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1.
J Hosp Infect ; 120: 48-56, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34861315

RESUMO

BACKGROUND: An outbreak of VIM carbapenemase-expressing Enterobacter cloacae complex occurred between March and October 2020 in an intensive care unit (ICU) of a tertiary care and teaching hospital in France. At the same time, the hospital was facing the COVID-19 first wave. AIM: To describe the management of an outbreak caused by a VIM-producing Enterobacter cloacae complex strain during the COVID-19 pandemic in an ICU and to show the importance of an integrated approach. METHODS: A multi-focal investigation was conducted including descriptive and molecular epidemiology, environmental screening, and assessment of infection prevention and control measures. FINDINGS: A total of 14 cases were identified in this outbreak with a high attributable mortality rate (85.7%). The outbreak management was coordinated by a crisis cell, and involved the implementation of multi-disciplinary actions such as: enhanced hygiene measures, microbiological and molecular analysis of patients and environmental E. cloacae complex strains, and simulation-based teaching. All 23 E. cloacae complex strains isolated from patients and environment samples belonged to multi-locus sequence type ST78 and carried bla-VIM4 gene. Using Fourier transform infrared spectroscopy, all but two isolates were also found to belong to a single cluster. Although the source of this outbreak could not be pinpointed, the spread of the strain was controlled thanks to this multi-focal approach and multi-disciplinary implementation. CONCLUSION: This investigation highlighted the usefulness of Fourier transform infra-red spectroscopy in the rapid typing of outbreak strains as well as the importance of an integrated approach to successfully fight against multidrug-resistant micro-organism dissemination and healthcare-associated infections.


Assuntos
COVID-19 , Infecção Hospitalar , Infecções por Enterobacteriaceae , Antibacterianos , Proteínas de Bactérias , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Enterobacter cloacae/genética , Infecções por Enterobacteriaceae/epidemiologia , Hospitais , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Pandemias , SARS-CoV-2 , beta-Lactamases/genética
2.
Pathol Biol (Paris) ; 58(1): 11-7, 2010 Feb.
Artigo em Francês | MEDLINE | ID: mdl-19892479

RESUMO

BACKGROUND: Stenotrophomonas maltophilia (Smalto) is a prominent nosocomial pathogen, commonly isolated in the hospital environment. Multiple Smalto nosocomial outbreaks have been linked to contaminated water sources. This study aimed to develop a medium able to ease healthcare environment Smalto isolation. METHODS: Financed, from March 2007 to June 2008, by a university hospital of Amiens' clinical research program, this study allowed Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) development. SM2i is constituted of Mueller Hinton agar (MH), maltose, DL-methionine, bromothymol blue. The mixture sterilized is refreshed at 50 degrees C, its pH adjusted to 7.1, and render selective by addition of vancomycin, imipenem and amphotericin B. Then, SM2i agar is sunk into 90 cm diameter Petri dish dated and stored at 4 degrees C for 4 weeks. SM2i is developed using Pasteur Institute culture type collection (CIP) strains of Smalto, Burkholderia cepacia, Pseudomonas aeruginosa (Psa) and a Smalto strain of our hygiene laboratory collection. It was validate on Psa imipenem-resistant and Enterococcus faecium vancomycin-resistant strains, then, tested on cold water first jet and faucet cotton-swabs samples. SM2i tests were made in comparison with the MH agar, MH agar plus four paper disks loaded 10 microg of imipenem and Cetrimed agar. Its sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, accuracy, likehood-ratio (LR) and Youden index have been determined. RESULTS: SM2i agar is better in culturing Smalto test-strains. On SM2i, Smalto colonies are smooth, round, greeny, olive or lime green, have a green olive centre with a peripheral lighter or a dark green centre with an olive green suburb surrounded by a blue halo. SM2i is a selective, specific, predictive, accurate medium to search for Smalto in healthcare environment. In 122 pairs of cold water first jet and taps cotton-swabs samples, Smalto was isolated from 14.8% of water samples, 10.7% of cotton-swabs samples. It was isolated alone in 6.6% of water samples and 2.5% of swab samples. Thus, smalto has biocontaminated 17.2% of cold water taps. Compared to MH agar, SM2i sensitivity, specificity, PPV, NPV, accuracy, LR were 100, 100, 100, 100, 100% and infinity, and 87.5, 100, 100, 98.1, 98.4% and infinity for water and cotton-swabs samples respectively. CONCLUSION: SM2i is a selective, specific, predictive medium which can allow easily isolating and identifying accurately Smalto in environmental samples. Its evaluation on clinical samples is on going.


