Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
NosoVeille – Bulletin de veille Mai 2012 NosoVeille n°5 Mai 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 Pour recevoir, tous les mois, NosoVeille dans votre messagerie : Abonnement / Désabonnement Sommaire de ce numéro Acinetobacter baumannii Alimentation Antibiotique Bactériémie Candida Cathétérisme Chirurgie EHPAD / Personne âgée Entérobactérie Enterovirus Environnement Gale Gestion des risques Hygiène des mains Médecine de ville Médicament Peau Pédiatrie Personnel Pneumonie Réanimation Réglementation Rotavirus Staphylococcus aureus Tuberculose Vaccination 1 / 29 NosoVeille – Bulletin de veille Mai 2012 Acinetobacter baumannii NosoBase n° 33795 Trois clones distincts d'Acinetobacter baumannii résistant aux carbapénèmes avec une grande diversité de carbapénèmases isolés chez des patients de deux centres hospitaliers du Koweit Al-Sweih NA; Al-Hubail M; Rotimi VO. Three distinct clones of carbapenem-resistant Acinetobacter baumannii with high diversity of carbapenemases isolated from patients in two hospitals in Kuwait. Journal of infection and public health 2012/02; 5(1): 102-108. Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; CARBAPENEME; MULTIRESISTANCE; BIOLOGIE MOLECULAIRE; PCR; PFGE; TYPAGE; GENOTYPE; ANTIBIOTIQUE Objectives: This study was undertaken to investigate the clonal relatedness of multidrug-resistant (MDR) Acinetobacter baumannii isolates collected from patients in two teaching hospitals in Kuwait. Materials and methods: Clinically significant consecutive isolates of A. baumannii obtained from patients in the Mubarak (36) and Adan (58) hospitals over a period of 6 months were studied. These isolates were identified using molecular methods, and their antimicrobial susceptibility was determined by the Etest method. The mechanism of resistance to carbapenem was investigated by PCR, and pulsed-field gel electrophoresis (PFGE) was used to determine the clonal relatedness of MDR isolates. Results: Of the 94 isolates investigated, 80 (85.1%) were multidrug resistant (MDR). The A. baumannii PFGE clone A and subclone A1 were the most prevalent in patients infected with MDR isolates. Fifty-five (94.8%) and 15 (41.7%) of the MDR isolates from the Adan and Mubarak hospitals, respectively, belonged to PFGE clone A; isolates in this group showed higher resistance rates to antibiotics than isolates form other groups. Of the 94 isolates, 40 (42.6%) were resistant to either imipenem or meropenem or to both (CRAB). Most CRAB isolates (29/40 or 72.5%) carried bla genes, which code for MBL (VIM-2 and IMP-1) enzymes. Two isolates harbored bla(OXA-23). Conclusion: Three distinct clones of CRAB were isolated, providing evidence of a high diversity of carbapenemases among our geographically related isolates. NosoBase n° 33807 Epidémiologie moléculaire d'Acinetobacter baumannii résistant aux carbapénèmes au Japon Endo S; Yano H; Hirakata Y; Arai K; Kanamori H; Ogawa M; et al. Molecular epidemiology of carbapenemnon-susceptible Acinetobacter baumannii in Japan. The Journal of antimicrobial chemotherapy 2012; in press: 4 pages. Mots-clés : ACINETOBACTER BAUMANNII; EPIDEMIOLOGIE; CARBAPENEME; ANTIBIORESISTANCE; PCR; TYPAGE; CMI BIOLOGIE MOLECULAIRE; Methods: A total of 305 non-duplicate clinical isolates of Acinetobacter spp. from 176 medical facilities in all geographical regions of Japan were tested for susceptibility to antimicrobial agents by the agar dilution method. Isolates with MICs of imipenem=4 mg/L underwent PCR analysis of OXA-type ß-lactamase gene clusters and metallo-ß-lactamase genes. These isolates were further analysed by sequencing of OXA-type ßlactamases and by multilocus sequence typing (MLST). Results: Fifty-five of the 305 clinical isolates had MICs of imipenem=4 mg/L. The OXA-51-like carbapenemase gene was detected in 52 of these 55 isolates. Within the OXA-51-like gene cluster, OXA-66 was found in 43 (82.7%) of the 52 isolates. MLST identified the following sequence types (STs): ST74, ST76, ST92, ST106, ST188 and ST195 in 2 (3.8%), 2 (3.8%), 40 (76.9%), 5 (9.6%), 2 (3.8%) and 1 (1.9%) of the isolates, respectively. In particular, ST92 was found in 31 (91.2%) of the 34 A. baumannii isolates with MICs of imipenem=16 mg/L. Conclusions: This is the first report on the molecular epidemiology of A. baumannii with MICs of imipenem=4 mg/L in Japan. OXA-66 and ST92 were dominant among these isolates. Alimentation NosoBase n° 33847 Avis de l'Agence française de sécurité sanitaire des produits de santé - Utilisation de biberons stériles à l'oxyde d'éthylène 2 / 29 NosoVeille – Bulletin de veille Mai 2012 Agence française de sécurité sanitaire des produits de santé (AFSSAPS). AFSSAPS 2012/04: 21 pages. Mots-clés : ALIMENTATION; BIBERONNERIE; OXYDE D'ETHYLENE; STERILISATION Les hôpitaux et maternités qui organisaient auparavant la stérilisation de biberons réutilisables à des fins d'hygiène et de limitation des infections nosocomiales ont évolué à partir du début des années 2000 vers l'usage de biberons à usage unique. Des fabricants ont alors mis sur le marché des biberons à usage unique en tant que dispositifs médicaux avec des revendications de stockage du lait maternel ou de la maîtrise des volumes administrés (nutrition ou médicament). Ces biberons sont stérilisés à l'oxyde d'éthylène (OE). Cet avis précise les conditions d'utilisation des biberons stérilisés à l'oxyde d'éthylène. Antibiotique NosoBase n° 33873 Surveillance de la consommation des antibiotiques Réseau ATB-Raisin - Résultats 2010 CClin Sud-Ouest; Réseau d'alerte, d'investigation et de surveillance des infections nosocomiales (RAISIN); Institut de veille sanitaire (InVS). Surveillance of antibiotic use in hospitals - Reseau ATB Raisin - Results 2010. Institut de veille sanitaire 2012/04: 1-80. Mots-clés : SURVEILLANCE; ANTIBIOTIQUE; ANTIBIORESISTANCE; CONSOMMATION; CARBAPENEME; PENICILLINE; CEPHALOSPORINE; QUINOLONE; FLUOROQUINOLONE La surveillance de la consommation des antibiotiques (ATB) conduite dans le cadre du réseau ATB-Raisin participe au bon usage des ATB. Les objectifs sont de permettre à chaque établissement de santé (ES) de décrire et d'analyser ses consommations par rapport à un ensemble comparable et de les confronter aux données de résistance bactérienne. Les ATB à visée systémique de la classe J01 de la classification Anatomical Therapeutic Chemical (ATC), la rifampicine et les imidazolés per os, dispensés en hospitalisation complète, ont été exprimés en nombre de doses définies journalières (DDJ) et rapportés à l'activité en journées d'hospitalisation (JH) selon les recommandations nationales et de l'Organisation mondiale de la santé (système ATC-DDD, 2010). Des données de résistance ont été collectées pour sept couples bactérie/ antibiotique. Les 1 115 ES participants en 2010 représentaient 52 % des lits d'hospitalisation et avaient consommé 374 DDJ/1 000 JH. Les ATB les plus utilisés étaient l'association amoxicilline-acide clavulanique (31 %), l'amoxicilline (17 %) et l'ofloxacine (5 %). La consommation médiane d'ATB variait de 54 DDJ/1 000 JH dans les hôpitaux psychiatriques à 693 dans les hôpitaux d'instruction des armées. Des variations étaient observées selon les secteurs d'activité, de 63 DDJ/1 000 JH en psychiatrie à 1 556 en réanimation. Les données de résistance étaient en cohérence avec celles issues de réseaux spécifiques. La surveillance en réseau des consommations détaillées permet à chaque ES de se situer, dans un objectif de comparaison, d'échanger sur les pratiques et organisations et de suivre les tendances évolutives. L'analyse des consommations d'ATB est à compléter d'évaluation des pratiques. NosoBase n° 33615 Audit et retour d'information pour réduire l'utilisation d'antibiotiques à large spectre en soins intensifs : une analyse de séries temporelles interrompues contrôlée Elligsen M; Walker SA; Pinto R; Simor A; Mubareka S; Rachlis A; et al. Audit and feedback to reduce broadspectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infection control and hospital epidemiology 2012/04; 33(4): 354-361. Mots-clés : AUDIT; ANTIBIOTIQUE; SOIN INTENSIF; ETUDE PROSPECTIVE; COUT; SOIN INTENSIF; DDJ; CLOSTRIDIUM DIFFICILE; CENTRE HOSPITALIER UNIVERSITAIRE Objective: We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients. Design: Prospective, controlled interrupted time series. Setting: Single tertiary care center with 3 intensive care units. Patients and interventions: A formal review of all critical care patients on their third or tenth day of broadspectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were communicated to the critical care team. 3 / 29 NosoVeille – Bulletin de veille Mai 2012 Outcomes: The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days; secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial Clostridium difficile infections, length of stay, and mortality. Results: The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period ([Formula: see text]); time series modeling confirmed an immediate decrease (± standard error) of [Formula: see text] days of therapy per 1,000 patient-days ([Formula: see text]). In contrast, no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units, whereas the incidence increased from 87 to 116 cases in the control wards ([Formula: see text]). Overall gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of stay and mortality did not change. Conclusions: Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care. NosoBase n° 33614 Taux et pertinence de la prescription d'antibiotiques dans un centre hospitalier pédiatrique universitaire, 2007-2010 Levy ER; Swami S; Dubois SG; Wendt R; Banerjee R. Rates and appropriateness of antimicrobial prescribing at an academic children's hospital, 2007-2010. Infection control and hospital epidemiology 2012/04; 33(4): 346-351. Mots-clés : PEDIATRIE; ANTIBIOTIQUE; CONSOMMATION; TAUX; PRESCRIPTION; DDJ; ETUDE RETROSPECTIVE; SOIN INTENSIF; CHIRURGIE; FORMATION; VANCOMYCINE; CEFEPIME Objective and design: Antimicrobial use in hospitalized children has not been well described. To identify targets for antimicrobial stewardship interventions, we retrospectively examined pediatric utilization rates for 48 antimicrobials from 2007 to 2010 as well as appropriateness of vancomycin and cefepime use in 2010. Patients and setting: All children hospitalized between 2007 and 2010 at the Mayo Clinic Children's Hospital, a 120-bed facility within a larger adult hospital in Rochester, Minnesota. Methods: We calculated antimicrobial utilization rates in days of therapy per 1,000 patient-days. Details of vancomycin and cefepime use in 2010 were abstracted by chart review. Two pediatric infectious disease physicians independently assessed appropriateness of antibiotic use. Results: From 2007 to 2010, 9,880 of 17,242 (57%) hospitalized children received 1 or more antimicrobials. Antimicrobials (days of therapy per 1,000 patient-days) used most frequently in 2010 were cefazolin (97.8), vancomycin (97.1), fluconazole (76.4), piperacillin-tazobactam (70.7), and cefepime (67.6). Utilization rates increased significantly from 2007 to 2010 for 10 antimicrobials, including vancomycin, fluconazole, piperacillin-tazobactam, cefepime, trimethoprim-sulfamethoxazole, caspofungin, and cefotaxime. In 2010, inappropriate use of vancomycin and cefepime was greater in the pediatric intensive care unit than ward (vancomycin: 17.8% vs 6.4%, [Formula: see text]; cefepime: 9.2% vs 3.9%, [Formula: see text]) and on surgical versus medical services (vancomycin: 20.5% vs 8.0%, [Formula: see text]; cefepime: 19.4% vs 3.4%, [Formula: see text]). The most common reason for inappropriate antibiotic use was failure to discontinue or de-escalate therapy. Conclusions: In our children's hospital, use of 10 antimicrobials increased during the study period. Inappropriate use of vancomycin and cefepime was greatest on the critical care and surgical services, largely as a result of failure to de-escalate therapy, suggesting targets for future antimicrobial stewardship interventions. NosoBase n° 33617 Diminution de la résistance des Pseudomonas aeruginosa par une limitation des prescriptions de ciprofloxanine dans les services de soins intensifs et de soins de suite d’un grand centre hospitalier universitaire Lewis GJ; Fang X; Gooch M; Cook PP. Decreased resistance of Pseudomonas aeruginosa with restriction of ciprofloxacin in a large teaching hospital's intensive care and intermediate care units. Infection control and hospital epidemiology 2012/04; 33(4): 368-373. 