[Policies for the use of antibiotic in 99 Southwestern French hospitals in 2002]. / Politique d'utilisation des antibiotiques: état des lieux dans 99 établissements de santé de l'interrégion Sud-Ouest.

OBJECTIVE: Increasing antimicrobial resistance in bacteria is a major health problem and requires the implementation of stringent policies to optimize the use of antibiotics. DESIGN: In 2003 the authors conducted a study in southwestern French hospitals, using a questionnaire to assess the implementation of antibiotic policies according to national guidelines issued by the French government in 2002. RESULTS: The most frequent actions quoted by the 99 respondents were: issuing of a list of available antibiotics, issuing of information regarding antibiotic consumption and bacterial resistance, and control of antibiotics dispensation. Local guidelines were available in 45% of hospitals for curative treatment and in 87% for antibioprophylaxis in surgery. The evaluation of antibiotic use and computer links between clinical settings, pharmacy and microbiology lab were the less widespread measures. The number and type of actions were related to hospital size and activity. CONCLUSIONS: These findings support that policies for an appropriate use of antimicrobials should be reinforced by issuing treatment guidelines and specific tools for dispensation and evaluation. This survey also emphasizes the need for appropriate policies relating to the size and medical activities of healthcare institutions.

Agrobacterium radiobacter as a cause of pseudobacteremia.

Agrobacterium radiobacter was isolated from 15 blood cultures collected from 15 newborns. Contamination of blood cultures was suspected because, in most cases, the babies' illnesses seemed incompatible with infection. A radiobacter was isolated from citrated tubes used for clotting-factor studies. Review of venipuncture technique revealed that occasionally the coagulation study tubes were being inoculated before the blood-culture bottles. This investigation demonstrated how an environmental source coupled with faulty technique caused a cluster of false-positive blood cultures.

Comparison of protein patterns of Listeria monocytogenes grown in biofilm or in planktonic mode by proteomic analysis.

The proteome of a Listeria monocytogenes strain isolated from a food plant was investigated to study the differential protein pattern expressed by biofilms and planktonic bacteria. The approach used in this study was a combination of two-dimensional electrophoresis, matrix-assisted laser desorption ionization-time of flight and database searches for the protein identification. Thirty-one proteins varied significantly between the two growth conditions. Twenty-two and nine proteins were up- and down-regulated respectively and nine proteins were successfully identified. The variations of the protein patterns indicated that the biofilm development is probably controlled by specific regulation of protein expression involved at various levels of cellular physiology.

Spectrum of antimicrobial activity and user acceptability of the hand disinfectant agent Sterillium Gel.

The antimicrobial efficacy of alcohol-based hand gels has been shown to be significantly less than liquid hand rubs probably because of a lower concentration of alcohol. Sterillium Gel is the first hand gel with 85% ethanol. Its antimicrobial efficacy and user acceptability was studied. Bactericidal activity was tested according to prEN 12054 against Staphylococcus aureus, Enterococcus hirae, Pseudomonas aeruginosa and Escherichia coli (suspension test) and EN 1500 (15 volunteers; four replicates), fungicidal activity according to EN 1275 against Candida albicans and spores of Aspergillus niger (suspension test) and tuberculocidal activity against Mycobacterium terrae using the DGHM suspension test. Virucidal activity was determined in suspension tests based on reduction of infectivity with and without interfering substances (10% fetal calf serum; 0.3% erythrocytes and 0.3% bovine serum albumin). Ninety-six healthcare workers in hospitals in France and the UK used the gel for four weeks and assessed it by filling out a questionnaire. The gel was bactericidal (a reduction factor of > 10(5)-fold), tuberculocidal (reduction factor > 10(5)) and fungicidal (reduction factor > 10(4)) in 30 s. Irrespective of interfering substances the gel inactivated orthopoxvirus and herpes simplex virus type 1 and 2 in 15 s, adenovirus in 2 min, poliovirus in 3 min and papovavirus in 15 min by a factor of > 10(4)-fold. Rotavirus and human immunodeficiency virus were inactivated in 30 s (without interfering substances). Under practical use conditions it was as effective in 30 s as the reference alcohol in 60 s. Most users described the tackiness, aggregation, skin feeling after use and smell as positive or acceptable. A total of 65.6% assessed the new gel to be better than a comparator irrespective of its type (gel or liquid). Overall Sterillium Gel had a unique spectrum of antimicrobial activity. It is probably the first alcohol-based hand gel to pass EN 1500 in 30 s. Due to the excellent acceptance by healthcare workers it may significantly improve compliance for hand hygiene and thereby help to reduce the incidence of nosocomial infection.

Use of antibiotics in hospitals in south-western France.

Data on the use of antibiotics were collected by means of a questionnaire from 49 hospitals in south-western France. Use was expressed as a usage density rate: number of defined daily doses (DDDs) per 1000 patient-days. The average use of antibiotics amounted to 402 DDDs per 1000 patient-days and varied between 60 and 734. In acute-care wards, the amount of antibiotic use increased with the size of the hospital: 461 DDDs per 1000 patient-days for group A (<100 beds), 510 DDDs per 1000 patient-days for group B (more than 100 and less then 300 beds) and 676 DDDs per 1000 patient-days for group C (>300 beds). The rate of use differed among different types of hospital areas and varied from 58 for psychiatry departments to more than 1273 DDDs per 1000 patient-days for the infectious diseases departments. Broad-spectrum penicillins were the most frequently prescribed antibiotics. Fluoroquinolone and third-generation cephalosporin use were relatively uniform in the three size categories. This study shows that it is possible for a hospital to benchmark its consumption with other hospitals that are similar in size. In this way, surveillance of antibiotic use can aid hospitals in targeting infection control efforts.

Effects of pH or a(w) stress on growth of Listeria monocytogenes.

The growth of three strains of Listeria monocytogenes at 20 degrees C in a meat broth of different pH or water activity was investigated. At inoculation or at the beginning of the exponential phase, cells were exposed to stress by the addition of NaOH or NH4+, acetic acid, NaCl or KCl, in order to reach a pH of either 9.0 or 5.6, or an a(w) of 0.950 or 0.965, respectively. The effects of the exposure to stress on the generation and lag times of each strain were analysed by turbidity measurements for cultures in micro-titer plates. Results were confirmed by conducting the same experiments in a fermentor, except for the maximal population reached. The three strains showed similar behaviour. Cells were able to overcome the alkaline stress rapidly whereas acid and osmotic shocks induced important changes of the growth parameters. Cells exposed to acid or osmotic conditions from the time of inoculation were less affected than cells exposed at the beginning of the mid-exponential phase.

Effect of several decontamination procedures on Listeria monocytogenes growing in biofilms.

Listeria monocytogenes is a pathogenic bacterium which has been implicated in several foodborne illnesses. This microorganism grows into biofilms attached to the surfaces in food-processing plants, increasing its resistance to antimicrobial agents. The present work was realized to investigate the attachment of L. monocytogenes isolates to glass surfaces and to find a decontamination procedure to remove these bacteria in biofilms. Three-day biofilms were prepared by growing L. monocytogenes isolates from food plant environments on glass surfaces. Sixteen decontamination treatments at different pHs, temperatures, and times of exposure were tested against L. monocytogenes biofilms. The most efficient treatments were those applied at 63 degrees C. Combinations of decontamination treatments applied at 55 degrees C for 30 min provided different results according to the other factors used. In general, L. monocytogenes biofilms were found to be not very susceptible to high osmolarity (10.5% NaCl), and the interaction of sodium chloride and acid did not seem to have important effects in inactivating these bacteria (from a 1.3-to a 1.9-log-CFU/cm2 reduction). The combination of NaOH (pH 10.5; 100 mM) and acetic acid (pH 5.4; 76.7 mM) applied sequentially at 55 degrees C for even 5 min was shown to be the most effective treatment to remove L. monocytogenes from biofilms (at least a 4.5-to 5.0-log-CFU/cm2 decline).

[Evaluation of decontamination procedures used at digestive endoscopy units in Gironde]. / Evaluation des procédures de décontamination utilisées dans les centres d'endoscopie digestive de Gironde.

Decontamination procedures used for endoscopes were noted in 23 digestive endoscopy units, public and private, in the department of Gironde and compared to recommended procedures. Serial, bacteriological samples were obtained from one esogastroscope and one colonoscope in each unit, after upper endoscopy and colonoscopy diagnostic procedures at the end of the endoscopy session. Six units of 23 used complete decontamination procedures. In the 17 other units, principal errors of decontamination procedures were: inadequate cleaning of internal channel of scopes (12 units) and lack of utilization of glutaraldehyde between each endoscopy (8 units). Bacteriological samples were negative in 11/12 endoscopes after a complete decontamination procedure and in 8/39 after an inadequate procedure (p less than 0.01). Complete procedures are efficacious but not used often enough. Information and changes in endoscopic practices are necessary in digestive endoscopy units.

[Information campaign in Aquitaine about protection against malaria for travelers going to tropical regions]. / Campagne d'information en Aquitaine pour la protection contre le paludisme des voyageurs se déplaçant en zone tropicale.

The incidence of imported malaria is increasing in France, in relation to the increasing frequency of travel to tropical areas and the extension of chemoresistant strains of Plasmodium falciparum throughout the world. Worsening morbidity and mortality due to this parasite in the last 5 years is having an impact in socioeconomic terms; this is all the more prejudicial in that a young healthy population is concerned. Traditional chemoprophylaxis is at present insufficient for adequately controlling this recrudescence. Both the public and general practitioners should be made more aware of the measures to be taken during, and especially after foreign travel, in order to reverse the present tendency concerning imported malaria, and to improve travellers' protection.

[Medical liability: new obligations concerning information of patients on infectious risks]. / Responsabilité médicale: les nouvelles obligations en matière d'information sur les risques infectieux.

Nosocomial infections have always been considered as "unbearable" by patients and public opinion. Court decisions progressively evolved to a greater compensation until the 4 March 2002 law, "relative to the rights of patients and to the healthcare system quality" which set up a very specific protocol for liability and access to compensation, whether care is given in public or private practice. Furthermore, this law has determined new obligations concerning information of patients, especially concerning nosocomial infections which must be acknowledged by physicians.

[The cost of hospitalizing patients with AIDS in Bordeaux]. / Le coût de l'hospitalisation des malades atteints de SIDA à Bordeaux.

The study deals with the infectious diseases department of the university hospital of Bordeaux where most of the AIDS patients in south western France are admitted. In 1986, the department counted 64 admissions (and readmissions) from 35 AIDS patients and 1376 admissions (and readmissions) from 707 other patients. Taking into account admissions of AIDS patients into other hospital departments, the average cost of a hospital day of an AIDS patient was estimated at 1815 French francs in 1986. The length of stay, per AIDS patient and per year, was of 31.5 days in Bordeaux (1986), as compared to 18 days in San Francisco, USA (1984) and 33 days in the Massachusetts, USA (1984). In Bordeaux, the length of stay for other patients in the same department was 17 days. The consumption of diagnostic-related biological exams of AIDS patients in Bordeaux was twofold that of other patients. Per capita, overall hospital costs incurred by AIDS patients increased by 56 percent, as compared to other patients. For the time being, there is no need to build a new department, the existing facilities being sufficient to cope with the AIDS epidemic. If a new department has to be established, the hospital cost of AIDS patients would of course be much higher.