NosoVeille Août 2011

NosoVeille – Bulletin de veille
Février 2016
NosoVeille n°2
Février 2016
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Acinetobacter baumannii
Antibiotique / Antibiorésistance
Bactériémie
Biologie
Cathétérisme
Chirurgie
Clostridium difficile
Désinfection
EHPAD
Elizabethkingia meningoseptica
Endoscopie
Entérobactérie
Environnement
Grippe
Hygiène des mains
Infection respiratoire
Legionella
Néonatologie
Personnel
Plasmodium falciparum
Prévention
Pseudomonas aeruginosa
Soins intensifs
Staphylococcus aureus
Tenue vestimentaire
Usagers
Zika
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Acinetobacter baumannii
NosoBase ID notice : 407391
Etude nationale auprès des infectiologues thaïlandais sur le traitement des pneumonies à
Acinetobacter baumannii résistant aux carbapénèmes acquises sous ventilation assistée : rôle de la
sensibilisation à l’hygiène hospitalière
Buppajarntham A; Apisarnthanarak A; Khawcharoenporn T; Rutjanawech S; Singh N. National survey of Thai
infectious disease physicians on treatment of carbapenem-resistant Acinetobacter baumannii ventilatorassociated pneumonia: The role of infection control awareness. Infection control and hospital epidemiology
2016/01; 37(1): 61-69.
Mots-clés :
ACINETOBACTER
BAUMANNII;
PNEUMONIE;
VENTILATION
ANTIBIORESISTANCE; CARBAPENEME; TAUX; TRAITEMENT; MEDECIN SPECIALISTE
ASSISTEE;
Objective: To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs)
regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP).
Methods: From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success
rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as
the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success
rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice
of each IDP. The expected and clinical success rates were divided into low (80%) categories and were then
compared with standard clinical response rates archived in the existing literature.
Results: Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical
success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a
hospital that implemented the standard intervention combined with an intensified infection control (IC)
intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17-7.73; P=.02) was
associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI,
2.16-15.37; P60%). We identified a significant correlation between expected and clinical success rates
(r=0.58; P<.001).
Conclusions: Awareness of IC among IDPs can improve physicians' expected and clinical success rates for
CRAB VAP treatment, and treatment experience impacts overall treatment success.
Antibiotique / Antibiorésistance
NosoBase ID notice : 406327
Mortalité attribuable aux infections à Klebsiella pneumoniae résistant aux carbapénèmes dans une
étude de cohorte prospective avec appariement en Italie, 2012-2013
Hoxha A; Kärki T; Giambi C; Montano C; Sisto A; Bella A; et al. Attributable mortality of carbapenem-resistant
Klebsiella pneumoniae infections in a prospective matched cohort study in Italy, 2012-2013. The journal of
hospital infection 2016/01; 92(1): 61-66.
Mots-clés : KLEBSIELLA PNEUMONIAE; MORTALITE; ANTIBIORESISTANCE; CARBAPENEME;
COHORTE; APPARIEMENT; ETUDE PROSPECTIVE; INCIDENCE; FACTEUR DE RISQUE
Background: In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased
markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options
for infected patients.
Aim: To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical
characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP)
infection.
Methods: We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP.
The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP
from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of
CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson
regression.
Findings: The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone
more invasive procedures and also tended to have more serious conditions, measured by higher Simplified
Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three
times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval
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(CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI:
1.3-7.1).
Conclusion: CRKP infection had a marked effect on patient mortality, even after adjusting for other patient
characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals
where CRKP is found.
NosoBase ID notice : 407392
Indications d’antibiothérapie et types d’antibiotiques utilisés dans 6 centres hospitaliers de court
séjour, 2009-2010 : étude d’observation rétrospective et pragmatique
Kelesidis T; Braykov N; Uslan DZ; Morgan D; Gandra S; Johannsson B; et al. Indications and types of
antibiotic agents used in 6 acute care hospitals, 2009-2010: A pragmatic retrospective observational study.
Infection control and hospital epidemiology 2016/01; 37(1): 70-79.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; PREVALENCE; TRAITEMENT; ANTI-INFECTIEUX;
ANTIBIOPROPHYLAXIE;
FLUOROQUINOLONE;
VANCOMYCINE;
PENICILLINE;
ETUDE
RETROSPECTIVE
Background: To design better antimicrobial stewardship programs, detailed data on the primary drivers and
patterns of antibiotic use are needed.
Objective: To characterize the indications for antibiotic therapy, agents used, duration, combinations, and
microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial
stewardship programs.
Design, participants, and setting: Retrospective medical chart review was performed on a random crosssectional sample of 1,200 adult inpatients, hospitalized (>24 hrs) in 6 hospitals, and receiving at least 1
antibiotic dose on 4 index dates chosen at equal intervals through a 1-year study period (October 1, 2009September 30, 2010).
Methods: Infectious disease specialists recorded patient demographic characteristics, comorbidities,
microbiological and radiological testing, and agents used, dose, duration, and indication for antibiotic
prescriptions.
Results: On the index dates 4,119 (60.5%) of 6,812 inpatients were receiving antibiotics. The random sample
of 1,200 case patients was receiving 2,527 antibiotics (average: 2.1 per patient); 540 (21.4%) were
prophylactic and 1,987 (78.6%) were therapeutic, of which 372 (18.7%) were pathogen-directed at start. Of
the 1,615 empirical starts, 382 (23.7%) were subsequently pathogen-directed and 1,231 (76.2%) remained
empirical. Use was primarily for respiratory (27.6% of prescriptions) followed by gastrointestinal (13.1%)
infections. Fluoroquinolones, vancomycin, and antipseudomonal penicillins together accounted for 47.1% of
therapy-days.
Conclusions: Use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities and in most
instances was not subsequently pathogen directed. Fluoroquinolones, vancomycin, and antipseudomonal
penicillins were the most frequently used antibiotics, particularly for respiratory indications.
NosoBase ID notice : 406690
Infections sur prothèse articulaire : une revue microbiologique
Lalremruata R. Prosthetic joint infection: A microbiological review. Journal of medical society 2015/09; 29(3):
120-128.
Mots-clés : PROTHESE; PROTHESE ARTICULAIRE; FACTEUR DE RISQUE; BACTERIE A GRAM
NEGATIF; BACTERIE A GRAM POSITIF; STAPHYLOCOCCUS AUREUS; CANDIDA; ANTIBIOTIQUE;
ANTIBIOTHERAPIE; REVUE DE LA LITTERATURE
Joint replacement is a highly effective intervention that significantly improves patients’ quality of life, providing
symptom relief, restoration of joint function, improved mobility, and independence. Prosthetic joint infection
(PJI) remains one of the most serious complications of prosthetic joint implantation. PJI positions a
substantial burden on individuals, communities, and the health-care system, and thus early diagnosis and
appropriate intervention are extremely important. Determining the various host and environmental factors that
put an individual at risk for development of PJI may reduce the morbidity and cost of total joint arthroplasties.
Microbial agents implicated in the causation of PJI range from Grampositive to Gram-negative bacteria. PJI
with fungi is commonly seen in immunocompromised patients. Numerous novel, uncultivable, and fastidious
organisms have been identified as potential pathogens with the use of non-culture techniques. The majority of
cases of PJI require surgical treatment, while the use of antimicrobials is essential when prosthetic removal is
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not possible or contraindicated. The microbiology and treatment of PJI in the light of improved culture and
diagnostic methods are reviewed.
NosoBase ID notice : 405981
Impact des infections à Escherichia coli ou Klebsiella pneumoniae producteurs de bêta-lactamases à
spectre étendu sur l’évolution et les coûts d’hospitalisation
Maslikowska JA; Walker SA; Elligsen M; Mittmann N; Palmay L; Daneman N; et al. Impact of infection with
extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella species on outcome and
hospitalization costs. The journal of hospital infection 2016/01; 92(1): 33-41.
Mots-clés : ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; COUT; SEJOUR; BETA-LACTAMASE A
SPECTRE ELARGI; MORTALITE; MICROBIOLOGIE; ETUDE RETROSPECTIVE; CAS TEMOIN; DUREE
DE SEJOUR; ANTIBIOTIQUE; TRAITEMENT
Background: Extended-spectrum β-lactamase (ESBL)-producing bacteria are important sources of infection;
however, Canadian data evaluating the impact of ESBL-associated infection are lacking.
Aim: To determine whether patients infected with ESBL-producing Escherichia coli or Klebsiella species
(ESBL-EcKs) exhibit differences in clinical outcome, microbiological outcome, mortality, and/or hospital
resource use compared to patients infected with non-ESBL-producing strains.
Methods: A retrospective case-control study of 75 case patients with ESBL-EcKs matched to controls infected
with non-ESBL-EcKs who were hospitalized from June 2010 to April 2013 was conducted. Patient-level cost
data were provided by the institution's business office. Clinical data were collected using the electronic
databases and paper charts.
Findings: Median infection-related hospitalization costs per patient were greater for cases than controls
(C$10,507 vs C$7,882; median difference: C$3,416; P=0.04). The primary driver of increased costs was
prolonged infection-related hospital length of stay (8 vs 6 days; P=0.02) with patient location (ward, ICU) and
indirect care costs (including costs associated with infection prevention and control) as the leading cost
categories. Cases were more likely to experience clinical failure (25% vs 11%; P=0.03), with a higher allcause mortality (17% vs 5%; P=0.04). Less than half of case patients were prescribed appropriate empiric
antimicrobial therapy, whereas controls received adequate initial treatment in nearly all circumstances (48%
vs 96%; P<0.01).
Conclusion: Patients with infection caused by ESBL-EcKs are at increased risk for clinical failure and
mortality, with additional cost to the Canadian healthcare system of C$3,416 per patient.
NosoBase ID notice : 407371
Epidémiologie des colonisations et infections à Klebsiella pneumoniae résistant aux carbapénèmes
chez les résidents d’un établissement de longue durée
Mills JP; Talati NJ; Alby K; Han JH. The epidemiology of carbapenem-resistant Klebsiella pneumoniae
colonization and infection among long-term acute care hospital residents. Infection control and hospital
epidemiology 2016/01; 37(1): 55-60.
Mots-clés : KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE; CARBAPENEME; INFECTION
NOSOCOMIALE; EPIDEMIOLOGIE; COLONISATION; FACTEUR DE RISQUE; TAUX; SOIN DE LONGUE
DUREE; CAS-TEMOIN
Objective: An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term
acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for
colonization or infection with CRKP in LTACH residents.
Methods: A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases
were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical
cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to
identify risk factors for CRKP infection or colonization.
Results: A total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99
(45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors
associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation
(OR, 5.05; 95% CI, 1.23-20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24-5.28; P=.01), fecal
incontinence (OR, 5.78; 95% CI, 1.52-22.0; P=.01), and exposure in the prior 30 days to meropenem (OR,
3.55; 95% CI, 1.04-12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18-7.32; P=.02), and metronidazole (OR,
4.22; 95% CI, 1.28-14.0; P=.02).
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Conclusions: Rates of colonization and infection with CRKP were high in the LTACH setting, with nearly half
of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on
interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of highrisk patients and effective antibiotic stewardship measures.
NosoBase ID notice : 407369
Augmentation de l’incidence des Escherichia coli producteurs de β-lactamase à spectre étendu dans
les hôpitaux locaux de tout le sud-est des Etats Unis
Thaden JT; Fowler VG; Sexton DJ; Anderson DJ. Increasing incidence of extended-spectrum β-lactamaseproducing Escherichia coli in community hospitals throughout the Southeastern United States. Infection
control and hospital epidemiology 2016/01; 37(1): 49-54.
Mots-clés : ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; BETA-LACTAMASE A SPECTRE ELARGI;
INFECTION NOSOCOMIALE; INFECTION COMMUNAUTAIRE; INCIDENCE; TAUX; SOIN INTENSIF;
ETUDE RETROSPECTIVE
Objective: To describe the epidemiology of extended-spectrum β-lactamase (ESBL)-producing Escherichia
coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections
Design: Retrospective cohort
Setting: Inpatient care at community hospitals
Patients: All patients with ESBL-EC or ESBL-KP infections
Methods: ESBL-EC and ESBL-KP infections from 26 community hospitals were prospectively entered into a
centralized database from January 2009 to December 2014.
Results: A total of 925 infections caused by ESBL-EC (10.5 infections per 100,000 patient days) and 463
infections caused by ESBL-KP (5.3 infections per 100,000 patient days) were identified during 8,791,243
patient days of surveillance. The incidence of ESBL-EC infections increased from 5.28 to 10.5 patients per
100,000 patient days during the study period (P=.006). The number of community hospitals with ESBL-EC
infections increased from 17 (65%) in 2009 to 20 (77%) in 2014. The median ESBL-EC infection rates among
individual hospitals with ≥1 ESBL-EC infection increased from 11.1 infections/100,000 patient days (range,
2.2-33.9 days) in 2009 to 22.1 infections per 100,000 patient days (range, 0.66-134 days) in 2014 (P=.05).
The incidence of ESBL-KP infections remained constant over the study period (P=.14). Communityassociated and healthcare-associated ESBL-EC infections trended upward (P=.006 and P=.02, respectively),
while hospital-onset infections remained stable (P=.07). ESBL-EC infections were more common in females
(54% vs 44%, P<.001) and Caucasians (50% vs 40%, P<.0001), and were more likely to be isolated from the
urinary tract (61% vs 52%, P<.0001) than ESBL-KP infections.
Conclusions: The incidence of ESBL-EC infection has increased in community hospitals throughout the
southeastern United States, while the incidence of ESBL-KP infection has remained stable. Community- and
healthcare-associated ESBL-EC infections are driving the upward trend.
NosoBase ID notice : 406331
Prévention et contrôle de bactéries multirésistantes aux antibiotiques : recommandations d’un
groupe de travail
Wilson APR; Livermore DM; Otter JA; Warren RE; Jenks P; Enoch DA; et al. Prevention and control of multidrug-resistant Gram-negative bacteria: recommendations from a Joint Working Party. The journal of hospital
infection 2016/01; 92(Suppl. 1): S1-S44.