4 / 29 NosoVeille – Bulletin de veille Mai 2012 Mots-clés : PSEUDOMONAS AERUGINOSA; SOIN INTENSIF; CIPROFLOXACINE; PRESCRIPTION; CARBAPENEME; ANALYSE; ANTIBIORESISTANCE; MULTIRESISTANCE; CENTRE HOSPITALIER UNIVERSITAIRE Objective: To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems. Design: Interrupted time-series analysis. Setting: Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds. Patients: All nosocomial isolates of P. aeruginosa. Intervention: Restriction of ciprofloxacin. Results: There was a significant decreasing trend observed in the percentage ([Formula: see text]) and the rate ([Formula: see text]) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage ([Formula: see text]) and the rate ([Formula: see text]) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined ([Formula: see text]) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems ([Formula: see text]); the use of ciprofloxacin decreased significantly ([Formula: see text]). There were no significant changes in the use of piperacillin-tazobactam or cefepime. Conclusion: Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa. NosoBase n° 33673 Disparité des pratiques de lutte contre le risque infectieux concernant les entérobactéries multirésistantes aux antibiotiques Lowe C; Katz K; McGeer A; Muller MP. Disparity in infection control practices for multidrug-resistant Enterobacteriaceae. American journal of infection control 2012; in press: 4 pages. Mots-clés : ENTEROBACTERIE; PREVENTION; PRATIQUE; ANTIBIORESISTANCE; MULTIRESISTANCE; TRANSMISSION; BETA-LACTAMASE A SPECTRE ELARGI; CARBAPENEME Background: There is a lack of empiric evidence regarding the optimal approach to controlling the transmission of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenemresistant Enterobacteriaceae (CRE). In this context, we expect that infection control practices for these organisms vary widely between hospitals. Methods: A survey examining infection control practices for ESBL-E and CRE was distributed to 6 academic and 9 community hospitals in Toronto, Canada. Results: All hospitals responded to the survey. Among 15 hospitals in 1 geographic area, 8 different approaches to the management of ESBL-E were utilized. There was wide variation in the use infection control practices including admission screening (53% and 53%), contact precautions (53% and 100%), and isolation (60% and 100%) for ESBL-E and CRE, respectively. Of hospitals performing admission screening, 75% used risk factor-based screening for ESBL-E and CRE. Conclusion: Even within a single geographic area, there is wide variation in infection control strategies to contain or control ESBL-E and CRE. These results are concerning given evidence that a coordinated approach may be required to prevent or limit the emergence of CRE. NosoBase n° 33612 Gestion des antibiotiques - état de l'art en 2011 : focus sur les résultats et les méthodes McGowan JE. Antimicrobial stewardship - the states of the art in 2011: focus on outcome and methods. Infection control and hospital epidemiology 2012/04; 33(4): 331-337. Mots-clés : INFECTION; ANTIBIORESISTANCE ANTIBIOTIQUE; PRESCRIPTION; COUT; EVALUATION; COUT; 5 / 29 NosoVeille – Bulletin de veille Mai 2012 Antimicrobial stewardship programs attempt to optimize prescribing of these drugs to benefit both current and future patients. Recent regulatory and other incentives have led to widespread adoption of such programs. Measurements of the success of these programs have focused primarily on process measures. However, evaluation of outcome measures will be needed to ensure sustainability of these efforts. Outcome efforts to date provide some evidence for improved care of individual patients, some evidence for minimizing emergence of resistance, and ample evidence for cost reduction. Attention to evaluation methods must be increased to provide convincing evidence for the continuation of such programs. NosoBase n° 33801 Première détection d'Escherichia coli producteur de metallo-bêta-lactamase VIM-4 en Russie Shevchenko OV; Mudrak DY; Skleenova EY; Kozyreva VK; Llina EN; Ikryannikova LN; et al. First detection of VIM-4 metallo-beta-lactamase-producing Escherichia coli in Russia. Clinical microbiology and infection 2012; in press: 4 pages. Mots-clés : ESCHERICHIA COLI; ANTIBIORESISTANCE; CARBAPENEME An Escherichia coli isolate co-producing VIM-4 metallo-ß-lactamase and CTX-M-15 extended spectrum ßlactamase was recovered from the urine of a patient with head trauma in Moscow, Russia. The bla(VIM-4) and bla(CTX-M-15) genes were carried, respectively, by transmissible plasmids of IncW and IncI1 groups. The nucleotide sequence of the VIM-4-encoding integron was nearly identical to that of In416, which represent a large group of structurally related integrons previously found in Enterobacteriaceae all around the Mediterranean basin. This is the first report of a metallo-ß-lactamase-producing E. coli in Russia. NosoBase n° 33613 Gestion des antibiotiques dans un grand centre hospitalier universitaire : l’analyse des coûts avant, pendant et après un programme de 7 ans Standiford HC; Chan S; Tripoli M; Weekes E; Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infection control and hospital epidemiology 2012/04; 33(4): 338-345. Mots-clés : ANTIBIOTIQUE; COUT; CENTRE HOSPITALIER UNIVERSITAIRE; MEDECIN; PHARMACIEN; FORMATION; ETUDE TRANSVERSALE Background: An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship. Design: A descriptive cost analysis before, during, and after the program. Patients/setting: A large tertiary care teaching medical center. Methods: Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY. Results: The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category. Conclusions: The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period. NosoBase n° 33610 Politique de gestion des antibiotiques par les sociétés savantes américaines "Society for healthcare epidemiology of America" (SHEA), "Infectious diseases society of America" (IDSA), et "Pediatric infectious diseases society" (PIDS) 6 / 29 NosoVeille – Bulletin de veille Mai 2012 Society for Healthcare Epidemiology of America; Infectious Diseases Society OF America; Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the society for healthcare epidemiology of America (SHEA), the infectious diseases society of America (IDSA), and the pediatric infectious diseases society (PIDS). Infection control and hospital epidemiology 2012/04; 33(4): 322-327. Mots-clés : ANTIBIOTIQUE; PEDIATRIE; RECOMMANDATION; ANTIBIORESISTANCE; PRESCRIPTION; DDJ; COUT; EFFET INDESIRABLE; PRESSION DE SELECTION; FORMATION Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States. NosoBase n° 33772 Un clone multi-résistant aux antibiotiques de Staphylococcus epidermidis (ST2) est responsable en continu d'infections nosocomiales dans un hôpital d'Australie occidentale Widerstrom M; McCullough CA; Coombs GW; Monsen T; Christiansen KJ. A multidrug-resistant Staphylococcus epidermidis clone (ST2) is an ongoing cause of hospital acquired infection in a Western australian hospital. Journal of clinical microbiology 2012; in pres: 16 pages. Mots-clés : STAPHYLOCOCCUS EPIDERMIDIS; STAPHYLOCOCCUS; ANTIBIORESISTANCE; MULTIRESISTANCE; TYPAGE; GENOTYPE ANTIBIOTIQUE; We report the molecular epidemiology of twenty-seven clinical multidrug-resistant Staphylococcus epidermidis (MDRSE) collected between 2003 and 2007 in an Australian teaching hospital. The dominant genotype (ST2) accounted for 85% of the isolates tested and was indistinguishable from a MDRSE genotype identified in European hospitals, which may indicate that highly adaptable healthcare-associated genotypes of S. epidermidis have emerged and disseminated worldwide in the healthcare setting. Bactériémie NosoBase n° 33825 Bactériémies à Staphylococcus aureus associées aux soins versus nosocomiales Bishara J; Goldberg E; Leibovici L; Samra Z; Shaked H; Mansur N; et al. Healthcare-associated vs. hospital acquired Staphylococcus aureus bacteremia. International journal of infectious diseases 2012; in press: 7 pages. Mots-clés : STAPHYLOCOCCUS AUREUS; BACTERIEMIE; COHORTE; ETUDE RETROSPECTIVE; FACTEUR DE RISQUE Objective: To analyze clinical features and outcomes of patients with hospital-acquired (HA) and healthcareassociated (HCA) Staphylococcus aureus bacteremia. Methods: A retrospective cohort study was conducted from 1988 to 2007. We compared patients with clinically significant HA with those with HCA S. aureus bacteremia. Risk factors for 30-day all-cause mortality were assessed using multivariable logistic regression analysis. Cox regression analysis was used to estimate the hazard ratio (HR) for 5-year mortality with 95% confidence intervals (CI). Results: Of 1261 episodes, 735 (58.3%) were HA and 526 (41.7%) were HCA. The percentage of MRSA was 48.2% (354/735) in HA vs. 42.2% (222/526) in HCA bacteremia; p=0.04. The percentages of HCA S. aureus bacteremia and MRSA bacteremia did not vary throughout the study period. Mortality at 30 days was 40.2% (507/1261) and at 1 year was 63.4% (800/1261); this was comparable for HA and HCA bacteremia. Five-year 7 / 29 NosoVeille – Bulletin de veille Mai 2012 survival curves in both settings followed very similar patterns (HR 1.01, 95% CI 0.89-1.15). Risk factors for 30-day mortality were similar, except for primary bacteremia and pre-existing heart valve disease in the HA group. Conclusions: HCA S. aureus bacteremia shares many similarities with HA bacteremia with respect to the prevalence of MRSA strains, mortality rates, and risk factors for death, and should be managed similarly. NosoBase n° 33626 Elaborer des recommandations, spécifiques à chaque service, pour le traitement empirique de bactériémies primaires et bactériémies associées à un cathéter en déterminant la probabilité d’une thérapie inadaptée Davis ME; Anderson DJ; Sharpe M; Chen LF; Drew RH. Constructing unit-specific empiric treatment guidelines for catheter-related and primary bacteremia by determining the ikelihood of inadequate therapy. Infection control and hospital epidemiology 2012/04; 33(4): 416-420. Mots-clés : BACTERIEMIE; RECOMMANDATION; TRAITEMENT; STATISTIQUE; ANTIBIOTYPIE This study aimed to determine the feasibility of using likelihood of inadequate therapy (LIT), a parameter calculated by using pathogen frequency and in vitro susceptibility for determination of appropriate empiric antibiotic therapy for primary bloodstream infections. Our study demonstrates that LIT may reveal differences in traditional antibiograms. NosoBase n° 33834 La catégorie distincte de bactériémies associées aux soins Lenz R; Leal JR; Church DL; Gregson DB; Ross T; Laupland KB. The distinct category of healthcare associated bloodstream infections. BMC infectious diseases 2012; in press: 11 pages. Mots-clés : BACTERIEMIE; EPIDEMIOLOGIE; MICROBIOLOGIE; DUREE DE SEJOUR; ESCHERICHIA COLI; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS PNEUMONIAE; MORTALITE; COHORTE; SURVEILLANCE; DEFINITION Background: Bloodstream infections (BSI) have been traditionally classified as either community acquired (CA) or hospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community onset disease has been increasingly recognized. The objective of this study was to compare and contrast characteristics of HCA-BSI with CA-BSI and HA-BSI. Methods: All first episodes of BSI occurring among adults admitted to hospitals in a large health region in Canada during 2000-2007 were identified from regional databases. Cases were classified using a series of validated algorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic, microbiologic, and outcome characteristics. Results: A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088 (40%) had CA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical illnesses than patients with HCA-BSI or HA-BSI (p<0.001). The proportion of cases in males was higher for HA-BSI (60%; p<0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54 %; p=0.13). The proportion of cases that had a poly-microbial etiology was significantly lower for CA-BSI (5.5%; p<0.001) compared to both HA and HCA (8.6 vs. 8.3 %). The median length of stay following BSI diagnosis 15 days for HA, 9 days for HCA, and 8 days for CA (p<0.001). Overall the most common species causing bloodstream infection were Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. The distribution and relative rank of importance of these species varied according to classification of acquisition. Twenty eight day all cause case-fatality rates were 26%, 19%, and 10% for HA-BSI, HCA-BSI, and CA-BSI, respectively (p<0.001). Conclusion: Healthcare-associated community onset infections are distinctly different from CA and HA infections based on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds further support for the classification of community onset BSI into separate CA and HCA categories. 8 / 29 NosoVeille – Bulletin de veille Mai 2012 NosoBase n° 33780 Bactériémies à Proteus mirabilis multirésistant aux antibiotiques : facteurs de risque et évolution Tumbarello M; Trecarichi EM; Fiori B; Losito AR; D'Inzeo T; Campana L; et al. Multidrug-resistant Proteus mirabilis bloodstream infections: risk factors and outcomes. Antimicrobial agents and chemotherapy 2012; in press: 29 pages. Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; BACTERIEMIE; PROTEUS; ENTEROBACTERIE; PROTEUS MIRABILIS; FACTEUR DE RISQUE; ETUDE RETROSPECTIVE; CAS TEMOIN; CENTRE HOSPITALIER UNIVERSITAIRE; SURVEILLANCE Our aims were to identify 1) risk factors associated with the acquisition of multidrug resistant (MDR, to 3 or more classes of antimicrobials) Proteus mirabilis (Pm) isolates responsible for bloodstream infections (BSIs) and 2) the impact on mortality of such infections. Risk factors for acquiring MDR Pm BSIs were investigated in a case-case-control study; those associated with mortality were assessed by comparing survivors and non survivors in a cohort study. The population consisted of 99 adult inpatients with Pm BSIs identified by our laboratory over an 11-year period (1999-2009), 36 (33.3%) of which were caused by MDR strains, and the overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with admission from a long-term care facility (odds ratio [OR], 9.78; 95% confidence interval [CI], 1.94-49.16)); previous therapy with fluoroquinolones (OR, 5.52; 95% CI, 1.30-23.43) or oxyimino-cephalosporins (OR, 4.72; 95% CI, 1.31-16.99); urinary catheterization (OR, 3.89; 95% CI, 1.50-10.09); and previous hospitalization (OR, 2.68; 95% CI, 1.04-6.89). Patients with MDR-Pm BSIs received inadequate empirical antimicrobial therapy (IIAT, i.e., treatment with drugs to which the isolate displayed in vitro resistance) more frequently than those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset hospital stays. In multivariate regression analysis, 21-day-mortality was associated with septic shock at BSI onset (OR 12.97; 95% CI, 3.22-52.23); Pm isolates that were MDR (OR 6.62, 95% CI 1.64-26.68); and IIAT (OR, 9.85 95% CI 2.67-36.25)- the only modifiable risk factor of the 3. These findings can potentially improve clinicians' ability to identify Pm BSIs likely to be MDR, thereby reducing the risk of IIAT-a major risk factor for mortality in these cases-and facilitating prompt implementation of appropriate infection control measures. Candida NsoBase n° 33836 Diagnostic, gestion et évolution des endocardites à Candida Lefort A; Chartier L; Sendid B; Wolff M; Mainardi JL; Podglajen I; et al. Diagnosis, management and outcome of Candida endocarditis. Clinical microbiology and infection 2012/04; 18(4): E99-E109. Mots-clés : DIAGNOSTIC; ENDOCARDE; CANDIDA; TRAITEMENT; ANTIFONGIQUE; MORTALITE; PCR Limited data exist on Candida endocarditis (CE) outcome in the era of new antifungals. As early diagnosis of CE remains difficult, non-culture-based tools need to be evaluated. Through the French prospective MYCENDO study (2005-2007), the overall characteristics and risk factors for death from CE were analysed. The contribution of antigen detection (mannan/anti-mannan antibodies and (1, 3)-ß-d-glucans) and molecular tools was evaluated. Among 30 CE cases, 19 were caused by non-albicans species. Sixteen patients (53%) had a predisposing cardiac disease, which was a valvular prosthesis in ten (33%). Nine patients (30%) were intravenous drug users; none of them had right-sided CE. Among the 21 patients who were not intravenous drug users, 18 (86%) had healthcare-associated CE. Initial therapy consisted of a combination of antifungals in 12 of 30 patients (40%). Thirteen patients (43%) underwent valve replacement. The median follow-up was 1 year after discharge from hospital (range, 5 months to 4 years) and hospital mortality was 37%. On univariate analysis, patients aged =60 years had a higher mortality risk (OR 11, 95% CI 1.2-103.9; p 0.024), whereas intravenous drug use was associated with a lower risk of death (OR 0.12, 95% CI 0.02-0.7; p 0.03). Among 18 patients screened for both serum mannan/anti-mannan antibodies and (1, 3)-ß-d-glucans, all had a positive result with at least one of either test at CE diagnosis. Real-time PCR was performed on blood (SeptiFast) in 12 of 18, and this confirmed the blood culture results. In conclusion, CE prognosis remains poor, with a better outcome among younger patients and intravenous drug users. Detection of serum antigens and molecular tools may contribute to earlier CE diagnosis. 9 / 29 NosoVeille – Bulletin de veille Mai 2012 NosoBase n° 33798 Importance clinique de la colonisation des cathéters vasculaires par Candida en l'absence de candidémie documentée Lopez-Medrano F; Fernandez-Ruiz M; Origuen J; Belarte-Tornero LC; Carazo-Medina R; Panizo-Mota F; et al. Clinical significance of Candida colonization of intravascular catheters in the absence of documented candidemia. Diagnostic microbiology and infectious disease 2012; in press: 5 pages. Mots-clés : CANDIDA; VEINEUX CENTRAL COLONISATION; CATHETER; MORTALITE; ANTIFONGIQUE; CATHETER In order to assess the significance of Candida colonization of intravascular catheters (IVC) in patients without documented candidemia, we retrospectively reviewed all Candida-positive IVC tip cultures over a 4-year period. Cases were defined as those with a culture yielding=15 colony-forming units of Candida spp. that either did not have blood cultures (BC) taken or had concomitant BC negative for Candida. Patients were followed up until death or 8 months after discharge. Risk factors for poor outcome following IVC removal (death, candidemia, or Candida-related complication) were analyzed. We analyzed a total of 40 patients. Overall mortality was 40.0%, with no death directly attributed to Candida infection. Twenty-two patients received antifungal therapy at the time of IVC removal. Only 1 patient developed a metastatic complication (chorioretinitis) attributable to transient candidemia (2.5% of the global cohort and 3.7% among those with concomitant BC). There were no cases of subsequent candidemia. In the multivariate analysis, the use of antifungal therapy did not show any impact on the risk of poor outcome. The risk of invasive disease in patients with isolated IVC colonization by Candida seems to be low. Nevertheless, the initiation of systemic antifungal therapy should be carefully considered in such context. Cathétérisme NosoBase n° 33778 Le décollement du pansement est un facteur de risque majeur d'infections liées au cathéter Timsit JF; Bouadma L; Ruckly S; Schwebel C; Garrouste-Orgeas M; Bronchard R; et al. Dressing disruption is a major risk factor for catheter-related infections. Critical care medicine 2012; 40(6): 1-8. Mots-clés : FACTEUR DE RISQUE; CATHETER; PANSEMENT; PREVENTION; SYNDROME SEPTIQUE; COLONISATION; PRATIQUE; COUT; RECOMMANDATION BACTERIEMIE; Objective: Major catheter-related infection includes catheter-related bloodstream infections and clinical sepsis without bloodstream infection resolving after catheter removal with a positive quantitative tip culture. Insertion site dressings are a major mean to reduce catheter infections by the extraluminal route. However, the importance of dressing disruptions in the occurrence of major catheter-related infection has never been studied in a large cohort of patients. Design: A secondary analysis of a randomized multicenter trial was performed in order to determine the importance of dressing disruption on the risk for development of catheter-related bloodstream infection. Measurements and main results: Among 1,419 patients (3,275 arterial or central-vein catheters) included, we identified 296 colonized catheters, 29 major catheter-related infections, and 23 catheter-related bloodstream infections. Of the 11,036 dressings changes, 7,347 (67%) were performed before the planned date because of soiling or undressing. Dressing disruption occurred more frequently in patients with higher Sequential Organ Failure Assessment scores and in patients receiving renal replacement therapies; it was less frequent in males and patients admitted for coma. Subclavian access protected from dressing disruption. Dressing cost (especially staff cost) was inversely related to the rate of disruption. The number of dressing disruptions was related to increased risk for colonization of the skin around the catheter at removal (p<.0001). The risk of major catheter-related infection and catheter-related bloodstream infection increased by more than three-fold after the second dressing disruption and by more than ten-fold if the final dressing was disrupted, independently of other risk factors of infection. Conclusion: Disruption of catheter dressings was common and was an important risk factor for catheterrelated infections. These data support the preferential use of the subclavian insertion site and enhanced efforts to reduce dressing disruption in postinsertion bundles of care. 10 / 29 NosoVeille – Bulletin de veille Mai 2012 Chirurgie NosoBase n° 33782 Différences inter-professionnelles dans l'observance des précautions standard au bloc opératoire : étude multi-sites, différentes méthodes Cutter J; Jordan S. Inter-professional differences in compliance with standard precautions in operating theatres: a multi-site, mixed methods study. International journal of nursing studies 2012; in press: 16 pages. Mots-clés : RISQUE; OBSERVANCE; PERSONNEL; BLOC OPERATOIRE; PRECAUTION STANDARD; CHIRURGIEN; INFIRMIER; EXPOSITION AU SANG; INFIRMIER DE BLOC OPERATOIRE; INFIRMIER HYGIENISTE; MATERIEL DE SECURITE; FORMATION; QUESTIONNAIRE; TRAVAIL; PERCEPTION Background: Occupational acquisition of blood-borne infections has been reported following exposure to blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection. Objectives: To identify: the frequency of self-reported adverse exposure to blood and body fluids among surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of compliance with standard precautions; and factors influencing compliance with precautions. Design: A multi-site mixed methods study incorporating a cross-sectional survey and interviews. Settings: Six NHS trusts in Wales between January 2006 and August 2008. Participants: Surgeons and scrub nurses and Senior Infection Control Nurses. Methods: A postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures, followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection Control Nurses. Results: Response rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an inoculation injury in the last five years: 183/315 (58.1%) reported sharps' injuries and 40/315 (12.7%) splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated with increased risk of sharps' injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04-2.88 and adjusted odds ratio 2.0, 1.11-3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions; 64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.110.71) and to attend training sessions (odds ratio 0.111, 0.061-0.19). The professions viewed the risks associated with their roles differently, with nurses being more willing to follow protocols. Conclusion: Inter-professional differences in experiencing adverse exposures must be addressed to improve safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote compliance with policies and procedures. NosoBase n° 33685 Observance des recommandations internationales et nationales pour la prévention des infections du site opératoire en Italie : résultats d'une étude prospective d'observation en chirurgie réglée Durando P; Bassetti M; Orengo G; Crimi P; Battistini A; Bellina D; et al. Adherence to international and national recommendations for the prevention of surgical site infections in Italy: results from an observational prospective study in elective surgery. American journal of infection control 2012; in press: 4 pages. Mots-clés : PREVENTION; RECOMMANDATION; SITE OPERATOIRE; ETUDE PROSPECTIVE; CHIRURGIE; CENTRE HOSPITALIER UNIVERSITAIRE; PRATIQUE; DOUCHE; PRE-OPERATOIRE; DEPILATION; ANTIBIOPROPHYLAXIE; BLOC OPERATOIRE; ANTISEPTIQUE; GESTION DES RISQUES; OBSERVANCE; PERSONNEL Background: An observational prospective study of the perioperative procedures for prevention of surgical site infections (SSIs) was carried out in a tertiary referral teaching hospital in Liguria, Italy, to evaluate their adherence to international and national standards. Methods: A 1-month survey was performed in all surgical departments, monitored by turns by trained survey teams. Data regarding presurgical patient preparation and intraoperative infection control practices were collected. Results: A total of 717 elective interventions were actively monitored in 703 patients who underwent surgery. Hair-shaving was performed mainly using a razor (92%) by the nurses (72.8%) on the day before the operation (83.5%). All of the patients showered, either with a common detergent (87%) or with an antiseptic solution (13%). Antimicrobial prophylaxis was administered properly in 75.7% of the patients at induction of 11 / 29 NosoVeille – Bulletin de veille Mai 2012 anaesthesia; however, according to current Italian guidelines, inappropriate prophylaxis was provided in 55.2% patients. Appropriate antisepsis of the incision area was done in 97.4% of the operations, and nearly 90% of the interventions lasted less than the respective 75th percentile. The doors of the operating theatres were mostly open during the duration of the operation in 36.3% of the cases. Conclusions: This review of infection control policies identified significant opportunities for improving the safety and the quality of routine surgical practice. EHPAD / Personne âgée NosoBase n° 33777 Pneumonies acquises en EHPAD en Allemagne. Huit ans d'étude prospective multicentrique Ewig S; Klapdor B; Pletz MW; Rohde G; Schutte H; Schaberg T; et al. Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study. Thorax 2012/02; 67(2): 132-138. Mots-clés : PNEUMONIE; ETUDE PROSPECTIVE; RESEAU; STREPTOCOCCUS; STREPTOCOCCUS PNEUMONIAE; MORTALITE; PERSONNE AGEE; EHPAD; ANTIBIOTIQUE; TRAITEMENT Objective: To determine differences in aetiologies, initial antimicrobial treatment choices and outcomes in patients with nursing-home-acquired pneumonia (NHAP) compared with patients with community-acquired pneumonia (CAP), which is a controversial issue. Methods: Data from the prospective multicentre Competence Network for Community-acquired pneumonia (CAPNETZ) database were analysed for hospitalised patients aged =65 years with CAP or NHAP. Potential differences in baseline characteristics, comorbidities, physical examination findings, severity at presentation, initial laboratory investigations, blood gases, microbial investigations, aetiologies, antimicrobial treatment and outcomes were determined between the two groups. Results: Patients with NHAP presented with more severe pneumonia as assessed by CRB-65 (confusion, respiratory rate, blood pressure, 65 years and older) score than patients with CAP but received the same frequency of mechanical ventilation and less antimicrobial combination treatment. There were no clinically relevant differences in aetiology, with Streptococcus pneumoniae the most important pathogen in both groups, and potential multidrug-resistant pathogens were very rare (<5%). Only Staphylococcus aureus was more frequent in the NHAP group (n=12, 2.3% of the total population, 3.1% of those with microbial sampling compared with 0.7% and 0.8% in the CAP group, respectively). Short-term and long-term mortality in the NHAP group was higher than in the CAP group for patients aged =65 years (26.6% vs 7.2% and 43.8% vs 14.6%, respectively). However, there was no association between excess mortality and potential multidrugresistant pathogens. Conclusions: Excess mortality in patients with NHAP cannot be attributed to a different microbial pattern but appears to result from increased comorbidities, and consequently, pneumonia is frequently considered and managed as a terminal event. NosoBase n° 33897 Epidémies successives d'infections à Streptococcus groupe A dans des établissements de soins pour personnes âgées ; leçons tirées Inkster T; Wright P; Kane H; Paterson E; Dodd S; Slorach J. Successive outbreaks of group A streptococcus (GAS) in care of the elderly settings; lessons learned. Journal of infection prevention 2012/03; 13(2): 38-43. Mots-clés : EPIDEMIE; PERSONNE AGEE; GERIATRIE; STREPTOCOCCUS; STREPTOCOCCUS GROUPE A; ERADICATION; CONTROLE; PERSONNEL; ENQUETE; DEPISTAGE; HYGIENE DES MAINS; ENVIRONNEMENT; PANSEMENT; SOIN DE PLAIE CUTANEE; SURVEILLANCE Group A streptococcal (GAS) outbreaks in care of the elderly settings are rare. We describe two successive outbreaks involving care of the elderly patients. The first outbreak involved 18 patients and the second involved six patients and two healthcare workers. We describe the difficulties encountered controlling GAS outbreaks in care of the elderly settings and how the lessons learned from the first outbreak influenced management of the second incident. Stringent infection control measures including isolation until completion of treatment and re-screening for evidence of eradication were required to bring outbreak one under control. These measures were adopted early in outbreak two and we suspect that these measures and the rapid identification of carriers brought this second outbreak under control quickly. 