Despite its dominance as a commensal, Staphylococcus lugdunensis (SLU) is a particularly virulent coagulase-negative Staphylococcus that is predominantly associated with community-acquired soft-tissue and skin infections. The aim of our study was to identify genotypic and phenotypic traits associated with the clinical presentations of SLU-associated infections, such as prosthetic joint infections, infective endocarditis (IE), and skin and soft tissue infections. Between January 2001 and December 2016, 73 pathogenic (including 18 strains responsible for IE) and 3 nonpathogenic SLU strains were retrospectively collected from nine French hospitals. All the strains belonged to six clonal complexes (CC1 to CC6) and 12 sequence types (STs). Interestingly, the capacity of the IE-associated strains to bind the von Willebrand factor was greater than that of the other strains, regardless of the CC. Biofilm formation was significantly increased for the most common CCs involved in infections (CC1, CC2, and CC3) and for IE-associated strains. The ability of SLU to inhibit other pathogens varied depending on the CCs caused by specific mutations within the lug operon that resulted in truncated protein expression. Genetic variants from genome virulence genes such as agrC and atIL also vary according to STs. The Galleria mellonella infection model revealed that CC4 was more virulent than the other CCs. On the basis of a large sequenced collection of SLU strains, we found that important phenotypic variation occurred among clinical strains and seemed to be related to some type of infection.IMPORTANCEStaphylococcus lugdunensis is a coagulase-negative Staphylococcus recognized for its virulence in human clinical infections. However, few studies have focused on investigating the phenotypic and genotypic aspects, as well as the population characteristics, of clinical strains involved in severe invasive infections such as endocarditis or skin and soft tissue infections, or of strains associated with so-called cutaneous carriage. Here, we compared different virulence gene variants in terms of populational aspects and also highlighted important phenotypic trait changes according to the clinical presentation and site of isolation of the strains.

Introduction: Coordinated practice supports a comprehensive approach combining infection prevention and the rational use of antibiotics (RUA), both essential to tackling antibiotic resistance effectively. Over 90% of prescriptions in France are issued in primary care, mainly by general practitioners. Purpose of the study: This study analyzes how RUA is integrated into the activities of Professional and Territorial Health Communities (CPTS; Communaut & eacute;s professionnelles territoriales de sant & eacute;) based on a survey of health care professionals in two CPTS from three French regions chosen for their engagement in national initiatives on antibiotic resistance. A total of 488 health care professionals were selected, with a participation rate of 32,4%. Results: The results show uneven awareness of RUA and the "One Health" concept among professionals. While antibiotic resistance is perceived as a major issue, its integration into the CPTS's objectives remains limited. The study highlights the need to improve interprofessional coordination and ongoing training to optimize RUA, adapting strategies to each profession's specific needs and strengthening collaboration with regional centers for antibiotic stewardship (CRAtb). Conclusion: Integrating antibiotic resistance into CPTS missions appears to be a key strategy for effectively addressing this public health issue at the local level.

OBJECTIVES:Antimicrobial resistance (AMR) is a critical public health issue, with overuse of antibiotics being a key driver. This study aimed to examine the determinants of antibiotic prescription in primary care in France, using nationwide panel data from 2022. METHODS:Data were obtained from several open sources. Antibiotic consumption was measured by the number of prescriptions of all systemic antibiotics per 1000 inhabitants, and patient, physician, healthcare system and seasonal viral outbreak (influenza and COVID-19) were considered as potential related factors. We then performed a linear multivariate regression model. RESULTS:The main findings were that patients <15 years (β = 7.36, P < 0.001), females (β = 9.54, P = 0.01), those with chronic diseases (β = 16.29, P < 0.001), white-collar workers (β = 3.40, P < 0.001) and European Deprivation Index score (β = 4.19, P < 0.001) had higher antibiotic prescription rates. Older physicians (age > 50 years: β = 1.35, P < 0.001) and those practising in areas with higher healthcare accessibility (Local Potential Accessibility score: β = 40.93, P < 0.001) were also associated with higher prescription volumes. In contrast, female physicians were linked to lower prescription rates (β = -0.62, P = 0.002). CONCLUSIONS:The study emphasizes the complexity of antibiotic prescription behaviours, showing that both clinical and non-clinical factors contribute to prescription patterns. It also highlights social and accessibility factors as significant drivers of antibiotic use. In order to be effective, strategies for the correct use of antibiotics must account for these different aspects.

Objectives: To analyse the time elapsed between the prescription of antibiotics and their pick-up at the pharmacy and identify their determinants. Methods: We used the National Health Insurance reimbursement databases on antibiotics delivery in 2021 in La Manche, Western France. Delayed delivery was defined as the time between prescription and antibiotic pick-up of >24 hours. Results: We enrolled 207 250 prescriptions, of whom 18 728 (9.0%) collected their antibiotics at the community pharmacy >24 hours after prescription. Independent factors associated with delayed delivery were age >15 years (15-64 years: OR, 2.08 [1.98-2.19]; p < 0.001 and >65 years OR, 3.27 [3.09 -3.46]; p < 0.001), male sex (OR, 00.77 [0.75-0.80]; p < 0.001), low income (OR, 1.08 [1.02-1.15]; p 1/4 0.013), chronic diseases (OR, 1.29 [1.25-1.34]; p < 0.001), prescription during the weekend (OR, 1.49 [1.43-1.56]; p < 0.001), summer season (OR, 1.11 [1.07-1.16]; p < 0.001), lock-down period (OR, 4.15 [3.80-4.53]; p < 0.001), and distance from the patient home to his general practitioner office and the pharmacy >10 km (OR, 1.17 [1.13-1.21]; p < 0.001). Discussion: The delayed delivery of antibiotics after prescription is not uncommon, especially in elderly patients, those with low income or chronic diseases, in case of weekend prescriptions, summer season and when the pharmacy is > 10 km away from the patient's home and his general practitioner office. If confirmed, this potential indicator of unnecessary prescriptions, readily available in some databases, may be used to target antimicrobial stewardship programmes and monitor the effect of interventions. (c) 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Objectives: In France, 75% of systemic antibiotics are prescribed by general practitioners (GPs) in primary care. We aimed to estimate the burden of inappropriate use related to excessive prescription duration. Patients and methods: In 2021, we performed a cross-sectional and pharmaco-economic study of a network of six GPs. The references for optimal durations were those of the French national guidelines for antibiotic prescription. Results: Out of 196 antibiotic prescriptions, 33.7 % were of excessive duration, with a mean excess of 0.9 [0.86-0.94] to 1.6 [1.45-1.72] days per prescription. Ear, nose, and throat, respiratory tract, and skin and skin structure infections were the main infections associated with excessive prescription. The pharmaco-economic analysis showed that the cost of excessive prescription duration would range from an estimated 151 to 262 million in France in 2021. Conclusion: Addressing excessive antibiotic prescription duration by GPs may represent a powerful and cost- saving tool in antimicrobial stewardship programs.

Antibiotic resistance poses a significant human and economic burden. In France, which ranks among the highest consumers of antibiotics in Europe, 93% of prescriptions are issued in primary care, primarily for respiratory tract infections. It is crucial to limit both the indications and the duration of antibiotic prescriptions, with recently updated recommendations in France aimed at achieving this goal. Our main objective was to evaluate whether general practitioners' antibiotic initiation and prescription durations for respiratory infections align with these recommendations. In this prospective cross-sectional study conducted over six weeks in two multi-professional health centers, all consultations for respiratory infections (in both adults and children) documented in patients' medical records were reviewed. Overall, 46.8% (N = 334/714) of consultations resulted in an antibiotic prescription (15.8% for nasopharyngitis and 83.5% for acute cough and bronchitis). Compliance with recommended antibiotic durations was observed in 66.7% (N = 476/714) [95% CI: 63.1%-70.0%] of consultations, with adherence rates exceeding 80% for nasopharyngitis and pharyngitis but falling below 20% for community-acquired pneumonia and acute cough and bronchitis. In total, 1,194 excess days of antibiotic therapy were identified, with an average excess of 1.7 days per prescription [95% CI: 1.4-1.9]. There remains significant room for improvement in both reducing the initiation of antibiotic treatments and shortening their prescribed durations. Managing acute coughs and bronchitis continues to be one of the key challenges in primary care. For nasopharyngitis, the high frequency of this condition translates into potentially large prescribing volumes on a collective scale. Efforts to promote the new paradigm of "shorter is better" for antibiotic prescription durations need to be intensified.

