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Theses

BLSE hospitalière en France : comprendre pour contrôler

Abstract : Extended-spectrum β-lactamases enterobacteria (ESBL-PE) have increasingly been reported in France and worldwide. Moreover, ESBL-PE dissemination is a problem in health care facilities and is associated with higher morbidity and mortality rates, as well as higher hospital costs. Currently, infection control measures are based on the respect of standard precautions for all patients (including hand hygiene) and the implementation of contact precaution for patients carrying multidrug-resistant organisms (MDROs) including ESBL-PE. The objective of this research project was to study the epidemiology of ESBL-PE, from transmission, acquisition, carriage to infection in French hospitals. Data for the project was obtained through local surveillance of ESBL-PE in a Parisian hospital and a cross-sectional survey of ESBL-PE carriage conducted in 2016. The first part of the study describes the evolution of methicillin-resistant Staphylococcus aureus (MRSA) and ESBL-PE acquisition in two intensive care units, using surveillance data between 1997 and 2015. Results showed that colonization pressure contributed to the increasing incidence of ESBL-PE but not MRSA. This study suggests that preventive control measures should be customized to MDROs. The second part of the study presents the results of a cross-sectional survey. We found that 17% of patients were digestive carrier of ESBL-PE, and most of them had not been previously identified as carrier. Greater age, recent travel abroad, exposition to antibiotics and prolonged hospitalization were associated with ESBL-PE carriage. These results suggest reinforcing standard precautions rather than contact precautions for controlling the spread of ESBL-PE. In the third part of the study concerning infection, from prospective surveillance of surgical wound infection following cardiac surgery, we determined risk factors for surgical wound infection with ESBL-PE: previous intensive care unit admission during the preceding 6 months, postoperative intensive care unit stay longer than 5 days, and being born outside France. Our results suggest that ESBL-PE should be considered for pre-emptive antibiotic therapy in patients with one of these risk factors. This work provides new insights into the hospital epidemiology of ESBL-PE in France, that might influence French infection control policies, by considering for instance to reinforce standard precautions rather than contact precautions.
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Sarah Jolivet. BLSE hospitalière en France : comprendre pour contrôler. Santé publique et épidémiologie. Université Paris Cité, 2019. Français. ⟨NNT : 2019UNIP7209⟩. ⟨tel-03693601⟩

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