Download NosoVeille Août 2011 - CClin

NosoVeille – Bulletin de veille
Novembre 2015
NosoVeille n°11
Novembre 2015
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Antibiotique / Antibiorésistance
Bilan standardisé
Chirurgie
Clostridium difficile
Dispositif médical
Ebola
EHPAD
Entérobactérie
Environnement
Epidémie
Excréta
Grippe
Hygiène des mains
Néonatologie
Norovirus
Personnel
Pneumonie
Soin intensif
Stérilisation
Surveillance
Tuberculose
1 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Antibiotique / Antibiorésistance
NosoBase ID notice : 402624
Rôles actuels et frictions des programmes de surveillance des infections néonatales dans le combat
contre l’antibiorésistance
Cailes B; Vergnano S; Kortsalioudaki C; Heath P; Sharland M. The current and future roles of neonatal
infection surveillance programmes in combating antimicrobial resistance. Early human development 2015/11;
91(11): 613-618.
Mots-clés : SURVEILLANCE; PREVENTION; ANTIBIORESISTANCE; NEONATOLOGIE; QUALITE;
SYNDROME SEPTIQUE; FACTEUR DE RISQUE; EPIDEMIOLOGIE; ETUDE INTERNATIONALE
Neonatal sepsis is an important cause of morbidity and mortality, particularly in premature or low birth weight
babies. Hospital-acquired blood stream infections represent a significant and largely preventable cause of
disease in this population. Neonatal units have been identified as a common site for the development and
transmission of antimicrobial-resistant pathogens, a significant issue in modern medicine. Neonatal
surveillance programmes collect prospective data on infection rates and may be used to optimise therapy,
benchmark practice and develop quality improvement programmes. Despite this, the number of networks is
relatively few and these are largely concentrated in resource-rich nations. Furthermore, surveillance
definitions may vary between programmes impairing our ability to draw comparisons between them. Better
harmonisation is required between networks to ensure that they achieve their potential as a valuable tool for
benchmarking of hospital-acquired infection rates between units.
NosoBase ID notice : 402610
La consommation de fluoroquinolone est le plus important facteur de risque de charge bactérienne
élevée chez des patients présentant une colonisation nasale et digestive à Acinetobacter baumannii
multi-résistant aux antibiotiques
Cheng VC; Chen JH; So SY; Wong SC; Yan MK; Chau PH; et al. Use of fluoroquinolones is the single most
important risk factor for the high bacterial load in patients with nasal and gastrointestinal colonization by
multidrug-resistant Acinetobacter baumannii. European journal of clinical microbiology and infectious
diseases 2015/09/15; in press: 8 pages.
Mots-clés : ACINETOBACTER BAUMANNII; COLONISATION; FLUOROQUINOLONE; COLONISATION
DIGESTIVE; COLONISATION NASALE; FACTEUR DE RISQUE; MULTIRESISTANCE ;
Gastrointestinal colonization by carbapenem-resistant Acinetobacter baumannii (CRAB) and multidrugresistant Acinetobacter baumannii (MRAB) provides an important reservoir for clinical infections and hospital
outbreaks. We conducted a 7-month study in a 3200-bed healthcare network to investigate the prevalence of
gastrointestinal colonization of CRAB and MRAB in Hong Kong. Between 1 June and 31 December 2014, a
total of 17,760 fecal specimens from 9469 patients were screened. Testing showed that 340 (1.9%)
specimens from 224 (2.6%) patients were CRAB-positive, which included 70 (0.39%) MRAB-positive
specimens from 54 (0.57%) patients. The presence of wound or ulcer, use of broad-spectrum antibiotics in
the preceding 6 months, and residence in elderly homes are independent risk factors for gastrointestinal
colonization of CRAB. Quantitative bacterial counts in various body sites (rectal, nasal, axilla, wound,
catheterized urine, if available) were performed in 33 (61.1%) of 54 MRAB patients. Ten (30.3%) and 8
(24.2%) patients had high bacterial load (defined as over 3 log10) in rectal and nasal swabs, with a median of
5.04 log10 cfu/ml of rectal swab and 4.89 log10 cfu/ml of nasal swab in saline diluent, respectively. Nine
(81.8%) of 11 patients with wounds had high bacterial load in wound swabs, with a median of 5.62 log10
cfu/ml. Use of fluoroquinolones 6 months before admission was the only significant factor associated with
high bacterial load in nasal and rectal swabs. With the implementation of directly observed hand hygiene
before meals and medications to all conscious hospitalized patients, no hospital outbreaks were observed
during our study period.
NosoBase ID notice : 403377
Réexaminer la nécessité de mise en place de précautions contact en cas de Staphylococcus aureus
résistant à la méticilline ou d’Enterococcus résistant à la vancomycine endémiques
2 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Morgan DJ; Murthy R; Munoz-Price LS; Barnden M; Camins BC; Johnston BL; et al. Reconsidering contact
precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.
Infection control and hospital epidemiology 2015/10; 36(10): 1163-1172.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; ANTIBIORESISTANCE;
ENTEROCOCCUS; VANCOMYCINE; COLONISATION; PRECAUTION CONTACT; INFECTION
NOSOCOMIALE; TRANSMISSION; EPIDEMIE; PEDIATRIE; REVUE DE LA LITTERATURE
Background: Whether contact precautions (CP) are required to control the endemic transmission of
methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute
care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental
cleaning and disinfection, fomite elimination, and chlorhexidine bathing.
Objective: To provide a framework for decision making around use of CP for endemic MRSA and VRE based
on a summary of evidence related to use of CP, including impact on patients and patient care processes, and
current practices in use of CP for MRSA and VRE in US hospitals.
Design: A literature review, a survey of Society for Healthcare Epidemiology of America Research Network
members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals
not using CP for MRSA or VRE.
Participants: Hospital epidemiologists and infection prevention experts.
Results: No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more
than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested
in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or
VRE.
Conclusions: Higher quality research on the benefits and harms of CP in the control of endemic MRSA and
VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute
care hospitals should be guided by local needs and resources.
NosoBase ID notice : 403008
Impact de la résistance aux carbapénèmes sur l’épidémiologie et l’évolution des infections non
bactériémiques à Klebsiella pneumoniae
Ny P; Nieberg P; Wong-Beringer A. Impact of carbapenem resistance on epidemiology and outcomes of
nonbacteremic Klebsiella pneumoniae infections. American journal of infection control 2015/10; 43(10): 10761080.
Mots-clés : KLEBSIELLA PNEUMONIAE; EPIDEMIOLOGIE; ANTIBIORESISTANCE; CARBAPENEME;
ADULTE; ETUDE RETROSPECTIVE; APPARIEMENT; CAS TEMOIN; RISQUE; FACTEUR DE RISQUE;
BETA-LACTAMASE A SPECTRE ELARGI; COHORTE
Background: Although high mortality associated with carbapenem-resistant Klebsiella pneumoniae (CRKP)
bacteremia has been well described, the epidemiology and outcomes of nonbacteremic infection are
unknown.
Methods: Medical charts of adults hospitalized for CRKP pneumonia or urinary tract infection between
January 2011 and December 2013 were reviewed retrospectively for relevant demographic and clinical
details. Cases were matched to controls (non-carbapenem-resistant, non-extended-spectrum beta-lactamase
[ESBL]-producing K pneumoniae [NRKP]) by the primary site of infection and year of isolation and compared
in terms of risk of acquisition and outcomes.
Results: The CRKP and NRKP arms (n=48 each) were elderly (median age, 74 years). Compared with
controls, more patients in the CRKP arm resided in skilled nursing/long-term acute care facilities (77% vs
29%; P<.01), had a chronic tracheostomy (29% vs 0%; P<.001), decubitus ulcers (69% vs 17%; P<.01),
higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (median, 21.5 vs 14; P=.02), and
required intensive care unit admission (54% vs 31%; P=.04). More patients in the CRKP arm had previous
ESBL infection (23% vs 6%; P=.04), and this arm had at least a 10-fold greater risk of coinfection with other
carbapenem-resistant pathogens (44% vs 4%; P<.01), as well as a 7-fold greater likelihood of previous
carbapenem therapy (23% vs 4%; P=.01). Patients in the CRKP arm had prolonged hospitalization (median,
13 days) and a 32% rate of readmission within 30 days of discharge.
Conclusions: CRKP nonbacteremic infections occur in debilitated patients and are associated with frequent
previous carbapenem exposure and high resource utilization, underscoring the need to focus efforts on
antimicrobial stewardship and infection control.
3 / 26
NosoVeille – Bulletin de veille
Novembre 2015
NosoBase ID notice : 400915
Diffusion et transmission de Klebsiella pneumoniae résistant aux carbapénèmes dans des services
de médecine et de chirurgie d’un centre hospitalier universitaire de Milan, Italie
Ridolfo AL; Rimoldi SG; Pagani C; Marino AF; Piol A; Rimoldi M; et al. Diffusion and transmission of
carbapenem-resistant Klebsiella pneumoniae in the medical and surgical wards of a university hospital in
Milan, Italy. Journal of infection and public health 2015/06/23; in press: 1-10.
Mots-clés : KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE; INCIDENCE; TRANSMISSION;
MEDECINE; CHIRURGIE; CENTRE HOSPITALIER UNIVERSITAIRE; CARBAPENEME; GENOTYPE;
ETUDE RETROSPECTIVE; MICROBIOLOGIE
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a public health problem worldwide. In
Italy, a remarkable increase in CRKP cases has been reported since 2010. In this study, CRKP diffusion,
distribution and in-hospital transmission trends were evaluated in a university hospital in Milan, Italy, from
January 2012 to December 2013. Isolates from 63 newly detected CRKP-positive patients were genotyped,
and possible transmission was determined by combining the molecular results with data concerning the
patients' admission and in-hospital transfers. Most of the cases (90.4%) were from general medical and
surgery wards, and the remaining 9.6% were from the intensive care unit. Fifteen of the 46 hospitalassociated cases (32.6%) were attributable to in-hospital transmission. After the introduction of targeted and
hospital-wide control measures, the transmission index significantly decreased from 0.65 to 0.13 (p=0.01).
There was also a decrease in the overall nosocomial case incidence, from 0.37 to 0.17 per 1000 person-days
(p=0.07). Our findings indicate that the spread of CRKP in Northern Italy hospitals may go far beyond highrisk settings (i.e., intensive care units) and that strict surveillance should be extended to general areas of
care.
NosoBase ID notice : 403415
Comparer les coûts de l’antibiothérapie dans les centres hospitaliers pédiatriques des Etats-Unis
Ross RK; Hersh AL; Kronman MP; Newland JG; Gerber JS. Cost of antimicrobial therapy across US
children's hospitals. Infection control and hospital epidemiology 2015/10; 36(10): 1242-1244.
Mots-clés : ANTIBIOTIQUE; COUT; PEDIATRIE; PRESCRIPTION; DDJ
We analyzed the cost of antimicrobial prescribing across freestanding children's hospitals. A few specific
antimicrobials accounted for a large proportion of expenditures, and antimicrobial spending varied
substantially across hospitals, even within specific clinical conditions. Antimicrobial stewardship programs
should consider these data to incorporate high-value antimicrobial prescribing when clinically appropriate.
Bilan standardisé
NosoBase ID notice : 404198
Contrôles de la qualité des bilans de lutte contre les infections nosocomiales : expérience d’une
agence régionale de santé
Berthod C; Coquel C; Poulet JP. Contrôles de la qualité des bilans de lutte contre les infections
nosocomiales : expérience d’une agence régionale de santé. Hygiènes 2015/09; 23(4): 235-241.
