NosoVeille mars 2010

NosoVeille – Bulletin de veille
mars 2010
.
NosoVeille n°3
Mars 2010
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications
scientifiques publiées au cours du mois écoulé.
La recherche documentaire est effectuée dans la base de données
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Abonnement / Désabonnement
Sommaire de ce numéro
Antibiotique
Appareil respiratoire
Candida
Cathétérisme
Chirurgie
Clostridium
Désinfection
Environnement
Grippe
Hémodialyse
Hygiène des mains
Néonatalogie
Ophtalmologie
Organisation
Personne âgée
Personnel
Soins intensifs
Staphylococcus
Surveillance
Tatouage
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
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Antibiotique
NosoBase n° 26369
Améliorer l'hygiène environnementale dans 27 unités de réanimation afin de diminuer la
transmission de bactéries multirésistantes aux antibiotiques
Carling PC; Parry MF; Bruno-Murtha LA; Dick B. Improving environmental in 27 intensive care units
todecrease multidrug-resistant bacterial transmission. Critical care medicine 2010; in press: 6 pages.
Mots-clés :
SOIN
INTENSIF;
TRANSMISSION;
ENVIRONNEMENT;
BIONETTOYAGE; CHAMBRE; QUALITE; ETUDE PROSPECTIVE; SURFACE
MULTIRESISTANCE;
Objective: To determine the thoroughness of terminal disinfection and cleaning of patient rooms in hospital
intensive care units and to assess the value of a structured intervention program to improve the quality of
cleaning as a means of reducing environmental transmission of multidrug-resistant organisms within the
intensive care unit.
Design: Prospective, multicenter, and pre- and postinterventional study.
Setting: Intensive care unit rooms in 27 acute care hospitals. Hospitals ranged in size from 25 beds to 709
beds (mean, 206 beds).
Interventions: A fluorescent targeting method was used to objectively evaluate the thoroughness of terminal
room cleaning before and after structured educational, procedural, and administrative interventions.
Systematic covert monitoring was performed by infection control personnel to assure accuracy and lack of
bias.
Measurements and main results: In total, 3532 environmental surfaces (14 standardized objects) were
assessed after terminal cleaning in 260 intensive care unit rooms. Only 49.5% (1748) of surfaces were
cleaned at baseline (95% confidence interval, 42% to 57%). Thoroughness of cleaning at baseline did not
correlate with hospital size, patient volume, case mix index, geographic location, or teaching status. After
intervention and multiple cycles of objective performance feedback to environmental services staff,
thoroughness of cleaning improved to 82% (95% confidence interval, 78% to 86%).
Conclusions: Significant improvements in intensive care unit room cleaning can be achieved in most
hospitals by using a structured approach that incorporates a simple, highly objective surface targeting
method and repeated performance feedback to environmental services personnel. Given the documented
environmental transmission of a wide range of multidrug-resistant pathogens, our findings identify a
substantial opportunity to enhance patient safety by improving the thoroughness of intensive care unit
environmental hygiene.
NosoBase n° 26388
Contrôler la dissémination de pathogènes à Gram négatif producteurs de carbapénèmases :
approche thérapeutique et lutte contre le risque infectieux
Carmeli Y; Akova M; Cornaglia G; Daikos Gl; Garau J; Harbarth S; et al. Controlling the spread of
carbapenemase-producing gram-negatives: therapeutic approach and infection control
Clinical microbiology and infection 2010/02; 16(2): 102-111.
Mots-clés : BACILLE GRAM NEGATIF; CARBAPENEME; ANTIBIORESISTANCE; TRAITEMENT;
CONTROLE; BIBLIOGRAPHIE; EUROPE
Although the rapid spread of carbapenemase-producing Gram-negatives (CPGNs) is providing the scientific
community with a great deal of information about the molecular epidemiology of these enzymes and their
genetic background, data on how to treat multidrug-resistant or extended drug-resistant carbapenemaseproducing Enterobacteriaceae and how to contain their spread are still surprisingly limited, in spite of the
rapidly increasing prevalence of these organisms and of their isolation from patients suffering from lifethreatening infections. Limited clinical experience and several in vitro synergy studies seem to support the
view that antibiotic combinations should be preferred to monotherapies. But, in light of the data available to
date, it is currently impossible to quantify the real advantage of drug combinations in the treatment of these
infections. Comprehensive clinical studies of the main therapeutic options, broken down by pathogen,
enzyme and clinical syndrome, are definitely lacking and, as carbapenemases keep spreading, are urgently
needed. This spread is unveiling the substantial unpreparedness of European public health structures to
face this worrisome emergency, although experiences from different countries-chiefly Greece and Israelhave shown that CPGN transmission and cross-infection can cause a substantial threat to the healthcare
system. This unpreparedness also affects the treatment of individual patients and infection control policies,
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
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with dramatic scarcities of both therapeutic options and infection control measures. Although correct
implementation of such measures is presumably cumbersome and expensive, the huge clinical and public
health problems related to CPGN transmission, alongside the current scarcity of therapeutic options, seem
to fully justify this choice.
NosoBase n° 26530
Désescalade après traitement empirique par le méropénème en réanimation : fiction ou réalité ?
De Waele JJ; Ravyts M; Depuydt P; Blot Si; Decruyenaere J; vogelaers D. De-escalation after empirical
meropenem treatment in the intensive care unit: fiction or reality? Journal of critical care 2010; in press: 6
pages.
Mots-clés : TRAITEMENT; SOIN INTENSIF; MEROPENEME; ANTIBIOTIQUE; ANALYSE; ETUDE
RETROSPECTIVE; CHIRURGIE; MORTALITE
Introduction: De-escalation of antimicrobial therapy is often advocated to reduce the use of broad-spectrum
antibiotics in critically ill patients. However, little data are available on the application of this strategy in daily
clinical practice.
Methods: This is a retrospective analysis of all meropenem prescriptions in a surgical intensive care unit
(ICU) during 1 year. Age, Acute Physiology and Chronic Health Evaluation II score on admission to the ICU,
site of infection, causative organism, duration of meropenem administration, other antibiotic prescription for
the same infectious episode for which meropenem was administered, and ICU mortality were recorded. Deescalation was defined as the administration of an antibiotic with a narrower spectrum within 3 days of the
start of meropenem.
Results: Data from 113 meropenem prescriptions were available for analysis. Pulmonary (46%) and
complicated intraabdominal (31%) infections were the most frequent infections. In 37 patients, meropenem
was used after identification of a multiresistant gram-negative organism (MRGN), whereas in 76 patients,
empirical treatment with meropenem was started. Empirical prescription of meropenem was de-escalated in
42% of the patients. In the majority of the patients in whom de-escalation was not done, no conclusive
cultures were available to guide treatment; also, colonization with MRGN at other sites was frequently
associated with non-de-escalation. Patients in whom antibiotics were de-escalated had a trend toward a
lower mortality rate (7% vs 21%, P = .12).
Conclusions: De-escalation after empirical treatment with meropenem was performed in less than half of the
patients. Reasons for not de-escalating included the absence of conclusive microbiology and colonization
with MRGN.
NosoBase n° 26212
Augmentation de la résistance des Acinetobacter à l’imipénème dans des hôpitaux des Etats-Unis,
1999-2006
Hoffmann MS; Eber MR; Laxminarayan R. Increasing resistance of Acinetobacter species to imipenem in
United States hospitals, 1999-2006. Infection control and hospital epidemiology 2010/02; 31(2): 196-197.
Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; ACINETOBACTER; IMIPENEME; SENSIBILITE;
SURVEILLANCE; LABORATOIRE
NosoBase n° 26206
Comparaison entre les taux de contamination des hémocultures après antisepsie cutanée au
gluconate de chlorhexidine et à la povidone-iodine dans un service d’urgence pédiatrique
Marlowe L; Mistry RD; Coffin S; Leckerman KH; Mcgowan KL; Dai D; et al. Blood culture contamination
rates after skin antisepsis with chlorhexidine gluconate versus povidone-iodine in a pediatric emergency
department. Infection control and hospital epidemiology 2010/02; 31(2): 171-176.
Mots-clés : CONTAMINATION; PEAU; CHLORHEXIDINE; POLYVIDONE IODEE; ANTISEPTIQUE;
PEDIATRIE; HEMOCULTURE; URGENCE; ETUDE RETROSPECTIVE
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Objective: To determine blood culture contamination rates after skin antisepsis with chlorhexidine, compared
with povidone-iodine.
Design: Retrospective, quasi-experimental study.
Setting: Emergency department of a tertiary care children's hospital.
Patients: Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008.
Control patients were children younger than 2 months with peripheral blood culture results.
Methods: Blood culture contamination rates were compared using segmented regression analysis of timeseries data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention
period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 236 months during the 26-month postintervention period, in which 3% chlorhexidine gluconate was used; and
(3) patients younger than 2 months not exposed to the chlorhexidine intervention (ie, the control group).
Results: Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group,
4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months,
the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000
cultures (P < .05) after implementation of chlorhexidine. This decrease of 7.62 contaminated cultures per
1,000 cultures (95% confidence interval, -0.781 to -15.16) represented a 30% relative decrease from the
preintervention period and was sustained over the entire postintervention period. No change in
contamination rate was observed in the control group (P = .337).
Conclusion: Skin antisepsis with chlorhexidine significantly reduces the blood culture contamination rate
among young children, as compared with povidone-iodine.
NosoBase n° 26389
Carbapénèmases acquises dans des pathogènes bactériens à Gram négatif : détection et
surveillance
Miriagou V; Cornaglia G; Edelstein M; Galani I; Giske CG; Gniadkowski M; et al. Acquired carbapenemases
in gram-negative bacterial pathogens: detection and surveillance issues. Clinical microbiology and infection
2010/02; 16(2): 112-122.
Mots-clés : BACILLE GRAM NEGATIF; CARBAPENEME; ANTIBIORESISTANCE; SURVEILLANCE;
PSEUDOMONAS AERUGINOSA; ACINETOBACTER; ANTIBIOTIQUE; KLEBSIELLA PNEUMONIAE;
DIAGNOSTIC BIOLOGIQUE; BIBLIOGRAPHIE
Acquired carbapenemases are emerging resistance determinants in Gram-negative pathogens, including
Enterobacteriaceae, Pseudomonas aeruginosa and other Gram-negative non-fermenters. A consistent
number of acquired carbapenemases have been identified during the past few years, belonging to either
molecular class B (metallo-beta-lactamases) or molecular classes A and D (serine carbapenemases), and
genes encoding these enzymes are associated with mobile genetic elements that allow their rapid
dissemination in the clinical setting. Therefore, detection and surveillance of carbapenemase-producing
organisms have become matters of major importance for the selection of appropriate therapeutic schemes
and the implementation of infection control measures. As carbapenemase production cannot be simply
inferred from the resistance profile, criteria must be established for which isolates should be suspected and
screened for carbapenemase production, and for which tests (phenotypic and/or genotypic) should be
adopted for confirmation of the resistance mechanism. Moreover, strategies should be devised for
surveillance of carbapenemase producers in order to enable the implementation of effective surveillance
programmes. The above issues are addressed in this article, as a follow-up to an expert meeting on
acquired carbapenemases that was recently organized by the ESCMID Study Group for Antibiotic
Resistance Surveillance.
NosoBase n° 26488
Précautions contact pour des microorganismes
recommandations actuelles et pratiques réelles
multirésistants
aux
antibiotiques
:
Clock SA; Cohen B; Behta M; Ross B; Larson EL. Contact precautions for multidrug-resistant organisms:
current recommendations and actual practice. American journal of infection control 2010/03; 38(2): 105-111.
Motst-clés : RECOMMANDATION; MULTIRESISTANCE; PRECAUTION CONTACT; PRATIQUE; TAUX;
OBSERVANCE; ENTEROCOCCUS; VANCOMYCINE; ANTIBIORESISTANCE; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; PREVENTION; GANT; BLOUSE
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Background: Contact precautions are recommended for interactions with patients colonized/infected with
multidrug-resistant organisms; however, actual rates of implementation of contact precautions are unknown.
Methods: Observers recorded the availability of supplies and staff/visitor adherence to contact precautions
at rooms of patients indicated for contact precautions. Data were collected at 3 sites in a New York City
hospital network.
Results: Contact precautions signs were present for 85.4% of indicated patients. The largest proportions
were indicated for isolation for vancomycin-resistant enterococci and methicillin-resistant Staphylococcus
aureus cultures. Isolation carts were available outside 93.7% to 96.7% of rooms displaying signs, and
personal protective equipment was available at rates of 49.4% to 72.1% for gloves (all sizes: small, medium,
and large) and 91.7% to 95.2% for gowns. Overall adherence rates on room entry and exit, respectively,
were 19.4% and 48.4% for hand hygiene, 67.5% and 63.5% for gloves, and 67.9% and 77.1% for gowns.
Adherence was significantly better in intensive care units (P < .05) and by patient care staff (P < .05), and
patient care staff compliance with one contact precautions behavior was predictive of adherence to
additional behaviors (P < .001).
Conclusions: Our findings support the recommendation that methods to monitor contact precautions and
identify and correct nonadherent practices should be a standard component of infection prevention and
control programs.
