Background:Antimicrobial resistance (AMR) represents a major global public health threat. Infection prevention and control (IPC) and antimicrobial stewardship are key pillars to limit AMR, yet little is known about medical residents' perceived preparedness in these areas. The aim of this study was to assess French medical and surgical residents' self-reported level of confidence (LOC) regarding IPC and appropriate use of antibiotics (AUA) and to explore factors associated with confidence levels. Methods:We conducted a national cross-sectional self-administered survey among French residents involved in antibiotic prescribing. Confidence levels were assessed using a 0-10 numeric scale across predefined IPC- and AUA-related clinical situations. Demographic characteristics, training setting, exposure to IPC and AUA training modules and awareness of the national AMR strategy were collected. Non-parametric statistical analyses were performed. Results:A total of 151 residents were included. Overall, confidence ratings were significantly higher for AUA-related situations than for IPC-related situations (P < 0.001). Attendance of IPC training modules was associated with higher IPC confidence (P = 0.011), whereas attendance of AUA training modules was not significantly associated with AUA confidence. Training in a university hospital showed limited association with confidence levels. Awareness of the national AMR action plan was low, reported by only 17% of participants. Conclusions:French residents report heterogeneous confidence profiles, with lower perceived confidence in IPC than in antibiotic-related decision-making. These findings support the need for earlier, multidisciplinary and practice-oriented training programmes integrating IPC and antimicrobial stewardship throughout residency.

Antimicrobial resistance (AMR) has made multidrug-resistant organisms (MDROs), particularly ESKAPE-E pathogens (including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp, and Escherichia coli), a major threat to modern medicine. Although novel antibiotics, antimicrobial stewardship, and infection prevention remain essential, such interventions are unlikely to offset projected AMR trends on their own. Vaccines can help to mitigate AMR by preventing infections and reducing antibiotic exposure. WHO estimates that vaccines targeting 23 pathogens (excluding Neisseria gonorrhoea) could reduce global antibiotic need by 22%, equivalent to 2·5 billion defined daily doses annually. In the mRNA era, modular vaccine platforms enable rapid design of protein antigens and multivalent constructs, with emerging preclinical proof of concept against selected bacterial pathogens. In this Personal View, we argue that mRNA vaccines should be considered enabling platforms for selected protein-based MDRO targets rather than universal solutions for antibacterial vaccine development. We propose a microbiome-informed framework that distinguishes systemic protection from mucosal decolonisation and aligns antigen selection, delivery route, and trial endpoints with colonisation dynamics, microbiome resilience, and AMR reduction goals.

Antimicrobial resistance (AMR) remains one of the gravest global health threats, responsible for over 35 000 deaths annually in the EU/EEA and projected to cause nearly 2 million deaths worldwide each year by 2050. While Europe has long positioned itself as a frontrunner in the fight against AMR, growing international mobility and fragmented policy implementation continue to undermine progress. This viewpoint argues that strengthening a coordinated One Health response is essential to address the transboundary nature of antimicrobial resistance. The European response must now evolve beyond national and regional frameworks, with strengthened surveillance at borders, stronger political commitment at the continental level, to curb imported and emerging resistant infections. Only a unified, globally connected Europe can lead an effective and sustainable response to this silent pandemic.

BACKGROUND:Colonization of the gastrointestinal tract by multidrug-resistant organisms (MDROs) is a precursor to endogenous infection and onward transmission. The gut microbiome provides colonization resistance (CR)-the ability to prevent or limit the establishment of pathogens, including MDROs-through nutrient and niche competition, production of inhibitory metabolites, and immune modulation. However, its integrity is threatened by antibiotics, adverse diet, and healthcare exposures. OBJECTIVES:To describe mechanistic, epidemiological, and interventional evidence on the role of the gut microbiome in MDRO colonization and infection, and to highlight implications for clinical practice, policy, and research. SOURCES:PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from 1 January 2000 to 30 September 2025, supplemented by hand-searching of key international guidelines (EUCIC/ESCMID, WHO, CDC/ECDC, NICE/UKHSA) and reference lists. CONTENT:CR is shaped by microbial and host factors, including metabolic interactions, immune responses, and environmental exposures. Antimicrobials, nonantimicrobial drugs, diet, travel, and healthcare contact can disrupt the microbiota, predisposing to MDRO acquisition and infection. Observational data link gut microbial composition to risk of colonization and infection outcomes, but predictive models are imperfect. Interventions to preserve or restore CR-such as diet-based strategies, probiotics, and faecal microbiota transplant-show promise but require robust and repeated, context-specific evaluation. IMPLICATIONS:Protecting the microbiome must be a clinical and policy priority. Short-course, microbiome-sparing antimicrobial regimens, microbiome-aware diagnostics, and public health measures that support microbiome resilience could reduce MDRO burden and infections. Rigorous trials of microbiota-based therapies and integration of microbiome stewardship into antimicrobial resistance strategies are essential for translating mechanistic insights into patient benefit.

