Download NosoVeille Août 2011

NosoVeille – Bulletin de veille
Septembre 2013
NosoVeille n°9
Septembre 2013
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://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Acinetobacter baumannii
Antibiotique / Antibiorésistance
Antiseptique
Candida
Cathétérisme
Chirurgie
Clostridium difficile
Coronavirus
EHPAD
Enterobacter
Environnement
Epidémie
Grippe
Hémodialyse
Infection urinaire
Klebsiella pneumoniae
Hygiène des mains
Néonatologie
Pédiatrie
Personnel
Pneumonie
Prévention
Réglementation
Rougeole
Staphylococcus aureus
Tatouage
Ventilation
Virus West Nile
1 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Acinetobacter baumannii
NosoBase ID notice : 369471
Epidémie d'Acinetobacter baumannii producteurs de NDM-1 en France, janvier à mai 2013
Decousser JW; Jansen C; Nordmann P; Emirian A; Bonnin RA; Anais L; et al. Outbreak of NDM-1-producing
Acinetobacter baumannii in France, January to May 2013. Eurosurveillance 2013/08; 18(31): 1-4.
Mots-clés : ACINETOBACTER BAUMANNII; EPIDEMIE; ANTIBIORESISTANCE; CARBAPENEME
We report the first outbreak of carbapenem-resistant NDM-1-producing Acinetobacter baumannii in Europe, in
a French intensive-care unit in January to May 2013. The index patient was transferred from Algeria and led
to the infection/colonisation of five additional patients. Concurrently, another imported case from Algeria was
identified. The seven isolates were genetically indistinguishable, belonging to ST85. The blaNDM-1
carbapenemase gene was part of the chromosomally located composite transposon Tn125. This report
underscores the growing concern about the spread of NDM-1-producing A. baumannii in Europe.
NosoBase ID notice : 368729
Les infections à Acinetobacter baumannii ont diminué grâce à la rénovation structurelle d'une unité
de réanimation médicale
Nah SS; Park YH; Chung JW; Yoo S; Hong SB; Lim CM; et al. Acinetobacter baumannii infection was
decreased by the structural renovation of a medical intensive care unit. Journal of critical care 2013/08; 28(4):
328-334.
Mots-clés :
ACINETOBACTER
BAUMANNII;
SOIN
INTENSIF;
MEDECINE;
INCIDENCE;
ANTIBIORESISTANCE; ENVIRONNEMENT; TRAVAUX HOSPITALIERS; HYGIENE DES MAINS;
PNEUMONIE; BACTERIEMIE
Purpose: The study aimed to determine whether improvements in intensive care unit (ICU) structural
environment affect the incidence of ICU-acquired infections (IAIs), particularly those caused by multidrugresistant pathogens.
Methods: The incidence of IAI and the number of infections caused by organisms during the 6 months
immediately before ICU renovation and during the 6 months immediately after ICU renovation were
compared. The observational duration was prolonged for an additional 1 year after recruiting the afterrenovation data to observe if the found effect of ICU structural renovation is maintained. The relevant data
were prospectively gathered.
Results: The overall IAI incidence and distribution of infection site showed no difference in both periods. In
IAI-causing pathogens, no considerable difference was found between before and after renovation, except for
Acinetobacter baumannii. In comparison of the major pathogens' identification rate between the entire
hospital and the renovated ICU during the study periods, only A baumannii cases in the renovated ICU
significantly decreased. However, the reduction of the IAI cases by A baumannii was not sustained for more
than 1 year.
Conclusions: These results suggest that structural ICU renovations only may not improve overall IAI
incidence, except for transient decrease in IAI by A baumannii.
Antibiotique / Antibiorésistance
NosoBase ID notice : 369360
Evolution dans le temps des bactériémies nosocomiales : les bactéries resistantes aux antibiotiques
alourdissent le poids total de l’infection
Ammerlaan HS; Harbarth S; Buiting AG; Crook DW; Fitzpatrick F; Hanberger H; et al. Secular trends in
nosocomial bloodstream infections: antibiotic-resistant bacteria increase the total burden of infection. Clinical
infectious diseases 2013/05/15; 56(6): 798-805.
Mots-clés : BACTERIEMIE; INCIDENCE; ANTIBIORESISTANCE; COHORTE; FACTEUR DE RISQUE
It is unknown whether rising incidence rates of nosocomial bloodstream infections (BSIs) caused by antibioticresistant bacteria (ARB) replace antibiotic-susceptible bacteria (ASB), leaving the total BSI rate unaffected.
2 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Methods: We investigated temporal trends in annual incidence densities (events per 100 000 patient-days) of
nosocomial BSIs caused by methicillin-resistant Staphylococcus aureus (MRSA), ARB other than MRSA, and
ASB in 7 ARB-endemic and 7 ARB-nonendemic hospitals between 1998 and 2007.
Results: 33 130 nosocomial BSIs (14% caused by ARB) yielded 36 679 microorganisms. From 1998 to 2007,
the MRSA incidence density increased from 0.2 to 0.7 (annual increase, 22%) in ARB-nonendemic hospitals,
and from 3.1 to 11.7 (annual increase, 10%) in ARB-endemic hospitals (P=.2), increasing the incidence
density difference between ARB-endemic and ARB-nonendemic hospitals from 2.9 to 11.0. The non-MRSA
ARB incidence density increased from 2.8 to 4.1 (annual increase, 5%) in ARB-nonendemic hospitals, and
from 1.5 to 17.4 (annual increase, 22%) in ARB-endemic hospitals (P<.001), changing the incidence density
difference from -1.3 to 13.3. Trends in ASB incidence densities were similar in both groups (P=.7). With
annual increases of 3.8% and 5.4% of all nosocomial BSIs in ARB-nonendemic and ARB-endemic hospitals,
respectively (P < .001), the overall incidence density difference of 3.8 increased to 24.4.
Conclusions: Increased nosocomial BSI rates due to ARB occur in addition to infections caused by ASB,
increasing the total burden of disease. Hospitals with high ARB infection rates in 2005 had an excess burden
of BSI of 20.6 per 100 000 patient-days in a 10-year period, mainly caused by infections with ARB.
NosoBase ID notice : 369346
Les sept voies pour préserver le miracle des antibiotiques
Bartlett JG; Gilbert DN; Spellberg B. Seven ways to preserve the miracle of antibiotics. Clinical infectious
diseases 2013/05/15; 56(10): 1445-1450.
Mots-clés : ANTIBIOTIQUE; PREVENTION; ANTIBIORESISTANCE; PRATIQUE
Antibiotic resistance is a well-acknowledged crisis with no clearly defined comprehensive, national corrective
plan. We propose a number of interventions that, collectively, could make a large difference. These include
collection of data to inform decisions, efforts to reduce antibiotic abuse in people and animals, great emphasis
on antibiotic stewardship, performance incentives, optimal use of newer diagnostics, better support for clinical
and basic resistance-related research, and novel methods to foster new antibiotic development.
NosoBase ID notice : 369487
Rapport du premier cas d’isolat clinique d’Enterobacter résistant à la colistine producteur de IMI-1 en
Irlande, mars 2013
Boo TW; O'Connell N; Power L; O'Connor M; King J; McGrath E; et al. First report of IMI-1-producing colistinresistant Enterobacter clinical isolate in Ireland, March 2013. Eurosurveillance 2013/08; 18(31): 1-3.
Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; COLISTINE; FOSFOMYCINE; CARBAPENEME;
LABORATOIRE
We report the first case in Ireland of an IMI-1 carbapenemase producing Enterobacter asburiae, which was
resistant to both colistin and fosfomycin. The circumstances under which this isolate was acquired were
unclear. Several reports of IMI-producing Enterobacter spp. have emerged in recent years, and colistin
resistance in Enterobacteriaceae is also increasingly reported. Laboratories should be aware of the unusual
antibiograms of IMI-producing isolates.
NosoBase ID notice : 368714
Bêta-lactamases types CTX-M : une histoire réussie d'antibiorésistance
D'Andrea MM; Arena F; Pallecchi L; Rossolini GM. CTX-M-type β-lactamases: a successful story of antibiotic
resistance. International journal of medical microbiology 2013/08; 303(6-7): 305-317.
Mots-clés : ANTIBIORESISTANCE; BETA-LACTAMASE A SPECTRE ELARGI; ENTEROBACTERIE;
EPIDEMIOLOGIE; ESCHERICHIA COLI; BIBLIOGRAPHIE
Production of extended-spectrum β-lactamases (ESBLs) is the principal mechanism of resistance to
oxyimino-cephalosporins evolved by members of the family Enterobacteriaceae. Among the several ESBLs
emerged among clinical pathogens, the CTX-M-type enzymes have proved the most successful in terms of
promiscuity and diffusion in different epidemiological settings, where they have largely replaced and
outnumbered other types of ESBLs. Originated by the capture and mobilization of chromosomal β-lactamase
3 / 26
NosoVeille – Bulletin de veille
Septembre 2013
genes of strains of Kluyvera species, the blaCTX-M genes have become associated with a variety of mobile
genetic elements that have mediated rapid and efficient inter-replicon and cell-to-cell dissemination involving
highly successful enterobacterial lineages (e.g. Escherichia coli ST131 and ST405, or Klebsiella pneumoniae
CC11 and ST147) to yield high-risk multiresistant clones that have spread on a global scale. The CTX-Mβlactamase lineage exhibits a striking plasticity, with a large number of allelic variants belonging in several
sublineages, which can be associated with functional heterogeneity of clinical relevance. This review article
provides an update on CTX-M-type ESBLs, with focus on structural and functional diversity, epidemiology and
clinical significance.
NosoBase ID notice : 368256
Vivre avec une bêta-lactamase à spectre étendu : étude qualitative des expériences des patients
Wiklund S; Hallberg U; Kahlmeter G; Tammelin A. Living with extended-spectrum β-lactamase: a qualitative
study of patient experiences. American journal of infection control 2013/08; 41(8): 723-727.
Mots-clés :
USAGER;
BETA-LACTAMASE
A
SPECTRE
ELARGI;
MULTIRESISTANCE; COLONISATION; INFORMATION; PERCEPTION
ANTIBIORESISTANCE;
Background: Extended-spectrum β-lactamase (ESBL) is an enzyme that conveys resistance to most β-lactam
antibiotics. Infections caused by bacteria producing ESBL are often difficult to treat because of general
multiresistance, and hospital care may be necessary even for nonserious infections.
Methods: The aim of this study was to increase our understanding of how infected individuals perceive their
situation as "carriers" of multiresistant bacteria. A modified version of grounded theory was used to analyze 7
open interviews.
Results: The analysis resulted in the core category Being thrown into the scary and unknown without a map
and compass. All informants thought they had received no or insufficient information about ESBL from the
health care providers. Informants who had been given some information still had many unanswered thoughts
and reflections. Health care staff were lacking in knowledge about ESBL and their own fears that led to the
use of extreme hygiene measures, which increased the stigma for the patient.
Conclusion: To manage their life situation, it is important that persons diagnosed as carriers of ESBLproducing bacteria receive adequate information from the attending doctor.
Antiseptique
NosoBase ID notice : 368373
Evaluation des lingettes au gluconate de chlorhexidine et des gants de toilette préimprégnés pour la
prévention de la dissémination des pathogènes – Revue systématique
Afonso E; Llauradó M; Gallart E. The value of chlorhexidine gluconate wipes and prepacked washcloths to
prevent the spread of pathogens - A systematic review. Australian critical care 2013; in press: 9 pages.
