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NosoVeille – Bulletin de veille Octobre 2016
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé.
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Abonnement / Désabonnement
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Cathéter / Cathétérisme
Hygiène des mains
NosoBase ID notice : 418199
La validation clinique d'un test par RT-PCR pour la détection rapide de la colonisation à Acinetobacter baumannii
Blanco-Lobo P; González-Galán V; García-Quintanilla M; Valencia R; Cazalla A; Martin C; et al. Clinical validation of a real-time polymerase chain reaction assay for rapid detection of Acinetobacter baumannii colonization. The journal of hospital infection 2016/09; 94(1): 68-71.
Mots-clés : ACINETOBACTER BAUMANNII; COLONISATION; PCR; ETUDE PROSPECTIVE; SOIN INTENSIF; CARBAPENEME; SURVEILLANCE; INFECTION NOSOCOMIALE
Real-time polymerase chain reaction (PCR)-based approaches have not been assessed in terms of their ability to detect patients colonized by Acinetobacter baumannii during active surveillance. This prospective, double-blind study demonstrated that a real-time PCR assay had high sensitivity (100%) and specificity (91.2%) compared with conventional culture for detecting A. baumannii in 397 active surveillance samples, and provided results within 3h. Receiver-operator curve analyses demonstrated that the technique has diagnostic accuracy of 97.7% (95% confidence interval 96.0-99.3%). This method could facilitate the rapid implementation of infection control measures for preventing the transmission of A. baumannii.
NosoBase ID notice : 418943
Transmission d'entérobactéries résistantes aux carbapénèmes dans des établissements de santé, Wisconsin, Février-mai 2015
Centers for disease control and prevention (CDC); Elbadawi LI; Borlaug G; Gundlach KM; Monson T; Warshauer D. Carbapenem-resistant Enterobacteriaceae transmission in health care facilities - Wisconsin, february-may 2015. MMWR Morbidity and mortality weekly report 2016/09/02; 65(34): 906-909.
Mots-clés : ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; CARBAPENEME; ANTIBIORESISTANCE; INVESTIGATION; EPIDEMIE
What is already known about this topic?
Carbapenem-resistant Enterobacteriaceae (CRE) are multidrug-resistant gram-negative bacilli that can cause infections associated with high case fatality rates, and are emerging as epidemiologically important health care–associated pathogens in the United States. Prevention of CRE transmission in health care settings is dependent on recognition of cases, isolation of colonized and infected patients, effective use of infection control measures, and the correct use of antibiotics.
What is added by this report?
Through the Wisconsin State Laboratory of Hygiene laboratory-based CRE surveillance program, which requests all clinical microbiology laboratories to submit carbapenem-nonsusceptible Enterobacteriaceae isolates for molecular testing by one or more methods (e.g., polymerase chain reaction [PCR], pulsed-field gel electrophoresis [PFGE], and whole genome sequencing [WGS]), a cluster of CRE infections among four hospital inpatients at two southeastern Wisconsin hospitals was discovered. At the time, personnel at the two implicated hospitals were not previously aware of the possibility of transmission of CRE among their patients.
What are the implications for public health practice?
The use of molecular technologies, including PCR testing, PFGE, and WGS, can lead to detection of transmission events and interruption of transmission by uncommon and multidrug-resistant organisms. Public health and other programs that include antibiotic stewardship and antimicrobial resistance monitoring might benefit from data generated by molecular testing of multidrug-resistant organisms to enhance detection of intra- and interfacility transmission events.
NosoBase ID notice : 419475
Les progrès de la prévention et le traitement d'infections à Enterococcus résistant à la vancomycine
Isenman H; Fisher D. Advances in prevention and treatment of vancomycin-resistant Enterococcus infection. Current opinion in infectious diseases 2016/08/31; in press: 1-6.
Mots-clés : PREVENTION; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; INFECTION NOSOCOMIALE; EPIDEMIOLOGIE; COLONISATION; DAPTOMYCINE; ANTIBIORESISTANCE
Purpose of review: This article reviews data, particularly from the last 2 years, addressing the prevention and treatment of vancomycin-resistant Enterococcus (VRE). We focus on infection control, particularly active screening, use of contact precautions as well as pharmacologic options for therapy. This is timely given the evolving priorities in efforts towards the prevention and treatment of multidrug-resistant organisms globally.
