NosoVeille Août 2011

NosoVeille – Bulletin de veille
Septembre 2014
NosoVeille n°9
Septembre 2014
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Secrétariat de rédaction : Nathalie Vincent
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cours du mois écoulé.
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Sommaire de ce numéro :
Antibiotique / Antibiorésistance
Bactériémie
Chikungunya
Chirurgie
Clostridium difficile
Coût
Dialyse
Ebola
EHPAD
Entérobactérie
Environnement
Grippe
Hygiène des mains
Infection urinaire
Maladie de Creutzfleldt-Jakob
Metapneumovirus
Norovirus
Pneumonie
Réanimation
Réglementation
Staphylococcus aureus
Surveillance
Vaccination
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Septembre 2014
Antibiotique / Antibiorésistance
NosoBase ID notice : 384683
Emergence de bactéries à Gram négatif productrices de carbapénèmases à St Petersburg, Russie
Ageevets VA; Partina IV; Lisitsyna ES; Ilina EN; Lobzin YV; Shlyapnikov SA; et al. Emergence of
carbapenemase-producing Gram-negative bacteria in Saint Petersburg, Russia. International journal of
antimicrobial agents 2014/08; 44(2): 152-155.
Mots-clés : BACTERIE A GRAM NEGATIF; CARBAPENEME; ANTIBIORESISTANCE; KLEBSIELLA
PNEUMONIAE; ACINETOBACTER; BIOLOGIE MOLECULAIRE; CARBAPENEMASE; ACINETOBACTER
NOSOCOMIALIS; BETA-LACTAMASE
The emergence and spread of carbapenemase-producing Gram-negative bacteria represents a serious public
health concern. Here we show that of 477 Gram-negative isolates collected from 18 hospitals between
November 2011 and February 2013 in Saint Petersburg (Russia), minimum inhibitory concentrations (MICs)
were greater than the European Committee on Antimicrobial Susceptibility Testing (EUCAST) epidemiological
cut-off value of at least one carbapenem antibiotic in 101 isolates (21.2%). The blaNDM-1 gene was detected
by PCR in 17 Klebsiella pneumoniae and 1 Acinetobacter nosocomialis isolate. Multilocus sequence typing
(MLST) revealed that all NDM-1-producing K. pneumoniae isolates belonged to sequence type 340 (ST340)
and harboured genes encoding additional β-lactamases; presence of the blaCTX-M-1-like gene correlated
with aztreonam resistance, whilst its absence correlated with susceptibility. The epidemiological situation in
Saint Petersburg can be assessed as regional spread of NDM-1-producers. The blaKPC-2 gene was
detected in two K. pneumoniae isolates (ST258 and ST273) and one Enterobacter cloacae isolate. Two E.
cloacae isolates harboured the blaVIM-4 gene, and one K. pneumoniae (ST395) isolate harboured the
blaOXA-48 gene. In NDM-1-producers, MICs of biapenem were the lowest compared with those of other
carbapenems. Most isolates were susceptible to tigecycline and polymyxin, except for one K. pneumoniae
isolate that was found to be polymyxin-resistant and one E. cloacae isolate that was tigecycline-resistant.
Only one patient with a urinary tract infection caused by KPC-2-producing K. pneumoniae had a history of
travel abroad (Southeast Asia). Thus, there is an actual threat of the emergence of an alarming endemic
situation with NDM-1-producers in Saint Petersburg.
NosoBase ID notice : 384561
Antibiorésistance : une question géo-politique. CMI de novembre 2014 thème "gestion des
antibiotiques : une urgence internationale"
Carlet J; Pulcini C; Piddock LJ. CMI november 2014 themed section on "Antimicrobial stewardship: an
international emergency". Antibiotic resistance: A geo-political issue. Clinical microbiology and infection 2014;
in press: 14 pages.
Mots-clés : ANTIBIORESISTANCE; ORGANISATION MONDIALE DE LA SANTE; CDC; ECDC
Antibiotic resistance, associated with a lack of new antibiotics, is a major threat. Some countries have been
able to contain resistance, but in most countries the numbers of antibiotic resistant bacteria continue to rise
as well as antibiotic consumption in humans and animals. Antibiotic resistance is a global issue and concern
all decision makers worldwide. Some actions have been undertaken in the last 15 years, in particular by the
World Health Organisation (WHO), the European Centre for Diseases Prevention and Control (ECDC) and
the Centre for Diseases Control and Prevention (CDC), but those actions were partial and poorly
implemented, without coordination. Very recently, some important activitieshave been carried out by the
WHO. Since 2009, a task force between the USA and Europe, the Trans-Atlantic Task Force on Antibiotic
Resistance (TATFAR), has been working on common recommendations. At a national level some important
actions were implemented, in particular in European countries and in the USA. The Chennai declaration, in
India, is also a good example of a multidisciplinary and national action, which was highly political. Finally
several non-governmental non-profit organisations are also very active, and have helped raising awareness
on the problem of antibiotic resistance. In the future, this global issue will need political involvement and
strong cooperation between countries and between international agencies.
NosoBase ID notice : 384681
Antibiorésistance dans les centres hospitaliers de Hong Kong : statut actuel 2009-2011
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Lai CK; Chuang WM; Kong MY; Siu HK; Tsang DN. Antimicrobial susceptibility in hospitals in Hong Kong:
The current status 2009–2011. Journal of global antimicrobial resistance 2014; in press: 7 pages.
Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; SURVEILLANCE; ENTEROBACTERIE;
CARBAPENEME;
ESCHERICHIA
COLI;
KLEBSIELLA;
PSEUDOMONAS
AERUGINOSA;
ACINETOBACTER; ENTEROCOCCUS; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS GROUPE A;
ETUDE MULTICENTRIQUE
Hospitals in Hong Kong, like many hospitals in the world, are constantly challenged by the increasing rate of
non-susceptible and multidrug-resistant organisms (MDROs). Accurate and timely surveillance is essential for
effective control. The Hospital Authority of Hong Kong has developed a comprehensive antimicrobial
susceptibility monitoring system that utilises data obtained from all of its 38 hospitals. In this review, the
susceptibility pattern of more than 320 000 isolates covering the period 2009–2011 will be discussed. Special
attention will be paid to MDROs.
NosoBase ID notice : 384418
Le programme "Antimicrobial Resistance Monitoring and Research "(ARMoR) : la réponse du
département américain à la Défense à la montée de l'antibiorésistance
Lesho EP; Waterman PE; Chukwuma U; McAuliffe K; Neumann C; Julius MD; et al. The antimicrobial
resistance monitoring and research (ARMOR) program: the US department of defense response to escalating
antimicrobial resistance. Clinical infectious diseases 2014/08/01; 59(3): 390-397.
Mots-clés :
ANTIBIORESISTANCE;
PREVENTION;
RECOMMANDATIONS DE BONNE PRATIQUE
SURVEILLANCE;
CARBAPENEME;
Responding to escalating antimicrobial resistance (AMR), the US Department of Defense implemented an
enterprise-wide collaboration, the Antimicrobial Resistance Monitoring and Research Program, to aid in
infection prevention and control. It consists of a network of epidemiologists, bioinformaticists, microbiology
researchers, policy makers, hospital-based infection preventionists, and healthcare providers who collaborate
to collect relevant AMR data, conduct centralized molecular characterization, and use AMR characterization
feedback to implement appropriate infection prevention and control measures and influence policy. A
particularly concerning type of AMR, carbapenem-resistant Enterobacteriaceae, significantly declined after
the program was launched. Similarly, there have been no further reports or outbreaks of another concerning
type of AMR, colistin resistance in Acinetobacter, in the Department of Defense since the program was
initiated. However, bacteria containing AMR-encoding genes are increasing. To update program stakeholders
and other healthcare systems facing such challenges, we describe the processes and impact of the program.
NosoBase ID notice : 384824
Étude multi-site, utilisant des méthodes quantitatives et qualitatives, des pratiques de prise de
décision clinique pour la prescription d'antibiotiques des professionnels de santé aux urgences
May L; Gudger G; Armstrong P; Brooks G; Hinds P; Bhat R; et al. Multisite exploration of clinical decision
making for antibiotic use by emergency medicine providers using quantitative and qualitative methods.
Infection control and hospital epidemiology 2014/09; 35(9): 1114-1125.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; EVALUATION; URGENCE
Objectives: To explore current practices and decision making regarding antimicrobial prescribing among
emergency department (ED) clinical providers.
Methods: We conducted a survey of ED providers recruited from 8 sites in 3 cities. Using purposeful
sampling, we then recruited 21 providers for in-depth interviews. Additionally, we observed 10 patientprovider interactions at one of the ED sites. SAS 9.3 was used for descriptive and predictive statistics.
Interviews were audio recorded, transcribed, and analyzed using a thematic, constructivist approach with
consensus coding using NVivo 10.0. Field and interview notes collected during the observational study were
aligned with themes identified through individual interviews.
Results: Of 150 survey respondents, 76% agreed or strongly agreed that antibiotics are overused in the ED,
while half believed they personally did not overprescribe. Eighty-nine percent used a smartphone or tablet in
the ED for antibiotic prescribing decisions. Several significant differences were found between attending and
resident physicians. Interview analysis identified 42 codes aggregated into the following themes: (1) resource
and environmental factors that affect care; (2) access to and quality of care received outside of the ED
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consult; (3) patient-provider relationships; (4) clinical inertia; and (5) local knowledge generation. The
observational study revealed limited patient understanding of antibiotic use. Providers relied heavily upon
diagnostics and provided limited education to patients. Most patients denied a priori expectations of being
prescribed antibiotics.
Conclusions: Patient, provider, and healthcare system factors should be considered when designing
interventions to improve antimicrobial stewardship in the ED setting.
NosoBase ID notice : 384575
Infections du système nerveux central à entérocoques résistant à la vancomycine : série de cas et
revue de la littérature
Wang JS; Muzevich K; Edmond MB; Bearman G; Stevens MP. Central nervous system infections due to
vancomycin-resistant enterococci: case series and review of the literature. International journal of infectious
diseases 2014/08; 25: 26-31.
Mots-clés :
VANCOMYCINE;
SYSTEME
NERVEUX
CENTRAL;
ENTEROCOCCUS;
ANTIBIORESISTANCE; REVUE DE LA LITTERATURE; MORTALITE; DUREE DE SEJOUR; DISPOSITIF
MEDICAL
Objectives: To evaluate reported cases of central nervous system (CNS) infections due to vancomycinresistant enterococci (VRE) and describe the data necessary to better understand clinical characteristics of
this rare disease process.
Methods: We report two cases of VRE CNS infection and review 36 cases reported in the literature.
Results: Eighty-two percent (31/38) of cases were due to Enterococcus faecium. The median length of stay
prior to diagnosis was 14 days (interquartile range 9-33). Fifty-eight percent (22/38) of cases had significant
underlying non-malignant CNS disease processes and 63% (24/38) had CNS devices in situ. Forty percent
(15/38) of patients had other positive culture sites. Ninety-two percent (35/38) of patients experienced
microbiological cure and 74% (28/38) experienced clinical and microbiological cure following a variety of
antimicrobial therapies. Seventy-four percent (14/19) of patients who experienced clinical/microbiological cure
with CNS devices had them either removed or replaced. Eighteen percent (7/38) died from VRE CNS
infections.
Conclusions: VRE CNS infections are uncommon nosocomial infections that most commonly affect patients
with underlying CNS disease processes. The vast majority of cases are due to E. faecium, and many cases
involve multiple positive culture sites. Optimal antimicrobial therapy remains undefined, but should be coupled
with removal or replacement of indwelling CNS devices.
Bactériémie
NosoBase ID notice : 384828
Impact de plusieurs cathéters veineux centraux concomitants sur les bactériémies associées aux
voies centrales
Concannon C; van Wijngaarden E; Stevens V; Dumyati G. The effect of multiple concurrent central venous
catheters on central line-associated bloodstream infections. Infection control and hospital epidemiology
2014/09; 35(9): 1140-1146.
Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; TAUX; STATISTIQUE; CAS TEMOIN;
FACTEUR DE RISQUE; SCORE
Objective: The current central line-associated bloodstream infection (CLABSI) surveillance rate calculation
does not account for multiple concurrent central venous catheters (CVCs). The presence of multiple CVCs
creates more points of entry into the bloodstream, potentially increasing CLABSI risk. Multiple CVCs may be
used in sicker patients, making it difficult to separate the relative contributions of multiple CVCs and
comorbidities to CLABSI risk. We explored the relative impact of multiple CVCs, patient comorbidities, and
disease severity on the risk of CLABSI.
Design: Case-control study.
Setting: A total of 197 case patients and 201 control subjects with a CVC inserted during hospitalization at a
tertiary care academic medical center from January 1, 2008, to December 31, 2010.
Methods: Multiple CVCs was the exposure of interest; the primary outcome was CLABSI. Multivariable
logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs)
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describing the association between CLABSI and multiple CVCs with and without controlling for Acute
Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index (CCI) scores as
measures of disease severity and patient comorbidities, respectively.
Results: Patients with multiple CVCs (n=78) showed a 4.2 (95% CI, 2.2-8.4) times greater risk of CLABSI
compared with patients with 1 CVC after adjusting for CLABSI risk factors. When including APACHE II and
CCI scores, multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4 [95% CI, 1.7-6.9]).
Conclusions: Multiple CVCs is an independent risk factor for CLABSI even after adjusting for severity of
illness. Adjustment for this risk may be necessary to accurately compare rates between hospitals.
NosoBase ID notice : 384594
La sonication pour le diagnostic des infections associées au cathéter n'est pas meilleure que la
culture traditionnelle par roulage : étude de cohorte prospective sur des cathéters veineux centraux
Erb S; Frei R; Schregenberger K; Dange Ml; Nogarth D; Widmer AF. Sonication for diagnosis of catheterrelated infection is not better than traditional roll-plate culture: a prospective cohort study with central venous
catheters. Clinical infectious diseases 2014/08/15; 59(4): 541-544.
Mots-clés : ETUDE PROSPECTIVE; RANDOMISATION; CATHETER VEINEUX CENTRAL; BACTERIEMIE;
DIAGNOSTIC; ULTRA-SON
This prospective randomized controlled study with 975 nontunneled central venous catheters (CVCs) showed
that the semiquantitative roll-plate culture technique (SQC) was as accurate as the sonication method for
diagnosis of catheter-related infections. Sonication is difficult to standardize, whereas SQC is simpler, faster,
and as reliable as the sonication method for culturing CVCs.
NosoBase ID notice : 384915
Bloodstream infection due to extended-spectrum beta-lactamase (ESBL)-positive K. pneumoniae and
E. coli: an analysis of the disease burden in a large cohort
Leistner R; Gürntke S; Sakellariou C; Denkel LA; Bloch A; Gastmeier P; et al. Bloodstream infection due to
extended-spectrum beta-lactamase (ESBL)-positive K. pneumoniae and E. coli: an analysis of the disease
burden in a large cohort. Infection 2014/08/07; in press : 7 pages.
Mots-clés : KLEBSIELLA PNEUMONIAE; BETA-LACTAMASE A SPECTRE ELARGI; BACTERIEMIE;
ESCHERICHIA COLI; ANALYSE; COHORTE; COUT; DUREE DE SEJOUR; MORBIDITE; ANALYSE
MULTIVARIEE; MORTALITE
Purpose: The burden of extended-spectrum beta-lactamase (ESBL)-positive Enterobacteriaceae (ESBL-E) is
growing worldwide. We aimed to determine the financial disease burden attributable to ESBL-positive species
in cases of bloodstream infection (BSI) due to K. pneumoniae and E. coli.
Methods: We conducted a cohort study on patients with BSI due to K. pneumoniae or E. coli between 2008
and 2011 in our institution. Data were collected on true hospital costs, length of stay (LOS), basic
demographic parameters, underlying diseases as Charlson comorbidity index (CCI) and ESBL positivity of the
pathogens. Multivariable regression analysis on hospital costs and length of stay was performed.
Results: Overall we found 1,851 consecutive cases of ESBL-E BSI, 352 (19.0%) cases of K. pneumoniae BSI
and 1,499 (81.0%) cases of E. coli BSI. Sixty-six of E. coli BSI (18.8%) and 178 of K. pneumoniae BSI
(11.9%) cases were due to ESBL-positive isolates, respectively (p=0.001). 830 (44.8 %) cases were hospitalonset, 215 (61.1%) of the K. pneumoniae and 615 (41.0%) of the E. coli cases (p<0.001). In-hospital mortality
was overall 19.8, 25.0% in K. pneumoniae cases and 18.5% in E. coli cases (p=0.006). Increased hospital
costs and length of stay were significantly associated to BSI with ESBL-positive K. pneumoniae.
Conclusion: In contrast to BSI due to ESBL-positive E. coli, cases of ESBL-positive K. pneumoniae BSI were
associated with significantly increased costs and length of stay. Infection prevention measures should
differentiate between both pathogens.
NosoBase ID notice : 384836
Forte prévalence de la sensibilité diminuée à la chlorhexidine pour des micro-organismes
responsables de bactériémie sur voies centrales
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Suwantarat N; Carroll KC; Tekle T; Ross T; Maragakis LL; Cosgrove SE; et al. High prevalence of reduced
chlorhexidine susceptibility in organisms causing central line-associated bloodstream infections. Infection
control and hospital epidemiology 2014/09; 35(9): 1183-1186.
Mots-clés : CHLORHEXIDINE; BACTERIEMIE; CATHETER
TOILETTE; SOIN INTENSIF; MULTIRESISTANCE; CANDIDA
VEINEUX
CENTRAL;
PREVALENCE;
In units that bathe patients daily with chlorhexidine gluconate (CHG), organisms causing central lineassociated bloodstream infections (CLABSIs) were more likely to have reduced CHG susceptibility than
organisms causing CLABSIs in units that do not bathe patients daily with CHG (86% vs 64%; P=.028).
Surveillance is needed to detect reduced CHG susceptibility with widespread CHG use.
NosoBase ID notice : 385018
Verrou éthanol versus verrou héparine pour la prévention des bactériémies associées au cathéter
veineux central : essai randomisé chez des patients adultes d'hématologie porteur d'un cathéter de
Hickman
Worth LJ; Slavin MA; Heath S; Szer J; Grigg AP. Ethanol versus heparin locks for the prevention of central
venous catheter-associated bloodstream infections: a randomized trial in adult haematology patients with
Hickman devices. The journal of hospital infection 2014/09; 88(1): 48-51.
Mots-clés : CATHETER VEINEUX CENTRAL; ALCOOL; BACTERIEMIE; PREVENTION;
THERAPEUTIQUE; AGE; ADULTE; HEMATOLOGIE; RANDOMISATION; EFFICACITE
ESSAI
The effectiveness of ethanol locks for prevention of central venous catheter (CVC)-associated bloodstream
infection (CLABSI) in adult haematology patients has not been thoroughly evaluated. This study aimed to
compare prospectively heparinized saline with 70% ethanol locks using 2 h dwell time in patients with
tunnelled CVCs. In saline (N=43) and ethanol (N ¼ 42) groups, CLABSI rates were 6.0 [95% confidence
interval (CI): 3.4e9.8] and 4.1 (95% CI: 1.9e7.7) per 1000 CVC days, respectively (P=0.42). In the ethanol
group, two exit-site infections and one tunnel/pocket infection were observed. Reduction in deviceassociated
infection was not achieved with prophylactic 70% ethanol locks in patients with
haematological malignancy and tunnelled CVCs.
Chikungunya
NosoBase ID notice : 384577
Le nombre important de cas importés de Chikungunya en France métropolitaine représente un défi
pour la surveillance et l’intervention.
Paty MC; Six C; Charlet F; Heuzé G; Cochet A; Wiegandt A; et al. Le nombre important de cas importés de
Chikungunya en France métropolitaine représente un défi pour la sur veillance et l’intervention. Bulletin
épidémiologique hebdomadaire 2014/07/23; 23: 404-408.
Mots-clés : SURVEILLANCE; CHIKUNGUNYA; AEDES ALBOPICTUS
Pendant l’été 2014, toutes les conditions sont réunies pour une transmission autochtone du virus du
chikungunya dans certains départements du sud de la France : un vecteur compétent, Aedes albopictus, et
un grand nombre de voyageurs revenant des départements français d’Amérique où sévit une épidémie de
Chikungunya. Cet article présente l’organisation du dispositif de surveillance du Chikungunya et de la dengue
en France métropolitaine et ses résultats. Du 2 mai au 4 juillet 2014, 126 cas importés confirmés ont été
notifiés en France métropolitaine.
Chirurgie
NosoBase ID notice : 384505
Valeur des messages écrits sur téléphone mobile destinés à augmenter le taux de réponse pour la
surveillance des infections du site opératoire après la sortie de l’hôpital
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Berry E. The value of text messages to increase response rates for post-discharge surgical site infection
surveillance. The journal of hospital infection 2014/08; 87(4): 246-247.
Mots-clés : CLOSTRIDIUM DIFFICILE; SURVEILLANCE; SEJOUR; SORTIE; CHIRURGIE; CENTRE
HOSPITALIER UNIVERSITAIRE; CESARIENNE; TELEPHONE
NosoBase ID notice : 385471
Pansements pour la prévention des infections du site opératoire
Dumville JC; Gray TA; Walter CJ; Sharp CA; Page T. Dressings for the prevention of surgical site infection.
The Cochrane database of systematic reviews 2014/09; 9: 1-81.
Mots-clés : PANSEMENT; PREVENTION; CHIRURGIE; ANTISEPTIQUE; REVUE DE LA LITTERATURE;
PANSEMENT HYDROCOLLOÏDE
Background: Surgical wounds (incisions) heal by primary intention when the wound edges are brought
together and secured - often with sutures, staples, clips or glue. Wound dressings, usually applied after
wound closure, provide physical support, protection from bacterial contamination and absorb exudate.
Surgical site infection (SSI) is a common complication of surgical wounds that may delay healing.
Objectives: To assess the effects of wound dressings for preventing SSI in people with surgical wounds
healing by primary intention.
Search methods: In February 2014 we searched: The Cochrane Wounds Group Specialised Register; The
Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); The Database of
Abstracts of Reviews of Effects (DARE) (The Cochrane Library); The Health Technology Assessment
Database (HTA) (The Cochrane Library); NHS Economic Evaluation Database (NHSEED) (The Cochrane
Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and
EBSCO CINAHL. There were no restrictions based on language or date of publication or study setting.
Selection criteria: Randomised controlled trials (RCTs) comparing alternative wound dressings or wound
dressing with no dressing (wound exposure) for the postoperative management of surgical wounds healing by
primary intention.
Data collection And Analysis: Two review authors performed study selection, risk of bias assessment and
data extraction independently.
Main results: Twenty RCTs were included (3623 participants). All trials were at unclear or high risk of bias.
Twelve trials included people with wounds resulting from surgical procedures with a contamination
classification of 'clean', two trials included people with wounds resulting from surgical procedures with a
'clean/contaminated' contamination classification and the remaining trials evaluated people with wounds
resulting from various surgical procedures with different contamination classifications. Two trials compared
wound dressings with leaving wounds exposed. The remaining 18 trials compared two alternative dressing
types. No evidence was identified to suggest that any dressing significantly reduced the risk of developing an
SSI compared with leaving wounds exposed or compared with alternative dressings in people who had
surgical wounds healing by primary intention.
Authors' conclusions: At present, there is insufficient evidence as to whether covering surgical wounds
healing by primary intention with wound dressings reduces the risk of SSI or whether any particular wound
dressing is more effective than others in reducing the rates of SSI, improving scarring, pain control, patient
acceptability or ease of dressing removal. Most trials in this review were small and at high or unclear risk of
bias. However, based on the current evidence, we conclude that decisions on wound dressing should be
based on dressing costs and the symptom management properties offered by each dressing type e.g.
exudate management.
NosoBase ID notice : 385487
Bouquet d’interventions (bundle) destinées à la prévention des infections du site opératoire en
chirurgie colorectale. Une approche efficace pour la réduction des infections du site opératoire et la
réalisation d’économies sur les soins en santé
Keenan JE; Speicher PJ; Thacker JK; Walter M; Kuchibhatla M; Mantyh CR. The preventive surgical site
infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health
care cost savings. JAMA surgery 2014/08/27; in press: 18 pages.
Mots-clés : PREVENTION; CHIRURGIE; CHIRURGIE DIGESTIVE; TAUX; ETUDE RETROSPECTIVE;
CENTRE HOSPITALIER UNIVERSITAIRE; INFECTION PROFONDE; SYNDROME SEPTIQUE;
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APPARIEMENT; INFECTION SUPERFICIELLE; DUREE DE SEJOUR;
OBSERVANCE; ANTIBIOPROPHYLAXIE; COUT; BUNDLE; ORGANE
Septembre 2014
COHORTE;
QUALITE;
Importance: Surgical site infections (SSIs) in colorectal surgery are associated with increased morbidity and
health care costs.
Objective: To determine the effect of a preventive SSI bundle (hereafter bundle) on SSI rates and costs in
colorectal surgery.
Design: Retrospective study of institutional clinical and cost data. The study period was January 1, 2008, to
December 31, 2012, and outcomes were assessed and compared before and after implementation of the
bundle on July 1, 2011.
Setting and participants: Academic tertiary referral center among 559 patients who underwent major elective
colorectal surgery.
Main outcomes and measures: The primary outcome was the rate of superficial SSIs before and after
implementation of the bundle. Secondary outcomes included deep SSIs, organ-space SSIs, wound
disruption, postoperative sepsis, length of stay, 30-day readmission, and variable direct costs of the index
admission.
Results: Of 559 patients in the study, 346 (61.9%) and 213 (38.1%) underwent their operation before and
after implementation of the bundle, respectively. Groups were matched on their propensity to be treated with
the bundle to account for significant differences in the preimplementation and postimplementation
characteristics. Comparison of the matched groups revealed that implementation of the bundle was
associated with reduced superficial SSIs (19.3% vs 5.7%, P<.001) and postoperative sepsis (8.5% vs 2.4%,
P=.009). No significant difference was observed in deep SSIs, organ-space SSIs, wound disruption, length of
stay, 30-day readmission, or variable direct costs between the matched groups. However, in a subgroup
analysis of the postbundle period, superficial SSI occurrence was associated with a 35.5% increase in
variable direct costs ($13 253 vs $9779, P=.001) and a 71.7% increase in length of stay (7.9 vs 4.6 days,
P<.001).
Conclusions and relevance: The preventive SSI bundle was associated with a substantial reduction in SSIs
after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an
effective approach to reduce health care costs.
NosoBase ID notice : 384834
Cas groupés d’infections du site opératoire (ISO) à Mycobacterium wolinskyi dans un centre
hospitalier universitaire
Nagpal A; Wentink JE; Berbari EF; Aronhalt KC; Wright AJ; Krageschmidt DA; et al. A cluster of
Mycobacterium wolinskyi surgical site infections at an academic medical center. Infection control and hospital
epidemiology 2014/09; 35(9): 1169-1175.
Mots-clés : CHIRURGIE CARDIO-VASCULAIRE: MYCOBACTERIE; CAS TEMOIN; EPIDEMIE; PFGE;
BLOC OPERATOIRE; AIR; EAU; DISPOSITIF MEDICAL; SITE OPERATOIRE; MYCOBACTERIUM
WOLINSKYI
Objective: To study a cluster of Mycobacterium wolinskyi surgical site infections (SSIs).
Design: Observational and case-control study.
Setting: Academic hospital.
Patients: Subjects who developed SSIs with M. wolinskyi following cardiothoracic surgery.
Methods: Electronic surveillance was performed for case finding as well as electronic medical record review
of infected cases. Surgical procedures were observed. Medical chart review was conducted to identify risk
factors. A case-control study was performed to identify risk factors for infection; Fisher exact or Kruskal-Wallis
tests were used for comparisons of proportions and medians, respectively. Patient isolates were studied
using pulsed-field gel electrophoresis (PFGE). Environmental microbiologic sampling was performed in
operating rooms, including high-volume water sampling.
Results: Six definite cases of M. wolinskyi SSI following cardiothoracic surgery were identified during the
outbreak period (October 1, 2008-September 30, 2011). Having cardiac surgery in operating room A was
significantly associated with infection (odds ratio, 40; P=.0027). Observational investigation revealed a coldair blaster exclusive to operating room A as well a microbially contaminated, self-contained water source used
in heart-lung machines. The isolates were indistinguishable or closely related by PFGE. No environmental
samples were positive for M. wolinskyi.
Conclusions: No single point source was established, but 2 potential sources, including a cold-air blaster and
a microbially contaminated, self-contained water system used in heart-lung machines for cardiothoracic
operations, were identified. Both of these potential sources were removed, and subsequent active
surveillance did not reveal any further cases of M. wolinskyi SSI.
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NosoBase ID notice : 384690
Infections après transplantation hépatique orthotopique
Pedersen M; Seetharam A. Infections after orthotopic liver transplantation. Journal of clinical and
experimental hepatology 2014; in press: 14 pages.
Mots-clés : TRANSPLANTATION; TRANSPLANTATION HEPATIQUE; DEFICIT IMMUNITAIRE;
ANTIBIOPROPHYLAXIE; TUBERCULOSE; MYCOBACTERIE; MYCOLOGIE; VIRUS; PREVENTION;
REVUE DE LA LITTERATURE
Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation.
Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria,
viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are
also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may
guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms
of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive
procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial
prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients
after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic
liver transplantation and highlight recent developments in their diagnosis and management.
NosoBase ID notice : 385050
Impact d'une administration d'antibiotique en post-opératoire sur les infections post-opératoires
après cholécystectomie pour cholécystite aigue lithiasique. Essai clinique randomisé
Regimbeau JM; Fuks D; Pautrat K; Mauvais F; Haccart V; Msika S; et al. Effect of postoperative antibiotic
administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a
randomized clinical trial. JAMA 2014/07; 12(2): 145-154.
Mots-clés : CHIRURGIE; TRAITEMENT; ANTIBIOTIQUE; POST-OPERATOIRE; CHIRURGIE DIGESTIVE;
RANDOMISATION; ESSAI THERAPEUTIQUE; AMOXICILLINE; ACIDE CLAVULANIQUE; INCIDENCE;
ANTIBIOPROPHYLAXIE; PREVENTION; ETUDE MULTICENTRIQUE
Ninety percent of cases of acute calculous cholecystitis are of mild (grade I) or moderate (grade II) severity.
Although the preoperative and intraoperative antibiotic management of acute calculous cholecystitis has been
standardized, few data exist on the utility of postoperative antibiotic treatment.
Objective: To determine the effect of postoperative amoxicillin plus clavulanic acid on infection rates after
cholecystectomy.
Design, setting, and patients: A total of 414 patients treated at 17 medical centers for grade I or II acute
calculous cholecystitis and who received 2 g of amoxicillin plus clavulanic acid 3 times a day while in the
hospital before and once at the time of surgery were randomized after surgery to an open-label, noninferiority,
randomized clinical trial between May 2010 and August 2012.
Interventions: After surgery, no antibiotics or continue with the preoperative antibiotic regimen 3 times daily
for 5 days.
Main outcomes and measures: The proportion of postoperative surgical site or distant infections recorded
before or at the 4-week follow-up visit.
Results: An imputed intention-to-treat analysis of 414 patients showed that the postoperative infection rates
were 17% (35 of 207) in the nontreatment group and 15% (31 of 207) in the antibiotic group (absolute
difference, 1.93%; 95% CI, -8.98% to 5.12%). In the per-protocol analysis, which involved 338 patients, the
corresponding rates were both 13% (absolute difference, 0.3%; 95% CI, -5.0% to 6.3%). Based on a
noninferiority margin of 11%, the lack of postoperative antibiotic treatment was not associated with worse
outcomes than antibiotic treatment. Bile cultures showed that 60.9% were pathogen free. Both groups had
similar Clavien complication severity outcomes: 195 patients (94.2%) in the nontreatment group had a score
of 0 to I and 2 patients (0.97%) had a score of III to V, and 182 patients (87.8%) in the antibiotic group had a
score of 0 to I and 4 patients (1.93%) had a score of III to V.
Conclusions and relevance: Among patients with mild or moderate calculous cholecystitis who received
preoperative and intraoperative antibiotics, lack of postoperative treatment with amoxicillin plus clavulanic
acid did not result in a greater incidence of postoperative infections.
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NosoBase ID notice : 385016
Treize ans de surveillance des infections du site opératoire dans des centres hospitaliers
Staszewicz W; Eisenring MC; Bettschart V; Harbarth S; Troillet N. Thirteen years of surgical site infection
surveillance in Swiss hospitals. The journal of hospital infection 2014/09; 88(1): 40-47.
Mots-clés : SURVEILLANCE; PREVENTION; TAUX; FACTEUR DE RISQUE; CHIRURGIE; CHIRURGIE
DIGESTIVE; CHIRURGIE ORTHOPEDIQUE; ETUDE MULTICENTRIQUE
Surveillance is an essential element of surgical site infection (SSI) prevention. Few studies have evaluated
the long-term effect of these programmes.
Aim: To present data from a 13-year multicentre SSI surveillance programme from western and southern
Switzerland.
Methods: Surveillance with post-discharge follow-up was performed according to the US National Nosocomial
Infections Surveillance (NNIS) system methods. SSI rates were
calculated for each surveyed type of surgery, overall and by year of participation in the programme. Risk
factors for SSI and the effect of surveillance time on SSI rates were analysed by multiple logistic regression.
Findings: Overall SSI rates were 18.2% after 7411 colectomies, 6.4% after 6383 appendicectomies, 2.3%
after 7411 cholecystectomies, 1.7% after 9933 herniorrhaphies, 1.6% after
6341 hip arthroplasties, and 1.3% after 3667 knee arthroplasties. The frequency of SSI detected after
discharge varied between 21% for colectomy and 94% for knee arthroplasty. Independent risk factors for SSI
differed between operations. The NNIS risk index was predictive of SSI in gastrointestinal surgery only.
Laparoscopic technique was protective overall, but associated with higher rates of organ-space infections
after appendicectomy.
The duration of participation in the surveillance programme was not associated with a decreased SSI rate for
any of the included procedure.
Conclusion: These data confirm the effect of post-discharge surveillance on SSI rates and the protective
effect of laparoscopy. There is a need to establish alternative case-mix
adjustment methods. In contrast to other European programmes, no positive impact of surveillance duration
on SSI rates was observed.
NosoBase ID notice : 384669
Infections post-opératoires après chirurgie cytoréductive et chimiothérapie hyperthermique
intrapéritonéale pour carcinose péritonéale : propositions et résultats d’une étude prospective de
protocole de prévention, surveillance et traitement
Valle M; Federici O; Carboni F; Toma L; Gallo MT; Prignano G; et al. Postoperative infections after
cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective
protocol study of prevention, surveillance and treatment. European journal of surgical oncology 2014/08;
40(8): 950-956.
Mots-clés : CANCER; CANCEROLOGIE; CHIRURGIE; CHIRURGIE CARCINOLOGIQUE;
PROSPECTIVE; PREVENTION; SURVEILLANCE; TRAITEMENT; PROTOCOLE
ETUDE
The incidence of infectious complications due to several contributory causes is particularly elevated and lifethreatening in patients undergoing peritonectomy and HIPEC procedure for peritoneal carcinomatosis.
Following a previous experience, we started a prospective protocol study of preoperative screening,
perioperative prophylaxis and postoperative surveillance and treatment. A total of 111 patients with peritoneal
carcinomatosis of various origin underwent CRS with HIPEC between April 2004 and December 2012. The
group was divided into a pilot group of 30 patients (04/04 to 05/08) and a main group of 81 patients (06/08 to
12/12). Overall postoperative morbidity rate was 44%, with 35.8% of symptomatic infections. No postoperative mortality was observed. Microorganisms were isolated in 24 patients (80.0%) in the first group and
54 (66.7%) in the second. They were symptomatic in 18 cases (75.0%) and 25 (46.3%) cases respectively. In
addition, 7 invasive candidosis were recorded (25.9%). Colon resection (P=0.01) and duration of surgery
(P=0.0008) were associated with infection at logistic regression model. Concerning symptomatic infections,
only Infection Risk Index (P=0.009) showed significance at multivariate analysis. Despite a significant
incidence of infectious complications, establishment of a prevention, surveillance and treatment protocol lead
to a zero mortality rate in the observed patients of our experience. Owing to the obtained results, we suggest
the use of a standardized protocol for the prevention, monitoring and treatment in all patients enrolled for
cytoreductive surgery and HIPEC.
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NosoBase ID notice : 384623
Présentation clinique et traitement des infections associées aux implants orthopédiques
Zimmerli W. Clinical presentation and treatment of orthopaedic implant-associated infection. Journal of
internal medicine 2014/08; 276(2): 111-119.
Mots-clés : CHIRURGIE ORTHOPEDIQUE; MATERIEL ETRANGER; BIOFILM; ANTIBIOTIQUE;
RIFAMPICINE; STAPHYLOCOCCUS AUREUS; RISQUE; TRAITEMENT; PREVENTION; REVUE DE LA
LITTERATURE
Orthopaedic implants are highly susceptible to infection. The aims of treatment of infection associated with
internal fixation devices are fracture consolidation and prevention of chronic osteomyelitis. Complete biofilm
eradication is not the primary goal, as remaining adherent microorganisms can be removed with the device
after fracture consolidation. By contrast, in periprosthetic joint infection (PJI), biofilm elimination is required.
Surgical treatment of PJI includes debridement with retention, one- or two-stage exchange and removal
without reimplantation. In addition, prolonged antibiotic treatment, preferably with an agent that is effective
against biofilm bacteria, is required. Rifampicin is an example of an antibiotic with these properties against
staphylococci. However, to avoid the emergence of resistance, rifampicin must always be combined with
another antimicrobial agent. With this novel treatment approach, orthopaedic implant-associated infection is
likely to be eradicated in up to 80-90% of patients. Because most antibiotics have a limited effect against
biofilm infections, novel prophylactic and therapeutic options are needed. Surface coating with antimicrobial
peptides that reduce bacterial attachment and biofilm formation can potentially prevent implant-associated
infection. In addition, quorum-sensing inhibitors are a novel therapeutic option against biofilm infections.
Clostridium difficile
NosoBase ID notice : 385011
Séjours hospitaliers et coûts attribuables aux infections à Clostridium difficile : revue critique
Gabriel L; Beriot-Mathiot A. Hospitalization stay and costs attributable to Clostridium difficile infection: a
critical review. The journal of hospital infection 2014/09; 88(1): 12-21 ;
Mots-clés : CLOSTRIDIUM DIFFICILE; SEJOUR; COUT; DUREE DE SEJOUR
In most healthcare systems, third-party payers fund the costs for patients admitted to hospital for Clostridium
difficile infection (CDI) whereas, for CDI cases arising as complications of hospitalization, not all related costs
are refundable to the hospital. We therefore aimed to critically review and categorize hospital costs and length
of hospital stay (LOS) attributable to Clostridium difficile infection and to investigate the economic burden
associated with it. A comprehensive literature review selected papers describing the costs and LOS for
hospitalized patients as outcomes of CDI, following the use of statistics to identify costs and LOS solely
attributable to CDI. Twenty-four studies were selected. Estimated attributable costs, all ranges expressed in
US dollars, were $6,774 e$10,212 for CDI requiring admission, $2,992e$29,000 for hospital-acquired CDI,
and $2,454e$12,850 where no categorization was made. The ranges for LOS values were 5e13.6, 2.7e21.3,
and 2.8e17.9 days, respectively. The categorization of CDI attributable costs allows budget holders to
anticipate the cost per CDI case, a perspective that should enrich the design of appropriate incentives for the
various budget holders to invest in prevention so that CDI prevention is optimized globally.
NosoBase ID notice : 385444
Infections à Clostridium difficile chez des bénéficiaires de transplantation d’organes solides
Honda H; Dubberke ER. Clostridium difficile infection in solid organ transplant recipients. Current opinion in
infectious diseases 2014/08; 27(4): 336-341.
Mots-clés : CLOSTRIDIUM DIFFICILE; REVUE DE LA LITTERATURE;
DIAGNOSTIC; TRAITEMENT; FACTEUR DE RISQUE; PREVENTION
TRANSPLANTATION;
Purpose of review: Clostridium difficile infection (CDI) is one of the most common healthcare-associated
infections, and the threat associated with CDI continues to grow in all patient populations. There is increasing
evidence that CDI has a substantial impact on the morbidity and mortality in solid organ transplant (SOT)
recipients. Furthermore, new diagnostic and treatment options and strategies for CDI have emerged over the
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last decade. The purpose of this review is to provide a general understanding of CDI and its evidence-based
diagnosis and management strategies, with a focus on SOT recipients.
Recent findings: The incidence and severity of CDI have significantly increased since the year 2000. Studies
have identified novel risk factors for CDI, and a new epidemic strain, the NAP1/BI/027, has emerged. Despite
the development of newer testing methods and approaches, including nucleic acid amplification tests and
testing algorithms, the optimal method for diagnosing CDI is an area of controversy. New agents for treating
CDI are being developed, and the use of fecal microbiota transplantation to treat recurrent CDI in SOT
recipients is also evolving.
Summary: CDI is a significant problem for SOT recipients. Further studies on diagnostic and therapeutic
strategies with a focus on SOT recipients are needed to further improve patient outcomes.
Coût
NosoBase ID notice : 385452
Comment les coûts changent avec les efforts de prévention du risque infectieux
Graves N. How costs change with infection prevention efforts. Current opinion in infectious diseases 2014/08;
27(4): 390-393.
Mots-clés : COUT; PREVENTION; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM
Purpose of review: To describe articles since January 2013 that include information on how costs change with
infection prevention efforts.
Recent findings: Three articles described only the costs imposed by nosocomial infection and so provided
limited information about whether or not infection prevention efforts should be changed. One article was found
that described the costs of supplying alcohol-based hand run in low-income countries. Eight articles showed
the extra costs and cost savings from changing infection prevention programmes and discussed the health
benefits. All concluded that the changes are economically worthwhile. There was a systematic review of the
costs of methicillin-resistant Staphylococcus aureus control programmes and a methods article for how to
make cost estimates for infection prevention programmes.
Summary: The balance has shifted away from studies that report the high cost of nosocomial infections
toward articles that address the value for money of infection prevention. This is good as simply showing a
disease is high cost does not inform decisions to reduce it. More research, done well, on the costs of
implementation, cost savings and change to health benefits in this area needs to be done as many gaps exist
in our knowledge.
Dialyse
NosoBase ID notice : 384617
Péritonite liée à la dialyse péritonéale : vers une amélioration. Preuves, pratiques et évolutions
Cho Y; Johnson DW. Peritoneal dialysis-related peritonitis: Towards improving. Evidence, practices, and
outcomes. American journal of kidney diseases 2014/08; 64(2): 278-289.
Mots-clés : DIALYSE RENALE; DIALYSE PERITONEALE; PERITOINE; PERITONITE; PRATIQUE;
COMPLICATION; EPIDEMIOLOGIE; FACTEUR DE RISQUE; DIAGNOSTIC; TRAITEMENT; PREVENTION;
REVUE DE LA LITTERATURE; MICROBIOLOGIE; STAPHYLOCOCCUS
Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity,
mortality, and health care costs. It also significantly limits the use of this important dialysis modality. Despite
its importance as a patient safety issue, peritonitis practices and outcomes vary markedly and unacceptably
among different centers, regions, and countries. This article reviews peritonitis risk factors, diagnosis,
treatment, and prevention, particularly focusing on potential drivers of variable practices and outcomes,
controversial or unresolved areas, and promising avenues warranting further research. Potential strategies for
augmenting the existing limited evidence base and reducing the gap between evidence-based best practice
and actual practice also are discussed.
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Ebola
NosoBase ID notice : 385458
Procédure de prise en charge des appels pour suspicion de fièvre à virus Ebola (FVE)
Samu-Urgences de France (SUdF); Société Française de Médecine d'Urgence (SFMU). Procédure de prise
en charge des appels pour suspicion de fièvre à virus Ebola (FVE). SFMU 2014/09: 1-11.
Mots-clés : FIEVRE HEMORRAGIQUE; PROTOCOLE; CONDUITE A TENIR; EBOLA
L’actuelle épidémie de fièvre virale hémorragique à virus Ebola dans certains pays de l’Afrique de l’ouest et la
probabilité, mais faible, d’importation de la maladie en France imposent la mise en place de procédures
spécifique de régulation médicale au niveau de Samu--‐Centre 15 et de prise en charge et de transport par
les Services Mobiles d’Urgence et de Réanimation (SMUR).
Cette procédure fait suite au MARS 06.08.14--‐1 et à une demande de la Direction Générale de la Santé
(DGS) au COREB (réseau de Coordination du Risque Epidémiologique et Biologique, et vient compléter les
procédures déjà élaborées :
(1) Procédure SPIF--‐COREB : fièvre à virus Ebola (FVE) du 2 août 2014,
(2) Le transport du patient en isolement – Urgences 2012, chapitre 113,
(3) Avis du HCSP du 10 avril 2014 relatif à la conduite à tenir autour des cas suspects de fièvre
hémorragique à virus Ebola.
NosoBase ID notice : 385288
La plus vaste épidémie jamais survenue d'infections par le virus Ebola pousse les thérapies
expérimentales, les vaccins sous la lumière
Hampton T. Largest-ever outbreak of Ebola virus disease thrusts experimental therapies, vaccines into
spotlight. JAMA 2014/08/27; in press: 2 pages.
Mots-clés : EPIDEMIE; VIRUS; TRAITEMENT; VACCIN; FIEVRE HEMORRAGIQUE; EBOLA
NosoBase ID notice : 385496
Relation entre température, humidité et épidémies d'infections à virus Ebola en Afrique, 1976 à 2014
Ng S; Basta NE; Cowling BJ. Association between temperature, humidity and ebolavirus disease outbreaks in
Africa, 1976 to 2014. Eurosurveillance 2014/09; 19(35): 1-9.
Mots-clés : FIEVRE HEMORRAGIQUE; EPIDEMIE; ENVIRONNEMENT; CLIMAT; EBOLA
Ebolavirus disease (EVD) outbreaks have been occurring sporadically in Central Africa since 1976. In 2014,
the first outbreak in West Africa was reported in Guinea. Subsequent outbreaks then appeared in Liberia,
Sierra Leone and Nigeria. The study of environmental factors underlying EVD epidemiology may provide
useful insights into when and where EVD outbreaks are more likely occur. In this paper, we aimed to
investigate the association between climatic factors and onset of EVD outbreaks in humans. Our results
suggest lower temperature and higher absolute humidity are associated with EVD outbreak onset in the
previous EVD outbreaks in Africa during 1976 to 2014. Potential mechanisms through which climate may
have an influence on ebolavirus infection in the natural host, intermediate hosts and humans are discussed.
Current and future surveillance efforts should be supported to further understand ebolavirus transmission.
NosoBase ID notice : 384790
Guide provisoire de prévention et contrôle du risque infectieux lors des soins aux patients suspects
ou confirmés de fièvre hémorragique à filovirus dans des établissements de soins, et en particulier à
Ebola
Organisation mondiale de la santé (OMS). Interim infection prevention and control guidance for care of
patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola.
OMS 2014/08: 1-24.
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Mots-clés : VIRUS; RECOMMANDATIONS DE BONNE PRATIQUE; ENVIRONNEMENT; NETTOYAGE;
LINGE; DECHET; PREVENTION; HYGIENE DES MAINS; TENUE VESTIMENTAIRE; MASQUE; GANT;
ACCIDENT D'EXPOSITION AU SANG; ORGANISATION MONDIALE DE LA SANTE; EBOLA; FIEVRE
HEMORRAGIQUE; FILOVIRUS
EHPAD
NosoBase ID notice : 355687
Guide de prévention des infections dans les résidences privées pour aînés. Mise à jour 2014.
Santé et Services Sociaux Québec. Guide de prévention des infections dans les résidences privées pour
aînés. Mise à jour 2014. Santé et Services Sociaux Québec 2014/08: 132 pages.
Mots-clés : PERSONNE AGEE; EHPAD; PREVENTION; RESPONSABILITE; TRANSMISSION; HYGIENE
DES MAINS; TENUE VESTIMENTAIRE; GANT; MASQUE; NETTOYAGE; SURFACE; ANIMAL;
CLOSTRIDIUM DIFFICILE; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; ALIMENTATION;
VACCINATION; GALE; GASTRO-ENTERITE; GRIPPE; POUX; STAPHYLOCOCCUS AUREUS; HERPES
ZOSTER VIRUS; AIR; HUMIDIFICATEUR; PRECAUTION COMPLEMENTAIRE; TOILETTE DU PATIENT;
PUNAISE; SARM|
Le "Guide de prévention des infections dans les résidences privées pour aînés" s’adresse aux exploitants des
résidences et à leur personnel ainsi qu'aux intervenants du réseau de la santé qui œuvrent auprès de ces
résidences. Le guide contient des recommandations adaptées à ces milieux de vie et des outils pour prévenir
la transmission des infections dans les résidences. Ce guide est constitué de trois sections principales soit :
- les principes et pratiques de bases en prévention des infections (hygiène des mains, équipement de
protection personnelle, hygiène personnelle des résidents, préparation des repas, vaccination, etc.);
- les mesures spécifiques à appliquer pour les infections rencontrées fréquemment dans ces milieux y
compris les situations d'éclosions (par exemple le Clostridium difficile ou la grippe) ;
- des outils, en annexe, pour faciliter la prévention des infections.
Tous ont un rôle à jouer dans la prévention des infections dans les résidences privées pour aînés et parfois
des gestes aussi simples que l'hygiène des mains peuvent faire une différence.
NosoBase ID notice : 385449
La prévention du risque infectieux dans les établissements de soins de longue durée et EHPAD
Nicolle LE. Infection prevention issues in long-term care. Current opinion in infectious diseases 2014/08;
27(4): 363-369.
Mots-clés : SOIN DE LONGUE DUREE; PREVENTION; PREVALENCE; EPIDEMIE; CLOSTRIDIUM
DIFFICILE; DISPOSITIF MEDICAL; CATHETER; SONDAGE URINAIRE; STAPHYLOCOCCUS AUREUS;
ENTEROCOCCUS; ANTIBIORESISTANCE; SURVEILLANCE; ANTIBIOTIQUE; EHPAD; PERSONNE AGEE
Purpose of review: Infections and antimicrobial use are common in residents of long-term care facilities. This
review discusses recent articles that address infection prevention and control and antimicrobial stewardship in
these facilities.
Recent findings: National surveys confirm the continuing high prevalence of infections in residents of longterm care facilities, with the greatest risk for patients with the highest acuity and greatest functional disability.
Long-term acute care facilities are a unique environment where residents are characterized by high levels of
indwelling device use and antimicrobial-resistant organisms. The major determinant of antimicrobial
resistance in long-term care facilities is antimicrobial use. The Centers for Disease Control (CDC) has
proposed revised evidence-based definitions for surveillance of infections on the basis of the original McGeer
criteria. Consensus national performance standards for infection prevention and antimicrobial stewardship
programs in long-term care facilities have been developed in a European initiative. Evidence to support the
efficacy of infection control programs is limited. Antimicrobial stewardship programs may, however, be
effective in reducing inappropriate antimicrobial use.
Summary: The extent to which endemic infections or antimicrobial resistance in long-term care facilities can
be prevented remains unclear. Efforts to limit infections in these facilities should focus on outbreak prevention
and standard procedures for environmental cleaning, food preparation, and hand hygiene, together with
optimal resident medical care. Antimicrobial stewardship programs should be implemented.
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Entérobactérie
NosoBase ID notice : 368652
Emergence d’Enterobacter spp. producteurs de bêta-lactamase à spectre élargi chez des patients
présentant une bactériémie dans un centre hospitalier universitaire du Sud du Brésil
Nogueira K; Paganini MC; Conte A; Cogo LL; Taborda de Messias Reason I; da Silva MJ; et al. Emergence
of extended-spectrum β-lactamase-producing Enterobacter spp. in patients with bacteremia in a tertiary
hospital in southern Brazil. Enfermedades infecciosas y microbiología clínica 2014/02; 32(2): 87-92.
Mots-clés : ENTEROBACTER; BETA-LACTAMASE A SPECTRE ELARGI; BACTERIEMIE; CENTRE
HOSPITALIER UNIVERSITAIRE; ETUDE RETROSPECTIVE; PREVALENCE; FACTEUR DE RISQUE; PCR;
PFGE; BIOLOGIE MOLECULAIRE
Background: Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp.,
posing a challenge to the treatment of infections caused by this microorganism. The purpose of this
retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with
bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period
2004-2008.
Methods: The presence of blaCTX-M, blaTEM, blaSHV, and blaPER genes was detected by polymerase
chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by
pulsed-field gel electrophoresis (PFGE).
Results: Enterobacter spp. was identified in 205 of 4907 of the patients who had positive blood cultures
during hospitalization. Of those cases, 41 (20%) were ESBL-producing Enterobacter spp. Nosocomial
pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence
of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2
(23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains
showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal.
Conclusion: Although no difference in clinical outcomes was observed between patients with infections by
ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the
change of antimicrobials in 75% of cases, having important implications in the decision-making regarding
adequate antimicrobial therapy.
NosoBase ID notice : 384574
Emergence d’entérobactéries productrices de NDM-1 à Porto-Alegre, Brésil
Rozales FP; Ribeiro VB; Magagnin CM; Pagano M; Lutz L; Falci D; et al. Emergence of NDM-1-producing
Enterobacteriaceae in Porto Alegre, Brazil. International journal of infectious diseases 2014/08; 25: 79-81.
Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; PFGE; PCR; SURVEILLANCE; CARBAPENEME;
ENTEROBACTER CLOACAE; MORGANELLA; MORGANELLA MORGANII; METALLO-BETA-LACTAMASE;
ETUDE MULTICENTRIQUE
Objectives: To evaluate the emergence of New Delhi metallo-β-lactamase 1 (NDM-1)-producing
Enterobacteriaceae isolates in Brazil.
Methods: From April to October 2013, following the detection of the first NDM-1-producing isolate, a
surveillance study was performed for the detection of blaNDM-1 among Enterobacteriaceae isolates with
reduced susceptibility to carbapenems in 17 hospitals of Porto Alegre, Brazil. Real-time PCR was used to
determine the presence of carbapenemase genes, which were further sequenced. Clonal relatedness was
assessed by pulsed-field gel electrophoresis (PFGE).
Results: A total of 1134 isolates were evaluated. blaNDM-1 was detected in 11 (0.97%) isolates: nine
Enterobacter cloacae complex (eight belonging to a single clone recovered from two distinct hospitals and the
other strain from a third hospital) and two Morganella morganii (belonging to a single clone recovered from
one hospital). Most isolates presented high-level resistance to carbapenems.
Conclusions: NDM-1-producing Enterobacteriaceae have emerged rapidly in the hospitals of the Brazilian city
where they were first detected. The emergence of NDM-1 in Brazil is of great concern, since it is a severe
threat to antimicrobial therapy against Enterobacteriaceae in this country.
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Environnement
NosoBase ID notice : 385010
Technologie par lumière 405 nm pour l'inactivation de pathogènes et son rôle potentiel pour la
désinfection de l'environnement et la lutte contre le risque infectieux
Maclean M; McKenzie K; Anderson JG; Gettinby G; MacGregor SJ. 405 nm light technology for the
inactivation of pathogens and its potential role for environmental disinfection and infection control. The journal
of hospital infection 2014/09; 88(1): 1-11.
Mots-clés : ENVIRONNEMENT; DESINFECTION; PREVENTION; EFFICACITE; AIR; SURFACE; REVUE
DE LA LITTERATURE
Although the germicidal properties of ultraviolet (UV) light have long been known, it is only comparatively
recently that the antimicrobial properties of visible violeteblue 405 nm light have been discovered and used
for environmental disinfection and infection control applications.
Aim: To review the antimicrobial properties of 405 nm light and to describe its application as an environmental
decontamination technology with particular reference to disinfection of the hospital environment.
Methods: Extensive literature searches for relevant scientific papers and reports.
Findings: A large body of scientific evidence is now available that provides underpinning knowledge of the
405 nm light-induced photodynamic inactivation process involved in the
destruction of a wide range of prokaryotic and eukaryotic microbial species, including resistant forms such as
bacterial and fungal spores. For practical application, a highintensity
narrow-spectrum light environmental disinfection system (HINS-light EDS) has been developed and tested in
hospital isolation rooms. The trial results have demonstrated that this 405 nm light system can provide
continuous disinfection of air and
exposed surfaces in occupied areas of the hospital, thereby substantially enhancing standard cleaning and
infection control procedures.
Conclusion: Violeteblue light, particularly 405 nm light, has significant antimicrobial properties against a wide
range of bacterial and fungal pathogens and, although germicidal efficacy is lower than UV light, this limitation
is offset by its facility for safe, continuous use in occupied environments. Promising results on disinfection
efficacy have been obtained in hospital trials but the full impact of this technology on reduction of healthcareassociated infection has yet to be determined.
NosoBase ID notice : 384738
Les téléphones mobiles portent le microbiome personnel de leurs propriétaires
Meadow JF; Altrichter AE; Green JL. Mobile phones carry the personal microbiome of their owners. PeerJ
2014/06/24; 2: 1-14.
Mots-clés : SURFACE; TELEPHONE; MAIN; DOIGT; BIOLOGIE MOLECULAIRE; PCR; MICROBIOLOGIE;
STREPTOCOCCUS; STAPHYLOCOCCUS; MICROBIOME
Most people on the planet own mobile phones, and these devices are increasingly being utilized to gather
data relevant to our personal health, behavior, and environment. During an educational workshop, we
investigated the utility of mobile phones to gather data about the personal microbiome - the collection of
microorganisms associated with the personal effects of an individual. We characterized microbial
communities on smartphone touchscreens to determine whether there was significant overlap with the skin
microbiome sampled directly from their owners. We found that about 22% of the bacterial taxa on participants'
fingers were also present on their own phones, as compared to 17% they shared on average with other
people's phones. When considered as a group, bacterial communities on men's phones were significantly
different from those on their fingers, while women's were not. Yet when considered on an individual level,
men and women both shared significantly more of their bacterial communities with their own phones than with
anyone else's. In fact, 82% of the OTUs were shared between a person's index and phone when considering
the dominant taxa (OTUs with more than 0.1% of the sequences in an individual's dataset). Our results
suggest that mobile phones hold untapped potential as personal microbiome sensors.
NosoBase ID notice : 385168
Bonnes pratiques dans la décontamination de l'environnement hospitalier
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Siani H; Maillard JY. Best practice in healthcare environment decontamination. European journal of clinical
microbiology and infectious diseases 2014/07: 11 pages.
Mots-clés : PREVENTION; REVUE DE LA LITTERATURE; SURFACE; PERSONNEL; INFORMATION;
EFFICACITE; DESINFECTION; NETTOYAGE; PRATIQUE; ENVIRONNEMENT
There is now strong evidence that surface contamination is linked to healthcare-associated infections
(HCAIs). Cleaning and disinfection should be sufficient to decrease the microbial bioburden from surfaces in
healthcare settings, and, overall, help in decreasing infections. It is, however, not necessarily the case.
Evidence suggests that there is a link between educational interventions and a reduction in infections. To
improve the overall efficacy and appropriate usage of disinfectants, manufacturers need to engage with the
end users in providing clear claim information and product usage instructions. This review provides a clear
analysis of the scientific evidence supporting the role of surfaces in HCAIs and the role of education in
decreasing such infections. It also examines the debate opposing the use of cleaning versus disinfection in
healthcare settings.
Grippe
NosoBase ID notice : 385121
Les systèmes de détection des épidémies au niveau de l'hôpital peuvent-ils compléter les réseaux
régionaux de surveillance : étude de cas avec l'épidémie de grippe
Gerbier-Colomban S; Potinet-Pagliaroli V; Metzger MH. Can epidemic detection systems at the hospital level
complement regional surveillance networks: Case study with the influenza epidemic? BMC infectious
diseases 2014/07; 14(381): 10 pages.
Mots-clés : SURVEILLANCE; EPIDEMIE; RESEAU; GRIPPE; URGENCE; INFECTION COMMUNAUTAIRE;
SPECIFICITE
Background: Early knowledge of influenza outbreaks in the community allows local hospital healthcare
workers to recognise the clinical signs of influenza in hospitalised patients and to apply effective precautions.
The objective was to assess intra-hospital surveillance systems to detect earlier than regional surveillance
systems influenza outbreaks in the community.
Methods: Time series obtained from computerized medical data from patients who visited a French hospital
emergency department (ED) between June 1st, 2007 and March 31st, 2011 for influenza, or were
hospitalised for influenza or a respiratory syndrome after an ED visit, were compared to different regional
series. Algorithms using CUSUM method were constructed to determine the epidemic detection threshold
with the local data series. Sensitivity, specificity and mean timeliness were calculated to assess their
performance to detect community outbreaks of influenza. A sensitivity analysis was conducted, excluding the
year 2009, due to the particular epidemiological situation related to pandemic influenza this year.
Results: The local series closely followed the seasonal trends reported by regional surveillance. The
algorithms achieved a sensitivity of detection equal to 100% with series of patients hospitalised with
respiratory syndrome (specificity ranging from 31.9 and 92.9% and mean timeliness from −58.3 to 20.3 days)
and series of patients who consulted the ED for flu (specificity ranging from 84.3 to 93.2% and mean
timeliness from −32.3 to 9.8 days). The algorithm with the best balance between specificity (87.7%) and
mean timeliness (0.5 day) was obtained with series built by analysis of the ICD-10 codes assigned by
physicians after ED consultation. Excluding the year 2009, the same series keeps the best performance with
specificity equal to 95.7% and mean timeliness equal to −1.7 day.
Conclusions: The implementation of an automatic surveillance system to detect patients with influenza or
respiratory syndrome from computerized ED records could allow outbreak alerts at the intra-hospital level
before the publication of regional data and could accelerate the implementation of preventive transmissionbased precautions in hospital settings.
Hygiène des mains
NosoBase ID notice : 384831
Prévention de la transmission des bactéries multirésistantes : modéliser l’importance relative de la
formation à hygiène des mains et au nettoyage de l’environnement
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Barnes SL; Morgan DJ; Harris AD; Carling PC; Thom KA. Preventing the transmission of multidrug-resistant
organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions.
Infection control and hospital epidemiology 2014/09; 35(9): 1156-1162.
Mots-clés : HYGIENE DES MAINS; NETTOYAGE; TRANSMISSION; MULTIRESISTANCE; SARM;
ACINETOBACTER BAUMANNII; COLONISATION; FORMATION; CHAMBRE DU MALADE; SCENARIO
Objective: Hand hygiene and environmental cleaning are essential infection prevention strategies, but the
relative impact of each is unknown. This information is important in assessing resource allocation.
Methods: We developed an agent-based model of patient-to-patient transmission-via the hands of transiently
colonized healthcare workers and incompletely terminally cleaned rooms-in a 20-patient intensive care unit.
Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to
patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant
Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and
observed data to inform model input parameters.
Results: We simulated 175 parameter-based scenarios and compared the effects of hand hygiene and
environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in
hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline,
a 2∶1 improvement in terminal cleaning compared with hand hygiene was required to match an equal
reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the
reduction in acquisition due to a 10% improvement in hand hygiene compliance).
Conclusions: Hand hygiene should remain a priority for infection control programs, but environmental
cleaning can have significant benefit for hospitals or individual hospital units that have either high hand
hygiene compliance levels or low terminal cleaning thoroughness.
NosoBase ID notice : 384911
Le port de gants non stériles en complément de l'hygiène des mains pour la prévention des infections
de survenue tardive chez des nouveau-nés prématurés. Essai clinique randomisé
Kaufman DA; Blackman A; Conaway M; Sinkin RA. Nonsterile glove use in addition to hand hygiene to
prevent late-onset infection in preterm infants. Randomized clinical trial. JAMA pediatrics 2014/08/11; in
press: E1-E8.
Mots-clés : HYGIENE DES MAINS; PREVENTION; GANT; PREMATURE; NOUVEAU-NE;
NEONATALOGIE; RANDOMISATION; CATHETER; ETUDE PROSPECTIVE; SOIN INTENSIF;
BACTERIEMIE; INFECTION URINAIRE; ENTEROCOLITE; LCR; CATHETER VEINEUX; LIQUIDE
CEPHALO-RACHIDIEN
Importance: Late-onset infections commonly occur in extremely preterm infants and are associated with high
rates of mortality and neurodevelopmental impairment. Hand hygiene alone does not always achieve the
desired clean hands, as microorganisms are still present more than 50% of the time. We hypothesize that
glove use after hand hygiene may further decrease these infections.
Objective: To determine if nonsterile glove use after hand hygiene before all patient and intravenous catheter
contact, compared with hand hygiene alone, prevents late-onset infections in preterm infants.
Design, settings, and participants: A prospective, single-center, clinical, randomized trial was conducted in
infants admitted to the neonatal intensive care unit who weighed less than 1000 g and/or had a gestational
age of less than 29 weeks and were less than 8 days old. There were 175 eligible infants, of which 120 were
enrolled during a 30-month period from December 8, 2008, to June 20, 2011.
Interventions: Infants were randomly assigned to receive care with nonsterile gloves after hand hygiene
(group A) or care after hand hygiene alone (group B) before all patient and intravenous line (central and
peripheral) contact. Study intervention was continued while patients had central or peripheral venous access.
Main outcomes and measures: One or more episodes of late-onset (>72 hours of age) infection in the
bloodstream, urinary tract, or cerebrospinal fluid or necrotizing enterocolitis.
Results: The 2 groups were similar in baseline demographic characteristics. Late-onset invasive infection or
necrotizing enterocolitis occurred in 32% of infants (19 of 60) in group A compared with 45% of infants (27 of
60) in group B (difference, -12%; 95% CI, -28% to 6%; P=.13). In group A compared with group B, there were
53% fewer gram-positive bloodstream infections (15% [9 of 60] vs 32% [19 of 60]; difference, -17%; 95% CI, 31% to -1%; P=.03) and 64% fewer central line-associated bloodstream infections (3.4 vs 9.4 per 1000
central line days; ratio, 0.36; 95% CI, 0.16 to 0.81; P=.01).
Conclusions and relevance: Glove use after hand hygiene prior to patient and line contact is associated with
fewer gram-positive bloodstream infections and possible central line-associated bloodstream infections in
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preterm infants. This readily implementable infection control measure may result in decreased infections in
high-risk preterm infants.
NosoBase ID notice : 384832
Déterminer des critères reposant sur des preuves pour les programmes d’audit d’observation directe
de l’observance de l’hygiène des mains : une étude de cohorte prospective multicentrique
Yin J; Reisinger HS; Weg MV; Schweizer ML; Jesson A; Morgan DJ; et al. Establishing evidence-based
criteria for directly observed hand hygiene compliance monitoring programs: a prospective, multicenter cohort
study. Infection control and hospital epidemiology 2014/09; 35(9): 1163-1168.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; AUDIT; DEFINITION; TAUX; PERSONNEL; ETUDE
PROSPECTIVE; OPPORTUNITE; EFFET HAWTHORNE
Objective: Hand hygiene surveillance programs that rely on direct observations of healthcare worker activity
may be limited by the Hawthorne effect. In addition, comparing compliance rates from period to period
requires adequately sized samples of observations. We aimed to statistically determine whether the
Hawthorne effect is stable over an observation period and statistically derive sample sizes of observations
necessary to compare compliance rates.
Design: Prospective multicenter cohort study.
Setting: Five intensive care units and 6 medical/surgical wards in 3 geographically distinct acute care
hospitals.
