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Background\ud \ud The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks.\ud Objectives\ud \ud We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement.\ud Methods\ud \ud A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121.\ud Results\ud \ud Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents.\ud Conclusion\ud \ud Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.

[Introduction] 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., [Methods] 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., [Results] 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., [Conclusions] 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., This network has been supported under the 7th transnational call within the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), Network Call on Surveillance (2018) and was thereby funded by ZonMw (grant 549007001). This project also received support from the COMBACTE MAGNET EPI-Net project funded by the Innovative Medicines Initiative Joint Undertaking under grant agreement 115523 | 115620 | 115737 | 777362, resources of which are composed of financial contribution from the European Union Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution. J.K.V. was supported by grants from Region Stockholm and Vinnova. H.H. reports grants from Pfizer and Astellas as well as personal fees from Pfizer outside the submitted work.

International audience; The COVID-19 pandemic has the potential to affect the human microbiome in infected and uninfected individuals, having a substantial impact on human health over the long term. This pandemic intersects with a decades-long decline in microbial diversity and ancestral microbes due to hygiene, antibiotics, and urban living (the hygiene hypothesis). High-risk groups succumbing to COVID-19 include those with preexisting conditions, such as diabetes and obesity, which are also associated with microbiome abnormalities. Current pandemic control measures and practices will have broad, uneven, and potentially long-term effects for the human microbiome across the planet, given the implementation of physical separation, extensive hygiene, travel barriers, and other measures that influence overall microbial loss and inability for reinoculation. Although much remains uncertain or unknown about the virus and its consequences, implementing pandemic control practices could significantly affect the microbiome. In this Perspective, we explore many facets of COVID-19−induced societal changes and their possible effects on the microbiome, and discuss current and future challenges regarding the interplay between this pandemic and the microbiome. Recent recognition of the microbiome’s influence on human health makes it critical to consider both how the microbiome, shaped by biosocial processes, affects susceptibility to the coronavirus and, conversely, how COVID-19 disease and prevention measures may affect the microbiome. This knowledge may prove key in prevention and treatment, and long-term biological and social outcomes of this pandemic.

International audience

Resume Face a l’emergence de la pandemie a COVID 19, l’activite de chirurgie bariatrique/metabolique a ete arretee. Le confinement et l’arret de cette chirurgie ont eu un impact sous-estime sur la population obese avec prise de poids, et aggravation des comorbidites. Un certain nombre de candidats a cette chirurgie sont exposes a un risque important de mortalite liee a la pandemie. En effet, l’obesite et le diabete sont deux facteurs de risque majeurs de forme grave d’infection a COVID-19. Le seul traitement efficace actuel de l’obesite est la chirurgie metabolique avec un benefice rapide et durable. Il parait donc necessaire de reprendre une activite de chirurgie metabolique. Le but de ce travail est de hierarchiser la reprise chirurgicale afin qu’elle soit progressive et coherente. Les organigrammes proposes aideront les centres a determiner les patients prioritaires selon la balance benefice-risque. Le diabete a une place centrale dans l’arbre decisionnel. Les modalites de reprise seront variables d’un centre a l’autre selon les ressources humaines, materielles et medicamenteuses, et seront a adapter a l’evolution epidemique. Un consentement eclaire specifique sera necessaire. Un depistage chez les patients obeses est a envisager dont les modalites de depistage sont elaborees sur la base des connaissances disponibles. En cas de suspicion de COVID, la chirurgie doit etre differee. Il faut insister sur les mesures et gestes barrieres afin de proteger le patient et le personnel soignant. Un confinement est fortement suggere pour le patient durant le premier mois postoperatoire. Le suivi des patients sera effectue de preference par teleconsultation.

International audience; Preparing for emerging respiratory pathogens is a fundamental requirement for enhancements of the safeguard in healthcare settings. We are facing an increasing pressure to be prepared more than before. Healthcare organizations should be ready to deal with such emerging infectious disease. Here, we share some points that are essential to be considered while we prepare our institutions to prevent the transmission of emerging respiratory pathogens such as MERS-CoV and the recently emerging pandemic of SARS-CoV-2, the causative agent of COVID-19.

Investigation Team : Santé publique France, Direction des régions, Cellule Régionale Nouvelle Aquitaine, Bordeaux, France: Laurent Filleul, Stéphanie Vandentorren.Santé publique France, Direction des régions, Cellule Régionale Auvergne-Rhône-Alpes, Lyon, France: Guillaume Spaccaferri.Santé publique France, Direction des régions, Cellule Régionale Hauts-de-France, Lille, France: Hélène Prouvost.Centre national de référence Virus des infections respiratoires, dont la grippe, Institut Pasteur, Paris, France: Mélanie Albert, Marion Barbet, Angela Brisebarre, Flora Donati, Sylvie van der Werf.Agence Régionale de Santé Ile-de-France, Paris, France: Alexis Ardoin, Marion Dreyer, Karim Tararbit.Agence Régionale de Santé Nouvelle-Aquitaine, Bordeaux, France: Matthieu Amodeo, Elodie Couaillier, Pascal Fabre, Daniel Habold.Santé publique France, Direction des maladies infectieuses, Saint-Maurice, France: Didier Che.AP-HP, Hôpital Bichat, Service des maladies infectieuses et tropicales, Paris, France: Gisèle Bendjelloul, Marine Billaudelle Lallemant, Valentine Charachon, Laurène Deconinck, Diane Descamps, Sandrine Gérard, Nadirha Houhou, Quentin Le Hingrat, Isabelle Lolom, Jean-Christophe Lucet, Annabelle Pourbaix, Simon Valayer, Yazdan Yazdanpanah.Centre Hospitalier Universitaire de Bordeaux, Bordeaux GeoSentinel Site, Bordeaux, France: Alexandre Boyer, Benjamin Clouzeau, Xavier Combes, Arnaud Desclaux, Jean-Michel Dindart, Alexandre Duvignaud, Isabelle Garrigue, Didier Gruson, Marie-Edith Lafon, Pauline Perreau, Thierry Pistone, Maxime Poteau, Eric Tentillier.Direction Générale de la Santé, Ministère des solidarités et de la santé, Centre opérationnel de réception et de régulation des urgences sanitaires et sociales, Paris, France: Pauline Mathieu; International audience; A novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) causing a cluster of respiratory infections (coronavirus disease 2019, COVID-19) in Wuhan, China, was identified on 7 January 2020. The epidemic quickly disseminated from Wuhan and as at 12 February 2020, 45,179 cases have been confirmed in 25 countries, including 1,116 deaths. Strengthened surveillance was implemented in France on 10 January 2020 in order to identify imported cases early and prevent secondary transmission. Three categories of risk exposure and follow-up procedure were defined for contacts. Three cases of COVID-19 were confirmed on 24 January, the first cases in Europe. Contact tracing was immediately initiated. Five contacts were evaluated as at low risk of exposure and 18 at moderate/high risk. As at 12 February 2020, two cases have been discharged and the third one remains symptomatic with a persistent cough, and no secondary transmission has been identified. Effective collaboration between all parties involved in the surveillance and response to emerging threats is required to detect imported cases early and to implement adequate control measures.

International audience

Continuous malaria control in Papua New Guinea has resulted in a marked decline of Plasmodium falciparum and P. vivax prevalence. Yet, an increasing proportion of submicroscopic infections, many of them carrying gametocytes, demands for novel strategies to target residual transmission., Background The scale-up of effective malaria control in the last decade has resulted in a substantial decline in the incidence of clinical malaria in many countries. The effects on the proportions of asymptomatic and submicroscopic infections and on transmission potential are yet poorly understood. Methods In Papua New Guinea, vector control has been intensified since 2008, and improved diagnosis and treatment was introduced in 2012. Cross-sectional surveys were conducted in Madang Province in 2006 (with 1280 survey participants), 2010 (with 2117 participants), and 2014 (with 2516 participants). Infections were quantified by highly sensitive quantitative polymerase chain reaction (PCR) analysis, and gametocytes were quantified by reverse-transcription qPCR analysis. Results Plasmodium falciparum prevalence determined by qPCR decreased from 42% in 2006 to 9% in 2014. The P. vivax prevalence decreased from 42% in 2006 to 13% in 2010 but then increased to 20% in 2014. Parasite densities decreased 5-fold from 2006 to 2010; 72% of P. falciparum and 87% of P. vivax infections were submicroscopic in 2014. Gametocyte density and positivity correlated closely with parasitemia, and population gametocyte prevalence decreased 3-fold for P. falciparum and 29% for P. vivax from 2010 to 2014. Conclusions Sustained control has resulted in reduced malaria transmission potential, but an increasing proportion of gametocyte carriers are asymptomatic and submicroscopic and represent a challenge to malaria control.

