Oral third-generation cephalosporins (3GC) are a major source of antibiotic resistance, with 70 % of prescriptions issued by general practitioners (GPs). The main objective of this study was to identify the factors that lead GPs to prescribe oral 3GCs. The secondary objective was to identify the physician profiles most likely to prescribe them.
Materials and Methods
This was an observational, descriptive, declarative study. A questionnaire was distributed to GPs in a french area (Pays de le Loire).
Results
We included 74 responses from GPs. Several determinants were identified that positively influenced the prescription of oral 3GCs: situations of therapeutic failure (64.9 % of GPs), penicillin allergy (49.5 %), altered general condition (35.2 %), age over 65 (33.8 %). Physicians practising in semi-rural and rural areas seemed to be more inclined to prescribe 3GCs in cases of altered general condition (p < 0.027) or diagnostic doubt (p < 0.025).
Conclusion
The results of this study can be used to tailor GP training to the context in which they provide care.
{"title":"Determinants of third-generation oral cephalosporin prescribing by general practitioners: A regional survey in France","authors":"Astrid Descolas , Ramassamy Jérôme , Thibaut Riom , Lellouch Jérémy , Peurois Matthieu","doi":"10.1016/j.clinpr.2025.100514","DOIUrl":"10.1016/j.clinpr.2025.100514","url":null,"abstract":"<div><h3>Introduction</h3><div>Oral third-generation cephalosporins (3GC) are a major source of antibiotic resistance, with 70 % of prescriptions issued by general practitioners (GPs). The main objective of this study was to identify the factors that lead GPs to prescribe oral 3GCs. The secondary objective was to identify the physician profiles most likely to prescribe them.</div></div><div><h3>Materials and Methods</h3><div>This was an observational, descriptive, declarative study. A questionnaire was distributed to GPs in a french area (Pays de le Loire).</div></div><div><h3>Results</h3><div>We included 74 responses from GPs. Several determinants were identified that positively influenced the prescription of oral 3GCs: situations of therapeutic failure (64.9 % of GPs), penicillin allergy (49.5 %), altered general condition (35.2 %), age over 65 (33.8 %). Physicians practising in semi-rural and rural areas seemed to be more inclined to prescribe 3GCs in cases of altered general condition (p < 0.027) or diagnostic doubt (p < 0.025).</div></div><div><h3>Conclusion</h3><div>The results of this study can be used to tailor GP training to the context in which they provide care.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"28 ","pages":"Article 100514"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.clinpr.2025.100511
Benjamin Griffin , Lara Payne , Laura Nabarro , Neda Minakaran , Gauri Godbole
Background
Ocular onchocerciasis, commonly known as “river blindness,” is a parasitic infection caused by the filarial nematode Onchocerca volvulus. Although presentation within the United Kingdom is extremely rare, with no reports evident within the literature, it is the second leading cause of infectious blindness worldwide. Diagnosis is traditionally made through skin snip biopsy, serological testing and, where available, quantitative-polymerase chain reaction. Diagnostic imaging is not traditionally utilised due to limited availability within endemic regions.
Case Report
In this case, of a man presenting to a tertiary London ophthalmology unit with recurrent anterior uveitis, both anterior segment ocular examination with paracentesis, demonstrating microfilariae, and fluorodeoxyglucose – positron emission tomography / computed tomography, demonstrating an onchocercoma, play a crucial role in allowing targeted ultrasound-guided fine needle aspiration which confirmed the diagnosis.
Conclusion
This case highlights the role of anterior segment examination and diagnostic imaging in the diagnosis of infectious diseases. It also demonstrates novel anterior segment ocular imaging findings of in vivo microfilariae as seen in ocular onchocerciasis.
{"title":"Onchocerciasis identified with anterior segment ocular examination and FDG-PET/CT imaging","authors":"Benjamin Griffin , Lara Payne , Laura Nabarro , Neda Minakaran , Gauri Godbole","doi":"10.1016/j.clinpr.2025.100511","DOIUrl":"10.1016/j.clinpr.2025.100511","url":null,"abstract":"<div><h3>Background</h3><div>Ocular onchocerciasis, commonly known as “river blindness,” is a parasitic infection caused by the filarial nematode <em>Onchocerca volvulus</em>. Although presentation within the United Kingdom is extremely rare, with no reports evident within the literature, it is the second leading cause of infectious blindness worldwide. Diagnosis is traditionally made through skin snip biopsy, serological testing and, where available, quantitative-polymerase chain reaction. Diagnostic imaging is not traditionally utilised due to limited availability within endemic regions.</div></div><div><h3>Case Report</h3><div>In this case, of a man presenting to a tertiary London ophthalmology unit with recurrent anterior uveitis, both anterior segment ocular examination with paracentesis, demonstrating microfilariae, and fluorodeoxyglucose – positron emission tomography / computed tomography, demonstrating an onchocercoma, play a crucial role in allowing targeted ultrasound-guided fine needle aspiration which confirmed the diagnosis.</div></div><div><h3>Conclusion</h3><div>This case highlights the role of anterior segment examination and diagnostic imaging in the diagnosis of infectious diseases. It also demonstrates novel anterior segment ocular imaging findings of in vivo microfilariae as seen in ocular onchocerciasis.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"28 ","pages":"Article 100511"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.clinpr.2025.100512
Sara Hamid , Krishna Girotra , Timothy Kemp , Sajeed Mohammed Abdul , Jooly Joseph , Krishna Banavathi
Introduction
Gram-negative bacterial meningitis has a high mortality rate. We present a case of community acquired bacterial meningitis caused by Pseudomonas aeruginosa with a successful outcome following prolonged intravenous antibiotics.
Pseudomonas aeruginosa is an uncommon Gram-negative bacterial cause of meningitis. In its rarity, it has no well-established optimal antibiotic therapy (2).
Patients with the above face a severe clinical picture − of the etiological agents, Gram-negative bacilli have the highest fatality rate; 54%.(3) Therefore, the occurrence of Pseudomonas aeruginosa meningitis in the absence of predisposing factors is both an exceptionally rare, and dangerous, finding (3) – here, we describe such a case.
{"title":"Community-acquired Pseudomonas aeruginosa meningitis − A rare case presentation","authors":"Sara Hamid , Krishna Girotra , Timothy Kemp , Sajeed Mohammed Abdul , Jooly Joseph , Krishna Banavathi","doi":"10.1016/j.clinpr.2025.100512","DOIUrl":"10.1016/j.clinpr.2025.100512","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Gram-negative bacterial meningitis has a high mortality rate. We present a case of community acquired bacterial meningitis caused by</em> Pseudomonas aeruginosa <em>with a successful outcome following prolonged intravenous antibiotics.</em></div><div>Pseudomonas aeruginosa <em>is an uncommon Gram-negative bacterial cause of meningitis. In its rarity, it has no well-established optimal antibiotic therapy</em> (2)<em>.</em></div><div><em>Patients with the above face a severe clinical picture − of the etiological agents, Gram-negative bacilli have the highest fatality rate; 54%.</em>(3) <em>Therefore, the occurrence of</em> Pseudomonas aeruginosa <em>meningitis in the absence of predisposing factors is both an exceptionally rare, and dangerous, finding</em> (3) <em>– here, we describe such a case.</em></div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"28 ","pages":"Article 100512"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145106237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-31DOI: 10.1016/j.clinpr.2025.100509
F.D. Halstead , E. Yates , C. Onwukwe , E. Tennant , E. Leakey , M. Roberts , D. Braganza Menezes , J. Bartlett , A.M. Borman , E.M. Johnson , A. Johnson , G.B. Wijayaratne
Background
Coccidioides spp, are dimorphic fungi endemic to arid and semi-arid regions of the Western USA, Central America, and South America, which can cause coccidioidomycosis. Although the majority of infections are mild or sub-clinical, disseminated coccidioidomycosis can occur, typically affecting immunocompromised individuals. This report presents a case of disseminated coccidioidomycosis that remained undiagnosed for decades.
Case report
A 68 year old Caucasian female presented to the Accident and Emergency (A&E) Department of a UK hospital in late 2024 with fever, chills, vomiting, and joint pain. On examination she was febrile and hypotensive, with a clear chest and unremarkable cardiovascular and abdominal examinations. She had an extensive past medical history, involving rheumatoid arthritis and sarcoidosis (treated with a range of immunosuppressive agents), and knee swelling and pain, for which she underwent a unilateral total knee replacement with no resolution of symptoms.
During the most recent presentation, a range of microbiology samples were collected, including a knee aspirate (inoculated into a blood culture bottle). A fungus was isolated which was later identified by the National reference laboratory as Coccidioides immitis. The patient was treated with dual-antifungal therapy and remains on lifelong suppressive fluconazole (alongside steroids), under regular follow up.
Conclusion
Although there was an extensive travel history to endemic countries, and compatible clinical features, no diagnosis was made for many years. The recent laboratory investigations which clinched the diagnosis were also challenging as no travel history was provided, and our diagnostic equipment was not set up to detect this pathogen.
This case underscores the diagnostic challenges of coccidioidomycosis in non-endemic regions, emphasizing the critical role of a detailed travel history. It also highlights the occupational risks associated with handling Coccidioides in the laboratory, and the need for increased awareness of rare pathogens, particularly in immunocompromised patients with relevant travel histories.
{"title":"An unwanted souvenir: Case report of delayed diagnosis of a coccidioidomycosis prosthetic joint infection","authors":"F.D. Halstead , E. Yates , C. Onwukwe , E. Tennant , E. Leakey , M. Roberts , D. Braganza Menezes , J. Bartlett , A.M. Borman , E.M. Johnson , A. Johnson , G.B. Wijayaratne","doi":"10.1016/j.clinpr.2025.100509","DOIUrl":"10.1016/j.clinpr.2025.100509","url":null,"abstract":"<div><h3>Background</h3><div><em>Coccidioides</em> spp, are dimorphic fungi endemic to arid and semi-arid regions of the Western USA, Central America, and South America, which can cause coccidioidomycosis. Although the majority of infections are mild or sub-clinical, disseminated coccidioidomycosis can occur, typically affecting immunocompromised individuals. This report presents a case of disseminated coccidioidomycosis that remained undiagnosed for decades.</div></div><div><h3>Case report</h3><div>A 68 year old Caucasian female presented to the Accident and Emergency (A&E) Department of a UK hospital in late 2024 with fever, chills, vomiting, and joint pain. On examination she was febrile and hypotensive, with a clear chest and unremarkable cardiovascular and abdominal examinations. She had an extensive past medical history, involving rheumatoid arthritis and sarcoidosis (treated with a range of immunosuppressive agents), and knee swelling and pain, for which she underwent a unilateral total knee replacement with no resolution of symptoms.</div><div>During the most recent presentation, a range of microbiology samples were collected, including a knee aspirate (inoculated into a blood culture bottle). A fungus was isolated which was later identified by the National reference laboratory as <em>Coccidioides immitis.</em> The patient was treated with dual-antifungal therapy and remains on lifelong suppressive fluconazole (alongside steroids), under regular follow up.</div></div><div><h3>Conclusion</h3><div>Although there was an extensive travel history to endemic countries, and compatible clinical features, no diagnosis was made for many years. The recent laboratory investigations which clinched the diagnosis were also challenging as no travel history was provided, and our diagnostic equipment was not set up to detect this pathogen.</div><div>This case underscores the diagnostic challenges of coccidioidomycosis in non-endemic regions, emphasizing the critical role of a detailed travel history. It also highlights the occupational risks associated with handling <em>Coccidioides</em> in the laboratory, and the need for increased awareness of rare pathogens, particularly in immunocompromised patients with relevant travel histories.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"28 ","pages":"Article 100509"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.clinpr.2025.100508
