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30 results on '"MESH : Cross Infection"'

1. Early expansion of circulating granulocytic myeloid-derived suppressor cells predicts development of nosocomial infections in septic patients

Author

Uhel, Fabrice, Azzaoui, Imane, Grégoire, Murielle, Pangault, Céline, Dulong, Joelle, Tadié, Jean-Marc, Gacouin, Arnaud, Camus, Christophe, Cynober, Luc, Fest, Thierry, Le Tulzo, Yves, Roussel, Mikael, Tarte, Karin, Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Centre d'Investigation Clinique [Rennes] ( CIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Microenvironment, Cell Differentiation, Immunology and Cancer ( MICMAC ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] ( EFS Bretagne ), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d’immunologie, de thérapie cellulaire et d’hématopoïèse, Prévention et traitement de la perte protéique musculaire en situation de résistance à l'anabolisme ( PRETRRAM - EA 4466 ), Université Paris Descartes - Paris 5 ( UPD5 ), Service de biochimie et de génétique moléculaire [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Research grant from the French Intensive Care Society / Société de Réanimation de Langue Française (FICS/SRLF), Research grant from the National Institute of Cancer and Direction Générale de l'Organisation des Soins Ministère de la Santé (Projet Recherche Translationnelle 2010), Research grant from the Comité de la Recherche Translationnelle (CORECT), Rennes University Hospital, UHEL, Fabrice, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Microenvironment, Cell Differentiation, Immunology and Cancer (MICMAC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Etablissement français du sang [Rennes] (EFS Bretagne), Prévention et traitement de la perte protéique musculaire en situation de résistance à l'anabolisme (PRETRRAM - EA 4466), Université Paris Descartes - Paris 5 (UPD5), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
immune tolerance, MESH : monocytes, [SDV.IMM] Life Sciences [q-bio]/Immunology, MDSC, [SDV.BC.IC] Life Sciences [q-bio]/Cellular Biology/Cell Behavior [q-bio.CB], [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, infections nosocomiales, choc septique, [ SDV.BC.IC ] Life Sciences [q-bio]/Cellular Biology/Cell Behavior [q-bio.CB], sepsis, MESH: immune tolerance, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, [SDV.BC.IC]Life Sciences [q-bio]/Cellular Biology/Cell Behavior [q-bio.CB], nosocomial infections, polynucléaires neutrophiles, [ SDV.IMM ] Life Sciences [q-bio]/Immunology, MESH : granulocytes, MESH: granulocytes, [SDV.IMM.II] Life Sciences [q-bio]/Immunology/Innate immunity, MESH: Sepsis, [ SDV.IMM.II ] Life Sciences [q-bio]/Immunology/Innate immunity, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: monocytes, cytométrie en flux, flow cytometry, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, granulocytes, myeloid-derived suppressor cells, cross infection, MESH: cross infection, MESH : immune tolerance, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.IMM]Life Sciences [q-bio]/Immunology, septic shock, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Sepsis, MESH : cross infection, monocytes, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Rationale - Sepsis induces a sustained immune dysfunction responsible for poor outcome and nosocomial infections. Myeloid-derived suppressor cells (MDSCs) described in cancer and inflammatory processes may be involved in sepsis-induced immune suppression, but their clinical impact remains poorly defined.Objectives - To clarify phenotype, suppressive activity, origin, and clinical impact of MDSCs in patients with sepsis.Methods - Peripheral blood transcriptomic analysis was performed on 29 patients with sepsis and 15 healthy donors. A second cohort of 94 consecutive patients with sepsis, 11 severity-matched intensive care patients, and 67 healthy donors was prospectively enrolled for flow cytometry and functional experiments.Measurements and main results - Genes involved in MDSC suppressive functions, including S100A12, S100A9, MMP8, and ARG1, were up-regulated in the peripheral blood of patients with sepsis. CD14HLA-DR monocytic (M)-MDSCs were expanded in intensive care unit patients with and without sepsis and CD14CD15 low-density granulocytes/granulocytic (G)-MDSCs were more specifically expanded in patients with sepsis (P Conclusions - M-MDSCs and G-MDSCs strongly contribute to T-cell dysfunction in patients with sepsis. More specifically, G-MDSCs producing arginase 1 are associated with a higher incidence of nosocomial infections and seem to be major actors of sepsis-induced immune suppression.

Published
2017
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2. Coagulase-negative staphylococcal prosthetic valve endocarditis--a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study

Author

Chu, V. H., Miro, J. M., Hoen, B., Cabel, C. H., Pappa, P. A., Jones, P., Stryjewski, M. E., Anguera, I., Braun, S., Mu&#241, oz, P., Commerford, P., Tornos, P., Francis, J., Oyonarte, M., Selton-Suty, C., Morris, A. J., Habib, G., Almirante, B., Sexton, D. J., Corey, G. R., Fowler, V. G. Jr, International Collaboration on Endocarditis-Prospective Cohort Study Group Investigators: Baršić, Bruno et al., Chu, Vh, Miro, Jm, Hoen, B, Cabell, Ch, Pappas, Pa, Jones, P, Stryjewski, Me, Anguera, I, Braun, S, Muñoz, P, Commerford, P, Tornos, P, Francis, J, Oyonarte, M, Selton Suty, C, Morris, Aj, Habib, G, Almirante, B, Sexton, Dj, Corey, Gr, Fowler VG, Jr, among International Collaboration on Endocarditis Prospective Cohort Study Group, Investigator, Utili, Riccardo, Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Department of Physics [Jyväskylä Univ] (JYU), University of Jyväskylä (JYU), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Department of Physics, University of Jyvaskyl ( University of Jyvaskyl ), University of Jyvaskyl, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), AII - Amsterdam institute for Infection and Immunity, Infectious diseases, and Laboratoire Chrono-environnement (UMR 6249) (LCE)

Subjects
Male, Time Factors, MESH: Drug Resistance, Microbial, MESH : Aged, MESH : Prospective Studies, MESH : Coagulase, 030204 cardiovascular system & hematology, Postoperative Complications, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Postoperative Complications, MESH: Staphylococcus aureus, MESH : Female, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, MESH : Endocarditis, Bacterial, Abscess, Prospective cohort study, MESH: Aged, Cross Infection, MESH: Statistics, Nonparametric, MESH: Middle Aged, biology, MESH : Staphylococcus aureus, valvular heart disease, cons, Drug Resistance, Microbial, coagulase-negative staphylococci, endoccarditis, prosthetic valves, Middle Aged, Staphylococcal Infections, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Heart Valve Prosthesis, Infective endocarditis, Female, MESH: Coagulase, Cardiology and Cardiovascular Medicine, MESH : Cross Infection, Cohort study, MESH : Time Factors, Coagulase, Staphylococcus aureus, medicine.medical_specialty, Prosthesis-Related Infections, MESH: Heart Valve Prosthesis, MESH : Male, MESH: Staphylococcal Infections, MESH : Bioprosthesis, Statistics, Nonparametric, MESH : Prosthesis-Related Infections, MESH : Heart Valve Prosthesis, MESH : Hospital Mortality, 03 medical and health sciences, MESH : Drug Resistance, Microbial, medicine, Humans, Endocarditis, MESH : Middle Aged, MESH: Endocarditis, Bacterial, MESH: Hospital Mortality, MESH : Statistics, Nonparametric, Aged, Bioprosthesis, MESH: Humans, business.industry, MESH: Prosthesis-Related Infections, MESH : Humans, MESH: Time Factors, MESH: Cross Infection, Endocarditis, Bacterial, medicine.disease, biology.organism_classification, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, MESH: Male, MESH: Prospective Studies, Surgery, MESH: Bioprosthesis, Viridans streptococci, MESH : Postoperative Complications, MESH : Staphylococcal Infections, business, MESH: Female
Abstract

International audience; OBJECTIVE: To describe the contemporary features of coagulase-negative staphylococcal (CoNS) prosthetic valve endocarditis (PVE). DESIGN: Observational study of prospectively collected data from a multinational cohort of patients with infective endocarditis. Patients with CoNS PVE were compared to patients with Staphylococcus aureus and viridans streptococcal (VGS) PVE. SETTING: The International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) is a contemporary cohort of patients with infective endocarditis from 61 centres in 28 countries. PATIENTS: Adult patients in the ICE-PCS with definite PVE and no history of injecting drug use from June 2000 to August 2005 were included. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Heart failure, intracardiac abscess, death. RESULTS: CoNS caused 16% (n = 86) of 537 cases of definite non-injecting drug use-associated PVE. Nearly one-half (n = 33/69, 48%) of patients with CoNS PVE presented between 60 days and 365 days of valve implantation. The rate of intracardiac abscess was significantly higher in patients with CoNS PVE (38%) than in patients with either S aureus (23%, p = 0.03) or VGS (20%, p = 0.05) PVE. The rate of abscess was particularly high in early (50%) and intermediate (52%) CoNS PVE. In-hospital mortality was 24% for CoNS PVE, 36% for S aureus PVE (p = 0.09) and 9.1% for VGS PVE (p = 0.08). Meticillin resistance was present in 68% of CoNS strains. CONCLUSIONS: Nearly one-half of CoNS PVE cases occur between 60 days and 365 days of prosthetic valve implantation. CoNS PVE is associated with a high rate of meticillin resistance and significant valvular complications.

Published
2009
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3. Trends of extended-spectrum β-lactamase-producing Escherichia coli sequence type 131 and its H30 subclone in a French hospital over a 15-year period

Author

Michelle Thouverez, Xavier Bertrand, Andréa Vannier, Marie-Hélène Nicolas-Chanoine, Marlène Sauget, Didier Hocquet, Pascal Cholley, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement - CNRS - UFC (UMR 6249) (LCE), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre de recherche sur l'inflamation - UMR 1149, Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
0301 basic medicine, MESH : Escherichia coli, MESH : Retrospective Studies, MESH : Multilocus Sequence Typing, MESH: beta-Lactamases, MESH : Genotype, Multidrug resistance, medicine.disease_cause, Hospitals, University, MESH: Genotype, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Pharmacology (medical), MESH: Incidence, MESH: Genetic Variation, Escherichia coli Infections, ComputingMilieux_MISCELLANEOUS, Cross Infection, Molecular Epidemiology, Extraintestinal Pathogenic Escherichia coli, MESH: Escherichia coli, Incidence, Incidence (epidemiology), MESH : beta-Lactamases, General Medicine, PFGE, MESH : Incidence, Electrophoresis, Gel, Pulsed-Field, 3. Good health, Infectious Diseases, MESH: Electrophoresis, Gel, Pulsed-Field, MESH: Multilocus Sequence Typing, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH : Escherichia coli Infections, [SDE]Environmental Sciences, France, MESH : Cross Infection, Microbiology (medical), clone (Java method), Lineage (genetic), Genotype, MESH : Molecular Epidemiology, 030106 microbiology, Biology, beta-Lactamases, Microbiology, 03 medical and health sciences, Extended-spectrum β-lactamase, MESH : Genetic Variation, Escherichia coli, Pulsed-field gel electrophoresis, medicine, Humans, MESH: Molecular Epidemiology, Typing, MESH : France, MESH : Hospitals, University, Retrospective Studies, MESH : Electrophoresis, Gel, Pulsed-Field, MESH: Escherichia coli Infections, MESH: Hospitals, University, MESH: Humans, MESH : Humans, Genetic Variation, MESH: Cross Infection, MESH: Retrospective Studies, bacterial infections and mycoses, Multiple drug resistance, MESH: France, ESBL, Multilocus Sequence Typing
Abstract

International audience; Sequence type 131 (ST131) is a predominant lineage among extraintestinal pathogenic Escherichia coli. It plays a major role in the worldwide dissemination of E. coli producing extended-spectrum β-lactamases (ESBLs). Here we describe the long-term epidemiology of this clonal group in a French university hospital, where the incidence of ESBL-producing E. coli has increased from 0.018 case per 1000 patient-days in the year 2000 to 0.50 case per 1000 patient-days in 2014. The first of the 141 ST131 isolates was recovered in 2006, and the ST131 clonal group accounted for 18.1% of total ESBL-producing E. coli over the whole period (2000-2014). Subclonal typing showed that 75.9% (107/141) of ST131 isolates were H30, of which 81.3% (87/107) were H30-Rx. The large majority (137/141) of ESBLs produced were of the CTX-M group, with 94 CTX-M-15, 19 CTX-M-1, 10 CTX-M-27, 8 CTX-M-14 and four other CTX-M types (n = 6). Pulsed-field gel electrophoresis (PFGE) analysis showed high diversity, which increased during the course of the study. The 141 ST131 isolates clustered in 53 pulsotypes (PTs), with 2 dominant PTs (PT14 and PT13) with 36 and 17 isolates, respectively. These findings showed that ST131 was a predominant clone among ESBL-producing E. coli in our hospital, even though it only accounted for