International audience; We celebrated in 2016 the centenary of the death of Ilya Ilitch Metchnikov (1845–1916), the founding father of innate immunology. His studies on the description of macrophages, their phagocytic function, and their key role in eliminating microbes were recognized by the Nobel Prize in Physiology and Medicine, and constitute a cornerstone of immunology (https://www.nobelprize.org/nobel_prizes/medicine/laureates/1908/mechnikov-facts.html). Since then, macrophages are typically considered as tissue scavengers, that capture and destroy microbial intruders, thereby ensuring tissue protection and host defense against infections.

Hospital-acquired infections (HAIs), including emerging multi-drug resistant organisms, threaten healthcare systems worldwide. Efficient containment measures of HAIs must mobilize the entire healthcare network. Thus, to best understand how to reduce the potential scale of HAI epidemic spread, we explore patient transfer patterns in the French healthcare system. Using an exhaustive database of all hospital discharge summaries in France in 2014, we construct and analyze three patient networks based on the following: transfers of patients with HAI (HAI-specific network); patients with suspected HAI (suspected-HAI network); and all patients (general network). All three networks have heterogeneous patient flow and demonstrate small-world and scale-free characteristics. Patient populations that comprise these networks are also heterogeneous in their movement patterns. Ranking of hospitals by centrality measures and comparing community clustering using community detection algorithms shows that despite the differences in patient population, the HAI-specific and suspected-HAI networks rely on the same underlying structure as that of the general network. As a result, the general network may be more reliable in studying potential spread of HAIs. Finally, we identify transfer patterns at both the French regional and departmental (county) levels that are important in the identification of key hospital centers, patient flow trajectories, and regional clusters that may serve as a basis for novel wide-scale infection control strategies., Author summary Hospital-acquired infections (HAIs), including emerging multi-drug resistant organisms, threaten healthcare systems worldwide. Efficient containment measures of HAIs must mobilize the entire healthcare network. Thus, to best understand how to reduce the scale of potential HAI epidemic spread, we explore patient transfer patterns in the French healthcare system. We construct and compare the characteristics of three different patient transfer networks based on data on transfers of patients with diagnosed HAIs, suspected HAIs, or of all patients. Our analyses show that these healthcare networks, the patient populations that comprise them and the patient movement patterns are heterogeneous and centralized. Despite the differences in patient populations, the HAI-specific and suspected-HAI healthcare networks have the same underlying structure as that of the general healthcare network. We identify key hospital centers, patient flow trajectories, at both the regional and department (county) level that may serve as a basis for proposing novel wide-scale infection control strategies.

International audience; Because infectious diseases are a major source of morbidity and mortality in the majority of patients with primary immunodeficiencies (PIDs), the application of a prophylactic regimen is often necessary. However, because of the variety of PIDs and pathogens involved, and because evidence is scarce, practices are heterogeneous. To homog-enize practices among centers, the French National Reference Center for PIDs aimed at elaborating recommendations for anti-infectious prophylaxis for the most common PIDs. We performed a literature review of infectious complications and prophylactic regimens associated with the most frequent PIDs. Then, a working group including different specialists systematically debated about chemoprophylaxis, immunotherapy, immunization, and recommendations for patients. Grading of prophylaxis was done using strength of recommendations (decreasing from A to D) and evidence level (decreasing from I to III). These might help infectious diseases specialists in the management of PIDs and improving the outcome of patients with PIDs.

