BACKGROUND:The European Society of Cardiology (ESC) diagnostic criteria for infective endocarditis (IE) were updated in 2023. Using a prospective multicentre cohort of patients treated for IE, we compared the performance of the 2023 ESC classification to that of 2015 ESC, 2019 European Heart Rhythm Association (EHRA) and 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) classifications in patients with or without cardiac implantable electronic devices (CIEDs). METHODS:A total of 1180 patients treated for IE between January 2017 and October 2022 were categorised as having either definite or possible/rejected IE within each classification. The gold standard diagnosis of IE was independently adjudicated by experts as 'certain' or not. Definite and 'certain' cases of IE were cross-tabulated to calculate sensitivity, specificity and accuracy.Suspicion of lead IE was defined by specific anatomical or metabolic features of cardiac lead infection on imaging; or by pulmonary embolism without valvular vegetation; or by positive culture of a lead extracted during open-heart surgery. RESULTS:In the 269 patients with CIEDs, 208 (77.3%) were adjudicated as 'certain IE'; 2023 Duke-ISCVID and 2023 ESC classifications achieved higher sensitivity (97.1% and 93.8%, respectively) but markedly lower specificity (31.1% and 41.0%, respectively) than 2015 ESC and 2019 EHRA classifications.In the 159 patients with CIEDs and lead IE (78.6% 'certain IE'), while sensitivity remained high for all classifications, specificity dropped for 2023 Duke-ISCVID and 2023 ESC classifications (11.8% and 32.4%, respectively), but not for 2019 EHRA classification (67.6%).In the 911 patients without CIEDs (81.0% 'certain IE'), sensitivity was higher than 96% for all classifications and specificity was 55.5%, 52.6% and 48.0% for 2015 ESC, 2023 Duke-ISCVID and 2023 ESC classifications, respectively. CONCLUSIONS:The 2023 ESC and 2023 Duke-ISCVID classifications had a higher sensitivity but a lower specificity than the 2015 ESC classification in patients with CIEDs, especially among those with lead IE. In patients with CIEDs, the 2019 EHRA classification was the most accurate.

Infective endocarditis (IE) is a potentially fatal condition. Early consultation with the nearest IE team and timely referral in the event of complications are recommended. This study investigated the association between receiving care in a reference centre and one-year mortality among patients with IE. Patients with definite IE enrolled in the EI 2008 cohort, a prospective population based-study, were categorised into three groups: 1) initially admitted to a reference centre (R); 2) initially admitted to a nonreference centre and subsequently referred to a reference centre (NR-R); and 3) exclusively managed in a nonreference centre (NR). Cox models were used for analysis. In our sample, 496 patients (279 R, 160 NR-R, and 57 NR) were included. Patients in the R and NR-R groups were younger and had a higher rate of indications for cardiac surgery. Overall, 142 patients (28.6%) died during follow-up. Care in a reference centre at any point was not associated with one-year mortality (crude-HR [95% CI]: 0.87 [0.57–1.33], p = 0.518; adjusted-HR 0.98 [0.62–1.56], p = 0.933). Further adjustment for valve surgery did not affect these results (adjusted HR 0.95 [0.59–1.53], p = 0.831). Management at a reference centre was not associated with one-year mortality. Trial registration: NCT03295045.

OBJECTIVES:To describe bacterial infections among people who inject drugs (PWID) in France, identify factors associated with systemic infection and define patient groups based on demographic and consumption profiles. METHODS:National, cross-sectional, multicenter study using spontaneous reports collected by the French Addictovigilance Network from January 2019 to December 2024. Local and systemic infections were compared to identify associated sociodemographic and injection-related factors. These variables were used to build patient profiles through hierarchical clustering approach. RESULTS:A total of 727 bacterial infections were analyzed (56% local and 44% systemic) in mainly men (79%), with a median age of 39 years. The most common infections were soft skin and tissue infections (65%), abscesses (51%), endocarditis (20%) and sepsis (15%). Cocaine (46.5%), heroin (16.5%) and buprenorphine (16.6%) were the main injected substances. Injecting stimulants only was associated with lower odds of systemic infection when compared to injecting a stimulants/opioids combination (OR 0.61 [95%CI: 0.40-0.93]) while older age (OR 1.02 [95%CI: 1.01-1.04]) and HIV-negative individuals not engaging in slam (OR 3.62 [95%CI: 1.46-8.98]) were associated with systemic infection compared to HIV-negative individuals engaging in slam. Five clusters were identified: I- Male, single substance injectors, opioids or stimulant, II- Female, single substance injectors, opioids or stimulant, III- Both opioids and stimulants injectors, IV- Young PWID, injectors of single substances outside opioids/stimulants presenting local infections, V- HIV-positive men, engaging in slam, having local infections. CONCLUSION:Our findings illustrate how the type of psychoactive substances and the sociodemographic profile are related to the infection type among PWID.

