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NosoVeille – Bulletin de veille
Juillet 2014
NosoVeille n°7
Juillet 2014
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html
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Abonnement / Désabonnement
Sommaire de ce numéro :
Acinetobacter baumannii
Antibiotique / Antibiorésistance
Aspergillose
Bactériémie
Candida
Cathétérisme
Chirurgie
Clostridium difficile
Coronavirus
Coût
Désinfection
EHPAD
Entérobactérie
Entérocoque
Environnement
Gastro-entérite
Gestion des risques
Grippe
Hémodialyse
Hygiène des mains
Indicateur
Infection urinaire
Mycologie
Odontologie
Personnel
Précaution standard
Soin intensif
Staphylococcus aureus
Surveillance
Transport sanitaire
Travaux hospitaliers
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NosoVeille – Bulletin de veille
Juillet 2014
Acinetobacter baumannii
NosoBase ID notice : 382208
Détection d’Acinetobacter baumannii résistant à tous les antibiotiques (pan-résistant) en Allemagne
Göttig S; Gruber TM; Higgins PG; Wachsmuth M; Seifert H; Kempf VA. Detection of pan drug-resistant
Acinetobacter baumannii in Germany. Journal of antimicrobial chemotherapy 2014; in press: 2 pages.
Mots-clés :
ACINETOBACTER
BAUMANNII;
ANTIBIORESISTANCE;
CARBAPENEME; BIOLOGIE MOLECULAIRE; TYPAGE
MULTIRESISTANCE;
NosoBase ID notice : 381533
Dissémination clonale d’Acinetobacter baumannii ultra-résistant producteur de bêta-lactamases OXA23 dans un centre hospitalier universitaire à Shanghai, Chine
Li Y; Guo Q; Wang P; Zhu D; Ye X; Wu S; et al. Clonal dissemination of extensively drug-resistant
Acinetobacter baumannii producing an OXA-23 β-lactamase at a teaching hospital in Shanghai, China.
Journal of microbiology, immunology and infection 2014; in press: 8 pages.
Mots-clés :
ACINETOBACTER
BAUMANNII;
ANTIBIORESISTANCE;
CENTRE
HOSPITALIER
UNIVERSITAIRE; CARBAPENEME; PCR; TYPAGE; ETUDE RETROSPECTIVE; FACTEUR DE RISQUE
Background/purpose: Extensively drug-resistant (XDR) Acinetobacter baumannii presents a serious
therapeutic and infection control challenge. This study aimed to explore the causes for the rapid increase of
XDR A. baumannii at a teaching hospital in Shanghai.
Methods: All consecutive clinical isolates of XDR A. baumannii were collected from January to December
2010 at Huashan Hospital in Shanghai. The prevalence of carbapenemase genes was investigated by
polymerase chain reaction (PCR) amplification. Genetic relatedness of the isolates was determined by
enterobacterial repetitive intergenic consensus-PCR and multilocus sequence typing. A retrospective casecontrol study was performed for the identification of risk factors of XDR A. baumannii infections.
Results: All 106 XDR A. baumannii isolates carried the blaOxA-23 gene and were resistant to all antimicrobial
agents tested, except colistin, tigecycline and cefoperazone-sulbactam. One hundred and five of the strains
belonged to clonal complex 92 by multilocus sequence typing, and 78 were classified as clone A1 by
enterobacterial repetitive intergenic consensus-PCR. Intensive care unit residency at the time of isolation,
recent general anesthesia, the number of previous antibiotic classes administered and previous
hospitalization were identified as risk factors by case-control study. Efficacy rates were 62.5% (5/8), 47.4%
(9/19), and 42.9% (3/7) when the XDR patients were treated with cefoperazone-sulbactam, carbapenems, or
both cefoperazone-sulbactam and carbapenem, alone or in combination with other agents, respectively.
Conclusion: XDR A. baumannii producing OXA-23 β-lactamase was clonally disseminated at a university
hospital in Shanghai. Cefoperazone-sulbactam and carbapenems alone or combined with other antibiotics
may benefit XDR A. baumannii infections in the absence of other effective antibiotics.
Antibiotique / Antibiorésistance
NosoBase ID notice : 382815
Alliance contre le développement des bactéries multi-résistantes. Déclaration de la WAAAR (World
Alliance Against Antibiotic Resistance) contre la résistance bactérienne
Carlet J. Alliance contre le développement des bactéries multi-résistantes. Déclaration de la WAAAR (World
Alliance Against Antibiotic Resistance) contre la résistance bactérienne. WAAAR 2014/06: 4 pages.
Mots-clés : ANTIBIORESISTANCE; ANTIBIOTIQUE; PREVENTION; INFORMATION
Déclaration de la WAAR (Allaince contre le développement des bactéries multirésistantes). "Préserver
l'efficacité des antibiotiques et stabiliser l'écosystème bactérien doivent être un objectif global absolu".
NosoBase ID notice : 382528
L’hygiène et autres mesures de prévention des infections associés aux bactéries multirésistantes.
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NosoVeille – Bulletin de veille
Juillet 2014
Institut national de santé publique Québec. L’hygiène et autres mesures de prévention des infections
associés aux bactéries multirésistantes. Institut national de santé publique Québec 2014/06: 1-13.
Mots-clés : PREVENTION; HYGIENE DES MAINS; DESINFECTION; SURFACE; DEPISTAGE;
STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; PRECAUTION
CONTACT
La réduction des éclosions de bactéries multirésistantes (BMR) est une préoccupation du réseau de la santé.
Le présent document propose une stratégie de prévention pour contrer ces infections. Cette stratégie est
constituée d’un ensemble de pratiques cliniques exemplaires (EPE) qui minimise la transmission de ces
bactéries et d’outils pour s’assurer de la conformité à cet EPE. Elle comporte également des mesures de
l’efficacité de ces pratiques sur l’incidence des infections associées aux BMR. Ainsi, le document suggère
des outils de surveillance des taux d’acquisition des colonisations nosocomiales Staphyloccocus aureus
résistant à la méthicilline (SARM), à l’entérocoque résistant à la vancomycine (ERV) et aux bacilles à Gram
négatif producteurs de carbapénémases (BGNPC).
Pour obtenir une diminution significative de ces infections associées aux BMR, tous les éléments de
l’ensemble de pratiques cliniques exemplaires (EPE) doivent être mis en place et appliqués, mais les moyens
retenus ainsi que le rythme d’implantation sont laissés à la discrétion des établissements.
NosoBase ID notice : 380952
Génotypage, prévalence locale et dissémination internationale de souches de Kingella kingae
productrices de bêta-lactamases
Basmaci R; Bonacorsi S; Bidet P; Balashova NV; Lau J; Muñoz-Almagro C; et al. Genotyping, local
prevalence, and international dissemination of β-lactamase-producing Kingella kingae strains. Clinical
microbiology and infection 2014; in press: 23 pages.
Mots-clés : PREVALENCE; TYPAGE; GENOTYPE; BIOLOGIE MOLECULAIRE; ANTIBIORESISTANCE;
BACILLE GRAM NEGATIF
β-lactamase production has been sporadically reported in the emerging Kingella kingae pathogen but the
phenomenon has not been studied in-depth. We investigated the prevalence of β-lactamase production
among K. kingae isolates from different geographic origins and genetically characterized β-lactamaseproducing strains. 778 isolates from Iceland, the USA, France, Israel, Spain and Canada were screened for
β-lactamase production and, if positive, were characterized by PFGE and MLST genotyping, as well as rtxA,
por, blaTEM and 16S rRNA sequencing. β-lactamase was identified in invasive strains from Iceland (n=4/14,
28.6%), the USA (n=3/15, 20.0%) and Israel (n=2/190, 1.1%) and in carriage strains in the USA (n=5/17,
29.4%) and Israel (n=66/429, 15.4%). No French, Spanish or Canadian isolates were β-lactamase producers.
Among β-lactamase producers, a perfect congruency between the different typing methods was observed.
Surprisingly, all US and Icelandic β-lactamase-producing isolates were almost indistinguishable, belonged to
the major international invasive PFGE clone K/MLST ST-6, but differed from the four genetically unrelated
Israeli β-lactamase-producing clones. Representative strains of different genotypes produced TEM-1 enzyme.
K. kingae β-lactamase-producers exhibit a clear clonal distribution and have dissimilar invasive potential.
Presence of the enzyme in isolates belonging to the major worldwide invasive clone K/ST-6 highlights the
possible spread of β-lactam resistance, and emphasizes the importance of routine testing all K. kingae clinical
isolates for β-lactamase production.
NosoBase ID notice : 382011
Contrôle de deux épidémies concomitantes d’infections à entérobactéries productrices de
carbapénémase et à Acinetobacter baumannii multirésistant dans un service de réanimation ayant
mis en place les mesures recommandées dans la boite à outils 2012 du CDC pour lutter contre les
entérobactéries résistantes aux carbapénèmes
Enfield KB; Huq NN; Gosseling MF; Low DJ; Hazen KC; Toney DM; et al. Control of simultaneous outbreaks
of carbapenemase-producing Enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii
infection in an intensive care unit using interventions promoted in the centers for disease control and
prevention 2012 carbapenemase-resistant enterobacteriaceae toolkit. Infection control and hospital
epidemiology 2014/07; 35(7): 810-817.
Mots-clés :
ACINETOBACTER
BAUMANNII;
ENTEROBACTERIE;
ANTIBIORESISTANCE;
CARBAPENEME; EPIDEMIE; SOIN INTENSIF; INCIDENCE; TAUX; COLONISATION; TRANSMISSION
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NosoVeille – Bulletin de veille
Juillet 2014
Objective: We describe the efficacy of enhanced infection control measures, including those recommended in
the Centers for Disease Control and Prevention's 2012 carbapenem-resistant Enterobacteriaceae (CRE)
toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and
extensively drug-resistant Acinetobacter baumannii (XDR-AB).
Design: Before-after intervention study.
Setting: Fifteen-bed surgical trauma intensive care unit (ICU).
Methods: We investigated the impact of enhanced infection control measures in response to clusters of CPE
and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to
detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was
performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response
to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the
incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.
Results: The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases
per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases
per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDRAB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased
to 1.22 cases per 1,000 patient-days (P=.001), and no more cases of XDR-AB were identified.
Conclusions: Use of infection control measures described in the Centers for Disease Control and Prevention's
2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB
transmission.
NosoBase ID notice : 381944
Contrôle à long terme des entérobactéries productrices de carbapénémase à l’échelle d’une large
institution multi-sites, l’AP-HP : une expérience française de 9 ans, de 2004 à 2012
Fournier S; Monteil C; Lepainteur M; Richard C; Brun-Buisson C; Jarlier V. Long-term control of
carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nineyear experience, France, 2004 to 2012. Eurosurveillance 2014/05; 19(19): 1-8.
Mots-clés : INFECTION NOSOCOMIALE; ENTEROBACTERIE; ANTIBIORESISTANCE; CARBAPENEME;
EPIDEMIE; PRECAUTION COMPLEMENTAIRE; DEPISTAGE; SUJET CONTACT; DEFINITION;
PERSONNEL; CONTROLE
In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae
(CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance
Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate,
and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross
transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140
CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an
increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation
abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10%
(13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32)
to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and
strength of the measures implemented around the CPE index case: quick (within two days of patient
admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier
precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to
control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an
emerging stage.
NosoBase ID notice : 381562
Emergence d’une infection à Enterobacter cloacae producteur de carbapénèmase OXA-48 en Pologne
Majewski P; Wieczorek P; Sacha PT; Frank M; Juszczyk G; Ojdana D; et al. Emergence of OXA-48
carbapenemase-producing Enterobacter cloacae ST89 infection in Poland. International journal of infectious
diseases 2014/08; 25: e107-e109.
Mots-clés : ANTIBIORESISTANCE; CARBAPENEME; ENTEROBACTER
MOLECULAIRE; CHIRURGIE CARDIO-VASCULAIRE; PCR
CLOACAE;
BIOLOGIE
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NosoVeille – Bulletin de veille
Juillet 2014
Background: The utility of carbapenems, which are considered 'last-line' agents, is being diminished by the
growing incidence of various resistance mechanisms in bacteria. We aimed to investigate the molecular
mechanism of carbapenem resistance in Enterobacter cloacae recovered from a 76-year-old patient who had
undergone coronary artery bypass grafting and repair of the mitral and tricuspid valves. Interestingly, the
patient had no prior history of hospital admission abroad.
Methods: The Carba-NP test II and synergy testing were performed to confirm carbapenemase activity. PCR
was used to detect carbapenemase-encoding genes. Nucleotide and amino acid sequence analysis was
performed to identify OXA-48 variants. Moreover, we performed multilocus sequence typing (MLST) of
multidrug-resistant (MDR) E. cloacae.
Results: We detected no significant increase in zone diameter around disks with inhibitors. However, the
Carba-NP test II revealed carbapenemase activity in all isolates. All isolates showed the presence of the
exact OXA-48 carbapenemase variant. Furthermore, MLST analysis revealed that the MDR E. cloacae
isolates belonged to ST89.
Conclusions: We report a case of infection caused by a unique carbapenem-resistant E. cloacae ST89
producing OXA-48 carbapenemase. Interestingly, these pathogens developed resistance to other 'last-resort'
agents, namely colistin and tigecycline. There is a crucial need for surveillance programs aimed at screening
for carbapenemase-producing Gram-negative bacteria, especially in patients transferred from high-incidence
areas.
NosoBase ID notice : 380954
Prévalence élevée de souches de Bordetella pertussis résistantes à l’érythromycine à Xi’an, en Chine
Wang Z; Cui Z; Li Y; Hou T; Liu X; Xi Y; et al. High prevalence of erythromycin-resistant Bordetella pertussis
in Xi'an, China. Clinical microbiology and infection 2014; in press: 18 pages.
Mots-clés : PREVALENCE; ANTIBIORESISTANCE; ERYTHROMYCINE; BORDETELLA PERTUSSIS;
PCR; DIAGNOSTIC; VACCIN; ETUDE PROSPECTIVE; PEDIATRIE
Resistance of Bordetella pertussis, the causative agent of pertussis, to erythromycin is rare. Recently, several
Chinese isolates were found to be erythromycin-resistant. This study aimed to investigate the occurrence of
pertussis in children suffering persistent cough and the prevalence of B. pertussis resistance to erythromycin
in Xi'an, China. Three hundreds thirteen patients with suspected pertussis admitted in Xi'an Children's
Hospital, from January 2012 through December 2013 were included and their nasopharyngeal (NP) swabs
were taken for culture and PCRs (targeting IS481 and ptx-Pr). PCR-based sequencing was used to identify
A2047G mutation of B. pertussis 23S rRNA directly from the NP samples. Sixteen (5.1%) and 168 (53.7%)
patients were positive for culture and IS481 PCR. Of the 168 samples positive for IS481 PCR, 122 (72.6%)
and 100 (59.5%) were positive for ptx-Pr and 23S rRNA PCRs, respectively. All culture-positive samples were
also positive for the three PCRs. Fourteen (87.5%) of the 16 B. pertussis isolates were found to be resistant
to erythromycin (MICs > 256 mg/L). All the 14 isolates were confirmed to have a homogeneous A2047G
mutation of 23S rRNA. Of the 100 samples positive for 23S rRNA PCR, 85 (85.0%) were found to have the
A2047G mutation by sequencing. Our results indicate that in Xi'an, China, pertussis remains endemic in
young children, and the circulating B. pertussis strains are mostly erythromycin-resistant.
NosoBase ID notice : 382560
Etude prospective d’observation de la prévalence et des facteurs de risque de colonisation par des
bactéries résistantes aux antibiotiques parmi des patients lors de leur admission à l’hôpital à
Singapour
Young BE; Lye DC; Krishnan P; Chan SP; Leo YS. A prospective observational study of the prevalence and
risk factors for colonization by antibiotic resistant bacteria in patients at admission to hospital in Singapore.
BMC infectious diseases 2014/06/02; 14(1): 1-7.
Mots-clés : PREVALENCE; ANTIBIORESISTANCE; ETUDE PROSPECTIVE; FACTEUR DE RISQUE;
COLONISATION;
SEJOUR;
CENTRE
HOSPITALIER
UNIVERSITAIRE;
ENTEROCOCCUS;
VANCOMYCINE; ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; DEPISTAGE
Background: Drug resistant organisms pose an increasing threat to the successful treatment of common
infections. Understanding colonization patterns of these bacteria is important for effective antibiotic treatment
and infection control guidelines.
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NosoVeille – Bulletin de veille
Juillet 2014
Methods: A prospective observational study was performed to determine the prevalence of colonization with
extended-spectrum
β-lactamase-producing
Enterobacteriaceae
(ESBL-E),
methicillin-resistant
Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) among patients admitted via
the emergency department to a public tertiary hospital in Singapore. Anterior nares, groin, axillary and rectal
swabs were collected at admission and cultured using standard bacteriological techniques. Clinical data
including healthcare contact within the past 12 months and recent antibiotic use was collected and analyzed
using a logistic regression model.
Results: 1006 patients were screened. 124 (12.4%) were colonized by ESBL-E, 18 (1.8%) by MRSA while no
VRE was detected. Antibiotic use within the past month was the only significant predictor for ESBL-E
colonization in the regression model, with an adjusted odds ratio (AOR) of 2.58 (1.04 to 6.42). In participants
recently prescribed antibiotics and hospitalized in the previous 3 months, 29.4% were colonized by ESBL-E.
