Recherche des facteurs cliniques et biologiques associés à la survenue d'une infection nosocomiale en réanimation chirurgicale

Contexte: Les infections nosocomiales (IN) sont un problème important de santé publique car responsables d'une morbi-mortalité et d'un coût élevés. Les services de réanimation sont les plus touchés par l'infection nosocomiale. La malnutrition est un des facteurs de risque importants d'acquisition d'une infection nosocomiale. Les apports caloriques quotidiens chez le patient de Réanimation ainsi que les paramètres du ionogramme sanguin influencent-ils la survenue d'une IN en Réanimation ? Objectif principal: Rechercher quelle est l'influence des apports caloriques totaux quotidiens chez le patient de réanimation sur le risque de survenue d'une infection nosocomiale au cours de son séjour. Méthodes: Il s'agit d'une étude de cohorte rétrospective. Notre échantillon était constitué des patients hospitalisés en Réanimation Picard sur l'année 2008. Les données cliniques et biologiques étaient recueillies de manière rétrospective à partir du dossier médical de Réanimation Picard du patient. Le critère de jugement principal était l'acquisition d'une infection nosocomiale par le patient au cours de son séjour en Réanimation. Conclusion: Nous n'avons pas mis en évidence d'effet des apports caloriques de nutrition artificielle sur l'acquisition d'une IN en Réanimation Picard.NANCY1-SCD Medecine (545472101) / SudocSudocFranceF

Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence

International audienceOBJECTIVE: To evaluate long-term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery.PATIENTS AND METHODS: Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow-up. Kaplan-Meier survival curves estimated the survival rate of the device without needing explantation or revision.RESULTS: In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64-72) years. The median (IQR) duration of follow-up was 15 (8.25-19.75) years. At the end of follow-up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow-up, in intention-to-treat analysis, 77.2% of patients were continent.CONCLUSION: In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision

Transmission de coccidioïdomycose donneur-transplanté en zone non endémique

International audienc

Traitement de l’incontinence urinaire masculine neurologique par le sphincter urinaire artificiel AMS 800™ (Boston Scientific, Boston, États-Unis) : résultats à très long terme (> 25 ans)

International audienceObjective: The aim of the study was to report the very long-term functional outcomes of artificial urinary sphincter (AUS) in male neurological patients.Material and methods: Male neurological patients diagnosed with stress urinary incontinence due to sphincter deficiency and undergoing AUS (AMS 800®) implantation between 1985 and 1992 were enrolled. Continence, defined by no pad/condom usage, explantation and revision rates were reported.Results: Fourteen patients with a median age of 27.3 years (IQR: 27.3–40.8) were included: four had a spinal cord injury and ten a spina bifida. Prior continence surgery was reported by 6 patients (42.9 %). Artificial urinary sphincter was implanted in a peribulbar (n = 4) or periprostatic position (n = 10). Median follow-up was 18.3 years (IQR: 10.1–20.3). At last follow-up, all patients were alive. Three native devices were still in place, eight were revised (four of them were secondarily explanted) and three were explanted due to erosion or infection. The 5-, 10-, 15-, 20-year explantation-free survival rates were respectively 85.7, 62.3, 52.0, 39.0 %. The 5-, 10-, 15-, 20-year revision-free survival rates were respectively 78.6, 42.9, 28.6, 7.1 %. At last follow-up, 50 % patients were continent.Conclusion: In the very long run, AUS provided a 50 % continence rate in male neurological patients but the revision rates were important.Level of evidence: 4Objectif: Le but de cette étude était d’évaluer les résultats fonctionnels à très long terme du sphincter urinaire artificiel (SUA) implanté chez les hommes neurologiques.Matériels et méthodes: Tous les hommes neurologiques implantés avec un SUA (AMS 800®) dans notre institution entre 1985 et 1992 ont été inclus. La continence, définie par l’absence de port de protections, les taux d’explantation et de révision ont été évalués.Résultats: Au total, quatorze patients d’âge médian 27,3 ans (IQ : 27,3,5–40,8) ont été inclus : quatre étaient des blessés médullaires et dix avaient un spina bifida. Un antécédent de chirurgie de la continence était rapporté chez six patients (42,9 %). Le SUA a été implanté en position péribulbaire (n = 4) ou périprostatique (n = 10). La durée médiane de suivi était de 18,3 ans (IQR : 10,1–20,3). Tous les patients étaient vivants au terme du suivi. Trois SUA étaient natifs, huit furent révisés (dont quatre furent explantés dans un second temps) et trois explantés pour infection ou érosion. Le taux de survie sans explantation à 5, 10, 15 et 20 ans était de 85,7 %, 62,3 %, 52,0 % et 39,0 % respectivement. Le taux de survie sans révision à 5, 10, 15 et 20 ans était de 78,6, 42,9, 28,6 et 7,1 %, respectivement. Au terme du suivi, 50 % des patients étaient continents.Conclusion: À très long terme, le SUA a permis d’obtenir un taux de continence de 50 % chez les hommes neurologiques au prix d’un taux de révision important.Niveau de preuve: 4

Factors determining poor practice in alcoholic gel hand rub technique in hospital workers

SummaryBackgroundHand hygiene of healthcare personnel is one of the most important interventions for reducing transmission of nosocomial pathogens. Previous studies have demonstrated that the use of alcohol-based hand gel increases hand hygiene compliance, but that effective use of this product cannot be taken for granted.ObjectiveEvaluate factors associated with poor hand hygiene effectiveness of hospital workers using an alcohol-based hand gel and the effect of an education program.DesignA direct observational prospective study of hand hygiene effectiveness prior to training and immediately after training.Setting and subjects3067 hospital workers of different professional categories in several hospital units in the University Hospital of Nancy (France).ResultsTime after program start (OR 0.97, 95%CI 0.96–0.97) and being female (OR 0.37, 0.24–0.58) were highly associated with increased effectiveness of hand hygiene prior to training. Wearing rings other than a wedding ring (OR 1.8, 1.2–2.7), a bracelet (OR 2.0, 1.1–3.6), a watch (OR 1.9, 1.3–2.9) and having long nails were associated with ineffective hand rub use. Professional background was also a strong predictor with nurses and especially senior nurses demonstrating much better effectiveness than all other professional groups. Wearing wedding rings or long sleeves, and having varnished nails, visibly dirty hands prior to washing and cutaneous lesions were not associated with effective gel use.ConclusionThese results demonstrate that an educational program can significantly improve the proper practices for using hand rub and hand washing compliance. This study has also demonstrated that wearing rings, bracelets, watches and long nails impair hand gel application but that wedding rings, long sleeves and varnished nails do not. The finding of that hand hygiene effectiveness increased with time even prior to training indicates that knowledge gained by staff trained early diffused into those who had not yet been trained

Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units

International audienceTo increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment