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To compare the occurrence of healthcare-associated infections acquired in intensive care units (HAI-ICUs) in France among patients with COVID-19 and those without it in 2020 and the latter with that in patients before the COVID-19 pandemic. Multicentre HAI-ICU surveillance network (REA-REZO) data were used to identify 3 groups: 2019 patients (2019Control), a COVID-19 group (2020Cov), and a non–COVID-19 group (2020NonCov). The primary outcome was the occurrence of HAI-ICU (ventilator-associated pneumonia [VAP], bloodstream infections [BSIs], catheter-related bacteraemia). Standardized infection ratios of VAP were calculated for each quarter in 2020 and compared with those in 2019. A total of 30 105 patients were included in 2020: 23 798 in the 2020NonCov group, 4465 in 2020Cov group, and 39 635 patients in the 2019Control group. The frequency of VAP was strikingly greater in the 2020Cov group: 35.6 (33.4–37.8) episodes/1000 days of mechanical ventilation versus 18.4 (17.6–19.2) in the 2020NonCov group. VAP standardized infection ratio was high in 2020 patients, particularly during the 2 quarters corresponding to the 2 waves. BSI/1000 days were more frequent in the 2020Cov group (6.4% [6.4–6.4%] vs. 3.9% [3.8–3.9%] in the 2020NonCov group). VAP and BSI were also more frequent in the 2020NonCov group than in the 2019Control group. The microbial epidemiology was only slightly different. The data presented here indicate that HAI-ICUs were more frequent during the COVID-19 period, whether the patients were admitted for COVID-19 or, to a lesser extent, for another cause. This implies that managing patients with severe disease in a pandemic context carries risks for all patients. [ABSTRACT FROM AUTHOR]

A survey was undertaken to evaluate the level of computerization in intensive care units (ICUs) within a French network dedicated to the surveillance of healthcare-associated infections, antimicrobial use (AMU) and antimicrobial resistance (AMR) in ICUs (REA-REZO). Ninety-eight ICUs responded, and patient records were computerized in 57%, antimicrobial prescriptions were computerized in 59% and AMR epidemiology was computerized in 72%. AMU and AMR feedback was provided to the ICU itself for 77% and 65% of ICUs, respectively, and feedback was provided to the national surveillance for 79% and 65% of ICUs, respectively. This study suggests that the level of computerization in ICUs requires further improvement. [ABSTRACT FROM AUTHOR]

Due to large outbreaks observed worldwide, Candida auris has emerged as a major threat to healthcare facilities. To prevent these phenomena, a systematic screening should be performed in patients transferred from regions where the pathogen is highly endemic. In this study, we recorded and analyzed French mycologists' current knowledge and practice regarding C. auris screening and diagnosis. Thirty-six centers answered an online questionnaire. Only 11 (30.6 %) participants were aware of any systematic screening for C. auris for patients admitted to their hospital. In the case of post-admission screening, axillae/groins (n = 21), nares (n = 7), rectum (n = 9), and mouth (n = 6) alone or various combinations were the body sites the most frequently sampled. Only six centers (8.3 %) reported using a commercially available plate allowing the differentiation of C. auris colonies from that of other Candida species, while five laboratories (13.8 %) had implemented a C. auris -specific qPCR. Considering the potential impact on infected patients and the risk of disorganization in the care of patients, it is crucial to remember to biologists and clinicians the utmost importance of systematic screening on admission. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas aeruginosa remains one of the most common nosocomial pathogens in intensive care units (ICUs). Although exogenous acquisition has been widely documented in outbreaks, its importance is unclear in non-epidemic situations.Aim: To elucidate the role of exogenous origin of P. aeruginosa in ICU patients.Methods: A chronological analysis of the acquisition of P. aeruginosa was performed using samples collected in 2009 in the DYNAPYO cohort study, during which patients and tap water were screened weekly. Molecular relatedness of P. aeruginosa isolates was investigated by pulsed-field gel electrophoresis. Exogenous acquisition was defined as identification of a P. aeruginosa pulsotype previously isolated from another patient or tap water in the ICU.Findings: The DYNAPYO cohort included 1808 patients (10,402 samples) and 233 water taps (4946 samples). Typing of 1515 isolates from 373 patients and 375 isolates from 81 tap water samples identified 296 pulsotypes. Analysis showed exogenous acquisition in 170 (45.6%) of 373 patients. The pulsotype identified had previously been isolated from another patient and from a tap water sample for 86 and 29 patients, respectively. The results differed according to the ICU.Conclusion: Exogenous acquisition of P. aeruginosa could be prevented in half of patients. The overall findings of this survey support the need for studies on routes of transmission and risk assessment approach to better define how to control exogenous acquisition in ICUs. [ABSTRACT FROM AUTHOR]

