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Background Osteomyelitis-complicating pressure ulcers are frequent among patients with spinal cord injuries (SCIs), and the optimal management is unknown. In our referral center, the current management is debridement and flap coverage surgeries, followed by a short antibiotic treatment. We aimed to evaluate patients' outcomes a year after surgery. Methods We performed a quasi-experimental retrospective before/after study on SCI patients with presumed osteomyelitis associated with perineal pressure ulcers. We included all patients who underwent surgery with debridement and flap covering, followed by effective antibiotic treatment, between May 1, 2016, and October 30, 2020. The effective antimicrobial treatment duration included the 10 days leading up to January 1, 2018 (before period), and the 5 to 7 days after (after period). We also compared the efficacy of 5–7-day vs 10-day antibiotic treatment and performed uni- and multivariable analyses to identify factors associated with failure. Results Overall, 415 patients were included (77.6% male patients; mean age ± SD, 53.0 ± 14.4 years). Multidrug-resistant organisms (MDROs) were involved in 20.7% of cases. Favorable outcomes were recorded in 69.2% of cases: 117/179 (65.3%) in the 10-day treatment group vs 169/287 (71.9%) in the 5–7-day treatment group (P =.153). The only factor associated with failure in the multivariate analysis was a positive culture from suction drainage (odds ratio, 1.622; 95% CI, 1.005–2.617; P =.046). Effective treatment duration >7 days and intraoperative samples negative for MDROs were not associated with better outcomes (P =.153 and P =.241, respectively). Conclusions A treatment strategy combining surgical debridement and flap covering, followed by 5 to 7 days of effective antibiotic treatment seems safe. [ABSTRACT FROM AUTHOR]

Les infections ostéo-articulaires (IOA) regroupent différentes pathologies d'une grande hétérogénéité : infections aiguës, chronique, sur matériel, infection sur articulation native, ostéomyélite, atteinte de l'os cortical ou médullaire, pied diabétique... De manière schématique, on peut distinguer : 1) Les infections aiguës qui ne posent pas de problème diagnostique et impliquent le plus souvent Staphylococcus aureus. Il s'agit d'infection, cliniquement, bruyantes (fièvre importante, douleur aiguë ± impotence fonctionnelle sévère, rougeur, chaleur et œdème localisé au niveau de l'articulation infectée). 2) Les infections chroniques qui surviennent le plus souvent sur matériel ne sont en règle générale pas des urgences thérapeutiques. La seule urgence est diagnostique car la prise en charge associera une antibiothérapie prolongée (12 semaines) ciblée sur la bactérie identifiée et un geste chirurgical. Les IOA sont très rarement associées à des signes de gravité systémiques. Le score quick SOFA (qSOFA), utilisable au lit du malade comprant les items suivants : fréquence respiratoire ≥ 22/min, présence d'un trouble des fonctions supérieures, pression artérielle systolique ≤ 100 mmHg. Lorsque qSOFA ≥ 2, la prise en charge en réanimation est indiquée. Dans la plupart des cas, les IOA sont des infections engageant uniquement le pronostic fonctionnel et pour lesquelles, le risque de dysfonction d'organe engageant le pronostic vital, i.e le risque de sepsis, est faible. Les IOA bactériémiantes ne représentent que 20 % des cas. En cas de sepsis, l'antibiothérapie probabiliste devra être efficace vis-à-vis des bactéries à cocci Gram positif au vu de leur fréquence. Les staphylocoques dorés producteurs de leucocidine de Panto-Valentine sont responsables d'IOA sévères nécessitant une prise en charge médico-chirurgicale agressive adaptée et précoce. Bone and joint infection (BJI) are heterogeneous: acute infections, chronic infections, prothetic infections, osteomyelitis, diabetic foot infections... Acute infections are not diagnostic problems. Staphylococcus aureus is mostly involved and cause noisy clinical manifestation (fever, pain ± functional impairment, redness, heat and edema). Chronic infections mainly concerned prosthetic joint infection and usually are not therapeutic emergencies but a diagnostic challenge. Indeed, the management of this type of infection combine prolonged antibiotic therapy (12 weeks) with heavy operative procedure. Overall, BJIs very rarely show signs of systemic severity, however there are some elements of poor prognosis to be aware of. The SOFA quick score (qSOFA) can be used at bedside. This score includes the following clinical items: respiratory rate ≥ 22 / min, upper function disorders, systolic blood pressure ≤ 100 mmHg. A qSOFA score ≥ 2 implicated a transfer in intensive care unit. The sepsis criteria were simplified in 2016 during the "Surviving sepsis campaign". The new recommendations define sepsis as life-threatening organ dysfunction due to a dysregulated host response to infection. BJIs imply the functional prognosis but the risk of sepsis is low. Bacteriemia during BJIs occurs in 20% of cases. In case of sepsis during BJI, the probabilistic antibiotic therapy must include an anti-gram positive cocci. The involvement of methicillin-resistant Staphylococcus aureus and Ponto-Valentine Staphylococcus aureus in BJIs should be identified early in order to limit the consequences through appropriate aggressive medico-surgical management. [ABSTRACT FROM AUTHOR]

