NosoVeille - juin 2010

NosoVeille – Bulletin de veille
juin 2010
.
NosoVeille n°6
Juin 2010
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications
scientifiques publiées au cours du mois écoulé.
La recherche documentaire est effectuée dans la base de données
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro
Antibiotique
Cathétérisme
Clostridium
Enterococcus
Environnement
Epidémie
Gale
Grippe
Hépatite
Hygiène des mains
Maladie de Creutzfeld-Jakob
Maternité
Médecine ambulatoire
Pédiatrie
Personnel
Pneumonie
Soins intensifs
Staphylococcus
Surveillance
Tuberculose
Usager
Vaccination
CCLIN Sud-Est – [email protected]
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Antibiotique
NosoBase n° 27242
Critères d'ajustement facilement disponibles pour la comparaison de la consommation des
antibiotiques dans un milieu hospitalier : expérience en France
Amadeo B; Dumartin C; Robinson P; Venier AG; Parneix P; Gachie JP; et al. Easily available adjustment
criteria for the comparison of antibiotic consumption in a hospital setting: experience in France. Clinical
microbiology and infection 2010/06; 16(6): 735-741.
Mots-clés : ANTIBIOTIQUE; CONSOMMATION; DDJ; BACTERIEMIE; CATHETER VEINEUX CENTRAL;
STATISTIQUE; DUREE DE SEJOUR
Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that this differs
among hospitals. The aim of the current study was to identify relevant and easily available adjustment
criteria for the purpose of benchmarking. We analysed data from 34 public non-teaching hospitals and 43
private hospitals located in south-western France and overseas departments using retrospective data from
2005. This study investigated the relationship between AbC expressed as defined daily doses per 1000
patient-days (DDD/1000 PDs) or per 100 admissions (DDD/100 admissions) and the number of venous
central lines, the number of episodes of bacteraemia and various hospital characteristics. The relationship
was tested using multiple linear analyses. The median total AbC in public hospitals was 395 DDD/1000 PDs
(range, 196-737) and 341 DDD/100 admissions (range, 180-792). In private hospitals this was 422
DDD/1000 PDs (range, 113-717) and 212 DDD/100 admissions (range, 38-510). The best model for public
hospitals included the proportion of PDs in surgery, intensive care and medical wards and explained 84% of
the variability in AbC expressed as DDD/1000 PDs. For private hospitals, the mean length of stay and the
proportion of PDs in surgery and medical wards explained 68% of the variability in AbC expressed as
DDD/100 admissions. Overall, this French experience shows that relevant adjustment criteria for the
comparison among hospitals are easily available. It is important that each country establish its own model
considering the intrinsic peculiarities of the hospital system and taking into account both indicators
(DDD/1000 PDs or DDD/100 admissions) to design the best model.
NosoBase n° 27112
Rôle potentiel d’une surveillance active dans le contrôle d’une épidémie à Klebsiella pneumoniae
résistant aux carbapénèmes sur l’ensemble de l’hôpital
Ben-David D; Maor Y; Keller N; Regev-Yochay G; Tal I; Shachar D; et al. Potential role of active surveillance
in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infection
control and hospital epidemiology 2010/06; 31(6): 620-626.
Mots-clés : SURVEILLANCE; EPIDEMIE; KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE;
CARBAPENEME; ENTEROBACTERIE; TAUX; INCIDENCE; PRECAUTION CONTACT; COLONISATION;
CENTRE HOSPITALIER UNIVERSITAIRE
The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for
hospitalized patients, and effective strategies are needed.
Objective: To assess the effect of an intensified intervention, which included active surveillance, on the
incidence of infection with carbapenem-resistant Klebsiella pneumoniae.
Setting: Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.
Design. Quasi-experimental study.
Methods: The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae
infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to
contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical
carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series
analysis was performed.
Results: The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from
the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical
microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a
nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal
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colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or
infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact
precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of
infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K.
pneumoniae infection.
Conclusions: The use of active surveillance and contact precautions, as part of a multifactorial intervention,
may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K.
pneumoniae colonization or infection.
NosoBase n° 27316
Prescription et surveillance des antibiotiques
Gras G; Choutet P. La Revue du praticien 2010/04/20; 60: 573-579.
Mots-clés : ANTIBIOTIQUE; SURVEILLANCE; ANTIBIORESISTANCE; PRESCRIPTION
Le principal objectif d'un bon usage des antiobiotiques est d'obtenir la prévention ou une guérison complète
et définitive d'une infection bactérienne et donc du malade en ayant une efficacité optimale, une bonne
tolérance, des effets indésirables, dont la résistance bactérienne, minimaux et un coût acceptable pour la
société. Une antibiothérapie adaptée impose au préalable un diagnostic précis. Ne sont pas abordées les
antibiothérapies par voie locale (aérosols, cutanées, ORL, oculaires).
NosoBase n° 27265
Analyse bénéfice-risque de la restriction de prescription des antibiotiques chez les enfants : que
devons-nous vraiment savoir ?
Keith T; Saxena S; Murray J; Sharland M. Risk-benefit analysis of restricting antimicrobial prescribing in
children: what do we really know? Current opinion in infectious diseases 2010/06; 23(3): 242-246.
Mots-clés : ANALYSE; ANTIBIOTIQUE; PRESCRIPTION; PEDIATRIE; RISQUE; ANTIBIORESISTANCE;
TOLERANCE; EFFET INDESIRABLE; COUT; APPAREIL RESPIRATOIRE; COMPLICATION
Purpose of review: Most childhood respiratory infections including acute otitis media (AOM), sore throat,
upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive
guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance,
antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of
rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This
review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in
children.
Recent findings: From a key observational study reporting antibiotic use in children, the calculated excess
risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic
was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of
antibiotics upon the risk of brain abscess after sinusitis in children.
Summary: New information from observational studies suggests antibiotics show little benefit in preventing
complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following
URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and
optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for
antibiotic prescription.
NosoBase n° 27251
Prévention et contrôle des infections nosocomiales et résistance aux antibiotiques en Europe ;
d'abord ne pas nuire : éléments de prévention réussie et contrôle des infections associées aux soins
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Mielke M. Prevention and control of nosocomial infections and resistance to antibiotics in Europe - Primum
non-nocere: elements of successful prevention and control of healthcare-associated infections. International
journal of medical microbiology 2010; in press: 5 pages.
Mots-clés : PREVENTION;
SURVEILLANCE
CONTROLE;
ANTIBIORESISTANCE;
EUROPE;
RECOMMANDATION;
October 2004, the WHO launched the World Alliance for Patient Safety. In 2006, the Council of Europe
adopted a recommendation on the management of patient safety and prevention of adverse events in
healthcare to acknowledge that patients can expect each EU health system to secure a systematic approach
to ensuring patient safety. This review is a compilation of broadly accepted instruments for the prevention
and control of healthcare-associated infections and resistance to antibiotics in Europe. Antibiotic-resistant
bacteria do not stop at the exit of a hospital. The implementation of the various elements of a whole bundle
of recommended prevention and control measures in the context of interacting healthcare institutions
including long-term care, rehabilitation facilities, ambulatory care practices, and home care, is therefore
facilitated by the establishment of regional networks and the integration of prevention and control strategies
into disease management programmes. In order to increase efficiency of prevention and control measures,
there is a need for the careful design of interventional studies to figure out the most efficient single or bundle
of preventive measures. In addition, methods for the discovery of clusters on the basis of routinely obtained
data should be improved.
NosoBase n° 27128
Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Acutalisation 2010
SFAR; Martin C; Auboyer C; Dupont H; Gauzit R; Kitzis M; et al. 2010/04; 1-29.
Mots-clés :
ANTIBIOPROPHYLAXIE;
ANTIBIOTIQUE;
CHIRURGIE;
RECOMMANDATION;
NEUROCHIRURGIE;
CHIRURGIE
OPHTALMOLOGIQUE;
CHIRRUGIE
CARDIOVASCULAIRE;
CHIRURGIR ORTHOPEDIQUE; TRAUMATOLOGIE; STOMATOLOGIE; CHIRURGIE DIGESTIVE;
CHIRURGIE ORL; CHIRURGIE GYNECOLOGIQUE; RADIOLOGIE; ENDOCARDE
Recommandations
interventionnelle.
de
la
SFAR
concernant
l’antibioprophylaxie
en
chirurgie
et
en
médecine
NosoBase n° 27097
Utilité de la prophylaxie antibiotique avant un geste dentaire pour les porteurs de prothèses totales
du genou ou de la hanche
Uckay I; Hoffmeyer P; Trampuz A; Borens O; Terzic A; Scolozzi P; et al. Revue médicale suisse 2010/04/07;
: 727-730.
Mots-clés : ANTIBIOPROPHYLAXIE; PROTHESE TOTALE DE GENOU; PROTHESE TOTALE DE
HANCHE; ODONTOLOGIE; BACTERIEMIE; EFFICACITE; MICROBIOLOGIE; RECOMMANDATION
Il est d'usage de prescrire une prophylaxie antibiotique aux patients porteurs de prothèses totales de la
hanche ou de genou avant un geste dentaire. Cette attitude ne résiste pas à une analyse critique de
l'évidence scientifique pour plusieurs raisons :
1) les pathogènes habituels de l'infection de prothèse ne sont pas de provenance buccale ;
2) même si administrés, les antibiotiques n'empêchent pas complètement des bactériémies occultes liées au
traitement dentaire ;
3) l'être humain vit jusqu'à douze épisodes de bactériémies occultes d'origine dentaire par jour. Il importe
donc de distinguer les situations d'infection buccale avérée dans lesquelles la prophylaxie antibiotique reste
bien évidemment nécessaire. Une bonne hygiène dentaire est importante en termes de prévention et doit
être encouragée chez tout porteur d'arthroplastie.
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Cathétérisme
NosoBase n° 27248
Efficacité et tolérance de la daptomycine dans le traitement des bactériémies à pathogènes à Gram
positif liées aux cathéters chez des patients atteints de cancer
Chaftari AM; Hachem R; Mulanovich V; Chemaly RF; Adachi J; Jacobson K; et al. Efficacy and safety of
daptomycin in the treatment of Gram-positive catheter-related bloodstream infections in cancer patients.
International journal of antimicrobial agents 2010; in press: 5 pages.
Mots-clés : DAPTOMYCINE; EFFICACITE; TOLERANCE; BACTERIEMIE; BACTERIE A GRAM POSITIF;
CATHETER; CANCER; VANCOMYCINE; ANTIBIORESISTANCE; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; ETUDE PROSPECTIVE
Excessive vancomycin usage has contributed to the emergence of vancomycin-resistant enterococci, and a
high vancomycin minimal inhibitory concentration (MIC) >1.0mug/mL has been associated with poor
outcome in patients with meticillin-resistant Staphylococcus aureus (MRSA) infection. In view of these
limitations, there is a need for an alternative agent. We evaluated the clinical efficacy and safety of
daptomycin given as an alternative agent in the treatment of Gram-positive catheter-related bloodstream
infections (CRBSIs) in cancer patients. Between June 2006 and March 2008, 40 patients with probable or
definite CRBSI caused by Gram-positive organisms were prospectively enrolled to receive daptomycin
intravenous 6mg/kg/day for up to 4 weeks. In addition, 40 historical matched control patients treated with
vancomycin were retrospectively identified. The control group was matched based on underlying disease,
organism and neutropenic status. The daptomycin group was comparable with the vancomycin group in
terms of neutropenia rate, complications, adverse events, length of hospital stay and death. However, more
patients in the daptomycin group achieved symptom resolution at 48h compared with the vancomycin group
(76% vs. 53%; P=0.04). Similarly, more patients in the daptomycin group achieved microbiological
eradication at 48h compared with the vancomycin group (78% vs. 34%; P<0.001). Although not significant,
nephrotoxicity was almost three-fold lower in the daptomycin group. The overall response was significantly
better for daptomycin compared with vancomycin (68% vs. 32%; P=0.003). In conclusion, compared with
vancomycin, daptomycin treatment of Gram-positive CRBSI in cancer patients was significantly associated
with earlier clinical and microbiological response as well as improved overall response.
NosoBase n° 27234
Désinfection cutanée à l'aide de chlorhydrate d'octénidine pour le site d'insertion du cathéter
veineux central : essai contrôlé, randomisé, en double aveugle
Dettenkofer M; Wilson C; Gratwohl A; Schmoor C; Bertz H; Frei R; et al. Skin disinfection with octenidine
dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Clinical
microbiology and infection 2010/06; 16(6): 600-606.
