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NosoVeille – Bulletin de veille Novembre 2010

NosoVeille n°11

Novembre 2010Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve

Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé.

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AntibiotiqueBactériémieChirurgieClostridium difficileDésinfectionDispositif médicalEHPADEnvironnementGrippeHépatite Hygiène des mainsPédiatriePersonnelSignalementSoins intensifs/RéanimationStaphylococcus StérilisationUsager

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Antibiotique

NosoBase n° 28667Prévalence de l'antibiorésistance parmi des isolats à Gram négatif dans une unité de réanimation pour adultes dans un centre hospitalier universitaire en Arabie Saoudite

Al Johani SM; Akhter J; Balkhy H; El-Saed A; Younan M; Memish Z. Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia. Annals of saudi medicine 2010/10; 30(5): 364-369.

Mots-clés : PREVALENCE; SOIN INTENSIF; ANTIBIORESISTANCE; ETUDE RETROSPECTIVE; BACILLE GRAM NEGATIF; ESCHERICHIA COLI; PSEUDOMONAS AERUGINOSA; KLEBSIELLA PNEUMONIAE;ENTEROBACTER; CARBAPENEME; CEPHALOSPORINE

Background and objectives: Patients in the ICU have encountered an increasing emergence and spread of antibiotic-resistant pathogens. We examined patterns of antimicrobial susceptibility in gram-negative isolates to commonly used drugs in an adult ICU at a tertiary care hospital in Riyadh, Saudi Arabia.Methods: A retrospective study was carried out of gram-negative isolates from the adult ICU of King Fahad National Guard Hospital (KFNGH) between 2004 and 2009. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method.Results: The most frequently isolated organism was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pnemoniae, Stenotrophomonas maltophilia, and Enterobacter. Antibiotic susceptibility patterns significantly declined in many organisms, especially A baumannii, E coli, S marcescens, and Enterobacter. A baumannii susceptibility was significantly decreased to imipenem (55% to 10%), meropenem (33% to 10%), ciprofloxacin (22% to 10%), and amikacin (12% to 6%). E coli susceptibility was markedly decreased (from 75% to 50% or less) to cefuroxime, ceftazidime, cefotaxime, and cefepime. S marcescens susceptibility was markedly decreased to cefotaxime (100% to 32%), ceftazidime (100% to 35%), and cefepime (100% to 66%). Enterobacter susceptibility was markedly decreased to ceftazidime (34% to 5%), cefotaxime (34% to 6%), and pipracillin-tazobactam (51% to 35%). Respiratory samples were the most frequently indicative of multidrug-resistant pathogens (63%), followedby urinary samples (57%).Conclusion: Antimicrobial resistance is an emerging problem in the KFNGH ICU, justifying new more stringent antibiotic prescription guidelines. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future.

NosoBase n° 28615Epidémiologie clinique et moléculaire d'Escherichia coli et de Klebsiella pneumoniae producteurs de bêta-lactamases à spectre élargi dans une étude à long terme au Japon

Chong Y; Yakushiji H; Kamimura T. Clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a long-term study from Japan. European journal of clinical microbiology and infectious disease 2010; in press: 5 pages.

Mots-clés : ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; BETA-LACTAMASE A SPECTRE ELARGI; TAUX; PROTEUS MIRABILIS; ANTIBIORESISTANCE

The detection rates of extended-spectrum ß-lactamase (ESBL)-producing bacteria in Japan are very low (~5%) compared with those obtained worldwide. Further, the current trend of these bacteria in Japan is not known, and few studies with longitudinal observations have been reported. To obtain epidemiologic data on ESBL-producing bacteria, their genotypic features, and their antibiotic resistance patterns in Japan, we analyzed bacterial isolates from hospitalized patients at our institution over the 7-year period from 2003 to 2009. Of 2,304 isolates, 202 (8.8%) were found to be ESBL producers, including Escherichia coli, Klebsiella pneumonia, and Proteus mirabilis. The detection rates of the ESBL-producing isolates gradually increased and reached 17.1% and 10.5% for the E. coli and K. pneumoniae strains, respectively, in 2009. Genotyping analysis showed that ~90% of the ESBL-producing isolates carried the CTX-M genotype, in which the CTX-M-9 group was predominant, although the CTX-M-2 group is considered to be the main genotype in Japan; further, many of the strains produced multiple ß-lactamases. The detection rates of ESBL-producing bacteria may tend to be high within a limited region in Japan. A countrywide survey is required to understand the trend for ESBL-producing bacteria at the national level. In addition, our findings suggest that the genotypes of the detected ESBL producers are similar to those exhibiting a successful nosocomial spread worldwide.

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NosoBase n° 28416Faut-il abandonner la vancomycine ?

Daurel C; Leclercq R. Vancomycin, what else? Archives de pédiatrie 2010/09/01; 17(Suppl 4): S121-S128.

Mots-clés : PEDIATRIE; ANTIBIORESISTANCE; VANCOMYCINE; STAPHYLOCOCCUS AUREUS; GLYCOPEPTIDE; LINEZOLIDE La vancomycine et la téicoplanine sont des glycopeptides utilisés depuis de nombreuses années dans les infections à staphylocoque doré résistant à la méticilline (SARM). Une certaine néphrotoxicité de la vancomycine, et une efficacité clinique lente font discuter d’alternatives possibles. Les glycopeptides ont une activité moindre que celle de l’oxacilline contre les staphylocoques sensibles à la méticilline et doivent être réservés aux infections à SARM. La prévalence des SARM est devenue basse ces dernières années en pédiatrie mais peut être fréquente chez les nouveau-nés en soins intensifs. Les staphylocoques à coagulase-négative, cause majeure d’infections en néonatalogie, sont souvent résistants à la méticilline. Les SARM communautaires producteurs de toxine de Panton-Valentine responsables d’infections cutanées sévères et de rares pneumonies nécrosantes graves chez l’enfant disséminent depuis quelques années mais leur fréquence reste basse (2-4 % des SARM). Un nouveau clone de SARM communautaire, producteur de toxine de choc staphylococcique devient plus fréquent. L’efficacité de la vancomycine contre les staphylocoques est corrélée en sens inverse à la CMI. Il faut donc que la CMI soit déterminée dans les infections sévères et qu’une valeur cible du taux sérique d’au moins 8 fois la CMI soit atteinte. La résistance aux glycopeptides est rare chez Staphylococcus aureus, mais pas celle à la téicoplanine chez les staphylocoques à coagulase-négative. Les SARM restent actuellement sensibles à plusieurs antibiotiques outre les glycopeptides. Parmi les antibiotiques récemment commercialisés, le linézolide et la daptomycine n’ont pas d’autorisation de mise sur le marché chez l’enfant mais pourraient avoir un intérêt.

NosoBase n° 28419Entérobactéries productrices de bêta-lactamases à spectre étendu

Doit C; Mariani-Kurkdjian P; Bingen E. Extended-spectrum beta-lactamase producing-enterobacteriaceae.Archives de pédiatrie 2010/09/01; 17(Suppl 4): S140-S144.

Mots-clés : BETA-LACTAMASE A SPECTRE ELARGI; ESCHERICHIA COLI; PEDIATRIE; KLEBSIELLA PNEUMONIAE; INCIDENCE

Les bêta-lactamases à spectre étendu (BLSE) sont des enzymes qui hydrolysent l’ensemble des pénicillines et les céphalosporines à l’exception des céphamycines (céfotixine, céfotétan) du moxalactam et des carbapénèmes. Les premières BLSE dérivaient des pénicillinases de type TEM ou SHV-1 par mutation ponctuelle. Plus récemment, de nouvelles BLSE non dérivées des pénicillinases ont émergé : les céfotaximases de type CTX-M et les ceftazidimases de type PER, GES et VEB. La distribution des espèces bactériennes au sein de ces souches a également évolué : K. pneumoniae qui représentait environ 60 % de ces souches en 1995, n’en représente plus que 20 %. C’est chez Escherichia coli que la progression est la plus nette, passant de moins de 10 % en 1995 à 55 % en 2008. En France, la prévalence des souches d’ E. coli résistantes aux céphalosporines de troisième génération isolées d’hémocultures reste < 5 %, mais augmente régulièrement depuis 2002. En pédiatrie, ces souches sont principalement responsables de cystites et de pyélonéphrites. De rares cas d’infections maternofoetales et de méningites néonatales impliquant ces souches ont été publiés. À l’hôpital Robert-Debré, la prévalence des souches d’E. coli produisant ce type d’enzyme ne cesse de croître depuis le début des années 2000. Ces souches sont fréquemment résistantes au cotrimoxazole, aux quinolones et aux aminosides. L’arsenal thérapeutique vis-à-vis de ces souches peut se restreindre aux carbapénèmes, à la colimycine, et à la fosfomycine.

NosoBase n° 28521 Activité comparative de doripénème, méropénème et imipénème dans des isolats cliniques récents obtenus au cours de l'étude de surveillance épidémiologique COMPACT-Espagne

Gimeno C; Canton R; Garcia A; Gobernado M. Comparative activity of doripenem, meropenem and imipenem in recent clinical isolates obtained during the COMPACT-Spain epidemiological surveillance study. Revista expanola de quimioterapia 20/10/09; 23(3): 144-152.

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Mots-clés : EPIDEMIOLOGIE; CARBAPENEME; DORIPENEME; MEROPENEME; IMIPENEME; SURVEILLANCE; CMI; ENTEROBACTERIE; ANTIBIORESISTANCE; PSEUDOMONAS AERUGINOSA; ACINETOBACTER

Introduction: Doripenem is a new carbapenem with broad spectrum antibacterial activity indicated for the treatment of nosocomial pneumonia and complicated urinary and intraabdominal infections.Methods: Isolates of Pseudomonas aeruginosa, Acinetobacter and Enterobacteriaceae from patients with nosocomial pneumonia, bacteremia and complicated intraabdominal infections attended in 16 Spanish hospitals were included (October 2008 - May 2009). Susceptibility to imipenem, meropenem and doripenem was studied with the Etest method, and the results were interpreted according to the EUCAST criteria.Results: Considering all the isolates, doripenem (MIC50 0.12 mg/L) was 2- to 8-fold more active than meropenem (0.25 mg/L) and imipenem (1 mg/L). In relation to Enterobacteriaceae, the MIC50 and MIC90 values of doripenem and meropenem were similar (0.03 and 0.12 mg/L, respectively) and clearly superior to those of imipenem (0.25 and 1 mg/L). In the case of P. aeruginosa, MIC50 and MIC90 were more favorable to doripenem (0.25 and 16 mg/L) than to meropenem (0.5 and >or= 64 mg/L) or imipenem (2 and >or= 64 mg/L). In this species, the percentage of strains with lower MIC values for doripenem among those exhibiting intermediate susceptibility and resistance to meropenem was 63.0% (29/46) and 61.7% (63/102), respectively, versus only 4.3% (2/46) and 1.9% (2/102) with higher MIC values for doripenem.Conclusions: The results obtained in this study are similar to those reported in other countries, and reinforce the superior in vitro activity of doripenem versus the other carbapenems and its position in the treatment guidelines regarding the nosocomial infections for which it is indicated.

NosoBase n° 28781Prévalence et diversité des carbapénèmases parmi des isolats d'Acinetobacter non sensibles à l'imipénème en Corée : émergence d'une nouvelle OXA-182

Kim CK; Lee Y; Lee H; Woo GJ; Song W; KIm MN; et al. Prevalence and diversity of carbapenemases among imipenem-nonsusceptible Acinetobacter isolates in Korea: emergence of a novel OXA-182. Diagnostic microbiology and infectious disease 2010; in press: 7 pages.

Mots-clés : PREVALENCE; ACINETOBACTER; ANTIBIORESISTANCE; CARBAPENEME; IMIPENEME

Increase in multidrug-resistant Acinetobacter poses a serious problem in Korea. In this study, 190 imipenem (IPM)-nonsusceptible (NS) Acinetobacter isolates from 12 Korean hospitals in 2007 were used to determine species, prevalence, and antimicrobial susceptibility of OXA carbapenemase- and metallo-ß-lactamase (MBL)-producing isolates. bla(OXA-23)-like and ISAba1-asssociated bla(OXA-51)-like genes were detected in 80% and 12% of 178 IPM-NS Acinetobacter baumannii isolates, respectively. A novel bla(OXA-182) was detected in 12 IPM-NS A. baumannii isolates. Twelve out of 14 MBL-producing isolates were non-baumannii Acinetobacter. A. baumannii isolates with OXA carbapenemase were more often resistant to aminoglycosides, ciprofloxacin, and tigecycline than non-baumannii Acinetobacter isolates with MBL. Identical pulsed- field gel electrophoresis patterns were observed in 89% of A. baumannii isolates with bla(OXA-23)-like gene. In conclusion, extremely rapid increase of IPM-NS A. baumannii in previous Korean studies was mainly due to clonal spread of OXA-23-producing A. baumannii isolates. A novel OXA-182 emerged in Korea.

NosoBase n° 28422Les carbapénèmases des entérobactéries

Nordmann P; Carrer A. Carbapenemases in enterobacteriaceae. Archives de pédiatrie 2010/09/01; 17(Suppl 4): S154-S162.

