Publications
43 results found
Terzić V, Miantezila Basilua J, Billard N, et al., 2024, Cardiac Adverse Events and Remdesivir in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19): A Post Hoc Safety Analysis of the Randomized DisCoVeRy Trial., Clin Infect Dis
BACKGROUND: We aimed to evaluate the cardiac adverse events (AEs) in hospitalized patients with Coronavirus Disease 2019 (COVID-19) receiving remdesivir plus standard of care (SoC) compared to SoC alone (control), as an association was noted in some cohort studies and disproportionality analyses of safety databases. METHODS: This post-hoc safety analysis is based on data from the multicenter, randomized, open-label, controlled DisCoVeRy trial in hospitalized patients with COVID-19 (NCT04315948). Any first AE occurring between randomization and day 29 in the modified intention-to-treat (mITT) population randomized to either remdesivir or control group was considered. Analysis was performed using Kaplan-Meier survival curves and Kaplan-Meier estimates were calculated for event rates. RESULTS: Cardiac AEs were reported in 46 (11.2%) of 410 and 48 (11.3%) of 423 patients in the mITT population (n = 833) enrolled in the remdesivir and control groups, respectively. The difference between both groups was not significant (HR 1.0, 95% CI 0.7-1.5, p = 0.98), even when evaluating serious and non-serious cardiac AEs separately. The majority of reports in both groups were of arrhythmic nature (remdesivir, 84.8%; control, 83.3%) and were associated with a favorable outcome. There was no significant difference between remdesivir and control groups in the occurrence of different cardiac AE subclasses, including arrhythmic events (HR 1.1, 95% CI: 0.7-1.7, p = 0.68). CONCLUSIONS: Remdesivir treatment was not associated with an increased risk of cardiac AEs, whether serious or not, and regardless of AE severity, compared to control, in patients hospitalized with moderate or severe COVID-19. This is consistent with the results of other randomized controlled trials and meta-analyses.
Bertin C, Tarhini H, Rahi M, et al., 2023, Complicated scarring following mpox infection, BRITISH JOURNAL OF DERMATOLOGY, Vol: 189, Pages: 225-226, ISSN: 0007-0963
Dagenais C, Kielende M, Coulibaly A, et al., 2023, Lessons Learned from Field Experiences on Hospitals' Resilience to the COVID-19 Pandemic: A Systematic Approach, HEALTH SYSTEMS & REFORM, Vol: 9, ISSN: 2328-8604
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Bertin C, Beaumont A-L, Merlant M, et al., 2023, Erythematous maculopapular rash in monkeypox virus infection: A retrospective case series of 30 patients, JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY, Vol: 37, Pages: E638-E641, ISSN: 0926-9959
Beaumont A-L, Rozencwajg S, Peiffer-Smadja N, et al., 2023, COVID-19: Brief overview of therapeutic strategies., Anaesth Crit Care Pain Med, Vol: 42
Kherabi Y, Ming D, Rawson TM, et al., 2022, Challenges in implementing clinical decision support systems for the management of infectious diseases, Diverse Perspectives and State-of-the-Art Approaches to the Utilization of Data-Driven Clinical Decision Support Systems, Pages: 151-160, ISBN: 9781668450925
The increased availability of routine healthcare data collected through electronic medical record (EMR) systems provide opportunities for a much greater data-driven approach to healthcare. In infectious diseases, a number of Clinical Decision Support Systems (CDSSs) have shown promising results to improve quality and safety of healthcare management. However, most CDSSs have not been evaluated in real-world clinical settings and are not implemented into clinical practice. The aim of this chapter is to highlight the major challenges in translating CDSS research in infectious diseases into effective tools suitable for use in the clinical setting. Exemplars of real-world implementations and experience of introducing CDSS in infectious diseases are provided, and discussion on measurable outcomes, integration, and framework for clinical implementation proposed.