OBJECTIVES:Respiratory syncytial virus (RSV) is recognized as a leading cause of severe respiratory tract infections (RTIs) in older adults. However, the clinical burden of other paramyxoviruses-parainfluenza virus (PIV) and human metapneumovirus (hMPV)-remains under-investigated in this population. We aimed to compare morbidity and mortality associated with RSV, PIV, and hMPV infections in hospitalized adults. METHODS:Multicenter retrospective cohort study (2016-2018) in three hospitals of the Paris-Saclay network, including adults with RT-PCR confirmed RSV, PIV (1-3), or hMPV infection. Outcomes included hospital and ICU admission, short-term favorable outcome (defined as stability criteria within 5 days) and 90-day mortality. RESULTS:Of 242 patients (mean age 72.8 ± 16.2 years), 45.0% (n = 109) had RSV, 18.2% (n = 44) PIV and 36.8% (n = 89) hMPV. Overall, 88.4% were hospitalized. Median length of stay was similar across viruses (P = 0.59). In multivariable analysis, hMPV infection was independently associated with higher odds of short-term favorable outcome (adjusted OR 4.22, 95% CI [1.42-12.6]; P = 0.01), whereas eosinophil count >50/mm³ was also associated with lower ICU admission risk and better short-term outcomes. Ninety-day mortality was low and comparable (RSV 6.5%, PIV 2.4%, hMPV 5.1%; P = 0.62). CONCLUSION:RSV, PIV, and hMPV infections cause similar morbidity and mortality in hospitalized adults, yet PIV and hMPV remain markedly under-estimated causes of severe respiratory disease in this population. The unexpectedly better stability criteria observed with hMPV warrants further investigation. These findings highlight the importance of including hMPV and PIV in respiratory virus surveillance and future vaccine strategies.

Respiratory syncytial virus (RSV) peaks in fall-winter and is well known in children. In adults, however, severe outcomes especially compared to influenza are less well-defined. With RSV vaccines newly available in 2024, this study evaluated RSV burden versus influenza. Multicenter retrospective cohort study including adults ≥ 50 years with RT-PCR-confirmed influenza (A/B) or RSV during two pre-COVID-19 fall-winter seasons (2016–2018). Outcomes were hospital admission, length of stay, short-term favorable outcome (within 5 days), intensive care unit (ICU) admission, superinfection, and 90-day mortality. Of 386 patients, 288 (74.6

The rise of antimicrobial resistance presents a challenge to public health, undermines the efficacy of antibiotics, and compromises the management of infectious diseases. Gut colonisation by multidrug-resistant organisms, such as multidrug-resistant Enterobacterales and vancomycin-resistant enterococci, is associated with increased morbidity and mortality rates, as well as health-care costs. Of late, the role of the gut microbiome in combating colonisation by multidrug-resistant organisms, which could precede invasive infection, has garnered interest. Innovative interventions, including faecal microbiota transplantation, probiotics, phage therapy, and bacterial consortia, represent potential preventive or therapeutic options to counteract colonisation by multidrug-resistant organisms. In this Personal View, we have synthesised the current findings on these interventions and elucidated their potential as solutions to the crisis of antimicrobial resistance.

Objectives: Influenza significantly contributes to seasonal morbidity and strains healthcare resources, yet data directly comparing types A and B remain limited. This study assesses potential differences in clinical severity and outcomes between these two influenza types. Methods: We conducted a multicenter retrospective study of adult patients diagnosed with either influenza A or B. Using logistic regression, we identified predictors of adverse outcomes across demographics, comorbidities, and clinical parameters. Results: The influenza A and B cohorts included 234 and 113 patients, respectively. In comparison to influenza B, influenza A patients were more likely to receive oseltamivir (43.5% vs 27.9%, p = 0.01) and showed similar rates of radiological abnormalities (27.8% vs 24.8%, p = 0.6). Age ≥65 years remained the strongest predictor of hospitalization (aOR 4.78, p = 0.01). Predictors of ICU admission included age<65 (aOR 3.18, p = 0.02), radiological bilateral involvement (aOR 19.4, p < 0.001), receiving oseltamivir treatment (aOR 2.43, p = 0.01) with a trend towards documented superinfection (aOR 2.56, p = 0.07). Short-term favorable outcomes were more common in influenza B (aOR 2.52, p = 0.02), whereas chronic respiratory disease and Charlson comorbidity index reduced likelihood of favorable outcomes (aOR 0.34, p = 0.04 and 0.25, p = 0.001, respectively). Kaplan-Meier survival curves revealed similar mortality rates at 90 days between influenza A and B types (13.4% vs 8.7%, p = 0.3). Conclusion: Influenza type A and B exhibit distinct clinical trajectories and influenza B should not be neglected. These findings underscore the need for earlier diagnosis testing to promote earlier antiviral initiation and broader vaccination policies tailored to both influenza types.

Respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and parainfluenza viruses (PIV) drive substantial morbidity in adults, yet remain underdiagnosed due to diagnostic gaps. While influenza and COVID-19 benefit from rapid triplex antigenic tests and PCR, HMPV and PIV lack routine diagnostics, and RSV testing is underutilised in adults, leading to frequent misdiagnosis as common colds or bacterial infections. This opinion paper highlights the burden of these "forgotten viruses" in elderly and comorbid populations, where RSV and HMPV cause significant hospitalizations. Misdiagnosis fuels cardiovascular complications and antimicrobial resistance through inappropriate antibiotic use. Recent RSV vaccine successes offer a blueprint for HMPV and PIV, but improved diagnostics are critical to guide vaccine strategies and inform prevention efforts. Addressing these gaps can reduce healthcare costs and protect vulnerable populations from these hidden respiratory threats.

Antimicrobial resistance (AMR) causes over 35,000 deaths annually in the EU/EEA and is projected to result in 1.91 million global deaths each year by 2050. The second Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI-2), uniting 128 partners from 30 countries, represents a coordinated EU/EEA effort to curb AMR through a One Health approach. Although nearly all EU/EEA countries have an AMR National Action Plan, our initial assessment revealed that implementation remains constrained by limited resources, weak intersectoral coordination and fragmented leadership. EU-JAMRAI-2 addresses these challenges by promoting harmonized surveillance, strengthening infection prevention and control, applying behaviorally tailored stewardship interventions, ensuring sustainable access to essential antibiotics, and raising awareness among priority target audiences. By analyzing policy gaps and operational barriers, this paper underscores the need for stronger accountability and political commitment to translate strategies into sustainable action. Strengthening AMR governance through a unified European approach is essential to achieve effective, lasting progress against this silent pandemic.

Introduction : La vaccination parmi les professionnels de la santé, y compris ceux en formation, se révèle cruciale pour la protection des populations, notamment face aux risques infectieux émergents. Les étudiants en santé constituent une population potentiellement exposée aux virus, avec le potentiel de les transmettre, tout en jouant un rôle majeur en tant que futurs prescripteurs. Malgré leur importance, il existe peu d’études sur l’hésitation vaccinale au sein de cette population. But de l’étude : L’objectif de cette revue de littérature est de rassembler, organiser et analyser les données existantes concernant l’hésitation vaccinale des étudiants en santé dans le monde et les facteurs qui y sont associés. Résultats : Dix-neuf articles ont été inclus dans l’analyse. La définition retenue pour l’hésitation vaccinale était non consensuelle. Selon les études, les estimations de l’hésitation vaccinale des étudiants en santé, toutes vaccinations confondues, s’étendaient de 6,7 % à 80,2 %. Un des principaux facteurs associés à l’hésitation vaccinale mis en évidence était le doute, la peur, l’inquiétude ou l’expression d’un manque de sécurité du vaccin avec la crainte des effets indésirables. Enfin, l’hésitation vaccinale dépendait fortement de la vaccination étudiée, elle était plus élevée pour les infections émergentes (COVID-19, grippe H1N1). Elle dépendait également du pays et de la filière d’étude. Conclusions : Pour aborder l’enjeu actuel de la vaccination des étudiants en santé, il est essentiel d’approfondir qualitativement l’hésitation vaccinale. Cela implique une exploration plus détaillée des contextes socio-culturels et professionnels liés à cette hésitation, ainsi qu’une description plus approfondie des enseignements associés à la vaccination par filières.

