[What academic training for pharmacy students for clinical pharmacy? Example of shared medication report]. / Quelle formation académique pour les nouvelles missions de pharmacie clinique à l'officine ? Exemple du bilan partagé de médication du sujet âgé.

OBJECTIVES: In 2018, the implementation of shared medication reports in pharmacy encourages pharmacists to cooperate with other healthcare professionals. This job allows a decrease of medication errors in elderly. This requires a reorganization of the training offered by universities (initial and continuing training). The aim is to present the results of this pedagogical experimentation. METHODS: The experimentation (years 2017-2018 and 2018-2019) required the creation of a course to allow students to carry out a pharmaceutical analysis suitable to elderly people, to set up and carry out a shared medication report in pharmacy. Then, during their 6th year internship, students had to carry out at least one shared medication report per month. A monthly follow-up was organized with a database online. RESULTS: Sixty-four students and 35 internship supervisors participated in the experimentation. All the students improved their ease in using clinical pharmacy tools (pharmaceutical analysis, pharmaceutical interventions, assessment of adherence, etc.). They carried out 345 shared medication reports. In 24.3% of cases, an improvement in the prescription was proposed to the doctor (general practitioner or specialist). For 80% of the internship supervisors, the initial training of the students helped to set up this new pharmacy activity. CONCLUSIONS: This teaching is appreciated by students and internship supervisors. It enabled the adoption of the various tools essential for carrying out shared medication reports in pharmacy. Shared medication reports reinforce the multidisciplinary work of pharmacists, especially with general practitioners.

[Implementation of prehospital transfusion in case of trauma shock]. / Instauration d'un protocole de transfusion préhospitalière dans le choc hémorragique traumatique.

Transfusion plays a major role in the management of hemorrhagic shock where every minute counts. A pre-hospital transfusion protocol is established in the medical vehicle within the emergency department of CHR hospital Liège. It is based on predefined clinical and biological severity criteria which allow us to start a massive transfusion protocol as early as possible and thus to optimize its effect during traumatic hemorrhagic shock.

La transfusion occupe une place majeure dans la prise en charge du choc hémorragique où chaque minute compte. Un protocole de transfusion préhospitalière est instauré via le véhicule SMUR (Service Mobile d'Urgence-Réanimation) au sein du service des urgences du CHR de Liège. Il est basé sur des critères de gravité cliniques et biologiques prédéfinis qui permettent de débuter, le plus précocement possible, un protocole de transfusion massive et, ainsi, d'optimaliser son effet lors de choc hémorragique traumatique.

Antibiotics associated with acquisition of carbapenem-resistant Pseudomonas aeruginosa in ICUs: a multicentre nested case-case-control study.

Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) strains are involved in severe infections, mostly in ICUs. Exposure to antibiotics other than carbapenems may be associated with isolation of CRPA; therefore, we aimed to identify those antibiotics using the case-case-control study design. Methods: A case-case-control study was conducted in 2015 in a prospective multicentre cohort that included 1808 adults hospitalized in 2009 in 10 French ICUs. Patients were screened for P. aeruginosa at admission to the ICU and then weekly. Cases were patients with CRPA and patients with carbapenem-susceptible P. aeruginosa (CSPA) isolation. Controls were patients without P. aeruginosa isolation, matched with each case according to centre, length of stay and hospitalization period. Effects of antibiotic exposure were explored, after adjusting for prior treatment with carbapenems and confounding factors comprising colonization pressure with two logistic regression models. The two models were compared to identify specific risk factors for CRPA isolation. Results: Fifty-nine CRPA, 83 CSPA and 142 controls were compared. In adjusted multivariable analyses, exposure to carbapenems and to antibiotics belonging to the group of ß-lactams inactive against P. aeruginosa were independent risk factors for CRPA isolation (OR, 1.205; 95% CI, 1.079-1.346 and OR, 1.101; 95% CI, 1.010-1.201, respectively). Conversely, exposure to ß-lactams active against P. aeruginosa was an independent protective factor for CSPA isolation (OR, 0.868; 95% CI, 0.772-0.976). Conclusions: Besides carbapenem exposure, exposure to ß-lactams inactive against P. aeruginosa was a specific risk factor for CRPA isolation. Clinicians should counterweigh the potential benefits of administering these antibiotics against the increased risk of CRPA infection.

[A case of periodic thyrotoxic paralysis]. / Le cas clinique du mois. Paralysie périodique thyrotoxique.

Periodic thyrotoxic paralysis (TPP) is a disease that usually affects Asian men from 20 to 50 years. It is secondary to genetic mutations of ion channels for the transport of sodium and potassium. It is characterized by recurrent and brutal bouts of paresis / flaccid paralysis, without sensory involvement, in a context of hyperthyroidism. Seizures preferentially affect proximal muscles and are often associated with severe hypokalemia. However, serious repercussions are rare, except in cases of extreme weakness of the respiratory muscles or cardiac arrhythmia induced by hypokalemia. The treatment of ionic disorders, followed by the correction of hyperthyroïdism, leads to the complete disappearance of symptoms.

La paralysie périodique thyrotoxique (PPT) est une maladie affectant généralement les hommes d'origine asiatique entre 20 et 50 ans. Elle est secondaire à des mutations génétiques de certains canaux ioniques permettant le transport du sodium et du potassium. Elle se caractérise par la survenue d'accès récurrents et brutaux de parésie/paralysie flasque, sans atteinte sensitive, dans un contexte d'hyperthyroïdie. Les crises touchent préférentiellement les muscles proximaux et sont très souvent associées à une hypokaliémie parfois sévère. Cette maladie n'a toutefois que rarement des répercussions graves, sauf en cas de faiblesse extrême des muscles respiratoires ou d'arythmie cardiaque induite par l'hypokaliémie. Le traitement des troubles ioniques, suivi de la correction de l'hyperthyroïdie, conduit à la disparition complète des symptômes.

[Subarachnoid hemorrhage resulting from a ruptured aneurysm : management in an emergency department]. / L'hémorragie méningée sur rupture d'anévrisme Prise en charge dans un service d'Urgences.

Subarachnoid hemorrhage is a neurovascular emergency affecting relatively young adults. A ruptured cerebral aneurysm is the main non-traumatic cause. Except for the non-specific symptom of headache, which frequently occurs in subarachnoid hemorrhage, the clinical presentation is atypical, making the diagnosis difficult with possible dramatic consequences. The diagnosis is based on the CT scan without contrast, which, when negative, will be followed by a lumbar puncture. The etiologic analysis is based on an urgent arteriography, revealing the characteristics of the aneurysm such as the anatomy of the intracerebral vessels, the identification of the bleeding site and the size and location of the aneurysm. The main complications are bleeding relapse, hydrocephaly and vasospasm. Early treatment is based on the final repair of the aneurysm through two possible approaches: microvascular neurosurgical clipping or coiling via endovascular access. This article discusses the diagnostic and therapeutic aspects of subarachnoid hemorrhage.

L'hémorragie méningée représente une urgence neuro-vasculaire grave affectant l'adulte relativement jeune. La rupture d'anévrisme cérébral en est la principale cause non traumatique. Hormis la présence fréquente de céphalées, son mode de présentation clinique est variable, ce qui rend le diagnostic difficile et peut entraîner des conséquences dramatiques. La mise au point diagnostique repose sur le scanner cérébral sans injection de produit de contraste qui, s'il est négatif, est suivi d'une ponction lombaire. Le bilan étiologique repose sur l'artériographie, laquelle renseigne sur les caractéristiques de l'anévrisme : anatomie des vaisseaux intracérébraux, identification du site de saignement, taille et localisation de l'anévrisme. Les principales complications sont la récidive de saignement, l'hydrocéphalie et le vasospasme. Le traitement, précoce, repose sur la réparation définitive de l'anévrisme par deux principaux abords : la voie neurochirurgicale (clippage microvasculaire) ou le traitement endovasculaire par pose de spires métalliques (ou coiling). Cet article aborde les aspects diagnostiques et thérapeutiques de la prise en charge de l'hémorragie méningée.

[Mediastinitis on oesphagal perforation]. / Le cas clinique du mois. Médiastinite sur perforation oesophagienne.

Vomiting is less benign than it seems … Esophageal perforations and ruptures cause the contents of the esophageal lumen to leak into the cervical retroesophageal space, the mediastinum or the abdomen, which can trigger, among other adverse events, a mediastinitis, the diagnosis of which is difficult and should be established as promptly as possible. It's a rare pathology involving a high risk of diagnostic errors.

Les perforations et les ruptures de l'œsophage mettent en communication la lumière oesophagienne avec les espaces rétro-oesophagiens cervicaux, le médiastin ou l'abdomen. Ceci peut, entre autres, provoquer une médiastinite, dont le diagnostic, difficile, doit être le plus précoce possible. Il s'agit d'une pathologie rare entraînant des risques importants d'erreur diagnostique.

