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NosoVeille – Bulletin de veille
Octobre 2012
NosoVeille n°10
Octobre 2012
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.
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Abonnement / Désabonnement
Sommaire de ce numéro
Acinetobacter
Antibiorésistance
Aspergillus
Bactériémie
Chirurgie
Coqueluche
Environnement
Grippe
Hémodialyse
Hépatite B
Klebsiella pneumoniae
Législation
Maternité
Néonatologie
Norovirus
Personne âgée
Personnel
Pneumonie
Réanimation
Rotavirus
Rougeole
Staphylococcus aureus
Tuberculose
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NosoVeille – Bulletin de veille
Octobre 2012
Acinetobacter
NosoBase n° 35421
Réduction de la dissemination d’Acinetobacter baumannii et Staphylococcus aureus méticillinorésistant dans une unité pour brûlés à l’aide d’un bouquet d’interventions pour la lutte contre le
risque infectieux
Barbut F; Yezli S; Mimoun M; Pham J; Chaouat M; Otter JA. Reducing the spread of Acinetobacter baumannii
and methicillin-resistant Staphylococcus aureus on a burns unit through the intervention of an infection control
bundle. Burns 2012; in press: 9 pages.
Mots-clés : PREVENTION; BRULE; PROTOCOLE; ACINETOBACTER BAUMANNII; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; INCIDENCE; VAPEUR; PEROXYDE D’HYDROGENE;
DESINFECTANT; ENVIRONNEMENT; TEST
Methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii are major nosocomial
pathogens in burns units. We investigated the impact of an infection control bundle on the incidence of
nosocomial MRSA and A. baumannii in our burns unit, comparing a pre-intervention period (December 2006August 2008) with an intervention period (September 2008-December 2009). The bundle comprised regular
hydrogen peroxide vapour (HPV) disinfection of the rooms following discharge of patients colonized or
infected by multidrug-resistant bacteria, pre-emptive cohort isolation of newly admitted patients before being
proven culture negative, cohorting of colonized or infected patients, installation of two air disinfection systems
in the corridors of the unit and improvement of material storage. We also investigated the microbiological
efficacy of HPV disinfection by sampling the environment before and after HPV treatments. HPV disinfection
eliminated pathogens from the environment and significantly reduced total bacterial surface counts, and total
fungal air and surface counts, on both a unit and room scale. The incidence of nosocomial MRSA infection or
colonization fell by 89.3% from 7.22 to 0.77 cases/1000 patient days (p<0.0001) and A. baumannii fell by
88.8% from 6.92 to 0.77 cases/1000 patient days (p=0.002) in the intervention period with no further
outbreaks of these organisms occurring in this period. The infection control bundle resulted in a significant
reduction in the incidence of nosocomial MRSA and A. baumannii in our burns unit and prevented further
outbreaks of these organisms.
NosoBase n° 35369
Isolats de différentes espèces d'Acinetobacter provenant d'environnements divers : étude des
espèces et observations de l'antibiorésistance
Choi JY; Kim Y; Ko EA; Park YK; Jheong WH; Ko G; et al. Acinetobacter species isolates from a range of
environments: species survey and observations of antimicrobial resistance. Diagnostic microbiology and
infectious disease 2012/10; 74(2): 177-180.
Mots-clés : ACINETOBACTER; ENVIRONNEMENT; ANTIBIORESISTANCE; IMIPENEME; COLISTINE;
SURFACE
Acinetobacter species isolates from a range of environments, including soil, were investigated. We
determined 16S rRNA and rpoB gene sequences for species identification and performed tests of
antimicrobial resistance susceptibility. Twenty-nine of the isolates (8 from soil and 21 from life environment)
belonged to the genus Acinetobacter. Fourteen Acinetobacter species were identified among 29 isolates: 4 A.
baumannii, 3 A. calcoaceticus, 1 A. nosocomialis, 2 A. pittii, and 2 Acinetobacter gen. sp. 'close to 13TU' as
A. calcoaceticus-baumannii complex. Three Acinetobacter species isolates were identified as novel species
candidates. Three Acinetobacter species isolates were resistant to imipenem: 1 A. parvus and 2 novel
species candidates of Acinetobacter. Eight isolates showed resistance to colistin: all Acinetobacter gen. sp.
'close to 13TU' (2 isolates) and A. parvus isolates (3 isolates) were resistant to colistin. Although the
genotypes of A. baumannii isolates from various natural environments were different from those of clinical
isolates, the presence of clinically important and antimicrobial resistant Acinetobacter species in the natural
environment may represent a threat to public health.
NosoBase n° 35362
Facteurs de risque de mortalité et de résistance aux carbapénèmes des bactériémies à Acinetobacter
baumannii chez des enfants
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Octobre 2012
Punpanich W; Nithitamsakun N; Treeratweeraphong V; Suntarattiwong P. Risk factors for carbapenem nonsusceptibility and mortality in Acinetobacter baumannii bacteremia in children. International journal of
infectious diseases 2012; in press: 5 pages.
Mots-clés :
ACINETOBACTER
BAUMANNII ;
PEDIATRIE ;
FACTEUR
DE
RISQUE ;
ANTIBIORESISTANCE ; CARBAPENEME ; MORTALITE ; BACTERIEMIE ; ETUDE RETROSPECTIVE ;
CATHETER ; CANCER ; SOIN INTENSIF ; ANTIBIOTIQUE
Objective: To examine the risk factors of carbapenem non-susceptibility and mortality among children with
Acinetobacter baumannii bacteremia.
Methods: A retrospective chart review was conducted of 180 cases with A. baumannii bacteremia.
Results: The 30-day mortality risk of A. baumannii bacteremia was 26.1%. Carbapenem-non-susceptible A.
baumannii was identified in 51.7% of cases. Logistic regression analysis indicated that prematurity, use of
mechanical ventilation, and prior exposure to carbapenem antibiotics were independently associated with
carbapenem-non-susceptible A. baumannii bacteremia, with adjusted odds ratios (aORs) and 95%
confidence intervals (CIs) of 3.36 (1.17-9.65), 5.59 (2.24-13.97), and 2.97 (1.01-8.77), respectively. Further,
carbapenem non-susceptibility, cancer-related neutropenia, organ dysfunction, admission to the intensive
care unit, catheter-related bacteremia, and treatment with sulbactam-containing regimens were associated
with mortality with aORs and 95% CIs of 4.76 (1.58-14.32), 4.54 (1.09-18.79), 25.95 (5.13-131.33), 3.53
(1.29-9.71), 0.25 (0.084-0.72), and 0.14 (0.046-0.45), respectively.
Conclusions: The majority of A. baumannii bacteremia was caused by carbapenem-non-susceptible strains
with a high mortality rate. Carbapenem non-susceptibility, cancer-related neutropenia, the presence of organ
dysfunction, and admission to an intensive care unit were associated with an increased mortality risk,
whereas catheter-related bacteremia and treatment with a sulbactam-containing regimen were associated
with decreased mortality among children with A. baumannii bacteremia.
Antibiorésistance
NosoBase n° 35422
Facteurs de risque d'infection ou de colonisation à Escherichia coli positifs pour des bêta-lactamases
à spectre étendu de type CTX-M
Han JH; Kasahara K; Edelstein PH; Bilker WB; Lautenbach E. Risk factors for infection or colonization with
CTX-E extended-spectrum beta-lactamase (ESBL)-positive Escherichia coli. Antimicrobial agents and
chemotherapy 2012; in press: 26 pages.
Mots-clés : FACTEUR DE RISQUE; COLONISATION; ESCHERICHIA COLI; BETA-LACTAMASE A
SPECTRE ELARGI; PREVALENCE; CAS TEMOIN; ANTIBIORESISTANCE; ANALYSE MULTIVARIEE;
ANTIBIOTIQUE; PIPERACILLINE; TAZOBACTAM; FLUOROQUINOLONE
Background: There has been a significant increase in the prevalence of Enterobacteriaceae that produce
CTX-M-type extended-spectrum ß-lactamases. The objective of this study was to evaluate risk factors for
infection or colonization with CTX-M-positive Escherichia coli.
Methods: A case-control study was conducted within a university system from January 1, 2007 to December
31, 2008. All patients with clinical cultures with E. coli demonstrating resistance to extended-spectrum
cephalosporins were included. Case patients were designated as those with cultures positive for CTX-Mpositive E. coli, and control patients as those with non-CTX-M-producing E. coli. Multivariable logistic
regression analyses were performed to evaluate risk factors for CTX-M-positive isolates.
Results: 83 (56.8%) of a total of 146 patients had cultures with CTX-M-positive E. coli. On multivariable
analyses, there was a significant association between infection or colonization with CTX-M-type ß-lactamasepositive E. coli and receipt of piperacillin-tazobactam in the 30 days prior to the culture date (odds ratio [OR],
7.36; 95% confidence interval [CI], 1.61-33.8; P=0.01) and a urinary culture source (OR, 0.36; 95% CI, 0.170.77; P=0.008). Rates of resistance to fluoroquinolones was significantly higher in isolates from case as
opposed to control patients (90.4% and 50.8%, respectively; P<0.001).
Conclusions: We found that non-urinary sources of clinical cultures and the recent use of piperacillintazobactam conferred an increased risk of colonization or infection with CTX-M-positive E. coli. Future studies
will need to focus on outcomes associated with infections due to CTX-M-positive E. coli, as well as infection
control strategies to limit the spread of these increasingly common organisms.
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NosoBase n° 35284
Impact d'une préparation cutanée sans rinçage au gluconate de chlorhexidine sur la prévention des
infections associées aux soins et la colonisation par des microorganismes multirésistants aux
antibiotiques : revue systématique
Karki S; Cheng AC. Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of
healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. The
Journal of hospital infection 2012/10; 82(2): 71-84.
Mots-clés :
PREVENTION;
CHLORHEXIDINE;
COLONISATION;
ANTIBIORESISTANCE;
MULTIRESISTANCE; ANTISEPTIQUE; BIBLIOGRAPHIE; INCIDENCE; BACTERIEMIE; RISQUE;
CATHETER; SITE OPERATOIRE; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE;
ENTEROCOCCUS; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE
Background: The topical use of chlorhexidine gluconate (CHG) is intended to reduce bacterial density on
patients' skin.
Aim: To assess the impact of body bath or skin cleansing with CHG-impregnated or CHG-saturated
washcloths in preventing healthcare-associated infections and colonization.
Methods: This systematic review included published randomized controlled trials, cross-over trials, cohort
studies and before-and-after studies. Studies were included if they compared the use of CHG in washcloths
with any of the following; soap and water bathing, routine advice, no intervention.
Findings: Sixteen published studies and four conference abstracts were included for systematic review. Nine
studies reported the impact of CHG on incidence of central-line-associated bloodstream infection (CLABSI);
the incidence rate ratio (IRR) was 0.43 [95% confidence interval (CI): 0.26-0.71]. Five studies assessed the
impact of CHG washcloths on incidence of surgical site infection (SSI); the RR was 0.29 (95% CI: 0.17-0.49).
Four studies reported the impact on vancomycin-resistant enterococci (VRE) colonization; the IRR was 0.43
(95% CI: 0.32-0.59). Three studies reported the impact on meticillin-resistant Staphylococcus aureus (MRSA)
colonization rate; the IRR was 0.48 (95% CI: 0.24-0.95). Six studies reported the impact on VRE infection; the
IRR was 0.90 (95% CI: 0.42-1.93). Six studies reported the impact on MRSA infection; the IRR was 0.82
(95% CI: 0.51-1.30). There was no reduction in Acinetobacter infection rates in the three studies where this
was reported.
Conclusion: These results suggest that the use of non-rinse CHG application significantly reduces the risk of
CLABSI, SSI and colonization with VRE or MRSA, but not infection.
NosoBase n° 35285
Priorités pour la prévention et le contrôle des entérobactéries multirésistantes aux antibiotiques dans
les hôpitaux
Khan AS; Dancer SJ; Humphreys H. Priorities in the prevention and control of multidrug-resistant
Enterobacteriaceae in hospitals. The Journal of hospital infection 2012/10; 82(2): 85-93.
Mots-clés :
PREVENTION;
CONTROLE;
ENTEROBACTERIE;
ANTIBIORESISTANCE;
MULTIRESISTANCE; CARBAPENEME; ENVIRONNEMENT; DEPISTAGE; HYGIENE DES MAINS;
PRECAUTION STANDARD; PRECAUTION COMPLEMENTAIRE; BETA-LACTAMASE A SPECTRE
ELARGI; ANTIBIOTIQUE; BIBLIOGRAPHIE
Background: Multidrug-resistant Enterobacteriaceae (MDE) are a major public health threat due to
international spread and few options for treatment. Furthermore, unlike meticillin-resistant Staphylococcus
aureus (MRSA), MDE encompass several genera and multiple resistance mechanisms, including extendedspectrum beta-lactamases and carbapenemases, which complicate detection in the routine diagnostic
laboratory. Current measures to contain spread in many hospitals are somewhat ad hoc as there are no
formal national or international guidelines. AIM: We sought to establish what should be the priorities for the
prevention and control of MDE and what is feasible for implementation. We also identify areas for further
research.
Methods: We reviewed the published literature and other sources e.g. national agencies, for measures and
interventions used to control MDE.
Findings: Certain categories of at risk patients should be screened, especially in critical care areas, using
appropriate laboratory methods. Standard and contact precautions are essential and hand hygiene
compliance requires continued emphasis and high compliance levels. As MDE may persist on environmental
surfaces for weeks, environmental decontamination could also be an effective control intervention. There are
limited options for decolonisation with inadequate studies to date and antibiotic stewardship within and
outside the hospital remains important.
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Conclusion: As there is a clear deficit in the evidence base to infor guidance on prevention and control,
research in key areas, such as rapid detection, is urgently required.
NosoBase n° 35393
Emergence d'Acinetobacter baumannii complex ultra-résistants aux antibiotiques sur une période de
dix ans : résultats nationaux du programme TSAR de surveillance de l'antibiorésistance à Taiwan
Kuo SC; Chang SC; Wang HY; Lai HF; Chen PC; Shiau YR; et al. Emergence of extensively drug-resistant
Acinetobacter baumannii complex over 10 years: nationwide data from the Taiwan surveillance of
antimicrobial resistance (TSAR) program. BMC infectious diseases 2012/08/28; 12: 1-9.
Mots-clés : ANTIBIORESISTANCE; ACINETOBACTER BAUMANNII; SURVEILLANCE; IMIPENEME; CMI;
PREVALENCE
Background: Acinetobacter baumannii complex (ABC) has emerged as an important pathogen causing a
variety of infections. Longitudinal multicenter surveillance data on ABC from different sources in Taiwan have
not been published. Using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) conducted
biennially, we investigated the secular change in resistance of 1640 ABC from 2002 to 2010 (TSAR period III
to VII) to different antimicrobial agents and identified factors associated with imipenem-resistant and
extensively drug-resistant ABC (IRABC and XDRABC).
Methods: Isolates were collected by TSAR from the same 26 hospitals located in all 4 regions of Taiwan.
Minimum inhibitory concentrations (MIC) were determined by reference broth microdilution method. Isolates
nonsusceptible to all tested aminoglycosides, fluoroquinolones, beta-lactam, beta-lactam/beta-lactam
inhibitors, and carbapenems were defined as extensively drug-resistant (XDR). Multivariate logistic regression
analysis was performed to assess the relationship between predictor variables among patients with resistant
ABC and patients with non-resistant ABC.