This represented 20.2% of the total ESBL-E burden, and ESBL-E was also detected in 6.3% of participants
with no healthcare contact. Hospitalization and outpatient hospital visits predicted MRSA colonization in the
univariate analysis. Neither was statistically significant in the logistic regression model, with AORs for MRSA
colonization following hospitalization in the past 3 and 12 months of 3.81 [95% CI 0.84-17.28] and 3.48 [0.6418.92] respectively.
Conclusion: A high prevalence of colonization with ESBL-E was evident among patients at admission, even in
the absence of recent antibiotic use or contact with healthcare.
Aspergillose
NosoBase ID notice : 380949
Variables environnementales associées à un risque augmenté d’aspergillose invasive
Garcia-Vidal C; Royo-Cebrecos C; Peghin M; Moreno A; Ruiz-Camps I; Cervera C; et al. Environmental
variables associated with an increased risk of invasive aspergillosis. Clinical microbiology and infection 2014;
in press: 21 pages.
Mots-clés : RISQUE; ENVIRONNEMENT; ASPERGILLUS; INCIDENCE;
RETROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; VIRUS
COHORTE;
ETUDE
Information on the environmental variables that may affect the incidence of invasive aspergillosis (IA) is
scarce. We sought to determine the relationship between airborne spore counts, climatic conditions, and IA.
We also examined whether circulating respiratory viruses predispose to IA in a multicentre cohort study of
hospitalized adults with IA. Data on environmental mould spores, climatic conditions, and circulating
respiratory viruses were obtained from the Environmental Department of the Autonomous University of
Barcelona, the Meteorological Service of Catalonia, and the Acute Respiratory Infection Surveillance Project
in Catalonia respectively. Between 2008 and 2011, 165 patients with IA were identified. Diagnosis was based
on one or more of the following: culture (125 cases), galactomannan antigen (98), and histology (34). One
hundred and twenty-seven cases (77%) had criteria for probable IA, and the remainder for proven IA.
Environmental mould spore counts from the period 28-42 days preceding infection presented significant
associations with admissions due to IA. None of the climatic conditions were associated with an increased
risk of IA, but, the presence of circulating respiratory viruses was associated with a higher risk of infection: the
most strongly associated viruses were respiratory syncytial virus, influenza A(H1N1), and adenovirus. In
conclusion, the presence of high numbers of spores in air increases the risk of admission due to IA.
Circulating respiratory viruses appear to be associated with a higher risk for developing IA. Physicians should
be aware of this association in order to optimize prevention and diagnosis strategies for IA during viral
epidemic periods.
Bactériémie
NosoBase ID notice : 382822
La prévention des bactériémies associées aux cathéters vasculaires centraux
Institut national de santé publique Québec (INSPQ). La prévention des bactériémies associées aux cathéters
vasculaires centraux. Institut national de santé publique Québec 2014/06: 39 pages.
Mots-clés : CATHETER; CATHETER VEINEUX CENTRAL; BACTERIEMIE; PREVENTION; HYGIENE DES
MAINS; PANSEMENT; ANTISEPTIQUE; CHLORHEXIDINE
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NosoVeille – Bulletin de veille
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Le présent document propose une stratégie de prévention pour contrer ces bactériémies qui sont souvent
évitables. Cette stratégie est constituée d'un ensemble de pratiques cliniques exemplaires (EPE) qui en
minimise le risque, d'outils pour s'assurer de la conformité de ces nouveaux processus ainsi que de mesures
de l'efficacité de cet ensemble de pratiques sur les BACC.
NosoBase ID notice : 380974
Incidence, facteurs de risque et évolution des bactériémies à Enterococcus spp : étude de population
Billington EO; Phang SH; Gregson DB; Pitout JD; Ross T; Church DL; et al. Incidence, risk factors, and
outcomes of Enterococcus spp blood stream infections: a population-based study. International journal of
infectious diseases 2014; in press: e1-e7.
Mots-clés : BACTERIEMIE; ENTEROCOCCUS; INCIDENCE; FACTEUR DE RISQUE; ENTEROCOCCUS
FAECALIS; ENTEROCOCCUS FAECIUM; MICROBIOLOGIE; MORTALITE; SURVEILLANCE
Background: Enterococci are a clinically significant cause of bloodstream infections (BSI), particularly in the
nosocomial setting. The purpose of this study was to characterize the incidence, risk factors for acquisition,
microbiological characteristics, and mortality of enterococcal BSI within the well-defined population of a large
Canadian health region.
Methods: Surveillance for all episodes of enterococcal BSI occurring among residents of the Calgary Health
Zone (population 1.2 million) between 2000 and 2008 was conducted using an electronic surveillance system.
Clinical features, microbiology, and outcomes were obtained.
Results: A total of 710 incident episodes of enterococcal BSI were identified for an annual incidence of 6.9
episodes per 100000; the incidences of Enterococcus faecalis and Enterococcus faecium BSI were 4.5 and
1.6 per 100000, respectively. E. faecalis infections were associated with a urinary focus, genitourinary
malignancy, and abnormal genitourinary anatomy. E. faecium infections were associated with a
gastrointestinal focus. Resistance to ampicillin, vancomycin, and ciprofloxacin was higher in E. faecium
infection. The overall case fatality rate was 23%, and was higher for E. faecium infection.
Conclusions: This is the second population-based study to assess the risk factors for enterococcal BSI and
compare the characteristics of infection with E. faecalis and E. faecium. Results suggest that BSI with E.
faecalis and E. faecium should be regarded as two clinically different entities with unique sets of risk factors
and microbiological characteristics.
NosoBase ID notice : 381462
Pas d’association entre l’insertion des cathéters veineux centraux sous surveillance échographique
et bactériémies : étude prospective d’observation
Cartier V; Haenny A; Inan C; Walder B; Zingg W. No association between ultrasound-guided insertion of
central venous catheters and bloodstream infection: a prospective observational study. The journal of hospital
infection 2014/06; 87(2): 103-108.
Mots-clés : CATHETER; CATHETER VEINEUX CENTRAL; BACTERIEMIE; ETUDE PROSPECTIVE;
COHORTE; MEDECIN; ANESTHESIE; SURVEILLANCE; MORTALITE
Background: Ultrasound guidance for the insertion of central venous catheters (CVCs) reduces mechanical
complications and shortens insertion time, but its effect on CVC-associated bloodstream infection (CABSI)
remains controversial.
Aim: To test the effect of ultrasound-guided CVC insertion on CABSI in a hospital-wide setting.
Methods: A four-year prospective cohort study was conducted at a university-affiliated, tertiary care centre. All
patients receiving a non-tunnelled CVC, inserted by an anaesthetist, were enrolled. Catheter surveillance was
performed by trained infection control nurses and checked by an infection control doctor. The primary
outcome was CABSI as defined by the US Centers for Disease Control and Prevention. The secondary
outcome was all-cause mortality up to 28 days after CVC removal.
Findings: In total, 2312 patients with 2483 CVCs were included and analysed. Ultrasound guidance was used
for 844 CVC insertions (34.0%), with a significant increasing trend over the study period [incidence rate ratio
1.13, 95% confidence interval (CI) 01.11-1.15; P<0.001]. Forty-seven CABSIs were identified, representing
an overall incidence of 2.1 episodes per 1000 catheter-days. No association was detected between
ultrasound guidance and CABSI (hazard ratio 0.69, 95% CI 0.36-1.30; P=0.252). All-cause mortality was
11.0% (253/2312), with no significant trend and no association with ultrasound guidance.
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Conclusion: Ultrasound guidance had no effect on CABSI or mortality. In a hospital-wide setting with baseline
CABSI rates at the standard level currently found in high-income countries, the use of ultrasound has no
additional benefit for the prevention of CABSI.
NosoBase ID notice : 382656
Epidémie de bactériémies à Pseudomonas aeruginosa et à Klebsiella pneumoniae dans un centre de
chimiothérapies en ambulatoire
Dobbs TE; Guh AY; Oakes P; Vince MJ; Forbi JC; Jensen B; et al. Outbreak of Pseudomonas aeruginosa
and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center. American journal of
infection control 2014/07; 42(7): 731-734.
Mots-clés : PSEUDOMONAS AERUGINOSA; KLEBSIELLA PNEUMONIAE; BACTERIEMIE; EPIDEMIE;
AMBULATOIRE; CHIMIOTHERAPIE; TRAITEMENT; CANCEROLOGIE; PERFUSION; PFGE; PRATIQUE
Background: Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection
(BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received
infusion services at the same outpatient oncology center.
Methods: Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among
patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel
electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations
identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients
who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne
pathogen (BBP) testing; genetic relatedness was determined by molecular testing.
Results: Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved
symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before
blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety
lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared
medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified
patients (53%).
Conclusions: Improper preparation and handling of injectable medications likely caused the outbreak.
Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.
NosoBase ID notice : 382652
Réduction durable des bactériémies associées aux voies centrales en dehors de l’unité de
réanimation grâce à une intervention multimodale centrée sur la maintenance des voies centrales
Dumyati G; Concannon C; van Wijngaarden E; Love TM; Graman P; Pettis AM; et al. Sustained reduction of
central line-associated bloodstream infections outside the intensive care unit with a multimodal intervention
focusing on central line maintenance. American journal of infection control 2014/07; 42(7): 723-730.
Mots-clés : PREVENTION; BACTERIEMIE; CATHETER; PERSONNEL; FORMATION; CATHETER
VEINEUX CENTRAL; SURVEILLANCE; INCIDENCE; INFIRMIER
Background: Central venous catheter use is common outside the intensive care units (ICUs), but prevention
in this setting is not well studied. We initiated surveillance for central line-associated bloodstream infections
(CLABSIs) outside the ICU setting and studied the impact of a multimodal intervention on the incidence of
CLABSIs across multiple hospitals.
Methods: This project was constructed as a prospective preintervention-postintervention design. The project
comprised 3 phases (preintervention [baseline], intervention, and postintervention) over a 4.5-year period
(2008-2012) and was implemented through a collaborative of 37 adult non-ICU wards at 6 hospitals in the
Rochester, NY area. The intervention focused on engagement of nursing staff and leadership, nursing
education on line care maintenance, competence evaluation, audits of line care, and regular feedback on
CLABSI rates. Quarterly rates were compared over time in relation to intervention implementation.
Results: The overall CLABSI rate for all participating units decreased from 2.6/1000 line-days preintervention
to 2.1/1,000 line-days during the intervention and to 1.3/1,000 line-days postintervention, a 50% reduction
(95% confidence interval, .40-.59) compared with the preintervention period (P .0179).
Conclusion: A multipronged approach blending both the adaptive and technical aspects of care including front
line engagement, education, execution of best practices, and evaluation of both process and outcome
measures may provide an effective strategy for reducing CLABSI rates outside the ICU.
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NosoBase ID notice : 382188
Identification et contrôle d’une épidémie de bactériémies à Pseudomonas spp (P. fulva et P. putida)
dans un centre hospitalier universitaire de Pékin, Chine
Liu Y; Liu K; Yu X; Li B; Cao B. Identification and control of a Pseudomonas spp (P. fulva and P. putida)
bloodstream infection outbreak in a teaching hospital in Beijing, China. International journal of infectious
diseases 2014/06; 23: 105-108.
Mots-clés :
PSEUDOMONAS;
CONTAMINATION
BACTERIEMIE;
EPIDEMIE;
EPIDEMIOLOGIE;
ENQUETE;
Objectives: An outbreak of bacteremia caused by Pseudomonas spp (P. fulva and P. putida) was first
identified in our hospital in the summer of 2010 and reoccurred in the following year. Based on the
epidemiological data collected in these 2 years, we initiated an investigation on the source of the outbreak.
The aim of this study was to report the results of the investigation, as well as the intervention strategies that
resulted in successful control of the outbreak.
Methods: An infection control team was set up consisting of infectious disease specialists, microbiologists,
infection control practitioners, and head nurses. The microbiology and medical records of case-patients with
P. fulva or P. putida bloodstream infections were reviewed. Environmental samples and intravenous (IV)
solutions from the wards and the pharmacy center were collected for culturing. The molecular characteristics
of the bacterial isolates were studied by pulsed-field gel electrophoresis (PFGE). Strict infection control
strategies were implemented.
Results: A total of 20 case-patients from five inpatient wards were identified during three summer seasons
from 2010 to 2012. Nineteen of them recovered with proper antibiotics. Unfortunately one died from
complications of heart failure. A total of 19 isolates of P. fulva and four of P. putida were identified, of which
20 were from blood, two from environmental surface samples from the hospital pharmacy, and one from an
in-use compounded solution from a case-patient in the cardiology ward. Molecular analysis revealed that the
P. fulva isolated from the in-use compounded solution (5% glucose solution containing insulin, isosorbide
dinitrate, and potassium magnesium aspartate) and the environmental samples had the same PFGE type as
the clinical isolates.
Conclusions: The investigation identified that contaminated IV solution was the source of the P. fulva
bacteremia, which prompted us to implement intensified control measures that resulted in successful control
of the outbreakthe spread of influenza, should be considered seriously when intervention strategies are
implemented.
NosoBase ID notice : 381999
Stratégies pour prévenir les bactériémies sur voies centrales dans les hôpitaux de court séjour : mise
à jour 2014
Marschall J; Mermel LA; Fakih MG; Hadaway L; Kallen AJ; O'Grady NP; et al. Strategies to prevent central
line-associated bloodstream infections in acute care hospitals: 2014 update. Infection control and hospital
epidemiology 2014/07; 35(7): 753-771.
Mots-clés : PREVENTION; CATHETER VEINEUX CENTRAL; BACTERIEMIE; COURT SEJOUR; SOIN
INTENSIF; SURVEILLANCE; TAUX; ANTISEPTIQUE
Previously published guidelines are available that provide comprehensive recommendations for detecting and
preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical
recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing
their central line–associated bloodstream infection (CLABSI) prevention efforts. This document updates
“Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in
2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America
(SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America
(IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and
Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number
of organizations and societies with content expertise. The list of endorsing and supporting organizations is
presented in the introduction to the 2014 updates.
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Candida
NosoBase ID notice : 382181
Tendances mondiales dans la distribution de Candida sp. responsables de candidémies
Guinea J. Global trends in the distribution of Candida species causing candidemia. Clinical microbiology and
infection 2014/06; 20(Suppl. 6): 5-10.
Mots-clés : CANDIDA; CANDIDEMIE; EPIDEMIOLOGIE; SURVEILLANCE; INCIDENCE; REVUE DE LA
LITTERATURE
Only five species account for 92% of cases of candidemia (Candida albicans, C. glabrata, C. tropicalis, C.
parapsilosis, and C. krusei); however, their distribution varies in population-based studies conducted in
different geographical areas. C. albicans is the most frequent species, but considerable differences are found
between the number of cases caused by C. glabrata and C. parapsilosis. Studies from Northern Europe and
the USA reported a high number of cases caused by C. glabrata, whereas studies from Spain and Brazil
demonstrated a lower number of cases caused by C. glabrata and a higher number of cases attributed to C.
parapsilosis. Globally, the frequency of C. albicans is decreasing, while that of C. glabrata and C. krusei is
stable, and C. parapsilosis and C. tropicalis are increasing. Patient characteristics and prior antifungal therapy
also have a considerable influence on the distribution and frequency of Candida spp. regardless of the
geographical area. C. albicans is more frequent in patients aged up to 18 years, the frequency of C.
parapsilosis decreases with age, and C. glabrata is more common in the elderly. Finally, the presence of
horizontal transmission of Candida spp. isolates (reported mainly in patients from the adult medical and postsurgical ICU, patients from oncology-haematology units, and neonates) can affect species distribution.
Cathétérisme
NosoBase ID notice : 381845
Infections des voies veineuses centrales en nutrition parentérale à domicile : étude rétrospective
monocentrique sur 2 ans.
Moreau E; Bresson V; Bosdure E; Sarles J; Coste ME. Infections des voies veineuses centrales en nutrition
parentérale à domicile : étude rétrospective monocentrique sur 2 ans. Archives de pédiatrie 2014/06; 21(6):
571-578.
Mots-clés : PEDIATRIE; CATHETER VEINEUX CENTRAL; ALIMENTATION PARENTERALE; ETUDE
RETROSPECTIVE; BACTERIEMIE; STAPHYLOCOCCUS; SOIN A DOMICILE
Introduction : L’infection de la voie veineuse centrale (VVC) est la principale complication de la nutrition
parentérale. L’objectif de notre travail était de connaître l’écologie de ces infections dans notre centre de
nutrition parentérale à domicile et d’évaluer notre protocole de prise en charge.
Patients et méthodes : Il s’est agi d’une étude monocentrique, rétrospective réalisée au centre hospitalier
universitaire (CHU) de Marseille entre le 1er janvier 2011 et le 31 mai 2012. Les enfants en nutrition
parentérale, exclusive ou non, admis pour fièvre en urgence et ayant des hémocultures positives ont été
inclus. Les caractéristiques de ces infections ont été analysées.
Résultats : En 17 mois, 29 enfants ont été suivis, 17 ont présenté une infection de leur VVC, 47 bactériémies
ont été recensées, soit 5,4 infections pour 1000 jours de VVC. Le nombre moyen d’hémocultures réalisées à
l’arrivée était de 2,8. Le germe le plus fréquemment identifié était le Staphylococcus hominis. Les traitements
avaient initialement associé une bi-antibiothérapie en hospitalisation et des verrous antibiotiques.
