NosoVeille n° 9 - septembre 2009

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  • NosoVeille Bulletin de veille septembre 2009 NosoVeille n9 Septembre 2009 Rdacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publies au cours du mois coul. La recherche documentaire est effectue dans la base de donnes Pour recevoir, tous les mois, NosoVeille dans votre messagerie : Abonnement / Dsabonnement Sommaire de ce numro Antibiotique Bactrimie Candida Chirurgie Clostridium Dsinfection/Strilisation Entrocoque Environnement Hmodialyse Hpatite Hygine des mains Pdiatrie Personnel Pneumonie Prvention Ranimation Staphylocoque CCLIN Sud-Est cclinse@chu-lyon.fr 1 / 23
  • NosoVeille Bulletin de veille septembre 2009 Antibiotique NosoBase n 25233 Cellulite orbitaire et endophtalmie endogne secondaire une cholcystite Proteus mirabilis Argelich R; Ibanez-Flores N; Bardavio J; Bures-Jelstrup A; Garcia-Segarra G; Coll-Colell R; et al. Orbital cellulitis and endogenous endophthalmitis secondary to Proteus mirabilis cholecystitis. Diagnostic microbiology and infectious disease. 2009/08; 64(4): 442-444 Mots-cls : ENDOPHTALMIE; OEIL; VESICULE BILIAIRE; PROTEUS MIRABILIS; BACTERIEMIE We report the first case of orbital cellulitis and endogenous endophthalmitis secondary to Proteus mirabilis bacteremia that resulted from a calculus cholecystitis. Despite resolution of the gallbladder infection with antimicrobial therapy, the patient required evisceration of the affected eye. The pathogenesis of hematogenous endophthalmitis due to Gram-negative bacilli is discussed. NosoBase n 24902 Programme national franais pour la prvention des infections nosocomiales et de lantibiorsistance, 1992-2008 : amlioration constate mais ncessit de poursuivre laction Carlet J; Astagneau P; Brun-Buisson C; Coignard B; Salomon V; Tran B; et al. French national program for prevention of healthcare-associated infections and antimicrobial resistance, 1992-2008: positive trends, but perseverance needed. Infection control and hospital epidemiology 2009/08; 30(8): 737-745 Mots-cls : PREVENTION; ANTIBIORESISTANCE; CHIRURGIE; STAPHYLOCOCCUS AUREUS; PREVALENCE Objective: To describe the French program for the prevention of healthcare-associated infections and antibiotic resistance and provide results for some of the indicators available to evaluate the program. In addition to structures and process indicators, the 2 outcome indicators selected were the rate of surgical site infection and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the S. aureus isolates recovered. Design: Descriptive study of the evolution of the national structures for control of healthcare-associated infections since 1992. Through national surveillance networks, process indicators were available from 1993 to 2006, surgical site infection rates were available from 1999 to 2005, and prevalence rates for MRSA infection were available from 2001 to 2007. Results: A comprehensive national program has gradually been set up in France during the period from 1993 to 2004, which included strengthening of organized infection control activities at the local, regional, and national levels and developing large networks for surveillance of specific infections and antibiotic resistance. These achievements were complemented by instituting mandatory notification for unusual nosocomial events, especially outbreaks. The second phase of the program involved the implementation of 5 national quality indicators with public reporting. Surgical site infection rates decreased by 25% over a 6-year period. In France, the median proportion of MRSA among S. aureus isolates recovered from patients with bacteremia decreased from 33.4% to 25.7% during the period from 2001 to 2007, whereas this proportion increased in many other European countries. Conclusions: Very few national programs have been evaluated since the Study on the Efficacy of Nosocomial Infection Control. Although continuing efforts are required, the French program appears to have been effective at reducing infection rates. NosoBase n 24911 Epidmiologie de lantibiorsistance de micro-organismes Gram ngatif isols chez des patients hospitaliss dans les services long sjour dun rseau hospitalier multi-tats des USA Lautenbach E; Marsicano R; Tolomeo P; Heard M; Serrano S; Stieritz DD. Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities. Infection control and hospital epidemiology 2009/08; 30(8): 790-793 Mots-cls : EPIDEMIOLOGIE; ANTIBIORESISTANCE; BACTERIE A GRAM-NEGATIF; EHPAD; FLUOROQUINOLONE; ESCHERICHIA COLI CCLIN Sud-Est cclinse@chu-lyon.fr 2 / 23