Mots-clés : PEAU; CATHETER VEINEUX CENTRAL; ANTISEPTIQUE; ESSAI THERAPEUTIQUE;
ALCOOL; BACTERIEMIE; COLONISATION CUTANEE; PREVENTION; RANDOMISATION
To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation
and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a
double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit
of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different
skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol,
and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site;
(ii) positive culture from the catheter tip (>/=15 CFU); and (iii) occurrence of CVC-associated bloodstream
infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were
enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics
and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly
reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p
<0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%)
than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine
had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44;
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95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial
supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better
option than alcohol alone for the prevention of CVC-associated infections.
NosoBase n° 27243
Développement de bactériémie ou de fongémie après ablation de cathéters veineux centraux
colonisés chez des patients présentant des hémocultures concomitantes négatives
Park KH; Song EH; Jang EY; Lee EJ; Chong YP; Choi SH; et al. Development of bacteraemia on fungaemia
after removal of colonized central venous catheters in patients with negative concomitant blood cultures.
Clinical microbiology and infection 2010/06; 16(6): 742-746.
Mots-clés : COLONISATION; CATHETER
HEMOCULTURE; MICROBIOLOGIE
VEINEUX
CENTRAL;
BACTERIEMIE;
FONGEMIE;
There are limited data on the clinical significance of positive central venous catheter (CVC) tip cultures
associated with concomitant negative blood cultures performed at the time of CVC removal. A retrospective
cohort study of all patients who yielded isolated positive CVC tip cultures was conducted in a tertiary-care
hospital with 2200 beds during a 10-year period. All patients with isolated positive CVC tip cultures were
observed for the development of subsequent bacteraemia or fungaemia between 2 and 28 days after CVC
removal. An isolated positive CVC tip culture was defined as a case in which (i) a CVC tip culture yielded
>/=15 colonies using a semiquantitative culture method and (ii) at least two sets of blood samples revealed
no organism at, or close to, the time of CVC removal (48 h before to 48 h after CVC removal). During the
study period, 312 patients with isolated positive CVC cultures were enrolled. Eight (2.6%; 95% CI 1.2-5.1) of
the 312 patients yielding isolated bacterial or fungal CVC tip cultures developed subsequent bloodstream
infection (BSI) caused by the same species as that isolated from the tip culture (Staphylococcus aureus, 1:
Enterococcus spp.; 2: Pseudomonas aeruginosa; and 3: Candida spp.). Among 125 patients from whose
CVC tips the above four organisms were grown, seven (12.3%) of 57 patients who did not receive
appropriate antibiotic therapy within 48 h after CVC removal subsequently developed BSI, but only one
(1.5%) of 68 patients who did receive appropriate therapy developed BSI (OR 0.11, p 0.02).
NosoBase n° 27290
Impacts bactéricides des sondes endotrachéales imprégnées d'argent et de dioxyde de titane sur
Pseudomonas aeruginosa et Staphylococcus aureus
Tarquinio KM; Kothurkar NK; Goswami DY; Sanders RC; Zaritsky AL; Levine AM. Bactericidal effects of
silver plus titanium dioxide-coated endotracheal tubes on Pseudomonas aeruginosa and Staphylococcus
aureus. International journal of nanomedicine 2010/04/07; 5: 177-183.
Mots-clés : STAPHYLOCOCCUS AUREUS; BACTERICIDIE; PSEUDOMONAS AERUGINOSA;
CATHETER IMPREGNE; INTUBATION; PNEUMONIE; VENTILATION ASSISTEE; PREVENTION;
COLONISATION
Purpose: Ventilator-associated pneumonia (VAP) is a nosocomial infection resulting in significant morbidity
and mortality. Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) are
pathogens associated with VAP. Silver (Ag) coating of endotracheal tubes (ETTs) reduces bacterial
colonization, however titanium dioxide (TiO(2)) coating has not been studied.
Methods: Five types of ETT coatings were applied over silica layer: Ag, solgel TiO(2), solgel TiO(2) with Ag,
Degussa P25 TiO(2) (Degussa TiO(2)), and Degussa TiO(2) with Ag. After ETTs were incubated with P.
aeruginosa or S. aureus; colonization was determined quantitatively.
Results: Pseudomonas aeruginosa and S. aureus grew for 5 days on standard ETTs. Compared to standard
ETTs, P. aeruginosa growth was significantly inhibited by solgel TiO(2) with Ag at 24 hours, and by Degussa
TiO(2) with Ag at 24 and 48 hours after inoculation. No significant difference in S. aureus growth was
observed between the control and any of the five coatings for 5 days.
Conclusion: In vitro, solgel TiO(2) with Ag and Degussa TiO(2) with Ag both attenuated P. aeruginosa
growth, but demonstrated no effect on S. aureus colonization. Further studies using alternative coating and
incorporating UV light exposure are needed to identify their potential utility in reducing VAP.
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Clostridium
NosoBase n° 27115
Pseudo-épidémie d’infections à Clostridium sordellii suite à une probable contamination croisée
dans un laboratoire de microbiologie hospitalier
Aronoff DM; Thelen T; Walk ST; Petersen K; Jackson J; Grossman S; et al. Pseudo-outbreak of Clostridium
sordellii infection following probable cross-contamination in a hospital clinical microbiology laboratory.
Infection control and hospital epidemiology 2010/06; 31(6): 640-642.
Mots-clés : LABORATOIRE; MICROBIOLOGIE; CLOSTRIDIUM; CONTAMINATION
We report a pseudo-outbreak of infection caused by Clostridium sordellii, an uncommon human pathogen.
The pseudo-outbreak involved 6 patients and was temporally associated with a change by the clinical
microbiology laboratory in the protocol of handling anaerobic culture specimens. All isolates were genetically
indistinguishable from a laboratory reference strain used for quality control.
NosoBase n° 27247
Synthèse sur la prise en charge médicale et chirurgicale des infections à Clostridium difficile
Faris B; Blackmore A; Haboubi N. Review of medical and surgical management of Clostridium difficile
infection.Techniques in coloproctology 2010; in press: 9 pages.
Mots-clés :
CLOSTRIDIUM
DIFFICILE;
BIBLIOGRAPHIE;
TRAITEMENT;
MICROBIOLOGIE; DIAGNOSTIC; ENDOSCOPIE; CHIRURGIE; MORTALITE
EPIDEMIOLOGIE;
Clostridium difficile infection (CDI) has become an important area in our daily clinical practice. C. difficile is
known to cause a broad spectrum of conditions ranging from asymptomatic carriage, through mild or
moderately severe disease with watery diarrhoea, to the life-threatening pseudomembranous colitis (PMC),
with toxic megacolon and ileus. Peoples who have been treated with broad-spectrum antibiotics, patients
with serious underlying co-morbidities and the elderly are at greatest risk. Over 80% of CDIs reported are in
people aged over 65. Due to the alarming increase in its frequency, appearance of more virulent strains and
occasional need for life-saving surgical intervention, a more coherent multidisciplinary approach is needed.
Combination of rapid turn round time and accurate diagnosis will result in a better management of CDI and a
timely implementation of infection control measure. Discontinuation of causative agents such as antibiotic
treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the
treatment of choice. Relapses of CDI have been reported in about 20-25% of cases, this may increase to
45-60% after the first recurrence. Patients should be treated as soon as possible when the diagnosis of
Clostridium difficile colitis is made to avoid sepsis or bowel perforation. Colectomy may improve the outcome
of the patient with systemic or complicated Clostridium difficile colitis. This article reviews the changing
epidemiological picture, microbiology, histopathology and both medical and surgical managements.
NosoBase n° 27103
Efficacité des solutions hydro-alcooliques pour éliminer les spores de Clostridium difficile des
mains
Jabbar U; Leischner J; Kasper D; Gerber R; Sambol SP; Parada JP; et al. Effectiveness of alcohol-based
hand rubs for removal of Clostridium difficile spores from hands. Infection control and hospital epidemiology
2010/06; 31(6): 565-570.
Mots-clés : CLOSTRIDIUM DIFFICILE; SOLUTION HYDROALCOOLIQUE; HYGIENE DES MAINS;
LAVAGE SIMPLE DES MAINS
Background: Alcohol-based hand rubs (ABHRs) are an effective means of decreasing the transmission of
bacterial pathogens. Alcohol is not effective against Clostridium difficile spores. We examined the retention
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of C. difficile spores on the hands of volunteers after ABHR use and the subsequent transfer of these spores
through physical contact.
Methods: Nontoxigenic C. difficile spores were spread on the bare palms of 10 volunteers. Use of 3 ABHRs
and chlorhexidine soap-and-water washing were compared with plain water rubbing alone for removal of C.
difficile spores. Palmar cultures were performed before and after hand decontamination by means of a plate
stamping method. Transferability of C. difficile after application of ABHR was tested by having each
volunteer shake hands with an uninoculated volunteer.
Results: Plain water rubbing reduced palmar culture counts by a mean (+/- standard deviation [SD]) of 1.57
+/- 0.11 log(10) colony-forming units (CFU) per cm(2), and this value was set as the zero point for the other
products. Compared with water washing, chlorhexidine soap washing reduced spore counts by a mean (+/SD) of 0.89 +/- 0.34 log(10) CFU per cm(2); among the ABHRs, Isagel accounted for a reduction of 0.11 +/0.20 log(10) CFU per cm(2) ([Formula: see text]), Endure for a reduction of 0.37 +/- 0.42 log(10) CFU per
cm(2) ([Formula: see text]), and Purell for a reduction of 0.14 +/- 0.33 log(10) CFU per cm(2) ([Formula: see
text]). There were no statistically significant differences between the reductions achieved by the ABHRs;
only Endure had a reduction statistically different from that for water control rubbing ([Formula: see text]).
After ABHR use, handshaking transferred a mean of 30% of the residual C. difficile spores to the hands of
recipients.
Conclusions: Hand washing with soap and water is significantly more effective at removing C. difficile spores
from the hands of volunteers than are ABHRs. Residual spores are readily transferred by a handshake after
use of ABHR.
NosoBase n° 27104
Révision des techniques d’hygiène des mains et de la communication sur ce sujet au moment où les
colonisations et les infections à Clostridium difficile augmentent
Ellingson K; Mcdonald C. Reexamining methods and messaging for hand hygiene in the era of increasing
Clostridium difficile colonization and infection. Infection control and hospital epidemiology 2010/06; 31(6):
571-573.
Mots-clés : CLOSTRIDIUM
FORMATION
DIFFICILE;
COLONISATION;
INFECTION;
HYGIENE
DES
MAINS;
Réponse à l’article n° 27103.
NosoBase n° 27255
Infection associée à Clostridium difficile acquise en réanimation neurologique
Musa SA; Robertshaw H; Thomson SJ; Cowan ML; Rahman TM. Clostridium difficile-associated disease
acquired in the neurocritical care unit. Neurocritical care 2010; in press: 6 pages.
Mots-clés : CLOSTRIDIUM DIFFICILE; SOIN INTENSIF; PREVALENCE; NEUROLOGIE; FACTEUR DE
RISQUE; ANTIBIOTIQUE; NEUROCHIRURGIE
Background: Clostridium difficile is an important cause of nosocomial infection on the intensive care unit.
Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to
determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease
(CDAD) acquired on the NICU.
Methods: Patients on NICU with a positive stool Clostridium difficile toxin assay, from August 2004 to
February 2008, were identified by the Department of Microbiology. Each patient's medical notes and charts
were reviewed in turn. Patients with a positive assay within 48 h of NICU admission were excluded.
Results: Twenty-one (0.6%) NICU patients developed CDAD. All were emergency admissions, 18 (86.0%)
were neurosurgical. Subarachnoid hemorrhage was the most common diagnosis, 5 (23.8%) patients.
Median age and APACHE II score on admission were 55 (IQR 40-66) and 21 (IQR 16-24), respectively.
Thirteen (61.9%) patients were female. Median interval between NICU admission and diarrhea onset and
CDAD diagnosis were 5 (3-8) days and 7 (4-12) days, respectively. At the time of diagnosis most, 11
(52.4%) patients, had moderate CDAD. Previously identified risk factors for ICU-acquired CDAD comprised:
age > 65 (6), antibiotics (21), and medical device requirements (21). Five (23.8%) patients deteriorated
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clinically as a result of CDAD. The overall in-hospital mortality for those with NICU acquired CDAD was
19%.
