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BACKGROUND: Bacterial infections have historically posed significant challenges until the discovery of antibiotics, which revolutionized infectious disease treatment. However, bacterial adaptation mechanisms over time have led to increased antimicrobial resistance, necessitating judicious antibiotic use. OBJECTIVES: This study aims to comprehensively analyze pharmaceutical interventions related to antibiotic prescriptions governed by antibiotic order forms to identify and rectify medication errors, optimizing antibiotic prescribing practices. MATERIAL AND METHODS: Approval for this research was obtained from the institutional review board of the Main Military Training Hospital of Tunis, Tunisia. A retrospective study was conducted at the main military training hospital of Tunis over 4 months. Pharmaceutical validation of antibiotic prescriptions through antibiotic order forms was conducted by a pharmacy resident. Pharmaceutical interventions were initiated upon detection of errors, and patient records were accessed through institutional software. RESULTS: Out of 1100 prescription forms analyzed, 41 pharmaceutical interventions were conducted for 7 antibiotics. Twenty-four percent of all interventions were related to antibiotic order forms, with the intensive care unit accounting for the highest number of errors. Under-dosage and prescription errors were common. CONCLUSION: Our pharmaceutical interventions related to antibiotic order forms are crucial for optimizing antibiotic therapy. Feedback mechanisms to healthcare teams are essential for enhancing prescription quality and patient care outcomes. Ongoing surveillance and improvement efforts are necessary to address medication errors and enhance antimicrobial stewardship.

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INTRODUCTION: The escalating bacterial resistance stands as an increasingly pertinent concern, particularly in the post-pandemic era where the use of antibiotics appears to be relentlessly surging, giving rise to profound apprehensions. The substantial utilization of last-generation penicillins and cephalosporins is anticipated to imminently result in the emergence of superbugs for which therapeutic solutions will be scarce. METHODS: An analysis of antibiotic consumption in the hospital setting has been conducted in an Italian healthcare organization. Querying the internal management system facilitated the calculation of indicators and assessment of prescription trends. RESULTS: A comparison has been made between the first half of 2023 and the first half of 2022, to highlight the exponential growth in the consumption of beta-lactam antibiotics, with consumption doubling compared to the previous year's semester. Overall, considering the prescription averages, there is a prescribing growth of +29% concerning hospitalization and +28% concerning hospital discharge. However, it should be noted that the consumption of certain antibiotics such as sulphonamides and trimethoprim (-103.00%), tetracyclines (-54.00%), macrolides, lincosamides and streptogramins (-50.00%) and colistin (-13.00%) decreased. CONCLUSION: This real-world evidence analysis aimed to support the justified and comprehensible global concerns regarding bacterial resistance. The extensive consumption of antibiotics will inevitably lead to the development of increasingly drug-resistant bacteria for which no antibiotic may be efficacious. National programs addressing antibiotic resistance and the awareness of all healthcare personnel must be accorded the utmost priority to enhance consumption data and, consequently, safeguard future human survival.

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Antibiotic resistance is the direct deleterious consequence of two synergistic causes linked to human activity: the massive use of antibiotics in human and animal health, which leads to the selection of the most resistant bacteria, and the spread of these selected resistant bacteria, directly by cross-transmission within human and animal populations and indirectly via the environment. The "one health" concept enables an integrated approach of the various components of the issue, linking human, animal and environmental ecosystems and their dynamics.

La résistance aux antibiotiques est la conséquence délétère directe de deux causes synergiques liées à l'activité humaine : l'utilisation massive d'antibiotiques en santé humaine et animale, qui entraîne la sélection des bactéries les plus résistantes, et la dissémination des bactéries résistantes ainsi sélectionnées, directement par transmission au sein des populations humaines et animales (« transmission croisée ¼), et indirectement via l'environnement. Le concept « une seule santé ¼ permet une approche intégrée des différentes composantes de la question, en permettant de relier les écosystèmes humains, animaux et environnementaux et leurs dynamiques.

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The fight against antibiotic resistance must incorporate the "One Health" concept to be effective. This means having a holistic approach embracing the different ecosystems, human, animal, and environment. Transfers of resistance genes may exist between these three domains and different stresses related to the exposome may influence these transfers. Various targeted or pan-genomic molecular biology techniques can be used to better characterise the dissemination of bacterial clones and to identify exchanges of genes and mobile genetic elements between ecosystems.

La lutte contre la résistance aux antibiotiques doit intégrer le concept «  Une seule santé  ¼ pour être efficace. Ceci consiste à avoir une approche holistique embrassant les différents écosystèmes, homme, animal et environnement. Des transferts de gènes de résistance peuvent exister entre ces trois domaines et différents stress liés à l'exposome peuvent influencer ces transferts. Différentes techniques de biologie moléculaire ciblées ou pan-génomiques peuvent être mises en œuvre pour mieux caractériser les circulations de clones bactériens mais aussi pour identifier les échanges de gènes et d'éléments génétiques mobiles entre écosystèmes.

