[Infectious diseases: what's new in 2023]. / Maladies infectieuses: ce qui a changé en 2023.

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.

L'année 2023 est marquée par la publication d'études touchant des domaines variés de l'infectiologie. La mortalité de pneumonies communautaires sévères est diminuée par l'administration de corticostéroïdes. Lors de rapport sexuel à risque, l'administration de doxycycline en prophylaxie postexpositionnelle diminue le risque d'infections sexuellement transmissibles bactériennes, cependant au risque de sélectionner des bactéries résistantes. Une préparation de plantes diminue la mortalité du sepsis. Une méta-analyse conclut que l'oseltamivir ne diminue pas significativement le risque d'hospitalisation lors de grippe. L'arrêt de la prophylaxie antibiotique lors d'intervention dentaire en Suède n'a pas augmenté l'incidence d'endocardite à streptocoques du groupe viridans. Plusieurs études ont mené à l'introduction de la vaccination VRS (virus respiratoire syncytial humain). 2023 a aussi vu la résurgence d'infections invasives à streptocoques du groupe A dont le clinicien doit se méfier.

When Enterococcus faecalis becomes a murderer.

We describe the case of a 64 years old patient, known for an Enterococcus faecalis endocarditis on a 25 mm Edwards-Carpentier biological aortic valve in 2020, who was re-hospitalized one year later in cardiac surgery for a recurrence of Enterococcus faecalisbacteriemia. During hospitalization, the patient presented a cardiac arrest. The coronarography revealed an acute occlusion of the left coronary artery. The autopsy confirmed an Enterococcus faecalis thrombus on aortic valve and left coronary artery. Although systemic embolism is a common complication of infective endocarditis, septic embolism is an unsual cause of acute coronary syndrome and a very rare cause of cardiac arrest. Our case highlights a rare and potentially fatal complication of infective endocarditis: acute coronary syndrome on septic coronary embolism.

Transcriptomic Signature Differences Between SARS-CoV-2 and Influenza Virus Infected Patients.

The reason why most individuals with COVID-19 have relatively limited symptoms while other develop respiratory distress with life-threatening complications remains unknown. Increasing evidence suggests that COVID-19 associated adverse outcomes mainly rely on dysregulated immunity. Here, we compared transcriptomic profiles of blood cells from 103 patients with different severity levels of COVID-19 with that of 27 healthy and 22 influenza-infected individuals. Data provided a complete overview of SARS-CoV-2-induced immune signature, including a dramatic defect in IFN responses, a reduction of toxicity-related molecules in NK cells, an increased degranulation of neutrophils, a dysregulation of T cells, a dramatic increase in B cell function and immunoglobulin production, as well as an important over-expression of genes involved in metabolism and cell cycle in patients infected with SARS-CoV-2 compared to those infected with influenza viruses. These features also differed according to COVID-19 severity. Overall and specific gene expression patterns across groups can be visualized on an interactive website (https://bix.unil.ch/covid/). Collectively, these transcriptomic host responses to SARS-CoV-2 infection are discussed in the context of current studies, thereby improving our understanding of COVID-19 pathogenesis and shaping the severity level of COVID-19.

[Cephalosporins in clinical practice]. / Céphalosporines : quelques considérations en pratique Clinique.

Cephalosporins belong to the betalactam group and are frequently prescribed in both out and inpatient settings. Their broad spectrum of activity allows a varied use in most medical specialties, ranging from preoperative prophylaxis to treatment of febrile agranulocytosis. There are currently five generations of cephalosporins, mainly differentiated according to their structure, spectrum of activity and side-effect profile. So-called siderophore cephalosporins are active against many multiresistant bacteria, especially in cases of complicated urinary tract infections or ventilator-associated pneumonia. This article intends to review some general clinical principles in prescription and monitoring of patients treated with cephalosporins.

Les céphalosporines, qui font partie du groupe des bêtalactamines, sont fréquemment prescrites en milieu ambulatoire comme en milieu hospitalier. Leur spectre d'activité étendu permet une utilisation variée dans la plupart des spécialités médicales, allant de la prophylaxie préopératoire au traitement de l'agranulocytose fébrile. Il existe actuellement cinq générations de céphalosporines, que l'on différencie essentiellement selon leur structure, leur spectre d'activité et leur profil d'effets secondaires. Les céphalosporines dites « sidérophores ¼ sont actives contre de nombreuses bactéries multirésistantes, notamment en cas d'infections urinaires compliquées ou de pneumonies liées à la ventilation mécanique. Cet article propose une synthèse de quelques principes généraux utiles pour la prescription et le suivi de patients traités par céphalosporines.

[Outbreak of listeriosis in Valais, 2020: review of causes of food contamination.] / Flambée de listérioses en Valais au printemps 2020: revue des sources de contamination alimentaire.