Kherabi Y, Messika J, Peiffer-Smadja N, 2022, Machine learning, antimicrobial stewardship, and solid organ transplantation: Is this the future?, TRANSPLANT INFECTIOUS DISEASE, Vol: 24, ISSN: 1398-2273
Lingas G, Néant N, Gaymard A, et al., 2022, Effect of remdesivir on viral dynamics in COVID-19 hospitalized patients: a modelling analysis of the randomized, controlled, open-label DisCoVeRy trial., J Antimicrob Chemother, Vol: 77, Pages: 1404-1412
BACKGROUND: The antiviral efficacy of remdesivir in COVID-19 hospitalized patients remains controversial. OBJECTIVES: To estimate the effect of remdesivir in blocking viral replication. METHODS: We analysed nasopharyngeal normalized viral loads from 665 hospitalized patients included in the DisCoVeRy trial (NCT04315948; EudraCT 2020-000936-23), randomized to either standard of care (SoC) or SoC + remdesivir. We used a mathematical model to reconstruct viral kinetic profiles and estimate the antiviral efficacy of remdesivir in blocking viral replication. Additional analyses were conducted stratified on time of treatment initiation (≤7 or >7 days since symptom onset) or viral load at randomization (< or ≥3.5 log10 copies/104 cells). RESULTS: In our model, remdesivir reduced viral production by infected cells by 2-fold on average (95% CI: 1.5-3.2-fold). Model-based simulations predict that remdesivir reduced time to viral clearance by 0.7 days compared with SoC, with large inter-individual variabilities (IQR: 0.0-1.3 days). Remdesivir had a larger impact in patients with high viral load at randomization, reducing viral production by 5-fold on average (95% CI: 2.8-25-fold) and the median time to viral clearance by 2.4 days (IQR: 0.9-4.5 days). CONCLUSIONS: Remdesivir halved viral production, leading to a median reduction of 0.7 days in the time to viral clearance compared with SoC. The efficacy was larger in patients with high viral load at randomization.
Bouiller K, Peiffer-Smadja N, Cevik M, et al., 2022, Role and perception of clinical microbiology and infectious diseases trainees during the COVID-19 crisis., Future Microbiol, Vol: 17, Pages: 411-416
Aim: To evaluate the role and perceptions of trainees during the COVID-19 pandemic. Method: An online survey was designed to provide an insight into the significance of the COVID-19 pandemic on working conditions of infectious diseases and clinical microbiology trainees. Results: The main roles of trainees included management of patients hospitalized for COVID-19 (55%), research (53%) and diagnostic procedures (43%). The majority (82%) of trainees felt useful in managing the crisis. However, more than two-thirds felt more stressed and more tired compared with other rotations. Only 39% of the participants had access to psychological support. Conclusion: Due to the significant impact of the pandemic on infectious diseases and clinical microbiology trainees, further research should focus on their health and welfare in the post-pandemic period.
Mahamat-Saleh Y, Fiolet T, Rebeaud ME, et al., 2021, Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies, BMJ Open, Vol: 11, ISSN: 2044-6055
Objectives We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions.Methods Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework.Results A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose–response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22–24, and a 1.5–2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40–45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to
Dellière S, Peiffer-Smadja N, João-Lopes M, et al., 2021, Aims and challenges of building national trainee networks in clinical microbiology and infectious disease disciplines., Future Microbiol, Vol: 16, Pages: 687-695
Trainees represent the medical practice of tomorrow. Interactions and collaborations at the early stage in career will strengthen the future of our specialties, clinical microbiology and infectious diseases. Trainee networks at the national level help access the best education and career opportunities. The aim of this collaborative white paper between the Trainee Association of European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and four national trainee networks is to discuss the motivation for building such networks and offer guidance for their creation and sustainability even during a health crisis.
