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NosoVeille – Bulletin de veille
Septembre 2015
NosoVeille n°9
Septembre 2015
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
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Sommaire de ce numéro :
Antibiorésistance
Arbovirus
Bactériémie
Chirurgie
Clostridium difficile
Coronavirus
Coût
Ebola
EHPAD
Endoscopie
Epidémie
Gestion des risques
Grippe
Hygiène des mains
Maladie émergente
Maternité
Néonatologie
Personnel
PICC
Pneumonie
Responsabilité
Soins intensifs
Sondage urinaire
Staphylococcus aureus
Vaccination
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Septembre 2015
Antibiorésistance
NosoBase ID notice : 401741
Persistance du portage de bactéries multirésistantes après la réanimation
Cattoen C. Persistance du portage de bactéries multirésistantes après la réanimation. Réanimation 2015/05;
24(3): 249-255.
Mots-clés :
SOIN
INTENSIF;
COLONISATION;
MULTIRESISTANCE;
EPIDEMIOLOGIE;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENTEROBACTERIE; BETA-LACTAMASE A
SPECTRE ELARGI; CARBAPENEME; BMR; EBLSE; EPC
La résistance aux antibiotiques est un problème majeur qui ne fait que s’accentuer dans les unités de soins
intensifs et de réanimation. La persistance d’une colonisation avec des bactéries multirésistantes (BMR) chez
les patients peut jouer un rôle important dans la diffusion de ces bactéries. La durée de colonisation à BMR
est mal connue, en particulier après la sortie des patients de réanimation. La connaissance de cette durée de
portage chez les patients hospitalisés et chez ceux qui sont réadmis est néanmoins déterminante, car elle
impacte la stratégie et les mesures de prévention à mettre en oeuvre. Plusieurs facteurs influencent la durée
de colonisation : le type de BMR, le traitement antibiotique, les hospitalisations répétées, la sensibilité des
tests de dépistage utilisés (cultures, polymerase chain reaction [PCR]). La plupart des études publiées ont
été menées chez des patients hospitalisés, colonisés par des BMR et réadmis en réanimation. Ces études
montrent la complexité des facteurs influençant la durée de colonisation et rapportent une médiane de temps
de clairance des BMR mesurée à plusieurs mois. Des portages de longue durée sont décrits dans plusieurs
travaux pour différentes BMR : Staphylococcus aureus résistant à la méticilline (SARM) [un à quatre ans],
entérobactéries productrices de bêtalactamase à spectre étendu (EBLSE) [trois ans], entérocoques résistants
aux glycopeptides (50 semaines), entérobactéries résistantes aux carbapénèmes (un an), Acinetobacter
baumannii multirésistant (42 mois). Les antibiotiques jouent un rôle majeur, non seulement dans la sélection,
mais également dans la persistance du portage des BMR.
NosoBase ID notice : 401737
Mesures de prévention et de contrôle de la transmission des bacilles Gram négatif multirésistants
dans les milieux de soins aigus au Québec
Institut national de santé publique Québec (INSPQ); Comité sur les infections nosocomiales du Québec
(CINQ). Mesures de prévention et de contrôle de la transmission des bacilles Gram négatif multirésistants
dans les milieux de soins aigus au Québec. INSPQ 2015/08: 1-15.
Mots-clés : PREVENTION; BACILLE GRAM NEGATIF; MULTIRESISTANCE; ANTIBIORESISTANCE;
ENTEROBACTERIE; EPIDEMIOLOGIE; PSEUDOMONAS AERUGINOSA; ACINETOBACTER BAUMANNII;
STENOTROPHOMONAS MALTOPHILIA; DEPISTAGE; PRECAUTION COMPLEMENTAIRE
Les bacilles Gram négatif (BGN) sont des bactéries fréquemment rencontrées en clinique, tant au niveau des
flores normales qu'en tant qu'agent pathogène dans une variété d'infections. Avec l'utilisation des
antibiotiques, différents mécanismes de résistance sont apparus et certaines de ces bactéries sont
maintenant résistantes à plusieurs classes d'antibiotiques. Ce document a été élaboré dans le but d'aider les
équipes de prévention et de contrôle des infections nosocomiales (PCI) à reconnaître les bacilles Gram
négatif multirésistants (BGNMR) d'importance ainsi qu'à mettre en place les mesures de PCI pour éviter leur
transmission dans les milieux de soins aigus du Québec.
Ce document se veut d'abord une référence de base pour les centres qui ne sont pas aux prises avec une
éclosion. Alors que les mesures à mettre en place en cas d'éclosion sont souvent rapportées dans la
littérature, très peu d'articles mentionnent les mesures pour éviter la transmission hors d'un tel contexte. Les
recommandations qui suivent sont donc basées en grande partie sur l'avis du groupe de travail, des
collaborateurs et des membres du Comité sur les infections nosocomiales du Québec (CINQ). Elles tiennent
compte des données actuelles et devront être révisées selon l'évolution de l'épidémiologie et des
connaissances sur les réservoirs et la transmission.
En plus des mesures spécifiques, les pratiques de base de PCI, en particulier l'hygiène des mains, ont un
rôle primordial dans la prévention de la transmission des bactéries multirésistantes. Les pratiques
exemplaires de la campagne québécoise pour les soins sécuritaires sont un outil important dans la lutte
contre les infections par ces bactéries (INSPQ, 2014). L'antibiogouvernance a aussi un rôle important, en
limitant l'exposition des bactéries aux antibiotiques et en évitant la sélection des bactéries résistantes.
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NosoBase ID notice : 400110
Facteurs de risque de récurrence de colonisation à entérobactéries résistantes aux carbapénèmes :
une étude cas-témoin
Bart Y; Paul M; Eluk O; Geffen Y; Rabino G; Hussein K. Risk factors for recurrence of carbapenem-resistant
Enterobacteriaceae carriage: Case-control study. Infection control and hospital epidemiology 2015/08; 36(8):
936-941.
Mots-clés : ENTEROBACTERIE; CARBAPENEME; ANTIBIORESISTANCE; INFECTION NOSOCOMIALE;
COLONISATION; INFECTION RECURRENTE; FACTEUR DE RISQUE; DEPISTAGE; CAS TEMOIN
Background: The natural history of carbapenem-resistant Enterobacteriaceae (CRE) carriage and the timing
and procedures required to safely presume a CRE-free status are unclear.
Objective: To determine risk factors for recurrence of CRE among presumed CRE-free patients.
Methods: Case-control study including CRE carriers in whom CRE carriage presumably ended, following at
least 2 negative screening samples on separate days. Recurrence of CRE carriage was identified through
clinical samples and repeated rectal screening in subsequent admissions to any healthcare facility in Israel.
Patients with CRE recurrence (cases) were compared with recurrence-free patients (controls). The duration of
follow-up was 1 year for all surviving patients.
Results: Included were 276 prior CRE carriers who were declared CRE-free. Thirty-six persons (13%)
experienced recurrence of CRE carriage within a year after presumed eradication. Factors significantly
associated with CRE recurrence on multivariable analysis were the time in months between the last positive
CRE sample and presumed eradication (odds ratio, 0.94 [95% CI, 0.89-0.99] per month), presence of foreign
bodies at the time of presumed eradication (4.6 [1.64-12.85]), and recurrent admissions to healthcare facilities
during follow-up (3.15 [1.05-9.47]). The rate of CRE recurrence was 25% (11/44) when the carrier status was
presumed to be eradicated 6 months after the last known CRE-positive sample, compared with 7.5% (10/134)
if presumed to be eradicated after 1 year.
Conclusions: We suggest that the CRE-carrier status be maintained for at least 1 year following the last
positive sample. Screening of all prior CRE carriers regardless of current carriage status is advised.
NosoBase ID notice : 400848
L'alliance mondiale contre la résistance aux antibiotiques : consensus pour une déclaration
Carlet J. The world alliance against antibiotic resistance: consensus for a declaration. Clinical infectious
diseases 2015/06/15; 60(12): 1752-1759.
Mots-clés : ANTIBIORESISTANCE; PRESCRIPTION; PREVENTION
Antibiotic resistance is increasing worldwide and has become a very important threat to public health. The
overconsumption of antibiotics is the most important cause of this problem. We created a World Alliance
Against Antibiotic Resistance (WAAAR), which now includes 720 people from 55 different countries and is
supported by 145 medical societies or various groups. In June 2014, WAAAR launched a declaration against
antibiotic resistance. This article describes the process and the content of this declaration.
NosoBase ID notice : 399994
Persistance d’un clone endémique majeur de Staphylococcus lugdunensis résistant à l’oxacilline de
séquence de type 6 dans un centre hospitalier universitaire du nord de Taïwan
Cheng CW; Liu TP; Yeh CF; Lee MH; Chang SC; Lu JJ. Persistence of a major endemic clone of oxacillinresistant Staphylococcus lugdunensis sequence type 6 at a tertiary medical centre in northern Taiwan.
International journal of infectious diseases 2015/07; 36: 72-77.
Mots-clés :
ENDEMIE;
STAPHYLOCOCCUS;
ANTIBIORESISTANCE;
HOSPITALIER UNIVERSITAIRE; PFGE; TYPAGE; ETUDE RETROSPECTIVE
OXACILLINE;
CENTRE
Objectives: The aim of this study was to investigate the molecular epidemiology and clinical characteristics of
a major clone of oxacillin-resistant Staphylococcus lugdunensis in a tertiary hospital.
Methods: All S. lugdunensis isolated from sterile sites between June 2003 and May 2013 were collected for
analysis. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed to
study their genetic relationships.
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Results: A total of 118 S. lugdunensis isolates were analysed by PFGE. Three major PFGE pulsotypes were
found: A, H, and L. Most of the pulsotype A isolates were oxacillin-resistant, and SCCmec type V and type
VT. Isolates from another major clonal group that consisted primarily of pulsotype L were oxacillin-resistant
and SCCmec type II. These 14 SCCmec type II S. lugdunensis isolates demonstrated high PFGE similarity
and were obtained in the study hospital over a period of 40 months. Three of these 14 patients had clinically
significant bacteraemia, and all three cases were in the intensive care unit. Further MLST analysis of the
isolates identified an endemic S. lugdunensis strain of sequence type 6, clonal complex 1.
Conclusions: This study identified a major endemic clone of S. lugdunensis that is oxacillin-resistant,
SCCmec type II, ST6, and capable of long-term persistence in the hospital. Continuous infection control
surveillance and monitoring of S. lugdunensis should be considered in endemic areas.
NosoBase ID notice : 398321
Efficacité des précautions contact contre la transmission de microorganismes multirésistants aux
antibiotiques en soins aigus : revue systématique de la littérature
Cohen CC; Cohen B; Shang J. Effectiveness of contact precautions against multidrug-resistant organism
transmission in acute care: a systematic review of the literature. The journal of hospital infection 2015/08;
90(4): 275-284.
Mots-clés : REVUE DE LA LITTERATURE;
TRANSMISSION; PREVENTION; EFFICACITE
PRECAUTION
CONTACT;
MULTIRESISTANCE;
Contact precautions are widely recommended to prevent multidrug-resistant organism (MDRO) transmission.
However, conflicting data exist regarding their effectiveness. Prior systematic reviews examined contact
precautions as part of a larger bundled approach, limiting ability to understand their effectiveness. The aim of
this review was to characterize the effectiveness of contact precautions alone against transmission of any
MDRO among adult acute care patients. Directed by the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses statement, comprehensive searches of four electronic scientific literature databases were
conducted for studies published in English from January 2004 to June 2014. Studies were included if
interventional, original research, evaluating contact isolation precautions against MDRO transmission among
inpatients. Searches returned 284 studies, six of which were included in the review. These studies measured
four different MDROs with one study showing a reduction in transmission. Whereas studies were of high
quality regarding outcome operationalization and statistical analyses, overall quality was moderate to low due
to poor intervention description, population characterization and potential biases. Where compliance was
measured (N=4), it presented a threat to validity because it included select parts of the intervention, ranged
from 21% to 87%, and was significantly different across study phases (N=2). The poor quality of evidence on
this topic continues to limit interpretation of these data. Hence, this conflicting body of literature does not
constitute evidence for or against contact precautions. We recommend that researchers consider power
calculation, compliance monitoring, non-equivalent concurrent controls when designing future studies on this
topic.
NosoBase ID notice : 400543
Impacts de différents programmes de gestion des antibiotiques sur la consommation des
antibiotiques et l’antibiorésistance parmi des bacilles à Gram négatif communs responsables
d’infections associées aux soins : comparaison multicentrique
Lai CC; Shi ZY; Chen YH; Wang FD. Effects of various antimicrobial stewardship programs on antimicrobial
usage and resistance among common gram-negative bacilli causing healthcare-associated infections: a
multicenter comparison. Journal of microbiology, immunology and infection 2015/06/27; in press: 45 pages.
Mots-clés :
ANTIBIOTIQUE;
ANTIBIORESISTANCE;
BACILLE
GRAM
NEGATIF;
ETUDE
MULTICENTRIQUE;
CONSOMMATION;
ETUDE
RETROSPECTIVE;
CARBAPENEME;
MULTIRESISTANCE; PSEUDOMONAS AERUGINOSA; ACINETOBACTER BAUMANNII; KLEBSIELLA
PNEUMONIAE; ESCHERICHIA COLI
Backgrounds: The effects of various antimicrobial stewardship programs (ASPs) on both antibiotic
consumption and resistance among different hospitals within the same insurance system have rarely been
investigated.
Methods: This 6-year retrospective study included three medical centers with similar facilities and infection
control measures in Taiwan. These hospitals used different types of ASPs: one had a hospital-wide preauthorization requirement by infectious diseases physicians for all broad-spectrum antibiotics, covering all
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NosoVeille – Bulletin de veille
Septembre 2015
intensive care units; the second used the same program, but excluded all intensive care units, and the third
used post-prescription review only. The non-susceptibility of unduplicated isolates of gram-negative bacilli
causing healthcare-associated infections and consumption of broad-spectrum antibiotics were analyzed.
Results: Overall, the usage of broad-spectrum antibiotics of all classes escalated significantly over time in all
three hospitals, but the consumption was the lowest under hospital-wide pre-authorization program. Under
this ASP, despite a two-fold increase in the total broad-spectrum antibiotic consumption during study period,
some declining trends of resistance were found, including ciprofloxacin-resistant Pseudomonas aeruginosa
and Acinetobacter baumannii and carbapenem-resistant P. aeruginosa. In contrast, the other two hospitals
with pre-authorization program excluding all intensive care units and post-prescription review had similar high
broad-spectrum antibiotic consumption, comparable growing trends of resistant strains in general, and the
correlations of antibiotic consumption and resistance were basically positive. Carbapenem-resistant A.
baumannii increased significantly over time in all three hospitals.
Conclusions: This inter-hospital comparison suggested that hospital-wide pre-authorization program is the
most effective to reduce key gram-negative bacilli resistance, with the exception of carbapenem-resistant A.
baumannii.
NosoBase ID notice : 401803
Information concernant la colonisation ou infection par une bactérie multirésistante dans le courrier
médical de transfert
Lefebvre A; Laporte S; Tiv M; Chavanet P; Belpois-Duchamp C; Astruc K; et al. Information concerning
multidrug-resistant bacterial colonization or infection in the medical transfer letter. Médecine et maladies
infectieuses 2015/07; 45(7): 286-292.
Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; INFECTION NOSOCOMIALE; COLONISATION;
PRECAUTION COMPLEMENTAIRE; COURRIER; INFORMATIQUE; TRANSFERT; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; SARM; PSEUDOMONAS AERUGINOSA; ENTEROBACTERIE;
BETA-LACTAMASE A SPECTRE ELARGI
Objectifs : L’objectif de cette étude était d’évaluer la proportion de courriers de transfert qui comportaient les
informations relatives à la colonisation ou l’infection par une bactérie multirésistante (BMR) et les facteurs
associés à la présence de ces informations.
Patients et méthodes : Les patients pour lesquels au moins une des trois BMR suivantes (Staphylococcus
aureus résistant à la méticilline, entérobactérie productrice de bêtalactamase à spectre élargi ou
Pseudomonas aeruginosa multirésistant) était isolée pendant leur séjour et transférés dans un autre
établissement de soins entre 2009 et 2012 étaient inclus. L’information concernant la BMR et la notion de
précautions complémentaires dans le courrier de transfert était recherchée dans le dossier informatique.
