[Community-acquired bacterial infections].

Abstract

CORTICOSTEROIDS IN BACTERIAL MENINGITIS: A randomised multicentre study on meningitis in adults versus a placebo showed significant benefits of corticoids in terms of reduction in mortality and neurological complications. These results were essentially observed in pneumococcal infections. THE INTEREST IN MONITORING BLOOD CULTURES: Several works on Staphylococcus aureus bacteremia have confirmed the necessity of monitoring hemocultures, 48-72 hours following initiation of treatment. The persistence of bacteremia strongly suggests the poor prognosis and endocardial grafting should be envisaged. CARDIOVASCULAR RISK: Persisting Salmonella enterica bacteremia in an adult aged over 50 must lead to search for a cardiovascular infection, notably mycotic aneurism, in view of the risk of rupture and the necessity of early surgery. This type of infection is observed in 10 to 23% of cases. BACTERIAL ENDOCARDITIS: The size of the vegetations > 2 cm and the neurological complications of embolic nature are clearly identified as predictive factors of death in endocarditis of drug addicts. Early surgery in the case of voluminous vegetations, including in the right endocardium, is therefore discussed. URINARY INFECTIONS: A randomised study against a placebo in asymptomatic urinary infections of diabetic women showed no significant benefits of the antibiotherapy on reducing morbidity.