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Background & Aims: HBV coinfection is common among people living with HIV (PLWH) and is the most important cause of hepatocellular carcinoma (HCC). While risk prediction tools for HCC have been validated in patients with HBV monoinfection, they have not been evaluated in PLWH. Thus, we performed an external validation of PAGE-B in people with HIV/HBV coinfection.Methods: We included data on PLWH from four European cohorts who were positive for HBsAg and did not have HCC before starting tenofovir. We estimated the predictive performance of PAGE-B for HCC occurrence over 15 years in patients receiving tenofovir-containing antiretroviral therapy. Model discrimination was assessed after multiple imputation using Cox regression with the prognostic index as a covariate, and by calculating Harrell's c-index. Calibration was assessed by comparing our cumulative incidence with the PAGE-B derivation study using Kaplan-Meier curves.Results: In total, 2,963 individuals with HIV/HBV coinfection on tenofovir-containing antiretroviral therapy were included. PAGE-B was Conclusions: For individuals with HIV/HBV coinfection, PAGE-B is a valid tool to determine the need for HCC screening. Impact and implications: Chronic HBV infection is the most important cause of hepatocellular carcinoma (HCC) among people living with HIV. Valid risk prediction may enable better targeting of HCC screening efforts to high-risk individuals. We aimed to validate PAGE-B, a risk prediction tool that is based on age, sex, and platelets, in 2,963 individuals with HIV/HBV coinfection who received tenofovir-containing antiretroviral therapy. In the present study, PAGE-B showed good discrimination, adequate calibration, and a cut-off of

Numerous prophylactic antibiotic regimens (PBR) have been evaluated particularly in surgical abortion, hysterosalpingography or caesarean section, but few randomized comparative trials are available. Recommendations for PBR should take into account, expected and demonstrated benefits that reduce the risk of surgical site infection, but also the impact on the microbiota, the risk of bacterial resistance selection, and the overall cost to the community. In addition, antibiotic prophylaxis is not the only one factor to reduce the risk of surgical site infection, such as preventive measures and good hygiene practices.

Objectives Establish recommendations for the management of UTIs in MS patients. Background Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis. Methods The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980–12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences. Results UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures). Conclusion Physicians and patients should be aware of the updated recommendations for UTis and MS.

Objectives Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections. Methods Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website. Results The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables. Conclusion This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.

International audience; OBJECTIVE: To compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018.METHODS: We conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations.RESULTS: We included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P

To provide up-to-date guidelines on management of pelvic inflammatory disease (PID).An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines.PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100mg×2/d, and metronidazole 500mg×2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2g/d until clinical improvement, doxycycline 100mg×2/d, IV or PO, and metronidazole 500mg×3/d, IV or PO for 14days (grade B). Drainage of TOA is indicated if the collection measures more than 3cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions.Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.

Numerous prophylactic antibiotic regimens (PBR) have been evaluated particularly in surgical abortion, hysterosalpingography or caesarean section, but few randomized comparative trials are available. Recommendations for PBR should take into account, expected and demonstrated benefits that reduce the risk of surgical site infection, but also the impact on the microbiota, the risk of bacterial resistance selection, and the overall cost to the community. In addition, antibiotic prophylaxis is not the only one factor to reduce the risk of surgical site infection, such as preventive measures and good hygiene practices.

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.

