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Raoultella planticola is a rare environmental bacteria. It is currently associated with an increasing number of human infections including those of soft tissues, pancreatitis, urinary tract infections, gastro-intestinal and oropharyngeal. We report the first case of R. planticola meningitis in a newborn. The objective of this study is to report a case of neonatal meningitis caused by R. planticola and to present the difficulties of management in our working conditions. R. planticola bacterial meningitis in newborns is serious. The ability of R. planticola to be a multiresistant organism to common antibiotics underlines the need for special attention from medical personnel in this age group with early and appropriate treatment. [ABSTRACT FROM AUTHOR]

Within nursing homes, infection control remains a public health issue. We wanted to assess the impact of protective and confinement measures on the incidence of bacterial infections in nursing homes. Secondary objectives were to evaluate this impact on the incidence of different infection types, and to study the factors influencing the prescription of antibiotics. This multicenter quantitative retrospective study compares a group of 274 patients not exposed to protective measures (March 2019 - March 2020) and a group of 269 patients exposed to them (March 2020 - March 2021). We observed a 21% decrease in antibiotic prescription (RR = 0.79; 95% CI [0.71-0.87]; p < 0.001). and a 49% decrease in antibiotic prescription for respiratory infections (RR = 0.51; 95% CI [0.37-0.69]; p < 0.001). The patient's degree of dependence was a factor influencing the antibiotic therapy used. The significant drop in the incidence of respiratory infections due to confinement and protective measures is weighted against side effects, especially involving mental health. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Otorrhea is a common symptom of acute otitis media (AOM). It is sometimes the first and only symptom of a perforated AOM (absence of fever or pain). National and international recommendations consider it as a noisy symptom or a sign of seriousness of an AOM, justifying systematic oral antibiotic therapy, whatever the age of the child and whatever the symptomatic character (fever or pain). What randomized clinical trials (RCTs) or meta-analyses of RCTs support these recommendations? What is the effectiveness of oral or topical antibiotics in children with isolated otorrhea on AOM? A systematic review of RCTs and meta-analyses of RCTs (MA) concerning the antibiotic treatment of otorrhea isolated on AOM in children was conducted. The Medline and Cochrane databases were consulted until 30/07/2019. Results: No RCT or MA of RCT evaluated the effect of oral or topical antibiotic therapy in children with asymptomatic otorrhea following a perforated AOM. Conclusion: Current recommendations to systematically treat children with isolated otorrhea on AOM with antibiotics are not justified by an RCT. [ABSTRACT FROM AUTHOR]

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Résumé: Contexte : L'antibiorésistance représente un enjeu majeur de santé publique. La majorité des antibiotiques sont prescrits par des médecins de ville dans des pathologies qui ne nécessitent que très rarement une antibiothérapie. La prescription différée d'antibiotique (PDA) se présente comme une option dans cet objectif de diminution de consommation d'antibiotique. Méthodes : Étude prospective, interventionnelle, quantitative de deux groupes parallèles auprès de médecins généralistes habitués à la pratique de PDA en France. Le critère de jugement principal était le taux de consommation d'antibiotique par le patient selon son groupe (PDA protocolisées ou PDA habituelles). Le groupe de PDA protocolisées devait coller une étiquette sur l'ordonnance. L'étiquette mentionnait des informations pour le patient sur les conditions de prise et de délai avant la prise d'antibiotique. Résultats : 205 PDA ont pu être analysées. La consommation d'antibiotiques dans le groupe avec étiquette (40,7 %) était inférieure à celle du groupe sans étiquette (51,9 %) (p = 0,11). Afin d'être le plus fidèle à la pratique, nous avons réalisé une deuxième comparaison en séparant les PDA avec modalités orales seules (sur lesquelles il n'y avait pas d'indications écrites sur la PDA) et les PDA avec modalités écrites. La consommation d'antibiotiques avec modalités écrites (43,7 %) était inférieure à celle avec modalité orale seule (52,4 %) (p = 0,25). Dans notre étude 42 sur 137 (30,7 %) patients sont allés chercher les antibiotiques à la pharmacie mais ne l'ont pas consommé. Conclusion : Nos résultats montrent une tendance vers la diminution de consommation des antibiotiques après une consigne écrite chez des médecins habitués à la réalisation de la PDA. Quelles que soient les modalités de prescription par des médecins généralistes habitués à cette pratique, la consommation d'antibiotique diminue tant que les informations transmises sont claires et appropriées Background: Antibiotic resistance is a major public health issue. Most antibiotics are prescribed by general practitioners for pathologies that rarely require antibiotic therapy. Delayed antibiotic prescription (DAP) is an alternative way to reduce antibiotic consumption. Methods: Prospective, interventional, quantitative study of two parallel groups of general practitioners accustomed to the practice of DAP in France. The primary outcome was the rate of antibiotic consumption by the patient according to group (protocolized DAP or usual DAP). The protocolized DAP group had to stick a label on the prescription. The label included information for the patient on the conditions for taking the antibiotic and the delay before taking it. Results : 205 DAPs were analyzed. Antibiotic consumption in the labelled group (40.7%) was lower than in the unlabeled group (51.9%) (P = 0.11). We performed a second comparison by separating DAPs with oral modalities only (on which there were no written indications on the DAP) and DAPs with written modalities. Antibiotic consumption with written modalities (43.7%) was lower than that with oral modality alone (52.4%) (P = 0.25). In our study 42 out of 137 (30.7%) patients went to the pharmacy to get the antibiotics but did not consume it Conclusion: Our results show a tendency towards a decrease in antibiotic consumption after written instructions in physicians accustomed to performing DAP. Regardless of the prescribing methods used by general practitioners accustomed to this practice, antibiotic consumption decreased if the information transmitted is clear and appropriate. [ABSTRACT FROM AUTHOR]