Published
2016
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4. Clinical epidemiology and resistance mechanisms of carbapenem-resistant Acinetobacter baumannii, French Guiana, 2008-2014

Author

Magalie Demar, Pierre Couppié, Hatem Kallel, Mathieu Nacher, Christine Simonnet, Didier Hommel, Félix Djossou, Aba Mahamat, Xavier Bertrand, B. Moreau, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Institut de l’Élevage, Centre Hospitalier Andrée-Rosemond, Epidemiologie des Parasitoses Tropicales ( EPaT Team ), Université des Antilles et de la Guyane ( UAG ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Département de Biologie, Unité de Biochimie des Lipides et des Protéines, Faculté des Sciences de Tunis, Ecosystemes Amazoniens et Pathologie Tropicale ( EPat ), Université de Guyane ( UG ) -Institut Pasteur de la Guyane, Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Coordination Régionale de la lutte contre le Virus de L'Immunodéficience Humaine (COREVIH)-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-Université des Antilles ( UA ), Unité des Maladies Infectieuses et Tropicales [Cayenne, Guyanne Française], Centre d'investigation clinique Antilles-Guyane ( CIC - Antilles Guyane ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de la Martinique-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Coordination Régionale de la lutte contre le Virus de L'Immunodéficience Humaine ( COREVIH Guyane ), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Ecosystemes Amazoniens et Pathologie Tropicale (EPat), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Guyane (UG), Faculté des Sciences Mathématiques, Physiques et Naturelles de Tunis (FST), Université de Tunis El Manar (UTM)-Université de Tunis El Manar (UTM), Coordination Régionale de la lutte contre le Virus de L'Immunodéficience Humaine (COREVIH)-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-Université des Antilles (UA), Centre d'investigation clinique Antilles-Guyane (CIC - Antilles Guyane), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU de la Martinique [Fort de France]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], and Coordination Régionale de la lutte contre le Virus de L'Immunodéficience Humaine (COREVIH Guyane)

Subjects
0301 basic medicine, Male, Acinetobacter baumannii, Imipenem, MESH : Retrospective Studies, Epidemiology, MESH : Multilocus Sequence Typing, MESH: beta-Lactamases, MESH : Carbapenems, Disease Outbreaks, MESH: Carbapenems, Disk Diffusion Antimicrobial Tests, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, polycyclic compounds, MESH : Bacterial Proteins, Pharmacology (medical), MESH : Female, MESH: Disease Outbreaks, MESH: Bacterial Proteins, Cross Infection, Molecular Epidemiology, MESH: Middle Aged, biology, MESH : beta-Lactamases, General Medicine, Middle Aged, MESH : Adult, MESH: Hospitals, Hospitals, 3. Good health, Electrophoresis, Gel, Pulsed-Field, French Guiana, MESH : Hospitals, Infectious Diseases, MESH: Multilocus Sequence Typing, MESH: Electrophoresis, Gel, Pulsed-Field, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Amikacin, MESH: Young Adult, MESH: Disk Diffusion Antimicrobial Tests, Female, MESH: Acinetobacter Infections, MESH : Cross Infection, medicine.drug, Acinetobacter Infections, Microbiology (medical), Adult, MESH : French Guiana, MESH : Male, 030106 microbiology, MESH : Molecular Epidemiology, MESH : Young Adult, Tazobactam, beta-Lactam Resistance, beta-Lactamases, Microbiology, Carbapenem-resistant, 03 medical and health sciences, Young Adult, Bacterial Proteins, MESH : beta-Lactam Resistance, MESH: French Guiana, medicine, Humans, MESH: Molecular Epidemiology, MESH : Acinetobacter Infections, Intensive care unit, MESH : Middle Aged, MESH : Disease Outbreaks, MESH : Disk Diffusion Antimicrobial Tests, MESH : Acinetobacter baumannii, Retrospective Studies, MESH : Electrophoresis, Gel, Pulsed-Field, MESH: Humans, Molecular epidemiology, business.industry, MESH: Acinetobacter baumannii, MESH : Humans, Outbreak, MESH: Cross Infection, MESH: Retrospective Studies, MESH: Adult, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, MESH: Male, MESH: beta-Lactam Resistance, Carbapenems, Colistin, Nosocomial, business, MESH: Female, Piperacillin, Multilocus Sequence Typing
Abstract

International audience; This study investigated the clinical epidemiology and resistance mechanisms of Acinetobacter baumannii and characterised the clonal diversity of carbapenem-resistant A. baumannii (CRAB) during an ICU-associated outbreak at Cayenne Hospital, French Guiana. All non-duplicate A. baumannii isolates from 2008 to 2014 were tested for antibiotic susceptibility by disk diffusion. Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on CRAB. Of the 441 A. baumannii isolates, most were from males (54.0%) and were detected mainly from the ICU (30.8%) and medicine wards (21.8%). In the ICU, strains were mainly isolated from the respiratory tract (44.1%) and bloodstream (14.0%), whereas in medicine wards they mainly were from wound/drainage (36.5%) and bloodstream (25.0%). A. baumannii showed the greatest susceptibility to piperacillin/tazobactam (92.7%), imipenem (92.5%), colistin (95.6%) and amikacin (97.2%), being lower in the ICU and medicine wards compared with other wards. An outbreak of OXA-23-producing CRAB occurred in the 13-bed ICU in 2010. CRAB strains were more co-resistant to other antimicrobials compared with non-CRAB. Molecular genetics analysis revealed five sequence types [ST78, ST107 and ST642 and two new STs (ST830 and ST831)]. Analysis of PFGE profiles indicated cross-transmissions of CRAB within the ICU, between the ICU and one medicine ward during transfer of patients, and within that medicine ward. This study provides the first clinical and molecular data of A. baumannii from French Guiana and the Amazon basin. The ICU was the highest risk unit of this nosocomial outbreak of OXA-23-producing CRAB, which could subsequently disseminate within the hospital.

Published
2016

5. One-Step Multiplex PCR Assay for Differentiating Proposed New Species 'Clostridium neonatale' from Closely Related Species

Author

Philippe Bouvet, Marie Jose Butel, Sophia Schönherr, Laurent Ferraris, Julio Aires, Brunhilde Dauphin, Michel R. Popoff, Ecosystème intestinal, probiotiques, antibiotiques (EA 4065), Université Paris Descartes - Paris 5 (UPD5), Bactéries anaérobies et Toxines, Institut Pasteur [Paris], Andromas SAS, Institut Pasteur [Paris] (IP), Ecosystème intestinal, probiotiques, antibiotiques ( EA 4065 ), and Université Paris Descartes - Paris 5 ( UPD5 )

Subjects
[SDV]Life Sciences [q-bio], [ SDV.TOX ] Life Sciences [q-bio]/Toxicology, law.invention, Disease Outbreaks, Feces, Clostridium, law, RNA, Ribosomal, 16S, MESH : Clostridium, MESH : Multiplex Polymerase Chain Reaction, MESH : DNA, Bacterial, Multiplex, MESH: Disease Outbreaks, Polymerase chain reaction, MESH : Intestines, Cross Infection, biology, MESH: Multiplex Polymerase Chain Reaction, MESH: Infant, Newborn, MESH: Feces, 3. Good health, Intestines, MESH: RNA, Ribosomal, 16S, MESH : Canada, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Necrotizing enterocolitis, MESH : DNA Primers, Variants of PCR, MESH : Cross Infection, MESH: Intestines, Microbiology (medical), DNA, Bacterial, MESH: DNA Primers, Canada, Clostridium neonatale, MESH: Enterocolitis, Necrotizing, MESH : Intensive Care Units, Neonatal, MESH : Infant, Newborn, Microbiology, Enterocolitis, Necrotizing, MESH: Canada, Intensive Care Units, Neonatal, Multiplex polymerase chain reaction, parasitic diseases, medicine, Humans, MESH : Disease Outbreaks, DNA Primers, MESH: Humans, [ SDV ] Life Sciences [q-bio], MESH: Clostridium, MESH : Humans, Infant, Newborn, Outbreak, MESH: Cross Infection, Bacteriology, MESH : Feces, biology.organism_classification, medicine.disease, bacterial infections and mycoses, MESH: DNA, Bacterial, MESH : RNA, Ribosomal, 16S, MESH : Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, MESH: Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Multiplex Polymerase Chain Reaction, MESH : Enterocolitis, Necrotizing, MESH: Intensive Care Units, Neonatal
Abstract

“ Clostridium neonatale ” sp. nov., previously involved in an outbreak of neonatal necrotizing enterocolitis, was recently proposed as a new species of the Clostridium genus sensu stricto . We developed a one-step multiplex colony PCR for C. neonatale identification and investigated C. neonatale intestinal colonization frequency in healthy preterm neonates.

Published
2015
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6. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants

Author

Y. Aujard, Monique Kaminski, Béatrice Larroque, Antoine Burguet, Pierre-Yves Ancel, Stéphane Marret, Rachel Vieux, Gérard Thiriez, Ayoub Mitha, Patrick Truffert, Catherine Arnaud, Pascal Boileau, Laurence Foix-L’Hélias, Gilles Cambonie, Jean-Christophe Rozé, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), Unité de Néonatalogie, Hôpital Jeanne de Flandre [Lille], Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité d'Epidémiologie Clinique, CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Service de pédiatrie néonatale et réanimation - neuropédiatrie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Endothélium microcirculatoire cérébral et lésions du système nerveux central au cours du développement (Néovasc), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Neonatal Intensive Care Unit (NICU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré, Service Pédiatrie, Hôpital Saint-Jacques-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Unité d'Epidémiologie et Recherche Clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néonatalogie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Service Pédiatrique, Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Médecine Néonatale, Université de Nantes (UN), CIC - Nantes, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche Epidémiologique sur la Qualité des Soins, Université de Lille, Droit et Santé, EPIPAGE study group, Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Epidémiologie clinique et santé publique [CHU Toulouse], Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pédiatrie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de pédiatrie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Debs, Nayla, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Épidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps, Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de pédiatrie néonatale et réanimation - neuropédiatrie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Hôpital Charles Nicolle [Rouen], Endothélium microcirculatoire cérébral et lésions du système nerveux central au cours du développement ( Néovasc ), Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Institute for Research and Innovation in Biomedicine ( IRIB ), Normandie Université ( NU ) -Normandie Université ( NU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Neonatal Intensive Care Unit ( NICU ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université de Franche-Comté ( UFC ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Beaujon, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Centre Hospitalier de Poissy Saint-Germain (CHIPS), Université de Nantes ( UN ), and Université de Nantes ( UN ) -IFR26-Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Male, Pediatrics, MESH : Infant, Premature, Diseases, Developmental Disabilities, Infant, Premature, Diseases, Neuropsychological Tests, MESH : Child, Preschool, MESH : Cerebral Palsy, Cohort Studies, 0302 clinical medicine, MESH : Cross-Sectional Studies, Risk Factors, MESH: Risk Factors, MESH: Gestational Age, Infant, Very Low Birth Weight, MESH : Female, MESH: Infant, Very Low Birth Weight, 030212 general & internal medicine, Longitudinal Studies, MESH : Infant, Very Low Birth Weight, MESH : Infectious Disease Transmission, Vertical, MESH: Longitudinal Studies, MESH: Sepsis, MESH: Cohort Studies, MESH : Longitudinal Studies, education.field_of_study, Cross Infection, MESH: Infant, Newborn, neurodevelopmental outcome, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Neuropsychological Tests, MESH : Risk Factors, MESH: Infant, MESH: Infant, Premature, Diseases, 3. Good health, MESH : Neuropsychological Tests, MESH: Infectious Disease Transmission, Vertical, population-based study, Child, Preschool, Cohort, Gestation, Female, MESH : Sepsis, France, MESH : Cross Infection, Cohort study, medicine.medical_specialty, MESH: Cerebral Palsy, MESH : Male, Population, MESH : Cohort Studies, Gestational Age, MESH : Infant, Newborn, MESH : Developmental Disabilities, Cerebral palsy, 03 medical and health sciences, MESH : Cognition Disorders, MESH: Cross-Sectional Studies, 030225 pediatrics, Sepsis, medicine, cohort study, Humans, neonatal infection, very preterm infants, education, MESH : France, MESH: Humans, business.industry, Cerebral Palsy, MESH : Humans, MESH: Child, Preschool, Infant, Newborn, Infant, MESH: Cross Infection, Odds ratio, medicine.disease, Confidence interval, Infectious Disease Transmission, Vertical, MESH: Male, MESH: France, Neonatal infection, MESH: Cognition Disorders, Cross-Sectional Studies, MESH: Developmental Disabilities, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Pediatrics, Perinatology and Child Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Cognition Disorders, MESH: Female, MESH : Gestational Age
Abstract

OBJECTIVE:To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children.METHODS:We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models.RESULTS:A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84−3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14−2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02−5.33]). There was no association between neonatal infection and cognitive impairment.CONCLUSIONS:Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.

Published
2013
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7. Temporal effects of infection control practices and the use of antibiotics on the incidence of MRSA

Author

C. Slekovec, Didier Hocquet, J.M. López-Lozano, Xavier Bertrand, Daniel Talon, Michelle Thouverez, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Hôpital Jean Minjoz, and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon )

Subjects
Antibiotics, Hospitals, University, MESH: Infection Control, 0302 clinical medicine, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Medicine, Infection control, 030212 general & internal medicine, MESH: Incidence, MESH : Anti-Bacterial Agents, 0303 health sciences, Cross Infection, Incidence (epidemiology), Incidence, General Medicine, Staphylococcal Infections, University hospital, MESH : Incidence, 3. Good health, Anti-Bacterial Agents, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, France, Negative correlation, MESH : Cross Infection, Microbiology (medical), Methicillin-Resistant Staphylococcus aureus, medicine.medical_specialty, medicine.drug_class, MESH: Staphylococcal Infections, MESH: Methicillin-Resistant Staphylococcus aureus, 03 medical and health sciences, Internal medicine, MESH: Anti-Bacterial Agents, Humans, MESH : Methicillin-Resistant Staphylococcus aureus, Intensive care medicine, MESH : France, Hand disinfection, MESH : Hospitals, University, Hand rub, MESH: Hospitals, University, Infection Control, MESH: Humans, MESH : Infection Control, 030306 microbiology, business.industry, MRSA colonization, MESH : Humans, MESH: Cross Infection, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, MESH: France, MESH : Staphylococcal Infections, business
Abstract

International audience; BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) has spread throughout the world and has become highly endemic worldwide. The need for implementing MRSA control strategies is no longer a matter of debate. AIM: To determine the temporal association between various infection control practices, the use of antibiotics and the incidence of MRSA in a 1200-bed French university hospital. METHODS: A multi-variate time-series analysis, based on monthly data from a nine-year period (January 2000-December 2008), was performed in a 1200-bed French university hospital to determine the temporal association between different variables and the incidence of MRSA. MRSA colonization pressure, infection control practices and use of antibiotics were considered in the analysis. FINDINGS: Time-series analysis showed a positive significant relationship between the incidence of hospital-acquired MRSA (HA-MRSA) and MRSA colonization pressure, the use of antibiotics (fluoroquinolones, macrolides and aminoglycosides) and the use of gloves. Conversely, a global negative correlation was observed between the incidence of HA-MRSA and the use of alcohol-based hand rub. Overall, the model explained 40.5% of the variance in the monthly incidence of MRSA. CONCLUSION: This study showed that admission of patients with MRSA, the use of antibiotics and infection control practices contributed to the incidence of HA-MRSA. This suggests that efforts should be focused on high compliance with hand disinfection. These results also raise concerns about the use of gloves when caring for patients with MRSA.

Published
2012
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8. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey

Author

Christine Selton-Suty, Claire POYART, Tristan Ferry, Albert HAGEGE, Bernard Iung, Cellier Christophe, Francois Vandenesch, Anne TRISTAN, Francois Philippart, BRUNO MOURVILLIER, Vincent Le Moing, François Alla, Céline Plainvert, Patrick Assayag, Nataf Patrick, Catherine Sportouch, Albert Sotto, Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), services de maladies infectieuses, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), CHU Pontchaillou [Rennes], Centre National de référence des Staphylocoques, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, AEPEI Study Group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Recherches Translationnelles sur le VIH et les maladies infectieuses ( TransVIHMI ), Université de Montpellier ( UM ) -Universtié Yaoundé 1 [Cameroun]-Université Cheikh Anta Diop ( UCAD ) -Université Montpellier 1 ( UM1 ) -Institut de Recherche pour le Développement ( IRD ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ), Centre d'Epidémiologie Clinique ( CIC-EC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Université Montpellier 1 ( UM1 ) -Université Cheikh Anta Diop ( UCAD ) -Universtié Yaoundé 1 (Cameroun)-Université de Montpellier ( UM ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
Male, Staphylococcus, [SDV]Life Sciences [q-bio], MESH : Aged, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, MESH : Population Surveillance, MESH: Staphylococcus aureus, MESH : Female, 030212 general & internal medicine, MESH: Incidence, Young adult, MESH : Endocarditis, Bacterial, Aged, 80 and over, MESH: Aged, education.field_of_study, Cross Infection, MESH : Prognosis, MESH: Middle Aged, Incidence (epidemiology), Incidence, MESH : Staphylococcus aureus, Hazard ratio, MESH: Staphylococcus, Middle Aged, Staphylococcal Infections, MESH : Adult, Prognosis, MESH: Hospitals, MESH : Risk Factors, Hospitals, MESH : Incidence, 3. Good health, Community-Acquired Infections, MESH : Hospitals, Infectious Diseases, MESH: Community-Acquired Infections, MESH: Young Adult, Infective endocarditis, Population Surveillance, Female, France, MESH : Cross Infection, Microbiology (medical), Adult, MESH : Community-Acquired Infections, medicine.medical_specialty, Staphylococcus aureus, Adolescent, MESH : Male, Population, MESH : Young Adult, MESH: Staphylococcal Infections, [SDU.STU.PE]Sciences of the Universe [physics]/Earth Sciences/Petrography, MESH: Prognosis, MESH: Population Surveillance, 03 medical and health sciences, Young Adult, Internal medicine, MESH : Adolescent, medicine, Endocarditis, Humans, MESH : Middle Aged, MESH: Endocarditis, Bacterial, education, MESH : Aged, 80 and over, MESH : France, Aged, MESH : Staphylococcus, [ SDU.STU.PE ] Sciences of the Universe [physics]/Earth Sciences/Petrography, MESH: Adolescent, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, Proportional hazards model, MESH : Humans, MESH: Cross Infection, MESH: Adult, Endocarditis, Bacterial, medicine.disease, Confidence interval, MESH: Male, Surgery, MESH: France, MESH : Staphylococcal Infections, business, MESH: Female
Abstract

International audience; BACKGROUND: Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE. METHODS: A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death. RESULTS: The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]). CONCLUSIONS: S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.

Published
2012
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9. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices

Author

David Gordon, Emilio Bouza, Víctor José González Ramallo, Christine Selton-Suty, Francesc Marco, Eugene Athan, Emanuele Durante-Mangoni, Anna Lisa Chamis, Zainab Samad, Nuria Fernández-Hidalgo, Carlos Cervera, Jorge Solis, Corentine ALAUZET, François Alla, Sarah Israel, Hussien Rizk, Patricia Carmen Muñoz García, Andrew Wang, Juan M Pericas, Souha Kanj, Carlos Falces, Pierre-Edouard Fournier, Assoc Prof Margaret J Henry, Asunción Moreno Camacho, Martin Stryjewski, Antonio Toniolo, Didier Raoult, Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Monaldi Hospital, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Département de Cardiologie, Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Madrid, Spain - Spanish Network for Research in Infectious Diseases (REIPI RD06/0008), ICE-PCS Investigators, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), and Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE)

Subjects
Male, Pacemaker, Artificial, MESH: Endocarditis, MESH : Prevalence, [SDV]Life Sciences [q-bio], Heart Valve Diseases, MESH : Aged, MESH : Prospective Studies, MESH: Hospitalization, 030204 cardiovascular system & hematology, 0302 clinical medicine, prevention, MESH: Tricuspid Valve, Interquartile range, MESH : Device Removal, Prevalence, MESH : Female, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Endocarditis, prosthesis, infection, etiology, survival, Prospective cohort study, MESH: Treatment Outcome, MESH: Aged, Cross Infection, MESH: Middle Aged, Infective endocarditis, Impalntable cardiac device, Mortality rate, Hazard ratio, General Medicine, Middle Aged, Staphylococcal Infections, MESH : Tricuspid Valve, MESH : Endocarditis, Defibrillators, Implantable, 3. Good health, MESH : Heart Valve Diseases, Hospitalization, Treatment Outcome, MESH: Survival Analysis, MESH: Pacemaker, Artificial, MESH : Hospitalization, Female, Tricuspid Valve, MESH : Cross Infection, Cohort study, medicine.medical_specialty, MESH : Male, MESH: Staphylococcal Infections, [SDU.STU.PE]Sciences of the Universe [physics]/Earth Sciences/Petrography, Context (language use), MESH : Treatment Outcome, MESH: Defibrillators, Implantable, MESH : Hospital Mortality, 03 medical and health sciences, Internal medicine, medicine, Humans, MESH : Middle Aged, MESH: Hospital Mortality, MESH: Device Removal, Device Removal, MESH: Prevalence, Aged, [ SDU.STU.PE ] Sciences of the Universe [physics]/Earth Sciences/Petrography, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, MESH : Pacemaker, Artificial, MESH : Humans, MESH: Cross Infection, MESH: Heart Valve Diseases, medicine.disease, Survival Analysis, MESH: Male, MESH: Prospective Studies, Surgery, MESH : Staphylococcal Infections, MESH : Survival Analysis, business, MESH: Female, MESH : Defibrillators, Implantable
Abstract

International audience; CONTEXT: Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs. OBJECTIVES: To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome. DESIGN, SETTING, AND PATIENTS: Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria. MAIN OUTCOME MEASURES: In-hospital and 1-year mortality. RESULTS: CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]). CONCLUSIONS: Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year.

Published
2012
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10. Influenza vaccination of healthcare workers in acute-care hospitals: a case-control study of its effect on hospital-acquired influenza among patients

Author

Bruno Lina, Corinne Régis, Brigitte Coppéré, Silene Cronenberger, Olivier Robert, Brigitte Comte, Philippe Vanhems, Nicolas Voirin, Thomas Bénet, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon ( HCL ), Laboratoire de Biométrie et Biologie Evolutive ( LBBE ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Centre National de la Recherche Scientifique ( CNRS ), Institut Camille Jordan [Villeurbanne] ( ICJ ), École Centrale de Lyon ( ECL ), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Institut National des Sciences Appliquées ( INSA ) -Université Jean Monnet [Saint-Étienne] ( UJM ) -Centre National de la Recherche Scientifique ( CNRS ), Virologie et pathologie humaine ( VirPath ), Université de Lyon-Université de Lyon, Service de médecine gériatrique, Hospices Civils de Lyon ( HCL ) -Hôpital Edouard Herriot [CHU - HCL], Service d'Hygiène, Epidémiologie et Prévention [Hôpital Edouard Herriot - HCL], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Institut Camille Jordan (ICJ), École Centrale de Lyon (ECL), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Centre National de la Recherche Scientifique (CNRS), Virologie et pathologie humaine (VirPath), Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut Camille Jordan [Villeurbanne] (ICJ), Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, MESH : Orthomyxoviridae, [SDV]Life Sciences [q-bio], MESH : Aged, MESH : Prospective Studies, MESH: Influenza Vaccines, MESH: Aged, 80 and over, 0302 clinical medicine, Medical microbiology, Acute care, Health care, Medicine, MESH : Female, Prospective Studies, 030212 general & internal medicine, MESH : Influenza, Human, Prospective cohort study, MESH: Orthomyxoviridae, MESH: Aged, Aged, 80 and over, Cross Infection, 0303 health sciences, MESH: Middle Aged, biology, MESH: Influenza, Human, Vaccination, MESH: Nose, Healthcare worker, virus diseases, Middle Aged, MESH : Adult, MESH: Hospitals, Orthomyxoviridae, MESH: Case-Control Studies, Hospitals, 3. Good health, MESH : Hospitals, Infectious Diseases, MESH: Hemagglutination Inhibition Tests, Influenza Vaccines, Female, MESH : Nose, MESH : Cross Infection, Research Article, Adult, medicine.medical_specialty, MESH : Case-Control Studies, animal structures, Health Personnel, MESH : Male, education, Nose, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Influenza, Human, Humans, lcsh:RC109-216, MESH : Middle Aged, MESH : Aged, 80 and over, Aged, MESH: Humans, [ SDV ] Life Sciences [q-bio], 030306 microbiology, business.industry, MESH : Humans, Case-control study, MESH: Cross Infection, MESH: Adult, MESH: Vaccination, Hemagglutination Inhibition Tests, biology.organism_classification, MESH: Male, MESH: Prospective Studies, MESH : Hemagglutination Inhibition Tests, MESH : Influenza Vaccines, MESH : Vaccination, Case-Control Studies, Immunology, Emergency medicine, MESH: Health Personnel, MESH : Health Personnel, business, MESH: Female
Abstract

Background In acute-care hospitals, no evidence of a protective effect of healthcare worker (HCW) vaccination on hospital-acquired influenza (HAI) in patients has been documented. Our study objective was to ascertain the effectiveness of influenza vaccination of HCW on HAI among patients. Methods A nested case-control investigation was implemented in a prospective surveillance study of influenza-like illness (ILI) in a tertiary acute-care university hospital. Cases were patients with virologically-confirmed influenza occurring ≥ 72 h after admission, and controls were patients with ILI presenting during hospitalisation with negative influenza results after nasal swab testing. Four controls per case, matched per influenza season (2004-05, 2005-06 and 2006-07), were randomly selected. Univariate and multivariate conditional logistic regression models were fitted to assess factors associated with HAI among patients. Results In total, among 55 patients analysed, 11 (20%) had laboratory-confirmed HAI. The median HCW vaccination rate in the units was 36%. The median proportion of vaccinated HCW in these units was 11.5% for cases vs. 36.1% for the controls (P = 0.11); 2 (20%) cases and 21 (48%) controls were vaccinated against influenza in the current season (P = 0.16). The proportion of ≥ 35% vaccinated HCW in short-stay units appeared to protect against HAI among patients (odds ratio = 0.07; 95% confidence interval 0.005-0.98), independently of patient age, influenza season and potential influenza source in the units. Conclusions Our observational study indicates a shielding effect of more than 35% of vaccinated HCW on HAI among patients in acute-care units. Investigations, such as controlled clinical trials, are needed to validate the benefits of HCW vaccination on HAI incidence in patients.

