NosoVeille - Novembre 2010

NosoVeille Bulletin de veille Novembre 2010

NosoVeille n11

Novembre 2010

Rdacteurs: Nathalie Sanlaville, Sandrine Yvars, Annie Treyve

Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publies au cours du mois coul.

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Abonnement / Dsabonnement

Sommaire de ce numro

Antibiotique

Bactrimie

Chirurgie

Clostridium difficile

Dsinfection

Dispositif mdical

EHPAD

Environnement

Grippe

Hpatite

Hygine des mains

Pdiatrie

Personnel

Signalement

Soins intensifs/Ranimation

Staphylococcus

Strilisation

Usager

Antibiotique

NosoBase n 28667

Prvalence de l'antibiorsistance parmi des isolats Gram ngatif dans une unit de ranimation pour adultes dans un centre hospitalier universitaire en Arabie Saoudite

Al Johani SM; Akhter J; Balkhy H; El-Saed A; Younan M; Memish Z. Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia. Annals of saudi medicine 2010/10; 30(5): 364-369.

Mots-cls : PREVALENCE; SOIN INTENSIF; ANTIBIORESISTANCE; ETUDE RETROSPECTIVE; BACILLE GRAM NEGATIF; ESCHERICHIA COLI; PSEUDOMONAS AERUGINOSA; KLEBSIELLA PNEUMONIAE;

ENTEROBACTER; CARBAPENEME; CEPHALOSPORINE

Background and objectives: Patients in the ICU have encountered an increasing emergence and spread of antibiotic-resistant pathogens. We examined patterns of antimicrobial susceptibility in gram-negative isolates to commonly used drugs in an adult ICU at a tertiary care hospital in Riyadh, Saudi Arabia.

Methods: A retrospective study was carried out of gram-negative isolates from the adult ICU of King Fahad National Guard Hospital (KFNGH) between 2004 and 2009. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method.

Results: The most frequently isolated organism was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pnemoniae, Stenotrophomonas maltophilia, and Enterobacter. Antibiotic susceptibility patterns significantly declined in many organisms, especially A baumannii, E coli, S marcescens, and Enterobacter. A baumannii susceptibility was significantly decreased to imipenem (55% to 10%), meropenem (33% to 10%), ciprofloxacin (22% to 10%), and amikacin (12% to 6%). E coli susceptibility was markedly decreased (from 75% to 50% or less) to cefuroxime, ceftazidime, cefotaxime, and cefepime. S marcescens susceptibility was markedly decreased to cefotaxime (100% to 32%), ceftazidime (100% to 35%), and cefepime (100% to 66%). Enterobacter susceptibility was markedly decreased to ceftazidime (34% to 5%), cefotaxime (34% to 6%), and pipracillin-tazobactam (51% to 35%). Respiratory samples were the most frequently indicative of multidrug-resistant pathogens (63%), followed

by urinary samples (57%).

Conclusion: Antimicrobial resistance is an emerging problem in the KFNGH ICU, justifying new more stringent antibiotic prescription guidelines. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future.

NosoBase n 28615

Epidmiologie clinique et molculaire d'Escherichia coli et de Klebsiella pneumoniae producteurs de bta-lactamases spectre largi dans une tude long terme au Japon

Chong Y; Yakushiji H; Kamimura T. Clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a long-term study from Japan. European journal of clinical microbiology and infectious disease 2010; in press: 5 pages.

Mots-cls : ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; BETA-LACTAMASE A SPECTRE ELARGI; TAUX; PROTEUS MIRABILIS; ANTIBIORESISTANCE

The detection rates of extended-spectrum -lactamase (ESBL)-producing bacteria in Japan are very low (~5%) compared with those obtained worldwide. Further, the current trend of these bacteria in Japan is not known, and few studies with longitudinal observations have been reported. To obtain epidemiologic data on ESBL-producing bacteria, their genotypic features, and their antibiotic resistance patterns in Japan, we analyzed bacterial isolates from hospitalized patients at our institution over the 7-year period from 2003 to 2009. Of 2,304 isolates, 202 (8.8%) were found to be ESBL producers, including Escherichia coli, Klebsiella pneumonia, and Proteus mirabilis. The detection rates of the ESBL-producing isolates gradually increased and reached 17.1% and 10.5% for the E. coli and K. pneumoniae strains, respectively, in 2009. Genotyping analysis showed that ~90% of the ESBL-producing isolates carried the CTX-M genotype, in which the CTX-M-9 group was predominant, although the CTX-M-2 group is considered to be the main genotype in Japan; further, many of the strains produced multiple -lactamases. The detection rates of ESBL-producing bacteria may tend to be high within a limited region in Japan. A countrywide survey is required to understand the trend for ESBL-producing bacteria at the national level. In addition, our findings suggest that the genotypes of the detected ESBL producers are similar to those exhibiting a successful nosocomial spread worldwide.

