Qu’elles soient symptomatiques ou non, les infections néonatales à entérovirus (EV) peuvent être à l’origine d’infections nosocomiales dans les services de néonatologie et de réanimation pédiatrique. ...Nous décrivons 2 observations cliniques d’infections néonatales neuro-méningées à echovirus 11 et apportons la preuve moléculaire de la transmission nosocomiale de la souche dans un service de néonatalogie, grâce au génotypage et à l’analyse phylogénétique. Ces observations illustrent l’importance d’inclure les recherches moléculaires prospectives de ces infections dans tout bilan infectieux pour ne pas les sous-estimer chez les nouveau-nés, l’intérêt d’identifier les EV au-delà du genre et l’aide à la preuve de la transmission nosocomiale par l’analyse phylogénétique.
Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.
To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem ...(PA-OprD).
The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before and after an incidental relocation of the ICU. The role of tap water as a route of contamination for colonization/infection of patients with PA-OprD was assessed as a secondary aim.
A single-centre, observational, before/after comparison study was conducted from October 2013 to October 2015. The ICU was relocated at the end of October 2014. All P. aeruginosa-positive samples isolated from patients hospitalized ≥48 h in the ICU were included. Tap water specimens were collected every three months in the ICU. PA-OprD strains isolated from patients and tap water were genotyped using pulse-field gel electrophoresis.
A total of 139 clinical specimens of P. aeruginosa and 19 tap water samples were analysed. The proportion of PA-OprD strains decreased significantly from 31% to 7.7% after the relocation of the ICU (P = 0.004). All PA-OprD clinical specimens had a distinct genotype. Surprisingly, tap water was colonized with a single PA-OprD strain during both periods, but this single clone has never been isolated from clinical specimens.
Relocation of the ICU was associated with a marked decrease in P. aeruginosa strains resistant to imipenem. The polyclonal character of PA-OprD strains isolated from patients and the absence of tap-water-to-patient contamination highlight the complexity of the environmental impact on the endogenous colonization/infection with P. aeruginosa.
Detection of faecal carriers of carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE) has become a routine medical practice in many countries. In an outbreak ...setting, several public health organizations recommend three-weekly rectal screenings to rule-out acquisition in contact patients. This strategy, associated with bed closures and reduction of medical activity for a relatively long time, seems costly.
The objective of this study was to test the positive and negative predictive values of reverse transcription polymerase chain reaction (RT-PCR; GeneXpert®) carried-out at Day 0, compared with conventional three-weekly culture-based rectal screenings, in identifying, among contact patients, those who acquired CPE/VRE.
A multicentre retrospective study was conducted from January2015 to October2018. All contact patients (CPs) were included identified from index patients (IPs) colonized or infected with CPE/VRE, incidentally discovered. Each CP was investigated at Day 0 by PCR (GeneXpert®), and by the recommended three-weekly screenings.
Twenty-two IPs and 159 CPs were included. An average of 0.77 secondary cases per patient was noted, with a mean duration of contact of 10 days (range 1–64). Among the 159 CPs, 16 (10%) had a CPE/VRE-positive culture during the monitoring period. Rectal screenings were positive at Day 0 (10 patients), Day 7 (two patients), Day 14 (four patients). Thirteen of 16 patients with positive culture had a positive PCR at Day 0. Overall, a concordance of 97.5% (155/159) was observed between the three-weekly screenings and Day 0 PCR results. When performed on CPs at Day 0 of the identification of an IP, PCR (GeneXpert®) allowed the reduction in turnaround time by five to 27 days, compared to three-weekly screenings. Positive predictive value and negative predictive value were 100% and 98%, respectively.
The use of RT-PCR (GeneXpert®) can avoid the three-weekly rectal samplings needed to rule-out acquisition of CPE/VRE.
Cohorting carbapenemase-producing Enterobacteriaceae (CPE) carriers during hospitalization limits in-hospital spreading.
To identify risk factors for CPE acquisition among contacts of an index ...patient in non-cohorted populations.
