NosoVeille Août 2011 - CPias

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|[pic] |NosoVeille n°12 |
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| |Décembre 2017 | [pic] Ce bulletin de veille est une publication mensuelle qui recueille les
publications scientifiques enregistrées au cours du mois écoulé. Il est disponible sur le site de NosoBase à l'adresse suivante :
http://www.cpias.fr/nosobase Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
[pic] Sommaire de ce numéro : Antibiotique / Antibiorésistance
Bactériémie
Cathétérisme
Chirurgie
Clostridium difficile
Communication
Désinfection
Endoscopie
Entérobactérie
Environnement
Epidémie
Grippe
Hygiène des mains
Infection urinaire
Laboratoire
Maladie de Creutzfeldt-Jakob
Personne âgée
Personnel
Prévention
Réglementation
Soins intensifs
Staphylococcus aureus
Transport
Vaccination
Antibiotique / Antibiorésistance Avis relatif à l'ajout du poliovirus au projet d'arrêté fixant les listes
des infections transmissibles prescrivant ou portant interdiction de
certaines opérations funéraires mentionnées à l'article R. 2213-2-1 du Code
général des collectivités territoriales : 13 octobre 2017, HCSP Haut Conseil de Santé Publique (HCSP). Avis relatif à l'ajout du poliovirus
au projet d'arrêté fixant les listes des infections transmissibles
prescrivant ou portant interdiction de certaines opérations funéraires
mentionnées à l'article R. 2213-2-1 du Code général des collectivités
territoriales : 13 octobre 2017. HCSP 2017/11/22: 1-12. Mots-clés : MALADIE TRANSMISSIBLE, MORGUE, VIRUS, VACCINATION, PERSONNEL,
POLIOVIRUS, POLIOMYELITE Le HCSP a évalué la pertinence de l'ajout des poliovirus aux listes
réglementaires des maladies transmissibles prescrivant ou interdisant
certaines opérations funéraires.
Le HCSP a fait le point sur les infections à poliovirus observées dans le
monde en fonction des couvertures vaccinales des populations et sur les
risques de contamination de l'environnement.
Au regard des très faibles risques de dissémination du virus, de la
surveillance effectuée et de la couverture vaccinale élevée en France, le
HCSP considère qu'il n'est pas justifié d'ajouter les poliovirus à ces
listes de maladies transmissibles.
Le HCSP rappelle le calendrier vaccinal en vigueur vis-à-vis de la
poliomyélite en population générale et chez les professionnels concernés.
http://www.hcsp.fr/explore.cgi/avisrapportsdomaine?clefr=635
[pic] Réduction de la sensibilité à la chlorhexidine et à la daptomycine chez
Enterococcus faecium résistant à la vancomycine après exposition en série à
la chlorhexidine Bhardwaj Pooja, Hans Amrita, Ruikar Kinnari, Guan Ziqiang, Palmer Kelli L.
Reduced chlorhexidine and daptomycin susceptibility in vancomycin-resistant
Enterococcus faecium after serial chlorhexidine exposure, Antimicrobial
agents and chemotherapy 2017/10/16; in press: 1-32. Mots-clés : CHLORHEXIDINE, DAPTOMYCINE, ENTEROCOCCUS FAECIUM,
ANTIBIORESISTANCE, ENTEROCOCCUS RESISTANT A LA VANCOMYCINE, GENOMIQUE Vancomycin-resistant Enterococcus faecium (VREfm) are critical public
health concerns because they are among the leading causes of hospital-
acquired bloodstream infections. Chlorhexidine (CHX) is a bisbiguanide
cationic antiseptic that is routinely used for patient bathing and other
infection control practices. VREfm are likely frequently exposed to CHX;
however, the long-term effects of CHX exposure have not been studied in
enterococci. In this study, we serially exposed VREfm to increasing
concentrations of CHX for a period of 21 days in two independent
experimental evolution trials. Reduced CHX susceptibility emerged (4-fold
shift in CHX MIC). Sub-populations with reduced daptomycin (DAP)
susceptibility were detected, which were further analyzed by genome
sequencing and lipidomic analysis. Across the trials, we identified
adaptive changes in genes with predicted or experimentally confirmed roles
in chlorhexidine susceptibility (efrE), global nutritional stress response
(relA), nucleotide metabolism (cmk), phosphate acquisition (phoU), and
glycolipid biosynthesis (bgsB), among others. Moreover, significant
alterations in membrane phospholipids were identified for some populations
with reduced DAP susceptibility. Our results are clinically significant
because they identify a link between serial sub-inhibitory CHX exposure and
reduced DAP susceptibility. In addition, the CHX-induced genetic and
lipidomic changes described in this study offer new insights into the
mechanisms underlying the emergence of antibiotic resistance in VREfm.
