NosoVeille - juin 2010

NosoVeille – Bulletin de veille juin 2010
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NosoVeille n°6
Juin 2010
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications
scientifiques publiées au cours du mois écoulé.
La recherche documentaire est effectuée dans la base de données
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
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Sommaire de ce numéro
Antibiotique
Cathétérisme
Clostridium
Enterococcus
Environnement
Epidémie
Gale
Grippe
Hépatite
Hygiène des mains
Maladie de Creutzfeld-Jakob
Maternité
Médecine ambulatoire
Pédiatrie
Personnel
Pneumonie
Soins intensifs
Staphylococcus
Surveillance
Tuberculose
Usager
Vaccination

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Antibiotique
NosoBase n° 27242
Critères d'ajustement facilement disponibles pour la comparaison de la consommation des
antibiotiques dans un milieu hospitalier : expérience en France
Amadeo B; Dumartin C; Robinson P; Venier AG; Parneix P; Gachie JP; et al. Easily available adjustment
criteria for the comparison of antibiotic consumption in a hospital setting: experience in France. Clinical
microbiology and infection 2010/06; 16(6): 735-741.
Mots-clés : ANTIBIOTIQUE; CONSOMMATION; DDJ; BACTERIEMIE; CATHETER VEINEUX CENTRAL;
STATISTIQUE; DUREE DE SEJOUR
Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that this differs
among hospitals. The aim of the current study was to identify relevant and easily available adjustment
criteria for the purpose of benchmarking. We analysed data from 34 public non-teaching hospitals and 43
private hospitals located in south-western France and overseas departments using retrospective data from
2005. This study investigated the relationship between AbC expressed as defined daily doses per 1000
patient-days (DDD/1000 PDs) or per 100 admissions (DDD/100 admissions) and the number of venous
central lines, the number of episodes of bacteraemia and various hospital characteristics. The relationship
was tested using multiple linear analyses. The median total AbC in public hospitals was 395 DDD/1000 PDs
(range, 196-737) and 341 DDD/100 admissions (range, 180-792). In private hospitals this was 422
DDD/1000 PDs (range, 113-717) and 212 DDD/100 admissions (range, 38-510). The best model for public
hospitals included the proportion of PDs in surgery, intensive care and medical wards and explained 84% of
the variability in AbC expressed as DDD/1000 PDs. For private hospitals, the mean length of stay and the
proportion of PDs in surgery and medical wards explained 68% of the variability in AbC expressed as
DDD/100 admissions. Overall, this French experience shows that relevant adjustment criteria for the
comparison among hospitals are easily available. It is important that each country establish its own model
considering the intrinsic peculiarities of the hospital system and taking into account both indicators
(DDD/1000 PDs or DDD/100 admissions) to design the best model.
NosoBase n° 27112
Rôle potentiel d’une surveillance active dans le contrôle d’une épidémie à Klebsiella pneumoniae
résistant aux carbapénèmes sur l’ensemble de l’hôpital
Ben-David D; Maor Y; Keller N; Regev-Yochay G; Tal I; Shachar D; et al. Potential role of active surveillance
in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infection
control and hospital epidemiology 2010/06; 31(6): 620-626.
Mots-clés : SURVEILLANCE; EPIDEMIE; KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE;
CARBAPENEME; ENTEROBACTERIE; TAUX; INCIDENCE; PRECAUTION CONTACT; COLONISATION;
CENTRE HOSPITALIER UNIVERSITAIRE
The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for
hospitalized patients, and effective strategies are needed.
Objective: To assess the effect of an intensified intervention, which included active surveillance, on the
incidence of infection with carbapenem-resistant Klebsiella pneumoniae.
Setting: Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.
Design. Quasi-experimental study.
Methods: The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae
infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to
contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical
carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series
analysis was performed.
Results: The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from
the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical
microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a
nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal

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colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or
infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact
precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of
infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K.
pneumoniae infection.
Conclusions: The use of active surveillance and contact precautions, as part of a multifactorial intervention,
may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K.
pneumoniae colonization or infection.
NosoBase n° 27316
Prescription et surveillance des antibiotiques
Gras G; Choutet P. La Revue du praticien 2010/04/20; 60: 573-579.
Mots-clés : ANTIBIOTIQUE; SURVEILLANCE; ANTIBIORESISTANCE; PRESCRIPTION
Le principal objectif d'un bon usage des antiobiotiques est d'obtenir la prévention ou une guérison complète
et définitive d'une infection bactérienne et donc du malade en ayant une efficacité optimale, une bonne
tolérance, des effets indésirables, dont la résistance bactérienne, minimaux et un coût acceptable pour la
société. Une antibiothérapie adaptée impose au préalable un diagnostic précis. Ne sont pas abordées les
antibiothérapies par voie locale (aérosols, cutanées, ORL, oculaires).
NosoBase n° 27265
Analyse bénéfice-risque de la restriction de prescription des antibiotiques chez les enfants : que
devons-nous vraiment savoir ?
Keith T; Saxena S; Murray J; Sharland M. Risk-benefit analysis of restricting antimicrobial prescribing in
children: what do we really know? Current opinion in infectious diseases 2010/06; 23(3): 242-246.
Mots-clés : ANALYSE; ANTIBIOTIQUE; PRESCRIPTION; PEDIATRIE; RISQUE; ANTIBIORESISTANCE;
TOLERANCE; EFFET INDESIRABLE; COUT; APPAREIL RESPIRATOIRE; COMPLICATION
Purpose of review: Most childhood respiratory infections including acute otitis media (AOM), sore throat,
upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive
guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance,
antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of
rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This
review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in
children.
Recent findings: From a key observational study reporting antibiotic use in children, the calculated excess
risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic
was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of
antibiotics upon the risk of brain abscess after sinusitis in children.
Summary: New information from observational studies suggests antibiotics show little benefit in preventing
complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following
URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and
optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for
antibiotic prescription.
NosoBase n° 27251
Prévention et contrôle des infections nosocomiales et résistance aux antibiotiques en Europe ;
d'abord ne pas nuire : éléments de prévention réussie et contrôle des infections associées aux soins

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Mielke M. Prevention and control of nosocomial infections and resistance to antibiotics in Europe - Primum
non-nocere: elements of successful prevention and control of healthcare-associated infections. International
journal of medical microbiology 2010; in press: 5 pages.
Mots-clés : PREVENTION; CONTROLE; ANTIBIORESISTANCE; EUROPE; RECOMMANDATION;
SURVEILLANCE
October 2004, the WHO launched the World Alliance for Patient Safety. In 2006, the Council of Europe
adopted a recommendation on the management of patient safety and prevention of adverse events in
healthcare to acknowledge that patients can expect each EU health system to secure a systematic approach
to ensuring patient safety. This review is a compilation of broadly accepted instruments for the prevention
and control of healthcare-associated infections and resistance to antibiotics in Europe. Antibiotic-resistant
bacteria do not stop at the exit of a hospital. The implementation of the various elements of a whole bundle
of recommended prevention and control measures in the context of interacting healthcare institutions
including long-term care, rehabilitation facilities, ambulatory care practices, and home care, is therefore
facilitated by the establishment of regional networks and the integration of prevention and control strategies
into disease management programmes. In order to increase efficiency of prevention and control measures,
there is a need for the careful design of interventional studies to figure out the most efficient single or bundle
of preventive measures. In addition, methods for the discovery of clusters on the basis of routinely obtained
data should be improved.
NosoBase n° 27128
Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Acutalisation 2010
SFAR; Martin C; Auboyer C; Dupont H; Gauzit R; Kitzis M; et al. 2010/04; 1-29.
Mots-clés : ANTIBIOPROPHYLAXIE; ANTIBIOTIQUE; CHIRURGIE; RECOMMANDATION;
NEUROCHIRURGIE; CHIRURGIE OPHTALMOLOGIQUE; CHIRRUGIE CARDIOVASCULAIRE;
CHIRURGIR ORTHOPEDIQUE; TRAUMATOLOGIE; STOMATOLOGIE; CHIRURGIE DIGESTIVE;
CHIRURGIE ORL; CHIRURGIE GYNECOLOGIQUE; RADIOLOGIE; ENDOCARDE
Recommandations de la SFAR concernant l’antibioprophylaxie en chirurgie et en médecine
interventionnelle.
NosoBase n° 27097
Utilité de la prophylaxie antibiotique avant un geste dentaire pour les porteurs de prothèses totales
du genou ou de la hanche
Uckay I; Hoffmeyer P; Trampuz A; Borens O; Terzic A; Scolozzi P; et al. Revue médicale suisse 2010/04/07;
: 727-730.
Mots-clés : ANTIBIOPROPHYLAXIE; PROTHESE TOTALE DE GENOU; PROTHESE TOTALE DE
HANCHE; ODONTOLOGIE; BACTERIEMIE; EFFICACITE; MICROBIOLOGIE; RECOMMANDATION
Il est d'usage de prescrire une prophylaxie antibiotique aux patients porteurs de prothèses totales de la
hanche ou de genou avant un geste dentaire. Cette attitude ne résiste pas à une analyse critique de
l'évidence scientifique pour plusieurs raisons :
1) les pathogènes habituels de l'infection de prothèse ne sont pas de provenance buccale ;
2) même si administrés, les antibiotiques n'empêchent pas complètement des bactériémies occultes liées au
traitement dentaire ;
3) l'être humain vit jusqu'à douze épisodes de bactériémies occultes d'origine dentaire par jour. Il importe
donc de distinguer les situations d'infection buccale avérée dans lesquelles la prophylaxie antibiotique reste
bien évidemment nécessaire. Une bonne hygiène dentaire est importante en termes de prévention et doit
être encouragée chez tout porteur d'arthroplastie.

