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NosoVeille – Bulletin de veille
Mai 2012
NosoVeille n°5
Mai 2012
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
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Sommaire de ce numéro
Acinetobacter baumannii
Alimentation
Antibiotique
Bactériémie
Candida
Cathétérisme
Chirurgie
EHPAD / Personne âgée
Entérobactérie
Enterovirus
Environnement
Gale
Gestion des risques
Hygiène des mains
Médecine de ville
Médicament
Peau
Pédiatrie
Personnel
Pneumonie
Réanimation
Réglementation
Rotavirus
Staphylococcus aureus
Tuberculose
Vaccination
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NosoVeille – Bulletin de veille
Mai 2012
Acinetobacter baumannii
NosoBase n° 33795
Trois clones distincts d'Acinetobacter baumannii résistant aux carbapénèmes avec une grande
diversité de carbapénèmases isolés chez des patients de deux centres hospitaliers du Koweit
Al-Sweih NA; Al-Hubail M; Rotimi VO. Three distinct clones of carbapenem-resistant Acinetobacter baumannii
with high diversity of carbapenemases isolated from patients in two hospitals in Kuwait. Journal of infection
and public health 2012/02; 5(1): 102-108.
Mots-clés :
ACINETOBACTER
BAUMANNII;
ANTIBIORESISTANCE;
CARBAPENEME;
MULTIRESISTANCE; BIOLOGIE MOLECULAIRE; PCR; PFGE; TYPAGE; GENOTYPE; ANTIBIOTIQUE
Objectives: This study was undertaken to investigate the clonal relatedness of multidrug-resistant (MDR)
Acinetobacter baumannii isolates collected from patients in two teaching hospitals in Kuwait.
Materials and methods: Clinically significant consecutive isolates of A. baumannii obtained from patients in
the Mubarak (36) and Adan (58) hospitals over a period of 6 months were studied. These isolates were
identified using molecular methods, and their antimicrobial susceptibility was determined by the Etest method.
The mechanism of resistance to carbapenem was investigated by PCR, and pulsed-field gel electrophoresis
(PFGE) was used to determine the clonal relatedness of MDR isolates.
Results: Of the 94 isolates investigated, 80 (85.1%) were multidrug resistant (MDR). The A. baumannii PFGE
clone A and subclone A1 were the most prevalent in patients infected with MDR isolates. Fifty-five (94.8%)
and 15 (41.7%) of the MDR isolates from the Adan and Mubarak hospitals, respectively, belonged to PFGE
clone A; isolates in this group showed higher resistance rates to antibiotics than isolates form other groups.
Of the 94 isolates, 40 (42.6%) were resistant to either imipenem or meropenem or to both (CRAB). Most
CRAB isolates (29/40 or 72.5%) carried bla genes, which code for MBL (VIM-2 and IMP-1) enzymes. Two
isolates harbored bla(OXA-23).
Conclusion: Three distinct clones of CRAB were isolated, providing evidence of a high diversity of
carbapenemases among our geographically related isolates.
NosoBase n° 33807
Epidémiologie moléculaire d'Acinetobacter baumannii résistant aux carbapénèmes au Japon
Endo S; Yano H; Hirakata Y; Arai K; Kanamori H; Ogawa M; et al. Molecular epidemiology of carbapenemnon-susceptible Acinetobacter baumannii in Japan. The Journal of antimicrobial chemotherapy 2012; in
press: 4 pages.
Mots-clés :
ACINETOBACTER
BAUMANNII;
EPIDEMIOLOGIE;
CARBAPENEME; ANTIBIORESISTANCE; PCR; TYPAGE; CMI
BIOLOGIE
MOLECULAIRE;
Methods: A total of 305 non-duplicate clinical isolates of Acinetobacter spp. from 176 medical facilities in all
geographical regions of Japan were tested for susceptibility to antimicrobial agents by the agar dilution
method. Isolates with MICs of imipenem=4 mg/L underwent PCR analysis of OXA-type ß-lactamase gene
clusters and metallo-ß-lactamase genes. These isolates were further analysed by sequencing of OXA-type ßlactamases and by multilocus sequence typing (MLST).
Results: Fifty-five of the 305 clinical isolates had MICs of imipenem=4 mg/L. The OXA-51-like
carbapenemase gene was detected in 52 of these 55 isolates. Within the OXA-51-like gene cluster, OXA-66
was found in 43 (82.7%) of the 52 isolates. MLST identified the following sequence types (STs): ST74, ST76,
ST92, ST106, ST188 and ST195 in 2 (3.8%), 2 (3.8%), 40 (76.9%), 5 (9.6%), 2 (3.8%) and 1 (1.9%) of the
isolates, respectively. In particular, ST92 was found in 31 (91.2%) of the 34 A. baumannii isolates with MICs
of imipenem=16 mg/L.
Conclusions: This is the first report on the molecular epidemiology of A. baumannii with MICs of imipenem=4
mg/L in Japan. OXA-66 and ST92 were dominant among these isolates.
Alimentation
NosoBase n° 33847
Avis de l'Agence française de sécurité sanitaire des produits de santé - Utilisation de biberons
stériles à l'oxyde d'éthylène
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NosoVeille – Bulletin de veille
Mai 2012
Agence française de sécurité sanitaire des produits de santé (AFSSAPS). AFSSAPS 2012/04: 21 pages.
Mots-clés : ALIMENTATION; BIBERONNERIE; OXYDE D'ETHYLENE; STERILISATION
Les hôpitaux et maternités qui organisaient auparavant la stérilisation de biberons réutilisables à des fins
d'hygiène et de limitation des infections nosocomiales ont évolué à partir du début des années 2000 vers
l'usage de biberons à usage unique. Des fabricants ont alors mis sur le marché des biberons à usage unique
en tant que dispositifs médicaux avec des revendications de stockage du lait maternel ou de la maîtrise des
volumes administrés (nutrition ou médicament). Ces biberons sont stérilisés à l'oxyde d'éthylène (OE). Cet
avis précise les conditions d'utilisation des biberons stérilisés à l'oxyde d'éthylène.
Antibiotique
NosoBase n° 33873
Surveillance de la consommation des antibiotiques Réseau ATB-Raisin - Résultats 2010
CClin Sud-Ouest; Réseau d'alerte, d'investigation et de surveillance des infections nosocomiales (RAISIN);
Institut de veille sanitaire (InVS). Surveillance of antibiotic use in hospitals - Reseau ATB Raisin - Results
2010. Institut de veille sanitaire 2012/04: 1-80.
Mots-clés :
SURVEILLANCE;
ANTIBIOTIQUE;
ANTIBIORESISTANCE;
CONSOMMATION;
CARBAPENEME; PENICILLINE; CEPHALOSPORINE; QUINOLONE; FLUOROQUINOLONE
La surveillance de la consommation des antibiotiques (ATB) conduite dans le cadre du réseau ATB-Raisin
participe au bon usage des ATB. Les objectifs sont de permettre à chaque établissement de santé (ES) de
décrire et d'analyser ses consommations par rapport à un ensemble comparable et de les confronter aux
données de résistance bactérienne. Les ATB à visée systémique de la classe J01 de la classification
Anatomical Therapeutic Chemical (ATC), la rifampicine et les imidazolés per os, dispensés en hospitalisation
complète, ont été exprimés en nombre de doses définies journalières (DDJ) et rapportés à l'activité en
journées d'hospitalisation (JH) selon les recommandations nationales et de l'Organisation mondiale de la
santé (système ATC-DDD, 2010). Des données de résistance ont été collectées pour sept couples bactérie/
antibiotique. Les 1 115 ES participants en 2010 représentaient 52 % des lits d'hospitalisation et avaient
consommé 374 DDJ/1 000 JH. Les ATB les plus utilisés étaient l'association amoxicilline-acide clavulanique
(31 %), l'amoxicilline (17 %) et l'ofloxacine (5 %). La consommation médiane d'ATB variait de 54 DDJ/1 000
JH dans les hôpitaux psychiatriques à 693 dans les hôpitaux d'instruction des armées. Des variations étaient
observées selon les secteurs d'activité, de 63 DDJ/1 000 JH en psychiatrie à 1 556 en réanimation. Les
données de résistance étaient en cohérence avec celles issues de réseaux spécifiques. La surveillance en
réseau des consommations détaillées permet à chaque ES de se situer, dans un objectif de comparaison,
d'échanger sur les pratiques et organisations et de suivre les tendances évolutives. L'analyse des
consommations d'ATB est à compléter d'évaluation des pratiques.
NosoBase n° 33615
Audit et retour d'information pour réduire l'utilisation d'antibiotiques à large spectre en soins
intensifs : une analyse de séries temporelles interrompues contrôlée
Elligsen M; Walker SA; Pinto R; Simor A; Mubareka S; Rachlis A; et al. Audit and feedback to reduce broadspectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis.
Infection control and hospital epidemiology 2012/04; 33(4): 354-361.
Mots-clés : AUDIT; ANTIBIOTIQUE; SOIN INTENSIF; ETUDE PROSPECTIVE; COUT; SOIN INTENSIF;
DDJ; CLOSTRIDIUM DIFFICILE; CENTRE HOSPITALIER UNIVERSITAIRE
Objective: We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum
antimicrobial use among critical care patients.
Design: Prospective, controlled interrupted time series.
Setting: Single tertiary care center with 3 intensive care units.
Patients and interventions: A formal review of all critical care patients on their third or tenth day of broadspectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were
communicated to the critical care team.
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Mai 2012
Outcomes: The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days;
secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial
Clostridium difficile infections, length of stay, and mortality.
Results: The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000
patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the
postintervention period ([Formula: see text]); time series modeling confirmed an immediate decrease (±
standard error) of [Formula: see text] days of therapy per 1,000 patient-days ([Formula: see text]). In contrast,
no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention
medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The
incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units,
whereas the incidence increased from 87 to 116 cases in the control wards ([Formula: see text]). Overall
gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of
stay and mortality did not change.
Conclusions: Institution of a formal prospective audit and feedback program appears to be a safe and
effective means to improve broad-spectrum antimicrobial use in critical care.
NosoBase n° 33614
Taux et pertinence de la prescription d'antibiotiques dans un centre hospitalier pédiatrique
universitaire, 2007-2010
Levy ER; Swami S; Dubois SG; Wendt R; Banerjee R. Rates and appropriateness of antimicrobial prescribing
at an academic children's hospital, 2007-2010. Infection control and hospital epidemiology 2012/04; 33(4):
346-351.
Mots-clés : PEDIATRIE; ANTIBIOTIQUE; CONSOMMATION; TAUX; PRESCRIPTION; DDJ; ETUDE
RETROSPECTIVE; SOIN INTENSIF; CHIRURGIE; FORMATION; VANCOMYCINE; CEFEPIME
Objective and design: Antimicrobial use in hospitalized children has not been well described. To identify
targets for antimicrobial stewardship interventions, we retrospectively examined pediatric utilization rates for
48 antimicrobials from 2007 to 2010 as well as appropriateness of vancomycin and cefepime use in 2010.
Patients and setting: All children hospitalized between 2007 and 2010 at the Mayo Clinic Children's Hospital,
a 120-bed facility within a larger adult hospital in Rochester, Minnesota.
Methods: We calculated antimicrobial utilization rates in days of therapy per 1,000 patient-days. Details of
vancomycin and cefepime use in 2010 were abstracted by chart review. Two pediatric infectious disease
physicians independently assessed appropriateness of antibiotic use.
Results: From 2007 to 2010, 9,880 of 17,242 (57%) hospitalized children received 1 or more antimicrobials.
Antimicrobials (days of therapy per 1,000 patient-days) used most frequently in 2010 were cefazolin (97.8),
vancomycin (97.1), fluconazole (76.4), piperacillin-tazobactam (70.7), and cefepime (67.6). Utilization rates
increased significantly from 2007 to 2010 for 10 antimicrobials, including vancomycin, fluconazole,
piperacillin-tazobactam, cefepime, trimethoprim-sulfamethoxazole, caspofungin, and cefotaxime. In 2010,
inappropriate use of vancomycin and cefepime was greater in the pediatric intensive care unit than ward
(vancomycin: 17.8% vs 6.4%, [Formula: see text]; cefepime: 9.2% vs 3.9%, [Formula: see text]) and on
surgical versus medical services (vancomycin: 20.5% vs 8.0%, [Formula: see text]; cefepime: 19.4% vs 3.4%,
[Formula: see text]). The most common reason for inappropriate antibiotic use was failure to discontinue or
de-escalate therapy.
Conclusions: In our children's hospital, use of 10 antimicrobials increased during the study period.
Inappropriate use of vancomycin and cefepime was greatest on the critical care and surgical services, largely
as a result of failure to de-escalate therapy, suggesting targets for future antimicrobial stewardship
interventions.
NosoBase n° 33617
Diminution de la résistance des Pseudomonas aeruginosa par une limitation des prescriptions de
ciprofloxanine dans les services de soins intensifs et de soins de suite d’un grand centre hospitalier
universitaire
Lewis GJ; Fang X; Gooch M; Cook PP. Decreased resistance of Pseudomonas aeruginosa with restriction of
ciprofloxacin in a large teaching hospital's intensive care and intermediate care units. Infection control and
hospital epidemiology 2012/04; 33(4): 368-373.
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Mots-clés : PSEUDOMONAS AERUGINOSA; SOIN INTENSIF; CIPROFLOXACINE; PRESCRIPTION;
CARBAPENEME; ANALYSE; ANTIBIORESISTANCE; MULTIRESISTANCE; CENTRE HOSPITALIER
UNIVERSITAIRE
Objective: To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative
bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.
Design: Interrupted time-series analysis.
Setting: Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295
beds.
Patients: All nosocomial isolates of P. aeruginosa.
Intervention: Restriction of ciprofloxacin.
Results: There was a significant decreasing trend observed in the percentage ([Formula: see text]) and the
rate ([Formula: see text]) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems
following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the
percentage ([Formula: see text]) and the rate ([Formula: see text]) of isolates of ciprofloxacin-resistant P.
aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined ([Formula: see text]) but the
percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes
observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were
no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter
baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase
in the use of carbapenems ([Formula: see text]); the use of ciprofloxacin decreased significantly ([Formula:
see text]). There were no significant changes in the use of piperacillin-tazobactam or cefepime.
Conclusion: Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates
to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care
units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A.
baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means
of controlling multidrug-resistant P. aeruginosa.
NosoBase n° 33673
Disparité des pratiques de lutte contre le risque infectieux concernant les entérobactéries multirésistantes aux antibiotiques
Lowe C; Katz K; McGeer A; Muller MP. Disparity in infection control practices for multidrug-resistant
Enterobacteriaceae. American journal of infection control 2012; in press: 4 pages.
Mots-clés : ENTEROBACTERIE; PREVENTION; PRATIQUE; ANTIBIORESISTANCE; MULTIRESISTANCE;
TRANSMISSION; BETA-LACTAMASE A SPECTRE ELARGI; CARBAPENEME
Background: There is a lack of empiric evidence regarding the optimal approach to controlling the
transmission of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenemresistant Enterobacteriaceae (CRE). In this context, we expect that infection control practices for these
organisms vary widely between hospitals.
Methods: A survey examining infection control practices for ESBL-E and CRE was distributed to 6 academic
and 9 community hospitals in Toronto, Canada.
Results: All hospitals responded to the survey. Among 15 hospitals in 1 geographic area, 8 different
approaches to the management of ESBL-E were utilized. There was wide variation in the use infection control
practices including admission screening (53% and 53%), contact precautions (53% and 100%), and isolation
(60% and 100%) for ESBL-E and CRE, respectively. Of hospitals performing admission screening, 75% used
risk factor-based screening for ESBL-E and CRE.
Conclusion: Even within a single geographic area, there is wide variation in infection control strategies to
contain or control ESBL-E and CRE. These results are concerning given evidence that a coordinated
approach may be required to prevent or limit the emergence of CRE.
NosoBase n° 33612
Gestion des antibiotiques - état de l'art en 2011 : focus sur les résultats et les méthodes
McGowan JE. Antimicrobial stewardship - the states of the art in 2011: focus on outcome and methods.
Infection control and hospital epidemiology 2012/04; 33(4): 331-337.
Mots-clés : INFECTION;
ANTIBIORESISTANCE
ANTIBIOTIQUE;
PRESCRIPTION;
COUT;
EVALUATION;
COUT;
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NosoVeille – Bulletin de veille
Mai 2012
Antimicrobial stewardship programs attempt to optimize prescribing of these drugs to benefit both current and
future patients. Recent regulatory and other incentives have led to widespread adoption of such programs.
Measurements of the success of these programs have focused primarily on process measures. However,
evaluation of outcome measures will be needed to ensure sustainability of these efforts. Outcome efforts to
date provide some evidence for improved care of individual patients, some evidence for minimizing
emergence of resistance, and ample evidence for cost reduction. Attention to evaluation methods must be
increased to provide convincing evidence for the continuation of such programs.
NosoBase n° 33801
Première détection d'Escherichia coli producteur de metallo-bêta-lactamase VIM-4 en Russie
Shevchenko OV; Mudrak DY; Skleenova EY; Kozyreva VK; Llina EN; Ikryannikova LN; et al. First detection of
VIM-4 metallo-beta-lactamase-producing Escherichia coli in Russia. Clinical microbiology and infection 2012;
in press: 4 pages.
Mots-clés : ESCHERICHIA COLI; ANTIBIORESISTANCE; CARBAPENEME
An Escherichia coli isolate co-producing VIM-4 metallo-ß-lactamase and CTX-M-15 extended spectrum ßlactamase was recovered from the urine of a patient with head trauma in Moscow, Russia. The bla(VIM-4)
and bla(CTX-M-15) genes were carried, respectively, by transmissible plasmids of IncW and IncI1 groups.
The nucleotide sequence of the VIM-4-encoding integron was nearly identical to that of In416, which
represent a large group of structurally related integrons previously found in Enterobacteriaceae all around the
Mediterranean basin. This is the first report of a metallo-ß-lactamase-producing E. coli in Russia.
NosoBase n° 33613
Gestion des antibiotiques dans un grand centre hospitalier universitaire : l’analyse des coûts avant,
pendant et après un programme de 7 ans
Standiford HC; Chan S; Tripoli M; Weekes E; Forrest GN. Antimicrobial stewardship at a large tertiary care
academic medical center: cost analysis before, during, and after a 7-year program. Infection control and
hospital epidemiology 2012/04; 33(4): 338-345.
Mots-clés : ANTIBIOTIQUE; COUT; CENTRE HOSPITALIER UNIVERSITAIRE; MEDECIN; PHARMACIEN;
FORMATION; ETUDE TRANSVERSALE
Background: An antimicrobial stewardship program was fully implemented at the University of Maryland
Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an
antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a
part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active
intervention and education when necessary. The program continued for 7 years and was terminated in order
to use the resources to increase infectious diseases consults throughout the medical center as an alternative
mode of stewardship.
Design: A descriptive cost analysis before, during, and after the program.
Patients/setting: A large tertiary care teaching medical center.
Methods: Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.
Results: The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full
implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY
2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result
of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the
end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3%
increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the
antibacterial category.
Conclusions: The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely
cost effective over this 7-year period.
NosoBase n° 33610
Politique de gestion des antibiotiques par les sociétés savantes américaines "Society for healthcare
epidemiology of America" (SHEA), "Infectious diseases society of America" (IDSA), et "Pediatric
infectious diseases society" (PIDS)
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Society for Healthcare Epidemiology of America; Infectious Diseases Society OF America; Pediatric
Infectious Diseases Society. Policy statement on antimicrobial stewardship by the society for healthcare
epidemiology of America (SHEA), the infectious diseases society of America (IDSA), and the pediatric
infectious diseases society (PIDS). Infection control and hospital epidemiology 2012/04; 33(4): 322-327.
Mots-clés : ANTIBIOTIQUE; PEDIATRIE; RECOMMANDATION; ANTIBIORESISTANCE; PRESCRIPTION;
DDJ; COUT; EFFET INDESIRABLE; PRESSION DE SELECTION; FORMATION
Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the
twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a
critical threat to the public health of the United States. Antimicrobial stewardship programs optimize
antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective
pressures that drive the emergence of resistance and may also reduce excessive costs attributable to
suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all
healthcare institutions across the continuum of care. This position statement of the Society for Healthcare
Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases
Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship
throughout health care, suggests process and outcome measures to monitor these interventions, and
addresses deficiencies in education and research in this field as well as the lack of accurate data on
antimicrobial use in the United States.
NosoBase n° 33772
Un clone multi-résistant aux antibiotiques de Staphylococcus epidermidis (ST2) est responsable en
continu d'infections nosocomiales dans un hôpital d'Australie occidentale
Widerstrom M; McCullough CA; Coombs GW; Monsen T; Christiansen KJ. A multidrug-resistant
Staphylococcus epidermidis clone (ST2) is an ongoing cause of hospital acquired infection in a Western
australian hospital. Journal of clinical microbiology 2012; in pres: 16 pages.
Mots-clés
:
STAPHYLOCOCCUS
EPIDERMIDIS;
STAPHYLOCOCCUS;
ANTIBIORESISTANCE; MULTIRESISTANCE; TYPAGE; GENOTYPE
ANTIBIOTIQUE;
We report the molecular epidemiology of twenty-seven clinical multidrug-resistant Staphylococcus
epidermidis (MDRSE) collected between 2003 and 2007 in an Australian teaching hospital. The dominant
genotype (ST2) accounted for 85% of the isolates tested and was indistinguishable from a MDRSE genotype
identified in European hospitals, which may indicate that highly adaptable healthcare-associated genotypes of
S. epidermidis have emerged and disseminated worldwide in the healthcare setting.
Bactériémie
NosoBase n° 33825
Bactériémies à Staphylococcus aureus associées aux soins versus nosocomiales
Bishara J; Goldberg E; Leibovici L; Samra Z; Shaked H; Mansur N; et al. Healthcare-associated vs. hospital
acquired Staphylococcus aureus bacteremia. International journal of infectious diseases 2012; in press: 7
pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; BACTERIEMIE; COHORTE; ETUDE RETROSPECTIVE;
FACTEUR DE RISQUE
Objective: To analyze clinical features and outcomes of patients with hospital-acquired (HA) and healthcareassociated (HCA) Staphylococcus aureus bacteremia.
Methods: A retrospective cohort study was conducted from 1988 to 2007. We compared patients with
clinically significant HA with those with HCA S. aureus bacteremia. Risk factors for 30-day all-cause mortality
were assessed using multivariable logistic regression analysis. Cox regression analysis was used to estimate
the hazard ratio (HR) for 5-year mortality with 95% confidence intervals (CI).
Results: Of 1261 episodes, 735 (58.3%) were HA and 526 (41.7%) were HCA. The percentage of MRSA was
48.2% (354/735) in HA vs. 42.2% (222/526) in HCA bacteremia; p=0.04. The percentages of HCA S. aureus
bacteremia and MRSA bacteremia did not vary throughout the study period. Mortality at 30 days was 40.2%
(507/1261) and at 1 year was 63.4% (800/1261); this was comparable for HA and HCA bacteremia. Five-year
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survival curves in both settings followed very similar patterns (HR 1.01, 95% CI 0.89-1.15). Risk factors for
30-day mortality were similar, except for primary bacteremia and pre-existing heart valve disease in the HA
group.
Conclusions: HCA S. aureus bacteremia shares many similarities with HA bacteremia with respect to the
prevalence of MRSA strains, mortality rates, and risk factors for death, and should be managed similarly.
NosoBase n° 33626
Elaborer des recommandations, spécifiques à chaque service, pour le traitement empirique de
bactériémies primaires et bactériémies associées à un cathéter en déterminant la probabilité d’une
thérapie inadaptée
Davis ME; Anderson DJ; Sharpe M; Chen LF; Drew RH. Constructing unit-specific empiric treatment
guidelines for catheter-related and primary bacteremia by determining the ikelihood of inadequate therapy.
Infection control and hospital epidemiology 2012/04; 33(4): 416-420.
Mots-clés : BACTERIEMIE; RECOMMANDATION; TRAITEMENT; STATISTIQUE; ANTIBIOTYPIE
This study aimed to determine the feasibility of using likelihood of inadequate therapy (LIT), a parameter
calculated by using pathogen frequency and in vitro susceptibility for determination of appropriate empiric
antibiotic therapy for primary bloodstream infections. Our study demonstrates that LIT may reveal differences
in traditional antibiograms.
NosoBase n° 33834
La catégorie distincte de bactériémies associées aux soins
Lenz R; Leal JR; Church DL; Gregson DB; Ross T; Laupland KB. The distinct category of healthcare
associated bloodstream infections. BMC infectious diseases 2012; in press: 11 pages.
Mots-clés : BACTERIEMIE; EPIDEMIOLOGIE; MICROBIOLOGIE; DUREE DE SEJOUR; ESCHERICHIA
COLI; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS PNEUMONIAE; MORTALITE; COHORTE;
SURVEILLANCE; DEFINITION
Background: Bloodstream infections (BSI) have been traditionally classified as either community acquired
(CA) or hospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community
onset disease has been increasingly recognized. The objective of this study was to compare and contrast
characteristics of HCA-BSI with CA-BSI and HA-BSI.
Methods: All first episodes of BSI occurring among adults admitted to hospitals in a large health region in
Canada during 2000-2007 were identified from regional databases. Cases were classified using a series of
validated algorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic,
microbiologic, and outcome characteristics.
Results: A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088
(40%) had CA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical
illnesses than patients with HCA-BSI or HA-BSI (p<0.001). The proportion of cases in males was higher for
HA-BSI (60%; p<0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54 %; p=0.13). The
proportion of cases that had a poly-microbial etiology was significantly lower for CA-BSI (5.5%; p<0.001)
compared to both HA and HCA (8.6 vs. 8.3 %). The median length of stay following BSI diagnosis 15 days for
HA, 9 days for HCA, and 8 days for CA (p<0.001). Overall the most common species causing bloodstream
infection were Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. The distribution and
relative rank of importance of these species varied according to classification of acquisition. Twenty eight day
all cause case-fatality rates were 26%, 19%, and 10% for HA-BSI, HCA-BSI, and CA-BSI, respectively
(p<0.001).
Conclusion: Healthcare-associated community onset infections are distinctly different from CA and HA
infections based on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds
further support for the classification of community onset BSI into separate CA and HCA categories.
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NosoBase n° 33780
Bactériémies à Proteus mirabilis multirésistant aux antibiotiques : facteurs de risque et évolution
Tumbarello M; Trecarichi EM; Fiori B; Losito AR; D'Inzeo T; Campana L; et al. Multidrug-resistant Proteus
mirabilis bloodstream infections: risk factors and outcomes. Antimicrobial agents and chemotherapy 2012; in
press: 29 pages.
Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; BACTERIEMIE; PROTEUS; ENTEROBACTERIE;
PROTEUS MIRABILIS; FACTEUR DE RISQUE; ETUDE RETROSPECTIVE; CAS TEMOIN; CENTRE
HOSPITALIER UNIVERSITAIRE; SURVEILLANCE
Our aims were to identify 1) risk factors associated with the acquisition of multidrug resistant (MDR, to 3 or
more classes of antimicrobials) Proteus mirabilis (Pm) isolates responsible for bloodstream infections (BSIs)
and 2) the impact on mortality of such infections. Risk factors for acquiring MDR Pm BSIs were investigated
in a case-case-control study; those associated with mortality were assessed by comparing survivors and non
survivors in a cohort study. The population consisted of 99 adult inpatients with Pm BSIs identified by our
laboratory over an 11-year period (1999-2009), 36 (33.3%) of which were caused by MDR strains, and the
overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with
admission from a long-term care facility (odds ratio [OR], 9.78; 95% confidence interval [CI], 1.94-49.16));
previous therapy with fluoroquinolones (OR, 5.52; 95% CI, 1.30-23.43) or oxyimino-cephalosporins (OR, 4.72;
95% CI, 1.31-16.99); urinary catheterization (OR, 3.89; 95% CI, 1.50-10.09); and previous hospitalization
(OR, 2.68; 95% CI, 1.04-6.89). Patients with MDR-Pm BSIs received inadequate empirical antimicrobial
therapy (IIAT, i.e., treatment with drugs to which the isolate displayed in vitro resistance) more frequently than
those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset
hospital stays. In multivariate regression analysis, 21-day-mortality was associated with septic shock at BSI
onset (OR 12.97; 95% CI, 3.22-52.23); Pm isolates that were MDR (OR 6.62, 95% CI 1.64-26.68); and IIAT
(OR, 9.85 95% CI 2.67-36.25)- the only modifiable risk factor of the 3. These findings can potentially improve
clinicians' ability to identify Pm BSIs likely to be MDR, thereby reducing the risk of IIAT-a major risk factor for
mortality in these cases-and facilitating prompt implementation of appropriate infection control measures.
Candida
NsoBase n° 33836
Diagnostic, gestion et évolution des endocardites à Candida
Lefort A; Chartier L; Sendid B; Wolff M; Mainardi JL; Podglajen I; et al. Diagnosis, management and outcome
of Candida endocarditis. Clinical microbiology and infection 2012/04; 18(4): E99-E109.
Mots-clés : DIAGNOSTIC; ENDOCARDE; CANDIDA; TRAITEMENT; ANTIFONGIQUE; MORTALITE; PCR
Limited data exist on Candida endocarditis (CE) outcome in the era of new antifungals. As early diagnosis of
CE remains difficult, non-culture-based tools need to be evaluated. Through the French prospective
MYCENDO study (2005-2007), the overall characteristics and risk factors for death from CE were analysed.
The contribution of antigen detection (mannan/anti-mannan antibodies and (1, 3)-ß-d-glucans) and molecular
tools was evaluated. Among 30 CE cases, 19 were caused by non-albicans species. Sixteen patients (53%)
had a predisposing cardiac disease, which was a valvular prosthesis in ten (33%). Nine patients (30%) were
intravenous drug users; none of them had right-sided CE. Among the 21 patients who were not intravenous
drug users, 18 (86%) had healthcare-associated CE. Initial therapy consisted of a combination of antifungals
in 12 of 30 patients (40%). Thirteen patients (43%) underwent valve replacement. The median follow-up was
1 year after discharge from hospital (range, 5 months to 4 years) and hospital mortality was 37%. On
univariate analysis, patients aged =60 years had a higher mortality risk (OR 11, 95% CI 1.2-103.9; p 0.024),
whereas intravenous drug use was associated with a lower risk of death (OR 0.12, 95% CI 0.02-0.7; p 0.03).
Among 18 patients screened for both serum mannan/anti-mannan antibodies and (1, 3)-ß-d-glucans, all had a
positive result with at least one of either test at CE diagnosis. Real-time PCR was performed on blood
(SeptiFast) in 12 of 18, and this confirmed the blood culture results. In conclusion, CE prognosis remains
poor, with a better outcome among younger patients and intravenous drug users. Detection of serum antigens
and molecular tools may contribute to earlier CE diagnosis.
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NosoBase n° 33798
Importance clinique de la colonisation des cathéters vasculaires par Candida en l'absence de
candidémie documentée
Lopez-Medrano F; Fernandez-Ruiz M; Origuen J; Belarte-Tornero LC; Carazo-Medina R; Panizo-Mota F; et
al. Clinical significance of Candida colonization of intravascular catheters in the absence of documented
candidemia. Diagnostic microbiology and infectious disease 2012; in press: 5 pages.
Mots-clés : CANDIDA;
VEINEUX CENTRAL
COLONISATION;
CATHETER;
MORTALITE;
ANTIFONGIQUE;
CATHETER
In order to assess the significance of Candida colonization of intravascular catheters (IVC) in patients without
documented candidemia, we retrospectively reviewed all Candida-positive IVC tip cultures over a 4-year
period. Cases were defined as those with a culture yielding=15 colony-forming units of Candida spp. that
either did not have blood cultures (BC) taken or had concomitant BC negative for Candida. Patients were
followed up until death or 8 months after discharge. Risk factors for poor outcome following IVC removal
(death, candidemia, or Candida-related complication) were analyzed. We analyzed a total of 40 patients.
Overall mortality was 40.0%, with no death directly attributed to Candida infection. Twenty-two patients
received antifungal therapy at the time of IVC removal. Only 1 patient developed a metastatic complication
(chorioretinitis) attributable to transient candidemia (2.5% of the global cohort and 3.7% among those with
concomitant BC). There were no cases of subsequent candidemia. In the multivariate analysis, the use of
antifungal therapy did not show any impact on the risk of poor outcome. The risk of invasive disease in
patients with isolated IVC colonization by Candida seems to be low. Nevertheless, the initiation of systemic
antifungal therapy should be carefully considered in such context.
Cathétérisme
NosoBase n° 33778
Le décollement du pansement est un facteur de risque majeur d'infections liées au cathéter
Timsit JF; Bouadma L; Ruckly S; Schwebel C; Garrouste-Orgeas M; Bronchard R; et al. Dressing disruption
is a major risk factor for catheter-related infections. Critical care medicine 2012; 40(6): 1-8.
Mots-clés : FACTEUR DE RISQUE; CATHETER; PANSEMENT; PREVENTION;
SYNDROME SEPTIQUE; COLONISATION; PRATIQUE; COUT; RECOMMANDATION
BACTERIEMIE;
Objective: Major catheter-related infection includes catheter-related bloodstream infections and clinical sepsis
without bloodstream infection resolving after catheter removal with a positive quantitative tip culture. Insertion
site dressings are a major mean to reduce catheter infections by the extraluminal route. However, the
importance of dressing disruptions in the occurrence of major catheter-related infection has never been
studied in a large cohort of patients.
Design: A secondary analysis of a randomized multicenter trial was performed in order to determine the
importance of dressing disruption on the risk for development of catheter-related bloodstream infection.
Measurements and main results: Among 1,419 patients (3,275 arterial or central-vein catheters) included, we
identified 296 colonized catheters, 29 major catheter-related infections, and 23 catheter-related bloodstream
infections. Of the 11,036 dressings changes, 7,347 (67%) were performed before the planned date because
of soiling or undressing. Dressing disruption occurred more frequently in patients with higher Sequential
Organ Failure Assessment scores and in patients receiving renal replacement therapies; it was less frequent
in males and patients admitted for coma. Subclavian access protected from dressing disruption. Dressing
cost (especially staff cost) was inversely related to the rate of disruption. The number of dressing disruptions
was related to increased risk for colonization of the skin around the catheter at removal (p<.0001). The risk of
major catheter-related infection and catheter-related bloodstream infection increased by more than three-fold
after the second dressing disruption and by more than ten-fold if the final dressing was disrupted,
independently of other risk factors of infection.
Conclusion: Disruption of catheter dressings was common and was an important risk factor for catheterrelated infections. These data support the preferential use of the subclavian insertion site and enhanced
efforts to reduce dressing disruption in postinsertion bundles of care.
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Chirurgie
NosoBase n° 33782
Différences inter-professionnelles dans l'observance des précautions standard au bloc opératoire :
étude multi-sites, différentes méthodes
Cutter J; Jordan S. Inter-professional differences in compliance with standard precautions in operating
theatres: a multi-site, mixed methods study. International journal of nursing studies 2012; in press: 16 pages.
Mots-clés : RISQUE; OBSERVANCE; PERSONNEL; BLOC OPERATOIRE; PRECAUTION STANDARD;
CHIRURGIEN; INFIRMIER; EXPOSITION AU SANG; INFIRMIER DE BLOC OPERATOIRE; INFIRMIER
HYGIENISTE; MATERIEL DE SECURITE; FORMATION; QUESTIONNAIRE; TRAVAIL; PERCEPTION
Background: Occupational acquisition of blood-borne infections has been reported following exposure to
blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection.
Objectives: To identify: the frequency of self-reported adverse exposure to blood and body fluids among
surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of
compliance with standard precautions; and factors influencing compliance with precautions.
Design: A multi-site mixed methods study incorporating a cross-sectional survey and interviews.
Settings: Six NHS trusts in Wales between January 2006 and August 2008.
Participants: Surgeons and scrub nurses and Senior Infection Control Nurses.
Methods: A postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures,
followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection
Control Nurses.
Results: Response rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an
inoculation injury in the last five years: 183/315 (58.1%) reported sharps' injuries and 40/315 (12.7%)
splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated
with increased risk of sharps' injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04-2.88 and
adjusted odds ratio 2.0, 1.11-3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents
always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions;
64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and
259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their
own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.110.71) and to attend training sessions (odds ratio 0.111, 0.061-0.19). The professions viewed the risks
associated with their roles differently, with nurses being more willing to follow protocols.
Conclusion: Inter-professional differences in experiencing adverse exposures must be addressed to improve
safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote
compliance with policies and procedures.
NosoBase n° 33685
Observance des recommandations internationales et nationales pour la prévention des infections du
site opératoire en Italie : résultats d'une étude prospective d'observation en chirurgie réglée
Durando P; Bassetti M; Orengo G; Crimi P; Battistini A; Bellina D; et al. Adherence to international and
national recommendations for the prevention of surgical site infections in Italy: results from an observational
prospective study in elective surgery. American journal of infection control 2012; in press: 4 pages.
Mots-clés : PREVENTION; RECOMMANDATION; SITE OPERATOIRE; ETUDE PROSPECTIVE;
CHIRURGIE; CENTRE HOSPITALIER UNIVERSITAIRE; PRATIQUE; DOUCHE; PRE-OPERATOIRE;
DEPILATION; ANTIBIOPROPHYLAXIE; BLOC OPERATOIRE; ANTISEPTIQUE; GESTION DES RISQUES;
OBSERVANCE; PERSONNEL
Background: An observational prospective study of the perioperative procedures for prevention of surgical
site infections (SSIs) was carried out in a tertiary referral teaching hospital in Liguria, Italy, to evaluate their
adherence to international and national standards.
Methods: A 1-month survey was performed in all surgical departments, monitored by turns by trained survey
teams. Data regarding presurgical patient preparation and intraoperative infection control practices were
collected.
Results: A total of 717 elective interventions were actively monitored in 703 patients who underwent surgery.
Hair-shaving was performed mainly using a razor (92%) by the nurses (72.8%) on the day before the
operation (83.5%). All of the patients showered, either with a common detergent (87%) or with an antiseptic
solution (13%). Antimicrobial prophylaxis was administered properly in 75.7% of the patients at induction of
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anaesthesia; however, according to current Italian guidelines, inappropriate prophylaxis was provided in
55.2% patients. Appropriate antisepsis of the incision area was done in 97.4% of the operations, and nearly
90% of the interventions lasted less than the respective 75th percentile. The doors of the operating theatres
were mostly open during the duration of the operation in 36.3% of the cases.
Conclusions: This review of infection control policies identified significant opportunities for improving the
safety and the quality of routine surgical practice.
EHPAD / Personne âgée
NosoBase n° 33777
Pneumonies acquises en EHPAD en Allemagne. Huit ans d'étude prospective multicentrique
Ewig S; Klapdor B; Pletz MW; Rohde G; Schutte H; Schaberg T; et al. Nursing-home-acquired pneumonia in
Germany: an 8-year prospective multicentre study. Thorax 2012/02; 67(2): 132-138.
Mots-clés : PNEUMONIE; ETUDE PROSPECTIVE; RESEAU; STREPTOCOCCUS; STREPTOCOCCUS
PNEUMONIAE; MORTALITE; PERSONNE AGEE; EHPAD; ANTIBIOTIQUE; TRAITEMENT
Objective: To determine differences in aetiologies, initial antimicrobial treatment choices and outcomes in
patients with nursing-home-acquired pneumonia (NHAP) compared with patients with community-acquired
pneumonia (CAP), which is a controversial issue.
Methods: Data from the prospective multicentre Competence Network for Community-acquired pneumonia
(CAPNETZ) database were analysed for hospitalised patients aged =65 years with CAP or NHAP. Potential
differences in baseline characteristics, comorbidities, physical examination findings, severity at presentation,
initial laboratory investigations, blood gases, microbial investigations, aetiologies, antimicrobial treatment and
outcomes were determined between the two groups.
