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ObjectivesThe emergence of SARS-CoV-2 variants raised questions over the extent to which vaccines designed in 2020 have remained effective. We aimed to assess whether vaccine status was associated with the severity of Omicron SARS-CoV-2 infection in hospitalised patients.MethodsWe conducted an international, multicentric, retrospective study in 14 centres (Bulgaria, Croatia, France, Turkey). We collected data on patients hospitalised ≥24 hours between 01/12/2021 and 03/03/2022, with PCR-confirmed infection at a time of exclusive Omicron circulation, with hospitalisation related or not to the infection. Patients who had received prophylaxis by monoclonal antibodies were excluded. Patients were considered fully vaccinated if they had received at least 2 injections of either mRNA and/or ChAdOx1-S, or 1 injection of Ad26.CoV2-S vaccines.ResultsAmong the 1215 patients (median [IQR] age 73.0 [57.0; 84.0]; 51.3% males), 746 (61.4%) were fully vaccinated. In multivariate analysis, being vaccinated was associated with lower 28-day mortality (RR=0.50 [0.32-0.77]), ICU admission (R=0.40 [0.26-0.62], and oxygen requirement (RR=0.34 [0.25-0.46]), independently of age and comorbidities. When co-analysing these Omicron patients with 948 Delta patients from a study we recently conducted, Omicron infection was associated with lower 28-day mortality (RR=0.53 [0.37-0.76]), ICU admission (R=0.19 [0.12-0.28], and oxygen requirements (RR=0.50 [0.38-0.67]), independently of age, comorbidities and vaccination status.ConclusionsmRNA- and adenovirus-based vaccines have remained effective on severity of Omicron SARS-CoV-2 infection. Omicron is associated with a lower risk of severe forms, independently of vaccination and patient characteristics.

Summary Background Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired pneumonia who were stable after 3 days of treatment. Methods We did this double-blind, randomised, placebo-controlled, non-inferiority trial (the Pneumonia Short Treatment [PTC]) in 16 centres in France. Adult patients (aged ≥18 years) admitted to hospital with moderately severe community-acquired pneumonia (defined as patients admitted to a non-critical care unit) and who met prespecified clinical stability criteria after 3 days of treatment with β-lactam therapy were randomly assigned (1:1) to receive β-lactam therapy (oral amoxicillin 1 g plus clavulanate 125 mg three times a day) or matched placebo for 5 extra days. Randomisation was done using a web-based system with permuted blocks with random sizes and stratified by randomisation site and Pneumonia Severity Index score. Participants, clinicians, and study staff were masked to treatment allocation. The primary outcome was cure 15 days after first antibiotic intake, defined by apyrexia (temperature ≤37·8°C), resolution or improvement of respiratory symptoms, and no additional antibiotic treatment for any cause. A non-inferiority margin of 10 percentage points was chosen. The primary outcome was assessed in all patients who were randomly assigned and received any treatment (intention-to-treat [ITT] population) and in all patients who received their assigned treatment (per-protocol population). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT01963442, and is now complete. Findings Between Dec 19, 2013, and Feb 1, 2018, 706 patients were assessed for eligibility, and after 3 days of β-lactam treatment, 310 eligible patients were randomly assigned to receive either placebo (n=157) or β-lactam treatment (n=153). Seven patients withdrew consent before taking any study drug, five in the placebo group and two in the β-lactam group. In the ITT population, median age was 73·0 years (IQR 57·0–84·0) and 123 (41%) of 303 participants were female. In the ITT analysis, cure at day 15 occurred in 117 (77%) of 152 participants in the placebo group and 102 (68%) of 151 participants in the β-lactam group (between-group difference of 9·42%, 95% CI −0·38 to 20·04), indicating non-inferiority. In the per-protocol analysis, 113 (78%) of 145 participants in the placebo treatment group and 100 (68%) of 146 participants in the β-lactam treatment group were cured at day 15 (difference of 9·44% [95% CI −0·15 to 20·34]), indicating non-inferiority. Incidence of adverse events was similar between the treatment groups (22 [14%] of 152 in the placebo group and 29 [19%] of 151 in the β-lactam group). The most common adverse events were digestive disorders, reported in 17 (11%) of 152 patients in the placebo group and 28 (19%) of 151 patients in the β-lactam group. By day 30, three (2%) patients had died in the placebo group (one due to bacteraemia due to Staphylococcus aureus, one due to cardiogenic shock after acute pulmonary oedema, and one due to heart failure associated with acute renal failure) and two (1%) in the β-lactam group (due to pneumonia recurrence and possible acute pulmonary oedema). Interpretation Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These findings could allow substantial reduction of antibiotic consumption. Funding French Ministry of Health.

