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Ferriot C, Durance C, Trutt L, Rozo C, Louvigné C, Bressollette-Bodin C, Birgand G. A COVID-19 Superspreading Event Involving Two Variants during Sociotherapy Activities in French Mental Health Centre. J Hosp Infect 2022; 127:34-38. [PMID: 35594982 PMCID: PMC9113770 DOI: 10.1016/j.jhin.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022]
Abstract
A COVID-19 superspreading event during sociotherapy activities highlighted the risk of a choir for transmission in mental health centres and the community, and the need for close control of such activities. The simultaneous identification of delta and beta variants of SARS-CoV-2 illustrated their different spreading abilities.
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Affiliation(s)
- C Ferriot
- Centre d'appui pour la Prévention des Infections Associées aux Soins des Pays de la Loire, Nantes, Pays de la Loire, France.
| | - C Durance
- EPSYLAN, Blain, Pays la Loire, France
| | - L Trutt
- Agence Régionale de Santé des Pays de la Loire, Nantes, Pays de la Loire, France
| | - C Rozo
- EPSYLAN, Blain, Pays la Loire, France
| | - C Louvigné
- Centre d'appui pour la Prévention des Infections Associées aux Soins des Pays de la Loire, Nantes, Pays de la Loire, France
| | - C Bressollette-Bodin
- Service de virologie, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - G Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins des Pays de la Loire, Nantes, Pays de la Loire, France
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Ali-Brandmeyer O, Blanckaert K, Nion-Huang M, Simon L, Birgand G. Consumption of alcohol-based hand rub in French nursing homes: results from a nationwide survey, 2018-2019. J Hosp Infect 2021; 118:27-31. [PMID: 34534602 DOI: 10.1016/j.jhin.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022]
Abstract
This study assessed the hand hygiene performance in French nursing homes using the consumption of alcohol-based hand rubs (AHRs) as a surrogate. Nursing homes from the 17 French regions were contacted to collect their AHR consumption and occupancy in 2018 and 2019. A total of 1290 nursing homes from 15 French regions participated in the survey. The estimated median number of hand hygiene actions per resident-day was 1.48 (interquartile range: 1.04-2.03) in 2018 and 1.60 (1.10-2.26) in 2019. A significantly higher AHR consumption was observed in public nursing homes with an infection control team or link nurse.
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Affiliation(s)
- O Ali-Brandmeyer
- Centre d'appui à la prévention des infections associées aux soins Grand Est, Nancy, France; National Center for the Surveillance and Prevention of the Antimicrobial Resistance and Healthcare Associated Infections in Primary Cares and Nursing Homes, PRIMO, France
| | - K Blanckaert
- National Center for the Surveillance and Prevention of the Antimicrobial Resistance and Healthcare Associated Infections in Primary Cares and Nursing Homes, PRIMO, France; Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire, Nantes, France
| | - M Nion-Huang
- Santé Publique France, Département des Maladies Infectieuses, Saint Maurice, France
| | - L Simon
- Centre d'appui à la prévention des infections associées aux soins Grand Est, Nancy, France; National Center for the Surveillance and Prevention of the Antimicrobial Resistance and Healthcare Associated Infections in Primary Cares and Nursing Homes, PRIMO, France
| | - G Birgand
- National Center for the Surveillance and Prevention of the Antimicrobial Resistance and Healthcare Associated Infections in Primary Cares and Nursing Homes, PRIMO, France; Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire, Nantes, France; NIHR Health Protection Research Unit, Antimicrobial Resistance and Healthcare Associated Infection at Imperial College London, London, UK.
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Prévost N, Gaultier A, Birgand G, Mocquard J, Terrien N, Rochais E, Dumont R. Compliance with antibiotic prophylaxis guidelines in surgery: Results of a targeted audit in a large-scale region-based French hospital network. Infect Dis Now 2020; 51:170-178. [PMID: 33068683 DOI: 10.1016/j.medmal.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/20/2019] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While regional monitoring of antibiotic use has decreased since 2011 by 3.2%, in some healthcare facilities a significant increase (+43%) has occurred. The purpose of this study was to assess regional antibiotic prophylaxis (ABP) compliance with national guidelines. MATERIAL AND METHODS In 2015, 26 healthcare facilities, both public and private, were requested to audit five items: utilization of antibiotic prophylaxis, the antimicrobial agent (the molecule) administered, time between injection and incision, initial dose, number of intraoperative and postoperative additional doses. Seven surgical procedures were selected for assessment: appendicectomy (APP), cataract (CAT), cesarean section (CES), colorectal cancer surgery (CCR), hysterectomy (HYS), total hip arthroplasty (THA) and transurethral resection of the prostate (TURP). A statistical analysis of the 2303 records included was carried out. RESULTS The general rate of antibiotic prophylaxis compliance was 64%. The antimicrobial agent used and initial dose were in compliance with the guidelines for 93% and 97.4% of cases respectively, and administration of antibiotic prophylaxis was achieved 60minutes before incision in 77.6% of the records included. Regarding gastrointestinal surgery, amoxicillin/clavulanic acid was used in 32% of patients. In 26% of appendectomy files, administration occurred after incision, and one out of two files showed non-complaint perioperative and postoperative consumption. CONCLUSION Compliance with nationwide ABP guidelines is in need of pronounced improvement, especially with regard to time interval between injection and incision and the molecule prescribed. An action plan based on specific recommendations addressed to each establishment and an updated regionwide ABP protocol are aimed at achieving better and reduced consumption of antimicrobial agents.
