{"id":26750428,"date":"2024-02-16T10:34:51","date_gmt":"2024-02-16T09:34:51","guid":{"rendered":"https:\/\/www.chu-poitiers.fr\/?p=26750428"},"modified":"2024-02-16T10:37:55","modified_gmt":"2024-02-16T09:37:55","slug":"une-etude-qui-va-changer-les-pratiques","status":"publish","type":"post","link":"https:\/\/www.chu-poitiers.fr\/en\/une-etude-qui-va-changer-les-pratiques\/","title":{"rendered":"Une \u00e9tude qui va changer les pratiques"},"content":{"rendered":"\n

Intitul\u00e9e \u00ab Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial \u00bb, l\u2019\u00e9tude PROPHY-VAP du Pr Claire Dahyot-Fizelier a \u00e9t\u00e9 soutenue par le minist\u00e8re de la Sant\u00e9 dans le cadre d\u2019un programme hospitalier de recherche clinique interr\u00e9gional. L\u2019objectif principal de l\u2019\u00e9tude \u00e9tait de diminuer l\u2019incidence des pneumopathies acquises sous ventilation m\u00e9canique (PAVM) pr\u00e9coces, premi\u00e8re cause d\u2019infection associ\u00e9e aux soins en r\u00e9animation, chez des patients c\u00e9r\u00e9bro-l\u00e9s\u00e9s. Les PAVM pr\u00e9coces touchent davantage encore les patients dans le coma, qui selon les \u00e9tudes, toucheraient entre 1\/3 \u00e0 2\/3 des c\u00e9r\u00e9brol\u00e9s\u00e9s n\u00e9cessitant la ventilation artificielle. Ces infections allongent la dur\u00e9e de ventilation m\u00e9canique, la dur\u00e9e d\u2019hospitalisation, et aggravent le pronostic de ces patients. Les recommandations nationales et internationales pour pr\u00e9venir les PAVM proposent de faire une antibioprophylaxie intra-veineuse de deux \u00e0 cinq jours, associ\u00e9e \u00e0 une d\u00e9contamination orale et\/ou digestive par d\u2019autres anti-infectieux. \u00ab Ces recommandations sont peu appliqu\u00e9es dans nos services de r\u00e9animation tout d\u2019abord du fait du niveau de preuve, mais aussi parce qu\u2019elles sont difficiles \u00e0 appliquer, et surtout par crainte du risque d\u2019antibior\u00e9sistance\u00a0<\/em>\u00bb, pr\u00e9cise le Pr Claire Dahyot-Fizelier.<\/p>\n

