RESUMO
Surgical site infection (SSI) in plastic, reconstructive and aesthetic surgery (ERCP) is quite uncommon compared to other surgical specialities but remains one of the main complications. The aim of our study was to provide feedback on the systematic investigation of SSI in ERCP. This is a monocentric retrospective study, including all paediatric and adult patients who have undergone ERCP surgery between 01/01/2014 and 31/12/2021. During this period, the department systematically investigated all SSI cases. Eight thousand eight hundred and seventy-eight surgical procedures were performed. The SSI rate was 0.34%. Thirty SSIs (19W,11M), with a mean age of 56 years (none paediatric), were investigated. Twenty-seven patients suffered from comorbidities. The surgical indications included 17 cases of skin cancer, 7 cases of weight loss, 4 cases of breast reconstruction, 1 lipoma, 1 pectus excavatum. Eleven surgeries consisted in lymphnode procedures (8 sentinel lymphnodes, 3 curage). The average operating time was 116minutes. Nineteen patients received antibiotic prophylaxis. The average time to onset of SSI after surgery was 10 days. The most prevalent bacteria were commensals of the skin flora and the digestive tract. Apart from surgical management, 100% of patients were treated with antibiotics. High age, multiple comorbidities, long, combined procedures, placement of equipment, lymph node surgery, post-operative punctures on implanted equipment, are all risks factors for SSI. The implementation of a systematic monitoring of SSI within our department has provided us with the opportunity to analyse our data in real time and allow us to adjust our practices if necessary. This process can be used in other plastic reconstructive and aesthetic surgery departments. The collection and analysis of SSIs is both easily done and the procedure is well standardized. The assistance of the operational hygiene team is a key asset for the success of this project. The development of this type of procedure on a national level could be an asset to improve the management of SSI by taking advantage of the experience of a larger number of centres.
Assuntos
Procedimentos de Cirurgia Plástica , Cirurgia Plástica , Adulto , Humanos , Criança , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/epidemiologia , Estudos Retrospectivos , Retroalimentação , Fatores de RiscoRESUMO
OBJECTIVE: To estimate the benefits of iterative prevalence surveys in detecting trends of hospital-acquired infections (HAIs). METHODS: On the basis of the French protocol for national prevalence studies, HAI data of 15 consecutive annual surveys performed at the same period by the same group of investigators was gathered in a single database to describe the trend of HAIs in a University Hospital over a 15-year period. RESULTS: A total of 20,401 patients were included. Overall, the prevalence of patients presenting with at least one HAI acquired in our University Hospital was 5.1% [95% CI, 4.8-5.4%]. The prevalence of HAIs and antimicrobial drug use significantly decreased over time (P<0.01). CONCLUSION: Despite limitations, repeated prevalence surveys can be a useful tool for promoting control measures to better prevent HAIs.
Assuntos
Infecção Hospitalar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Uso de Medicamentos/tendências , Feminino , França/epidemiologia , Inquéritos Epidemiológicos , Hospitais Universitários , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Tempo , Adulto JovemRESUMO
In the care setting, hand washing constitutes an essential measure for preventing hand-transmitted infections. Best practices also recommend the principle of zero jewellery. Not so easy to implement, especially when it comes to the removal of wedding rings. A nurse shares her thoughts on this sensitive issue regarding the safety of care.
Assuntos
Atitude do Pessoal de Saúde , Infecção Hospitalar/enfermagem , Infecção Hospitalar/transmissão , Desinfecção das Mãos/normas , Joias/microbiologia , Infecção Hospitalar/prevenção & controle , Resistência Microbiana a Medicamentos , França , Desinfecção das Mãos/métodos , Humanos , Fatores de RiscoRESUMO
INTRODUCTION: Urinary tract infection is the most common healthcare-association infection, especially because of urinary catheter. We evaluated our practices concerning catheter insertion and management in our institution. MATERIALS AND METHODS: We conducted a single-centre descriptive cross-sectional study during 1 week in September 2014 in all adult departments. We noted prevalence, indications, length, management of urinary catheter (UC) and symptomatic catheter-associated urinary tract infections (SCAUTI). RESULTS: Amongst 1046 patients audited, 125 (12%) had UC. The mean age was 72 years (64.8-79.2). UC prevalence was higher in surgical (88%) and medical (87%) intensive care, urology (50%), geriatrics (18%) and long-term care (18%) departments. The average catheterisation length was 7.8 days (3.8-11.8); it was shorter in surgery than in medicine departments (3.6 vs 9.7 days, P<0.001). Catheters were present for more than 4 days in 60% of the cases. Acute urinary retention was the most frequent indication (59%), significantly more in medical than surgical departments (75% vs 26%). Others indications were perioperative (17%), diuresis monitoring (12%), strict immobilization (4%) and unnecessary indications or staff comfort (4%). A SCAUTI was present in 10% of cases, mostly in medicine department (30% vs 8%). CONCLUSION: The prevalence of our institution is higher than the national prevalence (8.1%), but still below the European average (17.2%). Control of the risk of CAUTI requires compliance with UC appropriate indications, UC management, and prompt removal of unnecessary UC. LEVEL OF EVIDENCE: 4.
