NosoVeille aout 2010

NosoVeille – Bulletin de veille
août 2010
NosoVeille n°8
Août 2010
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications
scientifiques publiées au cours du mois écoulé.
http://nosobase.chu-lyon.fr/
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Sommaire de ce numéro
Acinetobacter baumannii
Antibiotique
Bactériémie
Chirurgie
Clostridium difficile
Endoscopie
Grippe
Hémodialyse
Hygiène des mains
Klebsiella pneumoniae
Maladie de Creutzfeldt-Jakob
Pédiatrie
Personne âgée/EHPAD
Personnel
Psychiatrie
Réanimation/Soins intensifs
Staphylococcus aureus
Surveillance
Transplantation
Ventilation assistée
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
août 2010
Acinetobacter baumannii
NosoBase n° 27907
Infections à Acinetobacter baumannii multirésistant aux antibiotiques : épidémiologie et prise en
charge
Garnacho-Montero J; Amaya-Villar R. Multiresistant Acinetobacter baumannii infections: epidemiology and
management. Current opinion in infectious diseases 2010/08; 23(4): 332-339.
Mots-clés :
EPIDEMIOLOGIE;
MULTIRESISTANCE;
ACINETOBACTER
ANTIBIORESISTANCE; TRAITEMENT; QUALITE; CARBAPENEME; COLISTINE;
SULBACTAM; RIFAMPICINE; BIBLIOGRAPHIE
BAUMANNII;
TIGECYCLINE;
Purpose of review: We present recent data about epidemiology of Acinetobacter baumannii in the hospital
setting, major resistance mechanisms, and therapeutic options for infections caused by multidrug-resistant
strains.
Recent findings: A. baumannii has emerged as a major cause of healthcare-associated infections. It
commonly presents resistance to multiple antimicrobial agents, including carbapenems. These strains are
now ussually resistant to the rest of antipseudomonal beta-lactams and sulbactam, a beta-lactamase
inhibitor with bactericide activity against A. baumannii. Rifampicin has demonstrated its effectiveness
in animal models but can never be used in monotherapy because of the rapid development of resistance.
Colistin, an old antibiotic, has re-emerged as a valid alternative given its excellent in-vitro activity. Numerous
studies have confirmed its efficacy in serious infections, including ventilator-associated pneumonia and
nosocomial meningitis, with an acceptable safety profile. Tigecycline appears as a promising therapeutic
option for multidrug resistant A. baumannii, althogh more clinical data about its efficacy especially in
pulmonary infections are required. The role of combination therapy or the use or colistin in alternative routes
(nebulized or intrathecally) has not been established.
Summary: The optimal treatment for multidrug-resistant A. baumannii nosocomial infections has not been
established. Carbapenems are the mainstay of treatment in susceptible isolates. Colistin and tigecycline
retain good in-vitro activity and in many cases represent the only therapeutic options.
NosoBase n° 27845
Impact d'une antibiothérapie inappropriée sur l'évolution de patients hospitalisés présentant une
pneumonie nosocomiale à Acinetobacter baumannii
Joung MK; Kwon KT; Kang CI; Cheong HS; Rhee jy; Jung DS; et al. Impact of inappropriate antimicrobial
therapy on outcome in patients with hospital-acquired pneumonia caused by. Acinetobacter baumannii. The
Journal of infection 2010; in press: 20 pages.
Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIOTIQUE; TRAITEMENT; PNEUMONIE; ETUDE
RETROSPECTIVE; MULTIRESISTANCE; MORTALITE
Objectives: The purpose of this study was to evaluate the impact of inappropriate antimicrobial therapy on
the outcome of patients with hospital-acquired pneumonia (HAP) caused by Acinetobacter baumannii.
Methods: All cases of HAP caused by A. baumannii from January 2000 to March 2006 at the Samsung
Medical Center (Seoul, Korea) were analyzed retrospectively.
Results: A total of 116 patients with clinically significant Acinetobacter HAP were enrolled. Among the A.
baumannii isolates, 60.3% showed multi-drug resistance (MDR), 16.4% were found to have imipenem
resistance, and 15.5% had pan-drug resistance (PDR). The mean APACHE II score of the patients was
22.3+/-7.9. The overall in-hospital and pneumonia-related mortality rates were 47.4% and 37.9%,
respectively. The univariate analysis showed that the factors associated with pneumonia-related mortality
were: MDR, PDR, high APACHE II score, inappropriate empirical antimicrobial therapy, and inappropriate
definitive antimicrobial treatment (All p<0.05). Among these, a high APACHE II score and inappropriate
definitive antimicrobial therapy were found to be independent factors associated with a high mortality, after
adjustment for other variables.
Conclusions: The appropriate definitive antimicrobial therapy should be provided in patients with
HAP caused by A. baumannii.
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
août 2010
NosoBase n° 27467
Contamination fréquente des gants, des blouses et des mains du personnel soignant à
Acinetobacter baumannii multirésistant
Morgan DJ; Liang SY; Smith CL; Johnson JK; Harris AD; Furuno JP; et al. Frequent multidrug-resistant
Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infection control
and hospital epidemiology 2010/07; 31(7): 716-721.
Mots-clés : ACINETOBACTER BAUMANNII; PSEUDOMONAS AERUGINOSA; MULTIRESISTANCE;
INCIDENCE; MAIN; GANT; BLOUSE; CONTAMINATION; ETUDE PROSPECTIVE; SOIN INTENSIF;
FACTEUR DE RISQUE; TRANSMISSION SOIGNE-SOIGNANT; MEDECIN; INFIRMIER; CHAMBRE;
PANSEMENT; SOIN RESPIRATOIRE; AUDIT
Background: Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.
Objective: To determine the incidence of transmission of MDR Acinetobacter baumannii and Pseudomonas
aeruginosa from patients to healthcare workers (HCWs) during routine patient care.
Design: Prospective cohort study.
Setting: Medical and surgical intensive care units.
Methods: We observed HCWs who entered the rooms of patients colonized with MDR A. baumannii or
colonized with both MDR A. baumannii and MDR P. aeruginosa. We examined their hands before room
entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal
of gloves and/or gowns and before hand hygiene.
Results: Sixty-five interactions occurred with patients colonized with MDR A. baumannii and 134 with
patients colonized with both MDR A. baumannii and MDR P. aeruginosa. Of 199 interactions between
HCWs and patients colonized with MDR A. baumannii, 77 (38.7% [95% confidence interval {CI}, 31.9%45.5%]) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% [95% CI, 1.6%-7.4%]) resulted
in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients
colonized with MDR P. aeruginosa, 11 (8.2% [95% CI, 3.6%-12.9%]) resulted in HCW contamination of
gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for
contamination with MDR A. baumannii were manipulation of wound dressing (adjusted odds ratio [aOR],
25.9 [95% CI, 3.1-208.8]), manipulation of artificial airway (aOR, 2.1 [95% CI, 1.1-4.0]), time in room longer
than 5 minutes (aOR, 4.3 [95% CI, 2.0-9.1]), being a physician or nurse practitioner (aOR, 7.4 [95% CI, 1.635.2]), and being a nurse (aOR, 2.3 [95% CI, 1.1-4.8]).
Conclusions: Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDR A.
baumannii. MDR A. baumannii appears to be more easily transmitted than MDR P. aeruginosa and perhaps
more easily transmitted than previously studied methicillin-resistant Staphylococcus aureus or vancomycinresistant Enterococcus. This ease of transmission may help explain the emergence of MDR A. baumannii.
Antibiotique
NosoBase n° 27906
Comment endiguer le flux d'enterobactéries qui produisent des carbapénèmases : stratégies
proactives ou réactives ?
Bilavsky E; Schwaber MJ; Carmeli Y. How to stem the tide of carbapenemase-producing
enterobacteriaceae? proactive versus reactive strategies. Current opinion in infectious diseases 2010/08;
23(4): 327-331.
Mots-clés :
ENTEROBACTERIE;
RECOMMANDATION;
CONTROLE;
ENTEROBACTER; BIBLIOGRAPHIE
CARBAPENEME;
PREVENTION;
ANTIBIORESISTANCE;
ESCHERICHIA
COLI;
INCIDENCE;
KLEBSIELLA;
Purpose of review: The spread of carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemaseproducing Enterobacteriaceae in healthcare settings is an important medical problem and a major public
health threat. Infections with CRE are associated with high rates of morbidity and mortality, and are
spreading rapidly across the globe. The medical community can either observe the natural course of this
epidemic or act proactively and take adequate preventive measures to contain the spread of these bacteria.
The purpose of this review is to highlight the impact of these problematic pathogens and to examine
infection control policies needed in order to limit their spread.
CCLIN Sud-Est – [email protected]
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Recent findings: The incidence of CRE is on the rise in several parts of the world; however, data regarding
proper infection control methods on this issue are scarce. Great variability exists in infection control
measures taken to confront CRE in various settings. Recently, two sets of guidelines to control CRE have
been issued, one by the US Centers for Disease Control and Prevention and the other by an expert group
under the auspices of the European Society of Clinical Microbiology and Infectious Diseases. These
guidelines have many similarities but also considerable differences.
Summary: Whereas clinical information regarding how to contain infections by CRE pathogens is still limited,
it is obvious that it relies on a multifaceted approach and implementation of strict infection control measures.
Since it has been observed that lack of adequate and timely reaction is common and associated with great
morbidity and mortality, preparation plans should be evaluated and implemented locally, regionally,
nationally and even on an international level.
NosoBase n° 27834
Evaluation prospective de la pertinence des associations d'antibiotiques en médecine interne
Caruba T; Sabatier B; Matta M; Arlet JB; Ranque B; Capron L; et al. Prospective evaluation of the relevance
of prescribing antibiotic combinations in an internal medicine department. La Revue de médecine interne
2010/07; 31(7): 469-475.
Mots-clés : EVALUATION; ANTIBIOTIQUE; MEDECINE INTERNE; ETUDE PROSPECTIVE ;
CENTRE HOSPITALIER UNIVERSITAIRE
Propos : Évaluer la conformité des associations d'antibiotiques, définie par l'adéquation entre l'association
prescrite et l'ensemble des recommandations disponibles.
Méthodes : Étude prospective monocentrique réalisée pendant 12 mois dans un service hospitalouniversitaire de médecine interne.Toutes les associations d'antibiotiques ont été évaluées en tenant compte
du site de l'infection, de la bactérie, des antibiotiques, des doses prescrites et des durées de traitement. Un
comité scientifique a classé chaque association comme : (1) conforme aux recommandations existantes ;
(2) conforme à l'antibiogramme en l'absence de recommandation ; (3) non conforme (NC) sans
conséquence clinique ; (4) NC avec conséquence clinique.
Résultats : Quatre-vingt-sept associations d'antibiotiques ont été analysées. Le taux de conformité était de
77 % (67cas). Les associations NC, avec et sans conséquence clinique, étaient respectivement de 7 % (six
cas) et 16 % (14 cas). Les motifs de non-conformité étaient : (1) monothérapie suffisante ou aucun
antibiotique nécessaire (14 cas) ; (2) antibiotique prescrit ne correspondant pas à l'antibiogramme (trois cas)
; (3) antibiotique prescrit inefficace sur les principales espèces bactériennes habituellement rencontrées
(traitement probabiliste) (trois cas). Pour 52 % des prescriptions, l'avis de l'unité mobile de microbiologie
clinique avait été demandé ; le taux de conformité après avis était de 96 % contre 57 % en l'absence d'avis
(p < 0,001).
Conclusion : Soixante-dix-sept pourcent des associations sont conformes aux recommandations et le
conseil auprès d'une structure référente améliore significativement ce pourcentage.
NosoBase n° 27983
Traitement par le linezolide des infections bactériennes à pathogènes à Gram positif chez des
nouveau-nés prématurés : revue systématique
Kocher S; Muller W; Resch B. Linezolid treatment of nosocomial bacterial infection with multiresistant grampositive pathogens in preterm infants: a systematic review. International journal of antimicrobial agents
2010/08; 36(2): 106-110.
Mots-clés : LINEZOLIDE; TRAITEMENT; MULTIRESISTANCE;
VANCOMYCINE; TOLERANCE; BACTERIE A GRAM POSITIF
PREMATURE;
NEONATALOGIE;
Linezolid is an antibiotic of the oxazolidinone class that has bacteriostatic and bactericidal activity against a
broad range of Gram-positive bacteria, including multiresistant pathogens. Owing to increasing resistance of
Gram-positive pathogens to traditional antibiotics such as vancomycin, the oxazolidinones were introduced
into therapy. The aim of this review was to summarise actual data on the pharmacokinetics, safety and
clinical use of linezolid in preterm infants. The Medline and EMBASE databases were searched using the
term 'linezolid' combined with 'newborn', 'neonate', 'preterm' and 'premature' for papers published between
January 1987 and June 2009. Studies reporting on a population including preterm infants and other age
groups as well as case reports on preterm infants only were acceptable for analysis. Five studies and eight
case reports were identified evaluating linezolid in preterm infants. A dosage regimen of 10mg/kg body
CCLIN Sud-Est – [email protected]
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weight given either orally or intravenously every 8h in infants aged >or=1 week and the same dose given
every 12h in infants <1 week was shown to be safe and effective with a mean treatment duration of 10-28
days. In summary, linezolid was shown to be a safe and effective alternative to vancomycin in the treatment
of infections with multiresistant Gram-positive pathogens in preterm infants.
NosoBase n° 27804
Résumé du consensus sur l'administration d'antibiotiques par aérosol
Le J; Ashley ED; Neuhauser MM; Brown J; Gentry C; Klepser ME; et al. Consensus summary of
aerosolized antimicrobial agents: application of guideline criteria. Pharmacotherapy 2010/06; 30(6): 562584.