Mots-clés : ARS; BILAN STANDARDISE; ICSHA; ICATB; CONTROLE; ISCHA2; ICABMR; ICATB2
Objectif : Dans le cadre de la lutte contre les infections nosocomiales, un système déclaratif est instauré
depuis plusieurs années en France, Afin de s’assurer de la fiabilité des scores obtenus suite à la déclaration
du « tableau de bord des infections nosocomiales », les agences régionales de santé (ARS) sont chargées
de procéder à des contrôles sur site. Les établissements doivent présenter un dossier réunissant des
éléments de preuve. Ce retour d’expérience pointe les difficultés rencontrées par les établissements de santé
et permet d’apporter quelques conseils pour constituer leur dossier.
Méthode : En 2014, les contrôles ont été menés auprès de 25 établissements de la région Rhône-Alpes soit
environ 10 % des déclarants. Les inspecteurs de l’ARS se sont basés sur les éléments de preuve décrits
dans l’instruction pour les indicateurs éligibles en 2014 soit ICA-BMR (indicateur composite de maîtrise de la
diffusion des bactéries multirésistantes), ICATB.2 (indicateur composite de bon usage des antibiotiques
version 2) et ICSHA.2 (indicateur de consommation de produits hydroalcooliques version 2).
4 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Résultats : Les résultats des contrôles montrent une bonne fiabilité des déclarations pour l’ICSHA.2, une
conformité moyenne pour l’ICA-BMR et une fiabilité médiocre pour l’ICATB.2.
Conclusion : Il apparaît que l’indicateur le plus récent (en termes de version) produit les moins bons résultats.
Les praticiens hygiénistes des établissements ont besoin de temps pour s’approprier les éléments de preuve
surtout en matière de rédaction de procédures. Les contrôles ont souvent constitué un temps d’échange
constructif entre l’équipe opérationnelle d’hygiène et l’inspecteur.
Chirurgie
NosoBase ID notice : 403221
Suivi par appels téléphoniques de patients sortis après avoir bénéficié de chirurgie orthopédique :
essai contrôlé, randomisé, en double aveugle de l’efficacité
Clari M; Frigerio S; Ricceri F; Pici A; Alvaro R; Dimonte V. Follow-up telephone calls to patients discharged
after undergoing orthopaedic surgery: double-blind, randomised controlled trial of efficacy. Journal of clinical
nursing 2015/10; 24(19-20): 2736-2744 ;
Mots-clés : SORTIE; CHIRURGIE ORTHOPEDIQUE; RANDOMISATION; EFFICACITE; INFIRMIER;
PREVENTION
Aims and objectives: To evaluate the effectiveness of a follow-up telephone call to reduce the number of
issues after hospital discharge.
Background: The postdischarge period is often a time of uncertainty and risk. The decreasing length of
hospital stays has increased the need for specific instructions about the postdischarge period. A telephone
follow-up could be a valuable tool to fill this information gap.
Design: Double-blind, randomised controlled trial.
Methods: The participants included medium or low-intensity orthopaedic patients. We implemented a
structured telephone follow-up call conducted by a senior orthopaedic nurse to provide educational support to
the intervention group (n=110), while the control group (n=109) received routine care after being discharged.
Data were collected between September 2011-January 2012. Statistical differences between the two groups
were tested using chi-square test or Wilcoxon rank sum test, as appropriate. A linear regression model was
performed to investigate factors involved into postdischarge outcomes.
Results: The intervention group had a statistically significant reduction in all postdischarge problems except
for pain and mobilisation; the group also had a lower chance of experiencing frequent or severe problems.
The educational intervention and prior poor health had a strong correlation with problems after discharge.
Patients who received a telephone follow-up call believed the information provided was valuable.
Conclusion: This nurse-led follow-up intervention significantly contributed to solving or reducing postdischarge
health problems and contributed to reduce unnecessary burden on the community health system.
Relevance to clinical practice: A nurse-led telephone follow-up is a simple, feasible and low-cost tool to
improve patients' outcomes after discharge
NosoBase ID notice : 402398
Efficacité antimicrobienne de l’antisepsie cutanée pré-opératoire et relation clonale à la flore de la
peau et du site opératoire après l’antisepsie chez des patients bénéficiant de chirurgie orthopédique
propre
Daeschlein G; Napp M; Layer F; von Podewils S; Haase H; Spitzmueller R; et al. Antimicrobial efficacy of
preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients
undergoing clean orthopedic surgery. European journal of clinical microbiology and infectious diseases
2015/11; 34(11): 2265-2273.
Mots-clés : ANTIBIOTIQUE; EFFICACITE; ANTIFONGIQUE; CHIRURGIE PROPRE; CHIRURGIE
ORTHOPEDIQUE; ETUDE PROSPECTIVE; ESSAI THERAPEUTIQUE; STAPHYLOCOCCUS
Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying
mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora
surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical
trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany.
Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound
base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during
phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In
5 / 26
NosoVeille – Bulletin de veille
Novembre 2015
phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were
positive for bacterial growth in the wound base, 24.5% in the margin, and 27.3% in the suture. Only 65.5% of
patients showed a 100% reduction of the skin flora after antisepsis. The microbial spectrum in all
postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related
staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus
(MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the
wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into
the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further
studies are needed in order to understand the origin of this flora to allow further reduction of SSI.
NosoBase ID notice : 403502
Facteurs de risque d’infection du site opératoire en post-opératoire en cas de chorioamniotite et de
césarienne
Dotters-Katz SK; Feldman C; Puechl A; Grotegut CA; Heine RP. Risk factors for post-operative wound
infection in the setting of chorioamnionitis and cesarean delivery. The Journal of maternal-fetal and neonatal
medicine 21/07/2015; in press: 1-5.
Mots-clés : FACTEUR DE RISQUE;
RETROSPECTIVE; TABAGISME
ACCOUCHEMENT;
CESARIENNE;
COHORTE;
ETUDE
Objective: The objective of this study was to identify factors associated with an increased risk of postoperative wound infection in women with chorioamnionitis who undergo cesarean delivery.
Methods: We conducted a retrospective cohort study of women with clinical chorioamnionitis who underwent
cesarean delivery at a tertiary-care center between June 2010 and May 2013. Demographic data, labor and
delivery details and post-operative outcomes were collected. Women with and without post-operative wound
infections were compared.
Results: Of 213 women with clinical chorioamnionitis who underwent cesarean delivery, 32 (15%) developed
wound infections. Women with wound infection were more likely to have a body mass index (BMI) greater
than or equal to 40 (p=0.04), chronic hypertension (p=0.03), leukocytosis on presentation (p=0.046) or use
tobacco (p=0.002). Women who received ertapenem postpartum were less likely to develop wound infection
than those who did not receive antibiotics (p=0.02) or those that received ampicillin, gentamicin and
clindamycin (p=0.005).
Conclusions: Elevated BMI, tobacco use, chronic hypertension and leukocytosis at admission were
associated with an increased risk of wound infection. Ertapenem appeared to reduce the risk of postoperative wound infections in women who had chorioamnionitis and underwent cesarean delivery. This could
be considered as a treatment option for this high-risk population.
NosoBase ID notice : 403406
Infections du site opératoire après arthroplastie primaire de la hanche ou du genou : une étude de
cohorte à partir de la base de données de l’hôpital
Grammatico-Guillon L; Baron S; Rosset P; Gaborit C; Engineer S; Bernard L; et al. Surgical site infection after
primary hip and knee arthroplasty: A cohort study using a hospital database. Infection control and hospital
epidemiology 2015/10; 36(10): 1198-1207.
Mots-clés : CHIRURGIE ORTHOPEDIQUE; INFECTION NOSOCOMIALE; MATERIEL ETRANGER;
PROTHESE TOTALE DE HANCHE; PROTHESE TOTALE DE GENOU; INCIDENCE; APPAREIL OSTEOARTICULAIRE; STATISTIQUE; COHORTE; PMSI; TAUX; FACTEUR DE RISQUE; SITE OPERATOIRE
Background: Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.
Objective: To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as
a novel additional tool for surveillance.
Methods: A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or
knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients
with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then
tracked in the follow-up on the basis of a previously validated algorithm using International Statistical
Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density
incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using
Cox regression.
6 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Results: A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence
was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days
after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male,
or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in
HKAI patients was 11.4%.
Conclusions: The hospital database method used to measure occurrence and risk factors of prosthetic joint
infection helped to survey HKAI and could optimize healthcare delivery.
NosoBase ID notice : 403508
Endocardites infectieuses (EI) : recommandations ESC 2015. Groupe de travail pour la gestion des
endocardites infectieuses de la Société européenne de cardiologie (SEC). Approuvé par :
l’Association européenne de chirurgie cardio-thoracique (EACTS) et l’Association européenne de
médecine nucléaire (AEMN)
Habib G; Lancellotti P; Antunes MJ; Bongiorni MG; Casalta JP; Del Zotti F; et al. 2015 ESC Guidelines for the
management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the
European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery
(EACTS), the European Association of Nuclear Medicine (EANM). European heart journal 29/08/2015; in
press: 54 pages.
Mots-clés : ENDOCARDITE INFECTIEUSE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE
LA LITTERATURE
Il s’agit d’une actualisation de la version précédente des recommandations de la European Society of
Cardiology, datant de 2009 et qui avaient été approuvées par la SPILF.
Ce texte précise la place des progrès de l’imagerie (PET scan, scanner multi-coupe, échographie
transoesophagienne 3D ….). Pour le diagnostic microbiologie, il propose un nouvel algorithme, utilisant
précocement la spectrométrie de masse pour l’identification bactérienne, et des techniques moléculaires pour
le diagnostic des endocardites à hémocultures, et sérologies négatives.
NosoBase ID notice : 402984
Amélioration du rapport et de la prévention des infections des sites opératoires cardiaques grâce à
l’utilisation des registres de données pour la détermination des cas
Nayar V; Kennedy A; Pappas J; Atchley KD; Field C; Smathers S; et al. Improving cardiac surgical site
infection reporting and prevention by using registry data for case ascertainment. The Annals of thoracic
surgery 2015/09/23; in press: 1-10.
Mots-clés : CHIRURGIE CARDIO-VASCULAIRE; PREVENTION; QUALITE; RISQUE; PERSONNEL;
PEDIATRIE; SURVEILLANCE; FORMATION; BUNDLE
Background: The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate
reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and
administrative databases to improve reporting and reduce the incidence of SSI [2].
Methods: At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STSCHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing
electronic health record (EHR) billing data. A data visualization tool was created to (1) use the STS-CHSD for
case ascertainment, (2) resolve discrepancies between the databases, and (3) assess impact of QI initiatives,
including wound alert reports, bedside reviews, prevention bundles, and billing coder education.
Results: Over the 24-month study period, 1,715 surgical cases were ascertained according to the STS-CHSD
clinical criteria, with 23 SSIs identified through the STS-CHSD, 20 SSIs identified through the ISD, and 32
SSIs identified through the billing database. The rolling 12-month STS-CHSD SSI rate decreased from 2.73%
(21 of 769 as of January 2013) to 1.11% (9 of 813 as of December 2014). Thirty reporting discrepancies were
reviewed to ensure accuracy. Workflow changes facilitated communication and improved adjudication of
suspected SSIs. Billing coder education increased coding accuracy and narrowed variation between the 3
SSI sources. The data visualization tool demonstrated temporal relationships between QI initiatives and SSI
rate reductions.
Conclusions: Linkage of registry and infection control surveillance data with the EHR improves SSI
surveillance. The visualization tool and workflow changes facilitated communication, SSI adjudication, and
assessment of the QI initiatives. Implementation of these initiatives was associated with decreased SSI rates.
7 / 26
NosoVeille – Bulletin de veille
Novembre 2015
NosoBase ID notice : 403505
Infection du site opératoire après césarienne : facteurs spécifiques au patient, au personnel et à la
procédure
Shree R; Park SY; Beigi RH; Dunn SL; Krans EE. Surgical site infection following cesarean delivery: patient,
provider, and procedure-specific risk factors. American journal of perinatology 2015/09/07; in press: 8 pages.
Mots-clés : CESARIENNE; FACTEUR DE RISQUE; USAGER DE LA SANTE; PERSONNEL; ETUDE
RETROSPECTIVE; ANALYSE MULTIVARIEE; TABAGISME
Objective: This study aims to identify risk factors for cesarean delivery (CD) surgical site infection (SSI).
Study design: Retrospective analysis of 2,739 CDs performed at the University of Pittsburgh in 2011. CD
SSIs were defined using National Healthcare Safety Network (NHSN) criteria. Chi-square test and t-test were
used for bivariate analyses and multivariate logistic regression was used to identify SSI risk factors.
Results: Of 2,739 CDs, 178 (6.5%) were complicated by SSI. Patients with a SSI were more likely to have
Medicaid, have resident physicians perform the CD, an American Society of Anesthesiologists (ASA) class
of ≥ 3, chorioamnionitis, tobacco use, and labor before CD. In multivariable analysis, labor (odds ratio [OR],
2.35; 95% confidence interval [95% CI], 1.65-3.38), chorioamnionitis (OR, 2.24; 95% CI, 1.25-3.83), resident
teaching service (OR, 2.15; 95% CI, 1.54-3.00), tobacco use (OR, 1.70; 95% CI, 1.04-2.70), ASA class ≥ 3
(OR, 1.61; 95% CI, 1.06-2.39), and CDs performed for nonreassuring fetal status (OR, 0.43; 95% CI, 0.260.67) were significantly associated with CD SSI.
Conclusion: Multiple patient, provider, and procedure-specific risk factors contribute to CD SSI risk which may
be targeted in infection-control efforts.
Clostridium difficile
NosoBase ID notice : 400928
Etude nationale de l’épidémiologie moléculaire de Clostridium difficile en Israël : dissémination de la
souche ribotype 027 présentant une sensibilité diminuée à la vancomycine et au métronidazole
Adler A; Miller-Roll T; Bradenstein R; Block C; Mendelson B; Parizade M; et al. A national survey of the
molecular epidemiology of Clostridium difficile in Israel: the dissemination of the ribotype 027 strain with
reduced susceptibility to vancomycin and metronidazole. Diagnostic microbiology and infectious disease
2015/09; 83(1): 21-24.
Mots-clés : CLOSTRIDIUM DIFFICILE; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; RIBOTYPE;
ANTIBIORESISTANCE; VANCOMYCINE; METRONIDAZOLE; ETUDE MULTICENTRIQUE
Our goals were to study the molecular epidemiology and antimicrobial susceptibilities of C. difficile strains in
Israel. Microbiology laboratories serving 6 general hospitals (GH) and 10 long-term care facilities (LTCF) were
asked to submit all stool samples in January-February 2014 that tested positive for C. difficile. Toxigenic C.
difficile isolates were recovered in 208 out of 217 samples (95.8%), of which 50 (23.6%) were from LTCFs.
Ribotype 027 was the most common type overall, identified in 65 samples (31.8%), and was the predominant
strain in the 3 GHs with the highest incidence of C. difficile infections. Other common strains were slpA types
cr-02 (n=45) and hr-02 (n=18). The proportions of vancomycin and metronidazole MIC values >2mg/L were
high in ribotype 027 (87.7% and 44.6%, respectively) and slpA-cr-02 strains (88.8% and 17.8%, respectively).
This study demonstrates that the ribotype 027 strain has disseminated across Israel and is now the most
common strain.
NosoBase ID notice : 402974
Transplantation de microbiote fécal dans des maladies gastro-intestinales : ce que les médecins
devraient savoir
Borody TJ; Connelly N; Mitchell SW. Fecal microbiota transplantation in gastrointestinal diseases: What
practicing physicians should know. Polskie Archiwum Medycyny Wewnetrznek 23/09/2015; in press: 16
pages.
Mots-clés : TRANSPLANTATION; SELLES; APPAREIL DIGESTIF; MEDECIN; CONNAISSANCE;
CLOSTRIDIUM DIFFICILE; COUT; TRAITEMENT; NEUROLOGIE; REVUE DE LA LITTERATURE;
DIARRHEE; MICROBIOTE
8 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Clostridium difficile infection (CDI) is one of the most commonly reported nosocomial pathogens in the United
States (US) and Europe with recent US CDI-associated mortality approaching 30,000 deaths annually.
Antibiotics remain the preferred CDI treatment, however a minority of patients experience numerous relapses
and are treated with restoration of the bowel microbiota, termed fecal microbiota transplantation (FMT). FMT
involves the introduction of a fecal suspension from a healthy donor into the gut of the infected patient to cure
the CDI and replace depleted components of the gut microbiota. FMT is particularly effective and safe in
curing CDI using a colonoscope or enema to deliver 1-2 infusions. Given that 6425 CDI were reported in
Poland in 2014 practicing physicians should understand the benefits and limitations of FMT in CDI as this
novel therapy has rapidly advanced to the level of 'standard-of-care' status in Australia, the US and many
parts of Europe. FMT has been administered either as a suspension in saline, a highly refined liquid product
which can be frozen, as lyophilised powder in capsules, and as an encapsulated spore preparation. The
ultimate products to reach the market will be shaped by the indications approved by regulatory bodies. At
present the faecal suspension in saline remains the treatment of choice to terminate relapsing and severe
CDI, which we will review here. The use of FMT for non-CDI indications such as inflammatory bowel disease
and irritable bowel syndrome, is likely to increase. Presently, these indications remain in the domain of
research institutions.
NosoBase ID notice : 402980
Antibiothérapie et infections à Clostridium difficile - D’abord ne pas nuire
Crowther GS; Wilcox MH. Antibiotic therapy and Clostridium difficile infection - primum non nocere - first do
no harm. Infection and drug resistance 2015/09/15; 8: 333-337.
Mots-clés : CLOSTRIDIUM DIFFICILE; TRAITEMENT; ANTIBIOTIQUE; PREVENTION; VACCIN
Treatment options for Clostridium difficile infection (CDI) remain limited despite this usually nosocomial
infection posing an urgent threat to public health. A major paradox of the management of CDI is the use of
antimicrobial agents to treat infection, which runs the risk of prolonged gut microbiota perturbation and so
recurrence of infection. Here, we explore alternative CDI treatment and prevention options currently available
or in development. Notably, strategies that aim to reduce the negative effects of antibiotics on gut microbiota
offer the potential to alter current antimicrobial stewardship approaches to preventing CDI.
NosoBase ID notice : 402394
Les facteurs prédictifs d’infection sévère à Clostridium difficile dépendent de la définition utilisée
Khanafer N; Barbut F; Eckert C; Perraud M; Demont C; Luxemburger C; et al. Factors predictive of severe
Clostridium difficile infection depend on the definition used. Anaerobe 31/08/2015; in press: 1-6.
Mots-clés : CLOSTRIDIUM DIFFICILE; DEFINITION; FACTEUR DE RISQUE; COHORTE; CENTRE
HOSPITALIER UNIVERSITAIRE; ANALYSE MULTIVARIEE; INCIDENCE
Context: Clostridium difficile infection (CDI) produces a variety of clinical presentations ranging from mild
diarrhea to severe infection with fulminant colitis, septic shock, and death. Over the past decade, the
emergence of the BI/NAP1/027 strain has been linked to higher prevalence and severity of CDI. The
guidelines to treat patients with CDI are currently based on severity factors identified in the literature and on
expert opinion and have not been systematically evaluated.
Objective: The objective of this study was to identify factors associated with severe CDI defined according to
four different severity definitions (Def): the 2010 SHEA/IDSA guidelines (Def1), the 2014 ESCMID guidelines
(Def2), complicated CDI at the end of diarrhea (Def3), and our hospital-specific guidelines (white blood cell
(WBC) count ≥15×109/L, serum creatinine concentration >50% above baseline, pseudomembranous colitis,
megacolon, intestinal perforation, or septic shock requiring intensive care unit admission.
Methods: A three-year cohort study was conducted in a university hospital in Lyon, France. All hospitalized
(≥48 h) patients ≥18 years old, suffering from CDI, and agreeing to participate were included. Patients were
followed-up for 60 days after CDI diagnosis. After bivariate regression analyses, factors associated with
severe CDI during the course of disease were identified by a multivariate logistic regression. Statistical
significance was reached with a two-sided p-value <0.05.
Results: 233 CDI patients diagnosed between 2011 and 2014 were included for a mean incidence rate of
2.15 cases/1000 hospitalized patients or 3.16 cases/10,000 patient days. Mean age was 65.3 years and
52.5% were men. Death occurred in 37 patients (15.9%) within 60 days of diagnosis. Death was related to
CDI in 15 patients (40.5%). Frequency of severe CDI ranges from 11.6% to 59.2% depending on the case9 / 26
NosoVeille – Bulletin de veille
Novembre 2015
definition. Factors independently associated with severe CDI were: age ≥68 years, male gender, renal
disease, and serum albumin <30 g/L according to Def1 (n=106, 45.5%); exposure to antivirals in the previous
4 weeks, renal disease, and blood neutrophils >7,5×109/L in patients with Def2 (n = 138, 59.2%); abdominal
pain, serum albumin <30 g/L, and WBC >10×109/L according to Def3 (n=27, 11.6%); age ≥68 years, renal
disease, serum albumin <30 g/L, serum lactate dehydrogenase >248 IU/L, and blood neutrophils >7,5×109/L
were associated with severe CDI in patients with Def4 (n=113, 48.5%).
Conclusions: Our results indicate that appropriate case definition is needed for characterizing patients at risk
of developing severe CDI. Our study suggest that serum albumin and the presence of renal disease,
associated with severe CDI in three definitions, may be useful for identifying patients at risk of a poor
outcome.
NosoBase ID notice : 401880
Coût pour les hôpitaux des infections à Clostridium difficile incluant la contribution des récurrences
dans des centres hospitaliers universitaires en France
Le Monnier A; Duburcq A; Zahar JR; Corvec S; Guillard T; Cattoir V; et al. Hospital cost of Clostridium difficile
infection including the contribution of recurrences in French acute-care hospitals. The journal of hospital
infection 2015/10; 91(2): 117-122.
Mots-clés : CLOSTRIDIUM DIFFICILE; COUT; CENTRE HOSPITALIER UNIVERSITAIRE; INFECTION
RECURRENTE; ETUDE RETROSPECTIVE; APPARIEMENT; CAS TEMOIN; DUREE DE SEJOUR
Les prises en charge des infections à Clostridium difficile auraient représenté un surcoût de 163 millions
d'euros en 2011 dans les établissements publics ayant une activité de médecine, chirurgie, obstétrique
(MCO). Afin d'estimer le coût attribuable aux infections à C. difficile en France, l’équipe de F. Barbut du
groupe hospitalier Paris-Saint-Joseph à Paris ont analysé les données relatives à 12 grands établissements
de santé publics ayant une activité de MCO en 2011. Les auteurs se sont basés sur 1.067 infections à C.
difficile qui ont affecté 906 patients et sont survenues au cours de 979 séjours. Le taux de récidives s'élevait
à 12 % et le séjour moyen durait 64 jours, contre 25 jours pour les séjours sans infection à C. difficile. Les
auteurs ont calculé le surcoût de l'infection nosocomiale à partir de l'étude nationale de coûts à méthodologie
commune (ENCC). Pour certains cas où l'infection à C. difficile était identifiée comme le diagnostic primaire
et non secondaire à une autre maladie, l'équipe a pris en compte la totalité du coût du séjour. D'après ces
données, le surcoût médian d'une infection à C. difficile s'élevait à 7.514 euros. Selon une extrapolation, le
coût pour l'ensemble des établissements français publics de MCO a atteint 163 millions d'euros en 2011.