Mots-clés : CHLORHEXIDINE; PREVENTION; LINGE; HYGIENE CORPORELLE; TOILETTE DU PATIENT;
BIBLIOGRAPHIE; ANTISEPTIQUE
Background: Use of chlorhexidine gluconate wipes and pre-packed washcloths has been described for
preventing pathogen spread in healthcare settings.
Aim: To assess the impact of chlorhexidine washcloths/wipes in preventing the spread of pathogens.
Methods: Extensive and structured literature search from studies in Google Academic, Cochrane Library,
Web of Science, Pubmed and Cinahl from their inception until November 2012.
Findings: Final analysis included 15 studies, 9 of which were randomised controlled trials. The most frequent
setting was the intensive care unit. In intensive care units, a significant reduction of bloodstream infection was
associated with intervention and 3 studies revealed a decrease in blood culture contamination. One study
showed a decrease in staff and environmental contamination and no increase in chlorhexidine resistance with
intervention. Positive blood cultures for multiple pathogens also declined with intervention. In a paediatric
intensive care unit, intervention decreased bacteraemia and catheter-associated bloodstream infection. In
hospital wards, intervention was associated to a 64% reduction of pathogen transmission. One study had no
statistically significant results. Pre-surgical chlorhexidine use significantly decreased bacterial colonisation but
had no impact on surgical site infections. Regarding maternal and perinatal setting, one study did not show
reduction of early onset neonatal sepsis and pathogen transmission. Another study of vaginal and neonatal
decolonisation with chlorhexidine wiping revealed significant reduction in colonisation. One study concluded
that single and multiple umbilical cord cleansing reduced the likelihood for a positive swab in 25% and 29%,
4 / 26
NosoVeille – Bulletin de veille
Septembre 2013
respectively. Neonatal wiping maintained low levels of skin colonisation for a 24h period, for multiple
pathogens.
Conclusion: Current evidence supports the usefulness of chlorhexidine washcloths and wipes in an intensive
care, hospital and pre-surgical setting. More studies are required to encourage its use for prevention of
perinatal and neonatal transmission of pathogens.
NosoBase ID notice : 368137
Activité antibactérienne et stabilité de l’acide acétique
Fraise AP; Wilkinson MAC; Bradley CR; Oppenheim B; Moiemen N. The antibacterial activity and stability of
acetic acid. The journal of hospital infection 2013/08; 84(4): 329-331.
Mots-clés :
ANTISEPTIQUE;
EFFICACITE;
PANSEMENT;
STAPHYLOCOCCUS
ACINETOBACTER BAUMANNII; PSEUDOMONAS AERUGINOSA; TEST
AUREUS;
Acetic acid has been shown to have good antibacterial activity against micro-organisms such as
Pseudomonas aeruginosa. This study examined the activity against a range of bacterial pathogens and also
assessed any reduction in antibacterial activity due to evaporation or inactivation by organic material in
dressings. Acetic acid was active at dilutions as low as 0.166% and the activity was not reduced by
evaporation nor by inactivation by cotton swabs. Burn injuries are a major problem in countries with limited
resources. Acetic acid is an ideal candidate for use in patients who are treated in those parts of the world.
Candida
NosoBase ID notice : 368655
Epidémiologie et prévention des infections nosocomiales à champignons filamenteux et levures
Pemán J; Salavert M. Epidemiología y prevención de las infecciones nosocomiales causadas por especies
de hongos filamentosos y levaduras. Enfermedades infecciosas y microbiología clínica 2013/05; 31(5): 328341.
Mots-clés : EPIDEMIOLOGIE; PREVENTION; MYCOLOGIE; LEVURE; CHAMPIGNON FILAMENTEUX;
RISQUE; FACTEUR DE RISQUE; ANTIFONGIQUE; RESISTANCE; AIR; EAU; QUALITE; PREVENTION;
CANDIDA; ASPERGILLUS; PNEUMOCYSTIS; RECOMMANDATION; BIBLIOGRAPHIE
Knowledge of the epidemiology of invasive fungal diseases in health care settings helps to establish the
action levels necessary for its prevention. A first step is to identify groups of patients at high risk of invasive
fungal diseases, establish accurate risk factors, observing the periods of greatest risk, and analyze the
epidemiological profile in genera and species, as well as the patterns of antifungal resistance. Secondly,
mechanisms to avoid persistent exposure to potential fungal pathogens must be established, protecting areas
and recommending measures, such as the control of the quality of the air and water inside and outside the
hospital, and determining and promoting appropriate architectural designs of health institutions. Finally, apart
from the correct implementation of these measures, the use of antifungal prophylaxis should be considered in
selected patients at very high risk, following the guidelines published.
Cathétérisme
NosoBase ID notice : 368594
Survenue précoce contre survenue tardive des infections sur PICC : analyse des facteurs de risque et
microbiologie
Chittick P; Azhar S; Movva K; Keller P; Boura JA; Band J. Early onset versus late onset peripherally inserted
central venous catheter infections: an analysis of risk factors and microbiology. Infection control and hospital
epidemiology 2013/09; 34(9): 980-983.
Mots-clés : FACTEUR DE RISQUE; CATHETER VEINEUX CENTRAL; BACTERIEMIE; RISQUE;
MICROBIOLOGIE; ETUDE RETROSPECTIVE
5 / 26
NosoVeille – Bulletin de veille
Septembre 2013
The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than
those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared
patients with early- and late-onset PICC bloodstream infections at our institution and found significant
differences in microbiologic etiologies.
NosoBase ID notice : 368575
Le risque de bactériémie sur cathéter inséré par voie périphérique (PICC) comparé au risque sur
cathéter veineux central chez l’adulte : revue systématique et méta-analyse
Chopra V; O'Horo JC; Rogers MAM; Maki DG; Safdar N. The risk of bloodstream infection associated with
peripherally inserted central catheters compared with central venous catheters in adults: a systematic review
and meta-analysis. Infection control and hospital epidemiology 2013/09; 34(9): 908-918.
Mots-clés : RISQUE; CATHETER VEINEUX CENTRAL
Background: Peripherally inserted central catheters (PICCs) are associated with central line–associated
bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is
unknown.
Objective: To compare risk of CLABSI between PICCs and CVCs.
Methods: MEDLINE, CinAHL, Scopus, EmBASE, and Cochrane CENTRAL were searched. Full-text studies
comparing the risk of CLABSI between PICCs and CVCs were included. Studies involving adults 18 years of
age or older who underwent insertion of a PICC or a CVC and reported CLABSI were included in our
analysis. Studies were evaluated using the Downs and Black scale for risk of bias. Random effects metaanalyses were used to generate summary estimates of CLABSI risk in patients with PICCs versus CVCs.
Results: Of 1,185 studies identified, 23 studies involving 57,250 patients met eligibility criteria. Twenty of 23
eligible studies reported the total number of CLABSI episodes in patients with PICCs and CVCs. Pooled
meta-analyses of these studies revealed that PICCs were associated with a lower risk of CLABSI than were
CVCs (relative risk [RR], 0.62; 95% confidence interval [CI], 0.40–0.94). Statistical heterogeneity prompted
subgroup analysis, which demonstrated that CLABSI reduction was greatest in outpatients (RR [95% CI],
0.22 [0.18–0.27]) compared with hospitalized patients who received PICCs (RR [95% CI], 0.73 [0.54–0.98]).
Thirteen of the included 23 studies reported CLABSI per catheter-day. Within these studies, PICC-related
CLABSI occurred as frequently as CLABSI from CVCs (incidence rate ratio [95% CI], 0.91 [0.46–1.79]).
Limitations: Only 1 randomized trial met inclusion criteria. CLABSI definition and infection prevention
strategies were variably reported. Few studies reported infections by catheter-days.
Conclusions: Although PICCs are associated with a lower risk of CLABSI than CVCs in outpatients,
hospitalized patients may be just as likely to experience CLABSI with PICCs as with CVCs. Consideration of
risks and benefits before PICC use in inpatient settings is warranted.
NosoBase ID notice : 368573
Evolution des bactériémies sur voies centrales en fonction des différents pathogènes en soins
intensifs aux Etats-Unis, 1990-2010
Fagan RP; Edwards JR; Park BJ; Fridkin SK; Magill SS. Incidence trends in pathogen-specific central lineassociated bloodstream infections in US intensive care units, 1990-2010. Infection control and hospital
epidemiology 2013/09; 34(9): 893-899.
Mots-clés : INCIDENCE; SOIN INTENSIF
Objective: To quantify historical trends in rates of central line–associated bloodstream infections (CLABSIs) in
US intensive care units (ICUs) caused by major pathogen groups, including Candida spp., Enterococcus spp.,
specified gram-negative rods, and Staphylococcus aureus.
Design: Active surveillance in a cohort of participating ICUs through the Centers for Disease Control and
Prevention, the National Nosocomial Infections Surveillance system during 1990–2004, and the National
Healthcare Safety Network during 2006–2010.
Setting: ICUs.
Participants: Patients who were admitted to participating ICUs.
Results: The CLABSI incidence density rate for S. aureus decreased annually starting in 2002 and remained
lower than for other pathogen groups. Since 2006, the annual decrease for S. aureus CLABSIs in
nonpediatric ICU types was -18.3% (95% confidence interval [CI], -20.8% to -15.8%), whereas the incidence
density rate for S. aureus among pediatric ICUs did not change. The annual decrease for all ICUs combined
6 / 26
NosoVeille – Bulletin de veille
Septembre 2013
since 2006 was -17.8% (95% CI, -19.4% to -16.1%) for Enterococcus spp., -16.4% (95% CI, -18.2% to 14.7%) for gram-negative rods, and -13.5% (95% CI, -15.4% to -11.5%) for Candida spp.
Conclusions: Patterns of ICU CLABSI incidence density rates among major pathogen groups have changed
considerably during recent decades. CLABSI incidence declined steeply since 2006, except for CLABSI due
to S. aureus in pediatric ICUs. There is a need to better understand CLABSIs that still do occur, on the basis
of microbiological and patient characteristics. New prevention approaches may be needed in addition to
central line insertion and maintenance practices.
NosoBase ID notice : 368254
Impact d’un bouquet d’intervention (bundle) concernant les voies centrales sur les bactériémies
associées aux voies centrales dans des unités de réanimation
Jeong IS; Park SM; Lee JM; Song JY; Lee SJ. Effect of central line bundle on central line-associated
bloodstream infections in intensive care units. American journal of infection control 2013/08; 41(8): 710-716.
Mots-clés : SOIN INTENSIF; BACTERIEMIE; CATHETER; SURVEILLANCE; HYGIENE DES MAINS;
FORMATION;
OBSERVANCE;
CATHETER
VEINEUX
CENTRAL;
CENTRE
HOSPITALIER
UNIVERSITAIRE; INCIDENCE
Background: This study was conducted in 4 intensive care units (ICUs) to investigate the effect of the central
line (CL) bundle on central line-associated bloodstream infection (CLABSI).
Methods: During phase 1 (baseline, from April 2009 to March 2010), active surveillance and training on hand
hygiene only were conducted. During phase 2 (intervention, from April 2010 to December 2011), systemic
training on the CL bundle and active surveillance and feedback with an electronic CL insertion checklist were
performed.
Results: Adherence to the CL bundle significantly increased from 0.0% in phase 1 to 37.1% in phase 2
(P<.001), but the change of CLABSI rate was insignificant for adults in ICUs. However, adherence to the CL
bundle significantly increased from 0.8% in phase 1 to 20.1% in phase 2 (P<.001), and the CLABSI rate
significantly decreased from 3.7 to 0.0 per 1,000 catheter-days (P=.014) for children in ICUs.
