NosoVeille_0911

NosoVeille – Bulletin de veille Septembre 2011









NosoVeille n°9

Septembre 2011

Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve







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Sommaire de ce numéro



Antibiotique

Aspergillose

Cathétérisme

Chirurgie

Clostridium difficile

Coût

EHPAD / Personne âgée

Environnement

Epidémie

Gippe

Gynécologie/Obstétrique

Hygiène corporelle

Hygiène des mains

Infection urinaire

Kinésithérapie

Médicament

Pédiatrie

Personnel

Prévalence

Prévention

Pseudomonas aeruginosa

Réglementation

Rougeole

Soins intensifs









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Antibiotique



NosoBase n° 31071

Klebsiella pneumoniae productrices de carbapénèmases : (quand) pourrions-nous encore envisager

de traiter par des carbapénèmes ?



Daikos GL; Markogiannakis A. Carbapenemase-producing Klebsiella pneumoniae: (when) might we still

consider treating with carbapenems? Clinical microbiology and infection 2011/08; 17(8): 1235-1141.



Mots-clés : KLEBSIELLA PNEUMONIAE; CARBAPENEME; ANTIBIORESISTANCE; CMI; ANTIBIOTIQUE;

TRAITEMENT; BIBLIOGRAPHIE; ANIMAL



Infections caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) are increasing in frequency

worldwide. CPKP isolates exhibit extensive drug resistance phenotypes, complicate therapy, and limit

treatment options. Although CPKP isolates are often highly resistant to carbapenems, a proportion of these

have relatively low MICs for carbapenems, raising the question of whether this class of agents has any

therapeutic potential against CPKP infections. Results from animal studies and patient outcome data indicate

that carbapenems retain meaningful in vitro activity against CPKP isolates with carbapenem MICs of =4 mg/L.

Accumulating clinical experience also suggests that the therapeutic efficacy of carbapenems against CPKP

isolates with MICs of =4 mg/L is enhanced when these agents are administered in combination with another

active antibiotic. The results of human pharmacokinetic/pharmacodynamic studies are in line with the above

observations; it is highly probable that a high-dose/prolonged-infusion regimen of a carbapenem would attain

a time above the MIC value of 50% for CPKP isolates with MICs up to 4 mg/L, ensuring acceptable drug

exposure and favourable treatment outcome. The analyses summarized in this review support the notion that

carbapenems have their place in the treatment of CPKP infections and that the currently proposed EUCAST

clinical breakpoints could direct physicians in making treatment decisions.





NosoBase n° 32045

Les enterobactéries résistantes aux carbapénèmes : épidémiologie et prévention



Gupta N; Limbago BM; Patel JB; Kallen AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and

prevention. Clinical infectious diseases 2011/07/01; 53(1): 60-67.



Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; CARBAPENEME; EPIDEMIOLOGIE;

PREVENTION; BIBLIOGRAPHIE; KLEBSIELLA PNEUMONIAE



Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an

increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the United States.

Infections caused by CRE have limited treatment options and have been associated with high mortality rates.

In the previous year, other carbapenemase subtypes, including New Delhi metallo-beta-lactamase, have

been identified among Enterobacteriaceae in the United States. Like KPC, these enzymes are frequently

found on mobile genetic elements and have the potential to spread widely. As a result, preventing both CRE

transmission and CRE infections have become important public health objectives. This review describes the

current epidemiology of CRE in the United States and highlights important prevention strategies.





NosoBase n° 31287

Résistance aux antibiotiques de l'ensemble des isolats urinaires d'Escherichia coli isolés chez des

patients hospitalisés : résultats du programme d'étude pour la surveillance des évolutions de

l'antibiorésistance (SMART) : 2009-2010



Hoban DJ; Nicolle LE; Hawser S; Bouchillon S; Badal R. Antimicrobial susceptibility of global inpatient urinary

tract isolates of Escherichia coli: results from the study for monitoring antimicrobial resistance trends

(SMART) program: 2009-2010. Diagnostic microbiology and infectious disease 2011/08; 70(4): 507-511.



Mots-clés : ESCHERICHIA COLI; PRELEVEMENT; APPAREIL URINAIRE; ANTIBIORESISTANCE;

IMIPENEME; BETA-LACTAMASE A SPECTRE ELARGI; ANTIBIOTIQUE; SURVEILLANCE



Escherichia coli is the most important uropathogen. The Study for Monitoring Antimicrobial Resistance Trends

program collected 1643 E. coli isolates in 2009-2010 from urinary tract infection (UTI) specimens of

hospitalized patients in countries worldwide. Ertapenem and imipenem were the most active agents tested,

inhibiting >98% of all E. coli phenotypes. Overall, 17.9% of isolates were extended-spectrum beta-lactamase



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(ESBL) producers. The highest ESBL rate was from the Asia/Pacific region (27.7%). Amikacin and

piperacillin-tazobactam achieved 90% inhibition levels only for ESBL-negative isolates. Ciprofloxacin and

levofloxacin were not effective for ESBL-positive isolates, with only 14.6% and 15.9% susceptible,

respectively. These observations highlight the need for continued monitoring of susceptibility of E. coli

isolated from hospitalized patients with UTIs.





NosoBase n° 32044

Les transferts de patients d'un pays à l'autre et le risque d'infection à bactéries multirésistantes



Rogers BA; Aminzadeh Z; Hayashi Y; Paterson DL. Country-to-country transfer of patients and the risk of

multi-resistant bacterial infection. Clinical infectious diseases 2011/07/01; 53(1): 49-56.



Mots-clés : MULTIRESISTANCE; FACTEUR DE RISQUE; EPIDEMIOLOGIE; PAYS ETRANGER



Management of patients with a history of healthcare contact in multiple countries is now a reality for many

clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and

changing patterns of human migration may all contribute to this emerging epidemiological trend. Such

individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria.

Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella

pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-beta-lactamase-

producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and

hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their

dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to

mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to

hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect

the risk of multiresistant organisms in these patients.





NosoBase n° 31249

Co-colonisation par de multiples espèces différentes de bactéries à Gram négatif multi-résistantes

aux antibiotiques



Snyder GM ; O'Fallon E; D'Agata E. Co-colonization with multiple different species of multidrug-resistant

gram-negative bacteria. American journal of infection control 2011/08; 39(6): 506-510.



Mots-clés : COLONISATION; BACTERIE A GRAM NEGATIF; ANTIBIORESISTANCE; MULTIRESISTANCE;

PREVALENCE; RISQUE; TYPAGE; BIOLOGIE MOLECULAIRE; PFGE; EHPAD; FACTEUR DE RISQUE;

PROTEUS; ANTIBIORESISTANCE; ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE



Background: The characteristics of co-colonization with multiple different species of multidrug-resistant gram-

negative bacteria (MDRGN) have not been fully elucidated. Quantifying the prevalence of co-colonization and

those patients at higher risk of co-colonization may have important implications for strategies aimed at limiting

the spread of MDRGN.

Methods: To determine the prevalence of MDRGN colonization, rectal swabs were obtained from 212

residents residing in a 600-bed long-term care facility. Co-colonization was defined as colonization with =2

different MDRGN species. Co-colonized residents were compared with residents colonized with a single

MDRGN species to identify factors associated with an increased risk for co-colonization. Molecular typing was

performed to determine the contribution of cross transmission to the co-colonized state.

Results: A total of 53 (25%) residents was colonized with =1 MDRGN. Among these, 11 (21%) were

colonized with =2 different species of MDRGN. A global deterioration score of =5 representing advanced

dementia and an increased requirement for assistance from health care workers was significantly associated

with co-colonization (P = .05). Clonally related MDRGN strains were identified among 7 (64%) co-colonized

residents.

Conclusion: The prevalence of co-colonization with =2 different MDRGN is substantial. Cross transmission of

MDRGN is a major contributor to the co-colonized state.









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Aspergillose



NosoBase n° 31309

Aspergillose invasive chez des patients présentant des cancers hématologiques : incidence et

description de 127 cas inclus dans une étude prospective réalisée dans un seul établissement de

2004 à 2009



Nicolle MC; Benet T; Thiebaut A; Bienvenu AL; Voirin N; Duclos A; et al. Invasive aspergillosis in patients with

hematological malignancies: incidence and description of 127 cases enrolled in a single institution

prospective survey from 2004 to 2009. Haematologica 2011; in press: 25 pages.



Mots-clés : INCIDENCE; CANCEROLOGIE; CANCER; HEMATOLOGIE; ASPERGILLUS; ETUDE

PROSPECTIVE; MORTALITE; FACTEUR DE RISQUE; DIAGNOSTIC; DEFICIT IMMUNITAIRE



Background: The study objectives were: 1) to report on invasive aspergillosis patients in an hematology

department, and 2) to estimate its incidence according to the hematological diagnosis.

Design and Methods: A prospective survey of invasive aspergillosis cases was undertaken between January

2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians,

mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis

cases. Demographic characteristics, clinical and complementary examination results were noted

prospectively. Information on hospitalization was extracted from administrative databases. Invasive

aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria,

and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends

of invasive aspergillosis incidence assessed by adjusted Poisson regression.

Results: Overall, 4,073 hospitalized patients (78,360 patient-days) were included. Totally, 127 (3.1%) patients

presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence

interval: 1.4,1.9) with a decrease of 16% per year (-1%,-28%). The incidence was 1.9 per 1,000 patient-days

(1.5,2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%,-36%). Serum Aspergillus

antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung

CT-scans. One-month mortality was 13%, 3-month mortality was 42%. Mortality tended to decrease between

2004 and 2009.

Conclusions: Invasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of

invasive aspergillosis characteristics and its clinical course should help to improve the management of these

patients with severe disease.





Cathétérisme



NosoBase n° 31461

Les biofilms de Candida albicans formés dans des cathéters et des sondes et leur résistance à

l'amphotéricine B



Boucherit Atmani Z; Seddiki SML; Boucherit K; Sari; et al. Candida albicans biofilms formed into catheters

and probes and their resistance to amphotericin B. Journal de mycologie médicale 2011: 6 pages.



