Medecine et maladies infectieuses最新文献

Introduction

Many factors influence vaccination practices and attitudes. This study aimed to identify vaccine information sources used by parents of children aged 1–15 years to get a better understanding of the relation between vaccine information sources, practices for two vaccines (MMR, HBV), vaccine acceptance, and vaccine hesitancy.

Methods

A total of 3938 parents, drawn by random sampling, were interviewed by telephone as part of the “2016 health barometer” survey. Vaccine information sources were described and analyzed according to socio-demographic variables. Multivariate logistic regression models were then built to explain vaccine information sources usage, vaccination practices and attitudes.

Results

Healthcare professionals (HCP), the Internet, and relatives were the three main vaccine information sources. Vaccination practices and acceptance were better when parents were getting information from HCPs compared with parents getting information from the Internet or relatives. Besides, getting information from the three different types of sources was associated with the highest rate of vaccine hesitancy: 70.9% (OR = 4.6; P < 0.0001) versus 34.6% among parents getting information from HCPs only.

Conclusion

Those results suggest an interest in providing quality information about vaccination on the Internet. The primary role of HCPs in vaccination decision is once again demonstrated.

Less than 20% of African adolescents aged 10–19 years are aware of their HIV status, whereas HIV screening remains the gateway to care and while AIDS has become the leading cause of death among adolescents in Sub-Saharan Africa. According to the UNAIDS target, scalable HIV testing strategies specific to various age groups, populations, and geographical areas must be implemented to end the AIDS epidemic by 2030. Many African countries have implemented policies supporting HIV self-testing (HIVST). Evidence of practicability and efficiency of HIVST in Sub-Saharan Africa settings has been reported, including HIVST data among adolescents. Adapted strategies of HIVST are urgently needed to promote HIV testing among adolescents living in sub-Saharan Africa.

Purpose

Invasive fungal diseases and especially Cryptococcus neoformans infections are increasingly reported in patients with hematological malignancies receiving ibrutinib, a Bruton's tyrosine kinase inhibitor.

Patients and method

We reported three additional cases and reviewed 16 previous published cases together with cases from the international pharmacovigilance database.

Results

Patients were mainly treated for chronic lymphocytic leukemia. Cryptococcosis mostly occurred during the first six months (66%) and especially the first two months (44%) of treatment. Clinical presentation is often pulmonary (68%) and the outcome is usually favorable despite ibrutinib continuation.

Conclusion

Clinicians must be aware of this infection in patients with hematological malignancies on ibrutinib.

Objectives

Knowledge of local antimicrobial resistance (AMR) patterns is required for effective empirical treatment of bacterial diseases. Very little is known about current resistance patterns of common pathogenic bacteria in the African region and particularly in the Sahel region. We aimed to describe the local bacterial epidemiology and to determine whether French recommendations for empirical treatment could be implemented.

Patients and methods

We performed a single-center observational study. Data was collected retrospectively from the Forward Medical and Surgical Center (FFMSC) bacterial database from January 2015 to December 2018. All bacteriological analyses, negative or positive, were included.

Results

A total of 2194 samples were analyzed. Infectious diseases were urinary tract infections (20.8%), bone and joint infections (20.4%), skin infections of chronic wounds (13.4%), soft tissue abscesses (13%), and gastroenteritis (10.8%). The most frequent infections were enterobacterial infections (43.6%) and staphylococcal infections (31.1%). The prevalence of AMR was 32.1%. Significantly more ESBL-producing bacteria (41.3%) were observed in the Chadian population than in the French population in N’djamena (6.3%) (P < 0.001).

Conclusions

We reported a high rate of ESBL-producing bacteria in N’Djamena. The use of empirical antibiotic therapies in the FFMSC may thus be questioned: French recommendations cannot be implemented in such setting and the use of carbapenems or new anti-ESBL antibiotics should be considered. Prospective studies are required to conclude.

Objective

This 2018 report of Healthcare-Associated Infections Early Warning and Response System (HAI-EWRS) notifications of carbapenemase-producing Enterobacteriaceae (CPE) or glycopeptide-resistant Enterococcus faecium (GRE), and of strains analysed by the National Reference Center for anti-microbial resistance (NRC) aimed to describe the epidemiology of emerging extensively drug-resistant bacteria (eXDR) in France and control measures implemented in hospital settings.