Introduction L’etude CONDUCT a ete initiee pour repondre a la demande de la Haute Autorite de sante de decrire les conditions d’utilisation du ceftolozane/tazobactam (C/T) en pratique clinique courante en France. Materiels et methodes Il s’agit d’une etude observationnelle nationale multicentrique prospective dont l’objectif principal est de decrire les caracteristiques demographiques, cliniques et microbiologiques des patients recevant du C/T, les modalites d’utilisation et les causes d’arret de traitement. Resultats Cette analyse intermediaire decrit 84 patients inclus entre octobre 2018 et mai 2019, avec un âge moyen de 61 ans dont 68 % d’hommes. Le score de Charlson etait disponible pour 64 patients avec une moyenne de 3,5 (4,0) et 43 (51 %) patients avec un score ≥ 5. Trente-deux (38 %) presentaient une pathologie pulmonaire chronique, 27 (32 %) un diabete, 22 (26 %) un cancer, 26 (31 %) etaient immunodeprimes et 57 (70 %) avaient un ou plusieurs facteurs de risque (FR) de germe multiresistant (MDR). Parmi les 84 patients inclus, 76 (91 %) des patients etaient infectes par une bacterie a Gram negatif MDR. P. aeruginosa etait le germe le plus frequent avec 83 % de souches isolees chez 71 patients, 80/86 (93 %) des souches etaient sensibles au C/T. L’infection a ete declaree nosocomiale pour 59 (70 %) des cas. Parmi les 84 patients, 21 (25 %) avaient 2 sites infectes dont 13 (62 %) presentaient une bacteriemie. Un diagnostic de pneumonie (PNM) a ete identifie chez 42 (50 %) patients dont 15 etaient sous ventilation mecanique invasive. Parmi les autres sites infectieux, 12 (14 %) concernaient des infections urinaires compliquees (IUC) et pyelonephrites aigues (PNA), 9 (12 %) des infections intra-abdominales compliquees (IAI). La majorite des patients (30, 36 %) etaient hospitalises en service de reanimation et 14 (17 %) en pneumologie. Le C/T etait initie apres documentation bacteriologique pour 63 (75 %) patients et empiriquement chez 21 (25 %) patients severes et/ou presentant des FR. Dans 59 (70 %) cas, le C/T etait debute apres echec d’une premiere ligne de traitement, dont 25 (40 %) avaient recu un carbapenem. La dose a l’inclusion etait majoritairement de 3 g/1,5 g pour les IUC, PNA, IAI et une distribution proportionnee 3 g/1,5 g et 6 g/3 g pour les PNM. Un traitement antibiotique concomitant a ete prescrit pour pres de la moitie des patients (41, 49 %). La duree moyenne de traitement etait de 13,7 (14,8, 1–83) jours prescrit seul et de 16,1 (11,0, 4–51) jours en association avec un autre antibiotique. Le motif d’arret de traitement etait la guerison complete (44, 61 %), l’adaptation du traitement aux resultats microbiologiques (4, 6 %), le deces (4, 6 %), l’echec du traitement (3, 4 %) et un evenement indesirable (3, 4 %). Conclusion L’analyse rapporte un usage de C/T principalement chez des patients severes, dans des infections a P. aeruginosa MDR, en situation documentee (75 %) justifie par le profile clinique.

International audience; Objectives: To evaluate the current practice and the willingness to shorten the duration of antibiotic therapy among infection specialists.Methods: Infection specialists giving at least weekly advice on antibiotic prescriptions were invited to participate in an online cross-sectional survey between September and December 2016. The questionnaire included 15 clinical vignettes corresponding to common clinical cases with favourable outcomes; part A asked about the antibiotic treatment duration they would usually advise to prescribers and part B asked about the shortest duration they were willing to recommend.Results: We included 866 participants, mostly clinical microbiologists (22.8%, 197/863) or infectious diseases specialists (58.7%, 507/863), members of an antibiotic stewardship team in 73% (624/854) of the cases, coming from 58 countries on all continents. Thirty-six percent of participants (271/749) already advised short durations of antibiotic therapy (compared with the literature) to prescribers for more than half of the vignettes and 47% (312/662) chose shorter durations in part B compared with part A for more than half of the vignettes. Twenty-two percent (192/861) of the participants declared that their regional/national guidelines expressed durations of antibiotic therapy for a specific clinical situation as a fixed duration as opposed to a range and in the multivariable analysis this was associated with respondents advising short durations for more than half of the vignettes (adjusted OR 1.5, P = 0.02).Conclusions: The majority of infection specialists currently do not advise the shortest possible duration of antibiotic therapy to prescribers. Promoting short durations among these experts is urgently needed.