Results: The prevalence of IRABC increased from 3.4% in 2002 to 58.7% in 2010 (P<0.001; odds ratio [OR],
2.138; 95% confidence interval [CI], 1.947 to 2.347) and that of XDRABC increased from 1.3% in 2002 to
41.0% in 2010 (P<0.001; OR, 1.970; 95% CI, 1.773-2.189). The rates of non-susceptibility to other
antimicrobial agents remained high (>55%) over the years with some fluctuations before and after TSAR V
(2006) on some agents. Multivariate analysis revealed that recovery from elderly patients, origins other than
blood, from ICU settings, or geographic regions are independent factors associated with IRABC and
XDRABC. Although the prevalence of XDRABC increased in all four regions of Taiwan over the years, central
Taiwan had higher prevalence of XDRABC starting in 2008. Susceptibility to polymyxin remained high
(97.7%) even for the XDRABC isolates.
Conclusions: This longitudinal multicenter surveillance program revealed significant increase and nationwide
emergence of IRABC and XDRABC in Taiwan over the years. This study also identified factors associated
with IRABC and XDRABC to help guide empirical therapy and at-risk groups requiring more intense
interventional infection control measures with focused surveillance efforts.
NosoBase n° 35361
Antibiorésistance et formation de biofilms de petites colonies de variants de Staphylococcus
epidermidis associées à des infections de prothèses articulaires
Maduka-Ezeh AN; Greenwood-Quaintance KE; Karau MJ; Berbari EF; Osmon DR; Hanssen AD; et al.
Antimicrobial susceptibility and biofilm formation of Staphylococcus epidermidis small colony variants
associated with prosthetic joint infection. Diagnostic microbiology and infectious disease 2012; in press: 6
pages.
Mots-clés : STAPHYLOCOCCUS EPIDERMIDIS; BIOFILM; STAPHYLOCOCCUS; ANTIBIORESISTANCE;
CHIRURGIE; CHIRURGIE ORTHOPEDIQUE; MATERIEL ETRANGER; PFGE
We determined the frequency of isolation of non-aureus staphylococcal small colony variants (SCVs) from 31
patients with staphylococcal prosthetic joint infection (PJI) and described the antimicrobial susceptibility,
auxotrophy, and biofilm-forming capacity of these SCVs. Eleven non-aureus SCVs were recovered, all of
which were Staphylococcus epidermidis, and none of which was auxotrophic for hemin, menadione, or
thymidine. Aminoglycoside resistance was detected in 5. Two were proficient, and 7 were poor, biofilm
formers. With passage on antimicrobial free media, we observed a fluctuating phenotype in 3 isolates. We
also noted a difference in antimicrobial susceptibility of different morphology isolates recovered from the
same joints despite similar pulsed-field gel electrophoresis patterns. Our findings suggest S. epidermidis
SCVs are common in PJI, and while they have a similar appearance to S. aureus SCVs, they do not
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NosoVeille – Bulletin de veille
Octobre 2012
necessarily share such characteristics as aminoglycoside resistance; auxotrophy for hemin, menadione, or
thymidine; or enhanced biofilm formation. We also underscore the importance of antimicrobial susceptibility
testing of all morphologies of isolates recovered from PJI.
NosoBase n° 35453
Vastes variations dans l'adoption du dépistage et dans les interventions de lutte contre le risque
infectieux pour les micro-organismes multirésistants aux antibiotiques : étude nationale
Pogorzelska M; Stone PW; Larson EL. Wide variation in adoption of screening and infection control
interventions for multidrug-resistant organisms: a national study. American journal of infection control
2012/10; 40(8): 696-700.
Mots-clés : DEPISTAGE; ANTIBIORESISTANCE; MULTIRESISTANCE; CONTROLE; SOIN INTENSIF;
STATISTIQUE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENTEROCOCCUS;
VANCOMYCINE; BACILLE GRAM NEGATIF; CLOSTRIDIUM DIFFICILE; PROTOCOLE; PREVENTION;
PRECAUTION COMPLEMENTAIRE
Background: We performed a survey of National Healthcare Safety Network hospitals in 2008 to describe
adoption of screening and infection control policies aimed at multidrug-resistant organisms (MDRO) in
intensive care units (ICUs) and identify predictors of their presence, monitoring, and implementation.
Methods: Four hundred forty-one infection control directors were surveyed using a modified Dillman
technique. To explore differences in screening and infection control policies by setting characteristics,
bivariate and multivariable logistic regression models were constructed.
Results: In total, 250 hospitals participated (57% response rate). Study ICUs (n ¼ 413) routinely screened for
methicillin-resistant Staphylococcus aureus (59%); vancomycin-resistant Enterococcus (22%); multidrugresistant, gram-negative rods (12%); and Clostridium difficile (11%). Directors reported ICU policies to screen
all admissions for any MDRO (40%), screen periodically (27%), utilize presumptive isolation/contact
precautions pending a screen (31%), and cohort colonized patients (42%). Several independent predictors of
the presence and implementation of different interventions including mandatory reporting and teaching status
were identified.
Conclusion: This study found wide variation in adoption of MDRO screening and infection control
interventions, which may reflect differences in published recommendations or their interpretation. Further
research is needed to provide additional insight on effective strategies and how best to promote compliance.
NosoBase n° 35351
Epidémie d'infections à Klebsiella pneumoniae productrices de carbapénèmase OXA-48 concernant
un clone ST11 en Grèce
Voulgari E; Zarkotou O; Ranellou K; Karageoropoulos DE; Vrioni G; Mamali V; et al. Outbreak of OXA-48
carbapenemase-producing Klebsiella pneumoniae in Greece involving an ST11 clone. The Journal of
antimicrobial chemotherapy 2012; in press: 5 pages.
Mots-clés : KLEBSIELLA PNEUMONIAE; EPIDEMIE; CARBAPENEME; ANTIBIORESISTANCE; PCR;
PFGE; BIOLOGIE MOLECULAIRE
Objectives: First detected in Enterobacteriaceae isolates in Turkey, the OXA-48 carbapenemase has
gradually disseminated in the wider Mediterranean area and Europe. Despite reports from other European
regions, until now no such isolates have been detected in Greece. We describe the characteristics of the first
outbreak caused by OXA-48-producing Klebsiella pneumoniae in Greece.
Methods: From December 2011 to March 2012, 13 ertapenem-resistant K. pneumoniae isolates, which were
positive by the modified Hodge test while remaining negative by phenotypic screening for metallo-ßlactamase (MBL) and KPC production, were recovered from nine patients. Patient records were retrieved to
access patterns of acquisition. Resistance genes were identified by PCR and sequencing. ompK35, ompK36
and the genetic environment of the bla(OXA-48) gene were investigated. Plasmid profiling, conjugation
experiments, PFGE and multilocus sequence typing (MLST) were performed.
Results: All isolates harboured the bla(OXA-48) gene along with the bla(CTX-M-15) and bla(OXA-1) genes.
The bla(OXA-48) gene was located on a self-transferable IncL/M-type plasmid of ~62 kb, which harboured no
other resistance genes. IS1999 was located upstream of the bla(OXA-48) gene. Genetic disruptions of the
ompK35 and ompK36 genes were not detected. The isolates belonged to a unique PFGE clone and MLST
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NosoVeille – Bulletin de veille
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assigned them to sequence type ST11. All cases were characterized as hospital acquired and none of them
was linked to immigration or history of travel in endemic areas.
Conclusions: Carbapenem resistance due to MBL and KPC carbapenemases is currently on an endemic
scale in Greece and this report highlights the wider undetected dissemination of yet another carbapenemase
in this region.
Aspergillus
NosoBase n° 35368
Sept ans de surveillance d'aspergilloses nosocomiales invasives dans un centre hospitalier
universitaire français
Garnaud C; Brenier-Pinchart MP; Thiebaut-Bertrand A; Hamidfar R; Quesada JL; Bosseray A; et al. Sevenyears surveillance of nosocomial invasive aspergillosis in a french university hospital. The Journal of infection
2012; in press: 9 pages.
Mots-clés : ASPERGILLUS; SURVEILLANCE; CENTRE HOSPITALIER UNIVERSITAIRE; EPIDEMIOLOGIE;
PREVENTION; EFFICACITE; ENVIRONNEMENT
Objectives: This study aims at describing the evolution of the epidemiology of invasive aspergillosis (IA) in a
French University Hospital focussing on nosocomial cases, in order to assess the efficiency of the
environmental preventive measures which were implemented.
Methods: From 2003 to 2009, IA cases were reviewed monthly and classified according to the EORTC/MSG
criteria and the origin of contamination.
Results: Five proven and 65 probable IA cases were diagnosed. Most of the cases (74.3%) occurred in
patients with haematological malignancies. Incidences of IA and nosocomial IA (NIA) were 0.106 and 0.032
cases per 1000 admissions, respectively. All the 21 NIA cases occurred in the absence of air treatment
(laminar air flow facilities or Plasmair® decontamination units) and/or during construction works. The 3-month
and 1-year overall survival rates were 50.6% [38.2e61.7] and 31.1% [20e42.9] respectively, and did not differ
according to the origin of contamination.
Conclusion: Nosocomial IA still accounted for a third of all IA cases diagnosed from 2003 to 2009 and mainly
occurred in the absence of environmental protective measures, which were confirmed to be effective when
applied. Our results show that extension and/or reinforcement of these measures is needed, especially in the
haematology unit and during construction works.
NosoBase n° 35408
Nouvelle catégorie d'aspergillose pulmonaire invasive probable chez des patients d'hématologie
Girmenia C; Guerrisi P; Frustaci AM; Fama A; Finolezzi E; Perrone S; et al. New category of probable
invasive pulmonary aspergillosis in haematological patients. Clinical microbiology and infection 2012/10;
18(10): 990-996.
Mots-clés : ASPERGILLUS; APPAREIL RESPIRATOIRE; HEMATOLOGIE; ETUDE RETROSPECTIVE;
COHORTE; RADIOLOGIE
The European Organization for Research and Treatment of Cancer and the Mycosis Study Group (EORTCMSG) radiological definitions of invasive pulmonary aspergillosis (IPA) may lack diagnostic sensitivity. We
evaluated applying less restrictive radiological criteria, when supported by specific microbiological findings, to
define IPA in acute myeloid leukaemia (AML), lymphoproliferative diseases (LD) and allogeneic stem cell
transplant (allo-SCT) patients. Overall, 109 consecutive episodes of proven/probable IPA in 56 AML, 31 LD
and 22 allo-SCT patients diagnosed from February 2006 through to January 2011 were considered. IPA was
diagnosed with EORTC-MSG criteria (control group, 76 patients) or without prespecified radiological criteria
(study group, 33 patients). The latter differed from the former by the inclusion of patients with pulmonary
infiltrates not fulfilling the three EORTC-MSG IPA specific findings of dense, well-circumscribed lesions with
or without halo sign, air crescent sign or cavity. All the analysed clinical and mycological characteristics, 3month response to antifungal therapy and 1- and 3-month cumulative survival were comparable in the control
and study groups in AML, LD and allo-SCT patients. Seventeen of 33 (51.5%) patients of the study group
fulfilled EORTC-MSG radiological criteria at subsequent imaging performed a median of 15 days (range, 6-40
days) after documentation of the pulmonary infection. Our study seems to confirm the possibility of revising
the EORTC-MSG criteria by extending the radiological suspicion of IPA to less specific chest computerized
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Octobre 2012
tomography scan findings when supported by microbiological evidence of Aspergillus infection in high-risk
haematological patients.
Bactériémie
NosoBase n° 34968
Diagnostic et surveillance des bactériémies sur voies centrales
Beekmann SE; Diekema DJ; Huskins WC; Herwaldt L; Boyce JM; Sherertz RJ; et al. Diagnosing and
reporting of central line-associated bloodstream infections. Infection control and hospital epidemiology
2012/09; 33(9): 875-882.
Mots-clés : DIAGNOSTIC; SURVEILLANCE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; ENQUETE ;
MEDECIN
Background: The diagnosis of central line-associated bloodstream infections (CLABSIs) is often controversial,
and existing guidelines differ in important ways.
Objective: To determine both the range of practices involved in obtaining blood culture samples and how
central line-associated infections are diagnosed and to obtain members' opinions regarding the process of
designating bloodstream infections as publicly reportable CLABSIs. DESIGN: Electronic and paper 11question survey of infectious-diseases physician members of the Infectious Diseases Society of America
Emerging Infections Network (IDSA EIN).
Participants: All 1,364 IDSA EIN members were invited to participate.
Results: 692 (51%) members responded; 52% of respondents with adult practices reported that more than
half of the blood culture samples for intensive care unit (ICU) patients with central lines were drawn through
existing lines. A sizable majority of respondents used time to positivity, differential time to positivity when
paired blood cultures are used, and quantitative culture of catheter tips when diagnosing CLABSI or
determining the source of that bacteremia. When determining whether a bacteremia met the reportable
CLABSI definition, a majority used a decision method that involved clinical judgment.
Conclusions: Our survey documents a strong preference for drawing 1 set of blood culture samples from a
peripheral line and 1 from the central line when evaluating fever in an ICU patient, as recommended by IDSA
guidelines and in contrast to current Centers for Disease Control and Prevention recommendations. Our data
show substantial variability when infectious-diseases physicians were asked to determine whether
bloodstream infections were primary bacteremias, and therefore subject to public reporting by National
Healthcare Safety Network guidelines, or secondary bacteremias, which are not reportable.
NosoBase n° 34966
Evolution de la définition de la surveillance des bactériémies sur voies centrales chez des patients
atteints de cancers hématologiques
Digiorgio MJ; Fatica C; Oden M; Bolwell B; Sekeres M; Kalaycio M; et al. Development of a modified
surveillance definition of central line-associated bloodstream infections for patients with hematologic
malignancies. Infection control and hospital epidemiology 2012/09; 33(9): 865-868.
Mots-clés : SURVEILLANCE; DEFINITION; BACTERIEMIE; CATHETER VEINEUX CENTRAL; DEFINITION;
ONCOLOGIE
Objective: To develop a modified surveillance definition of central line-associated bloodstream infection
(mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing
improvement efforts at our hospital.
Design: Retrospective cohort study.
Patients: Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow
transplant (BMT) unit and a 22-bed leukemia unit.
Methods: An mCLABSI definition was developed, and pathogens and rates were compared against those
determined using the National Healthcare Safety Network (NHSN) definition.
Results: By the NHSN definition the CLABSI rate on the BMT unit was 6.0 per 1,000 central line-days, and by
the mCLABSI definition the rate was 2.0 per 1,000 line-days ([Formula: see text]). On the leukemia unit, the
NHSN CLABSI rate was 14.4 per 1,000 line-days, and the mCLABSI rate was 8.2 per 1,000 line-days
([Formula: see text]). The top 3 CLABSI pathogens by the NHSN definition were Enterococcus species,
Klebsiella species, and Escherichia coli. The top 3 CLABSI pathogens by the mCLABSI definition were
coagulase-negative Staphylococcus (CONS), Pseudomonas aeruginosa, and Staphylococcus aureus. The
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difference in the incidence of CONS as a cause of CLABSI under the 2 definitions was statistically significant
([Formula: see text]).
Conclusions: A modified surveillance definition of CLABSI was associated with an increase in the
identification of staphylococci as the cause of CLABSIs, as opposed to enteric pathogens, and a decrease in
CLABSI rates.
NosoBase n° 35129
Prévention des bactériémies au cours de l'insertion des cathéters
Petree C; Wright DL; Sanders V; Killion JB. Reducing blood stream infections during catheter insertion.
Radiologic technology 2012/08; 83(6): 532-540.
Mots-clés : CATHETER; BACTERIEMIE; PREVENTION; PERSONNEL; FORMATION; RADIOLOGIE;
BIBLIOGRAPHIE; DISPOSITIF MEDICAL; MATERIEL DE SECURITE; ANTIBIOTIQUE; PRECAUTION
STANDARD; CHLORHEXIDINE; ANTISEPTIQUE
Background: Registered radiologist assistants (R.R.A.s) and other health care providers frequently are
responsible for placing peripherally inserted central catheter (PICC) lines. Postprocedure blood stream
infections are a potentially costly and medically serious complication.