Conclusion: The higher adherence to the CL bundle was not positively correlated to a reduction in the
CLABSI rate in adults, but it was related to a zero CLABSI for 18 monts among children in the ICUs.
NosoBase ID notice : 368574
Documentation électronique des journées-cathéter veineux central : une validation est impérative
Tejedor SC; Garrett G; Jacob JT; Meyer E; Reyes MD; Robichaux C; et al. Electronic documentation of
central venous catheter-days: validation is essential. Infection control and hospital epidemiology 2013/09;
34(9): 900-907.
Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; TAUX; INFORMATIQUE
Background: Measurement of central line–associated bloodstream infection (CLABSI) rates outside of
intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use.
The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVCdays, but validation of electronic data has not been studied systematically.
Objective: To design and validate a process to reliably measure CVC-days outside of the intensive care units
that leverages electronic documentation.
Methods: Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing
documentation were studied. Electronic queries were created to capture patient and CVC information, and
tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate
electronic data included comparisons with manual CVC-day determinations and automated data validation
using customized tools. Interventions included redesign of documentation interface, real-time audit with
feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVCday measurement compared with manually counted CVC-days.
Results: At baseline, there were a mean (+/- standard deviation) of 0.32 +/- 0.25 electronic CVC-day errors
(omission and commission errors summed and counted equally) per manually counted CVC-day. After
several process improvement cycles over 7 months, the error rate decreased to !0.05 errors per CVC-day and
remained at or below this level for 2 years.
Conclusions: Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced
errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure
accuracy, particularly if these data will be used for interinstitutional comparison.
7 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Chirurgie
NosoBase ID notice : 369224
Transmission de Strongyloides
Pennsylvanie, 2012
stercoralis
lors d'une transplantation
d'organes solides
-
Centers for disease control and prevention. Transmission of Strongyloides stercoralis through transplantation
of solid organs - Pennsylvania, 2012. MMWR Morbidity and mortality weekly report 2013/04/12; 62(14): 264266.
Mots-clés : TRANSPLANTATION; IVERMECTINE; INVESTIGATION
Strongyloides stercoralis is an intestinal nematode endemic in the tropics and subtropics. Immunocompetent
hosts typically are asymptomatic, despite chronic Strongyloides infection. In contrast, immunocompromised
patients are at risk for hyperinfection syndrome and disseminated disease, with a fatality rate >50%. The
infection source for immunocompromised patients, such as solid organ transplant recipients, is not always
apparent and might result from reactivation of chronic infection after initiation of immunosuppressive therapy
or transmission from the donor. In October 2012, the United Network for Organ Sharing (UNOS) notified CDC
of a left kidney and pancreas recipient in Pennsylvania diagnosed with strongyloidiasis. This report
summarizes the results of the investigation of the source of Strongyloides infection in three of four organ
recipients. Testing of pretransplant donor and recipient sera confirmed that infection in the recipients was
donor derived. This investigation underscores the importance of prompt communication between organ
procurement organizations, transplant centers, and public health authorities to prevent adverse events in
recipients when transmission is suspected. Additionally, it emphasizes the utility of stored pretransplant
samples for investigation of suspected transplant-transmitted infections and the need to consider the risk for
Strongyloides infection in organ donors.
NosoBase ID notice : 369344
Une infection bactérienne comme cause probable de réactions secondaires à des produits de
comblement à base de gel en polyacrylamide en chirurgie esthétique
Christensen L; Breiting V; Bjarnsholt T; Eickhardt S; Høgdall E; Janssen M; et al . Bacterial infection as a
likely cause of adverse reactions to polyacrylamide hydrogel fillers in cosmetic surgery. Clinical infectious
diseases 2013/05/15; 56(10): 1438-1444.
Mots-clés : ESTHETIQUE; CAS TEMOIN; PROPIONIBACTERIUM; STAPHYLOCOCCUS EPIDERMIDIS;
INJECTION
Background: The etiology of long-lasting adverse reactions to gel fillers used in cosmetic surgery is not
known. Bacterial infection and immunological reaction to the product have been suggested.
Methods: We performed a case-control study, with 77 biopsies and 30 cytology specimens originating from 59
patients with adverse reactions to polyacrylamide gel, and 54 biopsies and 2 cytology specimens from 28
control subjects with no adverse reactions. Samples from 5 patients and 4 controls could not be investigated
for presence of bacteria owing to limited material. Samples from the remaining 54 patients and 24 controls
were systematically examined for the presence of bacteria by culture, 16S rRNA gene sequencing, Gram
stain, and fluorescence in situ hybridization.
Results: Bacteria, mostly normal skin bacteria such as Staphylococcus epidermidis and Propionibacterium
acnes, were identified in bacteriologically investigated samples from 53 of 54 patients (98%), and in none of
the 24 controls (0%). The bacteria were lying in small clusters, which in symptomatic lesions were detected
up to 5 years postinjection.
Conclusions: Commensal bacteria of low virulence are capable of producing long-term infection in the
presence of polyacrylamide filler in cosmetic surgery, possibly due to a biofilm mode of growth. Adequate skin
preparation and use of sterile technique in these procedures are mandatory, but antibiotic prophylaxis prior to
injection of nondegradable gels like polyacrylamide should be explored as well.
NosoBase ID notice : 368315
Contamination bactérienne de gants non stériles, à usage unique, inutilisés dans un service
hospitalier de chirurgie orthopédique
8 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Hughes KA; Cornwall J; Theis JC; Brooks HJL. Bacterial contamination of unused, disposable non-sterile
gloves on a hospital orthopaedic ward. Australasian medical journal 2013/06/30; 6(6): 331-338.
Mots-clés : CONTAMINATION; GANT; CHIRURGIE ORTHOPEDIQUE; USAGE UNIQUE; ETUDE
PROSPECTIVE; AUDIT; STAPHYLOCOCCUS; ANTIBIORESISTANCE; PCR
Background: Non-sterile disposable gloves are used on large hospital wards, however their potential role as a
vehicle for pathogen transmission has not been explored in this setting.
AIMS: This study investigates glove use on a hospital orthopaedic ward to examine whether pathogen
contamination occurs prior to contact with patients.
Method: Glove samples were aseptically removed from boxes on a hospital orthopaedic ward on opening and
days 3, 6 and 9 thereafter. Following elution of bacteria and viable counts, glove isolates were identified by
standard techniques and 16s rDNA sequencing. Methicillin resistance of staphylococci was determined by
disc diffusion, Epsilon tests and PCR. Gloves were inoculated to determine two isolate survival rates.
Results: Total bacterial counts ranged from 0 to 9.6 x 10(3) cfu/glove. Environmental bacteria, particularly
Bacillus species, were present on 31/38 (81.6%) of samples. Half (19/38) the samples were contaminated
with skin commensals; coagulase negative staphylococci were predominant. Enterococcus faecalis ,
Klebsiella pneumoniae , Pseudomonas sp. or methicillin susceptible Staphylococcus aureus were recovered
from 5/38 (13.2%) of samples. Significantly more skin commensals and pathogens were recovered from
samples from days 3, 6, 9 than box-opening samples. Staphylococcus epidermidis and Klebsiella
pneumoniae inoculated onto gloves remained viable for several days but counts decreased.
Conclusion: Health care workers introduced skin commensals and pathogenic bacteria into glove boxes
indicating that unused, non-sterile gloves are potential pathogen transmission vehicles in hospitals. Findings
highlight adherence to handwashing guidelines, common glove retrieval practice, and glove-box design as
targets for decreasing bacteria transmission via gloves on hospital wards.
Clostridium difficile
NosoBase ID notice : 368337
Epidémiologie des infections à Clostridium difficile en Asie
Collins DA; Hawkey PM; Riley TV. Epidemiology of Clostridium difficile infection in Asia. Antimicrobial
resistance and infection control 2013/07/01; 2(1): 1-9.
Mots-clés : EPIDEMIOLOGIE; CLOSTRIDIUM DIFFICILE; PREVALENCE; BIBLIOGRAPHIE; TYPAGE;
RIBOTYPE; PREVENTION; CONTROLE; ANTIBIORESISTANCE
While Clostridium difficile infection (CDI) has come to prominence as major epidemics have occurred in North
America and Europe over the recent decade, awareness and surveillance of CDI in Asia have remained poor.
Limited studies performed throughout Asia indicate that CDI is also a significant nosocomial pathogen in this
region, but the true prevalence of CDI remains unknown. A lack of regulated antibiotic use in many Asian
countries suggests that the prevalence of CDI may be comparatively high. Molecular studies indicate that
ribotypes 027 and 078, which have caused significant outbreaks in other regions of the world, are rare in
Asia. However, variant toxin A-negative/toxin B-positive strains of ribotype 017 have caused epidemics
across several Asian countries. Ribotype smz/018 has caused widespread disease across Japan over the
last decade and more recently emerged in Korea. This review summarises current knowledge on CDI in
Asian countries.
NosoBase ID notice : 368730
Durée de séjour et mortalité dues aux infections à Clostridium difficile acquises en réanimation
Dodek PM; Norena M; Ayas NT; Romney M; Wong H. Length of stay and mortality due to Clostridium difficile
infection acquired in the intensive care unit. Journal of critical care 2013/08; 28(4): 335-340.
Mots-clés : CLOSTRIDIUM DIFFICILE; MORTALITE; SOIN INTENSIF; DUREE DE SEJOUR; RISQUE;
ETUDE RETROSPECTIVE; COHORTE; APPARIEMENT; ANALYSE
Purpose: The purpose of this study was to determine the attributable intensive care unit (ICU) and hospital
length of stay and mortality of ICU-acquired Clostridium difficile infection (CDI).
Materials and methods: In this retrospective cohort study of 3 tertiary and 3 community ICUs, we screened all
patients admitted between April 2006 and December 2011 for ICU-acquired CDI. Using both complete and
9 / 26
NosoVeille – Bulletin de veille
Septembre 2013
matched cohort designs and Cox proportional hazards analysis, we determined the association between CDI
and ICU and hospital length of stay and mortality. Adjustment or matching variables were site, age, sex,
severity of illness, and year of admission; any infection as an ICU admitting or acquired diagnosis before the
diagnosis of CDI and diagnosis of CDI were time-dependent exposures.
Results: Of 15314 patients admitted to the ICUs during the study period, 236 developed CDI in the ICU. In the
complete cohort analysis, the hazard ratios (95% confidence interval) for CDI related to ICU and hospital
discharge were 0.82 (0.72, 0.94) and 0.83 (0.73, 0.95), respectively (0.5 additional ICU days and 3.4 hospital
days), and related to death in ICU and hospital, they were 1.00 (0.73, 1.38) and 1.19 (0.93, 1.52),
respectively. In the matched analysis, the hazard ratios for CDI related to ICU and hospital discharge were
0.91 (0.81, 1.03) and 0.98 (0.85, 1.13), respectively, and related to death in ICU and hospital, they were 1.18
(0.85, 1.63) and 1.08 (0.82, 1.43), respectively.
Conclusions: C difficile infection acquired in ICU is associated with an increase in length of ICU and hospital
stay but not with any difference in ICU or hospital mortality.
NosoBase ID notice : 369350
Causes de mortalité des patients hospitalisés avec une infection à Clostridium difficile : une étude de
cohorte multicentrique
Hensgens MP; Goorhuis A; Dekkers OM; VAN Benthem B; Kuijper EJ. All-cause and disease-specific
mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study. Clinical
infectious diseases 15/04/2013; 56(8): 1108-1016.