Listeria monocytogenes, a gram-positive bacterium, is the cause of Listeriosis. Its mortality is currently the highest for food borne diseases. Affected are mainly elderly or immunocompromised patients, as well as pregnant women. Despite food hygiene measures and surveillance, outbreaks are possible in developed countries. In the canton of Valais, six hospitalized cases including one death occurred between end of March and the beginning of May 2020. The typing of these strains of L. monocytogenes showed a link to a larger Swiss outbreak associated with contaminated soft cheese (Brie). The outbreak ended once the producer recalled the incriminated cheese. This article describes the outbreak with a review of other outbreaks' sources and a reminder of preventive measures.

La listériose humaine est due à Listeria monocytogenes, bactérie Gram positif. C'est aujourd'hui la plus mortelle des maladies transmises par les aliments. Elle est principalement responsable d'infections chez le sujet âgé ou immunodéprimé et la femme enceinte. Malgré des mesures d'hygiène et de surveillance, elle est toujours présente dans les pays développés, notamment en Valais où une série exceptionnelle de 6 cas hospitalisés, dont 1 décès, a été constatée entre fin mars et début mai 2020. Le typage des souches a permis d'établir le lien avec une flambée de listériose en Suisse associée à du Brie contaminé. L'épidémie a pris fin une fois l'alerte donnée et le produit retiré des circuits de distribution. Cet article décrit la flambée avec une revue des sources de contamination et un rappel des mesures de prévention.

[Toxin-infections and toxin-related diseases due to Clostridia other than Clostridium difficile]. / Toxi-infections et maladies toxiniques liées à des clostridies autres que Clostridium difficile.

Clostridia cause severe diseases. Tetanus is rare in Switzerland because of vaccine coverage and the application of guidelines for the management of contaminated wounds. Tetanus requires wound debridement and the administration of antibiotics and anti-tetanus immune. Besides gastroenteritis, infections due to C. perfringens most often require surgery, in addition to antibiotic treatment with penicillin and clindamycin. Botulism is a rare disease caused by a toxin produced by C. botulinum that causes flaccid paralysis. The clinical syndrome must be recognized early in order to administer the antitoxin and improve the prognosis. The other, rarer species of Clostridia require surgical and antibiotic management, but their prognosis remains poor.

Les clostridies causent des maladies graves. Le tétanos est rare en Suisse grâce à la vaccination et à l'application de directives pour la gestion des plaies souillées. Sa prise en charge nécessite un débridement de plaie, l'administration d'antibiotiques et d'immunoglobulines antitétaniques. En dehors des gastroentérites, les infections à C. perfringens nécessitent en règle générale une chirurgie, en sus d'une antibiothérapie par pénicilline et clindamycine. Le botulisme est une maladie rare due à une toxine produite par C. botulinum qui entraîne une paralysie flasque descendante. Le syndrome clinique doit être reconnu précocement afin d'administrer l'antitoxine et améliorer le pronostic. Les infections invasives dues à des espèces plus rares de clostridies nécessitent une prise en charge chirurgicale et l'administration d'antibiotiques, mais leur pronostic est défavorable.

Point prevalence of healthcare-associated infections and antibiotic use in three large Swiss acute-care hospitals.

BACKGROUND: The overall burden of healthcare-associated infections (HAIs) remains high, even in high-income countries. However, the current burden of HAI in Switzerland is unknown. Prevalence surveys have a long tradition in the field of infection prevention and control for measuring both HAI and antimicrobial use. The objective of this survey was to test the point prevalence survey (PPS) methodology of the European Centre for Disease Prevention and Control (ECDC) in acute-care hospitals in Switzerland. METHODS: Two tertiary care hospitals and one secondary care hospital in central and western Switzerland participated in the survey. Patients from all wards except for emergency departments and psychiatric wards were included. Data were collected on a single day for every ward with a maximum time frame of 2 weeks for completing data collection. Methodology and definitions were based on the most recent ECDC PPS protocol. RESULTS: Data on a total of 2421 patients were analysed. One hundred thirty-six patients had 153 HAIs, corresponding to a prevalence of 5.6% (95% confidence interval [CI] 4.7-6.5%). Rapidly fatal McCabe score, hospitalisation in the intensive care unit (ICU), and having a medical device in place were independent risk factors for HAI. Lower respiratory tract infection was the most frequent HAI type (24.8%), followed by surgical site infection (22.2%), bloodstream infection (17.0%) and urinary tract infection (13.7%). The highest HAI prevalence (26.2%) was observed in the ICU. In total, 60.8% of all HAIs were microbiologically confirmed. The most common microorganism was Escherichia coli (21.1%). Six hundred sixty-nine patients (27.6%, 95% CI 25.9-29.4%) received 893 antimicrobials for 705 indications. Community-acquired infections (39.0%) were the most common indication for antimicrobial use and amoxicillin-clavulanate was the most commonly prescribed antimicrobial (18.4%). CONCLUSIONS: HAI prevalence and antimicrobial use in this survey were similar to findings of the past ECDC PPS. The ECDC methodology proved applicable to Swiss acute-care hospitals.

[Infectious diseases]. / Maladies infectieuses.

