Médiastinites infectieuses aux Hôpitaux Universitaires de Strasbourg : cohorte rétrospective/thèse présentée pour le diplôme d'État de docteur en médecine, diplôme d'État, mention D.E.S de Maladies Infectieuses et Tropicales

Médecine (maladies infectieuses et tropicales)Les médiastinites sont des infections rares et graves. Il existe trois principales étiologies : les médiastinites post-sternotomie, celles liées à une perforation oesophagienne et les médiastinites nécrotiques descendantes d’origine pharyngée. Leur diagnostic repose sur un faisceau d’arguments, et leur prise en charge est complexe et multidisciplinaire. Nous avons mené une étude observationnelle rétrospective portant sur les médiastinites prises en charge à Strasbourg entre 2010 et 2020. L’objectif était de décrire les cas recueillis puis d’analyser l’impact de la durée d’antibiothérapie reçue sur le pronostic. Nous avons recueilli 151 cas de médiastinites au total, dont 63 cas post-sternotomie, 60 d’origine digestive et 17 nécrotiques descendantes. La survie globale à 1 an était estimée à 64,8%. Notre étude n'a pas montré d'impact péjoratif sur le pronostic d’une durée de traitement anti-infectieux inférieure à 28 jours. Néanmoins, la grande hétérogénéité des médiastinites encourage à envisager chaque situation indépendamment.Mediastinitis are rare and serious infections. There are three main etiologies: post-sternotomy mediastinitis, those related to esophageal perforation and descending necrotic mediastinitis of pharyngeal origin. Their diagnosis is based on a range of arguments, and their management is complex and multidisciplinary. We conducted a retrospective observational study on mediastinitis treated in Strasbourg between 2010 and 2020. The objectives were to describe the cases collected and to analyze the impact of the duration of antibiotic therapy received on the prognosis. We collected 151 cases of mediastinitis in total, including 63 post-sternotomy cases, 60 of digestive origin and 17 descending necrotic mediastinitis. Overall survival at 1 year was estimated at 64.8%. Our study did not show any pejorative impact on the prognosis of an anti-infective treatment during less than 28 days. Nevertheless, the heterogeneity of mediastinitis encourages to consider each situation independently.Thèses et écrits académique

Overinduction of CYP51A Gene After Exposure to Azole Antifungals Provides a First Clue to Resistance Mechanism in Fusarium solani Species Complex

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High syphilis prevalence and incidence in people living with HIV and Preexposure Prophylaxis users: A retrospective review in the French Dat’AIDS cohort

International audienceBackground In the past years, we observed a sharp increase of Syphilis, especially among male who have sex with male (MSM), either HIV-infected, or on pre-exposure prophylaxis (PrEP). Our aim was to assess syphilis prevalence and incidence among people living with HIV (PLWH) and PrEP users.Methods PLWH were included from 2010 to 2020 and PrEP users from 2016 to 2020 from the Dat’AIDS French cohort. We calculated syphilis prevalence and incidences for first infections, re-infections, and iterative infections (> 2 times). T-Tests, Wilcoxon tests and Chi2 test were used for descriptive analysis and multivariate logistic regression models were used to estimate Odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with syphilis.Results Among the 8 583 PLWH, prevalence of subject with past or present syphilis was 19.9%. These subjects were more likely MSM or transgender and aged over 35 years, but prevalence was lower in AIDS subjects. Same pattern was seen for incident infection and re-infection. Incidence was 3.8 per 100 person-years for infection and 6.5 per 100 person-years for re-infection. Among 1 680 PrEP users, syphilis prevalence was 25.8%, with an estimated 7.2% frequency of active syphilis. Risk of syphilis infection was higher in male and increased with age. Incidence was 11.2 per 100 person-years for infection and 11.1 per 100 person-years for re-infection.Conclusion Syphilis prevalence and incidence were high, especially in older MSM with controlled HIV infection and PrEP users, enhancing the need to improve syphilis screening and behavioral risk reduction counseling among high-risk subjects