Résultats : L’information (mention de BMR ou de précautions complémentaires) était présente dans 57 % [52
; 65] des dossiers. L’information complète (genre et espèce, concept de BMR et mention des précautions
complémentaires) était retrouvée dans 20 % [16 ; 25] des dossiers. La présence d’un item spécifique dans la
trame du courrier de transfert était positivement associée à la présence de l’information. L’information était
moins souvent retrouvée lorsque la BMR était un P. aeruginosa que dans les deux autres cas.
Conclusion : La présence de l’information concernant la colonisation ou l’infection par une BMR a augmenté
mais demeure insuffisante. Des mesures pour améliorer cette information sont nécessaires. En effet,
l’information constitue la première étape pour la mise en place des précautions complémentaires. Un item
pourrait être intégré à la trame de tous les courriers de sortie. Un item pourrait également être ajouté aux
indicateurs utilisés pour l’évaluation de la qualité et de la sécurité des soins dans les établissements de
santé.
NosoBase ID notice : 399650
Rôle des réseaux de surveillance face à la crise mondiale d’antibiorésistance des bactéries
Perez F; Villegas MV. The role of surveillance systems in confronting the global crisis of antibiotic-resistant
bacteria. Current opinion in infectious diseases 2015/08; 28(4): 375-383.
Mots-clés : SURVEILLANCE; ANTIBIORESISTANCE; BACILLE GRAM NEGATIF; ENTEROBACTERIE;
CARBAPENEME; KLEBSIELLA PNEUMONIAE; EPIDEMIOLOGIE; ORGANISATION MONDIALE DE LA
SANTE; PAYS EN DEVELOPPEMENT; RESEAU; PNEUMONIE; BACTERIEMIE; INFECTION URINAIRE;
MICROBIOLOGIE
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Purpose of review: It is widely accepted that infection control, advanced diagnostics, and novel therapeutics
are crucial to mitigate the impact of antibiotic-resistant bacteria. The role of global, national, and regional
surveillance systems as part of the response to the challenge posed by antibiotic resistance is not sufficiently
highlighted. We provide an overview of contemporary surveillance programs, with emphasis on gramnegative bacteria.
Recent findings: The WHO and public health agencies in Europe and the United States recently published
comprehensive surveillance reports. These highlight the emergence and dissemination of carbapenemresistant Enterobacteriaceae and other multidrug-resistant gram-negative bacteria. In Israel, public health
action to control carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae
carbapenemase producing K. pneumoniae, has advanced together with a better understanding of its
epidemiology. Surveillance models adapted to the requirements and capacities of each country are in
development.
Summary: Robust surveillance systems are essential to combat antibiotic resistance, and need to emphasize
a 'one health' approach. Refinements in surveillance will come from advances in bioinformatics and genomics
that permit the integration of global and local information about antibiotic consumption in humans and
animals, molecular mechanisms of resistance, and bacterial genotyping.
NosoBase ID notice : 400111
Résider dans un centre de soins spécialisés est associé à une non-sensibilité à la tigécycline pour les
Klebsiella pneumoniae résistantes aux carbapénèmes
van Duin D; Cober E; Richter SS; Perez F; Kalayjian RC; Salata RA; et al. Residence in skilled nursing
facilities is associated with tigecycline nonsusceptibility in carbapenem-resistant Klebsiella pneumoniae.
Infection control and hospital epidemiology 2015/08; 36(8): 942-948.
Mots-clés : KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE; CARBAPENEME; TIGECYCLINE;
INFECTION NOSOCOMIALE; FACTEUR DE RISQUE; TAUX; ETUDE PROSPECTIVE
Objective: To determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenemresistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patients
Design: Multicenter prospective observational study
Setting: Acute care hospitals participating in the Consortium on Resistance against Carbapenems in
Klebsiella pneumoniae (CRaCKle)
Patients: A cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalization
Methods: For the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient
with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included.
Clinical data were entered into a centralized database, including data regarding pre-hospital origin.
Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were
used to interpret tigecycline susceptibility testing.
Results: Of 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all
index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate
modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing
facility (OR, 2.51; 95% CI, 1.51-4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95%
CI, 1.06-3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37-17.01, P=.02).
Conclusions: In hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed
in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing
facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last
resort for treatment of CRKPs.
NosoBase ID notice : 400713
Analyse systématique de la relation entre la consommation d’antibiotiques et la résistance des
entérobactéries par bêta-lactamases à spectre étendu dans un centre hospitalier français : analyse de
séries temporelles
Vibet MA; Roux J; Montassier E; Corvec S; Juvin ME; Ngohou C; et al. Systematic analysis of the relationship
between antibiotic use and extended-spectrum beta-lactamase resistance in Enterobacteriaceae in a French
hospital: a time series analysis. European journal of clinical microbiology and infectious diseases 2015/07/24;
in press: 7 pages.
Mots-clés : ANTIBIOTIQUE; CONSOMMATION; ANTIBIORESISTANCE; BETA-LACTAMASE A SPECTRE
ELARGI; ENTEROBACTERIE; ANALYSE
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The influence of hospital use of antibiotics other than cephalosporins and fluoroquinolones on extendedspectrum beta-lactamase (ESBL) resistance among Enterobacteriaceae is poorly known. Our objective was
to explore the association between ESBL and hospital use of various classes of antibacterial agents. The
relationship between monthly use of 19 classes of antibacterial agents and incidence of nosocomial ESBLproducing Enterobacteriaceae in a French hospital was studied between 2007 and 2013. Five antibiotic
classes were significantly and independently associated with ESBL resistance. Uses of tetracyclines (link
estimate ± SE, 0.0066 ± 0.0033), lincosamides (0.0093 ± 0.0029), and other antibacterial agents
(0.0050 ± 0.0023) were associated with an increased incidence, while nitrofurantoin (-0.0188 ± 0.0062) and
ticarcillin and piperacillin with or without enzyme inhibitor (-0.0078 ± 0.0031) were associated with a
decreased incidence. In a multivariate model including 3rd- and 4th-generation cephalosporins,
fluoroquinolones, amoxicillin, and amoxicillin-clavulanate, 3rd- and 4th-generation cephalosporins
(0.0019 ± 0.0009) and fluoroquinolones (0.0020 ± 0.0008) were associated with an increased ESBL
resistance, whereas amoxicillin and amoxicillin-clavulanate were not. Hospital use of tetracyclines and
lincosamides may promote ESBL resistance in Enterobacteriaceae. Nitrofurantoin and ticarcillin and
piperacillin with or without enzyme inhibitor should be considered as potential alternatives to broad-spectrum
cephalosporins and fluoroquinolones to control the diffusion of ESBL resistance.
Arbovirus
NosoBase ID notice : 400953
Avis relatif à la prise en charge médicale des personnes atteintes par le virus Zika
Haut conseil de la santé publique (HCSP). Avis relatif à la prise en charge médicale des personnes atteintes
par le virus Zika. HCSP 2015/07/28: 1-5.
Mots-clés : VIRUS; ARBOVIRUS; EPIDEMIE; PREVENTION; DIAGNOSTIC BIOLOGIQUE; DEFINITION;
VIRUS ZIKA
Le virus Zika est un arbovirus. La transmission est presque exclusivement vectorielle par les moustiques du
genre Aedes qui sont également vecteurs de la dengue et du chikungunya.
Depuis 2007, des épidémies d’infections à virus Zika sont survenues en Micronésie, en Polynésie française,
en Nouvelle-Calédonie et une épidémie, identifiée en mai 2015, sévit actuellement au Brésil.
Le Haut conseil de la santé publique (HCSP) fait le point des connaissances sur le virus Zika, les modalités
de transmission, la situation épidémiologique, l’expression clinique des infections par ce virus et les moyens
de diagnostic biologique.
Compte tenu de la présence des moustiques vecteurs et des flux de voyageurs, le HCSP a évalué le risque
d’introduction de la maladie Zika et l’impact épidémique possible dans les départements français d’Amérique
(DFA), à La Réunion, à Mayotte ainsi que dans les départements métropolitains où Aedes albopictus est
implanté.
Le HCSP fait des recommandations en termes de stratégie de surveillance épidémiologique de la maladie
Zika, de diagnostic biologique en distinguant les zones où co-circule le virus de la dengue, et de prise en
charge des patients.
NosoBase ID notice : 400954
Prise en charge médicale des personnes atteintes par le virus Zika
Haut conseil de la santé publique (HCSP). Prise en charge médicale des personnes atteintes par le virus
Zika. HCSP 2015/07: 1-23.
Mots-clés : VIRUS; ARBOVIRUS; EPIDEMIOLOGIE; TRANSMISSION;
BIOLOGIQUE; SURVEILLANCE; SIGNALEMENT; VIRUS ZIKA
EPIDEMIE;
DIAGNOSTIC
Le virus Zika est un arbovirus. La transmission est presque exclusivement vectorielle par les moustiques du
genre Aedes qui sont également vecteurs de la dengue et du chikungunya. Depuis 2007, des épidémies
d’infections à virus Zika sont survenues en Micronésie, en Polynésie française, en Nouvelle-Calédonie et une
épidémie, identifiée en mai 2015, sévit actuellement au Brésil.
Le Haut conseil de la santé publique (HCSP) fait le point des connaissances sur le virus Zika, les modalités
de transmission, la situation épidémiologique, l’expression clinique des infections par ce virus et les moyens
de diagnostic biologique.
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Compte tenu de la présence des moustiques vecteurs et des flux de voyageurs, le HCSP a évalué le risque
d’introduction de la maladie Zika et l’impact épidémique possible dans les départements français d’Amérique
(DFA), à La Réunion, à Mayotte ainsi que dans les départements métropolitains où Aedes albopictus est
implanté.
Le HCSP fait des recommandations en termes de stratégie de surveillance épidémiologique de la maladie
Zika, de diagnostic biologique en distinguant les zones où co-circule le virus de la dengue, et de prise en
charge des patients.
Bactériémie
NosoBase ID notice : 400102
Impact du signalement obligatoire des bactériémies associées aux voies centrales sur la prescription
d’hémoculture ou d’antibiotiques dans des unités de réanimation pédiatrique et néonatale
Flett KB; Ozonoff AI; Graham DA; Sandora TJ; Priebe GP. Impact of mandatory public reporting of central
line-associated bloodstream infections on blood culture and antibiotic utilization in pediatric and neonatal
intensive care units. Infection control and hospital epidemiology 2015/08; 36(8): 878-885.
Mots-clés : SOIN INTENSIF; CATHETER VEINEUX CENTRALE; BACTERIEMIE; INFECTION
NOSOCOMIALE; PEDIATRIE; NEONATOLOGIE; HEMOCULTURE; ANTIBIOTIQUE; STATISTIQUE
Background: As mandatory public reporting of healthcare-associated infections increases, there is concern
that clinicians could attempt to decrease rates by avoiding the diagnosis of reportable infections.
Objective: To determine whether blood culture and antibiotic utilization changed after mandatory public
reporting of central line-associated bloodstream infection (CLABSI).
Design: Interrupted time-series of blood culture and antibiotic rates before and after state-specific
implementation of mandatory public reporting. We analyzed data from pediatric and neonatal intensive care
units (ICUs) at 17 children's hospitals that contributed to the Pediatric Health Information System
administrative database. We used multivariable regression with generalized linear mixed-effects models to
determine adjusted rate ratios (ARRs) after implementation of mandatory public reporting. We conducted
subgroup analysis on patients with central venous catheters. To assess temporal trends, we separately
analyzed data from 4 pediatric hospitals in states without mandatory public reporting.
Results: There was no significant effect of mandatory public reporting on rates of blood culture (pediatric ICU
ARR, 1.03 [95% CI, 0.82-1.28]; neonatal ICU ARR, 1.06 [0.85-1.33]) or antibiotic utilization (pediatric ICU
ARR, 0.86 [0.72-1.04]; neonatal ICU ARR, 1.09 [0.87-1.35]). Results were similar in the subgroup of patients
with central venous catheter codes. Hospitals with and without mandatory public reporting experienced small
decreases in blood culture and antibiotic use across the study period.
Conclusions: Mandatory public reporting of central line-associated bloodstream infection did not impact blood
culture and antibiotic utilization, suggesting that clinicians have not shifted their practice in an attempt to
detect fewer infections.
NosoBase ID notice : 400103
Probabilité de réadmission à l’hôpital parmi les patients souffrant de bactériémies nosocomiales sur
voie centrale
Khong CJ; Baggs J; Kleinbaum D; Cochran R; Jernigan JA. The likelihood of hospital readmission among
patients with hospital-onset central line-associated bloodstream infections. Infection control and hospital
epidemiology 2015/08; 36(8): 886-892.
Mots-clés : INFECTION NOSOCOMIALE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; ADMISSION;
SORTIE; COUT; ETUDE RETROSPECTIVE
Objective: To determine whether central line-associated bloodstream infections (CLABSIs) increase the
likelihood of readmission.
Design: Retrospective matched cohort study for the years 2008-2009.
Setting: Acute care hospitals.
Participants: Medicare recipients. CLABSI and readmission status were determined by linking National
Healthcare Safety Network surveillance data to the Centers for Medicare and Medicaid Services' Medical
Provider and Analysis Review in 8 states. Frequency matching was used on International Classification of
Diseases, Ninth Revision, Clinical Modification procedure code category and intensive care unit status.
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Septembre 2015
Methods: We compared the rate of readmission among patients with and without CLABSI during an index
hospitalization. Cox proportional hazard analysis was used to assess rate of readmission (the first
hospitalization within 30 days after index discharge). Multivariate models included the following covariates:
race, sex, length of index hospitalization stay, central line procedure code, Gagne comorbidity score, and
individual chronic conditions.
Results: Of the 8,097 patients, 2,260 were readmitted within 30 days (27.9%). The rate of first readmission
was 7.1 events/person-year for CLABSI patients and 4.3 events/person-year for non-CLABSI patients
(P<.001). The final model revealed a small but significant increase in the rate of 30-day readmissions for
patients with a CLABSI compared with similar non-CLABSI patients. In the first readmission for CLABSI
patients, we also observed an increase in diagnostic categories consistent with CLABSI, including septicemia
and complications of a device.
Conclusions: Our analysis found a statistically significant association between CLABSI status and
readmission, suggesting that CLABSI may have adverse health impact that extends beyond hospital
discharge.
NosoBase ID notice : 399993
Emergence à Taïwan d’un nouvel Acinetobacter baumannii ST455 résistant à l’imipénème
responsable de bactériémies chez des patients de réanimation
Lee HY; Huang CW; Chen CL; Wang YH; Chang CJ; Chiu CH. Emergence in Taiwan of novel imipenemresistant Acinetobacter baumannii ST455 causing bloodstream infection in critical patients. Journal of
microbiology, immunology and infection 2015/05/14; in press : 1-9.
Mots-clés : BACTERIEMIE; ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; CARBAPENEME;
IMIPENEME; SOIN INTENSIF; TRAITEMENT; MORTALITE; PNEUMONIE; VENTILATION ASSISTEE
Background: Acinetobacter baumannii is one of the most important nosocomial pathogens worldwide. This
study aimed to use multilocus sequence typing (MLST) for the epidemiological surveillance of A. baumannii
isolates in Taiwan and analyze the clinical presentations and patients' outcome.
Methods: MLST according to both Bartual's PubMLST and Pasteur's MLST schemes was applied to
characterize bloodstream imipenem-resistant A. baumannii (IRAB) infection in intensive care units in a
medical center. A total of 39 clinical IRAB bloodstream isolates in 2010 were enrolled. We also collected 13
imipenem-susceptible A. baumannii (ISAB) bloodstream isolates and 30 clinical sputum isolates (24 IRAB
and 6 ISAB) for comparison. Clinical presentations and outcome of the patients were analyzed.
