Late delivery of antibiotics: a new proxy for antimicrobial stewardship?

OBJECTIVES: To analyse the time elapsed between the prescription of antibiotics and their pick-up at the pharmacy and identify their determinants. METHODS: We used the National Health Insurance reimbursement databases on antibiotics delivery in 2021 in La Manche, Western France. Delayed delivery was defined as the time between prescription and antibiotic pick-up of >24 hours. RESULTS: We enrolled 207 250 prescriptions, of whom 18 728 (9.0%) collected their antibiotics at the community pharmacy >24 hours after prescription. Independent factors associated with delayed delivery were age >15 years (15-64 years: OR, 2.08 [1.98-2.19]; p < 0.001 and >65 years OR, 3.27 [3.09-3.46]; p < 0.001), male sex (OR, 00.77 [0.75-0.80]; p < 0.001), low income (OR, 1.08 [1.02-1.15]; p = 0.013), chronic diseases (OR, 1.29 [1.25-1.34]; p < 0.001), prescription during the weekend (OR, 1.49 [1.43-1.56]; p < 0.001), summer season (OR, 1.11 [1.07-1.16]; p < 0.001), lock-down period (OR, 4.15 [3.80-4.53]; p < 0.001), and distance from the patient home to his general practitioner office and the pharmacy >10 km (OR, 1.17 [1.13-1.21]; p < 0.001). DISCUSSION: The delayed delivery of antibiotics after prescription is not uncommon, especially in elderly patients, those with low income or chronic diseases, in case of weekend prescriptions, summer season and when the pharmacy is > 10 km away from the patient's home and his general practitioner office. If confirmed, this potential indicator of unnecessary prescriptions, readily available in some databases, may be used to target antimicrobial stewardship programmes and monitor the effect of interventions.

Attitudes, Knowledge, Risk Perception of Antimicrobial Resistance and Antibiotic Use Behaviors: A Cross-Sectional Survey in a Young Adult Population.

Background: The emergence and spread of bacterial resistance to antibiotics is a major threat to global public health. There is strong evidence that the general public plays a role in the emergence and spread of antimicrobial resistance. Objective: In this study, the impact of attitudes, knowledge, and risk perception of antimicrobial resistance on students' antibiotic use behaviors was investigated. Methods: A cross-sectional survey was conducted using a questionnaire with a sample of 279 young adults. Descriptive analysis and hierarchical regression analyses were used to analyze the data. Results: The results indicated that positive attitudes, a minimal level of knowledge about antimicrobial resistance, and awareness of the seriousness of this phenomenon have a positive influence on the appropriate use of antibiotics. Conclusions: Overall, the results of this study highlight the need for awareness campaigns that provide the public with accurate information about the risks associated with antibiotic resistance and appropriate antibiotic use.

The Socioeconomic Impact of Surgical Site Infections.

Précis: Surgical site infections are an ever-increasing phenomenon worldwide due to different factors. This brief report aimeds to highlight at a glance, for both physicians and political and institutional leaders, the economic burden of surgical site infections. Objectives: This brief report aimed to highlight the economic burden of surgical site infections (SSIs). Methods: A narrative review focusing on this subject has been carried out. Results: Surgical site infections are responsible for generating important costs. In 2017, a French cohort highlighted a mean cost of each SSI treatment to be around €1,814; the same year, the Centers for Disease Control and Prevention guidelines evaluated the mean cost caused by SSI treatment to be from $10,443 to $25,546 per SSI. This cost depends on many factors including the patient himself and the type of surgery. Conclusions: Prevention of the risk of infection is, therefore, a profitable concept for surgery that must be integrated within all healthcare managements worldwide.

General practitioners' clinical practice on the management of cystitis in Normandy, France: A clinical vignettes-based study.

RATIONALE, AIMS, AND OBJECTIVES: The objective was to measure the quality of clinical practice for the management of cystitis in adult women in general practice by collaborating with quality circles and the regional centre for antibiotic counsel. METHOD: This descriptive cross-sectional study was performed in 2018 in Normandy, France. A questionnaire composed of clinical vignettes was used to evaluate practices of general practitioners (GPs) with regard to cystitis classified into four categories: simple, at risk of complication, recurrent, and caused by multidrug-resistant bacteria. The 2017 French Infectious Diseases Society's guidelines were used as a reference. RESULTS: A total of 142 GPs participated in the study (45.5% of the solicited). Fosfomycin-trometamol and pivmecillinam were cited as first-line treatments for simple cystitis by 134 (94%) and 38 (27%) participants, respectively. For at risk of complication cystitis, the treatments cited were cefixime by 64 participants (45%), ofloxacin by 50 (35%), pivmecillinam by 49 (35%), fosfomycin-trometamol by 38 (27%), nitrofurantoin by 36 (25%), and amoxicillin-clavulanic acid by 28 (20%). Mean compliance rates were 85% for simple cystitis, 39% for at risk of complication cystitis, 60% for recurrent cystitis and 14% for cystitis caused by multidrug-resistant bacteria. Two criteria had less than 10% of the compliant answers: comprehensive knowledge of cystitis complication risk factors (9%) and positivity thresholds of urine cultures (10%). CONCLUSIONS: In this study, diagnostic means, follow-up testing, and simple cystitis treatment (with fosfomycin predominantly mentioned) were broadly compliant. The use of critical antibiotics was too frequent for at risk of complication cystitis. There may be a need to improve the knowledge of professionals on antibiotic resistance and appropriate antibiotic use.