Assuntos
Infecção Hospitalar/microbiologia , Meios de Cultura/farmacologia , Infecções por Bactérias Gram-Negativas/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Ágar , Técnicas Bacteriológicas , Meios de Cultura/química , Contaminação de Equipamentos , Humanos , Indicadores e Reagentes , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Stenotrophomonas maltophilia/efeitos dos fármacos , Stenotrophomonas maltophilia/crescimento & desenvolvimento , Microbiologia da Água
3.
Pathol Biol (Paris) ; 58(2): e1-5, 2010 Apr.
Artigo em Francês | MEDLINE | ID: mdl-19892487

RESUMO

BACKGROUND: Pseudomonas aeruginosa (Psa) and Stenotrophomonas maltophilia (Smalto) are major opportunistic waterborne pathogens causing hospital-acquired infections. This study aimed to assess the biocontamination level of cold water used in Amiens' university hospital wards, from March to June 2008. METHODS: We cultivated 122 pairs of cold water first jet and taps cotton-swabs on Cetrimide agar for Psa, on Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) for Smalto, on Mueller Hinton agar used as isolation medium reference for both, 48h at 30 degrees C. Data analysed with Epi-Info 6.04dFr were compared with chi(2) test, significant at p<.05. RESULTS: Psa and Smalto were isolated in 26.2 and 14.8% of water samples and in 21.3 and 10.7% of swab samples respectively. They were associated in 11.5% of water samples and 5% of swab samples. Psa was alone in 13.1% of water samples and 7.4% of swab samples whereas Smalto was found in 6.6% of water and 2.5% of swabs. Psa and Smalto were isolated from 14.8% of water samples and 8.2% of swab samples of the same tap. Finally, respectively 35.2 and 17.2% of the cold water taps were biocontaminated by Psa and Smalto. In fact, microbiologic water taps contamination risk was two-fold higher for Psa than for Smalto, p<.001, without variation between wards. CONCLUSION: Sm2i and Cetrimide are suited and efficient medium respectively for Smalto and Psa isolation. Cold-water samples are sufficient for waterborne pathogens biocontamination risk appraisal. Our results urged healthcare workers on efficient water fittings microbiologic risk control to prevent healthcare associated waterborne infections, notably due to Psa and Smalto.


Assuntos
Infecções por Bactérias Gram-Negativas/prevenção & controle , Hospitais Universitários , Infecções por Pseudomonas/prevenção & controle , Pseudomonas aeruginosa/isolamento & purificação , Stenotrophomonas maltophilia/isolamento & purificação , Microbiologia da Água , Poluição da Água , Técnicas Bacteriológicas , Infecção Hospitalar/prevenção & controle , Meios de Cultura , Contaminação de Equipamentos , França , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Quartos de Pacientes , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Medição de Risco , Gestão da Segurança , Engenharia Sanitária/instrumentação , Stenotrophomonas maltophilia/crescimento & desenvolvimento , Abastecimento de Água
4.
J Med Microbiol ; 68(1): 67-76, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30507374