Mots-clés : PREVENTION; MULTIRESISTANCE; CONTROLE; BACTERIE A GRAM NEGATIF;
RECOMMANDATIONS DE BONNE PRATIQUE; SURVEILLANCE; DEPISTAGE; EPIDEMIOLOGIE;
PREUVE
Multi-drug-resistant (MDR) Gram-negative bacterial infections have become prevalent in some European
countries. Moreover, increased use of broad-spectrum antimicrobial agents selects organisms with resistance
and, by increasing their numbers, increases their chance of spread. This report describes measures that are
clinically effective for preventing transmission when used by healthcare workers in acute and primary
healthcare premises. Methods for systematic review 1946-2014 were in accordance with SIGN 50 and the
Cochrane Collaboration; critical appraisal was applied using AGREEII. Accepted guidelines were used as part
of the evidence base and to support expert consensus. Questions for review were derived from the Working
Party Group, which included patient representatives in accordance with the Patient Intervention Comparison
Outcome (PICO) process. Recommendations are made in the following areas: screening, diagnosis and
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infection control precautions including hand hygiene, single-room accommodation, and environmental
screening and cleaning. Recommendations for specific organisms are given where there are species
differences. Antibiotic stewardship is covered in a separate publication.
Bactériémie
NosoBase ID notice : 407366
Evolution des bactériémies à ERV et ESV à un stade où le traitement des ERV est efficace : étude
systématique et méta-analyse
Prematunge C; MacDougall C; Johnstone J; Adomako K; Lam F; Robertson J; et al. VRE and VSE
bacteremia outcomes in the era of effective VRE therapy: A systematic review and meta-analysis. Infection
control and hospital epidemiology 2016/01; 37(1): 26-35.
Mots-clés : BACTERIEMIE; ENTEROCOCCUS; VANCOMYCINE; ANTIBIORESISTANCE; SENSIBILITE;
INFECTION NOSOCOMIALE; DUREE DE SEJOUR; ENTEROCOCCUS FAECIUM; ENTEROCOCCUS
FAECALIS; MORTALITE
Background: Prior data suggest that vancomycin-resistant Enterococcus (VRE) bacteremia is associated with
worse outcomes than vancomycin-sensitive Enterococcus (VSE) bacteremia. However, many studies
evaluating such outcomes were conducted prior to the availability of effective VRE therapies.
Objective: To systematically review VRE and VSE bacteremia outcomes among hospital patients in the era of
effective VRE therapy.
Methods: Electronic databases and grey literature published between January 1997 and December 2014
were searched to identify all primary research studies comparing outcomes of VRE and VSE bacteremias
among hospital patients, following the availability of effective VRE therapies. The primary outcome was allcause, in-hospital mortality, while total hospital length of stay (LOS) was a secondary outcome. All metaanalyses were conducted in Review Manager 5.3 using random-effects, inverse variance modeling.
Results: Among all the studies reviewed, 12 cohort studies and 1 case control study met inclusion criteria.
Similar study designs were combined in meta-analyses for mortality and LOS. VRE bacteremia was
associated with increased mortality compared with VSE bacteremia among cohort studies (odds ratio [OR],
1.80; 95% confidence interval [CI], 1.38-2.35; I2=0%; n=11); the case-control study estimate was similar, but
not significant (OR, 1.93; 95% CI, 0.97-3.82). LOS was greater for VRE bacteremia patients than for VSE
bacteremia patients (mean difference, 5.01 days; 95% CI, 0.58-9.44]; I2=0%; n=5).
Conclusions: Despite the availability of effective VRE therapy, VRE bacteremia remains associated with an
increased risk of in-hospital mortality and LOS when compared to VSE bacteremia.
Biologie
NosoBase ID notice : 408637
Décret n° 2016-46 du 26 janvier 2016 relatif à la biologie médicale.
Ministère des affaires sociales, de la santé et des droits des femmes. Décret n° 2016-46 du 26 janvier 2016
relatif à la biologie médicale. Journal officiel de la République française Lois et décrets 2016/01/28: 16 pages.
Mots-clés : LEGISLATION; LABORATOIRE; BIOLOGIE MEDICALE; EXAMEN DE LABORATOIRE;
PRELEVEMENT; DISPOSITIF MEDICAL; ACCREDITATION; QUALITE
Le présent décret prévoit les conditions dans lesquelles sont effectués les examens de biologie médicale. Il
codifie les règles permettant d’apprécier l’activité d’un laboratoire de biologie médicale et le pourcentage
maximum d’échantillons biologiques pouvant être transmis entre laboratoires de biologie médicale. Il pose
par ailleurs les conditions d’installation des laboratoires de biologie médicale. Il prévoit ainsi les modalités
d’accréditation et d’évaluation des laboratoires ainsi que la possibilité de maintien, à titre dérogatoire, des
laboratoires qui, à la date d’entrée en vigueur du décret, sont implantés sur plus de trois territoires limitrophes
ou sur des territoires non limitrophes.
Cathétérisme
NosoBase ID notice : 408292
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Prévention de la contamination bactérienne des valves bidirectionnelles : faut-il passer aux
capuchons imprégnés ?
Dupont C; Lurton Y. Prévention de la contamination bactérienne des valves bidirectionnelles : faut-il passer
aux capuchons imprégnés ? Hygiènes 2015/12; 23(6): 373-378.
Mots-clés : PREVENTION; CONTAMINATION; CATHETER; DESINFECTION; ALCOOL; CAPUCHON;
VALVE
L’analyse de la littérature consacrée aux infections liées au cathétérisme (ILC) suite à l’utilisation de valves
bidirectionnelles suggère deux facteurs de risque liés à ce dispositif : le design des valves qui permet leur
contamination et l’inefficacité des pratiques de leur désinfection. La recommandation d’une désinfection par
friction de quinze secondes avec une compresse stérile imprégnée d’antiseptique alcoolique ne garantit pas
en pratique la décontamination du dispositif. La mise à disposition d’un capuchon contenant un tampon
imbibé d’antiseptique, destiné à se placer sur la valve bidirectionnelle peut amener une solution à ce
problème de décontamination. Ce capuchon qui peut rester en place jusqu’à sept jours décontamine et
protège efficacement la valve. Son utilisation paraît indiquée pour protéger une valve placée sur une ligne
veineuse non utilisée et pour diminuer les ilc lorsque les précautions standard se sont révélées inefficaces.
Vu son coût actuel, sa généralisation à l’ensemble des accès à la ligne veineuse quel que soit le contexte
doit être discutée.
NosoBase ID notice : 407353
Bactériémies associées à des lésions de la barrière muqueuse confirmées par le laboratoire : analyse
descriptive des données rapportées au National Healthcare Safety Network (NHSN), 2013
Epstein L; See I; Edwards JR; Magill SN; Thompson ND. Mucosal barrier injury laboratory-confirmed
bloodstream infections (MBI-LCBI): Descriptive analysis of data reported to National Healthcare Safety
Network (NHSN), 2013. Infection control and hospital epidemiology 2016/01; 37(1): 2-7.
Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; INFECTION NOSOCOMIALE; TAUX;
CANCEROLOGIE; SURVEILLANCE; LABORATOIRE
Objectives: To determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections
(MBI-LCBIs) on central-line-associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI
reporting to the National Healthcare Safety Network (NHSN)
Design: Descriptive analysis of 2013 NHSN data
Setting: Selected inpatient locations in acute care hospitals
Methods: A descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days
were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI,
and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location
type.
Results: From 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were
reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the
CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward
locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs,
removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38%
decrease); decreases in other locations ranged from 1.2% to 4.2%.
Conclusions: An understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed
to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting
programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where
patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across
inpatient locations appears to be more modest.
NosoBase ID notice : 405848
Evaluation clinique d’un pansement gel à la chlorhexidine pour cathéters vasculaires sur des
cathéters veineux centraux à court terme
Karpanen TJ; Casey AL; Whitehouse T; Nightingale P; Das I; Elliott TSJ. Clinical evaluation of a chlorhexidine
intravascular catheter gel dressing on short-term central venous catheters. American journal of infection
control 2016/01; 44(1): 54-60.
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Mots-clés : CHLORHEXIDINE;
COLONISATION
Février 2016
CATHETER
VEINEUX
CENTRAL;
PANSEMENT;
PREVENTION;
Background: A major source of microbial colonization of short-term central venous catheters (CVC) is the
patients' endogenous skin microorganisms located at the CVC insertion site. The aim of this study was to
determine if a transparent film dressing incorporating a 2% (weight/weight) chlorhexidine gluconate (CHG) gel
decreases CVC and insertion site microbial colonization compared with a nonantimicrobial dressing in adult
patients in critical care.
Methods: On CVC removal, samples for microbiological investigation were taken from both the skin
surrounding the CVC insertion site and also from sutures securing the CVC. The sutures and intradermal and
tip sections of the CVC were also collected for microbiological investigation. Microorganisms recovered from
the samples were subsequently tested for susceptibility to CHG.
Results: There was a significant reduction in the number of microorganisms recovered from the CVC insertion
site, suture site, sutures, and catheter surface in the CHG dressing group (n=136) compared with the
nonantimicrobial dressing group (n=137). There was no significant difference in susceptibility to CHG
between the microorganisms isolated from the CHG and standard dressing study patients.
Conclusion: A film dressing incorporating a CHG gel pad significantly reduced the number of microorganisms
at the CVC insertion and suture sites with concomitant reduced catheter colonization.
NosoBase ID notice : 407575
Cathéters veineux imprégnés sulfadiazine chlorhexidine-argent ou rifampicine-miconazole diminuent
le risque de bactériémie liée au cathéter
Lorente L; Lecuona M; Jiménez A; Raja L; Cabrera J; Gonzalez O; et al. Chlorhexidine-silver sulfadiazine- or
rifampicin-miconazole-impregnated venous catheters decrease the risk of catheter-related bloodstream
infection similarly. American journal of infection control 2016/01; 44(1): 50-53.
Mots-clés : CATHETERISME; BACTERIEMIE; CATHETER IMPREGNE; CHLORHEXIDINE; RIFAMPICINE;
SULFADIAZINE; MICONAZOLE
Background: The objective of this study was to compare the incidence of catheter-related bloodstream
infection (CRBSI) with the use of second-generation chlorhexidine-silver sulfadiazine (CHSS)-impregnated
catheters, rifampicin-miconazole (RM)-impregnated catheters, and standard catheters.
Methods: Retrospective study of patients admitted to an intensive care unit who received CHSS, RM, or
standard catheters in femoral venous access.
Results: We diagnosed 18 CRBSIs in 245 patients with standard catheters in 2,061 days, zero CRBSI in 169
patients with CHSS-impregnated catheters in 1,489 days, and zero CRBSI in 227 patients with RMimpregnated catheters in 2,009 days. Patients with standard catheters compared with CHSS- and RMimpregnated catheters showed a higher rate of CRBSI (7.3%, 0%, and 0%, respectively; P<.001) and higher
incidence density of CRBSI (8.7, 0, and 0 per 1,000 catheter days, respectively; P<.001). We found in the
exact Poisson regression that standard catheters were associated with a higher CRBSI incidence than
CHSS-impregnated catheters (P<.001) and RM-impregnated catheters (P<.001), controlling for catheter
duration. We found in survival analysis that standard catheters were associated with a lower CRBSI-free time
than CHSS-impregnated catheters (P<.001) and RM-impregnated catheters (P<.001).
Conclusion: We found that CHSS- and RM-impregnated catheters decreased similarly the risk of CRBSI.
Chirurgie
NosoBase ID notice : 408294
Radiographie au chevet en réanimation chirurgicale : évaluation du risque de transmission croisée
Fondrinier C; Mouet A; Le Coutour X. Radiographie au chevet en réanimation chirurgicale : évaluation du
risque de transmission croisée. Hygiènes 2015/12; 23(6): 379-381.
Mots-clés : TRANSMISSION; SOIN INTENSIF; HYGIENE DES MAINS; INFORMATION; RADIOGRAPHIE;
GESTION DES RISQUES; EVALUATION DES PRATIQUES PROFESSIONNELLES; MULTIRESISTANCE;
PRECAUTION COMPLEMENTAIRE; PRECAUTION CONTACT; BMR
Les auteurs ont souhaité analyser les risques de transmission croisée lors de la radiographie au chevet du
patient et proposer les actions susceptibles de les maîtriser.
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NosoBase ID notice : 407418
Variation saisonnière des infections du site opératoire : pourquoi cela se produit-il, pourquoi cela a-til une importance ?
Manian FA. Seasonal variation of surgical site infections: Why does it occur, why does it matter? Infection
control and hospital epidemiology 2016/01; 37(1): 121-123.
Mots-clés : CHIRURGIE;
PERSONNEL; PEAU
PRE-OPERATOIRE;
STAPHYLOCOCCUS
AUREUS;
COLONISATION;
NosoBase ID notice : 407398
Diabète et risques d’infection du site opératoire : revue systématique et méta-analyse
Martin ET; Kaye KS; Knott C; Nguyen H; Santarossa M; Evans R; et al. Diabetes and risk of surgical site
infection: A systematic review and meta-analysis. Infection control and hospital epidemiology 2016/01; 37(1):
88-99.
Mots-clés : INFECTION NOSOCOMIALE; CHIRURGIE;
HYPERGLYCEMIE; PRE-OPERATOIRE; META-ANALYSE
DIABETE;
FACTEUR
DE
RISQUE;
Objective: To determine the independent association between diabetes and surgical site infection (SSI)
across multiple surgical procedures.
Design: Systematic review and meta-analysis.
Methods: Studies indexed in PubMed published between December 1985 and through July 2015 were
identified through the search terms "risk factors" or "glucose" and "surgical site infection." A total of 3,631
abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these,
94 articles met the criteria for inclusion. Standardized data collection forms were used to extract studyspecific estimates for diabetes, blood glucose levels, and body mass index (BMI). A random-effects metaanalysis was used to generate pooled estimates, and meta-regression was used to evaluate specific
hypothesized sources of heterogeneity.
