Investigation of Serratia marcescens surgical site infection outbreak associated with peroperative ultrasonography probe.

Early postoperative infections due to Serratia marcescens have been reported by both clinicians and microbiologists in our teaching hospital. Here, we present an interlinked clinical, epidemiological, environmental and genomic investigation of this outbreak due to a T-shaped intraoperative probe contaminated by S. marcescens used during peroperative ultrasonography in laparoscopic liver resection.

First nosocomial outbreak of vanA-type vancomycin-resistant Enterococcus raffinosus in France.

BACKGROUND: Vancomycin-resistant Enterococcus raffinosus has rarely been associated with nosocomial infection and outbreaks. AIM: To report the successful control of a nosocomial outbreak of vanA-type vancomycin-resistant E. raffinosus in a surgical intensive care unit. METHODS: The investigation of the outbreak is reported with control measures taken. Molecular typing of vancomycin-resistant E. raffinosus isolates was performed by repetitive sequence-based polymerase chain reaction (PCR). FINDINGS: Between September and October 2014, vancomycin-resistant E. raffinosus isolates were isolated from four patients. The index patient had been hospitalized previously in Portugal, and was not found to be colonized by vancomycin-resistant enterococci on screening cultures obtained at admission. However, vancomycin-resistant E. raffinosus was isolated from a bile sample 19 days after hospital admission. All four isolates were resistant to both vancomycin and teicoplanin due to the presence of the vanA gene, while remaining susceptible to daptomycin and linezolid. Repetitive sequence-based PCR confirmed the spread of a single vanA-positive E. raffinosus clone. Infection control measures including direct PCR screening on rectal specimens, contact precautions, and cohorting of patients and personnel led to successful control of the outbreak. CONCLUSION: This is the first reported outbreak of vanA-type vancomycin-resistant E. raffinosus in France in both clinical and screening specimens among hospitalized patients. The inability of routine selective screening media to detect the vancomycin-resistant E. raffinosus in the index case likely contributed to the outbreak.

[Audit "Toys and incubators in neonatology"]. / Audit << Les jouets et les couveuses en néonatologie >>

Owing to an increase in nosocomial septicaemias in the Neonatalogy department, we've judged it necessary to consider the role of items not linked to the nursing procedures, and nevertheless present in the incubators, as well as the hygiene techniques applied to them. In November 2007, we've made a longitudinal prospective study consisting in an observation audit during 3 successive days, observing every single incubator with a newborn baby. In each incubator, we've checked whether there were or not items that weren't required by the nursing activities, along with their characteristics and the hygiene procedures applied to them. We've inquired as well whether the parents and the nursing staff knew and applied the required hygiene procedures. In 13 among the 17 incubators under survey, at least one item not strictly required by the nursing procedures could be found. The number of toys in each incubator varied from seven to one. Among the 33 toys surveyed, 24 (73%) of them showed a score of maximum fluffiness (4 out of 4), and only 10 wore labels giving cleansing advice from the manufacturers. Without any record about the cleaning/disinfecting of the toys brought in hospital, we have observed that the parents were given varied advice about how to clean the toys at home before putting them in the incubators (only four parents had washed the toys in their washing machines at more than 30 degrees C). From the six samples under scrutiny, all the culture results were tested positive. In particular two of the soft toys sampled were found infected by a Pseudomonas oryzihabitans. These particular toys belonged to a baby who had been diagnosed with a septicaemia characterized by hemocultures positive to a P. oryzihabitans of a different strain. Our audit has been an efficient reminder that any item put in an incubator is a potential vector and reservoir of pathogen organisms. After a general feedback towards the department staff, the medical staff then prescribed to permanently ban all the items not strictly required by the nursing activities from all the incubators of the department.

[Fortified antibiotic (vancomycin, amikacin and ceftazidime) eye drop stability assessment at -20 degrees C]. / Stabilité à -20 degrés C des collyres antibiotiques renforcés (amikacine, ceftazidime, vancomycine).

INTRODUCTION: Fortified antibiotic ophthalmic solutions are regularly administered as an immediate treatment for bacterial keratitis. Fortified antibiotics used to be self-prepared by nurses. To solve this problem, pharmacy staff studied the stability of three 5% solutions of vancomycin, amikacin, and ceftazidime prepared in aseptic conditions from parenteral antibiotic solutions. MATERIAL AND METHODS: Solutions were frozen at -20 degrees C. Each solution were examined before storage and over a 75-day period. Ceftazidime and amikacin were diluted in 0.9% sodium chloride and vancomycin in 5% dextrose. Over a 75-day period, physical and pharmacological (absorbance spectra) properties and the sterility of each stock solution were studied. RESULTS: The pH of amikacin (6.51), ceftazidime (6.47), and vancomycin (3.77) remained stable during the 75-day period. Osmolarities also remained stable (367, 488, and 351 mOsm/L, respectively). There were no significant differences in the concentration, osmolarity, and pH of the three antibiotic solutions before storage and after 75 days of freezing. Over a 75-day period, the stability of amikacin, ceftazidime, and vancomycin remained constant; no contamination was detected before storage and after 75 days. CONCLUSION: Topical fortified antibiotic solutions can be stored for 75 days at -20 degrees C (15 days quarantine). After this time, these eye-drops should be stored at 4 degrees C and should be discarded after 3 days.

[Pseudomonas aeruginosa and cystic fibrosis: first colonization to chronic infection]. / Pseudomonas aeruginosa et mucoviscidose: "de la primocolonisation a l'infection chronique".

Pseudomonas aeruginosa (Pa) is the most common virulent respiratory pathogen in cystic fibrosis and is characterized by an important capacity of adaptation, adherence and communication. The factors of virulence of Pa play a major part in adherence with the respiratory epithelial cells and in occurrence of infectious episodes. The factors responsible for the transition of first Pa acquisition to the chronic infection are not elucidated yet. The system of secretion of type III and the quorum sensing (QS) play an important role. The QS would intervene in the maturation of the biofilm of Pa, responsible for the "mucoid" phenotype of Pa, associated to a degradation of the respiratory function. We made a retrospective study on the period 1984-2005 within the Center of Cystic fibrosis of Caen allow to determine the percentage of firstly-colonized and chronic infected patients with Pa according to age. At 6 months of life, 11% of the infants were colonized with Pa reaching 48% to 7 years and 85% at the 18 years age. The percentage of chronic children carrying Pa was 0% at 1 year, 11% at 4 years, 44% at 12 years and 74% at 18 years according to the method of Kaplan-Meier. Comparing the period 1984-1994 with that of 1995-2005, the firstly-colonization and the chronic carrying of Pa occurred earlier and significantly during the second period. The current objective, beside the respiratory care, comprises the maintenance of an optimal nutritional statute and, waiting for an effective vaccine, the development of new therapeutic targets in order to attenuate the virulence of the stocks of Pa and as much as possible to delay the age of firstly-colonization and the age of chronic colonization with mucoid Pa.