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Objectives Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Reference anti-CMV treatment is valganciclovir/ganciclovir, which is contraindicated in pregnancy given questions about teratogenicity. Methods We analysed reports from VigiBase, the world’s largest safety database, and performed a disproportionality analysis of adverse pregnancy outcomes associated with (val)ganciclovir compared with any other drugs or with (val)aciclovir as comparators. Results Among 3 104 984 reports related to childbearing-age women or to pregnancy topics, 6186 were exposed to (val)ganciclovir or (val)aciclovir including 251 adverse pregnancy outcomes with (val)ganciclovir (n = 34) or (val)aciclovir (n = 217). We did not evidence any increased reporting of any adverse pregnancy outcome [miscarriage, stillbirth, small weight for gestational age, preterm birth ( Conclusions These preliminary results require confirmation but suggest the possibility for trial evaluation of val(ganciclovir) in severe maternal or fetal CMV infections.

Immunocompromised patients have an increased risk of a severe form of COVID-19. The clinical efficacy of the tixagevimab/cilgavimab monoclonal antibody combination as pre-exposure prophylaxis against BA.1 and BA.2 SARS-CoV-2 Omicron sublineages is unknown. We aimed to describe the incidence and outcomes of COVID-19 among immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis during the Omicron wave in France.This was an observational multicentre cohort study of immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis between December 28, 2021 and March 31, 2022. Patients received tixagevimab/cilgavimab 150/150 mg intramuscularly if they had impaired vaccine response and a high risk of severe form of COVID-19.Tixagevimab/cilgavimab was administered to 1112 immunocompromised patients. After a median (range) follow-up of 63 (49-73) days, COVID-19 was confirmed in 49/1112 (4.4%) ≥5 days after treatment. During the study period, mean weekly incidence rate was 1669 in 100 000 inhabitants in Ile-de-France and 530 in 100 000 among patients who received tixagevimab/cilgavimab prophylaxis. Among infected patients, 43/49 (88%) had a mild-to-moderate form and 6/49 (12%) had a moderate-to-severe form of COVID-19. Patients with moderate-to-severe illnesses were less likely to have received early therapies than patients with mild forms (53.5% vs. 16.7% respectively) and 2/49 (4%) patients died from COVID-19.Our study reported a low rate of infections and severe illnesses among immunocompromised patients treated with tixagevimab/cilgavimab. A global preventive strategy including vaccines, preexposure prophylaxis with monoclonal antibodies, and early therapies might be effective to prevent severe forms of COVID-19 among severely immunocompromised patients.

International audience; The etiologies of undifferentiated fever in pregnant women have not been studied thoroughly. Because of its non-specific presentation but severe prognosis, listeriosis is often suspected in this setting, but in most cases not confirmed. We studied the causes of undifferentiated fever in pregnant women who received preemptive listeriosis treatment. We conducted from November 1, 2011, to June 30, 2013, a prospective multicentric observational cohort study of pregnant women referred to obstetrical wards with undifferentiated fever and who received listeriosis preemptive treatment. Clinical and biological features, treatment, outcome, and final diagnosis were collected. We enrolled 103 febrile pregnant women. A cause was identified in 77/103 (75%): viral infection in 52/103 (50%, influenza in 21 (20%)), bacterial infection in 22 (21%, including 16 pyelonephritis (16%) and 3 pneumonias (3%)), and TORCH infection in 3 (3%, varicella, toxoplasmosis, and cytomegalovirus primo-infections, n=1, each). Viral infections collected during influenza outbreaks (December–March) accounted for 43/57 (75%) cases. Two fetal losses were reported in the context of febrile pneumonia. Final diagnoses required adapting medical care in 46/77 (60%) of cases, for bacterial, influenza, or TORCH infections. A large array of benign to potentially severe infections manifests as acute undifferentiated fever in pregnant women, requiring careful repeated evaluation.

We studied 11 cases of culture-proven Listeria-associated lymphadenitis reported to the French National Reference Center for Listeria from 1994 to 2019 and 8 additional published cases. Listeria-associated lymphadenitis is rare, but it is associated with a mortality as high as for invasive listeriosis, and it is frequently diagnosed with concomitant neoplasia., We studied 11 cases of Listeria-associated lymphadenitis reported to the French Reference Center for Listeria, and 8 published cases. Listeria-associated lymphadenitis is rare but associated with a mortality as high as for invasive listeriosis, and frequently diagnosed with concomitant neoplasia.