Systemic Erysipelothrix rhusiopathiae infection not associated with endocarditis highlighting bacteriological diagnosis difficulties Case report and literature review.

Erysipelothrix rhusiopathiae is mostly isolated in swine causing erysipelas. Human invasive infections due to E. rhusiopathiae remain poorly described and interestingly bacteraemia associated with endocarditis are a source of ineffective empirical antibiotherapy. We report a case of sepsis without endocarditis due to E. rhusiopathiae and a review of the literature.

Long-term clinical and economic benefits associated with the management of a nosocomial outbreak resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.

OBJECTIVE: In 2005, there was an epidemic of infections resulting from extended-spectrum ß-lactamase-producing Klebsiella pneumoniae in the intensive care department. The aim of this study was to evaluate the potential long-term clinical and economic benefits resulting from the management of this epidemic and the resulting changes in practices. DESIGN: Two periods were defined: the period leading up to and including the epidemic (2003-2005; period I) and the postepidemic period (2006-2008; period II). We estimated the number of nosocomial infections prevented between these two periods in three ways: comparison of attack rates, incidence rates, and calculation of standardized infection ratios. A cost-benefit analysis was then carried out by multiplying the number of nosocomial infections prevented by their cost as estimated from a literature review. MEASUREMENTS AND MAIN RESULTS: The characteristics of the populations hospitalized during these two periods were comparable in terms of age, sex, Simplified Acute Physiologic Scale II score, origin, and type of diagnosis. The death rate was similar in the two periods (21.8% vs. 23.3%; p = .63). The number of nosocomial infections prevented was 54.1 (95% confidence interval 25.8-83.1; 30.4, 95% confidence interval 5.3-54.9; 32.8, 95% confidence interval 6.0-63.7; and 30.1, 95% confidence interval 17.7-42.5) according to the methodology. The savings cost potentially associated with the infection control intervention ranged from €149,928 (USD $183,781) to €269,472 (USD $330,318). CONCLUSION: The management of this epidemic and the change in medical practices that it triggered were associated with a significant decrease in the number of infections acquired in the intensive care unit. There were substantial cost savings, highlighting the value of investment in the prevention of nosocomial infections.

High seroprevalence of herpes simplex virus type 2 infection in French human immunodeficiency virus type 1-infected outpatients.

Using commercially available herpes simplex virus (HSV) type-specific serological diagnostic tests, HSV type 2 (HSV-2) antibody prevalence was assessed in two parallel prospective studies including 534 human immunodeficiency virus type 1 (HIV-1)-infected outpatients living in two areas of northern France. In the first cohort of 434 subjects, 223 (51%) individuals demonstrated a positive HSV-2 serological status while 66 (66%) of 100 subjects in the second cohort were seropositive for HSV-2 (51 versus 66%; P = 0.08). Among the 223 HSV-2-seropositive subjects identified in the first study cohort, only 22 (10%) had suffered from recurrent anogenital lesions during the past 12 months while 154 (69%) had no clinical history of herpesvirus infection. Our findings demonstrate high proportions of subclinical and undiagnosed HSV-2 infection in HIV-1-infected individuals and suggest that HSV type-specific serological testing in the French HIV-1-infected subpopulation could be an efficient strategy to diagnose clinically asymptomatic HSV-2 infections.

Postoperative spondylodiskitis due to Stomatococcus mucilaginosus in an immunocompetent patient.

A case is reported of postoperative spondylodiskitis due to Stomatococcus mucilaginosus in an immunocompetent woman. The route of infection remains unknown. Intravenous treatment with cefotaxime and fosfomycin was given, followed by oral administration of rifampin and pristinamycin until resolution of infection. This report shows that this bacterium can cause severe infections in immunocompetent patients.

Direct costs associated with a nosocomial outbreak of adenoviral conjunctivitis infection in a long-term care institution.

BACKGROUND: In October 2000, 41 people were infected during an outbreak of adenoviral keratoconjunctivitis. Such nosocomial outbreaks are frequently reported in long-term care institutions, even though simple measures to prevent or limit such occurrences are well documented. This study describes the significant direct costs incurred as a result of this nosocomial outbreak that involved patients and staff. METHODS: The costs measured in this study were grouped into the following 4 categories: medical, investigative, preventive, and lost productivity. Information about costs incurred by the hospital was gathered from a number of sources. RESULTS: The outbreak cost the hospital US $29,527 ($1085 for medical costs, $8210 for investigative costs, $3048 for preventive measures, and $17,184 for lost productivity). CONCLUSION: This study demonstrates the substantial expense incurred by 1 hospital as a result of an outbreak of a preventable disease. The measures necessary to prevent such a costly outbreak are simple and, therefore, cost-effective.