Results: The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention
surveillance criteria. The overall effect size for the association between diabetes and SSI was odds ratio
(OR)=1.53 (95% predictive interval [PI], 1.11-2.12; I2, 57.2%). SSI class, study design, or patient BMI did not
significantly impact study results in a meta-regression model. The association was higher for cardiac surgery
2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001).
Conclusions: These results support the consideration of diabetes as an independent risk factor for SSIs for
multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic
patients.
NosoBase ID notice : 407395
Caractéristiques des interventions chirurgicales et risques d’accidents d’exposition au sang et aux
liquides biologiques par piqûre/coupure
Myers DJ; Lipscomb HJ; Epling C; Hunt D; Richardson W; Smith-Lovin L; et al. Surgical procedure
characteristics and risk of sharps-related blood and body fluid exposure. Infection control and hospital
epidemiology 2016/01; 37(1): 80-87.
Mots-clés : ACCIDENT D'EXPOSITION AU SANG; CHIRURGIE;
CHIRURGIE; SANG; SUTURE; PERSONNEL; FACTEUR DE RISQUE
INFECTION
NOSOCOMIALE;
Objective: To use a unique multicomponent administrative data set assembled at a large academic teaching
hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating
rooms.
Design: A 10-year retrospective cohort design.
Setting: A single large academic teaching hospital.
Participants: All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF
exposures were analyzed.
Methods: Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and
account for procedure duration. BBF exposures involving suture needles were examined separately from
those involving other device types to examine possible differences in risk factors.
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Results: The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000
surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000
procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood
loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000
procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000
procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results
showed associations were generally stronger for suture needle-related exposures.
Conclusions: Results largely support other studies found in the literature. However, additional research
should investigate differences in risk factors for BBF exposures associated with suture needles and those
associated with all other device types.
Clostridium difficile
NosoBase ID notice : 408649
Outil d’évaluation des pratiques - Analyse des scénario : prévention de la diffusion des infections à
Clostridium difficile
CClin-Arlin. Outil d’évaluation des pratiques - Analyse des scénario : prévention de la diffusion des infections
à Clostridium difficile. CClin-Arlin 2016/01: 1-15.
Mots-clés : CLOSTRIDIUM DIFFICILE; GESTION DES RISQUES; PREVENTION; METHODOLOGIE;
PERSONNEL; EVALUATION; ANALYSES DES CAUSES; EHPAD; PSYCHIATRIE; STRUCTURE DE
SOINS DE SUITE ET READAPTATION; ANALYSE DE SCENARIO
Les infections à Clostridium difficile sont des événements indésirables fréquents qui peuvent parfois
présenter un caractère de gravité sous forme d’entérocolite nécrosante, au point d’engager le pronostic vital
des patients. La bactérie responsable de l’infection, de par sa persistance dans l’environnement des patients
atteints, sa grande résistance aux produits habituellement utilisés pour désinfecter l’environnement et le
matériel, présente un caractère épidémiogène important (en particulier le clone 027).
De nombreux établissements sanitaires et médico-sociaux ont été concernés en France, et des épidémies
d’ampleurs régionales ont été rapportées. L’identification rapide et la prise en charge adéquate de ce type
d’infections représentent donc un enjeu majeur de santé publique, si l’on veut prévenir la survenue d’une
épidémie au sein d’un service ou d’un établissement. Les recommandations émises par le Haut conseil de
Santé Publique en 2008 et déclinées par le réseau CCLIN-ARLIN, qu’elles prennent place autour d’un cas ou
dans le cadre d’un phénomène épidémique, ont fait la preuve de leur efficacité et doivent donc être connues,
maîtrisées et appliquées.
Le programme national 2015 de prévention des infections associées aux soins (PROPIAS), développe des
objectifs spécifiques de lutte contre les infections à C. difficile, ce qui souligne l’importance de cette lutte et sa
prise en compte institutionnelle.
Depuis la mise en place du décret n° 2010-1408 du 12 novembre 2010 relatif à la lutte contre les évènements
indésirables associés aux soins dans les établissements de santé, le développement des retours
d’expérience sur les évènements indésirables dans les établissements doit être renforcé afin d’améliorer la
qualité et la sécurité des soins. L’analyse de scénario est une méthode d’évaluation des pratiques
professionnelles en équipe qui permet l’introduction d’actions pertinentes dans les programmes d’actions
d’amélioration continue de la qualité et de la sécurité des soins. Ce projet est ciblé sur les mesures de
prévention des infections à C. difficile. Il repose sur une méthode d’analyse des risques à priori développée
par le CClin Sud-Ouest avec le Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine
(CCECQA) : l’analyse de scénario clinique.
NosoBase ID notice : 408461
Transplantation du microbiote gelé versus frais et résolution clinique de la diarrhée chez les patients
atteints d’une infection récurrente à Clostridium difficile - Un essai clinique randomisé
Lee CH; Steiner T; Petrof EO; Smieja M; Roscoe D; Nematallah A; et al. Frozen vs fresh fecal microbiota
transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection - A
randomized clinical trial. JAMA, the journal of the American Medical Association 12/01/2016; 315(2): 142-149.
Mots-clés : CLOSTRIDIUM DIFFICILE; DIARRHEE; ESSAI CLINIQUE; RANDOMISATION; MORTALITE;
TRANSPLANTATION FECALE
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Importance: Clostridium difficile infection (CDI) is a major burden in health care and community settings. CDI
recurrence is of particular concern because of limited treatment options and associated clinical and infection
control issues. Fecal microbiota transplantation (FMT) is a promising, but not readily available, intervention.
Objective: To determine whether frozen-and-thawed (frozen, experimental) FMT is noninferior to fresh
(standard) FMT in terms of clinical efficacy among patients with recurrent or refractory CDI and to assess the
safety of both types of FMT.
Design, setting, and participants: Randomized, double-blind, noninferiority trial enrolling 232 adults with
recurrent or refractory CDI, conducted between July 2012 and September 2014 at 6 academic medical
centers in Canada.
Interventions: Patients were randomly allocated to receive frozen (n=114) or fresh (n=118) FMT via enema.
Main outcomes and measures: The primary outcome measures were clinical resolution of diarrhea without
relapse at 13 weeks and adverse events. Noninferiority margin was set at 15%.
Results: A total of 219 patients (n=108 in the frozen FMT group and n=111 in the fresh FMT group) were
included in the modified intention-to-treat (mITT) population and 178 (frozen FMT: n=91, fresh FMT: n=87) in
the per-protocol population. In the per-protocol population, the proportion of patients with clinical resolution
was 83.5% for the frozen FMT group and 85.1% for the fresh FMT group (difference, -1.6% [95% CI, -10.5%
to ∞]; P=.01 for noninferiority). In the mITT population the clinical resolution was 75.0% for the frozen FMT
group and 70.3% for the fresh FMT group (difference, 4.7% [95% CI, -5.2% to ∞]; P<.001 for noninferiority).
There were no differences in the proportion of adverse or serious adverse events between the treatment
groups.
Conclusions and relevance: Among adults with recurrent or refractory CDI, the use of frozen compared with
fresh FMT did not result in worse proportion of clinical resolution of diarrhea. Given the potential advantages
of providing frozen FMT, its use is a reasonable option in this setting.
NosoBase ID notice : 407356
Transmission de Clostridium difficile au cours d’une hospitalisation pour transplantation allogène de
cellules souches
Kamboj M; Sheahan A; Sun J; Taur Y; Robilotti E; Babady NE; et al. Transmission of Clostridium difficile
during hospitalization for allogeneic stem cell transplant. Infection control and hospital epidemiology 2016/01;
37(1): 8-15.
Mots-clés :
CLOSTRIDIUM
DIFFICILE;
TRANSMISSION;
INFECTION
NOSOCOMIALE;
TRANSPLANTATION; SYSTEME NERVEUX CENTRAL; HEMATOLOGIE; COLONISATION; COHORTE
Objective: To determine the role of unit-based transmission that accounts for cases of early Clostridium
difficile infection (CDI) during hospitalization for allogeneic stem cell transplant.
Setting: Stem cell transplant unit at a tertiary care cancer center.
Methods: Serially collected stool from patients admitted for transplant was screened for toxigenic C. difficile
through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates
retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly
characterized. Transmission links were established by time-space clustering of cases and carriers of shared
toxigenic C. difficile strains.
Results: During the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had
evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52
cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission,
among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this
group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of
acquisition; donor source could be established in half of these cases.
Conclusions: Most cases of CDI after stem cell transplant represent delayed onset disease in
nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases
in our cohort with a probable donor source established in half of the cases.
NosoBase ID notice : 407365
Evaluation de l’utilisation de l’indice du case mix (ICM) pour un ajustement sur le risque des données
d’infections associées aux soins : une illustration faite à partir des données d’infections à
Clostridium difficile du réseau National Healthcare Safety Network
Thompson ND; Edwards JR; Dudeck MA; Fridkin SK; Magill SS. Evaluating the use of the case mix index for
risk adjustment of healthcare-associated infection data: An illustration using Clostridium difficile infection data
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from the national healthcare safety network. Infection control and hospital epidemiology 2016/01; 37(1): 1925.
Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION NOSOCOMIALE; INCIDENCE; TAUX; SCORE; CMI;
RISQUE
Background: Case mix index (CMI) has been used as a facility-level indicator of patient disease severity. We
sought to evaluate the potential for CMI to be used for risk adjustment of National Healthcare Safety Network
(NHSN) healthcare-associated infection (HAI) data.
Methods: NHSN facility-wide laboratory-identified Clostridium difficile infection event data from 2012 were
merged with the fiscal year 2012 Inpatient Prospective Payment System (IPPS) Impact file by CMS
certification number (CCN) to obtain a CMI value for hospitals reporting to NHSN. Negative binomial
regression was used to evaluate whether CMI was significantly associated with healthcare facility-onset (HO)
CDI in univariate and multivariate analysis.
Results: Among 1,468 acute care hospitals reporting CDI data to NHSN in 2012, 1,429 matched by CCN to a
CMI value in the Impact file. CMI (median, 1.49; interquartile range, 1.36-1.66) was a significant predictor of
HO CDI in univariate analysis (P<.0001). After controlling for community onset CDI prevalence rate, medical
school affiliation, hospital size, and CDI test type use, CMI remained highly significant (P<.0001), with an
increase of 0.1 point in CMI associated with a 3.4% increase in the HO CDI incidence rate.
Conclusions: CMI was a significant predictor of NHSN HO CDI incidence. Additional work to explore the
feasibility of using CMI for risk adjustment of NHSN data is necessary.
NosoBase ID notice : 407022
Disparités raciales et ethniques dans les infections à Clostridium difficile associées aux soins aux
Etats-Unis : état de la science
Yang S; Rider BB; Baehr A; Ducoffe AR; Hu DJ. Racial and ethnic disparities in health care-associated
Clostridium difficile infections in the United States: State of the science. American journal of infection control
2016/01; 44(1): 91-96.
Mots-clés : CLOSTRIDIUM DIFFICILE; REVUE DE LA LITTERATURE; RACE; ETHNIE
Background: Among health care-associated infections (HAIs), Clostridium difficile infections (CDIs) are a
major cause of morbidity and mortality in the United States. As national progress toward CDI prevention
continues, it will be critical to ensure that the benefits from CDI prevention are realized across different patient
demographic groups, including any targeted interventions.
Methods: Through a comprehensive review of existing evidence for racial/ethnic and other disparities in CDIs,
we identified a few general trends, but the results were heterogeneous and highlight significant gaps in the
literature.
Results: The majority of analyzed studies identified white patients as at increased risk of CDIs, although there
is a very limited literature base, and many studies had significant methodological limitations.
Conclusion: Key recommendations for future research are provided to address antimicrobial stewardship
programs and populations that may be at increased risk for CDIs.
Désinfection
NosoBase ID notice : 408289
Cartographie de l’utilisation des désinfectants oxydants à base de peroxyde d’hydrogène et/ou
d’acide peracétique dans les établissements de santé lorrains
Dreyer M; Lizon J; Guillaso M; Forin J; Florentin A. Cartographie de l’utilisation des désinfectants oxydants à
base de peroxyde d’hydrogène et/ou d’acide peracétique dans les établissements de santé lorrains.
Hygiènes 2015/12; 23(6): 364-370.
Mots-clés : DESINFECTANT; PEROXYDE D'HYDROGENE; ACIDE PERACETIQUE; STRUCTURE DE
SOINS; DESINFECTION; DETERGENT; OXYDANT; RISQUE PROFESSIONNEL; STRUCTURE MEDICOSOCIALE; ENDOSCOPIE; DISPOSITIF MEDICAL; DIALYSE RENALE; DESINFECTION PAR VOIE
AERIENNE; SURFACE
Les désinfectants et les détergents jouent un rôle primordial dans la lutte contre les infections associées aux
soins mais leur utilisation est associée à un nombre important de cas d’asthme et de rhinite d’origine
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professionnelle. Récemment introduite en milieux de soins, l’exposition professionnelle aux oxydants est peu
connue. L’objectif de notre étude était de cartographier les utilisations des désinfectants contenant de l’acide
peracétique et/ou du peroxyde d’hydrogène en milieu de soins. Nous avons élaboré un questionnaire
permettant de recueillir des données d’utilisation en termes de produits, de lieux et d’activités. Ce
questionnaire a été diffusé aux établissements sanitaires et médicosociaux de Lorraine. Trente et un
questionnaires ont été retournés (21 %). Quinze établissements (48 %) effectuaient au moins une activité de
désinfection avec des produits contenant des oxydants. La désinfection du matériel endoscopique a été citée
par 73 % des utilisateurs. Six pour cent des établissements réalisaient des désinfections par voie aérienne et
16 % des désinfections de sols et surfaces lors de phénomènes épidémiques particuliers. Cette cartographie
nous a permis de constater une grande diversité des indications, des formulations, et des modalités d’usage
avec des fréquences d’utilisation et des personnels exposés très variables selon les opérations de
désinfection. De plus cette étude a révélé un potentiel risque pour la santé des personnes manipulant ces
produits.
