Renan Le Cras, Patricia Vidal, Patricia Pavese, Patrice François, Anna Sette, Philippe Lesprit
{"title":"Efficacy of antimicrobial stewardship indicators in assessing the impact of a regional antibiotic therapy center in primary care and nursing homes.","authors":"Renan Le Cras, Patricia Vidal, Patricia Pavese, Patrice François, Anna Sette, Philippe Lesprit","doi":"10.1016/j.idnow.2025.105165","DOIUrl":"https://doi.org/10.1016/j.idnow.2025.105165","url":null,"abstract":"<p><strong>Objective: </strong>This study describes the implementation and short-term evolution of the antibiotherapy indicators selected by the Regional Antibiotherapy Center of Auvergne-Rhône-Alpes for utilization in primary care and nursing homes.</p><p><strong>Material and methods: </strong>This retrospective observational study was based on public reimbursement data between 2021 and 2023. Seven indicators were selected for the community and eight for nursing homes.</p><p><strong>Results: </strong>We observed positive trends for first-line antibiotics for female urinary tract infections (community: + 28 %, nursing homes: +18 %), treatment duration > 7 days (community: -7,8%; -13,4% for amoxicillin-clavulanic acid; nursing homes: -20,5%), fluoroquinolones in nursing homes (-16 %) and a combination of amoxicillin-clavulanic acid with metronidazole or amoxicillin in the community (-22 %). That said, total antibiotic consumption increased in the community (+16.5 %), while remaining stable in nursing homes.</p><p><strong>Conclusion: </strong>This study identified areas for improvement in antibiotic therapy in our region. A longer follow-up will be necessary to assess the potential impact of initiatives such as ours on proper antibiotic use.</p>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":" ","pages":"105165"},"PeriodicalIF":2.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B HOELLINGER , D REY , P KLEE , C CHENEAU , C MENOULOU , T LEMMET , P GANTNER , A URSENBACH
{"title":"Real-life evaluation of intermittent triple antiretroviral therapy maintenance strategies","authors":"B HOELLINGER , D REY , P KLEE , C CHENEAU , C MENOULOU , T LEMMET , P GANTNER , A URSENBACH","doi":"10.1016/j.idnow.2025.105164","DOIUrl":"10.1016/j.idnow.2025.105164","url":null,"abstract":"<div><h3>Introduction</h3><div>Intermittent antiretroviral therapy (ART) is commonly prescribed in France, but this strategy is not recommended internationally. The objective of this study was to evaluate real-life efficacy of intermittent ART in virologically suppressed individuals.</div></div><div><h3>Methods</h3><div>We conducted a retrospective non-comparative cohort study at Strasbourg University Hospital and included all people living with HIV (PLWH) on intermittent ART between 2017 and 2024. The primary outcome was virological success at W48 after initiation of intermittent ART.</div></div><div><h3>Results</h3><div>We included 160 PLWH. They were mainly males (80 %), with 59.4 % reporting sex with men and 75 % were born in France. Mean CD4 count was 672/mm<sup>3</sup>, and mean duration of viral suppression was 7.9 years. The third agent was a non-nucleoside reverse transcriptase inhibitor in 87/160 (54.3 %) participants, an integrase strand transfer inhibitor in 72/160 (45.0 %) participants, and one participant had a protease inhibitor. Three participants discontinued the intermittent ART strategy before W48, and five were lost to follow-up before W48, without virological failure at the time of the last update. We did not observe any virological failure at W48 for the remaining 152 participants, nor during longer follow-up (median 131 weeks). A blip occurred in five participants. Throughout the study period, 21/160 (13.1 %) PLWH discontinued intermittent ART strategy, mainly to switch for injectable ART (12/21, 57 %).</div></div><div><h3>Conclusions</h3><div>Our findings in real-life setting support intermittent triple ART as a safe, cost-effective, and well-tolerated maintenance option in selected compliant PLWH, including regimens with a lower genetic barrier to resistance.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105164"},"PeriodicalIF":2.2,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julien Carvelli , Coline Mortier , Mohamed Boucekine , Vincent Gilles , Yvonnick Boué , Guillaume Le Balle , Jeanne Broyon , Annabelle Lapostolle , Tanguy Cholin , Manon Dory , Chloé Andres , Renaud Piarroux , Louis Collet , Abdourahim Chamouine , Mohamadou Niang , for the CHOLEMAY Study Group
