Variabilité régionale de l’incidence des bactéries multirésistantes aux antibiotiques (BMR) En France : réseau de surveillance BMR-Raisin

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Ongoing increasing temporal and geographical trends of the incidence of extended-spectrum beta-lactamase-producing Enterobacteriaceae infections in France, 2009 to 2013.

International audienceExtended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are a major focus of multidrug-resistant organisms (MRO) surveillance programmes in France. To describe the temporal and geographical trends of these pathogens, we conducted an epidemiological study based on data extracted from the nationwide MRO surveillance network from 2009 to 2013. During this time, the incidence of ESBL-E infections in French hospitals increased by 73%, from 0.35 to 0.60 per 1,000 patient days (PD) (p<0.001) and ESBL-E bacteraemia by 77%, from 0.03 to 0.05 per 1,000 PD (p<0.001). The incidence of ESBL-E infections was higher in intensive-care units (1.62 to 2.44 per 1,000 PD (p<0.001)) than in recovery and long-term care facilities (0.20 to 0.31 per 1,000 PD (p<0.001)). Escherichia coli was the most frequent extended-spectrum beta-lactamase-producing (ESBL) pathogen, representing 59% (26,238/44,425) of all ESBL isolates, followed by Klebsiella pneumoniae (20%; 8,856/44,425) in 2013. The most frequent infection was urinary tract infection, for all species. The incidence of ESBL-E varied by region but showed an upward trend overall. Reinforcement of control measures for halting the spread of such MRO is crucial

Outbreaks of health care-associated influenza-like illness in France: Impact of electronic notification

International audienceBACKGROUND: Mandatory notification of health care-associated (HA) infections, including influenza-like illness (ILI) outbreaks, has been implemented in France since 2001. In 2012, the system moved to online electronic notification of HA infections (e-SIN). The objectives of this study are to describe ILI outbreak notifications to Santé publique France (SPF), the French national public health agency, and to evaluate the impact of notification dematerialization. METHODS: All notifications of HA ILI outbreaks between July 2001 and June 2015 were included. Notifications before and after e-SIN implementation were compared regarding notification delay and information exhaustiveness. RESULTS: Overall, 506 HA ILI outbreaks were reported, accounting for 7,861 patients and health care professionals. Median delay between occurrence of the first case and notification was, respectively, 32 and 13 days before and after e-SIN utilization (P \textless .001). Information exhaustiveness was improved by electronic notification regarding HA status (8.5% of missing data before and 2.3% after e-SIN, P = .003), hypotheses of cause (25.4% of missing data before vs 8.0% after e-SIN, P \textless .001), and level of event control (23.7% of missing data before vs 7.5% after e-SIN, P \textless .001). CONCLUSIONS: HA influenza notifications, including HA ILI or influenza, to health authorities are essential to guide decisional instances and health care practices. Electronic notifications have improved the timeliness and quality of information transmitted

Incidence of urinary tract infections and antibiotic resistance in the outpatient setting: a cross-sectional study

International audiencePurposeIn 2012–2013, a cross-sectional survey was conducted in women visiting a general practitioner for urinary tract infection (UTI), to estimate the annual incidence of UTIs due to antibiotic-resistant Escherichia coli (E. coli).MethodsA sampling design (stratification, stages and sampling weights) was taken into account in all analyses. Urine analyses were performed for each woman and centralised in one laboratory.ResultsAmong 538 included women, urine culture confirmed UTI in 75.2 % of cases. E. coli represented 82.8 % of species. Among E. coli, resistance (I + R) was most common to amoxicillin [38 % (95 % confidence interval 31.1–44.5)] and to trimethoprim/sulfamethoxazole [18.1 % (12.0–24.1)]. Resistance to ciprofloxacin and cefotaxime was lower [1.9 % in both cases, (0.3–3.5)], as it was for nitrofurantoin [0.4 (0–1.0)] and fosfomycin (0). Extended-spectrum β-lactamase (ESBL) represented 1.6 % of E. coli (0.2–2.9). Annual incidence rate of confirmed UTI was estimated at 2400 per 100,000 women (1800–3000). Incidence rates of UTI due to fluoroquinolone-resistant and ESBL-producing E. coli were estimated at 102 per 100,000 women (75–129) and at 32 (24–41), respectively.ConclusionsESBL had been found in a community population, and even though the rate was low, it represents a warning and confirms that surveillance should continue

Potential exposure to hepatitis C virus through accidental blood contact in interventional radiology.

PURPOSE: To quantify the prevalence of accidental blood exposure (ABE) among interventional radiologists and contrast that with the prevalence of patients with hepatitis C virus (HCV) undergoing interventional radiology procedures. MATERIALS AND METHODS: A multicenter epidemiologic study was conducted in radiology wards in France. The risk of ABE to radiologists was assessed based on personal interviews that determined the frequency and type of ABE and the use of standard protective barriers. Patients who underwent invasive procedures underwent prospective sampling for HCV serologic analysis. HCV viremia was measured in patients who tested positive for HCV. RESULTS: Of the 77 radiologists who participated in 11 interventional radiology wards, 44% reported at least one incident of mucous membrane blood exposure and 52% reported at least one percutaneous injury since the beginning of their occupational activity. Compliance with standard precautions was poor, especially for the use of protective clothes and safety material. Overall, 91 of 944 treated patients (9.7%) tested positive for HCV during the study period, of whom 90.1% had positive viremia results, demonstrating a high potential for contamination through blood contacts. CONCLUSIONS: The probability of HCV transmission from contact with contaminated blood after percutaneous injury ranged from 0.013 to 0.030; the high frequency of accidental blood exposure and high percentage of patients with HCV could generate a risk of exposure to HCV for radiologists who perform invasive procedures with frequent blood contact. The need to reinforce compliance with standard hygiene precautions is becoming crucial for medical and technical personnel working in these wards

Risk factors for resistance in urinary tract infections in women in general practice: A cross-sectional survey

International audienceObjectives : In 2012 and 2013, a cross-sectional survey was conducted in women visiting a general practitioner for a urinary tract infection (UTI) to i) describe the patterns of antibiotic resistance of Enterobacteriaceae involved in community-acquired UTIs and ii) identify the factors associated with UTIs due to a multi-drug-resistant Enterobacteriaceae (MDREB).Methods : Urine analyses were performed systematically for all adult women presenting with signs of UTI. Characteristics of women with UTI due to MDREB were compared to those with UTI due to non-MDREB. Weighted logistic regressions were performed to adjust for the sampling design of the survey.Results : Significant factors associated with MDREB included the use of penicillin by the patient in the last three months (OR = 3.1; [1.2–8.0]); having provided accommodation in the previous 12 months to a resident from a country at high risk for drug resistance (OR = 4.0; [1.2–15.1]); and the consumption of raw meat within the previous three months (OR = 0.3; [0.1–0.9]).Conclusions : In the community, antibiotic use and exposure to a person returning from an area with a high risk of drug resistance are associated with UTIs due to MDREB. The potentially protective role of raw meat consumption warrants further study

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.