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Melioidosis is an infectious, tropical and emerging disease, due to a bacterium of the hydrotelluric environment, Burkholderia pseudomallei, which is considered as a potential biological weapon because of its exceptional resistance and virulence capacities. Its worldwide spread, outside the original endemic foci of Southeast Asia and Australia, is favoured by global warming and the diabetes mellitus pandemic, which is the main predisposing factor.In humans, melioidosis is an opportunistic infection, following professional (rice farmers, soldiers) or accidental contamination, by inhalation or inoculation. B. pseudomallei is a facultative intracellular bacterium that can overcome host immune defences, induce acute, subacute, or chronic invasive infection, or remain latent for years. The acute infection is polymorphic, bacteraemic in more than 50% of cases, frequently complicated by shock, and revealed by visceral abscesses, most often pulmonary. It is fatal in 20 to 50% of cases, the prognosis depending on the delay before the establishment of effective first-line antibiotic therapy, using ceftazidime or carbapenems, and therefore on the speed of bacteriological diagnosis.B. pseudomallei is a saprophytic bacterium, resident of the rhizosphere where it has developed and accumulated capacities to overcome environmental stresses and competition with organisms living in such ecosystem. These adaptation mechanisms are also the virulence factors that make melioidosis serious, in particular the efflux pumps that are the main support for its multi-resistance to antibiotics.

La mélioïdose est une maladie infectieuse, tropicale et émergente, due à une bactérie de l'environnement hydrotellurique, Burkholderia pseudomallei, qui est considérée comme arme biologique potentielle en raison de ses exceptionnelles capacités de résistance et de virulence. Son extension mondiale, en dehors des foyers endémiques originels d'Asie du Sud-Est et d'Australie, est favorisée par le réchauffement climatique et par la pandémie de diabète de type 2 qui en est le principal facteur prédisposant.Chez l'Homme, la mélioïdose est une infection opportuniste, consécutive à une contamination professionnelle (riziculteurs, militaires) ou accidentelle, par inhalation ou par inoculation. B. pseudomallei est une bactérie intracellulaire facultative qui peut déjouer les défenses immunitaires de l'hôte, induire une infection invasive, aiguë, subaiguë ou chronique, ou rester latente pendant des années. L'infection aiguë est polymorphe, bactériémique dans plus de 50 % des cas, fréquemment compliquée de choc, et révélée par des abcès viscéraux le plus souvent pulmonaires. Elle est mortelle dans 20 à 50 % des cas, le pronostic dépendant du délai avant la mise en place d'une antibiothérapie efficace, utilisant la ceftazidime ou les carbapénèmes, donc de la rapidité du diagnostic bactériologique.B. pseudomallei est une bactérie saprophyte, résidente de la rhizosphère où elle a développé et accumulé des capacités pour supporter les stress environnementaux et la compétition avec les organismes vivant dans cet écosystème. Ces mécanismes d'adaptation sont aussi les facteurs de virulence qui font toute la gravité de la mélioïdose, en particulier les pompes d'efflux qui sont le support principal de sa multirésistance aux antibiotiques.

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Mycobacterium abscessus is a fast-growing non-tuberculous mycobacteria complex causing pulmonary infections, comprising the subspecies abscessus, massiliense and bolletii. Differences are based predominantly on natural inducible macrolide resistance, active in most Mycobacterium abscessus spp abscessus species and in Mycobacterium abscessus spp bolletii but inactive in Mycobacterium abscessus spp massiliense. Therapy consists in long-term treatment, combining multiple antibiotics. Prognosis is poor, as only 40% of patients experience cure. Pharmacodynamic and pharmacokinetic data on M. abscessus have recently been published, showing that therapy ineffectiveness might be explained by intrinsic bacterial resistance (macrolides…) and by the unfavorable pharmacokinetics of the recommended antibiotics. Other molecules and inhaled antibiotics are promising.

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PURPOSE: To compare the safety and efficacy of fortified antibiotics and fluoroquinolones in the treatment of bacterial keratitis. METHODS: PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched for randomized controlled trials (RCT) of treatment of bacterial keratitis with fortified antibiotics and fluoroquinolones. Rev Man 5.3 software was used to analyze outcome index cure rate, time to cure, and adverse events in a meta-analysis. RESULTS: After literature search and screening, 9 randomized controlled trials were included in this study. Compared with traditional fortified antibiotic therapy, fluoroquinolones show consistency in terms of cure rate and incidence of adverse events: cure rates (OR=0.99, 95% CI: 0.75, 1.30) and incidence of adverse events (OR=0.75, 95% CI: 0.48, 1.17). However, the time to cure for fluoroquinolones was shorter than that of fortified antibiotics (MD=0.96, 95% CI: 0.50, 1.41). CONCLUSION: The cure rate and safety of fluoroquinolones are equivalent to those of fortified antibiotics, so it seems reasonable to use fluoroquinolones as the preferred treatment for bacterial keratitis.