BackgroundUnderstanding COVID-19 outcomes remains a challenge. While numerous biomarkers have been proposed for severity at admission, limited exploration exists for markers during the infection course, especially for the requirement of oxygen therapy. This study investigates the potential of eosinophil count normalization as a predictor for oxygen weaning during the initial wave of the pandemic.MethodsA retrospective study was conducted between March and April 2020 (first wave) among adults admitted directly to a medicine ward. Biological abnormalities, including lymphocyte count, eosinophil count, and C-reactive protein (CRP), were gathered daily during the first week of admission according to oxygen level. In case of worsening, oxygen level was censored at 15 L/min. The primary aim was to assess whether eosinophil count normalization predicts a subsequent decrease in oxygen requirements.ResultsOverall, 132 patients were admitted, with a mean age of 59.0 ± 16.3 years. Of the patients, 72% required oxygen, and 20.5% were admitted to the intensive care unit after a median delay of 48 hours. The median CRP at admission was 79 (26–130) mg/L, whereas the eosinophil count was 10 (0–60)/mm3. Eosinophil count normalization (≥100/mm3) by day 2 correlated significantly with decreased oxygen needs (<2 L) with hazard ratio (HR) = 3.7 [1.1–12.9] (p = 0.04). Likewise, CRP < 80 mg/L was associated with reduced oxygen requirements (p < 0.001). Predictors, including underlying chronic respiratory disease, exhibited a trend toward a negative association (p = 0.06).ConclusionThe study highlights the relationship between eosinophil count and CRP, with implications for predicting oxygen weaning during COVID-19. Further research is warranted to explore the relevance of these biomarkers in other respiratory infections.

Introduction La transplantation de microbiote fécal (TMF) est le traitement recommandé pour les infections à C. difficile (ICD) multi-récidivantes (≥2 récidives). Son efficacité a également été décrite pour les ICD sévère-compliquées ou dès un premier épisode d'ICD. Nous rapportons ici les résultats de l'utilisation de la TMF pour ICD en France dans le cadre de l'observatoire du Groupe Français de Transplantation Fécale (GFTF) et l'analyse des facteurs cliniques et pharmaceutiques associés à l'efficacité de la TMF dans l'ICD en vie réelle. Matériels et méthodes Etude portant sur l'analyse de toutes les TMF réalisées au sein du Groupe français de transplantation fécale pour ICD de 2018 à 2022. Les données cliniques (antécédents médicaux, traitements, efficacité, voie d'administration utilisée) et démographiques ont été recueillies rétrospectivement à partir des dossiers médicaux des receveurs, tandis que les caractéristiques techniques de préparation du transplant fécal (poids et mode de préparation des selles) ont été recueillies prospectivement au sein de chaque pharmacie préparatrice. Des analyses univariées (test de Fisher) et multivariées (régression logistique multiple) ont été réalisées pour identifier les facteurs associés au succès de la TMF défini par l'absence de récidive de l'ICD à 8 semaines. Résultats Sur la période d'étude, 658 TMF ont été réalisées en France dans 17 centres. L'efficacité globale de la TMF était de 79,0 % (520/658), avec 0,5 % d'effets indésirables sévères possiblement liés à la TMF (3/658). En analyse multivariée, l'insuffisance rénale chronique sévère (OR : 2,12, IC95%:1,12 - 3,93), l'ICD réfractaire non sévère (OR : 11,60, IC95%: 1,03 - 261,7), l'utilisation de glycérol dans les préparations congelées (OR : 2,26, IC95% 1,02 - 4, 98), et l'échec technique de la procédure (nettoyage insuffisant de l'intestin ou rétention insuffisante de la TMF; OR 5,05, IC95% : 1,35 - 21,58) étaient associés à la récidive de l'ICD dans les 8 semaines alors que la décongélation des fèces congelées à l'aide d'un bain-marie à 37°C était protectrice (OR : 0,25, IC95% : 0,10 - 0,64). Il n'y avait pas d'association significative entre l'efficacité de la TMF et la voie d'administration (voie gastro-duodénale: n=393 p=0,06; lavement: n=77, p=0,13; capsule: n=90, p=0,26; ou coloscopie: n=42, p=0.24), un pré-traitement par fidaxomicine en monothérapie (n=64; p=0,87) ou l'utilisation d'un poids de selles <30g (n=140 p=0,48). Conclusion L'expérience française montre que l'efficacité de la TMF pour les formes multi-récidivantes, sévère-compliquées ou avec <2 de récidives est confirmée en vie réelle alors que l'utilisation de la TMF pour ICD réfractaire non sévère est associée à un risque d'échec important devant probablement faire évoquer en premier lieu un diagnostic différentiel. La méthode de décongélation et les conditions de congélation sont des paramètres clés sous-estimés qui doivent être mieux standardisés pour optimiser l'efficacité de la TMF en particulier chez des patients insuffisants rénaux sévères à haut risque d'échec.Liens d'intérêts déclarés :N.B. a reçu des honoraires de Tillots Pharma et des bourses de voyage de Pfizer, a participé à réalisé une activité de conseil pour Ferring Pharmaceuticals avec paiement à son institution, est un PI d'un essai clinique soutenu par Exeliom Biosciences.