Patients and methods

All HAI-EWRS notifications of eXDR received at the national level and all eXDR strains received at the NRC between January 1, 2018 and January 31, 2018 were analysed. Variables analysed were number of cases, number of strains, resistance mechanism, sample type, link with a foreign country, and control measures implemented.

Results

In 2018, 1704 CPE notifications and 315 GRE notifications were reported in France, with an increasing trend since 2012 (× 6 for CPE, × 3 for GRE), from respectively 364 and 155 hospitals (+66% for CPE, +57% for GRE since 2012). eXDR strains were mainly isolated from rectal screening swabs. Notifications with patients receiving standard precautions were more often associated with outbreaks than notifications with patients receiving contact precautions at admission. NRC received 2674 CPE strains and 775 GRE strains in 2018 (× 8.3 and × 2.8 compared with 2012).

Conclusion

The increasing annual number of eXDR notifications and eXDR strains received by the NRC is multifactorial but reflects a worrying spread of eXDR in France. The number of infections remains low, but this article shows that existing recommendations are not fully implemented.

Objective

Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.

Methods

We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.

Results

A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).

Conclusion

Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.

Objectives

To characterize the risk factors, impact of screening, and clinical burden of colonization and/or infection by carbapenemase-producing bacteria (CPB) in hospitalized patients.

Method

Retrospective study in a tertiary care hospital between 2008 and 2016.

Results

Among 88 included patients, 41% were colonized, 59% developed an infection, and 69% of all cases were hospital-acquired. Risk factors for CPB contamination included recent invasive medical device (94% of patients), antibiotic therapy (82%), travel abroad (17%), and hospitalization (> 50%) with 80% of all patients with underlying chronic condition. Intestinal carriage represented 89% of all colonization cases and 50% of infections were located in the urinary tract. The recent use of mechanical ventilation devices was significantly more observed in infected patients than colonized patients. The most frequent CPB was Klebsiella pneumoniae and the most frequent carbapenemase was OXA-48. Overall mortality rate was 19%. Prevalence of CPB detection in intensive care units (ICU) based on systematical rectal screen swab upon admission remained < 0.5%. The infected/colonized ratio (CPB colonization cases evolving into an infection) was 23%. The time between CPB infection diagnosis and start of appropriate antimicrobial therapy increased from 1 day in previously screened patients with positive CPB to 4 days in patients with previous negative or absent screening.

Conclusion

Our results emphasize the importance of CPB screening in all ICU patients and in at-risk patients hospitalized in other units, to allow earlier adequate antibiotic therapy in case of infection which occurred in 23% of the colonized patients.

Objective

We aimed to determine the reasons for irrational antibiotic use, to evaluate knowledge, attitudes, and behaviors of physicians regarding such use, to find factors affecting knowledge of physicians, and to explore precautions that need to be taken to stop irrational antibiotic use.

Material and methods

We performed the study between January 2014 and June 2014. We included 202 physicians who answered a questionnaire with 22 multiple-choice questions about knowledge (eight questions), behavior and attitudes of physicians (nine questions), and recommendations for reducing antibiotic consumption (five questions). Answers to all questions were assessed according to the physician's age, educational status, metropolitan areas, and healthcare facilities.

Results

The effects of parents’ expectations and satisfaction (7.4%–40.0%) (P < 0.0001) and socioeconomical status of families (33%–62%) (P = 0.007) increased as the participants’ age decreased. Participants working at public hospitals (42.6%) considered expectations and satisfaction of parents more important than other participants (10.5%–26.9%; P = 0.002). Rapid recovery of patients was not an essential determinant for administering antibiotics for pediatricians (25.7%) and pediatric assistants (26.9%). However, it was important for emergency physicians (55.6%) and family physicians (60%, P = 0.016). Physicians working at university hospitals did not consider this determinant as important as physicians working in other healthcare facilities (P = 0.001).

Conclusion

To determine the obstacles associated with promoting rational antibiotic usage, every country should assess the attitudes, behavior, and knowledge of physicians related to such use. The present study is one of the few in Turkey to address the problems associated with irrational antibiotic use.