NosoBase n 28416

Faut-il abandonner la vancomycine ?

Daurel C; Leclercq R. Vancomycin, what else? Archives de pdiatrie 2010/09/01; 17(Suppl 4): S121-S128.

Mots-cls: PEDIATRIE; ANTIBIORESISTANCE; VANCOMYCINE; STAPHYLOCOCCUS AUREUS; GLYCOPEPTIDE; LINEZOLIDE

La vancomycine et la ticoplanine sont des glycopeptides utiliss depuis de nombreuses annes dans les infections staphylocoque dor rsistant la mticilline (SARM). Une certaine nphrotoxicit de la vancomycine, et une efficacit clinique lente font discuter dalternatives possibles. Les glycopeptides ont une activit moindre que celle de loxacilline contre les staphylocoques sensibles la mticilline et doivent tre rservs aux infections SARM. La prvalence des SARM est devenue basse ces dernires annes en pdiatrie mais peut tre frquente chez les nouveau-ns en soins intensifs. Les staphylocoques coagulase-ngative, cause majeure dinfections en nonatalogie, sont souvent rsistants la mticilline. Les SARM communautaires producteurs de toxine de Panton-Valentine responsables dinfections cutanes svres et de rares pneumonies ncrosantes graves chez lenfant dissminent depuis quelques annes mais leur frquence reste basse (2-4 % des SARM). Un nouveau clone de SARM communautaire, producteur de toxine de choc staphylococcique devient plus frquent. Lefficacit de la vancomycine contre les staphylocoques est corrle en sens inverse la CMI. Il faut donc que la CMI soit dtermine dans les infections svres et quune valeur cible du taux srique dau moins 8 fois la CMI soit atteinte. La rsistance aux glycopeptides est rare chez Staphylococcus aureus, mais pas celle la ticoplanine chez les staphylocoques coagulase-ngative. Les SARM restent actuellement sensibles plusieurs antibiotiques outre les glycopeptides. Parmi les antibiotiques rcemment commercialiss, le linzolide et la daptomycine nont pas dautorisation de mise sur le march chez lenfant mais pourraient avoir un intrt.

NosoBase n 28419

Entrobactries productrices de bta-lactamases spectre tendu

Doit C; Mariani-Kurkdjian P; Bingen E. Extended-spectrum beta-lactamase producing-enterobacteriaceae.

Archives de pdiatrie 2010/09/01; 17(Suppl 4): S140-S144.

Mots-cls : BETA-LACTAMASE A SPECTRE ELARGI; ESCHERICHIA COLI; PEDIATRIE; KLEBSIELLA PNEUMONIAE; INCIDENCE

Les bta-lactamases spectre tendu (BLSE) sont des enzymes qui hydrolysent lensemble des pnicillines et les cphalosporines lexception des cphamycines (cfotixine, cfottan) du moxalactam et des carbapnmes. Les premires BLSE drivaient des pnicillinases de type TEM ou SHV-1 par mutation ponctuelle. Plus rcemment, de nouvelles BLSE non drives des pnicillinases ont merg : les cfotaximases de type CTX-M et les ceftazidimases de type PER, GES et VEB. La distribution des espces bactriennes au sein de ces souches a galement volu : K. pneumoniae qui reprsentait environ 60 % de ces souches en 1995, nen reprsente plus que 20 %. Cest chez Escherichia coli que la progression est la plus nette, passant de moins de 10 % en 1995 55 % en 2008. En France, la prvalence des souches dE. coli rsistantes aux cphalosporines de troisime gnration isoles dhmocultures reste < 5 %, mais augmente rgulirement depuis 2002. En pdiatrie, ces souches sont principalement responsables de cystites et de pylonphrites. De rares cas dinfections maternofoetales et de mningites nonatales impliquant ces souches ont t publis. lhpital Robert-Debr, la prvalence des souches dE. coli produisant ce type denzyme ne cesse de crotre depuis le dbut des annes 2000. Ces souches sont frquemment rsistantes au cotrimoxazole, aux quinolones et aux aminosides. Larsenal thrapeutique vis--vis de ces souches peut se restreindre aux carbapnmes, la colimycine, et la fosfomycine.