Mots-clés : CLOSTRIDIUM DIFFICILE; MORTALITE; COHORTE; ETUDE MULTICENTRIQUE
Background: Mortality among patients with Clostridium difficile infection (CDI) is high. Because of high age
and multiple underlying diseases, CDI-related mortality is difficult to estimate. We estimated CDI-related
mortality in an endemic situation, not influenced by outbreaks and consequently certain patients and C.
difficile strains.
Methods: Between 2006 and 2009, 13 Dutch hospitals included all hospitalized CDI patients. Nine hospitals
individually matched each CDI patient to 2 control patients, based on ward and time of CDI hospitalization.
Survival status was obtained via the Dutch Civil Registration System. Kaplan-Meier and Cox regression were
used for survival analysis.
Results: We identified 1366 patients with CDI (1.33 per 1000 admissions). All-cause mortality risk was 13%
after 30 days and 37% after 1 year. The highest mortality was seen among elderly patients and patients with
polymerase chain reaction ribotype 027. Three hundred seventeen CDI patients were matched to 317
patients without diarrhea and 232 patients with diarrhea, with a 30-day mortality risk of 5.4% and 8.6%,
respectively. CDI patients had a 2.5-fold increased 30-day mortality rate compared to controls without
diarrhea (hazard ratio 2.5 [95% confidence interval, 1.4-4.3]) when adjusted for age, sex, and underlying
diseases. CDI-related death occurred mainly within 30 days after diagnosis.
Conclusions: Mortality among CDI patients is high, even in an endemic situation. Our results show that CDI is
associated with to a 2.5-fold increase in 30-day mortality. This highlights the considerable disease burden and
clinical impact of CDI, even in absence of an outbreak.
NosoBase ID notice : 369352
Attitude des médecins vis-à-vis de la transplantation fécale pour traiter les infections récurrentes à
Clostridium difficile dans une métropole
Jiang ZD; Hoang LN; Lasco TM; Garey KW; DuPont HL. Physician attitudes toward the use of fecal
transplantation for recurrent Clostridium difficile infection in a metropolitan area. Clinical infectious diseases
2013/04/01; 56(7): 1059-1060.
Mots-clés : CLOSTRIDIUM DIFFICILE; ATTITUDE; MEDECIN
Background: Mortality among patients with Clostridium difficile infection (CDI) is high. Because of high age
and multiple underlying diseases, CDI-related mortality is difficult to estimate. We estimated CDI-related
mortality in an endemic situation, not influenced by outbreaks and consequently certain patients and C.
difficile strains.
Methods: Between 2006 and 2009, 13 Dutch hospitals included all hospitalized CDI patients. Nine hospitals
individually matched each CDI patient to 2 control patients, based on ward and time of CDI hospitalization.
Survival status was obtained via the Dutch Civil Registration System. Kaplan-Meier and Cox regression were
used for survival analysis.
10 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Results: We identified 1366 patients with CDI (1.33 per 1000 admissions). All-cause mortality risk was 13%
after 30 days and 37% after 1 year. The highest mortality was seen among elderly patients and patients with
polymerase chain reaction ribotype 027. Three hundred seventeen CDI patients were matched to 317
patients without diarrhea and 232 patients with diarrhea, with a 30-day mortality risk of 5.4% and 8.6%,
respectively. CDI patients had a 2.5-fold increased 30-day mortality rate compared to controls without
diarrhea (hazard ratio 2.5 [95% confidence interval, 1.4-4.3]) when adjusted for age, sex, and underlying
diseases. CDI-related death occurred mainly within 30 days after diagnosis.
Conclusions: Mortality among CDI patients is high, even in an endemic situation. Our results show that CDI is
associated with to a 2.5-fold increase in 30-day mortality. This highlights the considerable disease burden and
clinical impact of CDI, even in absence of an outbreak.
NosoBase ID notice : 369341
L'épidémiologie de l'infection à Clostridium difficile chez les enfants : une étude de population
Khanna S; Baddour LM; Huskins WC; Kammer PP; Faubion WA; Zinsmeister AR; et al. The epidemiology of
Clostridium difficile infection in children: a population-based study. Clinical infectious diseases 2012/05/15;
56(10): 1401-1406.
Background: The incidence of Clostridium difficile infection (CDI) is increasing, even in populations previously
thought to be at low risk, including children. Most incidence studies have included only hospitalized patients
and are thus potentially influenced by referral or hospitalization biases.
Methods: We performed a population-based study of CDI in pediatric residents (aged 0-18 years) of Olmsted
County, Minnesota, from 1991 through 2009 to assess the incidence, severity, treatment response, and
outcomes of CDI.
Results: We identified 92 patients with CDI, with a median age of 2.3 years (range, 1 month-17.6 years). The
majority of cases (75%) were community-acquired. The overall age- and sex-adjusted CDI incidence was
13.8 per 100 000 persons, which increased 12.5-fold, from 2.6 (1991-1997) to 32.6 per 100 000 (2004-2009),
over the study period (P<.0001). The incidence of community-acquired CDI was 10.3 per 100 000 persons
and increased 10.5-fold, from 2.2 (1991-1997) to 23.4 per 100 000 (2004-2009) (P<.0001). Severe, severecomplicated, and recurrent CDI occurred in 9%, 3%, and 20% of patients, respectively. The initial treatment in
82% of patients was metronidazole, and 18% experienced treatment failure. In contrast, the initial treatment in
8% of patients was vancomycin and none of them failed therapy.
Conclusions: In this population-based cohort, CDI incidence in children increased significantly from 1991
through 2009. Given that the majority of cases were community-acquired, estimates of the incidence of CDI
that include only hospitalized children may significantly underestimate the burden of disease in children.
NosoBase ID notice : 368663
Epidémiologie des événements indésirables et diarrhées associées à Clostridium difficile lors d’une
antibiothérapie à long terme pour infections ostéoarticulaires
Schindler M; Bernard L; Belaieff W; Gamulin A; Racloz G; Emonet S; et al. Epidemiology of adverse events
and Clostridium difficile-associated diarrhea during long-term antibiotic therapy for osteoarticular infections.
Journal of infection 2013; in press: 6 pages.
Mots-clés : EPIDEMIOLOGIE; TOLERANCE; EFFET INDESIRABLE; DIARRHEE; CLOSTRIDIUM
DIFFICILE; ANTIBIOTIQUE; TRAITEMENT; APPAREIL OSTEO-ARTICULAIRE; COHORTE; CENTRE
HOSPITALIER UNIVERSITAIRE
Objective: Osteoarticular infections require several weeks of antibiotic therapy, but little is known about the
epidemiology of adverse events (AE) including symptomatic Clostridium difficile-associated diarrhea during
treatment in these patients.
Methods: Cohort study (1996-2011) at a tertiary hospital non-endemic for clostridial ribotype O27. Patients
with previous C. difficile episodes and metronidazole treatment were excluded.
Results: A total of 393 episodes were identified. Median age of patients was 69 years; 122 were immunesuppressed. All patients received antibiotic treatment for a median of 8 weeks, including 2 weeks
intravenously (range, 0-9 weeks). Oral rifampin (600 mg/d) was used in combination in 167 (42%) episodes.
A relatively small number of episodes (115/393; 29%) were complicated by AE (diarrhea, nausea,
cholestasis, gastric intolerance to rifampin, rash, and mycosis), of which 41 (36%) led to treatment
modification. AE occurred mainly after a median of 21 days. Fourteen patients (14/393; 3.6%) developed
symptomatic C. difficile diarrhea. By multivariate Cox regression analysis, total duration of antibiotic therapy,
and intravenous administration were significantly associated with AE (all p<0.01). Regarding symptomatic C.
11 / 26
NosoVeille – Bulletin de veille
Septembre 2013
difficile infection, rifampin (hazard ratio 0.21; 95% CI, 0.05-0.97) protected from diarrhea, but not gender or
age. Hospital stay was significantly longer among patients with AE than patients without (median 78 vs. 42 d;
p<0.01).
Conclusions: AE were frequent and were observed in 29% of patients treated for osteoarticular infections and
prolonged the hospital stay. In contrast, diarrhea due to C. difficile was rare, while oral rifampin might act
protectively against it.
Coronavirus
NosoBase ID notice : 369229
Infections respiratoires sévères liées au Coronavirus responsable du syndrome respiratoire du
Moyen-Orient (MERS-Cov) à travers le monde, 2012-2013
Centers for disease control and prevention. Update: Severe respiratory illness associated with Middle East
Respiratory Syndrome Coronavirus (MERS-CoV)--worldwide, 2012-2013. MMWR Morbidity and mortality
weekly report 2013/06/14; 62(23): 480-483.
Mots-clés : CORONAVIRUS; EPIDEMIE; TRANSMISSION
CDC continues to work in consultation with the World Health Organization (WHO) and other partners to better
understand the public health risk posed by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV),
formerly known as novel coronavirus, which was first reported to cause human infection in September 2012.
The continued reporting of new cases indicates that there is an ongoing risk for transmission to humans in the
area of the Arabian Peninsula. New reports of cases outside the region raise concerns about importation to
other geographic areas. Nosocomial outbreaks with transmission to health-care personnel highlight the
importance of infection control procedures. Recent data suggest that mild respiratory illness might be part of
the clinical spectrum of MERS-CoV infection, and presentations might not initially include respiratory
symptoms. In addition, patients with comorbidities or immunosuppression might be at increased risk for
infection, severe disease, or both. Importantly, the incubation period might be longer than previously
estimated. Finally, lower respiratory tract specimens (e.g., sputum, bronchoalveolar lavage, bronchial wash,
or tracheal aspirate) should be collected in addition to nasopharyngeal sampling for evaluation of patients
under investigation. An Emergency Use Authorization (EUA) was recently issued by the Food and Drug
Administration (FDA) to allow for expanded availability of diagnostic testing in the United States.
NosoBase ID notice : 369230
Mise à jour des recommandations pour le Coronavirus responsable du syndrome respiratoire du
Moyen-Orient (MERS-Cov) à travers le monde, 2012-2013
Centers for disease control and prevention. Update: recommendations for Middle East Respiratory Syndrome
Coronavirus (MERS-CoV). MMWR Morbidity and mortality weekly report 12/07/2013; 62(27): 557.
Mots-clés : CORONAVIRUS; EPIDEMIE; RECOMMANDATION
CDC continues to work in consultation with the World Health Organization (WHO) and other partners to better
understand the public health risk posed by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV),
formerly known as novel coronavirus, which was first reported to cause human infection in September 2012.
The continued reporting of new cases indicates that there is an ongoing risk for transmission to humans in the
area of the Arabian Peninsula. New reports of cases outside the region raise concerns about importation to
other geographic areas. Nosocomial outbreaks with transmission to health-care personnel highlight the
importance of infection control procedures. Recent data suggest that mild respiratory illness might be part of
the clinical spectrum of MERS-CoV infection, and presentations might not initially include respiratory
symptoms. In addition, patients with comorbidities or immunosuppression might be at increased risk for
infection, severe disease, or both. Importantly, the incubation period might be longer than previously
estimated. Finally, lower respiratory tract specimens (e.g., sputum, bronchoalveolar lavage, bronchial wash,
or tracheal aspirate) should be collected in addition to nasopharyngeal sampling for evaluation of patients
under investigation. An Emergency Use Authorization (EUA) was recently issued by the Food and Drug
Administration (FDA) to allow for expanded availability of diagnostic testing in the United States.
