Lower respiratory tract infections caused by Mycoplasma pneumoniae are most often characterized by mild, self-limiting symptoms, including fever, cough, and shortness of breath. They mainly affect schoolaged children and young adults, in whom this germ is the third leading cause of community-acquired bacterial pneumonia. Infection with a macrolide-resistant strain of Mycoplasma pneumoniae (MR-MP) presents with a similar clinical picture; however, the duration of fever, cough, and hospitalization tends to be prolonged. The prolonged duration of symptoms is not associated with an increased risk of complications, but it often leads to a delay in the initiation of appropriate treatment. In Switzerland, doxycycline is currently considered the first-line treatment for MR-MP infection in adults.

Background:Cutibacterium acnes (C. acnes) is a pathogen linked to infections following shoulder surgery. Exposure can occur during surgical dissection and spread in the surgical field through the surgeon's gloves and instruments. Disinfection of the subcutaneous tissue has been shown to reduce its contamination. No evidence has been provided for a decrease in the transmission rate when the dissection is performed with an electrocautery. The aim of this study was to ascertain whether disinfection of subcutaneous tissue can reduce the C. acnes rate in primary open shoulder surgery in comparison with dissection performed with electrocautery. We also wanted to compare the contamination rate of the operating field after electrocautery dissection with those found in the literature. Methods:All patients who qualified for primary open shoulder surgery via a deltopectoral approach were prospectively included in our single-blinded, two-arm randomized clinical trial. For every patient, a skin swab from the surgical area was taken before the standard preparation of the skin. In the disinfection group, the subcutaneous layer was treated with povidone iodine solution after exposure of the deltoid fascia. The cautery group underwent subcutaneous tissue dissection using an electrocautery. After fully exposing the proximal humerus, 5 swabs were collected from various locations for microbiological analysis, following a rigorous protocol. All cultures were incubated for 14 days under both aerobic and anaerobic conditions. Results:Between February 2020 and July 2021, 210 shoulders were enrolled in 2 groups (140 disinfection vs. 70 cautery). The 2 groups showed no significant differences in terms of sex, age, body mass index, or diabetes prevalence. The subcutaneous disinfection protocol led to a significant decrease in the overall positive culture rate of the operating field for all bacteria (P = .001) and specifically for C. acnes (P = .021). The reduction of positive swabs for C. acnes was significant for both the surgeon's gloves (P = .004) and for the subcutaneous tissue (P = .009). C. acnes contamination rate was noted in 26% of patients in the electrocautery group and 13% in the disinfection group after exclusion of the outside scalpel blade sample, which was removed from the scrub nurse's instrument table and therefore no longer used during the procedure. Conclusion:Disinfection of the subcutaneous tissue reduces the contamination rate of C. acnes by a factor of 2 during open shoulder surgery compared with an approach performed with electrocautery and could limit the contamination of the operating field.

The year 2023 saw the publication of several studies in various areas of infectious diseases. The administration of corticosteroids decreased mortality in severe community-acquired pneumonia. Administration of doxycycline post-exposure prophylaxis reduced the risk of bacterial sexually transmitted infections at the risk of resistance selection. An herbal preparation decreased mortality in sepsis. A meta-analysis concludes that oseltamivir does not significantly reduce the risk of hospitalisation for influenza. Discontinuation of antibiotic prophylaxis during dental procedures in Sweden did not increase the incidence of viridans group Streptococcus endocarditis. Several studies have led to the introduction of RSV (Respiratory Syncytial Virus (RSV) vaccination. 2023 also saw the resurgence of invasive Group A Streptococcal infections, of which clinicians must be wary.

The year 2023 saw the publication of several studies in various areas of infectious diseases. The administration of corticosteroids decreased mortality in severe community-acquired pneumonia. Administration of doxycycline post-exposure prophylaxis reduced the risk of bacterial sexually transmitted infections at the risk of resistance selection. An herbal preparation decreased mortality in sepsis. A meta-analysis concludes that oseltamivir does not significantly reduce the risk of hospitalisation for influenza. Discontinuation of antibiotic prophylaxis during dental procedures in Sweden did not increase the incidence of viridans group Streptococcus endocarditis. Several studies have led to the introduction of RSV (Respiratory Syncytial Virus (RSV) vaccination. 2023 also saw the resurgence of invasive Group A Streptococcal infections, of which clinicians must be wary.