Recent findings: Key findings include new data regarding the impact of contact precautions on the incidence of VRE colonization and bloodstream infection, new laboratory screening methods, and novel decolonization strategies and treatments.
Summary: Additional and specific measures beyond standard precautions for infection prevention of VRE remain controversial. Horizontal measures such as chlorhexidine bathing appear beneficial, as are nontouch environmental cleaning methods. Treatment options for invasive disease have improved considerably in the last decade. Decolonization strategies require further research. Overall, the threat of VRE seems exaggerated.
NosoBase ID notice : 418354
Combinaisons d'antibiotiques contre Acinetobacter baumannii pan-résistant avec des isolats présentant des mécanismes de résistance différents
Leite GC; Oliveira MS; Vieira Perdigão-Neto L; Kamia Dias Rocha C; Guimarães T; Rizek C; et al. Antimicrobial combinations against pan-resistant Acinetobacter baumannii isolates with different resistance mechanisms. PLoS One 2016/03/21; 11(3): 1-16.
Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; MULTIRESISTANCE; ANTIBIOTIQUE; CMI; PCR; PFGE; BIOLOGIE MOLECULAIRE; TRAITEMENT; MORTALITE; COLISTINE; RIFAMPICINE; VANCOMYCINE; FOSFOMYCINE; AMIKACINE; REVUE DE LA LITTERATURE
The study investigated the effect of antibiotic combinations against 20 clinical isolates of A. baumannii (seven colistin-resistant and 13 colistin-susceptible) with different resistance mechanisms. Clinical data, treatment, and patient mortality were evaluated. The following methods were used: MIC, PCRs, and outer membrane protein (OMP) analysis. Synergy was investigated using the checkerboard and time-kill methods. Clonality was evaluated by PFGE. Based on clonality, the whole genome sequence of six A. baumannii isolates was analyzed. All isolates were resistant to meropenem, rifampicin, and fosfomycin. OXA-23 and OXA-143 were the most frequent carbapenemases found. Four isolates showed loss of a 43kDa OMP. The colistin-susceptible isolates belonged to different clones and showed the highest synergistic effect with fosfomycin-amikacin. Among colistin-resistant isolates, the highest synergistic effect was observed with the combinations of colistin-rifampicin followed by colistin-vancomycin. All colistin-resistant isolates harbored blaOXA-23-like and belonged to CC113. Clinical and demographic data were available for 18 of 20 patients. Fourteen received treatment and eight patients died during treatment. The most frequent site of infection was the blood in 13 of 14 patients. Seven patients received vancomycin plus an active drug against A. baumannii; however, mortality did not differ in this group. The synergistic effect was similar for colistin-susceptible isolates of distinct clonal origin presenting with the same resistance mechanism. Overall mortality and death during treatment was high, and despite the high synergism in vitro with vancomycin, death did not differ comparing the use or not of vancomycin plus an active drug against A. baumannii.
NosoBase ID notice : 418687
Recommandations sur la gestion des antibiotiques destinées au praticien hygiéniste
Nagel JL; Kaye KS; LaPlante KL; Pogue JM. Antimicrobial stewardship for the infection control practitioner. Infectious disease clinics of North America 2016/09; 30(3): 771-784.