Guidelines recommend penicillin, amoxicillin or ceftriaxone for the treatment of streptococcal infective endocarditis (IE) but do not specify the criteria for choosing the β-lactam to be used. Our objectives were to identify which antibiotics are preferentially considered for susceptibility testing and treatment. A practice survey was addressed to infectious disease specialists and clinical microbiologists. The questionnaire was diffused to international learned societies as an online google form between September 2022 and 2023. 94 responses were collected, mainly from participants residing in Europe (60/94, 69

Background: While difficult-to-treat multidrug-resistant Gram-negative bacteria infections increase over time, the real-world effectiveness, use, and safety of ceftazidime-avibactam (CAZ-AVI) for treating hospitalized patients was assessed in 41 French centers. Procedures: OZAVIE was a prospective, multicenter, observational study conducted between March 2019 and November 2021. Hospitalized adult patients having initiated CAZ-AVI for infections within 14 days before enrolment were eligible. Demographic, clinical, microbiological, and therapeutic data were collected. Outcome was categorized as "failure" if the patient died from the initial infection, or if the infections persisted and required another antibiotic or surgery, or if CAZ-AVI was discontinued due to intolerance, and as "global success" otherwise. Patients whose outcome was not "failure", did not die and required no other antibiotics during the index hospitalization were categorized as "therapeutic success". Results: 257 patients were enrolled: 76 females/181 males, mean age 58.4 years, with diabetes (30.0 %), chronic renal failure (25.7 %), end-stage liver disease (9.3 %) and/or immunocompromised (31.1 %). CAZ-AVI was prescribed for nosocomial pneumonia (34.2 %), complicated urinary tract infections (17.5 %), complicated intraabdominal infections (14.8 %) and other specified sites (27.6 %). The main pathogens were Pseudomonas aeruginosa (52.4 %), Klebsiella spp. (34.9 %), Enterobacter spp. (18.4 %). Global and therapeutic successes were observed in 79.0 % and 63.4 % of patients, respectively, and 28-day mortality was 20.2 %. Overall, adverse events possibly related to CAZ-AVI were reported in 17.4 % of patients, including serious AEs in 6.2 %. Conclusions: CAZ-AVI is effective and well tolerated for treating various infections - including difficult-to-treat infection sites - and for treating various infections strains, including Pseudomonas aeruginosa and Enterobacter spp.

BACKGROUND:Although widely used, cefazolin efficacy for the treatment of meticillin-susceptible Staphylococcus aureus (MSSA) bacteraemia has not thus far been investigated in a clinical trial. In this study, we aimed to compare the efficacy and safety of cefazolin with that of cloxacillin in patients with MSSA bacteraemia. METHODS:We conducted an open-label, non-inferiority, randomised clinical trial in 21 university and non-university hospitals in France in adults (aged ≥18 years) with MSSA bacteraemia, without intravascular implant or suspicion of CNS infection. Participants were randomly assigned (1:1) to receive intravenously cefazolin (25-50 mg/kg every 8 h) or cloxacillin (25-50 mg/kg every 4-6 h) for the first 7 days of therapy using computer-generated blocks of various sizes and stratification on vascular-access associated bacteraemia and centre. Subsequent treatment was left to the choice of the investigator (total duration ≥14 days). The primary endpoint was a composite of sterile blood cultures at day 3 (day 5 for endocarditis) without relapse of bacteraemia, survival, and clinical success at day 90, and was assessed in the intention-to-treat population. A non-inferiority margin of 12% was chosen. This trial is registered on ClinicalTrials.gov (NCT03248063) and is complete. FINDINGS:Between Sept 5, 2018, and Nov 16, 2023, 315 participants were enrolled and assigned to cefazolin (n=158) or cloxacillin (n=157); 12 participants were excluded from analysis in the cefazolin group, and 11 in the cloxacillin group (final population of 146 in each group). Mean age was 62·7 years (SD 16·4), 215 (74%) participants were male, and race or ethnicity data were not collected. Median Pitt score was 0 (IQR 0-0). The primary endpoint was met in 109 (75%) of 146 participants in the cefazolin group versus 108 (74%) of 146 participants in the cloxacillin group (treatment difference -1%; 95% CI -11 to 9; p=0·012). At the end of study treatment, 22 (15%) of 146 participants assigned to cefazolin and 40 (27%) of 146 participants assigned to cloxacillin had had a serious adverse event (p=0·010). Acute kidney injury occurred more frequently in participants assigned to cloxacillin (15 [12%] of 128) than in those assigned to cefazolin (one [1%] of 134; p=0·0002). INTERPRETATION:Cefazolin constitutes an alternative to cloxacillin for the treatment of MSSA bacteraemia, offering non-inferior clinical efficacy and potentially enhanced tolerability. FUNDING:French Ministry of Health.

