Infectious diseases now最新文献

英文中文

Septic patients: time to do better! 脓毒症患者：时间做得更好！

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-10-18 DOI: 10.1016/j.idnow.2025.105167

Pierre Fillâtre , Rémy Gauzit

引用次数: 0

Evolution of the inappropriate use of broad-spectrum antibiotics for Pseudomonas aeruginosa infections following the 2022 CA-SFM guidelines 根据2022年CA-SFM指南，铜绿假单胞菌感染的广谱抗生素不适当使用的演变

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-10-14 DOI: 10.1016/j.idnow.2025.105166

C. Ourghanlian , D. Kharchenko , V. Fihman , A. Galy , P-L. Woerther , R. Lepeule

Introduction

The European Committee on Antimicrobial Susceptibility Testing (EUCAST) changed the definition of the ‘intermediate’ (I) category in 2019, now defined as ‘susceptible, increased exposure’. We previously reported an increase in prescriptions for antibiotics still reported as ‘S’, compared with those now reported as ‘I’. This study aimed to evaluate the influence of a more explicit abbreviation (SFP or ‘Susceptible increased exposure’) than ‘I’ on the use of overly broad-spectrum antibiotics for the treatment of infections caused by wild-type (WT) Pseudomonas aeruginosa.

Methods

A retrospective observational multicenter study was conducted across five hospitals. Two study periods were defined, before and after the implementation of the new abbreviation (from September 2020 to February 2022, and from March 2022 to August 2023). All patients with an infection caused by WT P. aeruginosa treated with β-lactams were included. The main endpoint was the proportion of patients treated with an overly broad-spectrum antibiotic treatment by meropenem or ceftolozane/tazobactam.

Results

A total of 279 patients were included. No difference between groups was found, in terms of infection, microbiology, or demographic characteristics. Eight overly broad-spectrum antibiotic treatments by meropenem or ceftolozane/tazobactam were observed in Period 1 (5.6 %), versus one in Period 2 (0.7 %; p = 0.026). No overly broad-spectrum treatment was observed when the antimicrobial stewardship team had given advice.

Conclusions

The French recommendations derived from the EUCAST guidelines, with a new abbreviation, have contributed to a reduction in the prescription of broad-spectrum antibiotics and have helped mitigate clinicians’ misunderstanding of the previous guidelines.

导语：欧洲抗微生物药敏试验委员会（EUCAST）于2019年更改了“中间”(I)类别的定义，现在定义为“易感，暴露增加”。我们以前报道过，与现在报告的抗生素处方“I”相比，仍然报告为“S”的抗生素处方有所增加。本研究旨在评估比“I”更明确的缩写（SFP或“易感增加暴露”）对使用过度广谱抗生素治疗野生型（WT）铜绿假单胞菌引起的感染的影响。方法：在5家医院进行回顾性观察性多中心研究。定义了新缩写实施前后的两个研究时期（2020年9月至2022年2月和2022年3月至2023年8月）。所有接受β-内酰胺治疗的铜绿假单胞菌感染患者均被纳入研究。主要终点是接受美罗培南或头孢唑烷/他唑巴坦等过度广谱抗生素治疗的患者比例。结果：共纳入279例患者。在感染、微生物学或人口统计学特征方面，各组之间没有发现差异。第1期观察到美罗培南或头孢唑烷/他唑巴坦的8个过度广谱抗生素治疗（5.6 %），第2期观察到1个（0.7 %;p = 0.026）。当抗菌素管理小组给出建议时，没有观察到过度广谱的治疗。结论：由EUCAST指南衍生而来的法国推荐，使用了一个新的缩写，有助于减少广谱抗生素的处方，并有助于减轻临床医生对以前指南的误解。

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引用次数: 0

Efficacy of antimicrobial stewardship indicators in assessing the impact of a regional antibiotic therapy center in primary care and nursing homes 抗菌药物管理指标在评估区域抗生素治疗中心在初级保健和养老院的影响中的功效。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-10-10 DOI: 10.1016/j.idnow.2025.105165

Renan Le Cras , Patricia Vidal , Patricia Pavese , Patrice François , Anna Sette , Philippe Lesprit , on behalf of the CRAtb-AuRA

Objective

This study describes the implementation and short-term evolution of the antibiotherapy indicators selected by the Regional Antibiotherapy Center of Auvergne-Rhône-Alpes for utilization in primary care and nursing homes.

