BackgroundBacteria of the Achromobacter genus, more particularly xylosoxidans species, are responsible for various healthcare associated infections (HAI) which are increasingly described since the last decade. Cystic fibrosis (CF) patients are considered as potential reservoirs in hospitals. We performed a retrospective study to estimate the frequencies of Achromobacter spp. HAI among patients from French West Indies, to determine characteristics of infected patients and establish a possible link between CF and infections.MethodsAll adults with at least one Achromobacter spp. positive sample and infection criteria in accordance with European official definitions of HAI, hospitalized in University Hospital of Martinique from 2006 to 2016 for more than 48h, were included. Patient clinical features, immune status and underlying diseases were obtained from medical files. A list of CF patients was given by clinicians.Antibiotic-susceptibility profiles of the strains were determined using an automated method.ResultsMean incidence density was 0.038/1000days of hospitalization. Achromobacter spp. HAI evolved as an endemic situation with a low but pretty much stable incidence rate over the 11-year observation period. An epidemic peak was noticed in 2013. Among the 66 included patients, 56.1% were immunocompetent and no one had CF. Pneumonia and bacteraemia were the two main HAI. Among the 79 isolated strains, 92.4% were resistant to at least 1 major antibiotic and 16.4% met the definition of multidrug-resistant bacteria.ConclusionsThis microorganism, little known in our country because of the scarcity of CF patients, represents a threat for both immunosuppressed and immunocompetent patients and a therapeutic challenge because of its high resistance.

BACKGROUND:Seasonal influenza has a major individual and collective impact, especially among the elderly living in nursing homes. To prevent infection by influenza viruses, vaccination of residents and professionals is an essential measure. However, while the vaccination rates of residents are generally high (>85%), rates among professionals are generally approximately 20%. To evaluate the effectiveness of an intervention campaign on the improvement of the influenza vaccination rate of professionals, a regional intervention study was proposed for nursing homes during the 2014-15 season. METHODS:Cluster-randomized controlled trial (with a nursing home representing a cluster). In the intervention group, a campaign on influenza vaccination was offered to staff, combining different teaching aids in a multimodal approach. In the control group, no intervention was proposed. The primary endpoint was the rate of influenza vaccination among staff. Before and after the study, professionals were asked to complete short questionnaires on their perceptions of influenza vaccination. A multilevel analysis was carried out to compare the vaccination rates between the 2 groups and their evolution before/after the winter period. RESULTS:A total of 32 nursing homes were randomized, and 6 were excluded. Initial vaccination rates were 27.6% in the intervention group and 24.2% in the control group (p = 0.16). After the study, these rates increased to 33.7% and 22.9%, respectively, which was a relative difference of +22.1% in the intervention group compared to -5.4% in the control group, p = 0.0025. CONCLUSIONS:Despite professionals' reluctance to be vaccinate, participation in a promotional campaign with a pragmatic approach has increased the rate of influenza vaccination. The approach will be offered to all nursing homes in the region after revision of the tools to enhance their ease of use and pedagogical messages focused on the direct benefits to professionals.

Objectives: To evaluate the rate and circumstances of outborn deliveries within a French perinatal network, and to determine their avoidability.Study design: Cohort study including preterm infants <33 weeks gestation and/or weighing <1500 g born outside a level III maternity unit in Lower Normandy region, France, in 2008-2010. In 2008 and 2009, only neonates transferred to the Caen University Teaching Hospital (CHU) were included. In 2010, all outborn neonates in the region were included by means of a medical information system program. A panel of 7 experts was set up to determine the avoidability of each outborn case using a two-stage modified Delphi procedure. Inter-expert agreement was evaluated using the kappa index.Results: Sixty-four cases (71 neonates) were included. The outborn rate in 2010 was 16.1% (40/248,95% CI (116-207%)). The most common reason for delivery was spontaneous onset of labour (57.8%). In 12 cases, the place of birth (level 2b maternity unit) was considered to be appropriate by the experts (term >= 32 WG), but 8 cases involved infants of low birth weight (<1500 g). For the 52 cases born in inappropriate sites, 9.6% were considered to be avoidable (kappa index = 0.42 (p < 10-3)).Conclusion: Our outborn rate meets regionalisation targets. Our method of expert evaluation identified a small percentage of avoidable births in inappropriate sites. Regular reassessment of obstetric practices and good coordination between network actors are crucial to improve the management of pregnancies at risk of outborn delivery. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Background. In the middle of October 2011, the Hygiene Department of Caen University Hospital suspected an outbreak of surgical site infections (SSI) after open-heart operations with an unusually high proportion of microorganisms belonging to the Enterobacteriaceae family. The attack rate was 3.8%, significantly different (p = 0.035) from the attack rate of 1.2% in 2010 over the equivalent period. A case-control study was conducted to search specifically for risk factors for Enterobacteriaceae infections after median sternotomy in cardiac patients.Methods. Case patients were defined retrospectively as patients with superficial or deep surgical site infection with Enterobacteriaceae within 30 days of median sternotomy. Four control patients were selected per case patient from patients matched for date of operation (+/- 15 days) and European System for Cardiac Operative Risk Evaluation (<5, [5-10], >10).Results. Univariate analysis identified the following risk factors: inappropriate skin preparation on the morning of the intervention (p = 0.046), use of vancomycin (p = 0.030), and number of sternotomy dressings (p = 0.033). A multivariate logistic regression analysis found that vancomycin use was independently associated with an increased risk of postoperative SSI with Enterobacteriaceae (p = 0.019; odds ratio = 7.4).Conclusions. Although vancomycin is known to be effective for preventing infection with methicillin-sensitive organisms, our results suggest that it was associated with a risk for the development of SSI with gram-negative organisms after median sternotomy. This study led to a multi-disciplinary meeting that defined new guidelines for prophylactic antibiotic therapy before open-heart operations. (C) 2013 by The Society of Thoracic Surgeons