Discussion : Le taux d’infection durant la période étudiée était très élevé. Ce taux a été surévalué du fait des
conditions de prélèvement des hémocultures et d’analyse. Enfin, on note que certains enfants ont fait des
infections récidivantes sans qu’un facteur prédisposant ait pu être mis en évidence. Le traitement par biantibiothérapie était en accord avec les bonnes pratiques et l’écologie bactérienne.
Conclusion : Le nombre important d’infections constatées pendant la période étudiée nous a amené à une
évaluation prospective de nos pratiques.
NosoBase ID notice : 382659
Une intervention d’amélioration de la qualité réduit les épisodes d’infections associées aux voies
centrales dans un hôpital de long séjour en soins aigus
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Edwards M; Purpura J; Kochvar G. Quality improvement intervention reduces episodes of long-term acute
care hospital central line-associated infections. American journal of infection control 2014/07; 42(7): 735-738.
Mots-clés : QUALITE; CATHETER; SOIN DE LONGUE DUREE; PREVENTION; PREVALENCE; TOILETTE
DU PATIENT; PRATIQUE; CHLORHEXIDINE; BACTERIEMIE; ETUDE RETROSPECTIVE
Background: Reducing central line-associated bloodstream infections (CLABSIs) poses a set of unique
challenges in long-term acute care hospitals (LTACHS). Patients are often admitted to LTACHs with central
lines in place from the previous hospitalization; thus, LTACHs lack control over insertion techniques and
respective central line care and maintenance. This study aimed to demonstrate the impact of a methodical
bathing approach with 2% chlorhexidine gluconate (CHG) cloths and a correlation with a reduced prevalence
of CLABSIs in our LTACH population.
Methods: This retrospective observational quality initiative conducted in a 105-bed LTACH used plan-dostudy-act methodology to assess the effects of a revised bathing approach using 2% CHG.
Results: Statistical significance demonstrated a 65% reduction in CLABSI on the pilot unit after the 6-month
initial trial. The results of the quality initiative were evaluated through the end of 2012.
Conclusions: The decision was made to implement the revised bathing protocol throughout the entire LTACH
hospital stay.
NosoBase ID notice : 382489
Requêtes concernant des infections liées aux cathéters vasculaires auprès de la compagnie
d’assurances en santé : souvent évitables
Gagneux-Brunon A; Timsit JF; Lepape A; Berthelot P. Vascular catheter-related infection claims to health
insurance company: often preventable. Clinical microbiology and infection 2014; in press: 4 pages.
Mots-clés : ETUDE RETROSPECTIVE; CATHETER; PREVENTION; INCIDENCE; CATHETER VEINEUX
CENTRAL; CATHETER VEINEUX PERIPHERIQUE; STAPHYLOCOCCUS AUREUS; MORTALITE;
BACTERIEMIE
Using the main French health insurance company database over a 10-year period, the preventability of
catheter-related infections of patients who claimed compensation after prosecution was reviewed by a panel
expert. They occurred in 71 patients with few co-morbidities or risk factors for nosocomial infection and were
mainly related to the use of a peripheral vascular catheter (42 cases) and due to Staphylococcus aureus (51
cases). Forty-two infections were considered to be preventable. Infections due to peripheral venous catheters
were significantly more often preventable than those due to central ones (p<0.05). We conclude that catheterrelated infections perceived by patients and the justice system as not related to unforeseeable medical
complications are mainly peripheral catheter infections due to S. aureus and might be an appropriate target
for new preventive strategies.
Chirurgie
NosoBase ID notice : 382812
Surveillance des infections du site opératoire France, 2012. Résultats
CClin Ouest; CClin Arlin; Réseau d'alerte d'investigation et de surveillance des infections nosocomiales
(Raisin); Institut de veille sanitaire(InVS). Surveillance des infections du site opératoire France, 2012.
Résultats. InVS 2014/06: 1-87.
Mots-clés : SURVEILLANCE; CHIRURGIE; INDICATEUR; TABLEAU DE BORD; INCIDENCE
La réduction d’incidence des infections du site opératoire (ISO) est l’un des objectifs du programme national
de lutte contre les infections nosocomiales (IN). Les surveillances interrégionales des ISO sont coordonnées
par le réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin) depuis 2001.
Chaque année, les services de chirurgie volontaires recueillent des informations concernant le patient et son
intervention. Tous les patients inclus sont suivis jusqu'au 30e jour postopératoire. Les ISO (incision
superficielle ou profonde, organe/espace) sont définies selon les critères standard usuels.
En 2012, 1 006 services dans 407 établissements ont inclus 105 069 interventions chirurgicales sur 6 mois
dont plus des 2/3 concernaient la chirurgie viscérale (31,7 %), l’orthopédie (27,1 %), et la gynécologieobstétrique (24,0 %). Le taux d’incidence des ISO était compris entre 0,23 % pour la chirurgie vasculaire et
3,29 % pour la chirurgie urologique, soit un taux brut de 1,36 % (1 429 ISO, tous types d’interventions
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confondues) : plus des 2/3 des ISO concernaient des interventions en chirurgie viscérale (43,2 %) ou en
gynécologie-obstétrique (27,2 %). De 2008 à 2012, un ralentissement de la baisse de l’incidence des ISO est
confirmé ainsi qu’une augmentation en 2012 pour certains groupes d’interventions prioritaires, notamment
pour les prothèses totales de hanche (+35 %). En revanche, l’incidence a diminué pour les césariennes (-11
%). Le ralentissement de la baisse de l’incidence des ISO observée en 2012 suggère que l’on approche de
valeurs seuils, ce qui explique en partie le fait que les objectifs quantifiés nationaux ne soient pas atteints.
NosoBase ID notice : 382527
La prévention des infections du site opératoire
Institut national de santé publique Québec (INSPQ). La prévention des infections du site opératoire. Institut
national de santé publique Québec 2014/06: 1-25.
Mots-clés : PREVENTION; CHIRURGIE; DEPILATION; ANTIBIOPROPHYLAXIE; CHLORHEXIDINE;
GLYCEMIE; INCIDENCE; INDICATEUR
Les infections du site opératoire (ISO) constituent une source majeure de morbidité et de mortalité chez les
patients soumis à des procédures chirurgicales. Aux États-Unis, elles représentent de 14 à 16 % de toutes
les infections nosocomiales, soit la deuxième cause la plus fréquemment rapportée. On estime que de 2 à
6% des patients ayant subi une chirurgie développeront une infection. Celle-ci prolonge la durée
d’hospitalisation de 7 à 10 jours et multiplie de 2 à 11 fois les risques de mortalité chez les patients en
comparaison de ceux qui ne souffriront pas d'une telle infection.
Le présent document propose une stratégie de prévention pour contrer ces infections, car elles sont pour la
plupart évitables. Cette stratégie est constituée d'un ensemble de pratiques cliniques exemplaires (EPE) qui
minimise le développement de ces infections, d’outils pour s'assurer de la conformité à cet EPE (la
surveillance des processus) ainsi que de mesures de l'efficacité du EPE sur l'incidence des ISO.
Pour obtenir une diminution significative de ces ISO, tous les éléments de l'ensemble de pratiques cliniques
exemplaires doivent être mis en place et appliqués, mais les moyens retenus ainsi que le rythme
d'implantation sont laissés à la discrétion des établissements.
NosoBase ID notice : 381946
Les ISO en orthopédie dans l’interrégion ouest. Incidence des infections survenues plus de trente
jours après l’intervention
Perennec-Olivier M; Jarno P; Aupée M. Les ISO en orthopédie dans l’interrégion ouest. Incidence des
infections survenues plus de trente jours après l’intervention. Hygiènes 2014/05; 22(2): 99-104.
Mots-clés : INCIDENCE; ORTHOPEDIE; PROTHESE; HANCHE; PROTHESE TOTALE DE HANCHE;
PROTHESE TOTALE DE GENOU; GENOU; SURVEILLANCE
Objectifs : Décrire le délai diagnostique des infections du site opératoire (ISO) et le suivi des patients, en
orthopédie prothétique. Évaluer la sous-estimation de l’incidence due à l’exclusion des infections survenues
plus de 30 jours (J 30) après l’intervention.
Matériel et méthode : Les prothèses de hanche (totales, partielles, pour reprise) et de genou effectuées entre
2008 et 2011 par les services ayant participé à la surveillance des ISO de l’interrégion ouest ont été incluses.
Les incidences avant et après exclusion des infections survenues plus de 30 jours après l’intervention ont été
comparées et leurs évolutions analysées.
Résultats : Entre 2008 et 2011, 29 514 interventions ont été réalisées. En 2011, 94 services ont participé : 54
sans infection, 22 avec au moins une infection et toujours moins de 30 jours après l’intervention et 18 avec au
moins une infection plus de 30 jours après l’intervention. Parmi les infections, 68,3 % surviennent dans les 30
jours après l’intervention, 25,6 % entre J 30 et J 90, et 6,1 % au-delà de J 90. Les incidences avant et après
exclusion à J 30 étaient de 0,96 % et 0,65 % (p < 0,05) tandis que l’incidence après exclusion à J 90 était de
0,90 %. Entre 2008 et 2011, la baisse du taux d’infection était significative après exclusion et non significative
avant.
Conclusion : Près d’un tiers des infections était non inclus dans le calcul de l’incidence. Suite à ces résultats,
le comité de pilotage ISO prévoit pour 2014 d’étendre la durée d’inclusion des ISO en chirurgie prothétique
orthopédique à 90 jours, comme le recommandent la Société française d’hygiène hospitalière et l’European
Centre for Disease Prevention and Control.
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NosoBase ID notice : 380972
Infections complexes à Klebsiella pneumoniae productrices de carbapénèmase sur prothèses
articulaires : un défi unique à l’époque des infections incurables
de Sanctis J; Teixeira L; van Duin D; Odio C; Hall G; Tomford JW; et al. Complex prosthetic joint infections
due to carbapenemase-producing Klebsiella pneumoniae: a unique challenge in the era of untreatable
infections. International journal of infectious diseases 2014; in press: e1-e6.
Mots-clés : KLEBSIELLA PNEUMONIAE; CHIRURGIE ORTHOPEDIQUE; MATERIEL ETRANGER;
CARBAPENEME; ANTIBIORESISTANCE; MULTIRESISTANCE; BACILLE GRAM NEGATIF; ETUDE
RETROSPECTIVE; PCR; TRAITEMENT; PROTHESE TOTALE DE GENOU
Objectives: Limited clinical experience exists regarding the management of prosthetic joint infection (PJI) due
to multidrug-resistant (MDR) Gram-negative organisms. We review three cases of carbapenem-resistant
Klebsiella pneumoniae (CRKP) complicating PJI.
Methods: This was a retrospective study of all patients at a tertiary care institution with CRKP complicating
PJI between January 2007 and December 2010. Demographic data, procedures, organisms involved, length
of stay, antibiotic treatments, and outcomes were collected. Antimicrobial susceptibility testing was performed
on CRKP isolates, and the mechanism of resistance was ascertained by PCR.
Results: This analysis demonstrated that: (1) the CRKP possessed blaKPC and were difficult to eradicate
(persistent) in PJI; (2) multiple surgeries and antibiotic courses were undertaken and patients required a
prolonged length of stay; (3) resistance to colistin and amikacin emerged on therapy; (4) the same strain of
CRKP may be responsible for relapse of infection; (5) significant morbidity and mortality resulted.
Conclusions: These cases highlight the opportunistic and chronic nature of CRKP in PJIs and the need for
aggressive medical and surgical treatment. Further investigations of the management of CRKP PJI and new
drug therapies for infections due to MDR Gram-negative organisms are urgently needed.
NosoBase ID notice : 380936
Contamination bactérienne des tenues de bloc opératoire portées en dehors du bloc opératoire.
Etude transversale randomisée
Hee HI; Lee S; Chia SN; Lu QS; Liew AP; Ng A. Bacterial contamination of surgical scrub suits worn outside
the operating theatre: a randomised crossover study. Anaesthesia 2014; in press: 10 pages.
Mots-clés : CONTAMINATION; TENUE VESTIMENTAIRE;
RANDOMISATION; MEDECIN; ANESTHESIE; PERSONNEL
CHIRURGIE;
BLOC
OPERATOIRE;
In this study, we aimed to evaluate the bacterial contamination of surgical scrub suits worn outside the
operating theatre. We randomised 16 anaesthetists on separate occasions into one of 3 groups: restricted to
the operating theatre only; theatre and surgical wards; and theatre and departmental office. For each group,
sample fabric pieces attached to the chest, waist and hip areas of each suit were removed at 150 min
intervals between 08:30 and 16:00 on the day of study, and sent for microbiological assessment. Mean
bacterial counts increased significantly over the course of the working day (p=0.036), and were lower in the
chest compared to the hip (p=0.007) and waist areas (p=0.016). The mean (SD) bacterial counts, expressed
as colony-forming units per cm2 at 16:00 on the day of study, were 25.2 (43.5) for those restricted to theatre
and 18.5 (25.9) and 17.9 (31.0) for those allowed out to visit the ward and office, respectively (p=0.370). We
conclude that visits to ward and office did not significantly increase bacterial contamination of scrub suits.
NosoBase ID notice : 382013
Prévenir les infections du site opératoire : essai ouvert, randomisé d'une pommade nasale à la
mupirocine versus une solution nasale à la povidone iodée
Phillips M; Rosenberg A; Shopsin B; Cuff G; Skeete F; Foti A; et al. Preventing surgical site infections: a
randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution. Infection control
and hospital epidemiology 2014/07; 35(7): 826-832.
Mots-clés : STAPHYLOCOCCUS AUREUS; MUPIROCINE; CHLORHEXIDINE; POLYVIDONE IODEE;
COLONISATION NASALE; NEZ; CHIRURGIE ORTHOPEDIQUE; PREVENTION
Background: Treatment of Staphylococcus aureus colonization before surgery reduces risk of surgical site
infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but
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cost and patient compliance may be a barrier. Nasal povidone-iodine solution may provide an alternative to
mupirocin.
Methods: We conducted an investigator-initiated, open-label, randomized trial comparing SSI after
arthroplasty or spine fusion in patients receiving topical chlorhexidine wipes in combination with either twice
daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidoneiodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI
within the 3 months after surgery.
Results: In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in
the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P=.1); S. aureus deep
SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidoneiodine group (P=.2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical
procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P=.03).
Conclusions: Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted
approach to reduce SSI.
NosoBase ID notice : 382640
Observation en vidéo pour cartographier les contacts des mains et la transmission bactérienne dans
des blocs opératoires
Rowlands J; Yeager MP; Beach M; Patel HM; Huysman BC; Loftus RW. Video observation to map hand
contact and bacterial transmission in operating rooms. American journal of infection control 2014/07; 42(7):
698-701.
Mots-clés : TRANSMISSION; CONTAMINATION; HYGIENE DES MAINS; OBSERVANCE; SURFACE;
EQUIPEMENT; ANESTHESIE; BLOC OPERATOIRE
Background: Hand hygiene (HH) is considered a primary intervention to avoid transmission of bacteria in
health care settings and to prevent health care-associated infections. Despite efforts to decrease the
incidence of health care-associated infections by improving HH, HH compliance rates vary widely depending
on the hospital environment.
Methods: We used intraoperative video observation to map temporal patterns of anesthesia provider hand
contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. Serial bacterial
cultures of high contact objects were subsequently used to characterize bacterial transmission over time.
Results: Using World Health Organization criteria, we found a large number of HH opportunities and a low
rate of HH compliance by anesthesia providers (mean, 2.9%). We observed an inverse correlation between
provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%,
respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively) at these
time points. We found no correlation between frequency of hand contact with the AWE and bacterial
contamination.
Conclusions: Compliance with current HH recommendations by anesthesia providers is not feasible.
However, there does appear to be a correlation between HH compliance rates and bacterial contamination of
the AWE, an observation that should stimulate further work to design new methods for control of bacterial
transmission in operating rooms.
NosoBase ID notice : 382090
Efficacité d’un laveur-désinfecteur pour éliminer les pathogènes associés aux soins des instruments
chirurgicaux
Rutala WA; Gergen MF; Weber DJ. Efficacy of a washer-disinfector in eliminating healthcare-associated
pathogens from surgical instruments. Infection control and hospital epidemiology 2014/07; 35(7): 883-885.
Mots-clés : LAVEUR-DESINFECTEUR; INSTRUMENT; DECONTAMINATION; EFFICACITE
This study was designed to test the efficacy of a washer-disinfector in eliminating selected healthcareassociated pathogens from surgical instruments. Our results showed that a washer-disinfector was extremely
effective in eliminating microorganisms (>7-log10 reduction), including vegetative and spore-forming bacteria,
from experimentally contaminated instruments. The washer-disinfector remained effective in eliminating
microorganisms in the absence of enzymatic cleaners and detergents.
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NosoBase ID notice : 381299
Améliorer la prédiction du risque d’infection du site opératoire à l’aide d’une modélisation
multiniveaux
Saunders L; Perennec-Olivier M; Jarno P; L'Hériteau F; Venier AG; Simon L; et al. Improving prediction of
surgical site infection risk with multilevel modeling. PLoS One 2014/05; 9(5): 1-8.
Mots-clés : RISQUE; SURVEILLANCE; PREVENTION; STATISTIQUE; RESEAU; RANDOMISATION;
RAISIN
Background: Surgical site infection (SSI) surveillance is a key factor in the elaboration of strategies to reduce
SSI occurrence and in providing surgeons with appropriate data feedback (risk indicators, clinical prediction
rule).
Aim: To improve the predictive performance of an individual-based SSI risk model by considering a multilevel
hierarchical structure.
Patients and methods: Data were collected anonymously by the French SSI active surveillance system in
2011. An SSI diagnosis was made by the surgical teams and infection control practitioners following
standardized criteria. A random 20% sample comprising 151 hospitals, 502 wards and 62280 patients was
used. Three-level (patient, ward, hospital) hierarchical logistic regression models were initially performed.
Parameters were estimated using the simulation-based Markov Chain Monte Carlo procedure.
Results: A total of 623 SSI were diagnosed (1%). The hospital level was discarded from the analysis as it did
not contribute to variability of SSI occurrence (p=0.32). Established individual risk factors (patient history,
surgical procedure and hospitalization characteristics) were identified. A significant heterogeneity in SSI
occurrence between wards was found (median odds ratio [MOR] 3.59, 95% credibility interval [CI] 3.03 to
4.33) after adjusting for patient-level variables. The effects of the follow-up duration varied between wards
(p<10-9), with an increased heterogeneity when follow-up was <15 days (MOR 6.92, 95% CI 5.31 to 9.07]).
The final two-level model significantly improved the discriminative accuracy compared to the single level
reference model (p<10-9), with an area under the ROC curve of 0.84.
Conclusion: This study sheds new light on the respective contribution of patient-, ward- and hospital-levels to
SSI occurrence and demonstrates the significant impact of the ward level over and above risk factors present
at patient level (i.e., independently from patient case-mix).
NosoBase ID notice : 382200
Evaluation rétrospective de l’antibioprophylaxie dans la prévention des infections du site opératoire
dans la population pédiatrique
Shah GS; Christensen RE; Wagner DS; Pearce BK; Sweeney J; Tait AR. Retrospective evaluation of
antimicrobial prophylaxis in prevention of surgical site infection in the pediatric population. Pediatric
anesthesia 2014; in press: 1-5.
Mots-clés :
PEDIATRIE;
EFFICACITE; CHIRURGIE
ANTIBIOPROPHYLAXIE;
ETUDE
RETROSPECTIVE;
PREVENTION;
Background and objectives: Few studies have been conducted in pediatric patients evaluating efficacy of
prophylactic antibiotics for prevention of surgical site infection (SSI). This retrospective study was undertaken
to determine the effect of antibiotic prophylaxis in the prevention of SSI in children.
Methods: With IRB approval, our perioperative electronic clinical information database was queried. Pediatric
patients (≤18 years) undergoing general surgery, cardiac surgery, and spinal surgery at Mott Children's
Hospital from January 2000 to April 2010 were included. Demographics and preoperative data were obtained
from the Centricity Intraoperative Database, and any episodes of SSI were obtained by review of the infection
control records.
Results: A total 5023 pediatric patients underwent surgery from January 2000 to April 2010. The average age
of the children in the sample was 4.16±5.5 years, and of these, 57% were boys. Overall, 119 (2.37%) cases
of SSI were identified. There were no associations between the various patient factors and the development
of SSIs. Children for whom antibiotics were administered incorrectly had a 1.7-fold increased risk of SSIs
compared with children who received antibiotics within the recommended guidelines (P<0.02). Children who
received antibiotics were more likely to suffer an SSI compared with those who did not.
Conclusions: Proper administration of preoperative antibiotics in pediatric patients is one of the few modifiable
and significant factors in prevention of SSI.
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Clostridium difficile
NosoBase ID notice : 382211
Impact des programmes de gestion des antibiotiques sur l’incidence de Clostridium difficile : revue
systématique et méta-analyse
Feazel LM; Malhotra A; Perencevich EN; Kaboli P; Diekema DJ; Schweizer ML. Effect of antibiotic
stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. Journal of
antimicrobial chemotherapy 2014/07; 69(7): 1748-1754.
Mots-clés : INCIDENCE; CLOSTRIDIUM DIFFICILE; ANTIBIOTIQUE; META-ANALYSE; PREVENTION
Objectives: Despite vigorous infection control measures, Clostridium difficile continues to cause significant
disease burden. Antibiotic stewardship programmes (ASPs) may prevent C. difficile infections by limiting
exposure to certain antibiotics. Our objective was to perform a meta-analysis of published studies to assess
the effect of ASPs on the risk of C. difficile infection in hospitalized adult patients.
Methods: Searches of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature
and two Cochrane databases were conducted to find all published studies on interventions related to
antibiotic stewardship and C. difficile. Two investigators independently assessed study eligibility and extracted
data. Risk of bias was assessed using the Downs and Black tool. Risk ratios were pooled using random
effects models. Heterogeneity was evaluated using the I2 statistic.
Results: The final search yielded 891 articles; 78 full articles were reviewed and 16 articles were identified for
inclusion. Included articles used quasi-experimental (interrupted time series or before-after) or observational
(case-control) study designs. When the results of all studies were pooled in a random effects model, a
significant protective effect (pooled risk ratio 0.48; 95% CI: 0.38, 0.62) was observed between ASPs and C.
difficile incidence. When stratified by intervention type, a significant effect was found for restrictive ASPs
(complete removal of drug or prior approval requirement). Furthermore, ASPs were particularly effective in
geriatric settings.
Conclusions: Restrictive ASPs can be used to reduce the risk of C. difficile infection.
NosoBase ID notice : 380969
Diagnostic des infections à Clostridium difficile dans une population pédiatrique : comparaison de
méthodologies
Hart J; Putsathit P; Knight DR; Sammels L; Riley TV; Keil A. Clostridium difficile infection diagnosis in a
paediatric population: comparison of methodologies. European journal of clinical microbiology and infectious
diseases 2014; in press: 10 pages.
Mots-clés : CLOSTRIDIUM DIFFICILE; PEDIATRIE; DIAGNOSTIC; SELLE; PCR; TYPAGE
The increasing incidence of Clostridium difficile infection (CDI) in paediatric hospitalised populations,
combined with the emergence of hypervirulent strains, community-acquired CDI and the need for prompt
treatment and infection control, makes the rapid, accurate diagnosis of CDI crucial. We validated commonly
used C. difficile diagnostic tests in a paediatric hospital population. From October 2011 to January 2012, 150
consecutive stools were collected from 75 patients at a tertiary paediatric hospital in Perth, Western Australia.
Stools were tested using: C. Diff Quik Chek Complete, Illumigene C. difficile, GeneOhm Cdiff, cycloserine
cefoxitin fructose agar (CCFA) culture, and cell culture cytotoxin neutralisation assay (CCNA). The reference
standard was growth on CCFA or Cdiff Chromagar and PCR on isolates to detect tcdA, tcdB, cdtA, and cdtB.
Isolates were PCR ribotyped. The prevalence of CDI was high (43 % of patients). Quik Chek Complete
glutamate dehydrogenase (GDH) demonstrated a low negative predictive value (NPV) (93 %). Both CCNA
and Quik Chek Complete toxin A/B had poor sensitivity (33 % and 29 % respectively). Molecular methods
both had 89 % sensitivity. Algorithms using GDH + Illumigene or GeneOhm reduced the sensitivity to 85 %
and 83 % respectively. Ribotype UK014/20 predominated. GDH NPV and GeneOhm and Illumigene
sensitivities were reduced compared with adult studies. Quik Chek Complete and CCNA cannot reliably
detect toxigenic CDI. A GDH first algorithm showed reduced sensitivity. In a high prevalence paediatric
population, molecular methods alone are recommended over the use of GDH algorithm or culture and CCNA,
as they demonstrate the best test performance characteristics.
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NosoBase ID notice : 382841
Coût-efficacité des stratégies concurrentes pour contrôler l'infection récurrente à Clostridium difficile
: une analyse décisionnelle
Konijeti GG; Sauk J; Shrime MG; Gupta M; Ananthakrishnan AN. Cost-effectiveness of competing strategies
for management of recurrent Clostridium difficile infection: a decision analysis. Clinical infectious diseases
2014/06/01; 58(11): 1507-1514.
Mots-clés : CLOSTRIDIUM DIFFICILE; TRANSPLANTATION; SELLE; INFECTION RECURRENTE;
TRAITEMENT; COUT-EFFICACITE; VANCOMYCINE; METRONIDAZOLE; ANALYSE DECISIONNELLE
Background: Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and
is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent
CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to
analyze the cost effectiveness of competing strategies for recurrent CDI.
Methods: We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment
of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and
fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence.
We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on
different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year.
Results: At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most
cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin.
Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT
colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates
<14.9%. Fidaxomicin required a cost <$1359 to meet our cost-effectiveness threshold. In clinical settings
where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral
vancomycin.
Conclusions: In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that
FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI.
NosoBase ID notice : 382107
Prédiction des infections à Clostridium difficile compliquées chez les enfants
Tschudin-Sutter S; Tamma PD; Milstone AM; Perl TM. The prediction of complicated Clostridium difficile
infections in children. Infection control and hospital epidemiology 2014/07; 35(7): 901-903.
Mots-clés : CLOSTRIDIUM DIFFICILE; PEDIATRIE; INFECTION; COMPLICATION; DEFINITION; ETUDE
RETROSPECTIVE
We validated proposed definitions for severe Clostridium difficile infection (CDI) in adults for prediction of
complicated CDI in children. Complicated CDI occurred in 9 of 202 cases. Definitions for severe CDI in adults
showed poor measures for discrimination of complicated CDI in children, which calls into question the
usefulness of such definitions in pediatric cohorts.
NosoBase ID notice : 382701
Clostridium difficile dans un centre hospitalier pédiatrique : étude de la contamination
environnementale
Warrack S; Duster M; Van Hoof S; Schmitz M; Safdar N. Clostridium difficile in a children's hospital:
assessment of environmental contamination. American journal of infection control 2014/07; 42(7): 802-804.
Mots-clés :
CLOSTRIDIUM
DIFFICILE;
PEDIATRIE;
CONTAMINATION;
HEMATOLOGIE; CANCEROLOGIE; PFGE; BIOLOGIE MOLECULAIRE; TYPAGE
ENVIRONNEMENT;
Clostridium difficile infection (CDI) is the most frequent infectious cause of health care-associated diarrhea.
Three cases of CDI, in children age 2, 3, and 14 years, occurred in the hematology/oncology ward of our
children's hospital over 48 hours. We aimed to assess environmental contamination with C difficile in the
shared areas of this unit, and to determine whether person-to-person transmission occurred. C difficile was
recovered from 5 of 18 samples (28%). We compared C difficile isolated from each patient and the
environment using pulsed-field gel electrophoresis, and found that none of the patient strains matched any of
the others, and that none matched any strains recovered from the environment, suggesting that person-to17 / 38
NosoVeille – Bulletin de veille
Juillet 2014
person transmission had not occurred. We found that C difficile was prevalent in the environment throughout
shared areas of the children's hospital unit. Molecular typing to identify mechanisms of transmission is useful
for devising appropriate interventions.
NosoBase ID notice : 382503
Transplantation de microbiote fécal pour des infections à Clostridium difficile en utilisant un
inoculum congelé de donneurs non apparentés : étude pilote randomisée contrôlée ouverte
Youngster I; Sauk J; Pindar C; Wilson R; Kaplan JL; Smith MB; et al. Fecal microbiota transplant for relapsing
Clostridium difficile infection using a frozen inoculum from unrelated donors: a randomized, open-label,
controlled pilot study. Clinical infectious diseases 2014/06; 58(11): 1515-1522.
Mots-clés : CLOSTRIDIUM DIFFICILE; TRANSPLANTATION; SELLE; INFECTION RECURRENTE;
RANDOMISATION
Background: Recurrent Clostridium difficile infection (CDI) with poor response to standard antimicrobial
therapy is a growing medical concern. We aimed to investigate the outcomes of fecal microbiota transplant
(FMT) for relapsing CDI using a frozen suspension from unrelated donors, comparing colonoscopic and
nasogastric tube (NGT) administration.
Methods: Healthy volunteer donors were screened and a frozen fecal suspension was generated. Patients
with relapsing/refractory CDI were randomized to receive an infusion of donor stools by colonoscopy or NGT.
The primary endpoint was clinical resolution of diarrhea without relapse after 8 weeks. The secondary
endpoint was self-reported health score using standardized questionnaires.
Results: A total of 20 patients were enrolled, 10 in each treatment arm. Patients had a median of 4 (range, 216) relapses prior to study enrollment, with 5 (range, 3-15) antibiotic treatment failures. Resolution of diarrhea
was achieved in 14 patients (70%) after a single FMT (8 of 10 in the colonoscopy group and 6 of 10 in the
NGT group). Five patients were retreated, with 4 obtaining cure, resulting in an overall cure rate of 90%. Daily
number of bowel movements changed from a median of 7 (interquartile range [IQR], 5-10) the day prior to
FMT to 2 (IQR, 1-2) after the infusion. Self-ranked health score improved significantly, from a median of 4
(IQR, 2-6) before transplant to 8 (IQR, 5-9) after transplant. No serious or unexpected adverse events
occurred.
Conclusions: In our initial feasibility study, FMT using a frozen inoculum from unrelated donors is effective in
treating relapsing CDI. NGT administration appears to be as effective as colonoscopic administration.
Coronavirus
NosoBase ID notice : 382453
Infections à Coronavirus responsable du syndrome respiratoire du Moyen-Orient (MERS-CoV) chez
deux voyageurs de retour aux Pays-Bas, mai 2014
Kraaij-Dirkzwager M; Timen A; Dirksen K; Gelinck L; Leyten E; Groeneveld P; et al. Middle East respiratory
syndrome coronavirus (MERS-CoV) infections in two returning travellers in the Netherlands, May 2014.
Eurosurveillance 2014/05; 19(21): 1-6.
Mots-clés : INFECTION NOSOCOMIALE; VOYAGE; CORONAVIRUS; INVESTIGATION; INFECTION
COMMUNAUTAIRE; LABORATOIRE; PCR; SUJET CONTACT; DEFINITION; DIAGNOSTIC
Two patients, returning to the Netherlands from pilgrimage in Medina and Mecca, Kingdom of Saudi Arabia,
were diagnosed with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in May 2014. The
source and mode of transmission have not yet been determined. Hospital-acquired infection and communityacquired infection are both possible.
Coût
NosoBase ID notice : 381457
Financement de la recherche sur les infections associées aux soins : analyse systématique des
investissements pour la recherche au Royaume-Uni, 1997-2010
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Head MG; Fitchett JR; Holmes AH; Atun R. Funding healthcare-associated infection research: a systematic
analysis of UK research investments, 1997-2010. The journal of hospital infection 2014/06; 87(2): 84-91.
Mots-clés :
COUT;
ANALYSE;
STAPHYLOCOCCUS
AUREUS;
CLOSTRIDIUM DIFFICILE; PNEUMONIE; ANTIBIORESISTANCE
METICILLINO-RESISTANCE;
Background: Healthcare-associated infections (HCAIs) are a cause of high health and economic burden in
the UK. The number of HCAI research studies funded in the UK, and the associated amount of investment,
has not previously been analysed.
Aim: To assess the level of research funding awarded to UK institutions for HCAI research and the
relationship of funded research to clinical and public health burden of HCAIs.
Methods: Databases and websites were systematically searched for information on how infectious disease
research studies were funded for the period 1997-2010. Studies specifically related to HCAI research were
identified and categorized in terms of funding by pathogen, disease, and by a research and development
value chain describing the type of science.
Findings: The overall dataset included 6165 studies (total investment £2.6 billion) of which £57.7 million was
clearly directed towards HCAI research across 297 studies (2.2% of total spend, 2.1% of total studies). Of the
HCAI-related projects, 45 studies had a specific focus on MRSA (£10.3 million), 14 towards Clostridium
difficile (£10.7 million), two towards pneumonia (£0.3 million) and 103 studies related to surgical infections
(£14.1 million). Mean and median study funding was £194,129 (standard deviation: £429,723) and £52,684
(interquartile range: £9,168 to £201,658) respectively. Award size ranged from £108 to £50.0 million.
Conclusions: Research investment for HCAIs has gradually increased in the study period, but remains low
due to the health, economic, and social burden of HCAI. Research for hospital-acquired pneumonia,
behavioural interventions, economic analyses, and research on emerging pathogens exhibiting antimicrobial
resistance remain underfunded.
Désinfection
NosoBase ID notice : 381455
Désinfection des iPad : évaluation de méthodes efficaces
Howell V; Thoppil A; Mariyaselvam M; Jones R; Young H; Sharma S; et al. Disinfecting the iPad: evaluating
effective methods. The journal of hospital infection 2014/06; 87(2): 77-83.
Mots-clés : EFFICACITE; DESINFECTION; SURFACE; CONTAMINATION; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; ENTEROCOCCUS; ANTIBIORESISTANCE; VANCOMYCINE;
ALCOOL; CHLORHEXIDINE; CLOSTRIDIUM DIFFICILE
Background: Tablet computers are increasingly used in healthcare, but they may carry nosocomial
pathogens. There are few data available on how to clean an iPad effectively for use in the clinical setting.
Aim: We aimed to identify the most effective method of decontaminating the Apple iPad, without causing
damage, and establish the duration of any residual effect.
Methods: Following contamination with a microbial broth (meticillin-resistant Staphylococcus aureus (MRSA),
vancomycin-resistant enterococcus (VRE) and Clostridium difficile), we examined efficacy of iPad disinfection
in the laboratory using six different disinfectant wipes: Sani-Cloth CHG 2% (chlorhexidine 2%/alcohol 70%),
Clorox, Tristel, Trigene, soap and water, and plain cloth. Following cleaning, iPads were recontaminated to
examine residual activity. After 480 Sani-Cloth CHG 2% disinfecting episodes, functional and visual analysis
of iPads was performed by blinded subjects.