Background: We evaluated the contribution of a rapid antibiotic susceptibility test performed directly from a positive blood culture (PBC), the dRAST™, in the management of patients with bacteremia., Methods: We retrospectively compared the time from sampling to availability of antibiotic susceptibility test (AST) results («time-to-result», TTR) between dRAST™ and classic AST (Vitek®2), in 150 patients with bacteremia. The antibiotic treatment of these 150 patients was classified into three categories (optimal, suboptimal, ineffective) according to the time of availability of AST results., Results: Adaptation of antibiotic treatment to optimal therapy following AST results occurred in 46/100 (46 %) of Gram-negative PBC and in 4/50 (2 %) of Gram-positive HP. TTR was significantly lower with dRAST™ compared with classic AST (29:35 (± 08:48) hours versus 50:55 (± 12:45) hours, p < 0.001)., Conclusion: For patients with bacteremia requiring adjustment of empirical antibiotic therapy based on AST, dRAST™ could allow a faster administration of optimal therapy.

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ, it occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates a special management. This report describes the first case in Europe of a patient with chronic constrictive pericarditis from nocardia brasiliens, successfully treated with pericardiectomy and appropriate antibiotic therapy., Competing Interests: Conflit d'intérêts Les auteurs déclarent n'avoir aucun conflit d'intérêts., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé L’endémie d’entérobactéries sécrétrices de bêta-lactamase à spectre élargi (EBLSE) que nous vivons actuellement est liée à la diffusion d’un mécanisme de résistance plasmidique au sein des entérobactéries et particulièrement l’espèce Escherichia coli . Cette situation épidémiologique nécessite un niveau d’observance élevé des précautions standards et une maîtrise de la prescription antibiotique. D’autres mesures complémentaires peuvent être justifiées de par les données épidémiologiques locales. Lutter contre la diffusion de ce mécanisme de résistance est une priorité dans la mesure où sa diffusion fait le lit de la diffusion des Entérobactéries productrices de carbapénémase. Summary We are living an endemic situation related to the spread of ESBL-producing Enterobacteriaceae. To contain this phenomena we need a high compliance to hand hygiene and standard precautions associated with an efficient control of the antibiotic consumption. However local epidemiological data could justify additional measures. Our priority should be to combat the spread of ESBL-PE, as it is the first step before spreading of Carbapenemase producing enterobacteriaceae. [ABSTRACT FROM AUTHOR]

