COVID-19 has been associated with high rates of ventilator-associated pneumonia relapse. Antibiotic underdosing due to augmented renal clearance (ARC) has been suggested as a possible contributing factor. This retrospective study compared plasmatic beta-lactam concentrations between critically-ill COVID-19 and non-COVID-19 patients.
Patients and methods
We included measurements for cefotaxime, ceftazidime, cefepime and piperacillin. A multivariable logistic regression model was used to identify variables associated with underdosing.
Results
All in all, 361 samples were included from 126 patients. Median concentrations did not differ between COVID-19 and non-COVID-19 patients for any molecule, nor did the rate of underdosing (38 % vs 42 %, p = 0.68). In a logistic regression model adjusting for age, gender, BMI, creatinine clearance and type of beta-lactam molecule, COVID-19 status was not associated with underdosing (OR = 0.83 [0.38–1.83], p = 0.997).
Conclusions
Although underdosing of most commonly prescribed beta-lactams occurred in more than one third of cases in critically-ill COVID-19 patients, this rate did not differ from non-COVID-19 patients.
{"title":"Beta-lactam underdosing is not more frequent in COVID-19 than in non-COVID-19 critically ill patients","authors":"Maeva Palayer , Juliette Bernier , Emmanuel Pardo , Franck Verdonk , Tomas Urbina , Emmanuel Bourgogne","doi":"10.1016/j.idnow.2025.105137","DOIUrl":"10.1016/j.idnow.2025.105137","url":null,"abstract":"<div><h3>Objectives</h3><div>COVID-19 has been associated with high rates of ventilator-associated pneumonia relapse. Antibiotic underdosing due to augmented renal clearance (ARC) has been suggested as a possible contributing factor. This retrospective study compared plasmatic beta-lactam concentrations between critically-ill COVID-19 and non-COVID-19 patients.</div></div><div><h3>Patients and methods</h3><div>We included measurements for cefotaxime, ceftazidime, cefepime and piperacillin. A multivariable logistic regression model was used to identify variables associated with underdosing.</div></div><div><h3>Results</h3><div>All in all, 361 samples were included from 126 patients. Median concentrations did not differ between COVID-19 and non-COVID-19 patients for any molecule, nor did the rate of underdosing (38 % <em>vs</em> 42 %, p = 0.68). In a logistic regression model adjusting for age, gender, BMI, creatinine clearance and type of beta-lactam molecule, COVID-19 status was not associated with underdosing (OR = 0.83 [0.38–1.83], p = 0.997).</div></div><div><h3>Conclusions</h3><div>Although underdosing of most commonly prescribed beta-lactams occurred in more than one third of cases in critically-ill COVID-19 patients, this rate did not differ from non-COVID-19 patients.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105137"},"PeriodicalIF":2.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/j.idnow.2025.105135
In the aftermath of the COVID-19 pandemic, the structuring of a nationwide research network for preparation and response to emerging infectious diseases (EID) with epidemic or pandemic potential has become increasingly essential.
A nationwide EID operational research network (OPEN-ReMIE),is funded for five years through the France 2030 program and run by the French national research agency (ANR). Its primary missions are to accelerate hospital-based clinical research under epidemic or pandemic conditions with academic or industrial sponsors, and to pursue this effort in international research networks. OPEN-ReMIE governance is geared to steering this network and to guaranteeing its operability in inter- as well as crisis modes. It will be the point of entry for key international trial platforms, academic and private sponsors, regulatory agencies, associations of citizens and patients, and think tanks committed to promoting scientific integrity.
OPEN-ReMIE encompasses six work packages: (i) regulatory affairs, sponsoring, fast-track procedures and contracts; (ii) clinical site network management; (iii) methodology and management centers to provide methodological expertise (generic master protocols, sets of core and extended variable catalogs, electronic case reports form templates, data management and interoperability, monitoring…); (iv) laboratory and biological resource center management; (v) drug supply and pharmacovigilance supervisory board; (vi) training programs and communication plans for various stakeholders: research teams, healthcare professionals, students, associations of citizens and patients and, increasingly, civil society actors.
