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Abstract: Through numerous reports of Pseudomonas aeruginosa outbreaks linked to transmission from environmental reservoirs, infection control practitionners have a univocal picture of its epidemiology: it is an opportunistic pathogen responsible of major outbreaks in intensive care units (ICU) with a major role played by the water network. The objective of this review was to answer to three questions: what is the part of hospital acquisition of P. aeruginosa? What is the part of outbreaks on incidence of hospital-acquired infections? What is the part of environment as a reservoir for transmission? Genotyping of hospital-acquired P. aeruginosa isolates allows us to define the endogenous or exogenous source of the infection and replace the concept of imported/acquired infection. If 80% of infections could be considered as acquired in ICU, the proportion of infections from exogenous source could be estimated at 50%. Even in a context of major outbreak, the epidemic clone represents 20% of the patients colonized and among these patients, only 50% are recognized with clinical samples. Some studies show that water fittings are a major source of P. aeruginosa in ICU. Other reports demonstrate a weak epidemiological link between environmental and clinical strains. Finally, despite the fact that the relative contributions of endogenous and exogenous sources to P. aeruginosa acquisition are not well established, we can assume that the epidemiological pattern of P. aeruginosa infection and colonization is not univocal and may vary both between ICU and within ICU depending on the period considered. [Copyright &y& Elsevier]

The aim of this study was to rank the risk of nosocomial infection (NI) according to patient type by analysing the results of annual prevalence studies carried out in Franche-Comté from 2001 to 2004. Patients (N=14 905) were divided into four categories according to the number of endogenous risk factors (age, immunodepression, MacCabe score). The overall prevalence of infection was 6.1% and varied according to the category of patient from 1.93% (no risk factors) to 15.2% (three risk factors). The frequencies of NI related to an invasive procedure and to cross-contamination with multi-drug-resistant (MDR) bacteria were 30.9% and 12.3%, respectively; these percentages did not depend on the type of patient. The prevalence of NI decreased over time for patients with two or three risk factors, but was stable for patients with no risk factors. More than 40% of NIs were potentially avoidable (related to invasive procedures or involving cross-transmission of an MDR bacterium) regardless of the category of patient. This study suggests that at least 30% of NIs could be avoided. Copyright © 2006 The Hospital Infection Society [ABSTRACT FROM AUTHOR]

Background. – The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is now increasing in rehabilitation and chronic-care-facilities (R-CCF). The aim of this study was to use published data and our own experience to discuss the roles of screening for MRSA carriers, the type of isolation to be implemented and the efficiency of chemical decontamination.Discussion. – Screening identifies over 90% of patients colonized with MRSA upon admission to R-CCF versus only 50% for intensive care units. Only totally dependent patients acquire MRSA. Thus, strict geographical isolation, as opposed to “social reinsertion”, is clearly of no value. However, this should not lead to the abandoning of isolation, which remains essential during the administration of care. The use of chemicals to decolonize the nose and healthy skin appeared to be of some value and the application of this procedure could make technical isolation unnecessary in a non-negligible proportion of cases.Summary. – Given the increase in morbidity associated with MRSA observed in numerous hospitals, the emergence of a community-acquired disease associated with these strains and the evolution of glycopeptide-resistant strains, the voluntary application of a strategy combining screening, technical isolation and chemical decolonization in R-CCF appears to be an urgent matter of priority. [Copyright &y& Elsevier]

Objectives – To determine the volume and pattern of vancomycin use in a university-affiliated hospital.Material and methods – Total vancomycin use was determined and expressed as vancomycin courses per 100 admitted patients and defined daily doses (DDD) of vancomycin per 1,000 patient-days. The indication for vancomycin use was classified as appropriate or inappropriate according to the guidelines issued by the HICPAC.Results – A total of 311 vancomycin courses were given, as 2098 DDD, giving crude incidences of 1.17 courses per 100 admitted patients and of 11.9 defined daily doses per 1,000 patient-days. The frequency of appropriate courses was 66.7%. Of the 63 inappropriate courses of vancomycin, 39.7% and 28.6% were empiric therapy for nosocomial and community-acquired infections, respectively; 20.6% and 6.3% were specific therapy for nosocomial and community-acquired infections, respectively; and 4.7% were prophylactic.Conclusions – This study show that vancomycin use in our hospital resulted in a lower selection pressure than has been reported for US university-affiliated hospitals and that comprehensive programs to improve the use of vancomycin are needed in our institution. [Copyright &y& Elsevier]

Summary: In August 2006, the regional unit for nosocomial infection control (ARLIN) was notified of a case of symptomatic acute hepatitis B (HBV) infection in an immunosuppressed 87-year-old patient who had received a blood transfusion five months previously. Immunosuppression for the treatment of a variety of conditions is increasing. Immunosuppressed patients should be investigated for previous HBV infection and given pre-emptive therapy where indicated. We report our experience investigating a case of HBV reactivation in an immunosuppressed patient. We describe the investigation and highlight the continued need for vigilance for HBV reactivation in immunosuppressed patients who may present to a range of clinicians. [ABSTRACT FROM AUTHOR]

Objectives and method: We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions. Results: The median age was 42years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7days. Conclusions: We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis. [ABSTRACT FROM AUTHOR]