International audience; Objective: To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors of early-onset sepsis.Study design: This is a secondary analysis of the EPIPAGE-2 study, a prospective national population-based cohort that included all liveborn infants at 22-31 completed weeks of gestation in France in 2011. Infants at high risk of early-onset sepsis (born after preterm labor or preterm premature rupture of membranes, or from mother who had clinical chorioamnionitis or received antibiotics during the last 72 hours) were excluded. Early antibiotic exposure was defined as antibiotics started at Day 0 or Day 1 of life, regardless of the duration and type of antibiotics. We compared treated and untreated patients by using inverse probability of treatment weighting based on estimated propensity score. Results: Among 648 very preterm infants at low risk of early-onset sepsis, 173 (26.2%) had early antibiotics treatment. Early antibiotic exposure was not associated with death or late-onset sepsis or necrotizing enterocolitis (OR=1.04 [95%CI=0.72-1.50]). However, it was associated with higher odds of severe cerebral lesions (OR=2.71 [95%CI=1.25-5.86]) and moderate-to-severe bronchopulmonary dysplasia (OR=2.30 [95%CI=1.21-4.38]). Conclusion: Early empirical antibiotics administrated in very preterm infants at low risk of early-onset sepsis were associated with a higher risk of severe cerebral lesions and moderate-to-severe bronchopulmonary dysplasia.

Background Maintenance ART with dolutegravir-based dual regimens have proved their efficacy among HIV-1-infected subjects in randomized trials. However, real-life data are scarce, with limited populations and follow-up. Objectives We assessed virological failure (VF) and resistance-associated mutations (RAMs) on dolutegravir maintenance regimens in combination with rilpivirine or with lamivudine or emtricitabine (xTC) and analysed the factors associated with VF. Methods Between 2014 and 2018, all HIV-1-infected adults included in the Dat’AIDS cohort and starting dolutegravir/rilpivirine or dolutegravir/xTC as a maintenance dolutegravir-based dual regimen were selected. VF was defined as two consecutive HIV RNA values >50 copies/mL or a single value >400 copies/mL. We compared cumulative genotypes before initiation of a maintenance dolutegravir-based dual regimen with genotype at VF. Results We analysed 1374 subjects (799 on dolutegravir/rilpivirine and 575 on dolutegravir/xTC) with a median follow-up of 20 months (IQR = 11–31) and 19 months (IQR = 11–31), respectively. VF occurred in 3.8% (n = 30) of dolutegravir/rilpivirine subjects and 2.6% (n = 15) of dolutegravir/xTC subjects. Among subjects receiving dolutegravir/rilpivirine, two genotypes harboured emerging RAMs at VF: E138K on NNRTI (n = 1); and E138K+K101E on NNRTI and N155H on INSTI (n = 1). Among subjects receiving dolutegravir/xTC, no new RAM was detected. The only predictive factor of VF on dolutegravir/rilpivirine was the history of failure on an NNRTI-based regimen (adjusted HR = 2.97, 95% CI = 1.28–6.93). No factor was associated with VF on dolutegravir/xTC. Conclusions In this large real-life cohort, dolutegravir/rilpivirine and dolutegravir/xTC sustained virological suppression and were associated with a low rate of VF and RAM emergence. Careful virological screening is essential before switching to dolutegravir/rilpivirine in virologically suppressed patients with a history of NNRTI therapy.

International audience; Several cases of herpes zoster (HZ) following mRNA COVID-19 vaccination (BNT162b2 and mRNA-1273) have been reported, and the first epidemiological evidence suggests an increased risk. We used the worldwide pharmacovigilance database VigiBase to describe HZ cases following mRNA COVID-19 vaccination. We performed disproportionality analyses (case/non-case statistical approach) to assess the relative risk of HZ reporting in mRNA COVID-19 vaccine recipients compared to influenza vaccine recipients and according to patient age. To 30 June 2021, of 716 928 reports with mRNA COVID-19 vaccines, we found 7728 HZ cases. When compared to influenza vaccines, mRNA COVID-19 vaccines were associated with a significantly higher reporting of HZ (reporting odds ratio 1.9, 95% CI 1.8–2.1). Furthermore, we found a reduced risk of reporting HZ among under 40-year-old persons compared to older persons (reporting odds ratio 0.39, 95% CI 0.36–0.41). Mild and infrequent HZ reactions may occur shortly after mRNA COVID-19 vaccination, at higher frequency than reported with influenza vaccination, especially in patients over 40 years old. Further analyses are needed to confirm this risk.