EHPAD
NosoBase ID notice : 408463
Impact des échantillons microbiologiques dans la gestion hospitalière des
communautaires, acquises en EHPAD et acquises à l'hôpital chez les patients âgés
pneumonies
Putot A; Tetu J; Perrin S; Bailly H; Piroth L; Besancenot J; et al. Impact of microbiological samples in the
hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in
older patients. European journal of clinical microbiology and infectious diseases 2016/01/11; in press: 7
pages.
Mots-clés :
PNEUMONIE;
PERSONNE
MICROBIOLOGIE; ANTIBIOTIQUE
AGEE;
EHPAD;
INFECTION
COMMUNAUTAIRE;
We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact
of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired
pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75
years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of
medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intrahospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138
CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6% of CAP, NHAP and HAP,
respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3% of patients for CAP, NHAP and
HAP, respectively (p=0.05). Non-covered pathogens were detected for 8% of CAP, 2% of NHAP and 13.6%
of HAP (p=0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were
positive (46.7% vs. 10.8% when MS were negative, p=10(-7)). The MS positivity rate was significantly lower
in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2% of NHAP. These results
show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised
older patients and suggest that their use should be rationalised.
Elizabethkingia meningoseptica
NosoBase ID notice : 406180
Infections à Elizabethkingia meningoseptica chez des patients de traumatologie sévèrement blessés :
sept ans d’étude
Rastogi N; Mathur P; Bindra A; Goyal K; Sokhal N; Kumar S; et al. Infections due to Elizabethkingia
meningoseptica in critically injured trauma patients: a seven-year study. The journal of hospital infection
2016/01; 92(1): 30-32.
Mots-clés : BACILLE GRAM NEGATIF; TRAUMATOLOGIE; ETUDE RETROSPECTIVE; FACTEUR DE
RISQUE;
ANTIBIORESISTANCE;
VENTILATION
ASSISTEE;
CATHETER;
ELIZABETHKINGIA
MENINGOSEPTICA
Elizabethkingia meningoseptica is an infrequent cause of hospital-acquired infections. The clinical and
microbiological profiles of infections due to E. meningoseptica over a seven-year period at a Level I trauma
centre are reported in this study. Medical records of patients from whose clinical samples E. meningoseptica
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was isolated on at least two occasions were reviewed. A total of 21 cases were observed during the study, 16
(76.2%) of which exhibited multidrug resistance. The observed in-hospital mortality rate was 47.6%. A high
index of clinical suspicion and effective detection of E. meningoseptica in clinical samples are requisite for
improved clinical outcome.
Endoscopie
NosoBase ID notice : 408459
Principes de prévention de l'infection et désinfection en endoscopie ORL
Kramer A; Kohnen W; Israel S; Ryll S; Hübner NO; Luckhaupt H; et al. Principles of infection prevention and
reprocessing in ENT endoscopy. GMS Current topics in otorhinolaryngology - Head and neck surgery
2015/12/22; 14: 1-10.
Mots-clés : PREVENTION; ENDOSCOPIE; DESINFECTION; CHIRURGIE; ORL; DIAGNOSTIC; ENQUETE;
LAVE-ENDOSCOPE
This article gives an overview on the principles of reprocessing of rigid and flexible endoscopes used in ENT
units including structural and spatial requirements based on general and ENT-specific risks of infection
associated with diagnostic and therapeutic endoscopy. The underlying legal principles as well as
recommendations from scientific societies will be exemplified in order to give a practical guidance to the
otorhinolaryngologist. Preliminary results of a small nation-wide survey on infection control standards based
on data of 29 ENT practices in Germany reveal current deficits of varying degree concerning infection control
management including reprocessing of endoscopes. The presented review aims to give support to the
establishment of a structured infection control management program including the evaluation of results by
means of a prospective surveillance.
Entérobactérie
NosoBase ID notice : 406178
Evolution dans l’épidémiologie d’entérobactéries productrices de carbapénèmases au Portugal :
cohorte rétrospective 2012 dans un centre hospitalier universitaire de Lisbonne
Pires D; Zagalo A; Santos C; Cota de Madeiros F; Duarte A; Lito L; et al. Evolving epidemiology of
carbapenemase-producing Enterobacteriaceae in Portugal: 2012 retrospective cohort at a tertiary hospital in
Lisbon. The journal of hospital infection 2016/01; 92(1): 82-85.
Mots-clés : EPIDEMIOLOGIE; ENTEROBACTERIE; ANTIBIORESISTANCE; CARBAPENEME; CENTRE
HOSPITALIER UNIVERSITAIRE; COHORTE; ETUDE RETROSPECTIVE; ADULTE; KLEBSIELLA
PNEUMONIAE; CARBAPENEMASE
Despite great efforts to enhance European epidemiological surveillance on carbapenemase-producing
Enterobacteriaceae (CPE), information from several countries remains scarce. To address CPE epidemiology
in Portugal, we have undertaken a retrospective cohort study of adults with CPE cultures identified in the
microbiology laboratory of a tertiary hospital, in 2012. Sixty patients from 25 wards or intensive care units
were identified. This is, to the best of our knowledge, the first report of clinical data on CPE in Portugal. It
shows a hospital-wide CPE dissemination and alerts us to an evolving epidemiological situation not
previously described.
NosoBase ID notice : 406094
Evaluation de la carte d’alerte d’entérobactéries productrices de carbapénèmases portée par le
patient
Poole K; George R; Shryane T; Shankar K; Cawthorne J; Worsley M; et al. Evaluation of patient-held
carbapenemase-producing Enterobacteriaceae (CPE) alert card. The journal of hospital infection 2016/01;
92(1): 102-105.
Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; CARBAPENEME;
COLONISATION; CENTRE HOSPITALIER UNIVERSITAIRE; CARBAPENEMASE
MULTIRESISTANCE;
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Public Health England recommends patient-held cards for those colonized with carbapenemase-producing
Enterobacteriaceae (CPE). Alert cards were provided to 104 CPE-positive inpatients, with follow-up at six
months. Excluding those who died, the response rate was 39%. Sixteen patients (46%) recalled receiving the
card; 13 (81%) of these retained it, most (64%) of whom reported using it. This is the first evaluation of a
patient-held alert card for any antimicrobial-resistant (AMR) bacteria in the UK. This study demonstrated that,
when retained, CPE alert cards can be an effective communication tool. Further work is required to evaluate
effectiveness and improve retention.
NosoBase ID notice : 406320
Facteurs de risque de colonisation à entérobactéries productrices de carbapénèmases de porteurs
asymptomatiques à l’admission dans un centre hospitalier de réadaptation en Italie
Rossini A; Di Santo SG; Libori MF; Tiracchia V; Balice MP; Salvia A. Risk factors for carbapenemaseproducing Enterobacteriaceae colonization of asymptomatic carriers on admission to an Italian rehabilitation
hospital. The journal of hospital infection 2016/01; 92(1): 78-81.
Mots-clés : COLONISATION; ENTEROBACTERIE; CARBAPENEME; SEJOUR; ANTIBIORESISTANCE;
EPIDEMIOLOGIE; DEPISTAGE; ANALYSE MULTIVARIEE; FACTEUR DE RISQUE; CATHETER VEINEUX
CENTRAL; CARBAPENEMASE; SSR
The spread of carbapenemase-producing Enterobacteriaceae (CPE) has become a worldwide problem. Early
identification and isolation of asymptomatic carriers are important for infection prevention and control
measures. All inpatients (N=1427) admitted to 'Fondazione Santa Lucia' Rehabilitation Hospital in 2014 were
screened by rectal swab; 10.2% of them were CPE-colonized. The multivariate analysis on anamnestic data
showed that both previous admission to an intensive care unit (odds ratio: 4.04; 95% confidence interval:
2.20-7.44; P<0.001) or post-acute care hospitals (2.88; 1.74-4.77; P<0.001) and presence of a central venous
catheter (2.19; 1.34-3.59; P<0.001) were significant risk factors.
Environnement
NosoBase ID notice : 408296
Mise au point d’une méthode de contrôle visuel du bionettoyage des véhicules de secours et
d’assistance aux victimes au sein d’un service départemental d’incendie et de secours
Favier L; Marini H; Mougeolle CP; Barré A; Flotté J; Lemarchand C; et al. Mise au point d’une méthode de
contrôle visuel du bionettoyage des véhicules de secours et d’assistance aux victimes au sein d’un service
départemental d’incendie et de secours. Hygiènes 2015/12; 23(6): 383-386.
Mots-clés : BIONETTOYAGE; TRANSPORT SANITAIRE; SECOURS D'URGENCE; EVALUATION;
DESINFECTION; SAPEUR-POMPIER
L’objectif des auteurs de l’article était donc de mettre au point une méthodologie de contrôle et d’évaluation
de l’hygiène des véhicules de secours et d’assistance aux victimes (VSAV) simple, fiable et reproductible, et
de proposer des mesures d’amélioration visant à améliorer le bionettoyage des VSAV.
NosoBase ID notice : 405134
Contrôle et analyse microbiologique [Dossier]
Thibaudon M. Contrôle et analyse microbiologique [Dossier]. Salles propres 2015/11; 100: 25-43.
Mots-clés : QUALITE; IDENTIFICATION DE L’AGENT INFECTIEUX; MICROBIOLOGIE; LEGISLATION;
GENOTYPE; ARCHITECTURE; NORME; AIR; SURFACE; SALLE PROPRE
Sommaire du dossier :
- Est-il possible de procéder à une classification microbiologique d'une salle propre ?
- Comparaison des différentes techniques d'identification microbienne
- Spécificité des milieux de culture utilisés dans les contrôles d'environnement
- Méthodes alternatives rapides en contrôle qualité
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Février 2016
NosoBase ID notice : 406181
Nettoyage manuel des matelas à l’hôpital : étude d’observation comparant des régions à ressources
élevées et à ressources faibles
Hopman J; Hakizimana B; Meintjes WAJ; Nillessen M; de Both E; Voss A; et al. Manual cleaning of hospital
mattresses: an observational study comparing high- and low-resource settings. The journal of hospital
infection 2016/01; 92(1): 14-18.
Mots-clés : LIT; NETTOYAGE; CONTAMINATION; CENTRE HOSPITALIER UNIVERSITAIRE;
PERSONNEL; FORMATION; ETUDE MULTICENTRIQUE; MATELAS; ETUDE D'OBSERVATION|
Background: Hospital-associated infections (HAIs) are more frequently encountered in low- than in highresource settings. There is a need to identify and implement feasible and sustainable approaches to
strengthen HAI prevention in low-resource settings.
Aim: To evaluate the biological contamination of routinely cleaned mattresses in both high- and low-resource
settings.
Methods: In this two-stage observational study, routine manual bed cleaning was evaluated at two university
hospitals using adenosine triphosphate (ATP). Standardized training of cleaning personnel was achieved in
both high- and low-resource settings. Qualitative analysis of the cleaning process was performed to identify
predictors of cleaning outcome in low-resource settings.
Findings: Mattresses in low-resource settings were highly contaminated prior to cleaning. Cleaning
significantly reduced biological contamination of mattresses in low-resource settings (P<0.0001). After
training, the contamination observed after cleaning in both the high- and low-resource settings seemed
comparable. Cleaning with appropriate type of cleaning materials reduced the contamination of mattresses
adequately. Predictors for mattresses that remained contaminated in a low-resource setting included: type of
product used, type of ward, training, and the level of contamination prior to cleaning.
Conclusion: In low-resource settings mattresses were highly contaminated as noted by ATP levels. Routine
manual cleaning by trained staff can be as effective in a low-resource setting as in a high-resource setting.
We recommend a multi-modal cleaning strategy that consists of training of domestic services staff, availability
of adequate time to clean beds between patients, and application of the correct type of cleaning products.
Grippe
NosoBase ID notice : 408898
Instruction n°DGS/RI1/DGOS/DGCS/2016/4 du 08 janvier 2016 relative aux mesures de prévention et
de contrôle de la grippe saisonnière
Ministère des affaires sociales, de la santé et des droits des femmes. Instruction
n°DGS/RI1/DGOS/DGCS/2016/4 du 08 janvier 2016 relative aux mesures de prévention et de contrôle de la
grippe saisonnière. Non parue au Journal officiel 2016/01/08: 36 pages.
Mots-clés : LEGISLATION; PREVENTION; CONTROLE; GRIPPE; RECOMMANDATIONS DE BONNES
PRATIQUE; VACCINATION; ANTIVIRAL; DIAGNOSTIC CLINIQUE; HYGIENE DES MAINS; MASQUE;
EHPAD; STRUCTURE SANITAIRE; EPIDEMIOLOGIE; TRANSMISSION; RT-PCR; SURVEILLANCE;
OFFRE DE SOINS; PROFESSION LIBERALE; INFIRMIER; SAGE-FEMME; MEDECIN GENERALISTE;
PHARMACIEN; MASSEUR KINESITHERAPEUTE; INFORMATION; MASQUE CHIRURGICAL; TROD;
TEST RAPIDE D’ORIENTATION DIAGNOSTIQUE; TWEETER
Les épidémies de grippe saisonnière représentent un problème majeur de santé publique. La prévention de
cette pathologie repose sur la vaccination mais aussi sur le respect de mesures barrières afin d’en limiter la
transmission. Dans certains cas, le recours aux antiviraux est recommandé. Enfin, l’organisation de l’offre de
soins doit permettre de faire face aux situations exceptionnelles. Des fiches techniques et des annexes
synthétisent les recommandations actualisées.
NosoBase ID notice : 406955
Evaluation de l’efficacité du vaccin contre la grippe dans un réseau de surveillance sentinelle
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Février 2016
Cowling BJ; Feng S; Finelli L; Steffens A; Fowlkes A. Assessment of influenza vaccine effectiveness in a
sentinel surveillance network 2010-13, United States. Vaccine 2016/01/02; 34(1): 61-66.
Mots-clés : GRIPPE; SURVEILLANCE; VACCIN; EVALUATION; EFFICACITE
Background: Influenza vaccines are now widely used to reduce the burden of annual epidemics of influenza
virus infections. Influenza vaccine effectiveness (VE) is monitored annually to determine VE against each
season's circulating influenza strains in different groups such as children, adults and the elderly. Few
prospective surveillance programs are available to evaluate influenza VE against medically attended illness
for patients of all ages in the United States.
