Prosthetic Joint Infections due to Candida Species: A Multicenter International Study.

BACKGROUND: Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI. METHODS: This was a retrospective observational multinational study including patients diagnosed with Candida-related PJI between 2010 and 2021. Treatment outcome was assessed at 2-year follow-up. RESULTS: A total of 269 patients were analyzed. Median age was 73.0 (interquartile range [IQR], 64.0-79.0) years; 46.5% of patients were male and 10.8% were immunosuppressed. Main infection sites were hip (53.0%) and knee (43.1%), and 33.8% patients had fistulas. Surgical procedures included debridement, antibiotics, and implant retention (DAIR) (35.7%), 1-stage exchange (28.3%), and 2-stage exchange (29.0%). Candida spp identified were Candida albicans (55.8%), Candida parapsilosis (29.4%), Candida glabrata (7.8%), and Candida tropicalis (5.6%). Coinfection with bacteria was found in 51.3% of cases. The primary antifungal agents prescribed were azoles (75.8%) and echinocandins (30.9%), administered for a median of 92.0 (IQR, 54.5-181.3) days. Cure was observed in 156 of 269 (58.0%) cases. Treatment failure was associated with age >70 years (OR, 1.811 [95% confidence interval {CI}: 1.079-3.072]), and the use of DAIR (OR, 1.946 [95% CI: 1.157-3.285]). Candida parapsilosis infection was associated with better outcome (OR, 0.546 [95% CI: .305-.958]). Cure rates were significantly different between DAIR versus 1-stage exchange (46.9% vs 67.1%, P = .008) and DAIR versus 2-stage exchange (46.9% vs 69.2%, P = .003), but there was no difference comparing 1- to 2-stage exchanges (P = .777). CONCLUSIONS: Candida PJI prognosis seems poor, with high rate of failure, which does not appear to be linked to immunosuppression, use of azoles, or treatment duration.

[When should shortterm antibiotic therapy be chosen?] / Quand choisir une antibiothérapie de courte durée ?

WHEN SHOULD SHORT-TERM ANTIBIOTIC THERAPY BE CHOSEN? Reducing antibiotic exposure by shortening treatment duration is a public health priority that could mitigate the emergence of bacterial resistance, minimize adverse effects, and lower costs. Additionally, a short yet effective antibiotic regimen is associated with improved patient compliance and satisfaction. Several trials in recent years have confirmed the efficacy of shorter treatment durations. For instance, five days of antibiotics are sufficient for uncomplicated pyelonephritis, while seven days suffice for non-febrile urinary tract infections in males. However, a 14-day regimen appears necessary for febrile urinary tract infections in men. A study examining a five-day treatment period found no difference compared to a 10-day regimen for skin and soft tissue infections. In acute community-acquired pneumonia, two randomized trials found three days of beta-lactam therapy to be effective. In intra-abdominal infections, durations ranging from four to eight days were found to be non-inferior to 15-day courses in two trials. Regarding osteoarticular infections, six weeks are adequate for spondylodiscitis, whereas 12 weeks are required for prosthetic joint infections. These findings validate shorter treatment durations across many clinical scenarios. However, in rare conditions such as febrile male urinary tract infections and prosthetic joint infections, shortening the duration may not be feasible. It is imperative to prescribe the shortest effective antibiotic duration possible in routine medical practice to combat antibiotic resistance.

QUAND CHOISIR UNE ANTIBIOTHÉRAPIE DE COURTE DURÉE ? Réduire l'exposition antibiotique en diminuant la durée de traitement est un enjeu de santé publique qui permettrait de limiter l'émergence des résistances bactériennes, réduire les effets indésirables, les coûts. En outre, une durée courte et efficace de traitement antibiotique est associée à une meilleure observance et satisfaction du patient. Ces dernières années, plusieurs essais ont permis de valider l'efficacité de durées de traitement court. Cinq jours d'antibiotique suffisent au cours des pyélonéphrites simples et sept jours au cours des infections urinaires masculines non fébriles. En revanche, un traitement de quatorze jours semble nécessaire au cours des infections urinaires fébriles de l'homme. Une étude portant sur cinq jours de traitement n'a pas retrouvé de différence avec un traitement de dix jours au cours des infections de la peau et des tissus mous. Dans les pneumonies aiguës communautaires, deux essais randomisés ont prouvé l'efficacité d'un traitement de trois jours par bêtalactamines. Au cours des infections intra- abdominales, deux essais ont montré que des durées d'antibiothérapie de quatre à huit jours étaient non inférieures à des traitements de quinze jours. Concernant les infections ostéoarticulaires, une durée de six semaines suffit au cours des spondylodiscites alors que douze semaines restent nécessaires lors des infections sur prothèse ostéoarticulaire. Ces données permettent de valider des durées de traitement courtes dans un grand nombre de situations cliniques. Cependant, dans de rares pathologies comme les infections urinaires masculines fébriles et les infections sur prothèses ostéoarticulaires, la durée ne semble pas pouvoir être raccourcie. Il convient de prescrire la durée de traitement antibiotique efficace la plus courte possible en pratique médicale courante afin de lutter contre l'antibiorésistance.

