Universite Paris Est Creteil Val De Marne

Adult immunoglobulin A vasculitis (IgAV) course is variable, and its prognostic factors are poorly understood.

To identify risk factors for IgAV recurrence/relapse in adults.

We included adult patients with IgAV between January 2016 and July 2022. The primary outcome was the time to recurrence/relapse. Factors associated with recurrence/relapse were assessed with hazard ratios (HR) and 95% confidence intervals (CI). Treatment effectiveness was assessed using inverse probability of treatment weighting.

A total of 229 patients were included. Abdominal purpura and articular involvement were associated with a higher risk of recurrence/relapse (HR: 2.03 [95%CI: 1.16-3.58]; P = .014; HR: 2.29 [95%CI: 1.25-4.20]; P = .0074, respectively), as well as fever at diagnosis (HR: 3.54 [95%CI: 1.19-10.5]; P = .023]). Factors associated with lower risk were post-bacterial cause (HR: 0.26 [95%CI: 0.07-0.93]; P = .039) and systemic corticosteroids administration (HR: 0.30 [95%CI: 0.12-0.75]; P = .0098). In the inverse probability of treatment weighting analysis, corticosteroids were still associated with a reduced risk of recurrence/relapse (HR: 0.41 [95%CI: 0.18-0.93]; P = .03), whereas colchicine was not (HR: 0.84 [95%CI: 0.42-1.69]; P = .63).

Retrospective design.

Systemic corticosteroid administration and post-bacterial etiology appear to protect against recurrence/relapse in adult IgAV. Conversely, fever at diagnosis, abdominal purpura, and articular involvement may be associated with an increased risk.

Cellulitis and impetigo account for many outpatients’ visits and antibiotic prescriptions. They are mainly caused respectively by Streptococcus spp. and Staphylococcus aureus. French guidelines recommend amoxicillin as a first-line antibiotic for cellulitis and pristinamycin for severe impetigo, whereas the UK guidelines recommend flucloxacillin for both infections and no Belgian guidelines are published.

To investigate the prescription patterns of cellulitis and impetigo in general practice and to assess the potential impact of the implementation of national guidelines.

We used a prescription software database (Cegedim) from 2013 to 2023 in France, the UK and Belgium. The annual rate of antibiotic prescription associated with cellulitis and impetigo was assessed. A segmented linear regression was performed to assess the impact of the implementation of the guidelines in 2019.

The use of amoxicillin for the diagnosis of cellulitis increased from 18.2% to 36.2% in France. Flucloxacillin use increased from 41.1% to 51.6% in the UK. In Belgium, no change in antibiotic use was observed with amoxicillin-clavulanate being the most commonly prescribed antibiotic.In France, the use of pristinamycin and amoxicillin-clavulanate for the diagnosis of impetigo increased from 13.8% and 22.2% to 21.1% and 33.1%, respectively. In Belgium and the UK, flucloxacillin was the most commonly prescribed antibiotic, with prescription rates increasing from 55.7% to 62.6% and from 71.8% to 82.6%, respectively.Publication of guidelines did not affect antibiotic prescribing patterns

Prescribing patterns are very heterogeneous across European countries and publication of guidelines did not affect prescribing habits.