Purpose: To determine the most effective methods for R.R.A.s and other health professionals to reduce blood
stream infections related to PICC line insertion and management.
Methods: Using specific inclusion criteria, the authors searched for scholarly reviewed articles related to PICC
lines, infection, and adulthood.
Results: The search produced 2237 articles, from which the authors selected 35 for review, in addition to 6
articles identified in the reference lists of articles not selected. The authors investigated 6 topics related to
infection control in PICCs among nonimmunocompromised adults: securement devices, staff education,
needleless systems, site preparation, maximum sterile barriers, and antimicrobial patches.
Conclusion: In the long run, proactive continuing education is less expensive than the cost of complications
caused by postprocedure infections. Although further research is needed, specific strategies reported in the
literature included prepping the skin using chlorhexidine and antimicrobial patches to reduce the
microorganisms in the area. These steps should be followed by maximum sterile barriers. Needleless
connectors and positive-pressure valves were found to be more effective than the alternatives, and proper
securement with self-adhesive anchoring devices was found to be more effective than suturing for reducing
blood stream infections.
NosoBase n° 34967
Surveillance des bactériémies sur voies centrales en dehors des soins intensifs : une étude
multicentrique
Son CH; Daniels TL; Eagan JA; Edmond MB; Fishman NO; Fraser TG; et al. Central line-associated
bloodstream infection surveillance outside the intensive care unit: a multicenter survey. Infection control and
hospital epidemiology 2012/09; 33(9): 869-874.
Mots-clés : SURVEILLANCE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; SOIN INTENSIF ; ETUDE
MULTICENTRIQUE
Objective: The success of central line-associated bloodstream infection (CLABSI) prevention programs in
intensive care units (ICUs) has led to the expansion of surveillance at many hospitals. We sought to compare
non-ICU CLABSI (nCLABSI) rates with national reports and describe methods of surveillance at several
participating US institutions.
Design and setting: An electronic survey of several medical centers about infection surveillance practices and
rate data for non-ICU patients.
Participants: Ten tertiary care hospitals.
Methods: In March 2011, a survey was sent to 10 medical centers. The survey consisted of 12 questions
regarding demographics and CLABSI surveillance methodology for non-ICU patients at each center.
Participants were also asked to provide available rate and device utilization data.
Results: Hospitals ranged in size from 238 to 1,400 total beds (median, 815). All hospitals reported using
Centers for Disease Control and Prevention (CDC) definitions. Denominators were collected by different
means: counting patients with central lines every day (5 hospitals), indirectly estimating on the basis of
electronic orders ([Formula: see text]), or another automated method ([Formula: see text]). Rates of nCLABSI
ranged from 0.2 to 4.2 infections per 1,000 catheter-days (median, 2.5). The national rate reported by the
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CDC using 2009 data from the National Healthcare Surveillance Network was 1.14 infections per 1,000
catheter-days.
Conclusions: Only 2 hospitals were below the pooled CLABSI rate for inpatient wards; all others exceeded
this rate. Possible explanations include differences in average central line utilization or hospital size in the
impact of certain clinical risk factors notably absent from the definition and in interpretation and reporting
practices. Further investigation is necessary to determine whether the national benchmarks are low or
whether the hospitals surveyed here represent a selection of outliers.
Chirurgie
NosoBase n° 35157
Infections du site opératoire avec chirurgie pour pontage coronarien : incidence, séjour hospitalier
périopératoire, réadmissions et chirurgies pour révisions
Cristofolini M; Worlitzsch D; Wienke A; Silber RE; Borneff-Lipp M. Surgical site infections after coronary artery
bypass graft surgery: incidence, perioperative hospital stay, readmissions, and revision surgeries. Infection
2012/08; 40(4): 397-404.
Mots-clés : SITE OPERATOIRE; CHIRURGIE CARDIO-VASCULAIRE; INCIDENCE; DUREE DE SEJOUR;
CHIRURGIE
Purpose: High-tech operations performed in cardiac surgery are associated with an increased risk of surgical
site infections. In this study, we investigated if surgical site infections following cardiac surgery influence
revision surgeries and patients' length of stay, and compared the results to German hospital infection
surveillance data.
Methods: Over a period of 3 years, 2,621 patients of a cardiac surgery unit were enrolled following cardiac
artery bypass graft surgery. Patients were examined for the incidence of surgical site infections, revision
surgeries, and length of stay. The results were compared to the National Reference Center (NRC) data
retrospectively.
Results: Of the observed population, 4.5% suffer from surgical site infections, and in 7.7% of the patients,
revision surgery had to be performed. The length of stay was exceeded significantly for the patients with
surgical site infections (average stay 14.5 vs. 42.2 days, p<0.001). Compared to the NRC data, severe
surgical site infections were not increased significantly.
Conclusion: Surgical site infections resulted in revision surgeries with a significantly increased inpatient stay.
However, this increase did not differ significantly from comparable German university hospitals.
NosoBase n° 35371
Etude prospective des infections ostéoarticulaires aigues dans une unité de chirurgie orthopédique
pédiatrique en France
Ferroni A; AL Khoury Salem H; Dana C; Quesnes G; Berche P; et al. Prospective survey of acute
osteoarticular infections in a french paediatric orthopedic surgery unit. Clinical microbiology and infection
2012; in press: 18 pages.
Mots-clés : ETUDE PROSPECTIVE; CHIRURGIE; CHIRURGIE ORTHOPEDIQUE; APPAREIL OSTEOARTICULAIRE; EPIDEMIOLOGIE; TRAITEMENT; ANTIBIOTIQUE; PCR; PEDIATRIE; MICROBIOLOGIE;
BACILLE GRAM NEGATIF; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS; DIAGNOSTIC
Epidemiology of acute paediatric osteo-articular infections (OAI) has recently evolved, mainly by improvement
of microbiological diagnosis. We conducted a prospective study to analyse the recent epidemiology and the
clinical evolution of paediatric OAI in order to validate the adequacy of our probabilistic first line antibiotic
treatment (intraveinous cefamandole + gentamicin). All children suspected of communautary OAI were
included and followed up during three years. The etiologic diagnosis was based on blood cultures, joint
aspirations and bone punctures. All osteo-articular (OA) samples were systematically inoculated into blood
culture bottles. Real-time universal 16S rRNA and PCR targeted on Staphylococcus aureus, Kingella kingae,
Streptococcus pneumoniae and Streptococcus pyogenes were performed twice a week. From 17/03/07 to
26/02/09, 98 septic arthritis, 70 osteomyelitis, 23 osteoarthritis and 6 spondylodiscitis were analysed. A portal
of entry was suspected in 44% of cases, including 55% of otothinolaryngological infections. C reactive protein
was the most sensitive inflammatory marker. PCR increased by 54% the performance of bacteriological
diagnosis. Among the patients completely investigated (blood culture and OAI samples), there were 63%
documented OAI. The main pathogens found were K. kingae (52%), S. aureus (28%), S. pyogenes (7%), S.
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pneumoniae (3%), and Streptococcus agalactiae (2%). All isolated bacteria were sensitive to the probabilist
treatment and outcome was favourable PCR has significantly improved the performance and the delay of IOA
diagnosis in children, for which K. kingae turned out to be the first causative agent. The probabilistic treatment
was active against the main bacteria responsible of paediatric OAI.
NosoBase n° 35162
L'obésité est un facteur de risque d'infection du site opératoire après gastrectomie distale pour
cancer gastrique
Hirao M; Tsujinaka T; Imamura H; Kurokawa Y; Inoue K; Kimura Y; et al. Overweight is a risk factor for
surgical site infection following distal gastrectomy for gastric cancer. Gastric cancer 2012; in press: 6 pages.
Mots-clés : FACTEUR DE RISQUE; SITE OPERATOIRE; CANCEROLOGIE; CHIRURGIE DIGESTIVE;
OBESITE; INCIDENCE; RANDOMISATION; ANALYSE MULTICENTRIQUE; ANTIBIOPROPHYLAXIE;
CHIRURGIE
Background: Our objective was to assess the risk factors for surgical site infections (SSIs) in gastric surgery
using the results of the Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) 0501 phase 3
trial.
Methods: The OGSG 0501 trial was conducted to compare standard prophylactic antibiotic administration
versus extended prophylactic antibiotic administration in 355 patients who underwent open distal gastrectomy
for gastric cancer. Various risk factors associated with the incidence of SSI following gastrectomy were
analyzed from the results of this multi-institutional randomized controlled trial.
Results: Among the 355 patients, there were 24 SSIs, for an overall SSI rate of 7%. Multivariate analysis
using eight baseline factors (administration of antibiotics, age, sex, body mass index [BMI], prognostic
nutritional index, tumor stage, lymph node dissection, reconstructive method) identified that BMI =25 kg/m(2)
was an independent risk factor for the occurrence of SSI (odds ratio 2.82; 95% confidence interval [CI] 1.057.52; P=.049). BMI also showed significant relationships with the volume of blood loss and the operation time
(P=0.001 and P<0.001, respectively).
Conclusion: Compared with patients of normal weight, overweight patients had a significantly higher risk of
SSI after distal gastrectomy for cancer.
NosoBase n° 35349
Prévention et contrôle des infections du site opératoire : revue de l'étude de cohorte de Bâle
Junker T; Mujagic E; Hoffmann H; Rosenthal R; Misteli H; Zwahlen M; et al. Prevention and control of surgical
site infections: review of the basel cohort study. Swiss medical weekly 2012/09/04; 142: 1-9.
Mots-clés : PREVENTION ; CONTROLE ; SITE OPERATOIRE ; COHORTE ; FACTEUR DE RISQUE ;
PREVENTION ; ETUDE PROSPECTIVE ; ANTIBIOPROPHYLAXIE ; COUT ; SURVEILLANCE ; GANT ;
STAPHYLOCOCCUS AUREUS ; EFFICACITE
Introduction: Surgical site infections (SSI) are the most common hospital-acquired infections among surgical
patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was
performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the
present article was to review the main results of this study and its implications for clinical practice and future
research.
Summary of methods of the basel SSI cohort study: The prospective observational cohort study included
6,283 consecutive general surgery procedures closely monitored for evidence of SSI up to 1 year after
surgery. The dataset was analysed for the influence of various potential SSI risk factors, including timing of
surgical antimicrobial prophylaxis (SAP), glove perforation, anaemia, transfusion and tutorial assistance,
using multiple logistic regression analyses. In addition, post hoc analyses were performed to assess the
economic burden of SSI, the efficiency of the clinical SSI surveillance system, and the spectrum of SSIcausing pathogens.
Review of main results of the Basel SSI cohort study: The overall SSI rate was 4.7% (293/6,283). While SAP
was administered in most patients between 44 and 0 minutes before surgical incision, the lowest risk of SSI
was recorded when the antibiotics were administered between 74 and 30 minutes before surgery. Glove
perforation in the absence of SAP increased the risk of SSI (OR 2.0; CI 1.4-2.8; p<0.001). No significant
association was found for anaemia, transfusion and tutorial assistance with the risk of SSI. The mean
additional hospital cost in the event of SSI was CHF 19,638 (95% CI, 8,492-30,784). The surgical staff
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documented only 49% of in-hospital SSI; the infection control team registered the remaining 51%.
Staphylococcus aureus was the most common SSI-causing pathogen (29% of all SSI with documented
microbiology). No case of an antimicrobial-resistant pathogen was identified in this series.
Conclusions: The Basel SSI Cohort Study suggested that SAP should be administered between 74 and 30
minutes before surgery. Due to the observational nature of these data, corroboration is planned in a
randomized controlled trial, which is supported by the Swiss National Science Foundation. Routine change of
gloves or double gloving is recommended in the absence of SAP. Anaemia, transfusion and tutorial
assistance do not increase the risk of SSI. The substantial economic burden of in-hospital SSI has been
confirmed. SSI surveillance by the surgical staff detected only half of all in-hospital SSI, which prompted the
introduction of an electronic SSI surveillance system at the University Hospital of Basel and the Cantonal
Hospital of Aarau. Due to the absence of multiresistant SSI-causing pathogens, the continuous use of singleshot single-drug SAP with cefuroxime (plus metronidazole in colorectal surgery) has been validated.
NosoBase n° 34971
Diminuer la contamination pathogène de l’environnement au bloc opératoire par l’amélioration des
pratiques du bionettoyage
Munoz-Price L; Birnbach DJ; Lubarsky DA; Arheart KL; Fajardo-Aquino Y; Rosalsky M; et al. Decreasing
operating room environmental pathogen contamination through improved cleaning practice; Infection control
and hospital epidemiology 2012/09; 33(9): 897-904.
Mots-clés : CONTAMINATION;
DESINFECTION
ENVIRONNEMENT;
BIONETTOYAGE;
BLOC
OPERATOIRE;
Objective: Potential transmission of organisms from the environment to patients is a concern, especially in
enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between
patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms
is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the
proportion of environmental surfaces within operating rooms from which pathogenic organisms were
recovered.
Design: Prospective environmental study using feedback with UV markers and environmental cultures.
Setting: A 1,500-bed county teaching hospital.
Participants: Environmental service personnel, hospital administration, and medical and nursing leadership
Results: The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95%
confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last
month of observations ([Formula: see text]). Nevertheless, the percentage of samples from which pathogenic
organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not
change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of
surfaces during the follow-up period ([Formula: see text]). However, the percentage of surfaces from which
gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period.
Conclusions: Feedback using Gram staining of environmental cultures and UV markers was successful at
improving the degree of cleaning in our operating rooms.
NosoBase n° 34970
Relation entre la concentration d’une préparation cutanée au gluconate de chlorhexidine et la densité
de la flore microbienne cutanée de patients en état critique dont la toilette quotidienne est faite au
gluconate de chlorhexidine
Popovich KJ; Lyles R; Hayes R; Hota B; Trick W; Weinstein RA; et al. Relationship between chlorhexidine
gluconate skin concentration and microbial density on the skin of critically ill patients bathed daily with
chlorhexidine gluconate. Infection control and hospital epidemiology 2012/09; 33(9): 889-896.
Mots-clés : CHLORHEXIDINE; TOILETTE; SOIN INTENSIF
Objective and design: Previous work has shown that daily skin cleansing with chlorhexidine gluconate (CHG)
is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative
indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of
patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG
bathing stopped.
Patients and setting: MICU patients at Rush University Medical Center.
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Methods: CHG concentration on skin was measured and skin sites were cultured quantitatively. The
relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model
using gram-positive colony-forming unit (CFU) counts.
Results: For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0-18.75 µg/mL)
and the highest gram-positive CFU counts were on the neck (median, 1.07 log(10) CFUs; [Formula: see
text]). CHG concentration increased postbath and decreased over 24 hours ([Formula: see text]). In parallel,
median log(10) CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline
of 0.78 ([Formula: see text]). A CHG concentration above 18.75 µg/mL was associated with decreased grampositive CFUs ([Formula: see text]). In all but 2 instances, CHG was detected on patient skin during the entire
interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU
discharge (80 measurements), CHG skin concentrations fell below effective levels after 1-3 days.
Conclusion: In MICU patients bathed daily with CHG, CHG concentration was inversely associated with
microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of
CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by
healthcare workers.
NosoBase n° 35439
Bain ou douche préopératoire à l’aide d’antiseptiques cutanés pour la prévention des infections du
site opératoire (Revue) 2012 – 4ème version
Webster J; Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site
infection (Review). Cochrane database of systematic reviews 2012/09; 9: 1-48.
Mots-clés : TOILETTE DU PATIENT; DOUCHE; ANTISEPTIQUE; PREVENTION; SITE OPERATOIRE;
CHIRURGIE
Background: Surgical site infections (SSIs) are wound infections that occur after invasive (surgical)
procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted
procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a
lower incidence of surgical site infection.