Background The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization’s decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work. Methods We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of “not stressed” (≤20), “borderline” (21 ≤ PSS-10 ≤ 26), and “stressed” (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made. Results Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40–3.50], p verbatims revealed that GPs felt isolated in a hospital-based model. Conclusion The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.

BackgroundThe diffusion of the SARS-CoV-2 delta (B.1.617.2) variant and the waning of immune response after primary Covid-19 vaccination favoured the breakthrough SARS-CoV-2 infections in vaccinated subjects. To assess the impact of vaccination, we determined the severity of infection in hospitalised patients according to vaccine status.MethodsWe retrospectively analysed data from patients hospitalised in 10 centres with a SARS-CoV-2 infection (delta variant) from July to November 2021: i) all patients who had completed their primary vaccination at least 14 days before hospital admission; and ii) the same number of completely unvaccinated patients. We assessed the impact of vaccination and other risk factors through logistic regression.FindingsWe included 955 patients (474 vaccinated and 481 unvaccinated). Vaccinated patients were significantly older, more frequently males, and with more comorbidities. They were less often admitted for Covid-19 (59·3% vs. 75·1%, pConclusionsAmong patients hospitalised with a delta variant SARS-CoV-2 infection, vaccination was associated with less severe forms, even in the presence of comorbidities.

International audience; Elderly people are at high risk for pneumococcal infections. However, older age is not an eligibility factor for pneumococcal vaccination in France. Adults with certain co-morbidities or immunocompromised states are eligible for vaccination, which leaves adults aged ≥65 years without comorbidities at-risk for pneumococcal infections. The objective of the study was to evaluate the acceptability to healthcare professionals (HCPs) of extending pneumococcal vaccination to all individuals ≥65 years. Based on themes identified in semi-structured interviews with 24 HCPs, a representative sample of 500 general practitioners and pharmacists were surveyed about their knowledge, attitudes and beliefs with respect to pneumococcal vaccination for individuals ≥65 years. Current recommendations for pneumococcal vaccination are poorly understood by participants (mean score: 5.8/10). Respondents were generally supportive of inclusion of age in vaccination recommendations (7.5/10), with 58% being very supportive. For 72% of HCPs, this would contribute to improved vaccination coverage. The strategy could be facilitated by associating pneumococcal vaccination with the influenza vaccination campaign (8.3/10). Pharmacists were favourable to participating in pneumococcal vaccination (8.5/10). In conclusion, extension of pneumococcal vaccination to all people aged ≥65 years would be welcomed by HCPs, simplifying identification of patients to be vaccinated and potentially improving vaccination coverage.

Describing the characteristics of COVID-19 patients in the hospital is of importance to assist in the management of hospital capacity in the future. Here, we analyze the trajectories of 1321 patients admitted to hospitals in northern and eastern France. We found that the time from onset to hospitalization decreased with age, from 7.3 days in the 20&ndash, 65 year-olds to 4.5 in the &gt, 80 year-olds (p &lt, 0.0001). Overall, the length of stay in the hospital was 15.9 days, and the death rate was 20%. One patient out of four was admitted to the intensive care unit (ICU) for approximately one month. The characteristics of trajectories changed with age: fewer older patients were admitted to the ICU and the death rate was larger in the elderly. Admission shortly after onset was associated with increased mortality (odds-ratio (OR) = 1.8, Confidence Interval (CI) 95% [1.3, 2.6]) as well as male sex (OR = 2.1, CI 95% [1.5, 2.9]). Time from admission within the hospital to the transfer to ICU was short. The age- and sex-adjusted mortality rate decreased over the course of the epidemic, suggesting improvement in care over time. In the SARS-CoV-2 epidemic, the urgent need for ICU at admission and the prolonged length of stay in ICU are a challenge for bed management and organization of care.

International audience; Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.

