BACKGROUND:Transmission of infections via contaminated endoscopes is a common problem. Manual cleaning, using at least a detergent, is an important step in endoscope processing and should be performed as soon as possible to avoid drying of organic residues that might interfere with high-level disinfection and promote biofilm formation. AIM:To assess the efficacy of two detergent-disinfectants, enzymatic and non-enzymatic, and of an enzymatic detergent used during the manual cleaning against a Klebsiella pneumoniae biofilm. METHODS:A 24 h biofilm statically formed in a Tygon tube was exposed to detergent-disinfectants at 20 °C and 35 °C for 10 mn, and to enzymatic detergent at 45 °C for 60 mn. The logarithmic reduction in bacteria in the Tygon tube and the number of bacteria in the product supernatant were calculated. FINDINGS:Biofilm formation was reproducible between assays. After exposure to detergent-disinfectants, the logarithmic reduction was between 6.32 and 6.71 log10 cfu/cm2 in the Tygon tubes. No bacteria were found in their supernatants. Results in the detergent-disinfectant group were not affected by the exposure temperature or the addition of enzymes. No decrease in the bacterial load was observed in the Tygon tubes after exposure to the enzymatic detergent. Bacteria were found in its supernatant. CONCLUSION:These results show the importance of the choice of products used during the manual cleaning phase. They also show the potential benefit of combining detergent and disinfectant activity to decrease the bacterial load during the manual cleaning step of endoscope processing.

OBJECTIVES:Little is known about efficacy and safety of ethanol lock therapy (ELT) to treat totally implantable venous access device (TIVAD) infections. The objective of this trial was to evaluate the effectiveness and safety profile of a local treatment with ELT without removal for TIVAD infection due to coagulase-negative staphylococci.METHODS:We performed a prospective, multicenter, double-blind, randomized clinical trial comparing the efficacy of 40% ELT versus vancomycin lock therapy (VLT) in TIVAD infections due to coagulase-negative staphylococci, complicated or not by bloodstream infection.RESULTS:Thirty-one patients were assigned to the ELT group and 30 to the VLT arm. Concomitant bacteremia was present in 41 patients (67.2%). Treatment success was 58.1 % (18 of 31) for the ELT arm and 46.7% (14 of 30) for the VLT arm (p = 0.37). The overall treatment success was 52.5% (32). The risk of treatment failure due to uncontrolled infections, superinfections, and mechanical complications did not differ significantly between participants receiving ELT (13 out of 31 [42%]) and those receiving VLT (16 out of 30 [53%]) with a hazard ratio of 0.70 (p = 0.343; 95% CI [0.34-1.46], Cox model). Catheter malfunctions were significantly more frequent in the ELT arm (11 patients versus 2 in the VLT group, p = 0.01).CONCLUSIONS:We found an overall high rate of treatment failure that did not differ between the ELT arm and the VLT arm. TIVAD removal must be prioritized to prevent complications (uncontrolled infections, superinfections, and catheter malfunctions) except in exceptional situations.

Biofilm in endoscopes is a major problem that can result in failure of disinfection. We studied the survival of K. pneumoniae in a biofilm formed on endoscope tubes subjected to combined chemical and physical stresses. We monitored bacterial survival in the biofilm after the action of 1% and 2% GTA either immediately or after 15 days of desiccation and described the ability of surviving bacteria to recolonize endoscope tubing in a dynamic model. There were surviving bacteria after 5-min exposure to 2% and 1% GTA. The percentage of survivors after 2% and 1% GTA was greater when the GTA treatment was performed after 15 days of prior desiccation of the biofilm. The survivors were able to recolonize and reform biofilm on abiotic surfaces probably because of the survival of persisters in a viable but non-culturable state in the biofilm. Our findings emphasize that the current guidelines on endoscope reprocessing should be strictly followed but that once constituted the biofilm in endoscope tubing will be very difficult to eradicate with present practices.