Objectives: To review the evidence for preoperative bathing or showering with antiseptics for preventing
hospital-acquired (nosocomial) surgical site infections.
Search methods: For this fourth update we searched the Cochrane Wounds Group Specialised Register
(searched 29 June 2012); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012
Issue 6); Ovid MEDLINE (2010 to June Week 3 2012), Ovid MEDLINE (In-Process & Other Non-Indexed
Citations June 27, 2012); Ovid EMBASE (2010 to 2012 Week 25), EBSCO CINAHL (1882 to 21 June 2012)
and reference lists of articles.
Selection criteria: Randomised controlled trials comparing any antiseptic preparation used for preoperative
full-body bathing or showering with non-antiseptic preparations in people undergoing surgery.
Data collection and analysis: Two review authors independently assessed studies for selection, risk of bias
and extracted data. Study authors were contacted for additional information.
Main results: We did not identify any new trials for inclusion in this fourth update. Seven trials involving a total
of 10,157 participants were included. Four of the included trials had three comparison groups. The antiseptic
used in all trials was 4% chlorhexidine gluconate (Hibiscrub/Riohex). Three trials involving 7791 participants
compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with placebo did not result in a
statistically significant reduction in SSIs; the relative risk of SSI (RR) was 0.91 (95% confidence interval (CI)
0.80 to 1.04). When only trials of high quality were included in this comparison, the RR of SSI was 0.95
(95%CI 0.82 to 1.10). Three trials of 1443 participants compared bar soap with chlorhexidine; when combined
there was no difference in the risk of SSIs (RR 1.02, 95% CI 0.57 to 1.84). Three trials of 1192 patients
compared bathing with chlorhexidine with no washing, one large study found a statistically significant
difference in favour of bathing with chlorhexidine (RR 0.36, 95%CI 0.17 to 0.79). The smaller studies found no
difference between patients who washed with chlorhexidine and those who did not wash preoperatively.
Authors' conclusions: This review provides no clear evidence of benefit for preoperative showering or bathing
with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence
of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.
Coqueluche
NosoBase n° 35386
Surveillance nationale de la coqueluche en Corée du Sud 1955-2011 - Tendances cliniques et
épidémiologiques
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Choe YJ; Park YJ; Jung C; Bae GR; Lee DH. National pertussis surveillance in South Korea 1955-2011:
epidemiological and clinical trends. International journal of infectious diseases 2012; in press: 5 pages.
Mots-clés : SURVEILLANCE; EPIDEMIOLOGIE; BORDETELLA PERTUSSIS; AGE
Background: Although there has been substantial progress in controlling pertussis in South Korea, the
reported number of pertussis case-patients has gradually been increasing during the last decade. To address
this, we summarized the surveillance data on pertussis collected during the period 1955-2011. Detailed
epidemiologic and clinical data were determined, primarily using data from recent years.
Methods: We analyzed data from the national surveillance system to describe the occurrence of pertussis.
The annual numbers of reported pertussis case-patients were identified for the period 1955-2000. For 20012009, information including limited demographic characteristics and the date of onset of symptoms were
identified. For 2010-2011, detailed epidemiologic and clinical information of reported pertussis case-patients
were collected.
Results: During 1955-2011, the secular trend was characterized by a gradual decrease in the reported
number of cases from 1955 to the late 1990s, then a recent increase starting in the early 2000s. In 2009, a
large number of reported cases occurred in infants <1 year of age. In 2011, an increase in reported cases
among adolescents and adults aged =15 years was observed. During 2010-2011, 29.8% of reported cases
were not immunized and 11.3% had not been immunized in a timely manner. Of adolescents and adults aged
=15 years, 91.7% did not have a record of immunization.
Conclusions: During 2010-2011, a shift in age group was observed in pertussis case-patients: 33.8% were
young infants <3 months of age and 29.0% were adolescents and adults =15 years of age. Considering that
infants without timely vaccination may be vulnerable to an increased risk of pertussis infection, steps to
provide timely vaccination to infants, to provide Tdap vaccination to adolescents and adults, and to enhance
surveillance to capture adult pertussis cases should be taken in South Korea.
Environnement
NosoBase n° 34979
Aérocontamination de l’environnement des patients colonisés par des bactéries multirésistantes
Bernard MC; Lanotte P; Lawrence C; Goudeau A; Bernard L. Air contamination around patients colonized
with multidrug-resistant organisms. Infection control and hospital epidemiology 2012/09; 33(9): 949-951.
Mots-clés : AIR; CONTAMINATION; COLONISATION; MULTIRESISTANCE
Care-related infections are a major public health concern. Their transmission can be associated with
environmental factors. This study looks at air contamination around 45 patients colonized with multidrugresistant organisms (MDROs). We found that 30 hospital rooms (67%) were contaminated with MDRO
species and 10 rooms (22%) were contaminated with at least 1 MDRO.
NosoBase n° 35120
Epidémies d'infections à Pseudomonas aeruginosa multi-résistant aux antibiotiques dans deux
hôpitaux : association à des réseaux d'eaux usées hospitalières contaminés
Breathnach AS; Cubbon MD; Karunaharan RN; Pope CF; Planche TD. Multidrug-resistant Pseudomonas
aeruginosa outbreaks in two hospitals: association with contaminated hospital-waste-water systems. The
Journal of hospital infection 2012/09; 82(1): 19-24.
Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; PSEUDOMONAS AERUGINOSA; EPIDEMIE;
DECHET; CONTAMINATION; EAU; EPIDEMIOLOGIE; MICROBIOLOGIE; ENVIRONNEMENT; TYPAGE;
SANITAIRE; NETTOYAGE; PROTOCOLE; EAU USEE
Background: Multidrug-resistant Pseudomonas aeruginosa (MDR-P) expressing VIM-metallo-beta-lactamase
is an emerging infection control problem. The source of many such infections is unclear, though there are
reports of hospital outbreaks of P. aeruginosa related to environmental contamination, including tap water.
Aim: We describe two outbreaks of MDR-P, sensitive only to colistin, in order to highlight the potential for
hospital waste-water systems to harbour this organism.
Methods: The outbreaks were investigated by a combination of descriptive epidemiology, inspection and
microbiological sampling of the environment, and molecular strain typing.
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Findings: The outbreaks occurred in two English hospitals; each involved a distinct genotype of MDR-P. One
outbreak was hospital-wide, involving 85 patients, and the other was limited to four cases in one specialized
medical unit. Extensive environmental sampling in each outbreak yielded MDR-P only from the waste-water
systems. Inspection of the environment and estates records revealed many factors that may have contributed
to contamination of clinical areas, including faulty sink, shower and toilet design, clean items stored near
sluices, and frequent blockages and leaks from waste pipes. Blockages were due to paper towels, patient
wipes, or improper use of bedpan macerators. Control measures included replacing sinks and toilets with
easier-to-clean models less prone to splashback, educating staff to reduce blockages and inappropriate
storage, reviewing cleaning protocols, and reducing shower flow rates to reduce flooding. These measures
were followed by significant reductions in cases.
Conclusion: The outbreaks highlight the potential of hospital waste systems to act as a reservoir of MDR-P
and other nosocomial pathogens.
NosoBase n° 35440
Les animaux de compagnie et les voyages sont des facteurs de risque de colonisation à Escherichia
coli producteurs de bêta-lactamases à spectre étendu
Meyer E; Gastmeier P; Kola A; Schwab F. Pet animals and foreign travel are risk factors for colonisation with
extended-spectrum beta-lactamase-producing Escherichia coli. Infection 2012; in press: 3 pages.
Mots-clés : ESCHERICHIA COLI; ANIMAL; COLONISATION; FACTEUR DE RISQUE; BETA-LACTAMASE A
SPECTRE ELARGI; PREVALENCE; COLONISATION; ANTIBIORESISTANCE; ENTEROCOCCUS;
INFECTION COMMUNAUTAIRE
Objective: The purpose of this study was to determine the prevalence of extended-spectrum ß-lactamase
(ESBL) and vancomycin-resistant enterococci (VRE) colonisation among healthy infection control personnel
and to determine risk factors for ESBL or VRE colonisation within this group.
Methods: Participants were recruited at an infection control symposium in 2011. Volunteers were asked to
perform a rectal swab and to fill in questionnaires on risk factors of ESBL or VRE carriage (report on diet,
contact with domestic or production animals, travel, hospital stay and antibiotic use all within the last 12
months). Rectal swabs were inoculated onto ESBL and VRE chromogenic agar; species identification and
susceptibility testing was done by using a VITEK 2 system. In the multivariable analysis, a logistic regression
with stepwise forward variable selection was performed.
Results: Two hundred and thirty people participated in the study, i.e. 36% of the symposium attendees
(231/639). No VRE faecium or faecalis were isolated, whereas ESBL were isolated from 8 out of 231
individuals, i.e. 3.5% (95% confidence interval 1.5-6.7). In the multivariable analysis, travel to Greece or
Africa and contact with pets were independently associated with ESBL positivity. The odds ratios were as
follows: travel to Greece 15.2, travel to Africa 14.8 and for having a pet animal 6.7.
Conclusion: This is the first report showing that contact with pets increases by almost seven-fold the chance
to be colonised with ESBL Escherichia coli. A colonisation rate of 3.5% with ESBL-producing
enterobacteriaceae among infection control personnel is of concern and reflects probably less an
occupational health risk but the reservoir of and the expansion into the community, especially in persons with
pet animals and travel history to high-endemicity countries.
NosoBase n° 35124
Contamination microbienne de lingettes de nettoyage en intissé imprégnées de désinfectant
Oie S; Arakawa J; Furukawa H; Matsumoto S; Matsuda N; Wakamatsu H. Microbial contamination of a
disinfectant-soaked unwoven cleaning cloth. The Journal of hospital infection 2012/09; 82(1): 61-63.
Mots-clés : CONTAMINATION; DESINFECTANT; ENQUETE; PNEUMONIE; BURKHOLDERIA CEPACIA;
SOIN INTENSIF; CENTRE HOSPITALIER UNIVERSITAIRE; ENVIRONNEMENT; NETTOYAGE;
PSEUDOMONAS; PSEUDOMONAS AERUGINOSA; BIOLOGIE MOLECULAIRE; PFGE; EAU POTABLE;
BACILLE GRAM NEGATIF; BACILLE GRAM POSITIF; BACILLUS
In December 2009, a 76-year-old male patient developed pneumonia due to Burkholderia cepacia whilst in an
intensive care unit at a Japanese university hospital. During the subsequent environmental investigation to
find the source, B. cepacia with an identical DNA type was found in his denture storage solution. Open
packets of unwoven rayon cloths soaked in 0.2% alkyldiaminoethylglycine hydrochloride, used for
environmental cleaning, were shown to be contaminated with B. cepacia, Alcaligenes xylosoxidans,
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Octobre 2012
Pseudomonas fluorescens and Pseudomonas aeruginosa. B. cepacia of a different DNA type was found in
five of 42 samples from sealed packets of cloths.
NosoBase n° 35161
La finition antibactérienne réduit la contamination des textiles hospitaliers : étude expérimentale
Romano CL; Romano D; De Vecchi E; Logoluso N; Drago L. Antibacterial finishing reduces hospital textiles
contamination: an experimental study. European journal of clinical microbiology and infectious disease 2012;
in press: 6 pages.
Mots-clés : LINGE; TENUE VESTIMENTAIRE; PREVENTION; NORME; EFFICACITE; TEST; BLOC
OPERATOIRE; CONTAMINATION; BACTERICIDIE; BLOUSE
Introduction and methods: Contaminated dressings are particularly suitable for growth of microorganisms and
a wellknown source of bacterial spreading in the hospital environment. This study evaluates the bacterial
contamination of white coats and surgical gowns and drapes treated with a novel antibacterial finishing
technology of hospital textiles. Bacterial contamination rates of untreated white coats and surgical gowns and
drapes were compared to treated textiles. In vitro determination of antibacterial activity against reference
bacterial strains and clinical isolates was performed according to the European guideline EN ISO 20645.
Efficacy of the treatment was verified in clinical setting by comparing the amount of bacteria isolated from
treated and untreated textiles used for clinical and surgical activities.
Result and conclusion: Treated textiles demonstrated in vitro activity against most of the tested
microorganisms with the exception of Pseudomonas aeruginosa. Bacterial contamination was markedly lower
for treated white coats after 1 week of use and for surgical gowns and textiles at the end of surgery when
compared to untreated dressings and textiles used in the same conditions. The tested treatment proved to be
able to reduce bacterial contamination of hospital textiles both in vitro and in the clinical and surgical settings.
Grippe
NosoBase n° 34735
Prévention et contrôle de la grippe par la vaccination : recommandations de l'Advisory Comittee on
Immunization Practices (ACIP) - Etats-Unis, grippe saisonnière 2012-13
Centers for disease control and prevention (CDC). Prevention and control of influenza with vaccines:
recommendations of the advisory committee on immunization practices (ACIP) - United States, 2012-13
influenza season. MMWR Morbidity and mortality weekly report 2012/08/17; 61(32): 613-618.
Mots-clés : GRIPPE; VACCIN; PREVENTION; RECOMMANDATION; AGE
In 2010, the Advisory Committee on Immunization Practices (ACIP) first recommended annual influenza
vaccination for all persons aged ≥6 months in the United States. Annual influenza vaccination of all persons
aged ≥6 months continues to be recommended. This document 1) describes influenza vaccine virus strains
included in the U.S. seasonal influenza vaccine for 2012-13; 2) provides guidance for the use of influenza
vaccines during the 2012-13 season, including an updated vaccination schedule for children aged 6 months
through 8 years and a description of available vaccine products and indications; 3) discusses febrile seizures
associated with administration of influenza and 13-valent pneumococcal conjugate (PCV-13) vaccines; 4)
provides vaccination recommendations for persons with a history of egg allergy; and 5) discusses the
development of quadrivalent influenza vaccines for use in future influenza seasons. Information regarding
issues related to influenza vaccination that are not addressed in this update is available in CDC's Prevention
and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization
Practices (ACIP), 2010 and associated updates.
NosoBase n° 35441
Recommandations pour la prévention et le contrôle de la grippe chez les enfants, 2012-2013
Committee on infectious diseases. Recommendations for prevention and control of influenza in children,
2012-2013. Pediatrics 2012/10; 130(4): 780-792.
Mots-clés : PREVENTION; RECOMMANDATION;
TRAITEMENT; SURVEILLANCE
GRIPPE;
PEDIATRIE;
VACCIN;
ANTIVIRAL;
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The purpose of this statement is to update recommendations for routine use of trivalent seasonal influenza
vaccine and antiviral medications for the prevention and treatment of influenza in children. The key points for
the upcoming 2012-2013 season are: (1) this year's trivalent influenza vaccine contains A/California/7/2009
(H1N1)-like antigen (derived from influenza A [H1N1] pdm09 [pH1N1] virus); A/Victoria/361/2011 (H3N2)-like
antigen; and B/Wisconsin/1/2010-like antigen (the influenza A [H3N2] and B antigens differ from those
contained in the 2010-2011 and 2011-2012 seasonal vaccines); (2) annual universal influenza immunization
is indicated; and (3) an updated dosing algorithm for administration of influenza vaccine to children 6 months
through 8 years of age has been created. Pediatricians, nurses, and all health care personnel should promote
influenza vaccine use and infection control measures. In addition, pediatricians should promptly identify
influenza infections to enable rapid treatment, when indicated, to reduce morbidity and mortality
NosoBase n° 35373
Vaccination contre la grippe H1N1 et contre la grippe saisonnière du personnel de santé des EtatsUnis en 2010
Lu PJ; Ding H; Black CL. H1N1 and seasonal influenza vaccination of U.S. healthcare personnel, 2010.
American journal of preventive medicine 2012/09; 43(3): 282-292.