La réalisation d’une revue de la littérature a permis de faire le point sur l’efficacité des méthodes d’apprentissage de l’accouchement physiologique. Dix-sept études comportant une évaluation des méthodes testées ont été identifiées, neuf sur l’accouchement physiologique et huit sur la prévention des déchirures périnéales, toutes très différentes sur le plan méthodologique. Elles montraient dans leur ensemble un bénéfice de la formation sur simulateur, soit par comparaison avant/après la formation, soit par rapport à d’autres méthodes.

Introduction The use of high fraction of inspired oxygen (FiO2) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been replicated with varying success and subsequent meta-analysis are equivocal. Recent advancements in perioperative care, including the increased use of laparoscopic surgery and pneumoperitoneum and shifts in fluid and temperature management, can affect peripheral oxygen delivery and may explain the inconsistency in reproducibility. However, the published data provides insufficient detail on the participant level to test these hypotheses. The purpose of this individual participant data meta-analysis is to assess the described benefits and harms of intraoperative high FiO2compared with regular (0.21–0.40) FiO2 and its potential effect modifiers.Methods and analysis Two reviewers will search medical databases and online trial registries, including MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and WHO regional databases, for randomised and quasi-RCT comparing the effect of intraoperative high FiO2 (0.60–1.00) to regular FiO2 (0.21–0.40) on SSI within 90 days after surgery in adult patients. Secondary outcome will be all-cause mortality within the longest available follow-up. Investigators of the identified trials will be invited to collaborate. Data will be analysed with the one-step approach using the generalised linear mixed model framework and the statistical model appropriate for the type of outcome being analysed (logistic and cox regression, respectively), with a random treatment effect term to account for the clustering of patients within studies. The bias will be assessed using the Cochrane risk-of-bias tool for randomised trials V.2 and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. Prespecified subgroup analyses include use of mechanical ventilation, nitrous oxide, preoperative antibiotic prophylaxis, temperature (<35°C), fluid supplementation (<15 mL/kg/hour) and procedure duration (>2.5 hour).Ethics and dissemination Ethics approval is not required. Investigators will deidentify individual participant data before it is shared. The results will be submitted to a peer-review journal.PROSPERO registration number CRD42018090261.

Older adults living in nursing homes (NH) paid a heavy price to the COVID-19 pandemic, despite early and often drastic prevention measures. To study the characteristics and the impact of the pandemic on NH residents and professionals over 2 years. Cross-sectional study of COVID-19 clusters among residents and/or professionals in NH, from March 2020 to February 2022, in Normandy, France. We used data from the French mandatory reporting system, and cross-correlation analysis. The weekly proportion of NH with clusters was strongly correlated with population incidence (r > 0.70). Attack rates among residents and professionals were significantly lower in period 2 (vaccination rate in residents ≥ 50