• Ventilator-associated pneumonia (VAP) in adults intensive care units ICUs. • Restricted risk factors for multidrug-resistant microorganisms (MDROs) infection. • Decrease of the percentage of MDROs involved in VAP over year. • 23.9% of MDROs involved in VAP starting 2 days after ICU admission. • Increase of the percentage of MDROs involved in VAP after 10 days in ICUs. The aim of this study was to describe the proportion of multidrug-resistant microorganisms (MDROs) involved in ventilator-associated pneumonia (VAP) as the first hospital-acquired infection in 536 adults with restricted risk factors for MDRO-related infection. We found a significant decrease in the percentage of MDROs involved in VAP between 2003 and 2016 and this percentage increased when VAP occurred after day 10. [ABSTRACT FROM AUTHOR]

Objective: Candidaemia is a life-threatening infectious disease, associated with septic shock, multiple organ failure, and a high mortality rate. In France, reported data on the incidence of ICU-acquired candidaemia and the causative Candida species are scarce. The objective of this study was to determine temporal trends in epidemiology and risk factors of intensive care unit-acquired candidaemia (ICU-Cand) and ICU mortality among a very large population of ICU patients.Method: Demographics, patient risk factors, invasive device exposure and nosocomial infection in ICU patient were collected from 2004 to 2013 in a national network of 213 ICUs: REA-RAISIN. Incidence and risk factors for candidaemia and ICU mortality were assessed.Results: Out of 246,459 ICU patients, 851 developed an ICU-cand, representing 0.3 per 1000 patients-days. The incidence rose sharply over time. Candida albicans was the main species. The overall and ICU mortality was 52.4% in ICU-cand patients. The main risk factors of ICU-cand were length of stay, severity of illness and antimicrobial therapy at ICU admission, immune status and use of invasive procedure. ICU-cand was an independent risk factor of mortality (OR: 1.53; 95%CI [1.40-1.70]); in a sub-group analysis, independent effects on mortality were observed with C. albicans (OR: 1.45 [1.23-1.71]), Candida tropicalis (OR: 2.11 [1.31-3.39]) and "other" Candida species (OR: 1.64 [1.09-2.45]).Conclusion: ICU candidaemia ranked sixth among bloodstream infections, and its average annual incidence was 0.3 per 1000 patients days. Despite of new therapy and international recommendation, the incidence rose sharply during the study period, and ICU mortality remained high. [ABSTRACT FROM AUTHOR]

The description of the systemic inflammatory response syndrome (SIRS) as a reaction to numerous insults marked a turning point in the understanding of acute critical states, which are intensive care basic cases. This concept highlighted the final inflammatory response features whichever the injury mechanism is: infectious, or non-infectious such as extensive burns, traumas, major surgery or acute pancreatitis. In these cases of severe non-infectious insult, many endogenous mediators are released. Like infectious agents components, they can activate the immune system (via common signaling pathways) and initiate an inflammatory response. They are danger signals or alarmins. These molecules generally play an intracellular physiological role and acquire new functions when released in extracellular space. Many progresses brought new information on these molecules and on their function in infectious and non-infectious inflammation. These danger signals can be used as biomarkers and provide new pathophysiological and therapeutic approaches, particularly for immune dysfunctions occurring after an acute injury. We present herein the danger model, the main danger signals and the clinical consequences. [ABSTRACT FROM AUTHOR]

Summary Background Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. Aim To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. Methods A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. Findings Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa . Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward ‘nine equivalents of nursing manpower use score’ (NEMS) [hazard ratio (HR): 1.47 for ≥30 points; 95% confidence interval (CI): 1.06–2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09–2.84). Conclusion Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition. [ABSTRACT FROM AUTHOR]