NosoBase n 28521

Activit comparative de doripnme, mropnme et imipnme dans des isolats cliniques rcents obtenus au cours de l'tude de surveillance pidmiologique COMPACT-Espagne

Gimeno C; Canton R; Garcia A; Gobernado M. Comparative activity of doripenem, meropenem and imipenem in recent clinical isolates obtained during the COMPACT-Spain epidemiological surveillance study. Revista expanola de quimioterapia 20/10/09; 23(3): 144-152.

Mots-cls: EPIDEMIOLOGIE; CARBAPENEME; DORIPENEME; MEROPENEME; IMIPENEME; SURVEILLANCE; CMI; ENTEROBACTERIE; ANTIBIORESISTANCE; PSEUDOMONAS AERUGINOSA; ACINETOBACTER

Introduction: Doripenem is a new carbapenem with broad spectrum antibacterial activity indicated for the treatment of nosocomial pneumonia and complicated urinary and intraabdominal infections.

Methods: Isolates of Pseudomonas aeruginosa, Acinetobacter and Enterobacteriaceae from patients with nosocomial pneumonia, bacteremia and complicated intraabdominal infections attended in 16 Spanish hospitals were included (October 2008 - May 2009). Susceptibility to imipenem, meropenem and doripenem was studied with the Etest method, and the results were interpreted according to the EUCAST criteria.

Results: Considering all the isolates, doripenem (MIC50 0.12 mg/L) was 2- to 8-fold more active than meropenem (0.25 mg/L) and imipenem (1 mg/L). In relation to Enterobacteriaceae, the MIC50 and MIC90 values of doripenem and meropenem were similar (0.03 and 0.12 mg/L, respectively) and clearly superior to those of imipenem (0.25 and 1 mg/L). In the case of P. aeruginosa, MIC50 and MIC90 were more favorable to doripenem (0.25 and 16 mg/L) than to meropenem (0.5 and >or= 64 mg/L) or imipenem (2 and >or= 64 mg/L). In this species, the percentage of strains with lower MIC values for doripenem among those exhibiting intermediate susceptibility and resistance to meropenem was 63.0% (29/46) and 61.7% (63/102), respectively, versus only 4.3% (2/46) and 1.9% (2/102) with higher MIC values for doripenem.

Conclusions: The results obtained in this study are similar to those reported in other countries, and reinforce the superior in vitro activity of doripenem versus the other carbapenems and its position in the treatment guidelines regarding the nosocomial infections for which it is indicated.

NosoBase n 28781

Prvalence et diversit des carbapnmases parmi des isolats d'Acinetobacter non sensibles l'imipnme en Core : mergence d'une nouvelle OXA-182

Kim CK; Lee Y; Lee H; Woo GJ; Song W; KIm MN; et al. Prevalence and diversity of carbapenemases among imipenem-nonsusceptible Acinetobacter isolates in Korea: emergence of a novel OXA-182. Diagnostic microbiology and infectious disease 2010; in press: 7 pages.

Mots-cls : PREVALENCE; ACINETOBACTER; ANTIBIORESISTANCE; CARBAPENEME; IMIPENEME

Increase in multidrug-resistant Acinetobacter poses a serious problem in Korea. In this study, 190 imipenem (IPM)-nonsusceptible (NS) Acinetobacter isolates from 12 Korean hospitals in 2007 were used to determine species, prevalence, and antimicrobial susceptibility of OXA carbapenemase- and metallo--lactamase (MBL)-producing isolates. bla(OXA-23)-like and ISAba1-asssociated bla(OXA-51)-like genes were detected in 80% and 12% of 178 IPM-NS Acinetobacter baumannii isolates, respectively. A novel bla(OXA-182) was detected in 12 IPM-NS A. baumannii isolates. Twelve out of 14 MBL-producing isolates were non-baumannii Acinetobacter. A. baumannii isolates with OXA carbapenemase were more often resistant to aminoglycosides, ciprofloxacin, and tigecycline than non-baumannii Acinetobacter isolates with MBL. Identical pulsed- field gel electrophoresis patterns were observed in 89% of A. baumannii isolates with bla(OXA-23)-like gene. In conclusion, extremely rapid increase of IPM-NS A. baumannii in previous Korean studies was mainly due to clonal spread of OXA-23-producing A. baumannii isolates. A novel OXA-182 emerged in Korea.