BACKGROUND: Intrapartum intravenous zidovudine (ZDV) prophylaxis is a long-standing component of prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in high-resource countries. In some recent guidelines, intravenous ZDV is no longer systematically recommended for mothers receiving combination antiretroviral therapy (cART) with low viral load. We evaluated the impact of intravenous ZDV according to viral load and obstetrical conditions. METHODS: All HIV-1-infected women delivering between 1 January 1997 and 31 December 2010 in the French Perinatal Cohort (ANRS-EPF) were analyzed if they received ART during pregnancy and did not breastfeed. We identified maternal and obstetrical characteristics related to lack of intravenous ZDV and compared its association with MTCT rate and other infant parameters, according to various risk factors. RESULTS: Intravenous ZDV was used in 95.2% of the 11 538 deliveries. Older age, multiparity, and preterm and vaginal delivery were associated with lack of intravenous ZDV (n = 554). In women who delivered with viral load ≥1000 copies/mL, the overall MTCT rate was higher without than with intravenous ZDV (7.5% vs 2.9%; P = .01); however, there was no such difference when the neonate received postnatal intensification therapy. Among them, 77% of women who had viral load

The case is described of a frail patient who developed prosthetic valve endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA). Conventional antimicrobial treatments either failed or were contraindicated, and the patient was judged unsuitable for a further valve replacement. A salvage therapy with high doses of a new cephalosporin, ceftaroline, given three times daily was undertaken; subsequently, the patient had not relapsed at two months after completing a six-week course of ceftaroline. Ceftaroline deserves major attention as an alternative choice in difficult-to-treat MRSA endocarditis.

Critically ill patients with infection in the intensive care unit (ICU) would certainly benefit from timely bacterial identification and effective antimicrobial treatment. Diagnostic techniques have clearly improved in the last years and allow earlier identification of bacterial strains in some cases, but these techniques are still quite expensive and not readily available in all institutions. Moreover, the ever increasing rates of resistance to antimicrobials, especially in Gram-negative pathogens, are threatening the outcome for such patients because of the lack of effective medical treatment; ICU physicians are therefore resorting to combination therapies to overcome resistance, with the direct consequence of promoting further resistance. A more appropriate use of available antimicrobials in the ICU should be pursued, and adjustments in doses and dosing through pharmacokinetics and pharmacodynamics have recently shown promising results in improving outcomes and reducing antimicrobial resistance. The aim of multidisciplinary antimicrobial stewardship programs is to improve antimicrobial prescription, and in this review we analyze the available experiences of such programs carried out in ICUs, with emphasis on results, challenges, and pitfalls. Any effective intervention aimed at improving antibiotic usage in ICUs must be brought about at the present time; otherwise, we will face the challenge of intractable infections in critically ill patients in the near future.

La situation socio-économique (SSE) dans le suivi d’une personne vivant avec le VIH (PVVIH) semble un critère jouant un rôle important dans son adhérence au traitement. Les études disponibles sur le sujet démontrent que si les caractéristiques qui composent la SSE et la situation socio-démographique s’avèrent dissociables, la preuve de leur implication dans le contrôle immuno-virologique semble d’abord dépendre des outils de mesure de SSE utilisés. Nous avons réalisé une étude en choisissant d’analyser ces éléments avec un score linéaire croissant de précarité dénommé EPICES (évaluation de la précarité et des inégalités de santé dans les centres d’examens de santé) à l’occasion d’une consultation de suivi d’une PVVIH dans un hôpital de l’Arc Alpin. A partir de résultats préliminaires recueillis chez 20% de la population prévue, nous observons que cet échantillon de la file active présente un score médian de 36. Cette médiane est au-dessus du seuil de précarité défini par EPICES, avec 39% de l’échantillon en situation de précarité extrême. L’estimation des revenus mensuels fait apparaître une population très hétérogène sur le plan financier, avec la principale fourchette de revenus représentée à 44% entre 500 et 1500 euros, tandis que la seconde à 17% regroupe les PVVIH percevant plus de 3000 euros par mois. L’introduction d’un traitement remonte chez ces patients en moyenne à 13 ans et la dernière charge virale est indétectable chez 93% d'entre eux. Les données partielles suggèrent une répartition de la population d’étude aux deux extrêmes de la SSE, ce qui devrait nous permettre de répondre à la question posée concernant l’impact de la précarité sur la réponse thérapeutique. Une mini-revue de la littérature a été présentée dans ce travail de thèse afin de contextualiser les déterminants de la SSE sur l’observance du traitement, notamment en considérant le VIH dans d’autres pays à haut revenus et en comparant l’implication de ces déterminants dans d’autres affections chroniques. Les afférents du mécanisme par lequel la SSE influe sur la prise du traitement, étudié ici à un an de la pandémie à SARS-CoV-2, viennent renforcer la littérature qui témoigne d’une représentation sociale et culturelle décisives sur la facilité d’observance d’une PVVIH.

