Clinical Impact of MALDI-TOF MS Identification and Rapid Susceptibility Testing on Adequate Antimicrobial Treatment in Sepsis with Positive Blood Cultures.

Shortening the turn-around time (TAT) of positive blood culture (BC) identification (ID) and susceptibility results is essential to optimize antimicrobial treatment in patients with sepsis. We aimed to evaluate the impact on antimicrobial prescription of a modified workflow of positive BCs providing ID and partial susceptibility results for Enterobacteriaceae (EB), Pseudomonas aeruginosa and Staphylococcus aureus on the day of BC positivity detection. This study was divided into a pre-intervention period (P0) with a standard BC workflow followed by 2 intervention periods (P1, P2) with an identical modified workflow. ID was performed with MALDI-TOF MS from blood, on early or on overnight subcultures. According to ID results, rapid phenotypic assays were realized to detect third generation cephalosporin resistant EB/P. aeruginosa or methicillin resistant S. aureus. Results were transmitted to the antimicrobial stewardship team for patient's treatment revision. Times to ID, to susceptibility results and to optimal antimicrobial treatment (OAT) were compared across the three study periods. Overall, 134, 112 and 154 positive BC episodes in P0, P1 and P2 respectively were included in the analysis. Mean time to ID (28.3 hours in P0) was reduced by 65.3% in P1 (10.2 hours) and 61.8% in P2 (10.8 hours). Mean time to complete susceptibility results was reduced by 27.5% in P1 and 27% in P2, with results obtained after 32.4 and 32.6 hours compared to 44.7 hours in P0. Rapid tests allowed partial susceptibility results to be obtained after a mean time of 11.8 hours in P1 and 11.7 hours in P2. Mean time to OAT was decreased to 21.6 hours in P1 and to 17.9 hours in P2 compared to 36.1 hours in P0. Reducing TAT of positive BC with MALDI-TOF MS ID and rapid susceptibility testing accelerated prescription of targeted antimicrobial treatment thereby potentially improving the patients' clinical outcome

Pharmacogénétique et antirétroviraux : le cas du Darunavir et du Raltegravir

The human immunodeficiency virus (HIV) affects nearly 37 million people worldwide. Combination antiretroviral therapy (cART) has radically changed the natural evolution of the infection allowing prolonged survival and preventing HIV transmission. However, eradication of HIV cannot be achieved with current cART. Thereby, lifelong, chronic therapy without treatment interruption is the standard of care exposing patients to a risk of toxicity. In addition, the inter-individual variability in the response to ARV is well known. The aim of this work was to assess the impact of genetic polymorphisms affecting metabolizing enzymes (CYP3A, UGT1A1) and transport proteins (ABCB1 and OTAP) on two ARV drugs: Darunavir (DRV) and Raltegravir (RAL). In relation to DRV, a major interaction between DRV and Etravirine in patients expressing CYP3A5 (which is very common in Africans, whereas it is rare in Caucasians) has been demonstrated for the very first time. CYP3A5 expressors might be more at risk of infra-therapeutic DRV plasma concentrations when ETR is included in their therapeutic regimen. Concerning RAL, a significant impact of the UGT1A1*28 polymorphism has been demonstrated on RAL exposure. Pharmacogenetics can therefore contribute to the improvement of clinical response in the field of antiretroviral therapy.(MED - Sciences médicales) -- UCL, 201

Delayed Large Local Reactions to mRNA Vaccines.

To the Editor: Blumenthal et al. (April 1 issue)1 report delayed injection-site reactions in 12 patients who had received the mRNA-1273 vaccine against SARS-CoV-2. We observed a case of a delayed local reaction in a 38-year-old woman who had received the first dose of the BNT162b2 vaccine. Pain at the injection site had completely resolved within 2 days after the vaccination. Six days after the injection, erythema of the upper arm (Figure 1A) with associated numbness of the fingers appeared. These symptoms resolved within 5 days. [...

: A Review of Microbiological and Clinical Features.

