Critical care medicine in the French Territories in the Americas: Current situation and prospects

Kallel, Hatem; Résière, Dabor; Houcke, Stéphanie; Hommel, Didier; Pujo, Jean Marc; Martino, Frédéric; Carlès, Michel; Mehdaoui, Hossein

doi:10.26633/rpsp.2021.46

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…First, this was a mono-centric observational study. However, the Cayenne General Hospital provides care for more than two-thirds of the Guianese population [24]. Second, the involved bacteria were only identified in a limited number of cases (58.2%), having little clinical evidence of infection, probably because of a low inoculum, the involvement of anaerobic bacteria, antibiotics exposure, or the lack of microbiological sampling in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded all patients with a history of snakebite without signs of envenoming. Our hospital is a 510-bed general center that serves as a first-line medical center for an urban population of 100,000 inhabitants and as a referral center for a larger population coming from all the communities of French Guiana, accounting for almost 300,000 inhabitants [24].…”

Section: Methodsmentioning

confidence: 99%

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Characteristics of Snakebite-Related Infection in French Guiana

Houcke

Résière

Lontsingoula

et al. 2022

Toxins

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Wound infection is frequently reported following snakebite (SB). This study is retrospective. It was conducted in the emergency department and the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 July 2021. We included 172 consecutive patients hospitalized for SB envenoming. All patients were monitored for wound infection. Sixty-three patients received antibiotics at admission (36.6%). The main antibiotic used was amoxicillin–clavulanate (92.1%). Wound infection was recorded in 55 cases (32%). It was 19% in grade 1, 35% in grade 2, and 53% in grade 3. It included abscess (69.1%), necrotizing fasciitis (16.4%), and cellulitis (21.8%). The time from SB to wound infection was 6 days (IQR: 3–8). The main isolated microorganisms were A. hydrophila and M. morganii (37.5% and 18.8% of isolated organisms). Surgery was required in 48 patients (28.1%), and a necrosectomy was performed on 16 of them (33.3%). The independent factors associated with snakebite-associated infection were necrosis (p < 0.001, OR 13.15, 95% CI: 4.04–42.84), thrombocytopenia (p = 0.002, OR: 3.37, 95% CI: 1.59–7.16), and rhabdomyolysis (p = 0.046, OR: 2.29, 95% CI: 1.015–5.187). In conclusion, wound infection following SB is frequent, mainly in grade 2 and 3 envenomed patients, especially those with necrosis, thrombocytopenia, and rhabdomyolysis. The main involved bacteria are A. hydrophila and M. morganii.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Characteristics of Snakebite-Related Infection in French Guiana

Houcke

Résière

Lontsingoula

et al. 2022

Toxins

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“…It is also a referral center for a larger population coming from all over French Guiana and the border countries. 10 We reviewed all positive urine cultures and antibiotic susceptibility testing. Fungal cultures, anaerobic bacterial cultures, polymicrobial cultures, and negative cultures were excluded from this study.…”

Section: Methodsmentioning

confidence: 99%

Antimicrobial Susceptibility of Community-Acquired Urine Bacterial Isolates in French Amazonia

NkontCho

Sainte-Rose

Abboud

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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Bacterial resistance in community-acquired urinary tract infections (UTIs) is increasing worldwide. Our study aimed to assess the microbiological epidemiology and antimicrobial susceptibility patterns of community-acquired urine bacterial isolates in French Amazonia. Our study is retrospective. It was conducted from January 2015 to December 2019 in the microbiology laboratory of the Cayenne General Hospital (French Guiana). It includes all positive urine samples from adult (> 18 years) outpatients (N = 2,533). Isolated microorganisms were Gram-negative rods in 83.9%, mainly Enterobacterales (98.4%). The main isolated bacteria were Escherichia coli (58.7%) and Klebsiella pneumoniae (13.3%). Among the isolated E. coli, 37.2% were susceptible to amoxicillin, 77.9% to amoxicillin/clavulanic acid, 94.9% to cefotaxime, 78.9% to ofloxacin, and 98.9% to nitrofurantoin. In 106 cases (5.1%), isolated Enterobacterales were extended-spectrum β-lactamase producers (5% of E. coli and 8.9% of K. pneumoniae). Overall, high levels of cross- and co-resistance were registered. The main isolated Gram-positive bacteria was Staphylococcus saprophyticus (28.9%). It was resistant to oxacillin in 52.5% of cases and susceptible to nitrofurantoin in 99.1% of cases. Patients with S. saprophyticus were young women in almost all cases. In conclusion, the most isolated microorganisms from outpatient urinalyses were E. coli and K. pneumoniae. They showed a high resistance rate to amoxicillin, but they were susceptible to the most remaining antibiotics. S. saprophyticus was isolated mainly in young women and was resistant to oxacillin in half of the cases. Interestingly, nitrofurantoin was active against most isolated organisms and can be considered as empirical treatment in uncomplicated UTIs.

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“…Our hospital has a capacity of 500 to 600 beds and serves as a referral center for almost 300,000 inhabitants from all of French Guiana [37]. Our ICU works according to European and French standards with a 1:2 nurse-to-patient ratio.…”

Section: Setting and Patientsmentioning

confidence: 99%

Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana

et al. 2022

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(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42–4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02–0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.

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Critical care medicine in the French Territories in the Americas: Current situation and prospects

Cited by 10 publications

References 23 publications

Characteristics of Snakebite-Related Infection in French Guiana

Characteristics of Snakebite-Related Infection in French Guiana

Antimicrobial Susceptibility of Community-Acquired Urine Bacterial Isolates in French Amazonia

Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana

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