Mots-clés : VACCIN; GRIPPE; VIRUS INFLUENZA TYPE A; PERSONNEL; ATTITUDE; TRAVAIL;
OBSERVANCE
Background: Seasonal influenza vaccination routinely has been recommended for healthcare personnel
(HCP) since 1984. The influenza A (H1N1) 2009 monovalent vaccine (H1N1 vaccine) became available in the
U.S. in October 2009. PURPOSE: To assess 2009 H1N1 and seasonal influenza vaccination coverage and
identify factors independently associated with vaccination among HCP in the U.S.
Methods: Data from the 2009-2010 Behavioral Risk Factor Surveillance System (BRFSS) influenza
supplemental survey were analyzed in 2011. Multivariable logistic regression and predictive marginal models
were performed to identify factors independently associated with vaccination among HCP. The Kaplan-Meier
survival analysis procedure was used to estimate the cumulative proportion of people vaccinated.
Results: Among 16,975 HCP surveyed, 2009 H1N1, seasonal, and any-dose vaccination coverage were
34.1% (95% CI=32.7%, 35.5%); 52.4% (95% CI=50.9%, 53.9%); and 58.0% (95% CI=56.5%, 59.5%),
respectively, all of which were significantly higher than those for non-HCP (19.1%, 34.9%, and 40.3%,
respectively). The H1N1 vaccination coverage among HCP ranged from 18.4% in Mississippi to 56.1% in
Massachusetts and seasonal influenza vaccination coverage ranged from 40.4% in Florida to 73.1% in
Nebraska. Characteristics independently associated with an increased likelihood of 2009 H1N1, seasonal,
and any-dose vaccinations among HCP were as follows: non-Hispanic white, higher income, having a highrisk condition, having health insurance, the ability to see a doctor if needed, and having had a routine
checkup in the previous year.
Conclusions: Vaccination coverage was higher among HCP than non-HCP but still below the national health
objective of 90%. Knowledge of national and state-specific H1N1 and seasonal vaccination coverage among
HCP is useful for evaluating the vaccination campaign and implementing strategies for increasing yearly
seasonal vaccination coverage and improving vaccination coverage among HCP in possible future
pandemics.
NosoBase n° 35409
Facteurs associés à une observance continue de la vaccination contre la grippe chez les personnes
âgées
Martinez-Baz I; Aguilar I; Moran J; Albeniz E; Aldaz P; Casilla J. Factors associated with continued
adherence to influenza vaccination in the elderly. Preventive medicine 2012/09; 55(3): 246-250.
Mots-clés : VACCIN;
COMMUNAUTAIRE
GRIPPE;
PERSONNE
AGEE;
OBSERVANCE;
MEDECIN;
INFECTION
Objective: We aimed to analyze the factors influencing continued adherence to influenza vaccination in
elderly persons vaccinated in the preceding season.
Methods: Using a population-based vaccination registry, we evaluated the proportion of persons vaccinated
against influenza in Navarre, Spain, in the 2010-11 season among non-institutionalized persons aged
65years or over who had been vaccinated in the 2009-10 season. Logistic regression was used to analyze
the influence of sociodemographic, clinical and health care factors.
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Results: Of the 64,245 persons vaccinated against influenza in the 2009-10 season, 87% were vaccinated in
the 2010-11 season. Continued adherence to vaccination increased with the number of physician visits per
year. It was lower in women, in the 65-69 and =95year age-groups, in those hospitalized or diagnosed with
any major chronic condition in the previous year, and in persons with hematological cancer or dementia.
Health districts and physicians with higher coverage in the previous season continued to have higher
adherence in the following season.
Conclusions: People vaccinated against influenza in one season tend to be vaccinated in the following one.
Sociodemographic, clinical and health care factors have a moderate effect on the continuity of vaccination,
with the most important factor being the treating physician.
NosoBase n° 34978
Etude qualitative de la performance de la mesure des taux de vaccination anti-grippale rapportés
parmi le personnel soignant
MacCannell T; Shugart A; Schneider AK; Lindley MC; Lorick SA; Rao A; et al. A qualitative assessment of a
performance measure for reporting infuenza vaccination rates among healthcare personnel. Infection control
and hospital epidemiology 2012/09; 33(9): 945-948.
Mots-clés : VACCIN; PERSONNEL; GRIPPE
To understand the feasibility of implementing a standardized performance measure for collecting and
reporting influenza vaccination rates among healthcare personnel, qualitative, semistructured interviews were
conducted with key informants in 32 healthcare facilities. Despite practical and logistical challenges to
implementing the measure, respondents perceived clear benefits to its use.
NosoBase n° 34975
Comprendre le refus de vaccination anti-grippale du personnel soignant par des approches
innovantes pour élaborer les stratégies d’une nouvelle campagne
Schult TM; Awosika ER; Hodgson MJ; Hirsch PR; Nichol KL; Dyrenforth SR; et al. Innovative approaches for
understanding seasonal influenza vaccine declination in healthcare personnel support development of new
campaign strategies. Infection control and hospital epidemiology 2012/09; 33(9): 924-931.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; OBSERVANCE; ENQUETE
Objective: The main objectives of our study were to explore reasons for seasonal influenza vaccine
acceptance and declination in employees of a large integrated healthcare system and to identify underlying
constructs that influence acceptance versus declination. Secondary objectives were to determine whether
vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability.
Design: A national health promotion survey of employees was conducted that included items on vaccination
in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a
stratified fashion: approximately 40% of participating employees were randomly assigned to complete the
health promotion survey.
Setting: National single-payer healthcare system with 152 hospitals.
Participants: Employees of the healthcare system in 2010 who responded to the survey.
Methods: Factor analysis was used to identify underlying constructs that influenced vaccine acceptance
versus declination. Mean factor scores were examined in relation to demographic characteristics and
occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied
by location and to identify facility-level measures that explained variability. Results. Four factors were
identified related to vaccine declination and were labeled as (1) "don't care," (2) "don't want," (3) "don't
believe," and (4) "don't know." Significant differences in mean factor scores existed by demographic
characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous
year were an important facility-level predictor.
Conclusions: Results should guide interventions that tailor messages on the basis of particular reasons for
declination. Occupation-specific and culturally appropriate messaging should be considered. Continued
efforts will be taken to better understand how workplace context influences vaccine acceptance.
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Octobre 2012
Hémodialyse
NosoBase n° 34977
Prévention des bactériémies sur voies centrales chez des patients en hémodialyse
Boyce JM. Prevention of central line-associated bloodstream infections in hemodialysis patients. Infection
control and hospital epidemiology 2012/09; 33(9): 936-944.
Mots-clés : PREVENTION; HEMODIALYSE
An increasing proportion of central line-associated bloodstream infections (CLABSIs) are seen in outpatient
settings. Many of such infections are due to hemodialysis catheters (HD-CLABSIs). Such infections are
associated with substantial morbidity, mortality, and excess healthcare costs. Patients who receive dialysis
through a catheter are 2-3 times more likely to be hospitalized for infection and to die of septic complications
than dialysis patients with grafts or fistulas. Prevention measures include minimizing the use of hemodialysis
catheters, use of CLABSI prevention bundles for line insertion and maintenance, and application of
antimicrobial ointment to the catheter exit site. Instillation into dialysis catheters of antimicrobial solutions that
remain in the catheter lumen between dialyses (antimicrobial lock solutions) has been studied, but it is not yet
standard practice in some dialysis units. At least 34 studies have evaluated the impact of antimicrobial lock
solutions on HD-CLABSI rates. Thirty-two (94%) of the 34 studies demonstrated reductions in HD-CLABSI
rates among patients treated with antimicrobial lock solutions. Recent multicenter randomized controlled trials
demonstrated that the use of such solutions resulted in significantly lower HD-CLABSI rates, even though
such rates were low in control groups. The available evidence supports more routine use of antimicrobial lock
solutions as an HD-CLABSI prevention measure in hemodialysis units.
NosoBase n° 35141
Association entre des cathéters centraux à insertion périphérique (PICC) antérieurs et une absence
de fonctionnement des fistules artérioveineuses – Etude cas-témoin chez des patients hémodialysés
El Ters M; Schears GJ; Taler SJ; Williams AW; Albright RC; Jenson BM; et al. Association between prior
peripherally inserted central catheters and lack of functioning arteriovenous fistulas: a case-control study in
hemodialysis patients. American journal of kidney diseases 2012/10; 60(4): 601-608.
Mots-clés : CATHETER; HEMODIALYSE; CAS TEMOIN; ETUDE RETROSPECTIVE
Background: Although an arteriovenous fistula (AVF) is the hemodialysis access of choice, its prevalence
continues to be lower than recommended in the United States. We assessed the association between past
peripherally inserted central catheters (PICCs) and lack of functioning AVFs.
Study design: Case-control study.
Participants & setting: Prevalent hemodialysis population in 7 Mayo Clinic outpatient hemodialysis units.
Cases were without functioning AVFs and controls were with functioning AVFs on January 31, 2011.
Predictors: History of PICCs.
Outcomes: Lack of functioning AVFs.
Results: On January 31, 2011, a total of 425 patients were receiving maintenance hemodialysis, of whom 282
were included in this study. Of these, 120 (42.5%; cases) were dialyzing through a tunneled dialysis catheter
or synthetic arteriovenous graft and 162 (57.5%; controls) had a functioning AVF. PICC use was evaluated in
both groups and identified in 30% of hemodialysis patients, with 54% of these placed after dialysis therapy
initiation. Cases were more likely to be women (52.5% vs 33.3% in the control group; P=0.001), with smaller
mean vein (4.9 vs 5.8 mm; P<0.001) and artery diameters (4.6 vs 4.9 mm; P=0.01) than controls. A PICC was
identified in 53 (44.2%) cases, but only 32 (19.7%) controls (P<0.001). We found a strong and independent
association between PICC use and lack of a functioning AVF (OR, 3.2; 95% CI, 1.9-5.5; P<0.001). This
association persisted after adjustment for confounders, including upper-extremity vein and artery diameters,
sex, and history of central venous catheter (OR, 2.8; 95% CI, 1.5-5.5; P=0.002).
Limitations: Retrospective study, participants mostly white.
Conclusion: PICCs are commonly placed in patients with end-stage renal disease and are a strong
independent risk factor for lack of functioning AVFs.
NosoBase n° 35165
Infections liées aux cathéters en hémodialyse chronique : vision clinique et économique
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Stefan G; Stancu S; Capusa C; Ailioaie OR; Mircescu G. Catheter-related infections in chronic hemodialysis:
a clinical and economic perspective. International urology and nephrology 2012; in press: 7 pages.
Mots-clés : CATHETER; HEMODIALYSE; COUT; CATHETER VEINEUX CENTRAL; BACTERIEMIE;
INCIDENCE; ETUDE RETROSPECTIVE; STAPHYLOCOCCUS AUREUS; MORTALITE; DUREE DE
SEJOUR
Purpose: Central venous catheters emerged as a major risk factor for infectious complications in
hemodialysis (HD) patients. We aimed to assess the incidence of bacteremia in catheter-dependent HD
patients and to characterize its clinical and economic impact.
Methods: We retrospectively collected clinical data and healthcare costs from 15 months for 75 admitted
catheter-dependent HD patients, to document the type of bacteremia (complicated or not), pathogen and
inflammation.
Results: Bacteremia (97% with Staphylococcus aureus, 33% methicillin-resistant) was present in 51 %
patients, with an overall infections incidence of 5.79 per 1,000 catheter-days. Metastatic complications
occurred in 21% of bacteremic patients and were associated with higher mortality (38 vs. 4%; p=0.001).
Although, in patients starting dialysis on catheter (41%) as compared to those using catheter as bridge
angioaccess, inflammation (higher C-reactive protein; p=0.006) and anemia (lower Hb; p=0.008) were more
pronounced, bacteremia occurred in a lower proportion (32 vs. 64%, p=0.007). The total medical costs were
47% higher in patients with complicated bacteremia than in those without bacteremia (p=0.008) and 45%
higher in patients starting HD on catheter than in those using catheter as bridge angioaccess (p=0.002).
Conclusions: Despite the limitations resulting from retrospective cross-sectional single-center design, our
study suggests that patients already on HD who required catheters as bridge angioaccess were more prone
to bacteremia. This highlights the importance of close angioaccess monitoring to avoid unnecessary catheter
usage. A similar increase in costs when initiating dialysis on catheter as in case of complicated bacteremia
strongly supports the initial placement of a native arteriovenous fistula.
Hépatite B
NosoBase n° 34733
Mise à jour des recommandations des CDC pour la prise en charge des personnels de santé et les
étudiants infectés par le virus de l'hépatite B
Centers for disease control and prevention (CDC). Updated CDC recommendations for the management of
hepatitis B virus-infected health-care providers and students. MMWR Morbidity and mortality weekly report
2012/07/06; 61(RR3): 1-12.
Mots-clés : HEPATITE B; PERSONNEL; ETUDIANT; RECOMMANDATION; DIAGNOSTIC; PREVENTION;
TRANSMISSION; INCIDENCE; GESTION DES RISQUES
This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)-infected
health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of
exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human
immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR
1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States
and advances in the medical management of chronic HBV infection and policy directives issued by health
authorities since 1991. The primary goal of this report is to promote patient safety while providing risk
management and practice guidance to HBV-infected health-care providers and students, particularly those
performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries
sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a
potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of
operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures.
These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should
not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health
fields. The previous recommendations have been updated to include the following changes: no prenotification
of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than
hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight,
specific suggestions for composition of expert review panels and threshold value of serum HBV DNA
considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of
medical and dental students who are discovered to have chronic HBV infection. For most chronically HBVinfected providers and students who conform to current standards for infection control, HBV infection status
alone does not require any curtailing of their practices or supervised learning experiences. These updated
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Octobre 2012
recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can
be used by the appropriate occupational or student health authorities to develop their own institutional
policies. These recommendations also can be used by an institutional expert panel that monitors providers
who perform exposure-prone procedures
Klebsiella pneumoniae
NosoBase n° 35399
Facteurs de risque de colonisation digestive à Klebsiella pneumoniae productrices de KPC à
l'admission en réanimation
Papadimitriou-Olivgeris M; Marangos M; Fligou F;Christofidou M; Bartzavali C; Anastassiou ED; et al. Risk
factors for KPC-producing Klebsiella pneumoniae enteric colonization upon ICU admission. The Journal of
antimicrobial chemotherapy 2012; in press: 6 pages.
Mots-clés : FACTEUR DE RISQUE; KLEBSIELLA PNEUMONIAE; COLONISATION; COLONISATION
DIGESTIVE;
SOIN
INTENSIF;
SEJOUR;
ETUDE
PROSPECTIVE;
CARBAPENEME;
ANTIBIORESISTANCE; PCR; EPIDEMIOLOGIE
Objectives: To identify risk factors for KPC-producing Klebsiella pneumoniae (KPC-Kp) enteric colonization at
intensive care unit (ICU) admission. Recently, the emergence and spread of KPC-producing
Enterobacteriaceae in healthcare facilities has become an important issue. Understanding the extent of the
reservoir in ICUs may be important for targeted intervention.
Methods: A prospective observational study of all patients (n=405) admitted to an ICU was conducted during
a 22 month period. Rectal samples were taken from each patient within 12-48 h of admission and were
inoculated in selective chromogenic agar. K. pneumoniae isolates were characterized by standard
methodology. Antibiotic susceptibility testing (agar disc diffusion method), MIC determination (Etest),
identification of carbapenemase-producing isolates (Hodge test) and determination of KPC production
(boronic acid-imipenem disc test) were performed. The presence of the bla(KPC) gene was confirmed by
PCR. Epidemiological data were collected from the ICU computerized database and patient chart reviews.