Un patient de 63 ans transplanté rénal a présenté une cryptococcose méningée et cutanée. L’examen mycologique de la biopsie cutanée a retrouvé Cryptococcus neoformans mais aussi un phaeohyphomycète, Alternaria alternata. Cette co-infection rare a pu être traitée par chirurgie et un traitement antifongique adapté.

OBJECTIVES:To report long-term clinical efficacy, safety, pharmacokinetics, immunogenicity and seroneutralization results of AZD7442 (monoclonal antibodies tixagevimab-cilgavimab) in patients hospitalized with COVID-19. METHODS:In this phase 3, double-blind, randomized, multicentre trial, hospitalized adults with PCR-confirmed SARS-CoV-2 infection were randomly assigned 1:1 to receive AZD7442 or placebo, and followed-up until day 456, with repeated blood sample collections until day 365. Clinical endpoints included clinical status, mortality, rehospitalization, SARS-CoV-2 reinfection, and adverse events. Antidrug antibodies and serum drug concentrations were measured. Analyses were performed on the modified intention-to-treat (mITT) populations, defined as participants who actually received the intervention. RESULTS:Between April 28, 2021, and June 23, 2022, 237 participants were randomly assigned to AZD7442 (n = 127) or placebo (n = 110), and 123 participants actually received AZD7442. Participants were infected with pre-Omicron variants in 58.8% (133/226) of cases, versus 33.2% (75/226) of Omicron BA1, BA2, or BA5, and 8% (18/226) missing data. There was no significant difference in the distribution of the 7-point ordinal scale between the AZD7442 and placebo groups, either on day 15 (primary endpoint) (OR = 0.93 [0.54-1.61], p 0.81), or any other time point. Significantly more rehospitalizations occurred between discharge and day 456 among participants who received AZD7442 in the global mITT population (OR = 2.04 [1.03-4.05], p 0.04), but not in the antigen-positive mITT population (OR = 1.78 [0.80-3.94], p 0.15). No significant differences were observed in mortality, SARS-CoV-2 reinfection, or adverse events. In the AZD7442 group, 12 of 87 participants (13.8%) had treatment-emergent antidrug antibodies versus 5 of 69 (7.2%) in the placebo group (OR = 2.02 [0.66-6.14], p 0.21). Serum drug concentrations were detectable up to day 365 for all sampled participants (35/35). Neutralizing antibody titres were significantly higher in the AZD7442 group up to day 180. CONCLUSIONS:AZD7442 did not demonstrate any clinical benefit and was safe up to 15 months. This study also provides valuable data on the pharmacokinetics, immunogenicity, and neutralizing activity of AZD7442 in patients hospitalized with COVID-19.

