Evolution of antibiotic treatments for healthcare-associated infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae in France

BACKGROUND: Infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) remain a public health challenge. AIM: We traced the evolution of antibiotics prescribed for patients with ESBLE-healthcare associated infections (ESBLE-HAI) between 2012 and 2017, with a specific focus on treatments for lower urinary tract infections (LUTI). METHODS: We used the 2012 and 2017 French point prevalence survey data. Patients with ESBLE-HAI were defined as those diagnosed with at least one Enterobacteriaceae with ESBL production. Patients with LUTI caused by ESBLE (ESBLE-LUTI) were defined as those with LUTI as the reported infection site and diagnosed with ESBLE. We only analysed treatments intended for HAI. RESULTS: In 2017, more than half of treatments for ESBLE-HAIs were β-lactams. While from 2012 to 2017 the proportion of carbapenem treatments decreased from 30% to 25%, penicillin treatments doubled. Among patients treated for ESBLE-LUTI, a larger proportion received a single antibiotic in 2017. The most frequently prescribed antibiotics for these infections were amoxicillin/clavulanic acid, nitrofurantoin and ofloxacin. More than one out of six treatments lasted for more than 7 days. Carbapenem use was halved between 2012 and 2017, and decreases were likewise observed for aminoglycosides. CONCLUSION: In accordance with French recommendations, comparison of the two most recent French point prevalence surveys showed an evolution in ESBLE-HAI treatment, especially for ESBLE-LUTI. However, treatment durations remained longer than recommended. Data from the 2022 survey should provide insights on the future evolution of prescription trends

Towards One Health surveillance of antibiotic resistance: characterisation and mapping of existing programmes in humans, animals, food and the environment in France, 2021

International audienceBackground International organisations are calling for One Health approaches to tackle antimicrobial resistance. In France, getting an overview of the current surveillance system and its level of integration is difficult due to the diversity of surveillance programmes. Aim This study aimed to map and describe all French surveillance programmes for antibiotic resistance (ABR), antibiotic use (ABU) and antibiotic residues, in humans, animals, food and the environment, in 2021. Another objective was to identify integration points, gaps and overlaps in the system. Methods We reviewed the literature for surveillance programmes and their descriptions. To further characterise programmes found, semi-directed interviews were conducted with their coordinators. Results In total 48 programmes in the human (n = 35), animal (n = 12), food (n = 3) and/or the environment (n = 1) sectors were identified; 35 programmes focused on ABR, 14 on ABU and two on antibiotic residues. Two programmes were cross-sectoral. Among the 35 ABR programmes, 23 collected bacterial isolates. Bacteria most targeted were Escherichia coli (n = 17 programmes), Klebsiella pneumoniae (n = 13), and Staphylococcus aureus (n = 12). Extended-spectrum beta-lactamase-producing E. coli was monitored by most ABR programmes (15 of 35) in humans, animals and food, and is a good candidate for integrated analyses. ABU indicators were highly variable. Areas poorly covered were the environmental sector, overseas territories, antibiotic-resistant-bacterial colonisation in humans and ABU in companion animals. Conclusion The French surveillance system appears extensive but has gaps and is highly fragmented. We believe our mapping will interest policymakers and surveillance stakeholders. Our methodology may inspire other countries considering One Health surveillance of ABR

MCR-1 in ESBL-producing Escherichia coli responsible for human infections in New Caledonia

MCR-1 in ESBL-producing Escherichia coli responsible for human infections in New Caledoni

Additional file 1 of Perceptions and attitudes about antibiotic resistance in the general public and general practitioners in France

Additional file 1. Fig. S1 General Public Sample Structure. (% Adjusted) and Fig. S2 General Practitioners’ Sample structur

Bactéries multirésistantes (BMR) en milieu hospitalier : entérobactéries productrices de β-lactamases à spectre étendu (EBLSE) et Staphylococcus aureus résistants à la méticilline (Sarm ), Réseau BMR-Raisin, 2002-2010