In the context of the COVID-19 pandemic, the WHO warned health professionals about the possible occurrence of stress. This study assessed stress in general practitioners (GPs) during the first wave and identified associated factors. Between April 8 and June 30, 2020, a questionnaire was sent to GPs in Auvergne-Rhône-Alpes area at various time. Stress was measured using the 10-item Perceived Stress Score (PSS-10). Verbatims were analyzed too. A first cross-sectional analysis, conducted on 898 GPs between April 8 and May 10, revealed a high-stress level in 437 GPs (49%). Follow-up over time of a cohort of 102 GPs showed a decrease in stress over the study period: 53% of GPs were stressed at the beginning of April compared to 37% at the end of May. Factors associated with high initial stress were : being overwhelmed by the information received, patient's anxiety, making difficult decisions and feeling lonely. Absence of value conflicts reduced stress. The verbatims highlighted a hospital-centered pandemic management, in which it was sometimes difficult for GPs to find their place. In conclusion, the level of stress was unusually high among GPs during the first pandemic wave. In the context of a health crisis, a structured communication chain should be set up early by the health authorities. Better structuring of city-hospital links could be developed. It seems crucial to involve GPs as early as possible in crisis management to improve the health care system's responsiveness and avoid stress that would invalidate the functioning of the health care system.; En contexte de pandémie COVID-19, l'OMS a mis en garde les professionnels de santé quant à l'apparition possible de stress. Cette étude a évalué le stress des médecins généralistes (MG) au cours de la première vague, et a identifié les facteurs associés. Entre le 8 avril et le 30 juin 2020, un questionnaire a été envoyé à différentes dates aux MG d'Auvergne-Rhône-Alpes. Le stress a été mesuré à l'aide du Perceived Stress Score en 10 items (PSS-10). Des verbatims ont été analysés. Une première analyse transversale, menée sur 898 MG entre le 8 avril et le 10 mai, a révélé un niveau de stress élevé chez 437 MG (49%). Le suivi dans le temps d'une cohorte de 102 MG a montré une diminution du stress sur la période d' étude : 53% MG étaient stressés début avril contre 37% fin mai. Les facteurs associés à un stress initial élévé étaient : le fait d'être submergé par les informations recues, l'anxiété des patients, la prise de décisions difficiles et le fait de se sentir seul. L'abscence de conflit de valeur diminuait le stress. Les verbatims ont souligné une gestion de la pandémie hospitalo-centrée, dans laquelle les MG ont parfois eu du mal à trouver leur place. En conclusion, le niveau de stress était inhabituellement élevé chez les MG au cours de la première vague pandémique. En contexte de crise sanitaire, une chaîne de communication structurée devrait être mise en place précocement par les autorités sanitaires. La collaboration ville-hôpital pourrait etre renforcée. Il parait crucial d'impliquer au plus tôt les MG dans la gestion de crise pour améliorer la réactivité du système de soin et éviter un stress invalidant le fonctionnement de ce dit système.