12 / 29 NosoVeille – Bulletin de veille Mai 2012 NosoBase n° 33811 Surveillance du poids des infections en EHPAD Lim CJ; McLellan SC; Cheng AC; Culton JM; Parikh SN; Peleg AY; Kong DC. Surveillance of infection burden in residential aged care facilities. The Medical journal of Australia 2012/03/19; 196(5): 327-333. Mots-clés : SURVEILLANCE; CONSOMMATION; ANTIBIOTIQUE; ETUDE RETROSPECTIVE; EHPAD; PERSONNE AGEE; RESEAU; INCIDENCE; APPAREIL RESPIRATOIRE Objectives: To explore the burden of illness associated with infectious syndromes and to measure the associated use of antimicrobials in residential aged care facilities (RACFs). Design, setting and subjects: Retrospective analysis of data for January 2006 to December 2010 from an infection surveillance system covering residents of four co-located RACFs, with a total of 150 residential care beds, in Melbourne, Victoria. Main outcome measures: Number of episodes and incidence of health care-associated infection (HCAI); rate of antimicrobial use; prescribing concordance with McGeer criteria for infection; frequency of clinical specimen collection. Results: There were 1114 episodes of an infectious syndrome over 267 684 occupied bed-days (OBD), affording an average HCAI rate of 4.16 episodes/1000 OBD annually over 5 years (95% CI, 3.92-4.41). The mean rate of antimicrobial use was 7.07 courses/1000 OBD (range, 6.71-7.84). Around 40% of antimicrobial prescribing was for episodes that did not fulfil the McGeer criteria for clinical infection; this included about half of suspected urinary tract and upper respiratory tract infections (URTI), and about one-third of suspected lower respiratory tract and skin infections. Antimicrobials were routinely prescribed for URTI and bronchitis. Of all episodes treated with antimicrobials, 36% had documentation that a clinical specimen was obtained. Conclusions: The HCAI rate remained relatively stable over time. Routine surveillance and feedback of infection rates to the facilities did not result in a noticeable decrease of infection burden over time. It is of immediate concern that antimicrobials were being prescribed for a large proportion of suspected infections that did not meet criteria for clinical infection. Opportunities exist to further improve the use of antimicrobials in the RACF setting. NosoBase n° 33804 Usage et mauvais usage des antibiotiques en EHPAD Stuart RL; Wilson J; Bellaard-Smith E; Brown R; Wright L; Vandergraaf S; et al. Antibiotic use and misuse in residential aged care facilities. Internal medicine journal 2012; in press: 15 pages. Mots-clés : ANTIBIOTIQUE; EHPAD; PREVALENCE; PRESCRIPTION; PERSONNE AGEE; MULTIRESISTANCE; COLONISATION; ESCHERICHIA COLI; BETA-LACTAMASE A SPECTRE ELARGI; COHORTE Introduction: The prevention and control of transmission of antimicrobial-resistant pathogens in Residential Aged Care Facilities (RACF) is an area that has been neglected yet has significant implications for health services. The aim of this study was to describe the prevalence and appropriateness of antibiotic use within five RACF associated with our health service. Methods: Demographic data on each RACF and all residents was obtained and antibiotics prescribed (the type, indication and duration) at the time of the survey were recorded. The appropriateness of antibiotic prescribing was assessed using well-established criteria. Results: Of the 257 residents, 28% were greater than 85 years of age, almost 50% were male and 71% had been in their RACF for more than a year. Sixty-seven percent were incontinent of urine or feces and 80% had some degree of cognitive impairment. Among the residents, 23 (9%) were receiving antibiotics at the time of the survey. Seventeen (74%) were for treatment while 6 (26%) were given for prophylactic reasons. Data on the appropriateness of antibiotic use was available for the preceding 26-month period. During this time there were 988 antibiotic courses administered, of these 392 (39.7%) did not fulfill the criteria for bacterial infection. Discussion: This, the first Australian study to report on the use of antibiotics within RACF, shows a high rate of antimicrobial prescribing and inappropriate antibiotic use. Antibiotic stewardship is of paramount importance in RACF. Programs to promote the rational use of antibiotics and minimize the emergence of resistant pathogens are urgently required in Australian RACF. 13 / 29 NosoVeille – Bulletin de veille Mai 2012 Entérobactérie NosoBase n° 33868 Les entérobactéries productrices de carbapénémases Boutet-Dubois A; Pantel A; Sotto A; Lavigne JP. Alin&as 2012/04; 2: 1-5. Mots-clés : ENTEROBACTER; CARBAPENEME; ANTIBIORESISTANCE; EPIDEMIOLOGIE; DEPISTAGE L'émergence des entérobactéries résistantes aux carbapénèmes constitue un réel problème de santé publique. Les carbapénèmes représentent très souvent les dernières molécules actives de l'arsenal thérapeutique pour combattre les bactéries multirésistantes. Enterovirus NosoBase n° 33771 Dépistage et détection d'infections par l'enterovirus humain 71 par RT-PCR en temps réel à Marseille, France, 2009-2011 Tan C; Gonfrier G; Ninove L; Zandotti C; Dubot-Peres A; De Lamballerie X; et al. Screening and detection of human enterovirus 71 infection by a real-time RT-PCR assay in Marseille, France, 2009-2011. Clinical microbiology and infection 2012/04; 18(4): E77-E80. Mots-clés : DEPISTAGE; VIRUS; ENTEROVIRUS; PCR; BIOLOGIE MOLECULAIRE; PEDIATRIE Enterovirus-positive samples diagnosed in Marseille (January 2009 to September 2011) were screened for EV71 by real-time RT-PCR. EV71 was detected in three children below the age of 2 years with no history of overseas travel; two of these cases were associated with severe clinical presentation. Viruses demonstrated genetic similarity to other European genogroup C2 strains. Strain MRS/09/3663 complete sequencing revealed 97.6% identity across the entire genome with a 2008 Singapore isolate, without signs of possible recombination events. To our knowledge, this is the first detection of EV71 infection in Marseille, France, that confirms the current circulation of EV71 in France. Environnement NosoBase n° 33699 Les rideaux de séparation des hôpitaux sont fréquemment et rapidement contaminés par des bactéries potentiellement pathogènes Ohl M; Schweizer M; Graham M; Heilmann K; Boyken L; Diekema D. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. American journal of infection control 2012; in press: 3 pages. Mots-clés : CONTAMINATION; CHAMBRE; ENVIRONNEMENT; PREVALENCE; PRELEVEMENT; STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS; BACILLE GRAM NEGATIF; ANTIBIORESISTANCE; TYPAGE; PFGE Background: Privacy curtains are a potentially important site of bacterial contamination in hospitals. We performed a longitudinal study to determine the prevalence and time course of bacterial contamination on privacy curtains. Methods: Over a 3-week period, swab cultures (n=180) were obtained twice weekly from the leading edge of 43 curtains in 30 rooms in 2 intensive care units and a medical ward. Curtains were marked to determine when they were changed. Contamination with Staphylococcus aureus, methicillin-resistant S aureus (MRSA), Enterococcus spp, vancomycin-resistant Enterococcus (VRE), or aerobic gram-negative rods was determined by standard microbiologic methods. To distinguish persistence of pathogens on curtains from recontamination, all VRE and MRSA were typed using pulsed-field gel electrophoresis. Results: Twelve of 13 curtains (92%) placed during the study showed contamination within 1 week. Forty-one of 43 curtains (95%) demonstrated contamination on at least 1 occasion, including 21% with MRSA and 42% with VRE. Eight curtains yielded VRE at multiple time points: 3 with persistence of a single isolate type and 5 with different types, suggesting frequent recontamination. 14 / 29 NosoVeille – Bulletin de veille Mai 2012 Conclusion: Privacy curtains are rapidly contaminated with potentially pathogenic bacteria. Further studies should investigate the role of privacy curtains in pathogen transmission and provide interventions to reduce curtain contamination. NosoBase n° 33785 Les stéthoscopes source de Staphylococcus aureus méticillino-résistant d'origine nosocomiale Russell A; Screst J; Schreeder C. Stethoscopes as a source of hospital-acquired methicillin-resistant Staphylococcus aureus. Journal of perianesthesia nursing 2012/04; 27(2): 82-87. Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; STETHOSCOPE; ALCOOL; SOIN INTENSIF; CENTRE HOSPITALIER UNIVERSITAIRE; ECHANTILLON; DESINFECTION; PERSONNEL; COLONISATION; EFFICACITE; DISPOSITIF MEDICAL Stethoscopes are potential vectors of methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this project was to determine the presence of MRSA on the diaphragms of personal and unit stethoscopes within a hospital setting before and after cleaning with alcohol prep pads. The sample consisted of 141 personal and unit stethoscopes in adult medical-surgical and intensive care units of a large university hospital in the Southeast. Each stethoscope was cultured once before cleaning and once after cleaning. Cultures were obtained using sterile swabs and inoculated on a selective medium for MRSA. Bacterial growth was noted in the precleaning group, but no MRSA colonies were detected. The postcleaning group had no bacterial growth. There was not enough data to statistically support that isopropyl alcohol is effective in decreasing bacterial counts; however, these findings suggest that current disinfection guidelines are effective in preventing MRSA colonization on stethoscopes in this setting. Gale NosoBase n° 33770 La gale dans les pays en développement : prévalence, complications et prise en charge Hay RJ; Steer AC; Engelman D; Walton S. Scabies in the developing world-its prevalence, complications, and management. Clinical microbiology and infection 2012/04; 18(4): 313-323. Mots-clés : PREVALENCE; GALE; PAYS EN DEVELOPPEMENT; PEAU; PEDIATRIE; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS; STREPTOCOCCUS GROUPE A; TRANSMISSION; DIAGNOSTIC; TRAITEMENT; CONTROLE; ENVIRONNEMENT; EPIDEMIOLOGIE; BIBLIOGRAPHIE Scabies remains one of the commonest of skin diseases seen in developing countries. Although its distribution is subject to a cycle of infection, with peaks and troughs of disease prevalence, this periodicity is often less obvious in poor communities. Scabies is a condition that affects families, particularly the most vulnerable; it also has the greatest impact on young children. Largely through the association with secondary bacterial infection caused by group A streptococci and Staphylococcus aureus, the burden of disease is compounded by nephritis, rheumatic fever and sepsis in developing countries. However, with a few notable exceptions, it remains largely neglected as an important public health problem. The purpose of this review is to provide an update on the current position of scabies with regard to its complications and control in resource-poor countries. NosoBase n° 33779 Contrôle de vastes épidémies de gales dans une institution Stoevesandt J; Carle L; Leverkus M; Hamm H. Control of large institutional scabies outbreaks. Journal der deutsches dermatologischen gesellschaft 2012; in press: 12 pages. Mots-clés : INFECTION BIBLIOGRAPHIE COMMUNAUTAIRE; GALE; EPIDEMIE; CONTROLE; TRAITEMENT; Background: Scabies outbreaks in community facilities may reach large dimensions and take a protracted course. Highly contagious crusted scabies is a major cause of nosocomial outbreaks. Patients and methods: On the occasion of an extensive scabies outbreak in a north Bavarian sheltered workshop and its associated residential homes with over 500 exposed individuals, a multifaceted control 15 / 29 NosoVeille – Bulletin de veille Mai 2012 strategy was developed and pursued. Knowledge from a comprehensive review of the literature was utilized. Results: Our successful scabies elimination concept includes: 1) Careful organization (formation of an outbreak management team, registration and information of all exposed individuals, prospective time management, financial calculation); 2) simultaneous clinical examination of all individuals at