Rapid urine preparation prior to identification of uropathogens by MALDI-TOF MS.

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-ToF MS) has been introduced in clinical routine microbiology laboratories. For the rapid diagnosis of urinary tract infections, culture-independent methods prior MALDI-mediated identification have been described. Here, we describe a comparison of three of these methods based on their performance of bacterial identification and their potential as a routine tool for microbiology labs : (i) differential centrifugation, (ii) urine filtration and (iii) a 5-h bacterial cultivation on solid culture media. For 19 urine samples, all methods were directly compared and correct bacterial species identification by MALDI was used as performance indicator. A higher percentage of correct MALDI identification was obtained after filtration (78.9 %) and the growth-based method (84.2 %) as compared to differential centrifugation (68.4 %). Additional testing of 76 mono-microbial specimens (bacteriuria > 10(5) CFU/mL) confirmed the good performance of short growth with a 90.8 % correct MALDI score, with a potentially better fit to the routine workflow of microbiology labs.

[Anxiety: an independent factor of axillary brachial plexus block failure?]. / Anxiété: facteur prédictif d'échec du bloc axillaire sous neurostimulation?

OBJECTIVE: To evaluate the impact of the anxiety level using Spielberger test on axillary block success. STUDY DESIGN: Prospective double-blind study. PATIENTS AND METHODS: An axillary brachial plexus block was performed with a nerve stimulator for all patients undergoing elective or emergency upper limb surgery. Spielberger test result was blinded for both patient and anaesthesiologist performing the block. Time to perform the block (minutes) was measured. Anxiety and pain scores were assessed, using a numeric scale (NS), at different time. Successful block was defined as complete sensory blockade combined with painless during surgical incision. Data were compared using Spearman test and multivariate logistical regression analysis. RESULTS: Patients (184) were included (elective surgery=62%; emergency=38%). Failure rate was 10%. On multivariate logistical regression analysis, time to perform the block and NS anxiety score before starting the block were associated with block failure. Spielberger score correlated with NS anxiety score before puncture (Rho = 0,586, p<10(-4)). Anxiety level was increased in emergency context. CONCLUSION: Patient's anxiety level before axillary brachial plexus block is a risk factor of failure, especially in emergency condition. We suggest anesthesiologists to evaluate patient anxiety prior to block performance. A specific anxiolytic treatment may be recommend in some cases.

[Electrical nerve localization: non-linear relationship between intensity and pulse duration to stimulate a nerve]. / Neurostimulation: relation non linéaire entre intensité et durée pour stimuler un nerf.

OBJECTIVE: When performing a peripheral nerve block, the current allowing local anaesthetic injection is between 0.3 and 0.5 mA. It has never been assessed if such a threshold remains the same whatever be the pulse duration. The aim of this study was to determine the minimal current required to stimulate a nerve while different pulse durations were applied, and to evaluate the importance of the placement of the cutaneous electrode. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: One hundred and twenty posterior popliteal sciatic (S), femoral (F), or median (M) nerve blocks performed with a nerve stimulator were included. The minimal current for a clearly visible motor response of the corresponding muscle was recorded with a pulse duration set at 50, 150 and 300 micros. The same procedure was repeated with the electrode sited on the controlateral side, before injection of local anaesthetic. RESULTS: The mean lowest charge of current required to stimulate a nerve was 24+/-8 nC at 50 micros. At 150 and 300 micros, it has to be increased by 175 % (42+/-14 nC) and 280 % (67+/-23 nC), respectively. No significant difference in the charge required was noted either among S, F, or M, or by changing the cutaneous electrode position. Adequate anaesthesia was noted in all cases. CONCLUSION: The relationship between intensity and pulse duration is not linear. Moreover, a low charge of current does not seem to be appropriate with pulse duration equal or superior to 300 micros. The location of the cutaneous electrode does not seem to be important.

[Peripheral nerve block in orthopaedic surgery: multicentric evaluation of practicing professionals and impact on the activity of the recovery room]. / ALR périphérique en orthopédie: évaluation multicentrique des pratiques et impact sur l'activité de la SSPI.

OBJECTIVES: Since the last national survey on evaluation of professional practice in France, many peripheral nerve blocks techniques were developed. The aim of this study was to assess the place of such techniques and their impact on the stay in recovery room after orthopaedic surgery. STUDY DESIGN: Prospective, multicentric study. PATIENTS AND METHODS: Consecutive patients receiving a regional anaesthetic technique for orthopaedic surgery over a 15-day period were included in this multicenter study (four private clinics, two non-university and three university hospitals). Characteristics of blocks, duration of stay and activity of nurses in post-anaesthetic care unit (PACU) were recorded for each patient. RESULTS: A total of 289 blocks performed in 283 patients were analyzed. A regional anaesthetic technique was performed alone or associated with a light sedation (58 and 8% respectively) or with a general anaesthesia (44%). A continuous peripheral nerve block (mainly for femoral and iliofascial blocks) was performed in 25% of patients, mostly in university hospital and private clinics (35 and 26% respectively), but only in 3% of cases in non-university hospital. Mean duration of PACU stay was 64+/-67 minutes. This time was longer when regional anaesthesia was associated to or performed after general anaesthesia. Workload of nurses was a simple supervision in 47% of the cases (in 61% of patients receiving regional anaesthesia alone vs 21% in those with general anaesthesia, p<0.05). CONCLUSION: This survey confirms that peripheral nerve block became widely used in orthopaedic surgery. This decreases the medical workload in PACU, especially for distal upper limb surgery. Regional anaesthetic techniques must be well taught during formation cursus of residents.