Abstract: Septic syndromes (systemic inflammatory response associated with infection) remain a major although largely under-recognized health care problem and represent the first cause of mortality in intensive care units. Regarding immune response, it is now agreed that sepsis induces an anti-inflammatory process, acting as a negative feedback. This inhibitory mechanism becomes deleterious as nearly all immune functions are rapidly compromised. The magnitude and persistence over time of this immunosuppression is correlated with nosocomial infections and mortality. Decreased HLA-DR expression on monocytes/increased percentage of regulatory T cells are biomarkers identifying patients at risk who could benefit from immunotherapy. This review attempts to integrate these new facts into an up-to-date account of sepsis pathophysiology. [Copyright &y& Elsevier]

The aim of this study was to evaluate seven different strategies for the automated detection of nosocomial infections (NIs) in an intensive care unit (ICU) by using different hospital information systems: microbiology database, antibiotic prescriptions, medico-administrative database, and textual hospital discharge summaries. The study involved 1499 patients admitted to an ICU of the University Hospital of Lyon (France) between 2000 and 2006. The data were extracted from the microbiology laboratory information system, the clinical information system on the ward and the medico-administrative database. Different algorithms and strategies were developed, using these data sources individually or in combination. The performances of each strategy were assessed by comparing the results with the ward data collected as a national standardised surveillance protocol, adapted from the National Nosocomial Infections Surveillance system as the gold standard. From 1499 patients, 282 NIs were reported. The strategy with the best sensitivity for detecting these infections using an automated method was the combination of antibiotic prescription or microbiology, with a sensitivity of 99.3% [95% confidence interval (CI): 98.2-100] and a specificity of 56.8% (95% CI: 54.0-59.6). Automated methods of NI detection represent an alternative to traditional monitoring methods. Further study involving more ICUs should be performed before national recommendations can be established. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare risk factors of early- (E) and late-onset (L) ventilator-associated pneumonia (VAP). Materials and Methods: An epidemiological survey based on a nosocomial infection surveillance program of 11 intensive care units (ICUs) of university teaching hospitals in Lyon, France, was conducted. A total of 7236 consecutive ventilated patients, older than 18 years and hospitalized in ICUs for at least 48 hours, were studied between 1996 and 2002. Data during ICU stay, patient-dependent risk factors, device exposure, nosocomial infections occurrence, and outcome were collected. The cutoff point definition between E-VAP (≤6 days) and L-VAP (>six days) was based on the daily hazard rate of VAP. Results: The VAP incidence rate was 13.1%, 356 (37.6%) E-VAP (within 6 days of admission) and 590 (62.4%) L-VAP were reported. Independent risk factor for E-VAP vs L-VAP was surgical diagnostic category (odds ratio [OR], 1.49 [95% confidence interval, 1.07-2.07]), whereas independent risk factors for L-VAP vs E-VAP were older age (OR, 1.01 [1.01-1.02]), high Simplified Acute Physiology Score II (OR, 1.01 [1.00-1.02]), infection on admission (OR=2.22 [1.61-3.03]), another nosocomial infection before VAP (OR, 5.88 [3.33-11.11]), and exposure to central venous catheter before VAP (OR, 4.76 [1.04-20.00]). Conclusions: E-VAP and L-VAP have different risk factors, highlighting the need for developing specific preventive measures. [Copyright &y& Elsevier]

Abstract: Management of septic shock requires complex and multiple diagnostic as well as therapeutic procedures in a limited time-frame. This issue is a major source of medical errors. The author presents a critical analysis of tools (guidelines, clinical path, algorithm, check-lists) to help physicians for the management of patients with septic shock. [Copyright &y& Elsevier]

Abstract: After microbiological identification, several points are to be taken into account: microbiological results, clinical signs of severity, catheter withdrawal or not. French and American recommendations are very different for coagulase negative staphylococci. Catheter withdrawal and antibiotic treatment are recommended by all the authors for coagulase positive staphylococci infections. There is no a clear guideline or studies on Enterobacteriaceae or Pseudomonas infections. Catheter removal and antifungal treatment are recommended for Candida infection. [Copyright &y& Elsevier]