Methods: Trained observers monitored hand hygiene compliance during routine care in fixed 1-hour periods,
using a standardized collection tool. We estimated the impact of the Hawthorne effect using empirical
fluctuation processes and F tests for structural change. Standard sample-size calculation methods were used
to estimate how many hand hygiene opportunities are required to accurately measure hand hygiene across
various levels of baseline and target compliance.
Results: Exit hand hygiene compliance increased after 14 minutes of observation (from 56.2% to 60.5%;
P<.001) and increased further after 50 minutes (from 60.5% to 66.0%; P<.001). Entry compliance increased
after 38 minutes (from 40.4% to 43.4%; P=.005). Between 79 and 723 opportunities are required during each
period, depending on baseline compliance rates (range, 35%-90%) and targeted improvement (5% or 10%).
Conclusions: Limiting direct observation periods to approximately 15 minutes to minimize the Hawthorne
effect and determining required number of hand hygiene opportunities observed per period on the basis of
statistical power calculations would be expected to improve the validity of hand hygiene surveillance
programs.
Infection urinaire
NosoBase ID notice : 384830
Fonctionnalité et impact des rappels d’un système automatisé d'aide à la décision clinique conçu
pour diminuer le nombre de poses de sonde urinaire et les infections associées
Baillie CA; Epps M; Hanish A; Fishman NO; French B; Umscheid CA. Usability and impact of a computerized
clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated
urinary tract infections. Infection control and hospital epidemiology 2014/09; 35(9): 1147-1155.
Mots-clés : SONDAGE URINAIRE; INFECTION URINAIRE; INFORMATIQUE; TAUX; DUREE; ETUDE
RETROSPECTIVE
Objective: To evaluate the usability and effectiveness of a computerized clinical decision support (CDS)
intervention aimed at reducing the duration of urinary tract catheterizations.
Design: Retrospective cohort study.
Setting: Academic healthcare system.
Patients: All adult patients admitted from March 2009 through May 2012.
Intervention: A CDS intervention was integrated into a commercial electronic health record. Providers were
prompted at order entry to specify the indication for urinary catheter insertion. On the basis of the indication
chosen, providers were alerted to reassess the need for the urinary catheter if it was not removed within the
recommended time. Three time periods were examined: baseline, after implementation of the first intervention
(stock reminder), and after a second iteration (homegrown reminder). The primary endpoint was the usability
of the intervention as measured by the proportion of reminders through which providers submitted a remove
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urinary catheter order. Secondary endpoints were the urinary catheter utilization ratio and the rate of hospitalacquired catheter-associated urinary tract infections (CAUTIs).
Result: The first intervention displayed limited usability, with 2% of reminders resulting in a remove order.
Usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time
periods (0.22, 0.20, and 0.19, respectively; P<.001), as did CAUTIs per 1,000 patient-days (0.84, 0.70, and
0.51, respectively; P<.001).
Conclusions: A urinary catheter removal reminder system was successfully integrated within a healthcare
system's electronic health record. The usability of the reminder was highly dependent on its user interface,
with a homegrown version of the reminder resulting in higher impact than a stock reminder.
NosoBase ID notice : 385119
Infections urinaires associées aux cathéters
Nicolle LE. Catheter associated urinary tract infections. Antimicrobial resistance & infection control 2014/07;
3: 1-8.
Mots-clés : INFECTION URINAIRE; CATHETER; BACTERIURIE; BACTERIEMIE; BIOFILM;
MICROBIOLOGIE; ESCHERICHIA COLI; ENTEROCOCCUS; PSEUDOMONAS AERUGINOSA;
STAPHYLOCOCCUS; CANDIDA; DIAGNOSTIC; PREVENTION; SURVEILLANCE
Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common
infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices,
the major determinant for development of bacteriuria is duration of catheterization. While the proportion of
bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary
catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary
infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities,
and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection
are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon
as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies
to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter
indications, and complications. Ultimately, prevention of these infections will require technical advances in
catheter materials which prevent biofilm formation.
NosoBase ID notice : 384465
Facteurs de risque d’infections urinaires associées aux cathéters parmi des personnes âgées en Italie
Vincitorio D; Barbadoro P; Pennacchietti L; Pellegrini I; David S; Ponzio E; et al. Risk factors for catheterassociated urinary tract infection in Italian elderly. American journal of infection control 2014/08; 42(8): 898901.
Mots-clés : INFECTION URINAIRE; CATHETER; SONDE; SONDAGE URINAIRE; FACTEUR DE RISQUE;
PERSONNE AGEE; INCIDENCE; MORBIDITE; MORTALITE; GERIATRIE; COURT SEJOUR; SEXE; AGE;
DUREE DE SEJOUR
Background: Catheter-associated urinary tract infections (CAUTIs) are the most common cause of hospitalacquired infections, especially in elderly patients. Data on CAUTIs in older persons in acute care settings are
lacking, however. This study aimed to describe the epidemiology of CAUTIs and related outcomes (ie, length
of stay and mortality), in patients admitted to an acute geriatric care hospital in central Italy.
Methods: A CAUTI surveillance program was implemented from October 2011 to April 2012, according to the
Centers for Disease Control and Prevention’s National Healthcare Safety Network methodology.
Results: A total of 2773 patients aged ≥65 years were included in the study, and 483 catheterized patients
were monitored for the risk of CAUTI. The catheterization rate was 16.7% (95% confidence interval [CI],
15.3%-18.2%), and the overall CAUTI incidence rate was 14.7/1000 device-days (95% CI, 11.7-18.3/ 1000).
Mortality was significantly higher in catheterized patients with a CAUTI compared with noncatheterized
patients (19.2% vs 10.5%; P<.05). Female sex (odds ratio [OR], 1.31; 95% CI, 1.06-1.67), increasing age
(≥90 years: OR, 2.76; 95% CI, 2.00-3.83), and longer hospital stay before catheter insertion (≥15 days: OR,
2.90; 95% CI, 2.20-3.83) were independent risk factors for catheterization; increasing age (>90 years: OR,
2.75; 95% CI, 1.03-7.35), and duration of hospital stay before catheter insertion (OR, 2.41; 95% CI, 1.125.51) were associated with CAUTIs.
Conclusions: These results underscore the importance of the proper choice of patients for catheterization,
particularly in individuals aged >90 years.
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Maladie de Creutzfledt-Jakob
NosoBase ID notice : 385012
Gestion du risque de transmission iatrogène de la maladie de Creutzfeldt-Jakob au Royaume-Uni
Hall V; Brookes D; Nacul L; Gill ON; Connor N. Managing the risk of iatrogenic transmission of CreutzfeldtJakob disease in the UK. The journal of hospital infection 2014/09; 88(2): 22-27.
Mots-clés : MALADIE DE CREUTZFELDT-JAKOB; TRANSMISSION; NEUROLOGIE; GESTION DES
RISQUES; TRANSFUSION SANGUINE; PREVENTION
With the emergence of bovine spongiform encephalopathy (BSE) and variant CreutzfeldteJakob disease
(CJD) in the UK, there is concern about iatrogenic transmission, and the approach to managing this risk is
unique.
Aim: To describe and review CJD incident management and the notification of individuals ‘at increased risk’
as a strategy for reducing iatrogenic transmission.
Methods: A description of iatrogenic CJD transmission, the CJD Incidents Panel’s role, the number and
nature of CJD incidents reported and the individuals considered ‘at increased
risk’ by mid-2012. Findings: Seventy-seven UK cases of CJD are likely to have resulted from iatrogenic
transmission, among recipients of human-derived growth hormone (64 cases), dura mater grafts (eight
cases), blood transfusions (four cases) and plasma products (one case). To limit transmission, the Panel
reviewed 490 incidents and advised on look-backs, recalls of blood and plasma products, and quarantining
and disposing of surgical instruments.
Additionally, on Panel advice, around 6000 asymptomatic individuals have been informed they are at
increased risk of CJD and have been asked to follow public health precautions.
Conclusion: The strategy to reduce iatrogenic transmission of CJD has been developed in a context of
scientific uncertainty. The rarity of transmission events could indicate that incident-related exposures present
negligible transmission risks, or e given the prolonged incubation and subclinical phenotypes of CJD e
infections could be yet to occur or have been undetected. Scientific developments, including better estimates
of infection prevalence, a screening test, or improvements in decontaminating surgical instruments, may
change future risk management.
NosoBase ID notice : 384709
Des prions dans l'urine des patients avec la maladie de Creutzfeldt–Jakob
Moda F; Gambetti P; Notari S; Concha-Marambio L; Catania M; Park KW; et al. Prions in the urine of patients
with variant Creutzfeldt–jakob disease. The New England journal of medicine 2014/08/07; 371(6): 530-539.
Mots-clés : MALADIE DE CREUTZFELDT-JAKOB; URINE; BIOLOGIE MOLECULAIRE
Background : Prions, the infectious agents responsible for transmissible spongiform encephalopathies,
consist mainly of the misfolded prion protein (PrPSc). The unique mechanism of transmission and the
appearance of a variant form of Creutzfeldt–Jakob disease, which has been linked to consumption of prioncontaminated cattle meat, have raised concerns about public health. Evidence suggests that variant
Creutzfeldt–Jakob disease prions circulate in body fluids from people in whom the disease is silently
incubating.
Methods: To investigate whether PrPSc can be detected in the urine of patients with variant Creutzfeldt–
Jakob disease, we used the protein misfolding cyclic amplification (PMCA) technique to amplify minute
quantities of PrPSc, enabling highly sensitive detection of the protein. We analyzed urine samples from
several patients with various transmissible spongiform encephalopathies (variant and sporadic Creutzfeldt–
Jakob disease and genetic forms of prion disease), patients with other degenerative or nondegenerative
neurologic disorders, and healthy persons.
Results : PrPSc was detectable only in the urine of patients with variant Creutzfeldt–Jakob disease and had
the typical electrophoretic profile associated with this disease. PrPSc was detected in 13 of 14 urine samples
obtained from patients with variant Creutzfeldt–Jakob disease and in none of the 224 urine samples obtained
from patients with other neurologic diseases and from healthy controls, resulting in an estimated sensitivity of
92.9% (95% confidence interval [CI], 66.1 to 99.8) and a specificity of 100.0% (95% CI, 98.4 to 100.0). The
PrPSc concentration in urine calculated by means of quantitative PMCA was estimated at 1×10−16 g per
milliliter, or 3×10−21 mol per milliliter, which extrapolates to approximately 40 to 100 oligomeric particles of
PrPSc per milliliter of urine.
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Conclusions : Urine samples obtained from patients with variant Creutzfeldt–Jakob disease contained minute
quantities of PrPSc. (Funded by the National Institutes of Health and others.).
Metapneumovirus
NosoBase ID notice : 384573
Metapneumovirus humain : revue d’un important pathogène respiratoire
Panda S; Mohakud NK; Pena L; Kumar S. Human metapneumovirus: review of an important respiratory
pathogen. International journal of infectious diseases 2014/08; 25: 45-52.
Mots-clés : VIRUS; INFECTION RESPIRATOIRE HAUTE; INFECTION RESPIRATOIRE BASSE;
PEDIATRIE; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; PCR; TRAITEMENT; DIAGNOSTIC;
METAPNEUMOVIRUS
Human metapneumovirus (hMPV), discovered in 2001, most commonly causes upper and lower respiratory
tract infections in young children, but is also a concern for elderly subjects and immune-compromised
patients. hMPV is the major etiological agent responsible for about 5% to 10% of hospitalizations of children
suffering from acute respiratory tract infections. hMPV infection can cause severe bronchiolitis and
pneumonia in children, and its symptoms are indistinguishable from those caused by human respiratory
syncytial virus. Initial infection with hMPV usually occurs during early childhood, but re-infections are common
throughout life. Due to the slow growth of the virus in cell culture, molecular methods (such as reverse
transcriptase PCR (RT-PCR)) are the preferred diagnostic modality for detecting hMPV. A few vaccine
candidates have been shown to be effective in preventing clinical disease, but none are yet commercially
available. Our understanding of hMPV has undergone major changes in recent years and in this article we will
review the currently available information on the molecular biology and epidemiology of hMPV. We will also
review the current therapeutic interventions and strategies being used to control hMPV infection, with an
emphasis on possible approaches that could be used to develop an effective vaccine against hMPV.
Norovirus
NosoBase ID notice : 384560
Infections par des norovirus chez des hôtes en déficit immunitaire
Green KY. Norovirus infection in immunocompromised hosts. Clinical microbiology and infection 2014/08;
20(8): 717-723
Mots-clés : VIRUS; NOROVIRUS; DEFICIT IMMUNITAIRE; GASTRO-ENTERITE; RISQUE; PEDIATRIE;
EPIDEMIE; FACTEUR DE RISQUE; TRAITEMENT; CONTROLE; ANTIVIRAL; REVUE DE LA
LITTERATURE
Acute gastroenteritis caused by the noroviruses (NV) is often of 2-3 days duration and is characteristically
self-limiting. In contrast, chronic infection caused by noroviruses in immunocompromised individuals can last
from weeks to years, making clinical management difficult. The mechanisms by which noroviruses establish
persistent infection, and the role of immunocompromised hosts as a reservoir for noroviruses in the general
human population are not known. However, study of this patient cohort may lead to new insights into
norovirus biology and approaches to treatment.
Pneumonie
NosoBase ID notice : 384700
Procédures prophylactiques de soins de bouche destinées à prévenir les pneumonies nosocomiales
et acquises sous ventilation : revue systématique
El-Rabbany M; Zaghlol N; Bhandari M; Azarpazhooh A. Prophylactic oral health procedures to prevent
hospital-acquired and ventilator-associated pneumonia: A systematic review. International journal of nursing
studies 2014; in press: 37 pages.