A l’occasion de la journee europeenne des antibiotiques et de la semaine mondiale sur les antibiotiques, la SPILF a publie, en 2015 un point sur les nouveautes en matiere de programmes de bon usage des antibiotiques. Ce nouvel editorial publie a l’occasion de la journee 2016 veut s’inscrire dans cette meme tradition.

Introduction Le respect des durees de traitement recommandees et l’usage des durees courtes peuvent permettre une diminution de la consommation d’antibiotiques. L’objectif est d’evaluer la connaissance des recommandations de traitement probabiliste (molecule et duree) des infections communautaires en medecine generale. Materiels et methodes Un web questionnaire, 12 cas cliniques a questions ouvertes d’une duree de realisation de 6 minutes, a ete diffuse, via les reseaux sociaux medicaux des unions regionales des professionnels de sante et des facultes, a des medecins generalistes. Resultats Entre le 13 octobre 2018 et 8 janvier 2019, 413 questionnaires ont ete remplis. Les repondants sont des femmes pour 290 (70 %) et l’âge median etait de 31 [29–35] ans. 299 (72 %) sont des medecins theses avec une mediane d’installation de 4[2–8,5] ans. Le lieu d’exercice est rural 87 (23 %), urbain 179 (47 %) et mixte 116 (30 %). Ils exercent en groupe pour 262 (77 %) d’entre eux, et 49 (12 %) ont une activite partagee hospitaliere. Le choix des molecules etait en adequation avec les recommandations pour les indications d’otite moyenne aigue (OMA) 248 (60 %), angine streptococcique 407 (98 %), sinusite maxillaire 297 (72 %), sinusite frontale 328 (79 %), pneumonie 170 (41 %), cystite simple 397 (96 %) et dermo-hypodermite bacterienne (DHB) 347(48 %). La duree de traitement etait en adequation avec les recommandations pour les indications d’angine streptococcique 320 (77 %), sinusite maxillaire 320 (77 %), sinusite frontale 284 (69 %), pneumonie 241(58 %), cystite 400(97 %), DHB 365 (89 %). Les facteurs identifies associes la non connaissance des durees de traitement est l’âge superieur a 40 ans (p = 0,001) et la moins bonne connaissance du choix des antibiotiques (p Conclusion La connaissance du choix des molecules est satisfaisante et plus importante que la connaissance des durees de traitement avec des niveaux heterogenes selon les differents diagnostics. Un exercice partage entre la ville et l’hopital et l’âge du medecin sont associes a de moins bonnes connaissances. Des programmes de formation continue ciblant specifiquement les durees des traitements antibiotiques en ville devraient etre envisages.

National audience

International audience; For many patients living with HIV-1, the efficacy of combined ART (cART) has made the infection turn to a chronic disease. Because cART is associated with a risk of long-term toxicity, switching patients with virological success to another therapy remains a major issue. Studies undertaken and published over recent years have shown that switching patients exhibiting virological suppression to less-drug regimens (LDR) is a possible option of maintenance strategy. The use of ritonavir-boosted PIs (PI/r) as the backbone of LDR-based maintenance therapy is consistent with their virological potency and a high genetic barrier of resistance. Atazanavir is the most documented PI/r regarding maintenance in dual therapy, with favourable results in terms of virological suppression, tolerance improvement and absence of emergence of mutations. Furthermore, atazanavir is the only commonly prescribed PI that can be used after withdrawal of ritonavir, with maintenance of virological suppression whatever the backbone of associated NRTIs. Based on clinical studies, and taking into account the characteristics of the patients included, one may consider that for any patient with a virological suppression on cART for at least 12 months, with the nadir CD4 >100 cells/mm3 and an absence of encephalitis, an LDR-based maintenance therapy including atazanavir can be considered. Cumulative genotypes must be available to make sure that the LDR will not jeopardize future therapeutic options. The final decision regarding the most appropriate LDR must be guided by the objectives shared by the physician and his/her patient.

