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International audience; The spread of carbapenemase-producing Gram-negative rods is an emerging global problem. This study describes the epidemiologic features of an outbreak caused by an environmental reservoir of OXA-48-producing Klebsiella pneumoniae caused by persistence of the bacteria during 20 months in an intensive care unit in France. This report emphasizes the importance of early environmental screening to interrupt the transmission of carbapenemase-producingEnterobacteriaceae.

Resume Objectif Surveiller les infections du site operatoire (ISO) en chirurgie digestive et positionner notre etablissement dans l’interregion Sud-Est. Comparer le taux global d’ISO au taux de deux actes traceurs : la cholecystectomie et la cure de hernie (CHOL, HERN). Methode Selon la methode du CCLIN Sud-Est, une surveillance globale de toutes les interventions a ete realisee entre juin et aout 2006. Resultats Trois cent trente-huit interventions ont ete incluses. Nous avons enregistre 20 infections (5,92 %), toutes confirmees par un chirurgien. En analyse univariee, six facteurs lies a la survenue d’infection ont ete identifies : âge, classe de contamination (3,4), ASA (3–5), duree d’intervention (superieure a deux heures), caractere multiple et chirurgie carcinologique. Seuls le score ASA et la duree d’intervention etaient significatifs en analyse multivariee. Les taux d’ISO pour les actes HERN et CHOL etaient respectivement de 2,7 (2/73) et 2,9 % (2/68). Conclusion Le taux global d’infections etait eleve par rapport aux resultats du CCLIN Sud-Est 2005. Cependant, les CHU ne representaient que 8 % des interventions et ils sont habituellement plus frequentes par des patients a risque. Ainsi, le suivi global necessite de stratifier les resultats en groupes homogenes de patients (NNIS) afin de rendre les resultats comparables dans le temps et entre etablissements. Si les actes traceurs CHOL et HERN sont plus fiables a des fins de comparaisons et moins chronophages, ils ne refletent pas le taux global d’ISO.

We estimated the direct additional medical costs of nosocomial infections (NI) using a cohort study in acute and longer-term care at Nîmes University Hospital in France. Patients hospitalised between May 2001 and January 2003 with NI were considered as exposed; all others were eligible as non-exposed. Thirty patients were randomly chosen for each site of infection: respiratory tract, bloodstream, surgical site, urinary tract and other sites for a total of 150 exposed patients. Each exposed patient was matched with a non-exposed patient according to gender, age, severity of the underlying disease, diagnosis according to hospital discharge records, ward type and length of hospitalisation before inclusion. Additional direct medical costs for the exposed patients compared to the non-exposed and the difference between actual costs and the diagnosis-related group rate were measured. Costs resulting from laboratory tests, radiology, surgery and exploratory examinations, and antimicrobial agents were estimated to be Euro2421 for a respiratory tract infection, Euro1814 for a surgical site infection, Euro953 for a bloodstream infection and Euro574 for a urinary tract infection. Total additional costs of NI (direct medical costs and costs of extra length of stay) in acute care were estimated to be up to Euro3.2 million per year (95% confidence interval: 2,275,063-4,132,157). In conclusion, both prevention of avoidable NI and better estimation of the actual costs of NI should be priorities for all healthcare facilities.