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NosoVeille n°7
Juillet 2016
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Kae Trouilloud
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
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Sommaire de ce numéro :
Acinetobacter baumannii
Antibiorésistance
Antibiotique
Antiseptique
Bactériémie
Cancérologie
Chirurgie
Clostridium difficile
Désinfection
Endoscopie
Environnement
Gestion des risques
Hygiène des mains
Infection urinaire
Matériel médico-chirurgical
Mycobactérie
Odontologie
Personnel
Personne âgée
Pneumonie
Précautions complémentaires
Prévention
Règlementation
Soin intensif
Staphylococcus aureus
Vaccination
Zika

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Acinetobacter baumannii
NosoBase ID notice : 414959
Epidémiologie moléculaire et impact clinique sur le complexe Acinetobacter calcoaceticus-baumannii
dans un centre belge pour brûlé
De Vos D; Pirnay JP; Bilocq F; Jennes S; Verbeken G; Rose T; et al. Molecular epidemiology and clinical
impact of Acinetobacter calcoaceticus-baumannii complex in a Belgian burn wound center. PLoS One
2016/05/25; 11(5): 1-26.
Mots-clés : EPIDEMIOLOGIE; ACINETOBACTER BAUMANNII; BRULE; EPIDEMIE; ANTIBIOTIQUE;
BIOLOGIE MOLECULAIRE; TYPAGE; ACINETOBACTER CALCOACETICUS|
Multidrug resistant Acinetobacter baumannii and its closely related species A. pittii and A. nosocomialis, all
members of the Acinetobacter calcoaceticus-baumannii (Acb) complex, are a major cause of hospital
acquired infection. In the burn wound center of the Queen Astrid military hospital in Brussels, 48 patients
were colonized or infected with Acb complex over a 52-month period. We report the molecular epidemiology
of these organisms, their clinical impact and infection control measures taken. A representative set of 157
Acb complex isolates was analyzed using repetitive sequence-based PCR (rep-PCR) (DiversiLab) and a
multiplex PCR targeting OXA-51-like and OXA-23-like genes. We identified 31 rep-PCR genotypes (strains).
Representatives of each rep-type were identified to species by rpoB sequence analysis: 13 types to A.
baumannii, 10 to A. pittii, and 3 to A. nosocomialis. It was assumed that isolates that belonged to the same
rep-type also belonged to the same species. Thus, 83.4% of all isolates were identified to A. baumannii, 9.6%
to A. pittii and 4.5% to A. nosocomialis. We observed 12 extensively drug resistant Acb strains (10 A.
baumannii and 2 A. nosocomialis), all carbapenem-non-susceptible/colistin-susceptible and imported into the
burn wound center through patients injured in North Africa. The two most prevalent rep-types 12 and 13
harbored an OXA-23-like gene. Multilocus sequence typing allocated them to clonal complex 1 corresponding
to EU (international) clone I. Both strains caused consecutive outbreaks, interspersed with periods of
apparent eradication. Patients infected with carbapenem resistant A. baumannii were successfully treated
with colistin/rifampicin. Extensive infection control measures were required to eradicate the organisms.
Acinetobacter infection and colonization was not associated with increased attributable mortality.
Antibiorésistance
NosoBase ID notice : 411415
Le succès croissant d’Acinetobacter baumannii résistant aux antibiotiques demeure un défi en tant
que pathogène nosocomial
Gonzalez-Villoria AM; Valverde-Garduno V. Antibiotic-resistant Acinetobacter baumannii increasing success
remains a challenge as a nosocomial pathogen. Journal of pathogens 2016; 2016: 1-10.
Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; MULTIRESISTANCE; REVUE DE LA
LITTERATURE; EPIDEMIOLOGIE; SURVEILLANCE; SIGNALEMENT
Antibiotic-resistant infectious bacteria currently imply a high risk and therefore constitute a strong challenge
when treating patients in hospital settings. Characterization of these species and of particular strains is a
priority for the establishment of diagnostic tests and preventive procedures. The relevance of Acinetobacter
baumannii as a problematic microorganism in inpatient facilities, particularly intensive care units, has
increased over time. This review aims to draw attention to (i) the historical emergence of carbapenem-
resistant Acinetobacter baumannii, (ii) the current status of surveillance needs in Latin America, and (iii)
recent data suggesting that A. baumannii continues to spread and evolve in hospital settings. First, we
present synopsis of the series of events leading to the discovery and precise identification of this
microorganism in hospital settings. Then key events in the acquisition of antibiotic-resistant genes by this
microorganism are summarized, highlighting the race between new antibiotic generation and emergence of A.
baumannii resistant strains. Here we review the historical development of this species as an infectious threat,
the current state of its distribution, and antibiotic resistance characteristics, and we discuss future prospects
for its control.
NosoBase ID notice : 414719
Attitudes et perceptions des personnels de santé dans le Nord-Est de l’Allemagne vis-à-vis des
organismes multirésistants

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Marschall P; Hübner NO; Maletzki S; Wilke F; Dittmann K; Kramer A. Attitudes and perceptions of health care
workers in Northeastern Germany about multidrug-resistant organisms. American journal of infection control
2016/06; 44(6): e91-e94.
Mots-clés : ATTITUDE; PERSONNEL; RESISTANCE; ANTIBIORESISTANCE
There were 256 health care workers in 39 facilities who were interviewed about their perceptions of the
quality of care of patients with and without multidrug-resistant organisms based on a standardized
questionnaire. There are remarkable differences in the responses between facility types (acute care hospitals,
long-term care hospitals, rehabilitation hospitals, and home care services). Hygiene management must be
specifically tailored to the requirements of each facility.
NosoBase ID notice : 415723
Modification et évaluation du test Carba NP en utilisant une bande de papier pour une détection
simple et rapide d’entérobactéries productrices de carbapénèmes
Srisrattakarn A; Lulitanond A; Wilailuckana C; Charoensri N; Wonglakorn L; Piyapatthanakul S; et al.
Modification and evaluation of the Carba NP test by use of paper strip for simple and rapid detection of
carbapenemase-producing Enterobacteriaceae. World journal of microbiology and biotechnology 2016/07;
32(7): 8 pages.
Mots-clés : ENTEROBACTERIE; ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; PSEUDOMONAS
AERUGINOSA; TECHNIQUE DE DIAGNOSTIC; TEST; DEPISTAGE; BETA-LACTAMASE A SPECTRE
ELARGI; PCR; COUT-EFFICACITE; CARBAPENEME; IMIPENEME
Carbapenemase-producing Enterobacteriaceae (CPE) isolates have now emerged worldwide. We therefore
modified the phenotypic Carba NP test by use of a filter paper strip for easily and rapidly identifying CPE in
routine laboratory. A collection of 56 CPE and carbapenemase-producing Pseudomonas spp. isolates
(including 28 NDM-1, 11 IMP-14a, 1 IMP-1, 1 IMP-4, 1 IMP-9, 1 IMP-15, 4 VIM-2, 1 VIM-1, 1 IMP-14a with
VIM-2, 3 OXA-48, 3 OXA-181 and 1 KPC-2 producers) and 41 non-CPE isolates (including 19 ESBL, 7
pAmpC, 3 AmpC, 9 ESBL with pAmpC and 3 non-ESBL & non-AmpC producers) as confirmed by the PCR
methods were tested by the paper strip method using pharmaceutical imipenem/cilastatin as a substrate.
Bacterial colonies of each isolate were applied directly on filter paper strips dropped with either imipenem-
phenol red (test strip) or phenol red solution alone (control strip). The reaction was read within 5 min. This test
failed to detect 3 OXA-181, 2 OXA-48 and 3 IMP-14a producers (85.7% sensitivity), whereas no false
positives were seen (100% specificity). Further evaluation of the paper strip test in 267 CPE screening-
positive isolates from three hospitals by their medical technologists showed 92.0% sensitivity (100% for NDM
producers) and 100% specificity compared with the PCR methods. Because of its ease, rapidness and cost
effective, the paper strip test has a potential for routine CPE testing in low-resource laboratories particularly in
areas with high prevalence of NDM enzymes, leading to appropriate antimicrobial therapy and infection
control strategy.
Antibiotique
NosoBase ID notice : 415800
Préserver l’efficacité des antibiotiques, limiter l’émergence des bactéries multirésistantes
Fascia P; Cauterman M; Giard M; Dumartin C; Savey A; Gauzit R. Préserver l’efficacité des antibiotiques,
limiter l’émergence des bactéries multirésistantes. Bulletin CClin-Arlin 2016/06; 3: 1-3.
Mots-clés : ANTIBIOTIQUE; INFORMATION; MULTIRESISTANCE
Dans le cadre du Plan d’alerte sur les antibiotiques 2011-2016, un collectif regroupant une fédération
hospitalière (la Fédération Hospitalière de France), une société savante (la SPILF) et une association
d’usagers (Le Lien) a initié une campagne sur le juste usage des antibiotiques. Cette campagne s’intitule «les
antibios… juste ce qu’il faut» et elle s’inscrit dans un partenariat avec l’Alliance contre le développement des
bactéries multirésistantes (AC2BMR).
Cette campagne repose sur un engagement des établissements de santé et un engagement individuel
nominatif des prescripteurs. Ces engagements, rendus publics par affichage, ont pour objectif principal
d’améliorer l’usage des antibiotiques.

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NosoBase ID notice : 415816
Ressources humaines nécessaires aux équipes multidisciplinaires en antibiothérapie dans les
établissements de santé français
Le Coz P; Carlet J; Roblot F; Pulcini C. Human resources needed to perform antimicrobial stewardship
teams’ activities in French hospitals. Médecine et maladies infectieuses 2016/06; 46(4): 200-206.
Mots-clés : MULTIRESISTANCE; ANTIBIOTIQUE; PRESCRIPTION; RECOMMANDATIONS DE BONNE
PRATIQUE; ENQUETE; MEDECIN SPECIALISTE; CHARGE DE TRAVAIL; COUT
Objectif : En janvier 2015, la ministre de la santé française a constitué un groupe de travail sur
l’Antibiorésistance. Le groupe « Bon usage des antibiotiques » a mené une étude pour évaluer les
ressources humaines nécessaires afin d’assurer toutes les missions des équipes multidisciplinaires en
antibiothérapie (EMA, associant référents en antibiothérapie/infectiologie, microbiologistes et pharmaciens)
dans les établissements de santé (ES) français.
Méthodes : Nous avons mené une enquête nationale à l’aide d’un questionnaire disponible sur Internet,
conçu à partir de textes réglementaires et de consensus d’experts. L’enquête s’est déroulée de mars à mai
2015. Nous avons utilisé la liste de diffusion mail de la Société de pathologie infectieuse de langue française
(SPILF).
Résultats : Au total, 65 ES ont participé à l’étude. Les ressources humaines nécessaires pour mener à bien
toutes les missions des EMA ont été évaluées à 3,6 postes équivalents temps pleins (ETP) de référents en
antibiothérapie/infectiologie pour 1000 lits de médecine-chirurgie-obstétrique, 2,5 ETP pharmaciens/1000 lits
et 0,6 ETP microbiologistes/1000 lits. Ceci équivaut à près de 2000 postes ETP pour tous les ES français
(publics et privés), soit un coût annuel d’environ 200 millions d’euros.
Conclusion : Un financement dédié et pérenne des EMA est indispensable à court terme si nous souhaitons
mettre en place des programmes de bon usage des anti-infectieux complets et effectifs dans tous les ES.
NosoBase ID notice : 414197
Méthodes de recherche concernant l’épidémiologie en santé et la gestion des antibiotiques : essais
contrôlés randomisés
Anderson DJ; Juthani-Mehta M; Morgan DJ. Research methods in healthcare epidemiology and antimicrobial
stewardship: Randomized controlled trials. Infection control and hospital epidemiology 2016/06; 37(6): 629-
634.
