OBJECTIVE To compare incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) acquisition in the intensive care unit (ICU) before and after discontinuation of contact precautions (CP) and application of standard precautions (SP). DESIGN Prospective noninferiority before-and-after study comparing 2 periods: January 1, 2012, to January 31, 2014 (the CP period) and February 1, 2014, to February 29, 2016 (the SP period). SETTING A 16-bed polyvalent ICU in France with only single-bed rooms with dedicated equipment and reusable medical devices. PATIENTS All patients admitted to the ICU during the CP and SP periods were included: 1,547 and 1,577 patients, respectively. METHODS Incidence densities of ICU-acquired MRSA or ESBLE were determined per 1,000 patient days. Other studied factors included (1) patient characteristics, (2) incidence densities of MRSA or ESBLE carried at admission, (3) compliance with hand hygiene protocols, and (4) antibiotic consumption. RESULTS Incidence densities of ICU-acquired MRSA were 0.82 (95% confidence interval [CI], 0.31-1.33) and 0.79 (95% CI, 0.30-1.29) per 1,000 patient days during the CP and SP periods, respectively. For ESBLE, values were 2.7 (95% CI, 1.78-3.62) and 2.06 (95% CI, 1.27-2.86) per 1,000 patient days. These rates were significantly nonsuperior during the SP period compared to CP period, with a margin of 1 per 1,000 patient days for both MRSA (P=.002) and ESBLE (P=.004). Other factors were comparable during the 2 periods. Only ESBLE carried at admission was inferior during the SP period. We observed a high level of compliance to hand hygiene protocols. CONCLUSIONS Discontinuing CP did not increase acquired MRSA and ESBLE in our ICU with single rooms with dedicated equipment, strict application of hand hygiene, medical and paramedical leadership, and good antibiotic stewardship. Infect Control Hosp Epidemiol 2017;38:1342-1350.

Background: Totally implantable venous access port (TIVAP)-related infections (RIs) remain a serious health problem in cancer patients receiving an intravenous (i.v.) therapy. Patients and Methods: The ATAPAC study was a prospective, randomized, monocentric, phase IV trial evaluating the efficacy of taurolidine lock solution versus standard saline solution for primary TIVAP-RI prevention in nonhematological cancer patients receiving i.v. chemotherapy. The primary endpoint was the TIVAP-RI incidence rate. From December 2014 to September 2015, 163 patients were enrolled in the study (taurolidine: n = 86 vs. control: n = 77). Four patients in the control group (5%) had a Staphylococcus epidermidis TIVAP-RI, and 1 patient (1%) in the taurolidine group had a Staphylococcus aureus infection. The TIVAP-RI incidence rate was 0.4 and 0.1‰ catheter-days, respectively (p = 0.21). The infection-free TIVAP survival was not statistically significant (p = 0.09). TIVAP-RI required a total of 22 hospitalization days in the taurolidine group versus 106 days in the control arm with associated costs of EUR 4,849 and EUR 36,020, respectively. Taurolidine-related toxicity was transitory and classified as grade I. Conclusions: The ATAPAC trial did not show a significant risk-infection reduction by TauroLock™. A larger, prospective, randomized trial is needed to assess TauroLock efficacy for primary TIVAP-RI prevention in low-risk cancer patients.

Objectives: The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods: A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. Results: Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates 0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate 51%, prevalence of sinks with visible splashes 14%, prevalence of sinks close to the patient's bed 21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016). Discussion: Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

