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Corynebacterium spp. are associated with respiratory infections in immunocompromised hosts. A link with bronchial complications after lung transplantation (LTx) has been suggested. We aimed to assess the link between respiratory sampling of Corynebacterium spp. and significant bronchial complication (SBC) after LTx. We performed a single center retrospective study. Inclusion of LTx recipients with at least one respiratory Corynebacterium spp. sample (July 2014 to December 2018). Subjects were matched to unexposed LTx recipients. Primary outcome was SBC occurrence after Corynebacterium spp. isolation. Secondary outcomes were Corynebacterium spp. persistent sampling, chronic lung allograft dysfunction (CLAD) onset and all-cause mortality. Fifty-nine patients with Corynebacterium spp. sampling with 59 without isolation were included. Corynebacterium spp. identification was not associated with SBC occurrence (32.4% vs. 21.6%, p = 0.342). Previous SBC was associated with further isolation of Corynebacterium spp. (OR 3.94, 95% CI [1.72–9.05]). Previous SBC and corticosteroids pulses in the last 3 months were the only factors associated with increased risk of Corynebacterium spp. isolation in multivariate analysis. Corynebacterium spp. sampling was significantly associated with CLAD onset (27.1% vs. 6.9%, p = 0.021). Corynebacterium spp. isolation was not associated with SBC but with higher risk of CLAD. Whether CLAD evolution is affected by Corynebacterium spp. eradication remains to be investigated.

Background The outcome of lung transplantation (LT) is correlated with donor selection. A donor age of 65 years is classically considered a contraindication to lung procurement, and the results of LT from elderly donors remain to be established. Methods This was a retrospective study of a prospectively maintained database including all LTs performed in a single institution (Bichat Hospital, University of Paris, Paris, France) from January 2014 to March 2019. Donors65 years of age or older were included in the elderly group, whereas donors younger than 65 years of age were included in the control group. Results The study group included 241 LTs, including 44 (18%) in the elderly group and 197 (82%) in the control group. As compared with the control group, the elderly group was characterized by the following: donors of shorter stature (166 cm vs 172 cm; P = .04) and with less smoking history (14% vs 40%; P = .001), less bronchoscopic abnormality (20% vs 36%; P = .042), and less chest opacity (16% vs 30%; P = .048); and recipients of shorter stature (166 cm vs 170 cm; P = .04) but with similar diagnoses and gravity. There was no significant difference between the groups in any of the outcomes studied, including primary graft dysfunction, 30-day mortality, 1-year survival, chronic lung allograft dysfunction–free survival, and overall survival. In univariate analysis, the Oto lung donor score was the only factor associated with 1-year survival (score of 6 in alive patients vs score of 7 in dead patients; P = .04); donor age 65 years old or older was not. Conclusions Carefully selected lung grafts from donors 65 years of age or older are associated with outcomes similar to those reported with grafts from younger donors Grafts from older donors thus provide an interesting option to expand the donor pool during a shortage.

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The effect of red blood cell (RBC) transfusion on mortality after lung transplantation (LT) was assessed in some retrospective studies, with contradictory results. The first aim of this study was to assess the 90-day survival of LT recipients according to massive intraoperative transfusion (MIOT).This prospective, observational, single-centre study analysed the intraoperative transfusion (IOT) of all consecutive LT recipients between January 2016 and February 2019. MIOT was defined as transfusion of 5 RBC units or more. The results are presented as the median [IQR] and absolute numbers (proportions) and were analysed using χ2, Fisher, and Mann-Whitney tests (p 0.05 as significance). Multivariate analyses were performed to identify independent risk factors for MIOT, 90-day and one-year mortality and grade 3 PGD at day 3. Ninety-day and one-year survivals were studied (Kaplan-Meier curves, log rank test). The Paris-North-Hospitals Institutional Review Board approved the study.Overall, 147 patients were included in the analysis, 27 (18%) of them received MIOT. In multivariate analysis, predictive factors of MIOT included preoperative ECMO support (p = 0.017), and bilateral LT (p = 0.023). The SOFA score on ICU admission after LT was higher in cases with MIOT (p 0.001). MIOT was an independent risk factor for 90-days and one-year mortality (p = 0.002 and 0.008 respectively). The number of RBCs unit transfused during surgery was an independent risk factor for grade 3 PGD at day 3 (OR 1.14, 95% CI [1.00-1.29], p = 0.040).Increased preoperative severity of recipients predicts MIOT. MIOT is associated with increased early postoperative morbidity and mortality rates.

Patient-important outcomes (PIOs) have emerged in respiratory medicine, in order to place the patient at the center of research. Mortality is a debated PIO in lung transplantation (LTx). The use of PIO in this specific setting has never been studied. We aimed to systematically review the use of PIOs in LTx research.MEDLINE, Cochrane Library and Embase databases were searched to include prospective studies published in 2019, involving adult LTx recipients. We excluded articles reporting non-prognostic studies, letters, reviews, commentaries, or case reports. PIOs considered were mortality, pain, physical function, pulmonary, gastrointestinal, neuropsychological, cardiac, sleep or sexual symptoms and quality of life. This systematic review was prospectively registered in the PROSPERO register (CRD42020163425).Among 1048 references retrieved, 51 were finally included in the analysis. In total, 26 (51%) studies investigated at least one PIO, as a primary outcome in 12 (23.5%) and secondary outcome in 21 (41.2%). In 15 (29.4%) studies, mortality was the most frequently reported PIO; 11 (21.5%) studies evaluated at least one PIO other than mortality, quality of life being this PIO in 6.PIOs were described in half of prospective articles dealing with adult LTx recipients published in 2019. Outcomes other than mortality were insufficiently considered. A core outcome set of PIOs in LTx should be developed with patient input to guide future research in LTx.