NosoBase ID notice : 369237
12 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Aspects cliniques et analyses virales d'un cas de Coronavirus responsable du syndrome respiratoire
du Moyen-Orient
Drosten C; Seilmaier M; Corman VM; Hartmann W; Scheible G; Sack S; et al. Clinical features and virological
analysis of a case of Middle East respiratory syndrome coronavirus infection. The Lancet infectious diseases
2013/09/01; 13(9): 745-751.
Mots-clés : CORONAVIRUS; INFECTION RESPIRATOIRE; DIAGNOSTIC; EPIDEMIOLOGIE
The Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging virus involved in cases and
case clusters of severe acute respiratory infection in the Arabian Peninsula, Tunisia, Morocco, France, Italy,
Germany, and the UK. We provide a full description of a fatal case of MERS-CoV infection and associated
phylogenetic analyses.
Methods: We report data for a patient who was admitted to the Klinikum Schwabing (Munich, Germany) for
severe acute respiratory infection. We did diagnostic RT-PCR and indirect immunofluorescence. From time of
diagnosis, respiratory, faecal, and urine samples were obtained for virus quantification. We constructed a
maximum likelihood tree of the five available complete MERS-CoV genomes.
Findings: A 73-year-old man from Abu Dhabi, United Arab Emirates, was transferred to Klinikum Schwabing
on March 19, 2013, on day 11 of illness. He had been diagnosed with multiple myeloma in 2008, and had
received several lines of treatment. The patient died on day 18, due to septic shock. MERS-CoV was
detected in two samples of bronchoalveolar fluid. Viral loads were highest in samples from the lower
respiratory tract (up to 1·2 × 10(6) copies per mL). Maximum virus concentration in urine samples was 2691
RNA copies per mL on day 13; the virus was not present in the urine after renal failure on day 14. Stool
samples obtained on days 12 and 16 contained the virus, with up to 1031 RNA copies per g (close to the
lowest detection limit of the assay). One of two oronasal swabs obtained on day 16 were positive, but yielded
little viral RNA (5370 copies per mL). No virus was detected in blood. The full virus genome was combined
with four other available full genome sequences in a maximum likelihood phylogeny, correlating branch
lengths with dates of isolation. The time of the common ancestor was halfway through 2011. Addition of novel
genome data from an unlinked case treated 6 months previously in Essen, Germany, showed a clustering of
viruses derived from Qatar and the United Arab Emirates.
Interpretation: We have provided the first complete viral load profile in a case of MERS-CoV infection. MERSCoV might have shedding patterns that are different from those of severe acute respiratory syndrome and so
might need alternative diagnostic approaches.
EHPAD
NosoBase ID notice : 369227
Transmission du VHB parmi les résidents d'un centre pour personnes âgées en perte d'autonomie Virginie, 2012
Centers for disease control and prevention (CDC). Notes from the field: transmission of HBV among assistedliving-facility residents - Virginia, 2012. MMWR Morbidity and mortality weekly report 17/05/2013; 62(19): 389.
Mots-clés : EPIDEMIE; HEPATITE B; LECTEUR DE GLYCEMIE; PERSONNE AGEE; FACTEUR DE
RISQUE
On June 29, 2012, the Rappahannock Area Health District in northwestern Virginia received a report of an
acute hepatitis B virus (HBV) infection in an elderly resident of an assisted-living facility (ALF). The resident
reported no risk factors for HBV infection except assisted monitoring of blood glucose (AMBG), which has
been implicated in the transmission of HBV in ALFs and other long-term-care facilities. Rappahannock Area
Health District investigated the source of the infection and the scope of transmission. Investigators observed
facility infection control practices and procedures and conducted staff interviews. The facility was scheduled
to close July 31, 2012, necessitating prompt response before residents were transferred.
Enterobacter
NosoBase ID notice : 368652
Emergence d’Enterobacter spp. producteurs de bêta-lactamase à spectre élargi chez des patients
présentant une bactériémie dans un centre hospitalier universitaire du Sud du Brésil
13 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Nogueira K; Paganini MC; Conte A; Cogo LL; Taborda de Messias Reason I; Da Silva MJ; et al. Emergence
of extended-spectrum β-lactamase-producing Enterobacter spp. in patients with bacteremia in a tertiary
hospital in southern Brazil. Enfermedades infecciosas y microbiología clínica 2013; in press: 6 pages.
Mots-clés : ENTEROBACTER; BETA-LACTAMASE A SPECTRE ELARGI; BACTERIEMIE; CENTRE
HOSPITALIER UNIVERSITAIRE; ETUDE RETROSPECTIVE; PREVALENCE; FACTEUR DE RISQUE; PCR;
PFGE; BIOLOGIE MOLECULAIRE
Background: Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp.,
posing a challenge to the treatment of infections caused by this microorganism. The purpose of this
retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with
bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period
2004-2008.
Methods: The presence of blaCTX-M, blaTEM, blaSHV, and blaPER genes was detected by polymerase
chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by
pulsed-field gel electrophoresis (PFGE).
Results: Enterobacter spp. was identified in 205 of 4907 of the patients who had positive blood cultures
during hospitalization. Of those cases, 41 (20%) were ESBL-producing Enterobacter spp. Nosocomial
pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence
of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2
(23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains
showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal.
Conclusion: Although no difference in clinical outcomes was observed between patients with infections by
ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the
change of antimicrobials in 75% of cases, having important implications in the decision-making regarding
adequate antimicrobial therapy.
Environnement
NosoBase ID notice : 368125
Rôles de la lumière solaire et de la ventilation naturelle pour le contrôle des infections : point de vue
historique et actuel
Hobday RA; Dancer SJ. Roles of sunlight and natural ventilation for controlling infection: historical and current
perspectives. The journal of hospital infection 2013/08; 84(4): 271-282.
Mots-clés : AIR; CONTROLE; TRANSMISSION; VIRUS; GRIPPE; TUBERCULOSE; STAPHYLOCOCCUS
AUREUS; STREPTOCOCCUS
Background: Infections caught in buildings are a major global cause of sickness and mortality. Understanding
how infections spread is pivotal to public health yet current knowledge of indoor transmission remains poor.
Aim: To review the roles of natural ventilation and sunlight for controlling infection within healthcare
environments.
Methods: Comprehensive literature search was performed, using electronic and library databases to retrieve
English language papers combining infection; risk; pathogen; and mention of ventilation; fresh air; and
sunlight. Foreign language articles with English translation were included, with no limit imposed on publication
date.
Findings: In the past, hospitals were designed with south-facing glazing, cross-ventilation and high ceilings
because fresh air and sunlight were thought to reduce infection risk. Historical and recent studies suggest that
natural ventilation offers protection from transmission of airborne pathogens. Particle size, dispersal
characteristics and transmission risk require more work to justify infection control practices concerning
airborne pathogens. Sunlight boosts resistance to infection, with older studies suggesting potential roles for
surface decontamination.
Conclusions: Current knowledge of indoor transmission of pathogens is inadequate, partly due to lack of
agreed definitions for particle types and mechanisms of spread. There is recent evidence to support historical
data on the effects of natural ventilation but virtually none for sunlight. Modern practice of designing
healthcare buildings for comfort favours pathogen persistence. As the number of effective antimicrobial
agents declines, further work is required to clarify absolute risks from airborne pathogens along with any
potential benefits from additional fresh air and sunlight.
14 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Epidémie
NosoBase ID notice : 369231
Epidémie de kératoconjonctivites à adenovirus dans quatre états, 2008-2012
Centers for disease control and prevention (CDC). Adenovirus-associated epidemic keratoconjunctivitis
outbreaks - four States, 2008-2010. MMWR Morbidity and mortality weekly report 2013/8/16; 62(32): 637641.
Mots-clés : ADENOVIRUS; EPIDEMIE; CONJONCTIVITE; CABINET MEDICAL; OPHTALMOLOGIE; COUT
Epidemic keratoconjunctivitis (EKC) is a highly contagious, severe form of conjunctivitis. During 2008-2010,
six unrelated EKC outbreaks associated with human adenovirus (HAdV) in four states were reported to CDC.
In total, 411 EKC cases were identified in Florida, Illinois, Minnesota, and New Jersey. In each outbreak,
health-care-associated transmission appeared to occur via ophthalmologic examination; however, community
transmission was also documented. These outbreaks resulted in significant morbidity and cost resulting from
the number of persons affected, duration of the outbreaks, and the temporary closure of a neonatal intensivecare unit (NICU) and several clinics. Clusters of EKC infections should be reported to the appropriate state or
local health department. In settings where ophthalmologic care is provided, routine adherence to basic
infection control measures and early implementation of enhanced outbreak control measures are essential to
prevent HAdV transmission.
NosoBase ID notice : 369226
Infections spinales et para-spinales associées à des injections d'acétate de méthylprednisolone Michigan, 2012-2013
Centers for disease control and prevention (CDC). Spinal and paraspinal infections associated with
contaminated methylprednisolone acetate injections - Michigan, 2012-2013. MMWR Morbidity and mortality
weekly report 17/05/2013; 62(19): 377-381.
Mots-clés : EPIDEMIE; INJECTION; INJECTIONS RACHIDIENNES; CONTAMINATION; MENINGITE;
ASPERGILLUS FUMIGATUS; STEROIDE
As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without
meningitis associated with the 2012-2013 fungal meningitis outbreak nationally. Although the index patient
had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in
unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold
found on plants and in soil. Exposures have occurred through epidural, paraspinal, peripheral nerve, and
intra-articular injection with MPA from contaminated lots compounded by the New England Compounding
Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted
case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to
determine factors that might have contributed to the high percentage of spinal and paraspinal infections
reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with
paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12-121 days) were
observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI)
finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients
who received injections with contaminated MPA but have not developed infection.
Grippe
NosoBase ID notice : 369339
Efficacité du vaccin contre la grippe dans la communauté et dans le milieu familial
Ohmit SE; Petrie JG; Malosh RE; Cowling BJ; Thompson MG; Shay DK; et al. Influenza vaccine effectiveness
in the community and the household. Clinical infectious diseases 15/05/2013; 6(10): 1363-1369.
Mots-clés : EPIDEMIE; GRIPPE; VACCINATION; EFFICACITE
There is a recognized need to determine influenza vaccine effectiveness on an annual basis and a long
history of studying respiratory illnesses in households.
15 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Methods: We recruited 328 households with 1441 members, including 839 children, and followed them during
the 2010-2011 influenza season. Specimens were collected from subjects with reported acute respiratory
illnesses and tested by real-time reverse transcriptase polymerase chain reaction. Receipt of influenza
vaccine was defined based on documented evidence of vaccination in medical records or an immunization
registry. The effectiveness of 2010-2011 influenza vaccination in preventing laboratory-confirmed influenza
was estimated using Cox proportional hazards models adjusted for age and presence of high-risk condition,
and stratified by prior season (2009-2010) vaccination status.
Results: Influenza was identified in 78 (24%) households and 125 (9%) individuals; the infection risk was
8.5% in the vaccinated and 8.9% in the unvaccinated (P=.83). Adjusted vaccine effectiveness in preventing
community-acquired influenza was 31% (95% confidence interval [CI], -7% to 55%). In vaccinated subjects
with no evidence of prior season vaccination, significant protection (62% [95% CI, 17%-82%]) against
community-acquired influenza was demonstrated. Substantially lower effectiveness was noted among
subjects who were vaccinated in both the current and prior season. There was no evidence that vaccination
prevented household transmission once influenza was introduced; adults were at particular risk despite
vaccination.
Conclusions: Vaccine effectiveness estimates were lower than those demonstrated in other observational
studies carried out during the same season. The unexpected findings of lower effectiveness with repeated
vaccination and no protection given household exposure require further study.