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Affiliation(s)
- N Prévost
- Observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique (OMEDIT) Pays de la Loire, 85, rue Saint-Jacques, 44093 Nantes, France
| | - A Gaultier
- Réseau Qualirel santé, 85, rue Saint-Jacques, 44093 Nantes, France
| | - G Birgand
- CPias Pays de la Loire, CHU de Nantes, 5, rue Professeur Yves-Boquien, 44093 Nantes, France
| | - J Mocquard
- Observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique (OMEDIT) Pays de la Loire, 85, rue Saint-Jacques, 44093 Nantes, France
| | - N Terrien
- Réseau Qualirel santé, 85, rue Saint-Jacques, 44093 Nantes, France
| | - E Rochais
- Observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique (OMEDIT) Pays de la Loire, 85, rue Saint-Jacques, 44093 Nantes, France.
| | - R Dumont
- CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes, France
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Thibaut S, Coeffic T, Boutoille D, Lemenand O, Birgand G, Caillon J. Diminution d’Escherichia coli résistant aux céphalosporines de troisième génération dans les établissements d’hébergement pour personnes âgées dépendantes (Ehpad) et en soins de ville depuis 2015. Sommes-nous sur la bonne voie ? Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thibaut S, Coeffic T, Boutoille D, Lemenand O, Birgand G, Caillon J. Résistance aux antibiotiques des Entérobactéries urinaires isolées chez les patients vivant en établissements d’hébergement pour personnes âgées dépendantes (Ehpad). Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thibaut S, Coeffic T, Boutoille D, Lemenand O, Birgand G, Caillon J. Phénotypes de résistance aux antibiotiques de Staphylococcus aureus isolées d’hémoculture en soins de ville. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Veepanattu P, Singh S, Mendelson M, Nampoothiri V, Edathadatil F, Surendran S, Bonaconsa C, Mbamalu O, Ahuja S, Birgand G, Tarrant C, Sevdalis N, Ahmad R, Castro-Sanchez E, Holmes A, Charani E. Building resilient and responsive research collaborations to tackle antimicrobial resistance-Lessons learnt from India, South Africa, and UK. Int J Infect Dis 2020; 100:278-282. [PMID: 32860949 PMCID: PMC7449941 DOI: 10.1016/j.ijid.2020.08.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022] Open
Abstract
Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.
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Affiliation(s)
- P Veepanattu
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - S Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - V Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - F Edathadatil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - S Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - C Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - O Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Ahuja
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - G Birgand
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - C Tarrant
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - R Ahmad
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Division of Health Sciences, City University, London, UK
| | - E Castro-Sanchez
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Division of Health Sciences, City University, London, UK
| | - A Holmes
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - E Charani
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK.
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Ong C, Lucet JC, Bourigault C, Birgand G, Aho S, Lepelletier D. Staphylococcus aureus nasal decolonization before cardiac and orthopaedic surgeries: first descriptive survey in France. J Hosp Infect 2020; 106:332-334. [PMID: 32805310 DOI: 10.1016/j.jhin.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
The objective was to describe French hospital nasal screening and decolonization procedures before clean surgery procedures. Information for participants was sent to the French Society for Infection Control members in June 2018. Seventy hospitals participated in the survey; 40% (N = 28) declared having institutional decolonization procedures: 64% (N = 18) in orthopaedic and 56% (N = 15) in cardiac surgeries. All hospitals used mupirocin for nasal decolonization and body decolonization with chlorhexidine (N = 16) or povidone iodine (N = 10). This study is the first to be performed in France giving information in this field. Screening/decolonization procedures are heterogeneous and the evaluation of their clinical impact remains complex.
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Affiliation(s)
- C Ong
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - J-C Lucet
- Infection Control Unit UHLIN, Bichat Hospital, AP-HP Paris, Paris, France
| | - C Bourigault
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - G Birgand
- Centre for Infection Control and Prevention, Pays de la Loire, Nantes, France
| | - S Aho
- Epidemiology and Infection Control Department, Dijon University Hospital, Dijon, France
| | - D Lepelletier
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France; MiHAR lab, University of Nantes, Nantes, France.
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Peiffer-Smadja N, Rawson TM, Ahmad R, Buchard A, Georgiou P, Lescure FX, Birgand G, Holmes AH. Corrigendum to 'machine learning for clinical decision support in infectious diseases: a narrative review of current applications' clinical microbiology and infection (2020) 584-595. Clin Microbiol Infect 2020; 26:1118. [PMID: 32450256 DOI: 10.1016/j.cmi.2020.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR, 1137, University Paris Diderot, Paris, France.
| | - T M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - R Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | - P Georgiou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - F-X Lescure
- French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR, 1137, University Paris Diderot, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hˆopitaux de Paris, Paris, France
| | - G Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - A H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Peiffer-Smadja N, Dellière S, Rodriguez C, Birgand G, Lescure FX, Fourati S, Ruppé E. Machine learning in the clinical microbiology laboratory: has the time come for routine practice? Clin Microbiol Infect 2020; 26:1300-1309. [PMID: 32061795 DOI: 10.1016/j.cmi.2020.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Machine learning (ML) allows the analysis of complex and large data sets and has the potential to improve health care. The clinical microbiology laboratory, at the interface of clinical practice and diagnostics, is of special interest for the development of ML systems. AIMS This narrative review aims to explore the current use of ML In clinical microbiology. SOURCES References for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, biorXiv, arXiV, ACM Digital Library and IEEE Xplore Digital Library up to November 2019. CONTENT We found 97 ML systems aiming to assist clinical microbiologists. Overall, 82 ML systems (85%) targeted bacterial infections, 11 (11%) parasitic infections, nine (9%) viral infections and three (3%) fungal infections. Forty ML systems (41%) focused on microorganism detection, identification and quantification, 36 (37%) evaluated antimicrobial susceptibility, and 21 (22%) targeted the diagnosis, disease classification and prediction of clinical outcomes. The ML systems used very diverse data sources: 21 (22%) used genomic data of microorganisms, 19 (20%) microbiota data obtained by metagenomic sequencing, 19 (20%) analysed microscopic images, 17 (18%) spectroscopy data, eight (8%) targeted gene sequencing, six (6%) volatile organic compounds, four (4%) photographs of bacterial colonies, four (4%) transcriptome data, three (3%) protein structure, and three (3%) clinical data. Most systems used data from high-income countries (n = 71, 73%) but a significant number used data from low- and middle-income countries (n = 36, 37%). Performance measures were reported for the 97 ML systems, but no article described their use in clinical practice or reported impact on processes or clinical outcomes. IMPLICATIONS In clinical microbiology, ML has been used with various data sources and diverse practical applications. The evaluation and implementation processes represent the main gap in existing ML systems, requiring a focus on their interpretability and potential integration into real-world settings.
