BACKGROUND:Diagnosing infective endocarditis (IE) in older adults remains challenging. We aimed to assess the diagnostic contribution of echocardiography in geriatric patients with suspected IE. METHODS:We conducted a retrospective multicenter cohort study in three university hospitals between May 2016 and April 2021. All consecutive episodes of suspected IE discussed by a multidisciplinary endocarditis team were included. Final team adjudication served as the reference standard. Duke classification was assessed before and after transthoracic (TTE) and/or transesophageal echocardiography (TEE). Patients were compared according to age (<75 versus ≥ 75 years). RESULTS:A total of 184 suspected IE episodes (181 patients) were analyzed; median age was 74 years, and 49% were aged ≥ 75 years. Older patients had a higher Charlson comorbidity index (7.5 vs 4.5) and a higher 12-month mortality rate (37% vs 26% overall). TTE was performed in 96% of cases, whereas TEE was performed in only 38%, significantly less frequently in patients ≥ 75 years (23% vs 51%) and after a longer time (10.3 vs 5.6 days). Echocardiography modified Duke classification in 30% of cases overall, including 24% in patients ≥ 75 years. The proportion of definite IE increased from 8% before echocardiography to 33% after imaging, and from 9% to 28% in older patients. Echocardiography provided a major Duke criterion in 33% of cases, while findings were inconclusive in 25%. Neurological disorders and biological prosthetic valves were independently associated with echocardiographic diagnosis of IE. CONCLUSIONS:Despite underuse and delayed TEE, echocardiography improved diagnostic classification.

BACKGROUND:Infective endocarditis (IE) is a rare but severe disease with high morbidity and mortality, increasingly affecting older adults. Data on antibiotic tolerance in this population remain limited. METHODS:We conducted a hospital network cohort study including all patients over 65 years old. diagnosed with IE between May 2016 and August 2024 in the greater Paris area. Antibiotic-related adverse events (AEs) were systematically collected, within six months of follow-up. RESULTS:Among 83 patients (median age: 84 years), 21 (25.3%) experienced at least one AE. Patients with AEs had longer hospital stays but similar age, autonomy, and in-hospital outcomes compared to those without AEs. Cognitive impairment was significantly associated with a higher risk of AEs, particularly in patients aged ≥ 75 years. Streptococcal IE was less frequently associated with AEs. Most AEs were biological abnormalities or clinical events, mainly involving amoxicillin and cefazolin. CONCLUSIONS:Age alone did not markedly affect antibiotic tolerance.

Background Vascular graft infections (VGIs) are rare but severe complications associated with high morbidity and mortality. Method We conducted a retrospective study in a French reference center for vascular grafting, including all patients who underwent surgery for VGI between 2020 and 2025. Data on patient and infection characteristics, surgical and medical management, and follow-up up to 1 year after surgery were collected. Infection-related mortality was defined as death occurring within 1 year after surgery and directly attributable to the infection or its complications. Results We included 129 patients with a median age of 71 years (IQR 61-81); most were male (82%). Major comorbidities were smoking (82%), high blood pressure (64%), and diabetes (32%). VGIs were mostly extracavitary (85%) and occurred early (<4 months after surgery) in 57% of cases. Revision surgery is mostly considered a conservative approach, namely, debridement without graft replacement (71%). Polymicrobial infections were common (49%), and Staphylococcus aureus was the predominant pathogen, accounting for 16% of isolates. The overall mortality rate reached 43% at 1 year. In univariate analysis, age >75 years, intensive care unit (ICU) admission, and infection with multidrug-resistant bacteria were associated with increased mortality. In multivariate analysis, age >75 years (P = .03) and ICU admission (P = .045) emerged as independent predictors of infection-related mortality. Conclusions VGIs carry a poor prognosis despite surgical management and targeted antimicrobial therapy. Advanced age and disease severity at presentation appear to be the main predictors of mortality. The respective impact of surgical strategy and microbiological profile requires further investigation in larger multicentric studies.

To optimize the management of male urinary tract infections, it is essential to analyze the various pharmacokinetic and pharmacodynamic parameters in the different organs of the male urinary tract. In the literature, the quantity and quality of data vary considerably depending on the class of antibiotics and the methodological approaches used. Beta-lactams achieve effective concentrations in prostate tissue, the testes, and urine, but reach only limited levels in prostatic secretions. Fosfomycin reaches therapeutic concentrations in prostate tissue, prostatic secretions, seminal fluid, bladder tissue, and urine. Trimethoprim-sulfamethoxazole reaches effective concentrations in prostate tissue, the testes, and urine. Only trimethoprim reaches effective concentrations in prostatic secretions and seminal fluid. Fluoroquinolones have the most favorable pharmacokinetic and pharmacodynamic profile and achieve therapeutic concentrations in prostate tissue, prostate secretions, seminal fluid, the testes, bladder tissue, and urine, as well as excellent intracellular diffusion and significant antibiofilm activity. The pharmacokinetics of aminoglycosides in the prostate and testes remain poorly characterized, despite the high concentrations observed in the kidneys and urine. Nitrofurantoin achieves a low plasma concentration, indicating limited tissue distribution. Azithromycin and doxycycline exhibit significant concentrations in prostatic tissue. Further research is needed to enhance understanding of the pharmacokinetics and pharmacodynamics of antibiotics in the male urinary tract, particularly in the context of growing antibiotic resistance.

BACKGROUND:Infections due to AmpC-producing Enterobacterales represent an increasing therapeutic challenge. Third-generation cephalosporins may select resistant mutants, inducing clinicians to use cefepime or carbapenems and thereby contributing to carbapenem resistance. While temocillin is a narrow-spectrum beta-lactam stable against AmpC enzymes, evidence of its impact in non-urinary tract infections remains limited. METHODS:We conducted a retrospective study of adult patients treated with temocillin for non-urinary tract infections caused by AmpC-producing Enterobacterales between 2016 and 2021. Clinical, microbiological and therapeutic data were collected. The primary outcome was treatment failure within twenty-eight days. RESULTS:Six patients were included, with a median age of sixty-one years; three required intensive care. Infection sites were digestive or respiratory. All patients had achieved clinical cure by day twenty-eight, without recurrence, infection-related mortality, or adverse events. CONCLUSION:Having led to favorable outcomes, temocillin may represent a carbapenem-sparing option when in vitro susceptibility is confirmed. These findings call for further evaluation in larger prospective clinical studies.

OBJECTIVES:Teleconsultation is increasingly used in primary care for acute respiratory infections, including sore throat. However, limited physical examination and restricted access to rapid diagnostic testing may affect antibiotic prescribing in remote care. Therefore, we aimed to evaluate the impact of a guideline-based educational intervention on physicians' management of acute pharyngitis during teleconsultations, with a particular focus on the quality of clinical assessment and documentation, antibiotic prescribing METHODS: We conducted a retrospective study of teleconsultations for sore throat or suspected acute pharyngitis on a French primary care telemedicine platform. A physician training program based on national guidelines was implemented. Clinical practices before and after training were compared, focusing on documentation quality, remote examination, antibiotic prescribing, and referral to in-person care. RESULTS:A total of 105 teleconsultations were analyzed (53 before and 52 after training). Following the educational intervention, documentation of medical history increased from 13.2% to 60.8% (P < 0.001), allergies from 18.9% to 74.4% (P < 0.001), and ongoing treatments from 5.7% to 67.3% (P < 0.001). Requests for oropharyngeal photographs increased from 56.6% to 79.2% (P = 0.021), while photograph quality also improved, with adequate lighting rising from 65.1% to 86.4% (P = 0.037) and clear images from 62.8% to 84.1% (P = 0.044). Assessment of swallowing difficulty increased from 30.2% to 63.3% (P = 0.001), and referral to in-person consultation rose from 2.0% to 35.8% (P < 0.001). Documentation of the McIsaac score remained uncommon, increasing from 1.9% to 13.2% (P = 0.060). In contrast, antibiotic prescribing remained high and unchanged (75.5% vs 77.4%, P = 1.00), as did rapid antigen detection test prescribing (81.1% vs 83.0%, P = 1.00). CONCLUSION:Training improved teleconsultation practices but did not reduce antibiotic prescribing, highlighting persistent stewardship challenges in telemedicine.

