Towards One Health surveillance of antibiotic resistance: characterisation and mapping of existing programmes in humans, animals, food and the environment in France, 2021

BackgroundInternational organisations are calling for One Health approaches to tackle antimicrobial resistance. In France, getting an overview of the current surveillance system and its level of integration is difficult due to the diversity of surveillance programmes.AimThis study aimed to map and describe all French surveillance programmes for antibiotic resistance (ABR), antibiotic use (ABU) and antibiotic residues, in humans, animals, food and the environment, in 2021. Another objective was to identify integration points, gaps and overlaps in the system.MethodsWe reviewed the literature for surveillance programmes and their descriptions. To further characterise programmes found, semi-directed interviews were conducted with their coordinators.ResultsIn total 48 programmes in the human (n = 35), animal (n = 12), food (n = 3) and/or the environment (n = 1) sectors were identified; 35 programmes focused on ABR, 14 on ABU and two on antibiotic residues. Two programmes were cross-sectoral. Among the 35 ABR programmes, 23 collected bacterial isolates. Bacteria most targeted were Escherichia coli (n = 17 programmes), Klebsiella pneumoniae (n = 13), and Staphylococcus aureus (n = 12). Extended-spectrum beta-lactamase-producing E. coli was monitored by most ABR programmes (15 of 35) in humans, animals and food, and is a good candidate for integrated analyses. ABU indicators were highly variable. Areas poorly covered were the environmental sector, overseas territories, antibiotic-resistant-bacterial colonisation in humans and ABU in companion animals.ConclusionThe French surveillance system appears extensive but has gaps and is highly fragmented. We believe our mapping will interest policymakers and surveillance stakeholders. Our methodology may inspire other countries considering One Health surveillance of ABR.

Perceptions and attitudes about antibiotic resistance in the general public and general practitioners in France

BACKGROUND

During the last 20 years, France has taken important steps to tackle antibiotic resistance. These include national awareness campaigns for the general public, and supporting changes in terms of antibiotic prescription for healthcare practitioners. To prepare the upcoming 2022/2023 campaign, we conducted two surveys to assess (1) the general public's knowledge, attitudes and behaviours regarding antibiotics and (2) the perceptions and practices of general practitioners (GPs).

METHODS

Two quantitative telephone surveys were conducted using the same methodology as that used in 2010 by the National Health Insurance Authority. The first was conducted in 2019 in a national representative quota sample of 1204 persons aged over 15 years living in metropolitan France, including an over-sample of 332 parents of children aged six years or under. The second was conducted in 2020 in a national representative sample of 388 GPs.

RESULTS

Twenty-seven percent of respondents reported taking antibiotics during the previous year. Sixty-five percent of GPs declared prescribing fewer antibiotics during the previous five years. However, 33% of GPs reported they often had patients who put high pressure to get antibiotics. The pressure from elderly patients, especially those with comorbidities was notable. Three percent of respondent patients reported putting often pressure on their GP. All respondents expressed total trust in their GP irrespective of whether s/he had prescribed them antibiotics. Half knew that antibiotics act only on bacteria, and 38% said they understood precisely what antibiotic resistance is.

CONCLUSION

Although antibiotic use is decreasing in France, patient pressure on GPs to prescribe antibiotics is very high. GPs are key ambassadors in reducing antibiotic use. Awareness campaigns must target elderly patients in particular.

Description des clusters de Covid-19 nosocomiaux chez des patients, France 2020-2022

Introduction

Matériels et méthodes

Résultats

Conclusion

Association of Healthcare and Aesthetic Procedures with Infections Caused by Nontuberculous Mycobacteria, France, 2012‒2020

We describe nontuberculous mycobacteria (NTM) infections during 2012–2020 associated with health care and aesthetic procedures in France. We obtained epidemiologic data from the national early warning response system for healtcare-associated infections and data on NTM isolates from the National Reference Center for Mycobacteria. We compared clinical and environmental isolates by using whole-genome sequencing. The 85 original cases were reported after surgery (48, 56%), other invasive procedures (28, 33%) and other procedures (9, 11%). NTM isolates belonged to rapidly growing (73, 86%) and slowly growing (10, 12%) species; in 2 cases, the species was not identified. We performed environmental investigations for 38 (45%) cases; results for 12 (32%) were positive for the same NTM species as for the infection. In 10 cases that had environmental and clinical samples whose genomes were similar, the infection source was probably the water used in the procedures. NTM infections could be preventable by using sterile water in all invasive procedures.