International audience

Resume Introduction Le nombre des transplantations pulmonaires realisees dans le monde n’a cesse d’augmenter au fil du temps. A mesure de l’experience accumulee, l’âge est passe d’une contre-indication absolue a une contre-indication relative. Nous rapportons ici notre premiere experience avec les receveurs âges de 65 ans et plus. Methodes Toutes les transplantations pulmonaires entre janvier 2014 et mars 2019 chez les patients âges de 65 ans et plus ont ete retrospectivement analysees a partir d’une base de donnees prospective. Resultats Vingt-cinq patients âges de 65 ans et plus ont ete transplantes durant la periode de l'etude parmi les 241 patients transplantes a l'hopital Bichat (Paris). Les indications etaient les pathologies interstitielles (72 %) et les troubles ventilatoires obstructifs (28 %). Les transplantations etaient mono-pulmonaires dans 80 % des cas. Seize patients ont necessite une assistance circulatoire par ECMO veino-arterielle peripherique en peroperatoire. Les complications precoces ont ete dominees par la defaillance primaire du greffon grade 3 (12 %) et le rejet cellulaire (20 %). La survie globale a un an a ete de 76 %. Conclusion Les resultats precoces de cette courte serie monocentrique et retrospective sont encourageants et nous permettent de continuer a proposer l’acces a la transplantation chez les patients âges de 65 ans et plus sous reserve d’une selection rigoureuse.

BackgroundWhereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis.Research questionTo assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance.Study design and methodsThis multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset ResultsBleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery.Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved.ConclusionIn non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events.Trial registration numberNCT01278199

Chronic pulmonary aspergillosis (CPA) is a chronic fungal infection of the lung associated with high morbidity and mortality. The CPA Research network (CPAnet) registry established in 2018 is an international multicenter collaboration aiming to improve CPA knowledge and patient care. This study&rsquo, s aim was to describe the data collection process and content of CPAnet registry with preliminary clinical data. In the CPAnet registry, clinical data are collected through a web-based questionnaire. Data include CPA phenotype, comorbidities, treatment, outcome, and follow-up from several international centers. An exemplary descriptive analysis was performed on 74 patients, who were registered online before April 2020. CPA patients were predominantly (72%) male, 39% had chronic obstructive pulmonary disease, and 68% had a history of smoking. Chronic cavitary pulmonary aspergillosis was the most common CPA subtype (62%). In 32 patients (52%), voriconazole was the preferred first-line therapy. The multicenter multinational CPAnet registry is a valuable approach to gather comprehensive data on a large study population and reflects real-world clinical practice rather than focusing on specific patient populations in more specialized centers. Additional CPA reference centers are being encouraged to join this promising clinical research collaboration.

Background: Chronic pulmonary aspergillosis (CPA) is a chronic fungal infection of the lung associated with high morbidity and mortality. The CPAnet registry established in 2018 is an international multicenter collaboration aiming to improve CPA knowledge and patient care. In 2020, it has been awarded a Clinical Research Collaboration (CRC) by the ERS. This study’s aim was to describe the data collection process and content of CPAnet registry, by presenting preliminary clinical data. Methods: In the CPAnet registry, clinical data are collected through a web-based questionnaire. Data include CPA phenotype, comorbidities, treatment, outcome and follow-up from several international centers. An exemplary descriptive analysis was performed on 74 patients, who were registered online before April 2020. Results: CPA patients were predominantly (72%) male, 39% had chronic obstructive pulmonary disease and 68% had a history of smoking. Chronic cavitary pulmonary aspergillosis was the most common CPA subtype (62%). In 32 patients (52%), voriconazole was the preferred first-line therapy. Conclusion: The multicenter multinational CPAnet registry is a valuable approach to gather comprehensive data on a large study population and reflects real-world clinical practice rather than focusing on specific patient populations in more specialized centers. Additional CPA reference centers are being encouraged to join this promising CRC. * The 2 first (EVB and LVA) and 2 last authors (CBL and JRD) contributed equally.

We read with interest the letter from Jouneau et al. untitled “ To be malnourished or not to be malnourished: that is the question! ”, referencing our study in which we overviewed the epidemiology and prognostic of chronic pulmonary aspergillosis (CPA) in France [1]. Based on the French nationwide administrative hospital database (PMSI), which is designed to include discharge abstracts for all inpatients admitted to public and private hospitals in France, we reported that malnutrition is one of the most frequent CPA underlying conditions concerning 38 to 44% of CPA patients from 2014 to 2018. Moreover, in CPA incident cases, malnutrition increased significantly in-hospital mortality at their first hospitalization but also at 1 and 5 years, in multivariate analyses. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: T. Maitre has nothing to disclose. Conflict of interest: J. Cottenet has nothing to disclose. Conflict of interest: C. Godet received consultancy or speaker fees and travel support from Pfizer, Astellas, Gilead, MSD, SOS Oxygene, Elivie, Pulmatrix and ISIS Medical. Conflict of interest: A. Roussot has nothing to disclose. Conflict of interest: N. Abdoul Carime has nothing to disclose. Conflict of interest: V. Ok has nothing to disclose. Conflict of interest: A. Parrot has nothing to disclose. Conflict of interest: P. Bonniaud has nothing to disclose. Conflict of interest: C. Quantin has nothing to disclose. Conflict of interest: J. Cadranel has nothing to disclose.

Background The COVID-19 pandemic has been associated with an increase in anxiety and depression symptoms in people. We investigated the impact of the pandemic on coping strategies and anxiety and depression in lung transplantation (LT) recipients and patients with end-stage chronic lung disease awaiting LT. Methods We retrospectively investigated coping strategies by using the Coping Inventory for Stressful Situations questionnaire and anxiety and depression symptoms by the Hospital Anxiety and Depression scale in 115 LT candidates and recipients. Results Overall, 63 participants (20 women; median age 59 years [interquartile range 52–65]) answered one or both questionnaires (49 LT recipients and 14 LT candidates). The preferred coping strategy was task-focused for 51 (86.4%) participants, with no difference between LT recipients and candidates nor according to the main anamnestic and clinical data. Eleven patients had suspected or proven depression symptoms, and 18 had suspected or proven anxiety symptoms. Coping strategies related to COVID-19 did not differ by presence of anxiety or depression symptoms. Conclusion In the current pandemic, healthcare professionals should consider these results to provide relevant psychological help to these fragile populations and promote a systematic and wide multidisciplinary assessment of LT recipients and candidates.

