Probabilistic Antibiotic Therapy Research Articles

Thyroid Abscess: A Very Rare Entity in Child.

Thyroid abscess is a very rare clinical entity, but potentially fatal emergency in the pediatric age group, with a mortality of 3.7%-9% in acute suppurative thyroiditis (AST), it is imperative to make a timely diagnosis and start treatment accordingly, it represents 0.1% of surgical pathologies of the thyroid. The anatomical and physiological characteristics of the gland provide it with resistance to pathogens. Recurrence is still exceptional. In this case report, we discuss a rare case of thyroid abscess in a 7-year-old girl revealing a piriform sinus fistula. Through this article, we attempt to stress the need for quick and accurate diagnosis and timely intervention to prevent complications as the condition is rare and unusual. The child presented to the pediatric emergency in January 2023 for a first episode of febrile torticollis the exploration objectified a thyroid abscess treated by probabilistic antibiotic therapy with good clinical and biological evolution, 6 months later, the child consulted again for the same symptomatology with febrile torticollis, dysphagia without signs of dysthyroidism, fever, and night sweats. Cervical computed tomography showed a mass occupying the left thyroid lobe. A cervical ultrasound showed heterogeneous hypoechoic collection; poorly limited. The biological assessment objectified a hyperleukocytosis in 19090 with a predominance of neutrophils with a C-reactive protein at 150 mg/l. The management was medical including intravenous antibiotic therapy based on amoxicillin-clavulanic acid and exploration by nasofibroscopy completed by hypopharyngoscopy showed a fistula of the piriform sinus. The treatment is based on surgery by cauterization of the sinus.

Bacteriological profile of meningitis in children aged 3 months to 15 years in sub-Saharan Africa: About a systematic review and critical reading of the literature

Objective : Bacterial meningitis is a serious, urgent, debilitating and fatal disease. It is therefore necessary to have data on bacterial epidemiology and the profile of sensitivity to antibiotics on which the emergency treatment protocol could be based. The objective of this study was to identify the bacteriological profile of meningitis in children aged 3 months to 15 years in sub-Saharan Africa by conducting a systematic review of recent literature.Methods : This is a systematic review of the literature for which we visited free databases including PubMed, Cochrane, Medline, Google scholar and PMC Free. The key words used were: bacterial meningitis, Sub-Saharan Africa, Acute bacterial meningitis; Culture; Gram stain; Incidence, meningitis; pneumococcus; Haemophilus influenzae. Our research considered articles conducted in sub-Saharan Africa, of all languages, and published since 2004. In total, the search generated 48 studies, which after applying the criteria mentioned above, only 7 studies were retained.Results : This systematic review showed that the bacterial flora during meningitis in children aged between 3 months to 15 years is essentially dominated by Streptococcus pneumonia in the majority with a weighted frequency of 42.9% (35.2-47. 4) and significant heterogeneity between different authors (p < 0.001). This was followed by Haemophilus influenzae with a weighted frequency of 13.8% (11.3-18.1). Escherichia coli and meningococci were observed in a small proportion. The germs identified were more sensitive to cefotaxime, ceftriaxone, then to amoxicillin, gentamicin and oxacillin.Conclusion : Studies are necessary to regularly revisit the bacterial flora during meningitis in children in order to adapt the treatment according to the antibiogram and for probabilistic antibiotic therapy to be based on research results, because this flora bacterial infection varies from one period to another and from one country to another.

Elizabethkingia meningoseptica Bacteremia in a Newborn at the University Hospital Yalgado Ouedraogo, Burkina Faso: A Case Report

Elizabethkingia meningoseptica is a Gram-negative, aerobic bacillus found in the environment. It is an important hospital-acquired bacterium, mainly affecting newborn and immunocompromised patients. It is naturally resistant to many standard antibiotics, making it difficult to choose the right probabilistic antibiotic therapy. We report the first case of E. meningoseptica bacteremia in a newborn in a tertiary care university hospital in Burkina Faso, with the aim of raising awareness among practitioners to reduce morbidity and mortality attributable to infections caused by this emerging bacterium.

Midurethral sling infectious complications: A systematic review

BackgroundThe French Health Authority (Haute Autorité de santé) and French scientific societies (Collège national des gynécologues et obstétriciens français) recommend the use of midurethral slings as the surgical treatment of choice for stress incontinence due to urethral hypermobility and failure of hygienic diet and pelvic rehabilitation. Within a year of implantation, almost 90% of patients no longer experience stress urinary incontinence. Despite their recognized efficacy, retropubic and/or trans-obturator midurethral sling can expose patients to potentially severe infectious complications. MethodsA comprehensive literature review using Pubmed, Medline, Embase and Cochrane: “stress urinary incontinence”, and/or the following keywords “complications”, “infections”, “abscess”, “prosthetic exposures”, “fistula”, “erosion”, “cellulitis”, “fasciitis” in association with the keywords “midurethral slings”, “suburethral sling”, “tension free vaginal tape” and “trans-obturator tape. In the 330 articles, 61 really dealt with infectious complications following the implantation of synthetic midurethral slings in women. ResultsPreoperative urinalysis and intraoperative antibiotic prophylaxis were rarely reported (n=1 and n=11, respectively). We recorded thirty-six cases of abscess, twenty-one cases of cellulitis, sixteen cases of fistula and forty-one cases of prosthetic exposure. In 95.5% of cases, patients were treated with broad-spectrum antibiotics. Total explantation of the prosthesis was performed in 56% of patients at the initial management, with two-stage explantation performed in 23% of cases, partial explantation was carried out in 12% of cases, and the prosthesis was left in place in 9% of cases. No deaths were recorded. ConclusionTo limit the risk of urinary tract infections and potential prosthetic infections, a prophylactic approach should be adopted by performing a preoperative urinalysis and administering intraoperative antibiotic prophylaxis should be discussed. In the event of prosthetic and/or surgical site infection, broad-spectrum probabilistic antibiotic therapy should be initiated as early as possible until targeted antibiotic therapy. Total explantation of the prosthesis appears to be the most appropriate surgical strategy.

Study of Presumed Bacterial Sexually Transmitted Infections

Purpose: The aim of the study was to evaluate the application of the WHO syndromic STI management strategy. Patients and methods: We carried out a prospective, descriptive study of patients admitted to our hospital. For presumed bacterial STIs at the urology department of CHU Gabriel TOURE from February 2017 to May 2018. HIV cases were not included. Results: We obtained the following results: 100 STI cases (Dysuria, Cystitis, Scrotal swelling, Prostatitis). The sex ratio was 88% in favor of males. The 26-35 age group was the most affected, with married patients the most represented. All cases were clinically diagnosed, and further investigations were requested to confirm the diagnosis. In terms of syndromic management, probabilistic antibiotic therapy was applied to each type of STI, and the antibiotic therapy was readapted. Treatment was adapted to the antibiogram. Overall, 88.28% of all patients were cured. Conclusion: The WHO proposes syndromic management of STIs in countries where laboratory diagnosis is not possible due to doubtful results, insufficient human resources or obsolete equipment.

Cytobacteriological testing of drainage pus from peritonsillar abscess is not contributive in clinical practice: A STROBE analysis

PurposePeritonsillar abscess (PTA) is a frequent pathology. Treatment consists in drainage of the collection, associated to probabilistic antibiotic therapy. The usefulness of cytobacteriological testing (CBT) of the drainage pus is controversial. Material and methodsA retrospective study of patients managed for PTA between 2013 and 2020 in our university hospital was performed. The main objective was to assess the usefulness of CBT in the management of PTA. The secondary objectives were to determine the bacteriological profile involved in the onset of PTA and to assess the rate of bacterial resistance to antibiotics prescribed on a probabilistic basis. ResultsThe study included 207 patients: 70 outpatients (33%) and 137 inpatients (67%). Probabilistic antibiotic therapy was implemented in 100% of patients. CBT was performed systematically and was negative in 106 patients, revealing oropharyngeal flora in 40% of cases, polymicrobial flora in 50% and sterile samples in 10%. In the 101 patients with positive CBT, the bacteria isolated were penicillin-sensitive in 99%. All patients were successfully treated. In the light of the bacteriological results, no changes were made to the probabilistic antibiotic therapy introduced on admission. ConclusionCBT on drainage pus had no impact on the management of PTA. CBT is therefore unnecessary in patients with no comorbidities and no signs of severity at admission.