International audienceLa maîtrise de la diffusion des bactéries multirésistantes (BMR) dans les établissements de santé (ES) est une priorité du Programme national de lutte contre les infections nosocomiales depuis le milieu des années 1990. Depuis 2002, le Raisin coordonne la surveillance nationale des Staphylococcus aureus résistants à la méticilline (SARM) et des entérobactéries productrices de ²-lactamases à spectre étendu (EBLSE), isolés de prélèvements à visée diagnostique dans les ES français. En 2010, 933 ES ont participé à la surveillance, soit une augmentation de 91% par rapport à 2002. En 2010, la densité d'incidence (DI) globale des SARM était de 0,40 pour 1 000 journées d'hospitalisation (IC95% : [0,39-0,41]) et celle des EBLSE de 0,39 [0,38-0,40]. De 2002 à 2010, la DI des SARM a diminué globalement de 43%, passant de 0,72 [0,70-0,74] à 0,41 [0,39-0,42] (p<0,001), et celle des EBLSE a augmenté de 282%, passant de 0,17 [0,16-0,18] à 0,48 [0,46-0,50] (p<0,001). La proportion de l'espèce Escherichia coli au sein des EBLSE a augmenté, passant de 18,5% en 2002 à 59,7% en 2010. L'analyse régionale des DI en 2010 montre (a) des variations régionales des DI pour les SARM et EBLSE et (b) des DI de EBLSE parfois supérieures à celles des SARM dans certaines régions (8/25). La diminution de la DI des SARM suggère un impact positif des actions de prévention instituées dans les services participant au réseau. L'augmentation de la DI des EBLSE, en particulier des E. coli, est par contre très préoccupante et doit mobiliser l'ensemble de la communauté médicale. (R.A.

Bactéries multirésistantes (BMR) en milieu hospitalier : entérobactéries productrices de β-lactamases à spectre étendu (EBLSE) et Staphylococcus aureus résistants à la méticilline (Sarm ), Réseau BMR-Raisin, 2002-2010

International audienceLa maîtrise de la diffusion des bactéries multirésistantes (BMR) dans les établissements de santé (ES) est une priorité du Programme national de lutte contre les infections nosocomiales depuis le milieu des années 1990. Depuis 2002, le Raisin coordonne la surveillance nationale des Staphylococcus aureus résistants à la méticilline (SARM) et des entérobactéries productrices de ²-lactamases à spectre étendu (EBLSE), isolés de prélèvements à visée diagnostique dans les ES français. En 2010, 933 ES ont participé à la surveillance, soit une augmentation de 91% par rapport à 2002. En 2010, la densité d'incidence (DI) globale des SARM était de 0,40 pour 1 000 journées d'hospitalisation (IC95% : [0,39-0,41]) et celle des EBLSE de 0,39 [0,38-0,40]. De 2002 à 2010, la DI des SARM a diminué globalement de 43%, passant de 0,72 [0,70-0,74] à 0,41 [0,39-0,42] (p<0,001), et celle des EBLSE a augmenté de 282%, passant de 0,17 [0,16-0,18] à 0,48 [0,46-0,50] (p<0,001). La proportion de l'espèce Escherichia coli au sein des EBLSE a augmenté, passant de 18,5% en 2002 à 59,7% en 2010. L'analyse régionale des DI en 2010 montre (a) des variations régionales des DI pour les SARM et EBLSE et (b) des DI de EBLSE parfois supérieures à celles des SARM dans certaines régions (8/25). La diminution de la DI des SARM suggère un impact positif des actions de prévention instituées dans les services participant au réseau. L'augmentation de la DI des EBLSE, en particulier des E. coli, est par contre très préoccupante et doit mobiliser l'ensemble de la communauté médicale. (R.A.

