Knowledge and perceptions of antibiotic resistance in the French population.

OBJECTIVE: To draw up an inventory of health behaviors and knowledge of the French population regarding antibiotic resistance. RESULTS: Overall, 44% of participants properly defined antibiotic resistance. Antibiotic abuse was identified as the main cause of antibiotic resistance, and 66% believed that an antibiotic-resistant infection can be fatal. However, 32% did not strictly comply with the dosage and duration of an antibiotic treatment. Analysis of social representations of antibiotic resistance revealed erroneous beliefs about this phenomenon. CONCLUSION: Our results highlight the need to continue to inform the French public of antibiotic resistance. Associated beliefs could be obstacles to the proper use of antibiotics.

Patterns of antibiotic use in hospital-acquired infections.

BACKGROUND: Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data. METHODS: We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile. RESULTS: Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S. aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E. coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E. coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem. CONCLUSIONS: This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted.

Hajj-associated infections.

BACKGROUND: The Hajj is the largest annual mass gathering event in the world, thus favoring the transmission of various infections: 183 different nationalities, high temperatures, coincidence with the start of the flu season in the Northern hemisphere, a long barefoot walk, tent-type accommodation, communal toilet facilities, absence of food control, and sharing of razors. Infections are the first cause of hospital admission, which often occurs in the home country of pilgrims. METHODS: Literature review on PubMed from 1952 to November 2015 on the epidemiology and prevention of infections contracted during the Hajj, using the keywords "Hajj" and "infections". RESULTS: Respiratory tract infections, ENT infections, influenza, pyogenic pneumonia, whooping cough, and tuberculosis are most frequently observed during the Hajj. Outbreaks of meningococcal meningitis have been reported in pilgrims and their contacts. Waterborne infections such as gastroenteritis and hepatitis A are common, despite the improvement of health conditions. Pyoderma and furuncles are also frequently observed. Recently, dengue fever, Alkhumra hemorrhagic fever, and Rift Valley fever have emerged but no case of MERS-coronavirus, appeared in Saudi Arabia in 2012, have yet been observed during the 2012-2014 Hajj. CONCLUSION: Prevention is based on compulsory meningococcal vaccination, vaccination against seasonal influenza and pneumococcal infections for pilgrims at high risk of contracting the infection, and on vaccination against hepatitis A. Updating immunization for diphtheria/tetanus/poliomyelitis/pertussis and measles/mumps is also crucial and pilgrims must comply with hygiene precautions.

Economic impact of healthcare-associated rotavirus infection in a paediatric hospital.

The aim of this prospective study was to determine the extra-length of stay and the average cost for rotavirus healthcare-associated infection (HAI). Children admitted to the paediatric ward of the Reims University Hospital between the 1 December 2001 and 31 March 2002, were included in a pairwise matched (1:1) case-control study. Cases were defined as patients with rotavirus HAI. Controls were selected according to matching variables in a stepwise fashion. The costs measured in this study included all expenses sustained by the hospital. Information on costs was obtained from medical records and the hospital economic department. The attack rate and the incidence of healthcare-associated acquired rotavirus infection were 6.6% and 15.8 per 1000 hospital days, respectively, during a winter outbreak. Fifteen percent of HAI were identified after discharge. The average cost per case was 1930 and the mean excess length of stay was 4.9 days. Our findings clearly demonstrate the substantial expense incurred as a result of HAI caused by rotavirus in children. To prevent these costly infections, several cost-effective measures such as standard precautions should be reinforced in the education of the healthcare workers.

[Nosocomial Burkholderia cepacia outbreak in an intensive pediatric care unit]. / Epidémie nosocomiale à Burkholderia cepacia dans une unité de réanimation infantile.

BACKGROUND: We report an outbreak of Burkholderia cepacia respiratory tract infection and colonization in an intensive pediatric care unit.P PATIENTS AND METHODS: Between February and December 1999, B. cepacia was isolated from five children hospitalized in this unit. We reviewed the charts of the patients, evaluated the antiseptics use and the disinfection practices for reusable patient care equipment. An environmental study was conducted and comparison of B. cepacia was performed with genotypic method (RAPD). RESULTS: All patients were mechanically ventilated and had received large spectrum antibiotics. The disinfection procedure for reusable equipment was not respected and some single-dose of antiseptics solutions were used for several patients. B. cepacia was not found in 34 environmental samples. The RAPD assay revealed that all five isolates had identical DNA profiles. CONCLUSION: Despite the investigation the source of the B. cepacia clone in this nosocomial outbreak remained unknown, but antiseptics use and disinfection practices were revised. No new B. cepacia infections were identified after control measures were implemented.

Direct costs associated with a hospital-acquired outbreak of rotaviral gastroenteritis infection in a long term care institution.

In January 2008, 63 patients were infected during an outbreak of rotaviral gastroenteritis in a long term care facility for elderly patients. The aim of this study was to evaluate the direct financial costs of this outbreak to the hospital. Data on costs were gathered from both medical records and the hospital finance department. The total hospital cost of the outbreak was euro17,959, or euro285.1 per case, comprising: euro4,948 for medical investigation and treatment costs, euro4,400 for isolation, euro1,879 for infection control staff, euro4,170 for other staff and euro2,562 for bed-day loss. The cost of this outbreak emphasises the importance of the early recognition of an outbreak and implementation of infection control measures.

[Evaluation of antibiotic curative treatments in a French orthopedic surgery unit]. / Evaluation des antibiothérapies curatives dans les services de chirurgie orthopédique d'un CHG.

INTRODUCTION: The aim of this study was to evaluate the technical quality and the relevance of antibiotics used in an orthopedic unit. DESIGN: A prospective and descriptive assessment was made of patients hospitalized in the orthopedic surgery department of our general hospital, receiving antimicrobial therapy. The relevance of antibiotics was evaluated using as a reference local guidelines previously validated by the antibiotics committee. RESULT: During the period of study, 37 of the 249 hospitalized patients received antibiotics (14.9 %). The reasons for hospitalization were mainly lower limb trauma (38 %) and an infectious disease (35 %). Hospital-acquired infections accounted for 16.2 % of antibiotic prescriptions. During the study, we observed that the dose regimen was inappropriate in 9 % of the cases, that the expected length of treatment was not indicated (76 %), and that the mode of administration was not mentioned in 8 % of the cases. Twenty five percent of combinations were not relevant. Finally, 27.3 % of prescriptions were not in conformity with guidelines. CONCLUSIONS: The quality and relevance of antibiotics used as curative treatments in the orthopedic surgery unit seem satisfactory for the dose regimen, the route and dose of administration and combinations used. We identified a few points which need to be improved: update and improvement of local antibiotherapy guidelines, promotion of training sessions for new prescribers in the institution.