Antibiotic resistance of Enterobacteriaceae causing urinary tract infections in elderly patients living in the community and in the nursing home: a retrospective observational study.

OBJECTIVES: Although nursing homes are thought to be significant reservoirs of antibiotic-resistant bacteria, very few large population-based studies comparing antibiotic resistance prevalence in nursing homes and in the community have adjusted for patient characteristics. Our objective was to compare the prevalence of antibiotic resistance of Enterobacteriaceae cultured from urine samples of nursing home residents with that of community-dwelling adults, all aged 65 years or older. METHODS: This study analysed around 20 000 positive urine samples sent to a large laboratory in north-eastern France from 2014 to 2017, collected from individuals aged 65 years or older. A multivariable logistic regression model adjusted for patient characteristics (gender, age, year of sampling, presence of urinary catheter and number of urine samples/year) compared the resistance of Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae to amoxicillin/clavulanate, nitrofurantoin, trimethoprim/sulfamethoxazole, nalidixic acid, ofloxacin, ciprofloxacin and ceftriaxone, as well as their possible EBSL production, in nursing home residents and community-dwellers. RESULTS: Nursing home residents had a higher adjusted OR (aOR) of Enterobacteriaceae (E. coli, P. mirabilis or K. pneumoniae) resistant to amoxicillin/clavulanate (aOR 1.38, 95% CI 1.27-1.50), ciprofloxacin (aOR 1.33, 95% CI 1.20-1.49) and ceftriaxone (aOR 1.37, 95% CI 1.15-1.63) or producing an ESBL (aOR 1.43, 95% CI 1.18-1.72), but did not differ in resistance to nitrofurantoin or trimethoprim/sulfamethoxazole. CONCLUSIONS: Elderly people in nursing homes had a risk around 40% higher than their community-dwelling peers of having antibiotic-resistant Enterobacteriaceae cultured from their urine samples. Antibiotic stewardship and infection prevention and control programmes should be implemented in nursing homes.

Factors associated with influenza vaccination of general medicine interns in Nancy, France, in 2017.

Winter flu is an epidemic infectious disease which sometimes causes serious complications in vulnerable people treated in general practice. Currently, the most effective means of prevention is influenza vaccination, which is recommended for healthcare professionals, including general medicine interns. The target of 75% coverage set by WHO for healthcare professional is rarely reached. Our survey provides an assessment of reported influenza vaccination of general medicine interns (GMI) and evaluates factors influencing their vaccination status. A cross-sectional survey was conducted from 27 September to 2 November 2017 in the Faculty of Medicine at the University of Lorraine in France. An anonymous self-administered questionnaire was distributed electronically (SurveyMonkey software) to all GMI. It collected data on their vaccination status and on levers and barriers to influenza vaccination. The data were analysed using SAS 9.4 software. Multivariate analysis helped identify factors associated with their influenza vaccination status. Of the 595 GMI invited, 269 participated in the survey, with a response rate of 45.2%. During the 2015, 2016, and 2017 winters, overall self-declared vaccine coverage was 37.9, 49.4, and 56.5%, respectively. Being at the end of training (p = 0.008, OR = 3.2), the presence of a mobile vaccination team (p = 0.019, OR = 3.1), and recommending vaccination to one's relatives and friends (p < 0.0001, OR = 5.4) were the three factors independently associated with influenza vaccination. The two main reasons which had a strong influence on non-vaccination were forgetting to do so (30.5%) and lack of time (24.8%). Influenza vaccination coverage of GMI in Nancy falls well short of WHO targets. Vaccination campaigns and facilitated access to vaccination at study and work placement locations should be considered.

Report of a fatal case of Lassa fever in Parakou in 2018: clinical, therapeutic and diagnostic aspects.

BACKGROUND: Lassa fever is one of the most lethal neglected tropical diseases in West Africa. It is a serious public health problem in this region of Africa where it is endemic in several countries. However, it remains a very little known disease by healthcare workers. The lack of specificity of its clinical manifestations makes its diagnosis difficult even in an epidemic context. CASE PRESENTATION: We report here a confirmed case of Lassa fever whose diagnosis could not be suspected until 11 days after the symptomatology began. This case was recognized as a suspected case of Lassa fever in the Internal Medicine Department of the Regional and Teaching Hospital of Borgou due to the persistence of the fever and the worsening of the patient's clinical condition despite triple antibiotic therapy in general and especially due to the appearance of hemorrhages. Confirmation of the presence of Lassa fever virus by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay on blood sample was obtained after his death despite late initiation of Ribavirin treatment. CONCLUSION: This case challenges Benin's health authorities on the need to facilitate access to diagnosis of viral hemorrhagic fevers and to train caregivers at all levels of the health system for better management of these diseases.

A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin.

We report here a case of giant vulval condyloma in a two-year-old infant infected by her "baby sitter" without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient.

Therapeutic itinerary of severe malaria in adults admitted to a teaching hospital in Dakar, Senegal.

INTRODUCTION: Despite prevention efforts, malaria remains a public health problem. METHODOLOGY: This was a prospective study conducted between October and December 2010 that aimed to describe the therapeutic route of adults presenting with severe malaria prior to being admitted to Fann Teaching Hospital in Dakar, Senegal. RESULTS: A total of 90 patients were included. The majority of them had consulted a public or private health care facility (92%) prior to admission. First consultation occurred on average two days after the onset of the disease. Self-medication (67.4%) and traditional medicine (26.1%) were the main causes of delaying care. CONCLUSIONS: Early care and adequate management are needed to reduce malaria mortality.