Trends of Incidence and Risk Factors of Ventilator-Associated Pneumonia in Elderly Patients Admitted to French ICUs Between 2007 and 2014

International audienceOBJECTIVES: To assess trends and risk factors of ventilator-associated pneumonia according to age, particularly in the elderly admitted to French ICUs between 2007 and 2014. DESIGN: Multicenter, prospective French national Healthcare-Associated Infection surveillance network of ICUs ("Réseau REA-Raisin"). SETTINGS: Two-hundred fifty six ICUs in 246 settings in France. PATIENTS: Included were all adult patients hospitalized greater than or equal to 48 hours in ICUs participating in the network. INTERVENTIONS: Ventilator-associated pneumonia surveillance over time. MEASUREMENTS AND MAIN RESULTS: Overall and multidrug-resistant organism-related ventilator-associated pneumonia incidence rates were expressed per 1,000 intubation days at risk. Age was stratified into three groups: young (18-64 yr old), old (65-74 yr old), and very old (75+ yr old). Age-stratified multivariate mixed-effects Poisson regressions were undertaken to assess trends of ventilator-associated pneumonia incidence over time, with center as the random effect. Ventilator-associated pneumonia risk factors were also evaluated. Of 206,223 patients, 134,510 were intubated: 47.8% were young, 22.3% were old, and 29.9% were very old. Ventilator-associated pneumonia incidence was lower in the very old group compared with the young group (14.51; 95% CI, 16.95-17.70 vs 17.32; 95% CI, 16.95-17.70, respectively, p \textless 0.001). Methicillin-resistant Staphylococcus aureus and third-generation cephalosporin-resistant Enterobacteriaceae were identified more frequently in very old patients (p \textless 0.001 and 0.014, respectively). Age-stratified models disclosed that adjusted ventilator-associated pneumonia incidence decreased selectively in the young and old groups over time (adjusted incidence rate ratios, 0.88; 95% CI, 0.82-0.94; p \textless 0.001 and adjusted incidence rate ratios, 0.95; 95% CI, 0.86-1.04; p = 0.28, respectively). Male gender and trauma were independently associated with ventilator-associated pneumonia in the three age groups, whereas antibiotics at admission was a protective factor. Scheduled surgical ICU and immunodeficiency were risk factors of ventilator-associated pneumonia in the old group (p = 0.003). CONCLUSIONS: Ventilator-associated pneumonia incidence is lower but did not decrease over time in very old patients compared with young patients

Epidemiology of Clostridioides difficile infections, France, 2010 to 2017

International audienceBackground: Clostridioides difficile is a leading cause of healthcare-associated diarrhoea in middle and high-income countries. Up to 2018, there has been no systematic, annual surveillance for C. difficile infections (CDI) in France.AimsTo provide an updated overview of the epidemiology of CDI in France between 2010 and 2017 based on five different data sources.Methods: This is a descriptive study of retrospective surveillance and alerts data. Incidence of CDI cases was estimated through the CDI incidence survey (2016) and data from the French National Uniform Hospital Discharge Database (PMSI; 2010-16). Testing frequency for CDI was estimated through the CDI incidence survey and point prevalence studies on healthcare-associated infections (HAI; 2012 and 2017). The national early warning response system for HAI (HAI-EWRS, 2012-17) and National Reference Laboratory data (2012-17) were used to follow the number of severe CDI cases and/or outbreaks.Results: In 2016, CDI incidence in acute care was 3.6 cases per 10,000 patient days (PD). There was a statistically significant increase in CDI incidence between 2010 and 2016 (+ 14% annually) and testing frequency was 47.4 per 10,000 PD. The number of CDI HAI-EWRS notifications decreased between 2015 and 2017 with only a few large outbreaks reported.Conclusion: The CDI incidence estimate increased from 2010, but remained below the European average of 7 per 10,000 PD in 2014; there were fewer severe cases or clusters reported in France. The consistency between PMSI and laboratory-based estimated CDI incidence could allow for more routine monitoring of CDI incidence