OBJECTIVES:Haemophilus influenzae is a frequent cause of community-acquired pneumonia (CAP) in adults, but determinants of severity and recurrence remain poorly described. METHODS:We performed a retrospective multicenter study in nine tertiary hospitals in Paris, France, from September 2022 to August 2023. Adults hospitalized for CAP H. influenzae were included. Severe pneumonia was defined by intensive care unit admission. Definite recurrence was defined as a new episode within 3 months, with repeat microbiological documentation of H. influenzae; probable recurrences within 1 month without microbiological confirmation were included in a sensitivity analysis. RESULTS:Among 203 patients, the median age was 64.9 years, 61.6% were male, 56.2% had chronic pulmonary disease, and 44.0% were immunocompromised. Severe pneumonia occurred in 37 of 203 (18.2%) patients and was independently associated with chronic left-sided heart failure and chronic obstructive pulmonary disease. Definite recurrence occurred in 27 of 203 (13.3%) patients and was independently associated with humoral immunodeficiency, combined immunodeficiency, and close contact with children aged <5 years. In the sensitivity analysis, recurrence reached 52 of 203 (25.6%) when probable recurrences were included. CONCLUSION:In hospitalized adults with H. influenzae CAP, severity was associated with cardiorespiratory comorbidities, whereas recurrence was associated with immune defects and exposure to young children.

Background Management of prosthetic joint infections (PJIs) due to Candida spp. remains challenging and poorly standardized. Epidemiological patterns and therapeutic strategies may vary between centers and countries, potentially reflecting differences in access to antifungal agents.Methods We performed a secondary analysis of an international, multicenter, retrospective study supported by the European Society of Clinical Microbiology and Infectious Diseases, including Candida PJI diagnosed between 2010 and 2020. Cases met European Bone and Joint Infection Society criteria, combining clinical signs of infection with at least 2 intraoperative samples positive for Candida spp. Follow-up was 2 years. Epidemiology, management, and outcomes were compared across 5 groups: France, Spain, England, Austria, and other countries.Results Overall, 268 cases were included: France (n = 142), Spain (n = 42), England (n = 38), Austria (n = 36), and others (Brazil, Lithuania, Italy; n = 9). Distribution of infected sites was similar across countries (hip 53.4%, knee 43.3%, and other 3.3%), as was species epidemiology (Candida albicans 55.6%, Candida parapsilosis 29.5%, Candida glabrata 7.8%, and Candida tropicalis 5.6%). Surgical strategies differed: 1-stage exchange was more frequent in France (36.0%) and Austria (34.3%), whereas 2-stage exchange predominated in England (42.1%) and Spain (37.2%). Echinocandins were prescribed significantly more often in France (41.8%) than elsewhere. Overall outcomes were poor, with a global failure rate of 43%, without significant differences between countries.Conclusions International differences in epidemiology and management of Candida PJI appear limited. Variations in surgical and antifungal strategies did not translate into improved outcomes, highlighting the need for optimized and standardized management approaches in future collaborative prospective studies worldwide and clinical.

Infections caused by nonfermenting gram-negative bacilli (NF-GNB), particularly Acinetobacter baumannii, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa, are associated with high morbidity and mortality, especially among critically ill or immunocompromised patients. The rise of multidrug resistance has rendered many first-line antibiotics ineffective, highlighting the need for novel agents such as cefiderocol, a siderophore cephalosporin with unique pharmacokinetics and broad in vitro activity against resistant gram-negative pathogens. A multidisciplinary panel of French experts in infectious diseases, microbiology, pharmacology, and intensive care reviewed the available evidence and clinical experience of cefiderocol. Using a structured consensus process, the group developed pragmatic, expert-based recommendations for its use against A. baumannii, S. maltophilia, and P. aeruginosa, considering clinical scenarios, resistance mechanisms, pharmacokinetic/pharmacodynamic (PK/PD) optimization, and practical implementation. Cefiderocol demonstrates potent in vitro activity against NF-GNB, including colistin- and imipenem-resistant isolates. Clinical success, however, depends on optimized PK/PD exposure, particularly in high-inoculum infections or patients with augmented renal clearance. Cohort studies and meta-analyses suggest lower mortality and markedly reduced nephrotoxicity compared with colistin-based regimens in A. baumannii infections. For S. maltophilia, cefiderocol shows consistently low minimum inhibitory concentration (MIC) and serves as a reliable alternative to trimethoprim–sulfamethoxazole or fluoroquinolones. Against P. aeruginosa, it retains high in vitro activity and should be considered after failure of newer β-lactams, with caution in New Delhi metallo-β-lactamase (NDM)-producing isolates. Continuous infusion and early therapeutic drug monitoring are encouraged to maximize efficacy. Cefiderocol is a valuable therapeutic option for severe NF-GNB infections when conventional agents fail. Its use should be guided by pathogen-specific MICs and PK/PD-based dosing. The expert panel underscores the importance of early microbiological diagnosis, susceptibility testing, and optimized administration to achieve maximal clinical benefit while preserving cefiderocol’s role within antimicrobial stewardship.

