La Revue du praticien最新文献

Antimicrobial resistance in human and veterinary medicine: WHERE ARE WE ? In both human and veterinary medicine, the evolution of antimicrobial resistance is worrying for some antibiotics or bacterial species, but less for others. In humans and animals, the picture for respiratory infections is rather favorable. On the other hand, resistance to fluoroquinolones of bacteria causing sexually transmitted infections in humans, or of Campylobacter_in animals, has increased significantly. Two major indicators of antimicrobial resistance, common to both sectors, are resistance to 3rd generation cephalosporins in Enterobacterales and resistance to methicillin in Staphylococcus aureus. Favorable trends in humans and animals are shown ; they remind of the dual importance, in the fight against antimicrobial resistance in a One Health approach of controlling antibiotic consumption on the one hand, and of respecting hygiene practices, on the other.

HOW TO READ NEW ANTIMICROBIAL SUSCEPTIBILITY TESTING RESULTS? Antimicrobial susceptibility testing (AST) results (formerly 'susceptible', 'intermediate' and 'resistant') are now expressed with the new susceptibility categories 'susceptible, standard dosing regimen', 'susceptible, increased exposure' and 'resistant'. These new categories introduce a paradigm shift in the way clinicians have to interpret AST results: uncertainties (previously embedded in the 'intermediate' category) now have to be dealt with exclusively by the laboratory, independently from the clinical categorization itself, and both 'susceptible, standard dosing regimen' and 'susceptible, increased exposure' categories are associated with a high likelihood of therapeutic success if appropriate dosing regimen is used. To help clinicians, a dosing table (fitting dosing regimens usually recommended in France, and consistent with clinical breakpoints) is now available as an appendix to the CA-SFM document (Comité de l'antibiogramme de la Société française de microbiologie), and can also be downloaded from the SPILF website (Société de pathologie infectieuse de langue française).

UTERINE FIBROIDS. Uterine fibroids are the most common tumors of the female genital tract. They can be asymptomatic or associated with various symptoms like abnormal uterine bleeding, pelvic pain, pelvic or extra pelvic compressive signs, or anaemia. They can also be associated with infertility. The main further examination for fibroids diagnosis is pelvic ultrasound. Pelvic MRI (Magnetic Resonance Imaging) is also useful before surgery or interventional radiology for fibroid mapping. All fibroids must be located according to the FIGO classification. No treatment is necessary in the absence of clinical symptoms. The management of uterine fibroids depends on the clinical signs, the mapping, and the preservation of the uterus as well as fertility. Medical treatment is the first-line option. In case of failure, therapeutic options include surgery or uterine artery embolization.

PREVENTION STRATEGY FOR INVASIVE MENINGOCOCCAL DISEASE. The prevention strategy for invasive meningococcal disease (IMD) includes vaccination and antibiotic prophylaxis in the vicinity of a case. IMD is unpredictable, difficult to recognize at an early stage, and very severe, with a mortality rate about 10 %, and 20 to 25 % of survivors suffering from permanent disabling sequelae that impact their quality of life. Meningococcal conjugate vaccines against A, C, ACWY provide both individual and collective protection due to their effect on meningococcal carriage. Protein-based vaccines against serogroup B have been developed. These vaccines demonstrate effectiveness in the field in children and adolescents with acceptable tolerance. Immunization programs have been adapted to recent epidemiologic modifications. Immunization with the ACWY meningococcal conjugate vaccine has replaced meningococcal C vaccination and is now mandatory for infants, along with the meningococcal B vaccine. The ACWY meningococcal vaccine is recommended for adolescents aged 11-14 years, with a catchup program for those aged 15 to 2 5 years.