Broad ischemic stroke is mainly due to a cardiac embolus or to an atheromatous plaque. In young subjects, one of the main causes of ischemic stroke (broad ischemic stroke in particolar) is embolic heart disease including infective endocarditis. Infective endocarditis is a contraindication against the anticoagulant therapy (which is indicated for the treatment of embolic heart disease complicated by ischemic stroke). One neurologic complications of infective endocarditis is ischemic stroke which often occurs in multiple sites. We here report the case of a 44-year old man with afebrile acute onset of severe left hemiplegia associated with a sistolic mitral murmur, who had fever in hospital on day 5 with no other obvious source of infection present. Brain CT scan showed full broad ischaemic stroke of the right middle cerebral artery territory and doppler ultrasound, performed after stroke onset, showed infective endocarditis affecting the small mitral valve. He was treated with 4 weeks of antibiotic therapy without anticoagulant therapy; evolution was marked by the disappearance of mitral valve vegetations and by movement sequelae involving the left side of the body. In practical terms, our problem was the onset of the fever which didn't accompany or pre-exist patient's deficit, leading us to the misdiagnosis of ischemic stroke of cardioembolic origin. This case study underlines the importance of doppler ultrasound, in the diagnosis of all broad ischemic strokes, especially superficial, before starting anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Résumé Les antithyroïdiens de synthèse (carbimazole, méthimazole [non disponible en France], thiamazole, benzylthiouracile et propylthiouracile) sont l’une des classes médicamenteuses les plus à risque d’agranulocytose médicamenteuse. Une neutropénie aiguë, profonde (< 0,5 × 10 9 /L), isolée, survenant chez un sujet traité par antithyroïdiens de synthèse doit, jusque preuve du contraire, faire suspecter une agranulocytose médicamenteuse. Le spectre clinique va de la découverte d’une neutropénie aiguë, sévère, asymptomatique, à une fièvre « nue », à des infections localisées (surtout ORL et pulmonaires) et des septicémies. Avec une prise en charge optimale (arrêt de la molécule, antibiothérapie en contexte fébrile, voire utilisation de facteur de croissance hématopoïétique), la mortalité actuelle est proche de 2 %. The antithyroid agents (carbimazole, methimazole, thiamazole, propylthiouracil and benzylthiouracile) are the drug class that is associated with a high risk of agranulocytosis. Acute and profound (< 0.5 × 10 9 /L) isolated neutropenia occurring in a subject treated with antithyroid agents should be considered as a drug-induced agranulocytosis, until proven otherwise. The clinical spectrum ranges from discovery of acute severe but asymptomatic neutropenia, to isolated fever, localized infections (especially ear, nose and throat, or pulmonary) or septicemia. With an optimal management (discontinuation of antithyroid agents, antibiotics in the presence of fever or a documented infection, or use of hematopoietic growth factor) the current mortality is close to 2%. [ABSTRACT FROM AUTHOR]

Résumé Les abcès du cerveau à pyogènes (AC) sont une infection relativement rare et de diagnostic parfois difficile en raison de l’absence de signes cliniques ou biologiques spécifiques. Cependant, l’utilisation des séquences de diffusion lors de l’IRM cérébrale a radicalement modifié la prise en charge des AC. En effet, l’imagerie permet maintenant de façon très sensible et spécifique de différencier les abcès du cerveau à pyogènes de tumeurs nécrotiques, diagnostic différentiel le plus fréquent. L’imagerie devrait être rapidement suivie par une ponction-aspiration de l’abcès à visée diagnostique et thérapeutique. Cette procédure doit être effectuée si possible avant le début des antibiotiques afin d’optimiser le diagnostic microbiologique. Les changements épidémiologiques récents comprennent une augmentation du nombre de patients immunodéprimés et une diminution des causes traditionnelles d’AC (inoculation directe, infections ORL et de voisinage, etc.). En conséquence, un plus large éventail d’espèces bactériennes peuvent être impliquées, ce qui rend d’autant plus nécessaire l’obtention d’un diagnostic microbiologique. De nombreuses incertitudes subsistent en ce qui concerne la durée du traitement antibiotique, le suivi radiologique optimal et la place des traitements associés tels que les corticoïdes et le traitement anticonvulsivant. Les AC restent une infection sévère avec des taux de mortalité et de morbidité élevés ; le facteur le plus régulièrement associé à un mauvais pronostic est l’état neurologique des patients au moment du diagnostic. Pyogenic brain abscesses (BA) are rare and their diagnosis may be difficult because of the absence of specific clinical or biological signs. However, the use of diffusion-weighted brain MRI sequences has modified the management of BA, as they are highly sensitive and specific to differentiate pyogenic brain abscesses from necrotic tumors, which are the most frequent differential diagnosis in case of ring-enhancing lesions on CT scan. This new tool allows for a rapid diagnosis and should be followed by a CT-guided aspiration of BA. This safe procedure should be performed if possible before starting antibiotics in order to optimize microbiological diagnosis. Recent epidemiological changes include an increase in the numbers of immunocompromised patients and a decrease in the traditional causes of BA (direct inoculation, ear nose and throat infections, etc.). In consequence, a wider range of bacterial species may be involved, making it all the more necessary to obtain a microbiological diagnosis. Many uncertainties remain in terms of the duration of antibiotic treatment, the optimal radiological follow-up and the place for associated treatments such as corticosteroids and anticonvulsive therapy. BA remain severe infections with high mortality and morbidity rates; the factor most regularly associated with a poor prognosis is the patients neurological status at diagnosis. [ABSTRACT FROM AUTHOR]