Results: We found that infection by ST455B/ST2P and inappropriate initial therapy were statistically
significant risk factors for mortality. More than one-third of the IRAB isolates belonged to ST455B/ST2P. Most
ST455B/ST2P (80%) carried ISAba1-blaOXA-23, including 10 (66.7%) with Tn2006 (ISAba1-blaOXA-23ISAba1) in an AbaR4-type resistance island. ST455B/ST2P appears to evolve from ST208B/ST2P of clonal
complex (CC) 92B/CC2P. In this hospital-based study, A. baumannii ST455 accounted for 38.5% of IRAB
bacteremia, with a high mortality of 86.7%. Approximately 85% of ST455B/ST2P bacteremia had a primary
source of ventilation-associated pneumonia.
Conclusion: We report the emergence in Taiwan of IRAB ST455B/ST2P, which is the current predominant
clone of IRAB in our hospital and has been causing bacteremia with high mortality in critical patients.
NosoBase ID notice : 399718
Bactériémies à staphylocoques à coagulase négative : la vancomycine reste-t-elle un traitement
empirique approprié ?
Valencia-Rey P; Weinberg J; Miller N; Barlam TF. Coagulase-negative staphylococcal bloodstream infections:
Does vancomycin remain appropriate empiric therapy? Journal of infection 2015/07; 71(1): 53-60.
Mots-clés : STAPHYLOCOCCUS; STAPHYLOCOQUE A COAGULASE NEGATIVE; BACTERIEMIE;
TRAITEMENT; ANTIBIOTIQUE; VANCOMYCINE; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER
UNIVERSITAIRE; MORTALITE; CMI
Objectives: It is unknown if vancomycin minimal inhibitory concentrations (MICs) have increased in
coagulase-negative staphylococci (CoNS) or whether vancomycin remains appropriate empiric therapy.
Methods: We performed a retrospective study at a single tertiary care center over 8 years. Adult inpatients
with ≥2 positive blood cultures for CoNS within a 48-h period were eligible. Susceptibilities were performed by
automated broth based-microdilution. Changes in antimicrobial susceptibility were analyzed using logistic
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regression. The clinical characteristics and outcomes of patients with bloodstream infections (BSI) were
compared by MIC.
Results: Of 308 episodes of possible CoNS bacteremia, the vancomycin MIC was ≤1 μg/mL in 80 (26%)
isolates, 2 μg/mL in 223 (72.4%) isolates and 4 μg/mL in 5 (1.6%) isolates. No isolates were resistant. We
observed an 11-fold increased chance of having an isolate with a vancomycin MIC ≤1 μg/mL in 2009-2011
compared with 2004-2008 (OR 10.8, 95% CI 6.0-19.5, p<0.05). In 152 patients with BSI, the median days of
bacteremia, hospital mortality and readmissions at 30 days were similar in BSI caused by isolates with high
vancomycin MICs (2-4 μg/mL) and low vancomycin MICs (≤1 μg/mL).
Conclusions: We conclude vancomycin is still appropriate empiric therapy for CoNS BSIs. CoNS vancomycin
MICs decreased over the study period despite widespread use of vancomycin.
Chirurgie
NosoBase ID notice : 399644
Diarrhée chez des bénéficiaires de transplantation d’organes solides
Angarone M; Ison MG. Diarrhea in solid organ transplant recipients. Current opinion in infectious diseases
2015/08; 28(4): 308-316.
Mots-clés : DIARRHEE; TRANSPLANTATION; CHIRURGIE; DEFICIT IMMUNITAIRE; CLOSTRIDIUM
DIFFICILE; NOROVIRUS; CYTOMEGALOVIRUS; EPIDEMIOLOGIE; DIAGNOSTIC BIOLOGIQUE; REVUE
DE LA LITTERATURE
Purpose of review: Diarrhea is a common complaint in the solid organ transplant recipient. Unlike the
immune-competent patient, diarrhea in an organ transplant recipient may result in dehydration, increased
toxicity of medications, and rejection. There is a wide range of causes for diarrhea in transplant recipients, but
the most common causes are Clostridium difficile infection, cytomegalovirus, and norovirus. This review will
focus on new epidemiology data as to the cause of diarrhea in the transplant population.
Recent findings: Recent data have identified C. difficile, cytomegalovirus, and norovirus as important causes
of diarrhea in this population, and management should be focused on these causes. Newer diagnostic
platforms (such as PCR) are being evaluated, which may help in identification of the cause of diarrhea.
Summary: New epidemiologic data and new testing techniques offer an opportunity for research into better
testing strategies for transplant patients with diarrhea. These newer testing strategies may offer better insight
into the cause of diarrhea and more appropriate treatment for this illness.
NosoBase ID notice : 399992
Evaluation de l’admission lors d’un week-end sur la prévalence des états associés aux soins chez
des patients bénéficiant d’arthrodèses thoraco-lombaires
Attenello FJ; Wen T; Huang C; Cen S; Mack WJ; Acosta FL. Evaluation of weekend admission on the
prevalence of hospital acquired conditions in patients receiving thoracolumbar fusions. Journal of clinical
neuroscience 2015/08; 22(8): 1349-1354.
Mots-clés : PREVALENCE; SEJOUR; CHIRURGIE; NEUROCHIRURGIE; DUREE DE SEJOUR; RISQUE;
COHORTE; ANALYSE MULTIVARIEE; ETUDE NATIONALE
We evaluated the Nationwide Inpatient Sample (NIS) database for increased hospital acquired condition
(HAC) rate as a function of weekend admission in patients receiving thoracolumbar fusions. In 2008, the
Centers for Medicare and Medicaid Services (CMS) compiled a list of HAC for a new payment policy for
preventable adverse events without reimbursement of resulting hospital costs. In this, the thoracolumbar
patients represented a population with significant increased rates of HAC and, to our knowledge, no prior
studies have evaluated the effect of weekend admission on HAC rate. We collated data for patients who
underwent thoracolumbar fusions from the 2002-2010 NIS database. Using CMS definitions, HAC were
abstracted using the Ninth Edition of International Classification of Diseases Clinical Modification (ICD-9CM).
Multivariate analysis assessed the impact of a weekend admission on HAC occurrence and prolonged length
of stay (LOS) adjusting for patient, admission severity, and hospital covariates. There were 1,842,231 total
admissions between 2002 and 2010 associated with thoracolumbar procedures. HAC occurred at a frequency
of 5.2% overall. Surgical site infections (n=10,656) and falls/trauma (n=83,999) were the most common. After
adjusting for disease severity and urgency of admission, patients admitted on the weekend were more than
two times more likely to incur a HAC compared to those admitted on weekdays (odds ratio 2.41; 95%
confidence interval 2.19-2.65; p<0.05). HAC occurrence and weekend admission were also associated with
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Septembre 2015
prolonged LOS (p<0.05). We found that weekend admission is associated with increased HAC rate. Though
our conclusions must be tempered by limitations of the coded national database, further study is warranted to
confirm this disparity and evaluate potential for improvement.
NosoBase ID notice : 398354
Encrassement biologique des instruments électriques de chirurgie au cours de l’usage en routine
Deshpande A; Smith GWG; Smith AJ. Biofouling of surgical power tools during routine use. The journal of
hospital infection 2015/07; 90(3): 179-185.
Mots-clés : REVUE DE LA LITTERATURE; CHIRURGIE; INSTRUMENT; CONTAMINATION;
MICROBIOLOGIE; ODONTOLOGIE; DERMATOLOGIE; OPHTALMOLOGIE; NEUROCHIRURGIE;
STAPHYLOCOCCUS; ULTRA-SON; NETTOYAGE; DESINFECTION; DISPOSITIF MEDICAL; LASER;
ROBOTIQUE
Surgical power tools (SPTs) are frequently used in many surgical specialties such as dentistry, orthopaedics,
ophthalmology, neurology, and podiatry. They have complex designs that may restrict access to cleaning and
sterilization agents and frequently become contaminated with microbial and tissue residues following use.
Due to these challenges, surgical power tools can be considered the weak link in the decontamination cycle
and present a potential for iatrogenic transmission of infection. We aimed to review the existing literature on
the decontamination of surgical power tools and associated iatrogenic transmission of infection. A search of
the medical literature was performed using Ovid online using the following databases: Ovid Medline 19502014, Embase 1980-2014, and EBM Reviews Full Text - Cochrane DSR, ACP Journal Club, and Dare.
Despite challenges to decontamination processes, reported episodes of iatrogenic infection directly linked to
SPTs appear rare. This may reflect a true picture but more likely represents incomplete reporting, failure to
investigate power tools, or lack of surveillance linking surgical site infections (SSIs) to power tools. Healthcare
professionals should be aware of the complexities associated with the decontamination of different SPTs, and
should review manufacturers' reprocessing instructions prior to purchase. More clarity is required in the
manufacturers' validation of these reprocessing instructions. This particularly applies to the emerging surgical
robot systems that present extreme challenges to decontamination between uses. Investigation of crossinfection incidents or SSI surveillance should include an element of assessment of SPT decontamination to
further elucidate the contribution of SPTs to skin and soft tissue infections.
NosoBase ID notice : 400121
Evaluation de l’humidité résiduelle et du maintien de la stérilité des sets d’instruments chirurgicaux
après stérilisation
Fayard C; Lambert C; Guimier-Pingault C; Levast M; Germi R. Assessment of residual moisture and
maintenance of sterility in surgical instrument sets after sterilization. Infection control and hospital
epidemiology 2015/08; 36(8): 990-992.
Mots-clés : STERILISATION; INSTRUMENT; HUMIDITE; CONTAMINATION; AIR; CONTENEUR
Good sterilization practices include discarding items containing residual moisture after steam sterilization. In
this small laboratory study, however, the presence of residual water did not appear to compromise the sterility
of surgical instruments in 2 commonly used types of packaging during routine storage after steam
sterilization.
NosoBase ID notice : 399642
Cryptococcose chez des bénéficiaires de transplantation d’organes solides
Henao-Martinez AF; Beckham JD. Cryptococcosis in solid organ transplant recipients. Current opinion in
infectious diseases 2015/08; 28(4): 300-307.
Mots-clés : TRANSPLANTATION; CHIRURGIE; CRYPTOCOCCUS; TRAITEMENT; EPIDEMIOLOGIE;
MORTALITE; SYSTEME NERVEUX CENTRAL; APPAREIL RESPIRATOIRE; PEAU; REVUE DE LA
LITTERATURE
Purpose of review: Cryptococcosis among solid organ transplant (SOT) recipients is a source of significant
morbidity. Its pathogenesis, the etiology of immune reconstitution syndrome, and the optimal therapy in this
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Septembre 2015
setting are still not well defined. Herein, we review the epidemiology, the latest findings on pathogenesis,
unique clinical manifestations, and the treatment of Cryptococcosis in this specific vulnerable population.
Recent findings: Cryptococcosis is a common fungal complication among SOT recipients. It follows in
frequency only to aspergillosis and candidiasis. Cryptococcal infection carries a high mortality, up to 27%
during the first year posttransplantation. Host factors, environmental factors, medications, and the type of
transplant all play a role in the clinical presentation and severity of infection. Clinical manifestations can be
atypical among SOT recipients, and therefore, clinical suspicion and diagnostic evaluation must consider
cryptococcal central nervous system disease. During meningitis treatment, measurement of Flucytosine
levels is recommended to increase safety and optimize the therapeutic effect.
Summary: Cryptococcosis among SOT recipients is an evolving field. Increased recognition and
understanding of the disease pathogenesis, its uncommon clinical manifestations, complications and
particular therapeutic strategies are the cornerstone for the optimal outcome of this often fatal condition.
NosoBase ID notice : 400106
Incidence des infections du site opératoire après mastectomie avec ou sans reconstruction
immédiate à partir des demandes d’indemnisation auprès des compagnies d’assurances privées
Olsen MA; Nickel KB; Fox IK; Margenthaler JA; Ball KE; Mines D; et al. Incidence of surgical site infection
following mastectomy with and without immediate reconstruction using private insurer claims data. Infection
control and hospital epidemiology 2015/08; 36(8): 907-914.
Mots-clés : CHIRURGIE MAMMAIRE; SEIN; INCIDENCE; TAUX; INFECTION NOSOCOMIALE; ETUDE
RETROSPECTIVE; SITE OPERATOIRE
Objective: The National Healthcare Safety Network classifies breast operations as clean procedures with an
expected 1%-2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following
mastectomy with and without immediate reconstruction in a large, geographically diverse population.
Design: Retrospective cohort study
Patients: Commercially insured women aged 18-64 years with ICD-9-CM procedure or CPT-4 codes for
mastectomy from January 1, 2004 through December 31, 2011
Methods: Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The
incidences of SSI after mastectomy with and without immediate reconstruction were compared using the χ2
test.
Results: From 2004 to 2011, 18,696 mastectomy procedures among 18,085 women were identified, with
immediate reconstruction in 10,836 procedures (58%). The incidence of SSI within 180 days following
mastectomy with or without reconstruction was 8.1% (1,520 of 18,696). In total, 49% of SSIs were identified
within 30 days post-mastectomy, 24.5% were identified 31-60 days post-mastectomy, 10.5% were identified
61-90 days post-mastectomy, and 15.7% were identified 91-180 days post-mastectomy. The incidences of
SSI were 5.0% (395 of 7,860) after mastectomy only, 10.3% (848 of 8,217) after mastectomy plus implant,
10.7% (207 of 1,942) after mastectomy plus flap, and 10.3% (70 of 677) after mastectomy plus flap and
implant (P<.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with immediate
reconstruction (11.4% vs 9.4%, P=.001) than without (6.1% vs 4.7%, P=.021) immediate reconstruction.
Conclusions: SSI incidence was twice that after mastectomy with immediate reconstruction than after
mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest that
stratification by procedure type facilitates comparison of SSI rates after breast operations between facilities.
NosoBase ID notice : 399648
Mythes sur le bloc opératoire : sur quelles preuves reposent ces pratiques courantes ?
Pada S; Perl TM. Operating room myths: what is the evidence for common practices. Current opinion in
infectious diseases 2015/08; 28(4): 369-374.
Mots-clés : BLOC OPERATOIRE; PRATIQUE; AIR; PREVENTION; FLUX LAMINAIRE; PREUVE;
MEDECINE FACTUELLE; BRUIT
Purpose of review: In order to ensure patient safety and prevent surgical site infections (SSIs), operating
theaters/rooms have evolved into complex, highly technical environments. Prevention of healthcareassociated infections, and strategies to limit patient harm, have gained momentum over the last decade. This
article aims to examine and dispute some commonly held beliefs with specific reference to: laminar airflow,
noise and operating theater door openings and how these impact SSI.
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Septembre 2015
Recent findings: Laminar airflow may not be necessary for prosthetic implant surgery. Some recent data
suggest that there may be patient harm. With the development of better surgical techniques and perioperative
care, such costly systems may not be needed. Operating rooms with a high number of door openings have
also been shown to experience higher SSI rates, as have operating rooms with high noise levels. These may
serve as surrogate markers for operating room discipline. Initiatives which target these areas may be worth
considering when devising strategies to reduce SSIs.
Summary: Improved surveillance systems for SSIs are needed and should include operating theater airflow
type. This will allow further analysis of the effect of laminar air flow on SSIs and provide evidence for a
decisive recommendation. Cultivating a culture of good operating theater discipline may also reduce SSIs.
NosoBase ID notice : 400814
Traitement médical des infections sur greffes vasculaires prosthétiques : revue de la littérature et
propositions d’un groupe de travail
Revest M; Camou F; Senneville E; Caillon J; Laurent F; Calvet B; et al. Medical treatment of prosthetic
vascular graft infections: Review of the literature and proposals of a Working Group. International journal of
antimicrobial agents 2015/09; 46(3): 254-265.