All in all, OPEN-ReMIE is a nationwide “preparedness task force” embedded in a large-scale European consortium for EID clinical research and working with other international EID clinical research platforms.
{"title":"Rapid-sequence clinical research before and during a pandemic: Lessons learned and the way forward","authors":"","doi":"10.1016/j.idnow.2025.105135","DOIUrl":"10.1016/j.idnow.2025.105135","url":null,"abstract":"<div><div>In the aftermath of the COVID-19 pandemic, the structuring of a nationwide research network for preparation and response to emerging infectious diseases (EID) with epidemic or pandemic potential has become increasingly essential.</div><div>A nationwide EID operational research network (OPEN-ReMIE),is funded for five years through the <em>France 2030</em> program and run by the French national research agency (ANR). Its primary missions are to accelerate hospital-based clinical research under epidemic or pandemic conditions with academic or industrial sponsors, and to pursue this effort in international research networks. OPEN-ReMIE governance is geared to steering this network and to guaranteeing its operability in inter- as well as crisis modes. It will be the point of entry for key international trial platforms, academic and private sponsors, regulatory agencies, associations of citizens and patients, and think tanks committed to promoting scientific integrity.</div><div>OPEN-ReMIE encompasses six work packages: <em>(i)</em> regulatory affairs, sponsoring, fast-track procedures and contracts; <em>(ii)</em> clinical site network management; <em>(iii)</em> methodology and management centers to provide methodological expertise (generic master protocols, sets of core and extended variable catalogs, electronic case reports form templates, data management and interoperability, monitoring…); <em>(iv)</em> laboratory and biological resource center management; <em>(v)</em> drug supply and pharmacovigilance supervisory board; <em>(vi)</em> training programs and communication plans for various stakeholders: research teams, healthcare professionals, students, associations of citizens and patients and, increasingly, civil society actors.</div><div>All in all, OPEN-ReMIE is a nationwide “preparedness task force” embedded in a large-scale European consortium for EID clinical research and working with other international EID clinical research platforms.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 7","pages":"Article 105135"},"PeriodicalIF":2.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the microbiological distribution and sensitivity of clinical strains from respiratory samples of inpatients to the antibiotics usually recommended for treatment of lower respiratory tract infection (LRTI).
Methods
Using the French SPARES (Surveillance et Prévention de l’AntibioRésistance en Etablissement de Santé) database, we recorded all respiratory microbiological samples collected in 2022 in 409 hospitals located in all regions of France. The distribution of main bacterial species and their resistance to the most frequently prescribed antibiotics for LRTI were compared by age group (18–64 years, 65–79 years, ≥ 80 years).
Results
Among 48,721 strains, 47.7 % were isolated from patients aged 18–64 years, 37.9 % aged 65–79 years, and 14.4 % aged ≥ 80 years. Enterobacteriaceae (30.1 %, 36.0 % and 35.1 %, respectively) and Pseudomonas aeruginosa (19.0 %, 25.0 % and 27.1 %) were the most prevalent pathogens, especially in older patients. Conversely, Haemophilus influenzae (14.5 %, 10.7 % and 8.7 %) and Streptococcus pneumoniae (8.3 %, 5.6 % and 3.4 %) were rare in older age. Overall antibiotic resistance increased with age across all classes: in increasing order of resistance, levofloxacin (9.2 %, 11.1 % and 13.2 %), piperacillin-tazobactam (14.5 %, 16.8 % and 17.4 %), cefotaxime (27.4 %, 34.3 % and 39.5 %), doxycycline (28.2 %, 37.4 % and 39.5 %), cotrimoxazole (32.1 %, 38.5 % and 40.2 %), and amoxicillin-clavulanate (37.2 %, 46.0 % and 51.4 %, p < 0.05 for all comparisons). More than half of the strains were resistant to amoxicillin and erythromycin.
Conclusions
In this large nationwide database of respiratory samples, older age was associated with a high prevalence of Enterobacteriaceae and P. aeruginosa and beta-lactam resistance, a finding challenging current LRTI probabilistic treatment. Conversely, H. influenzae and S. pneumoniae were rarely observed in patients over 80 years of age.
目的探讨住院患者呼吸道样本微生物学分布及对常用下呼吸道感染（LRTI）抗生素的敏感性。方法利用法国SPARES （Surveillance et prevention de l’antibio或健康状况监测与预防系统）数据库，对法国所有地区409家医院于2022年采集的所有呼吸道微生物样本进行记录。比较各年龄组（18-64岁、65-79岁、≥80岁）LRTI主要菌种分布及对常用抗生素的耐药性。结果48721株分离株中，18 ~ 64岁占47.7%，65 ~ 79岁占37.9%，≥80岁占14.4%。肠杆菌科（分别为30.1%、36.0%和35.1%）和铜绿假单胞菌（分别为19.0%、25.0%和27.1%）是最常见的致病菌，尤其是在老年患者中。相反，流感嗜血杆菌（14.5%，10.7%和8.7%）和肺炎链球菌（8.3%，5.6%和3.4%）在老年人中很少见。总体耐药率随年龄增长呈上升趋势，耐药率依次为左氧氟沙星（9.2%、11.1%、13.2%）、哌拉西林-他唑巴坦（14.5%、16.8%、17.4%）、头孢噻肟（27.4%、34.3%、39.5%）、多西环素（28.2%、37.4%、39.5%）、复方新诺明（32.1%、38.5%、40.2%）、阿莫西林-克拉维酸酯（37.2%、46.0%、51.4%），p <；0.05为所有比较)。半数以上的菌株对阿莫西林和红霉素具有耐药性。结论在这个庞大的全国呼吸样本数据库中，年龄越大，肠杆菌科和铜绿假单胞菌的患病率越高，β -内酰胺耐药性也越高，这一发现对目前的LRTI概率治疗提出了挑战。相反，在80岁以上的患者中很少观察到流感嗜血杆菌和肺炎链球菌。
{"title":"Antibiotic susceptibility according to age of clinical strains from hospital respiratory samples: A nationwide study","authors":"Alain Putot , Elodie Couve-Deacon , Marie-Cécile Ploy , Thibaut Fraisse , Jean-Philippe Lanoix , Virginie Prendki , Sylvain Diamantis","doi":"10.1016/j.idnow.2025.105133","DOIUrl":"10.1016/j.idnow.2025.105133","url":null,"abstract":"<div><h3>Objectives</h3><div>This study evaluated the microbiological distribution and sensitivity of clinical strains from respiratory samples of inpatients to the antibiotics usually recommended for treatment of lower respiratory tract infection (LRTI).</div></div><div><h3>Methods</h3><div>Using the French SPARES (<em>Surveillance et Prévention de l’AntibioRésistance en Etablissement de Santé</em>) database, we recorded all respiratory microbiological samples collected in 2022 in 409 hospitals located in all regions of France. The distribution of main bacterial species and their resistance to the most frequently prescribed antibiotics for LRTI were compared by age group (18–64 years, 65–79 years, ≥ 80 years).</div></div><div><h3>Results</h3><div>Among 48,721 strains, 47.7 % were isolated from patients aged 18–64 years, 37.9 % aged 65–79 years, and 14.4 % aged ≥ 80 years. <em>Enterobacteriaceae</em> (30.1 %, 36.0 % and 35.1 %, respectively) and <em>Pseudomonas aeruginosa</em> (19.0 %, 25.0 % and 27.1 %) were the most prevalent pathogens, especially in older patients. Conversely, <em>Haemophilus influenzae</em> (14.5 %, 10.7 % and 8.7 %) and <em>Streptococcus pneumoniae</em> (8.3 %, 5.6 % and 3.4 %) were rare in older age. Overall antibiotic resistance increased with age across all classes: in increasing order of resistance, levofloxacin (9.2 %, 11.1 % and 13.2 %), piperacillin-tazobactam (14.5 %, 16.8 % and 17.4 %), cefotaxime (27.4 %, 34.3 % and 39.5 %), doxycycline (28.2 %, 37.4 % and 39.5 %), cotrimoxazole (32.1 %, 38.5 % and 40.2 %), and amoxicillin-clavulanate (37.2 %, 46.0 % and 51.4 %, p < 0.05 for all comparisons). More than half of the strains were resistant to amoxicillin and erythromycin.</div></div><div><h3>Conclusions</h3><div>In this large nationwide database of respiratory samples, older age was associated with a high prevalence of <em>Enterobacteriaceae</em> and <em>P. aeruginosa</em> and beta-lactam resistance, a finding challenging current LRTI probabilistic treatment. Conversely, <em>H. influenzae</em> and <em>S. pneumoniae</em> were rarely observed in patients over 80 years of age.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 7","pages":"Article 105133"},"PeriodicalIF":2.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.idnow.2025.105126
Pierre Fillatre , Mathieu Blot , Damien Basille , Yacine Tandjaoui-Lambiotte , François Barbier , Aurélien Dinh