Findings: With the exception of Clostridium difficile, Sani-Cloth CHG 2% and Clorox wipes were most
effective against MRSA and VRE, and they were significantly better than the Apple-recommended plain cloth
(P≤0.001). A substantial residual antimicrobial effect was seen for >6h after wiping the iPad with Sani-Cloth
CHG 2% despite repeated recontamination and without further disinfection. The functionality or visual
appearance of the iPad was not damaged by repeated use of Sani-Cloth CHG 2% wipes.
Conclusions: Sani-Cloth CHG 2% wipes effectively disinfect the iPad against MRSA and VRE, with a residual
antibacterial effect and without causing damage.
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EHPAD
NosoBase ID notice : 381945
Gestion des risques infectieux en établissement d’hébergement pour personnes âgées dépendantes :
un tableau de bord expérimenté dans la région Drôme-Ardèche
Armand N; Roche M; Michel C; Hajjar J. Gestion des risques infectieux en établissement d’hébergement pour
personnes âgées dépendantes : un tableau de bord expérimenté dans la région Drôme-Ardèche. Hygiènes
2014/05; 22(2): 93-98.
Mots-clés : PERSONNE AGEE; EHPAD; EVALUATION; TABLEAU DE BORD; ICALIN; ICSHA; VACCIN;
GRIPPE; ACCIDENT D'EXPOSITION AU SANG; PREVENTION; INDICATEUR
La mise en place du programme expérimental de prévention des infections en établissement d’hébergement
pour personnes âgées dépendantes (Ehpad) s’est accompagnée d’une réflexion sur l’évaluation des actions
entreprises et des résultats obtenus entre 2008 et 2011. Des indicateurs de résultats ont été réfléchis et
présentés sous forme de tableaux de bord. Les objectifs étaient d’évaluer : l’organisation de la prévention du
risque infectieux, les moyens alloués par les Ehpad en termes de moyens humains ou matériels et les actions
réalisées. Dans un second temps, ils permettent de mesurer des interventions de l’équipe mobile d’hygiène.
Les indicateurs proposés sont Icalin (Indice composite des activités de lutte contre les infections
nosocomiales)-Ehpad, Icsha (Indicateur de consommation de solutions hydroalcooliques)-Ehpad et
vaccination grippe (résident et professionnels) pneumocoque (résidents). Cette démarche complète la
démarche d’évaluation interne qui pose un diagnostic généraliste de la qualité des prestations et prises en
charges des résidents. L’objet de ce travail est de présenter la conception du tableau de bord Ehpad, les
résultats obtenus de 2008 à 2011 et d’évaluer sa faisabilité en termes de réponses et d’exigences de l’équipe
mobile d’hygiène.
NosoBase ID notice : 382578
Gâle se manifestant comme un pemphigus bulleux chez un résident en EHPAD
Mir F; Cruz-Oliver DM. Scabies manifesting as Bullous pemphigus in a nursing home resident. Journal of the
american geriatrics society 2014/06; 62(6): 1201-1203.
Mots-clés : DERMATOLOGIE; GALE; EHPAD; PERSONNE AGEE
Entérobactérie
NosoBase ID notice : 382698
Apparition d’entérobactéries productrices de bêta-lactamases à spectre étendu parmi des chiens et
des chats de compagnie : une menace de santé publique émergente en dehors des établissements de
santé
Abdel-Moein KA; Samir A. Occurrence of extended spectrum β-lactamase-producing Enterobacteriaceae
among pet dogs and cats: an emerging public health threat outside health care facilities. American journal of
infection control 2014/07; 42(7): 796-798.
Mots-clés : ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; ANIMAL; EPIDEMIOLOGIE;
DEPISTAGE; GENOTYPE; TYPAGE; KLEBSIELLA PNEUMONIAE; PROTEUS MIRABILIS; ESCHERICHIA
COLI
We aimed to investigate the potential role of pet dogs and cats in the epidemiology of extended spectrum βlactamase-producing Enterobacteriaceae. Twenty bacterial isolates were recovered from rectal swabs
obtained from 110 dogs and cats. The occurrence of extended spectrum β-lactamase-producing
Enterobacteriaceae in pets spotlights the emergence of a significant public health threat.
NosoBase n° 39999 ID notice : 382233
La mère, facteur de risque le plus important de colonisation des nouveau-nés de très petit poids de
naissance par des entérobactéries productrices de β-lactamase à spectre étendu (E-BLSE)
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Juillet 2014
Denkel LA; Schwab F; Kola A; Leistner R; Garten L; von Weizsäcker K; et al. The mother as most important
risk factor for colonization of very low birth weight (VLBW) infants with extended-spectrum β-lactamaseproducing Enterobacteriaceae (ESBL-E). Journal of antimicrobial chemotherapy 2014; in press: 8 pages.
Mots-clés : NOUVEAU-NE; COLONISATION; PREMATURE; FACTEUR DE RISQUE; ACCOUCHEMENT;
BETA-LACTAMASE A SPECTRE ELARGI; ENTEROBACTERIE; PREVALENCE; DEPISTAGE; RESEAU;
SURVEILLANCE; TRANSMISSION MATERNO-FŒTALE
Objectives: This study aimed to determine the prevalence of and risk factors for colonization with extendedspectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and methicillin-resistant Staphylococcus
aureus (MRSA) in very low birth weight (VLBW; <1500 g) infants and their mothers.
Methods: This investigation was conducted in the perinatal centre at the Charité Berlin between May 2012
and June 2013. VLBW infants and their mothers were screened for colonization with ESBL-E and MRSA.
Demographic and clinical data were obtained from the German nationwide surveillance system for
nosocomial infections in VLBW infants (NEO-KISS) and used to perform univariate and multivariate analyses.
Results: Of 209 VLBW infants, 12 (5.7%) were colonized with ESBL-E. Eighteen of 209 (8.6%) ESBL-Etested neonates were related to an ESBL-E-positive mother. Univariate analysis, strain typing and
multivariate analysis (OR 7.4, 95% CI 2.1-26.7, P = 0.002) identified an ESBL-E-positive mother and maternalneonatal transmission as a main source of colonization. The prevalence of MRSA was 2.3% (5 of 221) among
VLBW infants. One of the 221 (0.5%) MRSA-tested neonates was related to an MRSA-positive mother. No
risk factors for transmission of MRSA could be detected in this study.
Conclusions: Our study demonstrated that maternal-neonatal transmission of ESBL-E from mother to child is
an important risk factor for colonization of VLBW infants. As a consequence, routine ESBL-E screening of
neonates and mothers should be considered as a means of reducing neonatal morbidity and mortality.
Entérocoque
NosoBase ID notice : 382210
Augmentation spectaculaire des entérocoques résistant à la vancomycine en Allemagne
Gastmeier P; Schröder C; Behnke M; Meyer E; Geffers C. Dramatic increase in vancomycin-resistant
enterococci in Germany. Journal of antimicrobial chemotherapy 2014/06; 69(6): 1660-1664.
Mots-clés : VANCOMYCINE; ENTEROCOCCUS; ANTIBIORESISTANCE; RESEAU; SURVEILLANCE;
BACTERIEMIE; INFECTION URINAIRE; SOIN INTENSIF; INCIDENCE; TAUX
Objectives: Among European countries, Germany has one of the highest proportions of vancomycin-resistant
Enterococcus faecium bloodstream infections. The aim of this study was to investigate the development of
vancomycin-resistant enterococci (VRE) in German hospitals and to consider the regional distribution of VRE
in Germany.
Methods: Data from three components of the German national nosocomial surveillance system (KISS) from
the period 2007-12 were used for analysis: ICU-KISS data on nosocomial primary bloodstream infections and
urinary tract infections from intensive care units (ICUs); OP-KISS data on surgical site infections from surgical
departments; and Pathogen-KISS data concentrating on VRE cases (infections and colonizations) in ICUs.
Trends over time were calculated and a map according to German federal states was prepared.
Results: Data from up to 645 ICUs and 681 surgical departments for 2 year periods from 2007 to 2012 were
analysed. The proportion of VRE increased significantly for surgical site infections (526%; P < 0.01) and
bloodstream infections (265%; P < 0.01) and non-significantly for urinary tract infections (278%; P = 0.07). A
large subgroup of ICUs also reported VRE cases in the same period, with a significant increase of 282%. The
mapping of federal states showed large variation in VRE proportions and incidence rates in a belt of states
with significantly higher VRE proportions from west (North Rhine-Westphalia) to east (Saxony).
Conclusions: The high overall VRE proportion in Germany is mainly due to the situation in four states. There
is an urgent need to analyse the epidemiology of VRE in detail to develop appropriate infection control
strategies.
NosoBase ID notice : 382012
Evaluation de la morbidité associée aux entérocoques résistants à la vancomycine (ERV) après un
assouplissement des mesures de dépistage et des précautions d’isolement pour ERV dans un centre
hospitalier universitaire
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Popiel KY; Miller MA. Evaluation of vancomycin-resistant enterococci (VRE)-associated morbidity following
relaxation of VRE screening and isolation precautions in a tertiary care hospital. Infection control and hospital
epidemiology 2014/07; 35(7): 818-825.
Mots-clés : VANCOMYCINE; ENTEROCOCCUS; ANTIBIORESISTANCE; INCIDENCE; MORBIDITE;
DEPISTAGE; PCR; COLONISATION; PRECAUTION COMPLEMENTAIRE; ETUDE RETROSPECTIVE
Objective: To determine whether relaxing vancomycin-resistant enterococci (VRE) precautions results in an
increase in the incidence of invasive VRE infections over time.
Design: Retrospective analysis of a microbiology database before and after relaxation of VRE screening and
isolation precautions.
Setting: Urban tertiary care teaching hospital in Montreal, Canada.
Participants: All hospitalized and emergency room patients over a 13-year period from January 1, 2000, to
March 31, 2013.
Methods: We assessed the results of all microbiology cultures for the presence of VRE as well as the results
of all polymerase chain reaction assays for vanA and vanB during the study period. Applying criteria for 4
clinical situations (bacteremia, definite infection, possible infection, and colonization with VRE), we analyzed
the effects of relaxed VRE screening and isolation precautions on the incidence of each of these outcomes
over the time preceding and following this change.
Results: When VRE screening and isolation precautions were relaxed, a marked rise in VRE colonization was
observed, with a lesser but definite rise in the 3 other outcomes. Despite this initial rise in all measures, all
incidences other than colonization plateaued during the 34 months of follow-up.
Conclusions: Relaxation of VRE screening and isolation precautions was associated with an immediate
increase in colonization and infection incidence. Despite increasing colonization, infection outcomes remained
infrequent and stable, suggesting a finite number of susceptible hosts at risk. Relaxation of VRE protocols
may not lead to increasing infection incidence in a hospital setting, advocating that cost effectiveness
exercises, with targeted screening and isolation precautions, are crucial.
Environnement
NosoBase ID notice : 381957
Etude de l’effet antimicrobien du laiton AB+® : pour une maîtrise des biocontaminations des
équipements hospitaliers
Ruelle A; Sion M; Damiani C; Totet A; Segard C; Leke A; et al. Etude de l’effet antimicrobien du laiton AB+® :
pour une maîtrise des biocontaminations des équipements hospitaliers. Hygiènes 2014/05; 22(2): 117-122.
Mots-clés : REANIMATION; SURFACE; EQUIPEMENT; MOBILIER; PEDIATRIE; BACTERIE; VIRUS;
MYCOLOGIE
Objectif : Il est démontré que des surfaces à base de cuivre réduisent les biocontaminations. Afin de valider
les aptitudes antimicrobiennes d’un alliage laiton AB+ ®, une étude in situ a été réalisée dans deux services
de pédiatrie d’un centre hospitalier universitaire.
Méthodes : Durant cinq mois, le potentiel antimicrobien de quatorze poignées en laiton AB+ ® a été comparé à
celui de quatorze poignées en inox. Les 28 poignées ont été écouvillonnées périodiquement (norme NF ISO
18593 : 2004). Les écouvillons ont été ensemencés pour le dénombrement et l’identification des bactéries et
champignons. Des techniques de culture cellulaire et de RT-PCR ont été utilisées en virologie.
Résultats : Le nombre de bactéries est significativement réduit sur les poignées laiton comparées à celles en
inox (flore aérobie totale : p = 0,03). Pour les champignons, leur faible nombre détecté ne permet pas de
conclure. Aucun entérovirus n’a été détecté sur les 28 poignées.
Conclusion : La réduction du taux de bactéries témoigne des propriétés bactéricides du laiton AB+ ®. Les
résultats ne permettent pas de conclure à un effet antifongique. L’absence d’entérovirus s’explique par la
sensibilité des techniques utilisées et des prélèvements réalisés hors épidémie. La bonne hygiène des mains
associée aux surfaces antimicrobiennes devrait permettre de réduire le transfert de contaminations avec un
effet sur les infections.
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Gastro-entérite
NosoBase ID notice : 381460
Dépistage saisonnier de gastroentérites virales parmi de jeunes enfants et des personnes âgées
hospitalisées : est-il digne d’intérêt ?
Borrows CL; Turner PC. Seasonal screening for viral gastroenteritis in young children and elderly hospitalized
patients: is it worthwhile? The journal of hospital infection 2014/06; 87(2): 98-102.
Mots-clés : DEPISTAGE; VIRUS; GASTRO-ENTERITE; PEDIATRIE;
MULTIPLEX; SELLE; ROTAVIRUS; ADENOVIRUS; NOROVIRUS; COUT
PERSONNE
AGEE;
PCR
Background: Viral gastroenteritis is common, especially in young children. In adults, particularly amongst the
elderly, it can lead to outbreaks at a time when demands on clinical services are at their peak.
Aim: To evaluate seasonal screening of young children and elderly patients with suspected viral
gastroenteritis using multiplex polymerase chain reaction (PCR) for enteric viruses within a general hospital
setting.
Methods: Stool samples from 200 children aged five years and under were screened for rotavirus,
adenovirus, astrovirus, sapovirus and norovirus using multiplex PCR and a combined rotavirus/adenovirus
immunochromatographic test (ICT) during the winter of 2012. Diarrhoeal samples submitted to the laboratory
from 195 adults aged 65 years and over attending as inpatients were also evaluated by multiplex PCR.
Findings: One or more enteric viruses were detected by PCR in 56% of children. Rotavirus was the most
prevalent virus, found in 19% of samples. Enteric (diarrhoea-associated) adenovirus was detected in 5% of
samples and non-enteric adenovirus was detected in 14% of samples. Astrovirus, norovirus and sapovirus
were detected in 18%, 12% and 10% of samples, respectively. The ICT yielded a slightly lower rate for
rotavirus and enteric adenovirus, but gave more rapid results. Norovirus, rotavirus and adenovirus were
detected in 15%, 2.5% and 1% of elderly adults attending hospital as inpatients, respectively.
Conclusions: Rapid screening of young children (for rotavirus, adenovirus and norovirus) and symptomatic,
elderly adults (for norovirus) during winter months may help to limit nosocomial spread.
Gestion des risques
NosoBase ID notice : 382710
Comment les sites Web des hôpitaux italiens communiquent sur les stratégies de gestion des risques
: le cas des infections nosocomiales
Gallone MS; Tafuri S; Preziosa VP; Quarto M; Germinario C. How Italian hospital Web sites communicate risk
management strategies: the case of hospital-acquired infections. American journal of infection control
2014/07; 42(7): 813-814.
Mots-clés : RISQUE; GESTION DES
SURVEILLANCE; HYGIENE DES MAINS
RISQUES;
INTERNET;
INFORMATION;
PREVENTION;
We aimed to investigate the Web site contents of Italian National Health System structures regarding health
care-associated infection (HAI). For each Web site a form inquiring about the availability of information about
HAI issues and their prevention was filled in. An HAI section was available in the Web site of 19.3% of
facilities. In 1.6% of Web sites this information was available on the homepage. The most frequently reported
information was related to infection control practitioners, HAI surveillance systems, and handwashing
hygiene. In conclusion, the communication of risks related to clinical practice should be part of risk
management systems and should assume a significant position in content strategy activities.
Grippe
NosoBase ID notice : 381826
Avis relatif à l’efficacité de la vaccination contre la grippe saisonnière notamment chez les personnes
âgées et à la place de la vaccination des professionnels de santé dans la stratégie de prévention de la
grippe.
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Haut Conseil de la Santé Publique (HCSP). Avis relatif à l’efficacité de la vaccination contre la grippe
saisonnière notamment chez les personnes âgées et à la place de la vaccination des professionnels de santé
dans la stratégie de prévention de la grippe. HCSP 2014/03/28: 1-11.
Mots-clés : PERSONNE AGEE; VACCINATION; GRIPPE; PERSONNEL; EFFICACITE; TOLERANCE
Suite à une publication d'articles et de méta-analyses susceptibles de remettre en cause l'efficacité et la
pertinence de la vaccination contre la grippe saisonnière chez les personnes âgées ainsi que chez les
professionnels de santé, le Directeur général de la santé a saisi le Haut Conseil de la santé publique (HCSP).
Après avoir procédé à une analyse critique des données existantes, le HCSP émet des propositions
d'aménagement de la stratégie de vaccination et des suggestions d'études à mener en vue de l'amélioration
de la connaissance nécessaire au choix de stratégie.
