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NosoVeille n°2
Février 2017
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Animal
Antibiotique / Antibiorésistance
Bactériémie
Cathétérisme
Chirurgie
Clostridium difficile
Désinfection
Environnement
Epidémie
Hygiène des mains
Personnel
Précautions complémentaires
Prévalence
Prévention
Pseudomonas aeruginosa
Réglementation
Soin intensif
Staphylococcus aureus
Transplantation
Vaccination
Zika

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Animal
NosoBase ID notice : 422666
OXA-23 et ISAba 1-OXA-66 bêta-lactamases de classe D dépistées dans des isolats d'Acinetobacter
baumannii provenant des animaux de compagnie
Ewers C; Klotz P; Leidner U; Stamm I; Prenger-Berninghoff E; Göttig S; et al. OXA-23 and ISAba1-OXA-66
class D β-lactamases in Acinetobacter baumannii isolates from companion animals. International journal of
antimicrobial agents 2017/01; 49(1): 37-44.
Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; BETA-LACTAMASE A SPECTRE
ELARGI; CARBAPENEME; ANIMAL; CMI; TYPAGE; TRANSMISSION; CLONAGE
Acinetobacter baumannii is recognised as a major pathogen of nosocomial infections that frequently show
resistance to last-resort antimicrobials. To investigate whether A. baumannii from companion animals harbour
carbapenem resistance mechanisms, 223 clinical isolates obtained from veterinary clinics between 2000 and
2013 in Germany were screened for carbapenem-non-susceptibility employing meropenem-containing
Mueller-Hinton agar plates. Minimum inhibitory concentration (MIC) data were obtained using the VITEK®2
system. Assignment to international clones (ICs) was done by multiplex PCR or repetitive sequence-based
PCR employing the DiversiLab system. Clonality was studied using pulsed-field gel electrophoresis (PFGE)
and multilocus sequence typing (MLST). Genes encoding carbapenemases and aminoglycoside-modifying
enzymes were detected by PCR. In three samples from dogs, carbapenem-resistant A. baumannii carrying
the blaOXA-23 gene on plasmids and located on transposon Tn2008 were identified. The isolates belonged to
sequence type ST1P (clonal complex CC1/IC1/pulsotype II) and ST10P (CC10/IC8/pulsotype IV) according to
the Pasteur MLST scheme, and to ST231Ox (CC109) and ST585Ox (CC447) following the Oxford scheme.
Insertion sequence ISAba1 was identified upstream of blaOXA-66 in 58 A. baumannii isolates. MLST referred
them to ST2P (CC2/IC2/pulsotypes I and III), ST208Ox, ST350Ox and ST556Ox (all CC118), respectively. PFGE
suggested nosocomial spread of these highly related strains, which frequently demonstrated a multidrug-
resistant phenotype, in one veterinary clinic. These data show that A. baumannii from companion animals
reveal resistance determinants and clonal lineages of strains globally emerging in humans. This suggests an
interspecies transmission and warrants molecular surveillance of A. baumannii in veterinary clinics to mitigate
its further spread.
DOI: https://doi.org/10.1016/j.ijantimicag.2016.09.033
Antibiotique / Antibiorésistance
NosoBase ID notice : 424090
L’évolution des consommations d’antibiotiques en France entre 2000 et 2015
Martin D; Agence nationale de sécurité du médicament et des produits de santé (ANSM). L’évolution des
consommations d’antibiotiques en France entre 2000 et 2015. ANSM 2017/01: 1-41.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; GLYCOPEPTIDE; CEPHALOSPORINE; COLISTINE;
PENICILLINE; CEFTRIAXOME; DDJ; AGE; PROFESSION LIBERALE; HOPITAL
Au début des années 2000, le développement des résistances bactériennes a conduit la France – comme
beaucoup d’autres pays - à mettre en œuvre des actions favorisant un moindre et un meilleur usage des
antibiotiques afin d’en préserver l’efficacité.
Ces actions ont abouti à faire diminuer la consommation d’antibiotiques, tant en ville qu’à l’hôpital. Cette
baisse n’a cependant pas été continue. Depuis plusieurs années, l’ANSM observe une tendance à la reprise,
que les résultats 2015 confirment. L’incidence élevée des pathologies hivernales en 2015 doit bien sûr être
prise en compte, mais elle ne peut que partiellement expliquer la hausse constatée.
