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NosoVeille – Bulletin de veille Février 2013







NosoVeille n°2
Février 2013



Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve

Secrétariat de rédaction : Nathalie Vincent

Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html

Pour recevoir, tous les mois, NosoVeille dans votre messagerie :

Abonnement / Désabonnement


Sommaire de ce numéro :
Acinetobacter baumannii

Antibiotique

Bactériémie

Cathétérisme

Chirurgie

Clostridium difficile

EHPAD

Endoscopie

Environnement

Escherichia coli

Gestion des risques

Grippe

Hygiène des mains

Indicateur

Infection urinaire

Klebsiella pneumoniae

Legionella

Maternité

Médecine générale

Néonatologie

Pédiatrie

Personnel

Prévalence

Prévention

Radiologie

Réanimation

Signalement

Staphylococcus aureus
Acinetobacter baumannii
NosoBase n°357389

Epidémie prolongée à Acinetobacter baumannii multirésistant après les transferts intercontinentaux de patients colonisés
Landelle C; Legrand P; Lesprit P; Cizeau F; Ducellier D; Gouot C; et al. Protracted outbreak of multidrug-resistant Acinetobacter baumannii after intercontinental transfer of colonized patients. Infection control and hospital epidemiology 2013/02; 34(2):119-124.
Mots-clés : ACINETOBACTER BAUMANNII; COLONISATION; EPIDEMIE; MULTIRESISTANCE; SOIN INTENSIF; ISOLEMENT; PAYS ETRANGER; TRANSMISSION; ROBINET D'EAU; NETTOYAGE
Objective: To describe the course and management of a protracted outbreak after intercontinental transfer of 2 patients colonized with multidrug-resistant Acinetobacter baumannii (MDRAB).

Design: An 18-month outbreak investigation.

Setting: An 860-bed university hospital in France.

Patients: Case patients (ie, carriers) were those colonized or infected with an MDRAB isolate.

Methods: During the epidemic period, all intensive care unit (ICU) patients and contacts of carriers who were transferred to wards were screened for MDRAB carriage. Contact precautions, environmental screening, and auditing of healthcare worker (HCW) practices were implemented; rooms were cleaned with hydrogen peroxide mist disinfection. One ICU, in which most of the cases occurred, was closed on 4 occasions for thorough cleaning and disinfection.

Results: The 2 index case patients were identified as 2 patients who carried the same MDRAB strain and who were admitted to the hospital after repatriation from Tahiti 5 months apart. During an 18-month period, a total of 84 secondary cases occurred. Reintroduction of MDRAB into the ICUs occurred from patients previously colonized or from healthcare personnel. Termination of the outbreak was only achieved when all carriers from wards or the ICU were cohorted to an isolation unit with dedicated healthcare personnel.

Conclusions: Intercontinental transfer of carriers of MDRAB can result in extensive outbreaks and serious disruption of the hospital's organization. Transmission from carriers most likely occurred via the hands of HCWs, poor cleaning protocols, airborne spread, and contaminated water from sink traps. This protracted outbreak was controlled only after implementation of an extensive control program and eventual cohorting of all carriers in an isolation unit with dedicated healthcare personnel.


NosoBase n°357646

Diversité clonale et prévalence élevée d'OXA-58 parmi des souches d'Acinetobacter baumannii provenant d'hémocultures dans un centre hospitalier universitaire de Turquie
Metan G; Sariguzel F; Sumerkan B; Van der Reijden T; Dijkshoorn L. Clonal diversity and high prevalence of OXA-58 among Acinetobacter baumannii isolates from blood cultures in a tertiary care centre in Turkey. Infection, genetics and evolution 2013; in press: 6 pages.
Mots-clés : ACINETOBACTER BAUMANNII; PREVALENCE; ANTIBIORESISTANCE; HEMOCULTURE; CARBAPENEME; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; CENTRE HOSPITALIER UNIVERSITAIRE
Genotypic diversity, antimicrobial susceptibilty, and presence of OXA-genes were assessed in 100 nosocomial Acinetobacter strains from a tertiary-care hospital, Turkey. Ninety-eight isolates were identified by AFLP library identification to Acinetobacter baumannii. Furthermore, the isolates were divided into 30 AFLP clusters and single strains at a similarity cut-off level of 90%, the defined strain level. Most of these clusters grouped together in larger clusters at a lower similarity level, indicating diversification beyond the strain level. At a similarity level of 80%, the A. baumannii isolates were allocated to eight clusters of multiple isolates (A, C, D, E, G, H, J, L) and 3 single isolates (B, F, I). Comparison of the isolates to those of the Leiden AFLP database revealed that the large cluster H (41 isolates) corresponded to a tentative novel international clone previously identified both by AFLP and MLST (CC15). Clusters D and E grouped with European (EU) clone II isolates, and cluster J with those EU clone I. Clusters A, C, G, and L could not be identified to any international clone. MLST of selected isolates of the major clusters corroborated the clone allocation by AFLP, except for the tested cluster A isolate which was identified to CC2 (EU clone II). Carbapenem resistance of 75 A. baumannii isolates was associated with the bla(OXA-58-like) gene or bla(OXA-51-like) with ISAba1 upstream. Altogether, 99% of the Acinetobacter isolates were multidrug resistant (MDR) and 77% extensively drug resistant (XDR). The findings show that multiple strains and clones MDR and XDR A. baumannii were endemic in the hospital.


NosoBase n°357538

Epidémiologie, caractéristiques cliniques et évolution des infections à Acinetobacter baumannii ultra-résistant aux antibiotiques chez des receveurs de transplantation d'organes solides
Shields RK; Clancy CJ; Gillis LM; Kwak EJ; Silveira FP; Massish RC; et al. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012/12; 12(7): 1-10.
Mots-clés : EPIDEMIOLOGIE; TRANSPLANTATION; ACINETOBACTER BAUMANNII; EPIDEMIOLOGIE; ANTIBIORESISTANCE; ETUDE RETROSPECTIVE; APPAREIL RESPIRATOIRE; PNEUMONIE; VENTILATION ASSISTEE; MORTALITE; COLISTINE; CARBAPENEME
Background: Extensively drug-resistant Acinetobacter baumannii (XDR-Ab) has emerged as a major nosocomial pathogen, but optimal treatment regimens are unknown. Although solid organ transplant (SOT) recipients are particularly susceptible to XDR-Ab infections, studies in this population are limited. Our objectives were to determine the epidemiology, clinical characteristics and outcomes of XDR-Ab infections among SOT patients.

Methods: A retrospective study of SOT recipients at our center who were colonized or infected with XDR-Ab between November 2006 and December 2011 was conducted. Among infected patients, the primary outcome was survival at 28 days. Secondary outcomes included survival at 90 days and clinical success at 28 days, and XDR-Ab infection recurrence.

Results: XDR-Ab was isolated from 69 SOT patients, of whom 41% (28) and 59% (41) were colonized and infected, respectively. Infections were significantly more common among cardiothoracic than abdominal transplant recipients (p=0.0004). Ninety-eight percent (40/41) of patients had respiratory tract infections, most commonly ventilator-associated pneumonia (VAP; 88% [36/41]). Survival rates at 28 and 90 days were 54% (22/41) and 46% (19/41), respectively. Treatment with a colistin-carbapenem regimen was an independent predictor of 28-day survival (p=0.01; odds ratio=7.88 [95% CI: 1.60-38.76]). Clinical success at 28 days was achieved in 49% (18/37) of patients who received antimicrobial therapy, but 44% (8/18) of successes were associated with infection recurrence within 3 months. Colistin resistance emerged in 18% (2/11) and 100% (3/3) of patients treated with colistin-carbapenem and colistin-tigecycline, respectively (p=0.03).

Conclusions: XDR-Ab causes VAP and other respiratory infections following SOT that are associated with significant recurrence and mortality rates. Cardiothoracic transplant recipients are at greatest risk. Results from this retrospective study suggest that colistin-carbapenem combinations may result in improved clinical responses and survival compared to other regimens and may also limit the emergence of colistin resistance.


NosoBase n°358102

Comparer la transmission potentielle de Staphylococcus aureus méticillino-résistant et d’Acinetobacter baumannii multirésistant aux antibiotiques parmi des patients hospitalisés à l’aide d’une surveillance environnementale ciblée
Sui W; Wang J; Wang H; Wang M; Huang Y; Zhuo J; et al. Comparing the transmission potential of Methicillin-resistant Staphylococcus aureus and multidrug-resistant Acinetobacter baumannii among inpatients using target environmental monitoring. American journal of infection control 2013; in press: 5 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ACINETOBACTER BAUMANNII; TRANSMISSION; LINGE; ENVIRONNEMENT; DEPISTAGE; SOIN INTENSIF; CONTAMINATION; ANTIBIORESISTANCE; MULTIRESISTANCE
Background: With the increasing isolation rate of multidrug-resistant Acinetobacter baumannii (MDR-AB) in China hospitals, more researches focused on its antimicrobial resistance, but few studies reported its nosocomial transmission. In this study, we aim to investigate the transmission features of MDR-AB among inpatients using target environmental monitoring.

Methods: Methicillin-resistant Staphylococcus aureus (MRSA) and MDR-AB active screening and target environmental screening were performed from March 2010 to October 2011 in respiratory intensive care unit (RICU). We compared bed linen contamination rate and acquisition rate of MDR-AB with those of MRSA and analyzed the correlation between weekly colonization pressure adjusted by degree of bed linen contamination (WCPe) and weekly acquisition rate (WAR) of MDR-AB.

Results: We found that both the bed linen contamination rate and the acquisition rate of MDR-AB were higher than those of MRSA (χ2=98.081, P<.01; χ2=49.844, P<.01, respectively). The correlation analysis showed positive correlation between MDR-AB WCPe and WAR (r(s)=0.560, P<.01). The WCPe and WAR of MDR-AB were higher than those of MRSA (Z=-5.439, P<.01; Z=-3.258, P<.01, respectively).

Conclusion: Compared with MRSA, MDR-AB carriers showed stronger ability to contaminate their immediate environment, and MDR-AB was easier to transmit among inpatients. Therefore, it was likely more important to perform active environmental monitoring as a method of transmission evaluation and a measure of routine infection control to prevent and control MDR-AB nosocomial transmission more effectively.

Antibiotique
NosoBase n°357192

Actualisation sur la prévalence et caractérisation génétique d'entérobactéries productrices de NDM-1 dans des hôpitaux indiens
Castanheira M; Deshpande LM; Farrell SE; Shetye S; Shah N; Jones RN. Update on the prevalence and genetic characterization of NDM-1-producing Enterobacteriaceae in Indian hospitals during 2010. Diagnostic microbiology and infectious disease 2012; in press: 4 pages.
Mots-clés : PREVALENCE; ENTEROBACTERIE; ANTIBIORESISTANCE; CARBAPENEME; ESCHERICHIA COLI; BIOLOGIE MOLECULAIRE; PCR; IDENTIFICATION; KLEBSIELLA PNEUMONIAE
Thirteen NDM-1-producing Enterobacteriaceae, representing all carbapenem-resistant strains (5.2% overall) collected in 3 Indian hospitals during 2010, were analyzed. Eleven genetically distinct strains of 4 bacterial species were observed. All 3 E. coli strains belonged to ST101. Strains harbored bla(CTX-M-15) and at least 1 other β-lactamase. Fluoroquinolone and aminoglycoside resistance genes were detected in 11 and 6 strains, respectively. bla(NDM-1) was carried in plasmids of various sizes and incompatibility types, and 3 were transferred by conjugation. This study confirms the ability of bla(NDM-1) to disseminate among different bacterial species and the genetic variability of the structures carrying this metallo-β-lactamase gene in India.


NosoBase n°357737

Surveillance moléculaire et évolutions cliniques des infections à Escherichia coli et Klebsiella pneumoniae résistant aux carbapénèmes
Huang SR; Liu MF; Lin CF; Shi ZY. Molecular surveillance and clinical outcomes of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae infections. Journal of microbiology, immunology and infection 2012; in press: 10 pages.
Mots-clés : SURVEILLANCE; BIOLOGIE MOLECULARE; CARBAPENEME; ESCHERICHIA COLI; ANTIBIORESISTANCE; KLEBSIELLA PNEUMONIAE; ENTEROBACTERIE; CMI; PCR; MORTALITE
Background/Purpose: The emergence of carbapenem-resistant Enterobacteriaceae (CRE) is a cause for great concern. The aim of this study was to evaluate antimicrobial susceptibility, mechanisms of carbapenem-resistance in two members of the Enterobacteriaceae family (Escherichia coli and Klebsiella pneumoniae), and clinical outcomes of their infections.

Methods: The susceptibility tests of 16 E. coli and 60 K. pneumoniae isolates, collected from 2010 to 2011, were assessed. The minimal inhibitory concentrations of eight antimicrobial agents were assessed by the broth microdilution method according to the recommendations of the Clinical and Laboratory Standards Institute. The detection of beta-lactamase genes was performed by polymerase chain reaction. The genetic relatedness of these isolates was determined by pulsed-field gel electrophoresis (PFGE) fingerprinting.

Results: The carbapenemase genes bla(KPC-2) and bla(OxA) were detected in one and five K. pneumoniae isolates, respectively. The genetic combinations bla(SHV-5)-bla(DHA) and bla(SHV-5)-bla(CTx-M-G9) were prevalent in 45% and 26.7% of 60 K. pneumoniae isolates, respectively. The susceptibility rates of 60 K. pneumoniae isolates to colistin and tigecycline were 58.3% and 50.0%, respectively. The 30-day mortality rates of the patients treated with carbapenem, colistin, or tigecycline were as high as 60.6%. Nine clusters of K. pneumoniae isolates were identified by PFGE fingerprinting.

Conclusion: The findings of carbapenemase genes in a few isolates and small clusters of CRE indicated the emerging problems in the hospital. The high mortality rates were observed in the patients treated by colistin and tigecycline, although they were the only alternative treatment options for CRE infections. Active surveillance and an effective infection control strategy should be implemented to control the spread of CRE infections.

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