ABSTRACT
A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.
Subject(s)
Cross Infection/virology , Influenza A Virus, H1N1 Subtype , Influenza, Human/virology , Acinetobacter Infections/complications , Acinetobacter baumannii , Anti-Infective Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bacteremia/complications , Blood Component Transfusion , Cross Infection/complications , Cross Infection/drug therapy , Cross Infection/therapy , Epidemics , Extracorporeal Membrane Oxygenation , Fatal Outcome , Female , Hodgkin Disease/complications , Hodgkin Disease/drug therapy , Humans , Immunocompromised Host , Influenza, Human/complications , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Influenza, Human/therapy , Multiple Organ Failure/etiology , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Reunion/epidemiology , Staphylococcal Infections/complications , Transplantation Conditioning/adverse effects , Young AdultABSTRACT
AIM OF THE STUDY: The antibiotic resistance of enterobacteriacae knows a worldwide worrying evolution with an increase of the extended spectrum betalactamases (ESBL) that spread into the community. Few publications describe this problem in the Indian Ocean area. The aim of this study is first to identify in Félix Guyon Hospital (Reunion Island) the emergent antibiotics resistance for enterobacteriaceae between 1997/1998 and 2006/2007 periods, at second, to update the prophylactic and therapeutic measures for handling the risk linked to multiresistant enterobacteriaceae in our hospital and third, to assess the risk in Reunion Island and especially at the community level. METHODS: The antibiotic susceptibility of 7814 enterobacteriaceae strains collected among patients, during 1997/1998 and 2006/2007 periods, were analysed as well as the consumption of the third generation cephalosporins, imipenem and fluoroquinolones. RESULTS: Within a span of time of 10 years, an important increase (+57 %) of the resistance prevalence of enterobacteriaceae is observed. The resistance by the ESBL production mechanism is predominant especially for Enterobacter cloacae and Escherichia coli. An important use of broad spectrum antibiotics is correlated with this resistance evolution. CONCLUSION: The emergence of ESBL-producing enterobacteriaceae in our hospital is impairing both therapeutic and health care. It requires a much better control of antibiotics prescriptions and therefore, an important multidisciplinary implication. A proof molecular analysis would allow to evaluate the risk more precisely, especially at the community level.