Introduction Un inconvenient majeur de la transplantation monopulmonaire (TMP) est que le poumon natif reste expose a des complications se developpant en son sein (infection, hemoptysie, pneumothorax, neoplasie). En cas de TMP pour fibrose pulmonaire, on assiste en general a une aggravation progressive des lesions de fibrose du natif au fil du temps, sans consequence notable sur l’hematose. Methodes Nous presentons les cas de 2 patients qui, dans les suites de TMP pour fibrose pulmonaire idiopathique (FPI), ont developpe a l’occasion d’une infection virale severe une progression rapide de la fibrose du cote natif. Resultats Il s’agissait du patient A : 65 ans, TMP 7 mois plus tot, ayant developpe au decours des 6 mois de prophylaxie anti-CMV une primo-infection CMV (D+/R − ) sous la forme d’une maladie a CMV avec PCR > 0 et atteinte gastrique sans signes de pneumonie a CMV ; et du patient B, 62 ans, TMP 4 mois plus tot, ayant developpe une infection a COVID-19 nosocomiale en avril 2020. Les caracteristiques communes a ces 2 patients sont les suivantes : apparition en quelques jours d’une insuffisance respiratoire aigue hypoxemiante (avec transfert en reanimation et prescription d’oxygenotherapie a haut debit dans les 2 cas), en parallele avec une opacification TDM du poumon natif (verre depoli surajoute a la fibrose), avec au niveau du poumon greffe une absence d’anomalies chez le patient A et des lesions de verre depoli COVID-19 beaucoup moins marquees que sur le natif ; contexte d’infection virale severe en cours ; negativite de tout le bilan infectieux en dehors de l’infection virale en cours ; amelioration tres progressive de l’hypoxemie sur quelques semaines mais persistance de l’opacite du poumon natif avec aggravation nette des lesions de fibrose (majoration du rayon de miel, perte de volume nette). Notre hypothese est que : – le mecanisme conduisant a la progression rapide de la fibrose sur le natif est une agression virale directe sur un parenchyme deja atteint, responsable d’une exacerbation aigue de FPI ; – la severite de l’atteinte pulmonaire du poumon natif a conduit a des anomalies majeures des rapports ventilation/perfusion au sein du natif ; – l’amelioration progressive de l’etat respiratoire etait principalement liee a une baisse progressive de la perfusion vers le poumon natif au fil du temps plutot qu’a un traitement antiviral. Conclusion Une infection virale severe peut conduire a une aggravation rapide des lesions de fibrose du natif apres TMP pour FPI.

Is respiratory Pseudomonas aeruginosa infection or persistence in lung transplant recipients an early marker of an emerging chronic lung organ dysfunction? Or its by-product?https://bit.ly/3nyPHlW

Chronic pulmonary aspergillosis (CPA) is a severe fungal infectionwith a highmorbidity andmortality, and is usuallyseen in immunocompetent patients with respiratory disorders. Clinical presentation is nonspecific and often overlapswith the symptoms and the radiological pattern caused by the underlying disease. Clinical management ofCPA is further hampered by limited information about the epidemiology, disease dynamics, sensitivity and specificityof differentmycological tests,mechanisms of antifungal resistance, efficient treatment andmanagement strategies.In order to contribute to a better understanding and to improve CPA patientmanagement and outcome, weestablished the Chronic Pulmonary Aspergillosis Network (CPAnet), a self-organizedmultinational research collaboration.Key research priorities, defined by using a modified Delphi process, include the establishment of a multinationalweb-based registry, the validation of different diagnostic tests, the establishment of a culture collection fromsamples of patientswith proven CPA and the establishment of a consensus on a treatment outcome definition.

Resume Etat des connaissances L’aspergillose bronchopulmonaire allergique (ABPA) touche 3 a 13 % des patients atteints d’asthme. Son histoire naturelle comporte des exacerbations, pouvant menacer le pronostic vital et une evolution vers des troubles ventilatoires obstructifs fixes, voire des lesions de fibrose pulmonaire irreversibles. Le pronostic de l’ABPA est directement associe au controle des exacerbations et l’objectif principal du traitement est de diminuer la frequence et la duree des exacerbations. Les recommandations sont peu precises concernant les posologies et les durees de traitement. Le traitement d’attaque actuellement utilise associant itraconazole et corticotherapie comporte de nombreuses limites. L’interet de la nebulisation de l’amphotericine B liposomale (LAmB) est d’obtenir des concentrations in situ elevees, de s’affranchir des interactions medicamenteuses et de diminuer les toxicites potentielles des antifongiques systemiques. Enfin, cette strategie permet de limiter l’emergence de souches resistantes aux azoles. Methodes Il s’agit d’un essai therapeutique, de phase II, prospectif, multicentrique, controle, randomise, en simple insu qui a pour but d’evaluer le benefice potentiel sur le controle des exacerbations d’un traitement d’entretien par nebulisation de LAmB. L’objectif principal est de comparer l’incidence des exacerbations cliniques severes dans la prise en charge des ABPA, entre une strategie avec un traitement d’entretien par LAmB nebulise et une strategie conventionnelle sans traitement antifongique d’entretien. Resultats attendus Les resultats permettront de guider les praticiens dans la conduite des traitements de l’ABPA en definissant mieux la place des aerosols de LAmB sur des criteres d’« evidence base medicine ».

A 56-year-old HIV1/HBV co-infected Caucasian man with medical history of asthma and chronic obstructive pulmonary disease (COPD) presented with cough, increasing dyspnea, and general weakness. He h...