Empirical dual combination therapy with beta-lactam and macrolide is often the standard treatment of community-acquired acute pneumonia (CAP) in adults hospitalized in non-intensive care units. However, several recent studies question this standard treatment. The present literature review analyzes available data that compare beta-lactam monotherapy and dual antibiotic therapies in moderate CAP. Macrolides are associated with frequent adverse events (digestive, cardiovascular) as well as with an increase in bacterial resistance, and their clinical benefit in non-severe forms of CAP has yet to be proven. Three randomized trials of good quality did not show any reduction in mortality in patients treated with dual antibiotic therapy, and a large-scale observational real-life study did not show the clinical advantage of dual antibiotic therapy. Only patients with severe CAP could benefit from the addition of a macrolide as it covers atypical bacteria (and potentially because of its immuno-modulatory properties). Considering the current state of knowledge, beta-lactam monotherapy seems to be enough and preferable in moderate CAP, thus allowing to reduce exposure to macrolides and their consequences. The 2025 guidelines confirm the absence of indication for dual antibiotic therapy for mild documented CAP (except for Panton-Valentine leukocidin-producing S. aureus). Empirical dual antibiotic therapy is also recommended for patients hospitalized for severe CAP, with rapid de-escalation to monotherapy depending on the clinical evolution and microbiological results.
{"title":"Antibiotic combination indications for the treatment of community-acquired acute pneumonia","authors":"Pierre Fillatre , Mathieu Blot , Damien Basille , Yacine Tandjaoui-Lambiotte , François Barbier , Aurélien Dinh","doi":"10.1016/j.idnow.2025.105126","DOIUrl":"10.1016/j.idnow.2025.105126","url":null,"abstract":"<div><div>Empirical dual combination therapy with beta-lactam and macrolide is often the standard treatment of community-acquired acute pneumonia (CAP) in adults hospitalized in non-intensive care units. However, several recent studies question this standard treatment. The present literature review analyzes available data that compare beta-lactam monotherapy and dual antibiotic therapies in moderate CAP. Macrolides are associated with frequent adverse events (digestive, cardiovascular) as well as with an increase in bacterial resistance, and their clinical benefit in non-severe forms of CAP has yet to be proven. Three randomized trials of good quality did not show any reduction in mortality in patients treated with dual antibiotic therapy, and a large-scale observational real-life study did not show the clinical advantage of dual antibiotic therapy. Only patients with severe CAP could benefit from the addition of a macrolide as it covers atypical bacteria (and potentially because of its immuno-modulatory properties). Considering the current state of knowledge, beta-lactam monotherapy seems to be enough and preferable in moderate CAP, thus allowing to reduce exposure to macrolides and their consequences. The 2025 guidelines confirm the absence of indication for dual antibiotic therapy for mild documented CAP (except for Panton-Valentine leukocidin-producing <em>S.<!--> <!-->aureus</em>). Empirical dual antibiotic therapy is also recommended for patients hospitalized for severe CAP, with rapid de-escalation to monotherapy depending on the clinical evolution and microbiological results.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 6","pages":"Article 105126"},"PeriodicalIF":2.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.idnow.2025.105127
Mathieu Blot , Damien Basille , Aurélien Dinh , François Barbier , Pierre Fillatre
Preceding guidelines on treatment and management of community-acquired pneumonia (CAP) do not endorse systematic use of corticosteroids. The data in the literature show contradictory results; while some have suggested clinical improvement in cases of severe CAP, others have reported no significant benefit.
