Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
RATIONALE: Optimal management of complicated parapneumonic effusions (CPPE) remains controversial. OBJECTIVES: to assess safety and efficacy of iterative therapeutic thoracentesis (ITTC), the first-line treatment of CPPE in Rennes University Hospital. METHODS: Patients with CPPE were identified through our computerized database. We retrospectively studied all cases of CPPE initially managed with ITTC in our institution between 2001 and 2010. ITTC failure was defined by the need for additional treatment (i.e. surgery or percutaneous drainage), or death. RESULTS: Seventy-nine consecutive patients were included. The success rate was 81% (n = 64). Only 3 patients (4%) were referred to thoracic surgery. The one-year survival rate was 88%. On multivariate analysis, microorganisms observed in pleural fluid after Gram staining and first thoracentesis volume ≥450 mL were associated with ITTC failure with adjusted odds-ratios of 7.65 [95% CI, 1.44-40.67] and 6.97 [95% CI, 1.86-26.07], respectively. The main complications of ITTC were iatrogenic pneumothorax (n = 5, 6%) and vasovagal reactions (n = 3, 4%). None of the pneumothoraces required chest tube drainage, and no hemothorax or re-expansion pulmonary edema was observed. CONCLUSIONS: Although not indicated in international recommendations, ITTC is safe and effective as first-line treatment of CPPE, with limited invasiveness.
ISSN: 1932-6203

hal-00945622
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00945622
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00945622/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00945622/file/fetchObject.pdf
PUBMED : 24400113

Éditeur(s) : HAL CCSD Centers for Disease Control and Prevention
Résumé : International audience
We report 20 cases of extensively drug-resistant tuberculosis managed in France. Treatment was individualized and included bedaquiline and linezolid for most patients and surgery in 8 patients. At last follow-up (22 months), 19 patients had achieved conversion from positive to negative on culture testing. These promising results of comprehensive management obtained in a small series deserve confirmation.
ISSN: 1080-6040

hal-01294307
http://hal.upmc.fr/hal-01294307
http://hal.upmc.fr/hal-01294307/document
http://hal.upmc.fr/hal-01294307/file/15-1130.pdf
DOI : 10.3201/eid2203.151130

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Parapneumonic pleural effusions represent the main cause of pleural infections. Their incidence is constantly increasing. Although by definition they are considered to be a “parapneumonic” phenomenon, the microbial epidemiology of these effusions differs from pneumonia with a higher prevalence of anaerobic bacteria. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated parapneumonic effusions. Only complicated parapneumonic effusions need to be drained. Therapeutic evacuation modalities include repeated therapeutic thoracentesis, chest tube drainage or thoracic surgery. The choice of the first-line evacuation treatment is still controversial and there are few prospective controlled studies. The effectiveness of fibrinolytic agents is not established except when they are combined with DNase. Antibiotics are mandatory; they should be initiated as quickly as possible and should be active against anaerobic bacteria except for in the context of pneumococcal infections. There are few data on the use of chest physiotherapy, which remains widely used. Mortality is still high and is influenced by underlying comorbidities.
Les épanchements pleuraux parapneumoniques représentent la principale étiologie des pleurésies infectieuses. Leur incidence est en constante augmentation. Bien qu’ils soient qualifiés de « parapneumoniques », l’épidémiologie microbienne est différente de celle des pneumonies avec notamment une plus grande fréquence des germes anaérobies. La ponction pleurale exploratrice représente l’étape diagnostique centrale qui permet de distinguer les épanchements parapneumoniques compliqués et non compliqués. Seuls les épanchements parapneumoniques compliqués doivent faire l’objet d’un traitement évacuateur reposant sur la mise en œuvre de ponctions pleurales répétées (PPR), d’un drainage thoracique ou d’une prise en charge chirurgicale. Le choix de la technique évacuatrice première reste débattu car il existe peu d’études prospectives comparatives. L’utilisation d’agents fibrinolytiques n’a pas fait la preuve de son efficacité sauf lorsqu’ils sont utilisés en association à la DNAse. L’antibiothérapie doit être systématique, précoce et couvrir les germes anaérobies, sauf en cas d’infection à pneumocoque. Il existe peu de données sur la place de la kinésithérapie qui reste largement utilisée. La mortalité est élevée et directement influencée par les comorbidités sous-jacentes.
ISSN: 0761-8425

hal-01117905
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117905
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117905/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117905/file/Les%20%C3%A9panchements%20pleuraux%20parapneumoniques_accepted.pdf
DOI : 10.1016/j.rmr.2014.12.001