RESUMO

PURPOSE: Multidrug-resistant Klebsiella pneumoniae strains are regularly involved in hospital outbreaks. This study describes an ESBL-producing K. pneumoniae clone (ST607-K25) responsible for a nosocomial outbreak in a neonatal intensive care unit. METHODOLOGY: Fourteen strains isolated from 13 patients were included. Antimicrobial susceptibility testing was performed by the agar diffusion method. A clonal link was first investigated by fingerprinting (ERIC-PCR and REP-PCR) then confirmed by MLST. Characterization was performed by molecular detection and identification of several drug resistance and virulence determinants. RESULTS: All strains expressed the same antibiotype, combining ESBL production, fluoroquinolones and aminoglycoside resistance, except for one which remained susceptible to fluoroquinolones. Fingerprinting methods confirmed the clonal link and MLST identified a ST607 clone. Molecular investigations revealed: (I) genes encoding for two narrow-spectrum beta-lactamases (SHV-1 and TEM-1) and an ESBL (CTX-M-15); (II) absence of any chromosomal mutation in quinolone resistance-determining- regions (QRDR) of gyrA/gyrB and parC/parE genes; (III) genes encoding for three plasmid-mediated quinolone-resistance (PMQR) determinants: oqxAB (14/14), aac(6')-Ib-cr (14/14) and qnrB (13/14); (IV) production of a K25 capsule; and (V) carriage of three genes encoding for virulence factors: mrkD (type 3 fimbriae) (14/14), ybts (yersiniabactin) (12/14) and entB (enterobactin) (14/14). CONCLUSION: We described a multidrug-resistant Kp ST607 clone responsible for a nosocomial outbreak in vulnerable and premature newborns. Molecular investigations allowed us to identify several resistance factors responsible for ESBL production (CTX-M-15) and quinolone resistance (three PMQR determinants). The detection of a gene (ybtS) belonging to the high-pathogenicity island yersiniabactin could partly explain its high colonization and diffusion potential.


Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Aminoglicosídeos/farmacologia , Proteínas de Bactérias/genética , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Fluoroquinolonas/farmacologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Fatores R/genética , beta-Lactamases/efeitos dos fármacos
5.
J Clin Microbiol ; 46(3): 1037-44, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18234876

RESUMO

Sixty-two clinical isolates of Enterobacter aerogenes resistant to expanded-spectrum cephalosporins were collected between July 2003 and May 2005. Among these isolates, 23 (37.1%) were imipenem (IPM) susceptible, and 39 (62.9%) were IPM insusceptible, of which 89.7% (35/39) were resistant and 10.3% (4/39) were intermediate. Isolate genotypes were compared by pulsed-field gel electrophoresis. Of 62 isolates, 48 belonged to epidemic pulsotype A (77.4%). This pulsotype included 37.5% and 58.4% of beta-lactam phenotypes b and a, respectively. Nine isolates (14.5%) belonged to pulsotype E, which included 22.3% and 77.7% of phenotypes b and a, respectively. The beta-lactamases with pIs of 5.4, 6.5, 8.2, and 8.2 corresponded to extended-spectrum beta-lactamases (ESBLs) TEM-20, TEM-24, SHV-5, and SHV-12, respectively. Of 39 IPM-insusceptible E. aerogenes isolates, 26 (66.6%) were determined to be metallo-beta-lactamase producers, by using a phenotypic method. Of these isolates, 24 harbored a bla(IMP-1) gene encoding a protein with a pI of >9.5, and two carried the bla(VIM-2) gene encoding a protein with a pI of 5.3, corresponding to beta-lactamases IMP-1 and VIM-2, respectively. The remaining 13 (33.4%) isolates were negative for the bla(IMP-1) and bla(VIM-2) genes but showed an alteration of their outer membrane proteins (OMPs). Ten of these isolates produced the two possible OMPs (32 and 42 kDa), with IPM MICs between 8 and 32 microg/ml, and three others produced only a 32-kDa OMP with IPM MICs >32 microg/ml. This work demonstrates that, in addition to resistance to expanded-spectrum cephalosporins, IPM resistance can occur in ESBL-producing E. aerogenes isolates by carbapenemase production or by the loss of porin in the outer membrane.