Background: Chlamydia trachomatis (CT) infections are among the most prevalent sexually transmitted infections (STIs), particularly affecting young adults. In women, CT can cause pelvic inflammatory disease, infertility, and ectopic pregnancy, justifying routine vaginal swab screening. However, due to diverse sexual practices, CT can colonize multiple anatomical sites, including the pharynx. Pharyngeal CT carriage in women is underdiagnosed and may contribute to ongoing transmission. Objectives and Methods: This study aimed to assess the rate of pharyngeal CT carriage, describe the rate of isolated pharyngeal CT carriage, and identify factors with pharyngeal CT carriage. We conducted a retrospective study at Montpellier University Hospital (France) and the public STI clinic of the city, including all cisgender women who provided at least one pharyngeal sample for CT testing between May 1st, 2018, and June 30, 2023. Results: A total of 567 women (median age 24 years) contributed 666 samples. Pharyngeal CT carriage was found in 2.8% of the population. Most cases were concurrent with vaginal CT, but 5 women had isolated pharyngeal carriage, representing 0.9% of the study population and accounting for 11.1% of detected cases. Young age and a history of CT infection appeared to be independently associated with pharyngeal CT carriage in multivariate mixed model analysis. Conclusion: We observed a pharyngeal CT carriage rate consistent with the literature, which was low but not insignificant. Notably, 11.1% of CT infections would have been missed without pharyngeal screening, underscoring the importance of considering extragenital testing.

BACKGROUND:Single-sampling strategy (SSS) for blood cultures (BCs) has not been evaluated in infective endocarditis (IE). We assessed the diagnostic performance of SSS versus conventional multisampling strategy (MSS) in IE diagnosis. METHODS:Patients suspected of IE were prospectively enrolled in 8 tertiary-care centers. Five BC bottle pairs were sampled from each patient. Pairs 1, 2, and 3 were sampled simultaneously, followed by 2 additional separate pairs (4 and 5) sampled more than 1 hour later. Pairs 1, 2, and 3 emulated SSS and pairs 1, 4, and 5 emulated MSS. The sensitivity and specificity of the major microbiologic criterion of the 2015 European Society of Cardiology IE diagnostic criteria, based on the SSS and MSS BC results, were calculated using the endocarditis team's diagnosis as the gold standard. RESULTS:An IE was diagnosed in 101 (39.4%) of the 256 patients enrolled. Sensitivity rates of SSS and MSS were 50.5% (95% CI: 40.7-60.2) and 45.5% (95% CI: 35.8-55.3), respectively (P = .063), whereas specificity rates were 94.8% (95% CI: 91.4-98.3) and 95.5% (95% CI: 92.2-98.8), respectively (P = 1). In IE patients, SSS compared to MSS accurately upgraded the diagnosis from possible to definite IE in 1 patient and downgraded it in none. CONCLUSIONS:Using SSS to define the major microbiologic criterion was as sensitive and specific as using MSS for diagnosing IE. Using SSS instead of MSS BC results did not lead to erroneous changes in diagnostic class according to the 2015 European Society of Cardiology criteria. Consequently, SSS may be regarded as standard practice for IE diagnosis.

Seoul virus (SEOV) is a worldwide ratborne orthohantavirus. We describe an SEOV infection in an adult returning to France from Kenya, followed by Guillain-Barré syndrome. We confirmed SEOV infection by PCR and sequencing. Although transmission might have occurred in Kenya, the epidemiologic information available is not sufficient to confirm that possibility.

Background The 2023 Duke-International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria. Methods Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals. Results Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval [CI], 91.6-94.8), 95.0% (95% CI, 93.7-96.4), and 97.6% (95% CI, 96.6-98.6), respectively (P < .001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2-67.4), 60.5% (95% CI, 54.4-66.6), and 46.0% (95% CI, 39.8-52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2-96.4), 96.5% (95% CI, 95.1-97.8), and 97.7% (95% CI, 96.6-98.8); specificity rates were 59.0% (95% CI, 51.6-66.3), 56.6% (95% CI, 49.3-64.0), and 53.8% (95% CI, 46.3-61.2), respectively. Conclusions Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED.