The management of male urinary tract infections (UTIs) has historically been based on a monolithic approach, under which every episode was treated as acute prostatitis, leading to prolonged antibiotic courses. To address rising bacterial resistance and promote antimicrobial stewardship, the French Infectious Diseases Society (SPILF) updated its guidelines in 2026, introducing a stratified management framework. This review outlines the scientific evidence underlying these updated recommendations. A comprehensive review of recent literature, including randomized controlled trials and large-scale retrospective cohorts, was conducted so as to evaluate antibiotic efficacy, resistance patterns, and optimal treatment durations for male cystitis, febrile UTIs (prostatitis/pyelonephritis), and acute epididymo-orchitis. Evidence validates distinguishing male cystitis from febrile UTI. For male cystitis, 7-day regimens using narrow-spectrum oral agents-such as fosfomycin trometamol, nitrofurantoin, or pivmecillinam-achieve satisfactory clinical success with minimal risk of complications. Conversely, febrile UTIs require initial parenteral third-generation cephalosporins or oral fluoroquinolones. For targeted oral step-down therapy in prostatitis, cotrimoxazole is preferred over fluoroquinolones so as to minimize ecological impact, while amoxicillin remains the drug of choice for enterococcal coverage. Although recent data show that seven days can be sufficient for selected bacteremic presentations, to prevent relapses a conventional 14-day duration remains the standard for acute prostatitis. Non-sexually transmitted orchitis and epididymitis require a 10-day course of fluoroquinolones or cotrimoxazole. The 2026 SPILF guidelines represent a paradigm shift toward a tailored, stratified approach.

Burkholderia pseudomallei causes melioidosis, a potentially life-threatening infection that can rapidly progress to septic shock and multi-organ failure if not promptly recognized and treated. Current international guidelines recommend meropenem as first-line therapy for severe melioidosis, whereas prolonged oral eradication therapy is essential to prevent relapse. We report a 39-year-old man with diabetes mellitus and chronic hepatitis B who initially improved on intravenous ceftazidime for disseminated melioidosis, but relapsed after an inadequate eradication phase consisting of only one week of oral amoxicillin-clavulanate. During the second admission, he presented with septic shock and multiple deep abscesses. He initially stabilized on combination therapy including meropenem and ceftazidime, but deteriorated after de-escalation to meropenem monotherapy despite repeated in vitro susceptibility. Clinical improvement occurred after reintroduction and continuation of high-dose ceftazidime together with drainage of accessible abscesses. This case highlights that apparent clinical failure on meropenem monotherapy may be confounded by inadequate eradication therapy, incomplete source control, borderline baseline susceptibility, and possible pharmacokinetic factors. It also underscores the need to interpret in vitro susceptibility cautiously in severe relapsed melioidosis.