VZV infection can involve every level of the neurologic system: from the central nervous system (CNS) to the peripheral nervous system (PNS), including aseptic meningitis. Prognosis seems to differ between these neurological involvements. Prognostic factors remain unknown.This is a retrospective multicenter study including all patients with a positive VZV polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) from eight centers in Paris (France) between 2011 and 2018. Unfavorable outcome was defined as mortality linked to VZV or incomplete recovery. Modified Rankin Scale (mRS) evaluated disability before and after the infection, with the difference designated as Rankin Delta.Seventy-two patients were included (53% male, median age 51 years, median mRS 0). Immunosuppression was reported in 42%. The clinical spectrum included 26 cases of meningitis, 27 instances of CNS involvement, 16 of PNS involvement, and 3 isolated replications (positive PCR but no criteria for neurological complications from VZV). Antiviral treatment was administered to 69 patients (96%). Sixty-two patients completed follow-up. Death linked to VZV occurred in eight cases. Unfavorable outcome (UO) occurred in 60% and was significantly associated with a higher prior mRS (Odd-ratio (OR) 3.1 [1.4-8.8] p = .012) and the presence of PNS or CNS manifestations (OR 22 [4-181] p = .001, OR 6.2 [1.3-33] p = .03, respectively, compared to meningitis). In the CSF, higher protein level (p .0001) was also significantly associated with a higher Rankin Delta.Neurological complications of VZV with evidence of CSF viral replication are heterogeneous: aseptic meningitis has a good prognosis, whereas presence of CNS and PNS involvement is associated with a higher risk of mortality and of sequelae, respectively.

International audience; Background: Intravenous benzylpenicillin is the gold-standard treatment for neurosyphilis, but it requires prolonged hospitalisation. Ceftriaxone is a possible alternative treatment, the effectiveness of which remains unclear. We aimed to assess the effectiveness of ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis. Methods: We did a retrospective multicentre study including patients with neurosyphilis who were treated at one of eight tertiary care centres in France, from Jan 1, 1997, to Dec 31, 2017. We defined neurosyphilis as positive treponemal and non-treponemal tests and at least one of otic syphilis, ocular syphilis, either neurological symptom with a positive result on cerebrospinal fluid (CSF)-VDRL or CSF-PCR tests, or more than five leukocytes in a CSF cell count. Patients with neurosyphilis were identified from the medical information department database of each centre and assigned to one of two groups on the basis of the initial treatment received (ie, benzylpenicillin group or ceftriaxone group). The primary outcome was the overall clinical response (ie, proportion of patients with a complete or partial response) 1 month after treatment initiation. The secondary endpoints were proportions of patients with a complete response at 1 month and serological response at 6 months, and length of hospital stay. Findings: Of 365 patients with a coded diagnosis of neurosyphilis in one of the eight care centres during 1997–2017, 208 were included in this study (42 in the ceftriaxone group and 166 in the benzylpenicillin group). The mean age of patients was 44·4 years (SD 13·4), and 193 (93%) were men. We observed 41 instances of overall clinical response (98%) in the ceftriaxone group versus 125 (76%) in the benzylpenicillin group (crude odds ratio [OR] 13·02 [95% CI 1·73–97·66], p=0·017). After propensity score weighting, overall clinical response rates remained different between the groups (OR 1·22 [95% CI 1·12–1·33], p

To determine the impact of antibiotic therapy (ATBT) on outcomes of renal cyst infection (CyI) in patients with polycystic kidney disease.We undertook a single-center retrospective study of CyI in autosomal dominant polycystic kidney disease (January 1, 2000, through December 31, 2018). Cyst infections were classified as definite (microbiologically proven), probable (radiologic signs), or possible (clinical or biologic signs only). We studied the determinants of ATBT failure (persistence of infection beyond 72 hours of microbiologically adequate initial ATBT, with requirement for ATBT change, cyst drainage, or nephrectomy) and recurrences (14 days after the end of ATBT).Among 90 patients, 139 CyIs (11 definite, 74 probable, 54 possible) were compiled. Cultures were positive in 106 of 139 (76%) episodes, with Escherichia coli found in 89 of 106 (84%). Treatment failures and recurrences within 1 year of follow-up were more frequent in definite/probable CyI (20/85 [34%] and 16/85 [19%]) than in possible CyI (2/54 [4%] and 4/54 [7%]; P.01 and P=.08, respectively). Male sex (odds ratio [OR], 7.79; 95% CI, 1.72 to 46.68; P.01), peak C-reactive protein level above 250 mg/L (OR, 7.29; 95% CI, 1.78 to 35.74; P.01; to convert C-reactive protein values to nmol/L, multiply by 9.524), and cyst wall thickening (OR, 7.70; 95% CI, 1.77 to 43.47; P=.01) but not the modalities of initial ATBT were independently associated with higher risk of failure. In a Cox proportional hazards model, kidney transplant recipients exhibited higher risk of recurrence (hazard ratio, 3.76; 95% CI, 1.06 to 13.37; P=.04), whereas a total duration of ATBT of 28 days or longer was protective (hazard ratio, 0.02; 95% CI, 0.00 to 0.16; P.001), with an inverse correlation between duration and recurrence (81% for treatment21 days, 47% for 21 to 27 days, 2% for ≥28 days; P.0001).Initial first-line ATBT had no significant effect on renal CyI treatment failure. Treatment duration of 28 days and longer reduced recurrences.