Mots-clés : CATHETER; BIOFILM; CANDIDA; CANDIDA ALBICANS; AMPHOTERICINE B; RESISTANCE;

ANTIFONGIQUE



En Algérie, les biofilms bactériens dans le milieu hospitalier ont été largement étudiés, cependant les biofilms

fongiques, surtout ceux de Candida albicans n'ont pas été clarifiés. De ce fait, notre travail a été effectué à

l'hôpital Chabane Hamdoune de Maghnia (Algérie) où 51 souches de C. albicans ont été isolées représentant

16,94 % de l'ensemble des prélèvements effectués. Ces souches sont isolées des différents services de

l'hôpital à partir des cathéters et des sondes après leurs ablations. Il s'est révélé que le service le plus affecté

est celui de l'unité des soins intensifs (40,74%), suivi par le service de gynécologie (17,39%), tandis que celui

de chirurgie générale se classe en troisième rang (15,79%). Les tests antifongiques de l'amphotéricine B

(AmB) ont montré clairement que les cellules sessiles de C. albicans sont beaucoup plus résistantes que

leurs homologues planctoniques (cellules en suspension), cette résistance augmente au cours des

différentes phases de la formation des biofilms jusqu'à ce qu'elle atteigne son seuil à la phase de maturation

(48 heures). La microscopie électronique à balayage effectuée sur les souches isolées de C. albicans prouve

la formation des biofilms sur les cathéters ; étonnamment, l'observation a aussi révélé la présence d'une

nouvelle structure dans le biofilm de C. albicans : une chlamydospore ?





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NosoVeille – Bulletin de veille Septembre 2011



NosoBase n° 31484

Le PICC, un atout pour les soignants et les patients



Dupont C. Objectif soins 2011(197): 21-24.



Mots-clés : PERSONNEL; CATHETER VEINEUX CENTRAL; CATHETER VEINEUX PERIPHERIQUE;

ANTIBIOTIQUE; MEDICAMENT



Le PICC (Peripherally inserted central catheter) est un cathéter central d'insertion périphérique. Dans le

cadre des traitements intraveineux comme les cures d'antibiotiques de quelques semaines, il apporte confort

et sécurité pour la majorité des patients. La pose d'un PICC facilite l'externalisation des soins.





Chirurgie



NosoBase n° 31353

Facteurs de risque et évolution des infections du site opératoire chez des enfants



Bucher BT; Guth RM; Elward AM; Hamilton NA; Dillon PA; Warner BW; et al. Risk factors and outcomes of

surgical site infection in children. Journal of the American College of Surgeons 2011/06; 212(6): 1033-1038.



Mots-clés : FACTEUR DE RISQUE; PEDIATRIE; SITE OPERATOIRE; ETUDE RETROSPECTIVE; CAS

TEMOIN; ANALYSE; CATHETER; SONDAGE URINAIRE; MATERIEL ETRANGER



Background: Indices for prediction of surgical site infection (SSI) are well documented in the adult population;

however, these factors have not been validated in children.

Study Design: A retrospective case-control study was performed by examining the medical records of children

(0 to 18 years) who developed an SSI within 30 days of selected class I and class II procedures at our

institution from 1996 to 2008. Two controls were selected from among patients undergoing identical

procedures within 12 months of each case. Statistical analysis was performed using Wilcoxon test for

continuous and chi-square test for categorical variable. Factors thought a priori to be associated with risk of

SSI and statistically significant variables from a univariate analysis were used to create a logistic regression

model.

Results: Of 16,031 patients, 159 children (0.99%) developed an SSI. Univariate analysis showed race,

postoperative location, skin preparation, urinary catheter, procedure duration, and implantable device as risk

factors for development of an SSI. Independent predictors of SSI in multiple conditional logistic regression

were age (adjusted odds ratio [aOR] 4.97 neonate vs adolescent; 95% CI 1.38 to 17.90), race (aOR 2.36 for

African American vs white; 95% CI 1.32 to 4.18), postoperative location (aOR 6.55 ICU vs home; 95% CI 1.58

to 27.21), urinary catheter placement (aOR 3.56; 95% CI 1.50 to 8.48), and implantable device (aOR 3.05;

95% CI 1.14 to 8.21). Wound classification and antibiotic administration were not independent predictors of

SSI.

Conclusions: Postoperative location, urinary catheter insertion, and use of an implantable device are

potentially modifiable risk factors for an SSI in children. The higher risk of SSI in younger patients and non-

white race suggest a possible developmental, socioeconomic, or genetic marker for impaired host defense.





NosoBase n° 31339

Infection à Candida associée à du matériel orthopédique : revue rétrospective des caractéristiques et

de l'évolution des patients



Chue AL; Moran E; Atkins BL; Byren I. Orthopaedic device associated candida infection – a retrospective

review of patient characteristics and outcome. The Journal of infection 2011/08; 63(2): 167-171.



Mots-clés : CHIRURGIE ORTHOPEDIQUE; MATERIEL ETRANGER; CANDIDA; ETUDE RETROSPECTIVE;

TRAITEMENT; ANTIFONGIQUE; MICROBIOLOGIE; STAPHYLOCOCCUS; ENTEROCOCCUS





NosoBase n° 31330

Durée prolongée de l'intervention chirurgicale : un indicateur de complication de la chirurgie ou de

(mauvaise) gestion chirurgicale ?



Gastmeier P; Sohr D; Breier A; Behnke M; Geffers C. Prolonged duration of operation: an indicator of

complicated surgery or of surgical (mis)management? Infection 2011/06; 39(3): 211-215.



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NosoVeille – Bulletin de veille Septembre 2011







Mots clés : RESEAU; CHIRURGIE; INDICATEUR; QUALITE; BLOC OPERATOIRE; FACTEUR DE RISQUE;

USAGER; SITE OPERATOIRE; TAUX; ANALYSE; STATISTIQUE; SURVEILLANCE



Purpose: The aim of this study was to investigate whether a prolonged operative time should be regarded as

an indicator of quality problems in operating rooms or as patient-specific risk factors when analyzing surgical

site infection (SSI) rates.

Method: Data from the SSI component of the German national nosocomial infection surveillance system

(KISS) were used to address this question. Eight procedure categories tracked by at least 30 departments

participating in KISS were included in the analysis, namely, hip (2 types) and knee prosthesis, breast surgery,

hernia repair, C-section, cholecystectomy and colon operations. Various multiple logistic regression analyses

were performed for each procedure category to predict duration of operation. Patient factors (sex, age,

American Society of Anesthesiologists score, wound contamination class) and hospital factors (hospital

status, size, annual volume) were considered. The area under the receiver operating characteristic (ROC)

curve was used to evaluate predictive power including patient- and hospital-based factors.

Results: A total of 253,454 operations were included in the analysis. In general, the predictive power of the

model including all variables for the different procedure types was relatively low (C-index range: 0.57-0.63)

and not much higher than that of the models including only patient-based or only hospital-based variables,

respectively. The predictive power for the duration of operative time based on the model including only

hospital-based variables was as good as or better than that of the model including only patient-based factors.

Conclusion: Duration of operation is at least partially determined by hospital factors and, consequently,

should be used as a quality indicator to compare SSI infections between hospitals, rather than being used as

a patient factor to adjust comparisons between hospitals.





NosoBase n° 32108

Surveillance informatisée des infections du site opératoire : implications pour l'estimation des

risques et des coûts



Hollenbeak CS; Boltz MM; Nikkel LE; Schaefer E; Ortenzi G; Dillon PW. Electronic measures of surgical site

infection: implications for estimating risks and costs. Infection control and hospital epidemiology 2011/08;

32(8): 784-790.



Mots-clés : SITE OPERATOIRE; SURVEILLANCE; INFORMATIQUE; RISQUE; COUT; TAUX; DEFINITION;

FACTEUR DE RISQUE; CHIRURGIE CARDIO-VASCULAIRE; CHIRURGIE



Objective: Electronic measures of surgical site infections (SSIs) are being used more frequently in place of

labor-intensive measures. This study compares performance characteristics of 2 electronic measures of SSIs

with a clinical measure and studies the implications of using electronic measures to estimate risk factors and

costs of SSIs among surgery patients.

Methods: Data included 1,066 general and vascular surgery patients at a single academic center between

2007 and 2008. Clinical data were from the National Surgical Quality Improvement Program (NSQIP)

database, which includes a nurse-derived measure of SSI. We compared the NSQIP SSI measure with 2

electronic measures of SSI: MedMined Nosocomial Infection Marker (NIM) and International Classification of

Diseases, Ninth Revision (ICD-9) coding for SSIs. We compared infection rates for each measure, estimated

sensitivity and specificity of electronic measures, compared effects of SSI measures on risk factors for

mortality using logistic regression, and compared estimated costs of SSIs for measures using linear

regression.

Results: SSIs were observed in 8.8% of patients according to the NSQIP definition, 2.6% of patients

according to the NIM definition, and 5.8% according to the ICD-9 definition. Logistic regression for each SSI

measure revealed large differences in estimated risk factors. NIM and ICD-9 measures overestimated the

cost of SSIs by 134% and 33%, respectively.

Conclusions: Caution should be taken when relying on electronic measures for SSI surveillance and when

estimating risk and costs attributable to SSIs. Electronic measures are convenient, but in this data set they

did not correlate well with a clinical measure of infection.





NosoBase n° 31400

Infections sur prothèses de hanche et de genou à Streptocoque du groupe B



Sendi P; Christensson B; Uckay I; Trampuz A; Achermann Y; Boggian K; et al. Group B streptococcus in

prosthetic hip and knee joint-associated infections. The Journal of hospital infection 2011/09; 79(1): 64-69.





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NosoVeille – Bulletin de veille Septembre 2011



Mots-clés : STREPTOCOCCUS; STREPTOCOCCUS GROUPE B; MATERIEL ETRANGER; PROTHESE

TOTALE DE GENOU; PROTHESE TOTALE DE HANCHE; CHIRURGIE ORTHOPEDIQUE; ANTIBIOTIQUE;

ANTIBIORESISTANCE; TRAITEMENT



The incidence of invasive group B streptococcus (GBS) infections in non-pregnant adults is increasing. Little

is known about GBS in periprosthetic joint infections (PJIs). We aimed to analyse the clinical presentation of

GBS PJI and its treatment in association with the outcome. The characteristics of 36 GBS PJIs collected from

10 centres were investigated. In 34 episodes, follow-up examination of =2 years was available, allowing

treatment and outcome analysis. Most infections (75%) occurred =3 months after implantation. Most patients

(91%) had at least one comorbidity; 69% presented with acute symptoms and 83% with damaged

periprosthetic soft tissue. In 20 of 34 episodes debridement and retention of implant was attempted, but in five

of these the prosthesis was ultimately removed. Hence, in 19 (56%) episodes, the implant was removed,

including 14 immediate removals. In four episodes the removal was permanent. Penicillin derivatives and

clindamycin were the most common antimicrobials administered (68%). In 94% the infection was cured, and

in 82% functional mobility preserved. Debridement with implant retention was successful if the duration of

symptoms was short, the prosthesis stable, and the tissue damage minor (10/10 vs 3/10 episodes, P =

0.003). Surgery that complied with a published algorithm was associated with a favourable outcome (P =

0.049).





Clostridium difficile



NosoBase n° 31073

Facteurs de risque de récurence des infections à Clostridium difficile : impact de la colonisation par

des entérocoques résistant à la vancomycine



Choi HK; Kim KH; Lee SH; Lee SJ. Risk factors for recurrence of Clostridium difficile infection: effect of

vancomycin-resistant enterococci colonization. Journal of Korean medical science 2011/07; 26(7): 859-864.



Mots-clés : CLOSTRIDIUM DIFFICILE; FACTEUR DE RISQUE; COLONISATION; INFECTION

RECURRENTE; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; ENTEROCOCCUS; TRAITEMENT;

ANTIBIOTIQUE



Recurrent Clostridium difficile infection (CDI) is one of the most difficult problems in healthcare infection

control. We evaluated the risk factors associated with recurrence in patients with CDI. A retrospective cohort

study of 84 patients with CDI from December 2008 through October 2010 was performed at Pusan National

University Yangsan Hospital. Recurrence occurred in 13.1% (11/84) of the cases and in-hospital mortality rate

was 7.1% (6/84). Stool colonization with vancomycin-resistant enterococci (VRE) (P = 0.006), exposure to

more than 3 antibiotics (P = 0.009), low hemoglobin levels (P = 0.025) and continued use of previous

antibiotics (P = 0.05) were found to be more frequent in the recurrent group. Multivariate analysis indicated

that, stool VRE colonization was independently associated with CDI recurrence (odds ratio, 14.519; 95%

confidence interval, 1.157-182.229; P = 0.038). This result suggests that stool VRE colonization is a

significant risk factor for CDI recurrence.





NosoBase n° 31345

Facteurs de risque d'infection à Clostridium difficile chez des patients hospitalisés



Monge D; Morosini M; Millan I; Perez Canosa C; Manso M; Guzman MF; et al. Factores de riesgo de

infeccion por Clostridium difficile en pacientes hospitalizados. Medicina clinica 2011; in press: 6 pages.



Mots-clés : CLOSTRIDIUM DIFFICILE; FACTEUR DE RISQUE; MORTALITE; CAS TEMOIN;

CEPHALOSPORINE; QUINOLONE; TRAITEMENT; DUREE DE SEJOUR; ANTIBIOTIQUE



Background and Objectives: To identify risk factors, and to estimate the crude effects attributable to hospital

acquired Clostridium difficile infection (CDI).

Patients and Methods: Case-control study matched by age, gender, and admission date. Patient and

healthcare risk factors were evaluated. Hospital stays and mortality were compared.

Results: Thirty-eight cases and 76 controls were included (mean age 73 years). Cases presented worse

Charlson index (P .02), higher pre-infection stay (median 10 vs. 5.5 days) and had received antibiotic

treatment more frequently (89.5 vs. 40.7%) than their control counterparts. Albuminemia 10(3) reduction in viability

after 60 min (the pass criterion for the Standard) under both clean and dirty conditions. However, only eight

products achieved >10(3) reduction in viability within 1min under dirty conditions. Three products failed to

reduce the viability of the C. difficile spores by a factor of 10(3) in any of the test conditions. This study

highlights that the application of disinfectants claiming to be sporicidal is not, in itself, a panacea in the

environmental control of C. difficile, but that carefully chosen environmental disinfectants could form part of a

wider raft of control measures that include a range of selected cleaning strategies.





NosoBase n° 32043

Exposition cumulée aux antibiotiques et risque d'infection à Clostridium difficile



Stevens V; Dumyati G; Fine LS; Fisher SG; Van Wijngaarden E. Cumulative antibiotic exposures over time

and the risk of Clostridium difficile infection. Clinical infectious diseases 2011/07/01; 53(1): 42-48.



Mots-clés : CLOSTRIDIUM DIFFICILE; ANTIBIOTIQUE; CONSOMMATION; COHORTE; ETUDE

RETROSPECTIVE; FLUOROQUINOLONE; FACTEUR DE RISQUE



Background: Clostridium difficile infection (CDI) is a major cause of hospital-acquired diarrhea and is most

commonly associated with changes in normal intestinal flora caused by administration of antibiotics. Few

studies have examined the risk of CDI associated with total dose, duration, or number of antibiotics while

taking into account the complex changes in exposures over time.

Methods: A retrospective cohort study conducted from 1 January to 31 December 2005 among hospitalized

patients 18 years or older receiving 2 or more days of antibiotics.

Results: The study identified 10,154 hospitalizations for 7,792 unique patients and 241 cases of CDI, defined

as the detection of C. difficile toxin in a diarrheal stool sample within 60 days of discharge. We observed

dose-dependent increases in the risk of CDI associated with increasing cumulative dose, number of

antibiotics, and days of antibiotic exposure. Compared to patients who received only 1 antibiotic, the adjusted

hazard ratios (HRs) for those who received 2, 3 or 4, or 5 or more antibiotics were 2.5 (95% confidence

interval [CI] 1.6-4.0), 3.3 (CI 2.2-5.2), and 9.6 (CI 6.1-15.1), respectively. The receipt of fluoroquinolones was

associated with an increased risk of CDI, while metronidazole was associated with reduced risk.

Conclusions: Cumulative antibiotic exposures appear to be associated with the risk of CDI. Antimicrobial

stewardship programs that focus on the overall reduction of total dose as well as number and days of

antibiotic exposure and the substitution of high-risk antibiotic classes for lower-risk alternatives may reduce

the incidence of hospital-acquired CDI.









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NosoVeille – Bulletin de veille Septembre 2011



Coût



NosoBase n° 31328

Coûts des infections nosocomiales et transférabilité des évaluations : revue systématique



Fukuda H; Lee J; Imanaka Y. Costs of hospital-acquired infection and transferability of the estimates: a

systematic review. Infection 2011/06; 39(3): 185-199.



Mots-clés : COUT; METHODOLOGIE; COUT-EFFICACITE; ANALYSE; BIBLIOGRAPHIE



Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a relatively

high frequency of occurrence and considerable damage caused. There has been an increase in the number

of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of

HAI (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI

estimates from existing published literature when evaluating the economic impact of HAI control measures, it

has been observed that the results of economic evaluations may not be directly applied to other jurisdictions

due to differences in the context and circumstances in which the original results were produced. The aims of

this study were to conduct a systematic review of published studies that have produced COHAI estimates

from 1980 to 2006 and to evaluate the quality of these estimates from the perspective of transferability. From

a total of 89 publications, only eight papers (9.0%) had a high level of transferability in which all components

of costs were described, data for costs in each component were reported, and unit costs were estimated with

actual costing. We also did not observe a higher citation level for studies with high levels of transferability. We

feel that, in order to ensure an appropriate contribution to the infection control program decision-making

process, it is essential for researchers who estimate COHAI, analysts who use COHAI estimates for decision-

making, as well as relevant journal reviewers and editors to recognize the importance of a transferability

paradigm.





NosoBase n° 28500

Contrôler les coûts associés aux soins pour l'élimination des déchets : ce que les médecins

américains peuvent faire maintenant



Swensen SJ; Kaplan GS; Meyer GS; Nelson EC; Hunt GC; Pryor DB; et al. Controlling healthcare costs by

removing waste: what American doctors can do now. BMJ quality and safety 2011/06; 20(6): 534-537.



Mots-clés : DECHET; COUT; ORGANISATION



Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing

(deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led

strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3)

waste within healthcare processes. These challenges know no borders.





EHPAD / Personne âgée



NosoBase n° 31402

Recommandations pour la lutte contre le risque infectieux dans les EHPAD : étude de consensus

Delphi sur internet



Chami K; Gavazzi G; De Wazieres B; Lejeune B; Carrat F; Piette F, et al. Guidelines for infection control in

nursing homes: a delphi consensus web-based survey. The Journal of hospital infection 2011/09; 79(1): 75-

89.



Mots-clés : CONSENSUS; EHPAD; RECOMMANDATION; GERIATRIE; PRECAUTION STANDARD;

PREVENTION; SOIN DE BOUCHE; HYGIENE CORPORELLE; SONDAGE URINAIRE; DISPOSITIF

MEDICAL; AEROSOL; ALIMENTATION ENTERALE; CATHETER; SURVEILLANCE



Une étude nationale a été conduite à l'aide d'une méthode Delphi sur internet en deux étapes afin de

développer un ensemble de recommandations de consensus pour la prévention des infections parmi les

résidents des EHPAD. Un groupe de six experts spécialisés en maladies infectieuses, gériatrie, santé

publique et hygiène hospitalière a conduit le groupe de recherche. A partir d'une liste de 301

recommandations, 264 ont été retenues : 240 ont obtenu un agrément élevé (consensus), 24 sont proches



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du consensus. Ces recommandations ont été développées en 4 parties : 1) Précautions standard (22) : elles

portent sur l'exposition au sang, l'usage des gants, masques, la tenue vestimentaire, l'hygiène des mains,

l'hygiène environnementale, 2) Mesures générales non spécifiques pour la prévention des infections

nosocomiales (57) : en particulier soins de bouche et hygiène corporelle, 3) Mesures pour la prévention des

infections nosocomiales (156) : elles portent sur le sondage urinaire, l'aérosol thérapie, l'alimentation

entérale, les cathéters veineux, 4) Les principes d'organisation (29) : ils concernent la surveillance des

pathogènes multirésistants aux antibiotiques, la surveillance, la formation du personnel, la gestion des

antibiotiques, la gestion des épidémies.





NosoBase n° 31394

Excès de mortalité après entérite à norovirus d'origine communautaire chez les personnes âgées



Gustavsson L; Andersson LM; Lindh M; Westin J. Excess mortality following community-onset norovirus

enteritis in the elderly. The Journal of hospital infection 2011/09; 79(1): 27-31.



Mots-clés : MORTALITE; GASTRO-ENTERITE; PERSONNE AGEE; INFECTION COMMUNAUTAIRE;

VIRUS; NOROVIRUS; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE;

APPARIEMENT; DUREE DE SEJOUR



Norovirus has been associated with excess deaths. A retrospective study of mortality following norovirus

enteritis (NVE) was undertaken. All hospitalized adult patients with a stool sample positive for norovirus

genogroup II on polymerase chain reaction, treated at Sahlgrenska University Hospital, Gothenburg, Sweden

between August 2008 and June 2009, were included as cases (N=598, aged 18-101 years). Matched controls

without enteritis (N=1196) were selected for comparison. Medical records were reviewed and deaths up to 90

days following positive sampling were noted, as well as comorbidities and length of hospital stay. Thirty- and

90-day survival rates were calculated. Total 30-day mortality was 7.6% and no deaths were recorded in cases

aged 18-59 years. Thirty-day mortality was higher in cases with underlying medical conditions compared with

those without these comorbidities (age 60-101 years: 89.5% vs 94.7% alive at Day 30, respectively; P80 years, mortality was higher in those with community-onset NVE (N=64) compared with

hospital-onset NVE (N=305) (81.2% vs 90.2% alive at Day 30, respectively; P2 visits to the unit during the study period and follow-up by a physician who

assessed =100patients/year (senior physician). CDC stage, recent CD4 count, diabetes, BMI>30 and

pregnancy were not associated with vaccination. After multivariate analysis, vaccination remained

significantly associated with age= 50years (aOR 1.56, CI 1.16-2.09), time since HIV diagnosis (aOR per





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NosoVeille – Bulletin de veille Septembre 2011



1year 1.02, CI 1.00-1.04), previous pneumococcal vaccination (aOR 2.56, CI 1.96-3.34), >2 visits to the unit

(aOR 5.09, CI 3.87-6.68) and follow-up by a senior physician (aOR 1.73, CI 1.20-2.48).

Conclusion: A/H1N1 vaccination was more successful in HIV-infected patients than in the French general

population. Organization of the vaccination in a convenient location and implication of the physicians seem to

be determining factors for A/H1N1 acceptability in this population.





NosoBase n° 31290

Facteurs de motivation pour des taux élevés de vaccination contre la grippe parmi le personnel

hospitalier



Hakim H; Gaur AH; Mccullers JA. Motivating factors for high rates of influenza vaccination among healthcare

workers. Vaccine 2011/08/11; 29(35): 5963-5969.



Mots-clés : VACCIN; GRIPPE; PERSONNEL; PEDIATRIE; CANCEROLOGIE; OBSERVANCE; VIRUS

INFLUENZA TYPE A; COHORTE; TAUX; ATTITUDE



Background: Recent guidance from related regulatory agencies and medical societies supports mandatory

vaccination of healthcare workers (HCW) against influenza. At St. Jude Children's Research Hospital, a

pediatric oncology referral center, more than 90% of HCWs receive vaccine each year without a policy

mandating immunization. Factors associated with HCW uptake of influenza vaccines have not previously

been evaluated in a high compliance rate setting.

Methods: A structured, anonymous, electronic questionnaire was distributed in August 2010 to employees

(HCW and non-HCW). Demographics, prior receipt of influenza vaccines, reasons for acceptance or refusal

of seasonal and 2009 H1N1 pandemic vaccine, and attitudes on mandatory vaccination were assessed.

Results: 95.0% of 925 HCWs and 63.1% of all 3227 qualifying employees responded to the survey. 93.8%

and 75.2% of HCW reported receiving seasonal and 2009 H1N1 influenza vaccines, respectively, in the 2009-

2010 season. Benefits to self and/or patients were cited as the most frequent reasons for accepting seasonal

(83.5% and 78.3%, respectively) and 2009 H1N1 (85.9% and 81.1%, respectively) vaccination. 36.6% of

HCWs opposed mandating influenza vaccination; 88.2% and 59.9% of whom reported receiving the seasonal

and 2009 H1N1 influenza vaccines, respectively. Violation of freedom of choice and personal autonomy were

the most frequently reported reasons for opposition.

Conclusion: In this cohort of HCWs with a high influenza vaccination rate, realistic assessments of the

potential benefits of vaccination appear to have driven the choice to accept immunization. Despite this,

mandating vaccination was viewed unfavorably by a significant minority of vaccinated individuals. Employee

concerns over autonomy should be addressed as institutions transition to mandatory vaccination policies.





NosoBase n° 32113

Evaluation prospective de la grippe A H1N1 2009 chez des patients avec de la fièvre à l'admission

dans un service de cancérologie



Seiter K; Shah D; Sandoval C; Liu D; Nadelman RB; Sinaki B; et al. Prospective evaluation of 2009 H1N1

influenza A in patients admitted with fever to an oncology unit. Infection control and hospital epidemiology

2011/08; 32(8): 815-817



Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; ETUDE PROSPECTIVE; CANCEROLOGIE; ANTIVIRAL



We prospectively evaluated all oncology inpatients for 2009 H1N1 influenza virus. All patients recovered

completely. Evaluating all oncology patients with fever for influenza involved over treatment of influenza-

negative patients and involved a significant infection control burden. However, early antiviral intervention

could have contributed to a favorable outcome.





Gynécologie / Obstétrique



NosoBase n° 31366

Obésité, diabète et risque d'infections diagnostiquées à l'hôpital et d’infections après la sortie après

césarienne. Etude de cohorte prospective



Leth R;Uldbjerg N; Norgaard M; Moller JK; Thomsen RW. Obesity, diabetes, and the risk of infections

diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study. Acta

obstetrician et gynecologica scandinavica 2011/05; 90(5): 501-509.



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Mots-clés : OBESITE; RISQUE; DIABETE; ETUDE PROSPECTIVE; COHORTE; CESARIENNE;

ACCOUCHEMENT; INCIDENCE; SEIN; ENDOMETRE; BACTERIEMIE; SITE OPERATOIRE



Objective: To assess the impact of obesity and diabetes on the risk of post-cesarean infections.

Design: Prospective cohort study.

Setting: Obstetric departments at three hospitals in Denmark.

Population: 2,492 consecutive women having cesarean section (CS) from February 2007 to August 2008.

Methods: We collected complete data from medical records and databases on CS, body mass index,

diabetes (type 1, type 2, and gestational), and post-cesarean infections. Post-discharge infections diagnosed

by general practitioners were ascertained through positive microbiological cultures and antibiotic

prescriptions.

Main outcome measures: Cumulative incidences of infections within 30 days after CS.

Results: Of 2,492 women having CS, 373 (15.2%) were obese and 123 (4.9%) had diabetes. Overall, 458

women (18.4%) had a post-cesarean infection within 30 days and 174 (7.0%) were diagnosed in-hospital.

The risk of post-cesarean infections was higher among obese than non-obese women: adjusted (for diabetes

and emergency/elective CS) odds ratio (OR)=1.43; 95% confidence interval (CI): 1.09-1.88, particularly for in-

hospital infections (OR=1.86; 95%CI: 1.28-2.72). After controlling for obesity and mode of CS, type 2 or

gestational diabetes were weak predictors of infection risk (OR=1.18; 95%CI: 0.72-1.93), whereas the

adjusted OR in women with type 1 diabetes was 1.65 (95%CI: 0.64-4.25). Among diabetic women, obesity

increased the risk of post-cesarean infections more than twofold; the adjusted ORs were 2.06 (95%CI: 1.13-

3.75) for infections overall and 2.74 (95%CI: 1.25-6.01) for in-hospital infections.

Conclusion: Obesity increases the risk of post-cesarean infections and diabetes further strengthens this

association.





Hygiène corporelle



NosoBase n° 31312

Intervention de promotion de la santé bucco-dentaire et mycoses buccales chez des patients

hospitalisées et en état sévère : revue systématique



Lam OL; Bandara H; Samaranayake LP; McGrath C; Li LS. Oral health promotion interventions on oral yeast

in hospitalised and medically compromised patients: a systematic review. Mycoses 2011; in press: 20 pages.



Mots-clés : BIBLIOGRAPHIE; SOIN DE BOUCHE; LEVURE; CHLORHEXIDINE; INFORMATION; CANDIDA;

RESISTANCE; ANTIFONGIQUE; POLYVIDONE IODEE; TRICLOSAN; DEFICIT IMMUNITAIRE



Yeast are major aetiological agents of localised oral mucosal lesions, and are also leading causes of

nosocomial bloodstream infections. The purpose of this systematic review was to examine the effectiveness

of oral health promotion interventions on the prevalence and incidence of these opportunistic oral pathogens

in hospitalised and medically compromised patients. The PubMed, ISI Web of Science and Cochrane Library

databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral

yeast. Chlorhexidine delivered in a variety of oral hygiene products appeared to have some effect on oral

yeast, although some studies found equivocal effects. Although a wide array of other compounds have also

been investigated, their clinical effectiveness remains to be substantiated. Likewise, the utility of mechanical

oral hygiene interventions and other oral health promotion measures such as topical application of salivary

substitute, remains unsettled. Although many chemical agents contained in oral hygiene products have

proven in vitro activity against oral yeast, their clinical effectiveness and potential role as adjuncts or

alternative therapies to conventional treatment remains to be confirmed by further high-quality randomised

controlled trials. This is pertinent, given the recent emergence of yeast resistance to conventional antifungal

agents.





Hygiène des mains



NosoBase n° 31242

Evaluation des pratiques de l'hygiène des mains reposant sur l'observation et impacts d'une

intervention dans une cafétéria d'hôpital ouverte au public









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Filion K; Kukanich KS; Chapman B; Hardigree MK; Powell DA. Observation-based evaluation of hand

hygiene practices and the effects of an intervention at a public hospital cafeteria. American journal of infection

control 2011/08; 39(6): 464-470.



Mots-clés : EVALUATION DES PRATIQUES PROFESSIONNELLES; PRATIQUE; HYGIENE DES MAINS;

OBSERVANCE; FORMATION; ALIMENTATION; SOLUTION HYDROALCOOLIQUE; PERSONNEL ;

USAGER; VISITE; OBSERVANCE; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION



Background: Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may

have had recent contact with infectious agents. Few interventions to improve hand hygiene have had

measureable success. This study was designed to use a poster intervention to encourage hand hygiene

among health care workers (HCWs) and hospital visitors (HVs) upon entry to a hospital cafeteria.

Methods: Over a 5-week period, a poster intervention with an accessible hand sanitizer unit was deployed to

improve hand hygiene in a hospital cafeteria. The dependent variable observed was hand hygiene attempts.

Study phases included a baseline, intervention, and follow-up phase, with each consisting of 3 randomized

days of observation for 3 hours during lunch.

Results: During the 27 hours of observation, 5,551 participants were observed, and overall hand hygiene

frequency was 4.79%. Hygiene attempts occurred more frequently by HCWs than HVs (P = .0008) and

females than males (P = .0281). Hygiene attempts occurred more frequently after poster introduction than

baseline (P = .0050), and this improvement was because of an increase in frequency of HV hand hygiene

rather than HCW hand hygiene.

