[Infectious diseases: what's new in 2023]. / Maladies infectieuses: ce qui a changé en 2023.

The year 2023 saw the publication of several studies in various areas of infectious diseases. The administration of corticosteroids decreased mortality in severe community-acquired pneumonia. Administration of doxycycline post-exposure prophylaxis reduced the risk of bacterial sexually transmitted infections at the risk of resistance selection. An herbal preparation decreased mortality in sepsis. A meta-analysis concludes that oseltamivir does not significantly reduce the risk of hospitalisation for influenza. Discontinuation of antibiotic prophylaxis during dental procedures in Sweden did not increase the incidence of viridans group Streptococcus endocarditis. Several studies have led to the introduction of RSV (Respiratory Syncytial Virus (RSV) vaccination. 2023 also saw the resurgence of invasive Group A Streptococcal infections, of which clinicians must be wary.

L'année 2023 est marquée par la publication d'études touchant des domaines variés de l'infectiologie. La mortalité de pneumonies communautaires sévères est diminuée par l'administration de corticostéroïdes. Lors de rapport sexuel à risque, l'administration de doxycycline en prophylaxie postexpositionnelle diminue le risque d'infections sexuellement transmissibles bactériennes, cependant au risque de sélectionner des bactéries résistantes. Une préparation de plantes diminue la mortalité du sepsis. Une méta-analyse conclut que l'oseltamivir ne diminue pas significativement le risque d'hospitalisation lors de grippe. L'arrêt de la prophylaxie antibiotique lors d'intervention dentaire en Suède n'a pas augmenté l'incidence d'endocardite à streptocoques du groupe viridans. Plusieurs études ont mené à l'introduction de la vaccination VRS (virus respiratoire syncytial humain). 2023 a aussi vu la résurgence d'infections invasives à streptocoques du groupe A dont le clinicien doit se méfier.

Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020.

A large clonal outbreak caused by vancomycin-resistant Enterococcus faecium (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as vanB VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.

[Diagnosis, prevention and treatment of HIV : what's new in 2018 ?] / Nouveautés dans le dépistage, la prévention et la prise en charge du VIH en 2018.

In 2018, many innovations have appeared in the field of HIV. From the laboratory to self-test sold in pharmacy, all aspects of the HIV spectrum are affected. These new features not only concern HIV infected patients and their specialists but all health workers. The constant improvement of HIV care and prevention is essential to reach the ambitious goal set by UNAIDS : 90­90­90. By 2020, 90 % of all people living with HIV know their status, 90 % of all people diagnosed with HIV receive antiretroviral treatment and 90 % of all people receiving therapy are virally suppressed. In this article we review what we thought were the most significant innovations of 2018 : self-testing, newly approved 4th generation screening tests with a shortened 6-week window period, use of PrEP, new treatments and the latest research about reservoirs.

En 2018 de nombreuses nouveautés, du laboratoire du chercheur à l'autotest en vente libre, ont fait leur apparition dans le domaine du VIH. Ces nouveautés ne concerneront donc pas uniquement les patients infectés par le VIH et les spécialistes mais tous les acteurs du domaine de la santé. La perpétuelle amélioration de la prise en charge et de la prévention du VIH s'inscrit dans l'objectif ambitieux de l'ONU-SIDA 90­90­90 : 90 % de personnes infectées par le VIH connaissant leur statut, 90 % sous antirétroviraux et 90 % avec une virémie indétectable d'ici 2020. Dans cet article, nous survolons les changements de 2018 qui nous semblent les plus significatifs, à savoir : les autotests, le délai à 6 semaines pour les tests de dépistage de 4e génération, la prophylaxie préexposition, les nouveaux traitements et les dernières découvertes concernant les réservoirs.

[Septic arthritis diagnosis : the role of microbiology]. / Diagnostic microbiologique des arthrites septiques.

Septic arthritis is a medical and surgical emergency. It is therefore essential to promptly differentiate an infectious from a non-infectious origin in order to improve the prognostic (mortality and morbidity). To do so the clinician needs not only to know which tests are available but also how to adequately use them and interpret their results. In this article, we review the various tests in use for the evaluation of acute arthritis, highlighting the most useful ones for the diagnosis of septic arthritis. We will also have a quick look at the use of intra-articular injection of corticosteroid.

L'arthrite septique est une urgence médicale et souvent chirurgicale. Dès lors, il est essentiel de rapidement distinguer une arthrite infectieuse d'une arthrite d'autre étiologie afin d'améliorer le pronostic en termes de morbidité et même de mortalité. Pour ce faire, de nombreux tests biologiques et microbiologiques sont à disposition du clinicien. Encore faut-il choisir le bon et l'interpréter correctement. Dans cet article, nous passons en revue les différents examens utiles (et moins utiles) au diagnostic d'arthrite septique. Nous évoquons également la question de l'utilisation de corticostéroïdes intra-articulaires en cas d'arthrite aiguë.

[Fever and rash in the adult patient]. / Exanthème fébrile chez l'adulte.

Fever with rash is a frequent reason for consultation. A detailed medical history and thorough physical examination are essential since laboratory tests often lack specificity. Certain infectious and non-infectious causes are considered medical emergencies and must always be investigated upon initial evaluation. In the case of a history of recent travel the differential diagnosis has to be broadened but it should not be forgotten that resurgent « childhood ¼ viral diseases like measles can be acquired while traveling.

L'exanthème fébrile est un motif fréquent de consultations. Une anamnèse détaillée et un status minutieux sont les clés pour poser le diagnostic car les examens de laboratoire sont souvent peu spécifiques. Certaines causes infectieuses et non infectieuses représentent des urgences et doivent toujours être évoquées et recherchées lors de l'évaluation initiale. L'élément « retour de voyage ¼ élargit le diagnostic différentiel, mais ne doit pas faire oublier que certains « exanthèmes infantiles ¼ comme la rougeole peuvent aussi être acquis en voyageant.

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism.

We present 3 cases of pseudoallergic (anaphylactoid) reactions to perioperatively administered rocuronium, which rapidly resolved after sugammadex injection. Allergological workup showed no evidence for immediate-type hypersensitivity to the drugs used for anesthesia, including rocuronium. However, rocuronium induced an irritative reaction in skin tests in all 3 patients and in 3 healthy individuals. This reaction was specifically suppressed by adding sugammadex at a 1:1 molecular proportion to rocuronium before the skin tests. This observation suggests that the patients suffered from a pseudoallergic reaction, and indicates that sugammadex might act via the inhibition of non-IgE mediated MRGPRX2 (Mas-related G-protein-coupled receptor member X2)-triggered mast cell degranulation induced by rocuronium.

[It is not only about cost ... when it comes to generic medication]. / Le coût, ce n'est pas tout ... à propos des médicaments génériques.

The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Patients' representations suggest that they might be confident in taking a generic medication: when the generic medication is prescribed by the physician and each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Economic arguments are not sufficient to accept substitution. Negative representations require attention and need be considered.

Comparison of clinical outcomes over time of inpatients with healthcare-associated or community-acquired coronavirus disease 2019 (COVID-19): A multicenter, prospective cohort study.

OBJECTIVE: To compare clinical outcomes over time of inpatients with healthcare-associated coronavirus disease 2019 (HA-COVID-19) versus community-acquired COVID-19 (CA-COVID-19). DESIGN: We conducted a multicenter, prospective observational cohort study of inpatients with COVID-19. SETTING: The study was conducted across 16 acute-care hospitals in Switzerland. PARTICIPANTS AND METHODS: We compared HA-COVID-19 cases, defined as patients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test > 5 days after hospital admission, with hospitalized CA-COVID-19 cases, defined as those who tested positive within 5 days of admission. The composite primary outcome was patient transfer to an intensive care unit (ICU) or an intermediate care unit (IMCU) and/or all-cause in-hospital mortality. We used cause-specific Cox regression and Fine-Gray regression to model the time to the composite clinical outcome, adjusting for confounders and accounting for the competing event of discharge from hospital. We compared our results to those from a conventional approach using an adjusted logistic regression model where time-varying effects and competitive risk were ignored. RESULTS: Between February 19, 2020, and December 31, 2020, we included 1,337 HA-COVID-19 cases and 9,068 CA-COVID-19 cases. HA-COVID-19 patients were significantly older: median, 80 (interquartile range [IQR], 71-87) versus median 70 (IQR, 57-80) (P < .001). A greater proportion of HA-COVID-19 patients had a Charlson comorbidity index ≥ 5 (79% vs 55%; P < .001) than did CA-COVID-19 patients. In time-varying analyses, between day 0 and 8, HA-COVID-19 cases had a decreased risk of death or ICU or IMCU transfer compared to CA-COVID-19 cases (cause-specific hazard ratio [csHR], 0.43; 95% confidence interval [CI], 0.33-0.56). In contrast, from day 8 to 30, HA-COVID-19 cases had an increased risk of death or ICU or IMCU transfer (csHR, 1.49; 95% CI, 1.20-1.85), with no significant effect on the rate of discharge (csHR, 0.83; 95% CI, 0.61-1.14). In the conventional logistic regression model, HA-COVID-19 was protective against transfer to an ICU or IMCU and/or all-cause in-hospital mortality (adjusted odds ratio [aOR], 0.79, 95% CI, 0.67-0.93). CONCLUSIONS: The risk of adverse clinical outcomes for HA-COVID-19 cases increased substantially over time in hospital and exceeded that for CA-COVID-19. Using approaches that do not account for time-varying effects or competing events may not fully capture the true risk of HA-COVID-19 compared to CA-COVID-19.