NosoBase n° 26432
Schémas des traitements antibiotiques dans des infections nosocomiales sévères : choix
empiriques, proportion de traitements appropriés et taux d'adaptation. Etude multicentrique
d'observation
Vogelaers D; De Bels D; Foret F; Cran S; Gilbert E; Schoonheydt K; et al. Patterns of antimicrobial therapy
in severe nosocomial infections: empiric choices, proportion of appropriate therapy, and adaptation rates - a
multicentre, observational survey in critically ill patients. International journal of antimicrobial agents 2010, in
press: 7 pages
Mots-clés : INFECTION TRAITEMENT; ANTIBIOTIQUE; ETUDE PROSPECTIVE; TAUX; SOIN INTENSIF;
PNEUMONIE; BACTERIEMIE; FACTEUR DE RISQUE; VENTILATION ASSISTEE; MEROPENEME
This prospective, observational multicentre (n=24) study investigated relationships between antimicrobial
choices and rates of empiric appropriate or adequate therapy, and subsequent adaptation of therapy in 171
ICU patients with severe nosocomial infections. Appropriate antibiotic therapy was defined as in vitro
susceptibility of the causative pathogen and clinical response to the agent administered. In nonmicrobiologically documented infections, therapy was considered adequate in the case of favourable clinical
response <5 days. Patients had pneumonia (n=127; 66 ventilator-associated), intra-abdominal infection
(n=23), and bloodstream infection (n=21). Predominant pathogens were Pseudomonas aeruginosa (n=29)
Escherichia coli (n=26), Staphylococcus aureus (n=22), and Enterobacter aerogenes (n=21). In 49.6% of
infections multidrug-resistant (MDR) bacteria were involved, mostly extended-spectrum beta-lactamase
(EBSL)-producing Enterobacteriaceae and MDR non-fermenting Gram-negative bacteria. Prior antibiotic
exposure and hospitalisation in a general ward prior to ICU admission were risk factors for MDR. Empiric
therapy was appropriate/adequate in 63.7% of cases. Empiric schemes were classified according to
coverage of (i) ESBL-producing Enterobacteriaceae and non-fermenting Gram-negative bacteria
("meropenem-based"), (ii) non-fermenting Gram-negative bacteria (schemes with an antipseudomonal
agent), and (iii) first-line agents not covering ESBL-Enterobacteriaceae nor non-fermenting Gram-negative
bacteria. Meropenem-based schemes allowed for significantly higher rates of appropriate/adequate therapy
(p<0.001). This benefit remained when only patients without risk factors for MDR were considered
(p=0.021). In 106 patients (61%) empiric therapy was modified: in 60 cases following initial
inappropriate/inadequate therapy, in 46 patients in order to refine empiric therapy. In this study reflecting
real-life practice, first-line use of meropenem provided significantly higher rates of the appropriate/adequate
therapy, irrespective of presence of risk factors for MDR.
Appareil respiratoire
NosoBase n° 26540
Fréquence, prévention, évolution et traitement des trachéobronchites associées à la ventilation :
revue systématique et méta-analyse
CCLIN Sud-Est – [email protected]
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Agrafiotis M; Siempos II; Falagas ME. Frequency, prevention, outcome and treatment of ventilatorassociated tracheobronchitis: systematic review and meta-analysis. Respiratory medicine 2010/03; 104(3):
325-336.
Mots-clés : STAPHYLOCOCCUS AUREUS; PREVENTION; TRAITEMENT; VENTILATION ASSISTEE;
BRONCHITE;
INFECTION
RESPIRATOIRE
BASSE;
BIBLIOGRAPHIE;
META-ANALYSE;
DECONTAMINATION DIGESTIVE SELECTIVE; MORTALITE; ANTIBIOTIQUE; DUREE DE SEJOUR;
PSEUDOMONAS AERUGINOSA; ACINETOBACTER
Objective: To clarify issues regarding the frequency, prevention, outcome, and treatment of patients with
ventilator-associated tracheobronchitis (VAT), which is a lower respiratory tract infection involving the
tracheobronchial tree, while sparing the lung parenchyma.
Methods: We performed a systematic review and meta-analysis of relevant available data, gathered though
searches of PubMed, Scopus, and reference lists, without time restrictions. A conservative random effects
model was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI).
Results: Out of the 564 initially retrieved articles, 17 papers were included. Frequency of VAT was 11.5%.
Selective digestive decontamination was not proved an effective preventive strategy against VAT (OR: 0.62,
95% CI: 0.31-1.26). Presence, as opposed to the absence, of VAT was not associated with higher
attributable mortality (OR: 1.02, 95% CI: 0.57-1.81). Administration of systemic antimicrobials (with or
without inhaled ones), as opposed to placebo or no treatment, in patients with VAT was not associated with
lower mortality (OR: 0.56, 95% CI: 0.27-1.14). Most of the studies providing relevant data noted that
administration of antimicrobial agents, as opposed to placebo or no treatment, in patients with VAT was
associated with lower frequency of subsequent pneumonia and more ventilator-free days, but without
shorter length of intensive care unit stay or shorter duration of mechanical ventilation.
Conclusions: Approximately one tenth of mechanically ventilated patients suffer from VAT. Antimicrobial
treatment of patients with VAT may protect against the development of subsequent ventilator-associated
pneumonia and improve weaning outcome.
Candida
NosoBase n° 26458
Candidose systématique néonatale : caryotypage de souches de Candida albicans isolées chez des
nouveau-nés et des membres du personnel soignant
Ben Abdeljelil J; Ben Saida N; Saghrouni F; Fathallah A; Boukadida J; Sboui H et al. Systemic neonatal
candidosis: the karyotyping of Candida albicans strains isolated from neonates and health-workers.
Mycoses 2010/01; 53(1): 72-77.
Mots-clés : NEONATALOGIE;
TRANSMISSION
CANDIDA
ALBICANS;
SOIN
INTENSIF;
INFIRMIER ;
PFGE ;
Candida albicans has become an important cause of nosocomial infections in neonatal intensive care units
(NICUs). The aim of the present study was to compare C. albicans strains isolated from neonates (NN)
suffering from systemic candidosis and from nurses in order to determine the relatedness between NN and
health workers' strains. Thirty-one C. albicans strains were isolated from 18 NN admitted to the NICU of the
neonatology service of Farhat Hached Hospital of Sousse, Tunisia and suffering from systemic candidosis,
together with five strains recovered from nurses suffering from C. albicans onychomycosis. Two additional
strains were tested, one from an adult patient who developed a systemic candidosis and the second from an
adult with inguinal intertrigo. All strains were karyotyped by pulsed-field gel electrophoresis (PFGE) with a
CHEF-DR II system. Analysis of PFGE patterns yielded by the 38 strains tested led to the identification of
three pulsotypes that were designated I, II and III, and consisted of six chromosomal bands with a size
ranging from 700 to >2500 kbp. The most widespread was the pulsotype I, which was shared by 17 NN and
the five nurses' strains. The identity between NN and nurses' strains is very suggestive of a nosocomial
acquisition from health-workers.
NosoBase n° 26512
Infections à Candida haemulonii : identification des espèces, sensibilité aux antifongiques et
évolution
Ruan SY; Kuo YW; Huang CT; Hsiue HC; Hsueh PR. Infections due to Candida haemulonii: species
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identification, antifungal susceptibility and outcomes. International journal of antimicrobial agents 2010/01;
35(1): 85-88.
Mots-clés : CANDIDA; ANTIFONGIQUE; RESISTANCE; FLUCONAZOLE; AMPHOTERICINE B; CMI;
TRAITEMENT
Here we report the clinical features and treatment outcomes of three patients with Candida haemulonii
infection. Candida haemulonii was confirmed by sequence analysis of the internal transcribed spacer (ITS)
regions of the rRNA genes and the 18S rRNA genes. Two of the three isolates were associated with
fungaemia and reduced susceptibility to fluconazole [minimum inhibitory concentrations (MICs) of 16 mg/L]
and amphotericin B (MICs of 2 mg/L). However, one of these two patients responded to fluconazole therapy.
Echinocandins, voriconazole and posaconazole demonstrated excellent in vitro potency against the isolates.
Cathétérisme
NosoBase n° 26494
Cathéters veineux centraux insérés par voie périphérique en unité de soins aigus : une alternative
sûre aux cathéters veineux centraux à risque élevé à court terme
Al Raiy B; Fakih MG; Bryan-Nomides N; Hopfner D; Riegel E; Nenninger T; et al. Peripherally inserted
central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous
catheters. American journal of infection control 2010/03; 38(2): 149-153.
Mots-clés : CATHETER VEINEUX CENTRAL; CATHETER; BACTERIEMIE; RISQUE; ETUDE
PROSPECTIVE; TAUX; VOIE INTRA-VEINEUSE; CENTRE HOSPITALIER UNIVERSITAIRE;
PERSONNEL
Background: Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term
central venous catheters (CVCs) for providing intravenous (IV) access in the hospital. It is not clear which
device has a lower risk of central line-associated bloodstream infection (CLABSI). We compared CVC- and
PICC-related CLABSI rates in the setting of an intervention to remove high-risk CVCs.
Methods: We prospectively followed patients with CVCs in the non-intensive care units (ICUs) and those
with PICCs hospital-wide. A team evaluated the need for the CVC and the risk of infection, recommended
the discontinuation of unnecessary or high-risk CVCs, and suggested PICC insertion for patients requiring
prolonged access. Data on age, gender, type of catheter, duration of catheter utilization, and the
development of CLABSIs were obtained.
Results: A total of 638 CVCs were placed for 4917 catheter-days, during which 12 patients had a CLABSI,
for a rate of 2.4 per 1000 catheter-days. A total of 622 PICCs were placed for 5703 catheter-days, during
which 13 patients had a CLABSI, for a rate of 2.3 per 1000 catheter-days. The median time to development
of infection was significantly longer in the patients with a PICC (23 vs 13 days; P=.03).
Conclusion: In the presence of active surveillance and intervention to remove unnecessary or high-risk
CVCs, CVCs and PICCs had similar rates of CLABSIs. Given their longer time to the development of
infection, PICCs may be a safe alternative for prolonged inpatient IV access.
NosoBase n° 26366
Occurrence de bactériémies liées à différents types de cathéters vasculaires centraux chez des
nouveau-nés en état sévère
De Brito CS; De Brito D; Abdallah V; Filho P. Occurrence of bloodstream infection with different types of
central vascular catheter in critically neonates. The Journal of infection 2010/02; 60(2): 128-132.
Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; SOIN INTENSIF; NEONATALOGIE;
CENTRE HOSPITALIER UNIVERSITAIRE; INCIDENCE; HEMOCULTURE; MICROBIOLOGIE
Objective: The aim of this research was to assess the incidence of CVCassociated/related to bloodstream
infection (BSI) to different types of CVC, by classes of neonatal birth weight. Methods: The research was
conducted in the Neonatal Intensive Care Unit of Uberlandia University Hospital from April/2006 through
April/2008. The population analyzed comprised neonates who had at least one CVC placed for longer than
24 h, followed-up through epidemiologic vigilance..National Healthcare Safety Network... Patients were
followed daily from their entry into the study to their discharge or death. Results: At birth, 50.7% of neonates
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had low weight (<or=1500 g), 24.5% between 1501 and 2500 g and 24.8% over 2500 g. The highest density
of CVC use (0.96) was found in neonates with birth weight ranging from 751 g to 1000 g. The incidence of
CVC-associated/related to BSI was 13.0 and 2.1 per 1000 days CVC, respectively, and the higher
representativeness in the weight group of 1501e2500 g (15.8) and <or=750 g (3.3), respectively. A higher
proportion of CVC-associated to BSI was observed in PICC (6.0) than in the other CVCs (P < 0.01).
Coagulase negative Staphylococcus was the most common microorganism (39.7%) in BSI, followed by
Staphylococcus aureus (24. 6%) and Gram-negative bacilli (19.2%). Conclusion: Although neonates
weighing less than 750 g comprise the group with lower representativeness at the unit (5.4%), they reveal
the highest CVC related to BSI incidence rate (3.3/1000 days CVC).
NosoBase n° 26346
Incidence plus élevée des bactériémies sur cathéter en site jugulaire avec trachéotomie qu'en site
fémoral
Lorente L; Jimenez A; Naranjo C; Martinez J; Iribarren JL; Jimenez JJ; et al. Higher incidence of catheterrelated bacteremia in jugular site with tracheostomy than in femoral site. Infection control and hospital
epidemiology 2010/03; 31(3): 311-313.
Mots-clés : INCIDENCE; CATHETER; BACTERIEMIE; INCIDENCE; CATHETER VEINEUX; BACTERIEMIE
NosoBase n° 26340
Comparaison de la durée d’activité antimicrobienne de 2 cathéters veineux centraux imprégnés
d’antibiotiques différents
Matheos T; Walz JM; Adams JP; Johnson K; Longtine K; Longtine J; et al. Comparison of the duration of
antimicrobial activity of 2 different antimicrobial central venous catheters. Infection control and hospital
epidemiology 2010/03; 31(3): 295-297.
Mots-clés : CATHETER VEINEUX CENTRAL; CATHETER IMPREGNE; ANTIBIOTIQUE; DISPOSITIF
MEDICAL; STAPHYLOCOCCUS ENTEROCOCCUS
We compared the duration of antimicrobial effectiveness of 2 different antimicrobial catheters. The baseline
activity of minocycline-rifampin catheters was greater than that of silver-platinum-carbon catheters against
Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecalis. The antimicrobial activity
of the minocycline-rifampin catheters against these pathogens persisted for up to 12 days, while that of the
silver-platinum-carbon catheters was depleted by day 10 (P<.05).
NosoBase n° 26539
Evaluation des pratiques de gestion des cathéters veineux centraux dans les réanimations
chirurgicales universitaires françaises
Mimoz O; Moreira R; Frasca D; Boisson M; Dahyot-Fizelier C. Practice assessment of central venous lines
care in surgical ICU of french university hospitals. Annales françaises d'anesthésie et de réanimation 2010;
in press: 9 pages.