Mots-clés: CARBAPENEME; PEDIATRIE; BETA-LACTAMASE A SPECTRE ELARGI; ENTEROBACTERIE; EPIDEMIOLOGIE; TRAITEMENT

Les bêta-lactamases ayant une activité de carbapénèmase sont les plus puissants mécanismes de résistance aux carbapénèmes. Ces carbapénèmases sont identifiées de façon croissante chez les entérobactéries dans le monde entier. Les carbapénèmases de type KPC décrites tout d’abord aux États-Unis chez Klebsiella pneumoniae ont une diffusion mondiale avec une endémicité marquée également en Israel et en Grèce. Les carbapénèmases de type métallo-enzymes (VIM, IMP.) ont été également décrites dans le monde entier avec une forte prévalence en Europe du Sud et en Asie. OXA-48 est l’une des carbapénèmases les plus récemment décrites, structurellement différente des précédentes et

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essentiellement identifiée dans des pays méditerranéens. Les gènes de ces carbapénèmases sont le plus souvent plasmidiques, majoritairement dans des souches hospitalières de K. pneumoniae mais leur diffusion communautaire a déjà été rapportée. Ces carbapénèmases sont présentes dans des souches multirésistantes aux antibiotiques. Les infections à entérobactéries productrices de carbapénèmases sont difficiles à traiter et peuvent être la source d’impasses thérapeutiques. Leur détection très difficile (détection des infectés comme des porteurs), expliquerait leur diffusion à bas bruit aux conséquences thérapeutiques dramatiques.

NosoBase n° 28708Acquisition de bactéries à Gram négatif multirésistantes aux antibiotiques : incidence et facteurs de risque chez des patients en long séjour

O'Fallon E; Kandell R; Schreiber R; D'Agata E. Acquisition of multidrug-resistant gram-negative bacteria:incidence and risk factors within a long-term care population. Infection control and hospital epidemiology2010/11; 31(11): 1148-1153.

Mots-clés : MULTIRESISTANCE; FACTEUR DE RISQUE; INCIDENCE; BACTERIE A GRAM NEGATIF; SOIN DE LONGUE DUREE; ETUDE PROSPECTIVE; PRELEVEMENT; COLONISATION; TRANSMISSION SOIGNE-SOIGNE

Background and objective: An improved understanding of the transmission dynamics of multidrug-resistant (MDR) gram-negative bacteria and the mechanism of acquisition in long-term care facilities (LTCFs) could aid in the development of prevention strategies specific to LTCFs. We thus investigated the incidence of acquisition of these pathogens among an LTCF population. Design: Prospective cohort study. Setting: Three separate wards at a 600-bed LTCF in metropolitan Boston, Massachusetts, during the periodOctober 31, 2006, through October 22, 2007. Participants: One hundred seventy-two LTCF residents. Methods: A series of rectal samples were cultured to determine acquisition of MDR gram-negative bacteria, defined as absence of MDR gram-negative bacterial colonization at baseline and de novo recovery of MDR gram-negative bacteria from a follow-up culture. Molecular typing was performed to identify genetically linked strains. A nested matched case-control study was performed to identify risk factors associated with acquisition. Results: Among 135 residents for whom at least 1 follow-up culture was performed, 52 (39%) acquired at least 1 MDR gram-negative organism during the study period. Thirty-two residents (62%) had not been colonized at baseline and had acquired at least 1 MDR gram-negative species at follow-up culture, and 20 residents (38%) were colonized at baseline and had acquired at least 1 MDR gram-negative species at follow-up culture. The most common coresistance pattern was resistance to extended-spectrum penicillins, ciprofloxacin, and gentamicin (57 isolates [42.5%]). Genetically related strains of MDR gram-negative bacteria were identified among multiple residents and between roommates. On conditional logistic regression analysis, antibiotic exposure during the study period was significantly associated with acquisition of MDR gram-negative bacteria (odds ratio, 5.6 [95% confidence interval, 1.1-28.7]; P= .04).Conclusions: Acquisition of MDR gram-negative bacteria occurred frequently through resident-to-resident transmission. Existing infection control interventions need to be reevaluated.

NosoBase n° 28420Description et investigation d’une épidémie nosocomiale de colonisations et d’infections à Escherichia coli producteur d’une bêta-lactamase à spectre étendu dans un service de néonatologie

Quinet B; Mitanchez D; Salauze B; Carbonne A; Bingen E; Fournier S; et al. Description and investigation of an outbreak of extended-spectrum beta-lactamase producing Escherichia coli strain in a neonatal unit. Archives de pédiatrie 2010/09/01; 17(Suppl 4): S145-S149.

Mots-clés : NEONATALOGIE; EPIDEMIE; BETA-LACTAMASE A SPECTRE ELARGI; ESCHERICHIA COLI; COLONISATION; BACTERIEMIE Nous rapportons la description et l’investigation d’une épidémie à Escherichia coli producteur de bêta-lactamase à spectre étendu (BLSE) survenue dans un service de néonatologie sur une période de 5 semaines, ayant entraîné la colonisation digestive de 27 nouveau-nés sur 59 soit un taux d’attaque de 45,7 %. Parmi ces enfants colonisés, l’un a développé une méningite avec bactériémie d’évolution favorable et un second une conjonctivite. La gestion de l’épidémie a nécessité l’arrêt des admissions dans le service,

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associé à des mesures strictes de regroupement de patients et au renforcement des précautions standard d’hygiène. L’enquête épidémiologique n’a pas retrouvé de cause unique à la contamination croisée mais plusieurs dysfonctionnements. La progression du nombre d’E. coli BLSE depuis une décennie, aussi bien à l’origine d’infections communautaires qu’hospitalières, pose un réel problème de santé publique et de choix thérapeutique.

NosoBase n° 28804Une antibiothérapie inappropriée dans des sepsis à pathogène à Gram négatif augmente la durée du séjour hospitalier

Shorr AF; Micek ST; Welch EC; Doherty JA; Reichley RM; Kollef MH. Inappropriate antibiotic therapy in gram-negative sepsis increases hospital length of stay. Critical care medicine 2010; in press: 6 pages.

Mots-clés : BACTERIEMIE; TRAITEMENT; ANTIBIOTIQUE; SYNDROME SEPTIQUE; BACILLE GRAM NEGATIF; DUREE DE SEJOUR; COHORTE; ETUDE RETROSPECTIVE; ESCHERICHIA COLI; PSEUDOMONAS

Objectives: To describe the impact of initially inappropriate antibiotic therapy on hospital length of stay in Gram-negative severe sepsis and septic shock.Design: Retrospective cohort.Setting: Academic urban hospital.Patients: Patients with Gram-negative bacteremia (primary or secondary, nosocomial or non-nosocomial) and severe sepsis or septic shock.Interventions: None.Measurements and main results: We defined initially inappropriate antibiotic therapy as occurring when the patient either was not administered an antibiotic within 24 hrs of sepsis onset or was treated with an antibiotic to which the culprit pathogen was resistant in vitro. The cohort included 760 subjects (mean age 59.3 ± 16.3 yrs, mean Acute Physiology and Chronic Health Evaluation II score 23.7 ± 6.7). More than half of infections were nosocomial (55.1%), and Escherichia coli represented the most common pathogen (n = 225). Pseudomonas species were isolated in 17.4% of patients. Nearly one-third of patients (31.3%) received initially inappropriate antibiotic therapy. Patients administered initially inappropriate antibiotic therapy were more likely to have a nosocomial infection, to have underlying cancer or diabetes or both, to require chronic hemodialysis, and to undergo mechanical ventilation. Those administered initially inappropriate antibiotic therapy also faced higher inhospital mortality. The unadjusted median length of stay after sepsis onset in those administered initially inappropriate antibiotic therapy was 11 days compared to 9 days in those treated appropriately (p = .028 by log-rank test). In a Cox model controlling for the multiple confounders noted, initially inappropriate antibiotic therapy independently correlated with continued hospitalization (adjusted hazard ratio 1.19, 95% confidence interval 1.01-1.40, p = .044). Adjusting for these covariates indicated that initially inappropriate antibiotic therapy independently increased the median attributable length of stay by 2 days.Conclusions: Initially inappropriate antibiotic therapy occurs in one-third of persons with severe sepsis and septic shock attributable to Gram-negative organisms. Beyond its impact on mortality, initially inappropriate antibiotic therapy is significantly associated with length of stay in this population. Efforts to decrease rates of initially inappropriate antibiotic therapy may serve to improve hospital resource use by leading to shorter overall hospital stays.

NosoBase n° 28754Antibioprophylaxie dans le cadre d'interventions obstétricales

Société des obstétriciens et gynécologues du Canada; SOGC. Journal of obstetrics and gynaecology Canada 2010/09; (247): 886-893.

Mots-clés : ANTIBIOPROPHYLAXIE; OBSTETRIQUE; RECOMMANDATION; PREVENTION; CESARIENNE; CEPHALOSPORINE PREMIERE GENERATION; SITE OPERATOIRE; ACCOUCHEMENT; ENDOCARDE

Objectif : Analyser les résultats et formuler des recommandations sur le recours à l’antibioprophylaxie dans le cadre d’interventions obstétricales. Issues : Parmi les issues évaluées, on trouve la nécessité et l’efficacité du recours à des antibiotiques aux fins de la prévention des infections dans le cadre d’interventions obstétricales.

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Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans Medline et The Cochrane Library au moyen de la rubrique « antibioprophylaxie dans le cadre d’interventions obstétricales ». Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Les recherches ont été mises à jour de façon régulière et les articles publiés entre janvier 1978 et juin 2009 ont été incorporés à la directive clinique. Les lignes directrices actuellement publiées par le American College of Obstetrics and Gynecology ont également été incorporées à la directive clinique. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : Les résultats obtenus ont été analysés et évalués par le comité sur les maladies infectieuses de la Société des obstétriciens et gynécologues du Canada sous la gouverne des auteures principales, et les recommandations ont été formulées conformément aux lignes directrices élaborées par le Groupe d’étude canadien sur les soins de santé préventifs (Tableau 1). Avantages, désavantages et coûts : La mise en oeuvre de la présente directive clinique devrait réduire les coûts et les torts attribuables à l’administration d’antibiotiques lorsque celle-ci ne s’avère pas requise, ainsi que les torts attribuables à la non-administration d’antibiotiques lorsque ceux-ci pourraient s’avérer bénéfiques.Déclarations sommaires :1. Les données disponibles ne soutiennent pas le recours à l’antibioprophylaxie en vue d’atténuer la morbidité infectieuse à la suite d’un accouchement vaginal opératoire. (II-1)2. Nous ne disposons pas de données suffisantes pour soutenir ou déconseiller le recours à l’antibioprophylaxie en vue d’atténuer la morbidité infectieuse dans les cas de retrait manuel du placenta. (III)3. Nous ne disposons pas de données suffisantes pour soutenir ou déconseiller le recours à l’antibioprophylaxie au moment de la dilatation-curetage postpartum visant des produits de conception en rétention. (III)4. Les données disponibles ne soutiennent pas le recours à l’antibioprophylaxie en vue d’atténuer la morbidité infectieuse à la suite d'un cerclage planifié ou d'urgence. (II-3)

Bactériémie

NosoBase n° 28606Surveillance sentinelle nationale des bactériémies à Candida spp dans 40 centres hospitaliers en Espagne

Cisterna R; Ezpeleta G; Telleria O; Guinea J; Regueiro B; Rodriguez J; et al. A nationwide sentinel surveillance of bloodstream Candida spp. Infections study in 40 tertiary - care hospitals in Spain. Journal of clinical microbiology 2010; in press: 24 pages.

Mots-clés : SURVEILLANCE; CANDIDA; BACTERIEMIE; ETUDE PROSPECTIVE; ANTIFONGIQUE;RESISTANCE; FACTEUR DE RISQUE; HEMOCULTURE; INCIDENCE; MORTALITE; FLUCONAZOLE;VORICONAZOLE; TRAITEMENT

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Spain to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for acquiring a Candida spp. infection. Prospective laboratory-based surveillance was conducted from June 2008 to June 2009 in 40 medical centers located around the country. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 984 cases, for an overall incidence of 1.09 cases per 1,000 admissions. The crude mortality was 20.20%. C. albicans was the most common species (49.08%), followed by C. parapsilosis (20.73%), C. glabrata (13.61%) and C. tropicalis (10.77%). Overall, decreased susceptibility to fluconazole occurred in 69 (7.01%) of incident isolates. Antifungal resistance was rare and a moderate linear correlation between fluconazole and voriconazole MICs was observed. This is the largest multicenter candidemia study conducted and shows the substantial morbidity and mortality of candidemia in Spain.

NosoBase n° Notice 28298Facteurs de risque et évolution des bactériémies à entérocoques résistants à la vancomycine chez les enfants

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Haas EJ; Zaoutis TE; Prasad P; Li M; Coffin SE. Risk factors and outcomes for vancomycin-resistant Enterococcus bloodstream infection in children. Infection control and hospital epidemiology 2010/10; 31(10): 1038-1042.

Mots-clés : FACTEUR DE RISQUE; VANCOMYCINE; PEDIATRIE; BACTERIEMIE; ETUDE RETROSPECTIVE; MORTALITE; VENTILATION ASSISTEE; DUREE DE SEJOUR

Background and objective: Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistant Enterococcus (VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptible Enterococcus (VSE) BSI in this population. Methods: A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.Results: We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]). Conclusion: Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

NosoBase n° 28661Bactériémies à Enterobacter cloacae producteur de bêta-lactamase à spectre élargi : rôle du traitement par des carbapénèmes

Lee CC; Lee NY; Yan JJ; Lee HC; Chen PL; Chang CM; et al. Bacteremia due to extended-spectrum-beta-lactamase-producing Enterobacter cloacae: role of carbapenem therapy. Antimicrobial agents and chemotherapy 2010/09; 54(9): 3551-3556.