Results: Patients with NHAP presented with more severe pneumonia as assessed by CRB-65 (confusion,
respiratory rate, blood pressure, 65 years and older) score than patients with CAP but received the same
frequency of mechanical ventilation and less antimicrobial combination treatment. There were no clinically
relevant differences in aetiology, with Streptococcus pneumoniae the most important pathogen in both
groups, and potential multidrug-resistant pathogens were very rare (<5%). Only Staphylococcus aureus was
more frequent in the NHAP group (n=12, 2.3% of the total population, 3.1% of those with microbial sampling
compared with 0.7% and 0.8% in the CAP group, respectively). Short-term and long-term mortality in the
NHAP group was higher than in the CAP group for patients aged =65 years (26.6% vs 7.2% and 43.8% vs
14.6%, respectively). However, there was no association between excess mortality and potential multidrugresistant pathogens.
Conclusions: Excess mortality in patients with NHAP cannot be attributed to a different microbial pattern but
appears to result from increased comorbidities, and consequently, pneumonia is frequently considered and
managed as a terminal event.
NosoBase n° 33897
Epidémies successives d'infections à Streptococcus groupe A dans des établissements de soins
pour personnes âgées ; leçons tirées
Inkster T; Wright P; Kane H; Paterson E; Dodd S; Slorach J. Successive outbreaks of group A streptococcus
(GAS) in care of the elderly settings; lessons learned. Journal of infection prevention 2012/03; 13(2): 38-43.
Mots-clés : EPIDEMIE; PERSONNE AGEE; GERIATRIE; STREPTOCOCCUS; STREPTOCOCCUS
GROUPE A; ERADICATION; CONTROLE; PERSONNEL; ENQUETE; DEPISTAGE; HYGIENE DES MAINS;
ENVIRONNEMENT; PANSEMENT; SOIN DE PLAIE CUTANEE; SURVEILLANCE
Group A streptococcal (GAS) outbreaks in care of the elderly settings are rare. We describe two successive
outbreaks involving care of the elderly patients. The first outbreak involved 18 patients and the second
involved six patients and two healthcare workers. We describe the difficulties encountered controlling GAS
outbreaks in care of the elderly settings and how the lessons learned from the first outbreak influenced
management of the second incident. Stringent infection control measures including isolation until completion
of treatment and re-screening for evidence of eradication were required to bring outbreak one under control.
These measures were adopted early in outbreak two and we suspect that these measures and the rapid
identification of carriers brought this second outbreak under control quickly.
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NosoBase n° 33811
Surveillance du poids des infections en EHPAD
Lim CJ; McLellan SC; Cheng AC; Culton JM; Parikh SN; Peleg AY; Kong DC. Surveillance of infection burden
in residential aged care facilities. The Medical journal of Australia 2012/03/19; 196(5): 327-333.
Mots-clés : SURVEILLANCE; CONSOMMATION; ANTIBIOTIQUE; ETUDE RETROSPECTIVE; EHPAD;
PERSONNE AGEE; RESEAU; INCIDENCE; APPAREIL RESPIRATOIRE
Objectives: To explore the burden of illness associated with infectious syndromes and to measure the
associated use of antimicrobials in residential aged care facilities (RACFs).
Design, setting and subjects: Retrospective analysis of data for January 2006 to December 2010 from an
infection surveillance system covering residents of four co-located RACFs, with a total of 150 residential care
beds, in Melbourne, Victoria.
Main outcome measures: Number of episodes and incidence of health care-associated infection (HCAI); rate
of antimicrobial use; prescribing concordance with McGeer criteria for infection; frequency of clinical
specimen collection.
Results: There were 1114 episodes of an infectious syndrome over 267 684 occupied bed-days (OBD),
affording an average HCAI rate of 4.16 episodes/1000 OBD annually over 5 years (95% CI, 3.92-4.41). The
mean rate of antimicrobial use was 7.07 courses/1000 OBD (range, 6.71-7.84). Around 40% of antimicrobial
prescribing was for episodes that did not fulfil the McGeer criteria for clinical infection; this included about half
of suspected urinary tract and upper respiratory tract infections (URTI), and about one-third of suspected
lower respiratory tract and skin infections. Antimicrobials were routinely prescribed for URTI and bronchitis. Of
all episodes treated with antimicrobials, 36% had documentation that a clinical specimen was obtained.
Conclusions: The HCAI rate remained relatively stable over time. Routine surveillance and feedback of
infection rates to the facilities did not result in a noticeable decrease of infection burden over time. It is of
immediate concern that antimicrobials were being prescribed for a large proportion of suspected infections
that did not meet criteria for clinical infection. Opportunities exist to further improve the use of antimicrobials in
the RACF setting.
NosoBase n° 33804
Usage et mauvais usage des antibiotiques en EHPAD
Stuart RL; Wilson J; Bellaard-Smith E; Brown R; Wright L; Vandergraaf S; et al. Antibiotic use and misuse in
residential aged care facilities. Internal medicine journal 2012; in press: 15 pages.
Mots-clés :
ANTIBIOTIQUE;
EHPAD;
PREVALENCE;
PRESCRIPTION;
PERSONNE
AGEE;
MULTIRESISTANCE; COLONISATION; ESCHERICHIA COLI; BETA-LACTAMASE A SPECTRE ELARGI;
COHORTE
Introduction: The prevention and control of transmission of antimicrobial-resistant pathogens in Residential
Aged Care Facilities (RACF) is an area that has been neglected yet has significant implications for health
services. The aim of this study was to describe the prevalence and appropriateness of antibiotic use within
five RACF associated with our health service.
Methods: Demographic data on each RACF and all residents was obtained and antibiotics prescribed (the
type, indication and duration) at the time of the survey were recorded. The appropriateness of antibiotic
prescribing was assessed using well-established criteria.
Results: Of the 257 residents, 28% were greater than 85 years of age, almost 50% were male and 71% had
been in their RACF for more than a year. Sixty-seven percent were incontinent of urine or feces and 80% had
some degree of cognitive impairment. Among the residents, 23 (9%) were receiving antibiotics at the time of
the survey. Seventeen (74%) were for treatment while 6 (26%) were given for prophylactic reasons. Data on
the appropriateness of antibiotic use was available for the preceding 26-month period. During this time there
were 988 antibiotic courses administered, of these 392 (39.7%) did not fulfill the criteria for bacterial infection.
Discussion: This, the first Australian study to report on the use of antibiotics within RACF, shows a high rate
of antimicrobial prescribing and inappropriate antibiotic use. Antibiotic stewardship is of paramount
importance in RACF. Programs to promote the rational use of antibiotics and minimize the emergence of
resistant pathogens are urgently required in Australian RACF.
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Entérobactérie
NosoBase n° 33868
Les entérobactéries productrices de carbapénémases
Boutet-Dubois A; Pantel A; Sotto A; Lavigne JP. Alin&as 2012/04; 2: 1-5.
Mots-clés : ENTEROBACTER; CARBAPENEME; ANTIBIORESISTANCE; EPIDEMIOLOGIE; DEPISTAGE
L'émergence des entérobactéries résistantes aux carbapénèmes constitue un réel problème de santé
publique. Les carbapénèmes représentent très souvent les dernières molécules actives de l'arsenal
thérapeutique pour combattre les bactéries multirésistantes.
Enterovirus
NosoBase n° 33771
Dépistage et détection d'infections par l'enterovirus humain 71 par RT-PCR en temps réel à Marseille,
France, 2009-2011
Tan C; Gonfrier G; Ninove L; Zandotti C; Dubot-Peres A; De Lamballerie X; et al. Screening and detection of
human enterovirus 71 infection by a real-time RT-PCR assay in Marseille, France, 2009-2011. Clinical
microbiology and infection 2012/04; 18(4): E77-E80.
Mots-clés : DEPISTAGE; VIRUS; ENTEROVIRUS; PCR; BIOLOGIE MOLECULAIRE; PEDIATRIE
Enterovirus-positive samples diagnosed in Marseille (January 2009 to September 2011) were screened for
EV71 by real-time RT-PCR. EV71 was detected in three children below the age of 2 years with no history of
overseas travel; two of these cases were associated with severe clinical presentation. Viruses demonstrated
genetic similarity to other European genogroup C2 strains. Strain MRS/09/3663 complete sequencing
revealed 97.6% identity across the entire genome with a 2008 Singapore isolate, without signs of possible
recombination events. To our knowledge, this is the first detection of EV71 infection in Marseille, France, that
confirms the current circulation of EV71 in France.
Environnement
NosoBase n° 33699
Les rideaux de séparation des hôpitaux sont fréquemment et rapidement contaminés par des
bactéries potentiellement pathogènes
Ohl M; Schweizer M; Graham M; Heilmann K; Boyken L; Diekema D. Hospital privacy curtains are frequently
and rapidly contaminated with potentially pathogenic bacteria. American journal of infection control 2012; in
press: 3 pages.
Mots-clés : CONTAMINATION; CHAMBRE; ENVIRONNEMENT; PREVALENCE; PRELEVEMENT;
STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS; BACILLE GRAM NEGATIF; ANTIBIORESISTANCE;
TYPAGE; PFGE
Background: Privacy curtains are a potentially important site of bacterial contamination in hospitals. We
performed a longitudinal study to determine the prevalence and time course of bacterial contamination on
privacy curtains.
Methods: Over a 3-week period, swab cultures (n=180) were obtained twice weekly from the leading edge of
43 curtains in 30 rooms in 2 intensive care units and a medical ward. Curtains were marked to determine
when they were changed. Contamination with Staphylococcus aureus, methicillin-resistant S aureus (MRSA),
Enterococcus spp, vancomycin-resistant Enterococcus (VRE), or aerobic gram-negative rods was determined
by standard microbiologic methods. To distinguish persistence of pathogens on curtains from
recontamination, all VRE and MRSA were typed using pulsed-field gel electrophoresis.
Results: Twelve of 13 curtains (92%) placed during the study showed contamination within 1 week. Forty-one
of 43 curtains (95%) demonstrated contamination on at least 1 occasion, including 21% with MRSA and 42%
with VRE. Eight curtains yielded VRE at multiple time points: 3 with persistence of a single isolate type and 5
with different types, suggesting frequent recontamination.
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Conclusion: Privacy curtains are rapidly contaminated with potentially pathogenic bacteria. Further studies
should investigate the role of privacy curtains in pathogen transmission and provide interventions to reduce
curtain contamination.
NosoBase n° 33785
Les stéthoscopes source de Staphylococcus aureus méticillino-résistant d'origine nosocomiale
Russell A; Screst J; Schreeder C. Stethoscopes as a source of hospital-acquired methicillin-resistant
Staphylococcus aureus. Journal of perianesthesia nursing 2012/04; 27(2): 82-87.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; STETHOSCOPE; ALCOOL; SOIN
INTENSIF; CENTRE HOSPITALIER UNIVERSITAIRE; ECHANTILLON; DESINFECTION; PERSONNEL;
COLONISATION; EFFICACITE; DISPOSITIF MEDICAL
Stethoscopes are potential vectors of methicillin-resistant Staphylococcus aureus (MRSA). The purpose of
this project was to determine the presence of MRSA on the diaphragms of personal and unit stethoscopes
within a hospital setting before and after cleaning with alcohol prep pads. The sample consisted of 141
personal and unit stethoscopes in adult medical-surgical and intensive care units of a large university hospital
in the Southeast. Each stethoscope was cultured once before cleaning and once after cleaning. Cultures
were obtained using sterile swabs and inoculated on a selective medium for MRSA. Bacterial growth was
noted in the precleaning group, but no MRSA colonies were detected. The postcleaning group had no
bacterial growth. There was not enough data to statistically support that isopropyl alcohol is effective in
decreasing bacterial counts; however, these findings suggest that current disinfection guidelines are effective
in preventing MRSA colonization on stethoscopes in this setting.
Gale
NosoBase n° 33770
La gale dans les pays en développement : prévalence, complications et prise en charge
Hay RJ; Steer AC; Engelman D; Walton S. Scabies in the developing world-its prevalence, complications, and
management. Clinical microbiology and infection 2012/04; 18(4): 313-323.
Mots-clés : PREVALENCE; GALE; PAYS EN DEVELOPPEMENT; PEAU; PEDIATRIE; STAPHYLOCOCCUS
AUREUS; STREPTOCOCCUS; STREPTOCOCCUS GROUPE A; TRANSMISSION; DIAGNOSTIC;
TRAITEMENT; CONTROLE; ENVIRONNEMENT; EPIDEMIOLOGIE; BIBLIOGRAPHIE
Scabies remains one of the commonest of skin diseases seen in developing countries. Although its
distribution is subject to a cycle of infection, with peaks and troughs of disease prevalence, this periodicity is
often less obvious in poor communities. Scabies is a condition that affects families, particularly the most
vulnerable; it also has the greatest impact on young children. Largely through the association with secondary
bacterial infection caused by group A streptococci and Staphylococcus aureus, the burden of disease is
compounded by nephritis, rheumatic fever and sepsis in developing countries. However, with a few notable
exceptions, it remains largely neglected as an important public health problem. The purpose of this review is
to provide an update on the current position of scabies with regard to its complications and control in
resource-poor countries.
NosoBase n° 33779
Contrôle de vastes épidémies de gales dans une institution
Stoevesandt J; Carle L; Leverkus M; Hamm H. Control of large institutional scabies outbreaks. Journal der
deutsches dermatologischen gesellschaft 2012; in press: 12 pages.
Mots-clés : INFECTION
BIBLIOGRAPHIE
COMMUNAUTAIRE;
GALE;
EPIDEMIE;
CONTROLE;
TRAITEMENT;
Background: Scabies outbreaks in community facilities may reach large dimensions and take a protracted
course. Highly contagious crusted scabies is a major cause of nosocomial outbreaks.