Assuntos
Proteínas de Bactérias/biossíntese , Resistência às Cefalosporinas , Enterobacter aerogenes/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Hospitais Universitários , beta-Lactamases/biossíntese , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Proteínas da Membrana Bacteriana Externa/química , Proteínas da Membrana Bacteriana Externa/metabolismo , Proteínas de Bactérias/genética , Enterobacter aerogenes/efeitos dos fármacos , Enterobacter aerogenes/enzimologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , França/epidemiologia , Humanos , Focalização Isoelétrica , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Porinas/análise , Análise de Sequência de DNA , beta-Lactamases/genética
6.
Arch Pediatr ; 25(4): 263-268, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29656034

RESUMO

A total of 1099 breastmilk donations received by the milk bank at the Amiens University Hospital from January to June 2016 were assessed for bacteriological contamination according to French regulations. This consisted in enumerating the total aerobic flora before and after heat treatment as well as the specific enumeration of coagulase-positive staphylococci. Results above the mandatory limits for at least one of these parameters were found in 25.9% of the donations, resulting in the destruction of approximately one-quarter of the volume of the donations (∼195L). This is a huge loss in both economic and health-related terms for neonates, especially for pre-terms. To identify ways to improve the bacteriological assessment results and reduce the percentage of discarded milk, an analysis of the causes was conducted. The two main causes of non-compliance were the detection of a cultivable aerobic flora after heat treatment and the presence of coagulase-positive staphylococci above the mandatory limit (11.7% and 11.2% of the tested donations, respectively). Bacillus spp. were the leading cause of post-heat-treatment non-compliance. Therefore, the implementation of better environmental control could help reduce this kind of contamination. As for samples harboring coagulase-positive staphylococci, a further detection of toxins using molecular biology techniques could help discriminate actual health-hazardous donations that have to be destroyed while enabling the use of toxin-negative donations. Nevertheless, the economic viability of this proposal needs to be further assessed because these techniques are costly. Finally, a change in breastmilk dilutions used to enumerate the total aerobic flora to better reflect the actual level of these bacteria in the milk was proposed. Indeed, the comparison of various combinations of milk dilutions led to the conclusion that the association of the 1/10 and 1/100 dilutions was the best compromise between technical ease of enumeration and ensuring the safety of the donations. Implementing these suggestions would help reduce the rate of non-compliance and give better access to safe breastmilk donations for neonates.


Assuntos
Contaminação de Alimentos , Bancos de Leite Humano , Leite Humano/microbiologia , Animais , Bactérias/isolamento & purificação , Árvores de Decisões , Humanos , Pasteurização
7.
Trans R Soc Trop Med Hyg ; 92(6): 621-4, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-10326103

RESUMO

We report the results of a seroepidemiological study on the prevalence of cysticercosis in Bénin. Cluster sampling at 3 levels was performed in the 6 départements (Atacora, Borgou, Zou, Mono, Atlantique and Oueme) and 2625 serum samples, from 1329 adult females and 1296 adult males, were collected. Antibodies against Taenia solium cysticerci were first searched for by enzyme-linked immunosorbent assay and the 41 seropositive samples were then examined by enzyme-linked electroimmunotransfer blot assay (EITB). Thirty-five samples gave positive results in the EITB. The overall seroprevalence of cysticercosis was therefore 1.3% (95% confidence interval [95% CI] 0.9-1.9). The seroprevalence was 1.9% in males (95% CI 1.2-2.7) and 0.8% (95% CI 0.4-1.5) in females (P < 0.05). A progressive increase in seroprevalence with increasing age was found. The highest seroprevalences were observed in Atacora and Atlantique, 2 non-Muslim départements (3.3% and 3.0%, respectively). This study demonstrated the public health importance of cysticercosis in Bénin.


Assuntos
Cisticercose/epidemiologia , Taenia/isolamento & purificação , Adolescente , Adulto , Animais , Benin/epidemiologia , Ensaio de Imunoadsorção Enzimática , Estudos Epidemiológicos , Feminino , Humanos , Immunoblotting/métodos , Masculino , Pessoa de Meia-Idade , Parasitologia/métodos
8.
Vet Parasitol ; 87(2-3): 133-8, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10622604

RESUMO

Investigations at the slaughterhouse of Limoges (Central France) were performed in 1994-1996 to determine the prevalence of Paramphistomum daubneyi infection in cattle. In 1994/1995, higher prevalences of P. daubneyi were recorded in May, October, and January. In 1996, smaller variations were recorded, and prevalence in April and May was higher. The prevalence of P. daubneyi in summer was lower. Breed and age of cattle were not significantly associated to P. daubneyi infection, but females were significantly more infected than males. P daubneyi infection was related to that of Fasciola hepatica, but not to that of Dicrocoelium lanceolatum.


Assuntos
Doenças dos Bovinos/epidemiologia , Paramphistomatidae/isolamento & purificação , Infecções por Trematódeos/veterinária , Matadouros , Fatores Etários , Animais , Bovinos , Doenças dos Bovinos/parasitologia , Feminino , França/epidemiologia , Masculino , Prevalência , Estações do Ano , Fatores Sexuais , Infecções por Trematódeos/epidemiologia
9.
Bull Soc Pathol Exot ; 89(1): 24-9, 1996.
Artigo em Francês | MEDLINE | ID: mdl-8765952

RESUMO

Cysticercosis is a parasitic disease due to the infection of man with Cysticercus cellulose, the larva of Taenia solium. This disease is frequent in countries with low socio-economic development and is linked to sanitary conditions. The aim is to assess the seroprevalence of cysticercosis in the lacustrine vicinity of Vekky, located on the lake Nokoué, District Atlantic, south Benin, an epidemiological survey was undertaken in April and May 1994. The lacustrian vicinity of Vekky comprises 12 villages including 16, 142 inhabitants. Population has been sampled using cluster sampling method (n = 30) at two levels (village and household). The whole samples consisted in 319 adults (123 females and 196 males, mean of ages: 32.8 +/- 18.3). Titration of cysticercosis antibodies has been made using ELISA. Eleven patients (3 females and 8 males) showed a positive ELISA response for cysticercosis, i.e. the seroprevalence of cysticercosis was 3.5% (CI 95%:1.3-8%). There was no significant difference according to age and sex. The seroprevalence of cysticercosis reached 9.1% in patients who presented history of epilepsy. We failed to find any linkage between seropositivity and i) clinical history of epilepsy or taeniasis, or ii) several studied environmental factors such as consumption of pork, wandering of pigs, lack of veterinary supervision, religion and occupation. Human seroprevalence of cysticercosis reaches 3.5% in vicinity of Vekky, which denotes a high endemic level. Further epidemiological studies are necessary to precise the factors involving cysticercosis in this area.


Assuntos
Anticorpos Anti-Helmínticos/sangue , Cisticercose/epidemiologia , Cysticercus/imunologia , Adolescente , Adulto , Animais , Benin , Criança , Ensaio de Imunoadsorção Enzimática , Humanos , Pessoa de Meia-Idade
10.
Presse Med ; 28(38): 2100-2, 1999 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-10613197

RESUMO

BACKGROUND: Since the advent of antibiotics, Streptococcus pneumoniae has become a very unusual agent of materno-fetal infection. We report two cases. CASE REPORTS: In case n(o) 1, early neonatal meningitis was caused by a penicillin-resistant strain. In case n(o) 2, the mother developed meningitis 16 days after delivery. In both cases, premature rupture of the membranes in otherwise asymptomatic mothers was the initial event and outcome was favorable under amoxicillin alone. The pneumococci were easily recovered fom placental, amniotic and neonatal samples, less easily from the maternal samples. DISCUSSION: The increasing prevalence of penicillin-resistant pneumococci is an emerging problem of real concern. It might increase the very low present incidence of pneumococcal neonatal materno-fetal infection which is a particularly serious infection with up to 60% neonatal mortality. Any type of S. pneumoniae infection, or even colonization, occurring in the peripartum should prompt adequate treatment and suggests considering first line vancomycin for the newborn.


