Acute respiratory infections are a significant challenge in primary care and hospital settings. Viruses are the most common etiology and the overlapping symptomatology among major respiratory viruses, such as influenza, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus, requires the use of diagnostic tests that deliver early and accurate results. With the increasing availability of rapid antigen tests (RATS), it is tempting to prefer them over polymerase chain reaction (PCR) tests. However, compelling arguments support the existing recommendations in some European countries to maintain PCR testing for patient management throughout the year. RATs show sensitivities below 30% with lower viral loads, which are common and can have significant clinical implications. RATs perform well at lower cycle threshold (Ct) values, with sensitivity reaching 97.9% for Ct values below 20, which drops significantly for values above 25. Factors affecting viral load include disease stage, vaccination status, and viral variants, all of which can compromise the accuracy of antigen tests. Multi-target PCR tests effectively overcome these issues, ensuring reliable diagnosis. Additionally, the early detection of paucisymptomatic cases is essential in primary care and hospital settings to facilitate isolation and prevent secondary infections. Economic analyses support the use of comprehensive PCR tests, such as triplex-type tests, detecting SARS-CoV-2, influenza viruses, and RSV, as a first-line approach, as they can reduce case numbers and healthcare resource utilization. Maintaining PCR testing year-round is therefore crucial for the effective management of respiratory infections.

The incidence of diphtheria has been rising over the past decade, particularly in its cutaneous form. A clinical review of the case series was therefore required. We reviewed the epidemiological, clinical, microbiological and therapeutic data of cutaneous diphtheria cases, in adult patients living in metropolitan France with a skin sample positive for corynebacteria of the diphtheriae complex between 2018 and 2022. Of the 132 cases identified, 63 met the inclusion criteria. The mean age was 53.8 years, 68.3% were men and 56.7% had travelled outside mainland France. Immunization rate was 44%. Lesions involved the lower limbs (86.9%), corresponded to ulcerations in 82% of cases. Two species were identified in the study: C. diphtheriae (77%) and C. ulcerans (23%). 39% were toxigenic. Other bacteria were present in 88.9% of cases: Staphylococcus aureus (54.7%) and Streptococcus pyogenes (49.1%). 17.5% of clinicians ignored the presence of Corynebacteria of the diphtheriae species complex. Clinicians seem to be unfamiliar with this disease due to under-reporting and a lack of knowledge and awareness among clinicians, and rarely mention it, which explains the frequent failure to comply with French recommendations. Clinical data are consistent with the literature. Continued epidemiological surveillance, increased vaccination coverage in high-risk populations and better information of clinicians are essential to prevent and control this preventable disease.

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vaccination has the main tool in the strategy to fight COVID- 19 as it reduces the severity of the disease, 1 the infectiousness of infected cases and the circulation of the virus by contributing to achieving herd immunity. We report the investigation of a COVID- 19 outbreak that occurred among the 91 crew members of a French Navy ship from May to July 2021. Before the mission, 87% of the crew were immune: 57% were fully vaccinated with the BNT162b2 vaccine in April–May 2021, 30% had had a previous SARS- CoV- 2 infection less than three months before (Alpha or Beta variants) and were not vaccinated (recovered), and 13% had no immunity at all. All had been tested with Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) and were negative, so that face masks were not mandatory on board. Once the mission began, an RT- PCR test was required for any crew members who had symptoms, for the entire crew before disembarking, and for those who were still negative seven days later at the end of the quaran-tine period. We studied the outbreak dynamics based on the epidemic curve and the instantaneous reproduction rate (Rt). confirmed

One of the main barriers for the implementation of metagenomic sequencing in routine diagnosis of infectious diseases is the presence of host DNA. While several enrichment methods are likely to overcome this issue, their effectiveness for specimens such as bone in the case of chronic infections remains to be determined. We compared the relevance of two methods for bacterial DNA enrichment when compared to a reference protocol during pretreatment of bone samples from fracture-related infections before HTS by both Illumina Miseq and Oxford Nanopore Technology (ONT). The bacterial/human DNA ratio was higher for either protocols than the reference technique (p = 0.00012), without any significant difference between them. HTS sensitivity over culture ranged from 21.7 % to 85 %. The ability of the studied protocols to improve the bacterial/human DNA ratio depends on the sequencing technique employed. In this context, there is room for improvement in enhancing the sensitivity of HTS for diagnostic purpose.

