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Lepainteur M.,University Hospital Antoine Beclere | Lepainteur M.,University Paris - Sud | Desroches M.,University Hospital Antoine Beclere | Desroches M.,University Paris - Sud | And 10 more authors.
Pediatric Infectious Disease Journal | Year: 2013

Background: Pathogenesis of coagulase-negative staphylococcal bloodstream infections among preterm neonates is debated: central venous catheters (CVCs) are considered the major cause and the cornerstone of prevention measures. The role of other means of transmission is unknown. Methods: We developed a specific quantitative polymerase chain reaction assay targeting the dual gene from Staphylococcus epidermidis and Staphylococcus capitis to detect DNA from CVC used in preterms. Performance of the polymerase chain reaction was tested against 2 control groups of CVC yielding positive (n = 24) or negative (n = 63) conventional cultures. We also explored retrospectively the DNA load of CVC having a negative conventional bacterial culture and obtained from 34 very preterm neonates with catheter-related bloodstream infections (CR-BSIs) established by usual clinical and biologic criteria. Results: The molecular approach allowed detection of corresponding DNA from all the positive control catheters. Among the 34 episodes of CR-BSI yielding a negative conventional CVC culture, 8 (23.5%) had a positive polymerase chain reaction signal (5 S. epidermidis and 3 S. capitis'). This percentage did not significantly differ according to the staphylococcal species, the delay between the CVC insertion and the beginning of the sepsis or between the blood culture collection and the CVC removal. These results conform to the previously published 70% of CR-BSI for whom the origin could be questioned. Conclusions: CVC removal in preterms is often performed in cases of CRBSI; our study supports the hypothesis that in some cases the responsibility of CVC is questionable. Copyright © 2013 by Lippincott Williams & Wilkins.

Traore P.,Center hospitalier Sud Essonne | Bourgeois-Nicolaos N.,University Hospital Antoine Beclere | Ruimy R.,University of Nice Sophia Antipolis | Laurent F.,French National Reference Center for Staphylococci | And 4 more authors.
Folia Microbiologica | Year: 2014

For the first time, it was reported in France a cluster of autochthonous severe community-acquired (CA) infections due to the USA300 methicillin-resistant Staphylococcus aureus (MRSA) clone. The three cases belonged to the same family without any identified clue of abroad importation pathway. The domestic spread of USA300 in France is of concern. © 2014, Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i.

Decousser J.-W.,University Hospital Henri Mondor | Ramarao N.,French National Institute for Agricultural Research | Duport C.,University Hospital Antoine Beclere | Dorval M.,University Hospital Antoine Beclere | And 5 more authors.
American Journal of Infection Control | Year: 2013

Background: Bacillus cereus is an environmental pathogen whose spores resist the usual cleaning procedure applied by the food industry and hospitals. We reported a cluster of severe intestinal infections due to B cereus in 2 very low birth weight neonates from a neonatal intensive care unit. Methods: Environmental sampling and bacteriological analysis of pooled breast milk (PBM) were performed. Practices for preparation and administration of milk were observed and additional laboratory experiments performed. Strains were typed using M13-polymerase chain reaction and their virulence tested using cellular and insect models. Results: B cereus strains were exclusively isolated from intestinal tracts and PBM. No environmental culture yielded any viable B cereus. Although genotypically diverse, both clinical and food strains exhibited high virulence potency. These findings pointed out the pathogenic potency of B cereus in neonates; the putative role of PBM as a reservoir for pathogenic B cereus and the triggered effect of a defective care procedure, which allowed the growth of bacteria in pasteurized PBM. Well described from dried formula, the presence of pathogenic B cereus strains in PBM was not previously reported. Conclusions: Careful monitoring of conditions during collection, conservation, and administration of PBM should be implemented in high-risk populations such as premature neonates. Copyright © 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc.

Laupland K.B.,Albert Bonniot Institute | Laupland K.B.,University of Calgary | Zahar J.-R.,Albert Bonniot Institute | Zahar J.-R.,Necker University Hospital | And 15 more authors.
Clinical Infectious Diseases | Year: 2012

Background. Although hypothermia is widely accepted as a risk factor for subsequent infection in surgical patients, it has not been well defined in medical patients. We sought to assess the risk of acquiring intensive care unit (ICU)-acquired infection after hypothermia among medical ICU patients. Methods. Adults (≥18 years) admitted to French ICUs for at least 2 days between April 2000 and November 2010 were included. Surgical patients were excluded. Patient were classified as having had mild hypothermia (35.0°C-35.9°C), moderate hypothermia (32°C-34.9°C), or severe hypothermia (<32°C), and were followed for the development of pneumonia or bloodstream infection until ICU discharge. Results. A total of 6237 patients were included. Within the first day of admission, 648 (10%) patients had mild hypothermia, 288 (5%) patients had moderate hypothermia, and 45 (1%) patients had severe hypothermia. Among the 5256 patients who did not have any hypothermia at day 1, subsequent hypothermia developed in 868 (17%), of which 673 (13%), 176 (3%), and 19 (<1%) patients had lowest temperatures of 35.0°C-35.9°C, 32.0°C-34.9°C, and <32°C, respectively. During the course of ICU admission, 320 (5%) patients developed ICU-acquired bloodstream infection and 724 (12%) patients developed ICU-acquired pneumonia. After controlling for confounding variables in multivariable analyses, severe hypothermia was found to increase the risk for subsequent ICU-acquired infection, particularly in patients who did not present with severe sepsis or septic shock.Conclusions.The presence of severe hypothermia is a risk factor for development of ICU-acquired infection in medical patients. © 2012 The Author.

Lepainteur M.,University Hospital Antoine Beclere | Lepainteur M.,University Paris - Sud | Royer G.,University Hospital Antoine Beclere | Royer G.,University Paris - Sud | And 7 more authors.
Journal of Hospital Infection | Year: 2013

In neonatal intensive care units, topical agents represent an increasing part of the infection control armamentarium. Fifty-one coagulase-negative staphylococci (CNS) isolated from catheter-associated bloodstream infections in very preterm neonates were investigated in this study: 41.2% exhibited decreased susceptibility to at least one antiseptic (chlorhexidine 12%, benzalkonium 24%, acriflavine 33%) and 61% were resistant to mupirocin. QacA/B, mupA and both genes were detected by polymerase chain reaction in 59%, 63% and 49% of CNS, respectively. Seventy-six percent of Staphylococcus epidermidis (5/5 pulsed-field-gel electrophoresis subgroups) and 11% of Staphylococcus capitis (1/3 subgroups) were multi-resistant. Skin antisepsis using low-concentration aqueous formulations and off-label mupirocin indications should benefit from a stewardship programme. © 2012 The Healthcare Infection Society.

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