Summary Background Sequence type 131 (ST131) is a predominant lineage among extraintestinal pathogenic Escherichia coli. It plays a major role in the worldwide dissemination of extended-spectrum β-lactamase (ESBL)-producing E. coli . The ST131 pandemic is mainly the result of clonal expansion of the single well-adapted subclone H 30-Rx, which is acquired in hospitals more frequently than other ESBL-producing E. coli clones. Aim To develop a rapid method using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) to identify ST131 for infection control purposes. Methods Peak biomarkers of ST131 were identified from the mass spectrum profiles of 109 E. coli isolates (including 50 ST131 isolates). Findings The models accurately identified ST131 isolates from mass spectrum profiles obtained with and without protein extraction. Conclusions The rapid identification of ST131 isolates with MALDI-TOF MS can be easily implemented in the laboratory, and could help to target infection control measures in patients carrying multi-drug-resistant E. coli that are more likely to spread.

This article describes an outbreak of ACC-1-producing Klebsiella pneumoniae involving 40 patients. These were mainly men under 40 years old with a spinal cord injury, in a physical medicine and rehabilitation unit. The main risk factors were prolonged hospital stay, multiple-bed rooms, tracheostomy care and assisted defaecation. The outbreak was only controlled after the introduction of rigorous patient placement (i.e. single rooms or cohorting in the same room), while allowing the patients to have free access to the various technical services (e.g. physiotherapy and occupational therapy) and living spaces necessary for re-education.

F. Lanternier : Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Hopital Necker-Enfants malades, Universite Paris Descartes, 149, rue de Sevres, 75015 Paris France. M. Lecuit : Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Hopital Necker-Enfants malades, Universite Paris Descartes, 149, rue de Sevres, 75015 Paris France. Groupe « Micro-organismes et Barrieres de l’Hote », Inserm avenir U604, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris France. O. Lortholary : Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Hopital Necker-Enfants malades, Universite Paris Descartes, 149, rue de Sevres, 75015 Paris France. Unite de Mycologie Moleculaire, CNRS URA3012, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris France. fanny.lanternier@nck.aphp.fr Grippe aviaire en decembre 2007

International audience; BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) has spread throughout the world and has become highly endemic worldwide. The need for implementing MRSA control strategies is no longer a matter of debate. AIM: To determine the temporal association between various infection control practices, the use of antibiotics and the incidence of MRSA in a 1200-bed French university hospital. METHODS: A multi-variate time-series analysis, based on monthly data from a nine-year period (January 2000-December 2008), was performed in a 1200-bed French university hospital to determine the temporal association between different variables and the incidence of MRSA. MRSA colonization pressure, infection control practices and use of antibiotics were considered in the analysis. FINDINGS: Time-series analysis showed a positive significant relationship between the incidence of hospital-acquired MRSA (HA-MRSA) and MRSA colonization pressure, the use of antibiotics (fluoroquinolones, macrolides and aminoglycosides) and the use of gloves. Conversely, a global negative correlation was observed between the incidence of HA-MRSA and the use of alcohol-based hand rub. Overall, the model explained 40.5% of the variance in the monthly incidence of MRSA. CONCLUSION: This study showed that admission of patients with MRSA, the use of antibiotics and infection control practices contributed to the incidence of HA-MRSA. This suggests that efforts should be focused on high compliance with hand disinfection. These results also raise concerns about the use of gloves when caring for patients with MRSA.

