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. Toulouse, Université de Toulouse 3 Paul Sabatier Faculté de chirurgie dentaire, 2013.

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, Haute Autorité de Santé -Critères d'évaluation des pratiques professionnelles (EPP)

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, Le calcul du score de Charlson a été effectué à l'aide de l'algorithme présenté sur le site internet de la Société de Réanimation de Langue Française

, Les dossiers classés non conformes pour le choix des molécules sont les suivants : -Une EI à hémocultures négatives après changement d'une bioprothèse aortique traitée par amoxicilline 12g/j IV et gentamicine 3mg/kg/j IV sur les conseils du chirurgien cardiaque de Saint Augustin

, L'avis de l'infectiologue n'a pas été demandé. -Une EI à SCN meti-R sur TAVI, traitée par linézolide et rifampicine, posologie non précisée, relai oral à J15. La patiente n'a pas été présentée en RCP. d'un AVC massif avec hémiplégie gauche et paralysie faciale droite

, Une EI à Streptococcus dysgalactiae de résistance intermédiaire à l'amoxicilline (CMI= 0,15) sur valve mitrale native traitée par amoxicilline 12g/j IV + gentamicine (dose et durée non précisées), survenue d'une toxidermie. Un relai a été pris par daptomycine

, Une EI à Streptococcus gallolyticus traitée par amoxicilline-acide clavulanique 3g/j IV pendant 7 jours puis décès

, Une EI à SAMS sur valve native mitrale traitée initialement par cloxacilline 12g IV + rifampicine 1200mg PO (avis de la RCP de Libourne) pendant 3 semaines et relayée par sulfamethoxazoletrimétoprime 1cp*2/j PO + rifampicine 1200mg PO pour 3 semaines supplémentaires

, Il s'agissait d'un abcès intra-cardiaque dans deux cas : -Un patient de 68 ans (Charlson=6) ayant une EI à Enterococcus faecalis sur bioprothèse aortique, avec présence d'un abcès péri-prothétique. Le médecin en charge du patient conclut à l'absence d'indication chirurgicale. Le patient n'a pas été présenté en RCP à Libourne ni à Bordeaux

, Une patiente de 78 ans (Charlson=4) ayant une EI à hémocultures négatives sur bioprothèse aortique compliquée d'un AVC sylvien droit profond. Doute sur la présence d'un abcès du trigone

, Un patient de 85 ans (Charlson=11) présentant une EI à Enterococcus faecalis sur sa bioprothèse aortique compliquée de trois abcès de la paroi aortique. La RCP de Libourne n'évoque pas la chirurgie. L'expert a jugé la prise en charge chirurgicale CONFORME. ? Une « décompensation cardiaque » : -Un patient de 84 ans (Charlson=6) ayant présenté un choc septique à Streptococcus agalactiae en post-opératoire d'une néphrectomie pour adénocarcinome du rein gauche. Plusieurs végétations (tailles non précisées) étaient repérables sur sa valve mécanique aortique. Il n'a pas été présenté en RCP à Libourne ni à Bordeaux. L'avis de l'infectiologue n'a pas été demandé

«. ?-une, ayant une myélodysplasie de bon pronostic, une bactériémie à SCN meti-S, une végétation de 10mm sur valve aortique native, et des emboles : un AVC ischémique de la capsule interne droite et une spondylodiscite L2-L3-L4. Son dossier n'a pas été présenté en RCP à Libourne ni à Bordeaux. L'avis de l'infectiologue n'a pas été demandé, Une patiente de 79 ans (Charlson=8)

D. Serment and . Hippocrate,

, Au moment d'être admis à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité

, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux, individuels et sociaux

, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte

, Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences

, Reçu à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs

, Je ne prolongerai pas abusivement les agonies. Je ne provoquerai jamais la mort délibérément

, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés

, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité

, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses