La Revue du praticien最新文献

RISK OF ACQUIRING ANTIBIOTIC-RESISTAN. BACTERIA AND TRAVEL. The continuing expansion of international tourism increases the opportunities of contact with diverse epidemiological environments, leading to both a risk of bacterial acquisition or infection for the traveler and the circulation of the micro-organisms around the world. With the disparate increase in antibiotic resistance worldwide, the traveler becomes a microbiological sentinel for resistance surveillance. Travel has been associated with the acquisition of digestive carriage of multidrug-resistant Enterobacterales, most frequently associated with travel to South Asia, enhanced by diarrhea and/or antibiotic use. But travel has also been the cause of authentic infections caused by multi- or extensively resistant bacteria, such as shigellosis, typhoid fever caused by Salmonella typhi, sexually transmitted infections caused by gonococci, or skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA), for which worry is the low number of antibiotics remaining effective. It is therefore necessary to advise travelers during pre-travel consultations on how to reduce the risk of acquisition.

SHORTENED ANTIMICROBIAL THERAPY DURATION. Antibiotic treatment durations represent an important field of current clinical research. Indeed, shortening antibiotic duration during bacterial pathologies has several advantages: reducing the emergence of resistance on an individual and collective scale, reducing costs, adverse effects and the environmental impact. However, a rigorous investigation is necessary to properly assess the absence of impact on the individual prognosis. In recent years, several randomized trials have made it possible to validate short durations of antibiotic therapy for frequent bacterial pathologies: 5 days during simple acute pyelonephritis, 7 days for non-febrile urinary tract infections in men, 3 to 5 days during acute bacterial pneumonia, 6 weeks for pyogenic spondylodiscitis. However, some durations seem incompressible and/or require individualization: 14 days for febrile male urinary tract infections, 12 weeks for infections on osteoarticular prostheses. It is necessary to reduce the duration of antibiotic treatment to the minimum necessary and to evaluate personalized durations taking into account, in particular, immunocompromised patients who are often excluded from trials.

HOSPITAL ANTIMICROBIAL STEWARDSHIP. Hospital antimicrobial stewardship programs have been thought to preserve the efficacy of antimicrobials for the treatment of human and animal bacterial infections. They must apply for every patient regardless of the type of healthcare facility- large or small, urban or rural, academic or community. Better and less prescribing antimicrobials is mandatory and must follow well established rules including a right diagnosis, effort to document infection, appropriate choice of the drug and shorter duration of therapy. In France, hospital programs have been in place for more than 20 years and met some success, but they remain insufficient regarding some other European countries. Notably, educative strategies including better diagnosis and improvement of antimicrobial use has been facilitated by the implementation of multidisciplinary teams. However, the success of these programs needs more involvement of other hospital practictioners, who must understand and adhere to these principles.

RECENT EVOLUTION OF THE EPIDEMIOLOGY AND BURDEN OF INVASIVE MENINGOCOCAL DISEASE. The landscape of invasive meningococcal disease (IMD) has changed considerably since the COVID-19 pandemic. The number of cases has decreased significantly following the non-pharmaceutical interventions employed to counter the pandemic, but vaccination rates were also lower during the pandemic than pre-pandemic levels. Once the health restrictions were lifted, IMD rapidly rebounded, initially with a resurgence in adolescents/young adults, then in other age groups, reaching a higher number of cases in 2023 than in the pre-pandemic period, with profound epidemiological and genotypic changes, particularly for serogroups W and Y. The number of serogroup C cases remains very low, thanks to the protection offered by the serogroup C conjugate vaccination program for children.

ACCIDENTS AT WORK, OCCUPATIONAL DISEASES AND WORK-RELATED. DISEASES: TO SEE MORE CLEARLY. Occupational factors have a major impact on population health. Occupational diseases or work-related diseases and accident at work are diverse and multifactorial. Nevertheless, exposure to occupational risk factors and associated disorders are avoidable. Preventive actions must be applied and adapted to working conditions and working population characteristics. Recognition of the professional origins allows for treatment and various financial compensation. Medical professions have a major role in supporting patients by considering the possibility of a professional origin.