NosoBase ID notice : 403010
Relation entre les conteneurs pour objets piquant/coupant et les infections à Clostridium difficile
dans des centres hospitaliers
Pogorzelska-Maziarz M. Relationship between sharps disposal containers and Clostridium difficile infections
in acute care hospitals. American journal of infection control 2015/10; 43(10): 1081-1085.
Mots-clés : CLOSTRIDIUM DIFFICILE; CONTENEUR; ACCIDENT D'EXPOSITION AU SANG; ETUDE
MULTICENTRIQUE; REUTILISABLE; USAGE UNIQUE; TRANSMISSION; RISQUE; PERSONNEL;
SECURITE SANITAIRE; ETUDE NATIONALE
Background: Sharps disposal containers are ubiquitous in health care facilities; however, there is paucity of
data on their potential role in pathogen transmission. This study assessed the relationship between use of
single-use versus reusable sharps containers and rates of Clostridium difficile infections in a national sample
of hospitals.
Methods: A 2013 survey of 1,990 hospitals collected data on the use of sharps containers. Responses were
linked to the 2012 Medicare Provider Analysis and Review dataset. Bivariate and multivariable negative
binomial regression were conducted to examine differences in C difficile rates between hospitals using singleuse versus reusable containers.
Results: There were 604 hospitals who completed the survey; of these, 539 provided data on use of sharps
containers in 2012 (27% response rate). Hospitals had, on average, 289 beds (SD±203) and were
predominantly non-for-profit (67%) and nonteaching (63%). Most used reusable sharps containers (72%). In
bivariate regression, hospitals using single-use containers had significantly lower rates of C difficile versus
hospitals using reusable containers (incidence rate ratio [IRR]=0.846, P=.001). This relationship persisted in
multivariable regression (IRR=0.870, P=.003) after controlling for other hospital characteristics.
10 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Conclusion: This is the first study to show a link between use of single-use sharps containers and lower C
difficile rates. Future research should investigate the potential for environmental contamination of reusable
containers and the role they may play in pathogen transmission.
NosoBase ID notice : 403383
Facteurs de risque de mortalité hospitalière dans une cohorte d’enfants ayant une infection à
Clostridium difficile
Vendetti N; Zaoutis T; Coffin SE; Sammons JS. Risk factors for in-hospital mortality among a cohort of
children with Clostridium difficile infection. Infection control and hospital epidemiology 2015/10; 36(10): 11831189.
Mots-clés : CLOSTRIDIUM DIFFICILE; MORTALITE,; INCIDENCE;
PEDIATRIE; ADMISSION; FACTEUR DE RISQUE; ANTIBIOTIQUE
INFECTION
NOSOCOMIALE;
Objective: The incidence of Clostridium difficile infection (CDI) has increased and has been associated with
poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was
to identify risk factors for all-cause in-hospital mortality among children with CDI.
Methods: A multicenter cohort of children with CDI, aged 1-18 years, was established among children
hospitalized at 41 freestanding children's hospitals between January 1, 2006 and August 31, 2011. Children
with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test
charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause
in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression
model.
Results: We identified 7,318 children with CDI during the study period. The median age of this cohort was 6
years [interquartile range (IQR): 2-13]; the mortality rate was 1.5% (n=109); and the median number of days
between C. difficile testing and death was 12 (IQR, 7-20). Independent risk factors for death included older
age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40-3.77)], underlying malignancy [3.57 (2.365.40)], cardiovascular disease [2.06 (1.28-3.30)], hematologic/immunologic condition [1.89 (1.05-3.39)],
gastric acid suppression [2.70 (1.43-5.08)], and presence of >1 severity of illness marker [3.88 (2.44-6.19)].
Conclusion: Patients with select chronic conditions and more severe disease are at increased risk of death.
Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit
from targeted CDI prevention and treatment strategies.
Dispositif médical
NosoBase ID notice : 403045
Nouveau dispositif UV-LED pour la désinfection automatique des membranes de stéthoscopes
Messina G; Burgassi S; Messina D; Montagnani V; Cevenini G. A new UV-LED device for automatic
disinfection of stethoscope membranes. American journal of infection control 2015/10; 43(10): e61-e66.
Mots-clés : DESINFECTION; DISPOSITIF MEDICAL; ULTRA-VIOLET; ESCHERICHIA COLI;
STAPHYLOCOCCUS AUREUS; PSEUDOMONAS AERUGINOSA; ENTEROCOCCUS FAECALIS;
SURFACE; STETHOSCOPE
Background: Stethoscopes are widely used by doctors and nurses. Poor stethoscope hygiene is a potential
source of nosocomial infection. This study aimed to propose an innovative solution, based on the latest
advances in ultraviolet (UV) light-emitting diodes (LEDs), for disinfecting stethoscope membranes
automatically and efficiently.
Methods: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis
were sown on 28 stethoscope membranes and then transferred to Petri dishes. Treatment involved
illuminating exposed Petri dishes with a UVC LED for 1 minute. For each microbe, the number of colonyforming units (cfu) at 36°C was compared in control and treated dishes using the Wilcoxon signed-rank test.
The Kruskal-Wallis test was used to assess percent reductions in bacteria. Statistical significance was set at
99%.
Results: A significant reduction in cfu counts after UV treatment (P<.01) was found for all bacteria: 85.5% for
E faecalis, 87.5% for S aureus, 94.3% for E coli, and 94.9% for P aeruginosa . No significant differences in
percent reduction in cfu were found between bacteria (P>.01).
Conclusion: The stethoscope, symbol of medicine and health care professionals, has been demonstrated to
be a carrier of microorganisms. The treatment technique was effective and efficient in disinfecting the
11 / 26
NosoVeille – Bulletin de veille
Novembre 2015
membranes. These promising results represent a step forward toward eliminating stethoscope membrane
contamination with an innovative approach.
NosoBase ID notice : 403172
Réutilisation de stylos injecteurs d’insuline chez de nombreux patients dans deux centres médicaux
des « Veterans Affairs »
Schirmer P; Winston CA; Lucero-Obusan C; Winters M; Lesse A; Comarmond C; et al. Reuse of insulin pens
among multiple patients at 2 veterans affairs medical centers. Infection control and hospital epidemiology
2015/10; 36(10): 1121-1129.
Mots-clés : INSULINE; STYLO INJECTEUR; PATIENT; INFECTION NOSOCOMIALE; TRANSMISSION
SOIGNE-SOIGNE; HEPATITE B; HEPATITE C; INVESTIGATION; ETUDE RETROSPECTIVE
Objective: To determine whether reuse of insulin pens among multiple patients resulted in transmission of
bloodborne pathogens (BBP).
Design: Retrospective cohort study.
Setting: Two Veterans Affairs medical centers.
Patients: Veterans who received insulin via insulin pens from 2010 to 2013.
Methods: Patients were identified through electronic health records, notified of possible exposure, and
serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly
discovered case patients were assessed in relation to potential proximate patients to determine viral strain
relatedness by HCV envelope (env) gene sequencing.
Results: Of 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1
viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For
human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients
was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes)
were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for
further testing. None of the 26 remaining proximate patients had blood available for further testing. Median
genetic distance between the HCV env sequences of those available for additional testing ranged from 14%
to 24%, indicating nonrelatedness.
Conclusions: Our investigation revealed that exposure to insulin pen reuse did not result in HCV transmission
among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of
blood-borne pathogens was limited by the available samples.
Ebola
NosoBase ID notice : 403018
Détection des thèmes préoccupant le public : analyse d’une extraction de textes de la discussion en
direct concernant Ebola sur le compte Twitter du CDC
Lazard AJ; Scheinfeld E; Bernhardt JM; Wilcox GB; Suran M. Detecting themes of public concern: A text
mining analysis of the Centers for Disease Control and Prevention's Ebola live Twitter chat. American journal
of infection control 2015/10; 43(10): 1109-1111.
Mots-clés : ANALYSE; CONTROLE; PREVENTION; FIEVRE HEMORRAGIQUE; USAGER DE LA SANTE;
INFORMATION; TRANSMISSION; CDC; EPIDEMIE; EBOLA; RESEAUX SOCIAUX; VOYAGE|
A diagnosis of Ebola on US soil triggered widespread panic. In response, the Centers for Disease Control and
Prevention held a live Twitter chat to address public concerns. This study applied a textual analytics method
to reveal insights from these tweets that can inform communication strategies. User-generated tweets were
collected, sorted, and analyzed to reveal major themes. The public was concerned with symptoms and
lifespan of the virus, disease transfer and contraction, safe travel, and protection of one's body.
NosoBase ID notice : 402386
Infections à entérobactéries productrices de bêta-lactamases à spectre étendu (BLSE) : les
alternatives aux carbapénèmes sont-elles réalisables en pratique quotidienne ?
12 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Pilmis B; Delory T; Groh M; Weiss E; Emirian A; Lecuyer H; et al. Extended-spectrum beta-lactamaseproducing Enterobacteriaceae (ESBL-PE) infections: are carbapenem alternatives achievable in daily
practice? International journal of infectious diseases 2015/10; 39: 62-67.
Mots-clés : ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; CARBAPENEME; ETUDE
PROSPECTIVE; COHORTE; ETUDE MULTICENTRIQUE; INFECTION URINAIRE; PNEUMONIE;
BACTERIEMIE; ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; ENTEROBACTER CLOACAE;
ANTIBIOTIQUE; PRESCRIPTION; ETUDE D'OBSERVATION
Objectives: To avoid the use of carbapenems, alternatives such as cephamycin, piperacillin-tazobactam, and
others are suggested for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae
(ESBL-PE) infections. The aim of this study was to evaluate the frequency and the feasibility of antimicrobial
de-escalation for ESBL-PE-related infections.
Methods: A prospective observational, two-centre cohort study was conducted. All patients with ESBL-PE
infections were included. De-escalation was systematically suggested if patients were clinically stable and the
isolate was susceptible to possible alternatives.
Results: Seventy-nine patients were included: 36 (45.6%) were children, 27 (34.1%) were hospitalized in
intensive care units, and 37 (47%) were immunocompromised. Urinary tract infections, pneumonia, and
catheter-related bloodstream infections accounted for 45.6%, 19%, and 10%, respectively, of the cohort.
Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were the three most frequent causative
organisms isolated. On day 5, 47 (59.2%) of the patients were still receiving carbapenems. Antimicrobial
resistance (44.7%), infection relapse (26.9%), and clinical instability (19.2%) were the most important reasons
for not prescribing alternatives. E. coli-related infections appeared to be a protective factor against
maintaining the carbapenem prescription (odds ratio 0.11, 95% confidence interval 0.041-0.324; p=0.0013).
Conclusions: In clinical practice, less than 50% of patients with ESBL-PE-related infections were de-escalated
after empirical treatment with carbapenems.
NosoBase ID notice : 403409
Cabine de décontamination pour le virus Ébola : évaluation d’une cabine UV-C fermée
désinfecter l’équipement de protection individuel (EPI) contaminé avant le déshabillage
pour
Tomas ME; Cadnum JL; Jencson A; Donskey CJ. The Ebola disinfection booth: Evaluation of an enclosed
ultraviolet light booth for disinfection of contaminated personal protective equipment prior to removal. Infection
control and hospital epidemiology 2015/10; 36(10): 1226-1228.
Mots-clés : FIEVRE HEMORRAGIQUE; TENUE VESTIMENTAIRE; EQUIPEMENT DE PROTECTION;
PERSONNEL; CONTAMINATION; DESINFECTION; ULTRA-VIOLET; INFECTION NOSOCOMIALE; EBOLA
A portable booth designed to disinfect full-body coverage protective equipment before removal using
ultraviolet-C radiation resulted in at least 3 log reductions in bacteriophage MS2 and methicillin-resistant
Staphylococcus aureus within 3 minutes. The booth could be useful for disinfection of contaminated
protective equipment before removal during care of Ebola patients.