Mots-clés : ANTIBIOTIQUE; CONSENSUS; AEROSOL; RECOMMANDATION; PHARMACIEN; APPAREIL
RESPIRATOIRE;
EFFICACITE;
TOLERANCE;
PREVENTION;
TRAITEMENT;
PNEUMONIE;
MUCOVISCIDOSE; ANTIFONGIQUE; TOBRAMYCINE; COLISTINE; ANTIBIOTIQUE; AMINOSIDE
Aerosolized delivery of antimicrobial agents is an attractive option for management of pulmonary infections,
as this is an ideal method of providing high local drug concentrations while minimizing systemic exposure.
With the paucity of consensus regarding the safety, efficacy, and means with which to use aerosolized
antimicrobials, a task force was created by the Society of Infectious Diseases Pharmacists to critically
review and evaluate the literature on the use of aerosolized antiinfective agents. This article summarizes key
findings and statements for preventing or treating a variety of infectious diseases, including cystic fibrosis,
bronchiecstasis, hospital-acquired pneumonia, fungal infections, nontuberculosis mycobacterial infection,
and Pneumocystis jiroveci pneumonia. Our intention was to provide guidance for clinicians on the use of
aerosolized antibiotics through evidence-based pharmacotherapy. Further research with well-designed
clinical trials is necessary to elucidate the optimal dosage and duration of therapy and, of equal importance,
to appreciate the true risks associated with the use of aerosolized delivery systems.
NosoBase n° 27905
Escherichia coli producteur de bêta-lactamases à spectre élargi : changements d'épidémiologie et
impact clinique
Oteo J; Perez-Vazquez M; Campos J. Extended-spectrum beta-lactamase producing Escherichia coli:
changing epidemiology and clinical impact. Current opinion in infectious diseases 2010/08; 23(4): 320-326.
Mots-clés : EPIDEMIOLOGIE; ESCHERICHIA COLI; BETA-LACTAMASE A SPECTRE ELARGI;
BIBLIOGRAPHIE; FACTEUR DE RISQUE; MORTALITE; ANTIBIOTIQUE; TRAITEMENT; INFECTION
URINAIRE; BIOLOGIE MOLECULAIRE; ANTIBIORESISTANCE; COLONISATION DIGESTIVE;
INFECTION COMMUNAUTAIRE
Purpose of review: This review discusses the recent findings (July 2008-January 2010) on extendedspectrum [beta]-lactamase (ESBL)-producing Escherichia coli, mainly focussed on the epidemiology and
clinical impact of infections owing to this pathogen.
Recent findings: CTX-M-producing E. coli, mainly the CTX-M-15 producers, has emerged and disseminated
worldwide as an important cause of both nosocomial and community-onset infections. The clonal spread of
the ST131 epidemic E. coli strain is linked not only to the CTX-M-15 pandemia but also to other ESBLs
types. The most commonly reported risk factors for community-onset ESBL-producing E. coli infections are
contact with healthcare centres, recent use of antimicrobial agents, and presence of comorbidities. But
infections owing to ESBL-producing E. coli in patients without obvious risk factors can occur, probably
related to the increase of healthy carriers colonized with this pathogen. The main significant predictor of
mortality caused by ESBL-producing E. coli is inadequate initial antimicrobial therapy. Alternatives of
treatment of severe ESBL-producing E. coli infections included carbapenems, amikacin, tigecycline, and
[beta]-lactam/[beta]-lactamase inhibitor combinations; with some of them enough clinical evidence is lacking
(tigecycline, [beta]-lactam/[beta]-lactamase inhibitor combinations). For urinary tract infections, fosfomycin
and nitrofurantoin could be useful.
Summary: The worldwide emergence of multiresistant ESBL-producing E. coli raises key therapeutic
problems; interventions addressed to their quick detection and early appropriate antibiotic treatment and
prevention are urgently needed.
CCLIN Sud-Est – [email protected]
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NosoBase n° 27851
Analyse quantitative de modèles de différents protocoles de traitement destinés à prévenir la
résistance aux antibiotiques
Sun HR; Lu X; Ruan S. Qualitative analysis of models with different treatment protocols to prevent antibiotic
resistance. Mathematical biosciences 2010; in press: 12 pages.
Mots-clés :
PREVENTION;
PROTOCOLE;
ANTIBIORESISTANCE; STATISTIQUE
ANTIBIOTIQUE;
ANALYSE;
TRAITEMENT;
This paper is concerned with the qualitative analysis of two models (Bonhoeffer et al., Proc. Natl. Acad. Sci.
USA94 (1997), 12106-12111) for different treatment protocols to prevent antibiotic resistance. Detailed
qualitative analysis about the local or global stability of the equilibria of both models is carried out in term of
the basic reproduction number R(0)<1. For the model with a single antibiotic therapy, we show that if
R(0)<1, then the disease-free equilibrium is globally asymptotically stable; if R(0)<1, then the disease
endemic equilibrium is globally asymptotically stable. For the model with multiple antibiotic therapies,
stabilities of various equilibria are analyzed and combining treatment is shown better than cycling treatment.
Numerical simulations are performed to show that the dynamical properties depend intimately upon the
parameters.
NosoBase n° 27733
Mise en place d'un projet pour une antibioprophylaxie appropriée dans un centre hospitalier
Takahashi Y; Takesue Y; Nakajima K; Ichiki K; Wada Y; Tsuchida T; et al. Implementation of a hospita-wide
project for appropriate antimicrobial prophylaxis. Journal of infection and chemotherapy 2010; in press: 6
pages.
Mots-clés : ANTIBIOPROPHYLAXIE; ANTIBIORESISTANCE; TAUX; PSEUDOMONAS AERUGINOSA;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ETUDE TRANSVERSALE; CHIRURGIE;
CHIRURGIE PROPRE; CHIRURGIE PROPRE-CONTAMINEE; ANTIBIOTIQUE
The aim of this study was to confirm the effect of implementing a hospital-wide project for appropriate use of
antimicrobial prophylaxis (AMP) to reduce the rate of antibiotic-resistant organisms. Fifteen different
manuals for each surgical department have been simultaneously implemented since February 2007.
Compliance rate was compared between pre- and postintervention periods (3 months for each period). As
an effect of this intervention, we analyzed changes in the rates of Pseudomonas aeruginosa and methicillinresistant Staphylococcus aureus among organisms isolated postoperatively. The number of operations was
1,627 in both periods. Among patients whose surgeries were longer than 3 h in duration, 75% received an
additional intraoperative antimicrobial dose in the postintervention period and 23% in the preintervention
period (P<0.001). Although most patients received postoperative AMP with an interval of q12 h in the
preintervention period, 63% of the patients received AMP with an interval of q8 h in the postintervention
period. The duration of AMP use was reduced from 2.4 ± 1.9 to 1.6 ± 1.5 days (P<0.001). Forty-seven
percent of patients discontinued AMP within 24 h and 81% within 48 h. Isolation rates of P. aeruginosa
among all gramnegative organisms significantly decreased from 13% (68/538 patients) to 7.3% (37/509
patients) (P = 0.004). Execution of a hospital-wide project to promote the appropriate use of AMP, including
shortening the duration of AMP use, was useful to decrease the rate of P. aeruginosa isolated
postoperatively.
Bactériémie
NosoBase n° 28042
Efficacité d'un faisceau de mesures de lutte contre les bactériémies liées aux cathéters dans un
centre hospitalier universitaire de Thaïlande : 3 ans d'étude
Apisarnthanarak A; Thongphubeth K; Yuekyen C; Warren DK; Fraser VJ. Effectiveness of a catheterassociated bloodstream infection bundle in a Thai tertiary care center: a 3-year study. American journal of
infection control 2010/08; 38(6): 449-450.
Mots-clés : CATHETER; BACTERIEMIE; CENTRE HOSPITALIER UNIVERSITAIRE; TAUX; ETUDE
PROSPECTIVE; HYGIENE DES MAINS; INCIDENCE; PREVENTION
CCLIN Sud-Est – [email protected]
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Background: We sought to determine the long-term impact of "bundled" infection control interventions on the
rates of catheter-associated bloodstream infection (CA-BSI) in a middle-income country.
Setting: A 500-bed tertiary care center in Thailand.
Methods: A 3-year, hospital-wide, prospective quasi-experimental study was conducted for 1 year before the
intervention (period 1), 1 year after implementation of the CA-BSI bundle (period 2), and at a 1-year followup after the intervention with intensified hand hygiene promotion (period 3).
Results: In period 1, 88 episodes of CA-BSI (14 cases per 1000 catheter-days) were recorded. During
period 2, the CA-BSI rate decreased by 54.1 % (6.4 cases per 1000 catheter-days; P <.001). Compared with
period 1 (8% adherence), hand hygiene adherence was improved in period 2 (24%; P <.001) and period 3
(54%; P <.001). The CA-BSI rate was further decreased by 78% (1.4 cases per 1000 catheter-days; P
<.001) during period 3. Notably, no CA-BSIs were seen in 6 of the 12 months (50%) of period 3. Compared
with period 1, the mean number of catheter-days was significantly reduced in period 2 (4.9 +/- 1.5 days; P
<.001) and period 3 (4.1 +/- 1.1 days; P <.001).
Conclusion: Bundled infection control practices are feasible and effective in sustaining reduced incidence of
CA-BSI in patients with central venous catheters in a resource-limited setting.
NosoBase n° 27863
Quinupristine-dalfopristine versus linezolide pour le traitement des bactériémies à Enterococcus
faecium résistant à la vancomycine : efficacité et développement d'antibiorésistance
Chong YP; Lee SO; Song EH; Lee EJ; Jang EY; Kim SH; et al. Quinupristin-dalfopristin versus linezolid for
the treatment of vancomycin-resistant Enterococcus faecium bacteraemia: efficacy and development of
resistance. Scandinavian journal of infectious diseases 2010; 42(6-7): 491-499.
Mots-clés : DALFOPRISTINE QUINUPRISTINE; LINEZOLIDE; TRAITEMENT; ENTEROCOCCUS
FAECIUM;
BACTERIEMIE;
ANTIBIORESISTANCE;
VANCOMYCINE;
EFFICACITE;
CENTRE
HOSPITALIER UNIVERSITAIRE; MORTALITE; PRONOSTIC; EFFET INDESIRABLE
Quinupristin-dalfopristin and linezolid are widely used for the treatment of vancomycin-resistant
Enterococcus faecium (VREF) infections. Increasing resistance of VREF to quinupristin-dalfopristin and
linezolid is a cause for concern. To determine the efficacy of and the rate of development of resistance to
quinupristin-dalfopristin and linezolid, we analyzed all episodes of clinically significant VREF bacteraemia at
a tertiary-care hospital from January 2003 to June 2007. The main outcomes were rates of 30-day mortality,
microbiological response, and development of resistance. Fifty-two patients were treated with quinupristindalfopristin and 61 were treated with linezolid. Baseline demographic and clinical characteristics were similar
between the 2 groups. There were no significant between-group differences in 30-day mortality (48% in the
quinupristin-dalfopristin group vs 41% in the linezolid group; p = 0.45) or microbiological response (60% vs
66%; p = 0.51). However, prolonged bacteraemia (18% of 45 evaluable cases vs 4% of 55 evaluable cases;
p = 0.04) and development of resistance in blood isolates (11% vs 0%; p = 0.02) were more frequently
observed in the quinupristin-dalfopristin group than in the linezolid group. There was no significant difference
between the efficacy of quinupristin-dalfopristin and linezolid. However, prolonged bacteraemia and the
development of resistance were more common in quinupristin-dalfopristin-treated patients.
NosoBase n° 28039
Réduction des bactériémies liées aux voies centrales par mise en place d'un faisceau de soins postinsertion
Guerin K; Wagner J; Rains K; Bessesen M. Reduction in central line-associated bloodstream infections by
implementation of a postinsertion care bundle. American journal of infection control 2010/08; 38(6): 430-433.
Mots-clés : CATHETER; BACTERIEMIE; PREVENTION; INCIDENCE; SURVEILLANCE; HYGIENE DES
MAINS; CHLORHEXIDINE; PANSEMENT; CATHETER VEINEUX CENTRAL
Background: Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and
incur excess costs. The use of a central line insertion bundle has been shown to reduce the incidence of
CLABSI. Postinsertion care has been included in some studies of CLABSI, but this has not been studied
independently of other interventions.
Methods: Surveillance for CLABSI was conducted by trained infection preventionists using National Health
Safety Network case definitions and device-day measurement methods. During the intervention period,
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nursing staff used a postinsertion care bundle consisting of daily inspection of the insertion site; site care if
the dressing was wet, soiled, or had not been changed for 7 days; documentation of ongoing need for the
catheter; proper application of a chlorohexidine gluconate-impregnated sponge at the insertion site;
performance of hand hygiene before handling the intravenous system; and application of an alcohol scrub
to the infusion hub for 15 seconds before each entry.
Results: During the preintervention period, there were 4415 documented catheter-days and 25 CLABSIs, for
an incidence density of 5.7 CLABSIs per 1000 catheter-days. After implementation of the interventions,
there were 2825 catheter-days and 3 CLABSIs, for an incidence density of 1.1 per 1000 catheter-days. The
relative risk for a CLABSI occurring during the postintervention period compared with the preintervention
period was 0.19 (95% confidence interval, 0.06-0.63; P = .004).
Conclusion: This study demonstrates that implementation of a central venous catheter postinsertion care
bundle was associated with a significant reduction in CLABSI in a setting where compliance with the central
line insertion bundle was already high.
NosoBase n° 27726
Bactériémies à Enterobacter cloacae producteur de bêta-lactamases à spectre élargi. Rôle du
traitement par des carbapénèmes
Lee CC; Lee NY; Yan JJ; LeeHC; Chen PL; Chang CM; et al. Bacteremia due to extended-spectrum
beta-lactamase-producing Enterobacter cloacae: role of carbapenem therapy. Antimicrobial agents and
chemotherapy 2010;I n press: 24 pages.