Mots-clés : BACTERIEMIE; ENTEROBACTER CLOACAE; BETA-LACTAMASE A SPECTRE ELARGI; CARBAPENEME; TRAITEMENT; CEFOTAXIME; SOIN INTENSIF; DUREE DE SEJOUR; MORTALITE; ETUDE RETROSPECTIVE

Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum beta-lactamase (ESBL)-producing E. cloacae infections have been published. During an 8-year period in a medical center, of 610 E. cloacae bacteremic isolates, 138 (22.6%) with ESBL genes were designated the ESBL group, and 120 (19.6%) cefotaxime-nonsusceptible isolates without the ESBL phenotype and genes were designated the control group. Of the former group of isolates, 133 (96.3%) carried the bla(SHV-12) gene, 3 (2.1%) had bla(CTX-M3), and 2 (1.4%) had both the bla(SHV-12) and bla(CTX-M3) genes. After patients under the age of 18 years were excluded, there were 206 adults with E. cloacae bacteremia, and these consisted of 121 patients in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial bacteremia, increased severity of illness, more cases of bacteremia onset in intensive care units (ICUs), and longer stays in the hospital and ICU after bacteremia onset were noted in the ESBL group. However, the crude and sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related mortality rate of patients definitively treated by a carbapenem was lower than that of those treated by noncarbapenem beta-lactams (5/53, or 9.4%, versus 13/44, or 29.5%; P = 0.01) though the difference was not significant in the hierarchical multivariate analysis (P = 0.46). Among 62 patients with follow-up blood cultures within 14 days of bacteremia onset, breakthrough bacteremia was more common in those treated by a noncarbapenem beta-lactam agent than in those treated by a carbapenem (18/31, or 58.0%, versus 3/31, or 9.6%; P < 0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae that cause bacteremia may provide therapeutic benefits.

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NosoBase n° 28301Conséquences cliniques des bactériémies à Acinetobacter baumannii résistant aux carbapénèmes : étude d’une épidémie à double profil monoclonal

Munoz-Price LS; Zembower T; Penugonda S; Schreckenberger P; Lavin MA; Welbel S; et al. Clinical outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections: study of a 2-statemonoclonal outbreak. Infection control and hospital epidemiology 2010/10; 31(10): 1057-1062.

Mots-clés : ACINETOBACTER BAUMANNII; BACTERIEMIE; AUDIT; CARBAPENEME; ANTIBIORESISTANCE; EPIDEMIE; CENTRE HOSPITALIER UNIVERSITAIRE; ETUDE RETROSPECTIVE; FACTEUR DE RISQUE; SOIN INTENSIF; HEMOCULTURE; BIOLOGIE MOLECULAIRE

Objective: To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak. Design: Multicenter observational study. Setting: Four tertiary care hospitals and 1 long-term acute care hospital. Methods: A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii. Results: We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality. Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36-86 days). Conclusions: To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.

NosoBase n° 28839Du linge hospitalier contaminé responsable d'une épidémie de bactériémies à Bacillus cereus

Sasahara T; Hayashi S; Morisawa Y; Sakihama T; Yoshimura A; Hirai Y. Bacillus cereus bacteremia outbreak due to contaminated hospital linens. European journal of clinical microbiology and infectious disease 2010; in press: 8 pages.

Mots-clés : BACILLUS CEREUS; BACTERIEMIE; EPIDEMIE; LINGE; CONTAMINATION; CENTRE HOSPITALIER UNIVERSITAIRE; CONTROLE; CATHETER; ETUDE RETROSPECTIVE; ENQUETE We describe an outbreak of Bacillus cereus bacteremia that occurred at Jichi Medical University Hospital in 2006. This study aimed to identify the source of this outbreak and to implement appropriate control measures. We reviewed the charts of patients with blood cultures positive for B. cereus, and investigated B. cereus contamination within the hospital environment. Genetic relationships among B. cereus isolates were analyzed. Eleven patients developed B. cereus bacteremia between January and August 2006. The hospital linens and the washing machine were highly contaminated with B. cereus, which was also isolated from the intravenous fluid. All of the contaminated linens were autoclaved, the washing machine was cleaned with a detergent, and hand hygiene was promoted among the hospital staff. The number of patients per month that developed new B. cereus bacteremia rapidly decreased after implementing these measures. The source of this outbreak was B. cereus contamination of hospital linens, and B. cereus was transmitted from the linens to patients via catheter infection. Our findings demonstrated that bacterial contamination of hospital linens can cause nosocomial bacteremia. Thus, blood cultures that are positive for B. cereus should not be regarded as false positives in the clinical setting.

NosoBase n° 28641

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Tendances parmi des pathogènes rapportés comme responsables de bactériémies en Angleterre, 2004-2008

Wilson J; Elgohari S; Livermore DM; Cookson B; Johnson A; Lamagni T. Trends among pathogens reported as causing bacteraemia in England, 2004-2008. Clinical microbiology and infection 2010; in press: 8 pages.

Mots-clés : BACTERIEMIE; MICROBIOLOGIE; ESCHERICHIA COLI; STAPHYLOCOQUE A COAGULASE NEGATIVE; STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS

The Health Protection Agency in England operates a voluntary surveillance system that collects data on bacteraemias reported by over 90% of laboratories in England. Trends in causative microorganisms reported between 2004 and 2008 were analyzed using a generalized linear model with a log link function for Poisson distribution. In 2008, 101 276 episodes of bacteraemia were reported; a rate of 189 per 100 000 population. More than one-half occurred in those aged over 65 years and males. The most common organisms reported were Escherichia coli (23%), coagulase-negative staphylococci (CNS) (16.9%) and Staphylococcus aureus (11.4%). Between 2004 and 2008, E. coli bacteraemia increased by 33% (p <0.001); the species now accounts for more than 30% of bacteraemia in those aged over 75 years. There also were significant increases in bacteraemia caused by other Gram-negative pathogens and marked seasonal variation. Bacteraemia caused by S. aureus increased until 2005, with a decline after 2006 (p <0.001) entirely due to methicillin-resistant strains. CNS bacteraemia have declined significantly since 2007. The renewed dominance of Gram-negative pathogens as major causes of bacteraemia in England is of particular concern because they are associated with a high morbidity and increasing resistance to antibiotics. Further investigation of the underlying causes and prevention strategies is a public health priority. Recent declines in methicillin-resistant S. aureus bacteraemia have not been reflected in other pathogens, including methicillin-susceptible S. aureus.

NosoBase n° 28300Facteurs de risque de bactériémies liées aux cathéters centraux dans des unités de réanimation pédiatrique

Wylie MC; Graham DA; Potter-Bynoe G; Kleinman ME; Randolph AG; Costello JM; et al. Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infection control and hospital epidemiology 2010/10; 31(10): 1049-1056.

Mots-clés : FACTEUR DE RISQUE; SOIN INTENSIF; PEDIATRIE; CATHETER VEINEUX CENTRAL;BACTERIEMIE; CAS TEMOIN; ETUDE PROSPECTIVE; CHIRURGIE; CHIRURGIE CARDIO-VASCULAIRE; ALIMENTATION PARENTERALE; TRANSFUSION

Objective: We sought to identify risk factors for central line-associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.Design: Case-control study of children admitted to the medical-surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007. Setting: Children's Hospital Boston is a freestanding, 396-bed quaternary care pediatric hospital with a 29-bed medical-surgical ICU and a 24-bed cardiac ICU. Patients: Case patients were patients with CLABSI who were identified by means of prospective surveillance. Control subjects were patients with a central venous catheter who were matched by ICU admission date. Methods: Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI and to derive and to validate a prediction rule. Results: Two hundred three case patients were matched with 406 control subjects. Independent predictors of CLABSI included duration of ICU central access (odds ratio [OR] for 15 or more days, 18.41 [95% confidence interval {CI}, 4.10-82.56]; [Formula: see text]), central venous catheter placement in the ICU (OR for 2 or more ICU-placed catheters, 8.63 [95% CI, 2.63-28.38]; [Formula: see text]), nonoperative cardiovascular disease (OR, 7.44 [95% CI, 2.13-25.98]; [Formula: see text]), presence of gastrostomy tube (OR, 3.48 [95% CI, 1.55-7.79]; [Formula: see text]), receipt of parenteral nutrition (OR, 3.12 [95% CI, 1.55-6.32]; [Formula: see text]), and receipt of blood transfusion (OR, 2.55 [95% CI, 1.21-5.36]; [Formula: see text]). By use of risk factors known before central venous catheter placement, our model predicted CLABSI with a positive predictive value of 54% and a negative predictive value of 79%. Conclusions: Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter.

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Chirurgie

NosoBase n° 28809Gestion des risques au bloc opératoire

Hind A; El Ouam A; Chefchaouni M. Gestions hospitalières 2010/09; (49): 440-443.

Mots-clés : BLOC OPERATOIRE; GESTION DES RISQUES; ANALYSE DES RISQUES; PERSONNEL

Le bloc opératoire est une structure critique pour toute institution vouée aux soins chirurgicaux : c'est un lieu dans lequel s'exerce une activité humaine intense, lourde de responsabilité et où le risque est omniprésent. Face à ce système, a été élaboré au centre hospitalier d'Ibn Sina, à Rabat, un outil de travail coopératif et pratique qui permet la maîtrise des différents risques liés au processus opératoire dans le but de les rendre acceptables par tous.

NosoBase n° 28731Infections invasives à streptocoques du groupe B dans une unité d'orthopédie

Jenkins PJ; Clement ND; Gaston P; Breusch S; Simpson H; Dave J. Invasive group B streptococcal disease in an orthopaedic unit. The Journal of hospital infection 2010/11; 76(3): 231-233.

Mots-clés : STREPTOCOCCUS GROUPE B; EPIDEMIOLOGIE; INCIDENCE; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; MACROLIDE; ANTIBIORESISTANCE; CHIRURGIE ORTHOPEDIQUE

Invasive group B Streptococcus (GBS) is an increasing cause of infection in orthopaedic patients. Risk factors include increasing age, diabetes mellitus and immune deficiency. It may cause native and periprosthetic joint sepsis, cellulitis, fasciitis, soft tissue abscesses and osteomyelitis. We describe the epidemiology and outcome from GBS infection in a large cohort of general orthopaedic patients. All those presenting to our institution with deep tissue or aspirate samples containing group B streptococcus over three years were identified and their case records examined retrospectively. There were 17 cases, giving an annual incidence of 0.69 per 100000 adult population. They comprised 0.12% of all emergency admissions. Eight were related to joint prostheses, giving an incidence of 0.15% following joint replacement. Other infections related to underlying metalwork, osteomyelitis or chronic soft tissue infection. All the isolates were susceptible to benzylpenicillin, but six demonstrated intermediate resistance to macrolides. Sixteen patients required surgical debridement, and two ultimately required amputations. This study should raise awareness of GBS as a potential infectious agent in soft tissue and joint infections in patients with specific risk factors.

NosoBase n° 28733Etude d'une table à instruments à flux laminaire horizontal pour disposer d'un espace ultrapropre supplémentaire en chirurgie

Nilsson KG; Lundholm R; Friberg S. Assessment of horizontal laminar air flow instrument table for additional ultraclean space during surgery. The Journal of hospital infection 2010/11; 76(3): 243-246.

Mots-clés : CHIRURGIE; AIR; FILTRATION; FLUX LAMINAIRE; BLOC OPERATOIRE

The area in a vertical ultraclean laminar air flow (LAF) theatre is usually too small to accommodate all the equipment needed for major surgery. We investigated the addition of an instrument table supplied with fixed ultraclean LAF and placed alongside the existing main LAF unit, to determine its physical and bacteriological effect on the main unit. In phase 1, with two investigators but without a patient, smoke tests showed no intrusion of air from the table into the main unit and particle counts did not show any adverse effect on the main LAF unit. In phase 2, during patients undergoing two total knee replacements, the LAF table and a table without LAF were placed alongside the main LAF unit. The tables were subjected to the activity of an extra operating room (OR) nurse working from inside the main LAF vigorously simulating handling of instruments. During this activity, the >5µm particle counts were 275/m(3) at the instrument table with LAF and 8550/m(3) at the table without LAF (P<0.0001). Also, without the OR nurse activity, the particle counts, just inside the main unit and adjacent to the LAF table, were significantly reduced (P<0.03-0.003). Sedimentation plates on the LAF table and in the main unit registered 22 and 25cfu/m(2)/h respectively

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compared with 45cfu/m(2)/h at the instrument table without LAF. In conclusion, the results from the smoke tests, particle counts and bacteriological evaluation showed that the additional instrument table supplied with LAF is efficient and can be safely used as an extension additional to a main OR LAF unit.

NosoBase n° 28765Spondylodiscite postopératoire à Propionibacterium acnes

Pers YM; Chekroun J; Lukas C; Combe B; Morel J. La Presse médicale 2010/09; (9): 988-990.

Mots-clés : SITE OPERATOIRE; DISQUE INTERVERTEBRAL Propionibacterium acnes (P. acnes) est un bacille Gram positif, anaérobie, commensal de la peau, des muqueuses et de leurs annexes qui contaminent fréquemment les hémocultures. Il peut cependant exceptionnellement être responsable d'infections systémiques telles que des abcès cérébraux, des endocardites, des infections oculaires et ostéo-articulaires. Nous rapportons un cas de spondylodiscite infectieuse due à P. acnes survenue tardivement après une intervention chirurgicale pour une hernie discale.