NosoBase ID notice : 403410
Protéger le personnel soignant de la contamination au virus Ebola
Weber DJ; Fischer WA; Wohl DA; Rutala WA. Protecting healthcare personnel from acquiring Ebola virus
diseas. Infection control and hospital epidemiology 2015/10; 36(10): 1229-1232.
Mots-clés : FIEVRE HEMORRAGIQUE; PERSONNEL; TENUE VESTIMENTAIRE; EQUIPEMENT DE
PROTECTION; CONTAMINATION; TRANSMISSION; EBOLA; EPI
EHPAD
NosoBase ID notice : 403186
Prévalence et facteurs de risque de colonisation à Acinetobacter baumannii multirésistant chez des
résidents d’EHPAD à haut risque
13 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Mody L; Gibson KE; Horcher A; Prenovost K; McNamara SE; Foxman B; et al. Prevalence of and risk factors
for multidrug-resistant Acinetobacter baumannii colonization among high-risk nursing home residents.
Infection control and hospital epidemiology 2015/10; 36(10): 1155-1162.
Mots-clés : ACINETOBACTER BAUMANNII; MULTIRESISTANCE; COLONISATION; FACTEUR DE
RISQUE; EPIDEMIOLOGIE; SONDAGE URINAIRE; ALIMENTATION ENTERALE; EHPAD; ETUDE
PROSPECTIVE
Objective: To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii
colonization in high-risk nursing home (NH) residents.
Design: Nested case-control study within a multicenter prospective intervention trial.
Setting: Four NHs in Southeast Michigan.
Participants: Case patients and control subjects were NH residents with an indwelling device (urinary catheter
and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were
residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never
colonized with MDR A. baumannii.
Methods: For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area,
wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A.
baumannii strains and their susceptibilities were identified using standard microbiologic methods.
Results: Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143
controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95%
CI, 1.8-14.9]; P<.004), colonized with Proteus mirabilis (5.8 [1.9-17.9]; P<.003), and diabetic (3.4 [1.2-9.9];
P<.03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%)
exhibited co-colonization with at least one other resistant gram-negative bacteria.
Conclusion: Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for
colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic
resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention
and improved infection control practices in these residents
Entérobactérie
NosoBase ID notice : 402623
Entérobactéries productrices de NDM en Pologne, 2012-2014 : épidémie interrégionale à Klebsiella
pneumoniae ST11 et cas sporadiques
Baraniak A; Izdebski R; Fiett J; Gawryszewska I; Bojarska K; Herda M; et al. NDM-producing
Enterobacteriaceae in Poland, 2012-14: inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic
cases. Journal of antimicrobial chemotherapy 2015/09/19; in press: 1-7
Mots-clés : KLEBSIELLA PNEUMONIAE; ENTEROBACTERIE; ANTIBIORESISTANCE; EPIDEMIE;
TYPAGE; BIOLOGIE MOLECULAIRE; ESCHERICHIA COLI; PROTEUS MIRABILIS; NEW-DELHI
METALLO-BETA-LACTAMASE; ND
Objectives: The objective of this study was to characterize New Delhi metallo-β-lactamase (NDM)-producing
Enterobacteriaceae isolates reported in Poland in 2012-14.
Methods: Representative isolates were typed by PFGE and MLST. NDM and other β-lactamase genes were
amplified and sequenced. Plasmids with blaNDM genes were analysed by nuclease S1 plus hybridization
profiling, by transfer assays and by PCR-based replicon typing. The blaNDM genetic context was studied by
PCR mapping assays.
Results: Of 374 cases of infection/colonization with NDM-positive Enterobacteriaceae identified in 2012-14,
370 cases in 40 hospitals, 10 outpatient clinics and 1 nursing home were associated with a Klebsiella
pneumoniae outbreak with epicentres in Poznań and Warsaw. The outbreak strain of K. pneumoniae ST11
was similar to an isolate from the Czech Republic from 2013. Like the Czech strain, many of the isolates had
two blaNDM-1-carrying IncFII- and IncR-type plasmids of variable size, sharing a blaNDM-1-containing
segment. The early isolates also produced CTX-M-15 co-encoded by the IncR-type plasmids, and
differentiated later by extensive plasmid rearrangements. Four other NDM cases were reported in 2013, three
being associated with arrivals from Montenegro, India or Afghanistan. The Indian Escherichia coli ST448
NDM-5 isolate revealed similarity to a recent isolate from Spain, including the blaNDM genetic context
observed previously in E. coli strains in Poland and France (of Congolese and Indian origins, respectively).
The Afghani Proteus mirabilis was the second isolate of this species with a chromosomal blaNDM-1 location.
Conclusions: The largest NDM outbreak in a non-endemic country has been observed, being an alarming
phenomenon in resistance epidemiology in Poland.
14 / 26
NosoVeille – Bulletin de veille
Novembre 2015
NosoBase ID notice : 403183
Modéliser la dissémination des bactéries productrices de KPC dans des établissements de long
séjour de la région de Chicago, Etats-Unis
Haverkate MR; Bootsma MC; Weiner S; Blom D; Lin MY; Lolans K; et al. Modeling spread of KPC-producing
bacteria in long-term acute care hospitals in the Chicago region, USA. Infection control and hospital
epidemiology 2015/10; 36(10): 1148-1154.
Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; PREVALENCE; SOIN DE LONGUE DUREE;
COLONISATION; TRANSMISSION; INFECTION NOSOCOMIALE; COHORTE; CHLORHEXIDINE;
FORMATION; PRELEVEMENT; CHAMBRE INDIVIDUELLE; KPC; MODELE DE MARKOV
Objective: Prevalence of bla KPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care
hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and
transmission capacity of KPC in LTACHs and the effect of patient cohorting.
Methods: Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of
bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing,
medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single
rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with
KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model
the transmission process.
Results: Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized;
the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The
number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms
for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.
Conclusions: Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the
resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in
place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single
rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a
mixed cohort.
NosoBase ID notice : 402608
Epidémies à entérobactéries productrices de bêta-lactamases à spectre étendu dans des unités de
réanimation néonatale : revue systématique
Stapleton PJ; Murphy M; McCallion N; Brennan M; Cunney R; Drew RJ. Outbreaks of extended spectrum
beta-lactamase-producing Enterobacteriaceae in neonatal intensive care units: a systematic review. Archives
of disease in childhood. Fetal and neonatal edition 2015/09/14; in press: F1-F7.
Mots-clés : ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; EPIDEMIE; SOIN INTENSIF;
NEONATOLOGIE; REVUE DE LA LITTERATURE; MORTALITE; TAUX; PERSONNEL
Objective: To establish the number of outbreaks of extended spectrum beta-lactamase (ESBL) producing
organisms in neonatal intensive care units (NICUs), to determine causes, mortality rates, proportions of
infants colonised and infected and the interventions that terminated outbreaks.
Methods: A systematic review of the literature in English, Spanish and French was undertaken with searches
in four databases. The review conformed to the PRISMA guidelines, and the data extraction was modelled on
the ORION criteria for studies of nosocomial infection.
Results: 75 studies fulfilled the inclusion criteria. There were 1185 cases of colonisation, 860 infections and
139 deaths. The median outbreak duration was 6.2 months (IQR 2.0-7.5 months). Klebsiella pneumoniae was
the most frequently implicated pathogen. Understaffing was the most frequent risk factor for outbreaks. The
most commonly identified source was admission of an ESBL-colonised infant with subsequent horizontal
dissemination. The main interventions described were improved infection-control procedures and screening of
staff and the environment. 26 studies were included in the quantitative analysis. Random effects metaanalysis indicated high mortality rates in infants who developed infection (31%, 95% CI 20% to 43%).
Conclusion: ESBL outbreaks in NICUs are associated with significant mortality and prolonged disruption.
Understaffing is a major risk factor, but is infrequently addressed by interventions. Poor infection-control
procedures are frequently implicated as contributing to ESBL spread. Better reporting of outbreaks may help
clarify the role for routine ESBL screening in NICUs.
15 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Environnement
NosoBase ID notice : 401982
Méthode adénosine triphosphate (ATP) comme outil de contrôle qualité pour évaluer la "propreté" de
surfaces hosptalières fréquemment touchées
Knape L; Hambraeus A; Lytsy B. The adenosine triphosphate method as a quality control tool to assess
'cleanliness' of frequently touched hospital surfaces. The journal of hospital infection 2015/10; 91(2): 166-170.
Mots-clés : NETTOYAGE; BIONETTOYAGE; SURFACE; QUALITE; EFFICACITE; ETUDE PROSPECTIVE;
FORMATION; PERSONNEL; PROTOCOLE; CONTAMINATION; ENVIRONNEMENT
Background: The adenosine triphosphate (ATP) method is widely accepted as a quality control method to
complement visual assessment, in the specifications of requirements, when purchasing cleaning contractors
in Swedish hospitals.
Aim: To examine whether the amount of biological load, as measured by ATP on frequently touched nearpatient surfaces, had been reduced after an intervention; to evaluate the correlation between visual
assessment and ATP levels on the same surfaces; to identify aspects of the performance of the ATP method
as a tool in evaluating hospital cleanliness.
Methods: A prospective intervention study in three phases was carried out in a medical ward and an intensive
care unit (ICU) at a regional hospital in mid-Sweden between 2012 and 2013. Existing cleaning procedures
were defined and baseline tests were sampled by visual inspection and ATP measurements of ten frequently
touched surfaces in patients' rooms before and after intervention. The intervention consisted of educating
nursing staff about the importance of hospital cleaning and direct feedback of ATP levels before and after
cleaning.
Findings: The mixed model showed a significant decrease in ATP levels after the intervention (P<0.001).
Relative light unit values were lower in the ICU. Cleanliness as judged by visual assessments improved. In
the logistic regression analysis, there was a significant association between visual assessments and ATP
levels.
Conclusion: Direct feedback of ATP levels, together with education and introduction of written cleaning
protocols, were effective tools to improve cleanliness. Visual assessment correlated with the level of ATP but
the correlation was not absolute. The ATP method could serve as an educational tool for staff, but is not
enough to assess hospital cleanliness in general as only a limited part of a large area is covered.
NosoBase ID notice : 403177
Corrélation entre nettoyage, ADN dans l’environnement et infections associées aux soins dans un
nouveau centre hospitalier dont l’architecture a été conçue à partir d’un design fondé/basé sur les
preuves
Lesho E; Carling P; Hosford E; Ong A; Snesrud E; Sparks M; et al. Relationships among cleaning,
environmental DNA, and healthcare-associated infections in a new evidence-based design hospital. Infection
control and hospital epidemiology 2015/10; 36(10): 1130-1138.
Mots-clés : ENVIRONNEMENT; NETTOYAGE; INFECTION NOSOCOMIALE; ADN; ARCHITECTURE
Objective: Hospital environments influence healthcare-associated infection (HAI) patterns, but the role of
evidenced-based design (EBD) and residual bacterial DNA (previously thought to be clinically inert) remain
incompletely understood.
Methods: In a newly built EBD hospital, we used culture-based and culture-free (molecular) assays, pulsedfield gel electrophoresis (PFGE), and whole-genome sequencing (WGS) to determine: (1) patterns of
environmental contamination with target organisms (TOs) and multidrug-resistant (MDR) target organisms
(MDR-TOs); (2) genetic relatedness between environmentally isolated MDR-TO and those from HAIs; and (3)
correlation between surface contamination and HAIs.
Results: A total of 1,273 high-touch surfaces were swabbed before and after terminal cleaning during 77 room
visits. Of the 2,546 paired swabs, 47% had cultivable biomaterial and 42% had PCR-amplifiable DNA. The
ratios of TOs detected to surfaces assayed were 85 per 1,273 for the culture-based method and 106 per
1,273 for the PCR-based method. Sinks, toilet rails, and bedside tables most frequently harbored biomaterial.