Assuntos
Troca Materno-Fetal , Meningite/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Líquido Amniótico/microbiologia , Índice de Apgar , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Meningite/diagnóstico , Paridade , Resistência às Penicilinas , Placenta/microbiologia , Gravidez
11.
J Mycol Med ; 22(1): 64-71, 2012 Mar.
Artigo em Francês | MEDLINE | ID: mdl-23177816

RESUMO

Construction works in healthcare establishments produce airborne fungal spores and considerably increase the risk of exposure of immunosuppressed patients. It is necessary to reinforce protective measures, or even to implement specific precautions, during this critical phase. The aim of these precautions is to protect both those areas, which are susceptible to dust, and patients at risk of a fungal infection particularly invasive aspergillosis. When construction works are planned in healthcare establishments, the first step consists in the characterisation of the environmental fungal risk and the second one in proposing risk management methods. It is then essential to establish impact indicators in order to evaluate the risk management precautions applied. The working group promoted by the French societies of medical mycology and hospital hygiene (SFMM & SF2H) details here both environmental and epidemiological impact indicators that can be used.


Assuntos
Microbiologia do Ar/normas , Infecção Hospitalar/epidemiologia , Arquitetura Hospitalar/normas , Controle de Infecções/métodos , Micoses/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Contaminação de Equipamentos/prevenção & controle , Arquitetura Hospitalar/métodos , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Micoses/etiologia , Micoses/prevenção & controle , Medição de Risco , Fatores de Risco
12.
Int J Microbiol ; 2010: 150464, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21052490

RESUMO

We studied 138 glycopeptide-resistant enterococci (GRE) strains, consisting of 131 glycopeptide-resistant Enterococcus faecium (GREfm) and 7 glycopeptide-resistant Enterococcus faecalis (GREfs). The GREfm strains were resistant to penicillin, ampicillin, vancomycin, and teicoplanin, while the GREfs strains were only resistant to vancomycin and teicoplanin. The van A gene was the only glycopeptide determinant present in all GRE isolates investigated. Genes coding for Hyl and Hyl+ Esp were detected in 39 (29.8%) and 92 (70.2%) of the 131 GREfm isolates, respectively. Three of the 7 GREfs were positive for gelE+asa 1 genes, 3 for gel E gene, and 1 for asa 1 gene. The genetic relationship between the 138 GRE was analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). GREfm isolates were clustered in a single genogroup (pulsotype A), and GREfs were clustered in six genogroups (pulsotypes B-G). Among the isolates investigated by MLST, only 18 PCR products were sequenced (12 E. faecium and 6 E. faecalis), and 9 sequence types (STs) were identified.

13.
Pathol Biol (Paris) ; 54(8-9): 510-7, 2006.
Artigo em Francês | MEDLINE | ID: mdl-17030458

RESUMO

OBJECTIVES: Study the health-care associated infection risk due to Extended-Spectrum Betalactamases Producing Escherichia coli (ESBL Esc) isolated from diagnostic samples. METHODS: Descriptive, longitudinal and prospective study of 104 diagnostic isolates of ESBL Esc, one per patient, identified in Amiens university hospital between February 1999 and December 2005. Patients (sex, age, contamination risk factor, antecedent hospitalization) and microbiological data were progressively collected, entered into EPI INFO 6.04dFr software (ENSP, France) database, and compared using the chi-square test and Wilcoxon rank sum test, as appropriate. A p value of less than 0.05 was considered significant. RESULTS: Diagnostic ESBL Esc isolates raised, per 1000 isolates of Esc, from 1.2 in 1999 to 6 in 2005. Global and acquired isolates number of ESBL Esc varied from 7 and 3 in 2002 to 25 and 19 in 2003 (P=0.22). ESBL Esc global and acquired incidence per 10(5) patient-days were, 0.8 and 0.6 in 1999 and 4.99 and 3.4 in 2005 (P<10(-6)), but rose from 0.6 acquired isolate in 2002 to 3.9 in 2003 (P=0.002). ESBL Esc, isolated from urines, stools, pulmonary, blood and surgical site samples of patients of>/=65 years aged (68.3%), were imipenem and latamoxef sensitive. Their acquisition risk factors found were hospitalization during the last 6 month period (40/104) and transfer from other institutions (20/104). CONCLUSION: ESBL Esc isolates, among ESBL-producing Enterobacteriaceae, constitute an escalating health-care associated risk in our institution. The research at admission time of ESBL-producing Enterobacteriaceae, mainly in acute geriatric wards, strict isolation precaution and hand hygiene observance, rational antibiotic usage, are the key actions to control their cross transmission. Nonetheless, other studies are needed to determine whether we are in front of an ESBL Esc new clone emergence.


