Povidone iodine: properties, mechanisms of action and role in infection control and staphylococcus aureus decolonization

Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an Expert's workshop on resistance and MRSA decolonization. When compared to chlorhexidine and mupirocin, respectively, PVP-I 10% and 7.5% solution had rapid and superior bactericidal activity against MRSA in in vitro and ex vivo studies. Notably, PVP-I 10% and 5% solutions were also active against both chlorhexidine-resistant and mupirocin-resistant strains, respectively. Unlike chlorhexidine and mupirocin, available reports have not observed a link between PVP-I and the induction of bacterial resistance or cross-resistance to antiseptics and antibiotics. These pre-clinical findings also translate into clinical decolonization, where intranasal PVP-I significantly improved the efficacy of chlorhexidine wash and was as effective as mupirocin in reducing surgical site infection (SSI) in orthopedic surgery. Overall, these qualities of PVP-I make it a useful alternative decolonizing agent for the prevention of S. aureus infections, but additional experimental and clinical data are required to further evaluate the use of PVP-I in this setting

Experimenting cross-disciplinary cooperation by an experimental One Health degree program around the triad Animal-Man-Food

Magras Catherine, Diguet Anne-Laure, Lepelletier Didier, Eveillard Mathieu, Couvreur Sébastien, Ruvoen-Clouet Nathalie, Krempf Michel. L’Idefi Man-Imal : une formation One-Health de la pluri- à l’interdisciplinarité. In: Bulletin de l'Académie Vétérinaire de France tome 171 n°2, 2018. pp. 100-102

Empiric antimicrobial therapy for ventilator-associated pneumonia after brain injury

International audienceIssues regarding recommendations on empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) have emerged in specific populations.To develop and validate a score to guide empiric therapy in brain-injured patients with VAP, we prospectively followed a cohort of 379 brain-injured patients in five intensive care units. The score was externally validated in an independent cohort of 252 brain-injured patients and its extrapolation was tested in 221 burn patients.The multivariate analysis for predicting resistance (incidence 16.4%) showed two independent factors: preceding antimicrobial therapy ≥48 h (p\textless0.001) and VAP onset ≥10 days (p\textless0.001); the area under the receiver operating characteristic curve (AUC) was 0.822 (95% CI 0.770-0.883) in the learning cohort and 0.805 (95% CI 0.732-0.877) in the validation cohort. The score built from the factors selected in multivariate analysis predicted resistance with a sensitivity of 83%, a specificity of 71%, a positive predictive value of 37% and a negative predictive value of 96% in the validation cohort. The AUC of the multivariate analysis was poor in burn patients (0.671, 95% CI 0.596-0.751).Limited-spectrum empirical antimicrobial therapy has low risk of failure in brain-injured patients presenting with VAP before day 10 and when prior antimicrobial therapy lasts \textless48 

Electronic Sensors for Assessing Interactions between Healthcare Workers and Patients under Airborne Precautions

International audienceBackground: Direct observation has been widely used to assess interactions between healthcare workers (HCWs) and patients but is time-consuming and feasible only over short periods. We used a Radio Frequency Identification Device (RFID) system to automatically measure HCW-patient interactions. Methods: We equipped 50 patient rooms with fixed sensors and 111 HCW volunteers with mobile sensors in two clinical wards of two hospitals. For 3 months, we recorded all interactions between HCWs and 54 patients under airborne precautions for suspected (n=40) or confirmed (n=14) tuberculosis. Number and duration of HCW entries into patient rooms were collected daily. Concomitantly, we directly observed room entries and interviewed HCWs to evaluate their self- perception of the number and duration of contacts with tuberculosis patients. Results: After signal reconstruction, 5490 interactions were recorded between 82 HCWs and 54 tuberculosis patients during 404 days of airborne isolation. Median (interquartile range) interaction duration was 2.1 (0.8-4.4) min overall, 2.3 (0.8-5.0) in the mornings, 1.8 (0.8-3.7) in the afternoons, and 2.0 (0.7-4.3) at night (P,1024). Number of interactions/day/HCW was 3.0 (1.0-6.0) and total daily duration was 7.6 (2.4-22.5) min. Durations estimated from 28 direct observations and 26 interviews were not significantly different from those recorded by the network. Conclusions: The RFID was well accepted by HCWs. This original technique holds promise for accurately and continuously measuring interactions between HCWs and patients, as a less resource-consuming substitute for direct observation. The results could be used to model the transmission of significant pathogens. HCW perceptions of interactions with patients accurately reflected reality

Social representations of mask wearing in the general population during the COVID-19 pandemic

IntroductionAlthough one of the most prominent interventions against COVID-19, face masks seem poorly adopted by the general population. A growing body of literature has found that using face masks has social meaning. This qualitative study assessed the perceptions, representations and practices of mask wearing in the general population.MethodsA qualitative survey by short semi-structured walking interviews was carried out from April to December 2021 in 11 cities in France's Pays de la Loire region. Study locations were selected for their varied geographical, social, and economic characteristics, with urbanized and rural areas. Four domains linked to perceptions of masks and wearing them were explored: (i) evolution in mask wearing, (ii) decision-making methods for wearing and not wearing; (iii) incorporating the mask into way of life; (iv) projecting into the future.ResultsA total of 116 people were interviewed. Masks marked a shift from the ordinary world to the pandemic. Overall, interviewees considered masks an obstacle to breathing, communication, and social interactions, leading to establishing strategies circumventing the mask mandate. Poor attention was paid to their medical usefulness as an obligatory clothing accessory. Mask-wearing decisions were driven by social relations, common sense, and vulnerability. The greater the feeling of security (i.e., being with close relatives), the less it was worn or worn properly, with decreased attention to others and their health. Most participants did not remember learning to wear a mask. Some were convinced that mask-wearing could not be learned (experiential knowledge). Institutions (school and work) played a central role by facilitating incorporation of masks into daily life.ConclusionsThis study emphasizes the need to reinforce the individual medical values of face masks to prevent COVID-19. Ambitious education and training programmes should be planned to learn how and when to wear masks. Institutions (work and school) may be critical for this purpose

Agreement among Health Care Professionals in Diagnosing Case Vignette-Based Surgical Site Infections

OBJECTIVE: To assess agreement in diagnosing surgical site infection (SSI) among healthcare professionals involved in SSI surveillance. METHODS: Case-vignette study done in 2009 in 140 healthcare professionals from seven specialties (20 in each specialty, Anesthesiologists, Surgeons, Public health specialists, Infection control physicians, Infection control nurses, Infectious diseases specialists, Microbiologists) in 29 University and 36 non-University hospitals in France. We developed 40 case-vignettes based on cardiac and gastrointestinal surgery patients with suspected SSI. Each participant scored six randomly assigned case-vignettes before and after reading the SSI definition on an online secure relational database. The intraclass correlation coefficient (ICC) was used to assess agreement regarding SSI diagnosis on a seven-point Likert scale and the kappa coefficient to assess agreement for superficial or deep SSI on a three-point scale. RESULTS: Based on a consensus, SSI was present in 21 of 40 vignettes (52.5%). Intraspecialty agreement for SSI diagnosis ranged across specialties from 0.15 (95% confidence interval, 0.00-0.59) (anesthesiologists and infection control nurses) to 0.73 (0.32-0.90) (infectious diseases specialists). Reading the SSI definition improved agreement in the specialties with poor initial agreement. Intraspecialty agreement for superficial or deep SSI ranged from 0.10 (-0.19-0.38) to 0.54 (0.25-0.83) (surgeons) and increased after reading the SSI definition only among the infection control nurses from 0.10 (-0.19-0.38) to 0.41 (-0.09-0.72). Interspecialty agreement for SSI diagnosis was 0.36 (0.22-0.54) and increased to 0.47 (0.31-0.64) after reading the SSI definition. CONCLUSION: Among healthcare professionals evaluating case-vignettes for possible surgical site infection, there was large disagreement in diagnosis that varied both between and within specialties

Notes for genera: basal clades of Fungi (including Aphelidiomycota, Basidiobolomycota, Blastocladiomycota, Calcarisporiellomycota, Caulochytriomycota, Chytridiomycota, Entomophthoromycota, Glomeromycota, Kickxellomycota, Monoblepharomycota, Mortierellomycota, Mucoromycota, Neocallimastigomycota, Olpidiomycota, Rozellomycota and Zoopagomycota)

Compared to the higher fungi (Dikarya), taxonomic and evolutionary studies on the basal clades of fungi are fewer in number. Thus, the generic boundaries and higher ranks in the basal clades of fungi are poorly known. Recent DNA based taxonomic studies have provided reliable and accurate information. It is therefore necessary to compile all available information since basal clades genera lack updated checklists or outlines. Recently, Tedersoo et al. (MycoKeys 13:1--20, 2016) accepted Aphelidiomycota and Rozellomycota in Fungal clade. Thus, we regard both these phyla as members in Kingdom Fungi. We accept 16 phyla in basal clades viz. Aphelidiomycota, Basidiobolomycota, Blastocladiomycota, Calcarisporiellomycota, Caulochytriomycota, Chytridiomycota, Entomophthoromycota, Glomeromycota, Kickxellomycota, Monoblepharomycota, Mortierellomycota, Mucoromycota, Neocallimastigomycota, Olpidiomycota, Rozellomycota and Zoopagomycota. Thus, 611 genera in 153 families, 43 orders and 18 classes are provided with details of classification, synonyms, life modes, distribution, recent literature and genomic data. Moreover, Catenariaceae Couch is proposed to be conserved, Cladochytriales Mozl.-Standr. is emended and the family Nephridiophagaceae is introduced