Conclusions: Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may
experience complications. Prospective validation of severity definitions and treatment guidelines may help to
reduce the complication rates.
Enterococcus
NosoBase n° 27232
Prise en charge des infections à entérocoques multirésistants aux antibiotiques
Arias CA; Contreras GA; Murray BE. Management of multidrug-resistant enterococcal infections.
Clinical microbiology and infection 2010/06; 16(6): 555-562
Mots-clés : BIBLIOGRAPHIE; MULTIRESISTANCE; ENTEROCOCCUS; ENTEROCOCCUS FAECIUM;
ANTIBIORESISTANCE; AMPICILLINE; VANCOMYCINE; AMINOSIDE; TRAITEMENT; ENTEROCOCCUS
FAECALIS
Enterococci are organisms with a remarkable ability to adapt to the environment and acquire antibiotic
resistance determinants. The evolution of antimicrobial resistance in these organisms poses enormous
challenges for clinicians when faced with patients affected with severe infections. The increased prevalence
and dissemination of multi-drug resistant Enterococcus faecium worldwide has resulted in a major decrease
in therapeutic options, since the majority of E. faecium isolates are now resistant to ampicillin, vancomycin
and exhibit high-level resistance to aminoglycosides, three of the traditionally most useful anti-enterococcal
antibiotics. Newer antibiotics such as linezolid, daptomycin and tigecycline have good in vitro activity against
enterococcal isolates but their clinical use may be limited in certain clinical scenarios due to reduced rates of
success, possible underdosing for enterococci and low serum levels, respectively, and also by the
emergence of resistance. The experimental agent oritavancin may offer some hope for the treatment of
vancomycin-resistant enterococci but clinical data are still lacking. Thus, optimal therapies for the treatment
of multi-drug resistant enterococcal infections continue to be based on empirical observations and
extrapolations from in vitro and animal data. Clinical studies evaluating new strategies, including
combination therapies to treat severe vancomycin-resistant E. faecium infections are urgently needed.
NosoBase n° 27257
Nouveau test PCR multiplex pour la détection simultanée d'entérocoques résistant à la vancomycine
dans des prélèvements rectaux
Benadof D; San Martin M; Aguirre J; Paredes L; Malig R; Melo F; et al. A new multiplex PCR assay for the
simultaneous detection of vancomycin-resistant enterococci from rectal swabs. The Journal of infection
2010; (60): 354-359.
Mots-clés
:
PCR
MULTIPLEX;
PRELEVEMENT;
ENTEROCOCCUS;
VANCOMYCINE;
ANTIBIORESISTANCE; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; BIOLOGIE
MOLECULAIRE; DIAGNOSTIC; ENTEROCOCCUS FAECIUM; ENTEROCOCCUS FAECALIS;
SENSIBILITE; SPECIFICITE
Objectives: This study describes the diagnostic performance of a recently available multiplex PCR-based kit
for the simultaneous detection and identification of Enterococcus faecium, Enterococcus faecalis, vanA,
vanB, vanC1 and vanC2/C3 genes, directly from rectal swabs constituting the most complete existing
molecular assay currently available.
Methods: The diagnostic performance of this assay was evaluated by a multicenter study involving three
independent public hospitals and consisted in the analysis of 187 rectal swabs from patients at high risk for
vancomycin-resistant enterococci colonization.
Results: When bacteria culture was used as the gold standard, the sensitivity, specificity, positive and
negative predicted values for the assay were 96.8%, 76.0%, 67.7% and 97.9%, respectively. When a
composite reference standard consisting of culture and DNA sequencing of PCR products was used as the
gold standard, the sensitivity, specificity, positive and negative predicted values for the PCR-based assay
were 97.8%, 96.9%, 96.7% and 97.9%, respectively.
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Conclusions: Based on these results, we conclude that this assay is considerably more sensitive than
traditional microbiological methods for detecting vancomycin-resistant enterococci from rectal swabs. It is
also much faster than culture. We believe that the implementation of this assay in routine clinical
laboratories could help to reduce hospital-acquired vancomycin-resistant enterococci infections.
Environnement
NosoBase n° 27206
Réduction de la surface de contamination bactérienne dans l'environnement hospitalier par
application d'un nouveau produit à effet rémanent
Hedin G; Rynback J; Lore B. Reduction of bacterial surface contamination in the hospital environment by
application of a new product with persistent effect. The Journal of hospital infection 2010/06; 75(2): 112-115.
Mots-clés : CONTAMINATION; SURFACE; ENVIRONNEMENT; DESINFECTANT; BIGUANIDE; TEST
The benefit of routine surface disinfection in hospitals has been discussed. In this study we have
investigated a new product, Appeartex. After application on surfaces a remnant effect is achieved due to the
positive charge of the active molecule. We studied the persistent effect of Appeartex one day after
application in both an experimental study in the laboratory and a field study in a hospital ward. Surfaces of
bedside tables were investigated. In the experimental study, large inocula of >or=10(6)cfu of S. aureus or
enterococci were inoculated on to well-defined areas which had been treated/not treated with Appeartex.
One hour later, samples were taken with a swab rinse technique. A reduction in the number of viable
bacteria in the magnitude 10-10(3) cfu was seen due to the effect of Appeartex. In the field study the effect
on naturally occurring low level contamination was studied. Defined surfaces on bedside tables used by
patients were treated/not treated with Appeartex. One day later, samples were taken with contact agar
plates and with a new swab method using two sequential nylon flocked swabs. Significantly fewer bacteria
were found on Appeartex-treated surfaces compared with untreated surfaces. The median counts on
Appeartex-treated surfaces were 10 cfu/50 cm(2), and on untreated surfaces 20 cfu/50 cm(2). There was no
significant difference in the number of bacteria found by culture of samples taken with the contact agar
method compared with samples taken using the nylon flocked swab method.
NosoBase n° 27332
Les cadres font "verdir" l'hôpital
Langlois G. Objectif soins 2010/05; (186): 19-21.
Mots-clés : ENVIRONNEMENT ; STRUCTURE DE SOINS ; NETTOYAGE; VAPEUR; JAVEL;
BIONETTOYAGE; DIALYSE RENALE
Elle a beau ne concerner que la construction, la norme de haute qualité environnementale (HQE) a cela de
bon qu'elle modifie les conditions de travail des agents comme des responsables et met les équipes sur les
rails du développement durale. A charge pour tous, ensuite, d'enrichir la démarche sur les plans humains,
social et écologique.
Epidémie
NosoBase n° 27238
Impact des procédures de diagnostic sur la prise en charge des patients et les coûts
d'hospitalisation au cours des épidémies d'infections à entérovirus en 2000 et 2005 à Marseille,
France
Ninove L; Tan C; Nougairede A; Zandotti C; Richet H; Charrel R; et al. Impact of diagnostic procedures on
patient management and hospitalization cost during the 2000 and 2005 enterovirus epidemics in Marseilles,
France. Clinical microbiology and infection 2010/06; 16(6): 651-656.
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Mots-clés : EPIDEMIOLOGIE; DIAGNOSTIC; COUT; ENTEROVIRUS; RT-PCR; EPIDEMIE; PROTOCOLE;
DIAGNOSTIC BIOLOGIQUE
Enteroviruses are frequent aetiological agents of central nervous system infections in humans. In 2000 and
2005, two large outbreaks of Echovirus 30 (a member of species human enterovirusB) were observed in the
University Hospitals of Marseilles (France). Between the two epidemics, the diagnostic protocols for
enterovirus infection were modified, moving from viral cultures and classic RT-PCR in 2000 to real-time RTPCR in 2005. We compared some viral and epidemiological characteristics of the 2000 and 2005 outbreaks
with special attention to diagnostic procedures and to the subsequent clinical management of patients.
Despite similar virological and epidemiological characteristics during both outbreaks, our results show that
real-time RT-PCR techniques used in 2005 noticeably shortened the period of time necessary to deliver
diagnostic results and suggest that this was associated with a decrease in the duration of hospitalization for
positive cases. In conclusion, this study suggests that the improvement of enterovirus diagnosis had a major
financial impact on the management of the 2005 epidemic in Marseilles and may constitute an interesting
example of how new diagnostic methods in microbiology can be self-financed through improvement in
patient management.
NosoBase n° 27154
Co-circulation de multiples génotypes du virus de la rougeole durant une épidémie en France en
2008
Waku-Kouomou D; Freymuth F; Parent du Chatelet I; Wild tf; Horvat B. Co-circulation of multiple measles
virus genotypes during an epidemic in France in 2008. Journal of medical virology 2010/05; 82(6): 10331043.
Mots-clés : VIRUS; ROUGEOLE;
SURVEILLANCE; RESEAU
EPIDEMIE;
BIOLOGIE
MOLECULAIRE;
PCR;
GENOTYPE;
In 2008, measles reappeared in France in a series of outbreaks. During this period, 604 measles cases
were reported to a routine surveillance system and 305 (50%) of these cases were then confirmed in the
laboratory. To understand better the current epidemiological situation and the circulation of different measles
strains, a phylogenetic characterization of 113 (19%) of the measles cases from these outbreaks was
performed. All measles cases met the WHO clinical criteria and were confirmed either by laboratory
detection of measles-specific IgM and/or by detection of the virus genome by polymerase chain reaction
(PCR) and viral isolation. PCR products generated from blood, oral fluid, urine, or nasopharyngeal-swab
samples were sequenced for molecular epidemiology studies. Phylogenetic analysis showed a co-circulation
of genotypes D4 and D5 during the first measles outbreak in the city of Reims in early 2008. Over the course
of the year, the A, B3.2, D8, and D9 genotypes also appeared. The data from this study show the
simultaneous circulation of several measles genotypes in France and describe genotypes D8 and D9 for the
first time in this country. The data also suggest that there are still many pockets of unvaccinated individuals
helping to maintain the circulation of measles virus in the population. Phylogenetic studies allowed the
corroboration of epidemiologic links and showed that nosocomial transmission can create significant risk for
measles dissemination. Finally, the pattern of changes in viral genotypes during 2008 suggests a regular
introduction of measles strains from abroad.
Gale
NosoBase n° 27312
Recommandations de traitement en cas de gale dans les hôpitaux de soins aigus et les institutions
de longs séjours
Buhlmann M; Itin P; Bellini C; Zanetti G; Widmer AF. Swiss-NOSO 2010; 16(2): 4-6.
Mots-clés : RECOMMANDATION; GALE; SOIN DE LONGUE DUREE; TRAITEMENT; STRUCTURE DE
SOINS; PERSONNE AGEE; GANT; PRECAUTION COMPLEMENTAIRE; PREVENTION; MEDICAMENT;
BLOUSE
A l'apparition d'un cas de gale, les mesures suivantes sont indiquées :
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1. Le diagnostic doit être confirmé par un dermatologue expérimenté
2. Port de surblouse de protection et gants à usage unique lors des soins directs, ou application des
mesures additionnelles de contact
3. Traitement des personnes atteintes de gale documentée
4. Traitement concomitant des personnes exposées dans l'hôpital
5. Traitement concomitant de l'entourage du patient
6. Fixer un jour au cours duquel toutes les personnes impliquées se traitent simultanément
7. Jusqu'au jour fixé : port de surblouse de protection et gants à usage unique lors des soins directs
8. Pour l'interruption de l'épidémie, adopter la règle : "Hit hard and early".
Grippe
NosoBase n° 27157
Prise en charge clinique de la pandémie de grippe A(H1N1) 2009
Hui DS; Lee N; Chan P. Clinical management of pandemic 2009 influenza A(H1N1) infection. Chest
2010/04; 137(4): 916-925.
Mots-clés : GRIPPE; EPIDEMIE;
PREVENTION; VACCIN
TRAITEMENT; CONTROLE;
VIRUS;
FACTEUR
DE
RISQUE;
Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1)
but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with
dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be
hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more
severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the
results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate
pressure, in addition to a conservative fluid management approach, is recommended when treating adult
patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy
for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute
respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of
refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune
globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV
gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and Nacetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with
suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating
procedures. Nonpharmacologic measures, such as early case isolation, household quarantine,
school/workplace closure, good community hygiene, and restrictions on travel are useful measures in
controlling an influenza pandemic at its early phase.
NosoBase n° 27250
Intervention destinée à améliorer l'observance des précautions liées à la transmission de la grippe
dans le service des urgences : succès et défis
May L; Lung D; Harter K. An intervention to improve compliance with transmission precautions for influenza
in the emergency department: successes and challenges. The journal of emergency medicine 2010; in
press: 7 pages.
