Clichy Sous Bois

Multidrug resistant (MDR) bacteria are a growing global health threat, especially in Intensive Care Units (ICU) where antibiotic use is high. Ventilator associated pneumonia (VAP) is the leading healthcare-associated infection in ICUs and accounts for more than half of antibiotic prescriptions there. This trial explores whether antimicrobial stewardship, involving daily assessments to determine if antibiotic treatment can be safely stopped, is as effective as standard fixed-duration antibiotic therapy for VAP in reducing mortality, treatment failure, or new pneumonia episodes. This phase III, national, multicenter, randomized clinical trial compares two treatment approaches for confirmed VAP. One group will undergo antimicrobial stewardship with daily clinical evaluations to decide if antibiotics can be discontinued early based on clinical cure. The control group will receive the standard guideline-recommended 7-day antibiotic course regardless of daily clinical assessments. Both groups are monitored closely throughout treatment. Participants will be followed for 28 days to assess outcomes including mortality, treatment failure, and new pneumonia episodes. Daily clinical assessments will guide treatment decisions in the stewardship group, while the control group follows fixed treatment durations. Researchers will collect clinical data, microbiological results, and oxygenation status, aiming to demonstrate that shorter antibiotic courses guided by daily evaluations do not worsen patient outcomes compared to standard care.

Researchers are investigating hereditary pancreatitis (HP), a rare condition caused by mutations in the PRSS1 gene or family history of chronic pancreatitis without other known causes like alcohol use. This study aims to understand the natural course of hereditary pancreatitis linked to PRSS1 mutations and to measure how often pancreatic adenocarcinoma, a type of pancreatic cancer, occurs in affected patients. Participants in this study are identified through genetic testing records from three French hospital laboratories. Those carrying a PRSS1 mutation and receiving care at these centers are invited to join. The study involves collecting health data from medical records and completing questionnaires during routine care visits. The patient group is continuously updated as new cases are diagnosed, and data completeness is reviewed every five years. Participants are followed annually during their regular healthcare visits, where medical information is gathered. Additionally, questionnaires are administered every five years to collect more detailed information. The main outcome measured is the incidence of pancreatic adenocarcinoma over a 20-year period, allowing researchers to better understand the long-term risks and natural history of hereditary pancreatitis in this population.

Researchers are evaluating whether liver transplantation after selective internal radiation therapy (SIRT) combined with chemotherapy can improve the 3-year overall survival in patients with locally advanced intrahepatic cholangiocarcinoma, which is a type of liver cancer that cannot be surgically removed but has not spread to other parts of the body. This study focuses on patients aged 18 to 65 who have a limited number of liver tumors and no spread outside the liver, aiming to improve treatment outcomes in this difficult-to-treat cancer. Participants will first receive SIRT along with gemcitabine and cisplatin chemotherapy. After this treatment, doctors will use CT scans, liver MRI, and PET-CT to check the tumor's response or stability. Then, patients will undergo exploratory surgery to ensure they are suitable for liver transplantation. Those without contraindications will be placed on a transplant waiting list, with at least a 3-month waiting period before the transplant. During the study, participants will be closely monitored after the liver transplant to assess liver graft function and to evaluate how well they tolerate immunosuppressive therapy, which prevents transplant rejection. The main outcome measured is the overall survival rate three years after the transplant. The entire study involves following patients through their treatments and post-transplant care to understand the benefits and safety of this combined approach.