Bilan des signalements COVID-19 sur la plateforme e-SIN, France, 2020

Introduction

Le signalement des infections nosocomiales via l’outil e-SIN est depuis le début de l’épidémie utilisé par les équipes opérationnelles d’hygiène des établissements de santé pour signaler les cas nosocomiaux de Covid19.

Matériels et méthodes

La période d’étude est l’année 2020, du 01-01-2020 au 03-01-2021. L’analyse concerne plus précisément les cas groupés définis à partir de 3 cas survenus dans un délai entre 2 cas de 4 à 7 jours¹. Le caractère nosocomial² est caractérisé par les équipes opérationnelles d’hygiène qui signalent. Les signalements de Covid19 sont extraits de l’outil e-SIN puis analysés dans une base Microsoft® Excel (2016). ¹ Ministère des solidarités et de la santé. Gestion des cas groupés - clusters de COVID-19. (2020). ²Surveillance definitions for COVID-19. European Centre for Disease Prevention and Control.

Résultats

En 2020, 4,352 signalements (SIN) de Covid-19 nosocomiales ont été émis. Parmi ces SIN, 1845 cas groupés (CG) représentant 18 778 cas patients (60%), 12 574 cas soignants (40 %) et 10 cas visiteurs. La répartition par service des CG signalés est la suivante : 828 en médecine, 567 en SSR, 139 en chirurgie, 108 en SLD, 61 en secteur EHPAD, 42 en soins intensifs, 35 aux urgences, 13 en gynécologie-obstétrique, 3 en imagerie et 48 dans les services supports (laboratoire, cuisine, …). La part des professionnels dans les CG est variable selon les services: elle est proche de la moyenne dans les services de médecine (46 %) et de chirurgie (53 %), elle est plus faible dans les services de SSR (34 %), SLD (27 %) et secteur EHPAD (26 %) et plus élevée en Gynécologie-Obstétrique (63%), en Soins Intensifs (74 %), aux urgences (92 %) et en Imagerie (100 %). Les principales hypothèses formulées pour expliquer la transmission du virus sont: (1) la découverte fortuite d’un cas, (2) le non-respect strict des mesures barrières et (3) les pauses/transmissions entre professionnels sur leur lieu de travail. La première hypothèse est au premier plan dans les services de médecine (38 %) et de chirurgie (44 %), secteur EHPAD (46 %), SLD (41 %) et SSR (42 %). La 3^e hypothèse est au premier plan dans les services de gynécologie-obstétrique (62 %), imagerie (100 %) et urgences (43 %). En soins intensifs les 3 hypothèses sont au même niveau (environ 1/3). Le dépistage et le renforcement des mesures barrières sont de loin les 2 mesures correctives les plus décrites dans les 1,621 CG ayant renseigné des mesures correctives, tout type de service confondu.

Conclusion

La transmission nosocomiale de Covid-19 est une réalité à prendre en compte pour maîtriser la diffusion du virus. Elle prend des aspects différents selon les services. Les patients représentent la plus grande part des cas, souvent parce que le cas index n’est pas identifié à l’admission. Ce constat incite à renforcer les précautions standard, le dépistage et les mesures barrières spécifiques dès l’identification des cas. Une part importante des cas groupés implique des professionnels souvent contaminés lors des pauses ou transmission pendant lesquelles le strict respect des mesures barrières doit être maintenu.

Burden of COVID-19 on workers in hospital settings: The French situation during the first wave of the pandemic

We launched a survey in April 2020 to assess the number and proportion of hospital workers infected during the first wave of the COVID-19 pandemic in France, and to assess the attributable mortality. All French hospital settings (HS) were invited to declare new cases and attributable deaths by occupation category each week. Between March 1 and June 28, 2020, participating HS accounted for 69.5% of the total number of HS workers in France, and declared 31,088 infected workers; 16 died from the infection. We estimated that 3.43% (95% CI: 3.42–3.45) of French workers in HS, and 3.97% (95% CI: 3.95–3.99) of healthcare workers were infected during the first wave. Workers in regions with a cumulative rate of hospitalized COVID-19 patients equal or above the national rate, HS other than tertiary hospitals, or occupations with frequent patient contacts were particularly impacted. Targeted prevention campaigns should be elaborated.

Patterns of antibiotic use in hospital-acquired infections

BACKGROUND

Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data.

METHODS

We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile.

RESULTS

Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S. aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E. coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E. coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem.

CONCLUSIONS

This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted.

Epidemiology of Clostridioides difficile infections, France, 2010 to 2017

BackgroundClostridioides difficile is a leading cause of healthcare-associated diarrhoea in middle and high-income countries. Up to 2018, there has been no systematic, annual surveillance for C. difficile infections (CDI) in France.AimsTo provide an updated overview of the epidemiology of CDI in France between 2010 and 2017 based on five different data sources.MethodsThis is a descriptive study of retrospective surveillance and alerts data. Incidence of CDI cases was estimated through the CDI incidence survey (2016) and data from the French National Uniform Hospital Discharge Database (PMSI; 2010-16). Testing frequency for CDI was estimated through the CDI incidence survey and point prevalence studies on healthcare-associated infections (HAI; 2012 and 2017). The national early warning response system for HAI (HAI-EWRS, 2012-17) and National Reference Laboratory data (2012-17) were used to follow the number of severe CDI cases and/or outbreaks.ResultsIn 2016, CDI incidence in acute care was 3.6 cases per 10,000 patient days (PD). There was a statistically significant increase in CDI incidence between 2010 and 2016 (+ 14% annually) and testing frequency was 47.4 per 10,000 PD. The number of CDI HAI-EWRS notifications decreased between 2015 and 2017 with only a few large outbreaks reported.ConclusionThe CDI incidence estimate increased from 2010, but remained below the European average of 7 per 10,000 PD in 2014; there were fewer severe cases or clusters reported in France. The consistency between PMSI and laboratory-based estimated CDI incidence could allow for more routine monitoring of CDI incidence.

[Accidents exposing to blood in France]

Occupational blood and body fluids exposure. Occupational blood and body fluids exposure (BBFE) is a serious daily risk to healthcare workers (HCW) wherever they work (i.e. hospital, nursing home or private care). The knowledge of BBFE epidemiology over these 3 sectors of care allows HCF to be aware of BBFE circumstances and can enhance prevention in order to improve overall BBFE prevention. The improvement for compliance with standard precautions and protocols to prevent exposure to BBFE and the increase of safety device disposal use are the main keys of HCW safety.

ICU-acquired candidaemia in France: Epidemiology and temporal trends, 2004-2013 - A study from the REA-RAISIN network

OBJECTIVE

Candidaemia is a life-threatening infectious disease, associated with septic shock, multiple organ failure, and a high mortality rate. In France, reported data on the incidence of ICU-acquired candidaemia and the causative Candida species are scarce. The objective of this study was to determine temporal trends in epidemiology and risk factors of intensive care unit-acquired candidaemia (ICU-Cand) and ICU mortality among a very large population of ICU patients.

METHOD

Demographics, patient risk factors, invasive device exposure and nosocomial infection in ICU patient were collected from 2004 to 2013 in a national network of 213 ICUs: REA-RAISIN. Incidence and risk factors for candidaemia and ICU mortality were assessed.

RESULTS

Out of 246,459 ICU patients, 851 developed an ICU-cand, representing 0.3 per 1000 patients-days. The incidence rose sharply over time. Candida albicans was the main species. The overall and ICU mortality was 52.4% in ICU-cand patients. The main risk factors of ICU-cand were length of stay, severity of illness and antimicrobial therapy at ICU admission, immune status and use of invasive procedure. ICU-cand was an independent risk factor of mortality (OR: 1.53; 95%CI [1.40-1.70]); in a sub-group analysis, independent effects on mortality were observed with C. albicans (OR: 1.45 [1.23-1.71]), Candida tropicalis (OR: 2.11 [1.31-3.39]) and "other" Candida species (OR: 1.64 [1.09-2.45]).

CONCLUSION

ICU candidaemia ranked sixth among bloodstream infections, and its average annual incidence was 0.3 per 1000 patients days. Despite of new therapy and international recommendation, the incidence rose sharply during the study period, and ICU mortality remained high.