Search

Objective: To analyse antibiotic prescription rates in ambulatory care for COVID-19 patients by general practitioners (GPs) in four European countries. Methods: A total of 4,513,955 anonymised electronic prescribing records of 3656 GPs in four European countries were analysed. Diagnosis and prescriptions were retrieved. Antibiotic prescription rates during COVID-19 consultations were analysed and compared between France, the UK, Belgium and Romania. Results: Overall prescription rate was in France and Belgium (6.66 and 7.46%). However, analysing median GP prescribing rates, we found that 33.9% of the GPs in Belgium prescribed antibiotics with a median of 16 prescriptions per 100 COVID-19 consultations, while 55.21% of the GPs in France prescribed a median of 8 antibiotic prescriptions per 100 COVID-19 consultations. Overall antibiotic prescription rates were less in Romania than in the UK (22% vs 32%); however, 73% of the Romanian GPs vs 57% of the British GPs prescribed antibiotics. Depending on the country, the proportion of each type of antibiotic was statistically different, with the proportion of azithromycin being more than 50% of all antibiotics in each country except for the UK where it was less than 1%. Conclusion: Both individual GPs prescribing patterns in addition to overall consumption patterns should be analysed in order to implement a tailored antimicrobial stewardship programme. Furthermore, antibiotic prescribing rates in COVID-19 are lower than other respiratory tract infections. [ABSTRACT FROM AUTHOR]

Objectives: Extra-genital manifestations of gonococcal infection are rare (0.5–3%). Among them, gonococcal arthritis (GA) is the most frequent, accounting for 30–90% of disseminated infections. Our study aimed to describe all hospital cases of GA in Reunion Island, a French overseas territory. Methods: We conducted a retrospective, multicentric, observational study of all cases of certain, probable or possible GA from 2008 to 2020. Results: We identified 58 cases of GA, mostly certain cases (n = 48). Sex ratio was balanced, but men were older than women (51 vs 27 years, p < 0.001). A total of 41% had travelled abroad during the previous 3 months, mostly in Madagascar or South-East Asia. The most frequently infected joint was the knee, followed by ankle, wrist and fingers or carpal joints. Only 16% of cases had genital symptoms, but 50% had another extra-genital manifestation, mainly skin lesions (40%). Positivity rate of joint puncture was 91%, with a purulent liquid. Only 58% had a positive culture, and 33% had only a positive PCR. There was no 3GC-resistant strain. In comparison with gonococcal infection without arthritis, patients were older and had fewer genital but more extra-genital symptoms. On discharge 60% had persistent articular symptoms. GA represented 18% of all hospitalised septic arthritis cases with microbial identification in 2019. Conclusions: GA is rare but it is important to make an early diagnosis and treat promptly, as joint destruction may be important, leading to persistent symptoms after discharge. PCR use in joint puncture is useful in cases with negative culture. Key Points • Gonococcal arthritis is rare but is the most frequent form of extra-genital gonococcal infection. It accounts for more than 30% of hospitalised community-acquired proven septic arthritis in Reunion Island. • It affects mostly the knee joint, is most of the time oligo- or poly-articular and is associated with tenosynovitis and extra-genital symptoms in half of the cases. Concomitant genital symptoms are often missing. • Profitability of joint puncture is high. As culture is not very sensitive, the use of PCR helps the diagnosis and should systematically be performed if available. • There seems to be a high proportion of joint persistent symptoms at and after discharge. [ABSTRACT FROM AUTHOR]