Introduction L’association entre infection ou colonisation a corynebacterie non diphterique (CND) et complications anastomotiques bronchiques apres transplantation pulmonaire (TP) a ete soulevee [1] . Methodes Il s’agit d’une etude retrospective, monocentrique. Les patients TP avec CND isolee sur un prelevement respiratoire profond (juillet 2014–decembre 2018) ont ete inclus et compares a une serie appariee de notre cohorte. L’objectif principal est de decrire le lien entre l’isolement d’une CND sur un prelevement respiratoire profond et la survenue de complications bronchiques (fistule bronchique ou stenose necessitant une dilatation endoscopique ou un stent) apres TP. Les objectifs secondaires sont de decrire les facteurs associes a l’isolement d’une CND et le pronostic a long terme. Resultats Une CND a ete isolee chez 59 patients transplantes sur la periode, dans un delai median de 128 jours (34–517) apres TP. L’espece la plus frequemment isolee etait C. striatum pour 42 patients (71%). Parmi ces 59 patients, 34 (58%) avaient des signes cliniques d’infection pulmonaire basse, 25 (42%) avaient au moins une autre espece bacterienne au seuil (Pseudomonas aeruginosa pour n = 10), et la CND etait associee a une autre espece bacterienne infra-seuil ou une flore oropharyngee chez 33 autres. Des signes d’ischemie bronchiques existaient a l’isolement de la CND chez 27 patients (46%); 20 (34%) avaient un stent bronchique. La survenue prealable d’un rejet humoral etait associee a l’isolement d’une CND (27% vs 8%; p = 0,01). Les patients infectes ou colonises a CND ont developpe significativement plus de complications bronchiques (72% vs 28%; p = 0,003), plus de dysfonction chronique du greffon (27% vs 6,7%, p = 0,006) que les temoins. La mortalite a un an ne differait pas significativement (29% vs 39%). Conclusion Dans cette serie monocentrique de patients TP, l’isolement d’une CND etait associe a une plus grande frequence de complications bronchiques. La causalite des CND dans la survenue de ces complications reste a determiner.

Introduction Les criteres de jugements (CJ) importants pour le patient (patient-important outcomes [PIO]) sont definis comme des caracteristiques ou variables qui refletent la facon dont le patient ressent, fonctionne ou survit [1] . L’importance de la necessite de prise en compte de ces PIO emerge dans la recherche medicale, afin de replacer le patient au cœur de la recherche. La mortalite est insuffisante comme CJ en transplantation pulmonaire (TP) [2] . La place des PIO dans ce domaine n’a jamais ete evaluee. L’objectif de cette etude est de realiser un etat des lieux de l’utilisation des PIO dans la litterature de TP. Methodes Revue systematique de la litterature internationale de 2018–2019 sur 3 bases de donnees (PubMed, Embase et Cochrane). Inclusion de toutes les etudes, prospectives ou retrospectives sur base de donnees, incluant exclusivement ou majoritairement des patients TP. Enregistrement PROSPERO CRD42020163425. Resultats Parmi 859 references retrouvees, 150 articles ont ete selectionnes apres une double lecture independante sur titres et abstracts, et 79 inclus sur texte entier. Cinquante-trois (67 %) etaient des etudes prospectives, dont 13 (16 %) des essais randomises. Les etudes observationnelles en representaient 72 % (n = 57). Au moins un PIO etait utilise dans 41 (52 %) etudes (dont 26 prospectives et 6 essais randomises). Ce PIO etait le CJ principal de 26 etudes (32 %). Dans la moitie des cas (n = 13), il s’agissait de la mortalite. Au moins un PIO etait evalue en CJ secondaire dans 30 (38 %) etudes, dont la mortalite pour 19 (63 %) d’entre elles. Seules 32 (41 %) etudes (15 prospectives, 8 interventionnelles, 4 randomisees) evaluaient un PIO autre que la mortalite. La qualite de vie etait ce PIO dans 6 etudes (CJ principal pour 2 etudes et CJ secondaire pour 4). Conclusion Les PIO sont des criteres de jugements principaux dans moins d’1/3 des etudes publiees en TP. Les aspects autres que la mortalite sont insuffisamment pris en compte. L’elaboration d’un « core-outcome set » de PIO en TP est necessaire afin de mesurer le benefice ressenti par les patients des interventions testees dans la recherche sur ce domaine.

Introduction La transplantation (TxP) est le seul traitement curatif de la fibrose pulmonaire idiopathique (FPI). Des traitements antifibrosants (pirfenidone et nintedanib), qui ralentissent l’evolution de la maladie, ont ete developpes recemment. Ils pourraient augmenter le risque de complications post-operatoires lors de la TxP des patients traites. L’objectif de cette etude etait d’evaluer l’association entre la prise d’un traitement antifibrosant et les complications apres une TxP. Methodes Il s’agit d’une etude retrospective multicentrique francaise, ayant inclus des patients atteints de FPI et ayant beneficie d’une TxP entre 2011 et 2018. Nous avons compare l’incidence des complications post operatoires (complications bronchiques et hemorragiques) et la survie des patients ayant recu ou non des antifibrosants au minimum un mois avant la TxP. Resultats Parmi les 205 patients inclus, 57 (27,8%) ont recu un traitement antifibrosant: pirfenidone pour 36 patients (63%) et nintedanib pour 21 patients (37%). La duree mediane de traitement antifibrosant avant la TxP etait de 532 jours. Il n’y avait pas de difference entre les deux groupes dans la survenue de complications anastomotiques bronchiques (p = 0,90), hemorragiques (p = 0,14) ou de cicatrisation cutanee (p = 0,65). La mortalite a 90 jours post-TxP dans le groupe traite etait significativement inferieure (7%) a celle du groupe controle (18,2%, p = 0,04). La mortalite a 30 jours post-TxP des deux groupes ne differait pas (p = 0,18). Le groupe traite presentait egalement moins de dysfonction primaire du greffon (DPG) (29,8%) que le groupe controle (43,2%, p = 0,01). Conclusion Les antifibrosants ne sont pas associes a une augmentation du risque de complications post-TxP et peuvent donc etre utilises sans risque avant la transplantation. Leur utilisation semble etre associee a une diminution de la DPG et de la mortalite a 90 jours. Cette difference de mortalite, deja rapportee par une equipe australienne [1] , devra cependant etre confirmee par d’autres etudes.

