The French Armed Forces are regularly deployed in areas of endemic rabies, a virus responsible for 59,000 deaths worldwide per year. During Operation DAMAN 50 at the end of 2024, rapid conflict intensification in southern Lebanon at once significantly increased the rabies exposure of French servicemen and decreased access to laboratory analyses. Exposures of military personnel to scratches from cats of unknown rabies status multiplied, putting post-exposure prophylaxis (PEP) stocks under extreme strain. To minimize the risk of a PEP shortage and its consequences, the medical personnel deployed in Operation DAMAN 50 adopted a pragmatic strategy updating existing recommendations. At the individual level, watch-and-see PEP occurred only when veterinary cat observation was possible. In the absence of reliable laboratory service, it was based on pathophysiological, epidemiological, environmental and operational data. On a wider scale, the strategy involved controlling the feline population. Based on the clinical field skills and global appraisal of situations not previously encountered by military practitioners, operational capacity was maintained, while limited vaccine supplies were reserved for patients in dire need.

The use of intravascular catheters is associated with a risk of catheter-related septic thrombosis (CRST), which management remains highly variable due to a lack of robust scientific evidence. This study aimed to describe current practices in France through a systematic survey. A web-based survey was disseminated via 10 French medical societies between June and October 2024. Among 156 respondents, 69 were infectious disease specialists. For catheter-related bloodstream infections, ultrasound imaging is not routinely performed by 60% of respondents but is typically performed in the presence of local inflammatory signs or antimicrobial therapy (AMT) failure. Over 60% of respondents reported prescribing AMT for≤21days. In cases of CRST involving a deep vein (DV), more than 80% of respondents considered the use of curative anticoagulation. For proximal DV CRST, 126 of 156 (81%) respondents performed follow-up ultrasound imaging to assess venous repermeabilization. The most frequently cited research priorities included the need for and appropriate use of anticoagulation (n=71/156; 46%), as well as AMT optimal duration (n=47/156; 30%). Despite the heterogeneity in clinical practice, our findings highlight a prevailing trend toward prescribing AMT for≤21days and the use of curative anticoagulation in cases of DV thrombosis. However, these approaches require further investigation through well-designed studies to establish their benefit.