A multicentre retrospective matched case–control study was conducted in five hospitals. Each contact patient (case) who acquired Klebsiella pneumoniae (KP)-OXA-48 from an index patient was compared to three contact (controls) with the same index patients matched with hospitalization in the same unit and similar exposure times.
Fifty-one secondary cases and 131 controls were included. By univariate analysis, exposure time (odds ratio: 1.06; 95% confidence interval: 1.02–1.1; P = 0.006), concomitant infection at admission (3.23; 1.42–7.35; P = 0.005), antimicrobial therapy within the last month before hospitalization (2.88; 1.34–6.2; P = 0.007), antimicrobial therapy during the exposure time (5.36; 2.28–12.6; P < 0.001), use of at least one invasive procedure (2.99; 1.25–7.15; P = 0.014), number of invasive procedures (1.52; 1.05–2.19; P = 0.025), and geographical proximity (2.84; 1.15–7.00; P = 0.023) were associated with CPE acquisition. By multivariate analysis, antimicrobial therapy during the exposure time (odds ratio: 6.36; 95% confidence interval: 2.46–16.44; P < 0.001), at least one invasive procedure (2.92; 1.04–8.17; P = 0.041), and geographical proximity (3.69; 1.15–11.86; P = 0.028) were associated with acquisition.
In this study, geographical proximity, invasive procedure, and antimicrobial therapy during exposure time were significantly associated with KP-OXA-48 acquisition.
We describe the prevalence of carriage and variables associated with introduction of highly drug-resistant microorganisms (HDRMO) into a French hospital via patients repatriated or recently ...hospitalized in a foreign country. The prevalence of HDRMO was 11% (15/132), with nine carbapenamase-producing Enterobacteriaceae, nine carbapenem-resistant Acinetobacter baumannii and six glycopeptide-resistant enterococci. Half of the admitted patients (63/132, 48%) were colonized with extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE). Among the four episodes with secondary cases, three involved A. baumannii.
La pneumonie nécrosante à Staphylococcus aureus sécréteur de leucocidine de Panton-Valentine est une cause rare de pneumonie communautaire grave caractérisée par une mortalité très élevée. Sa ...présentation clinique particulière doit être connue du réanimateur afin qu’il puisse faire rapidement le diagnostic, pour mettre en route une antibiothérapie optimale et envisager un traitement adjuvant par immunoglobulines polyvalentes intraveineuses. Par ailleurs, la conduite à tenir vis-à-vis des cas contacts proches (familiaux et soignants) d’un patient qui présente une telle pneumonie n’est pas bien connue. Le cas que nous rapportons permet de souligner la présentation caractéristique de cette pneumonie, les particularités de sa prise en charge, et précise la conduite à tenir vis-à-vis des cas contacts.
Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia associated with a high fatality rate. The specificities of its presentation must be known by the critical care doctor, in order to quickly make the diagnosis and start the right antibiotics and discuss adjunctive therapy with intravenous immunoglobin. Moreover, the management of close contacts (household and healthcare workers) of patient with such a pneumonia is not well-known. The present case report underlines the clinical presentation of this pneumonia, the specificities of its treatment, and specifies the management of close contacts.
Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a ...potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.
The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their ...association with clinical infections in the intensive care setting.
A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey.
Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates ≥0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate ≥51%, prevalence of sinks with visible splashes ≥14%, prevalence of sinks close to the patient's bed ≥21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016).
Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.
Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia associated with a high fatality rate. The specificities of its ...presentation must be known by the critical care doctor, in order to quickly make the diagnosis and start the right antibiotics and discuss adjunctive therapy with intravenous immunoglobin. Moreover, the management of close contacts (household and healthcare workers) of patient with such a pneumonia is not well-known. The present case report underlines the clinical presentation of this pneumonia, the specificities of its treatment, and specifies the management of close contacts.