Bacterial species and antimicrobial resistance differ between catheter and non-catheter-associated urinary tract infections: Data from a national surveillance network.

Objective: To investigate clinically relevant microbiological characteristics of uropathogens and to compare patients with catheter-associated urinary tract infections (CAUTIs) to those with non-CAUTIs. Methods: All urine cultures from the calendar year 2019 of the Swiss Centre for Antibiotic Resistance database were analyzed. Group differences in the proportions of bacterial species and antibiotic-resistant isolates from CAUTI and non-CAUTI samples were investigated. Results: Data from 27,158 urine cultures met the inclusion criteria. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis together represented 70% and 85% of pathogens identified in CAUTI and non-CAUTI samples, respectively. Pseudomonas aeruginosa was significantly more often detected in CAUTI samples. The overall resistance rate for the empirically often-prescribed antibiotics ciprofloxacin (CIP), norfloxacin (NOR), and trimethoprim-sulfamethoxazole (TMP-SMX) was between 13% and 31%. Except for nitrofurantoin, E. coli from CAUTI samples were more often resistant (P ≤ .048) to all classes of antibiotics analyzed, including third-generation cephalosporines used as surrogate for extended-spectrum ß-lactamase (ESBL). Significanty higher resistance proportions in CAUTI samples versus non-CAUTI samples were observed for CIP (P = .001) and NOR (P = .033) in K. pneumoniae, for NOR (P = .011) in P. mirabilis, and for cefepime (P = .015), and piperacillin-tazobactam (P = .043) in P. aeruginosa. Conclusion: CAUTI pathogens were more often resistant to recommended empirical antibiotics than non-CAUTI pathogens. This finding emphasizes the need for urine sampling for culturing before initiating therapy for CAUTI and the importance of considering therapeutic alternatives.

Mycobaterium fortuitum disseminated infection in an immunocompetent patient without predisposing factors.

Most Mycobacterium fortuitum infections described involve direct inoculation through skin lesions. We describe the case of a patient without risk factors who presented with an intracranial mass and a pulmonary infection with M. fortuitum As M. fortuitum are rarely pathogens, there is little knowledge about the optimal treatment and outcome of such infections: what is the best mode of administration, what is the best therapy duration and is surgery always required are some of the unanswered questions. In our patient, surgical removal of the mass associated with a 1-year antimycobacterial therapy led to a full recovery. Even though M. fortuitum was rapidly identified in sputum, it was initially considered non-pathogenic and the definitive diagnosis required almost 6 weeks of investigations. New molecular techniques will probably lead to more identifications of M. fortuitum in the next few years and a better knowledge of their possible pathogenicity and optimal treatment.

Prescribing Generic Medication in Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience in a Swiss Cohort.

OBJECTIVE: Parallel to an ever stronger advocacy for the use of generics, various sources of information report concerns regarding substitution. The literature indicates that information regarding substitution is not univocal. The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. METHODS: Qualitative methods were selected because the aim was to access the range of patients' representations and to consider their conceptions. Standardized face-to-face semi-structured interviews were used, and transcripts were submitted to content analysis. RESULTS: Patients' representations suggest that they might be confident in taking a generic medication: when he/she has an understanding of generics as resulting from a development process that has become part of the public domain; the generic medication is prescribed by the physician; each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. DISCUSSION: Economic arguments are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. Even in non-life-threatening diseases, negative cues require attention and need be de-emphasized - in particular lower price as an indication of lower quality, and generic status as contradictory with advocating individualization of medication.