Therapies - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le samedi 28 aout 2021

Resume Objectif Determiner les criteres de diagnostic de l'infection intra-uterine (IIU), les modalites du traitement : antibiotherapie et mode d'accouchement. Methode Recherche bibliographique en langue anglaise et francaise a l'aide des bases de donnees informatiques Medline et de la Cochrane Library entre 1980 et 2018 et des recommandations des societes savantes. Resultats L'IIU correspond a une infection des membranes fœtales et/ou de la decidua maternelle et/ou des autres composants de la cavite amniotique (liquide amniotique, placenta, cordon ombilical et fœtus). Ce terme doit etre prefere a celui de chorioamniotite, trop imprecis (accord professionnel). Les signes cliniques d'IIU ont une sensibilite et une specificite limitees (NP3). Le diagnostic est pose devant une fievre definie par une temperature ≥ 38 C, sans autre cause evidente et associee a au moins deux des signes suivants : tachycardie fœtale > 160 battements/min pendant ≥ 10 minutes, douleurs uterines ou travail spontane, liquide amniotique purulent a l'orifice cervical (accord professionnel). Une hyperleucocytose maternelle en l'absence de corticotherapie antenatale ou une elevation de la CRP plasmatique sont des arguments supplementaires pour une IIU malgre des sensibilites et specificites faibles (NP3). L'IIU doit conduire a l'accouchement (Grade A). Elle ne justifie pas a elle-seule le recours a une cesarienne (accord professionnel). Le traitement antibiotique doit etre actif sur Streptococcus agalactiae (streptocoque B) et Escherichia coli. Il doit etre debute des le diagnostic pose et poursuivi pendant et apres l'accouchement pour reduire la morbidite neonatale et maternelle (Grade B). Le traitement de choix est la combinaison d'une betalactamine et d'un aminoside par voie intraveineuse (Grade B). Dans le post-partum, une dose unique d'antibiotique est suffisante apres un accouchement par voie vaginale (Grade C). Un traitement plus long s'impose en presence d'une bacteriemie et peut se discuter en cas de persistance d'une fievre, d'obesite ou de cesarienne (accord professionnel).

