Search

• ± 50% of pleocytosis are infectious meningitis in emergency departments. • 24/7 multiplex-PCR strategy has an impact on rate of hospitalization for patients with confirmed viral meningitis. • A CSF WBC threshold of 10 /mm3 is adapted for systematic triggering of multiplex-PCR in adults. Summary The relevance of syndromic multiplex-PCR for the etiological diagnosis of meningitis or meningoencephalitis is still a matter of debate. Here, we studied the impact of a 24/7 multiplex-PCR on the management of patients consulting in the emergency department for suspicion of community-acquired meningitis. We conducted a single-center retrospective study at the Emergency department of Lariboisière University Hospital (Paris, France) including all patients suspected of meningitis. During period 1 (April 2014-March 2017), the molecular assays used for the detection of infectious agents in the cerebrospinal fluid (CSF) were performed during the daytime. During period 2 (April 2017-March 2019), multiplex-PCR (BioFire® Filmarray® Meningitis/Encephalitis Panel [ME], bioMérieux) was performed 24/7. During the periods 1 and 2, 4 100 and 3 574 patients were included and 284 (6.9%) and 308 (8.6%) meningitis were diagnosed, respectively. During the periods 1 and 2, the most common causes of meningitis were enterovirus (23.9% and 29.5%), varicella zoster virus (10.2% and 6.8%) and herpes simplex virus-2 (4.2% and 8.1%). For patients with confirmed viral meningitis, a significant decrease was found between period 1 and period 2, respectively for the rate of hospitalization (73.9% vs 42.0%; p < 0.05), the length of stay (3[2–5] vs 2[1–3] days; p < 0.05), the empirical antiviral (26.1% vs 14.5%) and antibacterial administrations (29.3% vs 14.5%; p < 0.05). Multiplex-PCR is an important tool in the diagnosis of infectious meningitis in the emergency department and is relevant in the management of meningitis by screening for patients who do not require hospitalization and antibacterial therapy. [ABSTRACT FROM AUTHOR]

• A carbapenemase NDM-1-producing K. pneumoniae outbreak occurred during COVID-19 epidemic. • The nonoptimal application of bio-cleaning procedures may have contributed to the outbreak. • Workload, patient severity and inappropriate glove excessive use may have contributed additionally. An outbreak of Klebsiella pneumoniae producing the carbapenemase NDM-1 occurred in our ICU during the last COVID-19 wave. Twelve patients were tested positive, seven remained asymptomatic whereas 5 developed an infection. Resistome and in silico multilocus sequence typing confirmed the clonal origin of the strains. The identification of a possible environmental reservoir suggested that difficulties in observing optimal bio-cleaning procedures due to workload and exhaustion contributed to the outbreak besides the inappropriate excessive glove use. [ABSTRACT FROM AUTHOR]

Highlights • We report and analyse all multi-resistant Acinetobacter baumannii (MR-AB) infections in patients hospitalized in a burn unit from April to November 2014 in a prospective observational study. • We found that among 86 patients admitted to the ward, 15 acquired MR-AB nosocomial infection with a median time of 22 days. • Risk factors for MR-AB infection were SAPS II and ABSI scores, MR-AB colonization, invasive procedures and ≥2 skin grafts. • MR-AB infection was associated with an increased risk of death and a longer hospital stay. • Surveillance cultures should be performed to identify colonized patients in whom the risk of MR-AB infection is widely increased. • As it seems difficult to limit the number of skin grafts or invasive procedures needed to manage severely burned patients, prevention of MR-AB colonization remains critical. • This study is, to our knowledge, the first prospective study on the subject, which is a great asset. Abstract Background Multidrug-Resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in burn units. We aimed to study the incidence, risk factors and outcome of MR-AB infections in a burn unit (BU). Methods A prospective study was conducted from April to November, 2014 during an outbreak in a BU in Paris. Weekly surveillance cultures were performed to determine MR-AB colonization. MR-AB nosocomial infections, discharge or death without MR-AB infection were considered as competing events. To identify risk factors for MR-AB infection, baseline characteristics and time-dependent variables were investigated in univariate analyses using Cox models. Results Eighty-six patients admissions were analyzed during the study period. Among them, 15 (17%) acquired MR-AB nosocomial infection. Median time to infection was 22 days (interquartile range: 10–26 days). Cumulative incidence of MR-AB infections was 15% at 28 days (95% CI = 8–24). Risk factors for MR-AB infection in univariate analysis were SAPS II (Hazard Ratio (HR):1.08; 95% CI:1.05–1.12; P < 0.0001) and ABSI (Abbreviated Burn Severity Index) scores (HR:1.32; 95% CI:1.12–1.56; P = 0.001), MR-AB colonization (HR:10.2; 95%CI:2.05–50.3; P = 0.004), invasive procedures (ventilation, arterial and/or venous catheter) (P = 0.0001) and ≥2 skin grafts (HR:10.2; 95% CI:1.76–59.6; P = 0.010). MR-AB infection was associated with an increased risk of death (HR: 7.11; 95%CI: 1.52–33.2; P = 0.013) and longer hospital stay with a median estimated increase of 10 days (IQR: 6; 14). Conclusions Incidence of MR-AB nosocomial infection was high during this outbreak, and was associated with prolonged hospitalization and increased risk of death. High patient severity scores, prior MR-AB colonization, invasive procedures and repeated skin grafts were associated with an increased risk of nosocomial infection. [ABSTRACT FROM AUTHOR]