Parth Aphale, Shashank Dokania, Himanshu Shekhar
{"title":"Cryptic hepatitis E virus infections in immunocompromised hosts: A silent threat in high-income settings","authors":"Parth Aphale, Shashank Dokania, Himanshu Shekhar","doi":"10.1016/j.clinpr.2025.100508","DOIUrl":"10.1016/j.clinpr.2025.100508","url":null,"abstract":"","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"28 ","pages":"Article 100508"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.clinpr.2025.100503
Marisa B. Kaelin , Lukas A. Walker , Vera Ihle , Lisa Jungblut , Martina Greminger , Bettina Schulthess , Johannes Nemeth
The incidence of extrapulmonary non-tuberculous mycobacterial (NTM) infections is increasing globally, particularly among immunosuppressed patients. These infections are notoriously difficult to treat and often require long-term multidrug therapy leading to significant side effects. Although anecdotal evidence supports thermal therapy as beneficial, it remains underutilized and absent from treatment guidelines.
We present a case of chronic tenosynovitis and osteomyelitis in the index finger caused by Mycobacterium chelonae, where the patient showed minimal recovery with surgery and antibiotics but experienced rapid improvement after starting local thermal therapy.
Our literature review reveals multiple case reports supporting thermal therapy in treating NTM infections. Given the observed benefits and low toxicity, we recommend further exploration and incorporation of thermal therapy as a potential adjunct in the management of infections with heat-sensitive NTM.
{"title":"Bringing the heat to non-tuberculous mycobacterial infections: a comprehensive review inspired by a striking case of successful treatment","authors":"Marisa B. Kaelin , Lukas A. Walker , Vera Ihle , Lisa Jungblut , Martina Greminger , Bettina Schulthess , Johannes Nemeth","doi":"10.1016/j.clinpr.2025.100503","DOIUrl":"10.1016/j.clinpr.2025.100503","url":null,"abstract":"<div><div>The incidence of extrapulmonary non-tuberculous mycobacterial (NTM) infections is increasing globally, particularly among immunosuppressed patients. These infections are notoriously difficult to treat and often require long-term multidrug therapy leading to significant side effects. Although anecdotal evidence supports thermal therapy as beneficial, it remains underutilized and absent from treatment guidelines.</div><div>We present a case of chronic tenosynovitis and osteomyelitis in the index finger caused by <em>Mycobacterium chelonae</em>, where the patient showed minimal recovery with surgery and antibiotics but experienced rapid improvement after starting local thermal therapy.</div><div>Our literature review reveals multiple case reports supporting thermal therapy in treating NTM infections. Given the observed benefits and low toxicity, we recommend further exploration and incorporation of thermal therapy as a potential adjunct in the management of infections with heat-sensitive NTM.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"27 ","pages":"Article 100503"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.clinpr.2025.100505
Peter Crook , Elisabeth Grey-Davies , Faraan Khan , Tihana Bicanic
Background
Cryptococcus is an important cause of central nervous system infection in immunocompromised hosts. Although best described in those with advanced HIV infection, it is increasingly being seen in other settings, including in patients on ibrutinib (a Bruton tyrosine kinase inhibitor). In order to manage this opportunistic infection well, clinicians must understand both the pathogen and the host immune system.