Mots-clés : BACTERIEMIE; ENTEROBACTER CLOACAE; BETA-LACTAMASE A SPECTRE ELARGI;
TRAITEMENT; CARBAPENEME; ANTIBIORESISTANCE; ETUDE RETROSPECTIVE; AGE; PCR;
MORTALITE; CEFOTAXIME; FACTEUR DE RISQUE; ANALYSE MULTIVARIEE; CEPHALOSPORINE
Enterobacter cloacae is one of important nosocomial pathogens. However, few studies specifically dealing
with clinical characteristics and outcome of extended-spectrum beta-lactamase (ESBL)-producing E.
cloacae infections have been published. During an eight-year period in a medical center, of 610 E. cloacae
bacteremic isolates, 138 (22.6 %) with ESBL genes were designated as the ESBL group; and 120 (19.6 %)
with cefotaxime-nonsusceptible without ESBL phenotype and genes as the control group. Of the former
isolates, 133 (96.3%) had blaSHV-12, three (2.1%) blaCTX-M3, and two (1.4%) both blaSHV-12 and
blaCTX-M3. After exclusion of age <18 year, there were 206 adults with E. cloacae bacteremia, 121 patients
in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial
bacteremia, increased severity of illness, more bacteremic onset in intensive care units (ICUs), and longer
stay in the hospital and ICU after bacteremic onset, were noted in the ESBL group. However, the crude and
sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related
mortality rate of patients definitively treated by a carbapenem was lower than that of those by noncarbapenem ss-lactams (5/53, 9.4% vs. 13/44, 29.5%; P=0.01), though the difference was not significant in
the hierarchical multivariate analysis (P=0.46). Among 62 patients with follow-up blood cultures within 14
days of bacteremic onset, breakthrough bacteremia was more common in those treated by a noncarbapenem beta-lactam agent than those treated by a carbapenem (18/31, 58.0% vs. 3/31, 9.6%;
P<0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae bacteremia may provide therapeutic
benefits.
NosoBase n° 28040
Impact d'un programme destiné à prévenir les bactériémies associées aux voies centrales dans une
ère de tolérance zéro
Marra AR; Rodrigues RG; Souza Durao M; Correa L; Guastelli LR; Moura DF; et al. Impact of a program to
prevent central line-associated bloodstream infection in the zero tolerance era. American journal of infection
control 2010/08; 38(6): 434-439.
Mots-clés : PREVENTION; CATHETER; BACTERIEMIE; INCIDENCE; CATHETER VEINEUX CENTRAL;
EPIDEMIOLOGIE; OBSERVANCE; HYGIENE DES MAINS; CHLORHEXIDINE; PANSEMENT;
HEMODIALYSE; MICROBIOLOGIE
Background: Central line-associated bloodstream infection (CLABSI) is one of the most important health
care-associated infections in the critical care setting.
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
août 2010
Methods: A quasiexperimental study involving multiple interventions to reduce the incidence of CLABSI was
conducted in a medical-surgical intensive care unit (ICU) and in 2 step-down units (SDUs). From March
2005 to March 2007 (phase 1 [P1]), some Centers for Disease Control and Prevention evidence-based
practices were implemented. From April 2007 to April 2009 (P2), we intervened in these processes at the
same time that performance monitoring was occurring at the bedside, and we implemented the Institute for
Healthcare Improvement central line bundle for all ICU and SDU patients requiring central venous lines.
Results: The mean incidence density of CLABSI per 1000 catheter-days in the ICU was 6.4 in phase 1 and
3.2 in phase 2, P < .001. The mean incidence density of CLABSI per 1000 catheter-days in the SDUs was
4.1 in phase 1 and 1.6 in phase 2, P = .005.
Conclusion: These results suggest that reducing CLABSI rates in an ICU setting is a complex process that
involves multiple performance measures and interventions that can also be applied to SDU settings.
Chirurgie
NosoBase n° 27465
Variation du type et de la fréquence des infections postopératoires invasives à Staphylococcus
aureus en fonction du type d'intervention chirurgicale
Anderson DJ; Arduino JM; Reed SD; Sexton DJ; Kaye KS; Grussemeyer CA; et al. Variation in the type and
frequency of postoperative invasive Staphylococcus aureus infections according to type of surgical
procedure. Infection control and hospital epidemiology 2010/07; 31(7): 701-709.
Mots-clés : STAPHYLOCOCCUS AUREUS; SITE OPERATOIRE; ETUDE RETROSPECTIVE;
NEUROCHIRURGIE; CHIRURGIE ORTHOPEDIQUE; CHIRURGIE CARDIO-VASCULAIRE; ESTHETIQUE;
BACTERIEMIE; INCIDENCE; TAUX
Objective: To determine the epidemiological characteristics of postoperative invasive Staphylococcus
aureus infection following 4 types of major surgical procedures.
Design: Retrospective cohort study.
Setting: Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.
Patients: Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.
Methods: We used previously validated, prospectively collected surgical surveillance data for surgical site
infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We
defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream
infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were
generated using the Pearson chi(2) test, Student t test, or Wilcoxon rank-sum test, as appropriate.
Results: In total, 81,267 patients underwent 96,455 procedures during the study period. The overall
incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43-0.52); 227
(51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more
common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62-0.97])
than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32-0.42]), neurosurgical
procedures (0.62 infections per 100 procedures [95% CI, 0.53-0.72]), or plastic surgical procedures (0.32
infections per 100 procedures [95% CI, 0.17-0.47]) ([Formula: see text]). Similarly, S. aureus bloodstream
infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures
[95% CI, 0.43-0.72]; [Formula: see text], compared with other procedure types), comprising almost threequarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site
infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95%
CI, 0.42-0.59]; [Formula: see text], compared with other procedure types), comprising 80% of invasive S.
aureus infections after these procedures.
Conclusion. The frequency and type of postoperative invasive S. aureus infection varied significantly across
procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for
ongoing preventative interventions.
NosoBase n° 27805
Prévention des infections du site opératoire
Bauch J; Betzler M; Oestern HJ. Prävention postoperativer wundinfektionen. Der Chirurg 2010; in press: 10
pages.
CCLIN Sud-Est – [email protected]
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août 2010
Mots-clés : PREVENTION; SITE OPERATOIRE; CHIRURGIE; FACTEUR DE RISQUE; EPIDEMIOLOGIE;
MICROBIOLOGIE; ANTISEPTIQUE; ANTIBIOPROPHYLAXIE
Approximately 6.4 million operative procedures are carried out each year in Germany. Besides nosocomial
pneumonia and urinary tract infections, postoperative wound infections account for 16% and are the third
most common kind of infection in German hospitals. The spectrum of pathogens depends on the type and
localization of the operative procedure. The pathogens can penetrate the wound from outside (exogenic) or
from the patient’s own skin or mucosal flora (endogenic). There are different kinds of risk factors whereby
those of the patient can be influenced in a limited manner and are differentiated from those which can be
influenced by preventive actions against infections in the context of the organization of perioperative nursing.
NosoBase n° 27973
L'approche laparoscopique réduit significativement les infections du site opératoire après chirurgie
colorectale : résultats du programme national d'amélioration de la qualité en chirurgie
Kiran RP; El-Gazzaz GH; Vogel JD; Remzi FH. Laparoscopic approach significantly reduces surgical site
infections after colorectal surgery: data from national surgical quality improvement program. Journal of the
American College of Surgeons 2010; in press: 7 pages.
Mots-clés : LAPAROSCOPIE; PREVENTION; SITE OPERATOIRE; CHIRURGIE DIGESTIVE; CHIRURGIE
ABDOMINALE; QUALITE; TAUX; ANALYSE MULTIVARIEE; FACTEUR DE RISQUE; INFECTION
SUPERFICIELLE; INFECTION PROFONDE
Background: The goal of this study was to compare surgical site infection (SSI) rates between laparoscopic
(LAP) and open colorectal surgery using the National Surgical Quality Improvement Program (NSQIP)
database. Study design: We identified patients included in the NSQIP database from 2006 to 2007 who
underwent LAP and open colorectal surgery. SSI rates were compared for the 2 groups. Association
between patient demographics, diagnosis, type of procedure, comorbidities, laboratory values, intraoperative
factors, and SSI within 30 days of surgery, were determined using a logistic regression analysis.
Results: Among 10,979 patients undergoing colorectal surgery (LAP 31.1%, open 68.9%), the SSI rate was
14.0% (9.5% LAP vs 16.1% open, p < 0.001). LAP patients were younger (p < 0.001), with lower American
Society of Anesthesiologists (ASA) scores (p < 0.001) and comorbidities (p = 0.001) involving benign and
inflammatory conditions rather than malignancy (p < 0.001), but operative time was greater (p = 0.001). On
multivariate analysis age, ASA >/=3, smoking, diabetes, operative time >180 minutes, appendicitis or
diverticulitis, and regional enteritis diseases were found to be significantly associated with high SSI; the LAP
approach was associated with a reduced SSI rate.
Conclusions: The LAP approach is independently associated with a reduced SSI when compared with open
surgery and should, when feasible, be considered for colon and rectal conditions.
NosoBase n° 27842
Complications après implantation
Le Moniteur hospitalier 2010/07; (227): 31-40.
Mots-clés : MATERIEL ETRANGER; CHIRURGIE ORTHOPEDIQUE; COMPLICATION; OS; POSTOPERATOIRE; CONTAMINATION; TRAITEMENT; ARTICULATION
Malgré les progrès de la chirurgie orthopédique, toute intervention, si bénigne soit-elle et quelles que soient
les précautions prises, implique un risque. Cet article fait le point sur les principaux incidents ou
complications pouvant émailler l'implantation d'une prothèse des membres inférieurs ou supérieurs.
Clostridium difficile
NosoBase n° 27877
Infections à Clostridium difficile ribotype 078 : premier rapport de cas en République d'Irlande
Burns K; Morris-Downes M; Fawley WN; Smyth E; Wilcox MH; Fitzpatrick F. Infection due to C. difficile
ribotype 078: first report of cases in the Republic of Ireland. The Journal of hospital infection 2010/08; 75
(4): 287-291.
CCLIN Sud-Est – [email protected]
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août 2010
Mots-clés : CLOSTRIDIUM DIFFICILE; RIBOTYPE; EPIDEMIE; RIBOTYPE; PCR
Clostridium difficile is an important healthcare-associated pathogen. Hypervirulent strains such as those
belonging to ribotype 027 have been widely reported in recent years. A second strain associated with
hypervirulence is ribotype 078 and the prevalence of Clostridium difficile infection (CDI) due to this ribotype
appears to be increasing. This report describes an outbreak, in which 15cases of CDI due to ribotype 078
were detected in an Irish hospital and from a nursing home in the hospital's catchment area. C. difficile
ribotype 078 accounted for 15% of total isolates submitted for ribotyping. The average age of patients with
CDI due to ribotype 078 was 76 years. Forty-six percent of patients experienced recurrence of symptoms
within eight weeks of diagnosis and CDI was felt to have directly contributed to five of the eight deaths. Use
of enhanced DNA fingerprinting identified clusters within the 15 cases and suggested hitherto unrecognised
links between some patients with CDI. Such approaches offer the promise to delineate common sources
and transmission routes for C. difficile.
NosoBase n° 27875
Réduire Clostridium difficile par une identification précoce des cas groupés et l'usage d'un
ensemble standard d'interventions
Hardy KJ; Gossain S; Thomlinson D; Pillay DG; Hawkey PM. Reducing Clostridium difficile through early
identification of clusters and the use of a standardised set of interventions. The Journal of hospital infection
2010/08; 75(4): 277-281.
Mots-clés : CLOSTRIDIUM DIFFICILE; PREVENTION; CONTROLE; TYPAGE; INCIDENCE; ENQUETE;
RIBOTYPE; RECOMMANDATION; AUDIT; HYGIENE DES MAINS; OBSERVANCE; ANTIBIOTIQUE;
ENVIRONNEMENT; BIONETTOYAGE; DESINFECTION
In recent years the rates of Clostridium difficile infection (CDI) have increased worldwide with several large
outbreaks occurring within the UK. New guidance from the UK Department of Health describes measures to
investigate periods of increased incidence (PII) of CDI which include informing staff, ribotyping isolates,
enhanced cleaning, audits and monitoring of antibiotic prescribing. This study aimed to determine whether a
standardised set of measures could be used to control the incidence of CDI within an acute hospital setting
over an 18 month period. During the study period a total of 102 PII involving 439 patients were investigated.
The number of PII per month ranged from 14 in February 2008 to one in June 2009. From January 2008 to
September 2008, ribotyping of patient isolates was only carried out on PII involving more than 10 patients,
but from October 2008 it was carried out on all PII. During the period October 2008 to June 2009, 28 PII
were investigated on 21 different wards, with seven wards having two PII. Ribotyping of the isolates
confirmed nine (32%) of these PII to be outbreaks, with three being due to ribotype 027, two ribotype 078
and the others distinct ribotypes. Use of a set of standardised interventions has resulted in a decrease in the
incidence of PII and a reduction in the number of patients involved. By taking early action with a set of
standardised measures the incidence of hospital-acquired CDI can be reduced.
NosoBase n° 27632
Synthèse sur la mortalité attribuable aux infections à Clostridium difficile
Karas JA; Enoch DA; Aliyu SH. A review of mortality due to Clostridium difficile infection. The Journal of
infection 2010/07; 61(1): 1-8.