BackgroundHealth care workers (HCWs) are particularly exposed to COVID-19 and therefore it is important to study preventive measures in this population. AimTo investigate socio-demographic factors and professional practice associated with the risk of COVID-19 among HCWs in health establishments in Normandy, France. MethodsA cross-sectional and 3 case-control studies using bootstrap methods were conducted in order to explore the possible risk factors that lead to SARS-CoV2 transmission within HCWs. Case-control studies focused on risk factors associated with (a) care of COVID-19 patients, (b) care of non COVID-19 patients and (c) contacts between colleagues. Participants2,058 respondents, respectively 1,363 (66.2%) and 695 (33.8%) in medical and medico-social establishments, including HCW with and without contact with patients. Results301 participants (14.6%) reported having been infected by SARS-CoV2. When caring for COVID-19 patients, HCWs who declared wearing respirators, either for all patient care (ORa 0.39; 95% CI: 0.29-0.51) or only when exposed to aerosol-generating procedures (ORa 0.56; 95% CI: 0.43-0.70), had a lower risk of infection compared with HCWs who declared wearing mainly surgical masks. During care of non COVID-19 patients, wearing mainly a respirator was associated with a higher risk of infection (ORa 1.84; 95% CI: 1.06-3.37). An increased risk was also found for HCWs who changed uniform in workplace changing rooms (ORa 1.93; 95% CI: 1.63-2.29). ConclusionCorrect use of PPE adapted to the situation and risk level is essential in protecting HCWs against infection.

OBJECTIVES: We aimed to evaluate the association between proton pump inhibitor (PPI) exposure and nosocomial infection (NI) during PICU stay. DESIGN: Propensity score matched analysis of a single-center retrospective cohort from January 1, 2017, to December 31, 2018. SETTING: Tertiary medical and surgical PICU in France. PATIENTS: Patients younger than 18 years old, admitted to the PICU with a stay greater than 48 hours. INTERVENTION: Patients were retrospectively allocated into two groups and compared depending on whether they received a PPI or not. MEASUREMENTS AND MAIN RESULTS: Seven-hundred fifty-four patients were included of which 231 received a PPI (31%). PPIs were mostly used for stress ulcer prophylaxis (174/231; 75%), but upper gastrointestinal bleed risk factors were rarely present (18%). In the unadjusted analyses, the rate of NI was 8% in the PPI exposed group versus 2% in the nonexposed group. After propensity score matching (n = 184 per group), we failed to identify an association between PPI exposure and greater odds of NI (adjusted odds ratio 2.9 [95% CI, 0.9-9.3]; p = 0.082). However, these data have not excluded the possibility that there is up to nine-fold greater odds of NI. CONCLUSIONS: This study highlights the prevalent use of PPIs in the PICU, and the potential association between PPIs and nine-fold greater odds of NI is not excluded.