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Affiliation(s)
- N Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - S Dellière
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - C Rodriguez
- Department of Prevention, Diagnosis and Treatment of Infections, Henri-Mondor Hospital, APHP, Université Paris-Est Créteil, IMRB, INSERM U955, Créteil, France
| | - G Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - F-X Lescure
- Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - S Fourati
- Department of Prevention, Diagnosis and Treatment of Infections, Henri-Mondor Hospital, APHP, Université Paris-Est Créteil, IMRB, INSERM U955, Créteil, France
| | - E Ruppé
- Université de Paris, IAME, INSERM, F-75018 Paris, France.
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Birgand G, Troughton R, Mariano V, Hettiaratchy S, Hopkins S, Otter JA, Holmes A. How do surgeons feel about the 'Getting it Right First Time' national audit? Results from a qualitative assessment. J Hosp Infect 2019; 104:328-331. [PMID: 31711792 DOI: 10.1016/j.jhin.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022]
Abstract
The implementation of the national 'Getting It Right First Time' was assessed by interviewing six surgeons involved at various levels in surgical site infection (SSI) audit. The positive impacts were to create new professional collaboration, improve stakeholder engagement, and increase the profile of SSIs. One particular knowledge gap highlighted was that some participants had been unaware until that point of the criteria for diagnosing an SSI. The quality of data collected was felt to be poor due to methodological flaws. The audit was described as highly time-consuming and unsustainable if leaning on junior surgeons, without protected time and designated responsibility.
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Affiliation(s)
- G Birgand
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK.
| | - R Troughton
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK
| | - V Mariano
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK
| | - S Hettiaratchy
- Major Trauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, UK
| | - S Hopkins
- National Infection Service, Public Health England, London, UK
| | - J A Otter
- Infection Control, Imperial College Healthcare NHS Trust, London, UK
| | - A Holmes
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, London, UK
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Vaillant L, Birgand G, Esposito-Farese M, Astagneau P, Pulcini C, Robert J, Zahar JR, Sales-Wuillemin E, Tubach F, Lucet JC. Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey. Antimicrob Resist Infect Control 2019; 8:173. [PMID: 31749961 PMCID: PMC6852912 DOI: 10.1186/s13756-019-0625-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Much effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs. Methods A multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception. Results Between June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation. Conclusions We found a low level of MDRO awareness and knowledge of associated control measures among French HCWs. Training on hand hygiene and measures to control MDRO spread may be helpful in shaping beliefs and perceptions on MDRO control among other possible associated factors. Messages should be tailored to professional status and their perception. Other approaches should be designed, with more effective methods of training and cognitive interventions. Trial registration Clinical Trials.gov NCT02265471. Registered 16 October 2014 - Retrospectively registered.
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Affiliation(s)
- L Vaillant
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France
| | - G Birgand
- 2Department of Medicine, NIHR, Imperial College London, Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | - M Esposito-Farese
- AP-HP, Bichat-Claude Bernard Hospital, Unité de Recherche Clinique Paris Nord Val de Seine and CIC-EC 1425, 48 rue Henri Huchard, F-75018 Paris, France
| | - P Astagneau
- 4Medecine Sorbonne University, AP-HP, Regional centre for Prevention of Healthcare-associated infections, 8 rue Maria Helena Vieira da Silva, 75014 Paris, France
| | - C Pulcini
- 5EA 4360 APEMAC, CHRU de Nancy, University of Lorraine, Infectious and Tropical Diseases Unit, 34 Cours Léopold, 54000 Nancy, France
| | - J Robert
- Sorbonne University, U1135, Team E13, CR7 INSERM, AP-HP, Pitié-Salpêtrière Hospital, Bactériologie-Hygiène, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - J R Zahar
- 7AP-HP, Avicenne Hospital, Infection Control Unit, 125 Rue de Stalingrad, 93000 Bobigny, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
| | | | - F Tubach
- INSERM, UMR 1123, AP-HP, Pitié-Salpêtrière Hospital, Centre de Pharmacoépidémiologie (Cephepi), 75013 Paris, France
| | - J C Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
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Peiffer-Smadja N, Rawson TM, Ahmad R, Buchard A, Georgiou P, Lescure FX, Birgand G, Holmes AH. Machine learning for clinical decision support in infectious diseases: a narrative review of current applications. Clin Microbiol Infect 2019; 26:584-595. [PMID: 31539636 DOI: 10.1016/j.cmi.2019.09.009] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Machine learning (ML) is a growing field in medicine. This narrative review describes the current body of literature on ML for clinical decision support in infectious diseases (ID). OBJECTIVES We aim to inform clinicians about the use of ML for diagnosis, classification, outcome prediction and antimicrobial management in ID. SOURCES References for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, biorXiv, ACM Digital Library, arXiV and IEEE Xplore Digital Library up to July 2019. CONTENT We found 60 unique ML-clinical decision support systems (ML-CDSS) aiming to assist ID clinicians. Overall, 37 (62%) focused on bacterial infections, 10 (17%) on viral infections, nine (15%) on tuberculosis and four (7%) on any kind of infection. Among them, 20 (33%) addressed the diagnosis of infection, 18 (30%) the prediction, early detection or stratification of sepsis, 13 (22%) the prediction of treatment response, four (7%) the prediction of antibiotic resistance, three (5%) the choice of antibiotic regimen and two (3%) the choice of a combination antiretroviral therapy. The ML-CDSS were developed for intensive care units (n = 24, 40%), ID consultation (n = 15, 25%), medical or surgical wards (n = 13, 20%), emergency department (n = 4, 7%), primary care (n = 3, 5%) and antimicrobial stewardship (n = 1, 2%). Fifty-three ML-CDSS (88%) were developed using data from high-income countries and seven (12%) with data from low- and middle-income countries (LMIC). The evaluation of ML-CDSS was limited to measures of performance (e.g. sensitivity, specificity) for 57 ML-CDSS (95%) and included data in clinical practice for three (5%). IMPLICATIONS Considering comprehensive patient data from socioeconomically diverse healthcare settings, including primary care and LMICs, may improve the ability of ML-CDSS to suggest decisions adapted to various clinical contexts. Currents gaps identified in the evaluation of ML-CDSS must also be addressed in order to know the potential impact of such tools for clinicians and patients.