Les infections urinaires sont la 1re cause d'infections associées aux soins. Elles sont généralement associées aux cathéters urinaires. Différencier infection (IUAC) ou colonisation (CUAC) associée au cathéter urinaire reste difficile d'où une prescription inappropriée d'ECBU et des traitements anti-infectieux inutiles. L'objectif de ce travail est une comparaison des épisodes d'IUAC et CUAC associée à une évaluation des différences entre les recommandations et la pratique clinique. Les ECBU positifs ont été recueillis sur 3 mois. L'analyse rétrospective des dossiers a été réalisée avec un médecin infectiologue et chaque épisode classé en IUAC ou CUAC suivant les recommandations. La comparaison a été réalisée en analyses uni- et multivariées. La pertinence de la prescription d'ECBU et la conformité des traitements anti-infectieux ont été évaluées par rapport aux référentiels. Sur 540 ECBU, 374 ont été inclus et classés en 100 IUAC et 274 CUAC. En analyse uni- ou multivariée, aucun facteur de risque n'était spécifiquement associé à l'IUAC. Parmi les symptômes d'infection urinaire, seuls la fièvre (p < 0,001), les signes fonctionnels urinaires (p < 0,001) et l'asthénie (p 0,008) étaient statistiquement associés aux IUAC. Ce n'était pas le cas pour l'altération du statut mental ou l'hypotension artérielle. Sur le plan biologique, seule l'hyperleucocytose (p 0,015) était significativement associée à l'IUAC mais pas l'insuffisance rénale, ni l'élévation de la CRP. Les patients de plus de 80 ans avaient moins d'épisodes fébriles (p 0,019), une augmentation de l'asthénie (p 0,031) et de l'insuffisance rénale (p < 0,001). Les CUAC présentaient une plus grande diversité microbienne et statistiquement plus d'entérobactéries productrices de bêtalactamase à spectre étendu (p 0,01). Les ECBU étaient injustifiés dans 28,3 % (106/374) des cas, principalement des CUAC, avec pour motifs : augmentation isolée de la CRP, retrait du cathéter urinaire, urines malodorantes ou foncées. Un tiers d'entre eux étaient effectués sans prescription médicale. Parmi les 93 IUAC traitées, 83,9 % (78/93) des traitements étaient conformes aux référentiels, 6,4 % (6/93) ne l'étaient pas et 9,7 % (9/93) l'étaient partiellement. Un traitement anti-infectieux a été prescrit pour 26/274 (9,3 %) CUAC. Malgré les recommandations, le diagnostic des IUAC reste difficile avec une proportion non négligeable d'ECBU injustifiés et un risque de traitement inutile. Il en résulte l'émergence de bactéries multirésistantes avec un risque de transmission croisée notamment à partir des patients colonisés. Les indications d'ECBU restent méconnues des soignants. Il est important d'améliorer la connaissance des référentiels et cela passe par la formation des soignants.

Objectives To document the prevalence of new headaches in patients with Covid-19 infection and the potential association with other neuro-sensorial symptoms (anosmia and ageusia). The persistence of these symptoms 1 month after recovery was also documented. Background Headaches are a very common symptom of viral infections. Surprisingly, early Chinese studies reported a relatively low prevalence (12-15%) of headaches associated with Covid-19. Methods All the patients with laboratory-confirmed or chest-CT-confirmed Covid-19 infection, diagnosed between February 27(th)and April 15(th), 2020 in the dedicated laboratory of Clermont-Ferrand University Hospital were followed for 1 month after recovery. Results A total of 139 consecutive patients (mean [SD] age, 48.5 [15.3] years; 87 women [62.6%]) were interviewed 1 month after disappearance of fever and dyspnea (semi-structured phone interview). Overall, 59.0% (82/139) of people with Covid-19 had mild disease, 36.7% (51/139) had severe disease, and 4.3% (6/139) had critical illness. Eighty-two (59.0%; 95% CI: 50.3 to 67.3) reported new headaches during the acute phase and 3.6% (5/139) had persistent headaches 1 month after fever and dyspnea remission. Anosmia and ageusia were also very common, occurring in 60.4% (84/139) and 58.3% (81/139) of the patients, respectively. These 2 symptoms persisted in 14.4% (20/139) and 11.5% (16/139) of Covid-19 patients 1 month after recovery. Headaches were neither clearly associated with anosmia, nor with ageusia, and were not associated with disease severity (ie, requiring hospitalization or intensive care unit). Conclusion This specific study highlights the high prevalence of new headaches during Covid-19 infection in French patients. Further studies are needed to refine the characterization of patients with Covid-19-associated headaches.

Healthcare workers are highly exposed to the risk of acquisition of coronavirus disease 2019 (COVID-19) [[1]Schwartz J. King C.-C. Yen M.-Y. Protecting healthcare workers during the coronavirus disease 2019 (COVID-19) outbreak: lessons from Taiwan's severe acute respiratory syndrome response.Clin Infect Dis. 2020; 71: 858-860Crossref PubMed Scopus (260) Google Scholar]. Severe acute respiratory coronavirus 2 (SARS-CoV-2) can survive in stools and in respiratory specimens and persist on inanimate surfaces for several days [2Lai M.Y.Y. Cheng P.K.C. Lim W.W.L. Survival of severe acute respiratory syndrome coronavirus.Clin Infect Dis. 2005; 41: e67-71Crossref PubMed Scopus (242) Google Scholar, 3Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19.JAMA. 2020; 323: 1837-1838PubMed Google Scholar, 4Kampf G. Todt D. Pfaender S. Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents.J Hosp Infect. 2020; 104: 246-251Abstract Full Text Full Text PDF PubMed Scopus (2495) Google Scholar]. Against this background, personal protective equipment (PPE) of healthcare workers should include face masks, eye protection, and long-sleeved gowns [[1]Schwartz J. King C.-C. Yen M.-Y. Protecting healthcare workers during the coronavirus disease 2019 (COVID-19) outbreak: lessons from Taiwan's severe acute respiratory syndrome response.Clin Infect Dis. 2020; 71: 858-860Crossref PubMed Scopus (260) Google Scholar]. Additional protection is required for nursing care (gloves, plastic apron) or pulmonary rehabilitation (gloves, plastic apron, and filtering facepiece 2 mask). Long-sleeved gowns are the second-most-used item of PPE after gloves and can be contaminated by contact or droplets during patient care. No data are available about the rate of long-sleeved gown contamination by SARS-CoV-2 during patient care and its usefulness in highly contagious patients according to the nature of the care. We investigated long-sleeve gown contamination by SARS-CoV-2 in our infectious disease ward during healthcare of patients considered at high risk of transmission in four situations: long-sleeved gown kept in place near the head of the patient (<50 cm) for 24 h, clinical examination, nursing care, and pulmonary rehabilitation. The patients had documented SARS-CoV2 infection established by reverse transcription–polymerase chain reaction (RT–PCR) and chest computed tomography; respiratory signs such as coughing and/or digestive signs such as diarrhoea; and had not received antiviral treatment for SARS-CoV-2. Non-woven long-sleeved gowns were sampled with two dry swabs on the sleeves (one swab per sleeve) and on the chest plate (one swab). Sampling was standardized and consisted in 20 rubs per swab using each side of the swab. The swabbed area was 40 cm long by 10 cm wide. For each patient, four samplings of non-woven gowns were scheduled, four from chest plates and four from sleeves. One gown, hung less than 50 cm from the head of the patient on the day of inclusion, was sampled after 24 h; the gown used by the doctor after the clinical examination and the gown worn by the healthcare worker after nursing care were sampled at day 1; the gown used by the physio-therapist was sampled after respiratory rehabilitation. To validate the sampling method, we contaminated a 40 × 10 cm piece of non-woven gown with a solution of SARS-CoV-2 (cycle threshold, CT: 20) and sampled it at different times: immediately, and then after 1, 4, 8, 12, and 24 h. Each test was positive with the same CT ∼33. SARS-CoV-2 detection has been performed with a real-time one-step RT–PCR targeting RNA-dependent RNA polymerase (IP2 and IP4), according to the protocol of the Institut Pasteur, Paris (available at: https://www.who.int/docs/default-source/coronaviruse/real-time-rt-pcr-assays-for-the-detection-of-sars-cov-2-institut-pasteur-paris.pdf?sfvrsn=3662fcb6_2). Six patients were included (Table I) and, of the 48 scheduled samples, 42 were analysed. Six RT–PCR were not performed because of technical problems or because pulmonary rehabilitation was not needed. Only two of the 21 samples from sleeves were positive for SARS-CoV-2. They were taken from long-sleeved gowns after nursing care (patient 3, duration of care 25 min) and after pulmonary rehabilitation (patient 2, duration 30 min). Nursing care comprised assistance with personal care, patient mobilization in the bed or in a chair, monitoring of vital parameters, bed-making and cleaning of the patient environment (Table I).Table IDescription of COVID-19 patients and results of SARS-CoV-2 tests on long-sleeved gownsVariablePatient no.123456Sex (age, years)M, 71F, 72M, 67M, 53M, 71M, 67Severe infection risk factor Chronic renal failureStage IVDialysis Type 2 diabetesInsulin.ControlledInsulin.Non-controlledNo insulin. ComplicationsNo insulin.Non-controlledNo insulin. ControlledNo insulin.Complications Cardiovascular diseaseHBPHBP, IHD, arrhythmiaHeart rhythm disorderHBP, IHD, arrhythmiaHBP CirrhosisChild CSymptoms Time prior to inclusion (days)631472311 Fever >38°C+–++++ Cough+++++– Dyspnoea++–+++ Intense fatigue+–+–++ Anosmia/ageusia––––+– Diarrhoea++++–+Chest computed tomography Ground-glass opacification++++++ Crazy-paving+–++–– Condensation–+++++ Lobes infected535455 ExtensionModerateModerateSevereModerateCriticalSevereRT–PCR SARS-CoV-2 Clinical samplesNasopharyngealPositivePositivePositivePositivePositivePositiveBloodPositivePositiveNegativeNegativeNegativeNDStoolPositivePositivePositiveNDNDND 24 h bed head LSGaLong-sleeved gown left during 24 h at least 50 cm from the bed head.Chest plateNegativeNegativeNegativeNDNegativeNegativeSleevesNegativeNegativeNegativeNDNegativeNegative Clinical examination LSGChest plateNegativeNegativeNegativeNegativeNegativeNegativeSleevesNegativeNegativeNegativeNegativeNegativeNegative Nursing care LSGDuration (mn)453025402040Chest plateNegativeNegativeNegativeNegativeNegativeNegativeSleevesNegativeNegativePositiveNegativeNegativeNegative Pulmonary rehabilitation LSGDuration (mn)2530ND20ND20Chest plateNegativeNegativeNDNegativeNDNegativeSleevesNegativePositiveNDNegativeNDNegativeRT–PCR, reverse transcription–polymerase chain reaction; +, presence; –, absence; HBP, high blood pressure; IHD, ischaemic heart disease; ND, not done; LSG, long-sleeved gown.a Long-sleeved gown left during 24 h at least 50 cm from the bed head. Open table in a new tab RT–PCR, reverse transcription–polymerase chain reaction; +, presence; –, absence; HBP, high blood pressure; IHD, ischaemic heart disease; ND, not done; LSG, long-sleeved gown. To our knowledge, our small study is the first to characterize the contamination of PPE with SARS-CoV-2 in real field conditions after provision of care to infected patients. Appropriate PPE when administering care to patients with acute respiratory infections can include a combination of medical or surgical masks, gloves, long-sleeved gowns, and eye protection (goggles or face shields) [[5]Verbeek J.H. Rajamaki B. Ijaz S. Sauni R. Toomey E. Blackwood B. et al.Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff.Cochrane Database Syst Rev. 2020; CD011621Google Scholar]. For COVID-19, the recommended PPE are gloves, masks, goggles or face shields, and long-sleeved gowns, with respirators recommended over masks for aerosolizing procedures [[6]World Health Organization. Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages. n.d. Available at: https://www.who.int/publications-detail-redirect/rational-use-of-personal-protective-equipment-for-coronavirus-disease-(covid-19)-and-considerations-during-severe-shortages [last accessed June 2020].Google Scholar]. During the COVID-19 pandemic, healthcare facilities are experiencing difficulty in accessing the PPE needed and are having to identify alternative ways to provide patient care [[7]Centers for Disease Control and PreventionCoronavirus Disease 2019 (COVID-19).Cent Dis Control Prev. 2020; (Available at:) ([last accessed June 2020])https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.htmlGoogle Scholar]. We wanted to determine whether plastic aprons could be an alternative to gowns. In our study, one sleeve sample out of six was positive after nursing care and one out of four after respiratory rehabilitation. No sample out of six was positive after simple clinical care. No torso samples were positive for SARS-CoV-2. Surprisingly, samples from gowns placed near the patient's head for 24 h yielded negative results although the patients had been coughing. This study has several limitations. Our analytical methods identified viral RNA, which does not signify viral infectivity. Also, as expected, our validation experiments showed that the gown sampling method had low efficiency. Thus, we assume that high viral loads could have been present on the sleeves immediately after care and we cannot rule out that lower viral loads were present on the torso of the gowns. We conclude that long-sleeved gowns should be mandatory for high-exposure care. Aprons could be an alternative but only in low-exposure environments and in association with hand hygiene extended to the forearms. We wish to acknowledge the role of the Infectious and Tropical Disease Department disease ward and of the Virology Department ward in the achievement of this work. We thank J. Watts for his help in preparing the manuscript. None declared. None.

