Tocilizumab, an anti-interleukin-6 receptor, administrated during the right timeframe may be beneficial against coronavirus-disease-2019 (COVID-19) pneumonia. All patients admitted for severe COVID-19 pneumonia (SpO2 ≤ 96% despite O2-support ≥ 6 L/min) without invasive mechanical ventilation were included in a retrospective cohort study in a primary care hospital. The treatment effect of a single-dose, 400 mg, of tocilizumab was assessed by comparing those who received tocilizumab to those who did not. Selection bias was mitigated using three statistical methods. Primary outcome measure was a composite of mortality and ventilation at day 28. A total of 246 patients were included (106 were treated with tocilizumab). Overall, 105 (42.7%) patients presented the primary outcome, with 71 (28.9%) deaths during the 28-day follow-up. Propensity-score-matched 84 pairs of comparable patients. In the matched cohort (n = 168), tocilizumab was associated with fewer primary outcomes than the control group (hazard ratio (HR) = 0.49 (95% confidence interval (95%CI) = 0.3–0.81), p-value = 0.005). These results were similar in the overall cohort (n = 246), with Cox multivariable analysis yielding a protective association between tocilizumab and primary outcome (adjusted HR = 0.26 (95%CI = 0.135–0.51, p = 0.0001), confirmed by inverse probability score weighting (IPSW) analysis (p < 0.0001). Analyses on mortality only, with 28 days of follow-up, yielded similar results. In this study, tocilizumab 400 mg in a single-dose was associated with improved survival without mechanical ventilation in patients with severe COVID-19.

Background. Tocilizumab, a drug targeting interleukin-6 administrated in the right timeframe may be beneficial in coronavirus-disease-2019 (COVID-19). We aimed to assess its benefit, drawing from observations in compassionately treated patients. Methods: In a retrospective case-control study, treatment effect (tocilizumab 400mg, single-dose) was assessed using three statistical methods: propensity-score matching, Cox multivariable survival and inverse probability score weighting (IPSW) analyses. Were included all patients hospitalized with COVID-19, who presented severity criteria with SpO2<96% despite O2-support >6L/min for more than 6 hours. Were excluded patients in critical care medicine department and those under invasive mechanical ventilation. Primary outcome was a composite of mortality and ventilation, with a maximum follow-up of 28 days. Results: 246 patients were included (106 treated by tocilizumab). They were 67.6 +/-15.3 years-old, with 95 (38.5%) women. Delay between first symptoms and inclusion was 8.4 +/-4.5 days. Overall, 105 (42.7%) patients presented the primary outcome, with 71 (28.9%) deaths during the 28-days follow-up. Propensity-score-matched 84 pairs of comparable patients. In the matched cohort (n=168), tocilizumab was associated with fewer primary outcomes (hazard ratio (HR)=0.49 (95% confidence interval (95CI)=0.3-0.81), p-value=0.005). These results were similar in the overall cohort (n=246), with Cox multivariable analysis yielding a protective association between tocilizumab and primary outcome (adjusted HR=0.26 (95CI=0.135-0.51, p=0.0001), confirmed by IPSW analysis (p<0.0001). Analyses on mortality with 28-days follow-up yielded similar results. Conclusion: In this retrospective study, tocilizumab single-dose was associated with improved survival without mechanical ventilation in patients with severe COVID-19.

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Background: In our hospital, children with appendicular plastron or abscess receive a medical treatment with cefotaxime, metronidazole and gentamicin followed by amoxicillin/clavulanic acid as an oral switch. Appendectomy is performed 10 to 12 weeks after the beginning of the discharge. A high failure rate was noticed with a switch to a second line treatments, rehospitalization or an emergency surgery. The objective of our study was to highlight predictive factors for the treatment response. Methods: We conducted a retrospective monocentric study between 2009 and 2019. Inclusion criteria were children under 16 years old diagnosed with appendicular plastron or abscess, treated with a medical treatment. We divided the cohort into a success and a failure group and compared their demographic data, clinical symptoms, inflammatory markers, abdominal imaging and antibiotic regimen. Results: Seventy-four patients were enrolled in the study and the failure rate was 36% (n=27). The median age in the success group was 8.7 years old (2-14) and 9.4 years old (2-15) in the failure group. Multiple abscesses (6.5% versus 32%, p=0.02) and diarrhea at admission (19% versus 44%, p=0.02) were significantly associated with a failure. Palpable mass (47% versus 67%, p=0.09) and stercoliths (34% versus 52%, p=0.13) appeared to be more important in the failure group. Discussion and conclusion: Several factors were analyzed to predict the response to the medical treatment for children with appendicular abscess or plastron. Patients with multiple abscesses will no longer be treated with antibiotics. We also recommended greater vigilance after detecting stercoliths in the medical imaging based on other studies results. Time to hospitalization, time to apyrexia, CRP and white blood cells level at admission were not different between the success and the failure group. Finally, a wider bacterial epidemiology study is needed in order to adjust our local guidelines and the antibiotic therapy.

Background Treating osteoarticular infections is difficult. Purpose To evaluate professional practise, we studied the effect of a multidisciplinary staff meeting on the quality of antibiotic treatment in an orthopaedic surgery care unit. Materials and Methods Via the coding process, we retrospectively studied patients hospitalised for osteoarticular infections (diabetic foot excluded) in the orthopaedic care unit of a general hospital in France. We compared antibiotic treatment conformity to good practise (bacteriology, dose, length of treatment, time taken to implementing microbiology report), length of hospitalisation and 6 month-outcome, for patients with osteoarticular infections, before (March 2007 to March 2009) and after (March 2009 to March 2011).implementation of the multidisciplinary staff meeting. Results85 patients were selected and 77 files were examined. Fifty-five medical records were actively devoted to osteoarticular infection and all of them were analysed: this worked out at 30 patients (32 infections) before the staff meetings and 26 patients (28 infections) after the staff meetings had started. Staff meeting decisions were reported in medical files in 72% of cases. Before staff meetings were instituted, antibiotic treatment was changed in 47% of cases, versus 96% since establishment of the staff meeting (p < 0.0001). Dose was optimum in 72% of infections before staff meetings were instituted, versus 89% afterwards (P = 0.11) and length of antibiotic treatment conformed to recommendations in 41% of infections before staff meetings, versus 86% after staff meetings had begun (P = 0,0005). The average time to respond to an antibiogram decreased from 2 days before staff meetings to 1.7 days after staff meeting (P = 0.43), and length of hospitalisation was 19.8 days before staff meetings versus 23.1 days after (P = 0.49). Recovery at 6 months accounted for 62% of patients before staff meetings, versus 76% after staff meetings (P = 0.35) and failure at 6 months concerned 29% of infections before staff meetings versus 24% after their institution (P = 0.75). Conclusions Since the beginning of multidisciplinary staff meeting in our orthopaedic surgery care unit, antibiotic treatment has significantly improved concerning spectrum and duration of treatment (p ≤ 0.0005). With this limited sample, clinical impact at 6 months was not significant. No conflict of interest.