CONTEXTE ET OBJECTIFSLe fardeau de l'antibiorésistance reste peu étudié en Afrique subsaharienne (ASS).Les entérobactéries comptent parmi les principales bactéries responsables de sepsis chez les enfants en ASS.Notre étude s'intéresse à la proportion d'entérobactéries résistantes dans cette population.Cette méta-analyse comprend un deuxième volet, présenté dans un autre abstract, concernant la colonisation par des entérobactéries multi-résistantes.

Summary Background The increasing resistance of Enterobacterales to third-generation cephalosporins and carbapenems in sub-Saharan Africa (SSA) is a major public health concern. We did a systematic review and meta-analysis of studies to estimate the carriage prevalence of Enterobacterales not susceptible to third-generation cephalosporins or carbapenems among paediatric populations in SSA. Methods We performed a systematic literature review and meta-analysis of cross-sectional and cohort studies to estimate the prevalence of childhood (0–18 years old) carriage of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) or carbapenem-resistant Enterobacterales (CRE) in SSA. Medline, EMBASE and the Cochrane Library were searched for studies published from 1 January 2005 to 1 June 2022. Studies with <10 occurrences per bacteria, case reports, and meta-analyses were excluded. Quality and risk of bias were assessed using the Newcastle–Ottawa scale. Meta-analyses of prevalences and odds ratios were calculated using generalised linear mixed-effects models. Heterogeneity was assessed using I2 statistics. The protocol is available on PROSPERO (CRD42021260157). Findings Of 1111 studies examined, 40 met our inclusion criteria, reporting on the carriage prevalence of Enterobacterales in 9408 children. The pooled carriage prevalence of ESCR-E was 32.2% (95% CI: 25.2%–40.2%). Between-study heterogeneity was high (I2 = 96%). The main sources of bias pertained to participant selection and the heterogeneity of the microbiological specimens. Carriage proportions were higher among sick children than healthy ones (35.7% vs 16.9%). The pooled proportion of nosocomial acquisition was 53.8% (95% CI: 32.1%–74.1%) among the 922 children without ESCR-E carriage at hospital admission. The pooled odds ratio of ESCR-E carriage after antibiotic treatment within the previous 3 months was 3.20 (95% CI: 2.10–4.88). The proportion of pooled carbapenem-resistant for Enterobacterales was 3.6% (95% CI: 0.7%–16.4%). Interpretation This study suggests that ESCR-E carriage among children in SSA is frequent. Microbiology capacity and infection control must be scaled-up to reduce the spread of those multidrug-resistant microorganisms. Funding There was no funding source for this study.