Nannizziopsis spp., fungi responsible for emerging diseases, are rarely involved in human bone and joint infections. We present a rare case of septic arthritis with necrotizing cellulitis caused by N. obscura in a patient in France who had undergone kidney transplant. Rapid, aggressive medical and surgical management led to a favorable outcome. [ABSTRACT FROM AUTHOR]

In a large regional observational cohort study of adult (≥ 18 years), outpatients with COVID-19, prevalence, characteristics, and outcome of patients with rash and/or chilblain-like lesions (CLL), compared with population without cutaneous features, were studied. In total, 28,957 outpatients were included; the prevalence of rash and CCL were 9.5% and 3.7%, respectively. Presence of rash was significantly associated with presence of asthenia, shivers or myalgia, respiratory and gastro-intestinal symptoms, and anosmia/ageusia. The presence of CCL was associated with chest pain, chest oppression, nausea/vomiting, and anosmia/ageusia. Patients with CCL were significantly less prone to an unfavourable outcome (hospitalization or death). [ABSTRACT FROM AUTHOR]

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a current pandemic worldwide. This virus can reach all organs and disturbs the immune system, leading to a cytokine storm in severe forms. We aimed to report cutaneous features among coronavirus disease 2019 (COVID-19) hospitalized patients. Methods We performed a cross-sectional study on 1 given day among all patients hospitalized in acute care for COVID-19 and included all patients with cutaneous features. Follow-up 48 hours later was obtained. Results Among 59 adult patients hospitalized on the day of the study in an infectious diseases ward for SARS-CoV-2 infection who were confirmed by molecular assay and/or radiological findings (computed tomography scan), 40 were included. Several cutaneous manifestations were found: macular exanthema (80%), face edema (32%), livedo (13%), urticarial rash (8%), purpura (5%), oral lichenoid lesions (33%), and conjunctivitis (18%). Cutaneous biopsy was performed in 17 patients. Histological findings showed mast cell hyperplasia (100%), superficial perivascular infiltrate of lymphocytes (94%), and superficial edema (47%) consistent with capillary leak. Conclusions Various dermatological signs can be encountered during COVID-19. A macular rash was the most frequent. All cutaneous features could be related to a vascular leak process. [ABSTRACT FROM AUTHOR]

To assess the time to resolution of respiratory and systemic symptoms and their associated factors in outpatients during the coronavirus disease 2019 (COVID-19) pandemic. Cohort study including adult outpatients, managed with Covidom, a telesurveillance solution, with RT-PCR-confirmed diagnosis, from 9 March 2020 until 23 February 2021. Follow up was 30 days after symptom onset. Among the 9667 patients included, mean age was 43.2 ± 14.0 years, and 67.5% were female (n = 6522). Median body mass index (BMI) was 25.0 kg/m2 (interquartile range 22.1–28.8 kg/m2). Main co-morbidities were: hypertension (12.9%; n = 1247), asthma (11.0%; n = 1063) and diabetes mellitus (5.5%; n = 527). The most frequent symptom during follow up was dyspnoea (65.1%; n = 6296), followed by tachypnoea (49.9%; n = 4821), shivers (45.6%; n = 4410) and fever (36.7%; n = 3550). Median times to resolution of systemic and respiratory symptoms were 3 days (95% CI 2−4 days) and 7 days (95% CI 6−8 days), respectively. Ultimately, 17.2% (95% CI 15.7%−18.8%) still presented respiratory symptoms at day 30. Longer time to respiratory symptom resolution was associated with older age, increased BMI, chronic obstructive pulmonary disease, coronary artery disease, asthma and heart failure. Regarding systemic symptoms, coronary artery disease, asthma, age above 40 years and elevated BMI were associated with longer time to resolution. Time to symptom resolution among outpatients with COVID-19 seemed shorter for systemic than respiratory symptoms. Prolonged respiratory symptoms were common at day 30. Risk factors associated with later resolution included age, and cardiovascular and pulmonary diseases. [ABSTRACT FROM AUTHOR]

In our hospital, during COVID-19 pandemic, overall consumption of antibiotics increased during the three first surges, mainly due to ICU prescription However, antibiotic consumption decreased in the Infectious Diseases Department. Rates of ESBL Enterobacterales remained stable., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)