Pris dans leur ensemble, ces résultats montrent que les habitudes de prescription et les comportements
peuvent être infléchis. Même si elle se situe toujours parmi les pays dont le niveau de consommation est
élevé, la France n’est plus - pour le secteur de ville - le premier consommateur d’antibiotiques en Europe,
comme c’était le cas au début des années 2000. En 2015, elle se situait au 4e rang pour le secteur
ambulatoire. À l’hôpital, la consommation française se situe désormais à un niveau proche de la moyenne
européenne. Néanmoins des progrès conséquents restent à faire pour renforcer le bon usage des
antibiotiques et limiter leur consommation.

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NosoBase ID notice : 424186
Evolution clinique et mobilisation des ressources de santé en lien avec les infections à bacilles gram-
négatif multirésistants dans des centres hospitaliers
Dicks KV; Anderson DJ; Baker AW; Sexton DJ; Lewis SS. Clinical outcomes and healthcare utilization related
to multidrug-resistant gram-negative infections in community hospitals. Infection control and hospital
epidemiology 2017/01; 38(1): 31-38.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; COLONISATION; BACILLE GRAM
NEGATIF; MORTALITE
Objective: To evaluate the impact of multidrug-resistant gram-negative rod (MDR-GNR) infections on
mortality and healthcare resource utilization in community hospitals.
Design: Two matched case-control analyses.
Setting: Six community hospitals participating in the Duke Infection Control Outreach Network from January 1,
2010, through December 31, 2012.
Participants: Adult patients admitted to study hospitals during the study period.
Methods: Patients with MDR-GNR bloodstream and urinary tract infections were compared with 2 groups: (1)
patients with infections due to nonMDR-GNR and (2) control patients representative of the nonpsychiatric,
non-obstetric hospitalized population. Four outcomes were assessed: mortality, direct cost of hospitalization,
length of stay, and 30-day readmission rates. Multivariable regression models were created to estimate the
effect of MDR status on each outcome measure.
Results: No mortality difference was seen in either analysis. Patients with MDR-GNR infections had 2.03
higher odds of 30-day readmission compared with patients with nonMDR-GNR infections (95% CI, 1.04–3.97,
P=.04). There was no difference in hospital direct costs between
Patients with MDR-GNR infections and patients with nonMDR-GNR infections. Hospitalizations for patients
with MDR-GNR infections cost $5,320.03 more (95% CI, $2,366.02–$8,274.05, P<.001) and resulted in 3.40
extra hospital days (95% CI, 1.41–5.40, P<.001) than hospitalizations for control patients.
Conclusions: Our study provides novel data regarding the clinical and financial impact of MDR gram-negative
bacterial infections in community hospitals. There was no difference in mortality between patients with MDR-
GNR infections and patients with nonMDR-GNR infections or control patients.
DOI: https://doi.org/10.1017/ice.2016.230
NosoBase ID notice : 424184
Les bactéries multirésistantes détectées après 48 heures d’admission à l’hôpital peuvent ne pas avoir
été acquises à l’hôpital
Erb S; Frei; Dangel M; Widmer A. Multidrug-resistant organisms detected more than 48 hours after hospital
admission are not necessarily hospital-acquired. Infection control and hospital epidemiology 2017/01; 38(1):
18-23.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; COLONISATION; DEFINITION;
ADMISSION
Background: Infections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours
after hospital admission are considered healthcare-acquired according to the definition of the Centers for
Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true
acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such
infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups
(DRGs).
Objective: The goal of the study was to estimate the preventable proportion of healthcare-acquired infections
in a tertiary care hospital in Switzerland by analyzing patients colonized or infected with MDROs.
Methods: All hospitalized patients with healthcare-acquired MDRO infection or colonization (HAMIC) or
according to the CDC definition (CDC-HAMIC) were prospectively assessed from 2002 to 2011 to determine
whether there was evidence for nosocomial transmission. We utilized an additional work-up with
epidemiological, microbiological, and molecular typing data to determine the true preventable proportion of
HAMICs.
Results: Overall, 1,190 cases with infection or colonization with MDROs were analyzed; 274 (23.0%) were
classified as CDC-HAMICs. Only 51.8% of CDC-HAMICs had confirmed evidence of hospital-acquisition and
were considered preventable. Specifically, 57% of MRSA infections, 83.3% of VRE infections, 43.9% of ESBL
infections, and 74.1% of non-ESBL MDRO infections were preventable HAMICs.