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Affiliation(s)
- N Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University Paris Diderot, Paris, France.
| | - T M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - R Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | - P Georgiou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - F-X Lescure
- French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University Paris Diderot, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - G Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - A H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Coeffic T, Thibaut S, Birgand G, Boutoille D, Caillon J. Épidémiologie et résistance aux antibiotiques des entérobactéries isolées d’infections urinaires en milieu communautaire et en EHPAD non adossé à un établissement sanitaire en 2018. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hue R, Coroller-Bec C, Guilloteau V, Libeau B, Birgand G. Highly drug-resistant bacteria: Is intra- and inter-hospital communication optimal? Med Mal Infect 2019; 49:447-455. [PMID: 30914214 DOI: 10.1016/j.medmal.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Communication represents a key component of the control of highly drug-resistant bacteria (HDRB) in healthcare settings. This survey assessed communication strategies developed and adopted in a large hospital network. METHODS An online survey was sent to 83 infection control specialists working in hospitals of the Pays de la Loire region, France, in June 2016. Internal and external systems of identification and communication of HDRB status (colonized and contact patients) were assessed at the following steps of the hospital pathway: patient admission, during the stay, at discharge, and at readmission. RESULTS Sixty-one hospitals (73%) participated in the survey: 31 (51%) had recently managed colonized patients and 51 (93%) had recently managed contact patients. At patient admission, 28 (46%) hospitals had an identification system for repatriated patients. During hospital stay, the colonized or contact status was informed in computerized patient records for 47/57 (82%) and 43 (75%) hospitals, respectively. At patient discharge, 56/61 (92%) hospitals declared transmitting the HDRB status to the downstream ward. Twenty-six and 25/60 (43% and 42%) hospitals had an automated alert system at readmission of colonized or contact patients, respectively. This strategy met the expectations of 15/61 (26%) infection control specialists. CONCLUSION Efforts are still required in terms of communication for HDRB control. Sharing experiences and tools developed by hospitals may be beneficial for the entire hospital network.
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Affiliation(s)
- R Hue
- Équipe opérationnelle d'hygiène, structure locale d'appui et d'expertise ECLIN, centre hospitalier Loire Vendée Océan, 85300 Challans, France
| | - C Coroller-Bec
- Équipe opérationnelle d'hygiène, structure locale d'appui et d'expertise LUTIN, centre hospitalier du Mans, 72037 Le Mans, France
| | - V Guilloteau
- Équipe opérationnelle d'hygiène, hôpital de la Corniche Angevine, 49290 Chalonnes, France
| | - B Libeau
- Équipe opérationnelle d'hygiène, structure locale d'appui et d'expertise COLINES, centre hospitalier de Saint-Nazaire, 44600 Saint-Nazaire, France
| | - G Birgand
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire, CHU - Le Tourville, 5, rue Pr-Yves-Boquien, 44093 Nantes, France.; NIHR Health Protection Research Unit, Antimicrobial Resistance and Healthcare Associated Infection at Imperial College London, Hammersmith Campus, W12 0NN London, UK.
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N'Guyen TTH, Bourigault C, Guillet V, Buttes ACGD, Montassier E, Batard E, Birgand G, Lepelletier D. Association between excreta management and incidence of extended-spectrum β-lactamase-producing Enterobacteriaceae: role of healthcare workers' knowledge and practices. J Hosp Infect 2018; 102:31-36. [PMID: 30557588 DOI: 10.1016/j.jhin.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spread of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in healthcare environments has become a major public health threat in recent years. AIM To assess how healthcare workers (HCWs) manage excreta and the possible association with the incidence of ESBL-PE. METHODS Eight hundred HCWs and 74 nurse-supervisors were questioned through two self-report questionnaires in order to assess their knowledge and practices, and to determine the equipment utilized for excreta management in 74 healthcare departments. Performance on equipment utilized, knowledge and practices were scored as good (score of 1), intermediate (score of 2) or poor (score of 3) on the basis of pre-established thresholds. Linear regression was performed to evaluate the association between HCWs' knowledge/practices and the incidence of ESBL-PE. FINDINGS Six hundred and eighty-eight HCWs (86%) and all nurse-supervisors participated in the survey. The proportions of respondents scoring 1, 2 and 3 were: 14.8%, 71.6% and 17.6% for equipment; 30.1%, 40.6 % and 29.3% for knowledge; and 2.0%, 71.9% and 26.1% for practices, respectively. The single regression mathematic model highlighted that poor practices (score of 3) among HCWs was significantly associated with increased incidence of ESBL-PE (P = 0.002). CONCLUSIONS A positive correlation was found between HCWs' practices for managing excreta and the incidence of ESBL-PE, especially in surgical units. There is an urgent need for development of public health efforts to enhance knowledge and practices of HCWs to better control the spread of multi-drug-resistant bacteria, and these should be integrated within infection control programmes.