Si la vaccination a permis de freiner la propagation de certaines maladies infectieuses et de limiter les épidémies, l’éducation à l’hygiène et à la santé, la rédaction de protocoles et la formation ont rendu les soins encore plus sécuritaires pour les malades et le personnel hospitalier. Une rétrospective des grandes pandémies et une analyse de la crise de la Covid-19 montrent qu’il faut demeurer très vigilant. En milieu de soins, la notion de protection et d’hygiène reste, encore de nos jours, primordiale.

OBJECTIVESTo analyse the frequency and causes of treatment discontinuation in patients who were treated with an integrase strand transfer inhibitor (INSTI), with a focus on neuropsychiatric adverse events (NPAEs).METHODSPatients in 18 HIV reference centres in France were prospectively included in the Dat'AIDS cohort. Data were collected from all patients starting an INSTI-containing regimen between 1 January 2006 and 31 December 2016. All causes of INSTI-containing regimen discontinuations were analysed, and patients' characteristics related to discontinuation due to NPAEs were sought.RESULTSINSTIs were prescribed to 21315 patients: 6274 received dolutegravir, 3421 received elvitegravir boosted by cobicistat, and 11620 received raltegravir. Discontinuation was observed in 12.5%, 20.2% and 50.9% of the dolutegravir-, elvitegravir- and raltegravir-treated patients, respectively (P < 0.001). Discontinuation for NPAEs occurred in 2.7%, 1.3% and 1.7% of the dolutegravir-, elvitegravir-, and raltegravir-treated patients, respectively (P < 0.001). In the multivariate analysis, discontinuation for NPAEs was related to dolutegravir versus elvitegravir (HR = 2.27; 95% CI 1.63-3.17; P < 0.0001) and versus raltegravir (HR = 2.46; 95% CI 2.00-3.40; P < 0.0001), but neither gender (HR for women = 1.19; 95% CI 0.97-1.46; P = 0.09) nor age (P = 0.12) was related. The association with abacavir was not retained in the final model.CONCLUSIONSAlthough discontinuation for side effects was less frequent with dolutegravir than with boosted elvitegravir, discontinuation for NPAEs, although rare (2.7%), was more frequent with dolutegravir. No patient characteristic was found to be associated with these side effects in this very large population.

BACKGROUNDIntramuscular injections (IMIs) remain a frequent practice in mental health. Few studies have examined the issue of nurses' practices concerning IMI in this domain, and none considered specifically hygiene. Finally, no study appears to have looked at emergency situations and their possible influence on practices. The principal objective of our study was to assess the practices associated with IMI in mental health, especially the hygiene-related practices. The secondary objectives were as follows: 1) to assess the practices for the preparation and administration of IMI in mental health for criteria other than hygiene and 2) to determine whether professional experience and emergency situations influence these practices.DESIGNSingle-centre cross-sectional study in a psychiatric Hospital and adherence to the STROBE guidelines.METHODSThe participating nurses all worked with inpatients, and all volunteered for the study. A self-administered questionnaire was sent to all participants. The questionnaire included questions about knowledge and practices associated with IMI, some considered in two different situations: emergencies and planned injections. The distribution of the responses was tested by the chi-squared test or Fisher's exact test, as appropriate, or by McNemar's chi-squared test or Friedman's nonparametric chi-squared test for matched data.RESULTSResponse rate was 48.6%. Overall, 81% of nurses reported correct handwashing before preparation, 87.5% responded that the dorsogluteal site is currently recommended for IMI, and 74.6% that they did not know the "Z track" technique. In planned injections, 58.7% reported that the choice of needle was determined, at least in part, by the patient's body mass index. In emergency situations, adherence to guidelines was less frequent for all types of practices.CONCLUSIONSThis study shows the need to improve practices for the frequently used procedure of IMI among mental health nurses.RELEVANCE TO CLINICAL PRACTICEBetter professional education appears necessary to develop optimal practices, especially in emergency situations.