NosoBase n 28422

Les carbapnmases des entrobactries

Nordmann P; Carrer A. Carbapenemases in enterobacteriaceae. Archives de pdiatrie 2010/09/01; 17

(Suppl 4): S154-S162.

Mots-cls: CARBAPENEME; PEDIATRIE; BETA-LACTAMASE A SPECTRE ELARGI; ENTEROBACTERIE; EPIDEMIOLOGIE; TRAITEMENT

Les bta-lactamases ayant une activit de carbapnmase sont les plus puissants mcanismes de rsistance aux carbapnmes. Ces carbapnmases sont identifies de faon croissante chez les entrobactries dans le monde entier. Les carbapnmases de type KPC dcrites tout dabord aux tats-Unis chez Klebsiella pneumoniae ont une diffusion mondiale avec une endmicit marque galement en Israel et en Grce. Les carbapnmases de type mtallo-enzymes (VIM, IMP.) ont t galement dcrites dans le monde entier avec une forte prvalence en Europe du Sud et en Asie. OXA-48 est lune des carbapnmases les plus rcemment dcrites, structurellement diffrente des prcdentes et essentiellement identifie dans des pays mditerranens. Les gnes de ces carbapnmases sont le plus souvent plasmidiques, majoritairement dans des souches hospitalires de K. pneumoniae mais leur diffusion communautaire a dj t rapporte. Ces carbapnmases sont prsentes dans des souches multirsistantes aux antibiotiques. Les infections entrobactries productrices de carbapnmases sont difficiles traiter et peuvent tre la source dimpasses thrapeutiques. Leur dtection trs difficile (dtection des infects comme des porteurs), expliquerait leur diffusion bas bruit aux consquences thrapeutiques dramatiques.

NosoBase n 28708

Acquisition de bactries Gram ngatif multirsistantes aux antibiotiques : incidence et facteurs de risque chez des patients en long sjour

O'Fallon E; Kandell R; Schreiber R; D'Agata E. Acquisition of multidrug-resistant gram-negative bacteria:

incidence and risk factors within a long-term care population. Infection control and hospital epidemiology

2010/11; 31(11): 1148-1153.

Mots-cls: MULTIRESISTANCE; FACTEUR DE RISQUE; INCIDENCE; BACTERIE A GRAM NEGATIF; SOIN DE LONGUE DUREE; ETUDE PROSPECTIVE; PRELEVEMENT; COLONISATION; TRANSMISSION SOIGNE-SOIGNE

Background and objective: An improved understanding of the transmission dynamics of multidrug-resistant (MDR) gram-negative bacteria and the mechanism of acquisition in long-term care facilities (LTCFs) could aid in the development of prevention strategies specific to LTCFs. We thus investigated the incidence of acquisition of these pathogens among an LTCF population.

Design: Prospective cohort study.

Setting: Three separate wards at a 600-bed LTCF in metropolitan Boston, Massachusetts, during the period

October 31, 2006, through October 22, 2007.

Participants: One hundred seventy-two LTCF residents.

Methods: A series of rectal samples were cultured to determine acquisition of MDR gram-negative bacteria, defined as absence of MDR gram-negative bacterial colonization at baseline and de novo recovery of MDR gram-negative bacteria from a follow-up culture. Molecular typing was performed to identify genetically linked strains. A nested matched case-control study was performed to identify risk factors associated with acquisition.