Patients and methods: On the occasion of an extensive scabies outbreak in a north Bavarian sheltered
workshop and its associated residential homes with over 500 exposed individuals, a multifaceted control
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strategy was developed and pursued. Knowledge from a comprehensive review of the literature was utilized.
Results: Our successful scabies elimination concept includes: 1) Careful organization (formation of an
outbreak management team, registration and information of all exposed individuals, prospective time
management, financial calculation); 2) simultaneous clinical examination of all individuals at risk; 3)
synchronous topical treatment of all exposed individuals with permethrin 5 % cream on day 0, repeated
treatment of proven and doubtful cases on days 1 and 14; systemic treatment of selected cases with oral
ivermectin; 4) decontamination and quarantine measures; 5) follow-up investigations and repeated treatment
if indicated.
Conclusions: Management of large institutional scabies outbreaks requires a high degree of motivation,
communication skills and perseverance.
NosoBase n° 33784
Facteurs de risque de gale à Taïwan
Wang CH; Lee SC; Huang SS; Kao YC; See LC; Yang SH. Risk factors for scabies in Taiwan. Journal of
microbiology immunology and infection 2012; in press: 5 pages.
Mots-clés : FACTEUR DE RISQUE; GALE; CAS TEMOIN; CATHETER
Background: Scabies is a global problem. Transmission of scabies is usually due to direct or indirect contact.
Delay in diagnosis may result in the spread of the scabies mite. Prompt diagnosis and treatment are
important.
Methods: In this study, we collected data from 52 scabies patients and analyzed the risk factors for scabies
with the case-control method.
Results: Our study has revealed that the patients who were bedridden [odds ratio (OR) 6.72, p<0.0001], living
in a nursing home (OR 9.89, p<0.0001), had a higher clinical severity status before admission (OR 1.25,
p<0.0001), and a catheter inserted (including nasogastric tube, Foley catheter, Port-A, or Hickman catheter)
(OR 9.05, p<0.0001) were significantly more likely to acquire scabies infection.
Conclusion: To prevent scabies, proper management of the nursing home setting, including adequate
cleaning of the contaminated clothing, bedding and equipment, in combination with treating all suspected
scabies patients, and contact isolation are important and necessary.
Gestion des risques
NosoBase n° 33876
Amélioration des pratiques et sécurité des soins. La sécurité des patients - Mettre en oeuvre la
gestion des risques associés aux soins en établissement de santé : Des concepts à la pratique
Haute Autorité de santé (HAS). HAS 2012/03: 1-219.
Mots-clés : RECOMMANDATION; GESTION DES RISQUES; QUALITE; SECURITE; RISQUE;
ORGANISATION; EVENEMENT INDESIRABLE GRAVE; INCIDENCE; METHODOLOGIE; CERTIFICATION;
ACCREDITATION; SIGNALEMENT; INDICATEUR; AUDIT
La gestion des risques associés aux soins en établissement de santé relève d'une démarche collective.
L'enjeu est la sécurité des patients pris en charge au sein d'organisations marquées par des succès locaux
indéniables, mais aussi par la survenue d'évènements indésirables susceptibles de compromettre la
performance collective. Des enquêtes montrent que ceux-ci sont fréquents, parfois graves, souvent évitables.
Une mobilisation générale sur cette problématique explique les évolutions récentes en termes de politique
publique, de réglementation et de procédure de certification des établissements de santé. Ce guide, qui ne
peut se substituer aux actions de formation nécessaires à tous les niveaux concernés (gouvernance,
coordination, mise en oeuvre opérationnelle), constitue l'un des moyens d'accompagnement de cette
démarche. Ce document méthodologique n'a pas vocation à être opposable. Il appartient en effet à chaque
établissement de santé de s'approprier les différentes préconisations proposées et de les adapter à sa propre
organisation. Ceci avec l'objectif essentiel de réduire le risque de survenue d'évènements indésirables graves
évitables. Conçu sur un principe modulaire pour aider des non spécialistes de la gestion des risques associés
aux soins, ce guide est structuré selon trois niveaux :
- par grandes fonctions (gouvernance, coordination, mise en oeuvre opérationnelle),
- par axes d'actions thématiques identifiés au sein de chacune de ces fonctions,
- en méthodes et outils proposés au moyen de fiches techniques illustrées destinées à faciliter la démarche
au sein des axes d'actions concernés.
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Cette approche favorise une lecture thématique, mais aussi des actions ciblées (en réflexion stratégique, en
mise en oeuvre opérationnelle, en communication, en formation, en applications documentaires diverses,
etc.).
Hygiène des mains
NosoBase n° 33704
Absorption dermique et pulmonaire de l'éthanol à partir de produit hydro-alcoolique pour la friction
des mains
Ahmed-Lecheheb D; Cunat L; Hartemann P; Hautemanière A. Dermal and pulmonary absorption of ethanol
from alcohol-based hand rub. The Journal of hospital infection 2012/05; 81(1): 31-35.
Mots-clés : ALCOOL; GEL HYDROALCOOLIQUE; HYGIENE DES MAINS; PERSONNEL; TRAITEMENT
HYGIENIQUE DES MAINS PAR FRICTION; PRODUIT DE FRICTION POUR LES MAINS
Background: Ethanol intoxication of healthcare workers (HCWs) using alcohol-based hand rubs (ABHRs) in
the workplace is a potentially serious issue. This study quantified the level of ethanol absorption among
HCWs after hygienic hand disinfection.
Methods: Eighty-six HCWs from Nancy University Hospital were tested before and after a 4-h shift.
Participants used ABHR containing 70% ethanol. Levels of ethanol, acetaldehyde and acetate in blood and
urine were determined using gas chromatography. A breathalyzer was used to measure the level of ethanol in
expired air.
Results: Ethanol [mean concentration 0.076 (standard deviation 0.05) mg/L] was detected in the expired air of
28 HCWs 1-2 min post exposure. Ethanol, acetaldehyde and acetate were undetectable in blood after a 4-h
shift, and urine tests were negative in all participants.
Conclusion: Ethanol exposure from ABHR, particularly inhalation of vapours, resulted in positive breathalyzer
readings 1-2 min after exposure. Dermal absorption of ethanol was not detected. Pulmonary absorption was
detected but was below toxic levels.
NosoBase n° 33687
Une information sur l'hygiène des mains via l'économiseur d'écran d'ordinateur infléchit une
tendance négative du comportement concernant l'hygiène des mains
Helder OK; Weggelaar AM; Waarsenburg D; Looman C; Van Goudoever JB; Brug J; et al. Computer screen
saver hand hygiene information curbs a negative trend in hand hygiene behavior. American journal of
infection control 2012; in press: 4 pages.
Mots-clés : HYGIENE DES MAINS; NEONATALOGIE; SOIN INTENSIF; INFORMATION; ORDINATEUR;
ATTITUDE; DISTRIBUTEUR; SOLUTION HYDROALCOOLIQUE; OBSERVANCE
Background: Appropriate hand hygiene among health care workers is the most important infection prevention
measure; however, compliance is generally low. Gain-framed messages (ie, messages that emphasize the
benefits of hand hygiene rather than the risks of noncompliance) may be most effective, but have not been
tested.
Methods: The study was conducted in a 27-bed neonatal intensive care unit. We performed an interrupted
time series analysis of objectively measured hand disinfection events. We used electronic devices in hand
alcohol dispensers, which continuously documented the frequency of hand disinfection events. In addition,
hand hygiene compliance before and after the intervention period were directly observed.
Results: The negative trend in hand hygiene events per patient-day before the intervention (decrease by 2.3
[standard error, 0.5] per week) changed to a significant positive trend (increase of 1.5 [0.5] per week) after the
intervention (P<.001). The direct observations confirmed these results, showing a significant improvement in
hand hygiene compliance from 193 of 303 (63.6%) observed hand hygiene events at pretest to 201 of 281
(71.5%) at posttest.
Conclusions: We conclude that gain-framed messages concerning hand hygiene presented on screen savers
may improve hand hygiene compliance.
NosoBase n° 33814
Hygiène des mains chez des étudiants en médecine : réalisation, formation et connaissances
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Scheithauer S; Haefner H; Schwanz T; Lopez-Conzalez L; Bank C; Schulze-Robbecke R; et al. Hand hygiene
in medical students: performance, education and knowledge. International journal of hygiene and
environmental health 2012; in press: 4 pages.
Mots-clés : HYGIENE DES MAINS; ETUDIANT; MEDECIN; FORMATION; CONNAISSANCE; TRAVAIL;
OBSERVANCE; QUALITE
Background: Despite several guidelines on hand hygiene (HH), compliance especially in physicians is
reported to be low which has huge implications for healthcare-associated infections. To evaluate performance
of HH, influence of teaching and influence of monitoring the results in medical students, we conducted an
observational study.
Methods: Performance of hand disinfection was evaluated in first (N=28), third (N=193) and fifth (N=45) year
medical students using fluorescent hand disinfectant. The influence of teaching and information about result
control was assessed. The students perception of the impact of HH was also evaluated by a questionnaire.
Results: Presence of disinfectant gaps was observed significantly more often in first year medical students
compared to third year ones (82% vs, 60%; p=0.02). In additional, >3 gaps were seen significantly more often
in first year medical students compared to fifth year students (36% vs. 9%; p=0.007). Both information about
teaching and monitoring the results improved outcome significantly. For example, gaps were present in 92%
without information and without teaching, in 70% (RR: 1.3 (1.0-1.6); p=0.003) with information about result
control only, and in only 18% (5.1 (3.0-8.5); p=0.0001) after teaching. Notably, the medical students ascribed
HH to be of a great importance regardless of their level of education.
Conclusions: Performance of HH could be improved by practical training as evidenced by best HH
performance being documented immediately after teaching and a training effect during the course of medical
studies was also observed. Thus, we suggest implementing regular education and practical training on HH
from early on in the medical studies curricula to improve overall quality of patient care. regular education and
practical training on HH from early on in the medical studies curricula to improve overall quality of patient
care.
NosoBase n° 33678
Estimer le volume de produit alcoolique pour la friction des mains nécessaire pour un programme
d'hygiène des mains
Sicoli S; Hunter L; Shymanski J; Suh K; Roth VR. Estimating the volume of alcohol-based hand rub required
for a hand hygiene program. American journal of infection control 2012; in press: 5 pages.
Mots-clés : HYGIENE DES MAINS; PRODUIT DE FRICTION POUR LES MAINS; CONSOMMATION;
ENVIRONNEMENT; AUDIT
Background: Providing alcohol-based hand rub (ABHR) at the point of care is a key success factor in enabling
health care providers to achieve optimal hand hygiene practices. There are few tools available for health care
organizations to assess the number of points of care, estimate the number of hand hygiene indications at
each point of care, and estimate the anticipated volume of ABHR required to support a hand hygiene
program.
Methods: We developed an assessment tool to systematically evaluate the environmental hand hygiene
needs in diverse care settings across a multisite health care organization.
Results: We identified 1,103 points of care in 34 clinical units, of which only 53% had ABHR at point of care.
There are an estimated 171,468,240 (95% confidence interval: 146,844,406-191,871,179) hand hygiene
indications per year in our in-patient and emergency areas. If 100% compliance with hand hygiene is
achieved, 240,056 L of ABHR will be required each year.
Conclusions: Our environmental assessment was invaluable in estimating the number of hand hygiene
indications by unit and the logistical and financial requirements to implement a hand hygiene program. Other
health care organizations may find this a useful framework to estimate their own environmental hand hygiene
needs.
Médecine de ville
NosoBase n° 33749
Infections nosocomiales en médecine de ville : inéquité pour les victimes
Jousset N; Rouge-Maillart C. Nosocomial infections occurring in practitioners' offices: disparities among
victims. Médecine et droit 2012; in press: 5 pages.
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Mots-clés : PROFESSION LIBERALE; USAGER; RESPONSABILITE; LEGISLATION; ODONTOLOGIE;
HISTORIQUE
Le régime d’indemnisation des infections nosocomiales issu des lois du 4 mars et du 30 décembre 2002 est
très positif, tant sur les règles de définition des régimes de responsabilité que sur la procédure des CRCI.
Des perfectionnements semblent cependant nécessaires. La loi récente a soumis les établissements de
santé et les professionnels de santé à un régime différent de responsabilité. Alors que la jurisprudence
judiciaire antérieure à la loi du 4 mars soumettait les cliniques et les praticiens libéraux au même régime de
responsabilité objective pour manquement à une obligation de sécurité de résultat, les infections de
médecine de villes sont désormais exclues du régime de responsabilité de plein droit prévu par l’article L.
1142-1 du code de la santé publique et relèvent du régime de la responsabilité pour faute. Une victime d’une
infection associée aux soins contractée au cours d’une intervention pratiquée dans un cabinet libéral ne
pourra être indemnisée que si elle établit une faute, alors qu’elle aurait été indemnisée de plein droit si cette
même intervention avait été réalisée dans un établissement de santé. Sachant que certains actes médicaux
invasifs ne nécessitent pas d’hospitalisation, cette différence de traitement des victimes ayant subi un même
acte, nous conduit à nous interroger sur la nécessité d’étendre le régime de responsabilité de plein droit aux
infections contractées en médecine de ville.
Médicament
NosoBase n° 33708
Qualité de la prise en charge médicamenteuse - Outils pour les établissements de santé
Direction générale de l’offre de soins (DGOS); Ministère du travail, de l'emploi et de la santé. DGOS 2012/02:
1-45.
