Changement de pratiques au CHU Ste-Justine (Montréal) : mise en place des perfusions rapides de rituximab dans une population pédiatrique

Le Centre Hospitalier Universitaire Ste-Justine est un hôpital mère-enfant de 550 lits à Montréal. Le rituximab y est utilisé de façon croissante dans diverses indications d oncologie et d immunologie. Les temps de perfusion de cet anticorps recommandés par le fabricant font peser une lourde contrainte sur les soignants et les patients. Pour y faire face, il a été décidé d implanter les perfusions rapides de rituximab à Ste-Justine. Nous avons procédé à une revue bibliographique des perfusions rapides de rituximab. Nous l avons complétée par une étude rétrospective de l utilisation du rituximab dans notre institution. Cette étude se penchait en particulier sur les réactions à la perfusion, effet indésirable redouté dans ce changement de pratiques. Soixante-huit patients ont été recrutés, et 43 réactions à la perfusion constatées chez 30 d entre eux. Ces réactions étaient peu graves, et facilement prises en charge. Elles survenaient pour 88,4% d entre elles lors d une première dose. Nous avons démontré la possibilité d appliquer un protocole de perfusions rapides de rituximab chez une population pédiatrique, à l image de ce qui se pratique chez l adulte. Les perfusions suivantes, à compter d une première perfusion tolérée, se déroulaient sur 90 minutes. Ce protocole s est révélé applicable à une majorité de la population pédiatrique traitée par cet anticorps à Ste-Justine (68,0%). Le traitement de 17 patients pour un total de 37 perfusions rapides a montré une bonne tolérance, avec 2,7% de réactions à la perfusion. Ce changement de pratiques a permis des gains de temps substantiels dans notre centre tout en maintenant une utilisation sécuritaire du rituximab.The University Hospital Ste-Justine is a 550 beds mother-children hospital in Montréal. Rituximab is prescribed in a growing number of indications in oncology and immunology in this hospital. The infusion rates recommended by the manufacturer for this antibody put a heavy strain on hospital resources and patient comfort. To answer this issue, it was decided to implement a rapid-infusion of rituximab protocol in Ste-Justine. We reviewed the literature on rapid-infusion of rituximab. We completed this review with a retrospective study on the use of rituximab at Ste-Justine Hospital. We focused on infusion-related reactions, which is the main side-effect feared with that change of practice. Sixty-eight patients were recruited, 43 infusion-related reactions analyzed in 30 of them. These reactions were benign and easily manageable. They mainly occured on first infusion (88,4%). We proved the feasibility of implementing a rapid infusion protocol in a pediatric population. The subsequent infusions, after a well tolerated first infusion, were administered over 90 minutes. We could include a majority of patients in this protocol (68,0%). A total of 37 infusions administered to 17 patients showed a good tolerance, with 2.7% of infusion-related reactions. Substantial savings of time were made with that change of practice while maintaining security of use of rituximab.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Rapid Infusion of Rituximab in a Heterogenous Pediatric Population

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Is cohorting the only solution to control carbapenemase-producing Enterobacteriaceae outbreaks? A single-centre experience

International audienceBACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are a major health issue. Cohorting may help to control spread of CPEs in hospitals, but is expensive and hard to implement.AIM: To identify ward variables associated with CPE in-hospital transmission in a hospital where cohorting has never been implemented.METHODS: Cohort prospective study, comparing 14-consecutive-day periods regarding in-hospital transmission. Each period met the two following conditions: (i) CPE carriers/infected admitted for ≥48&nbsp;h; (ii) 80% of relative contact patients were screened at least twice. Periods (a) with no acquired CPE case among relative contact patients were compared to periods (b) during which one or more CPE case acquisition was identified. Variables potentially associated with CPE transmission were assessed: colonization pressure, caregiver:patient ratio, hand hygiene compliance, hydro-alcoholic product consumption, antibiotic consumption, and infection control team (ICT) involvement on the ward.FINDINGS: Sixty-eight periods of two consecutive weeks were included, 18 (26.5%) included at least one CPE case acquisition. By multivariate analysis, colonization pressure (odds ratio: 1.12; 95% confidence interval: 1.0-1.25; P&nbsp;=&nbsp;0.042) and antibiotic consumption (2.41; 1.02-5.66; P&nbsp;=&nbsp;0.044) were associated with CPE in-hospital transmission. Caregiver:patient ratio potentiated both these variables, suggesting a role for understaffing in CPE transmission.CONCLUSION: Understanding ward variables associated with CPE spread can help design suitable solutions. Colonization pressure and antibiotic consumption seems to be driving in-hospital transmission, along with caregiver:patient ratio. In presence of high colonization pressure, dedicated healthcare workers for managing CPE patients should be implemented. Co-ordination between ICT and antimicrobial stewardship team is also crucial to prevent CPE spread.</p

Extended-spectrum β-lactamase Enterobacteriaceae (ESBLE) in intensive care units: strong correlation with the ESBLE colonization pressure in patients but not same species

International audienceSink drains (SD) of six intensive care units (ICUs) were sampled for screening contamination with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE). A high prevalence (59.4%) of SD contamination was observed. Analyzing the data by ICU, the ratio "number of ESBLE species isolated in SD/total number of SD sampled" was strongly correlated (Spearman coefficient, 0.87; P = .02) with the ratio "number of hospitalization days for patients with ESBLE carriage identified within the preceding year/total number of hospitalization days within the preceding year". Concurrently, the distribution of ESBLE species was strongly different between patients and SD

High prevalence of contamination of sink drains with carbapenemase-producing Enterobacteriaceae in 4 intensive care units apart from any epidemic context

International audienceWe report a high prevalence (28%) of sink drains contaminated with carbapenemase-producing Enterobac-teriaceae (CPE) in 4 intensive care units with a history of CPE carriage in hospitalized patients within the previous 5 years, but apart from any current epidemic context. Carbapenemase genes, particularly bla VIM and bla NDM , were identified by polymerase chain reaction in sink drains in which no CPE was detected, but very few data are available in the literature concerning their presence in sink drains

Association between COVID-19 infection and work exposure assessed by the Mat-O-Covid job exposure matrix in the CONSTANCES cohort

International audienceObjectives The COVID-19 pandemic has brought to light a new occupational health threat. We aimed to evaluate the association between COVID-19 infection and work exposure to SARS-CoV-2 assessed by a job-exposure matrix (JEM), in a large population cohort. We also estimated the population-attributable fraction among exposed subjects. Methods We used the SAPRIS-SERO sample of the CONSTANCES cohort, limited to subjects actively working, and with a job code available and a questionnaire on extra work activities. The following outcomes were assessed: COVID-19 diagnosis was made by a physician; a seropositivity to the ELISA-S test (‘serology strict’) and ELISA-S test intermediate with positive ELISA-NP or a positive neutralising antibodies SN (‘serology large’). Job exposure was assessed using Mat-O-Covid, an expert-based JEM with an Index used as a continuous variable and a threshold at 13/1000. Results The sample included 18 999 subjects with 389 different jobs, 47.7% were men with a mean age of 46.2 years (±9.2 years). The Mat-O-Covid index taken as a continuous variable or with a threshold greater than 13/1000 was associated with all the outcomes in bivariable and multivariable logistic models. ORs were between 1.30 and 1.58, and proportion of COVID-19 attributable to work among exposed participants was between 20% and 40%. Discussion Using the Mat-O-Covid JEM applied to a large population, we found a significant association between work exposure to SARS-CoV-2 and COVID-19 infection, though the estimation of attributable fraction among exposed people remained low to moderate. Further studies during other exposed periods and with other methods are necessary

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