Comparative diffusion assay to assess efficacy of topical antimicrobial agents against Pseudomonas aeruginosa in burns care

<p>Abstract</p> <p>Background</p> <p>Severely burned patients may develop life-threatening nosocomial infections due to <it>Pseudomonas aeruginosa</it>, which can exhibit a high-level of resistance to antimicrobial drugs and has a propensity to cause nosocomial outbreaks. Antiseptic and topical antimicrobial compounds constitute major resources for burns care but in vitro testing of their activity is not performed in practice.</p> <p>Results</p> <p>In our burn unit, a <it>P. aeruginosa </it>clone multiresistant to antibiotics colonized or infected 26 patients over a 2-year period. This resident clone was characterized by PCR based on ERIC sequences. We investigated the susceptibility of the resident clone to silver sulphadiazine and to the main topical antimicrobial agents currently used in the burn unit. We proposed an optimized diffusion assay used for comparative analysis of <it>P. aeruginosa </it>strains. The resident clone displayed lower susceptibility to silver sulphadiazine and cerium silver sulphadiazine than strains unrelated to the resident clone in the unit or unrelated to the burn unit.</p> <p>Conclusions</p> <p>The diffusion assay developed herein detects differences in behaviour against antimicrobials between tested strains and a reference population. The method could be proposed for use in semi-routine practice of medical microbiology.</p

Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study

Abstract Background Peripherally Inserted Central Catheters (PICCs) are widely used for hospitalized patients and among outpatients. Despite many advantages, PICC-related complications can occur such as infection, thrombosis or mechanical complications. We aimed to evaluate rates and nature of PICC-related complications from insertion to removal and analyze risk factors of complications at baseline and during healthcare. Methods We performed a prospective cohort study looking at PICC-related complication rates in the inpatient and outpatient settings of 163 patients over a 7-month period. Pertinent patient demographics as well as catheter-related factors were collected. The data were analyzed to identify catheter-related complications using univariate and multivariate analysis. Results One hundred ninety-two PICCs were monitored for a total of 5218 PICC-days (3337 PICC-days for inpatients, 1881 PICC-days for outpatients). The overall complication rate was 30.2% (11.1 per 1000 PICC-days) with a mean time to onset of 16.1 days. Complications included occlusion (8.9%), accidental withdrawal (8.9%), infections (6.3%) including 9 local infections (4.7%) and 3 bloodstream infections (1.6%), venous thrombosis (1.6%) and hematoma (1%). Complication rate was higher in the hospitalization setting (36.1%; 14.38 per 1000 PICC-days) than in the outpatient setting (19.4%; 3.19 per 1000 PICC-days). Multivariate logistic regression analysis showed that the occurrence of occlusion was significantly associated with an age > 65 years (OR = 4.19; 95% CI [1.1–15.81]) and the presence of a pre-occlusive event the week before PICC removal (OR = 76.35; 95% CI [9.36–622.97]). Conclusions PICCs appear safe in the inpatient and outpatient settings with low rates of infectious or thrombotic complications. Occlusion and accidental withdrawal were the most common complications, with age > 65 and catheter pre-occlusive event associated with an increased likelihood of catheter occlusion

Impact de l’environnement sur les microbiotes : focus sur l’hospitalisation et les microbiotes cutanés et chirurgicaux

International audienc

Sécurisation et contrôle de l’environnement des chambres lors de la sortie de patients porteurs ou infectés par une Bactérie Hautement Résistante et émergentes (BHRe)

International audienceLes Bactéries Hautement Résistantes émergentes (BHRe) entraînent des échecs thérapeutiques et des épidémieshospitalières. Afin de limiter leur diffusion, notre CHU applique depuis 2013 le «protocole BHRe» afin de sécuriser leschambres après sortie d’un patient porteur et avant l’entrée d’un nouveau patient. Cette étude présente les résultatsde cette sécurisation et l’évaluation des performances des méthodes échantillonnage des surfaces

Impact et coûts d’une épidémie d’infections/colonisations à entérobactérie productrice de carbapénémase dans un CHU.

International audienc

"Heatmap" des fondamentaux en hygiène : du diagnostic à l'indicateur.

International audienceLe respect des bonnes pratiques d’hygiène est essentiel pour la maîtrise du risque infectieux. Un outil déployé dans notre hôpital évalue le risque encouru par les patients exposés aux différentes pratiques de soins. L’objectif est de garantir l’application des fondamentaux en hygiène dans chaque unité de soins

Investigation autour d’infections urinaires à Pseudomonas aeruginosa après cystoscopie.

International audienceNous rapportons l’investigation menée autour d’infections urinaires à P. aeruginosa d’allure sporadique, survenues en6 mois au décours de cystoscopies ambulatoires chez trois patients. L’investigation a permis de déceler a posteriori unlien épidémiologique entre les cas et un examen avec un cystoscope souple. Les objectifs étaient de recenser l’ensembledes cas chez les patients exposés et de relier ces infections au cystoscope

Persisting transmission of carbapenemase-producing Klebsiella pneumoniae due to an environmental reservoir in a university hospital, France, 2012 to 2014

International audienceIn France, the proportion of episodes of carbapenemase-producing Enterobacteriaceae (CPE) with no recent stay or hospitalisation abroad is increasing. In this study, we investigate epidemiological links between apparently unrelated cases of OXA-48-producing Klebsiella pneumoniae (Kp OXA-48) colonisation or infection. We genotyped detected organisms by repetitive sequence-based PCR, and used a dynamic registry of cases and contacts to cross-reference patients' hospital stays. Between 1 November 2012 and 28 February 2014, 23 Kp OXA-48 cases were detected in a university hospital in Montpellier, of which 15 were involved in three outbreaks: outbreaks I and II occurred in November 2012 and outbreak III in October 2013. Molecular comparison of bacterial strains revealed clonal identity between cases involved in outbreaks II and III and four single cases. Cross-referencing of hospital stays revealed that these single cases and the index case of outbreak III had occupied the same room. Active case search among former occupants of that room found an additional Kp OXA-48 carrier. A clonal strain was isolated from the sink of that room. The epidemiological link between the contaminated room and outbreak II remained undetected. This study is a reminder that environmental reservoirs should be considered as a source of CPE transmission