risk; 3) synchronous topical treatment of all exposed individuals with permethrin 5 % cream on day 0, repeated treatment of proven and doubtful cases on days 1 and 14; systemic treatment of selected cases with oral ivermectin; 4) decontamination and quarantine measures; 5) follow-up investigations and repeated treatment if indicated. Conclusions: Management of large institutional scabies outbreaks requires a high degree of motivation, communication skills and perseverance. NosoBase n° 33784 Facteurs de risque de gale à Taïwan Wang CH; Lee SC; Huang SS; Kao YC; See LC; Yang SH. Risk factors for scabies in Taiwan. Journal of microbiology immunology and infection 2012; in press: 5 pages. Mots-clés : FACTEUR DE RISQUE; GALE; CAS TEMOIN; CATHETER Background: Scabies is a global problem. Transmission of scabies is usually due to direct or indirect contact. Delay in diagnosis may result in the spread of the scabies mite. Prompt diagnosis and treatment are important. Methods: In this study, we collected data from 52 scabies patients and analyzed the risk factors for scabies with the case-control method. Results: Our study has revealed that the patients who were bedridden [odds ratio (OR) 6.72, p<0.0001], living in a nursing home (OR 9.89, p<0.0001), had a higher clinical severity status before admission (OR 1.25, p<0.0001), and a catheter inserted (including nasogastric tube, Foley catheter, Port-A, or Hickman catheter) (OR 9.05, p<0.0001) were significantly more likely to acquire scabies infection. Conclusion: To prevent scabies, proper management of the nursing home setting, including adequate cleaning of the contaminated clothing, bedding and equipment, in combination with treating all suspected scabies patients, and contact isolation are important and necessary. Gestion des risques NosoBase n° 33876 Amélioration des pratiques et sécurité des soins. La sécurité des patients - Mettre en oeuvre la gestion des risques associés aux soins en établissement de santé : Des concepts à la pratique Haute Autorité de santé (HAS). HAS 2012/03: 1-219. Mots-clés : RECOMMANDATION; GESTION DES RISQUES; QUALITE; SECURITE; RISQUE; ORGANISATION; EVENEMENT INDESIRABLE GRAVE; INCIDENCE; METHODOLOGIE; CERTIFICATION; ACCREDITATION; SIGNALEMENT; INDICATEUR; AUDIT La gestion des risques associés aux soins en établissement de santé relève d'une démarche collective. L'enjeu est la sécurité des patients pris en charge au sein d'organisations marquées par des succès locaux indéniables, mais aussi par la survenue d'évènements indésirables susceptibles de compromettre la performance collective. Des enquêtes montrent que ceux-ci sont fréquents, parfois graves, souvent évitables. Une mobilisation générale sur cette problématique explique les évolutions récentes en termes de politique publique, de réglementation et de procédure de certification des établissements de santé. Ce guide, qui ne peut se substituer aux actions de formation nécessaires à tous les niveaux concernés (gouvernance, coordination, mise en oeuvre opérationnelle), constitue l'un des moyens d'accompagnement de cette démarche. Ce document méthodologique n'a pas vocation à être opposable. Il appartient en effet à chaque établissement de santé de s'approprier les différentes préconisations proposées et de les adapter à sa propre organisation. Ceci avec l'objectif essentiel de réduire le risque de survenue d'évènements indésirables graves évitables. Conçu sur un principe modulaire pour aider des non spécialistes de la gestion des risques associés aux soins, ce guide est structuré selon trois niveaux : - par grandes fonctions (gouvernance, coordination, mise en oeuvre opérationnelle), - par axes d'actions thématiques identifiés au sein de chacune de ces fonctions, - en méthodes et outils proposés au moyen de fiches techniques illustrées destinées à faciliter la démarche au sein des axes d'actions concernés. 16 / 29 NosoVeille – Bulletin de veille Mai 2012 Cette approche favorise une lecture thématique, mais aussi des actions ciblées (en réflexion stratégique, en mise en oeuvre opérationnelle, en communication, en formation, en applications documentaires diverses, etc.). Hygiène des mains NosoBase n° 33704 Absorption dermique et pulmonaire de l'éthanol à partir de produit hydro-alcoolique pour la friction des mains Ahmed-Lecheheb D; Cunat L; Hartemann P; Hautemanière A. Dermal and pulmonary absorption of ethanol from alcohol-based hand rub. The Journal of hospital infection 2012/05; 81(1): 31-35. Mots-clés : ALCOOL; GEL HYDROALCOOLIQUE; HYGIENE DES MAINS; PERSONNEL; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION; PRODUIT DE FRICTION POUR LES MAINS Background: Ethanol intoxication of healthcare workers (HCWs) using alcohol-based hand rubs (ABHRs) in the workplace is a potentially serious issue. This study quantified the level of ethanol absorption among HCWs after hygienic hand disinfection. Methods: Eighty-six HCWs from Nancy University Hospital were tested before and after a 4-h shift. Participants used ABHR containing 70% ethanol. Levels of ethanol, acetaldehyde and acetate in blood and urine were determined using gas chromatography. A breathalyzer was used to measure the level of ethanol in expired air. Results: Ethanol [mean concentration 0.076 (standard deviation 0.05) mg/L] was detected in the expired air of 28 HCWs 1-2 min post exposure. Ethanol, acetaldehyde and acetate were undetectable in blood after a 4-h shift, and urine tests were negative in all participants. Conclusion: Ethanol exposure from ABHR, particularly inhalation of vapours, resulted in positive breathalyzer readings 1-2 min after exposure. Dermal absorption of ethanol was not detected. Pulmonary absorption was detected but was below toxic levels. NosoBase n° 33687 Une information sur l'hygiène des mains via l'économiseur d'écran d'ordinateur infléchit une tendance négative du comportement concernant l'hygiène des mains Helder OK; Weggelaar AM; Waarsenburg D; Looman C; Van Goudoever JB; Brug J; et al. Computer screen saver hand hygiene information curbs a negative trend in hand hygiene behavior. American journal of infection control 2012; in press: 4 pages. Mots-clés : HYGIENE DES MAINS; NEONATALOGIE; SOIN INTENSIF; INFORMATION; ORDINATEUR; ATTITUDE; DISTRIBUTEUR; SOLUTION HYDROALCOOLIQUE; OBSERVANCE Background: Appropriate hand hygiene among health care workers is the most important infection prevention measure; however, compliance is generally low. Gain-framed messages (ie, messages that emphasize the benefits of hand hygiene rather than the risks of noncompliance) may be most effective, but have not been tested. Methods: The study was conducted in a 27-bed neonatal intensive care unit. We performed an interrupted time series analysis of objectively measured hand disinfection events. We used electronic devices in hand alcohol dispensers, which continuously documented the frequency of hand disinfection events. In addition, hand hygiene compliance before and after the intervention period were directly observed. Results: The negative trend in hand hygiene events per patient-day before the intervention (decrease by 2.3 [standard error, 0.5] per week) changed to a significant positive trend (increase of 1.5 [0.5] per week) after the intervention (P<.001). The direct observations confirmed these results, showing a significant improvement in hand hygiene compliance from 193 of 303 (63.6%) observed hand hygiene events at pretest to 201 of 281 (71.5%) at posttest. Conclusions: We conclude that gain-framed messages concerning hand hygiene presented on screen savers may improve hand hygiene compliance. NosoBase n° 33814 Hygiène des mains chez des étudiants en médecine : réalisation, formation et connaissances 17 / 29 NosoVeille – Bulletin de veille Mai 2012 Scheithauer S; Haefner H; Schwanz T; Lopez-Conzalez L; Bank C; Schulze-Robbecke R; et al. Hand hygiene in medical students: performance, education and knowledge. International journal of hygiene and environmental health 2012; in press: 4 pages. Mots-clés : HYGIENE DES MAINS; ETUDIANT; MEDECIN; FORMATION; CONNAISSANCE; TRAVAIL; OBSERVANCE; QUALITE Background: Despite several guidelines on hand hygiene (HH), compliance especially in physicians is reported to be low which has huge implications for healthcare-associated infections. To evaluate performance of HH, influence of teaching and influence of monitoring the results in medical students, we conducted an observational study. Methods: Performance of hand disinfection was evaluated in first (N=28), third (N=193) and fifth (N=45) year medical students using fluorescent hand disinfectant. The influence of teaching and information about result control was assessed. The students perception of the impact of HH was also evaluated by a questionnaire. Results: Presence of disinfectant gaps was observed significantly more often in first year medical students compared to third year ones (82% vs, 60%; p=0.02). In additional, >3 gaps were seen significantly more often in first year medical students compared to fifth year students (36% vs. 9%; p=0.007). Both information about teaching and monitoring the results improved outcome significantly. For example, gaps were present in 92% without information and without teaching, in 70% (RR: 1.3 (1.0-1.6); p=0.003) with information about result control only, and in only 18% (5.1 (3.0-8.5); p=0.0001) after teaching. Notably, the medical students ascribed HH to be of a great importance regardless of their level of education. Conclusions: Performance of HH could be improved by practical training as evidenced by best HH performance being documented immediately after teaching and a training effect during the course of medical studies was also observed. Thus, we suggest implementing regular education and practical training on HH from early on in the medical studies curricula to improve overall quality of patient care. regular education and practical training on HH from early on in the medical studies curricula to improve overall quality of patient care. NosoBase n° 33678 Estimer le volume de produit alcoolique pour la friction des mains nécessaire pour un programme d'hygiène des mains Sicoli S; Hunter L; Shymanski J; Suh K; Roth VR. Estimating the volume of alcohol-based hand rub required for a hand hygiene program. American journal of infection control 2012; in press: 5 pages. Mots-clés : HYGIENE DES MAINS; PRODUIT DE FRICTION POUR LES MAINS; CONSOMMATION; ENVIRONNEMENT; AUDIT Background: Providing alcohol-based hand rub (ABHR) at the point of care is a key success factor in enabling health care providers to achieve optimal hand hygiene practices. There are few tools available for health care organizations to assess the number of points of care, estimate the number of hand hygiene indications at each point of care, and estimate the anticipated volume of ABHR required to support a hand hygiene program. Methods: We developed an assessment tool to systematically evaluate the environmental hand hygiene needs in diverse care settings across a multisite health care organization. Results: We identified 1,103 points of care in 34 clinical units, of which only 53% had ABHR at point of care. There are an estimated 171,468,240 (95% confidence interval: 146,844,406-191,871,179) hand hygiene indications per year in our in-patient and emergency areas. If 100% compliance with hand hygiene is achieved, 240,056 L of ABHR will be required each year. Conclusions: Our environmental assessment was invaluable in estimating the number of hand hygiene indications by unit and the logistical and financial requirements to implement a hand hygiene program. Other health care organizations may find this a useful framework to estimate their own environmental hand hygiene needs. Médecine de ville NosoBase n° 33749 Infections nosocomiales en médecine de ville : inéquité pour les victimes Jousset N; Rouge-Maillart C. Nosocomial infections occurring in practitioners' offices: disparities among victims. Médecine et droit 2012; in press: 5 pages. 18 / 29 NosoVeille – Bulletin de veille Mai 2012 Mots-clés : PROFESSION LIBERALE; USAGER; RESPONSABILITE; LEGISLATION; ODONTOLOGIE; HISTORIQUE Le régime d’indemnisation des infections nosocomiales issu des lois du 4 mars et du 30 décembre 2002 est très positif, tant sur les règles de définition des régimes de responsabilité que sur la procédure des CRCI. Des perfectionnements semblent cependant nécessaires. La loi récente a soumis les établissements de santé et les professionnels de santé à un régime différent de responsabilité. Alors que la jurisprudence judiciaire antérieure à la loi du 4 mars soumettait les cliniques et les praticiens libéraux au même régime de responsabilité objective pour manquement à une obligation de sécurité de résultat, les infections de médecine de villes sont désormais exclues du régime de responsabilité de plein droit prévu par l’article L. 1142-1 du code de la santé publique et relèvent du régime de la responsabilité pour faute. Une victime d’une infection associée aux soins contractée au cours d’une intervention pratiquée dans un cabinet libéral ne pourra être indemnisée que si elle établit une faute, alors qu’elle aurait été indemnisée de plein droit si cette même intervention avait été réalisée dans un établissement de santé. Sachant que certains actes médicaux invasifs ne nécessitent pas d’hospitalisation, cette différence de traitement des victimes ayant subi un même acte, nous conduit à nous interroger sur la nécessité d’étendre le régime de responsabilité de plein droit aux infections contractées en médecine de ville. Médicament NosoBase n° 33708 Qualité de la prise en charge médicamenteuse - Outils pour les établissements de santé Direction générale de l’offre de soins (DGOS); Ministère du travail, de l'emploi et de la santé. DGOS 2012/02: 1-45. Mots-clés : MEDICAMENT; LEGISLATION; INDICATEUR; INFORMATIQUE; PRESCRIPTION; RISQUE; CIRCUIT; DEFINITION; TRANSPORT; STOCKAGE; INFORMATION La prise en charge médicamenteuse est un processus combinant des étapes pluridisciplinaires et interdépendantes visant un objectif commun : l'utilisation sécurisée, appropriée et efficiente du médicament chez le patient pris en charge en établissement. La prise en charge se décline selon les étapes suivantes : - la prescription (y compris la gestion du traitement personnel du patient à l'admission, les vérifications des prescriptions lors des transferts de patients et la prescription de sortie) ; - la préparation ; - la dispensation ; - l'approvisionnement ; - le transport ; - la détention et le stockage ; - l'administration ; - l'information du patient ; - la surveillance du traitement. La sécurisation de la prise en charge médicamenteuse est un objectif prioritaire inscrit dans l'ensemble des démarches nationales (tarification à l'activité, certification, contrat de bon usage des médicaments et produits et prestations, contrats pluriannuels d'objectif et de moyens). De la bonne organisation de ce circuit dépend la prise en charge optimale des patients qui associe la réduction des risques, notamment iatrogènes, et la réduction des coûts des soins. Peau NosoBase n° 33786 Epidémiologie et évolutions des infections compliquées de la peau et des tissus mous parmi des patients hospitalisés Zervos MJ; Freeman K; Vo L; Haque N; Pokharna H; Raut M; et al. Epidemiology and outcomes of complicated skin and soft tissue infections in hospitalized patients. Journal of clinical microbiology 2012/02; 50(2): 238-245. 