IntroductionDu 27/11/2023 au 27/01/2024, 124 patients de la bande de Gaza, victimes civiles du conflit armé entre Israël et le Hamas, ont été hospitalisés à bord du Dixmude, porte-hélicoptère amphibie de la Marine Nationale comportant une capacité hospitalière du Service de Santé des Armées.Matériels et méthodesLes données cliniques, paracliniques et thérapeutiques des infections complexes documentées ont été recueillies et analysées. La capacité de réaliser des cultures bactériologiques et des antibiogrammes n'était pas disponible. Les moyens diagnostiques comprenaient 4 panels de PCR : BCID2, CARBA Xpert SSTI, gastro intestinal et pneumonia panel plus.RésultatsSur un total de 124 patients hospitalisés, 20 patients présentaient une suspicion clinique d'infection profonde complexe. Parmi eux, 14 infections profondes ont été documentées par outil biomoléculaire et ont été incluses dans l'analyse.Il s'agissait de 3 femmes et 11 hommes, d'âge moyen 25 ans (de 4 à 50 ans). Dans les comorbidités, on notait un tabagisme (n=2), un diabète (n=1), une HTA (n=1) et une obésité (n=1).Il s'agissait dans 57% (n= 8) d'infections ostéo-articulaires, dans 43% de traumatismes thoraco-abdominaux (n=6) et dans 7% de fracas faciaux (n=1). La prise en charge avait lieu en moyenne 39 jours après la blessure initiale causée par bombardement dans la majorité des cas.31 prélèvements ont été réalisés dont 29 étaient positifs. 13 étaient des prélèvements d'os, 7 de tissus mous, 4 de liquide péritonéal ; les autres prélèvements étaient de la bile (n=1), du liquide broncho-alvéolaire (n=2) et du liquide pleural (n=1). 5 prélèvements d'os étaient polybactériens, les 4 prélèvements de liquide péritonéal et les 4 prélèvements de tissu mou concernant la paroi abdominale étaient polybactériens ; 1/3 prélèvements des tissus mous des membres était polybactérien. Les infections ostéoarticulaires étaient liées à des bactéries variées : Staphylococcus aureus (n=3), Pseudomonas aeruginosa (n=2), Streptococcus pyogenes (n=1), Acinetobacter sp. (n=1), Klebsiella pneumoniae (n=1), Neisseria meningitidis (n=1). Les infections péritonéales étaient liées à des bactéries variées : Staphylococcus aureus (n=3), Acinetobacter sp. (n=3), Streptococcus (n=2), Escherichia coli (n=2), Pseudomonas aeruginosa (n=2), Enterococcus sp. (n=2). Tous les S aureus étaient résistants à la vancomycine. Le gène de résistance CTX-M était détecté pour 3 infections osseuses et pour toutes les infections abdominales, et le gène NDM pour 3 infections abdominales sur 4.Le traitement a reposé sur la vancomycine pour 6 patients et sur ceftazidime-avibactam pour 5 patients.ConclusionL'insécurité des zones de conflit est source d'un retard de prise en charge (effondrement du système sanitaire local). Le profil des infections ostéo-articulaires et abdominales qui représentent la majeure partie des patients blessés survivants est très varié et toujours polymicrobien pour les infections abdominales. La prévalence des gènes de résistance est très élevée imposant le recours d'emblée à la vancomycine ou à des antibiotiques de dernière génération.Aucun lien d'intérêt