Mots-clés : TRAITEMENT; CHIRURGIE CARDIO-VASCULAIRE; MATERIEL ETRANGER; ANTIBIOTIQUE;
STAPHYLOCOCCUS AUREUS; BACILLE GRAM NEGATIF; ESCHERICHIA COLI; STREPTOCOCCUS;
ENTEROCOCCUS; ENTEROBACTERIE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA
LITTERATURE
More than 400000 vascular grafts are inserted annually in the USA. Graft insertion is complicated by infection
in 0.5-4% of cases. Vascular graft infections (VGIs) are becoming one of the most frequent prosthesis-related
infections and are associated with considerable mortality, ranging from 10 to 25% within 30 days following the
diagnosis. Treatment of VGI is based on urgent surgical removal of the infected graft followed by prolonged
antibiotherapy. Data regarding the best antibiotherapy to use are lacking since no well designed trial to study
antimicrobial treatment of VGI exists. Moreover, since VGIs demonstrate very specific pathophysiology,
guidelines on other material-related infections or infective endocarditis treatment cannot be entirely applied to
VGI. A French multidisciplinary group gathering infectious diseases specialists, anaesthesiologists,
intensivists, microbiologists, radiologists and vascular surgeons was created to review the literature dealing
with VGI and to make some proposals regarding empirical and documented antibiotic therapy for these
infections. This article reveals these proposals.
NosoBase ID notice : 400857
Efficacité d'éponges de collagène imprégnées de gentamicine pour la prévention des infections du
site opératoire après arthroplastie de la hanche : essai randomisé multicentrique
Westberg M; Frihagen F; Brun OC; Figved W; Grøgaard B; Valland H; et al. Effectiveness of gentamicincontaining collagen sponges for prevention of surgical site infection after hip arthroplasty: a multicenter
randomized trial. Clinical infectious diseases 2015/06/15; 60(12): 1837-1841.
Mots-clés : SITE OPERATOIRE; INFECTION NOSOCOMIALE; ANTIBIOPROPHYLAXIE; HANCHE;
RANDOMISATION; ANALYSE MULTICENTRIQUE; GENTAMICINE
In 2012, dozens of patients of Exeter Hospital in New Hampshire contracted new hepatitis C infections that
were tracked back to a cardiac technician who ultimately confessed to drug diversion. A multistate
epidemiological investigation of hepatitis C cases occurring in multiple hospitals revealed that the technician
had been fired from prior institutions due to similar drug diversion activity, about which Exeter Hospital had
not been notified. In this article, we highlight the institutional ethical issues raised by this outbreak, and
propose a national centralized reporting system to support institutional fulfillment of the ethical obligation to
protect the health of patients by preventing such nosocomial outbreaks
NosoBase ID notice : 400827
Le diabète sucré est associé à un risque augmenté d’infections du site opératoire : méta-analyse
d’études de cohorte prospectives
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Septembre 2015
Zhang Y; Zheng QJ; Wang S; Zeng SX; Zhang YP; Bai XJ; et al. Diabetes mellitus is associated with
increased risk of surgical site infections: A meta-analysis of prospective cohort studies. American journal of
infection control 2015/08; 43(8): 810-815.
Mots-clés : DIABETE; FACTEUR DE RISQUE; COHORTE; ETUDE PROSPECTIVE; META-ANALYSE;
CHIRURGIE; SITE OPERATOIRE
Background and Objective: Observational studies have suggested an association between diabetes mellitus
and the risk of surgical site infections (SSIs), but the results remain inconclusive. We conducted a
metaanalysis of prospective cohort studies to elucidate the relationship between diabetes mellitus and SSIs.
Methods: We searched PubMed, Embase, and Web of Science databases and reviewed the reference lists of
the retrieved articles to identify relevant studies. Associations were tested in subgroups representing different
patient characteristics and study quality criteria. The random-effect model was used to calculate the overall
relative risk (RR).
Results: Fourteen prospective cohort studies (N=91,094 participants) were included in this metaanalysis, and
the pooled crude RR was 2.02 (95% confidence interval, 1.68-2.43) with significant between-study
heterogeneity observed (I(2)=56.50%). Significant association was also detected after we derived adjusted
RRs for studies not reporting the adjusted RRs and calculated the combined adjusted RR of the 14 studies
(RR, 1.69; 95% confidence interval, 1.33-2.13). Results were consistent and statistically significant in all
subgroups. Stratified analyses found the number of confounders adjusted for, sample size, and method of
diabetes case ascertainment might be the potential sources of heterogeneity. Sensitivity analysis further
demonstrated the robustness of the result.
Conclusions: This meta-analysis suggests diabetes mellitus is significantly associated with increased risk of
SSIs. Future studies are encouraged to reveal the mechanisms underlying this association.
Clostridium difficile
NosoBase ID notice : 401742
Actualités épidémiologiques et thérapeutiques des infections à Clostridium difficile
Dinh A; Bouchand F; Le Monnier A. Actualités épidémiologiques et thérapeutiques des infections à
Clostridium difficile. La Revue de médecine interne 2015/09; 36(9): 596-602.
Mots-clés :
CLOSTRIDIUM
DIFFICILE;
EPIDEMIOLOGIE;
VANCOMYCINE; TRAITEMENT; TRANSPLANTATION FECALE
INCIDENCE;
METRONIDAZOLE;
Les infections à Clostridium difficile (ICD) sont devenues au cours de cette dernière décennie un problème de
santé publique important. D’une part, leur épidémiologie a été profondément modifiée avec une augmentation
du nombre total de cas, des taux plus élevés de formes sévères et récidivantes, et des échecs plus fréquents
des traitements conventionnels. D’autre part, on constate une extension des ICD à la population
communautaire et aux populations exemptes des facteurs de risque habituels (absence d’exposition aux
antibiotiques, population jeune, femmes enceintes, etc.). Ces modifications sont en partie liées à l’émergence
du clone hypervirulent et hyperépidémique NAP1/BI/027. De nouvelles stratégies thérapeutiques
(antibiotiques, immunoglobulines, résines chélatrices, transplantation de flore fécale) ont fait leur apparition et
les traitements classiquement utilisés (métronidazole et vancomycine) ont été réévalués avec de nouvelles
recommandations. Les études récentes montrent une efficacité supérieure de la vancomycine par rapport au
métronidazole notamment pour les formes sévères. Par ailleurs, la fidaxomicine, un nouvel antibiotique
récemment commercialisé, présente des caractéristiques intéressantes et son efficacité clinique s’est révélée
non inférieure à celle de la vancomycine avec une meilleure prévention des récidives. Enfin, dans les cas de
récidives multiples, la transplantation fécale semble être la stratégie de choix. Nous présentons les
différentes données disponibles à notre connaissance dans cette revue.
NosoBase ID notice : 397936
Optimiser les tests de diagnostic de Clostridium difficile : perception des médecins et des infirmiers
sur le moment où il faut demander le test de Clostridium difficile
Blakney R; Yanke E; Fink C; Wigton R; Safdar N. Optimizing diagnostic testing for Clostridium difficile: The
perceptions of physicians and nurses on when to order testing for C difficile. American journal of infection
control 2015/08; 43(8): 889-891.
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Mots-clés : CLOSTRIDIUM DIFFICILE; DIAGNOSTIC BIOLOGIQUE; MEDECIN; INFIRMIER;
PERSONNEL; AIDE A LA DECISION; SELLES; PCR; FACTEUR DE RISQUE; ANTIBIOTIQUE
Physicians and nurses at a single hospital were surveyed on which risk factors were most important in
deciding to order Clostridium difficile diagnostic testing. Disagreement between physicians and nurses on the
relative importance of several of the risk factors warrants further investigation.
NosoBase ID notice : 400917
Emergence d’infections à Clostridium difficile d’origine communautaire : expérience d’un centre
hospitalier français et revue de la littérature
Ogielska M; Lanotte P; Le Brun C; Valentin AS; Garot D; Tellier AC; et al. Emergence of community-acquired
Clostridium difficile infection: the experience of a French hospital and review of the literature. International
journal of infectious diseases 2015/06/17; 37: 36-41.
Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION COMMUNAUTAIRE; ETUDE RETROSPECTIVE;
FACTEUR DE RISQUE; ANTIBIOTIQUE; SOIN INTENSIF; DIARRHEE
Background: Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the
general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of
morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI).
Methods: The cases of 136 adult patients with CDI treated at the University Hospital of Tours, France
between 2008 and 2012 are described. This was a retrospective study.
Results: Among the 136 patients included, 62 were men and 74 were women. Their median age was 64.4
years (range 18-97 years). Twenty-six of the 136 (19%) cases were community-acquired (CA) and 110 (81%)
were healthcare-acquired (HCA). The major risk factors for both groups were long-term treatment with proton
pump inhibitors (54% of CA, 53% of HCA patients) and antibiotic treatment within the 2.5 months preceding
the CDI (50% of CA, 91% of HCA). The CSI was higher in the CA-CDI group (1.56) than in the HCA-CDI
group (1.39). Intensive care was required for 8% of CA-CDI and 16.5% of HCA-CDI patients.
Conclusions: CDI can cause community-acquired diarrhoea, and CA-CDI may be more severe than HCACDI. Prospective studies of CDI involving people from the general community without risk factors are required
to confirm this observation.
NosoBase ID notice : 400115
Infections à Clostridium difficile aux Etats-Unis : une étude nationale pour évaluer les pratiques de
prévention mises en place et la perception des preuves de ces pratiques
Saint S; Fowler KE; Krein SL; Ratz D; Flanders SA; Dubberke ER; et al. Clostridium difficile infection in the
United States: A national study assessing preventive practices used and perceptions of practice evidence.
Infection control and hospital epidemiology 2015/08; 36(8): 969-971.
Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION; INFECTION NOSOCOMIALE;
HOSPITALIERE; PRATIQUE; PERCEPTION; EVALUATION; ANTIBIOTIQUE
HYGIENE
We surveyed 571 US hospitals about practices used to prevent Clostridium difficile infection (CDI). Most
hospitals reported regularly using key CDI prevention practices, and perceived their strength of evidence as
high. The largest discrepancy between regular use and perceived evidence strength occurred with
antimicrobial stewardship programs.
NosoBase ID notice : 400104
Identifier une infection à Clostridium difficile récurrente à partir des codes administratifs : fiabilité et
implications pour les surveillances
Wen J; Barber GE; Ananthakrishnan AN. Identification of recurrent Clostridium difficile infection using
administrative codes: Accuracy and implications for surveillance. Infection control and hospital epidemiology
2015/08; 36(8): 893-898.
Mots-clés : CLOSTRIDIUM DIFFICILE; SURVEILLANCE; INFECTION RECURRENTE; INFECTION
NOSOCOMIALE; INFORMATIQUE; ALGORITHME; DIAGNOSTIC BIOLOGIQUE
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Objective: To develop an algorithm using administrative codes, laboratory data, and medication data to
identify recurrent Clostridium difficile infection (CDI) and to examine the sensitivity, specificity, positive and
negative predictive values, and performance of this algorithm.
Methods: We identified all patients with 2 or more International Classification of Diseases, Ninth Edition,
Clinical Modification (ICD-9-CM) codes for CDI (008.45) from January 1 through December 31, 2013.
Information on number of diagnosis codes, stool toxin assays (enzyme immunoassay or polymerase chain
reaction), and unique prescriptions for metronidazole and vancomycin was identified. Logistic regression was
used to identify independent predictors of recurrent CDI and a predictive model was developed.
Results: A total of 591 patients with at least 2 ICD-9 codes for CDI were included (median age, 66 years). The
derivation cohort consisted of 157 patients among whom 43 (27%) had recurrent CDI. Presence of 3 or more
ICD-9 codes for CDI (odds ratio, 2.49), 2 or more stool tests (odds ratio, 2.88), and 2 or more prescriptions for
vancomycin (odds ratio, 5.87) were independently associated with confirmed recurrent CDI. A classifier
incorporating 2 or more prescriptions for vancomycin and either 2 or more stool tests or 3 or more ICD-9-CM
codes had a positive predictive value of 41% and negative predictive value of 90%. The area under the
receiver operating characteristic curve for this combined classifier was modest (0.69).
Conclusion: Identification of recurrent episodes of CDI in administrative data poses challenges. Accurate
assessment of burden requires individual case review to confirm diagnosis.
Coronavirus
NosoBase ID notice : 399764
Rôle de la « superpropagation » dans la transmission du syndrome respiratoire à coronavirus du
Moyen-Orient (MERS-CoV)
Kucharski AJ; Althaus CL. The role of superspreading in Middle East respiratory syndrome coronavirus
(MERS-CoV) transmission. Eurosurveillance 2015/06/25; 20(25): 1-5.
Mots-clés : CORONAVIRUS; EPIDEMIOLOGIE; TRANSMISSION; INFECTION VIRALE; STATISTIQUE;
MERS-CoV
As at 15 June 2015, a large transmission cluster of Middle East respiratory syndrome coronavirus (MERSCoV) was ongoing in South Korea. To examine the potential for such events, we estimated the level of
heterogeneity in MERS-CoV transmission by analysing data on cluster size distributions. We found
substantial potential for superspreading; even though it is likely that R0 < 1 overall, our analysis indicates that
cluster sizes of over 150 cases are not unexpected for MERS-CoV infection.
Coût
NosoBase ID notice : 400101
Impact de la politique se rapportant aux conditions de déclaration d’infections nosocomiales mise en
place par les centres « Medicare » et « Medicaid » sur les taux de facturation de 2 infections
associées aux soins ciblées
Kawai AT; Calderwood MS; Jin R; Soumerai SB; Vaz LE; Goldmann DA; et al. Impact of the centers for
medicare and medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcareassociated infections. Infection control and hospital epidemiology 2015/08; 36(8): 871-877.
Mots-clés : INFECTION NOSOCOMIALE; COUT; CATHETER
INFECTION URINAIRE; TAUX
VEINEUX; SONDAGE
URINAIRE;
Background: The 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited
additional payment for conditions deemed reasonably preventable.
Objective: To examine whether this policy was associated with decreases in billing rates for 2 targeted
conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections
(CAUTI).
Study population: Adult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts,
or New York and subject to the policy.
Design: We used an interrupted times series design to assess whether the hospital-acquired conditions policy
was associated with changes in billing rates for VCAI and CAUTI.
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Septembre 2015
Results: Before the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter
for VCAI, 1.17 [95% CI, 1.11-1.23]; for CAUTI, 1.19 [1.16-1.23]). The policy was associated with an
immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI,
0.75 [95% CI, 0.69-0.81]; for CAUTI, 0.87 [0.79-0.96]). In the postpolicy period, we observed a decreasing
trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per
quarter for VCAI, 0.98 [95% CI, 0.97-0.99]; for CAUTI, 0.99 [0.97-1.00]).
Conclusions: The Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to
have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight
decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in
clinically meaningful patient outcomes and may reflect changes in coding practices.
Ebola
NosoBase ID notice : 400951
Avis : Stratégie de classement des patients « cas suspects » de maladie à virus Ebola
Haut Conseil de la santé publique (HCSP). Avis : Stratégie de classement des patients « cas suspects » de
maladie à virus Ebola. HCSP 2015/07/08 : 1-5.
Mots-clés : FIEVRE HEMORRAGIQUE; DIAGNOSTIC BIOLOGIQUE; TEST; EBOLA
Le Haut Conseil de la santé publique (HCSP) rappelle la définition des cas de maladie à virus Ebola –
suspect, possible, confirmé, exclu – et les modalités de diagnostic biologique de maladie à virus Ebola.
Il a pris en considération les données de surveillance épidémiologique en Afrique de l’Ouest, l’expérience de
la gestion des cas « suspects » et « possibles » en France et les spécificités de prise en charge des deux
grands types de patients susceptibles de constituer des cas « suspects » : les personnes migrantes
originaires d’Afrique de l’Ouest et les personnels français revenant de mission. Le HCSP a également pris en
compte les données concernant le test de diagnostic rapide « Altona ® ».
Le Haut Conseil de la santé publique recommande de privilégier l’analyse et la décision collégiale pour
l’interprétation des éléments anamnestiques et cliniques afin de conduire à un classement en « cas possible
» ou « exclu ». Il encourage le déploiement du kit « Altona® » ou tout kit de diagnostic rapide par RT-PCR
accompagné d’une procédure et d’une formation validées. Il précise la conduite à tenir en fonction des
résultats de ce test de diagnostic rapide en termes de confirmation biologique et de levée de l’isolement.
Enfin le HCSP indique que le contexte du développement du kit « Altona® » en lien avec le Centre national de
référence d’une part, et l’évolution de l’épidémie en Afrique de l’Ouest et du nombre de recours aux
établissements de santé de référence habilités (ESRH) en France d’autre part, ne justifient plus actuellement
une modification des définitions à ce stade de l’épidémie.