Results: Among 135 residents for whom at least 1 follow-up culture was performed, 52 (39%) acquired at least 1 MDR gram-negative organism during the study period. Thirty-two residents (62%) had not been colonized at baseline and had acquired at least 1 MDR gram-negative species at follow-up culture, and 20 residents (38%) were colonized at baseline and had acquired at least 1 MDR gram-negative species at follow-up culture. The most common coresistance pattern was resistance to extended-spectrum penicillins, ciprofloxacin, and gentamicin (57 isolates [42.5%]). Genetically related strains of MDR gram-negative bacteria were identified among multiple residents and between roommates. On conditional logistic regression analysis, antibiotic exposure during the study period was significantly associated with acquisition of MDR gram-negative bacteria (odds ratio, 5.6 [95% confidence interval, 1.1-28.7]; P= .04).

Conclusions: Acquisition of MDR gram-negative bacteria occurred frequently through resident-to-resident transmission. Existing infection control interventions need to be reevaluated.

NosoBase n 28420

Description et investigation dune pidmie nosocomiale de colonisations et dinfections Escherichia coli producteur dune bta-lactamase spectre tendu dans un service de nonatologie

Quinet B; Mitanchez D; Salauze B; Carbonne A; Bingen E; Fournier S; et al. Description and investigation of an outbreak of extended-spectrum beta-lactamase producing Escherichia coli strain in a neonatal unit. Archives de pdiatrie 2010/09/01; 17(Suppl 4): S145-S149.

Mots-cls : NEONATALOGIE; EPIDEMIE; BETA-LACTAMASE A SPECTRE ELARGI; ESCHERICHIA COLI; COLONISATION; BACTERIEMIE

Nous rapportons la description et linvestigation dune pidmie Escherichia coli producteur de bta-lactamase spectre tendu (BLSE) survenue dans un service de nonatologie sur une priode de 5 semaines, ayant entran la colonisation digestive de 27 nouveau-ns sur 59 soit un taux dattaque de 45,7 %. Parmi ces enfants coloniss, lun a dvelopp une mningite avec bactrimie dvolution favorable et un second une conjonctivite. La gestion de lpidmie a ncessit larrt des admissions dans le service, associ des mesures strictes de regroupement de patients et au renforcement des prcautions standard dhygine. Lenqute pidmiologique na pas retrouv de cause unique la contamination croise mais plusieurs dysfonctionnements. La progression du nombre dE. coli BLSE depuis une dcennie, aussi bien lorigine dinfections communautaires quhospitalires, pose un rel problme de sant publique et de choix thrapeutique.

NosoBase n 28804

Une antibiothrapie inapproprie dans des sepsis pathogne Gram ngatif augmente la dure du sjour hospitalier

Shorr AF; Micek ST; Welch EC; Doherty JA; Reichley RM; Kollef MH. Inappropriate antibiotic therapy in gram-negative sepsis increases hospital length of stay. Critical care medicine 2010; in press: 6 pages.

Mots-cls: BACTERIEMIE; TRAITEMENT; ANTIBIOTIQUE; SYNDROME SEPTIQUE; BACILLE GRAM NEGATIF; DUREE DE SEJOUR; COHORTE; ETUDE RETROSPECTIVE; ESCHERICHIA COLI; PSEUDOMONAS

Objectives: To describe the impact of initially inappropriate antibiotic therapy on hospital length of stay in Gram-negative severe sepsis and septic shock.

Design: Retrospective cohort.

Setting: Academic urban hospital.

Patients: Patients with Gram-negative bacteremia (primary or secondary, nosocomial or non-nosocomial) and severe sepsis or septic shock.

Interventions: None.

Measurements and main results: We defined initially inappropriate antibiotic therapy as occurring when the patient either was not administered an antibiotic within 24 hrs of sepsis onset or was treated with an antibiotic to which the culprit pathogen was resistant in vitro. The cohort included 760 subjects (mean age 59.3 16.3 yrs, mean Acute Physiology and Chronic Health Evaluation II score 23.7 6.7). More than half of infections were nosocomial (55.1%), and Escherichia coli represented the most common pathogen (n = 225). Pseudomonas species were isolated in 17.4% of patients. Nearly one-third of patients (31.3%) received initially inappropriate antibiotic therapy. Patients administered initially inappropriate antibiotic therapy were more likely to have a nosocomial infection, to have underlying cancer or diabetes or both, to require chronic hemodialysis, and to undergo mechanical ventilation. Those administered initially inappropriate antibiotic therapy also faced higher inhospital mortality. The unadjusted median length of stay after sepsis onset in those administered initially inappropriate antibiotic therapy was 11 days compared to 9 days in those treated appropriately (p = .028 by log-rank test). In a Cox model controlling for the multiple confounders noted, initially inappropriate antibiotic therapy independently correlated with continued hospitalization (adjusted hazard ratio 1.19, 95% confidence interval 1.01-1.40, p = .044). Adjusting for these covariates indicated that initially inappropriate antibiotic therapy independently increased the median attributable length of stay by 2 days.

