Community-acquired Legionnaires' disease in a renal transplant recipient with unclear incubation period: the importance of molecular typing.

Transplant recipients are at risk of developing Legionnaires' disease (LD) because of impaired cellular immunity. Here, we describe a renal transplant recipient who developed LD at least 10 days after hospital admission and transplantation. The hospital water network was initially suspected, but further testing determined that the probable source was the patient's domestic water supply. Our report also suggests that the patient's immunosuppressed state may have switched potential colonization to pneumonia.

Invasive aspergillosis: an important risk factor on the short- and long-term survival of acute myeloid leukemia (AML) patients.

Invasive aspergillosis (IA) during induction chemotherapy of acute myeloid leukemia (AML) could worsen the prognosis. Our objective was to study how the development of IA during AML interferes with the therapeutic strategy and to evaluate its impact on the short- and long-term survival. Newly diagnosed AML patients between the years 2004 and 2007 were retrospectively analyzed. The outcome was death of the patient. A Cox proportional hazards model with the diagnosis of IA and post-induction response evaluation as the main exposure was fitted. Overall, 262 patients were analyzed and 58 IA were observed. The 2-year survival of patients having had remission of AML was 54% and, for patients with failure of chemotherapy, it was 5% (p < 0.001). The 2-year survival of patients having had IA was 14%, and without IA, it was 32% (p = 0.01). Multivariate analysis showed that IA was associated with a higher risk of death in case of remission compared to no IA (hazard ratio [HR] = 1.66 [1.05-2.65], p = 0.031) and also in case of failure (HR = 6.43, p < 0.001). IA was associated with an increased risk of death for patients if they were either in remission or in failure after induction chemotherapy.

[Orion (Outbreak Reports and Intervention studies of Nosocomial Infection) used for evaluating interventions and investigations of nosocomial infection outbreaks]. / Orion (Outbreak Reports and Intervention Studies of Nosocomial Infection) pour l'évaluation des interventions et des investigations d'épidémie dans le domaine des infections nosocomiales.

INTRODUCTION: British colleagues have developed the Outbreak Reports and Intervention studies of Nosocomial Infection (Orion) guidelines with the aim to promote transparency of publications in the field of health-care associated infections and particularly for reports of outbreak investigation or intervention studies. The aim of this study was to translate the Orion criteria and to promote their use in France. RESULTS: The Orion guidelines include a checklist of 22 commented items related to the title, abstract, introduction, methods, results, and discussion sections of a scientific article. Specific points for each item are developed to enhance its relevance. CONCLUSION: The use of Orion guidelines by authors and editors should be encouraged and should improve the quality of standards in research, intervention studies, and publications on nosocomial infections and health-care associated infections.

[Surgical site infection after total knee arthroplasty: a monocenter analysis of 923 first-intention implantations]. / Infection du site opératoire après arthroplastie totale de genou.

PURPOSE OF THE STUDY: We report the results of a retrospective analysis of 923 cases of first-intention total knee arthroplasties. The objective was to determine retrospectively the rate of surgical site infections, including all infections diagnosed during the first year, and to search for risk factors. We also wanted to present our surveillance system planned for a 10-year period. MATERIAL AND METHODS: From January 1994 to January 2004, first-intention total knee arthroplasty (TKA) was performed on 999 knees. HLS prostheses were implanted. At minimum 12 months, follow-up data was complete for 923 implants which constituted the study group. Female gender predominated (72%). Mean patient was 71 years (range 26-93). Anterior surgery was performed for 25% of the knees. Etiologies were osteoarthritis (87.5%), and rheumatoid polyarthritis (6.9%). Cefazolin was used for systematic preoperative (one injection) and postoperative (48 hr) antibiotic proxphylaxis. Vancomycin was used for patients with a contraindication for cefazolin. Information was collected from two sources: computerized consultation charts for all follow-up visits completed prospectively since 1995 et data collected by the Hygiene and Epidemiology Unit during the year following implantation. Data on surgical site infections was collected from the hospitalization files, outpatient files and control visits. Each case of infection was validated at an annual interdisciplinary meeting. We retained for analysis deep infections requiring revision surgery with identification of the causal agent on the intraoperative samples. We identified a subgroup of infections occurring during the first postoperative year, the delay generally retained for surgical site infections. RESULTS: Twenty surgical site infections after TKA were identified during the 10-year surveillance period (2.1%). Mean follow-up was 43 months (range 12-123 months, median 37 months). The rate of surgical site infections occurring during the first postoperative year was 1.4%. Eighty-percent of the infections (n=16) occurred within the first two postoperative months. Two infections were diagnosed two to five years after surgery and two others more than five years after surgery due to hematogenous contamination. All of the observed infections involved a single causal germ. Agents identified were: Gram+ (90%) and Gram- (10%), with a clear predominance for Staphylococcus aureus (n=9). Infections developed 2.1-fold more often in patients with an inflammatory disease (rheumatoid polyarthritis). Age and body mass index did not differ between patients with and without surgical site infection. CONCLUSION: The analysis of our series demonstrated the difficulties in conducting long-term surveillance.

Outbreaks of contaminated broncho-alveolar lavage related to intrinsically defective bronchoscopes.

From 5 March 2001 to 19 October 2001, outbreaks of broncho-alveolar lavage (BAL) contamination with Enterobacteraceae were detected in our 700-bed institution. We report the investigation of these outbreaks. A case was defined as the occurrence of pairs of specific Enterobacteraceae in BAL specimens among any patients who underwent bronchoscopy in the respiratory unit during the period of the outbreak. Contamination was identified in 117 BAL samples during three outbreaks among 418 patients, and was associated with bronchoscopes 11 and 12 (P<0.001). The other five devices in use were not linked with the outbreaks. During the first outbreak, particular pairs of micro-organisms were associated with a specific bronchoscope (Klebsiella pneumoniae/Proteus vulgaris with bronchoscope 11, and Morganella morganii/Proteus mirabilis with bronchoscope 12). Cultures of sputa from two patients also yielded M. morganii some days after bronchoscopic examination. Isolates from contaminated BAL samples and bronchoscope 11 had similar patterns by pulsed-field gel electrophoresis. No further cases occurred after removal of the implicated bronchoscopes. No deficiencies in disinfection procedures were detected and the source of contamination was found to be a loose port of the biopsy channel of the bronchoscope. Our findings underscore the urgent need to test bronchoscopic samples regularly and to improve the design and structure of bronchoscopes.

[Nosocomial septicemia and pseudobacteremia caused by Serratia marcescens]. / Septicémies nosocomiales et pseudo-bactériémies à Serratia marcescens.

An epidemiological survey was carried out which included a dual epidemic of septicaemia and pseudo-bacteremia caused by Serratia marcescens. The survey enabled 15 septicaemias and 43 pseudobacteremias to be detected in a regional hospital between March and August, 1983. Two mishandlings were at the origin of the outbreak: citrated tube normally reserved for coagulation tests were severely contaminated by Serratia marcescens, and inaccurate samplings had been made. Once the mechanisms of contamination were found, specific preventive measures put an end to the epidemic. The authors insist on the need for uncontaminated tubes and citrate solutions and for the development of precise sampling methods which are essential to avoid the occurrence of pseudo-bacteremia or septicaemia. It is important to detect such epidemics at an early stage by an efficient control of nosocomial infections, thus avoiding their extension.

[Hospital infection in maternity homes]. / Gospital'naia infektsiia v rodil'nykh domakh.

The results of the prospective survey of hospital infections in mothers and newborns at the obstetrical clinic of the Edouard Herriot Hospital in Lyon are presented. Surveillance lasting six successive years covered 18,026 deliveries with or without the use of cesarean section. The incidence of hospital infections (not taking into account cases of bacteriuria) was 1.6% in parturient women not subjected to cesarean section and 11.7% in those having had this operation. Urinary tract and parietal infections, endometritis were in leading cases. The average incidence of hospital infection in newborns was 2.68%, the leading clinical manifestations being peripheral staphylococcal lesions in the form of pustules.

Hospital washbasin water: risk of Legionella-contaminated aerosol inhalation.

The contamination of aerosols by washbasin water colonized by Legionella in a hospital was evaluated. Aerosol samples were collected by two impingement technologies. Legionella was never detected by culture in all the (aerosol) samples. However, 45% (18/40) of aerosol samples were positive for Legionella spp. by polymerase chain reaction, with measurable concentrations in 10% of samples (4/40). Moreover, immunoassay detected Legionella pneumophila serogroup 1 and L. anisa, and potentially viable bacteria were seen on viability testing. These data suggest that colonized hospital washbasins could represent risks of exposure to Legionella aerosol inhalation, especially by immunocompromised patients.

[Prevention methods of nosocomial urinary tract infections]. / Les méthodes de prévention des infections urinaires nosocomiales.

After classifying the nosocomial urinary tract infections, between the hospital acquired infections, this paper review different prevention means proposed to limit their incidence. These consist essentially of recommendations concerning the vesical catheterism. Thus are reviewed catheter indications, the choice of the catheter, its putting conditions, the creation and conservation of a closed system. Besides, patient informations and bacteriological survey of the catheterized patients are also discussed.

[Evaluation of prevention methods of nosocomial urinary tract infections]. / Evaluation des méthodes de prévention des infections urinaires nosocomiales.

Some recommendations for the prevention of nosocomial urinary tract infections are irrefutable, thoroughly admitted. They concern before all the aseptic conditions of setting and care of catheter, to avoid the bacterial penetration in the closed system. They concern the merits of catheter indications, the diminution of catheter conservation period, the applying of a strict asepsis during setting and manipulation of the catheter, the use of a sterile and closed drainage system with a continuous flow. Several improvements concerning the catheter and the drainage system have been proposed. Some of these recommendations have been proved serious and can be applied. On the contrary, the efficiency of others remain to be proved by control assays. Finally, measures with uncertain or unproved values should not be considered.

[Indicators of quality for hospital antisepsis]. / Indicateurs de qualité pour l'antisepsie à l'hôpital.

In any health care institution, the most important quality indicator for antisepsis is the existence of systems of reference of use, secondly the knowledge of those systems and then the compliance by the different classes of professionals. These refrentials must be regularly evaluated and updated according to general consensus.

Air filtration and prevention of aspergillary pneumopathies. Preliminary comparative study of two mobile units for bacteriological air purification with recycling.

Two mobile units for air filtration with recycling designed to reduce the aerobiocontamination of hospital rooms were tested. Their efficacity was evaluated by measurement of particle retention and by quantitative determination of the reduction of aerobiocontamination in rooms occupied by patients. Results show a significant improvement in the aerobiocontamination of test rooms as compared to control rooms. It is thus reasonable to suppose that these systems may provide a practical solution to the problems posed by hospitalization in ordinary rooms of patients subjected to aplasive chemotherapy. A randomized clinical trial is in progress.