Chlamydiae trachomatis (CT) infections are the most common sexually transmitted diseases (STD) in Europe. They can cause severe genital lesions in women, real burden on fertility. Sexual habits evolve, as oral and anal sex becomes more and more common, multipartner sex as well. Despite these facts, CT screening methods remain heterogeneous. Our study was led to determine CT infections prevalence in persons attending STD clinics in Auvergne Rhone Alpes (ARA). We also looked over STD clinic’s methods for CT screening. It is a descriptive, multicentre, retrospective prevalence study. ARA’s STD clinics were recruited to determine CT’s prevalence among their consultants from January to December 2017. CT infection prevalence was 7.84% in ARA’s STD’s consultant between January and December 2017. CT’s genitourinary prevalence was 7.55%, 10.27% anal, 1.56% pharyngeal, 10.88% in the three sites. Extra genital CT screening would be especially offered to men who have sex with men. Reluctantness to offer a systematic extragenital screening was due to economic difficulties. CT infections ‘s prevalence found by our study was 7.84%, which is similar to literature’s data. Extragenital CT infections was highlighted, constituting a way to spread the epidemy. Further studies would be interesting to look for extragenital CT holding risk factors, this to enhance CT’s screening and though contain the epidemy spreading.; Les infections à Chlamydiae trachomatis (ICT) sont les infections sexuellement transmissibles les plus fréquentes en Europe. Elles sont responsables d’atteintes pouvant être sévères chez la femme avec un poids certain sur la fertilité. Les pratiques sexuelles changent avec une généralisation des rapports oraux et anaux, ainsi que des rapports multipartenaires. Malgré cela, les pratiques de dépistage extra génital du CT sont hétérogènes. Nous avons mené notre étude afin de déterminer la prévalence des ICT chez les consultants en centre de dépistage d’Auvergne Rhône Alpes (ARA). Il s’agit d’une étude descriptive multicentrique rétrospective de prévalence. Les CeGIDD d’ARA ont été recrutés afin de déterminer la prévalence des ICT chez les consultants en centre de dépistage d’ARA entre janvier et décembre 2017. Les modalités du dépistage du CT ont été décrites dans ces centres. La prévalence des ICT chez les consultants en CeGIDD d’ARA en 2017 était de 7,84%. La prévalence de portage du CT était de 7,55% en génito-urinaire, 10,27% en anal, 1,56% en pharyngé, 10,88% en poolant les résultats sur les trois sites. Les CeGIDD dépistaient en extragénital en priorité les hommes ayant des relations sexuelles avec les hommes. Les freins rapportés au dépistage triple site étaient d’ordre économique. Cette étude retrouvait une prévalence du CT comparable aux études antérieures. Le portage extra génital de CT a été mis en évidence, constituant un foyer de diffusion possible de l’épidémie. D’autres études seraient nécessaires pour établir les déterminants comportementaux et populationnels du portage extra génital de CT afin d’optimiser le dépistage et juguler l’épidémie d’ICT.

Background: Sexually transmitted diseases have become a major health issue. Their incidence have been increasing in the past 20 years as has the diversity of sexual practices but screening of people at risk has been insufficient. Among those at risk are young people therefore junior doctors who should be sensitive to problem. Junior doctors have a renowned high drink and drugs consumption. However they have poor health care and a high self-prescription rate. Aim: To describe risk factors and screening methods of STD’s amongst junior doctors in France. Method: This was an epidemiological, descriptive, transversal, self-declared, multicenter enquiry conducted with the help of anonymous surveys. Results. Junior doctor unions in 29 cities in France were solicited between June and August 2018. Following these requests, 456 junior doctors answered fully from 12 cities. The main risk factors found were sexual intercourse under the influence of psycho active products for 68 %, internet based encounters for 27% and not using a condom systematically with a partner of unknown serological status for 18 %. The majority had screened themselves for STD’s by self-prescription 46 % and 38 % admitted not screening systematically at the beginning of every new relationship. Moreover, 34 % did not either when believing a sexual risk had been taken. For those who had undergone screening, 9,4 % had been infected by Chlamydia and 3,4 % by HPV. The main obstacles for screening were trust in the sexual partner for 18 % and lack of time for 12 %. However the vast majority (72 %) were in favor of installing screening sessions for them in their work establishment. Conclusion. Junior doctors present risk factors for STD’s mainly linked to the use of psycho active products and have insufficient screening methods. Targeted screening sessions are called for and would help improve junior doctor’s health which relies highly on self-prescription.; Contexte : Les IST sont en hausse depuis 20 ans associé à une diversification des pratiques sexuelles et à un manque de dépistage chez les personnes à risque dont les jeunes et donc les étudiants en médecine. Il est décrit chez eux une haute consommation de produits psychoactifs, désinhibants sexuel et un suivi médical précaire. Objectif : état des lieux des facteurs de risque des IST et du dépistage chez les internes en médecine. Méthode : enquête épidémiologique descriptive, analytique transversale auto-déclarative multicentrique, menée à l’aide d’un questionnaire anonyme. Résultats : 456 réponses ont été obtenues de 12 villes participantes entre juin et août 2018. Les principaux facteurs de risque retrouvés étaient des rapports sexuels sous produits psychoactifs (68%), des rencontres sur internet (27%), l’absence d’utilisation du préservatif systématique en cas de risque (18%). 46% ont eu recours à l’auto-prescription pour la réalisation d’un dépistage et 38 % ont déclaré ne pas se faire dépister au début de chaque relation stable et 34 % lorsqu’ils estimaient avoir pris un risque sexuel. Parmi les dépistés, une infection par chlamydia (9,4%) et par HPV (3,4%) ont été déclarés. Les obstacles aux dépistages étaient respectivement la confiance dans le partenaire (18%) et le manque de temps (12%). Les internes se sont dits favorables (72%) à la mise en place de séances de dépistages ciblées. Conclusion : Les internes ont des facteurs de risque liés à la consommation de produits psychoactifs et ont des modalités de dépistage insuffisantes par rapport à leurs connaissances. La création d’un dépistage ciblé est plébiscitée qui permettrait d'estomper l'auto-prescription.