Mots-clés : EVALUATION; CATHETER VEINEUX CENTRAL; SOIN INTENSIF; ENQUETE; MEDECIN;
QUESTIONNAIRE
Introduction: Recommendations on insertion and maintenance of central venous catheters (CVC) in
intensive care unit (ICU) patients were updated in 2002. The aim of this study was to estimate their
knowledge and/or application by physicians in French university hospital ICUs.
Methods: Two forms were sent to 124 professors of anaesthesia and intensive care encouraging them to
participate to the survey. The first one was completed by the physician in charge of each unit and concerned
the structure and activity of the unit in 2006. The second one was filled by each junior or senior physician
working in the units and asked for experience, CVC insertion modalities and knowledge of CVC care
protocols.
CCLIN Sud-Est – [email protected]
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mars 2010
Results: Forty-one (75 %) university hospitals with at least one adult surgical ICU took part to the study. A
questionnaire was filled by 124 senior (75 % of the staff) and 53 junior (43 % of the staff) physicians
inserting an average of 10 CVC per month (range, 1-35). A written protocol for CVC insertion was known by
127 (72 %) of them. CVC insertion was done while wearing sterile gown (97 %), cap (100 %) and surgical
mask (100 %) and using large sterile draps (96 %). The antiseptic solution used for cutaneous antisepsis
was povidone iodine in aqueous (36 %) or alcoholic solution (40 %), or an alcoholic solution of chlorhexidine
(24 %) applied one (9 %), two (64 %) or three (27 %) times before insertion. A 4-times disinfection sequence
(washing, rinsing, drying and disinfection) was performed by 161 (91 %) physicians. Ultrasound-guided
insertion was realized by only eight (5 %) operators. CVCs were made of polyurethane (84 %), usually multilumens (>96 %) and rarely tunnelised (14 %). Only two physicians (1 %) sometimes use catheters coated
with antibiotics or antiseptics. The site for catheter insertion was mostly the sub-clavian (47 %) or internal
jugular vein (34 %), and rarely the femoral vein (20 %). CVCs were secured with a thread (99 %) and
covered with a semi-permeable dressing (76 %). Concerning CVCs maintenance, 91 % of physicians
acknowledged the existence of a written protocol in the unit. Dressings were changed every day (10 %),
every two days (49 %), every three days (29 %) or every four days or more (12 %) by using the same
antiseptic solution and semi-permeable transparent dressing in 78 % of cases. Venous lines changes were
done during dressing maintenance (48 %), every day in case of administration of lipids (32 %) or just after
administration of blood products via the catheter (32 %). Routine change of CVC was rarely
recommended (11 %).
Conclusion: The high number of answers allows setting of a precise state of CVCs insertion practices in
adult surgical ICUs. Recommendations for central venous catheter insertion and maintenance are not still
known and\or applied.
NosoBase n° 26436
Devrait-on utiliser des poches à perfusion à système ouvert ou à système clos pour la prévention
des bactériémies ?
Rangel-Frausto MS; Higuera-Ramirez F; Martinez-Soto J; Rosenthal VD. Should we use closed or open
infusion containers for prevention of bloodstream infections? Annals of clinical microbiology and
antimicrobials 2010; in press: 32 pages.
Mots-clés : PREVENTION; BACTERIEMIE; PERFUSION; CATHETER; COHORTE;
PROSPECTIVE; RISQUE; CONTAMINATION; VOIE INTRA-VEINEUSE; INCIDENCE
ETUDE
Background: Hospitalized patients in critical care settings are at risk for bloodstream infections (BSI). Most
BSIs originate from a central line (CL), and they increase length of stay, cost, and mortality. Open infusion
containers may increase the risk of contamination and administration-related CLAB because they allow the
entry of air into the system, thereby also providing an opportunity for microbial entry. Closed infusion
containers were designed to overcome this flaw. However, open infusion containers are still widely used
throughout the world. The objective of the study was to determine the effect of switching from open (glass,
burettes, and semi-rigid) infusion containers to closed, fully collapsible, plastic infusion containers (Viaflex)
on the rate and time to onset of central line-associated bloodstream infections (CLABs).
Methods: An open label, prospective cohort, active healthcare-associated infection surveillance, sequential
study was conducted in four ICUs in Mexico. Centers for Disease Control National Nosocomial Infections
Surveillance Systems definitions were used to define device-associated infections.
Results: A total of 1,096 adult patients who had a central line in place for >24 hours were enrolled. The
CLAB rate was significantly higher during the open versus the closed container period (16.1 versus 3.2
CLAB/1000 central line days; RR=0.20, 95%, C I=0.11-0.36, P<0.0001). The probability of developing CLAB
remained relatively constant in the closed container period (1.4% Days 2-4 to 0.5% Days 8-10), but
increased in the open container period (4.9% Days 2-4 to 5.4% Days 8-10). The chance of acquiring a CLAB
was significantly decreased (81%) in the closed container period (Cox proportional hazard ratio 0.19,
P<0.0001). Mortality was statistically significantly lower during the closed versus the open container period
(23.4% versus 16.1%; RR=0.69, 95% CI=0.54-0.88, P<0.01).
Conclusions: Closed infusion containers significantly reduced CLAB rate, the probability of acquiring CLAB,
and mortality.
Chirurgie
NosoBase n° 26341
Les facteurs de risque associés à un diagnostic ultérieur d’infection sur prothèse articulaire
CCLIN Sud-Est – [email protected]
9 / 29
NosoVeille – Bulletin de veille
mars 2010
Aslam S; Reitman C; Darouiche RO. Risk factors for subsequent diagnosis of prosthetic joint infection.
Infection control and hospital epidemiology 2010/03; 31(3): 298-301.
Mots-clés : FACTEUR DE RISQUE; PROTHESE TOTALE DE GENOU
The factors associated with prosthetic joint infection for 126 patients in a case-control study were as follows:
bacteremia during the previous year (odds ratio [OR], 4.25 [95% confidence interval {CI}, 1.3-3.8]),
nonsurgical trauma to the prosthetic joint (OR, 21.5 [95% CI, 2.6-175.2]), and surgical site infection (OR,
5.25 [95% CI, 1.7-16.7]).
NosoBase n° 26344
Avec quelle précision les heures du début d’un acte opératoire sont-elles documentées dans un
dossier médical ? Impact sur la mesure de la performance de la prévention des ISO
Bozikis MR; Braun BI; Kritchevsky SB. How accurately are starting times documented in the medical record?
Implications for surgical infection prevention performance measurement. Infection control and hospital
epidemiology 2010/03; 31(3): 307-309.
Mots-clés : PREVENTION; SITE OPERATOIRE; ANTIBIOPROPHYLAXIE;
PROSPECTIVE; RANDOMISATION; RECOMMANDATION; USAGER
QUALITE;
ETUDE
NosoBase n° 26466
Recommandations de bonnes pratiques cliniques : l'antibioprophylaxie en chirurgie urologique, par
le Comité d'infectiologie de l'association française d'urologie (CIAFU)
Bruyere F; Sotto A; Escaravage L; Cariou G; Mignard JP; Coloby P; et al. Recommendations of the
infectious disease committee of the french association of urology (AFU): antibiotic prophylaxis for urological
procedures. Progrès en urologie 2010/02; 20(2): 101-108.
Mots-clés :
RECOMMANDATION;
ANTIBIOTIQUE; PROTOCOLE
UROLOGIE;
ANTIBIOPROPHYLAXIE;
MICRO-ORGANISME;
En urologie, la prescription de l’antibioprophylaxie chirurgicale suit les recommandations de la SFAR 1999.
Aucune mise à jour n’a été réalisée depuis. Néanmoins, la progression des résistances des germes aux
antibiotiques et l’arrivée de nouvelles techniques chirurgicales nous imposent une actualisation de ces
recommandations. Nous présentons ici les recommandations du comité d’infectiologie de l’AFU sur
l’antibioprophylaxie en urologie.
NosoBase n° 26522
Facteurs de risque d'infections post-opératoires chez des patients présentant une fracture de
hanche traitée par arthroplastie de Thompson
Garcia-Alvarez F; Al-Ghanem R; Garcia-Alvarez I; Lopez-Baisson A; Bernal M. Risk factors for
postoperative infections in patients with hip fracture treated by means of Thompson arthroplasty.
Archives of gerontology and geriatrics 2010/02; 50(1): 51-55.
Mots-clés : FACTEUR DE RISQUE; CHIRURGIE ORTHOPEDIQUE; ETUDE PROSPECTIVE;
INFECTION URINAIRE; PNEUMONIE; SITE OPERATOIRE; TRANSFUSION
Specific conditions associated with surgery may predispose elderly people to septic complications after hip
fracture surgery. This study investigated the risk factors predisposing infection in aged patients with
subcapital hip fracture. We performed a prospective study of 290 patients with displaced subcapital hip
fracture, operated by means of Thompson hip hemi-arthroplasty (83.5% fractures in women). The mean age
was 85.42+/-6.06 years (ranging from 69 to 104). Follow-up was realized until death or at least for 2 years.
The chi(2) test, analysis of variance, Kruskal-Wallis test, correlation analysis and the Spearman test were
applied. Odds ratios (OR) were calculated. During the hospital stay, there were diagnosed 94 urinary tract
infections, 25 pneumonias, 50 superficial wound infections, 11 deep wound infections. Transfusions were
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
mars 2010
made in 120 patients (in average: 2.54+/-1.45 units of red cell concentrate/transfused patient). Transfusion
appeared to be correlated with superficial wound infection (OR=1.96), urinary infection (OR=1.76) and
pneumonia (OR=2.85). Higher number of days waiting for surgery were related significantly with pneumonia
(9.8+/-7.44 days vs. 6.39+/-3.75), or urinary tract infection (7.76+/-4.39 days vs. 6.17+/-4.14). We concluded
that the transfusion and longer waiting time for surgery have been associated with the septic complications
in elderly patients treated surgically for hip fracture.
NosoBase n° 26426
Cas groupés d'infections du site opératoire : protocole et résultats d'une enquête. Impact d'un
produit à base d'alcool pour la désinfection chirurgicale des mains et du comportement humain
Haessler S; Connelly NR; Kanter G; Fitzgerald J; Scales ME; Golubchik A; et al. A surgical site infection
cluster: the process and outcome of an investigation - The impact of an alcohol-based surgical antisepsis
product and human behaviour. Anesthesia and analgesia 2010; in press: 5 pages.
Mots-clés : SITE OPERATOIRE; ENQUETE; SOLUTION HYDROALCOOLIQUE; HYGIENE DES MAINS;
DESINFECTION CHIRURGICALE DES MAINS PAR FRICTION; PRATIQUE; DESINFECTION
CHIRURGICALE DES MAINS PAR LAVAGE
Background: The institution of a process used to successfully execute a perioperative antibiotic
administration system is but 1 component of preventing postoperative infections. Continued surveillance of
infections is an important part of the process of decreasing postoperative infections. We recently
experienced an increase in the number of postoperative infections in our patients. Using standard infection
control methods of outbreak investigation, we tracked multiple variables to search for a common cause. We
describe herein the process by which Quality Improvement methodology was used to investigate and
manage this surgical site infection (SSI) cluster.
Methods: As part of routine surveillance for SSI, the infection control division seeks out evidence of
postoperative infections. Patients were defined as having an SSI according to National Healthcare Safety
Network SSI criteria. SSI data are reviewed monthly and aggregated on a quarterly basis. The SSI rate was
above our usual level for 3 consecutive quarters of 2007. This increase in the infection rate led to an internal
outbreak investigation, termed a "cluster investigation." This investigation comprised multiple concurrent
methods including manual chart review of all cases; review of microbiological data; and inspection of
operating rooms, instrument processing facilities, and storage areas.
Results: During 3 quarters, a trend emerged in our general surgical population that demonstrated that 4
surgical types had a sustained increase in SSI. The institutional antibiotic protocol was appropriate for
prevention of the majority of these SSIs. As part of the investigation, direct observation of hand hygiene and
surgical hand antisepsis technique was undertaken. At this time, there were 2 types of surgical hand
preparation being used, at the discretion of the clinician: either a "standard" scrub with an antimicrobial soap
or the application of a chlorhexidine gluconate and alcohol-based surgical hand antisepsis product.
Observers noted improper use of this alcohol-based surgical hand antiseptic. This product was withdrawn
from our operating rooms, and the SSI rate markedly decreased in the following 2 quarters.
Discussion: In conclusion, we report the results of a quality improvement process that investigated a 3quarter increase in our SSI rate. An investigation was undertaken, and it was thought that the (mis)use of an
alcohol-based hand antiseptic product was associated with the increased infection rate. Removing this
product, along with reemphasizing the importance of infection control, was associated with a decrease in the
infection rate to a level at or below our historical rate.
NosoBase n° 26495
Concentration de bactéries passant à travers des trous occasionnés par des piqûres dans des gants
chirurgicaux
Harnob JC; Partecke LI; Heidecke CD; Hubner NO; Kramer A; Assadian O. Concentration of bacteria
passing through puncture holes in surgical gloves. American journal of infection control 2010/03; 38(2): 154158.
Mots-clés : GANT; PIQURE; CHIRURGIE; PREVENTION; CHIRURGIE DIGESTIVE
CCLIN Sud-Est – [email protected]
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mars 2010
Background: The reasons for gloving-up for surgery are to protect the surgical field from microorganisms on
the surgeon's hands and protect the surgeon from the patient's microorganisms. This study measured the
concentration of bacteria passing through glove punctures under surgical conditions.
