Evolution of anti-SARS-CoV-2 immune response in a cohort of French healthcare workers followed for 7 months

International audienceObjectives: We aimed to understand the immune response among healthcare workers (HCWs) following SARS-CoV-2 infection, and to determine the infection prevalence during the first wave of the pandemic among workers in our hospital.Methods: Determination of the serological status against SARS-CoV-2 (nucleocapsid) was offered to all HCWs. All HCWs with positive SARS-CoV-2 serology were proposed to be included in a longitudinal medical and serological follow-up (anti-spike) for 7months.Results: We included 3062 HCWs; 256 (8.4%) were positive for anti-SARS-CoV-2 nucleocapsid IgG. Among them, early decrease in the anti-nucleocapsid antibody index was observed between the first (S1) and second (S2) serology samplings in 208 HCWs (84.2%). The initial anti-nucleocapsid IgG index seemed to be related to the HCWs' age. Seventy-four HCWs were included in the 7-month cohort study. Among them, 69 (90.5%) had detectable anti-spike IgG after 7months and 24 (32.4%) reported persistent symptoms consistent with post-acute COVID-19 syndrome diagnosis.Conclusion: The prevalence of serological positivity among HCWs was 6.7%. Infection should be followed by vaccination because of antibody decrease

Epidemiology and clinical characteristics of Klebsiella spp. meningitis in France

International audienceObjectives: To describe the epidemiology of Klebsiella spp. meningitis in France with respect to clinical and bacteriological data.Methods: We performed a four-year multicenter, retrospective, observational study. The primary objective was to provide a clinical description of patients with Klebsiella spp. meningitis. Secondary objectives were to compare community-acquired meningitis and healthcare-associated meningitis and to analyze factors associated with mortality.Results: We enrolled 131 patients with Klebsiella spp. meningitis. Eighty-two (62.6%) infections were reported following neurosurgery. Twenty-eight strains (21.4%) were resistant to third-generation cephalosporins (3GC). The median [IQR] cellularity was 980/mm3 [116-5550], the median protein level was 5.67 [1.62-9] g/L and the median CSF glucose level was 2.5 [0-3.4] mmol/L. The in-hospital mortality rate was 23.6%. Community-acquired meningitis isolates were more frequently susceptible to 3GC than isolates from healthcare-associated meningitis (89.2% versus 72%; P=0.04). Comorbidities reported for patients with community-acquired meningitis were mainly diabetes mellitus and liver cirrhosis. In multivariate analysis, focal neurological disorder at the time of diagnosis was the only factor associated with in-hospital mortality (P=0.01).Conclusions: Purulent meningitis caused by Klebsiella spp. needs to be considered in patients with community-acquired meningitis and preexisting conditions, as well as in case of meningitis following neurosurgical procedures

Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints

The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCASTguidelines v2 (24 mm versus 19 mm).We assessed its impact on categorization of Enterobacterales recovered from urine samples in emergency departments. A total of 7749 and 2348 strains were tested usingthe DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpointwas in accordance with the BMD. Using the 24-mm breakpoint,the overall rate offosfomycin resistance inEnterobacterales increased by three-fold (5.6% vs 18.1%, P < 0.01) and reached 2.8% and 86.5% in E. coli andK. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remainappropriate. The accuracy ofthe methods for routine fosfomycin susceptibility testing should be assessed.The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. colishould be evaluated considering its rate of resistance and recent data reporting low accuracy