NosoBase n° 39935 ID notice : 381825
Efficacité de la vaccination contre la grippe saisonnière chez les personnes âgées et les
professionnels de santé.
Haut Conseil de la Santé Publique (HCSP). Efficacité de la vaccination contre la grippe saisonnière chez les
personnes âgées et les professionnels de santé. HCSP 2014/03: 1-38.
Mots-clés : PERSONNE AGEE; VACCINATION; GRIPPE; PERSONNEL; TOLERANCE; EFFICACITE
La grippe saisonnière touche annuellement 2 à 8 millions de personnes en France et entraîne le décès de
plusieurs milliers de personnes, essentiellement des personnes de plus de 65 ans.
Le HCSP a revu les données récentes – notamment les méta-analyses - relatives à la vaccination contre la
grippe des personnes âgées, le risque particulier de grippe chez les professionnels de santé, le risque de
grippe nosocomiale liée aux soignants ainsi que les études relatives à l’intérêt de vacciner les soignants pour
protéger les patients.
Le HCSP considère, concernant les méta-analyses, que l’absence de démonstration d’efficacité (pour des
raisons méthodologiques) de la vaccination contre la grippe saisonnière dans certaines populations ne
signifie pas que celle-ci n’est pas efficace. D’autres études en effet, notamment françaises, permettent
d’attribuer au vaccin une efficacité dans ces populations et la balance bénéfice/risque de la vaccination reste
positive, les vaccins grippaux ayant par ailleurs un bon profil de tolérance.
Il recommande notamment :
- la poursuite des campagnes annuelles de vaccination contre la grippe des personnes âgées de 65 ans et
plus ;
- la poursuite de la vaccination contre la grippe des personnels de santé qui doit s’intégrer dans un
programme global de prévention de l’infection nosocomiale, en complément des mesures barrières.
Le Haut Conseil de la santé publique estime par ailleurs qu’il est nécessaire de favoriser la recherche
académique pour la mise au point de vaccins plus efficaces. Une stratégie complémentaire, visant à la
protection indirecte des personnes les plus à risque de complications, en vaccinant les enfants de leur
entourage, pourrait être envisagée. Ceci nécessiterait une mise à disposition du vaccin grippal vivant nasal,
une étude indépendante d’acceptabilité auprès des professionnels de santé et du grand public et une
modalité d’administration du vaccin permettant l’obtention d’une couverture vaccinale élevée.
NosoBase ID notice : 382104
Efficacité des désinfectants courants contre le virus de la grippe H1N1 sur les masques en
élastomère réutilisables
Subhash SS; Cavaiuolo M; Radonovich LJ; Eagan A; Lee ML; Campbell S; et al. Effectiveness of common
healthcare disinfectants against H1N1 influenza virus on reusable elastomeric respirators. Infection control
and hospital epidemiology 2014/07; 35(7): 894-897.
Mots-clés : GRIPPE; VIRUS INFLUENZA
QUATERNAIRE; JAVEL; PCR; EFFICACITE
TYPE
A;
DESINFECTANT;
MASQUE;
AMMONIUM
This study evaluated the efficacy of 3 common hospital disinfectants to inactivate influenza virus on
elastomeric respirators. Quaternary ammonium/isopropyl alcohol and bleach detergent wipes eliminated live
virus, whereas 70% isopropyl alcohol alone was ineffective.
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Hémodialyse
NosoBase ID notice : 382192
Lutte contre le risque infectieux dans des unités d’hémodialyse : accès rapide à des éléments
essentiels
Karkar A; Bouhaha BM; Dammang ML. Infection control in hemodialysis units: a quick access to essential
elements. Saudi journal of kidney diseases and transplantation 2014/06; 25(3): 496-519.
Mots-clés : HEMODIALYSE; DEFICIT IMMUNITAIRE; PERSONNEL; PREVENTION; CONTROLE;
HYGIENE DES MAINS; DESINFECTION; ENVIRONNEMENT; SURFACE; EAU; PRATIQUE; DEPISTAGE;
VACCIN; REVUE DE LA LITTERATURE; NETTOYAGE
Infection is the most common cause of hospitalization and the second most common cause of mortality
among hemodialysis (HD) patients, after cardiovascular disease. HD patients as well as the dialysis staff are
vulnerable to contracting health-care-associated infections (HAIs) due to frequent and prolonged exposure to
many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the
associated common environmental conditions and the immune compromised status of HD patients are major
predisposing factors. The evident increased potential for transmission of infections in the HD settings led to
the creation and implementation of specific and stricter infection prevention and control measures in addition
to the usual standard precautions. Different international organizations have generated guidelines and
recommendations on infection prevention and control for implementation in the HD settings. These include
the Centers for Disease Control and Prevention (CDC), the Association of Professionals in Infection Control
(APIC), the Kidney Disease Outcomes Quality Initiative (K/DOQI), the European Best Practice
Guidelines/European Renal Best Practice (EBPG/ERBP) and the Kidney Disease: Improving Global
Outcomes (KDIGO). However, these guidelines are extensive and sometimes vary among different guidelineproducing bodies. Our aim in this review is to facilitate the access, increase the awareness and encourage
implementation among dialysis providers by reviewing, extracting and comparing the essential elements of
guidelines and recommendations on infection prevention and control in HD units.
NosoBase ID notice : 382058
Etude des pratiques d’hygiène dans des services d’hémodialyse : prévenir les bactériémies
associées aux accès vasculaires
Trépanier P; Quach C; Gonzales M; Fortin E; Kaouache M; Desmeules S; et al. Survey of infection control
practices in hemodialysis units: preventing vascular access-associated bloodstream infections. Infection
control and hospital epidemiology 2014/07; 35(7): 833-838.
Mots-clés : HEMODIALYSE; BACTERIEMIE; PREVENTION; FISTULE; ENQUETE; PROTOCOLE;
OBSERVANCE; CATHETER; SOIN CUTANE
Objective: Despite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no
improvement in vascular access-associated bloodstream infections in hemodialysis (HD). We aimed to
determine the infection control measures recommended and implemented in Quebec's HD units, compliance
of local protocols to infection control practice guidelines, and reasons behind the low prevalence of
arteriovenous fistulas.
Methods: An online survey was elaborated on the basis of the Centers for Disease Control and Prevention
(CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The
questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in
Quebec (n=40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression.
Results: Thirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central
catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except
for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention
measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at
least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the
insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in
only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack
of surgical resources (39%; P=.01).
Conclusions: Improvement in standardization of care according to practice guidelines is necessary. Fistula
rate could be increased by improving access to surgical resources and patient education. Strategies are now
being elaborated to address these findings.
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Hygiène des mains
NosoBase ID notice : 382535
Les cinq indications de l’hygiène des mains : prise en charge d’un patient avec un cathéter urinaire
(Affiche)
World Health Organization (WHO). Les cinq indications de l’hygiène des mains : prise en charge d’un patient
avec un cathéter urinaire. WHO 2014: 1 page.
Mots-clés : HYGIENE
RECOMMANDATION
DES
MAINS;
CATHETER;
APPAREIL
URINAIRE;
SONDE;
GANT;
Cette affiche de l’Organisation mondiale de la santé (OMS) rappelle les cinq indications de l’hygiène des
mains lors de la prise en charge d’un patient avec un cathéter urinaire :
1- Avant de toucher un patient
2- Avant un geste aseptique
3- Après un risque d’exposition à un liquide biologique
4- Après avoir touché un patient
5- Après avoir touché l’environnement d’un patient
NosoBase ID notice : 382647
Impact d’un programme obligatoire pour l’hygiène des mains dans une province : messages du
terrain
Bryce E; Islam S; Nelson B; Gamage B; Wilson R; Welsh P; et al. Impact of a mandated provincial hand
hygiene program: messages from the field. American journal of infection control 2014/07; 42(7): 708-712.
Mots-clés : HYGIENE DES MAINS; AUDIT; INFORMATION; ATTITUDE; PERSONNEL; QUALITE;
PERCEPTION; PRATIQUE
Background: The British Columbia Provincial Hand Hygiene Working Group was formed in September 2010
and tasked with the development and implementation of a provincial hand hygiene (HH) program for health
care.
Methods: As part of an evaluation of the provincial HH program, qualitative key informant interviews of
program developers, senior administrators, and field workers were performed from December 2011 to March
2012 (phase 1) and again in April to June 2013 (phase 2).
Results: The following 5 broad themes were identified: (1) the provincial HH program became a platform for
cooperation; (2) standardization (of HH audits and program components) strengthened and provided
credibility to the provincial HH program; (3) quality results and good communication enabled a learning
process that resulted in positive change management; (4) with ownership came pride and program success;
and (5) management support and infrastructure is needed to sustain a positive culture change.
Conclusion: Positive behavior change for HH can be achieved on a provincial scale through a program that is
standardized, has mandated components, is well communicated, owned by the frontline workers, and
receives sustained support from senior management.
NosoBase ID notice : 382649
Une promotion séquentielle de l’hygiène des mains contribue à réduire le taux de bactériémies
nosocomiales parmi des nouveau-nés de très petit poids de naissance : séries temporelles
interrompues sur 10 ans
Helder OK; Brug J; van Goudoever JB; Looman C; Reiss IK; Kornelisse RF. Sequential hand hygiene
promotion contributes to a reduced nosocomial bloodstream infection rate among very low-birth weight
infants: an interrupted time series over a 10-year period. American journal of infection control 2014/07; 42(7):
718-722.
Mots-clés : HYGIENE DES MAINS; PREVENTION; BACTERIEMIE; TAUX; NOUVEAU-NE; PREMATURE;
STATISTIQUE; OBSERVANCE; PERSONNEL; FORMATION; GANT; STAPHYLOCOCCUS; INCIDENCE;
NEONATOLOGIE
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Background: Sustained high compliance with hand hygiene (HH) is needed to reduce nosocomial
bloodstream infections (NBSIs). However, over time, a wash out effect often occurs. We studied the long-term
effect of sequential HH-promoting interventions.
Methods: An observational study with an interrupted time series analysis of the occurrence of NBSI was
performed in very low-birth weight (VLBW) infants. Interventions consisted of an education program, gainframed screen saver messages, and an infection prevention week with an introduction on consistent glove
use.
Results: A total of 1,964 VLBW infants admitted between January 1, 2002, and December 31, 2011, were
studied. The proportion of infants with ≥1 NBSI decreased from 47.6%-21.2% (P<.01); the number of NBSIs
per 1,000 patient days decreased from 16.8-8.9 (P<.01). Preintervention, the number of NBSIs per 1,000
patient days significantly increased by 0.74 per quartile (95% confidence interval [CI], 0.27-1.22). The first
intervention was followed by a significantly declining trend in NBSIs of -1.27 per quartile (95% CI, -2.04 to 0.49). The next interventions were followed by a neutral trend change. The relative contributions of
coagulase-negative staphylococci and Staphylococcus aureus as causative pathogens decreased
significantly over time.
Conclusions: Sequential HH promotion seems to contribute to a sustained low NBSI rate.
NosoBase ID notice : 382498
Impact des bains quotidiens à la chlorhexidine et de l’observance de l’hygiène des mains sur les taux
d’infections nosocomiales parmi des patients de réanimation
Martínez Reséndez MF; Garza-González E; Mendoza-Olazaran S; Herrera-Guerra A; Rodríguez-López JM;
Pérez-Rodríguez E; et al. Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial
infection rates in critically ill patients. American journal of infection control 2014/07; 42(7): 713-717.
Mots-clés : CHLORHEXIDINE; TOILETTE DU PATIENT; HYGIENE DES MAINS; OBSERVANCE; TAUX;
PREVENTION; SOIN INTENSIF; PNEUMONIE; VENTILATION ASSISTEE; INFECTION URINAIRE;
SONDAGE URINAIRE; ACINETOBACTER BAUMANNII; CANDIDA
Background: Up to 25% of all nosocomial infections (NIs) develop in critically ill patients. Our objective was to
evaluate chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in the reduction of NIs in the
intensive care unit.
Methods: The study comprised three 6-month periods: preintervention (PIP; soap/water bathing), intervention
(IP; bathing with CHX-impregnated wipes), and postintervention (PoIP; soap/water bathing). An HH program
was implemented during the IP and PoIP. Primary outcomes were global and specific NI rates.
Results: A total of 1007 patients were included. Infection rates per 100 discharges were higher in the PIP
compared with the IP and also higher in the PoIP compared with the IP (P=.0004 and .0109, respectively).
Global infection rates per 1000 hospital-days were higher in the PIP than in the IP (P=.0268). The rates of
ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) were higher in
the PIP than in the IP (P=.036 and .0001, respectively). Isolation of Acinetobacter baumannii from VAP
specimens (P=.0204) and isolation of Candida spp from CAUTI specimens (P=.0005) decreased as well.
Conclusion: The combined intervention reduced global and specific infection rates, including rates of VAP
associated with A baumannii and CAUTI associated with Candida spp.
NosoBase ID notice : 382696
Evaluation de la minutie de l’hygiène des mains : "Voir c’est croire"
Pan SC; Chen E; Tien KL; Hung IC; Sheng WH; Chen YC; et al. Assessing the thoroughness of hand
hygiene: "Seeing is believing". American journal of infection control 2014/07; 42(7): 799-801.
Mots-clés : HYGIENE DES MAINS; PRATIQUE; PERSONNEL; EFFICACITE; FORMATION; CENTRE
HOSPITALIER UNIVERSITAIRE
The thoroughness of hand hygiene (HH) was evaluated using a simulation method in which health care
workers (HCWs) rubbed their hands with a fluorescent substance, washed with water, and placed their hands
under an ultraviolet detector to identify areas missed. Most residue points were located in the tips of the nails
(38.6%), followed by fingertips (17.4%). This stress-free "seeing is believing" program can encourage HCWs'
active participation in sustaining the HH culture of health care institutions.
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Indicateur
NosoBase ID notice : 382530
Infections associées aux soins : propositions pour des indicateurs de résultats à visée de diffusion
publique. Rapport d’auditions.
Haut Conseil de la Santé Publique (HCSP). Infections associées aux soins : propositions pour des indicateurs
de résultats à visée de diffusion publique. Rapport d’auditions. HCSP 2014/05: 1-21.
Mots-clés : INDICATEUR; USAGER DE LA SANTE; INFORMATION; CHIRURGIE; BACTERIEMIE;
VACCINATION; GRIPPE
Afin d’améliorer l’information du public sur la performance des établissements de santé dans la lutte contre
les infections nosocomiales, le HCSP avait sélectionné début 2012 dans un rapport précédent cinq
indicateurs, ciblés sur les résultats, susceptibles de faire partie d’un tableau de bord annuel des
établissements de santé en complément des indicateurs existants.
Ces indicateurs, considérés comme les plus appropriés par les experts, étaient les suivants :
- Chirurgie prothétique de hanche ou de genou pour les patients considérés comme à risque faible (NNIS-0)
- Bactériémies liées aux cathéters veineux centraux (CVC) en réanimation
- Bactériémies liées aux CVC chez les nouveau-nés
- Bactériémies à Staphylococcus aureus résistant à la méticilline (SARM)
- Proportion de soignants vaccinés contre la grippe
Le travail des experts a été complété par l’audition de différents acteurs et potentiels utilisateurs de ces
indicateurs.
Le présent rapport, qui fait suite à une saisine de la Direction générale de l’offre de soins du 26 août 2013,
établit une synthèse de ces auditions. Aucun des indicateurs n’a été considéré comme ne pouvant pas faire
l’objet d’une diffusion publique, cependant des divergences sont apparues entre les différents indicateurs
étudiés.
Infection urinaire
NosoBase ID notice : 382708
Evaluation de la peau des patients, des surfaces de l’environnement et des sondes urinaires en tant
que sources pour la transmission des pathogènes urinaires
Linder KA; Hecker MT; Kundrapu S; Cadnum JL; Musuuza JS; Sethi AK; et al. Evaluation of patients' skin,
environmental surfaces, and urinary catheters as sources for transmission of urinary pathogens. American
journal of infection control 2014/07; 42(7): 810-812.
Mots-clés : CATHETER; PEAU; SURFACE; ENVIRONNEMENT; SONDE; SONDAGE URINAIRE;
TRANSMISSION; INFECTION URINAIRE; BACTERIURIE; CONTAMINATION; TRANSMISSION
MANUPORTEE
In hospitalized patients with urinary tract infection or asymptomatic bacteriuria, urinary pathogens frequently
contaminate skin, high-touch environmental surfaces, and urinary catheters. Contamination is more common
in patients with a urinary catheter in place and with gram-positive pathogens. Patients' skin and
environmental surfaces may provide an important source for transmission of urinary pathogens.
Mycologie
NosoBase ID notice : 382176
Rôle de la prophylaxie antifongique primaire parmi des patients d'oncologie hématologique
Pagano L; Caira M. The role of primary antifungal prophylaxis in patients with haematological malignancies.
Clinical microbiology and infection 2014/06; 20(Suppl. 6): 19-26.