Objective: In 2005, there was an epidemic of infections resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in the intensive care department. The aim of this study was to evaluate the potential long-term clinical and economic benefits resulting from the management of this epidemic and the resulting changes in practices.Design: Two periods were defined: the period leading up to and including the epidemic (2003-2005; period I) and the postepidemic period (2006-2008; period II). We estimated the number of nosocomial infections prevented between these two periods in three ways: comparison of attack rates, incidence rates, and calculation of standardized infection ratios. A cost-benefit analysis was then carried out by multiplying the number of nosocomial infections prevented by their cost as estimated from a literature review.Measurements and Main Results: The characteristics of the populations hospitalized during these two periods were comparable in terms of age, sex, Simplified Acute Physiologic Scale II score, origin, and type of diagnosis. The death rate was similar in the two periods (21.8% vs. 23.3%; p = .63). The number of nosocomial infections prevented was 54.1 (95% confidence interval 25.8-83.1; 30.4, 95% confidence interval 5.3-54.9; 32.8, 95% confidence interval 6.0-63.7; and 30.1, 95% confidence interval 17.7-42.5) according to the methodology. The savings cost potentially associated with the infection control intervention ranged from (sic)149,928 (USD $ 183,781) to (sic)269,472 (USD $ 330,318).Conclusion: The management of this epidemic and the change in medical practices that it triggered were associated with a significant decrease in the number of infections acquired in the intensive care unit. There were substantial cost savings, highlighting the value of investment in the prevention of nosocomial infections. (Crit Care Med 2011; 39:2672-2677)

Background Benefits and limitations of supplementation with 80% fraction of inspired oxygen for preventing surgical site infections have not yet been clearly defined. Some studies have reported benefits in colorectal surgery, whereas trials in abdominal and gynecologic surgery have reported either no effect or a deleterious effect. Methods Controlled, randomized, assessor-blind multicenter trial, the ISO2 study, comparing the effects of hyperoxygenation (fraction of inspired oxygen, 80%) with those of 30% oxygen on the frequency of surgical site infections in routine abdominal, gynecologic, and breast surgery on 434 patients. Patients not seen in consultation after discharge were contacted. Results In total, 208 patients received 30% perioperative oxygen and 226 received 80%. There was no difference between the two groups for baseline, intraoperative, and postoperative characteristics, except for oxygen saturation at closure, higher in the 80% group (P=0.01). The frequency of 30-day surgical site infections was 7.2% (15/208) in the 30% group and 6.6% (15/226) in the 80% group (relative risk, 0.92; 95% CI [0.46-1.84], P=0.81). Frequency of adverse events (nausea and vomiting, sternal pain, cough, hypotension) was similar in the two groups. Desaturation and bradycardia were more frequent in the 30% group. In an updated meta-analysis including the result of this trial and those of eight published randomized trials, the overall relative risk was 0.97; 95% CI (0.68-1.40), I2 (inconsistency degree)=73%, (P=0.88). Conclusions The routine use of hyperoxygenation throughout abdominal, gynecologic, and breast surgery had no effect on the frequency of 30-day surgical site infections and was not accompanied by more frequent adverse effects.

Sensitive markers of infection are rare or of limited validity in neutropenic patients. Procalcitonin (PCT), a precursor protein of calcitonin, is a specific and sensitive marker of severe bacterial infections during short-term neutropenia. Because the value of PCT measurements among patients undergoing long periods of neutropenia remains uncertain and because several mechanisms, such as bacterial or fungal infections, reactions to drugs or blood products or tumor-associated events, can cause fever, we described the dynamics of PCT in 29 acute myeloid leukemia (AML) patients with 39 instances of chemotherapy-induced neutropenia. Plasma levels of PCT were determined prospectively by an immunoluminometric assay every four days starting at the onset of chemotherapy and continuing until the resolution of fever. We found that bacteremia did increase PCT levels above 0.5ng/mL and these levels predicted bacteremia at day 15 of chemotherapy. This finding may be relevant in the decision to alter antibiotic regimens to decrease toxicity and cost when patients remain febrile at day 15.

