Pseudomonas aeruginosa acquisition on an intensive care unit: relationship between antibiotic selective pressure and patients' environment

International audienceABSTRACT: INTRODUCTION: To investigate the relationship between Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa. METHODS: An open, prospective cohort study was carried out in a 16-bed medical ICU where P. aeruginosa was endemic. Over a 6-month period, all patients without P. aeruginosa on admission and with a length of stay >72 h were included. Throat, nasal, rectal, sputum and urine samples were taken on admission and at weekly intervals and screened for P. aeruginosa. All antibiotic treatments were recorded daily. Environmental analysis included weekly tap water specimen culture and presence of other patients colonized with P. aeruginosa. RESULTS: One-hundred and twenty-six patients were included, comprising 1345 patient-days. Antibiotics were given to 106 patients (antibiotic selective pressure for P. aeruginosa in 39). P. aeruginosa was acquired by 20 patients (16%) and was isolated from 164/536 environmental samples (31%). Two conditions were independently associated with P. aeruginosa acquisition by multivariate analysis: (i) patients receiving [greater than or equal to]3 days of antibiotic selective pressure together with at least one colonized patient on the same ward on the previous day (OR=10.3 [95%CI: 1.8-57.4]; P=0.01); and (ii) presence of an invasive device (OR=7.7 [95%CI: 2.3-25.7]; P=0.001). CONCLUSIONS: Specific interaction between both patient colonization pressure and selective antibiotic pressure is the most relevant factor for P. aeruginosa acquisition on an ICU. This suggests that combined efforts are needed against both factors to decrease colonization with P. aeruginosa

Le point de vue des adolescents sur leur relation avec le médecin généraliste

Selon les adolescents, le médecin généraliste n'est pas leur interlocuteur privilégié pour leur problème de mal-être, principalement parce qu'ils considèrent que ce n est pas le rôle du médecin généraliste de s'occuper de ces troubles. Ils le cantonnent à soigner les pathologies organiques. De plus, il existe une méconnaissance de leur droit à des soins confidentiels même en tant que mineur, associée à une ambiguïté entre secret médical et confidentialité face à l autorité parentale. Certains facteurs favorisent le dialogue entre l adolescent et son médecin traitant, et d autres n interfèrent pas dans cette relation : le sexe du médecin, notamment par rapport à celui de l adolescent, l ancienneté du suivi par un même médecin. Les facteurs favorisants le dialogue sont :- le sexe de l adolescent : les filles arrivent plus facilement à se confier à leur médecin. - le fait de tutoyer l adolescent semble être préféré au vouvoiement - s appuyer sur la famille car d une part, c est un des interlocuteurs privilégiés des adolescents, et d autre part, cela permet de comprendre le fonctionnement des relations familiales ; ainsi, les parents sont invités à être présents une partie de la consultation. - informer les adolescents de leur droit à des soins confidentiels, et par conséquent, préserver un temps de consultation avec l adolescent seul. - évoquer un symptôme lié à la somatisation permet d introduire la notion d autres problèmes de l adolescence au sens large. - provoquer la question, ne pas attendre que l adolescent évoque de lui-même un souci ; au moindre doute, ne pas hésiter à utiliser des tests de dépistage tel que le TSTS. - la fréquence des consultations : plus l adolescent est vu régulièrement, plus il a de chances de se confier ; ainsi, il est conseillé de reprogrammer un rendez-vous systématiquement en fonction du besoin. - un regard neuf et neutre permettrait d'instaurer un dialogue plus facilement (par exemple en consultant un autre médecin).NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

J Infect

Background In France about 32% of hospitalized patients have a vascular access placement. However, a common complication associated with these is catheter-related bloodstream infection (CRBI) due to the introduction of microorganisms from the skin during catheter insertion. There is no consensus on the best way to clean the skin prior to catheter insertion, which could be a key element of CRBI prevention. The two techniques most commonly used to apply antiseptic to the skin are the concentric circle and back-and-forth techniques, but these have not been compared in clinical trials. Hence, this study conducted this comparison. Methods This single-center, non-comparative, randomized, matched pilot study investigated the levels of cutaneous microorganisms before and after antiseptic application using both techniques in a population of healthy French volunteers. The two application methods were used on each participant's arms at the elbow fold, with randomization for the application side (right or left). Quantification of cutaneous microorganisms was performed in a blinded manner with regard to the technique used. Findings From April 8 to July 17, 2019, 132 healthy volunteers participated in the study. For the whole study population, the mean initial colonization level was 2.68 log10 colony forming units (CFU)/mL (SD 0.82) before the back-and-forth technique, and 2.66 log10 CFU/mL (SD 0.85) before the concentric circle technique. The mean differences in number of microorganisms between the initial sample and the final sample were 2.45 log10 CFU/mL (95% CI: 2.29 to 2.61) for the back-and-forth technique and 2.43 log10 CFU/mL (95% CI: 2.27 to 2.59) for the concentric circle technique. The mean difference in reduction in microorganisms between the back-and-forth technique and the concentric circle technique was 0.02 log10 CFU/mL (95% CI: –0.11 to 0.15). Interpretation There was no clinically difference in reduction of microorganisms between the concentric circle and back-and-forth techniques at the bend of the healthy volunteer's elbow, after the 30 s of drying of the antiseptic. These findings have a significant impact on time required to achieve antiseptic application before catheter insertion because there is yet no argument to justify application for 30 s, because a single concentric circle pass was much faster with similar results. Future studies should investigate the impact of skin application technique on the prevention of infectious risk associated with catheter insertion on admission to health care facilities (conventional, outpatient, or emergency) and throughout the period of stay in a health care facility