Assuntos
Infecções Relacionadas a Cateter/etiologia , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Estudos Transversais , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaAssuntos
Infecções por Corynebacterium/microbiologia , Corynebacterium/isolamento & purificação , Infecção Hospitalar/microbiologia , Meningites Bacterianas/microbiologia , Acidentes de Trânsito , Adulto , Antibacterianos/uso terapêutico , Edema Encefálico/etiologia , Derivações do Líquido Cefalorraquidiano , Corynebacterium/patogenicidade , Infecções por Corynebacterium/etiologia , Evolução Fatal , Fungemia/complicações , Hematoma Subdural/complicações , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Masculino , Meningites Bacterianas/etiologia , Traumatismo Múltiplo , Pneumonia Associada à Ventilação Mecânica/complicações , Fraturas Cranianas/complicações , Infecções Urinárias/complicaçõesRESUMO
OBJECTIVES: We aimed to study the characteristics of patients presenting with a Bacillus cereus infection in a university hospital. METHODS: We performed a retrospective analysis of the clinical, biological, and treatment-related data of patients hospitalized in our university hospital between January 1st, 2008 and December 31st, 2012 and diagnosed with a B. cereus infection. We identified a subgroup of patients presenting with bacteremia and looked for risk factors for death within that group of patients. RESULTS: We included 57 patients in our study; 31 (54.4%) were hospitalized in a medical ward. We identified 24 bacteremia case patients, including 17 patients presenting with bacteremia alone (29.8%). Other frequently observed infection sites were skin infections (16; 28.1%) and bone and joint infections (10; 17.5%). We recorded 9 deaths (11.8%); 2 patients, despite being on an appropriate antibiotic therapy, died from a medical device-related infection that had not been removed. The empirical administration of a beta-lactam antibiotic was significantly associated with death (P=0.022). Three patients presenting with recurrent bacteremia were identified. The patients only recovered once the infected device had been removed. CONCLUSION: B. cereus infections may have various clinical presentations. Prospective data is needed to put forward a consensual treatment approach and guide physicians in choosing the appropriate antibiotic therapy and in removing the infected device.
Assuntos
Bacillus cereus , Bacteriemia/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The management of epidemics of multi-drug and highly resistant bacteria must be based on a structured organisation. Within each region it requires the expertise of centres for the interregional coordination of nosocomial infection control (CCLINs) and their regional branches of nosocomial infection control (Arlin) which support hospitals in reporting these types of epidemics.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla , Instalações de Saúde , França , HumanosRESUMO
The increase in antibiotic-resistant bacteria and emerging highly drug-resistant bacteria is resulting in alarming situations of treatment failure. In hospitals, precautionary measures to control nosocomial infections are put in place through the collaboration between caregivers, the operational hygiene team and the nosocomial infection control committee, in accordance with official recommendations.
Assuntos
Antibacterianos/farmacologia , Controle de Infecções , Equipe de Assistência ao Paciente , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla , HumanosRESUMO
Fungal infections are a major cause of morbidity and mortality, and are frequently associated with the implantation of vascular catheters, especially in immune-compromised patients. Unfortunately, the therapeutic arsenal available for the treatment of these infections, caused generally by the yeasts of the genus Candida is still limited because of the toxicity and/or of the emergence of resistance against some antifungal agents. That is why we have undertaken this study, which is to determine the incidence and the degree of sensitivity of Candida spp., isolated from peripheral venous catheters at the University Hospital of Tlemcen (Algeria) to caspofungin and amphotericin B. The results show that the rate of colonization of vascular catheters was 19 % by yeasts of Candida spp., of which 60 % are Candida parapsilosis, 20 % Candida albicans, 14.3 % Candida glabrata and 5.7 % Candida famata. The minimum inhibitory concentrations (MIC) for amphotericin B are between 0.5 and 2 µg/mL and for caspofungin, they are between 0.125 and 2 µg/mL.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Argélia/epidemiologia , Antifúngicos/farmacologia , Candidíase/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo/efeitos adversos , Cateterismo/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Fúngica/efeitos dos fármacos , Hospitais Universitários , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores de Risco , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/microbiologiaAssuntos
Proteínas de Bactérias/biossíntese , Surtos de Doenças/prevenção & controle , Departamentos Hospitalares , Controle de Infecções/métodos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/prevenção & controle , Klebsiella pneumoniae/enzimologia , Medicina Física e Reabilitação , beta-Lactamases/biossíntese , Portador Sadio/microbiologia , Feminino , França/epidemiologia , Humanos , MasculinoRESUMO
Four cases of nosocomial aspergillosis are described where the responsibility of pleural drainage is advocated. Infection was pulmonary once, pleural three times. Pleural suction had been long lasting with incomplete re-expansion of the lung and major air leaks. The hypothesis of the responsibility of pleural drainage in the advent of aspergillosis is reinforced by the revision of medical papers, which leads to the conviction that similar cases have been described yet, even though the mechanism of the contamination had not been understood. Prevention needs to limitate the lasting of the suction, especially if there are major air leaks. Cure needs total re-expansion of the lung and suppression of any pleural cavity, even if a thoracoplasty is needed. An anti-fungal therapy is not always needed.
Assuntos
Aspergilose/etiologia , Drenagem/efeitos adversos , Doenças Pleurais/etiologia , Pneumotórax/terapia , Adolescente , Idoso , Aspergilose/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/diagnóstico por imagem , Pleura/patologia , Doenças Pleurais/diagnóstico por imagem , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , RadiografiaRESUMO
Multidrug-resistant bacteria are a major worldwide health public concern. It results from the growing increase in antibiotic prescriptions, which are responsible for selection pressure on bacteria. In France like in other countries, enterobacteriaceae producing extended spectrum beta-lactamase (EESBL) are the predominant multidrug-resistant bacteria. EESBL may be responsible for severe infections and require prescription of broad-spectrum antibacterial agents. The current EESBL outbreak is different from methicillin-resistant Staphylococcus aureus outbreak that occurred in the early 1980. Consistently, EESBL are isolated both in hospital and community. Moreover, standard hygiene measures appear ineffective since EESBL prevalence is still increasing. The current inability to contain EESBL outbreak is due to several factors, including the existence of a wide community- and hospital-acquired tank of EESBL, failure to follow strict rules for hygiene, and the current irrational prescription of antibiotics.