Mots-clés : MORTALITE; CLOSTRIDIUM DIFFICILE; BIBLIOGRAPHIE; FACTEUR DE RISQUE; AGE
In this review we examine published literature to ascertain mortality in relation to Clostridium difficile
infection (CDI) and the factors associated with mortality. In the 27 studies that had sufficient data, there were
10975 cases of CDI with great heterogeneity in the methods for reporting mortality. We calculated the
overall associated mortality to be at least 5.99% within 3 months of diagnosis. The most important finding is
that higher mortality is associated with advanced age, being 13.5% in patients over 80 years. Studies
performed after 2000 had a significantly higher mortality than those before this date. We propose minimum
standards for reporting mortality in future studies.
CCLIN Sud-Est – [email protected]
11 / 29
NosoVeille – Bulletin de veille
août 2010
Endoscopie
NosoBase n° 27794
Transmission de Klebsiella pneumoniae productrices de KPC-2 bêta-lactamase résistant aux
carbapénèmes associée à un acte d'endoscopie
Naas T; Cuzon G; Babics A; Fortineau N; Boytchev I; Gayral F; et al. Endoscopy-associated transmission of
carbapenem-resistant Klebsiella pneumoniae producing KPC-2 beta-lactamase. The Journal of antimicrobial
chemotherapy 2010/06; 65(6): 1305-1306.
Mots-clés : TRANSMISSION; ENDOSCOPIE; KLEBSIELLA PNEUMONIAE; CARBAPENEME;
ANTIBIORESISTANCE; ENDOSCOPIE; TRANSMISSION; EPIDEMIE; CONTAMINATION
NosoBase n° 27477
Cas groupés de pseudo-infections à Burkholderia cepacia associées à un laveur-désinfecteur
contaminé dans une unité de bronchoscopie
Rosengarten D; Block C; Hidalgo-Grass C; Temper V; Gross I; Budin-Mizrahi A; et al. Cluster of
pseudoinfections with Burkholderia cepacia associated with a contaminated washer-disinfector in a
bronchoscopy unit. Infection control and hospital epidemiology 2010/07; 31(7): 769-771.
Mots-clés
:
LAVEUR-DESINFECTEUR;
CONTAMINATION;
BURKHOLDERIA
BRONCHOSCOPIE; EPIDEMIE; FILTRE; EAU; LAVAGE BRONCHO-ALVEOLAIRE
CEPACIA;
In December 2008, bronchoalveolar lavage fluid samples obtained from 3 patients were positive for
Burkholderia cepacia complex on culture. Samples obtained from bronchoscopes and rinse-water samples
obtained from the washer-disinfector were found to be positive for B. cepacia complex. The cause of this
pseudo-outbreak was that the washer-disinfector was installed without the required antibacterial filter.
Grippe
NosoBase n° 27463
Facteurs déterminants incitant le personnel soignant à se faire vacciner contre la grippe
Godin G; Vezina-Im LA; Naccache H. Determinants of influenza vaccination among healthcare workers.
Infection control and hospital epidemiology 2010/07; 31(7): 689-693.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; ETUDE PROSPECTIVE; QUESTIONNAIRE; ATTITUDE ;
CENTRE HOSPITALIER UNIVERSITAIRE
Objective: To identify the determinants of influenza vaccination and the moderators of the intention-behavior
relationship among healthcare workers (HCWs).
Design: Prospective survey with 2-month follow-up.
Setting: Three university-affiliated public hospitals.
Participants: Random sample of 424 HCWs.
Methods: The intention of an HCW to get vaccinated against influenza was measured by means of a selfadministered questionnaire based on an extended version of the theory of planned behavior. An objective
measure of behavior was extracted 2 months later from the vaccination database of the hospitals.
Results: Controlling for past behavior, we found that the determinants of influenza vaccination were intention
(odds ratio [OR], 8.32 [95% confidence interval {CI}, 2.82-24.50]), moral norm (OR, 3.01 [95% CI, 1.177.76]), anticipated regret (OR, 2.33 [95% CI, 1.23-4.41]), and work status (ie, full time vs part time; OR, 1.99
[95% CI, 1.92-3.29]). Moral norm also interacted with intention as a significant moderator of the intentionbehavior relationship (OR, 0.09 [95% CI, 0.03-0.30]). Again, apart from the influence of past behavior,
intention to get vaccinated was predicted by use of the following variables: attitude ([Formula: see text];
[Formula: see text]), professional norm ([Formula: see text]; [Formula: see text]), moral norm ([Formula: see
text]; [Formula: see text]), subjective norm ([Formula: see text]; [Formula: see text]), and self-efficacy
([Formula: see text]; [Formula: see text]). This latter model explained 89% of the variance in HCWs'
intentions to get vaccinated against influenza during the next vaccination campaign. Conclusions. Our study
suggests that influenza vaccination among HCWs is mainly a motivational issue. In this regard, it can be
suggested to reinforce the idea that getting vaccinated can reduce worry and protect family members.
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
août 2010
NosoBase n° 27898
Avis relatif à l'actualisation de la stratégie vaccinale grippe, saison 2010-2011
Haut conseil de la santé publique. HCSP 2010/06/25; 1-2.
Mots-clés : VACCIN; LEGISLATION; PERSONNEL; PERSONNE AGEE; FACTEUR DE RISQUE;
ENDOCRINOLOGIE; APPAREIL RESPIRATOIRE
Le Haut conseil de la santé publique (HCSP) actualise l'avis du 23/04/2010 relatif à la stratégie vaccinale
grippe pour la saison 2010-2011, en ce qui concerne :
- la posologie du vaccin monovalent contre la grippe pandémique A(H1N1)2009 Focétria(R) pour les enfants
âgés de 6 mois à 9 ans et
- le tableau des populations.
NosoBase n° 27829
Numéro thématique. Epidémie de grippe A(H1N1)2009 : premiers éléments de bilan en France
Institut de veille sanitaire; INVS. Special issue- Influenza A(H1N1)2009 epidemic: preliminary assessment
results in France. Bulletin épidémiologique hebdomadaire 2010/06/29; (24-25-26): 257-288.
Mots-clés : GRIPPE; EPIDEMIE; VIRUS INFLUENZA TYPE A; SURVEILLANCE; VACCIN
NosoBase n° 28047
Nouvelles interventions pour améliorer les taux de vaccination contre la grippe parmi le personnel
de santé
Llupia A; Garcia-Basteiro AL; Olive V; Costas L; Rios J; Quesada S; et al. New interventions to increase
influenza vaccination rates in health care workers. American journal of infection control 2010/08; 38(6): 476481.
Mots-clés : GRIPPE; VACCIN; OBSERVANCE; TAUX; PERSONNEL; FORMATION; INFORMATION;
INTERNET; CENTRE HOSPITALIER UNIVERSITAIRE; INCIDENCE
Background: The most effective strategy for avoiding nosocomial influenza outbreaks is through vaccination
of health care workers (HCWs). In Spain, HCW vaccination coverage rarely exceeds 25%. The objective of
this study was to determine whether an active vaccination campaign promoting communication among
HCWs increased influenza vaccination coverage rates and permitted a shorter campaign.
Methods: This was a before-after trial, comparing free mobile vaccination teams without and with strategies
promoting HCW involvement by means of weekly educational and promotional messages through electronic
mail, including 2 prize draws for vaccinated HCWs and a Web page including pictures of vaccinated HCWs
and all senior hospital management. Weekly coverages were publicized, the staff of mobile units was
increased, and their routes in the hospital were advertised. The study population was >4500 HCWs
(permanent and temporary staff) at a Spanish university hospital during the 2007-08 and 2008-09 influenza
seasons.
Results: Coverage was 23% (95% confidence interval [CI], 22.5%-24.9%) in the 2007-08 season and 37%
(95% CI, 34.7%-37.4%) in 2008-09 season. The vaccination rate was highest in HCWs aged >/=65 years
and in physicians. The weekly vaccination rates were significantly higher for the 2008-09 season compared
with the 2007-08 season except for the first and third weeks; for example, in week 2, the rate was 1.7 HCWs
per 100 persons-week (95% CI, 1.3-2.1) in 2007-08, compared with 3.7 HCWs per 100 persons-week (95%
CI, 3.2-4.4) in 2009-09. Rate increases were concentrated in the first weeks of the program, with a peak
occurring in week 3 during the 2007-08 season and in week 2 during the 2008-09 season.
Conclusion: This intervention improved influenza vaccination coverage of HCWs and allowed more rapid
achievement of higher coverage.
NosoBase n° 27462
Echec des techniques de diagnostic en routine pour détecter la grippe chez des patients âgés
CCLIN Sud-Est – [email protected]
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août 2010
Talbot HK; Williams JV; Zhu Y; Poehling KA; Griffin MR; Edwards KM. Failure of routine diagnostic methods
to detect influenza in hospitalized older adults. Infection control and hospital epidemiology 2010/07; 31(7):
683-688.
Mots-clés : DIAGNOSTIC; GRIPPE; GERIATRIE; APPAREIL RESPIRATOIRE; TEST; PCR; ANTIGENE
Objective: To define the utility of using routine diagnostic methods to detect influenza in older, hospitalized
adults.
Design: Descriptive study.
Setting: One academic hospital and 1 community hospital during the 2006-2007 and 2007-2008 influenza
seasons.
Participants: Hospitalized adults 50 years of age or older.
Methods: Adults who were 50 years of age or older and hospitalized with symptoms of respiratory illness
were enrolled and tested for influenza by use of reverse-transcriptase polymerase chain reaction (RT-PCR).
Using RT-PCR as the gold standard, we assessed the performances of rapid antigen tests and conventional
influenza culture and the diagnostic use of the clinical definition of influenza-like illness.
Results: Influenza was detected by use of RT-PCR in 26 (11%) of 228 patients enrolled in our study. The
sensitivity of the rapid antigen test performed at bedside by research staff members was 19.2% (95%
confidence interval, 8.51%-37.9%); the sensitivity of conventional influenza culture was 34.6% (95%
confidence interval, 19.4%-53.8%). The ability to detect influenza with both the rapid antigen test and culture
was associated with patients with a higher viral load ([Formula: see text] and [Formula: see text],
respectively). The ability to diagnose influenza by use of the clinical definition of influenza-like illness had a
higher sensitivity (80.8%) but lacked specificity (40.6%).
Conclusion: Because rapid antigen testing and viral culture have poor sensitivity (19.2% and 34.6%,
respectively), neither testing method is sufficient to use to determine what type of isolation procedures to
implement in a hospital setting.
Hémodialyse
NosoBase n° 27731
Interventions destinées à prévenir les complications infectieuses chez des patients hémodialysés à
l'aide de cathéters veineux centraux (revue bibliographique)
Mccann M; Moore ZEH. Interventions for preventing infectious complications in haemodialysis patients with
central venous catheters (review). Cochrane database of systematic reviews 2010; (1): 1-74.
Mots-clés : PREVENTION; COMPLICATION; HEMODIALYSE; CATHETER VEINEUX CENTRAL;
BIBLIOGRAPHIE; ANTIBIOTIQUE; ANTISEPTIQUE; PANSEMENT; BACTERIEMIE; MUPIROCINE;
POLYVIDONE IODEE; INCIDENCE
Background: Central venous catheters (CVC) continue to play a prominent role in haemodialysis vascular
access with 46% to 70% of patients commencing haemodialysis via a CVC. CVC access is associated with
catheter-related infections, increased patient hospitalisations and death due to infection. A variety of
interventions are used to prevent CVC infection.
Objectives: To evaluate the benefits and harms of prophylactic topical antimicrobials, topical antiseptics,
medicated and non-medicated dressings on infectious complications among haemodialysis patients with
CVC. Search strategy: We searched the Cochrane Renal Group's specialised register, the Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles without
language restriction.
Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs investigating any
intervention that prevented infectious complications among haemodialysis patients with CVC. We excluded
antimicrobial impregnated CVC or CVC using locking solutions with antimicrobial properties.
Data collection and analysis: Two authors assessed study quality and extracted data. Dichotomous
outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI) and continuous outcomes
as mean differences (MD).
Main results: Ten studies (786 patients) were included. Mupirocin ointment reduced the risk of catheterrelated bacteraemia (RR 0.17, 95%CI 0.07 to 0.43) and had a significant effect on catheter-related infections
caused by S. aureus. The risk of catheter-related bacteraemia was reduced by polysporin (RR 0.40, 95%CI
0.19 to 0.86) and povidone-iodine ointment (RR 0.10, 95%CI 0.01 to 0.72). Subgroup analysis suggested
mupirocin (RR 0.12, 95%CI 0.01 to 2.13) and povidone-iodine ointment (RR 0.84, 95%CI 0.24 to 2.98) had
no effect on all-cause mortality while polysporin ointment showed a significant reduction (RR 0.22, 95%CI
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
août 2010
0.07 to 0.74). Mortality related to infection was not reduced by mupirocin, polysporin or povidone-iodine
ointment. Topical honey did not reduce the risk of exit site infection (RR 0.45, 95%CI 0.10 to 2.11) or
catheter-related bacteraemia (RR 0.80, 95%CI 0.37 to 1.73). Transparent polyurethane dressing compared
to dry gauze dressing did not reduce the risk of CVC or exit site infection, or catheter-related bacteraemia.
Authors' conclusions: Mupirocin ointment appears effective in reducing the risk of catheter-related
bacteraemia. Insufficient reporting on mupirocin resistance was noted and needs to be considered in future
studies. A lack of high quality data on the routine use of povidone-iodine ointment, polysporin ointment and
topical honey warrant larger RCTs. Insufficient data were available to determine which dressing type
(transparent polyurethane or dry gauze dressing) has the lowest risk of catheter-related infections.
NosoBase n° 27732
Epidémiologie, surveillance et prévention des infections par les virus de l'hépatite C chez des
patients hémodialysés
Patel PR; Thompson ND; Kallen AJ; Arduino MJ. Epidemiology, surveillance, and prevention of hepatitis C
virus infections in hemodialysis patients. American journal of kidney diseases 2010; in press: 8 pages.