Introduction: With the improvement of ARVs and therapeutic strategies, the life expectancy of HIV infected patients becomes similar to the general population. However, the infection over-risk persists in this population. In this context, specific vaccine recommendations were published in 2012 in France by HCSP and updated in 2014. The aim of the study was to assess PLWHA immunization coverage following the publication of these recommendations. Secondary objectives were to identify prescribers and the determinants of immunization coverage. Materials and methods: The study was conducted from November 2016 to June 2017 in a cohort of HIV infected patients monitored in a regional hospital. Vaccine status has been defined on the basis of written data. Questionnaires for patients and general practitioners have made it possible to identify factors influencing the vaccine rate in this population. Results: Were included 146 patients. The median age was 51 years [18-77] and the sex ratio was 2.1 (M/F). More than 82% of patients brought their vaccination card. Immunization coverage was estimated at 62.3% for dTP and 45.2% for pneumococcal vaccination. Of the 21 patients born after 1980, 19% were vaccinated against measles-mumps-rubella. Influenza vaccination coverage was 25.3%. For hepatitis B, 63.6% of patients were up to date. Of the 68 patients with vaccinal indication for Neisseria meningitidis group C, 10.2% were vaccinated. In the 85 patients of the hepatitis A risk group, 41.1% were up to date. Infectiologists prescribed 73% of the vaccines. The most frequent reasons for non-vaccination were lack of proposal by doctors (57%) and patients refusal (16%). Conclusion: Immunization coverage among HIV infected patients remains insufficient despite the diffusion of specific national recommendations. The strengthening of physicians and patients vaccine knowledges and the use of tools to improve traceability seems to be the levers to improve the vaccination of these patients.; Introduction : Avec l'amélioration des ARV et des nouvelles stratégies thérapeutiques, l'espérance de vie des PVVIH devient identique à celle de la population générale. Pourtant le surrisque infectieux persiste au sein de cette population. Dans ce contexte, des recommandations vaccinales spécifiques ont été publiées en 2012 en France par le HCSP et actualisées en 2014. L'objectif principal de l'étude était d'évaluer la couverture vaccinale des PVVIH. Les objectifs secondaires étaient d'identifier les prescripteurs et les déterminants de la couverture vaccinale. Matériels et méthodes : L'étude a été menée de novembre 2016 à juin 2017 dans une cohorte de PVVIH suivies en centre hospitalier régional. Les statuts vaccinaux ont été définis à partir de données tracées. Résultats : 146 PVVIH ont été inclues. L'âge médian était de 51 ans [18 -77] et le sex-ratio de 2,1 (H/F). La couverture vaccinale était de 62,3% pour le dTP et à 45,2% pour la vaccination contre le pneumocoque. Chez les 21 PVVIH nées après 1980, 19% étaient vaccinées contre le ROR. La couverture vaccinale anti grippale était de 25,3% et de 63,6% pour l'hépatite B. Parmi les 68 PVVIH relevant de l'indication vaccinale contre Neisseria meningiditis du groupe C, 10,2% étaient à jour. Chez les 85 patients à risque d'hépatite A, 41,1% étaient à jour. Conclusion : La couverture vaccinale chez les PVVIH reste insuffisante malgré la diffusion de recommandations nationales spécifiques. Le renforcement des connaissances vaccinales des médecins et des patients et l'utilisation d'outils améliorant la traçabilité, sont des leviers actuels dans la prise en charge de ces patients.

