Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018-2021.

Background: Recent regulatory and reimbursement changes facilitated the development of teleconsultation within primary care. French guidance advises against antibiotic prescribing in children in teleconsultation. We assessed paediatric antibiotic prescribing on a French teleconsultation platform. Methods: This cross-sectional observational study analysed paediatric (0-14 years) visits on a national direct-to-consumer teleconsultation platform between January 2018 and December 2021. Teleconsultations with complete information regarding diagnosis (ICD-10 coding) and prescriptions were included. We assessed antibiotic prescription rates per 100 visits across diagnoses and used logistic regression to identify factors associated with antibiotic prescribing. Results: In the 37 587 included paediatric teleconsultations (median age 3 years) performed by 713 general practitioners (GPs) and 89 paediatricians, antibiotics were prescribed for 12.1%. Respiratory tract infections (RTIs) accounted for 49.5% of antibiotic prescriptions. Antibiotic prescription rates per 100 visits were: sinusitis, 69.5%; urinary tract infections, 62.2%; pharyngitis, 59.0%; pneumonia, 45.5%; otitis, 46.6%; bronchitis, 19.6%; rhinitis, 11.6%; bronchiolitis 6.6%. Antibiotic prescription rates were higher in GPs than paediatricians [OR 2.21 (IC95% 2.07-2.35)], among physicians aged 45-54 and over 65 [OR 1.66 (1.48-1.85) and 1.48 (1.32-1.66), respectively], in female practitioners [OR 1.13 (1.05-1.21)], in children 3-6 years old [OR 1.41 (1.28-1.56)] and over 6 [OR 1.50 (1.35-1.66)], during winter [OR 1.28 (1.21-1.37)] and for RTIs [OR 1.99 (1.87-2.10)]. Antibiotic prescription rates were lower in doctors with extensive experience in teleconsultation [OR 0.92 (0.86-0.98)]. Conclusions: Despite current recommendations, paediatric patients were frequently prescribed antibiotics during acute care teleconsultations. Specific antibiotic stewardship campaigns should target paediatric teleconsultations.

Automated ICD10-Coding of Teleconsultations Conclusions in Primary Care.

The national teleconsultation platform Qare offers a promising tool to collect data in primary care by sharing the same EHR among teleconsultants. Conclusions for every teleconsultation are thus collected by a text using an ICD10 code or not. Nevertheless, the use of the ICD10 classification by primary care doctors is scarce. We developed an algorithm based on bags of words that associates an ICD10 code for each textual conclusion and evaluated it. It shows good performances (88 to 89% concordance) to assign ICD10 category. It could be used to enhance the volume of coded teleconsultations ready to be reused.

Improving Antibiotic Prescribing for Dentistry in France Using an Ontology.

Antibiotic overprescribing in dentistry is a major concern that contributes to the emergence of antimicrobial resistance. It is due in part to the misuse of antibiotics by dentists but also by other practitioners who see patients in emergency for dental care. We used the Protégé software to create an ontology regarding the most common dental diseases and the most used antibiotics to treat them. It is an easy shareable knowledge base that could be used directly as decision support tool to improve the use of antibiotics in dental care.

Eosinophilic meningitis in New Caledonia: The role of Angiostrongylus cantonensis?

INTRODUCTION: Eosinophilic meningitis is a rare form of meningitis with sequelae or death occurring in approximately 2-3% of cases. The most frequent etiological agent is the parasite Angiostrongylus cantonensis. The aim of this study was to characterize New Caledonian cases and to assess the extent to which of A. cantonensis was involved. MATERIAL AND METHODS: We performed a retrospective study of all cases of eosinophilic meningitis (EM) admitted to the Territorial Hospital of New Caledonia, from 2004 to 2019. We performed a descriptive and a multivariate analysis to identify association of variables with severe and fatal cases (or cases with sequelae). CONCLUSION: Angiostrongyliasis was confirmed as being responsible for 17 of the 92 reported EM cases in New Caledonia from 2004 to 2019 with most being young adults and non-walking infants, and with two peaks of incidence one during the dry season and one during the rainy season. Considering the high incidence and regularity of cases, the potential reservoirs should be identified to target prevention campaigns.

Knowledge, attitudes and practices about vaccination in Trentino, Italy in 2019.