CONTEXT:Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access. OBJECTIVE:To determine whether jugular catheterization decreases the risk of nosocomial complications compared with femoral catheterization. DESIGN, SETTING, AND PATIENTS:A concealed, randomized, multicenter, evaluator-blinded, parallel-group trial (the Cathedia Study) of 750 patients from a network of 9 tertiary care university medical centers and 3 general hospitals in France conducted between May 2004 and May 2007. The severely ill, bed-bound adults had a body mass index (BMI) of less than 45 and required a first catheter insertion for renal replacement therapy. INTERVENTION:Patients were randomized to receive jugular or femoral vein catheterization by operators experienced in placement at both sites. MAIN OUTCOME MEASURES:Rates of infectious complications, defined as catheter colonization on removal (primary end point), and catheter-related bloodstream infection. RESULTS:Patient and catheter characteristics, including duration of catheterization, were similar in both groups. More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%], respectively; P = .03). The risk of catheter colonization at removal did not differ significantly between the femoral and jugular groups (incidence of 40.8 vs 35.7 per 1000 catheter-days; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.62-1.16; P = .31). A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI (P for the interaction term < .001). Jugular catheterization significantly increased incidence of catheter colonization vs femoral catheterization (45.4 vs 23.7 per 1000 catheter-days; HR, 2.10; 95% CI, 1.13-3.91; P = .017) in the lowest tercile (BMI <24.2), whereas jugular catheterization significantly decreased this incidence (24.5 vs 50.9 per 1000 catheter-days; HR, 0.40; 95% CI, 0.23-0.69; P < .001) in the highest tercile (BMI >28.4). The rate of catheter-related bloodstream infection was similar in both groups (2.3 vs 1.5 per 1000 catheter-days, respectively; P = .42). CONCLUSION:Jugular venous catheterization access does not appear to reduce the risk of infection compared with femoral access, except among adults with a high BMI, and may have a higher risk of hematoma. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00277888.

Objective To compare effectiveness in preventing central venous catheter colonization and infection of two protocols of cutaneous antisepsis using povidone-iodine solution in combination with ethanol or water. Design Randomized trial. Setting Medical intensive care department in a university hospital. Patients Consecutive patients requiring central venous catheter in two similar 11-bed units from January 1, 2001, to January 1, 2002. Interventions Alcoholic povidone-iodine solution protocol was randomly assigned to one of two units when the study began. Every 3 months the alcoholic protocol was switched from one unit to the other. Depending on the unit and the time the patient was admitted, catheters were inserted and cared for with 10% aqueous povidone-iodine solution or 5% povidone-iodine solution 70% ethanol-based combination. Measurements and Main Results Rates of catheter colonization, catheter-related bacteremia, and catheter-related infection were compared in the two protocols; 223 catheters were included in an intent-to-treat analysis. The incidence of catheter colonization was significantly lower in the alcoholic povidone-iodine solution protocol than in the aqueous povidone-iodine solution protocol (relative risk, 0.38; 95% confidence interval, 0.22–0.65, p < .001), and so was the incidence of catheter-related infection (relative risk, 0.34; 95% confidence interval, 0.13–0.91, p < .04). Catheter-related bacteremia were similar in both protocols. After adjusting for other risk factors, time to central venous catheter colonization was significantly longer in the alcoholic solution (adjusted hazards ratio, 0.3; 95% confidence interval, 0.2–0.6, p < .001). Based on a subgroup of 114 patients (57 in each protocol), analysis of 57 pairs of central venous catheters matched for age, duration, and site of insertion found similar results regarding the superiority of alcoholic povidone-iodine solution in preventing central venous catheter colonization and infection. Conclusions The use of alcoholic povidone-iodine for skin disinfection reduced the incidence of catheter colonization and related infection compared with aqueous 10% povidone-iodine disinfection in an adult intensive care unit.

Quinze ans après le lancement national du Programme «Périnatalité», le Comité Technique Régional de la Naissance et la DRASS ont souhaité parfaire leurs connaissances de la périnatalité en Basse-Normandie et ont réalisé entre 1987 et 1989 une enquête épidémiologique pour caractériser le phénomène de la prématurité, sa distribution géographique et les filières de prise en charge des enfants prématurés. L'identification des 2462 enfants nés avant terme et la domiciliation des naissances se firent à partir des registres de salle d'accouchement et avec le concours d'un réseau épidémiologique original constitué par les sages- femmes sentinelles des trente maternités implantées en Basse-Normandie. La cartographie de la prématurité a permis de révéler des oppositions tranchées entre les entités géographiques bas-normandes (plaine/Bocage) et d'identifier les zones à risques susceptibles de bénéficier d'actions préventives. Le critère géographique de reconnaissance constitue en premier lieu un marqueur destiné à susciter des hypothèses et à aider les planificateurs et les décideurs politiques à une utilisation optimale des moyens mis en oeuvre. Il permet en second lieu de définir les bassins de recrutement des services de néonatalogie de la région et de soutenir l'idée fondamentale que les collaborations, les échanges et la qualité des transferts anténataux optimisent la qualité des soins par une organisation efficace de l'offre sanitaire. Cette étude a permis aux instances institutionnelles et politiques : - de disposer de vues synoptiques de la prématurité en Basse-Normandie, - et de renforcer leurs actions de prévention dans certains secteurs géographiques.