Methods: We conducted surveillance of patients with acute respiratory illnesses in 101 clinics across the US
during three consecutive influenza seasons. We analyzed laboratory testing results for influenza virus, selfreported vaccine history, and patient characteristics, defining cases as patients who tested positive for
influenza virus and controls as patients who tested negative for influenza virus. Comparison of influenza
vaccination coverage among cases versus controls, adjusted for potential confounders, was used to estimate
VE as one minus the adjusted odds ratio multiplied by 100%.
Results: We included 10,650 patients during three influenza seasons from August 2010 through December
2013, and estimated influenza VE in children 6m-5y of age (58%; 95% CI: 49%-66%), children 6-17y (45%;
95% CI: 34%-53%), adults 18-49y (36%; 95% CI: 24%, 46%), and adults ≥50y (34%, 95% CI: 13%, 51%). VE
was higher against influenza A(H1N1) compared to A(H3N2) and B.
Conclusions: Our estimates of moderate influenza VE confirm the important role of vaccination in protecting
against medically attended influenza virus infection.
NosoBase ID notice : 405975
Transmission des coronavirus du SRAS et de MERS et de la grippe en établissements de santé : rôle
possible de la contamination de surfaces sèches
Otter JA; Donskey C; Yezli S; Douthwaite S; Goldenberg SD; Weber DJ. Transmission of SARS and MERS
coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. The
journal of hospital infection 2015/10/03; in press: 1-16.
Mots-clés : TRANSMISSION; CONTAMINATION; VIRUS; SRAS; CORONAVIRUS; GRIPPE; SURFACE;
ENVIRONNEMENT; NETTOYAGE; DESINFECTION; PREVENTION; TENUE VESTIMENTAIRE;
MATERIAU; GANT; STETHOSCOPE; MERS-CCV
Viruses with pandemic potential including H1N1, H5N1, and H5N7 influenza viruses, and severe acute
respiratory syndrome (SARS)/Middle East respiratory syndrome (MERS) coronaviruses (CoV) have emerged
in recent years. SARS-CoV, MERS-CoV, and influenza virus can survive on surfaces for extended periods,
sometimes up to months. Factors influencing the survival of these viruses on surfaces include: strain
variation, titre, surface type, suspending medium, mode of deposition, temperature and relative humidity, and
the method used to determine the viability of the virus. Environmental sampling has identified contamination
in field-settings with SARS-CoV and influenza virus, although the frequent use of molecular detection
methods may not necessarily represent the presence of viable virus. The importance of indirect contact
transmission (involving contamination of inanimate surfaces) is uncertain compared with other transmission
routes, principally direct contact transmission (independent of surface contamination), droplet, and airborne
routes. However, influenza virus and SARS-CoV may be shed into the environment and be transferred from
environmental surfaces to hands of patients and healthcare providers. Emerging data suggest that MERSCoV also shares these properties. Once contaminated from the environment, hands can then initiate selfinoculation of mucous membranes of the nose, eyes or mouth. Mathematical and animal models, and
intervention studies suggest that contact transmission is the most important route in some scenarios. Infection
prevention and control implications include the need for hand hygiene and personal protective equipment to
minimize self-contamination and to protect against inoculation of mucosal surfaces and the respiratory tract,
and enhanced surface cleaning and disinfection in healthcare settings.
NosoBase ID notice : 400547
Infection humaine avec un nouveau virus de grippe aviaire (H5N6) hautement pathogène : résultats
virologiques et cliniques
Pan M; Gao R; Lv Q; Huang S; Zhou Z; Yang L; et al. Human infection with a novel highly pathogenic avian
influenza A (H5N6) virus: Virological and clinical findings. Journal of infection 2016/01; 72(1): 52-59.
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Février 2016
Mots-clés : VIRUS; GRIPPE; VIRUS INFLUENZA TYPE A; GRIPPE AVIAIRE; EPIDEMIOLOGIE; PCR; RTPCR; TYPAGE; ANIMAL; ENQUETE; GRIPPE A (H5N6)|
Objectives: Human severe infection with avian influenza A (H5N6) virus infection was identified firstly in 2014
in China. It was unknown or unclear on the disease or the pathogen by people. This study would illustrate the
virological and clinical findings of a fatal human case with H5N6 virus infection.
Methods: We obtained and analyzed the clinical, epidemiological and virological data from the patient. RTPCR, viral culture and sequencing were conducted for determination of causative pathogen.
Results: The patient who presented with fever, severe pneumonia, leucopenia and lymphopenia, developed
septic shock and ARDS, and died on day 10 after illness onset. A novel reassortant avian-origin influenza A
(H5N6) virus was isolated from the throat swab or trachea aspirate of the patient. The virus was reassorted
with HA gene of Clade 2.3.4.4 H5, internal genes of Clade 2.3.2.1 H5 and NA gene of H6N6 avian viruses.
The cleavage site of HA gene contained multiple basic amino acids indicating the novel H5N6 virus was
highly pathogenic in chicken.
Conclusions: A novel highly pathogenic avian influenza H5N6 virus with the backbone of H5N1 virus acquired
NA gene from H6N6 virus was first identified, and caused human infection with severe respiratory disease.
Hygiène des mains
NosoBase ID notice : 407446
Une enquête de prévalence ponctuelle sur l’hygiène des mains, avec un accent particulier sur les
espèces de Candida
Brühwasser C; Hinterberger G; Mutschlechner W; Kaltseis J; Lass-Flörl C; Mayr A. A point prevalence survey
on hand hygiene, with a special focus on Candida species. American journal of infection control 2016/01;
44(1): 71-73.
Mots-clés : PREVALENCE; CANDIDA; HYGIENE DES MAINS; ENQUETE
Background: A 1-day point prevalence study evaluated hand hygiene compliance, yeast colonization, and
contamination, focusing on the hands of health care workers (HCWs) and patient-oriented surfaces.
Methods: Hand hygiene compliance was evaluated by applying the direct observation technique and the
World Health Organization's compliance program, "My Five Moments for Hand Hygiene." A total of 128
samples from HCWs working in intensive care (n=11) and intermediate care (n=2) units and 65 environmental
samples from Innsbruck Medical University Hospital were investigated.
Results: Hand hygiene compliance was superior for nurses (83.5%) and moderate for medical doctors
(45.2%). In general, fungal growth was unique; only 9 of 128 HCW samples and only 4 of 65 environmental
samples yielded positive results. The genetic relatedness of yeasts from the same species was investigated
by random amplified polymorphic DNA (RAPD) typing. RAPD profiles exhibited the potential for crosstransmission of yeasts.
Conclusion: In general, the fungal colonization and contamination rate was low, but a high level of hand
hygiene compliance was lacking.
NosoBase ID notice : 406415
Evaluation de la dissémination virale pendant le séchage des mains : comparaison de trois méthodes
Kimmitt PT; Redway KP. Evaluation of the potential for virus dispersal during hand drying: a comparison of
three methods. Journal of applied microbiology 2016/02; 120(2): 478-486.
Mots-clés : VIRUS; HYGIENE DES MAINS; TRANSMISSION; ESSUIE-MAIN; SECHE-MAINS
Aims: To use a MS2 bacteriophage model to compare three hand-drying methods, paper towels (PT), a warm
air dryer (WAD) and a jet air dryer (JAD), for their potential to disperse viruses and contaminate the
immediate environment during use.
Methods and results: Participants washed their gloved hands with a suspension of MS2 bacteriophage and
hands were dried with one of the three hand-drying devices. The quantity of MS2 present in the areas around
each device was determined using a plaque assay. Samples were collected from plates containing the
indicator strain, placed at varying heights and distances and also from the air. Over a height range of 0.151.65 m, the JAD dispersed an average of >60 and >1300-fold more plaque-forming units (pfu) compared to
the WAD and PT (P<0.0001), respectively. The JAD dispersed an average of >20 and >190-fold more pfu in
total compared to WAD and PT at all distances tested up to 3 m (P<0.01), respectively. Air samples collected
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NosoVeille – Bulletin de veille
Février 2016
around each device 15 minutes after use indicated that the JAD dispersed an average of >50 and >100-fold
more pfu compared to the WAD and PT (P<0.001), respectively.
Conclusions: Use of the JAD lead to significantly greater and further dispersal of MS2 bacteriophage from
artificially contaminated hands when compared to the WAD and PT.
Significance and impact of study: The choice of hand drying device should be considered carefully in areas
where infection prevention concerns are paramount, such as healthcare settings and the food industry.
NosoBase ID notice : 405850
Une mauvaise hygiène des mains des étudiants liée à plus de survenue de maladies infectieuses, de
visites médicales et d’absences de cours
Prater KJ; Fortuna CA; McGill JL; Brandeberry MS; Stone AR; Lu X. Poor hand hygiene by college students
linked to more occurrences of infectious diseases, medical visits, and absence from classes. American
journal of infection control 2016/01; 44(1): 66-70.
Mots-clés :
HYGIENE
COMMUNAUTAIRE
DES
MAINS;
ETUDIANT;
FORMATION;
COLONISATION;
MILIEU
Background: Proper hand hygiene has been linked to lower susceptibility to infectious diseases in many types
of communities, but it has not been well established on college campuses. This study investigated the hand
hygiene statuses of college students and their occurrences in relation to infectious diseases, medical visits,
and absence from classes or work. It also examined the effects of education on handwashing technique to
improve hand hygiene.
Methods: College students enrolled at a university in Northwestern Ohio were recruited as study subjects.
Microbial samples were collected 3 times from each of the 220 valid volunteers before washing their hands,
after washing with their own procedures, and after washing with a procedure recommended by the Centers
for Disease Control and Prevention (CDC). Each volunteer also answered a survey including questions on
their health conditions, medical visits, and absence from classes or work.
Results: Hands of 57.7% volunteers were colonized by an uncountable number of microbial colonies, which
were significantly linked to more occurrences to infectious diseases (P<.05), medical visits (P<.05), and
arguably more absence from classes or work (P=.09). The handwashing procedure provided by the CDC
significantly improved hand hygiene.
Conclusion: It is critical to promote education on proper handwashing in colleges, in grade schools, and at
home to improve health and learning outcomes.
Infection respiratoire
NosoBase ID notice : 405136
Transport et dépôt de particules issues d'une émission oropharyngée
Da G; Géhin E; Zambrelli A; Delaby S; Ritoux S; Ha TL; et al. Transport et dépôt de particules issues d'une
émission oropharyngée. Salles propres 2015/11; (100): 47-50.
Mots-clés : TRANSMISSION AERIENNE; VIRUS; APPAREIL RESPIRATOIRE; SURFACE; AIR
La transmission de virus aéroportés via des particules exhalées lors d'activités respiratoires représente un
enjeu important en environnement intérieur. Les grosses gouttelettes émises dans le jet peuvent le quitter
rapidement et se déposer sous l'effet de la gravité, tandis que les plus petites peuvent rester en suspension
dans l'air sous forme de résidus pendant de longues périodes.
Un banc de génération de gouttelettes monodispersées a été développé. Les résultats ont montré l'absence
de dépôts de gouttelettes pour la configuration étudiée, ceux-ci étant exclusivement dus à des résidus secs.
Legionella
NosoBase ID notice : 407631
Eradication dans l'ensemble de l'hôptal d'une épidémie nosocomiales de Legionella pneumophila
Serogroup 1
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NosoVeille – Bulletin de veille
Février 2016
Bartley PB; Ben Zakour NL; Stanton-Cook M; Muguli R; Prado L; Garnys V; et al. Hospital-wide eradication of
a nosocomial Legionella pneumophila serogroup 1 outbreak. Clinical infectious diseases 2016/02/01; 62(3):
273-279.
Mots-clés : LEGIONELLA PNEUMOPHILA; EPIDEMIE; BIOLOGIE MOLECULAIRE
Background: Two proven nosocomial cases of Legionella pneumonia occurred at the Wesley Hospital
(Brisbane, Australia) in May 2013. To trace the epidemiology of these cases, whole genome sequence
analysis was performed on Legionella pneumophila isolates from the infected patients, prospective isolates
collected from the hospital water distribution system (WDS), and retrospective patient isolates available from
the Wesley Hospital and other local hospitals.
Methods: Legionella pneumophila serogroup 1 isolates were cultured from patient sputum (n=3),
endobronchial washings (n=3), pleural fluid (n=1), and the Wesley Hospital WDS (n=39). Whole genome
sequencing and de novo assembly allowed comparison with the L. pneumophila Paris reference strain to infer
phylogenetic and epidemiological relationships. Rapid disinfection of the hospital WDS with a chlorinated,
alkaline detergent and subsequent superchlorination followed by maintenance of residual free chlorine,
combined with removal of redundant plumbing, was instituted.
Results: The 2011 and 2013 L. pneumophila patient isolates were serogroup 1 and closely related to all 2013
hospital water isolates based on single nucleotide polymorphisms and mobile genetic element profiles,
suggesting a single L. pneumophila population as the source of nosocomial infection. The L. pneumophila
population has evolved to comprise 3 clonal variants, each associated with different parts of the hospital
WDS.
Conclusions: This study provides an exemplar for the use of clinical and genomic epidemiological methods
together with a program of rapid, effective remedial biofilm, plumbing and water treatment to characterize and
eliminate a L. pneumophila population responsible for nosocomial infections.
Néonatologie
NosoBase ID notice : 407448
Surveillance des infections associées aux soins dans une unité néonatale de soins intensifs tertiaire:
une étude clinique prospective après avoir déménagé dans un nouveau bâtiment
Cura C; Ozen M; Akaslan Kara A; Alkan G; Sesli Cetin E. Health care-associated infection surveillance in a
tertiary neonatal intensive care unit: A prospective clinical study after moving to a new building. American
journal of infection control 2016/01; 44(1): 80-84.
Mots-clés : SURVEILLANCE; NEONATOLOGIE; PREVENTION; INCIDENCE
Background: There are very few prospective clinical studies on neonatal health care-associated infection
(HAI) surveillance. HAI surveillance helps reduce not only mortality, but also morbidity, length of hospital stay,
and health care costs.
Methods: This prospective clinical study covered a period of 12 months in a tertiary neonatal intensive care
unit (NICU). HAI rates were calculated using different denominators: number of patients hospitalized in the
NICU, number of patient-days, and number of specific device-days.