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Conclusions: The CDC definition overestimates the preventable proportion of HAMICs with MDROs by more
than 50%. Relying only on the CDC definition of HAMICs may lead to inaccurate measurement of the impact
of infection control interventions and to inadequate reimbursement under the DRG system.
DOI: https://doi.org/10.1017/ice.2016.226
NosoBase ID notice : 424188
Analyse multicentrique longitudinale des évolutions cliniques après l’arrêt des mesures de lutte
contre les entérocoques résistants à la vancomycine
Lemieux C; Gardam M; Evans G; John M; Suh KN; van Walraven C; et al. Longitudinal multicenter analysis of
outcomes after cessation of control measures for vancomycin-resistant Enterococci. Infection control and
hospital epidemiology 2017/01; 38(1): 24-30.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; COLONISATION; ENTEROCOCCUS;
VANCOMYCINE; ANTIBIORESISTANCE
Objective: To assess clinically relevant outcomes after complete cessation of control measures for
vancomycin-resistant enterococci (VRE).
Design: Quasi-experimental ecological study over 3.5 years.
Methods: All VRE screening and isolation practices at 4 large academic hospitals in Ontario, Canada, were
stopped on July 1, 2012. In total, 618 anonymized abstracted charts of patients with VRE-positive clinical
isolates identified between July 1, 2010, and December 31, 2013, were reviewed to determine whether the
case was a true VRE infection, a VRE colonization or contaminant, or a true VRE bacteremia. All deaths
within 30 days of the last VRE infection were also reviewed to determine whether the death was fully or
partially attributable to VRE. All-cause mortality was evaluated over the study period. Generalized estimating
equation methods were used to cluster outcome rates within hospitals, and negative binomial models were
created for each outcome.
Results: The incidence rate ratio (IRR) for VRE infections was 0.59 and the associated P value was .34. For
VRE bacteremias, the IRR was 0.54 and P=.38; for all-cause mortality the IRR was 0.70 and P=.66; and for
VRE attributable death, the IRR was 0.35 and P= 49. VRE control measures were not significantly associated
with any of the outcomes. Rates of all outcomes appeared to increase during the 18-month period after
cessation of VRE control measures, but none reached statistical significance.
Conclusion: Clinically significant VRE outcomes remain rare. Cessation of all control measures for VRE had
no significant attributable adverse clinical impact.
DOI: https://doi.org/10.1017/ice.2016.235
NosoBase ID notice : 424211
Impact de deux politiques différentes de gestion des antibiotiques sur la fréquence d’optimisation
des prescriptions d’antibiotiques chez des patients ayant une bactériémie
Lukaszewicz Bushen J; Mehta JM; Hamilton KW; Binkley S; Timko DR; Lautenbach E; et al. Impact of two
different antimicrobial stewardship methods on frequency of streamlining antimicrobial agents in patients with
bacteremia. Infection control and hospital epidemiology 2017/01; 38(1): 89-95.
Mots-clés : BACTERIEMIE; TRAITEMENT; ANTIBIOTIQUE; AUDIT; BACILLE GRAM NEGATIVE;
STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS; URGENCES HOSPITALIERES; SERVICE; ETUDE
RETROSPECTIVE
Objective: To assess the likelihood of antimicrobial streamlining between 2 antimicrobial stewardship
methods.
Design: Retrospective cohort study.
Setting: Large academic medical center.
Methods: Frequency and time to antimicrobial streamlining were compared during a prior authorization and a
prospective audit period. Streamlining was defined as an antimicrobial change to a narrower agent if available
or to a broader agent if the isolate was resistant to empiric therapy. Patients included were ≥18 years old with
monomicrobial bacteremia with S. aureus, Enterococcus spp., or any aerobic Gram-negative organism.
Results: A total of 665 cases of bacteremia met inclusion criteria. Frequency of streamlining was similar
between periods for all cases of bacteremia (audit vs restriction: 60.7% vs 53.2%; P= .12), S. aureus
bacteremia (73.2% vs 76.9%; P=.671), and Enterococcus bacteremia (81.6% vs 71.9%; P= .335). Compared
to restriction, the audit period was associated with an increased frequency of streamlining for cases of Gram-
negative bacteremia (51.4% vs 35.6%; odds ratio [OR], 1.85; 95% confidence interval [CI], 1.06–3.25), those

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on the medical service (67.9% vs 53.1%; OR, 1.86; 95% CI, 1.09–3.16), and those admitted through the
emergency department (71.6% vs 51.4%; OR, 2.32; 95% CI, 1.24–4.34). Characteristics associated with
increased streamlining included: absence of β-lactam allergy (P<.001), Gram-negative bacteremia (P<.001),
admission through the emergency department (P=.001), and admission to a medical service (P=.011).