  • NosoVeille Bulletin de veille septembre 2009 We identified 1,805 gram-negative organisms in cultures of urine samples obtained over a 10-month period from residents of 63 long-term care facilities. The prevalence of fluoroquinolone resistance in Escherichia coli was 51% (446 of 874 isolates), whereas the prevalences of ceftazidime and imipenem resistance in Klebsiella species were 26% and 6% (84 and 19 of 323 isolates), respectively. The prevalence of resistance varied significantly by facility type, size, and geographic location. NosoBase n 25152 Epoque de rsistance et de slection des antibiotiques Wilcox MH. The tide of antimicrobial resistance and selection International journal of antimicrobial agents. 2009/08; 34(Supplment 3): S6-S10 Mots-cls : ANTIBIORESISTANCE; PRESSION DE SELECTION; CARBAPENEME; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ANTIBIOTIQUE; TIGECYCLINE; CLOSTRIDIUM DIFFICILE The cumulative ecological damage, both to the individual patient and to patient populations, secondary to antibiotic prescribing is increasingly recognised. The impact of antibiotics on pathogens and normal flora should be a criterion for antimicrobial selection. Measures to reduce the use of third-generation cephalosporins and fluoroquinolones should be considered. Increased reliance on carbapenems may accelerate the emergence of extremely resistant isolates, and these antimicrobials should be restricted to key scenarios. There is a clear need for new agents with novel modes of action and low ecological damage potential to treat nosocomial infections. Tigecycline has a spectrum of activity that theoretically may reduce the selection pressure for key nosocomial pathogens, and represents an alternative to carbapenems. Further studies are needed to confirm this potentially low selection pressure. Bactrimie NosoBase n 25191 Evolution de la rsistance aux antibiotiques des isolats sanguins d'Escherichia coli : tude de population, 1998-2007 Al-Hasan MN; Lahr BD; Eckel-Passow JE; Baddour LM. Antimicrobial resistance trends of Escherichia coli bloodstream isolates: a population-based study, 1998-2007. The Journal of antimicrobial chemotherapy 2009/07; 64(1): 169-174 Mots-cls : ANTIBIORESISTANCE; ESCHERICHIA COLI; ANTIBIOTIQUE Background: There have been contradictory results regarding temporal changes in the antimicrobial resistance of Escherichia coli from tertiary care centres. Therefore, we performed a population-based investigation to examine in vitro antimicrobial resistance trends of E. coli bloodstream isolates. Methods: In this retrospective population-based incidence study, we identified 461 unique patients with first episodes of E. coli bloodstream infection (BSI) from 1 January 1998 to 31 December 2007 through microbiology records at the two laboratories in Olmsted County, Minnesota. Logistic regression was used to examine temporal changes in antimicrobial resistance and Poisson regression for changes in incidence rates. Results: The median age of patients with E. coli BSI was 69 years; 306 (66.4%) were female. The ageadjusted incidence rate of E. coli BSI per 100000 person-years was 48.0 (95% CI: 42.5-53.4) in females and 34.0 (95% CI: 28.6-39.6) in males. The urinary tract was the most common primary source of infection (79.8%). During the study period, resistance rates of E. coli bloodstream isolates increased from 32% to 53% for ampicillin, from 23% to 45% for ampicillin/ sulbactam, from 9% to 28% for trimethoprim/ sulfamethoxazole and from 0% to 12% for ciprofloxacin. Resistance rates to carbapenems, cephalosporins and piperacillin/tazobactam remained low and stable. Conclusions: To our knowledge, this is the first population-based study on antimicrobial resistance trends of E. coli bloodstream isolates in the USA. We demonstrated linear trends of increasing resistance among these isolates to three different classes of antimicrobial over the past decade. NosoBase n 25275 Rduction des bactrimies associes une voie centrale chez des patients neutropniques donco- hmatologie grce une surveillance CCLIN Sud-Est cclinse@chu-lyon.fr 3 / 23