Introduction Peu de donnees sont actuellement disponibles pour determiner le meilleur traitement a proposer aux patients presentant une infection pulmonaire a Mycobacterium xenopi (MX) (2 etudes randomisees avec respectivement 42 et 34 patients inclus). Les donnees disponibles sont en faveur d’un traitement contenant rifampicine (RIF) et ethambutol (EMB), molecules proposees par toutes les societes savantes, en grande partie par rapprochement avec M. avium et utilisees dans les deux etudes randomisees. La plupart des experts proposent l’adjonction d’un troisieme antibiotique. La moxifloxacine (MXF) et la clarithromycine (CLA) sont toutes deux candidates au vu de leur CMI basses sur MX. Methodes Aucune donnee n’etant disponible sur le taux de negativation des prelevements a 6 mois, l’objectif principal de CaMoMy est de determiner la proportion de patients avec une infection pulmonaire a MX ayant negative leur prelevement sous un traitement associant RIF-EMB avec soit CLA, soit MXF. Les objectifs secondaires sont de comparer ces 2 associations therapeutiques (CLA-RIF-EMB versus MXF-RIF-EMB) en termes d’efficacite et de tolerance. L’essai CaMoMy est une etude multicentrique francaise (51 centres) randomisee, controlee, avec analyses sequentielles, incluant tous les patients presentant une infection pulmonaire a MX selon les criteres ATS/IDSA 2007, sans contre-indication a l’un des antibiotiques utilises. Resultats 92 patients ont ete inclus. Les donnees concernant le critere de jugement principal sont actuellement disponibles pour 72 patients. La derniere analyse intermediaire faite sur ces 72 patients retrouvait un taux d’echec de 24,2 % dans le groupe MXF (8 echecs) et 23,9 % dans le groupe CLA (9 echecs). Le taux de succes global (patient vivant et avec prelevement negatif a 6 mois) etait de 76,4 %. Un switch d’antibiotique a ete realise dans 3 cas pour le bras CLA et dans 2 pour le bras MXF. Le taux d’effets indesirables graves n’etait pas different. Conclusion L’ensemble des analyses intermediaires effectuees n’a pas mis en evidence de difference entre les 2 bras de traitement (CLA-RIF-EMB versus MXF-RIF-EMB) que ce soit en termes de tolerance ou d’efficacite. Les Resultats definitifs nous permettront bientot de confirmer ou non ces analyses.

Introduction L’aspergillose pulmonaire chronique (APC) est une infection emergente survenant chez des patients (pts) avec un terrain respiratoire fragilise par une pathologie pulmonaire preexistante (PPP) ; leur prevalence est liee a celle de la tuberculose (TB) dans les pays a forte endemie tuberculeuse [1] , [2] . Les donnees epidemiologiques sont insuffisantes dans les pays a faible incidence tuberculeuse comme la France. L’objectif de cette etude est de decrire la prevalence, l’incidence et le pronostic des APC et des PPP chez les pts hospitalises en France de 2009 a 2018. Methodes A partir de la base nationale de donnees du Programme de medicalisation des systemes d’information (PMSI), nous avons calcule la prevalence, et l’incidence hospitaliere des APC de 2009 a 2018. La morbi-mortalite et les proportions de PPP ont ete evaluees 5 ans avant et apres le diagnostic d’APC. Resultats La prevalence annuelle des APC a augmente de 1759 cas en 2009 a 2100 cas en 2018 (p Tableau 1 ). Les proportions de TB et d’infections a mycobacteries non-TB ne representaient que 3 % chacune. Chez les 1705 cas incidents d’APC hospitalisees en 2013, la mortalite globale etait de 45 % a 5 ans. Les proportions a 5 ans, de nouvel episode d’APC et de chirurgie thoracique etaient de 3 et 10 % respectivement. Conclusion Nous decrivons ici la plus grande cohorte d’APC hospitalisee en France. L’APC est plus frequemment associee a la BPCO, l’emphyseme, le cancer bronchique et la fibrose pulmonaire qu’aux infections a mycobacterie. La frequence et mortalite importante des APC hospitalisees pourraient beneficier d’un depistage cible des pts atteints de PPP.

Isavuconazole is a new antifungal prodrug to treat invasive aspergillosis and mucormycosis, theoretically not requiring drug monitoring. However, we reported 4 clinical cases with toxic concentrations. Based on Desai’s population pharmacokinetic model, we estimated patients’ kinetic profile. Clearance was abnormally low, likely related to CYP3A4/5 polymorphisms. Thus, we recommend to collect blood sample just before the first maintenance dose to estimate pharmacokinetic profile and individualized dose. For patients presenting high concentrations, pharmacogenetics can be done.

Chronic pulmonary aspergillosis (CPA) complicates conditions including tuberculosis, chronic obstructive pulmonary disease and sarcoidosis, and is associated with high morbidity and mortality. Surgical cure should be considered where feasible; however, many patients are unsuitable for surgery due to extensive disease or poor respiratory function. Azoles are the only oral drug with anti-Aspergillus activity and itraconazole and voriconazole are considered as first-line drugs. A randomized controlled trial demonstrated improvement or stability in three-quarters of patients given 6 months of itraconazole, but a quarter relapsed on stopping therapy. Long-term treatment may therefore be required in some cases. Itraconazole, voriconazole and posaconazole require therapeutic drug monitoring. No published data are yet available for isavuconazole. Adverse drug effects of azoles are common, including peripheral neuropathy, heart failure, elevated liver enzymes, QTc prolongation and sun sensitivity. Many serious drug-drug interactions occur, including major interactions with rifamycins, simvastatin, warfarin, clopidogrel, immunosuppressant drugs like sirolimus. Furthermore, drug resistance occurs, including cross-resistance to all azoles, but the true prevalence is not yet determined. Intravenous therapy is possible with echinocandins or amphotericin B, but long-term use is challenging. Hemoptysis complicates CPA and can be fatal. Tranexamic acid should be given acutely to reduce bleeding. Bronchial artery embolization can stop acute bleeds. In some circumstances, emergency surgery may be necessary to resect the source of the bleed. Current CPA treatments can be beneficial but have many drawbacks. New oral anti-Aspergillus agents are needed, along with optimization of currently available treatments.