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Affiliation(s)
| | - C Bourigault
- MiHAR Lab, University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - V Guillet
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - A-C Guille des Buttes
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - E Montassier
- MiHAR Lab, University of Nantes, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - E Batard
- MiHAR Lab, University of Nantes, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - G Birgand
- MiHAR Lab, University of Nantes, Nantes, France; Regional Infection Control Centre, Pays de la Loire, Nantes, France
| | - D Lepelletier
- MiHAR Lab, University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
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Troughton R, Birgand G, Johnson A, Naylor N, Gharbi M, Aylin P, Hopkins S, Jaffer U, Holmes A. Mapping national surveillance of surgical site infections in England: needs and priorities. J Hosp Infect 2018; 100:378-385. [DOI: 10.1016/j.jhin.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet JC, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar JR, Caron F, Hermieu JF. [Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. Prog Urol 2018; 28:943-952. [PMID: 30501940 DOI: 10.1016/j.purol.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Egrot
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Dinh
- Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, centre hospitalier régional Bretonneau, 37000 Tours, France
| | - G Birgand
- Centre de prévention des infections associées aux soins, CHU de Nantes, 5, rue du Pr-Boquien, 44000 Nantes, France
| | - F Bruyère
- Service d'urologie, centre hospitalier régional universitaire de Tours, 37000 Tours, France
| | - E Chartier-Kastler
- Médecine Sorbonne Université, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - M Cosson
- Laboratoire BioTIM, école centrale de Lille, université de Lille, CHU de Lille, 59000 Lille, France
| | - X Deffieux
- Service de gynécologie obstétrique, université Paris-Sud, hôpital Antoine-Béclère, groupe hospitalier Sud, AP-HP, 92140 Clamart, France
| | - P Denys
- Service de neuro-urologie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - M Etienne
- Service de maladies infectieuses et tropicales, hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - B Fatton
- Unité d'urogynécologie, groupe hospitalier Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 86000 Poitiers, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - C Lawrence
- Service microbiologie et hygiène, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - L Lenormand
- Service d'urologie, centre fédératif de pelvipérinéologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France
| | - D Lepelletier
- Service bactériologie et hygiène hospitalière, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-C Lucet
- Service de bactériologie, hygiène, virologie, parasitologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - E Marit Ducamp
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - C Pulcini
- Infectious Diseases Department, université de Lorraine, APEMAC, CHRU de Nancy, 54000 Nancy, France
| | - G Robain
- Service de rééducation neurologique, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, CHRU de Lille, 59200 Tourcoing, France
| | - M de Sèze
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex, France
| | - J-R Zahar
- Département de microbiologie, hôpital Avicenne, AP-HP, groupe hospitalier Paris-Seine-Saint-Denis, 93000 Bobigny, France; Unité de recherche Inserm 1137, IAME, université Paris-13, 93000 Bobigny, France
| | - F Caron
- Service des maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - J-F Hermieu
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Legeay C, Hue R, Berton C, Cormier H, Chenouard R, Corvec S, Birgand G. Control strategy for carbapenemase-producing Enterobacteriaceae in nursing homes: perspectives inspired from three outbreaks. J Hosp Infect 2018; 101:183-187. [PMID: 30389597 DOI: 10.1016/j.jhin.2018.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/24/2018] [Indexed: 12/22/2022]
Abstract
Three outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) in three nursing homes in western France were retrospectively assessed. In all, ten cases of colonization or infection with CPE were detected upon admission in neighbouring hospitals. Antibiotic consumption or high frailty was infrequent among them. Nursing homes should be included in a regional strategy to limit CPE spread.
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Affiliation(s)
- C Legeay
- Unité de Prévention et de Lutte contre les Infections Nosocomiales, Angers University Hospital, Angers, France.
| | - R Hue
- Infection Control Unit, Centre Hospitalier Loire Vendée Océan, Challans, France
| | - C Berton
- Medical Biology Laboratory, Centre Hospitalier Loire Vendée Océan, Challans, France
| | - H Cormier
- Unité de Prévention et de Lutte contre les Infections Nosocomiales, Angers University Hospital, Angers, France
| | - R Chenouard
- Microbiology Unit, Angers University Hospital, Angers, France
| | - S Corvec
- Microbiology Unit, Nantes University Hospital, Nantes, France
| | - G Birgand
- CPias Pays de la Loire, Nantes University Hospital, Nantes, France; Health Protection Research Unit, Imperial College London, UK
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Charani E, Smith I, Skodvin B, Prozziello A, Lucet JC, Lescure X, Birgand G, Poda A, Singh S, Holmes A. The implementation of antimicrobial stewardship in low, middle and high income countries. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bourigault C, Le Gallou F, Bodet N, Musquer N, Juvin ME, Corvec S, Ferronnière N, Wiesel S, Gournay J, Birgand G, Le Rhun M, Lepelletier D. Duodenoscopy: an amplifier of cross-transmission during a carbapenemase-producing Enterobacteriaceae outbreak in a gastroenterology pathway. J Hosp Infect 2018; 99:422-426. [DOI: 10.1016/j.jhin.2018.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/13/2018] [Indexed: 12/01/2022]
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Lemaignen A, Armand-Lefevre L, Birgand G, Mabileau G, Lolom I, Ghodbane W, Dilly MP, Nataf P, Lucet JC. Thirteen-year experience with universal Staphylococcus aureus nasal decolonization prior to cardiac surgery: a quasi-experimental study. J Hosp Infect 2018; 100:322-328. [PMID: 29733924 DOI: 10.1016/j.jhin.2018.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sternal wound infection (SWI) after cardiac surgery is a severe complication. Among preventive measures, pre-operative decolonization of nasal carriage of Staphylococcus aureus has recently been shown to be beneficial. This quasi-experimental study assessed the effect of decolonization on the incidence of S. aureus-associated SWI based on 19 years of prospective surveillance. METHODS Segmented negative binomial regression was used to analyse the change over time in the incidence of S. aureus mediastinitis requiring re-operation after cardiac surgery in a French university hospital between 1996 and 2014. Universal nasal decolonization with mupirocin was introduced in December 2001. The association between pre-operative nasal carriage and SWI due to S. aureus was analysed between 2006 and 2012. RESULTS Among 17,261 patients who underwent a cardiac surgical procedure, 565 developed SWI (3.3%), which was caused by S. aureus in 181 cases (1%). The incidence of mediastinitis caused by S. aureus decreased significantly over the study period (1.43% in 1996-2001 vs 0.61% and 0.64% in 2002-2005 and 2006-2014, respectively; P<0.001). In segmented analysis, there was a significant break in 2002, corresponding to the introduction of decolonization. Despite this intervention, pre-operative nasal carriage remained a significant risk factor for S. aureus mediastinitis (adjusted odds ratio 2.2; 95% confidence interval 1.2-4.2), as were obesity, critical pre-operative status, coronary artery bypass grafting (CABG), and combined surgery with valve replacement and CABG. CONCLUSION Universal nasal decolonization before cardiac surgery was effective in decreasing the incidence of mediastinitis caused by S. aureus. Nasal carriage of S. aureus remained a risk factor for S. aureus-associated SWI.