Although cleaned surfaces were less likely to have cultivable TOs than precleaned surfaces, they were not
less likely to harbor bacterial DNA. The rate of MDR-TOs to surfaces swabbed was 0.1% (3/2546). Although
environmental MDR-TOs and MDR-TOs from HAIs were genetically related by PFGE, WGS revealed that
16 / 26
NosoVeille – Bulletin de veille
Novembre 2015
they were unrelated. Environmental levels of cultivable Enterococcus spp. and E. coli DNA were positively
correlated with infection incidences (P<.04 and P<.005, respectively).
Conclusion: MDR-TOs were rarely detected during surveillance and were not implicated in HAIs. The roles of
environmental DNA and EBD, particularly with respect to water-associated fixtures or the potential
suppression of cultivable environmental MDR-TOs, warrant multicenter investigations.
Epidémie
NosoBase ID notice : 402397
Caractéristiques de transmission de MERS et de SRAS en établissement de soins : étude comparative
Chowell G; Abdirizak F; Lee S; Lee J; Jung E; Nishiura H; et al. Transmission characteristics of MERS and
SARS in the healthcare setting: a comparative study. BMC medicine 2015/09/03; 13(210): 1-12.
Mots-clés : TRANSMISSION; CORONAVIRUS; EPIDEMIE; APPAREIL RESPIRATOIRE; REVUE DE LA
LITTERATURE; MERS; SRAS
Background: The Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in
the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential,
there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe
acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of
exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the
most recent South Korean outbreak of MERS in 2015.
Methods: To assess the unexpected nature of the recent South Korean nosocomial outbreak of MERS and
estimate the probability of future large hospital clusters, we compared exposure and transmission patterns for
previously reported hospital clusters of MERS and SARS, based on individual-level data and transmission
tree information. We carried out simulations of nosocomial outbreaks of MERS and SARS using branching
process models rooted in transmission tree data, and inferred the probability and characteristics of large
outbreaks.
Results: A significant fraction of MERS cases were linked to the healthcare setting, ranging from 43.5 % for
the nosocomial outbreak in Jeddah, Saudi Arabia, in 2014 to 100 % for both the outbreak in Al-Hasa, Saudi
Arabia, in 2013 and the outbreak in South Korea in 2015. Both MERS and SARS nosocomial outbreaks are
characterized by early nosocomial super-spreading events, with the reproduction number dropping below 1
within three to five disease generations. There was a systematic difference in the exposure patterns of MERS
and SARS: a majority of MERS cases occurred among patients who sought care in the same facilities as the
index case, whereas there was a greater concentration of SARS cases among healthcare workers throughout
the outbreak. Exposure patterns differed slightly by disease generation, however, especially for SARS.
Moreover, the distributions of secondary cases per single primary case varied highly across individual
hospital outbreaks (Kruskal-Wallis test; P<0.0001), with significantly higher transmission heterogeneity in the
distribution of secondary cases for MERS than SARS. Simulations indicate a 2-fold higher probability of
occurrence of large outbreaks (>100 cases) for SARS than MERS (2% versus 1%); however, owing to higher
transmission heterogeneity, the largest outbreaks of MERS are characterized by sharper incidence peaks.
The probability of occurrence of MERS outbreaks larger than the South Korean cluster (n=186) is of the order
of 1%.
Conclusions: Our study suggests that the South Korean outbreak followed a similar progression to previously
described hospital clusters involving coronaviruses, with early super-spreading events generating a
disproportionately large number of secondary infections, and the transmission potential diminishing greatly in
subsequent generations. Differences in relative exposure patterns and transmission heterogeneity of MERS
and SARS could point to changes in hospital practices since 2003 or differences in transmission mechanisms
of these coronaviruses.
NosoBase ID notice : 403007
Délai prolongé pour le contrôle d’une épidémie à Klebsiella pneumoniae productrices de KPC-2 : rôle
de la prise en charge clinique
Delory T; Seringe E; Antoniotti G; Novakova I; Goulenok C; Paysant I; et al. Prolonged delay for controlling
KPC-2-producing Klebsiella pneumoniae outbreak: The role of clinical management. American journal of
infection control 2015/10; 43(10): 1070-1075.
Mots-clés : CONTROLE; EPIDEMIE; KLEBSIELLA PNEUMONIAE; ENQUETE; EPIDEMIOLOGIE; AUDIT;
PERSONNEL; SOIN INTENSIF; CARBAPENEMASE
17 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Background: Carbapenemase-producing Enterobacteriaceae (CPE) are becoming of immediate concern for
infection control policies. Prompt detection of CPE on health care setting admission is crucial to halt the
spread of an outbreak. We report a cluster of 13 Klebsiella pneumoniae carbapenemase (KPC)-2-producing
K pneumoniae cases in a tertiary care hospital.The objective of this study was to identify contributing factors
originating the outbreak.
Methods: An outbreak investigation was conducted using descriptive epidemiology, observation of health care
practices, and interviews of management staff. A root cause analysis was performed to identify patent and
latent failures of infection control measures using the association of litigation and risk management method.
Results: The main patent failure was the delay in identifying KPC-2-producing K pneumoniae carriers.
Contributing factors were work and environmental factors: understaffing, lack of predefined protocols, staff
members' characteristics, and underlying patients' characteristics. Latent failures were as follows: no
promotion of the national guidelines for prevention of CPE transmission, no clear procedure for the
management of patients hospitalized abroad, no clear initiative for promoting a culture of quality in the
hospital, biologic activity recently outsourced to a private laboratory, and poor communication among hospital
members.
Conclusion: Clinical management should be better promoted to control hospital outbreaks and should include
team work and safety culture.
Excreta
NosoBase ID notice : 404199
Gestion des excreta : entre la théorie et la réalité
Zraïb A; Négrin N. Gestion des excreta : entre la théorie et la réalité. Hygiènes 2015/09; 23(4): 243-245.
Mots-clés : INFIRMIER; AIDE-SOIGNANT; LAVE-BASSIN; GANT; EOH; EXCRETA
La gestion des excreta n’a pas toujours été la préoccupation majeure des établissements de santé. Toutefois
elle est aujourd’hui plus présente dans les recommandations, publications et manifestations relatives à
l’hygiène, dans le cadre des précautions standard. L’importance du réservoir fécal et celle du risque de
transmission croisée justifient pleinement cet intérêt renouvelé. La gestion des excreta est un enjeu réel pour
les établissements de santé, notamment dans le contexte des épidémies de bactéries hautement résistantes
émergentes (BHRe). L’objectif de ce travail était de décrire, évaluer et améliorer les pratiques
professionnelles de la gestion des excreta dans le centre hospitalier de Grasse.
Grippe
NosoBase ID notice : 404557
Prévention de la grippe et des infections respiratoires virales saisonnières
Haut Conseil de la santé publique (HCSP). Prévention de la grippe et des infections respiratoires virales
saisonnières. HCSP 2015/09/25: 1-22.
Mots-clés : PREVENTION; INFECTION RESPIRATOIRE GRIPPE; MASQUE; HYGIENE DES MAINS;
BIBLIOGRAPHIE
Le virus grippal et les autres virus respiratoires peuvent causer des infections très contagieuses sources
d’hospitalisations et de formes graves notamment chez les personnes fragiles.
Pour la grippe, le HCSP rappelle que la vaccination annuelle est le moyen le plus efficace de prévention,
chez les personnes à risque de complications, celles qui s’en occupent ou leur entourage, dans les milieux de
soins, les collectivités, la vie courante. Il rappelle aussi les modalités d’utilisation ciblée des antiviraux
spécifiques.
Pour toutes les infections respiratoires, les mesures d’hygiène incluant les mesures barrières sont des
moyens importants de prévention. La revue de la littérature concernant les appareils de protection
respiratoire ne montre pas d’éléments nouveaux justifiant la modification des recommandations de 2011 et
2013. En milieu communautaire, l’hygiène des mains doit être promue pour la lutte contre les infections
respiratoires ou non et repose surtout sur le lavage à l’eau et au savon, voire l’utilisation de solutés hydroalcooliques (SHA). En collectivité de soins, l’hygiène des mains est primordiale pour limiter la transmission
18 / 26
NosoVeille – Bulletin de veille
Novembre 2015
croisée en privilégiant la friction hydro-alcoolique des mains en l’absence de souillures, sinon avec l’eau et le
savon.
Le HCSP recommande des campagnes d’information auprès du public sur la mise en œuvre des mesures
barrières non spécifiques telles que l’hygiène des mains, la limitation des contacts entre les personnes
malades et les autres, en particulier les sujets à risque.
Il recommande une large diffusion de ces mesures auprès des établissements médicaux, médico-sociaux et
d’enseignement.
NosoBase ID notice : 404558
Avis relatif à l’utilisation des mesures barrières en prévention des infections respiratoires aiguës et
des infections respiratoires nosocomiales
Haut Conseil de la santé publique (HCSP). Avis relatif à l’utilisation des mesures barrières en prévention des
infections respiratoires aiguës et des infections respiratoires nosocomiales. HCSP 2015/09: 1-6 ;
Mots-clés : PREVENTION; INFECTION RESPIRATOIRE GRIPPE; MASQUE; HYGIENE DES MAINS;
VACCINATION; INFORMATION; PERSONNEL; USAGER
Le Haut Conseil de la santé publique a reçu de la Direction générale de la santé le 2 juin 2015 une saisine
relative à l’utilisation des mesures barrières en prévention des infections respiratoires aiguës et des infections
respiratoires nosocomiales.
Il est demandé au HCSP de réaliser un point actualisé sur les mesures barrières applicables et sur leur
efficacité en s’appuyant sur une revue de la littérature afin d’établir ou de revoir les recommandations
destinées aux professionnels de santé ainsi qu’à la population générale.
Le présent avis concerne la grippe et les autres infections respiratoires épidémiques saisonnières d’origine
virale.
NosoBase ID notice : 403695
Grippe 2014-2015 : une épidémie de forte intensité [Dossier]
Bonmarin I; Raguenaud ME; Brouard C. Grippe 2014-2015 : une épidémie de forte intensité [Dossier].
Bulletin épidémiologique hebdomadaire 2015/10/13; 32-33: 591-616.
Mots-clés : GRIPPE; SURVEILLANCE; EPIDEMIOLOGIE; EPIDEMIE; VACCIN; PERSONNE AGEE;
MORTALITE
Sommaire du dossier :
- La grippe est l’infection épidémique qui tue, chaque année, le plus de personnes en France
- Surveillance de la grippe en France métropolitaine. Saison 2014-2015
- Surveillance virologique de la grippe : saison 2014-2015
- La surveillance des épidémies de grippe à un niveau régional. Exemple de l’épidémie de l’hiver 2014-2015
dans les Pays de la Loire, France
- Impact de la vaccination contre la grippe saisonnière sur la mortalité des personnes âgées en France, de
novembre 2000 à avril 2009
NosoBase ID notice : 401981
Mise en place d’une déclinaison de programmes destinée à améliorer l’observance du vaccin contre
la grippe par le personnel des centres de lésions de la moelle épinière du "Department of Veterans
Affairs" : étude pilote
Hill JN; Smith BM; Evans CT; Anaya H; Goldstein B; LaVela SL. Implementing a declination form programme
to improve influenza vaccine uptake by staff in Department of Veterans Affairs spinal cord injury centres: a
pilot study. The journal of hospital infection 2015/10; 91(2): 158-165.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; NEUROLOGIE; NEUROCHIRURGIE; OBSERVANCE;
QUESTIONNAIRE
Background: Individuals with spinal cord injuries and disorders are at high risk for respiratory and influenzarelated complications after developing influenza. These individuals often have frequent contact with the
healthcare system. Vaccination rates in healthcare workers at Department of Veterans Affairs (VA) spinal
19 / 26
NosoVeille – Bulletin de veille
Novembre 2015
cord injury (SCI) centres have been approximately 50% for several years. Efforts are needed to increase
vaccination uptake among SCI HCWs. Declination form programmes (DFPs) in combination with other
strategies have resulted in significant increases in influenza vaccination uptake in HCWs.