Nosocomial urinary tract infection (NUTI) is the second most frequent nosocomial infection in ICU. Decreasing the infectious risk can only be achieved by targeting indications, and duration of catheterizing. Inserting a urinary catheter is often performed under aseptic surgical conditions even though the efficacy of this procedure has not been demonstrated in ICU. Several studies have reported that using catheters coated with antiseptics or antibiotics decreases the frequency of UTIs, but induces overcosts. The closed system remains a reference technique. Basic body hygiene seems to be efficient enough for daily care. To conclude, the prevention of UTIs is linked to the quality of care, especially nursing care, and for some a marker of the quality of care. [Copyright &y& Elsevier]

Using the main French health insurance company database over a 10-year period, the preventability of catheter-related infections of patients who claimed compensation after prosecution was reviewed by a panel expert. They occurred in 71 patients with few co-morbidities or risk factors for nosocomial infection and were mainly related to the use of a peripheral vascular catheter (42 cases) and due to Staphylococcus aureus (51 cases). Forty-two infections were considered to be preventable. Infections due to peripheral venous catheters were significantly more often preventable than those due to central ones (p < 0.05). We conclude that catheter-related infections perceived by patients and the justice system as not related to unforeseeable medical complications are mainly peripheral catheter infections due to S. aureus and might be an appropriate target for new preventive strategies. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAI) are among the most common adverse events of medical care. Surveillance of HAI is a key component of successful infection prevention programmes. Conventional surveillance – manual chart review – is resource intensive and limited by concerns regarding interrater reliability. This has led to the development and use of automated surveillance (AS). Many AS systems are the product of in-house development efforts and heterogeneous in their design and methods. With this roadmap, the PRAISE network aims to provide guidance on how to move AS from the research setting to large-scale implementation, and how to ensure the delivery of surveillance data that are uniform and useful for improvement of quality of care. The PRAISE network brings together 30 experts from ten European countries. This roadmap is based on the outcome of two workshops, teleconference meetings and review by an independent panel of international experts. This roadmap focuses on the surveillance of HAI within networks of healthcare facilities for the purpose of comparison, prevention and quality improvement initiatives. The roadmap does the following: discusses the selection of surveillance targets, different organizational and methodologic approaches and their advantages, disadvantages and risks; defines key performance requirements of AS systems and suggestions for their design; provides guidance on successful implementation and maintenance; and discusses areas of future research and training requirements for the infection prevention and related disciplines. The roadmap is supported by accompanying documents regarding the governance and information technology aspects of implementing AS. Large-scale implementation of AS requires guidance and coordination within and across surveillance networks. Transitions to large-scale AS entail redevelopment of surveillance methods and their interpretation, intensive dialogue with stakeholders and the investment of considerable resources. This roadmap can be used to guide future steps towards implementation, including designing solutions for AS and practical guidance checklists. [ABSTRACT FROM AUTHOR]

Infection is a risk for any intervention. In surgery, for example, pathogenic bacteria are found in more than 90% of operative wounds during closure. This exists whatever the surgical technique and whatever the environment (the laminar flow does not entirely eliminate this risk). These bacteria are few in number but can proliferate. They find in the operative wound a favourable environment (haematoma, ischaemia, modification of oxido-reduction potential...) and the intervention induces anomalies of the immune defences. In the case of the installation of foreign material, the risk is increased. The objective of antibiotic prophylaxis (ABP) is to prevent bacterial growth in order to reduce the risk of infection at the site of the intervention. The preoperative consultation represents a privileged moment to decide on the prescription of a ABP. It is possible to define the type of intervention planned, the associated risk of infection (and therefore the necessity or not of ABP), the time of prescription before surgery and any allergic antecedents which may modify the choice of the selected antibiotic molecule. [ABSTRACT FROM AUTHOR]