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Mots-clés : PNEUMONIE; REVUE DE LA LITTERATURE; VENTILATION ASSISTEE; SOIN DE BOUCHE;
SOIN
INTENSIF;
EHPAD;
PREVENTION;
INCIDENCE;
RANDOMISATION;
EFFICACITE;
CHLORHEXIDINE
Objectives: Given the severity of hospital-acquired pneumonia and ventilator-associated pneumonia, the
purpose of this systematic review was to identify various oral health procedures, in intensive care unit or
nursing home setting, shown to help reduce the incidence of hospital-acquired and ventilator-associated
pneumonia.
Design: Randomized controlled trials evaluating the efficacy of at least one prophylactic oral health procedure
in reducing hospital-acquired pneumonia or ventilator-associated pneumonia were included.
Data sources: MEDLINE, EMBASE, and CINAHL were searched for relevant studies. In addition, references
of studies included for full-text review were examined for potentially relevant studies. Grey literature was
searched for by reviewing the first 200 results obtained in Google Scholar™.
Review methods: Two authors conducted study selection and data extraction for this review. The Cochrane
risk of bias tool was applied to assess the quality of the included trials (namely sequence generation,
allocation concealment, blinding, the completeness of data assessment, the lack of selective reporting, and
the lack of other miscellaneous biases) based on the information in the original publications. An assessment
of a high, unclear, or low risk of bias was assigned to each domain.
Results: Through review of the 28 trials included in this review, we found that good oral health care was
suggested to be associated with a reduction in the risk for hospitalacquired and ventilator-associated
pneumonia in high-risk patients. Furthermore, through the review of studies evaluating the efficacy of
chlorhexidine, we found that, despite the presence of mixed results, that chlorhexidine may be a particularly
effective means of lowering the risk for hospital-acquired and ventilator-associated pneumonia. The efficacy
of other prophylactic oral health techniques such as the use of tooth brushing or iodine swab was uncertain.
Conclusions: Current evidence suggests that chlorhexidine rinses, gels and swabs may be effective oral
disinfectants in patients at high risk for hospital-acquired and ventilator associated pneumonia. The evidence
supporting the effectiveness of other oral care means still remains scarce and methodologically weak. As
such, efforts to promote the increase of high-quality studies and to support nursing educational efforts to
promote the dissemination of evidence-based knowledge of oral prophylaxis into clinical practice are
warranted.
NosoBase ID notice : 384758
Résultats à long terme d’un programme de prévention des pneumonies post-opératoires pour le
service d’hospitalisation en chirurgie
Kazaure HS; Martin M; Yoon J; Wren SM. Long-term results of a postoperative pneumonia prevention
program for the inpatient surgical ward. JAMA surgery 2014; in press: E1-E5.
Mots-clés : PNEUMONIE; PREVENTION; CHIRURGIE; TAUX; COHORTE; ETUDE RETROSPECTIVE;
INCIDENCE
Importance: Pneumonia is the third most common complication in postoperative patients and is associated
with significant morbidity and high cost of care. Prevention has focused primarily on mechanically ventilated
patients. This study outlines the results of the longest-running postoperative pneumonia prevention program
for nonmechanically ventilated patients, to our knowledge.
Objective: To present long-term results (2008-2012) of a standardized postoperative ward-acquired
pneumonia prevention program introduced in 2007 on the surgical ward of our hospital and compare our
postintervention pneumonia rates with those captured in the American College of Surgeons National Surgical
Quality Improvement Program (ACS-NSQIP). We also estimate the cost savings attributable to the
pneumonia prevention program.
Design, Setting, and Participants: Retrospective cohort study at a university-affiliated Veterans Affairs hospital
of all noncardiac surgical patients with ward-acquired postoperative pneumonia.
Intervention: A previously described standardized postoperative pneumonia prevention program for patients
on the surgical ward.
Main outcome and measure: Ward-acquired postoperative pneumonia.
Results: Between 2008 and 2012, there were 18 cases of postoperative pneumonia among 4099 at-risk
patients hospitalized on the surgical ward, yielding a case rate of 0.44%. This represents a 43.6% decrease
from our preintervention rate (0.78%) (P=.01). The pneumonia rates in all years were lower than the
preintervention rate (0.25%, 0.50%, 0.58%, 0.68%, and 0.13% in 2008-2012, respectively). The overall
pneumonia rate in ACS-NSQIP was 2.56% (14 033 cases of pneumonia among 547 571 at-risk patients),
which is 582% higher than the postintervention rate at our ward. Using a national average of $46 400 in
attributable health care cost of postoperative pneumonia and a benchmark of a 43.6% decrease in
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NosoVeille – Bulletin de veille
Septembre 2014
pneumonia rate achieved at our facility over the 5-year study period, a similar percentage of decrease in
pneumonia occurrence at ACS-NSQIP hospitals would represent approximately 6118 prevented pneumonia
cases and a cost savings of more than $280 million.
Conclusions and relevance: The standardized pneumonia prevention program achieved substantial and
sustained reduction in postoperative pneumonia incidence on our surgical ward; its wider adoption could
improve postoperative outcomes and reduce overall health care costs.
Réanimation
NosoBase ID notice : 384825
Pratiques d’hygiène hospitalière dans les unités de réanimation néonatale déclarant leurs infections
associées aux soins au NHSN (National Healthcare Safety Network)
Hocevar SN; Lessa FC; Gallagher L; Conover C; Gorwitz R; Iwamoto M. Infection prevention practices in
neonatal intensive care units reporting to the national healthcare safety network. Infection control and hospital
epidemiology 2014/09; 35(9): 1126-1132.
Mots-clés : SOIN INTENSIF; NEONATALOGIE; INFECTION NOSOCOMIALE; SURVEILLANCE; TAUX;
PRATIQUE; SARM; BACTERIEMIE; CATHETER VEINEUX CENTRAL; COLONISATION; PANSEMENT;
ANTISEPTIQUE
Background: Patients in the neonatal intensive care unit (NICU) are at high risk for healthcare-associated
infections. Variability in reported infection rates among NICUs exists, possibly related to differences in
prevention strategies. A better understanding of current prevention practices may help identify prevention
gaps and areas for further research.
Methods: We surveyed infection control staff in NICUs reporting to the National Healthcare Safety Network
(NHSN) to assess strategies used to prevent methicillin-resistant Staphylococcus aureus (MRSA)
transmission and central line-associated bloodstream infections in NICUs.
Results: Staff from 162 of 342 NICUs responded (response rate, 47.3%). Most (92.3%) NICUs use central
line insertion and maintenance bundles, but maintenance practices varied, including agents used for
antisepsis and frequency of dressing changes. Forty-two percent reported routine screening for MRSA
colonization upon admission for all patients. Chlorhexidine gluconate (CHG) use for central line care for at
least 1 indication (central line insertion, dressing changes, or port/cap antisepsis) was reported in 82 NICUs
(51.3%). Among sixty-five NICUs responding to questions on CHG use restrictions, 46.2% reported no
restrictions.
Conclusions: Our survey illustrated heterogeneity of CLABSI and MRSA prevention practices and
underscores the need for further research to define optimal strategies and evidence-based prevention
recommendations for neonates.
NosoBase ID notice : 384670
Evaluation du risque d’infection nosocomiale à l’aide des scores APACHE II en unité de réanimation
neurologique
Li HY; Li SJ; Yang N; Hu WL. Evaluation of nosocomial infection risk using APACHE II scores in the
neurological intensive care unit. Journal of clinical neuroscience 2014/08; 21(8): 1409-1412.
Mots-clés : SOIN INTENSIF; EVALUATION; SCORE; RISQUE; NEUROLOGIE; ETUDE RETROSPECTIVE;
ANALYSE; DUREE DE SEJOUR; DISPOSITIF MEDICAL; PREVENTION
To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II
(APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care
unit (NICU), 216 patients transferred to NICU within 24hours of admission were retrospectively evaluated.
Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores
representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU
patients were analyzed and compared with published reports on patient outcome. Statistical analysis of
nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups
(p<0.05). The area under the receiver operating characteristic curve of the APACHE II model in predicting the
risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In
addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization
(device-days) between different risk groups (p<0.05). Thus the APACHE II scoring system was validated in
predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate
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Septembre 2014
assessment of patients' condition, so that appropriate prevention strategies can be implemented based on
admission APACHE II scores.
NosoBase ID notice : 384814
Aspergillus dans l'appareil respiratoire bas de patients de soins intensifs immunocompétents
Lugosi M; Alberti C; Zahar JR; Garrouste M; Lemiale V; Descorps-Desclère A; et al. Aspergillus in the lower
respiratory tract of immunocompetent critically ill patients. Journal of infection 2014/09; 69(3): 284-292.
Mots-clés : ASPERGILLUS; CAS-TEMOIN; FACTEUR DE RISQUE; APPARIEMENT; SOIN INTENSIF;
PRELEVEMENT; APPAREIL RESPIRATOIRE; MORTALITE; ETUDE MULTICENTRIQUE
Objectives: To shed light on the meaning of Aspergillus-positive lower-respiratory-tract samples in non
immunocompromized critically ill patients.
Methods: Multicentre matched case-control (1:5) study. We used prospectively collected data to identify risk
factors for Aspergillus-positive specimens, as well as outcomes in Aspergillus-positive patients.
Results: 66 cases (5 with definite invasive pulmonary aspergillosis (IPA), 18 with probable IPA, and 43
colonisations) were matched to 330 controls. In the multivariate conditional logistic model, independent risk
factors for at least one Aspergillus-positive respiratory-tract specimen were worse SAPSII at admission [OR,
1.10; 95%CI, 1.00-1.21], ARDS [OR, 2.64; 95%CI, 1.29-5.40]; long-term steroid therapy [OR, 4.77; 95%CI,
1.49-15.23]; steroid therapy started in the ICU [OR, 11.03; 95%CI, 4.40-27.67]; and bacterial infection [OR,
2.73; 95%CI, 1.37-5.42]. The risk of death, compared to the controls, was not higher in the cases overall [HR,
0.66; 95%CI, 0.41-1.08; p=0.1] or in the subgroups with definite IPA [HR, 1.60; 95%CI, 0.43-5.94; p=0.48],
probable IPA [HR, 0.84; 95%CI, 0.28-2.50; p=0.76], or colonisation [HR, 0.58; 95%CI, 0.33-1.02; p=0.06]. In
cases who received antifungal therapy, mortality was not lower than in untreated cases [HR, 0.67; 95%CI,
0.36-1.24; p=0.20].
Conclusions: In critically ill immunocompetent patients, risk factors for presence of Aspergillus in lower
respiratory tract specimens are steroid therapy (either chronic or initiated in the ICU), ARDS, and high
severity of the acute illness. Prospective studies are warranted to further examine these risk factors and to
investigate immune functions as well as the impact of antifungal therapy on patient outcomes.
NosoBase ID notice : 384471
Epidémiologie et antibiorésistance des pathogènes responsables de pneumonies acquises sous
ventilation dans des unités de réanimation néonatale en Chine : méta-analyse
Tan B; Xian-Yang X; Zhang X; Peng-Zhou X; Wang P; Xue J; et al. Epidemiology of pathogens and drug
resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: A meta-analysis.
American journal of infection control 2014/08; 42(8): 902-910.
Mots-clés : EPIDEMIOLOGIE; PNEUMONIE; ANTIBIORESISTANCE; META-ANALYSE; SOIN INTENSIF;
NEONATOLOGIE; VENTILATION ASSISTEE; INCIDENCE; MORTALITE; BACTERIE A GRAM NEGATIF;
MICROBIOLOGIE;
KLEBSIELLA;
PSEUDOMONAS;
ACINETOBACTER;
STAPHYLOCOCCUS;
STREPTOCOCCUS; ESCHERICHIA COLI
Background: Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care
units. However, limited literature has been reviewed to synthesize the findings about the incidence, case
fatality rate, pathogen distribution, and drug resistance of neonatal VAP in China.
Methods: A search of electronic databases was undertaken to identify the incidence, case fatality rate,
pathogen distribution, and drug resistance of neonatal VAP based on the inclusion and exclusion criteria.
Meta-analysis was carried out using R3.0.2 software.
Results: A total of 16,587 participants were included in our final analysis. The incidence and case fatality
rates were 42.8% and 16.4%, respectively. Gram-negative bacteria were detected in 77.6% of cultures,
followed by gram-positive bacteria (18.8%) and fungi (3.7%). Gram-negative bacteria were sensitive to
meropenem, imipenem, and ciprofloxacin, with resistance rates of 1.5%-25.0%, 4.9%-29.0%, and 8.5%24.7%, respectively. Gram-positive bacteria have resistance rates as high as 72.7%-99.1% to penicillin,
62.6%-90.9% to erythromycin, and 80.3%-91.9% to oxacillin.
Conclusions: The incidence and case fatality rates of neonatal VAP are high in China. VAP was mainly
caused by gram-negative bacteria that were resistant to most common antibiotics. The future study of drugresistance mechanisms should be intensified, and effective measures of hospital infection control should be
considered to prevent the outbreak of drug-resistant strains.
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Septembre 2014
NosoBase ID notice : 384719
Une alimentation entérale très riche en protéines enrichie avec des nutriments immunomodulateurs
versus alimentation entérale standard enrichie en protéines et infections nosocomiales en
réanimation. Essai clinique randomisé
van Zanten AR; Sztark F; Kaisers UX; Zielmann S; Felbinger TW; Sablotzki AR; et al. High-protein enteral
nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial
infections in the ICU. A randomized clinical trial. JAMA 2014/08/06; 312(5): 514-524.
