[Practical management of post-COVID-19 condition. Update and illustration by clinical situations]. / Prise en charge pratique de l'affection post-Covid-19. Mise à jour et illustration par des situations cliniques.

Persistent manifestations of COVID-19, known as «long COVID¼ or post-COVID-19 condition (RA02, CIM-11), affect many infected individuals, with a 24-month prevalence depending on the studies context (18 % in a recent Swiss study). The diversity of clinical presentation, the sometimes complex diagnostic methods, and the multidisciplinary management highlight the importance of a holistic approach, with practical advice for assessing work capacity in the outpatient setting. This article offers an update and synthesis of current knowledge concerning post-COVID-19 condition with practical recommendations for primary care medicine, illustrated by real clinical situations.

Les manifestations persistantes du Covid-19, connues sous le nom de « Covid long ¼ ou affection post-Covid-19 (RA02, CIM-11), concernent un nombre significatif de personnes infectées, avec une prévalence à 24 mois de l'infection variant en fonction des études et du contexte (18 % dans une étude suisse récente). La diversité de présentation clinique, les méthodes diagnostiques, parfois complexes, et les approches multidisciplinaires pour la prise en charge soulignent l'importance d'une approche holistique. Cet article propose une mise à jour et une synthèse des connaissances actuelles concernant l'affection post-Covid-19, avec des recommandations pratiques de prise en charge en médecine de premiers recours, illustrées par des situations cliniques réelles et des conseils pratiques pour l'appréciation de la capacité de travail.

[Leptospirosis, the diagnostic challenge of an indigenous case]. / Leptospirose, le défi diagnostique d'un cas autochtone.

Leptospirosis is a global widespread zoonosis caused by a Gram-negative bacterium of the genus Leptospira, belonging to the Spirochaetes phylum, favored by unhealthy living conditions and some professional and recreational aquatic activities. Its diagnosis could be very difficult due to the presence of non-specific clinical presentation and biological anomalies common to other infectious diseases. To detect it, the choice of the right diagnostic method is fundamental. We hereby introduce the case of a patient with no classic risk factors for leptospirosis, showing febrile headaches and rapid deterioration of her general conditions with evolution towards septicemia.

La leptospirose est une zoonose causée par une bactérie Gram négatif du genre Leptospira, appartenant au phylum des Spirochaetes. Elle est répandue dans le monde entier, favorisée par des conditions de vie insalubres et certaines activités professionnelles et récréatives en milieu aquatique. Son diagnostic peut s'avérer difficile en raison de sa présentation clinique et de ses anomalies biologiques peu spécifiques et communes à d'autres maladies. Évoquer ce diagnostic et effectuer le test diagnostique approprié demeure, donc, fondamental. Nous présentons l'histoire d'une patiente sans facteurs de risque classiques de leptospirose, présentant des céphalées fébriles et une détérioration rapide de son état avec une évolution vers une septicémie.

Should we treat Blastocystis sp.? A double-blind placebo-controlled randomized pilot trial.

BACKGROUND: Blastocystis sp. is a worldwide-distributed protist colonizing the guts of humans and a great variety of animals. It is unclear whether it is just a commensal or an infectious parasite that prompts eradication.The main objective of this study was to evaluate the usefulness of metronidazole in patients with gastrointestinal symptoms harbouring only Blastocystis sp. In addition, we explored whether Blastocystis subtype or concomitant parasitic infection detected by polymerase chain reaction (PCR) may influence treatment outcome. METHODS: We included adults with persistent gastrointestinal symptoms (>14 days) visiting a primary care physician and in whom stool microscopy revealed only Blastocystis sp. Eligible patients were randomized to receive 10 days of metronidazole or placebo, followed by a crossover if still symptomatic. The primary outcome was normal stool consistency. Secondary outcomes were the changes in other abdominal symptoms (bloating, flatulence, abdominal pain, number of daily bowel movements) and general wellbeing. After the clinical phase of the study, Blastocystis subtypes were determined by PCR sequencing and stool samples were tested for 11 other protozoa with an in-house PCR. RESULTS: We screened 581 outpatients for inclusion, of which 50 met the eligibility criteria. There was no difference in the primary outcome, nor any of the secondary outcomes between the subjects treated with metronidazole and placebo.The most frequent Blastocystis subtypes were ST4 (11/36) and ST2 (10/36). The in-house PCR was positive for other protozoa in 25% (10/40) of the patients. We identified Dientamoeba fragilis in 5, Entamoeba dispar in 3 and Cyclospora cayetanensis in 2 patients. Stratified analysis according to Blastocystis subtype or the presence of other protozoa showed no significant difference in treatment outcome with metronidazole or placebo. CONCLUSIONS: Among patients infected with Blastocystis sp., metronidazole, compared with placebo, was not better in improving gastrointestinal symptoms, irrespective of subtype or microscopically undetected coinfection with other protozoa.