Facteurs de risque de pneumopathies nosocomiales acquises sous ventilation mécanique chez le traumatisé crânien

La pneumopathie acquise sous ventilation représente l'infection la plus fréquente en réanimation. Sa prévalence chez le traumatisé crânien est très élevée. Le but de notre étude a été de rechercher des facteurs de risque de pneumopathie spécifiques chez le traumatisé crânien. Cent soixante deux traumatisés crâniens ventilés plus de 48 heures, admis dans le service de réanimation chirurgicale entre 01/2000 et 12/2002, ont été inclus rétrospectivement dans cette étude. Les données anamnestiques, cliniques, thérapeutiques et microbiologiques ont été collectées. Les patients ont été répartis en deux groupes selon la survenue (n=66) ou non d'une pneumopathie nosocomiale (n=96). Les patients ayant présenté plusieurs pneumopathies ont été analysés en tant que " cas " à chaque épisode de pneumopathie. Parmi les 66 patients ayant présenté une pneumopathie, 9 ont présenté deux pneumopathies et 1 patient a présenté trois pneumopathies, soit 77 cas. Les deux groupes ont été comparés en analyse univariée ( tests de Chi-2 ou exact de Fischer pour les variables binaires et par ANOVA ou test de Mann-Whitney pour les variables continues ; p<0,05), puis dans un modèle de régression logistique standard pour les variables avec p<0,1. Résultats : Les variables suivantes sont associées à la survenue d'une pneumopathie acquise sous ventilation : sédation (p<10'5), durée de ventilation mécanique (p<10'6), barbiturique (p<0,005), monitorage de la pression intracrânienne (p<0,001) et la sinusite (p<0,02). L'administration d'anti- ulcéreux (p<0,0005) et la chirurgie de type orthopédique (p<0,01) apparaissent comme des facteurs protecteurs en analyse univariée. Après régression logistique, le seul facteur de risque indépendant de pneumopathie acquise sous ventilation, notamment tardive, est la durée de ventilation mécanique alors que l'administration d'anti-ulcéreux est un facteur protecteur indépendant. La chirurgie avant l'admission apparaît comme un facteur protecteur de pneumopathie précoce, probablement lié en partie à l'antibioprophylaxie.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Détection des bactéries multi- et hautement résistantes aux antibiotiques chez des patients aux antécédents récents de voyages à l'étranger

TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

Phlegmons péri-amygdaliens chez l'adulte (épidémiologie de 34 observations nantaises)

Objectifs : Recenser les phlegmons péri-amygdaliens (PPA) pris en charge en ORL au CHU de Nantes et objectiver une réémergence de cette pathologie; analyser leurs caractéristiques épidémiologiques ; proposer une conduite à tenir; introduire un Projet Hospitalier de Recherche Clinique (PHRC) dont le titre est Impact des anti-inflammatoires et de l antibiothérapie sur l émergence des abcès péri-amygdaliens . Nature : Etude rétrospective monocentrique incluant les adultes de plus de 15 ans et trois mois, hospitalisés en ORL et aux urgences au CHU de Nantes entre les mois de décembre 2005 et 2006 pour PPA. Résultats : Nous avons recensé 34 patients, confirmant l impression de réémergence des PPA en France. La conduite à tenir proposée consiste à admettre prioritairement les patients en ORL, à réaliser une numération sanguine et un bilan de coagulation, à évacuer la collection par ponction-aspiration ou incision-drainage, et à associer une antibiothérapie de 10 jours par amoxycilline + acide clavulanique à la dose de 3 g/j, par voie veineuse avec relais oral ; en cas d antécédent de PPA ou d angines répétées, une amygdalectomie à chaud peut être proposée. Par ailleurs, la prise en charge des angines en ambulatoire ne semblent pas toujours adaptée, malgré la généralisation des tests de diagnostic rapide (TDR) et la parution de recommandations. De plus, 87% des patients avaient pris des AINS avant le diagnostic de PPA. Le PHRC a pour but de rechercher un lien entre la prise d AINS et la survenue de PPA, parallèlement à la réduction de prescription d antibiotiques dans les angines en France depuis l utilisation des TDR.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF