Curbing Methicillin-Resistant Staphylococcus aureus in 38 French Hospitals Through a 15-Year Institutional Control Program

Jarlier, Vincent; Trystram, David; Brun‐Buisson, Christian; Fournier, Sandra; Carbonne, A.; Marty, L; Andremont, Antoine; Arlet, Guillaume; Buu-Hoï, Annie; Carlet, Jean; Decré, Dominique; Gottot, Serge; Gutmann, Laurent; Joly-Guillou, Marie-Laure; Legrand, Patrick; Nicolas–Chanoine, Marie–Hélène; Soussy, Claude-James; Wolf, Michel; Lucet, Jean‐Christophe; Aggoune, M; Brücker, Gilles; Régnier, B.

doi:10.1001/archinternmed.2010.32

Cited by 142 publications

(73 citation statements)

References 44 publications

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“…In each hospital, a local infection control team (LICT) is in charge of prevention and surveillance of healthcare-associated infections, but decisions of foremost importance for the whole institution, e.g. multidrug resistance control programme, are coordinated by a multidisciplinary central infection control team (CICT), including one infectious disease physician, one bacteriologist, one epidemiologist and one nurse [7].…”

Section: Methods Settingmentioning

confidence: 99%

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

et al. 2014

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In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate, and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140 CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10% (13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32) to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and strength of the measures implemented around the CPE index case: quick (within two days of patient admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an emerging stage.

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Section: Methods Settingmentioning

confidence: 99%

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

et al. 2014

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“…1). [13][14][15][16] Although this reduction was attributed to improved infection control practices in the West, the decline was also noted from the developing countries where infection control remains to be an unsolved problem, although the figures reported from these countries may be less reliable. 12 The most recent data available from ECDC in 2013 indicate that in Europe, Romania has the highest rates of MRSA (>50%) isolated from cerebrospinal fluid (CSF) or blood and additional 5 countries in the EU region (Cyprus, Greece, Hungary, Italy and Spain) have rates between 25% and 50%.…”

Section: Gram-positive Bacteriamentioning

confidence: 99%

Epidemiology of antimicrobial resistance in bloodstream infections

2016

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Antimicrobial resistance in bacterial pathogens is a worldwide challenge leading high morbidity and mortality in clinical settings. Multidrug resistant patterns in gram-positive and -negative bacteria have resulted in difficult-to-treat or even untreatable infections with conventional antimicrobials. Since the early identification of causative microorganisms and their antimicrobial susceptibility patterns in patients with bacteremia and other serious infections is lacking in many healthcare institutions, broad spectrum antibiotics are liberally and mostly unnecessarily used. Such practice has, in turn, caused dramatic increases in emerging resistance and when coupled with poor practice of infection control, resistant bacteria can easily be disseminated to the other patients and the environment. Thus, availability of updated epidemiological data on antimicrobial resistance in frequently encountered bacterial pathogens will be useful not only for deciding on empirical treatment strategies, but also devising an effective antimicrobial stewardship program in hospitals.

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“…Jarlier et al reported a concerted campaign in France, starting in 1993, based primarily on guidelines, barrier precautions and isolation. 22 Improvement over subsequent years was modest, but increased following a central ministerial initiative in 2001 that implemented five reportable national quality indicators to benchmark hospital performance. 23 Improvement was sharpest in intensive care units and less rapid in general wards, especially in medical departments where the reduction before 2001 was negligible.…”

Section: Boxmentioning

confidence: 99%

“…23 Improvement was sharpest in intensive care units and less rapid in general wards, especially in medical departments where the reduction before 2001 was negligible. 22 Malta and Italy have also reported significant improvement in MRSA incidence in intensive care that was not evident in general wards. In high UAI backgrounds, change may be more difficult to implement in the heterogeneous environments found in general wards as opposed to intensive care environments, where nurses are normally assigned to individual patients and may feel a greater personal ownership for the outcome.…”

Section: Boxmentioning

confidence: 99%

Understanding the epidemiology of MRSA in Europe: do we need to think outside the box?

Borg

Camilleri

Waisfisz³

2012

Journal of Hospital Infection

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Background: The epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) infections, using bacteraemia as a marker, shows a striking geographical pattern in Europe. The prevalence of MRSA is low in Northern European countries, increases into central Europe and reaches its highest levels in the Mediterranean region. This has been attributed to varying levels of implementation of infection control and antibiotic stewardship (ICAS) programmes, but reasons for this variation have not been clearly established. Aim: To investigate the possible impact of national cultural dimensions on the epidemiology of MRSA in Europe. Methods: Median proportions of MRSA bacteraemia were sourced for countries participating in the EARS-Net surveillance network in 2010, and correlated with the national cultural dimension scores of Hofstede et al. Findings: Significant associations were identified between MRSA proportions and the cultural constructs of uncertainty avoidance (UAI), masculinity (MAS) and power distance. Multiple regression models found significant associations for UAI, MAS and short-term orientation (R 2 adjusted ¼ 0.475; P < 0.001). The model was found to be predictive of MRSA trends identified in several European countries between 2006 and 2010. Conclusion: Implementation of ICAS programmes often requires behavioural change. Cultural dimensions appear to be key factors affecting perceptions and values among healthcare workers, which in turn are critical for compliance and uptake. Customizing ICAS initiatives to reflect the local cultural background may improve their chances of success.

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Curbing Methicillin-Resistant Staphylococcus aureus in 38 French Hospitals Through a 15-Year Institutional Control Program

Abstract: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period.

Cited by 142 publications

References 44 publications

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

Epidemiology of antimicrobial resistance in bloodstream infections

Understanding the epidemiology of MRSA in Europe: do we need to think outside the box?

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