Introduction: In the early phase of the coronavirus disease (COVID-19) epidemic in France, knowledge of SARS-COV-2 characteristics was limited, and personal protective equipment (PPE) was lacking. Thus, health care workers (HCWs) were exposed to nosocomial transmission. Methods: A multicenter regional descriptive study of fifty-two heath care facilities covering 30,533 HCWs in western Normandy, France, from March 3 to March 27, 2020, before the incidence threshold of 10/100,000 inhabitants was crossed in the study area. The incidence rate of COVID-19 in HCWs, the attack rates and the serial interval distribution of nosocomial transmission were computed. Demographic characteristics of HCWs, contacts with index cases, and the use of personal protective equipment were collected by a structured questionnaire. Results: The incidence rate of COVID-19 in HCWs was 2.7 parts per thousand. Among 19 situations (13 clusters >2 cases), 10 were HCW-HCW and 9 patient-HCW transmission, the global attack rate was 13.7% (95% confidence interval, 10.6%-17.3%), and 68 HCWs were involved (10 index cases, with 58 secondary cases). Exposure of secondary cases was only in the pre-symptomatic phase of the index case in 29% of cases, 48% for HCW-HCW and 10% for patient-HCW transmission (P<0.001). The mean serial interval was 5.1 days (95% CI, 4.2 - 5.9 days). Preventative measures were not optimal. Conclusions: Our investigation demonstrated that HCWs who were not assigned to the care of COVID-19 patients were not prepared for the arrival of this particularly insidious new virus, which spread rapidly from an often asymptomatic colleague or patient. (c) 2020 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction: Maternal underweight (BMI < 18.5) is an uncommon situation with potentially serious obstetric consequences, though data in the literature are scarce. Objective: To compare the obstetrical prognosis of patients with normal BMI and BMI < 18.5. Study design: We performed a retrospective study in France (Normandy). Results: We included 14,246 patients between January 2011 and November 2017, among whom 12,648 (88.8 %) had normal BMI, 1269 were considered mild underweight (17 <= BMI < 18.5 kg/m(2)) and 329 (2.3 %) were considered severe to moderate underweight (BMI < 17 kg/m(2)). The risk of preterm birth was all the greater as the thinness was severe (ORa: 1.34 [1.12-1.60] and ORa 1.77 [1.31-2.34]) and the risk of intrauterine growth retardation also increased with severe thinness (ORa: 1.63 [1.35-1.96] and ORa 2.28 [1.69-3.07]). The risk of a caesarean section or scheduled labour was no different. Neonatal parameters were comparable between the groups. Conclusion: Our study confirms an increased risk of preterm delivery and intrauterine growth retardation with increased thinness after adjusting for confounding factors. This link had only been shown previously in 2 studies Neither the type of prematurity (induced or spontaneous) nor the severity of prematurity is influenced by the severity of thinness; however, the low prevalence of thinness limits the power of these data. It would be interesting to study the medico-economic relevance of a policy of close maternal-foetal surveillance in this target population. (C) 2020 Published by Elsevier B.V.

Une étude rétrospective cas-témoins sur les accouchements extrahospitaliers inopinés à terme a été réalisée au centre hospitalier universitaire de Caen durant six ans. Malgré la politique de centralisation des maternités, leur incidence semble stable dans ce secteur géographique. Un certain nombre de facteurs de risque ont été identifiés. Si la morbidité maternelle n’augmente pas dans ce contexte, l’hypothermie néonatale est plus fréquente. Les efforts de prévention et de formation doivent être poursuivis.

RATIONALE, AIMS, AND OBJECTIVES:The objective was to measure the quality of clinical practice for the management of cystitis in adult women in general practice by collaborating with quality circles and the regional centre for antibiotic counsel.METHOD:This descriptive cross-sectional study was performed in 2018 in Normandy, France. A questionnaire composed of clinical vignettes was used to evaluate practices of general practitioners (GPs) with regard to cystitis classified into four categories: simple, at risk of complication, recurrent, and caused by multidrug-resistant bacteria. The 2017 French Infectious Diseases Society's guidelines were used as a reference.RESULTS:A total of 142 GPs participated in the study (45.5% of the solicited). Fosfomycin-trometamol and pivmecillinam were cited as first-line treatments for simple cystitis by 134 (94%) and 38 (27%) participants, respectively. For at risk of complication cystitis, the treatments cited were cefixime by 64 participants (45%), ofloxacin by 50 (35%), pivmecillinam by 49 (35%), fosfomycin-trometamol by 38 (27%), nitrofurantoin by 36 (25%), and amoxicillin-clavulanic acid by 28 (20%). Mean compliance rates were 85% for simple cystitis, 39% for at risk of complication cystitis, 60% for recurrent cystitis and 14% for cystitis caused by multidrug-resistant bacteria. Two criteria had less than 10% of the compliant answers: comprehensive knowledge of cystitis complication risk factors (9%) and positivity thresholds of urine cultures (10%).CONCLUSIONS:In this study, diagnostic means, follow-up testing, and simple cystitis treatment (with fosfomycin predominantly mentioned) were broadly compliant. The use of critical antibiotics was too frequent for at risk of complication cystitis. There may be a need to improve the knowledge of professionals on antibiotic resistance and appropriate antibiotic use.