Background Isavuconazole is a new antifungal prodrug for the treatment of invasive aspergillosis and mucormycosis. As no clear pharmacokinetic-pharmacodynamic relationship has been established for patients, therapeutic drug monitoring is not currently required. However, as isavuconazole is a new drug, clinicians are sometimes sceptical about the exposure achieved in their patients and seek pharmacokinetic exploration. A minimal response consists of determining that the patient’s pharmacokinetic profile agrees with profiles reported by Desai et al. using concentrations from the SECURE study. Methods Based on one concentration and Desai et al.’s population-pharmacokinetic model, it is possible to estimate a patient’s most likely pharmacokinetic profile. If a patient’s pharmacokinetic profile is close to the profiles reported by Desai et al., therapeutic drug monitoring is not required. In contrast, when the pharmacokinetic profile differs from the Desai et al. profiles, isavuconazole concentration monitoring and pharmacokinetic profile modeling are the only methods for obtaining information on a patient’s exposure and the efficacy of isavuconazole. Results Four patients presented with surprising pharmacokinetic profiles, unexplained by drug interactions or cytochrome P450 3A4/5 polymorphisms. For two of them, a drug dosage adjustment was proposed and applied by clinicians, together with a check for a new pharmacokinetic profile a few days later. Conclusions Collecting one blood sample just before the first maintenance dose to make an early estimation of the patient’s most likely pharmacokinetic profile is one method of identifying patients with outlier pharmacokinetic behavior.

Introduction Dans l’optique de la reduction des couts, les recommandations du dernier rapport Morlat incitent a l’utilisation des generiques des traitements anti-retroviraux (ARV) actuellement disponibles pour le Truvada (TVD) et le Kivexa (KVX), notamment si le patient l’accepte, pouvant conduire au passage d’un traitement quotidien en un comprime par jour (STR) a un traitement en comprimes multiples (MTR). Nous avons voulu evaluer l’acceptabilite du passage aux generiques dans la vraie vie dans une cohorte de PVVIH. Materiels et methodes Entre le 01/11/2017 et 31/01/2018 tous les PVVIH traites efficacement (charge virale VIH Resultats Deux cent dix neuf patients ont ete inclus dans l’etude, repartis en 3 groupes : groupe 1 (n = 95) sous TVD ou KVX plus un 3e agent, groupe 2 (n = 82) sous un STR pouvant etre remplace par un MTR, groupe 3 (n = 42) avec une combinaison d’ARV sans passage au generique possible. L’âge moyen de la cohorte etait de 51,9 ans [25–87], sex-ratio 1,8. Le passage au generique dans le groupe 1 a ete realise pour tous les patients permettant de diminuer le cout annuel des ARV de 284 665 € (2996€/an/patient). Parmi les patients du groupe 2 (47 hommes et 35 femmes) d’âge moyen 50,3 ans [28–77], 48 % (n = 39) ont accepte de prendre un MTR (soit une economie annuelle de 97 586 € ou 2502 €/an/patient) ; parmi les autres, le maintien du STR a ete motive par la peur : de l’inobservance (n = 9), d’une intolerance (n = 2) et/ou d’un trop grand nombre de comprimes (n = 32). L’acceptation du passage d’un STR a un MTR etait liee au fait d’etre un homme (p Conclusion Les PVVIH ne s’opposent pas necessairement a la prescription de generiques, meme lorsqu’il s’agit de passer a un MTR, dans le but de reduire les couts de sante. Le passage vers les generiques a permis dans notre etude de reduire le cout annuel lie aux ARV de 382 251 euros. Dans la conjoncture actuelle, le patient doit etre implique a toutes les etapes de sa prise en charge et l’information concernant les generiques doit desormais s’inscrire pleinement a notre temps de consultation.

Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic SCT (HSCT) is recognized as a new-onset obstructive lung defect (OLD) in pulmonary function testing and is related to pulmonary chronic GVHD. Little is known about the different phenotypes of patients with BOS and their outcomes. We reviewed the data of all allogeneic HSCT recipients referred to our pulmonary department for a non-infectious bronchial disease between 1999 and 2010. We identified 103 patients (BOS (n=77), asthma (n=11) and chronic bronchitis (n=15)). In patients with BOS, we identified two functional phenotypes: a typical OLD, that is, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio

Summary Objective of the study An estimation of burden of serious fungal diseases in France is essential data to inform public health priorities on the importance of resources and research needed on these infections. In France, precise data are available for invasive fungal diseases but estimates for several other diseases such as chronic and immunoallergic diseases are by contrast less known. Materials and methods A systematic literature search was conducted using the Web of Science Platform. Published epidemiology papers reporting fungal infection rates from France were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. Results The model predicts high prevalences of severe asthma with fungal sensitization episodes (189 cases/100,000 adults per year), of allergic bronchopulmonary aspergillosis (145/100,000) and of chronic pulmonary aspergillosis (5.24/100,000). Besides, estimated incidence for invasive aspergillosis is 1.8/100,000 annually based on classical high risk factors. Estimates for invasive mucormycosis, pneumocystosis and cryptococcosis are 0.12/100,000, 1/100,000 and 0.2/100,000, respectively. Regarding invasive candidiasis, more than 10,000 cases per year are estimated, and a much higher number of recurrent vaginal candidiasis is probable but must be confirmed. Finally, this survey was an opportunity to report a first picture of the frequency of tinea capitis in France. Conclusion Using local and literature data of the incidence or prevalence of fungal infections, approximately 1,000,000 (1.47%) people in France are estimated to suffer from serious fungal infections each year.

Long-term antifungal therapy is usually the only treatment option for chronic pulmonary aspergillosis. However, response rates are difficult to compare because the reported clinical, mycologic, or radiologic criteria are not standardized. Objective parameters are therefore needed. To define the most relevant CT imaging variables in assessment of response to treatment, we investigated changes over time in CT imaging variables.Changes in CT imaging variables were assessed by systematic analysis of the CT scan findings of 36 patients at diagnosis and 6 months after initiation of treatment. The relevant radiologic variables were determined by selecting those showing significant changes over time. Two experienced thoracic radiologists, blinded for clinical and serologic response, independently performed CT scan analyses. Interreader agreement and concordance between radiologic and clinical response were evaluated.Of the 36 patients, seven experienced clinical deterioration while undergoing therapy. Significantly evolving radiologic variables included cavity and pleural wall thickening (P .05), which were associated with clinical improvement. There was a strong association between fungus ball disappearance and cavity/pleural wall thickening reduction and clinical improvement (P = .04). There was poor agreement between size changes of cavities or nodules, and clinical evolution (Cohen's κ, -0.13 to -0.24).Variations in cavity and pleural wall thickness may be the most relevant CT imaging variables for assessing response to treatment. Loss of fungus ball is strongly associated with clinical and radiologic improvement, but cavity size changes are unrelated to chronic pulmonary aspergillosis evolution. All these CT imaging variables may be applied in future clinical trials to assess treatment outcome.