Septic patients develop immune dysfunctions, the intensities and durations of which are associated with deleterious outcomes. LILRB2 (leukocyte immunoglobulin-like receptors subfamily B, member 2), an inhibitory member of the LILR family of receptors, is known for its immunoregulatory properties. In a microarray study, we identified LILRB2 as an upregulated gene in septic shock patients. On monocytes primed with LPS ex vivo , LILRB2 mRNA and protein expressions were dose-dependently downregulated and subsequently highly upregulated versus non-stimulated cells. This is concordant with clinical data, since both LILRB2 mRNA and protein expressions were significantly increased in septic shock patients at day 3. In a cohort of more than 700 patients, only after septic shock were LILRB2 mRNA levels increased compared with non-infected or less severely infected patients. This was preceded by a phase of downregulated mRNA expression during the first hours after septic shock. Interestingly, the intensity of this decrease was associated with increased risk of death after septic shock. LILRB2 protein and mRNA expressions are deregulated on monocytes after septic shock and this can be reproduced ex vivo after LPS challenge. Considering LILRB2 inhibitory properties, we can hypothesize that LILRB2 may participate in the altered immune response after septic shock. [ABSTRACT FROM AUTHOR]

Objectives We aimed to assess antibiotic prescriptions to identify potential targets for improvement. Methods We conducted a point prevalence survey (November 2010) of antibiotic use in 314 voluntary hospitals recruited by the French Infectious Diseases Society (SPILF) and the National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials (ONERBA). Data were entered online, immediately analyzed and exported. Results The prevalence of antibiotic use was 19.5% (9059/46,446 patients). A higher prevalence was observed in the infectious disease (58.4%), hematology (58%), and intensive care (48.7%) units. The three most frequently used antibiotic classes were aminopenicillins (23.8%), fluoroquinolones (17.9%), and 3rd-generation cephalosporins (16.7%). A monotherapy was prescribed to 64% of patients. The reasons for the antibiotic prescription were written in the medical records of 74% of patients and 62% were consistent with the local guidelines. Conclusion Our results are similar to that of other studies. Various local targets for improvement have been identified to help hospitals define a better antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Introduction La voie intraveineuse est la principale voie d’administration des médicaments chez les patients de soins intensifs [1] . Dans ce contexte, se pose la problématique de l’administration simultanée de plusieurs médicaments sur une même voie d’administration [2] , en sachant que le nombre de voies est limité chez ces patients. Les complications répertoriées dans la littérature font mention d’occlusions et de dysfonctionnements de cathéters réduisant potentiellement l’efficacité du traitement, des réactions inflammatoires locales et systémiques ainsi que les risques associés à la nécessité du changement de voies veineuses : thromboses, sepsis, insuffisance veineuse chronique, embolie pulmonaire [3] . L’objectif de ce travail est d’évaluer la fréquence des interactions physico-chimiques, d’identifier les médicaments les plus impliqués dans celles-ci et de créer un outil à destination du personnel médical et paramédical répertoriant les principales incompatibilités. Matériel et méthodes Une étude observationnelle a été réalisée en prospectif dans les deux services de réanimation du Centre Hospitalier Lyon Sud (CHLS). L’observation a été conduite un jour donné, réitérée à une semaine d’intervalle. Les patients présents d’une semaine sur l’autre n’ont été comptabilisés qu’une seule fois. Nous avons considéré que tous les médicaments injectables (continus et discontinus) ont été administrés en même temps. Tous les médicaments injectables en continus et discontinus ont été analysés en termes de compatibilité ou incopatibilités à l’aide des données issues du logiciel Stabilis ® et du Trissel Handbook on injectable drugs 17th edition Trissel LA. Résultats Quarante-deux patients ont été inclus dont 57,1 % d’hommes. La moyenne d’âge est de 67 ± 12 ans. Le nombre moyen de médicaments injectables par patient est de 6,7 ± 2,5. Soixante-cinq principes actifs ont été relevés pour un total de 962 associations médicamenteuses. Un total de 51,9 % des associations sont compatibles, 8,5 % sont incompatibles, et 39,6 % sont sans données disponibles. Les médicaments les plus impliqués dans les interactions physico-chimiques sont le pantoprazole (15,2 %), le furosémide (12,8 %), le midazolam (8,5 %), et l’amiodarone (7,3 %). Les 3 principaux couples d’interactions physico-chimiques sont : furosémide/midazolam (6,1 %), amiodarone/furosémide (4,9 %) et ciprofloxacine/furosémide (4,9 %). Discussion Un premier travail avait conduit à l’élaboration de règles, les amines et les médicaments sédatifs devant être administrés sur des lumières séparées de la voie veineuse centrale. L’étude ne répertorie aucune association à risque d’interactions parmi la liste des médicaments cités ci-dessus. Les médicaments identifiés, sources d’interactions médicamenteuses représentent 70,4 % des prescriptions médicamenteuses, et font partie du top dix des consommations annuelles médicamenteuses. Cette étude a été réalisée sur 2 jours, sur la base du postulat que tous les médicaments étaient administrés au même moment, nous devons compléter cette étude par le relevé des horaires et de la voie d’administration (distale/proximale ou médiane). Un tableau à double entrée regroupant les associations incompatibles a été construit. [ABSTRACT FROM AUTHOR]

Introduction La culture de sécurité de soins (CS) est un concept en pleine émergence. Le développement d’une CS au sein d’une équipe est un des outils pour améliorer la sécurité et la qualité des soins rendu aux patients. Ainsi, ont été développés des outils de mesure permettant de réaliser une évaluation quantitative de la CS des professionnels dispensant des soins. Le Safety Attitudes Questionnaire d’origine Nord-Américaine (SAQ) est un de ces outils largement utilisé dans la littérature. C’est le seul questionnaire pour lequel il existe une version spécifiquement adapté à la réanimation (SAQ-ICU). Dans le cadre de la préparation d’une étude nationale, et après avoir obtenu le consentement des auteurs de la version original américaine, nous avons réalisé une version française du questionnaire puis nous l’avons testée auprès des professionnels de santé des deux unités de réanimation de l’établissement. Nous présentons ici les résultats de ce test et les développements attendus. Matériel et méthodes Le questionnaire a été administré à tous les professionnels (médecins, AS, IDE) exerçant depuis plus de 6 mois dans l’unité. Il est constitué de 30 items permettant d’explorer les 6 dimensions de la CS ( Tableau 1 ). Une dimension est considérée comme « développée » si le score est > 75 %, et « à améliorer » s’il est < 50 %. Résultats Le questionnaire a été distribué à 116 personnels médicaux et non médicaux, d’âge médian 36 ans, une ancienneté professionnelle médiane de 10 ans et une ancienneté dans le service médiane de 4,5 années. L’enquête a pu être réalisée dans les 2 unités avec plus de 80 % de répondants dans chacune d’elles. On observe des résultats superposables dans les deux unités : 4 dimensions sur 6 obtiennent un score compris entre 50 et 75 % et seules les dimensions 5 et 6 (Perception de l’équipe d’encadrement ; conditions de travail) sont « à améliorer » (score < 50 %). Parmi les 30 items, deux recueillent un score positif > à 75 %, il s’agit de « Je suis moins efficace au travail lorsque je suis fatigué » appréciation de la reconnaissance du stress et « J’aime mon travail » reflet de la positivité de l’expérience de travail. La dimension 5 (soutien du management pour la sécurité des soins) est celle qui obtient le plus mauvais scores ( Tableau 1 ). Discussion Jusqu’à présent il n’existait que des questionnaires généralistes en langue française ou des questionnaires spécifiques à la réanimation mais en langue anglaise. Nous avons réalisé une version francophone adaptée à l’évaluation du niveau de CS dans les services de réanimation similaire à la version américaine, spécifique au service de réanimation et explorant 6 dimensions de la CS. Le taux de réponse > 80 % est très satisfaisant et l’enquête donne une image sans doute proche de la réalité des opinions et pratiques des soignants travaillant dans ces unités. Une étude nationale est en cours utilisant la version française du SAQ-ICU, réalisée dans 8 unités de réanimations afin d’étudier les propriétés psychométriques de cette version (PREPS 2012). [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Dans le domaine de la ventilation en réanimation, préciser le matériel, la formation des équipes, la maintenance et les référentiels disponibles. Type d’étude: Enquête déclarative. Méthodes: Entre septembre et décembre 2010, ont été recueillis : répartition et type des ventilateurs (ventilateurs lourds, de dépannage, ventilation non invasive (VNI) et de transport), formation des médecins et des soignants, maintenance, présence de référentiels. Les résultats sont présentés en médiane/extrêmes ou proportions. Résultats: Les 62 unités analysées étaient équipées de 15 ventilateurs (médiane, extrêmes 1−50), de plusieurs marques 47 (76 %) fois. Des ventilateurs étaient spécifiquement disponibles pour la VNI 22 fois (35 %), le dépannage 49 (79 %) fois, et le transport dans 100 % des unités. Les soignants étaient formés par les médecins dans 54 unités (87 %) ou par un industriel dans 29 unités (47 %). Les médecins étaient formés par les médecins séniors dans 55 unités (89 %) ou par un industriel dans 21 unités (34 %). Les formations étaient ponctuelles dans 24 (39 %) unités ou semestrielles 16 (26 %) fois. L’entretien était effectué par le personnel de réanimation dans 39 (63 %) unités, par du personnel dédié (17 [27 %] cas), du personnel biomédical (14 [23 %] cas). Un référentiel pour l’entretien existait dans 48 (77 %) unités, le réglage du ventilateur 22 (35 %) fois et en cas de panne 20 (32 %) fois. Conclusion: Cette première enquête montre une grande hétérogénéité des pratiques et de distribution du matériel. La formation et la connaissance des équipements sont des cibles pour l’amélioration de la sécurité. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the demographic characteristics, incidence of extra-abdominal hospital-acquired infections and outcome of patients admitted to intensive care unit (ICU) with severe acute pancreatitis. Study design: A retrospective, observational multiple center (65 centers) analysis of prospectively acquired data. Patients and methods: During 2 years, all consecutive admitted patients to ICU for severe acute pancreatitis in the centers participating in the nosocomial infections surveillance network CClin Sud-Est were included. Patients whose ICU stay was less than 48hours were not included. Demographic characteristics, extra-abdominal hospital-acquired infections and clinical course were described. Results: During the study period, 510 patients were included which represented 2 % of patients with a length of stay longer than 48hours in the 65 participating ICUs. The global attack rate of extra-abdominal hospital-acquired infections (pneumonia, bacteremia, urinary tract or central venous catheter infection) was 23 % in overall patients and it was 33 % in the 294 mechanically ventilated patients. ICU mortality was 20 % in overall patients and it was 34 % in mechanically ventilated patients. Conclusion: Severe acute pancreatitis represents 2 % of ICU stay longer than 48hours. Its clinical course is frequently complicated by hospital-acquired infections and is associated with an high ICU mortality rate. This epidemiological observational study may be used for calculating sample size for future multicenter interventional therapeutic studies. [Copyright &y& Elsevier]

Abstract: We report the case of a 38-year-old woman with a necrotizing bacterial skin and soft tissue infection with muscular involvement. The clinical picture was similar to a gaseous gangrene of the right lower limb with a septic shock and multiple organ failure, without predisposing factor such as trauma, and necessitating a hip amputation. The primary site of the disease was a perforated colic adenocarcinoma with peritoneal and retroperitoneal infection. The association of necrotizing skin and soft tissue infection with muscular involvement due to Clostridium septicum to a neoplasma is classical and in front of such an infection a neoplasma should be researched. [Copyright &y& Elsevier]

Factorial correspondence analysis was performed on 341 quails from a F2 cross between two lines divergently selected on the duration of tonic immobility over 29 generations. Several fear- or stress-related traits were recorded, i.e. tonic immobility duration, number of inductions needed to induce tonic immobility, open-field behaviour (time spent walking, latency before first movement and number of defecations), asymmetry of tibia lengths and corticosterone concentration after restraint stress. Variables were categorised in classes and analysed by factorial correspondence analysis. The first axis was mostly described by open-field behaviour, and the second by tonic immobility traits (duration of tonic immobility and number of inductions), which showed that these behaviours were almost independent. No relationship was found between axes of the factorial correspondence analysis and corticosterone concentration or asymmetry of tibia lengths, showing that these variables reflected other characteristics of stress susceptibility than those described by tonic immobility and open-field behaviour. These results show that reaction to stress of quails is a multidimensional trait and cannot be summarised by one trait. [Copyright &y& Elsevier]