Introduction Reduire les durees d’antibiotherapie limite l’emergence des resistances bacteriennes. Les pratiques actuelles concernant les durees des antibiotherapies sont cependant mal connues. Materiels et methodes Cette enquete internationale ESCMID-SPILF, ouverte du 1 er septembre au 1 er decembre 2016, avait pour but d’evaluer les durees d’antibiotherapie conseillees par les medecins/pharmaciens seniors donnant des avis au minimum hebdomadaires en antibiotherapie. Nous avons evalue leurs pratiques a l’aide de quinze vignettes presentant des situations cliniques d’evolution favorable frequemment rencontrees en pratique courante. Les participants ont ensuite ete interroges sur la duree minimale de traitement qu’ils seraient prets a prescrire dans les memes situations. Resultats Huit cent soixante-six professionnels (infectiologues 59 % et microbiologistes 23 %) provenant de 58 pays (France 19 %, Royaume-Uni 16 %, Espagne 9 % et Allemagne 8 %) ont participe. La duree de prescription conseillee par les participants excedait parfois la duree minimale validee dans la litterature : 8 jours conseilles versus 7 jours valides dans la litterature pour un erysipele, 7 vs 5 jours pour une exacerbation de BPCO, ou 7 vs 5 jours pour une cholecystite aigue non compliquee et operee dans les 24 heures. Les durees conseillees etaient cependant majoritairement (10/15 vignettes) en accord avec la litterature. Les participants declaraient etre prets a raccourcir les durees conseillees dans 8/15 vignettes, avec par exemple 28 jours de traitement pour une infection de pied diabetique, 5 jours pour une exacerbation de BPCO ou 10 jours pour une bacteriemie a S . aureus non compliquee. Conclusion Les professionnels ayant une activite de conseil en antibiotherapie declarent recommander des durees plutot courtes d’antibiotherapie, et semblent meme enclins a raccourcir encore ces durees. L’application des futures propositions de la SPILF sur le sujet semble donc possible en pratique.

RE is a well-known Gram positive bacillus which is usually pathogenic in animals. Disease in humans is rare, but incidence has clearly increased with the advent of AIDS. In humans, RE predominantly infect people with impaired cellular immunity so that it is considered an opportunistic agent. Its must common manifestation in immuno-compromised patients is a slowly progressive pneumonia which may cavitate. Even with early diagnostic and optimal and prolonged antibiotic therapy, the mortality of RE, infections remain high (20 to 55%). Problems in clinical and therapic management are illustrated in our two cases of cavitated pneumonia in two AIDS patients.

International audience; New factors that influence the viral response in HCV non-genotype 2/3 patients must be identified in order to optimize anti-HCV treatment. This multicenter prospective study evaluates the influence of HCV variability and pharmacological parameters on the virological response of these patients to pegylated interferon α2a (peg-IFN-α2a: 180 µg/week) and ribavirin (800-1200 mg/day) for 48 weeks. HCV subtypes were identified by sequencing the NS5B region. Serum ribavirin and peg-IFN-α2a concentrations were measured at weeks 4 and 12. The 115 patients (67 men; median age=49, range [31-76]) included 64 who had never been treated and 27 co-infected with HIV. The mean baseline HCV RNA was 6.30 ± 0.06 log IU/mL and the HCV genotypes were: G1 (n=93) with 1a (n=37) and 1b (n=50), G4 (n=20) and G5 (n=2). Most patients (79/108; 73%) had an early virological response. Independent predictors of an early virological response were interferon naive patients (OR=2.98 [1.15; 7.72]) and ribavirin of > 2,200 ng/mL at week 12 (OR=3.41 [1.31; 8.90]). Forty of 104 patients (38%) had a sustained virological response. The only independent predictors of a sustained virological response were subtype 1b (OR=6.82 [1.7; 26.8]), and HCV RNA 2,200 ng/mL was associated with an early virological response and patients infected with HCV subtype 1b had a better chance of a sustained virological response than did those infected with subtype 1a.