Introduction: Therapeutic advances have changed malignant hemopathy epidemiology and patients’ quality of life. They are especially at risk of infection due to the immunosuppression caused by their pathology and chemotherapy. Vaccination is a key element of prevention, but vaccinal coverage is still insufficient despite the latest guidelines. The study's aim was to identify the existing impediments to vaccination and assess the impact of information tools on vaccinal coverage. Methods: This prospective observational study was based on pre/post analysis carried out in hematology departments of a university hospital and a regional center. Patients with malignant hemopathy under chemotherapy were sampled and surveyed. A flyer was given to patients and a guideline summary on vaccination to hematologists prior to a second assessment of vaccinal coverage. Results: 403 patients were included. Vaccinal coverage did not increase significantly. Only pneumococcal coverage improved according to haematological records. Initial vaccinal coverage was low for influenza (19.3%), pneumococcus (9.7%), DTP (36.2%) and hepatitis B (15%). According to the hematologists, lack of vaccinal anamnesy for patient (75%), lack of vaccination tracability (58.3%) and difficulties to access guidelines (41.6%) were the main obstacles for better vaccinal coverage. Most of the patients considered vaccination as an important part of their treatment (75.4%), but too few were well-informed (24.6%). Discussion: This study confirms vaccine deficit and the low impact of the communication tools provided. It suggests the need for developing online vaccinal booklet and for holding dedicated consultations.; Introduction : Les avancées thérapeutiques ont modifié l’épidémiologie et la qualité de vie des patients souffrant d’hémopathie maligne. Ceux-ci sont particulièrement à risque d’infection. Cependant la couverture vaccinale reste insuffisante malgré les recommandations du HCSP. Les objectifs de l'étude étaient d’identifier les freins à la vaccination et de mesurer l’impact d’outils d’information sur la couverture vaccinale. Méthode : Cette étude était prospective observationnelle sur un schéma avant/après dans les services d’hématologie d’un CHU et d’un CHR. Les patients atteints d’hémopathie maligne sous chimiothérapie ont été inclus. Une brochure d’information pour les patients et une fiche de synthèse des recommandations vaccinales pour les hématologues ont été diffusées avant une nouvelle évaluation de la couverture vaccinale. Résultats : 403 patients ont été inclus. La couverture vaccinale globale n’a pas augmenté significativement. Seule la couverture anti-pneumococcique était améliorée selon les dossiers hématologues. La couverture vaccinale initiale était basse pour la grippe (19,3%), le pneumocoque (9,7 %), le DTP (36.2%) et l’hépatite B (15%). Les freins objectivés côté hématologues étaient l’absence d’information sur les antécédents vaccinaux des patients (75%), l’absence de support pour tracer les vaccins (58.3%) et la difficulté d’accès aux recommandations (41.6%). Côté patients, la majorité considérait la vaccination comme importante (75.4%) mais peu étaient informés (24.6%). Discussion : Cette étude confirme le déficit vaccinal et l’impact modéré des outils. Elle suggère de développer un outil de partage vaccinal informatisé ou des consultations dédiées.

