Our aim was to determine the impact of antimicrobial stewardship tools (ASTs) and the COVID-19 pandemic on antibiotic consumption (AC). We used the national software Consores® to determine AC in DDD/1000 days of hospitalization from 2017 to 2022 in voluntary private hospitals in France. The ASTs considered were: 1. internal guidelines; 2. the list of antibiotics with restricted access; 3. the presence of an antibiotic referent or 4. an ID specialist; and 5. proof of an annual meeting on antimicrobial resistance. Institutions with dedicated units for COVID-19 patients were specified. In 30 institutions, the total AC varied from (means) 390 to 405 DDD/1000 DH from 2017 to 2022. Fluoroquinolones and amoxicillin/clavulanate consumption decreased from 50 to 36 (p = 0.003) and from 112 to 77 (p = 0.025), respectively, but consumption of piperacillin/tazobactam increased from 9 to 21 (p < 0.001). Over the study period, 10 institutions with ≤2 AST had lower AC compared to 20 institutions with ≥3 AST (p < 0.01). COVID-19 units opened in 10 institutions were associated with a trend toward higher macrolide consumption from 15 to 25 from 2017 to 2020 (p = 0.065) and with an acceleration of piperacillin/tazobactam consumption from 2020 to 2022 (p ≤ 0.003). Antibiotic consumption in 30 private hospitals in France was inversely related to the number of AST. The COVID-19 pandemic was associated with limited impact on AC, but special attention should be paid to piperacillin/tazobactam consumption.

En France, l'exercice privé de l'infectiologie est actuellement marginal. Cependant, le nombre de praticiens exerçant ainsi tend à augmenter régulièrement : on en compte aujourd'hui une trentaine. Cette pratique étant peu connue, nous avons souhaité réaliser une enquête afin de mieux nous connaître et faire connaître notre mode d'exercice. Au cours du premier semestre 2022, nous avons réalisé une enquête (voir document annexe 1) auprès des infectiologues libéraux afin de mieux les connaître et de pouvoir échanger avec les autorités qui connaissent mal cette spécialité. Sur les 33 médecins infectiologues privés connus, 31 ont répondu à l'enquête. Cette dernière montre que, même si cela ne semble pas évident à première vue, cette spécialité peut être pratiquée dans le secteur privé et qu'elle ne diffère pas beaucoup de l'activité dans le secteur public, que ce soit en termes de pathologies traitées, de recherche clinique et de publications ou encore d'enseignement. La grande différence vient de la rémunération, qui est pénalisée par l'absence de codes spécifiques à la spécialité et l'absence d'actes techniques rémunérateurs. L'infectiologie libérale est complémentaire du public et ne doit pas lui être opposée. C'est une pratique viable qui va se développer compte tenu des bénéfices que les établissements peuvent en tirer, notamment avec les contraintes de qualité et de bonnes pratiques de prescription des antibiotiques. In France, the private practice of infectiology is currently marginal. However, the number of infectious diseases specialists (IDS) tends to increase regularly and currently approximately thirty of them practice in the private sector. As this practice is not well known, we carried out a survey to better describe the profiles and organizations of private-sector IDS, with the objective of making them better known to the public and health care authorities. During the first semester of 2022, we conducted a survey among private infectious disease specialists by means of a standardized questionnaire (see appendix 1). Of the 33 known private infectious disease physicians, 31 responded to the survey. This survey shows that this specialty, even if at first glance it does not seem obvious, can be practiced in the private sector and that it does not differ much from the activity in the public sector, either in terms of pathologies treated, clinical research and publications or teaching. The big difference comes from the remuneration which is penalized by the absence of specific codes for the specialty and the absence of remunerative technical acts. Liberal infectiology is complementary to the public and should not be opposed to it. It is a viable practice that should be developed given the benefits that institutions can derive from it, particularly with the constraints of quality and good antibiotic prescription practices.

Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft-tissue infections (SSTIs), but its real-life use is not well known. The aim of this study was to describe all first prescriptions in France over an 16-month period. A retrospective study on all adult patients receiving at least one dose of dalbavancin from 1 June 2017 to 31 September 2018 was performed (75 patients from 29 French hospitals). Data were collected via a standard questionnaire. Failure was defined as persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment, and/or death from infection. The main indications were bone and joint infection (BJI) (64.0%), endocarditis (25.3%), and SSTI (17.3%). The main bacteria involved were Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%), and coagulase-negative staphylococci (44.4%). Median minimum inhibitory concentrations (MICs) for staphylococci to vancomycin and dalbavancin ranged from 0.875–2.0 mg/L and 0.032–0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. The main treatment regimens for dalbavancin were a two-dose regimen (1500 mg each) in 38 cases (50.7%) and a single-dose regimen (1500 mg) in 13 cases (17.3%). Overall, at the patient's last visit, clinical cure was observed in 54/68 patients, whilst failure was observed in 14/68 patients. First use of dalbavancin in France was mostly off-label. Most were due to BJI, often as rescue therapy for severe infections. Even in off-label situations, dalbavancin appears safe and effective.

Ongoing HIV-1 replication in lymphoid cells is one explanation of the persistence of HIV-1 reservoirs despite highly active antiretroviral therapy (cART). We tested the potential of cART intensification by Maraviroc plus Raltegravir to decrease proviral HIV-1 DNA levels in lymphoid cells during a randomized trial.