Eradication of an outbreak of vancomycin-resistant Enterococcus (VRE): the cost of a failure in the systematic screening

BACKGROUND: Vancomycin-resistant enterococci (VRE) are still a concern in hospital units tending to seriously ill patients. However, the cost-effectiveness of active surveillance program to identify asymptomatically VRE colonized patient remains debatable. This work aims at evaluating the cost of a failure in the active surveillance of VRE that had resulted in an outbreak in a French University Hospital. FINDINGS: A VRE outbreak was triggered by a failure in the systematic VRE screening in a medico-surgical ward specialised in liver transplantation as a patient was not tested for VRE. This failure was likely caused by the reduction of healthcare resource. The outbreak involved 13 patients. Colonized patients were grouped in a dedicated part of the infectious diseases unit and tended by a dedicated staff. Transmission was halted within two months after discovery of the index case. The direct cost of the outbreak was assessed as the cost of staffing, disposable materials, hygiene procedures, and surveillance cultures. The loss of income from spare isolation beds was computed by difference with the same period in the preceding year. Payments were drawn from the hospital database. The direct cost of the outbreak (2008 Euros) was €60 524 and the loss of income reached €110 915. CONCLUSIONS: Despite this failure, the rapid eradication of the VRE outbreak was a consequence of the rapid isolation of colonized patient. Yet, eradicating even a limited outbreak requires substantial efforts and resources. This underlines that special attention has to be paid to strictly adhere to active surveillance program

A case of phage therapy against pandrug-resistant Achromobacter xylosoxidans in a 12-year-old lung-transplanted cystic fibrosis patient

Bacteriophages are a promising therapeutic strategy among cystic fibrosis and lung-transplanted patients, considering the high frequency of colonization/infection caused by pandrug-resistant bacteria. However, little clinical data are available regarding the use of phages for infections with Achromobacter xylosoxidans. A 12-year-old lung-transplanted cystic fibrosis patient received two rounds of phage therapy because of persistent lung infection with pandrug-resistant A. xylosoxidans. Clinical tolerance was perfect, but initial bronchoalveolar lavage (BAL) still grew A. xylosoxidans. The patient's respiratory condition slowly improved and oxygen therapy was stopped. Low-grade airway colonization by A. xylosoxidans persisted for months before samples turned negative. No re-colonisation occurred more than two years after phage therapy was performed and imipenem treatment was stopped. Whole genome sequencing indicated that the eight A. xylosoxidans isolates, collected during phage therapy, belonged to four delineated strains, whereby one had a stop mutation in a gene for a phage receptor. The dynamics of lung colonisation were documented by means of strain-specific qPCRs on different BALs. We report the first case of phage therapy for A. xylosoxidans lung infection in a lung-transplanted patient. The dynamics of airway colonization was more complex than deduced from bacterial culture, involving phage susceptible as well as phage resistant strains

Klebsielle Pneumoniae nosocomial pathogen resistance and virulence

In the first part of our work, following two outbreaks that involved K. pneumoniae producing carbapenemases, we defined a clear strategy that allowed us to control and stop the spread of those strains. Similar measures have been applied successfully in other hospitals in France, Israel and the United States. These two outbreaks, linked to the spread of epidemic clones, led us to study the prevalence of virulence factors among an international collection of multidrug-resistant K. pneumoniae strains. We could establish a link between resistance and virulence with, especially a high prevalence (42%) of a pathogenicity island bearing the yersiniabactin, Ybts, which plays an essential role in the expression of hyper-virulent phenotype of Yersinia sp. In the second part of our work, we showed that strains of K. pneumoniae producing CTX-M-15 type ESBL, are associated with plasmids belonging to incompatibility group IncF whereas plasmids carrying blaSHV genes and carbapenemases, are less well characterized by the PCR method. These results lead to the sequencing of plasmids. We report the complete nucleotide sequence of the first IncX plasmid carrying a blaKPC-2 gene from Klebsiella. It consists of the backbone of the IncX plasmid and carries a region encoding both KPC-2 and SHV-12. The transposon Tn4401 is inserted in a part encoding the blaSHV-12Dans la première partie du travail, suite à deux épidémies à K. pneumoniae productrices de carbapénémases, nous avons défini une stratégie précise qui nous a permis de maîtriser et de stopper la première épidémie et de très rapidement contrôler la seconde. Des mesures similaires ont été appliquées avec succès dans d'autres hôpitaux en France, en Israël et aux USA. Ces deux épidémies étant liées à la diffusion de clone épidémique, nous avons étudié la prévalence des facteurs de virulence parmi une collection internationale de souches de K. pneumoniae multirésistantes aux antibiotiques. Nous avons pu établir un lien entre résistance et virulence avec, en particulier une forte prévalence (42%) d'un îlot de pathogénicité portant la yersiniabactine, Ybts, qui joue essentiel dans l'expression du phénotype hyper-virulent de Yersinia sp. Dans la deuxième partie, nous montrons que les souches de K. pneumoniae productrices de BLSE de type CTX-M-15, sont associées à des plasmides appartenant au groupe d'incompatibilité IncF alors que les plasmides portant les gènes blaSHV et ceux portant les carbapénémases, sont moins bien caractérisés et souvent non typables par la méthode de PCR. Ces résultats incitent au séquençage des plasmides. Nous avons procédé au séquençage et à l'annotation du premier plasmide portant à la fois KPC-2 et SHV-12 isolé d'une souche de K. pneumoniae. Cette analyse nous a permis de mettre en évidence un nouveau groupe d'incompatibilité (IncX) impliqué pour la première fois dans la multirésistance chez K. pneumoniae. Nous avons pu montrer l'insertion du transposon Tn4401 (KPC) au sein du transposon portant la BLSE de type SHV-1

