NosoVeille Août 2011

NosoVeille – Bulletin de veille
Avril 2015
NosoVeille n°4
Avril 2015
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
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://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html
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Abonnement / Désabonnement
Sommaire de ce numéro :
Acinetobacter baumannii
Antibiotique / Antibiorésistance
Antiseptique
Bactériémie
Chirurgie
Clostridium difficile
Ebola
EHPAD
Environnement
Epidémie
Grippe
Hépatite
Hygiène des mains
Infection fongique
Infection urinaire
Légionellose
Néonatologie
Norovirus
Personnel
Pneumonie
Prévention
Pseudomonas aeruginosa
Réglementation
Staphylococcus aureus
Stérilisation
Surveillance
Tuberculose
Vaccination
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Avril 2015
Acinetobacter baumannii
NosoBase ID notice : 393743
Acinetobacter baumannii producteurs de biofilm multirésistant aux antibiotiques : un défi émergent
Badave GK; Dhananjay K. Biofilm producing multidrug resistant Acinetobacter baumannii: an emerging
challenge. Journal of clinical and diagnostic research 2015/01; 9(1): 8-10.
Mots-clés : ACINETOBACTER BAUMANNII; MULTIRESISTANCE; BIOFILM
Aim: To study the quantitative method for biofilm formation and examine the correlation between biofilm
formation and antibiotic resistance among the clinical isolates of Acinetobacter baumannii.
Materials and methods: A total of 72 A. baumannii isolates from different clinical specimens were processed
and confirmed by conventional microbiological methods. Antimicrobial susceptibility testing was performed by
Kirby Bauer disc diffusion method using six antibiotics. Biofilm formation was studied by microtitre plate
assay.
Results: Forty five (62.5%) of 72 isolates produced biofilm. Resistance to ampicillin-sulbactam was least.
36.1% isolates were resistant to imipenem, 66.6% to ceftazidime, 72.2% to ciprofloxacin, 80.5% to amikacin
and 84.7% to piperacillin. Biofilm formers showed greater resistance to ampicillin- sulbactam, amikacin,
ciprofloxacin and ceftazidime as compared to imipenem and piperacillin. In all 65 (90.3%) isolates showed
multiple drug resistance. Correlation between multidrug resistance and biofilm formation was analysed
statistically and p-value was found to be significant (p-value =0.0004; p-value <0.05 is significant by Chi Square Test).
Conclusion: The study concludes that there a positive correlation between biofilm formation and multiple drug
resistance in A. baumannii.
Antibiotique / Antibiorésistance
NosoBase ID notice : 393272
La procalcitonine est-elle un marqueur efficace en termes de coût-efficacité pour mettre en place et
réévaluer l’antibiothérapie de patients adultes suspectés d’infection bactérienne et de sepsis ?
Harrison M; Collins CD. Is procalcitonin-guided antimicrobial use cost-effective in adult patients with
suspected bacterial infection and sepsis? Infection control and hospital epidemiology 2015/03; 36(3): 265272.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; PROCALCITONINE; SOIN INTENSIF; COUT-EFFICACITE;
COUT; COHORTE; INFECTION; SYNDROME SEPTIQUE
Objective: Procalcitonin has emerged as a promising biomarker of bacterial infection. Published literature
demonstrates that use of procalcitonin testing and an associated treatment pathway reduces duration of
antibiotic therapy without impacting mortality. The objective of this study was to determine the financial impact
of utilizing a procalcitonin-guided treatment algorithm in hospitalized patients with sepsis.
Design: Cost-minimization and cost-utility analysis.
Patients: Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis.
Methods: Utilizing published clinical and economic data, a decision analytic model was developed from the
U.S. hospital perspective. Effectiveness and utility measures were defined using cost-per-clinical episode and
cost per quality-adjusted life years (QALYs). Upper and lower sensitivity ranges were determined for all
inputs. Univariate and probabilistic sensitivity analyses assessed the robustness of our model and variables.
Incremental cost-effectiveness ratios (ICERs) were calculated and compared to predetermined willingness-topay thresholds.
Results: Base-case results predicted the use of a procalcitonin-guided treatment algorithm dominated
standard care with improved quality (0.0002 QALYs) and decreased overall treatment costs ($65). The model
was sensitive to a number of key variables that had the potential to impact results, including algorithm
adherence (<42.3%), number and cost of procalcitonin tests ordered (≥9 and >$46), days of antimicrobial
reduction (<1.6 d), incidence of nephrotoxicity and rate of nephrotoxicity reduction.
Conclusion: The combination of procalcitonin testing with an evidence-based treatment algorithm may
improve patients' quality of life while decreasing costs in ICU patients with suspected bacterial infection and
sepsis; however, results were highly dependent on a number of variables and assumptions.
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NosoBase ID notice : 393269
Mise en place de politiques de gestion des antibiotiques dans les hôpitaux américains : résultats
d’une enquête nationale
Pogorzelska-Maziarz M; Herzig CT; Larson EL; Furuya EY; Perencevich EN; Stone PW. Implementation of
antimicrobial stewardship policies in U.S. hospitals: findings from a national survey. Infection control and
hospital epidemiology 2015/03; 36(3): 261-264.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; CONSOMMATION; ENQUETE; RESEAU
Objective: To describe the use of antimicrobial stewardship policies and to investigate factors associated with
implementation in a national sample of acute care hospitals.
Design: Cross-sectional survey.
Participants: Infection Control Directors from acute care hospitals participating in the National Healthcare
Safety Network (NHSN).
Methods: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to
their 2011 NHSN annual survey data.
Results: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%)
reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most
frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and
those that are part of a system that shares resources were more likely to report a policy in place (P<.01).
Hospitals located in California were more likely to have policy in place than in hospitals located in other states
(P=.014).
Conclusion: This study provides a snapshot of the implementation of antimicrobial stewardship policies in
place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect.
Further research is needed to identify factors that foster the adoption of these policies.
NosoBase ID notice : 395061
Endocardite infectieuse sur pacemaker à Stenotrophomonas maltophilia
Reynaud Q; Weber E; Gagneux-Brunon A; Suy F; Lucht F; Botelho-Nevers E. Late Stenotrophomonas
maltophilia pacemaker infective endocarditis. Médecine et maladies infectieuses 2015/03; 45 (3): 95-97.
Mots-clés : ENDOCARDE; INFECTION; STIMULATEUR
MORTALITE; STENOTROPHOMONAS MALTOPHILIA
CARDIAQUE;
ANTIBIORESISTANCE;
Antiseptique
NosoBase ID notice : 395020
Evaluation de l’activité bactéricide de 3 antiseptiques cutanéomuqueux en présence de substances
interférentes : peut-on compléter la norme NF EN 13727 ?
Salvatico S; Feuillolay C; Mas Y; Verrière F; Roques C. Bactericidal activity of 3 cutaneous/mucosal
antiseptic solutions in the presence of interfering substances: Improvement of the NF EN 13727 European
Standard? Médecine et maladies infectieuses 2015/03; 45(3): 89-94.
Mots-clés : ANTISEPTIQUE; BACTERICIDIE; TEST; PEAU; CONTACT
CHLORHEXIDINE; POLYVIDONE IODEE; GYNECOLOGIE; DERMATOLOGIE
MUQUEUX;
NORME;
Objectifs : L’évaluation des antiseptiques à visée cutanéomuqueuse, en présence de substances
interférentes, ne fait l’objet d’aucun protocole normatif. Notre objectif était de proposer des conditions d’essai
adaptées de la norme NF EN 13727 pour l’évaluation d’antiseptiques utilisés en gynécologie et dermatologie.
Méthode : Trois antiseptiques : une association chlorhexidine-benzalkonium (CB), une association
hexamidine-chlorhexidine-chlorocrésol (HCC) et la povidone iodée (P) ont été testés in vitro. L’adaptation des
conditions d’essai de la norme a concerné le choix des dilutions, du diluant et des substances interférentes.
L’activité des produits a été évaluée sur les souches de la norme aux concentrations de 97 % (utilisation
pure), de 50 % et 10 % (utilisation diluée) et de 1 %. Pour répondre aux exigences de bactéricidie, une
réduction logarithmique ≥ 5 était attendue pour 60 secondes de contact.
Résultats : HCC n’avait pas d’activité bactéricide à l’exception de la concentration à 97 % sur P. aeruginosa .
P n’avait pas d’activité bactéricide sur E. hirae , quelle que soit la concentration testée, ni sur S. aureus à 97
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%. CB avait l’activité bactéricide la plus homogène avec réduction>5 log sur les 4 souches bactériennes à 97
%, 50 % et 10 %.
Conclusion : L’adaptation de la norme NF EN 13727 permet de discriminer les 3 produits testés : seul CB
était bactéricide en conditions de saleté. Ce travail souligne la possibilité de valider le choix des antiseptiques
in vitro dans des conditions représentatives de la pratique, dans le traitement d’appoint des affections
cutanéomuqueuses primitivement bactériennes ou susceptibles de se surinfecter.
Bactériémie
NosoBase ID notice : 395001
Les bactériémies associées aux soins à Staphylococcus aureus : un indicateur des infections
associées aux cathéters
Bonnal C; Birgand G; Lolom I; Diamantis S; Dumortier C; L'Hériteau F; et al. Staphylococcus aureus
healthcare associated bacteraemia: An indicator of catheter related infections. Médecine et maladies
infectieuses 2015/03; 45(3): 84-88.
Mots-clés : INFECTION NOSOCOMIALE; CATHETER VEINEUX; STAPHYLOCOCCUS AUREUS;
BACTERIEMIE; INDICATEUR; CATHETER VEINEUX PERIPHERIQUE; CATHETER VEINEUX CENTRAL;
METICILLINO-RESISTANCE; SARM; SURVEILLANCE; INCIDENCE; ETUDE PROSPECTIVE
Objectifs : Les établissements de santé doivent disposer d’indicateurs pertinents permettant d’évaluer et de
surveiller les infections associées aux soins dites évitables et en particulier celles liées aux cathéters. Le but
de ce travail était de montrer que la surveillance des bactériémies nosocomiales à Staphylococcus aureus
pouvait être un de ces indicateurs.
Patients et méthode : Nous avons réalisé une surveillance prospective sur 10 ans des bactériémies
associées aux soins à S. aureus dans notre hôpital de 940 lits en nous basant sur les définitions standard.
Résultats : Entre 2002 et 2012, 2784 bactériémies associées aux soins ont été identifiées, dont 573 (18 %)
étaient dues à S. aureus. Parmi ces 573 bactériémies, 189 (32,8 %) avaient pour origine un cathéter
vasculaire et 84 % (158/189) survenaient en dehors des services de réanimation. S. aureus était associé à 56
% (61/109) des bactériémies liées à un cathéter veineux périphérique (CVP) et à 34 % (103/301) de celles
dues à un cathéter veineux central (CVC). Les souches de S. aureus résistantes à la méticilline isolées des
bactériémies ont diminué de 50,3 % à 18,4 % entre 2002 et 2012. Les bactériémies sur CVP ont baissé de 20
à 7 par an pendant l’étude.
Conclusion : Dans notre expérience, la surveillance des bactériémies associées aux soins à S. aureus serait
donc un indicateur simple et efficace des infections sur cathéter et donc de la qualité des soins, en particulier
dans des secteurs non couverts habituellement par d’autres types de surveillance.
NosoBase ID notice : 393276
Comparaison entre connecteurs sans aiguille imprégnés d'argent et connecteurs sans aiguille
standard dans la prévention des bactériémies sur voie centrale
Jacob JT; Tejedor SC; Reyes MD; Lu X; Easley KA; Aurand WL; et al. Comparison of a silver-coated
needleless connector and a standard needleless connector for the prevention of central line-associated
bloodstream infections. Infection control and hospital epidemiology 2015/03; 36(3): 294-301.
Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; MATERIEL MEDICO-CHIRURGICAL; TAUX;
ETUDE PROSPECTIVE; CONNECTEUR
Objective: To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-lineassociated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver
coating.
Design: Prospective longitudinal observation study
Setting: Two 500-bed university hospitals
Patients: All hospitalized adults from November 2009 to June 2011 with non-hemodialysis central lines
Interventions: Hospital A started with silver-coated NCs and switched to standard NCs in September 2010;
hospital B started with standard NCs and switched to silver-coated NCs. The primary outcome was the
difference revealed by Poisson multivariate regression in CLABSI rate using standard Centers for Disease
Control and Prevention surveillance definitions. The secondary outcome was a comparison of organismspecific CLABSI rates by NC type.
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Results: Among 15,845 hospital admissions, 140,186 central-line days and 221 CLABSIs were recorded
during the study period. In a multivariate model, the CLABSI rate per 1,000 central-line days was lower with
silver-coated NCs than with standard NCs (1.21 vs 1.79; incidence rate ratio=0.68 [95% CI: 0.52-0.89],
P=.005). A lower CLABSI rate per 1,000 central-line days for the silver-coated NCs versus the standard NCs
was observed with S. aureus (0.11 vs 0.30, P=.02), enterococci (0.10 vs 0.27, P=.03), and Gram-negative
organisms (0.28 vs 0.63, P=.003) but not with coagulase-negative staphylococci (0.31 vs 0.36) or Candida
spp. (0.42 vs 0.40).
Conclusions: The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts
should include efforts to minimize contamination of NCs.
NosoBase ID notice : 393741
Comparaison des bactériémies à Acinetobacter pittii et à Acinetobacter nosocomialis
Liu YM; Lee YT; Kuo SC; Chen TL; Liu CP; Liu CE. Comparison between bacteremia caused by
Acinetobacter pittii and Acinetobacter nosocomialis. Journal of microbiology, immunology and infection
2015/01/30; in press: 1-6.
Mots-clés : BACTERIEMIE; ACINETOBACTER; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER
UNIVERSITAIRE; APPARIEMENT; MORTALITE; ACINETOBACTER PITTII; ACINETOBACTER
NOSOCOMIALIS
Background/Purpose: Patients with Acinetobacter pittii and Acinetobacter nosocomialis bacteremia have
lower mortality rates than those with Acinetobacter baumannii bacteremia. However, it is unknown whether
these organisms differ in outcomes of bacteremic patients. We conducted this study to answer this question.
Methods: In this retrospective study conducted at a teaching hospital in Taiwan, we enrolled all 86 patients
who had developed A. pittii bacteremia and those with A. nosocomialis bacteremia from 2000 to 2008 while
matching for age, sex, Acute Physiology and Chronic Health Evaluation II score, and appropriate
antimicrobial therapy. After adjustment, we accessed the clinical characteristics and 14- and 28-day
mortalities.
Results: We found that the patients with A. pittii bacteremia had multiple comorbidities less often and received
invasive procedures less frequently. The 14-day mortality rate of patients with A. pittii or A. nosocomialis
bacteremia was 14% and 7%, respectively, whereas their 28-day mortality rate was 17% and 9%,
respectively. Using the mortality rate in patients with A. nosocomialis bacteremia as a reference, the odds
ratios for the 14- and 28-day crude morality in those with A. pittii were 2.16 [95% confidence interval (CI),
0.77-6.05] and 2.06 (95% CI, 0.82-5.15), respectively, whereas the adjusted odds ratios for 14- and 28-day
mortality were 1.89 (95% CI, 0.56-6.14) and 1.67 (95% CI, 0.59-4.78) respectively.
Conclusion: Our 8-year study showed that the mortality rate of A. pittii bacteremia was higher but the
difference was not statistically significant.
NosoBase ID notice : 394304
Impact d’interventions de lutte contre le risque infectieux sur les taux de bactériémies à
Staphylococcus aureus dans des hôpitaux pour soins aigus du NHS, Est des Midlands, Royaume-Uni,
à l’aide d’une analyse de series temporelles interrompues
Newitt S; Myles PR; Birkin JA; Maskell V; Slack RC; Nguyen-Van-Tam JS; et al. Impact of infection control
interventions on rates of Staphylococcus aureus bacteraemia in National Health Service acute hospitals, East
Midlands, UK, using interrupted time-series analysis. The journal of hospital infection 2015/01/15; in press: 110.
Mots-clés : ANALYSE; TAUX; BACTERIEMIE;
EFFICACITE; ETUDE MULTICENTRIQUE
STAPHYLOCOCCUS
AUREUS;
PREVENTION;
Background: Reducing healthcare-associated infection (HCAI) is a UK national priority. Multiple national and
regional interventions aimed at reduction have been implemented in National Health Service acute hospitals,
but assessment of their effectiveness is methodologically challenging.
Aim: To assess the effectiveness of national and regional interventions undertaken between 2004 and 2008
on rates of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-sensitive Staphylococcus aureus
(MSSA) bacteraemia within acute hospitals in the East Midlands, using interrupted time-series analysis.
Methods: We used segmented regression to compare rates of MRSA and MSSA bacteraemia in the preintervention, implementation, and post-intervention phases for combined intervention packages in eight acute
hospitals.
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Findings: Most of the change in MSSA and MRSA rates occurred during the implementation phase. During
this phase, there were significant downward trends in MRSA rates for seven of eight acute hospital groups; in
four, this was a steeper quarter-on-quarter decline compared with the pre-intervention phase, and, in one, an
upward trend in the pre-intervention phase was reversed. Regarding MSSA, there was a significant positive
effect in four hospital groups: one upward trend during the pre-intervention phase was reversed, two upward
trends plateaued, and in one hospital group an indeterminate trend decreased significantly. However, there
were significant increasing trends in quarterly MSSA rates in four hospital groups during the implementation
or post-intervention periods.
Conclusion: The impact of interventions varied by hospital group but the overall results suggest that national
and regional campaigns had a beneficial impact on MRSA and MSSA bacteraemia within the East Midlands.
NosoBase ID notice : 393699
Mortalité attribuable aux bactériémies associées aux voies centrales : revue systématique et métaanalyse
Ziegler MJ; Pellegrini DC; Safdar N. Attributable mortality of central line associated bloodstream infection:
systematic review and meta-analysis. Infection 2015/02; 43(1): 29-36.
Mots-clés : MORTALITE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; META-ANALYSE
Purpose: To identify the attributable mortality of central line associated blood stream infections (CLABSI)
through meta-analysis.
Methods: Meta-analysis of case control and cohort studies, matched and unmatched, that reported on
mortality of patients with and without CLABSI was performed. MEDLINE, CENTRAL, CINAHL were searched.
Non-interventional studies of all languages that reported mortality in patients with CLABSI were included.
Data were extracted on patient population, study setting, design, diagnostic criteria for CLABSI, and mortality.
Results from studies comparing mortality due to CLABSI were pooled using a random effects model with
assessment of heterogeneity. Heterogeneity of studies was assessed with an I (2) statistic and a funnel plot
was generated to assess for publication bias.
Results: Eighteen studies were included with 1,976 CLABSI cases. Of the included studies, 17 took place in
intensive care unit settings, most involved a mixed population of medical and surgical patients, and ten were
matched using an illness severity index. Our findings show an odds ratio of in hospital death associated with
CLABSI as 2.75 (CI 1.86-4.07) and 1.51 (CI 1.08-2.09) in the subgroup of the ten matched studies. Those
studies where greater than 30 % of CLABSI were attributed to coagulase-negative Staphylococcus had an
odds ratio of death of 1.64 (95 % CI 1.02-2.65) compared with 4.71 (95 % CI 1.54-14.39).
Conclusions: CLABSI is associated with a significantly increased risk of death supporting the use of extensive
efforts to reduce these infections.
Chirurgie
NosoBase ID notice : 393761
Actualisation des preuves sur la prévention des infections du site opératoire
Leaper D; Ousey K. Evidence update on prevention of surgical site infection. Current opinion in infectious
diseases 2015/04; 28(2): 158-163.
Mots-clés : REVUE DE LA LITTERATURE; PREVENTION; ANTISEPTIQUE; ANTIBIOPROPHYLAXIE;
CHIRURGIE; PANSEMENT; EFFICACITE; PREUVE; MEDECINE FACTUELLE
Purpose of review: Surgical site infection (SSI) is a common healthcare-associated infection and complicates
up to 10-20% of operations with considerable strain on healthcare resources. Apart from the widely adopted
use of appropriate hair removal, antibiotic prophylaxis, avoidance of hypothermia and perioperative glycaemic
control to reduce SSIs, this review has considered new research and systematic reviews, and whether their
findings should be included in guidelines.
Recent findings: The efficacy of preoperative bathing/showering, antibiotic prophylaxis for clean surgery and
perioperative oxygen supplementation to reduce the risk of SSI is still in doubt. By contrast, the use of 2%
chlorhexidine in alcohol skin preparation, postoperative negative pressure wound therapy and antiseptic
surgical dressings do show promise. Antimicrobial sutures in independent meta-analyses were found to
reduce the risk of SSI after all classes of surgery (except dirty) whereas the use of wound guards, or
diathermy skin incision (compared with scalpel incision), did not.
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Summary: The incidence of SSI after surgery is not falling. Based on this review of published trials and
evidence-based systematic reviews some advances might be included into these care bundles. More
research is needed together with improved compliance with care bundles.
NosoBase ID notice : 393282
Stratification du risque d’infections du site opératoire en fonction des facteurs de risque liés à
l’intervention et comparaison des taux d’infections après réparation chirurgicale de hernie
Olsen MA; Nickel KB; Wallace AE; Mines D; Fraser VJ; Warren DK. Stratification of surgical site infection by
operative factors and comparison of infection rates after hernia repair. Infection control and hospital
epidemiology 2015/03; 36(3): 329-335.
Mots-clés : CHIRURGIE; CHIRURGIE DIGESTIVE; INFECTION NOSOCOMIALE; TAUX; INCIDENCE;
FACTEUR DE RISQUE; ETUDE RETROSPECTIVE
Objective: To investigate whether operative factors are associated with risk of surgical site infection (SSI)
after hernia repair.
Design: Retrospective cohort study. Patients Commercially insured enrollees aged 6 months-64 years with
International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural
Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair
procedures from January 1, 2004, through December 31, 2010.
Methods: SSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact
tests were used to compare SSI incidence by operative factors.
Results: A total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly
by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and
4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was
significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524],
P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI
was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis
for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355]
vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16%
[491/11,805], P=.645).
Conclusions: The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia
repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may
facilitate accurate comparison of SSI rates between facilities.
Clostridium difficile
NosoBase ID notice : 393710
Prévalence des infections à Clostridium difficile chez les patients hospitalisés avec une diarrhée :
résultats d'une étude française prospective multicentrique
Barbut F; Ramé L; Petit A; Suzon L; de Chevigny A; Eckert C. Prévalence des infections à Clostridium difficile
chez les patients hospitalisés avec une diarrhée : résultats d'une étude française prospective multicentrique.
La Presse médicale 2015/02/27; in press: e1-e9.
Mots-clés : CLOSTRIDIUM DIFFICILE; DIARRHEE; ANALYSE MULTICENTRIQUE; PREVALENCE;
SELLES; INCIDENCE
Introduction : Les infections digestives à Clostridium difficile (CD) représentent la principale cause de
diarrhées associées aux soins chez l'adulte. L'objectif de l'étude était de déterminer l'incidence des infections
à C. difficile (ICD) en 2012 et d'évaluer l'ampleur du sous-diagnostic en France.
Méthodes : Soixante-dix établissements de santé (ES) répartis sur l'ensemble du territoire ont participé à une
étude de prévalence bi-annuelle. Chaque ES a systématiquement adressé au centre national de référence
(CNR) C. difficile, toutes les selles diarrhéiques de patients hospitalisés reçues au laboratoire au cours de 2
journées (un jour en décembre 2012 et un jour en juillet 2013), indépendamment de la prescription médicale
de la recherche de CD. L'analyse des selles au CNR a été réalisée par le test Quik Chek Complete ® (Alere).
Les selles positives en Glutamate déshydrogénase (GDH) ou en toxines ont été cultivées sur milieu sélectif
Taurocholate, Cyclosérine, Céfoxitine, Agar (TCCA) et les souches isolées ont été caractérisées par PCR visà-vis des toxines A et B. Les résultats obtenus par le CNR ont été confrontés à ceux obtenus par chaque
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laboratoire participant. Un questionnaire a permis de recueillir les données d'incidence des ICD en 2012 de
chaque ES.
Résultats : L'incidence moyenne des ICD rapportées en 2012 par les ES participants était de 3,6 ± 2,9 pour
10000 patients-jours; l'incidence était positivement corrélée à la densité de prescription (nombre de tests
réalisés pour 10000 patients-jours) qui variait largement d'un ES à l'autre (médiane 29 pour 10000 patientsjours;IQR19-50). Lors de l'enquête de prévalence bi-annuelle, 651 selles ont été analysées et 90 se sont
révélées positives à CD en culture. La prévalence globale des patients infectés par CD toxinogène était de
9,7 % (63/651) et celle des patients colonisés à CD non toxinogène était de 4,2 % (27/651). Parmi les ICD
diagnostiquées par le CNR, 35/63 (55,6 %) ne l'ont pas été par les laboratoires participants, soit par manque
de sensibilité des méthodes utilisées (16/63, 25,4 %) soit par manque de suspicion clinique (19/63, 30,2 %).
Conclusion : L'incidence des ICD en France en 2012 est en augmentation par rapport à 2009 mais reste
largement sous-estimée par un défaut de sensibilité des tests utilisés et par un manque de suspicion clinique.
NosoBase ID notice : 394259
Comment éradiquer Clostridium difficile de l’environnement
Barbut F. How to eradicate Clostridium difficile from the environment. The journal of hospital infection
2015/04; 89(4): 287-295.
Mots-clés : CLOSTRIDIUM DIFFICILE; ERADICATION; ENVIRONNEMENT; TRANSMISSION;
RECOMMANDATIONS DE BONNE PRATIQUE; DESINFECTION; ULTRA-VIOLET; PEROXYDE
D'HYDROGENE
During the last decade, Clostridium difficile has emerged as a major cause of healthcare-associated
diarrhoea and death. Transmission of this spore-forming bacterium is thought to occur via the hands of
healthcare providers or via the contaminated environment. Therefore, enhanced environmental
cleaning/disinfection of the rooms housing C. difficile-infected patients is warranted. Guidelines from various
scientific bodies have been published. They recommend performing environmental decontamination of rooms
of patients with C. difficile infection (CDI) using hypochlorite (diluted 1/10) or a sporicidal product. Compliance
with cleaning and disinfection is a critical point and is often suboptimal. Novel 'no-touch' methods for room
disinfection have recently been introduced. Ultraviolet (UV) light or hydrogen peroxide systems are most
widely used. In-vitro studies suggest that hydrogen peroxide vapour (from 30% hydrogen peroxide) methods
achieve a >6 log10 reduction in C. difficile spores placed on carriers, and that aerosolized hydrogen peroxide
systems (from 5% to 6% hydrogen peroxide) achieve ~4 log10 reduction, whereas UV-based methods
achieve ~2 log10 reduction. Very few studies have assessed the impact of these devices on the transmission
of C. difficile. Major limitations of these devices include the fact that they can only be used after the patient's
discharge, because patients and staff must be removed from the room. The new no-touch methods for room
disinfection supplement, but do not replace, daily cleaning.
NosoBase ID notice : 394302
Réduction de la contamination environnementale à Clostridium difficile par des patients traités par
fidaxomicine
Biswas J; Patel S; Otter A; Wade JA; Newsholme P; van Kleef W; et al. Reduction in Clostridium difficile
environmental contamination by hospitalized patients treated with fidaxomicin. The journal of hospital
infection 2015/02/09; in pres: 1-4.
Mots-clés : CLOSTRIDIUM DIFFICILE;
ANTIBIOTIQUE; SPORICIDIE; SURFACE
PREVENTION;
ENVIRONNEMENT;
CONTAMINATION;
Fidaxomicin is sporicidal and may be associated with a reduced time to resolution of diarrhoea when used to
treat patients with Clostridium difficile infection (CDI). This study investigated whether fidaxomicin for
treatment of all patients with CDI reduced C. difficile environmental contamination. Surfaces in the rooms of
66 hospitalized patients treated with metronidazole and/or vancomycin and 68 hospitalized patients treated
with fidaxomicin were sampled. Patients treated with fidaxomicin were less likely to contaminate their
environment (25/68, 36.8%) than patients treated with metronidazole and/or vancomycin (38/66 57.6%)
(P=0.02). Treatment with fidaxomicin was associated with reduced environmental contamination with C.
difficile.
NosoBase ID notice : 393274
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Gravité des infections à Clostridium difficile et évolution clinique des patients infectés par la souche
NAP1/BI/027 hors cadre épidémique
Scardina T; Labuszewski L; Pacheco SM; Adams W; Schreckenberger P; Johnson S. Clostridium difficile
infection (CDI) severity and outcome among patients infected with the NAP1/BI/027 strain in a non-epidemic
setting. Infection control and hospital epidemiology 2015/03; 36(3): 280-286.
Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION; GRAVITE; PCR; AGE; GERIATRIE; FACTEUR DE
RISQUE; TRAITEMENT
Objective: Determine whether the NAP1 strain identified by polymerase chain reaction (PCR)-based stool
assay is correlated with CDI severity and clinical outcomes.
Methods: Medical records of adult patients with positive stool Xpert® Clostridium difficile PCR assay for an
initial episode of CDI between January 2012 and January 2013 at a tertiary care hospital in Chicago were
reviewed. Two patients diagnosed with CDI caused by a non-NAP1 strain (positive Xpert® C. difficile assay
but negative Xpert® C. difficile Epi assay) were included for each patient diagnosed with CDI caused by a
NAP1 strain (positive Epi assay). Patient charts were reviewed for markers of severity, risk factors, treatment
regimens, and outcomes.
Results: Of 494 stool specimens, 90 (18%) that were positive for C. difficile by PCR were positive for NAP1
strain. In total, 37 patients with CDI due to NAP1 were matched with 74 patients with CDI due to non-NAP1
strains. Multivariable model revealed individuals ≥65 years old were 3 times more likely to have NAP1 strain
than individuals <65 (P=.02). Residents of a nursing home prior to hospitalization were 10 times more likely to
have NAP1 strain than patients residing in their homes (P=.001). More NAP1 cases had a change in
treatment from metronidazole to oral vancomycin plus intravenous metronidazole (P=.01). The severity of
CDI, incidence of mortality and recurrent CDI were similar between groups.
Conclusions: In a nonepidemic setting, NAP1 strains were more common in older patients and individuals
admitted from nursing homes. Identification of NAP1 by PCR of stool specimens was associated in a change
of therapy but did not predict worse outcomes. Reporting strain results may not be clinically useful in routine
settings.
NosoBase ID notice : 393273
La récurrence d’une infection à Clostridium difficile chez des patients en soins intensifs est un
facteur prédictif fort d’une ré-hospitalisation dans les 30 jours
Zilberberg M; Shorr AF; Micek ST; Kollef MH. Clostridium difficile recurrence is a strong predictor of 30-day
rehospitalization among patients in intensive care. Infection control and hospital epidemiology 2015/03; 36(3):
273-279.
Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION; FACTEUR DE RISQUE; ADMISSION; SOIN
INTENSIF; ETUDE RETROSPECTIVE; COHORTE
Objective: While incidence, mortality, morbidity, and recurrence rates of C. difficile infection (CDI) among the
critically ill have been investigated, the impact of its recurrence on 30-day rehospitalization (ReAd), an
important policy focus, has not been examined.
Design: Secondary analysis of a multicenter retrospective cohort study Patients Adult critically ill patients who
survived their index hospitalization complicated by CDI METHODS: CDI was defined by diarrhea or
pseudomembranous colitis and a positive assay for C. difficile toxins A and/or B. CDI recurrence (rCDI) was
defined as diarrhea, positive C. difficile toxin and need for retreatment after cessation of therapy. Descriptive
statistics and a logistic regression examined ReAd rates and characteristics, and factors that impact it.
Results: Among 287 hospital survivors, 76 (26.5%) required ReAd (ReAd+). At baseline, the ReAd+ group did
not differ significantly from the ReAd- group based on demographics, comorbidities, APACHE II scores, or
ICU type. ReAd+ patients were more likely to have hypotension at CDI onset (48.7% vs 34.1%, P=.025) and
to require vasopressors (40.0% vs 27.1%, P=.038); they were less likely to require mechanical ventilation
(56.0% vs 77.3%, P<.001). A far greater proportion of ReAd+ than ReAd- had developed a recurrence either
during the index hospitalization or within 30 days after discharge (32.89% vs 2.84%, P<.001). In a logistic
regression, rCDI was a strong predictor of ReAd+ (adjusted odd ratio, 15.33, 95% confidence interval, 5.6841.40).
Conclusions: Greater than 25% of all survivors of critical illness complicated by CDI require readmission
within 30 days of discharge. CDI recurrence is a strong predictor of such rehospitalizations.
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Ebola
NosoBase ID notice : 393749
Vaccination post-exposition en urgence après exposition au sang à l’aide d’un vaccin contre Ebola
utilisant des virus de la stomatite vésiculaire
Lai L; Davey R; Beck A; Xu Y; Suffredini AF; Palmore T; et al. Emergency postexposure vaccination with
vesicular stomatitis virus-vectored Ebola vaccine after needlestick. JAMA, the journal of the American Medical
Association 2015/03/24; 313(12): 1249-1255.
Mots-clés : URGENCES HOSPITALIERES; VACCIN; ACCIDENT D'EXPOSITION AU SANG; FIEVRE
HEMORRAGIQUE; EBOLA
NosoBase ID notice : 394305
Infections aux virus Ebola en Afrique : épidémiologie et transmission nosocomiale
Shears P; O'Dempsey TD. Ebola virus disease in Africa: epidemiology and nosocomial transmission. The
journal of hospital infection 2015/01/20; in press: 1-9.
Mots-clés : EPIDEMIOLOGIE; TRANSMISSION; VIRUS; FIEVRE HEMORRAGIQUE;
MORTALITE; RISQUE; REVUE DE LA LITTERATURE; PREVENTION; EBOLA
EPIDEMIE;
The 2014 Ebola outbreak in West Africa, primarily affecting Guinea, Sierra Leone, and Liberia, has exceeded
all previous Ebola outbreaks in the number of cases and in international response. There have been 20
significant outbreaks of Ebola virus disease in Sub-Saharan Africa prior to the 2014 outbreak, the largest
being that in Uganda in 2000, with 425 cases and a mortality of 53%. Since the first outbreaks in Sudan and
Zaire in 1976, transmission within health facilities has been of major concern, affecting healthcare workers
and acting as amplifiers of spread into the community. The lack of resources for infection control and personal
protective equipment are the main reasons for nosocomial transmission. Local strategies to improve infection
control, and a greater understanding of local community views on the disease, have helped to bring outbreaks
under control. Recommendations from previous outbreaks include improved disease surveillance to enable
more rapid health responses, the wider availability of personal protective equipment, and greater international
preparedness.
EHPAD
NosoBase ID notice : 394320
Qualité de l’air intérieur, ventilation et santé sur le plan respiratoire de residents âgés vivant en
EHPAD en Europe
Bentayeb M; Norback D; Bednarek M; Bernard A; Cai G; Cerrai S; et al. Indoor air quality, ventilation and
respiratory health in elderly residents living in nursing homes in Europe. The European respiratory journal
2015/03/11; in press: 1-11.
Mots-clés : ETUDE MULTICENTRIQUE; EHPAD; PERSONNE AGEE; AIR; QUALITE; GERIATRIE;
APPAREIL RESPIRATOIRE; ENVIRONNEMENT; TAUX
Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context
of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity
among elderly people permanently living in nursing homes in seven European countries. 600 elderly people
from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air
quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations
of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity
ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of
<0.1 µm (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1).
Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.152.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and
aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1
(aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide
with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively).
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Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely
related to wheeze in the past year and usual cough. Elderly subjects aged ⩾80 years were at higher risk.
Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality
affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with
age. The effects were modulated by ventilation.
NosoBase ID notice : 393646
Porteurs asymptomatiques de Clostridium difficile toxinogène dans des EHPAD : méta-analyse de la
prévalence et des facteurs de risque
Ziakas PD; Zacharioudakis IM; Zervou FN; Grigoras C; Pliakos EE; Mylonakis E. Asymptomatic carriers of
toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors. PLoS One
2015/02/23; 10(2): 1-14.
Mots-clés : CLOSTRIDIUM DIFFICILE; COLONISATION; PREVALENCE; FACTEUR DE RISQUE; METAANALYSE; EPIDEMIOLOGIE; EHPAD; PERSONNE AGEE
Background: The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately
explored. As a result, asymptomatic carriage is not considered in the development of infection control policies
and the burden of carrier state in long-term care facilities (LTCFs) is unknown.
Purpose: To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and
describe its impact on healthcare management.
Data sources: PubMed, Embase and Web of Science (up to June 2014) without language restriction,
complemented by reference lists of eligible studies.
Study selection: All studies providing extractable data on the prevalence of toxigenic C. difficile colonization
among asymptomatic residents in LTCFs.
Data extraction: Two authors extracted data independently.
Statistical methods: The pooled colonization estimates were calculated using the double arcsine methodology
and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird
weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were
reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective
reproduction number R through a Monte Carlo technique.
Results: Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we
found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile.
Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p=0.01).
Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR
2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68;
95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate
at admission was 8.9%.
Conclusion: Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is
associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use.
These findings can impact infection control measures at LTCFs.
Environnement
NosoBase ID notice : 394221
Evaluation du contact manuel des surfaces fréquemment touchées et des surfaces mutuellement
touchées par le personnel de santé, les patients et les visiteurs
Cheng VC; Chau PH; Lee WM; Ho SK; Lee DW; So SY; et al. Hand-touch contact assessment of high-touch
and mutual-touch surfaces among healthcare workers, patients, and visitors. The journal of hospital infection
2015/03/06; in press: 1-18.
Mots-clés : SURFACE; PERSONNEL; USAGER DE LA SANTE; ENVIRONNEMENT; TRANSMISSION;
CENTRE HOSPITALIER UNIVERSITAIRE; LIT; CHAMBRE DU MALADE; VISITE AUX HOSPITALISES;
ETUDE D'OBSERVATION
Background: Unlike direct contact with patients’ body, hand hygiene practice is often neglected by healthcare
workers (HCWs) and visitors after contact with patients’ environment. Contact with hospital environmental
items may increase risk of pathogen transmission.
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Aim: To enumerate the number of hand-touch contacts by patients, HCWs and visitors with any hospital
environmental items.
Methods: All contact-episodes between person and item were recorded by direct observation in a six-bed
cubicle of acute wards for 33 working days. High-touch and mutual-touch items with high contact frequencies
by HCWs, patients, and visitors were analysed.
Findings: In total, 1107 person-episodes with 6144 contact-episodes were observed in 66 observation hours
(average: 16.8 person-episodes and 93.1 contact-episodes per hour). Eight of the top 10 high-touch items,
including bedside rail, bedside table, patients’ bodies, patients’ files, linen, bed curtain, bed frame, and locker
were mutually touched by HCWs, patients, and visitors. Bedside rail topped the list with 13.6 contactepisodes per hour (mean), followed by bedside table (12.3 contact-episodes per hour). Using patients’ body
contacts as a reference, it was found that medical staff and nursing staff contacted bedside table [rate ratio
(RR): 1.741, 1.427, respectively] and patients’ file (RR: 1.358, 1.324, respectively) more than patients’ bodies,
and nursing staff also contacted bedside rails (RR: 1.490) more than patients’ body.
Conclusion: Patients’ surroundings may be links in the transmission of nosocomial infections because many
are frequently touched and mutually contacted by HCWs, patients, and visitors. Therefore, the focus of hand
hygiene education, environmental disinfection, and other system changes should be enhanced with respect
to high-touch and mutual-touch items.
Epidémie
NosoBase ID notice : 394478
Emergence d’une souche clonale de Providencia stuartii productrice de VIM-1 panrésistante aux
antibiotiques responsable d’une épidémie dans une unite de reanimation en Grèce
Douka E; Perivolioti E; Kraniotaki E; Fountoulis K; Economidou F; Tsakris A; et al. Emergence of a pandrugresistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek intensive care
unit. International journal of antimicrobial agents 2015/02/16; in press: 1-4.
Mots-clés : SOIN INTENSIF; BACILLE GRAM NEGATIF; PROVIDENCIA; EPIDEMIE; PFGE;
TRANSMISSION; CONTROLE; CENTRE HOSPITALIER UNIVERSITAIRE; ANTIBIORESISTANCE;
TYPAGE; BIOLOGIE MOLECULAIRE; MULTIRESISTANCE; PROVIDENCIA STUARTII|
Here we describe an outbreak caused by a pandrug-resistant Providencia stuartii strain involving 15 critically
ill patients in a Greek intensive care unit (ICU) during September-November 2011. All isolates harboured the
blaVIM-1 gene and a class 1 integron structure of 1913 bp as well as blaSHV-5 and blaTEM-1. Pulsed-field
gel electrophoresis (PFGE) demonstrated that isolates from all 15 patients belonged to a single P. stuartii
clonal type. As all of the infected patients were hospitalised during overlapping time periods, horizontal intraICU transmission was considered as the main route for the dissemination of the outbreak strain. The outbreak
ended following reinforcement of infection control measures, including implementation of additional barrier
precautions for infected patients.
NosoBase ID notice : 394289
Défis pour le contrôle d’une vaste épidémie à Klebsiella pneumonia productrices de carbapénèmase
type OXA-48 dans un centre hospitalier universitaire en France
Semin-Pelletier B; Cazet L; Bourigault C; Juvin ME; Boutoille D; Raffi F; et al. Challenges of controlling a
large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae in a French university hospital.
The journal of hospital infection 2015/04; 89(4): 248-253.
Mots-clés :
KLEBSIELLA
PNEUMONIAE;
CONTROLE;
EPIDEMIE;
ANTIBIORESISTANCE;
CARBAPENEME; CENTRE HOSPITALIER UNIVERSITAIRE; DEPISTAGE; COLONISATION DIGESTIVE;
INFECTIOLOGIE;
MEDECINE
INTERNE;
PERSONNEL;
ENQUETE;
NEPHROLOGIE;
TRANSPLANTATION; PRECAUTION STANDARD; CARBAPENEMASE
A large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae at Nantes University Hospital
was investigated. The index case had no history of travel or hospitalization abroad and had been hospitalized
in the internal medicine department for more than one month when the epidemic strain was isolated from a
urine sample in June 2013. Seventy-two secondary cases were detected by weekly screening for
gastrointestinal colonization during the two phases of the outbreak from June to October 2013 (33 cases) and
from November 2013 to August 2014 (39 cases). Spread of the epidemic strain was attributed to the proximity
of, and staff movement between, the infectious diseases (32 cases) and the internal medicine (26 cases)
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departments; 14 secondary cases were also observed in the renal transplant department following the
transfer of an exposed patient from the infectious diseases department. Most of the patients (90%) were
colonized and no death was linked to the epidemic strain. More than 3000 contact patients were reviewed
and 6000 rectal swabs were performed. Initial control measures failed to control the outbreak owing to the
late detection of the index case. The late implementation of three successive cohort units, the large number of
transfers between wards, and the frequent readmission of cases contributed to the incomplete success of
control measures.
Grippe
NosoBase ID notice : 394306
Tests rapides au lit du patient pour le diagnostic, la prise en charge et la prévention de la grippe
nosocomiale
Bouscambert M; Valette M; Lina B. Rapid bedside tests for diagnosis, management, and prevention of
nosocomial influenza. The journal of hospital infection 2015/04; 89(4): 314-318.
Mots-clés : GRIPPE; DIAGNOSTIC BIOLOGIQUE; PREVENTION; EPIDEMIOLOGIE; VIRUS; ANTIVIRAL;
TRANSMISSION
Like other respiratory viruses, influenza is responsible for devastating nosocomial epidemics in nursing
homes as well as in conventional wards and emergency departments. Patients, healthcare workers, and
visitors may be the source of nosocomial influenza. Despite their limited sensitivity, rapid diagnostic tests for
influenza can be of real value; they enable early introduction of measures to prevent spread and early specific
antiviral treatment of cases. However, these tests cannot detect oseltamivir resistance, susceptibility testing
being carried out only in specialist laboratories. Although resistance is rare, it can emerge during treatment,
especially of very young children or immunocompromised patients. In the latter, the shedding of resistant
influenza virus can last several weeks. Sporadic instances of nosocomial transmission among
immunocompromised patients have been reported. The limitations of bedside tests for influenza make them
unsuitable for use as stand-alone diagnostic tools. However, their limitations do not preclude their use for
detection and subsequent management of nosocomial influenza, for which they are rapid, easy, and costeffective. Recent developments in these tests look promising, offering prospects of increased sensitivity,
increased specificity, and screening for antiviral susceptibility.
NosoBase ID notice : 393265
Facteurs cliniques prédictifs des infections au virus de la grippe confirmées par le laboratoire :
évaluer les définitions de cas des syndromes pseudo-grippaux
Shah SC; Rumoro DP; Hallock M; Trenholme GM; Gibbs GS; Silva JC; et al. Clinical predictors for laboratoryconfirmed influenza infections: exploring case definitions for influenza-like illness. Infection control and
hospital epidemiology 2015/03; 36(3): 241-248.
Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; LABORATOIRE; URGENCES HOSPITALIERES;
DEFINITION; HYPERTHERMIE; TOUX; MYALGIE; NEZ; AGE; PRELEVEMENT; ETUDE RETROSPECTIVE
Objective: To identify clinical signs and symptoms (ie, "terms") that accurately predict laboratory-confirmed
influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for
detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint
improves the accuracy of predicting influenza.
Design: Retrospective, cross-sectional study.
Setting: Large urban academic medical center hospital.
Participants: A total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab
followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28,
2010, and March 26, 2011.
Methods: An electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR)
and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic
regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.
Results: The best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever
(DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included
combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%-92% and
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Avril 2015
specificity=38%-44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case
definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough
ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using
only the chief complaint data.
Conclusions: A simplified case definition of fever and cough may be suitable for implementation for all ages,
while inclusion of rhinorrhea may further improve influenza detection for the 0-4-year-old age group. Finally,
ILI surveillance based on the entire EMR is recommended.
NosoBase ID notice : 393266
Comparer la réponse immunitaire au vaccin contre la grippe du personnel soignant obèse à celle du
personnel soignant non-obèse
Sweet MA; McCullers JA; Lasala PR; Briggs FE; Smithmyer A; Khakoo RA. Comparison of immune response
to the influenza vaccine in obese and nonobese healthcare workers. Infection control and hospital
epidemiology 2015/03; 36(3): 249-253.
Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; PERSONNEL; VACCIN; IMMUNITE; OBESITE
Objective: To determine whether there is a difference in antibody titers and functionality after receipt of the
influenza vaccine for obese versus nonobese healthcare workers (HCW).
Design: Prospective observational study.
Setting: Tertiary medical center.
Participants: Healthcare workers.
Methods: Baseline influenza antibody titers for obese and nonobese HCW were recorded during the
hospital's 2011 annual influenza vaccination day and follow-up antibody titers were measured 4 weeks later.
Antibodies were measured using the hemagglutination inhibition assay and functionality was measured using
the micro-neutralization method.
Results: Of 200 initial HCWs, 190 completed the study (97 obese and 93 nonobese). Seroprotection after
immunization was not significantly different for nonobese compared with obese HCW for each strain
(influenza A [H1N1], 99% and 99%; influenza A [H3N2], 100% and 99%; and influenza B, 67% and 71%,
respectively) All geometric mean titers measured by micro-neutralization showed statistically significant
increases in activity. In comparison, there was no difference in the 4-fold increase in H1N1 or B titers. There
was a significant difference in the 4-fold increase of H3N2 titers between the nonobese and obese HCWs
(82/93 [88%] vs 64/97 [66%], P=.003) In an ad hoc analysis we found that obese HCWs had a statistically
greater number of 4-fold decreases in titers with H1N1 and H3N2.
Conclusions: There was no significant difference in protection from influenza between obese and nonobese
HCWs after immunization.
NosoBase ID notice : 394472
Immunisation contre la grippe par le vaccin ou politique du masque pour le personnel de santé :
strategies pour une mise en place coût-efficace et reductions subséquentes de l’abstentéisme du
personnel pour maladie
Van Buynder PG; Konrad S; Kersteins F; Preston E; Brown PD; Keen D; et al. Healthcare worker influenza
immunization vaccinate or mask policy: Strategies for cost effective implementation and subsequent
reductions in staff absenteeism due to illness. Vaccine 2015/03/24; 33(13): 1625-1628.
Mots-clés : PERSONNEL; GRIPPE; ETAT IMMUNITAIRE; VACCIN; MASQUE; COUT-EFFICACITE;
PREVENTION; COHORTE; ETUDE RETROSPECTIVE
Background: A new policy requiring staff in clinical areas to vaccinate or wear a mask was implemented in
British Columbia (BC) in the 2012/13 winter. This review assessed the impact of the policy on absenteeism in
health care workers.
Methods: A retrospective cohort study of full-time HCW that worked prior to and during the 2012/13 influenza
season in a health authority in BC. The rate of absenteeism due to all cause illness was compared between
vaccinated and unvaccinated staff controlling for behaviors outside influenza season.
Results: Of the 10079 HCW, 77% were vaccinated. By comparison to absenteeism rates in the pre-influenza
season, unvaccinated staff in winter had twice the increase in absenteeism due to all-cause illness than
vaccinated staff.
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Conclusion: After controlling for baseline differences between those vaccinated and unvaccinated, influenza
vaccination was associated with reduced absenteeism, saving the Health Authority substantial money. Having
regular staff in attendance increases the quality of care.
NosoBase ID notice : 393268
Utilisation combinée de données détaillées de contacts et de données virologiques pour étudier la
transmission de la grippe dans un centre hospitalo-universitaire
Voirin N; Payet C; Barrat A; Cattuto C; Khanafer N; Régis C; et al. Combining high-resolution contact data
with virological data to investigate influenza transmission in a tertiary care hospital. Infection control and
hospital epidemiology 2015/03; 36(3): 254-260.
Mots-clés : TRANSMISSION; GRIPPE; VIRUS INFLUENZA TYPE A; SUJET CONTACT; PRELEVEMENT;
PCR; BIOLOGIE MOLECULAIRE; TYPE DE DONNEE; PERSONNE AGEE; INFIRMIER; MEDECIN;
GERIATRIE; CENTRE HOSPITALIER UNIVERSITAIRE; VIRUS INFLUENZA TYPE B
Objective: Contact patterns and microbiological data contribute to a detailed understanding of infectious
disease transmission. We explored the automated collection of high-resolution contact data by wearable
sensors combined with virological data to investigate influenza transmission among patients and healthcare
workers in a geriatric unit.
Design: Proof-of-concept observational study. Detailed information on contact patterns were collected by
wearable sensors over 12 days. Systematic nasopharyngeal swabs were taken, analyzed for influenza A and
B viruses by real-time polymerase chain reaction, and cultured for phylogenetic analysis.
Setting: An acute-care geriatric unit in a tertiary care hospital.
Participants: Patients, nurses, and medical doctors.
Results: A total of 18,765 contacts were recorded among 37 patients, 32 nurses, and 15 medical doctors.
Most contacts occurred between nurses or between a nurse and a patient. Fifteen individuals had influenza A
(H3N2). Among these, 11 study participants were positive at the beginning of the study or at admission, and 3
patients and 1 nurse acquired laboratory-confirmed influenza during the study. Infectious medical doctors and
nurses were identified as potential sources of hospital-acquired influenza (HA-Flu) for patients, and infectious
patients were identified as likely sources for nurses. Only 1 potential transmission between nurses was
observed.
Conclusions: Combining high-resolution contact data and virological data allowed us to identify a potential
transmission route in each possible case of HA-Flu. This promising method should be applied for longer
periods in larger populations, with more complete use of phylogenetic analyses, for a better understanding of
influenza transmission dynamics in a hospital setting.
Hépatite
NosoBase ID notice : 393653
Identification, enquête de gestion de la transmission patient-patient d’hépatite B dans un service
d’hospitalisation en néphrologie du nord-ouest de l’Angleterre
Kliner M; Dardamissis E; Abraham KA; Sen R; Lal P; Pandya B; et al. Identification, investigation and
management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West
England. Clinical kidney journal 2015/02; 8(1): 102-106.
Mots-clés : HEPATITE B; TRANSMISSION; TRANSMISSION SOIGNE-SOIGNE; NEPHROLOGIE;
ENQUETE; CONTAMINATION; ENVIRONNEMENT; DISPOSITIF MEDICAL; VACCIN
Background: Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries.
The aim of the article is to outline the process of identification and management of transmission of acute
hepatitis B in a renal inpatient ward.
Methods: The case was identified through routine reporting to public health specialists, and epidemiological,
virological and environmental assessment was undertaken to investigate the source of infection. An audit of
HBV vaccination in patients with chronic kidney disease was undertaken.
Results: Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a
source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in
infection control leading to a contaminated environment and blood glucose testing equipment, failure to
isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease
may have contributed to the transmission.
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Conclusions: Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the
UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection
control, including reducing multi-function use of wards, developing policies for non-compliant patients,
improving cleaning policies and implementing competency assessment for glucometer use and
decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV.
Consistent national guidance should be available, and clear pathways should be in place between primary
and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.
Hygiène des mains
NosoBase ID notice : 393278
Facteurs modifiant l’évaluation des produits de friction hydro-alcoolique dans les essais de terrain
Girard R; Carré E; Mermet V; Adjidé CC; Blaise S; Dagain M; et al. Factors influencing field testing of alcoholbased hand rubs. Infection control and hospital epidemiology 2015/03; 36(3): 302-310.
Mots-clés : HYGIENE DES MAINS; PRODUIT HYDROALCOOLIQUE; TRAITEMENT HYGIENIQUE DES
MAINS PAR FRICTION; PRATIQUE; PERSONNEL; TOLERANCE; PEAU; MAIN
Background: According to the World Health Organization guidelines, field tests, in the context of a bid for the
supply of alcohol-based hand rubs, should take into account climatic region, test period, products already in
use, and type of use (hygienic or surgical) when assessing tolerance. This laborious method is often
contested.
Objective: To conduct a post hoc analysis of the data of a large bid, including 5 factors, to validate the
relevance of their inclusion.
Methods: For the purposes of the bid, products were compared in terms of the 4 World Health Organization
tolerance criteria (appearance, intactness, moisture content, sensation) during product testing and were
separated into groups on the basis of the studied factors. The post hoc analysis method included (1)
comparison of the mean before-and-after difference based on the self-evaluation of the skin with the 4 World
Health Organization tolerance criteria, between climatic regions, periods, products in use, test product, and
the type of use; (2) generalized linear models, taking into account all studied factors.
Results: The analysis included data for 1,925 pairs of professionals. The means of the differences observed
were independently and significantly associated with the test period (P<.001), the hygienic or surgical use
(P=.010 to .041, not significant for appearance), the product already in use (significant for appearance
P=.021), and the test product (P<.001). The association with climatic region was found to be significant only
in the nonadjusted analysis.
Conclusion: The type of use, the test period, and the product in use should be taken into account when
designing field tests of alcohol-based hand rubs.
NosoBase ID notice : 393630
Erreurs dans les pratiques de l’hygiène des mains en Ukraine : détection, conséquences et voies
d’élimination
Klymenko I; Kampf G. Systemic mistakes in hand hygiene practice in Ukraine: detection, consequences and
ways of elimination. GMS Hygiene and infection control 2015/01/14; 10: 1-9.
Mots-clés : HYGIENE DES MAINS; PRATIQUE; OBSERVANCE; ATTITUDE; TRAVAIL; PERSONNEL;
ETUDE D'OBSERVATION
Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable
part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to
reduce the level of infection. We evaluated various aspects related to the situational behavior and
prioritization regarding hand hygiene measures among the healthcare workers of Ukraine.
Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect
observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as
during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the
level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315
master-classes and presentations on proper hand hygiene were realized. The target audience included health
care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of
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pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took
part in anonymous survey on hand hygiene practice.
Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash
hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand
hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and
pharmaceutical industry workers highlighted the need for practical and understandable instructions of various
hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground
for us to create individual master classes on hand hygiene for each cluster of healthcare workers.
Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical
practice and by involving healthcare workers in teaching and training.
Infection fongique
NosoBase ID notice : 393281
Les transferts intra-hospitaliers sont des facteurs de risque d’infection fongique filamenteuse
invasive pour les patients atteints de cancers hématologiques : une étude cas-témoin appariée
Gayet-Ageron A; Iten A; van Delden C; Farquet N; Masouridi-Levrat S; Von Dach E; et al. In-hospital transfer
is a risk factor for invasive filamentous fungal infection among hospitalized patients with hematological
malignancies: a matched case-control study. Infection control and hospital epidemiology 2015/03; 36(3): 320328.
Mots-clés : DEFICIT IMMUNITAIRE; CANCER; HEMATOLOGIE; INFECTION NOSOCOMIALE;
MYCOLOGIE; CHAMPIGNON FILAMENTEUX; TRANSFERT; COULOIR; ETUDE RETROSPECTIVE;
EPIDEMIE; MORTALITE
Objective: Immunocompromised patients now benefit from a longer life expectancy due to advanced medical
techniques, but they are also weakened by aggressive treatment approaches and are at high risk for invasive
fungal disease. We determined risk factors associated with an outbreak of invasive filamentous fungal
infection (IFFI) among hospitalized hemato-oncological patients.
Methods: A retrospective, matched, case-control study was conducted between January 1, 2009, and April
31, 2011, including 29 cases (6 proven, 8 probable, and 15 possible) of IFFI and 102 matched control
patients hospitalized during the same time period. Control patients were identified from the hospital electronic
database. Conditional logistic regression was performed to identify independent risk factors for IFFI.
Results: Overall mortality associated with IFFI was 20.7% (8.0%-39.7%). Myelodysplastic syndrome was
associated with a higher risk for IFFI compared to chronic hematological malignancies. After adjustment for
major risk factors and confounders, >5 patient transfers outside the protected environment of the hematology
ward increased the IFFI risk by 6.1-fold. The risk increased by 6.7-fold when transfers were performed during
neutropenia.
Conclusion: This IFFI outbreak was characterized by a strong association with exposure to the unprotected
environment outside the hematology ward during patient transfer. The independent associations of a high
number of transfers with the presence of neutropenia suggest that affected patients were probably not
sufficiently protected during transport in the corridors. Our study highlights that a heightened awareness of
the need for preventive measures during the entire care process of at-risk patients should be promoted
among healthcare workers.
Infection urinaire
NosoBase ID notice : 394206
Contrôle des infections urinaires associées au cathétérisme vésical intermittent dans des centres
hospitaliers gériatriques
Girard R; Gaujard S; Pergay V; Pornon P; Martin Gaujard G; Vieux C; et al. Controlling urinary tract infections
associated with intermittent bladder catheterization in geriatric hospitals. The journal of hospital infection
2015/03/05; in press: 1-26.
Mots-clés : INFECTION URINAIRE; GERIATRIE; PERSONNE AGEE; SONDAGE URINAIRE; SONDAGE
EVACUATEUR; CONTROLE; EPIDEMIOLOGIE; ETUDE PROSPECTIVE; CATHETER; ETUDE
MULTICENTRIQUE; PERSONNEL; INCIDENCE; CONNAISSANCE; PRATIQUE; COHORTE
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Background: Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric
patients.
Aim: After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group
implemented and evaluated corrective measures.
Methods: In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors
and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was
administered to physicians and nurses working in these geriatric units. In 2011, the working group developed
a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and
indications for catheter drainage; limit available medical devices; and improve prescription and traceability
procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was
repeated in 2012 to assess the impact of the programme.
Findings: Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%.
The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters
(29.7 vs 9.9 UTI per 100 patients, P=0.1013) which contradicts the literature. In 2010, the 269 responses to
the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff
had poor knowledge of the recommended indications and techniques, and the equipment varied widely
between units. Following implementation of the programme, the study was repeated in 2012 with over 1500
patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature.
Conclusion: Multi-modal programmes are an effective means to control UTI.
Légionellose
NosoBase ID notice : 395009
Légionellose en France
Campese C; Descours G; Lepoutre A; Beraud L; Maine C; Che D; et al. Legionnaires’ disease in France.
Médecine et maladies infectieuses 2015/03; 45(3): 65-71.
Mots-clés :
LEGIONELLA;
CONNAISSANCE;
CONTAMINATION; CONTROLE; PREVENTION
EPIDEMIOLOGIE;
DIAGNOSTIC
BIOLOGIQUE;
Cet article avait pour objectif d’effectuer une synthèse sur les connaissances actuelles de la légionellose
illustrées par le bilan épidémiologique en France en 2013. La légionellose est une pneumopathie souvent
sévère due en majorité aux bactéries Legionella pneumophila sérogroupe 1. Le diagnostic repose
essentiellement sur la détection de l’antigène dans les urines, méthode permettant d’écourter le délai entre la
suspicion clinique et la mise en route d’un traitement adapté. Cependant, la disponibilité d’une souche
clinique est primordiale car elle permet d’améliorer les connaissances sur les bactéries, de documenter les
cas groupés et de préciser les sources de contamination. Pour la majorité des cas, la source de
contamination demeure inconnue. Les principales installations susceptibles d’être à l’origine des cas sont les
réseaux d’eaux sanitaires et les tours aéroréfrigérantes. Grâce au renforcement de la surveillance et à la
diffusion de nombreuses règlementations visant l’amélioration des mesures de contrôles et de prévention,
aucune épidémie n’a été identifiée en France depuis 2006. Malgré ces efforts, le nombre de cas de
légionellose ne diminue pas ces dernières années. Pour mieux comprendre la dynamique temporospatiale de
la légionellose et l’ensemble des déterminants de la maladie (impact des facteurs environnementaux,
caractéristiques des sources d’exposition, des souches et de l’hôte…), il est essentiel que les recherches
appliquées se poursuivent. Parallèlement, les connaissances fondamentales ont largement progressé. Ces
recherches contribueront à terme à la définition de nouvelles stratégies de diagnostic, de contrôle et de
prévention et à faire régresser le nombre de cas de légionellose diagnostiqués chaque année.
NosoBase ID notice : 394473
Caractéristiques épidémiologiques associées aux clones ST23 par comparaison à celles des clones
STI et ST47 des cas de légionellose en France
Cassier P; Campese C; Le Strat Y; Che D; Ginevra C; Etienne J; et al. Epidemiologic characteristics
associated with ST23 clones compared to ST1 and ST47 clones of Legionnaires disease cases in France.
New microbes and new infections 2015/01; 3(C): 29-33.
Mots-clés : EPIDEMIOLOGIE; LEGIONELLA; LEGIONELLOSE; TYPAGE; LEGIONELLA PNEUMOPHILA;
INCIDENCE; TRAITEMENT; FACTEUR DE RISQUE
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In France, approximately 1200 cases of Legionnaires disease (LD) are reported annually, and isolates are
available for approximately 20% of cases identified since 2000. All Legionella pneumophila serogroup 1 (sg1)
isolates are characterized by sequence-based typing at the National Reference Centre. LD cases caused by
L. pneumophila sg1 reported from 2008 through 2012 were considered for the study. Our study objective was
to describe cases according to their sequence type (ST). We also constructed multivariable modified Poisson
regression models to estimate the incidence rate ratio (IRR) and to identify characteristics potentially
associated with ST23 clones compared to ST1 and ST47 clones. We studied 1192 patients infected by ST1
(n=109), ST23 (n=236), ST47 (n=123) or other STs (n=724). The geographic distribution of the ST23 cases
across the country was significantly different compared to other ST groups. This genotype was significantly
associated with the absence of corticosteroid therapy compared to ST1 (IRR=0.56; p 0.016). Concerning
exposure, the ST23 genotype was significantly less associated with hospital-acquired infections compared to
ST1 (IRR=0.32; p 0.001), but it was more associated with infections acquired in hospitals and elderly settings
compared with ST47. Finally, the ST23 genotype was less frequently associated with travel than other STs.
Despite the large number of cases of ST23 infection, we did not identify any characteristics specific to this ST.
However, we identified independent associations between ST1 and nosocomial transmission and steroid
therapy. These findings should encourage further exploration, especially in terms of environmental diffusion,
strain virulence and host factors.
Néonatologie
NosoBase ID notice : 393275
Changement du circuit d’assistance respiratoire une fois par semaine versus tous les deux jours en
cas de ventilation assistée prolongée chez le nouveau-né : coût-efficacité et impact sur les
pneumonies acquises sous ventilation
Chu SM; Yang MC; Hsiao HF; Hsu JF; Lien R; Chiang MC; et al. One-week versus 2-day ventilator circuit
change in neonates with prolonged ventilation: cost-effectiveness and impact on ventilator-associated
pneumonia. Infection control and hospital epidemiology 2015/03; 36(3): 287-293.
Mots-clés : PNEUMONIE; SOIN INTENSIF; NEONATOLOGIE; VENTILATION ASSISTEE; CIRCUIT;
MATERIEL MEDICO-CHIRURGICAL; INTUBATION; COUT-EFFICACITE; INFECTION NOSOCOMIALE;
TAUX; BACTERIEMIE
NosoBase ID notice : 394283
Prévention des infections associées aux soins parmi des nouveau-nés : place à l’amélioration
Legeay C; Bourigault C; Lepelletier D; Zahar JR. Prevention of healthcare-associated infections in neonates:
room for improvement. The journal of hospital infection 2015/04; 89(4): 319-323.
Mots-clés : PREVENTION; NOUVEAU-NE; CONTROLE; SOIN INTENSIF; EPIDEMIOLOGIE;
BACTERIEMIE; CATHETER VEINEUX CENTRAL; PNEUMONIE; CANDIDEMIE; STAPHYLOCOCCUS
AUREUS; PEAU; VIRUS; SURFACE; INCUBATEUR; ENTEROCOLITE; INFECTION ASSOCIEE AUX
SOINS; JOUET
Infants in neonatal intensive care units (NICUs) are highly susceptible to infection due to the immaturity of
their immune systems. Healthcare-associated infections (HCAIs) are associated with prolonged hospital stay,
and represent a significant risk factor for neurological development problems and death. Improving HCAI
control is a priority for NICUs. Many factors contribute to the occurrence of HCAIs in neonates such as poor
hand hygiene, low nurse-infant ratios, environmental contamination and unnecessary use of antibiotics.
Prevention is based on improving neonatal management, avoiding unnecessary use of central venous
catheters, restricting use of antibiotics and H2 blockers, and introducing antifungal prophylaxis if necessary.
Quality improvement interventions to reduce HCAIs in neonates seem to be the cornerstone of infection
control.
Norovirus
NosoBase ID notice : 394285
Poids des norovirus dans les établissements de santé et stratégies pour le contrôle des épidémies
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Kambhampati A; Koopmans M; Lopman BA. Burden of norovirus in healthcare facilities and strategies for
outbreak control. The journal of hospital infection 2015/04; 89(4): 296-301.
Mots-clés : VIRUS; NOROVIRUS; EPIDEMIE; CONTROLE; GASTRO-ENTERITE; TRANSMISSION; COUT;
TRAITEMENT; VACCIN
Norovirus is the most frequently occurring cause of community-acquired acute gastroenteritis in people of all
ages. It is also one of the most frequent causes of outbreaks in healthcare settings, affecting both long-term
care facilities and acute care hospitals. Whereas norovirus gastroenteritis is typically mild and resolves
without medical attention, healthcare-associated infections often affect vulnerable populations, resulting in
severe infections and disruption of healthcare services. Globally, most norovirus outbreaks in hospitals and
residential care institutions are associated with genogroup II type 4 (GII.4) strains. Recent data demonstrate
that excess mortality occurs during outbreak periods in healthcare facilities. Nosocomial outbreaks can result
in large economic and societal costs. Current control measures for norovirus are largely based on general
infection control principles, and treatment is mainly supportive and non-specific. While neither vaccines nor
antiviral agents are currently available, both are being developed with encouraging results.
Personnel
NosoBase ID notice : 392903
Les bonnes pratiques aides-soignantes dans le cadre des infections nosocomiales
Beuzit L; Randriamalala MJ. Les bonnes pratiques aides-soignantes dans le cadre des infections
nosocomiales. Soins aides soignantes 2015/01; 62: 24-25.
Mots-clés : INFECTION NOSOCOMIALE; PREVENTION; AIDE-SOIGNANT; HYGIENE; GANT;
TRANSMISSION; EXOGENE; ENDOGENE; HYGIENE DES MAINS; MASQUE; TENUE VESTIMENTAIRE
Les infections nosocomiales sont aujourd’hui reconnues comme des problèmes majeurs en santé publique
de par leur fréquence, leur gravité et leur coût. L’aide-soignante, amenée quotidiennement à effectuer de
nombreux soins de nursing auprès du patient, joue un role majeur de prévention.
NosoBase ID notice : 393283
Protéger le personnel en première ligne : concevoir une plateforme de prévention du risque infectieux
pour protéger le personnel soignant des infections respiratoires à virus émergent
Branch-Elliman W; Savor Price C; McGeer A; Perl TM. Protecting the frontline: designing an infection
prevention platform for preventing emerging respiratory viral illnesses in healthcare personnel. Infection
control and hospital epidemiology 2015/03; 36(3): 336-345.
Mots-clés : PERSONNEL; APPAREIL RESPIRATOIRE; FORMATION; VIRUS; GRIPPE; HYGIENE
HOSPITALIERE; PRECAUTION COMPLEMENTAIRE; MERS-CoV; SARS-CoV
Healthcare personnel often find themselves on the frontlines of any epidemic, and may be at particularly high
risk of acquiring respiratory viral illnesses when compared to the general population. Many aspects dictate
how respiratory viruses spread both inside the hospital and out: Elements to consider include the specific type
of virus being targeted for prevention, as well as environmental conditions and host factors, such as age and
immune status. Due to the diverse nature of these agents, multiple modes of transmission, including contact,
droplet, aerosol, and transocular, must be considered when designing an effective infection prevention
program. In this review, we examine the data behind current theories of respiratory virus transmission and
key elements of any respiratory illness prevention program. We also highlight other influences that may come
into play, such as the cost-effectiveness of choosing one respiratory protection strategy over another.
NosoBase ID notice : 394300
Harmoniser et soutenir la formation en hygiène hospitalière en Europe
Brusaferro S; Arnoldo L; Cattani G; Fabbro E; Cookson B; Gallagher R; et al. Harmonizing and supporting
infection control training in Europe. The journal of hospital infection 2015/04; 89(4): 351-356.
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Mots-clés : FORMATION; PERSONNEL; SECURITE SANITAIRE; PREVENTION; EOH; INFIRMIER
HYGIENISTE; QUESTIONNAIRE; ECDC
Healthcare-associated infection (HCAI), patient safety, and the harmonization of related policies and
programmes are the focus of increasing attention and activity in Europe. Infection control training for
healthcare workers (HCWs) is a cornerstone of all patient safety and HCAI prevention and control
programmes. In 2009 the European Centre for Disease Prevention and Control (ECDC) commissioned an
assessment of needs for training in infection control in Europe (TRICE), which showed a substantial increase
in commitment to HCAI prevention. On the other hand, it also identified obstacles to the harmonization and
promotion of training in infection control and hospital hygiene (IC/HH), mostly due to differences between
countries in: (i) the required qualifications of HCWs, particularly nurses; (ii) the available resources; and (iii)
the sustainability of IC/HH programmes. In 2013, ECDC published core competencies for infection control
and hospital hygiene professionals in the European Union and a new project was launched ['Implementation
of a training strategy for infection control in the European Union' (TRICE-IS)] that aimed to: define an agreed
methodology and standards for the evaluation of IC/HH courses and training programmes; develop a flexible
IC/HH taxonomy; and implement an easily accessible web tool in 'Wiki' format for IC/HH professionals. This
paper reviews several aspects of the TRICE and the TRICE-IS projects.
NosoBase ID notice : 395263
Evaluation du risque pour les personnels de santé après un cas de rage et revue de la littérature
Kan VL; Joyce P; Benator D; Agnes K; Gill J; Irmler M; et al. Risk assessment for healthcare workers after a
sentinel case of rabies and review of the literature. Clinical infectious diseases 2015/02/01; 60(3): 341-348.
Mots-clés : ANALYSE DES RISQUES; RAGE; INVESTIGATION; PERSONNEL; REVUE DE LA
LITTERATURE; TRAITEMENT
After a case of rabies, healthcare workers (HCWs) had fear of contagion from the infected patient. Although
transmission of rabies to HCWs has never been documented, high-risk exposures theoretically include direct
contact of broken skin and/or mucosa with saliva, tears, oropharyngeal secretions, cerebrospinal fluid, and
neural tissue. Urine/kidney exposure posed a concern, as our patient's renal transplant was identified as the
infection source.
Methods: Our risk assessment included (1) identification of exposed HCWs; (2) notification of HCWs; (3) risk
assessment using a tool from the local health department; (4) supplemental screening for urine/kidney
exposure; and (5) postexposure prophylaxis (PEP) when indicated.
