NosoVeille Août 2011 - NosoBase

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|[pic] |NosoVeille n°3 |
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| |Mars 2017 | [pic] Ce bulletin de veille est une publication mensuelle qui recueille les
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[pic] Sommaire de ce numéro : Antibiotique / Antibiorésistance
Antisepsie
Bactériémie
Cathétérisme
Chirurgie
Clositridium difficile
EHPAD
Endoscopie
Environnement
Epidémie
Grippe
Hygiène des mains
Infection urinaire
Législation
Néonatologie
Personnel
Prévention
Risque professionnel
Soin intensif
Staphylococcus aureus
Vaccination
Antibiotique / Antibiorésistance NosoBase ID notice : 424660
Epidémiologie et mesures de prévention des épidémies dues aux organismes
antibiorésistants en Europe (EMBARGO) : protocole d'une revue systématique Babu Rajendran N; Gladstone BP; Rodriguez-Baño J; Sifakis F; Voss A;
Carmeli Y; et al. Epidemiology and control measures of outbreaks due to
Antibiotic-Resistant organisms in Europe (EMBARGO): a systematic review
protocol. BMJ Open 2017/01/05; 7(1): 1-4. Mots-clés : EPIDEMIOLOGIE; ANTIBIORESISTANCE; EPIDEMIE; PREVENTION; REVUE
DE LA LITTERATURE Introduction: Improving our understanding of outbreaks due to antibiotic-
resistant bacteria (ARB) and their control is critical in the current
public health scenario. The threat of outbreaks due to ARB requires
multifaceted efforts. However, a global overview of epidemiological
characteristics of outbreaks due to ARB and effective infection control
measures is missing. In this paper, we describe the protocol of a
systematic review aimed at mapping and characterising the epidemiological
aspects of outbreaks due to ARB and infection control measures in European
countries.
Methods and analysis: The databases MEDLINE, Web of Knowledge and Cochrane
library will be searched using a 3-step search strategy. Selection of
articles for inclusion will be performed by 2 reviewers using predefined
eligibility criteria. All study designs will be included if they report an
outbreak and define the microbiological methods used for microorganism
identification. The target bacteria will be methicillin-resistant and
vancomycin-resistant Staphylococcus aureus, vancomycin-resistant
Enterococcus, ceftazidime-resistant and carbapenem-resistant Acinetobacter
baumannii, ceftazidime-resistant and carbapenem-resistant Pseudomonas
aeruginosa, ciprofloxacin-resistant Escherichia coli, extended-spectrum ?-
lactamase-producing E. coli and Klebsiella pneumoniae, carbapenem-resistant
and carbapenamase-producing Enterobacteriaceae. Data will be extracted
using a tailored pilot tested form and the quality of reporting will be
assessed using the ORION (Outbreak Reports and Intervention Studies Of
Nosocomial infections) tool. Data will be synthesised and reported by the
type of ARB, setting and country. Infection control measures and bundles of
measures will be described. The effectiveness will be reported as defined
by the authors. Regression analysis will be used to define independent
factors associated with outbreaks' control. Heterogeneity between studies
will be assessed by forest plots and I² statistics.
Ethics and dissemination: Ethical approval is not applicable for this
study. Findings will be disseminated through journal publication and
conference presentations and talks.
[pic] NosoBase ID notice : 424699
Impact de la durée des antibiotiques sur les évènements cliniques chez les
patients atteints de pneumonie associée à la ventilation due à Pseudomonas
aeruginosa : protocôle d'étude pour une étude contrôlée randomisée Bouglé A; Foucrier A; Dupont H; Montravers P; Ouattara A; Kalfon P; et al.
Impact of the duration of antibiotics on clinical events in patients with
Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for
a randomized controlled study. Trials 2017/01/23; 18(37): 1-8. Mots-clés : ANTIBIOTIQUE; PSEUDOMONAS AERUGINOSA; PNEUMONIE; PRESCRIPTION;
ASSISTANCE RESPIRATOIRE; TRAITEMENT; ESSAI CLINIQUE; ESSAI THERAPEUTIQUE;
SOIN INTENSIF Background: Ventilator-associated pneumonia (VAP) accounts for 25% of
infections in intensive care units. Compared to a long duration (LD) of
antibiotic therapy, a short duration (SD) has a comparable clinical
efficacy with less antibiotic use and less multidrug-resistant (MDR)
pathogen emergence, with the exception of documented VAP of non-fermenting
Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA).