[How I treat a poisoning with tricyclic antidepressants : potential role of a treatment with lipid emulsion]. / Comment je traite l'intoxication aux antidépresseurs tricycliques : efficacité potentielle d'un traitement par émulsion lipidique.

Poisoning with tricyclic antidepressants is common and can be life-threatening. The classic management is well known (chelating gastrointestinal, sodium bicarbonate, benzodiazepine, norepinephrine). A few years ago, a treatment with lipid emulsion, previously used in local anesthetics poisoning, has been successfully tested in tricyclic poisoning with cardiac arrest. We are currently unable to explain the exact mechanism of this treatment but it could have a place in the treatment of severe tricyclic poisoning with hemodynamic instability in addition to the conventional treatment.

L'intoxication aux antidépresseurs tricycliques n'est pas rare et peut engager le pronostic vital du patient. La prise en charge classique est bien connue (chélateurs gastrointestinaux, bicarbonate de sodium, benzodiazépines, amines vasoactives). Il y a quelques années, un traitement par émulsion lipidique, jusque-là utilisé dans les intoxications aux anesthésiques locaux, a été testé avec succès dans les intoxications aux tricycliques en arrêt cardio-respiratoire. Nous sommes, actuellement, incapables d'expliquer le fonctionnement exact de ce traitement, mais il pourrait avoir une place dans la prise en charge des intoxications aux tricycliques avec instabilité hémodynamique échappant au traitement conventionnel.

The incidence of Staphylococcus aureus ST8-USA300 among French pediatric inpatients is rising.

Methicillin-resistant Staphylococcus aureus (MRSA) formerly colonized and infected only inpatients in hospitals, but have been reported in community settings worldwide over the last 20 years. In France, the prevalence of such MRSA remains low and outbreaks have, until now, been mainly due to the ST80 clone. However, there were two outbreaks of MRSA clone ST-USA300 recently in France, including one involving children. To investigate epidemiological developments, we studied the 77 MRSA isolated from pediatric patients hospitalized between 2008 and 2013 in three French hospitals. The median incidence of MRSA was stable and low (0.137 per 100 admissions). The prevalence of Panton-Valentine leukocidin (PVL)-positive MRSA was high (33.8 %). The 26 PVL-positive MRSA were genetically diverse, with two clones being predominant: ST80 (12 isolates, 46.1 %) and ST8-USA300 (8 isolates, 30.8 %). The incidence of ST8-USA300 increased over the 6-year period. We believe that screening for ST8-USA300 should be improved: medical biologists should be encouraged to search for PVL genes in all MRSA isolates recovered from abscesses, whatever the susceptibility pattern of the isolate, and not only when suggestive of ST80.

Pseudomonas aeruginosa in French hospitals between 2001 and 2011: back to susceptibility.

The European Antimicrobial Resistance Surveillance Network (EARS-Net) reported an increase in the rates of resistance of Pseudomonas aeruginosa to antimicrobials between 2008 and 2011 in France. This alarming report was based on data collected during the harmonisation of breakpoints by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) committee. However, these data were not supported by the findings of other national surveillance networks. In this study, we assessed the trends in P. aeruginosa antimicrobial drug resistance at six French hospitals over a longer period of time (2001-2011) and with a constant definition of resistance. After the exclusion of incomplete data and duplicates, we sorted 34,065 isolates into the antimicrobial resistance patterns defined by the European Centre for Disease Prevention and Control (ECDC). The proportion of isolates with a resistant pattern (non-susceptible to one or two antimicrobial categories), a multidrug-resistant pattern (non-susceptible to three or four antimicrobial categories) or an extensively drug-resistant pattern (non-susceptible to five or six antimicrobial categories) decreased significantly over time. Logically, the proportion of isolates with a wild-type resistance pattern has increased significantly over the same period. No significant changes in the rates of resistance to cephalosporins and penicillins were observed, whereas carbapenem resistance rates increased. By contrast, the proportion of isolates resistant to fluoroquinolones, aminoglycosides and monobactams decreased significantly over time. In conclusion, our data do not confirm the EARS-net data, suggesting instead that antimicrobial drug resistance in P. aeruginosa might not have increased in French hospitals over the last decade.

Antibiotic resistance in elderly patients: Comparison of Enterobacterales causing urinary tract infections between community, nursing homes and hospital settings.

