Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene.

In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.

Incidence and Time-to-Onset of Carbapenemase-Producing Enterobacterales (CPE) Infections in CPE Carriers: a Retrospective Cohort Study.

This study aimed to assess the proportion of carbapenemase-producing Enterobacterales (CPE) infections among all infectious episodes in CPE carriers, compare the time-to-onset of CPE infections with that of other infections, assess the mortality of patients with CPE infections, and identify risk factors for CPE infections in CPE carriers. A retrospective cohort study was performed over a 10-year period in our University Hospital, and 274 CPE carriers were identified. All infectious episodes within the first 6 months following the diagnosis of CPE rectal carriage were considered. Risk factor analysis for CPE infections in CPE carriers was performed by univariate and multivariate analyses. This study revealed an incidence of 24.1% (66/274) of CPE infection within 6 months of CPE carriage diagnosis. The 28-day all-cause mortality due to CPE infections was 25.7%. CPE infections represented 52.6% (70/133) of all infectious episodes in CPE carriers in the first 6 months following CPE carriage detection, and these significantly occurred earlier than non-CPE infections, with a median time of 15 versus 51 days, respectively (P < 0.01). Based on the multivariate analysis, prior neurological disease was the only risk factor associated with CPE infections in CPE carriers. CPE infections have an early onset, accounting for a large proportion of infections in CPE carriers, and are associated with high mortality. IMPORTANCE Carbapenemase-producing Enterobacterales (CPE) infections are emerging infections and may represent a therapeutic challenge, while effective antibiotic therapy is likely to be delayed. We aimed to assess the proportion of CPE infections in CPE carriers and to identify risk factors of CPE infections among this population that could guide empirical antibiotic therapy. We showed that CPE infections are frequent in CPE carriers, have an early onset after CPE carriage diagnosis, and represent a significant proportion of all infectious episodes in CPE carriers. No significant risk factors for CPE infections could be identified. Overall, this study suggests that empirical antibiotic treatment covering CPE might be initiated in CPE carriers at least in the first month after its diagnosis and in severe infections due to the high frequency and early occurrence of CPE infections in these patients.

The potential of mRNA expression evaluation in predicting HER2 positivity in gastroesophageal cancer.

Gastroesophageal cancer (GEC) is an aggressive disease characterized by a high frequency of metastasis and poor overall survival rates. GEC presents HER2 overexpression in 5 to 25% of tumors eligible for HER2-targeted therapy. HER2 evaluation requires protein levels and copy number alteration analyses by immunohistochemistry (IHC) and in situ hybridization (FISH or SISH), respectively. These are semiquantitative methodologies that need an expert and well-trained pathologist. Therefore, the use of new surrogate methods for HER2 evaluation in cancer, such as gene expression analysis, might improve GEC HER2 classification. We evaluated HER2 positivity in GEC through conventional IHC and SISH analyses and investigated the potential application of HER2 mRNA expression by quantitative PCR to categorize GEC samples as HER2-positive or HER2-negative. Among 270 GEC samples, 10.9% were HER2-positive by IHC and SISH analyses. HER2 mRNA was overexpressed in HER2-positive GEC samples and presented high accuracy in distinguishing those tumors from HER2-negative GEC. Nevertheless, HER2 mRNA analysis was not capable of classifying HER2-equivocal GEC samples into HER2-positive or -negative according to SISH data. Quantitative PCR analysis showed HER2 overexpression in HER2-positive GEC samples. Nevertheless, HER2 mRNA analysis failed to classify HER2-equivocal GEC according to SISH data.

Digital Volume Correlation for large deformations of soft tissues: Pipeline and proof of concept for the application to breast ex vivo deformations.

Being able to reposition tumors from prone imaging to supine surgery stances is key for bypassing current invasive marking used for conservative breast surgery. This study aims to demonstrate the feasibility of using Digital Volume Correlation (DVC) to measure the deformation of a female quarter thorax between two different body positioning when subjected to gravity. A segmented multipart mesh (bones, cartilage and tissue) was constructed and a three-step FE-based DVC procedure with heterogeneous elastic regularization was implemented. With the proposed framework, the large displacement field of a hard/soft breast sample was recovered with low registration residuals and small error between the measured and manually determined deformations of phase interfaces. The present study showed the capacity of FE-based DVC to faithfully capture large deformations of hard/soft tissues.

Société de Biomécanique Young Investigator Award 2021: Numerical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue in the context of pressure ulcer prevention.