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OBJECTIVES: To assess the impact of interventions of a clinical pharmacist in a unit of orthopedic surgery specialized in bone and joint infections. METHODS: Daily, in routine, a clinical pharmacist analyzed medication prescribed to inpatients via a computerized physician order entry (CPOE) (Phedra software). His attention was particularly focused on the impact of antibiotics on other medications. For this study, all of the pharmacist interventions (PI) have been retrospectively collected, then anonymized, and assessed over a two-month period. RESULTS: Thirty-eight patients were hospitalized during the study period, with a mean age of 63 years old. Forty-five interventions were identified which represents a mean of 1.18 pharmaceutical interventions per patient. Most of them concerned lack of follow-up (24%) and drug-drug interactions (22%) and widely non-anti-infectious medication (35 interventions) with levothyroxine (10 interventions) as the most involved non-anti-infectious molecule. Among antibiotics, with respectively 9 and 8 interventions, rifampicin and fluoroquinolones (6 interventions for moxifloxacin) were the most concerned notably for drug-drug interactions with usual treatment. CONCLUSION: In this observational retrospective study, 1.18 pharmacist interventions (PI) per patient were observed. Most of them are lack of follow-up and drug-drug interactions especially with usual treatment of patients. Moxifloxacin and rifampicin were the most antibiotics involved. Patients' characteristics (older, polypharmacy), long-term hospitalization and surgery are known to be predictive factors of medication errors and this study highlights the importance of the presence of clinical pharmacist in orthopedic surgery wards.

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INTRODUCTION: The aim of this study was to evaluate the current use of antibiotics by Swiss equine veterinarians and to compare the results with a similar study from 2013 before the introduction of the web tool Antibiotic Scout. The survey was sent to equine veterinarians according to the member database of the Swiss Veterinary Association (GST, SVS). The demographic data of the respondents and their antibiotics usage were collected. In addition, six different case scenarios were presented with questions to their potential antibiotic usage, active substance/preparation and the dosing scheme. The dosage provided was compared with the dosage information approved by Swissmedic in the information for healthcare professionals and the recommendations of the antibiotic scout. A backward logistic regression analysis was performed to assess the association between different aspects of antibiotic use and demographic data. The response rate was 94/739 (13 %), 22 of the 94 (23 %) had also participated in the 2013 study. 47/94 (50 %) of the respondents obtained their information from the antibiotic scout. The respondents indicated that they used an antibiotic in 16 %-88 % depending on the case scenario. Neither 3rd nor 4th generation cephalosporins or fluoroquinolones were used in the case scenarios. Dihydrostreptomycin was indicated as a possible antibiotic in a case scenario by 14/94 (15 %) of the respondents. Respondents who had already taken part in the 2013 survey used dihydrostreptomycin significantly more frequently (7/22, 32 % vs. 7/72, 10 %; p = 0,047). 29/81 (36 %) had underdosed compared to the prescribing information and 38/81 (47 %) compared to the antibiotic scout; neither was associated with demographic data. The use of non-equine-licensed antimicrobial products was directly related to the number of veterinarians in the practice (p = 0,007) and to the percentage of horses (p = 0,02). No association between demographics and peri-operative antibiotic use >24h (17/44, 39 %) was detected. The antibiotic prescribing habits of Swiss equine veterinarians have improved over the last 10 years. The antibiotic use decreased compared to the study of Schwechler et al. in 2013 by 0-16 % depending on the case scenario. The use of 3rd and 4th generation cephalosporins was reduced by 4 % and fluoroquinolones by 7 %. Underdosing according to scientific recommendations was reduced by 32 %. Furthermore, there is a need for additional information regarding the indication for antimicrobial use and the adequate use of perioperative antibiotics.