{"title":"The 2024 cholera outbreak in Mayotte. Clinical and biological factors associated with severe forms of the disease in an observational cohort of 206 patients","authors":"Julien Carvelli , Coline Mortier , Mohamed Boucekine , Vincent Gilles , Yvonnick Boué , Guillaume Le Balle , Jeanne Broyon , Annabelle Lapostolle , Tanguy Cholin , Manon Dory , Chloé Andres , Renaud Piarroux , Louis Collet , Abdourahim Chamouine , Mohamadou Niang , for the CHOLEMAY Study Group","doi":"10.1016/j.idnow.2025.105163","DOIUrl":"10.1016/j.idnow.2025.105163","url":null,"abstract":"<div><h3>Objective</h3><div>In 2024, the island of Mayotte (France) was affected by a cholera outbreak. The objective of this study was to identify clinical and laboratory criteria associated with severity (defined as hypovolemic shock and/or severe acidosis) in view of improving patient triage and therapeutic management in subsequent outbreaks.</div></div><div><h3>Methods</h3><div>From March 18 to July 12, 2024, we screened 215 patients with cholera (positive stool PCR). We excluded five patients who died outside hospital (no data, lethality = 2.3 %) and four patients for whom no data were available. We ultimately enrolled 206 patients. Severe forms of cholera were defined as the presence of at least one of the following three objective criteria: arterial hypotension; and/or neurological impairment (GCS < 14) (hypovolemic shock); and/or venous pH < 7.20 (severe acidosis) at first medical assessment.</div></div><div><h3>Findings</h3><div>Median patient age was 19 years (8–32 years), and 83 patients (40 %) presented with a severe form, which often consisted in fever (n = 13/83, 13 % vs. n = 6/123, 5 %, <em>p</em> = 0.04), vomiting (n = 71/83, 86 % vs. n = 79/123, 64 %, <em>p</em> < 0.001), a higher stool output (8 (4.5–10) vs. 4 (2–6) stools on day 1, <em>p</em> < 0.001) and severe hemoconcentration (Ht = 54 (47–60) vs. 43 (38–50), p < 0.001). In multivariate analysis, only hemoconcentration was associated with significantly greater severity (OR 95 % CI = 1.12 [1.04–1.21], <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Cholera is a toxin-mediated infection responsible for severe, occasionally fatal acute watery diarrhea. Severity is associated with neurological impairment, metabolic acidosis, and hemoconcentration. Triage and care of these patients are absolutely essential means of preventing death.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105163"},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prevalence of digestive carriage of multi-drug resistant enterobacterales in hospitalized and community-based patients in Togo: a prospective study","authors":"Rogatien Comlan Atoun , Iman Frédéric Youa , Lidaw Déassoua Bawe , Isidore Tchaou , Bodombossou Madera , Awereou Kotosso , Alexandre Bleibtreu , Taïssiri Adedjouma , André Pouwedeou Bedekelabou , Jules Tchédié , Yvette Siliadin , Eric Cardinale , Laurence Armand Lefevre , Brücker Gilles , Salou Mounerou , Claver Anoumou Dagnra , Didier Koumavi Ekouevi , Dominique Salmon","doi":"10.1016/j.idnow.2025.105160","DOIUrl":"10.1016/j.idnow.2025.105160","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to estimate the prevalence of digestive tract carriage of ESBL-E/CPE among patients having consulted or been hospitalized in two university hospitals in Lomé in 2023.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from January to June 2023. Rectal swabs were collected from 230 participants (100 in maternity, 50 in pediatrics, 50 in trauma-orthopedics, and 30 in intensive care).</div></div><div><h3>Results</h3><div>Median age was four years for children and 30 years for adults. Overall prevalence of ESBL-E carriage was 59.6 %, while that of CPB was 6.1 %. Carriage was more frequent in hospital settings than in the community (64.6 % vs. 53.0 %). The main isolated species were Escherichia coli (95.6 %) and Klebsiella pneumoniae (27.7 %). Hospitalization units were associated with multidrug-resistant bacteria carriage.</div></div><div><h3>Conclusion</h3><div>These findings highlight a high prevalence of digestive tract carriage in hospital as well as community settings.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 7","pages":"Article 105160"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Peiffer-Smadja , M. Thy , T. Delory , P. Jeanmougin , L. Giordano , J.Le Bel , E. Bouvet , Alison Helen Holmes , S. Lariven , R. Ahmad , F.X. Lescure
{"title":"Determinants of sustainable adoption in primary care of a clinical decision support system for antimicrobial prescribing: A qualitative study","authors":"N. Peiffer-Smadja , M. Thy , T. Delory , P. Jeanmougin , L. Giordano , J.Le Bel , E. Bouvet , Alison Helen Holmes , S. Lariven , R. Ahmad , F.X. Lescure","doi":"10.1016/j.idnow.2025.105157","DOIUrl":"10.1016/j.idnow.2025.105157","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of the study was to analyse the determinants for sustainable adoption by General Practitioners (GPs) of Antibioclic, a Clinical Decision Support System (CDSS) for antimicrobial prescribing, and the results of and limitations to its use in clinical practice.