BackgroundSpinal epidural abscesses (SEA) are rare but severe infections with a risk of neurological sequelae. Data focusing specifically on Staphylococcus aureus SEA remain scarce, despite this pathogen being the leading cause. The prognosis of primary versus secondary SEA, and the role of medical versus surgical management remain debated. We aimed to describe the clinical, microbiological and therapeutic features of S. aureus SEA and to identify potential prognostic factors.MethodsWe conducted a retrospective review of S. aureus SEA managed in two French tertiary centers. Comparative analyses were performed between primary and secondary SEA, and between patients with favorable versus poor neurological outcomes.ResultsBetween May 2007 and June 2025, 65 patients were included, representing the largest cohort focusing exclusively on S. aureus SEA. Median age was 61 years (IQR 51-71), with a male predominance (63%). Intravenous drug use was frequent (16%). Most cases were secondary to spondylodiscitis (86%), while primary SEA accounted for 14% and were associated with more severe initial neurological deficits. A cutaneous portal of entry was associated with better outcomes, whereas implant-related infections and unidentified sources predicted poorer prognosis. Methicillin-resistant S. aureus showed a non-significant trend toward worse outcomes. Surgery was performed in 40% of patients, mainly in those with deficits. Among medically managed patients, 78% were alive without neurological sequelae at three months.ConclusionThis study highlights clinical differences between primary and secondary SEA and the prognostic value of portal-of-entry identification. Conservative management appears effective in selected patients without neurological deficits, provided careful multidisciplinary monitoring is ensured.

INTRODUCTION:While recent guidelines for treatment of community-acquired pneumonia (CAP) recommend short antibiotic duration, evidence regarding Legionella pneumophila pneumonia remains limited. METHODS:We conducted a narrative review of studies identified via PubMed and Embase, including randomized trials, observational studies and meta-analyses assessing treatment duration and outcomes. RESULTS:No randomized trials specifically address legionellosis. Data from CAP consistently support short courses (≤5-7 days), even for atypical pathogens. Observational studies suggest a clinical course similar to that applied for typical CAP, with rapidly attained stability and short intravenous treatment durations. Meta-analyses show no differences in clinical cure, relapse, or mortality between short and long regimens, with fewer adverse events occurring in shorter courses. CONCLUSION:While short-course therapy appears appropriate for legionellosis (3-5 days for non-severe cases, 10-14 days for severe cases and/or immunocompromised patients), prospective studies remain needed.

OXA-48-producing Enterobacterales (OXA-48-PE) represent a growing global health threat. Most of OXA-48-PE remain categorized susceptible to carbapenems, which might encourage their use despite uncertain clinical efficacy. This study evaluated clinical outcomes of infections caused by OXA-48-PE treated with carbapenem compared with alternative active therapies. The analyses were performed at three levels: a descriptive analysis of the French cohort, a comparative descriptive analysis of all published studies, and a meta-analysis restricted to studies providing direct comparisons between carbapenem-based and alternative active regimens. Between September 2021 and March 2023, 59 patients with monomicrobial OXA-48-PE infections were included in a French multicenter retrospective cohort. In parallel, a systematic review was conducted to identify clinical studies published through 31 December 2024, reporting outcomes of OXA-48-PE infections. In the French cohort, the overall 30-day mortality was 49.1%. Clinical failure occurred in 57.1% of patients receiving meropenem monotherapy, including patients infected with isolates exhibiting meropenem MICs within the susceptible range. Across 12 clinical studies (817 patients), carbapenem therapy was associated with high and variable crude mortality (52%), whereas newer agents active against OXA-48-PE, particularly ceftazidime-avibactam, were associated with lower and more consistent crude mortality (30.7%). In the primary meta-analysis of 6 human comparative studies, carbapenem therapy was associated with an increased risk of clinical failure compared with alternative active regimens (OR = 2.02; 95% CI = 1.05-3.88). Despite apparent in vitro susceptibility, carbapenem therapy was consistently associated with unfavourable clinical outcomes in OXA-48-PE infections, supporting the prioritization of alternative active agents whenever available.

