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NosoVeille – Bulletin de veille Mars 2017
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques enregistrées au cours du mois écoulé.
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Abonnement / Désabonnement
Sommaire de ce numéro :
Antibiotique / Antibiorésistance
Hygiène des mains
Antibiotique / Antibiorésistance
NosoBase ID notice : 424660
Epidémiologie et mesures de prévention des épidémies dues aux organismes antibiorésistants en Europe (EMBARGO) : protocole d'une revue systématique
Babu Rajendran N; Gladstone BP; Rodriguez-Baño J; Sifakis F; Voss A; Carmeli Y; et al. Epidemiology and control measures of outbreaks due to Antibiotic-Resistant organisms in Europe (EMBARGO): a systematic review protocol. BMJ Open 2017/01/05; 7(1): 1-4.
Mots-clés : EPIDEMIOLOGIE; ANTIBIORESISTANCE; EPIDEMIE; PREVENTION; REVUE DE LA LITTERATURE
Introduction: Improving our understanding of outbreaks due to antibiotic-resistant bacteria (ARB) and their control is critical in the current public health scenario. The threat of outbreaks due to ARB requires multifaceted efforts. However, a global overview of epidemiological characteristics of outbreaks due to ARB and effective infection control measures is missing. In this paper, we describe the protocol of a systematic review aimed at mapping and characterising the epidemiological aspects of outbreaks due to ARB and infection control measures in European countries.
Methods and analysis: The databases MEDLINE, Web of Knowledge and Cochrane library will be searched using a 3-step search strategy. Selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. All study designs will be included if they report an outbreak and define the microbiological methods used for microorganism identification. The target bacteria will be methicillin-resistant and vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, ceftazidime-resistant and carbapenem-resistant Acinetobacter baumannii, ceftazidime-resistant and carbapenem-resistant Pseudomonas aeruginosa, ciprofloxacin-resistant Escherichia coli, extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae, carbapenem-resistant and carbapenamase-producing Enterobacteriaceae. Data will be extracted using a tailored pilot tested form and the quality of reporting will be assessed using the ORION (Outbreak Reports and Intervention Studies Of Nosocomial infections) tool. Data will be synthesised and reported by the type of ARB, setting and country. Infection control measures and bundles of measures will be described. The effectiveness will be reported as defined by the authors. Regression analysis will be used to define independent factors associated with outbreaks' control. Heterogeneity between studies will be assessed by forest plots and I² statistics.
Ethics and dissemination: Ethical approval is not applicable for this study. Findings will be disseminated through journal publication and conference presentations and talks.
NosoBase ID notice : 424699
Impact de la durée des antibiotiques sur les évènements cliniques chez les patients atteints de pneumonie associée à la ventilation due à Pseudomonas aeruginosa : protocôle d'étude pour une étude contrôlée randomisée
Bouglé A; Foucrier A; Dupont H; Montravers P; Ouattara A; Kalfon P; et al. Impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for a randomized controlled study. Trials 2017/01/23; 18(37): 1-8.
Mots-clés : ANTIBIOTIQUE; PSEUDOMONAS AERUGINOSA; PNEUMONIE; PRESCRIPTION; ASSISTANCE RESPIRATOIRE; TRAITEMENT; ESSAI CLINIQUE; ESSAI THERAPEUTIQUE; SOIN INTENSIF
Background: Ventilator-associated pneumonia (VAP) accounts for 25% of infections in intensive care units. Compared to a long duration (LD) of antibiotic therapy, a short duration (SD) has a comparable clinical efficacy with less antibiotic use and less multidrug-resistant (MDR) pathogen emergence, with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). These results have led the American Thoracic Society to recommend SD therapy for VAP, except for PA-VAP. Thus the beneficial effect of SD therapy in PA-VAP is still a matter of debate. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) versus prolonged antibiotic therapy (15 days) in PA-VAP.
Methods/Design: The impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia (iDIAPASON) trial is a randomized, open-labeled non-inferiority controlled trial, conducted in 34 French intensive care units (ICUs), comparing two groups of patients with PA-VAP according to the duration (8 days or 15 days) of effective antibiotic therapy against PA. The primary outcome is a composite endpoint combining day 90 mortality and PA-VAP recurrence rate during hospitalization in the ICU. Furthermore, durations of mechanical ventilation and hospitalization, as well as number and types of extrapulmonary infections or acquisition of MDR pathogens during the hospitalization in the ICU will be recorded. Recurrence with predefined criteria (clinical suspicion of VAP associated with a positive quantitative culture of a respiratory sample) will be evaluated by two independent experts.
Discussion: Demonstrating that an SD (8 days) versus LD (15 days) therapy strategy in PA-VAP treatment is safe and not associated with an increased mortality or recurrence rate could lead to a change in practices and guidelines in the management of antibiotic therapy of this frequent ICU complication. This strategy could lead to decreased antibiotic exposure during hospitalization in the ICU and in turn reduce the acquisition and the spread of MDR pathogens.
NosoBase ID notice : 424673
Incidence et évolution clinique liées aux infections à entérocoques résistants à la vancomycine aux Etats-Unis : revue systématique de la littérature et méta-analyse
Chiang HY; Perencevich EN; Nair R; Nelson RE; Samore M; Khader K; et al. Incidence and outcomes associated with infections caused by vancomycin-resistant enterococci in the United States: systematic literature review and meta-analysis. Infection control and hospital epidemiology 2017/02; 38(2): 203-215.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; ANTIBIORESISTANCE; ENTEROCOCCUS; VANCOMYCINE; INCIDENCE; MORTALITE; DUREE DE SEJOUR; READMISSION; COUT; TRAITEMENT; REVUE DE LA LITTERATURE; META-ANALYSE
Background: Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics.