Maatoug R, Peiffer-Smadja N, Delval G, et al., 2021, Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study., JMIR Form Res, Vol: 5
BACKGROUND: Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. OBJECTIVE: The main objective of this study was twofold: (1) to assess patients' compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. METHODS: Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients' data into a user-friendly format. RESULTS: Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). CONCLUSIONS: This preliminary study with a prolonged follow-up demonstrates si
Birgand G, Peiffer-Smadja N, Fournier S, et al., 2020, Assessment of air contamination by SARS-CoV-2 in hospital settings, Jama Network Open, Vol: 3, ISSN: 2574-3805
IMPORTANCE: Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).OBJECTIVE: To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. EVIDENCE REVIEW: The MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between December 1, 2019, and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for ScopingReviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patient. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose per meter cubed were analyzed after categorization as less than 1 μm, from 1 to 4 μm, and greater than 4 μm. FINDINGS: Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples from close patients’ environment (17.4%) were positive for SARS-CoV-2 RNA, without difference according to the setting (intensive care unit, 27 of 107[25.2%]; non–intensive care unit, 39 of 364 [10.7%];P< .01), the distance from patients (<1 m, 3 of118 [2.5%]; 1-5 m, 13 of 236 [5.5%];P= .20). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) were positive, all from close patient envi
Peiffer-Smadja N, Ardellier F-D, Thill P, et al., 2020, How and why do French medical students choose the specialty of infectious and tropical diseases? A national cross-sectional study., BMC Med Educ, Vol: 20
BACKGROUND: Infectious and tropical diseases (ID) physicians are needed now more than ever to tackle existing and emerging global threats. However, in many countries, ID is not recognized as a qualifying specialty. The creation of ID residency in 2017 in France offers the opportunity to know how and why the specialty is chosen by medical students. METHODS: We first analyzed the choice of specialty of all French medical students in 2017 and 2018 according to their rank at the national exam that ends medical studies. A web questionnaire was then sent in January 2019 to all ID residents in France (n = 100) to assess the factors influencing their choice of specialty and their career plan. RESULTS: We analyzed the choice of 17,087 medical students. ID was the first-chosen specialty with a median national rank of 526/8539, followed by plastic surgery and ophthalmology. The questionnaire was completed by 90% of the French ID residents (n = 100). The most encouraging factors to choose ID were the multi-system approach of the specialty, the importance of diagnostic medicine and having done an internship in ID during medical school. The potential deterrents were the work-life balance, the workload and the salary. CONCLUSIONS: The recent recognition of ID as a qualifying specialty in France can be considered a success insofar as the specialty is the most popular among all medical and surgical specialties. Individuals who choose ID are attracted by the intellectual stimulation of the specialty but express concerns about the working conditions and salaries.
Peiffer-Smadja N, Lescure F-X, Sallard E, et al., 2020, Anticovid, a comprehensive open-access real-time platform of registered clinical studies for COVID-19, Journal of Antimicrobial Chemotherapy, Vol: 75, Pages: 2708-2710, ISSN: 0305-7453
Peiffer-Smadja N, Allison R, Jones LF, et al., 2020, Preventing and Managing Urinary Tract Infections: Enhancing the Role of Community Pharmacists-A Mixed Methods Study, ANTIBIOTICS-BASEL, Vol: 9, ISSN: 2079-6382
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- Citations: 6
Peiffer-Smadja N, Rawson TM, Ahmad R, et al., 2020, machine learning for clinical decision support in infectious diseases: a narrative review of current applications (vol 26, pg 584, 2020), Clinical Microbiology and Infection, Vol: 26, Pages: 1118-1118, ISSN: 1198-743X