BackgroundPanitumumab is a fully human monoclonal antibody Ig G2 whose target is the epidermal growth factor receptor (EGFR). It is indicated as monotherapy to treat patients with metastatic colorectal cancer (mCRC) that show EGFR with wild-type KRAS, after failure of chemotherapy regimens containing fluoropyrimidine, oxaliplatin and/or irinotecan.PurposeThe purpose of this study was to evaluate the effectiveness and safety of panitumumab monotherapy in patients with mCRC.Material and methodsThis was a retrospective observational study of patients with mCRC treated with panitumumab as monotherapy from June 2008 to September 2015. Demographic, clinical and pharmacotherapeutic information was collected from the computerised medical records. The main effectiveness variables were: type of response to treatment (following RECIST criteria), progression free survival (PFS) and overall survival (OS). Frequency of adverse effects and severity (according to CTCAE V.4.0) established the safety profile of the treatment.Results30 patients were included: 73% men (n=22), average age 65.4 years (SD=10.7), 56.6% (n=17) ECOG PS 2 at the beginning of treatment and 46.7% (n=14) stage IV diagnosed. Panitumumab was used as a second-(n=10), third- (n=11) and fourth-line (n=9) treatment. Median number of cycles was 6 (IQR 4–10) and the average treatment period was 3.9 months (SD=2.6). Objective response rate was 10% (n=3), all being partial responses. 10% (n=3) showed stabilisation of disease and 63.3% (n=19) progression. In 5 patients the response was not evaluable (2 treatment cycles until death). The SLP median was 3 months (95% CI 1.7–4.2) and the SG median was 8 months (95% CI 3.6–12.3). Dermatologic toxicities occurred in 70% (n=21) of patients, and were severe (grade 3 and higher) in 15% of patients receiving panitumumab monotherapy. It was necessary to reduce the drug dose in 3 patients (due to dermal toxicity), with an average reduction of 26% (SD=11.5, range 20–40).ConclusionPanitumumab as monotherapy showed adequate effectiveness (SLP median 3 months and SG median 8 months) in patients with mCRC: pretreated, KRAS wild-type and poor performance status. It should be noted that dermal toxicity was observed in 70% of patients, characteristic of the EGFR inhibitor family. Future guidelines for mCRC treatment will have to establish the optimum sequence of use of the available therapies with the aim of achieving the greatest clinical benefit in patients.References and/or acknowledgementsI want to thank Beatriz Sánchez Castellanos for her support and time.No conflict of interest

BackgroundBosentan, an orphan drug, is a dual endothelin receptor antagonist indicated in pulmonary hypertension and in the prevention of new digital ulcers (DU) in patients with systemic sclerosis and ongoing digital ulcer disease.PurposeTo evaluate the effectiveness and safety of bosentan in the treatment of clinical manifestations associated with underlying autoimmune disease (Raynaud’s phenomenon (RP), DU and other location skin ulcers (SU)), all of them considered rare diseases.Material and methodsRetrospective observational study including patients treated with bosentan from January 2012 to September 2014, on compassionate use.Variables collected were: sex, age, underlying disease, indication, previous treatments, dose and follow-up time.Effectiveness was evaluated as: absence of new ulcers, improvement of the basal ulcers and decrease in the number of RP episodes.The safety profile was determined according to the adverse reactions.Results14 patients were included; follow up (median, range): 22 (2–55) months; sex: 10 (71%) female; age: 52 (25–81) years.All of them had previously been treated with first-line treatment until resistance or intolerance had developed.In 11 cases bosentan was indicated to treat RP and prevent/treat DU (4 systemic sclerosis, 3 pre-systemic sclerosis, 2 systemic lupus erythematosus (SLE), 1 dermatomyositis and 1 Buerger´s disease. Getting the next results: 63.6% effective (7), 18.2% ineffective (2) and 18.2% could not be evaluated.In the other 3 cases, bosentan was used to treat other location SUs (1 polyarteritis nodosa,1 SLE and 1 necrobiosis lipoidica) with 100% effectiveness.The treatment was discontinued in two cases due to digestive intolerance. In another two cases, the dose was adjusted as a consequence of an initial increase in the hepatic enzymes.ConclusionBosentan may be considered an appropriate alternative in these diseases which have been refractory to conventional treatment. The number of patients is limited due to the low prevalence of these diseases and to the off-label use of the drug. Therefore, it could be said that value of research lies in the possibility of opening new therapeutic perspectives with this drug.References and/or AcknowledgementsNo conflict of interest.