BACKGROUND: Pressure-induced tissue strain is one major pathway for Pressure Ulcer development and, especially, Deep Tissue Injury. Biomechanical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue is therefore essential. In the literature, a viscoelastic formulation is generally assumed for the experimental characterization of skeletal muscles, with the limitation that the underlying physical mechanisms that give rise to the time dependent stress-strain behaviour are not known. The objective of this study is to explore the capability of poroelasticity to reproduce the apparent viscoelastic behaviour of passive muscle tissue under confined compression. METHODS: Experimental stress-relaxation response of 31 cylindrical porcine samples tested under fast and slow confined compression by Vaidya and collaborators were used. An axisymmetric Finite Element model was developed in ABAQUS and, for each sample a one-to-one inverse analysis was performed to calibrate the specimen-specific constitutive parameters, namely, the drained Young's modulus, the void ratio, hydraulic permeability, the Poisson's ratio, the solid grain's and fluid's bulk moduli. FINDINGS: The peak stress and consolidation were recovered for most of the samples (N=25) by the poroelastic model (normalised root-mean-square error ≤0.03 for fast and slow confined compression conditions). INTERPRETATION: The strength of the proposed model is its fewer number of variables (N=6 for the proposed poroelastic model versus N=18 for the viscohyperelastic model proposed by Vaidya and collaborators). The incorporation of poroelasticity to clinical models of Pessure Ulcer formation could lead to more precise and mechanistic explorations of soft tissue injury risk factors.

The potential of mRNA expression evaluation in predicting HER2 positivity in gastroesophageal cancer

Gastroesophageal cancer (GEC) is an aggressive disease characterized by a high frequency of metastasis and poor overall survival rates. GEC presents HER2 overexpression in 5 to 25% of tumors eligible for HER2-targeted therapy. HER2 evaluation requires protein levels and copy number alteration analyses by immunohistochemistry (IHC) and in situ hybridization (FISH or SISH), respectively. These are semiquantitative methodologies that need an expert and well-trained pathologist. Therefore, the use of new surrogate methods for HER2 evaluation in cancer, such as gene expression analysis, might improve GEC HER2 classification. We evaluated HER2 positivity in GEC through conventional IHC and SISH analyses and investigated the potential application of HER2 mRNA expression by quantitative PCR to categorize GEC samples as HER2-positive or HER2-negative. Among 270 GEC samples, 10.9% were HER2-positive by IHC and SISH analyses. HER2 mRNA was overexpressed in HER2-positive GEC samples and presented high accuracy in distinguishing those tumors from HER2-negative GEC. Nevertheless, HER2 mRNA analysis was not capable of classifying HER2-equivocal GEC samples into HER2-positive or -negative according to SISH data. Quantitative PCR analysis showed HER2 overexpression in HER2-positive GEC samples. Nevertheless, HER2 mRNA analysis failed to classify HER2-equivocal GEC according to SISH data.

Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak.

The aim of our study was to describe and to investigate the factors associated with glycopeptide-resistant enterococci (GRE) acquisition during a single-strain outbreak which occurred in several wards of hospital from September 2013 to January 2014. We designed a case-control study. Analyses were performed using Bayesian methods. Univariate logistic regressions with informative priors from published studies were conducted. A multivariate model was build including variables with a probability of odd-ratio exceeding one (Pr) >85% or <15%. Thirteen cases and 52 controls were recruited. The description of this outbreak highlighted the importance to quickly detect patients at risk of GRE carriage in order to implement the isolation measures and to transfer to dedicated department if they are effectively carriers. Following multivariate analysis, antibiotics during hospitalisation (Pr = 0.968), number of hospitalisation days in the year (Pr = 0.964), antacids intake (Pr = 0.878) (with a risk increase), immunosuppression (Pr = 0.026) and isolation measures (Pr = 0.003) (both with protective effect) were associated with GRE acquisition. The use of Bayesian statistics was useful because of our study's small population size and prior information availability.

[Diet of neutropenic patients in pediatric oncology service; the experience of the university hospital of Strasbourg (HUS)]. / L'alimentation des patients neutropéniques d'un service d'onco-hématologie pédiatrique; l'expérience des hôpitaux universitaires de Strasbourg (HUS).

OBJECTIVE: This article clarifies the choices made by the HUS concerning the ways of preparing food reserved to neutropenic children hospitalized in pediatric oncology service. We will describe the results of microbiological analysis of food realized from 2002 to 2007. METHODS: A specific team prepares this food which is canned and treated by "appertisation" (autoclaving). Each dish portion produced is provided to the service only if the microbiological results are conform, that is to say free of organisms. RESULTS: Three thousand and seventy-eight dishes were analysed: 82.9% of the analysed packs were conform. The contamination ratio decreased significantly (P<0.001) from 2002 to 2007. The organisms which cause the majority of dishes contamination are Bacillus (44.7%) and environmental mould exhibiting sterile mycelium (8.7%). The food which is the most frequently "nonconform" is the dry food with a contamination rate of 37.9%. The identified concentrations remain mainly lower than 50 colony-forming units per millilitre (CFU/mL): 66.2% for the bacteria and 97.2% for the fungi. CONCLUSION: Considering the lack of consensus on the acceptable microbiological thresholds and on the food protection level, the HUS make it a rule to have a maximal precautionary principle. Currently, this principle appears to us to be a safety option required for the patients hospitalized in pediatric oncology service.