Enterobacteriaceae bacteremia: Risk factors for ESBLPE Neulier, C.; Birgand, G.; Ruppé, É. ...
Médecine et maladies infectieuses,
January 2014, 2014, 2014-Jan, 2014-01-00, 20140101, Letnik:
44, Številka:
1
Journal Article
Odprti dostop
The increasing prevalence of extended spectrum beta-lactamase producing enterobacteriaceae (ESBLPE) requires defining the use of carbapenems in first intention. We analyzed the associations between ...enterobacteriaceae bacteremia (EbBact) and ESBLPE carriage during 10 years in a 950-bed teaching hospital.
We analyzed a 10-year (July 2001 to June 2011) prospective collection of bacteremia cases including 2 databases: (1) EbBact and (2) a computerized database of patients carrying EBLSE. Only one episode of EbBact was analyzed per patient and hospital stay. Factors associated with ESBLPE bacteremia were assessed by univariate and multivariate logistic regression analysis.
Overall, 2355 cases of EbBact were identified, among which 135 (5.7%) were ESBLPE (2001–05: 1.4%, 2006–09: 7.6%, 2010–11: 14.2%). ESBLPE bacteremia was observed in 52 of the 88 (59%) patients carrying ESBLPE and in 83/2267 (3.7%) patients not known to be colonized with ESBLPE. Factors associated with ESBLPE bacteremia in patients not known to be colonized were: female gender (ORa=0.56, CI95% 0.34–0.91), hospitalization in the ICU (ORa=2.51 1.27–5.05) or medical/surgical wards (ORa=1.83 1.04–3.38), the period (2006–09, ORa=4.08 2.21–8.16; 2010–11, ORa=8.17 4.14–17.06 compared to 2001–05), and history of EbBact (ORa=2.29 0.97–4.79).
In case of EbBact, patients known to be colonized with ESBLPE present with ESBLPE bacteremia in more than half of the cases, requiring carbapenems as empirical antibiotic treatment. The global prevalence of ESBLPE among patients presenting with EbBact not known to be colonized with ESBLPE was 3.7%.
L’augmentation de la prévalence des entérobactéries productrices de bêtalactamase à spectre étendu (EBLSE) nécessite de définir la place des carbapénèmes en première intention. Nous avons analysé les associations entre bactériémie à entérobactérie (BactEb) et portage d’EBLSE en 10ans dans un CHU de 950 lits.
Analyse rétrospective d’un recueil prospectif entre juillet 2001 et juin 2011 avec fusion de deux bases : (1) BactEb et (2) base informatisée des patients (Pts) porteurs d’EBLSE. Un seul épisode de BactEb par Pt et par hospitalisation était conservé. Les facteurs associés à une Bact à EBLSE ont été recherchés en analyse univariée, puis multivariée.
Au total, 2355 BactEb ont été identifiées, dont 135 (5,7 %) à EBLSE (2001–05 : 1,4 %, 2006–09 : 7,6 %, 2010–11 : 14,2 %). Une Bact à EBLSE était identifiée chez 52 des 88 Pts (59 %) connus porteurs d’EBLSE et 83/2267 (3,7 %) des Pts non connus porteurs. Les facteurs associés à une Bact à EBLSE chez les 2267 Pts non connus porteurs étaient le sexe féminin (ORa=0,56, IC95 % 0,34–0,91), l’hospitalisation en réanimation (ORa=2,51 1,27–5,05) ou service de médecine/chirurgie (ORa=1,83 1,04–3,38), la période (2006–09, ORa=4,08 2,21–8,16 ; 2010–11, ORa=8,17 4,14–17,06 par rapport à 2001–05) et les antécédents de BactEb (ORa=2,29 0,97–4,79).
En cas de BactEb, les Pts connus porteurs d’EBLSE développent une Bact à EBLSE dans plus de la moitié des cas, imposant l’utilisation probabiliste de carbapénèmes. La prévalence globale d’EBLSE parmi les Pts développant une BactEb et non connus porteurs était de 3,7 %.
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