INTRODUCTION: L'objectif de cette étude était d'évaluer l'utilisation actuelle des antibiotiques par les vétérinaires équins suisses et de comparer les résultats avec une étude similaire de 2013 avant l'introduction de l'outil web AntibioticScout. L'enquête a été envoyée aux vétérinaires équins selon la base de données des membres de la Société des Vétérinaires Suisses (SVS). Les données démographiques des répondants et leur utilisation d'antibiotiques ont été collectées. En outre, six scénarios de cas différents ont été présentés avec des questions quant à l'utilisation potentielle d'antibiotiques, la substance active/préparation et le schéma posologique. La posologie fournie a été comparée à celle approuvée par Swissmedic dans les informations destinées aux professionnels de la santé et aux recommandations de l'AntibioticScout. Une analyse de régression logistique inverse a été réalisée pour évaluer l'association entre les différents aspects de l'utilisation des antibiotiques et les données démographiques. Le taux de réponse était de 94/739 (13 %), 22 des 94 (23 %) avaient également participé à l'étude de 2013. 47/94 (50 %) des répondants ont obtenu leurs informations à partir de AntibioticScout. Les répondants ont indiqué avoir utilisé un antibiotique dans 16 %-88 % selon le cas de figure. Ni les céphalosporines de 3ème ou 4ème génération ni les fluoroquinolones n'ont été utilisées dans les scénarios de cas. La dihydrostreptomycine a été indiquée comme un antibiotique possible dans un scénario de cas par 14/94 (15 %) des répondants. Les répondants qui avaient déjà participé à l>enquête de 2013 ont utilisé la dihydrostreptomycine significativement plus fréquemment (7/22, 32 % vs. 7/72, 10 % ; p = 0,047). 29/81 (36 %) avaient sous-dosé par rapport aux informations de prescription et 38/81 (47 %) par rapport à AntibioticScout ; ni l'un ni l'autre n'était associé aux données démographiques. L'utilisation de produits antimicrobiens non homologués pour les équidés était directement liée au nombre de vétérinaires dans le cabinet (p = 0,007) et au pourcentage de chevaux (p = 0,02). Aucune association entre les données démographiques et l'utilisation périopératoire d'antibiotiques >24h (17/44, 39 %) n'a été détectée. Les habitudes de prescription d'antibiotiques des vétérinaires équins suisses se sont améliorées au cours des 10 dernières années. L'utilisation d'antibiotiques a diminué par rapport à l'étude de Schwechler et al. en 2013 de 0 à 16 % selon le scénario du cas. L'utilisation des céphalosporines de 3ème et 4ème génération a été réduite de 4 % et les fluoroquinolones de 7 %. Le sous-dosage selon les recommandations scientifiques a été réduit de 32 %. Il est d'autre part nécessaire d>obtenir des informations supplémentaires concernant l>indication de l>utilisation d>antimicrobiens et l>utilisation adéquate des antibiotiques périopératoires.

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BACKGROUND: The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM: This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD: We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT: The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS: Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

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BACKGROUNDS: Necrotizing fasciitis is a severe bacterial infection characterized by involvement of all skin's layers, including the superficial fascia. Diagnosis and treatment must be as quick as possible. Once suspected, extensive surgical debridement is required. METHODS: All necrotizing fasciitis, managed in our hospital in Dijon, during the period from January 2011 to May 2021, were retrospectively analyzed. Demographics characteristics of patients, biological parameters, and type of bacteria were collected. Statistical analysis was performed on the cost of hospitalization, as well as on the death rate between type I and II NF and the speed of management. Student's t-test and Chi2 test were performed with a significant level P<0.05. FINDINGS: A total of 65 patients were included over the period. The mean age was 68.8 years. The average length of stay was 32.4 days, with an average cost of 79,305 €. The main locations were the lower limbs (57%) and the perineum (35%). Cost of hospitalization did not differ between type I and II (P=0.21), unlike mortality rate (P=0.003). Furthermore, the mortality rate according to the speed of management did not vary in our series (P=0.45). CONCLUSION: Necrotizing fasciitis is quickly fatal if left untreated. Early diagnosis, combined with surgical debridement and probabilistic antibiotic therapy are required. Our study shows the impact of necrotizing fasciitis in terms of cost to society and the importance of prevention of certain risk factors. A global management of the patient is necessary to increase the survival rate.

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BACKGROUND: Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital. METHODS: Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded. RESULTS: In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8-15.6 days). CONCLUSIONS: Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.

HISTORIQUE : Chez les patients hospitalisés, une fenêtre de 48 heures après le moment de l'hospitalisation définit les infections nosocomiales et oriente la sélection d'antibiotiques empiriques. Cette période peut favoriser la surutilisation d'antibiotiques à large spectre. L'objectif primaire de l'étude visait à déterminer la période la plus courte et la période médiane à compter de l'admission pour que les patients admis en soins intensifs à partir d'un hôpital universitaire de soins tertiaires contractent des agents pathogènes antibiorésistants. MÉTHODOLOGIE: Les chercheurs ont procédé à un examen rétrospectif des dossiers des patients adultes admis en soins intensifs à partir de la maison ou d'un autre hôpital de la même autorité sanitaire en 2018, afin de déterminer la période avant de contracter des agents pathogènes associés au milieu hospitalier : Staphylococcus aureus résistant à la méthicilline, entérocoque résistant à la vancomycine, Enterobacterales producteurs de bêta-lactamases à spectre élargi (BLSE), Enterobacterales résistant à la ceftriaxine non producteurs de BLSE, Pseudomonas aeruginosa et Stenotrophomonas maltophilia. Ont été exclus les patients transférés d'un hôpital hors de l'autorité sanitaire, admis en soins intensifs plus de 14 jours après l'hospitalisation, receveurs d'un organe plein ou de moelle osseuse ou autrement immunodéprimés. RÉSULTATS: En 2018, 1 343 patients ont été admis en soins intensifs, dont 820 respectaient les critères d'inclusion. De ce nombre, 121 (14,67 %) ont contracté un agent pathogène en soins intensifs. La probabilité d'isoler un tel agent dans les 48 heures suivant l'admission en milieu hospitalier s'élevait à 3 %. Ces agents pathogènes ont été isolés au plus tôt 29 heures après l'hospitalisation, et au bout d'une période médiane de neuf jours (plage interquartile [PIQ] 3,8 à 15,6 jours). CONCLUSIONS: La plupart des patients (85,3%) de cette unité de soins intensifs n'ont jamais contracté d'agent pathogène associé au milieu hospitalier. Selon la période médiane avant d'acquérir un tel agent pathogène chez les autres patients, il serait prématuré d'entreprendre une antibiothérapie à large spectre au seuil de 48 heures.