Mots-clés : EPIDEMIOLOGIE; SURVEILLANCE; PREVENTION; HEPATITE C; HEMODIALYSE; VIRUS;
TRANSMISSION; PRATIQUE; OBSERVANCE; RECOMMANDATION; HYGIENE DES MAINS;
CONTAMINATION; PRECAUTION STANDARD; BIBLIOGRAPHIE
Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; the
prevalence in maintenance hemodialysis patients substantially exceeds that in the general population. In
hemodialysis patients, HCV infection has been associated with increased occurrence of cirrhosis and
hepatocellular carcinoma and increased mortality. Injection drug use and receipt of blood transfusions
before 1992 has accounted for most prevalent HCV infections in the United States. However, HCV
transmission among patients undergoing hemodialysis has been documented frequently. Outbreak
investigations have implicated lapses in infection control practices as the cause of HCV infections.
Preventing these infections is an emerging priority for renal care providers, public health agencies, and
regulators. Adherence to recommended infection control practices is effective in preventing HCV
transmission in hemodialysis facilities. In addition, adoption of routine screening to facilitate the detection of
incident HCV infections and hemodialysis-related transmission is an essential component of patient safety
and infection prevention efforts. This article describes the current epidemiology of HCV infection in US
maintenance hemodialysis patients and prevention practices to decrease its incidence and transmission.
Hygiène des mains
NosoBase n° 27474
Hygiène des mains dans des établissements de soins de longue durée : une étude multicentrique
sur les connaissances, les attitudes, les pratiques et les obstacles
Ashraf MS; Hussain SW; Agarwal N; Ashraf S; El-Kass G; Hussain R; et al. Hand hygiene in long-term care
facilities: a multicenter study of knowledge, attitudes, practices, and barriers. Infection control and hospital
epidemiology 2010/07; 31(7): 758-762.
Mots-clés : HYGIENE DES MAINS; ATTITUDE; CONNAISSANCE; PRATIQUE; RECOMMANDATION;
OBSERVANCE; SOIN DE LONGUE DUREE; PERSONNEL
An anonymous survey of 1143 employees in 17 nursing facilities assessed knowledge of, attitudes about,
self-perceived compliance with, and barriers to implementing the 2002 Centers for Disease Control and
Prevention hand hygiene guidelines. Overall, employees reported positive attitudes toward the guidelines
but differed with regard to knowledge, compliance, and perceived barriers. These findings provide guidance
for practice improvement programs in long-term care settings.
NosoBase n° 27873
Désinfection systématique des mains des patients : impact sur les taux d'infection à Staphylococcus
aureus méticillino-résistant dans un centre hospitalier général
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Gagne D; Bedard G; Maziade PJ. Systematic patients' hand disinfection: impact on meticillin-resistant
Staphylococcus aureus infection rates in a community hospital. The Journal of hospital infection 2010/08;
75(4): 269-272.
Mots-clés : USAGER; HYGIENE DES MAINS; OBSERVANCE; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; TAUX; TRANSMISSION; GEL HYDROALCOOLIQUE; PRODUIT DE
FRICTION POUR LES MAINS; PERSONNEL; COUT-BENEFICE; AUDIT; COLONISATION NASALE;
CENTRE HOSPITALIER GENERAL
The role of patients and their relatives as unidentified transient meticillin-resistant Staphylococcus aureus
(MRSA) carriers and sources of dissemination in healthcare institutions has not been systematically
addressed. Patients' and their relatives' hands may represent a substantial and 'unaccounted for' mode of
transmission. This study aimed to verify this hypothesis in our 250-bed community hospital. The trial
consisted of a systematic waterless washing and gel rinse disinfection of all patients' and visiting relatives'
hands for a period of one year, along with retrospective comparison of the nosocomial infection rates. Under
the supervision of infection control personnel, a team of four full-time and four part-time attendants was
trained to meet all patients and visiting relatives and encourage them to clean their hands with an alcohol gel
rinse twice a day on every weekday. Rates of MRSA infections per thousand admissions, cost-benefit
analysis and staff hand hygiene compliance were audited throughout. From the comparative year, the rate of
MRSA nosocomial infections per thousand admissions decreased by 51%. Assuming that the incidence of
MRSA was maintained from comparative to study year, the intervention may have prevented 51 cases of
MRSA infection and resulted in substantial savings. While focusing extensively on staff behaviour to prevent
MRSA transmission, we may have overlooked hand hygiene practices by patients and their relatives as a
potential mode of transmission. Systematic hand hygiene of patients and relatives appears to be an
inexpensive and highly effective preventive measure against MRSA nosocomial transmission.
Klebsiella pneumoniae
NosoBase n° 27860
Etude cas-témoin des risques d'acquisition urinaire de Klebsiella pneumoniae productrices de CTXM-15 en situation d'épidémie en Suède
Lytsy B; Lindback J; Torell E; Sylvan S; Velicko I; Melhus A. A case-control study of risk factors for urinary
acquisition of Klebsiella pneumoniae producing CTX-M-15 in an outbreak situation in Sweden. Scandinavian
journal of infectious diseases 2010; 42(6-7): 439-444.
Mots-clés : CAS TEMOIN; FACTEUR DE RISQUE; INFECTION URINAIRE; KLEBSIELLA PNEUMONIAE;
EPIDEMIE; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; APPARIEMENT;
DUREE DE SEJOUR; ALIMENTATION; SONDAGE GASTRIQUE; DIARRHEE; ANTIBIOTIQUE;
PERSONNE AGEE; BETA-LACTAMASE A SPECTRE ELARGI; ANTIBIORESISTANCE; PCR;
ESCHERICHIA COLI
A retrospective case-control study was initiated at Uppsala University Hospital in 2006 during a major
outbreak caused by a Klebsiella pneumoniae strain producing CTX-M-15. To identify risk factors associated
with acquisition of the outbreak strain in the urinary tract, 52 case patients with a urine culture positive for
the outbreak strain between 1 May and 31 December 2005 were enrolled. Case patients were matched 1:2
with concurrently hospitalized control patients with significant growth of susceptible Escherichia coli in a
urine sample. Conditional logistic regression analyses identified hospital stay >or=9 days (odds ratio (OR)
18.8, 95% confidence interval (CI) 5.74-61.2), nasogastric feeding tube (OR 18.0, 95% CI 2.28-142) and
diarrhoea (OR 9.62, 95% CI 3.30-28.1) as risk factors with high ORs. The odds of previous use of
cephalosporins were 7.58 (95% CI 3.13-18.4) times higher in case patients compared with the controls.
Several multivariable models were evaluated to reduce bias from confounding. These models identified
prolonged period of hospitalization, diarrhoea, malignancy and antibiotic use as the most important risk
factors for acquisition of the outbreak strain, factors that are often found in elderly patients with a poor
functional status.
Maladie de Creutzfeldt-Jakob
NosoBase n° 27941
Conclusions de l'étude relative au "protocole standard prion"
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Agence française de sécurité sanitaire des produits de santé. AFSSAPS 2010/07/06; 1-21.
Mots-clés : PROTOCOLE; AGENT TRANSMISSIBLE
CONTAMINATION; DESINFECTION; STERILISATION
NON
CONVENTIONNEL;
EVALUATION;
Le Protocole Standard Prion est un protocole opératoire devant permettre aux fabricants d’évaluer les
performances de produits ou procédés revendiquant une élimination ou une inactivation des agents
transmissibles non conventionnels (ATNC) présents sur les dispositifs médicaux réutilisables après la
dispensation des soins.
NosoBase n° 27882
Risque actuel de maladie de Creutzfeldt-Jakob iatrogène au Royaume-Uni : efficacité des produits
chimiques disponibles et réutilisations des instruments de neurochirurgie
Herve R; Secker TJ; Keevil CW. Current risk of iatrogenic Creutzfeldt-Jakob disease in the UK: efficacy of
available cleaning chemistries and reusability of neurosurgical instruments. The Journal of hospital infection
2010/08; 75(4): 309-313.
Mots-clés : MALADIE DE CREUTZFELDT-JAKOB; RISQUE; NEUROCHIRURGIE;
REUTILISABLE; STERILISATION; SURFACE; CONTAMINATION
INSTRUMENT;
The initial cleaning of reusable surgical devices is critical to ensure the efficacy of the subsequent
sterilisation process. Transmissible spongiform encephalopathies (TSEs) are incurable and fatal
neurodegenerative diseases apparently transmitted simply by the absorption or ingestion of self-aggregating
protease-resistant prions (PrP(Sc)), which are very resilient to most standard cleaning chemistries and heatbased decontamination techniques. Therefore there is a risk of iatrogenic transmission from reusable
surgical devices if these are allowed to retain potentially infectious material after standard reprocessing
through sterile service departments (SSDs). We aimed to assess the current state of surgical instrument
decontamination with the collaboration of anonymous SSDs. Surgical stainless steel surfaces were spiked
with prion-infected brain homogenates, and episcopic differential interference contrast/epifluorescence
(EDIC/EF) microscopy was applied to quantify the amount of residual prion amyloid and other proteins
remaining after decontamination with enzymatic cleaners currently employed by SSDs. Reusable
instruments deemed 'clean and ready to use' were also stained for comparison with our findings in the
laboratory. All cleaning chemistries were only partially effective under the recommended conditions. More
importantly, PrP(Sc) constituted the main fraction of the remaining contamination left on these surfaces. The
neurosurgery instruments also harboured amyloid and general protein contamination. This study shows that
currently marketed cleaning chemistries and recent decontamination protocols do not completely suppress
the threat from iatrogenic CJD. These findings should be taken into account for risk assessment purposes
and re-evaluating instrument handling and decontamination practices.
Pédiatrie
NosoBase n° 27946
Infections chez des patients de pédiatrie bénéficiaires de transplantation : pas seulement de petits
adultes
Michaels MG; Green M. Infections in pediatric transplant recipients: not just small adults. Infectious disease
clinics of North America 2010/06; 24(2): 307-318.
Mots-clés : PEDIATRIE; TRANSPLANTATION; DEFICIT IMMUNITAIRE; VIRUS; CYTOMEGALOVIRUS;
VACCIN; FACTEUR DE RISQUE; PREVENTION; BIBLIOGRAPHIE
Transplantation increasingly is being used as treatment for children with end-stage organ diseases,
hematopoietic rescue from therapy used to treat malignancies, and as cure for primary immune deficiencies.
This article reviews some of the major concepts regarding infections that complicate pediatric
transplantation, highlighting differences in epidemiology, evaluation, treatment and prevention for children
compared with adult recipients.
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NosoBase n° 27755
Prévalence plus élevée de la colonisation pharyngée que de la colonisation nasale à Staphylococcus
aureus dans des unités de soins intensifs en pédiatrie
Nakamura MM; Mcadam AJ; Sandora TJ; Moreira KR; LeeGM. Higher prevalence of pharyngeal than nasal
Staphylococcus aureus carriage in pediatric intensive care units. Journal of clinical microbiology 2010; in
press: 14 pages.
Mots-clés : PREVALENCE; STAPHYLOCOCCUS AUREUS; SOIN INTENSIF;
COLONISATION NASALE; PEDIATRIE; PREVALENCE; DEPISTAGE; SENSIBILITE
COLONISATION;
Sensitive detection of Staphylococcus aureus colonization is important for epidemiologic studies, infection
control, and decolonization measures. We examined the sensitivity of nasal and pharyngeal sampling for S.
aureus colonization in 331 children admitted to intensive care units. Pharyngeal screening was more
sensitive than nasal screening (92.6% versus 63.1%, p<0.0001).
NosoBase n° 27902
Prévention des infections associées aux soins en pédiatrie : nouvelles stratégies et succès
Sandora TJ. Prevention of healthcare-associated infections in children: new strategies and success stories.
Current opinion in infectious diseases 2010/08; 23(4): 300-305.
Mots-clés : PREVENTION; PEDIATRIE; CONTROLE; BACTERIEMIE; CATHETER VEINEUX CENTRAL;
NEONATALOGIE; SOIN INTENSIF; PNEUMONIE; VENTILATION ASSISTEE; SITE OPERATOIRE;
MULTIRESISTANCE; BIBLIOGRAPHIE; ANTISEPTIQUE
Purpose of review: Attention to patient safety has made hospital infection prevention and control strategies a
subject of increasing focus from healthcare personnel, patients and families, accrediting organizations, and
government. This review highlights recent literature and new successes in the prevention of healthcareassociated infections in children.
Recent findings: Emerging evidence about risk factors for various healthcare-associated infections in
children will help target available adjunctive preventive interventions. Multicenter pediatric collaborative
efforts to emphasize best practices have resulted in decreases in infection rates, particularly for central lineassociated bloodstream infections. A low prevalence of colonization or infection with multidrug-resistant
organisms in hospitalized children, combined with a lack of compelling evidence of effectiveness for active
surveillance and decolonization, have made decisions about routine screening challenging.
Summary: A renewed interest in infection prevention by multiple stakeholders has energized our field and
contributed to impressive successes in reducing rates of healthcare-associated infections. Nevertheless,
important knowledge gaps remain and an emphasis on funding of high-quality, rigorous studies to answer
unresolved questions will be critical to our efforts to further prevent infections for hospitalized children.
Personne âgée / EHPAD
NosoBase n° 27473
Epidémie d'infections à Adénovirus de type 4 dans un établissement de soins de longue durée pour
personnes âgées
Kandel R; Srinivasan A; D'Agata EM; Lu X; Erdman D; Jhung M. Outbreak of Adenovirus type 4 infection in
a long-term care facility for the elderly. Infection control and hospital epidemiology 2010/07; 31(7): 755-757.