Conclusions: Initially inappropriate antibiotic therapy occurs in one-third of persons with severe sepsis and septic shock attributable to Gram-negative organisms. Beyond its impact on mortality, initially inappropriate antibiotic therapy is significantly associated with length of stay in this population. Efforts to decrease rates of initially inappropriate antibiotic therapy may serve to improve hospital resource use by leading to shorter overall hospital stays.

NosoBase n 28754

Antibioprophylaxie dans le cadre d'interventions obsttricales

Socit des obsttriciens et gyncologues du Canada; SOGC. Journal of obstetrics and gynaecology Canada 2010/09; (247): 886-893.

Mots-cls: ANTIBIOPROPHYLAXIE; OBSTETRIQUE; RECOMMANDATION; PREVENTION; CESARIENNE; CEPHALOSPORINE PREMIERE GENERATION; SITE OPERATOIRE; ACCOUCHEMENT; ENDOCARDE

Objectif : Analyser les rsultats et formuler des recommandations sur le recours lantibioprophylaxie dans le cadre dinterventions obsttricales. Issues : Parmi les issues values, on trouve la ncessit et lefficacit du recours des antibiotiques aux fins de la prvention des infections dans le cadre dinterventions obsttricales.

Rsultats : La littrature publie a t rcupre par lintermdiaire de recherches menes dans Medline et The Cochrane Library au moyen de la rubrique antibioprophylaxie dans le cadre dinterventions obsttricales . Les rsultats ont t restreints aux analyses systmatiques, aux essais comparatifs randomiss / essais cliniques comparatifs et aux tudes observationnelles. Les recherches ont t mises jour de faon rgulire et les articles publis entre janvier 1978 et juin 2009 ont t incorpors la directive clinique. Les lignes directrices actuellement publies par le American College of Obstetrics and Gynecology ont galement t incorpores la directive clinique. La littrature grise (non publie) a t identifie par lintermdiaire de recherches menes dans les sites Web dorganismes sintressant lvaluation des technologies dans le domaine de la sant et dorganismes connexes, dans des collections de directives cliniques, dans des registres dessais cliniques et auprs de socits de spcialit mdicale nationales et internationales. Valeurs : Les rsultats obtenus ont t analyss et valus par le comit sur les maladies infectieuses de la Socit des obsttriciens et gyncologues du Canada sous la gouverne des auteures principales, et les recommandations ont t formules conformment aux lignes directrices labores par le Groupe dtude canadien sur les soins de sant prventifs (Tableau 1). Avantages, dsavantages et cots : La mise en oeuvre de la prsente directive clinique devrait rduire les cots et les torts attribuables ladministration dantibiotiques lorsque celle-ci ne savre pas requise, ainsi que les torts attribuables la non-administration dantibiotiques lorsque ceux-ci pourraient savrer bnfiques.

Dclarations sommaires:

1. Les donnes disponibles ne soutiennent pas le recours lantibioprophylaxie en vue dattnuer la morbidit infectieuse la suite dun accouchement vaginal opratoire. (II-1)

2. Nous ne disposons pas de donnes suffisantes pour soutenir ou dconseiller le recours lantibioprophylaxie en vue dattnuer la morbidit infectieuse dans les cas de retrait manuel du placenta. (III)

3. Nous ne disposons pas de donnes suffisantes pour soutenir ou dconseiller le recours lantibioprophylaxie au moment de la dilatation-curetage postpartum visant des produits de conception en rtention. (III)

4. Les donnes disponibles ne soutiennent pas le recours lantibioprophylaxie en vue dattnuer la morbidit infectieuse la suite d'un cerclage planifi ou d'urgence. (II-3)

Bactrimie

NosoBase n 28606

Surveillance sentinelle nationale des bactrimies Candida spp dans 40 centres hospitaliers en Espagne

Cisterna R; Ezpeleta G; Telleria O; Guinea J; Regueiro B; Rodriguez J; et al. A nationwide sentinel surveillance of bloodstream Candida spp. Infections study in 40 tertiary - care hospitals in Spain. Journal of clinical microbiology 2010; in press: 24 pages.