Objective: To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes.
Methods: We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data.
Results: Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more).
Conclusions: VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.
NosoBase ID notice : 425041
Evolutions des entérobactéries productrices de carbapénémase, France, 2012 à 2014
Dortet L; Cuzon G; Pontiès V; Nordmann P. Trends in carbapenemase-producing Enterobacteriaceae, France, 2012 to 2014. Eurosurveillance 2017/02/09; 2(6): 1-9.
Mots-clés : ENTEROBACTERIE; KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE; CARBAPENEME; ESCHERICHIA COLI; CNR; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; COLONISATION; INFECTION NOSOCOMIALE; EPC; OXA-48; NDM; KPC
In 2014, a total of 2,976 Enterobacteriaceae isolates with decreased susceptibility to carbapenems were received at the French Associated National Reference Center for Antibiotic Resistance (NRC) and were characterised for their molecular resistance mechanism to carbapenems and compared with results obtained during 2012 and 2013.The overall number of enterobacterial isolates with decreased susceptibility to carbapenems received at the NRC rapidly increased (more than twofold in two years) with a growing proportion of carbapenemase producers (23.1% in 2012 vs 28.6% in 2013 vs 36.2% in 2014). Between 2012 and 2014, the main carbapenemase type was OXA-48, with an increase in OXA-48 variants (mostly OXA-181) and NDM producers, whereas the number KPC producers decreased. We identified a potential spread of OXA-181 producers in the tropical region of Africa. Finally, OXA-48 and OXA-48-related enzymes remained the predominant carbapenemases in France. The number of carbapenemase-producing Escherichia coli isolates was multiplied by fivefold between 2012 and 2014, suggesting a possible dissemination in the community.
NosoBase ID notice : 424470
Bon usage des antibiotiques dans le soins des plaies : document de position de la Société britanique pour l'antibiothérapie et l'Association européenne pour le traitement des plaies
Lipsky BA; Dryden M; Gottrup F; Nathwani D; Seaton RA; Stryja J. Antimicrobial stewardship in wound care: a Position Paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. Journal of antimicrobial chemotherapy 2016/11; 71(11): 3026-3035.
Mots-clés : ANTIBIOTIQUE; PLAIE; TRAITEMENT; SOIN DE PLAIE CUTANEE; ESCARRE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE
Background: With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing antibiotics.
Objectives: This guidance document is aimed at providing clinicians an understanding of: the basic principles of why AMS is important in caring for patients with infected wounds; who should be involved in AMS; and how to conduct AMS for patients with infected wounds.
Methods: We assembled a group of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document.
Results: All open wounds will be colonized with bacteria, but antibiotic therapy is only required for those that are clinically infected. Therapy is usually empirical to start, but definitive therapy should be based on results of appropriately collected specimens for culture. When prescribed, it should be as narrowly focused, and administered for the shortest duration, as possible. AMS teams should be interdisciplinary, especially including specialists in infection and pharmacy, with input from administrative personnel, the treating clinicians and their patients.
Conclusions: Available evidence is limited, but suggests that applying principles of AMS to the care of patients with wounds should help to reduce the unnecessary use of systemic or topical antibiotic therapy and ensure the safest and most clinically effective therapy for infected wounds.
NosoBase ID notice : 424679
Comprendre l’impact des interventions pour la prévention des infections à bactéries multirésistantes dans les établissements de long séjour : revue et guide pratique d’une modélisation mathématique
Rosello A; Horner C; Hopkins S; Hayward A; Deeny SR. Understanding the impact of interventions to prevent antimicrobial resistant infections in the long-term care facility: a review and practical guide to mathematical modeling. Infection control and hospital epidemiology 2017/02; 38(2): 216-225.
Mots-clés : INFECTION NOSOCOMIALE; ANTIBIOTIQUE; ANTIBIORESISTANCE; STAPHYLOCOCCUS AUREUS; MODELISATION; FORMATION; RECOMMANDATIONS DE BONNE PRATIQUE; EHPAD; CHECK-LIST|
Objectives: (1) To systematically search for all dynamic mathematical models of infectious disease transmission in long-term care facilities (LTCFs); (2) to critically evaluate models of interventions against antimicrobial resistance (AMR) in this setting; and (3) to develop a checklist for hospital epidemiologists and policy makers by which to distinguish good quality models of AMR in LTCFs.
Methods: The CINAHL, EMBASE, Global Health, MEDLINE, and Scopus databases were systematically searched for studies of dynamic mathematical models set in LTCFs. Models of interventions targeting methicillin-resistant Staphylococcus aureus in LTCFs were critically assessed. Using this analysis, we developed a checklist for good quality mathematical models of AMR in LTCFs.
Results and discussion: Overall, 18 papers described mathematical models that characterized the spread of infectious diseases in LTCFs, but no models of AMR in gram-negative bacteria in this setting were described. Future models of AMR in LTCFs require a more robust methodology (ie, formal model fitting to data and validation), greater transparency regarding model assumptions, setting-specific data, realistic and current setting-specific parameters, and inclusion of movement dynamics between LTCFs and hospitals.
Conclusions: Mathematical models of AMR in gram-negative bacteria in the LTCF setting, where these bacteria are increasingly becoming prevalent, are needed to help guide infection prevention and control. Improvements are required to develop outputs of sufficient quality to help guide interventions and policy.
«Miser sur le développement durable : pour une meilleure qualité de vie» Le ministre Mulcair tiendra des rencontres de consultation...
«Qu'est-ce qu'un auteur ?», Bulletin de la Société française de philosophie, 63e année, no 3, juillet-septembre 1969, pp. 73-104