Resume Objectif Determiner la prise en charge des patientes avec une rupture prematuree des membranes avant 37 semaines d’amenorrhee (SA). Methodes Synthese de la litterature a partir des bases de donnees PubMed et Cochrane et des recommandations des societes et colleges francais et etrangers. Resultats En France, la frequence de la rupture prematuree des membranes (RPM) est de 2 a 3 % avant 37 SA (Niveau de preuve [NP] 2) et de moins de 1 % avant 34 SA (NP2). La prematurite et l’infection intra-uterine sont les complications majeures de la RPM avant terme (NP2). La prolongation de la duree de latence est benefique (NP2). Par rapport aux autres causes de prematurite, la RPM avant terme n’est pas associee a un sur-risque evident de morbi-mortalite neonatale, sauf en cas d’infection intra-uterine, qui est associee a une augmentation des morts fœtales in utero (NP3), des infections neonatales precoces (NP2) et des enterocolites ulceronecrosantes (NP2). Le diagnostic de la RPM avant terme est principalement clinique (accord professionnel). En cas de doute diagnostique, il est recommande d’utiliser les tests de detection d’IGFBP-1 ou de PAMG-1 (accord professionnel). Il est recommande d’hospitaliser les patientes lors du diagnostic de RPM avant terme (accord professionnel). Il n’existe pas d’argument suffisant pour recommander ou ne pas recommander une tocolyse initiale (grade C). Si une tocolyse etait prescrite, il est recommande de ne pas la prolonger plus de 48 heures (grade C). Il est recommande d’administrer une cure antenatale de corticoides si l’âge gestationnel est inferieur a 34 SA (grade A) et du sulfate de magnesium en cas d’accouchement imminent avant 32 SA (grade A). Il est recommande de prescrire une antibioprophylaxie a l’admission (grade A) pour reduire la morbidite neonatale et maternelle (NP1). L’amoxicilline, les cephalosporines de 3eme generation et l’erythromycine (accord professionnel) peuvent etre utilisees en monotherapie, ou l’association erythromycine–amoxicilline (accord professionnel), pour une duree de 7 jours (grade C). Toutefois, un arret precoce de l’antibioprophylaxie semble acceptable en cas de prelevement vaginal initial negatif (accord professionnel). Il n’est pas recommande de prescrire comme antibioprophylaxie l’association amoxicilline-acide clavulanique (accord professionnel), des aminosides, des glycopeptides, des cephalosporines de premiere ou deuxieme generation, de la clindamycine ou du metronidazole (accord professionnel). La prise en charge a domicile des patientes cliniquement stables apres au moins 48 heures de surveillance hospitaliere est possible (accord professionnel). Au cours de la surveillance, il est recommande d’identifier les elements cliniques et biologiques evocateurs d’une infection intra-uterine (accord professionnel). Il n’est pas possible d’emettre de recommandations sur la frequence de cette surveillance (accord professionnel). En cas d’examen de surveillance isolement positif chez une patiente asymptomatique (CRP augmentee, hyperleucocytose, prelevement vaginal positif), il n’est pas recommande d’initier systematiquement une antibiotherapie (accord professionnel). En cas d’infection intra-uterine, il est recommande d’administrer immediatement une antibiotherapie associant une betalactamine a un aminoside (grade B), par voie intraveineuse (grade B) et de faire naitre l’enfant (grade A). La cesarienne en cas d’infection intra-uterine est reservee aux indications obstetricales habituelles (accord professionnel). Il est recommande d’avoir une attitude expectative en cas de RPM non compliquee avant 37 SA (grade A), meme en cas de prelevement positif pour le streptocoque B, sous couvert d’une antibioprophylaxie a l’admission (accord professionnel). L’ocytocine et les prostaglandines sont deux options envisageables pour le declenchement du travail en cas de RPM avant terme (accord professionnel). Conclusion La prise en charge de la rupture prematuree des membranes avant terme non compliquee repose sur l’expectative jusqu’a 37 SA (grade A).

Background and Aims Renal cyst infection (CI) is a major complication of autosomal dominant polycystic kidney disease (ADPKD), associated with frequent hospitalization, worsening of kidney function and significant mortality. Data regarding treatment are scarce and recommendations only expert-based, with low level of evidence. Prolonged treatment duration and use of lipid-soluble antibiotics may increase antibiotic concentration in infected kidney cysts. However, benefits of this strategy have never been investigated in clinical practice. Method We undertook a monocentric retrospective study of CI in ADPKD patients from 2000 to 2018. CI were classified as “definite” (microbiologically proven), “probable” (clinical/biological and radiological signs) or possible (clinical/biological signs). Determinants of treatment failure and recurrences were studied. Results 139 CI (11 “definite”, 74 “probable”, 54 “possible”) were compiled among 90 patients. Median age was 53 years. 28/90 (31%) were kidney transplant recipients. Escherichia coli was identified in 89/106 (84%) episodes. Treatment failure was reported in 22/139 (16%), and found associated with cyst diameter >5cm (80% vs 36%, P Conclusion Treatment of kidney CI should last ≥28 days and include when possible lipid soluble antibiotics.

Background Listeriosis is caused by the foodborne pathogen Listeria monocytogenes. It can present as a maternal–neonatal infection. We implemented a nationwide prospective cohort and analyzed the features of neonatal listeriosis. Methods We studied all neonates born alive from mothers with microbiologically proven maternal–neonatal listeriosis enrolled from November 2009 to December 2017. We analyzed presentation, neonatal outcome at discharge, and predictors of severe presentation and outcome. Results We studied 189 infants; 133 of 189 (70%) had abnormal clinical status at birth, including acute respiratory distress in 106 of 189 (56%). There were 132 of 189 (70%) infants who developed early-onset listeriosis and 12 of 189 (6%) who developed late-onset listeriosis; all presented with acute meningitis. There were 17 of 189 (9%) infants who had major adverse outcomes: 3%, (5 of 189) death; 6% (12 of 189), severe brain injury; and 2% (3 of 189), severe bronchopulmonary dysplasia. Fifteen of 17 infants were born Conclusions Antenatal maternal antimicrobial treatment is associated with reduced neonatal listeriosis severity, justifying the prescription of preemptive maternal antimicrobial therapy when maternal–fetal listeriosis is suspected. Neonatal outcome is better than reported earlier, and its major determinant is gestational age at birth. Clinical Trials Registration NCT01520597.

