Publications by authors named "Joris Muller"

8 Publications

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Normal chest CT in 1091 symptomatic patients with confirmed Covid-19: frequency, characteristics and outcome.

Eur Radiol 2021 Jan 13. Epub 2021 Jan 13.

Hôpitaux Universitaires de Strasbourg, Service de Radiologie, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France.

Objective: Frequency of normal chest CT in symptomatic COVID-19 patients as well as the outcome of these patients remains unknown. The objectives of this work were to assess the incidence of initially normal chest CT in a cohort of consecutive confirmed COVID-19 patients with respiratory symptoms and to compare their clinical characteristics and their outcome to matched patients with typical COVID-19 lesions at initial CT.

Methods: From March 6 to April 22, all consecutive adult patients referred to the COVID-19 clinic of our Emergency Department were retrospectively analyzed. Each patient with a positive SARS-CoV-2 RT-PCR and a normal initial chest CT after second reading was 1:1 matched based on sex, age and date of CT acquisition to a patient with positive RT-PCR and initial chest CT with typical COVID-19 lesions. Clinical data, laboratory results and outcomes (major being mechanical ventilation and/or death) were compared between both groups, using Wilcoxon signed-rank test, McNemar's chi-squared test and/or exact McNemar's test where appropriate.

Results: Fifty-seven chest CT out of 1091 (5.2%, 95% CI 4.0-6.7) in symptomatic patients with positive RT-PCR were normal, with a median onset of symptoms of 4.5 days (IQR [1.25-10.25]). After a median follow-up of 43 days, death and/or mechanical ventilation occurred in 3 patients (5.3%) in the study group, versus 11 (19.3%) in the control group (p = 0.011).

Conclusions: Normal initial chest CT occurred in 5.2% of symptomatic confirmed COVID-19 cases in our cohort. While better than those with abnormal chest CT, outcome was not entirely benign with 5.3% death and/or mechanical ventilation.

Key Points: • In a cohort of 1091 symptomatic COVID-19 patients, initial chest CT was normal in 5.2% of cases. • Normal chest CT in confirmed COVID-19 is frequent even when onset of symptoms is greater than 3 days. • The outcome of COVID-19 patients with initial normal chest CT, while better than those with abnormal CT, was not entirely benign with 5.3% death and/or mechanical ventilation.
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http://dx.doi.org/10.1007/s00330-020-07593-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804574PMC
January 2021

Temporal variations in the diagnostic performance of chest CT for Covid-19 depending on disease prevalence: Experience from North-Eastern France.

Eur J Radiol 2021 Jan 20;134:109425. Epub 2020 Nov 20.

Hôpitaux Universitaires de Strasbourg, Service de Radiologie, Nouvel Hôpital Civil, Strasbourg, France.

Rationale And Objective: The purpose of this work was to analyze temporal variations in the diagnostic performance of chest CT for Covid-19 throughout the first wave, depending on disease prevalence variations between the ascending, peak and descending phases of the epidemic in North-Eastern France.

Materials And Methods: From March 6th to April 22nd 2020, all consecutive adult patients referred to the "Covid-19 clinic" of our Emergency Department with the availability of chest CT and of at least one RT-PCR result were retrospectively included in the present study. Chest CT was considered positive when typical Covid-19 lesions were observed (bilateral and predominantly peripheral and sub-pleural ground glass opacities and/or alveolar consolidations). RT-PCR results were considered as the reference standard. Ascending, peak and descending phases were determined based on the number of CT scans performed daily. CT diagnostic performance were calculated and variations between phases were tested for equivalence or difference using Bayesian methods.

Results: 2194 consecutive chest CT were analyzed. Overall CT diagnostic performance was Se = 84.2 [82.0 ; 86.3], Sp = 86.6 [84.5 ; 88.5], PPV = 86.1 [84.0 ; 88.1], NPV = 84.7 [82.6 ; 86.7] and accuracy = 85.4 [83.9 ; 86.8], with no significant differences between chest and non-chest radiologists. Variations between the ascending (11 days, 281 chest CT, disease prevalence 37.0 %), the peak (18 days, 1167 chest CT, disease prevalence 64 %) and the descending phases (19 days, 746 chest CT, disease prevalence 32.2 %) were highest for PPV and NPV with a probability of difference >99.9 %, and smallest for accuracy and specificity with a probability of equivalence >98.8 %.