Systematic culture of central catheters and infections related to catheters in a neonatal intensive care unit: an observational study

Systematic culture of the tip of central lines is performed in many neonatal intensive care units (NICUs) to guide any subsequent antibiotic therapy. The clinical relevance of this procedure is debated, given the significant bacterial contamination during its removal. We aimed to describe infections related to catheters and assess the usefulness of central catheter systematic cultures for probabilistic antibiotic therapy in cases of suspicion of catheter-related infections in a NICU. A retrospective study in a NICU included all newborn patients hospitalized with a central catheter, between January 2018, and June 2019. The main outcome measures were bacterial catheter colonization, catheter-related infection rate, and simulation-based approach to antibiotic prescription. Three hundred and seventy-five newborns, with 634 central catheters were included. There were 273 (43%) catheters that were colonized by at least one microorganism. There were 183 cases of suspected sepsis, with 31 infections definitively related to the catheter. In our simulation antibiotic prescription approach, there was no significant difference in terms of the efficacy toward the microorganism(s) involved between the probabilistic antibiotic therapies proposed by the experts and those ultimately prescribed. Performing a catheter culture only if catheter-related infection is suspected could be an alternative to routine screening.

Appropriate prescription of cytobacteriological urine examinations in older adults.

Cytobacteriological urine examinations (CBEU) are frequently ordered for the older adults, sometimes without straightforward indication and with the risk of prescribing empirical antibiotics. The aim of this study was to evaluate the relevance of the CBEU prescription and empiric antibiotic therapy in our geriatric hospital. Among 129 patients (mean age 84 years, sex ratio 0.69), 229 CBEU were collected with 20.9% of inappropriate indication. Cultures were sterile in 43% (n = 99) of cases and positive in 57% (n = 130) cases. Gram-negative bacilli dominated the isolated bacteria (76.9%) followed by gram-positive cocci (17.6%). In 113 patients, probabilistic antibiotic therapy was prescribed of which 68 treatments were initiated before the CBEU. Ceftriaxone and amoxicillin plus clavulanic acid were the main therapeutic option used representing 70.8% of cases. Antibiotic therapy was re-evaluated after 3 days in 74.3% of patients. Efforts to reduce the number of useless ECBUs by training doctors to follow official guidelines are a priority.

Pyopneumothorax revealing a complicated hydatid cyst of the lung

Pulmonary hydatidosis remains asymptomatic for a long time, and may be revealed following a complication such as intrapleural rupture. This entity, known as pyopneumothorax, poses a diagnostic problem even in countries with high hydatid endemicity. The aim of this study was to investigate the clinical, radiological and therapeutic aspects of pulmonary hydatid cysts revealed by spontaneous pyopneumothorax. This is a retrospective descriptive study of 5 patients with spontaneous pyopneumothorax revealing complicated pulmonary hydatidosis collected over 8 years at the Pneumology Department, CHU Mohamed VI, Marrakech, Morocco. Patients were younger and male. Clinical signs were dominated by cough and fever. Chest X-ray showed a hydroaeric image. Pleural puncture revealed a purulent fluid. Direct examination and culture of this fluid did not isolate any germs. All patients were drained and put on initial probabilistic antibiotic therapy. In view of the lack of clinical, biological and radiological improvement and the clinical presentation, we suspected complicated pulmonary hydatidosis. CT scan and thoracic ultrasound confirmed the diagnosis of ruptured KHP.