Introduction: Vaccination is among the most important areas of progress in the worldwide history of public health. However, a crescent wave of anti-vaccine groups has grown in Western countries, especially in Italy, in the last two decades. Our aim was to evaluate adult's hesitancy and knowledge about vaccines and related diseases in Trentino-Alto Adige -the Italian region with the lowest vaccination coverages. Methods: We administered self-answered structured questionnaires in three malls in the Trentino province in June 2019. We collected demographic data and information on knowledge about vaccines, infectious diseases and attitude in seeking health information. We utilized a descriptive and multivariate analysis to investigate factors associated with vaccine hesitancy. Results: We collected 567 questionnaires, 18% of the people interviewed were hesitant toward vaccination and 16% were against mandatory vaccination. In the multivariate analysis a poor level of information, being younger than 60 years and being against compulsory vaccination were associated with vaccine hesitancy. Regarding information about vaccines, 76.5% of the people relied on physicians, and/or 49% navigated the internet, while social media are used by 16% of the study population. Though 41.5% searched information on official sites, only 14% knew the website VaccinarSì and 4.7% had visited it. Discussion: Compared to a previous study conducted in all of Italy except Trentino Alto Adige, the level of vaccination hesitancy was higher. It is important to utilize health professionals, the internet and especially social media to spread scientific information about vaccination.

Three New Cases of Melioidosis, Guadeloupe, French West Indies.

Melioidosis has been detected in the Caribbean, and an increasing number of cases has been reported in the past few decades, but only 2 cases were reported in Guadeloupe during the past 20 years. We describe 3 more cases that occurred during 2016-2017 and examine arguments for increasing endemicity.

Impact of an SMS reminder service on outpatient clinic attendance rates by patients with HIV followed-up at Pointe-à-Pitre University Hospital.

OBJECTIVE: By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. METHODS: The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. RESULTS: A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking anti-retroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. CONCLUSION: Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.

Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean.

BACKGROUND: Community-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin. CASE PRESENTATION: A 55 year old man with a history of essential hypertension, benign prostate hyperplasia, hyperlipidemia, obstructive sleep apnea, and chronic alcoholism was admitted for meningitis due to Klebsiella pneumoniae with a wild-type susceptibility profile. Its genomic features were consistent with a capsular K2 strain belonging to clonal group 86 (CG86) displaying the large virulence of Klebsiella plasmid (pLVPK) with heavy metal resistance gene clusters, aerobactin, rmpA. CONCLUSION: This is the first case of community-acquired meningitis caused by a hypervirulent strain of hvKP ever reported in the Caribbean.

Liver Abscess Caused by Infection with Community-Acquired Klebsiella quasipneumoniae subsp. quasipneumoniae.

We report a case of pyogenic liver abscess caused by community-acquired Klebsiella quasipneumoniae subsp. quasipneumoniae. The infecting isolate had 2 prominent features of hypervirulent K. pneumoniae strains: the capsular polysaccharide synthesis region for K1 serotype and the integrative and conjugative element ICEKp1, which encodes the virulence factors yersiniabactin, salmochelin, and RmpA.

Bacteremic community-acquired infections due to Klebsiella pneumoniae: clinical and microbiological presentation in New Caledonia, 2008-2013.

OBJECTIVES: To provide data on severe bacteremic community-acquired infections due to Klebsiella pneumoniae in New Caledonia. METHODS: All patients admitted with bacteremic community-acquired infections due to K. pneumoniae at the only tertiary medical center in New Caledonia, from 2008 to 2013, were included retrospectively in this study. Clinical and microbiological characteristics were analyzed, as well as risk factors for mortality. RESULTS: The characteristics of 119 patients were analyzed. The most common clinical presentation was urinary tract infection (40 cases, 33%), followed by pneumonia (28 cases, 23%), deep abscesses (15 cases, 13%), liver abscess (12 cases, 9%), meningitis in (five cases, 4%), and endophthalmitis (two cases, 1%). Multiple localizations were reported in 18 cases (15%) and isolated bacteremia was reported in 22 cases (18%). The overall mortality rate was 22% (26/119) and the mortality rate in the intensive care unit was 33% (14/42). Renal impairment, chronic liver disease, pneumonia, and isolated bacteremia were independent risk factors for mortality. CONCLUSIONS: K. pneumoniae is a dominant cause of severe community-acquired bacteremic infection in New Caledonia. Physicians should be aware of the poor prognosis of any patient with a bacteremic K. pneumoniae infection and should monitor patients presenting with risk factors closely.