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Objective To access the potential health impact on the population during mass gathering over time using labelling procedure in emergency department (ED). Introduction The massive flow of people to mass gathering events, such as festivals or sports events like EURO 2016, may increase public health risks. In the particular context of several terrorist attacks that took place in France in 2015, the French national Public Health agency has decided to strengthen the population health surveillance systems using the mandatory notification disease system and the French national syndromic surveillance SurSaUD®. The objectives in terms of health surveillance of mass gathering are: 1/ the timely detection of a health event (infectious cluster, environmental exposure, collective foodborne disease…) 2/ the health impact assessment of an unexpected event such as a terrorist attack. In collaboration with the Regional Emergency Observatory (ORU), a procedure for the labeling of emergencies has been tested to identify the ED records that could be considered as linked to the event. Methods During summer 2016, the procedure was tested on seven major festive events throughout the region. In addition to the main medical diagnosis, a specific ICD-10 code “Y3388” was chosen to be used in associated diagnosis for records that were supposed to linked to the event. Information on the labeling procedure was insured by the ORU to the emergency departments. All records with medical diagnoses or medical pattern beginning by Y33 have been analyzed. Results No significant increase in the global indicator was observed in the ED impacted by mass gathering. The ED labelling procedure identified 260 records: two thirds corresponded to young men and 17% came from abroad. Among the 250 records labeled in associated diagnosis, 39% were associated to traumatisms and 31% corresponded to alcohol intake. Conclusions This study shows that a labelling procedure allows the identification, quantification and characterization of the population ED records associated with mass gathering. Additionally, a labelling procedure to assess a potential impact of an event as mass gathering can be implemented fairly rapidly.

Antibiotic-use policies may affect pneumococcal conjugate-vaccine effectiveness. The reported increase of pneumococcal meningitis from 2001 to 2009 in France, where a national campaign to reduce antibiotic use was implemented in parallel to the introduction of the 7-valent conjugate vaccine, provides unique data to assess these effects. We constructed a mechanistic pneumococcal transmission model and used likelihood to assess the ability of competing hypotheses to explain that increase. We find that a model integrating a fitness cost of penicillin resistance successfully explains the overall and age-stratified pattern of serotype replacement. By simulating counterfactual scenarios of public health interventions in France, we propose that this fitness cost caused a gradual and pernicious interaction between the two interventions by increasing the spread of nonvaccine, penicillin-susceptible strains. More generally, our results indicate that reductions of antibiotic use may counteract the benefits of conjugate vaccines introduced into countries with low vaccine-serotype coverages and high-resistance frequencies. Our findings highlight the key role of antibiotic use in vaccine-induced serotype replacement and suggest the need for more integrated approaches to control pneumococcal infections.

Background. Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a well-established riskfactor for subsequent infection and a key event in interindividual transmission. Some studies have showed an asso-ciation between fluoroquinolones and MRSA colonization or infection. The present study was performed to identifyspecific risk factors for MRSA acquisition in long-term care facilities (LTCFs).Methods. A prospective cohort of patients naive for S. aureus colonization was established and followed(January 2008 through October 2010) in 4 French LTCFs. Nasal colonization status and potential risk factorswere assessed weekly for 13 weeks after inclusion. Variables associated with S. aureus acquisition were identifiedin a nested-matched case-case-control study using conditional logistic regression models. Cases were patientswho acquired MRSA (or methicillin-sensitive S. aureus [MSSA]). Patients whose nasal swab samples were alwaysnegative served as controls. Matching criteria were center, date of first nasal swab sample, and exposure time.Results. Among451includedpatients,76MRSAcaseswerematchedto207controlsand112MSSAcasesto208controls. Multivariable analysis retained fluoroquinolones (odds ratio, 2.17; 95% confidence interval, 1.01–4.67),male sex (2.09; 1.10–3.98), and more intensive care at admission (3.24; 1.74–6.04) as significantly associated withMRSA acquisition, and body-washing assistance (2.85; 1.27–6.42) and use of a urination device (1.79; 1.01–3.18)as significantly associated with MSSA acquisition.Conclusions. OurresultssuggestthatfluoroquinolonesareariskfactorforMRSAacquisition.Controlmeasuresto limit MRSA spread in LTCFs should also be based on optimization of fluoroquinolone use.Keywords. methicillin-resistantStaphylococcusaureus;fluoroquinolone;case-case-controlstudy;long-termcarefacility; acquisition.Staphylococcus aureus is a commensal organism colo-nizing several sites in the human body, especially theanteriornares.ThisGram-positivebacteriumisrespon-sible for numerous infections including skin infections,bacteremia or respiratory diseases. Notably, 30%–50%of healthy adults are colonized by S. aureus, and nasalcolonization is known tobe an important risk factor forsubsequentinfection[1,2],withinfectionrateshigherincarriers than noncarriers [3–5]and individuals usually

Antibiotic overconsumption is the main force driving the emergence of multidrug-resistant bacterial strains. To promote better antibiotic use in France, a nationwide campaign has been run every year from October to March since 2002. In 2007, it was shown that winter outpatient antibiotic consumption had decreased by 26.5% compared to the 2000-2002 baseline period. Here, we quantified outpatient antibiotic use between 2000 and 2010 as a follow-up analysis of the nationwide campaign. Reimbursed outpatient antibiotic prescriptions were extracted from computerized French National Health Insurance databases. Entire series and age group and antibiotic class analyses were computed. Time series analyses used autoregressive moving-average models with exogenous variables and intervention functions. Two periods were considered: October to March “campaign” periods and April to September “warm” periods. Compared to the precampaign (2000-2002) baseline period, the numbers of weekly antibiotic prescriptions per 1,000 inhabitants during campaign periods decreased until winter 2006 to 2007 (−30% [95% confidence interval {CI}, −36.3 to −23.8%]; P < 0.001) and then stabilized except for individuals >60 years of age, for whom prescriptions reached the precampaign level. During the warm periods from April to September, no significant differences were estimated compared to the baseline level for the entire series, but seniors had an increasing trend that became significant as of 2005, reaching +21% (95% CI, +12.9 to +29.6%) in 2009 ( P < 0.0001). These results highlight the need for a better understanding of antibiotic use by the elderly, requiring research with targeted and tailored public health actions for this population.

Objective To investigate the risk factors of empyema after acute viral infection and to clarify the hypothesized association(s) between empyema and some viruses and/or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Study design A case-control study was conducted in 15 centers. Cases and controls were enrolled for a source population of children 3-15 years of age with acute viral infections between 2006 and 2009. Results Among 215 empyemas, 83 cases (children with empyema and acute viral infection within the 15 preceding days) were included, and 83 controls (children with acute viral infection) were matched to cases. Considering the intake of any drug within 72 hours after acute viral infection onset and at least 6 consecutive days of antibiotic use and at least 1 day of NSAIDs exposure, the multivariable analysis retained an increased risk of empyema associated with NSAIDs exposure (aOR 2.79, 95% CI 1.4-5.58, P = .004), and a decreased risk associated with antibiotic use (aOR 0.32, 95% CI 0.11-0.97, P = .04). The risk of empyema associated with NSAIDs exposure was greater for children not prescribed an antibiotic and antibiotic intake diminished that risk for children given NSAIDs. Conclusions NSAIDs use during acute viral infection is associated with an increased risk of empyema in children, and antibiotics are associated with a decreased risk. The presence of antibiotic-NSAIDs interaction with this risk is suggested. These findings suggest that NSAIDs should not be recommended as a first-line antipyretic treatment during acute viral infections in children.

The potential role of a patient's resident microbial flora in the risk of acquiring multiresistant bacteria (MRB) during hospitalization is unclear. We investigated this role by cross-sectional study of 103 patients at risk of acquisition of Staphylococcus aureus (SA), resistant (MRSA) or not (MSSA) to methicillin, recruited in four French hospitals. The flora was analysed by an exhaustive culture-based approach combined with molecular and/or mass-spectrometry-based identification, and SA strain typing. Forty-three of the 53 SA-negative patients at entry were followed for up to 52 weeks: 19 (44.2%) remained negative for SA and 24 (55.8%) became positive, including 19 (79%) who acquired an MSSA, four (17%) who acquired an MRSA and one who acquired both (4%). Fifty-one different species were identified among the 103 patients, of which two, Corynebacterium accolens and Staphylococcus haemolyticus (p = 0.02-0.01), were more prevalent in the absence of SA. However, the same number of patients carrying or not these two species acquired an MSSA/MRSA during follow-up, regardless of antibiotic treatment received. Clustering analysis showed that the microbial flora was highly specific to each patient, and not predictive for acquisition of MSSA/MRSA or not. Patient-specific microbial resident flora is not predictive of SA acquisition.

Understanding transmission routes of hospital-acquired infections (HAI) is key to improve their control. In this context, describing and analyzing dynamic inter-individual contact patterns in hospitals is essential. In this study, we used wearable sensors to detect Close Proximity Interactions (CPIs) among patients and hospital staff in a 200-bed long-term care facility over 4 months. First, the dynamic CPI data was described in terms of contact frequency and duration per individual status or activity and per ward. Second, we investigated the individual factors associated with high contact frequency or duration using generalized linear mixed-effect models to account for inter-ward heterogeneity. Hospital porters and physicians had the highest daily number of distinct contacts, making them more likely to disseminate HAI among individuals. Conversely, contact duration was highest between patients, with potential implications in terms of HAI acquisition risk. Contact patterns differed among hospital wards, reflecting varying care patterns depending on reason for hospitalization, with more frequent contacts in neurologic wards and fewer, longer contacts in geriatric wards. This study is the first to report proximity-sensing data informing on inter-individual contacts in long-term care settings. Our results should help better understand HAI spread, parameterize future mathematical models, and propose efficient control strategies.