Results: Upon ICU admission, 52/405 (12.8%) patients were colonized with KPC-Kp that was associated with
the following risk factors: previous ICU stay (OR 12.5; 95% CI 1.8-86.8), chronic obstructive pulmonary
disease (OR 6.3; 95% CI 1.2-31.9), duration of previous hospitalization (OR 1.3; 95% CI 1.1-1.4), previous
use of carbapenems (OR 5.2; 95% CI 1.0-26.2) and previous use of ß-lactams/ß-lactamase inhibitors (OR
6.7; 95% CI 1.4-32.9). For patients previously hospitalized on peripheral wards the following risk factors were
identified: duration of hospitalization prior to ICU admission (OR 1.1; 95% CI 1.1-1.3), number of
comorbidities (OR 1.9; 95% CI 1.1-3.5) and number of antimicrobials administered (OR 2.1; 95% CI 1.3-3.3).
Conclusions: The high prevalence of KPC-Kp enteric carriage in ICU patients at admission dictates the
importance of implementation of infection control measures and strict antibiotic policies prior to ICU transfer.
Législation
NosoBase n° 35562
Instruction n°DGOS/PF2/2012/352 du 28/09/2012 relative à l’organisation de retours d’expérience dans
le cadre de la gestion des risques associés aux soins et de la sécurisation de la prise en charge
médicamenteuse en établissement de santé
Ministère des affaires sociales et de la santé. Non parue au Journal officiel 2012: 6 pages.
Mots-clés : LEGISLATION; GESTION DES RISQUES; SOIN; MEDICAMENT; STRUCTURE DE SOINS;
QUALITE; EVENEMENT INDESIRABLE GRAVE; EVALUATION; RETOUR D’EXPERIENCE
NosoBase n° 35278
Décret n°2012-969 du 20/08/2012 modifiant certaines conditions techniques de fonctionnement des
structures alternatives à l'hospitalisation
Ministère des affaires sociales et de la santé. Journal officiel 2012/08/22: 3 pages.
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Mots-clés : LEGISLATION; CHIRURGIE AMBULATOIRE; DECHET D'ACTIVITE DE SOINS A RISQUE
INFECTIEUX; AIDE SOIGNANTE; MEDECIN; INFIRMIER; INDICATEUR; QUALITE; SOIN
NosoBase n° 35280
Instruction n°DGOS/RH1/2012/317 du 09/08/2012 relative à la mise en oeuvre des plans de santé
publique dans les programmes de formation initiale des professions paramédicales
Ministère des affaires sociales et de la santé. Non parue au Journal officiel 2012: 9 pages.
Mots-clés : LEGISLATION; SANTE PUBLIQUE; FORMATION; PERSONNEL; ANTIBIOTIQUE; CANCER
Maternité
NosoBase n° 35123
Légionella pneumophila serogroupe 1 dans une piscine de naissance
Teare L; Millership S. Legionella pneumophila serogroup 1 in a birthing pool. The Journal of hospital infection
2012/09; 82(1): 58-60.
Mots-clés : LEGIONELLA; LEGIONELLA PNEUMOPHILA; EAU; ACCOUCHEMENT; NOUVEAU-NE;
ECHANTILLON; PISCINE
This report describes a risk assessment and subsequent actions following isolation of Legionella pneumophila
serogroup 1 in the water supply to a birthing pool during a planned maintenance programme. A literature
search for cases of neonatal legionellosis identified 24 reports of cases among babies aged <2 months, two
of which were associated with water births. On this basis, the pool was closed until Legionella spp. were
undetectable. Control proved difficult as hyperchlorination failed, and a filter fitted to the thermostatic mixer
tap supplying the pool slowed filling so much that additional taps were required to achieve a satisfactory flow
rate.
Néonatologie
NosoBase n° 35293
Coqueluche dans une unité de réanimation néonatale : identification de la mère comme source
probable
Elumogo TN; Booth D; Enoch DA; Kuppuswamy A; Tremlett C; Williams CJ; et al. Bordetella pertussis in a
neonatal intensive care unit: identification of the mother as the likely source. The Journal of hospital infection
2012/10; 82(2): 133-135.
Mots-clés : BORDETELLA PERTUSSIS; NEONATALOGIE; SOIN INTENSIF; DIAGNOSTIC BIOLOGIQUE;
CHIMIOPROPHYLAXIE; TRAITEMENT; VACCIN; TRANSMISSION
Bordetella pertussis, the cause of whooping cough, is highly contagious. A female, twin 1, born at 34 weeks
of gestation and present on a neonatal intensive care unit for 19 days, became apnoeic and bradycardic. A
pernasal swab, sent when pertussis was clinically suspected, grew B. pertussis. Twin 2 had similar
symptoms. The mother admitted having a prolonged cough. Polymerase chain reaction of pernasal swabs
was positive for both twins, and the mother had positive pertussis serology. An incident management
committee was convened. Fifty neonates and 117 healthcare workers were identified as contacts and were
offered information, azithromycin chemoprophylaxis and/or pertussis vaccination according to UK national
guidelines.
NosoBase n° 35277
Position de l'extrémité du cathéter central inséré par voie périphérique et risque de complications
associées chez des nouveau-nés
Jain A; Deshpande P; Shah P. Peripherally inserted central catheter tip position and risk of associated
complications in neonates. Journal of perinatology 2012; in press: 6 pages.
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Mots-clés : CATHETER; RISQUE; COMPLICATION; NOUVEAU-NE;
COHORTE; SOIN INTENSIF; NEONATALOGIE; CATHETER VEINEUX
Octobre 2012
ETUDE
RETROSPECTIVE;
Objective: To characterize the relationship between peripherally inserted central catheters (PICC) tip
positions and associated complications in neonates.
Study design: Catheter tip position for 319 infants was classified into superior vena cava (SVC, n=131),
inferior vena cava (IVC, n=72), brachiocephalic (BC, n=59), midclavicular (MC, n=49) or iliac. Duration of
catheter stay and complication profile was compared between central (SVC/IVC) vs non-central PICC, and
between SVC vs IVC, SVC vs BC and SVC vs MC. Kaplan-Meier survival analysis and regression models
were used.
Result: Overall length of catheter stay was similar between central and non-central group. Non-central
catheters (n=116) had higher complication rates (47 vs 29%; P=0.001), non-elective removals (45 vs 27%;
P=0.002) and shorter time to complication (6.2 vs 11.4 days; P=0.043). This difference was primarily due to
the complications encountered in MC group, which had the highest rate of infiltration (P<0.001) and
mechanical complications while outcomes were similar among other subgroups. Interestingly, catheter
survival probability was similar in all groups for first 4 days. Rate and types of blood stream infections were
not related to catheter tip position.
Conclusion: Non-central PICCs are associated with higher rates of infiltration and mechanical complications
when the tip is in MC region. BC catheters may have comparable outcomes to SVC in neonates. A careful
risk-benefit analysis is warranted when MC catheters are used in neonates.
NosoBase n° 35387
Banques de lait : opinions et pratiques actuelles dans des unités de réanimation néonatale
Lam EY; Kecskes Z; Abdel-Latif ME. Breast milk banking: current opinion and practice in Australian neonatal
intensive care units. Journal of paediatrics and child health 2012/09; 48(9): 833-839.
Mots-clés : SOIN INTENSIF; NEONATALOGIE; BANQUE DE LAIT; ALLAITEMENT; LAIT; RISQUE;
PERSONNEL; TRAVAIL; CONNAISSANCE; ETUDE TRANSVERSALE; QUESTIONNAIRE
Aim: To find out the knowledge and attitudes of health-care professionals (HCPs) in Australian neonatal
intensive care units (NICUs) towards breast milk banking (BMBg) and pasteurised donated breast milk
(PDBM).
Methods: Cross-sectional structured survey of HCPs in all 25 NICUs in Australia.
Results: Response rate was 43.4% (n=358 of 825). Participants included nurses and midwives (291, 81.3%)
and the remainder were neonatologists and neonatal trainees (67, 18.7%). A variable number of HCPs
agreed that PDBM would decrease the risk of necrotising enterocolitis (81%) and allergies (48.9%), 8.4%
thought PDBM will carry risk of infections and 78.8% agreed that PDBM is preferable over formula, but only
67.5% thought that establishing breast milk banks (BMBs) are justifiable. Significant differences were found
between doctors and nurses/midwives, with 19.4% of doctors compared with 5.8% of nurses/midwives
agreed that PDBM carried an increased risk of infection. Although, over 90% of nurses/midwives and 70% of
doctors agreed that the donation of breast milk is important, only 71% of nurses/midwives and 52.2% of
doctors thought that setting up a BMB was justifiable.
Conclusion: The opinions about BMBg differ widely between HCPs; however, the majority support the
practice. HCPs had different knowledge gaps in regard to BMBg. Nurses/midwives positively view the
practice of BMBg more strongly compared with neonatologists.
NosoBase n° 35425
Surveillance en réseau des bactériémies sur cathéter en néonatologie : résultats 2010 du réseau
NEOCAT
L'Hériteau F; Lacave L; Leboucher B; Decousser JW; De Chillaz C; Astagneau P; et al. Archives de pédiatrie
2012/09; 19(9): 984-989.
Mots-clés : SURVEILLANCE; BACTERIEMIE; NEONATALOGIE
Le réseau NEOCAT, animé par le Centre de coordination de lutte contre les infections nosocomiales (CCLIN)
Paris-Nord, propose depuis 2006 une surveillance en réseau des bactériémies liées aux cathéters veineux
centraux (CVC) (bactériémies liées au cathéter [BLC]) en néonatologie. Les résultats de la surveillance 2010
sont présentés dans cette étude. Les services de néonatologie volontaires incluaient, toute l’année, tous les
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Octobre 2012
nouveau-nés lors de la pose d’un CVC quels que soient la pathologie et le motif de pose. Les cathéters
veineux ombilicaux (CVO) et les autres CVC ont été analysés séparément. En 2010, 26 services ont participé
(niveau III 15, niveau IIB 10, niveau IIA 1). Ils ont inclus 2953 nouveau-nés d’âge gestationnel (AG) médian
de 32 semaines et de poids de naissance (PN) médian de 1550 g. Ces nouveau-nés étaient porteurs de
2551 CVO (durée médiane de maintien 4 j) et 2147 CVC (durée médiane 12 j). Trente-trois BLC ont été
identifiées sur CVO correspondant a` une densité d’incidence (DI) de 2,9/1000 j-CVO, IC95 % (1,9–3,8). Le
de´ lai médian d’apparition était de 5 j après la pose du CVO. Les principaux micro-organismes isole´s par les
hémocultures étaient des staphylocoques à coagulase négative (SCN, n = 27), S. aureus (n = 3), et des
entérobactéries (n = 5). Trois cent six BLC ont été identifiées sur CVC soit une DI de 11,2/1000 j-CVC, IC95
% (10,0–12,5) (délai médian d’apparition 12 j après la pose du CVC). Les principaux micro-organismes isole´
s par les hémocultures étaient également des SCN (83 %), S. aureus (6 %), et des entérobactéries (5 %).
Cette surveillance constitue un référentiel sur la DI des BLC en néonatologie permettant aux établissements
de santé de se comparer entre eux
NosoBase n° 35400
Infections nosocomiales à Rhinovirus chez des nouveau-nés prématurés
Steiner M; Strassl R; Straub J; Bohm J; Popow-Kraupp T; Berger A. Nosocomial Rhinovirus infection in
preterm infants. The Pediatric infectious disease journal 2012; in press: 12 pages.
Mots-clés : VIRUS; CORYZA; NEONATALOGIE; PREMATURE; BIOLOGIE MOLECULAIRE; PCR;
APPAREIL RESPIRATOIRE; DEPISTAGE
During eleven months all preterm infants admitted to our neonatal care facility with suspected respiratory tract
infection were screened for respiratory viruses by PCR. Rhinovirus infection was identified in 16 infants,
leading to severe respiratory compromise in most cases. Distribution of rhinovirus infections during the year
showed a strong clustering trend, suggesting a major role for nosocomial transmission.
Norovirus
NosoBase n° 35288
Utilisation d'un cycle PDSA d'amélioration de la qualité pour augmenter le niveau de préparation et la
prise en charge des Norovirus dans le système NHS en Ecosse
Curran ET; Bunyan D. Using a PDSA cycle of improvement to increase preparedness for, and management
of, norovirus in NHS Scotland. The Journal of hospital infection 2012/10; 82(2): 108-113.
Mots-clés : NOROVIRUS; VIRUS; EPIDEMIE; QUALITE; INCIDENCE; PREVENTION
Background: The 2009-2010 norovirus season was reported anecdotally by infection prevention and control
teams (IPCTs) to be one of the worst seasons in Scotland. At its peak, Health Protection Scotland's (HPS)
weekly point prevalence identified that 53 wards were closed.
Aim: To develop an annual cycle of learning lessons and improving systems to reduce the impact and
incidence of norovirus outbreaks in Scotland.
Methods: An analysis of two end-of-year norovirus season evaluations (2009-2010 and 2010-2011) by IPCTs
in Scotland using a national Plan, Do, Study, Act (PDSA) model.
Findings: The first evaluation (2009-2010) identified that IPCTs responded well when outbreaks were
reported, but were not optimally prepared for the season. In addition, IPCTs had little data to describe their
particular problems in detail. HPS planned for the 2010-2011 season with tools to optimize preparedness and
norovirus management. The second evaluation (2010-2011) identified much more proactive responses to
both preparedness and norovirus management.
Conclusion: This national PDSA cycle has led to system improvements designed to reduce the incidence and
impact of norovirus in NHS Scotland. The incidence of norovirus was reduced in the 2011-2012 season;
however, confounding from the variation in circulating viruses makes it difficult to measure any effect of the
system improvements. As noroviruses challenge the health service every year, mainly in winter months, the
end-of-season evaluations can be used to improve planning for subsequent seasons to share and
demonstrate good practice. As more years of data become available for analysis, the impact of system
improvements will become measurable.
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Personne âgée
NosoBase n° 35253
Un pas en avant important : des définitions pour la surveillance des infections dans les
établissements de long séjour
Moro ML. A significant step forward: definitions for surveillance of infections in long-term care. Infection
control and hospital epidemiology 2012/10; 33(10): 978-980.
Mots-clés : SURVEILLANCE; DEFINITION; EHPAD ; MULTIRESISTANCE
NosoBase n° 35252
Définitions de la surveillance des infections dans les établissements de long séjour : revisiter les
critères de McGeer.
Stone ND; Ashraf MS; Calder J; Crnich CJ; Crossley K; Drinka PJ; et al. Surveillance definitions of infections
in long-term care facilities: revisiting the McGeer criteria. Infection control and hospital epidemiology 2012/10;
33(10): 965-977.
Mots-clés : SURVEILLANCE; DEFINITION; EHPAD ; GERIATRIE; INFECTION URINAIRE; APPAREIL
RESPIRATOIRE; NOROVIRUS; GASTRO-ENTERITE; CLOSTRIDIUM DIFFICILE
Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated
since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the
literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections.
New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.
NosoBase n° 35292
Facteurs affectant la prévention et le contrôle des épidémies de gastroentérites virales dans des
établissements de soins de longue durée et des EHPAD
Vivancos R; Trainor E; Oyinloye A; Keenan A. Factors affecting prevention and control of viral gastroenteritis
outbreaks in care homes. The Journal of hospital infection 2012/10; 82(2): 129-132.
Mots-clés : EPIDEMIE; PREVENTION; GASTRO-ENTERITE; CONTROLE; PCR; EHPAD; SOIN DE
LONGUE DUREE
We assess the effect of key care quality indicators on viral gastroenteritis outbreaks and control in care
homes using mandatory inspection data collected by a non-departmental public body. Outbreak occurrence
was associated with care home size but not with overall quality or individual environmental standards. Care
home size, hygiene and infection control standard scores were inversely associated with attack rate in
residents, whereas delayed reporting to the local public health agency was associated with higher attack
rates.