Case Report
We present a case of cryptococcal meningitis (CM) in an HIV-negative patient on ibrutinib for chronic lymphocytic leukaemia. At presentation, he was fungaemic with Cryptococcus neoformans and had a lymphocytic cerebrospinal fluid (CSF) with positive cryptococcal antigen. He improved initially with liposomal amphotericin B and flucytosine. Four weeks into treatment, however, he suffered an unexpected clinical and radiological deterioration, with new confusion and hallucinations, accompanied by widespread leptomeningeal enhancement and new occipital micro-abscesses on neuroimaging. CSF cultures remained sterile and his deterioration was attributed to an inflammatory phenomenon due to immune reconstitution, following cessation of ibrutinib and fungal clearance. He was treated with steroids with a good radiological and clinical response.
Discussion
An immune reconstitution inflammatory syndrome is well described in HIV; there is also increasing recognition of a post-infectious inflammatory response syndrome in non-HIV-associated CM. This case highlights the challenge of managing opportunistic infections in novel risk groups of immunocompromised hosts and illustrates the dynamic interplay between pathogen and host immunity. We review here the key immune mechanisms involved in inflammatory syndromes relating to cryptococcal meningitis.
{"title":"A case of ibrutinib-associated cryptococcal meningitis with a steroid-responsive immune reconstitution syndrome","authors":"Peter Crook , Elisabeth Grey-Davies , Faraan Khan , Tihana Bicanic","doi":"10.1016/j.clinpr.2025.100505","DOIUrl":"10.1016/j.clinpr.2025.100505","url":null,"abstract":"<div><h3>Background</h3><div>Cryptococcus is an important cause of central nervous system infection in immunocompromised hosts. Although best described in those with advanced HIV infection, it is increasingly being seen in other settings, including in patients on ibrutinib (a Bruton tyrosine kinase inhibitor). In order to manage this opportunistic infection well, clinicians must understand both the pathogen and the host immune system.</div></div><div><h3>Case Report</h3><div>We present a case of cryptococcal meningitis (CM) in an HIV-negative patient on ibrutinib for chronic lymphocytic leukaemia. At presentation, he was fungaemic with <em>Cryptococcus neoformans</em> and had a lymphocytic cerebrospinal fluid (CSF) with positive cryptococcal antigen. He improved initially with liposomal amphotericin B and flucytosine. Four weeks into treatment, however, he suffered an unexpected clinical and radiological deterioration, with new confusion and hallucinations, accompanied by widespread leptomeningeal enhancement and new occipital micro-abscesses on neuroimaging. CSF cultures remained sterile and his deterioration was attributed to an inflammatory phenomenon due to immune reconstitution, following cessation of ibrutinib and fungal clearance. He was treated with steroids with a good radiological and clinical response.</div></div><div><h3>Discussion</h3><div>An immune reconstitution inflammatory syndrome is well described in HIV; there is also increasing recognition of a post-infectious inflammatory response syndrome in non-HIV-associated CM. This case highlights the challenge of managing opportunistic infections in novel risk groups of immunocompromised hosts and illustrates the dynamic interplay between pathogen and host immunity. We review here the key immune mechanisms involved in inflammatory syndromes relating to cryptococcal meningitis.</div></div>","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"27 ","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.clinpr.2025.100507
Sudip Bhattacharya , Alok Singh , Rachana Mehta , Aroop Mohanty , Sanjit Sah , Ranjan K Mohapatra , Jaime David Acosta-España , Lysien Zambrano , Alfonso J. Rodriguez-Morales.
{"title":"Resurgent COVID-19 in Southeast Asia: A critical opinion of emerging trends, public health gaps, and future preparedness","authors":"Sudip Bhattacharya , Alok Singh , Rachana Mehta , Aroop Mohanty , Sanjit Sah , Ranjan K Mohapatra , Jaime David Acosta-España , Lysien Zambrano , Alfonso J. Rodriguez-Morales.","doi":"10.1016/j.clinpr.2025.100507","DOIUrl":"10.1016/j.clinpr.2025.100507","url":null,"abstract":"","PeriodicalId":33837,"journal":{"name":"Clinical Infection in Practice","volume":"27 ","pages":"Article 100507"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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