Summary A 19-year-old man presented with a 1.5-cm nodule on the first dorsal metacarpal ray. The patient denied having contact with fish tanks or fish, but recalled handling many reptiles without gloves in the vivarium where he worked. A culture of a skin biopsy specimen yielded Mycobacterium marinum . The clinical outcome was favourable after a 2-week course of intramuscular gentamicin (180mg daily) combined with a 6-week course of oral clarithromycin (500mg twice a day). Doctors should be aware that vivariums, in addition to fish tanks, can be sources of M. marinum exposure.

OFDM is widely used as the physical radio layer in an increasingly high number of standards due to its ability to manage time and frequency SNR variations on the radio channels. First described by Chang in 1966, the high digital processing resources required for its implementation have delayed its commercialization until the 1990s. In order to speed up the algorithms implementations for real time transmission, the fixed point implementation is needed (based on ASIC, FPGA or DSP). As a drawback, fixed point implementation leads to quantification and round errors that needs to be taken into consideration in the algorithm design.

To the Editor: Oculoglandular tularemia accounts for 3%–5% of all diagnosed tularemia cases (1). We report the diagnosis of this disease in 2 patients in France by real-time PCR. Patient A, a 43-year-old woman, was referred in October 2006 to the infectious disease department of Auch Hospital (Auch, France). She had a fever (39°C) and severe conjunctivitis of the right eye that had evolved over 2 weeks despite administration of amoxicillin/clavulanate. The patient lived in a rural area endemic for tularemia and had regular contact with dogs and ring doves. She remembered harvesting mushrooms in a nearby forest a few days before onset of clinical symptoms. Physical examination showed a hyperemic and painful right conjunctiva, enlarged (0.5–1.5 cm in diameter) and tender preauricular and submandibular lymph nodes, and cellulitis of the right hemiface. Her condition rapidly improved after she received doxycycline and gentamicin. Patient B, a 42-year-old woman, was referred in October 2008 to the infectious disease department of Dijon University Hospital (Dijon, France) for intermittent fever (38.5°C) and swollen left-sided pretragal and cervical lymph nodes, which had evolved for 3 weeks despite administration of amoxicillin, followed by pristinamycin and prednisone, and ciprofloxacin for 7 days. The patient remembered being scratched on the left hand by her dog several weeks earlier; the scratch healed spontaneously. She had recently walked in a nearby forest that was endemic for tularemia. Physical examination showed enlarged (2–3 cm in diameter), tender lymph nodes and bilateral conjunctivitis. Her condition improved after doxycycline therapy, but the pretragal lymph nodes were removed surgically in late November 2008 because of suppuration and necrosis. Ofloxacin was administered until January 2009 because of persistence of inflammation in cervical lymph nodes and suppuration with skin fistulization in the pretragal region. Diagnostic investigations (Table) conducted at Grenoble University Hospital included serologic tests (microagglutination and indirect immunofluorescent antibody assay by using locally prepared Francisella tularensis subsp. holarctica antigen), culture, and 2 real-time PCRs. These PCRs were specific for insertion sequence ISFtu2 or the Tul4 protein–encoding gene of Francisella sp. and used previously described primers, probes, an amplification protocol (2), and a LightCycler 2.0 apparatus (Roche, Meylan, France). We tested 5 μL of DNA extracted from clinical samples by using the QIAamp DNA Mini kit (QIAGEN, Hilden, Germany). Three negative controls (DNA-free water) and 1 positive control (DNA extracted