Enterococcal bone and joint infections (BJIs) are reported to have poor outcomes, but there are conflicting results. This study aimed to describe the clinical characteristics and outcomes of patients with enterococcal BJI and to assess the factors associated with treatment failure. We conducted a retrospective cohort study at Nimes University Hospital from January 2007 to December 2020. The factors associated with treatment failure were assessed using a Cox model. We included 90 consecutive adult patients, 11 with native BJIs, 40 with prosthetic joint infections and 39 with orthopedic implant-associated infections. Two-thirds of patients had local signs of infection, but few (9%) had fever. Most BJIs were caused by Enterococcus faecalis (n = 82, 91%) and were polymicrobial (n = 75, 83%). The treatment failure rate was 39%, and treatment failure was associated with coinfection with Staphylococcus epidermidis (adjusted hazard ratio = 3.04, confidence interval at 95% [1.31–7.07], p = 0.01) and with the presence of local signs of inflammation at the time of diagnosis (aHR = 2.39, CI 95% [1.22–4.69], p = 0.01). Our results confirm the poor prognosis of enterococcal BJIs, prompting clinicians to carefully monitor for local signs of infection and to optimize the medical-surgical management in case of coinfections, especially with S. epidermidis.

We aimed to assess the factors associated with mortality in patients treated with tocilizumab for a SARS-CoV-2 pneumonia due to the delta or omicron variants of concern (VOC) and detect an effect of tocilizumab on mortality. We conducted a prospective cohort study in a tertiary hospital from 1 August 2021 to 31 March 2022 including patients with severe COVID-19, treated with tocilizumab. Factors associated with mortality were assessed in a Cox model; then, the 60-day mortality rates of COVID-19 patients treated with standard of care (SoC) +/− tocilizumab were compared after 1:1 propensity score matching. The mortality rate was 22% (N = 26/118) and was similar between delta and omicron cases (p = 0.6). The factors independently associated with mortality were age (HR 1.06; 95% CI (1.02–1.11), p = 0.002), Charlson index (HR 1.33; 95% CI (1.11–1.6), p = 0.002), WHO-CPS (HR 2.56; 95% CI (1.07–6.22) p = 0.03), and tocilizumab infusion within the first 48 h following hospital admission (HR 0.37, 95% CI (0.14–0.97), p = 0.04). No significant differences in mortality between the tocilizumab plus SoC and SoC alone groups (p = 0.5) were highlighted. However, the patients treated with tocilizumab within the 48 h following hospital admission had better survival (p = 0.04). In conclusion, our results suggested a protective effect on mortality of the early administration of tocilizumab in patients with severe COVID-19 regardless of the VOC involved.

Despite current recommendation, vaccination coverage (VC) for patients with heart failure (HF) remains far too limited. To evaluate the VC of HF patients followed in our hospital center and investigate the barriers to vaccination and the ways to address them. This was a cross-sectional monocentric descriptive study conducted between December 2019 and January 2021 at the University Hospital of Montpellier, France. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status against influenza and pneumococcus. For non-vaccinated patients, opinion and willingness to be vaccinated were also obtained. Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years and the proportion of males was 72%. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p = 0.022) and 22% were up to date with pneumococcal vaccination (11% in CU, 35% in TP, p < 0.001). Among patients not vaccinated, 17% refused vaccination. Among unvaccinated patients who consider vaccination, 69% wanted to be vaccinated by their general practitioner (GP). The VC of HF patients remains insufficient. Patients in TP are more vaccinated than patients in CU, which could involve better management. The low rate of vaccinated patients is mainly explained by a lack of awareness. The medical team, including the clinical pharmacist by his dedicated time during medication reconciliation may play a major role in the management of hospitalized patients as well as GP's as local actors.

Bone and joint infections (BJIs) are complex and difficult to eradicate, and have high relapse rates and limited oral treatment options. Tetracyclines combine favorable bone penetration, oral bioavailability, and activity against multidrug-resistant (MDR) pathogens, but their clinical role in BJIs remains unclear. This study aimed to summarize experimental and clinical evidence on tetracyclines in the management of BJIs, including pharmacology, antimicrobial activity, clinical efficacy, and guideline recommendations. We performed a literature review of PubMed® (1960-2024) for animal, pharmacokinetic, and clinical studies evaluating tetracyclines in BJIs. Data on bone distribution, anti-biofilm activity, clinical outcomes, tolerability, and recommendations were extracted and synthesized. Tetracyclines display strong bone affinity but inconsistent tissue concentrations in experimental models. In vitro and in vivo studies suggest anti-biofilm activity, particularly in combination with rifampicin, although monotherapy is insufficient. Two randomized controlled trials reported inferior outcomes compared with standard regimens. Observational studies of minocycline and tigecycline demonstrated variable efficacy (40-80%), with better outcomes in salvage therapy for MDR infections, but frequent gastrointestinal intolerance. Data on omadacycline remain limited to a single small cohort. Tetracyclines are recommended in guidelines for zoonotic infections (e.g., Brucella) and as long-term suppressive therapy in selected prosthetic joint infections, but evidence is weak compared with other agents, especially fluoroquinolones. Tetracyclines may provide therapeutic options for refractory or MDR-related BJIs, and for suppressive therapy when surgical or antibiotic alternatives are limited. However, available data are heterogeneous and largely observational. Robust prospective studies are needed to clarify their role, particularly for newer agents such as omadacycline and eravacycline.

Background/Objectives: The COVID-19 pandemic has been reported to impact antimicrobial consumption (AMC) and antimicrobial resistance (AMR) worldwide. We aimed to assess this correlation in Klebsiella pneumoniae before and during the COVID-19 pandemic and to estimate the burden of each antibiotic. Methods: We collected data on AMC of penicillins and beta-lactamase inhibitors (PBIs), anti-pseudomonal activity penicillins and beta-lactamase inhibitors (AAPBIs), cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and AMR in K. pneumoniae strains. The correlation between AMC and AMR was studied using dynamic regression models. Results: Overall, AMC of AAPBIs and fourth-generation cephalosporin increased, while fluoroquinolone consumption and AMR in the 2862 K. pneumoniae strains analyzed decreased. However, during the first year of the pandemic, we reported an increase in AMC and AMR. We found that 46% to 48% of the increase in cephalosporin, AAPBI, and fluoroquinolone resistance was explained by increased cephalosporin and fluoroquinolone consumption, 55% of the increase in PBI resistance was explained by increased PBI, cephalosporin, and fluoroquinolone consumption, and 58% of the increase in aminoglycoside resistance was explained by increased aminoglycoside consumption. Conclusions: During the COVID-19 pandemic, the increase in AMR in K. pneumoniae was correlated with the increase in AMC of several antibiotics, mainly cephalosporins and especially fluoroquinolones.