, an enterohepatic Helicobacter, has proven its role in human diseases and has been rediscussed in recent years as its zoonotic potential is increasingly described. Routine microbiological detection of this pathogen is a difficult task as its culture may fail due to fastidious growth. It is therefore supposed that many clinical laboratories under-recognize infections. A review of all clinical and microbiological literature currently available from previous relevant human clinical cases, mainly bacteremia, added with a clinical case observed at the Cliniques universitaires Saint-Luc, was performed. Clinical features of reports show the presence of underlying clinical conditions in 89% of the cases, bacteremia in 83%, associated fever in 58%, and recent close contact with pets in 83%, especially dogs. The observed microbiological trends from 10 cases of bacteremia were a median of 4 days until positive blood culture bottle detection, subcultures showing a thin layer of small colonies under microaerophilic atmosphere at 35-42°C after 3-4 days of growth, and an identification requiring 16S rRNA sequencing given the difficulties observed with MALDI-TOF MS. Low MICs were observed for penicillins, amoxicillin/clavulanic acid, carbapenems, and metronidazole in opposition to high MICs for ciprofloxacin. A frequent association of and bacteremia in immunocompromised patients with recurrent fever in contact with pets, especially dogs, was identified. Considering the fastidious growing capacities, final identification from blood cultures may not be expected before 7 days. Intravenous ceftriaxone, oral doxycycline, or metronidazole has been suggested as efficient therapeutic choices

Imaging in Post-COVID Lung Disease: Does F-FDG PET/CT Have the Key?

No abstract availabl

Utilisation rationnelle des antibiotiques chez l’adulte en médecine générale - Du bon diagnostic à la bonne durée de traitement

Les infections respiratoires, urinaires et cutanées constituent une part importante des consultations en médecine générale. Il y a peu de nouveaux antibiotiques disponibles sur le marché, et avec l’augmentation des bactéries multi-résistantes, une utilisation rationnelle des antibiotiques est devenue indispensable. La rhinopharyngite, la rhinosinusite et la bronchite sont des infections principalement virales, le traitement est donc souvent symptomatique. Les antibiotiques ne sont nécessaires que si l’on suspecte une surinfection bactérienne; la durée du traitement est alors de 5 jours. Parmi les infections urinaires, il faut distinguer les simples des compliquées, en tenant compte de certains facteurs de risque spécifiques. Toutes deux peuvent néanmoins se compliquer d’un sepsis grave. Escherichia coli reste le principal agent des infections urinaires. La bactériurie asymptomatique est fréquente particulièrement chez la personne âgée. Le dépistage et le traitement ne sont indiqués que chez la femme enceinte et chez les patients qui doivent bénéficier d’une instrumentation des voies urinaires avec un risque de saignement. Les infections cutanées, également fréquentes, ne nécessitent pas toujours une antibiothérapie systémique notamment pour l’impétigo. Cet article a pour but de mettre à jour et de compléter les données retrouvées dans l’article sur le bon usage des antibiotiques en médecine générale : publié en 2015 dans ce même journal (Louvain Med 2015 ;7 :363-371). Il comprend en plus des données récentes sur la prise en charge des pneumonies, de la coqueluche et des infections cutanées[Rational use of antibiotics in adults in general practice – from the right diagnosis to the right treatment duration] Respiratory, urinary, and cutaneous infections make up a significant proportion of general practice consultations. Few new antibiotics are available on the market and given the increase of multiresistant bacteria, a rational use of antibiotics proves necessary. Rhinopharyngitis, rhinosinusitis, and bronchitis are most often of viral origin, and treatment is therefore symptomatic. Antibiotics are only required in case of suspected bacterial superinfection, in which case treatment duration is 5 days. Among urinary tract infections, a distinction should be made between complicated and uncomplicated infections, while taking into account some specific risk factors. Both can be complicated by severe sepsis. Escherichia coli remains the predominant uropathogen. There is an increase in multiresistant bacteria, even in the community. Asymptomatic bacteriuria (AB) is common, especially among elderly people. Screening and treatment of AB are indicated only in pregnant women and patients undergoing urinary tract instrumentation with a risk of mucosal bleeding. Skin infections, such as impetigo, do not always require systemic antibiotics. This article is aimed at supplementing and updating the data of an article on the rational use of antibiotics in general medicine published in 2015 in the same journal. It additionally includes recent data on the management of pneumonia, pertussis, and skin infections