NosoBase ID notice : 368651
Probable transmission de personne à personne d’un nouveau virus de la grippe aviaire (H7N9) dans
l’Est de la Chine, 2013 : enquête épidémiologique
Qi X; Qian YH; Bao CJ; Guo XL; Cui LB; Tang FY; et al. Probable person to person transmission of novel
avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation.British medical journal
2013/08; 347: 1-8.
Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; TRANSMISSION; ENQUETE; EPIDEMIOLOGIE;
BIOLOGIE MOLECULAIRE; PCR; RT-PCR
Objective: To determine whether the novel avian influenza H7N9 virus can transmit from person to person
and its efficiency.
Design: Epidemiological investigations conducted after a family cluster of two patients with avian H7N9 in
March 2013.
Setting: Wuxi, Eastern China.
Participants: Two patients, their close contacts, and relevant environments. Samples from the patients and
environments were collected and tested by real time reverse transcriptase-polymerase chain reaction (rRTPCR), viral culture, and haemagglutination inhibition assay. Any contacts who became ill had samples tested
for avian H7N9 by rRT-PCR. Paired serum samples were obtained from contacts for serological testing by
haemagglutination inhibition assays.
Main outcomes measures: Clinical data, history of exposure before the onset of illnesses, and results of
laboratory testing of pathogens and further analysis of sequences and phylogenetic tree to isolated strains.
Results: The index patient became ill five to six days after his last exposure to poultry. The second patient, his
daughter aged 32, who provided unprotected bedside care in the hospital, had no known exposure to poultry.
She developed symptoms six days after her last contact with her father. Two strains were isolated
successfully from the two patients. Genome sequence and analyses of phylogenetic trees showed that both
viruses were almost genetically identical. Forty three close contacts of both patients were identified. One had
mild illness but had negative results for avian H7N9 by rRT-PCR. All 43 close contacts tested negative for
haemagglutination inhibition antibodies specific for avian H7N9.
Conclusions: The infection of the daughter probably resulted from contact with her father (the index patient)
during unprotected exposure, suggesting that in this cluster the virus was able to transmit from person to
person. The transmissibility was limited and non-sustainable.
NosoBase ID notice : 368249
Utilisation d’un outil de promotion de la santé validé pour améliorer la sécurité du patient et
augmenter les taux de vaccination contre la grippe du personnel hospitalier
Real K; Kim S; Conigliaro J. Using a validated health promotion tool to improve patient safety and increase
health care personnel influenza vaccination rates. American journal of infection control 2013/08; 41(8): 691696.
16 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Mots-clés : VACCIN; GRIPPE; SECURITE; PREVENTION; RISQUE; PERCEPTION; TRAVAIL
Background: This study employed the risk perception attitude (RPA) framework to determine whether health
care personnel (HCP) influenza-related risk perceptions and efficacy beliefs could be used to segment
individuals into meaningful groups related to vaccination uptake, absenteeism, and patient safety beliefs.
Methods: After pilot interviews, a questionnaire was administered to 318 hospital-based HCP (80%) and
nonclinical support staff (20%) in Lexington, KY, in 2011. Follow-up interviews were conducted with 29
respondents.
Results: Cluster analysis was used to create 4 groups that correspond to the RPA framework: responsive
(high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and
indifference (low risk, weak efficacy). A significant association was found between membership in 1 or more
of the 4 RPA groups and the 3 study variables of interest: influenza vaccination uptake (F(7,299) =2.51,
P<.05), influenza-related absenteeism (F(7,269) =3.6, P<.001), and perceptions of patient safety climate
(F(7,304) =6.21, P<.001). A subset of respondents indicated the principal reasons for not getting vaccinated
were "had one before and got sick anyway," "concerned about vaccine safety," and "no convenient time." In
follow-up interviews, HCP indicated that employee vaccinations were altruistic, increased herd immunity, and
important for patient safety.
Conclusion: The RPA framework is a valid health promotion tool for improving patient safety, targeting
specific groups for interventions, and improving HCP influenza vaccination rates.
Hémodialyse
NosoBase ID notice : 368363
Composantes essentielles d'un programme de prévention du risque infectieux pour des centres
d'hémodialyse en ambulatoire
Hess S; Bren V. Essential components of an infection prevention program for outpatient hemodialysis
centers. Seminars in dialysis 2013/08; 26(4): 384-398.
Mots-clés : PREVENTION; HEMODIALYSE; AMBULATOIRE; EFFICACITE; QUALITE; SURVEILLANCE;
PRATIQUE; PERSONNEL; CATHETER; FORMATION; BIBLIOGRAPHIE
Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central linerelated bloodstream infections occurred in hemodialysis patients in 2008 and dialysis-associated outbreaks of
hepatitis C continue to be reported. While established hospital-based infection prevention programs have
existed since the 1970s, few dialysis facilities have an established in-center program, unless the dialysis
facility is hospital-associated. This review focuses on essential core components required for an effective
infection prevention program, extrapolating from acute-care programs and building on current dialysis
guidelines and recommendations. An effective infection prevention program requires infrastructure, including
leaders who place infection prevention as a top priority, active involvement from a multidisciplinary team,
surveillance of outcomes and processes with feedback, staff and patient education, and consistent use of
evidence-based practices. The program must be integrated into the existing Quality Assessment and
Performance Improvement program. Best practice recommendations for the prevention of infection, specific
to dialysis, continue to evolve as the epidemiology of dialysis-associated infections is further researched and
new evidence is gathered. A review of case studies illustrates that with an effective program in place,
infection prevention becomes part of the culture, reduces infection risk, and improves patient safety.
Infection urinaire
NosoBase ID notice : 368579
Evolution dans le temps de la résistance des bactéries à gram-négatif chez les patients hospitalisés
avec une infection urinaire sur sonde aux Etats-Unis, 2000-2009
Zilberberg MD; Shorr AF. Secular trends in gram-negative resistance among urinary tract infection
hospitalizations in the United States, 2000–2009. Infection control and hospital epidemiology 2013/09; 34(9):
940-946.
Mots-clés : INFECTION URINAIRE; BACILLE GRAM NEGATIF; ANTIBIORESISTANCE; PSEUDOMONAS
AERUGINOSA; ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; ENTEROBACTERIE; BETALACTAMASE; CARBAPENEME; EPIDEMIOLOGIE; TAUX
17 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Objective: Urinary tract infections (UTIs) are common among hospitalized patients. Selection of an
appropriate antibiotic for this infection requires knowledge of both its general microbiology and the
epidemiology of drug-resistant organisms. We sought to determine secular trends in UTI hospitalizations that
involve gram-negative (GN) multidrug-resistant Pseudomonas aeruginosa (MDR-PA), extended spectrum
beta-lactamase (ESBL)–producing Escherichia coli (EC) and Klebsiella pneumoniae (KP), and carbapenemresistant Enterobacteriaceae (CRE).
Design: Survey.
Patients: Patients with UTI in US hospitals between 2000 and 2009.
Methods: We first derived the total number of UTI hospitalizations in the United States from the Healthcare
Cost and Utilization Project Nationwide Inpatient Sample database years 2000–2009. Based on a literature
review, we then determined what proportion of all UTIs arise due to each of the organisms of interest,
irrespective of resistance pattern. Finally, we assessed the prevalence of resistance within each pathogen
based on the Eurofins Surveillance Network database 2000–2009. Susceptibility patterns served as
phenotypic surrogates for resistance.
Results: Between 2000 and 2009, the frequency of UTI hospitalizations increased by approximately 50%,
from 53 to 77 cases per 1,000 hospitalizations. Infections due to all GN bacteria followed a similar trajectory,
whereas those caused by resistant GN pathogens increased by approximately 50% (MDR-PA) to
approximately 300% (ESBL). CRE emerged and reached 0.5 cases per 1,000 hospitalizations in this 10-year
period.
Conclusions: The epidemiology and microbiology of GN UTI hospitalizations has shifted over the past
decade. The proportion of all hospitalizations involving this infection has climbed. Resistant GN bacteria are
becoming more prevalent and are implicated in an increasing proportion of UTIs among hospitalized patients.
Klebsiella pneumoniae
NosoBase ID notice : 369238
Epidémiologie clinique de l'expansion globale des carbapénémases chez Klebsiella pneumoniae
Silvia Munoz-Price L; Bonomo RA; Schwaber MJ; Daikos GL; Cormican M; Cornaglia G; et al. Clinical
epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. The Lancet infectious
diseases 2013/09/01; 13(9): 785-796.
Mots-clés : KLEBSIELLA PNEUMONIAE; CARBAPENEME; EPIDEMIOLOGIE; TRAITEMENT
Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then,
these versatile β-lactamases have spread internationally among Gram-negative bacteria, especially K
pneumoniae, although their precise epidemiology is diverse across countries and regions. The mortality
described among patients infected with organisms positive for KPC is high, perhaps as a result of the limited
antibiotic options remaining (often colistin, tigecycline, or aminoglycosides). Triple drug combinations using
colistin, tigecycline, and imipenem have recently been associated with improved survival among patients with
bacteraemia. In this Review, we summarise the epidemiology of KPCs across continents, and discuss issues
around detection, present antibiotic options and those in development, treatment outcome and mortality, and
infection control. In view of the limitations of present treatments and the paucity of new drugs in the pipeline,
infection control must be our primary defence for now.
NosoBase ID notice : 368474
Premier rapport de Klebsiella pneumoniae ST 258 producteur de KPC-2 résistant à la colistine en
Espagne
Valentín-Martín A; Valverde-De Francisco A; Bosque-Vall M; Cantón-Moreno R. First report of colistinresistant KPC-2 producing ST258-Klebsiella pneumoniae in Spain. Enfermedades infecciosas y microbiología
clínica 2013; in press: 2 pages.
Mots-clés : KLEBSIELLA PNEUMONIAE; COLISTINE; ANTIBIORESISTANCE; CARBAPENEME
Hygiène des mains
NosoBase ID notice : 368596
18 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Impact du changement de nombre ou d’emplacement des distributeurs de solutions hydroalcooliques sur leur utilisation dans un service de médecine générale d’un centre hospitalier
Chan BP; Homa K; Kirkland KB. Effect of varying the number and location of alcohol-based hand rub
dispensers on usage in a general inpatient medical unit. Infection control and hospital epidemiology 2013/09;
34(9): 987-989.
Mots-clés : HYGIENE DES MAINS; SOLUTION HYDRO-ALCOOLIQUE; EQUIPEMENT; ARCHITECTURE;
MEDECINE; COMPORTEMENT
We sequentially increased the number of wall-mounted alcoholbased hand rub dispensers in a small medical
unit to evaluate effects on hand hygiene performance. Above a certain point, addition of more dispensers did
not increase hand hygiene frequency, which appeared to be influenced more by location than by total number
of dispensers.
NosoBase ID notice : 368576
Mesures automatisées de l’observance de l’hygiène des mains du personnel soignant à l’aide de
transmetteurs à ultrasons : validation et essai contrôlé randomisé
Fisher DA; Seetoh T; May-Lin HO; Viswanathan S; Toh Y; Yin WC; et al. Automated measures of hand
hygiene compliance among healthcare workers using ultrasound: validation and a randomized controlled trial.
Infection control and hospital epidemiology 2013/09; 34(9): 919-928.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; SOLUTION HYDRO-ALCOOLIQUE; ULTRA-SON;
EQUIPEMENT; PERSONNEL
Objective: The primary objective of this study was to validate a novel method of assessing hand hygiene
compliance using ultrasound transmitters in patient zones and staff tagged with receivers. The secondary
objective was to assess the impact of audio reminders and quantified individual feedback.