Published
2012
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11. Early-onset ventilator-associated pneumonia in adults randomized clinical trial: comparison of 8 versus 15 days of antibiotic treatment

Author

C. Charpentier, Djillali Annane, Mariette Mercier, Thibault Desmettre, Christophe Faisy, Antoine Roch, Joel Cousson, Gilles Capellier, Samuel Limat, Laurent Papazian, Hélène Mockly, Gilles Blasco, CIT-IT Garches, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP Hôpital Raymond Poincaré [Garches]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Médecine Générale et Soins Intensifs, Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP Hôpital Raymond Poincaré [Garches], Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Service de Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique - Hôpitaux de Marseille ( APHM ), Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ) -Université Paris Descartes - Paris 5 ( UPD5 ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Université de Franche-Comté ( UFC ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Raymond Poincaré [AP-HP], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches], Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC), Laboratoire Chrono-environnement (UMR 6249) (LCE), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), and Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO)

Subjects
Male, Critical Care and Emergency Medicine, Pulmonology, MESH : Aged, MESH : Prospective Studies, MESH: Pneumonia, Ventilator-Associated, MESH : Pneumonia, Ventilator-Associated, MESH : Drug Resistance, Bacterial, MESH : Intensive Care, law.invention, 0302 clinical medicine, Antibiotics, Odds Ratio, Clinical endpoint, Prospective Studies, lcsh:Science, MESH : Intubation, MESH: Treatment Outcome, Cross Infection, MESH: Middle Aged, Death rates, Drug Information, Pneumonia, Ventilator-Associated, 3. Good health, Cohort, Medicine, MESH : Intensive Care Units, MESH : Bronchoalveolar Lavage, MESH : Cross Infection, Cohort study, medicine.medical_specialty, MESH : Drug Administration Schedule, MESH : Cohort Studies, MESH: Drug Administration Schedule, Drug Administration Schedule, 03 medical and health sciences, Sepsis, MESH: Anti-Bacterial Agents, Multicenter trial, Drug Resistance, Bacterial, Humans, Clinical Trials, MESH : Middle Aged, MESH: Intensive Care, Aged, MESH: Humans, [ SDV ] Life Sciences [q-bio], lcsh:R, MESH : Humans, MESH: Adult, Pneumonia, medicine.disease, 030228 respiratory system, Bacterial Pneumonia, lcsh:Q, Bacterial pathogens, Intubation, MESH: Female, Bacterial Diseases, Time Factors, Nosocomial Infections, [SDV]Life Sciences [q-bio], Enterococcus infections, lcsh:Medicine, Bronchoalveolar Lavage, Cohort Studies, Randomized controlled trial, law, MESH : Female, 030212 general & internal medicine, MESH : Anti-Bacterial Agents, Prospective cohort study, MESH: Cohort Studies, MESH: Aged, Intensive care units, Multidisciplinary, MESH: Bronchoalveolar Lavage, Ventilatory Support, Middle Aged, MESH : Adult, Anti-Bacterial Agents, Infectious Diseases, Treatment Outcome, Female, Research Article, MESH : Time Factors, Adult, Drugs and Devices, Critical Care, Clinical Research Design, Secondary infection, MESH : Male, MESH : Treatment Outcome, Respiratory Failure, Internal medicine, MESH: Drug Resistance, Bacterial, medicine, MESH: Intubation, business.industry, MESH: Time Factors, Respiratory infections, MESH: Cross Infection, MESH: Male, MESH: Odds Ratio, MESH: Prospective Studies, Surgery, MESH: Intensive Care Units, MESH : Odds Ratio, business
Abstract

Purpose The optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria. Objective To demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia. Methods Randomized, prospective, open, multicenter trial carried out from 1998 to 2002. Measurements The primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90. Results 225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90. Conclusion Our results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients. Trial Registration ClinicalTrials.gov NCT01559753

Published
2012
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12. Multilevel modelling of the prevalence of hospitalized patients infected with Pseudomonas aeruginosa

Author

Daniel Talon, Houssein Gbaguidi-Haore, Pascal Cholley, C Rabaud, Xavier Bertrand, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier ( LIRMM ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Male, Pediatrics, Epidemiology, Hospitalized patients, MESH : Prevalence, MESH : Aged, MESH: Logistic Models, MESH : Models, Biological, medicine.disease_cause, 0302 clinical medicine, Outcome variable, Risk Factors, MESH: Risk Factors, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Prevalence, Medicine, MESH : Female, 030212 general & internal medicine, MESH: Aged, Cross Infection, 0303 health sciences, MESH: Middle Aged, Nosocomial pathogens, MESH: Pseudomonas Infections, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Middle Aged, MESH : Pseudomonas aeruginosa, MESH : Pseudomonas Infections, MESH : Risk Factors, Total variability, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Infectious Diseases, Pseudomonas aeruginosa, MESH: Pseudomonas aeruginosa, Female, MESH : Cross Infection, medicine.medical_specialty, MESH : Male, Models, Biological, 03 medical and health sciences, Antibiotic resistance, Humans, Pseudomonas Infections, MESH : Middle Aged, MESH: Prevalence, Aged, MESH: Humans, 030306 microbiology, business.industry, Multilevel modelling, MESH : Humans, MESH: Models, Biological, MESH: Cross Infection, MESH: Male, Logistic Models, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography, MESH : Logistic Models
Abstract

SUMMARYPseudomonas aeruginosais one of the leading nosocomial pathogens. The question of the respective contribution of endogenous and exogenous sources remains controversial. In this study, we shed new light on this issue by means of a multilevel logistic regression analysis which allowed a simultaneous investigation of factors associated with prevalence of patients infected withP. aeruginosaat two levels: patient and healthcare facility (HCF) in the eastern regions of France. A total of 25 533 in-patients from 51 HCFs were included in the analysis. The overall prevalence was 0·37% (range 0–1·65%). Multilevel modelling estimated that P. aeruginosain the eastern HCFs of France.

Published
2011
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13. Molecular epidemiology of multidrug-resistant Pseudomonas aeruginosa in a French university hospital

Author

Daniel Talon, Michelle Thouverez, Houssein Gbaguidi-Haore, Patrick Plésiat, Pascal Cholley, Xavier Bertrand, Didier Hocquet, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Agents pathogènes et inflammation - UFC (EA 4266) ( API ), Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Agents pathogènes et inflammation - UFC (EA 4266) (API), and Université de Franche-Comté (UFC)

Subjects
Imipenem, MESH: beta-Lactamases, MESH : Genotype, Drug resistance, medicine.disease_cause, Hospitals, University, MESH: Genotype, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Drug Resistance, Multiple, Bacterial, MESH: DNA Fingerprinting, Cluster Analysis, MESH: Incidence, MESH : Anti-Bacterial Agents, Cross Infection, Molecular Epidemiology, 0303 health sciences, Incidence, MESH : beta-Lactamases, MESH: Pseudomonas Infections, General Medicine, MESH : DNA Fingerprinting, MESH : Pseudomonas aeruginosa, MESH : Pseudomonas Infections, MESH : Incidence, Anti-Bacterial Agents, Bacterial Typing Techniques, Electrophoresis, Gel, Pulsed-Field, 3. Good health, Infectious Diseases, MESH: Electrophoresis, Gel, Pulsed-Field, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Pseudomonas aeruginosa, MESH: Pseudomonas aeruginosa, France, MESH : Cross Infection, medicine.drug, Microbiology (medical), MESH : Drug Resistance, Multiple, Bacterial, Genotype, MESH : Molecular Epidemiology, beta-Lactamases, MESH: Bacterial Typing Techniques, Microbiology, 03 medical and health sciences, MESH: Anti-Bacterial Agents, medicine, Pulsed-field gel electrophoresis, Humans, MESH: Molecular Epidemiology, MESH : Cluster Analysis, Pseudomonas Infections, MESH : France, MESH : Hospitals, University, 030304 developmental biology, MESH : Electrophoresis, Gel, Pulsed-Field, MESH: Hospitals, University, MESH: Humans, Molecular epidemiology, 030306 microbiology, business.industry, MESH : Humans, MESH: Cross Infection, MESH: Drug Resistance, Multiple, Bacterial, DNA Fingerprinting, MESH: Cluster Analysis, Multiple drug resistance, MESH: France, Ticarcillin, MESH : Bacterial Typing Techniques, business, Piperacillin
Abstract

International audience; The aim of this study was to assess the incidence and molecular epidemiology of multidrug-resistant (MDR) Pseudomonas aeruginosa in our university hospital. Analysis included antimicrobial susceptibility profiling, bla gene identification and pulsed-field gel electrophoresis (PFGE). During the one-year study, 654 patients had at least one sample that tested positive for P. aeruginosa, of whom 38 (5.8%) were colonised or infected with an MDR isolate, giving an incidence of 0.1 patient per 1000 patient-days. The 38 non-duplicate isolates yielded 12 different PFGE patterns, three of which included isolates from four patients and one of which included isolates from 15 patients. Two isolates produced acquired extended-spectrum β-lactamase (one OXA-14 and one OXA-28). Genotyping showed that cross-transmission was responsible for about 70% of MDR P. aeruginosa cases although spatio-temporal analysis failed to demonstrate when this might have occurred for most cases. The major epidemic and the three main micro-epidemic clones were already present in our hospital with a more susceptible phenotype. It is likely that some P. aeruginosa clones are endemic in our hospital and that, within these clones, MDR isolates emerge under antibiotic pressure. Our results indicate that cross-transmission plays a major role in the spread of MDR P. aeruginosa and suggest that priority should be given to the improvement of standard hygienic precautions.