Conclusion: The poster intervention tool with easily accessible hand sanitizer can improve overall hand

hygiene performance in a US hospital cafeteria.





NosoBase n° 31252

Pratique de l'hygiène des mains et facteurs en déterminant l'observance dans des services de

chirurgie en Europe et en Israël : étude d'observation multicentrique



Lee A; Chalfine A; Daikos GL; Garilli S; Jovanovic B; et al. Hand hygiene practices and adherence

determinants in surgical wards across Europe and Israel: a multicenter observational study. American journal

of infection control 2011/08; 39(6): 517-520.



Mots-clés : HYGIENE DES MAINS; PRATIQUE; OBSERVANCE ;CHIRURGIE; GANT; PERSONNEL;

PRODUIT DE FRICTION POUR LES MAINS; CONSOMMATION; ANALYSE MULTIVARIEE; TRAITEMENT

HYGIENIQUE DES MAINS PAR FRICTION



We examined hand hygiene practices in surgical wards in 9 countries in Europe and Israel through direct

practice observation. There was marked interhospital variation in hand hygiene compliance (range, 14%-

76%), as well as glove and alcohol-based handrub use. After multivariable analysis, surgical subspecialty,

professional category, type of care activity, and workload were independently associated with compliance.

Hand hygiene practices are influenced by numerous factors, and a tailored approach may be required to

improve practices.





NosoBase n° 31300

Détermination de nouvelles étapes dans une initiative d'amélioration de l'hygiène des mains par

l'examen de la variation des taux d'observance de l'hygiène des mains



Oma K; Kirkland KB. Determining next steps in a hand hygiene improvement initiative by examining variation

in hand hygiene compliance rates. Quality management health care 2011/06; 20(2): 116-121.



Mots-clés : HYGIENE DES MAINS; OBSERVANCE; TAUX; PERSONNEL



Background: Health care worker hand hygiene (HH) is a major quality and safety concern since poor hand

hygiene has been linked with hospital associated infections. Dartmouth-Hitchcock Medical Center has been

involved in a 4-year initiative to improve hand hygiene. In 2006, HH compliance occurred 41% of the time and

by 2009, it had improved to 91%. We wanted to understand some of the unexplained variability in HH to help

determine where to target more specific strategies.

Methods: To help determine where some of the variability in HH compliance rates occurred, an analysis of

means chart was used to determine whether role type of the health care worker and hospital areas had

significantly different HH rates compared with the overall HH rate.





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Results: The overall HH rate between March 2008 and December 2009 was 87%. There was a wide and

significant variation between the 16 groups of 2 types of health care workers in 8 hospital areas from the

lowest rate of 64% to a high of 96%.

Conclusion: Analysis of means revealed significant differences in HH rates relative to the type of worker and

hospital areas. Although the method does not inform the organization of what type of intervention will work

where and why, it allows high and low performing groups to be identified, so that organizations can learn from

them to generate and test theories.





Infection urinaire



NosoBase n° 32103

Evolution des infections urinaires sur sonde chez des adultes en soins intensifs - Etats-Unis, 1990-

2007



Burton DC; Edwards JR; Srinivasan A; Fridkin SK; Gould CV. Trends in catheter-associated urinary tract

infections in adult intensive care units - United States, 1990-2007. Infection control and hospital epidemiology

2011/08; 32(8): 748-756.



Mots-clés : SOIN INTENSIF; INFECTION URINAIRE; SONDAGE URINAIRE; TAUX; RECOMMANDATION;

STATISTIQUE; SURVEILLANCE



Background: Over the past 2 decades, multiple interventions have been developed to prevent catheter-

associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection

Control Practices Advisory Committee were recently revised.

Objective: To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United

States from 1990 through 2007.

Methods: Data were reported to the Centers for Disease Control and Prevention (CDC) through the National

Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety

Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to

identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic

bacteriuria [ASB]) and urinary catheter-days (UC-days) in months selected for surveillance. Data from all

facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-

days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.

Results: Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing

1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173),

and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%-67% in SUTI rates and

29%-72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates

occurred in all ICU types except cardiothoracic ICUs.

Conclusions: Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities

reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these

decreases and to implement new CAUTI prevention guidelines.





NosoBase n° 32104

Un outil de surveillance informatisée des infections urinaires sur sonde



Choudhuri JA; Pergamit RF; Chan JD; Schreuder AB; McNamara E; Lynch JB; Dellit TH. An electronic

catheter-associated urinary tract infection surveillance tool. Infection control and hospital epidemiology

2011/08; 32(8): 757-762.



Mots-clés : SURVEILLANCE; INFECTION URINAIRE; SONDAGE URINAIRE; INFORMATIQUE; ETUDE

RETROSPECTIVE; TAUX; INCIDENCE; CENTRE HOSPITALIER UNIVERSITAIRE



Objective: To develop and validate an electronic surveillance tool for catheter-associated urinary tract

infections (CAUTIs).

Design: Retrospective cohort study.

Setting: 413-bed university-affiliated urban teaching hospital.

Methods: An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on

the objective components of the National Healthcare Safety Network (NHSN) definitions including fever,

urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).

Results: During January and February 2010, 204 positive urine cultures (=10(3) colony-forming units/mL)

were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic



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surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5

per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units,

0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In

comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136

of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%)

of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%)

infections. Agreement between the electronic surveillance and manual IP review was assessed as very good

(?, 0.80; 95% confidence interval, 0.71-0.89).

Conclusions: We report an attempt at automating surveillance for CAUTI. With a high negative predictive

value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of

rates and catheter utilization. This approach should be validated in different patient populations.





Kinésithérapie



NosoBase n° 31469

Observation des pratiques d'hygiène : le port du masque en masso-kinésithérapie



Hotte N; Planche MA. Kinésithérapie 2011; 114: 47-52.



Mots-clés : MASQUE; REEDUCATION; ATTITUDE; PERSONNEL; PRECAUTION COMPLEMENTAIRE;

QUESTIONNAIRE; SOIN; SOIN INTENSIF; PRECAUTION STANDARD; CHAMBRE; EVALUATION DES

PRATIQUES PROFESSIONNELLES; FORMATION



La pratique de la rééducation respiratoire expose au risque de transmission des infections respiratoires.

Ainsi, la mesure de protection essentielle est le port de masque par le thérapeute lors des soins. Cette

mesure est moins promue que le lavage des mains. Aussi, il nous a paru intéressant d'étudier le

comportement du masseur-kinésithérapeute (MK) face à cette recommandation. Nous avons donc réalisé

une observation des pratiques dont les conclusions pourraient être la base de propositions d'amélioration.

Cette observation montre des points positifs (le masque est porté systématiquement en réanimation, etc.),

ainsi que des points négatifs (le port est insuffisant lorsque le kinésithérapeute a une rhinopharyngite, la

formation est insuffisante, etc.). Ce travail pourrait être élargi, en particulier dans le secteur libéral, et pourrait

être intégré à l'évaluation des pratiques professionnelles en kinésithérapie respiratoire afin que le MK ne soit

pas un vecteur d'infection nosocomiale.





Médicament



NosoBase n° 31443

Gestion des risques et circuit du médicament au bloc opératoire



Bussières JF; Lebel D; Mathews S. Risques et qualité en milieu de soins 2011/07; 8(2): 165-172.



Mots-clés : BLOC OPERATOIRE; GESTION DES RISQUES; MEDICAMENT; CIRCUIT; HISTORIQUE;

EVALUATION



Objectif : L'objectif de cet article est de décrire brièvement l'état des lieux en ce qui concerne le circuit du

médicament au bloc opératoire et de présenter des initiatives d'optimisation de ce circuit au sein d'un

établissement québécois.

Contexte : Il existe peu de données sur la pratique pharmaceutique en bloc opératoire. Alors que la pratique

pharmaceutique est passée d'une profession axée sur les services et la dispensation de médicaments, à

l'émergence de pharmacie clinique puis de soins pharmaceutiques, cette évolution n'a pas mené à

l'implication très active des pharmaciens au bloc opératoire.

Resultats : En collaboration avec le chez du département d'anesthésie, des infirmières et des

inhalothérapeutes, nous avons élaboré 26 critères de conformité du circuit du médicament au bloc opératoire

et avons procédé à une autoévaluation à partir d'observations directes et de rencontres. 27% des situations

ont été jugées conformes aux critères (n=7), 65 % partiellement conforme (n=17) et 8% non-conformes (n=2).

Pour chaque critère, nous présentons un plan d'action et un échéancier d'implantation subdivisé selon les

actions réalisées et à venir.

Discussion et Conclusion : Il s'agit de la première évaluation publiée au Canada sur la conformité du circuit

du médicament au bloc opératoire faisant état de la démarche retenue et d'un plan d'action. Nul doute que le

circuit du médicament comporte un risque important d'erreurs médicamenteuses au bloc opératoire. Bien que



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NosoVeille – Bulletin de veille Septembre 2011



ce risque soit mal circonscrit dans la littérature, le département de pharmacie, de concert avec le

département d'anesthésie a tenté de définir plus clairement ce risque et de proposer un plan d'action visant à

le réduire.





Pédiatrie



NosoBase n° 31399

Gastroentérites nosocomiales à rotavirus dans un centre hospitalier pédiatrique au Canada :

incidence, poids des infections et patients infectés



Verhagen P; Moore D; Manges A; Quach C. Nosocomial rotavirus gastroenteritis in a Canadian paediatric

hospital: incidence, disease burden and patients affected. The Journal of hospital infection 2011/09; 79(1):

59-63.



Mots-clés : PEDIATRIE; GASTRO-ENTERITE; INCIDENCE; PEDIATRIE; NOROVIRUS; ETUDE

RETROSPECTIVE; COHORTE; SURVEILLANCE; MORBIDITE; DUREE DE SEJOUR



Rotavirus is a well-recognised nosocomial pathogen in paediatric settings. Although rotavirus gastroenteritis

is a vaccine-preventable disease, there is currently no publicly funded programme in Canada. The objective

of this study was to inform rotavirus vaccination strategy by determining the incidence of nosocomial rotavirus

gastroenteritis (NRVGE), estimating the burden of disease and characterising the patients affected. We

performed a retrospective cohort study of all NRVGE cases over a period of 10 years in a Canadian tertiary-

care paediatric hospital. Cases (N=214) were identified by the hospital's prospective surveillance programme

for nosocomial infections. The incidence was 0.5 per 1,000 patient-days (95% confidence interval: 0.43-0.57)

with no significant decline over the 10-year period. The infection rate per hospital day was highest among

patients with a hospital stay of >5 days. A chronic underlying medical condition was present in 126 patients

(59%), was often associated with previous hospitalisation, and was identifiable early in life for 95 patients

(44%). Rehydration was required for 132 (62%) patients and was intravenous in 98 (46%). Twenty-six

patients (12%) required readmission, for a median of four days, for NRVGE that occurred after discharge.