Results: A total of 222 HCWs including diverse hospital staff and medical trainees from university affiliates
were evaluated. Risk screening was initiated within 2 hours of rabies confirmation, and 95% of HCWs were
assessed within the first 8 days. There were 8 high-risk exposures related to broken skin contact or mucosal
splash with the patient's secretions, and 1 person without high-risk contact sought and received PEP outside
our hospital. Nine HCWs (4%) received PEP with good tolerance. Due to fear of rabies transmission,
additional HCWs without direct patient contact required counseling. There have been no secondary cases
after our sentinel rabies patient.
Conclusions: Rabies exposure represents a major concern for HCWs and requires rapid, comprehensive risk
screening and counseling of staff and timely PEP. Given the lack of human-to-human rabies transmission
from our own experience and the literature, a conservative approach seems appropriate for providing PEP to
HCWs.
NosoBase ID notice : 394218
Vers un changement de comportement du personnel de santé : étude qualitative explorant la nonobservance à travers l’évaluation des pratiques de contrôle et de prévention du risque infectieux
Shah N; Castro-Sánchez E; Charani E; Drumright LN; Holmes AH. Towards changing healthcare workers’
behaviour: a qualitative study exploring noncompliance through appraisals of infection prevention and control
practices. The journal of hospital infection 2015/02/26; in press: 1-26.
Mots-clés : TRAVAIL; ATTITUDE; PERSONNEL; OBSERVANCE; PREVENTION; RISQUE; PRATIQUE;
PROTOCOLE; ETUDE MULTICENTRIQUE; QUESTIONNAIRE; ANTIBIOTIQUE; PRESCRIPTION
Background: Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and
understanding the determinants of healthcare workers’ (HCWs) behaviour is fundamental to develop effective
and sustained behaviour change interventions.
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Aim: To identify behaviours of HCWs that facilitated non-compliance of IPC practices, focusing on how
appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant
behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of
others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working
environment that may explain inconsistencies in IPC practices.
Methods: Clinical staff at a National Health Service hospital group in London, UK were interviewed between
December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic
framework.
Findings: Three ways in which HCWs appraised their behaviour were identified through accounts of IPC
policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC
practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some
IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged
work relationships.
Conclusions: Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of
local normative practices, individual preferences and a degree of professional isolation.
Pneumonie
NosoBase ID notice : 393647
Prophylaxie par des probiotiques pour la prévention des pneumonies acquises sous ventilation (VAP)
parmi des enfants sous ventilation assistée : essai ouvert contrôlé randomisé
Banupriya B; Biswal N; Srinivasaraghavan R; Narayanan P; Mandal J. Probiotic prophylaxis to prevent
ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized
controlled trial. Intensive care medicine 2015/02/24; in press: 9 pages.
Mots-clés : PNEUMONIE; PREVENTION; VENTILATION ASSISTEE; PEDIATRIE; RANDOMISATION;
SOIN INTENSIF; INCIDENCE; PROBIOTIQUE
Purpose: Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections in the
pediatric intensive care unit (PICU). It is associated with increased mortality and prolonged hospital stay.
Several preventive strategies have been introduced to reduce VAP. One novel intervention is prophylactic
administration of probiotics. Studies on the effect of probiotics on VAP in pediatric populations are lacking.
Methods: This was an open-label randomized controlled trial. A total of 150 children no older than 12 years
admitted to the PICU were recruited from November 2011 to July 2013. Children who were likely to require
ventilation for more than 48 h were eligible for inclusion in the study. Patients were randomized into two
groups after stratification based on age groups. Children in the intervention group received probiotic
preparation twice a day beginning from the day of ICU admission till 7 days or discharge from ICU, whichever
was earlier. The control group did not receive any placebo. Children were examined daily for evidence of VAP
and were followed up till discharge from hospital. Incidence of VAP, duration of hospital stay, and mortality
were compared.
Results: Children who received prophylactic probiotics had a lower incidence of VAP compared to the control
group (17.1% in the probiotics group vs 48.6% in the control group, p<0.001; 22 per 1,000 ventilated days vs
39 per 1,000 ventilated days, p=0.02). On multiple logistic regression analysis, use of prophylactic probiotics
decreased the incidence of VAP by 77% and reduced the duration of ICU and hospital stays by an average of
2.1 and 3.3 days, respectively, after adjusting for the other confounders. No complications due to
administration of probiotics were observed in the study.
Conclusion: Prophylactic probiotics administration resulted in reduction of the incidence of VAP in critically ill
children in a setting where baseline VAP rates are high. The intervention was found to be safe.
Prévention
NosoBase ID notice : 393685
Recommandations de l’OMS sur l’usage de seringues de sécurité pour des
intramusculaires, intradermiques et sous-cutanées dans des établissements de soins
injections
Organisation mondiale de la santé (OMS). WHO guideline on the use of safety-engineered syringes for
intramuscular, intradermal and subcutaneous injections in health-care settings. OMS 2015/02/23: 1-31.
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Mots-clés : ORGANISATION MONDIALE DE LA SANTE; RECOMMANDATIONS DE BONNE PRATIQUE;
MATERIEL DE SECURITE; INJECTION; VOIE INTRADERMIQUE; VOIE INTRAMUSCULAIRE; VOIE
SOUS-CUTANEE; REUTILISABLE; ACCIDENT D'EXPOSITION AU SANG; DECHET; SECURITE
SANITAIRE; DISPOSITIF MEDICAL; QUALITE; PREUVE; NIVEAU DE PREUVE
NosoBase ID notice : 394771
Comment les pathogènes bactériens colonisent leurs hôtes et envahissent les tissus profonds
Ribet D; Cossart P. How bacterial pathogens colonize their hosts and invade deeper tissues. Microbes and
infection 2015/03; 17(3): 173-183.
Mots-clés : COLONISATION; BACTERIE; HELICOBACTER PYLORI; ESCHERICHIA COLI; LEGIONELLA;
MYCOBACTERIUM TUBERCULOSIS; SALMONELLA; REVUE DE LA LITTERATURE; MICROBIOTE
Bacterial pathogens have evolved a wide range of strategies to colonize and invade human organs, despite
the presence of multiple host defense mechanisms. In this review, we will describe how pathogenic bacteria
can adhere and multiply at the surface of host cells, how some bacteria can enter and proliferate inside these
cells, and finally how pathogens may cross epithelial or endothelial host barriers and get access to internal
tissues, leading to severe diseases in humans.
NosoBase ID notice : 393854
Organisation hospitalière, management, et structuration pour la prévention des infections associées
aux soins : revue systématique et consensus d'expert
Zingg W; Holmes A; Dettenkofer M; Goetting T; Secci F; Clack L; et al. Hospital organisation, management,
and structure for prevention of health-care-associated infection: a systematic review and expert consensus.
The Lancet infectious diseases 2015/02; 15(2): 212-224.
Mots-clés : PREVENTION; REVUE DE LA LITTERATURE; ORGANISATION; INDICATEUR; CHARGE DE
TRAVAIL; EFFECTIF
Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around
37 000 deaths each year. We did a systematic review to identify crucial elements for the organisation of
effective infection-prevention programmes in hospitals and key components for implementation of monitoring.
92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of
infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency
nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate
use of guidelines; education and training; auditing; surveillance and feedback; multimodal and
multidisciplinary prevention programmes that include behavioural change; engagement of champions; and
positive organisational culture. These components comprise manageable and widely applicable ways to
reduce health-care-associated infections and improve patients' safety.
Pseudomonas aeruginosa
NosoBase ID notice : 393279
Robinets électroniques et qualité de l’eau, leur impact sur la présence de Pseudomonas aeruginosa
dans les circuits d’eau : une étude sur plusieurs hôpitaux
Charron D; Bédard E; Lalancette C; Laferrière C; Prévost M. Impact of electronic faucets and water quality on
the occurrence of Pseudomonas aeruginosa in water: a multi-hospital study. Infection control and hospital
epidemiology 2015/03; 36(3): 311-319.
Mots-clés : PSEUDOMONAS AERUGINOSA; EAU; ROBINET D'EAU; QUALITE; CONTAMINATION;
PREVALENCE; PRELEVEMENT
Objective To compare Pseudomonas aeruginosa prevalence in electronic and manual faucets and assess the
influence of connecting pipes and water quality.
Setting Faucets in 4 healthcare centers in Quebec, Canada.
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Methods Water samples from 105 electronic, 90 manual, and 14 foot-operated faucets were analyzed for P.
aeruginosa by culture and enzymatic detection, and swab samples from drains and aerators were analyzed
by culture. Copper and residual chlorine concentrations, temperature, and flow rate were measured. P.
aeruginosa concentrations were analyzed in 4 consecutive volumes of cold water and a laboratory study was
conducted on copper pipes and flexible hoses.
Results P. aeruginosa contamination was found in drains more frequently (51%) than in aerators (1%) or
water (culture: 4%, enzyme detection: 16%). Prevalence in water samples was comparable between manual
(14%) and 2 types of electronic faucets (16%) while higher for foot-operated faucets (29%). However, type 2
electronic faucets were more often contaminated (31%) than type 1 (14%), suggesting that faucet architecture
and mitigated volume (30 mL vs 10 mL) influence P. aeruginosa growth. Concentrations were 100 times
higher in the first 250 mL than after flushing. Flexible hoses were more favorable to P. aeruginosa growth
than copper and a temperature of 40°C led to higher counts.
Conclusions The types of faucets and connecting pipes, flow rate, and water quality are important parameters
influencing the prevalence and the concentrations of P. aeruginosa in faucets. High concentrations of P.
aeruginosa in the first 250 mL suggest increased risk of exposure when using the first flush.
Réglementation
NosoBase ID notice : 395089
Instruction DGOS/PF2/DGS/PP2 n° 2015-85 du 20 mars 2015 relative à la gestion des risques liée à
l'activité de nutrition parentérale en réanimation néonatale, en néonatologie et en pédiatrie par la mise
en place de bonnes pratiques organisationnelles
Ministère des affaires sociales, de la santé et des droits des femmes. Instruction DGOS/PF2/DGS/PP2 n°
2015-85 du 20 mars 2015 relative à la gestion des risques liée à l'activité de nutrition parentérale en
réanimation néonatale, en néonatologie et en pédiatrie par la mise en place de bonnes pratiques
organisationnelles. Non parue au journal officiel: 11 pages.
Mots-clés : ALIMENTATION PARENTERALE; ASSISTANCE NUTRITIONNELLE; GESTION DES
RISQUES; SECURITE SANITAIRE; RECOMMANDATIONS DE BONNE PRATIQUE; NEONATOLOGIE;
PEDIATRIE
La présente instruction a pour objectif de rappeler les risques liés à l’activité de nutrition parentérale et à
l’obligation d’une mise en place d’une gestion des risques liée à cette activité.
Cette instruction demande aux agences régionales de santé d’effectuer un diagnostic de territoire de cette
activité.
Staphylococcus aureus
NosoBase ID notice : 393637
Prévalence, facteurs prédictifs et évolution d’infections à Staphylococcus aureus méticillinorésistante parmi des patients bénéficiant de procédures chirurgicales majeures aux Etats-Unis : étude
de population
Allareddy V; Das A; Lee MK; Nalliah RP; Rampa S; Allareddy V; et al. Prevalence, predictors, and outcomes
of methicillin-resistant Staphylococcus aureus infections in patients undergoing major surgical procedures in
the United States: a population-based study. The American journal of surgery 2015/01/29; in press: 1-9.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PREVALENCE; CHIRURGIE;
FACTEUR DE RISQUE; DUREE DE SEJOUR; MORTALITE; PRONOSTIC; ETUDE RETROSPECTIVE
Background: National estimates of methicillin-resistant Staphylococcus aureus (MRSA) infection rates in
hospitalized surgical patients and outcomes are lacking. We sought to estimate the prevalence, identify the
predictors, and describe the outcomes of MRSA infections in hospitalized patients undergoing major surgical
procedures (MSPs) in the United States.
Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample, the largest all-payer
hospital discharge database in the United States, for the years 2009 to 2010.