BackgroundIntegrase strand transfer inhibitors (INSTIs) are increasingly used in patients living with HIV due to their safety, effectiveness and high genetic barrier. However, an association with weight gain has recently been suggested and several cases of diabetes mellitus have been reported with raltegravir and dolutegravir. The long-time metabolic impact of these recent molecules remains unclear.ObjectivesTo assess if an INSTI as a third agent is statistically associated with new-onset diabetes mellitus compared with an NNRTI or a PI.Patients and methodsPatients undergoing first-line combined ART (cART) without diabetes at baseline were retrospectively included from the Dat’AIDS French cohort study (ClinicalTrials.gov NCT02898987). Incident diabetes mellitus was defined as a notification of new diabetes in the medical history, a glycated haemoglobin (HbA1c) level superior to 7.5% or the start of a diabetes therapy following the initiation of ART.ResultsFrom 2009 to 2017, 19 462 patients were included, among which 265 cases of diabetes mellitus occurred. Multivariate and survival analyses did not highlight an increase in new-onset diabetes in patients undergoing cART with an INSTI as a third agent compared with an NNRTI or a PI. BMI >30 kg/m2, age >37 years old (in survival analysis), black race or Hispanic ethnicity, arterial hypertension and AIDS were associated with a higher proportion of incident diabetes.ConclusionsINSTIs were not statistically associated with new-onset diabetes. However, clinicians should remain aware of this possible metabolic comorbidity, particularly in patients with a high BMI and older patients.

The incidence of herpes simplex virus (HSV) neonatal infection is estimated to be 8.9 per 100,000 live births in Europe. Early treatment with intravenous acyclovir has transformed the prognosis but this infection remains severe since, despite the treatment, mortality is frequent in disseminated diseases and neurological sequelae are frequent when central nervous system is involved. The major risk factor for transmission is the type of maternal infection. In women shedding the virus in their genital tract during childbirth, neonatal infection rates are 44 %, 25 % and 1.3 % in primary, non-primary and recurrent infections, respectively. The goals for the management of this infection during pregnancy encompass 1) the prevention of any contact between the newborn and the maternal virus by suppressing viral replication in the genital tract in late pregnancy and recommending a cesarean section in cases of genital lesions at delivery, and 2) the development of strategies allowing rapid identification and treatment of infected newborns.

Background – In case of breast abscess, many patients stop breastfeeding on the advice of a health professional. Purpose – We reviewed our experience of treatment of lactating breast abscesses by ultrasound-guided aspiration and suggest an algorithm of their management. We also analyzed the continuation of breastfeeding of these patients after advices from trained teams. Materiel and methods – We conducted a retrospective study from April 2016 to April 2017, including 34 patients referred for a breast abscess during lactation at the Duroc Breast Imaging Center. Results – A single aspiration was sufficient in 64.3% of cases. The delay between the occurrence of the abscess and the indication for drainage was significantly higher for patients who have needed finally surgical drainage (p = 0,0031). There were no difference of size of abscesses between patients receiving needle aspiration alone and those who have undergone surgery (p = 0,97). All patients who had been managed by needle aspiration continued breastfeeding after the treatment and 40% of the patients were still breastfeeding at 6 months. Conclusion - The management of lactating breast abscess by ultrasound-guided needle aspiration is an effective alternative to surgery. It appears to be effective regardless of the size of the abscess and is compatible with the continuation of breastfeeding. Our study has indeed shown that if they are well advised, the majority of patients continue breastfeeding so that it is essential that health professionals be better trained regarding the management of breastfeeding complication

Background In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count. Methods To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis. Results During the study period, 61 822 patients were followed in the Dat’AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39–33.47) months in 2007 to 0.77 (IQR, 0.37–1.60) months in 2017. A decrease in PHI (−35.1%) and PRHI (−25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8–2014.4) and 2013.1 (95% CI, 2011.3–2014.8), respectively. Conclusions Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017. Clinical Trials Registration NCT02898987.