Personnel
NosoBase n° 35122
Perceptions du personnel de santé concernant l'exposition professionnelle aux virus hématogènes et
barrières pour le signalement : étude d'après questionnaire
Winchester SA; Tomkins S; Cliffe S; Batty L; Ncube F; Zuckerman M. Healthcare workers' perceptions of
occupational exposure to blood-borne viruses and reporting barriers: a questionnaire-based study. The
Journal of hospital infection 2012/09; 82(1): 36-39.
Mots-clés : PERSONNEL; TRAVAIL; PERCEPTION; RISQUE PROFESSIONNEL; VIRUS; SANG;
SURVEILLANCE; SIGNALEMENT; VIRUS DE L'IMMUNODEFICIENCE HUMAINE; HEPATITE; HEPATITE
B; EXPOSITION AU SANG; CHIMIOPROPHYLAXIE; QUESTIONNAIRE; ODONTOLOGIE; MEDECINE
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Background: Healthcare workers (HCWs) are at significant risk of exposure to blood-borne viruses (BBV).
Aim: To investigate HCW perceptions concerning occupational exposures to BBV and possible barriers
involved in reporting incidents.
Methods: A total of 120 HCWs based at the Dental Institute, King's College Hospital NHS Foundation Trust,
completed an anonymous questionnaire as part of a multicentre study.
Findings: Eighty-six percent (99/115) of respondents worried about developing a BBV infection at work. Of
those who feared hepatitis C virus (HCV) the most, 69% (31/45) also believed that HCV posed the greatest
risk to their health, versus 53% (10/19) and 13% (5/40) with regard to hepatitis B virus (HBV) and HIV
infection, respectively (P<0.001). Of respondents with =21 years of health service experience, 75% (18/24)
knew the risk of HIV transmission versus 13% (2/16) of respondents with <5 years of health service
experience (P=0.002). All (23/23) respondents with =21 years of service were aware of HIV PEP versus 20%
(12/60) with <21 years of service. Ninety-two percent of respondents (104/113) agreed that it was important
to report all body fluid exposure incidents but only 58% (28/48) had reported all their exposure incidents. Fiftynine percent (60/102) agreed that an electronic reporting system would improve reporting of such incidents.
Conclusions: This study identified a need to improve HCWs' knowledge of BBV infection risks and their
management. Data gathered in this study will be used to inform the development of a web-based system for
the surveillance of occupational exposures to BBV in the UK.
Pneumonie
NosoBase n° 35382
Amélioration continue dans l'observance du "bundle" (bouquet d'interventions) pour les pneumonies
acquises sous ventilation : revue rétrospective de cas appariés
Beattie M; Shepherd A; Maher S; Grant J. Continual improvement in ventilator acquired pneumonia bundle
compliance: a retrospective case matched review. Intensive and critical care nursing 2012/10; 28(5): 255-262.
Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; PROTOCOLE; ETUDE RETROSPECTIVE;
APPARIEMENT; PREVENTION; OBSERVANCE; QUALITE; SOIN DE BOUCHE; DECUBITUS;
CHLORHEXIDINE
Objectives: This study aimed to describe the population of people who acquired ventilator acquired
pneumonia and determine the feasibility of a larger scale study to assess the degree to which bundle
compliance reduces or even eliminates, the risk of ventilator acquired pneumonia.
Research methodology/design: A retrospective matched case note review was conducted to scrutinise 10
VAP cases. Cases were matched with two controls for age, gender, APACHE score and number of ventilated
days. Compliance with the VAP bundle was determined by extracting data on compliance from case notes.
Binary logistic regression was used to calculate odds ratios with confidence intervals which were utilised to
determine numbers needed for a larger study.
Setting: A general intensive care unit within a 750 bedded district general hospital, serving a population of
approximately 270,000 people in Scotland.
Main outcome measure: The outcome variable of interest was ventilator acquired pneumonia and the
independent variable was ventilator acquired pneumonia bundle compliance.
Results: Binary logistic regression suggested that cases which did not receive the bundle reliably were more
likely to develop ventilator acquired pneumonia (OR 1.33, confidence interval (CI) 0.28-6.30). Statistical
results should be interpreted with caution due to the small sample size, which is demonstrated with the wide
ranging confidence intervals (CIs).
Conclusion: Wide confidence intervals enable only a cursory impression as to numbers that would be
required for a full scale trial. Nonetheless, the effect size indicated in this paper contributes towards
consideration as to numbers needed for future studies.
NosoBase n° 35333
Impact de la surveillance des infections nosocomiales sur l'incidence des pneumonies acquises sous
ventilation dans des unités de réanimation : étude quasi-expérimentale
Benet T; Allaouchiche B; Argaud L; Vanhems P. Impact of surveillance of hospital-acquired infections on the
incidence of ventilator-associated pneumonia in intensive care units: a quasi-experimental study. Critical care
2012; in press: 29 pages.
Mots-clés : PNEUMONIE; SURVEILLANCE; INCIDENCE; VENTILATION ASSISTEE; SOIN INTENSIF;
RESEAU; TAUX; MORTALITE; DUREE DE SEJOUR
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Introduction: The preventive impact of hospital-acquired infection (HAI) surveillance is difficult to assess. Our
objective was to investigate the effect of HAI surveillance disruption on ventilator-associated pneumonia
(VAP) incidence.
Methods: A quasi-experimental study with intervention group and control group was conducted between 1st
January 2004 and 31st December 2010 in two intensive care units (ICUs) of a university hospital that
participated in a national HAI surveillance network. Surveillance was interrupted during the year 2007 in unit
A (intervention group) and was continuous in unit B (control group). Period 1 (pre-test period) comprised
patients hospitalized during 2004-2006, and period 2 (post-test period) involved patients hospitalized during
2008-2010. Patients hospitalized [greater than or equal to]48 hours and intubated during their stay were
included. Multivariate Poisson regression was fitted to ascertain the influence of surveillance disruption.
Results: 2,771 patients, accounting for 19,848 intubation-days at risk, were studied in total; 307 had VAP. The
VAP attack rate increased in unit A from 7.8% during period 1 to 17.1% during period 2 (P<0.001); in unit B, it
was 7.2% and 11.2% for the 2 periods respectively (P=0.17). Adjusted VAP incidence rose in unit A after
surveillance disruption (incidence rate ratio=2.17, 95% confidence interval 1.05-4.47, P=0.036),
independently of VAP trend; no change was observed in unit B. All-cause mortality and length of stay
increased (P=0.028 and P=0.038, respectively) in unit A between periods 1 and 2. In unit B, no change in
mortality was observed (P=0.22), while length of stay decreased between periods 1 and 2 (P=0.002).
Conclusions: VAP incidence, length of stay, and all-cause mortality rose after HAI surveillance disruption in
ICU, which suggests a specific effect of HAI surveillance on VAP prevention and reinforces the role of data
feedback and counselling as a mechanism to facilitate performance improvement.
NosoBase n° 35437
Efficacité d'une approche multidimensionnelle pour la prévention des pneumonies acquises sous
ventilation dans des unités de réanimation pour adultes de 14 pays en développement sur quatre
continents : résultats de l'INICC
Rosenthal VD; Rodrigues C; Alvarez-Moreno C; Madani N; Mitrev Z; Ye G; et al. Effectiveness of a
multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units
from 14 developing countries of four continents: findings of the international nosocomial infection control
Consortium. Critical care medicine 2012; 40(12): 1-8.
Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; PREVENTION; SOIN INTENSIF; AGE; PAYS EN
DEVELOPPEMENT; EFFICACITE; SURVEILLANCE; ETUDE PROSPECTIVE
Objectives: The aim of this study was to analyze the effect of the International Nosocomial Infection Control
Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients
hospitalized in intensive care units.
Design: A prospective active surveillance before-after study. The study was divided into two phases. During
phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of
ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and
Prevention National Health Safety Network, and the methodology of International Nosocomial Infection
Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was
implemented at each intensive care unit, in addition to the active surveillance.
Setting: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial
Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China,
Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey.
Patients: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals. Interventions: The
International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional
approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3)
outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6)
performance feedback of infection-control practices.
Measurements: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates
obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention.
Main result: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the
implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate
of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2
per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83%
reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilatorassociated pneumonia rate was 55.83% lower than it was at the beginning of the study.
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Conclusion: The implementation the International Nosocomial Infection Control Consortium multidimensional
approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilatorassociated pneumonia rate in the adult intensive care units setting of
developing countries.
Réanimation
NosoBase n° 35396
Surveillance des tendances dans le temps de la mortalité et de l'incidence des infections associées
aux dispositifs médicaux dans l'unité de réanimation d'un centre hospitalier de Taiwan, 2000-2008 :
étude d'observation rétrospective
Chen YY; Chen LY; Lin SY; Chou P; Liao SY; Wang FD. Surveillance on secular trends of incidence and
mortality for device-associated infection in the intensive care unit setting at a tertiary medical center in
Taiwan, 2000-2008: a retrospective observational study. BMC infectious diseases 2012/19/10; 12: 1-11.
Mots-clés : INCIDENCE; SURVEILLANCE; MORTALITE; SOIN INTENSIF
Background: Device-associated infection (DAI) plays an important part in nosocomial infection. Active
surveillance and infection control are needed to disclose the specific situation in each hospital and to cope
with this problem effectively. We examined the rates of DAI by antimicrobial-resistant pathogens, and 30-day
and in-hospital mortality in the intensive care unit (ICU).
Methods: Prospective surveillance was conducted in a mixed medical and surgical ICU at a major teaching
hospital from 2000 through 2008. Trend analysis was performed and logistic regression was used to assess
prognostic factors of mortality.
Results: The overall rate of DAIs was 3.03 episodes per 1000 device-days. The most common DAI type was
catheter--associated urinary tract infection (3.76 per 1000 urinary catheter-days). There was a decrease in
DAI rates in 2005 and rates of ventilator-associated pneumonia (VAP, 3.18 per 1000 ventilator--days) have
remained low since then (p<0.001). The crude rates of 30-day (33.6%) and in-hospital (52.3%) mortality, as
well as infection by antibiotic-resistant VAP pathogens also decreased. The most common antimicrobialresistant pathogens were methicillin-resistant Staphylococcus aureus (94.9%) and imipenem-resistant
Acinetobacter baumannii (p<0.001), which also increased at the most rapid rate. The rate of antimicrobial
resistance among Enterobacteriaceae also increased significantly (p < 0.05). After controlling for potentially
confounding factors, the DAI was an independent prognostic factor for both 30-day mortality (OR 2.51, 95%
confidence interval [CI] 1.99-3.17, p=0.001) and in-hospital mortality (OR 3.61, 95% CI 2.10--3.25, p<0.001).
Conclusions: The decrease in the rate of DAI and infection by resistant bacteria on the impact of severe acute
respiratory syndrome can be attributed to active infection control and improved adherence after 2003.
NosoBase n° 35282
Structures et organisation des unités de réanimation : 300 recommandations
Fourrier F; Boiteau R; Charbonneau P; Drault JN; Dray S; Farkas JC; et al. 300 recommendations and
guidelines on structural and organizational requirements for intensive care units. Réanimation 2012; in press:
17 pages.
Mots-clés : SOIN INTENSIF; RECOMMANDATION ; ARCHITECTURE ; CHAMBRE ; UNITE DE SOIN ;
PERSONNEL ; SOIN ; LINGE ; EAU ; REVETEMENT ; PHARMACIE ; MEDICAMENT ; INFORMIER ; AIDESOIGNANTE ; KINESITHERAPEUTE ; EVALUATION
Ce référentiel de structures et d’organisation a été réalisé en prenant pour bases les recommandations
nationales, européennes et nord-américaines et l’analyse de la littérature médicale des 20 dernières années.
Les domaines suivants ont été étudiés : architecture générale et structuration physique de l’unité ;
architecture des zones de soins et des chambres des patients ; organisation logistique, management et
indicateurs ; organisation de l’unité pour l’enseignement et la recherche ; gestion et organisation des
ressources humaines médicales et paramédicales ; droits des patients et principes de bientraitance. Ce
référentiel propose 300 recommandations concernant l’organisation fonctionnelle, matérielle et humaine
d’une unité de réanimation (UR) autorisée selon les critères des schémas régionaux d'organisation des soins
(SROS), située au sein d’un établissement de santé (eS) public ou privé. Il en détermine les caractéristiques
optimales. Il ne traite pas de l’organisation et des structures des unités de soins intensifs ni des unités de
surveillance continue (USC).
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NosoBase n° 35383
Environnement sonore dans une chambre de patient en réanimation - Analyse de la teneur du niveau
sonore et expériences des patients
Johansson L; Bergbom I; Waye KP; Ryherd E; Lindahl B. The sound environment in an ICU patient room - A
content analysis of sound levels and patient experiences. Intensive and critical care nursing 2012/10; 28(5):
269-279.
Mots-clés : ENVIRONNEMENT; CHAMBRE; ANALYSE; USAGER
This study had two aims: first to describe, using both descriptive statistics and quantitative content analysis,
the noise environment in an ICU patient room over one day, a patient's physical status during the same day
and early signs of ICU delirium; second, to describe, using qualitative content analysis, patients' recall of the
noise environment in the ICU patient room. The final study group comprised 13 patients. General patient
health status data, ICU delirium observations and sound-level data were collected for each patient over a 24hour period. Finally, interviews were conducted following discharge from the ICU. The sound levels in the
patient room were higher than desirable and the LAF max levels exceed 55dB 70-90% of the time. Most
patients remembered some sounds from their stay in the ICU and whilst many were aware of the sounds they
were not disturbing to them. However, some also experienced feelings of fear related to sounds emanating
from treatments and investigations of the patient beside them. In this small sample, no statistical connection
between early signs of ICU delirium and high sound levels was seen, but more research will be needed to
clarify whether or not a correlation does exist between these two factors.
NosoBase n° 35290
Un lavabo contaminé responsable d'une mini-épidémie d'infections à Klebsiella pneumoniae
productrices de bêta-lactamases à spectre étendu dans une unité de réanimation
Starlander G; Melhus A. Minor outbreak of extended-spectrum beta-lactamase-producing Klebsiella
pneumoniae in an intensive care unit due to a contaminated sink. The Journal of hospital infection 2012/10;
82(2): 122-124.
Mots-clés : EPIDEMIE; KLEBSIELLA PNEUMONIAE; SOIN INTENSIF; BETA-LACTAMASE A SPECTRE
ELARGI; ENVIRONNEMENT; NEUROCHIRURGIE; SANITAIRE; CONTAMINATION; LAVABO
During a period of seven months four patients on the neurosurgical intensive care unit at a tertiary care
hospital in Sweden became infected or colonized by an extended-spectrum ß-lactamase-producing Klebsiella
pneumoniae strain. The investigation revealed that the source of the outbreak was a contaminated sink. By
replacing the sink and its plumbing and improving routines regarding sink practices, the outbreak was
successfully controlled.
Rotavirus
NosoBase n° 35364
Infections à Rotavirus en Allemagne - Etude prospective de cas très sévères
Shai S; Perez-Becker R; Wirsing Von Konig CH; Von Kries R; Heininger U; Forster J; et al. Rotavirus disease
in Germany - A prospective survey of very severe cases. The Pediatric infectious disease journal 2012; in
press: 26 pages.
Mots-clés : ROTAVIRUS; VIRUS; ETUDE PROSPECTIVE; GASTRO-ENTERITE; SURVEILLANCE; DUREE
DE SEJOUR; INCIDENCE; PEDIATRIE
Background: Rotavirus (RV) gastroenteritis is a notifiable disease in Germany. The reports to the authorities
contain few data concerning the severity of disease. Aims of this study were to determine incidence and
outcome of very severe cases of RV disease.