[Clinical presentation and short-term treatment of pulmonary actinomycosis]. / Manifestations cliniques et traitement de courte durée de l'actinomycose pulmonaire.

Actinomycosis is an uncommon disease caused by Actinomyces, a commensal of the oropharyngeal, digestive, and genital tract. Commonly, it manifests as cervicofacial infection and is often related to poor oral health, smoking, chronic alcoholism or immune deficiency. Pulmonary actinomycosis is a rare disease, characterized by unspecific clinical, biological, and radiological manifestations that may be confused with other diseases. It should always be considered in patients suspected of having tuberculosis, lung abscess or pulmonary neoplasia. We describe a case of pulmonary actinomycosis treated successfully with short-term antibiotic therapy of three months, with a short review of the literature.

L'actinomycose est une infection peu fréquente causée par l'espèce Actinomyces, un commensal du tractus oropharyngé, digestif et génital. Elle se manifeste généralement par une infection cervico-faciale, souvent liée à un mauvais état bucco-dentaire, un tabagisme, un éthylisme chronique, ou un déficit immunitaire. L'actinomycose pulmonaire est une affection peu commune, caractérisée par des manifestations cliniques, biologiques et radiologiques peu spécifiques qui peuvent être confondues avec d'autres maladies. Elle doit être évoquée en cas de suspicion de tuberculose, d'abcès et de néoplasie pulmonaire. Nous décrivons un cas d'actinomycose pulmonaire traitée avec succès par une antibiothérapie de courte durée de 3 mois, avec une revue simplifiée de la littérature.

[COVID-19, how to treat the disease during Fall 2022?] / Covid-19 : quelle prise en charge pour l'automne 2022 ?

Since the arrival of COVID-19, we have witnessed a series of new variants and new therapies, and it is therefore becoming difficult to stay up to date on the best management of an outpatient infected with SARS-CoV-2. In a patient at risk of an unfavorable evolution in the first 5 days of illness, the antiviral Paxlovid is recommended. Evusheld, administered in the hospitals, is recommended in patients with a documented negative serology, for treatment in early disease or as a pre-exposure prophylaxis. The activity of monoclonal antibodies seems to be reduced with the new variants. Dexamethasone is reserved for the hospital management of an oxygen-dependent patient. There is no place for antibiotic therapy apart from additional bacterial infection.

Depuis l'arrivée du Covid-19, nous avons assisté à l'apparition simultanée de nouveaux variants et de nouvelles thérapies, de ce fait, il devient difficile de rester à jour sur la prise en charge d'un patient infecté par le SARS-CoV-2. En ambulatoire, chez un patient à risque d'évolution défavorable dans les 5 premiers jours de maladie, l'antiviral Paxlovid est proposé. L'Evusheld est administré dans les centres spécialisés et conseillé chez des patients avec sérologie négative après vaccination, en traitement précoce ou en prophylaxie préexposition. L'activité des anticorps monoclonaux semble néanmoins réduite avec les nouveaux variants. La dexaméthasone est réservée à la prise en charge hospitalière d'un patient oxygénodépendant et une antibiothérapie n'a pas sa place en dehors d'une surinfection bactérienne.

[Travel vaccines: what is in the pipeline?] / Vaccins de voyage : quel horizon ?

While no vaccine is on the horizon to prevent traveler's diarrhea, progress has been made in the field of malaria and dengue fever. In both cases, the objective is not primarily the prevention among travelers but rather the reduction of morbidity and mortality in populations living in endemic areas. The immune mechanisms protecting against parasitosis are not well understood, which further complicates vaccine development. The fact that veterinary vaccines against the parasites causing cysticercosis and echinococcosis are available for animals, justifies a certain optimism that vaccines against parasitosis will also be available for humans in the future. We report on recent developments in dengue, malaria, schistosomiasis, and hookworm vaccines.

