ABSTRACT
We conducted a 6-year retrospective analysis of monitoring of carbapenemase-producing Enterobacteriaceae (CPE) in a large hospital in a low CPE incidence area, and we evaluated the "search and isolate" strategy implemented. In total, 40 CPE isolates were collected from 32 patients, and only 1.4% of contact patients screened were CPE carriers.
Subject(s)
Bacterial Proteins , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Cross Infection/prevention & control , Enterobacteriaceae Infections/prevention & control , Enterobacteriaceae , Hospitals, University , Infection Control/methods , beta-Lactamases , Aged , Cross Infection/microbiology , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Female , Humans , Incidence , Male , Population Surveillance , Retrospective StudiesSubject(s)
Bacteremia/epidemiology , Cross Infection/epidemiology , Disease Outbreaks , Hospitals, University , Infant, Premature, Diseases/epidemiology , Streptococcal Infections/epidemiology , Streptococcus , Bacteremia/microbiology , Cross Infection/microbiology , Female , France/epidemiology , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/microbiology , Male , Streptococcal Infections/microbiology , Streptococcus/classification , Streptococcus/genetics , Streptococcus/isolation & purificationABSTRACT
BACKGROUND: The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is now increasing in rehabilitation and chronic-care-facilities (R-CCF). The aim of this study was to use published data and our own experience to discuss the roles of screening for MRSA carriers, the type of isolation to be implemented and the efficiency of chemical decolonization. DISCUSSION: Screening identifies over 90% of patients colonised with MRSA upon admission to R-CCF versus only 50% for intensive care units. Only totally dependent patients acquire MRSA. Thus, strict geographical isolation, as opposed to "social reinsertion", is clearly of no value. However, this should not lead to the abandoning of isolation, which remains essential during the administration of care. The use of chemicals to decolonize the nose and healthy skin appeared to be of some value and the application of this procedure could make technical isolation unnecessary in a non-negligible proportion of cases. SUMMARY: Given the increase in morbidity associated with MRSA observed in numerous hospitals, the emergence of a community-acquired disease associated with these strains and the evolution of glycopeptide-resistant strains, the voluntary application of a strategy combining screening, technical isolation and chemical decolonization in R-CCF appears to be an urgent matter of priority.
ABSTRACT
OBJECTIVE: To report on the occurrence of Enterococcus faecalis hospital isolates obtained during 1 year in hospitals in the Franche-Comté region of France. METHODS: Clinical isolates of E. faecalis of different antibiotic susceptibility phenotypes from hospitalized patients were characterized by pulsed-field gel electrophoresis. Patients with positive cultures were investigated by three case-control studies to identify risk factors for colonization/infection. RESULTS: The crude incidence of colonization/infection was 2.37%, and 4-day and 7-day colonization rates after admission were 10.0% and 6.36%, respectively. The rates of high-level resistance to kanamycin (HLKR) and to gentamicin (HLGR) were 47.1% and 7.1%, respectively. No isolate was resistant to glycopeptides or produced beta-lactamase. The 209 hospital isolates obtained during the study yielded 98 major DNA patterns, of which two were major epidemic patterns including HLKR isolates. No single factor was significantly associated with colonization/infection by HLKR isolates. The length of hospitalization before isolation was associated with colonization by HLGR isolates. CONCLUSIONS: The isolation frequency of E. faecalis strains with acquired resistance to aminoglycoside antibiotics, and the wide dissemination of resistant strains with characteristics that allow them to persist and spread, argue for further large prospective surveys of clinical isolates of E. faecalis in hospitals.