The recent CAPE-COD trial demonstrated a marked reduction of mortality and intubation through early hydrocortisone treatment (200 mg/d). Consequently, the 2025 French guidelines recommend its being used in cases of severe CAP requiring critical care (excluding influenza, myelosuppression, and aspiration pneumonia, which are not considered in the trial), with progressive de-escalation over the course of eight to fourteen days. Since no benefit has seen shown for non-severe CAP, corticosteroid therapy is not recommended in these cases.
{"title":"Indications for corticosteroids in the treatment of Community-Acquired pneumonia","authors":"Mathieu Blot , Damien Basille , Aurélien Dinh , François Barbier , Pierre Fillatre","doi":"10.1016/j.idnow.2025.105127","DOIUrl":"10.1016/j.idnow.2025.105127","url":null,"abstract":"<div><div>Preceding guidelines on treatment and management of community-acquired pneumonia (CAP) do not endorse systematic use of corticosteroids. The data in the literature show contradictory results; while some have suggested clinical improvement in cases of severe CAP, others have reported no significant benefit.</div><div>The recent CAPE-COD trial demonstrated a marked reduction of mortality and intubation through early hydrocortisone treatment (200 mg/d). Consequently, the 2025 French guidelines recommend its being used in cases of severe CAP requiring critical care (excluding influenza, myelosuppression, and aspiration pneumonia, which are not considered in the trial), with progressive de-escalation over the course of eight to fourteen days. Since no benefit has seen shown for non-severe CAP, corticosteroid therapy is not recommended in these cases.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 6","pages":"Article 105127"},"PeriodicalIF":2.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.idnow.2025.105128
V. Cattoir , A. Dinh , S. Jarraud , A.Le Monnier , P. Loubet
For patients hospitalized with community-acquired acute pneumonia (CAP), molecular tools (especially multiplex PCR syndromic panels) are associated with a significant improvement of microbiological diagnosis yield, compared with conventional methods. Two main families of tests are currently available: targeted viral PCR tests (influenza, SARS-CoV-2, RSV) performed on nasopharyngeal swabs and adapted to epidemic situations; and “upper respiratory tract” (nasopharyngeal) or “lower respiratory tract” (deep swabs) syndromic panels to detect a broad spectrum of viral and bacterial agents, sometimes including resistance genes.
These tests are not recommended for routine use in CAP patients treated in ambulatory settings. In hospitalized CAP patients, their use must be guided by severity, epidemic context, and therapeutic implications. “Upper respiratory tract” panels can be useful when an atypical agent or a virus undetected by targeted PCR tests is suspected. “Lower respiratory tract” panels must only be used in case of severe forms or complex situations.
Clinical trials showed real diagnostic value but variable clinical impact, which is often limited in the absence of an optimization strategy for the antibiotic therapy.
Multiplex PCR syndromic panels represent a promising step forward in the management of patients hospitalized with CAP, but their clinical value still depends on several factors: type of panel and swab, quick results, presence of mobile teams of infectious diseases specialists, and capacity to correctly interpret results to guide treatment decisions.