Mots-clés : TRANSMISSION; GRIPPE; OBSERVANCE; TRANSPORT;
RETROSPECTIVE; URGENCE; PRECAUTION GOUTTELETTE
PREVENTION;
ETUDE
Concern with the potential for hospital-based transmission of influenza has come to the forefront due to
emergency department (ED) crowding and the novel H1N1 pandemic. Compliance with infection control
guidelines for influenza in the ED is generally unknown, and effective yet low-resource training is needed to
educate staff on the importance of decreasing the potential for ED transmission of the virus. Objectives: This
study evaluates compliance with patient assignment and transport precautions for influenza in an urban ED
before and after implementation of electronic reminders. Methods: We included patients with a diagnosis of
influenza for two consecutive influenza seasons, and retrospectively collected limited patient encounter data
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on patient location, transport, and compliance with assignment and transport precautions for both years. For
the second influenza season we sent monthly reminders to all ED providers via the electronic medical record
(EMR), explaining the importance and proper use of infection control precautions in patients with suspected
influenza. Compliance between the two seasons was compared using descriptive statistics and chi-squared
analysis. Results: Overall compliance with infection control precautions was poor, but increased with the use
of electronic reminders from 29% to 45% (p = 0.015). Compliance with precautions for patients moved to the
hallway or Radiology increased from 7% to 24% (p = 0.001). Conclusions: The EMR may be a useful tool for
improving compliance with transmission-based precautions by implementing reminders on order sets and
informational mailings, and by tracking compliance. Future study should be undertaken to determine the
most effective interventions to prevent ED transmission of influenza.
NosoBase n° 27068
Performance d'un test rapide contre la grippe chez des enfants hospitalisés
Stripeli F; Sakkou Z; Papadopoulos N; Georgiou V; Gratsia P; Christodoulou I; et al. Performance of rapid
influenza testing in hospitalized children. european journal of clinical microbiology and infectious disease
2010; in press: 6 pages.
Mots-clés : GRIPPE; PEDIATRIE; DIAGNOSTIC; PCR; RT-PCR; SENSIBILITE; SPECIFICITE
Influenza infection is associated with high hospitalization rates among young children. Rapid diagnosis of
influenza infection is particularly useful in order to prevent nosocomial infection and allows for the timely
initiation of antiviral treatment. We evaluated the performance of a rapid influenza test in hospitalized
children during the influenza season. All children (aged 6 months to 14 years) hospitalized with fever and/or
respiratory symptoms, admitted during the 2005 influenza season, participated in the study. A multiplex
reverse transcriptase polymerase chain reaction (RT-PCR), able to identify IFV-A H1N1, H3N2, and IFV-B
subtypes, was performed on nasopharyngeal aspirates. The nasal swab was tested with a lateral-flow
immunoassay (QuickVue Influenza Test). The performance of the rapid test was compared with the results
of PCR. Influenza infection was diagnosed by PCR in 41/217 (19%) patients. Infection with influenza A virus
(H3N2) was diagnosed in all cases. The performance of the QuickVue Influenza Test was estimated as
follows: sensitivity 67.5%, specificity 96%, positive predictive value 79%, and negative predictive value 93%.
The sensitivity of the test was higher in infants aged 6-12 months, in those with short duration of symptoms,
and in the peak phase of the epidemic. The QuickVue Influenza Test is useful and reasonably accurate to
detect influenza infection in hospitalized children during the influenza season. Infection with influenza virus is
unlikely if the test is negative. A positive result suggests that infection is probable if influenza virus circulates
in the community.
Hépatite
NosoBase n° 27315
Hépatite aiguë C : infection nosocomiale ou communautaire ?
Bourigault C; Nael V; Garnier E; Coste-Burel M; Chevaliez S; Villers D; et al. Acute hepatitis C virus
infection: hospital or community-acquired infection? BEH Web 2010/05/17; 1: 1-4.
Mots-clés : HEPATITE C; INFECTION COMMUNAUTAIRE; TRANSPLANTATION; MUCOVISCIDOSE;
HOSPITALISATION A DOMICILE; INVESTIGATION; PERSONNEL; TRANSMISSION SOIGNANT-SOIGNE
En 2008, une infection aiguë par le virus de l’hépatite C (VHC) a été diagnostiquée lors du bilan pré-greffe
d’une patiente de 29 ans atteinte de mucoviscidose. Une investigation épidémiologique a été réalisée pour
déterminer les facteurs de risque éventuels de la contamination. Les investigations n’ont pas retrouvé
d’argument en faveur d’une contamination par le VHC au sein de l’établissement. L’un des trois personnels
soignants ayant réalisé des soins au domicile de la patiente était séropositif pour le VHC, statut sérologique
ignoré avant le dépistage en juillet 2009. Les analyses génétique et phylogénique des souches de VHC
issues de la patiente et du soignant ont montré que les deux souches étaient proches. Ces analyses ne
permettent en aucun cas de préjuger du sens de la contamination. L’évaluation des pratiques de soins à
domicile reste nécessaire afin d’évaluer le risque encouru par les personnes soignées par un professionnel
séropositif.
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NosoBase n° 27169
Infection par le virus de l'hépatite E en dialyse et après transplantation
Kamar N; Abravanel F; Mansuy JM; Peron JM; Izopet J; Rostaing L. Hepatitis E infection in dialysis and
after transplantation. Nephrologie et therapeutique 2010/04; 6(2): 83-87.
Mots-clés : HEPATITE E; DIALYSE RENALE; TRANSPLANTATION; TRANSMISSION; TRAITEMENT;
PREVALENCE; INCIDENCE
Le virus de l'hépatite E (VHE) est un virus à ARN responsable d'épidémies dans les pays en voie de
développement et semble être un agent émergent dans les pays industrialisés. Il est transmis
essentiellement selon un mode féco-oral. L'infection par le VHE est une zoonose. Le VHE était considéré
comme une hépatite uniquement responsable d'hépatite aiguë, qui n'évolue pas vers l'hépatite chronique et
la cirrhose. Récemment, il a été montré que l'hépatite E peut évoluer vers la chronicité et la cirrhose au
moins chez les patients immunodéprimés. Dans ce cas, la réduction de l'immunosuppression pourrait être
une première option thérapeutique.
NosoBase n° 27272
Prévention de l'hépatite C chez des patients hémodialysés : 5 ans d'expérience dans un centre
d'hémodialyse
Mohamed WZ. Prevention of hepatitis C virus in hemodialysis patients: five years experience from a single
center. Saudi journal of kidney diseases and transplantation 2010/06; 21(3): 548-554.
Mots-clés : PREVENTION; HEPATITE C; VIRUS; HEMODIALYSE; RECOMMANDATION; INCIDENCE;
TRANSMISSION; OBSERVANCE; PRECAUTION STANDARD; DEPISTAGE
Hepatitis C virus (HCV) has been a significant problem in hemodialysis (HD) patients. In general, it carries
significant morbidity including liver cirrhosis, liver cell failure and hepa-toma. The study was conducted on 36
seronegative HD patients. All patients were managed with strict application of infection control guidelines as
well as isolation of HCV-positive patients. None of the patients received any blood transfusions and were
managed with iron and erythro-poietin. After five years of follow-up, we found that the incidence of HCV
seroconversion was zero. Our study further suggests that following infection control guidelines, isolation of
sero-positive patients and minimizing blood transfusions can help in prevention of HCV transmission among
HD patients.
Hygiène des mains
NosoBase n° 27151
Impact d'un programme de formation sur l'observance de l'hygiène des mains et l'incidence des
infections nosocomiales dans une unité de réanimation néonatale urbaine : étude d'intervention
avec comparaison avant-après
Helder OK; Brug J; Looman C; Van Goudoever JB; Kornelisse RF. The impact of an education program on
hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: an
intervention study with before and after comparison. International journal of nursing studies 2010; in press: 8
pages.
Mots-clés : FORMATION; HYGIENE DES MAINS; OBSERVANCE; INCIDENCE; NEONATALOGIE; SOIN
INTENSIF; BACTERIEMIE; CENTRE HOSPITALIER UNIVERSITAIRE; PERSONNEL; TAUX; SOLUTION
HYDROALCOOLIQUE; INCUBATEUR
Background: Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal
intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing
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these infections. However, hand hygiene compliance among healthcare professionals remains low despite
the well-known effect on infection reduction.
Objectives: We studied the effectiveness of a hand hygiene education program on the incidence of
nosocomial bloodstream infections.
Design: Observational study with two pretests and two posttest measurements and interrupted time series
analysis.
Setting: A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands.
Participants: Healthcare professionals who had physical contact with very low birth weight (VLBW) infants.
Methods: The study was conducted during a period of 4 years. Medical and nursing staff followed a
problem-based education program on hand hygiene. Hand hygiene practices before and after the education
program were compared by guided observations. The incidence of nosocomial infections in VLBW infants
was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth
weight infants were analyzed by a segmented loglinear regression analysis.
Results: During 1201 observations hand hygiene compliance before patient contact increased from 65% to
88% (p<0.001). Median (interquartile range) drying time increased from 4s (4-10) to 10s (7-14) (p<0.001).
The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate
per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene
intervention decreased from 44.5% to 36.1% (18.9%, p=0.03) and from 17.3% to 13.5% (22.0%, p=0.03),
respectively. At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07%
(95% CI -1.41 to +1.60) per month and decreased with -1.25% (95% CI -4.67 to +2.44) after the intervention
(p=0.51). The level of instant change was -14.8% (p=0.48).
Conclusions: The results are consistent with relevant improvement of hand hygiene practices among
healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in
nosocomial bloodstream infections
NosoBase n° 27114
Un système électronique de surveillance de l’hygiène des mains : étude pilote examinant des
critères de substitution pour mesurer l’observance de l’hygiène des mains
Sahud AG; Bhanot N; Radhakrishnan A; Bajwa R; Manyam H; Post JC. An electronic hand hygiene
surveillance device: a pilot study exploring surrogate markers for hand hygiene compliance. Infection control
and hospital epidemiology 2010/06; 31(6): 634-639.
Mots-clés : LAVAGE DES MAINS; SURVEILLANCE;
EVALUATION; CENTRE HOSPITALIER UNIVERSITAIRE
OBSERVANCE;
HYGIENE
DES
MAINS;
Objective: To evaluate the feasibility of using an electronic hand hygiene surveillance and feedback
monitoring device.
Design: A 2-phase pilot study included initial direct observation of hand hygiene practices as part of routine
hospital quality assurance (phase I) and subsequent monitoring using an electronic hand hygiene
surveillance device (phase II).
Setting: A 700-bed tertiary care teaching hospital.
Participants: Phase I included a convenience sample of healthcare workers. Phase II included 7 medical
interns and 7 registered nurses recruited through email and at work-related meetings.
Methods: During phase I, healthcare workers were directly observed at patient room entry and exit during
the period April through November 2008. During phase II, hand hygiene data were gathered through indirect
observation using the electronic device during a 4-week period in August 2009. Twenty patient rooms were
fitted with electronic trigger devices that signaled a reader unit worn by participants when they entered the
room, and 70 dispensers for liquid soap or hand sanitizer were fitted with triggers that signaled the reader
unit when the dispenser was used. The accuracy of the devices was checked by the principal investigator,
who manually recorded his room entries and exits and dispenser use while wearing a reader unit.
Results: During phase I, hand hygiene occurred before room entry for 95 (25.1%) and after room exit for 149
(39.4%) of 378 directly observed patient room visits, for a cumulative composite compliance rate of 32.3%.
Among the 378 room visits, 347 (91.8%) involved contact with the patient and/or environment. During phase
II, electronic monitoring revealed a cumulative composite compliance rate of 25.5%. The electronic device
captured 61 (98%) of 62 manually recorded room entries and 133 (95%) of 140 manually recorded
dispensing events.
Conclusions: The electronic hand hygiene surveillance device seems to be a practical method for routinely
monitoring hand hygiene compliance in healthcare workers.
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Maladie de Creutzfeld-Jakob
NosoBase n° 27261
Nouvelle variante de la maladie de Creutzfeldt-Jakob chez un receveur de transfusion sanguine :
coïncidence ou cause ?
Chohan G; Llewelyn C; Mackenzie J; Cousens S; Kennedy A; Will R; et al. Variant Creutzfeldt-Jakob
disease in a transfusion recipient: coincidence or cause? Transfusion 2010/05; 50: 1003-1006.