Si aucun vaccin ne pointe à l'horizon pour prévenir la diarrhée des voyageurs, des progrès ont été faits dans le domaine de la malaria et de la dengue. Dans les deux cas, l'objectif n'est pas prioritairement la prévention chez les voyageurs mais plutôt la diminution de la morbidité et mortalité dans les populations vivant en zone d'endémie. Les mécanismes immunitaires protégeant contre les parasitoses ne sont pas bien connus, ce qui complique encore le développement vaccinal. Le fait que des vaccins vétérinaires contre les parasites causant la cysticercose et l'échinococcose soient disponibles pour les animaux justifie un certain optimisme de voir à l'avenir aussi chez l'humain des vaccins contre des parasitoses. Nous faisons le point sur les développements récents des vaccins contre la dengue, la malaria, la schistosomiase et l'ankylostomiase.

Point prevalence study of antibiotic appropriateness and possibility of early discharge from hospital among patients treated with antibiotics in a Swiss University Hospital.

BACKGROUND: The growing threat of multidrug resistant organisms have led to increasingly promote prudent and rational use of antimicrobials as well as early hospital discharge plan. Antibiotic stewardship programs (ASP) have been developed as multifaceted approaches to improve use of current antibiotics and are now widely applied through different strategies. Proactive interventions are still limited in Switzerland and data on antimicrobial appropriateness and early discharge strategies are lacking. We aimed to describe the opportunities of antibiotics prescriptions optimization at Lausanne University Hospital, Switzerland and evaluate the suitability for early discharge among patients receiving antibiotics. The need for outpatient medical structures was also assessed. METHODS: We conducted a point prevalence survey of antibiotic prescriptions in adult medical and surgical units with exclusion of intermediate and intensive care units. All hospitalized patients receiving a systemic antibiotic on the day of evaluation were included. An infectious diseases specialist evaluated antimicrobial appropriateness and assessed suitability for discharge according to medical and nursing observations. The need of flexible additional outpatient facility for a close medical follow-up was evaluated concomitantly. RESULTS: A total of 564 patients' files were reviewed. 182 (32%) patients received one or more systemic antibiotic: 62 (34%) as a prophylaxis and 120 (66%) as a treatment with or without concomitant prophylaxis. 37/62 (60%) patients receiving prophylaxis had no indication to continue the antibacterial. Regarding the patients treated with antibiotics, 69/120 (58%) presented at least one opportunity for treatment optimization, mainly interruption of treatment. A previous ID consultation was recorded for 55/120 (46%) patients, of whom 21 (38%) could have benefited from antimicrobial therapy optimization on the day of the point assessment. 9.2% patients were eligible for discharge of whom 64% could leave the hospital with a close outpatient follow-up for infectious issues. CONCLUSIONS: This point prevalence study offers precious indicators for tailoring future antibiotic stewardship interventions that can be combined with early discharge. Any centre considering implementing ASP should conduct this type of analysis with a pragmatic approach to gain insight into local practices and needed resources.

[Management of human papillomavirus at the doctor's office : what to do for men ?] / Prise en charge du papillomavirus humain au cabinet médical : que faire pour les hommes ?

In primary care medicine, doctors may be facing with human papillomavirus (HPV)-related questions regarding prevention, screening or treatment, more so with women than with men. Through three clinical vignettes, this article aims to offer some clinical management recommendations in a primary care setting when HPV-related questions are raised by the male population.

En médecine de premier recours, le médecin peut être confronté à des questions de prévention, de dépistage ou de traitement en lien avec le papillomavirus (HPV), situations généralement ­rencontrées chez la femme mais parfois aussi chez l'homme. Au travers de trois vignettes cliniques, cet article vise à proposer quelques recommandations de prise en charge au cabinet dans le but de répondre aux questions liées au HPV susceptibles d'être soulevées par la population masculine.

[Practical management of long Covid disease in outpatients: illustration by clinical cases]. / Prise en charge des patients avec Covid long : illustration par des cas cliniques.

The SARS-CoV-2 pandemic has caused an unprecedented global public health crisis. The term long Covid is used to describe diverse and heterogeneous symptoms that persist more than 4 weeks after infection with an estimated incidence of 10-40%, which varies between studies. The principal characteristics of long Covid are fluctuating symptoms of prolonged duration affecting multiple organs, such as fatigue, dyspnea, cough, anosmia, dysgeusia, chest pain, palpitations, headache, myalgia, cognitive and gastrointestinal disorders. Contributing factors, possible pathophysiological explanations and international recommendations can help in the management of the disease in the outpatient setting. Biopsychosocial and multidisciplinary management in primary care medicine is essential.

La pandémie due au virus SARS-CoV-2 a provoqué une crise de santé publique sans précédent. Le terme Covid long est utilisé pour décrire les divers symptômes hétérogènes et persistant plus de 4 semaines après l'infection, avec une incidence de 10 à 40 %, qui varie selon les études. Les caractéristiques principales du Covid long sont une atteinte multisystémique et des symptômes fluctuants et prolongés comme la fatigue, la dyspnée, la toux, l'anosmie, la dysgueusie, les douleurs thoraciques, les palpitations, des céphalées, des myalgies, des troubles cognitifs et des troubles gastro-intestinaux. Les facteurs favorisants, les explications physiopathologiques possibles et les recommandations internationales rendent indispensable une prise en charge biopsychosociale et pluridisciplinaire en médecine de premiers recours.

Expert guidance for COVID-19 vaccine deployment in Switzerland: a Delphi process.

BACKGROUND AND AIM: Vaccines providing protection against COVID-19 are a core tool for ending the pandemic. Though international organisations created guidance in 2020 for vaccine deployment, this had to be adapted for each country's situation and values. We aimed to assist public health decision makers by identifying areas of consensus among Swiss experts for the deployment of one or more novel COVID-19 vaccines. METHODS: An electronic, modified Delphi process between September and November 2020. We recruited a convenience sample of experts working in Switzerland from a variety of specialities, who completed two anonymous questionnaires. They voted on clarification questions and guidance statements from 0 (complete disagreement) to 10 (complete agreement). Responses for guidance statements with a median ≥8 and a lower inter-quartile range bound ≥7 were considered as reaching consensus. RESULTS: Sixty-five experts accepted (66% response rate), with 47 completing the first questionnaire (72%), and 48 the second (74%). Statements reaching consensus included: in the first phase we should vaccinate front-line healthcare professionals and people ≥65 years with risk factors; widespread vaccination of children and adolescents should not be an early priority; and vaccines should be provided free of charge in the setting of national or cantonal vaccination campaigns. Statements not reaching consensus included: early vaccination of people living with someone with risk factors who are not themselves at risk; vaccination of people with previous confirmed or suspected COVID-19; and whether vaccination should be mandatory for individuals with certain activities, such as front-line healthcare professionals. CONCLUSIONS: Experts reached consensus on several statements that were available for decision-makers when making key decisions for COVID-19 vaccine deployment in Switzerland. Statements without consensus highlighted areas requiring expert and public dialogue. The modified Delphi process allowed us to rapidly synthesise views from a broad panel of experts on sensitive topics, and could be considered for a broad range of issues during public health crises.

[What does a general practitioner need to know about whooping cough?] / Que doit savoir un médecin généraliste sur la coqueluche ?

Pertussis (whooping cough) is a vaccine-preventable bacterial infectious disease. Nevertheless, serious cases continue to be reported every year in the paediatric population. Pertussis poses a danger mainly to unimmunized or partially immunized infants under six months of age. It is still considered as a diagnostic challenge. The aim of this article is to present, through a clinical situation, the strategies for the prevention of pertussis and the correct management in case of suspicion of this disease. Through answers to questions we review the basics which every general practitioner should know.

La coqueluche fait partie des maladies infectieuses bactériennes évitables par la vaccination. Néanmoins, des cas graves continuent d'être signalés chaque année dans la population pédiatrique. La coqueluche présente un danger principalement pour les nourrissons de moins de 6 mois non ou partiellement immunisés. Elle est aujourd'hui encore considérée comme un défi diagnostique. Le but de cet article est de présenter, au travers d'une situation clinique, les stratégies de prévention de la coqueluche, ainsi que sa prise en charge en cas de suspicion. Au travers des réponses à huit questions, nous rappelons les principes de bases à connaître par chaque généraliste.

[A story of neuroborreliosis†: case report]. / Histoire de neuroborréliose†: étude d'un cas.

Neuroborreliosis affects approximately 15 % of people infected with Borrelia burgdorferi. The symptoms are very varied, which can sometimes delay the diagnosis. We can diagnose a neuroborreliosis in front of a compatible clinic and laboratory examinations, in particular a lumbar puncture showing a pleocytosis, an intrathecal synthesis of antibodies against B. burgdorferi, and an increased level of chemokine CKCL13. We present the case of a patient in whom the diagnosis was delayed in connection with non-specific symptoms and we review the latest recommendations in terms of treatment of neuroborreliosis.