International audience; INTRODUCTION: Tinea capitis is common among schoolchildren in developing countries but underreported in Madagascar. We report the occurrence of an outbreak of gray patch tinea capitis due to Microsporum langeronii in a public primary school of Antananarivo, the capital city of Madagascar. METHODOLOGY: Forty-two children were included, 27 (64%) of them presenting with tinea capitis and 32 (76%) with Tinea corporis. Patients were treated with griseofulvin 500 mg and Povidone-iodine 4% and followed up for four weeks. RESULTS: Twenty-five (93%) of the 27 children with tinea capitis presented a gray patch as the main clinical feature. All these cases were fluorescent under Wood's UV light and positive in cultures for M. langeronii. All 27 children reported a contact with infected classmates, and 19 (70%) reported to have infected brothers and sisters at home. After four weeks of treatment, all patients recovered. CONCLUSION: Appropriate treatment and improved hygienic practices reduced the occurrence of tinea in the studied school and no more cases of tinea capitis or corporis occurred after the outbreak.

International audience; This article describes a two-year surveillance of neurosurgical site infections and an outbreak of infections in deep brain stimulation (DBS) cases. From April to December 2008, six patients had a DBS surgical site infection (SSI). Audits of hygiene practices, infection control of the healthcare environment, and preoperative antimicrobial prophylaxis characteristics were carried out. The results of surgical audits showed that skin preparation and antimicrobial prophylaxis were not being performed adequately. In 2008, the general SSI rate was 1.8% (27 SSIs/1471 patients). Length of preoperative stay was significantly longer among infected patients (2.7 ± 2.9 months) compared with uninfected patients (2.2 ± 4.6 months) (P=0.01). Based on these results, skin preparation and antimicrobial prophylaxis were reviewed with the neurosurgery team. In 2009, the general SSI rate was reduced to 1.1% (16 SSI in 1410 patients), a reduction from 2008 (P=0.12). Although the overall incidence of SSI in 2008 (1.8%) was within the range of published data, this surveillance of SSIs permitted identification of site operative infected patients surgically treated for DBS. A set of actions was then taken to reduce SSI risk. This work demonstrates how an active surveillance programme can successfully change clinical care practice.

International audience

Objective.To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistantStaphylococcus aureus(MRSA) in the intensive care unit (ICU).Design.Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.Setting.Medical ICUs of 2 French university hospitals.Participants.Five hundred adults with an expected length of stay in the ICU greater than 48 hours.Interventions.For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.Main Outcome Measure.MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.Results.In the intent-to-treat analysis (n= 488), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups (P=.58). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group (P=.63), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%;PP=.01).Conclusions.Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.Trial Registration.Clinicaltrials.gov identifier: NCT00151606.

SUMMARYThe scope of this reflection paper was to review the latest research on the risk of MRSA infection and colonization in animals. Attention focused on occurrence, risk factors for colonization and infection, and human contact hazard for livestock, horses, and companion animals. Whereas the clonal relationship between MRSA strains of CC398 is straightforward in livestock this is less obvious in horses. Small companion animals typically share MRSA strains that seem to exchange with a human reservoir. Management and therapeutic options have been suggested for livestock, horses, companion animals, as well as instructions on safety measures for persons in contact with animals. Conclusions were drawn with emphasis on future research activities, especially to confirm the apparent evolution of the organism and to demonstrate efficiency of control strategies.

We evaluated the usefulness of adding weekly methicillin-resistantStaphylococcus aureus(MRSA) screening to our established admission screening and clinical sampling in 4 acute care units of a university hospital. Our results suggest that weekly MRSA screening allows the detection of 56.1% of all cases of hospital-acquired MRSA carriage. These cases would have remained undetected had admission screening and clinical sampling been the only types of surveillance in place.

International audience; BACKGROUND: Nosocomial invasive filamentous fungi infections could result from inhalation of filamentous fungi conidia present in hospital environment. METHODS: The environmental fungal flora in 3 different hospital wards with similar air conditioning was prospectively studied during 30 months and compared to internal (presence of agranulocytosis patient, behavioral practices, activity, cleaning work) and outdoor factors (meteorologic data, outdoor fungi). The general preventive measures differed from one unit to another. RESULTS: The hematology wards with filamentous fungi preventive measures were significantly less contaminated than a conventional ward without specific measures. Internal and outdoor factors influenced the level of fungal flora. However, the influence of internal factors was greater in the conventional ward than in hematology wards. The variation of flora in the hospital environment was seasonal, and the level of this contamination in each ward was influenced by the meteorology. However, outdoor factors more readily explain the variations of fungal load in hematology than in the conventional ward. CONCLUSION: This study highlights that specific preventive measures participate significantly in the control of the filamentous fungal flora intensity due to internal factors but not those due to outdoor factors, stressing the importance of high-efficiency particulate air filtration in high-risk units.