Objective. - To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015. Methods. - We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015. Results. - We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load >5 log copies/mL were less likely to receive NNRTI (OR = 0.08) or INSTI regimens (OR = 0.69) than bPIs. Patients with initial CD4(+) T cell count <200/mm(3) were less likely to receive an NNRTI (OR = 0.28) or an INSTI regimen (OR = 0.52) than a bPI. Women were less likely to receive an NNRTI (OR = 0.79) or an INSTI regimen (OR = 0.71) than a bPI; although this depended on age. Conclusion. - The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4(+) T cell count, and in women. (C) 2018 Elsevier Masson SAS. All rights reserved.

Cette année, pour la première fois au sein de notre établissement, le port du masque systématique a été demandé aux professionnels de santé non vaccinés contre la grippe, dans tous les lieux de contact avec les patients. Cette obligation du port du masque a été décidée du fait du faible taux de vaccination chez les professionnels (environ 30 %), pour limiter la propagation de l'épidémie de grippe. Cette mesure était complémentaire de la vaccination, de la mise en place d'isolement gouttelettes en cas de grippe identifiée et des précautions habituelles d'hygiène. Cette étude prospective, réalisée en période d'épidémie grippale, a pour objectif d'évaluer le ressenti du personnel vis-à-vis de cette mesure. L'équipe infirmière du service de maladies infectieuses a élaboré un questionnaire sur le ressenti du port du masque. Ce questionnaire anonyme a été diffusé dans le service de maladies infectieuses, puis à l'ensemble des différents pôles de l'établissement. L'analyse préliminaire de 254 réponses montre une population jeune (âge moyen : 39,1 ans), majoritairement féminine (n = 190, 74,8 %), avec 82 infirmiers (32,3 %), 64 médecins (25,2 %), 44 aides-soignants (17,3 %) et 18 agents de service hospitalier (7,1 %). Près de la moitié (n = 121, 47,6 %) étaient vaccinés. Parmi les 121 vaccinés, 110 (91,7 %) l'ont fait par choix personnel et 98 (81 %) se sentent protégés. Quatre-vingt-cinq (70,2 %) pensent que le port du masque pour les non-vaccinés n'est pas suffisant pour éviter une épidémie. Soixante-deux (51,2 %) sont favorables au port du masque pour tous en période épidémique. Parmi les 133 non vaccinés, 72 (54,4 %) ne sont pas convaincus de l'efficacité du vaccin. La majorité (n = 105, 79,2 %) porte effectivement un masque. Cinquante professionnels (37,6 %) répondent que le port du masque est contraignant : 61 (45,6 %) signalent un inconfort physique et 52 (39,2 %) un impact négatif sur la communication. La culpabilité de porter un masque est faible (8,8 %) et peu d'agents (n = 14, 10,4 %) ont subi des remarques désagréables. Cent dix-neuf personnes (89,6 %) pensent être protégées de la grippe par le port du masque et 125 ont le sentiment de protéger les patients (93,9 %). Seuls quinze pensent se vacciner l'an prochain, 32 personnes se déclarent hésitantes. Le port du masque systématique en période épidémique par les professionnels non vaccinés est globalement bien accepté par les non-vaccinés. Les agents se sentent en sécurité et pensent protéger les patients. Les personnels vaccinés sont plus mitigés sur l'intérêt de cette mesure. Cette mesure semble être une mesure complémentaire intéressante à conserver dans un but de limitation de la transmission virale. Le fait de l'étendre à tous en complément de la vaccination peut être à discuter pour protéger d'autres virus que la grippe (VRS par exemple). La promotion de la vaccination reste indispensable.

ObjectivesTo study valve appearance and the presence of valve disease in a cohort of people living with HIV (PLHIV).DesignA prospective study of PLHIV examined at the cardiology department of the Clermont Ferrand university hospital group (CHU) between January 1, 2012, and December 31, 2014. Were excluded those with a history of infection associated with a possible endocarditis.MethodsDemographic, medical characteristics and cardiovascular disease risk factors at time of cardiovascular examination and Doppler-echocardiography were recorded and analyzed.ResultsIn total, 903 PLHIV were examined in the infectious diseases department, 255 of whom were included. These consisted of 67 women (26.3%) and 188 men, of a mean age of 51.2±9.7years, in whom coronary artery disease was diagnosed in 18 patients (7.0%), two women and 16 men, representing a prevalence of 3.0% in females and 8.5% in males. The appearance of the aortic cusps was considered dystrophic in 14.1% of cases (36/255), dysplastic in two cases (0.8%), exhibiting a bicuspid deformity in one case. The prevalence of aortic valve abnormality was therefore 6.0% in the women (4/67) and 17.0% in the men (32/188). On facing off this data with the Kora Monica study findings, an increase in prevalence appears only to truly manifest after 50years of age. We registered 35 aortic insufficiency cases (13.7%), representing a higher incidence than that of the Framingham cohort, with age and masculine gender being the determining factors.ConclusionValve disease, along with coronary artery disease, should be closely monitored in PLHIV.