Klebsielle Pneumoniae pathogène nosocomial, résistance et virulence

Dans la première partie du travail, suite à deux épidémies à K. pneumoniae productrices de carbapénémases, nous avons défini une stratégie précise qui nous a permis de maîtriser et de stopper la première épidémie et de très rapidement contrôler la seconde. Des mesures similaires ont été appliquées avec succès dans d autres hôpitaux en France, en Israël et aux USA. Ces deux épidémies étant liées à la diffusion de clone épidémique, nous avons étudié la prévalence des facteurs de virulence parmi une collection internationale de souches de K. pneumoniae multirésistantes aux antibiotiques. Nous avons pu établir un lien entre résistance et virulence avec, en particulier une forte prévalence (42%) d un îlot de pathogénicité portant la yersiniabactine, Ybts, qui joue essentiel dans l expression du phénotype hyper-virulent de Yersinia sp. Dans la deuxième partie, nous montrons que les souches de K. pneumoniae productrices de BLSE de type CTX-M-15, sont associées à des plasmides appartenant au groupe d incompatibilité IncF alors que les plasmides portant les gènes blaSHV et ceux portant les carbapénémases, sont moins bien caractérisés et souvent non typables par la méthode de PCR. Ces résultats incitent au séquençage des plasmides. Nous avons procédé au séquençage et à l annotation du premier plasmide portant à la fois KPC-2 et SHV-12 isolé d une souche de K. pneumoniae. Cette analyse nous a permis de mettre en évidence un nouveau groupe d incompatibilité (IncX) impliqué pour la première fois dans la multirésistance chez K. pneumoniae. Nous avons pu montrer l insertion du transposon Tn4401 (KPC) au sein du transposon portant la BLSE de type SHV-12In the first part of our work, following two outbreaks that involved K. pneumoniae producing carbapenemases, we defined a clear strategy that allowed us to control and stop the spread of those strains. Similar measures have been applied successfully in other hospitals in France, Israel and the United States. These two outbreaks, linked to the spread of epidemic clones, led us to study the prevalence of virulence factors among an international collection of multidrug-resistant K. pneumoniae strains. We could establish a link between resistance and virulence with, especially a high prevalence (42%) of a pathogenicity island bearing the yersiniabactin, Ybts, which plays an essential role in the expression of hyper-virulent phenotype of Yersinia sp. In the second part of our work, we showed that strains of K. pneumoniae producing CTX-M-15 type ESBL, are associated with plasmids belonging to incompatibility group IncF whereas plasmids carrying blaSHV genes and carbapenemases, are less well characterized by the PCR method. These results lead to the sequencing of plasmids. We report the complete nucleotide sequence of the first IncX plasmid carrying a blaKPC-2 gene from Klebsiella. It consists of the backbone of the IncX plasmid and carries a region encoding both KPC-2 and SHV-12. The transposon Tn4401 is inserted in a part encoding the blaSHV-12PARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF

Complete Nucleotide Sequence of the First KPC-2- and SHV-12-Encoding IncX Plasmid, pKpS90, from Klebsiella pneumoniae

International audienceWe report the complete nucleotide sequence of the pKpS90 plasmid, carrying the bla KPC-2 and bla SHV-12 genes. This plasmid was isolated from a sequence type 258 (ST258) Klebsiella pneumoniae strain responsible for an outbreak in a French university hospital in 2009. pKpS90 is a 53,286-bp plasmid that belongs to the IncX incompatibility group. pKpS90 consists of a backbone from IncX plasmids, in which the KPC-2-encoding Tn 4401 transposon and a bla SHV-12 -encoding region have been inserted