http://dx.doi.org/10.1128/AAC.01235-17
[pic] La télémédecine est une intervention efficace pour améliorer la
prescription pertinente d'antibiotiques et pour réduire les coûts en
pédiatrie Ceraldini Jacopo, Tozzi Alberto Eugenio, D'Argenio Patrizia, Bernaschi
Paola, Manuri Lucia, Brusco Carla, et al. Telemedicine as an effective
intervention to improve antibiotic appropriateness prescription and to
reduce costs in pediatrics. Italian journal of pediatrics 2017/11/17;
43(1): 1-4. Mots-clés : ANTIBIOTIQUE, PEDIATRIE, TELEMEDECINE, PRESCRIPTION,
CONSOMMATION, PREVENTION, POLITIQUE DE SANTE, TAUX, INFECTION NOSOCOMIALE,
COUT-BENEFICE, MULTIRESISTANCE Implementation of antimicrobial stewardship program is a pivotal practice
element for healthcare institution. We developed a remote infectious
disease consultancy program via telemedicine in a high-specialized
pediatric cardiac hospital. A consultation for antibiotic strategy for each
patient was available via telemedicine in addition to biweekly discussion
of all clinical cases. Aim of this study was to evaluate the impact of the
remote stewardship program in terms of a) appropriateness of antibiotic
prescription; b) incidence of multi-resistant infection; and c) cost. A
'before - after' study was performed comparing the period immediately
before starting the program and one year after. There was a trend in the
reduction of nosocomial infectious disease rate (9.5 vs 6.5 per 1000 person
days), with a reduction in the overall antibiotic cost (25,000 vs 15,000
EUR) and in the average antibiotics packages used per admission (9 vs 6.7
packages). A significant reduction in the multi-drug resistant isolation
rate was observed (104 vs 79 per 1000 person days, p=0.01). In conclusion,
the infectious disease meeting via telemedicine has been an effective tool
for economic and professional development and multidisciplinary management
of complex patients. The appropriate use of antibiotics reduced the multi-
drug resistant bacteria selection, thus improving patient safety.
http://dx.doi.org/10.1186/s13052-017-0423-3
[pic] Travailler à l'intersection du contexte, de la culture et de la technologie
: Points de vue des professionnels sur le bon usage des antibiotiques dans
le service d'urgence, en utilisant un support informatique avec aide à la
décision clinique sur des dossiers médicaux électroniques Chung Phillip, Scandlyn Jean, Dayan Peter S, Mistry Rakesh D. Working at
the intersection of context, culture, and technology: Provider perspectives
on antimicrobial stewardship in the emergency department using electronic
health record clinical decision support. American journal of infection
control 2017/11; 45(11): 1198-1202. Mots-clés : URGENCES HOSPITALIERES, ANTIBIOTIQUE, CONSOMMATION,
PRESCRIPTION, DOSSIER MEDICAL, INFORMATIQUE, LOGICIEL, ENQUETE, PERSONNEL,
QUALITE Background: Antibiotic stewardship programs (ASPs) have not been fully
developed for the emergency department (ED), in part the result of the
barriers characteristic of this setting. Electronic health record-based
clinical decision support (EHR CDS) represents a promising strategy to
implement ASPs in the ED. We aimed to determine the cultural beliefs and
structural barriers and facilitators to implementation of antimicrobial
stewardship in the pediatric ED using EHR CDS.
Methods: Interviews and focus groups were conducted with hospital and ED
leadership, attending ED physicians, nurse practitioners, physician
assistants, and residents at a single health system in Colorado. We
reviewed and coded the data using constant comparative analysis and
framework analysis until a final set of Themes emerged.
Results: Two dominant perceptions shaped providers' perspectives on ASPs in
the ED and EHR CDS: (1) maintaining workflow efficiency and (2) constrained
decision-making autonomy. Clinicians identified structural barriers to
ASPs, such as pace of the ED, and various beliefs that shaped patterns of
practice, including accommodating the prescribing decisions of other
providers and managing parental expectations. Recommendations to enhance
uptake focused on designing a simple yet flexible user interface, providing
clinicians with performance data, and on-boarding clinicians to enhance buy-
in.
Conclusions: Developing a successful ED-based ASP using EHR CDS should
attend to technologic needs, the institutional context, and the cultural
beliefs of practice associated with providers' antibiotic prescribing.
http://dx.doi.org/10.1016/j.ajic.2017.06.005
[pic] Réduction du taux de mortalité chez les patients qui ont reçu de la
vancomycine après la mise en ?uvre du programme pour le bon usage des
antibiotiques Conway Erin L, Sellick John A, Horey Amy, Foder