Objective. - We aimed to study factors associated with the outcome of totally implantable venous-access port (TIVAP)-related infections.Patients and methods. - We conducted a prospective and observational cohort study of patients presenting with a solid tumor and TIVAP-related infection.Results. - We monitored 97 patients for 12 weeks. The case fatality at 12 weeks was high (54%). Factors associated with case fatality at week 12 included patients' underlying cancer (metastatic status, parenteral nutrition, home care). Infectious complications (local abscess, hematogenous metastases, infection recurrence, septic shock) were frequently observed (48%). The delay in TIVAP removal was the only variable significantly associated with complications (TIVAP removed more than a week after removal decision, P = 0.001, or more than a week after onset of clinical symptoms, P = 0.002). On the basis of IDSA guidelines, we also observed that 25% of patients whose TIVAP had been removed could have benefited from a conservative treatment. Infections occurring within a month of TIVAP implantation were significantly associated with a Staphylococcus aureus infection (P = 0.008).Conclusion. - Case fatality is high in this population of patients due to the poor status of patients. TIVAP should be promptly removed when appropriate but the patient's poor status might delay or even prevent its removal. Some patients could instead benefit from a conservative treatment. There is currently no recommendation for this therapeutic option and studies are needed to clarify its efficacy. Additionally, infection occurring within a month of TIVAP insertion could be a supplementary criterion for removal as S. aureus is associated with early infection. (C) 2015 Elsevier Masson SAS. All rights reserved.

Medical devices can be contaminated by microbial biofilm which causes nosocomial infections. One of the strategies for the prevention of such microbial adhesion is to modify the biomaterials by creating micro or nanofeatures on their surface. This study aimed (1) to nanostructure acrylonitrile-butadiene-styrene (ABS), a polymer composing connectors in perfusion devices, using Anodic Alumina Oxide templates, and to control the reproducibility of this process; (2) to characterize the physico-chemical properties of the nanostructured surfaces such as wettability using captive-bubble contact angle measurement technique; (3) to test the impact of nanostructures on Staphylococcus epidermidis biofilm development. Fabrication of Anodic Alumina Oxide molds was realized by double anodization in oxalic acid. This process was reproducible. The obtained molds present hexagonally arranged 50 nm diameter pores, with a 100 nm interpore distance and a length of 100 nm. Acrylonitrile-butadiene-styrene nanostructures were successfully prepared using a polymer solution and two melt wetting methods. For all methods, the nanopicots were obtained but inside each sample their length was different. One method was selected essentially for industrial purposes and for better reproducibility results. The flat ABS surface presents a slightly hydrophilic character, which remains roughly unchanged after nanostructuration, the increasing apparent wettability observed in that case being explained by roughness effects. Also, the nanostructuration of the polymer surface does not induce any significant effect on Staphylococcus epidermidis adhesion.

Background Peripherally Inserted Central Catheters (PICCs) are long-term intravenous catheters used for drug administration when the duration of parenteral treatment exceeds six days. Purpose To analyse the incidence and nature of PICC-related complications in routine clinical practice. Material and methods A monocentric, prospective study. All PICCs implanted between December 1, 2012 and March 6, 2013 were included. Clinical data of inpatients and outpatients were collected until May 1, 2013. Results Of the 206 PICCs successfully inserted in 184 patients, 204 were analysed. They represented 5,116 catheter-days, of which 1,503 related to outpatients. Antibiotic treatment was the main use (70.5%). At the end of the follow-up, 194 PICCs had been removed with a median duration of 16.0 days (0–97). Complications led to the removal of 58 PICCs: two thromboses, 26 suspected infections, 12 obstructions and 18 accidental removals. The incidence rates were 2.45% or 0.98 per 1,000 catheter-days for catheter-related bloodstream infection with parenteral nutrition as a risk factor (OR = 13.0; CI95: 2.77–82.38, p = 0.0002), and 0.98% or 0.39 per 1,000 catheter-days for thrombosis. Catheter obstruction occurred for 40/204 PICCs with blood transfusion and blood samples as risk factors (OR = 3.0; CI95: 1.21–8.53, p = 0.01). Conclusion Due to their low organic complication rates and their significant use for outpatients, PICCs appear to be a good alternative if there is a need for central venous access in case of a medium- or a long-term catheter. A better understanding of their usage and training of healthcare workers are required to avoid complications. References and/or acknowledgements No conflict of interest.