The recommendations for the treatment of gonorrhea have been changed: ceftriaxone 500 mg IM plus azithromycin 1 g PO is recommended. Prophylaxis of recurrent cellulitis with penicillin 250 mg 2 x/d PO may be considered. E. coli ESBL does not require contact isolation anymore. Fecal transplantation seems so far to be the most effective treatment of recurrent C. dificile. Two new respiratory viruses, Middle East Coronavirus (MERS-CoV) and avian-origin Influenza A (H7N9) have been reported. Oral valganciclovir treatment reduces the risk of hearing loss in congenital CMV infection. An outbreak of mould infections of the central nervous system has been described in the United States following injection of contaminated steroids.

Underreporting of needlestick and sharps injuries among healthcare workers in a Swiss University Hospital.

OBJECTIVES: To determine 1) rates of needlestick and sharps injuries (NSSIs) not reported to occupational health services, 2) reasons for underreporting and 3) awareness of reporting procedures in a Swiss university hospital. MATERIALS AND METHODS: We surveyed 6,367 employees having close clinical contact with patients or patient specimens. The questionnaire covered age, sex, occupation, years spent in occupation, history of NSSI during the preceding twelve months, NSSI reporting, barriers to reporting and knowledge of reporting procedures. RESULTS: 2,778 questionnaires were returned (43.6%) of which 2,691 were suitable for analysis. 260/2,691 employees (9.7%) had sustained at least one NSSI during the preceding twelve months. NSSIs were more frequent among nurses (49.2%) and doctors performing invasive procedures (IPs) (36.9%). NSSI rate by occupation was 8.6% for nurses, 19% for doctors and 1.3% for domestic staff. Of the injured respondents, 73.1% reported all events, 12.3% some and 14.6% none. 42.7% of doctors performing invasive procedures (IPs) underreported NSSIs and represented 58.6% of underreported events. Estimation that transmission risk was low (87.1%) and perceived lack of time (34.3%) were the most common reasons for non-reporting. Regarding reporting procedures, 80.1% of respondents knew to contact occupational health services. CONCLUSION: Doctors performing IPs have high rates of NSSI and, through self-assessment that infection transmission risk is low or perceived lack of time, high rates of underreporting. If individual risk analyses underestimate the real risk, such underreporting represents a missed opportunity for post-exposure prophylaxis and identification of hazardous procedures. Doctors' training in NSSI reporting merits re-evaluation.

Outbreak of Mycobacterium haemophilum infections after permanent makeup of the eyebrows.

We report a Mycobacterium haemophilum outbreak after permanent make-up of the eyebrows performed by the same freelance artist. Twelve patients presented an eyebrow lesion and cervical lymphadenitis. All were treated with antibiotics. Surgery was required in 10 cases. M. haemophilum DNA was identified in the make-up ink.

Drug-induced long QT syndrome in injection drug users receiving methadone: high frequency in hospitalized patients and risk factors.

BACKGROUND: Drug-induced long QT syndrome is a serious adverse drug reaction. Methadone prolongs the QT interval in vitro in a dose-dependent manner. In the inpatient setting, the frequency of QT interval prolongation with methadone treatment, its dose dependence, and the importance of cofactors such as drug-drug interactions remain unknown. METHODS: We performed a systematic, retrospective study comparing active or former intravenous drug users receiving methadone and those not receiving methadone among all patients hospitalized over a 5-year period in a tertiary care hospital. A total of 167 patients receiving methadone fulfilled the inclusion criteria and were compared with a control group of 80 injection drug users not receiving methadone. In addition to methadone dose, 15 demographic, biological, and pharmacological variables were considered as potential risk factors for QT prolongation. RESULTS: Among 167 methadone maintenance patients, the prevalence of QTc prolongation to 0.50 second((1/2)) or longer was 16.2% compared with 0% in 80 control subjects. Six patients (3.6%) in the methadone group presented torsades de pointes. QTc length was weakly but significantly associated with methadone daily dose (Spearman rank correlation coefficient, 0.20; P<.01). Multivariate regression analysis allowed attribution of 31.8% of QTc variability to methadone dose, cytochrome P-450 3A4 drug-drug interactions, hypokalemia, and altered liver function. CONCLUSIONS: QT interval prolongation in methadone maintenance patients hospitalized in a tertiary care center is a frequent finding. Methadone dose, presence of cytochrome P-450 3A4 inhibitors, potassium level, and liver function contribute to QT prolongation. Long QT syndrome can occur with low doses of methadone.

SIADH consecutive to ciprofloxacin intake.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is often drug-induced. We describe the first case, to our knowledge, of SIADH consecutive to ciprofloxacin administration. On two occasions, a 70-year-old patient, known for post-actinic bladder with repeated episodes of hematuria, was given ciprofloxacin and developed severe hyponatremia with seizures. On both occasions, the patient's condition improved rapidly after withdrawal of the drug. As all organic diseases likely to cause SIADH were excluded, and because the drug rechallenge was positive, we suggest that ciprofloxacin be added to the list of drugs prone to induce SIADH.