  • NosoVeille Bulletin de veille septembre 2009 Chaberny IF; Ruseva E; Sohr D; Buchholz S; Ganser A; Mattner F; et al. Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies. Annals of hematology 2009/09; 88(9): 907-912 Mots-cls : SURVEILLANCE; HEMATOLOGIE; BACTERIEMIE; MOELLE OSSEUSE; TRANSPLANTATION; CATHETER VEINEUX CENTRAL; ANALYSE MULTIVARIEE; INCIDENCE; FACTEUR DE RISQUE; ONCOLOGIE To determine nosocomial catheter-associated bloodstream infections (CA-BSIs) and to improve the prevention measures, we performed a prospective surveillance in our hematopoietic stem cell transplantation unit at our university hospital. During the 36-month study period all patients with at least two consecutive neutropenic days (NDs) were included. After the first 18 months the recorded data were analyzed and compared with reference data and were then presented to the clinical staff. An intensive training to improve the handling of central venous lines was performed afterwards. At the end of the last 18- month study period the data were evaluated and a multivariate analysis was conducted. Altogether 268 patients were treated for a period of 10,013 patient days including 4,286 NDs. A total of 202/268 (75.4%) patients underwent transplantation (157/76.6% allogeneic, 48/23.4% autologous). Eighty-seven CA-BSIs were identified. The incidence density was 24.3 CA-BSI episodes per 1,000 NDs in the first period and 16.2 in the second. A significant reduction in the CA-BSI rate of adults was achieved (OR 0.58; 95% CI 0.339.0.987; p23.6 kg/m2; (ii) estimated blood volume loss >810 mL; (iii) presence of postoperative bile leakage of organ/space SSI; and (iv) use of the sliding scale method for postoperative glucose control. There was no observed SSI after liver resection in the group whose postoperative blood glucose levels were controlled by an artificial pancreas. This study reveals that lack of postoperative glycaemic control is associated with a significantly higher incidence of postoperative infectious complications and longer hospitalisation. Obesity and the level of intraoperative estimated blood loss and CCLIN Sud-Est cclinse@chu-lyon.fr 7 / 23
  • NosoVeille Bulletin de veille septembre 2009 bile leakage after hepatic resection are also risk factors with predictive value for SSI. Artificial pancreas is a safe and beneficial device to perform postoperative strict glycaemic control without hypoglycaemia for patients who undergo hepatic resection for liver diseases. Clostridium NosoBase n 25188 Effets temporels de l'utilisation de l'antibiotique et infections Clostridium difficile Verbaz N; Hill K; Leggeats S; Nathwani D; Philips G; Bonnabry P; et al. Temporal effects of antibiotic use and Clostridium difficile infections. The Journal of antimicrobial chemotherapy 2009/06; 63(6): 1272-1275 Mots-cls : ANTIBIOTIQUE; CLOSTRIDIUM; CEPHALOSPORINE; PENICILLINE; FLUOROQUINOLONE Objectives: We tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of Clostridium difficile infection in a hospital with stable incidence of infection at >1 case per 1000 admissions per month. Methods: The study period was from April 2004 to June 2008 and used data from Infection Control and Hospital Pharmacy. We first described the monthly variation in C. difficile infection and then constructed a multivariate transfer function model that included lag time (cases of C. difficile infection in previous months and delays between changes in antibiotic use and changes in C. difficile infection). Results: The average incidence of C. difficile infection was 1.5 cases per 1000 patients per month with no significant increase over 3 years. The number of cases of C. difficile infection in 1 month was dependent on the average number of cases of C. difficile infection in the previous 2 months. The models with data from the whole hospital showed a statistically significant relationship between the number of both hospital-acquired C. difficile infections and total C. difficile infections and consumption of piperacillin/tazobactam, ciprofloxacin and cefuroxime. The association between C. difficile infection and consumption of co-amoxiclav was only significant for hospital-acquired C. difficile infection. The model for hospital-acquired C. difficile infections explained 61% of the variance in C. difficile infections. Conclusions: These results provide support for antibiotic policies that minimize the use of broad-spectrum penicillins (co-amoxiclav and piperacillin/tazobactam), cephalosporins and fluoroquinolones. Dsinfection/Strilisation NosoBase n 25303 Efficacit de la dsinfection contre les parvovirus compare aux virus de rfrence Eterpi M; Mcdonnell G; Thomas V. Disinfection efficacy against parvoviruses compared with reference viruses. The Journal of hospital infection 2009/09; 73(1): 64-70 Mots...