Mots-clés : ANTIBIOTIQUE; GESTION DES RISQUES; ANTIBIORESISTANCE; MULTIRESISTANCE; FORMATION; PERSONNEL; TRAVAIL EN EQUIPE; REVUE DE LA LITTERATURE
The continued increase in the rates of antimicrobial-resistant organisms, the devastating impact of infections due to these pathogens on patient outcomes, and the lean antibiotic pipeline has created a health care industry in desperate need of enhanced antimicrobial stewardship strategies to both optimize outcomes in patients infected with these pathogens and to decrease their development and spread. These common goals lead to a natural alliance between antimicrobial stewardship clinicians and infection control practitioners. Antimicrobial stewardship and infection control within an institution should convene and develop collaborative goals and strategies for decreasing the development and spread of problematic pathogens, as well as defining optimal evidence-based strategies for management of patients infected with these pathogens. These strategies could include targeting high-risk antimicrobials and enhanced hand hygiene and contact precaution compliance due to increased C difficile rates, and screening for problematic MDROs within an institution to ensure both rapid isolation of colonized patients as well as communication to stewardship personnel so that future empiric therapies can be tailored accordingly. Furthermore, infection control and stewardship teams can work together to tailor educational strategies throughout the institution using existing relationships to ensure that the message of each discipline reaches the widest possible audience. Finally, stewardship and infection control personnel should determine the best metrics for measuring the success (or failures) of their combined efforts. These could include outcomes in patients infected with target pathogens (including time to appropriate or optimal antimicrobial therapy and time until a patient is placed in contact isolation), trends in C difficile rates within hospitalized patients, and/or antimicrobial use metrics. Ideally, institutions will develop a multifaceted dashboard of several such metrics to most appropriately measure the success of these complementary programs.
NosoBase ID notice : 419096
AGORA : une alliance mondiale pour optimiser le bon usage des antibiotiques face aux infections intra-abdominales
Sartelli M; Weber DG; Ruppé E; Bassetti M; Wright BJ; Ansaloni L; et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World Journal of Emergency Surgery 2016/07/15; 11(33): 1-32.
Mots-clés : ANTIBIOTIQUE; ANTIBIORESISTANCE; MULTIRESISTANCE; ABDOMEN; INFECTION; TRAITEMENT; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
NosoBase ID notice : 418284
Enquête téléphonique sur les pratiques de contrôle du risque infectieux et le bon usage des antibiotiques dans les établissements de soins de longue durée au Maryland
Yang M; Vleck K; Bellantoni M; Sood G. Telephone survey of infection-control and antibiotic stewardship practices in long-term care facilities in Maryland. Journal of the american medical directors association 2016/06/01; 17(6): 491-494.
Mots-clés : ANTIBIOTIQUE; PRATIQUE; PRESCRIPTION; PROTOCOLE; SOIN DE LONGUE DUREE; EHPAD; ENQUETE; PERSONNEL; MEDECIN HYGIENISTE; INFIRMIER HYGIENISTE; SONDAGE URINAIRE; CATHETER IMPREGNE; SIGNALEMENT; ISOLEMENT SEPTIQUE
Background: Multidrug-resistant organisms are an emerging and serious threat to the care of patients. Long-term care facilities are considered a reservoir of these organisms partly because of the over-prescribing of antibiotics. Antibiotic use is common in long-term care facilities. Antibiotic stewardship programs have been shown to reduce antibiotic consumption in acute-care facilities. The purpose of our study is to investigate existing infection-control practices and antibiotic stewardship programs in long-term care facilities in Maryland.
Methods: We telephoned the infection-control personnel in 231 long-term care facilities in Maryland between February 2014 and July 2015 and reached 124 facilities (59%).
Results: Among the 124 facilities surveyed, there were 14,371 beds and 337 infection-control personnel with basic infection-control training. Close to 20% of facilities use silver- or antimicrobial-impregnated urinary catheters. Most facilities (97%) track urinary tract infections. Although all report to the health department in the case of an outbreak, only 63 (50.8 %) report directly to the Centers for Disease Control and Prevention. About 80% of facilities isolate patients with Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococci with acute infections only. Eighty percent of facilities have basic guidance on choice of antibiotic, and 27% have a restricted formulary. Only 25% of facilities have an antibiotic approval process. Thirty-five percent of facilities have training for antibiotics prescribing. However, 17% of facilities did not know whether such training existed.
Conclusions: Antibiotic stewardship programs in long-term care facilities are still in early development stages, but our results demonstrate that the majority of facilities are collecting data on prescribing antibiotics, and a surprising number have antibiotic approval and antibiotics prescribing training.
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