International audience; Meticillin-resistant Staphylococcus aureus (MRSA) and other multiply resistant bacteria are frequently isolated in long-term care facilities (LTCFs). This study evaluated the contamination of staff clothing in three LTCFs. Over 500 samples were taken from uniforms and their pockets and these samples showed a high level of MRSA contamination. Wearing plastic aprons and managing pocket contents improved the contamination rate. Our results highlight the continued importance of hand hygiene, since staff have frequent contact with their uniforms and could potentially contaminate their hands before care.

International audience

International audience; PURPOSE OF REVIEW: To highlight the major advances in diagnosing and preventing catheter-related infections published in research articles published between March 2004 and May 2007. RECENT FINDINGS: The challenge remains to make the diagnosis of catheter-related infection with good accuracy without catheter removal. The differential time to obtain positive qualitative blood culture appeared to be the most accurate available technique. Many catheter-related bloodstream infections are preventable. Simple interventions are often useful and multimodal programs are very efficacious, particularly in the intensive care setting. For long-term catheter-related bloodstream infection prevention, patient education appeared promising. Interesting evidence suggested that anticoagulant, by decreasing the biofilm formation, could decrease the risk of infection. For short-term central venous catheter-related infections research is ongoing on antiseptic dressings. Antiseptic lock appeared promising for preventing long-term central venous catheter bloodstream infections. SUMMARY: Nowadays, multimodal programs of catheter infection prevention are efficacious. Levels of catheter-related bloodstream infection of more than one or two per 1000 catheter-days are usually only found in the intensive care unit. It is a prerequisite to evaluate the cost-effectiveness of new techniques of prevention. As catheter-related bloodstream infections become rarer, strategies limiting unnecessary removal of catheters need to be developed and tested.

International audience; The aim of this study was to design the best serologic strategy for diagnosing human alveolar echinococcosis (AE) cases in medical laboratory routine procedures. By combining 2 screening techniques, indirect hemagglutination with Em(2plus)-ELISA and/or recEm18-ELISA, 46 of 47 AE cases were detected. The necessary confirmation of results is then obtained by using immunoblot (LDBIO-IB and/or recEm18-IB).

Background: Invasive aspergillosis is one of the most lethal airborne dangers for immune-suppressed subjects. Providing patient protection from such airborne threats requires costly and high-maintenance facilities. We herein evaluate a new self-contained mobile unit as an alternative for creating a patient protective environment. Methods: Airborne contamination levels were monitored for different simulated scenarios and under actual clinical conditions. Functional tests were used to challenge the unit under adverse conditions, and a preliminary clinical study with patients and staff present was performed at 2 different French hospitals. Results: Functional tests demonstrated that the unit can rapidly decontaminate air in the protected zone created by the unit and in the surrounding room. In addition, the protected zone is not sensitive to large disturbances that occur in the room. The clinical study included 4 patients with 150 accumulated days of testing. The protected zone created by the unit systematically provided an environment with undetectable airborne fungal levels (ie, ,1 CFU/m 3 ) regardless of the levels in the room or corridor (P , .01). Conclusions: These tests show that the unit can be used to create a mobile protective environment for immune-suppressed patients in a standard hospital setting. (Am J Infect Control 2007;35:460-6.) Invasive aspergillosis, notably Aspergillus fumigatus, is one of the most lethal airborne dangers for immunesuppressed subjects. Although the reported attributable mortality from invasive pulmonary aspergillosis differs depending on the patient population studied, the Centers for Disease Control and Prevention (CDC) reports rates as high as 95% in recipients of allogeneic bone marrow transplants and patients who have aplastic anemia, compared with rates of 13%-80% in leukemic patients. 1 The most important nosocomial infection caused by Aspergillus sp is pneumonia, and the primary route of acquiring Aspergillus sp infection is via inhalation of the fungal spores. In severely immunesuppressed patients, primary Aspergillus sp pneumonia results from invasion of local lung tissue

