Staphylococcus aureus is the leading cause of bacterial infection in liver transplant recipients. Preoperative nasal carriage of methicillin-resistant S. aureus (MRSA) is associated with a high risk of infection. We conducted a retrospective cohort study in order to identify independent risk factors for early-onset S. aureus infection after liver transplantation. Patients were screened preoperatively for methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage. Risk factor analysis was performed by univariate analysis followed by stepwise logistic regression. Staphylococcus aureus has emerged as the leading cause of bacterial infection in liver transplant recipients. 1,2 These infections are mostly caused by strains that are resistant to methicillin, have an early postoperative onset, usually within 1 month of surgery, and are associated with high mortality rate. 1,3,4 Previous studies have shown that preoperative methicillin-resistant S. aureus (MRSA) nasal carriage is associated with a very high risk of S. aureus infection after orthotopic liver transplantation (OLT). 3,5,6 However, MRSA carriers usually have more advanced liver disease than noncarriers. 6,7 Thus, the relationship between MRSA nasal carriage and infection may indicate that colonization of the nares plays a direct role in the pathogenesis of S. aureus infection or that host characteristics associated with nasal carriage also predispose to infection. To establish that nasal carriage is an independent risk factor for infection, a multiple logistic regression model is required to control for the effects of confounding variables such as the type and severity of underlying disease. Previous studies addressing risk factors associated with S. aureus infection in these patients did not perform multivariate analysis. 1,3,6 Moreover, these studies did not investigate the risk associated with methicillin-susceptible S. aureus (MSSA) nasal carriage 6 or failed to demonstrate a significant association with infection because of a relatively small number of patients. 3,5 The aim of the present study was to determine independent risk factors for early S. aureus infection (i.e., within 1 month of surgery) in liver transplant recipients using a multiple logistic regression model. For this purpose, we conducted a retrospective cohort study including all consecutive liver transplant recipients at Beaujon Hospital over a 75-month period. All patients were screened preoperatively for both MSSA and MRSA nasal carriage.

Summary Enterobacteriaceae are now the predominant pathogens isolated in bloodstream infections complicating orthotopic liver transplantation (OLT). We conducted a retrospective cohort study of patients who underwent OLT in a University hospital between 01/01/1997 and 31/03/2003 to investigate the risk factors of Enterobacteriaceae bacteremia (EB) after OLT. EB was defined as the isolation of an Enterobacteriaceae species from at least one blood culture within 3 months following OLT. Pre‐, per‐ and postoperative variables were collected from the medical records and analyzed in relation to EB. Forty (12.5%) of the 320 patients developed EB. The origin of EB was abdominal in 32% of the patients, urinary in 18%, pulmonary in 10%, and primary in the remaining 40% of the patients. Two‐thirds of EB occurred within 1 month following OLT. The main pathogens were Escherichia coli (42%), Enterobacter cloacae (17%) and Klebsiella pneumoniae (17%). Susceptibility rates varied from 82.5% for ciprofloxacin to 95% for amikacin. Fourteen patients (35%) with EB died. Variables significantly associated with EB after multivariate analysis were a MELD score >20 (OR: 2.79 [1.24–6.30], P = 0.013), transplantation for posthepatitic B (OR: 4.47 [1.67–11.98], P = 0.03) or posthepatitic C (OR: 3.79 [1.59–9.01], P = 0.03) cirrhosis, a positive bile culture (OR: 3.47 [1.19–10.13], P = 0.023) and return to surgery (including retransplantation) (OR: 2.72 [1.32–5.58], P = 0.006). EB is a frequent and severe complication following OLT. Patients grafted for a posthepatitic cirrhosis, with a severe pretransplantation status, with a positive bile culture and those undergoing reoperation have a high risk of developing EB.

Background It is unclear whether HIV infection affects the long‐term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV‐uninfected (HIV−) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV− patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36‐month follow‐up. A total of 103 PLHIV and 195 HIV− patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow‐up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− patients (17.8% and 15.1%, P =0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67–3.82 [ P =0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32–30.21 [ P =0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P =0.01) and had smaller total cholesterol decreases (–22.3 versus –35.0 mg/dL; P =0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT00139958.

Les fouilles menées par R. et S. de Saint-Périer dans les années 1920 à la grotte des Scilles (Lespugue, Haute-Garonne) ont livré un ensemble de vestiges attribués au Magdalénien. L'étude de cette collection ancienne offre désormais la possibilité de préciser cette caractérisation à la lumière de travaux récents sur cette période. La présentation des différentes catégories de vestiges (industries lithique et osseuse, faune, parure, art mobilier et lampe) permet d'appréhender l'ensemble des registres d'activités documentés sur le site. En particulier, cet article présente les éléments typotechnologiques qui fournissent des arguments pour rattacher l'occupation de cette cavité au Magdalénien inférieur. Une date 14 C par SMA situe cette période autour de 16000 BP (19400 cal. BP) à la grotte des Scilles. La mise en évidence de ce premier jalon pyrénéen conduit ensuite les auteurs à discuter du peuplement magdalénien à la fin du Dernier Maximum glaciaire dans le Sud-Ouest de la France et le Nord de l'Espagne. Abstract The excavations by R. and S. de Saint-Périer at the Grotte des Scilles (Lespugue, Haute-Garonne, France) in 1923-1924 yielded archaeological material attributed to the Magdalenian. The re-examination of this old collection now allows a more precise characterization of it, in the light of recent research on this period. This article presents the different artefact types found (lithic and bone tools, faunal remains, personal ornaments, portable art items and one sandstone lamp) in order to consider all activities documented on the site. Particular attention is given to typological and technological data, the analyses of which point to a Lower Magdalenian chronological attribution. An SMA 14C date shows that occupation of the Grotte des Scilles took place around 16000 BP (19400 cal. BP). The identification, for the first time, of a Lower Magdalenian presence in the Pyrenees raises new questions concerning Magdalenian occupation at the end of the Last Glacial Maximum in southwestern France and northern Spain.

Malaria may be complicated by development of thrombocytopenia, elevated liver enzymes, and/or hemolysis, which may be difficult to distinguish from HELLP (hemolytic anemia; elevated liver enzymes; low platelet count) syndrome in a pregnant patient. A 33-year-old woman developed a HELLP-like syndrome and persistent fever postpartum without symptoms of preeclampsia. A malaria blood smear was performed and was positive for Plasmodium falciparum. The patient was immediately treated with quinine. The follow-up was uneventful with total disappearance of fever and prompt resolution of biochemical signs of HELLP-like syndrome 3 days later. Malaria in a pregnant woman can masquerade as HELLP syndrome. The wide overlap in symptoms (headache, malaise, digestive symptoms) does not suggest that symptoms would be effective in differentiating malaria and preeclampsia. A recent travel in endemic area, associated with malaria blood smear and clinic examination, should be the key of the differential diagnosis.