Résumé Les infections du tractus urinaire sont les plus communes des infections féminines. La majorité d’entre elles est représentée par la cystite dont la forme la plus courante est la cystite aiguë bactérienne simple. La prise en charge repose sur une antibiothérapie, les traitements complémentaires et de nombreux conseils qui permettent également de prévenir les récidives. Summary Cystitis: adapted treatment to prevent drug resistance. Urinary tract infections are most frequent among women, particularly cystitis, the most common form of which is simple bacterial acute cystitis. Treatment is based on antibiotic therapy, complementary treatments and advice to help to prevent recurrences. [ABSTRACT FROM AUTHOR]

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Résumé: À la suite d’un rappel de la définition de l’autisme infantile et de la maladie de Lyme, un cas clinique sera développé. Il s’agit d’un jeune patient avec autisme âgé de 14ans et demi, caractérisé par un développement initial typique pendant sa première année puis par une dégradation générale de ses aptitudes peu après avoir été atteint de la maladie de Lyme. À la suite d’une présentation sous la forme d’une vignette clinique, nous aborderons l’évolution de la symptomatologie et du comportement de ce jeune pendant un an d’antibiothérapie. Au quotidien, sont rapportées une amélioration des conduites interactionnelles et communicationnelles, de l’expression verbale, du sommeil et une réduction des comportements répétitifs. Cette présentation de cas permettra finalement d’interroger la définition de l’autisme, son étiologie et la validité du diagnostic établi initialement pour ce patient. [ABSTRACT FROM AUTHOR]

Résumé: L’antibioprophylaxie en chirurgie carcinologique ORL diminue l’incidence des infections du site opératoire (ISO). Toutefois, dans certaines chirurgies à risque, réalisées sur des terrains favorisants, avec persistance d’un ensemencement salivaire postopératoire, la question du choix entre antibioprophylaxie et antibiothérapie curative se pose. Nous avons mené une démarche pluridisciplinaire visant à un consensus local en adéquation avec les bonnes pratiques. Pour cela, une revue systématique de la littérature selon les recommandations PRISMA a été réalisée pour répondre aux questions des indications respectives de l’antibioprophylaxie et de l’antibiothérapie curative, de la durée optimale de l’antibioprophylaxie et de la nature de l’antibioprophylaxie en chirurgie carcinologique ORL. À l’issue de ce travail, il apparaît que les patients bénéficiant d’une procédure carcinologique ORL de classe Altemeier 2 à 3 doivent bénéficier d’une antibioprophylaxie peropératoire restreinte aux 24 premières heures postopératoires. Il n’a pas été démontré de bénéfice à sa prolongation au-delà de ces 24heures. Les associations de molécules à privilégier sont « amoxicilline+acide clavulanique » et « clindamycine+gentamicine ». Toutefois, le niveau de preuve concernant les chirurgies les plus délabrantes à haut risque d’ISO apparaît inférieur à celui concernant les chirurgies carcinologiques cantonnées au pharynx ou au larynx, rendant souhaitable la réalisation de nouvelles études randomisées de forte puissance chez ces patients. Il convient enfin de rappeler que l’antibioprophylaxie doit s’intégrer dans un ensemble de mesures préventives des ISO comportant une prise en charge générale du patient, des mesures d’hygiène peropératoires et une surveillance postopératoire attentive des signes d’ISO. [ABSTRACT FROM AUTHOR]