19 / 29 NosoVeille – Bulletin de veille Mai 2012 Mots-clés : EPIDEMIOLOGIE; PEAU; TISSU MOU; ANALYSE MULTIVARIEE; DUREE DE SEJOUR; DIALYSE RENALE; DIABETE; STAPHYLOCOCCUS AUREUS; ETUDE RETROSPECTIVE; COHORTE Complicated skin and soft tissue infections (cSSTIs) are among the most rapidly increasing reasons for hospitalization. To describe inpatients with regard to patient characteristics, cSSTI origin, appropriateness of initial antibiotics, and outcomes, we performed a retrospective cohort study in patients hospitalized for cSSTI. To identify independent predictors of outcomes, we performed multivariate analyses. Of 1,096 eligible patients, 48.7% had health care-associated (HCA) cSSTI and 51.3% had community-acquired (CA) cSSTI. After adjustment for baseline variables, hospital length of stay (LOS) was longer for HCA than for CA cSSTI (difference, 2.1 days; 95% confidence interval [CI], 0.8 to 3.5; P<0.05). Other covariates associated with a longer LOS were need for dialysis (regression coefficient ± standard error, 4.5±1.1) and diabetic wound diagnosis (2.6±1.0) (all P<0.05). In the subset with culture-positive cSSTI within 24 h of admission, the most common pathogen was Staphylococcus aureus (298/449 [66.4%]), of which 74.8% (223/298) were methicillinresistant S. aureus (MRSA). Eighty-three patients (18.5%) received inappropriate initial antibiotics. After adjustment for other variables, the following were associated with inappropriate initial therapy: direct admission to hospital (not via emergency department), cSSTI caused by MRSA or mixed pathogens, and cSSTI caused by pathogens other than S. aureus or streptococci (all P<0.05). We did not find an association between inappropriate therapy and outcomes, except in the subset with ulcers (adjusted odds ratio, 11.8; 95% CI, 1.3 to 111.1; P=0.03). More studies are needed to examine the impact of HCA cSSTI and inappropriate initial therapy on outcomes. Pédiatrie NosoBase n° 33794 Enquête et contrôle d'une épidémie d'infections à Acinetobacter baumannii résistant à l'imipénème dans une unité de réanimation pédiatrique Hong KB; Oh HS; Song JS; Lim JH; Kang DK; Son IS; et al. Investigation and control of an outbreak of imipenem-resistant Acinetobacter baumannii infection in a pediatric intensive care unit. The Pediatric infectious disease journal 2012; in press: 22 pages. Mots-clés : ACINETOBACTER BAUMANNII; PEDIATRIE; SOIN INTENSIF; CONTROLE; EPIDEMIE; EPIDEMIOLOGIE; PREVALENCE; PRECAUTION COMPLEMENTAIRE; PRECAUTION CONTACT; HYGIENE DES MAINS; ENVIRONNEMENT; DESINFECTION; DISPOSITIF MEDICAL; BIOLOGIE MOLECULAIRE; BACTERIEMIE; PNEUMONIE; COLONISATION; LAVABO Background: This study investigated clinical details and epidemiology of the imipenem-resistant Acinetobacter baumannii (IRAB) outbreak which occurred at a pediatric intensive care unit (PICU), and describes successful outcome of the implemented infection control measures. Methods: With the recognition of three clustered cases with IRAB bacteremia at the PICU of Seoul National University Children's Hospital, Korea from August to September 2010, the following outbreak control strategies were implemented; reinforcement of hand hygiene and contact precautions, investigation of environmental contamination, disinfection of the contaminated environment and medical equipment, active surveillance culture upon PICU admission, and isolation of IRAB-positive patients. The clinical and microbiological data were reviewed for A. baumannii positive cases in the PICU from Apr 2001 to June 2011. Multi locus sequence typing (MLST) was also performed. Results: Twenty IRAB-positive cases (bacteremia in 10, pneumonia in 3, and colonizers in 7) were detected from January 2010 to February 2011. Thirteen IRAB-infected patients were all placed on a mechanical ventilator, had central venous catheters, received broad-spectrum antimicrobial treatment, and had underlying diseases. Eleven (85%) of IRAB-infected patient died probably due to IRAB infection. IRAB grew from four samples obtained from sinks and water taps from 38 environmental samples. MLST analysis revealed two sequence types: ST138 (n=16) and its single-locus variant ST92 (n=4). Eleven weeks after the initiation of active surveillance, no further IRAB isolates were identified. Conclusions: This study identifies the environmental source of an IRAB outbreak in a PICU and describes successful control of the outbreak with a multicomponent intervention program. NosoBase n° 33793 Prévention des infections associées aux soins dans des unités de réanimation pédiatriques : revue 20 / 29 NosoVeille – Bulletin de veille Mai 2012 Joram N; De Saint Blanquat L; Stamm D; Launay E; Gras-le-Guen C. Healthcare-associated infection prevention in pediatric intensive care units: a review. European journal of clinical microbiology and infectious disease 2012; in press: 10 pages. Mots-clés : PEDIATRIE; PREVENTION; SOIN INTENSIF; BIBLIOGRAPHIE; ANTIBIOTIQUE; PNEUMONIE; VENTILATION ASSISTEE; INFECTION RECURRENTE; ANTIBIORESISTANCE; BACTERIEMIE; CATHETER; INFECTION URINAIRE; SITE OPERATOIRE The objective of this review was to summarize the current knowledge base on the prevention of nosocomial infections in pediatric intensive care units (PICUs). Healthcare-associated infections (HAIs) are a crucial problem in PICUs because of their impact on patient outcome, length of hospital stay, and costs. Studies published between 1998 and 2011 were identified using the MEDLINE and Cochrane databases. Randomized, cohort, case-control studies, and meta-analyses concerning global strategies of prevention, general organization of the wards, general recommendations on antibiotic management, and measures for the prevention of ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), urinary tract infections (UTIs), and surgical site infections (SSIs) were incorporated. Limits of age from 1 month to 18 years were used. When recommendations could not be supported by the pediatric literature, adult studies were also reviewed. This review excludes the neonate population. Specific pediatric data are often lacking so as to establish specific evidence-based pediatric recommendations. This review underlines the absolute necessity of pediatric studies and to harmonize the definitions of HAIs. NosoBase n° 33783 Facteurs de risque et interventions pour les pneumonies acquises sous ventilation parmi des patients de pédiatrie Morinec J; Iacaboni J; McNett M. Risk factors and interventions for ventilator-associated pneumonia in pediatric patients. Journal of pediatric nursing 2012; in press: 8 pages. Mots-clés : FACTEUR DE RISQUE; VENTILATION ASSISTEE; PEDIATRIE; PNEUMONIE; PREVENTION; SOIN INTENSIF; COHORTE; ETUDE RETROSPECTIVE; PNEUMONIE; PEDIATRIE Ventilator-associated pneumonia (VAP) is a leading nosocomial infection in pediatrics. Little research has investigated the risk factors or effectiveness of interventions for pediatric VAP prevention. The purposes of this study were to identify the risk factors associated with VAP in pediatric patients and describe current VAP prevention practices. Data were gathered retrospectively on ventilated patients admitted to the pediatric intensive care unit over 12 months. No variables were found to be predictive of VAP. Review of practices indicates that better documentation is needed of all interventions. Findings provide information to guide the implementation of VAP bundles. Implementation should focus on adequate documentation of VAP prevention efforts. Personnel NosoBase n° 33899 Motivation et satisfaction dans le travail parmi des membres du personnel assurant le nettoyage au NHS : étude pilote Jeanes A; Hall TJ; Coen PG; Odunaike A; Hickok SS; Gant VA. Motivation and job satisfaction of cleaning staff in the NHS: a pilot study. Journal of infection prevention 2012/03; 13(2): 55-64. Mots-clés : PERSONNEL; TRAVAIL; PSYCHOLOGIE; NETTOYAGE; ENVIRONNEMENT; QUALITE; EFFICACITE; SURFACE; REVETEMENT; QUESTIONNAIRE; FORMATION Fourteen NHS hospital ward cleaning staff were interviewed about their background, job satisfaction and motivation as part of the evaluation of a new cleaning system. Four (28%) staff had attended university, five (35%) had no qualifications and the remainder had a range of educational attainments. Nine (64%) did the job to earn money, three (22%) because they liked it and two (14%) because there were no other opportunities. Repetitive tasks were undertaken routinely with tight control of method and order of working. The work was tiring and ad hoc requests increased the burden. Although all staff knew what was expected of them in their job, nine (62%) reported they "knew themselves" if they had done a good job as feedback was frequently absent or belated. Opportunities including access to the internet were limited and long hours doing extra work 21 / 29 NosoVeille – Bulletin de veille Mai 2012 reduced free time. This pilot study highlights the potential of these healthcare cleaning professionals to contribute and develop given the opportunities. NosoBase n° 33859 Quelle représentation du correspondant en hygiène ? Une auto-évaluation Léger C; André C; Auvin N; Frugier F; Preschel A; Pefau M; et al. Hygiènes 2012/04; XX(2): 79-84. Mots-clés : PERSONNEL; EVALUATION; REFERENT; EOH; PERCEPTION La mise en place d’un réseau de correspondants en hygiène est un des piliers de l’organisation de la lutte contre les infections nosocomiales ; elle est intégrée dans la réglementation française depuis 1995. Depuis cette époque le Centre de coordination et de lutte contre les infections nosocomiales sud-ouest et son antenne régionale Poitou-Charentes se sont investis dans la formation de ces professionnels et dans l’animation du réseau régional qu’ils constituent. Toutefois l’évaluation de l’action de ces acteurs relais n’est pas aisée à faire, de même que celle de leur ressenti et de leur vécu de cette mission particulière, qui requiert de nombreuses qualités relationnelles. En s’inspirant des travaux anglais de Louise Teare, une étude a été réalisée à l’occasion de la journée régionale 2011 des correspondants en hygiène du Poitou-Charentes. Chaque participant s’est vu proposer de réaliser lors d’un atelier, et à l’aide d’une méthodologie standardisée, une figurine dont chaque partie du corps symbolise la représentation qu’il avait d’une des dimensions de la fonction de correspondant en hygiène. Au total les représentations de 86 correspondants ont été analysées dans cette étude. Selon les différentes dimensions les représentations positives ou très positives allaient de 79,8 % à 94,2 % et, sur un score maximal de 5, la moyenne de la reconnaissance de leur action était évaluée à 2,7. Cette étude montre, sur un échantillon de professionnels motivés, des résultats plutôt positifs, mais elle incite à approfondir et élargir la diffusion d’outils d’évaluation de la fonction de correspondant en hygiène qui demeure un levier reconnu de l’amélioration de la prévention des infections associées aux soins. NosoBase n° 33689 Descriptions des postes des professionnels en hygiène hospitalière : reflètent-elles les rôles étendus et les responsabilités ? Manning ML; Borton DL; Rumovitz DM. Infection preventionists' job descriptions: do they reflect expanded roles and responsabilities? American journal of infection control 2012; in press; 3 pages. Mots-clés : PREVENTION; INFIRMIER HYGIENISTE; MEDECIN HYGIENISTE; PERSONNEL; TRAVAIL; PRATIQUE; SURVEILLANCE; FORMATION; QUALITE; CONTROLE In the last decade, the scope of practice of infection preventionists has expanded beyond the traditional roles of solo practitioner and expert data collectors to roles of interventionists and crucial leaders in successful patient safety initiatives. We examined the job descriptions of a small group of practicing infection preventionists to determine whether they reflected this expanded scope and responsibilities. NosoBase n° 32183 Prévention des risques de transmission des infections : connaître les pratiques formelles et informelles du personnel hospitalier (Thèse) Seifert AM. Université de Laval – Québec 2012: 168 pages. Mots-clés : TRANSMISSION; PREVENTION; PRATIQUE; PERSONNEL; PERCEPTION; QUESTIONNAIRE; AUDIT; TRAVAIL; CLOSTRIDIUM DIFFICILE; CONTAMINATION; FORMATION; RISQUE La prévention des infections dans les établissements de santé est un sujet d’actualité. Malgré la promotion de mesures de prévention, on constate qu’elles ne sont pas complètement appliquées. Toutefois, s’attarder uniquement à ces manques offre une prise limitée pour améliorer la prévention, en ignorant d’autres mesures que le personnel pourrait avoir développées. L’objectif de la recherche est de décrire les pratiques, formelles et informelles, de prévention de la transmission des infections, utilisées par diverses catégories de personnel hospitalier, ainsi que d’explorer les représentations reliées à ces pratiques. L’approche qualitative utilisée permet une vision systémique des activités de prévention. Nous avons effectué, à Montréal, 27 entrevues et 186 heures d’observation de personnel infirmier, de préposées aux bénéficiaires et de préposées à l’entretien sanitaire, tous expérimentés, dans quatre unités de soins dont deux de courte et deux de longue durée. Les 22 / 29 NosoVeille – Bulletin de veille Mai 2012 résultats montrent que les mesures de prévention ne sont pas des actes isolés mais qu’elles font partie d’un processus débutant par l’identification des risques à partir de trois familles d’informations: la contamination du patient, celle de l’environnement et les difficultés d’interaction avec le patient. Nous avons identifié certaines pratiques permettant de pallier des situations où les mesures de prévention prescrites sont jugées insuffisantes et révèlent des compétences méconnues du personnel. Ces pratiques peuvent notamment faire appel au travail d'équipe, faisant ressortir l’importance de la dimension collective du travail pour la prévention des infections. L’analyse des représentations du risque relié au Clostridium difficile montre de plus que les participantes à la recherche craignent de le transmettre aux patients et à leur propre famille et adoptent en conséquence des pratiques spécifiques de prévention, au travail et hors travail. A cause de situations mettant en échec la prévention, certaines participantes pensent de plus être des porteuses saines de ce microorganisme et craignent son activation si elles sont affaiblies. Certains aspects de l’organisation du travail peuvent aussi entraver leurs efforts : l’absence de moments de concertation, la présence de personnel non régulier et le manque de formation. Nous concluons sur l’importance d’appuyer les efforts de prévention basés sur des stratégies qui font appel au travail d’équipe, qui semblent avoir un potentiel intéressant pour la prévention des infections, et sur la nécessité de prendre en compte les préoccupations du personnel dans les interventions éducatives le concernant. (Résumé d’auteur) Pneumonie NosoBase n° 33787 Les pneumonies nosocomiales au Japon ont un meilleur profil de mortalité que les pneumonies nosocomiales aux Etats-Unis : étude rétrospective Iwata K; Igarashi W; Honjo M; Oka H; Oba Y; Yoshida H; et al. Hospital-acquired pneumonia in Japan may have a better mortality profile than HAP in the United States: a retrospective study. Journal of infection and chemotherapy 2012; in press: 7 pages. Mots-clés : PNEUMONIE; MORTALITE; ETUDE RETROSPECTIVE; MICROBIOLOGIE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PSEUDOMONAS; CENTRE HOSPITALIER UNIVERSITAIRE The characteristics of hospital-acquired pneumonia (HAP) are not well documented. In the present study we investigated the severity and mortality, microbiological profile, and the value of Gram staining in cultureconfirmed HAP in a Japanese hospital by retrospective review conducted at a Japanese university hospital. Only culture-confirmed cases with good specimen quality were included in the analysis. The clinical characteristics of HAP, as well as the causative organisms, were investigated. Furthermore, the prognostic ability of existing prediction rules were evaluated for prediction of overall mortality. Forty-two cases were enrolled in this analysis. The majority of patients were admitted to the ICU (61.9 %), and 40.5 % had ventilator-associated pneumonia (VAP). The 30-day mortality was 23.8 %, which is less than that reported in the United States. Factors commonly known to be associated with worse outcome in the USA did not appear to influence the mortality from HAP in Japan. The most frequent causative organisms were methicillinresistant Staphylococcus aureus (MRSA), followed by Pseudomonas spp. Sensitivity and negative predictive value of Gram staining were 89.4 and 85.7 %, respectively. SMART-COP predicted 30-day mortality with an area under the ROC curve (AUC) >0.7. The characteristics of HAP in Japan differ from HAP reported in the USA. In addition to lower mortality, we found both fewer ICU cases and VAP. Gram staining of good-quality specimens demonstrated promising sensitivity to predict the causative organisms. SMART-COP predicted mortality with appropriate ROC curve (AUC). NosoBase n° 33819 Un taux de zéro pneumonie acquise sous ventilation est-il vraiment possible ? Klompas M. Is a ventilator-associated pneumonia rate of zero really possible? Current opinion in infectious diseases 2012/04; 25(2): 176-182. Mots-clés : TAUX; PNEUMONIE; VENTILATION; SURVEILLANCE; TAUX; ANTIBIOTIQUE; DIAGNOSTIC; QUALITE Purpose of review: The increasing number of hospitals reporting ventilator-associated pneumonia (VAP) rates at or close to zero begs the question of whether zero should become the national benchmark for VAP. This article explores the significance of very low VAP rates, reviews differences in surveillance and clinical rates, proposes reasons for their discrepancies, and suggests possible objective alternatives for surveillance. 23 / 29 NosoVeille – Bulletin de veille Mai 2012 Recent findings: Surveillance rates of VAP are decreasing, whereas clinical diagnoses and antibiotic prescribing remain prevalent. This growing discrepancy reflects the lack of objective and definitive signs to diagnose VAP. External reporting pressures may be encouraging stricter interpretation of subjective signs and other surveillance initiatives that can artifactually lower rates. It is impossible to disentangle the relative contribution of care improvements versus surveillance effects to currently observed low VAP rates. Summary: The increasing mismatch between surveillance rates and clinical diagnoses limits the utility of official VAP rates to estimate disease burden and guide quality improvement. Advocates are advised to consider objective alternatives such as average duration of mechanical ventilation, length of stay, mortality, and antibiotic prescribing. Emerging surveillance definitions that use more objective criteria may better reflect and inform future clinical practice. NosoBase n° 33434 Le linezolide dans le traitement des pneumonies nosocomiales à Staphylococcus aureus résistant à la méticilline : étude contrôlée, randomisée Wunderink RG; Niederman MS; Kollef MH; Shorr AF; Kunkel MJ; Baruch A; et al. Linezolid in methicillinresistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clinical infectious diseases 2012/03/01; 5: 621-629. Mots-clés : PNEUMONIE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; LINEZOLIDE; RANDOMISATION Background: Post hoc analyses of clinical trial data suggested that linezolid may be more effective than vancomycin for treatment of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. This study prospectively assessed efficacy and safety of linezolid, compared with a dose-optimized vancomycin regimen, for treatment of MRSA nosocomial pneumonia. Methods: This was a prospective, double-blind, controlled, multicenter trial involving hospitalized adult patients with hospital-acquired or healthcare-associated MRSA pneumonia. Patients were randomized to receive intravenous linezolid (600 mg every 12 hours) or vancomycin (15 mg/kg every 12 hours) for 7-14 days. Vancomycin dose was adjusted on the basis of trough levels. The primary end point was clinical outcome at end of study (EOS) in evaluable per-protocol (PP) patients. Prespecified secondary end points included response in the modified intent-to-treat (mITT) population at end of treatment (EOT) and EOS and microbiologic response in the PP and mITT populations at EOT and EOS. Survival and safety were also evaluated. Results: Of 1184 patients treated, 448 (linezolid, n=224; vancomycin, n=224) were included in the mITT and 348 (linezolid, n=172; vancomycin, n=176) in the PP population. In the PP population, 95 (57.6%) of 165 linezolid-treated patients and 81 (46.6%) of 174 vancomycin-treated patients achieved clinical success at EOS (95% confidence interval for difference, 0.5%-21.6%; P=.042). All-cause 60-day mortality was similar (linezolid, 15.7%; vancomycin, 17.0%), as was incidence of adverse events. Nephrotoxicity occurred more frequently with vancomycin (18.2%; linezolid, 8.4%). Conclusions: For the treatment of MRSA nosocomial pneumonia, clinical response at EOS in the PP population was significantly higher with linezolid than with vancomycin, although 60-day mortality was similar Réanimation NosoBase n° 33674 Charge bactérienne intrinsèque associée aux lits d'hôpitaux en réanimation : impact de la désinfection sur la récupération de la population bactérienne et l'atténuation du risque infectieux potentiel Attaway HH; Fairey S; Steed LL; Salgado CD; Michels HT; Schmidt MG. Intrinsic bacterial burden associated with intensive care unit hospital beds: effects of disinfection recovery and mitigation of potential infection risk. American journal of infection control 2012; in press: 6 pages. Mots-clés : SOIN INTENSIF; RISQUE; DESINFECTION; LIT; QUALITE; ENVIRONNEMENT; GESTION DES RISQUES; BACTERIE; MEDECINE; ECHANTILLON; DESINFECTANT; SURFACE; EFFICACITE; STAPHYLOCOCCUS Background: Commonly touched items are likely reservoirs from which patients, health care workers, and visitors may encounter and transfer microbes. A quantitative assessment was conducted of the risk 24 / 29 NosoVeille – Bulletin de veille Mai 2012 represented by the intrinsic bacterial burden associated with bed rails in a medical intensive care unit (MICU), and how disinfection might mitigate this risk. Methods: Bacteria present on the rails from 36 patient beds in the MICU were sampled immediately before cleaning and at 0.5, 2.5, 4.5, and 6.5 hours after cleaning. Beds were sanitized with either a bottled disinfectant (BD; CaviCide) or an automated bulk-diluted disinfectant (ABDD; Virex II 256). Results: The majority of bacteria recovered from the bed rails in the MICU were staphylococci, but not methicillin-resistant Staphylococcus aureus. Vancomycin-resistant enterococci were recovered from 3 beds. Bottled disinfectant reduced the average bacterial burden on the rails by 99%. However, the burden rebounded to 30% of that found before disinfection by 6.5 hours after disinfection. ABDD reduced the burden by an average of 45%, but levels rebounded within 2.5 hours. The effectiveness of both disinfectants was reflected in median reductions to burden of 98% for BD and 95% for ABDD. Conclusions: Cleaning with hospital-approved disinfectants reduced the intrinsic bacterial burden on bed rail surfaces by up to 99%, although the population, principally staphylococci, rebounded quickly to predisinfection levels. NosoBase n° 33680 Diminution des pneumonies associées à la ventilation en réanimation : programme global et durable d'amélioration de la qualité Heck K. Decreasing ventilator-associated pneumonia in the intensive care unit: a sustainable comprehensive quality improvement program. American journal of infection control 2012; in press: 3 pages. Mots-clés : SOIN INTENSIF; PNEUMONIE; VENTILATION ASSISTEE; QUALITE; PREVENTION; ETUDE RETROSPECTIVE; SOIN DE BOUCHE; PERSONNEL; ASPIRATION An intensive care unit implemented an oral care bundle to decrease ventilator-associated pneumonia (VAP). A retrospective analysis comparing like time periods revealed the VAP rate per 1,000 ventilator-days dropped significantly from 10.5 to 0 (P=.016). The oral care bundle remains in place as of end of May 2011 and has proven to be a sustainable method for VAP prevention. Réglementation NosoBase n° 33855 Circulaire interministérielle n°DGCS/DGS/2012/118 du 15/03/2012 relative à la mise en oeuvre du programme national de prévention des infections dans le secteur médico-social 2011/2013 Ministère du travail, de l'emploi et de la santé; Ministère des solidarités et de la cohésion sociale. Non parue au Journal officiel 2012: 14 pages. Abroge la circulaire du 30/09/2011 (Référence NosoBase n° 31968) Mots-clés : LEGISLATION; EHPAD; RISQUE; VACCIN; PERSONNE AGEE; EVALUATION; CCLIN; HYGIENE DES MAINS; SIGNALEMENT; ARS; DECLARATION; INFECTION RESPIRATOIRE BASSE; EOH; ARLIN; CIRE; EPIDEMIE ; ANTIBIOTIQUE; MULTIRESISTANCE; TRANSMISSION; PRECAUTION STANDARD Le programme national de prévention des infections dans le secteur médicosocial vise à la prise en compte du risque infectieux par une démarche d'analyse de risque. Les établissements concernés (EHPAD, MAS et FAM) pourront utilement s'appuyer dans cette démarche sur les audits d'autoévaluation y compris informatique développés à cette fin. NosoBase n° 33856 Circulaire n°DGOS/PF2/2012/134 du 27/03/2012 relative au bilan des activités de lutte contre les infections nosocomiales dans les établissements de santé pour l'année 2011 Ministère du travail, de l'emploi et de la santé. Non parue au Journal officiel 2012: 73 pages. Mots-clés : LEGISLATION; INDICATEUR; ICALIN; ICSHA; SIGNALEMENT; EOH; FORMATION; EXPOSITION AU SANG; HYGIENE DES MAINS; PRECAUTION STANDARD; PRECAUTION