These guidelines address acute community-acquired urinary tract infections (UTIs) in adult men. The following situations are not covered: pediatric UTIs, UTIs in immunocompromised patients, catheter-associated UTIs (vesical, ureteral, or nephrostomy), neurogenic bladder, nosocomial UTIs, chronic and recurrent UTIs. This update defines nosological entities, including confirmation of the existence of cystitis in men. Definitions are provided in the first chapter. Epidemiological and bacterial resistance data specific to male UTIs-previously scarce and fragmented-are presented in the second chapter. Pharmacokinetic and pharmacodynamic data for antibiotics used in male UTIs are comprehensively reviewed and summarized in the third section. Treatment recommendations for each entity are detailed in the fourth chapter. The final chapter outlines investigations to be considered after UTI in men and situations requiring urological referral. This document presents a concise text, and brief supporting arguments regarding key points have been added. Four clinical vignettes summarizing the diagnosis and management of cystitis, pyelonephritis, and epididymo-orchitis are presented at the end of this recommendation (Figs. 1, 2, 3 and 4).

Purpose: Surgery for benign prostatic hyperplasia (BPH) has undergone technical innovations in recent years. The aim of this study was to evaluate the factors associated with postoperative infectious in patients treated surgically for BPH. Materials and Methods: TOCUS is a multicenter, retrospective study including all patients treated for prostatic BPH surgery requiring screening for asymptomatic bacteriuria (ABU) from January 2016 to April 2023. The primary endpoint was occurrence of an infectious complication (surgical site infection or febrile urinary tract infection [UTI]) defined by postoperative fever associated with a clinical, biological and radiological exam suggestive of prostatitis or pyelonephritis, occurring within 30 days after surgery. Results: In our study, 498 patients were included. Median age at surgery was 71 years (interquartile range [IQR] 65-77). Median operative time was 70 minutes (IQR 47-105). Patients mostly underwent endoscopic techniques (95.2%), while 4.8% underwent open simple prostatectomy. The postoperative infection rate was 5.1%. Even though infected patients had positive preoperative urine culture (UC) (96.0%), only 68.0% received preoperative antibiotic therapy. UTI in the previous year was an associated factor for postoperative infection (odds ratio [OR] 4.84, 95% confidence interval [CI] 1.78-13.69, p=0.002), as were positive preoperative mono or bimicrobial UC (OR 35.44, 95% CI 3.51-864.11, p=0.006) and preoperative polymicrobial UC (OR 48.13, 95% CI 7.03-977.27, p<0.001). Preoperative antibiotic therapy (OR 0.46, p=0.367) and antibiotic prophylaxis (OR 1.79, p=0.303) were not associated with infectious complications. There was no significant difference between the different surgical techniques in terms of postoperative infection (p=0.11). Conclusions: This study did not find an association between the surgical technique used for BPH treatment and postoperative infectious risk. However, ABU, whether monomicrobial, bimicrobial, or polymicrobial, was strongly associated with postoperative infectious complications, with no impact of preoperative antibiotic therapy or antibiotic prophylaxis.

The management of prosthetic joint infections (PJIs) poses significant challenges, requiring a multidisciplinary approach involving surgical, microbiological, and pharmacological expertise. Suppressive antibiotic therapy (SAT) has emerged as a viable option in cases where curative interventions are deemed unfeasible. This review provides an updated synthesis of recent evidence on SAT, including its indications, efficacy, practical considerations, and associated challenges. We aim to highlight the nuances of this therapeutic approach, discuss the factors influencing its success, and offer future directions for research to optimize patient outcomes.

Community-Acquired Pneumonia (CAP) of Presumed Bacterial Origin: Updated Management Guidelines Community-acquired pneumonia (CAP) of presumed bacterial origin is a common condition with varying severity, requiring either outpatient, hospital, or even critical care management. The French Infectious Diseases Society (SPILF) and the French Language Pulmonology Society (SPLF), in collaboration with the French Societies of Microbiology (SFM), Emergency Medicine (SFMU), Radiology (SFR), and Intensive Care Medicine (SRLF), along with representatives of general practice, have coordinated an update of the previous management guidelines, which dated back to 2010. From a therapeutic perspective, the updated recommendations define the choice of initial empiric antibiotic therapy, indications for combination therapy, the use of anti-Pseudomonas beta-lactams, antibiotic treatment duration, and the indications and modalities for prescribing systemic corticosteroids. On a biological level, indications for biomarkers and microbiological investigations have been refined. Regarding imaging, the role of different modalities in the diagnosis and follow-up of CAP has been reassessed, including chest X-ray, pleuropulmonary ultrasound, and thoracic CT scan.