Methods: Double-layered surgical gloves were worn during visceral surgeries over a 4-month period. The
study included 128 outer gloves and 122 inner gloves from 20 septic laparotomies. To measure bacterial
passage though punctures, intraoperative swabs were made, yielding microorganisms that were compared
with microorganisms retrieved from the inner glove layer using a modified Gaschen bag method.
Results: Depending on the duration of glove wear, the microperforation rate of the outer layer averaged
15%. Approximately 82% of the perforations went unnoticed by the surgical team. Some 86% of perforations
occurred in the nondominant hand, with the index finger being the most frequently punctured location (36%).
Bacterial passage from the surgical site through punctures was detected in 4.7% of the investigated gloves.
Conclusion: Depending on the duration of wear, surgical gloves develop microperforations not immediately
recognized by staff. During surgery, such perforations allow passage of bacteria from the surgical site
through the punctures. Possible strategies for preventing passage of bacteria include strengthening of glove
areas prone to punctures and strict glove changing every 90 minutes.
NosoBase n° 26507
Incidence des infections sur prothèse articulaire après arthroplastie primaire du genou
Jamsen E; Varonen M; Huhtala H; Lehto M; Lumio J; Konttinen YT; et al. Incidence of prothetic joint
infections after primary knee arthroplasty. The Journal of arthroplasty 2010/01; 25(1): 87-92.
Mots-clés : INCIDENCE; PROTHESE TOTALE DE GENOU; CHIRURGIE ORTHOPEDIQUE; TAUX;
SURVEILLANCE; ETUDE PROSPECTIVE; PERSONNE; FACTEUR DE RISQUE; MATERIEL ETRANGER
We report the 1-year incidence of postoperative infections in an unselected series of 2647 consecutive
primary knee arthroplasties (3137 knees) performed in a modern specialized hospital dedicated solely to
joint arthroplasty surgery in 2002 to 2006. The rates of superficial and prosthetic joint infections were 2.9%
and 0.80%, respectively. Prospective surveillance by hospital infection register failed to detect 6 of the 24
prosthetic joint infections. Increased rate of prosthetic joint infections was associated with complex surgery
and with several patient-related factors, for example, comorbidity, obesity, and poor preoperative clinical
state. The rate of prosthetic joint infections in contemporary knee arthroplasty is low and mainly related to
patient-related factors, of which patient comorbidity has the most profound effect on the infection rate.
NosoBase n° 26527
Evaluation des pratiques de prévention du risque infectieux après arthroplastie totale de genou
Levent T; Vandevelde D; Delobelle JM; Labourdette P; Letendard J; Lesage P; et al. Infection risk
prevention following total knee arthoplasty. Revue de chirurgie orthopédique et traumatologique 2010/02;
96(1): 48-56.
Mots-clés : PREVENTION; AUDIT; PROTHESE TOTALE DE GENOU; INCIDENCE; SITE OPERATOIRE;
ANTIBIOPROPHYLAXIE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE
NosoBase n° 26427
Infections liées aux dispositifs parmi des patients porteurs de Pacemakeur ou de défibrillateurs
implantables : incidence, facteurs de risque et conséquences
Nery PB; Fernandes R; Nair G; Sumner GL; Ribas CS; Divakara Menon SM; et al. Device-related infection
among patients with pacemakers and implantable defibrillators: incidence, risk factors, and consequences.
Journal of cardiovascular electrophysiology 2010; in press: 5 pages.
Mots-clés : INCIDENCE; FACTEUR DE RISQUE; CHIRURGIE; ETUDE RETROSPECTIVE; ANALYSE
MULTIVARIEE; DISPOSITIF MEDICAL; CARDIOLOGIE; COMPLICATION; BACTERIEMIE; SITE
OPERATOIRE
CCLIN Sud-Est – [email protected]
12 / 29
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mars 2010
Risk Factors and Complications of Pacemaker and ICD Infection. Background: Device-related infection is a
major limitation of device therapy for cardiac arrhythmia.
Methods: The authors analyzed the incidence and risk factors for cardiac device infection (CDI) among
consecutive patients implanted with pacemaker (PM) or implantable cardioverter defibrillator (ICD) (including
cardiac resynchronization therapy devices) at a tertiary health center in Hamilton, Ontario, Canada. Most
patients with device-related infections were identified by an internal infection control system that reports any
positive wound and blood cultures following surgery, between 2005 and the present. A retrospective review
of patient records was also performed for all patients who received an ICD or PM between July 1, 2003 and
March 20, 2007. Results: A total of 24 infections were identified among 2,417 patients having device surgery
(1%). Fifteen of these infections (60%) were diagnosed within 90 days of the last surgical procedure.
Univariate analysis showed that patients presenting with CDI were more likely to have had a device
replacement, rather than a new implant, had more complex devices (dual/triple chamber vs single), and
were more likely to have had a prior lead dislodgement. Multivariate analysis found device replacement (P =
0.02) and cardiac resynchronization therapy (CRT)/dual-chamber devices (P = 0.048) to be independent
predictors of infection. One patient developed septic pulmonary emboli after having laser-assisted lead
extraction. No patient died and 22 patients received a new device. Conclusion: CDI occurs in about 1% of
cases in high volume facilities. Pulse generator replacement surgery and dual- or triple-chamber device
implantation were associated with a significantly increased risk of infection.
NosoBase n° 26506
La durée d'intervention en chirurgie générale est associée à une augmentation des taux de
complications infectieuses ajustés aux risques et de la durée du séjour hospitalier
Procter LD; Davenport DL; Bernard AC; Zwischenberger JB. General surgical operative duration is
associated with increased risk-adjusted infectious complication rates and length of hospital stay. Journal of
the American College of Surgeons 2010/01; 210(1): 60-65.
Mots-clés : RISQUE; CHIRURGIE; TAUX; COMPLICATION; DUREE DE SEJOUR; CHIRURGIE
GENERALE; ETUDE PROSPECTIVE; SITE OPERATOIRE; INFECTION URINAIRE; PNEUMONIE;
TRANSFUSION
Background: Studies of specific procedures have shown increases in infectious complications with operative
duration. We hypothesized that operative duration is independently associated with increased risk-adjusted
infectious complication (IC) rates in a broad range of general surgical procedures.
Study design: We queried the American College of Surgeons National Surgical Quality Improvement
Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection,
sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus
operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables,
operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated
laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without
intraoperative transfusion and with a clean or clean-contaminated wound class.
Results: In 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at
a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk
increased for each half hour of OD relative to cases lasting <or=1 hour, almost doubling at 2.1 to 2.5 hours
(odds ratio = 1.92; 95% CI, 1.82 to 2.03; p < 0.001). In isolated laparoscopic cholecystectomy, IC rates
increased linearly with OD (n = 17,018, chi-square test for linear trend, p < 0.001) with rates for 1.1 to 1.5
hour cases (1.4%) doubling those lasting <or=0.5 hour (0.7%). Across all procedures, adjusted LOS
increased geometrically with operative duration at a rate of about 6% per half hour (coefficient for natural log
transformed LOS = 0.059 per half hour; 95% CI, 0.058 to 0.060; p < 0.001). CONCLUSIONS: Operative
duration is independently associated with increased ICs and LOS after adjustment for procedure and patient
risk factors.
NosoBase n° 26516
Complications infectieuses après procédures chirurgicales vasculaires réglées
Vogel TR; Dombrovskiy VY; Carson JL; Haser PB; Lowry SF; Graham AM. Infectious complications after
elective vascular surgical procedures. Journal of vascular surgery 2010/01; 51(1): 122-130.
Mots-clés : COMPLICATION; CHIRURGIE VASCULAIRE; TAUX; PNEUMONIE; INFECTION URINAIRE;
CCLIN Sud-Est – [email protected]
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DUREE DE SEJOUR; COUT; FACTEUR DE RISQUE; ANALYSE MULTIVARIEE; SITE OPERATOIRE;
SYNDROME SEPTIQUE
Objective: This study was conducted to evaluate and compare the rates of postoperative infectious
complications and death after elective vascular surgery, define vascular procedures with the greatest risk of
developing nosocomial infections, and assess the effect of infection on health care resource utilization.
Methods: The Nationwide Inpatient Sample (2002-2006) was used to identify major vascular procedures by
International Classification of Diseases, 9th Clinical Modification (ICD-9-CM) codes. Infectious complications
identified included pneumonia, urinary tract infections (UTI), postoperative sepsis, and surgical site
infections (SSI). Case-mix-adjusted rates were calculated using a multivariate logistic regression model for
infectious complication or death as an outcome and indirect standardization.
Results: A total of 870,778 elective vascular surgical procedures were estimated and evaluated with an
overall postoperative infection rate of 3.70%. Open abdominal aortic surgery had the greatest rate of
postoperative infections, followed by open thoracic procedures and aorta-iliac-femoral bypass. Thoracic
endovascular aneurysm repair (TEVAR) infectious complication rates were two times greater than after
EVAR (P < .0001). Pneumonia was the most common infectious complication after open aortic surgery
(6.63%). UTI was the most common after TEVAR (2.86%) and EVAR (1.31%). Infectious complications were
greater in octogenarians (P < .0002), women (P < .0001), and blacks (P < .0001 vs whites and Hispanics).
Nosocomial infections after elective vascular surgery significantly increased hospital length of stay (13.8 +/15.4 vs 3.5 +/- 4.2 days; P < .001) and reported total hospital cost ($37,834 +/- $42,905 vs $11,851 +/$11,816; P < .001).
Conclusions: Elective vascular surgical procedures vary widely in the estimated risk of postoperative
infection. Open aortic surgery and endarterectomy of the head and neck vessels have, respectively, the
greatest and the lowest reported incidence for postoperative infectious complications. Women,
octogenarians, and blacks have the highest risk of infectious complications after elective vascular surgery.
Disparities in the development of infectious complications on a systems level were also found in larger
hospitals and teaching hospitals. Hospital infectious complications were found to significantly increase
health care resource utilization. Strategies that reduce nosocomial complications and target high-risk
procedures may offer significant future cost savings.
NosoBase n° 26489
Infections du site opératoire : pathogènes responsables et évolutions associées
Weigelt JA; Lipsky BA; Tabak YP; Derby KG; Kim M; Gupta V. Surgical site infections: causative pathogens
and associated outcomes. American journal of infection control 2010/03; 38(2): 112-120.
Mots-clés : SITE OPERATOIRE; MORTALITE; TAUX; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; DUREE DE SEJOUR; COUT; ANALYSE MULTIVARIEE; PSEUDOMONAS
Background: Surgical site infections (SSIs) are associated with substantial morbidity, mortality, and cost.
Few studies have examined the causative pathogens, mortality, and economic burden among patients
rehospitalized for SSIs.
Methods: From 2003 to 2007, 8302 patients were readmitted to 97 US hospitals with a culture-confirmed
SSI. We analyzed the causative pathogens and their associations with in-hospital mortality, length of stay
(LOS), and cost.
Results: The proportion of methicillin-resistant Staphylococcus aureus (MRSA) significantly increased
among culture-positive SSI patients during the study period (16.1% to 20.6%, respectively, P < .0001).
MRSA (compared with other) infections had higher raw mortality rates (1.4% vs 0.8%, respectively, P=.03),
longer LOS (median, 6 vs 5 days, respectively, P < .0001), and higher hospital costs ($7036 vs $6134,
respectively, P < .0001). The MRSA infection risk-adjusted attributable LOS increase was 0.93 days (95%
confidence interval [CI]: 0.65-1.21; P < .0001), and cost increase was $1157 (95% CI: $641-$1644; P <
.0001). Other significant independent risk factors increasing cost and LOS included illness severity, transfer
from another health care facility, previous admission (<30 days), and other polymicrobial infections (P < .05).
CONCLUSION: SSIs caused by MRSA increased significantly and were independently associated with
economic burden. Admission illness severity, transfer from another health care setting, and recent
hospitalization were associated with higher mortality, increased LOS, and cost.
Clostridium
NosoBase n° 26342
CCLIN Sud-Est – [email protected]
14 / 29
NosoVeille – Bulletin de veille
mars 2010
Une forte consommation d’antibiotiques en France est-elle associée aux infections à Clostridium
difficile ribotype PCR 027 ?
Birgand G; Miliani K; Carbonne A; Astagneau P. Is high consumption of antibiotics associated with
Clostridium difficile polymerase chain reaction-ribotype 027 infections in France? Infection control and
hospital epidemiology 2010/03; 31(3): 302-305.
Mots-clés : CLOSTRIDIUM; ANTIBIOTIQUE; CONSOMMATION; EPIDEMIE; RIBOTYPE; AMINOSIDE;
BETALACTAMINE; FLUOROQUINOLONE; LEVOFLOXACINE; IMIPENEME; ANALYSE MULTIVARIEE
We compared antibiotic consumption between hospitals affected by a strain of Clostridium difficile
designated as polymerase chain reaction-ribotype 027 (CD-027) and those unaffected during an outbreak in
northern France. The mean consumption of several beta-lactams, amikacin, and fluoroquinolones was high
in affected hospitals ([Formula: see text]). However, only levofloxacin and imipenem remained associated
with emerging CD-027 in the multivariate analysis, suggesting that those antibiotics should be better
targeted by prevention campaigns.
NosoBase n° 26442
Alimentation par sonde, microbiote et infection à Clostridium difficile
O'keefe S. Tube feeding, the microbiota, and Clostridium difficile infection. World journal of gastroenterology
2010/01/14; 16(2): 139-142.