NosoBase n° 28770Infections associées à des stimulateurs cardiaques (pace-maker) permanents et à des défibrillateursimplantables (ICD) : 10 ans d'étude régionale au Danemark

Smit J; Korup E; Schonheyder S. Infections associated with permanent pacemakers and implanted cardioverter-defibrillator devices. A 10-year regional study in Denmark. Scandinavian journal of infectious diseases 2010/09; 42(9): 658-664.

Mots-clés : STIMULATEUR CARDIAQUE; CHIRURGIE CARDIO-VASCULAIRE; ENDOCARDE; ETUDE RETROSPECTIVE; SYNDROME SEPTIQUE; BACTERIEMIE; STAPHYLOCOCCUS; MORTALITE

Endocarditis and localized pocket infections are recognized as serious adverse events in patients with implanted cardiac impulse generators. We have undertaken a 10-y retrospective study in North Denmark Region (population 0.5 million) in order to elucidate the clinical spectrum, causative microorganisms, management and outcome. Infections associated with permanent pacemakers (PPM) and implanted cardioverter-defibrillator (ICD) devices were identified by searching hospital databases. Ninety-one incident cases were recorded in 1999 through 2008: 26 patients had endocarditis, 39 patients had a localized pocket infection, and 9 patients developed surgical sepsis with or without local signs immediately after implantation or reoperation; the device was the likely but unconfirmed focus of infection in 17 patients with bacteraemia. Staphylococcus aureus, coagulase-negative staphylococci and other Gram-positive bacteria were the predominant causative agents; only 6 cases were culture-negative. Management included device and lead extraction and individualized antibiotic therapy. The all-cause 30-day case-fatality was 11%. Only 3 recurrences were recorded during 2 y of follow-up. In conclusion, infections associated with permanent impulse generators have a broader clinical spectrum than often reported in the literature. Most cases are culture-positive with staphylococcal predominance. The short-term mortality is notably high, but the risk of recurrence is low.

NosoBase n° 28684Complications et mortalité chez des patients de chirurgie âgés en Australie et en Nouvelle-Zélande (étude REASON) : étude d'observation prospective multicentrique

Story DA; Leslie K; Myles PS; Fink M; Poustie SJ; Forbes A; et al. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia 2010/10; 65(10): 1022-1030.

Mots-clés : CHIRURGIE; PERSONNE AGEE; MORTALITE; SITE OPERATOIRE; SOIN INTENSIF; ETUDE PROSPECTIVE; AGE

We conducted a prospective study of non-cardiac surgical patients aged 70 years or more in 23 hospitals in Australia and New Zealand. We studied 4158 consecutive patients of whom 2845 (68%) had pre-existing

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comorbidities. By day 30, 216 (5%) patients had died, and 835 (20%) suffered complications; 390 (9.4%) patients were admitted to the Intensive Care Unit. Pre-operative factors associated with mortality included: increasing age (80-89 years: OR 2.1 (95% CI 1.6-2.8), p < 0.001; 90+ years: OR 4.0 (95% CI 2.6-6.2), p < 0.001); worsening ASA physical status (ASA 3: OR 3.1 (95% CI 1.8-5.5), p < 0.001; ASA 4: OR 12.4 (95% CI 6.9-22.2), p < 0.001); a pre-operative plasma albumin < 30 g.l(-1) (OR: 2.5 (95% CI 1.8-3.5), p < 0.001); and non-scheduled surgery (OR 1.8 (95% CI 1.3-2.5), p < 0.001). Complications associated with mortality included: acute renal impairment (OR 3.3 (95% CI 2.1-5.0), p < 0.001); unplanned Intensive Care Unit admission (OR 3.1 (95% CI 1.9-4.9), p < 0.001); and systemic inflammation (OR 2.5 (95% CI 1.7-3.7), p < 0.001). Patient factors often had a stronger association with mortality than the type of surgery. Strategies are needed to reduce complications and mortality in older surgical patients.

Clostridium difficile

NosoBase n° 28297Etude multicentrique des taux d'infections à Clostridium difficile de 2000 à 2006

Dubberke ER; Butler AM; Yokoe DS; Mayer J; Hota B; Mangino JE. Multicenter study of Clostridium difficile infection rates from 2000 to 2006. Infection control and hospital epidemiology 2010/10; 31(10): 1030-1037.

Mots-clés : CLOSTRIDIUM DIFFICILE; TAUX; INCIDENCE; ENQUETE; DEFINITION; SURVEILLANCE;INFECTION COMMUNAUTAIRE

Objective: To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure. Methods: Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the chi(2) test for trend and the chi(2) summary test. Results: During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; [Formula: see text]); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; [Formula: see text]); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; [Formula: see text]). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs. Conclusions: The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.

Désinfection

NosoBase n° 28725La résistance ou l'adaptation microbienne aux biocides crée-t-elle un risque dans la prévention et le contrôle du risque infectieux ?

Meyer B; Cookson B. Does microbial resistance or adaptation to biocides create a hazard in infection prevention and control? The Journal of hospital infection 2010/11; 76(3): 200-205.

Mots-clés : PREVENTION; BIOCIDE; ANTIBIORESISTANCE; CONTROLE; RISQUE; DESINFECTION; SURFACE; BIBLIOGRAPHIE

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Increased numbers of healthcare-acquired infections, including those caused by antibiotic-resistant microbes, have created a need for improved infection control use of disinfection regimens. Commensurate with this has been an increasing number of reports on resistance to a wide variety of antimicrobials, including biocides. Cross-resistance between these biocides and other biocidal or antimicrobial agents has been well-documented. Much of the literature lacks clear distinctions between adaptation of organisms to exposure to biocides, which reverses upon removal of the biocide, as opposed to resistance. Depending on the genetic basis of this resistance, it may be high level and not readily reversible. This lack of clear definitions complicates the evaluation of the relevance of these phenomena in practice. In this review we propose definitions of adaptative processes and biocide resistance and survey the literature according to these definitions. We conclude that the current risks to healthcare delivery caused by resistance related to biocides are low, provided that biocides are used under appropriate conditions. The need for further research is addressed.

Dispositif médical

NosoBase n° 28764L'argent dans les dispositifs médicaux : marketing ou réel intérêt clinique ?

Fontenoy C; Sellal KO. Silver in medical devices: marketing or real clinical impact? Le Pharmacien hospitalier 2010/09; 45(3): 131-141.

Mots-clés : DISPOSITIF MEDICAL; SOIN DE PLAIE CUTANEE; HISTORIQUE; INCIDENCE; TOXICITE; CATHETER VEINEUX CENTRAL; VALVE ARTIFICIELLE; SONDAGE URINAIRE; PANSEMENT; LINGE;EFFICACITE; BIBLIOGRAPHIE

Objectif : Ce travail a pour objectif de faire une synthèse des données concernant l’usage au cours du temps de l’argent dans les dispositifs médicaux et de discuter du niveau de validation méthodologique de son intérêt clinique en tant qu’adjuvant dans les dispositifs médicaux en insistant sur son usage plus récent et dans son application dans le domaine des plaies et de leur cicatrisation.Méthode : Nous avons effectué une revue de la littérature et avons utilisé les fiches techniques des sociétés commercialisant ces dispositifs. Les études randomisées et contrôlées, multicentriques ou les avis d’experts ont été essentiellement retenus, sauf concernant les dispositifs médicaux hors pansements, ou la discussion sur les notions très récentes de propriétés procicatrisantes ou anti-inflammatoires de l’argent.Résultats et discussion : Les résultats varient d’un dispositif à l’autre avec cependant, pour chaque dispositif, des différences significatives concernant la colonisation bactérienne. Concernant le soin des plaies, seul un petit nombre d’études montre des différences significatives d’efficience entre les pansements ou topiques contenant de l’argent et les contrôles utilisés. Ces travaux de recherche ont également révélé une nouvelle piste pouvant expliquer les propriétés procicatrisantes et anti-inflammatoires des nanoparticules d’argent.

NosoBase n° 28768Indicateurs d'efficience et de sécurité pour la traçabilité des dispositifs médicaux implantables

Mockly-Postal H; Jehl-Rave M; Choulet MH; Grumblat A; Limat S. Valuable indicators for traceability of implantable medical devices. Le Pharmacien hospitalier 2010/09; 45(3): 108-116.

Mots-clés : TRACABILITE; DISPOSITIF MEDICAL; INDICATEUR; MATERIEL ETRANGER; COUT; LEGISLATION; MATERIOVIGILANCE; STERILISATION

Objectif : Ce travail a pour objectif de faire un état des lieux qualitatif et quantitatif et d’étudier l’intérêt d’un suivi régulier de trois séries d’implants : série 1 - implants « déstérilisés » ou échec de pose (ID), série 2 - implants déstérilisés ou échec de pose relevant d’un incident de « matériovigilance » (IM) et série 3 - implants « non tracés » (INT).Méthodologie : Extraction sur 2007 des trois séries à partir des bases de données de traçabilité ; classement et valorisation selon les classes d’implants, les pôles d’activité et le type de prise en charge (en sus ou compris dans les groupes homogènes de séjour [GHS]).Résultats : En 2007, 10 087 implants stériles ont été tracés pour une valeur de 4 394 608 toutes taxes comprises (TTC). Un tiers est facturable en sus des GHS. La proportion des séries 1, 2 et 3 est, respectivement, de 3,2% avec 318 ID, 0,1% avec 13 IM et 1% avec 105 INT. La valeur TTC de chacune des séries est, respectivement, de 108 956 euros, 11 219 euros et 28 613 euros. Pour les séries 1 et 3, 80%

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sont potentiellement facturables en sus des GHS. Les histogrammes cumulés par classe d’implants montrent, dans les séries 1 et 3, les classes d’implants à suivre.Discussion et conclusion : Le taux de ID et INT peut être un indicateur de suivi annuel des dépenses liées aux implants et de mise en évidence des dérives liées aux pratiques. La réduction de ces pertes nécessiterait une analyse plus fine par spécialité pour évaluer la part évitable.

EHPAD

NosoBase n° 28728Histoire naturelle d'une colonisation par SARM parmi des résidents d'établissements communautaires de séjours de longue durée (EHPAD) en Espagne

Manzur A; Dominguez MA; Ruiz de Gopegui E; Mariscal D; Gavalda L; Segura F; et al. Natural history of meticillin-resistant Staphylococcus aureus colonisation among residents in community long term care facilities in Spain. The Journal of hospital infection 2010/11; 76(3): 215-219 .

Mots-clés : COLONISATION; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PERSONNE AGEE; EHPAD; GERIATRIE; COHORTE; INCIDENCE; BIOLOGIE MOLECULAIRE; ANTIBIOTIQUE;EPIDEMIOLOGIE; FACTEUR DE RISQUE

The spread of meticillin-resistant Staphylococcus aureus (MRSA) is a major problem for both acute care hospitals and among residents in long term care facilities (LTCFs). We performed a cohort study to assess the natural history of MRSA colonisation in LTCF residents. Two cohorts of residents (231 MRSA carriers and 196 non-carriers) were followed up for an 18 month period, with cultures of nasal and decubitus ulcers performed every six months. In the MRSA carrier cohort, 110 (47.8%) residents had persistent MRSA colonisation for six months or longer, 44 (19.0%) had transient colonisation and nine (3.9%) were intermittently colonised. No risk factors for persistent MRSA colonisation could be determined. The annual incidence of MRSA acquisition was around 20% [95% confidence interval (CI): 14.3-25.5]. Antibiotic treatment was independently associated with MRSA acquisition (odds ratio: 2.27; 95% CI: 1.05-4.88; P=0.03). Just two clones were distinguishable by pulsed-field gel electrophoresis and multilocus sequence typing: CC5-MRSA IV, which is widely disseminated in Spanish hospitals, and ST22-MRSA IV. This study adds to the knowledge of the epidemiology of MRSA in community LTCFs, which are important components of long term care in Spain.

Environnement

NosoBase n° 28734Décontamination environnementale d'une chambre d'isolement à l'aide d'une lumière à haute intensité et à spectre étroit

Maclean M; Macgregor SJ; Anderson JG; Woolsey GA; Coia JE; Hamilton K; et al. Environmental decontamination of a hospital isolation room using high-intensity narrow-spectrum light. The Journal of hospital infection 2010/11; 76(3): 247-251.

Mots-clés : ENVIRONNEMENT; DESINFECTION; PREVENTION; CHAMBRE; ISOLEMENT PROTECTEUR; BRULE; EFFICACITE; STAPHYLOCOCCUS AUREUS

The performance of a new decontamination technology, referred to as 'high-intensity narrow-spectrum light environmental decontamination system' (HINS-light EDS) was evaluated by a series of three studies carried out in a hospital isolation room used to treat burns patients. The ceiling-mounted HINS-light EDS emits high-intensity 405nm light which, although bactericidal, is harmless to patients and staff thereby permitting continuous environmental disinfection throughout the day. Performance efficacy was assessed by contact agar plate sampling and enumeration of staphylococcal bacteria on environmental surfaces within the room before, during and after HINS-light EDS treatment. When the room was unoccupied, use of HINS-light EDS resulted in ~90% reduction of surface bacterial levels and when the room was occupied by an MRSA-infected burns patient, reductions between 56% and 86% were achieved, with the highest reduction (86%) measured following an extended period of HINS-light EDS operation. In an on/off intervention study, surface bacterial levels were reduced by 62% by HINS-light EDS treatment and returned to normal contamination levels two days after the system was switched off. These reductions of staphylococci, including Staphylococcus aureus and meticillin-resistant S. aureus, by HINS-light EDS treatment were greater than

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the reductions achieved by normal infection control and cleaning activities alone. The findings provide strong evidence that HINS-light EDS, used as a supplementary procedure, can make a significant contribution to bacterial decontamination in clinical environments.