EHPAD
NosoBase ID notice : 400109
Bactéries multirésistantes à bacilles gram négatif : inter et intra-dissémination dans des EHPAD pour
résidents souffrant de démence avancée
D'Agata EM; Habtemariam D; Mitchell S. Multidrug-resistant gram-negative bacteria: Inter- and
intradissemination among nursing homes of residents with advanced dementia. Infection control and hospital
epidemiology 2015/08; 36(8): 930-935.
Mots-clés : MULTIRESISTANCE; ANTIBIORESISTANCE; INFECTION NOSOCOMIALE; BACILLE GRAM
NEGATIF; COLONISATION; TRANSMISSION; DEMENCE; EHPAD; PRELEVEMENT; PFGE; ETUDE
PROSPECTIVE
Objective: To quantify the extent of inter- and intra-nursing home transmission of multidrug-resistant gramnegative bacteria (MDRGN) among residents with advanced dementia and characterize MDRGN colonization
among these residents.
Design: Prospective cohort study.
Setting: Twenty-two nursing homes in the greater Boston, Massachusetts, area.
Patients: Residents with advanced dementia.
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Methods: Serial rectal surveillance cultures for MDRGN and resident characteristics were obtained every 3
months for 12 months or until death. Molecular typing of MDRGN isolates was performed by pulsed-field gel
electrophoresis.
Results: A total of 190 MDRGN isolates from 152 residents with advanced dementia were included in the
analyses. Both intra- and inter-nursing home transmission were identified. Genetically related MDRGN
strains, recovered from different residents, were detected in 18 (82%) of the 22 nursing homes. The percent
of clonally related strains in these nursing homes ranged from 0% to 86% (average, 35%). More than 50% of
strains were clonally related in 3 nursing homes. Co-colonization with more than 1 different MDRGN species
occurred among 28 residents (18.4%). A total of 168 (88.4%), 20 (10.5%), and 2 (1.0%) of MDRGN isolates
were resistant to 3, 4, and 5 different antimicrobials or antimicrobial classes, respectively.
Conclusions: MDRGN are spread both within and between nursing homes among residents with advanced
dementia. Infection control interventions should begin to target this high-risk group of nursing home residents.
NosoBase ID notice : 399754
Prévalence actuelle des bactéries multirésistantes dans des établissements de soins de longue durée
dans la région du Rhin-Main, Allemagne, 2013
Hogardt M; Proba P; Mischler D; Cuny C; Kempf VA;Heudorf U. Current prevalence of multidrug-resistant
organisms in long-term care facilities in the Rhine-Main district, Germany, 2013. Eurosurveillance 2015/07/02;
20(26): 1-6.
Mots-clés : SURVEILLANCE; MULTIRESISTANCE; PREVALENCE; MAISON DE RETRAITE; GERIATRIE
Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms
(MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in
long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the
German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and
perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were
analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycinresistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and
455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE
were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history,
the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic
therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this
study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN
carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not
been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge.
Endoscopie
NosoBase ID notice : 400825
Contamination persistante de colonoscopes et de gastroscopes détectée par des cultures
biologiques et des indicateurs rapides malgré un traitement effectué en accord avec les
recommandations
Ofstead CL; Wetzler HP; Doyle EM; Rocco CK; Visrodia KH; Baron TH; et al. Persistent contamination on
colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing
performed in accordance with guidelines. American journal of infection control 2015/08; 43(8): 794-801.
Mots-clés : CONTAMINATION;
NETTOYAGE; DESINFECTION
ENDOSCOPIE;
RECOMMANDATIONS
DE
BONNE
PRATIQUE;
Background: Pathogens have been transmitted via flexible endoscopes that were reportedly reprocessed in
accordance with guidelines.
Methods: Researchers observed reprocessing activities to ensure guideline compliance in a large
gastrointestinal endoscopy unit. Contamination was assessed immediately after bedside cleaning, manual
cleaning, high-level disinfection, and overnight storage via visual inspection, aerobic cultures, and tests for
adenosine triphosphate (ATP), protein, carbohydrate, and hemoglobin.
Results: All colonoscopes and gastroscopes were reprocessed in accordance with guidelines during the
study. Researchers collected and tested samples during 60 encounters with 15 endoscopes. Viable microbes
were recovered from bedside-cleaned (92%), manually cleaned (46%), high-level disinfected (64%), and
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Septembre 2015
stored (9%) endoscopes. Rapid indicator tests detected contamination (protein, carbohydrate, hemoglobin, or
ATP) above benchmarks on bedside-cleaned (100%), manually cleaned (92%), high-level disinfected (73%),
and stored (82%) endoscopes. Visible residue was never observed on endoscopes, but it was often seen on
materials used to sample endoscopes. Seven endoscopes underwent additional reprocessing in response to
positive rapid indicators. Control endoscope channels were free of biologic residue and viable microbes.
Conclusion: Despite reprocessing in accordance with US guidelines, viable microbes and biologic debris
persisted on clinically used gastrointestinal endoscopes, suggesting current reprocessing guidelines are not
sufficient to ensure successful decontamination.
Epidémie
NosoBase ID notice : 399991
Epidémies à bactéries multirésistantes aux antibiotiques dans des unités pour brûlés : synthèse de la
littérature selon la méthode ORION
Girerd-Genessay I; Bénet T; Vanhems P. Multidrug-resistant bacterial outbreaks in burn units: A synthesis of
the literature according to the ORION statement. Journal of burn care & research 2015/05/28; in press: 1-9.
Mots-clés :
BRULE;
EPIDEMIE;
MULTIRESISTANCE;
ANTIBIORESISTANCE;
DEPISTAGE;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ACINETOBACTER BAUMANNII; FACTEUR
DE RISQUE; PERSONNEL
The objective of this study is to review the literature on multidrug-resistant bacteria (MDRB) outbreaks in burn
units according to the outbreak reports and intervention studies of nosocomial infection statement. A PubMed
search engine was enlisted to identify reports, in English and French, on MDRB outbreaks in burn units, with
no date restrictions, using the following key words: ("burn" OR "burns" OR "severe burn") AND ("unit" OR
"critical care" OR "acute care" OR "intensive care" OR "center" OR "centre" OR "department") AND
("outbreak" OR "epidemic") AND ("resistant" OR "multidrug-resistant" OR "resistance" OR "MDR" OR
"MDRO"). Twenty-nine articles on such outbreaks in burn units were analyzed. A wide variety of these
outbreaks were studied in terms of the microbial agents involved, length of outbreak, and attack rate (1.966.7%). The most frequent bacteria were methicillin-resistant Staphylococcus aureus and Acinetobacter
baumannii. Screening of staff revealed carrier rates of 0 to 20% in 16 studies. Environmental samples were
taken in 21 studies and were positive in 14 of them. The mortality rate among infected patients varied from 0
to 33%. Implementation of isolation precautions did not always suffice, with unit closure being necessary in
five outbreaks. The lack of consensus on how to manage such outbreak was highlighted. MDRB infections or
colonizations are responsible for increased morbidity and mortality in vulnerable burn patients. Their
management is problematic because of multifactorial transmission and limited therapeutic possibilities.
NosoBase ID notice : 400852
Transfert horizontal in vivo de la carbapénèmase OXA-48 lors d'une épidémie nosocomiale
Göttig S; Gruber TM; Stecher B; Wichelhaus TA; Kempf VA. In vivo horizontal gene transfer of the
carbapenemase OXA-48 during a nosocomial outbreak. Clinical infectious diseases 2015/06/15; 60(12):
1808-1815.
Mots-clés : ANTIBIORESISTANCE; KLEBSIELLA PNEUMONIAE; ESCHERICHIA COLI; EPIDEMIE; BETALACTAMASE A SPECTRE ELARGI; CARBAPENEME; BIOLOGIE MOLECULAIRE
Background: OXA-48 is a highly prevalent carbapenemase and has been isolated worldwide. Here, we
investigate the in vivo horizontal gene transfer (HGT) of blaOXA-48 from Klebsiella pneumoniae to
Escherichia coli in an infected patient.
Methods: Bacterial isolates were characterized by susceptibility testing, multilocus sequence typing,
DiversiLab, and plasmid analyses. Transferability of blaOXA-48 was evaluated by in vitro transconjugation
using the outbreak strain and E. coli J53. In vivo transconjugation was investigated using the larvae of the
greater wax moth (Galleria mellonella) and low-complexity-microbiota mice.
Results: OXA-48-harboring K. pneumoniae isolates belonging to ST14 were isolated during a nosocomial
outbreak from 6 patients. Molecular and epidemiological analyses revealed the HGT of an approximately 60kb OXA-48-containing IncL/M-type plasmid from K. pneumoniae to E. coli belonging to the novel ST666 in a
patient. In vitro conjugation experiments revealed a transconjugation frequency of 8.7 × 10(-7). HGT of OXA48 in a newly developed in vivo model using G. mellonella larvae revealed a higher transconjugation
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Septembre 2015
frequency of 1.3 × 10(-4). The conjugation frequency of OXA-48 from K. pneumoniae and E. coli in the gut of
low-complexity-microbiota mice was determined to be 2.9 × 10(-5).
Conclusions: The in vivo intergenus gene transfer of OXA-48 in the gut of an infected patient was verified in
vitro and in 2 in vivo models, which both showed even higher transmission frequencies vs in vitro conditions.
This implies that the current in vitro protocols might not correctly reflect the HGT of carbapenemase genes in
vivo
NosoBase ID notice : 400186
Enquête épidémiologique sur une épidémie nosocomiale d’Acinetobacter baumannii multirésistant
aux antibiotiques dans un centre de réanimation au Japon, 2011-2012
Ushizawa H; Yahata Y; Endo T; Iwashima T; Misawa M; Sonobe M; et al. An epidemiological investigation of
a nosocomial outbreak of multidrug-resistant Acinetobacter baumannii in a critical care center in Japan, 20112012. Japanese journal of infectious diseases 2015/06/12; in press: 22 pages.
Mots-clés : ENQUETE; EPIDEMIOLOGIE; ACINETOBACTER BAUMANNII; EPIDEMIE; SOIN INTENSIF;
MULTIRESISTANCE; CENTRE HOSPITALIER UNIVERSITAIRE; FACTEUR DE RISQUE; CAS TEMOIN;
CARBAPENEME; PFGE; TYPAGE
In 2011, a multidrug-resistant Acinetobacter baumannii (MDRAB) outbreak occurred at a critical care center
(CCC) in a tertiary hospital in Japan. Multidrug-resistance is defined as resistance to amikacin, carbapenem,
and fluoroquinolone. We conducted an epidemiological investigation of this outbreak to identify risk factors for
MDRAB respiratory tract acquisition in this hospital. A case was defined as a hospitalized patient whose
culture was MDRAB positive at least 3 days after admission to the CCC between June 1, 2011 and April 20,
2012. Fifteen MDRAB cases were identified, including three with infection and 12 with colonization. This
case-control study demonstrated that hypoalbuminemia and carbapenem administration were associated with
MDRAB respiratory tract acquisition. Pulsed-field gel electrophoresis analysis and multilocus sequence typing
using MDRAB isolates suggested a clonal dissemination of MDRAB strain with sequence type 74 among
patients admitted primarily to the CCC. Introduction of control measures from April 16, 2012, including the
closure of the emergency room and interruption of admission to the CCC, isolation of patients with MDRAB
colonization or infection within a single room, and environmental cleaning, decreased the isolation rate of
MDRAB in the hospital. No MDRAB case was detected between March 23 and April 20, 2012.
NosoBase ID notice : 400174
Epidémie de Klebsiella pneumoniae résistant à la colistine productrices de carbapénèmase type
Klebsiella pneumoniae (KPC) aux Pays-Bas (juillet à décembre 2013) avec une dissémination interétablissements
Weterings V; Zhou K; Rossen JW; van Stenis D; Thewessen E; Kluytmans J; et al. An outbreak of colistinresistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to
December 2013), with inter-institutional spread. European journal of clinical microbiology and infectious
diseases 2015/08; 34(8): 1647-1655.
Mots-clés :
EPIDEMIE;
ANTIBIORESISTANCE;
CARBAPENEME;
COLISTINE;
KLEBSIELLA
PNEUMONIAE; ETUDE MULTICENTRIQUE; CENTRE HOSPITALIER UNIVERSITAIRE; SOIN DE LONGUE
DUREE; TRANSMISSION; BIOLOGIE MOLECULAIRE; ENQUETE; ENVIRONNEMENT; CONTAMINATION;
TYPAGE; PRECAUTION COMPLEMENTAIRE; PRECAUTION CONTACT; VOYAGE; CARBAPENEMASE
We describe an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae
(KPC-KP) ST258 that occurred in two institutions (a hospital and a nursing home) in the Netherlands between
July and December 2013. In total, six patients were found to be positive for KPC-KP. All isolates were
resistant to colistin and exhibited reduced susceptibility to gentamicin and tigecycline. In all settings,
extensive environmental contamination was found. Whole genome sequencing revealed the presence of bla
KPC-2 and bla SHV-12 genes, as well as the close relatedness of patient and environmental isolates. In the
hospital setting, one transmission was detected, despite contact precautions. After upgrading to strict
isolation, no further spread was found. After the transfer of the index patient to a nursing home in the same
region, four further transmissions occurred. The outbreak in the nursing home was controlled by transferring
all KPC-KP-positive residents to a separate location outside the nursing home, where a dedicated nursing
team cared for patients. This outbreak illustrates that the spread of pan-resistant Enterobacteriaceae can be
controlled, but may be difficult, particularly in long-term care facilities. It, therefore, poses a major threat to
patient safety. Clear guidelines to control reservoirs in and outside the hospitals are urgently needed.
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Gestion des risques
NosoBase ID notice : 401744
Sécurisation de la perfusion en milieu hospitalier : de l’analyse de risques a priori au plan d’action
d’amélioration des pratiques
Pignard J; Cosserant S; Traoré O; Souweine B; Sautou V. Sécurisation de la perfusion en milieu hospitalier :
de l’analyse de risques a priori au plan d’action d’amélioration des pratiques. Annales pharmaceutiques
françaises 2015/09; in press: 1-11.
Mots-clés : PERFUSION; ANALYSE DES RISQUES; GESTION DES RISQUES; HYGIENE DES MAINS;
PRECAUTION STANDARD
Objectifs : La perfusion en service de soins, a fortiori en réanimation, est un processus complexe pouvant
être à l’origine de nombreux risques pour le patient. Dans le cadre de la démarche institutionnelle
d’amélioration de la qualité et de la sécurité des soins, une cartographie des risques liés à la perfusion a été
réalisée.
Methodes : L’analyse a ciblé les situations de perfusion intraveineuses chez l’adulte, la méthode d’évaluation
des risques a priori a été appliquée et un groupe de travail multidisciplinaire constitué.
Résultats : Pour l’ensemble du processus de perfusion (prescription, préparation et administration), 43
risques ont été identifiés. L’évaluation de ces risques et des moyens de maîtrise existants a montré que 48 %
d’entre eux avaient une forte criticité nette pour le patient. Des actions correctives et/ou préventives ont été
mises en oeuvre pour les 20 risques considérés comme les plus critiques pour limiter leur occurrence et leur
gravité, et améliorer leur niveau de maîtrise. Un plan d’action institutionnel a été élaboré, puis validé en
Commission du médicament et des dispositifs médicaux stériles.
Conclusion : Cette cartographie a permis de réaliser un état des lieux exhaustif des risques potentiels liés à la
perfusion. À l’issue de ce travail, des groupes pluridisciplinaires ont été mis en place pour travailler sur les
différentes thématiques et des réunions trimestrielles ont été instaurées pour suivre l’avancée des différents
projets. Une cartographie des risques sera réalisée en pédiatrie, puis en service d’oncologie où le risque lié à
la manipulation de produits toxiques est omniprésent.
NosoBase ID notice : 401738
Gestion globale des risques
Sghaier W; Hergon E; Desroches A. Gestion globale des risques. Transfusion clinique et biologique 2015/08;
22(3): 158-167.
