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NosoVeille – Bulletin de veille
Février 2012
NosoVeille n°2
Février 2012
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html
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Abonnement / Désabonnement
Sommaire de ce numéro
Antibiotique / Antibiorésistance
Bactériémie
Cathétérisme
Chirurgie
Clostridium difficile
Désinfection
EHPAD / Personne âgée
Environnement
Epidémie
Gestion des risques
Grippe
Hygiène des mains
Indicateurs
Infections émergentes
Maternité
Néonatologie
Personnel
Prévention
Soins à domicile
Soins intensifs
Sondage urinaire
Staphylococcus aureus
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NosoVeille – Bulletin de veille
Février 2012
Antibiotique / Antibiorésistance
NosoBase n° 32977
Introduction d'enterobactéries productives d'OXA-48 dans des hôpitaux israéliens par le tourisme
médical
Adler A; Shklyar M; Schwaber MJ; Navon-Venezia S; Dhaher Y; Edgar R; et al. Introduction of OXA-48producing enterobacteriaceae to Israeli hospitals by medical tourism. The Journal of antimicrobial
chemotherapy 2011/12; 66(12): 2763-2766.
Mots-clés : EPIDEMIOLOGIE; CARBAPENEME; ANTIBIORESISTANCE; ENTEROBACTERIE; BIOLOGIE
MOLECULAIRE; GENOTYPE; ENQUETE; ESCHERICHIA COLI; KLEBSIELLA; KLEBSIELLA
PNEUMONIAE; KLEBSIELLA OXYTOCA;TRANSMISSION
Objectives: The carbapenemase OXA-48 has been reported from different Mediterranean countries. It is
mostly encoded on a single plasmid in various Enterobacteriaceae species. We characterized the
epidemiological and molecular features of OXA-48-producing Enterobacteriaceae (OPE) in Israel.
Methods: Epidemiological investigation was conducted by the National Center for Infection Control.
Genotyping was performed using multilocus sequence typing. The bla(OXA-48)-carrying plasmids were
investigated using S1 endonuclease and restriction fragment length polymorphism (RFLP). Conjugation
efficiency of the bla(OXA-48)-carrying plasmids was studied in a filter mating experiment.
Results: Since 2007, four OPE-infected patients were identified, all non-Israeli (two Palestinian, one
Jordanian and one Georgian). Three had prior hospitalization; two in Jordan and one in Georgia. The
bla(OXA-48) gene was detected in three Escherichia coli strains belonging to different clonal complexes, one
Klebsiella oxytoca and one Klebsiella pneumoniae sequence type 101, as previously reported from Tunisia
and Spain. In all isolates, the bla(OXA-48) gene was located inside Tn1999.2 and was carried on a 60 kb
plasmid with an identical RFLP pattern. The plasmid was able to conjugate from Klebsiella spp. to E. coli, and
had a conjugation efficiency up to ~10000 times higher than that of pKpQIL.
Conclusions: OPE, introduced mainly by medical tourism, are an emerging threat to patients from affected
Mediterranean countries. The bla(OXA-48)-carrying plasmid demonstrated remarkable conjugation efficiency,
which is probably important in the success of its dissemination.
NosoBase n° 32854
Impact de l'usage des antibiotiques sur l'incidence et le profil de résistance des bactéries
productrices de bêta-lactamases à spectre étendu dans des secteurs de soins primaires et
secondaires
Aldeyab MA; Harbarth S; Vernaz N; Kearney MP; Scott MG; Elhajji FW; et al. The impact of antibiotic use on
the incidence and resistance pattern of ESBL-producing bacteria in primary and secondary healthcare
settings. British journal of clinical pharmacology 2012; in press: 31 pages.
Mots-clés : INCIDENCE; ANTIBIOTIQUE; ANTIBIORESISTANCE; BETA-LACTAMASE A SPECTRE
ELARGI;
FLUOROQUINOLONE;
ETUDE
RETROSPECTIVE;
PROTOCOLE;
PREVENTION;
CONSOMMATION
What is already known about this subject - The emergence and spread of bacteria producing extendedspectrum beta-lactamases (ESBLs) has important therapeutic and epidemiologic implications. - A key target
for the establishment of hospital antibiotic stewardship is reducing the occurrence of additional antibiotic
resistance. - Further research is needed to accumulate supporting evidence that reducing antibiotic use will
result in a parallel reduction in antibiotic resistance What this study adds - Fluoroquinolone restriction
reverses ciprofloxacin resistance in primary and secondary healthcare settings. - Fluoroquinolone restriction
reduced ESBL-producing bacteria incidence rates in both the primary and secondary healthcare settings Highlights the value of time-series analysis in designing efficient antibiotic stewardship.
Background: the objective of the present study was to study the relationship between hospital antibiotic use,
community antibiotic use, and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria
in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria
incidence rates. Methods: the study was retrospective and ecological in design. A multivariate autoregressive
integrated moving average (ARIMA) model was built to relate antibiotic use to ESBLs incidence rates and
resistance patterns over a five-year period (January 2005- December 2009).
Results: Analysis showed that hospital incidence of ESBLs had a positive relationship with the use of
fluoroquinolones in the hospital (coefficient=0.174, p=0.02), amoxicillin-clavulanic acid in the community
(coefficient=1.03, p=0.03), and mean co-morbidity scores for hospitalised patients (coefficient=2.15, p=0.03)
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NosoVeille – Bulletin de veille
Février 2012
with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use
of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 define daily doses (DDDs)/1000 beddays (p<0.001) and from 0.65 to 0.54 DDDs/1000 (p=0.0007) inhabitants per day, in both the hospital and its
surrounding community, respectively. This was associated with an improved ciprofloxacin-susceptibility in
both settings [ciprofloxacin-susceptibility being improved from 16% to 28% in the community (p<0.001)], and
with a statistically significant reduction in ESBL-producing bacteria incidence rates.
Discussion: This study supports the value of restricting the use of certain antimicrobial classes to control
ESBL, and demonstrate the feasibility of reversing resistance patterns post successful antibiotic restriction.
The study also highlights the potential value of the time-series analysis in designing efficient antibiotic
stewardship.
NosoBase n° 32776
Transmission nosocomiale d'Escherichia coli producteurs de NDM-1 dans une région non-endémique
en France
Denis C; Poirel L; Carricajo A; Grattard F; Fascia P; Verhoeven P; et al. Nosocomial transmission of NDM-1producing Escherichia coli within a non-endemic area in France. Clinical microbiology and infection 2012; in
press: 11 pages.
Mots-clés : TRANSMISSION; ESCHERICHIA COLI; ANTIBIORESISTANCE;
CITROBACTER; ENQUETE; ENTEROBACTER; BIOLOGIE MOLECULAIRE
MULTIRESISTANCE;
Two patients with no travel history and sharing the same room were colonized by the same strain of NDM-1producing Escherichia coli within a geographic area not endemic for this highly multidrug-resistant (HMDR)
bacterium. An absence of epidemiological and bacteriological link was demonstrated with a third patient
returning from India after surgery and found infected by a NDM-1-producing Citrobacter strain at the same
period. Despite extensive investigation, the source of contamination of the two former patients was not
elucidated. This case report illustrates the need to investigate rapidly the emergence of HMDR
Enterobacteriaceae to stop their dissemination in a nosocomial setting.
NosoBase n° 32839
Emergence de résistance aux carbapénèmes dans des souches d'Acinetobacter baumannii en
Europe : impact clinique et options thérapeutiques
Kempf M; Rolain JM. Emergence of resistance to carbapenems in Acinetobacter baumannii in Europe: clinical
impact and therapeutic options. International journal of antimicrobial agents 2012/02; 39(2): 105-114.
Mots-clés : BIBLIOGRAPHIE; CARBAPENEME; ANTIBIORESISTANCE; EUROPE; TRAITEMENT;
MULTIRESISTANCE; BIOLOGIE MOLECULAIRE; COLISTINE; COLONISATION; EPIDEMIOLOGIE;
ACINETOBACTER BAUMANNII
Despite having a reputation of low virulence, Acinetobacter baumannii is an emerging multidrug-resistant
(MDR) pathogen responsible for community- and hospital-acquired infections that are difficult to control and
treat. Interest in this pathogen emerged about one decade ago because of its natural MDR phenotype, its
capability of acquiring new mechanisms of resistance and the existence of nosocomial outbreaks. Recent
advances in molecular biology, including full genome sequencing of several A. baumannii isolates, has led to
the discovery of the extraordinary plasticity of their genomes, which is linked to their great propensity to adapt
to any environment, including hospitals. In this context, as well as the increasing antimicrobial resistance
amongst A. baumannii isolates to the last-line antibiotics carbapenems and colistin, therapeutic options are
very limited or absent in some cases of infections with pandrug-resistant bacteria. However, a large
proportion of patients may be colonised by such MDR bacteria without any sign of infection, leading to a
recurrent question for clinicians as to whether antibiotic treatment should be given and will be effective in the
presence of resistance mechanisms. The worldwide emergence of A. baumannii strains resistant to colistin is
worrying and the increasing use of colistin to treat infections caused by MDR bacteria will inevitably increase
the recovery rate of colistin-resistant isolates in the future. Current knowledge about A. baumannii, including
biological and epidemiological aspects as well as resistance to antibiotics and antibiotic therapy, are reviewed
in this article, in addition to therapeutic recommendations.
NosoBase n° 33114
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Février 2012
Impact des précautions complémentaires et des consommations d’antibiotiques sur l’incidence des
cas acquis d’infections ou de colonisations à Acinetobacter baumannii : une étude multiservice sur
dix ans
Lefebvre A; Gbaguidi-Haore H; Thouverez M; Bertrand X; Talon D. Impact of additional precautions and
consumption of antibiotics on the incidence of Acinetobacter baumannii infection or colonization: a study of
different services over 10 years. Hygiènes 2011/12; XIX(6): 357-363.
Mots-clés : ANTIBIOTIQUE; ACINETOBACTER BAUMANNII; INCIDENCE; COLONISATION
Acinetobacter baumannii est un pathogène opportuniste émergent dans les hôpitaux. Il est responsable
d’endémies et d’épidémies impliquant des souches multirésistantes, dont le contrôle constitue un enjeu
majeur actuel. Une étude écologique a été réalisée au centre hospitalier universitaire de Besançon afin
d’évaluer l’impact des précautions complémentaires contact et des consommations d’antibiotiques sur
l’incidence annuelle des cas acquis d’infections ou de colonisations à A. baumannii au niveau du service. La
corrélation entre les mesures répétées des différentes variables (précautions contact, consommations
d’antibiotiques par classes, etc.) étudiées chaque année (entre 2000 et 2009), et dans chaque service, a été
prise en compte grâce à deux approches : un modèle à effets aléatoires, et un modèle marginal « generalized
estimating equations ». Les deux approches donnaient des résultats concordants concernant les facteurs
indépendamment associés à l’incidence des cas acquis que sont les précautions contact (association
négative, p < 0,001), les consommations de fluoroquinolones (corrélation positive, p < 0,05), l’hospitalisation
en réanimation (association positive, p < 0,001), et l’année (corrélation positive, p < 0,05). Cette étude
confirme donc l’efficacité des précautions contact en complément des précautions standard pour le contrôle
de la diffusion d’A. baumannii dans les différents services de l’hôpital, et met en évidence le rôle de la
pression de sélection exercée par les fluoroquinolones.
NosoBase n° 32837
Emergence et facteurs de risque de résistance aux oxymino-bêta-lactamines par médiation de bêtalactamases dans des isolats d'entérobactéries
Manageiro V; Ferreira E; Jones-Dias D; Louro D; Pinto M; Diogo J; et al. Emergence and risk factors of betalactamase-mediated resistance to oxyimino-beta-lactams in Enterobacteriaceae isolates. Diagnostic
microbiology and infectious disease 2012; in press: 6 pages.
Mots-clés : FACTEUR DE RISQUE; ENTEROBACTERIE; ANTIBIORESISTANCE; BETALACTAMINE;
CEPHALOSPORINE; ESCHERICHIA COLI; CMI
We studied 193 Enterobacteriaceae isolates presenting diminished susceptibility to oxyimino-cephalosporins
recovered in a Portuguese hospital (2004-2008). CTX-M-3 producers, firstly detected in Portugal, were
associated with a Klebsiella pneumoniae microepidemic clone. Production of CTX-M-type enzymes (CTX-M1/-3/-9/-14/-15/-32), age =65 years, and nosocomial infection were risk factors for higher nonsusceptibility to
oxyimino-ß-lactams. CMY-2 and DHA-1 ß-lactamases were only identified in 1% of isolates.
NosoBase n° 32850
Impact de la résistance aux carbapénèmes sur la mortalité dans les bactériémies à Pseudomonas
aeruginosa. Etude prospective multicentrique
Pena C; Suarez C; Gozalo M; Murillas J; Almirante B; Pomar V; et al. Impact of carbapenem resistance on
mortality in Pseudomonas aeruginosa bloodstream infection. A prospective multicenter study. Antimicrobial
agents and chemotherapy 2012; in press: 33 pages.
Mots-clés : PSEUDOMONAS AERUGINOSA; ANTIBIORESISTANCE; COHORTE;
BACTERIEMIE; ETUDE PROSPECTIVE; INCIDENCE; RISQUE; MORTALITE
CARBAPENEME;
The impact of antimicrobial resistance on clinical outcome is the subject of ongoing investigation, although
uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance
on mortality in Pseudomonas aeruginosa (PA) bacteremia in a prospective multicenter (ten teaching
hospitals) observational study of patients with monomicrobial bacteremia followed up 30 days after
bacteremia onset. The adjusted influence of carbapenem resistance on mortality was studied using Cox
regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible isolates (CSPA),
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NosoVeille – Bulletin de veille
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and 145 (23%) by carbapenem-resistant (CRPA) isolates. The median incidence density of nosocomial CRPA
bacteremia was 2.3 episodes per 100,000 patient-days (95%CI 1.9 to 2.8). The regression demonstrated a
time-dependent effect of carbapenem resistance on mortality, as well as a significant interaction with the
Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson
index scores. The impact of resistance on mortality was statistically significant only from the 5(th) day after
the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratios [95% confidence
intervals] Charlson 0 at day 30 = 9.9 [3.3 - 29.4]; Charlson 5 at day 30 = 2.6 [0.8 - 8]). This study clarifies the
relationship between carbapenem resistance and mortality of patients with P. aeruginosa bacteremia.
Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious
effect may be not as great during the first days of the bacteremia or in the presence of comorbidities.
NosoBase n° 33115
La réévaluation de l’antibiothérapie en hôpital local
Richard AL; Borderan GC; Piednoir E. Re-assessing treatment by local hospitals. Hygiènes 2011/12; XIX(6):
365-371.
Mots-clés : ANTIBIOTIQUE; HOPITAL LOCAL; EVALUATION DES PRATIQUES PROFESSIONNELLES;
MEDECIN; PROFESSION LIBERALE; AUDIT
Introduction : Très peu de données sont disponibles sur la réévaluation des antibiothérapies en hôpital local.
La particularité étant que ces antibiotiques sont prescrits par des médecins libéraux. L’objectif de ce travail
est donc d’évaluer cette pratique au sein de deux hôpitaux locaux.
Méthodes : Un audit a été réalisé dans deux hôpitaux locaux avec étude de 30 dossiers dans chaque
établissement. La réévaluation a été étudiée selon deux approches : une basée sur la recherche de critères
objectifs de non-réévaluation et l’autre proposée par la Société de pathologie infectieuse de langue française
sur ce thème (traçabilité). En complément, les prescripteurs de ces deux établissements ont été ensuite
questionnés à l’aide d’un outil testé et validé.
Résultats : Sur les 50 dossiers (83 %) a priori réévalués, seulement six dossiers (10 %) sont tracés. Ces deux
approches nous ont permis d’estimer l’écart entre une démarche réalisée et tracée dans les dossiers de soins
et une démarche a priori réalisée mais non tracée (écart : 43 dossiers). D’après le questionnaire, 38 % des
médecins resserrent systématiquement le spectre des antibiotiques. La raison pour laquelle les médecins ne
réévaluent pas systématiquement leurs antibiothérapies est pour 42 % d’entre eux, la crainte de « changer
une équipe qui gagne ». L’autre principal motif évoqué est le fait que la traçabilité de cette réévaluation ne
soit pas un réflexe, d’autant qu’un passage systématique à J3 est difficile du fait de leur activité libérale.
Conclusion : Seulement 10 % des antibiothérapies sont réévaluées avec une traçabilité dans le dossier
patient. En pratique, même si les médecins réévaluent les antibiotiques prescrits, une grande majorité ne
retranscrit pas cette démarche dans le dossier médical. Il est donc nécessaire de promouvoir la réévaluation
et sa traçabilité afin que celle-ci fasse partie intégrante de la culture médicale.
NosoBase n° 32946
Etude de prévalence ponctuelle de l'usage des antibiotiques dans des hôpitaux français en 2009
Robert J; Pean Y; Varon E; Bru JP; Bedos JP; Bertrand X; et al. Point prevalence survey of antibiotic use in
French hospitals in 2009. The Journal of antimicrobial chemotherapy 2012; in press: 7 pages.
Mots-clés : PREVALENCE; ANTIBIOTIQUE; TRAITEMENT; ANTIBIOPROPHYLAXIE; MICROBIOLOGIE;
PENICILLINE; CEPHALOSPORINE; FLUOROQUINOLONE; SURVEILLANCE
Objectives: To evaluate the feasibility of a point prevalence survey for monitoring antibiotic use in a voluntary
sample of French hospitals.
Methods: Demographic and medical data were collected for all inpatients. Additional characteristics regarding
antimicrobial treatment, type of infection and microbiological results were collected only for patients receiving
antimicrobials.
Results: Among 3964 patients in 38 hospitals, 343 (8.7%) received antimicrobial prophylaxis and 1276
(32.2%) antimicrobial therapy. The duration of surgical antimicrobial prophylaxis was >1 day in 41 out of 200
(21%) of the cases. Among patients with antimicrobial therapy, 959 (75.2%) received ß-lactams (including
34.8% penicillins with ß-lactam inhibitors, 22.1% third-generation cephalosporins and 7.8% carbapenems)
and 301 (23.6%) received fluoroquinolones (50% orally). A total of 518 (40.6%) patients were treated with
more than one drug and 345 (27.2%) were treated for >7 days. Patients treated for hospital-acquired
infections (39.2%) were more likely to receive combinations (47.6% versus 34.4%, P<0.01), carbapenems
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Février 2012
(14.4% versus 2.6%, P<0.01), glycopeptides (14.4% versus 3.7%, P<0.01) and antifungals (17% versus
5.3%, P<0.01) for a longer duration (7.8 versus 6 days, P<0.01). Fifty-six patients (4.4%) were treated for >7
days and did not have any microbiological sample drawn. The time allocated for the survey represented 18.325.0 h for 100 patients.
Conclusions: The data provide directions for further interventions, such as better use of diagnostic tools,
decreasing the treatment duration and the use of combinations. In addition, the survey shows that, although
cumbersome, it is feasible to improve the representativeness of national data in European surveys.
NosoBase n° 32830
Colonisation et infection à entérobactéries productrices de bêta-lactamases AmpC à médiation
plasmidique
Rodriguez-Bano J; Miro E; Villar M; Coelho A; Gozalo M; Borrell N; et al. Colonisation and infection due to
Enterobacteriaceae producing plasmid-mediated ampC beta-lactamases. The Journal of infection 2012/02;
64(2): 176-183.
Mots-clés : ENTEROBACTERIE; EPIDEMIOLOGIE; CEPHALOSPORINE; ANTIBIORESISTANCE; ETUDE
PROSPECTIVE; COHORTE; ESCHERICHIA COLI; PROTEUS MIRABILIS; KLEBSIELLA PNEUMONIAE;
MORTALITE; TRAITEMENT; COLONISATION; INFECTION
Objectives: To investigate the epidemiology and clinical features of infections caused by Enterobacteria
producing plasmid-mediated AmpC ß-lactamases (pAmpC), which are emerging as a cause of resistance to
extended-spectrum cephalosporins.
Methods: A prospective multicentre cohort of patients with infection/colonisation due to pAmpC-producing
Enterobacteriaceae was performed in 7 Spanish hospitals from February throughout July 2009. pAmpCs
were characterised by PCR and sequencing.
Results: 140 patients were included; organisms isolated were Escherichia coli (n=100), Proteus mirabilis
(n=20), Klebsiella pneumoniae (n=17), and others (n=3). Overall, 90% had a chronic underlying condition.
The acquisition was nosocomial in 43%, healthcare-associated in 41% (14% of those were nursing home
residents), and community in 16%. Only 5% of patients had no predisposing feature for infection with
multidrug-resistant bacteria. Nineteen percent of patients were bacteraemic. Inappropriate empirical therapy
was administered to 81% of bacteraemic patients, who had a crude mortality rate of 48%. The most frequent
enzyme was CMY-2 (70%, predominantly in E. coli and P. mirabilis) followed by DHA-1 (19%, predominantly
in K. pneumoniae).
Conclusion: pAmpC-producing Enterobacteriaceae caused nosocomial, healthcare-associated and
community infections mainly in predisposed patients. Invasive infections were associated with high mortality
which might be partly related to inappropriate empirical therapy.
Bactériémie
NosoBase n° 32841
Bactériémies à levures rares opportunistes (non-Candida, non-Cryptococcus) chez des patients
cancéreux
Chitasombat MN; Kofteridis DP; Jiang Y; Tarrand J; Lewis RE; Kontoyiannis DP. Rare opportunistic (nonCandida, non-Cryptococcus) yeast bloodstream infections in patients with cancer. The Journal of infection
2012/01; 64(1): 68-75.
Mots-clés : CANCER; MYCOLOGIE; LEVURE; BACTERIEMIE; ETUDE RETROSPECTIVE; CATHETER;
RHODOTORULA; TRICHOSPORON; MALASSEZIA; PICHIA; SACCHAROMYCES; MORTALITE; RISQUE;
ANALYSE MULTIVARIEE; INCIDENCE
Background: Rare opportunistic (non-Candida, non-Cryptococcus) yeast bloodstream infections (ROYBSIs)
are rare, even in cancer patients.
Methods: We retrospectively reviewed all episodes of ROYBSIs occurring from 1998 to 2010 in our cancer
center.
Results: Of 2984 blood cultures positive for Candida and non-Candida yeasts, 94 (3.1%) were positive for
non-Candida yeasts, representing 41 ROYBSIs (incidence, 2.1 cases/100,000 patient-days). Catheterassociated fungemia occurred in 21 (51%) patients. Breakthrough ROYBSIs occurred in 20 (49%) patients.
The yeast species distribution was Rhodotorula in 21 (51%) patients, Trichosporon in 8 (20%) patients,
Saccharomyces cerevisiae in 8 (20%) patients, Geotrichum in 2 (5%) patients, Pichia anomala, and
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Malassezia furfur in 1 patient each. All tested Trichosporon, Geotrichum, and Pichia isolates were azolesusceptible, whereas the Rhodotorula isolates were mostly azole-resistant. We noted echinocandin
nonsusceptibility (minimal inhibitory concentration=2 mg/L) in all but the S. cerevisiae isolates. Most of the
isolates (28/33 [85%]) were susceptible to amphotericin B. The mortality rate in all patients at 30 days after
ROYBSIs diagnosis was 34%. Multivariate survival analysis revealed increased risk of death in patients with
S. cerevisiae infections (hazard ratio, 3.7), Geotrichum infections (hazard ratio, 111.3), or disseminated
infections (hazard ratio, 33.4) and reduced risk in patients who had catheter removal (hazard ratio, 0.1).
Conclusions: ROYBSIs are uncommon in patients with cancer, and catheters are common sources of them.
Half of the ROYBSIs occurred as breakthrough infections, and in vitro species-specific resistance to
echinocandins and azoles was common. Disseminated infections resulted in the high mortality rate.
NosoBase n° 32968
Surveillance obligatoire des bactériémies à Staphylococcus aureus méticillino-résistant en
Angleterre: 10 premières années
Johnson AP; Davies J; Guy R; Abernethy J; Sheridan E; Pearson A; et al. Mandatory surveillance of
methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in England: the first 10 years. The Journal
of antimicrobial chemotherapy 2012; in press: 8 pages.
Mots-clés
:
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
BACTERIEMIE; INCIDENCE; EPIDEMIOLOGIE; PREVENTION
SURVEILLANCE;
Since 2001 it has been mandatory for acute hospital Trusts (groups of hospitals under the same
management) in England to report all cases of bacteraemia due to Staphylococcus aureus together with
information on their susceptibility or resistance to methicillin. This allowed the incidence of methicillin-resistant
S. aureus (MRSA) bacteraemia (expressed as the number of cases per 1000 occupied bed days) to be
determined for each Trust. In late 2005, the scheme was enhanced to collect demographic, clinical and
epidemiological information on each case using a web-based data collection system. Analysis of this
mandatory dataset has provided important information on the trends in MRSA bacteraemia in England and
has documented a year-on-year decrease in incidence since 2006, following a government initiative in which
Trusts were tasked with halving their MRSA bacteraemia rates over a 3year period. In addition, the enhanced
mandatory surveillance scheme has captured a wealth of data that have helped to further define the
epidemiology of MRSA bacteraemia. It is to be hoped that based on the English experience of mandatory
surveillance, other countries will consider the implementation of similar schemes, not only for MRSA but for
other pathogens of public health importance.
NosoBase n° 32775
Caractérisation moléculaire et clinique des bactériémies à Escherichia coli producteurs de bêtalactamase AmpC à médiation plasmidique : comparaison avec des bactériémies à Escherichia coli
producteurs de bêta-lactamase à spectre étendu et à Escherichia coli non résistant aux antibiotiques
Matsumura Y; Nagao M; Iguchi M; Yagi T; Komori T; Fujita N; et al. Molecular and clinical characterisation of
plasmid-mediated ampC beta-lactamase-producing Escherichia coli bacteraemia: a comparison with
extended-spectrum beta-lactamase-producing and non-resistant E. coli bacteraemia. Clinical microbiology
and infection 2012; in press: 25 pages.
Mots-clés : BIOLOGIE MOLECULAIRE; ESCHERICHIA COLI; BACTERIEMIE; BETA-LACTAMASE A
SPECTRE ELARGI; ANTIBIORESISTANCE; CENTRE HOSPITALIER UNIVERSITAIRE; FACTEUR DE
RISQUE; ANTIBIOTIQUE; PREVALENCE; IDENTIFICATION
Plasmid-mediated AmpC beta-lactamase-producing E. coli (AmpC-E) bacteraemia was characterised by
comparison with bacteraemia caused by extended-spectrum beta-lactamase-producing E. coli (ESBL-E) and
non-resistant E. coli (NR-E) in the era of the worldwide spread of the CTX-M-15 producing O25b-ST131-B2
clone. Of 706 bloodstream E. coli isolates collected between 2005 and 2010 in 3 Japanese university
hospitals, 111 ESBL screening-positive isolates were analysed for AmpC and ESBL genes by PCR. A casecontrol study was performed in which the cases consisted of all the patients with AmpC-E bacteraemia.
Phylogenetic groups, sequence types, and O25b serotype were determined. Twenty-seven AmpC-E isolates
(26 of which were of the CMY-2 type) were identified, and 54 ESBL-E and 54 NR-E isolates were selected for
the controls. Nineteen AmpC-E isolates were also positive for ESBL. The CTX-M-14 was the most prevalent
ESBL type, both in the AmpC-E and ESBL-E isolates. The O25b-ST131-B2 clone was the most prevalent of
the ESBL-E (26%) and the second most prevalent of NR-E (13%), but only one O25b-ST131-B2 clone was
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found among the AmpC-E isolates. Twenty-three different sequence types were identified among the AmpCE isolates. When compared to bacteraemia with ESBL-E, previous isolation of multidrug-resistant bacteria
and intravascular catheterisation were independently associated with a lower risk for AmpC-E. When
compared to NR-E bacteraemia, prior use of antibiotics was the only significant risk factor for AmpC-E. Unlike
the spread of the O25b-ST131-B2 clone between ESBL-E and NR-E, the AmpC-E isolates were not
dominated by any specific clone.
NosoBase n° 32857
Collaboration dans l'ensemble d'un hôpital pour l'amélioration de la qualité afin de réduire les
bactériémies associées aux cathéters
Wheeler DS; Giaccone MJ; Hutchinson N; Haygood M; Bondurant P; Demmel K; et al. A hospital-wide
quality-improvement collaborative to reduce catheter-associated bloodstream infections. Pediatrics 2011/10;
128(4): e995-e1007.
Mots-clés : CATHETER; BACTERIEMIE; QUALITE; PREVENTION; PEDIATRIE; INCIDENCE; ETUDE
RETROSPECTIVE; ETUDE TRANSVERSALE; OBSERVANCE; PROTOCOLE; HYGIENE DES MAINS;
SOIN; CATHETER VEINEUX CENTRAL; PERSONNEL; CATHETER ARTERIEL; CATHETER VEINEUX
PERIPHERIQUE; CATHETER OMBILICAL; HEMODIALYSE
Background: Catheter-associated bloodstream infections (CA BSIs) are associated with increased hospital
length of stay, total hospital costs, and mortality. Quality-improvement collaboratives (QICs) are frequently
used to improve health care quality. Our PICU was previously involved in a successful national QIC to reduce
the incidence of CA BSI in critically ill children.
Objective: We hypothesized that the formation of a hospital-wide QIC would reduce the incidence of CA BSI
throughout our institution.
Methods: We retrospectively reviewed the incidence of CA BSI from March 2006 to March 2010. The
collaborative approach included hospital-wide implementation of central-line insertion and maintenance
bundles that emphasized full sterile barrier precautions and chlorhexidine skin preparation during line
insertion, daily discussion of catheter necessity, and meticulous site and tubing care. The hospital units
involved were our 3 critical care units, the oncology unit, the bone marrow transplant unit, and wards. Each
individual unit was responsible for collecting unit-specific data and performing event-cause analysis within 48
hours of identifying a CA BSI. These results were shared with the other hospital units during monthly
meetings. Compliance with the insertion and maintenance bundles was monitored and reported to each unit
monthly.
Results: The hospital-wide CA-BSI rate decreased from a baseline of 3.0 to <1.0 CA BSI per 1000 line-days
after implementation of the QIC.
Conclusions: Our hospital-wide QIC resulted in a significant reduction in the incidence of CA BSI at our
children's hospital. A collaborative model based on improvement science methodology is both feasible and
effective in reducing the incidence of CA BSI.
NosoBase n° 32773
Bactériémies nosocomiales à Acinetobacter baumannii, Acinetobacter pittii et Acinetobacter
nosocomialis aux Etats-Unis
Wisplinghoff H; Paulus T; Lugenheim M; Stefanik D; Higgins PG; Edmond MB; et al. Nosocomial bloodstream
infections due to Acinetobacter baumannii, Acinetobacter pittii and Acinetobacter nosocomialis in the United
States. The Journal of infection 2012; in press: 9 pages.
Mots-clés : ACINETOBACTER BAUMANNII; ACINETOBACTER; BACTERIEMIE; ANTIBIORESISTANCE;
CATHETER; MORTALITE; ANTIBIOTIQUE; TIGECYCLINE; COLISTINE; IMIPENEME; MULTIRESISTANCE
Objectives: To compare the clinical features and antimicrobial susceptibilities of the clinically most important
Acinetobacter species Acinetobacter baumannii, Acinetobacter pittii (formerly Acinetobacter genomic species
3) and Acinetobacter nosocomialis (formerly Acinetobacter genomic species 13TU).
Methods: 295 Acinetobacter isolates collected prospectively from patients with bloodstream infections (BSI) in
52 US hospitals were identified to species level. Clinical and microbiological features were compared
between species.
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Results: A. baumannii (63%) was the most prevalent species, followed by A. nosocomialis (21%), and A. pittii
(8%). Intravascular catheters (15.3%) and the respiratory tract (12.9%) were the most frequent sources of
BSI. A higher overall mortality was observed in patients with A. baumannii BSI than in patients with BSI
caused by A. nosocomialis and A. pittii (36.9% vs. 16.4% and 13.0%, resp., p < 0.001). The most active
antimicrobial agents as determined by broth microdilution were tigecycline (99.6% of isolates susceptible),
colistin (99.3%), amikacin (98.5%), and imipenem (95.2%). 27 isolates (10.0%) were multi-drug resistant, all
but one of these were A. baumannii.
Conclusions: About one third of Acinetobacter BSI in our study were caused by A. nosocomialis or A. pittii.
Patients with A. baumannii BSI had a less favorable outcome.
Cathétérisme
NosoBase n° 32629
Profils d'utilisation des cathéters veineux centraux temporaires dans un important centre hospitalier
universitaire : le suivi des « cathéters veineux centraux au repos »
Chernetsky S; Tong D; Stein J; Payne C; Dressler D; Xue W; et al. Temporary central venous catheter
utilization patterns in a large tertiary care center: tracking the "idle central venous catheter". Infection control
and hospital epidemiology 2012/01; 33(1): 50-57.
Mots-clés : CATHETER VEINEUX CENTRAL; ETUDE RETROSPECTIVE; BACTERIEMIE; CENTRE
HOSPITALIER UNIVERSITAIRE; DUREE DE SEJOUR
Objectives: Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related
bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed ("idle").
We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on
non-ICU wards.
Design: A retrospective observational study.
Setting: A 579-bed acute care, academic tertiary care facility.
Methods: A retrospective observational study of a random sample of patients on hospital wards who have a
temporary, non implanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle
CVC-days was used.
Results: We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361
(25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days
and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward
length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with
non-PICC temporary CVCs (other CVCs; [Formula: see text]). Patients with a PICC had 5.4 days in which
they also had a PIV, compared with 10 days in other CVC patients ([Formula: see text]). Patients with PICCs
had more days in which the only justification for the CVC was intravenous administration of antimicrobial
agents (8.5 vs 1.6 days; [Formula: see text]).
Conclusions: Significant proportions of ward CVC-days were unjustified. Reducing "idle CVC-days" and
facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.
NosoBase n° 33041
Essai randomisé comparant des verrous gentamicine / citrate et héparine pour des cathéters veineux
centraux de patients hémodialysés
Moran J; Sun S; Khababa I; Pedan A; Doss S; Schiller B. A randomized trial comparing gentamicin/citrate
and heparin locks for central venous catheters in maintenance hemodialysis patients. American journal of
kidney diseases 2012/01; 59(1): 102-107.
Mots-clés : HEMODIALYSE; CATHETER VEINEUX CENTRAL; ESSAI THERAPEUTIQUE;
RANDOMISATION; GENTAMICINE; PREVENTION; PANSEMENT; ANTIBIOTIQUE; BACTERIEMIE;
INCIDENCE; MICROBIOLOGIE
Background: Central venous catheters (CVCs) are used for vascular access in hemodialysis patients who
have no alternative access or are awaiting placement or maturation of a permanent access. The major
complications of CVCs are catheter-related bloodstream infection and clotting in the catheter lumen.
Study design: Parallel-group, randomized, multicenter clinical trial, with patients blinded to study intervention.
Setting and participants: 16 free-standing dialysis facilities in Northern California belonging to a single
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provider. 303 adult maintenance hemodialysis patients who were using a tunneled cuffed CVC for vascular
access.
Intervention: The treatment group received an antibiotic lock containing gentamicin 320 µg/mL in 4% sodium
citrate, whereas the control group received the standard catheter lock containing heparin 1,000 U/mL. Both
groups received triple-antibiotic ointment on the catheter exit site during dressing changes at each dialysis
treatment.
Outcomes: Catheter-related bloodstream infection and catheter clotting.
Measurements: Catheter-related bloodstream infection was defined as the occurrence of symptoms
consistent with bacteremia together with positive blood culture results in the absence of another obvious
source of infection. Catheter clotting was measured as the rate of thrombolytic agent use required to maintain
adequate blood flow. A single patient could contribute more than one infection or clotting episode.
Results: The rate of catheter-related bloodstream infection was 0.91 episodes/1,000 catheter-days in the
control group and 0.28 episodes/1,000 catheter-days in the treatment group (P=0.003). The time to the first
episode of bacteremia was significantly delayed (P=0.005). The rates of tissue plasminogen activator use
were similar in the treatment and control groups: 2.36 versus 3.42 events/1,000 catheter-days, respectively
(P=0.2).
Limitations: The requirement for dialysis facility staff to prepare the treatment intervention prevented a
completely blinded study.
Conclusion: Gentamicin 320 µg/mL in 4% sodium citrate used as a routine catheter lock in CVCs in patients
on maintenance hemodialysis therapy markedly decreases the incidence of catheter-related bloodstream
infection and is as effective as heparin 1,000 U/mL in preventing catheter clotting.
Chirurgie
NosoBase n° 32790
La mise en place d'une checklist périopératoire améliore la sécurité périopératoire des patients et la
satisfaction du personnel
Bohmer AB; Wappler F; Tinschmann T; Kindermann P; Rixen D; Bellendir M; et al. The implementation of a
perioperative checklist increases patients' perioperative safety and staff satisfaction. Acta anaesthesiologica
scandinavica 2012; in press: 7 pages.
QUALITE; SECURITE; PERSONNEL;
ANTIBIOPROPHYLAXIE; CHIRURGIEN
CHIRURGIE;
PREVENTION;
INCIDENCE;
MORTALITE;
Background: The implementation of the 'Surgical Safety Checklist' caused a significant reduction in the
incidence of complications and mortality among patients undergoing surgery. The aim of the present study
was to evaluate perioperative safety standards and the quality of interprofessional cooperation before and
after the introduction of a safety checklist from staff members' point of view.
Methods: Employees' attitude concerning safety-relevant aspects of the perioperative period, work processes,
and quality of interprofessional cooperation was surveyed before and 3 months after introducing an adapted
form of the 'Surgical Safety Checklist' by a 19-item questionnaire.
Results: After the implementation of the checklist, the cognizance of the names and functions of the individual
operating room (OR) staff members, verification of the patient's written consent for surgery, indication for
antibiotics before the surgical incision, and the quality of interprofessional cooperation were rated more
positively. Traumatology physicians were more convinced that all artifacts had been removed from the
surgical field. Finally, communication about intraoperative complications had improved.
Conclusions: Our attitude surveys demonstrate that from the OR staff's perspective, in the perioperative
setting, safety-relevant factors can be handled significantly better and with greater awareness by
implementing a safety checklist as proposed by the World Health Organization.
NosoBase n° 32925
Infections sur implants orthopédiques à Escherichia coli : analyse moléculaire et phénotypiques des
souches responsables
Cremet L; Corvec S; Bemer P; Bret L; Lebrun C; Lesimple B; et al. Orthopaedic-implant infections by
Escherichia coli: molecular and phenotypic analysis of the causative strains. The Journal of infection 2012/02;
64(2): 169-175.
Mots-clés : ESCHERICHIA COLI; CHIRURGIE ORTHOPEDIQUE; MATERIEL ETRANGER; BIOLOGIE
MOLECULAIRE; PCR
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Objectives: Little is known about Escherichia coli Orthopaedic Implant Infections (OII) pathogenesis. Thus, we
compared 30 clinical strains isolated in this context with 30 clinical strains of faecal origin, in order to identify
phenotypic and genetic features related to E. coli OII.
Methods: Phylogenetic analysis and detection of 19 virulence genes were performed by PCR. Ability to form
biofilm was studied using the crystal violet reference method and the innovative BioFilm Ring Test(.).
Results: Most of the OII isolates (56.7%) belonged to the virulence-associated phylogenetic group B2, but did
not present a specific set of virulence factors. S fimbriae was the only adhesin significantly associated with
OII isolates. Isolates varied greatly in their ability to form biofilm but OII isolates did not produce significantly
more biofilm in vitro than isolates of faecal origin, whatever the method used.
Conclusions: Neither a specific pathogenic signature nor an increased ability to form biofilm in vitro was
detected in E. coli strains isolated from OII. Nevertheless, genetic properties of these isolates could provide a
clue to their origin. Hence, we found that virulence factors of uropathogenic strains and urological disorders
were frequently detected among our OII cohort.
NosoBase n° 33053
Nouveau regard sur la douche pré-opératoire
Tanner J; Gould D; Jenkins P; Hilliam R; Mistry N; Walsh S. A fresh look at preoperative body washing.
Journal of infection prevention 2012/01; 13(1): 11-15.
Mots-clés :
HYGIENE
CORPORELLE;
DOUCHE;
CHIRURGIE;
PRE-OPERATOIRE;
ESSAI
THERAPEUTIQUE; RANDOMISATION; CHLORHEXIDINE; SAVON DOUX; PRELEVEMENT; EFFICACITE;
PREVENTION
National guidelines do not support preoperative body washing to reduce surgical site infections, instead
recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used
in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon
which guidelines are based, are dated and proposes a new investigation of preoperative body washing using
modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques
and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial
with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming
units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective
than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in
reducing CFUs in the groin.
Clostridium difficile
NosoBase n° 32625
Réadmissions fréquentes pour infections à Clostridium difficile à l'hôpital et impact sur les
estimations d'incidence des infections à Clostridium difficile nosocomiales
Murphy CR; Avery TR; Dubberke ER; Huang SS. Frequent hospital readmissions for Clostridium difficile
infection and the impact on estimates of hospital-associated C. difficile burden. Infection control and hospital
epidemiology 2012/01; 33(1): 20-28.
Mots-clés : CLOSTRIDIUM
RETROSPECTIVE
DIFFICILE;
INFECTION;
INCIDENCE;
SEJOUR;
SORTIE;
ETUDE
Objective: Clostridium difficile infection (CDI) is associated with hospitalization and may cause readmission
following admission for any reason. We aimed to measure the incidence of readmissions due to CDI.
Design: Retrospective cohort study.
Patients: Adult inpatients in Orange County, California, who presented with new-onset CDI within 12 weeks of
discharge.
Methods: We assessed mandatory 2000-2007 hospital discharge data for trends in hospital-associated CDI
(HA-CDI) incidence, with and without inclusion of postdischarge CDI (PD-CDI) events resulting in
rehospitalization within 12 weeks of discharge. We measured the effect of including PD-CDI events on
hospital-specific CDI incidence, a mandatory reporting measure in California, and on relative hospital ranks
by CDI incidence.
Results: From 2000 to 2007, countywide hospital-onset CDI (HO-CDI) incidence increased from 15 per
10,000 to 22 per 10,000 admissions. When including PD-CDI events, HA-CDI incidence doubled (29 per
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10,000 in 2000 and 52 per 10,000 in 2007). Overall, including PD-CDI events resulted in significantly higher
hospital-specific CDI incidence, although hospitals had disproportionate amounts of HA-CDI occurring
postdischarge. This resulted in substantial shifts in some hospitals' rankings by CDI incidence. In multivariate
models, both HO and PD-CDI were associated with increasing age, higher length of stay, and select
comorbidities. Race and Hispanic ethnicity were predictive of PD-CDI but not HO-CDI.
Conclusions: PD-CDI events associated with rehospitalization are increasingly common. The majority of HACDI cases may be occurring postdischarge, raising important questions about both accurate reporting and
effective prevention strategies. Some risk factors for PD-CDI may be different than those for HO-CDI,
allowing additional identification of high-risk groups before discharge.
NosoBase n° 32313
Infections nosocomiales à Clostridium difficile : facteurs déterminant une infection sévère
Wenisch JM; Schmid D; Kuo H; Simons E; Allerberger F; Michl V; et al. Hospital-acquired Clostridium difficile
infection: determinants for severe disease. European journal of clinical microbiology and infectious disease
2012; in press: 8 pages.
