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Introduction Le conseil en antibiothérapie est une composante essentielle de l’activité des services d’infectiologie dont la valorisation auprès de l’administration est difficile. Cette valorisation est d’autant plus complexe que le nombre d’avis donné est important et que l’effectif de l’équipe est réduit. Nous présentons comment nous avons pu quantifier et valoriser notre activité en utilisant un « questionnaire » incorporé dans un tableur Excel ® . Matériels et méthodes En quelques heures, nous avons développé un « questionnaire » très simple de recueil de données en utilisant le langage VBA dans Excel ® . Ce questionnaire a ensuite été utilisé par les infectiologues de notre service, pour permettre de décrire précisément tous les avis donnés par téléphone ou au sein des unités cliniques. Résultats Le questionnaire, comportant 24 items renseignés en 20 à 30 secondes (cases à cocher) a été utilisé sur une période de 4 mois (février–mai). Sur 1495 avis donnés, 364 (24,3 %) étaient un problème d’échec thérapeutique, 545 (36,5 %) une infection nosocomiale, 416 (27,8 %) une infection à BMR, 266 (17,8 %) une infection sur matériel, 47 (3,1 %) un problème allergique. Le type d’infections était très varié : 225 (15,4 %) intra-abdominale, 171 (11,7 %) pulmonaire, 162 (11,1 %) ostéoarticulaire, 140 (9,6 %) urogénitale. La prise en charge en cours, ne suivant pas les recommandations, était identifiée comme engageant le pronostic vital pour 46 patients (3,1 %), surtout en cas de bactériémie. Pour 142 (9,5 %), l’avis était considéré comme trop tardif. Seuls 158 avis (13,6 %) étaient tracés dans DX-care. L’exhaustivité du recueil par les cliniciens a été de 80 % permettant d’évaluer à 6000 le nombre d’avis donnés chaque année (20 à 30/jours). Conclusion Grace à un formulaire dans un tableur Excel ® nous avons pu préciser et quantifier rapidement le volume important de notre activité. Nous avons ainsi identifié que 20 à 30 % de nos interventions portaient sur des problématiques à fort risque médicolégal (infections sur matériel, infections à BMR ou nosocomiales) ou que l’avis était clairement sollicité trop tardivement. Malgré cela, la traçabilité de nos avis dans le dossier du patient reste faible, en raison d’un sous-effectif très net de notre équipe par rapport à la taille de notre établissement. Ces données sont désormais utilisées pour soutenir nos demandes de prêts ou de création de postes. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has decreased surgical activity, particularly in the field of oncology, because of the suspicion of a higher risk of COVID-19-related severe events. This study aimed to investigate the feasibility and safety of thoracic cancer surgery in the most severely affected European and Canadian regions during the COVID-19 pandemic., Methods: The study investigators prospectively collected data on surgical procedures for malignant thoracic diseases from January 1 to April 30, 2020. The study included patients from 6 high-volume thoracic surgery departments: Nancy and Strasbourg (France), Freiburg (Germany), Milan and Turin (Italy), and Montreal (Canada). The centers involved in this research are all located in the most severely affected regions of those countries. An assessment of COVID-19-related symptoms, polymerase chain reaction (PCR)-confirmed COVID-19 infection, rates of hospital and intensive care unit admissions, and death was performed for each patient. Every deceased patient was tested for COVID-19 by PCR., Results: In the study period, 731 patients who underwent 734 surgical procedures were included. In the whole cohort, 9 cases (1.2%) of COVID-19 were confirmed by PCR, including 5 in-hospital contaminants. Four patients (0.5%) needed readmission for oxygen requirements. In this subgroup, 2 patients (0.3%) needed intensive care unit and mechanical ventilatory support. The total number of deaths in the whole cohort was 22 (3%). A single death was related to COVID-19 (0.14%)., Conclusions: Maintaining surgical oncologic activity in the era of the COVID-19 pandemic seems safe and feasible, with very low postoperative morbidity or mortality. To continue to offer the best care to patients who do not have COVID-19, reports on other diseases are urgently needed., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

JC virus (JCV) causes progressive multifocal leukoencephalopathy (PML) in immunosuppressed patients. There is currently no effective specific antiviral treatment and PML management relies on immune restoration. Prognosis markers are crucially needed in this disease because of its high mortality rate. In this work, we investigated the compartmentalization of JCV strains as well as the humoral neutralizing response in various matrices to further understand the pathophysiology of PML and define markers of survival. Four patients were included, of which three died in the few months following PML onset. Cerebrospinal fluid (CSF) viral loads were the highest, with plasma samples having lower viral loads and urine samples being mostly negative. Whether at PML onset or during follow-up, neutralizing antibody (NAb) titers directed against the same autologous strain (genotype or mutant) were the highest in plasma, with CSF titers being on average 430-fold lower and urine titers 500-fold lower at the same timepoint. Plasma NAb titers against autologous genotype or mutant were lower in non-survivor patients, though no neutralization "blind spot" was observed. The surviving patient was followed up until nine months after PML onset and presented, at that time, an increase in neutralizing titers, from 38-fold against the autologous genotype to around 200-fold against PML mutants. Our results suggest that patients' humoral neutralizing response against their autologous strain may play a role in PML outcome, with survivors developing high NAb titers in both plasma and CSF.

Background: Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this "Endocarditis Team" (ET)., Methods: We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality., Results: We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20-0.96; P = .048)., Conclusions: This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE., (© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)