Mots-clés : MALADIE DE CREUTZFELDT-JAKOB; TRANSFUSION; SANG; TRANSMISSION
Background: to date there have been four instances of infection transmitted through blood transfusion
derived from individuals who later developed variant Creutzfeldt-Jakob disease (vCJD). The identification of
further transmission of vCJD through this route would have important implications for risk assessment and
public health.
Study design and methods: through the UK Transfusion Medicine Epidemiology Review (TMER) the fate of
blood donations from individuals who develop vCDJ is traced and recipients of labile components are
identified. The details of recipients are cross-checked with the register of vCJD cases held ar the National
CJD Surveillance Unit (NCJDSU) to identify any linkage between donors and recipients. In the reverse
study, when individuals with vCJD are found to have a history of blood transfusion the donors of the
transfused blood components are traced and their details cross-checked with the vCJD register to identify
any missed or unrecognized linkage between donors and recipients. Case report: a case of vCJD has been
identified with a history of blood transfuion in infancy. The donors who provided the components transfused
cannot be identified, but a blood donor know to have donated blood to another indivudal who subsequently
developed vCJD could bave been a donor to the index case.
Results: the at-risk donor is alive 20 years after the relevant donation and continued to donate for some
years, until identified as at risk, with 27 other blood components issued for use in patients, none of whom
are known to have developed vCJD. Conclusion: circumstantial evidence has raised the possibility that the
case in this report represents a further instance of transfusion transmission of vCJD. However, detailed
investigation indicates that the pattern of events may have occurred by chance and disease in this individual
may have been caused by transmission of bovine spongiform encephalopathy infection, as is the presumed
cause in other primary cases of vCJD.
Maternité
NosoBase n° 27417
Escherichia coli producteur de CTX-M dans un service de maternité : importation d'aspect
communautaire et preuve de transmission materno-fœtale
Dubois V; De Barbeyrac B; Rogues AM; Arpin C; Coulange L; Andre C et al. CTX-M-producing Escherichia
coli in a maternity ward: a likely community importation and evidence of mother-to-neonate transmission.
The Journal of antimicrobial chemotherapy 2010; in press: 4 pages.
Mots-clés : ESCHERICHIA COLI; TRANSMISSION MATERNO-FŒTALE; BETA-LACTAMASE A SPECTRE
ELARGI; CENTRE HOSPITALIER UNIVERSITAIRE; ANTIBIORESISTANCE; EPIDEMIE; PCR;
MATERNITE
Objectives: To investigate the high prevalence of extended-spectrum beta-lactamase (ESBL)-producing
strains of Escherichia coli (4%, 10/250 consecutive isolates) recovered during a 5 month period in the
maternity ward of the University Hospital of Bordeaux, France.
Methods: beta-Lactam resistance transfer was analysed by conjugation and transformation. ESBLs were
characterized by isoelectric focusing, PCR amplification and sequencing. The relatedness of the strains was
examined by PFGE and phylogenetic group determination. Plasmids were characterized by incompatibility
group and restriction analysis.
Results: Ten ESBL-producing E. coli were isolated from urinary or genital samples of eight mothers and
from gastric fluids of two newborns of carrier mothers. The patients were hospitalized in five different units of
the maternity ward. Transconjugants, obtained for 7 of the 10 strains, and wild-type strains exhibited various
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antibiotypes. Different CTX-M enzymes were characterized: CTX-M-1 (n = 4); CTX-M-14 (n = 3); CTX-M-32
(n = 2); and CTX-M-28 (n = 1). The strains recovered from two mothers and their respective babies were
identical. All the other strains were epidemiologically unrelated. Furthermore, various plasmids were
identified. Environmental samples from the common echographic and sampling rooms did not reveal the
presence of ESBL-producing enterobacteria.
Conclusions: The data argue against the occurrence of a nosocomial outbreak and support the hypothesis
of an importation of community-acquired ESBL-producing strains into the hospital through colonized/infected
patients. At present, not only patients transferred from other hospitals or long-term care facilities are at risk
of carrying ESBL-producing enterobacteria on hospital admission, but also community patients
NosoBase n° 27266
Sepsis maternel : épidémiologie, étiologie et évolution
Van Dillen J; Zwart J; Schutte J; Van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome.
Current opinion in infectious diseases 2010/06; 23(3): 249-254.
Mots-clés : SYNDROME SEPTIQUE; POST-PARTUM; EPIDEMIOLOGIE; MORTALITE; INCIDENCE;
MORBIDITE; FACTEUR DE RISQUE; CESARIENNE; ANTIBIOPROPHYLAXIE; STREPTOCOCCUS;
ESCHERICHIA COLI; CITROBACTER; STREPTOCOCCUS GROUPE A; STREPTOCOCCUS GROUPE B
Purpose of review: Sepsis is a major cause of maternal death worldwide. Little is known on the incidence of
severe maternal morbidity related to sepsis. In this review, we focus on new findings concerning
epidemiology, etiology and outcome of maternal sepsis in low-income as well as high-income countries.
Recent findings: It is estimated that puerperal sepsis causes at least 75,000 maternal deaths every year,
mostly in low-income countries. Studies from high-income countries report incidence of maternal morbidity
due to sepsis of 0.1-0.6 per 1000 deliveries. The causative microorganisms are generally polymicrobial with
beta-haemolytic streptococci group A (GAS) often being the cause of severe
cases of puerperal fever. The single most important risk factor for postpartum infection seems to be
caesarean section, and prophylactic antibiotics during the procedure substantially reduce the infection risk.
Improvements in service provision as promoted through the Surviving Sepsis Campaign can reduce the
overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income
countries.
Summary: Maternal sepsis is an infrequent, but important complication of pregnancy, childbirth and
puerperium, resulting in significant maternal morbidity and mortality worldwide. Improved outcome is
possible through improved service provision.
Médecine ambulatoire
NosoBase n° 27098
Infections nosocomiales en médecine ambulatoire : importance et prévention
Zanetti G; Lazor-Blanchet C; Petignat C. Revue médicale suisse 2010/04/07; 708-713.
Mots-clés : PRECAUTION STANDARD; AMBULATOIRE; PREVENTION; PROFESSION LIBERALE;
HYGIENE DES MAINS; RECOMMANDATION; GANT; MASQUE; DISPOSITIF MEDICAL; REUTILISABLE;
DESINFECTION; SURFACE; NETTOYAGE; PERSONNEL; VACCIN
Le concept d'infections nosocomiales (infections associées aux soins de santé) inclut la pratique
ambulatoire. Mais les données y sont beaucoup plus rares et imprécises qu'en milieu hospitalier, ce qui rend
difficile le choix de mesures préventives. L'application de toutes les mesures hospitalières ne se justifie pas
en cabinet médical, le risque d'infection nosocomiale y étant plus faible. Mais il est possible de s'en inspirer,
partant du principe que l'on peut contracter une infection lors d'une consultation ambulatoire par des
mécanismes analogues à ceux observés en milieu hospitalier. Cet article propose une stratégie de
prévention basée sur une adaptation des précautions dites "standards", à appliquer dans tous les cas, sur
des mesures additionnelles plus rarement indiquées et sur les règles d'asepsie lors de gestes invasifs.
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Pédiatrie
NosoBase n° 27313
Recommandations pour la prévention et le contrôle de l'infection dans les crèches d'hôpital
Buhlmann M; Berger C; Heininger U; Vaudaux B; Widmer AF. Swiss-NOSO 2010; 16(2): 1-3.
Mots-clés : PREVENTION; RECOMMANDATION; CONTROLE; CRECHE; STRUCTURE DE SOINS;
VACCIN; PERSONNEL; HYGIENE DES MAINS; NETTOYAGE; DESINFECTION; LOCAL; EVICTION;
VARICELLE; ROUGEOLE; NEISSERIA MENINGITIDIS; BORDETELLA PERTUSSIS; GASTRO-ENTERITE
A l'instar d'autres entreprises, certains hôpitaux mettent une crèche à disposition des enfants de leurs
collaborateurs. La particularité d'une crèche d'hôpital est que les parents des enfants qui y sont reçus sont
appelés à côtoyer des patients hospitalisés et donc susceptibles de leur transmettre une infection. Pour
cette raison, le groupe Swiss-Noso a préparé des recommandations adaptées à cette situation. Ces
recommandations sont, dans une certaine mesure, également applicables aux crèches hors contexte
hospitalier.
NosoBase n° 27264
Statut global des vaccins conjugués contre Haemophilus influenza type B et les pneumocoques :
preuves, protocoles et introductions
Levine OS; Knoll MD; Jones A; Walker DG; Risko N; Gilani Z. Global status of Haemophilus influenzae type
b and pneumococcal conjugate vaccines: evidence, policies, and introductions. Current opinion in infectious
diseases 2010/06; 23(3): 236-241.
Mots-clés : HAEMOPHILUS INFLUENZAE; STREPTOCOCCUS PNEUMONIAE; VACCIN; PROTOCOLE;
RECOMMANDATION; COUT-EFFICACITE; PEDIATRIE; PNEUMONIE; MENINGITE; OMS
Purpose of review: The leading causes of bacterial meningitis and pneumonia in children, Haemophilus
influenzae type b (Hib) and Streptococcus pneumoniae, are vaccine preventable. This study reviews the
status of vaccine use globally and the evidence base that supports policy recommendations for use of these
vaccines in children.
Recent findings: Recently, there have been substantial increases in the uptake of Hib and pneumococcal
vaccines worldwide. These programs are supported by recent policy recommendations by the World health
organization and an evidence base that includes recently published country-specific disease burden
estimates, meta-analyses of vaccine efficacy, and cost-effectiveness analyses.
Summary: The introduction of Hib and pneumococcal vaccines is progressing worldwide and at a rate
generally faster than that observed with hepatitis B vaccines. Efforts to expand the serotype coverage of
pneumococcal vaccines and to monitor the impact of Hib and pneumococcal vaccines and to assure
financing obstacles, especially in lower middle-income countries, are required.
NosoBase n° 27258
Maladies infectieuses chez des patients de pédiatrie bénéficiant d'une transplantation : revue de la
littérature 2007-2008
L'huillier AG; Posfay-Barbe KM. Infectious diseases in pediatric transplantation: review of the literature 20072008. Pedatric transplantation 2010; (14): 23-32.
Mots-clés
:
TRANSPLANTATION;
PEDIATRIE;
BIBLIOGRAPHIE;
VIRUS;
CYTOMEGALOVIRUS; HERPES VIRUS; ASPERGILLUS; DEFICIT IMMUNITAIRE
ADENOVIRUS;
After the first decades in the history of (pediatric) transplantation which focused on finding proper surgical
techniques and the best immunosuppressive regimen, infections have been increasingly recognized as
important for survival and quality of life in transplant recipients, and many researchers work on either
decreasing the risk for infection or treating it (or both). This not exhaustive review of the scientific articles
published between 2007 and 2008 looks from the infectious diseases point of view at the most exciting
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information for different types of transplanted organs. It reviews new approaches to frequent infections, such
as BK virus, cytomegalovirus, Epstein-Barr virus, and adenoviral infections but also to Aspergillus and mold
infections, which are linked with high mortality rates in transplant recipients. It also examines novel markers
to discriminate between infection and rejection. Comments to each manuscript have been added, but we
strongly encourage the reader to refer to the original work for more in depth evaluation.
Personnel
NosoBase n° 27207
Impact de la politique "nu en-dessous des coudes" sur la contamination des mains de 92 praticiens
hospitaliers dans un centre hospitalier général
Willis-Owen CA; Subramanian P; Kumari P; Houlihan-Burne D. Effects of "bare below the elbows" policy on
hand contamination of 92 hospitals doctors in a district general hospital. The Journal of hospital infection
2010/06; 75(2): 116-119.
Mots-clés : CONTAMINATION; MAIN; PROTOCOLE; MEDECIN; CENTRE HOSPITALIER GENERAL;
ETUDE PROSPECTIVE; EMPREINTE; ETUDE TRANSVERSALE
Despite a lack of evidence the UK's Department of Health introduced a policy of 'bare below the elbows'
attire in order to try to reduce the incidence of nosocomial infection. This study investigates the link between
this state of dress and hand contamination. A prospective observational study of doctors working in a district
general hospital was carried out. The fingertips of each hand were imprinted onto culture medium, and
resultant growth assessed for number of colony-forming units and presence of clinically significant
pathogens or multiply resistant organisms. These findings were correlated with attire, grade, sex and
specialty. Ninety-two doctors were recruited of whom 49 were 'bare below the elbows' compliant and 43
were not. There was no statistically significant difference between those doctors who were 'bare below the
elbows' and those that were not, either for the number of colony-forming units or for the presence of clinically
significant organisms. No multiply resistant organisms were cultured from doctors' hands. 'Bare below the
elbows' attire is not related to the degree of contamination on doctors' fingertips or the presence of clinically
significant pathogens. Further studies are required to establish whether investment in doctors' uniforms and
patient education campaigns are worthwhile.