OBJECTIVE: The objective was to compare the prevalence of antibiotic resistance of, Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae in elderly patients in, three sectors: community, nursing homes, and hospital settings. MATERIAL AND METHODS: This study was a retrospective observational study conducted in, Bourgogne Franche-Comté (France). We collected positive urine samples from, patients over 75 years of age from six private laboratories. RESULTS: Antibiotic resistance rate for E. coli in nursing homes was close to that of the, ommunity setting. Conversely, resistance of K. pneumoniae in nursing homes was, close to hospital settings. No difference in resistance of P. mirabilis was observed, between the three healthcare sectors. CONCLUSIONS: Patients living in nursing homes should not be considered more at risk of, infection by multi-drug resistant E. coli than patients living in community setting. Screening of multi-drug resistant K. pneumoniae could be of interest for nursing home, patients.

Genome-based typing reveals rare events of patient contamination with Pseudomonas aeruginosa from other patients and sink traps in a medical intensive care unit.

AIM: We used genome-based typing data with the aim of identifying the routes of acquisition of Pseudomonas aeruginosa by patients hospitalized in a medical intensive care unit (MICU) over a long period in a non-epidemic context. METHODS: This monocentric prospective study took place over 10 months in 2019 in a 15-bed MICU that applies standard precautions of hygiene. Lockable sink traps installed at all water points of use were bleach disinfected twice a week. We sampled all sink traps weekly to collect 404 P. aeruginosa environmental isolates and collected all P. aeruginosa isolates (N = 115) colonizing or infecting patients (N = 65). All isolates had their phenotypic resistance profile determined and their genome sequenced, from which we identified resistance determinants and assessed the population structure of the collection at the nucleotide level to identify events of P. aeruginosa transmission. FINDINGS: All sink traps were positive for P. aeruginosa, each sink trap being colonized for several months by one or more clones. The combination of genomic and spatiotemporal data identified one potential event of P. aeruginosa transmission from a sink trap to a patient (1/65, 1.5%) and six events of patient cross-transmission, leading to the contamination of five patients (5/65, 7.7%). All transmitted isolates were fully susceptible to ß-lactams and aminoglycosides. CONCLUSIONS: Genome-based typing revealed the contamination of patients by P. aeruginosa originating from sink traps to be infrequent (1.5%) in an MICU with sink trap-bleaching measures, and that only 7.7% of the patients acquired P. aeruginosa originating from another patient.

Validation of quantitative real-time polymerase chain reaction for detection of Legionella pneumophila in hospital water networks.

BACKGROUND: Rapid monitoring of Legionella pneumophila (Lp) is essential to reduce the risk of Legionnaires' disease in healthcare facilities. However, culture results take at least eight days, delaying the implementation of corrective measures. Here, we assessed the performance of a qPCR method and determined qPCR action thresholds for the detection of Lp in hospital hot water networks (HWNs). METHODS: Hot water samples (N = 459) were collected from a hospital HWN. Lp were quantified using iQ-Check® Quanti real-time PCR Quantification kits (Bio-Rad) and the results were compared with those of culture. qPCR thresholds corresponding to the culture action thresholds of 10 and 1000 cfu/L were determined on a training dataset and validated on an independent dataset. RESULTS: Lp concentrations measured by culture and qPCR were correlated for both the training dataset (Spearman's correlation coefficient ρ = 0.687, P<0.0001) and the validation dataset (ρ = 0.661, P<0.0001). Lp qPCR positivity thresholds corresponding to culture action thresholds of 10 cfu/L was 91 genome units (gu) per litre (sensitivity, 86.4%; negative predictive value - NPV, 93.3%) and that corresponding to culture action thresholds of 1000 cfu/L was 1048 gu/L (sensitivity, 100%; NPV, 100%). CONCLUSION: Detection of Lp by qPCR could be implemented with confidence in hospitals as a complement to culture in the monitoring strategy to speed up the implementation of corrective measures.

Point prevalence survey of antibiotic use in French hospitals in 2009.