Mots-cls : SURVEILLANCE; CANDIDA; BACTERIEMIE; ETUDE PROSPECTIVE; ANTIFONGIQUE;

RESISTANCE; FACTEUR DE RISQUE; HEMOCULTURE; INCIDENCE; MORTALITE; FLUCONAZOLE;

VORICONAZOLE; TRAITEMENT

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Spain to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for acquiring a Candida spp. infection. Prospective laboratory-based surveillance was conducted from June 2008 to June 2009 in 40 medical centers located around the country. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 984 cases, for an overall incidence of 1.09 cases per 1,000 admissions. The crude mortality was 20.20%. C. albicans was the most common species (49.08%), followed by C. parapsilosis (20.73%), C. glabrata (13.61%) and C. tropicalis (10.77%). Overall, decreased susceptibility to fluconazole occurred in 69 (7.01%) of incident isolates. Antifungal resistance was rare and a moderate linear correlation between fluconazole and voriconazole MICs was observed. This is the largest multicenter candidemia study conducted and shows the substantial morbidity and mortality of candidemia in Spain.

NosoBase n Notice 28298

Facteurs de risque et volution des bactrimies entrocoques rsistants la vancomycine chez les enfants

Haas EJ; Zaoutis TE; Prasad P; Li M; Coffin SE. Risk factors and outcomes for vancomycin-resistant Enterococcus bloodstream infection in children. Infection control and hospital epidemiology 2010/10; 31(10): 1038-1042.

Mots-cls: FACTEUR DE RISQUE; VANCOMYCINE; PEDIATRIE; BACTERIEMIE; ETUDE RETROSPECTIVE; MORTALITE; VENTILATION ASSISTEE; DUREE DE SEJOUR

Background and objective: Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistant Enterococcus (VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptible Enterococcus (VSE) BSI in this population.

Methods: A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.

Results: We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]).

Conclusion: Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

NosoBase n 28661

Bactrimies Enterobacter cloacae producteur de bta-lactamase spectre largi : rle du traitement par des carbapnmes

Lee CC; Lee NY; Yan JJ; Lee HC; Chen PL; Chang CM; et al. Bacteremia due to extended-spectrum-beta-lactamase-producing Enterobacter cloacae: role of carbapenem therapy. Antimicrobial agents and chemotherapy 2010/09; 54(9): 3551-3556.

Mots-cls: BACTERIEMIE; ENTEROBACTER CLOACAE; BETA-LACTAMASE A SPECTRE ELARGI; CARBAPENEME; TRAITEMENT; CEFOTAXIME; SOIN INTENSIF; DUREE DE SEJOUR; MORTALITE; ETUDE RETROSPECTIVE

Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum beta-lactamase (ESBL)-producing E. cloacae infections have been published. During an 8-year period in a medical center, of 610 E. cloacae bacteremic isolates, 138 (22.6%) with ESBL genes were designated the ESBL group, and 120 (19.6%) cefotaxime-nonsusceptible isolates without the ESBL phenotype and genes were designated the control group. Of the former group of isolates, 133 (96.3%) carried the bla(SHV-12) gene, 3 (2.1%) had bla(CTX-M3), and 2 (1.4%) had both the bla(SHV-12) and bla(CTX-M3) genes. After patients under the age of 18 years were excluded, there were 206 adults with E. cloacae bacteremia, and these consisted of 121 patients in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial bacteremia, increased severity of illness, more cases of bacteremia onset in intensive care units (ICUs), and longer stays in the hospital and ICU after bacteremia onset were noted in the ESBL group. However, the crude and sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related mortality rate of patients definitively treated by a carbapenem was lower than that of those treated by noncarbapenem beta-lactams (5/53, or 9.4%, versus 13/44, or 29.5%; P = 0.01) though the difference was not significant in the hierarchical multivariate analysis (P = 0.46). Among 62 patients with follow-up blood cultures within 14 days of bacteremia onset, breakthrough bacteremia was more common in those treated by a noncarbapenem beta-lactam agent than in those treated by a carbapenem (18/31, or 58.0%, versus 3/31, or 9.6%; P < 0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae that cause bacteremia may provide therapeutic benefits.