Published
2010
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14. Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: a prospective multicenter study involving 2,441 patients

Author

Karine Sitbon, Stéphane Bretagne, Françoise Dromer, Marie Desnos-Ollivier, Olivier Lortholary, Arnaud Fontanet, Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire (CNRMA), Institut Pasteur [Paris], Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Thérapeutique Recombinante Expérimentale (TIMC-IMAG-TheREx), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris] (IP), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Centre de Référence Déficits Immunitaires Héréditaires ( CEREDIH ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire ( CNRMA ), Epidémiologie des Maladies Emergentes, Conservatoire National des Arts et Métiers [CNAM] ( CNAM ) -Institut Pasteur [Paris]-Pasteur-Cnam risques infectieux et émergents ( PACRI ), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] ( CNAM ), Thérapeutique Recombinante Expérimentale ( TIMC-IMAG-THEREX ), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble] ( TIMC-IMAG ), and Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA )

Subjects
Antifungal Agents, MESH : Prevalence, MESH : Prospective Studies, Drug resistance, MESH : Child, Preschool, MESH: Candidemia, law.invention, chemistry.chemical_compound, Echinocandins, 0302 clinical medicine, MESH : Child, law, Caspofungin, MESH: Child, Epidemiology, Candida albicans, MESH : Population Surveillance, Prevalence, Pharmacology (medical), 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Child, Fluconazole, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, Candida, 0303 health sciences, MESH: Microbial Sensitivity Tests, Cross Infection, MESH: Paris, MESH : Paris, MESH : Adult, Intensive care unit, 3. Good health, Infectious Diseases, Child, Preschool, Population Surveillance, MESH : Fluconazole, MESH: Fluconazole, France, MESH : Cross Infection, medicine.drug, Adult, medicine.medical_specialty, Paris, MESH : Candida albicans, MESH : Antifungal Agents, Microbial Sensitivity Tests, Biology, Clinical Therapeutics, MESH: Drug Resistance, Fungal, MESH: Population Surveillance, 03 medical and health sciences, Lipopeptides, Species Specificity, MESH: Candida, Drug Resistance, Fungal, Internal medicine, medicine, MESH : Species Specificity, MESH : Candidemia, MESH: Species Specificity, Humans, MESH : France, MESH: Prevalence, MESH : Echinocandins, Pharmacology, MESH: Humans, 030306 microbiology, MESH: Candida albicans, MESH: Echinocandins, MESH : Humans, MESH: Child, Preschool, MESH : Drug Resistance, Fungal, MESH: Cross Infection, Candidemia, MESH: Adult, Odds ratio, biology.organism_classification, MESH: Antifungal Agents, MESH: Prospective Studies, Surgery, MESH: France, chemistry, MESH : Microbial Sensitivity Tests, MESH : Candida
Abstract

A prospective multicenter surveillance program on yeast bloodstream infections was implemented in the Paris, France, area without restrictions on ward of hospitalization (intensive care unit, hematology, and surgery) or age (adults and children). The present analysis concerns 2,618 isolates collected over 7 years from 2,441 patients. Centralized species identification and antifungal susceptibility testing using the EUCAST methodology were performed. Almost 10% (232/2,441) of the patients had recently (≤30 days) been treated with antifungal drugs. We analyzed the effect of recent exposure to fluconazole ( n = 159) or caspofungin ( n = 61) on the proportions of the five major Candida species. For both drugs, preexposure was associated with a decreased prevalence of Candida albicans in favor of less drug-susceptible species ( C. glabrata and C. krusei for the former and C. parapsilosis and, to a lesser extent, C. glabrata and C. krusei for the latter; P = 0.001). In the multivariate analysis, the risk of being infected with an isolate with decreased susceptibility to fluconazole was independently associated with an age of ≥15 years (odds ratio [OR] = 2.45; 95% confidence interval [CI] = 1.39 to 4.31; P = 0.002) and with recent exposure to fluconazole (OR = 2.17; 95% CI = 1.51 to 3.13; P < 0.001), while the risk of being infected with an isolate with decreased susceptibility to caspofungin was independently associated with an age P = 0.001) and with recent exposure to caspofungin (OR = 4.79; 95% CI = 2.47 to 9.28; P < 0.001). These findings could influence future recommendations for the management of candidemia.

Published
2010
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15. A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units

Author

Philippe Montravers, Olivier Leroy, Jean-Pierre Gangneux, Jean Paul Mira, Olivier Lortholary, Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie-Mycologie [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes (UR), Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire (CNRMA), Institut Pasteur [Paris] (IP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris]

Subjects
Male, Antifungal Agents, MESH : Prospective Studies, MESH : Aged, MESH : Candidiasis, chemistry.chemical_compound, MESH: Aged, 80 and over, 0302 clinical medicine, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Amphotericin B, fluconazole, MESH : Female, 030212 general & internal medicine, Prospective Studies, caspofungin, MESH: Treatment Outcome, Candida, MESH: Aged, Aged, 80 and over, MESH: Microbial Sensitivity Tests, 0303 health sciences, education.field_of_study, Cross Infection, MESH: Middle Aged, Candidiasis, General Medicine, MESH : Adult, Middle Aged, MESH: Candidiasis, 3. Good health, Intensive Care Units, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Infectious Diseases, Treatment Outcome, MESH: Young Adult, Female, France, MESH : Intensive Care Units, MESH : Cross Infection, medicine.drug, Microbiology (medical), Adult, medicine.medical_specialty, MESH: Peritonitis, Adolescent, MESH : Male, MESH : Antifungal Agents, Population, MESH : Young Adult, Peritonitis, MESH : Peritonitis, MESH : Treatment Outcome, Microbial Sensitivity Tests, Biology, Microbiology, 03 medical and health sciences, Young Adult, MESH: Candida, MESH : Adolescent, Internal medicine, Intensive care, medicine, Humans, MESH : Middle Aged, MESH : Aged, 80 and over, MESH : France, education, Mycosis, intensive-care unit, Aged, MESH: Adolescent, Voriconazole, MESH: Humans, 030306 microbiology, MESH : Humans, MESH: Cross Infection, MESH: Adult, MESH: Antifungal Agents, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: France, chemistry, MESH: Intensive Care Units, MESH : Microbial Sensitivity Tests, Caspofungin, MESH: Female, MESH : Candida, Fluconazole
Abstract

International audience; Information on the species causing Candida peritonitis, their in vitro susceptibility, antifungal strategies in this setting and patient outcome is still scarce. AmarCand was a prospective, non-interventional study in 271 adult intensive-care unit (ICU) patients with proven invasive Candida infection who received systemic antifungal therapy (France, 2005-2006). Of these ICU patients, 93 (median age 65 years, simplified acute physiology score II 52) had Candida peritonitis, including 73 nosocomial peritonitis, 53 concomitant bacterial peritoneal infections and 26 candidaemias. Candida species were C. albicans (n = 63/108 isolates, 58%), C. glabrata (n = 22, 20%), C. krusei (n = 9), C. kefyr (n = 5), C. parapsilosis (n = 3), C. tropicalis (n = 3), C. ciferii (n = 2) and C. lusitaniae (n = 1). Of tested isolates, 28% were fluconazole-resistant or susceptible dose-dependent (C. albicans 3/32, C. glabrata 9/14, C. krusei 4/4). Empiric antifungal treatment was started 1 day (median) after peritonitis diagnosis, with fluconazole (n = 2 patients), caspofungin (n = 12), voriconazole (n = 3), amphotericin B (n = 2), or a combination (n = 4). Following susceptibility testing, empiric antifungal treatment was judged inadequate in 9/45 (20%) patients and modified in 30 patients (fluconazole was replaced by caspofungin (n = 14) or voriconazole (n = 4)). Mortality in ICU was 38% (35/93) and was not influenced by type of Candida species, fluconazole susceptibility, time to treatment, candidaemia, nosocomial acquisition, or concomitant bacterial infection. No specific factors for death were identified. In summary, a high proportion of fluconazole-resistant or susceptible dose-dependent strains was cultured. These results confirm the high mortality rates of Candida peritonitis and plead for additional investigation in this population. Antifungal treatment for severe cases of Candida peritonitis in ICU patients remains the standard care.

Published
2010
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16. Usefulness of weekly methicillin-resistant Staphylococcus aureus screening

Author

Daniel Talon, Raouchan Rymzhanova, Xavier Bertrand, Michelle Thouverez, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Micrococcaceae, Meticillin, Time Factors, Epidemiology, Antibiotics, MESH : Hospital Units, Drug resistance, medicine.disease_cause, Hospitals, University, MESH: Infection Control, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Acute care, Mass Screening, Cross Infection, biology, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Staphylococcal Infections, MESH : Adult, 3. Good health, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH : Carrier State, Staphylococcus aureus, Carrier State, MESH: Hospital Units, MESH: Carrier State, Hospital Units, MESH : Cross Infection, medicine.drug, MESH : Time Factors, Microbiology (medical), Adult, Methicillin-Resistant Staphylococcus aureus, medicine.medical_specialty, medicine.drug_class, MESH: Staphylococcal Infections, MESH: Methicillin-Resistant Staphylococcus aureus, Internal medicine, medicine, Humans, MESH : Methicillin-Resistant Staphylococcus aureus, MESH: Mass Screening, Intensive care medicine, MESH : Hospitals, University, MESH: Hospitals, University, MESH : Mass Screening, Infection Control, MESH: Humans, MESH : Infection Control, business.industry, MESH: Time Factors, MESH : Humans, MESH: Cross Infection, MESH: Adult, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, Methicillin-resistant Staphylococcus aureus, Carriage, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Staphylococcal Infections, business
Abstract

We evaluated the usefulness of adding weekly methicillin-resistantStaphylococcus aureus(MRSA) screening to our established admission screening and clinical sampling in 4 acute care units of a university hospital. Our results suggest that weekly MRSA screening allows the detection of 56.1% of all cases of hospital-acquired MRSA carriage. These cases would have remained undetected had admission screening and clinical sampling been the only types of surveillance in place.

Published
2009
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17. Usefulness of antimicrobial resistance pattern for detecting PVL- or TSST-1-producing meticillin-resistant Staphylococcus aureus in a French university hospital

Author

Daniel Talon, Xavier Bertrand, Houssein Gbaguidi-Haore, Michelle Thouverez, Gérard Couetdic, Pascal Cholley, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
MESH : Leukocidins, Male, MESH : Retrospective Studies, MESH : Aged, MESH: Leukocidins, Hospitals, University, 0302 clinical medicine, MESH : Child, MESH: Superantigens, MESH: Child, MESH : Superantigens, Child, Aged, 80 and over, 0303 health sciences, Cross Infection, MESH: Middle Aged, Superantigens, MESH : Genes, Bacterial, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Staphylococcal Infections, Antimicrobial, MESH: Infant, 3. Good health, Electrophoresis, Gel, Pulsed-Field, MESH : Phenotype, MESH: Electrophoresis, Gel, Pulsed-Field, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Staphylococcus aureus, MESH: Young Adult, Child, Preschool, MESH : Cross Infection, Microbiology (medical), Methicillin-Resistant Staphylococcus aureus, Fusidic acid, MESH : Molecular Epidemiology, MESH: Staphylococcal Infections, MESH : Young Adult, Exotoxins, MESH: Methicillin-Resistant Staphylococcus aureus, Microbial Sensitivity Tests, MESH: Phenotype, Microbiology, 03 medical and health sciences, Antibiotic resistance, MESH : Adolescent, MESH: Molecular Epidemiology, MESH : Methicillin-Resistant Staphylococcus aureus, Humans, MESH : Middle Aged, MESH : Aged, 80 and over, MESH : Hospitals, University, MESH : Electrophoresis, Gel, Pulsed-Field, Aged, Retrospective Studies, MESH: Adolescent, MESH: Humans, MESH: Methicillin Resistance, 030306 microbiology, MESH: Child, Preschool, MESH : Humans, Infant, MESH: Adult, MESH: Retrospective Studies, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, Virology, MESH : Methicillin Resistance, MESH : Exotoxins, MESH : Staphylococcal Infections, MESH: Female, Meticillin, Drug resistance, MESH : Child, Preschool, medicine.disease_cause, Enterotoxins, MESH: Aged, 80 and over, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Leukocidins, MESH: Enterotoxins, MESH : Female, 030212 general & internal medicine, MESH : Enterotoxins, MESH: Aged, MESH: Microbial Sensitivity Tests, Molecular Epidemiology, MESH: Infant, Newborn, MESH : Adult, Middle Aged, Phenotype, Female, France, MESH: Genes, Bacterial, medicine.drug, Adult, Adolescent, MESH : Male, Bacterial Toxins, MESH : Infant, Newborn, Young Adult, medicine, MESH : France, MESH: Hospitals, University, business.industry, Infant, Newborn, MESH: Cross Infection, MESH: Exotoxins, MESH: Male, Multiple drug resistance, MESH: France, MESH: Bacterial Toxins, Genes, Bacterial, MESH : Bacterial Toxins, Multilocus sequence typing, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Methicillin Resistance, MESH : Microbial Sensitivity Tests, business
Abstract

Several recent reports have suggested that community-associated meticillin-resistant Staphylococcus aureus (MRSA) clones, particularly those harbouring genes for Panton–Valentine leukocidin (PVL) or toxic shock syndrome toxin 1 (TSST-1), are increasingly responsible for infections in hospitals. Here, a retrospective study was carried out to investigate whether antimicrobial resistance patterns could be used to detect these pathogens in a French university hospital. Isolates were characterized by antimicrobial susceptibility testing, PCR profiling (PVL genes and tst), PFGE typing and multilocus sequence typing. Demographic and clinical data were collected from all patients. For PVL-positive MRSA, the typical antimicrobial resistance pattern (susceptible to fluoroquinolones, non-susceptible to fusidic acid, kanamycin resistant and susceptible to gentamicin and tobramycin) had a sensitivity of 77.8 % and a positive predictive value (PPV) of 100 %. For tst-positive MRSA, the antimicrobial resistance pattern (susceptible to fluoroquinolones and non-susceptible to fusidic acid) had a sensitivity of 100 % and a PPV of 72.4 %. These results suggest that phenotypic rules based on antimicrobial resistance patterns are potentially useful for the detection of PVL- and tst-positive MRSA isolates.

