[Individual traceability to the instrument: Evolution of laser and micropercussion markings over the sterilisation cycles]. / Traçabilité individuelle à l'instrument : évolution des marquages laser et micropercussion au fil des cycles de stérilisation.

In order to implement individual instrument traceability, the evolution of laser and micropercussion markings was evaluated over 250 sterilisation cycles. A datamatrix associated with its alphanumeric code was applied on three types of instruments by laser or micropercussion. All instruments had a unique identifier affixed by the manufacturer. The sterilisation cycles corresponded to the usual cycles performed in our sterilisation unit. The laser markings had very good visibility but were quickly affected by corrosion: 12% of the markings were corroded after the 5th sterilisation cycle. Similar results were observed for unique identifiers applied by the manufacturer but with visibility attenuated by sterilisation cycles: 33% of identifiers were poorly visible after the 125th sterilisation cycle. Finally, micropercussion markings were less susceptible to corrosion but initially showed poorer contrast.

Dual Monoclonal Antibodies on Sars-Cov-2 Alpha and Delta Variants: Clinical and Virological Efficacy.

Monoclonal antibodies (MAbs) targeting the Spike glycoprotein of SARS-CoV-2 is a key strategy to prevent severe COVID-19. Here, the efficacy of two monoclonal antibody bitherapies against SARS-CoV-2 was assessed on 92 patients at high risk of severe COVID-19 between March and October 2021 (Bichat-Claude Bernard Hospital, Paris, France). Nine patients died despite appropriate management. From 14 days following treatment initiation, we observed a slower viral load decay for patients treated with the bitherapy Bamlanivimab/Etsevimab compared to the Casirivimab/Imdevimab association therapy (P = 0.045). The emergence of several mutations on the Spike protein known to diminish antiviral efficacy was observed from 1 to 3 weeks after infusion. The Q493R mutation was frequently selected, located in a region of joint structural overlap by Bamlanivimab/Etsevimab antibodies. Despite that this study was done on former SARS-CoV-2 variants (Alpha and Delta), the results provide new insights into resistance mechanisms in SARS-CoV-2 antibodies neutralization escape and should be considered for current and novel variants. IMPORTANCE Monoclonal antibody bitherapies (MAbs) are commonly prescribed to treat severe SARS-CoV-2-positive patients, and the rapid growth of resistance mutation emergence is alarming globally. To explore this issue, we conducted both clinical and genomic analyses of SARS-CoV-2 in a series of patients treated in 2021. We first noticed that the two dual therapies prescribed during the study had different kinetics of viral load decay. Rapidly after initiation of the treatments, resistance mutations emerged in the interface between the MAbs and the target Spike glycoprotein, demonstrating the importance to continuously screen the viral genome during treatment course. Taken together, the results highlight that viral mutations may emerge under selective pressure, conferring a putative competitive advantage, and could rapidly spread, as observed for the Omicron variant.

Do case vignettes accurately reflect antibiotic prescription?

BACKGROUND: Antibiotic prescription is frequently inappropriate in hospitals. Our objective was to evaluate whether the quality of antibiotic prescription could be measured using case vignettes to assess physicians' knowledge. METHODS: The study was conducted in 2 public teaching hospitals, where 33/41 units and 206/412 physicians regularly prescribing antibiotics to inpatients agreed to participate. A cross-sectional survey of knowledge was performed using 4 randomly assigned case vignette sets. Curative antibiotic prescriptions were then evaluated using standard criteria for appropriateness at initiation (day 0), after 2-3 days of treatment (days 2-3), and at treatment completion. We compared knowledge of the physicians with their observed prescriptions in the subset of 106 physicians who completed the case vignettes and prescribed antibiotics at least once. RESULTS: The median global case vignette score was 11.4/20 (interquartile range, 8.9-14.3). Of the 483 antibiotic prescriptions, 314 (65%) were deemed appropriate at day 0, 324 (72%) on days 2-3, and 227 (69%) at treatment completion. Prescriptions were appropriate at all 3 time points in only 43% of patients. Appropriate prescription was positively and independently associated with emergency prescription on day 0, documented infection on days 2-3, and 1 of the 2 hospitals at treatment completion. In addition, appropriateness at the 3 evaluation times was positively associated with prescription in anesthesiology or the intensive care unit. Case vignette scores above the median were significantly and independently associated with appropriate antibiotic prescription on days 2-3 and at treatment completion. CONCLUSIONS: Case vignettes are effective for identifying physicians or hospitals whose knowledge and practice regarding antibiotic prescription require improvement.

Antibiotic use: knowledge and perceptions in two university hospitals.

OBJECTIVES: To investigate knowledge and perceptions about antibiotic prescription in two university hospitals. METHODS: Physicians completed four case vignettes describing infections and a questionnaire. For each vignette, the physicians were asked to determine whether hospital admission and antibiotic treatment were needed; whether a treatment change was needed; and the duration of antibiotic treatment. The questionnaire collected data on beliefs and perceptions regarding antibiotic prescription. RESULTS: Of 412 eligible physicians, 206 agreed to participate. Factors associated with a vignette score above the median were anaesthesiologist/intensivist (adjusted odds ratio, 3.09; P=0.02), perception of inappropriate antibiotic use as risky for the patient (adjusted odds ratio, 2.84; P=0.03) and self-efficacy (adjusted odds ratio, 2.18; P=0.02), whereas being a surgeon was associated with a vignette score lower than the median (adjusted odds ratio, 0.14; P<0.0001). CONCLUSIONS: The high participation rate suggested awareness of antibiotic use. Educational programmes specifically targeted at surgeons are needed. We identified cognitive factors that affect knowledge of antibiotic prescription, and may help in the design of education programmes and interventions aimed at improving antibiotic use.