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Resume Les pathologies respiratoires infectieuses restent la complication la plus frequente des patients infectes par le virus de l’immunodeficience humaine (VIH) quelle que soit l’importance de l’immunodepression. Bien que la therapie antiretrovirale ait montre un effet protecteur, le risque de pneumonie bacterienne reste neanmoins eleve (y compris avec des CD4 > 500/mm3). Les germes les plus frequemment isoles sont Streptococcus pneumoniae et Haemophilus influenzae. La presentation clinique et radiologique des infections respiratoires basses chez les patients VIH est variee. La presentation clinique est d’autant plus severe et la presentation radiologique est d’autant plus atypique que l’immunodepression est profonde. L’antibiotherapie de premiere intention repose sur une cephalosporine de troisieme generation injectable (ceftriaxone ou cefotaxime) ou l’association amoxicilline-acide clavulanique. La vaccination antipneumococcique (de meme que la vaccination antigrippale) est fortement recommandee. Bien que rares, Nocardia spp. et Rhodococcus equi semblent plus frequents chez les patients au stade syndrome de l’immunodeficience acquise (SIDA).

Summary Objectives To describe and estimate the rate of breakthrough invasive mould diseases (IMD) in patients receiving caspofungin. Methods Retrospective, non-interventional study conducted in three University Hospitals. Results Nineteen breakthrough infections have been identified including 13 aspergillosis, 2 mucormycosis, a fusariosis, a Hormographiella aspergillata infection and 2 possible IMD. Cases were equally distributed between the centres. Fourteen patients had a haematologic malignancy, four were transplant recipients (allogeneic haematopoietic stem cells in three, liver in one) and one had hepatic cirrhosis. Caspofungin has been prescribed as prophylaxis ( n = 3), empirical therapy ( n = 9) or directed therapy for candidemia ( n = 5) or aspergillosis ( n = 2). Aspergillus galactomannan was positive in serum or in bronchoalveolar lavage fluid in 10 of the 13 aspergillosis. Median duration of caspofungin treatment before breakthrough IMD was 15 days. Nine patients died within twelve weeks. Rate of breakthrough IMD in onco-haematology patients has been estimated to 7.3% for all mould infections and to 4.2% when restricted to documented aspergillosis. Conclusions Our data call for Aspergillus galactomannan monitoring and close clinical and radiological examination in case of persistence or recurrence of infection signs in high-risk patients receiving caspofungin.

US and European guidelines recommend a daily divided gentamicin dose (3 mg/kg in two or three equally divided doses) for the treatment of infective endocarditis caused by staphylococci or enterococci, but once-daily dosing (3 mg/kg/day) is recommended for streptococcal endocarditis. However, studies have recommended the use of higher doses of gentamicin (4 or ≥5 mg/kg/day) administered once-daily. A survey was conducted in France by mailing a questionnaire to the 595 members of the French Infectious Disease Society regarding their gentamicin prescription patterns in infective endocarditis, focusing on the dosing regimen. The survey was answered by 137 physicians (23%). The proportions of physicians following guideline-based regimens were similar for each organism (30.9%, 38.8%, and 39.4% for staphylococci, enterococci, and streptococci, respectively [p=0.26]). In contrast, the proportions of physicians following literature-based regimens were significantly different for each organism (59.6%, 42.5%, and 27.7% for staphylococci, enterococci, and streptococci, respectively [p

Resume Une etude prospective a ete realisee afin de preciser les caracteristiques actuelles des patients atteints de pneumocystose (PPC), d’identifier ceux qui pourraient recevoir une prophylaxie et d’evaluer l’interet du dosage de S-adenosyl methionine (SAM) pour le diagnostic non invasif de cette infection. Les parametres analyses etaient les maladies sous-jacentes, les traitements immunosuppresseurs recus durant les deux ans precedant la PPC et le chiffre de lymphocytes CD4+ au moment du diagnostic. Cinquante-six patients ont ete inclus d’âge moyen 64 ± 14 ans (23–82). Les maladies sous-jacentes etaient une hemopathie ( n = 24, 43 %) et/ou une tumeur solide ( n = 14, 25 %) et/ou une maladie de systeme ( n = 15, 27 %) et/ou une transplantation ( n = 4,7 %). Au cours des deux annees precedentes, 37 (66 %) patients ont recu des traitements immunosuppresseurs dont cyclophosphamide ( n = 22, 39 %), vincristine ( n = 13, 23 %), cytarabine ( n = 6, 11 %), methotrexate ( n = 5, 9 %), etoposide ( n = 4, 7 %) et rituximab ( n = 12, 21 %). Quarante (71 %) patients ont recu une corticotherapie pour une duree superieure a un mois et un de l’infliximab. Le chiffre moyen des lymphocytes etait de 0,47 × 10 9 /l (0,02–73,8). La valeur mediane du nombre de lymphocytes CD4+ etait de 0,11 × 10 9 /l (0–1,4). Le dosage de SAM a ete realise chez 21 patients a j ± 2 du diagnostic. La valeur mediane de la concentration serique etait de 10 ng/l (5,7–90). Les maladies sous-jacentes et les traitements immunosuppresseurs associes au risque de PPC ont evolue. Le chiffre des lymphocytes CD4+ ne permet pas de preciser les indications de la prophylaxie chez ces patients.