Mots-clés : ANTIFONGIQUE; PREVENTION; CHIMIOPROPHYLAXIE; HEMATOLOGIE; CANCEROLOGIE;
INCIDENCE; MYCOLOGIE; FONGEMIE; TRAITEMENT; RISQUE; REVUE DE LA LITTERATURE
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NosoVeille – Bulletin de veille
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Invasive fungal infections (IFIs) represent important complications in patients with haematological
malignancies. Chemoprevention of IFIs may play an important role in this setting, but in the past decades the
majority of antifungal drugs utilized demonstrated poor efficacy, particularly in the prevention of invasive
aspergillosis. The new triazoles are very useful antifungal drugs, more suitable for prophylaxis of IFIs than
amphotericin B and echinocandins. In this review, the main clinical data about antifungal prophylaxis with
fluconazole, itraconazole, voriconazole and posaconazole are analysed. At present, posaconazole appears to
be the most efficacious azole in antifungal prophylaxis, particularly in patients with acute myeloid leukaemia.
NosoBase ID notice : 382164
Epidémiologie des mucormycoses en Europe
Petrikkos G; Skiada A; Drogari-Apiranthitou M. Epidemiology of mucormycosis in Europe. Clinical
microbiology and infection 2014/06; 20(Suppl. 6): 67-73.
Mots-clés : EPIDEMIOLOGIE; MUCORMYCOSE; MYCOLOGIE; INCIDENCE; DIAGNOSTIC; MORTALITE
Zygomycosis (mucormycosis) is being increasingly recognized as causing infection in recent years. National
and multinational European surveys attempting to analyse the epidemiological parameters of this potentially
devastating infection are very few. Although the exact incidence could not be defined due to the different
methodologies used in these studies and the absence of a denominator, there were some useful
observations made regarding the clinical presentation, sites of infection and diagnostic practices. Moreover,
the importance for a prompt and accurate diagnosis has been stressed. As early diagnosis can significantly
affect the initiation of treatment and decrease mortality, future research should focus on the development of
an epidemiological risk assessment tool and novel diagnostic methods.
Odontologie
NosoBase ID notice : 382190
Lutte contre le risque infectieux dans les cabinets dentaires
Weissfeld AS. Infection control in the dental office. Clinical microbiology newsletter 2014/06; 36(11): 79-84.
Mots-clés : ODONTOLOGIE; PREVENTION; PERSONNEL; VACCIN; RISQUE PROFESSIONNEL;
ACCIDENT D'EXPOSITION AU SANG; BIONETTOYAGE; STERILISATION; EAU; HEPATITE B; HEPATITE
C; VIRUS DE L'IMMUNODEFICIENCE HUMAINE; TUBERCULOSE; PRION
I am the daughter and granddaughter of dentists. Together, they practiced at the same location for more than
80 years. I remember a time when dentists worked with their bare hands and no mask. I guess it is inevitable
that as a clinical microbiologist I would continue to be interested in how infection control practices have
evolved since those “good old days.” This article addresses 21st century infection control guidelines. Oral
surgeons now place titanium implants into bone, and there is extensive literature addressing how dental care
practitioners need to protect themselves, their staff, and patients from a variety of infectious diseases no one
knew existed in the early 1900s. In fact, the history of infection control from the 1920s to now is probably also
the history of the discovery of new infectious diseases, especially hepatitis B virus, hepatitis C virus, and
human immunodeficiency virus infections.
Personnel
NosoBase ID notice : 381965
De l’intérêt de la mise en place de formations pour les tatoueurs perceurs
Pospisil F; Achard AM; Carrière D; Chaix V; de Rance H; Jacquemoud E; et al. De l’intérêt de la mise en
place de formations pour les tatoueurs perceurs. Hygiènes 2014/05; 22(2): 139-142.
Mots-clés : TATOUAGE; FORMATION; PIERCING; PRECAUTION STANDARD; HYGIENE DES MAINS;
GANT
En France, il n’existe aucune formation diplômante, ni théorique, ni technique et pratique, pour les tatoueursperceurs, ni aucun cours agréé par l’Etat français, ou par la profession. L’arrêté du 11 mars 2009 définit les
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règles générales d’hygiène et de salubrité applicables à la mise en œuvre des techniques de tatouage par
effraction cutanée. Cet arrêté prévoit également une formation obligatoire de 21 heures sur trois jours
consécutifs et elle est exigible pour tous.
NosoBase ID notice : 381452
La saleté et le dégoût comme facteurs clé des comportements des infirmiers dans la lutte contre le
risque infectieux : étude qualitative d’interprétation
Jackson C; Griffiths P. Dirt and disgust as key drivers in nurses' infection control behaviours: an
interpretative, qualitative study. The journal of hospital infection 2014/06; 87(2): 71-76.
Mots-clés : TRAVAIL; ATTITUDE; INFIRMIER; PREVENTION; ANALYSE; PERCEPTION; PSYCHOLOGUE
Background: Infection prevention remains a significant challenge for healthcare systems. Yet despite
considerable work to provide clear policies and scientifically proven techniques to reduce infection
transmission, beliefs and practices of healthcare workers do not always concur with scientific rationale.
Aim: To provide explanations for nurses' infection prevention behaviours.
Methods: An interpretative, qualitative approach was taken using semi-structured interviews. Twenty
interviews with registered nurses working in an acute hospital setting were conducted. Analysis was
conducted using the Framework method.
Findings: This paper focuses on the theme 'protection from dirt'. Within the findings clear distinction was
made between infection and dirt. Fear of contact with dirt, particularly dirt belonging to those who were
unknown, was a key driver in behaviour carried out to reduce threat. Familiarity with the patient resulted in a
reduction of the protective behaviours required. These behaviours, which initially appeared as part of an
infection prevention strategy, were primarily a form of self-protection from patients, who at first encounter
were considered as dirty.
Conclusion: Behaviours do not always fit with a rational response to infection, but instead may be responses
to dirt. Any programme that simply attempts to address scientific knowledge and behaviour deficits is unlikely
to have the desired goals if it does not take into account existing social constructions of dirt and the response
it evokes.
NosoBase ID notice : 382694
Adhésion et connaissances des bonnes pratiques et biorisques professionnels parmi des
manucures/pédicures
Garbaccio JL; de Oliveira AC. Adherence to and knowledge of best practices and occupational biohazards
among manicurists/pedicurists. American journal of infection control 2014/07; 42(7): 791-795.
Mots-clés : PRATIQUE; CONNAISSANCE;
PRECAUTION STANDARD
RISQUE
PROFESSIONNEL;
MAIN;
OBSERVANCE;
Background: Unsafe behaviors of the professionals working at health and beauty centers are arousing
concern among researchers, especially because of the risk of infections related to occupational health.
Methods: This study involved a survey of 153 manicurists/pedicurists working in beauty salons in Belo
Horizonte, Brazil between June 2012 and March 2013. The data were analyzed through descriptive statistics,
χ2 tests, and logistic regression. Participants' knowledge of and adherence to best practices were evaluated
based on the median results, and serologic markers for hepatitis B and C were identified.
Results: Associations (P<.05) were observed between adherence and workload, biosafety training, and
hepatitis B surface antibody (anti-HBs) serology, as well as between knowledge and courses in the area and
accidents with sharp instruments. Manicurists who participated in a course on biosafety (63.6%) and were
positive for anti-HBs reagents (56.8%) achieved better results on issues of adherence. Those who reported
taking a specific course on this topic had good scores on issues of knowledge (60%). Reactivity to hepatitis C
antibody was identified in 1.3%, and reactivity to anti-HBs was detected in 53%.
Conclusions: Overall, the participants demonstrated poor knowledge of and adherence to good safety
practices and exposure to occupational biohazards, such as contact with blood by accidents with sharp
instruments and minimal vaccine protection.
NosoBase ID notice : 382065
Coût-efficacité pour s’assurer que le personnel soignant préalablement vacciné soit bien protégé
contre l’hépatite B
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Hoerger TJ; Bradley C; Schillie SF; Reilly M; Murphy TV. Cost-effectiveness of ensuring hepatitis B protection
for previously vaccinated healthcare personnel. Infection control and hospital epidemiology 2014/07; 35(7):
845-854.
Mots-clés : HEPATITE B; PERSONNEL; VACCIN; COUT-EFFICACITE; ACCIDENT D'EXPOSITION AU
SANG; ANTICORPS; ANTIGENE
Objective: To examine the cost-effectiveness of pre- and postexposure approaches for ensuring hepatitis B
protection among previously vaccinated healthcare personnel (HCP).
Design: A decision-analytic model was developed for alternative strategies of ensuring hepatitis B protection
under assumptions of 68% and 95% long-term protection after a primary vaccination series. Costs and
quality-adjusted life years (QALYs) lost from infections were estimated, and incremental cost-effectiveness
ratios (ICERs) were calculated relative to a no intervention alternative over 10 years of intervention. Separate
analyses were performed for trainees and nontrainees, using the healthcare system perspective. Trainees
face higher risk of exposure and likely received primary vaccination as infants.
Setting: General healthcare settings.
Participants: Trainee and nontrainee HCP.
Interventions: Preexposure testing for antibody to hepatitis B surface antigen followed by additional
vaccination for HCP without protective antibody levels; postexposure evaluation and management for HCP
reporting blood or body fluid exposures
Results: The preexposure strategy prevents more infections and has higher costs than the postexposure
strategy or no intervention. For trainees, 10-year preexposure evaluation ICERs are $832,875 and $144,457
per QALY for 95% and 68% long-term vaccine protection, respectively. Trainee 10-year postexposure
evaluation ICERs are $1,146,660 and $191,579 per QALY under the 95% and 68% long-term protection
assumptions, respectively. For nontrainees, 10-year ICERs are $745,739 and $1,129,286 per QALY for the
preexposure and postexposure evaluation strategies, respectively.
Conclusions: ICERs may inform decision makers as they decide whether the added cost of the preexposure
strategy provides sufficient value in preventing infections.
Précaution standard
NosoBase ID notice : 381955
Evaluation de l’application des précautions standard dans les établissements de santé français
Laprugne Garcia E; Giard M; Caillat-Vallet E; Russell I; Verjat-Trannoy D; Ertzscheid MA; et al. Evaluation de
l’application des précautions standard dans les établissements de santé français. Hygiènes 2014/05; 22(2):
107-116.
Mots-clés : PRECAUTION STANDARD;
AUDIT; OBSERVANCE;
PERSONNEL;
ACCIDENT
D'EXPOSITION AU SANG; PRODUIT HYDROALCOOLIQUE; COLLECTEUR; TRANSPORT; GANT;
EQUIPEMENT DE PROTECTION
En 2011, le Groupe d’évaluation des pratiques en hygiène hospitalière (Grephh) du réseau des centres de
coordination de lutte contre les infections nosocomiales–antennes régionales de lutte contre les infections
nosocomiales (Cclin-Arlin) a proposé aux établissements de santé (ES) un outil pour évaluer la politique
institutionnelle, les ressources disponibles pour l’application des précautions standard (PS) ainsi que la
formation et les attitudes du personnel. Etaient inclus les ES, les services de soins ou médicotechniques et
tout le personnel. Les données ont été recueillies à l’aide de trois fiches (autoquestionnaire). Les résultats ont
été rendus en pourcentages d’objectifs atteints. Les attitudes des professionnels ont été rapportées en
pourcentages de « jamais », « parfois », « souvent », « toujours » répondus à chaque question. Un total de
1 599 ES a participé à l’audit, regroupant 14 968 unités de soins et 203 840 professionnels. Des pratiques
efficientes sont notées pour la promotion des PS, la présence de procédures et les ressources disponibles.
Les professionnels déclarent de bonnes pratiques pour le risque de contact avec du matériel souillé et la
conduite à tenir en cas de contact de liquide biologique avec les muqueuses. Les pratiques à améliorer
concernent en priorité le port d’équipements de protection individuelle, le changement de gants ou l’hygiène
des mains entre deux activités. En complément de ce thème, et pour faire suite à la réactualisation des
recommandations nationales précautions complémentaires contact, gouttelettes et air, le Grephh mettra à
disposition des établissements un outil d’audit sur les précautions complémentaires d’hygiène fin 2013.
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Soin intensif
NosoBase ID notice : 381959
Manuportage des levures dans les unités de soins intensifs à Sfax, Tunisie
Cheikhrouhou F; Makni F; Trabelsi H; Guidara R; Néji S; Sellami H; et al. Manuportage des levures dans les
unités de soins intensifs à Sfax, Tunisie. Hygiènes 2014/05; 22(2): 135-138.
Mots-clés : SOIN INTENSIF; TRANSMISSION MANUPORTEE; LEVURE; REANIMATION; PERSONNEL
MEDICAL; PROFESSION PARAMEDICALE; BRULE; MYCOLOGIE; TRANSMISSION SOIGNANT-SOIGNE;
CANDIDA TROPICALIS; CANDIDA ALBICANS; CANDIDA PARAPSILOSIS; CANDIDA KRUSEI; CANDIDA
LUSITANIAE; CANDIDA GLABRATA; CRYPTOCOCCUS; TRICHOSPORON; LAVAGE SIMPLE DES
MAINS; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION
Le but de notre travail a été d’étudier le manuportage des levures chez le personnel (médical, paramédical)
de l’unité des brûlés, des services de réanimation médicale et chirurgicale du centre hospitalier universitaire
Habib-Bourguiba de Sfax, Tunisie, et d’attirer l’attention sur la relation entre manuportage des levures chez le
personnel et la colonisation ou l’infection fongiques des patients. Ainsi, nous avons réalisé une étude
prospective qui a porté sur des prélèvements à partir des mains du personnel, selon la technique Broth bag.
Parmi les 62 personnels inclus dans notre étude, 62,9 % ont été porteurs de levures. Le portage des levures
a été significativement plus élevé chez le personnel paramédical que chez le personnel médical. Les espèces
de levures du genre Candida étaient prédominantes : C. tropicalis (33 %), C. albicans (24 %), C. famata (7 %)
C. parapsilosis (5 %), C. krusei (2 %), C. lusitaniae (2 %), C. glabrata (1 %) parmi les genres de levures
identifiés. Les espèces non-Candida ont été Cryptococcus laurentii (14 %), Pichia (7 %), Trichosporon (5 %).
Le lavage hygiénique des mains semble réduire le portage des levures plus que le lavage simple (p < 0,01).
Les précautions que nous devons prendre contre ce manuportage ne concernent pas uniquement les
services à risque mais aussi tout le personnel qui s’occupe de patients susceptibles d’infections fongiques.
NosoBase ID notice : 382820
La prévention de la pneumonie acquise sous ventilation mécanique
Institut national de santé publique Québec (INSPQ). La prévention de la pneumonie acquise sous ventilation
mécanique. 2014/06: 41 pages.
Mots-clés : PNEUMONIE; PREVENTION; VENTILATION ASSISTEE; SOIN DE BOUCHE; ALIMENTATION
ENTERALE; SURVEILLANCE; INCIDENCE; SOIN INTENSIF
La pneumonie acquise sous ventilation (PAV) est une infection répandue dans les unités de soins intensifs.
Cette infection affecte en effet de 10 à 20 % des patients ventilés et si le traitement est retardé ou
inapproprié, elle sera associée à des taux importants de mortalité. La démarche décrite dans le présent
document propose un ensemble de pratiques cliniques exemplaires (EPE) qui réduit les risques d'infection,
des outils pour s'assurer de la conformité à cet EPE ainsi que des mesures de son efficacité sur l'incidence
des pneumonies. En d'autres mots, le document suggère notamment des outils de surveillance des PAV et
des événements associés à la ventilation mécanique.
NosoBase ID notice : 381810
Dosage personnalisé des antibiotiques chez les patients de réanimation : challenges et solutions
envisagées
Roberts JA; Abdul-Aziz MH; Lipman J; Mouton JW; Vinks AA; Felton TW; et al. Individualised antibiotic
dosing for patients who are critically ill: challenges and potential solutions. The Lancet infectious diseases
2014/06; 14(6): 498-509.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; SOIN INTENSIF; REVUE DE LA LITTERATURE
Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have
severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens.
Antibiotic dosing that does not account for these features is likely to result in suboptimum outcomes. In this
Review, we explore the challenges related to patients and pathogens that contribute to inadequate antibiotic
dosing and discuss how to implement a process for individualised antibiotic therapy that increases the
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accuracy of dosing and optimises care for critically ill patients. To improve antibiotic dosing, any physiological
changes in patients that could alter antibiotic concentrations should first be established; such changes include
altered fluid status, changes in serum albumin concentrations and renal and hepatic function, and
microvascular failure. Second, antibiotic susceptibility of pathogens should be confirmed with microbiological
techniques. Data for bacterial susceptibility could then be combined with measured data for antibiotic
concentrations (when available) in clinical dosing software, which uses pharmacokinetic/pharmacodynamic
derived models from critically ill patients to predict accurately the dosing needs for individual patients.
Individualisation of dosing could optimise antibiotic exposure and maximise effectiveness.
NosoBase ID notice : 381469
Les lavabos, une source de contamination par bêta-lactamases à spectre étendu pour des patients de
réanimation que l’on peut corriger
Wolf I; Bergervoet PW; Sebens FW; van den Oever HL; Savelkoul PH; van der Zwet WC. The sink as a
correctable source of extended-spectrum β-lactamase contamination for patients in the intensive care unit.
The journal of hospital infection 2014/06; 87(2): 126-130.
Mots-clés : SOIN INTENSIF; CONTAMINATION; LAVABO; COLONISATION; TRANSMISSION; BETALACTAMASE A SPECTRE ELARGI; DESINFECTION
Between December 2010 and April 2012, intensive care unit (ICU) patients in our hospital were infrequently
colonized with extended-spectrum β-lactamase-positive bacteria (ESBLs). We hypothesized that these
ESBLs originated from patients' room sinks, and this was prospectively investigated by weekly culturing of
patients and sinks during a 20-week period. ESBLs were isolated from all 13 sinks. Four patients became
colonized with ESBLs that were genetically identical to ESBLs that had previously been isolated from the
sink. One of these patients died of pneumonia caused by the ESBL. Transmission from sinks to patients was
stopped by integrating self-disinfecting siphons to all sinks on the ICU.