Results: The HAI rate was 18%, and the incidence density was 17/1,000 patient-days. The most common HAI
was bloodstream infection (n=34; 50%). The most common pathogen was coagulase-negative staphylococci
(CoNS; 54.9%) in gram-positive bacteria and in general. Methicillin resistance was 96.4% for CoNS.
Klebsiella spp (13.7%) was the most common gram-negative bacteria. Extended-spectrum β-lactamase
positivity was 14.3% for Klebsiella spp and 25% for Escherichia coli. HAI-related mortality was 0.3%.
Conclusions: NICUs should perform their own HAI surveillance with prospective clinical design. Attention paid
to handwashing, disinfection and sanitizing, complying with the terms of asepsis, extending in-service
training, increasing the number of medical staff, preventing frequent changes in health care staff positions,
and improving physical environmental conditions in NICUs might eventually decrease HAI rates.
NosoBase ID notice : 398317
Epidémie à Escherichia coli producteurs de bêta-lactamase à sepctre élargi transmis par un partage
de lait maternel dans une unité de réanimation néonatale
Nakamura K; Kaneko M; Abe Y; Yamamoto N; Mori H; Yoshida A; et al. Outbreak of extended-spectrum βlactamase-producing Escherichia coli transmitted through breast milk sharing in a neonatal intensive care
unit. The journal of hospital infection 2016/01; 92(1): 42-46.
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Février 2016
Mots-clés : ESCHERICHIA COLI; SOIN INTENSIF; EPIDEMIE; ALLAITEMENT; LAIT; NEONATOLOGIE;
ENQUETE; CAS TEMOIN; FACTEUR DE RISQUE; TYPAGE; BIOLOGIE MOLECULAIRE;
CONTAMINATION
Background: Routine surveillance in a neonatal intensive care unit (NICU) showed an increased detection of
extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli) in August 2012, following
nearly a year without detection.
AIM: To describe the investigation and interventions by a hospital infection control team of an outbreak of
ESBL E. coli in a NICU.
Methods: Six neonates with positive cultures of ESBL E. coli (five with respiratory colonization, one with a
urinary tract infection), control infants who were negative for ESBL E. coli during the study period, and
mothers who donated their breast milk were included. A case-control study was performed to identify possible
risk factors for positive ESBL E. coli cultures and molecular typing of isolated strains by pulsed-field gel
electrophoresis.
Findings: The odds ratio for ESBL E. coli infection after receiving shared unpasteurized breast milk during the
study period was 49.17 (95% confidence interval: 6.02-354.68; P<0.05). The pulsed-field gel electrophoresis
pattern showed that all strains were identical, and the same pathogen was detected in freshly expressed milk
of a particular donor. After ceasing the breast milk sharing, the outbreak was successfully terminated.
Conclusion: This outbreak indicates that contamination of milk packs can result in transmission of a drugresistant pathogen to newborn infants. Providers of human breast milk need to be aware of the necessity for
low-temperature pasteurization and bacterial cultures, which should be conducted before and after freezing,
before prescribing to infants.
Personnel
NosoBase ID notice : 407578
Facteurs influençant l’observance infirmière aux précautions standard
Powers D; Armellino D; Dolansky M; Fitzpatrick J. Factors influencing nurse compliance with Standard
Precautions. American journal of infection control 2016/01; 44(1): 4-7.
Mots-clés : PRECAUTION STANDARD; OBSERVANCE; INFIRMIER; HEPATITE C
Background: Exposure to blood and bodily fluids represents a significant occupational risk for nurses. The
most effective means of preventing bloodborne pathogen transmission is through adherence to Standard
Precautions (SP). Despite published guidelines on infection control and negative health consequences of
noncompliance, significant issues remain around compliance with SP to protect nurses from bloodborne
infectious diseases, including hepatitis B virus, hepatitis C virus (HCV), and HIV.
Methods: A descriptive correlational study was conducted that measured self-reported compliance with SP,
knowledge of HCV, and perceived susceptibility and severity of HCV plus perceived benefits and barriers to
SP use. Relationships between the variables were examined. Registered nurses (N=231) working in
ambulatory settings were surveyed.
Results: Fewer than one-fifth (17.4%) of respondents reported compliance with all 9 SP items. Mean score for
correct responses to the HCV knowledge test was 81%. There was a significant relationship between
susceptibility of HCV and compliance and between barriers to SP use and compliance.
Conclusions: This study explored reasons why nurses fail to adopt behaviors that protect them and used the
Health Belief Model for the theoretical framework. It concentrated on SP and HCV because more than 5
million people in the United States and 200 million worldwide are infected with HCV, making it 1 of the
greatest public health threats faced in this century. Understanding reasons for noncompliance will help
determine a strategy for improving behavior and programs that target the aspects that were less than
satisfactory to improve overall compliance. It is critical to examine factors that influence compliance to
encourage those that will lead to total compliance and eliminate those that prevent it.
NosoBase ID notice : 407833
Contamination du personnel lors du retrait de l’équipement de protection individuelle
Tomas ME; Kundrapu S; Thota P; Sunkesula VCK; Cadnum JL; Mana TSC; et al. Contamination of health
care personnel during removal of personal protective equipment. JAMA internal medicine 2015/12; 175(12):
1904-1910.
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Mots-clés : CONTAMINATION; PERSONNEL;
EQUIPEMENT DE PROTECTION INDIVIDUEL
Février 2016
PEAU;
TENUE
VESTIMENTAIRE;
GANT;
MAIN;
Importance: Contamination of the skin and clothing of health care personnel during removal of personal
protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for
infection.
Objectives: To determine the frequency and sites of contamination on the skin and clothing of personnel
during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.
Design, setting, and participants: We conducted a point-prevalence study and quasi-experimental intervention
from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April
21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio
hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of
health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental
intervention that included education and practice in removal of contaminated PPE with immediate visual
feedback based on fluorescent lotion contamination of skin and clothing.
Main outcomes and measures: The primary outcomes were the frequency and sites of contamination on skin
and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention.
A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and
bacteriophage MS2, a nonpathogenic, nonenveloped virus.
Results: Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion
occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9%
vs 37.8%, P=.002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P<.001).
The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal
(60.0% before the intervention vs 18.9% after, P<.001) that was sustained after 1 and 3 months (12.0% at
both time points, P<.001 compared with before the intervention). During simulations of contaminated glove
removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2
(58.0% vs 52.0%, P=.45).
Conclusions and relevance: Contamination of the skin and clothing of health care personnel occurs frequently
during removal of contaminated gloves or gowns. Educational interventions that include practice with
immediate visual feedback on skin and clothing contamination can significantly reduce the risk of
contamination during removal of PPE.
Plasmodium falciparum
NosoBase ID notice : 407410
Transmission de Plasmodium falciparum associée aux soins à New York
Lee EH; Adams EH; Madison-Antenucci S; Lee L; Barnwell JW; Whitehouse J; et al. Healthcare-associated
transmission of Plasmodium falciparum in New York City. Infection control and hospital epidemiology
2016/01; 37(1): 113-115.
Mots-clés : TRANSMISSION; PLASMODIUM FALCIPARUM; INFECTION NOSOCOMIALE
A patient with no risk factors for malaria was hospitalized in New York City with Plasmodium falciparum
infection. After investigating all potential sources of infection, we concluded the patient had been exposed to
malaria while hospitalized less than 3 weeks earlier. Molecular genotyping implicated patient-to-patient
transmission in a hospital setting.
Prévention
NosoBase ID notice : 406319
Relations entre un climat de sécurité du patient et l’adhésion aux précautions standard : revue
systématique de la littérature
Hessels AJ; Larson EL. Relationship between patient safety climate and standard precaution adherence: a
systematic review of the literature. The journal of hospital infection 2015/09/25; in press: 1-14.
Mots-clés : PRECAUTION STANDARD; OBSERVANCE; SECURITE SANITAIRE; REVUE DE LA
LITTERATURE; PREVENTION
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Février 2016
Standard precaution (SP) adherence is universally suboptimal, despite being a core component of
healthcare-associated infection (HCAI) prevention and healthcare worker (HCW) safety. Emerging evidence
suggests that patient safety climate (PSC) factors may improve HCW behaviours. Our aim was to examine
the relationship between PSC and SP adherence by HCWs in acute care hospitals. A systematic review was
conducted as guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Three
electronic databases were comprehensively searched for literature published or available in English between
2000 and 2014. Seven of 888 articles identified were eligible for final inclusion in the review. Two reviewers
independently assessed study quality using a validated quality tool. The seven articles were assigned quality
scores ranging from 7 to 10 of 10 possible points. Five measured all aspects of SP and two solely measured
needlestick and sharps handling. Three included a secondary outcome of HCW exposure; none included
HCAIs. All reported a statistically significant relationship between better PSC and greater SP adherence and
used data from self-report surveys including validated PSC measures or measures of management support
and leadership. Although limited in number, studies were of high quality and confirmed that PSC and SP
adherence were correlated, suggesting that efforts to improve PSC may enhance adherence to a core
component of HCAI prevention and HCW safety. More clearly evident is the need for additional high-quality
research.
NosoBase ID notice : 405977
Surfaces antimicrobiennes pour la prévention des infections associées aux soins : revue
systématique
Muller MP; MacDougall C; Lim M. Antimicrobial surfaces to prevent healthcare-associated infections: a
systematic review. The journal of hospital infection 2016/01; 92(1): 7-13.
Mots-clés : PREVENTION; SURFACE; ENVIRONNEMENT; MATERIAU; CONTAMINATION; INCIDENCE;
TRANSMISSION; CUIVRE
Contamination of the healthcare environment with pathogenic organisms contributes to the burden of
healthcare-associated infection (HCAI). Antimicrobial surfaces are designed to reduce microbial
contamination of healthcare surfaces. We aimed to determine whether antimicrobial surfaces prevent HCAI,
transmission of antibiotic-resistant organisms (AROs), or microbial contamination, we conducted a systematic
review of the use of antimicrobial surfaces in patient rooms. Outcomes included HCAI, ARO, and quantitative
microbial contamination. Relevant databases were searched. Abstract review, full text review, and data
abstraction were performed in duplicate. Risk of bias was assessed using the Cochrane Effective Practice
and Organization Care (EPOC) Group risk of bias assessment tool and the strength of evidence determined
using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Eleven studies
assessed the effect of copper (N=7), silver (N=1), metal-alloy (N=1), or organosilane-treated surfaces (N=2)
on microbial contamination. Copper surfaces demonstrated a median (range) reduction of microbial
contamination of <1 log10 (<1 to 2 log10). Two studies addressed HCAI/ARO incidence. An RCT of copper
surfaces in an ICU demonstrated 58% reduction in HCAI (P=0.013) and 64% reduction in ARO transmission
(P=0.063) but was considered low-quality evidence due to improper randomization and incomplete blinding.
An uncontrolled before-after study evaluating copper-impregnated textiles in a long-term care ward
demonstrated 24% reduction in HCAI but was considered very-low-quality evidence based on the study
design. Copper surfaces used in clinical settings result in modest reductions in microbial contamination. One
study of copper surfaces and one of copper textiles demonstrated reduction in HCAI, but both were at high
risk of bias.
NosoBase ID notice : 407586
La structure pour la prévention des infections associées aux soins dans les hôpitaux brésiliens : une
étude dans tout le pays
Padoveze MC; Fortaleza CM; Kiffer C; Barth AL; Carneiro IC; Giamberardino HIG; et al. Structure for
prevention of health care-associated infections in Brazilian hospitals: A countrywide study. American journal
of infection control 2016/01; 44(1): 74-79.
Mots-clés : PREVENTION; ORGANISATION; SERVICE; HYGIENE HOSPITALIERE; STERILISATION;
HYGIENE DES MAINS; GEOGRAPHIE
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Février 2016
Background: Minimal structure is required for effective prevention of health care-associated infection (HAI).
The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian
hospitals.
Methods: This was a cross-sectional study from hospitals in 5 Brazilian regions (n=153; total beds: 13,983)
classified according to the number of beds; 11 university hospitals were used as reference for comparison.
Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of
conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control
Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology.
Results: The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with
>200 beds had the worst ratio of beds to sinks (3.9; P<.001). Regarding alcoholic product for handrubbing,
the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference
hospitals (3.3; P<.001). The CI for sterilization services showed huge variation ranging from 0.0-1.00.
Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals.
Conclusion: This study highlights the need for public health strategies aiming to improve the structure for HAI
prevention in Brazilian hospitals
Pseudomonas aeruginosa
NosoBase ID notice : 405980
Comment et pourquoi surveiller les infections à Pseudomonas aeruginosa à long terme dans un
centre pour les mucoviscidoses
Kalferstova L; Vilimovska Dedeckova K; Antuskova M; Melter O; Drevinek P. How and why to monitor
Pseudomonas aeruginosa infections in the long term at a cystic fibrosis centre. The journal of hospital
infection 2016/01; 92(1): 54-60.
Mots-clés : PSEUDOMONAS AERUGINOSA; SURVEILLANCE; MUCOVISCIDOSE; FACTEUR DE
RISQUE; EPIDEMIOLOGIE; TYPAGE
Background: Pseudomonas aeruginosa is a major cystic fibrosis (CF) pathogen causing chronic respiratory
infections and posing a risk for cross-infection between patients with CF.
Aim: To propose an algorithm for long-term surveillance of P. aeruginosa and assess its suitability for
monitoring the epidemiological situation at a CF centre with approximately 300 patients.
Methods: Over a nine-year period, over 300 P. aeruginosa isolates from 131 infected patients were tested by
multi-locus sequence typing (MLST) and/or random amplified polymorphic DNA (RAPD) assay.
Findings: MLST analysis led to the identification of 97 different sequence types which were distributed among
17 RAPD-generated (pseudo)clusters. This indicates that the easy-to-perform RAPD assay is only suitable for
intra-individual, not interindividual, strain analyses. No epidemic strains were observed. Longitudinal analysis
revealed that 110 of the 131 patients were infected with the same strain over the observation period, whereas
21 patients had a strain replacement or a new infection. Chronic infection was found in 99 of the 131 patients,
and the remaining 32 patients met the criteria for intermittent infection (as defined by the Leeds criteria).