Mots-clés : CLOSTRIDIUM DIFFICILE; FACTEUR DE RISQUE; ETUDE PROSPECTIVE; PCR; INFECTION
RECURRENTE; MORTALITE; INCIDENCE
Risk factors of severity (need for surgical intervention, intensive care or fatal outcome) were analysed in
hospital-acquired Clostridium difficile infection (CDI) in a 777-bed community hospital. In a prospective
analytical cross-sectional study, age (=65 years), sex, CDI characteristics, underlying diseases, severity of
comorbidity and PCR ribotypes were tested for associations with severe CDI. In total, 133 cases of hospitalacquired CDI (mean age 74.4 years) were identified, resulting in an incidence rate of 5.7/10,000 hospitaldays. A recurrent episode of diarrhoea occurred in 25 cases (18.8%) and complications including toxic
megacolon, dehydration and septicaemia in 69 cases (51.9%). Four cases (3.0%) required ICU admission,
one case (0.8%) surgical intervention and 22 cases (16.5%) died within the 30-day follow-up period. Variables
identified to be independently associated with severe CDI were severe diarrhoea (odds ratio [OR] 3.64, 95%
confidence interval [CI] 1.19-11.11, p=0.02), chronic pulmonary disease (OR 3.0, 95% CI 1.08-8.40, p=0.04),
chronic renal disease (OR 2.9, 95% CI 1.07-7.81, p=0.04) and diabetes mellitus (OR 4.30, 95% CI 1.5711.76, p=0.004). The case fatality of 16.5% underlines the importance of increased efforts in CDI prevention,
in particular for patients with underlying diseases.
Désinfection
NosoBase n° 33105
Note technique de la commission Désinfection de la SF2H - Point sur les normes de sporicidie V7
SF2H; Commission Européenne. SF2H 2012/01/17: 1-4.
Mots-clés : DESINFECTION; NORME; SPORICIDIE; DESINFECTANT
Récemment, les conditions d’utilisation de certains désinfectants à base d’acide peracétique revendiquant
une activité sporicide ont été modifiées avec un temps de contact significativement réduit. La commission
Désinfection de la SF2H a été interrogée sur l’opportunité de la modification des procédures requérant un
haut niveau de désinfection.
EHPAD / Personne âgée
NosoBase n° 32948
Prévalence élevée de la colonisation à Clostridium difficile parmi des résidents d'EHPAD à Hesse, en
Allemagne
Arvand M; Moser V; Schwehn C; Bettge-Weller G; Hensgens MP; Kuijper EJ. High prevalence of Clostridium
difficile colonization among nursing home residents in Hesse, Germany. PLos ONE 2012/01; 7(1):1-6.
Mots-clés : PREVALENCE; CLOSTRIDIUM DIFFICILE; COLONISATION;
ANTIBIOTIQUE; PERSONNE AGEE; RISQUE; BIOLOGIE MOLECULAIRE
EHPAD;
DIARRHEE;
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Clostridium difficile is the most common cause of antibiotic-associated diarrhoea in hospitals and other
healthcare facilities. The elderly are particularly susceptible and at increased risk for adverse outcome as a
result of C. difficile infection. The aim of this study was to determine the prevalence of C. difficile colonization
among residents of nursing homes in Hesse and to compare it with the prevalence in the general population
living outside long-term care facilities (LTCF). We assessed possible risk factors for C. difficile colonization
and determined the genotype of circulating strains. C. difficile was isolated from 11/240 (4.6%) nursing home
residents and 2/249 (0.8%) individuals living outside LTCF (p=0.02). Ten of 11 (90.9%) isolates from nursing
homes and one of two isolates from the population outside LTCF were toxigenic. The prevalence of C. difficile
colonization varied from 0% to 10% between different nursing homes. Facilities with known actual or recent
CDI cases were more likely to have colonized residents than facilities without known CDI cases. C. difficile
PCR-ribotypes 014 and 001 were the most prevalent genotypes and accounted for 30% and 20% of toxigenic
isolates in nursing homes, respectively. Interestingly, no individuals carried the epidemic strain PCR-ribotype
027. Our results suggest that residents of nursing homes in Germany are at high risk for colonization by
virulent C. difficile strains. The high prevalence of C. difficile colonization in nursing homes underscores the
importance of good adherence to standard infection control precautions even in the absence of a diagnosed
infection. They also emphasize the need for specific programs to increase the awareness of healthcare
professionals in LTCF for CDI.
NosoBase n° 32923
Mesures de contrôle pour des épidémies d'infections invasives à streptocoque du groupe A dans des
EHPAD
Cummins A; Millership S; Lamagni T; Foster K. Control measures for invasive group A streptococci (iGAS)
outbreaks in care homes. The Journal of infection 2012/02; 64(2): 156-161.
Mots-clés : INCIDENCE; CONTROLE; STREPTOCOCCUS; STREPTOCOCCUS GROUPE A; EPIDEMIE;
ANTIBIOPROPHYLAXIE; PERSONNE AGEE; EHPAD
Objectives: The incidence of invasive group A streptococcal infections (iGAS) is increasing in Europe, with a
particularly high morbidity and mortality in the elderly. Control of outbreaks in care homes is therefore
important; but is unclear how best to manage these incidents. We attempted to identify which control
measures are most likely to be effective.
Methods: We undertook literature searches using PubMed and Google Scholar and contacted colleagues in
Health Protection Units in England for unpublished outbreaks.
Results: We identified 31 outbreaks; of which 20 had sufficient detail for further analysis. Overall carriage
rates of GAS in care home residents identified in outbreak investigations were 4.7%, and in staff 3.2%. In 8
outbreaks mass antibiotic prophylaxis was offered, in 9 selective prophylaxis only and in 3 none at all.
Surveillance swabbing had limited influence on decisions regarding prophylaxis. A few papers mentioned the
role of environmental contamination and the risk from an affected roommate.
Conclusions: Pooling of results from these outbreaks failed to suggest any clear advantage to either a
selective or mass antibiotic prophylaxis strategy in controlling spread. Systematic investigation and data
collection from future outbreaks could be of benefit in informing future policy.
NosoBase n° 32786
Escarres chez les patients âgés hospitalisés et leur impact sur la durée de séjour : étude
rétrospective d'observation
Theisen S; Drabik A; Stock S. Pressure ulcers in older hospitalised patient and its impact on length of stay: a
retrospective observational study. Journal of clinical nursing 2012/02; 21(3-4): 380-387.
Mots-clés : ESCARRE; PERSONNE AGEE; DUREE DE SEJOUR; ETUDE RETROSPECTIVE; CENTRE
HOSPITALIER UNIVERSITAIRE
Objective: To examine the effect of pressure ulcers in older patients on the length of stay in hospital.
Background: Previous research on this topic did not focus solely on older people. A growing number of older
people require hospital admission.
Design: A retrospective observational study.
Methods: Data of 3198 patients age 75 years and older were included. The setting was a 1350-bed German
University Hospital. Data were drawn from quality indicator data recorded by nurses. The independent effect
of pressure ulcers was analysed using a multivariate Poisson-Regression model.
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Results: Of the participants, 7·1% had an ulcer during their hospitalisation. 87·3% were classified as
categories I and II. Mean age was 81·6 years for all patients and 83·2 years for pressure ulcer patients.
Pressure ulcer patients had a longer overall hospital stay (19·0 vs. 9·9 days) and a higher excess length of
stay (2·6 vs. 0·3 days). Pressure ulcers had a statistically significant effect (p = 0·0011) on the increase in
length of stay. The impact of hospital acquired pressure ulcers on length of stay was more pronounced
compared to those ulcers being present on admission. The pressure ulcer category was not significant.
Conclusions: Pressure ulcers during hospitalisation are an independent and significant predictor of a
prolonged inpatient stay for elderly patients. This study indicates that besides complications and comorbidities social factors, as well as the hospital's internal processes of patient care, also can play a
significant role.
Relevance to clinical practice: To evaluate the distinct role of hospital acquired pressure ulcers further
research is needed. The elderly patients in this study were a heterogeneous group. The implementation of
clinical and nursing processes for both the 'fit' and the 'sick' geriatric patients is an important challenge.
Environnement
NosoBase n° 33117
Prévention des risques liés à l’eau dans les établissements de santé de la Réunion
Denys JC; Deniau D. Prevention of risks from water in healthcare settings in La Réunion. Hygiènes 2011/12;
XIX(6): 379-386.
Mots-clés : EAU; RISQUE; LEGIONELLA; PREVENTION; EAU CHAUDE SANITAIRE; PSEUDOMONAS
AERUGINOSA; LEGISLATION; PRELEVEMENT; NORME; INVESTIGATION
Le risque de dégradation bactérienne de la qualité de l’eau dans les réseaux de distribution intérieure
constitue un facteur d’infections nosocomiales pour les établissements de soins. Aussi l’agence régionale de
santé océan Indien (ARS-OI) a-t-elle engagé un programme d’actions, consistant notamment à réaliser des
inspections-diagnostics des établissements. Les campagnes effectuées entre 2008 et 2011 ont permis de
détecter la présence de Legionella pneumophila sur les réseaux d’eau chaude sanitaire, avec dépassement
du seuil d’alerte-action dans un quart des établissements. Les investigations, élargies au contrôle de la
qualité des réseaux d’eau froide à compter de 2010, ont détecté la présence de Pseudomonas aeruginosa
pour plus du tiers des prélèvements ; démontrant que les réseaux d’eau froide constituent un réel vecteur de
contamination. Pour renforcer la procédure d’expertise de terrain et faciliter l’identification des points critiques
l’ARS-OI a testé un outil de mesure in situ de la biomasse active par ATP-métrie quantitative de seconde
génération. Au cours de cette étude, la méthode s’est avérée constituer une adaptation intéressante des
capacités de détection, de diagnostic et de surveillance pour gérer le risque de dégradation de la qualité de
l’eau. Le présent travail montre l’importance pour les établissements de soins d’établir des plans de gestion
de la sécurité sanitaire de l’eau fondés, d’une part sur les règles de conception des réseaux de distribution
d’eau intérieur (fonctionnement hydraulique, maîtrise des températures), d’autre part sur l’élaboration de
protocoles d’entretien préventif et curatif ainsi que de programmes de surveillance des installations.
NosoBase n° 32622
L'efficacité antimicrobienne de matériaux d'ameublement contenant un alliage de cuivre dans les
services hospitaliers : une étude croisée
Karpanen TJ; Casey AL; Lambert PA; Cookson BD; Nightingale P; Miruszenko K; et al. The antimicrobial
efficacy of copper alloy furnishing in the clinical environment: a crossover study. Infection control and hospital
epidemiology 2012/01; 33(1): 3-9.
Mots-clés : ENVIRONNEMENT; SURFACE; MATERIAU; MOBILIER; EQUIPEMENT; CONTAMINATION
Objective: To determine whether copper incorporated into hospital ward furnishings and equipment can
reduce their surface microbial load.
Design: A crossover study.
Setting: Acute care medical ward with 19 beds at a large university hospital.
Methods: Fourteen types of frequent-touch items made of copper alloy were installed in various locations on
an acute care medical ward. These included door handles and push plates, toilet seats and flush handles,
grab rails, light switches and pull cord toggles, sockets, overbed tables, dressing trolleys, commodes, taps,
and sink fittings. Their surfaces and those of equivalent standard items on the same ward were sampled once
weekly for 24 weeks. The copper and standard items were switched over after 12 weeks of sampling to
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reduce bias in usage patterns. The total aerobic microbial counts and the presence of indicator
microorganisms were determined.
Results: Eight of the 14 copper item types had microbial counts on their surfaces that were significantly lower
than counts on standard materials. The other 6 copper item types had reduced microbial numbers on their
surfaces, compared with microbial counts on standard items, but the reduction did not reach statistical
significance. Indicator microorganisms were recovered from both types of surfaces; however, significantly
fewer copper surfaces were contaminated with vancomycin-resistant enterococci, methicillin-susceptible
Staphylococcus aureus, and coliforms, compared with standard surfaces.
Conclusions: Copper alloys (greater than or equal to 58% copper), when incorporated into various hospital
furnishings and fittings, reduce the surface microorganisms. The use of copper in combination with optimal
infection-prevention strategies may therefore further reduce the risk that patients will acquire infection in
healthcare environments.
Epidémie
NosoBase n° 32759
Assistance du CDC pour les épidémies et prévention, 1946-2005
Supplement to American journal of epidemiology – Epidemic assistance by the centers for disease control
and prevention, 1946-2005. American journal of epidemiology 2011/12; 174(Supplément 11): S1-S114.
Mots-clés : EPIDEMIE; ENQUETE; CDC; HISTORIQUE; PREVENTION; CONTROLE; EPIDEMIOLOGIE;
SANTE PUBLIQUE
Document présentant les enquêtes épidémiologiques du CDC de 1946 à 2005 essentiellement, concernant
des infections que l'on peut prévenir grâce à des vaccins, les infections digestives et d'origine alimentaire, les
infections respiratoires, les infections associées aux soins, les épidémies liées à l'environnement et aux
catastrophes, les épidémies touchant certaines populations, les enquêtes internationales, la grippe A H1N1
2009.
NosoBase n° 32969
Epidémie nosocomiale à Enterobacter cloacae résistant aux carbapénèmes mettant en évidence la
transférabilité inter-espèces du gène bla OXA-48 dans la flore intestinale
Cremet L; Bourigault C; Lepelletier D; Guillouzouic A; Juvin ME; Reynaud A; et al. Nosocomial outbreak of
carbapenem-resistant Enterobacter cloacae highlighting the interspecies transferability of the bla(OXA-48)
gene in the gut flora. The Journal of antimicrobial chemotherapy 2012; in press: 3 pages.
Mots-clés : ENTEROBACTER
CLOACAE; ENTEROBACTER; ENTEROBACTERIE; EPIDEMIE;
ANTIBIORESISTANCE;
CARBAPENEME;
COLONISATION; BIOLOGIE MOLECULAIRE;
PCR;
ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE
NosoBase n° 33072
Epidémie d'endophtalmies post-chirurgie de la cataracte à Pseudomonas aeruginosa multirésistant
aux antibiotiques
Maltezou HC; Pappa O; Nikolopoulos G; Ftika L; Maragos A; Kaitsa H; et al. Post-cataract surgery
endophthalmitis outbreak caused by multidrug-resistant Pseudomonas aeruginosa. American journal of
infection control 2012/02; 40(1): 75-77.