Nosocomial rotavirus infection continues to be an important problem in paediatric hospitals, predominantly for

children with underlying medical conditions requiring recurrent and prolonged hospitalisation. A rotavirus

immunisation programme targeted at vulnerable patients, such as infants with congenital pathology and low

birth weight, requires assessment in Canada and other countries that have not introduced universal rotavirus

immunisation.





Personnel



NosoBase n° 31323

Prévention du prochain "SRAS". Attitude du personnel soignant européen envers le suivi de leur

santé pour la surveillance des nouvelles infections émergentes : étude qualitative



Aghaizu A; Elam G; Ncube F; Thomson G; Szilagyi E; Eckmanns T; et al. Preventing the next 'SARS' -

European healthcare workers' attitudes towards monitoring their health for the surveillance of newly emerging

infections: qualitative study. BMC public health 2011; in press: 32 pages.



Mots-clés : SURVEILLANCE; PREVENTION; SRAS; PERSONNEL; ATTITUDE; EUROPE; PERCEPTION;

TRAVAIL; RISQUE PROFESSIONNEL; FACTEUR DE RISQUE; EPIDEMIE; EUROPE



Background: Hospitals are often the epicentres of newly circulating infections. Healthcare workers (HCWs)

are at high risk of acquiring infectious diseases and may be among the first to contract emerging infections.

This study aims to explore European HCWs' perceptions and attitudes towards monitoring their absence and

symptom reports for surveillance of newly circulating infections.

Methods: A qualitative study with thematic analysis was conducted using focus group methodology. Forty-

nine hospital-based HCWs from 12 hospitals were recruited to six focus groups; two each in England and

Hungary and one each in Germany and Greece.

Results: HCWs perceived risk factors for occupationally acquired infectious diseases to be 1.) exposure to

patients with undiagnosed infections 2.) break-down in infection control procedures 3.) immuno-naivety and

4.) symptomatic colleagues. They were concerned that a lack of monitoring and guidelines for infectious

HCWs posed a risk to staff and patients and felt employers failed to take a positive interest in their health.

Staffing demands and loss of income were noted as pressures to attend work when unwell. In the UK,



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Hungary and Greece participants felt monitoring staff absence and the routine disclosure of symptoms could

be appropriate provided the effectiveness and efficiency of such a system were demonstrable. In Germany,

legislation, privacy and confidentiality were identified as barriers. All HCWs highlighted the need for

knowledge and structural improvements for timelier recognition of emerging infections. These included

increased suspicion and awareness among staff and standardised, homogenous absence reporting systems.

Conclusions: Monitoring absence and infectious disease symptom reports among HCWs may be a feasible

means of surveillance for emerging infections in some settings. A pre-requisite will be tackling the drivers for

symptomatic HCWs to attend work.





NosoBase n° 31246

Couverture vaccinale pour la grippe, l'hépatite B et le tétanos parmi le personnel soignant aux Etats-

Unis



Lu PJ; Euler GL. Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the

United States. American journal of infection control 2011/08; 39(6): 488-494.



Mots-clés : GRIPPE; HEPATITE B;CLOSTRIDIUM TETANI;VACCIN; PERSONNEL;RISQUE

PROFESSIONNEL;IMMUNITE;OBSERVANCE;ANALYSE;ENQUETE;QUESTIONNAIRE



Background: Health care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-

preventable diseases. Maintenance of immunity is an essential prevention practice for HCP. We assessed the

recent influenza, hepatitis B, and tetanus vaccination coverage among HCP in the United States.

Methods: We analyzed data from the 2007 National Immunization Survey-Adult restricted to survey

respondents aged 18 to 64 years. Influenza, hepatitis B, and tetanus vaccination coverage levels among HCP

were assessed. Multivariable logistic regression was conducted to assess factors independently associated

with receipt of vaccination among HCP.

Results: Among HCP aged 18 to 64 years, 46.7% (95% confidence interval [CI]: 39.6%-53.8%) had received

influenza vaccination for the 2006-2007 season, and 70.4% (95% CI: 63.9%-76.1%) received tetanus

vaccination in the past 10 years; 61.7% (95% CI: 52.5%-70.2%) had received 3 or more doses of hepatitis B

vaccination among HCP aged 18 to 49 years. Multiple logistic regression analysis showed that being married

was associated with influenza vaccination coverage, higher education level was associated with hepatitis B

vaccination coverage, and younger age was significantly associated with tetanus vaccination among HCP.

Among those HCP who did not receive influenza vaccination, the most common reason reported was

respondent concerns about vaccine safety and adverse effects.

Conclusion: By 2007, influenza and hepatitis B vaccination coverage among HCP remained well below the

Healthy People 2010 objectives. Tetanus vaccination level was 70%, and this study provided a baseline data

for tetanus vaccination among HCP. Innovative strategies are needed to further increase vaccination





Prévalence



NosoBase n° 32105

Prévalence des infections associées aux soins chez des personnes âgées dans des hôpitaux de court

séjour



Cairns S; Reilly J; Stewart S; Tolson D; Godwin J; Knight P. The prevalence of health care-associated

infection in older people in acute care hospitals. Infection control and hospital epidemiology 2011/08; 32(8):

763-767.



Mots-clés : PREVALENCE; COURT SEJOUR; PERSONNE AGEE; FACTEUR DE RISQUE; AGE;

GERIATRIE; MEDECINE; CHIRURGIE; CHIRURGIE ORTHOPEDIQUE



Objective- To determine the prevalence of health care-associated infection (HAI) in older people in acute care

hospitals, detailing the specific types of HAI and specialties in which these are most prevalent.

Design- Secondary analysis of the Scottish National Healthcare Associated Infection Prevalence Survey data

set.

Patients and setting- All inpatients in acute care ([Formula: see text]) in all acute care hospitals in Scotland

([Formula: see text]).

Results- The study found a linear relationship between prevalence of HAI and increasing age ([Formula: see

text]) in hospital inpatients in Scotland. Urinary tract infections and gastrointestinal infections represented the

largest burden of HAI in the 75-84- and over-85-year age groups, and surgical-site infections represented the

largest burden in inpatients under 75 years of age. The prevalence of urinary catheterization was higher in



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each of the over-65 age groups ([Formula: see text]). Importantly, this study reveals that a high prevalence of

HAI in inpatients over the age of 65 years is found across a range of specialties within acute hospital care. An

increased prevalence of HAI was observed in medical, orthopedic, and surgical specialties.

Conclusions- HAI is an important outcome indicator of acute inpatient hospital care, and our analysis

demonstrates that HAI prevalence increases linearly with increasing age ([Formula: see text]). Focusing

interventions on preventing urinary tract infection and gastrointestinal infections would have the biggest public

health benefit. To ensure patient safety, the importance of age as a risk factor for HAI cannot be

overemphasized to those working in all areas of acute care.





NosoBase n° 31331

Prévalence ponctuelle et facteurs de risque d'infections associées aux soins dans des services de

médecine générale



Puhto T; Ylipalosaari P; Ohtonen P; Syrjala H. Point prevalence and risk factors for healthcare-associated

infections in primary healthcare wards. Infection 2011/06; 39(3): 217-223.



Mots-clés : PREVALENCE; FACTEUR DE RISQUE; CENTRE HOSPITALIER GENERAL; MEDECINE

GENERALE; SOLUTION HYDROALCOOLIQUE; CONSOMMATION; ANTIBIOTIQUE; DDJ; ANALYSE

MULTIVARIEE; STRUCTURE DE SOINS



Purpose: The aim of this study was to document the point prevalence of healthcare-associated infections

(HAIs) in the public primary healthcare wards, which treat both acute and long-term care patients. We also

assessed the risk factors for HAI and the consumption of alcoholic hand rubs and antibiotics.

Methods: A cross-sectional study was performed in northern Finland in 2006 including all healthcare centers

in the Oulu University Hospital district.

Results: There were 1,190 patients eligible for study in 44 public primary healthcare wards. The point

prevalence of HAIs was 10.1%. The most common infections were urinary tract infections (30%), lower

respiratory tract infections (27%), and skin and soft tissue infections (20%). The prevalence of HAIs did not

depend on whether wards gave acute care, long-term care, or both acute and long-term care. In the

multivariate analysis, the main risk factors for HAI were: more than three antibiotic prescriptions during the

previous year, fully bedridden, renal disease, venous catheter, age over 80 years, previous hospitalization

during the past six months, and implanted foreign material. A prophylactic antibiotic was a protecting factor.

Antimicrobial treatment was given for 18% of the study population and another 18% received prophylactic

antimicrobials.

Conclusions: HAIs are common in Finnish primary healthcare wards and there is a need to improve everyday

practices in the wards in order to reduce the number of HAIs. It is also important to reduce the inappropriate

use of antibiotics.





NosoBase n° 31294

Précision et validité d'une étude de prévalence ponctuelle hebdomadaire pour l'évaluation des

tendances des infections associées aux soins dans un centre hospitalier universitaire en Turquie



Ustun C; Hosoglu S; Geyik MF; Parlak Z; Ayaz C. The accuracy and validity of a weekly point-prevalence

survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey. International

journal of infectious diseases 2011; in press: 4 pages.



Mots-clés : PREVALENCE; CENTRE HOSPITALIER UNIVERSITAIRE; SURVEILLANCE; ETUDE

PROSPECTIVE; EOH; PNEUMONIE; INFECTION URINAIRE; SOIN INTENSIF; BRULE



Objective: To evaluate the validity of a weekly point-prevalence survey (WPS) by comparing it with a

prospective-active incidence survey (PIS).

Methods: WPS and PIS were conducted at a tertiary referral hospital between January and December 2006.

Each Wednesday, an infection control team reviewed all clinical records of patients with hospital-acquired

infections (HAIs) by WPS. Routine PIS was conducted with daily visits by the same team. The Rhame and

Sudderth formula was used for converting the data between WPS and PIS.