Mots-clés : MEDICAMENT; LEGISLATION; INDICATEUR; INFORMATIQUE; PRESCRIPTION; RISQUE;
CIRCUIT; DEFINITION; TRANSPORT; STOCKAGE; INFORMATION
La prise en charge médicamenteuse est un processus combinant des étapes pluridisciplinaires et
interdépendantes visant un objectif commun : l'utilisation sécurisée, appropriée et efficiente du médicament
chez le patient pris en charge en établissement. La prise en charge se décline selon les étapes suivantes :
- la prescription (y compris la gestion du traitement personnel du patient à l'admission, les vérifications des
prescriptions lors des transferts de patients et la prescription de sortie) ;
- la préparation ;
- la dispensation ;
- l'approvisionnement ;
- le transport ;
- la détention et le stockage ;
- l'administration ;
- l'information du patient ;
- la surveillance du traitement.
La sécurisation de la prise en charge médicamenteuse est un objectif prioritaire inscrit dans l'ensemble des
démarches nationales (tarification à l'activité, certification, contrat de bon usage des médicaments et produits
et prestations, contrats pluriannuels d'objectif et de moyens).
De la bonne organisation de ce circuit dépend la prise en charge optimale des patients qui associe la
réduction des risques, notamment iatrogènes, et la réduction des coûts des soins.
Peau
NosoBase n° 33786
Epidémiologie et évolutions des infections compliquées de la peau et des tissus mous parmi des
patients hospitalisés
Zervos MJ; Freeman K; Vo L; Haque N; Pokharna H; Raut M; et al. Epidemiology and outcomes of
complicated skin and soft tissue infections in hospitalized patients. Journal of clinical microbiology 2012/02;
50(2): 238-245.
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Mots-clés : EPIDEMIOLOGIE; PEAU; TISSU MOU; ANALYSE MULTIVARIEE; DUREE DE SEJOUR;
DIALYSE RENALE; DIABETE; STAPHYLOCOCCUS AUREUS; ETUDE RETROSPECTIVE; COHORTE
Complicated skin and soft tissue infections (cSSTIs) are among the most rapidly increasing reasons for
hospitalization. To describe inpatients with regard to patient characteristics, cSSTI origin, appropriateness of
initial antibiotics, and outcomes, we performed a retrospective cohort study in patients hospitalized for cSSTI.
To identify independent predictors of outcomes, we performed multivariate analyses. Of 1,096 eligible
patients, 48.7% had health care-associated (HCA) cSSTI and 51.3% had community-acquired (CA) cSSTI.
After adjustment for baseline variables, hospital length of stay (LOS) was longer for HCA than for CA cSSTI
(difference, 2.1 days; 95% confidence interval [CI], 0.8 to 3.5; P<0.05). Other covariates associated with a
longer LOS were need for dialysis (regression coefficient ± standard error, 4.5±1.1) and diabetic wound
diagnosis (2.6±1.0) (all P<0.05). In the subset with culture-positive cSSTI within 24 h of admission, the most
common pathogen was Staphylococcus aureus (298/449 [66.4%]), of which 74.8% (223/298) were methicillinresistant S. aureus (MRSA). Eighty-three patients (18.5%) received inappropriate initial antibiotics. After
adjustment for other variables, the following were associated with inappropriate initial therapy: direct
admission to hospital (not via emergency department), cSSTI caused by MRSA or mixed pathogens, and
cSSTI caused by pathogens other than S. aureus or streptococci (all P<0.05). We did not find an association
between inappropriate therapy and outcomes, except in the subset with ulcers (adjusted odds ratio, 11.8;
95% CI, 1.3 to 111.1; P=0.03). More studies are needed to examine the impact of HCA cSSTI and
inappropriate initial therapy on outcomes.
Pédiatrie
NosoBase n° 33794
Enquête et contrôle d'une épidémie d'infections à Acinetobacter baumannii résistant à l'imipénème
dans une unité de réanimation pédiatrique
Hong KB; Oh HS; Song JS; Lim JH; Kang DK; Son IS; et al. Investigation and control of an outbreak of
imipenem-resistant Acinetobacter baumannii infection in a pediatric intensive care unit. The Pediatric
infectious disease journal 2012; in press: 22 pages.
Mots-clés : ACINETOBACTER BAUMANNII; PEDIATRIE; SOIN INTENSIF; CONTROLE; EPIDEMIE;
EPIDEMIOLOGIE; PREVALENCE; PRECAUTION COMPLEMENTAIRE; PRECAUTION CONTACT;
HYGIENE DES MAINS; ENVIRONNEMENT; DESINFECTION; DISPOSITIF MEDICAL; BIOLOGIE
MOLECULAIRE; BACTERIEMIE; PNEUMONIE; COLONISATION; LAVABO
Background: This study investigated clinical details and epidemiology of the imipenem-resistant Acinetobacter
baumannii (IRAB) outbreak which occurred at a pediatric intensive care unit (PICU), and describes successful
outcome of the implemented infection control measures.
Methods: With the recognition of three clustered cases with IRAB bacteremia at the PICU of Seoul National
University Children's Hospital, Korea from August to September 2010, the following outbreak control
strategies were implemented; reinforcement of hand hygiene and contact precautions, investigation of
environmental contamination, disinfection of the contaminated environment and medical equipment, active
surveillance culture upon PICU admission, and isolation of IRAB-positive patients. The clinical and
microbiological data were reviewed for A. baumannii positive cases in the PICU from Apr 2001 to June 2011.
Multi locus sequence typing (MLST) was also performed.
Results: Twenty IRAB-positive cases (bacteremia in 10, pneumonia in 3, and colonizers in 7) were detected
from January 2010 to February 2011. Thirteen IRAB-infected patients were all placed on a mechanical
ventilator, had central venous catheters, received broad-spectrum antimicrobial treatment, and had underlying
diseases. Eleven (85%) of IRAB-infected patient died probably due to IRAB infection. IRAB grew from four
samples obtained from sinks and water taps from 38 environmental samples. MLST analysis revealed two
sequence types: ST138 (n=16) and its single-locus variant ST92 (n=4). Eleven weeks after the initiation of
active surveillance, no further IRAB isolates were identified.
Conclusions: This study identifies the environmental source of an IRAB outbreak in a PICU and describes
successful control of the outbreak with a multicomponent intervention program.
NosoBase n° 33793
Prévention des infections associées aux soins dans des unités de réanimation pédiatriques : revue
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Joram N; De Saint Blanquat L; Stamm D; Launay E; Gras-le-Guen C. Healthcare-associated infection
prevention in pediatric intensive care units: a review. European journal of clinical microbiology and infectious
disease 2012; in press: 10 pages.
Mots-clés : PEDIATRIE; PREVENTION; SOIN INTENSIF; BIBLIOGRAPHIE; ANTIBIOTIQUE; PNEUMONIE;
VENTILATION ASSISTEE; INFECTION RECURRENTE; ANTIBIORESISTANCE; BACTERIEMIE;
CATHETER; INFECTION URINAIRE; SITE OPERATOIRE
The objective of this review was to summarize the current knowledge base on the prevention of nosocomial
infections in pediatric intensive care units (PICUs). Healthcare-associated infections (HAIs) are a crucial
problem in PICUs because of their impact on patient outcome, length of hospital stay, and costs. Studies
published between 1998 and 2011 were identified using the MEDLINE and Cochrane databases.
Randomized, cohort, case-control studies, and meta-analyses concerning global strategies of prevention,
general organization of the wards, general recommendations on antibiotic management, and measures for
the prevention of ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), urinary tract
infections (UTIs), and surgical site infections (SSIs) were incorporated. Limits of age from 1 month to 18 years
were used. When recommendations could not be supported by the pediatric literature, adult studies were also
reviewed. This review excludes the neonate population. Specific pediatric data are often lacking so as to
establish specific evidence-based pediatric recommendations. This review underlines the absolute necessity
of pediatric studies and to harmonize the definitions of HAIs.
NosoBase n° 33783
Facteurs de risque et interventions pour les pneumonies acquises sous ventilation parmi des patients
de pédiatrie
Morinec J; Iacaboni J; McNett M. Risk factors and interventions for ventilator-associated pneumonia in
pediatric patients. Journal of pediatric nursing 2012; in press: 8 pages.
Mots-clés : FACTEUR DE RISQUE; VENTILATION ASSISTEE; PEDIATRIE; PNEUMONIE; PREVENTION;
SOIN INTENSIF; COHORTE; ETUDE RETROSPECTIVE; PNEUMONIE; PEDIATRIE
Ventilator-associated pneumonia (VAP) is a leading nosocomial infection in pediatrics. Little research has
investigated the risk factors or effectiveness of interventions for pediatric VAP prevention. The purposes of
this study were to identify the risk factors associated with VAP in pediatric patients and describe current VAP
prevention practices. Data were gathered retrospectively on ventilated patients admitted to the pediatric
intensive care unit over 12 months. No variables were found to be predictive of VAP. Review of practices
indicates that better documentation is needed of all interventions. Findings provide information to guide the
implementation of VAP bundles. Implementation should focus on adequate documentation of VAP prevention
efforts.
Personnel
NosoBase n° 33899
Motivation et satisfaction dans le travail parmi des membres du personnel assurant le nettoyage au
NHS : étude pilote
Jeanes A; Hall TJ; Coen PG; Odunaike A; Hickok SS; Gant VA. Motivation and job satisfaction of cleaning
staff in the NHS: a pilot study. Journal of infection prevention 2012/03; 13(2): 55-64.
Mots-clés : PERSONNEL; TRAVAIL; PSYCHOLOGIE; NETTOYAGE; ENVIRONNEMENT; QUALITE;
EFFICACITE; SURFACE; REVETEMENT; QUESTIONNAIRE; FORMATION
Fourteen NHS hospital ward cleaning staff were interviewed about their background, job satisfaction and
motivation as part of the evaluation of a new cleaning system. Four (28%) staff had attended university, five
(35%) had no qualifications and the remainder had a range of educational attainments. Nine (64%) did the job
to earn money, three (22%) because they liked it and two (14%) because there were no other opportunities.
Repetitive tasks were undertaken routinely with tight control of method and order of working. The work was
tiring and ad hoc requests increased the burden. Although all staff knew what was expected of them in their
job, nine (62%) reported they "knew themselves" if they had done a good job as feedback was frequently
absent or belated. Opportunities including access to the internet were limited and long hours doing extra work
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reduced free time. This pilot study highlights the potential of these healthcare cleaning professionals to
contribute and develop given the opportunities.
NosoBase n° 33859
Quelle représentation du correspondant en hygiène ? Une auto-évaluation
Léger C; André C; Auvin N; Frugier F; Preschel A; Pefau M; et al. Hygiènes 2012/04; XX(2): 79-84.
Mots-clés : PERSONNEL; EVALUATION; REFERENT; EOH; PERCEPTION
La mise en place d’un réseau de correspondants en hygiène est un des piliers de l’organisation de la lutte
contre les infections nosocomiales ; elle est intégrée dans la réglementation française depuis 1995. Depuis
cette époque le Centre de coordination et de lutte contre les infections nosocomiales sud-ouest et son
antenne régionale Poitou-Charentes se sont investis dans la formation de ces professionnels et dans
l’animation du réseau régional qu’ils constituent. Toutefois l’évaluation de l’action de ces acteurs relais n’est
pas aisée à faire, de même que celle de leur ressenti et de leur vécu de cette mission particulière, qui requiert
de nombreuses qualités relationnelles. En s’inspirant des travaux anglais de Louise Teare, une étude a été
réalisée à l’occasion de la journée régionale 2011 des correspondants en hygiène du Poitou-Charentes.
Chaque participant s’est vu proposer de réaliser lors d’un atelier, et à l’aide d’une méthodologie standardisée,
une figurine dont chaque partie du corps symbolise la représentation qu’il avait d’une des dimensions de la
fonction de correspondant en hygiène. Au total les représentations de 86 correspondants ont été analysées
dans cette étude. Selon les différentes dimensions les représentations positives ou très positives allaient de
79,8 % à 94,2 % et, sur un score maximal de 5, la moyenne de la reconnaissance de leur action était évaluée
à 2,7. Cette étude montre, sur un échantillon de professionnels motivés, des résultats plutôt positifs, mais elle
incite à approfondir et élargir la diffusion d’outils d’évaluation de la fonction de correspondant en hygiène qui
demeure un levier reconnu de l’amélioration de la prévention des infections associées aux soins.
NosoBase n° 33689
Descriptions des postes des professionnels en hygiène hospitalière : reflètent-elles les rôles étendus
et les responsabilités ?
Manning ML; Borton DL; Rumovitz DM. Infection preventionists' job descriptions: do they reflect expanded
roles and responsabilities? American journal of infection control 2012; in press; 3 pages.
Mots-clés : PREVENTION; INFIRMIER HYGIENISTE; MEDECIN HYGIENISTE; PERSONNEL; TRAVAIL;
PRATIQUE; SURVEILLANCE; FORMATION; QUALITE; CONTROLE
In the last decade, the scope of practice of infection preventionists has expanded beyond the traditional roles
of solo practitioner and expert data collectors to roles of interventionists and crucial leaders in successful
patient safety initiatives. We examined the job descriptions of a small group of practicing infection
preventionists to determine whether they reflected this expanded scope and responsibilities.
NosoBase n° 32183
Prévention des risques de transmission des infections : connaître les pratiques formelles et
informelles du personnel hospitalier (Thèse)
Seifert AM. Université de Laval – Québec 2012: 168 pages.