IntroductionLa diphtérie voit son incidence augmenter dans les pays développés depuis une dizaine d'années particulièrement dans sa localisation cutanée. Une étude épidémiologique s'imposait en France.Matériels et méthodesEtude rétrospective et descriptive nationale incluant les patients majeurs, vivant en métropole avec des prélèvements cutanés positifs à Corynebacterium du complexe diphtheriae (CCD) en culture ou PCR entre le 1er janvier 2018 et le 31 décembre 2022 adressés au centre national de référence des corynébactéries. Critères de jugements principaux : description épidémiologique, clinique, microbiologique et thérapeutique des diphtéries cutanées. Les critères de jugements secondaires étaient la vérification de la mise en application des recommandations du Haut Conseil de la Santé Publique (HCSP).RésultatsSur les 132 prélèvements identifiés, 63 respectaient les critères d'inclusion et d'exclusion.Epidémiologique : L'âge moyen de la population étudiée était de 53,8 ans (18-93ans) et 68,3% des patients étaient des hommes. Les principales comorbidités associées étaient l'hypertension, le diabète, et l'artériopathie des membres inférieurs. 56,7% avaient voyagé hors de France métropolitaine dans l'année précédant le diagnostic : 67,6% en Afrique, 23,5% en Asie. Les patients étaient identifiés vaccinés dans 44 % des cas.Microbiologie : Le diagnostic était fortuit dans 82% des cas. Les espèces mises en évidence étaient : C. diphtheriae (77%) et C. ulcerans (23%). 39% des souches étaient tox+. Une co-infection de la lésion cutanée,avec au moins une autre espèce bactérienne a été identifiée dans 88,9% des cas : S. aureus (54,7%), S. pyogenes (49,1%).Clinique : L'atteinte cutanée concernait majoritairement les membres inférieurs (86,9%), avec des lésions multiples dans 58,1% des cas, évoluait depuis plus de deux semaines dans 61,3% des cas, et correspondaient à des ulcérations dans 82%. L'aspect de pseudo-membrane n'a été observé que pour 4 patients. Dans 70% des cas, il existait une lésion préexistante au diagnostic de diphtérie cutanée.Thérapeutique :17,5% des cliniciens n'ont pas tenu compte de la présence de la CCD. Six patients ont reçu une sérothérapie antidiphtérique. 47,6% n'ont pas eu de recherche de portage nasopharyngé et si positif :1/3 n'ont pas eu de recherche d'éradication à l'issue du traitement. Il n'y a pas eu de recherche de sujet contact dans 42,6% des cas.ConclusionCes données sont cohérentes avec les données de la littérature. Cette pathologie semble mal connue des cliniciens qui l'évoquent rarement devant des ulcérations chroniques au retour de voyage en zone d'endémie, d'où parfois le non-respect des recommandations du HCSP.Les infections cutanées par des CCD, toxinogènes ou non, sont actuellement ré-émergentes dans les pays industrialisés après avoir quasiment disparu. La poursuite d'une surveillance épidémiologique, le renforcement de la couverture vaccinale dans les populations les plus à risque et une meilleure information des cliniciens sont restent nécessaire.Aucun lien d'intérêt

Background Cladophialophora bantiana is one of the most virulent phaeohyphomycetes, typically causes non-angiogenic single (or sometimes multiple) cystic brain lesions, and has resulted in a mortality rate of up to 70%. Most C bantiana cases are described either in a series of isolated reports or in very small cohorts. The aim of this retrospective nation-based study was to share the data on C bantiana phaeohyphomycosis cases reported in France and French overseas territories over the past two decades to improve understanding of this disease. Methods Patients with C bantiana infection were processed through the active surveillance programme of invasive fungal infections launched by the National Reference Center for Mycoses and Antifungals, Institut Pasteur (Paris, France), and the French Surveillance Network of Invasive Fungal Infections, which involved 29 hospitals from mainland France and overseas French territories. Only proven and probable cases of infection, according to the revised and updated consensus definitions from the European Organization for Research and Treatment of Cancer and Mycoses Study Group, were included in the study. Patients were diagnosed or confirmed, or both, using a polyphasic approach at the Institut Pasteur between 2002 and 2022. Patients were separated into two groups: those with CNS involvement and those with no CNS involvement. The primary outcome was the survival rate. Findings A total of 23 patients with a C bantiana invasive infection were included during the study period (Jan 1, 2002, to Dec 31, 2022). The median age was 56 years in the CNS involvement group and 65 years in the non-CNS involvement group. Until 2021, the annual number of cases varied between zero and two, with six cases observed in 2022, the warmest year recorded in France since 1900. CNS involvement was observed in 15 (65%) patients, including three disseminated cases; skin and soft tissue involvement in seven (30%) patients and an isolated lung infection in one case. Diabetes was observed in five patients, and any immunodepression factor was observed in 14 (61%) of 23 patients. When considering only patients with CNS involvement, 9-month survival appeared higher in patients who underwent exeresis or large drainage (three [75%] of four patients vs three [27%] of 11 patients; p=0·24) and significantly higher in those treated for 2 or more weeks with triple antifungal therapy (liposomal amphotericin B plus posaconazole and flucytosine; seven [78%] of nine patients vs one [17%] of six patients; p=0·040). Two patients were treated with excision surgery alone (one patient with success, and the other patient lost to follow-up). Interpretation This study shows that the clinical presentations and underlying medical conditions of C bantiana infections are more diverse than previously described. It also emphasises a significant difference in mortality rate between those with and without CNS involvement. The prognosis improved when surgery was performed and triple antifungal therapy was administered. Such rare and devastating invasive fungal infections should be managed by a multidisciplinary team. Funding Santé Publique France.