IntroductionL'infection de prothèse articulaire à Cutibacterium acnes peut survenir aux membres inférieurs. Il existe peu de données dans la littérature qui comparent les données cliniques et le taux d'échec entre les infections de prothèses d'épaule (PE) et de prothèses du membre inférieur (PMI).Matériels et méthodesIl s'agit d'une étude comparative rétrospective portant sur les infections de prothèses articulaires monomicrobiennes à C. acnes de l'épaule, du genou et de la hanche, survenues entre 2012 et 2022 dans 2 CHU de France. Nous avons comparé les données cliniques et les taux d'échecs entre les PE et les PMI et évalué les facteurs prédictifs d'échecs notamment en fonction de l'antibiothérapie choisie et du tableau clinique.RésultatsNous avons inclus 56 patients, 27 infections sur PE et 29 infections sur PMI. L'infection était aigue dans 4% (1/27) des cas sur les PE et dans 24% (7/29) sur les PMI (P=0,05). L'infection était précoce (< 1 an après implantation) dans 59% (16/27) des cas sur les PE et dans 79% (23/29) sur les PMI (p=0,15). La douleur était significativement plus souvent rapportée sur les PMI (97% vs 78% p=0,048). Le diagnostic d'infection n'était suspecté que dans 61% (34/56) des cas avant la chirurgie. Le délai médian entre la date des premiers symptômes et le diagnostic d'infection était de 144 jours pour les PE et 251 jours pour les PMI (p=0,3) Il n'y avait pas de différence sur la stratégie chirurgicale ni sur l'antibiothérapie hormis une tendance à utiliser plus de bithérapies pour traiter les PE (44% vs 24% pour les PMI ; p = 0,16). Les principaux antibiotiques utilisés plus de 7 jours étaient clindamycine (88%), rifampicine (29%), amoxicilline (16%), fluoroquinolone (13%). Le taux d'échec était élevé et tendait à être plus important pour les PMI, 10/27 (37%) contre 5/24 (21%) pour les PE (p=0,23). Le délai médian de survenue de l'échec était de 453 jours pour les PE et de 114 jours pour les PMI (p=0.75). Les raisons de l'échec étaient différentes avec significativement plus de rechutes au même agent infectieux pour les PE (17% vs 0% P=0,043), et plus d'infections à un agent différent pour les PMI (30% vs 4% p=0,03). Les seuls facteurs associés à l'échec étaient un tableau d'infection aigue (p=0,004) et la présence de signes inflammatoires (p=0,03). Il n'y avait pas d'impact significatif de la nature de l'antibiothérapie sur le pronostic, notamment de l'adjonction de rifampicine.ConclusionLes infections de prothèse articulaire à C. acnes sont fréquentes aux membres inférieurs et sont plus souvent aiguës et associées à un moins bon pronostic que celles survenant à l'épaule. Les échecs plus précoces et représentés par des infections par un agent infectieux différent suggèrent que ce moins bon pronostic pourrait être en partie dû à une co-infection non diagnostiquée lors de la chirurgie initiale. Dans cette cohorte traitée principalement par monothérapie de clindamycine, nous n'avons pas mis en évidence d'impact de l'adjonction de rifampicine.Aucun lien d'intérêt

Introduction La prise en soins des personnes vivant avec le VIH (PVVIH) reste primordiale dans le contexte d’évolution de leur suivi. L'objectif de cette enquête de pratique était d’évaluer l'approche et la vision des jeunes infectiologues concernant la prise en soins des PVVIH pour les dix prochaines années. Méthode Le questionnaire a été élaboré par un comité scientifique et diffusé en 2023 via le Réseau des Jeunes Infectiologues Français (RéJIF) auprès de 680 jeunes infectiologues français. Résultats Cent vingt (120) infectiologues ont répondu : 52 participants (43 %) étaient des internes en cours de formation, et un quart étaient titulaires d'un diplôme universitaire spécialisé en VIH. Les trois quarts des répondants prenaient en charge des PVVIH en consultation, et pour la quasi-totalité des répondants en hospitalisation.Le VIH est placé en troisième position des thématiques d'intérêt d'infectiologie, avec une demande majoritairement exprimée (dans 84 % des cas) d'améliorer la place qui lui est accordée dans l'enseignement durant l'internat. L'infectiologie était perçue par les répondants comme devant avoir un rôle pour les dix années à venir principalement dans la prise en soins initiale des PVVIH, la gestion de l’échec thérapeutique, la gestion des cas complexes et des co-infections (hépatites/IST), ainsi que pour les modifications du traitement antirétroviral. Les jeunes infectiologues ont souligné le potentiel de la téléexpertise pour le renouvellement du traitement antirétroviral et la mise à jour du calendrier vaccinal. Conclusion L'intérêt des jeunes infectiologues pour la prise en soins des PVVIH a été confirmé par cette enquête nationale. La consolidation de la formation dédiée ainsi que le développement de la téléexpertise ciblée sont les axes de développement principaux identifiés pour l'avenir de la spécialité.