Nosocomial urinary tract infection in the intensive care unit: when should Pseudomonas aeruginosa be suspected? Experience of the French national surveillance of nosocomial infections in the intensive care unit, Rea-Raisin.

Individual and ward risk factors for P. aeruginosa-induced urinary tract infection in the case of nosocomial urinary tract infection in the intensive care unit were determined with hierarchical (multilevel) logistic regression. The 2004-2006 prospective French national intensive care unit nosocomial infection surveillance dataset was used and 3252 patients with urinary tract infection were included; 16% were infected by P. aeruginosa. Individual risk factors were male sex, duration of stay, antibiotics at admission and transfer from another intensive care unit. Ward risk factors were patient turnover and incidence of P. aeruginosa-infected patients.

Identifying new risk factors for Pseudomonas aeruginosa pneumonia in intensive care units: experience of the French national surveillance, REA-RAISIN.

Pseudomonas aeruginosa is an important pathogen of complicated pneumonia in intensive care units (ICUs). Our objective was to determine 'patient' and 'ward' risk factors for P. aeruginosa pneumonia among patients with nosocomial pneumonia in ICU. Data from the 2004-2006 prospective French national nosocomial infection surveillance in ICUs (REA-RAISIN) were used, including patients admitted for >48 h in ICU and who developed nosocomial pneumonia. Only first pneumonia was considered and categorised as either P. aeruginosa pneumonia or other micro-organism pneumonia. Multilevel logistic regression model (patient as first level and ward as second) with P. aeruginosa pneumonia as binary outcome was performed. Of 3,837 included patients from 201 different wards, 25% had P. aeruginosa pneumonia. P. aeruginosa was significantly more frequent in late onset pneumonia. Higher probability of P. aeruginosa pneumonia was associated with higher age and length of mechanical ventilation, antibiotics at admission, transfer from a medical unit or ICU, and admission in a ward with higher incidence of patients with P. aeruginosa infections. Lower probability of P. aeruginosa was associated with traumatism and admission in a ward with high patient turnover. Our analyses identified a patient's profile and some ward elements that could make suspect P. aeruginosa in case of nosocomial pneumonia.

[Management of a scabies epidemic in the Strasbourg teaching hospital, France]. / Gestion d'une épidémie de gale aux Hôpitaux universitaires de Strasbourg.

CONTEXT: An outbreak of scabies occurred in the geriatric department of the Strasbourg University Hospital in September 2005. The index case presented with hyperkeratosic scabies, an extremely contagious form. The epidemic spread to several wards and pavilions and also contaminated healthcare staff and patient's families. OBJECTIVE: Our objective was to describe the outbreak, its progression, and the measures taken to eradicate it. METHODOLOGY: All healthcare workers, patients, and families affected in the outbreak were retrospectively studied, using medical prescriptions recorded by the hospital pharmacy, listings established by the occupational health department, and patient files. RESULTS: Two epidemic waves were recorded, between August 31 and December 16, 2005, affecting 51 patients and staff members in the geriatric department, with a total of 58 episodes of scabies, seven of which were recurrences. Three main measures were taken to eradicate the epidemic: setting up of "contact" isolation precautions, information for the affected individuals, and treatment of the infected patients associated to mass treatment of contact cases. The mass treatment was widely applied, involving 490 patients and 592 caregivers. All of these measures successfully curtailed the outbreak in 3 months. CONCLUSION: Rapid and radical action is essential to prevent extension of scabies within a community.

[Incidence of hospital-acquired and community-acquired bloodstream infections in the University of Strasbourg Hospitals, France, between 2005 and 2007]. / Incidence des bactériémies et fongémies aux hôpitaux universitaires de Strasbourg de 2005 à 2007.

OBJECTIVE: To follow the evolution of incidence of the main feature of bloodstream infections identified in a french hospital between 2005 and 2007. METHODS: We included all the patients hospitalised during three times three-month periods, according to the protocol given by the coordination center against nosocomial infections. For every positive blood culture, we collected clinical and microbiological datas. RESULTS: Hospital-acquired bacteremias are the most frequent with an incidence rate between 0.996 to 1.31 per thousand days of hospitalisation. The population is mainly over 50 years old. The main sources of infection are central catheter, digestive and urinary tracts. Organisms causing the majority of nosocomial bloodstream infections are coagulase-negative staphylococci, Staphylococcus aureus and Escherichia coli. The mortality rate during the first week varies from 16% in 2005 to 8% in 2007. Community-acquired bloodstream infections represent 28% of all episodes, and affect people who are over 70 years old. The main sources of infection are urinary, digestive and pulmonary. Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae are most frequently isolated. The mortality rate during the first week varies from 3.7 to 9.8% according to the year of study. CONCLUSION: This annual investigation enables us to measure the infection risk level in our hospital, to identify the main sources implied and to create targeted actions to prevent nosocomial bloodstream infections.