NosoBase n° 28296Désinfection des chambres par rayons UV

Rutala WA; Gergen MF; Weber DJ. Room decontamination with UV radiation. Infection control and hospital epidemiology 2010/10; 31(10): 1025-1029.

Mots-clés : CLOSTRIDIUM DIFFICILE; ENTEROCOCCUS; ANTIBIORESISTANCE; VANCOMYCINE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ACINETOBACTER BAUMANNII; ULTRA-VIOLET; CHAMBRE; SURFACE; DECONTAMINATION; DESINFECTION; EQUIPEMENT

Objective: To determine the effectiveness of a UV-C-emitting device to eliminate clinically important nosocomial pathogens in a contaminated hospital room. Methods: This study was carried out in a standard but empty hospital room (phase 1) and in a room previously occupied by a patient with methicillin-resistant staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) infection (phase 2) in an acute care tertiary hospital in North Carolina from January 21 through September 21, 2009. During phase 1, [Formula: see text] cm Formica sheets contaminated with approximately 10(4)-10(5) organisms of MRSA, VRE, multidrug-resistant (MDR) Acinetobacter baumannii, or Clostridium difficile spores were placed in a hospital room, both in direct line of sight of the UV-C device and behind objects. After timed exposure, the presence of the microbes was assessed. During phase 2, specific sites in rooms that had housed patients with MRSA or VRE infection were sampled before and after UV-C irradiation. After timed exposure, the presence of MRSA and VRE and total colony counts were assessed. Results: In our test room, the effectiveness of UV-C radiation in reducing the counts of vegetative bacteria on surfaces was more than 99.9% within 15 minutes, and the reduction in C. difficile spores was 99.8% within 50 minutes. In rooms occupied by patients with MRSA, UV-C irradiation of approximately 15 minutes duration resulted in a decrease in total CFUs per plate (mean, 384 CFUs vs 19 CFUs; [Formula: see text]), in the number of samples positive for MRSA (81 [20.3%] of 400 plates vs 2 [0.5%] of 400 plates; [Formula: see text]), and in MRSA counts per MRSA-positive plate (mean, 37 CFUs vs 2 CFUs; [Formula: see text]). Conclusions: This UV-C device was effective in eliminating vegetative bacteria on contaminated surfaces both in the line of sight and behind objects within approximately 15 minutes and in eliminating C. difficile spores within 50 minutes.

NosoBase n° 28810La gestion des déchets d'activité de soins à risque infectieux

Saafadi L; Mouhir L; Belkadi S; Harif M; Lafrikh H; Makhloufi S; et al. Gestions hospitalières 2010/09; 498: 436-439.

Mots-clés : DECHET D'ACTIVITE DE SOINS A RISQUE INFECTIEUX; TRI; COLLECTE; LABORATOIRE; CIRCUIT

A l'instar des pays en voie de développement, la production de déchets de soins à risque infectieux (DASRI) a augmenté au Maroc de manière significative et il a fallu oeuvrer pour faire ressortir un cadre réglementaire régularisant leur génération. Les auteurs dressent un état des lieux de la gestion des Dasri au niveau du centre hospitalier universitaire Mohammed VI de Marrakech ; une étude exploratoire de la production quantitative et qualitative des déchets est envisageable via une méthodologie basée sur des campagnes de pesage et un suivi du circuit de gestion, de la production à l'élimination. Par ailleurs, le corps administratif du CHU a préconisé des mesures de tri et de conditionnement respectant les normes nationales.

Grippe

NosoBase n° 28292Réduction de la transmission de la grippe saisonnière chez le personnel soignant dans une unité de soins intensifs : une étude d'intervention de 4 ans en Thaïlande

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Apisarnthanarak A; Uyeki TM; Puthavathana P; Kitphati R; Mundy LM. Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand.Infection control and hospital epidemiology 2010/10; 31(10): 996-1003.

Mots-clés : SOIN INTENSIF; TRANSMISSION; PERSONNEL; GRIPPE; AIR; PNEUMONIE; ANTIVIRAL; COUT

Objective: To evaluate the feasibility and effectiveness of an influenza control bundle to minimize healthcare-associated seasonal influenza transmission among healthcare workers (HCWs) in an intensive care unit (ICU) equipped with central air conditioning. Methods: A quasi-experimental study was conducted in a 500-bed tertiary care center in Thailand from July 1, 2005, through June 30, 2009. The medical ICU (MICU) implemented an influenza control bundle including healthcare worker (HCW) education, influenza screening of adult community-acquired pneumonia patients, antiviral treatment of patients and ill HCWs who tested positive for influenza, promotion of influenza vaccination among HCWs, and reinforcement of standard infection control policies. The surgical ICU (SICU) and coronary care unit (CCU) received no intervention. Results: The numbers of influenza infections among HCWs during the pre- and postintervention periods were 18 cases in 5,294 HCW-days and 0 cases in 5,336 HCW-days in the MICU (3.4 vs 0 cases per 1,000 HCW-days; [Formula: see text]), 19 cases in 4,318 HCW-days and 20 cases in 4,348 HCW-days in the SICU (4.4 vs 4.6 cases per 1,000 HCW-days; [Formula: see text]), and 18 cases in 5,000 HCW-days and 18 cases in 5,143 HCW-days in the CCU (3.6 vs 3.5 cases per 1,000 HCW-days; [Formula: see text]), respectively. Outbreak-related influenza occurred in 7 MICU HCWs, 6 SICU HCWs, and 4 CCU HCWs before intervention and 0 MICU HCWs, 9 SICU HCWs, and 8 CCU HCWs after intervention. Before and after intervention, 25 (71%) and 35 (100%) of 35 MICU HCWs were vaccinated, respectively ([Formula: see text]); HCW vaccination coverage did not change significantly in the SICU (21 [70%] of 30 vs 24 [80%] of 30; [Formula: see text]) and CCU (19 [68%] of 28 vs 21 [75%] of 28; [Formula: see text]). The estimated costs of US $6,471 per unit for postintervention outbreak investigations exceeded the intervention costs of US $4,969. Conclusion: A sustained influenza intervention bundle was associated with clinical and economic benefits to a Thai hospital.

NosoBase n° 28679Insuffisance de couverture vaccinale grippale A(H1N1) 2009 en population générale et dans les groupes à risque durant la pandémie 2009-2010 en France

Guthmann JP; Nicolau J; Bone A; Levy-Bruhl D. Insufficient influenza A(H1N1)2009 vaccination coverage inthe global population and high risk groups during the 2009-2010 pandemic in France. BEH Web 2010/09/16;(3): 1-6.

Mots-clés : GRIPPE; VACCIN; VIRUS INFLUENZA TYPE A; SURVEILLANCE; SANTE PUBLIQUE

La campagne de vaccination contre la grippe A(H1N1) 2009 a débuté en France le 20 octobre 2009. Une invitation de vaccination gratuite dans un centre dédié a été envoyée par la Caisse nationale d’assurance maladie à tous les assurés sociaux en commençant par les groupes prioritaires. Les données individuelles ont été saisies dans une base de données centralisée contenant 64,9 millions d’enregistrements. Les auteurs ont estimé la couverture vaccinale globale et dans des groupes à risque spécifiques. Celle-ci a été définie comme le nombre de personnes ayant reçu au moins une dose de vaccin pandémique dans un groupe donné sur l’ensemble de la population invitée à se faire vacciner dans le même groupe. La couverture globale était de 7,9%. Elle variait avec l’âge : elle était la plus élevée chez les enfants de 6-23 mois (20,7%), diminuait ensuite pour atteindre 3,1% chez les personnes âgées de 18-24 ans, augmentait pour se situer entre 5 et 8% chez les adultes plus âgés et était de 7,6% chez les personnes âgées de 65 ans ou plus. Les femmes jeunes (25-44 ans) étaient mieux vaccinées que les hommes jeunes (8,2% versus 5,9%, p<0,001), alors que les hommes étaient mieux vaccinés que les femmes après 45 ans (8,2% versus 6,0%, p<0,001). Les estimations de couverture dans les 22 régions de France métropolitaine variaient de 6,1% (Languedoc-Roussillon) à 12% (Bretagne) (médiane=8,2%). La couverture chez les femmes enceintes était de 22,7%. Ces faibles couvertures vaccinales confirment que la population française a été peu réceptive aux messages délivrés par les autorités sanitaires, et reflètent probablement les controverses concernant le vaccin A(H1N1) 2009 et l’organisation de la campagne vaccinale, ainsi que la faible perception du risque lié à la grippe pandémique par la population. Ces résultats sont importants pour préparer les mesures à prendre en prévision de la nouvelle saison grippale et pour les futures pandémies.

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NosoBase n° 28668Recul spectaculaire de la mortalité dûe à la grippe. Le rôle de la vaccination

Mesle F; INED; Institut national d'études démographiques. Population & Sociétés 2010/09; (470): 4 pages.

Mots-clés : GRIPPE; MORTALITE; VACCIN; AGE; EPIDEMIE

Jusque dans les années 1970, une épidémie de grippe faisait directement de 10000 à 20000 morts, auxquels il faut ajouter les décès dus aux complications de la maladie. La mise au point d'un vaccin efficace, constamment remanié en fonction des mutations du virus, a permis de diviser la mortalité par dix en France comme dans les autres pays industriels en 40 ans. Ce succès a été renforcé par la diffusion gratuite du vaccin auprès des personnes âgées, particulièrement sujettes aux complications létales. Le XXe siècle a connu trois grandes pandémies, liées à des recombinaisons majeures du virus : la grippe espagnole de 1918-1919, la grippe asiatique de 1957-1958 et la grippe de Hong Kong de 1968-1969. Les jeunes enfants et les jeunes adultes en ont particulièrement souffert. C'est aussi le cas de l'épidémie de grippe A(H1N1) de 2009-2010 pour laquelle deux personnes décédées sur trois avaient moins de 65 ans mais, fort heureusement, l'épidémie s'est révélée beaucoup moins grave qu'annoncée (312 décès en France).

NosoBase n° 28294Équipements de protection du visage, personnel soignant et pandémies : impact du virus pandémique (H1N1) 2009 sur le personnel soignant et sur l’utilisation d’équipements de protection du visage

Murray M; Grant J; Bryce E; Chilton P; Forrester L. Facial protective equipment, personnel, and pandemics: impact of the pandemic (H1N1) 2009 virus on personnel and use of facial protective equipment. Infection control and hospital epidemiology 2010/10; 31(10): 1011-1016.

Mots-clé s : GRIPPE; PERSONNEL; CHARGE DE TRAVAIL; MASQUE; DUREE DE SEJOUR; ETUDE PROSPECTIVE

Background: Before the emergence of the pandemic (H1N1) 2009 virus, estimates of the stockpiles of facial protective equipment (FPE) and the impact that information had on personnel during a pandemic varied. Objective: To describe the impact of H1N1 on FPE use and hospital employee absenteeism. Setting: One tertiary care hospital and 2 community hospitals in the Vancouver Coastal Health (VCH) region,Vancouver, Canada. Patients: All persons with influenza-like illness admitted to the 3 VCH facilities during the period from June 28 through December 19, 2009. Methods: Data on patients and on FPE use were recorded prospectively. Data on salaried employee absenteeism were recorded during the period from August 1 through December 19, 2009. Results: During the study period, 865 patients with influenza-like illness were admitted to the 3 VCH facilities. Of these patients, 149 (17.2%) had laboratory-confirmed H1N1 influenza infection. The mean duration of hospital stay for these patients was 8.9 days, and the mean duration of intensive care unit stay was 9.2 days. A total of 134,281 masks and 173,145 N95 respirators (hereafter referred to as respirators) were used during the 24-week epidemic, double the weekly use of both items, compared with the previous influenza season. A ratio of 3 masks to 4 respirators was observed. Use of disposable eyewear doubled. Absenteeism mirrored the community epidemiologic curve, with a 260% increase in sick calls at the epidemic peak, compared with the nadir. Conclusion: Overall, FPE use more than doubled, compared with the previous influenza season, with respirator use exceeding literature estimates. A significant proportion of FPE resources were used while managing suspected cases. Planners should prepare for at least a doubling in mask and respirator use, and a 3.6-fold increase in staff sick calls.

NosoBase n° 28302Résultats d’une enquête nationale auprès des infectiologues, sur le programme de vaccination contre la grippe du personnel soignant

Polgreen PM; Septimus E; Talbot TR; Beekmann SE; Helms C. Results of a national survey of infectious diseases specialists regarding influenza vaccination programs for healthcare workers. Infection control and hospital epidemiology 2010/10; 31(10): 1063-1065.

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A minority of infectious diseases consultants currently work in healthcare institutions requiring influenza vaccination for healthcare workers, and in approximately half of these institutions, the healthcare workers who refuse vaccination do not face substantial consequences for their refusal. Although true mandatory policies are not common, a majority of infectious diseases consultants support such policies.

