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Objectives Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections. Methods Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website. Results The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables. Conclusion This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.

Introduction Les infections respiratoires basses sont une cause frequente d’hospitalisation. La place des antibiotiques dans la prise en charge des syndromes viraux est limitee, or on trouve dans la litterature des pourcentages eleves de prescriptions d’antibiotiques. Notre objectif etait d’evaluer l’impact de la mise en evidence d’un virus respiratoire sur la consommation d’antibiotiques. Materiels et methodes Une etude retrospective cas-temoin a ete realisee dans un centre hospitalier universitaire parmi des patients adultes hospitalises pour syndrome grippal d’origine communautaire du 05/12/16 au 12/03/17. Les patients presentant un prelevement mettant en evidence une surinfection bacterienne, ainsi que ceux juges a haut risque infectieux ou presentant un etat clinique grave necessitant une admission dans un service de reanimation ont ete exclus. Resultats Parmi les 612 patients inclus ayant un prelevement respiratoire analyse par PCR, 204 patients ayant une PCR grippe positive (cas) et 408 patients ayant une PCR grippe negative (temoins) ont ete compares. Les pourcentages de prescriptions d’antibiotiques etaient eleves dans les deux groupes sans difference significative entre les cas et temoins (74 vs 72 %, p = 0,633), mais il y avait significativement plus de prescriptions de dose unique (11 vs 5 %, p = 0,017), moins d’associations d’antibiotiques (23 vs 34 %, p = 0,016) et des durees d’antibiotherapies significativement plus courtes (6 vs 6 jours, p = 0,01) dans le groupe cas versus temoin. Les prescriptions d’antibiotiques etaient majoritairement debutees en pre-PCR dans les deux groupes (90 % vs 85 %, p = 0,183), alors que les prescriptions d’oseltamivir etaient moins frequemment debutes en pre-PCR (50 % vs 66 %). Pour ce qui est des facteurs influencant la poursuite ou non d’une antibiotherapie, d’apres l’analyse multivariee, l’obtention d’un resultat positif de PCR grippe etait significativement associee a l’arret de l’antibiotherapie en post-PCR, tandis qu’un âge et une valeur de CRP eleves etaient associes a une poursuite du traitement. La presence de comorbidites n’influencait pas significativement l’arret ou la poursuite de l’antibiotherapie. Conclusion L’obtention d’un diagnostic virologique de grippe aide a l’arret des antibiotherapies initiees en probabiliste mais l’impact sur la consommation globale d’antibiotiques n’a pas ete demontre. L’acces a une PCR multiplex identifiant de maniere precise le micro-organisme en cause, l’elaboration de recommandations specifiques au niveau de notre etablissement ainsi qu’un avis infectiologique systematique sont des moyens qui pourraient permettre de diminuer les prescriptions inappropriees d’antibiotiques, mais il serait egalement interessant d’agir en amont par une identification plus rapide du pathogene, qui pourraient eviter des prescriptions probabilistes.

Objectives This study had for aim to assess the acceptability of a model for continuing medical education, to improve the implementation of best practice recommendations for family practice. The training focused on the management of community acquired urinary tract infections in adults. The secondary objective was to identify barriers in the implementation of these best practice recommendations. Methods We conducted a prospective qualitative study. The intervention included an initial knowledge test, an audio-visual CD-ROM presentation, and a second knowledge test. After the session, family practitioners (FP) were asked to answer a face-to-face questionnaire in order to give their opinion on the training session. Ten FP, working in the Savoie and Isere sub-divisions in France, were included. Results All FP were satisfied with the e-learning training session. The element of the session, they best appreciated, was the audio-visual presentation. The comparison between initial and second test results showed a non-significant improvement of knowledge (P = 0.07). The barriers, most frequently mentioned for knowledge and use of best practice recommendations, were: lack of time, content unfit for family practice, habits, and the very broad field of expertise required. Conclusion FP accepted this model of continuing medical education. E-learning seems relevant to improve the implementation of best practice recommendations in family practice.

Q fever is a zoonosis caused by Coxiella burnetii with a presentation ranging from asymptomatic seroconversion to possibly fatal chronic Q fever. The Netherlands faced an exceptionally large outbreak of Q fever from 2007 to 2010: 4026 human cases were notified, which makes it the largest Q fever outbreak ever reported. This outbreak, because of its size, allowed collecting a wide range of information on the natural history of Q fever, as well as on its transmission and clinical presentation. It also posed unprecedented public healthcare problems, especially for the concomitant management of the epizootic by veterinarian authorities and public health authorities, but also for the management of transmission risk related to blood donation. The need for cost efficient measures emerged rapidly because of the great number of infected individuals or at risk of infection, with a need for guidance on follow-up of acute Q fever patients, screening of pregnant women, or implementation of diagnostic algorithms. The acute outbreak was controlled by drastic veterinarian measures but chronic Q fever will remain a problem for the coming years.