Cathéters veineux centraux avec chambres implantables : complications à connaître: Central venous catheters with an implantable chamber complications

Implantable Chamber Catheters (ICC) are the preferred devices for prolonged treatment of cancers (chemotherapy, parenteral nutrition, analgesics, blood products, antibiotics, antifungal and antiviral treatments). Their insertion is standardized, and ultrasound guidance is essential to limit thrombosis. Their handling requires experienced staff. Complications can be mechanical (linked to the implantable chamber or catheter), cutaneous, infectious, obstructive or thrombotic. The most serious complication is cutaneous necrosis (product extravasation). Infection is the most common cause of withdrawal, and probabilistic antibiotic therapy must be introduced and then adapted. Thrombosis is the most frequent complication. The ICC is left in place if functional, useful and noninfected. Curative anticoagulant treatment is recommended for at least 3 months, as long as the ICC is in place. Drug prophylaxis of ICC thrombosis is not recommended. Preventing complications of ICC is essential to reduce morbidity and mortality and improve the patient’s quality of life.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.

ETIOLOGICAL, CLINICAL AND THERAPEUTIC CHARACTERISTICS OF BACTERIAL PHARYNGO-TONSILLITIS IN BENIN

The term pharyngo-tonsillitis refers to inflammation and infection of the mucosa and lymphatic elements of the oropharynx: lymphoid structures and tonsils. This work aimed to determine in all tonsillitis, the proportion of bacterial tonsillitis, their clinical presentation in order to identify the germs involved and the treatment administered at the Padre Pio Humanitarian Health Center (CSVH) in Cotonou and at the Vallee de Grace Medical Clinic in Abomey-Calavi (CMVG). To achieve the objective of this work, a prospective analytical and descriptive study was carried out at the CSVH and the CVGAB over a period of 12 months (July 2022 to June 2023). The patients in whom the diagnosis of pharyngo-tonsillitis was made and the bacterial etiology confirmed after a throat swabwere considered in this study. The variables age, sex, months, clinical signs, etiology and treatment were taken into account. In total, 272 cases of pharyngo-tonsillitis out of 2896 consultations in pediatrics and ENT in the health facilities serving as the framework for the study, representing a prevalence of 9.39% with a monthly average of 22.67 cases. Among the 272 cases of pharyngo-tonsillitis, the bacterial origin was confirmed with 143 cases, representing a proportion of 52.57%. The bacteria involved were: S. pyogenes (41.38%), S.aureus (18.62%), S. pneumoniae (14.48%), S. viridans (14.48%). The isolated bacteria were sensitive mainly to antibiotics in varying proportions: Imipenem (100%), Ceftriaxone (67.57%), Cefixime (66.22%), Amoxicillin clavulanic acid (59.46%) and Cefuroxime (58.78%). %). Antibiotic therapy was dominated by amoxicillin + clavulanic acid (27.52%) followed by the 3rd generation cephalosporinscefixime (25.50%) and cefuroxime (14.09%).Bacterial origin represents 52.57% of pharyngo-tonsillitis in Benin this high rate is compatible with the probabilistic antibiotic therapy commonly used forpharyngo-tonsillitis in clinical practice where cytobacteriological examination is not easy.

Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital.

Acinetobacter species are non-fermenting and ubiquitous Gram-negative coccobacilli, which in recent years have become the leading cause of healthcare-associated infections worldwide. Our objective here was to study the epidemiology and risk factors associated with Acinetobacter baumannii infections in the intensive care unit (ICU). This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two ICUs of the Military Hospital of Instruction Mohammed V-Rabat over a 3 month period. We included 180 patients, of whom 60 had A. baumannii infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years [interquartile range (IQR) 59.5-77]. The median length of stay in the ICU before infection was 8.5 days (IQR 5-14). Multivariate logistic regression analysis identified the risk factors statistically associated with A. baumannii infection at the ICU level as follows: duration of invasive procedures >7 days [odds ratio (OR)=1.02], parenteral nutrition (OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin (OR=5.645), probabilistic antibiotic therapy >4 days (OR=9.063) and neoplastic pathology (OR=5.727). Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices and optimizing antibiotic therapy could decrease the incidence of these infections.

