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Impact d’une politique proactive de surveillance et de gestion des risques infectieux dans un centre hospitalo-universitaire parisien sur la diffusion des Bactéries Multi-Résistantes aux antibiotiques

Abstract : This work describes 15 years of fight against the spread of multi-drug resistant bacteria (MRB) in a tertiary care hospital, and includes several published studies focused on monitoring systems, cross-transmission control, and antibiotics policy. Data processing plays a crucial role in monitoring MRB. The configuration of a dedicated database, concentrating all resistance data, has to include accurate, standardized, and reproducible epidemiological settings. Significant changes in the methicillin-resistant staphylococcus aureus (MRSA) rate were observed, according to the method used to remove duplicates (27.6% to 33.8%), and the extrapolation of annual results from data collected from shorter period length, underestimates the annual value of MRSA incidence (from -42% to + 30%). These variations may affect the interpretation of MRSA official indicators. The MRB electronic alert, used to warn the staff of the readmission of a previously known colonized patient, conducted to increase the compliance for implementation of infection control measures (15% before vs 90.2% after), and participated in reducing the MRSA incidence (1.07 in 2002 vs. 0.37 in 2012). It also highlighted the strong colonization pressure due to readmitted MRSA colonized patients, since 46% of them were readmitted at least once, readmissions occurring less than three months after discharge in 2/3 cases. In intensive care units, 1/5 patient are colonized by Enterobacteriaceae producing broad spectrum beta-lactamase (ESBL) and/or high level cephalosporinase (HL-CASE), rates at admission being respectively 79.2% and 48.1% when considering all colonized patients. No screening strategy is able to detect 100% of colonization situations, the discontinuity of colonization during the hospital stay concerning a majority of patients. A significant inflexion in the slope in the HL-CASE incidence curve occurred after the substitution of ceftriaxone by cefotaxime. Finally, the optimization of ESBL screening by the assessment and then the use of a robot and dedicated culture media, allowed managing the increased number of screening specimens
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Patrick Grohs. Impact d’une politique proactive de surveillance et de gestion des risques infectieux dans un centre hospitalo-universitaire parisien sur la diffusion des Bactéries Multi-Résistantes aux antibiotiques. Santé. Université Paris-Est, 2017. Français. ⟨NNT : 2017PESC1070⟩. ⟨tel-01791618⟩

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