Staphylococcus aureus
NosoBase ID notice : 382003
Stratégies pour prévenir la transmission et les infections à Staphylococcus aureus résistant à la
méticilline dans les hôpitaux de court séjour : mise à jour 2014
Calfee DP; Salgado CD; Milstone AM; Harris AD; Kuhar DT; Moody J; et al. Strategies to prevent methicillinresistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infection
control and hospital epidemiology 2014/07; 35(7): 772-796.
Mots-clés :
STAPHYLOCOCCUS
TRANSMISSION; COURT SEJOUR
AUREUS;
METICILLINO-RESISTANCE;
PREVENTION;
Previously published guidelines are available that provide comprehensive recommendations for detecting and
preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical
recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing
their methicillin-resistant Staphylococcus aureus (MRSA) prevention efforts. This document updates
“Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals,”
published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology
of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society
of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection
Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives
of a number of organizations and societies with content expertise. The list of endorsing and supporting
organizations is presented in the introduction to the 2014 updates.
NosoBase ID notice : 380928
Clone pédiatrique de SARM exprimant les gènes ermC plus InuA responsable de transmission
nosocomiale et de colonisation du personnel de santé dans une unité de réanimation néonatale
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Faccone D; Togneri AM; Podesta L; Perez M; Gagetti P; Sanchez S; et al. MRSA pediatric clone expressing
ermC plus lnuA genes causing nosocomial transmission and healthcare workers colonization in a neonatal
intensive care unit. Infection, genetics and evolution 2014/07; 25: 78-80.
Mots-clés : TRANSMISSION; COLONISATION; NEONATOLOGIE; SOIN INTENSIF; PEDIATRIE;
EPIDEMIE; PERSONNEL; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; TYPAGE;
ANTIBIORESISTANCE; COLONISATION NASALE; BIOLOGIE MOLECULAIRE; PCR
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of both nosocomial and communityacquired infections. We describe an outbreak caused by the MRSA Pediatric clone expressing an unusual
lincosamide resistant phenotype. Between January and May 2006, an MRSA outbreak was detected at the
Neonatal Unit of Hospital Interzonal General de Agudos "Evita", Buenos Aires Province, Argentina that
affected ten patients. Seven isolates from seven patients plus five MRSA recovered from health care workers
(nasal carriage) were studied. Two phenotypes were observed: (i) ELCi (10), resistance to erythromycin and
lincomycin and inducible resistance to clindamycin; (ii) ELiCi (2), resistance to erythromycin and inducible
resistance to lincomycin and clindamycin. All 12 MRSA were resistant to oxacillin, erythromycin and
gentamicin. Isolates expressing the ELCi-phenotype showed lincomycin MIC values between 16 and 32mg/L,
while the remaining 2 isolates with ELiCi-phenotype presented a MIC value of 0.5mg/L. No differences were
observed between the clindamycin MIC values in both phenotypes, ranging 0.25-0.5mg/L. Isolates showing
ELCi-phenotype harbored ermC plus lnuA genes, and the other two only ermC gene. All 12 isolates were
genetically related and belonged to the Pediatric clone (ST100) harboring a new variant of SCCmecIV. This is
the first MRSA outbreak expressing an unusual ELCi phenotype due to a combination of ermC plus lnuA
genes.
NosoBase ID notice : 382085
Protocoles variables de dépistage et de décolonisation des patients porteurs de Staphylococcus
aureus avant une intervention chirurgicale
Kline S; Highness M; Herwaldt LA; Perl TM. Variable screening and decolonization protocols for
Staphylococcus aureus carriage prior to surgical procedures. Infection control and hospital epidemiology
2014/07; 35(7): 880-882.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
DEPISTAGE; COLONISATION; NEZ; PRE-OPERATOIRE; CHIRURGIE
CHIRURGIE ORTHOPEDIQUE; CHIRURGIE
PROTOCOLE; SARM;
CARDIO-VASCULAIRE;
We surveyed the Society for Healthcare Epidemiology of America Research Network, the Minnesota
Association for Professionals in Infection Control and Epidemiology, and the Minnesota Hospital Association
to assess presurgical Staphylococcus aureus screening and decolonization practices. The practices varied
widely among responding facilities. The majority of respondents (63%) did not screen for S. aureus
preoperatively.
NosoBase ID notice : 382080
Comparaison entre la contamination environnementale résultant de patients infectés et celle résultant
de patients colonisés à Staphylococcus aureus résistant à la méticilline ou à entérocoques résistants
à la vancomycine : une étude multicentrique
Knelson LP; Williams DA; Gergen MF; Rutala WA; Weber DJ; Sexton DJ; et al. A comparison of
environmental contamination by patients infected or colonized with methicillin-resistant Staphylococcus
aureus or vancomycin-resistant enterococci: a multicenter study. Infection control and hospital epidemiology
2014/07; 35(7): 872-875.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; VANCOMYCINE
A total of 1,023 environmental surfaces were sampled from 45 rooms with patients infected or colonized with
methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) before
terminal room cleaning. Colonized patients had higher median total target colony-forming units (CFU) of
MRSA or VRE than did infected patients (median, 25 CFU [interquartile range, 0-106 CFU] vs 0 CFU
[interquartile range, 0-29 CFU]; P=.033).
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NosoBase ID notice : 382847
Efficacité de la daptomycine versus de la vancomycine pour les bactériémies à Staphylococcus
aureus résistant à la méticilline chez des patients souffrant d'insuffisance rénale
Weston A; Golan Y; Holcroft C; Snydman DR. The efficacy of daptomycin versus vancomycin for methicillinresistant Staphylococcus aureus bloodstream infection in patients with impaired renal function. Clinical
infectious diseases 01/06/2014; 58(11): 1533-1539.
Mots-clés : VANCOMYCINE; DAPTOMYCINE; BACTERIEMIE; EFFICACITE;
AUREUS; METICILLINO-RESISTANCE; SARM; INSUFFISANCE RENALE
STAPHYLOCOCCUS
Background: Concerns regarding the efficacy of daptomycin for methicillin-resistant Staphylococcus aureus
(MRSA) bloodstream infections in patients with impaired renal function are reflected in a recent package
insert change by the Food and Drug Administration (FDA). However, this decision was based on a small
subgroup analysis and it is unclear if this is a true association.
Methods: We conducted a retrospective cohort study of patients with MRSA bacteremia treated at a tertiary
hospital from 2001 to 2011 and who received either vancomycin or daptomycin. We used propensity score
and multivariable logistic regression to assess the outcome of treatment failure, via blinded adjudication, in
daptomycin- vs vancomycin-treated subjects and the interaction with renal function.
Results: One hundred fifty patients were analyzed, 100 in the vancomycin arm and 50 in the daptomycin arm.
The average age was 61 years, and 60% were men. Of patients treated with daptomycin or vancomycin, 29
(58%) and 51 (51%), respectively, had an estimated glomerular filtration rate (GFR) <50 mL/minute/1.73
m(2). Compared with vancomycin, the usage of daptomycin in patients was not significantly associated with
treatment failure in patients with a GFR >50 mL/minute/1.73 m(2) (odds ratio [OR], 0.45; 95% confidence
interval [CI], .11 -1.79), nor in patients with a GFR of <50 mL/minute/1.73 m(2) (OR, 0.46; 95% CI, .11 -1.94).
There was no significant interaction between them (P = .54).
Conclusions: In patients with MRSA bacteremia, daptomycin efficacy was not affected by GFR level and was
similar to vancomycin's efficacy. Although our sample size was small, it was larger than than the one used by
the FDA. However, smaller differences may be significant with a larger sample size.
Surveillance
NosoBase n° 39925 ID notice : 381534
Résultats des douze premiers mois de surveillance nationale des épidémies d’infections associées
aux soins en Allemagne, 2011/2012
Haller S; Eckmanns T; Benzler J; Tolksdorf K; Claus H; Gilsdorf A; et al. Results from the first 12 months of
the national surveillance of healthcare associated outbreaks in Germany, 2011/2012. PLoS One 2014/05/29;
9(5): 1-8.
Mots-clés : SURVEILLANCE; EPIDEMIE; INFORMATION; CLOSTRIDIUM DIFFICILE; KLEBSIELLA;
STAPHYLOCOCCUS; ANTIBIORESISTANCE; MULTIRESISTANCE
Background: In August 2011, the German Protection against Infection Act was amended, mandating the
reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany
via local public health authorities and federal states to the Robert Koch Institute (RKI).
Objective: To describe the reported HAI-outbreaks and the surveillance system's structure and capabilities.
Methods: Information on each outbreak was collected using standard paper forms and notified to RKI.
Notifications were screened daily and regularly analysed.
Results: Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks,
between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among
the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella
spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%)
bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to
bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards
(16%).
Conclusion: The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with
a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus
research and preventive measures. Increasing the sensitivity and reliability of the data collection further will
facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures
to interrupt their propagation.
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NosoBase n° 40126 ID notice : 382685
Changements dans l’incidence des pathogènes associés aux soins dans un centre hospitalier
universitaire entre 2005 et 2011
Kang J; Sickbert-Bennett EE; Brown VM; Weber DJ; Rutala WA. Changes in the incidence of health careassociated pathogens at a university hospital from 2005 to 2011. American journal of infection control
2014/07; 42(7): 770-775.
Mots-clés : INCIDENCE; CENTRE HOSPITALIER UNIVERSITAIRE; SURVEILLANCE; CLOSTRIDIUM
DIFFICILE; BACTERIEMIE; INFECTION URINAIRE; CATHETER; PNEUMONIE; VENTILATION ASSISTEE;
DISPOSITIF MEDICAL
Background: Data on health care-associated infections (HAIs) outside of intensive care units (ICU) are
scarce. We assessed hospital-wide changes in the incidence of health care-associated pathogens by
infection site and by service between 2005 and 2011.
Methods: All data on health care-associated pathogens in 2005-2011 based on comprehensive hospital-wide
surveillance were extracted from an electronic database. The incidence of HAI by pathogen was calculated
per 1000 patient-days and per 1000 device-days. Regression analyses were conducted to estimate trend
changes in the yearly incidence of pathogens for selected HAIs.
Results: The majority (8784 of 10,070; 87.2%) of the HAIs recorded over the 7-year period had at least 1
pathogen; a total of 10,585 pathogens were isolated. Overall, across all major service categories (eg, ICU,
medicine), significant trends toward decreasing incidence were observed for all pathogens except Clostridium
difficile. The decrease in incidence was greatest for central line-associated bloodstream infections, less for
catheter-associated urinary tract infections, and lowest for ventilator-associated pneumonias.
Conclusions: This study showed significant decreases in incidence of the majority of HAIs caused by various
pathogens, but significant increases in patient-days during the study period. Only HAIs due to C difficile
showed a significantly increased incidence.
NosoBase ID notice : 381953
Le programme national de surveillance italien des infections du site opératoire et son impact positif,
2009 à 2011
Marchi M; Pan A; Gagliotti C; Morsillo F; Parenti M; Resi D; et al. The Italian national surgical site infection
surveillance programme and its positive impact, 2009 to 2011. Eurosurveillance 2014/05; 19(21): 1-7.
Mots-clés : SURVEILLANCE; TAUX; CHIRURGIE; STATISTIQUE; SORTIE; INFECTION
Programmes surveying surgical site infection (SSI) have been implemented throughout the world and are
associated with a reduction in SSI rates. We report data on non-prosthetic surgery from the Italian SSI
surveillance programme for the period 2009 to 2011. Participation in the programme was voluntary. We
evaluated the occurrence of SSI, based on protocols from the European Centre for Disease Prevention and
Control, within 30 days of surgery. Demographic data, risk factors, type of surgery and presence of SSI were
recorded. The National Coordinating Centre analysed the pooled data. On 355 surgical wards 60,460
operations were recorded, with the number of surveyed intervention doubling over the study period. SSI was
observed in 1,628 cases (2,6%) and 60% of SSI were diagnosed through 30-days post discharge
surveillance. Operations performed in hospitals with at least two years of surveillance showed a 29% lower
risk of SSI. Longer intervention duration, American Society of Anesthesiologists’ (ASA) score of at least three,
and pre-surgery hospital stay of at least two days were associated with increased risk of SSI, while
videoscopic procedures had reduced SSI rates. Implementation of a national surveillance programme was
helpful in reducing SSI rates and should be prioritised in all healthcare systems.
Transport sanitaire
NosoBase ID notice : 380955
Capacité de transport pour des patients présentant des maladies hautement infectieuses en Europe :
étude auprès de 16 nations
Schilling S; Maltezou HC; Fusco FM; De laco G; Brodt HR; Bannister B; et al. Transportation capacity for
patients with highly infectious diseases in Europe: a survey in 16 nations. Clinical microbiology and infection
2014; in press: 16 pages.
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NosoVeille – Bulletin de veille
Mots-clés : TRANSMISSION; RESEAU; RECOMMANDATION;
EQUIPEMENT; TRANSPORT; TRANSPORT SANITAIRE; SECURITE
Juillet 2014
PROTOCOLE;
DESINFECTION;
Highly Infectious Diseases (HIDs) are defined as being transmissible from person to person, causing life
threatening illnesses and presenting a serious public health hazard. In most European Union member states
(MS) specialised isolation facilities are responsible for the management of such cases. Ground ambulances
often affiliated with those facilities as rapid relocation of patients is most desirable. To date, no pooled data on
the accessibility, technical specifications and operational procedures for such transport capacities are
available. During 2009, the "European Network for HIDs" conducted a cross-sectional analysis of hospitals
responsible for HID patients in Europe including an assessment of (i) legal aspects; (ii) technical and
infrastructure aspects; and (iii) operational procedures for ground ambulances used for HID transport. Overall,
48 isolation facilities in 16 European countries were evaluated and feedback rates ranged from 78% to 100%
(n=37-48 centres). Only 46.8% (22/47) of all centres have both national and local guidelines regulating HID
patient transport. If recommended, specific equipment is found in 90% of centres (n=9/10), but standard
ambulances in 6/13 centres (46%), only. Exclusive entrances (n=32/45; 71%) and pathways (n=30/44;
68.2%) for patient admission as well as protocols for disinfection of ambulances (n=34/47; 72.3%) and
equipment (n=30/43; 69.8%) exist in the majority of centres. In conclusion, the availability and technical
specifications of ambulances broadly differ, reflecting different preparedness levels within the EU. Hence,
regulations for technical specifications and operational procedures should be harmonized in order to promote
patient and health-care workers safety.
Travaux hospitaliers
NosoBase ID notice : 381888
Ouverture d'un nouveau bâtiment d'hématologie : mesures mises en oeuvre pour la mise en eau et le
suivi bactériologique.
Coudrais S; Gardes S; Charel P; Droguet J; Perraud M; Jarraud S; et al. Ouverture d'un nouveau bâtiment
d'hématologie : mesures mises en oeuvre pour la mise en eau et le suivi bactériologique. Hygiènes 2014/05;
22(2): 123-132.
Mots-clés : MESURE D'HYGIENE; HYGIENE HOSPITALIERE; ARCHITECTURE; CONSTRUCTION;
LOCAUX HOSPITALIERS; CANCEROLOGIE; DISTRIBUTION D'EAU; HYGIENE DU MILIEU;
PREVENTION; GESTION DES RISQUES; LEGIONELLOSE; HEMATOLOGIE; TRAVAUX HOSPITALIERS;
EAU; LEGIONELLA; PSEUDOMONAS AERUGINOSA; LEGIONELLA ANISA; PRELEVEMENT;
CONTROLE; EAU CHAUDE
Objectif : La construction d’un nouveau bâtiment d’hématologie nécessite une réflexion multidisciplinaire et
des mesures de prévention dès la conception, afin de maîtriser la colonisation du réseau par Legionella et
Pseudomonas aeruginosa.
Méthodes : Le bâtiment a été construit avec un système de pasteurisation. La mise en eau a été retardée
autant que possible, les purges ont été initiées immédiatement, de même que les contrôles (Legionella
quantifiées par culture et PCR (Polymerase Chain Reaction), flore totale à 22 °C et à 37 °C et Pseudomonas
aeruginosa).
Résultats : L’environnement : décembre 2010-février 2012 : aucune Legionella n’a été détectée par culture ;
le suivi en PCR a montré des valeurs de 103 à 104 unités génomiques par litre pour Legionella spp. Les
résultats pour Legionella pneumophila sont toujours restés inférieurs à la limite de quantification et souvent
inférieurs à la limite de détection. Un cas de légionellose dû à Legionella anisa a été diagnostiqué en février
2012 par PCR. À la suite de ce cas, des mesures correctives ont été mises en place. Ultérieurement, une
colonisation croissante du réseau a conduit au maintien de filtres et à la réalisation de chocs chimiques.
Conclusion : Cette étude montre qu’une faible colonisation par Legionella anisa peut être responsable de cas
de légionellose, même si seule la présence d’ADN de Legionella dans l’environnement est détectée. Pour les
services avec des patients à haut risque, le suivi régulier de l’eau froide et de l’eau chaude sanitaire en PCR,
avec des seuils définis serait une exigence plus adaptée.
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NosoVeille – Bulletin de veille
Juillet 2014
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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