Mots-clés : ENDOPHTALMIE; PSEUDOMONAS AERUGINOSA;
ANTIBIORESISTANCE; MULTIRESISTANCE; PFGE; ENQUETE
EPIDEMIE;
ŒIL;
CHIRURGIE;
In June 2010, a severe outbreak of 13 cases of post-cataract surgery endophthalmitis caused by multidrugresistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95%
genetic similarity; however, extensive environmental and carriage investigation revealed no source of
infection.
NosoBase n° 33056
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Fréquences des enquêtes sur des épidémies dans des hôpitaux américains : résultats d'une étude
nationale auprès des praticiens en hygiène hospitalière
Rhinehart E; Walker S; Murphy D; O'Reilly K; Leeman P. Frequency of outbreak investigations in US
hospitals: results of a national survey of infection preventionists. American journal of infection control
2012/02; 40(1): 2-8.
Mots-clés : ENQUETE; EPIDEMIE; MEDECIN HYGIENISTE; INFORMATIQUE;
STAPHYLOCOCCUS AUREUS; ACINETOBACTER; CLOSTRIDIUM DIFFICILE
NOROVIRUS;
Background: A survey of infection preventionists was conducted to determine the frequency of outbreak
investigations in US hospitals.
Methods: A 2-part electronic survey was sent to Association for Professionals in Infection Control and
Epidemiology, Inc, members in US hospitals in January 2010. Part 1 of the survey tool involved hospital
demographics and the infection prevention/control program. Part 2 explored specific outbreak investigations
allowing responses for up to 8 investigations within the previous 24 months.
Results: A final sample of 822 responses was analyzed representing 386 outbreak investigations in 289 US
hospitals. Nearly 60% of the outbreaks were caused by 4 organisms: norovirus (18%), Staphylococcus
aureus (17%), Acinetobacter spp (14%), and Clostridium difficile (10%). Norovirus occurred most often in
behavioral health and rehabilitation/long-term acute care units, whereas the other organisms occurred in
medical/surgical units. Unit/department closure was reported in 22.6% of investigations and most often
associated with norovirus. Outbreak investigations are triggered by unusual organisms, rate above baseline
for specific site of infection, and rate above baseline for specific unit. Investigations were most frequently
conducted in community/nonteaching hospitals and facilities with 201 to 300 beds. Mean number of confirmed
cases was 10; mean duration was 58 days.
Conclusion: Norovirus is emerging as an increasingly common hospital-associated organism causing
outbreaks in nonacute settings and may lead to unit/department closures.
Gestion des risques
NosoBase n° 32956
Les combats de l'hygiéniste
Favier AL. Objectif soins 2011/11; 200: 25-27.
Mots-clés : DEFINITION; ACINETOBACTER BAUMANNII; ASPERGILLUS; AGENT TRANSMISSIBLE NON
CONVENTIONNEL; BIOFILM; CHIKUNGUNYA; CLOSTRIDIUM DIFFICILE; DECHET; ESCHERICHIA COLI;
ENTEROCOCCUS; GALE; GESTION DES RISQUES; HYGIENE DES MAINS; INFECTIOLOGIE; USAGE
UNIQUE; KLEBSIELLA PNEUMONIAE; LEGIONELLA; PSEUDOMONAS AERUGINOSA; SIGNALEMENT;
INFECTION URINAIRE
ABCDAIRE pour connaître les protagonistes dans le combat que l’hygiéniste mène chaque jour et
appréhender les armes utilisées dans cette bataille quotidienne.
NosoBase n° 32306
Quelle est la dangerosité d'une journée à l'hôpital ? Modèle pour les événements indésirables et la
durée de séjour des patients hospitalisés en médecine
Hauck K; Zhao X. How dangerous is a day in hospital? A model of adverse events and length of stay for
medical inpatients. Medical care 2011/12; 49(12): 1068-1075.
Mots-clés : DUREE DE SEJOUR; RISQUE; GESTION DES RISQUES; TOLERANCE; SEJOUR;
STATISTIQUE; MEDECINE; EVENEMENT INDESIRABLE GRAVE
Background: Despite extensive research into adverse events, there is no quantitative estimate for the risk of
experiencing adverse events per day spent in hospital. This is important information for hospital managers,
because they may consider discharging patients earlier to alternative care providers if this is associated with
lower risk, but other costs and benefits are similar.
Methods: We model adverse events as a function of patient risk factors, hospital fixed effects, and length of
stay. Potential endogeneity of length of stay is addressed with instrumental variable methods, using days and
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months of discharge as instruments. We use administrative hospital episode data for 206,489 medical
inpatients in all public hospitals in the state of Victoria, Australia, for the year 2005/2006.
Results: A hospital stay carries a 5.5% risk of an adverse drug reaction, 17.6% risk of infection, and 3.1% risk
of ulcer for an average episode, and each additional night in hospital increases the risk by 0.5% for adverse
drug reactions, 1.6% for infections, and 0.5% for ulcers. Length of stay is endogenous in models of adverse
events, and risks would be underestimated if length of stay was treated as exogenous.
Conclusions: The results of our research contribute to assessing the benefits and costs of hospital stays-and
their alternatives-in a quantitative manner. Instead of discharging patients early to alternative care, it would be
more desirable to address underlying causes of adverse events. However, this may prove costly, difficult, or
impossible, at least in the short run. In such situations, our research supports hospital managers in making
informed treatment and discharge decisions.
Grippe
NosoBase n° 32778
Efficacité d'un vaccin intranasal vivant atténué contre la grippe chez des enfants de 2 à 17 ans : métaanalyse de 8 essais contrôlés randomisés
Ambrose CS; Wu X; Knuff M; Wutzler P. The efficacy of intranasal live attenuated influenza vaccine in
children 2 through 17 years of age: a meta-analysis of 8 randomized controlled studies. Vaccine 2012/01/20;
30(5): 886-892.
Mots-clés : EFFICACITE; VACCIN; GRIPPE; VIRUS INFLUENZA TYPE A; PEDIATRIE; META-ANALYSE;
RANDOMISATION
Background: Nine randomized controlled clinical trials, including approximately 26,000 children aged 6
months to 17 years, have evaluated the efficacy of live attenuated influenza vaccine (LAIV) against cultureconfirmed influenza illness compared with placebo or trivalent inactivated influenza vaccine (TIV). The
objective of the current analysis was to integrate available LAIV efficacy data in children aged 2-17 years, the
group for whom LAIV is approved for use.
Methods: A meta-analysis was conducted using all available randomized controlled trials and a fixed-effects
model. Cases caused by drifted influenza B were analyzed as originally classified and with all antigenic
variants classified as dissimilar.
Results: Five placebo-controlled trials (4 were 2-season trials) and 3 single-season TIV-controlled trials were
analyzed. Compared with placebo, year 1 efficacy of 2 doses of LAIV was 83% (95% CI: 78, 87) against
antigenically similar strains; efficacy was 87% (95% CI: 78, 93), 86% (95% CI: 79, 91), and 76% (95% CI: 63,
84) for A/H1N1, A/H3N2, and B, respectively. Classifying B variants as dissimilar, efficacy against all similar
strains was 87% (95% CI: 83, 91) and 93% (95% CI: 83, 97) against similar B strains. Year 2 efficacy was
87% (95% CI: 82, 91) against similar strains. Compared with TIV, LAIV recipients experienced 44% (95% CI:
28, 56) and 48% (95% CI: 38, 57) fewer cases of influenza illness caused by similar strains and all strains,
respectively. LAIV efficacy estimates for children from Europe, the United States, and Middle East were
robust and were similar to or higher than those for the overall population.
Conclusions: In children aged 2-17 years, LAIV demonstrated high efficacy after 2 doses in year 1 and
revaccination in year 2, and greater efficacy compared with TIV. This meta-analysis provides precise
estimates of LAIV efficacy among the approved pediatric age group.
NosoBase n° 32777
Efficacité de la vaccination contre la grippe parmi des patients adultes d'un centre hospitalier
universitaire de Lyon (2004-2009)
Amour S; Voirin N; Régis C; Bouscambert-Duchamp M; Comte B; Coppere B; et al. Influenza vaccine
effectiveness among adult patients in a University of Lyon hospital (2004-2009). Vaccine 2012/01/20; 30(5):
821-824.
Mots-clés : GRIPPE; VACCIN; CENTRE HOSPITALIER UNIVERSITAIRE; EFFICACITE; PREVENTION;
SURVEILLANCE; CAS TEMOIN; AGE; DIAGNOSTIC BIOLOGIQUE
The aim of this study was to estimate influenza vaccine effectiveness (IVE) against laboratory-confirmed
influenza among hospitalized patients. A case-control investigation was based on the prospective surveillance
of influenza-like illness (ILI) during five flu seasons. We compared influenza-positive cases and influenzanegative controls. Unadjusted overall IVE was 62% (95% confidence interval 24% to 81%). We found that IVE
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was lower during the 2004-05 flu season (11%; 95% CI -232% to 76%) when the vaccine and circulating
viruses were mismatched. Expansion of the study to other hospitals could provide IVE estimates earlier in the
season, for different age groups and emerging virus strains.
NosoBase n° 32799
Facteurs influençant la vaccination contre la grippe A (H1N1) parmi le personnel de santé d'un centre
régional de pédiatrie : leçons destinées à améliorer les taux de vaccination
Chen SC; Hawkins G; Aspinall E; Patel N. Factors influencing uptake of influenza A (H1N1) vaccine amongst
healthcare workers in a regional pediatric centre: lessons for improving vaccination rates. Vaccine
2012/01/05; 30(2): 493-497.
Mots-clés : GRIPPE; VACCIN; PEDIATRIE; PERSONNEL; VIRUS INFLUENZA TYPE A; TAUX;
QUESTIONNAIRE; ETUDE TRANSVERSALE
Background: Influenza A (H1N1) vaccination has been recommended for all frontline healthcare workers
(HCWs) in the UK since October 2009, to protect individuals and their patients from infection. Understanding
the factors influencing vaccine uptake by HCW may improve future vaccination programmes in current and
subsequent years.
Aims: To assess the uptake of influenza A (H1N1) vaccine, and factors affecting vaccine uptake, in frontline
healthcare workers in a large pediatric hospital.
Method: A cross-sectional questionnaire survey conducted in a regional Pediatric Hospital in Scotland
incorporating intensive care and ECMO services. One page, anonymised questionnaires were distributed to
all frontline HCW in high risk departments of the hospital.
Results: 260 questionnaires were completed, capturing an estimated 52% of all staff. Vaccination rate was
49.6%, and was significantly higher amongst doctors (OR 2.4, 95% CI 1.3-4.5, P=0.005). Commonest
reasons for vaccine uptake were high risk of contact with H1N1 (88%) and responsibility to protect patients
(71%). Uncertainty about vaccine side-effects (47%), concern about vaccine safety (33%) and being too busy
to attend the vaccine clinic (22%) were the commonest reasons for non-vaccination. Reasons for vaccination
varied between staff grouping and department. 36% of non-vaccinated staff would accept the vaccine if
offered.
Conclusions: Vaccine uptake may be increased by addressing HCW knowledge and attitudes and access to
vaccine. Future vaccination programmes should include targeted education and vaccine delivery, at the
convenience of staff, and in their own department.
NosoBase n° 33002
Santé au travail et gestion des risques dans le secteur de la santé - Guide pour la prévention et les
bonnes pratiques
Commission Européenne. Occupational health and safety risk in the healthcare sector - Guide to prevention
and good practice. European commission 2011: 1-264.
Mots-clés : GESTION DES RISQUES; SECURITE; RISQUE PROFESSIONNEL; PREVENTION; PRATIQUE;
EXPOSITION AU SANG; AIR; PRECAUTION STANDARD; HYGIENE DES MAINS; TENUE
VESTIMENTAIRE; MASQUE; GANT; TUBERCULOSE; GRIPPE; QUESTIONNAIRE; DESINFECTANT;
NETTOYAGE; BIBLIOGRAPHIE
Ce document porte sur la conduite d'une étude de risque, les risques biologiques (exposition au sang, air,
contact et au cours de la grossesse), les risques musculo-squelettiques et psycho-sociaux. Il traite aussi des
risques chimiques : mesures de prévention et de protection, des activités de nettoyage et de désinfection des
substances cytotoxiques et des gaz anesthésiques et présente les bonnes pratiques.
NosoBase n° 32959
Etude sérologique de la pandémie 2009 de grippe A H1N1 dans la population de la France
métropolitaine
Delangue J; Salez N; Ninove L; Kieffer A; Zandotti C; Seston M; et al. Serological study of the 2009 pandemic
due to influenza A H1N1 in the metropolitan french population. Clinical microbiology and infection 2012/02;
18(2): 177-183.
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Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; EPIDEMIE; SERUM; INFECTION COMMUNAUTAIRE
We looked for evidence of antibodies to the 2009 influenza A/H1N1 pandemic virus in panels of sera from
individuals living in metropolitan France, obtained either before, during or after the epidemic, using standard
haemagglutination inhibition and microneutralization tests. The difference between seroprevalence values
measured in post- and pre-epidemic panels was used as an estimate of seroconversion rate in different age
groups (23.4% (0-24 years, age-group 0); 16.5% (25-34); 7.9% (35-44); 7.2% (45-54); 1.6% (55-64); and
3.1% (>65)), confirming that the distribution of cases in different age groups was similar to that of the
seasonal H1N1 virus. During the pre-pandemic period low-titre cross-reactive antibodies were present in a
large proportion of the population (presumably acquired against seasonal H1N1) whereas cross-reactive
antibodies were detected in individuals over the age of 65 years with significantly higher prevalence and
serological titres (presumably acquired previously against Spanish flu-related H1N1 strains). Clinical data and
analysis of post-pandemic seroprevalence showed that few of these latter patients were infected by the
influenza virus during the epidemic. In contrast, the majority of both clinical cases and seroconversions were
recorded in the 0-24 age group and a global inverse relationship between prevalence of antibodies to pH1N1
in the pre-pandemic period and rate of seroconversion was observed amongst age groups. Our results
emphasize the complex relationships involved in antigenic reactivity to pandemic and seasonal H1N1 viral
antigens; hence the difficulty in distinguishing between low-titre specific and cross-reactive antibodies,
establishing precise seroprevalence numbers and fully understanding the relationship between previous
immunity to seasonal viruses and protection against the novel variant.
NosoBase n° 33001
Mesures de prévention et de contrôle de la grippe saisonnière en centre hospitalier de soins
généraux et spécialisés
Institut national de santé publique du Québec 2012/01(1391): 1-83.
