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2. One-day prevalence of asymptomatic carriage of toxigenic and non-toxigenic Clostridioides difficile in 10 French hospitals

Author

Hartmann, C., Kazhalawi, A., Lambert-Bordes, S., Bleunven, S., Bedos, J.-P., Greder-Belan, A., Rigaudea, S., Lecuyer, H., Jousset, A., Lebeaux, D., Levy, B., Rabate, C., Collignon, A., Batah, J., Francois, V., Sebbane, G., Woerther, P.-L., Loggia, G., Michon, J., Verdon, R., Samba, D., Méar, J.-B., Guillard, T., Nguyen, Y., Banisadr, F., Delmer, A., Himberlin, C., Diallo, S., Furet, I., Achouri, B., Reksa, A., Jouveshomme, S., Menage, E., Philippart, F., Hadj-Abdeslam, M., Durand-Gasselin, B., Eveillard, M., Kouatchet, A., Schmidt, A., Salanoubat, C., Heurtaux, M.-N., Cronier, P., Foufa, A., Le Monnier, A., Candela, T., Mizrahi, A., Bille, E., Bourgeois-Nicolaos, N., Cattoir, V., Farfour, E., Grall, I., Lecointe, D., Limelette, A., Marcade, G., Poilane, I., Poupy, P., Kansau, I., Zahar, J-R., and Pilmis, B.

Published
2022
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11. Antibioprophylaxie et bilan urodynamique : recommandations de bonne pratique par consensus formalisé

Author

Egrot, C., Dinh, A., Amarenco, G., Bernard, L., Birgand, G., Bruyère, F., Chartier-Kastler, E., Cosson, M., Deffieux, X., Denys, P., Etienne, M., Fatton, B., Fritel, X., Gamé, X., Lawrence, C., Lenormand, L., Lepelletier, D., Lucet, J.-C., Marit Ducamp, E., Pulcini, C., Robain, G., Senneville, E., de Sèze, M., Sotto, A., Zahar, J.-R., Caron, F., and Hermieu, J.-F.

Published
2018
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14. Quelles mesures pour maîtriser le risque infectieux chez les patients immunodéprimés ? Recommandations formalisées d’experts

Author

Zahar, J.-R., Jolivet, S., Adam, H., Dananché, C., Lizon, J., Alfandari, S., Boulestreau, H., Baghdadi, N., Bay, J.-O., Bénéteau, A.-M., Bougnoux, M.-E., Brenier-Pinchart, M.-P., Dalle, J.-H., Fournier, S., Fuzibet, J.-G., Kauffmann-Lacroix, C., Le Guinche, I., Lepelletier, D., Loukili, N., Lory, A., Morvan, M., Oumedaly, R., Ribaud, P., Rohrlich, P., Vanhems, P., Aho, S., Vanjak, D., and Gangneux, J.-P.

Published
2017
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24. Prise en charge du patient neutropénique en réanimation (nouveau-nés exclus). Recommandations d’un panel d’experts de la Société de réanimation de langue française (SRLF) avec le Groupe francophone de réanimation et urgences pédiatriques (GFRUP), la Société française d’anesthésie et de réanimation (Sfar), la Société française d’hématologie (SFH), la Société française d’hygiène hospitalière (SF2H) et la Société de pathologies infectieuses de langue française (SPILF)

Author

Schnell, D., Azoulay, E., Benoit, D., Clouzeau, B., Demaret, P., Ducassou, S., Frange, P., Lafaurie, M., Legrand, M., Meert, A.-P., Mokart, D., Naudin, J., Pène, F., Rabbat, A., Raffoux, E., Ribaud, P., Richard, J.-C., Vincent, F., Zahar, J.-R., and Darmon, M.

Published
2017
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27. Prise en charge du patient neutropénique en réanimation (nouveau-nés exclus). Recommandations d’un panel d’experts de la Société de réanimation de langue française (SRLF) avec le Groupe francophone de réanimation et urgences pédiatriques (GFRUP), la Société française d’anesthésie et de réanimation (Sfar), la Société française d’hématologie (SFH), la Société française d’hygiène hospitalière (SF2H) et la Société de pathologies infectieuses de langue française (SPILF)

Author

Schnell, D., Azoulay, E., Benoit, D., Clouzeau, B., Demaret, P., Ducassou, S., Frange, P., Lafaurie, M., Legrand, M., Meert, A.-P., Mokart, D., Naudin, J., Pène, F., Rabbat, A., Raffoux, E., Ribaud, P., Richard, J.-C., Vincent, F., Zahar, J.-R., and Darmon, M.