Mots-clés : GESTION DES RISQUES; AUDIT; RISQUE
La gestion des risques est une des composantes fondamentales de la réussite d’une entreprise, que ce soit
en termes économique, sociétal, ou environnemental. La gestion des risques est une activité d’autant plus
importante pour les entreprises que l’enjeu de sécurité optimale des produits et services est grand. Ceci est
le cas particulièrement pour les établissements du secteur de la santé. Le management des risques apparaît
donc comme un outil d’aide à la décision et un moyen pour garantir la pérennité d’une organisation. Dans ce
contexte, quelles méthodes et démarches mettre en oeuvre pour gérer les risques d’une organisation ? A
travers cet état de l’art, nous nous intéressons à la notion de risque et au processus de gestion des risques.
Ensuite nous nous focalisons sur les différentes méthodes de gestion des risques et les critères de choix
entre ces différentes méthodes. Enfin nous mettons en avant le besoin de compléter ces méthodes par une
démarche systémique et globale notamment à travers l’évaluation des risques par les audits.
Grippe
NosoBase ID notice : 400548
Grippe durant la grossesse : revue
Meijer WJ; Van Noortwijk AG; Bruinse HW; Wensing AM. Influenza virus infection in pregnancy: a review.
Acta obstetricia et gynecologica scandinavica 2015/08; 94(8): 797-819.
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Mots-clés : GRIPPE; GROSSESSE; REVUE DE LA LITTERATURE; PANDEMIE; TRAITEMENT; VACCIN;
PREMATURE; MORTALITE; ANTIVIRAL; MORBIDITE
Background: Influenza virus infection is very common and a significant cause of morbidity and mortality in
specific populations like pregnant women. Following the 2009 pandemic, several reports on the effects of
influenza virus infection on maternal health and pregnancy outcome have been published. Also the safety
and efficacy of antiviral treatment and vaccination of pregnant women have been studied. In this review, we
have analyzed and summarized these data.
Objective: To provide information on the influence of influenza virus infection during pregnancy on maternal
health and pregnancy outcome and on the effect of treatment and vaccination.
Data sources: We have searched Medline, Embase and the Cochrane Library. We used influenza, influenz*,
pregnancy and pregnan* as search terms.
Study selection: In total, 294 reports were reviewed and judged according to the STROBE guidelines or
CONSORT statement. In all, 100 studies, published between 1961 and 2015, were included.
Results: Compared to the general population, pregnant women are more often hospitalized and admitted to
an intensive care unit due to influenza virus infection. For hospitalized patients, increased rates of preterm
birth and fetal/neonatal death are reported. Early treatment with oseltamivir is associated with a reduced risk
of severe disease. Vaccination of pregnant women is safe and reduces maternal and neonatal morbidity.
Conclusions: There is level 2b evidence that maternal health and pregnancy outcome can be severely
affected by influenza virus infection. Antiviral treatment may diminish these effects and vaccination protects
pregnant women and neonates from infection (level of evidence 2b and 1b, respectively).
Hygiène des mains
NosoBase ID notice : 399990
Evaluation de l’hygiène des mains dans une unité de réanimation : les visiteurs sont-ils un vecteur
potentiel de pathogènes ?
Birnbach DJ; Rosen LF; Fitzpatrick M; Arheart KL; Munoz-Price LS. An evaluation of hand hygiene in an
intensive care unit: Are visitors a potential vector for pathogens? Journal of infection and public health
2015/06/06; in press: 1-5.
Mots-clés : SOIN INTENSIF; HYGIENE DES MAINS; VISITE AUX HOSPITALISES; SECURITE
SANITAIRE; DISTRIBUTEUR; PRODUIT DE FRICTION POUR LES MAINS; TRAITEMENT HYGIENIQUE
DES MAINS PAR FRICTION; FACTEUR DE RISQUE; ETUDE D'OBSERVATION|
Patients in an intensive care unit (ICU) are frequently immunocompromised and might be highly susceptible
to infection. Visitors to an ICU who do not adequately clean their hands could carry pathogenic organisms,
resulting in risk to a vulnerable patient population. This observational study identifies pathogens carried on
the hands of visitors into an ICU and investigates the effect of hand hygiene. Two observers, one stationed
outside and one inside the ICU, evaluated whether visitors performed hand hygiene at any of the wallmounted alcohol-based hand sanitizer dispensers prior to reaching a patient's room. Upon reaching a
patient's room, the dominant hand of all of the participants was cultured. Of the 55 participating visitors, 35
did not disinfect their hands. Among the cultures of those who failed to perform hand hygiene, eight cultures
grew Gram-negative rods and one grew methicillin-resistant Staphylococcus aureus. Of the cultures of the 20
individuals who performed hand hygiene, 14 (70%) had no growth on the cultures, and the remaining six
(30%) showed only the usual skin flora. The visitors who do not perform hand hygiene might carry pathogens
that pose a risk to ICU patients.
NosoBase ID notice : 400113
Mesurer l’effet Hawthorne sur l’observance de l’hygiène des mains en comparant les résultats d’une
observation directe avec ceux d’un suivi électronique automatisé
Hagel S; Reischke J; Kesselmeier M; Math D; Winning J; Gastmeier P; et al. Quantifying the hawthorne effect
in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring.
Infection control and hospital epidemiology 2015/08; 36(8): 957-962.
Mots-clés : HYGIENE DES MAINS; SOIN INTENSIF; OBSERVANCE; INFECTION NOSOCOMIALE;
PERSONNEL; EQUIPEMENT; EFFET HAWTHORNE
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Objective: To quantify the Hawthorne effect of hand hygiene performance among healthcare workers using
direct observation.
Design: Prospective observational study.
Setting: Intensive care unit, university hospital.
Methods: Direct observation of hand hygiene compliance over 48 audits of 2 hours each. Simultaneously,
hand hygiene events (HHEs) were recorded using electronic alcohol-based handrub dispensers. Directly
observed and electronically recorded HHEs during the 2 hours of direct observation were compared using
Spearman correlations and Bland-Altman plots. To quantify the Hawthorne effect, we compared the number
of electronically recorded HHEs during the direct observation periods with the re-scaled electronically
recorded HHEs in the 6 remaining hours of the 8-hour working shift.
Results: A total of 3,978 opportunities for hand hygiene were observed during the 96 hours of direct
observation. Hand hygiene compliance was 51% (95% CI, 49%-53%). There was a strong positive correlation
between directly observed compliance and electronically recorded HHEs (ρ=0.68 [95% CI, 0.49-0.81],
P<.0001). In the 384 hours under surveillance, 4,180 HHEs were recorded by the electronic dispensers. Of
those, 2,029 HHEs were recorded during the 96 hours in which direct observation was also performed, and
2,151 HHEs were performed in the remaining 288 hours of the same working shift that were not under direct
observation. Healthcare workers performed 8 HHEs per hour when not under observation compared with 21
HHEs per hour during observation.
Conclusions: Directly and electronically observed HHEs were in agreement. We observed a marked influence
of the Hawthorne effect on hand hygiene performance.
NosoBase ID notice : 400828
Un système automatisé de formation à l’hygiène des mains améliore la technique mais non
l’observance de l’hygiène des mains
Kwok YL; Callard M; McLaws ML. An automated hand hygiene training system improves hand hygiene
technique but not compliance. American journal of infection control 2015/08; 43(8): 821-825.
Mots-clés : HYGIENE DES MAINS; PRATIQUE; OBSERVANCE; FORMATION
Introduction: The hand hygiene technique that the World Health Organization recommends for cleansing
hands with soap and water or alcohol-based handrub consists of 7 poses. We used an automated training
system to improve clinicians' hand hygiene technique and test whether this affected hospitalwide hand
hygiene compliance.
Methods: Seven hundred eighty-nine medical and nursing staff volunteered to participate in a self-directed
training session using the automated training system. The proportion of successful first attempts was reported
for each of the 7 poses. Hand hygiene compliance was collected according to the national requirement and
rates for 2011-2014 were used to determine the effect of the training system on compliance.
Results: The highest pass rate was for pose 1 (palm to palm) at 77% (606 out of 789), whereas pose 6 (clean
thumbs) had the lowest pass rate at 27% (216 out of 789). One hundred volunteers provided feedback to 8
items related to satisfaction with the automated training system and most (86%) expressed a high degree of
satisfaction and all reported that this method was time-efficient. There was no significant change in
compliance rates after the introduction of the automated training system. Observed compliance during the
posttraining period declined but increased to 82% in response to other strategies.
Conclusions: Technology for training clinicians in the 7 poses played an important education role but did not
affect compliance rates.
NosoBase ID notice : 398363
Le concept "Mes cinq moments pour l’hygiène des mains" pour les espaces surchargés dans des
systèmes de santé aux ressources limitées
Salmon S; Pittet D; Sax H; McLaws ML. The 'My five moments for hand hygiene' concept for the overcrowded
setting in resource-limited healthcare systems. The journal of hospital infection 2015/10; 91(2) : 95-99.
Mots-clés : HYGIENE DES MAINS; PERSONNEL; ENVIRONNEMENT; USAGER DE LA SANTE; LIT;
ARCHITECTURE; PAYS EN DEVELOPPEMENT; CAMPAGNE
Hand hygiene is a core activity of patient safety for the prevention of healthcare-associated infections
(HCAIs). To standardize hand hygiene practices globally the World Health Organization (WHO) released
Guidelines on Hand Hygiene in Health Care and introduced the 'My five moments for hand hygiene' concept
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to define indications for hand hygiene rooted in an evidence-based model for transmission of microorganisms by healthcare workers' (HCWs) hands. Central to the concept is the division of the healthcare
environment into two geographical care zones, the patient zone and the healthcare zone, that requires the
HCW to comply with specific hand hygiene moments. In resource-limited, overcrowded healthcare settings
inadequate or no spatial separation between beds occurs frequently. These conditions challenge the HCW's
ability to visualize and delineate patient zones. The 'My five moments for hand hygiene' concept has been
adapted for these conditions with the aim of assisting hand hygiene educators, auditors, and HCWs to
minimize ambiguity regarding shared patient zones and achieve the ultimate goal set by the WHO Guidelines
- the reduction of infectious risks.
NosoBase ID notice : 398358
Réduction de la contamination virale de la pulpe des doigts : le lavage des mains est plus efficace
que l’usage des désinfectants alcooliques pour la friction des mains
Tuladhar E; Hazeleger WC; Koopmans M; Zwietering MH; Duizer E; Beumer RR. Reducing viral
contamination from finger pads: handwashing is more effective than alcohol-based hand disinfectants. The
journal of hospital infection 2015/07; 90(3): 226-234.
Mots-clés : PREVENTION; VIRUS; CONTAMINATION; HYGIENE DES MAINS; LAVAGE DES MAINS;
MAIN; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION; PRODUIT DE FRICTION POUR LES
MAINS; EFFICACITE; ALCOOL; ROTAVIRUS; VIRUS INFLUENZA TYPE A; PCR
Background: Hand hygiene is important for interrupting transmission of viruses through hands. Effectiveness
of alcohol-based hand disinfectant has been shown for bacteria but their effectiveness in reducing
transmission of viruses is ambiguous.
Aim: To test efficacy of alcohol hand disinfectant against human enteric and respiratory viruses and to
compare efficacy of an alcohol-based hand disinfectant and handwashing with soap and water against
norovirus.
Methods: Efficacies of a propanol and an ethanol-based hand disinfectant against human enteric and
respiratory viruses were tested in carrier tests. Efficacy of an alcohol-based hand disinfectant and
handwashing with soap and water against noroviruses GI.4, GII.4, and MNV1 were tested using finger pad
tests.
Findings: The alcohol-based hand disinfectant reduced the infectivity of rotavirus and influenza A virus
completely within 30s whereas poliovirus Sabin 1, adenovirus type 5, parechovirus 1, and MNV1 infectivity
were reduced <3log10 within 3min. MNV1 infectivity reduction by washing hands with soap and water for 30s
(>3.0 ± 0.4log10) was significantly higher than treating hands with alcohol (2.8 ± 1.5log10). Washing with
soap and water for 30s removed genomic copies of MNV1 (>5log10), noroviruses GI.4 (>6log10), and GII.4
(4log10) completely from all finger pads. Treating hands with propanol-based hand disinfectant showed little
or no reduction to complete reduction with mean genomic copy reduction of noroviruses GI.4, GII.4, and
MNV1 being >2.6, >3.3, and >1.2log10 polymerase chain reaction units respectively.
Conclusions: Washing hands with soap and water is better than using alcohol-based hand disinfectants in
removing noroviruses from hands.
Maladie émergente
NosoBase ID notice : 399647
Risques liés aux maladies émergentes pour les professionnels de santé : leçons tirées de MERS-CoV,
Ebola, SRAS et grippe aviaire
Suwantarat N; Apisarnthanarak A. Risks to healthcare workers with emerging diseases: lessons from MERSCoV, Ebola, SARS, and avian flu. Current opinion in infectious diseases 2015/08; 28(4): 349-361.
Mots-clés : PERSONNEL; RISQUE PROFESSIONNEL; VIRUS; GRIPPE AVIAIRE; CORONAVIRUS;
SRAS; SURVEILLANCE; FACTEUR DE RISQUE; PREVENTION; REVUE DE LA LITTERATURE;
CONNAISSANCE; TRAVAIL; INFECTION EMERGENTE; EBOLA; MERS-COV
Purpose of review: Several viral diseases have emerged and impacted healthcare systems worldwide.
Healthcare personnels (HCPs) are at high risk of acquiring some emerging infections while caring for
patients. We provide a review of risk factors, evidence of infection in HCPs, and prevention strategies with
Middle East respiratory syndrome coronavirus, Ebola virus disease (Ebola), severe acute respiratory
syndrome (SARS), and avian influenza.
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Recent findings: HCP-related infections with Middle East respiratory syndrome coronavirus, Ebola, and SARS
have been reported among 1-27%, 2.5-12%, and 11-57% of total cases, respectively. The case fatality rate of
Ebola in HCPs has been reported up to 73%. The WHO guidelines for the global surveillance of SARS were
developed in 2004 and used as a template for other emerging diseases preparedness. Risks to HCPs with
emerging diseases are related to inappropriate and insufficient infection control measures during an initial
encounter, at the beginning of outbreak and with an overwhelming number of patient cases. To date, there
are no reports of avian influenza transmission to HCPs from affected cases.
Summary: Early and rapid detection of suspected infected patients with communicable diseases along with
appropriate infection control practice, education, national and global preparedness guidelines would help to
prevent disease transmission to HCPs.
Maternité
NosoBase ID notice : 400107
Pratiques pour réduire les taux d’infections du site opératoire chez des femmes accouchant par
césarienne : revue
McKibben RA; Pitts SI; Suarez-Cuervo C; Perl TM; Bass EB. Practices to reduce surgical site infections
among women undergoing cesarean section: A review. Infection control and hospital epidemiology 2015/08;
36(8): 915-921.
Mots-clés : OBSTETRIQUE; INFECTION NOSOCOMIALE; TAUX; CESARIENNE; FACTEUR DE RISQUE;
ENDOMETRE; PRE-OPERATOIRE; ANTIBIOPROPHYLAXIE; MATERNITE; REVUE DE LA LITTERATURE;
SITE OPERATOIRE
Objective: Surgical site infections (SSIs) are a leading cause of morbidity and mortality among women
undergoing cesarean section (C-section), a common procedure in North America. While risk factors for SSI
are often modifiable, wide variation in clinical practice exists. With this review, we provide a comprehensive
overview of the results and quality of systematic reviews and meta-analyses on interventions to reduce
surgical site infections among women undergoing C-section.
Methods: We searched PubMed and the Cochrane Database of Systematic Reviews for systematic reviews
and meta-analyses published between January 2000 and May 2014 on interventions to reduce the
occurrence of SSIs (incisional infections and endometritis), among women undergoing C-section. We
extracted data on the interventions, outcomes, and strength of evidence as determined by the original article
authors, and assessed the quality of each article based on a modified Assessment of Multiple Systematic
Reviews tool.