BACKGROUND AND AIMS OF THE STUDY: Congenital syphilis is a rare complication of syphilis in pregnant women. Vertical transmission may occur at any time during pregnancy. The incidence of congenital syphilis has been increasing worldwide. Congenital syphilis has been a notifiable disease for many years in Switzerland but reporting does not include maternal features associated with syphilis in pregnancy or infantʼs subsequent development. We described syphilis cases among pregnant women screened over a 10-year period in Switzerland and subsequent cases of congenital syphilis, in order to identify maternal risk profiles and to optimise prevention. Second, we compared the characteristics of pregnant women screened early (1st trimester) vs late in pregnancy (2nd or 3rd trimester). Finally, we assessed the risk factors for premature birth among these women with syphilis. METHODS: A multicentre retrospective study conducted in Swiss hospitals from 2012 to 2021, including pregnant women who screened positive for syphilis (Treponema pallidum haemagglutination assay [TPHA] / T. pallidum particle agglutination assay [TPPA ] ≥1:80) and newborns exposed to T. pallidum in utero and/or congenitally infected and with a positive syphilis serology at birth. Data were collected from medical records. RESULTS: A total of 147 syphilis-positive pregnant women and 102 infants were included. A history of treated syphilis was known for 44% (65/147) of the mothers corresponding to a serological scar and the remaining 56% (82/147) were newly identified syphilis cases. Syphilis screening was done during the first trimester in 54%, second trimester in 29% and third trimester in 13% of cases. Two babies were diagnosed with congenital syphilis (1.96%). Several potential factors that could contribute to women’s risk of syphilis during pregnancy were identified such as a foreign origin (93% of mothers), lack of healthcare insurance (25%), no employment status (37%), drug use (5%), co-infection with other sexually transmitted infections (24%) and a late first antenatal consultation (42%). The number of pregnant women without insurance was higher in women diagnosed in the second or third trimester than in those diagnosed in the first trimester (odds ratio 0.41; 95% CI 0.19–0.89; p = 0.024). Syphilis diagnosed in the second or third trimester was associated with a late first antenatal consultation (odds ratio 77.82; 95% CI 9.81–617.21; p <0.001). A high rate of intrauterine growth retardation and of preterm birth was observed in newborns (18% versus 6% in Switzerland in 2022). CONCLUSION: Congenital syphilis remains rare in Switzerland. However, we found potential maternal factors associated with a positive syphilis serology during pregnancy, which can help to improve future prevention measures. The study protocol was registered on ClinicalTrials.gov (ID NCT05975502).

Background. In the context of increasing antimicrobial resistance (AMR), whole-genome sequencing (WGS) of bacteria is considered a highly accurate and comprehensive surveillance method for detecting and tracking the spread of resistant pathogens. Two primary sequencing technologies exist: short-read sequencing (50–300 base pairs) and long-read sequencing (thousands of base pairs). The former, based on Illumina sequencing platforms (ISPs), provides extensive coverage and high accuracy for detecting single nucleotide polymorphisms (SNPs) and small insertions/deletions, but is limited by its read length. The latter, based on platforms such as Oxford Nanopore Technologies (ONT), enables the assembly of genomes, particularly those with repetitive regions and structural variants, although its accuracy has historically been lower. Results. We performed a head-to-head comparison of these techniques to sequence the K. pneumoniae VS17 isolate, focusing on blaNDM resistance gene alleles in the context of a surveillance program. Discrepancies between the ISP (blaNDM-4 allele identified) and ONT (blaNDM-1 and blaNDM-5 alleles identified) were observed. Conjugation assays and Sanger sequencing, used as the gold standard, confirmed the validity of ONT results. This study demonstrates the importance of long-read or hybrid assemblies for accurate carbapenemase resistance gene identification and highlights the limitations of short reads in the context of gene duplications or multiple alleles. Conclusions. In this proof-of-concept study, we conclude that recent long-read sequencing technology may outperform standard short-read sequencing for the accurate identification of carbapenemase alleles. Such information is crucial given the rising prevalence of strains producing multiple carbapenemases, especially as WGS is increasingly used for epidemiological surveillance and infection control.

Surgical Site Infections account for 15-30% of healthcare-associated infections. Surgical antibiotic prophylaxis is one of well-documented measures to decrease the risk of infections. However, many situations threaten its proper application and thereby its effectiveness: patient already receiving antibiotics or carrying resistant germs, clinicians' misunderstanding about timing and duration of antibiotic prophylaxis or patient history of penicillin allergy. In this article we try to clarify these situations to favour good practice in perioperative antibiotic prophylaxis.Les infections du site opératoire représentent 15-30 % des infections associées aux soins et l’antibioprophylaxie chirurgicale est l’une des mesures bien documentées pour en diminuer le risque. Cependant, de nombreuses situations prétéritent l’application adéquate de cette mesure et donc son efficacité : présence d’une antibiothérapie en cours, portage de germes résistants, incompréhensions sur le timing et la durée de l’antibioprophylaxie, notion d’allergie à la pénicilline. Dans cet article, nous tentons de clarifier ces situations afin de favoriser la bonne application de l’antibioprophylaxie.