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Affiliation(s)
- A Lemaignen
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France; Infectious Diseases Unit, University Hospital of Tours, Tours, France.
| | - L Armand-Lefevre
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, France; Bacteriology Laboratory, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Birgand
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France; Infectious Diseases Unit, University Hospital of Tours, Tours, France; IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, France
| | - G Mabileau
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, France
| | - I Lolom
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - W Ghodbane
- Cardiac Surgery Department, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - M-P Dilly
- Department of Anaesthesiology, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - P Nataf
- Cardiac Surgery Department, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - J-C Lucet
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France; Infectious Diseases Unit, University Hospital of Tours, Tours, France; IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, France
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Bourigault C, Birgand G, Lakhal K, Bretonnière C. Quelle surveillance des infections associées aux soins en réanimation en 2018 ? Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La surveillance des infections associées aux soins (IAS) est prioritaire en réanimation, secteur à haut risque du fait de l’état critique des patients et de leur exposition aux dispositifs invasifs. Elle présente un triple objectif : décrire l’épidémiologie et l’incidence des IAS ; évaluer l’impact des actions de prévention ou de contrôle et alerter face à une épidémie ou des phénomènes émergents. Cette surveillance des IAS peut être réalisée selon une méthodologie interne, définie par l’établissement, ou intégrée à un réseau de surveillance. L’intérêt de la surveillance pour la prévention des IAS en réanimation n’est plus à démontrer, mais la surveillance manuelle reste chronophage pour les cliniciens et les équipes d’hygiène, limitant ainsi le temps dédié à la prévention de ces infections. La surveillance automatisée apparaît aujourd’hui comme un outil intéressant, tant par ses performances que par le gain de temps qu’elle représente pour les équipes. Plusieurs éléments sont primordiaux pour obtenir des résultats fiables : la nécessité d’une harmonisation des définitions et des méthodes de surveillance ; la mise à disposition d’outils informatiques performants pour faciliter le suivi des patients ; le leadership des réanimateurs dans la surveillance. Cet article fait le point sur les méthodes de surveillance des IAS utilisées aujourd’hui en réanimation, l’intérêt de la mise en place de cette surveillance épidémiologique ainsi que la fiabilité des données recueillies et, enfin, les avantages du développement d’une surveillance semi-automatisée ou automatisée des IAS dans ce secteur.
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Birgand G, Hayatgheib N, Bémer P, Guilloteau V, Legeay C, Perron S, Chapelet G, Corvec S, Bourigault C, Batard E, Lepelletier D. Multi-drug-resistant Enterobacteriacae carriage in highly exposed nursing homes: prevalence in western France. J Hosp Infect 2017; 97:258-259. [PMID: 28774743 DOI: 10.1016/j.jhin.2017.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/19/2022]
Affiliation(s)
- G Birgand
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, France; Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - N Hayatgheib
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; ONIRIS National Veterinary School (Man-imal One Health Master 2 degree), Nantes, France
| | - P Bémer
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - V Guilloteau
- Infection Control Unit, Chalonnes Hospital Centre, Chalonnes, France
| | - C Legeay
- Infection Control Unit, Angers University Hospital, Angers, France
| | - S Perron
- Infection Control Unit, Saumur Hospital Centre, Saumur, France
| | - G Chapelet
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Gerontologic Department, Nantes University Hospital, Nantes, France
| | - S Corvec
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - C Bourigault
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - E Batard
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - D Lepelletier
- University of Nantes, MiHAR Lab, UFR Medicine, Nantes, France; ONIRIS National Veterinary School (Man-imal One Health Master 2 degree), Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
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Charani E, Ahmad R, Tarrant C, Birgand G, Leather A, Mendelson M, Moonesinghe SR, Sevdalis N, Singh S, Holmes A. Opportunities for system level improvement in antibiotic use across the surgical pathway. Int J Infect Dis 2017; 60:29-34. [PMID: 28483725 DOI: 10.1016/j.ijid.2017.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 12/16/2022] Open
Abstract
Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.
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Affiliation(s)
- E Charani
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK.
| | - R Ahmad
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK
| | - C Tarrant
- Department of Health Sciences, University of Leicester, Centre for Medicine, Leicester, UK
| | - G Birgand
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK
| | - A Leather
- King's Centre for Global Health & Health Partnerships, Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King's College London, UK
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital Observatory, Cape Town, South Africa
| | - S R Moonesinghe
- Centre for Anaesthesia Critical Care and Pain Medicine, University College London Hospitals, London, UK()
| | - N Sevdalis
- Centre for Implementation Science, Institute of Psychiatry, King's College London, Denmark Hill, UK
| | - S Singh
- School of Medicine, Amrita University, Tamilnadu, Kochi, India
| | - A Holmes
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, Department of Medicine, London, UK
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Birgand G, Johansson A, Szilagyi E, Lucet JC. Overcoming the obstacles of implementing infection prevention and control guidelines. Clin Microbiol Infect 2015; 21:1067-71. [PMID: 26369604 DOI: 10.1016/j.cmi.2015.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 12/21/2022]
Abstract
Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success.
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Affiliation(s)
- G Birgand
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; INSERM, IAME, UMR 1137, F-75018, Paris, France; AP-HP, Hôpital Bichat - Claude Bernard, Infection Control Unit, Paris, France.