Results: A total of 30 review articles met inclusion criteria and were reviewed. Among these articles, 77
distinct interventions were evaluated: 29% were supported with strong evidence as assessed by the original
article authors, and 83% of the reviews articles were classified as good quality based on our assessment. Ten
interventions were classified as being effective in reducing SSI with strong evidence in a good-quality article,
including preoperative vaginal cleansing, the use of perioperative antibiotic prophylaxis, and several surgical
techniques.
Conclusion: Efforts to reduce SSI rates among women undergoing C-section should include interventions
such as preoperative vaginal cleansing and the use of perioperative antibiotics because compelling evidence
exists to support their effectiveness.
NosoBase ID notice : 400826
Programme de prévention à aspects multiples pour la réduction des infections après césarienne :
interventions évaluées à l’aide d’un système de surveillance intensive après la sortie
Ng W; Brown A; Alexander D; Ho MF; Kerr B; Amato M; el al. A multifaceted prevention program to reduce
infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance
system. American journal of infection control 2015/08; 43(8): 805-809.
Mots-clés : PREVENTION; CESARIENNE; SURVEILLANCE; SORTIE; QUALITE; SECURITE SANITAIRE;
INFORMATION; ACCOUCHEMENT; CHECKLIST
Background: We assessed the effects of the components of a multifaceted and evidence-based caesareansection surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a
postdischarge surveillance (PDS) system.
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Methods: Multiple prevention interventions were serially implemented. SSI case finding was undertaken
through active inpatient surveillance and intensive PDS using a standardized form at the 6-week
postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention
standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes
in SSI rate were analyzed using segmented regression analysis.
Results: Nine thousand four hundred forty-two cesarean sections were assessed during the study period.
PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were
superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at
baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a
surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair.
Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher
rate compared with those without either risk factor (6.3% vs 3.2%; P<.001).
Conclusions: A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant
reduction in SSI rates after cesarean section.
Néonatologie
NosoBase ID notice : 399548
L’auto-désinfection des surfaces de lavabo réduit la biocharge en Pseudomonas aeruginosa dans
une unité de réanimation néonatale
Fusch C; Pogorzelski D; Main C; Meyer CL; el Helou S; Mertz D. Self-disinfecting sink drains reduce the
Pseudomonas aeruginosa bioburden in a neonatal intensive care unit. Acta paediatrica 2015/08; 104(8):
e344-e349.
Mots-clés : DESINFECTION; SANITAIRE; LAVABO; PSEUDOMONAS AERUGINOSA; SOIN INTENSIF;
NEONATOLOGIE; PREVENTION; ENVIRONNEMENT
Aim: Water in sink drains is a known source of gram-negative bacteria. We aimed to evaluate the impact of
self-disinfecting sink drains on the emission of aerosolised bacteria and on Pseudomonas aeruginosa
acquisition among neonates.
Methods: Aerosol bacterial growth and patient Pseudomonas aeruginosa acquisition rates were measured at
baseline (Phase One), for 13 months after sinks were relocated or redesigned during refurbishment (Phase
Two) and for 13 months after introducing self-disinfecting sink drains (Phase Three).
Results: Cultures were positive for bacterial growth in 56%, 24% and 13% of the tested aerosols in Phases
One, Two and Three, respectively. Comparing Phases Two and Three produced an odds ratio (OR) of 0.47,
with a 95% confidence interval (CI) of 0.22-0.99 (p=0.047), for all bacteria and an OR of 0.31 and CI of 0.120.79 (p=0.013) for Pseudomonas aeruginosa. Rates of Pseudomonas aeruginosa positive clinical cultures
were 0.34, 0.27 and 0.13 per 1000 patient days during the respective phases, with a significant increase of
time to the next positive clinical culture in Phase Three.
Conclusion: Self-disinfecting sink drains were superior to sink replacements in preventing emissions from
aerosols pathogens and may reduce hospital-acquired infections. The bioburden reduction should be
confirmed in a larger multicentre trial.
Personnel
NosoBase ID notice : 401743
Formation et attitudes des professionnels concernant les précautions standard
Laprugne-Garcia E. Formation et attitudes des professionnels concernant les précautions standard. Soins
2015/05; 795: 14-19.
Mots-clés : PRECAUTION STANDARD; AUDIT; FORMATION; GANT; HYGIENE DES MAINS; MASQUE;
ACCIDENT D'EXPOSITION AU SANG; TENUE VESTIMENTAIRE; AUDIT DES PRATIQUES; EPI;
EQUIPEMENT DE PROTECTION INDIVIDUELLE
En 2011, le Groupe d’évaluation des pratiques en hygiène hospitalière a proposé aux établissements de
santé un outil pour évaluer la politique institutionnelle et les ressources disponibles pour l’application des
précautions standard ainsi que la formation et les attitudes du personnel. Les professionnels déclarent de
bonnes pratiques pour le risque de contact avec du matériel souillé et la conduite à tenir en cas de contact de
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liquide biologique avec les muqueuses. Les pratiques à améliorer concernent en priorité le port
d’équipements de protection individuelle, le changement de gants et l’hygiène des mains entre deux activités.
NosoBase ID notice : 400114
Forte baisse des déclarations d’accidents d’exposition au sang et aux liquides biologiques dans les
établissements de santé français, 2003-2012 : résultats de l’enquête nationale du réseau national de
surveillance AES-RAISIN
Floret N; Ali-Brandemeyer O; L'Hériteau F; Bervas C; Barquins-Guichard S; Pelissier G; et al. Sharp
decrease of reported occupational blood and body fluid exposures in French hospitals, 2003-2012: Results of
the French national network survey, AES-RAISIN. Infection control and hospital epidemiology 2015/08; 36(8):
963-968.
Mots-clés : ACCIDENT D'EXPOSITION AU SANG; INFECTION NOSOCOMIALE; PERSONNEL;
SURVEILLANCE; INCIDENCE; TAUX; PIQURE; AIGUILLE; MATERIEL DE SECURITE; GANT;
CONTENEUR; COHORTE; ETUDE RETROSPECTIVE
Objective: To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in
French healthcare facilities.
Method: Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from
2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008-12).
Findings: Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus
16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012).
Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility
(68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed
(48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.
Conclusion: Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012,
compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past
10 years in France.
PICC
NosoBase ID notice : 401740
Evaluation des complications des PICC Lines dans un établissement public de santé
Viart H; Combe C; Martinelli T; Buiret G; Hida H. Evaluation des complications des PICC Lines dans un
établissement public de santé. Le Pharmacien Hospitalier & Clinicien 2015/08; in press: 1-6.
Mots-clés : CATHETER VEINEUX CENTRAL; COMPLICATION; STAPHYLOCOCCUS EPIDERMIDIS;
STAPHYLOCOCCUS AUREUS; ESCHERICHIA COLI; PICC
Introduction : Les cathéters centraux veineux d’insertion périphérique (PICCLine) ont été introduits en 2011
dans la gamme des cathéters centraux dans notre établissement de santé.
Objectifs : Evaluer les complications aussi bien infectieuses que thrombotiques chez des patients ayant
bénéficié d’une pose de PICC Line.
Matériel et méthode : A partir d’une cohorte de 70 patients, soit 81 poses pendant le premier semestre 2012,
une analyse rétrospective des dossiers patients de poses de PICC Line a été effectuée.
Résultats : Les indications retrouvées sont l’administration de chimiothérapie, d’antibiotique, de nutrition
parentérale mais aussi l’administration de médicaments chez les patients ayant un faible capital veineux. La
durée médiane de pose est de 18 jours. Le taux des complications infectieuses (2,24 pour 1000 jours de
cathétérisme) et thrombotiques (1,77 pour 1000 jours de cathétérisme) corroborent les données de la
littérature. Aucun facteur de risque (côté d’insertion, veine d’insertion, indication, type de cancer) n’a été
retrouvé comme influençant statistiquement les complications.
Conclusion : Avec la parution des recommandations de la Société française d’hygiène hospitalière en 2013,
les pratiques tendent à s’uniformiser par l’encadrement des indications et des formations nécessaires à la
manipulation de ce dispositif médical. Ainsi, les taux de complications devraient en être impactés. Il serait
nécessaire de réaliser une même étude après l’application de recommandations.
Pneumonie
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Septembre 2015
NosoBase ID notice : 400105
Prévention des pneumonies nosocomiales par des soins de bouche chez des patients sans
assistance respiratoire : revue systématique et méta-analyse d’essais contrôlés randomisés
Kaneoka A; Pisegna JM; Miloro KV; Lo M; Saito H; Riquelme LF; et al. Prevention of healthcare-associated
pneumonia with oral care in individuals without mechanical ventilation: A systematic review and meta-analysis
of randomized controlled trials. Infection control and hospital epidemiology 2015/08; 36(8): 899-906.
Mots-clés : PNEUMONIE; INFECTION
VENTILATION ASSISTEE; INCIDENCE
NOSOCOMIALE;
SOIN DE BOUCHE;
CHLORHEXIDINE;
Objective: Evidence is lacking on the preventive effect of oral care on healthcare-associated pneumonia in
hospitalized patients and nursing home residents who are not mechanically ventilated. The primary aim of this
review was to assess the effectiveness of oral care on the incidence of pneumonia in nonventilated patients.
Methods: We searched 8 databases (MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, LILACS,
ICHUSHI, and CiNii), in addition to trial registries and a manual search. Eligible studies were published and
unpublished randomized controlled trials examining the effect of any method of oral care on reported
incidence of pneumonia and/or fatal pneumonia. Relative risks (RR) and 95% confidence intervals were
calculated. Risk of bias was assessed for eligible studies.
Results: We identified 5 studies consisting of 1,009 subjects that met the inclusion criteria. Of these, 2 trials
assessed the effect of chlorhexidine in hospitalized patients; 3 studies examined mechanical oral cleaning in
nursing home residents. A meta-analysis could only be done on 4 trials; this analysis showed a significant risk
reduction in pneumonia through oral care interventions (RRfixed, 0.61; 95% CI, 0.40-0.91; P=.02). The effects
of mechanical oral care alone were significant when pooled across studies. (RRfixed, 0.61; 95% CI, 0.400.92; P=.02). Risk reduction for fatal pneumonia from mechanical oral cleaning was also significant (RRfixed,
0.41; 95% CI, 0.23-0.71; P=.002). Most studies had a high risk of bias.
Conclusions: This analysis suggests a preventive effect of oral care on pneumonia in nonventilated
individuals. This effect, however, should be interpreted with caution due to risk of bias in the included trials.
Responsabilité
NosoBase ID notice : 401739
Chronique de jurisprudence sur les infections nosocomiales
Haji Safar S. Chronique de jurisprudence sur les infections nosocomiales. Droit déontologie & soin
2015/08/04; in press: 1-8.
Mots-clés : JURISPRUDENCE; RESPONSABILITE; FAUTE PROFESSIONNELLE
Actualités de la jurisprudence sur les infections nosocomiales : notion, cause étrangère, responsabilité
deplein droit, faute médicale, perte de chance.
Soins intensifs
NosoBase ID notice : 399988
Facteurs de risque de colonisation à bactéries multi-résistantes aux antibiotiques parmi des patients
admis en réanimation après un retour de l’étranger
Angue M; Allou N; Belmonte O; Lefort Y; Lugagne N; Vandroux D; et al. Risk factors for colonization with
multidrug-resistant bacteria among patients admitted to the intensive care unit after returning from abroad.
Journal of travel medicine 2015/09; 22(5): 300-305.
Mots-clés : SOIN INTENSIF; COLONISATION; FACTEUR DE RISQUE; MULTIRESISTANCE;
ANTIBIORESISTANCE; ETUDE RETROSPECTIVE; PAYS ETRANGER; ETUDE D'OBSERVATION
Background: Few national recommendations exist on management of patients returning from abroad and all
focus on hospitalized patients. Our purpose was to compare, in an intensive care unit (ICU), the admission
prevalence and acquisition of multidrug-resistant (MDR) bacteria carriage in patients with ("Abroad") or
without ("Local") a recent stay abroad, and then identify the risk factors in "Abroad" patients.
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Methods: In this retrospective study, we reviewed charts of all the patients hospitalized in the ICU unit from
January 2011 through July 2013 with hygiene samplings performed. We identified all patients who had stayed
abroad ("Abroad") within 6 months prior to ICU admission.
Results: Of 1,842 ICU patients, 129 (7%) "Abroad" patients were reported. In the "Abroad" group, the rate of
MDR strain carriage was higher at admission (33% vs 6.7%, p<0.001) and also more often diagnosed during
the ICU stay (acquisition rate: 17% vs 5.2%, p<0.001) than in "Local" patients. Risk factors associated with
MDR bacteria carriage at admission in "Abroad" patients were diabetes mellitus [odds ratio (OR) 5.1 (1.714.8), p=0.003] and "hospitalization abroad with antibiotic treatment" [OR 10.7 (4.2-27.3), p<0.001].
Hospitalization abroad without antibiotic treatment was not identified as a risk factor.
Conclusions: The main factor associated with MDR bacteria carriage after a stay abroad seems to be a
hospitalization abroad only in case of antibiotic treatment abroad. Screening and isolation of "Abroad"
patients should be recommended, even in case of a first negative screening.
NosoBase ID notice : 399713
Infections d’origine communautaire et associées aux soins chez des patients de réanimation : étude
de cohorte multicentrique
Dabar G; Harmouche C; Salameh P; Jaber B; Jamaleddine G; Waked M; et al. Community- and healthcareassociated infections in critically ill patients: a multicenter cohort study. International journal of infectious
diseases 2015/06/04; in press: 1-6.
Mots-clés : SOIN INTENSIF; ETUDE MULTICENTRIQUE; COHORTE; SYNDROME SEPTIQUE;
MORTALITE; ETUDE PROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; MYCOLOGIE; BETALACTAMASE A SPECTRE ELARGI; CANCEROLOGIE; CANCER; FACTEUR DE RISQUE;
PSEUDOMONAS; MULTIRESISTANCE; MICROBIOLOGIE; PNEUMONIE
Objective: To compare the spectrum of infection, comorbidities, outcomes, and mortality of patients admitted
to the intensive care unit (ICU) due to community-acquired or healthcare-associated severe sepsis.
Methods: This prospective cohort study was conducted in three university medical centers in Lebanon from
February 2005 to December 2006. Patients with severe sepsis were included and followed up until hospital
discharge or death.
Results: One hundred and twenty patients were included of whom 60% had community-acquired infections
(CAI) and 40% had healthcare-associated infections (HAI). The most common infection in both groups was
pneumonia. Hematologic malignancies were the only comorbidity more prevalent in HAI than in CAI
(p=0.047). Fungal infections and extended-spectrum beta-lactamase (ESBL) organisms were more frequent
in HAI than in CAI (p=0.04 and 0.029, respectively). APACHE and SOFA scores were high and did not differ
between the two groups, nor did the proportion of septic shock, while mortality was significantly higher in the
HAI patients than in the CAI patients (p=0.004). On multivariate analysis for mortality, independent risk
factors were the source of infection acquisition (p=0.004), APACHE II score (p=0.006), multidrug-resistant
Pseudomonas infections (p=0.043), and fungal infections (p=0.006).
Conclusions: Severe sepsis and septic shock had a high mortality rate, especially in the HAI group. Patients
with risk factors for increased mortality should be monitored and aggressive treatment should be
administered.
Sondage urinaire
NosoBase ID notice : 400194
Efficacité d’une approche de gestion des antibiotiques pour des bactériuries asymptomatiques
associées aux sondes urinaires
Trautner BW; Grigoryan L; Petersen NJ; Hysong S; Cadena J; Patterson JE; et al. Effectiveness of an
antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA internal
medicine 2015/07; 175(7): 1120-1127.
Mots-clés : BACTERIURIE; SONDAGE URINAIRE; CATHETER; ANTIBIOTIQUE;
PRESCRIPTION; PREVENTION; SURVEILLANCE; ANALYSE MULTIVARIEE
EFFICACITE;
Importance: Overtreatment of asymptomatic bacteriuria (ASB) in patients with urinary catheters remains high.
Health care professionals have difficulty differentiating cases of ASB from catheter-associated urinary tract
infections.
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Objectives: To evaluate the effectiveness and sustainability of an intervention to reduce urine culture ordering
and antimicrobial prescribing for catheter-associated ASB compared with standard quality improvement
methods.