Mots-clés : TRANSMISSION; PREVENTION; PRATIQUE; PERSONNEL; PERCEPTION; QUESTIONNAIRE;
AUDIT; TRAVAIL; CLOSTRIDIUM DIFFICILE; CONTAMINATION; FORMATION; RISQUE
La prévention des infections dans les établissements de santé est un sujet d’actualité. Malgré la promotion de
mesures de prévention, on constate qu’elles ne sont pas complètement appliquées. Toutefois, s’attarder
uniquement à ces manques offre une prise limitée pour améliorer la prévention, en ignorant d’autres mesures
que le personnel pourrait avoir développées. L’objectif de la recherche est de décrire les pratiques, formelles
et informelles, de prévention de la transmission des infections, utilisées par diverses catégories de personnel
hospitalier, ainsi que d’explorer les représentations reliées à ces pratiques. L’approche qualitative utilisée
permet une vision systémique des activités de prévention. Nous avons effectué, à Montréal, 27 entrevues et
186 heures d’observation de personnel infirmier, de préposées aux bénéficiaires et de préposées à l’entretien
sanitaire, tous expérimentés, dans quatre unités de soins dont deux de courte et deux de longue durée. Les
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résultats montrent que les mesures de prévention ne sont pas des actes isolés mais qu’elles font partie d’un
processus débutant par l’identification des risques à partir de trois familles d’informations: la contamination du
patient, celle de l’environnement et les difficultés d’interaction avec le patient. Nous avons identifié certaines
pratiques permettant de pallier des situations où les mesures de prévention prescrites sont jugées
insuffisantes et révèlent des compétences méconnues du personnel. Ces pratiques peuvent notamment faire
appel au travail d'équipe, faisant ressortir l’importance de la dimension collective du travail pour la prévention
des infections. L’analyse des représentations du risque relié au Clostridium difficile montre de plus que les
participantes à la recherche craignent de le transmettre aux patients et à leur propre famille et adoptent en
conséquence des pratiques spécifiques de prévention, au travail et hors travail. A cause de situations mettant
en échec la prévention, certaines participantes pensent de plus être des porteuses saines de ce
microorganisme et craignent son activation si elles sont affaiblies. Certains aspects de l’organisation du
travail peuvent aussi entraver leurs efforts : l’absence de moments de concertation, la présence de personnel
non régulier et le manque de formation. Nous concluons sur l’importance d’appuyer les efforts de prévention
basés sur des stratégies qui font appel au travail d’équipe, qui semblent avoir un potentiel intéressant pour la
prévention des infections, et sur la nécessité de prendre en compte les préoccupations du personnel dans les
interventions éducatives le concernant. (Résumé d’auteur)
Pneumonie
NosoBase n° 33787
Les pneumonies nosocomiales au Japon ont un meilleur profil de mortalité que les pneumonies
nosocomiales aux Etats-Unis : étude rétrospective
Iwata K; Igarashi W; Honjo M; Oka H; Oba Y; Yoshida H; et al. Hospital-acquired pneumonia in Japan may
have a better mortality profile than HAP in the United States: a retrospective study. Journal of infection and
chemotherapy 2012; in press: 7 pages.
Mots-clés :
PNEUMONIE;
MORTALITE;
ETUDE
RETROSPECTIVE;
MICROBIOLOGIE;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PSEUDOMONAS; CENTRE HOSPITALIER
UNIVERSITAIRE
The characteristics of hospital-acquired pneumonia (HAP) are not well documented. In the present study we
investigated the severity and mortality, microbiological profile, and the value of Gram staining in cultureconfirmed HAP in a Japanese hospital by retrospective review conducted at a Japanese university hospital.
Only culture-confirmed cases with good specimen quality were included in the analysis. The clinical
characteristics of HAP, as well as the causative organisms, were investigated. Furthermore, the prognostic
ability of existing prediction rules were evaluated for prediction of overall mortality. Forty-two cases were
enrolled in this analysis. The majority of patients were admitted to the ICU (61.9 %), and 40.5 % had
ventilator-associated pneumonia (VAP). The 30-day mortality was 23.8 %, which is less than that reported in
the United States. Factors commonly known to be associated with worse outcome in the USA did not appear
to influence the mortality from HAP in Japan. The most frequent causative organisms were methicillinresistant Staphylococcus aureus (MRSA), followed by Pseudomonas spp. Sensitivity and negative predictive
value of Gram staining were 89.4 and 85.7 %, respectively. SMART-COP predicted 30-day mortality with an
area under the ROC curve (AUC) >0.7. The characteristics of HAP in Japan differ from HAP reported in the
USA. In addition to lower mortality, we found both fewer ICU cases and VAP. Gram staining of good-quality
specimens demonstrated promising sensitivity to predict the causative organisms. SMART-COP predicted
mortality with appropriate ROC curve (AUC).
NosoBase n° 33819
Un taux de zéro pneumonie acquise sous ventilation est-il vraiment possible ?
Klompas M. Is a ventilator-associated pneumonia rate of zero really possible? Current opinion in infectious
diseases 2012/04; 25(2): 176-182.
Mots-clés : TAUX; PNEUMONIE; VENTILATION; SURVEILLANCE; TAUX; ANTIBIOTIQUE; DIAGNOSTIC;
QUALITE
Purpose of review: The increasing number of hospitals reporting ventilator-associated pneumonia (VAP) rates
at or close to zero begs the question of whether zero should become the national benchmark for VAP. This
article explores the significance of very low VAP rates, reviews differences in surveillance and clinical rates,
proposes reasons for their discrepancies, and suggests possible objective alternatives for surveillance.
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Recent findings: Surveillance rates of VAP are decreasing, whereas clinical diagnoses and antibiotic
prescribing remain prevalent. This growing discrepancy reflects the lack of objective and definitive signs to
diagnose VAP. External reporting pressures may be encouraging stricter interpretation of subjective signs
and other surveillance initiatives that can artifactually lower rates. It is impossible to disentangle the relative
contribution of care improvements versus surveillance effects to currently observed low VAP rates.
Summary: The increasing mismatch between surveillance rates and clinical diagnoses limits the utility of
official VAP rates to estimate disease burden and guide quality improvement. Advocates are advised to
consider objective alternatives such as average duration of mechanical ventilation, length of stay, mortality,
and antibiotic prescribing. Emerging surveillance definitions that use more objective criteria may better reflect
and inform future clinical practice.
NosoBase n° 33434
Le linezolide dans le traitement des pneumonies nosocomiales à Staphylococcus aureus résistant à
la méticilline : étude contrôlée, randomisée
Wunderink RG; Niederman MS; Kollef MH; Shorr AF; Kunkel MJ; Baruch A; et al. Linezolid in methicillinresistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clinical infectious
diseases 2012/03/01; 5: 621-629.
Mots-clés : PNEUMONIE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; LINEZOLIDE;
RANDOMISATION
Background: Post hoc analyses of clinical trial data suggested that linezolid may be more effective than
vancomycin for treatment of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia.
This study prospectively assessed efficacy and safety of linezolid, compared with a dose-optimized
vancomycin regimen, for treatment of MRSA nosocomial pneumonia.
Methods: This was a prospective, double-blind, controlled, multicenter trial involving hospitalized adult
patients with hospital-acquired or healthcare-associated MRSA pneumonia. Patients were randomized to
receive intravenous linezolid (600 mg every 12 hours) or vancomycin (15 mg/kg every 12 hours) for 7-14
days. Vancomycin dose was adjusted on the basis of trough levels. The primary end point was clinical
outcome at end of study (EOS) in evaluable per-protocol (PP) patients. Prespecified secondary end points
included response in the modified intent-to-treat (mITT) population at end of treatment (EOT) and EOS and
microbiologic response in the PP and mITT populations at EOT and EOS. Survival and safety were also
evaluated.
Results: Of 1184 patients treated, 448 (linezolid, n=224; vancomycin, n=224) were included in the mITT and
348 (linezolid, n=172; vancomycin, n=176) in the PP population. In the PP population, 95 (57.6%) of 165
linezolid-treated patients and 81 (46.6%) of 174 vancomycin-treated patients achieved clinical success at
EOS (95% confidence interval for difference, 0.5%-21.6%; P=.042). All-cause 60-day mortality was similar
(linezolid, 15.7%; vancomycin, 17.0%), as was incidence of adverse events. Nephrotoxicity occurred more
frequently with vancomycin (18.2%; linezolid, 8.4%).
Conclusions: For the treatment of MRSA nosocomial pneumonia, clinical response at EOS in the PP
population was significantly higher with linezolid than with vancomycin, although 60-day mortality was similar
Réanimation
NosoBase n° 33674
Charge bactérienne intrinsèque associée aux lits d'hôpitaux en réanimation : impact de la
désinfection sur la récupération de la population bactérienne et l'atténuation du risque infectieux
potentiel
Attaway HH; Fairey S; Steed LL; Salgado CD; Michels HT; Schmidt MG. Intrinsic bacterial burden associated
with intensive care unit hospital beds: effects of disinfection recovery and mitigation of potential infection risk.
American journal of infection control 2012; in press: 6 pages.
Mots-clés : SOIN INTENSIF; RISQUE; DESINFECTION; LIT; QUALITE; ENVIRONNEMENT; GESTION DES
RISQUES; BACTERIE; MEDECINE; ECHANTILLON; DESINFECTANT; SURFACE; EFFICACITE;
STAPHYLOCOCCUS
Background: Commonly touched items are likely reservoirs from which patients, health care workers, and
visitors may encounter and transfer microbes. A quantitative assessment was conducted of the risk
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represented by the intrinsic bacterial burden associated with bed rails in a medical intensive care unit (MICU),
and how disinfection might mitigate this risk.
Methods: Bacteria present on the rails from 36 patient beds in the MICU were sampled immediately before
cleaning and at 0.5, 2.5, 4.5, and 6.5 hours after cleaning. Beds were sanitized with either a bottled
disinfectant (BD; CaviCide) or an automated bulk-diluted disinfectant (ABDD; Virex II 256).
Results: The majority of bacteria recovered from the bed rails in the MICU were staphylococci, but not
methicillin-resistant Staphylococcus aureus. Vancomycin-resistant enterococci were recovered from 3 beds.
Bottled disinfectant reduced the average bacterial burden on the rails by 99%. However, the burden
rebounded to 30% of that found before disinfection by 6.5 hours after disinfection. ABDD reduced the burden
by an average of 45%, but levels rebounded within 2.5 hours. The effectiveness of both disinfectants was
reflected in median reductions to burden of 98% for BD and 95% for ABDD.
Conclusions: Cleaning with hospital-approved disinfectants reduced the intrinsic bacterial burden on bed rail
surfaces by up to 99%, although the population, principally staphylococci, rebounded quickly to
predisinfection levels.
NosoBase n° 33680
Diminution des pneumonies associées à la ventilation en réanimation : programme global et durable
d'amélioration de la qualité
Heck K. Decreasing ventilator-associated pneumonia in the intensive care unit: a sustainable comprehensive
quality improvement program. American journal of infection control 2012; in press: 3 pages.
Mots-clés : SOIN INTENSIF; PNEUMONIE; VENTILATION ASSISTEE; QUALITE; PREVENTION; ETUDE
RETROSPECTIVE; SOIN DE BOUCHE; PERSONNEL; ASPIRATION
An intensive care unit implemented an oral care bundle to decrease ventilator-associated pneumonia (VAP).
A retrospective analysis comparing like time periods revealed the VAP rate per 1,000 ventilator-days dropped
significantly from 10.5 to 0 (P=.016). The oral care bundle remains in place as of end of May 2011 and has
proven to be a sustainable method for VAP prevention.
Réglementation
NosoBase n° 33855
Circulaire interministérielle n°DGCS/DGS/2012/118 du 15/03/2012 relative à la mise en oeuvre du
programme national de prévention des infections dans le secteur médico-social 2011/2013
Ministère du travail, de l'emploi et de la santé; Ministère des solidarités et de la cohésion sociale. Non parue
au Journal officiel 2012: 14 pages. Abroge la circulaire du 30/09/2011 (Référence NosoBase n° 31968)
Mots-clés : LEGISLATION; EHPAD; RISQUE; VACCIN; PERSONNE AGEE; EVALUATION; CCLIN;
HYGIENE DES MAINS; SIGNALEMENT; ARS; DECLARATION; INFECTION RESPIRATOIRE BASSE;
EOH; ARLIN; CIRE; EPIDEMIE ; ANTIBIOTIQUE; MULTIRESISTANCE; TRANSMISSION; PRECAUTION
STANDARD
Le programme national de prévention des infections dans le secteur médicosocial vise à la prise en compte
du risque infectieux par une démarche d'analyse de risque. Les établissements concernés (EHPAD, MAS et
FAM) pourront utilement s'appuyer dans cette démarche sur les audits d'autoévaluation y compris
informatique développés à cette fin.
NosoBase n° 33856
Circulaire n°DGOS/PF2/2012/134 du 27/03/2012 relative au bilan des activités de lutte contre les
infections nosocomiales dans les établissements de santé pour l'année 2011
Ministère du travail, de l'emploi et de la santé. Non parue au Journal officiel 2012: 73 pages.
Mots-clés : LEGISLATION; INDICATEUR; ICALIN; ICSHA; SIGNALEMENT; EOH; FORMATION;
EXPOSITION AU SANG; HYGIENE DES MAINS; PRECAUTION STANDARD; PRECAUTION
COMPLEMENTAIRE; INFECTION URINAIRE; EAU; AIR; SURVEILLANCE; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; ICATB; BLOC OPERATOIRE; BILAN STANDARDISE
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Recueil de données et traitement des bilans standardisés des activités de lutte contre les infections
nosocomiales 2011 dans les établissements de santé.