Published
2009
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18. Is there a threshold above which hand-rub solution consumption is efficient for decreasing MRSA incidence?

Author

Michelle Thouverez, Daniel Talon, Xavier Bertrand, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire Chrono-environnement ( LCE ), and Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC )

Subjects
Microbiology (medical), Cross infection, medicine.medical_specialty, MESH: Staphylococcal Infections, MESH: Methicillin-Resistant Staphylococcus aureus, 030501 epidemiology, MESH: Handwashing, Toxicology, 03 medical and health sciences, 0302 clinical medicine, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, medicine, MESH : Methicillin-Resistant Staphylococcus aureus, 030212 general & internal medicine, MESH: Incidence, Intensive care medicine, Hand disinfection, ComputingMilieux_MISCELLANEOUS, Consumption (economics), Which hand, MESH: Humans, business.industry, Incidence (epidemiology), MESH : Humans, MESH: Disinfectants, MESH: Cross Infection, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, MESH : Incidence, MESH : Disinfectants, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH : Handwashing, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Staphylococcal Infections, 0305 other medical science, business, MESH : Intensive Care Units, MESH : Cross Infection, Beta lactam antibiotics
Abstract

International audience

Published
2009
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19. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006)

Author

Leroy , Olivier, Gangneux , Jean-Pierre, Montravers , Philippe, Mira , Jean-Paul, Gouin , François, Sollet , Jean-Pierre, Carlet , Jean, Reynes , Jacques, Rosenheim , Michel, Regnier , Bernard, Lortholary , Olivier, Renseigné , Non, Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, Régulations des équilibres fonctionnels du foie normal et pathologique, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département anesthésie-réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), service de réanimation polyvalente, Centre Hospitalier Victor Dupuy, Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Groupe Hospitalier Paris Saint-Joseph (hpsj), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1)

Subjects
Male, critically ill, MESH : Aged, MESH : Prospective Studies, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Case fatality rate, Hospital Mortality, Prospective Studies, MESH: Incidence, Fungemia, MESH: Treatment Outcome, Cause of death, Aged, 80 and over, Cross Infection, 0303 health sciences, MESH: Middle Aged, Incidence, Candidiasis, MESH: Follow-Up Studies, MESH : Incidence, 3. Good health, Survival Rate, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Young Adult, MESH: Critical Illness, MESH : Intensive Care Units, MESH : Cross Infection, medicine.medical_specialty, MESH: Probability, Critical Illness, MESH : Young Adult, MESH : Cohort Studies, Statistics, Nonparametric, MESH : Hospital Mortality, 03 medical and health sciences, MESH: Critical Care, MESH: Fungemia, Intensive care, MESH : Adolescent, Humans, MESH : Middle Aged, MESH: Hospital Mortality, MESH : Aged, 80 and over, Mycosis, Aged, MESH: Adolescent, MESH: Humans, 030306 microbiology, MESH : Humans, MESH: Adult, MESH : Follow-Up Studies, MESH: Antifungal Agents, medicine.disease, chemistry, MESH: Female, Fluconazole, Antifungal Agents, MESH : Critical Illness, Cohort Studies, MESH: Cause of Death, chemistry.chemical_compound, MESH : Candidiasis, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Cause of Death, MESH : Female, 030212 general & internal medicine, MESH: Cohort Studies, MESH : Critical Care, Candida, intensive care, MESH: Aged, MESH: Statistics, Nonparametric, fungemia, Middle Aged, MESH : Adult, MESH : Survival Rate, MESH : Risk Factors, MESH: Candidiasis, Intensive Care Units, Treatment Outcome, Female, epidemiology, France, medicine.drug, Adult, Adolescent, Critical Care, MESH: Survival Rate, MESH : Male, MESH : Probability, MESH : Antifungal Agents, MESH : Treatment Outcome, Young Adult, Internal medicine, medicine, MESH : France, MESH : Statistics, Nonparametric, Probability, MESH : Cause of Death, Voriconazole, business.industry, MESH: Cross Infection, MESH: Male, MESH: Prospective Studies, Surgery, MESH: France, MESH : Fungemia, MESH: Intensive Care Units, Caspofungin, business, Follow-Up Studies
Abstract

International audience; OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.

Published
2009
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20. Meticillin-resistant Staphylococcus aureus contamination of healthcare workers' uniforms in long-term care facilities

Author

S. Gayet, D. Gunther, Philippe Gaspard, Daniel Talon, Xavier Bertrand, E. Eschbach, ARELIN, ARELIN, Strasbourg, France, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Meticillin, MESH : Aged, Nurses, 030501 epidemiology, medicine.disease_cause, MESH: Long-Term Care, MESH: Infection Control, 0302 clinical medicine, Protective Clothing, Hygiene, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Nursing Assistants, Infection control, Homes for the Aged, MESH: Nurses' Aides, 030212 general & internal medicine, MESH: Incidence, Antibacterial agent, media_common, MESH: Aged, Cross Infection, Incidence, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Staphylococcal Infections, MESH : Incidence, 3. Good health, Infectious Diseases, MESH: Nurses, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Fomites, MESH : Protective Clothing, France, MESH : Long-Term Care, 0305 other medical science, MESH: Equipment Contamination, MESH : Cross Infection, medicine.drug, Microbiology (medical), Methicillin-Resistant Staphylococcus aureus, medicine.medical_specialty, media_common.quotation_subject, MESH: Staphylococcal Infections, MESH: Methicillin-Resistant Staphylococcus aureus, MESH : Fomites, Staphylococcal infections, MESH: Protective Clothing, 03 medical and health sciences, MESH : Nurses' Aides, Environmental health, MESH : Nurses, medicine, MESH : Methicillin-Resistant Staphylococcus aureus, Humans, Intensive care medicine, MESH: Homes for the Aged, MESH : France, MESH : Homes for the Aged, Aged, Infection Control, MESH: Humans, MESH : Infection Control, business.industry, MESH : Humans, MESH: Cross Infection, medicine.disease, MESH: Fomites, Methicillin-resistant Staphylococcus aureus, Long-Term Care, Nursing Homes, MESH: France, Long-term care, MESH: Nursing Homes, MESH : Equipment Contamination, Equipment Contamination, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Staphylococcal Infections, business, MESH : Nursing Homes
Abstract

International audience; Meticillin-resistant Staphylococcus aureus (MRSA) and other multiply resistant bacteria are frequently isolated in long-term care facilities (LTCFs). This study evaluated the contamination of staff clothing in three LTCFs. Over 500 samples were taken from uniforms and their pockets and these samples showed a high level of MRSA contamination. Wearing plastic aprons and managing pocket contents improved the contamination rate. Our results highlight the continued importance of hand hygiene, since staff have frequent contact with their uniforms and could potentially contaminate their hands before care.

Published
2008
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21. Are antibiotic-resistant Pseudomonas aeruginosa isolated from hospitalised patients recovered in the hospital effluents?

Author

Xavier Bertrand, Michelle Thouverez, I. Patry, Houssein Gbaguidi-Haore, E. Tuméo, Daniel Talon, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Antibiotics, Drug resistance, 010501 environmental sciences, medicine.disease_cause, MESH : Drug Resistance, Bacterial, 01 natural sciences, Waste Disposal, Fluid, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, MESH : Medical Waste Disposal, Medical Waste Disposal, Antibacterial agent, 0303 health sciences, MESH: Microbial Sensitivity Tests, Cross Infection, MESH : Waste Disposal, Fluid, MESH: Pseudomonas Infections, MESH : Pseudomonas Infections, 6. Clean water, Drug Resistance, Multiple, 3. Good health, Bacterial Typing Techniques, Electrophoresis, Gel, Pulsed-Field, MESH: Electrophoresis, Gel, Pulsed-Field, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Wastewater, France, Water Microbiology, MESH : Cross Infection, medicine.drug_class, Microbial Sensitivity Tests, MESH: Bacterial Typing Techniques, Microbiology, MESH: Drug Resistance, Multiple, 03 medical and health sciences, Antibiotic resistance, MESH: Drug Resistance, Bacterial, Drug Resistance, Bacterial, Pulsed-field gel electrophoresis, medicine, Humans, Pseudomonas Infections, MESH : France, MESH: Medical Waste Disposal, 0105 earth and related environmental sciences, MESH : Electrophoresis, Gel, Pulsed-Field, MESH: Humans, 030306 microbiology, Pseudomonas aeruginosa, business.industry, MESH : Water Microbiology, MESH : Humans, Public Health, Environmental and Occupational Health, MESH: Cross Infection, MESH: Water Microbiology, MESH: France, MESH : Bacterial Typing Techniques, MESH : Microbial Sensitivity Tests, MESH: Waste Disposal, Fluid, business, Waste disposal, MESH : Drug Resistance, Multiple
Abstract

International audience; Previous reports have studied the presence of antibiotic-resistant Pseudomonas aeruginosa strains in hospital wastewater without determination of their clonal relationship with the clinical strains of this species. The objectives of this study were to quantify the presence of P. aeruginosa in wastewater of our hospital, to determine their antibiotic-resistance profile and to potentially trace clinical antibiotic-resistant strains from patients to wastewater. Specimens were taken at the end of the wastewater network of our hospital just before the reject in the collective network of the town. Two specimens were taken each Monday during 12 weeks. All P. aeruginosa isolates recovered from hospitalised patients during the study period were collected. Genotyping of both clinical and wastewater isolates was determined by using pulsed-field gel electrophoresis (PFGE). The antibiotic-resistance profile of wastewater isolates was different from that of clinical isolates. The mechanisms involved in antibiotic resistance were different according to the origin of the isolates (wastewater versus human isolates). There was no common PFGE pattern in antibiotic-resistant P. aeruginosa from humans and wastewater. This study suggests that the risk of spread of antibiotic resistance in hospital wastewater is limited.

Published
2008
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22. Nosocomial dermatitis caused by Dermanyssus gallinae

Author

Françoise Foulet, Anne-Pauline Bellanger, Françoise Botterel, Stéphane Bretagne, C. Bories, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Parasitologie-Mycologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de parasitologie [Mondor], Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), and Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 )

Subjects
Veterinary medicine, Dermanyssus gallinae, Epidemiology, MESH : Aged, Dermatitis, medicine.disease_cause, MESH : Dermatitis, MESH : Mite Infestations, 0403 veterinary science, 030207 dermatology & venereal diseases, 0302 clinical medicine, Nest, Medicine, MESH : Female, MESH: Animals, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, MESH: Aged, Cross Infection, Mites, biology, 04 agricultural and veterinary sciences, 3. Good health, Infectious Diseases, Female, France, MESH : Cross Infection, Microbiology (medical), Mite Infestations, 040301 veterinary sciences, MESH: Mites, 03 medical and health sciences, Infestation, parasitic diseases, Mite, Pruritic dermatitis, Animals, Humans, MESH: Dermatitis, MESH : Mites, Columbidae, MESH : France, Aged, MESH: Columbidae, MESH: Humans, business.industry, MESH : Humans, MESH: Cross Infection, biology.organism_classification, MESH: France, MESH: Mite Infestations, Immunology, MESH : Animals, MESH : Columbidae, business, MESH: Female
Abstract

The mite Dermanyssus gallinae may cause pruritic dermatitis in humans. We describe a case of nosocomial infestation with D. gallinae from an abandoned pigeon nest suspended on the front wall of the Hôpital Henri Mondor near a window. Close surveillance and regular destruction of pigeon nests could prevent these incidents of infection in humans.