Material and Methods

This retrospective observational study was based on public reimbursement data between 2021 and 2023. Seven indicators were selected for the community and eight for nursing homes.

Results

We observed positive trends for first-line antibiotics for female urinary tract infections (community: + 28 %, nursing homes: +18 %), treatment duration > 7 days (community: −7,8%; −13,4% for amoxicillin-clavulanic acid; nursing homes: −20,5%), fluoroquinolones in nursing homes (−16 %) and combination of amoxicillin-clavulanic acid with metronidazole or amoxicillin in the community (–22 %). That said, total antibiotic consumption increased in the community (+16.5 %), while remaining stable in nursing homes.

Conclusion

This study identified areas for improvement in antibiotic therapy in our region. A longer follow-up will be necessary to assess the potential impact of initiatives such as ours on proper antibiotic use.

目的：本研究描述了Auvergne-Rhône-Alpes区域抗生素治疗中心选择的抗生素治疗指标在初级保健和养老院使用的实施情况和短期演变。材料和方法：本回顾性观察性研究基于2021年至2023年的公共报销数据。社区选择了7个指标，养老院选择了8个指标。结果：我们观察到女性尿路感染一线抗生素治疗呈阳性趋势（社区：+ 28 %，养老院：+18 %），治疗持续时间 > 7天（社区：- 7.8%；阿莫西林-克拉维酸治疗：- 13.4%；养老院：- 20.5%），养老院氟喹诺酮类药物治疗（-16 %），社区阿莫西林-克拉维酸联合甲硝唑或阿莫西林治疗（-22 %）。也就是说，社区的抗生素总消费量增加了（+ 16.5% %），而疗养院的抗生素消费量保持稳定。结论：本研究确定了本地区抗生素治疗有待改进的领域。有必要进行更长时间的随访，以评估像我们这样的举措对正确使用抗生素的潜在影响。

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引用次数: 0

Prevention and management of syphilis in pregnant and perinatal women 孕妇和围产期妇女梅毒的预防和管理。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-10-06 DOI: 10.1016/j.idnow.2025.105162

Olivia Anselem , Chemsa Le Cœur , Asmaa Tazi , Marie Lachâtre , Roxane Gibert , Marion Caseris , Christelle Vauloup-Fellous , Didier Pinquier , Anaïs Chosidow , Marine Driessen , Elise Mallart , Aurélie Saunier , Mathilde Bergamelli , Najeh Hcini , Nadjet Benhaddou , Philippe Grange , Annick Barbaud , Angèle Soria , Jean-Winoc de Cousser , Maïder Coppry , Caroline Charlier

引用次数: 0

Real-life evaluation of intermittent triple antiretroviral therapy maintenance strategies 间歇性三联抗逆转录病毒治疗维持策略的现实评价。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-10-04 DOI: 10.1016/j.idnow.2025.105164

B HOELLINGER , D REY , P KLEE , C CHENEAU , C MENOULOU , T LEMMET , P GANTNER , A URSENBACH

Introduction

Intermittent antiretroviral therapy (ART) is commonly prescribed in France, but this strategy is not recommended internationally. The objective of this study was to evaluate real-life efficacy of intermittent ART in virologically suppressed individuals.

Methods

We conducted a retrospective non-comparative cohort study at Strasbourg University Hospital and included all people living with HIV (PLWH) on intermittent ART between 2017 and 2024. The primary outcome was virological success at W48 after initiation of intermittent ART.