These results have led the American Thoracic Society to recommend SD
therapy for VAP, except for PA-VAP. Thus the beneficial effect of SD
therapy in PA-VAP is still a matter of debate. We aimed to assess the non-
inferiority of a short duration of antibiotics (8 days) versus prolonged
antibiotic therapy (15 days) in PA-VAP.
Methods/Design: The impact of the duration of antibiotics on clinical
events in patients with Pseudomonas aeruginosa ventilator-associated
pneumonia (iDIAPASON) trial is a randomized, open-labeled non-inferiority
controlled trial, conducted in 34 French intensive care units (ICUs),
comparing two groups of patients with PA-VAP according to the duration (8
days or 15 days) of effective antibiotic therapy against PA. The primary
outcome is a composite endpoint combining day 90 mortality and PA-VAP
recurrence rate during hospitalization in the ICU. Furthermore, durations
of mechanical ventilation and hospitalization, as well as number and types
of extrapulmonary infections or acquisition of MDR pathogens during the
hospitalization in the ICU will be recorded. Recurrence with predefined
criteria (clinical suspicion of VAP associated with a positive quantitative
culture of a respiratory sample) will be evaluated by two independent
experts.
Discussion: Demonstrating that an SD (8 days) versus LD (15 days) therapy
strategy in PA-VAP treatment is safe and not associated with an increased
mortality or recurrence rate could lead to a change in practices and
guidelines in the management of antibiotic therapy of this frequent ICU
complication. This strategy could lead to decreased antibiotic exposure
during hospitalization in the ICU and in turn reduce the acquisition and
the spread of MDR pathogens.
[pic] NosoBase ID notice : 424673
Incidence et évolution clinique liées aux infections à entérocoques
résistants à la vancomycine aux Etats-Unis : revue systématique de la
littérature et méta-analyse Chiang HY; Perencevich EN; Nair R; Nelson RE; Samore M; Khader K; et al.
Incidence and outcomes associated with infections caused by vancomycin-
resistant enterococci in the United States: systematic literature review
and meta-analysis. Infection control and hospital epidemiology 2017/02;
38(2): 203-215. Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; ANTIBIORESISTANCE;
ENTEROCOCCUS; VANCOMYCINE; INCIDENCE; MORTALITE; DUREE DE SEJOUR;
READMISSION; COUT; TRAITEMENT; REVUE DE LA LITTERATURE; META-ANALYSE Background: Information about the health and economic impact of infections
caused by vancomycin-resistant enterococci (VRE) can inform investments in
infection prevention and development of novel therapeutics.
Objective: To systematically review the incidence of VRE infection in the
United States and the clinical and economic outcomes.
Methods: We searched various databases for US studies published from
January 1, 2000, through June 8, 2015, that evaluated incidence, mortality,
length of stay, discharge to a long-term care facility, readmission,
recurrence, or costs attributable to VRE infections. We included
multicenter studies that evaluated incidence and single-center and
multicenter studies that evaluated outcomes. We kept studies that did not
have a denominator or uninfected controls only if they assessed
postinfection length of stay, costs, or recurrence. We performed meta-
analysis to pool the mortality data.
Results: Five studies provided incidence data and 13 studies evaluated
outcomes or costs. The incidence of VRE infections increased in Atlanta and
Detroit but did not increase in national samples. Compared with uninfected
controls, VRE infection was associated with increased mortality (pooled
odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times
longer), increased risk of discharge to a long-term care facility (2.8- to
6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-
fold more).
Conclusions: VRE infection is associated with large attributable burdens,
including excess mortality, prolonged in-hospital stay, and increased
treatment costs. Multicenter studies that use suitable controls and adjust
for time at risk or confounders are needed to estimate the burden of VRE
infections.
[pic] NosoBase ID notice : 425041
Evolutions des entérobactéries productrices de carbapénémase, France, 2012
à 2014 Dortet L; Cuzon G; Pontiès V; Nordmann P. Trends in carbapenemase-producing
Enterobacteriaceae, France, 2012 to 2014. Eurosurveillance 2017/02/09;
2(6): 1-9. Mots-clés : ENTEROBACTERIE; KLEBSIELLA PNEUMONIAE; ANTIBIORESISTANCE;
CARBAPENEME; ESCHERICHI