Eyelid and periorbital necrotizing fasciitis, a severe preseptal infection, a systemic review of the literature and anatomical illustrations

In necrotizing fasciitis, aggressive surgical debridement and broad-spectrum antibiotics are the cornerstone of treatment but cannot be proposed for the eyelid and periorbital area because of the risk of blindness, eyeball exposure and disfiguration. The aim of this review was to determine the most effective management of this severe infection while preserving eye function. A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to March 2022; 53 patients were included.Management was probabilistic, combining antibiotic therapy with skin (+/- orbicularis oculi muscle) debridement in 67.9% of cases, and probabilistic antibiotic therapy alone in 16.9% of cases. Radical surgery with exenteration was performed in 11.1% of patients; 20.9% of patients had complete loss of vision, and 9.4% died of the disease. Aggressive debridement was rarely necessary possibly because of the anatomical particularities of this region.

Bacterial ecology of sepsis in febrile neutropenics on hematology-oncology services

Introduction: Febrile neutropenia is a hematologic emergency that develops following treatment of hematologic malignancies. It exposes patients to the risk of sepsis, which is a major cause of morbidity and mortality. Currently, coagulase-negative staphylococci are the most common bloodborne isolates while enterobacteria are isolated less frequently. The objective of our study is to determine the epidemiological, bacteriological and antibiotic susceptibility profile of strains isolated from blood cultures collected from febrile neutropenic patients at Hassan II University Hospital, Fez. Materials and methods: This is a prospective study, over a period of 4 years (January 2019 - December 2022) including 83 patients with bacteremia hospitalized in the department of hemato-oncology. Identification and detection of antibiotic resistance was performed according to conventional bacteriology methods and CA-SFM/EUCAST recommendations. Results: Among 524 blood cultures received, we diagnosed 83 cases of bacteremia. The average age of the patients was 55 years. The average age of the patients was 55 years. The predominance of women was noted, with a sex ratio of 0.88. The majority of the episodes, 94.87%, occurred in patients followed for a neoplastic pathology. Hematological malignancies were the most responsible with a rate of 61.54% against 33.33% of solid tumors. Gram-positive bacteria represent 56.6%, and 43.4% of Gram-negative bacteria. The proportions of the different bacterial classes (BGN / CG+) have remained stable over the last 4 years, Staphylococcus epidermidis was the most frequent isolated Gram-positive bacteria 24.1℅(n=29) then Staphylococcus aureus 24.6% (n=18), followed by Gram-negative bacteria of enterobacteria type especially Escherichia coli which was the most frequently isolated pathogen (16.86%), followed by Klebsiella pneumoniae (10.84℅) and non-fermenting Gram-negative bacteria such as Pseudomonas aeruginosa (8.4) and Acinetobacter baumanii (6℅). Bacteria of clinical interest have shown increasingly worrisome levels of beta-lactam resistance, with extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae accounting for 4, 8% with only one case of carbapenemase, meticillin-resistant Staphylococcus aureus was 3.61% while no imipenem-resistant Pseudomonas aeruginosa or vancomycin-resistant enterococci were found. While Acinetobacter baumanii isolates (n=5) showed increased resistance to the majority of antibiotics tested, especially to imipenem which was 100%. Discussion and conclusion: Gram-positive bacteremia of the genus coagulase-negative staphylococcus is the most common type of infection in febrile neutropenias showing an increasingly resistant profile to first-line antibiotics. However, Gram-negative infections have shown decreased susceptibility compared to previous years. A regular study of the bacterial ecology of blood culture isolates and a determination of antibiotic susceptibility are necessary to optimize the probabilistic antibiotic therapy of bacteremia.

Bacterial Infection in the Sickle Cell Population: Development and Enabling Factors.

The high frequency of bacterial infections represents a major threat to public health. In developing countries, they are still responsible for significant morbidity and mortality in pediatric populations with sickle cell disease, particularly in children under 5 years of age. Indeed, they have an increased susceptibility to bacterial infections due to their immune deficiency. This susceptibility is even greater for pneumococcal and salmonella infections. In addition, the underdevelopment of some countries and socio-economic factors increases this condition. This review examines the common and specific factors leading to infections in people with sickle cell disease in different types of developed and undeveloped countries. The threat of bacterial infections, particularly those caused by S. pneumoniae and Salmonella, is of increasing concern due to the rise in bacterial resistance to antibiotics. In light of this disturbing data, new strategies to control and prevent these infections are needed. Solutions could be systematic penicillin therapy, vaccinations, and probabilistic antibiotic therapy protocols.

Place of Standard Radiography in the Management of Bacterial Pneumonia in Albert Royer Children's University Hospital (Chnear) in Dakar, Dakar, Senegal

Bacterial pneumonias are acute lower respiratory infections related to an inflammation of the pulmonary parenchyma determining a radio-clinical syndrome of lobar or segmental condensation [1]. Frequent reasons for hospitalization in pediatric settings, their distribution is worldwide with a high prevalence in Africa. Streptococcus Pneumoniae (STO.P) or Pneumococcus first infectious cause of pediatric mortality is responsible for 15% of deaths before 5 years. In Africa, it is the cause of 21% of deaths, 28% if we include the neonatal period, or nearly a third of deaths. A real public health problem, pneumococcal pneumonia is the subject of numerous guidelines from the World Health Organization (WHO). The emergence of strains of Pneumococcus with reduced sensitivity to penicillin, the difficulty of their biological objectification and the co-detection of several pathogens in the same sample complicate their management [2]. Radiography, an available and inexpensive technique, makes it possible to diagnose parenchymal involvement, obtain an etiological orientation, guide antibiotic therapy, ensure follow-up, and thus avoid complications. The general objective of this work is to evaluate the role of standard radiography in the management of bacterial pneumopathies in children. The specific objectives are: − To list the pathogens involved in the different age groups after the introduction of the pneumococcal vaccine in the Extended Vaccination Program (EVP) of Senegal, − To describe the radiological syndromes characteristic of these pathogenic agents. The prognosis of bacterial pneumopathies in children being severe, it is imperative to make an early diagnosis. Unfortunately, non-specific clinical signs, late and random bacteriological results do not allow a good etiological orientation. The fine study of radiological syndromes, confronted with epidemiological and clinical data, has the merit of guiding probabilistic antibiotic therapy and avoiding complications.

A study on vaginal infections among reproductive-aged women in the region of Marrakech, Morocco

Purpose: The principal aim of this study was to establish the microbial epidemiology of vaginal infections and to study the susceptibility of strains isolated to antibiotics. The secondary aim was to orient probabilistic antibiotic therapy. Methods: This is a retrospective descriptive study, covering a period of 9 years, from 2013 to 2022, conducted in the Bacteriology Department of the Avicenne Military Hospital in Marrakech. Results: The number of vaginal swabs taken in our study over a period of 9 years (2013-2022) was 693, of which 131 cases of vaginal infections were diagnosed, i.e. 19%. On fresh examination the presence of Trichomonas vaginalis was observed in 15 samples or 2.1%. Direct examination after Gram staining showed the presence in 33.4% of cases of clue cells suggestive of Gardnerella vaginalis; Gram-positive Coccis were present in 22.1%, yeasts in 17%, and Gram-negative bacilli in 5%. The distribution by species showed the predominance of clues cells evoking Gardnerella vaginalis which represented 35% of the isolates, followed by Streptococcus agalactiae at 28%, Candida albicans at 10%, and Escherichia coli and Proteus mirabilis by 5%. Conclusion: Our study showed the great microbial diversity of female genital infections with a predominance of bacterial vaginosis due mainly to Gardnerella vaginalis but also an important frequency of bacterial vaginitis represented essentially by Streptococcus agalactiae, Escherichia coli and Klebsiella pneumoniae.

Infections et cytopénies… impact sur et de l’immunothérapie

Febrile neutropenia consists of a major complication of lung cancer chemotherapy. The frequent association of COPD with lung cancer supports the hospital management of such event. Frequency and potential severity of bacterial infections support the use of an early probabilistic antibiotic therapy. Its choice relies on the knowledge of local bacterial epidemiology and of the local profile of bacterial resistances to antibiotics, the presence of patient severity criteria or risk factors for a severe infection. The time to apyrexia and aplasia exit determines the eventual adaptations and length of antibiotic treatment. Antibiotic prophylaxis is not recommended anymore for prevention of febrile neutropenia. Primary prophylaxis with hematopoietic growth factors is recommended, according to the type of chemotherapy, to age, and the presence of progressive tumor disease.The occurrence of immune checkpoint-induced neutropenia is rare but often severe. Antibiotic prescription in the 60 days flanking the initiation of immunotherapy was evidenced to impair the efficacy such immunotherapy due to its effect on gut microbiota.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Early Empirical Antibiotic Therapy Modification in Sepsis Using Beta-Lacta Test Directly on Blood Cultures

Background: Sepsis caused by multi-drug-resistant Gram-negative bacilli lead physicians to prescribe broad-spectrum antibiotic therapy, such as carbapenems. Rapid susceptibility testing can help with the rational use of antibiotics. The aim of this study was to measure the clinical impact associated with rapid reporting of Beta-Lacta test (BLT) directly on blood cultures positive with Gram-negative bacilli. Methods: In an observational, multicentric, prospective study, we included patients with sepsis caused by Enterobacterales observed on Gram staining of the positive blood cultures. BLT and antimicrobial susceptibility testing (AST) were performed directly on the blood cultures. Clinical impact was measured on the proportion of patients for whom the probabilistic antibiotic therapy was modified according to BLT, including patients receiving carbapenem. Results: 170 patients were included, of whom 44 (25.9%) were receiving inadequate empirical antibiotic therapy. Among them, 27 (15.9%) benefited from an early modification, according to the BLT results. Among 126 (74.1%) patients receiving appropriate probabilistic antibiotic therapy, we modified the antibiotic therapy for 28 (16.5%) of them, including 4/14 (28.5%) de-escalation from carbapenem to a third-generation cephalosporin. Conclusions: Implementation of BLT performed directly on blood cultures allowed us to rapidly modify the empirical antibiotic therapy for about one-third of patients with sepsis caused by Enterobacterales.

Necrotizing fasciitis: A highly fatal infection

Necrotizing fasciitis is a severe bacterial infection characterized by involvement of all skin's layers, including the superficial fascia. Diagnosis and treatment must be as quick as possible. Once suspected, extensive surgical debridement is required. All necrotizing fasciitis, managed in our hospital in Dijon, during the period from January 2011 to May 2021, were retrospectively analyzed. Demographics characteristics of patients, biological parameters, and type of bacteria were collected. Statistical analysis was performed on the cost of hospitalization, as well as on the death rate between type I and II NF and the speed of management. Student's t-test and Chi2 test were performed with a significant level P<0.05. A total of 65 patients were included over the period. The mean age was 68.8 years. The average length of stay was 32.4 days, with an average cost of 79,305€. The main locations were the lower limbs (57%) and the perineum (35%). Cost of hospitalization did not differ between type I and II (P=0.21), unlike mortality rate (P=0.003). Furthermore, the mortality rate according to the speed of management did not vary in our series (P=0.45). Necrotizing fasciitis is quickly fatal if left untreated. Early diagnosis, combined with surgical debridement and probabilistic antibiotic therapy are required. Our study shows the impact of necrotizing fasciitis in terms of cost to society and the importance of prevention of certain risk factors. A global management of the patient is necessary to increase the survival rate.