Conclusion: In a homogenous cohort of 2194 consecutive chest CT performed over a 7-week epidemic wave, we observed significant variations of CT predictive values whereas CT specificity appeared marginally affected.
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http://dx.doi.org/10.1016/j.ejrad.2020.109425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836755PMC
January 2021

The Good, the Bad, and the Hoax: When Publication Instantaneously Impacts Treatment Strategies for COVID-19.

Antimicrob Agents Chemother 2020 07 22;64(8). Epub 2020 Jul 22.

CHU de Strasbourg, Service de Maladies Infectieuses et Tropicales, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1128/AAC.01127-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526849PMC
July 2020

Local outbreak of Clostridioides difficile PCR-Ribotype 018 investigated by multi locus variable number tandem repeat analysis, whole genome multi locus sequence typing and core genome single nucleotide polymorphism typing.

Anaerobe 2019 Dec 13;60:102087. Epub 2019 Aug 13.

National Reference Laboratory for Clostridium Difficile, Hôpital Saint-Antoine, 34, Rue Crozatier, Paris, France; Université Paris Descartes, Faculté de Pharmacie, Inserm UMR S-1139, 4 Avenue de l'Observatoire, 75006, Paris, France.

The prevalence of Clostridioides difficile PCR-ribotype (RT) 018 is low in Europe but variations are observed across countries. We report here the first RT 018-related outbreak in France that took place in 4 geriatric units (GU) in Strasbourg, France. From January to December 2017, 38 patients were diagnosed with C. difficile infection (CDI). Strains were first characterized by PCR ribotyping: 19 out of 38 (50%) strains belonged to RT 018. These strains as well as 12 RT 018 isolated in other French healthcare facilities and 2 strains of RT 018 isolated in the GU in 2015 were characterized by multi locus variable-number tandem repeat (VNTR) analysis (MLVA), whole genome multi locus sequence typing (wgMLST) and core genome single nucleotide polymorphism typing (cgSNP). The MLVA indicated that 15 out of 19 epidemic strains of RT 018 were included in 2 Clonal Complexes (CC). Four RT 018 strains from the outbreak did not belong to the CC. The wgMLST and cgSNP typing analysis revealed a single CC that included 19 strains from the geriatric unit (17 from GU in 2017 and 2 from GU in 2015) and 4 strains (33%) from other healthcare facilities (HCF). Our results suggest that a specific RT 018 clone has spread in the geriatric unit and has evolved slowly over time. MLVA, wgMLST and cgSNP typing results provided fairly consistent information but wgMLST and cgSNP typing better separated epidemic strains from non-epidemic strains. Compared to wgMLST, the cgSNP typing did not provide additional information.
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http://dx.doi.org/10.1016/j.anaerobe.2019.102087DOI Listing
December 2019

Sequential emergence of colistin and rifampicin resistance in an OXA-72- producing outbreak strain of Acinetobacter baumannii.

Int J Antimicrob Agents 2019 May 24;53(5):669-673. Epub 2019 Jan 24.

Centre National de Référence de la résistance aux antibiotiques, Centre Hospitalier Universitaire de Besançon, France; UMR6249 CNRS Chrono-Environnement, Université de Franche-Comté, Besançon, France.

Objectives: This study reported a hospital outbreak due to an extensively drug-resistant (XDR) OXA-72-producing strain of Acinetobacter baumannii (A. baumannii).

Methods And Results: The isolates were found to be genotypically indistinguishable by whole-genome multiple locus sequence typing, and to belong to the international clonal complex CC2. One of these isolates sequentially developed a high resistance to colistin and rifampicin under treatment, as a result of mutations in genes pmrB and rpoB, respectively. The bla gene was localised on a 10-kb transferable plasmid, named pAB-STR-1, whose sequence is nearly identical to that of another plasmid previously found in Lithuanian strains, pAB120.