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INTRODUCTION: The aim of the study was to evaluate the use of intramammary antibiotics before, during and after the elimination of Staphylococcus aureus genotype B (SAGTB). Data on intramammary antibiotic use was collected in 65 dairy farms as part of a pilot project for SAGTB elimination in the canton of Ticino from 2017 to 2019. The investigated farms were divided into 46 affected farms (with at least one SAGTB-positive animal) and 19 control farms (SAGTB-free farms). Data on antibiotic use were requested from veterinarians and treatment incidence, as a measure of antibiotic use, was calculated based on medical records and veterinary prescriptions. In addition, the treatment incidence was calculated for 47 farms during alpine farming period. In 2018 (elimination year), the mean incidence of treatment during lactation in the SAGTB-positive farms was significantly higher than in the control farms (p=0,003). In 2019 no significantly lower antibiotic use during lactation or dry period was detected between 2017 (before elimination) and 2019 (after elimination). Alpine farming places where only S. aureus genotype B-negative animals had access to had a significantly lower antibiotic use during lactation (p=0,004). The new federal database (Antibiotics Information System in Veterinary Medicine, IS ABV) should allow continuous monitoring and to confirm the reduction of antibiotic use in the coming years.

INTRODUCTION: L'objectif de l'étude était d'évaluer la consommation d'antibiotiques intramammaires avant, pendant et après l'assainissement de Staphylococcus aureus génotype B (SAGTB). Dans le cadre d'un projet pilote d'assainissement SAGTB dans le canton du Tessin, l'étude a recueilli des données sur la consommation d'antibiotiques intramammaires de 2017 à 2019 dans 65 exploitations laitières réparties en 46 exploitations test (avec au moins un animal positif au SAGTB) et 19 exploitations témoins (exploitations exemptes de SAGTB). Les données relatives à la consommation d'antibiotiques ont été demandées aux vétérinaires et, grâce aux enregistrements et aux prescriptions des vétérinaires, il a été possible de calculer l'incidence du traitement en tant que mesure de la consommation d'antibiotiques. En outre, l'incidence des traitements pendant l'alpage a également pu être calculée pour 47 exploitations. En 2018 (année d'assainissement), l'incidence des traitements pendant la lactation était en moyenne significativement plus élevée dans les exploitations SAGTB-positives que pour les exploitations de contrôle (p=0,003). En comparant 2017 (avant l'assainissement) et 2019 (après l'assainissement), il n'y a pas eu de baisse significative de la consommation d'antibiotiques pendant la lactation et le tarissement en 2019. Dans les exploitations d'estivage, on a constaté l'année suivant l'assainissement (2019) une consommation d'antibiotiques significativement plus faible pendant la lactation pour les alpages qui n'accueillaient que des animaux négatifs à S. aureus génotype B (p=0,004). Il faut espérer qu'avec l'aide de la nouvelle base de données fédérale (Système d'information sur les antibiotiques en médecine vétérinaire, IS ABV), le monitoring pourra être poursuivi dans les années à venir et que la réduction de la consommation d'antibiotiques sera confirmée dans les années suivantes.

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BACKGROUND: Febrile urinary tract infection (UTI) is a common health issue in pediatrics that can lead to serious infectious and renal complications, it requires early diagnosis and a targeted use of antibiotics. The aim of our study was to describe local bacterial agents causing febrile UTIs and their resistance patterns and confront the results with currently used empirical antibacterial therapy in pediatrics emergency departments in Strasbourg and Saverne. PATIENTS AND METHODS: We used billing codes (international classification of diseases) to identify all inpatients treated for febrile UTIs in two French pediatric emergency departments between January 2019 and December 2020. Microbial results of urine cultures were retrieved from the laboratory information system. RESULTS: Among 214 microbial results from 208 patients, the distribution of uropathogens was 82% Escherichia coli, with extended-spectrum beta-lactamase in 2.8%, 7% Enterococcus faecalis, 5% Klebsiella, 2% Proteus mirabilis. E. coli was resistant respectively to amoxicillin, amoxicillin/clavulanic acid and cotrimoxazol in 43, 33 and 14% of samples. A third-generation cephalosporin administered intravenously was mainly used (98%) as empirical treatment. Less than 2% of patients were treated with oral cephalosporin from the start. CONCLUSION: We present the spectrum of uropathogens and susceptibility test results in pediatric UTIs as well as the susceptibility pattern of E. coli, a local treatment protocol was designed based on our results in conformity with national guidelines.