Mots-clés: ADENOVIRUS; EPIDEMIE; GERIATRIE; SOIN DE LONGUE DUREE; MORTALITE;
DIAGNOSTIC; ANTIGENE; PCR
An outbreak of acute respiratory disease due to human adenovirus and a resulting increase in mortality
occurred in a long-term care facility for the elderly. By use of viral culture and polymerase chain reaction, not
a rapid antigen test, the virus was detected. Human adenovirus infection can occur in elderly individuals, but
detection by rapid antigen testing may be limited.
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NosoBase n° 27879
Coûts directs associés à une épidémie nosocomiale de gastroentérites à rotavirus dans un
établissement de soins de longue durée
Piednoir E; Borderan GC; Borgey F; Thibon P; Lesellier P; Leservoisier R; et al. Direct costs associated with
a hospital-acquired outbreak of rotaviral gastroenteritis infection in a long term care institution. The Journal
of hospital infection 2010/08; 75(4): 295-298.
Mots-clés : GASTRO-ENTERITE; COUT; EPIDEMIE; ROTAVIRUS; SOIN DE LONGUE DUREE;
PERSONNE AGEE; GERIATRIE; PERSONNEL; TRAITEMENT
In January 2008, 63 patients were infected during an outbreak of rotaviral gastroenteritis in a long term care
facility for elderly patients. The aim of this study was to evaluate the direct financial costs of this outbreak to
the hospital. Data on costs were gathered from both medical records and the hospital finance department.
The total hospital cost of the outbreak was euro17,959, or euro285.1 per case, comprising: euro4,948 for
medical investigation and treatment costs, euro4,400 for isolation, euro1,879 for infection control staff,
euro4,170 for other staff and euro2,562 for bed-day loss. The cost of this outbreak emphasises the
importance of the early recognition of an outbreak and implementation of infection control measures.
Personnel
NosoBase n° 27841
Le port des gants en milieu hospitalier
Blanco P; Joutard T. Objectif soins 2010/07; (187): 18-21.
Mots-clés : GANT; PERSONNEL; ETUDIANT; EXPOSITION AU SANG; ATTITUDE; PREVENTION
Evoquer le port des gants à l'hôpital, c'est tout d'abord évoquer l'hygiène. Mais vouloir diffuser et mettre en
oeuvre les bonnes pratiques en termes d'hygiène hospitalière amène en général à se heurter à deux
grandes familles de difficultés.
NosoBase n° 27381
Impact des désordres mentaux courants sur le fonctionnement au travail des infirmiers et
personnels associés : revue systématique
Gartner FR; Nieuwenhuijsen K; Van Dijk F; Sluiter JK. The impact of common mental disorders on the work
functioning of nurses and allied health professionals: a systematic review. International journal of nursing
studies 2010/08; 47(8): 1047-1061.
Mots-clés : PERSONNEL; INFIRMIER; BIBLIOGRAPHIE; MEDECINE PREVENTIVE; ATTITUDE;
SECURITE; QUALITE; EXPOSITION AU SANG
Objective: This study aims to inventory aspects of work functioning of nurses and allied health professionals
that are affected by common mental disorders.
Design: A systematic review of psychological and occupational health literature was performed.
Data sources: A sensitive systematic literature search based on index terms and text words was conducted
in four electronic databases: PubMed, PsycINFO, Embase, and Cinahl. The literature search was limited to
journal articles published between 1998 and 2008, written in English, German, or Dutch.
Review methods: For inclusion, studies had to examine a relationship between common mental disorders
and a measure of work functioning in nurses or allied health professionals. No restrictions on study design
were handled. Methodological quality was assessed for each study. The data were categorized into themes,
for which the strength of evidence was assessed using six levels of evidence.
Results: Sixteen of 2792 studies met the inclusion criteria, of which 13 had a cross-sectional design, 1 was a
vignette study, and 2 were narrative reviews. In all studies, the subjects were nurses. The retrieved aspects
of sub-optimal work functioning due to common mental disorders were merged into 15 themes. Strong
evidence was found for five themes: general errors, medication errors, near misses, patient safety, and
patient satisfaction. Moderate evidence was found that common mental disorders are associated with
complex motor skills and with general performance; while evidence for an association between common
mental disorders and needle stick injuries was inconclusive. Seven themes had only narrative evidence:
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interpersonal behaviour, energy, focus on goals and responsibility, work speed, avoiding work while on the
job, coping with emotions, and motivation.
Conclusion: Common mental disorders were found to be associated with various impairments in work
functioning in nurses, these include task-related, intrapersonal and interpersonal aspects of work. In
particular, strong evidence was found for an association between common mental disorders and general
errors, medication errors, near errors, patient safety, and patient satisfaction. These results provide input for
preventive actions to improve both health and work functioning in health care workers.
NosoBase n° 27847
Le sondage urinaire dans la formation des infirmiers en Grèce : audit des savoir-faire enseignés
Theofanidis D; Fountouki A. Bladder catheterization in Greek nursing education: an audit of the skills taught.
Nurse education today 2010; in press: 6 pages.
Mots-clés : CATHETER; AUDIT; PRATIQUE; SONDAGE URINAIRE; SEXE; INFIRMIER; FORMATION;
RECOMMANDATION; PREVENTION; INFECTION URINAIRE
Introduction: The auditing of nurse teaching is in its infancy in Greece. One area urgently in need of audit is
the teaching of male catheterization. AIMS: To assess the current educational model regarding male bladder
catheterization at a sole tertiary education nursing establishment in a major Greek city and to improve nurse
undergraduate training by implementing appropriate recommendations for change to the current educational
module and support these changes in the long term.
Methods: A systematic search of international databases for guidelines or best practice regarding bladder
catheterization was conducted. Audit measures included direct observation of the teaching process and
compilation of a checklist.
Results: The shortcomings are discussed under the following headings: patient pre-preparation, choice and
quality of materials used, appropriate aseptic techniques, catheter withdrawal, connecting and handling the
drainage bag, diminishing risk of Catheter Associated Urinary Track Infections (CAUTIs), no problem solving
trouble-shooting training, textbook and educational resources, lack of national guidelines, setting of the
educational experience.
Conclusions: The main problem with the teaching process exposed by the audit is entrenched use of an
outmoded textbook with little effort to enrich teaching with current evidence base practices.
NosoBase n° 27357
Communication sur les recommandations concernant la lutte contre le risque infectieux de l'expert
vers l'utilisateur
Verhoeven F; Steehouder MF; Hendrix R; Van Gemert-Pijnen j. From expert-driven to user-oritented
communication of infection control guidelines. International journal of human-computer studies 2010/06;
68(6): 328-343.
Mots-clés : RECOMMANDATION; INTERNET; INFORMATION; PERSONNEL; FORMATION; EFFICACITE;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE
Currently, infection control guidelines in hospitals and other healthcare institutions are more expert-driven
than user-oriented. In order to enhance the usability of the expert-driven guideline format, we developed a
website for the communication of existing guidelines that better fit the practical information needs of health
care workers (HCWs). We employed a user-centered design process that involved two studies. In the initial
study, 28 HCWs were asked to solve tasks using existing, paper-based infection control guidelines. In order
to detect their strategies and problems, the participants were asked to think aloud. Usability problems
occurred due to poorly structured information, insufficient quality of information, and a mismatch between
experts. and HCWs. vocabulary. To overcome these shortcomings, three design principles were applied for
communicating infection control guidelines: better navigation (the guidelines should be searchable in several
ways); multimodality (the guidelines should not be presented as text only), and action-orientation (the
guidelines should be presented as HCWs. behaviors). A website was developed to meet these principles. In
the second study, the same 28 HCWs completed tasks identical to those of the first study while thinking
aloud, but this time using the website.The percentage of correctly completed tasks increased and the mean
time for task completion decreased significantly. Also, respondents were more satisfied with the website
than the paper-based guidelines.The number of problems due to poor information quality and a mismatch in
vocabulary declined, although the number of structural problems increased.This can probably be explained
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by the fact that the navigation structure was user-generated (using Card Sort), in contrast to a standardized
answer format based on common usability principles.
Overall, we found that involving HCWs in the development process is important to create a sense of
ownership and to foster the implementation of the guidelines, which might eventually result in compliance
and reduce health care-associated infections.This paper outlines concrete steps for how to involve HCWs in
the design process.
Psychiatrie
NosoBase n° 27894
L'hygiène des mains semble être insuffisante pour la prévention de la transmission de SARM dans
un service de psychiatrie clos
Ebner W; Schlachetzki J; Schneider C; dettenkofer M; Langosch JM. Hand hygiene seems to be sufficient
for prevention of MRSA transmission on a closed psychiatric ward. The Journal of hospital infection
2010/08; 75(4): 334-335.
Mots-clés : HYGIENE DES MAINS; PREVENTION; TRANSMISSION; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; PSYCHIATRIE; MUPIROCINE; COLONISATION
NosoBase n° 28086
Rôle des désordres mentaux dans la survenue d'infections nosocomiales après traitement pour
fracture de hanche
Guerado E; Cano JR; Cruz E; Benitez-Parejo N; Perea-Milla E. Role of mental disorders in nosocomial
infections after hip fracture treatment. Interdisciplinary perspectives on infectious diseases 2010; 1-6.
Mots-clés : COMPLICATION; CHIRURGIE ORTHOPEDIQUE; ANALYSE MULTIVARIEE; RISQUE; AGE;
COHORTE; PSYCHIATRIE; SITE OPERATOIRE; PNEUMONIE; INFECTION URINAIRE
The association between mental disorders (MDs) and iatrogenic complications after hip fracture surgery has
been poorly studied. Among iatrogenic complications, nosocomial infections (NIs) are a major factor in hip
fracture surgery. The aim of this paper was to determine whether patients with a MD and a hip fracture
develop more NIs after hip surgery than patients with no MD. We studied 912 patients who underwent
surgery for a hip fracture (223 patients with a MD who underwent surgery for a hip fracture and 689 control
patients without a MD who also underwent surgery for a hip fracture) and followed them after surgery.
Univariable and multivariable analyses were performed using simple and multiple logistic regression
analysis (confidence interval, crude and adjusted odds ratios, and P value). We found that MDs, gender, and
comorbidities were not associated with a higher risk of developing a NI after surgery for a hip fracture.
Réanimation / Soins intensifs
NosoBase n° 28080
Impact des infections nosocomiales sur l'évolution clinique et la consommation des ressources
pour des patients en réanimation
Burgmann H; Hiesmayr JM; Savey A; Bauer P; Metnitz B; Metnitz P. Impact of nosocomial infections on
clinical outcome and resource consumption in critically ill patients. Intensive care medicine 2010/07; 5
pages.
Mots-clés : COUT; SOIN INTENSIF; MORTALITE; COHORTE; PNEUMONIE; CATHETER VEINEUX
CENTRAL; DUREE DE SEJOUR; INCIDENCE; TAUX; RISQUE; DISPOSITIF MEDICAL
Objective: Nosocomial infections still present a major problem in intensive care units (ICUs), accounting for
prolonged ICU and hospital stays and worsened outcomes. There exist differences in the literature regarding
the impact of nosocomial infections on attributable mortality and resource consumption. The aim of this
study was to observe these effects in a large cohort of critically ill patients.
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Patients and settings: Thirty-four Austrian ICUs participated in the study by documenting all nosocomial
infections from 1 June to 30 November 2003 according to the Hospital in Europe Link for Infection Control
through Surveillance (HELICS) protocol.
Measurements and results: Of 2,392 patients with a length-of-stay (LOS) >2 days, 683 (28.6%) developed at
least one nosocomial infection. The most common infection was pneumonia (n = 456), followed by central
venous catheter (CVC) infections (n = 101). Risk-adjusted mortality rates (standardized mortality ratios)
were significantly increased for infected patients [0.91 (0.83-0.99) vs. 0.68 (0.61-0.74)]. Significant
attributable risk-adjusted mortality was found for patients with pneumonia, combined infections (both 32%)
and CVC-related infections (26%). LOS in the ICU increased significantly for all infections.
Conclusions: We conclude that significant attributable mortality for several nosocomial infections exists in a
large cohort of critically ill patients, with the highest impact occurring in those with microbiologically
diagnosed pneumonia and combined infections. All infections were associated with an increased resource
consumption. Effective infection control measures could improve both clinical outcome and proper and
effective use of ICU resources.
NosoBase n° 27795
Impact de l'hygiène buccale et d'un gel local de chlorhexidine à 0,2 % sur la prévalence des
infections nosocomiales chez des patients de réanimation chirurgicale : étude randomisée contrôlée
contre placebo
Cabov T; Macan D; Husedzinovic I; Skrlin-Subic J; Bosnjak D; Sestan-Crnek S; et al. The impact of oral
health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care
patients: a randomized placebo-controlled study. Wiener klinische wochenschrift 2010; 1-8.
Mots-clés : CHLORHEXIDINE; SOIN DE BOUCHE; PREVALENCE; CHIRURGIE; SOIN INTENSIF;
RANDOMISATION; CENTRE HOSPITALIER UNIVERSITAIRE; COLONISATION; MORTALITE
Objectives: To evaluate the impact of oral health on the evolution of nosocomial infections and to document
the effects of oral antiseptic decontamination on oral health and on the rate of nosocomial infections in
patients in a surgical intensive-care unit (ICU).
Design: A prospective, randomized, double-blind, placebo-controlled clinical trial.
Setting: Surgical ICU in University Hospital Dubrava.
Patients: The study included 60 nonedentulous patients consecutively admitted to the surgical ICU and
requiring a minimum stay of three days.
Main outcome measures: After randomization, the treatment group underwent antiseptic decontamination of
dental plaque and the oral mucosa with chlorhexidine gel. The control group was treated with placebo gel.