Objectives: We had for objective to determine the rate of patients treated with antibiotics and the determinants of antibiotic stewardship in nursing homes for dependent elderly people (French acronym EHPAD), of a French region (Franche-Comté). Patients and methods: A representative sample of EHPAD, in Franche-Comté, was included in a cross-sectional study made between April and June 2012. An external auditor and the EHPAD head physician collected data on the facility and on residents receiving antibiotics on the study day. An infectious diseases specialist and an infection control practitioner analyzed each prescription, a posteriori, to assess criteria of antimicrobial stewardship including re-assessment of the prescription between 48 and 72h after initiation of antibiotic treatment. Results: Sixty-one (2.76%) of the 2210 residents in 18 nursing homes were under antibiotic treatment. This rate ranged from 0% to 7.5% among nursing homes. Sixty-two percent of prescriptions complied with recommendations regarding the choice of the drug, and 41.5% could not be improved by choosing an agent with a weaker ecological impact. Globally, 17.8% of prescriptions met all stewardship criteria including re-assessment of the prescription between 48 and 72h after initiation of antibiotic treatment. Conclusions: The study results differed. The rate of antibiotic prescription was low in Franche-Comté EHPAD compared to available European data, but antibiotic therapy could be greatly improved. This stresses the need to better train EHPAD physicians for antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Abstract: Background. – Influenza vaccination reduces the mortality of the patients when the vaccination rates of healthcare workers is important. Purpose and method of the study. – To investigate the vaccination rates at the Universitary Hospital of Besançon by anonymous questionnaire. Results. – Three thousand hundred seventy-seven answers were analyzed (228 men and 1145 women). Two hundred seventy-seven persons declared receiving the vaccine (20.1%) corresponding to sixty-three men (27.6%) and two hundred thirteen women (18.6%) (P =0.001). The average age of the healthcare workers vaccined was of 38.9±11 years. Among most than 50 years, 34% was vaccined. Among the doctors, 40.5% were vaccined against 20.6% of the nurses. In the services of geriatrics, 78.5% of the staff was vaccined. Conclusions. – Our results indicate a weak rate of influenza vaccination in our establishment and a misunderstanding of the character nosocomial of the influenza among the nurse. [Copyright &y& Elsevier]

Abstract: Objective. – Assisted delivery is necessary in many obstetrical conditions but is involved in maternal and foetal complications. The legal pressure and the commendable aim consisting in less neonatal morbidity and mortality have called forth a reflection about the type and the way of instrumental foetal extraction. In 1950, Thierry had already felt this problem and he invented spatula to replace obstetrical forceps. Although this instrument appears empirically little deleterious, literature about its evaluation is very poor. We studied this instrument in a retrospective 190 cases series. Patients and method. – Retrospective study of 190 Thierry''s spatula extractions, over a seven-year period (January 1996 to December 2002), at the Centre Hospitalier Général of Montbéliard. Results. – Out of a total of 8126 deliveries for the study period, the instrumental extraction rate was 5.3%, with 40.6% spatula extractions (190 cases). No failure of Thierry''s spatula extraction was noted. Discussion et conclusion. – Our study concludes that spatula is efficient but does not usually permit anterior rotation of occipito-posterior presentation. Maternal and foetal morbidity is not frequent. [Copyright &y& Elsevier]

Introduction La gestion d’épidémies de grippe en EHPAD est souvent difficile. Les déterminants multiples sont liés aux résidents, au mode d’hébergement, voire au retard de mise en place des mesures barrières. Devant tout syndrome respiratoire infectieux potentiellement transmissible et a fortiori lors de la circulation des virus de la grippe, des mesures barrières sont attendues sans délai pour casser la transmission. En complément de ces mesures, l’antenne régionale a coordonné la mise en place dès 2012 d’une expérimentation, qui permettait la mise à disposition de test rapide d’orientation diagnostique (TROD) pour faciliter le diagnostic précoce de grippe. Cette documentation est essentielle pour optimiser la prise en charge curative des cas et prophylactique de leurs contacts à risque. L’objectif de cette étude est d’évaluer l’impact de 4 années d’expérimentation sur le diagnostic et la gestion de la grippe dans les EHPAD de la région. Matériels et méthodes Entre 2012 et 2016, des TROD ont été mis à disposition de 115 EHPAD, sous forme de kits contenant chacun le matériel nécessaire à la réalisation de 3 tests. L’évaluation de cette expérimentation a été faite en 2 temps : suivi du nombre de tests utilisés et évaluation de la connaissance du dispositif et du recours aux TROD. Résultats Sur l’ensemble de la période d’étude, 147 des 700 TROD (21,0 %) mis à disposition des EHPAD ont été utilisés, 3 (4,3 %) ont servi pour la réalisation de contrôles qualité et 550 (78,6 %) ont dû être éliminés car arrivés à péremption. Le nombre de TROD-grippe dispensés au cours de la période d’étude variait de 12 à 66 par saison hivernale. L’utilisation des TROD a été la plus importante pour la saison 2014–2015 au cours de laquelle 18 cas de grippe furent confirmés et 35 exclus. Sept des neuf EHPAD ayant répondu au questionnaire déclaraient que la mise à disposition des TROD n’avait pas modifié les pratiques de mise en place des mesures barrières et n’avait pas eu d’impact sur l’utilisation des traitements antiviraux. Conclusion Cette expérimentation montre des résultats contrastés. L’organisation de la mise à disposition des TROD a nécessité une logistique consommatrice de temps pour une utilisation au final limitée. Ainsi, il a été décidé de ne pas généraliser cette mise à disposition au-delà de la période d’expérimentation. Les stratégies de prévention grippale doivent inclure de façon prioritaire la promotion de la vaccination des résidents et des professionnels et la mise en oeuvre rapide des mesures barrières. Avant de décider la mise à disposition de TROD et discuter sa plus-value dans un établissement, il est indispensable de prendre en compte les pratiques de prescription d’oséltamivir au sein des EHPAD et l’accessibilité des EHPAD à des tests diagnostiques plus performants que peuvent proposer les laboratoires partenaires. [ABSTRACT FROM AUTHOR]