Eighteen of the 32 patients (56%) with intermittent infection were infected with the same strain for up to nine
years.
Conclusion: The strain type only changed in 16% of 131 patients with chronic or intermittent infection. As
many as 56% of patients considered to have intermittent infection were actually chronically infected with the
same strain for many years.
Soins intensifs
NosoBase ID notice : 408651
Surveillance des infections nosocomiales en réanimation adulte. Réseau REA-Raisin, France Résultats 2014 et Annexes
Institut de veille sanitaire (InVS), Réseau d'aide d'investigation et de surveillance des infections nosocomiales
(Raisin), CClin-Arlin. Surveillance des infections nosocomiales en réanimation adulte. Réseau REA-Raisin,
France - Résultats 2014 et Annexes. InVS 2016/01: 1-47.
Mots-clés : SURVEILLANCE; REANIMATION; INCIDENCE; INDICATEUR; MICROORGANISME;
ANTIBIOTIQUE; ANTIBIORESISTANCE; SONDAGE URINAIRE; CATHETERISME; BACTERIEMIE;
PNEUMOPATHIE; FACTEUR DE RISQUE; CATHETER VEINEUX CENTRAL; HEMODIALYSE
24 / 31
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Février 2016
La surveillance des infections nosocomiales (IN) est prioritaire en réanimation, secteur à haut risque du fait
de l'état critique des patients et de leur exposition aux dispositifs invasifs. Depuis 2004, la surveillance
nationale REA-Raisin, coordonnée par le Réseau d’alerte, d’investigation et de surveillance des IN, cible en
réanimation adulte les infections associées à un dispositif invasif pour lesquelles une démarche de prévention
est essentielle : pneumonie (PNE), colonisation ou infection ou bactériémie (COL/ILC/BLC) liée au cathéter
veineux central (CVC) et bactériémie (BAC). Chaque année, les services volontaires recueillent pendant 6
mois les données concernant tout patient hospitalisé plus de 2 jours (j).
De janvier à juin 2014, 212 services ont inclus 34 226 patients (âge moyen : 64,3 ans), hospitalisés en
moyenne 11,6 j et dont 68,8 % relèvent à l'admission de la médecine, 18,0 % de chirurgie urgente et 13,2 %
de chirurgie réglée ; 7,8 % des patients sont traumatisés, 15,9 % immunodéprimés et 57,0 % ont reçu un
traitement antibiotique à l’admission. Le score IGS II moyen est de 45,3 et la mortalité intra-service de 17,2
%. L’exposition à un dispositif invasif est fréquente : intubation (63,8 %), CVC (65,3 %) et sonde urinaire
(87,4 %). Parmi les 34 226 patients, 10,7 % ont présenté au moins une infection surveillée. Les microorganismes les plus fréquemment isolés sont P. aeruginosa (14,8 %), S. aureus (11,6 %), E. coli (9,1 %).
Depuis 2004, la résistance aux antibiotiques diminue pour les souches de S. aureus (19,2 % SARM
(Staphylococcus aureus résistant à la méticilline) en 2014) et reste élevée pour EBLSE (entérobactéries
productrices de bêta-lactamases à spectre étendu) (18,3 % de souches productrices de BLSE avec 1,6 % I/R
à l'imipenème). Les taux d’incidence sont de 14,26 PNE pour 1 000 j-intubation, 3,53 BAC pour 1 000 j
d’hospitalisation, 0,66 ILC et 0,51 BLC pour 1 000 j-CVC. Ces taux varient fortement d’un service à l’autre en
lien avec les caractéristiques des patients.
Au cours des six dernières années (2009 à 2014) sur l’ensemble du réseau, certains facteurs de risque
augmentent (âge, IGS II, antibiotiques à l'entrée, immunodépression, moins de patients en chirurgie réglée,
moins de traumatisés), alors que la durée de séjour raccourcit de même que le ratio d'exposition pour
intubation et sondage urinaire. On observe une diminution significative des taux d'incidence pour 1 000 j
d'exposition : PNE (-6,2 %), BLC (-43,3 %) et ILC (-40,5 %) ou non significative pour BAC (-1,1 %). L'analyse
multivariée confirme la baisse significative en 2014 des PNE liées à l'intubation (Odds ratio, OR ajusté : 0,90 ;
Intervalle de confiance, IC95 : 0,84-0,97) et des BLC (OR ajusté: 0,56 ; IC95: 0,44-0,71), à mettre en relation
avec l'amélioration des pratiques professionnelles associées aux dispositifs invasifs en réanimation.
Avec une participation s'élevant à 50,4 % des lits de réanimation de France, les données de REA-Raisin
constituent une référence nationale pour mieux connaître les IN en réanimation et permettre aux services
participants de se comparer, d’évaluer et orienter leurs actions de prévention.
NosoBase ID notice : 407750
Elizabethkingia meningoseptica d'origine hydrique dans une unité de réanimation pour adultes
Moore LS; Owens DS; Jepson A; Turton JF; Ashworth S; Donaldson H; et al. Waterborne Elizabethkingia
meningoseptica in adult critical care. Emerging infectious diseases 2016/01; 22(1): 9-17.
Mots-clés : EAU; EPIDEMIE; PNEUMONIE; MICROBIOLOGIE; INVESTIGATION; ANTIBIOTIQUE;
BIOFILM; ELIZABETHKINGIA MENINGOSEPTICA
Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is
uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a
London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined
whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E.
meningoseptica acquisition (n=13) to have an attributable morbidity rate of 54% (systemic inflammatory
response syndrome >2, rising C-reactive protein, new radiographic changes), suggesting that E.
meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-sourceassociated in critical care but identified numerous other E. meningoseptica strains, indicating more
widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates
across a wider London hospital network suggests this outbreak, and possibly other recently reported
outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging
pathogen.
Staphylococcus aureus
NosoBase ID notice : 408148
Enquête auprès des néphrologues français sur les pratiques de dépistages et de décolonisation du
portage nasal de Staphylococcus aureus des patients dialysés chroniques
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NosoVeille – Bulletin de veille
Février 2016
Botelho-Nevers E; Verhoeven PO; Thibaudin D; Gagnaire J; Gagneux-Brunon A; Lucht F; et al. Enquête
auprès des néphrologues français sur les pratiques de dépistages et de décolonisation du portage nasal de
Staphylococcus aureus des patients dialysés chroniques. Néphrologie & thérapeutique 2015/12/24; in press:
1-4.
Mots-clés : NEPHROLOGIE; ENQUETE; DEPISTAGE; COLONISATION NASALE; STAPHYLOCOCCUS
AUREUS; DIALYSE RENALE; HEMODIALYSE; QUESTIONNAIRE
Le portage nasal de Staphylococcus aureus est fréquent chez les patients dialysés et est associé à un surrisque d’infections à S. aureus. Des données solides dans la littérature médicale montrent qu’il y a un
bénéfice à décoloniser ces patients afin de réduire le risque d’infections, notamment sur cathéter. Lors du
Congrès national de néphrologie en 2014, nous avons interrogé des médecins néphrologues français avec
une activité de dialyse sur leur pratique de dépistage et de décolonisation du portage nasal de S. aureus
chez leurs patients dialysés. Dans cette enquête déclarative, seuls 45,5 % (30/66) des médecins déclaraient
faire un dépistage de S. aureus en hémodialyse et 59,6 % (31/52) en dialyse péritonéale. Les participants
déclaraient décoloniser le patient avant pose de cathéter vasculaire dans 55,8 % des cas. Cette étude
nécessiterait d’être complétée par une étude nationale
NosoBase ID notice : 407021
Déshabiller la controverse des précautions contact pour Staphylococcus aureus méticillino-résistant
Kullar R; Vassallo A; Turkel S; Chopra T; Kaye KS; Dhar S. Degowning the controversies of contact
precautions for methicillin-resistant Staphylococcus aureus: A review. American journal of infection control
2016/01; 44(1): 97-103.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PRECAUTION CONTACT;
BLOUSE; GANT; USAGER DE LA SANTE; PSYCHOLOGIE; REVUE DE LA LITTERATURE
Background: Contact precautions (CPs) are recommended to prevent methicillin-resistant Staphylococcus
aureus (MRSA) transmission in institutions. Rising doubts about CP effectiveness and recognition of
unintended consequences for patients have raised questions about the benefit. The objective of this study
was to evaluate the effectiveness and adverse outcomes associated with CPs for prevention of MRSA
transmission.
Methods: We searched PubMed, Embase, and the Cochrane Library for articles related to effectiveness and
adverse outcomes of CPs in patients with MRSA. Criteria for inclusion included the following: articles
conducted in the United States, articles performed in an acute care setting, articles that were not a case
series or review, and those with standardized collection of data or inclusion of case and control groups.
Results were summarized and examined for potential limitations. Recommendations were based on our
findings.
Results: CPs reduced MRSA transmission in epidemic settings and in instances with high compliance, but a
decrease in infection rates was not shown. Unintended consequences of CPs include decreased health care
provider (HCP) time spent with patients, low HCP compliance, decreased perceptions of comfort from
patients, and greater likelihood of patient complaints and negative psychologic implications.
Conclusion: In endemic settings, there are few data to support routine use of CPs to control the spread of
MRSA. Education should be performed in hospitals to improve patients' perception of care and understanding
of CPs when implemented and HCPs' adherence to good hand hygiene and standard precautions practices.
NosoBase ID notice : 404604
Essai clinique randomisé, contrôle contre placebo, en double aveugle destiné à évaluer l’efficacité du
polyhexanide pour la décolonisation des porteurs de SARM
Landelle C; Von Dach E; Haustein T; Agostinho A; Renzi G; Renzoni A; et al. Randomized, placebocontrolled, double-blind clinical trial to evaluate the efficacy of polyhexanide for topical decolonization of
MRSA carriers. Journal of antimicrobial chemotherapy 2016/02; 71(2): 531-538.
Mots-clés :
RANDOMISATION;
EFFICACITE;
STAPHYLOCOCCUS
AUREUS;
RESISTANCE; COLONISATION; ESSAI THERAPEUTIQUE; GENOTYPE; SARM
METICILLINO-
Objectives: The objective of this study was to evaluate the efficacy of polyhexanide (Prontoderm ®) in
eliminating MRSA carriage.
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Février 2016
Methods: In a 1900 bed teaching hospital, MRSA-colonized patients were randomized into a double-blind,
placebo-controlled superiority trial between January 2011 and July 2014. Patients were treated with either
polyhexanide or placebo applied to the anterior nares (thrice daily) and skin (once daily) for 10 days. The
primary outcome was MRSA decolonization at day 28 (D28) after the end of treatment assessed by ITT
responder and PP analyses (microbiological follow-up ±7 days and topical treatment ≥5 days). Secondary
outcomes included safety, emergence of resistance and MRSA genotype changes. Registered trial number
ISRCTN02288276.
Results: Of 2590 patients screened, 146 (polyhexanide group, 71; placebo group, 75) were included. ITT
analysis showed that 24/71 (33.8%) patients in the polyhexanide group versus 22/75 (29.3%) in the placebo
group were MRSA-free at D28 (risk difference, 4.5%; 95% CI, -10.6% to 19.5%; P = 0.56). PP analysis
confirmed the results with 19/53 (35.8%) decolonized polyhexanide-treated patients versus 17/56 (30.4%) in
the placebo arm (risk difference, 5.5%; 95% CI, -12.2% to 23%; P = 0.54). Nine serious adverse events
occurred in the polyhexanide group versus 12 in the placebo group; none was attributable to study
medication. Emergence of polyhexanide resistance or cross-resistance between polyhexanide and
chlorhexidine was not observed. No case of exogenous recolonization by a genotypically different MRSA
strain was documented.
Conclusions: This study suggests that under real-life conditions, a single polyhexanide decolonization course
is not effective in eradicating MRSA carriage.
NosoBase ID notice : 408517
Epidémiologie moléculaire actuelle de Staphylococcus aureus méticillino-résistant chez les
personnes âgées françaises : clones génants sur l'horizon
Rondeau C; Chevet G; Blanc DS; Gbaguidi-Haore H; Decalonne M; Dos Santos S; et al. Current molecular
epidemiology of methicillin-resistant Staphylococcus aureus in elderly french people: troublesome clones on
the horizon. Frontiers in microbiology 2016/01; 7: 1-8.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; INCIDENCE; PERSONNE
AGEE; COLONISATION; BACTERIEMIE; GENE
Objective: In 2015, we conducted at 44 healthcare facilities (HCFs) and 21 nursing homes (NHs) a 3-month
bloodstream infection (BSI) survey, and a 1-day prevalence study to determine the rate of carriage of
methicillin-resistant Staphylococcus aureus (MRSA) in 891 patients and 470 residents. We investigated the
molecular characteristics of the BSI-associated and colonizing MRSA isolates, and assessed crosstransmission using double-locus sequence typing and pulsed-field gel electrophoresis protocol.
Results: The incidence of MRSA-BSI was 0.040/1000 patient-days (19 cases). The prevalence of MRSA
carriage was 4.2% in patients (n=39) and 8.7% in residents (n=41) (p<0.001). BSI-associated and colonizing
isolates were similar: non ewere PVL-positive; 86.9% belonged to clonal complexes 5 and 8;93.9% were
resistant to fluoroquinolones. The qacA/B gene was carried by 15.8% of the BSI-associated isolates [3/3 BSI
cases in intensive care units (ICUs)], and 7.7% of the colonizing isolates in HCFs. Probable resident-toresident Transmission was identified in four NHs.
Conclusion: Despite generally reassuring results, we identified two key concerns. First, aworryingly high
prevalence of the qacA/B gene in MRSA isolates. Antisepsis measures being crucial to prevent healthcareassociated infections, our findings raise questions about the potential risk associated with chlorhexidine use
in qacA/B+ MRSA carriers, particularly in ICUs. Second, NHs are a weak link in MRSA control. MRSA spread
was not controlled at several NHs; because of their frequent contact with the community, conditions are
favorable for these NHs to serve as reservoirs of USA300 clone for local HCFs.