Dental status was assessed using a caries-absent-occluded (CAO) score, and the amount of plaque was
assessed using a semi-quantitative score. Samples of dental plaque, oral mucosa and nasal and tracheal
aspirates were collected for bacterial culture, and nosocomial infections were assessed.
Results: The plaque score significantly increased in the control group and decreased in the treated patients.
Patients who developed a nosocomial infection had higher plaque scores on admission and during their ICU
stay. The control group showed increased colonization by aerobic pathogens throughout their ICU stay and
developed nosocomial infections (26.7%) significantly more often than the treated patients (6.7%); the
control group also stayed longer in the ICU (5.1 +/- 1.6 vs. 6.8 +/- 3.5 days, P = 0.019). Furthermore, a trend
in reduction of mortality was noted in the treated group (3.3% vs. 10%).
Conclusions: Among surgical ICU patients, poor oral health had a significant positive correlation with
bacterial colonization and the evolution of nosocomial infections. Oral decontamination with chlorhexidine
significantly decreased oropharyngeal colonization, the incidence of nosocomial infections, length of ICU
stay, and mortality in these patients.
NosoBase n° 27793
Usage des antibiotiques et impact sur l'évolution des bactériémies sévères : étude des bactériémies
en soin intensif (BASIC)
Corona A; Bertolini G; Lipman J; Wilson AP; Singer M. Antibiotic use and impact on outcome from
bacteraemic critical illness: the bacteraemia study in intensive care (BASIC). The Journal of antimicrobial
chemotherapy 2010/06; 65(6): 1276-1285.
Mots-clés : ANTIBIOTIQUE; SOIN
FONGEMIE; ETUDE PROSPECTIVE
CCLIN Sud-Est – [email protected]
INTENSIF;
BACTERIEMIE;
EPIDEMIOLOGIE;
MYCOLOGIE;
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Background: The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in
bacteraemic critically ill patients has led to a wide variety of strategies and major issues with drug
resistance. We therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in
intensive care units (ICUs); and the impact of timing, type and appropriateness of antibiotic intervention.
Methods: We conducted a multinational, multicentre, prospective observational study in 132 ICUs from 26
countries with no interventions.
Results: 1702 patients [European (69.6%), Australasian (12.2%), South American (8.3%) and Asian (9.9%)]
developed 1942 bacteraemic episodes over the study period. Mortality rates were similar for those receiving
empirical (40.5%), semi-targeted (37.6%) or fully targeted (33.3%) antibiotic therapy (P=0.40), and in those
initially receiving broad- (39.3%) or restricted-spectrum (39.1%) therapy (P=0.94). First-line therapy was
effective in terms of the antibiogram (where available) in 70.4% of cases. This in vitro susceptibility ranged
from 76.3% for broad-spectrum antibiotics to 46.3% for restricted-spectrum antibiotics (P<0.0001). However,
no antibiotic policy-associated variable, including in vitro susceptibility (odds ratio 0.89, 95% confidence
interval 0.61-1.30), was a statistically significant predictor of mortality.
Conclusions: We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro
activity and early commencement. Randomized, multicentre trials are urgently needed to establish the
appropriate duration, timing and combinations of antibiotics that will both optimally treat infection and
minimize development of resistance and other complications.
NosoBase n° 27756
Epidémie d'infections à Pseudomonas aeruginosa dans une unité de réanimation néonatale liée à
des bouteilles d'eau minérale : typage rapide à l'aide de l'analyse de la dénaturation en haute
résolution (HRM) et VNTR.
Naze F; Jouen E; Randriamahazo RT; Simac C; Laurent P; Bleriot A; et al. A Pseudomonas aeruginosa
outbreak in a neonatal intensive care unit linked to mineral water bottles: fast typing using high resolution
melting analysis of a variable number of tandem repeats locus. Journal of clinical microbiology 2010; in
press: 22 pages.
Mots-clés : PSEUDOMONAS AERUGINOSA; SOIN INTENSIF; NEONATALOGIE; EPIDEMIE; EAU
EMBOUTEILLEE; BIOLOGIE MOLECULAIRE; PFGE; PCR
Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen that causes nosocomial infections in
intensive care units. Determining a system of typing that is discriminatory is essential for epidemiological
surveillance of P. aeruginosa. We developed a method for the typing of Pseudomonas aeruginosa, multiplelocus variable number of tandem repeat (VNTR) with high resolution melting analysis (HRMA). The
technology was used to genotype a collection of forty three environmental and clinical strains isolated during
an outbreak in a neonatal intensive care unit (NICU) that we report. Nineteen strains isolated in other
departments or outside the hospital were tested. The genetic diversity of this collection was determined
using VNTR-HRMA and Amplified Fragment Length Polymorphism (AFLP) as a reference. Twenty five and
28 genotypes were identified respectively and both techniques produced congruent data. VNTR-HRMA
established clonal relationships between the strains of P. aeruginosa isolated during the outbreak in the
NICU and proved the role of mineral water as the inoculum source for the first time. VNTR typing with one
primer pair associated with HRMA is highly reproducible and discriminative, easily portable among
laboratories, fast, inexpensive and demonstrated an excellent typeability in this study. VNTR-HRMA
represents a promising tool for the molecular surveillance of P. aeruginosa and perhaps for molecular
epidemiology analysis of other hospital infections.
Staphylococcus aureus
NosoBase n° 28065
Résistance de Staphylococcus aureus méticillino-résistant à des antibiotiques autres que les bêtalactamines aux Etats-Unis de 1996 à 2008
Bordon J; Master RN; Clark RB; Duvvuri P; Karlowsky JA; Ayesu K; et al. Methicillin-resistant
Staphylococcus aureus resistance to non-beta-lactam antimicrobials in the United States from 1996 to 2008.
Diagnostic microbiology and infectious disease 2010/08; 67(4): 395-398.
Mots-clés : METICILLINO-RESISTANCE; STAPHYLOCOCCUS AUREUS; TAUX; ANTIBIOTIQUE;
CCLIN Sud-Est – [email protected]
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ANTIBIORESISTANCE; RESEAU; AGE; SURVEILLANCE
We report the resistance rates of Staphylococcus aureus to non-beta-lactam antimicrobials from The
Surveillance Network Database-USA (Eurofins-Medinet, Chantilly, VA). Specimens studied were from lower
respiratory tract, wounds, and blood. Patients were stratified by age group and patient setting. There were
2,053,219 isolates of S. aureus and 973,116 of methicillin-resistant S. aureus (MRSA). The MRSA rate
increased until 2004 and then leveled off. MRSA showed decreasing resistance to tetracycline and
trimethoprim-sulfamethoxazole (TMP-SMX). By age group, the greatest MRSA rate increase was for
individuals 17 years and younger. Non-beta-lactam antimicrobials and particularly TMP-SMX should be
considered therapeutic options for staphylococcal infections.
NosoBase n° 27995
Activité de la telavancine et d'antibiotiques de comparaison testés contre Staphylococcus spp.
isolés chez des patients hospitalisés en Europe (2007-2008)
Mendes RE; Sader HS; Jones RN. Activity of telavancin and comparator antimicrobial agents tested against
Staphylococcus spp. isolated from hospitalised patients in Europe (2007-2008). International journal of
antimicrobial agents 2010; in press: 6 pages.
Mots-clés : STAPHYLOCOCCUS; EUROPE; ANTIBIOTIQUE; SURVEILLANCE; ANTIBIORESISTANCE;
CMI;
VANCOMYCINE;
LINEZOLIDE;
DAPTOMYCINE;
DALFOPRISTINE
QUINUPRISTINE;
GLYCOPEPTIDE
The activity of telavancin was evaluated against Staphylococcus spp. collected from European hospitals as
part of an international surveillance study (2007-2008). A total of 7534 staphylococcal clinical isolates [5726
Staphylococcus aureus and 1808 coagulase-negative staphylococci (CoNS)] were included. Isolates were
tested for susceptibility according to reference methods and minimum inhibitory concentration (MIC) values
were interpreted based on Clinical and Laboratory Standards Institute (CLSI) 2010 and European
Committee on Antimicrobial Susceptibility Testing (EUCAST) 2009 criteria. Telavancin breakpoints approved
by the US Food and Drug Administration (FDA) were applied. Telavancin activity was evaluated against
meticillin-resistant S. aureus (MRSA) displaying several antibiogram resistance patterns, including
multidrug-resistant isolates. Telavancin was active against S. aureus [MIC(50/90) values (MICs for 50% and
90%
of
the
isolates,
respectively)=0.12/0.25mg/L;
100.0%
susceptible]
and
CoNS
(MIC(50/90)=0.12/0.25mg/L), inhibiting all isolates at </=0.5mg/L. Similar results were observed when S.
aureus were stratified by year or country of origin (MIC(50/90)=0.12/0.25mg/L). When MRSA isolates were
clustered according to 48 different resistance patterns, telavancin showed consistent MIC(90) values
(0.25mg/L) regardless of multidrug resistance. Amongst CoNS, telavancin was slightly more active against
Staphylococcus capitis, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus lugdunensis
and Staphylococcus xylosus (MIC(50)=0.12mg/L) compared with Staphylococcus haemolyticus,
Staphylococcus saprophyticus and Staphylococcus warneri (MIC(50)=0.25mg/L). Overall, telavancin
exhibited MIC(90) results two- to eight-fold lower than comparators (daptomycin, quinupristin/dalfopristin,
vancomycin and linezolid). Based upon MIC(90) values, telavancin demonstrated potent in vitro activity
against a contemporary (2007-2008) collection of Staphylococcus spp. recovered from nearly 30 European
medical centres.
NosoBase n° 27476
Identification et éradication d'une colonisation à Staphylococcus aureus résistant à la méticilline en
réanimation néonatale : résultats d'une enquête nationale
Milstone AML; Song X; Coffin S; Elward A. Identification and eradication of methicillin-resistant
Staphylococcus aureus colonization in the neonatal intensive care unit: results of a national survey. Infection
control and hospital epidemiology 2010/07; 31(7): 766-768.
Mots-clés :
STAPHYLOCOCCUS
COLONISATION
AUREUS;
METICILLINO-RESISTANCE;
SOIN
INTENSIF;
We surveyed members of the Society for Healthcare Epidemiology of America to assess current practice
with regard to identifying and eradicating methicillin-resistant Staphylococcus aureus (MRSA) colonization in
the neonatal intensive care unit (NICU). Although most respondents (86%) screened patients for MRSA
colonization, variation existed in the number of anatomic sites sampled and in the use of culture at NICU
CCLIN Sud-Est – [email protected]
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admission, empirical institution of isolation precautions, and MRSA decolonization therapy. Evidence-based
prevention strategies for MRSA transmission and infection are needed.
NosoBase n° 27871
Transmission nosocomiale et commnautaire de Staphylococcus aureus méticillino-résistant, positif
à la leucocidine de Panton-Valentine d'origine communautaire : implication pour les soins
Orendi JM; Coetzee N; Ellington MJ; Boakes E; Cookson BD; Hardy KJ; et al. Community and nosocomial
transmission
of
Panton-Valentine
leucocidin-positive
community-associated
meticillin-resistant
Staphylococcus aureus: implications for healthcare. The Journal of hospital infection 2010/08; 75(4): 258264.
Mots-clés :
TRANSMISSION;
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
EPIDEMIOLOGIE; PERSONNEL; RISQUE PROFESSIONNEL; CESARIENNE
In the UK, infections due to Panton-Valentine leucocidin-positive community-associated meticillin-resistant
Staphylococcus aureus (PVL-MRSA) have been reported sporadically. In September 2006, a fatal PVLMRSA infection occurred in a Filipino healthcare worker (HCW) after she underwent caesarean section.
Throat and nasal swabs were obtained from contacts of cases in community and hospital. MRSA with an
antibiogram similar to the PVL-MRSA strain were characterised including toxin gene profiling, polymerase
chain reaction- and sequence-based typing. Carriers underwent decolonisation treatment, and HCWs were
restricted from patient care until they and their household members were considered negative for PVLMRSA. The PVL-MRSA belonged to ST30, was protein A gene (spa) type t019, SCCmec IVc, agr 3, and
resistant only to beta-lactam antibiotics. Representatives of the same lineage were identified among a
further 16 individuals in community and hospital. Infections likely to be caused by PVL-MRSA had occurred
in 12 cases, and were likely to be hospital-acquired in two patients (one fatal) and occupationally acquired in
one HCW. Nine cases worked as nursing staff in the hospital. Eight of these had emigrated from the
Philippines in the previous five years and were linked socially. Thus, PVL-MRSA-ST30 was detected in a
HCW community in the UK. This is the first report of nosocomial transmission of this pandemic clone in the
UK associated with a fatality. Increased vigilance in healthcare and community is needed in response to this
emerging threat.
NosoBase n° 27861
Vitamine D et colonisation nasale à Staphylococcus aureus méticillino-résistant
Matheson EM; Mainous III AG; Hueston WJ; Diaz VA; Everett CJ. Vitamin D and methicillin-resistant
Staphylococcus aureus nasal carriage. Scandinavian journal of infectious diseases 2010; 42(6-7): 455-460.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; RISQUE
Studies have found that vitamin D plays an important role in mediating immune function via a number of
pathways, including enhancing the release of antimicrobial peptides in the skin. Given these findings, we
hypothesize that low serum vitamin D levels may increase the risk of nasal carriage of methicillin-resistant
Staphylococcus aureus (MRSA). A secondary data analysis of the National Health and Nutrition
Examination Survey 2001-2004 was performed to investigate the association between serum vitamin D
levels and MRSA nasal carriage for the non-institutionalized population of the USA. An estimated 2.7 million
persons (1.2% of the population) are MRSA nasal carriers. An estimated 63.3 million persons (28.4% of the
population) are vitamin D deficient (serum vitamin D <20 ng/ml). In an adjusted logistic regression analysis
controlling for age, race, gender, poverty income ratio, current health status, hospitalization in the past 12
months, and antibiotic use in the past month, individuals with vitamin D deficiency had a statistically
significant increased risk of MRSA carriage of 2.04 (95% CI 1.09-3.84). Vitamin D deficiency is associated
with an increased risk of MRSA nasal carriage. Further trials may be warranted to determine whether
vitamin D supplementation decreases the risk of MRSA colonization.