Introduction: General practitioners (GP) are the first medical source of health information for travelers. The pre-travel consultation (PTC) is strewn with difficulties for the practitioner, not mentioned in literature. The objective of this study is to evaluate these difficulties encountered in general medicine during the PTC. Methods: This is a descriptive, transversal study conducted between May and July 2016, by sending a computerized questionnaire to the GPs of the Rhône-Alpes-Auvergne region. Results: Two hundred and eight GP answered the questionnaire. The majority of GPs (90.4%) performed 1 to 4 PTCs per month. The questions about travel were broached by patients during consultations for another reason in 67.2% of the cases. The time between PTC and departure was too short for 69.2% of GPs. PTC was too long for 27.4% of respondents. Information source were difficult to access for 18.9% of the GPs. A need for training in the field of travel medicine was expressed by 27.6% of GPs. The complexity of the PTC resulted from the patient's uncertainty about his trip for 42.8% of the GPs and 44.8% from the lack of data on his vaccination status. Advising specific populations, such as pregnant women, or immunocompromised patients, was problematic for 88.6% of respondents. Conclusion: This study highlights the need for better access to repository of the specialty in the doctor’s office. Patient education, including consultation preparation, is essential to maximize the effectiveness of PTC. This preliminary work could be enhanced in the future by evaluating a computerized and accessible expertise tool, practical in general medicine.; Introduction : Le médecin généraliste (MG) est la première source d’information sanitaire des voyageurs. L’exercice de la consultation pré-voyage (CPV) est émaillé de difficultés pour le praticien, peu évoquées dans la littérature. L’objectif de cette étude est d’évaluer ces difficultés rencontrées en médecine générale lors de la CPV. Méthodes : Il s’agit d’une étude descriptive, transversale, réalisée entre mai et juillet 2016, par envoi d’un questionnaire informatisé aux MG de la région Rhône-Alpes-Auvergne. Résultats : Deux cent huit MG ont répondu au questionnaire. La majorité des MG (90,4%), réalisait 1 à 4 CPV par mois. Le voyage était abordé par le patient lors d’une consultation pour un autre motif dans 67,2% des cas. Le délai entre la CPV et le départ était trop court pour 69,2% des MG. La CPV était chronophage pour 27,4% des répondants. Les référentiels étaient difficiles d’accès pour 18,9% des MG. Un besoin de formation dans le domaine de la médecine des voyages était exprimé par 27,6% des MG. La complexité de réalisation de la CPV résidait dans les incertitudes du patient concernant son voyage pour 42,8% des MG et pour 44,8% dans le manque de données sur son statut vaccinal. Les conseils aux populations spécifiques mettaient en difficultés 88,6% des répondants. Conclusion : Cette étude souligne la nécessité d’un meilleur accès aux référentiels de la spécialité au cabinet. L’éducation du patient, notamment la préparation de la consultation, est primordiale pour optimiser l’efficacité de la CPV. Ce travail préliminaire pourrait être enrichi, à l’avenir, de l’évaluation d’un outil d’expertise informatisé et ergonomique, pratique en médecine générale.

HPV = human papillomavirus, HSH = homme ayant des relations sexuelles avec des hommes, VIH = virus de l’immunodéficience humaine; Depuis 1996, l’incidence du cancer anal HPV-médié (CA), en France, a été multipliée par 6, pour les personnes vivant avec le VIH (PVVIH). Chez les hommes ayant des relations sexuelles avec des hommes (HSH) elle est passée de 15 à 95 cas pour 100 000 personnes-années. Face à ce constat, en 2002, en France a été recommandé le dépistage systématique du CA chez les PVVIH à haut risque. L’objectif de l’étude est d’évaluer le suivi des recommandations de dépistage proctologique au sein des PVVIH HSH. Cette étude rétrospective observationnelle a inclus les HSH parmi les PVVIH suivis dans 2 centres de l’arc alpin. La notion de facteur de risque du CA, d’examen proctologique, le contexte de sa réalisation et son résultat ont été colligés. Au total, 547 patients (pts) ont été inclus. Un examen proctologique a été réalisé pour 51% des pts, 31,4% dans les 2 dernières années. Une condylomatose a été diagnostiquée au cours du suivi de 39% des pts examinés, une lésion de haut grade ou un carcinome in situ pour 5,4% et un CA pour 2,5% d’entre eux. Les facteurs de risque de développer une lésion anale étaient : la durée de vie avec un taux de CD4 inférieur à 200/mm3 et un antécédent de condylomatose. Les recommandations ne sont suivies dans ces centres que pour la moitié des PVVIH HSH. Une lésion précancéreuse a été retrouvée chez près de la moitié des personnes dépistées. Le dépistage du CA doit être renforcé. Ce travail nécessite d’être complété par une analyse des freins au dépistage afin de proposer des actions correctives, améliorer le suivi proctologique de nos pts et modifier l’épidémiologie des CA dans cette population à haut risque.