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Copyright of Italian Oral Surgery is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Modalities of bone infection therapeutic follow-up are controversial, notably for biological and radiological parameters. We have proposed six weeks of antibiotic therapy for all patients presenting with bone infection, since July 2005. Therefore, biological and radiological exams performed during the treatment were not taken into account when determining the duration of antibiotherapy. This protocol allows determining the usefulness of these biological and radiological parameters. Methods: All patients presenting with bone infection, from July 2005 to July 2008, were included. Inflammatory biological parameters such as C-reactive protein (CRP) and sedimentation rate were analyzed, and values were considered as normal when less than 10mg/L and less than 15mm respectively. All available CT- and MR imaging were analyzed by the same referent radiologist. Results: Eighty-seven patients presenting with bone infection received antibiotic therapy for a mean [SD] 42±0.3 days. Cure was reported in 82 patients (94%) with a mean follow-up after antibiotic therapy of 36±9 months, five patients relapsed. CRP was available in 66 cases by the end of antibiotic therapy, it was normal in 40/64 of patients with favorable outcome (62%) and in one case of unfavorable outcome. The sedimentation rate was available in 22 cases, and normal in seven cases of favorable outcome (32%). By the end of antibiotic therapy, CT-scan showed active bone infection for 15/23 of patients with favorable outcome (65%), while MR imaging suggested the same diagnosis in 8/14 cases (57%). Conclusion: Biological parameters and radiological findings are inadequate to determine the duration of antibiotic therapy in bone infection. [Copyright &y& Elsevier]

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Abstract: The evaluation of clinical practice includes three successive phases: demonstration of suboptimal clinical practice, proposals for improvement, and assessment of effective changes. We present a medical computerized database used for this evaluation. Patient and methods: Our database includes 24 parameters for all hospitalized patients among which diagnosis and antibiotherapy. The first assessment phase indicated an unjustified heterogeneous antibiotherapy for community-acquired pneumonia (CAP). The second phase was the drafting of our own consensus for CAP treatment, aiming at reducing the use of fluoroquinolones and third generation cephalosporin. The computerized database was used in the third phase to check observance of our consensus. Results: Two hundred and fifty patients were hospitalized for CAP before the consensus, from October to January 2005, 2006, and 2007, compared to 113 patients from October 2008 to March 2009. The rate of adequate prescriptions improved from the first period to the second one: 58% versus 69%, p =0.045. The inadequate use of fluoroquinolones and third generation cephalosporins was more frequent during the first period, compared to the second one: 49% versus 38%, p =0.048. The mean hospital stay was longer before applying our consensus: 9±5 days versus 7±4 days, p =0.009. Evolution was unfavorable in 15/250 cases (6%) and 3/113 cases (<1%), respectively. Conclusion: A medical database allows for a rapid implementation of two out of three phases of clinical evaluation, through the appropriation of a new consensus, with a reduction of antibiotic misuse without impact on infectious morbidity and mortality. [Copyright &y& Elsevier]

Summary: Introduction: Antibacterial prescribing practices between 2004 and 2008 were investigated in the P. Giaccone University Hospital in Palermo, Italy to provide a foundation for critical analysis of the appropriateness of health-care resource usage. Materials and methods: Antibiotic prescribing practices between 2004 and 2008 were analyzed in the hospital as a whole and in different specialty areas. Results were expressed as defined daily doses (DDD) as a function of bed-days, number of admissions, and Diagnosis Related Group (DRG) points. Results: During the study period, increases were observed in the overall DDD per 100 bed-days (68.7 vs. 91.3) and the DDD per admission (4.53 vs. 5.54), but less variation was observed in the DDD/DRG score (3.55 vs. 3.63). Use of metronidazole, carbapenems, and glycopeptides increased, while use of third-generation cephalosporins, quinolones, and oral penicillins remained fairly stable. The drugs most commonly used in 2008 were (% of total DDD): levofloxacin (18.08%), amoxicillin+clavulanic acid (13.32%), ceftriaxone (9.01%), ciprofloxacin (8.21%), clarithromycin (5.74%), metronidazole (5.36%), ceftazidime (5.16%), amoxicillin (4.92%), gentamicin (1.88%), and meropenem (1.80%). An overall trend toward the prescription of newer wide-spectrum antibacterial agents was noted. National guidelines on chemoprophylaxis in surgery were observed in only 3/17 (17.7%) units. The prevalence of nosocomial infections was lower than those reported in the literature. Discussion: Although the cases treated in the hospital have become more complex over the years, the DDD documented in our study are far too high with respect to the actual clinical needs. These findings point to a trend toward the practice of excessively defensive medicine. Greater responsibility among physicians and the promotion of primary and secondary measures of preventive hygiene are fundamental to reduce the prescriptive pressure, a goal that should also have ... [Copyright &y& Elsevier]

Summary: Background: Nursing home-acquired pneumonia (NHAP) was described in 1978, but only in 2005 it has been proposed as part of a new category (health care-associated pneumonia) distinct from community- or hospital-acquired infections. However, limited clinical data exist to validate this proposal. Aim of the study: To compare characteristics and outcome of patients hospitalised for pneumonia and coming from private residence or nursing home. Methods: Post-hoc analysis of the prospective phase of the FASTCAP study, performed to evaluate the impact of the Recommendations issued by the Italian Federation of Internal Medicine (FADOI) in 2002 on the management of hospitalised community-acquired pneumonia (CAP). Results: The study examined 1,219 patients coming from private residence, and 179 with NHAP. Failures of therapy were significantly more frequent in patients with NHAP (35.8% vs 24.9%; Odds Ratio 1.48; 95% confidence interval 1.05-2.09). Mortality was higher in patients coming from nursing home (24.0% vs 9.8%; OR 2.59; 95% CI 1.72-3.90). Antibiotic treatment was more frequently performed as monotherapy in case of NHAP. Conclusions: At the time of FASTCAP, NHAP was included in the category of CAP, and coherently, treatment of NHAP was not more aggressive if compared to community-acquired infections. However, our results confirm that NHAP is at increased risk for worst outcome, and probably worth considering for specific therapeutic strategies. Future studies are needed to better assess the microbiology of NHAP, and to evaluate if specific treatments, as those recommended by recent guidelines, may improve the outcome for these high-risk patients. [Copyright &y& Elsevier]

Abstract: Management of febrile neutropenic patients is described in guidelines. Each cancer center can adapt these according to its local bacterial ecology. We present a retrospective study made in a cancer center from 2001 to 2003. Method: Three hundred and fifteen febrile neutropenic episodes after chemotherapy (66% for solid tumor) were analysed. Results: For 279episodes, no antibiotic therapy was given before admission. Clinical or radiological manifestations occurred in 46%; microbiologically documented infections by hemocultures in 28% (Gram positive: 42%; Gram negative: 51%) and by puncture in 14% (Gram negative: 58%). The length of pyrexia was inferior to 7days in 88% and neutropenia inferior 7days in 80.8%. 79.7% of episodes were treated with one of the three antibiotic therapy recommended by the center (ceftriaxone+tobramycin; ceftriaxone+ciprofloxacin; ceftriaxone+ofloxacin); 13.3% were treated with an other therapy; 7% received no antibiotic therapy. 68.5% of patients treated with one of the three antibiotic therapies, became afebrile without changing the antibiotic protocol. Conclusion: In our study, there were a majority of Gram negative bacteria except for Pseudomonas aeruginosa. The three antibiotic therapy recommended by the center (third generation cephalosporin+aminoglycosides or fluoroquinolones) were effective and glycopeptide was not necessary in first intention treatment. [Copyright &y& Elsevier]