Aim: Use of external and internal facilitation including local teams and consensus processes to pilot a DFP in
two VA SCI centres and evaluate factors influencing implementation.
Methods: Implementation meetings and a consensus-building process with leadership and implementation
team members were conducted, along with semi-structured post-implementation interviews with members of
each implementation team (N=7).
Findings: The DFP was well accepted and easy to use. Leadership was a key facilitator for DFP
implementation. Barriers included difficulty communicating with HCWs working during early/late shifts.
Participation was 100% at Site 1 and 48% at Site 2.
Conclusion: Use of local teams and consensus to identify strategies to implement a DFP is feasible and
effective for achieving moderate-to-high levels of participation in the programme.
NosoBase ID notice : 402622
Caractéristiques épidémiologiques de la grippe chez des patients en réanimation au Canada
Taylor G; Abdesselam K; Pelude L; Fernandes R; Mitchell R; McGeer A; et al. Epidemiological features of
influenza in Canadian adult intensive care unit patients. Epidemiology and infection 18/09/2015; in press: 110.
Mots-clés : SOIN INTENSIF; EPIDEMIOLOGIE; GRIPPE; ADULTE; ETUDE PROSPECTIVE; COHORTE;
RESEAU; VIRUS INFLUENZA TYPE A; MORTALITE; FACTEUR DE RISQUE; GRIPPE A; GRIPPE B
To identify predictive factors and mortality of patients with influenza admitted to intensive care units (ICU) we
carried out a prospective cohort study of patients hospitalized with laboratory-confirmed influenza in adult
ICUs in a network of Canadian hospitals between 2006 and 2012. There were 626 influenza-positive patients
admitted to ICUs over the six influenza seasons, representing 17,9% of hospitalized influenza patients, 3,1/10
000 hospital admissions. Variability occurred in admission rate and proportion of hospital influenza patients
who were admitted to ICUs (proportion range by year: 11,7-29,4%; 21,3% in the 2009-2010 pandemic). In
logistic regression models ICU patients were younger during the pandemic and post-pandemic period, and
more likely to be obese than hospital non-ICU patients. Influenza B accounted for 14,2% of all ICU cases and
had a similar ICU admission rate as influenza A. Influenza-related mortality was 17,8% in ICU patients
compared to 2,0% in non-ICU patients.
Hygiène des mains
NosoBase ID notice : 404202
L’hygiène hospitalière et les arts font-ils bon ménage ?
Meunier O; Preschel A; Vergnes C; Deutschmann I; Salles F; Burger S; et al. L’hygiène hospitalière et les
arts font-ils bon ménage ? Hygiènes 2015/09; 23(4): 249-251.
Mots-clés : HYGIENE DES MAINS; PEDAGOGIE; ART; CONTE; INFORMATION
Les auteurs ont proposé - pour des étudiants en soins infirmiers et aides-soignants de l’institut de formation
en soins infirmiers de Haguenau- une après-midi intitulée « Hygiène hospitalière : 6e et 7e arts » pour parler
autrement de l’hygiène hospitalière, de l’hygiène des mains et de la prévention en général. Le projet veut
parier sur l’efficacité d’une approche ludique et artistique pour une sensibilisation par l’émotion et pour que la
séduction influence l’acceptation du message. Lors de cette après-midi, ce sont la poésie et le conte qui
représentent le 6e art, le cinéma le 7e art. Après le « spectable », les auteurs ont évalué par questionnaire la
pertinence de cette démarche originale comme outil pédagogique innovant en hygiène hospitalière. Ils
présentent cette expérience, son évaluation et ses perspectives.
Néonatologie
NosoBase ID notice : 401977
Durée des traitements antibiotiques et prévention des complications dans des bactériémies
néonatales à Staphylococcus aureus
20 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Kempley S; Kapellou O; McWilliams A; Banerjee J; McCorqodale A; Millar M. Antibiotic treatment duration
and prevention of complications in neonatal Staphylococcus aureus bacteraemia. The journal of hospital
infection 2015/10; 91(2): 129-135.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
TRAITEMENT;
ANTIBIOTIQUE;
PREVENTION;
COMPLICATION; NEONATOLOGIE; BACTERIEMIE; ETUDE PROSPECTIVE; COHORTE; FACTEUR DE
RISQUE; PREMATURE
Background: In adults with Staphylococcus aureus bacteraemia, short duration of effective antibiotic
treatment is associated with increased risk of complications and recurrence. The optimum duration of
treatment for neonates is unknown and practice varies widely.
Aim: To relate the duration of treatment of neonatal S. aureus bacteraemia to prevention of complications and
recurrence.
Methods: Retrospective cohort study of confirmed S. aureus bacteraemia occurring over a 10 year period in
two large tertiary neonatal units. Neonatal patients developing confirmed S. aureus bacteraemia between
birth and discharge from the neonatal unit were identified from microbiology department records. Clinical
details obtained from case notes included demographics, duration of antibiotics and clinical outcomes.
Recurrence was determined from laboratory and clinical records. Adverse outcomes were related to duration
of antibiotic therapy.
Findings: A total of 90 infants had S. aureus bacteraemia, of which six were meticillin-resistant S. aureus
(7%). Median gestation was 27 weeks (range: 23-41), birth weight 846g (434-3840) and postnatal age 16
days (0-116). Adverse outcomes were found in 44%, with death in 8%. Median duration of appropriate
antibiotics was 19 days (range: 0-54). There were no cases of recurrent bacteraemia after finishing
antibiotics. There was no relationship between antibiotic duration and complications.
Conclusion: Neonatal S. aureus bacteraemia mainly affected preterm neonates and had a significant
morbidity and mortality. Recurrent bacteraemia was rare, irrespective of treatment duration. For neonatal unit
patients with S. aureus bacteraemia, antibiotic therapy for 14 days in uncomplicated cases may be sufficient
to prevent recurrence, with longer treatment justified if there is inadequate source control.
NosoBase ID notice : 403001
Epidémie de colonisation à Enterococcus faecium vanB résistant à la vancomycine dans un service
de néonatologie
Lister DM; Kotsanas D; Ballard SA; Howden BP; Carse E; Tan K; et al. Outbreak of vanB vancomycinresistant Enterococcus faecium colonization in a neonatal service. American journal of infection control
2015/10; 43(10): 1061-1065.
Mots-clés : VANCOMYCINE; ANTIBIORESISTANCE; ENTEROCOCCUS FAECIUM; NEONATOLOGIE;
COLONISATION; EPIDEMIE; SOIN INTENSIF; SURVEILLANCE; CONTROLE; PREVALENCE; TYPAGE
Objective: To describe successful termination of an outbreak of vancomycin-resistant Enterococcus faecium
(VREfm) colonization within a neonatal service.
Setting: Multisite neonatal intensive care unit and special care nurseries within a single health care service.
Participants: Forty-four cases of VREfm-colonized neonatal inpatients-including 2 clinical isolates (eye swab
and catheter-urine specimen) and 42 screening isolates.
Interventions: Active surveillance cultures, patient isolation, contact precautions, enhanced environment
cleaning, and staff and parent education. Whole genome sequencing and multilocus sequence typing were
used to characterize the outbreak and refine infection control procedures.
Results: Peak prevalence of VREfm colonization across all sites was 31% upon discovery of the outbreak.
Subsequent to the intervention, transmission was halted within 8 weeks and no further isolates of the
outbreak strain have been detected as of 12 months following outbreak cessation. Environmental swabs
revealed VREfm colonization of baby-weighing scales, a baby bath, and a pharmacy refrigerator within the
neonatal intensive care unit. All isolates were of a single multilocus sequence type (sequence type 796) and
highly clonal at the core genome level.
Conclusions: Bundled infection control interventions were effective in rapidly terminating a clonal outbreak of
sequence type 796 VREfm colonization within a neonatal inpatient service. Strain-typing and active
surveillance cultures were critical in guiding the management of this outbreak. The closed environment of a
neonatal unit likely facilitated eradication of the patient and environment reservoirs of VREfm colonization.
21 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Norovirus
NosoBase ID notice : 403004
Contrôle d’une épidémie à norovirus dans une unité d’oncologie pédiatrique
Sheahan A; Copeland G; Richardson L; McKay S; Chou A; Babady NE; et al. Control of norovirus outbreak
on a pediatric oncology unit. American journal of infection control 2015/10; 43(10): 1066-1069.
Mots-clés : EPIDEMIE; VIRUS; NOROVIRUS; CANCEROLOGIE; PEDIATRIE; CANCER; HEMATOLOGIE;
RT-PCR; TRANSMISSION; TRANSPLANTATION; PRECAUTION COMPLEMENTAIRE
Background: Patients undergoing treatment for cancer with chemotherapy and hematopoietic stem cell
recipients are at risk for severe morbidity caused by norovirus (NV).
Methods: We describe a NV outbreak on the Memorial Sloan Kettering Cancer Center's pediatric oncology
unit. Stool testing for diagnosis of NV was performed by real-time polymerase chain reaction (PCR).
Results: Twelve NV cases occurred; 7 were hospital acquired. Twenty-five health care workers reported NV
compatible illness. Patient-to-patient transmission occurred once. The practices of the Centers for Disease
Control and Prevention were supplemented with electronic surveillance, surrogate screening for NV, and
heightened cleaning. Two additional cases occurred after implementation of interventions. Long-term
shedding was detected in 2 patients.
Conclusion: We describe interventions for controlling NV on a pediatric oncology unit. High-risk chronic
shedders pose ongoing transmission risks. PCR is a valuable diagnostic tool but may be overly sensitive.
Surrogate markers to assess NV burden in stool and studies on NV screening are needed to develop
guidelines for high-risk chronic shedders.
Personnel
NosoBase ID notice : 402999
Impacts cliniques et économiques de diverses stratégies pour le dépistage de l’immunité envers la
varicelle et la vaccination du personnel de santé
Baracco GJ; Eisert S; Saavedra S; Hirsch P; Marin M; Ortega-Sanchez IR. Clinical and economic impact of
various strategies for varicella immunity screening and vaccination of health care personnel. American journal
of infection control 2015/10; 43(10): 1053-1060.
Mots-clés : PERSONNEL; VIRUS; VARICELLE; HERPES ZOSTER VIRUS; DEPISTAGE; IMMUNITE;
VACCIN; COUT; PREVENTION; PROTOCOLE; PRATIQUE; EFFICACITE; COUT-EFFICACITE
Background: Exposure to patients with varicella or herpes zoster causes considerable disruption to a health
care facility's operations and has a significant health and economic impact. However, practices related to
screening for immunity and immunization of health care personnel (HCP) for varicella vary widely.
Methods: A decision tree model was built to evaluate the cost-effectiveness of 8 different strategies of
screening and vaccinating HCP for varicella. The outcomes are presented as probability of acquiring varicella,
economic impact of varicella per employee per year, and cost to prevent additional cases of varicella. Monte
Carlo simulations and 1-way sensitivity analyses were performed to address the uncertainties inherent to the
model. Alternative epidemiologic and technologic scenarios were also analyzed.
Results: Performing a clinical screening followed by serologic testing of HCP with negative history diminished
the cost impact of varicella by >99% compared with not having a program. Vaccinating HCP with negative
screen cost approximately $50,000 per case of varicella prevented at the current level of U.S. population
immunity, but was projected to be cost-saving at 92% or lower immunity prevalence. Improving vaccine
acceptance rates and using highly sensitive assays also optimize cost-effectiveness.
Conclusion: Strategies relying on screening and vaccinating HCP for varicella on employment were shown to
be cost-effective for health care facilities and are consistent with current national guidelines for varicella
prevention.