NosoBase n° 28291Révision des recommandations de la SHEA : vaccination contre la grippe du personnel soignant

Talbot TR; Babcock H; Caplan AL; Cotton D; Maragakis LL; Poland GA; et al. Revised SHEA position paper: influenza vaccination of healthcare personnel. Infection control and hospital epidemiology 2010/10; 31(10): 987-995.

Mots-clés : GRIPPE; VACCIN; PERSONNEL; TAUX; TRANSMISSION; MASQUE; ANTICORPS

NosoBase n° 28816Evolutions cliniques de la grippe saisonnière et de la pandémie de grippe A(H1N1) dans une population d'enfants hospitalisés en pédiatrie

Tamma PD; Turnbull A; Milstone AM; Cosgrove SE; Valsamakis A; Budd A; et al. Clinical outcomes of seasonal influenza and pandemic influenza A (H1N1) in pediatric inpatients. BMC Pediatrics 2010; in press:24 pages.

Mots-clés : EPIDEMIE; GRIPPE; PEDIATRIE; DUREE DE SEJOUR; COHORTE; ETUDE RETROSPECTIVE

Background: In April 2009, a novel influenza A H1N1 (nH1N1) virus emerged and spread rapidly worldwide. News of the pandemic led to a heightened awareness of the consequences of influenza and generally resulted in enhanced infection control practices and strengthened vaccination efforts for both healthcare workers and the general population. Seasonal influenza (SI) illness in the pediatric population has been previously shown to result in significant morbidity, mortality, and substantial hospital resource utilization. Although influenza pandemics have the possibility of resulting in considerable illness, we must not ignore the impact that we can experience annually with SI. Methods: We compared the outcomes of a large cohort of pediatric patients [less than or equal to]18 years of age at a large urban hospital with laboratory confirmed influenza and an influenza-like illness (ILI) during the 2009-2010 pandemic as well as two prior influenza seasons. The primary outcome measure was hospital length of stay (LOS). All variables potentially associated with LOS based on univariate analysis, previous studies, or hypothesized relationships were included in the regression models to ensure adjustment for their effects.Results: There were 133 pediatric cases of SI and 133 cases of nH1N1 admitted during the prior 2 influenza seasons (2007-8 and 2008-9). Thirty-six percent of children with SI and 18% of children with nH1N1 had no preexisting medical conditions (p =0.14). Children admitted with SI had 1.73 times longer adjusted LOS than children admitted for nH1N1 (95% CI 1.35 - 2.13). There was a trend towards more children with SI requiring mechanical ventilation compared with nH1N1 (16 vs.7, p=0.08).Conclusions: This study further strengthens the growing body of evidence demonstrating that SI results in significant morbidity in the pediatric population. Pandemic H1N1 received considerable attention with strong media messages urging people to be vaccinated and encouraging improved infection control efforts. We believe that this attention should become an annual effort for SI. Strong unified messages from health care providers and the media to receive the influenza vaccine will likely prove very useful in averting some of the morbidity of influenza when preparing for influenza epidemics.

NosoBase n° 28304La vaccination contre la grippe de l'entourage des nouveau-nés : une stratégie hospitalière pour augmenter les taux de vaccination

Walter EB; Allred NJ; Swamy GK; Hellkamp AS; Dolor RJ. Influenza vaccination of household contacts of newborns: a hospital-based strategy to increase vaccination rates. Infection control and hospital epidemiology 2010/10; 31(10): 1070-1073.

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Mots-clés : VACCIN; GRIPPE; NOUVEAU-NE; FAMILL; GROSSESS; RECOMMANDATION; OBSERVANCE

We implemented a hospital-based influenza vaccination program for household contacts of newborns. Among mothers not vaccinated prenatally, 44.7% were vaccinated through the program, as were 25.7% of fathers. A hospital-based program provided opportunities for vaccination of household contacts of newborns, thereby facilitating better adherence to national vaccination guidelines.

Hépatite

NosoBase n° 28767En France, la prévention de la transmission verticale de l'hépatite B est à améliorer ! A propos d'une enquête en Picardie

Braillon A; Lerat A; Lansac J; Dubois G. In France, prevention of vertical transmission of hepatitis B virus infection must be improved. A questionnaire survey in Picardie. Journal de gynecologie obstetrique et biologie de la reproduction 2010/10; 39(6): 478-483.

Mots-clés : TRANSMISSION; PREVENTION; HEPATITE B; ENQUETE; GYNECOLOGIE; OBSTETRIQUE; SAGE-FEMME; PREVALENCE; MATERNITE; QUESTIONNAIRE; VACCIN; ANTIGENE; DEPISTAGE; NOUVEAU-NE; ACCOUCHEMENT; PROTOCOLE; RECOMMANDATION; INFORMATION

Introduction : Une enquête a été menée auprès des gynécologues-obstétriciens (GO) et des sages-femmes (SF) des maternités publiques et privées de Picardie en 2008. But : Décrire les pratiques de prévention de la transmission verticale de l’hépatite B au cours de la grossesse et de l’accouchement.Matériel et méthodes : Les questionnaires ont été distribués par les SF cadres de santé. Des protocoles de soins ont été demandés. Résultats : Soixante-seize GO et 210 SF (66 et 79 %, respectivement) ont répondu. Quatre vingt-deux pour cent des GO et 80 % des SF déclarent doser systématiquement l’Ag HBs quand la mère est vaccinée contre l’hépatite B ; 86 % des GO et 91 % des SF dosent en urgence l’Ag HBs quand il est absent à l’accouchement. Huit des neuf protocoles transmis sont non conformes aux recommandations, peu pratiques ; un seul est conforme. Le suivi du nouveau-né (NN) n’apparaît pas organisé. Conclusion : Des actions d’amélioration spécifiques doivent être mises en place au niveau local (formations des équipes, aide à la rédaction de protocole) sur une base pluridisciplinaire/pluri-professionnelle. Une action nationale d’ampleur, de type conférence de consensus, apparaît nécessaire d’autant que pour la simple politique vaccinale la France est là encore dans une situation tristement exceptionnelle.

NosoBase n° 28664Epidémiologie et transmission de l'hépatite G chez des patients dialysés

Fallahian F; Alavian SM; Rasoulinejad M. Epidemiology and transmission of hepatitis G virus infection in dialysis patients. Saudi journal of kidney diseases and transplantation 2010/10; 21(5): 831-834.

Mots-clés : EPIDEMIOLOGIE; TRANSMISSION; HEPATITE G; VIRUS; CENTRE HOSPITALIER UNIVERSITAIRE; HEMODIALYSE; DIALYSE PERITONEALE

Hepatitis G virus (HGV) or GB-virus type C (GBV-C) is distributed globally and is present in the volunteer blood donor population. For epidemiological studies, HGV is of interest in hemodialysis patients who are at risk of parenterally transmitted infections. The role of HGV in producing illness and hepatic disease has yet to be determined. A review of literature was performed in 2009 to summarize scientific reports on epidemiology and pathogenesis of the HGV infection and its exposure through hemodialysis.

NosoBase n° 28766La prévention de la transmission de l'hépatite B au cours de l'accouchement doit être améliorée : analyse de 145 dossiers dans les maternités de Picardie (2006)

Lerat A; Braillon A; Capron D; Tiberghien JP; Dubois G. Prevention of hepatitis B transmission during the delivery in Picardy (2006). La Presse médicale 2010/09; (9): e182-e187.

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Mots-clés : HEPATITE B; TRANSMISSION; ACCOUCHEMENT; MATERNITE; TRACABILITE; IMMUNOGLOBULINE; PREVENTION; ETUDE TRANSVERSALE

Objectif : Aucune publication française n’est disponible pour évaluer la prise en charge des nouveau-nés (NN) de mères porteuses de l’antigène HBs (Ag HBs). Le but de cette étude était d’évaluer la traçabilité et la conformité aux recommandations des injections d’immunoglobulines spécifiques (Igs) aux NN dans les maternités publiques et privées de Picardie en 2006.Méthodes : Les dossiers des mères susceptibles d’être Ag HBs+ ont été cherchés par une requête dans le Programme de Médicalisation des systèmes d’information (PMSI). Les NN ayant reçu des Igs ont été recherchés à partir des registres de pharmacie et/ou des blocs obstétricaux et/ou d’une requête PMSI.Résultats : Dix-neuf des 20 maternités de Picardie ont fourni des données. Nous avons analysé 145 dossiers (65 mères Ag HBs+, 75 Ag HBs -, 5 de statut inconnu) et 81 injections d’Igs tracées et 5 non tracées dans les dossiers. Vingt pour cent des injections d’Igs tracées (16/81) ont été faites hors des indications des recommandations (mère Ag HBs -). Dans 85 % des cas la dose administrée était conforme aux recommandations (100 UI), et dans 79 % des cas l’horaire d’injection était conforme (dans les 12 h après l’accouchement). La traçabilité des Igs (numéro de lot) était présente dans le dossier dans 69 % des cas. Au total, 40 % (32/81) des injections d’Igs tracées ont eu une indication pertinente, une dose et un horaire conformes aux recommandations et un numéro de lot présent dans le dossier. Un courrier de suivi pour la prise en charge de la mère et/ou de l’enfant était noté dans 40 dossiers sur 145.Discussion : La prévention de la transmission verticale de l’hépatite B doit faire l’objet d’actions d’amélioration qui nécessitent une stratégie nationale et une mobilisation pluri-professionnelle avec une mise en oeuvre locale.

Hygiène des mains

NosoBase n° 28759Résumé des recommandations de l'OMS pour l'hygiène des mains au cours des soins. Premier défi mondial pour la sécurité des patients, un soin propre est un soin plus sûr

OMS; Organisation mondiale de la santé 2010; 54 pages.

Mots-clés : HYGIENE DES MAINS; PREVENTION; TRANSMISSION; OBSERVANCE; PERSONNEL; PRATIQUE; GANT; FORMATION; PRODUIT HYDROALCOOLIQUE; TOLERANCE; SECURITE; GESTION DES RISQUES; CLOSTRIDIUM DIFFICILE

Le résumé se présente en trois parties.Partie I : les infections associées aux soins et l'évidence de l'importance de l'hygiène des mains. Les infections associées aux soins (IAS) sont une cause majeure de mortalité et d'invalidité dans le monde et sont présentes dans les pays développés, en développement et parmi le personnel soignant. Le rôle de l'hygiène des mains dans la réduction des IAS et leurs conséquences sont développés dans la transmission des agents pathogènes, l'observance de l'hygiène des mains par le personnel soignant, les stratégies pour l'amélioration de l'observance, l'impact et le coût de la promotion.Partie II : les recommandations consensuelles. Indications et techniques d'hygiène des mains, recommandations pour la préparation en chirurgie, les soins de la peau, la sélection des produits, l'usage des gants, la formation du personnel et les différentes responsabilités. Partie III : mise en oeuvre des recommandations. Stratégies et outils, infrastructures nécessaires, l'utilisation des produits hydro-alcooliques, la tolérance et la sécurité dans leur usage, les produits hydro-alcooliques et Clostridim difficile et autres pathogènes résistants. Des schémas illustrent ces recommandations.

NosoBase n° 28735Etude d'observation de vingt-quatre heures sur l'observance de l'hygiène des mains

Randle J; Arthur A; Vaughan N. Twenty-four-hour observational study of hospital hand hygiene compliance.The Journal of hospital infection 2010/11; 76(3): 252-255.

Mots-clés : HYGIENE DES MAINS; OBSERVANCE; PERSONNEL; USAGER; MEDECINE

This observational study measured healthcare workers' (HCWs'), patients' and visitors' hand hygiene compliance over a 24h period in two hospital wards using the 'five moments of hand hygiene' observation tool. Hand hygiene is considered to be the most effective measure in reducing healthcare-associated infections but studies have reported suboptimal levels of compliance. Most studies have used random

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observational time-periods for data collection and this has been criticised. We monitored a total of 823 hand hygiene opportunities (HCWs, N=659; patients and visitors, N=164). Among HCWs, compliance was 47% for doctors, 75% for nurses, 78% for allied health professionals, and 59% for ancillary and other staff (P<0.001). There was no difference in compliance between patients and visitors (56% vs 57%, P=0.87). Hand hygiene compliance varied depending on which of the five moments of hygiene HCWs had undertaken (P<0.001), with compliance before an aseptic task being 100% (3/3); after body fluid exposure 93% (86/93); after patient contact 80% (114/142); before patient contact 68% (196/290); and after contact with surroundings 50% (65/129). Lower levels of compliance were found for HCWs working during the early shift (P<0.001). For patients and visitors there was no evidence of an association between moments of hygiene and compliance. Levels of compliance were higher compared with previous reported estimates. Medical staff had the lowest level of compliance and this continues to be a concern which warrants specific future interventions.

Pédiatrie

NosoBase n° 28784Surveillance prospective des infections virales nosocomiales durant et après l'hospitalisation dans un centre hospitalier universitaire pédiatrique

Buettcher M; Heininger U. Prospective surveillance of nosocomial viral infections during and after hospitalization at a university children's hospital. The Pediatric infectious disease journal 2010/10; 29(10): 950-956.