Design, setting, and participants: A preintervention and postintervention comparison with a contemporaneous
control group from July 2010 to June 2013 at 2 Veterans Affairs health care systems. Study populations were
patients with urinary catheters on acute medicine wards and long-term care units and health care
professionals who order urine cultures and prescribe antimicrobials.
Intervention: A multifaceted guidelines implementation intervention.
Main outcomes and measures: The primary outcomes were urine cultures ordered per 1000 bed-days and
cases of ASB receiving antibiotics (overtreatment) during intervention and maintenance periods compared
with baseline at both sites. Patient-level analysis of inappropriate antimicrobial use adjusted for individual
covariates.
Results: Study surveillance included 289 754 total bed-days. The overall rate of urine culture ordering
decreased significantly during the intervention period (from 41.2 to 23.3 per 1000 bed-days; incidence rate
ration [IRR], 0.57; 95% CI, 0.53-0.61) and further during the maintenance period (to 12.0 per 1000 bed-days;
IRR, 0.29; 95% CI, 0.26-0.32) (P<.001 for both). At the comparison site, urine cultures ordered did not
change significantly across all 3 periods. There was a significant difference in the number of urine cultures
ordered per month over time when comparing the 2 sites using longitudinal linear regression (P<.001).
Overtreatment of ASB at the intervention site fell significantly during the intervention period (from 1.6 to 0.6
per 1000 bed-days; IRR, 0.35; 95% CI, 0.22-0.55), and these reductions persisted during the maintenance
period (to 0.4 per 1000 bed-days; IRR, 0.24; 95% CI, 0.13-0.42) (P<.001 for both). Overtreatment of ASB at
the comparison site was similar across all periods (odds ratio, 1.32; 95% CI, 0.69-2.52). When analyzed by
type of ward, the decrease in ASB overtreatment was significant in long-term care.
Conclusions and relevance: A multifaceted intervention targeting health care professionals who diagnose and
treat patients with urinary catheters reduced overtreatment of ASB compared with standard quality
improvement methods. These improvements persisted during a low-intensity maintenance period. The impact
was more pronounced in long-term care, an emerging domain for antimicrobial stewardship.
Staphylococcus aureus
NosoBase ID notice : 400178
Pas de changement dans la distribution de types et de l’antibiorésistance d’isolats de
Staphylococcus aureus provenant de patients d’orthopédie sur une période de 12 ans
Aamot HV; Stavem K; Skråmm I. No change in the distribution of types and antibiotic resistance in clinical
Staphylococcus aureus isolates from orthopaedic patients during a period of 12 years. European journal of
clinical microbiology and infectious diseases 2015/09; 34(9): 1833-1837.
Mots-clés :
ANTIBIORESISTANCE;
CHIRURGIE;
CHIRURGIE
ORTHOPEDIQUE;
STAPHYLOCOCCUS AUREUS; CENTRE HOSPITALIER UNIVERSITAIRE
TYPAGE;
Staphylococcus aureus (S. aureus) is the most common cause of bone and joint infections. However, limited
information is available on the distribution of S. aureus geno- and phenotypes causing orthopaedic infections.
The aim of this study was to identify the dominating types causing infections in orthopaedic patients,
investigate if the characteristics of these types changed over time and examine if different types were more
often associated with surgical site infection (SSI) than primary infection (non-SSI). All clinical S. aureus
isolates collected from orthopaedic patients from 2000 through 2011 at Akershus University Hospital, Norway,
were characterised by S. aureus protein A (spa) typing and tested for antibiotic resistance. A total of 548
patients with orthopaedic S. aureus infections were included, of which 326 (59%) had SSI and 222 (41%) had
non-SSI. The median age was 62 years [range 2-97 years] and 54 % were male. Among the 242 unique spa
types, t084 was the most common (7%). Penicillin resistance was identified in 75% of the isolates, whereas
the resistances to the other antibiotics tested were <5%. Three isolates (0.5%) were resistant to methicillin.
There was no significant difference in the distribution of geno- and phenotypes over time and there was no
difference in types between SSI and non-SSI. In this large collection of S. aureus from orthopaedic patients,
the S. aureus infections, regardless of origin, were heterogeneous, mainly resistant to penicillin, stable over
time and consisted of similar types as previously found in both carrier and other patient populations.
NosoBase ID notice : 400118
Impact de l’arrêt des précautions complémentaires de type contact mises en place pour les ERV et les
SARM sur les infections associées aux dispositifs médicaux
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Edmond M; Masroor N; Stevens MP; Ober J; Bearman G. The impact of discontinuing contact precautions for
VRE and MRSA on device-associated infections. Infection control and hospital epidemiology 2015/08; 36(8):
978-980.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; ENTEROCOCCUS;
VANCOMYCINE; ANTIBIORESISTANCE; INFECTION NOSOCOMIALE; COLONISATION; DISPOSITIF
MEDICAL; COUT; PRECAUTION CONTACT; TAUX; TRANSMISSION
The impact of discontinuing contact precautions for patients with MRSA and VRE colonization/infection on
device-associated hospital-acquired infection rates at an academic medical center was investigated in this
before-and-after study. In the setting of a strong horizontal infection prevention platform, discontinuation of
contact precautions had no impact on device-associated hospital-acquired infection rates.
NosoBase ID notice : 400162
Infections à bactéries à Gram négatif multirésistantes aux antibiotiques dans une unité de
réanimation d’oncologie pédiatrique : facteurs de risque et évolution
de Oliveira Costa P; Atta EH; da Silva AR. Infection with multidrug-resistant gram-negative bacteria in a
pediatric oncology intensive care unit: risk factors and outcomes. Jornal de Pediatria 2015/06/06; in press: 17.
Mots-clés : BACTERIE A GRAM NEGATIF; MULTIRESISTANCE; PEDIATRIE; CANCEROLOGIE; SOIN
INTENSIF; FACTEUR DE RISQUE; ANTIBIOTIQUE; TRAITEMENT; MORTALITE; ANALYSE
MULTIVARIEE; HEMATOLOGIE
Objective: This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant
gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU).
Methods: Data were collected relating to all episodes of GNB infection that occurred in a PICU between
January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1)
infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest
included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter
use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the
preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay,
and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids,
chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment,
definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate
antibiotic therapy, and the 7- and 30-day mortality.
Results: Multivariate logistic regression analyses showed significant relationships between MDR-GNB and
hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p=0.021) and
healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p=0.015). There were significant
differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial
empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy.
Conclusions: Hematologic malignancy and healthcare-associated infection were significantly associated with
MDR-GNB infection in this sample of pediatric oncology patients.
NosoBase ID notice : 399945
Facteurs de risque de colonisation et impact de la colonisation à SARM sur l’évolution clinique de
patients sévèrement brûlés
Issler-Fisher AC; McKew G; Fisher OM; Harish V; Gottlieb T; Maitz PK. Risk factors for, and the effect of
MRSA colonization on the clinical outcomes of severely burnt patients. Burns 2015/09; 41(6): 1212-1220.
Mots-clés : COLONISATION; FACTEUR DE RISQUE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; BRULE; SOIN INTENSIF; DUREE DE SEJOUR; SARM
Background: MRSA is an on-going problem for burn patients.
Aim: To analyze risk factors for, and the effect of MRSA colonization on burn patients' outcome.
Methods: During 21 months burn patients' details and MRSA isolates were analyzed, and a case-control
study performed.
Results: Of 357 burn patients, 57 (16%) tested positive for MRSA. Compared to the MRSA negative group,
MRSA positive patients had a higher median total burn surface area (15%[IQR 5-17%] vs. 5%[IQR 2-8%];
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p<0.001), more admissions to ICU (54% vs. 26%; p<0.001), longer ICU length of stay (4.3 vs. 1.0 days;
p<0.001), required more operations (1.6 vs. 0.8; p<0.001), and had longer total hospital length of stay (25.5
vs. 8.0 days; p<0.001). MRSA positivity was a significant independent predictor of increased length of stay
(6.0 days, 95%CI 2.39-9.6 days; p=0.001) in a multivariable regression model correcting for patients TBSA
and co-morbidities. Cardiac comorbidities (OR 5.14, 95%CI 1.76-15.62; p<0.001) and a longer exposure to
the hospital environment (OR 1.05, 95%CI 1.02-1.09, p=0.005) increased the likelihood for MRSA positivity.
Conclusion: The negative impact of MRSA positivity on burn patients outcome indicates the need for
improved screening procedures for early identification and further efforts toward MRSA infection control to
prevent cross-infection as this may significantly impair patients' outcome.
NosoBase ID notice : 399446
La technique RT-PCR Xpert SARM/SASM est-elle fiable pour le détection de staphylocoques à
coagulase négative résistant à la pénicilline dans les infections articulaires périprothétiques ?
Lourtet-Hascoët J; Bicart-See A; Félicé MP; Giordano G; Bonnet E. Is Xpert MRSA/SA SSTI real-time PCR a
reliable tool for fast detection of methicillin-resistant coagulase-negative staphylococci in periprosthetic joint
infections? Diagnostic microbiology and infectious disease 2015/09; 83(1): 59-62.
Mots-clés : PCR; BIOLOGIE MOLECULAIRE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; STAPHYLOCOQUE A COAGULASE NEGATIVE; CHIRURGIE ORTHOPEDIQUE; RT-PCR;
ETUDE RETROSPECTIVE; MATERIEL ETRANGER; APPAREIL OSTEO-ARTICULAIRE; PROTHESE
TOTALE DE HANCHE; PROTHESE TOTALE DE GENOU
Periprosthetic joint infections (PJIs) are frequently caused by methicillin-resistant coagulase-negative
staphylococci (CoNS). Cultures remain the gold standard but often require a few days. Thus, a rapid test
could be interesting to guide antibiotic strategy earlier. The purpose of this study was to evaluate the
performances of RT-PCR Xpert® MRSA/SA technique for the detection of methicillin-resistant CoNS
(MRCoNS) from deep samples in patients with PJIs. RT-PCR was tested on 72 samples. Sensitivity,
specificity, positive predictive value, and negative predictive value of RT-PCR method were 0.36, 0.98, 0.90,
and 0.74, respectively. Although RT-PCR may allow early microbial diagnosis of PJI due to Staphylococcus
aureus (MSSA and MRSA), the low sensitivity and the high cost of this method to detect MRCoNS could limit
its use in this field.
NosoBase ID notice : 400108
Contacts de personne à personne et colonisation à Staphylococcus aureus résistant à la méticilline :
une étude cas-témoins nichée dans une cohorte
Obadia T; Opatowski L; Temime L; Herrmann JL; Fleury E; Boëlle PY; et al. Interindividual contacts and
carriage of methicillin-resistant Staphylococcus aureus: A nested case-control study. Infection control and
hospital epidemiology 2015/08; 36(8): 922-929.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; COLONISATION; INFECTION
NOSOCOMIALE; CONTAMINATION; TRANSMISSION; COHORTE; CAS TEMOIN; DEPISTAGE;
PRECAUTION COMPLEMENTAIRE; HYGIENE DES MAINS; OBSERVANCE; PERSONNEL
Background: Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current
methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers
(HCWs). More specific measures could rely on a better characterization of the contacts at risk of
dissemination.
Objective: To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination.
Design: Nested case-control study.
Setting: French long-term care facility in 2009.
Participants: Patients (n=329) and HCWs (n=261).
Methods: We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months
in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8
control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was
used to quantify associations between incidence and exposure to demographic, network, and carriage
covariables.
Results: The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage
acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio
[OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 132 / 34
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Septembre 2015
hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI
with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did
not capture associations between contacts and carriage.
Conclusions: Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of inhospital contact networks to design targeted intervention strategies.
Vaccination
NosoBase ID notice : 400821
Vaccination contre l’hépatite B : perceptions et pratiques des médecins généralistes, France, 2014
Gautier A; Lydié N; Jestin C; Pulcini C; Verger P. Vaccination contre l’hépatite B : perceptions et pratiques
des médecins généralistes, France, 2014. Bulletin épidémiologique hebdomadaire 2015/07/28; 26-27: 492498.
Mots-clés : VACCINATION; PROFESSION LIBERALE; HEPATITE B; PERCEPTION
Introduction : Cet article décrit les perceptions et pratiques de vaccination contre l’hépatite B des médecins
généralistes libéraux en France métropolitaine.
Méthodes : Un échantillon aléatoire de 1 582 médecins généralistes exerçant en France métropolitaine a été
interrogé par téléphone entre avril et juillet 2014.
Résultats : La majorité des médecins interrogés (90,3%) déclaraient avoir été complètement vaccinés contre
l’hépatite B. Les trois quarts des médecins, parents d’enfant(s) de 2 à 24 ans, déclaraient que leur(s)
enfant(s) étai(en)t bien vacciné(s) contre l’hépatite B. Pour 16,6%, aucun enfant ne l’était. La moitié des
généralistes estimait obtenir facilement l’adhésion à cette vaccination pour les adolescents non vaccinés. Le
lien entre le vaccin contre l’hépatite B et la sclérose en plaques était jugé « pas du tout probable » par 48,0 %
des médecins et « peu probable » par 40,3 %. La proposition de la vaccination contre l’hépatite B chez
l’adolescent était systématique pour un tiers des médecins (34,0 %). Un sur 10 ne la proposait « jamais ». La
moitié des médecins interrogés (51,9 %) déclarait « toujours » détailler les maladies ciblées par le vaccin
hexavalent quand ils le proposaient ; un médecin sur cinq déclarait le faire « parfois » ou « jamais ».
Conclusion : Si la majorité des médecins sont confiants vis-à-vis de la sécurité du vaccin contre l’hépatite B,
ils perçoivent leur patientèle comme réticente vis-à-vis de cette vaccination. Apporter aux médecins les
arguments nécessaires pour faciliter l’adhésion à cette vaccination semble ainsi indispensable.
NosoBase ID notice : 400552
Attitude, connaissances et facteurs associés à l’augmentation de la vaccination contre la grippe et les
pneumocoques dans une vaste cohorte de patients présentant un déficit immunitaire secondaire
Loubet P; Kernéis S; Groh M; Loulergue P; Blanche P; Verger P; et al. Attitude, knowledge and factors
associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary
immune deficiency. Vaccine 2015/07/17; 33(31): 3703-3708.
Mots-clés : CONNAISSANCE; ATTITUDE; FACTEUR DE RISQUE; VACCIN; GRIPPE; STREPTOCOCCUS
PNEUMONIAE; COHORTE; DEFICIT IMMUNITAIRE; ANALYSE MULTIVARIEE; QUESTIONNAIRE;
GRIPPE SAISONNIERE; MILIEU COMMUNAUTAIRE
Background: Immunocompromised patients are at increased risk for severe influenza and invasive
pneumococcal diseases. Population-specific vaccine recommendations are thus warranted. This study aimed
to estimate the prevalence and predictors of influenza and pneumococcal vaccine uptake in a large cohort of
patients with secondary immune deficiency.
Methods: An anonymous online survey was submitted to the members of 11 French associations of
immunocompromised patients. The questionnaire included questions concerning underlying disease, care
and treatment, flu and pneumococcal vaccine uptake, attitudes and knowledge about vaccination. Factors
associated with vaccine uptake were assessed by multivariate logistic regression.
Results: Among the 10,897 solicited patients, 3653 agreed to participate (33.5%): 75% were female, 20%
aged 65+, 79% were followed for an autoimmune disease, 13% were solid organ recipients or waiting for
transplantation and 8% were treated for hematological malignancies. 3109 (85%) participants were treated
with immunosuppressive therapy. Self-reported vaccine uptake was 59% (95%CI [57-60]) against seasonal
influenza and 49% (95%CI [47-50]) against pneumococcal diseases. Better knowledge of and favorable
attitudes toward vaccination were positively associated with vaccine uptake while being treated with a
biological therapy was negatively associated.
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Conclusion: Despite specific recommendations regarding immunocompromised patients, influenza and
pneumococcal vaccination rates do not reach recommended levels. Targeted information campaigns on
vaccination toward these populations should be implemented to improve vaccine coverage and thus reduce
the burden of infections.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
nathalie.vincent@chu
-lyon.fr
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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