Design: An observational comparison against manual assessment followed by assessment using an openlabel randomized control method.
Setting: Patient zones were established in 3 wards of 2 large teaching hospitals, including 88 general and 18
intensive care unit ward beds.
Participants:Consented regular ward nursing, medical, and allied health staff.
Methods: Concordance between 40 hours of manual observation using trained hand hygiene auditors and
automated measures of opportunities and compliance. Subsequent measured interventions were reminder
beeps and written individual feedback.
Results: When compared with manual observations, ultrasound monitoring underestimated percentage
compliances by a nonsignificant mean (95% confidence interval [CI]) difference of 5.2% (-20.1% to 9.8%;
Pp.491). After the intervention, adjusted multivariate analysis showed mean (95% CI) overall compliance in
the intervention arm was 6.8% (2.5%–11.1%; P=.002) higher than in the control arm. Results stratified by
compliance at entry and exit showed that the effect of intervention was stronger for compliance at exit than at
entry.
Conclusions: Our automated measure of hand hygiene compliance is valid when compared with the
traditional gold standard of manual observations. As an interventional tool, ultrasound-based automated hand
hygiene audits have significant benefit that can be built upon with enhancements and find increasing
acceptance with time.
Néonatologie
NosoBase ID notice : 368342
Sepsis néonatal à staphylocoques à coagulase négative : revue
Marchant EA; Boyce GK; Sadarangani M; Lavoie PM. Neonatal sepsis due to coagulase-negative
staphylococci. Clinical and development immunology 2013; 2013: 1-10.
Mots-clés : NEONATALOGIE; SYNDROME SEPTIQUE; STAPHYLOCOCCUS; STAPHYLOCOQUE A
COAGULASE
NEGATIVE;
EPIDEMIOLOGIE;
DIAGNOSTIC;
PREVENTION;
TRAITEMENT;
BIBLIOGRAPHIE; FACTEUR DE RISQUE; NOUVEAU-NE
19 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Neonates, especially those born prematurely, are at high risk of morbidity and mortality from sepsis. Multiple
factors, including prematurity, invasive life-saving medical interventions, and immaturity of the innate immune
system, put these infants at greater risk of developing infection. Although advanced neonatal care enables us
to save even the most preterm neonates, the very interventions sustaining those who are hospitalized
concurrently expose them to serious infections due to common nosocomial pathogens, particularly
coagulase-negative staphylococci bacteria (CoNS). Moreover, the health burden from infection in these
infants remains unacceptably high despite continuing efforts. In this paper, we review the epidemiology,
immunological risk factors, diagnosis, prevention, treatment, and outcomes of neonatal infection due to the
predominant neonatal pathogen CoNS.
Pédiatrie
NosoBase ID notice : 368361
Escarres nosocomiales liées à des dispositifs médicaux chez des enfants : revue
Murray JS; Noonan C; Quigley S; Curley MA. Medical device-related hospital-acquired pressure ulcers in
children: an integrative review. Journal of pediatric nursing 2013; in press: 11 pages.
Mots-clés : PEDIATRIE; ESCARRE; BIBLIOGRAPHIE; DISPOSITIF MEDICAL
The management, cost, physical and emotional suffering associated with pressure ulcers have a significant
impact on the health status of patients-especially infants and children. The purpose of this integrative review
was to identify factors associated with medical device-related (MDR) hospital acquired pressure ulcers
(HAPUs) in the pediatric population. Pediatric MDR HAPUs are becoming more prevalent and require further
exploration in terms of describing devices which cause injury and preventive interventions to improve patient
outcomes. Opportunities to uncover new methods for addressing this important problem and to inform and
advance the state of the science in this evolving area exist.
Personnel
NosoBase ID notice : 368572
Mises à jour des recommandations publiées par le Département de Santé Publique américain sur la
gestion des accidents d’exposition au VIH et de la prophylaxie post-exposition
Kuhar DT; Henderson DK; Struble KA; Heneine W; Thomas V; Cheever LW; et al. Updated US public health
service guidelines for the management of occupational exposures to human immunodeficiency virus and
recommendations for postexposure prophylaxis. Infection control and hospital epidemiology 2013/09; 34(9):
875-892.
Mots-clés : RECOMMANDATION; EXPOSITION AU SANG; VIH
This report updates US Public Health Service recommendations for the management of healthcare personnel
(HCP) who experience occupational exposure to blood and/or other body fluids that might contain human
immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged,
recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV followup testing for
exposed personnel have been updated. This report emphasizes the importance of primary prevention
strategies, the prompt reporting and management of occupational exposures, adherence to recommended
HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, followup of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to
treatment, as well as for virologic, immunologic, and serologic signs of infection. To ensure timely
postexposure management and administration of HIV PEP, clinicians should consider occupational
exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of
both the importance of and the institutional mechanisms available for reporting and seeking care for such
exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational
exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible,
to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after
occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new
recommendation—PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in
Appendix A) for all occupational exposures to HIV; (5) expert consultation is recommended for any
occupational exposures to HIV and at a minimum for situations described in Box 1; (6) close follow-up for
20 / 26
NosoVeille – Bulletin de veille
Septembre 2013
exposed personnel (Box 2) should be provided that includes counseling, baseline and follow-up HIV testing,
and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and
(7) new recommendation—if a newer fourth-generation combination HIV p24 antigen–HIV antibody test is
utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure
(Box 2); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after
an HIV exposure.
NosoBase ID notice : 368578
Difficultés à évaluer l’impact du “Needlestick Safety and Prevention Act” (législation relative à la
prévention des piqûres et coupures) sur le nombre d’accidents d’exposition au sang à l’hôpital
Phillips EK; Conaway M; Parker G; Perry J; Jagger J. Issues in understanding the impact of the needlestick
safety and prevention act on hospital sharps injuries. Infection control and hospital epidemiology 2013/09;
34(9): 935-939.
Mots-clés : PREVENTION; EXPOSITION AU SANG; RISQUE; COUT; PIQURE; COUPURE; TAUX; ETUDE
PROSPECTIVE; PERSONNEL
Objective: Measuring the effect of the Needlestick Safety and Prevention Act (NSPA) is challenging. No
agreement exists on a common denominator for calculating injury rates. Does it make a difference? How are
the law and safety-engineered devices related? What is the effect on injuries and costs? This study examines
those issues in assessing the impact of the legislation on hospital worker percutaneous injuries.
Methods: Using a historic prospective design, we analyzed injury data from 85 hospitals. Injury rates were
calculated per 100 full-time equivalents, 100 staffed beds, and 100 admissions each year from 1995 to 2005.
We compared changes for each denominator. We measured the proportion of the injury rate attributed to
safety-engineered devices. Finally, we estimated a national change in injuries and associated costs.
Results: For all denominators, a precipitous drop in injury rates of greater than one-third (P<.001) occurred in
2001, immediately following the legislation. The decrease was sustained through 2005. Concomitant with the
decrease in rates, the proportion of injuries from safety-engineered devices nearly tripled (P<.001) across all
denominators. We estimated annual reductions of more than 100,000 sharps injuries at a cost savings of
$69–$415 million.
Conclusions: While the data cannot demonstrate cause and effect, the evidence suggests a reduction in
hospital worker injury rates related to the NSPA, regardless of denominator. It also suggests an association
between the increase in safety-engineered devices and the reduction in overall injury rates. The decreases
observed translate into significant reductions in injuries and associated costs.
Pneumonie
NosoBase ID notice : 369366
Performances des systèmes de cotation pronostique chez les patients avec une pneumonie
nosocomiale
Jeong BH; Koh WJ; Yoo H; Um SW; Suh GY; Chung MP; et al. Performances of prognostic scoring systems
in patients with healthcare-associated pneumonia. Clinical infectious diseases 2013/03/01; 56(5): 625-632.
Mots-clés : PNEUMONIE; SCORE; MORTALITE; ETUDE RETROSPECTIVE
Background: There are limited data on the performance of the pneumonia severity index (PSI) and CURB-65
(confusion, urea, respiratory rate, blood pressure, age ≥65) score, which were originally developed for
community-acquired pneumonia (CAP), for patients with healthcare-associated pneumonia (HCAP).
Methods: The performances of PSI and CURB-65 were retrospectively evaluated in patients with HCAP
compared to patients with CAP using prospectively collected data between January 2008 and December
2010.
Results: In total, 938 patients hospitalized with pneumonia were eligible for this study, consisting of 519 (55%)
with CAP and 419 (45%) with HCAP. The PSI and CURB-65 scores had similar trends of increasing mortality
with worsening risk class in both the HCAP and CAP groups. In the HCAP group, however, the low-risk
patients identified using CURB-65 had a higher aggregate 30-day mortality compared with the low-risk
patients identified using PSI. Although the performances of PSI and CURB-65 in the HCAP group showed
similar trends to those observed in the CAP group, the estimated areas under the receiver operating
characteristic curve for PSI (0.679, 95% confidence interval [CI], .619-.739) and CURB-65 (0.599, 95% CI,
21 / 26
NosoVeille – Bulletin de veille
Septembre 2013
.522-.675) in the HCAP group were significantly lower than those in the CAP group (0.835, 95% CI, .768-.759
for PSI and .686-.832 for CURB-65).
Conclusions: The performances of PSI and CURB-65 for predicting 30-day mortality in patients with HCAP
were comparable to those in patients with CAP. However, the discriminatory powers of PSI and CURB-65 for
30-day mortality were significantly lower in the HACP group than those in the CAP group.
NosoBase ID notice : 369235
Mortalité attribuable aux pneumonies acquises sous ventilation : méta-analyse d'études de
prévention randomisées
Melsen WG; Rovers MM; Groenwold R; Bergmans DC; Camus C; Bauer TT; et al. Attributable mortality of
ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention
studies. The Lancet infectious diseases 2013/08/01; 13(8): 665-671.
Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; MORTALITE;
RANDOMISEE; BIBLIOGRAPHIE; SCORE; FACTEUR DE RISQUE
SOIN
INTENSIF;
ETUDE
Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding
factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the
attributable mortality using the individual original patient data of published randomised trials of ventilatorassociated pneumonia prevention.
Methods: We identified relevant studies through systematic review. We analysed individual patient data in a
one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the
relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk
analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different
categories of severity of illness scores.
Findings: Individual patient data were available for 6284 patients from 24 trials. The overall attributable
mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores
at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute
physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and
patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients
from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated
pneumonia was 1·13 (95% CI 0·98-1·31). The overall daily risk of discharge after ventilator-associated
pneumonia was 0·74 (0·68-0·80), leading to an overall cumulative risk for dying in the ICU of 2·20 (1·912·54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical
patients (2·97, 95% CI 2·24-3·94) and patients with mid-range severity scores at admission (ie, cumulative
risks of 2·49 [1·81-3·44] for patients with APACHE scores of 20-29 and 2·72 [1·95-3·78] for those with SAPS
2 scores of 35-58).
Interpretation: The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates
for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly
caused by prolonged exposure to the risk of dying due to increased length of ICU stay.
Prévention
NosoBase ID notice : 369228
Prévenir les pratiques d'injection non sécurisées dans le système de santé américain
Centers for disease control and prevention (CDC). CDC grand rounds: preventing unsafe injection practices
in the U.S. health-care system. MMWR Morbidity and mortality weekly report 2013/05/31; 62(21): 423-425.