Published
2008
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23. Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis

Author

Christopher H. Cabell, Pilar Tornos, Paul A. Pappas, David L. Gordon, Christopher W. Woods, Bruno Hoen, Tom S.J. Elliott, Eugene Athan, Francesc Marco, Claudio Querido Fortes, Francisco Nacinovich, G. Ralph Corey, Jerome J. Federspiel, Vivian H. Chu, Riccardo Utili, José M. Miró, Vance G. Fowler, Martin E. Stryjewski, Donald P. Levine, François Delahaye, Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
Male, Pacemaker, Artificial, Staphylococcus, MESH : Aged, MESH : Prospective Studies, MESH : Coagulase, Heart Valve Diseases, 030204 cardiovascular system & hematology, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Epidemiology, MESH : Female, Prospective Studies, MESH : Endocarditis, Bacterial, Prospective cohort study, MESH: Aged, 0303 health sciences, Cross Infection, MESH: Middle Aged, Mortality rate, cons, MESH: Staphylococcus, MESH : Adult, Middle Aged, MESH : Heart Valve Diseases, 3. Good health, Community-Acquired Infections, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Infectious Diseases, MESH: Community-Acquired Infections, MESH: Pacemaker, Artificial, Female, MESH: Coagulase, MESH : Cross Infection, MESH : Community-Acquired Infections, Microbiology (medical), Adult, Coagulase, medicine.medical_specialty, MESH : Male, 03 medical and health sciences, Internal medicine, medicine, Endocarditis, Humans, MESH : Middle Aged, MESH: Endocarditis, Bacterial, MESH : Staphylococcus, Aged, Heart Failure, Native Valve Endocarditis, MESH: Humans, MESH: Methicillin Resistance, 030306 microbiology, business.industry, MESH : Pacemaker, Artificial, MESH : Humans, MESH: Cross Infection, MESH: Adult, Odds ratio, Endocarditis, Bacterial, MESH: Heart Valve Diseases, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH : Methicillin Resistance, Surgery, Bacteremia, MESH: Heart Failure, Methicillin Resistance, MESH : Heart Failure, business, MESH: Female
Abstract

International audience; BACKGROUND: Coagulase-negative staphylococci (CoNS) are an infrequent cause of native valve endocarditis (NVE), and our understanding of NVE caused by CoNS is incomplete. METHOD: The International Collaboration on Endocarditis-Prospective Cohort Study includes patients with endocarditis from 61 centers in 28 countries. Patients with definite cases of NVE caused by CoNS who were enrolled during the period June 2000-August 2006 were compared with patients with definite cases of NVE caused by Staphylococcus aureus and patients with NVE caused by viridans group streptococci. Multivariable logistic regression was used to determine factors associated with death in patients with NVE caused by CoNS. RESULTS: Of 1635 patients with definite NVE and no history of injection drug use, 128 (7.8%) had NVE due to CoNS. Health care-associated infection occurred in 63 patients (49%) with NVE caused by CoNS. Comorbidities, long-term intravascular catheter use, and history of recent invasive procedures were similar among patients with NVE caused by CoNS and among patients with NVE caused by S. aureus. Surgical treatment for endocarditis occurred more frequently in patients with NVE due to CoNS (76 patients [60%]) than in patients with NVE due to S. aureus (150 [33%]; P=.01) or in patients with NVE due to viridans group streptococci (149 [44%]; P=.01). Despite the high rate of surgical procedures among patients with NVE due to CoNS, the mortality rates among patients with NVE due to CoNS and among patients with NVE due to S. aureus were similar (32 patients [25%] and 124 patients [27%], respectively; P=.44); the mortality rate among patients with NVE due to CoNS was higher than that among patients with NVE due to viridans group streptococci (24 [7.0%]; P=.01). Persistent bacteremia (odds ratio, 2.65; 95% confidence interval, 1.08-6.51), congestive heart failure (odds ratio, 3.35; 95% confidence interval, 1.57-7.12), and chronic illness (odds ratio, 2.86; 95% confidence interval, 1.34-6.06) were independently associated with death in patients with NVE due to CoNS (c index, 0.73). CONCLUSIONS: CoNS have emerged as an important cause of NVE in both community and health care settings. Despite high rates of surgical therapy, NVE caused by CoNS is associated with poor outcomes.

Published
2008
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24. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection

Author

C. Husson, A.-G. Venier, M. Badoz, Daniel Talon, J. Crouzet, Xavier Bertrand, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Institut de Mécanique des Fluides et des Solides (IMFS), Université Louis Pasteur - Strasbourg I-Centre National de la Recherche Scientifique (CNRS), Institut de Chimie des Substances Naturelles (ICSN), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Institut de Mécanique des Fluides et des Solides ( IMFS ), Université Louis Pasteur - Strasbourg I-Centre National de la Recherche Scientifique ( CNRS ), Institut de Chimie des Substances Naturelles ( ICSN ), Centre National de la Recherche Scientifique ( CNRS ), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), and Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Time Factors, MESH : Prevalence, medicine.medical_treatment, MESH : Prospective Studies, MESH : Aged, MESH: Logistic Models, MESH: Urinary Tract Infections, Logistic regression, Hospitals, University, 0302 clinical medicine, MESH: Aged, 80 and over, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Epidemiology, Prevalence, MESH : Urinary Tract Infections, MESH : Female, Prospective Studies, 030212 general & internal medicine, MESH: Incidence, Prospective cohort study, Aged, 80 and over, MESH: Aged, Cross Infection, 0303 health sciences, MESH: Middle Aged, Incidence, Incidence (epidemiology), MESH : Urinary Catheterization, General Medicine, MESH : Adult, Middle Aged, MESH : Incidence, 3. Good health, Catheter, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Intervention Studies, Urinary Tract Infections, Female, Urinary Catheterization, MESH : Cross Infection, MESH : Time Factors, Adult, Microbiology (medical), medicine.medical_specialty, Adolescent, MESH : Male, Urinary system, Urinary catheterization, 03 medical and health sciences, MESH : Adolescent, medicine, Humans, MESH : Middle Aged, Risk factor, MESH : Aged, 80 and over, MESH : Hospitals, University, MESH: Prevalence, Aged, MESH: Adolescent, MESH: Hospitals, University, MESH: Humans, 030306 microbiology, business.industry, MESH : Humans, MESH: Time Factors, MESH: Cross Infection, MESH: Adult, MESH: Male, MESH: Prospective Studies, Surgery, Logistic Models, Emergency medicine, MESH: Urinary Catheterization, MESH : Intervention Studies, business, MESH: Female, MESH : Logistic Models
Abstract

International audience; Catheter-associated urinary tract infection (CAUTI) is one of the most common types of nosocomial infection. Reducing the duration of catheterization may be a key intervention in CAUTI prevention. We carried out a prospective time-sequence, non-randomized intervention study in five departments of our university hospital. We wished to determine the impact of daily reminders from nurses to physicians to remove unnecessary urinary catheters four days after insertion. The intervention significantly decreased the duration of catheterization in two out of five departments. The frequency of late CAUTI (LCAUTI) among catheterized patients in all five departments decreased from 10.6 to 1.1 per 100 patients (P = 0.003) and the incidence of LCAUTI decreased from 12.3 to 1.8 per 1000 catheter-days (P = 0.03). Logistic regression analysis showed that duration of catheterization and iterative catheter changes were associated with LCAUTI. This study demonstrates that a simple measure can reduce the frequency of LCAUTI.

Published
2007
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25. Comparison of several commercial serologic kits and Em18 serology for detection of human alveolar echinococcosis

Author

Jean-Mathieu Bart, Akira Ito, Renaud Piarroux, Solange Bresson-Hadni, Yasuhito Sako, Martine Piarroux, Frédéric Grenouillet, WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, SERF Unit, Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ), Frontier Research Center for Global Change ( FRCGC ), Japan Agency for Marine-Earth Science and Technology ( JAMSTEC ), Asahikawa Medical College, Dept of Parasitology ( AMC ), Asahikawa Medical College, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Frontier Research Center for Global Change (FRCGC), Japan Agency for Marine-Earth Science and Technology (JAMSTEC), and Asahikawa Medical College, Dept of Parasitology (AMC)

Subjects
Male, Pathology, Screening techniques, MESH : Retrospective Studies, MESH: Hemagglutination Tests, MESH: Reagent Kits, Diagnostic, Medical laboratory, MESH : Aged, Alveolar echinococcosis, Serology, MESH: Infection Control, MESH : Candidiasis, MESH : Hemagglutination Tests, MESH: Hygiene, Medicine, MESH: Animals, MESH : Female, MESH: Incidence, MESH: Disease Outbreaks, MESH : Reagent Kits, Diagnostic, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, MESH : Immunoblotting, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, MESH: Academic Medical Centers, Immunoassay, MESH: Aged, 0303 health sciences, MESH: Middle Aged, MESH: Immunoblotting, Indirect hemagglutination, MESH: Echinococcosis, Hepatic, MESH : Questionnaires, MESH : Hygiene, General Medicine, Middle Aged, MESH : Adult, MESH : Immunoassay, Echinococcosis, MESH: Candidiasis, MESH : Incidence, 3. Good health, MESH : Serologic Tests, Infectious Diseases, MESH : Academic Medical Centers, Female, MESH : Sensitivity and Specificity, MESH: Immunoassay, MESH : Cross Infection, Adult, Microbiology (medical), Echinococcosis, Hepatic, medicine.medical_specialty, MESH : Male, Immunoblotting, Helminthiasis, Sensitivity and Specificity, 03 medical and health sciences, Animals, Humans, Serologic Tests, MESH : Middle Aged, MESH : Disease Outbreaks, MESH : France, Aged, 030304 developmental biology, MESH: Humans, MESH : Infection Control, 030306 microbiology, business.industry, MESH: Questionnaires, MESH: Serologic Tests, MESH : Humans, MESH: Cross Infection, MESH: Retrospective Studies, MESH: Adult, Hemagglutination Tests, medicine.disease, MESH: Male, MESH: Sensitivity and Specificity, MESH: France, Reagent Kits, Diagnostic, MESH : Animals, business, MESH : Echinococcosis, Hepatic, MESH: Female
Abstract

International audience; The aim of this study was to design the best serologic strategy for diagnosing human alveolar echinococcosis (AE) cases in medical laboratory routine procedures. By combining 2 screening techniques, indirect hemagglutination with Em(2plus)-ELISA and/or recEm18-ELISA, 46 of 47 AE cases were detected. The necessary confirmation of results is then obtained by using immunoblot (LDBIO-IB and/or recEm18-IB).

Published
2007
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26. Does catheter-associated urinary tract infection increase mortality in critically ill patients?

Author

Jean-Philippe Fosse, Samir Jamali, Dany Toledano, Yves Cohen, Christophe Clec’h, Elie Azoulay, Adrien Français, Christophe Adrie, Jean-François Timsit, Adrien Descorps-Declere, Carole Schwebel, Maité Garrouste-Orgeas, Didier Nakache, Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Medical-Surgical ICU, Hôpital de Gonesse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Hôpital de Dourdan, Medical - Surgical ICU, CHU CLAMART, Centre d'enseignement Cnam Paris (CNAM Paris), Conservatoire National des Arts et Métiers [CNAM] (CNAM), INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Vesin, Aurélien, Université Paris 13 ( UP13 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Avicenne, Institut d'oncologie/développement Albert Bonniot de Grenoble ( INSERM U823 ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Albert Michallon, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -Hôpital Saint Joseph, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, Conservatoire National des Arts et Métiers - Paris ( CNAM Paris ), Conservatoire National des Arts et Métiers [CNAM] ( CNAM ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Clinique de réanimation médicale, and Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Albert Michallon-Hôpital Albert Michallon

Subjects
Male, Pediatrics, MESH : Retrospective Studies, Epidemiology, MESH : Aged, MESH: Urinary Tract Infections, MESH : Critical Illness, Severity of Illness Index, law.invention, law, MESH : Urinary Tract Infections, MESH : Female, Hospital Mortality, Simplified Acute Physiology Score, MESH: Aged, education.field_of_study, Cross Infection, MESH: Middle Aged, Incidence (epidemiology), [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Middle Aged, Intensive care unit, MESH: Case-Control Studies, 3. Good health, Intensive Care Units, Infectious Diseases, Cohort, MESH: Critical Illness, Urinary Tract Infections, MESH : Severity of Illness Index, Female, France, MESH : Intensive Care Units, MESH : Cross Infection, Microbiology (medical), MESH : Case-Control Studies, medicine.medical_specialty, MESH : Male, Critical Illness, Population, MESH : Hospital Mortality, MESH: Severity of Illness Index, Severity of illness, medicine, Humans, MESH : Middle Aged, MESH: Hospital Mortality, MESH : France, education, Aged, Retrospective Studies, MESH: Humans, business.industry, MESH : Humans, MESH: Cross Infection, Retrospective cohort study, MESH: Retrospective Studies, Odds ratio, MESH: Male, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Case-Control Studies, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

Objective.To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.Design.Nested case-control study in a multicenter cohort (the OutcomeRea database).Setting.Twelve French medical or surgical ICUs.Methods.All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age ( ± 10 years), SAPS (Simplified Acute Physiology Score) II score ( ± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.Results.Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P>.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).Conclusion.After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.