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Considering the rising prevalence of antimicrobial resistance and the lack of recommendations on antibiotic treatment, the present study evaluated the necessity of local and systemic antibiotic therapy in addition to surgical debridement in superficial hand infections. Superficial hand infections were defined as not involving tendons, joints or bone. Data were analyzed for 180 patients, assigned to three study groups according to postoperative antimicrobial treatment. Patients in group I were treated with both systemic and local antibiotics; in group II antimicrobial therapy was limited to local antibiotics in the form of subcutaneous gentamicin bead chains; group III did not receive any antibiotic treatment after surgical debridement. Patients were followed up at two weeks and at three months. Immobilization time and length of stay were longer in group I, but there were no significant differences between the groups in terms of revision rate or recovery of hand function assessed by measurement of finger mobility, grip strength and the Disabilities of the Arm, Shoulder and Hand score at follow-up. Antibiotic treatment of hand infections should be considered carefully and reserved for specific indications: e.g., severe infections and selected patients such as those with diabetes or immunocompromising diseases.

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INTRODUCTION: The prevalence of methicillin-resistant Macrococcus spp. in calves and pigs at slaughterhouses and in retail beef and pork meat was determined using samples taken in 2019 within the framework of the national monitoring of methicillin-resistant Staphylococcus aureus in food producing animals in Switzerland. The isolates were submitted to antimicrobial susceptibility testing of 19 antibiotics and to molecular techniques (e.g. PCR, microarray, WGS) for the identification of resistance genes, elements containing the methicillin resistance genes mec and sequence type (ST). Methicillin-resistant Macrococcus spp. (M. caseolyticus (n=38), M. bohemicus (n=4) and Macrococcus spp. (n=2)) were isolated in 40 of 299 nasal swabs from calves representing a prevalence of 13,38 % (95 % CI, 9,98 % - 17,70 %), and in four of 303 nasal swabs from pigs [1,32 % (95 % CI, 0,36 % - 3,35 %)]. One of 311 samples of Swiss pork meat contained a Macrococcus sp. [0,32 % (95 % CI, 0,01 % - 1,78 %)], and four of 309 beef meat samples (260 domestic and 49 imported) contained M. caseolyticus [1,29 % (95 % CI, 0,35 % - 3,28 %)]. The M. caseolyticus strains belonged to diverse STs, with ST21 being the most common in both pigs and calves. The mecD gene was located on Macrococcus resistance island mecD (McRImecD) in 42 strains and on staphylococcal cassette chromosome mec (SCCmecD) in three strains, while mecB was found on plasmids in four strains. In addition to resistance to ß-lactams, the strains also exhibited resistance to tetracycline (n=17; tet(L), tet(K), tet(M)), streptomycin (n=13; str, ant(6)-Ia, rpsL mutation [K56R in ribosomal protein S12]), kanamycin (n=10; aac(6')-Ie - aph(2'')-Ia, aph(2')-Ib, aph(2')-Ic, ant(4')-Ia), clindamycin (n=9; erm(B), erm(45)), erythromycin (n=9; erm(B), msr(G), erm(45)), fusidic acid (n=9; fusC) and gentamicin (n=1; aac(6')-Ie - aph(2'')-Ia). This study represents the first national prevalence study of methicillin-resistant Macrococcus spp. in pigs, calves, pork and beef meat in Switzerland and revealed a reservoir of genetically diverse strains carrying several resistance traits.

