European intensive care physicians’ experience of infections due to antibiotic-resistant bacteria

Background Antimicrobial resistance (AMR) compromises the treatment of patients with serious infections in intensive care units (ICUs), and intensive care physicians are increasingly facing patients with bacterial infections with limited or no adequate therapeutic options. A survey was conducted to assess the intensive care physicians' perception of the AMR situation in the European Union/European Economic Area (EU/EEA). Methods Between May and July 2017, physicians working in European ICUs were invited to complete an online questionnaire hosted by the European Society of Intensive Care Medicine. The survey included 20 questions on hospital and ICU characteristics, frequency of infections with multidrug-resistant (MDR) bacteria and relevance of AMR in the respondent's ICU, management of antimicrobial treatment as well as the use of last-line antibiotics in the six months preceding the survey. For the analysis of regional differences, EU/EEA countries were grouped into the four sub-regions of Eastern, Northern, Southern and Western Europe. Results Overall, 1062 responses from four European sub-regions were analysed. Infections with MDR bacteria in their ICU were rated as a major problem by 257 (24.2%), moderate problem by 360 (33.9%) and minor problem by 391 (36.8%) respondents. Third-generation cephalosporin-resistant Enterobacteriaceae were the most frequently encountered MDR bacteria followed by, in order of decreasing frequency, meticillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and vancomycin-resistant enterococci. Perception of the relevance of the AMR problem and the frequency of specific MDR bacteria varied by European sub-region. Bacteria resistant to all or almost all available antibiotics were encountered by 132 (12.4%) respondents. Many physicians reported not having access to specific last-line antibiotics. Conclusions The percentage of European ICU physicians perceiving AMR as a substantial problem in their ICU is high with variation by sub-region in line with epidemiological studies. The reports of bacteria resistant to almost all available antibiotics and the limited availability of last-line antibiotics in ICUs in the EU/EEA are of concern

Relevance of a French National Database Dedicated to Infection Prevention and Control (NosoBase®): A Three-Step Quality Evaluation of a Specialized Bibliographic Database

Abstract Objective – NosoBase® is a collection of documentation centres with a national bibliographic database dedicated to infection prevention and control (IPC), with over 20 years of experience in France. As a quality assurance activity, this study was conducted in 2017 with a three-step approach to evaluate the bibliographic database regarding (1) the availability and coverage of citations; (2) the scope and relevance of content; and (3) the quality of the documentation centre services. Methods – The three-step quality approach involved (1) evaluating the availability and coverage of citations in NosoBase® by searching for the bibliographic citations of three systematic reviews on hand hygiene practices, published recently in three different peer-reviewed international journals; (2) evaluating the scope and relevance of content in NosoBase® by searching for all documents from 2015 indexed in NosoBase® under hand hygiene related keywords, and analyzing according to publication language, document type (e.g., legislation, research, or guidelines), and target audience; and 3) evaluating the strengths, weaknesses, and opportunities of the documentation centre services, with interviews involving the librarians. Results – NosoBase® contained 70.8%-80.9% of references directly concerning hand hygiene cited by the three systematic reviews. Of the 200 articles indexed in NosoBase® under hand hygiene related keywords in 2015, 22.5% were French language based, with a significant representation of French non-indexed literature. The analysis of the documentation centre services highlighted future opportunities for growth, building on the strengths of experience and collaborations, to improve marketing and usability, targeting francophone IPC professionals. Conclusion – Specialized bibliographic databases may be useful and time efficient for the retrieval of relevant specialized content. NosoBase® has significant relevance to French and francophone healthcare professionals in its representation of French documentation and healthcare literature not otherwise indexed internationally. NosoBase® needs to highlight its resources and adapt its services to allow easier access to its content

