David Lebeaux

Healthcare workers (HCW) have been at the frontline during the COVID-19 pandemic, with an increased risk of infection, particularly due to the emergence of the omicron variant. This study aims to assess risk factors for omicron acquisition among vaccinated HCW, comparing hybrid immunity (previous infection and vaccination) to vaccine-induced immunity alone. We took advantage of the COVID-HOP prospective cohort, which includes vaccinated HCW followed over several months, collecting detailed data on demographic characteristics, comorbidities, and professional and personal exposures to COVID-19. We analyzed factors associated with omicron acquisition after January 2022, with a focus on immunization scheme (hybrid or vaccine-induced immunity). Out of 698 HCW analyzed, 298 acquired the omicron variant. In the multivariable analysis (taking into account comorbidities, professional/personal exposure and lifestyle), the two independent factors associated with an increased risk of infection were: younger age (P = 0.005) and immunization scheme (OR associated with vaccine-induced immunity alone: 2.43 [95% Confidence Interval: 1.64-3.60]) with hybrid immunity as reference). HCW with hybrid immunity have a reduced risk of acquiring omicron compared to those with vaccine-induced immunity alone. These findings emphasize the importance of a combined vaccination strategy to better protect HCW against emerging variants, and to vaccine HCW who experienced previous COVID-19 episodes.

Objectives: The treatment of long-term intravenous catheter-related bloodstream infections (LTIVC-related BSI) often requires catheter removal or a conservative treatment using intra-catheter locks, with a 50-60% success rate. We previously demonstrated the synergistic effect of a combination of gentamicin and EDTA-Na ₂ against bacterial biofilms. We performed a phase 1/2 clinical trial to assess the tolerance and efficacy of the genta-EDTA-Na ₂ locks for the conservative treatment of LTIVC-related BSI. Methods: Prospective study including adult patients with a monomicrobial uncomplicated LTIVC-related BSI caused by a gentamicin-susceptible coagulase-negative staphylococci, Enterobacterales or Pseudomonas aeruginosa . Primary objective: assess the safety and efficacy at Day 40 (D40) of genta-EDTA-Na ₂ locks by evaluating the frequency of clinical and microbiological cure 30 days after the end of treatment (D40). Results: Eight patients were included. A complete follow-up was obtained for 7 patients, 6 of which met cure criteria. The single patient whose follow-up was incomplete met all criteria for cure at D23. A single microbiological failure occurred (relapse of P. aeruginosa LTIVC-related BSI). Two patients experienced at least one serious adverse event; none were attributed to the genta-EDTA-Na ₂ locks. Conclusion: Genta-EDTA-Na ₂ used as intra-catheter locks is a promising anti-biofilm candidate to be studied in a randomized controlled trial.

Nocardiosis, a bacterial opportunistic infection caused by Nocardia spp, has recently been reported in patients with anti–granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, but insufficient data are available about disease presentation, outcomes, and occurrence of autoimmune pulmonary alveolar proteinosis (aPAP) in this population. We performed a prospective, multicenter, nationwide study in France and included patients with a Nocardia infection who had anti-GM-CSF autoantibodies. We describe their clinical, microbiological, and radiological characteristics, and their outcome at 1 year of follow-up. Twenty patients (18 [90%] male) were included, with a median age of 69 (interquartile range, 44–75) years. The organs most frequently involved were the brain (14/20 [70%]) and the lung (12/20 [60%]). Half of the infections were disseminated (10/20 [50%]). Nocardia identification was predominantly made in abscess fluid (17/20 [85%]), among which 10 (59%) were brain abscesses. The 1-year all-cause mortality was 5% (1/20), and only 1 case of aPAP (1/20 [5%]) occurred during the follow-up period. Nocardiosis with anti-GM-CSF autoantibodies is associated with a low mortality rate despite a high incidence of brain involvement. Although the occurrence of aPAP was infrequent during the 1-year follow-up period, long-term clinical data are needed to fully understand the potential relationship between nocardiosis, anti-GM-CSF autoantibodies, and aPAP.

Purpose Major bleedings have been described with cefazolin. The objective was to determine the frequency of bleeding events in cefazolin-treated patients and to identify risk factors for these complications. Methods Monocenter prospective observational study of all consecutive cefazolin-treated patients. Patients benefited from a daily clinical assessment of bleedings and a twice-a-week blood sampling including hemostasis. Bleedings were classified according to the International Society on Thrombosis and Hemostasis classification: major, clinically relevant non-major bleedings (CRNMB) and minor bleedings. Results From September 2019 to July 2020, 120 patients were included, with a mean age of 59.4 (± 20.7) years; 70% of them (84/120) were men. At least 1 CRNMB or major bleeding were observed in 10% of the patients (12/120). Compared to patients with no or minor bleeding, patients with CRNMB or major bleeding were, upon start of cefazolin, more frequently hospitalized in an intensive care unit (7/12, 58.3%, vs. 12/108, 11.1%, P < 0.001, respectively) and receiving vitamin K antagonists (4/12, 33.3%, vs. 8/108, 7.4%, P = 0.019, respectively). After multivariate analysis, patients receiving vitamin K antagonists the day prior bleeding and/or treated for endocarditis were factors associated with an increased risk of CRNMB or major bleeding (odd ratio 1.36, confidence interval 95%, 1.06–1.76, P = 0.020 and 1.30, 1.06–1.61, P = 0.015, respectively). Conclusions Bleeding events associated with cefazolin treatment are frequent. Close clinical monitoring should be performed for patients treated for endocarditis and/or receiving vitamin K antagonists. Hemostasis work-up could be restricted to these patients.