from the F. tularensis subsp. holarctica LVS strain) were used for each PCR. Table Characteristics of the 2 patients in the study and test results for tularemia, France* Seroconversion was found between acute-phase and convalescent-phase serum samples from both patients. A conjunctival cotton swab sample from patient A and pretragal lymph node suppuration and biopsy samples from patient B were positive for F. tularensis by both real-time PCRs. A Francisella sp. strain was isolated from the conjunctival discharge from patient A at Auch Hospital and Grenoble Hospital laboratories. Cultures were grown in a BioSafety Level 3 laboratory at Grenoble University Hospital because results of both PCRs were positive. Cultures of specimens from patient B were negative. Both patients were infected with an F. tularensis subsp. holarctica strain. Infection was identified by PCR amplification and sequencing of the 16S rRNA gene (fD1 and rP2 primers) and the intergenic spacer region (FTitsFw 5′-ACCACGGAGTGATTCATGACTG-3′ and FTitsRv 5′-TCTCAATTGATTTCTCTTCCTAAGG-3′ primers) from the strain isolated from patient A and directly from the lymph node biopsy specimen from patient B. Conjunctival inoculation of F. tularensis usually occurs by contact when a contaminated finger comes into contact with the eyes, e.g., after handling of an infected animal or tick (3,4), but the source of infection often remains undetermined, as for our 2 patients. Symptoms are not specific and correspond to Parinaud oculoglandular syndrome (1). Reported complications include keratitis, occasional corneal perforation, and lymph node suppuration; tonsillitis, cellulitis in nearby skin tissue, retinitis, erythema nodosum, and progression to systemic disease occur less frequently (3–7). A specific microbiologic diagnosis is needed for appropriate treatment because many microorganisms can cause Parinaud oculoglandular syndrome and clinical symptoms are not specific (1,8). Fluoroquinolones are now considered first-line treatment for tularemia; β-lactam antimicrobial agents are not effective (9). Oculoglandular tularemia is a painful disease with a short incubation period (3–5 days), and results of serologic tests of acute-phase samples are often negative (1,9). Isolation of F. tularensis is difficult and hazardous to laboratory personnel (1,9). PCR-based techniques may enable a more rapid diagnosis (1,9,10). Heating clinical samples before testing prevents laboratory-acquired infections. We report the use of real-time PCR for detection of F. tularensis from a conjunctival swab specimen. Many clinical laboratories are now equipped with this technology. Transport conditions of clinical samples (4°C, no transport medium, 24–48 h) are not restrictive. When compared with PCR, real-time PCR does not require post-PCR processing, enabling a faster turn-around time. Oculoglandular tularemia is a rare but underestimated disease. Real-time PCR detection of F. tularensis DNA from conjunctival swab suspensions now provides a rapid, noninvasive, sensitive, and specific diagnosis of oculoglandular tularemia. This assay enables early establishment of specific antimicrobial drug therapy and poses no risk of infection for laboratory staff.

RE is a well-known Gram positive bacillus which is usually pathogenic in animals. Disease in humans is rare, but incidence has clearly increased with the advent of AIDS. In humans, RE predominantly infect people with impaired cellular immunity so that it is considered an opportunistic agent. Its must common manifestation in immuno-compromised patients is a slowly progressive pneumonia which may cavitate. Even with early diagnostic and optimal and prolonged antibiotic therapy, the mortality of RE, infections remain high (20 to 55%). Problems in clinical and therapic management are illustrated in our two cases of cavitated pneumonia in two AIDS patients.

