Introduction of highly resistant bacteria into a hospital via patients repatriated or recently hospitalized in a foreign country

AbstractWe describe the prevalence of carriage and variables associated with introduction of highly drug-resistant microorganisms (HDRMO) into a French hospital via patients repatriated or recently hospitalized in a foreign country. The prevalence of HDRMO was 11% (15/132), with nine carbapenamase-producing Enterobacteriaceae, nine carbapenem-resistant Acinetobacter baumannii and six glycopeptide-resistant enterococci. Half of the admitted patients (63/132, 48%) were colonized with extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE). Among the four episodes with secondary cases, three involved A. baumannii

Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

Programme hospitalier de bon usage des antibiotiques : le point de vue des prescripteurs, une enquête nationale

International audienceIntroductionLa lutte contre le développement des résistances bactériennes passe par un usage raisonné des antibiotiques. Pour ce faire, les hôpitaux ont déployé des programmes de bon usage des antibiotiques (PBUA) mais leur succès dépend de l’implication des prescripteurs et du respect des mesures.Matériels et méthodesEnquête réalisée dans 27 hôpitaux, tirés au sort parmi ceux de plus de 300 lits MCO, par auto-questionnaire un jour donné auprès de tous les prescripteurs présents, incluant les internes et les sages-femmes.RésultatsSur 1963 questionnaires distribués, 920 ont été complétés (47 %). Les répondants étaient principalement des médecins seniors (71,7 %), de spécialité médicale (62,4 %) et travaillaient dans des centre hospitalier non universitaires (75,0 %). La présence d’un référent en antibiothérapie était considérée comme un élément central du PBUA (96,2 % d’accord). L’avis du référent était jugé utile pour gérer des problèmes thérapeutiques — choisir le bon antibiotique pour améliorer la situation clinique du patient (84,7 %) ou adapter le traitement à des situations particulières (89,6 %) — mais moins utile pour établir un diagnostic (31,4 %). Les répondants indiquaient que le conseil était majoritairement dispensé par téléphone (72,4 %), à leur demande (96,0 %). Les conseils du référent étaient fréquemment cités (80,2 %) parmi les facteurs influençant les décisions de prescription d’antibiotiques. D’autres facteurs impactaient leurs pratiques comme l’influence des collègues et des supérieurs, notamment pour les internes. Les prescripteurs s’appuyaient davantage sur les recommandations propres à leur spécialité (76,7 %) que sur les recommandations locales (61,5 %). Les prescripteurs citaient peu l’existence d’avis non sollicités ou des contrôles post-prescription. Ils portaient un jugement plutôt négatif sur les mesures visant à restreindre la prescription des antibiotiques, comme la validation par le référent (28,8 %). Ils étaient davantage favorables à des mesures qui augmentent leurs capacités, comme des sessions de formation pour les seniors (74,0 %) ou les internes (73,0 %). La lutte contre les résistances bactériennes était identifiée comme l’un des enjeux du PBUA (77,8 %) mais seuls 51,7 % considéraient l’impact écologique au moment de prescrire.ConclusionLes prescripteurs sont positifs à l’égard des PBUA car ils correspondent à leurs préférences : conseil initié à la demande des cliniciens et peu de mesures contraignantes, dont ils reconnaissent peu l’utilité

High uptake of pre-exposure prophylaxis (PrEP) during early roll-out in Belgium: results from surveillance reports

Background Since 1 June 2017, oral pre-exposure prophylaxis (PrEP) could be prescribed and reimbursed in Belgium as prophylactic medication for people who are at increased risk of HIV acquisition. The aim of this study was to determine the uptake of daily and event-driven PrEP in Belgium during the first 9 months of&nbsp;roll-out. Methods:&nbsp;Routine aggregated data on the number of reimbursement requests and the number of boxes of Truvada (Gilead Sciences, Cambridge, UK) delivered for PrEP through the Belgian pharmacies were obtained from the National Institute for Health and Disability Insurance. We also collected aggregated data from seven Aids Reference Centres (ARCs) currently providing most of the PrEP care in&nbsp;Belgium. Results:&nbsp;From 1 June 2017 to 28 February 2018, 1352 requests for reimbursement were approved by the National Institute for Health and Disability Insurance. Almost 98% of those who bought at least one box of 30 tablets of emtricitabine 200mg/tenofovir disoproxil fumarate 300mg (FTC/TDF) in a Belgian pharmacy were male, and most (67%) were between 30 and 50 years of age. According to data obtained from ARCs, the proportion of those choosing event-driven PrEP initially ranged between 29% and&nbsp;73%. Conclusions:&nbsp;The uptake of PrEP in Belgium since the start of the roll-out in June 2017 has been high, and almost entirely limited to men who have sex with men, of whom 43% initially prefer a non-daily regimen. A better understanding is needed as to why other populations, such as sub-Saharan African migrants, are not accessing PrEP, as well as the development of a more sustainable PrEP delivery&nbsp;model.</p

Stochastic nash equilibrium problems: sample average approximation and applications

This paper presents a Nash equilibrium model where the underlying objective functions involve uncertainty and nonsmoothness. The well-known sample average approximation method is applied to solve the problem and the first order equilibrium conditions are characterized in terms of Clarke generalized gradients. Under some moderate conditions, it is shown that with probability one, a statistical estimator (a Nash equilibrium or a Nash-C-stationary point) obtained from sample average approximate equilibrium problem converges to its true counterpart. Moreover, under some calmness conditions of the Clarke generalized derivatives, it is shown that with probability approaching one exponentially fast by increasing sample size, the Nash-C-stationary point converges to a weak Nash-C-stationary point of the true problem. Finally, the model is applied to stochastic Nash equilibrium problem in the wholesale electricity market