Mots-clés : PREVENTION; GRIPPE; CONTROLE; VACCINATION; PERSONNEL; SURVEILLANCE;
INFORMATION; USAGER; FAMILLE; MASQUE
L'objectif de ce document est de fournir des recommandations sur les mesures de prévention et de contrôle
de la grippe saisonnière à appliquer dans les centres hospitaliers de soins généraux et spécialisés (CHSGS),
incluant les unités de pédiatrie. Il s'adresse aux équipes locales de prévention et de contrôle des infections
(PCI) qui travaillent en collaboration avec les autres directions concernées, avec leur service de santé et
sécurité au travail et aussi avec leur direction de santé publique, au besoin.
Ce document est divisé en cinq chapitres suivis de neuf annexes. Le premier chapitre aborde les notions
essentielles sur la grippe et la préparation à la saison grippale. Dans le deuxième chapitre, il est question de
vaccination et de surveillance. Le troisième chapitre porte sur la hiérarchie des mesures, les pratiques de
base, l'hygiène et l'étiquette respiratoire ainsi que les mesures de prévention et de contrôle. De plus, les
mesures spécifiques en présence d'un cas de grippe confirmé y sont expliquées avec des recommandations
spécifiques concernant les patients présentant un syndrome d'allure grippale (SAG), l'hygiène et salubrité, les
visiteurs, la prise en charge des travailleurs de la santé ainsi que les communications. Au quatrième chapitre,
la définition d'éclosion de grippe, les mesures de contrôle durant une éclosion avec les recommandations
spécifiques et les critères de signalement à la santé publique sont présentés. Finalement, la place de
l'utilisation des antiviraux décrite de façon plus détaillée fait l'objet du dernier chapitre.
NosoBase n° 32631
De volontaire à obligatoire : évolution des stratégies et des attitudes par rapport à la vaccination du
personnel soignant contre la grippe
Quan K; Tehrani DM; Dickey L; Spiritus E; Hizon D; Heck K; et al. Voluntary to mandatory: evolution of
strategies and attitudes toward influenza vaccination of healthcare personnel. Infection control and hospital
epidemiology 2012/01; 33(1): 63-70.
Mots-clés : VACCIN; PERSONNEL; GRIPPE; IMMUNITE; TAUX; VIRUS INFLUENZA TYPE A;
FORMATION; EVALUATION; ETUDE RETROSPECTIVE
Background: Assessing the relative success of serial strategies for increasing healthcare personnel (HCP)
influenza vaccination rates is important to guide hospital policies to increase vaccine uptake.
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Objective: To evaluate serial campaigns that include a mandatory HCP vaccination policy and to describe
HCP attitudes toward vaccination and reasons for declination.
Design: Retrospective cohort study.
Methods: We assessed the impact of serial vaccination campaigns on the proportions of HCP who received
influenza vaccination during the 2006-2011 influenza seasons. In addition, declination data over these 5
seasons and a 2007 survey of HCP attitudes toward vaccination were collected.
Results: HCP influenza vaccination rates increased from 44.0% (2,863 of 6,510 HCP) to 62.9% (4,037 of
6,414 HCP) after institution of mobile carts, mandatory declination, and peer-to-peer vaccination efforts.
Despite maximal attempts to improve accessibility and convenience, 27.2% (66 of 243) of the surveyed HCP
were unwilling to wait more than 10 minutes for a free influenza vaccination, and 23.3% (55 of 236) would be
indifferent if they were unable to be vaccinated. In this context, institution of a mandatory vaccination
campaign requiring unvaccinated HCP to mask during the influenza season increased rates of compliance to
over 90% and markedly reduced the proportion of HCP who declined vaccination as a result of preference.
Conclusions: A mandatory influenza vaccination program for HCP was essential to achieving high vaccination
rates, despite years of intensive vaccination campaigns focused on increasing accessibility and convenience.
Mandatory vaccination policies appear to successfully capture a large portion of HCP who are not opposed to
receipt of the vaccine but who have not made vaccination a priority.
NosoBase n° 32797
Etude de l'efficacité du vaccin contre la pandémie dans deux régions d'Italie à l'aide d'une méthode
de dépistage, 2009-2010
Seyler T; Bella A; Puzelli S; Donatelli I; Rizzo C. Estimating pandemic vaccine effectiveness in two Italian
regions using the screening method, 2009-2010. Vaccine 2012/01/05; 30(2): 109-111.
Mots-clés : VACCIN; EFFICACITE; EPIDEMIE; DEPISTAGE; GRIPPE; VIRUS INFLUENZA TYPE A;
RESEAU
The objective of this study, conducted within the I-MOVE project, was to estimate pandemic VE against
laboratory confirmed cases in two Italian regions using the screening method. We calculated vaccine
coverage using the number of first doses of pandemic vaccine administered and demographic data. A case
was defined as a patient who was swabbed from week 44 of 2009 to week 3 of 2010 and who tested positive
for A/H1N1v using RT-PCR. A case was considered vaccinated against influenza A/H1N1v if she/he had
received one dose of the vaccine more than 14 days before swabbing. We used Farrington's method to build
the confidence intervals. We included in the analysis 755 confirmed A/H1N1v cases. The median age of
cases was 24 years (range 0-89). One case (0.1%) had received one dose of vaccine more than 14 days
after swabbing. The overall crude estimated VE was 92.4% (95% CI: 46.3-98.9). It suggests that the
pandemic vaccine offered good protection against medically attended laboratory-confirmed A/H1N1v.
NosoBase n° 32987
Participation des patients à la sécurité des patients : protocole destiné au développement d'une
intervention utilisant les rapports des patients sur la sécurité de l'organisation et les rapports des
incidents concernant les patients
Ward JK; McEachan R; Lawton R; Armitage G; Watt I; Wright J. Patient involvement in patient safety:
protocol for developing an intervention using patient reports of organisational safety and patient incident
reporting. BMC health services research 2011; 11: 1-10.
Mots-clés : PROTOCOLE; USAGER; SECURITE; QUALITE; GESTION DES RISQUES; PERSONNEL;
BIBLIOGRAPHIE
Background: Patients have the potential to provide a rich source of information on both organisational aspects
of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote
organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient
incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when
and why they occur.
Methods: To develop the PMOS 1) literature will be reviewed to identify similar measures and key
contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient
interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test
acceptability and understanding. Qualitative data will be analysed using thematic content analysis.To develop
the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the
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development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each
of the tools for three months. The best performing tool will be identified from the frequency, volume and
quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the
PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week
later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture
questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be
assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed
by comparing reported incidents with those identified from case note review and the existing staff reporting
scheme. In a subsequent study these tools will be used to provide information to wards/units about their
priorities for patient safety. A patient panel will provide steering to the research.
Discussion: The PMOS and PIRT aim to provide a reliable means of eliciting patient views about patient
safety. Both interventions are likely to have relevance and practical utility for all NHS hospital trusts.
Hygiène des mains
NosoBase n° 32640
Evaluation quantitative de l'efficacité d'une solution hydro-alcoolique contre les entérocoques
résistants à la vancomycine sur les mains de volontaires
Grayson ML; Ballard SA; Gao W; Khumra S; Ward P; Johnson P; et al. Quantitative efficacy of alcohol-based
handrub against vancomycin-resistant enterococci on the hands of human volunteers. Infection control and
hospital epidemiology 2012/01; 33(1): 98-100.
Mots-clés : VANCOMYCINE; ENTEROCOCCUS; ANTIBIORESISTANCE; EVALUATION; EFFICACITE;
HYGIENE DES MAINS; MAIN; SOLUTION HYDROALCOOLIQUE
NosoBase n° 33121
Retirer son alliance ? Une photo pour convaincre
Meunier O; Salles F; Burger S; Boehm N; Hemmelé J. Hygiènes 2011/12; XIX(6): 399-400.
Mots-clés : HYGIENE DES MAINS; BIJOU; STREPTOCOCCUS; INFORMATION
L’alliance que les professionnels aimeraient pouvoir garder est-elle si lisse qu’elle y paraît ? Un bijou en métal
semi-précieux a été immergé dans une suspension de streptocoques, puis traité selon les procédures
habituelles pour l’observation en microscopie électronique à balayage. Les photographies réalisées montrent
les streptocoques parfaitement reconnaissables par leur disposition en chaînettes caractéristiques. Les
auteurs espèrent que la publication de ces images mettra à la disposition des équipes opérationnelles
d’hygiène des établissements de santé des arguments visuels probants pour leurs propres campagnes de
formation et de sensibilisation.
NosoBase n° 33113
L’hygiène des mains dans les établissements de santé de l’inter-région ouest : consommation des
produits hydro-alcooliques et des savons en 2009 et leur évolution depuis 2006
Pérennec M; Ertzscheid MA; Girot I; Dixon M; Aupée M. Hand hygiene in hospitals in the West of France:
consumption of alcohol-based rubs and soaps in 2009 and changes since 2009. Hygiènes 2011/12; XIX(6):
349-356.
Mots-clés : HYGIENE DES MAINS; PRODUIT HYDROALCOOLIQUE; CONSOMMATION; EVALUATION;
SAVON DOUX; SAVON DESINFECTANT; COHORTE; ENQUETE; AUDIT; ICSHA; UNITE DE SOIN
Objectifs : Evaluer au sein des établissements de santé (ES) de l’inter-région ouest, les consommations en
produits d’hygiène des mains (PHM), savons doux (SD), savons antiseptiques (SA), produits hydroalcooliques (PHA).
Matériel et méthodes : L’étude concernait des ES volontaires et comprenait le recueil des consommations
2009 en PHM pour l’ES et pour ses unités. Un indicateur de consommation a été calculé pour 1000 journéespatients (JP).
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Résultats : Au total 143 ES ont participé (486 unités). Les réanimations étaient les plus gros consommateurs
de PHM en 2009 avec 207,7 ml/JP : la consommation des PHA dépassait celle des SD (116 ml/JP contre 72
ml/JP) et la consommation des SA était en forte baisse depuis 2007. Dans pratiquement tous les types
d’unité, les PHA augmentaient significativement. Une cohorte de 66 ES suivie depuis 2006 a confirmé cette
tendance (consommation médiane de 4 ml en 2006 et de 14,3 ml/JP en 2009).
Conclusion : L’intérêt de l’étude se confirme chaque année de par sa complémentarité aux audits de
pratiques et du peu de références dans la littérature sur les consommations en PHM. Plusieurs facteurs
associés pourraient contribuer à la hausse significative des savons et PHA : audits, Journée mondiale du 5
mai, calcul de l’indicateur de consommation de produits hydro-alcooliques et travail de sensibilisation et
d’information continu des équipes opérationnelles d’hygiène.
NosoBase n° 33116
Une nouvelle approche méthodologique pour mesurer le nombre d’opportunités d’hygiène des mains
en unités d’hospitalisation
Slekovec C; Denizot V; Vettoretti L; Ponchon A; Mauny F; Hocquet D; et al. A new methodological approach
for measuring the number of hand hygiene opportunities in hospital wards. Hygiènes 2011/12; XIX(6): 373378.
Mots-clés : METHODOLOGIE; HYGIENE DES MAINS; PRODUIT HYDROALCOOLIQUE; MEDECINE;
CHIRURGIE; SOIN INTENSIF; SOIN; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION
Objectif : Mesurer le nombre d’opportunités de désinfection hydroalcoolique des mains dans différentes
unités de soins.
Matériel et méthodes : La charge en soins requis a été mesurée à travers les actes réalisés dans neuf
services de médecine (N = 4), de chirurgie (N = 4) et de réanimation (N = 1) pendant une période de deux
ans (méthode « Projet de recherche en nursing » [PRN]). La conversion du nombre d’actes en nombre
d’opportunités a été réalisée en prenant en compte la définition proposée par Pittet et al., le nombre
d’intervenants nécessaires à la réalisation de l’acte et selon le mode de réalisation (soins en série versus
soins globalisés).
Résultats : Pendant la période d’étude un total de 1 252 671 actes a fait l’objet d’un codage PRN pour les
neuf services inclus, et ce nombre correspondait à une durée moyenne de collecte de 734 jours par service
pour un total de 124 366 jours d’hospitalisation correspondant à 21 905 patients. Le nombre moyen par jour
et par patient d’actes cotés dans l’application PRN pour l’ensemble de la période d’étude était de 6,1 pour les
services de médecine, 7,6 pour les services de chirurgie et de 14,8 pour le service de réanimation. Le
nombre moyen d’opportunités obtenu par la méthode était de 35 par jour/patient pour la médecine, 49 pour la
chirurgie et 237 pour la réanimation.
Conclusion : Au total, notre approche méthodologique vient conforter les résultats issus de la littérature à
travers des études observationnelles et montre que le nombre réel d’opportunités est très supérieur au
nombre d’opportunités retenu pour mesurer la performance des établissements en matière d’hygiène des
mains.
Indicateurs
NosoBase n° 32898
Arrêté du 06/01/2012 fixant les conditions dans lesquelles l'établissement de santé met à la
disposition du public les résultats, publiés chaque année, des indicateurs de qualité et de sécurité
des soins
Ministère du travail, de l’emploi et de la santé. Journal officiel 2012/01/14: 2 pages.
Mots-clés : LEGISLATION; INDICATEUR; QUALITE ; SOIN ; INFORMATION; ICALIN ; ICSHA; SURVISO;
ICATB; SECURITE; MULTIRESISTANCE; ICATB; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; ESCARRE; RISQUE
NosoBase n° 32760
Indicateurs en vigie
Loukili N. Le moniteur hospitalier 2011/12; 241: 44-48.
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Mots-clés : INDICATEUR; HISTORIQUE; MULTIRESISTANCE; SURVEILLANCE; RESEAU; ICALIN; ICSHA;
ICATB; SURVISO; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE
Les indicateurs de lutte contre les infections nosocomiales sont aux avant-postes de la vigilance. Ils donnent
des pistes et permettent de guider l'élaboration d'une politique et d'un programme d'action.
Infections émergentes
NosoBase n° 32936
Stenotrophomonas maltophilia : un pathogène opportuniste émergent
Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clinical microbiology
reviews 2012/01; 25(1): 2-41.
Mots-clés : BACILLE GRAM NEGATIF; STENOTROPHOMONAS; STENOTROPHOMONAS MALTOPHILIA;
MICROBIOLOGIE; FACTEUR DE RISQUE; TRAITEMENT; ANTIBIORESISTANCE; BIOLOGIE
MOLECULAIRE; MUCOVISCIDOSE; BIBLIOGRAPHIE
Stenotrophomonas maltophilia is an emerging multidrug-resistant global opportunistic pathogen. The
increasing incidence of nosocomial and community-acquired S. maltophilia infections is of particular concern
for immunocompromised individuals, as this bacterial pathogen is associated with a significant fatality/case
ratio. S. maltophilia is an environmental bacterium found in aqueous habitats, including plant rhizospheres,
animals, foods, and water sources. Infections of S. maltophilia can occur in a range of organs and tissues; the
organism is commonly found in respiratory tract infections. This review summarizes the current literature and
presents S. maltophilia as an organism with various molecular mechanisms used for colonization and
infection. S. maltophilia can be recovered from polymicrobial infections, most notably from the respiratory
tract of cystic fibrosis patients, as a cocolonizer with Pseudomonas aeruginosa. Recent evidence of cell-cell
communication between these pathogens has implications for the development of novel pharmacological
therapies. Animal models of S. maltophilia infection have provided useful information about the type of host
immune response induced by this opportunistic pathogen. Current and emerging treatments for patients
infected with S. maltophilia are discussed.
