Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
NosoVeille – Bulletin de veille 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 Pour recevoir, tous les mois, NosoVeille dans votre messagerie : 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 1 / 38 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. 2 / 38 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 3 / 38 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 4 / 38 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. 5 / 38 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 6 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 7 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 8 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 9 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 10 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 11 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 12 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 13 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 14 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 15 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 16 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 18 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 19 / 38 NosoVeille – Bulletin de veille Juillet 2014 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) 20 / 38 NosoVeille – Bulletin de veille 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 21 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 22 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 23 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 24 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 25 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 26 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 27 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 28 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 29 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 30 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 31 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 32 / 38 NosoVeille – Bulletin de veille Juillet 2014 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 33 / 38 NosoVeille – Bulletin de veille Juillet 2014 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). 34 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 35 / 38 NosoVeille – Bulletin de veille Juillet 2014 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. 36 / 38 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. 37 / 38 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] 38 / 38