Objectives: Ceftolozane-tazobactam (C/T) proved its efficacy for the treatment of infections caused by non-carbapenemase producing Pseudomonas aeruginosa and Enterobacterales. Here, we aimed to provide susceptibility data on a large series of Enterobacterales since the revision of EUCAST categorization break-points in 2020.Methods: First, C/T susceptibility was determined on characterized Enterobacterales resistant to third generation cephalosporins (3GCs) (extended spectrum beta-lactamase [ESBL] production or different levels of AmpC overexpression) (n = 213) and carbapenem-resistant Enterobacterales (CRE) (n = 259), includ-ing 170 carbapenemase producers (CPE). Then, 1632 consecutive clinical Enterobacterales responsible for infection were prospectively collected in 23 French hospitals. C/T susceptibility was determined by E -test (R) (biomerieux) and broth microdilution (BMD) (SensititreTM, Thermo Scientific) to perform method comparison.Results: Within the collection isolates, 88% of 3GC resistant strains were susceptible to C/T, with impor-tant variation depending on the resistance mechanism: 93% vs. 13% susceptibility for CTX-M and SHV-ESBL producers, respectively. Only 20% of the CRE were susceptible to C/T. Among CPE, 80% of OXA-48-like producers were susceptible to C/T, whereas all metallo-,B-lactamase producers were resistant. The prospective study revealed that 95.6% of clinical isolates were susceptible to C/T. Method comparison performed on these 1632 clinical isolates demonstrated 99% of categorization agreement between MIC to C/T determined by E-test (R) in comparison with the BMD (reference) and only 74% of essential agreement. Conclusion: Overall, C/T showed good activity against wild-type Enterobacterales, AmpC producers, and ESBL-producing Escherichia coli but is less active against ESBL-producing Klebsiella pneumoniae, and CRE. E-test (R) led to an underestimation of the MICs in comparison to the BMD reference.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Objectives: Sexually transmitted infections (STIs) can cause leukocyturia. We aimed to estimate the prevalence of leukocyturia in asymptomatic aircrews and the proportion of STIs in those presenting leukocyturia. Methods: The LEUCO survey was a prospective cohort study conducted among aircrews between 14th October 2019 and 13th March 2020 at the Toulon aeromedical centre in France. All participants performed a dipstick urinalysis. Those positive for leukocyturia were offered STI screening by nucleic acid amplification test (NAAT) for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis. Results: Among the 2236 included asymptomatic participants (1912 men and 324 women), 127 (36 men and 91 women) were positive for leukocyturia. The prevalence of leukocyturia was 1.9% (1.3-2.6) in men and 28.1% (23.3-33.3) in women (p < 0.001). In men positive for leukocyturia, the NAAT positivity rate for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis was 28.6% (3.7-71.0) in the age group 18 -24, 20.0% (0.5-71.6) in the age group 25-34, and zero in the older age group (p 0.65). In women positive for leukocyturia it was 16.7% (4.7-37.4) in the age group 18-24, 18.2% (2.3-51.8) in the age group 25-34, and zero in the older age group (p 0.16). Conclusions: In asymptomatic individuals, leukocyturia is rare in men and more common in women. In asymptomatic adults under 35 years of age with leukocyturia, multiplex NAAT shows a high proportion of STIs and might be useful in improving STI detection. (C) 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The French Armed Forces Biomedical Research Institute (IRBA) deeply involved in research on SARS-COV-2, participated in the creation of the Obépine sentinel network in charge of detecting, qualifying and quantifying the virus genome in wastewater in France. During this pandemic, wastewater-based epidemiology has proven to be a first class public health tool for assessing viral dynamics in populations and environment. Obépine has also conducted research demonstrating the low infectivity of faeces and wastewater and allowed for early detection of epidemic waves linked to new variants. The IRBA has adapted this powerful tool to the monitoring of viral infections on board the aircraft carrier Charles-de-Gaulle in order to get an operational system for anticipation after the first local outbreak in 2020. The presence of this surveillance and anticipation tool has allowed a better management of SARS-CoV-2 contingent introductions on board during stopovers or crewmembers entries. The combination of a mandatory vaccination protocol and the surveillance of viral circulation in black waters has made it possible to identify and locate cases, and thus to continue the operational mission in the COVID-19 environment while limiting the spread and preserving the health of the crew. This innovative tool can easily be redirected to the search for any other pathogens in blackwater or even, in the long term, to ensure health surveillance of any military establishment, at sea or on land, in France or on overseas bases.