Mots-clés : ANTIBIOTIQUE; EPIDEMIOLOGIE; RANDOMISATION; ESSAI THERAPEUTIQUE;
RECHERCHE MEDICALE
Randomized controlled trials (RCT) produce the strongest level of clinical evidence when comparing
interventions. RCTs are technically difficult, costly, and require specific considerations including the use of
patient- and cluster-level randomization and outcome selection. In this methods paper, we focus on key
considerations for RCT methods in healthcare epidemiology and antimicrobial stewardship (HE&AS)
research, including the need for cluster randomization, conduct at multiple sites, behavior modification
interventions, and difficulty with identifying appropriate outcomes. We review key RCTs in HE&AS with a
focus on advantages and disadvantages of methods used. A checklist is provided to aid in the development
of RCTs in HE&AS.
NosoBase ID notice : 414199
Caractéristiques des programmes de gestion des antibiotiques dans les «Veterans Affairs Hospital» :
résultats d’une enquête nationale
Chou AF; Graber CJ; Jones MM; Zhang Y; Goetz MB; Madaras-Kelly K; et al. Characteristics of antimicrobial
stewardship programs at veterans affairs hospitals: Results of a nationwide survey. Infection control and
hospital epidemiology 2016/06; 37(6): 647-654.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; ANTIBIOGRAMME; DDJ; CLOSTRIDIUM DIFFICILE;
INFECTION NOSOCOMIALE
Background: Antimicrobial stewardship programs (ASPs) are variably implemented.

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Objective: To characterize variations of antimicrobial stewardship structure and practices across all inpatient
Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage.
Design: A web-based survey regarding stewardship activities was administered to each facility's designated
contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012
were determined.
Setting: Total of 130 Veterans Affairs facilities with inpatient services.
Results: Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an
approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams
included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied
across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]),
stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96
[74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03),
an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as
frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address
antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration
were associated with increased use (P=.03).
Conclusions: ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID
presence and certain select practices. Further statistical assessments may help optimize antimicrobial
practices.
NosoBase ID notice : 414216
Des processus d’audit avec retour d’expérience inclus dans des programmes de gestion des
antibiotiques : une enquête de la Society for Healthcare Epidemiology of America Research Network
(SRN)
Livorsi DJ; Heintz B; Jacob JT; Krein SL; Morgan DJ; Perencevich EN. Audit and feedback processes among
antimicrobial stewardship programs: A survey of the society for healthcare epidemiology of america research
network. Infection control and hospital epidemiology 2016/06; 37(6): 704-706.
Mots-clés : ANTIBIOTIQUE; AUDIT; PRESCRIPTION; MEDECIN; PHARMACIEN; COMPORTEMENT;
RECOMMANDATIONS DE BONNE PRATIQUE; SHEA
Optimal implementation of audit-and-feedback is an important part of advancing antimicrobial stewardship
programs. Our survey demonstrated variability in how 61 programs approach audit-and-feedback. The
median (interquartile range) number of recommendations per week was 9 (5-19) per 100 hospital-beds. A
major perceived barrier to more comprehensive stewardship was lack of resources.
NosoBase ID notice : 414196
Méthodes de recherche concernant l’épidémiologie en santé et la gestion des antibiotiques
Morgan DJ; Safdar N; Milstone AM; Anderson DJ. Research methods in healthcare epidemiology and
antimicrobial stewardship. Infection control and hospital epidemiology 2006/06; 37(6): 627-628.
Mots-clés : EPIDEMIOLOGIE; ANTIBIOTIQUE; PRESCRIPTION; RECHERCHE MEDICALE; ESSAI
THERAPEUTIQUE
Research in Healthcare Epidemiology and Antimicrobial Stewardship (HE&AS) is rapidly expanding with the
involvement of researchers from varied countries and backgrounds. Researchers must use scientific methods
that will provide the strongest evidence to advance healthcare epidemiology, but there are limited resources
for information on specific aspects of HE&AS research or easy ways to access examples of studies using
specific methods with HE&AS. In response to this need, the SHEA Research Committee has developed a
series of white papers on research methods in HE&AS. The objective of this series is to promote rigorous
healthcare epidemiology research by summarizing critical components, practical considerations, and pitfalls
of commonly used research methods.
NosoBase ID notice : 415720
Investigation d’une épidémie méconnue à grande échelle de fongémie : Candida parapsilosis sensu
stricto dans un centre hospitalier universitaire en Chine