Abstract: Monitoring of body temperature, but also of C-reactive protein (CRP) level is performed in infected patients treated with antibiotics. These two parameters having low specificity for any diagnosis, our aim was to evaluate the usefulness of CRP in this context. Patients and method: A representative sample of patients was randomly extracted from our medical computerized tables. All patients presented community-acquired infections and had at least two CRP level assessments. Kinetics of body temperature and CRP allowed to quantify clinical and biological discrepancy while the patient''s chart was studied to determine the etiologies. Results: Three hundred and ninety-two patients over 942 (42%) were admitted in our department over 2 years, including 147 cases of respiratory infections (37%), 91 of urinary infections (23%), 65 of cellulitis (17%), 70 of primary bacteremia (18%), 19 of digestive infections (5%). Ninety-four percent of the patients had been prescribed antibiotic therapy. We observed a correlation between temperature and CRP in 83% of the patients. Forty-seven percent of patients presented with normalized body temperature and persistently high levels of CRP, which was most of the time related to comorbid conditions. Twenty patients (5%) presented with unexplained persistent fever despite CRP normalization. Therapeutic modifications were mostly observed in the presence of clinicobiological discrepancy: 21% versus 6%, p <0.001. Discussion: Body temperature and CRP are two parameters leading to comparable information in more than 80% of infected patients receiving specific antibiotic therapy. These clinical and biological discrepancies are associated to a modified antibiotherapy with inconclusive results. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate, in patients with chronic obstructive pulmonary disease (COPD), stage 0 or 1, the percentage of patients who had spirometry, and to study their sociodemographic, clinical and epidemiological characteristics. Patients and methods: An epidemiological survey was conducted with 2389 general practitioners concerning 4769 patients with early COPD, consulting for the first time for exacerbation of COPD, presumed to be bacterial. Results: Spirometry under stable conditions was performed in only 30% of patients. When the physician does not have access to this examination to guide antibiotic prescription for an exacerbation presumed to be bacterial, recent guidelines have established a correlation between dyspnoea and the degree of severity of COPD (GOLD classification). This correlation was not confirmed by the present study: 34% of patients with stage 0 or 1 COPD complained of dyspnoea and 52% of patients with stage 2 or 3 COPD did not complain of dyspnoea. The main criterion in favour of a bacterial cause of exacerbation, frank purulent sputum, observed in one out of three patients, did not influence the decision to prescribe antibiotics, given to 98% of patients. Therapy used bronchodilators (73%), even in patients with no signs of obstruction, and inhaled steroids (72%), although, according to guidelines, they are only indicated in the most serious forms (stage 3). This survey illustrates the effort needed to ensure better concordance between guidelines and practice, by taking into account the difficulties encountered by practitioners. [Copyright &y& Elsevier]

Abstract: Objectives: To compare the clinical outcomes and the causative pathogens of early-onset and late-onset ventilator-associated pneumonia (VAP) diagnosed by bronchoalveolar lavage (BAL). Study design: Prospective, observational, epidemiological study. Patients and methods: During a 7-years period, all first episodes of VAP were prospectively included. Diagnosis was confirmed by a BAL with a threshold of 104 cfu/ml. Late-onset pneumonia was defined if occurred after the seventh day after mechanical ventilation. Results: One hundred and thirteen VAP were studied. Fifty were early-onsets and 63 late-onsets. Thirty-four per cent of early-onset VAP and 73% of late-onset VAP were due to potential multiresistants pathogens. Pseudomonas aeruginosa was the most commonly isolated bacteria both in early-onset and late-onset VAP (16 and 39% respectively). Morbidity and mortality (29 vs 29%, ns) were not statically different between the two groups (early-onset and late-onset VAP). Conclusion: In our study, both early-onset and late-onset VAP were mainly caused by potentially multiresistants bacteria, most commonly Gram negative bacilli. Even for early VAP, clinicians should be aware about all risk factors for potentially multiresistants pathogens and not only the delay of onset of the VAP episode. [Copyright &y& Elsevier]

Abstract: Severe sepsis, which is related to a high mortality rate, requires a very specific antibiotic strategy, which must be adapted to each case. The appropriateness of empiric therapy is based on the delay before administration of the molecule, the bacterial resistance profile, and the kinetic and/or dynamic properties of the available antibiotics. [Copyright &y& Elsevier]

Abstract: Objective: The authors had for aim to assess, the incidence of symptomatic bacteriuria and the level of antibiotic resistance in bacteria identified in long-term care facilities (LTC). Design: Symptomatic bacteriuria cases were prospectively collected, during 9 months in the two LTC of the Strasbourg French Teaching Hospital (196 beds). Results: One hundred and eleven bacteriuria cases were included. They concerned 67 of the 274 residents (cumulative incidence: 2.07/1,000 patients-day). A gram-negative bacillus was identified in 85% of the symptomatic bacteriuria cases, and Escherichia coli in 40%. Sixty percent of the identified bacterial strain was resistant to amoxicillin (Amx-R) and 42% to the clavulanic acid combination (AmC-R). Third generation cephalosporins (3GC) were effective in 90% of Urinary tract infections (UTIs) and fluoroquinolones in 65% (Fq). Four bacterias with broad β-lactamase spectrum were identified (0.04%) including 3 Enterobacter aerogenes. No yeast infection was diagnosed. E. coli strains were 65% Amx-R and 50% AmC-R. Concerning the Fq-R strains (15%), 50% were cotrimoxazole resistant (Stx-R) and 70% Amx-R; 3GC remained effective (82%). Conclusion: In LTC, multi-drug resistance bacteria are rare and 3GCs seem to be the best first line treatment. Nevertheless, Fq-R is increasing (15 vs 8%), and attention must be paid to the antibiotic therapy used. [Copyright &y& Elsevier]