OBJECTIVES: To evaluate the feasibility of a point prevalence survey for monitoring antibiotic use in a voluntary sample of French hospitals. METHODS: Demographic and medical data were collected for all inpatients. Additional characteristics regarding antimicrobial treatment, type of infection and microbiological results were collected only for patients receiving antimicrobials. RESULTS: Among 3964 patients in 38 hospitals, 343 (8.7%) received antimicrobial prophylaxis and 1276 (32.2%) antimicrobial therapy. The duration of surgical antimicrobial prophylaxis was >1 day in 41 out of 200 (21%) of the cases. Among patients with antimicrobial therapy, 959 (75.2%) received ß-lactams (including 34.8% penicillins with ß-lactam inhibitors, 22.1% third-generation cephalosporins and 7.8% carbapenems) and 301 (23.6%) received fluoroquinolones (50% orally). A total of 518 (40.6%) patients were treated with more than one drug and 345 (27.2%) were treated for >7 days. Patients treated for hospital-acquired infections (39.2%) were more likely to receive combinations (47.6% versus 34.4%, P < 0.01), carbapenems (14.4% versus 2.6%, P < 0.01), glycopeptides (14.4% versus 3.7%, P < 0.01) and antifungals (17% versus 5.3%, P < 0.01) for a longer duration (7.8 versus 6 days, P < 0.01). Fifty-six patients (4.4%) were treated for >7 days and did not have any microbiological sample drawn. The time allocated for the survey represented 18.3-25.0 h for 100 patients. CONCLUSIONS: The data provide directions for further interventions, such as better use of diagnostic tools, decreasing the treatment duration and the use of combinations. In addition, the survey shows that, although cumbersome, it is feasible to improve the representativeness of national data in European surveys.

[Chronic wound care leads to the bacterial contamination of the environment]. / Les soins des plaies chroniques entraînent une contamination bactérienne de l'environnement.

AIM: The aim of this study was to determine levels of bacterial contamination of the environment during chronic wound dressing changes. METHODS: Sampling of chronic wounds and of the environment (air and surfaces) was performed during changing of chronic wound dressing. A series of samples was defined as the entire sample for a given day for a given patient. Five sequential samples of air and six samples of surfaces were taken for each series. Staphylococcus aureus, Pseudomonas aeruginosa and enterobacteria were specifically cultured. RESULTS: Thirty series of samples were taken for 26 different patients. Twenty-seven out of these 30 series were colonized with one or two of the target species. For 13 series of the latter samples (13/27, 48.1%), bacteria isolated from the wound were recovered in the environment, namely S. aureus and P. aeruginosa. The six enterobacteria isolated from wounds were not retrieved in the environment. Air samples were more often positive than surfaces samples. CONCLUSION: We demonstrated frequent contamination of the hospital environment with bacteria colonizing wounds during dressing changes. This indicates that wearing of masks and hand disinfection after contact with the environment constitute key measures in the control of bacterial cross-transmission.

Multilevel modelling of the prevalence of hospitalized patients infected with Pseudomonas aeruginosa.

Pseudomonas aeruginosa is one of the leading nosocomial pathogens. The question of the respective contribution of endogenous and exogenous sources remains controversial. In this study, we shed new light on this issue by means of a multilevel logistic regression analysis which allowed a simultaneous investigation of factors associated with prevalence of patients infected with P. aeruginosa at two levels: patient and healthcare facility (HCF) in the eastern regions of France. A total of 25 533 in-patients from 51 HCFs were included in the analysis. The overall prevalence was 0·37% (range 0-1·65%). Multilevel modelling estimated that <14% of total variability of the outcome variable was explained by differences between HCFs and that after adjusting for patient-level variables, which explained 52% of HCF-level variance, the latter became non-significantly different from zero. A compositional effect (patient factors), rather than a contextual effect (ecological factors), explains heterogeneity of the prevalence of patients infected with P. aeruginosa in the eastern HCFs of France.

Bacterial contamination of organ graft preservation solution and infection after transplantation.

Infectious complications represent a major cause of morbidity and mortality in patients with organ transplantation. Contamination of preservation solution (PS) can lead to life-threatening complications in the recipients. For a 3-year period, we investigated the bacterial contamination of both PSs and graft fragments, recipient infections, and explored the link between them. In total 137 organs were transplanted, and 131 organ and perfusate cultures out of 426 tested (30.8%) gave a positive bacterial culture, mainly with coagulase-negative staphylococci. Overall, 80 recipients out of 137 (58.4%) had at least 1 infection during the 4-month post-graft surveillance period. Twelve recipients had an infection with the same bacterial species that was recovered in the corresponding graft. However, based on pulsed-field gel electrophoresis typing results, only 1 case was very likely cross-transmitted via the transplantation.

[Regional audit on fluoroquinolones usage in the hospital and the community: are these antibiotics over-used?]. / Audit régional de l'usage des fluoroquinolones à l'hôpital et en ville : y a-t-il une surconsommation de ces antibiotiques ?