Results

We included 160 PLWH. They were mainly males (80 %), with 59.4 % reporting sex with men and 75 % were born in France. Mean CD4 count was 672/mm³, and mean duration of viral suppression was 7.9 years. The third agent was a non-nucleoside reverse transcriptase inhibitor in 87/160 (54.3 %) participants, an integrase strand transfer inhibitor in 72/160 (45.0 %) participants, and one participant had a protease inhibitor. Three participants discontinued the intermittent ART strategy before W48, and five were lost to follow-up before W48, without virological failure at the time of the last update. We did not observe any virological failure at W48 for the remaining 152 participants, nor during longer follow-up (median 131 weeks). A blip occurred in five participants. Throughout the study period, 21/160 (13.1 %) PLWH discontinued intermittent ART strategy, mainly to switch for injectable ART (12/21, 57 %).

Conclusions

Our findings in real-life setting support intermittent triple ART as a safe, cost-effective, and well-tolerated maintenance option in selected compliant PLWH, including regimens with a lower genetic barrier to resistance.

简介：间歇性抗逆转录病毒治疗（ART）是法国常用的处方，但国际上不推荐这种策略。本研究的目的是评估间歇性抗逆转录病毒治疗在病毒学抑制个体中的实际疗效。方法：我们在斯特拉斯堡大学医院进行了一项回顾性非比较队列研究，纳入了2017年至2024年间接受间歇性抗逆转录病毒治疗的所有HIV感染者（PLWH）。主要结局是间歇抗逆转录病毒治疗开始后W48的病毒学成功。结果：我们纳入了160名PLWH。他们主要是男性（80% %），59.4% %报告与男性发生性行为，75% %出生在法国。平均CD4计数为672/mm3，平均病毒抑制时间为7.9 年。第三种药物是87/160（54.3 %）参与者的非核苷逆转录酶抑制剂，72/160（45.0 %）参与者的整合酶链转移抑制剂，一名参与者有蛋白酶抑制剂。3名参与者在W48之前停止了间歇性抗逆转录病毒治疗策略，5名参与者在W48之前失去了随访，在最后一次更新时没有病毒学失败。在其余152名参与者中，我们没有观察到W48时的任何病毒学失败，也没有观察到更长时间的随访（中位131 周）。有五名参与者出现了异常。在整个研究期间，21/160（13.1 %）的PLWH停止了间歇性抗逆转录病毒治疗策略，主要转向注射抗逆转录病毒治疗（12/ 21,57 %）。结论：我们在现实环境中的研究结果支持间歇性三联抗逆转录病毒治疗作为一种安全、经济、耐受性良好的维持选择，包括具有较低耐药性遗传屏障的方案。

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引用次数: 0

The 2024 cholera outbreak in Mayotte. Clinical and biological factors associated with severe forms of the disease in an observational cohort of 206 patients 2024年马约特霍乱爆发。在206例患者的观察队列中，临床和生物学因素与严重形式的疾病相关。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-25 DOI: 10.1016/j.idnow.2025.105163

Julien Carvelli , Coline Mortier , Mohamed Boucekine , Vincent Gilles , Yvonnick Boué , Guillaume Le Balle , Jeanne Broyon , Annabelle Lapostolle , Tanguy Cholin , Manon Dory , Chloé Andres , Renaud Piarroux , Louis Collet , Abdourahim Chamouine , Mohamadou Niang , for the CHOLEMAY Study Group

Objective

In 2024, the island of Mayotte (France) was affected by a cholera outbreak. The objective of this study was to identify clinical and laboratory criteria associated with severity (defined as hypovolemic shock and/or severe acidosis) in view of improving patient triage and therapeutic management in subsequent outbreaks.

Methods

From March 18 to July 12, 2024, we screened 215 patients with cholera (positive stool PCR). We excluded five patients who died outside hospital (no data, lethality = 2.3 %) and four patients for whom no data were available. We ultimately enrolled 206 patients. Severe forms of cholera were defined as the presence of at least one of the following three objective criteria: arterial hypotension; and/or neurological impairment (GCS < 14) (hypovolemic shock); and/or venous pH < 7.20 (severe acidosis) at first medical assessment.

