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NosoVeille n°9
Septembre 2014
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html
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Abonnement / Désabonnement
Sommaire de ce numéro :
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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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; SURVEILLANCE; CARBAPENEME;
RECOMMANDATIONS DE BONNE PRATIQUE
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 patient-
provider 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 vancomycin-
resistant 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 catheter-
related 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 hospital-
onset, 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