Mots-clés : CLOSTRIDIUM DIFFICILE; ALIMENTATION; TRAITEMENT; COLONISATION; CATHETER;
PREVENTION
Clostridium difficile (C. difficile) is now the leading cause of nosocomial diarrhea in the USA, accounting for
30% of patients with antibiotic-associated diarrhea, 70% of those with antibiotic-associated colitis, and most
cases of pseudomembranous colitis. The organism has evolved over the last 8 years to become more
virulent and resistant to antimicrobials (NAP1/027 strain) causing a more severe form of the disease that has
increased mortality and healthcare costs. While it is generally accepted that the problem results from the
overuse of antibiotics, and in particular second and third generation cephalosporins, fluoroquinolones and
macrolides, recent studies suggest that acid suppression with proton pump inhibitors (PPIs) may be equally
culpable. A further common, but less recognized, etiological factor is the prolonged use of elemental diets.
Such diets are totally absorbed within the small intestine and therefore deprive the colonic microbiota of their
source of nutrition, namely dietary fiber, fructose oligosaccharides, and resistant starch. The resultant
suppression of colonic fermentation leads to suppression of the "good" bacteria, such as butyrate-producers
(butyrate being essential for colonic mucosal health), and bifidobacteria and the creation of a "permissive"
environment for C. difficile colonization and subsequent infection. Based on this analysis, the best chance of
suppressing the emerging C. difficile epidemic is to adopt a 3-pronged attack consisting of (1) avoidance of
the use of prophylactic antibiotics, (2) the avoidance of prophylactic PPIs, and (3) the conversion of
elemental diet feeding to a diet containing adequate indigestible carbohydrate after the first week of critical
illness. In this review, we highlight the rising worldwide incidence of C. difficile associated diarrhea and the
role played by non-residue diets in destabilizing the colonic microbiota.
NosoBase n° 26536
Diarrhée à Clostridium difficile en post-opératoire
Southern WN; Rahmani R; Aroniadis O; Khorshidi I; Thanjan A; Ibrahim C; et al. Postoperative Clostridium
difficile-associated diarrhea. Surgery 2010; in press: 7 pages.
Mots-clés : CLOSTRIDIUM DIFFICILE; DIARRHEE; POST-OPERATOIRE; CHIRURGIE ABDOMINALE;
TAU; MORTALITE; ANTIBIOTIQUE
Background: Abdominal surgery is thought to be a risk factor for Clostridium difficile-associated diarrhea
(CDAD). The aims of this study were to discern pre-operative factors associated with postoperative CDAD,
examine outcomes after postoperative CDAD, and compare outcomes of postoperative versus medical
CDAD.
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Methods: Data from 3904 patients who had abdominal operations at Montefiore Medical Center were
extracted from Montefiore's clinical information system. Cases of 30-day postoperative CDAD were
identified. Pre-operative factors associated with developing postoperative CDAD were identified using
logistic regression. Medical patients and surgical patients with postoperative CDAD were compared for
demographic and clinical characteristics, CDAD recurrence, and 90-day postinfection mortality.
Results: The rate of 30-day postoperative CDAD was 1.2%. After adjustment for age and comorbidities,
factors significantly associated with postoperative CDAD were: antibiotic use (OR: 1.94), proton pump
inhibitor (PPI) use (OR: 2.32), prior hospitalization (OR: 2.27), and low serum albumin (OR: 2.05). In
comparison with medical patients with CDAD, postoperative patients with CDAD were significantly more
likely to have received antibiotics (98% vs 85%), less likely to have received a PPI (39% vs 58%), or to have
had a prior hospitalization (43% vs 67%). Postoperative patients with CDAD had decreased risk of mortality
when compared with medical patients with CDAD (HR 0.36).
Conclusion: CDAD is an infrequent complication after abdominal operations. Several avoidable preoperative exposures (eg, antibiotic and PPI use) were identified that increase the risk of postoperative
CDAD. Postoperative CDAD is associated with decreased risk of mortality when compared with CDAD on
the medical service.
Désinfection
NosoBase n° 26205
Evaluation de la désinfection par ultraviolet C des transducteurs à ultrasons de sondes
endocavitaires contaminés en dépit de l’utilisation d’une protection de la sonde
Kac G; Podglajen I; Si-Mohamed A; Rodi A; Grataloup C; Meyer G. Evaluation of ultraviolet C for
disinfection of endocavitary ultrasound transducers persistently contaminated despite probe covers.
Infection control and hospital epidemiology 2010/02; 31(2): 165-170.
Mots-clés : DESINFECTION; ULTRA-VIOLET; CONTAMINATION; SONDE; PRELEVEMENT; SURFACE;
HERPES; VIRUS; PAPILLOMAVIRUS; GYNECOLOGIE; HEPATO-GASTRO-ENTEROLOGIE
Objective: To determine the rate of bacterial and viral contamination of endocavitary ultrasound probes after
endorectal or endovaginal examination with the use of probe covers and to evaluate the antimicrobial
efficacy of a disinfection procedure consisting of cleaning with a disinfectant-impregnated towel followed by
disinfection with ultraviolet C (UVC) light.
Methods: Endovaginal or endorectal ultrasound examinations were performed for 440 patients in 3
institutions. All probes were covered by a condom or sheath during the examination. For bacterial analysis, 1
swab was applied lengthwise across one-half the surface of the probe just after removal of the probe cover.
The second swab was similarly applied over the probe immediately after the end of a 2-step process
consisting of cleaning with a towel impregnated with a disinfectant spray and a 5-minute UVC disinfection
cycle. Swabs were applied onto plates and incubated for 48 hours. The number of colony-forming units was
counted, and organisms were identified. A similar protocol was used for viral detection of Epstein-Barr virus,
human cytomegalovirus, and human papillomavirus, except that an additional swab was applied along the
entire external surface of the probe cover before its removal. Viruses were detected by means of a
polymerase chain reaction-based protocol.
Results: After removal of probe covers, contamination by pathogenic bacteria was found for 15 (3.4% [95%
confidence interval, 2.0%-5.6%]) of 440 probes, and viral genome was detected on 5 (1.5% [95% confidence
interval, 0.5%-3.5%]) of 336 probes. After cleaning with a towel impregnated with a disinfectant spray and
disinfecting with UVC light, neither bacterial pathogenic flora nor viral genome was recovered from the
probe.
Conclusions: Endocavitary ultrasound probes may carry pathogens after removal of covers under routine
conditions. A disinfection procedure consisting of cleaning with a disinfectant-impregnated towel followed by
disinfection with UVC may provide a useful method for disinfecting endocavitary ultrasound probes.
NosoBase n° 26196
Recommandations pour la désinfection et la stérilisation des instruments contaminés par le prion
SHEA; Rutala WA; Weber DJ. Guideline for disinfection and sterilization of prion-contaminated medical
instruments. Infection control and hospital epidemiology 2010/02; 31(2): 107-117.
CCLIN Sud-Est – [email protected]
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Mots-clés : DESINFECTION; CONTAMINATION; INSTRUMENT; AGENT TRANSMISSIBLE NON
CONVENTIONNEL
Environnement
NosoBase n° 26402
Arrêté du 01/02/2010 relatif à la surveillance des légionelles dans les installations de production, de
stockage et de distribution d'eau chaude sanitaire
Ministere de la sante et des sports. Journal officiel 2010/02/09; 3 pages.
Mots-clés : SURVEILLANCE; LEGISLATION; LEGIONELLA; CONTROLE; EAU CHAUDE SANITAIRE;
STRUCTURE DE SOINS; EHPAD; BALNEOTHERAPIE; PRELEVEMENT; LABORATOIRE
NosoBase n° 26542
La ventilation naturelle pour réduire les infections aéroportées dans les hôpitaux
Qian H; Li Y; Seto Wh; Ching P; Ching Wh; Sun HQ. Natural ventilation for reducing airborne infection in
hospitals. Building and environment 2010/03; 45(3): 559-565.
Mots-clés : AIR; CHAMBRE; PREVENTION; TRANSMISSION; ENVIRONNEMENT
High ventilation rate is shown to be effective for reducing cross-infection risk of airborne diseases in
hospitals and isolation rooms. Natural ventilation can deliver much higher ventilation rate than mechanical
ventilation in an energy-efficient manner. This paper reports a field measurement of naturally ventilated
hospital wards in Hong Kong and presents a possibility of using natural ventilation for infection control in
hospital wards. Our measurements showed that natural ventilation could achieve
high ventilation rates especially when both the windows and the doors were open in a ward. The highest
ventilation rate recorded in our study was 69.0 ACH. The airflow pattern and the airflow direction were found
to be unstable in some measurements with large openings. Mechanical fans were installed in a ward window
to create a negative pressure difference. Measurements showed that the negative pressure difference was
negligible with large openings but the overall airflow was controlled in the
expected direction. When all the openings were closed and the exhaust fans were turned on, a reasonable
negative pressure was created although the air temperature was uncontrolled. The high ventilation rate
provided by natural ventilation can reduce cross-infection of airborne diseases, and thus it is recommended
for consideration of use in appropriate hospital wards for infection control. Our results also demonstrated a
possibility of converting an existing ward using natural ventilation to a temporary isolation room through
installing mechanical exhaust fans.
Grippe
NosoBase n° 26479
Avis relatif à la pertinence de la poursuite de la campagne de vaccination contre la grippe
pandémique A (H1N1) 2009
Haut conseil de la sante publique. Haut Conseil de la santé publique 2010/01/29; 1-6.
Mots-clés : VIRUS INFLUENZA TYPE A; VACCIN; RECOMMANDATION; PERSONNEL
NosoBase n° 26203
Description d'une campagne de vaccination contre la grippe et l'utilisation d'une étude randomisée
pour déterminer les taux de participation
Tao X; Giampino J; Dooley DA; Humphrey FE; Baron DM; Bernacki EJ. Description of an influenza
vaccination campaign and use of a randomized survey to determine participation rates. Infection control and
hospital epidemiology 2010/02; 31(2): 151-157.
CCLIN Sud-Est – [email protected]
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mars 2010
Mots-clés : VACCIN; GRIPPE; TAUX; RANDOMISATION; FORMATION; PERSONNEL; CENTRE
HOSPITALIER UNIVERSITAIRE
Objectives: To describe the procedures used during an influenza immunization program and the use of a
randomized survey to quantify the vaccination rate among healthcare workers with and without patient
contact.
Design: Influenza immunization vaccination program and a randomized survey.
Setting: Johns Hopkins University and Health System.
Methods: The 2008/2009 Johns Hopkins Influenza Immunization Program was administered to 40,000
employees, including 10,763 healthcare workers. A 10% randomized sample (1,084) of individuals were
interviewed to evaluate the vaccination rate among healthcare workers with direct patient contact.
Results: Between September 23, 2008, and April 30, 2009, a total of 16,079 vaccinations were
administered. Ninety-four percent (94.5%) of persons who were vaccinated received the vaccine in the first 7
weeks of the campaign. The randomized survey demonstrated an overall vaccination rate of 71.3% (95%
confidence interval, 68.6%-74.0%) and a vaccination rate for employees with direct patient contact of 82.8%
(95% confidence interval, 80.1%-85.5%). The main reason (25.3%) for declining the program vaccine was
because the employee had received documented vaccination elsewhere.
Conclusions: The methods used to increase participation in the recent immunization program were
successful, and a randomized survey to assess participation was found to be an efficient means of
evaluating the workforce's level of potential immunity to the influenza virus.
Hémodialyse
NosoBase n° 26456
Analyse coût-bénéfice de la prévention des bactériémies nosocomiales parmi des patients
hémodialysés au Canada en 2004
Hong Z; Wu J; Tisdell C; O'leary C; Gomes J; Wen SW; et al. Cost-benefit analysis of preventing nosocomial
bloodstream infections among hemodialysis patients in Canada in 2004. Value in health 2010/02; 13(1): 4245.
Mots-clés : COUT-BENEFICE; PREVENTION; ANALYSE; BACTERIEMIE; INCIDENCE; HEMODIALYSE
Objectives: Hemodialysis-associated bloodstream infection (BSI) is a significant public health problem
because the number of hemodialysis patients in Canada had doubled from 1996 to 2005.Our study aimed to
determine the costs of nosocomial BSIs in Canada and estimate the investment expenses for establishing
infection control programs in general hospitals and conduct cost-benefit analysis.
Materials and Methods: The data from the Canadian Nosocomial Infection Surveillance Program was used
to estimate the incidence rate of nosocomial BSI. We used Canadian Institute of Health Information data to
estimate the extra costs of BSIs per stay across Canada in 2004. The cost of establishing and maintaining
an infection control program in 1985 was estimated by the US Centers for Disease Control and Prevention
and converted into 2004 Canadian costs. The possible 20% to 30% reduction of total nosocomial BSIs was
hypothesized.
Results: A total of 2524 hemodialysis-associated BSIs were projected among 15,278 hemodialysis patients
in Canada in 2004. The total annual costs to treat BSIs were estimated to be CDN$49.01 million. Total
investment costs in prevention and human resources were CDN$8.15 million. The savings of avoidable
medical costs after establishing infection control programs were CDN$14.52 million. The benefit/cost ratio
was 1.0 to 1.8:1.
Conclusion: Our study provides evidence that the economic benefit from implementing infection control
programs could be expected to be well in excess of additional cost postinfection if the reduction of BSI can
be reduced by 20% to 30%. Infection control offered double benefits: saving money while simultaneously
improving the quality of care.
Hygiène des mains
NosoBase n° 26462
Hygiène des mains : les changements proposés par les nouvelles recommandations françaises
CCLIN Sud-Est; Girard R. En Bref 2010/02; (43): 3 pages.