Surgical Site Infections account for 15-30% of healthcare-associated infections. Surgical antibiotic prophylaxis is one of well-documented measures to decrease the risk of infections. However, many situations threaten its proper application and thereby its effectiveness: patient already receiving antibiotics or carrying resistant germs, clinicians' misunderstanding about timing and duration of antibiotic prophylaxis or patient history of penicillin allergy. In this article we try to clarify these situations to favour good practice in perioperative antibiotic prophylaxis.

Background Antifungal treatment duration and changes for invasive mould infections (IMI) have been poorly described. Methods We performed a 10-year cohort study of adult (>= 18-year-old) allogeneic haematopoietic cell transplant recipients with proven/probable IMI to describe the duration and changes of antifungal treatment. All-cause-12-week mortality was described. Results Sixty-one patients with 66 IMI were identified. Overall treatment duration was 157 days (IQR: 14-675) and 213 (IQR: 90-675) days for patients still alive by Day 84 post-IMI diagnosis. There was at least one treatment change in 57/66 (86.4%) cases: median 2, (IQR: 0-6, range:0-8). There were 179 antifungal treatment changes due to 193 reasons: clinical efficacy (104/193, 53.9%), toxicity (55/193, 28.5%), toxicity or drug interactions resolution (15/193, 7.8%) and logistical reasons (11/193, 5.7%) and 15/193 (7.8%) changes due to unknown reasons. Clinical efficacy reasons included lack of improvement (34/104, 32.7%), targeted treatment (30/104, 28.8%), subtherapeutic drug levels (14/104, 13.5%) and other (26/104, 25%). Toxicity reasons included hepatotoxicity, nephrotoxicity, drug interactions, neurotoxicity and other in 24 (43.6%), 12 (21.8%), 12 (21.8%), 4 (7.4%) and 3 (5.5%) cases respectively. All-cause 12-week mortality was 31% (19/61), higher in patients whose antifungal treatment (logrank 0.04) or appropriate antifungal treatment (logrank 0.01) was started >7 days post-IMI diagnosis. All-cause 1-year mortality was higher in patients with >= 2 changes of treatment during the first 6 weeks post-IMI diagnosis (logrank 0.008) with an OR: 4.00 (p = .04). Conclusions Patients with IMI require long treatment courses with multiple changes for variable reasons and potential effects on clinical outcomes, demonstrating the need more effective and safer treatment options. Early initiation of appropriate antifungal treatment is associated with improved outcomes.

Quinolone's antibiotics, with their excellent biodisponibility, tissular penetration and broad spectrum of activity are commonly used in hospitals and outpatient settings. The properties of this class of antibiotics lead to overuse with inevitable selection of resistance, constantly rising in Switzerland. This article provides a summary of various elements useful to balance benefit/risk when using quinolones in daily clinical practice.