Several vaccines are now routinely used since fifty years in different developed countries. Their principal impact has been to decrease morbidity and mortality of the infectious diseases they are targeting. One disease, smallpox, is eradicated, poliomyelitis will be soon, diphteria is controlled in several countries but pertussis is still endemic although an efficacious vaccine was used. Why? Pertussis is an example of an infection for which the immunity of the population has changed after the introduction of generalized vaccination with killed whole cell pertussis vaccines, from a natural immunity due to infection to different types of vaccine-induced immunity. These different types of immunity have changed the protection against infection, disease and transmission. The impact of the generalized vaccination in a human population has been an important change in the epidemiology of the disease. In fact, a child-to-child transmission observed before the introduction of vaccination is now replaced by an adolescent-adult to infant transmission. The major consequence is an increase in the mortality and morbidity in non vaccinated infants mostly contaminated by their parents. Researches undertaken on the agent of the disease, the bacterium, Bordetella pertussis, conducted to the development of subunits vaccines, efficacious and better tolerated by infants than whole-cell vaccines. Many developed countries decided to change vaccines but also to add vaccine boosters for adolescents and adults in order to stop the transmission of the disease to infants. However, even after 15 years of studies in many countries, pertussis is still underestimated in adults and generalized adult vaccination remains difficult. The new goal now is to give information to medical students and health care workers in general in order to increase adolescent and adult's vaccination coverage.

International audience; OBJECTIVES: A high prevalence of chronic hepatitis B has been previously reported in heart transplant recipients in our center. Nosocomial transmission of hepatitis B has been therefore suggested. The aim of the present study was to investigate an outbreak of hepatitis B infection in heart transplant recipients and to to look for nosocomial acquisition of hepatitis B in these patients. METHODS: In a retrospective case-control study, review of transvenous endomyocardial biopsy (TEB) procedure, line probe assay and DNA sequencing for characterization of the outbreak isolate genotypes were performed in order to assess the possible risk of nosocomial transmission of hepatitis B in the setting of heart transplantation. Case was defined as a patient negative for HBsAg before heart transplantation and positive after. Controls were matched with cases by date of transplantation and time-interval of HBV infection occurrence in the cases patients. RESULTS: Transmission of HBV was associated with the number of HBsAg positive patients undergoing TEB the same day and in the same ward (OR=1.17, per additional encounter; 95%CI=1.01-1.37, P=0.02) and with the total number of TEB undergone after a HBsAg positive patient (OR=1.43 for additional encounter, 95%CI=0.97-2.1, P=0.056) but not with the number of biopsies. The virological study identified eight different strains. No common devices nor gloves, drapes, or medical solution were shared among patients during TEB. One staff member, but no surgeon, was HBsAg positive. No further case occurred after implementation of control measures. CONCLUSIONS: Patient-to-patient transmission during TEB sessions was demonstrated by the virological and the case-control studies. This transmission occurred without evidence of blood contact through vials or devices. There is strong evidence that this transmission may be due to the spread of infective blood droplets on the environmental surfaces and the material during the TEB procedure.; ButsUne prévalence élevée d'hépatite chronique B a été rapportée après transplantation cardiaque dans notre centre. Des travaux de notre groupe ont émis l'hypothèse d'une transmission nosocomiale de l'infection par le virus de l'hépatite B chez ces malades. Le but de cette étude était d'étudier une épidémie d'hépatite B chez les malades transplantés cardiaques de notre centre et de démontrer le caractère nosocomial de cette épidémie.MéthodesLors de cette étude rétrospective cas contrôles la procédure des biopsies myocardiques trans-veineuses (BTV) a été revue. Une analyse moléculaire avec caractérisation des isolats et des génotypes a été effectuée dans le but d'évaluer la possibilité d'une transmission nosocomiale de l'infection par le virus de l'hépatite B dans le contexte de la transplantation cardiaque. Les cas index étaient définis comme des malades antigène HBs négatif avant la transplantation et positif après. Les malades contrôles ont été appariés avec les cas index pour la date de la transplantation cardiaque et l'intervalle entre la greffe et l'apparition de l'antigène HBs chez les cas index.RésultatsLa transmission de l'infection par le virus de l'hépatite B était associée de façon significative avec le nombre de patients Antigène HBs positif ayant eu une BTV le même jour et dans la même salle de cathétérisme (OR = 1,17; IC 95 % 1,01-1,37, P = 0,02) et avec le nombre total de BTV réalisées après un malade antigène HBs positif (OR = 1,43; IC 95 % = 0,97-2,1, P = 0,056) mais pas avec le nombre de biopsies. L'analyse virologique a identifié 8 souches différentes. Aucun partage de linge, de matériels solides ou de perfusion n'a eu lieu entre les malades pendant les BTV. Un membre de l'équipe soignante était positif pour l'antigène HBs mais aucun chirurgien ne l'était. Après l'institution de mesures d'hygiène drastique aucune nouvelle contamination n'est apparue.ConclusionUne transmission de malade à malade de l'infection par le virus de l'hépatite B survenant lors des BTV a été documentée par l'analyse virologique et l'étude de cas témoins. Cette transmission a eu lieu en l'absence de contact sanglant direct ou indirect. Il existe une forte présomption d'une contamination liée à la dissémination de particules contaminantes sur les surfaces ou le matériel durant les BTV.

International audience; The aim of this study was to rank the risk of nosocomial infection (NI) according to patient type by analysing the results of annual prevalence studies carried out in Franche-Comté from 2001 to 2004. Patients (N=14,905) were divided into four categories according to the number of endogenous risk factors (age, immunodepression, MacCabe score). The overall prevalence of infection was 6.1% and varied according to the category of patient from 1.93% (no risk factors) to 15.2% (three risk factors). The frequencies of NI related to an invasive procedure and to cross-contamination with multi-drug-resistant (MDR) bacteria were 30.9% and 12.3%, respectively; these percentages did not depend on the type of patient. The prevalence of NI decreased over time for patients with two or three risk factors, but was stable for patients with no risk factors. More than 40% of NIs were potentially avoidable (related to invasive procedures or involving cross-transmission of an MDR bacterium) regardless of the category of patient. This study suggests that at least 30% of NIs could be avoided.

Background Implementation of a hand hygiene promotion program in a large university hospital required that we find a suitable method to assess health care workers' (HCWs) hand hygiene practices. This study aims at comparing direct observation and self-assessment methods. Methods Hand hygiene practices of 206 HCWs (physicians, nurses, and nurse assistants) in 25 care units were directly observed by trained auditors for 1 day. A week later, 1050 HCWs filled out a self-assessment questionnaire on their compliance with handwashing indications (participation rate was 83%). Results Average global self-reported compliance rate (SRR) after patient care was similar to the observed rate (OBR) (74%). According to the type of care, differences between SRR and OBR were nonsignificant, except for change of infusion bag by nurses and nursing care by nurse assistants. Physicians and nurse assistants tended systematically to over evaluate their compliance, whereas nurses tended to under evaluate their compliance with hand hygiene recommendations. Conclusions Mean compliance rates were higher than those reported in the literature but varied as a function of patient care activity and occupation of the HCW. A reinforced in-service educational program will be implemented that will target especially physicians and medical students. Self-assessment method, easy to use and inexpensive, gave encouraging results. The development of a broad-based, routine, self-assessment program is underway at Nantes University Hospital, but, before such a program can be implemented, reproducibility of these self-assessment indicators must be further confirmed.

The 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy took place in San Diego on 27 – 30 September 2002. The meeting was held in the light of current events. Bioterrorism, malaria, issues of surveillance and multiple resistance were discussed in depth. Few truly new drugs or potential targets were presented. Peptide deformylase inhibitors and several other metalloenzymes as new targets were among the most promising results.