Results: During the study period, 1287 HAIs were detected in 37 466 patients by WPS. The mean observed

prevalence and calculated prevalence were 5.42% and 5.45%, respectively. The reanimation intensive care

unit (ICU) (49.4%) and burns unit (27.6%) had the highest prevalence rates. Pneumonia (0.94%) and urinary

tract infections (0.37%) were the most frequent infections. Overall 602 HAIs were detected in 545 patients by

PIS. The mean observed incidence and calculated incidence were 2.42/1000-admissions and 2.41/1000-

admissions, respectively. The Critical care ICU (37.0/1000-admissions) and burns unit (24.8/1000-



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NosoVeille – Bulletin de veille Septembre 2011



admissions) had the highest incidences of HAI. Pneumonia (0.64/1000-admissions) and urinary tract

infections (0.37/1000-admissions) were the most frequent infections.

Conclusions: This study confirms a close relationship between prevalence and incidence data. WPS may be

a useful method for following HAIs when PIS cannot be performed.





Prévention



NosoBase n° 31243

Efficacité de la mise en place complète d'un faisceau de mesures individualisées de lutte contre le

risque infectieux pour la prévention des infections associées aux soins dans des services de

médecine générale



Korbkitjaroen M;Vaithayapichet S; Kachintorn K; Jintanothaitavorn D; Wiruchkul N;Thamlikitkul V.

Effectiveness of comprehensive implementation of individualized bundling infection control measures for

prevention of health care-associated infections in general medical wards. American journal of infection control

2011/08; 39(6): 471-476.



Mots-clés : PREVENTION; MEDECINE; EFFICACITE; RANDOMISATION; FACTEUR DE RISQUE;

PREVALENCE; TAUX; INFIRMIER HYGIENISTE; MEDECIN HYGIENISTE; OBSERVANCE; PERSONNEL



Background: The prevalence of health care-associated infections (HAIs) in general medical wards at Siriraj

Hospital in Bangkok, Thailand remains at 10% even after infection control measures were launched. The

present study aimed to determine the effectiveness of comprehensive individualized bundling infection control

measures in reducing HAIs and to identify the lowest possible rate of HAIs in general medical wards.

Methods: This was a cluster randomized controlled study conducted in 8 general medical wards (4 control

wards and 4 intervention wards) at Siriraj Hospital. The patients hospitalized in the control wards received

regular health care, as well as regular measures for preventing HAIs. The patients hospitalized in the

intervention wards received additional measures. Each patient in the intervention wards was visited by the

infection control team once a day until he or she left the hospital. The infection control team identified risk

factors for developing HAI in each patient, coordinated with the local health care team to eliminate or

minimize such risk factors, and encouraged responsible personnel to comply with the appropriate infection

control measures for each patient.

Results: Between January and April 2009, there were 954 patients (9,650 hospitalization-days) in the

intervention wards and 920 patients (9,777 hospitalization-days) in the control wards. The patient

characteristics were comparable in the 2 groups. The prevalence of HAI was significantly lower in the

intervention wards compared with the control wards (5.6% vs 9.2%; P = .003). Six episodes of HAI in patients

in the intervention wards could have been avoided.

Conclusion: Comprehensive individualized bundling infection control measures were effective in reducing the

prevalence of HAIs in general medical wards. The target overall prevalence of HAIs in general medical wards

should not exceed 4.9%.





Pseudomonas aeruginosa



NosoBase n° 31332

Isolements sporadiques d'un clone de Pseudomonas aeruginosa multi-résistant aux antibiotiques au

cours d'une épidémie de 14 mois dans un centre hospitalier d'Hiroshima.



Kouda S; Fujiue Y; Watanabe Y; Ohara M; Kayama S; Kato F; et al. Sporadic isolations of a multi-drug

resistant Pseudomonas aeruginosa clone during a 14-month epidemic in a general hospital in Hiroshima.

Infection 2011/06; 39(3): 247-253



Mots-clés : PSEUDOMONAS AERUGINOSA; EPIDEMIE; PFGE; MULTIRESISTANCE; EPIDEMIOLOGIE;

TYPAGE; BIOLOGIE MOLECULAIRE; ENVIRONNEMENT; PRELEVEMENT; CONTAMINATION;

SURVEILLANCE



Background: During 2005-2007, we experienced sporadic isolations of multidrug-resistant (MDRP)

Pseudomonas aeruginosa from wards in a general hospital in Hiroshima. The objective of this study was to

analyze epidemiology relationships and the mode of spread of the strains.









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Methods: Clonality was assessed using pulsed-field gel electrophoresis (PFGE) and serotyping. MICs were

determined using the microdilution broth method. Investigations of the affected patients' movements and

environmental sampling from the affected wards were conducted.

Results: An abrupt increase in MDRP isolations began at the end of 2005 and ended in February 2007. A

total of 25 MDRP strains were sporadically isolated from nine wards. Fourteen strains were genotypically and

serologically identical. Analysis of the patients' movements identified that six of the 14 MDRP-positive

patients became positive for MDRP when they were in the intensive care unit (ICU), and two became positive

after the patients moved from the ICU to another nursing unit. Four MDRP strains were isolated from patients

who did not stay in the ICU and were in ward E6, which had the second highest number of isolations. In July

2006, environmental sampling of the hospital identified a toilet brush in ward E6 that was contaminated with

MDRP that was genotypically and serologically identical to the clinical isolates.

Conclusions: Our study suggests that the sporadic increase in MDRP isolates during 2005-2007 in the

general hospital in Hiroshima was due to an epidemic of an MDRP clone. Continuity and spread of infection

was probably due to cross infection and contamination in the hospital with the MDRP strain.





NosoBase n° 31397

Contrôle d'une épidémie d'infections à Pseudomonas aeruginosa résistant aux carbapénèmes dans

une unité d'onco-hématologie



Nagao M; Linuma Y; Igawa J; Saito T; Yamashita K; Kondo T; et al. Control of an outbreak of carbapenem-

resistant Pseudomonas aeruginosa in a haemato-oncology unit. The Journal of hospital infection 2011/09;

79(1): 49-53.



Mots-clés : PSEUDOMONAS AERUGINOSA; HEMATOLOGIE; CANCEROLOGIE; CARBAPENEME;

ANTIBIORESISTANCE; EPIDEMIE; MULTIRESISTANCE; SURVEILLANCE; INCIDENCE; CENTRE

HOSPITALIER UNIVERSITAIRE; CONTROLE; PRECAUTION COMPLEMENTAIRE; CAS TEMOIN;

ENVIRONNEMENT



An outbreak of a multidrug-resistant Pseudomonas aeruginosa producing metallo-ß-lactamase (MBLPA) in a

haemato-oncology unit was controlled using multidisciplinary interventions. The present study assesses the

effects of these interventions by active surveillance of the incidence of MBLPA infection at the 1,240-bed

tertiary care Kyoto University Hospital in Kyoto, Japan. Infection control strategies in 2004 included

strengthening contact precautions, analysis of risk factors for MBLPA infection and cessation of urine

collection. However, new MBLPA infections were identified in 2006, which prompted enhanced environmental

cleaning, routine active surveillance, and restricting carbapenem usage. Between 2004 and 2010, 17 patients

in the unit became infected with indistinguishable MBLPA strains. The final five infected patients were found

by routine active surveillance, but horizontal transmission was undetectable. The MBLPA outbreak in the

haemato-oncology unit was finally contained in 2008.





NosoBase n° 31398

Acquisition de Pseudomonas aeruginosa ultra-résistants aux antibiotiques parmi des patients

hospitalisés : facteurs de risque et mécanismes de résistance aux carbapénèmes



Park YS; Lee H; Chin BS; Han SH; Hong SG; Hong SK; et al. Acquisition of extensive drug-resistant

Pseudomonas aeruginosa among hospitalized patients: risk factors and resistance mechanisms to

carbapenems. The Journal of hospital infection 2011/09; 79(1): 54-58.



Mots-clés : FACTEUR DE RISQUE; PSEUDOMONAS AERUGINOSA; CARBAPENEME;

ANTIBIORESISTANCE; CAS TEMOIN; IMIPENEME; PCR; BIOLOGIE MOLECULAIRE; SCORE;

VENTILATION ASSISTEE; PFGE; TRANSMISSION SOIGNE-SOIGNE



Extensive drug-resistant Pseudomonas aeruginosa (XDRPA) strains, defined as resistant to all available

antipseudomonal antibiotics, have been reported recently. This study aimed to investigate the risk factors for

XDRPA acquisition by patients and the resistance mechanisms to carbapenems. From June to November

2007, XDRPA isolates were collected from patients in eight tertiary care hospitals. A case-control study was

performed to determine factors associated with XDRPA acquisition. EDTA-imipenem disc synergy tests, and

polymerase chain reaction amplification and sequencing were performed to detect the presence of metallo-ß-

lactamases (MBLs). Risk factor analysis was performed for 33 patients. Mechanical ventilation [odds ratio

(OR) 8.2, 95% confidence interval (CI) 1.3-52.2; P=0.026] and APACHE II score (OR 1.2, 95% CI 1.0-1.3;

P=0.007) were identified as independent risk factors for XDRPA acquisition. Pulsed-field gel electrophoresis

of XDRPA identified clonal epidemic isolates co-existing with sporadic isolates. Eight of 43 (19%) XDRPA



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NosoVeille – Bulletin de veille Septembre 2011



isolates were shown to produce MBLs; four produced VIM-2 and four produced IMP-6. This study suggests a

major role for mechanical ventilation in XDRPA acquisition. Moreover, pulsed-field gel electrophoresis

identified a clonal epidemic within hospitals. Taken together, these results suggest that patient-to-patient

transmission contributes to XDRPA acquisition in Korea.





NosoBase n° 31304

Un clone épidémique de Pseudomonas aeruginosa producteur de métallo-bêta-lactamase ayant un

phénotype hétérogène de résistance aux carbapénèmes responsable d'infection chez un patient

présentant une mucoviscidose



Pollini S; Fiscarelli E; Mugnaioli C; Di Pilato V; Ricciotti G; Neri AS; et al. Pseudomonas aeruginosa infection

in cystic fibrosis caused by an epidemic metallo-beta-lactamase-producing clone with a heterogeneous

carbapenem resistance phenotype. Clinical microbiology and infection 2011/08; 17(8): 1272-1275.



Mots-clés : PSEUDOMONAS AERUGINOSA; MUCOVISCIDOSE; CARBAPENEME; ANTIBIORESISTANCE;

TYPAGE; BETALACTAMINE; PEDIATRIE



An epidemic IMP-13 metallo-ß-lactamase (MBL)-producing Pseudomonas aeruginosa clone, causing

infections and even large outbreaks in Italian critical care settings, was detected in a young cystic fibrosis

patient. In this patient, the chronic infection was sustained by distinct clonal sub-populations of the MBL-

producing P. aeruginosa clone, either susceptible or resistant to carbapenems. These findings underscore the

importance of infection prevention practices in cystic fibrosis settings and pose an important diagnostic and

therapeutic challenge.