Published
2007
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27. Results from a four-year study on the prevalence of nosocomial infections in Franche-Comté: attempt to rank the risk of nosocomial infection

Author

A. Picard, P. Bailly, C. Louis-Martinet, Daniel Talon, B. Claude, Xavier Bertrand, N. Floret, N. Tueffert, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire de Physique Nucléaire et de Hautes Énergies (LPNHE), Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Pierre et Marie Curie - Paris 6 (UPMC), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire de Physique Nucléaire et de Hautes Énergies ( LPNHE ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire Chrono-environnement (UMR 6249) (LCE), and Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Pediatrics, MESH: Chi-Square Distribution, MESH : Prevalence, MESH : Aged, 030501 epidemiology, MESH: Catheterization, Patient type, MESH: Infection Control, MESH : Catheterization, 0302 clinical medicine, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Risk Factors, MESH: Risk Factors, Epidemiology, Prevalence, MESH: Immunocompromised Host, 030212 general & internal medicine, MESH: Aged, Cross Infection, MESH: Middle Aged, Age Factors, MESH : Immunocompromised Host, General Medicine, Middle Aged, MESH : Risk Factors, 3. Good health, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, France, 0305 other medical science, MESH : Cross Infection, Microbiology (medical), medicine.medical_specialty, Catheterization, Immunocompromised Host, 03 medical and health sciences, medicine, Humans, MESH : Middle Aged, Risk factor, MESH : France, MESH: Prevalence, Aged, MESH: Age Factors, Infection Control, Chi-Square Distribution, MESH: Humans, MESH : Chi-Square Distribution, MESH : Infection Control, business.industry, Public health, MESH : Humans, MESH: Cross Infection, MESH: France, Prevalence studies, Endogenous risk, MESH : Age Factors, business
Abstract

International audience; 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.

Published
2006
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28. [Are isolation measures needed in the hospital management of Acinetobacter baumannii colonizations-infections?]

Author

Gbaguidi Haore, H., Bertrand, X., Müller, A., Thouverez, M., Talon, D., Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Max-Planck-Institut für Metallforschung and Institut für Nichtmetallische Anorganische Materialien, Max-Planck-Institut-Universität Stuttgart [Stuttgart], Physiopathologie du système nerveux., Université Louis Pasteur - Strasbourg I-IFR37-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Acinetobacter baumannii, MESH : Retrospective Studies, Bacteremia, MESH : Genotype, MESH : Drug Utilization, Disease Outbreaks, Patient Isolation, MESH: Genotype, MESH : Containment of Biohazards, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Drug Resistance, Multiple, Bacterial, MESH: Hygiene, MESH: Incidence, MESH: Disease Outbreaks, MESH: Drug Utilization, MESH : Anti-Bacterial Agents, MESH: Bacteremia, Cross Infection, Incidence, Hygiene, MESH : Hygiene, Containment of Biohazards, MESH : Incidence, Anti-Bacterial Agents, Bacterial Typing Techniques, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH : Carrier State, Carrier State, France, MESH: Carrier State, MESH: Acinetobacter Infections, MESH : Cross Infection, Acinetobacter Infections, MESH : Drug Resistance, Multiple, Bacterial, Genotype, MESH: Bacterial Typing Techniques, MESH: Containment of Biohazards, MESH : Patient Isolation, MESH: Anti-Bacterial Agents, Humans, MESH : Acinetobacter Infections, MESH : Disease Outbreaks, MESH : France, MESH : Acinetobacter baumannii, Retrospective Studies, MESH: Humans, MESH: Acinetobacter baumannii, MESH : Humans, MESH: Cross Infection, MESH: Retrospective Studies, MESH: Drug Resistance, Multiple, Bacterial, MESH : Bacteremia, Drug Utilization, MESH: Patient Isolation, MESH: France, MESH : Bacterial Typing Techniques
Abstract

International audience; Until 2001, the infection control department of the Besançon university hospital (France) recommended isolation precautions for all patients colonized-infected by Acinetobacter baumannii (Ab) whatever the antibiotic susceptibility of the strain. These systematic isolation procedures were given up at the beginning of 2002 since the number of colonized-infected patients remained stable from 1998 to 2001. OBJECTIVE: The aim of this study was to evaluate the impact of this decision on the risk of Ab infection. METHOD: Incidence rates of colonization-infections that were observed during years 2002 and 2003 were compared with expected incidence rate, based on data from 1998-2001 period. Infection control practices and antibiotics consumption were evaluated for each ward of hospitalisation. Genotyping made it possible to determine diversity of clones inside each unit and the whole hospital. RESULTS: The expected incidence per 1000 patients-days was 0.22 in comparison with observed data in 2002, 0.34 (CI(95%) [0.28-0.42]), and in 2003, 0.53 (CI(95%) [0.45-0.63]). The expected number of Ab bloodstream infections, about two per year compared with the observed numbers in 2002 and 2003 respectively seven and 17. The number of unit with more than three cases per year increased from seven in 1999 to 18 in 2003. Antibiotics consumption did not change significantly. CONCLUSION: Genotyping results show the importance of cross-transmission in these units. Finally, observed results suggest that some measures of isolation precautions in addition to standard precautions are needed to prevent outbreaks of Ab.

Published
2006
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29. Pontiac fever: an operational definition for epidemiological studies

Author

Philippe Hartemann, Denis Zmirou-Navier, Laurence Mathieu, Paul Tossa, M. Deloge-Abarkan, Evaluations et prévention des risques professionnels et environnementaux, Cancéropôle du Grand Est-Université Henri Poincaré - Nancy 1 ( UHP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'Hydroclimatologie Médicale Santé Environnement, École pratique des hautes études ( EPHE ), Faculté de Médecine [UHP], Université Henri Poincaré - Nancy 1 ( UHP ), This study was funded by AFSSE (French Agency for Environemental Sanitary Security), the French ministry of Health and Véolia. M. Deloge-Abarkan was recipient of a doctoral scholarship from ADEME and EDF. The design of the aerosol exposure assessment was extensively discussed with Enric Robine, from CSTB, the French Building Research Center. The water system critical point analysis procedure was elaborated by Veolia Environnement. Nathalie Diguio, a Master student at Inserm, contributed to the study follow-up., Cancéropôle du Grand Est-Université Henri Poincaré - Nancy 1 (UHP)-Institut National de la Santé et de la Recherche Médicale (INSERM), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Université Henri Poincaré - Nancy 1 (UHP), and Zmirou, Denis

Subjects
myalgia, Male, Hot Temperature, MESH : Aged, MESH : Research Suppo, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Surveys and Questionnaires, MESH: Incidence, MESH: In Situ Hybridization, Fluorescence, Toilet Facilities, Aged, 80 and over, 0303 health sciences, education.field_of_study, Cross Infection, Incidence, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Incidence, 3. Good health, MESH : In Situ Hybridization, Fluorescence, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Population Surveillance, MESH: Research Suppo, MESH : Fever, Coxiella Burnetii, MESH : Cross Infection, medicine.medical_specialty, Shower Water, Legionella, MESH : Legionellosis, Sampling Studies, MESH: Population Surveillance, 03 medical and health sciences, MESH: Fever, Humans, education, MESH : Aged, 80 and over, High Attack Rate, Aged, MESH: Humans, Legionellosis, 030306 microbiology, Public health, MESH: Questionnaires, MESH : Humans, Public Health, Environmental and Occupational Health, Outbreak, lcsh:RA1-1270, medicine.disease, Nursing Homes, Pontiac Fever, Immunology, MESH: Female, MESH : Nursing Homes, Pediatrics, Time Factors, MESH: Aerosols, MESH: Aged, 80 and over, Epidemiology, MESH: Antibodies, Bacterial, MESH : Population Surveillance, MESH : Female, 030212 general & internal medicine, In Situ Hybridization, Fluorescence, MESH: Aged, biology, lcsh:Public aspects of medicine, Incidence (epidemiology), MESH : Questionnaires, Antibodies, Bacterial, Nursing Home, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH : Aerosols, Female, medicine.symptom, Water Microbiology, Research Article, Fever, MESH : Male, Population, MESH: Heat, MESH : Legionella, MESH : Heat, medicine, MESH : Antibodies, Bacterial, Aerosols, business.industry, Pontiac fever, MESH: Cross Infection, biology.organism_classification, MESH: Male, MESH: Legionellosis, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Nursing Homes, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Legionella
Abstract

Background Pontiac fever is usually described in epidemic settings. Detection of Pontiac fever is a marker of an environmental contamination by Legionella and should thereby call for prevention measures in order to prevent outbreak of Legionnaire's disease. The objective of this study is to propose an operational definition of Pontiac fever that is amenable to epidemiological surveillance and investigation in a non epidemic setting. Methods A population of 560 elderly subjects residing in 25 nursing homes was followed during 4 months in order to assess the daily incidence of symptoms associated, in the literature, with Pontiac fever. The water and aerosol of one to 8 showers by nursing home were characterized combining conventional bacterial culture of Legionella and the Fluorescence In Situ Hybridization (FISH) technique that used oligonucleotides probes specific for Legionellaceae. A definition of Pontiac fever was devised based on clinical symptoms described in epidemic investigations and on their timing after the exposure event. The association between incidence of Pontiac fever and shower contamination levels was evaluated to test the relevance of this definition. Results The proposed definition of Pontiac fever associated the following criteria: occurrence of at least one symptom among headache, myalgia, fever and shivers, possibly associated with other 'minor' symptoms, within three days after a shower contaminated by Legionella, during a maximum of 8 days (minimum 2 days). 23 such cases occurred during the study (incidence rate: 0.125 cases per person-year [95% CI: 0.122–0.127]). A concentration of Legionella in water equal to or greater than 104.L-1 (FISH method) was associated with a significant increase of incidence of Pontiac fever (p = 0.04). Conclusion Once validated in other settings, the proposed definition of Pontiac fever might be used to develop epidemiological surveillance and help draw attention on sources of Legionella.

Published
2005
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30. [Impact of a multidisciplinary approach for monitoring prescribing of antibiotics in a hospital]

Author

Causse, R., Chouaid, C., Callaert, S., Le Paih, M. F., Cohen, R., Thebault, A., Sciences et Technologies de la Musique et du Son ( STMS ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -IRCAM-Centre National de la Recherche Scientifique ( CNRS ), Epidémiologie des maladies infectieuses et modélisation ( ESIM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'Ecologie Alpine ( LECA ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Université Savoie Mont Blanc ( USMB [Université de Savoie] [Université de Chambéry] ) -Centre National de la Recherche Scientifique ( CNRS ), R Causse, C Chouaid, S Callaert, Le Paih MF, Cohen R, A Thebault, Annesi-Maesano, Isabella, Sciences et Technologies de la Musique et du Son (STMS), Institut de Recherche et Coordination Acoustique/Musique (IRCAM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Ecologie Alpine (LECA), Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), and Université Joseph Fourier - Grenoble 1 (UJF)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Inservice Training, Cost Control, MESH : Drug Prescriptions, MESH : Inservice Training, MESH : Medical Audit, Health Services Misuse, MESH: Medical Audit, Drug Prescriptions, Drug Costs, MESH : Drug Costs, MESH : Drug Utilization, MESH : Cost Control, MESH : Hospital Costs, MESH: Patient Care Team, MESH: Drug Prescriptions, MESH : Child, MESH: Anti-Bacterial Agents, MESH: Child, MESH: Drug Costs, Humans, MESH : Health Services Misuse, MESH: Drug Utilization, Hospital Costs, MESH : Anti-Bacterial Agents, Child, MESH : France, MESH: Hospital Costs, Patient Care Team, Cross Infection, Medical Audit, MESH: Humans, MESH : Patient Care Team, MESH: Cost Control, MESH : Humans, MESH: Cross Infection, MESH: Adult, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, MESH: Health Services Misuse, MESH: Inservice Training, Drug Utilization, Anti-Bacterial Agents, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, MESH : Cross Infection
Abstract

International audience; OBJECTIVE: The aim of this study was to examine the impact of a rationalized antibiotic prescription program in a 600-bed hospital. PATIENTS AND METHODS: The program was based on a local consensus policy, developed with the prescribers themselves, together with individual nominative dispensing (IDN) of the most costly antibiotics, and training/information programs aimed at institutional prescribers. The impact of the program was assessed in terms of the relevance of prescriptions (6-monthly audits), changes in the overall cost of anti-infectives, the average daily cost per hospital patient, and changes in the pattern of antimicrobial resistance among pathogens isolated in the institution. RESULTS: Reference recommendations were established for most clinical settings encountered in the hospital (104 for adults, 78 for children). The four audits conducted since June 1996 show that the rate of unjustified prescriptions has remained below 6%. The cost of antimicrobials has fallen regularly, both in absolute terms and as a proportion of total drug costs. Finally, resistance rates among the different pathogens studied have fallen or remained stable. CONCLUSION: Rationalization of antimicrobial chemotherapy in a short-stay hospital necessitates an institution-based policy with long-term objectives, a large initial investment and, above all, a participative approach among all prescribers.

Published
1998

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