NosoBase n 28301

Consquences cliniques des bactrimies Acinetobacter baumannii rsistant aux carbapnmes : tude dune pidmie double profil monoclonal

Munoz-Price LS; Zembower T; Penugonda S; Schreckenberger P; Lavin MA; Welbel S; et al. Clinical outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections: study of a 2-state

monoclonal outbreak. Infection control and hospital epidemiology 2010/10; 31(10): 1057-1062.

Mots-cls : ACINETOBACTER BAUMANNII; BACTERIEMIE; AUDIT; CARBAPENEME; ANTIBIORESISTANCE; EPIDEMIE; CENTRE HOSPITALIER UNIVERSITAIRE; ETUDE RETROSPECTIVE; FACTEUR DE RISQUE; SOIN INTENSIF; HEMOCULTURE; BIOLOGIE MOLECULAIRE

Objective: To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.

Design: Multicenter observational study.

Setting: Four tertiary care hospitals and 1 long-term acute care hospital.

Methods: A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.

Results: We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality. Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36-86 days).

Conclusions: To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.

NosoBase n 28839

Du linge hospitalier contamin responsable d'une pidmie de bactrimies Bacillus cereus

Sasahara T; Hayashi S; Morisawa Y; Sakihama T; Yoshimura A; Hirai Y. Bacillus cereus bacteremia outbreak due to contaminated hospital linens. European journal of clinical microbiology and infectious disease 2010; in press: 8 pages.

Mots-cls : BACILLUS CEREUS; BACTERIEMIE; EPIDEMIE; LINGE; CONTAMINATION; CENTRE HOSPITALIER UNIVERSITAIRE; CONTROLE; CATHETER; ETUDE RETROSPECTIVE; ENQUETE

We describe an outbreak of Bacillus cereus bacteremia that occurred at Jichi Medical University Hospital in 2006. This study aimed to identify the source of this outbreak and to implement appropriate control measures. We reviewed the charts of patients with blood cultures positive for B. cereus, and investigated B. cereus contamination within the hospital environment. Genetic relationships among B. cereus isolates were analyzed. Eleven patients developed B. cereus bacteremia between January and August 2006. The hospital linens and the washing machine were highly contaminated with B. cereus, which was also isolated from the intravenous fluid. All of the contaminated linens were autoclaved, the washing machine was cleaned with a detergent, and hand hygiene was promoted among the hospital staff. The number of patients per month that developed new B. cereus bacteremia rapidly decreased after implementing these measures. The source of this outbreak was B. cereus contamination of hospital linens, and B. cereus was transmitted from the linens to patients via catheter infection. Our findings demonstrated that bacterial contamination of hospital linens can cause nosocomial bacteremia. Thus, blood cultures that are positive for B. cereus should not be regarded as false positives in the clinical setting.

NosoBase n 28641

Tendances parmi des pathognes rapports comme responsables de bactrimies en Angleterre, 2004-2008

Wilson J; Elgohari S; Livermore DM; Cookson B; Johnson A; Lamagni T. Trends among pathogens reported as causing bacteraemia in England, 2004-2008. Clinical microbiology and infection 2010; in press: 8 pages.

Mots-cls : BACTERIEMIE; MICROBIOLOGIE; ESCHERICHIA COLI; STAPHYLOCOQUE A COAGULASE NEGATIVE; STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS

The Health Protection Agency in England operates a voluntary surveillance system that collects data on bacteraemias reported by over 90% of laboratories in England. Trends in causative microorganisms reported between 2004 and 2008 were analyzed using a generalized linear model with a log link function for Poisson distribution. In 2008, 101 276 episodes of bacteraemia were reported; a rate of 189 per 100 000 population. More than one-half occurred in those aged over 65 years and males. The most common organisms reported were Escherichia coli (23%), coagulase-negative staphylococci (CNS) (16.9%) and Staphylococcus aureus (11.4%). Between 2004 and 2008, E. coli bacteraemia increased by 33% (p