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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 : Abonnement / Désabonnement 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 1 / 34 NosoVeille – Bulletin de veille 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. 2 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 3 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 4 / 34 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 5 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 6 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 7 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 8 / 34 NosoVeille – Bulletin de veille 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 9 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 10 / 34 NosoVeille – Bulletin de veille 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 11 / 34 NosoVeille – Bulletin de veille 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. 12 / 34 NosoVeille – Bulletin de veille 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 13 / 34 NosoVeille – Bulletin de veille 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. 14 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 15 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 16 / 34 NosoVeille – Bulletin de veille 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. 17 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 18 / 34 NosoVeille – Bulletin de veille 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 19 / 34 NosoVeille – Bulletin de veille 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. 20 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 21 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 22 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 23 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 24 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 25 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 26 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 27 / 34 NosoVeille – Bulletin de veille 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. 28 / 34 NosoVeille – Bulletin de veille Septembre 2015 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. 29 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 30 / 34 NosoVeille – Bulletin de veille Septembre 2015 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%]; 31 / 34 NosoVeille – Bulletin de veille Septembre 2015 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 NosoVeille – Bulletin de veille 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. 33 / 34 NosoVeille – Bulletin de veille Septembre 2015 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] 34 / 34