RESUMO
We conducted a retrospective study from 2005 to 2019 to describe the epidemiology and mortality of enterobacterial producing extended-spectrum ß-lactamase (E-ESBL) infections in our university hospital over a 17-year period of time. Clinical and microbiological data were extracted from different software used for continuous surveillance. Stool samples from systematic screening for E-ESBL colonization were excluded from the study. The incidence rate of infected patient was calculated by E-ESBL species and by year. A comparison of mortality rate in patients with bloodstream infections versus other types of infections was conducted using a Kaplan-Meier method survival curves. A log rank test (with a risk of 5%) was carried out. A total of 3324 patients with E-ESBL infection were included with an increased incidence density per 1000 days of hospitalization from 0.03 in 2005 to 0.47 in 2019. Escherichia coli was the most frequently isolated pathogen (64%). Global mortality rate was significantly higher with E. coli than with Klebsiella spp. and Enterobacter spp. (p < 0.001). Mortality was higher in patients with E-ESBL bloodstream infection than in patients with other type of E-ESBL infection (p < 0.001). Our study showed a significant increase of the E-ESBL incidence density over a 17-year period survey with a higher mortality in patients with E-ESBL bacteremia. This highlights the need to continue efforts to control the spread of these multi-resistant bacteria in our institution.
Assuntos
Bacteriemia , Infecções por Enterobacteriaceae , Infecções por Escherichia coli , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Escherichia coli , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Humanos , Incidência , Klebsiella , Estudos Retrospectivos , Fatores de Risco , beta-LactamasesRESUMO
An outbreak in a medical intensive care unit was due to an OXA-23-producing Acinetobacter baumannii strain imported from a repatriate hospitalized in Singapore. This outbreak revealed another multidrug resistant epidemic strain that had been present in the hospital for 2 years. Both outbreaks were controlled after 9 months of an extensive infection control program.
Assuntos
Infecções por Acinetobacter/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Farmacorresistência Bacteriana Múltipla , Contaminação de Equipamentos/prevenção & controle , Controle de Infecções/métodos , Infecções por Acinetobacter/prevenção & controle , Idoso , Infecção Hospitalar/prevenção & controle , Feminino , França , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , SingapuraRESUMO
We developed a quantitative real-time PCR assay targeting the mip gene of Legionella pneumophila for a prospective study from September 2004 to April 2005. It was compared with a standard culture method (French guideline AFNOR T90-431), analysing 120 water samples collected to monitor the risk related to Legionellae at Nantes hospital and to investigate a case of legionellosis acquired from hospital environment. Samples from six distinct water distribution systems were analysed by DNA extraction, amplification and detection with specific primers and FRET probes. The detection limit was 100 genomic units of L. pneumophila per liter (GU/l), the positivity threshold about 600 GU/l and the quantification limit 800 GU/l. PCR results were divided into three groups: negative (n=63), positive but non-quantifiable (n=22) or positive (n=35). PCR showed higher sensitivity than culture, whereas four culture-positive samples appeared negative by PCR (PCR inhibitor detected for two of them). Although no correlation was observed between both methods and real-time PCR cannot substitute for the reference method, it represents an interesting complement. Its sensitivity, reproducibility and rapidity appear particularly interesting in epidemic contexts in order to identify the source of contamination or to evaluate critical points of contamination in water distribution systems.