BackgroundThe Solidarity trial among COVID-19 inpatients has previously reported interim mortality analyses for four repurposed antiviral drugs. Lopinavir, hydroxychloroquine, and interferon (IFN)-β1a were discontinued for futility but randomisation to remdesivir continued. Here, we report the final results of Solidarity and meta-analyses of mortality in all relevant trials to date.MethodsSolidarity enrolled consenting adults (aged ≥18 years) recently hospitalised with, in the view of their doctor, definite COVID-19 and no contraindication to any of the study drugs, regardless of any other patient characteristics. Participants were randomly allocated, in equal proportions between the locally available options, to receive whichever of the four study drugs (lopinavir, hydroxychloroquine, IFN-β1a, or remdesivir) were locally available at that time or no study drug (controls). All patients also received the local standard of care. No placebos were given. The protocol-specified primary endpoint was in-hospital mortality, subdivided by disease severity. Secondary endpoints were progression to ventilation if not already ventilated, and time-to-discharge from hospital. Final log-rank and Kaplan-Meier analyses are presented for remdesivir, and are appended for all four study drugs. Meta-analyses give weighted averages of the mortality findings in this and all other randomised trials of these drugs among hospital inpatients. Solidarity is registered with ISRCTN, ISRCTN83971151, and ClinicalTrials.gov, NCT04315948.FindingsBetween March 22, 2020, and Jan 29, 2021, 14 304 potentially eligible patients were recruited from 454 hospitals in 35 countries in all six WHO regions. After the exclusion of 83 (0·6%) patients with a refuted COVID-19 diagnosis or encrypted consent not entered into the database, Solidarity enrolled 14 221 patients, including 8275 randomly allocated (1:1) either to remdesivir (ten daily infusions, unless discharged earlier) or to its control (allocated no study drug although remdesivir was locally available). Compliance was high in both groups. Overall, 602 (14·5%) of 4146 patients assigned to remdesivir died versus 643 (15·6%) of 4129 assigned to control (mortality rate ratio [RR] 0·91 [95% CI 0·82–1·02], p=0·12). Of those already ventilated, 151 (42·1%) of 359 assigned to remdesivir died versus 134 (38·6%) of 347 assigned to control (RR 1·13 [0·89–1·42], p=0·32). Of those not ventilated but on oxygen, 14·6% assigned to remdesivir died versus 16·3% assigned to control (RR 0·87 [0·76–0·99], p=0·03). Of 1730 not on oxygen initially, 2·9% assigned to remdesivir died versus 3·8% assigned to control (RR 0·76 [0·46–1·28], p=0·30). Combining all those not ventilated initially, 11·9% assigned to remdesivir died versus 13·5% assigned to control (RR 0·86 [0·76–0·98], p=0·02) and 14·1% versus 15·7% progressed to ventilation (RR 0·88 [0·77–1·00], p=0·04). The non-prespecified composite outcome of death or progression to ventilation occurred in 19·6% assigned to remdesivir versus 22·5% assigned to control (RR 0·84 [0·75–0·93], p=0·001). Allocation to daily remdesivir infusions (vs open-label control) delayed discharge by about 1 day during the 10-day treatment period. A meta-analysis of mortality in all randomised trials of remdesivir versus no remdesivir yielded similar findings.InterpretationRemdesivir has no significant effect on patients with COVID-19 who are already being ventilated. Among other hospitalised patients, it has a small effect against death or progression to ventilation (or both).FundingWHO.

BACKGROUND:Cutibacterium acnes is one of the major pathogens responsible for infection after shoulder surgery. Surgical dissection of the dermis may expose C acnes from sebum-producing hair follicles. Because of contact with the surgeon's gloves and instruments, further spread occurs throughout the surgical field. The purpose of this study was to determine whether subcutaneous tissue disinfection could reduce the C acnes culture rate in primary open shoulder surgery. METHODS:All patients eligible for primary open shoulder surgery by a deltopectoral approach were prospectively enrolled in our 2-arm, randomized, single-blinded clinical trial. In all patients, a skin swab of the operative field was taken prior to standard surgical skin preparation. After exposure of the deltoid fascia, the disinfection group received an additional preparation of the subcutaneous layer with povidone-iodine solution. Once the proximal humerus was completely exposed, 5 swabs from different sites were taken for microbiological examination according to a strict specimen collection protocol. All cultures were incubated in aerobic and anaerobic conditions for 14 days. RESULTS:Between February and December 2019, 108 patients were enrolled in the 2 groups: treatment (n = 70) and control (n = 38). The 2 groups did not show any significant difference in terms of sex, age, body mass index, or occurrence of diabetes. The subcutaneous disinfection protocol significantly reduced the positive culture rate of the operating field for all germs combined (P = .036) and specifically for C acnes (P = .013). The reduction of positive swabs for C acnes was significant for the surgeon's gloves (P = .041), as well as the retractors (P = .007). CONCLUSION:Disinfection of the subcutaneous tissue significantly reduced the C acnes culture rate during primary open shoulder surgery. We highly recommend this simple step as an adjunct to the current surgical practice to limit iatrogenic contamination of the surgical field. Future studies may observe a reduction in postoperative shoulder infection owing to this practice.