Real-life impact on antimicrobial prescription of Syndromic Molecular Testing in adults hospitalized in infectious disease departments. Respiratory Syndromic Molecular Testing panel: Is it worth it?

BACKGROUND: While sensitive molecular diagnostic tests enable accurate and rapid diagnosis of many respiratory viruses, their impact on antibiotic management remains uncertain. Our study aimed to evaluate the impact of respiratory syndromic molecular testing panel in real-life clinical practice. METHOD: Retrospective descriptive study involving consecutive hospitalized patients in an infectious disease department who had been prescribed a respiratory syndromic molecular testing panel on nasopharyngeal swab samples (FilmArray Respiratory Panel 2 plus) during hospitalization from October 1st, 2021, to February 28th, 2023. RESULTS: All in all, 94 out of 210 screened patients were included in the study. Syndromic molecular testing results influenced antibiotic treatment in seven cases: discontinuation in four cases (three virus identifications), changes in two (Mycoplasma pneumoniae positive cases), and initiation in two (negative viral PCRs and one positive bacterial culture). CONCLUSION: In our study, respiratory syndromic molecular testing had low impact on antibiotic modification.

Interest of Absolute Eosinopenia as a Marker of Influenza in Outpatients during the Fall-Winter Seasons 2016-2018 in the Greater Paris Area: The SUPERFLUOUS Study.

INTRODUCTION: Prior to the emergence of COVID-19, when influenza was the predominant cause of viral respiratory tract infections (VRTIs), this study aimed to analyze the distinct biological abnormalities associated with influenza in outpatient settings. METHODS: A multicenter retrospective study was conducted among outpatients, with the majority seeking consultation at the emergency department, who tested positive for VRTIs using RT-PCR between 2016 and 2018. Patient characteristics were compared between influenza (A and B types) and non-influenza viruses, and predictors of influenza were identified using two different models focusing on absolute eosinopenia (0/mm3) and lymphocyte count <800/mm3. RESULTS: Among 590 VRTIs, 116 (19.7%) were identified as outpatients, including 88 cases of influenza. Multivariable logistic regression analysis revealed the following predictors of influenza: in the first model, winter season (adjusted odds ratio [aOR] 7.1, 95% confidence interval [CI] 1.12-45.08) and absolute eosinopenia (aOR 6.16, 95% CI 1.14-33.24); in the second model, winter season (aOR 9.08, 95% CI 1.49-55.40) and lymphocyte count <800/mm3 (aOR 7.37, 95% CI 1.86-29.20). Absolute eosinopenia exhibited the highest specificity and positive predictive value (92% and 92.3%, respectively). CONCLUSION: During the winter season, specific biological abnormalities can aid physicians in identifying influenza cases and guide the appropriate use of antiviral therapy when rapid molecular tests are not readily available.

Digital health for remote home monitoring of patients with COVID-19 requiring oxygen: a cohort study and literature review.

Background: The clinical course and outcome of COVID-19 vary widely, from asymptomatic and mild to critical. Elderly patients and patients with comorbidities are at increased risk of respiratory failure and oxygen requirements. Due to the massive surge, the pandemic has created challenges for overwhelmed hospitals. Thus, the original home management of COVID-19 patients requiring oxygen and remote monitoring by a web app and a nurse at home were implemented in our center. We aimed to evaluate the outcome of patients with COVID-19 requiring oxygen who benefited from home remote monitoring management. Methods: We performed a retrospective cohort study on all COVID-19 patients requiring oxygen (< 5 L/min) who consulted from October 2020 to April 2021 at our emergency department and were managed with home remote monitoring by a web app and an in-home nurse. We also carried out a literature review of studies on COVID-19 patients requiring oxygen with remote monitoring. Results: We included 300 patients [184 (61.3%) male patients, median age 51 years]. The main comorbidities were cardiovascular disease (n = 117; 39.0%), diabetes mellitus (n = 72; 24.0%), and chronic respiratory disease (n = 32; 10.7%). Among the 28 (9.3%) patients readmitted to the hospital, 6 (1.9%) were hospitalized in the intensive care unit, and 3 (0.9%) died. In the multivariable analysis, risk factors for unplanned hospitalization were chronic respiratory failure (odds ratio (OR) =4.476, 95%CI 1.565-12.80), immunosuppression (OR = 3.736, 95%CI 1.208-11.552), and short delay between symptoms onset and start of telemonitoring (OR = 0.744, 95%CI 0.653-0.847). In the literature review, we identified seven other experiences of remote monitoring management. Mortality rate and unplanned hospitalization were low (maximum 1.9 and 12%, respectively). Conclusion: Our study confirms the safety of home remote monitoring of patients with COVID-19 who require oxygen, as well as our literature review. However, patients with chronic respiratory failure and immunosuppression should be closely monitored.

Short Antibiotic Treatment Duration for Osteomyelitis Complicating Pressure Ulcers: A Quasi-experimental Study.

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