Introduction: Obesity is currently not a medical indication for elective induction of labor although obese patients may not be eligible for expectant management after 41 W G. Few data on labor and complications in this population undergoing prolonged pregnancy are known. The objective of our study was to evaluate labor, mode of delivery, maternal and fetal outcomes in prolonged pregnancy in obese patients compared to normal body mass index (BMI). Materials and methods: It was a retrospective cohort study in patients who, after prolonged pregnancy gave birth to a single fetus, in cephalic presentation, between the first of January 2002 and December 31, 2018 in the Caen University Hospital Center. Patient's characteristics were compared within each BMI class using uni- and multivariate analysis with regression logistics models. Results: Overall, 9159 patients were included. Term of birth and spontaneous labor calculated rates were significantly increased in case of obesity (p < 0.001). The adjusted Odds Ratio (ORa) for induced labor in class III obesity was 1.73 [1.13-2.66]. After induction of labor, 83.0 % patients with normal BMI delivered vaginally versus 61.8 % in case of class III obesity (p < 0.001). The ORa for an emergency cesarean was 3.39 [2.04-5.63] and 1.78 [1.06-2.99] for neonatal morbidity in class III obesity. Conclusion: Morbid obese patients do not belong to a low risk patient's group when pregnancy is prolonged. Elective induction in case of morbid obesity may entail less risk than allowing the pregnancy to progress after 41 W G or even 39 W G. Further randomized prospective studies are nevertheless required. (C) 2020 Elsevier Masson SAS. All rights reserved.

BACKGROUND:Seasonal influenza has a major individual and collective impact, especially among the elderly living in nursing homes. To prevent infection by influenza viruses, vaccination of residents and professionals is an essential measure. However, while the vaccination rates of residents are generally high (>85%), rates among professionals are generally approximately 20%. To evaluate the effectiveness of an intervention campaign on the improvement of the influenza vaccination rate of professionals, a regional intervention study was proposed for nursing homes during the 2014-15 season. METHODS:Cluster-randomized controlled trial (with a nursing home representing a cluster). In the intervention group, a campaign on influenza vaccination was offered to staff, combining different teaching aids in a multimodal approach. In the control group, no intervention was proposed. The primary endpoint was the rate of influenza vaccination among staff. Before and after the study, professionals were asked to complete short questionnaires on their perceptions of influenza vaccination. A multilevel analysis was carried out to compare the vaccination rates between the 2 groups and their evolution before/after the winter period. RESULTS:A total of 32 nursing homes were randomized, and 6 were excluded. Initial vaccination rates were 27.6% in the intervention group and 24.2% in the control group (p = 0.16). After the study, these rates increased to 33.7% and 22.9%, respectively, which was a relative difference of +22.1% in the intervention group compared to -5.4% in the control group, p = 0.0025. CONCLUSIONS:Despite professionals' reluctance to be vaccinate, participation in a promotional campaign with a pragmatic approach has increased the rate of influenza vaccination. The approach will be offered to all nursing homes in the region after revision of the tools to enhance their ease of use and pedagogical messages focused on the direct benefits to professionals.

Among diagnostic tests for stillbirth, fetal autopsy is an important audit tool to identify the cause of death. However, many countries have reported a decrease in autopsy rates,1 ,2 due either to more frequent refusal from parents or to fewer proposals of this examination.We measured the evolution of autopsy refusal rate over a 10-year period in a French region and identified the circumstances associated with refusal: all fetal deaths registered in the Lower Normandy perinatal death registry from 2005 to 2014 were included (except induced abortions). The decade was divided into three periods to reduce …

Among diagnostic tests for stillbirth, fetal autopsy is an important audit tool to identify the cause of death. However, many countries have reported a decrease in autopsy rates,1 ,2 due either to more frequent refusal from parents or to fewer proposals of this examination. We measured the evolution of autopsy refusal rate over a 10-year period in a French region and identified the circumstances associated with refusal: all fetal deaths registered in the Lower Normandy perinatal death registry from 2005 to 2014 were included (except induced abortions). The decade was divided into three periods to reduce …