Findings

Median patient age was 19 years (8–32 years), and 83 patients (40 %) presented with a severe form, which often consisted in fever (n = 13/83, 13 % vs. n = 6/123, 5 %, p = 0.04), vomiting (n = 71/83, 86 % vs. n = 79/123, 64 %, p < 0.001), a higher stool output (8 (4.5–10) vs. 4 (2–6) stools on day 1, p < 0.001) and severe hemoconcentration (Ht = 54 (47–60) vs. 43 (38–50), p < 0.001). In multivariate analysis, only hemoconcentration was associated with significantly greater severity (OR 95 % CI = 1.12 [1.04–1.21], p < 0.001).

Conclusion

Cholera is a toxin-mediated infection responsible for severe, occasionally fatal acute watery diarrhea. Severity is associated with neurological impairment, metabolic acidosis, and hemoconcentration. Triage and care of these patients are absolutely essential means of preventing death.

目的：2024年，法国马约特岛发生霍乱疫情。本研究的目的是确定与严重程度（定义为低血容量性休克和/或严重酸中毒）相关的临床和实验室标准，以便在随后的疫情中改善患者分诊和治疗管理。方法：从2024年3月18日至7月12日，对215例霍乱患者（粪便PCR阳性）进行筛查。我们排除了5例院外死亡患者（无资料，致死率 = 2.3 %）和4例无资料的患者。我们最终招募了206名患者。严重形式的霍乱被定义为至少存在以下三个客观标准中的一个：动脉低血压；和/或神经功能障碍（GCS < 14）（低血容量性休克）；和/或首次医学评估时静脉pH < 7.20（严重酸中毒）。发现:病人平均年龄为19 年(8-32 年),和83例(40 %)出现严重的形式,通常是在发烧(n = 13/83,13 %与n = 6/123,5 % p = 0.04),呕吐(n = 71/83,86 %与n = 79/123,64 % p 结论:霍乱是一种toxin-mediated负责严重感染,有时致命的急性水样腹泻。严重程度与神经功能损害、代谢性酸中毒和血液浓缩有关。对这些病人进行分类和护理绝对是预防死亡的必要手段。

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引用次数: 0

Precise identification and improved surveillance of influenza viruses circulating in Conakry (Guinea) 准确识别和改进在科纳克里（几内亚）流行的流感病毒监测。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-15 DOI: 10.1016/j.idnow.2025.105161

F.A. Traore , M.L. Kourouma , G. Camara , I.I.A. Idriss , N. Camara , P. Fenano , M.B. Keita

引用次数: 0

Prevalence of digestive carriage of multi-drug resistant enterobacterales in hospitalized and community-based patients in Togo: a prospective study 多哥住院和社区患者消化道携带多重耐药肠杆菌的患病率：一项前瞻性研究。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-10 DOI: 10.1016/j.idnow.2025.105160

Rogatien Comlan Atoun , Iman Frédéric Youa , Lidaw Déassoua Bawe , Isidore Tchaou , Bodombossou Madera , Awereou Kotosso , Alexandre Bleibtreu , Taïssiri Adedjouma , André Pouwedeou Bedekelabou , Jules Tchédié , Yvette Siliadin , Eric Cardinale , Laurence Armand Lefevre , Brücker Gilles , Salou Mounerou , Claver Anoumou Dagnra , Didier Koumavi Ekouevi , Dominique Salmon

Introduction

The aim of this study was to estimate the prevalence of digestive tract carriage of ESBL-E/CPE among patients having consulted or been hospitalized in two university hospitals in Lomé in 2023.

Methods

A cross-sectional study was conducted from January to June 2023. Rectal swabs were collected from 230 participants (100 in maternity, 50 in pediatrics, 50 in trauma-orthopedics, and 30 in intensive care).

Results

Median age was four years for children and 30 years for adults. Overall prevalence of ESBL-E carriage was 59.6 %, while that of CPB was 6.1 %. Carriage was more frequent in hospital settings than in the community (64.6 % vs. 53.0 %). The main isolated species were Escherichia coli (95.6 %) and Klebsiella pneumoniae (27.7 %). Hospitalization units were associated with multidrug-resistant bacteria carriage.

Conclusion

These findings highlight a high prevalence of digestive tract carriage in hospital as well as community settings.