Results: Of the 22,932,948 hospitalizations that had an MSP, MRSA infection occurred in 235,636 (1.03%)
patients. Factors associated with "significantly" lower risk of MRSA occurrence include women (odds ratio
[OR] .68), elective procedure (OR .38), teaching institutes (OR .94), and large hospital size (OR .87). Blacks
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(OR 1.19), native Americans (OR 1.27), increased comorbid burden (OR 1.38), and uninsured patients were
associated with higher risk of MRSA occurrence. Outcomes in MSPs "with" MRSA versus "without" MRSA
include mean length of stay (14 vs 5 days) and in-hospital mortality (IHM) rate (3.7% vs 1.2%). Occurrence of
an MRSA was associated with significantly longer length of stay and higher odds of IHM (OR 1.39, 95%
confidence interval 1.30 to 1.48).
Conclusions: Although the occurrence of MRSA infections complicating MSPs was low, it is associated with
worse outcomes. Certain predictors of MRSA infection are identified.
NosoBase ID notice : 394241
Dépistage de Staphylococcus aureus méticillino-résistant dans une
hémodialysés : colonisation, caractéristiques démographiques et évolution
cohort
de
patients
Price A; Sarween N; Gupta I; Baharani J. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible
Staphylococcus aureus screening in a cohort of haemodialysis patients: carriage, demographics and
outcomes. The journal of hospital infection 2015/01/13; in press: 1-6.
Mots-clés : STAPHYLOCOCCUS AUREUS; DEPISTAGE; COHORTE; HEMODIALYSE; COLONISATION;
PREVALENCE; DISPOSITIF MEDICAL; MORTALITE; ERADICATION; CHLORHEXIDINE; MUPIROCINE
Background: Patients on haemodialysis are vulnerable to colonization with Staphylococcus aureus due to
frequent hospital contact, indwelling devices, and impaired immunity. Additionally colonization is associated
with increased risk of infection.
Aim: To determine the prevalence of both meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S.
aureus (MSSA) carriage in our haemodialysis cohort and to identify any risk factors predisposing to carriage,
recolonization, or persistent carriage following a decolonization programme.
Methods: All haemodialysis patients screened for S. aureus carriage between June 2009 and May 2011 were
retrospectively followed up for 18 months using hospital electronic records. Statistical analysis was performed
using IBM SPSS version 19.
Findings: Out of 578 patients screened, 288 patients (49%) had at least one positive swab (10% MRSA, 90%
MSSA). Of these patients, 265 completed a course of decolonization therapy following which 36%
successfully eradicated (eradicators) and 64% did not (non-eradicators). There was no statistically significant
difference in patient demography, type of vascular access, 18-month patient mortality, or number of hospital
admissions between the two groups. Those who failed to eradicate were more likely to have had an episode
of S. aureus bacteraemia within the study period compared to those who successfully decolonized (P=0.003).
Conclusion: Half of our haemodialysis cohort was colonized with S. aureus at any one time over an 18-month
period. Following decolonization, one-third of patients remained successfully eradicated for 18 months. Noneradicators have an increased risk of bacteraemia, which is associated with poor mortality. We would
recommend routine screening and aggressive attempts to decolonize.
NosoBase ID notice : 393745
Caractéristiques moléculaires et cliniques de souches de Staphylococcus aureus méticillino-résistant
d’apparition communautaire ou hospitalière associée à des bactériémies
Wang SH; Hines L; van Balen J; Mediavilla JR; Pan X; Hoet A; et al. Molecular and clinical characteristics of
hospital and community onset methicillin-resistant Staphylococcus aureus strains associated with blood
stream infections. Journal of clinical microbiology 2015/03/04; in press: 27 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BACTERIEMIE; BIOLOGIE
MOLECULAIRE; TYPAGE; PCR; PFGE; FACTEUR DE RISQUE;SARM
Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are classified
epidemiologically as healthcare-associated hospital-onset (HAHO), healthcare-associated community-onset
(HACO), or community-associated (CA)-MRSA. Clinical and molecular differences between HAHO- and
HACO-MRSA BSI are not well known. Thus, we evaluated clinical and molecular characteristics of MRSA BSI
to determine if distinct features are associated with HAHO- or HACO-MRSA strains. Molecular genotyping
and medical record review were conducted on 282 MRSA BSI isolates from 1/2007 to 12/2009. MRSA
classifications were 37.6% HAHO-, 54.3% HACO-, and 8% CA-MRSA. Comparing patients with HAHO- to
HACO-MRSA, HAHO-MRSA patients had significantly higher rates of malignancy, surgery, recent invasive
devices, longer hospital stays and mortality. In comparison, patients with HACO-MRSA were more likely to
have history of renal failure, hemodialysis, residence in a long term care facility, long term invasive devices,
and higher rate of MRSA relapse. Distinct MRSA molecular strain differences were also seen between
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HAHO-MRSA (60% SCCmec II, 30% SCCmec III, and 9% SCCmec IV) and HACO-MRSA (47% SCCmec II,
35% SCCmec III, and 16% SCCmec IV) (p<0.001). In summary, our study reveals significant clinical and
molecular differences between patients with HAHO- and HACO-MRSA BSI. In order to decrease rates of
MRSA infection, preventive efforts needs to be directed toward patients in the community with healthcare
associated risk factors in addition to inpatient infection control.
Stérilisation
NosoBase ID notice : 391913
Stérilisation des instruments médicaux : l'employeur est responsable
Fantoni-Quinton S. Stérilisation des instruments médicaux : l'employeur est responsable. Concours médical
2015/01; 137(1): 62-63.
Mots-clés : STERILISATION; INSTRUMENT; RESPONSABILITE; LEGISLATION; DISPOSITIF MEDICAL
Dans un cabinet médical de gynécologie, une salariée – agent d’entretien – a la charge du lavage et de la
stérilisation des instruments médicaux. Cette salariée me fait part de son inquiétude quant à sa responsabilité
sur la qualité de la stérilisation et quant à sa propre sécurité, car elle n’a pas reçu de formation de qualité
pour ces fonctions. Elle a été sommairement renseignée sur les gestes à faire par la salariée (de même
niveau professionnel) précédente. Existe-t-il une formation à ces tâches ? Sans cette formation, sa
responsabilité peut-elle être engagée ou plutôt celle de son employeur (médecin gynécologue) ?
NosoBase ID notice : 394308
Etude de cas sur l’oritentation des pièces à main de phacoémulsification durant les process de
stérilisation à la vapeur
van Doornmalen Gomez Hoyos JP; van Wezel RA; van Doornmalen HW. Case study on the orientation of
phaco hand pieces during steam sterilization processes. The journal of hospital infection 12015/02/10; in
press: 1-7.
Mots-clés : STERILISATION; QUALITE; VAPEUR; CHIRURGIE OPHTALMOLOGIQUE; PRATIQUE
Background: Steam sterilization is an essential part of infection prevention. The literature shows that
sterilization of medical instruments containing channels is not trivial. Phaco hand pieces have a simple
configuration: a device contains a channel with a constant radius. No literature was found indicating whether
the sterilization conditions on the inner surface of a phaco hand piece are influenced by the orientation of the
hand piece.
Aim: To determine whether the orientation of a phaco hand piece influences the results of a sterilization
process of this device.
Methods: A qualitative case study, including experiments, is performed with a protocolled combination of
steam sterilizer, process, phaco hand piece, orientation of the phaco hand piece, and wrapping.
Findings: In this specific case, the orientation of the hand piece influenced the result of the steam sterilization
process; in vertically (upright) oriented phaco hand pieces with free water drainage, sterilization conditions
are reproducibly established. In the same process, in horizontally oriented or vertically oriented hand pieces
without free drainage, these conditions are not established in a reproducible way.
Conclusion: In the investigated combination of sterilizer, process, load, loading pattern and wrapping, phaco
hand pieces have to be oriented vertically (upright) with free water drainage to obtain steam sterilization
conditions on the inner surface. It is likely that instruments with comparable configuration and dimensions will
yield comparable results. It is therefore recommended that this issue is considered during the development of
medical instruments and during performance qualifications of such instruments.
Surveillance
NosoBase ID notice : 394307
Incidence des infections associées aux soins dans un centre hospitalier universitaire : résultats issus
d’une période de surveillance électronique de trois années
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Puhto T; Syrjälä H. Incidence of healthcare-associated infections in a tertiary care hospital: results from a
three-year period of electronic surveillance. The journal of hospital infection 2015/01/26; in press: 1-6.
Mots-clés : INCIDENCE; CENTRE HOSPITALIER UNIVERSITAIRE; SURVEILLANCE; INFORMATIQUE;
ANTIBIOTIQUE; TRAITEMENT; CHIRURGIE CARDIO-VASCULAIRE; CHIRURGIE ORTHOPEDIQUE;
COHORTE; STATISTIQUE; INFECTION ASSOCIEE AUX SOINS; SENSIBILITE STATISTIQUE
Like other respiratory viruses, influenza is responsible for devastating nosocomial epidemics in nursing
homes as well as in conventional wards and emergency departments. Patients, healthcare workers, and
visitors may be the source of nosocomial influenza. Despite their limited sensitivity, rapid diagnostic tests for
influenza can be of real value; they enable early introduction of measures to prevent spread and early specific
antiviral treatment of cases. However, these tests cannot detect oseltamivir resistance, susceptibility testing
being carried out only in specialist laboratories. Although resistance is rare, it can emerge during treatment,
especially of very young children or immunocompromised patients. In the latter, the shedding of resistant
influenza virus can last several weeks. Sporadic instances of nosocomial transmission among
immunocompromised patients have been reported. The limitations of bedside tests for influenza make them
unsuitable for use as stand-alone diagnostic tools. However, their limitations do not preclude their use for
detection and subsequent management of nosocomial influenza, for which they are rapid, easy, and costeffective. Recent developments in these tests look promising, offering prospects of increased sensitivity,
increased specificity, and screening for antiviral susceptibility.
Tuberculose
NosoBase ID notice : 393642
Tuberculose latente dans une vaste cohorte d’étudiants en médecine dans un centre hospitalier
universitaire en Italie
Durando P; Alicino C; Orsi A; Barberis I; Paganino C; Dini G; et al. Latent tuberculosis infection among a
large cohort of medical students at a teaching hospital in Italy. BioMed research international 2015; 2015: 1-6.
Mots-clés : TUBERCULOSE; COHORTE; ETUDIANT; MEDECIN; PREVALENCE; FACTEUR DE RISQUE;
TEST TUBERCULINIQUE; ANALYSE MULTIVARIEE; MYCOBACTERIUM TUBERCULOSIS; DEPISTAGE
The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is
considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI
prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical
students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible
subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST
Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST
positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire
was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and
completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was
confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9-160.2; P
value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0-265.1; P value 0.003) are independently
associated with TST positivity. Despite the low prevalence of LTBI among Italian medical students, an
occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
Vaccination
NosoBase ID notice : 395242
Calendrier des vaccinations et recommandations vaccinales 2015. Protégeons-nous, vaccinons-nous
Ministère des affaires sociales et de la santé. Calendrier des vaccinations et recommandations vaccinales
2015. Protégeons-nous, vaccinons-nous. Ministère des affaires sociales et de la santé 2015/03: 1-50.
Mots-clés : VACCINATION; PREVENTION; BORDETELLA PERTUSSIS; GRIPPE; TETANOS; BCG;
HEPATITE A; HEPATITE B; PAPILLOMAVIRUS; NEISSERIA MENINGITIDIS; RAGE; ROUGEOLE;
OREILLONS; RUBEOLE; TUBERCULOSE; TYPHOIDE; VARICELLE; ADULTE; ENFANT; PERSONNEL
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La politique de vaccination est élaborée par le ministre chargé de la santé qui fixe les conditions
d’immunisation, énonce les recommandations nécessaires et rend public le calendrier des vaccinations après
avis du Haut conseil de la santé publique (HCSP).
Le calendrier vaccinal fixe les vaccinations applicables aux personnes résidant en France en fonction de leur
âge, émet les recommandations vaccinales générales et des recommandations vaccinales particulières
propres à des conditions spéciales (risques accrus de complications, d’exposition ou de transmission) ou à
des expositions professionnelles.
Le calendrier 2015 ne comporte pas de nouvelle recommandation en population générale mais seulement
des modifications mineures par rapport à l’an dernier.
Après avis du Haut conseil de la santé publique, les principales nouveautés concernent l’actualisation des
conduites à tenir devant :
- un ou plusieurs cas d’infection invasive à méningocoque ;
- un ou plusieurs cas de coqueluche.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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