Introduction Le diagnostic de tularemie est rare, voire exceptionnel depuis 10 ans dans notre region. Nous rapportons 6 cas de tularemie diagnostiques en 18 mois. Ils illustrent la variete des presentations cliniques d’infections a Francisella tularensis. Tous les patients ont eu une serologie positive, 4 fois la PCR s’est averee positive et 2 cultures ont ete obtenues (Pr M. Morin, centre de reference, Grenoble). Observation Quatre presentations cliniques trompeuses : – ganglionnaire pure, cervicale, chez un homme de 23 ans, chasseur. L’histologie du ganglion retrouve des granulomes epithelio-giganto-cellulaires avec necrose caseeuse ; – une angine ulcereuse febrile chez une femme de 41 ans, avec volumineuse adenopathie cervicale ; – un syndrome oculo-ganglionnaire chez une femme de 43 ans, attribue a une inoculation conjonctivale en ramassant des champignons ; – une fievre chronique de plus d’un mois, associee a des cephalees chez un chasseur (forme typhique). Deux syndromes ulcero-ganglionnaires classiques : – un homme de 25 ans chasseur, presentant une ulceration de l’avant bras avec adenopathie axillaire satellite ; – une ulceration de la main, febrile avec adenopathie axillaire secondaire, chez une femme de 45 ans, ayant ramasse des champignons. Discussion Ces observations illustrent la diversite clinique de la tularemie. Nous n’avons pas observe de forme pulmonaire. S’il est habituel d’evoquer le diagnostic chez un chasseur, il est moins habituel d’y penser chez les cueilleurs de champignons. Tous les patients avaient recu un primo-traitement inefficace par amoxicilline/ acide clavulanique ou pristinamycine. La guerison a ete obtenue apres antibiotherapie : doxycycline ou ciprofloxacine (21 jours) + gentamicine (7 jours) associee a une ponction (3 fois) ou biopsie exerese (1 fois). Conclusion L’evocation plus precoce ou systematique pourra eviter le retard et les errances diagnostiques et therapeutiques.

In march 2020, the International Working Group on the Diabetic Foot (IWGDF) published an update of the 2015 guidelines on the diagnosis and management of diabetic foot infection (DFI). While we (the French ID society, SPILF) endorsed some of these recommendations, we wanted to update our own 2006 guidelines and specifically provide informative elements on modalities of microbiological diagnosis and antibiotic treatment (especially first- and second-line regiments, oral switch and duration). The recommendations put forward in the present guidelines are addressed to healthcare professionals managing patients with DFI and more specifically focused on infectious disease management of this type of infection, which clearly needs a multidisciplinary approach. Staging of the severity of the infection is mandatory using the classification drawn up by the IWGDF. Microbiological samples should be taken only in the event of clinical signs suggesting infection in accordance with a strict preliminarily established protocol. Empirical antibiotic therapy should be chosen according to the IWGDF grade of infection and duration of the wound, but must always cover methicillin-sensitive Staphylococcus aureus. Early reevaluation of the patient is a fundamental step, and duration of antibiotic therapy can be shortened in many situations. When osteomyelitis is suspected, standard foot radiograph is the first-line imagery examination and a bone biopsy should be performed for microbiological documentation. Histological analysis of the bone sample is no longer recommended. High dosages of antibiotics are recommended in cases of confirmed osteomyelitis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Antibiotic prophylaxis is not recommended during surgical induced abortions. Systematic screening for Chlamydia trachomatis and Neisseria gonorrheae infection by polymerase chain reaction (PCR) on a vaginal sample is recommended before any surgical abortion. Moreover, the bacteriological result should be available before the abortion so that antibiotic treatment effective against the identified bacteria, if any, can be proposed before the procedure. The absence of bacteriological result on the day of the abortion must not, however, delay the procedure. If screening is positive for a sexually transmitted infection (STI), and the bacteriological result is only available after the abortion, it is recommended that antibiotic treatment start as soon as possible. The first-line antibiotic treatment is ceftriaxone 500mg in a single dose by the intramuscular route for N. gonorrheae, doxycycline 200mg per day orally for 7 days for C. trachomatis and azithromycin 500mg the first day (D1) then 250mg per day from D2 to D4 orally if Mycoplasma genitalium is detected by multiplex PCR. In case of positive screening, antibiotic treatment of the woman's partner(s) is recommended, adapted to the STI agent(s)., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)