Mots-clés : SURVEILLANCE; PEDIATRIE; ETUDE PROSPECTIVE; VIRUS; CENTRE HOSPITALIER UNIVERSITAIRE

Background: In Switzerland 5% to 10% of hospitalized adults acquire nosocomial infections (NI) but few data are available in children. Most former studies on NI in hospitalized children analyzed specific units or pathogens and neglected the postdischarge period. We aimed to prospectively assess viral NI occurring during and shortly after hospitalization in children.Methods: Prospective surveillance was performed during a 24-month period. Electronic standardized questionnaires were completed for each patient by physicians during hospital stay. On a ward-based rotational schedule, follow-up information was obtained from a subset of patients 1 week after hospital discharge. NI were defined using CDC recommendations.Results: Overall, 6250 patients (34,608 patient hospitalization days, PHD) were enrolled and 1272 patients were recruited for postdischarge surveillance. Mean hospitalization duration was 5 days. Fifty-two (0.8%) patients acquired 54 viral NI during hospitalization and 12 patients (1.1%) acquired 12 viral NI after hospital discharge (NI incidence: 1.9 per 1000 PHD including follow-up period). NI rate in infants was higher compared with children >12 months old (2.0% vs. 0.8%; P 0.05) and the infant ward also had the highest incidence (4.0 NI per 1000 PHD). Most NI were gastrointestinal tract infections with 55% caused by rotavirus infection. NI rates were highest between November and March.Conclusions: A significant part of NI will only be detected if surveillance includes the immediate postdischarge period. Given the strong seasonality of pediatric NI, intensifying hygiene measurements particularly on infant wards and prior to the cold season would be beneficial in reducing NI incidence.

NosoBase n° 28796Infections nosocomiales et microorganismes bactériens multirésistant aux antibiotiques dans l'unité de soins intensifs en pédiatrie

Mcgrath EJ; Asmar BI. Nosocomial infections and multidrug-resistant bacterial organisms in the pediatric intensive care unit. Indian journal of pediatrics 2010; in press: 9 pages.

Mots-clés : SOIN INTENSIF; PEDIATRIE; MULTIRESISTANCE; PREVENTION; CONTROLE; BIBLIOGRAPHIE; BACTERIEMIE; CATHETER; PNEUMONIE; VENTILATION ASSISTEE; INFECTION URINAIRE; STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS; CLOSTRIDIUM DIFFICILE; KLEBSIELLAPNEUMONIAE; BETA-LACTAMASE A SPECTRE ELARGI; ACINETOBACTER BAUMANNII

Nosocomial infections in Pediatric Intensive Care Units (PICUs) caused by multidrug-resistant bacterial organisms are increasing. This review attempts to report on significant findings in the current literature related to nosocomial infections in PICU settings with an international perspective. The types of nosocomial infections are addressed, including catheter-related bloodstream infections, ventilator-associated

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pneumonia, urinary tract infections, gastrointestinal infections and post-surgical wound infections. A review of emerging resistant bacterial pathogens includes methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus sp., Clostridium difficile, extended-spectrum ß-lactamase producing Gram-negative organisms, Klebsiella pneumoniae carbapenemase-producing strains and multi-drug resistant Acinetobacter baumannii. Basic and enhanced infection control methods for the management and control of multidrug-resistant organisms are also summarized with an emphasis on prevention.

Personnel

NosoBase n° 23797L’hygiène hospitalière et les étudiants en médecine

Duroy E; Le Coutour X. Médecine et maladies infectieuses 2010/09; 40(9): 530-536.

Mots-clés : ETUDIANT; MEDECINE; QUESTIONNAIRE; CONNAISSANCE; ENQUETE; FORMATION; HYGIENE DES MAINS; DISPOSITIF MEDICAL; TENUE VESTIMENTAIRE; CENTRE HOSPITALIER UNIVERSITAIRE

Objectifs : La formation en hygiène hospitalière est un élément essentiel de la prévention des infections nosocomiales et de la qualité des soins. Nous proposons les résultats d’une enquête réalisée chez les étudiants en médecine de Caen. Elle portait sur leurs connaissances des bonnes pratiques d’hygiène des mains, sur l’attention portée à leur matériel et à leur tenue de travail et sur leur avis concernant la qualité de la formation en hygiène hospitalière reçue au cours de leurs études. Population et méthode : Un questionnaire anonyme a été soumis aux étudiants en médecine des deuxième, troisième et quatrième années du second cycle des études médicales.Résultats : Lorsque les externes sont en stage ou en garde, l’hygiène fait « toujours » ou « souvent » partie de leurs priorités dans 94 % des cas. Cependant, près de la moitié des externes (46 %) ne connaît pas les différences entre un lavage simple et un lavage antiseptique des mains. Pour 50 % des externes, leur blouse est trop grande. En moyenne, elle est changée toutes les trois semaines et demie. Seulement 40 % des externes désinfectent leur stéthoscope régulièrement et 23 % leur marteau réflexes. Enfin, 66,5 % des étudiants sont insatisfaits par leur formation en hygiène qu’ils jugent insuffisante et inadaptée à la réalité de leur terrain de stage.Conclusion : Des points sont à travailler pour améliorer les connaissances des externes vis-à-vis de l’hygiène hospitalière. Un important accent sur la formation initiale semble devoir être mis pour pouvoir améliorer les pratiques.

NosoBase n° 28746Exposition aux bactéries des avant-bras du personnel soignant durant les soins dans des unités de gériatrie

Gaspard P; Bertrand X; Gunther D; Roth C; Talon D. Exposure to bacteria of healthcare workers' forearms during care in geriatric units. The Journal of hospital infection 2010/11; 76(3): 275-277.

Mots-clés : GERIATRIE; PERSONNEL; TRANSMISSION; RISQUE; PEAU

NosoBase n°28858Eduquer le personnel soignant à des pratiques de l'hygiène des mains optimales : répondre à la nécessité

Mathai E; Allegranzi B; Seto WH; Chraiti MN; Sax H; Larson E; et al. Educating healthcare workers to optimal hand hygiene practices: addressing the need. Infection 2010; 38(5): 349-356.

Mots-clés : FORMATION; PERSONNEL; HYGIENE DES MAINS; PRATIQU; RECOMMANDATION; OBSERVANCE; BIBLIOGRAPHIE

The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching-learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health

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Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.

NosoBase n° 23796Tuberculose pulmonaire chez les personnels de santé de l’inter-région Nord (2002-2007) : description des cas signalés et des campagnes de dépistage des sujets contacts

Migueres B; Carbonne A; Abiteboul D; Poirier C; Bouvet E; Astagneau P. Médecine et maladies infectieuses2010/09; 40(9): 524-529.

Mots-clés : TUBERCULOSE; PERSONNEL; SIGNALEMENT; INVESTIGATION; QUESTIONNAIRE; PRELEVEMENT; RADIOLOGIE; DEPISTAGE; TRAITEMENT; MEDECINE PREVENTIVE; TRANSMISSION SOIGNANT-SOIGNE

Depuis la mise en place du signalement des infections nosocomiales (IN), 28 cas de tuberculoses chez des personnels de santé (dans 30 établissements de santé), ont été signalés au CCLIN Paris-Nord. Objectif et Méthode: Analyse descriptive des investigations autour de ces cas à partir des données recueillies à l’aide d’un questionnaire standardisé élaboré au CCLIN Paris-Nord sur une période de cinq ans.Résultats : La recherche de BAAR à l’examen direct des prélèvements respiratoires était positive pour 22 cas index et 15 présentaient une lésion excavée radiologique. Au total, 7730 patients ont été estimés potentiellement exposés (91,6 % informés) et 4000 personnels (100 % informés). Environ 18 % des patients adultes, 75 % des enfants et 50 % des personnels ont bénéficié d’un premier dépistage. Une tuberculose infection latente a été dépistée chez 34 personnels, 80 patients et dix enfants. Un traitement antituberculeux préventif a été prescrit à 692 enfants. Une tuberculose maladie a été diagnostiquée chez un patient adulte et deux personnels.Conclusion : Au total, peu de cas de tuberculose infection ou maladie ont été diagnostiqués autour d’un soignant atteint d’une tuberculose contagieuse. Cependant, l’efficience des campagnes d’information dépistage est très faible du fait de la complexité du diagnostic d’infection latente, du nombre important des perdus de vue et surtout du fait de l’absence de ciblage proportionné. Ils rappellent l’importance du rôle des employeurs et du service de santé au travail dans la prévention de la transmission soignant.soigné.

Signalement

NosoBase n° 28762Signalements externes des infections nosocomiales, France, 2007-2009 Poujol I; Thiolet JM; Bernet C; Carbonne A; Dumartin C; Senechal H; et al. Notification of healthcare-associated infections, France, 2007-2009. Bulletin épidémiologique hebdomadaire 2010/10/12; (38-39): 393-397.

Mots-clés : SIGNALEMENT; CLOSTRIDIUM DIFFICILE; ENTEROCOCCUS; STAPHYLOCOCCUS; ENTEROCOCCUS RESISTANT AU GLYCOPEPTIDE; INVESTIGATION; EOH; CCLIN; INVS; DDASS; BACTERIE A GRAM NEGATIF; BACTERIE A GRAM POSITIF; VIRUS; PARASITOLOGIE; LEVURE; MULTIRESISTANCE; ROUGEOLE; BETA-LACTAMASE A SPECTRE ELARGI

Depuis 2001, le signalement externe de certaines infections nosocomiales (IN), rares ou sévères, est obligatoire dans les établissements de santé (ES) et le bon fonctionnement de ce système d’alerte repose notamment sur l’adhésion des équipes hospitalières. De 2007 à 2009, 3 721 signalements totalisant 15 192 cas d’infections ou colonisations ont été reçus au niveau national, soit une moyenne de 1 240 signalements par an, en augmentation de 23% par rapport à 2006 ; 35% des signalements recensés correspondaient à des cas groupés. Les microorganismes les plus fréquemment à l’origine d’un signalement étaient Clostridium difficile (15%), Enterococcus spp (14%) et Staphylococcus spp (9%). Outre une aide au quotidien apportée aux ES, le signalement a permis de confirmer le contrôle progressif d’épidémies régionales connues, en particulier celles à C. difficile dans le Nord-Pas-de-Calais ou à entérocoques résistants aux glycopeptides en Lorraine. Il a aussi permis d’identifier de nouveaux risques émergents, tels que ceux liés à l’importation de l’étranger de bactéries hautement résistantes, ou à certaines pratiques de soins en ville. En 2009, 46% des ES français avaient effectué au moins un signalement depuis 2001 ; des disparités subsistaient dans les taux de signalement selon les interrégions, en partie liées à certaines épidémies régionales et traduisant une appropriation encore variable du dispositif. De nouvelles initiatives permettront prochainement de renforcer ce système d’alerte : amélioration des retours d’expérience,

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programmes de formation renouvelés et déploiement de l’outil de signalement électronique Sin@pse fin 2011.

Soins intensifs/Réanimation

NosoBase n° 28309Impact économique des infections à Acinetobacter baumannii dans une unité de réanimation

Lee BY; Mcglone SM; Doi Y; Bailey RR; Harrison LH. Economic impact of Acinetobacter bauamnnii infection in the intensive care unit. Infection control and hospital epidemiology 2010/10; 31(10): 1087-1089.

Mots-clés : ACINETOBACTER BAUMANNII; SOIN INTENSIF; COUT; DUREE DE SEJOUR

NosoBase n° 28860Persistance à long terme de SARM chez des patients réadmis à l'hôpital

Mattner F; Biertz F; Ziesting S; Gastmeier P; Chaberny IF. Long-term persistence of MRSA in re-admitted patients. Infection 2010/10; 38(5): 363-371.

Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; CENTRE HOSPITALIER UNIVERSITAIRE; ANALYSE; COHORTE; SURVEILLANCE; ETUDE PROSPECTIVE; COLONISATION

Background: A better knowledge of methicillin-resistant Staphylococcus aureus (MRSA) persistence in hospitalised patients may impact on specific prevention strategies. We have investigated the persistence of MRSA-carriage in patients admitted and re-admitted to a university hospital.Patients and methods: Between January 2002 and October 2005 all MRSA-positive patients admitted to the university hospital of Hannover Medical School were assessed at first admission and all subsequent re-admissions. Patients re-admitted at least once were analysed for the persistence or loss of MRSA. The association of possible factors influencing the persistence of MRSA colonisation or infection (age group, gender, decolonisation therapy during first hospital stay due to MRSA positivity and colonisation of different anatomical sites) was analysed using univariate, multivariate and time-dependent analyses.Results: A total of 1,032 patients who had tested positive at least once for MRSA were admitted to our hospital during the study period, accounting for 2,038 admissions. Of these patients, 403 (39.1%) were admitted more than once (from two times to 21 times), and 238 (59.1%) of the re-admitted patients remained MRSA positive during all subsequent admissions. Fifty-five (13.6%) patients tested MRSA negative at their last admission, and 61 (15.1%) tested MRSA negative at at least two consecutive admissions. In 27 (6.7%) patients, the MRSA status differed more than once between subsequent admissions. Overall, the half-life time (HLT) of MRSA persistence was 549 days, with the duration of persistence dependent on the colonisation of different anatomical sites (HLT only wounds 117 days; HLT mouth, throat, bronchial secretions 627 days; HLT nose, wounds and other body sites 801 days; p < 0.01) and was prolonged if more than one body site was MRSA-positive (HR 2.18, 95% confidence interval 1.52-3.15).Conclusion: A detailed knowledge of the dynamics of the loss of MRSA infection could result in a reduction of the incidence of MRSA in the future. Multiple anatomical site carriage of MRSA appeared to predict a prolonged persistence in our cohort of patients re-admitted to a university hospital.