La recherche du Pr Claire Dahyot-Fizelier a consist\u00e9 \u00e0 v\u00e9rifier si l\u2019administration de 2g de ceftriaxone, antibiotique, \u00e0 des patients c\u00e9r\u00e9brol\u00e9s\u00e9s dans les 12 heures qui suivent l\u2019intubation trach\u00e9ale, permet de diminuer l\u2019apparition de PAVM pr\u00e9coces. Pour cela, les investigateurs ont r\u00e9alis\u00e9 une \u00e9tude randomis\u00e9e en double aveugle, contre placebo, avec comit\u00e9 de relecture des pneumopathies en aveugle. Les patients, victimes d\u2019un traumatisme cr\u00e2nien, d\u2019un accident cardio-vasculaire isch\u00e9mique ou h\u00e9morragique, ou d\u2019h\u00e9morragie m\u00e9ning\u00e9e, ont \u00e9t\u00e9 r\u00e9partis, de fa\u00e7on al\u00e9atoire, en deux groupes : l\u2019un recevant l\u2019antibiotique, l\u2019autre le placebo. Les soignants ne savaient pas s\u2019ils administraient le traitement ou le placebo. \u00ab Personne ne savait dans quel groupe se trouvait le patient. Ce sont, en g\u00e9n\u00e9ral, les \u00e9tudes les plus rigoureuses puisque personne n\u2019est au courant du <\/em>traitement re\u00e7u par le patient. Personne ne peut donc \u00eatre influenc\u00e9 lors du diagnostic ult\u00e9rieur de pneumopathie. Cependant, ces \u00e9tudes sont plus difficiles \u00e0 organiser, d\u2019autant plus que celle-ci \u00e9tait multicentrique \u00bb.<\/em> En effet, huit centres du r\u00e9seau de recherche AtlantaR\u00e9a ont particip\u00e9 et ont permis l\u2019inclusion de 345 patients. L\u2019\u00e9tude a d\u00e9montr\u00e9 que l\u2019administration de l\u2019antibiotique limite le d\u00e9veloppement des infections pulmonaires et, par cons\u00e9quent, diminue l\u2019exposition aux antibiotiques et possiblement les risques d\u2019antibior\u00e9sistance. \u00ab\u00a0Ces r\u00e9sultats s\u2019int\u00e8grent parfaitement dans la philosophie de l\u2019unit\u00e9 de recherche <\/em>Pharmacology of antimicrobial agents and antibioresistance<\/em>\u00a0(PHAR2 \u2013 Inserm U1070) dirig\u00e9e par le Pr Sandrine Marchand, au sein de laquelle je travaille depuis bient\u00f4t vingt ans <\/em>\u00bb. Les r\u00e9sultats de sa recherche, r\u00e9cemment publi\u00e9s dans The Lancet Respiratory Medecine, <\/em>avaient d\u00e9j\u00e0 \u00e9t\u00e9 r\u00e9compens\u00e9s lors du congr\u00e8s de l\u2019European Congress of Clinical Microbiology and infectious diseases (ECCMID) de Copenhague en avril 2023. Le Pr Claire Dahyot-Fizelier s\u2019est vu d\u00e9cerner l\u2019ISF-ESCMID Sepsis Award qui r\u00e9compense le meilleur abstract relatif au sepsis. Derni\u00e8re cons\u00e9cration, et non des moindres, le Pr Claire Dahyot-Fizelier a \u00e9t\u00e9 invit\u00e9e par l\u2019\u00e9ditrice en chef de The Lancet Respiratory Medicine<\/em> \u00e0 participer, en janvier 2024, au congr\u00e8s international de r\u00e9animation organis\u00e9 par la Society of Critical Care Medicine\u2019s, \u00e0 Phoenix. Tout comme deux autres chercheurs anglophones, elle a pr\u00e9sent\u00e9 les r\u00e9sultats de l\u2019\u00e9tude lors d\u2019une session intitul\u00e9e \u00ab Les \u00e9tudes qui vont changer nos pratiques \u00bb. Le Pr Claire Dahyot-Fizelier se r\u00e9jouit de cette reconnaissance : \u00ab je suis heureuse de voir les r\u00e9sultats incroyables que cette \u00e9tude a permis de d\u00e9montrer et ce qu\u2019elle va apporter aux patients. J\u2019esp\u00e8re vraiment que cela va changer les pratiques et am\u00e9liorer la prise en charge. J\u2019\u00e9tais tr\u00e8s fi\u00e8re de pr\u00e9senter nos r\u00e9sultats aupr\u00e8s de nos pairs. C\u2019est une grande reconnaissance pour tous les chercheurs qui ont particip\u00e9 au projet parce que c\u2019\u00e9tait vraiment un travail collectif, un \u00e9norme travail d\u2019inclusion, de v\u00e9rification et d\u2019analyses de donn\u00e9es, de coordination, etc. C\u2019est vraiment le fruit d\u2019une collaboration, notamment avec le Pr Olivier Mimoz, chef du service des urgences du CHU de Poitiers, qui m\u2019a envoy\u00e9 en 2013 la publication qui est \u00e0 l\u2019origine du sujet de recherche et avec lequel nous avons travaill\u00e9 \u00e9troitement pendant toute l\u2019\u00e9tude <\/em>\u00bb.<\/p>\n

Voir la conf\u00e9rence<\/a><\/p>\n\n\n\n

\n
\"\"<\/a><\/figure>\n<\/div><\/figure>\n","protected":false},"excerpt":{"rendered":"

Les r\u00e9sultats d\u2019une recherche clinique port\u00e9e par le Pr Claire Dahyot-Fizelier, m\u00e9decin en neuro-r\u00e9animation du CHU de Poitiers, viennent d\u2019\u00eatre\u2026","protected":false},"author":21,"featured_media":26751595,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[96],"tags":[],"class_list":["post-26750428","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-non-classifiee"],"acf":[],"yoast_head":"\nUne \u00e9tude qui va changer les pratiques - Site du CHU de Poitiers<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.chu-poitiers.fr\/une-etude-qui-va-changer-les-pratiques\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Une \u00e9tude qui va changer les pratiques - Site du CHU de Poitiers\" \/>\n<meta property=\"og:description\" content=\"Les r\u00e9sultats d\u2019une recherche clinique port\u00e9e par le Pr Claire Dahyot-Fizelier, m\u00e9decin en neuro-r\u00e9animation du CHU de Poitiers, viennent d\u2019\u00eatre publi\u00e9s dans The Lancet Respiratory Medicine. En plus d\u2019\u00eatre int\u00e9gr\u00e9e dans la prestigieuse revue internationale, l\u2019\u00e9tude a \u00e9t\u00e9 d\u00e9sign\u00e9e pour une pr\u00e9sentation lors de la session de \u00ab\u00a0Thought leader\u00a0: Late-breaking studies that will change your practice\u00a0\u00bb au congr\u00e8s de la Society of Critical Care Medicine le lendemain de sa publication en ligne. 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