</div></div><div><h3>Materials and methods</h3><div>Individual interviews with GPs and a focus group were carried out concerning their use of Antibioclic, a CDSS for antimicrobial prescribing in primary care. Antibioclic is a publicly funded, freely available CDSS targeting 48 common infectious diseases. Interviews were recorded, transcribed and coded using NVivo 12. Data were analysed via inductive thematic analysis.</div></div><div><h3>Results</h3><div>Interviews were conducted with 25 GPs, and nine additional GPs participated in the focus group. Median age was 34 years (IQR 32–43) and 20 participants (59 %) were women. All of them frequently and sustainably used Antibioclic in their practice. Adoption of the CDSS was explained by system characteristics: usability, up-to-dating and trustworthiness; it was also considered as routinized, interwoven with consultations and antimicrobial prescribing, and conducive to improved practices and communication with patients. The GPs emphasized the role of CDSSs role in bridging the gap between clinical guidelines and daily practice, while contributing to contextual learning and continuous medical education. Lastly, participants pointed out the importance of co-design of CDSSs with end-users.</div></div><div><h3>Conclusion</h3><div>These determinants of sustainable adoption of a CDSS may guide future implementation of electronic tools in into clinical practice.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 7","pages":"Article 105157"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Retrospective analysis of discharge antibiotic selection and 30-day readmission rate for community acquired pneumonia","authors":"Nick Hartwig , Eric Wombwell","doi":"10.1016/j.idnow.2025.105159","DOIUrl":"10.1016/j.idnow.2025.105159","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates 30-day community-acquired pneumonia (CAP) readmission rates dependent on discharge antibiotic selection.</div></div><div><h3>Patients and methods</h3><div>This is a retrospective, single-center, observational study of patients discharged with a diagnosis of CAP from July 1st, 2022 through June 30th, 2023. Patients included those empirically treated with ceftriaxone plus azithromycin and with documentation of discharge antibiotics.</div></div><div><h3>Results</h3><div>Beta-lactam combination therapy represented the most frequent discharge antibiotic regimen (n = 161). Only 6/368 patients were re-admitted within 30 days. No significant difference was detected in readmission rates between beta-lactam and non-beta-lactam monotherapy (p = 0.921), or between combination therapy and monotherapy (p = 0.604). The average total duration of combined inpatient (4 days) and outpatient (5 days) antibiotic therapy was 9 days.</div></div><div><h3>Conclusion</h3><div>Broad-spectrum or combination antibiotic therapy at discharge did not result in lower readmission rates. The significant antibiotic stewardship opportunities that remain at transition from in-patient to out-patient care should prioritize narrow spectrum, short-course, monotherapy antibiotic regimens when the causative pathogen is unknown.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 7","pages":"Article 105159"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infectious diseases nowPub Date : 2025-09-01Epub Date: 2025-07-31DOI: 10.1016/j.idnow.2025.105129
D Basille, Y Tandjaoui-Lambiotte, M Blot, P Fillatre, A Dinh, C De Margerie
{"title":"Lung ultrasonography for community-acquired pneumonia diagnosis.","authors":"D Basille, Y Tandjaoui-Lambiotte, M Blot, P Fillatre, A Dinh, C De Margerie","doi":"10.1016/j.idnow.2025.105129","DOIUrl":"10.1016/j.idnow.2025.105129","url":null,"abstract":"<p><p>Over the past two decades, several studies have assessed the performance of lung ultrasonography in the diagnosis of community-acquired pneumonia (CAP). The performance of this diagnostic tool, when used by clinicians other than radiologists, is excellent, with an area under the curve of 0.97, 92% sensitivity, and 93% specificity according to a recent meta-analysis including 5,108 patients. When ultrasonography is compared with chest CT-scan, sensitivity ranged from 68% to 98% and specificity from 61% to 98%. Compared with chest x-ray, ultrasonography seems more sensitive and specific. Lung ultrasonography can thus be considered a reliable tool for the diagnosis of CAP and may serve as a first-line imaging modality, provided that operators have received adequate training. Lung ultrasonography is particularly indicated in patients with acute respiratory failure, as good quality chest x-ray is difficult to perform in these patients. When diagnostic uncertainties remain after this radiological and clinical evaluation, low-dose chest CT-scan is recommended.</p>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":" ","pages":"105129"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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