Do Triclosan Sutures Modify the Microbial Diversity of Surgical Site Infections? A Systematic Review and Meta-Analysis

Randomised controlled clinical trials (RCTs) report a lower incidence rate of surgical site infections (SSIs) with triclosan sutures (TSs) compared with non-triclosan sutures (NTSs). Do triclosan sutures modify the microbial diversity of culture-confirmed SSIs (ccSSIs)? If so, this would support the association between TS antimicrobial activity and the SSI incidence rate. This prospective systematic literature review (PROSPERO CRD42019125099) was conducted according to PRISMA. RCTs that compared the incidence of SSIs with TSs and NTSs and reported microbial counts from SSI cultures per suture group were eligible. The microbial species were grouped by genus, and the association between genera and sutures was tested. The pooled relative risk (RR) of ccSSIs was also calculated. Twelve RCTs were eligible. No publication bias was identified. The microorganism count was 180 in 124 SSIs with TSs versus 246 in 199 SSIs with NTSs. No significant difference in microbial diversity was found, but statistical power was low for test results to support or challenge the association between the antimicrobial activity of TSs and the reduced rate of SSIs. The RR of the ccSSIs was significant and consistent with comprehensive meta-analyses. The certainty of the pooled RR was moderate

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

Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia

<p>Abstract</p> <p>Background</p> <p>Patients with <it>Enterobacter </it>community-acquired pneumonia (EnCAP) were admitted to our intensive care unit (ICU). Our primary aim was to describe them as few data are available on EnCAP. A comparison with CAP due to common and typical bacteria was performed.</p> <p>Methods</p> <p>Baseline clinical, biological and radiographic characteristics, criteria for health-care-associated pneumonia (HCAP) were compared between each case of EnCAP and thirty age-matched typical CAP cases. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with ENCAP. Their outcome was also compared.</p> <p>Results</p> <p>In comparison with CAP due to common bacteria, a lower leukocytosis and constant HCAP criteria were associated with EnCAP. Empiric antibiotic therapy was less effective in EnCAP (20%) than in typical CAP (97%) (p < 0.01). A delay in the initiation of appropriate antibiotic therapy (3.3 ± 1.6 vs. 1.2 ± 0.6 days; p < 0.01) and an increase in duration of mechanical ventilation (8.4 ± 5.2 vs. 4.0 ± 4.3 days; p = 0.01) and ICU stay were observed in EnCAP patients.</p> <p>Conclusions</p> <p>EnCAP is a severe infection which is more consistent with HCAP than with typical CAP. This retrospectively suggests that the application of HCAP guidelines should have improved EnCAP management.</p

How to measure hospital antibiotic consumption: comparison of two methods from data surveillance in France

BACKGROUND: Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. OBJECTIVES: To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. METHODS: The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman's correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. RESULTS: A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. CONCLUSIONS: Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement

Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs), medical and surgical wards between 2009 and 2013

Danish Integrated Antimicrobial Resistance Monitoring and Research Program

This program has led to changes in the use of antimicrobial agents in Denmark and other countries

Pseudomonas aeruginosa en réanimation (épidémiologie et facteurs de risque d'acquisition)

Malgré les avancées en matière de prévention, Pseudomonas aeruginosa reste un pathogène fréquent et délétère en réanimation. Des facteurs de risque d acquisition de ce micro-organisme ont déjà pu être identifiés, mais jamais dans un contexte multicentrique et rarement en ajustant sur des caractéristiques du service. Si l analyse de la littérature était jusqu alors en faveur d une forte origine individuelle, la part du contexte d hospitalisation et des caractéristiques de la réanimation paraît de moins en moins négligeable. Notre travail a permis non seulement de faire un état des lieux concernant les connaissances actuelles sur Pseudomonas aeruginosa en réanimation mais également d identifier des profils type de patients et services de réanimation plus à risque vis à vis de ce micro-organisme. L intérêt majeur est non seulement de pouvoir ainsi orienter les cliniciens face à une conjonction d éléments mais surtout, là où les facteurs patients restent souvent peu modifiables, d identifier des éléments contextuels d acquisition sur lesquels il serait possible d agir afin de réduire le risque infectieux.Despite major advance in techniques and reinforcement of infection control measures, Pseudomonas aeruginosa remains frequent in intensive care unit (ICU) and is responsible for severe hospital-acquired infections. Several patient and pathogen-specific risk factors have been associated with acquisition of P. aeruginosa in ICUs Nevertheless those risk factors were identified in monocentric studies which rarely took in account the context of cares. If individual risk factors for P. aeruginosa acquisition have appeared to be predominant since then, the role of contextual variables seems to have been underestimated. This thesis provides insight into the epidemiology of P. aeruginosa in ICU, identifies individual and contextual risk factors for P. aeruginosa infection and P. aeruginosa acquisition and emphasizes the interest of contextual variables which gives new perspectives to P. aeruginosa prevention.BORDEAUX2-Bib. électronique (335229905) / SudocSudocFranceF

La visite de risque appliquée à l'hygiène hospitalière (évaluer le risque infectieux autrement)

LIMOGES-BU Médecine pharmacie (870852108) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Déterminants de la consommation des antibiotiques et de la résistance de Staphylococcus Aureus à la méticiline dans les établissements de santé

En France, les établissements de santé ont été incités à surveiller leurs consommations des antibiotiques et leurs résistances bactériennes. Nos objectifs étaient d'étudier les déterminants de la consommation des antibiotiques et de la résistance de Staphylococcus aureus à la méticilline (SARM) dans 99 établissements de santé de l'interrégion Sud-Ouest afin de préciser les modalités d'interprétation des données et d'étudier les liens existants avec les politiques mises en place. Au delà de la typologie habituellement utilisée d'autres critères d'ajustement doivent être pris en compte pour une comparaison inter établissements. Les politiques de bon usage des antibiotiques et de lutte contre les infections nosocomiales étaient associées à une plus forte consommation d'antibiotiques et à une incidence plus élevée de SARM. L'incidence de SARM était corrélée à la consommation des fluoroquinolones mais la méthode ne permettait pas de préjuger d'une relation de causalité. L'analyse des données agrégées peut aider à l'interprétation des variations observées pour une comparaison des indicateurs dans les établissements de santé.Due to the high resistance rate and excessive use of antibiotics, French government has recommended that hospitals should monitor antibiotics consumption and incidence of methicillin-resistant Staphylococcus aureus (MRSA). Our aim was to determine factors that correlate with antibiotics use and Staphylococcus aureus resistance among 99 hospitals in south western France and to study relationship between these two indicators and policies developed by hospitals. Hospital type and hospitals areas stratification seems to be not enough homogenous to make valid comparisons. Number of beds could be used to explain difference when indicator of case mix is not available. Antibiotics policies and infection control program were associated with high consumption and high resistance rates. Fluoroquinolone use correlated with MRSA incidence but the relationships between antibiotic use and MRSA are complex and aggregated data do not prove causality link. However, such aggregated data may be helpful for comparison purpose.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF