inferior for patients born abroad (sensitivity 82.8% and specificity 97.7%) but the method achievements may be enhanced by additional manual validation steps. CONCLUSION Probabilistic linkage on data rendered anonymous enables to obtain information on vital status for a great number of subjects at low cost, in compliance with French legislation.

NAITRE study on the impact of conditional cash transfer on poor pregnancy outcomes in underprivileged women: protocol for a nationwide pragmatic cluster-randomised superiority clinical trial in France

Introduction Prenatal care is recommended during pregnancy to improve neonatal and maternal outcomes. Women of lower socioeconomic status (SES) are less compliant to recommended prenatal care and suffer a higher risk of adverse perinatal outcomes. Several attempts to encourage optimal pregnancy follow-up have shown controversial results, particularly in high-income countries. Few studies have assessed financial incentives to encourage prenatal care, and none reported materno-fetal events as the primary outcome. Our study aims to determine whether financial incentives could improve pregnancy outcomes in women with low SES in a high-income country. Methods and analysis This pragmatic cluster-randomised clinical trial includes pregnant women with the following criteria: (1) age above 18 years, (2) first pregnancy visit before 26 weeks of gestation and (3) belonging to a socioeconomically disadvantaged group. The intervention consists in offering financial incentives conditional on attending scheduled pregnancy follow-up consultations. Clusters are 2-month periods with random turnover across centres. A composite outcome of maternal and neonatal morbidity and mortality is the primary endpoint. Secondary endpoints include maternal or neonatal outcomes assessed separately, qualitative assessment of the perception of the intervention and cost-effectiveness analysis for which children will be followed to the end of their first year through the French health insurance database. The study started in June 2016, and based on an expected decrease in the primary endpoint from 18% to 14% in the intervention group, we plan to include 2000 women in each group. Ethics and dissemination Ethics approval was first gained on 28 September 2014. An independent data security and monitoring committee has been established. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. Trial registration number NCT02402855; pre-results.

O-0020SOCIO-ECONOMIC AND GEOGRAPHICAL DISPARITIES IN COLORECTAL ADENOMAS AND COLORECTAL CANCERS DETECTION : A POPULATION-BASED STUDY

Background: Rural areas were previously shown to be associated with colorectal adenoma detection rates that were lower than in urban areas, with no significant difference for colorectal cancer (CRC) incidence. However, this analysis was relatively crude and did not include socio-economic data. The present study aimed at assessing the impact of socio-geographical disparities on colorectal adenoma detection and CRC incidence in the Department of Cote d’Or, France, before mass screening implementation. Methods: The Cote d’Or registry of digestive tumours has collected all cases of colorectal polyps and cancers diagnosed in a well-defined geographical area (Cote d’Or, France) since 1976. The study population included all patients > 20 years, residing in Cote d’Or with a known place of residence, diagnosed for the first time either with colorectal adenomas or incident CRC between 01/01/1995 and 12/31/2002. Socio-geographical variables included distance to primary care physician (PCP), distance to gastroenterologist (GE) and the European Deprivation Index (EDI) collected in the smallest French areas available. Heterogeneity and spatial autocorrelation were tested. Spatial Bayesian poisson regression models were used and compared using the Deviance Information Criteria (DIC). Results: On the whole, 5,399 patients were diagnosed with at least one adenoma and 2,125 with invasive incident CRC. Age- and gender-standardized adenoma detection rate (/100 000) was 151 [CI95% 147-156], with variations according to the EDI and the distance to PCP. Thus, age- and gender-standardized adenoma detection rate ranged from 164 [CI95% : 155-173] for the most affluent quintile to 144 [CI95% : 134-154] and 151 [CI95% : 141-161] for the two most deprived quintiles. Regarding distance to PCP, adenoma detection rates were 161 [CI95% : 155-167] in the lowest quintile (lowest distance to PCP), versus 117 [CI95%: 102-133] for the highest quintile (highest distance to PCP). On the contrary, no significant differences were observed according to distance to GE. Age-and gender-standardized CRC incidence rate was 48 [CI95% : 46-51] without any significant variation according to socio-economic deprivation or according to the distance to physicians. Age and gender adjusted Bayesian model identified geographical disparities in colorectal adenoma detection: overdetection around the regional capital city and underdetection on the periphery of the

B-03 Métapneumovirus humain : un virus à ne pas négliger

Introduction et objectifs Le métapneumovirus humain (hMPV) – famille des Paramyxoviridae – a été identifié aux Pays-Bas en 2001. Ce virus est responsable de bronchiolites VRS-like (Virus Respiratoire Syncitial) chez l’enfant, avec le même caractère saisonnier. Il est aussi à l’origine d’infections respiratoires chez les personnes âgées. L’objectif est de mieux décrire l’épidémiologie des infections à hMPV et montrer l’intérêt de détecter ce virus en routine. Matériels et méthodes Au laboratoire de Virologie du CHU, hMPV est recherché en systématique par immuno-fluorescence indirecte sur les sécrétions nasales, les aspirations trachéales ou les liquides de lavage broncho-alvéolaire des patients. Parallèlement, six virus sont recherchés : Grippe A et B, VRS et Virus parainfluenzae (VP) 1, 2 et 3. Nous avons inclus les prélèvements de tout patient au cours de 2 saisons épidémiques : octobre 2007 à avril 2008 et octobre 2008 à janvier 2009. Les résultats positifs ont été recensés et colligés dans le tableau pour les 2 périodes étudiées : Prélèvements Oct. 2007/ Avr. 2008 Oct. 2008/ Jan. 2009 Total Positifs N % (positifs) N % (positifs) N Grippe A 27 14,8 38 20,0 65 Grippe B 17 9,3 2 1,0 19 VP 1,2,3 2 1,1 9 4,8 11 VRS 108 59,4 132 69,4 240 hMPV 28 15,4 9 4,8 37 Négatifs 583 / 334 / 917 Total 765 / 524 / 1289 Résultats Globalement, le VRS représente 64,5 % des prélèvements positifs, la grippe A 17,5 %. hMPV est, en terme de fréquence, le 3e virus isolé avec 10 % de prélèvements positifs. Sa prévalence sur la période 07/08 est de 3,6 % et sur 08/09 de 1,7 % (saison incomplète). L’âge médian observé est de 4 mois (extrêmes : 1-864) pour 07/08 et de 6 mois (extrêmes : 1-219) pour 08/09. Néanmoins, 71 % des prélèvements reviennent négatifs. En effet, les rhinovirus, coronavirus et adénovirus ne sont pas recherchés en routine. Conclusion Ainsi, 37 cas d’hMPV ont pu être recensés entraînant la mise en place de précautions complémentaires (gouttelettes et contact). Les nourrissons sont principalement touchés. Sans cette détection, les patients n’auraient probablement pas été isolés facilitant, de fait, la transmission nosocomiale du virus.