NosoBase ID notice : 407368
Dépistage systématique des Staphylococcus aureus résistants à la méticilline versus dépistage
reposant sur les facteurs de risque dans un important centre hospitalier universitaire multi-sites au
Canada
Roth VR; Longpre T; Taljaard M; Coyle D; Suh KN; Muldoon KA; et al. Universal vs risk factor screening for
methicillin-resistant Staphylococcus aureus in a large multicenter tertiary care facility in Canada. Infection
control and hospital epidemiology 2016/01; 37(1): 41-48.
Mots-clés : STÄPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; INFECTION
NOSOCOMIALE; BACTERIEMIE; DEPISTAGE; FACTEUR DE RISQUE; INCIDENCE; MUPIROCINE
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NosoVeille – Bulletin de veille
Février 2016
Objective: To assess the clinical effectiveness of a universal screening program compared with a risk factorbased program in reducing the rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA)
among admitted patients at the Ottawa Hospital.
Design: Quasi-experimental study.
Setting: Ottawa Hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000
admissions per year, and 1,200 beds.
Methods: From January 1, 2006 through December 31, 2007 (24 months), admitted patients underwent risk
factor-based MRSA screening. From January 1, 2008 through August 31, 2009 (20 months), all patients
admitted underwent universal MRSA screening. To measure the effectiveness of this intervention, segmented
regression modeling was used to examine monthly nosocomial MRSA incidence rates per 100,000 patientdays before and during the intervention period. To assess secular trends, nosocomial Clostridium difficile
infection, mupirocin prescriptions, and regional MRSA rates were investigated as controls.
Results: The nosocomial MRSA incidence rate was 46.79 cases per 100,000 patient-days, with no significant
differences before and after intervention. The MRSA detection rate per 1,000 admissions increased from 9.8
during risk factor-based screening to 26.2 during universal screening. A total of 644 new nosocomial MRSA
cases were observed in 1,448,488 patient-days, 323 during risk factor-based screening and 321 during
universal screening. Secular trends in C. difficile infection rates and mupirocin prescriptions remained stable
after the intervention whereas population-level MRSA rates decreased.
Conclusion: At Ottawa Hospital, the introduction of universal MRSA admission screening did not significantly
affect the rates of nosocomial MRSA compared with risk factor-based screening.
NosoBase ID notice : 407367
Utilisation en routine des précautions contact pour les Staphylococcus aureus résistant à la
méticilline et les entérocoques résistants à la vancomycine : de quel côté la balance penche-t-elle ?
Russell D; Beekmann SE; Polgreen PM; Rubin Z; Uslan DZ. Routine use of contact precautions for
methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Which way is the
pendulum swinging? Infection control and hospital epidemiology 2016/01; 37(1): 36-40.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; ENTEROCOCCUS;
VANCOMYCINE; ANTIBIORESISTANCE; PRECAUTION CONTACT; INFECTION NOSOCOMIALE;
CHLORHEXIDINE; COLONISATION; MUPIROCINE; BIONETTOYAGE; CHAMBRE DU MALADE
Background: Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus
aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks,
coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine
gluconate, have brought into question the value of routine CP for these organisms.
Objective: To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of
transmission in US hospitals.
Design: Cross-sectional survey.
Participants: Total of 751 physician members of the Emerging Infections Network.
Methods: An 8-question electronic survey distributed by email.
Results: A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for
methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The
most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for
discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine
gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets
of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room
disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and
process for initiation and discontinuation of CP.
Conclusions: Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains
commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly
used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and
horizontal interventions are needed.
NosoBase ID notice : 403827
Consultations en infectiologie pour des bactériémies à Staphylococcus aureus. Revue systématique
et méta-analyse
28 / 31
NosoVeille – Bulletin de veille
Février 2016
Vogel M; Schmitz RPH; Hagel S; Pletz MW; Gagelmann N; Scherag A; et al. Infectious disease consultation
for Staphylococcus aureus bacteremia - A systematic review and meta-analysis. Journal of infection 2016/01;
72(1): 19-28.
Mots-clés : STAPHYLOCOCCUS AUREUS; BACTERIEMIE; META-ANALYSE; QUALITE
Objective: Mortality and morbidity of Staphylococcus aureus bacteremia (SAB) still remains considerably
high. We aimed to evaluate the impact of infectious disease consultation (IDC) on the management and
outcomes of patients with SAB.
Methods: We systematically searched 3 publication databases from inception to 31st May 2015 and reference
lists of identified primary studies.
Results: Our search returned 2874 reports, of which 18 fulfilled the inclusion criteria, accounting for 5337
patients. Overall 30-day mortality was 19.95% [95% CI 14.37-27.02] with a significant difference in favour of
the IDC group (12.39% vs 26.07%) with a relative risk (RR) of 0.53 [95% CI 0.43-0.65]. 90-day mortality and
relapse risk for SAB were also reduced significantly with RRs of 0.77 [95% CI 0.64-0.92] and 0.62 [95% CI
0.39-0.99], respectively. Both, the appropriateness of antistaphylococcal agent and treatment duration was
improved by IDC (RR 1.14 [95% CI 1.08-1.20] and 1.85 [95% CI 1.39-2.46], respectively). Follow-up blood
cultures and echocardiography were performed more frequently following IDC (RR 1.35 [95% CI 1.25-1.46]
and 1.98 [95% CI 1.66-2.37], respectively).
Conclusions: Evidence-based clinical management enforced by IDC may improve outcome of patients with
SAB. Well-designed cluster-randomized controlled trials are needed to confirm this finding from observational
studies.
NosoBase ID notice : 407585
Epidémiologie des bactériémies causées par Staphylococcus aureus méticillino-résistant dans un
centre hospitalier universitaire à New York
Yasmin M; El Hage H; Obeid R; El Haddad H; Zaarour M; Khalil A. Epidemiology of bloodstream infections
caused by methicillin-resistant Staphylococcus aureus at a tertiary care hospital in New York. American
journal of infection control 2016/01; 44(1): 41-46.
Mots-clés :
EPIDEMIOLOGIE;
STAPHYLOCOCCUS
AUREUS;
BACTERIEMIE; FACTEUR DE RISQUE; ANTIBIORESISTANCE
METICILLINO-RESISTANCE;
Background: In the United States, bloodstream infections (BSIs) are predominated by Staphylococcus
aureus. The proportion of community-acquired methicillin-resistant S aureus (MRSA) BSI is on the rise. The
goal of this study is to explore the epidemiology of BSI caused by S aureus within Staten Island, New York.
Methods: This is a case-case-control study from April 2012-October 2014. Cases were comprised of patients
with BSI secondary to MRSA and methicillin-sensitive S aureus (MSSA). The control group contained patients
who were hospitalized during the same time period as cases but did not develop infections during their stay.
Two multivariable models compared each group of cases with the uninfected controls.
Results: A total of 354 patients were analyzed. Infections were community acquired in 76% of cases. The
major source of BSI was skin-related infections (n=76). The first multivariable model showed that recent
central venous catheter placement was an independent infection risk factor (odds ratio [OR]=80.7; 95%
confidence interval [CI], 2.2-3,014.1). In the second model, prior hospital stay >3 days (OR=4.1; 95% CI, 1.55.7) and chronic kidney disease (OR=3.0; 95% CI, 1.01-9.2) were uniquely associated with MSSA. Persistent
bacteremia, recurrence, and other hospital-acquired infections were more likely with MRSA BSI than MSSA
BSI.
Conclusion: Most infections were community acquired. The presence of a central venous catheter constituted
a robust independent risk factor for MRSA BSI. Patients with MRSA BSI suffered worse outcomes than those
with MSSA BSI.
Tenue vestimentaire
NosoBase ID notice : 406657
Précautions complémentaires dans le milieu hospitalier
Gottenborg EW; Barron MA. Isolation precautions in the inpatient setting. Hospital medicine clinics 2016/01;
5(1): 30-42.
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NosoVeille – Bulletin de veille
Février 2016
Mots-clés : PRECAUTION COMPLEMENTAIRE; PRECAUTION AIR; PRECAUTION GOUTTELETTE;
COUT; TUBERCULOSE; TENUE VESTIMENTAIRE; MASQUE
NosoBase ID notice : 407444
Blouses d’isolement dans les établissements de soins : études de laboratoire, les règlements et
normes, et les obstacles potentiels au choix de la blouse et à l’utilisation
Kilinc Balci FS. Isolation gowns in health care settings: Laboratory studies, regulations and standards, and
potential barriers of gown selection and use. American journal of infection control 2016/01; 44(1): 104-111.
Mots-clés : TENUE VESTIMENTAIRE; BLOUSE; USAGE UNIQUE; SANG; PRECAUTION STANDARD
Although they play an important role in infection prevention and control, textile materials and personal
protective equipment (PPE) used in health care settings are known to be one of the sources of crossinfection. Gowns are recommended to prevent transmission of infectious diseases in certain settings;
however, laboratory and field studies have produced mixed results of their efficacy. PPE used in health care
is regulated as either class I (low risk) or class II (intermediate risk) devices in the United States. Many
organizations have published guidelines for the use of PPE, including isolation gowns, in health care settings.
In addition, the Association for the Advancement of Medical Instrumentation published a guidance document
on the selection of gowns and a classification standard on liquid barrier performance for both surgical and
isolation gowns. However, there is currently no existing standard specific to isolation gowns that considers not
only the barrier resistance but also a wide array of end user desired attributes. As a result, infection
preventionists and purchasing agents face several difficulties in the selection process, and end users have
limited or no information on the levels of protection provided by isolation gowns. Lack of knowledge about the
performance of protective clothing used in health care became more apparent during the 2014 Ebola
epidemic. This article reviews laboratory studies, regulations, guidelines and standards pertaining to isolation
gowns, characterization problems, and other potential barriers of isolation gown selection and use.
Usagers
NosoBase ID notice : 406334
Définir le rôle de l’usager dans la lutte contre le risque infectieux
Ahmad R; Iwami M; Castro-Sánchez E; Husson F; Taiyari K; Zingg W; et al. Defining the user role in infection
control. The journal of hospital infection 2015/11/11; in press: 1-7.
Mots-clés : USAGER DE LA SANTE; SECURITE SANITAIRE; INFORMATION; QUESTIONNAIRE;
PERSONNEL; HYGIENE DES MAINS; INDICATEUR; QUALITE; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; PERCEPTION
Background: Health policy initiatives continue to recognize the valuable role of patients and the public in
improving safety, advocating the availability of information as well as involvement at the point of care. In
infection control, there is a limited understanding of how users interpret the plethora of publicly available
information about hospital performance, and little evidence to support strategies that include reminding
healthcare staff to adhere to hand hygiene practices.
Aim: To understand how users define their own role in patient safety, specifically in infection control.
Methods: Through group interviews, self-completed questionnaires and scenario evaluation, user views of 41
participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were
collected and analysed. In addition, the project's patient representative performed direct observation of the
research event to offer inter-rater reliability of the qualitative analysis.
Findings: Users considered evidence of systemic safety-related failings when presented with hospital choices,
and did not discount hospitals with high ('red' flagged) rates of meticillin-resistant Staphylococcus aureus.
Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those
most dissatisfied with the care they received were unlikely to ask staff, 'Have you washed your hands?'
Conclusion: This in-depth qualitative analysis of views from a relatively informed user sample shows 'what
matters', and provides new avenues for improvement initiatives. It is encouraging that users appear to take a
holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with
understanding the implications of patient satisfaction.
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NosoVeille – Bulletin de veille
Février 2016
Zika
NosoBase ID notice : 408572
Avis relatif à l’actualisation de l’avis du HCSP du 28 juillet 2015 relatif à la prise en charge médicale
des personnes atteintes par le virus Zika
Haut conseil de la santé publique (HCSP). Avis relatif à l’actualisation de l’avis du HCSP du 28 juillet 2015
relatif à la prise en charge médicale des personnes atteintes par le virus Zika. HCSP 2016/01/05: 1-27.
Mots-clés : ARBOVIRUS; EPIDEMIE; DENGUE; CHIKUNGUNYA; GROSSESSE; FEMME ENCEINTE;
INFORMATION; PERSONNEL; DIAGNOSTIC BIOLOGIQUE; TRAITEMENT; CONDUITE A TENIR;
PREVENTION; INSECTE; ZIKA; MICROCEPHALIE; MOUSTIQUE
Dans un contexte d’extension récente de la maladie due au virus Zika en Amérique du Sud et en Amérique
centrale et le signalement de premiers cas de Zika autochtones dans des Départements français d’Amérique
(Martinique, Guyane), le HCSP actualise ses recommandations de juillet 2015.
Sur la base des données actuellement disponibles et face à une situation de risques de complications graves
(microcéphalies, syndromes de Guillain-Barré, autres complications chez le nouveau-né, l’enfant ou l’adulte)
qui pourraient être induites lors d’une infection par le virus Zika, le HCSP émet des recommandations visant à
une meilleure connaissance du Zika et de ses complications, la mise en place de mesures de prévention par
la protection individuelle et collective contre les piqûres des moustiques vecteurs et une prise en charge
prioritaire des femmes enceintes exposées à une infection Zika.
Il recommande notamment :
- l’organisation d’une campagne d’information et de formation des professionnels de santé dans les territoires
touchés ou pouvant être touchés par le Zika ;
- la mise en place d’une surveillance épidémiologique et clinique permettant l’identification rapide des
premiers cas de Zika dans les territoires français d’outre-mer et en France métropolitaine ;
- l’organisation par les autorités sanitaires, en fonction des conditions locales, d’une information, d’un suivi et
d’une prise en charge renforcés de toutes les femmes enceintes dans les zones d’épidémie du virus Zika,
que ces femmes soient ou non suspectes d’infection par le virus Zika ;
- la mise en place d’un système de surveillance et d’alerte spécifique à la détection d’anomalies congénitales
neurologiques ou non ;
- la mise en œuvre et le contrôle du respect, par les autorités compétentes, des mesures collectives de
contrôle antivectoriel.
Cet avis est susceptible d’évoluer en fonction de l’avancée des connaissances sur le virus Zika et ses
modalités diagnostiques.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
nathalie.vincent@chu
-lyon.fr
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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