No SARS-CoV-2 reinfection among staff health-care workers: Prospective hospital-wide screening during the first and second waves in Paris

International audienceObjectivesRisk of reinfection with SARS-CoV-2 among health-care workers (HCWs) is unknown. We assessed the incidence rate of SARS-CoV-2 reinfection in the real-life setting of a longitudinal observational cohort of HCWs from the Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France, during the first and second waves of COVID-19 epidemic.MethodsFrom March to December 2020, HCWs were subjected to molecular and serology testing of SARS-CoV-2. Reinfection was defined as a positive test result during the first wave, either by serology or PCR, followed by a positive PCR during the second wave. Evolution of COVID-19 status of HWCs was assessed by a Sankey diagram.ResultsA total of 7765 tests (4579 PCR and 3186 serology) were carried out and 4168 HCWs had at least one test result during the follow-up period with a positivity rate of 15.9%. No case of reinfection during the second wave could be observed among 102 positive HCWs of the first wave, nor among 175 HCWs found positive by PCR during the second wave who were negative during the first wave.ConclusionsSARS-CoV-2 reinfection was not observed among HCWs, suggesting a protective immunity against reinfection that lasts at least 8 months post infection

Les mesures de décontamination individuelles divisent par deux le risque d'infection du site opératoire après chirurgie du rachis

International audienceIntroduction: L'incidence des infections du site opératoire (ISO) après chirurgie rachidienne est estimée entre 1 et 10 %. Ces évènements sont responsables d'une augmentation de la morbidité, de la mortalité et des coûts de prise en charge. La décontamination du portage du Staphylococcus aureus (S. aureus) a déjà montré son efficacité dans la prévention d'infection du site opératoire dans de nombreuses disciplines chirurgicales. L'objectif de cette étude était d’évaluer l'intérêt de stratégie de prévention des ISO, et en particulier la décolonisation du portage nasal du SA part un protocole d'application de mupirocine. Matériel et méthodes: Nous avons conduit une étude opérationnelle bicentrique, permettant d’évaluer 5314 patients après chirurgie rachidienne au cours d'une période de sept ans. Dans les deux centres nous avons comparé des périodes avant et après implantation de deux mesures: la modification de l'antibioprophylaxie et la décolonisation du portage du SA. L'homogénéité des différents échantillons de patient a été évaluée par le recueil de caractéristiques chirurgicales et individuelles. L'efficacité a été évaluée par la mesure mensuelle de l'incidence des ISO, permettant de mesurer son évolution après l'implantation de mesures. Résultats: L'incidence des ISO était divisée par 2, de 7,3 % à 3 % à l'hôpital Beaujon est de 8,3 % à 3,9 % à l'hôpital européen Georges Pompidou (HEGP). Nous n'avons observé aucune diminution significative du taux de SA à dans la par désinfection du site opératoire après implantation de mesures. Conclusions: Les mesures de décolonisation du portage du SA doivent être recommandées après chirurgie rachidienne. Elles doivent être intégrées à une réflexion globale d'amélioration de la prise en charge des patients opérés pour améliorer la prévention des infections du site opératoire

Individual decontamination measures reduce by two the incidence of surgical site infections in spinal surgery

International audienceBackground: In spinal surgery, incidence of surgical site infections (SSI) is estimated between 1 and 10%. It results in increased morbidity, mortality and cost of management. Individual Staphylococcus aureus (SA) decolonization has already proved efficiency to prevent those events in various surgical domains. The aim of this study was to evaluate a strategy of prevention of SSI and in particular the decolonization of the nasal carriage of SA by a protocol with Mupirocin application. Methods: We conducted a bicentric observational study on 5314 spinal surgery patients over a seven-year period. In both center, we compared periods before and after implementation of two measures: modification of antibioprophylaxis and staphylococcus decolonization. Homogeneity of the different samples of patients was assessed through measure of individual and surgical variables. We measured monthly incidence of SSI and evaluated its evolution in order to assess efficiency of these interventions. Results: The incidence of SSI decreased by half, from 7.3% to 3% at the Beaujon Hospital and from 8.3% to 3.9% at the Georges-Pompidou European Hospital (GPEH). We do not observe any significant decrease of SA rate in these SSI. Conclusion: We believe that Staphylococcus aureus decolonization should be recommended in spinal surgery, and should be combined with an overall improvement of the quality of care