INTRODUCTION: La prévalence des macrococques résistants à la méthicilline chez les veaux et les porcs à l'abattoir et dans la viande de bœuf et de porc au détail a été déterminée à partir d'échantillons prélevés en 2019 dans le cadre du monitoring national des Staphylococcus aureus résistants à la méthicilline chez les animaux de rente en Suisse. Les isolats ont été soumis à des tests de sensibilité à 19 antibiotiques et à des techniques moléculaires (par exemple PCR, microarray, WGS) pour l'identification des gènes de résistance, des éléments contenant les gènes mec responsible de la résistance à la méthicilline, ainsi que du type de séquence (ST). Des macocoques résistants à la méthicilline (M. caseolyticus (n=38), M. bohemicus (n=4) et Macrococcus spp. (n=2)) ont été isolés dans 40 des 299 écouvillons nasaux de veaux, ce qui représente une prévalence de 13,38 % (IC 95 %, 9,98 % ­ 17,70 %), et dans quatre des 303 écouvillons nasaux de porcs [1,32 % (IC 95 %, 0,36 % ­ 3,35 %)]. Un des 311 échantillons de viande de porc suisse contenait un Macrococcus sp. [0,32 % (IC 95 %, 0,01 % ­ 1,78 %)], et quatre des 309 échantillons de viande de bœuf (260 domestiques et 49 importés) contenaient M. caseolyticus [1,29 % (IC 95 %, 0,35 % ­ 3,28 %)]. Les souches de M. caseolyticus appartenaient à divers ST, le ST21 étant le plus fréquent chez les porcs et les veaux. Le gène mecD a été localisé sur des éléments du chromosome McRImecD dans 42 souches et SCCmecD dans trois souches, tandis que le gène mecB se trouvait sur des plasmides dans quatre souches. En plus de la résistance aux ß-lactamines, les souches étaient également résistantes à la tétracycline (n=17 ; tet(L), tet(K), tet(M)), à la streptomycine (n=13 ; str, ant(6)-Ia, mutation rpsL [K56R dans la protéine ribosomale S12]), à la kanamycine (n=10 ; aac(6')-Ie ­ aph(2'')-Ia, aph(2')-Ib, aph(2')-Ic, ant(4')-Ia), clindamycine (n=9 ; erm(B), erm(45)), érythromycine (n=9 ; erm(B), msr(G), erm(45)), acide fusidique (n=9 ; fusC) et gentamicine (n=1 ; aac(6')-Ie ­ aph(2'')-Ia). Cette étude est la première à déterminer prévalence des Macrococcus spp. résistants à la méthicilline chez les porcs, les veaux, la viande de porc et de bœuf en Suisse et a révélé un réservoir de souches génétiquement diverses et portant plusieurs traits de résistance.

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While monitoring the presence of antibiotic resistance in municipal wastewater bacteria from Mexico City, five Escherichia coli isolates were found to be resistant to carbapenems, antibiotics of "last resort" used mostly in hospitals. Further analysis revealed that these carbapenem-resistant isolates carried the gene encoding a metallo-beta-lactamase, NDM-5. The gene was found to be beared by a large, ∼145 kb conjugative plasmid, which also carries putative genes encoding resistance to sulfonamides, trimethoprim, tetracycline, ciprofloxacin, and chloramphenicol (although no phenotypic chloramphenicol resistance was detected) and quaternary-ammonium compounds. The plasmid also carried gene mobility determinants, such as integron integrase and two transposases. In addition to the direct public health threat posed by the presence of such multi-resistant organisms in wastewater released into the environment and used for crop irrigation; it is particularly concerning that carbapenem-resistant E. coli is rather rare in Mexican hospitals (<1%), but was found in small, 100 mL samples of municipal wastewater. This suggests that these organisms are under-reported by clinical microbiology laboratories, underlining the usefulness of wastewater monitoring, or that there is an unknown source of such carbapenem-resistant organisms that are being dumped into the wastewater. The source of these bacteria must be assessed and controlled to prevent further spread of this multi-resistance plasmid among other environmental and clinical microorganisms.

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OBJECTIVES: To evaluate the relevance and compliance of antibiotic prescriptions made in a Tunisian hospital and study the factors likely to influence them. METHODS: This is a cross-sectional, monocentric study of antibiotic prescriptions belonging to the Watch and Reserve Groups of the World Health Organization's AWaRe classification, between January 1 and February 29, 2020. RESULTS: A total of 310 antibiotic prescriptions were analyzed. Monotherapy represented 89,7 % of prescriptions. The most prescribed molecule was cefotaxime (42,8%). Antibiotic therapy was documented in 13% of cases. The antibiotic prescriptions were rational in 14,5% of cases. One third of prescriptions were irrelevant and 4,8% not justified. The dominant ground for non-compliance was unsuitable duration. The status of the prescriber and the prescribing service were factors influencing the relevance of prescriptions. CONCLUSION: Irrational use of antibiotics was common in this study. As a result, the establishment of an antibiotic therapy guide and a computerized decision-support tool seem essential to guarantee the quality of antibiotic prescriptions.

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We report the case of a 32-year-old man presentedwithleftpre-auricularswellingthathad been evolving for twomonths. Physical examination found a fixed inflammatory parotid mass. Ultrasound of the parotid region found a mixed parotid nodule with liquid redominance. The swelling was drained. Histological examination of a biopsy specimen of the parotid gland revealed an epithelioid granuloma with caseous necrosis. The patient is then treated with anti-tuberculosis with a favorable result.

Nous rapportons le cas d'un homme de 32 ans venu pour tuméfaction pré-auriculaire gauche évoluant depuis deux mois. L'examen physique a retrouvé une masse parotidienne fixe inflammatoire. L'échographie de la région parotidienne a retrouvé un nodule parotidien mixte à prédominance liquidienne. Un drainage de la tuméfaction a été fait. L'examen anatomopathologique d'une pièce biopsique de la glande parotide a retrouvé un granulome épithelioïde avec nécrose caséeuse. Le patient est ensuite traité par anti-tuberculeux avec un résultat favorable.

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INTRODUCTION: It was the objective of this study to evaluate morbidity, mortality, use of veterinary drugs and production output on seven representative Swiss beef fatteners, who bought on a regular basis batches of calves from traders (mean age and weight: 31 day, 75 kg) and practised an all in-all out system. From March 2015 until May 2016, 51 batches with a total of 1307 calves were included. The use of drugs during the first eight weeks following delivery of calves from the trader, casualty rate and carcass performance of 837 bulls. The administration of antimicrobials was calculated per calf as the number of days with effective therapeutic concentrations (daily doses per animal; DD/A). The average weight of the calves at arrival on the fattening unit was 75 kg and the age 31 days. The group size was between 13 to 47 calves (median 22, Q1 = 21, Q2 = 30). In 36 batches (70,6 %), a veterinary entry examination was performed which demonstrated that at admission 20 % of the calves suffered from a relevant disease. The median for the number of DD/A was 16 for the first 56 days on the farm (Q1 = 11, Q3 = 21); 68 % of these DD/A were attributed to metaphylactic medications after delivery. Thereafter, pneumonia (54 %), diarrhea (33 %) and otitis (10 %) were the most frequent indications for subsequent therapeutic interventions. Over all batches, a median of 71 % (Q1 = 47, Q3 = 85) of all DD/A were due to critically important antimicrobials (CIM) and drugs containing several antibiotics including a CIM. The losses due to death or euthanasia averaged 3,7 % of all calves. The median for daily weight gain for the total fattening period (median 354 days; Q1 = 328, Q3 = 379) accounted for 1325 g (Q1 = 1216, Q3 = 1425). The profound variation between the farms in respect to the results of drug use and production output reveals evidence for the strong impact of farm-specific factors (such as pen space per calf, barn climate, vaccination protocol, supervision). Concurrently, the remarkable differences between the results of different batches on one farm depict that there are further important risk factors which are beyond the control of the farmer (in particular season of the year, transport). It is concluded that a systematic minimization of risk factors as part of a continuous veterinary consultation is useful two improve herd health and to reduce the input of drugs in the production of beef.

INTRODUCTION: L'objectif de cette étude était d'évaluer la morbidité, la mortalité, l'utilisation de médicaments vétérinaires et la production de sept engraisseurs suisses représentatifs, qui achetaient régulièrement des lots de veaux à des commerçants (âge et poids moyens : 31 jours, 75 kg). et pratiquant le système «  all in-all out ¼. De mars 2015 à mai 2016, 51 lots avec un total de 1307 veaux ont été inclus. On a étudié l'utilisation de médicaments pendant les huit premières semaines suivant la livraison des veaux, le taux de mortalité et la performance carcasse de 837 taureaux. L'administration d'antimicrobiens par veau a été calculée individuellement en nombre de jours avec des concentrations thérapeutiques efficaces (doses quotidiennes par animal ; JJ/A). Le poids moyen des veaux à l'arrivée sur l'unité d'engraissement était de 75 kg et l'âge de 31 jours. La taille du groupe était comprise entre 13 et 47 veaux (médiane 22, Q1 = 21, Q2 = 30). Dans 36 lots (70,6 %), un examen vétérinaire d'entrée a été réalisé qui a démontré qu'à l'admission 20 % des veaux souffraient d'une maladie nécessitant un traitement. La médiane du nombre de DD/A était de 16 pour les 56 premiers jours à la ferme (Q1 = 11, Q3 = 21) ; 68 % de ces DD/A ont été constitués par des médicaments métaphylactiques après la livraison. Par la suite, la pneumonie (54 %), la diarrhée (33 %) et l'otite (10 %) étaient les indications les plus fréquentes des interventions thérapeutiques ultérieures. Sur l'ensemble des lots, une médiane de 71 % (Q1 = 47, Q3 = 85) de tous les DD/A étaient dus à des antimicrobiens d'importance critique (CIM) et à des médicaments contenant plusieurs antibiotiques, dont un CIM. Les pertes dues à la mort ou à l'euthanasie représentaient en moyenne 3,7 % de tous les veaux. La médiane du gain de poids quotidien pour la période d'engraissement totale (médiane 354 jours ; Q1 = 328, Q3 = 379) représentait 1325 g (Q1 = 1216, Q3 = 1425). La variation importante entre les exploitations en ce qui concerne les résultats de l'utilisation de médicaments et la production est la preuve du fort impact des facteurs spécifiques à l'exploitation (tels que l'espace en enclos par veau, le climat de l'étable, le protocole de vaccination, la supervision). Parallèlement, les différences remarquables entre les résultats de différents lots sur une exploitation montrent qu'il existe d'autres facteurs de risque importants qui échappent au contrôle de l'agriculteur (en particulier la saison, le transport). Il est conclu qu'une minimisation systématique des facteurs de risque dans le cadre d'une consultation vétérinaire continue est utile pour améliorer la santé du troupeau et réduire l'apport de médicaments dans la production de viande bovine.

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