Pneumonies communautaires à Streptococcus pneumoniae chez l'adulte hospitalisé (impact thérapeutique des souches intermédiaires ou résistantes à l'amoxicilline)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Enquête SPA2 de prévalence et de bon usage des anti-infectieux dans 314 hôpitaux français en 2010

International audienceObjectivesWe aimed to assess antibiotic prescriptions to identify potential targets for improvement.MethodsWe conducted a point prevalence survey (November 2010) of antibiotic use in 314 voluntary hospitals recruited by the French Infectious Diseases Society (SPILF) and the National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials (ONERBA). Data were entered online, immediately analyzed and exported.ResultsThe prevalence of antibiotic use was 19.5% (9059/46,446patients). A higher prevalence was observed in the infectious disease (58.4%), hematology (58%), and intensive care (48.7%) units. The three most frequently used antibiotic classes were aminopenicillins (23.8%), fluoroquinolones (17.9%), and 3rd-generation cephalosporins (16.7%). A monotherapy was prescribed to 64% of patients. The reasons for the antibiotic prescription were written in the medical records of 74% of patients and 62% were consistent with the local guidelines.ConclusionOur results are similar to that of other studies. Various local targets for improvement have been identified to help hospitals define a better antibiotic stewardship.ObjectifsÉvaluer les prescriptions antibiotiques afin de proposer des pistes d’amélioration.MéthodesNous avons réalisé une enquête de prévalence de l’antibiothérapie, en novembre 2010, dans 314 hôpitaux volontaires recrutés par les réseaux de la SPILF et de l’ONERBA. Les données étaient saisies en ligne avec une analyse instantanée et un export des données.RésultatsLa prévalence de l’antibiothérapie était de 19,5 % (9059/46 446patients). Elle était plus élevée en maladies infectieuses (58,4 %), hématologie (58 %) et réanimation (48,7 %). Les trois classes les plus fréquentes étaient les aminopénicillines (23,8 %), les fluoroquinolones (17,9 %) et les céphalosporines de 3e génération (16,7 %). Une monothérapie était utilisée dans 64 % des cas. Le motif de la prescription était noté dans le dossier médical dans 74 % des cas et était conforme aux recommandations locales dans 62 %.ConclusionsCes résultats sont similaires à ceux d’autres enquêtes. Des possibilités d’amélioration sur des critères locaux permettent aux établissements d’orienter leurs politiques d’amélioration de la prescription

Early identification and optimal management of carbapenem-resistant Gram-negative infection

Background: Carbapenem resistance in Gram-negative bacteria is associated with severe infections in the hospital setting. No uniform screening policy or agreed set of criteria exists within the EU to inform treatment decisions for infections caused by carbapenem-resistant Gram-negative bacteria. Aim: To develop a range of consensus statements to survey experts in carbapenem resistance, to identify potential similarities and differences across the EU and across specialties. Methods: The survey contained 43 statements, covering six key topics relating to carbapenem-resistant organisms: microbiological screening; diagnosis; infection control implementation; antibiotic stewardship; use of resources; and influencing policy. Findings: In total, 136 survey responses were received (66% infectious disease specialists, 18% microbiologists, 11% intensive care specialists, 4% other/unknown) from France, Germany, Greece, Italy, Spain, and the UK. High, or very high, levels of agreement were seen for all 43 consensus statements, indicating good alignment concerning early identification and optimal management of infection due to carbapenem-resistant organisms. Conclusion: We offer the following recommendations: (1) screening is required when a patient may have been exposed to the healthcare system in countries/hospitals where carbapenem-resistant organisms are endemic; (2) rapid diagnostic tools should be available in every institution; (3) all institutions should have a specific policy for the control of carbapenem-resistant organisms, which is routinely audited; (4) clear strategies are required to define both appropriate and inappropriate use of carbapenems; (5) priority funding should be allocated to the management of infections due to carbapenem-resistant organisms; and (6) international co-operation is required to reduce country-to-country transmission of carbapenem-resistant organisms. © 2020 The Author

Role of biomarkers in the management of antibiotic therapy: an expert panel review: I - currently available biomarkers for clinical use in acute infections

International audienceIn the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine currently available literature on the potential role of biomarkers to improve antimicrobial prescribing, by answering three questions: 1) Which are the biomarkers available for this purpose?; 2) What is their potential role in the initiation of antibiotic therapy?; and 3) What is their role in the decision to stop antibiotic therapy? To answer these questions, studies reviewed were limited to recent clinical studies ( 50) and restricted to controlled trials and meta-analyses for answering questions 2 and 3. With regard to the first question concerning routinely available biomarkers, which might be useful for antibiotic management of acute infections, these are currently limited to C-reactive protein (CRP) and procalcitonin (PCT). Other promising biomarkers that may prove useful in the near future but need to undergo more extensive clinical testing include sTREM-1, suPAR, ProADM, and Presepsin. New approaches to biomarkers of infections include point-of-care testing and genomics