Pneumonie
NosoBase n° 27118
Sous-estimation de l’impact des pneumonies associées à la ventilation assistée en utilisant les
données de surveillance
Drees L; Hausman S; Rogers A; Freeman L; Frosch K; Wroten K. Underestimating the impact of ventilatorassociated pneumonia by use of surveillance data. Infection control and hospital epidemiology 2010/06;
31(6): 650-652.
Mots-clés : PNEUMONIE; SURVEILLANCE; VENTILATION ASSISTEE; STATISTIQUE; TAUX; SOIN
INTENSIF
We calculated rates of ventilator-associated pneumonia (VAP) by using surveillance data, clinical data, and
coding data. Compared with the VAP rates calculated on the basis of surveillance data, the VAP rates
calculated on the basis of coding data were significantly overestimated in 4 of 5 intensive care units. Efforts
to improve coding and clinical documentation will address much but not all of this discrepancy between
surveillance and administrative data.
NosoBase n° 27407
Pneumonies à Acinetobacter : l'évolution est-elle différente de celle des pneumonies dues à d'autres
agents pathogènes ?
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Ebru CE; Osman NH; Ozlem T; Necdet S. Acinetobacter pneumonia: is the outcome different from the
pneumonias caused by other agents. Annals of Thoracic Medicine 2010/06; 5(2): 92-96.
Mots-clés : ACINETOBACTER; PNEUMONIE; FACTEUR DE RISQUE; ANTIBIOTIQUE; VENTILATION
ASSISTEE; MORTALITE
Background: the principal aim of the present study was to determine whether Acinetobacter spp. pneumonia
differs from hospital-acquired pneumonias (HAPs) caused by other agents with respect to therapeutic
success and survival rate. Methods: this study includes 140 adults patients diagnosed with HAPs caused by
identified etiologic agents between March 2005 and February 2006. These patients were divided into two
groups according to the agent responsible for their infection (Acinetobacter spp; [n=63] or non-Acinetobacter
spp; [n=77]). The groups were compared in terms of risk factors, therapeutic success and six-week survival
rates.
Results: previous antibiotic use and the risk of aspiration were independent factors responsible for the
development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical
ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp.
pneumonia. The clinical success rate at the end of therapy was 41.6% and, at the sixth week, the survival
rate was 35% among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the
control group, these values were 43 and 32%, respectively (P>0.05). We found that the use of the
appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival
(P<0.001).
Conclusion: the outcomes of Acinetobacter spp. pneumonia do not differ from HAPs associated with nonAcinetobacter spp. in terms of therapeutic success and survival rates.
NosoBase n° 27271
Trachéotomie précoce versus tardive pour la prévention des pneumonies acquises sous ventilation
chez des patients adultes en réanimation
Terragni PP; Antonelli M; Fumagalli R; Faggiano C; Berardino M; Pallavicini FB; et al. Early vs late
tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients. A randomized
controlled trial. JAMA 2010/04/21; 303(15): 1483-1489.
Mots-clés : PREVENTION; PNEUMONIE; VENTILATION ASSISTEE; SOIN INTENSIF; RANDOMISATION;
TRACHEOTOMIE; INCIDENCE; MORTALITE
Context: Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation;
however, there is considerable variability in the time considered optimal for performing tracheotomy. This is
of clinical importance because timing is a key criterion for performing a tracheotomy and patients who
receive one require a large amount of health care resources.
Objective: To determine the effectiveness of early tracheotomy (after 6-8 days of laryngeal intubation)
compared with late tracheotomy (after 13-15 days of laryngeal intubation) in reducing the incidence of
pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days.
Design, setting, and patients: Randomized controlled trial performed in 12 Italian ICUs from June 2004 to
June 2008 of 600 adult patients enrolled without lung infection, who had been ventilated for 24 hours, had a
Simplified Acute Physiology Score II between 35 and 65, and had a sequential organ failure assessment
score of 5 or greater.
Intervention: Patients who had worsening of respiratory conditions, unchanged or worse sequential organ
failure assessment score, and no pneumonia 48 hours after inclusion were randomized to early tracheotomy
(n = 209; 145 received tracheotomy) or late tracheotomy (n = 210; 119 received tracheotomy).
Main outcome measures: The primary endpoint was incidence of ventilator-associated pneumonia;
secondary endpoints during the 28 days immediately following randomization were number of ventilator-free
days, number of ICU-free days, and number of patients in each group who were still alive.
Results: Ventilator-associated pneumonia was observed in 30 patients in the early tracheotomy group (14%;
95% confidence interval [CI], 10%-19%) and in 44 patients in the late tracheotomy group (21%; 95% CI,
15%-26%) (P = .07). During the 28 days immediately following randomization, the hazard ratio of developing
ventilator-associated pneumonia was 0.66 (95% CI, 0.42-1.04), remaining connected to the ventilator was
0.70 (95% CI, 0.56-0.87), remaining in the ICU was 0.73 (95% CI, 0.55-0.97), and dying was 0.80 (95% CI,
0.56-1.15).
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Conclusion: Among mechanically ventilated adult ICU patients, early tracheotomy compared with late
tracheotomy did not result in statistically significant improvement in incidence of ventilator-associated
pneumonia.
NosoBase n° 27226
Les pneumopathies nosocomiales
Thiveaud D. Le moniteur hospitalier 2010/04; (225): 42-45.
Mots-clés : PNEUMOPATHIE; EPIDEMIOLOGIE; FACTEUR DE RISQUE; APPAREIL RESPIRATOIRE;
MICRO-ORGANISME; RECOMMANDATION; PREVENTION
Les infections respiratoires, regroupant principalement les pneumopathies, représentent la deuxième cause
d'infections nosocomiales en France. Les facteurs de risque sont nombreux et peuvent être multiples pour
un même patient. Leur surveillance est à associer aux mesures de prévention mises en oeuvre.
NosoBase n° 27150
Mise au point sur les pneumonies d'origine communautaire et nosocomiale en 2009
Torres A; Rello J. Update in community-acquired and nosocomial pneumonia 2009. American journal of
respiratory and critical care medicine 2010/04/15; 181(8): 782-787.
Mots-clés : PNEUMONIE; BIBLIOGRAPHIE; TAUX; MORTALITE; SOIN INTENSIF; RECOMMANDATION;
DIAGNOSTIC; TRAITEMENT; PRONOSTIC; PREVENTION; FACTEUR DE RISQUE
Soins intensifs
NosoBase n° 27304
Faut-il procéder à un dépistage du portage de Pseudomonas aeruginosa dans les services de
réanimation ?
Slekovec C; Navellou JC; Blasco G; Thouverez M; Bertrand X; Talon D. Is surveillance of Pseudomonas
aeruginosa carriage in intensive care units useful? Annales françaises d'anesthésie et de réanimation
2010/05; 29(4): 279-282.
Mots-clés : DEPISTAGE;
EVALUATION
PSEUDOMONAS
AERUGINOSA;
SOIN
INTENSIF;
COLONISATION;
Objectif : Evaluer l’intérêt potentiel du dépistage de Pseudomonas aeruginosa à l’admission ainsi qu’en
cours d’hospitalisation dans les services de réanimation.
Méthode : Etude rétrospective observationnelle réalisée en 2007 dans les deux services de réanimation
adulte du CHU de Besançon. Le dépistage du portage de P. aeruginosa a été réalisé à l’admission et de
façon hebdomadaire en cours d’hospitalisation. Les prélèvements à visée diagnostique, positifs à P.
aeruginosa, ont été recueillis.
Résultats : Parmi les 754 patients inclus, 146 ont présenté un dépistage positif, soit une incidence moyenne
de 19,4 pour 100 patients. Trente-cinq patients étaient positifs à l’admission et 111 au cours de
l.hospitalisation. Soixante et un patients ont présenté au moins une infection liée à P. aeruginosa, soit une
incidence de 8,1 pour 100 patients admis. La sensibilité, la spécificité, les valeurs prédictives positives et
négatives du dépistage comme indicateurs prédictifs d.une infection ultérieure étaient, respectivement, de
54,1 %, 86,9 %, 26,6 % et 95,6 %.
Conclusion : Les prélèvements de dépistage sont indispensables pour déterminer le niveau d’endémicité de
P. aeruginosa dans les services de réanimation. L’excellente valeur prédictive négative du dépistage peut
apparaître comme un bon argument pour la réduction de l’usage des antibiotiques spécifiquement
antipyocyaniques ; toutefois l’intérêt de cette stratégie reste à évaluer.
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Staphylococcus
NosoBase n° 27111
Evolution des caractéristiques moléculaires épidémiologiques des Staphylococcus aureus
résistants à la méticilline en réanimation néonatale
Carey AJ; Della-Latta P; Huard R; Wu F; Graham PL; Carp D; et al. Changes in the molecular
epidemiological characteristics of methicillin-resistant Staphylococcus aureus in a neonatal intensive care
unit; Infection control and hospital epidemiology 2010/06; 31(6): 613-619.
Mots-clés :
METICILLINO-RESISTANCE;
STAPHYLOCOCCUS
AUREUS;
SOIN
INTENSIF;
NEONATALOGIE; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; ELECTROPHORESE; ETUDE
RETROSPECTIVE; EPIDEMIE; INVESTIGATION; COLONISATION; INFECTION COMMUNAUTAIRE
Objective: To determine whether the molecular epidemiological characteristics of methicillin-resistant
Staphylococcus aureus (MRSA) had changed in a level III neonatal intensive care unit (NICU).
Design: Retrospective review of medical records.
Setting: Level III NICU of a university-affiliated children's hospital in New York.
Patients: Case patients were neonates hospitalized in the NICU who were colonized or infected with MRSA.
Methods: Rates of colonization and infection with MRSA during the period from 2000 through 2008 were
assessed. Staphylococcal chromosomal cassette (SCC) mecA analysis and genotyping for S. aureus
encoding protein A (spa) were performed on representative MRSA isolates from each clonal pulsed-field gel
electrophoresis pattern.
Results: Endemic MRSA infection and colonization occurred throughout the study period, which was
punctuated by 4 epidemiologic investigations during outbreak periods. During the study period, 93 neonates
were infected and 167 were colonized with MRSA. Surveillance cultures were performed for 1,336 neonates
during outbreak investigations, and 115 (8.6%) neonates had MRSA-positive culture results. During 20012004, healthcare-associated MRSA clones, carrying SCC mec type II, predominated. From 2005 on, most
MRSA clones were community-associated MRSA with SCC mec type IV, and in 2007, USA300 emerged as
the principal clone.
Conclusions: Molecular analysis demonstrated a shift from healthcare-associated MRSA (2001-2004) to
community-associated MRSA (2005-2008).
NosoBase n° 27205
Quand les mains du personnel soignant sont-elles positives pour Staphylococcus aureus
méticillino-résistant ?
Creamer E; Dorrian S; Dolan A; Sherlock O; Fitzgerald-Hughes D; Thomas T; et al. When are the hands of
healthcare workers positive for meticillin-resistant Staphylococcus aureus? The Journal of hospital infection
2010/06; 75(2): 107-111.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; MAIN; PERSONNEL; HYGIENE
DES MAINS; DEPISTAGE; EMPREINTE; FORMATION; CONTAMINATION
Hand hygiene is a key component in reducing infection. There are few reports on the prevalence of
methicillin-resistant Staphylococcus aureus (MRSA) on healthcare workers' (HCWs') hands. The aim of this
study was to establish whether HCWs' fingertips were contaminated with MRSA in a clinical hospital setting.
The study was conducted in an acute tertiary referral hospital on four MRSA wards that were part of a larger
research study on MRSA epidemiology and four other wards not included in the study. The fingertips from all
categories of 523 HCWs were sampled on 822 occasions by the imprinting of fingertips on MRSA
chromogenic agar plates. The type of hand hygiene agent used, if any, and the immediate prior activity of
the HCW were recorded. Overall, 38/822 (5%) fingertips from 523 HCWs were MRSA-positive; 12/194 (6%)
after clinical contact, 10/138 (10%) after contact with the patient's environment and 15/346 (4%) after no
specific contact. MRSA was recovered on 2/61 (3%) occasions after use of alcohol hand rub, 2/35 (6%) after
4% chlorhexidine detergent, 7/210 (3%) hand washing with soap and water, and 27/493 (5%) when no hand
hygiene had been performed. MRSA was recovered from HCWs on seven of the eight wards. MRSA was
more frequently present on fingertips on the four non-study wards vs the four MRSA study wards [18/250
(7%), 3/201 (1%), respectively; P<or=0.004]. The isolation of MRSA from HCWs' fingertips, including after
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hand hygiene, indicates that more educational programmes are necessary to improve the quality of hand
hygiene to prevent transmission of MRSA.
NosoBase n° 27204
Rapidité des techniques de détection moléculaire pour le dépistage de Staphylococcus aureus
méticillino-résistant à l'admission dans un centre hospitalier universitaire
Flore K; Van Den Abeele AM; Verschraegen G. Speed of molecular detection techniques for meticillinresistant Staphylococcus aureus admission screening in an acute care hospital. The Journal of hospital
infection 2010/06; 75(2): 103-106.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
MOLECULAIRE; PCR; PRELEVEMENT; COUT; TRANSPORT
DEPISTAGE;
BIOLOGIE
Active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) carriers is considered an
essential component of MRSA control strategies in acute care hospitals. Recently, molecular assays for
MRSA screening have been proposed with significant reduction of the sample processing time. Using a time
analysis model, we investigated the time gain after the introduction of a molecular assay and compared this
with a preceding control period, using culture-based techniques. During a four-month period all high risk
patients (N=44) and all known MRSA-positive patients readmitted to the hospital (N=41) were screened for
MRSA upon admission. In both groups the long pre-analytical phase - time from admission to sampling and
transportation of samples to the laboratory - was the determining factor in the entire process. A substantial
reduction of the sample processing time was achieved using molecular assays, compared with conventional
culture. Due to the long pre-analytical phase, in addition to the high costs associated with polymerase chain
reaction (PCR) testing, molecular techniques were not introduced for the admission screenings. In the group
of the readmission screenings, however, a fast test result could save a substantial number of unnecessary
isolation days, resulting in an economic benefit for the hospital. PCR testing might be of interest for the
readmission screenings. In conclusion, local policies for MRSA screening should be investigated before
introducing expensive PCR technology.
NosoBase n° 27249
Infections associées aux soins versus infections d'origine communautaire : un nouveau défi pour la
science et la société
Gastmeier P. Healthcare-associated versus community-acquired infections: a new challenge for science and
society. International journal of medical microbiology 2010; in press: 4 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PREVENTION; INFORMATION;
TRANSMISSION; ANTIBIOTIQUE; HYGIENE DES MAINS; INDICATEUR; EUROPE; BACTERIEMIE
Healthcare and community associated MRSA are meanwhile exchanged in all directions between hospitals,
long-term care facilities, nursing homes, and the community. This article is focusing on the situation
concerning MRSA, but the situation concerning other multidrug-resistant (MDR) pathogens such as
vancomycin-resistant enterococci or MDR Gram-negative pathogens is similar. Some European countries
have started national campaigns to improve the situation significantly. They require the successful
cooperation between healthcare facilities, public health authorities, health insurances, quality management
and patient safety organizations, educational facilities, the public, and the veterinarian sector. These
activities in the society need scientific data to provide evidence for the intervention measures and support
their implementation. To really support the activities in the society, intervention studies are urgently needed
to provide a more robust basis for decisions to improve the situation.
NosoBase n° 27201
Dépistage de Staphylococcus aureus méticillino-résistant en obstétrique : synthèse
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Gray J; Patwardhan SC; Martin W. Meticillin-resistant Straphylococcus aureus screening in obstetrics: a
review. The Journal of hospital infection 2010/06; 75(2): 89-92.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; DEPISTAGE; OBSTETRIQUE;
BIBLIOGRAPHIE; PREVALENCE; CESARIENNE; PRONOSTIC
Universal methicillin-resistant Staphylococcus aureus (MRSA) screening of adults admitted to hospital is
being introduced in England. Routine obstetric patients are currently exempt from screening, but 'high risk'
cases and women undergoing elective caesarean sections need to be included in the screening programme.
Most recent data on MRSA in obstetrics are derived from the USA, and provide little evidence that either
universal or targeted screening is beneficial for mothers or babies. The epidemiology of MRSA in the USA,
however, where community-associated MRSA strains are much more prevalent, is different from that in the
UK. This article reviews current knowledge of MRSA screening in pregnancy and makes recommendations
for current practice and future research.
NosoBase n° 27208
Un programme "chercher et éradiquer" peut-il réduire Staphylococcus aureus méticillino-résistant
d'origine nosocomiale dans un hôpital irlandais ?
Higgins A; Lynch M; Gethin G. Can "search and destroy" reduce nosocomial meticillin-resistant
Staphylococcus aureus in an Irish hospital? The Journal of hospital infection 2010/06; 75(2): 120-123.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
COHORTE; COLONISATION; PREVENTION; PRECAUTION CONTACT
DEPISTAGE;
TAUX;
Ireland, the Department of Health and Children recommends admission screening of patients at increased
risk of methicillin-resistant Staphylococcus aureus (MRSA), isolation of these patients until proven negative,
and eradication of any MRSA identified. These actions form the basis of a programme called 'search and
destroy' that has successfully reduced MRSA in Scandinavia. There is, however, very little information
published on the use of search and destroy in Ireland. This study was carried out using a quantitative, quasiexperimental design in the form of an interventional cohort study. The effect of reducing the turnaround time
for MRSA results (2007) and the introduction of pre-emptive isolation (2008) was examined in a hospital with
an established admission screening programme for MRSA. Rates of MRSA infection and colonisation were
monitored post-intervention and compared to baseline rates prior to the intervention (2005-2006). Rates of
hospital-acquired (nosocomial) MRSA infections and colonisation fell in both 2007 and 2008. However, due
to the quasi-experimental design of the study and the low endemic level of MRSA in the hospital, a causal
link could not be established.
NosoBase n° 27231
Colonisation par Staphylococcus aureus dans des maisons de retraite : identification des facteurs
de risque, y compris le rôle de la démence
Lasseter G; Charlett A; Lewis D; Donald I; Howell-Jones R; Mcnulty C. Staphylococcus aureus carriage in
care homes: identification of risk factors, including the role of dementia. Epidemiology and infection 2010;
138: 686-696.
Mots-clés : STAPHYLOCOCCUS AUREUS; FACTEUR DE RISQUE; COLONISATION; PRELEVEMENT;
EPIDEMIOLOGIE; PREVALENCE; ANALYSE MULTIVARIEE; COLONISATION NASALE; PSYCHIATRIE
The aim of this study was to investigate the prevalence and associated risk factors of methicillin-susceptible
and methicillin-resistant Staphylocccus aureus (MSSA and MRSA) carriage in care homes, with particular
focus on dementia. A point-prevalence survey of 748 residents in 51 care homes in Gloucestershire and
Greater Bristol was undertaken. Dementia was assessed by the clock test or abbreviated mini-mental test.
Nasal swabs were cultured for S. aureus on selective agar media. Multivariable analysis indicated that
dementia was not a significant risk factor for MSSA (16.2%) or MRSA (7.8%); and that residents able to
move around the home unassisted were at a lower risk of MRSA (P=0.04). MSSA carriage increased with
increasing age (P=0.03) but MRSA carriage decreased with increasing age (P=0.05). Hospitalization in the
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last 6 months increased the risk of MSSA (P=0.04) and MRSA (P=0.10). We concluded that cross-infection
through staff caring for more dependent residents may spread MRSA within care homes and from the
recently hospitalized. Control of MSSA and MRSA in care homes requires focused infection control
interventions.
NosoBase n° 27109
Surveillance universelle de Staphylococcus aureus résistant à la méticilline des adultes admis à
l'hôpital : un modèle économique et analyse
Lee By; Bailey RR; Smith KJ; Muder RR; Strotmeyer ES; Lewis GJ; et al. Universal methicillin-resistant
Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and
analysis. Infection control and hospital epidemiology 2010/06; 31(6): 598-606.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SURVEILLANCE; COUT;
ANALYSE; INFORMATIQUE; PRECAUTION COMPLEMENTAIRE; PRECAUTION GOUTTELETTE
Background: Methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections are a
continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at
hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic
studies to determine the cost-effectiveness of such a strategy.
Methods: We developed a stochastic computer simulation model to determine the potential economic impact
of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital
admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third
party-payor perspectives. Patients with positive surveillance culture results were placed under isolation
precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not
isolated could transmit MRSA to other hospital patients.
Results: The performance of universal MRSA surveillance was cost-effective (defined as an incremental
cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate
was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy
when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic
reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate
was 2.5 or greater and the prevalence was 5% or greater.
Conclusions: Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a
wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems
could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission
dynamics) with the benchmarks in our model to help determine their optimal local strategies.
NosoBase n° 27244
Etude cas-témoin destinée à identifier les facteurs associés à la mortalité parmi des patients
présentant une bactériémie à Staphylococcus aureus résistant à la méticilline
Marchaim D; Kaye KS; Fowler VG; Anderson DJ; Chawla V; Golan Y; et al. Case-control study to identify
factors associated with mortality among patients with methicillin-resistant Staphylococcus aureus
bacteraemia. Clinical microbiology and infection 2010/06; 16(6): 747-752.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BACTERIEMIE; MORTALITE;
FACTEUR DE RISQUE; CAS TEMOIN; ANALYSE MULTIVARIEE; AGE
Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with increased mortality.
Delay in appropriate antimicrobial therapy (DAAT) is an important risk factor for death, although confounding
between carriage of MRSA and DAAT has not been resolved. We studied the association of risk factors with
mortality and searched for specific populations vulnerable to DAAT. We conducted a case-control study
comparing patients with MRSA bacteraemia who died during hospitalization (cases) with patients with
MRSA bacteraemia who survived (controls) in three medical centres in two states. Patients were identified
using computerized hospital databases for the years 2001-2005. Medical records were retrieved and various
epidemiological data extracted. Bivariate and multivariate logistic regression analyses were performed.
Overall, 388 patients with MRSA bacteraemia were included, 164 cases and 224 controls. According to
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bivariate analyses, cases were significantly more likely than controls to (i) be older (>65 years), (ii) have
transferred from an institution, (iii) have stayed in an ICU, (iv) have had more invasive devices, (v) have a
poorer prognosis on admission, (vi) have higher disease severity at the time of bacteraemia, and (vii) have a
DAAT of >/=2 days. Upon multivariate analysis, among patients >65 years, DAAT was significantly
associated with increased mortality (p 0.04). Furthermore, patients >65 years with severe sepsis were much
more likely to experience DAAT (p 0.02). In elderly patients with MRSA bacteraemia, DAAT is associated
with increased mortality. Moreover, advanced age is a predictor for DAAT. These significant epidemiological
associations mandate early coverage of MRSA in septic elderly patients.
NosoBase n° 27217
Preuve d'une relation linéaire simple entre le taux de SARM et l'observance de l'hygiène des mains
Nicolau DV; Kith G; Oshmyansky A. Evidence for a simple linear relationship between MRSA rates and
hand-washing compliance. The Journal of hospital infection 2010/06; 75(2): 140-141.
Mots-clés : HYGIENE DES MAINS; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
OBSERVANCE; TAUX; INCIDENCE; SOLUTION HYDROALCOOLIQUE; CONSOMMATION
NosoBase n° 27240
Coût des bactériémies à Staphylococcus aureus méticillino-résistant vs méticillino-sensible en
Espagne : étude de cohorte, rétrospective
Rubio-Terres C; Garau J; Grau S; Martinez-Martinez L. Cost of bacteraemia caused by methicillin-resistant
vs. methicillin-susceptible Staphylococcus aureus in Spain: a retrospective cohort study. Clinical
microbiology and infection 2010/06; 16(6): 722-728.
Mots-clés : BACTERIEMIE; METICILLINO-RESISTANCE; STAPHYLOCOCCUS AUREUS; COUT;
EPIDEMIE; COHORTE; ETUDE RETROSPECTIVE; DUREE DE SEJOUR; ANTIBIOTIQUE; SOIN
INTENSIF; ANTIBIORESISTANCE
The aim of this study was to determine the impact on healthcare resource utilization and associated costs of
bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA) vs methicillin-susceptible S. aureus
(MSSA) strains in Spain. An observational, retrospective, cohort multicentre study was conducted during
2005. The target population comprised Spanish patients with S. aureus bacteraemia (five and ten cases per
hospital for resistant and susceptible strains, respectively). The resources used were obtained from the
hospital patient records. The unit costs were obtained from the participating hospitals and from Spanish
databases; the costs of a bacteraemic episode were estimated from resource utilization results and
expressed in euros (euro). Univariate sensitivity analyses were performed. The clinical records of 366 valid
patients with S. aureus bacteraemia (121 MRSA and 245 MSSA) from 27 Spanish hospitals were reviewed.
Resource use per bacteraemic episode was higher for MRSA cases than for MSSA cases, with longer
antibiotic treatment (3.1 additional days) and greater length of hospital stay (LOS) (2.2 additional days),
more diagnostic tests, and higher rates of admission to the intensive-care unit (ICU) (7.6%). As a
consequence, a higher cost per episode was incurred, with an additional euro1205 in episodes of MRSA
infections (1.12-fold increase). The main drivers of the cost difference were the higher rates of ICU
admission and hospital re-admission and increased LOS. The analysis confirmed that there were additional
costs due to resistant strains, ranging from euro293 to euro5188. Overall, MRSA was associated with higher
costs in bacteraemic patients, and this was attributable mainly to the greater rate of ICU admissions and
increased LOS.
NosoBase n° 27252
Succès par la diversité. Comment Staphylococcus epidermidis s'établit comme un pathogène
nosocomial
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Schoenfelder S; Lange C; Eckart M; Hennig S; Kozytska S; Ziebuhr W. Success through diversity - how
Staphylococcus epidermidis establishes as a nosocomial pathogen. International journal of medical
microbiology 2010; in press: 7 pages.
Mots-clés : STAPHYLOCOCCUS EPIDERMIDIS; BIOLOGIE MOLECULAIRE; TYPAGE;
METICILLINO-RESISTANCE; BIBLIOGRAPHIE
BIOFILM;
Staphylococcus epidermidis normally is a commensal inhabitant of the healthy human skin and mucosa, but
also a common nosocomial pathogen in immunocompromised patients. Living at the edge between
commensalism and pathogenicity, S. epidermidis has developed interesting strategies to conquer the
hospital environment as a novel ecological niche and to transform into a notorious pathogen. Recent
progress in genome analysis and molecular epidemiology gave interesting insights into the enormous
flexibility by which these bacteria generate continuously novel phenotypic and genotypic variants. Recent
multilocus sequence typing studies identified S. epidermidis as a highly diverse species that evolves mainly
by recombination and acquires readily mobile genetic elements. With respect to healthcare-associated
isolates, a limited number of epidemic clonal lineages were found to have emerged and established in
hospital settings worldwide. These isolates are characterised by the carriage of various SCCmec gene
cassettes, conferring methicillin resistance, and by a striking ability to form biofilms on medical devices.
Moreover, nosocomial S. epidermidis strains typically harbour multiple copies of the insertion sequence
element IS256 in their genomes. Nosocomial S. epidermidis strains vary virulence- and resistanceassociated gene expression in the course of an infection to a remarkably high degree. Heterogenous gene
expression in S. epidermidis is achieved, on the one hand, by complex regulatory pathways. On the other
hand, it is associated with genetic mechanisms that were found to be mediated by the action of the IS256
element which obviously represents an important driving force for the flexibility of the S. epidermidis
genome. The data accumulated so far suggest that recombination along with the frequent acquisition of
mobile genetic elements are crucial factors for the success of S. epidermidis as a nosocomial pathogen.
NosoBase n° 27256
Impact d'une surveillance active et des précautions contact sur la transmission de Staphylococcus
aureus méticillino-résistant dans des unités de réanimation dans des régions à prévalence élevée
Wang JT; Lauderdale TL; Lee WS; Huang JH; Wang TH; Chang SC. Impact of active surveillance and
contact isolation on transmission of methicillin-resistant Staphylococcus aureus in intensive care units in an
area with high prevalence. Journal of the Formosan Medical Association 2010/04; 109(4): 258-268.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
SOIN
INTENSIF;
METICILLINO-RESISTANCE;
PREVALENCE; SURVEILLANCE; PRECAUTION CONTACT; TRANSMISSION; PREVENTION;
INCIDENCE; FACTEUR DE RISQUE; APPAREIL RESPIRATOIRE; DUREE DE SEJOUR
Background/purpose: Previous research has suggested that active surveillance and early initiation of contact
isolation (ASI) can control the nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA),
especially among intensive care unit (ICU) patients. However, these interventions have never been
implemented in Taiwan.
Methods: This study was conducted from September 2005 to October 2006 to evaluate the effect of ASI on
the spread of MRSA in two medical centers in Taiwan with a high prevalence of MRSA. One ICU from each
hospital was selected as a study site. In phase I (the first 6 months), only active surveillance was introduced.
In phase II (the final 6 months), ASI for patients who had positive MRSA cultures was implemented.
Results: The incidence of acquiring MRSA during ICU stay did not differ significantly during phases I and II
in hospital A (p = 0.940) and hospital B (p = 0.810). The independent risk factors for acquiring MRSA in the
ICU were length of stay and presence of respiratory tract diseases.
Conclusion: This study demonstrated that, given the current resource limitations, ASI alone could not reduce
MRSA transmission in two ICUs in Taiwan, where the MRSA prevalence was high.
Surveillance
NosoBase n° 26268
Formulation d'un modèle pour la surveillance automatisée des infections : algorithme de détection
des bactériémies liées aux voies centrales
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Hota B; Lin M; Doherty JA; Borlawsky T; Woeltje K; Stevenson K; et al. Formulation of a model for
automating infection surveillance: algorithmic detection of central-line associated bloodstream infection.
Journal of the American medical informatics association 2010; 17: 42-48.
Mots-clés : STATISTIQUE;
INFORMATIQUE
SURVEILLANCE;
BACTERIEMIE;
CATHETER
VEINEUX
CENTRAL;
Objective: To formulate a model for translating manual infection control surveillance methods to automated,
algorithmic approaches.
Design: We propose a model for creating electronic surveillance algorithms by translating existing manual
surveillance practices into automated electronic methods. Our model suggests that three dimensions of
expert knowledge be consulted: clinical, surveillance, and informatics. Once collected, knowledge should be
applied through a process of conceptualization, synthesis, programming, and testing.
Results: We applied our framework to central vascular catheter associated bloodstream infection
surveillance, a major healthcare performance outcome measure. We found that despite major barriers such
as differences in availability of structured data, in types of databases used and in semantic representation of
clinical terms, bloodstream infection detection algorithms could be deployed at four very diverse medical
centers.
Conclusions: We present a framework that translates existing practice-manual infection detection-to an
automated process for surveillance. Our experience details barriers and solutions discovered during
development of electronic surveillance for central vascular catheter associated bloodstream infections at
four hospitals in a variety of data environments. Moving electronic surveillance to the next level-availability at
a majority of acute care hospitals nationwide-would be hastened by the incorporation of necessary data
elements, vocabularies and standards into commercially available electronic health records.
NosoBase n° 27079
Instruction n°DGOS/PF1/2010/112 du 07/04/2010 relative à la mise en place des conseils de
surveillance des établissements publics de santé suite à la loi portant réforme de l'hôpital et relative
aux patients, à la santé et aux territoires
Ministère de la santé et des sports. Non parue au Journal officiel 2010 :14 pages.
Mots-clés : LEGISLATION; STRUCTURE DE SOINS; CME; USAGER; CENTRE HOSPITALIER
UNIVERSITAIRE
La présente instruction concerne les travaux préparatoires à la mise en place des conseils de surveillance
au sein des établissements publics de santé.
Tuberculose
NosoBase n° 27149
Transmission nosocomiale d'une otite moyenne tuberculeuse dans une unité d'ORL en ambulatoire :
enquête clinique et hygiénique
Karcher H; Epple HJ; Schneider T; Eckmanns T; John P; Schweickert B. Nosocomia transmission of
tuberculous otitis media in an ear, nose and throat outpatient unit: a clinical and hygienical investigation. The
Journal of infection 2010; in press: 3 pages.
Mots-clés
:
TRANSMISSION;
TUBERCULOSE;
OREILLE;
OTO-RHINO-LARYNGOLOGIE;
AMBULATOIRE; ENQUETE; MYCOBACTERIUM TUBERCULOSIS; INVESTIGATION
NosoBase n° 27293
Risque de tuberculose latente chez des sujets employés dans le secteur de la santé en Allemagne :
étude multicentrique de prévalence
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Schablon A; Harling M; Diel R; Nienhaus A. Risk of latent TB infection in individuals employed in the
healthcare sector in Germany: a multicentre prevalence study. BMC infectious diseases 2010; in press: 26
pages.
Mots-clés : RISQUE PROFESSIONNEL; PREVALENCE; TUBERCULOSE; PERSONNEL; FACTEUR DE
RISQUE; AGE; TEST TUBERCULINIQUE; DEPISTAGE
Background: Healthcare workers are still recognised as a high-risk group for latent TB infection (LTBI).
Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to
infection control programmes in German hospitals. It was the aim of the study to determine the prevalence
and putative risk factors of LTBI.
Methods: We tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT)
test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB
high-risk groups following German OSH legislation.
Results: A positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians
showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence
was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in
the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was
14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology),
6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk
factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.42.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR
3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination,
workplace or profession.
Conclusion: The prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA
results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk.
Pre-employment screening might be helpful in this endeavour.
Usager
NosoBase n° 27209
Impact psychologique des mesures de précautions complémentaires à court terme chez des
patients hospitalisés
Wassenberg M; Severs D; Bonten M. Psychological impact of short-term isolation measures in hospitalised
patients. The Journal of hospital infection 2010/06; 75(2): 124-127.
Mots-clés : PRECAUTION COMPLEMENTAIRE; QUALITE; USAGER; COHORTE; APPARIEMENT;
ETUDE TRANSVERSALE; CENTRE HOSPITALIER UNIVERSITAIRE
Unintended negative effects, such as anxiety and depression, have been demonstrated in patients subjected
to infection control strategies, such as isolation for long periods. Yet isolation precautions are mostly shortterm. We therefore determined levels of anxiety, depression and quality of life in patients exposed to shortterm isolation. In a cross-sectional matched cohort study, performed in a single university hospital, patients
isolated for infection control were evaluated with the Hospital Anxiety and Depression Scale [HADS-A
(Anxiety) and HADS-D (Depression)], Visual Analogue Scale of EQ-5D (EQ VAS) and an isolation
evaluation questionnaire within 24-48 h after start of isolation. Two matched controls were selected for each
isolated patient. Isolated patients (N=42) and control patients (N=84) had comparable HADS-A (4.5 vs 5.0),
HADS-D (4.0 vs 5.0) and EQ VAS (65 vs 62) scores. In multiple regression analysis comorbidity was
associated with EQ VAS outcome (P=0.005), whereas all other variables, including being in isolation, were
unrelated to HADS and EQ VAS scores. Patients reported positive associations with isolation measures.
The quality of care provided by physicians and nurses, as perceived by isolated patients, was not negatively
affected in 74% and 71% of patients, respectively. In conclusion, short-term infection control measures do
not influence hospitalised patients' levels of anxiety and depression and quality of life. Isolated patients had
a positive attitude towards the precautions taken.
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Vaccination
NosoBase n° 27130
Le calendrier des vaccinations et les recommandations vaccinales 2010 selon l'avis du Haut conseil
de la santé publique
Institut de Veille Sanitaire; INVS. 2010 vaccination schedule and recommendations from the "Haut conseil
de la santé publique" in France. Bulletin épidémiologique hebdomadaire 2010/04/22; (14-15): 121-172.
Mots-clés : VACCIN; RECOMMANDATION; GRIPPE; ROUGEOLE; BORDETELLA PERTUSSIS;
HEPATITE A; HEPATITE B; NEISSERIA MENINGITIDIS; STREPTOCOCCUS PNEUMONIAE;
TUBERCULOSE; VARICELLE; VIRUS INFLUENZA TYPE A; CLOSTRIDIUM TETANI; RAGE
Le calendrier vaccinal fixe les vaccinations applicables aux personnes résidant en France en fonction de
leur âge, résume les recommandations vaccinales "générales". Il introduit de nouvelles recommandations
qui concernent les vaccinations contre le méningocoque C, les infections invasives à pneumocoque et la
rougeole.
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