NosoBase ID notice : 403040
Connaissance des étudiants en médecine sur la prévention et le contrôle du risque infectieux :
facteurs associés à de meilleurs résultats et marge d’amélioration
22 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Legeay C; Thépot-Seegers V; Groh M; Zaha JR. Medical students' knowledge of infection control and
prevention: Factors associated with better results and room for improvement. American journal of infection
control 2015/10; 43(10): 1142-1143.
Mots-clés : MEDECIN; ETUDIANT; CONNAISSANCE; PREVENTION;
PRECAUTION STANDARD; HYGIENE DES MAINS; PERSONNEL
ANALYSE
MULTIVARIEE;
Pneumonie
NosoBase ID notice : 403385
Pneumonies nosocomiales à Pseudomonas aeruginosa : impact de la classification des pneumonies
Micek ST; Kollef MH; Torres A; Chen C; Rello J; Chastre J; et al. Pseudomonas aeruginosa nosocomial
pneumonia: impact of pneumonia classification. Infection control and hospital epidemiology 2015/10; 36(10):
1190-1197.
Mots-clés : PSEUDOMONAS AERUGINOSA; PNEUMONIE; INFECTION NOSOCOMIALE; INFECTION
COMMUNAUTAIRE; VENTILATION ASSISTEE; DEFINITION; MULTIRESISTANCE; ANTIBIOTIQUE;
MORTALITE
Objective: To describe and compare the mortality associated with nosocomial pneumonia due to
Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia
[COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).
Design: We conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP
among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital
mortality and inappropriate initial antibiotic therapy (IIAT).
Setting: Twelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and
Spain, 3).
Patients/Participants: A total of 742 patients with Pa-NP.
Results: Hospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP
(24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia
classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate;
VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors).
Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and
HAP, whereas recent antibiotic administration was protective in patients with VAP.
Conclusions: Among patients with Pa-NP, pneumonia classification identified patients with different risks for
hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and
multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia
classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for
outcome and IIAT.
Soin intensif
NosoBase ID notice : 403381
Impact de la configuration des lits dans les unités de soins intensifs néonatales sur les taux de
colonisation et sur les taux de syndrome septique à survenue tardive à Staphylococcus aureus
résistant à la méticilline
Julian S; Burnham CA; Sellenriek P; Shannon WD; Hamvas A; Tarr PI; et al. Impact of neonatal intensive
care bed configuration on rates of late-onset bacterial sepsis and methicillin-resistant Staphylococcus aureus
colonization. Infection control and hospital epidemiology 2015/10; 36(10): 1173-1182.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; INFECTION
NOSOCOMIALE; NEONATOLOGIE; SOIN INTENSIF; COLONISATION; HYGIENE DES MAINS; CHAMBRE
INDIVIDUELLE; MORTALITE; BACTERIEMIE; ETUDE RETROSPECTIVE
Background: Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The
association between nursery design and nosocomial infections is unclear.
Objective: To determine whether rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA),
late-onset sepsis, and mortality are reduced in single-patient rooms.
23 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Design: Retrospective cohort study.
Setting: NICU in a tertiary referral center.
Methods: Our NICU is organized into single-patient and open-unit rooms. Clinical data sets including bed
location and microbiology results were examined over 29 months. Differences in outcomes between bed
configurations were determined by χ2 and Cox regression.
Patients: All NICU patients.
Results: Among 1,823 patients representing 55,166 patient-days, single-patient and open-unit models had
similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census
was associated with MRSA colonization rates only in single-patient rooms (hazard ratio, 1.31; P=.039),
whereas hand hygiene compliance on room entry and exit was associated with lower colonization rates
independent of bed configuration (hazard ratios, 0.834 and 0.719 per 1% higher compliance, respectively).
Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and
the combined outcome of sepsis or death. After controlling for demographic, clinical, and unit-based
variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA
colonization, late-onset sepsis, or mortality.
Conclusions: MRSA colonization rate was impacted by hand hygiene compliance, regardless of room
configuration, whereas average daily census affected only infants in single-patient rooms. Single-patient
rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.
NosoBase ID notice : 403180
Evaluation longitudinale de toutes les données d’infections associées aux soins recueillies au cours
des 12 dernières années suite à des mesures de surveillance et de lutte contre le risque infectieux
mises en place sur l’ensemble de l’hôpital : le poids important des infections associées aux soins,
hors soins intensifs et types d’infections cochées « Autre »
Kanamori H; Weber DJ; DiBiase LM; Sickbert-Bennett EE; Brooks R; Teal L; et al. Longitudinal trends in all
healthcare-associated infections through comprehensive hospital-wide surveillance and infection control
measures over the past 12 years: Substantial burden of healthcare-associated infections outside of intensive
care units and "other" types of infection. Infection control and hospital epidemiology 2015/10; 36(10): 11391147.
Mots-clés : SURVEILLANCE; SOIN INTENSIF; INFECTION NOSOCOMIALE; INCIDENCE; SONDAGE
URINAIRE; INFECTION URINAIRE; VENTILATION ASSISTEE; PNEUMONIE; CATHETER VEINEUX
CENTRAL; COUT; ETUDE RETROSPECTIVE
Objective: Targeted surveillance has focused on device-associated infections and surgical site infections
(SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in
all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We
examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period
(2001-2012).
Methods: This retrospective observational study was conducted at the University of North Carolina (UNC)
Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites
as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance.
Generalized linear models were used to examine the incidence rate difference by infection type over time.
Results: A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence
of overall HAIs decreased significantly hospital-wide (-3.4 infections per 1,000 patient days), in ICUs (-8.4
infections per 1,000 patient days), and in non-ICU settings (-1.9 infections per 1,000 patient days). The
incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings
decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged.
The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to
include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.
Conclusions: We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore
the necessity for surveillance and infection prevention interventions outside of the ICUs, for non-deviceassociated HAIs, and for CDI.
NosoBase ID notice : 400913
Mise en place d’un bouquet d’interventions (bundle) pour les cathéters veineux centraux dans une
unité de réanimation au Koweit : implact sur les bactériémies associées aux voies centrales
24 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Salama MF; Jamal W; Al Mousa H; Rotimi V. Implementation of central venous catheter bundle in an
intensive care unit in Kuwait: Effect on central line-associated bloodstream infections. Journal of infection and
public health 2015/06/29; in press: 1-8.
Mots-clés : SOIN INTENSIF; CATHETER VEINEUX CENTRAL; BACTERIEMIE; INCIDENCE;
SURVEILLANCE; PROTOCOLE; HYGIENE DES MAINS; PRECAUTION STANDARD; CHLORHEXIDINE;
ALCOOL; BUNDLE
Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in
the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central
venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to
study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in
an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team
using National Health Safety Network (NHSN) case definitions and device days measurement methods.
During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by
inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile
drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub
for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central
line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an
incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there
were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The
reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study
demonstrates that implementation of a central venous catheter post-insertion care bundle was associated
with a reduction in CLABSI in an intensive care area setting.
Stérilisation
NosoBase ID notice : 404197
Analyse des situations à risque d’une étape du processus de stérilisation « réception, tri, lavage » à
l’aide de la méthode AMDEC
Combeau D; Baillet L; Ade A; Sorin C; Lamberdière F; Tilleul P. Analyse des situations à risque d’une étape
du processus de stérilisation « réception, tri, lavage » à l’aide de la méthode AMDEC. Hygiènes 2015/09;
23(4): 223-233.
Mots-clés : STERILISATION; RISQUE; TRI; DISPOSITIF MEDICAL; ANALYSE DES RISQUES; GESTION
DES RISQUES; LAVEUR-DESINFECTEUR; ANALYSE A PRIORI
L’objectif de ce travail est de procéder à une analyse a priori des risques par la méthode Amdec (Analyse des
modes de défaillance, de leurs effets et de leur criticité) afin d’identifier les points critiques du sous-processus
de stérilisation « réception, tri et lavage » pour établir un programme d’action de réduction des risques
adaptés et améliorer la sécurité de prise en charge des patients. Ce travail a été réalisé sur le site de
stérilisation Babinski du groupe hospitalier (GH) Pitié-Salpêtrière (Assistance publique – Hôpitaux de Paris)
pour les dispositifs médicaux des blocs de neurochirurgie, d’oto-rhino-laryngologie et d’ophtalmologie. Un
groupe de travail pluridisciplinaire a identifié huit processus, 28 tâches et 102 modes de défaillance. Pour
chaque mode de défaillance, la criticité a été évaluée à l’aide d’une échelle de cotation, ainsi que les effets et
les causes. Le sous-processus a été coté avec une criticité moyenne de 15,6 sur une échelle allant de 1 à 48.
Un plan d’action a été mis en place suite à cette étude. Il s’agit d’une première expérience avec cette
méthode sur le processus de stérilisation du GH Pitié-Salpêtrière. Cette démarche de gestion des risques a
priori s’inscrit parfaitement dans le programme de mise en place d’un système qualité obligatoire par voie
réglementaire.
Surveillance
NosoBase ID notice : 403110
Méthodes d’analyse spatiale utilisées pour des enquêtes sur des épidémies de maladies infectieuses
: une revue systématique de la littérature
Smith CM; Le Comber SC; Fry H; Bull M; Leach S; Hayward AC. Spatial methods for infectious disease
outbreak investigations: systematic literature review. Eurosurveillance 2015/10/01; 20(39): 1-20.
25 / 26
NosoVeille – Bulletin de veille
Novembre 2015
Mots-clés : INFECTION NOSOCOMIALE; SURVEILLANCE; EPIDEMIE; INVESTIGATION; PREVALENCE;
ENVIRONNEMENT; EAU; REVUE DE LA LITTERATURE
Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place.
Although geographic information systems have increased the range of tools available, spatial analyses are
used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations
worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their
utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total
number of published outbreaks. Environmental or waterborne infections were the most commonly
investigated, and most reports were from the United Kingdom. A range of techniques were used, including
simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout
investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating
findings. They provided valuable insights that led to public health actions, but there is scope for much wider
implementation and development of new methods.
Tuberculose
NosoBase ID notice : 403408
Revue des tests d’amplification des acides nucléiques et des règles de prédiction clinique pour le
diagnostic de la tuberculose dans les établissements de soins de court séjour
Chitnis AS; Davis JL; Schecter GF; Barry PM; Flood JM. Review of nucleic acid amplification tests and clinical
prediction rules for diagnosis of tuberculosis in acute care facilities. Infection control and hospital
epidemiology 2015/10; 36(10): 1215-1225.
Mots-clés : MYCOBACTERIUM TUBERCULOSIS; PRECAUTION
EPIDEMIOLOGIE; DIAGNOSTIC CLINIQUE; TRAITEMENT
AIR;
TEST
TUBERCULINIQUE;
Tuberculosis (TB) remains an important cause of hospitalization and mortality in the United States.
Prevention of TB transmission in acute care facilities relies on prompt identification and implementation of
airborne isolation, rapid diagnosis, and treatment of presumptive pulmonary TB patients. In areas with low TB
burden, this strategy may result in inefficient utilization of airborne infection isolation rooms (AIIRs). We
reviewed TB epidemiology and diagnostic approaches to inform optimal TB detection in low-burden settings.
Published clinical prediction rules for individual studies have a sensitivity ranging from 81% to 100% and
specificity ranging from 14% to 63% for detection of culture-positive pulmonary TB patients admitted to acute
care facilities. Nucleic acid amplification tests (NAATs) have a specificity of >98%, and the sensitivity of
NAATs varies by acid-fast bacilli sputum smear status (positive smear, ≥95%; negative smear, 50%-70%).
We propose an infection prevention strategy using a clinical prediction rule to identify patients who warrant
diagnostic evaluation for TB in an AIIR with an NAAT. Future studies are needed to evaluate whether use of
clinical prediction rules and NAATs results in optimized utilization of AIIRs and improved detection and
treatment of presumptive pulmonary TB patients.
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]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
nathalie.vincent@chu
-lyon.fr
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
26 / 26