Peiffer-Smadja N, Poda A, Ouedraogo A-S, et al., 2020, Paving the Way for the Implementation of a Decision Support System for Antibiotic Prescribing in Primary Care in West Africa: Preimplementation and Co-Design Workshop With Physicians., J Med Internet Res, Vol: 22
BACKGROUND: Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR). Clinical decision support systems (CDSS) can assist prescribers with rapid access to up-to-date information. In low- and middle-income countries (LMIC), the introduction of CDSS for antibiotic prescribing could have a measurable impact. However, interventions to implement them are challenging because of cultural and structural constraints, and their adoption and sustainability in routine clinical care are often limited. Preimplementation research is needed to ensure relevant adaptation and fit within the context of primary care in West Africa. OBJECTIVE: This study examined the requirements for a CDSS adapted to the context of primary care in West Africa, to analyze the barriers and facilitators of its implementation and adaptation, and to ensure co-designed solutions for its adaptation and sustainable use. METHODS: We organized a workshop in Burkina Faso in June 2019 with 47 health care professionals representing 9 West African countries and 6 medical specialties. The workshop began with a presentation of Antibioclic, a publicly funded CDSS for antibiotic prescribing in primary care that provides personalized antibiotic recommendations for 37 infectious diseases. Antibioclic is freely available on the web and as a smartphone app (iOS, Android). The presentation was followed by a roundtable discussion and completion of a questionnaire with open-ended questions by participants. Qualitative data were analyzed using thematic analysis. RESULTS: Most of the participants had access to a smartphone during their clinical consultations (35/47, 74%), but only 49% (23/47) had access to a computer and none used CDSS for antibiotic prescribing. The participants considered that CDSS could have a number of benefits including updating the knowledge of practitioners on antibiotic prescribing, improving clinical care and reducing AMR, encouraging the establishment of national guidelines, and deve
Peiffer-Smadja N, Bouadma L, Mathy V, et al., 2020, Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia., Crit Care, Vol: 24
BACKGROUND: Early appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 h. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients. METHODS: In this prospective study, we performed a M-PCR on bronchoalveolar lavage (BAL) or plugged telescoping catheter (PTC) samples of patients with ventilated HAP or VAP with Gram-negative bacilli or clustered Gram-positive cocci. This study was conducted in 3 ICUs in a French academic hospital: the medical and infectious diseases ICU, the surgical ICU, and the cardio-surgical ICU. A multidisciplinary expert panel simulated the antibiotic changes they would have made if the M-PCR results had been available. RESULTS: We analyzed 95 clinical samples of ventilated HAP or VAP (72 BAL and 23 PTC) from 85 patients (62 males, median age 64 years). The median turnaround time of the M-PCR was 4.6 h (IQR 4.4-5). A total of 90/112 bacteria were detected by the M-PCR system with a global sensitivity of 80% (95% CI, 73-88%) and specificity of 99% (95% CI 99-100). The sensitivity was better for Gram-negative bacteria (90%) than for Gram-positive cocci (62%) (p = 0.005). Moreover, 5/8 extended-spectrum beta-lactamases (CTX-M gene) and 4/4 carbapenemases genes (3 NDM, one oxa-48) were detected. The M-PCR could have led to the earlier initiation of an effective antibiotic in 20/95 patients (21%) and to early de-escalation in 37 patients (39%) but could also have led to one (1%) inadequate antimicrobial therapy. Among 17 empiric antibiotic treatments with carbapenems, 10 could have been de-escalated in the following hours according to the M-PCR res
Peiffer-Smadja N, Maatoug R, Lescure F-X, et al., 2020, Machine Learning for COVID-19 needs global collaboration and data-sharing, NATURE MACHINE INTELLIGENCE, Vol: 2, Pages: 293-294
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Peiffer-Smadja N, Rawson TM, Ahmad R, et al., 2020, Machine learning for clinical decision support in infectious diseases: A narrative review of current applications, Clinical Microbiology and Infection, Vol: 26, Pages: 584-595, ISSN: 1198-743X