AIM OF THE STUDY: The ecological impact of an over-use or a mis-use of fluoroquinolones (FQs) appears of great importance according to published data. With the objective to set up a regional antibiotic stewardship program, we conducted a regional audit on FQs usage. MATERIAL AND METHODS: [corrected] Ninety general practionners and 15 health care facilities participated to this prospective study. Overall, 511 prescriptions were evaluated (276 from hospital physicians and 235 [46%] from general practionners). The compliance of FQs prescription with national recommendations and with a regional referential was assessed. This regional referential was established in order to preserve FQs. RESULTS: Only 14,3% of the prescriptions complied with the regional referential, even if the choice of FQs were in accordance with national recommendations in 56,8% of the prescriptions. Urinary tract infections (mostly non-complicated) were the most common indication for FQs prescription. CONCLUSION: Analysis of FQs prescriptions shows that there is a significant potential for FQs preservation in Franche-Comté.

[Mephedrone]. / La méphédrone: une nouvelle forme de toxicomanie.

Mephedrone is a designer drug recently appeared on the belgian market of the drugs of misuse. The aim of this journal paper is to provide a review on the available data about mephedrone and to call the attention of the first line practitioners who will have to face this emerging problem.

Influenza vaccination coverage at community pharmacies: Positioning, needs, expectations and involvement of community pharmacists in the Franche-Comté region.

INTRODUCTION: Influenza vaccination coverage currently remains below the 75% recommended threshold by the World Health Organization. To correct this situation, experiments have been successively carried out in France to enable community pharmacists to vaccinate at-risk populations. In this context, a study was conducted with pharmacists from the French Franche-Comté region to evaluate their positioning, needs and expectations regarding influenza vaccination at community pharmacies. MATERIALS AND METHODS: A survey was created and sent to licensed pharmacists in March of 2018. This consisted of 4 parts: characteristics of the community pharmacy; positioning of the pharmacist regarding vaccinations carried out at the pharmacy; training needs and expectations; and willingness to implement vaccinations. RESULTS: The participation rate in this survey was 32% (137/427). More than 90% of the pharmacists agreed that community pharmacies' assets were adequate for the implementation of these vaccinations (accessibility and availability), although 52% considered this complicated. Their main fears were reluctance from patients and conflicts of interest with other health professionals authorized to vaccinate (58%). The needs and expectations regarding pharmacy student training were essential for 94% of them as well as continuous training of practicing pharmacists (96%). The willingness of pharmacists to vaccinate stemmed from the fact that influenza vaccination coverage would increase for at-risk subjects (36%). CONCLUSION: This survey allowed us to assess the favorable positioning and the real interest of pharmacists from Franche-Comté regarding the influenza vaccination done at community pharmacies, given the proviso that they were given relevant training and allocated adequate resources.

Prevalence, genetic diversity of and factors associated with ESBL-producing Enterobacterales carriage in residents of French nursing homes.

OBJECTIVE: To determine the prevalence and genotypic characteristics of extended-spectrum ß-lactamase-producing Enterobacterales (ESBLE) and carbapenemase-producing Enterobacterales (CPE) in nursing homes (NHs) in a French region. Risk factors associated with their carriage were also investigated. METHODS: A point-prevalence survey was proposed from November 2017 to June 2018 to NHs in the study region. Volunteer residents were screened for ESBLE and CPE carriage. Escherichia coli and Klebsiella pneumoniae isolates were genotyped using multi-locus sequence typing, pulsed-field gel electrophoresis (PFGE) and phylogrouping (for E. coli alone). Collective and individual data were analysed by random-effects logistic regression. RESULTS: The study was conducted in 18 NHs and included 262 patients. Fifty-two patients (19.8%) carried at least one ESBLE, corresponding to 56 isolates (42 E. coli, 11 K. pneumoniae and three others), while no CPE was detected. The majority (27/42) of ESBL E. coli belonged to phylogroup B2, and ST131 was over-represented in this subset (21/27). PFGE analysis revealed ST131 cross-transmission within NHs. Regarding ESBL K. pneumoniae, nine of 11 isolates belonged to ST663, and PFGE suggested diffusion of the clone in six NHs. Significant individual risk factors for colonization by ESBLE were: use of a shared bathroom, previous antibiotic use and recent history of hospitalization. Significant collective protective factors were proper compliance with glove use and support of the NH by a healthcare facility. CONCLUSION: This study shows that NHs in the study region are an important reservoir of ESBLE, whereas no residents were CPE carriers. The control of ESBLE in NHs should focus on antibiotic stewardship and excreta management policies.