Surveillance
NosoBase n° 27903
Surveillance des infections du site opératoire : impact de la qualité des soins et dilemmes
CCLIN Sud-Est – [email protected]
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Astagneau P; L'Heriteau F. Surveillance of surgical-site infections: impact on quality of care and reporting
dilemmas. Current opinion in infectious diseases 2010/08; 23(4): 306-310.
Mots-clés : SURVEILLANCE; SITE OPERATOIRE; QUALITE; TAUX; RESEAU; METHODOLOGIE;
CHIRURGIE; RAISIN; INDICATEUR; INFORMATIQUE
Purpose of review: Among a wide range of publications on surgical-site infections (SSIs), many issues are
still controversial, especially those concerning their monitoring and feedback. This review focuses on recent
advances in surveillance as a tool for improving healthcare quality performance in surgery.
Recent findings: Recent data were obtained from many reference surveillance systems which tend to
demonstrate significant decrease in SSI incidence rates over a several-year period. Most studies emphasize
data feedback to surgical team is an important way to improve care quality and surgical performance. Few
data demonstrated the relationship between the lack of compliance to control measures and SSI risk,
including suboptimal antibiotic prophylaxis, perforated gloves, control of blood glucose, and avoidance of
shaving. No clear consensus is achieved yet regarding preoperative systematic screening and
decolonization of multidrug-resistant Staphylococcus aureus. There is a good amount of recent data
regarding the benchmark approach for ranking surgery wards according to SSI rates. However,
methodological issues on SSI indicator for public reporting are still being debated. Pilot studies attempt to
demonstrate the usefulness of more cost-effective surveillance systems, especially those based on
automated data process.
Summary: There are new exciting developments and perspectives in the field of surveillance and control of
SSI. More data are needed to better establish the relationship with global care quality.
NosoBase n° 28045
Surveillance après césarienne après la sortie de la maternité : incidence des infections du site
opératoire et facteurs associés
Cardoso del Monte M; Pinto Neto A. Postdischarge surveillance following cesarean section: the incidence of
surgical site infection and associated factors. American journal of infection control 2010/08; 38(6): 467-472.
Mots-clés : INCIDENCE; SURVEILLANCE; POST-OPERATOIRE; CESARIENNE; SITE OPERATOIRE;
CENTRE HOSPITALIER UNIVERSITAIRE; ANALYSE MULTIVARIEE; SORTIE
Background: The rate of surgical site infections (SSI) and their associated risk factors was identified by
performing postdischarge surveillance following cesarean section at a public university teaching hospital in
Brazil.
Methods: The study was conducted at the Center for Women's Integrated Health Care in Brazil between
May 2008 and March 2009. Women were contacted by telephone 15 and 30 days after cesarean section.
During hospitalization, a form was completed on factors associated with post-cesarean SSI. The chi(2) test
and Fisher exact test were used to analyze categorical variables and the Mann-Whitney test for numerical
variables. Relative risks (RR) and their respective 95% confidence intervals (95% CI) were calculated for
factors associated with SSI. P values < .05 were considered significant.
Results: The final sample consisted of 187 women. SSI was detected in 44 cases (23.5%). In 42 of 44
women (95%), SSI appeared following discharge from hospital, becoming evident within the first 15 days
following surgery. Number of prenatal consultations </=7 (RR, 2.09; 95% CI: 1.26-3.48) and hypertension
(RR, 2.07; 95% CI: 1.25-3.43) were significantly associated with SSI in the bivariate analysis. In the
multivariate analysis, only hypertension (RR, 2.47; 95% CI: 1.21-5.04) remained significant.
Conclusion: Postdischarge surveillance is essential for ensuring accurate estimates of post-cesarean
section SSI. A 15-day postdischarge follow-up was shown to be sufficient. Hypertension was a factor
associated with SSI.
NosoBase n° 27889
Quel est le dépistage nécessaire en soins intensifs : SARM ou Pseudomonas aeruginosa ?
Slekovec C; Talon D; Bertrand X. Which screening is needed in intensive care units: MRSA or
Pseudomonas aeruginosa? The Journal of hospital infection 2010/08; 75(4): 329-330.
Mots-clés : SOIN INTENSIF; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
PSEUDOMONAS AERUGINOSA; DEPISTAGE; CENTRE HOSPITALIER UNIVERSITAIRE;
EPIDEMIOLOGIE; COLONISATION; TAUX; RECOMMANDATION
CCLIN Sud-Est – [email protected]
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Transplantation
NosoBase n° 27911
Virus émergents dans les transplantations
Kumar D. Emerging viruses in transplantation. Current opinion in infectious diseases 2010/08; 23(4): 374378.
Mots-clés : TRANSPLANTATION; VIRUS;
BIBLIOGRAPHIE; DEFICIT IMMUNITAIRE
HERPES
VIRUS;
METAPNEUMOVIRUS
HUMAIN;
Purpose of review: Several viruses have recently gained importance for the transplant recipient. The
purpose of this review is to give an update on emerging viruses in transplantation.
Recent findings: BK virus-associated nephropathy (BKVAN) causes graft loss after kidney transplantation.
Immunosuppression lowering strategies have now been shown to have benefit in decreasing the incidence
of BKVAN. Guidelines for screening, prevention, and therapy have also been developed. Another
polyomavirus, JC virus, is a cause of progressive multifocal leukoencephalopathy and has also gained
prominence due to the increasing use of monoclonal antibodies in transplant recipients. The significance of
human herpesvirus-6 and -7 continues to be debated in the literature, and new data is available on their
association with clinical disease. Finally, newly discovered respiratory viruses, such as human
metapneumovirus, bocavirus, KI and WU viruses, have also been described in transplant recipients. Human
metapneumovirus appears to cause significant respiratory disease whereas the significance of bocavirus, KI
and WU viruses in transplant recipients remains uncertain.
Summary: Viral infections, such as polyomaviruses, human herpesvirus-6 and -7 and respiratory viruses,
are emerging as causes of significant disease in transplantation. Antiviral options for these viruses are
limited, and decreasing immunosuppression is the cornerstone of therapy.
NosoBase n° 27954
Infections transmises par les transplantations
Morris MI; Fischer SA; Ison MG. Infections transmitted by transplantation. Infectious disease clinics of North
America 2010/06; 24(2): 497-514.
Mots-clés : TRANSPLANTATION; TRANSMISSION; BIBLIOGRAPHIE; DEPISTAGE; EPIDEMIOLOGIE;
HEPATITE B; HEPATITE C; VIRUS; VIRUS DE L'IMMUNODEFICIENCE HUMAINE; MYCOBACTERIUM
TUBERCULOSIS; MYCOLOGIE; RISQUE
Infections are frequently transmitted through solid-organ and, to a lesser extent, stem cell transplantation.
There are 2 major types of donor-derived infections that are transmitted: those that would be expected
secondary to donor and recipient screening (ie, transmission of cytomegalovirus, Epstein-Barr virus, or
toxoplasmosis from a seropositive donor to a seronegative recipient) and those that are unexpected despite
routine donor screening (ie, human immunodeficiency virus and hepatitis C virus transmitted from a
seronegative donor). Expected transmissions occur frequently and screening and prophylaxis strategies are
applied to at-risk individuals in nearly all transplant centers globally. Several high profile donor-derived
infectious disease transmissions have been recognized; these reports have raised awareness of this rare
complication of transplantation. Issues related to the epidemiology of, screening for, and management of
proven or probable donor-derived infections are reviewed in this article.
NosoBase n° 27952
Infections fongiques chez des patients transplantés et des patients d'oncologie
Person AK; Kontoyiannis DP; Alexander BD. Fungal infections in transplant and oncology patients.
Infectious disease clinics of North America 2010/06; 24(2): 439-459.
Mots-clés : BIBLIOGRAPHIE; EPIDEMIOLOGIE; ASPERGILLUS; CANDIDA; ZYGOMYCETES;
PNEUMOCYSTIS JIROVECII; CRYPTOCOCCUS; TRAITEMENT; ANTIFONGIQUE; MYCOLOGIE
Recent shifts in the epidemiology of invasive fungal infections (IFIs) among transplant and oncology
populations have led to new recommendations on treatment; however, they have also brought new
controversies. New pharmacologic therapies are being studied and guidelines for management of several
CCLIN Sud-Est – [email protected]
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IFIs have been changed accordingly. More information is being discovered about unique genetic factors that
put some transplant recipients at greater risk than others for fungal infection. The role of immunomodulation
continues to be investigated, and the delicate balance of maintaining some immune integrity while assuring
protection of the graft remains critical. For transplant and oncology patients, the diagnosis and management
of IFIs remain challenging, and improving outcomes depends on continued progress in all of these arenas.
This article highlights recent advances and important factors to consider when treating transplant and
oncology patients with IFIs.
NosoBase n° 27943
Transplantation de cellules souches hématopoïétiques vue d'ensemble des risques infectieux et
épidémiologie
Wingard JR; Hsu J; Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infetion risks and
epidemiology. Infectious disease clinics of North America 2010/06; 24(2): 257-272.
Mots-clés : TRANSPLANTATION; RISQUE; EPIDEMIOLOGIE; MOELLE OSSEUSE; HEMATOLOGIE;
CANCEROLOGIE;
PNEUMONIE;
GASTRO-ENTERITE;
CLOSTRIDIUM
DIFFICILE;
CYTOMEGALOVIRUS; BIBLIOGRAPHIE
Hematopoietic stem cell transplantation (HSCT) is a treatment for multiple medical conditions that result in
bone marrow failure and as an antineoplastic adoptive immunotherapy for hematologic malignancies. HSCT
is associated with profound compromises in host barriers and all arms of innate and acquired immunity. The
degree of immune compromise varies by type of transplant and over time. Immune reconstitution occurs
within several months after autologous HSCT but takes up to a year or longer after allogeneic HSCT. In
those patients who develop chronic graft-versus-host disease, immune reconstitution may take years or may
never completely develop. Over time, with strengthening immune reconstitution and control of graft-versushost disease, the risk for infection dissipates.
Ventilation assistée
NosoBase n° 27862
Etiologie bactérienne des pneumonies acquises sous ventilation dans un centre hospitalier
universitaire suédois
AhlJ; Tham J; Walder M; Melander E; Odenholt I. Bacterial aetiology in ventilator-associated pneumonia at a
Swedish university hospital. Scandinavian journal of infectious diseases 2010; 42(6-7): 469-474.
Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; CENTRE HOSPITALIER UNIVERSITAIRE; ETUDE
RETROSPECTIVE;
MICROBIOLOGIE;
ENTEROBACTERIE;
PSEUDOMONAS
AERUGINOSA;
TRAITEMENT; ANTIBIOTIQUE; ANTIBIORESISTANCE
Ventilator-associated pneumonia (VAP) is a common complication of respiratory support and is associated
with increased mortality, morbidity and costs, and a prolonged stay in the intensive care unit. Scandinavian
data on the aetiology in VAP are lacking. We hereby present a retrospective study on the aetiology of VAP
diagnosed by protective specimen brush culture at Malmö University Hospital in relation to early- and lateonset VAP, antibiotic treatment and the incidence of drug-resistant bacteria. Patients registered with a
diagnosis of VAP between January 2004 and September 2007 were included in the study. Sixty-five of 109
patients diagnosed with VAP met the inclusion criteria, and 103 bacterial isolates were cultured from these
patients. The most common findings among the 65 VAP episodes were Enterobacteriaceae (28),
Pseudomonas aeruginosa (13), Haemophilus influenzae (12) and Staphylococcus aureus (8). Patients with
no antibiotic treatment at the onset of VAP had significantly more H. influenzae (p = 0.035) and Grampositive pathogenic bacteria (p = 0.019). There was no difference in incidence of P. aeruginosa between
early- and late-onset VAP. Resistant bacteria were found in 18% of the patients.
NosoBase n° 27994
Soins de bouche et risque de bactériémie chez des patients adultes sous ventilation mécanique
Jones DJ; Munro CL; Grap MJ; Kitten T; Edmond M. Oral care and bacteremia risk in mechanically
ventilated adults. Heart and lung 2010; in press: 9 pages.
CCLIN Sud-Est – [email protected]
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Mots-clés : RISQUE; BACTERIEMIE; SOIN DE BOUCHE; VENTILATION ASSISTEE; SOIN INTENSIF;
ETUDE PROSPECTIVE; HEMOCULTURE; INCIDENCE
Objective: Transient bacteremia occurs in healthy populations from toothbrushing. With the high incidence of
bacteremia in the intensive care unit and toothbrushing as an oral care method, this study examined the
incidence and clinical significance of transient bacteremia from toothbrushing in mechanically ventilated
adults.
Methods: Prospective pre- and post-test with all subjects (N = 30) receiving a toothbrushing intervention
twice per day (up to 48 hours). The planned microbial analysis used DNA typing to identify organisms from
oral and blood cultures collected immediately before, 1 minute, and 30 minutes after the interventions.
Results: Seventeen percent of subjects had oral cultures that were positive for selected pathogens before
the first toothbrushing intervention. None of the subjects had evidence of transient bacteremia by positive
quantitative blood cultures before or after the toothbrushing interventions. Patient characteristics were not
statistically significant predictors for systemic inflammatory response syndrome, length of hospital stay, or
length of intubation.
Conclusion: The toothbrushing intervention did not induce transient bacteremia in this patient population.
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