{"title":"Value of molecular biology tests in community-acquired acute pneumonia","authors":"V. Cattoir , A. Dinh , S. Jarraud , A.Le Monnier , P. Loubet","doi":"10.1016/j.idnow.2025.105128","DOIUrl":"10.1016/j.idnow.2025.105128","url":null,"abstract":"<div><div>For patients hospitalized with community-acquired acute pneumonia (CAP), molecular tools (especially multiplex PCR syndromic panels) are associated with a significant improvement of microbiological diagnosis yield, compared with conventional methods. Two main families of tests are currently available: targeted viral PCR tests (influenza, SARS-CoV-2, RSV) performed on nasopharyngeal swabs and adapted to epidemic situations; and “upper respiratory tract” (nasopharyngeal) or “lower respiratory tract” (deep swabs) syndromic panels to detect a broad spectrum of viral and bacterial agents, sometimes including resistance genes.</div><div>These tests are not recommended for routine use in CAP patients treated in ambulatory settings. In hospitalized CAP patients, their use must be guided by severity, epidemic context, and therapeutic implications. “Upper respiratory tract” panels can be useful when an atypical agent or a virus undetected by targeted PCR tests is suspected. “Lower respiratory tract” panels must only be used in case of severe forms or complex situations.</div><div>Clinical trials showed real diagnostic value but variable clinical impact, which is often limited in the absence of an optimization strategy for the antibiotic therapy.</div><div>Multiplex PCR syndromic panels represent a promising step forward in the management of patients hospitalized with CAP, but their clinical value still depends on several factors: type of panel and swab, quick results, presence of mobile teams of infectious diseases specialists, and capacity to correctly interpret results to guide treatment decisions.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 6","pages":"Article 105128"},"PeriodicalIF":2.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.idnow.2025.105125
Aurélien Dinh , David Lebeaux
Previous guidelines have recommended 5-day antibiotic treatment for community-acquired pneumonia (CAP) patients manifesting clinical improvement after 48–72 h, and seven-day treatment for other, uncomplicated forms of CAP.
Three meta-analyses and two randomized double-blind trials have confirmed the non-inferiority of short (3–7 days) as compared to long treatments (>7 days). A trial involving young patients with few comorbidities demonstrated the efficacy of 3-day treatment by amoxicillin in the event of clinical improvement at D3. A second trial, which involved older patients with more comorbidities, validated three-day antibiotic treatment by injectable beta-lactams for patients stabilized at D3.
The 2025 guidelines adopt a personalized approach premised on attainment of clinical stability: three days of antibiotic treatment for non-severe or moderate CAP stabilized at D3, five days when stability is achieved by D5, and seven days for other, uncomplicated forms of community-acquired pneumonia. Only when complications occur is prolonged duration indicated.
The ensuing recommendations are aimed at reducing antibiotic exposure while maintaining optimal efficacy of treatment for community-acquired pneumonia.
{"title":"Duration of antibiotic treatment for community-acquired pneumonia","authors":"Aurélien Dinh , David Lebeaux","doi":"10.1016/j.idnow.2025.105125","DOIUrl":"10.1016/j.idnow.2025.105125","url":null,"abstract":"<div><div>Previous guidelines have recommended 5-day antibiotic treatment for community-acquired pneumonia (CAP) patients manifesting clinical improvement after 48–72 h, and seven-day treatment for other, uncomplicated forms of CAP.</div><div>Three <em>meta</em>-analyses and two randomized double-blind trials have confirmed the non-inferiority of short (3–7 days) as compared to long treatments (>7 days). A trial involving young patients with few comorbidities demonstrated the efficacy of 3-day treatment by amoxicillin in the event of clinical improvement at D3. A second trial, which involved older patients with more comorbidities, validated three-day antibiotic treatment by injectable beta-lactams for patients stabilized at D3.</div><div>The 2025 guidelines adopt a personalized approach premised on attainment of clinical stability: three days of antibiotic treatment for non-severe or moderate CAP stabilized at D3, five days when stability is achieved by D5, and seven days for other, uncomplicated forms of community-acquired pneumonia. Only when complications occur is prolonged duration indicated.</div><div>The ensuing recommendations are aimed at reducing antibiotic exposure while maintaining optimal efficacy of treatment for community-acquired pneumonia.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 6","pages":"Article 105125"},"PeriodicalIF":2.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-26DOI: 10.1016/j.idnow.2025.105123
Sophie Reissier , Malo Penven , Marlène Amara , Laurent Dortet , Emeline Riverain , Yvan Caspar , Nicolas Degand , Eric Farfour , Stéphane Corvec , Olivier Barraud , Cécile Le Brun , Christophe Isnard , Hervé Jacquier , Assaf Mizrahi , Anaïs Potron , Sébastien Larréché , Audrey Mérens , Vincent Cattoir , on behalf of the GMC study group
Aim
The aim of this study was to describe the bacterial epidemiology and antibiotic resistance rates of bacterial isolates collected from urine specimens in male patients with suspected urinary tract infection (UTI).