Extrahepatic manifestations of chronic hepatitis C virus infection

International audienceDuring hepatitis C virus (HCV) chronic infection, extrahepatic manifestations are frequent and polymorphous. This article reports on a large cohort of patients with HCV-related autoimmune or lymphoproliferative disorders, from mixed cryoglobulinemia vasculitis to frank lymphomas. The relationship between HCV infection and such immune-related diseases has been formally demonstrated by epidemiological, clinical, immunological and pathological data, and results of therapeutic trials. More recently, other nonliver-related HCV disorders have been reported, including cardiovascular (i.e. stroke, ischemic heart disease), renal, metabolic and central nervous system diseases. For these manifestations, most evidence comes from large epidemiological studies; there is a need for mechanistic studies and therapeutic trials for confirmation. Beyond the risk of developing liver complications, that is, cirrhosis and liver cancer, patients with HCV infection have an increased risk of morbidity and mortality related to nonliver diseases. HCV chronic infection should be analyzed as a systemic disease in which extrahepatic consequences increase the weight of its pathological burden. The need for effective viral eradication measures is underlined

Effect of Standardized Surveillance of Intensive Care Unit-Acquired Infections on Ventilator-Associated Pneumonia Incidence

International audienceIn a multicenter surveillance of intensive care unit (ICU)–acquired infections, adjusted ventilator-associated pneumonia (VAP) incidence diminished by −1.0% per year (95% confidence interval [CI], −1.8 to −0.2; P = .02) in ICUs with continuous surveillance but increased by +16.1% (95% CI, 0.5%–34.1%; P = .04) in the year following surveillance disruption, suggesting a preventive effect of surveillance on VAP

Use of surveillance data to calculate the sample size and the statistical power of randomized clinical trials testing Staphylococcus aureus vaccine efficacy in orthopedic surgery

International audienceBACKGROUND: Patients undergoing primary total hip arthroplasty (THA) would be a worthy population for anti-staphylococcal vaccines. The objective is to assess sample size for significant vaccine efficacy (VE) in a randomized clinical trial (RCT). METHODS: Data from a surveillance network of surgical site infection in France between 2008 and 2011 were used. The outcome was S. aureus SSI (SASSI) within 30 days after surgery. Statistical power was estimated by simulations repeated for theoretical VE ranging from 20% to 100% and for sample sizes from 250 to 8000 individuals per arm. RESULTS: 18,688 patients undergoing THA were included; 66 (0.35%) SASSI occurred. For a 1% SASSI rate, the sample size would be at least 1316 patients per arm to detect significant VE of 80% with 80% power. CONCLUSION: Simulations with real-life data from surveillance of hospital acquired infections allow estimation of power for RCT and sample size to reach the required power

Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007.

International audienceOBJECTIVES: Antibiotic use in French hospitals is among the highest in Europe. A study was carried out to describe antibiotic consumption for inpatients at hospital and at ward levels. METHODS: Data were voluntarily collected retrospectively by 530 hospitals accounting for approximately 40 million patient-days (PD) on the following: antibacterials for systemic use [J01 class of the WHO Anatomical Therapeutic Chemical (ATC) classification, defined daily doses (DDD) system, 2007], rifampicin and oral imidazole derivatives, expressed in number of DDD and number of PD in 2007. Consumption was expressed in DDD/1000 PD. RESULTS: Median antibiotic use ranged from 60 DDD/1000 PD in long-term care (LTC) and psychiatric hospitals to 633 DDD/1000 PD in teaching hospitals. Penicillins and beta-lactamase inhibitors combinations were the most frequently used antibiotics, accounting for 26% of total use in cancer hospitals to 40% in LTC/psychiatric hospitals. Glycopeptides and carbapenems were mostly used in cancer and teaching hospitals. Level of consumption and pattern of use differed according to clinical ward from 60 DDD/1000 PD in psychiatric wards up to 1466 DDD/1000 PD in intensive care units (ICUs). In medicine, surgery, ICU and rehabilitation wards, fluoroquinolones accounted for 13%-19% of the total use. CONCLUSIONS: This multicentre survey provided detailed information on antibiotic use in a large sample of hospitals and wards, allowing relevant comparisons and benchmarking. Analysis of consumption at the ward level should help hospitals to target practice audits to improve antibiotic use