Since several years, the use of intravenous immunoglobulins (IVIg) has increased. This growth has encouraged some countries to publish guidelines. In parallel, some countries have conducted audits to know how IVIg are used in clinical practice in the light of the available guidelines. The objective of this study was to assess IVIg use in three French university hospitals in 2006. All IVIg administrations were evaluated during 6 months (12 September 2005-12 March 2006) in French university hospitals of Marseille. Different data were recorded for each administration: patient characteristics, indication, formulation and quantity. During the study period, 2802 administrations of IVIg (corresponding to a total quantity of 76 780 g) have been recorded. Four hundred and thirty-five patients received at least one of these administrations. The five most reported indications were multifocal motor neuropathy (11.0% of total quantity), chronic inflammatory demyelinating polyradiculoneuropathy (10.2%), corticoresistant dermatomyositis (10.2%), immune thrombocytopaenia (9.9%) and primary immune deficiency (9.1%). According to available French recommendations, 70% of the IVIg use was for 'acknowledged indications', 9% for 'indications to be assessed' and 18% for 'unwarranted indications'. The 10 most reported indications were 'acknowledged indications' according to available recommendations of the French expert group. Nevertheless, the two most reported indications were not approved by the French Health Products Agency (AFSSAPS) at the time of the study and were approved since.

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Introduction: Because of the increased use of im plantable access systems, the incidence of blood stream and catheter infections associated with these systems has concomitantly increased. Classically, he parin-lock flush solutions were used to prevent thrombosis; more recently, vancomycin was added to the solution to prevent infections caused by Gram- positive bacteria, particularly coagulase-negative Staphylococci. Disorders due to Gram-negative organ isms have now appeared in oncologic patients. We therefore tested the addition of colistin to heparin- vancomycin solutions. Colistin was chosen for its good activity against Gram-negative bacteria (98% susceptibility in our hospital), its good tolerance due to low systemic passage, and its low cost. Methods: We developed formulations contain ing heparin (100 IU/mL) and various concentrations of vancomycin (10-500 μg/mL) and colistin (10-100 μg/mL) in 0.9% NaCl. Each sterile solution was tested for physical and chemical compatibility (spectropho tometry, nuclear magnetic resonance, and pH mea surements) and its antibacterial activity (against ox acillin-resistant Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae exhibiting broad- spectrum betalactamase (BSBL), imipenem-resistant Pseudomonas aeruginosa) for 2 months at 4°C and at room temperature. Results: The most suitable combination of drugs is heparin (100 IU/mL), vancomycin (100 μg/mL), and colistin (100 μg/mL). This flush solution main tains activity when stored at 4°C for up to 1 month. Conclusions: We feel that the combination of heparin, vancomycin, and colistin can be used as a flush solution for indwelling catheters.

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AIMSThe objective of this study has been to evaluate, prospectively, to what extant the administration of antibiotics in surgical prophylaxis conforms with the established guide-lines laid down by the infections Comralilecs. MATERIAL AND METHODSAn incidence prospective multicontre study with a five weeks duration was carried out in 3 hospitals. All operated patients (n=562) were included with the exception of those from eye, ear, nose and throat surgery. A specially demgned form was used for data collection. The data used came from anesthesia and pharmacotherapeimc profiles.The valuation of prophylactic treatment was performed by a team of two pharmacists and one surgeon.hldication, antibiotic election, initiation and duration of prophylaxis were analyzed, RESULTSThirty-seven percent of 207 patients studied received antibiotic phrophylactic treatment Although there were differences betw-cn hospitals, an average of 40% of the antibiotic administered did not conform with the guide-lines established in each centre. The results "~ere 57%, 56% and 13% respectively. The adininistration of antibiotic phrophylaxis more than an hour before strutting surgery was the main inappropriate use (44%). CONCLUSIONSProspective studiesare useful for evaluating the use of antibiotics ill surgical prophylaxis. They enable the inclusion of a large number of patients and also an oblective measurement of the level of adherence to the Infection Comreattees recomanded guidu-lmes. This in turn determines wether or not corrective measures should be taken,