The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients’ being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.

/pdf/limiting-the-spread-of-multidrug-resistant-bacteria-in-low-1t0qb39n.pdf

Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All

Infecciones nosocomiales: conducta y estrategia terapéutica ante una epidemia

Infezioni nosocomiali: linea d’azione e strategia terapeutica di fronte a un’epidemia

Introduction: Nosocomial infection or infection associated with care is a serious concern in intensive care units. It is a serious infection because of its frequency, incidence and additional cost. The objective of the study was to determine the epidemiological, clinical, therapeutic and evolutionary aspects of nosocomial infections in the intensive care unit of the regional hospital of Saint Louis. Materials and Methods: A one year retrospective, descriptive and analytical study of all cases of nosocomial infections found during the study period. We analyzed anamnestic, clinical, therapeutic, evolutionary and prognostic data. Results: 28 cases of nosocomial infections out of 243 hospitalized patients, an incidence of nosocomial infection of 11.5%. The mean age of the patients was 37.57 years with a standard deviation of 20.5 years. The reasons for admission were altered consciousness (28.5%), postoperative follow-up (21.4%), and acute respiratory failure (14.2%). Invasive procedures were represented by bladder catheterization (100%), central venous catheterization (64%), oro-tracheal intubation (39.2%), hemodynamic support (28.5%), extra-renal purification and parenteral nutritional support in respectively 10.7% and 7%. Pneumonia acquired under mechanical ventilation represented 28.5% of the infections identified, bacteremia 21%, urinary and neuro-meningeal infections 18% each and surgical site infections 14%. The germs identified were gram-negative bacilli (75%) (8 pseudomonas and 13 enterobacteria), gram-positive cocci in 25% of cases (5 staphylococci aureus Meti S and 2 staphylococci Meti R). The rate of microbial resistance was 35.7%. The average length of hospitalization was 16 days (Extreme = 60 -3 days). The mortality rate was 35%. Discussion/Conclusion: Nosocomial infections in the ICU are frequent and are associated with high morbidity and mortality. Effective preventive measures are the key to improve the prognosis.

/pdf/nosocomial-infections-in-the-intensive-care-unit-of-saint-2zdkq3wd.pdf

Nosocomial Infections in the Intensive Care Unit of Saint Louis Regional Hospital: Status Report and Prognostic Factors of Mortality

Contexte : en reanimation, de nombreux patients sont intubes, et l’extubation non programmee (ENP) est un indicateur de la qualite des soins.L’isolement associe aux precautions « air » chez les patients Covid sous ventilation mecanique (VM) pourrait augmenter les ENP. L’objectif principal etait de comparer le taux d’ENP entre une periode COVID-19 et une periode controle, et les objectifs secondaires etaient d’etudier les facteurs de risque et le ressenti des soignants.Methode : il s’agit d’une etude cas-temoins retrospective monocentrique. Les patients majeurs sous VM etaient eligibles en deux periodes, controle du 01 au 29/02/20 puis COVID-19 du 01 au 31/03/20. Un questionnaire a ete distribue aux soignants de reanimation.Resultats : le taux d’ENP etait de 17 % (7 ENP) vs 20 % (9 ENP) periode controle vs COVID-19 (p=0,58), avec une preponderance nocturne (75 %). Un quart des patients remplissaient les criteres de sevrage. Le taux de participation au questionnaire etait de 71 % (n=49). Pour 76 % (n=37) des soignants, la periode COVID-19 etait a risque d’ENP avec le sentiment d’une charge de travail plus importante, de difficultes de surveillance et d’une diminution du nombre de passages dans les chambres.Conclusion : contrairement au ressenti des soignantes, le taux d’ENP etait similaire au cours des deux periodes, COVID-19 vs controle.

COVID-EX. Influence de la pandémie de Covid-19 sur le taux d’extubation non programmée en réanimation : étude castemoins rétrospective

/pdf/faut-il-isoler-les-patients-porteurs-de-bmr-1dgduf9mwt.pdf

Faut-il isoler les patients porteurs de BMR ?

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Faut-il isoler les patients porteurs de BMR ?