NosoBase n° 28677Nutrition parentérale : dangereuse en réanimation. Mythe ou réalité ?

Regrigny E. Réanimation 2010/10; 19(Hors Série 3): 10-12.

Mots-clés : SOIN INTENSIF; ALIMENTATION PARENTERALE; IMMUNITE; RISQUE; CATHETER

Sommaire de l'article : I - Effet sur le système respiratoireII - Nutrition parentérale et atteintes intestinalesIII - Complications métaboliques1. Hypertriglycéridémie2. HyperglycémieIV - La nutrition parentérale est-elle responsable du syndrome de renutrition ?V - Quid du risque infections ?

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VI - Nutrition parentérale et immunitéVII - Quels autres griefs ?VIII - Conclusion

Staphylococcus

NosoBase n° 28593Impact clinique de la méticillino-résistance sur l'évolution de patients présentant une infection à Staphylococcus aureus : analyse stratifiée selon les maladies sous-jacentes et les sites d'infection dans une large cohorte prospective

Kang CI; Song JH; Chung DR; Peck KR; Ko KS; Yeom JS; et al. Clinical impact of methicillin resistance on outcome of patients with Staphylococcus aureus infection: a stratified analysis according to underlying diseases and sites of infection in a large prospective cohort. The Journal of infection 2010/10; 61(4): 299-306.

Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ANALYSE; COHORTE;ETUDE PROSPECTIVE; SURVEILLANCE; RESEAU; ASIE; MORTALITE; BACTERIEMIE; FACTEUR DE RISQUE; PRONOSTIC; ANALYSE MULTIVARIEE; RISQUE

Objective: This study was conducted to identify the predictors of mortality and to evaluate the impact of methicillin resistance on outcome in patients with Staphylococcus aureus infection according to underlying conditions and type of infection.Methods: An observational cohort study including 4949 patients with S. aureus infection was conducted. We compared data from patients with MRSA infection with those with MSSA infection.Results: The 30-day mortality rate of MRSA group was significantly higher than that of MSSA group (15.6% vs. 6.2%, P < 0.001). However, MRSA infection was not found to be independent risk factor for mortality after adjusting for other variables (OR = 1.03, 95% CI = 0.80-1.32). When we analyzed patients with S. aureus bacteremia (n = 709), MRSA infection was found to be significantly associated with mortality in multivariate analysis (Adjusted OR = 1.69, 95% CI = 1.15-2.49). When the 30-day mortality rates were compared according to underlying diseases, the 30-day mortality rate of MRSA group was significantly higher than that of MSSA group in patients with malignancy or renal diseases. MRSA infection was also found to be one of the independent risk factors for mortality in patients with malignancy (adjusted OR = 1.69, 95% CI = 1.06-2.70) and in those with renal disease (adjusted OR = 1.70, 95% CI = 1.0-2.89), after adjustment for host variables.Conclusions: Methicillin resistance adversely affected the outcome of patients with S. aureus infection, in patients with cancer or renal disease and in those with S. aureus bacteremia, although MRSA infection was not found to be significantly associated with higher mortality in overall patient population.

NosoBase n° 28748Stéthoscope ou "staphoscope" ? Infection transmise par l'auscultation

Mitchell A; Dealwis N; Collins J; Chew K; Taylor R; Schwab U; et al. Stethoscope or 'Staphoscope"? Infection by auscultation. The Journal of hospital infection 2010/11; 76(3): 278-279.

Mots-clés : STETHOSCOPE; CONTAMINATION; MEDECIN; ETUDIANT; PRELEVEMENT; STAPHYLOCOCCUS AUREUS; MICROBIOLOGIE

NosoBase n° 28299Impact d'un test de détection rapide des Staphylococcus sp. et de leur sensibilité aux antibiotiques sur le traitement des patients avec une hémoculture positive

Parta M; Goebel M; Thomas J; Matloobi M; Stager C; Musher DM. Impact of an assay that enables rapid determination of Staphylococcus species and their drug susceptibility on the treatment of patients with positive blood culture results. Infection control and hospital epidemiology 2010/10; 31(10): 1043-1048.

Mots-clés : STAPHYLOCOCCUS; METICILLINO-RESISTANCE; TRAITEMENT; BACTERIEMIE; SENSIBILITE; HEMOCULTURE; DEPISTAGE; ANTIBIOTIQUE

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Objective: To determine whether an earlier determination of staphylococcal species and their antibiotic susceptibility decreases unnecessary antistaphylococcal treatment and/or facilitates earlier appropriate treatment. Methods: We used the Xpert MRSA/SA BC system (Cepheid) for immediate determination of species and their drug susceptibility in patients whose blood cultures revealed gram-positive cocci in clusters. We compared the treatment of patients whose physicians received early notification of these results (group 1) with the treatment of patients in a historical cohort with delayed reporting after traditional microbiological studies (group 2). Outcomes were analyzed according to whether blood culture was positive for Staphylococcus species other than S. aureus, methicillin-susceptible S. aureus (MSSA), or methicillin-resistant S. aureus (MRSA) and whether the drugs used were appropriate for methicillin-susceptible or methicillin-resistant staphylococci (hereafter referred to as "MSS drug" or "MRS drug" therapy, respectively). Results: There were 44 (76%) of 58 patients with bacteremia due to Staphylococcus species other than S. aureus in group 1 and 58 (55%) of 106 patients with bacteremia due to Staphylococcus species other than S. aureus in group 2 who received no antistaphylococcal antibiotics ([Formula: see text]). Five (6%) of 89 patients in group 1 and 31 (25%) of 123 patients in group 2 received 0-168 hours (0-7 days) of MRS drug therapy ([Formula: see text]). Among patients with MSSA bacteremia, the mean time to initiation of appropriate therapy was 5.2 hours in group 1 and 49.8 hours in group 2 ([Formula: see text]). Excluding patients who received MRS drug therapy for unrelated conditions, the mean duration of treatment was 19.7 hours in group 1 and 80.7 hours in group 2 ([Formula: see text]). Six (50%) of the 12 patients in group 1 and 39 (81%) of the 48 patients in group 2 received MRS drug therapy for MSSA bacteremia ([Formula: see text]). Time to initiation of therapy for MRSA bacteremia did not differ between groups. Conclusions: The use of an assay with rapid results reduced the use of antistaphylococcal therapy among patients who did not have S. aureus bacteremia; it also decreased the use of MRS drug therapy and led to earlier appropriate therapy among patients with MSSA bacteremia.

NosoBase n° 28729Epidémie d'infections à Staphylococcus aureus méticillino-résistant positif pour la leucocidine dePanton-Valentine dans des unités régionales pour les brûlés Teare L; Shelley OP; Millership S; Kearns A. Outbreak of Panton-Valentine leucocidin-positivemeticillin-resistant Staphylococcus aureus in a regional burns unit. The Journal of hospital infection2010/11; 76(3): 220-224.

Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; EPIDEMIE; BRULE; ANTIBIORESISTANCE; ENQUETE; PREVENTION; CONTROLE

Over a 16 month period, 30 individuals (19 patients, one relative and 10 members of staff) on a regional burns and plastics unit became colonised or infected with a single strain of Panton-Valentine leucocidin-producing meticillin-resistant Staphylococcus aureus (PVL-MRSA). The strain was resistant to ciprofloxacin, neomycin and gentamicin and belonged to a community-associated MRSA lineage known to be circulating in the UK. The outbreak occurred in four stages, the first being in burns outpatients, the second and third being on the burns unit itself and the final stage on a plastics ward. In spite of closing the affected unit and deep cleaning, including steam cleaning and hydrogen peroxide treatment, the outbreak continued. It was not until staff carriage was fully addressed that the outbreak was controlled.

NosoBase n° 28727Les follicules pileux, niche de Staphylococcus aureus dans le nez : une stratégie de décolonisation plus efficace est-elle nécessaire ?

Ten Broeke-Smits N; Kummer JA; Bleys R; Fluit AC; Boel CH. Hair follicles as a niche of Staphylococcus aureus in the nose; is a more effective decolonisation strategy needed? The Journal of hospital infection2010/11; 76(3): 211-214.

Mots-clés : STAPHYLOCOCCUS AUREUS; COLONISATION; COLONISATION NASALE; DEPISTAGE; PREVENTION; CONTROLE

Staphylococcus aureus is the major cause of surgical site infections, and meticillin-resistant S. aureus (MRSA) is increasingly accounting for infections worldwide. Preventing surgical site infections by screening and decolonising positive patients reduces the number of infections, but does not completely eradicate the risk. A balance between prevention, costs and the chance of mupirocin-resistant S. aureus needs to be evaluated and decolonisation strategies optimised. It is essential to know the site of S. aureus during

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colonisation. In this study, for the first time the exact location of S. aureus in the human nose was determined using a histological approach. We showed the presence of S. aureus in the cornified layer of squamous epithelium, associated keratin and mucous debris and within hair follicles in the vestibulum nasi. The presence of S. aureus in hair follicles suggests that this could be the niche from which relapses occur after decolonisation. Decolonisation strategies might have to be reconsidered.

NosoBase n° 28787Facteurs de risque de mortalité des bactériémies nosocomiales à Staphylococcus aureus méticillino-résistant (SARM) : enquête du rôle potentiel des souches de SARM d'origine communautaire

Wang JT; Wang JL; Fang CT; Chie WC; Lai MS; Lauderdale TL; et al. Risk factors for mortality of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection: with investigation of the potential role of community-associated MRSA strains. The Journal of infection 2010; in press: 9 pages.

Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; FACTEUR DE RISQUE; MORTALITE; BACTERIEMIE; ENQUETE; CENTRE HOSPITALIER UNIVERSITAIRE; MICROBIOLOGIE; VANCOMYCINE; CMI

Objectives: The difference in the outcomes of nosocomial bloodstream infection (BSI) caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains and healthcare-associated MRSA (HA-MRSA) strains remains unclear.Methods: From January 1, 2006 to December 31, 2008, all adult patients hospitalized at National Taiwan University Hospital with nosocomial MRSA BSI were analyzed. Available MRSA isolates were submitted for subsequent microbiologic studies to determine whether they belonged to CA-MRSA strains.Results: In total, 308 patients were enrolled and 253 MRSA isolates were available. Forty-seven isolates belonged to CA-MRSA strains. The all-cause mortality rates on Day 14 and Day 30 were 19.8% and 30.5%, respectively, and were not different between those caused by CA-MRSA and HA-MRSA strains. The independent risk factors for Day 14 mortality were septic shock, thrombocytopenia, and an inadequate serum trough level of vancomycin (p = <0.0001, 0.0003, and 0.0381, respectively). Those for Day 30 mortality were septic shock, anemia, thrombocytopenia, presence of underlying malignancies, and MRSA isolates with a vancomycin minimum inhibitory concentration of 2 mg/L (p = <0.0001, 0.0425, 0.0007, 0.0098, and 0.0012, respectively). Conclusions: The mortality rates of nosocomial MRSA BSI were not different between that caused by CA-MRSA and HA-MRSA strains.

Stérilisation

NosoBase n° 28829Stérilisation des dispositifs médicaux dans les PUI : ce qui change Les nouvelles pharmaceutiques 2010/10/14; (408): 1 page.

Mots-clés : DISPOSITIF MEDICAL; STERILISATION; PHARMACIE; LEGISLATION; ASSURANCE QUALITE

Cet article présente sous forme de tableaux les principales modifications apportées par le décret du 30/08/2010 relatif à la stérilisation des dispositifs médicaux dans les établissements de santé (Référence NosoBase n° 28288).

NosoBase n° 28833Gestion des risques en stérilisation - 1ère partie

Thiveaud D. Le moniteur hospitalier 2010/10; (229): 40-44.

Mots-clés : STERILISATION; GESTION DES RISQUES; DEFINITION; USAGER; NORME; DISPOSITIF MEDICAL; ANALYSE DES RISQUES; HISTORIQUE

La stérilisation à l'hôpital consiste à préparer des dispositifs médicaux stériles, en assurant leur traitement après utilisation, en vue de leur réutilisation. La gestion des risques en stérilisation conduit logiquement à la

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mise en place du système de management de la qualité. Par ailleurs, la dynamique du système qualité amène à s'interroger en continu sur l'amélioration des pratiques visant à réduire, sinon éliminer, les non-conformités.

Usager

NosoBase n° 28674Note d'information n°DGOS/PF2/2010/327 du 07/09/2010 relative à la généralisation de l'indicateur de mesure de la satisfaction des patients hospitalisés au sein des établissements de santé ayant une activité de médecine-chirurgie et obstétrique (MCO) y compris les centres de lutte contre le cancer (CLCC) à compter de 2011 Ministère de la santé et des sports. Non parue au journal officiel 2010; 4 pages.

Mots-clés : LEGISLATION; INDICATEUR; USAGER; QUALITE; SOIN; CENTRE DE LUTTE CONTRE LE CANCER; SATISFACTION; STRUCTURE DE SOINS; ENQUETE; INFORMATION; CHAMBRE; PERSONNEL; ATTITUDE; ALIMENTATION

NosoBase n° 28675Arrêté du 07/07/2010 portant agrément national des associations et unions d'associations représentant les usagers dans les instances hospitalières ou de santé public (rectificatif)

Ministère de la santé et des sports. Journal officiel 2010/10/02; 1 page.

Mots-clés : LEGISLATION; USAGER; SANTE PUBLIQUE

CCLIN Sud-Est – [email protected] 29 / 29


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