Prolonged measles virus detection in maternal saliva and blood was evidenced in 6 pregnant women. Maternal-fetal transmission was evidenced in 2 of 4 infants who were asymptomatic at birth, 21–24 weeks after maternal infection. Whereas peripartum congenital measles is severe, asymptomatic measles virus vertical transmission can occur earlier in pregnancy.

BackgroundHealthcare workers (HCWs) have paid a heavy toll during the coronavirus disease 2019 (COVID-19) outbreak. Routes of transmission remain to be fully understood.MethodsThis prospective study compared a 1500-bed adult and 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. From 24 February until 10 April 2020, all symptomatic HCWs were screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a nasopharyngeal swab. HCWs screened positive were questioned on their profession, symptoms, and occupational and nonoccupational exposures to SARS-CoV-2.ResultsAmong 1344 HCWs tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no deaths were reported. Most HCWs (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on 23 March, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment [PPE] for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric settings, respectively (P = .0022). In the adult setting, HCWs more frequently reported exposure to COVID-19 patients without PPE (25% vs 15%, P = .046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period.ConclusionsUniversal masking, reinforcement of hand hygiene, and PPE with medical masks for patients’ care allowed protection of HCWs and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.

The encounter of a pathogen and a pregnant host can happen at various steps of pregnancy and lead to a vast array of outcomes. Maternal infection can be more severe than in the general population, ...

International audience; Listeriosis is a rare and severe foodborne infection caused by Listeria monocytogenes. It manifests as septicemia, neurolisteriosis, and maternal-fetal infection. In pregnancy, it may cause maternal fever, premature delivery, fetal loss, neonatal systemic and central nervous system infections. Maternal listeriosis is mostly reported during the 2nd and 3rd trimester of pregnancy, as sporadic cases or in the context of outbreaks. Strains belonging to clonal complexes 1, 4 and 6, referred to as hypervirulent, are the most associated to maternal-neonatal infections. Here we review the clinical, pathophysiological, and microbiological features of maternal-neonatal listeriosis.

International audience

Background: From the start of the pandemic, health-care workers (HCW) have paid a heavy toll to the coronavirus desease-19 (COVID-19) outbreak. Routes of transmission however remain to be fully understood. Methods: This prospective study compared two settings of a tertiary-care university hospital located in central Paris: a 1,500-bed adult and a 600-bed paediatric setting, accounting for a total of 13,278 employees. From February 24th until April 10th, 2020, all symptomatic HCW were screened for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on a nasopharyngeal swab. HCW screened positive were prospectively questioned by phone on their profession, symptoms, occupational and non-occupational exposures to SARS-CoV-2. Findings: Among 1344 symptomatic HCW tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no death have been reported. Most HCW (70%) had patient-facing occupational activities and 22% in COVID-19 dedicated units. The total number of HCW cases peaked on week 13 (March 23rd, 2020) then decreased slowly until April 10th, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking for all hospital staff and personal protective equipment (PPE) for direct care to COVID-19 patients). Attack rates were of 3 · 2% and 2 · 3% in the adult and paediatric settings, respectively (p=0 · 0022). In the adult setting, HCW more frequently reported exposure to COVID-19 patients without PPE (25% versus 15%, p=0 · 046). In both settings, report of contacts with children attending out-of-home care facilities dramatically decreased all over the study period. Interpretation: In central Paris, implementation of universal masking, reinforcement of hand hygiene, social distancing and PPE with medical masks for patients’ care allowed protection of HCW and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities. Funding Statement: None. Declaration of Interests: AC reports personal fees and non-financial support from Janssen Cilag, outside the submitted work. RG reports personal fees and other from Sanofi, personal fees from MSD, personal fees from Eumedica, personal fees from Pfizer, personal fees from Frezenius, personal fees from Cubist, personal fees from Correvio, personal fees from Astellas, outside the submitted work. PF reports personal fees and nonfinancial support from MSD France, personal fees from ViiV Healthcare, non-financial support from Gilead Science, personal fees and non-financial support from Janssen Cilag, personal fees from Medtronic SAS, non-financial support from Astellas, non-financial support from GSK, outside the submitted work. MLV reports non-financial support from Biomerieux, non-financial support from Diasorin, outside the submitted work. OL reports personal fees from Pfizer, personal fees from Astellas, personal fees from MSD, personal fees from Gilead, outside the submitted work. SK reports research grants from bioMerieux, personal fees from Accelerate Diagnostics, bioMerieux, MSD and Menarini, and travel expenses from bioMerieux, Astellas, MSD and Pfizer, outside the submitted work. All other authors declare no conflict of interests. Ethics Approval Statement: This study was approved by the Ethical Review Committee for publications of the Cochin university Hospital (CLEP) (N°: AAA-2020-08012). According to French policy, a non-opposition statement was obtained for all participants, meaning that all had received written detailed information on the objectives of the study and were free to request withdrawal of their consent for participation at any time.