Resume Objectif Le diagnostic etiologique des infections respiratoires necessite d'etre realise rapidement pour une prise en charge efficace des patients. Nous avons evalue une PCR multiplex pour le diagnostic et l'epidemiosurveillance des infections grippales et a virus respiratoire syncytial (VRS). Patients et methodes Notre etude a porte sur 278 patients (âge moyen : 37,2 ± 22,9 ans) presentant un syndrome grippal ou pseudogrippal, consultant des medecins vigies du GROG Poitou-Charentes ou hospitalises au CHU de Poitiers. Une PCR multiplex detectant les virus grippaux A(H3), A(H1), B et les VRS A et B, a ete realisee en parallele a un examen direct par immunofluorescence et une culture cellulaire. Resultats Nous avons mis en evidence une infection virale chez 139 (50,0 %) patients : 99 cas de grippe A(H3), deux cas de grippe A(H1), 28 cas de grippe B et 11 cas d'infection a VRS. Le rendement diagnostique chez les patients du GROG (52,3 %) etait significativement plus eleve que celui observe chez les hospitalises (34,5 %) (p = 0,04). Nous avons obtenu une concordance technique de 61 %. La PCR multiplex a permis un gain de positivite de 22,3 % par rapport aux techniques traditionnelles. Tous les prelevements positifs par les techniques traditionnelles l'ont ete egalement en PCR multiplex. Nous avons observe une parfaite correlation entre les types et les sous-types viraux determines par PCR et par culture cellulaire. Conclusion La PCR multiplex est une technique sensible permettant un diagnostic efficace et rapide des infections respiratoires dues aux virus grippaux et au VRS.

Objectives To compare the risk of relapse of vertebral osteomyelitis (VO), according to the duration of antibiotic therapy (≤6 weeks versus >6 weeks). Methods We performed a 10-year retrospective study to assess the risk of VO relapse and to verify that this risk was not enhanced in patients who received 6 weeks of antibiotic therapy (Group 1) as compared with those who received a longer treatment (Group 2). VO was diagnosed based on clinical manifestations, magnetic resonance imaging and/or computed tomography findings, and isolation of a pyogenic organism in blood cultures and/or a discovertebral biopsy. Relapse was diagnosed based on isolation of the same organism in blood cultures and/or a discovertebral biopsy. Outcome was evaluated 6 months post-treatment and in December 2004. Results Group 1 included 36 patients (mean age, 58 ± 15 years) and Group 2 included 84 patients (mean age, 67 ± 15 years) (P = 0.003). Clinical data and microorganisms were comparable in the 2 groups. In the first 6 months, 6 (5%) patients died (Group 1, n = 2; Group 2, n = 4), and 5 (4%) in Group 2 relapsed, 2 with recurrent VO and 3 with recurrent bacteremia. In 2004, 91 patients were evaluated (mean follow-up, 40.6 ± 31 months): 77 (85%) were cured, 13 (14%) died (Group 1, n = 3; Group 2, n = 10), 1 had VO due to a different microorganism (Group 2), and no long-term relapses occurred. Conclusion Our results suggest that antibiotic therapy of VO could be safely shortened to 6 weeks without enhancing the risk of relapse.

Rational: Chronic pulmonary aspergillosis (CPA) is a debilitating syndrome characterized by slowly progressive lung cavitation in patients with pre-existing structural lung diseases. Long-term antifungal therapy is usually the only treatment option, which comprises substantial limitations. However, the response rates are difficult to compare between studies because the reported clinical, mycological or radiological criteria are not standardized. Objective parameters are therefore needed. Objectives: To determine the most relevant computed tomography (CT) criteria for assessing response to treatment in patients with CPA treated with antifungal therapy. Method: This is a retrospective analysis of clinical, biological and CT findings of 127 CPA from 8 academic centers. Thirty-six patients underwent follow-up CT at entry and 6 months later. The changes in CT parameters were assessed by systematic analysis of CT findings and definitions of patient improvement, stabilization or deterioration obtained with various scenario compared to those available in previous studies. Results: Radiological criteria significantly evolving in time were pleural and cavity wall thickening (P Conclusion: CT criteria can be applied for assessing treatment outcome in future cohort studies.

Cluster analysis based on clinical and radiological settings does not distinguish any specific phenotype of CPA http://ow.ly/QZq7V

Systemic steroids are the standard treatment for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) despite their poor efficacy and disabling side effects.To evaluate the effectiveness and tolerance of budesonide/formoterol as an alternative treatment for BOS after HSCT.In this randomized, double-blind, placebo-controlled study, we randomly assigned 32 HSCT recipients with mild/severe BOS to receive budesonide/formoterol or placebo for 6 months. The primary outcome was the change in the FEV1 after 1 month of treatment (M1) compared with the baseline value. Patients were unblinded at M1 if there was no improvement in the FEV1. Those who had initially received placebo were switched to budesonide/formoterol. Intention-to-treat analysis was performed to assess the primary outcome. Additional analyses took scheduled treatment contamination into account.At M1, the median FEV1 increased by 260 ml in the budesonide/formoterol arm compared with 5 ml in the placebo arm (P = 0.012). The median increases in the FEV1 at M1 relative to the baseline value for the treated and placebo groups were 13 and 0%, respectively (P = 0.019). Twenty-five patients received budesonide/formoterol during the study. The median difference in the FEV1 between the baseline and after 1 month of treatment for these patients was +240 ml (P = 0.0001). The effect of budesonide/formoterol on the FEV1 was maintained in the 13 patients who completed 6 months of treatment.Budesonide/formoterol administration led to a significant improvement in the FEV1 in patients with mild/severe BOS after allogeneic HSCT. Clinical trial registered with www.clinicaltrials.gov (NCT00624754).

Over the past 10 years the incidence of Aspergillus spp. has significantly increased, and it is now the most widespread air transmission fungal pathogen in developed countries. Whatever the clinical expression of the pulmonary disease and despite recent progress in antifungal drug therapy, morbidity and mortality related to aspergillosis lung disease still constitute a serious threat for immunosuppressed or mildly immunocompromised patients. Moreover, the treatments currently used have many limitations due to adverse effects and drug interactions. Finally, subjects exposed to azoles present an increased risk of Aspergillus-resistant strain emergence. We have reported five cases with aspergillosis lung diseases that were either difficult to control or in which patients had a contra-indication to triazole therapy, but which showed durable improvement following the administration of nebulised liposomal amphotericin B. Our alternative strategy could be of interest for patients with aspergillosis lung disease who otherwise cannot be conventionally treated by triazoles.

We describe three cases of Fusobacterium spp. diskitis and review with attention to risk factors, clinical features, diagnosis, treatment and outcome. In most of the reported cases, a ear-nose-throat infection was found. Clinical manifestations were similar to those of classic bacterial vertebral osteomyelitis. Clindamycin is the most appropriate antibiotic. The outcome seems to be very good without relapse with appropriate treatment compared to pyogenic vertebral osteomyelitis.