In this multicentric study performed in 12 French hospitals, we reported that 26.9% (14/52) of the amoxicillin-clavulanate-resistant Proteus mirabilis isolates produced the OXA-23 carbapenemase. We found that an inhibition zone diameter of <11 mm around the amoxicillin-clavulanate disc was an accurate screening cutoff to detect these OXA-23 producers.

L’Institut de recherche biomédicale des armées (IRBA), largement impliqué dans la recherche sur le SARS-CoV-2, a cofondé le réseau sentinelle Obépine chargé de détecter, de qualifier et de quantifier le génome du virus dans les eaux usées en France. Durant cette pandémie, l’épidémiologie basée sur les eaux usées s’est avérée être un outil de santé publique de premier ordre pour évaluer la dynamique virale dans les populations et l’environnement. Obépine a également mené des travaux de recherche ayant démontré la faible infectiosité des matières fécales et des eaux usées et permis de détecter en avance de phase les vagues épidémiques liées aux nouveaux variants. L’IRBA a adapté cet outil performant au suivi des infections virales sur le porte-avions Charles-de-Gaulle à la suite d’une première épidémie à bord en 2020. Cet outil de surveillance a facilité la gestion du risque de contamination virale à bord lors des escales et des entrées de personnels. La lutte contre la circulation virale permettant le maintien de la capacité opérationnelle repose sur un ensemble de mesures : vaccination du personnel, suivi des eaux noires par PCR pour la détection d’une circulation virale, capacité de diagnostic par PCR des sujets symptomatiques ou contacts pour l’identification et le suivi des cas. Cet outil innovant peut être réorienté vers la recherche d’autres agents pathogènes dans les eaux noires, voire, à terme, permettre d’assurer une surveillance sanitaire des militaires, en mer ou à terre, en métropole ou sur une base outre-mer.

Background: SARS-CoV-2 emergence was a threat for armed forces. A COVID-19 outbreak occurred on the French aircraft carrier Charles de Gaulle from mid-March to mid-April 2020. Aim: To understand how the virus was introduced, circulated then stopped circulation, risk factors for infection and severity, and effectiveness of preventive measures. Methods: We considered the entire crew as a cohort and collected personal, clinical, biological, and epidemiological data. We performed viral genome sequencing and searched for SARS-CoV-2 in the environment. Results: The attack rate was 65% (1,148/1,767); 1,568 (89%) were included. The male:female ratio was 6.9, and median age was 29 years (IQR: 24-36). We examined four clinical profiles: asymptomatic (13.0%), non-specific symptomatic (8.1%), specific symptomatic (76.3%), and severe (i.e. requiring oxygen therapy, 2.6%). Active smoking was not associated with severe COVID-19; age and obesity were risk factors. The instantaneous reproduction rate (R-t) and viral sequencing suggested several introductions of the virus with 4 of 5 introduced strains from within France, with an acceleration of R t when lifting preventive measures. Physical distancing prevented infection (adjusted OR: 0.55; 95% CI: 0.40-0.76). Transmission may have stopped when the proportion of infected personnel was large enough to prevent circulation (65%; 95% CI: 62-68). Conclusion: Non-specific clinical pictures of COVID-19 delayed detection of the outbreak. The lack of an isolation ward made it difficult to manage transmission; the outbreak spread until a protective threshold was reached. Physical distancing was effective when applied. Early surveillance with adapted prevention measures should prevent such an outbreak.

During a mission in French Polynesia, a man in his 50s presented with multiple lesions on his legs that resembled little bubbles. Two weeks later, after his return to Toulon, France, the patient had numerous and painful lesions on his legs and right hand, with fibrinous ulcerations covered by an adherent membrane. The patient did not report any specific risk activities during the mission (e.g. contact with animals, poor hygiene, intravenous drug use). Clinicians suspected a Staphylococcus aureus infection with toxin production.

In the context of increasing antimicrobial resistance in Enterobacterales, the management of these UTIs has become challenging. We retrospectively assess the prevalence of antimicrobial resistance in Enterobacterales isolates recovered from urinary tract samples in France, between 1 September 2017, to 31 August 2018. Twenty-six French clinical laboratories provided the susceptibility of 134,162 Enterobacterales isolates to 17 antimicrobials. The most frequent species were E. coli (72.0%), Klebsiella pneumoniae (9.7%), Proteus mirabilis (5.8%), and Enterobacter cloacae complex (2.9%). The overall rate of ESBL-producing Enterobacterales was 6.7%, and ranged from 1.0% in P. mirabilis to 19.5% in K. pneumoniae, and from 3.1% in outpatients to 13.6% in long-term care facilities. Overall, 4.1%, 9.3% and 10.5% of the isolates were resistant to cefoxitin, temocillin and pivmecillinam. Cotrimoxazole was the less active compound with 23.4% resistance. Conversely, 4.4%, 12.9%, and 14.3% of the strains were resistant to fosfomycin, nitrofurantoin, and ciprofloxacin. However, less than 1% of E. coli was resistant to fosfomycin and nitrofurantoin. We identified several trends in antibiotics resistances among Enterobacterales isolates recovered from the urinary tract samples in France. Carbapenem-sparing drugs, such as temocillin, mecillinam, fosfomycin, cefoxitin, and nitrofurantoin, remained highly active, including towards ESBL-E.

Background: Sexually transmitted infections (STIs) can cause leukocyturia in asymptomatic patient. We aimed to evaluate leukocyturia prevalence in asymptomatic aircrew and STIs proportion in leukocyturia. Methods: The LEUCO survey was a prospective, monocentre cohort study among aircrew, done at aeromedical center in France. Aircrews were included during five months. Systematic dipstick urinalysis leukocyturia result was collected. Participants with leukocyturia were proposed to perform a Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis, nucleic acid amplification test (NAAT). We calculated leukocyturia prevalence and STIs proportion among this. We used a logistic regression model to search for associations between leukocyturia and variables collected. This study was registered in our Institutional Review Board, number IRB 0011873202022. Findings: Between Oct 14, 2019, and Mar 13, 2020, 2236 participants performed dipstick urinalysis, of whom 127 (5.7%) had a leukocyturia. The prevalence of leukocyturia was significantly different between men, 1.9% (1.3−2.6) and women, 28.1% (23.3−33.3) (p<0.001). Female gender was associated with leukocyturia OR 21.6 (13.1−36.4) (p<0.001). In men with leukocyturia, NAAT positivity rate was very high in the 18-24 age group, 28.6% (3.7−71.0) and in the 25-34 age group, 20.0% (0.5-71.6). In women with leukocyturia, it was high in the 18-24 age group, 16.7% (4.7−37.4) and in the 25-34 age group, 18.2% (2.3−51.8). Interpretation Leukocyturia is rare in asymptomatic subjects. Patients with leukocyturia under 35 years old have high proportion of STIs. Multiplex NAAT has utility for STIs diagnosis in asymptomatic subjects under 35 years old presenting a leukocyturia. Trial Registration: Trial number IRB 0011873202022.Funding: French Army Health ServiceDeclaration of Interest: None to declare. Ethical Approval: The survey received a favorable ethical opinion from the clinical trials validation commission of the Sainte-Anne military hospital Toulon, France, registered as an Institutional Review Board (IRB 0011873202022 ).

