Place des infectiologues dans la prise en charge des bactériémies à Staphylococcus aureus aux Hôpitaux universitaires de Strasbourg

Médecine interneLes infections à Staphylococcus aureus sont fréquentes et particulièrement redoutées du fait de leur potentielle sévérité et du nombre élevé de complications, liés à de nombreux facteurs de virulence. Chaque année, plusieurs centaines de bactériémies à Staphylococcus aureus sont diagnostiquées aux Hôpitaux Universitaires de Strasbourg. Leur prise en charge est souvent complexe, justifiant l’application dans de nombreux hôpitaux de programmes d’antimicrobial stewardship au sein desquels les infectiologues jouent un rôle important. L’objectif de cette étude était double. Tout d’abord analyser de façon rétrospective la prise en charge des bactériémies à Staphylococcus aureus au CHU de Strasbourg et le devenir des patients selon qu’un avis infectieux ait été demandé ou non. Ensuite, analyser par une étude prospective interventionnelle l’applicabilité d’un tel programme d’antimicrobial stewardship (AMS) pour les bactériémies à S. aureus aux HUS. Sur les 200 épisodes de bactériémies analysés, l’application des recommandations n’était effective que pour 15,5 % des patients. Une bêtalactamine antistaphylococcique était prescrite dans 53,9 % des bactériémies à SAMS et la durée de traitement était adaptée dans 57,8 % des cas. Une ETT était réalisée chez 66,7 % des patients et le contrôle de la négativation des hémocultures chez 61 % des patients. Une ETO était indiquée chez 162 patients (81 %) mais réalisée uniquement chez 46 d’entre eux (28,4 %), majoritairement lorsqu’un avis infectieux était demandé (n=35). A 6 semaines, la survie était significativement meilleure lorsqu’un avis était demandé (89,9 % versus 75,2 % sans avis, p=0,0066). L’étude prospective confirme l’impact bénéfique d’une procédure d’appel systématique pour toute bactériémie à Staphylococcus aureus, permettant une meilleure application des recommandations. La majorité des cliniciens y semble favorable, ce qui confirme le rôle majeur des infectiologues dans la prise en charge de ces infections, et motive la mise en place de tels programmes d’AMS aux HUS

Rapid Radiological Worsening and Cytokine Storm Syndrome in COVID-19 Pneumonia

Background: In June 2020, a large randomised controlled clinical trial in the UK found that dexamethasone was effective in reducing the number of deaths in patients with severe coronavirus disease 2019 (COVID-19). Case description: We describe a patient with rapid worsening of COVID-19 pneumonia and its dramatic improvement under corticosteroids. Discussion: Corticosteroids could be useful in patients with an inflammatory profile, considering that acute respiratory distress syndrome may be the consequence of cytokine storm syndrome

First Case of Bacteraemia Due to Carbapenem-Resistant Bacteroides faecis

International audienceMultidrug resistant (MDR) bacteria are increasingly observed in nosocomial and community-acquired settings. Anaerobes are no exception to this rule, but there are fewer reports of MDR in the scientific literature on anaerobes than there are for other bacteria. In this short case report, we describe the first case of bacteraemia caused by a multidrug-resistant Bacteroides faecis, which produces a carbapenemase encoded by the blaCfiA gene. This bacteraemia followed a digestive surgery operation. Surprisingly, these findings did not lead to a change in antibiotic therapy, probably because the patient’s clinical state had improved. Nevertheless this report calls for better knowledge of anaerobic bacteria and for a systematic antimicrobial stewardship procedure following bacteraemia

Cefepime vs carbapenems for treating third-generation cephalosporin-resistant AmpC β-lactamase-hyperproducing Enterobacterales bloodstream infections: a multicenter retrospective study

Objectives: AmpC β-lactamase-hyperproducing Enterobacterales (ABLHE) bloodstream infections (BSI) are emerging and leading to therapeutic challenges worldwide. Prescriptions of carbapenems may lead to the emergence of resistance. This study aimed to compare cefepime with carbapenems for the treatment of third-generation cephalosporin-resistant ABLHE BSI. Methods: This retrospective multicenter study included patients with ABLHE BSI from two tertiary hospitals in France, between July 2017 and July 2022. Non-AmpC-producing Enterobacterales, extended-spectrum β-lactamase, and carbapenemase-producing Enterobacterales were excluded. Cefepime was prescribed only in case of minimal inhibitory concentration ≤1 mg/l. The primary outcome was 30-day in-hospital mortality from the date of index blood culture. Secondary outcomes were infection recurrence and treatment toxicity. An inverse probability of treatment weighting approach was used to balance the baseline characteristics between the two groups. Results: We analyzed 164 BSI, which included 77 in the cefepime group and 87 in the carbapenem group. In the weighted cohort, the 30-day mortality rates were similar between the cefepime group (23.3%) and the carbapenem group (19.6%) with a relative risk of 1.19 (95% confidence interval, 0.61-2.33 P = 0.614). No significant difference in recurrence or toxicity was found between the two groups. Conclusion: This study adds evidence in favor of the use of cefepime for treating third-generation cephalosporin-resistant ABLHE BSI in case of minimal inhibitory concentration ≤ 1 mg/l, which could spare carbapenems

Coronavirus Disease 2019: Associated Multiple Organ Damage

A 56-year-old man presented a particularly severe and multisystemic case of coronavirus disease 2019 (COVID-19). In addition to the common lung and quite common pulmonary embolism and kidney injuries, he presented ocular and intestinal injuries that, to our knowledge, have not been described in COVID-19 patients. Although it is difficult to make pathophysiological hypotheses about a single case, the multiplicity of injured organs argues for a systemic response to pulmonary infection. A better understanding of physiopathology should feed the discussion about therapeutic options in this type of multifocal damage related to severe acute respiratory syndrome coronavirus 2

Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

International audienc