CCLIN Sud-Est – [email protected]
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Mots-clés : RECOMMANDATION; HYGIENE DES MAINS; LAVAGE DES MAINS; DESINFECTION
CHIRURGICALE DES MAINS PAR FRICTION; SAVON DESINFECTANT; TRAITEMENT HYGIENIQUE
DES MAINS PAR FRICTION; PRODUIT HYDRO-ALCOOLIQUE; CHOIX
Les recommandations françaises publiées par la Société française d’hygiène hospitalière et par l’OMS en
2009 ont introduit des changements importants dans la désinfection des mains : fin de l’utilisation des
savons antiseptiques, précisions dans la gestuelle, modification des doses et durées recommandées,
séparation du lavage et de la désinfection pour la désinfection chirurgicale des mains par friction, et
démarche plus rigoureuse dans le choix des produits.
NosoBase n° 26534
Facteurs déterminant de mauvaises pratiques dans la technique de friction des mains avec un gel
hydroalcoolique parmi le personnel hospitalier
Hautemaniere A; Cunat L; Diguio N; Vernier N; Schall C; Daval MC et al. Factors determining poor practice
in alcoholic gel hand rub technique in hospital workers. Journal of infection and public health 2010; in press:
10 pages.
Mots-clés : BIJOU; ONGLE; HYGIENE DES MAINS; PERSONNEL; GEL HYDROALCOOLIQUE; ETUDE
PROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; FORMATION; PRATIQUE; PRODUIT DE
FRICTION POUR LES MAINS; EFFICACITE
NosoBase n° 26339
Revue systématique d’études sur l’observance des recommandations pour l’hygiène des mains
dans des centres hospitaliers
Erasmus V; Daha TJ; Brug H; Richardus JH; Behrendt MD; vos MC; et al. Systematic review of studies on
compliance with hand hygiene guidelines in hospital care. Infection control and hospital epidemiology
2010/03; 31(3): 283-294.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; PREVALENCE; BIBLIOGRAPHIE; MEDECIN;
INFIRMIER; ATTITUDE
Objectives. To assess the prevalence and correlates of compliance and noncompliance with hand hygiene
guidelines in hospital care.
Design. A systematic review of studies published before January 1, 2009, on observed or self-reported
compliance rates.
Methods. Articles on empirical studies written in English and conducted on general patient populations in
industrialized countries were included. The results were grouped by type of healthcare worker before and
after patient contact. Correlates contributing to compliance were grouped and listed.
Results. We included 96 empirical studies, the majority ([Formula: see text]) in intensive care units. In
general, the study methods were not very robust and often ill reported. We found an overall median
compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%-40%) than in
other settings (50%-60%), lower among physicians (32%) than among nurses (48%), and before (21%)
rather than after (47%) patient contact. The majority of the time, the situations that were associated with a
lower compliance rate were those with a high activity level and/or those in which a physician was involved.
The majority of the time, the situations that were associated with a higher compliance rate were those
having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and
accessibility of materials. A minority of studies ([Formula: see text]) have investigated the behavioral
determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive
results.
Conclusions. Noncompliance with hand hygiene guidelines is a universal problem, which calls for
standardized measures for research and monitoring. Theoretical models from the behavioral sciences
should be used internationally and should be adapted to better explain the complexities of hand hygiene.
NosoBase n° 26202
CCLIN Sud-Est – [email protected]
19 / 29
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mars 2010
Etude des pratiques d'hygiène des mains dans des groupes ciblés du personnel de santé d'un
centre hospitalier universitaire à Totonto, Canada
Jang JH; Wu S; Kirzner D; Moore C; Youssef G; Tong A; et al.
Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto,
Canada. Infection control and hospital epidemiology 2010/02; 31(2): 144-150.
Mots-clés : HYGIENE DES MAINS; EVALUATION; ATTITUDE; PERSONNEL; QUALITE; OBSERVANCE;
CENTRE HOSPITALIER UNIVERSITAIRE
Objective: To understand the behavioral determinants of hand hygiene in our hospital.
Design: Qualitative study based on 17 focus groups.
Setting: Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto.
Participants: We recruited 153 healthcare workers (HCWs) representing all major patient care job
categories.
Methods: Focus group discussions were transcribed verbatim. Thematic analysis was independently
conducted by 3 investigators.
Results: Participants reported that the realities of their workload (eg, urgent care and interruptions) make
complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and
participants expressed that their judgement is adequate to determine when to perform hand hygiene.
Discussions revealed gaps in knowledge among participants; most participants expressed interest in more
information and education. Participants reported self-protection as the primary reason for the performance of
hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection.
Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital
equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs'
adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In
particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such.
Conclusions: Our results confirm previous findings that hand hygiene is practiced for personal protection,
that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand
hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing
contaminated hospital equipment may improve compliance.
NosoBase n° 26410
Texte n° 2010-47 du 27/1/2010 portant sur la journée mondiale de l'hygiène des mains le 5 mai 2010
Ministère de la santé et des sports. Ministère de la santé et des sports 2010/01; 2 pages.
Mots-clés : HYGIENE DES MAINS; INFORMATION; PRODUIT HYDROALCOOLIQUE; ICSHA
Néonatalogie
NosoBase n° 26474
Epidémie de sepsis à Serratia marcescens dans une unité de soins intensifs en néonatalogie
Arslan U; Erayman I; Kirdar S; Yuksekkaya S; Cimen O; Tuncer I. Serratia marcescens sepsis outbreak in a
neonatal intensive care unit. Pediatrics international 2010; in press: 16 pages.
Mots-clés : SOIN INTENSIF; SERRATIA MARCESCENS; SYNDROME SEPTIQUE; NEONATALOGIE;
EPIDEMIE; PREMATURE; CENTRE HOSPITALIER UNIVERSITAIRE; BIOLOGIE MOLECULAIRE;
HEMOCULTURE; ALIMENTATION PARENTERALE; ENQUETE
Introduction: Contaminated parenteral nutrition (PN) is an important source of infection in neonates. Many
organisms have been reported to cause contamination that results in outbreaks in intensive care units. The
study aimed to investigate an outbreak caused by Serratia marcescens in a neonatal intensive care unit
(NICU).
Materials and methods: This was a descriptive study of an outbreak of sepsis in an NICU of a university
teaching hospital. The outbreak was detected in seven patients from 10 to 12 December 2005 following the
administration of PN. Extensive environmental samplings for culture were performed. Clonal relation among
isolates was tested by pulsed-field gel electrophoresis, RAPD-PCR and plasmid DNA typing.
CCLIN Sud-Est – [email protected]
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Results: Serratia marcescens was found in blood cultures from infected newborns and from in-use PN
solutions. Gestational age of the 7 babies ranged from 28 to 34 weeks (median, 32 weeks), birth weight
ranged from 1000 g to 2190 g (median, 1469 g), and postnatal age ranged from 8 to 22 days. The mortality
rate was 14.3 %. All these strains of Serratia marcescens had the same antibiotic susceptibility pattern and
the same genomic DNA profile. Plasmid typing, as well as RAPD-PCR showed that all isolates had the
same profile.
Conclusion: The source of the nosocomial sepsis in 7 of the neonates was the PN solution. Contamination
may occur during storage or repeated handling during PN preparation. The knowledge gained from this
outbreak led us to be carefull about PN and its preparation.
NosoBase n° 26211
Cas groupés, sur une période de 2 mois, de bactériémies à Streptococcus gallolyticus sous-espèce
pasteurianus chez 5 prématurés d’un centre hospitalier universitaire
Floret N; Bailly P; Thouverez M; Blanchot C; Alez-Martin D; Menget A; et al.
A cluster of bloodstream infections caused by Streptococcus gallolyticus subspecies pasteurianus that
involved 5 preterm neonates in a university hospital during a 2-month period. Infection control and hospital
epidemiology 2010/02; 31(2): 194-196.
Mots-clés: NEONATALOGIE; PREMATURE; BACTERIEMIE; STREPTOCOCCUS; EPIDEMIE;
INVESTIGATION; AUDIT; BIOLOGIE MOLECULAIRE; SYNDROME SEPTIQUE; HYGIENE DES MAINS;
CENTRE HOSPITALIER UNIVERSITAIRE
NosoBase n° 26207
Impact clinique et économique des colonisations ou infections à Staphylococcus aureus résistant à
la méticilline en réanimation néonatale
Song X; Perencevich E; Campos J; Short BL; Singh N. Clinical and economic impact of methicillin-resistant
Staphylococcus aureus colonization or infection on neonates in intensive care units. Infection control and
hospital epidemiology 2010/02; 31(2): 177-182.
Mots-clés : STAPHYLOCOCCUS AUREUS; COLONISATION; METICILLINO-RESISTANCE; COUT;
INCIDENCE; PRONOSTIC; MORTALITE; TAUX; NEONATALOGIE; DUREE DE SEJOUR; CHARGE DE
TRAVAIL; ETUDE RETROSPECTIVE; COHORTE
Objective: The rising incidence and mortality of methicillin-resistant Staphylococcus aureus (MRSA)
colonization or infection in children has become a great concern. This study aimed to determine the clinical
and economic impact of MRSA colonization or infection on infants and to measure excess mortality, length
of stay, and hospital charges attributable to MRSA.
Design: This is a retrospective cohort study.
Setting and patients: The study included infants admitted to a level III-IV neonatal intensive care unit from
September 1, 2004, through March 31, 2008.
Methods: A time-dependent proportional hazard model was used to analyze the association between MRSA
colonization or infection and mortality. The relationships between MRSA colonization or infection and length
of stay and between MRSA colonization or infection and hospital charges were assessed using a matched
cohort study design.
Results: of 2,280 infants, 191 (8.4%) had MRSA colonization or infection. Of 132 MRSA isolates with
antibiotic susceptibility results, 106 were resistant to clindamycin and/or trimethoprim-sulfamethoxazole, thus
representing a noncommunity phenotype. The mortality rate was 17.8% for patients with MRSA colonization
or infection and 11.5% for control subjects. Neither MRSA colonization (hazard ratio [HR], 0.9 [95%
confidence interval {CI}, 0.5-1.5]; P > .05 ) nor infection (HR, 1.2 [95% CI, 0.7-1.9]; P > .05 ) was associated
with increased mortality risk. Infection caused by MRSA strains that were resistant to clindamycin and/or
trimethoprim-sulfamethoxazole increased the mortality risk by 40% (HR, 1.4 [95% CI, 0.9-2.2]; P > .05 ),
compared with the mortality risk of control subjects, but the increase was not statistically significant. MRSA
infection independently increased length of stay by 40 days (95% CI, 34.2-45.6; [Formula: see text]) and
was associated with an extra charge of $164,301 (95% CI, $158,712-$169,889; P < .001).
Conclusions: MRSA colonization or infection in infants is associated with significant morbidity and financial
burden but is not independently associated with increased mortality.
CCLIN Sud-Est – [email protected]
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mars 2010
Ophtalmologie
NosoBase n° 26509
Endophtalmie aiguë unilatérale à Staphylococcus epidermidis après injection intra-vitréenne
bilatérale et concomitante de ranibizumab à partir d'un même flacon : à propos d'un cas
Cornut PL; Dumas-Stoeckel S; Nguyen AM; Feldman A; Benito Y; Vandenesch F; et al.
Unilateral acute endophthalmitis due to Staphylococcus epidermidis after simultaneous bilateral intravitreal
injection using the same ranibizumab vial: a case report. Journal français d'ophtalmologie 2010/01; 33(1):
31-35.
Mots-clés : STAPHYLOCOCCUS EPIDERMIDIS; ENDOPHTALMIE; INJECTION; ŒIL; CONTAMINATION
Objectif : Rapporter le cas d’un patient victime d’une endopthalmie aiguë unilatérale à Staphylococcus
epidermidis, survenue après injection bilatérale et concomitante de ranibizumab, effectuée à partir d’un seul
flacon et en utilisant la même seringue.
Observation : Nous rapportons le cas d’un patient phaque de 68 ans ayant déjà bénéficié de 2 séances
d’injections intra-vitréennes bilatérales et concomitantes de ranibizumab pour décompensation
néovasculaire bilatérale début 2008. Lors de la 3e séance d’injections, l’acuité visuelle du patient était de
7/10eP2 à droite et 2/10e P8 à gauche. Comme lors de chaque injection, l’intégralité du flacon de
ranibizumab (0,3 mL) était aspirée dans une seringue tuberculinique. Cette même seringue était ensuite
utilisée pour administrer 0,05mL de ranibizumab au niveau de l’oeil droit puis de l’oeil gauche du patient en
changeant les gants, l’aiguille, le champ de protection et l’écarteur de paupières entre chaque procédure.
Les suites furent marquées par la survenue d’une endophtalmie aiguë à Staphylococcus epidermidis à
droite (oeil injecté en premier) 3 jours après les injections, sans complication visible du côté de l’oeil gauche.
L’acuité visuelle était limitée aux perceptions lumineuses en raison d’une inflammation intra oculaire
majeure. Le patient a alors bénéficié de 2 injections intra-vitréennes d’antibiotiques après prélèvements
microbiologiques, puis d’une vitrectomie suivie d’une troisième injection intra-vitréenne d’antibiotiques avec
une évolution positive ayant conduit à une récupération fonctionnelle complète.
Discussion et conclusion : Ce cas illustre une complication rare mais potentielle de toute injection intra
vitréenne d’anti VEGF par endophtalmie bactérienne. L’infection résulte alors dans la plupart des cas d’une
auto-contamination du patient à partir de sa propre flore et le traitement intravitréen bilatéral et simultané
des 2 yeux est à éviter, sauf contexte particulier, en bannissant le recours au fractionnement d’un flacon à
usage unique.