前言：本研究的目的是估计2023年在lomoise两所大学医院就诊或住院的患者消化道携带ESBL-E/CPE的患病率。方法：于2023年1 - 6月进行横断面研究。收集230名参与者的直肠拭子（产科100名，儿科50名，创伤骨科50名，重症监护30名）。结果：儿童中位年龄为4岁，成人中位年龄为30 岁。ESBL-E携带的总患病率为59.6% %，而CPB为6.1 %。医院分娩比社区分娩更频繁（64.6 %对53.0 %）。主要分离种为大肠埃希菌（95.6% %）和肺炎克雷伯菌（27.7% %）。住院单位与多重耐药细菌携带相关。结论：这些发现突出了医院和社区环境中消化道运输的高患病率。

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引用次数: 0

An update of histoplasmosis focusing on Portuguese epidemiological specificities 组织胞浆菌病的最新情况，重点关注葡萄牙流行病学特异性。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-05 DOI: 10.1016/j.idnow.2025.105158

Raquel Sabino , Cristina Veríssimo , Francisco Antunes

引用次数: 0

Determinants of sustainable adoption in primary care of a clinical decision support system for antimicrobial prescribing: A qualitative study 抗菌药物处方临床决策支持系统在初级保健中可持续采用的决定因素：一项定性研究。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-09-05 DOI: 10.1016/j.idnow.2025.105157

N. Peiffer-Smadja , M. Thy , T. Delory , P. Jeanmougin , L. Giordano , J.Le Bel , E. Bouvet , Alison Helen Holmes , S. Lariven , R. Ahmad , F.X. Lescure

Objective

The objective of the study was to analyse the determinants for sustainable adoption by General Practitioners (GPs) of Antibioclic, a Clinical Decision Support System (CDSS) for antimicrobial prescribing, and the results of and limitations to its use in clinical practice.

Materials and methods

Individual interviews with GPs and a focus group were carried out concerning their use of Antibioclic, a CDSS for antimicrobial prescribing in primary care. Antibioclic is a publicly funded, freely available CDSS targeting 48 common infectious diseases. Interviews were recorded, transcribed and coded using NVivo 12. Data were analysed via inductive thematic analysis.

Results

Interviews were conducted with 25 GPs, and nine additional GPs participated in the focus group. Median age was 34 years (IQR 32–43) and 20 participants (59 %) were women. All of them frequently and sustainably used Antibioclic in their practice. Adoption of the CDSS was explained by system characteristics: usability, up-to-dating and trustworthiness; it was also considered as routinized, interwoven with consultations and antimicrobial prescribing, and conducive to improved practices and communication with patients. The GPs emphasized the role of CDSSs role in bridging the gap between clinical guidelines and daily practice, while contributing to contextual learning and continuous medical education. Lastly, participants pointed out the importance of co-design of CDSSs with end-users.

Conclusion

These determinants of sustainable adoption of a CDSS may guide future implementation of electronic tools in into clinical practice.

目的：本研究的目的是分析全科医生（gp）持续采用抗生素处方的临床决策支持系统（CDSS）的决定因素，以及其在临床实践中使用的结果和局限性。材料和方法：对全科医生和焦点小组进行个人访谈，了解他们使用抗生素的情况，这是一种用于初级保健抗菌药物处方的CDSS。抗生素是一种公共资助、免费提供的针对48种常见传染病的CDSS。使用NVivo 12对访谈进行记录、转录和编码。数据通过归纳专题分析进行分析。结果：对25名全科医生进行了访谈，另外9名全科医生参加了焦点小组。中位年龄为34 岁（IQR 32-43）， 20名参与者（59 %）为女性。他们在实践中都经常和持续地使用抗生素。系统的特点是：可用性、时代性和可靠性；它也被认为是常规化的，与会诊和抗菌药物处方交织在一起，有利于改善实践和与患者的沟通。全科医生强调了cdss在弥合临床指南和日常实践之间差距方面的作用，同时有助于背景学习和持续医学教育。最后，与会者指出与最终用户共同设计cds的重要性。结论：这些可持续采用CDSS的决定因素可能指导未来在临床实践中实施电子工具。

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