Resume Objectifs Analyser la litterature scientifique evaluant les benefices et les risques d’une antibioprophylaxie en cas de rupture prematuree des membranes (RPM) avant terme. Methodes Recherche bibliographique dans les bases de donnees Medline et Cochrane. Resultats Les deux principales bacteries impliquees dans les infections neonatales precoces sont le Streptoccoccus agalactiae (streptocoque du groupe B) et l’Escherichia coli (NP3). L’administration d’une antibioprophylaxie a l’admission est associee a une prolongation de la grossesse (NP2), une reduction de la morbidite neonatale (NP1) sans reduire la mortalite neonatale (NP2). L’administration d’amoxicilline-acide clavulanique semble associee a une augmentation du risque d’enterocolite ulceronecrosante (NP2). Il est recommande de prescrire une antibioprophylaxie a l’admission en cas de RPM avant terme (Grade A). L’amoxicilline, les cephalosporines de troisieme generation et l’erythromycine peuvent etre utilisees en monotherapie, de meme que l’association erythromycine–amoxicilline (Accord professionnel) pour une duree de 7 jours (Grade C). Un arret precoce est possible en cas de prelevement vaginal negatif (Accord professionnel). Il est recommande de ne pas prescrire d’amoxicilline-acide clavulanique, d’aminosides, de glycopeptides, de cephalosporines de premiere ou deuxieme generation, de la clindamycine ou du metronidazole (Accord professionnel). Conclusions A l’admission d’une patiente presentant une rupture prematuree des membranes avant terme, il est recommande de prescrire une antibioprophylaxie dirigee contre le streptocoque B et l’E. coli (Grade A). Il est recommande de privilegier une monotherapie par amoxicilline, cephalosporines de 3e generation ou erythromycine, ou une association erythromycine–amoxicilline (Accord professionnel).

Resume Objectif Determiner les criteres de diagnostic de l’infection intra-uterine (IIU), les modalites du traitement : antibiotherapie et mode d’accouchement. Methode Recherche bibliographique en langue anglaise et francaise a l’aide des bases de donnees informatiques Medline et de la Cochrane Library entre 1980 et 2018 et des recommandations des societes savantes. Resultats L’IIU correspond a une infection des membranes fœtales et/ou de la decidua maternelle et/ou des autres composants de la cavite amniotique (liquide amniotique, placenta, cordon ombilical et fœtus). Ce terme doit etre prefere a celui de chorioamniotite, trop imprecis (accord professionnel). Les signes cliniques d’IIU ont une sensibilite et une specificite limitees (NP3). Le diagnostic est pose devant une fievre definie par une temperature ≥ 38 °C, sans autre cause evidente et associee a au moins deux des signes suivants : tachycardie fœtale > 160 battements/min pendant ≥ 10 minutes, douleurs uterines ou travail spontane, liquide amniotique purulent a l’orifice cervical (accord professionnel). Une hyperleucocytose maternelle en l’absence de corticotherapie antenatale ou une elevation de la CRP plasmatique sont des arguments supplementaires pour une IIU malgre des sensibilites et specificites faibles (NP3). L’IIU doit conduire a l’accouchement (Grade A). Elle ne justifie pas a elle-seule le recours a une cesarienne (accord professionnel). Le traitement antibiotique doit etre actif sur Streptococcus agalactiae (streptocoque B) et Escherichia coli. Il doit etre debute des le diagnostic pose et poursuivi pendant et apres l’accouchement pour reduire la morbidite neonatale et maternelle (Grade B). Le traitement de choix est la combinaison d’une betalactamine et d’un aminoside par voie intraveineuse (Grade B). Dans le post-partum, une dose unique d’antibiotique est suffisante apres un accouchement par voie vaginale (Grade C). Un traitement plus long s’impose en presence d’une bacteriemie et peut se discuter en cas de persistance d’une fievre, d’obesite ou de cesarienne (accord professionnel).