Rotavirus
NosoBase n° 33812
Poids des gastroentérites à Rotavirus nosocomiales et d'origine communautaire dans la population
pédiatrique de l'Europe de l'Ouest : revue
Ogilvie I; Khoury H; Goetghebeur MM; Khoury AC; Giaquinto C. Burden of community-acquired and
nosocomial Rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review. BMC
infectious diseases 2012; in press: 30 pages.
Mots-clés : ROTAVIRUS; VIRUS; GASTRO-ENTERITE;
EPIDEMIOLOGIE; INCIDENCE; MORTALITE
PEDIATRIE;
EUROPE;
BIBLIOGRAPHIE;
Background: Rotavirus affects 95% of children worldwide by age 5 years and is the leading cause of severe
dehydrating diarrhea. The objective of this review was to estimate the burden of rotavirus gastroenteritis
(RVGE) in the Western European pediatric population.
Methods: A comprehensive literature search (1999-2010) was conducted in PubMed and other sources
(CDC; WHO, others). Data on the epidemiology and burden of RVGE among children <5 years-old in
Western Europe --including hospital-acquired disease--were extracted.
Results: 76 studies from 16 countries were identified. The mean percentage of acute gastroenteritis (AGE)
cases caused by rotavirus ranged from 25.3%-63.5% in children <5 years of age, peaking during winter.
Incidence rates of RVGE ranged from 1.33-4.96 cases/100 person-years. Hospitalization rates for RVGE
ranged from 7% to 81% among infected children, depending on the country. Nosocomial RVGE accounted for
47%-69% of all hospital-acquired AGE and prolonged hospital stays by 4-12 days. Each year, RVGE incurred
$0.54-$53.6 million in direct medical costs and $1.7-$22.4 million in indirect costs in the 16 countries studied.
Full serotyping data was available for 8 countries. G1P[8], G2P[4], G9P[8], and G3P[8] were the most
prevalent serotypes (cumulative frequency: 57.2%-98.7%). Serotype distribution in nosocomial RVGE was
similar.
Conclusions: This review confirms that RVGE is a common disease associated with significant morbidity and
costs across Western Europe. A vaccine protecting against multiple serotypes may decrease the
epidemiological and cost burden of RVGE in Western Europe.
Staphylococcus aureus
NosoBase n° 33805
Acquisition nosocomiale de Staphylococcus aureus meticillino-résistant (SARM) et d'entérobactéries
productrices de bêta-lactamases à spectre étendu chez des patients hospitalisés : étude prospective
multicentrique
De Angelis G; Restuccia G; Venturiello S; Cauda R; Malhotra-Kumar S; Goossens H; et al. Nosocomial
acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase
(ESBL) enterobacteriaceae in hospitalised patients: a prospective multicenter study. BMC infectious diseases
2012; in press: 10 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENTEROBACTERIE; BETALACTAMASE A SPECTRE ELARGI; ETUDE PROSPECTIVE; TRAITEMENT; ANTIBIOTIQUE; COHORTE;
DEPISTAGE; EPIDEMIOLOGIE; ANTIBIORESISTANCE; CAS TEMOIN
Background: The risk of acquisition of antibiotic resistant-bacteria during or shortly after antibiotic therapy is
still unclear and it is often confounded by scarce data on antibiotic usage. Primary objective of the study is to
compare rates of acquisition of methicillin-resistant Staphylococcus aureus and extended spectrum betalactamase-producing Enterobacteriaceae in hospitalised patients, after starting antibiotic therapy.
Methods: The study, running in three European hospitals, is a multicenter, prospective, longitudinal,
observational cohort study funded from the European Community's Seventh Framework Programme
[FP7/2007-2013] within the project 'Impact of Specific Antibiotic Therapies on the prevalence of hUman host
Resistant bacteria' (acronym SATURN). Nasal and rectal screening for methicillin-resistant Staphylococcus
aureus and extended spectrum beta-lactamases-producing Enterobacteriaceae will be obtained at hospital
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admission, discharge, at antibiotic start (t0, within one hour) and at the following intervals: day 3 (t1), 7 (t2),
15 (t3), and 30 (t4). Two nested case-control studies will be performed. The objective of the first study will be
to define individual level of risk related to specific antibiotics. Patients acquiring methicillin-resistant
Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae (cases) will be
compared with patients not acquiring antibiotic-resistant strains after starting antibiotic therapy (controls; ratio
1:4). To define the impact of antibiotics on new acquisition of target antibiotic-resistant bacteria, a second
nested case-control study will be done (ratio 1:4). Control group will be selected among patients not receiving
antibiotics, admitted in the same ward on the day of the corresponding case, with negative cultures at
admission. Epidemiological, clinical and microbiological data will be prospectively collected.
Discussion: The rationale of this study is to better understand the impact of antibiotic use on acquisition,
selection and transmission of antimicrobial resistant-bacteria in European hospitals.
NosoBase n° 33677
Trop près pour le confort : stratégie de dépistage destinée à détecter la conversion à Staphylococcus
aureus méticillino-résistant chez des voisins de chambre exposés
Ng W; George K; Muhammed N; Tomassi J; Katz KC. Too close for comfort: screening strategy to detect
methicillin-resistant Staphylococcus aureus conversion in exposed roommates. American journal of infection
control 2012; in press: 3 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; DEPISTAGE; PCR; BIOLOGIE
MOLECULAIRE; COLONISATION; COLONISATION NASALE; RISQUE; CHAMBRE; ENVIRONNEMENT
All 899 roommates exposed to methicillin-resistant Staphylococcus aureus (MRSA) index cases were studied
over 57 months. MRSA detection is better at approximately 3 days (50%-55%) or 7 days (56%) after contact
has been broken than day 0 (30%). Polymerase chain reaction testing at day 3 performs similarly to culture at
day 7. Nasal/rectal screening provides superior detection than nasal alone. Those exposed >48 hours are at
significantly greater risk of colonization.
Tuberculose
NosoBase n° 33885
Dossier : La tuberculose infantile, actualités et perspectives
Doually Y. Soins Pédiatrie puériculture 2012/02; 264: 13-38.
Mots-clés :
TUBERCULOSE;
TRANSMISSION;
ANTITUBERCULEUX;
BCG;
RECOMMANDATION; EPIDEMIOLOGIE; PEDIATRIE; TEST TUBERCULINIQUE; DEPISTAGE
VACCIN;
Extrait du sommaire :
- Fraisse P. La tuberculose, une maladie contagieuse (Référence NosoBase n°33887)
- Donato L, Mansilla M. Epidemiologie de la tuberculose en France (Référence NosoBase n°33888)
- Donato L, Mansilla M. Formes cliniques et traitement de la tuberculose chez l'enfant (Référence NosoBase
n°33889)
- Marchal G. Histoire et actutalité de la vaccination par le BCG (Référence NosoBase n°33890)
- Chadelat K. La prévention de la tuberculose par le dépistage (Référence NosoBase n°33891)
Vaccination
NosoBase n° 33846
Guide des vaccinations - Edition 2012 - 4ème édition
Direction Générale de la Santé (DGS); Comité technique des vaccinations; Institut National de Prévention et
d’éducation pour la Santé (INPES). INPES 2012/01: 1-486.
Mots-clés : RECOMMANDATION; VACCIN; BORDETELLA PERTUSSIS; GRIPPE; HEPATITE A; HEPATITE
B; OREILLONS; ROTAVIRUS; ROUGEOLE; RUBEOLE; VARICELLE; CLOSTRIDIUM TETANI;
TUBERCULOSE; BCG; ZONA; PERSONNEL
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La vaccination est la prévention la plus efficace contre les maladies infectieuses. L'objectif du Guide des
vaccinations 2012 est de mettre à disposition des professionnels de santé les connaissances les plus
récentes sur les vaccinations et de répondre aux questions qu'ils se posent. C'est un ouvrage collectif rédigé
par le Comité technique des vaccinations, la direction générale de la Santé, l'Institut de veille sanitaire,
l'Agence française de sécurité sanitaire des produits de santé, l'Inpes et de nombreux spécialistes. La
première partie apporte des informations pour la pratique professionnelle. Elle fait le point sur chaque
vaccination (épidémiologie de la maladie, caractéristiques des vaccins, mode d'administration, indications,
recommandations, effets indésirables). Elle précise les modalités spécifiques des vaccinations de certaines
populations et rappelle le calendrier vaccinal en cours. La seconde partie aborde les informations générales
sur la vaccination : bases immunologiques, mise au point des vaccins, politique vaccinale, suivi et évaluation
des programmes de vaccination. Les annexes fournissent des renseignements pratiques.
NosoBase n° 33711
Avis relatif aux recommandations vaccinales spécifiques des personnes immunodéprimées ou
aspléniques
Haut conseil de la santé publique (HCSP). HCSP 2012/02/16: 1-8.
Mots-clés : RECOMMANDATION; VACCINATION; DEFICIT IMMUNITAIRE; GRIPPE; HEPATITE B;
HEPATITE A; BCG; VARICELLE; STREPTOCOCCUS PNEUMONIAE
Le Haut Conseil de la santé publique s’est autosaisi par l’intermédiaire du Comité technique des vaccinations
(CTV) afin d’émettre des recommandations complémentaires sur la vaccination des sujets faisant état d’une
immunodépression ou d’une asplénie.
L’objectif était d’élaborer des recommandations spécifiques aux personnes immunodéprimées ou
aspléniques afin de les intégrer au calendrier vaccinal, d’en assurer la diffusion et l’application dans le but
d’améliorer la couverture vaccinale de ces populations à risque d’infection sévère et in fine diminuer la
morbidité et la mortalité de ces patients.
NosoBase n° 33858
Le calendrier des vaccinations et les recommandations vaccinales 2012 selon l'avis du Haut Conseil
de la santé publique
Institut de veille sanitaire (InVS); Floret D. Bulletin épidémiologique hebdomadaire 2012/04/10; 14-15: 161187.
Mots-clés : VACCIN; RECOMMANDATION; GRIPPE; STREPTOCOCCUS PNEUMONIAE; GROSSESSE;
PEDIATRIE; ROUGEOLE; TUBERCULOSE; BORDETELLA PERTUSSIS; HEPATITE A; HEPATITE B;
VARICELLE; PERSONNEL; DEFICIT IMMUNITAIRE
Le calendrier vaccinal 2012 introduit de nouvelles recommandations qui concernent les vaccinations contre la
grippe saisonnière, les infections invasives à pneumocoque et la tuberculose, le calendrier vaccinal des
jeunes enfants à Mayotte ainsi que les vaccinations des personnes immunodéprimées ou aspléniques.
NosoBase n° 33800
La vaccination contre la coqueluche dans l'enfance diminue l'incidence de la coqueluche et le taux
d'hospitalisation après une ou deux doses. Analyses de dix ans de surveillance de la coqueluche
Nilsson L; Lepp T; Von Segebaden K; Hallander H; Gustafsson L. Pertussis vaccination in infancy lowers the
incidence of pertussis disease and the rate of hospitalisation after one and two doses: analyses of 10 years of
pertussis surveillance. Vaccine 2012; 30(21): 3239-3247.
Mots-clés : VACCIN;
PEDIATRIE
INCIDENCE;
SURVEILLANCE;
BORDETELLA
PERTUSSIS;
PREVENTION;
Objectives: Shortly after pertussis vaccination was reintroduced in Sweden in 1996, an intensified pertussis
disease surveillance programme was set up. In this study, we report on in-depth analyses of age-dosenumber-specific incidences and the rate of pertussis hospitalisation for children with no, 1 or 2 doses of an
acellular pertussis vaccine before pertussis disease. Vaccine coverage, the timeliness of childhood
vaccination and the effect of later than scheduled pertussis vaccination(s) are also examined.
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Study design: Children with notified laboratory-confirmed (culture or PCR) pertussis disease were evaluated
among the surveillance population of about 1 million infants, born between 1996 and 2007 and followed for
pertussis disease from October 1997 to December 2007, for nearly 6 million person-years. Birth and
vaccination dates of the diseased children are known from the surveillance programme. To estimate
denominators of the age-dose-number-specific pertussis incidences, we used birth and vaccination dates
from a vaccine trial with more than 72,000 infants combined with national pertussis vaccine coverage data for
children in the surveillance population.
Results: For infants from 3 to <5 months of age, the incidence of pertussis disease with at least 14 days of
cough decreased from 264/100,000 for unvaccinated infants to 155/100,000 for infants with one dose of a
pertussis vaccine prior to onset of the disease. In the age range 5 to <12 months, the age-dose specific
incidences were 526, 95, and 24/100,000 for infants with no, 1 and 2 doses, respectively. The rate of
hospitalisation for infants with 1 dose of a pertussis vaccine prior to onset of the disease was significantly
lower than for unvaccinated infants of the same age. For many infants, there is a delay in administration of
the vaccine doses according to the regular 3-5-12 month schedule (which has been the case for many years).
Hypothetically, if all infants had been vaccinated exactly on schedule, we would expect about 28% fewer
pertussis cases with at least 14 days of cough and 38% fewer hospitalisations due to pertussis, of cases
possible to influence by vaccinations on schedule.
Conclusion: Pertussis vaccination had a significant effect among infants already after the first dose. This is
particularly important for premature infants and infants with severe respiratory and cardiac diseases. A
moderate decrease in the incidence of pertussis disease in infants and rate of hospitalisation could be
expected if primary vaccinations were carried out closer to the scheduled time than is currently the practice in
Sweden.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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