Mots-clés : ALIMENTATION ENTERALE; SOIN INTENSIF; INCIDENCE; VENTILATION ASSISTEE; ESSAI
THERAPEUTIQUE; MORTALITE; RANDOMISATION; DUREE DE SEJOUR; ETUDE MULTICENTRIQUE
Importance: Enteral administration of immune-modulating nutrients (eg, glutamine, omega-3 fatty acids,
selenium, and antioxidants) has been suggested to reduce infections and improve recovery from critical
illness. However, controversy exists on the use of immune-modulating enteral nutrition, reflected by lack of
consensus in guidelines.
Objective: To determine whether high-protein enteral nutrition enriched with immune-modulating nutrients
(IMHP) reduces the incidence of infections compared with standard high-protein enteral nutrition (HP) in
mechanically ventilated critically ill patients.
Design,sSetting, and participants: The MetaPlus study, a randomized, double-blind, multicenter trial, was
conducted from February 2010 through April 2012 including a 6-month follow-up period in 14 intensive care
units (ICUs) in the Netherlands, Germany, France, and Belgium. A total of 301 adult patients who were
expected to be ventilated for more than 72 hours and to require enteral nutrition for more than 72 hours were
randomized to the IMHP (n=152) or HP (n=149) group and included in an intention-to-treat analysis,
performed for the total population as well as predefined medical, surgical, and trauma subpopulations.
Interventions: High-protein enteral nutrition enriched with immune-modulating nutrients vs standard highprotein enteral nutrition, initiated within 48 hours of ICU admission and continued during the ICU stay for a
maximum of 28 days.
Main outcomes and measures: The primary outcome measure was incidence of new infections according to
the Centers for Disease Control and Prevention (CDC) definitions. Secondary end points included mortality,
Sequential Organ Failure Assessment (SOFA) scores, mechanical ventilation duration, ICU and hospital
lengths of stay, and subtypes of infections according CDC definitions.
Results: There were no statistically significant differences in incidence of new infections between the groups:
53% (95% CI, 44%-61%) in the IMHP group vs 52% (95% CI, 44%-61%) in the HP group (P=.96). No
statistically significant differences were observed in other end points, except for a higher 6-month mortality
rate in the medical subgroup: 54% (95% CI, 40%-67%) in the IMHP group vs 35% (95% CI, 22%-49%) in the
HP group (P=.04), with a hazard ratio of 1.57 (95% CI, 1.03-2.39; P=.04) for 6-month mortality adjusted for
age and Acute Physiology and Chronic Health Evaluation II score comparing the groups.
Conclusions and relevance: Among adult patients breathing with the aid of mechanical ventilation in the ICU,
IMHP compared with HP did not improve infectious complications or other clinical end points and may be
harmful as suggested by increased adjusted mortality at 6 months. These findings do not support the use of
IMHP nutrients in these patients.
Réglementation
NosoBase ID notice : 384698
Droit et infections nosocomiales
Haji Safar S. Droit et infections nosocomiales. Droit déontologie & soin 2014; in press: 7 pages.
Mots-clés : DROIT; CATHETER VEINEUX; STAPHYLOCOCCUS AUREUS
Actualités du droit et de jurisprudence en matière d’infections nosocomiales.
NosoBase ID notice : 384761
Instruction DGOS/RH4/2014/238 du 28 juillet 2014 sur les orientations en matière de développement
des compétences des personnels des établissements mentionnés à l'article 2 de la loi n° 89-33 du 9
janvier 1986 portant dispositions statutaires relatives à la fonction publique hospitalière
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Septembre 2014
Ministère des affaires sociales et de la santé. Instruction DGOS/RH4/2014/238 du 28 juillet 2014 sur les
orientations en matière de développement des compétences des personnels des établissements mentionnés
à l'article 2 de la loi n° 89-33 du 9 janvier 1986 portant dispositions statutaires relatives à la fonction publique
hospitalière. Non paru au Journal officiel : 77 pages.
Mots-clés : FORMATION CONTINUE; FORMATION TOUT AU LONG DE LA VIE; PERSONNEL
HOSPITALIER; COMPETENCE; VALIDATION DES ACQUIS; EVENEMENT INDESIRABLE GRAVE;
PERSONNE AGEE; PSYCHIATRIE; QUALITE DES SOINS; GESTION DES RISQUES; PREVENTION;
RISQUE PROFESSIONNEL; SANTE PUBLIQUE; GESTION DES RISQUES; DEVELOPPEMENT
PROFESSIONNEL CONTINU (DPC)
Axes prioritaires 2015 pour le développement des compétences des personnels des établissements relevant
de la fonction publique hospitalière.
Staphylococcus aureus
NosoBase ID notice : 385431
Epidémie nosocomiale d'épidermolyse staphylococcique chez des nouveau-nés en Angleterre,
décembre 2012 à mars 2013
Paranthaman K; Bentley A; Milne LM; Kearns A; Loader S; Thomas A; et al. Nosocomial outbreak of
staphyloccocal scalded skin syndrome in neonates in England, December 2012 to March 2013.
Eurosurveillance 2014/08; 1(33): 1-9.
Mots-clés : INFECTION NOSOCOMIALE; STAPHYLOCOCCUS AUREUS; EPIDEMIE; INVESTIGATION;
NOUVEAU-NE; PEAU; MATERNITE; PERSONNEL; EPIDERMOLYSE; TOXINE
Staphylococcal scalded skin syndrome (SSSS) is a blistering skin condition caused by exfoliative toxinproducing strains of Staphylococcus aureus. Outbreaks of SSSS in maternity settings are rarely reported. We
describe an outbreak of SSSS that occurred among neonates born at a maternity unit in England during
December 2012 to March 2013. Detailed epidemiological and microbiological investigations were undertaken.
Eight neonates were found to be infected with the outbreak strain of S. aureus, of spa type t346, representing
a single pulsotype. All eight isolates contained genes encoding exfoliative toxin A (eta) and six of them
contained genes encoding toxin B (etb). Nasal swabs taken during targeted staff screening yielded a
staphylococcal carriage rate of 21% (17/80), but none contained the outbreak strain. Mass screening
involving multi-site swabbing and pooled, enrichment culture identified a healthcare worker (HCW) with the
outbreak strain. This HCW was known to have a chronic skin condition and their initial nasal screen was
negative. The outbreak ended when they were excluded from work. This outbreak highlights the need for
implementing robust swabbing and culture methods when conventional techniques are unsuccessful in
identifying staff carrier(s). This study adds to the growing body of evidence on the role of HCWs in
nosocomial transmission of S. aureus.
NosoBase ID notice : 384913
Staphylococcus aureus dans un centre de néonatalogie : les souches méticillino-sensibles devraient
être un sujet de préoccupation important
Romano-Bertrand S; Filleron A; Mesnage R; Lotthé A; Didelot MN; Burgel L; et al. Staphylococcus aureus in
a neonatal care center: methicillin-susceptible strains should be a main concern. Antimicrobial resistance &
infection control 2014/07; 3: 1-9.
Mots-clés : STAPHYLOCOCCUS AUREUS; NEONATOLOGIE; EPIDEMIE; ANTIBIORESISTANCE;
BIOLOGIE MOLECULAIRE; AUDIT; HYGIENE DES MAINS; CATHETER; PRATIQUE; PREVALENCE;
PERSONNEL; TENUE VESTIMENTAIRE; BLOUSE; CONTAMINATION
Background: In the context of a methicillin-susceptible Staphylococcus aureus (MSSA) outbreak, we aimed to
improve our knowledge of S. aureus (SA) epidemiology in the neonatal care center (NCC) of a tertiary care
teaching hospital.
Methods: We performed a complete one-year review of SA carrier, colonized or infected patients. Monthly
prevalence and incidence of SA intestinal carriage, colonization and infection were calculated and the types
of infection analysed. During the MSSA outbreak, strains were studied for antimicrobial resistance, content of
virulence genes and comparative fingerprint in Pulsed-Field Gel Electrophoresis. Hand hygiene and catheter27 / 30
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Septembre 2014
related practices were assessed by direct observational audits. Environmental investigation was performed in
search of a SA reservoir.
Results: Epidemiological analyses showed 2 or 3 prevalence peaks on a background of SA endemicity. In the
NCC, during 2009, overall MSSA prevalence did not decrease below 5.5%, while mean MRSA prevalence
was about 1.53%. Analysis of infection cases revealed that the outbreak corresponded to the emergence of
catheter-related infections and was probably related to the relaxation in infection control practices in a context
of high colonization pressure. Health care workers' white coats appeared as a potential environmental
reservoir that could perpetuate SA circulation in the ward.
Conclusion: This report emphasizes the importance of integrating MSSA along with methicillin-resistant SA in
a program of epidemiological surveillance in the NCC.
Surveillance
NosoBase ID notice : 384578
Surveillance épidémiologique et prévention de l’infection du site opératoire
Troillet N; Widmer AF. Surveillance épidémiologique et prévention de l’infection du site opératoire. Swissnoso
2014/07; 19(1): 1-4.
Mots-clés : SURVEILLANCE; EPIDEMIOLOGIE; PREVENTION; SITE OPERATOIRE
Sommaire de l’article :
I- Introduction
II- Surveillance, qualité des soins et rendu public des résultats
III- Principes et défis de la surveillance des infections du site opératoire
IV- Ajustement des risques : indice NNIS et ratio standardisé d’infection
V- Conclusion
NosoBase ID notice : 384582
Rapport de surveillance : surveillance des hépatites B et des hépatites C en Europe, 2012
ECDC. Surveillance report. Hepatitis B and C surveillance in Europe 2012. ECDC 2014: 64 pages.
Mots-clés : HEPATITE B; HEPATITE C; SURVEILLANCE; EPIDEMIOLOGIE; TRANSMISSION; CDC
Ce rapport présente la définition européenne des cas, le recueil, la validation et la présentation des résultats
de la surveillance des hépatites B et des hépatites C. Il porte sur les data épidémiologiques 2012 et les
tendances 2006-2012 des hépatites B et C.
NosoBase ID notice : 385020
Questions méthodologiques concernant la méta-analyse de Leroy sur le risque de complications
infectieuses après échographies endovaginales et transrectales
Bénet T; Vanhems P. Methodological issues concerning the mata-analysis by Leroy on the risk of infectious
complications after endovaginal and transrectal ultrasonography. The journal of hospital infection 2014/09;
88(1): 52-53.
Mots-clés : RISQUE; DISPOSITIF MEDICAL; META-ANALYSE; ECHOGRAPHIE; CONTAMINATION;
PREVALENCE
NosoBase ID notice : 384739
Caractéristiques des services de maladies infectieuses et pratiques de lutte contre le risque
infectieux en France et en Turquie : étude transversale
Erdem H; Stahl JP; Inan A; Kil S; Akova M; Rioux C; et al. The features of infectious diseases departments
and anti-infective practices in France and Turkey: a cross-sectional study. European journal of clinical
microbiology and infectious diseases 2014/09; 33(9): 1591-1599.
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Mots-clés : PRATIQUE; CENTRE HOSPITALIER UNIVERSITAIRE; SURVEILLANCE; SERVICE; EOH;
PREVENTION; QUESTIONNAIRE; PERSONNEL; BIONETTOYAGE; HYGIENE DES MAINS;
ANTIBIOTIQUE; MICROBIOLOGIE
The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and
Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and
therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of
June 17-21, 2013. Overall, 36 ID departments from Turkey (n=21) and France (n=15) were involved. On the
study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID
departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU)
room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single
rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside
the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and
their qualifications and surveillance types were quite similar in both countries. Although differences existed
based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Grampositive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides,
and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more
frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in
France (p<0.05 for all significances). Various differences and similarities existed in France and Turkey in the
ID wards. However, the current scene is that ID are managed with high standards in both countries.
NosoBase ID notice : 384815
Données requises pour la mise en place d’une surveillance électronique des infections associées aux
soins
Woeltje KF; Lin MY; Klompas M; Wright MO; Zucotti G; Trick WE. Data requirements for electronic
surveillance of healthcare-associated infections. Infection control and hospital epidemiology 2014/09; 35(9):
1083-1091.
Mots-clés : SURVEILLANCE; INFORMATIQUE; BACTERIEMIE; CATHETER VEINEUX CENTRAL;
INFECTION URINAIRE; PNEUMONIE; VENTILATION ASSISTEE
Electronic surveillance for healthcare-associated infections (HAIs) is increasingly widespread. This is driven
by multiple factors: a greater burden on hospitals to provide surveillance data to state and national agencies,
financial pressures to be more efficient with HAI surveillance, the desire for more objective comparisons
between healthcare facilities, and the increasing amount of patient data available electronically. Optimal
implementation of electronic surveillance requires that specific information be available to the surveillance
systems. This white paper reviews different approaches to electronic surveillance, discusses the specific data
elements required for performing surveillance, and considers important issues of data validation.
Vaccination
NosoBase ID notice : 384569
Validité du statut vaccinal auto-rapporté parmi des étudiants français dans le domaine de la santé
Loulergue P; Pulcini C; Massin S; Bernhard M; Fonteneau L; Lévy-Bruhl D; et al. Validity of self-reported
vaccination status among French healthcare students. Clinical microbiology and infection 2014; in press: 8
pages.
Mots-clés : ETUDIANT; VACCIN; INFIRMIER; MEDECIN; SAGE-FEMME; RISQUE PROFESSIONNEL;
BCG; HEPATITE B; BORDETELLA PERTUSSIS; ROUGEOLE; COQUELUCHE
Healthcare workers and students (HCS) must be vaccinated to protect themselves and susceptible patients
from healthcare-acquired infections (1). In France, occupational vaccinations are either mandatory or
recommended (2). High vaccine coverage is all the more important since nosocomial outbreaks have been
described in Europe (3).
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Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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