Mots-clés : INJECTION; PREVENTION; RECOMMANDATION; PRATIQUE
Injectable medicines commonly are used in health-care settings for the prevention, diagnosis, and treatment
of various illnesses. Examples include chemotherapy, intravenous antibiotics, vaccinations, and medications
used for sedation and anesthesia. Medical injections often are administered in conjunction with surgical
procedures, endoscopy, imaging studies, pain control, and cosmetic or complementary and alternative
medicine procedures. Safe manufacturing and pharmacy practices are essential because every injection must
begin with sterile medication. The appropriate medication must then be safely prepared (typically drawn up in
a syringe), then administered in a manner that maintains sterility and minimizes risk for infection. Safe
administration depends on adherence to the practices outlined in CDC's evidence-based Standard
Precautions guideline. Health-care providers should never 1) administer medications from the same syringe
22 / 26
NosoVeille – Bulletin de veille
Septembre 2013
to more than one patient, 2) enter a vial with a used syringe or needle, or 3) administer medications from
single-dose vials to multiple patients. They also should maintain aseptic technique at all times and properly
dispose of used injection equipment.
NosoBase ID notice : 368723
Lutte contre le risque infectieux dans un monde connecté : cas d'une approche régionale
Ciccolini M; Donker T; Köck R; Mielke M; Hendrix R; Jurke A; et al. Infection prevention in a connected world:
the case for a regional approach. International journal of medical microbiology 2013/08; 303(6-7): 380-387.
Mots-clés : PREVENTION; RESEAU; MICROBIOLOGIE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; STATISTIQUE; EPIDEMIOLOGIE; TRANSMISSION
Results from microbiological and epidemiological investigations, as well as mathematical modelling, show that
the transmission dynamics of nosocomial pathogens, especially of multiple antibiotic-resistant bacteria, is not
exclusively amenable to single-hospital infection prevention measures. Crucially, their extent of spread
depends on the structure of an underlying "healthcare network", as determined by inter-institutional referrals
of patients. The current trend towards centralized healthcare systems favours the spread of hospitalassociated pathogens, and must be addressed by coordinated regional or national approaches to infection
prevention in order to maintain patient safety. Here we review recent advances that support this hypothesis,
and propose a "next-generation" network-approach to hospital infection prevention and control.
Réglementation
NosoBase ID notice : 368569
Arrêté du 25 juillet 2013 relatif au modèle d'attestation délivrée par un organisme de développement
professionnel continu à un professionnel de santé justifiant de sa participation à un programme de
développement professionnel continu
Ministère des affaires sociales et de la santé. Arrêté du 25 juillet 2013 relatif au modèle d'attestation délivrée
par un organisme de développement professionnel continu à un professionnel de santé justifiant de sa
participation à un programme de développement professionnel continu. Journal officiel de la République
française Lois et décrets 2013/08/03; 179: 13261-13262.
Mots-clés : FORMATION CONTINUE; PROFESSION SANITAIRE; ORGANISME DE FORMATION
NosoBase ID notice : 368384
Instruction DGOS/PF2 n° 2013-298 du 12 juillet 2013 relative au Programme national pour la sécurité
des patients
Ministère des affaires sociales et de la santé. Instruction DGOS/PF2 n° 2013-298 du 12 juillet 2013 relative
au Programme national pour la sécurité des patients. Non paru au Journal officiel: 4 pages.
Mots-clés : GESTION DES RISQUES; SECURITE SANITAIRE; RECOMMANDATION; INFORMATION DU
MALADE; EVENEMENT INDESIRABLE; SIGNALEMENT; ESSAI CLINIQUE; QUALITE DES SOINS;
FORMATION CONTINUE; PERSONNEL HOSPITALIER; SANTE PUBLIQUE; POLITIQUE DE SANTE
Rougeole
NosoBase ID notice : 367292
Ré-émergence de la rougeole en Corée du Sud. Implications pour les programmes d’immunisation et
de surveillance
Park YJ; Eom HS; Kim ES; Choe YJ; Bae GR; Lee DH. Reemergence of measles in South Korea:
implications for immunization and surveillance programs. Japanese journal of infectious diseases 2013; 66(1):
6-10.
23 / 26
NosoVeille – Bulletin de veille
Septembre 2013
Mots-clés : SURVEILLANCE; ROUGEOLE; VIRUS; IMMUNITE; EPIDEMIE; TRANSMISSION; BIOLOGIE
MOLECULAIRE; VACCIN
Following the implementation of the national measles elimination program, the Republic of Korea declared in
2006 that measles had been eliminated. However in 2011, a measles outbreak was reported in Gyeongnam
Province in the southeastern part of the country. We conducted active case-based surveillance and analyzed
the data of cases reported in 2011 to identify the factors contributing to the reemergence of measles in this
province. Of 41 confirmed measles cases reported in Korea, 32 were from within the Gyeongnam Province.
Among cases identified in the outbreak, 97% had inadequate history of immunization, 28% were not
immunized at the recommended ages, and 22% were infants aged 6-11 months. The outbreak involved
transmission in 3 hospitals, 1 kindergarten, 1 day-care center, and 3 households. Molecular analysis of
measles virus isolates from 11 cases revealed the same D9 genotype, which was the first to be discovered in
Korea. In conclusion, inadequate immunization coverage, non-timely immunization, infants under 12 months
of age, nosocomial transmission, and international importation may play important roles in the reemergence
of measles in Korea during the attempted sustained elimination of the disease.
Staphylococcus aureus
NosoBase ID notice : 368458
Epidémiologie moléculaire des infections à Staphylococcus aureus méticillino-résistant dans une
unité pour des brûlés au Brésil
Rodrigues MVP; Fortaleza CM; Riboli DF; Rocha RS; Rocha C; Cunha M. Molecular epidemiology of
methicillin-resistant Staphylococcus aureus in a burn unit from Brazil. Burns 2013/09; 39(6): 1242-1249.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; EPIDEMIOLOGIE; BIOLOGIE
MOLECULAIRE; BRULE; FACTEUR DE RISQUE; TYPAGE; CAS-TEMOIN; SOIN INTENSIF
Methicillin-resistant Staphylococcus aureus (MRSA) poses a threat for patients in burn units. Studies that mix
epidemiological designs with molecular typing may contribute to the development of strategies for MRSA
control. We conducted a study including: molecular characterization of Staphylococcal Chromosome Cassette
mecA (SCCmec), strain typing with pulsed field gel electrophoresis (PFGE) and detection of virulence genes,
altogether with a case-case-control study that assessed risk factors for MRSA and for methicillin-susceptible
S. aureus (MSSA), using S. aureus negative patients as controls. Strains were collected from clinical and
surveillance cultures from October 2006 through March 2009. MRSA was isolated from 96 patients. Most
isolates (94.8%) harbored SCCmec type III. SCCmec type IV was identified in isolates from four patients. In
only one case it could be epidemiologically characterized as "community-associated". PFGE typing identified
36 coexisting MRSA clones. When compared to MSSA (38 isolates), MRSA isolates were more likely to
harbor two virulence genes: tst and lukPV. Previous stay in other hospital and admission to Intensive Care
Unit were independent risk factors for both MRSA and MSSA, while the number of burn wound excisions was
significantly related with the former (OR=6.80, 95%CI=3.54-13.07). In conclusion, our study found polyclonal
endemicity of MRSA in a burn unit, possibly related to importing of strains from other hospitals. Also, it
pointed out to a role of surgical procedures in the dissemination of MRSA strains.
Tatouage
NosoBase ID notice : 369469
Revue systématique des infections cutanées à mycobactéries à croissance rapide associées au
tatouage et enquête de santé publique sur des cas groupés en Ecosse, 2010
Conaglen P; Laurenson IF; Sergeant A; Thorn SN; Rayner A; Stevenson J. Systematic review of tattooassociated skin infection with rapidly growing mycobacteria and public health investigation of a cluster in
Scotland, 2010. Eurosurveillance 2013/08; 18(32): 1-13.
Mots-clés : INVESTIGATION; PEAU; INFECTION; MYCOBACTERIE; MYCOBACTERIUM CHELONAE;
CONTAMINATION; EAU; BIBLIOGRAPHIE
Sporadic cases and outbreaks of tattoo-associated skin infection with rapidly growing mycobacteria have
been reported although they often contain few details of public health investigations and have not previously
been systematically collated. We present the details of the public health investigation of a cluster of cases,
24 / 26
NosoVeille – Bulletin de veille
Septembre 2013
which occurred in Scotland in 2010. Investigation of the cluster involved case finding, environmental
investigation of the tattoo studio and pathological and microbiological investigation of possible cases and
tattoo ink. Mycobacterium chelonae was isolated from one case and three probable cases were identified. M.
chelonae was grown from an opened bottle of ink sourced from the studio these cases had attended. In
addition, in order to identify all published cases, we conducted a systematic review of all reported cases of
tattoo-associated skin infection with rapidly growing mycobacteria. A total of 25 reports were identified,
describing 71 confirmed and 71 probable cases. Mycobacteria were isolated in 71 cases and M. chelonae
was cultured from 48 of these. The most frequently postulated cause of infection was the dilution of black ink
with tap water. Reports of tattoo-associated rapidly growing mycobacterial skin infection are increasing in
frequency. Interested agencies must work with the tattoo industry to reduce the risk of contamination during
tattoo ink manufacture, distribution and application.
Ventilation
NosoBase notice : 368512
Décubitus ventral dans le syndrôme de détresse respiratoire aigue sévère
Guérin C; Reignier J; Richard JC; Beuret P; Gacouin A; Boulain T; et al. Prone positioning in severe acute
respiratory distress syndrome. The New England journal of medicine 2013/06/06; 368(23): 2159-2168.
Mots-clés : VENTILATION ASSISTEE; ETUDE PROSPECTIVE; MORTALITE; RANDOMISATION; SOIN
INTENSIF; DECUBITUS
Background: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have
failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We
evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS.
Methods: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients
with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine
position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of
inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory
pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The
primary outcome was the proportion of patients who died from any cause within 28 days after inclusion.
Results: A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the
supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001).
The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63).
Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with
a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly
between the groups, except for the incidence of cardiac arrests, which was higher in the supine group.
Conclusions: In patients with severe ARDS, early application of prolonged prone-positioning sessions
significantly decreased 28-day and 90-day mortality.
Virus West Nile
NosoBase ID notice : 368314
Virus West Nile en Europe : émergence, épidémiologie, diagnostic, traitement et prévention
Sambri V; Capobianchi M; Charrel R; Fyodorova M; Gaibani P; Gould E; et al. West Nile virus in Europe:
emergence, epidemiology, diagnosis, treatment, and prevention. Clinical microbiology and infection 2013/08;
19(8): 699-704.
Mots-clés : EPIDEMIOLOGIE; VIRUS; TRAITEMENT; PREVENTION; DIAGNOSTIC; BIBLIOGRAPHIE
West Nile virus (WNV), a mosquito-borne flavivirus in the Japanese encephalitis antigenic group, has caused
sporadic outbreaks in humans, horses and birds throughout many of the warmer regions of Europe for at
least 20 years. Occasional cases of West Nile encephalitis have also been associated with infected blood
transfusions and organ donations. Currently, WNV appears to be expanding its geographical range in Europe
and causing increasing numbers of epidemics/outbreaks associated with human morbidity and mortality. This
brief review reports on the current epidemic situation regarding WNV in Europe, highlighting the clinical,
diagnostic and preventive measures available for controlling this apparently emerging human pathogen.
25 / 26
NosoVeille – Bulletin de veille
Septembre 2013
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
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
26 / 26