Abstract

La neutropénie est définie par une baisse du nombre absolu de polynucléaires ou par une dysfonction de ces derniers. Elle est source de complications pouvant nécessiter une admission en réanimation. Les spécificités de prise en charge des patients neutropéniques admis en réanimation ont motivé ce référentiel. Ces recommandations ont été réalisées sous l’égide de la Société de réanimation de langue française (SRLF) par un panel d’experts choisis au sein de la SRLF, du Groupe francophone de réanimation et d’urgences pédiatriques (GFRUP), de la Société française d’anesthésie et de réanimation (Sfar), de la Société française d’hématologie (SFH), de la Société française d’hygiène hospitalière (SF2H) et de la Société de pathologie infectieuse de langue française (SPILF). L’analyse du niveau de preuve et la formulation des recommandations ont suivi la méthode « GRADE » (grading of recommendations assessment, development and evaluation system). Les recommandations ont été cotées selon la méthode RAND/UCLA. Six champs ont été définis : 1) admission en réanimation et pronostic ; 2) isolement et prophylaxies ; 3) diagnostic des complications respiratoires ; 4) prise en charge des complications viscérales ; 5) traitements anti-infectieux : antibiothérapie et contrôle de la source ; 6) prise en charge hématologique. La plupart des recommandations sont de bas niveau de preuve, soulignant les besoins d’études spécifiques dans cette population. Cependant, sept recommandations de haut niveau de preuve ont pu être formulées concernant l’isolement protecteur, la stratégie diagnostique de l’insuffisance respiratoire aiguë, la prise en charge médicale et le délai de la chirurgie de l’entérocolite du neutropénique. Neutropenia is defined either by an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society (SRLF) in collaboration with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation (“GRADE”) system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: 1) ICU admission and prognosis; 2) protective isolation and prophylaxis; 3) management of acute respiratory failure; 4) organ failure and organ support; 5) antibiotic management and source control; and 6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were however associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management and timing of surgery in patients with typhlitis.

Published
2024
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28. One-day prevalence of asymptomatic carriage of toxigenic and non-toxigenic Clostridioides difficile in 10 French hospitals

Author

Le Monnier, A., primary, Candela, T., additional, Mizrahi, A., additional, Bille, E., additional, Bourgeois-Nicolaos, N., additional, Cattoir, V., additional, Farfour, E., additional, Grall, I., additional, Lecointe, D., additional, Limelette, A., additional, Marcade, G., additional, Poilane, I., additional, Poupy, P., additional, Kansau, I., additional, Zahar, J-R., additional, Pilmis, B., additional, Hartmann, C., additional, Kazhalawi, A., additional, Lambert-Bordes, S., additional, Bleunven, S., additional, Bedos, J.-P., additional, Greder-Belan, A., additional, Rigaudea, S., additional, Lecuyer, H., additional, Jousset, A., additional, Lebeaux, D., additional, Levy, B., additional, Rabate, C., additional, Collignon, A., additional, Batah, J., additional, Francois, V., additional, Sebbane, G., additional, Woerther, P.-L., additional, Loggia, G., additional, Michon, J., additional, Verdon, R., additional, Samba, D., additional, Méar, J.-B., additional, Guillard, T., additional, Nguyen, Y., additional, Banisadr, F., additional, Delmer, A., additional, Himberlin, C., additional, Diallo, S., additional, Furet, I., additional, Achouri, B., additional, Reksa, A., additional, Jouveshomme, S., additional, Menage, E., additional, Philippart, F., additional, Hadj-Abdeslam, M., additional, Durand-Gasselin, B., additional, Eveillard, M., additional, Kouatchet, A., additional, Schmidt, A., additional, Salanoubat, C., additional, Heurtaux, M.-N., additional, Cronier, P., additional, and Foufa, A., additional

Published
2022
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33. Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints

Author

Farfour, E., Degand, N., Riverain, E., Fihman, V., Le Brun, C., Péan de Ponfilly, G., Muggeo, A., Jousset, A., Piau, C., Lesprit, P., Chatelain, N., Dortet, L., Poisson, A., Guillard, T., Limelette, A., Mizrahi, A., Le Monnier, A., Fournier, D., Potron, A., Morand, P., Janvier, F., Otto, M.-P., Woerther, P.-L., Decousser, J.-W., Corvec, S., Plouzeau-Jayle, C., Broutin, L., Yin, N., Héry-Arnaud, G., Beauruelle, C., Grillon, Antoine, Lecuru, M., Bille, E., Godreuil, S., Jean Pierre, H., Jean-Pierre, Hélène, Amara, M., Henry, A., Zahar, J.-R., Carbonelle, E., Jaureguy, F., Lomont, A., Isnard, C., Cattoir, V., Canis, F., Diedrich, T., Flevin, E., Merens, A., Jacquier, H., Gyde, E., Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Besançon (CHU Besançon), Hôpital Foch [Suresnes], Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital Henri Mondor, Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire de Reims (CHU Reims), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU Pontchaillou [Rennes], Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hopital d'instruction des armées Sainte-Anne [Toulon] (HIA), CHU Henri Mondor, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Institut Gustave Roussy (IGR), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë, Université de Strasbourg (UNISTRA), CHU Necker - Enfants Malades [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Hydrosciences Montpellier (HSM), Institut national des sciences de l'Univers (INSU - CNRS)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier de Versailles André Mignot (CHV), Hôpital Avicenne [AP-HP], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Universitaire [Rennes], Centre hospitalier [Valenciennes, Nord], Centre hospitalier de Dieppe, Hôpital d'Instruction des Armées Begin, and Service de Santé des Armées

Subjects
Klebsiella spp, [SDV]Life Sciences [q-bio], Microbial Sensitivity Tests, Fosfomycin, Biology, Microbiology, 03 medical and health sciences, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Enterobacterales, Drug Resistance, Bacterial, medicine, ComputingMilieux_MISCELLANEOUS, 0303 health sciences, Bacteria, 030306 microbiology, Breakpoint, Broth microdilution, Anti-Bacterial Agents, 3. Good health, Infectious Diseases, T Urinary tract infection, Practice Guidelines as Topic, EUCAS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCAST guidelines v2 (24mm versus 19mm). We assessed its impact on categorization of Enterobacterales recovered from urine samples in emergency departments. A total of 7749 and 2348 strains were tested using the DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpoint was in accordance with the BMD. Using the 24-mm breakpoint, the overall rate of fosfomycin resistance in Enterobacterales increased by three-fold (5.6% vs 18.1%, P0.01) and reached 2.8% and 86.5% in E. coli and K. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remain appropriate. The accuracy of the methods for routine fosfomycin susceptibility testing should be assessed. The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. coli should be evaluated considering its rate of resistance and recent data reporting low accuracy.

Published
2020
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35. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies

Author

Blot, S. Ruppé, E. Harbarth, S. Asehnoune, K. Poulakou, G. Luyt, C.-E. Rello, J. Klompas, M. Depuydt, P. Eckmann, C. Martin-Loeches, I. Povoa, P. Bouadma, L. Timsit, J.-F. Zahar, J.-R.

Abstract

Patients in intensive care units (ICUs) are at high risk for healthcare-acquired infections (HAI) due to the high prevalence of invasive procedures and devices, induced immunosuppression, comorbidity, frailty and increased age. Over the past decade we have seen a successful reduction in the incidence of HAI related to invasive procedures and devices. However, the rate of ICU-acquired infections remains high. Within this context, the ongoing emergence of new pathogens, further complicates treatment and threatens patient outcomes. Additionally, the SARS-CoV-2 (COVID-19) pandemic highlighted the challenge that an emerging pathogen provides in adapting prevention measures regarding both the risk of exposure to caregivers and the need to maintain quality of care. ICU nurses hold a special place in the prevention and management of HAI as they are involved in basic hygienic care, steering and implementing quality improvement initiatives, correct microbiological sampling, and aspects antibiotic stewardship. The emergence of more sensitive microbiological techniques and our increased knowledge about interactions between critically ill patients and their microbiota are leading us to rethink how we define HAIs and best strategies to diagnose, treat and prevent these infections in the ICU. This multidisciplinary expert review, focused on the ICU setting, will summarise the recent epidemiology of ICU-HAI, discuss the place of modern microbiological techniques in their diagnosis, review operational and epidemiological definitions and redefine the place of several controversial preventive measures including antimicrobial-impregnated medical devices, chlorhexidine-impregnated washcloths, catheter dressings and chlorhexidine-based mouthwashes. Finally, general guidance is suggested that may reduce HAI incidence and especially outbreaks in ICUs. © 2022 Elsevier Ltd

Published
2022

39. De-escalation of pivotal beta-lactam in ventilator-associated pneumonia does not impact outcome and marginally affects MDR acquisition

Author

Weiss, E., Zahar, J. R., Garrouste-Orgeas, M., Ruckly, S., Essaied, W., Schwebel, C., and Timsit, J. F.