BACKGROUNDMachine learning (ML) is a growing field in medicine. This narrative review describes the current body of literature on ML for clinical decision support in infectious diseases (ID). OBJECTIVESWe aim to inform clinicians about the use of ML for diagnosis, classification, outcome prediction and antimicrobial management in ID.SOURCESReferences for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, biorXiv, ACM Digital Library, arXiV and IEEE Xplore Digital Library up to July 2019.CONTENTWe found 60 unique ML-CDSS aiming to assist ID clinicians. Overall, 37 (62%) focused on bacterial infections, 10 (17%) on viral infections, nine (15%) on tuberculosis and four (7%) on any kind of infection. Among them, 20 (33%) addressed the diagnosis of infection, 18 (30%) the prediction, early detection or stratification of sepsis, 13 (22%) the prediction of treatment response, four (7%) the prediction of antibiotic resistance, three (5%) the choice of antibiotic regimen and two (3%) the choice of a combination antiretroviral therapy. The ML-CDSS were developed for intensive care units (n=24, 40%), ID consultation (n=15, 25%), medical or surgical wards (n=13, 20%), emergency department (n=4, 7%), primary care (n=3, 5%) and antimicrobial stewardship (n=1, 2%). Fifty-three ML-CDSS (88%) were developed using data from high-income countries and seven (12%) with data from low- and middle-income countries (LMIC). The evaluation of ML-CDSS was limited to measures of performance (e.g. sensitivity, specificity) for 57 ML-CDSS (95%) and included data in clinical practice for three (5%). IMPLICATIONSConsidering comprehensive patient data from socioeconomically diverse health care settings, including primary care and LMICs, may improve the ability of ML-CDSS to suggest decisions adapted to various clinical contexts. Currents gaps identified in the evaluation of ML-CDSS must also be addressed in order to know the potential impact of such tools for cli
Peiffer-Smadja N, Guillotel E, Luque-Paz D, et al., 2019, <i>In vitro</i> bactericidal activity of amoxicillin combined with different cephalosporins against endocarditis-associated <i>Enterococcus faecalis</i> clinical isolates, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 74, Pages: 3511-3514, ISSN: 0305-7453
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- Citations: 8
Peiffer-Smadja N, Hanslik T, Mordant P, et al., 2019, Cultural Differences Between Surgical and Medical Teams: Is it Time for Comanagement?, CLINICAL INFECTIOUS DISEASES, Vol: 69, Pages: 560-561, ISSN: 1058-4838
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- Citations: 1
Peiffer-Smadja N, Bauvois A, Chilies M, et al., 2019, The French Society of Internal Medicine's Top-5 List of Recommendations: a National Web-Based Survey, JOURNAL OF GENERAL INTERNAL MEDICINE, Vol: 34, Pages: 1475-1485, ISSN: 0884-8734
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Peiffer-Smadja N, Ardellier F-D, Lemaignen A, et al., 2019, Motivations pour le choix du DES de Maladies Infectieuses et Tropicales : un sondage national du RéJIF, Médecine et Maladies Infectieuses, Vol: 49, Pages: S65-S65, ISSN: 0399-077X
Martins C, Bleibtreu A, Thill P, et al., 2019, Bilan à 1 an de la mise en place de la réforme du troisième cycle médical. Une Enquête du RéJIF, Médecine et Maladies Infectieuses, Vol: 49, Pages: S66-S66, ISSN: 0399-077X
Peiffer-Smadja N, Thy M, Hanslik T, et al., 2019, Comment les internes et assistants financent la participation aux congrès scientifiques ? Résultats d’un sondage national en ligne, Médecine et Maladies Infectieuses, Vol: 49, Pages: S65-S66, ISSN: 0399-077X
Peiffer-Smadja N, Domont F, Saadoun D, et al., 2019, Corticosteroids and immunosuppressive agents for idiopathic recurrent pericarditis, AUTOIMMUNITY REVIEWS, Vol: 18, Pages: 621-626, ISSN: 1568-9972
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Peiffer-Smadja N, Lescure FX, Maatoug R, et al., 2019, Re: 'Determinants of in- hospital antibiotic prescription behaviour' by Lambregts et al., CLINICAL MICROBIOLOGY AND INFECTION, Vol: 25, Pages: 635-637, ISSN: 1198-743X
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- Citations: 6
Peiffer-Smadja N, Cohen L, 2019, The cerebral bases of the bouba-kiki effect, NEUROIMAGE, Vol: 186, Pages: 679-689, ISSN: 1053-8119
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- Citations: 16
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