Economic impact of an outbreak of carbapenemase producing-Enterobacteriaceae in a surgical intensive care unit.

Background: A 15-month outbreak of carbapenemase-producing Enterobacterales (CPE) occurred in the surgical intensive care unit (SICU) of our institution. We aimed to estimate the financial impact of this outbreak from the perspective of the French public health insurance system.

Methods: The characteristics of the colonised/infected CPE patients and outbreak management according to French national guidelines were prospectively collected.

Simultaneous Hospital Outbreaks of New Delhi Metallo-β-Lactamase-Producing Unraveled Using Whole-Genome Sequencing.

Multidrug-resistant , including carbapenemase producers, are currently spreading in health care facilities and the community. The Bichat Claude Bernard hospital in Paris faced a prolonged NDM-producing (NDM-CPE) outbreak. Whole-genome sequencing (WGS) was performed on all isolated NDM-CPE to evaluate its benefits for outbreak surveillance and comprehension.

Costs associated with implementation of a strict policy for controlling spread of highly resistant microorganisms in France.

Objective: To assess costs associated with implementation of a strict 'search and isolate' strategy for controlling highly drug-resistant organisms (HDRO).

Design: Review of data from 2-year prospective surveillance (01/2012 to 12/2013) of HDRO.

Setting: Three university hospitals located in northern Paris.

Ventilator-associated pneumonia due to carbapenem-resistant Gram-negative bacilli in an intensive care unit without carbapenemase-producing Enterobacteriaceae or epidemic Acinetobacter baumannii.

Risk factors for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) have rarely been evaluated in intensive care units (ICU) without epidemic carbapenemase-producing Acinetobacter baumannii or Enterobacteriaceae. We addressed this issue in a cohort of 141 patients (previous antimicrobial exposure, n = 131) with a first episode of VAP in a medico-surgical ICU. Twenty-six VAP (18.

Rapid detection of glycopeptide-resistant enterococci: impact on decision-making and costs.

Background: According to French national recommendations, the detection of a patient colonized with glycopeptide-resistant enterococci (GRE) leads to interruption of new admissions and transfer of contact patients (CPs) to another unit or healthcare facility, with weekly screening of CPs.

Findings: We evaluated the medical and economic impact of a pragmatic adaptation of national guidelines associated with a real-time PCR (RTP) (Cepheid Xpert™ vanA/vanB) as part of the strategy for controlling GRE spread in two medical wards. Screening was previously performed using chromogenic selective medium (CSM).

Duration of colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae after hospital discharge.

Background: The duration of gastrointestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) may play a major role in the spread of these organisms. We evaluated the time to, and factors associated with, ESBL-E clearance after hospital discharge.

Methods: We retrospectively reviewed prospective surveillance results obtained over 14 years in a 1,000-bed hospital.

Is universal HBV vaccination of healthcare workers a relevant strategy in developing endemic countries? The case of a university hospital in Niger.

Background: Exposure to hepatitis B virus (HBV) remains a serious risk to healthcare workers (HCWs) in endemic developing countries owing to the strong prevalence of HBV in the general and hospital populations, and to the high rate of occupational blood exposure. Routine HBV vaccination programs targeted to high-risk groups and especially to HCWs are generally considered as a key element of prevention strategies. However, the high rate of natural immunization among adults in such countries where most infections occur perinatally or during early childhood must be taken into account.

Diversity of extended-spectrum β-lactamase-producing Enterobacteriaceae on hospital admission.

Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become prevalent in both the hospital and the community. We describe the epidemiology of ESBL-producing isolates and patient characteristics at hospital admission. Data on clinical properties, medical history, previous hospitalizations, and previous antibiotic treatments were collected.

Development of a phenotypic method for detection of fecal carriage of OXA-48-producing enterobacteriaceae after incidental detection from clinical specimen.

We report incidental isolation of an OXA-48-producing Escherichia coli strain in urine of a 62-year-old woman recently returning from a 2-month vacation in Morocco. Commercially available extended-spectrum beta-lactamase (ESBL)-targeting medium failed to detect it in the patient's stools, although a locally developed and easy-to-implement method using ertapenem-supplemented brain heart infusion (BHI) broths could.

Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit.

Background: Ventilator-associated pneumonia (VAP), the most common hospital-acquired infection in intensive care units, increases mortality and health care costs. We describe the long-term impact of a multifaceted program for decreasing VAP rates that markedly improved compliance with 8 targeted preventive measures.

Methods: We compared VAP rates during a 45-month baseline period and a 30-month intervention period in a cohort of patients who received mechanical ventilation for > 48 h.

Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia.

Purpose: Prevention of ventilator-associated pneumonia (VAP) requires a complex approach that should include factors affecting healthcare workers' (HCWs) behavior. This study attempted to assess change of individual factors throughout a multifaceted program focusing on VAP prevention.

Methods: The prevention program involved all HCWs in a 20-bed medical intensive care unit (ICU) and included a multidisciplinary task force, an educational session, direct observations and performance feedback, technical improvements, and reminders.

Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study.

Objectives: To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings.

Design: This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI.

A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures.

Objective: To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures.

Design: Pre- and postintervention observational study.

Setting: A 20-bed medical intensive care unit in a teaching hospital.

[Effect of a long-term quality improvement program on the risk of infection related to peripheral venous catheters].

Introduction: Although peripheral venous catheter (PVC) placement is one of the most common invasive procedures used in hospitals, data about the infectious risk associated with it are sparse. Nurses and physicians often underestimate this risk. We describe here a 10-year continuous quality improvement program in a large university hospital.

Epidemiology of multidrug-resistant bacteria in patients with long hospital stays.

Objective: To determine rates of colonization with multidrug-resistant (MDR) bacteria (ie, methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus [VRE], extended-spectrum beta -lactamase [ESBL]-producing Enterobacteriaceae, and Acinetobacter baumannii) after prolonged hospitalization and to assess the yield of surveillance cultures and variables associated with colonization with MDR bacteria.

Design: Prospective observational cohort study conducted from February 6 to May 26, 2006.

Methods: All patients who spent more than 30 days in our university hospital (Paris, France) were included.

Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units.

Objective: To evaluate the effectiveness of screening strategy and contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA).

Design And Setting: Prospective observational cohort from 1 February 1995 to 31 December 2001 in three intensive care units (45 beds) in a French teaching hospital.

Patients: 8,548 patients admitted to the three ICUs had nasal screening on ICU admission and weekly thereafter.