Organisation
NosoBase n° 26461
Evaluation du système de signalement des infections nosocomiales dans les établissements de
santé du Sud-Est de la France
CCLIN Sud-Est; Giard M; Laprugne-Garcia E; Bernet C; Savey A. En Bref 2010/02; (43): 2 pages.
Mots-clés : SIGNALEMENT; EVALUATION; OBSERVANCE
Un auto-questionnaire a été envoyé aux EOH de 943 établissements de santé de l’inter-région en décembre
2008. Les données recueillies concernaient l’organisation du signalement des infections nosocomiales au
sein des établissements et la perception du système comme de la fiche de recueil par les professionnels de
santé en charge du signalement.
NosoBase n° 26398
Décret 2010-114 du 03/02/2010 relatif au comité d'évaluation de la mise en oeuvre des dispositions
relatives à la modernisation des établissements de santé de la loi portant réforme de l'hôpital et
relative aux patients, à la santé et aux territoires
Ministère de la santé et des sports. Journal officiel 2010/02/04; :2 pages.
CCLIN Sud-Est – [email protected]
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mars 2010
Mots-clés : LEGISLATION; ORGANISATION; EVALUATION; STRUCTURE DE SOINS; QUALITE;
USAGER
NosoBase n° 26399
Arrêté du 06/02/2010 relatif à la composition du comité d'évaluation de la mise en oeuvre des
dispositions relatives à la modernisation des établissements de santé de la loi portant réforme de
l'hôpital et relative aux patients, à la santé et aux territoires
Ministère de la santé et des sports. Journal officiel 2010/02/07; 1 page.
Mots-clés : LEGISLATION; EVALUATION; STRUCTURE DE SOINS; QUALITE; ORGANISATION;
USAGER
NosoBase n° 26482
Circulaire n° DGS/DHOS/RI/R2/2010/60 du 12/02/2010 relative au bilan des activités de lutte contre les
infections nosocomiales dans les établissements de santé pour l'année 2009
Ministère de la santé et des sports. Ministère de la santé et des sports 2010/02; 1-63
Mots-clés : LEGISLATION; CLIN; INDICATEUR; BILAN STANDARDISE; ICALIN; ICATB; ICSHA
Personne âgée
NosoBase n° 26352
Les vaccins contre la grippe offrent une protection diminuée mais entraînent une réduction des
coûts chez des adultes âgés
Deans GD; Stiver HG; Mcelhaney JE. Influenza vaccines provide diminished protection but are
cost-saving in older adults. Journal of internal medicine 2010; 267(2): 220-227.
Mots-clés : VACCIN; GRIPPE; GERIATRIE; PREVENTION; COUT-EFFICACITE; COUT
Influenza is associated with substantial morbidity and mortality in adults aged over 65 years. Although
vaccination remains the most effective method of preventing influenza and its sequellae, current vaccination
strategies provide less protection to older adults than to younger persons. Influenza vaccination in
community-dwelling older adults is cost-effective, though there is room for improvement. Newer vaccine
strategies considered for use in older adults include alternate routes of administration (intradermal or
intranasal), addition of adjuvant, and novel methods of antigen presentation. Measuring cell-mediated
immune response to new vaccines in addition to antibody response may correlate better with vaccine
efficacy in this population. Whilst pandemic influenza A.(H1N1) 2009 (pH1N1) has largely spared older
adults, the impact of pH1N1 vaccination has yet to be determined.
NosoBase n° 26395
Infection à Candida albicans sur prothèse de hanche chez des sujets âgés : le fluconazole en
monothérapie est-il une option de traitement ?
Kelesidis T; Tsiodras S. Candida albicans prosthetic hip infection in elderly patients: is fluconazole
monotherapy an option? Scandinavian journal of infectious diseases 2010; 42(1): 12-21.
Mots-clés : CANDIDA ALBICANS; CHIRURGIE ORTHOPEDIQUE; MATERIEL ETRANGER; PROTHESE
TOTALE DE HANCHE; ANTIFONGIQUE; AZOLE; FLUCONAZOLE; BIBLIOGRAPHIE; DIAGNOSTIC;
TRAITEMENT
The increasing numbers of joint arthroplasties being undertaken, and the increase in patients with systemic
illnesses undergoing the procedure, have contributed to a continuing increase in prosthetic joint infections.
Candida prosthetic joint infection is a rare clinical entity, and only 12 cases of Candida albicans prosthetic
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hip infection have been described. Although surgery combined with a long period of antifungal medication is
the usual treatment for fungal prosthetic joint infections, monotherapy with antifungal agents has only very
rarely been used as a therapeutic option, especially in debilitated and elderly patients. We report herein the
second case, to our knowledge, of C. albicans prosthetic hip arthritis successfully treated with fluconazole
monotherapy and review the literature on the pathogenesis, clinical manifestations and management of
these infections. Further studies on the use of fluconazole in the management of fungal prosthetic infections
are needed.
NosoBase n° 26521
Chirurgie pour cancer de la tête et du cou chez des patients âgés. L'âge influence-t-il l'évolution
post-opératoire ?
Milet PR; Mallet Y; El Bedoui S; Penel N; Servent V; Lefebvre JL. Head and neck cancer surgery in the
elderly - does age infuence the postoperative course? Oral oncology 2010/02; 46(2): 92-95.
Mots-clés : CHIRURGIE CARCINOLOGIQUE; GERIATRIE; AGE; PNEUMONIE; SITE OPERATOIRE;
INCIDENCE; MULTIRESISTANCE; MORTALITE; COHORTE; CENTRE DE LUTTE CONTRE LE CANCER
There are few data focusing on postoperative course after major head and neck cancer surgery in the
elderly compared with the younger population. The aim of this study was to assess the impact of age on
postoperative outcomes. At hospital admission, we prospectively collected data from 261 patients separated
into two groups with regard to their age (those >or= 70 years and those < 70 years). Twenty-nine of them
were over 70 years old. Median length of stay was similar in both populations (22 vs. 21 days, p=0.66).
Incidence of severe postoperative complications was similar: surgical site infection (6/29 vs. 89/232,
p=0.77), pneumonia (4/29 vs. 29/232, p=0.13) and infection caused by multi-resistant pathogens (1/29 vs.
14/232, p=0.08). There was no significant increase in postoperative deaths (4/29 vs. 6/232, p=0.12). The
impact of age on postoperative deaths was assessed after adjustment for potential risk factors. In a logistic
regression model, postoperative death risk remained insignificantly increased in the elderly (adjusted Odds
Ratio=3.3 [0.7-14.9], p=0.22). In our experience, the postoperative course in elderly patients is not
significantly different from that than in younger patients.
Personnel
NosoBase n° 26486
Expositions professionnelles du personnel des structures fournissant des services médicaux
d'urgence ; connaissance et observance des précautions standard
Harris SA; Nicolai LA. Occupational exposures in emergency medical service providers and knowledge of
and compliance with universal precautions. American journal of infection control 2010/03; 38(2): 86-94.
Mots-clés : URGENCE; PERSONNEL; RISQUE PROFESSIONNEL; PRECAUTION STANDARD;
CONNAISSANCE; OBSERVANCE; EXPOSITION AU SANG; PERCEPTION; RISQUE; QUESTIONNAIRE
Background: Little is known about compliance with universal precautions (CUP) or occupational exposures
to blood and body fluids among Emergency Medical Services (EMS) providers. The objective of this study
was to obtain estimates of CUP and knowledge of universal precautions (KUP), occupational exposures,
and needle and lancet sticks in the prehospital environment.
Methods: A convenience sample of workers (n=311, 51% response) from 17 agencies in Virginia that
provided emergency ground transportation (volunteer, commercial, government rescue squads, and fire
departments) completed a questionnaire on certification and training, KUP, CUP, exposures and
needlesticks, risk perceptions, and demographic variables.
Results: Nearly all EMS providers reported exposures and were concerned about risk of HIV and hepatitis.
Providers reported inconsistent CUP when treating patients or using needles, including failure to wear
gloves (17%) and to appropriately dispose of contaminated materials (79%), including needles (87%), at all
times. Certification type (advanced and basic) was related to both KUP and CUP. Of those respondents
reporting current sharps use, 40% recapped needles. A lancet stick was reported by 1.4% (n=5), and 4.5%
reported a needlestick (n=14).
Conclusion: EMS providers working in the prehospital environment experience significant exposures but are
not consistently using universal precautions.
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NosoBase n° 26532
Charge de travail infirmier et allocation de personnel dans une unité de réanimation : étude pilote
selon le score "Nursing Activities Score " (NAS)
Padilha KG; De Sousa R; Garcia PC; Bento ST; Finardi EM; Hatarashi R. Nursing workload and staff
allocation in an intensive care unit: a pilot study according to Nursing Activities Score (NAS). Intensive and
critical care nursing 2010; in press: 6 pages.
Mots-clés : SOIN INTENSIF; PERSONNEL; SCORE; ETUDE PROSPECTIV; CHARGE DE TRAVAIL;
BIBLIOGRAPHIE
Objectives: The objectives of the study were to identify the daily nursing workload in an intensive care unit
(ICU) and to analyse the adequacy of nursing staff in a six hour shift according to the Nursing Activities
Score (NAS).
Method: The sample consisted of 68 patients from a general 25-bed adult ICU in a private hospital with 250
beds in São Paulo, Brazil. The nursing workload of all patients admitted in the ICU over a one month period
in 2004 were measured daily according to the NAS. For the analysis of nursing staff it was considered the
number of nurses available in a six hour shift. Data were submitted to descriptive analyses.
Results: Most patients were elderly and remained on average 12 (+/-16.4) days in the ICU. The mean NAS
was 63.7 (+/-2.4%) and remained above 58.5% throughout the month. Apart from the 16th day of data
collection there was an excess of nursing professionals in a six hour shift during the study period (range
from 0.8 to 4.8 professionals).
Conclusions: The study results show the importance of nursing staff adequacy to workload fluctuations for
reducing ICU costs.
Soins intensifs
NosoBase n° 26469
Epidémiologie moléculaire des infections à Pseudomonas aeruginosa dans des unités de
réanimation sur une période de dix ans (1998-2007)
Cuttelod M; Senn L; Terletskiy V; Nahimana I; Petignat C; Eggimann P; et al. Molecular epidemiology of
Pseudomonas aeruginosa in intensive care units (ICUs) over a 10-year period (1998-2007). Clinical
microbiology and infection 2010; in press: 17 pages.
Mots-clés : EPIDEMIOLOGIE; SOIN INTENSIF; PSEUDOMONAS AERUGINOSA; BIOLOGIE
MOLECULAIRE;
TYPAGE;
CONTAMINATION;
ENVIRONNEMENT;
CENTRE
HOSPITALIER
UNIVERSITAIRE; EAU
Pseudomonas aeruginosa is one of the leading nosocomial pathogens in ICUs. The source of this
microorganism can be either endogenous or exogenous. The proportion of cases due to transmission is still
debated, and its elucidation is important for implementing appropriate control measures. In order to
understand the relative importance of exogenous versus endogenous sources of P. aeruginosa, molecular
typing was performed on all available P. aeruginosa isolated from ICU clinical and environmental specimens
in 1998, 2000, 2003, 2004 and 2007. Patient samples were classified according to their P. aeruginosa
genotypes in 3 categories: A) identical to faucet, B) identical to at least one other patient sample and not
found in faucet, and C) unique genotype. Cases in categories A and B were considered as possibly
exogenous, and cases in category C as possibly endogenous. A mean number of 34 cases /1000
admissions per year were found to be colonized or infected by P. aeruginosa. Higher levels of faucet
contamination were correlated with a higher number of cases in category A. The number of cases in
category B varied from 1.9 to 20 cases/1000
admissions. This number exceeded 10/1000 admissions on 3 occasions and was correlated with an
outbreak in one occasion. Number of cases considered as endogenous (category C) was stable and
independent from the number of cases in categories A and B. Repeated molecular typing over time allowed
to document variations in the epidemiology of P. aeruginosa in ICU patients susceptible to require
continuous adaptation of infection control measures.
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NosoBase n° 26459
Epidémiologie des infections nosocomiales dans 125 unités de réanimation italiennes
Malacarne P; Boccalatte D; Acquarolo A; Agostini F; Anghileri A; Giardino M et al. Epidemiology of
nosocomial infection in 125 italian intensive care units. Minerva Anestesiologica 2010/01; 76(1): 13-23.
Mots-clés : EPIDEMIOLOGIE; SOIN INTENSIF; ETUDE PROSPECTIVE; SURVEILLANCE; INCIDENCE;
MORTALITE; PNEUMONIE; VENTILATION ASSISTEE; STAPHYLOCOCCUS; BACTERIEMIE
Aim: A continuous infection surveillance program was conducted by GiViTI throughout 2006 in Intensive
Care Units (ICUs).
Methods: This was a prospective epidemiological study carried out in 125 Italian intensive care units. All
patients have been included in the study. Aside from the detailed clinical information collected for all
patients, in cases of infection upon ICU admission and for the first site-specific episode that occurred during
the patient's stay, the following data were collected: severity upon admission, micro-organisms and their
antibiotic resistance patterns, subsequent multiple episodes in the same site, origin of infections and
maximum severity reached. The diagnostic criteria for all infections are explicitly stated.
Results: A total of 34472 patients entered the study. Infection upon admission was present in 12.6% of
patients, with a high level of ICU and hospital mortality (29.4% and 38.7%, respectively). In 3148 patients
one or more infections were reported as ICU-acquired with an overall incidence of 9.1% and an ICU and
hospital mortality of 27.2% and 35.1%, respectively. Out of the device-related infections, ventilatorassociated pneumonia was the most frequently diagnosed (8.9/1000 days on ventilator). Catheter-related
blood stream infection was reported with a low incidence (1.9/1000 central venous catheter days). Nearly
20% of more than 5000 isolated microorganisms were classified as multi-drug resistant, with methicillinresistant Staphylococcus aureus as the most frequently reported bug.