| | - A Johansson
- The Laboratory for Molecular Infection Medicine Sweden, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - E Szilagyi
- National Centre for Epidemiology, Budapest, Hungary
| | - J-C Lucet
- INSERM, IAME, UMR 1137, F-75018, Paris, France; AP-HP, Hôpital Bichat - Claude Bernard, Infection Control Unit, Paris, France
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27
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Lemaignen A, Birgand G, Ghodhbane W, Alkhoder S, Lolom I, Belorgey S, Lescure FX, Armand-Lefevre L, Raffoul R, Dilly MP, Nataf P, Lucet J. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation. Clin Microbiol Infect 2015; 21:674.e11-8. [DOI: 10.1016/j.cmi.2015.03.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/13/2015] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
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Bonnal C, Birgand G, Lolom I, Diamantis S, Dumortier C, L'Heriteau F, Armand-Lefevre L, Lucet JC. Staphylococcus aureus healthcare associated bacteraemia: An indicator of catheter related infections. Med Mal Infect 2015; 45:84-8. [PMID: 25676476 DOI: 10.1016/j.medmal.2015.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/01/2014] [Accepted: 01/13/2015] [Indexed: 01/11/2023]
Abstract
PURPOSE Surveillance of preventable healthcare associated infections and feedback of the results to clinicians is central in the efforts to improve performance. We assessed Staphylococcus aureus healthcare associated bloodstream infection (HA-BSI) as an indicator of healthcare quality. PATIENTS AND METHOD Between 2002 and 2012, we carried out a ten-year prospective bedside surveillance of S. aureus healthcare associated bacteraemia in a 940-bed university hospital using standard definitions. RESULTS Overall, 2784 HA-BSI were identified during the study period, among which 573 (18%) were due to S. aureus. Among these 573 S. aureus bacteraemias, 189 originated from intravascular catheters (32.8%) of which 84% (158/189) in patients outside intensive care units. The proportion of catheter related HA-BSI due to S. aureus was 56% (61/109) in PVC-related HA-BSI and 34% (103/301) in CVC-related HA-BSI. A sharp decrease of PVC-related HA-BSI from 20 to 7 per year was obtained during the same period. CONCLUSION In our experience, S. aureus HA-BSI is a simple and useful indicator of catheter associated infections, and therefore of healthcare quality, especially in units not covered by other type of surveillance.
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Affiliation(s)
- C Bonnal
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Bichat-Claude-Bernard, Paris, France.
| | - G Birgand
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Bichat-Claude-Bernard, Paris, France
| | - I Lolom
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Bichat-Claude-Bernard, Paris, France
| | - S Diamantis
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Bichat-Claude-Bernard, Paris, France
| | - C Dumortier
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Bichat-Claude-Bernard, Paris, France
| | | | - L Armand-Lefevre
- Laboratoire de bactériologie, hôpital Bichat-Claude-Bernard, Paris, France
| | - J C Lucet
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Bichat-Claude-Bernard, Paris, France
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Le Dorze M, Gault N, Foucrier A, Ruppé E, Mourvillier B, Woerther PL, Birgand G, Montravers P, Dilly MP, Tubach F, Andremont A, Timsit JF, Wolff M, Armand-Lefèvre L. Performance and impact of a rapid method combining mass spectrometry and direct antimicrobial susceptibility testing on treatment adequacy of patients with ventilator-associated pneumonia. Clin Microbiol Infect 2014; 21:468.e1-6. [PMID: 25656626 DOI: 10.1016/j.cmi.2014.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
Inappropriate antibiotic therapy in ventilator-associated pneumonia (VAP) is associated with increased mortality. Using broad-spectrum antibiotics for 48 h until the results of conventional cultures and antimicrobial susceptibility testing (AST) are available, may promote the emergence of drug-resistant bacteria. Performing AST directly on clinical respiratory samples would hasten the process by at least 24 h. Here, we analysed the diagnostic performance of a rapid method combining mass spectrometry and direct AST (DAST), and compared it with the conventional method (mass spectrometry with conventional AST (CAST)). Additionally, we assessed its potential impact on antimicrobial use in patients. Over a period of 18 months, the two methods were performed on 85 bronchoalveolar lavages obtained from intensive care unit patients with suspected VAP, and in which Gram-negative bacilli were observed on direct examination. Only the CAST results were reported to the clinicians. DAST produced useable results in 85.9% of the patients. The sensitivity and negative predictive values of DAST were 100% for all antibiotics tested, except gentamicin (97.1%, (95% CI 93.3-101) and 97.4% (93.7-101), respectively) and amikacin (88.9% (81.7-96.1) and 96.4% (92.1-100.7), respectively), compared with CAST. Specificity and positive predictive values ranged from 82.9 (74.2-91.5) to 100%, and from 86.4 (78.5-94.2) to 100%, respectively. If the DAST results had been reported to the clinicians, treatment could have been optimized 24 h earlier in 35/85 (41.2%) patients, with 17 carbapenem patient-days saved. Overall, routine use of the DAST method could help optimize earlier antibiotic treatment in patients with suspected VAP.
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Affiliation(s)
- M Le Dorze
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France
| | - N Gault
- Département Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE 801, Paris, France; UMR 1123 ECEVE, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - A Foucrier
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France
| | - E Ruppé
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - B Mourvillier
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - P L Woerther
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France
| | - G Birgand
- UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Unité hospitalière de lutte contre les infections nosocomiales, Hôpital Bichat, Paris, France
| | - P Montravers
- Réanimation chirurgicale, Hôpital Bichat, Paris, France
| | - M P Dilly
- Réanimation chirurgicale cardio-vasculaire, AP-HP, Hôpital Bichat, Paris, France
| | - F Tubach
- Département Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE 801, Paris, France; UMR 1123 ECEVE, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - A Andremont
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - J F Timsit
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - M Wolff
- Réanimation médicale et infectieuse, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - L Armand-Lefèvre
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat, Paris, France; UMR 1137, INSERM, IAME, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
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Birgand G, Armand-Lefevre L, Lepainteur M, Lolom I, Neulier C, Reibel F, Yazdanpanah Y, Andremont A, Lucet JC. Introduction of highly resistant bacteria into a hospital via patients repatriated or recently hospitalized in a foreign country. Clin Microbiol Infect 2014; 20:O887-90. [PMID: 25069719 DOI: 10.1111/1469-0691.12604] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 01/12/2023]
Abstract
We 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.
