Infectious diseases now最新文献

Introduction

Management of bone and joint infections (BJI) requires prolonged and high-dose antibiotic therapy to achieve target concentrations in bone tissue. However, these therapies often lead to adverse effects in patients who are frequently fragile, with multiple comorbidities and associated medications. The decision to treat these complex cases is made during a multidisciplinary team meeting at the reference centre for complex osteoarticular infections (CRIOAC).

Material and Methods

Elaborated by a pharmacist during CRIOAC meetings, a single-centre before-and-after comparative study of drug-related issues observed during pharmaceutical interventions (PIs), was conducted. For each patient included, a retrospective case was added. PIs were independently evaluated by a committee of infectiologists and pharmacists to assess their criticality.

Results

Sixty patients were included in the intervention group, with 59 controls. The population was homogeneous, with a median age of 65 years. Most BJI cases were complex (65.5 %), primarily involving prosthetic joint infections. Staphylococcus species were the predominant pathogens. Antibiotic therapy adapted to antibiograms was orally relayed for 74 % of patients, with 5.9 % requiring re-hospitalization due to adverse effects. Sixty-two PIs were performed, representing an average of 1.8 PIs per meeting or 34.4 % of patients. Dosage adjustment accounted for 42 % of PIs, drug interactions for 46 %, and treatment availability in community pharmacies for 8 %.

Regarding criticality, three PIs were classified as vital, 22 as major, 22 as moderate, and 15 as minor in both groups, with the same distribution between the intervention and control groups.

Conclusion

This study demonstrates that by collaborating with surgeons and infectiologists, pharmacists participating in CRIOAC meetings can strongly help to prevent drug-related problems in patients with BJIs.

Objective

Our aim was to audit antibiotic prescriptions from renewed medical staff.

Methods

A retrospective multicenter audit of antibiotic therapies was performed in four institutions with similar antimicrobial stewardship programs. We compared antibiotic prescriptions from physicians practicing before and after the pandemic. Antibiotic prescriptions were classified as optimal (OAT), suboptimal (SAT) or unnecessary antibiotic therapy (UAT).

Results

All in all, 165 antibiotic courses was audited in 2023: OAT, SAT and UAT rates were 21, 42 and 38% respectively. Sixty-seven out of 165 (41%) prescriptions were given by new physicians. In multivariate analysis, antibiotic prescriptions from the latter compared to former were associated with less diagnosis of infection written in patient charts: AOR [CI 95%] 3.68 [1.53–8.83], and with UAT: 2.76 [1.34–5.68].

Conclusions

Ensuring adequate antibiotic prescriptions with renewed medical staff requires a high level of education and training.

Objectives

This study aims to assess the urinary diffusion and clinical effectiveness of voriconazole in patients with fluconazole-resistant urinary candidiasis.

Patients and methods

In this prospective pilot study, we utilized a validated chromatography method to measure voriconazole in urine over a 12-hour period between two administrations of the drug and in plasma at trough.

Results

Thirty-five patients, including five with fluconazole-resistant urinary candidiasis, were included. Urine and plasma voriconazole concentrations, mean 1.7 mg/L (range: 0.3–12.6) and mean 2.0 mg/L (range: 0.1–11.1) respectively, exhibited a strong correlation (R² = 0.88). None of the five patients treated for candidiasis experienced clinical or microbiological failure following treatment, with urine concentrations ranging from 0.5 to 2.7 mg/L.

Conclusions

The urinary diffusion of voriconazole resulted in drug exposure above the target minimum inhibitory concentration (MIC) in the five patients treated for voriconazole-susceptible Candida strains in urine. Therapeutic drug monitoring may allow optimize in situ concentrations.

Background

Vector-borne diseases such as malaria and arboviruses are common etiologies of post-travel fever.

Methods

After excluding malaria, we retrospectively analyzed the diagnosis of dengue virus (DENV), chikungunya virus (CHIKV), and zika virus (ZIKV) infections following recent travel by patients treated at the Strasbourg University Hospital between 2014 and 2023. Available serums (n = 35) sampled in 2023 were retrospectively tested for DENV, CHIKV, and ZIKV infections.

Results

Our results showed that 78% of the 915 malaria-negative patients without changes over the course of ten years had not undergone arbovirus infection testing. Retrospective testing revealed missing arbovirus infections: two DENV infections and one CHIKV infection, representing 8.6% (3/35) of patients for whom no mandatory declaration or vector control could be undertaken.

Conclusion

Our results highlight the need for early case detection, particularly in the context of the upcoming 2024 Olympic Games.

As a variant of Vaccinia virus, Buffalopox virus is known to cause Buffalopox disease. In recent times, sporadic outbreaks of the infection in humans have been reported, especially in the endemic countries of Southeast Asia. Though mortality has not been high, associated morbidity is significant. Due to waning cross-protective immunity against smallpox, Buffalopox virus is one of the several orthopox viruses likely to emerge or reemerge. To combat this virus, early recognition, isolation, and management of the infection in animals and humans is of prime importance. In addition, vaccination in animals and humans at risk of acquiring infection is essential as a means of limiting animal-to-animal and animal-to-human spread of the virus. With this in mind, a collaborative approach between the animal and human health sectors is indispensable.

Objectives

To compare the supply of molnupiravir and nirmatrelvir/ritonavir in relation to patient characteristics and other co-prescribed medicines and to estimate the number of patients without contraindications to nirmatrelvir/ritonavir who were treated with molnupiravir.

Study design, setting

Retrospective observational study of patients identified in the Pharmaceutical Benefits Scheme (PBS) 10 % sample dataset who were supplied with either molnupiravir or nirmatrelvir/ritonavir between May and December 2022. We supplemented the PBS dataset with aggregated counts from published literature to determine prevalence of clinical contraindications to nirmatrelvir/ritonavir.

Main outcome measures

We used multivariable Poisson regression to estimate risk ratios (RR) of receiving nirmatrelvir/ritonavir over molnupiravir.

Results

We identified 54,550 patients who received either nirmatrelvir/ritonavir (26.8 %) or molnupiravir (73.2 %). Their average age was 71.6 (SD = 13.4) years and 57.1 % were female. Patients were less likely to receive nirmatrelvir/ritonavir with increasing age (RR = 0.50; 95 % CI: 0.48–0.53; for ages 85 + compared to < 65 years) or who had received medicines contraindicated for use with nirmatrelvir/ritonavir (RR = 0.66; 95 % CI: 0.64–0.68). During the study period, we estimated that between 28.4 % and 45.4 % of patients aged ≥ 65 years had received molnupiravir in the absence of pharmacological and clinical contraindications to nirmatrelvir/ritonavir.

Conclusion

Many prescriptions were written for molnupiravir where there were no contraindications to nirmatrelvir/ritonavir. The benefits that followed from prompt government action in approving and obtaining nirmatrelvir/ritonavir were therefore likely to be less than they could potentially have been. Governments should consider investing in quality improvement systems to ensure the best outcomes in terms of efficacy and safety.

Objectives

The objectives were to assess trends over the past 10 years in vaccination coverage rates (VCR) among adolescents in France aged 14–15 years, factors influencing decisions to vaccinate, and mothers’ opinions on adolescent vaccination.

Patients and Methods

The ‘Vaccinoscopie’ internet survey is completed each year by mothers of adolescents, with questions about vaccinations received by their children, and their attitudes and barriers to vaccination. The 2012 to 2021 surveys were analyzed in this study, including data from 1500 adolescents in 2012 and 1000 adolescents each year from 2013 to 2021.

Results

None of the adolescent VCR targets were met, despite significant increases since 2012 for vaccines with the lowest coverage rates and vaccines with high but insufficient coverage i.e., meningococcal C (28.7% to 60.8%), HPV in girls (14.2% to 40.8%), hepatitis B (31.6% to 47.3%) and pertussis (76.3% to 91.0%). Physicians remained the primary source of vaccination information for 90.4% of mothers, and their advice had a real impact on improving VCRs. Adolescents were increasingly involved (40.1%) in decisions about vaccination. Depending on the vaccine, over 80% of mothers currently consider adolescent vaccination as useful or essential. Since 2017, they also feel better informed.

Conclusions

Low and under-target VCRs put adolescents at risk of severe disease, and do not enable herd immunity or reduced transmission to other vulnerable age groups to be accomplished. Healthcare professionals must take every opportunity to check adolescents’ vaccination status and recommend catch-up vaccines where applicable. Vaccination in schools should be considered.

Introduction

Spinal tuberculosis is often associated with poor outcomes; host-directed inflammation involving the spine contributes to this disability.

Methods

A retrospective review of patients with complicated spinal tuberculosis having received tumor necrosis factor-alpha (TNF-α) antagonists at a referral hospital in South Africa. A literature review was performed to identify all published cases of complicated spinal tuberculosis that received a TNF-α antagonist as part of their treatment.

Results

We describe 23 cases, of which 19 were previously reported in the literature. All patients were treated with either thalidomide (n = 6) or infliximab (n = 16), except for one who received both. All in all, 21 (91%) cases improved neurologically and, at the end of follow-up, 18 could walk.

Conclusion

There is accumulating experience to confer the efficacy and safety of TNF-α antagonists in treating complicated spinal tuberculosis cases. Evidence from randomized controlled trials is urgently required to substantiate these findings.

Objectives

We aimed to quantify the individual risk of antimicrobial resistance among patients with community-acquired Escherichia coli urinary tract infection (UTI) according to their antibiotic exposure over the previous 18 months.

Patients and methods

French patients were prospectively recruited in two centers in 2015–2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files.

Results

Previous antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20–2.21], 1.59 [1.02–2.48], 3.01 [1.90–4.77], and 2.60 [1.75–3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41–1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18]).

Conclusions

Resistance of E. coli causing UTI is partially predicted by previous personal antibiotic delivery.

Objectives

This study aims to understand a major result of ComCor, an online epidemiological study conducted to identify the circumstances of COVID-19 infection in France from 2020 to 2022: One third of respondents reported ignoring the circumstances of their infection.

Methods

We conducted a qualitative study through semi-structured interviews, diagnosed in spring or summer 2021. Interviews were audio recorded, transcribed, and thematically analyzed.

Results

Fifty interviews were conducted. Half of the participants in Qualicor were able to identify several at-risk situations, most often involving their entourage (family, friends, colleagues), but were uncertain as to which specific situation was the source of infection. Less than one quarter strongly suspected a specific situation without certainty, a similar proportion were unable to identify any circumstances, and only two people were certain about the origin of the infection. Several factors contributed to this lack of knowledge: a desire to conceal these circumstances (in a few rare cases), limitations of the questionnaire, lack of knowledge about how the virus is transmitted, selective perception of at-risk situations, co-existence of several possible sources of infection, and the difficulty of taking an objective view of certain circumstances of transmission.

Conclusion

Our study shows the benefits of a mixed approach designed to better understand the perception of Covid 19 contamination circumstances in the French population. It also highlights the need to strengthen or improve communication on modes of virus transmission, especially airborne transmission, and the importance of maintaining certain preventive behaviors after vaccination.