Maternité
NosoBase n° 32791
Recommandations pour la prévention et le contrôle des infections à streptocoques groupe A dans
des services de soins aigus et en maternité au Royaume-Uni
Steer JA; Lamagni T; Healy B; Morgan M; Dryden M; Rao B; et al. Guidelines for prevention and control of
group A streptococcal infection in acute healthcare and maternity settings in the UK. The Journal of infection
2012/01; 64(1): 1-18.
Mots-clés : RECOMMANDATION; PREVENTION; CONTROLE; STREPTOCOCCUS; MATERNITE;
ENQUETE; TRANSMISSION; SANITAIRE; SURVEILLANCE; EPIDEMIE; BIBLIOGRAPHIE; PERSONNEL;
PRECAUTION
STANDARD;
PRECAUTION
COMPLEMENTAIRE;
HYGIENE
DES
MAINS;
ENVIRONNEMENT; FORMATION; DEPISTAGE
Ce document présente les recommandations pour la prévention et le contrôle des infections à streptocoque
du groupe A (Streptococcus pyogenes) dans des hôpitaux et en maternité. Il porte sur le rapport de cas, les
enquêtes, la surveillance prospective et rétrospective, les précautions complémentaires, l'hygiène des mains,
l'équipement de protection personnelle, le nettoyage environnemental, le linge et les déchets, le transfert des
patients. Il traite aussi des infections survenant chez les mères et leurs bébés, les différents modes de
transmission, la communication avec le personnel et les contacts, la gestion d'une épidémie, la prise en
charge du personnel colonisé ou infecté. Chaque sujet est assorti de recommandations avec niveaux de
preuve.
Néonatologie
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NosoBase n° 32984
Prévention des infections nosocomiales et surveillance des résistances émergentes en réanimation
néonatale
Cipolla D; Giuffre M; Mammina C; Corsello G. Prevention of nosocomial infections and surveillance of
emerging resistance in NICU. The Journal of maternal-fetal and neonatal medicine 2011/10; 24(Supplément
1): 23-26.
Mots-clés : PREVENTION; SURVEILLANCE; ANTIBIORESISTANCE; SOIN INTENSIF; NEONATALOGIE;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENTEROCOCCUS; BACILLE GRAM
NEGATIF; MULTIRESISTANCE; CARBAPENEME; ANTIBIOTIQUE
Neonates hospitalized in NICU are at risk for healthcare associated infections because of their poor immune
defenses, related to gestational age, colonization of mucous membranes and skin with nosocomial
microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers
(HCWs). Healthcare associated infections are the major source of morbidity and mortality in NICU in the
developed world. Most infections are caused by Gram-positive organisms, fulminant sepsis are often
associated to Gram-negative organisms, fungal sepsis occurs frequently in ELBW infants. Hand hygiene is
the most important preventive procedure, nevertheless hand hygiene compliance among HCWs remains low.
Continuous educational strategies can improve hand hygiene and contribute to reducing the incidence of
neonatal infections. Other important prevention strategies include early enteral feeding with human milk,
minimization and safety in the use of invasive devices, limiting unnecessary empiric broadspectrum
antibiotics, eventual use of lactoferrin bifidobacteria and lactobacilli, prophylactic administration of fluconazole
in VLBW. Emergence of multi drug resistant organisms (MDRO) is a worrying perspective. Methicillinresistant Staphylococcus aureus (MRSA) is an important healthcare-associated pathogen. Active surveillance
culturing for MRSA carriers, in combination with contact precautions and decolonization in some
hyperendemic settings, has been proved to reduce MRSA transmission and infection rates. Multidrugresistant Gram-negatives are frequently reported. Overuse of antimicrobial drugs and crosstransmission via
caregiver hands, contaminated equipment or inanimate objects are the major drivers of selection and
dissemination. Strategies to control outbreaks of MDRO colonization/infection in the NICU may include
performing hand hygiene, cohorting and isolating patients, screening healthcare workers and performing
admission and periodic surveillance cultures.
NosoBase n° 32985
Infections virales émergentes en réanimation néonatale
Tzialla C; Civardi E; Borghesi A; Sarasin A; Baldanti F; Stronati M. Emerging viral infections in neonatal
intensive care unit. The Journal of maternal-fetal and neonatal medicine 2011/10; 24(Supplément 1): 156158.
Mots-clés : VIRUS;
CONTROLE
SOIN
INTENSIF;
NEONATALOGIE;
INCIDENCE;
NOROVIRUS;
EPIDEMIE;
Nosocomial infections are the most important cause of morbidity and mortality among neonates and mostly in
infants admitted to neonatal intensive care units (NICU). The total number of neonates who develop
nosocomial infections per admission varies from 6.2 to 30%. The role of nosocomial virus infections is
generally neglected in the actual epidemiologic scenario mostly due to the lack of data in the medical
literature. Based on a worldwide database of health care-associated outbreaks (http://www.outbreakdatabase.com) we performed an analysis of the incidence, type of pathogens and clinical features of neonatal
viral outbreaks especially those reported in NICUs. We also describe, as an example of emerging virus in
NICU, a Norovirus outbreak along with clinical presentation that varies from mild to moderate clinical
symptoms like vomiting, gastric remainder, diarrhoea, abdominal distension or severe presentation like
necrotizing enterocolitis. and measures implemented for terminating the outbreak. In conclusion, our study
analyses the viral origins of nosocomial infections in NICU and underline that the role of viral agents in
neonatal nosocomial infections needs to be further investigated even in diseases traditionally considered of
bacterial origin like necrotizing enterocolitis.
Personnel
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NosoBase n° 33094 à 33100
Textes officiels concernant le développement professionnel continu
Mots-clés : LEGISLATION; FORMATION; MEDECIN; PHARMACIEN; SAGE-FEMME; INFIRMIER
Tous les textes sont accessibles sur le site NosoBase :
http://nosobase.chu-lyon.fr/Reglementation/Professionnel.html
Prévention
NosoBase n° 32828
Prévention des infections nosocomiales : étude nationale sur les pratiques rapportées par des
hôpitaux américains en 2005 et 2009
Krein SL; Kowalski CP; Hofer TP; Saint S. Preventing hospital-acquired infections: a national survey of
practices reported by U.S. hospitals in 2005 and 2009. Journal of general internal medicine 2012; in press: 7
pages.
Mots-clés : PREVENTION; PRATIQUE; BACTERIEMIE; CATHETER; PNEUMONIE; VENTILATION
ASSISTEE; INFECTION URINAIRE; SONDAGE URINAIRE; SONDE; SECURITE; QUALITE;
QUESTIONNAIRE; PRECAUTION COMPLEMENTAIRE; DECUBITUS; CHLORHEXIDINE; CATHETER
IMPREGNE; PANSEMENT
Background: Hospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to
reduce HAI-such as the Centers for Medicare and Medicaid Services (CMS) no payment rule-have increased
the use of preventive practices is not known.
Objective: To examine the use of infection prevention practices by U.S. hospitals and trends in use between
2005 and 2009.
Design, setting, and participants: Surveys of infection preventionists at non-federal general medical/surgical
hospitals and Department of Veterans Affairs (VA) hospitals, which are not subject to the CMS no payment
rule, in 2005 and 2009.
Main measures: Percent of hospitals using practices to prevent central line-associated bloodstream infection
(CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI).
Key results: Survey response was approximately 70%. More than 1/2 of non-federal hospitals reported a
moderate or large increase in CLABSI, VAP and CAUTI prevention as a facility priority due to the nonpayment rule; over 60% of VA hospitals reported no change in priority. However, both non-federal and VA
hospitals reported significant increases in use of most practices to prevent CLABSI, VAP and CAUTI from
2005 to 2009, with 90% or more using certain practices to prevent CLABSI and VAP in 2009. In contrast, only
one CAUTI prevention practice was used by at least 50% of hospitals.
Conclusions: Since 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in nonfederal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be
the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in
preventing CAUTI as a facility priority, prevention practice use remains low.
NosoBase n° 32766
L'isolement protecteur ou aseptique
Soulet T. Revue de l'infirmière 2011/12; 176: 53-54.
Mots-clés : DEFICIT IMMUNITAIRE; ISOLEMENT PROTECTEUR; CONTAMINATION; PREVENTION;
EFFICACITE; RISQUE; CHAMBRE; SAS; HYGIENE DES MAINS; TENUE VESTIMENTAIRE; GANT;
MASQUE; AIGUILLE; AIR; COLLECTEUR
Le patient en état d'immunodépression a besoin d'éviter tout contact avec les agents infectieux. C'est
pourquoi, lors de son hospitalisation, une partie de son traitement nécessite de l'isoler dans un
environnement le plus contrôlé possible. Une telle mesure comporte de nombreux gestes contraignants mais
indispensables.
Soins à domicile
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NosoBase n° 32909
Colonisation d'escarres par des microorganismes multirésistants aux antibiotiques chez des patients
bénéficiant de soins à domicile
Cataldo MC; Bonura C; Caputo G; Aleo A; Rizzo G; Geraci DM; et al. Colonization of pressure ulcers by
multidrug-resistant microorganisms in patients receiving home care. Scandinavian journal of infectious
diseases 2011/12; 43(11-12): 947-952.
Mots-clés : COLONISATION; ESCARRE; ANTIBIORESISTANCE; MULTIRESISTANCE; HOSPITALISATION
A DOMICILE; PREVALENCE; BACILLE GRAM NEGATIF; ENTEROCOCCUS; VANCOMYCINE;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE
Colonization and/or infection with multidrug-resistant microorganisms (MDRO) of pressure ulcers in patients
receiving care at home have seldom been investigated. The objective of this study was to assess the
prevalence of MDRO colonization in pressure ulcers of patients receiving home care in Palermo, Italy.
Vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and
multidrug-resistant Gram-negative bacilli (MDRGN) were isolated, identified, and characterized from pressure
ulcers and selected home environment surfaces. Thirty-two patients were enrolled, of whom 12 were under
antimicrobial therapy. Five patients had been admitted to hospital in the preceding year. Nineteen patients
tested positive for 1 or more MDROs. In particular, 1 patient was colonized by a vanA-containing strain of
VRE, 5 by MRSA, and 17 by MDRGN of different species. Our findings suggest that pressure ulcers in home
care patients could play a role in bringing MDROs into the community setting.
NosoBase n° 32765
Les règles d'hygiène pour l'infirmière libérale
Ciabrini B. Revue de l'infirmière 2011/12; 176: 35-36.
Mots-clés : INFIRMIER; PROFESSION LIBERALE; HOSPITALISATION A DOMICILE; SOIN; HYGIENE DES
MAINS; LAVAGE SIMPLE DES MAINS; GEL HYDROALCOOLIQUE; DECHET D'ACTIVITE DE SOINS A
RISQUE INFECTIEUX; INJECTION
L'infirmière libérale est tenue de respecter des mesures d'hygiène nécessaires au maintien de la santé du
patient à domicile. Ce dernier, cependant, ne se considère pas toujours comme malade ce qui implique que
l'infirmière explique avec tact les règles élémentaires d'hygiène. L'environnement du patient nécessite
également un entretien rigoureux. Sur ce point, l'infirmier a un rôle important dans l'éducation du patient et de
son entourage.
Soins intensifs
NosoBase n° 32838
Mortalité attribuable aux pneumonies acquises sous ventilation - Réévaluation utilisant une analyse
causale
Bekaert M; Timsit JF; Vansteelandt S; Depuydt P; Vesin A; Garrouste-Orgeas M; et al. Attritutable mortality of
ventilator-associated pneumonia - A reappraisal using causal analysis. American journal of respiratory and
critical care medicine 2011/11/15; 184(10): 1133-1139.
Mots-clés : MORTALITE; PNEUMONIE; VENTILATION ASSISTEE; COHORTE; SOIN INTENSIF; RISQUE;
RESEAU; PREVENTION
Rationale: Measuring the attributable mortality of ventilator-associated pneumonia (VAP) is challenging and
prone to different forms of bias. Studies addressing this issue have produced variable and controversial
results.
Objectives: We estimate the attributable mortality of VAP in a large multicenter cohort using statistical
methods from the field of causal inference.
Methods: Patients (n = 4,479) from the longitudinal prospective (1997-2008) French multicenter Outcomerea
database were included if they stayed in the intensive care unit (ICU) for at least 2 days and received
mechanical ventilation (MV) within 48 hours after ICU admission. A competing risk survival analysis, treating
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ICU discharge as a competing risk for ICU mortality, was conducted using a marginal structural modeling
approach to adjust for time-varying confounding by disease severity.
Measurements and main results: Six hundred eighty-five (15.3%) patients acquired at least one episode of
VAP. We estimated that 4.4% (95% confidence interval, 1.6-7.0%) of the deaths in the ICU on Day 30 and
5.9% (95% confidence interval, 2.5-9.1%) on Day 60 are attributable to VAP. With an observed ICU mortality
of 23.3% on Day 30 and 25.6% on Day 60, this corresponds to an ICU mortality attributable to VAP of about
1% on Day 30 and 1.5% on Day 60.
Conclusions: Our study on the attributable mortality of VAP is the first that simultaneously accounts for the
time of acquiring VAP, informative loss to follow-up after ICU discharge, and the existence of complex
feedback relations between VAP and the evolution of disease severity. In contrast to the majority of previous
reports, we detected a relatively limited attributable ICU mortality of VAP.
NosoBase n° 32784
Des risques d'escarre plus élevés en réanimation ? Comparaison entre les services de réanimation et
les autres services
Lahmann NA; Kottner J; Dassen T; Tannen A. Higher pressure ulcer risk on intensive care? – Comparison
between general wards and intensive care units. Journal of clinical nursing 2012/02; 21(3-4): 354-361.
Mots-clés : RISQUE; SOIN INTENSIF; ULCERE; PEAU
Objective: The objective of the study was to evaluate the effect of being treated in intensive care units in
comparison with general hospital wards regarding pressure ulcer occurrence when controlled for various risk
factors.
Background: Pressure ulcer occurrence is commonly used as an indicator for the quality of care. Large-scale
incidence studies are costly and difficult to perform.