The first French outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) USA300 clone was investigated. After outbreak investigation, hygiene measures were implemented in all family households and childminders’ homes. Several decontamination procedures were performed, which used a combination of topical mupirocin, total body application of chlorhexidine, chlorhexidine gargle (if >6 years old) and a course of antibiotic therapy in cases of infection or decontamination failure. Patients were followed up for MRSA skin and soft tissue infections (SSTIs) and carriage. Strains were characterised by antimicrobial drug resistance profile, pulsed-field gel electrophoresis (PFGE) and DNA microarrays. Between June 2011 and June 2012, six children and six adults among the ten corresponding relatives developed 28 SSTIs. None of the family members, including the index case, had any contact with foreigners or individuals known to have SSTIs. After infection control measures and prolonged decontamination have been implemented with a high adherence, six patients remained sustained CA-MRSA USA300 carriers, including one who developed mupirocin resistance and six who experienced minor CA-MRSA-related SSTIs. A baby was identified as an MRSA carrier 2 months after delivery. CA-MRSA decontamination using mupirocin and chlorhexidine in the community setting may also be a questionable strategy, associated with failure and resistance to both agents. Close monitoring of CA-MRSA SSTIs is required in France and in other European countries where MRSA USA300 has recently emerged. We showed that a closed management based on hygiene measures reinforcement, decolonisation and extended screening may fail to suppress CA-MRSA carriage and subsequent infections.

RésuméPrécautions « standard » vis-à-vis des agents infectieux véhiculés par le sang et les liquides biologiques.

Vancomycin lock solution (LS) is recommended for the conservative treatment of subcutaneous injection port (SIP)-related infections, but may be associated with failure. We used an in vitro dynamic model of biofilm formation in an SIP, based on a continuous flow circulating via a real SIP, to assess the effectiveness of vancomycin (5 mg/ml), daptomycin (5 mg/ml) and ethanol 40 % LS in eradicating a pre-established Staphylococcus epidermidis biofilm. Heparin, Ringer’s lactate and enoxaparin sodium LS were used as controls. The logarithmic reductions of colony-forming units (CFU) were compared by Student’s t-test. After 24 h of exposure, the vancomycin LS did not exert a greater bactericidal effect than the heparin LS control (mean logarithmic reduction: 2.27 ± 0.58 vs. 1.34 ± 0.22, respectively, p = 0.3). The mean logarithmic reduction was greater with daptomycin LS (5.45 ± 0.14 vs. 0.39 ± 0.12, p < 0.01) and ethanol LS (6.79 ± 1.03 vs. 1.43 ± 0.54, p = 0.02). Bacterial revival after exposure to 24 h of LS was assessed. The mean viable bacteria count was significantly higher for vancomycin LS (9.36 ± 0.10 log10CFU) and daptomycin LS (9.16 ± 0.02 log10CFU) than for ethanol LS (2.95 ± 1.65 log10CFU). Ethanol appeared to be the most attractive option to treat SIP-related infection, but its poor ability to entirely disrupt the biofilm structure may require its use in association with a dispersal agent to avoid renewal of the biofilm.

Mucormycoses are rare but emerging diseases with poor prognosis caused by ubiquitous fungi from the environment. In November 2008, our teaching hospital experienced three cutaneous mucormycosis due to Lichtheimia spp. (ex Absidia/Mycocladus) in the intensive care and orthopaedic units. Environmental and epidemiological investigations suggested a possible cross-transmission of L. ramosa between two patients in intensive care. This is the first report of possible person-to-person transmission of mucormycosis species. These cases show the ineffectiveness of hydro-alcoholic solutions against spores and underline the need to respect standard precautions to prevent fungi dissemination.