Methods
This retrospective multicenter study included routine data from midstream urine cultures of adult male patients with suspected UTI admitted to the emergency departments of 15 hospitals from 2019 to 2023. Urinalysis was performed according to the recommendations of the French Society for Microbiology and bacterial identification was carried out using MALDI-TOF mass spectrometry. Antimicrobial susceptibility testing was performed by disk diffusion or semi-automated methods and interpreted according to the CA-SFM/EUCAST guidelines.
Results
Overall, 38,279 bacterial isolates were detected among 33,113 male patients (mean age = 70.7 years). The most frequently encountered pathogen was E. coli (40.0 %) followed by E. faecalis (13.2 %), K. pneumoniae (7.8 %) and P. mirabilis (5.8 %). Overall prevalence of ESBL-E was 9.0 %, represented mainly by K. pneumoniae (22.8 %), E. cloacae complex (19.3 %) and E. coli (8.4 %). Prevalence of resistance to fluoroquinolones and cotrimoxazole was high (usually > 15–20 %). The resistance rates in E. coli were very low (around 1 %) for fosfomycin and nitrofurantoin, as was the overall prevalence of carbapenemase-producing Enterobacterales (0.1 %). In S. aureus, 20.4 % of isolates were resistant to methicillin, and only three vancomycin-resistant enterococci (<0.01 %) were detected.
Conclusion
This original study provides recent, nationwide and helpful data on bacterial epidemiology and antibiotic resistance rates of isolates recovered from urines in male patients with suspected UTIs.
{"title":"Bacterial epidemiology and antibiotic resistance rates in male urinary tract infections in France, 2019–2023","authors":"Sophie Reissier , Malo Penven , Marlène Amara , Laurent Dortet , Emeline Riverain , Yvan Caspar , Nicolas Degand , Eric Farfour , Stéphane Corvec , Olivier Barraud , Cécile Le Brun , Christophe Isnard , Hervé Jacquier , Assaf Mizrahi , Anaïs Potron , Sébastien Larréché , Audrey Mérens , Vincent Cattoir , on behalf of the GMC study group","doi":"10.1016/j.idnow.2025.105123","DOIUrl":"10.1016/j.idnow.2025.105123","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to describe the bacterial epidemiology and antibiotic resistance rates of bacterial isolates collected from urine specimens in male patients with suspected urinary tract infection (UTI).</div></div><div><h3>Methods</h3><div>This retrospective multicenter study included routine data from midstream urine cultures of adult male patients with suspected UTI admitted to the emergency departments of 15 hospitals from 2019 to 2023. Urinalysis was performed according to the recommendations of the French Society for Microbiology and bacterial identification was carried out using MALDI-TOF mass spectrometry. Antimicrobial susceptibility testing was performed by disk diffusion or semi-automated methods and interpreted according to the CA-SFM/EUCAST guidelines.</div></div><div><h3>Results</h3><div>Overall, 38,279 bacterial isolates were detected among 33,113 male patients (mean age = 70.7 years). The most frequently encountered pathogen was <em>E. coli</em> (40.0 %) followed by <em>E. faecalis</em> (13.2 %), <em>K. pneumoniae</em> (7.8 %) and <em>P. mirabilis</em> (5.8 %). Overall prevalence of ESBL-E was 9.0 %, represented mainly by <em>K. pneumoniae</em> (22.8 %), <em>E. cloacae</em> complex (19.3 %) and <em>E. coli</em> (8.4 %). Prevalence of resistance to fluoroquinolones and cotrimoxazole was high (usually > 15–20 %). The resistance rates in <em>E. coli</em> were very low (around 1 %) for fosfomycin and nitrofurantoin, as was the overall prevalence of carbapenemase-producing Enterobacterales (0.1 %). In <em>S. aureus</em>, 20.4 % of isolates were resistant to methicillin, and only three vancomycin-resistant enterococci (<0.01 %) were detected.</div></div><div><h3>Conclusion</h3><div>This original study provides recent, nationwide and helpful data on bacterial epidemiology and antibiotic resistance rates of isolates recovered from urines in male patients with suspected UTIs.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 7","pages":"Article 105123"},"PeriodicalIF":2.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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