Assuntos
Infecções por Escherichia coli/diagnóstico , Escherichia coli/metabolismo , beta-Lactamases/biossíntese , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Infecções por Escherichia coli/epidemiologia , França , Hospitais Universitários , Humanos , Incidência , Estudos Longitudinais
14.
Pathol Biol (Paris) ; 45(9): 701-8, 1997 Nov.
Artigo em Francês | MEDLINE | ID: mdl-9538467

RESUMO

The serological status for both hepatitis B, C and D viruses was analyzed for 500 HIV seropositive patients and for 1037 of a control group. The prevalence was 31.4% for anti HCV, 13.8% for HBs Ag and 69.0% for one or more HBV markers in HIV positive patients and respectively 2.5%, 2.7% and 13.1% in control group. The markers for hepatitis D were founded among 21% of the HBs Ag carriers (patients and control group), correlated with drug i.v. use. The prevalence of anti-HCV was 71.6% in subjects who had blood-borne HIV infection and 1.5% in those with sexually acquired infection. The prevalence in control group was 10.2% and 1.7% respectively according to the same risk factors. The prevalence of HBs Ag was higher among HIV positive patients with sexual risk (17.5%) than with blood exposition (9.9%) and a variation in the same direction is observed in control group (3% v.s. 1%). The relation between markers for hepatitis B and hepatitis C was negative.


Assuntos
Infecções por HIV/virologia , Hepacivirus/química , Vírus da Hepatite B/química , Vírus Delta da Hepatite/química , Adolescente , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais
15.
Pathol Biol (Paris) ; 52(8): 423-8, 2004 Oct.
Artigo em Francês | MEDLINE | ID: mdl-15465258

RESUMO

OBJECTIVES: To identify patient-related risk factors of infection and ways of transmission of extended-spectrum betalactamase (ESBL) producing Serratia marcescens in the paediatric intensive care unit (PICU) of Amiens university hospital (France) between June and July 2002. METHODS: Five cases (four pulmonary infected and one stool contaminated symptom-free neonates) and 35 controls, admitted in the PICU, are included. S. marcescens ESBL analysed are isolated from respiratory tract and faecal samples for cases and urine and pus samples from two non-paediatric other patients. Univariate and multivariate analysis are performed on EPI INFO 6.04 dFr and SPSS 11.0.1. RESULTS: S. marcescens ESBL infections or colonisations rate is 12.5% [4.7-27.6]. The incidence is 8.8 [6.7-11.6] per 1000 hospital-stay days. By univariate analysis, cases and controls don't differ with respect of age, sex, and weight at admission or preterm delivery. Cases don't have more often invasive nursing care than controls. But, they were intubated (P <0.03) and hospitalised (P <0.03) for a longer time than controls. Linear regression analysis showed that duration of intubation was independent predictor of acquisition of S. marcescens ESBL (P <0.008). S. marcescens ESBL strains implicated in pulmonary infections, showed the same pattern of multidrug resistant and ERIC-PCR profile. This clone differs from others isolated from stool or other samples from other hospital wards. CONCLUSION: As S. marcescens cross-colonization appears to be due to lake of hand hygiene and asepsis during invasive nursing care, reinforcing hygiene measures permit to contain the outbreak.


Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Serratia/transmissão , Serratia marcescens , beta-Lactamases/metabolismo , Adolescente , Adulto , Criança , Pré-Escolar , Surtos de Doenças , Fezes/microbiologia , Feminino , França/epidemiologia , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Sistema Respiratório/microbiologia , Serratia marcescens/enzimologia , Serratia marcescens/isolamento & purificação
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