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Affiliation(s)
- G Birgand
- AP-HP, Infection Control Unit, Hôpital Bichat - Claude Bernard, Paris, France; IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Neulier C, Birgand G, Ruppé É, Armand-Lefèvre L, Lolom I, Yazdanpanah Y, Lucet JC, Andremont A. Enterobacteriaceae bacteremia: risk factors for ESBLPE. Med Mal Infect 2013; 44:32-8. [PMID: 24321202 DOI: 10.1016/j.medmal.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/16/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The increasing prevalence of extended spectrum beta-lactamase producing enterobacteriaceae (ESBLPE) requires defining the use of carbapenems in first intention. We analyzed the associations between enterobacteriaceae bacteremia (EbBact) and ESBLPE carriage during 10 years in a 950-bed teaching hospital. METHODS We analyzed a 10-year (July 2001 to June 2011) prospective collection of bacteremia cases including 2 databases: (1) EbBact and (2) a computerized database of patients carrying EBLSE. Only one episode of EbBact was analyzed per patient and hospital stay. Factors associated with ESBLPE bacteremia were assessed by univariate and multivariate logistic regression analysis. RESULTS Overall, 2355 cases of EbBact were identified, among which 135 (5.7%) were ESBLPE (2001-05: 1.4%, 2006-09: 7.6%, 2010-11: 14.2%). ESBLPE bacteremia was observed in 52 of the 88 (59%) patients carrying ESBLPE and in 83/2267 (3.7%) patients not known to be colonized with ESBLPE. Factors associated with ESBLPE bacteremia in patients not known to be colonized were: female gender (ORa=0.56, CI95% [0.34-0.91]), hospitalization in the ICU (ORa=2.51 [1.27-5.05]) or medical/surgical wards (ORa=1.83 [1.04-3.38]), the period (2006-09, ORa=4.08 [2.21-8.16]; 2010-11, ORa=8.17 [4.14-17.06] compared to 2001-05), and history of EbBact (ORa=2.29 [0.97-4.79]). CONCLUSION In case of EbBact, patients known to be colonized with ESBLPE present with ESBLPE bacteremia in more than half of the cases, requiring carbapenems as empirical antibiotic treatment. The global prevalence of ESBLPE among patients presenting with EbBact not known to be colonized with ESBLPE was 3.7%.
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Affiliation(s)
- C Neulier
- Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - G Birgand
- Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; IAME, UMR 1137, université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; IAME, UMR 1137, INSERM, 75018 Paris, France.
| | - É Ruppé
- Bacteriology laboratory, Bichat-Claude-Bernard Hospital, 75018 Paris, France
| | - L Armand-Lefèvre
- Bacteriology laboratory, Bichat-Claude-Bernard Hospital, 75018 Paris, France
| | - I Lolom
- Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - Y Yazdanpanah
- IAME, UMR 1137, université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; IAME, UMR 1137, INSERM, 75018 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France
| | - J-C Lucet
- Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; IAME, UMR 1137, université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; IAME, UMR 1137, INSERM, 75018 Paris, France
| | - A Andremont
- Bacteriology laboratory, Bichat-Claude-Bernard Hospital, 75018 Paris, France
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Birgand G, Lolom I, Armand-Lefevre L, Belorgey S, Ruppé E, Andremont A, Lucet JC. O049: Can the search-and-isolate strategy for controlling the spread of highly resistant bacteria (HRB) be mitigated? Antimicrob Resist Infect Control 2013. [PMCID: PMC3687937 DOI: 10.1186/2047-2994-2-s1-o49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Decre D, Birgand G, Geneste D, Maury E, Petit JC, Barbut F, Arlet G. Possible importation and subsequent cross-transmission of OXA-48-producing Klebsiella pneumoniae, France, 2010. Euro Surveill 2010; 15. [DOI: 10.2807/ese.15.46.19718-en] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the possible first patient-to-patient transmission of Klebsiella pneumoniae with decreased susceptibility to imipenem and producing OXA-48, CTX-M15, TEM-1 and OXA-1 in a French hospital.
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Affiliation(s)
- D Decre
- University Pierre and Marie Curie, ER8 Antibiotiques et Flore digestive, Paris VI, France
- Assistance Publique-Hôpitaux de Paris, Microbiology, Saint-Antoine Hospital, Paris, France
| | - G Birgand
- Assistance Publique-Hôpitaux de Paris, Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Saint-Antoine Hospital, Paris, France
| | - D Geneste
- University Pierre and Marie Curie, ER8 Antibiotiques et Flore digestive, Paris VI, France
| | - E Maury
- Assistance Publique-Hôpitaux de Paris, Medical Intensive Care Unit, Saint-Antoine Hospital, Paris, France
| | - J C Petit
- Assistance Publique-Hôpitaux de Paris, Microbiology, Saint-Antoine Hospital, Paris, France
| | - F Barbut
- Assistance Publique-Hôpitaux de Paris, Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Saint-Antoine Hospital, Paris, France
| | - G Arlet
- University Pierre and Marie Curie, ER8 Antibiotiques et Flore digestive, Paris VI, France
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Birgand G, Blanckaert K, Carbonne A, Coignard B, Barbut F, Eckert C, Grandbastien B, Kadi Z, Astagneau P. Investigation of a large outbreak of Clostridium difficile PCR-ribotype 027 infections in northern France, 2006-2007 and associated clusters in 2008-2009. ACTA ACUST UNITED AC 2010; 15. [PMID: 20587362 DOI: 10.2807/ese.15.25.19597-en] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 2006 and 2007, a large outbreak of Clostridium difficile infections (CDIs) with PCR-ribotype 027 was identified in northern France. Overall, 38 healthcare facilities notified 529 CDIs over a 22-month period, including 281 laboratory-confirmed CDI 027 and 248 non-confirmed CDI 027 cases (incidence rate per 10,000 elective bed days: 1.63, range: 0.07 to 7.94). The cases occurred mainly in long-term care hospital facilities and nursing homes, near the border between France and Belgium. An active surveillance and prevention campaign was launched at the first epidemic peak including hygiene precautions for healthcare professionals, which supported healthcare facilities to improve care organisation. The outbreak was controlled at the end of 2007, but sporadic cases were identified until the end of 2009. A bundle of appropriate control measures may halt the spread of such outbreaks, provided that substantial human resources and financial support are available.
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Affiliation(s)
- G Birgand
- Regional coordinating centre for nosocomial infection control, Paris, France.
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36
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Birgand G, Carbonne A, Blanckaert K, Kadi Z, Grandbastien B, Coignard B, Barbut F, Astagneau P. Investigation sur deux années d’épidémie de Clostridium difficile ribotype 027 dans le Nord de la France. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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