Copyright of EMC-Hepato-Gastroenterologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Anesthesie--Reanimation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Intravesical instillations of BCG are recommended for the treatment of high-risk non-muscle-invasive bladder cancer. However, their prolonged use remains limited by the associated potentially serious adverse effects or complications. The purpose of this article was to provide updated recommendations for the diagnosis and management of adverse events (AEs) or complications of intravesical BCG instillations., Materials and Methods: Review of the literature in Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using the following MeSH keywords or a combination of these keywords: "bladder," "BCG," "complication," "toxicity," "adverse events," "prevention," and "treatment"., Results: AEs or complications of BCG included genitourinary and systemic symptoms. The most common complications (cystitis, moderate fever) should be treated symptomatically and may require adjustment to allow patients to have the most complete BCG treatment possible. Serious complications are rare but must be identified promptly because of the life-threatening nature of the disease. Their management is based on the combination of anti-tuberculosis treatments, anti-inflammatory drugs and the definitive discontinuation of BCG., Conclusion: The management of BCG AEs requires early identification, rational and effective treatment if necessary, and discussion of the continuation of treatment for each situation., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The massive inflow of patients with COVID-19 requiring urgent care has overloaded hospitals in France and impacts the management of other patients. Deferring hospitalization and non-urgent surgeries has become a priority for surgeons today in order to relieve the health care system. It is obviously not simple to reduce emergency surgery without altering the quality of care or leading to a loss of chance for the patient. Acute appendicitis is a very specific situation and the prevalence of this disease leads us to reconsider this particular disease in the context of the COVID-19 crisis. Indeed, while the currently recommended treatment for uncomplicated acute appendicitis is surgical appendectomy, the non-surgical alternative of medical management by antibiotic therapy alone has been widely evaluated by high-quality studies in the literature. Insofar as the main limitation of exclusively medical treatment of uncomplicated acute appendicitis is the risk of recurrent appendicitis, this treatment option represents an alternative of choice to reduce the intra-hospital overload in this context of health crisis. The aim of this work is therefore to provide physicians and surgeons with a practical guide based on a review of the literature on the medical treatment of uncomplicated acute appendicitis in adults, to offer this alternative treatment to the right patients and under good conditions, especially when access to the operating room is limited or impossible., (© 2020 Published by Elsevier Masson SAS.)

Emphysematous gastritis is characterized by the presence of gas in the stomach wall and it is due to infection by "gas-producing" germs. It has a poor prognosis associated with high mortality rates, requiring early diagnosis and treatment. The patient's clinical picture is not specific. The diagnosis is often radiological. Emergency surgical treatment is recommended in case of necrosis, perforation, peritonitis or rapid deterioration in patient's condition under medical treatment. We report the case of a 79-year old man, with a personal history of alzheimer lasting for 3 years; he was diabetic, treated with oral antidiabetic agents over a period of 30 years. He presented to the emergency department with epigastric pain of 48 hours of evolution. On examination, he was septic in febrile state (39,5 °C), chills and tendency to collapse. He was polypneic with abdominal defense at the supra-umbilical level. There was a hyperleukocytosis of 25 000/mm3, a CRP value of 280 mg/l and metabolic acidosis. Abdominal CT scan showed the presence of gas in the stomach wall and confirmed the diagnosis of gastritis emphysematous. Digestive system vascular axes, particularly the celiac trunk, were permeable. There was no portal venous gas. A broad spectrum antibiotic therapy active against gram negative bacteria and anaerobes was started and patient preparation for emergency surgery was initiated but the patient died of multiple organ failure associated with acute respiratory distress syndrome an hour after abdominal CT scan examination. [ABSTRACT FROM AUTHOR]