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International audience; OBJECTIVE:We aimed to assess medical practices of French infectious disease specialists or any other relevant physicians related to the management of non-necrotizing cellulitis (NNC).METHODS:We sent an online questionnaire to members of the French Infectious Diseases Society (SPILF) mailing list in September 2015.RESULTS:A total of 108 specialists took part in the survey and 10% (11/107) declared to always admit NNC patients to hospital. As for the others, 18% declared to admit patients in more than 80% of cases, 49% in 50-80% of cases, 26% in 20-50% of cases, and 7% in less than 20% of cases. The most frequent criteria for hospital admission were severe sepsis/septic shock (99%), poor social conditions (99%), rapid extension of skin lesions (93%), high level of pain (86%), and failure of first-line antibiotic therapy (84%). Participants mentioned similar criteria for reasons to initiate the intravenous (IV) antibiotic therapy. Fifty-three percent of respondents declared initiating antibiotic therapy using the IV route in more than 80% of cases. Physicians declared that the usual antibiotic therapy duration were 15 days (3%).CONCLUSION:Criteria for hospital admission and use of the IV route for antibiotic therapy as well as optimal treatment duration in patients presenting with NNC need to be detailed in guidelines and evaluated in prospective studies.

International audience; The use of fluoroquinolone (FQ) as first line therapy for typhoid fever should be reconsidered because of the emergence of Salmonella Typhi and Paratyphi A strains with decreased susceptibility to FQ, mainly from Asia. Relapse can occur when ciprofloxacin MIC is over 0.12 mg/l, as illustrated by our case report. Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates. Literature review led us to suggest a new therapeutic strategy for uncomplicated typhoid fever, the antibiotic was chosen according to nalidixic acid susceptibility and ciprofloxacin MIC of the strain. High-dose intravenous ceftriaxone (4 g per day) is always efficient in first line therapy. Depending on FQ susceptibility testing results, it is relayed by oral therapy with a FQ (ciprofloxacin 500 mg bid for 7 days) if the isolate has maintained susceptibility, or azithromycin (1 g first day and 500 mg per day, 7 days) if the isolate is resistant to nalidixic acid or has a ciprofloxacin MIC superior to 0.12 mg/l.; La place des fluoroquinolones (FQ) dans le traitement de première intention des fièvres typhoïdes (FT) doit être remise en question du fait de l’émergence de souches de Salmonella enterica serovar Typhi et Paratyphi A de sensibilité diminuée aux FQ en provenance d’Asie du sud-est. Des rechutes peuvent survenir quand la CMI de la ciprofloxacine est supérieure ou égale à 0,125 mg/l, comme l’illustre le cas clinique que nous rapportons. L’azithromycine a une efficacité démontrée sur les souches de sensibilité diminuée à la ciprofloxacine. À partir d’une revue de la littérature, nous proposons un nouveau schéma thérapeutique des FT non compliquées, où l’antibiothérapie est guidée par la sensibilité à l’acide nalidixique et la CMI de la ciprofloxacine de la souche. La ceftriaxone intraveineuse à forte dose (4 g/24 h) est toujours efficace en première intention ; elle est initiée dans l’attente des données de sensibilité de la souche. Un relais par voie orale est pris avec une FQ (ciprofloxacine 500 mg deux fois par jour, sept jours) en cas de sensibilité conservée, ou l’azithromycine (1 g le premier jour, puis 500 mg par jour, sept jours) en cas de résistance à l’acide nalidixique ou de CMI de la ciprofloxacine supérieure ou égale à 0,125 mg/l.

Objective In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's “antimicrobial stewardship” group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST – antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. Methods We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts’ consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. Results A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. Conclusion Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities.

International audience

International audience; In most cases, differentiating viral from bacterial meningitis is relatively easy, based on clinical examination, CSF appearance and results of CSF examination (cytology, biochemistry and Gram stain). However, in about 20% of cases, this diagnosis may be difficult. For such cases, additional non-microbiological tests may be helpful. CSF lactate level is a good predictor of bacterial meningitis for values greater than 3.5 mmol/l. Serum procalcitonin is effective to discriminate between bacterial and viral meningitis, using a threshold between 1 and 2 ng/ml, although this parameter may fail in individual situations. Accurate diagnosis scores or models have been validated and may be used in routine clinical practice, especially in emergency rooms, both for adults and children to help identify patients with a very low probability of bacterial meningitis in whom antibiotic may thus be avoided.