Design: Secondary analysis of patient data (n = 32,400) collected during 2002-2009 as part of eight
multicentre pressure ulcer surveys in 256 German hospitals.
Methods: Ward-acquired pressure ulcer rate was used for the calculation of effect sizes as a surrogate
parameter for pressure ulcer incidence. The SRISAG (surface, repositioning, immobility, shear forces, age,
gender) logistic regression model was used to control for differences in case mix.
Results: Pressure ulcer prevention and intrinsic and extrinsic risk factors differ for patients from hospital
wards compared with those from intensive care wards. The ward-acquired pressure ulcer rate in general
hospital wards was 3·9% (1·5% excluding grade 1). In intensive care, the rate was 14·9% (8·5% excluding
grade 1), which corresponds with an unadjusted odds ratio of 4·3 (95%CI 3·8-4·9). After the SRISAG model
was applied, the odds ratio was reduced to 1·5 (CI 1·2-1·7).
Conclusion: When surface, repositioning, immobility, shear forces, age and gender are controlled for the
institutional factor intensive care unit vs. general hospital wards is no longer a high-risk factor for the
development of pressure ulcer. The SRISAG model is simple and can be used to compare the occurrence of
pressure ulcer between different medical specialties.
Relevance to clinical practice: Application of this model allows more valuable comparison of the occurrence of
pressure ulcer in different specialities and enables clinical practitioners and health care planners to use this
outcome as an indicator for the quality of care to avoid confounding.
Sondage urinaire
NosoBase n° 32782
Réduire l'usage des sondes urinaires inappropriées
Fakih MG; Watson SR; Greene MT; Kennedy EH; Olmsted RN; Krein SL; et al. Reducing inappropriate
urinary catheter use - A statewide effort. Archives of internal medicine 2012; in press: 6 pages.
Mots-clés : CATHETER; SONDE; SONDAGE URINAIRE; PREVENTION;
RETROSPECTIVE; FORMATION; PREVALENCE; OBSERVANCE; TAUX
QUALITE;
ETUDE
Background: Indwelling urinary catheters may lead to both infectious and noninfectious complications and are
often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate
the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use.
Methods: Retrospective analysis of data collected between 2007 and 2010 as part of a statewide
collaborative initiative before, during, and after an educational intervention promoting adherence to
appropriate urinary catheter indications. The data were collected from 163 inpatient units in 71 participating
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Michigan hospitals. The intervention consisted of educating clinicians about the appropriate indications for
urinary catheter use and promoting the daily assessment of urinary catheter necessity during daily nursing
rounds. The main outcome measures were change in prevalence of urinary catheter use and adherence to
appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methods to
estimate rates over time while accounting for the clustering of patients within hospital units.
Results: The urinary catheter use rate decreased from 18.1% (95% CI, 16.8%-19.6%) at baseline to 13.8%
(95% CI, 12.9%-14.8%) at end of year 2 (P < .001). The proportion of catheterized patients with appropriate
indications increased from 44.3% (95% CI, 40.3%-48.4%) to 57.6% (95% CI, 51.7%-63.4%) by the end of
year 2 (P = .005).
Conclusions: A statewide effort to reduce inappropriate urinary catheter use was associated with a significant
reduction in catheter use and improved compliance with appropriate use. The effect of the intervention was
sustained for at least 2 years.
Staphylococcus aureus
NosoBase n° 32726
L’incidence des infections nosocomiales à Staphylococcus aureus résistant à la méticilline est triplée
si l’on inclut les infections signalées dans les 30 jours qui suivent le départ de l’hôpital
Avery TR; Kleinman KP; Klompas M; Aschengrau A; Huang SS. Inclusion of 30-day postdischarge detection
triples the incidence of hospital-onset methicillin-resistant Staphylococcus aureus. Infection control and
hospital epidemiology 2012/02; 33(2): 114-121.
Mots-clés : INCIDENCE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE
Background: Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus
aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be
detected after discharge.
Objective: We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to
the most recent hospitalization and identified patient characteristics associated with MRSA detection after
discharge.
Design: Retrospective cohort study.
Setting: Twenty-seven acute care hospitals in Orange County, California.
Participants: Adult acute care admissions (2002.2007).
Methods: Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA)
indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission
was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not
POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned
postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in
the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital
rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HOMRSA patients.
Results: Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median
hospitalHO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P < .0001). Hospital
ranking changed substantially when including post-DD HOMRSA. Patients with shorter stays were more likely
to have post-DD MRSA.
Conclusions: On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly
increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the
limitations of single-facility data when deriving HOMRSA incidence and rank.
NosoBase n° 33118
Evaluation de l’impact financier pour l’hôpital d’une infection à Staphylococcus aureus en service de
réanimation
Clément MC; Sauget M; Slekovec C; Ghaguibi-Haoré H; Bertrand X;Talon D. Evaluation of the financial
impact for a hospital from Staphylococcus aureus infection in an intensive care unit. Hygiènes 2011/12;
XIX(6): 387-392.
Mots-clés : COUT; STAPHYLOCOCCUS AUREUS; SOIN INTENSIF; SENSIBILITE; CAS TEMOIN; DUREE
DE SEJOUR; EVALUATION
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Différentes études ou rapports attribuent un surcoût hospitalier important aux infections nosocomiales. Ces
surcoûts représentaient une perte financière « sèche » pour les établissements dont le financement reposait
sur la dotation globale. L’objectif de cette étude était d’évaluer l’impact financier des infections nosocomiales
pour un établissement financé à l’activité. Pour cette étude le choix a été fait d’évaluer l’impact financier des
infections à Staphylococcus aureus sensible à la méticilline (SASM) en réanimation. Durant une année en
réanimation adulte au centre hospitalier universitaire de Besançon, 116 patients ayant présenté un
prélèvement positif à SAMS ont été inclus dans l’étude : 28 ont déclaré une infection durant leur séjour (les
cas) et 88 sont restés des porteurs sains (les contrôles). Les données issues des laboratoires de
bactériologie et d’hygiène hospitalière, mais aussi de la pharmacie hospitalière ont été utilisées de même que
les données médicales disponibles dans le « Programme de médicalisation des systèmes d’information ».
Concernant les cas et pour un séjour hospitalier, les résultats montraient une durée de séjour plus longue (p
= 10-2). Pour les cas, le « montant financier restant » total à l’hôpital est significativement plus élevé pour
chaque séjour (p = 0,03) alors que le « montant restant » journalier a tendance à baisser (p = 0,10). Ainsi,
contrairement à la situation antérieure où l’infection nosocomiale représentait une perte financière sèche pour
l’établissement, le financement à l’activité permet de valoriser financièrement l’infection nosocomiale.
NosoBase n° 32849
Stratégie de lutte contre le risque infectieux pour la prévention de la transmission de Staphylococcus
aureus méticillino-résistant (SARM) dans des établissements hébergeant des personnes âgées
(revue). Actualisation du 27 mai 2011
Hughes C; Smith M; Tunney M; Bradley MC. Infection control strategies for preventing the transmission of
meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane database of
systematic reviews 2011/12; 12: 1-24.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
TRANSMISSION ;
PREVENTION; EHPAD; BIBLIOGRAPHIE; PERSONNE AGEE; PREVALENCE; RISQUE; HYGIENE DES
MAINS; ENVIRONNEMENT
Objectives: To determine the effects of infection prevention and control strategies for preventing the
transmission of MRSA in nursing homes for older people.
Search Methods:We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane
Library 2011, Issue 2), the Cochrane Wounds Group Specialised Register (searched May 27th, 2011). We
also searched Ovid MEDLINE (from 1950 to April Week 2 2011), OVID MEDLINE (In-process and Other NonIndexed Citations, April 26th 2011) Ovid EMBASE (1980 to 2011 Week 16), EBSCO CINAHL (1982 to April
21st 2011), DARE (1992 to 2011, week 16), Web of Science (1981 to May 2011), and the Health Technology
Assessment (HTA) website (1988 to May 2011). Research in progress was sought through Current Clinical
Trials (www.controlled-trials.com), Medical Research Council Research portfolio, and HSRPRoj (current USA
projects).
Selection criteria: All randomised and controlled clinical trials, controlled before and after studies and
interrupted time series studies of infection prevention and control interventions in nursing homes for older
people were eligible for inclusion.
Data collection and analysis: Two review authors independently reviewed the results of the searches. Another
review author appraised identified papers and undertook data extraction which was checked by a second
review author.
Main results: For this second update only one study was identified, therefore it was not possible to undertake
a meta-analysis. A cluster randomised controlled trial in 32 nursing homes evaluated the effect of an infection
control education and training programme on MRSA prevalence. The primary outcome was MRSA
prevalence in residents and staff, and a change in infection control audit scores which measured adherence
to infection control standards. At the end of the 12 month study, there was no change in MRSA prevalence
between intervention and control sites, while mean infection control audit scores were significantly higher in
the intervention homes compared with control homes.
Authors' conclusions: There is a lack of research evaluating the effects on MRSA transmission of infection
prevention and control strategies in nursing homes. Rigorous studies should be conducted in nursing homes,
to test interventions that have been specifically designed for this unique environment.
NosoBase n° 32814
Défi de la prévention des infections à Staphylococcus aureus méticillino-résistant en hémodialyse
Parker MG; Doebbeling BN. The challenge of methicillin-resistant Staphylococcus aureus prevention in
hemodialysis therapy. Seminars in dialysis 2012; in press: 8 pages.
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Février 2012
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PREVENTION; HEMODIALYSE
Methicillin-resistant Staphylococcus aureus (MRSA) infections have challenged care process and resource
utilization in the acute hospital care setting for nearly 30 years. These infections have become important
causes of morbidity, mortality, and a source of concern in the primary and emergency care context over the
past decade. As individuals receiving recurrent therapy with features of both ambulatory care and acute care,
hemodialysis patients are exposed to numerous opportunities for MRSA acquisition. Surprisingly, high
prevalence rates for MRSA colonization have been demonstrated for both hemodialysis patients and their
care providers. The necessity of vascular access and the persistent high prevalence of endovascular catheter
use among patients repeatedly exposed to healthcare settings provide the perfect milieu for the troubling
rates of MRSA infection, particularly bloodstream infections, in outpatient dialysis care. Dialysis industry
shifts, including increased requirements for compliance and reporting in other areas of dialysis care, tax
resources for infection prevention processes. Multifaceted strategies that include reassessment of vascular
access care, attention to the interruption of MRSA transmission dynamics, and emphasis on organizational
learning processes are needed to accomplish a meaningful reduction in the morbidity, mortality, and cost
associated with MRSA infections in dialysis care.
NosoBase n° 32940
Actualisation sur la prévention et le contrôle des infections à Staphylococcus aureus méticillinorésistant d'origine communautaire (CA-MRSA)
Skov R; Christiansen K; Dancer SJ; Daum RS; Dryden M; Huang YC; et al. Update on the prevention and
control of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA). International journal of
antimicrobial agents 2012; in press: 8 pages.
Mots-clés : BIBLIOGRAPHIE; PREVENTION; CONTROLE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; INFECTION COMMUNAUTAIRE; PEAU; TISSU MOU; ANTIBIOTIQUE; DEPISTAGE;
TRANSMISSION; COLONISATION; CONGRES
The rapid dissemination of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) since
the early 2000s and the appearance of new successful lineages is a matter of concern. The burden of these
infections varies widely between different groups of individuals and in different regions of the world.
Estimating the total burden of disease is therefore problematic. Skin and soft-tissue infections, often in
otherwise healthy young individuals, are the most common clinical manifestation of these infections. The
antibiotic susceptibilities of these strains also vary, although they are often more susceptible to 'traditional'
antibiotics than related hospital-acquired strains. Preventing the dissemination of these organisms throughout
the general population requires a multifaceted approach, including screening and decolonisation, general
hygiene and cleaning measures, antibiotic stewardship programmes and, in the future, vaccination. The
current evidence on the prevention and control of CA-MRSA is appraised and summarised in this review.
NosoBase n° 32851
Prévalence élevée d'isolats à sensibilité diminuée aux glycopeptides dans des bactériémies
persistantes ou récurrentes à Staphylococcus aureus méticillino-résistant
Uckay I; Bernard L; Buzzi M; Harbarth S; Francois P; Huggler E; et al. High prevalence of isolates with
reduced glycopeptide susceptibility in persistent or recurrent bloodstream infections due to methicillin
resistant Staphylococcus aureus. Antimicrobial agents and chemotherapy 2012; in press: 27 pages.
Mots-clés : PREVALENCE; ANTIBIORESISTANCE; GLYCOPEPTIDE; CMI; BACTERIEMIE; INFECTION
RECURRENTE;
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
COHORTE;
VANCOMYCINE; TEICOPLANINE; TRAITEMENT; STAPHYLOCOCCUS AUREUS DE SENSIBILITE
DIMINUEE AUX GLYCOPEPTIDES
Reduced susceptibility to glycopeptides in methicillin-resistant Staphylococcus aureus (MRSA) clinical
isolates is considered a risk factor for failure of glycopeptide therapy. We compared the prevalence of MRSA
isolates with reduced glycopeptide susceptibility in patients with versus without persistent or recurrent MRSA
bloodstream infections. A retrospective, cohort study at the University Hospital of Geneva identified 27
patients with persistent or recurrent, clonally-related MRSA bacteremic episodes over an 8-year period that
included 208 consecutive, nosocomial MRSA bacteremic episodes. Vancomycin and teicoplanin MICs were
determined by a modified macrodilution assay allowing improved detection of glycopeptide-intermediate,
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Février 2012
MRSA isolates (GISA), characterized by elevated teicoplanin or/and vancomycin MICs (= 4 µg/ml). For 16
(59%) patients, their pre-therapy and/or post-therapy MRSA isolates showed elevated teicoplanin MICs,
among which 10 (37%) concomitantly displayed elevated vancomycin MICs. In contrast, 11 other patients
(41%) were persistently or recurrently infected with non-GISA isolates. In comparison, only 39 (22%) of 181
single isolates from patients with no microbiological evidence of persistent or recurrent infections showed
elevated teicoplanin MICs, among which 14 (8%) concomitantly displayed elevated vancomycin MICs.
Clinical, microbiological, and pharmacokinetic variables of patients persistently or recurrently infected with
GISA or non-GISA isolates were similar. Bacteremic patients with poor response to glycopeptide therapy had
a 2.8-fold and 4.8-fold higher rate of MRSA isolates displaying elevated teicoplanin and vancomycin MICs,
respectively, compared to patients with single isolates (P< 0.0001). Detection of elevated teicoplanin MICs
may help to predict poor response to glycopeptide therapy in MRSA bacteremic patients.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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