COMPLEMENTAIRE; INFECTION URINAIRE; EAU; AIR; SURVEILLANCE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ICATB; BLOC OPERATOIRE; BILAN STANDARDISE 25 / 29 NosoVeille – Bulletin de veille Mai 2012 Recueil de données et traitement des bilans standardisés des activités de lutte contre les infections nosocomiales 2011 dans les établissements de santé. Rotavirus NosoBase n° 33812 Poids des gastroentérites à Rotavirus nosocomiales et d'origine communautaire dans la population pédiatrique de l'Europe de l'Ouest : revue Ogilvie I; Khoury H; Goetghebeur MM; Khoury AC; Giaquinto C. Burden of community-acquired and nosocomial Rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review. BMC infectious diseases 2012; in press: 30 pages. Mots-clés : ROTAVIRUS; VIRUS; GASTRO-ENTERITE; EPIDEMIOLOGIE; INCIDENCE; MORTALITE PEDIATRIE; EUROPE; BIBLIOGRAPHIE; Background: Rotavirus affects 95% of children worldwide by age 5 years and is the leading cause of severe dehydrating diarrhea. The objective of this review was to estimate the burden of rotavirus gastroenteritis (RVGE) in the Western European pediatric population. Methods: A comprehensive literature search (1999-2010) was conducted in PubMed and other sources (CDC; WHO, others). Data on the epidemiology and burden of RVGE among children <5 years-old in Western Europe --including hospital-acquired disease--were extracted. Results: 76 studies from 16 countries were identified. The mean percentage of acute gastroenteritis (AGE) cases caused by rotavirus ranged from 25.3%-63.5% in children <5 years of age, peaking during winter. Incidence rates of RVGE ranged from 1.33-4.96 cases/100 person-years. Hospitalization rates for RVGE ranged from 7% to 81% among infected children, depending on the country. Nosocomial RVGE accounted for 47%-69% of all hospital-acquired AGE and prolonged hospital stays by 4-12 days. Each year, RVGE incurred $0.54-$53.6 million in direct medical costs and $1.7-$22.4 million in indirect costs in the 16 countries studied. Full serotyping data was available for 8 countries. G1P[8], G2P[4], G9P[8], and G3P[8] were the most prevalent serotypes (cumulative frequency: 57.2%-98.7%). Serotype distribution in nosocomial RVGE was similar. Conclusions: This review confirms that RVGE is a common disease associated with significant morbidity and costs across Western Europe. A vaccine protecting against multiple serotypes may decrease the epidemiological and cost burden of RVGE in Western Europe. Staphylococcus aureus NosoBase n° 33805 Acquisition nosocomiale de Staphylococcus aureus meticillino-résistant (SARM) et d'entérobactéries productrices de bêta-lactamases à spectre étendu chez des patients hospitalisés : étude prospective multicentrique De Angelis G; Restuccia G; Venturiello S; Cauda R; Malhotra-Kumar S; Goossens H; et al. Nosocomial acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) enterobacteriaceae in hospitalised patients: a prospective multicenter study. BMC infectious diseases 2012; in press: 10 pages. Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENTEROBACTERIE; BETALACTAMASE A SPECTRE ELARGI; ETUDE PROSPECTIVE; TRAITEMENT; ANTIBIOTIQUE; COHORTE; DEPISTAGE; EPIDEMIOLOGIE; ANTIBIORESISTANCE; CAS TEMOIN Background: The risk of acquisition of antibiotic resistant-bacteria during or shortly after antibiotic therapy is still unclear and it is often confounded by scarce data on antibiotic usage. Primary objective of the study is to compare rates of acquisition of methicillin-resistant Staphylococcus aureus and extended spectrum betalactamase-producing Enterobacteriaceae in hospitalised patients, after starting antibiotic therapy. Methods: The study, running in three European hospitals, is a multicenter, prospective, longitudinal, observational cohort study funded from the European Community's Seventh Framework Programme [FP7/2007-2013] within the project 'Impact of Specific Antibiotic Therapies on the prevalence of hUman host Resistant bacteria' (acronym SATURN). Nasal and rectal screening for methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamases-producing Enterobacteriaceae will be obtained at hospital 26 / 29 NosoVeille – Bulletin de veille Mai 2012 admission, discharge, at antibiotic start (t0, within one hour) and at the following intervals: day 3 (t1), 7 (t2), 15 (t3), and 30 (t4). Two nested case-control studies will be performed. The objective of the first study will be to define individual level of risk related to specific antibiotics. Patients acquiring methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae (cases) will be compared with patients not acquiring antibiotic-resistant strains after starting antibiotic therapy (controls; ratio 1:4). To define the impact of antibiotics on new acquisition of target antibiotic-resistant bacteria, a second nested case-control study will be done (ratio 1:4). Control group will be selected among patients not receiving antibiotics, admitted in the same ward on the day of the corresponding case, with negative cultures at admission. Epidemiological, clinical and microbiological data will be prospectively collected. Discussion: The rationale of this study is to better understand the impact of antibiotic use on acquisition, selection and transmission of antimicrobial resistant-bacteria in European hospitals. NosoBase n° 33677 Trop près pour le confort : stratégie de dépistage destinée à détecter la conversion à Staphylococcus aureus méticillino-résistant chez des voisins de chambre exposés Ng W; George K; Muhammed N; Tomassi J; Katz KC. Too close for comfort: screening strategy to detect methicillin-resistant Staphylococcus aureus conversion in exposed roommates. American journal of infection control 2012; in press: 3 pages. Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; DEPISTAGE; PCR; BIOLOGIE MOLECULAIRE; COLONISATION; COLONISATION NASALE; RISQUE; CHAMBRE; ENVIRONNEMENT All 899 roommates exposed to methicillin-resistant Staphylococcus aureus (MRSA) index cases were studied over 57 months. MRSA detection is better at approximately 3 days (50%-55%) or 7 days (56%) after contact has been broken than day 0 (30%). Polymerase chain reaction testing at day 3 performs similarly to culture at day 7. Nasal/rectal screening provides superior detection than nasal alone. Those exposed >48 hours are at significantly greater risk of colonization. Tuberculose NosoBase n° 33885 Dossier : La tuberculose infantile, actualités et perspectives Doually Y. Soins Pédiatrie puériculture 2012/02; 264: 13-38. Mots-clés : TUBERCULOSE; TRANSMISSION; ANTITUBERCULEUX; BCG; RECOMMANDATION; EPIDEMIOLOGIE; PEDIATRIE; TEST TUBERCULINIQUE; DEPISTAGE VACCIN; Extrait du sommaire : - Fraisse P. La tuberculose, une maladie contagieuse (Référence NosoBase n°33887) - Donato L, Mansilla M. Epidemiologie de la tuberculose en France (Référence NosoBase n°33888) - Donato L, Mansilla M. Formes cliniques et traitement de la tuberculose chez l'enfant (Référence NosoBase n°33889) - Marchal G. Histoire et actutalité de la vaccination par le BCG (Référence NosoBase n°33890) - Chadelat K. La prévention de la tuberculose par le dépistage (Référence NosoBase n°33891) Vaccination NosoBase n° 33846 Guide des vaccinations - Edition 2012 - 4ème édition Direction Générale de la Santé (DGS); Comité technique des vaccinations; Institut National de Prévention et d’éducation pour la Santé (INPES). INPES 2012/01: 1-486. Mots-clés : RECOMMANDATION; VACCIN; BORDETELLA PERTUSSIS; GRIPPE; HEPATITE A; HEPATITE B; OREILLONS; ROTAVIRUS; ROUGEOLE; RUBEOLE; VARICELLE; CLOSTRIDIUM TETANI; TUBERCULOSE; BCG; ZONA; PERSONNEL 27 / 29 NosoVeille – Bulletin de veille Mai 2012 La vaccination est la prévention la plus efficace contre les maladies infectieuses. L'objectif du Guide des vaccinations 2012 est de mettre à disposition des professionnels de santé les connaissances les plus récentes sur les vaccinations et de répondre aux questions qu'ils se posent. C'est un ouvrage collectif rédigé par le Comité technique des vaccinations, la direction générale de la Santé, l'Institut de veille sanitaire, l'Agence française de sécurité sanitaire des produits de santé, l'Inpes et de nombreux spécialistes. La première partie apporte des informations pour la pratique professionnelle. Elle fait le point sur chaque vaccination (épidémiologie de la maladie, caractéristiques des vaccins, mode d'administration, indications, recommandations, effets indésirables). Elle précise les modalités spécifiques des vaccinations de certaines populations et rappelle le calendrier vaccinal en cours. La seconde partie aborde les informations générales sur la vaccination : bases immunologiques, mise au point des vaccins, politique vaccinale, suivi et évaluation des programmes de vaccination. Les annexes fournissent des renseignements pratiques. NosoBase n° 33711 Avis relatif aux recommandations vaccinales spécifiques des personnes immunodéprimées ou aspléniques Haut conseil de la santé publique (HCSP). HCSP 2012/02/16: 1-8. Mots-clés : RECOMMANDATION; VACCINATION; DEFICIT IMMUNITAIRE; GRIPPE; HEPATITE B; HEPATITE A; BCG; VARICELLE; STREPTOCOCCUS PNEUMONIAE Le Haut Conseil de la santé publique s’est autosaisi par l’intermédiaire du Comité technique des vaccinations (CTV) afin d’émettre des recommandations complémentaires sur la vaccination des sujets faisant état d’une immunodépression ou d’une asplénie. L’objectif était d’élaborer des recommandations spécifiques aux personnes immunodéprimées ou aspléniques afin de les intégrer au calendrier vaccinal, d’en assurer la diffusion et l’application dans le but d’améliorer la couverture vaccinale de ces populations à risque d’infection sévère et in fine diminuer la morbidité et la mortalité de ces patients. NosoBase n° 33858 Le calendrier des vaccinations et les recommandations vaccinales 2012 selon l'avis du Haut Conseil de la santé publique Institut de veille sanitaire (InVS); Floret D. Bulletin épidémiologique hebdomadaire 2012/04/10; 14-15: 161187. Mots-clés : VACCIN; RECOMMANDATION; GRIPPE; STREPTOCOCCUS PNEUMONIAE; GROSSESSE; PEDIATRIE; ROUGEOLE; TUBERCULOSE; BORDETELLA PERTUSSIS; HEPATITE A; HEPATITE B; VARICELLE; PERSONNEL; DEFICIT IMMUNITAIRE Le calendrier vaccinal 2012 introduit de nouvelles recommandations qui concernent les vaccinations contre la grippe saisonnière, les infections invasives à pneumocoque et la tuberculose, le calendrier vaccinal des jeunes enfants à Mayotte ainsi que les vaccinations des personnes immunodéprimées ou aspléniques. NosoBase n° 33800 La vaccination contre la coqueluche dans l'enfance diminue l'incidence de la coqueluche et le taux d'hospitalisation après une ou deux doses. Analyses de dix ans de surveillance de la coqueluche Nilsson L; Lepp T; Von Segebaden K; Hallander H; Gustafsson L. Pertussis vaccination in infancy lowers the incidence of pertussis disease and the rate of hospitalisation after one and two doses: analyses of 10 years of pertussis surveillance. Vaccine 2012; 30(21): 3239-3247. Mots-clés : VACCIN; PEDIATRIE INCIDENCE; SURVEILLANCE; BORDETELLA PERTUSSIS; PREVENTION; Objectives: Shortly after pertussis vaccination was reintroduced in Sweden in 1996, an intensified pertussis disease surveillance programme was set up. In this study, we report on in-depth analyses of age-dosenumber-specific incidences and the rate of pertussis hospitalisation for children with no, 1 or 2 doses of an acellular pertussis vaccine before pertussis disease. Vaccine coverage, the timeliness of childhood vaccination and the effect of later than scheduled pertussis vaccination(s) are also examined. 28 / 29 NosoVeille – Bulletin de veille Mai 2012 Study design: Children with notified laboratory-confirmed (culture or PCR) pertussis disease were evaluated among the surveillance population of about 1 million infants, born between 1996 and 2007 and followed for pertussis disease from October 1997 to December 2007, for nearly 6 million person-years. Birth and vaccination dates of the diseased children are known from the surveillance programme. To estimate denominators of the age-dose-number-specific pertussis incidences, we used birth and vaccination dates from a vaccine trial with more than 72,000 infants combined with national pertussis vaccine coverage data for children in the surveillance population. Results: For infants from 3 to <5 months of age, the incidence of pertussis disease with at least 14 days of cough decreased from 264/100,000 for unvaccinated infants to 155/100,000 for infants with one dose of a pertussis vaccine prior to onset of the disease. In the age range 5 to <12 months, the age-dose specific incidences were 526, 95, and 24/100,000 for infants with no, 1 and 2 doses, respectively. The rate of hospitalisation for infants with 1 dose of a pertussis vaccine prior to onset of the disease was significantly lower than for unvaccinated infants of the same age. For many infants, there is a delay in administration of the vaccine doses according to the regular 3-5-12 month schedule (which has been the case for many years). Hypothetically, if all infants had been vaccinated exactly on schedule, we would expect about 28% fewer pertussis cases with at least 14 days of cough and 38% fewer hospitalisations due to pertussis, of cases possible to influence by vaccinations on schedule. Conclusion: Pertussis vaccination had a significant effect among infants already after the first dose. This is particularly important for premature infants and infants with severe respiratory and cardiac diseases. A moderate decrease in the incidence of pertussis disease in infants and rate of hospitalisation could be expected if primary vaccinations were carried out closer to the scheduled time than is currently the practice in Sweden. 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] 29 / 29