Conclusion: This report highlighted the need to carefully monitor the emergence of colistin and rifampicin resistance in patients treated for infections with multidrug-resistant A. baumannii.
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http://dx.doi.org/10.1016/j.ijantimicag.2019.01.012DOI Listing
May 2019

IT-CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety.

J Am Med Inform Assoc 2017 Mar;24(2):323-330

Department of Public Health, Univ. Lille EA 2694, CHU Lille, F-59000 Lille, France.

Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety.

Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases.

Material And Methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement.

Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data.

Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research.
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http://dx.doi.org/10.1093/jamia/ocw132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391728PMC
March 2017

Prevalence of cramps in patients over the age of 60 in primary care : a cross sectional study.

BMC Fam Pract 2016 08 12;17(1):111. Epub 2016 Aug 12.

General Medicine Department, Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, 67000, Strasbourg, France.

Background: Cramps are involuntary painful muscle contractions that mainly affect older people. Cramps may cause severe pain and sleep disturbance. Little information exists on the prevalence and the main features of cramps in primary care settings. The objective of this study was to estimate the prevalence and the main features of cramps among primary care patients aged 60 years and older.

Methods: We prospectively enrolled 516 patients aged 60 years and older in a cross-sectional study at 25 general practices in Alsace - France between October 2011 and March 2012. Questionnaires were used to obtain information about demographics, cramp presence and main features, medical history, and treatment.

Results: The adjusted prevalence was 46 % (95 % CI: 38-53 %). Thirty-one per cent of the study sample reported being woken up by cramps, 15 % had cramps more than 3 times a month. Logistic regression revealed a slightly higher prevalence in the age group 65-69 years compared to 60-64 years. No significant association was observed between other age groups and prevalence, or between gender and prevalence. The main localization of cramps was in the calves (80 %). The duration since onset was 5 years or more for 58 %.

Conclusions: Cramps are common in primary care, and although only a minority of patients report suffering from cramps more than once a week, many patients report cramp-related sleep disturbance. Further studies are needed to assess risk factors and therapeutic options for patients suffering from cramps in primary care.
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http://dx.doi.org/10.1186/s12875-016-0509-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983045PMC
August 2016

Trends in the risk of second primary cancer among bladder cancer survivors: a population-based cohort of 10 047 patients.

BJU Int 2016 07 17;118(1):53-9. Epub 2015 Nov 17.

Bas-Rhin Cancer Registry, EA 3430, FMTS, University of Strasbourg, Strasbourg, France.

Objectives: To determine whether the risk of second primary cancer (SPC) among patients with bladder cancer (BCa) has changed over past years.

Materials And Methods: Data from 10 French population-based cancer registries were used to establish a cohort of 10 047 patients diagnosed with a first invasive (≥T1) BCa between 1989 and 2004 and followed up until 2007. An SPC was defined as the first subsequent primary cancer occurring at least 2 months after a BCa diagnosis. Standardized incidence ratios (SIRs) of metachronous SPC were calculated. Multivariate Poisson regression models were used to assess the direct effect of the year of BCa diagnosis on the risk of SPC.

Results: The risk of new malignancy among BCa survivors was 60% higher than in the general population (SIR 1.60, 95% confidence interval [CI] 1.51-1.68). Male patients presented a high risk of SPC of the lung (SIR 3.12), head and neck (SIR 2.19) and prostate (SIR 1.54). In multivariate analyses adjusted for gender, age at diagnosis and follow-up, a significant increase in the risk of SPC of the lung was observed over the calendar year of BCa diagnosis (P for linear trend 0.010), with an SIR increasing by 3.7% for each year (95% CI 0.9-6.6%); however, no particular trend was observed regarding the risk of SPC of the head and neck (P = 0.596) or the prostate (P = 0.518).

Conclusions: As the risk of SPC of the lung increased between 1989 and 2004, this study contributes more evidence to support the promotion of tobacco smoking cessation interventions among patients with BCa.
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http://dx.doi.org/10.1111/bju.13351DOI Listing
July 2016