The aim of this multicentre study was to determine the in vitro susceptibility to anti-anaerobic antibiotics of Gram-positive anaerobic cocci (GPAC) isolates responsible for invasive infections in humans. A total of 133 GPAC isolates were collected in nine French hospitals from 2016 to 2020. All strains were identified to the species level (MALDI-TOF mass spectrometry, 16S rRNA sequencing). Minimum inhibitory concentrations (MICs) of amoxicillin, piperacillin, cefotaxime, imipenem, clindamycin, vancomycin, linezolid, moxifloxacin, rifampicin, and metronidazole were determined by the reference agar dilution method. Main erm-like genes were detected by PCR. The 133 GPAC isolates were identified as follows: 10 Anaerococcus spp., 49 Finegoldia magna, 33 Parvimonas micra, 30 Peptoniphilus spp., and 11 Peptostreptococcus anaerobius. All isolates were susceptible to imipenem, vancomycin (except 3 P. micra), linezolid and metronidazole. All isolates were susceptible to amoxicillin and piperacillin, except for P. anaerobius (54% and 45% susceptibility only, respectively). MICs of cefotaxime widely varied while activity of rifampicin, and moxifloxacin was also variable. Concerning clindamycin, 31 were categorized as resistant (22 erm(A) subclass erm(TR), 7 erm(B), 1 both genes and 1 negative for tested erm genes) with MICs from 8 to >32 mg/L. Although GPACs are usually susceptible to drugs commonly used for the treatment of anaerobic infections, antimicrobial susceptibility should be evaluated in vitro.

Abstract Introduction Preliminary reports indicated that smokers could be less susceptible to coronavirus SARS-CoV-2, which causes Covid-19. However, once infected an increased risk of severe disease is reported. We investigated the association between smoking and COVID-19 during an outbreak of the disease on a naval vessel. Methods We conducted a cross-sectional, observational study on the 1769 sailors of the same navy aircraft carrier at sea exposed at the same time to SARS-CoV2 to investigate the link between tobacco consumption and Covid-19. Results Among the 1688 crewmembers (87% men; median age = 28 [interquartile range 23–35]) included, 1279 (76%) developed Covid-19 (1038 [62%] reverse-transcriptase- polymerase chain reaction testing–positive and 241 [14%] with only clinical signs). One hundred and seven patients were hospitalized. The univariable analysis odds ratio (OR) for Covid-19 infection was 0.59 (95% confidence interval [CI], 0.45–0.78; p < .001) for current smokers versus former and nonsmokers; sex, body mass index or blood group had no significant impact. Crewmembers >50 years old had an increased risk of contracting Covid-19 (OR, 2.84 [95% CI, 1.30–7.5]; p = .01). Multivariable analysis retained the lower risk of current smokers becoming infected (OR, 0.64 [0.49–0.84]; p < .001) and age >50 years was significatively associated with Covid-19 (OR, 2.6 [1.17–6.9]; p = .03). Conclusions Current smoking status was associated with a lower risk of developing Covid-19 but cannot be considered as efficient protection against infection. The mechanism of the lower susceptibility of smokers to SARS-CoV-2 requires further research. Trial Registration IRB no.: 0011873-2020-09 Implications (1) Recent epidemiologic data suggest a paradoxical link between smoking and COVID-19. (2) Among the 1688 crewmembers (with an attack rate of 76% and exposed at the same time in the same place to SARS-CoV2), we found a significantly lower risk for developing COVID-19 in current smokers (71%) versus former and nonsmokers (80%). This finding strongly supports the need for further research on nicotine physiological pathway and its impact on COVID-19 infection whilst emphasizing that tobacco smoking should not be considered as efficient protection against COVID-19.