NosoBase n° 31293

Bactériémies à Pseudomonas aeruginosa à l'admission à l'hôpital : facteurs de risque de mortalité et

influence d'un traitement antibiotique empirique inadapté



Schechner V; Gottesman T; Schwartz O; Korem M; Maor Y; Rah AV; et al. Pseudomonas aeruginosa

bacteremia upon hospital admission: risk factors for mortality and influence of inadequate empirical

antimicrobial therapy. Diagnostic microbiology and infectious disease 2011; in press: 8 pages.



Mots-clés : PSEUDOMONAS AERUGINOSA; FACTEUR DE RISQUE; MORTALITE; SEJOUR;

BACTERIEMIE; ANTIBIOTIQUE; TRAITEMENT; ETUDE PROSPECTIVE; SYNDROME SEPTIQUE;

ANALYSE MULTIVARIEE



Pseudomonas aeruginosa is an uncommon cause of bacteremia upon hospital admission (UHA) and the

chosen empirical antimicrobial therapy may not cover it appropriately. In a multicenter prospective study

conducted in Israel, we evaluated risk factors for in-hospital mortality in patients with P. aeruginosa

bacteremia UHA and determined the influence of delay in adequate empirical antimicrobial therapy on

patients' outcome. Seventy-six adult patients with P. aeruginosa bacteremia within 72 h of hospital admission

were included. Demographic, clinical, and treatment data were collected. Microbiological adequacy of

empirical therapy was determined. Severe sepsis or septic shock at admission (OR, 21.9; P = 18 years, 4 (29%) were hospitalized, 7

(50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown

vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%)

was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed

that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583

tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2

hospitals spent US$799,136 responding to and containing 7 cases in these facilities.

Conclusions: Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring

rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated

spread and in minimizing hospital outbreak-response costs.





Soins intensifs



NosoBase n° 31462

Revue de morbi-mortalité (RMM) en anesthésie-réanimation : retour d'expérience au CHU de Nancy



Baumann A; Cuignet Royer E; Bouaziz H; Borgo J; Claudot F; Torrens J; et al. Annales françaises

d'anesthésie et de réanimation 2011; in press: 6 pages



Mots-clés : MORBIDITE; MORTALITE; GESTION DES RISQUES; SOIN INTENSIF; FORMATION; BLOC

OPERATOIRE



Objectives: Assessment of the morbidity mortality conferences (MMC) durableness in the Anaesthesiology

and Surgical Intensive Care Department of the Urban Hospitals of Nancy University Hospital; evaluation of

the proportion of medical education in the corrective actions implemented, and research for improvement

ways.

Patients: All the cases of death and near-death in the operating room and all the cases deemed to be

instructive or useful for security improvement.



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NosoVeille – Bulletin de veille Septembre 2011



Method: Retrospective analysis of MMC activity since its initiation in 2005.

Results: Durability of MMC and good attendance rate have been sustained over time. As in the USA, MMCs

result firstly in resident's education and continued medical education actions. Medical education actions

represent 75% of all corrective measures, followed by changes in practices (62%), in procedures (48%) and

in organisation (5%).

Discussion: The development process of a culture of the safety has been initiated and perpetuated. Some

ways of improvement have been proposed: MMC must certainly be widened as well regarding to the

categories of addressees, as the topics (any event deemed to be noteworthy for the safety of care) or the

time scale of the analysis. Others propositions: preparation of the presentations with a colleague experienced

in MMC; participation of external MMC experts; monitoring of local markers of security of care and of

corrective measures efficiency; inclusion of MMC cases presentation in the trainees pedagogic objectives.





NosoBase n° 31396

Détection automatisée des infections nosocomiales : évaluation de différentes stratégies dans une

unité de réanimation 2000-2006



Bouzbid S; Gicquel Q; Gerbier S; Chomarat M; Pradat E; Fabry J; et al. Automated detection of nosocomial

infections: evaluation of different strategies in an intensive care unit 2000-2006. The Journal of hospital

infection 2011/09; 79(1): 38-43.



Mots-clés : SOIN INTENSIF; INFORMATIQUE; CENTRE HOSPITALIER UNIVERSITAIRE;

SURVEILLANCE; SENSIBILITE; SPECIFICITE



The aim of this study was to evaluate seven different strategies for the automated detection of nosocomial

infections (NIs) in an intensive care unit (ICU) by using different hospital information systems: microbiology

database, antibiotic prescriptions, medico-administrative database, and textual hospital discharge summaries.

The study involved 1499 patients admitted to an ICU of the University Hospital of Lyon (France) between

2000 and 2006. The data were extracted from the microbiology laboratory information system, the clinical

information system on the ward and the medico-administrative database. Different algorithms and strategies

were developed, using these data sources individually or in combination. The performances of each strategy

were assessed by comparing the results with the ward data collected as a national standardised surveillance

protocol, adapted from the National Nosocomial Infections Surveillance system as the gold standard. From

1499 patients, 282 NIs were reported. The strategy with the best sensitivity for detecting these infections

using an automated method was the combination of antibiotic prescription or microbiology, with a sensitivity of

99.3% [95% confidence interval (CI): 98.2-100] and a specificity of 56.8% (95% CI: 54.0-59.6). Automated

methods of NI detection represent an alternative to traditional monitoring methods. Further study involving

more ICUs should be performed before national recommendations can be

established.





NosoBase n° 31357

Identification de nouveaux facteurs de risque de pneumonies à Pseudomonas aeruginosa dans des

unités de réanimation : expérience d'une surveillance nationale en France, REA-RAISIN



Venier AG; Gruson D; Lavigne T; Jarno P; L'Heriteau F; Coignard B; et al. Identifying new risk factors for

Pseudomonas aeruginosa pneumonia in intensive care units: experience of the French national surveillance,

REA-RAISIN. The Journal of hospital infection 2011/09; 79(1): 44-48.



PSEUDOMONAS AERUGINOSA; FACTEUR DE RISQUE; SURVEILLANCE; SOIN INTENSIF; RESEAU;

RAISIN; INCIDENCE; PNEUMONIE; STATISTIQUE



Pseudomonas aeruginosa is an important pathogen of complicated pneumonia in intensive care units (ICUs).

Our objective was to determine 'patient' and 'ward' risk factors for P. aeruginosa pneumonia among patients

with nosocomial pneumonia in ICU. Data from the 2004-2006 prospective French national nosocomial

infection surveillance in ICUs (REA-RAISIN) were used, including patients admitted for >48h in ICU and who

developed nosocomial pneumonia. Only first pneumonia was considered and categorised as either P.

aeruginosa pneumonia or other micro-organism pneumonia. Multilevel logistic regression model (patient as

first level and ward as second) with P. aeruginosa pneumonia as binary outcome was performed. Of 3,837

included patients from 201 different wards, 25% had P. aeruginosa pneumonia. P. aeruginosa was

significantly more frequent in late onset pneumonia. Higher probability of P. aeruginosa pneumonia was

associated with higher age and length of mechanical ventilation, antibiotics at admission, transfer from a

medical unit or ICU, and admission in a ward with higher incidence of patients with P. aeruginosa infections.



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NosoVeille – Bulletin de veille Septembre 2011



Lower probability of P. aeruginosa was associated with traumatism and admission in a ward with high patient

turnover. Our analyses identified a patient's profile and some ward elements that could make suspect P.

aeruginosa in case of nosocomial pneumonia.





NosoBase n° 32047

Les infections associées aux soins doivent cesser : un projet révolutionnaire visant à réduire les

infections associées aux soins en réanimation



Yngstrom D; Lindstrom K; Nystrom K; Nilsson-Marttala K; Hillblom L; Hansson L; et al. Healthcare-associated

infections must stop: a breakthrough project aimed at reducing healthcare-associated infections

in an intensive-care unit. BMJ quality and safety 2011/07; 20(7): 631-636.



Mots-clés : SOIN INTENSIF; PREVENTION; TRAITEMENT; PREVALENCE; VENTILATION;

OBSERVANCE; INCIDENCE; VENTILATION ASSISTEE; SOIN DE BOUCHE; ASPIRATION; SONDAGE

URINAIRE; TRACHEOTOMIE; PRECAUTION STANDARD; PERSONNEL; DECUBITUS; HYGIENE DES

MAINS; TENUE VESTIMENTAIRE; QUALITE



Background: Healthcare-associated infections are a problem for the Swedish healthcare system. In order to

reduce the risk of acquiring healthcare-associated infections, the intensive-care unit attended a breakthrough

project in 2004-2005, with the aims of studying methods of increasing patient safety and systematically

improving treatment outcomes. The intensive-care unit had no system for registering infections, and the

authors wanted to ascertain the prevalence of healthcare-associated infections, and register and prevent

them.

Objectives: 40% reduction in healthcare-associated infections in ventilated patients. 100% of staff to

implement basic hygiene routines.

Design: The method used was the Breakthrough Series, originally designed by the Institute for Healthcare

Improvement in Boston, Massachusetts, USA. The method aims to bridge the gap between what is known

and what is done, spreading best-practice methods even faster. Many ideas for changes are tested on a

small scale, with the basic rule that the small changes combine to create large changes that lead towards the

final goal.

Results: The frequency of healthcare-associated infections in ventilated patients was reduced by 43%.

Compliance with the basic hygiene routines improved greatly, from 72% on initial measurement to 98% today.

Conclusion: In order to reduce the risk of acquiring healthcare-associated infections and to increase patient

safety, a continuous, systematic effort involving continual measurement and review is necessary.









Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de

votre inter-région :



CCLIN Est CCLIN Ouest CCLIN Paris-Nord CCLIN Sud-Est CCLIN Sud-Ouest

Tél : 03.83.15.34.73 Tél : 02.99.87.35.31 Tél : 01.40.27.42.00 Tél : 04.78.86.49.50 Tél : 05.56.79.60.58

Fax : 03.83.15.39.73 Fax : 02.99.87.35.32 Fax : 01.40.27.42.17 Fax : 04.78.86.49.48 Fax : 05.56.79.60.12

cclin.est@chu-nancy.fr isabelle.girot@chu-rennes.fr karin.lebascle@sap.aphp.fr cclinse@chu-lyon.fr cclin.so@chu-bordeaux.fr









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