Subjects
Infection control, Health care industry
Abstract

Author(s): E. Weiss [sup.1], J. R. Zahar [sup.2], M. Garrouste-Orgeas [sup.3], S. Ruckly [sup.4], W. Essaied [sup.5], C. Schwebel [sup.6], J. F. Timsit [sup.5] [sup.7] Author Affiliations: (1) grid.7452.4, 0000000122170017, [...]

Published
2016
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40. Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events

Author

Zahar, J. R., Garrouste-Orgeas, M., Vesin, A., Schwebel, C., Bonadona, A., Philippart, F., and Ara-Somohano, C.

Subjects
Medical research -- Analysis, Medicine, Experimental -- Analysis, Bacterial pneumonia -- Analysis, Isolation (Hospital care) -- Analysis, Drug resistance in microorganisms -- Analysis, Medical errors -- Analysis, Pneumonia -- Analysis, Methicillin -- Analysis, Hyperglycemia -- Analysis, Health care industry
Abstract

Contact isolation of infected or colonised hospitalised patients is instrumental to interrupting multidrug-resistant organism (MDRO) cross-transmission. Many studies suggest an increased rate of adverse events associated with isolation. We aimed to compare isolated to non-isolated patients in intensive care units (ICUs) for the occurrence of adverse events and medical errors. Methods We used the large database of the Iatroref III study that included consecutive patients from three ICUs to compare the occurrence of pre-defined medical errors and adverse events among isolated vs. non-isolated patients. A subdistribution hazard regression model with careful adjustment on confounding factors was used to assess the effect of patient isolation on the occurrence of medical errors and adverse events. Results Two centres of the Iatroref III study were eligible, an 18-bed and a 10-bed ICU (nurse-to-bed ratio 2.8 and 2.5, respectively), with a total of 1,221 patients. After exclusion of the neutropenic and graft transplant patients, a total of 170 isolated patients were compared to 980 non-isolated patients. Errors in insulin administration and anticoagulant prescription were more frequent in isolated patients. Adverse events such as hypo- or hyperglycaemia, thromboembolic events, haemorrhage, and MDRO ventilator-associated pneumonia (VAP) were also more frequent with isolation. After careful adjustment of confounders, errors in anticoagulant prescription [subdistribution hazard ratio (sHR) = 1.7, p = 0.04], hypoglycaemia (sHR = 1.5, p = 0.01), hyperglycaemia (sHR = 1.5, p = 0.004), and MDRO VAP (sHR = 2.1, p = 0.001) remain more frequent in isolated patients. Conclusion Contact isolation of ICU patients is associated with an increased rate of some medical errors and adverse events, including non-infectious ones., Author(s): J. R. Zahar [sup.1] [sup.2], M. Garrouste-Orgeas [sup.3], A. Vesin [sup.1], C. Schwebel [sup.4], A. Bonadona [sup.4], F. Philippart [sup.3], C. Ara-Somohano [sup.4], B. Misset [sup.3], J. F. Timsit [...]

Published
2013
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45. Protocol for an international, multicentre, prospective, observational study of nosocomial pneumonia in intensive care units: The PneumoINSPIRE study

Author

Koulenti, D. Armaganidis, A. Arvaniti, K. Blot, S. Brun-Buisson, C. Deja, M. De Waele, J. Du, B. Dulhunty, J.M. Garcia-Diaz, J. Judd, M. Paterson, D.L. Putensen, C. Reina, R. Rello, J. Restrepo, M.I. Roberts, J.A. Sjovall, F. Timsit, J.-F. Tsiodras, S. Zahar, J.-R. Zhang, Y. Lipman, J. Working Group on Pneumonia of the European Society of Intensive Care Medicine

Abstract

Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration: ClinicalTrials.gov identifier NCT02793141. © 2021, College of Intensive Care Medicine. All rights reserved.

Published
2021

46. Elaboration of a consensual definition of de-escalation allowing a ranking of β-lactams

Author

Brun-Buisson, C., Bruneel, F., Chastre, J., Lasocki, S., Leone, M., Montravers, P., Nseir, S., Paugam-Burtz, C., Pease, S., Timsit, J.-F., Weiss, E., Wolff, M., Alfandari, S., Fantin, B., Gachot, B., Lesprit, P., Lucet, J.-C., Potel, G., Pulcini, C., Rabaud, C., Tattevin, P., Armand-Lefevre, L., Cavallo, J.-D., Jarlier, V., Joint-Lambert, O., Robert, J., Ruppé, E., Woerther, P.-L., Zahar, J.-R., and Ruppe, E.

Published
2015
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