Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: A time-series analysis in Paris region.

The impact of the COVID-19 pandemic on bloodstream infections (BSIs) due to Streptococcus pneumoniae and Streptococcus pyogenes was assessed in 25 university hospitals of Paris. Monthly BSIs incidence rates that appeared stable in 2018 and 2019, decreased for the 2 pathogens during the 2 COVID-19 lockdown periods of 2020. Containment policies, including social distancing, masking and hand hygiene strengthening in both community and hospital settings are likely to reduce BSIs due to these pathogens.

Detection of SARS-CoV-2 in Saliva and Nasopharyngeal Swabs According to Viral Variants.

The genome of the Omicron variant of concern (VOC) contains more than 50 mutations, many of which have been associated with increased transmissibility, differing disease severity, and the potential to elute immune responses acquired after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination or infection with previous VOCs. Due to a better tropism for the upper respiratory tract, it was suggested that the detection of the Omicron variant could be preferred in saliva, compared to nasopharyngeal swabs (NPS). Our objective was to compare the SARS-CoV-2 levels in saliva fluid and NPS to estimated Ct values, according to the main SARS-CoV-2 variants circulating in France since the beginning of 2021. We analyzed 1,289 positive reverse transcription-polymerase chain reaction (RT-PCR) results during the three major waves: Alpha, Delta, and Omicron. NPS and saliva sampling were performed for 909 (71%) and 380 (29%) cases, respectively. The Ct values were significantly lower in the NPS samples than in the saliva samples for the three main VOCs. Still, the difference was less pronounced with the Omicron variant than for the Alpha and Delta variants. In contrast, in the saliva samples, Ct values were significantly lower for the Omicron variant than for the Delta (difference of -2.7 Ct) and the Alpha (difference of -3.0 Ct) variants, confirming a higher viral load in saliva. To conclude, the higher viral load in saliva was evidenced for the Omicron variant, compared to the Alpha and Delta variants, suggesting that established diagnostic methods might require revalidation with the emergence of novel variants. IMPORTANCE Established methods for SARS-CoV-2 diagnostics might require revalidation with the emergence of novel variants. This is important for screening strategy programs and for the investigation of the characteristics of new variants in terms of tropism modification and increased viral burden leading to its spread. SARS-CoV-2 RT-PCR screening on saliva samples reported lower but acceptable performance, compared to nasopharyngeal samples. Due to a better tropism for the upper respiratory tract, it was suggested that the detection of the Omicron variant could be preferred in saliva, compared to nasopharyngeal swabs. Our study analyzed 1,289 positive RT-PCR results during the three major waves in France: Alpha, Delta, and Omicron. Our findings also showed a higher viral load in saliva for the Omicron variant, compared to the Alpha and Delta variants.

Dépistage COVID-19 des professionnels hospitaliers : exemple de coopération interprofessionnelle

Pour faire face à l’épidémie de Coronavirus SARS-CoV-2, les équipes opérationnelles d’hygiène (EOH) et les services de santé au travail (SST) des hôpitaux ont dû s’adapter rapidement afin de protéger les professionnels de santé. Début mars 2020, les hôpitaux universitaires Lariboisière–Fernand-Widal, AP–HP Nord, Paris, se sont organisés pour assurer le dépistage de leurs professionnels. Devant l’activité croissante en termes de dépistage, d’information et de suivi, le service de santé publique a été mobilisé. Le SST, l’EOH et la santé publique ont collaboré pour mettre en place l’unité de dépistage et de suivi des professionnels permettant d’assurer à la fois le dépistage, la prise en charge des personnes dépistées positives et le suivi de ces personnes. L’objectif est de montrer comment plusieurs services peuvent collaborer pour créer de novo une structure hospitalière évolutive s’adaptant à l’évolution des recommandations dans un contexte de crise sanitaire. À partir du 16 mars 2020, l’unité de dépistage et de suivi des professionnels hospitaliers composée de trois cellules (dépistage, annonce des résultats positifs et suivi) a été mise en place et placée sous la responsabilité du SST. Au plus fort de l’épidémie, l’unité fonctionnait 7 jours sur 7. Des externes volontaires ont été affectés à l’unité et des médecins seniors de différents services (psychiatres, neurologues, orthopédistes) sont venus la renforcer. Les professionnels de santé au travail, de santé publique et d’hygiène ont mobilisé leurs compétences spécifiques pour assurer la continuité de la prise en charge et préserver la confidentialité des données. Avec l’aide de la direction qualité, la santé publique a formalisé la prise en charge et le circuit d’informations entre les différentes cellules et professionnels mobilisés. L’EOH assurait l’enquête autour des cas. Le SST assurait le suivi des professionnels à risque de forme grave et prononçait des évictions si nécessaire. Le circuit de prise en charge des professionnels a été adapté au fur et à mesure que les besoins, les connaissances et les outils évoluaient (adaptation des horaires d’ouverture, possibilité de télésuivi par la plateforme Covidom, conseils de rééducation olfactive, réévaluation des durées des arrêts de travail). Cette coopération a permis de réaliser 1635 dépistages par RT-PCR entre le 5/03/20 et le 14/06/2020 (environ un tiers des professionnels de l’hôpital) et de suivre 356 personnes testées positives. La population soignante étant particulièrement exposée au SARS-CoV-2, il est indispensable de proposer une organisation spécifique intra-hospitalière pour limiter au maximum la transmission soignant-soigné ou entre soignants.

Surging bloodstream infections and antimicrobial resistance during the first wave of COVID-19: a study in a large multihospital institution in the Paris region.

OBJECTIVES: This study measured the impact of the first wave of COVID-19 pandemic (COVID-19) (March-April 2020) on the incidence of bloodstream infections (BSIs) at Assistance Publique - Hôpitaux de Paris (APHP), the largest multisite public healthcare institution in France. METHODS: The number of patient admission blood cultures (BCs) collected, number of positive BCs, and antibiotic resistance and consumption were analysed retrospectively for the first quarter of 2020, and also for the first quarter of 2019 for comparison, in 25 APHP hospitals (ca. 14 000 beds). RESULTS: Up to a fourth of patients admitted in March-April 2020 in these hospitals had COVID-19. The BSI rate per 100 admissions increased overall by 24% in March 2020 and 115% in April 2020, and separately for the major pathogens (Escherichia coli, Klebsiella pneumoniae, enterococci, Staphylococcus aureus, Pseudomonas aeruginosa, yeasts). A sharp increase in the rate of BSIs caused by microorganisms resistant to third-generation cephalosporins (3GC) was also observed in March-April 2020, particularly in K. pneumoniae, enterobacterial species naturally producing inducible AmpC (Enterobacter cloacae...), and P. aeruginosa. A concomitant increase in 3GC consumption occurred. CONCLUSIONS: The COVID-19 pandemic had a strong impact on hospital management and also unfavourable effects on severe infections, antimicrobial resistance, and laboratory work diagnostics.

Outbreak of NDM-1-producing Klebsiella pneumoniae in the intensive care unit during the COVID-19 pandemic: Another nightmare.

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.