La neuroborréliose touche entre 10 et 15 % des personnes infectées par Borrelia burgdorferi. Les symptômes sont très variés, ce qui peut parfois retarder le diagnostic. Celui-ci est posé en présence d'une clinique compatible et des examens de laboratoire, notamment une ponction lombaire montrant une pléocytose, une synthèse intrathécale d'anticorps contre B. burgdorferi et une augmentation de la chimiokine CXCL13. Nous présentons le cas d'un patient chez qui le diagnostic a mis du temps à être posé en lien avec des symptômes peu spécifiques et revoyons les dernières recommandations en termes de traitement de la neuroborréliose.

[Ticks-borne diseases in 2019†: between false beliefs and good practices]. / Maladies transmises par les tiques en 2019†: entre fausses croyances et bonnes pratiques.

In recent years, the media and internet have been the stage of a campaign of scientific disinformation led by patient advocacy groups, supported by some «â€…experts ¼ in the field, demanding recognition of health problems attributed to Lyme disease. The controversy has led several professional societies and leading scientific journals in Europe and the United States to reaffirm their position and update their recommendations. Tick bites are common in our area, and medical practitioners must know their potential complications, respond to questions from worried patients, and confront their own doubts and uncertainties. This article aims to give an update on current knowledge of tick-borne diseases based on a number of common assumptions.

Ces dernières années nous avons assisté à une campagne de désinformation scientifique menée par des associations de défense des malades, soutenue par certains «â€…experts ¼ du domaine, qui réclament une reconnaissance de leurs problèmes de santé attribués à la maladie de Lyme. Cette polémique a conduit plusieurs sociétés savantes et revues scientifiques de référence en Europe et aux Etats-Unis à réaffirmer leur position et mettre à jour leurs recommandations. Les morsures de tiques étant fréquentes dans nos régions, le médecin doit envisager leurs potentielles conséquences, répondre aux inquiétudes des patients et se confronter à ses propres doutes et incertitudes. Cet article a pour objectif de faire un point de situation sur les connaissances actuelles des maladies transmises par les tiques en partant d'un certain nombre d'idées reçues.

[Consensus for the management of infectious diseases among asylum seekers and detainees in the canton of Vaud]. / Consensus vaudois de prise en charge de maladies infectieuses auprès des requérants d'asile et détenus.

Our work develops procedures and useful tools for the screening, assessment and management of prevalent infectious or parasitic diseases (tuberculosis, measles, chickenpox, scabies, bed bugs) among asylum seekers and detainees in the canton of Vaud, populations living in similar closed settings. Its aim is to support health professionals in their work, to maintain the health of the target population and to protect the health of the community. Through a literature review and a focus group with experts, it is proposed to harmonize the existing procedures in asylum seekers centres end prisons of the canton of Vaud. The proposed decision algorithms are coherent with the recommendations of the literature and relevant in terms of public health and ethics, as well as feasible logistically and acceptable by the field health professionals.

Ce travail développe des procédures dans le cadre du dépistage et de la prise en charge de maladies infectieuses ou parasitaires prévalentes (tuberculose, rougeole, varicelle, gale, punaises de lit) chez les requérants d'asile et détenus du canton de Vaud, populations vivant dans des environnements similaires, afin de soutenir le personnel soignant dans son travail de terrain, veiller à la santé des personnes concernées et protéger la population locale. Il s'agit donc d'harmoniser, grâce à une revue de littérature et un focus group d'experts, les procédures existant dans les centres de requérants et de détenus vaudois en s'assurant que celles-ci correspondent aux recommandations de la littérature et soient pertinentes en termes de santé publique et d'éthique, ainsi que réalisables d'un point de vue logistique et acceptables par les équipes de terrain.

Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study.

Objectives: This study aimed to evaluate the efficacy and safety of continuous antimicrobial infusion using elastomeric pumps in an outpatient setting, while simultaneously documenting circulating antibiotic concentration exposure achieved with this mode of administration. Methods: Clinical outcomes, adverse events and antibiotic plasma concentrations were recorded for all patients treated by continuous infusion with elastomeric pumps at the outpatient parenteral antimicrobial therapy (OPAT) unit of the University Hospital of Lausanne between December 2013 and January 2017. The study was registered under ClinicalTrials.gov identifier NCT03221140. Results: One hundred and fifty outpatients were treated by continuous intravenous infusions using flucloxacillin (70 patients), cefepime (36), vancomycin (32) and piperacillin/tazobactam (12). The calculated free fractions of each antibiotic were above the epidemiological cut-off values for resistance (ECOFF) of the treated microorganisms in 92% of measurements. Cure was achieved in 143 patients (95%) 3 months after the end of treatment. Four patients needed unexpected readmission and three had a relapse. In none of the patients with unsuccessful treatment was the ratio of free antibiotic plasma concentration/ECOFF <1. Sixteen patients (11%) had an adverse event, none of them being of severity grade 4 or 5. Conclusions: Continuous infusions of flucloxacillin, cefepime, vancomycin and piperacillin/tazobactam using elastomeric pumps seem to be an effective and safe approach to treat outpatients. The number of treatment successes was very high and adverse events occurred at a similar rate as reported by other OPAT centres. The measured antibiotic plasma concentrations confirmed adequate drug concentration exposure for the vast majority of patients.

Malaria prevention strategies and recommendations, from chemoprophylaxis to stand-by emergency treatment: a 10-year prospective study in a Swiss Travel Clinic.

BACKGROUND: There are several possible malaria prevention strategies for travellers. In Switzerland, chemoprophylaxis (CP) is recommended for persons visiting areas highly endemic for malaria and stand-by emergency treatment (SBET) for areas with moderate to low risk. OBJECTIVE: To describe the type of malaria prevention prescribed to travel clinic attendees with a specific focus on changes over time following adaptation of recommendations. METHODS: All pre-travel first consultation data recorded between November 2002 and December 2012 were included. Country-specific malaria preventive recommendations provided and medicines prescribed over time were analysed. RESULTS: In total, 64 858 client-trips were recorded. 91% of travellers planned to visit a malaria endemic country. Among those clients, 42% were prescribed an antimalarial medicine as CP only, 36% as SBET only, and 3% both. Between 2002 and 2012, there was a 16% drop of CP prescription ( P < 0.001) and a 21% increase of SBET prescription ( P < 0.001). Among travellers receiving CP, the proportion of those prescribed mefloquine dropped from 82% in 2002 to 46% in 2012 while those prescribed atovaquone-proguanil (AP) increased from 7% to 39%. For those prescribed SBET, the proportion dropped from 46% to 30% for AP and increased from 2% to 61% for artemether-lumefantrine. CP prescription for travellers to India fell from 62% to 5% and SBET prescription increased from 40% to 88% after the change of recommendation from CP to SBET in 2005 for this country. Comparatively, CP prescription for travellers to Senegal, for which no change of recommendation occurred, remained relatively stable between 88% in 2002 and 89% in 2012. CONCLUSION: This study shows the considerable decline of antimalarial prescription for chemoprophylaxis that occurred over the 10-year period in favour of SBET.

Multidrug-resistant bacteria and travel. / Bactéries multirésistantes et voyage.

Antimicrobial resistance is a global problem which affects also tropical countries. Travelers to these regions expose themselves to the risk of being colonised and infected with multidrug-resistant bacteria. The region visited, the occurrence of diarrhoea and the use of antibiotics are the principal risk factors leading to colonisation with multidrug-resistant Enterobacteriaceae, which can affect up to 80% of travellers. Colonisation with meticillin resistant Staphylococcus aureus and vancomycin resistant enterococci are often due to contacts with the health care system of the visited country. For the practitioner evaluating a patient returning from abroad it is important to consider the risk of infection with multidrug-resistant bacteriae. Screening for these bacteriae in the stool or by mucocutaneous swabs can be discussed in certain situations.

La résistance aux antibiotiques est un problème global qui touche aussi les pays tropicaux. Les voyageurs dans ces régions s'exposent donc au risque d'être colonisés et infectés avec des germes multirésistants. La région visitée, la survenue de diarrhées et la prise d'antibiotiques sont les facteurs de risque principaux pour une colonisation digestive avec des entérobactéries multirésistantes qui peut aller jusqu'à 80 %. Les colonisations par les staphylocoques dorés résistant à la méticilline et les entérocoques résistant à la vancomycine sont souvent dues à un contact avec les services médicaux dans les pays visités. Pour le praticien, il est important de tenir compte du risque d'infections avec des bactéries multirésistantes chez les patients au retour d'un voyage. Un dépistage de ces germes dans les selles ou par des frottis mucocutanés peut être discuté dans certaines situations.