Conclusions: Compared with prior authorization, prospective audit increased antimicrobial streamlining for
cases of Gram-negative bacteremia, those admitted through the emergency department, and those admitted
to a medical but not surgical service.
DOI: https://doi.org/10.1017/ice.2016.243
NosoBase ID notice : 424285
Facteurs de risque associés au portage fécal de Klebsiella pneumoniae productrices de
carbapénèmases : étude cas-témoins dans un centre hospitalier universitaire espagnol
Madueño A; González García J; Ramos MJ; Pedroso Y; Díaz Z; Oteo J; et al. Risk factors associated with
carbapenemase-producing Klebsiella pneumoniae fecal carriage: A case-control study in a Spanish tertiary
care hospital. American journal of infection control 2017/01; 45(1): 77-79.
Mots-clés : FACTEUR DE RISQUE; COLONISATION DIGESTIVE; ENTEROBACTERIE;
ANTIBIORESISTANCE; CARBAPENEME; BETA-LACTAMASE A SPECTRE ELARGI; ETUDE
PROSPECTIVE; CAS-TEMOIN; CARBAPENEMASE
Asymptomatic colonization of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is
an important reservoir for transmission that may precede infection. This prospective, observational, case-
control study was designed to identify risk factors for carbapenemase-producing Klebsiella pneumoniae
(CPKP) fecal carriage. This study included 87 cases and 200 controls. Multivariate analysis identified length
of stay (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.03; P=.03), previous hospitalization (OR,
5.89; 95% CI, 1.73-20.68; P=.01), antibiotic use (OR, 0.20; 95% CI, 0.65-0.62; P=.01), and corticosteroid use
(OR, 0.33; 95% CI, 0.15-0.74; P=.007) as independent risk factors for CPKP rectal carriage. Length of
hospital stay, previous hospitalization, corticosteroid use, and antimicrobial exposure are important risk
factors for CPKP rectal colonization. Adherence to infection control practices and directed surveillance
programs appear to be critical components for CPKP control programs.
DOI: https://doi.org/10.1016/j.ajic.2016.06.024
NosoBase ID notice : 424193
Etat de la prévention des bactéries multirésistantes sur la scène internationale : une enquête du
réseau de recherche de la SHEA (Society for Healthcare Epidemiology of America)
Safdar N; Sengupta S; Musuuza J; Juthani-Mehta M; Drees M; Abbo LM; et al. Status of the prevention of
multidrug-resistant organisms in international settings: a survey of the Society for Healthcare Epidemiology of
America research network. Infection control and hospital epidemiology 2017/01; 38(1): 53-60.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; ANTIBIOTIQUE; PRECAUTION
CONTACT; TRANSMISSION; PREVENTION
Objective: To examine self-reported practices and policies to reduce infection and transmission of multidrug-
resistant organisms (MDRO) in healthcare settings outside the United States.
Design: Cross-sectional survey.
Participants: International members of the Society for Healthcare Epidemiology of America (SHEA) Research
Network.
Methods: Electronic survey of infection control and prevention practices, capabilities, and barriers outside the
United States and Canada. Participants were stratified according to their country’s economic development
status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and high-
income.
Results: A total of 76 respondents (33%) of 229 SHEA members outside the United States and Canada
completed the survey questionnaire, representing 30 countries. Forty (53%) were high-, 33 (43%) were
middle-, and 1 (1%) was a low-income country. Country data were missing for 2 respondents (3%). Of the 76
respondents, 64 (84%) reported having a formal or informal antibiotic stewardship program at their institution.
High-income countries were more likely than middle-income countries to have existing MDRO policies (39/64
[61%] vs 25/64 [39%], P=.003) and to place patients with MDRO in contact precautions (40/72 [56%] vs 31/72
[44%], P=.05). Major barriers to preventing MDRO transmission included constrained resources
(infrastructure, supplies, and trained staff) and challenges in changing provider behavior.