Methods: Cases of very severe RV disease were collected by the German Paediatric Surveillance Unit for
rare diseases (ESPED) using anonymous questionnaires based on hospitalized patients between April 2009
and March 2011. Inclusion criteria were detection of RV antigen in feces, patient age 0-16 years and one or
more of the following criteria: intensive care treatment, hyper- or hyponatremia (>155 mmol/l or <125 mmol/l),
clinical signs of encephalopathy (somnolence, seizures, apnea), RV associated death.
Results: During two years 130 cases of very severe RV disease were reported, 101/130 were verified.
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Seventeen patients had nosocomial infection, of whom 14 were neonates in intensive care. Among those, 12
infants had a verified or suspected necrotizing enterocolitis. Eighty four community acquired cases were
reported, median age was 10.5 months (0-108 months). The median hospital stay was 6 days and 48 patients
needed intensive care treatment. Among children less than 5 years of age the yearly incidence of community
acquired very severe RV disease was 1.2/100,000 (95% confidence interval 0.9 - 1.4/100,000). A total of
26/84 and 10/84 patients had severe hyper- or hyponatremia, respectively and 58/84 had signs of
encephalopathy. Three deaths were reported (1 nosocomial and 2 community acquired).
Conclusions: RV infection in Germany can have a life-threatening course. A substantial number are
nosocomial infections.
Rougeole
NosoBase n° 35379
La rougeole se répand encore en Europe : qui est responsable de l'échec de la vaccination ?
Carrillo-Santisteve P; Lopalco PL. Measles still spreads in Europe: who is responsible for the failure to
vaccinate? Clinical microbiology and infection 2012; in press: 7 pages.
Mots-clés : ROUGEOLE; VACCIN; EPIDEMIOLOGIE; EPIDEMIE; INCIDENCE; AGE
All countries in the European Region of the World Health Organization (WHO) have renewed their
commitment to eliminate measles transmission by 2015. Measles elimination is a feasible target but requires
vaccination coverage above 95% with two doses of a measles mumps- rubella vaccine (MMR) in all
population groups and in all geographical areas. Measles has re-emerged in the EU recently, due to
suboptimal immunization levels that led to accumulation of susceptible populations over the last years. In fact,
while an overall decreasing trend had been observed until 2009, the number of cases increased by a factor of
four between2010 and 2011. According to vaccination coverage data reported to the WHO, between 2000
and 2010, almost 5 million individuals in the EU in the age group 2-12 had not had MMR vaccination. Catchup vaccination activities for susceptible populations are paramount in order to reach the elimination goal, but
only feasible if a multi-component approach is put in place quickly and efficiently. Advocacy and
communication are key strategic areas.
NosoBase n° 35404
Epidémie de rougeole en Europe : sensibilité des enfants trop jeunes pour être immunisés
Leuridan E; Sabbe M; Van Damme P. Measles outbreak in Europe: susceptibility of infants too young to be
immunized. Vaccine 2012/09/07; 30(41): 5905-5913.
Mots-clés : EPIDEMIE; VIRUS; ROUGEOLE; VACCIN; INCIDENCE; PEDIATRIE; BIBLIOGRAPHIE;
PREVENTION
As women vaccinated against measles transfer low amounts of antibodies, an increasing number of infants
lack early protection through maternal antibodies until being immunised themselves. This paper reviews the
literature on disease burden of measles in the population too young to be immunized according to the
respective national recommendations during recent outbreaks in EU and EEA/EFTA countries. In addition,
specific control strategies adopted to protect this young population are reviewed. Pubmed, Unbound Medline,
Web of Knowledge and the Eurosurveillance database were searched using MESH terms: measles and
epidemiology, measles and infants, prevalence of measles, measles and outbreaks and measles and
epidemic. Additionally, data from Euvac.net and ECDC were consulted. Databases were searched from
January 2001 to September 2011. Fifty-three papers were included in the analysis. The percentage of all
measles cases during outbreaks affecting young infants ranged from 0.25% to 83.0%. Specific control
strategies were adopted: e.g. administration of the first or second vaccine dose earlier than recommended.
Infants younger than 12 months are often involved in measles outbreaks, and advancing the first vaccine
dose could reduce the burden of disease. However, immunization before 9 months of age is not
systematically recommended because of dysmature humoral immune responses of infants. High coverage
and timely administration of the recommended series of vaccines are the most important measures to
decrease measles incidence and measles circulation and protect vulnerable infants from infection.
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Staphylococcus aureus
NosoBase n° 34732
Infections invasives à Staphylococcus aureus associées à l'injection d'analgésiques et à la
réutilisation de flacons unidoses - Arizona et Delaware, 2012
Centers for disease control and prevention (CDC). Invasive Staphylococcus aureus infections associated with
pain injections and reuse of single-dose vials – Arizona and Delaware, 2012. MMWR Morbidity and mortality
weekly report 2012/07/13; 61: 501-504.
Mots-clés : STAPHYLOCOCCUS AUREUS; TRANSMISSION SOIGNE-SOIGNE; USAGE UNIQUE;
DISPOSITIF MEDICAL; INJECTION
Transmission of life-threatening bacterial infections can occur when health-care personnel do not adhere to
Standard Precautions and instead use medication in containers labeled as single-dose or single-use for more
than one patient. This report summarizes the investigation of two outbreaks of invasive Staphylococcus
aureus infection confirmed in 10 patients being treated for pain in outpatient clinics. In each outbreak, the use
of single-dose or single-use vials (SDVs) for more than one patient was associated with infection
transmission. In both investigations, clinicians reported difficulty obtaining the medication type or vial size that
best fit their procedural needs. These outbreaks are a reminder of the serious consequences that can result
when SDVs are used for more than one patient. Clinician adherence to safe injection practices, particularly
when appropriately sized SDVs are unavailable, is important to prevent infection transmission. If SDVs must
be used for more than one patient, full adherence to U.S. Pharmacopeia standards is critical to minimize the
risks of multipatient use.
NosoBase n° 35245
Des unités individuelles plutôt que l'hôpital entier comme base d'amélioration : exemple de deux
études de cohortes sur Staphylococcus aureus méticillino-résistant
Gastmeier P; Schwab F; Chaberny I; Geffers C. Individual units rather than entire hospital as the basis for
improvement: the example of two methicillin resistant Staphylococcus cohort studies. Antimicrobial resistance
and infection control 2012/02/13; 1(1): 1-6.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; INCIDENCE; SURVEILLANCE;
COHORTE; RESEAU; SOIN INTENSIF; PREVENTION
Background: Two MRSA surveillance components exist within the German national nosocomial infection
surveillance system KISS: one for the whole hospital (i.e. only hospital based data and no rates for individual
units) and one for ICU-based data (rates for each individual ICU). The objective of this study was to analyze
which surveillance system (a hospital based or a unit based) leads to a greater decrease in incidence density
of nosocomial MRSA.
Methods: Two cohort studies of surveillance data were used: Data from a total of 224 hospitals and 359 ICUs
in the period from 2004 to 2009. Development over time was described first for both surveillance systems. In
a second step only data were analyzed from those hospitals/ICUs with continuous participation for at least
four years. Incidence rate ratios (IRR) with 95% confidence intervals were calculated to compare incidence
densities between different time intervals.
Results: In the baseline year the mean MRSA incidence density of hospital acquired MRSA cases was 0.25
and the mean incidence density of ICU-acquired MRSA was 1.25 per 1000 patient days. No decrease in
hospital-acquired MRSA rates was found in a total of 111 hospitals with continuous participation in the
hospital-based system. However, in 159 ICUs with continuous participation in the unit-based system, a
significant decrease of 29% in ICU-acquired MRSA was identified.
Conclusions: A unit-based approach of surveillance and feedback seems to be more successful in decreasing
nosocomial MRSA rates, compared to a hospital-based approach. Therefore each surveillance system should
provide unit-based data to stimulate activities on the unit level.
NosoBase n° 35173
Staphylococcus aureus méticillino-résistant (SARM) dans un service d'urologie en Autriche : dix ans
d'expérience représentant 95161 patients
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Heidler S; Asboth F; Mert C; Madersbacher S. Methicillin-resistant Staphylococcus aureus (MRSA) in an
Austrian urological department: 10 years experience covering 95161 patients. World journal of urology 2012:
5 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; UROLOGIE; PREVALENCE;
COLONISATION; INFECTION; ETUDE RETROSPECTIVE; INCIDENCE
Purpose: So far, few data is available on Methicillin-resistant Staphylococcus aureus (MRSA) infections in
urology. To obtain a better insight into MRSA infections, we studied prevalence, colonization and infection site
and clinical implications of MRSA in a urological department over a 10-year period.
Methods: A retrospective study of all patients diagnosed with MRSA for the first time over a 10-year period
was set-up.
Results: Between 2000 and 2009, a total of 95.161 in- and outpatients were seen at our department. The
prevalence of patients with newly diagnosed MRSA was low, that is, <0.1% per year (mean 0.07%, 0.020.1%). In total, 62 MRSA cases were identified over a 10-year period. MRSA incidence was 10 times higher
in inpatients (0.2%) than in outpatients (0.02%). Asymptomatic MRSA colonization was present in 25/62
patients (40.3%), the remaining 59.7% (37/62) showed clinical symptoms: MRSA positive swabs from open
wounds were seen in 10/62 patients (16.1%). Urinary tract infections were seen in 26/10 patients (41.9%),
while life-threatening MRSA sepsis occurred in one patient only over a decade.
Conclusions: In summary, we observed very low rates of MRSA colonization and infection. Still, complications
like delayed wound healing, development of abscess and even sepsis may occur.
NosoBase n° 35164
Utilisation de la ceftaroline fosamil dans les endocardites à Staphylococcus aureus méticillinorésistant et les infections profondes à SARM : série de cas rétrospective de 10 patients
Lin JC; Aung G; Thomas A; Jahng M; Johns S; Fierer J. The use of ceftaroline fosamil in methicillin-resistant
Staphylococcus aureus endocarditis and deep-seated MRSA infections: a retrospective case series of 10
patients. Journal of infection and chemotherapy 2012; in press: 8 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENDOCARDE; ETUDE
RETROSPECTIVE; TRAITEMENT; ANTIBIOTIQUE; CEPHALOSPORINE; PNEUMONIE; BACTERIEMIE;
OS; APPAREIL OSTEO-ARTICULAIRE
There are many limitations to the current antibiotics used for the treatment of severe methicillin-resistant
Staphylococcus aureus (MRSA) infections. Ceftaroline is a new fifth-generation cephalosporin approved for
the treatment of skin and soft tissue infections caused by MRSA and community-acquired pneumonia. We
propose that ceftaroline can also be used successfully in more severe MRSA infections, including
endocarditis. We conducted a retrospective chart review in a university-affiliated Department of Veterans
Affairs hospital in San Diego, California (USA) of ten inpatients treated with ceftaroline for severe MRSA
infection, including five cases of probable endocarditis (including two endocardial pacemaker infections), one
case of pyomyositis with possible endocarditis, two cases of pneumonia (including one case of empyema),
two cases of septic arthritis (including one case of prosthetic joint infection), and two cases of osteomyelitis.
Seven of the 10 patients achieved microbiological cure. Six of the 10 patients achieved clinical cure. Seven
patients were discharged from the hospital. Three patients were placed on comfort care and expired in the
hospital; one achieved microbiological cure before death, and two remained bacteremic at time of death. In
most patients, ceftaroline was effective for treatment of MRSA bacteremia and other severe MRSA infections.
Adverse effects seen included rash, eosinophilia, pruritus, and Clostridium difficile infection. Ceftaroline can
be a safe and effective drug for treatment of severe MRSA infections, and further comparative studies are
warranted.
NosoBase n° 35376
La colonisation du cathéter veineux central par Staphylococcus aureus n'est pas toujours une
indication d'antibiothérapie
Munoz P; Cruz AF; Usubillaga R; Zorzano A; Rodriguez-Creixems M; Guembe M; et al. Central venous
catheter colonization wiht Staphylococcus aureus is not always an indication for antimicrobial therapy. Clinical
microbiology and infection 2012/09; 18(9): 877-882.
Mots-clés : STAPHYLOCOCCUS
ANTIBIOTIQUE; COLONISATION
AUREUS;
CATHETER
VEINEUX
CENTRAL;
TRAITEMENT;
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Whether patients whose catheter tip grows Staphylococcus aureus but who have no concomitant
bacteraemia should receive antimicrobials remains an unresolved issue. However, a proportion of patients
with catheter tips colonized by S. aureus have no blood cultures taken because of low suspicion of sepsis and
the meaning of this microbiological finding is unknown. We have analysed all catheter tips growing S. aureus
during a 6-year period and have selected patients without blood cultures taken 7 days before or after central
vascular catheter removal. Patient's evolution was classified into good and poor outcome. Poor outcome was
defined as S. aureus infection within 3 months after catheter withdrawal or death in the same period with no
obvious cause. Patients with good and poor outcomes were compared to assess whether antimicrobial
therapy influenced evolution. Sixty-seven patients fulfilled our inclusion criteria and five (7.4%) had a poor
outcome. The administration of early anti-staphylococcal therapy had no impact on the outcome of this
population (p 0.99). The only factor independently associated with a poor outcome was the presence of
clinical signs of sepsis when the catheter was removed (OR 20.8; 95% CI 2.0-206.1; p 0.009). Our data
suggest that patients with central vascular catheter tips colonized with S. aureus should be closely monitored
for signs and symptoms of ongoing infection, but if these are not present then antimicrobial therapy does not
seem justified.
Tuberculose
NosoBase n° 35352
Prise en charge des tuberculoses difficiles multirésistantes et ultrarésistantes aux antibiotiques Actualisation 2012
Chang KC; Yew WW. Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant
tuberculosis: update 2012. Respirology 2012; in press: 52 pages.
Mots-clés : MYCOBACTERIUM TUBERCULOSIS; ANTIBIORESISTANCE; MULTIRESISTANCE;
TRANSMISSION; TRAITEMENT; PREVENTION; EPIDEMIOLOGIE; VIRUS DE L'IMMUNODEFICIENCE
HUMAINE
Multidrug-resistant (MDR) tuberculosis (TB) denotes bacillary resistance to at least isoniazid and rifampicin.
Extensively drug-resistant (XDR) TB is MDR-TB with additional bacillary resistance to any fluoroquinolone
and at least one second-line injectable drugs. Rooted in inadequate TB treatment and compounded by a
vicious circle of diagnostic delay and improper treatment, MDR-TB/XDR-TB has become a global epidemic
that is fuelled by poverty, HIV, and neglect of air-borne infection control. The majority of MDR-TB cases in
some settings with high prevalence of MDR-TB are due to transmission of drug-resistant bacillary strains to
previously untreated patients. Global efforts in controlling MDR-TB/XDR-TB can no longer focus solely on
high-risk patients. It is difficult and costly to treat MDR-TB/XDR-TB. Without timely implementation of
preventive and management strategies, difficult MDR-TB/XDR-TB can cripple global TB control efforts.
Preventive strategies include prompt diagnosis with adequate TB treatment using the DOTS strategy and
drug-resistance programmes, airborne infection control, preventive treatment of TB/HIV, and optimal use of
antiretroviral therapy. Management strategies for established cases of difficult MDR-TB/XDR-TB rely on
harnessing existing drugs (notably newer-generation levofloxacin, high-dose isoniazid, linezolid, and
pyrazinamide with in vitro activity) in the best combinations and dosing schedules, together with adjunctive
surgery in carefully selected cases. Immunotherapy may also have a role in the future. New diagnostics,
drugs and vaccines are required to meet the challenge, but science alone is insufficient. Difficult MDRTB/XDR-TB cannot be tackled without achieving high cure rates with quality DOTS and beyond, and
concurrently addressing poverty and HIV.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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