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Cathétérisme
NosoBase n° 27248
Efficacité et tolérance de la daptomycine dans le traitement des bactériémies à pathogènes à Gram
positif liées aux cathéters chez des patients atteints de cancer
Chaftari AM; Hachem R; Mulanovich V; Chemaly RF; Adachi J; Jacobson K; et al. Efficacy and safety of
daptomycin in the treatment of Gram-positive catheter-related bloodstream infections in cancer patients.
International journal of antimicrobial agents 2010; in press: 5 pages.
Mots-clés : DAPTOMYCINE; EFFICACITE; TOLERANCE; BACTERIEMIE; BACTERIE A GRAM POSITIF;
CATHETER; CANCER; VANCOMYCINE; ANTIBIORESISTANCE; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; ETUDE PROSPECTIVE
Excessive vancomycin usage has contributed to the emergence of vancomycin-resistant enterococci, and a
high vancomycin minimal inhibitory concentration (MIC) >1.0mug/mL has been associated with poor
outcome in patients with meticillin-resistant Staphylococcus aureus (MRSA) infection. In view of these
limitations, there is a need for an alternative agent. We evaluated the clinical efficacy and safety of
daptomycin given as an alternative agent in the treatment of Gram-positive catheter-related bloodstream
infections (CRBSIs) in cancer patients. Between June 2006 and March 2008, 40 patients with probable or
definite CRBSI caused by Gram-positive organisms were prospectively enrolled to receive daptomycin
intravenous 6mg/kg/day for up to 4 weeks. In addition, 40 historical matched control patients treated with
vancomycin were retrospectively identified. The control group was matched based on underlying disease,
organism and neutropenic status. The daptomycin group was comparable with the vancomycin group in
terms of neutropenia rate, complications, adverse events, length of hospital stay and death. However, more
patients in the daptomycin group achieved symptom resolution at 48h compared with the vancomycin group
(76% vs. 53%; P=0.04). Similarly, more patients in the daptomycin group achieved microbiological
eradication at 48h compared with the vancomycin group (78% vs. 34%; P<0.001). Although not significant,
nephrotoxicity was almost three-fold lower in the daptomycin group. The overall response was significantly
better for daptomycin compared with vancomycin (68% vs. 32%; P=0.003). In conclusion, compared with
vancomycin, daptomycin treatment of Gram-positive CRBSI in cancer patients was significantly associated
with earlier clinical and microbiological response as well as improved overall response.
NosoBase n° 27234
Désinfection cutanée à l'aide de chlorhydrate d'octénidine pour le site d'insertion du cathéter
veineux central : essai contrôlé, randomisé, en double aveugle
Dettenkofer M; Wilson C; Gratwohl A; Schmoor C; Bertz H; Frei R; et al. Skin disinfection with octenidine
dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Clinical
microbiology and infection 2010/06; 16(6): 600-606.
Mots-clés : PEAU; CATHETER VEINEUX CENTRAL; ANTISEPTIQUE; ESSAI THERAPEUTIQUE;
ALCOOL; BACTERIEMIE; COLONISATION CUTANEE; PREVENTION; RANDOMISATION
To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation
and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a
double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit
of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different
skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol,
and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site;
(ii) positive culture from the catheter tip (>/=15 CFU); and (iii) occurrence of CVC-associated bloodstream
infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were
enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics
and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly
reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p
<0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%)
than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine
had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44;