Conclusions: The ad hoc expanded GiViTI software "Margherita2" allows continuous infection surveillance in
Italian ICUs, annually providing an extensive and updated database. Interventions to improve infection
prevention and patient safety should be tailored to accommodate these data.
Staphylococcus
NosoBase n° 26430
Caractéristiques et évolution des infections du site opératoire à Staphylococcus aureus méticillinorésistant chez des patients présentant un cancer : étude cas-témoin
Chemaly RF; Hachem RY; Husni RN; Bahna B; Abou G; Waked A; et al. Characteristics and outcomes of
methicillin-resistant Staphylococcus aureus surgical-site infections in patients with cancer: a case-control
study. Annals of surgical oncology 2010; in press: 8 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; CANCER; SITE OPERATOIRE;
CAS TEMOIN; APPARIEMENT; ANTIBIOTIQUE; QUINOLONE; DUREE DE SEJOUR; CHIRURGIE;
ANALYSE MULTIVARIEE; FACTEUR DE RISQUE
Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections remain a significant cause of
morbidity and mortality. We experienced an increased incidence of MRSA surgical-site infections (MRSA
SSIs) at our institution. However, to our knowledge, no studies have evaluated the risk factors and outcomes
of MRSA SSIs in cancer patients.
Methods: We conducted a case-control study and identified all patients who had developed MRSA SSIs at
our institution from July 1, 2002 to July 30, 2003, and all patients who had undergone surgery by the same
surgical team during the same time period but who had not developed MRSA SSIs. Cases and controls
were age-matched at 1:2 ratio.
Results: The study included 29 cases and 58 controls. Mean interval between surgery and MRSA SSI onset
was 17.8 days (range 3-75 days). Cases were more likely than controls to have progressive cancer (72
versus 38%), have received antibiotics (mainly quinolones) within 24 h of surgery (17 versus 2%), have had
ongoing infection (10 versus 0%), and have had longer hospital and intensive care unit stays (11.0 versus
7.8 days and 3.4 versus 1.5 days) (all P < 0.05). In a multivariate logistic regression analysis, significant
predictors of MRSA SSI in cancer patients were antibiotics use <24 h of surgery and progressive cancer. No
surgical factors (i.e., procedure time or timing of perioperative antibiotics) were associated with increased
risk of MRSA SSI.
Conclusions: Several clinical and postoperative factors were associated with increased risk of MRSA SSI in
cancer patients, but antibiotic use before surgery (especially quinolones) and progressive cancer were the
only independent predictors.
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NosoBase n° 26445
Etude européenne sur la prise en charge du traitement antibiotique des infections à Staphylococcus
aureus résistant à la méticilline : opinion et pratiques cliniques actuelles
Dryden M; Andrasevic AT; Bassetti M; Bouza E; Chastre J; Cornaglia G; et al. A European survey of
antibiotic management of methicillin-resistant Staphylococcus aureus infection: current clinical opinion and
practice. Clinical microbiology and infection 2010/03; 16(Supplément 1): 3-30.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ANTIBIOTIQUE; TRAITEMENT;
EUROPE; PNEUMONIE; BACTERIEMIE; PEAU; OS; TISSU MOU; EPIDEMIOLOGIE; QUESTIONNAIRE
Although the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) varies across Europe,
healthcare-associated MRSA infections are common in many countries. Despite several national guidelines,
the approach to treatment of MRSA infections varies across the continent, and there are multiple areas of
management uncertainty for which there is little clinical evidence to guide practice. A faculty, convened to
explore some of these areas, devised a survey that was used to compare the perspectives of infection
specialists from across Europe on the management of MRSA infections with those of the faculty specialists.
The survey instrument, a
web-based questionnaire, was sent to 3840 registered delegates of the 19th European Congress of Clinical
Microbiology and Infectious Diseases, held in April 2009. Of the 501 (13%) respondents to the survey, 84%
were infection/microbiology specialists and 80% were from Europe. This article reports the survey results
from European respondents, and shows a broad range of opinion and practice on a variety of issues
pertaining to the management of minor and serious MRSA infections, such as pneumonia, bacteraemia, and
skin and soft tissue infections. The issues include changing epidemiology, when and when not to treat,
choice of treatment, and
duration and route of treatment. The survey identified areas where practice can be improved and where
further research is needed, and also identified areas of pan-European consensus of opinion that could be
applied to European guidelines for the management of MRSA infection.
NosoBase n° 26531
Vaccin contre Staphylococcus aureus pour des patients de chirurgie orthopédique : modèle
économique et analyse
Lee BY; Wiringa AE; Bailey RR; Lewis GJ; Feura J; Muder RR. Staphylococcus aureus vaccine for
orthopedic patients: an economic model and analysis. Vaccine 2010, in press : 7 pages.
Mots-clés : VACCIN; STAPHYLOCOCCUS AUREUS; CHIRURGIE ORTHOPEDIQUE; COUT; PREOPERATOIRE; INFORMATIQUE; STATISTIQUE; BIBLIOGRAPHIE; ANALYSE
To evaluate the potential economic value of a Staphylococcus aureus vaccine for pre-operative orthopedic
surgery patients, we developed an economic computer simulation model. At MRSA colonization rates as low
as 1%, a $50 vaccine was cost-effective [</=$50,000 per quality-adjusted life year (QALY) saved] at vaccine
efficacy >/=30%, and a $100 vaccine at vaccine efficacy >/=70%. High MRSA prevalence (>/=25%) could
justify a vaccine price as high as $1000. Our results suggest that a S. aureus vaccine for the pre-operative
orthopedic population would be very cost-effective over a wide range of MRSA prevalence and vaccine
efficacies and costs.
NosoBase n° 26500
Endophtalmies à Staphylococcus aureus : antibiorésistance, méticillino-résistance et évolutions
Major JC; Engelbert M; Flynn HW; Miller D; Smiddy WE; Davis JL. Staphylococcus aureus endophthalmitis:
antibiotic susceptibilities, methicillin resistance, and clinical outcomes. American journal of ophthalmology
2010/02; 49(2): 278-283.
Mots-clés
:
STAPHYLOCOCCUS
AUREUS;
ENDOPHTALMIE;
METICILLINO-RESISTANCE;
ANTIBIORESISTANCE; ETUDE RETROSPECTIVE; CHIRURGIE OPHTALMOLOGIQUE; VANCOMYCINE;
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
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FLUOROQUINOLONE; MOXIFLOXACINE
Purpose: To investigate the antibiotic susceptibility and clinical outcomes of endophthalmitis caused by
methicillin-sensitive Staphylococcus aureus (MSSA) versus methicillin-resistant (MRSA) S. aureus.
Design: Retrospective, consecutive case series.
Methods: Charts of 32 patients with culture-proven S. aureus endophthalmitis seen at the Bascom Palmer
Eye Institute from January 1, 1995, through January 1, 2008, were reviewed. Antibiotic susceptibility profiles,
identified using standard microbiologic protocols, and visual acuity at 1 and 3 months were the main
outcome measures.
Results: MSSA was recovered from 19 (59%) of 32 patients and MRSA was recovered from 13 (41%) of 32
patients. Causes included cataract surgery in 18 (56%) of 32 patients, endogenous in 5 (16%) of 32
patients, bleb association in 4 (13%) of 32 patients, pars plana vitrectomy and ganciclovir implantation in 3
(9%) of 32 patients, and trauma in 2 (6%) of 32 patients. All isolates were sensitive to vancomycin. MSSA
isolates were sensitive to all tested antibiotics, except one that exhibited fluoroquinolone resistance. In the
MRSA group, frequent resistance occurred with the fourth-generation fluoroquinolones (moxifloxacin, 5 of 13
patients [38%]; gatifloxacin, 5 of 13 patients [38%]). The median presenting visual acuity was approximately
hand movements for both MSSA and MRSA eyes. All eyes received intravitreal antibiotics. Pars plana
vitrectomy was performed on 47% of MSSA and 61% of MRSA patients. A final visual acuity of 20/400 or
better at 3 months was achieved in 59% of MSSA and 36% of MRSA patients (P = .5).
Conclusions: Although all MSSA and MRSA isolates were sensitive to vancomycin, fewer than half of MRSA
isolates were sensitive to the fourth-generation fluoroquinolones. Visual acuity outcomes between MRSA
and MSSA eyes were not significantly different.
NosoBase n° 26475
Bactériémies d'origine communautaire et bactériémies nosocomiales à Staphylococcus aureus
résistant à la méticilline dans des hôpitaux espagnols
Millan AB; Dominguez MA; Borraz C; Gonzalez MP; Almirante B; Cercenado E; et al. Bacteriemas de
presentacion comunitaria y nosocomial por Staphylococcus aureus resistence a meticilina en hospitales
espanoles. Enfermedades infecciosas y microbiologia clinica 2010; in press: 6 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BACTERIEMIE
Introduction : Community-onset infections caused by methicillin-resistant Staphylococcus aureus (MRSA)
are increasing. However, there is little information about community-onset bacteremia (CB) due to MRSA in
Spain. The objectives of this study were to evaluate the prevalence, clinical and molecular epidemiology,
clinical features, and prognosis of CB due to MRSA in comparison with nosocomial bacteremia (NB).
Methods: Prospective multicenter cohort study; all new cases of bacteremia due to MRSA occurring during
June 2003 in 59 Spanish hospitals were included. Episodes diagnosed during the first 48 hours of admission
were considered CB, and otherwise, NB. Isolates were typed by pulsed field electrophoresis and multilocus
sequence typing. Staphylococcal cassete chromosome mec types and Panton-Valentine leukocidin genes
were studied by polymerase chain reaction.
Results: Sixty-four cases were included; 21 (33%) were classified as CB. In all CB cases, a relation was
found with health care, or the isolate proved to be clonally related to nosocomial isolates. There were no
significant differences between the groups in terms of demographic data, underlying conditions, prognosis,
or characteristics of the isolates. Regarding the source of bacteremia, catheter-related cases were more
frequent in NB than CB (39.5% vs 5%, P=0.005), whereas a urinary source was more frequent in CB than
NB (25% vs 0%, P=0.001). Most isolates belonged to 2 clones related to the pandemic "pediatric" clone.
Conclusion: MRSA should be considered in empiric treatment for certain infectious syndromes in patients
with healthcare-associated community-onset sepsis.
Surveillance
NosoBase n° 26487
Rapport du Consortium international de lutte contre les infections nosocomiales (INICC), résumé
des données de 2003-2008, édition juin 2009
Rosenthal VD; Maki DG; Jamulitrat S; Medeiros EA; Kumar Todi S; Yepes Gomez D; et al. International
Nosocomial Infection Control Consorticum (INICC) report, data summary fro 2003-2008, issued june 2009.
American journal of infection control 2010/03; 38(2): 95-104.
CCLIN Sud-Est – [email protected]
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Mots-clés : SURVEILLANCE; SOIN INTENSIF; CATHETER VEINEUX CENTRAL; BACTERIEMIE;
PNEUMONIE;
VENTILATION
ASSISTEE;
INFECTION
URINAIRE;
ANTIBIORESISTANCE;
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
KLEBSIELLA
PNEUMONIAE;
PSEUDOMONAS AERUGINOSA; ACINETOBACTER; RESEAU
Tatouage
NosoBase n° 26491
Réduction des risques d'activité des pathogènes hématogènes dans l'industrie du piercing corporel
et du tatouage
Lehman EJ; Huy J; Levy E; Viet SM; Mobley A; Mccleery TZ. Bloodborne pathogen risk reduction activities
in the body piercing and tattooing industry. American journal of infection control 2010/03; 38(2): 130-138.
Mots-clés : RISQUE; PIERCING; SANG; OBSERVANCE; RECOMMANDATION; PREVENTION
Background: This study examines how well regulations for bloodborne pathogens (BBPs), established
primarily to reduce exposure risk for health care workers, are being followed by workers and employers in
the tattooing and body piercing industry.
Method: Twelve shops performing tattooing and/or body piercing (body art) in Pennsylvania and Texas were
assessed for compliance with 5 administrative and 10 infection control standards for reducing exposure to
BBPs.
Results: All shops demonstrated compliance with infection control standards, but not with administrative
standards, such as maintaining an exposure control plan, offering hepatitis B vaccine, and training staff.
Shops staffed with members of professional body art organizations demonstrated higher compliance with
the administrative standards. Shops in locations where the body art industry was regulated and shops in
nonregulated locations demonstrated similar compliance, as did contractor- and employee-staffed shops.
Conclusions: Regulations to control occupational exposure to BBPs have been in place since 1991. This
study corroborates noncompliance with some standards within the body art industry reported by previous
studies. Without notable enforcement, regulation at national, state, or local levels does not affect
compliance. In this study, the factor most closely associated with compliance with administrative regulations
was the artist's membership in a professional body art association.
NosoBase n° 26401
Arrêté du 20/01/2010 modifiant l'arrêté du 12/12/2008 pris pour l'application de l'article R.1311-3 du
code de la santé publique et relatif à la formation des personnes qui mettent en oeuvre les
techniques de tatouage par effraction cutanée et de perçage corporel
Ministère de la santé et des sports. Journal officiel 2010/02/03; 2 pages.
Mots-clés : LEGISLATION; PEAU; FORMATION
CCLIN Sud-Est – [email protected]
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