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Biomedical subjects

J C Lucet

Publications and source records attributed to J C Lucet.

At least 19 recordsLinked to original sources
PubMed2003

Epidemiology of Pseudomonas aeruginosa and risk factors for carriage acquisition in an intensive care unit.

Because of a high prevalence of Pseudomonas aeruginosa infections, we conducted an epidemiological study to assess the need for systematic surveillance, as well as the value of applying barrier precautions toP. aeruginosa carriers. From July 1997 to February 1998, we conducted a prospective cohort study in an 18-bed medical intensive care unit (ICU), which is part of the infectious diseases department in a 1200-bed tertiary-care teaching hospital. Rectal and oropharyngeal swabs were obtained on admission and twice weekly. Acquired strains were genotypically characterized by pulsed-field gel electrophoresis (PFGE). A risk factor analysis for carriage, colonization and infection was performed. Among 269 eligible patients, 116 (43%) were P. aeruginosa carriers, with 46 (17%) detected on admission and 70 (26%) who acquired carriage during their stay in ICU. Among these 70 patients, 29 became colonized (N=13) or developed infection (N=16). Conversely, in the 121 patients who remained free of carriage, no colonization or infection were detected. Genotyping analysis using PFGE was performed for 81/85 (95%) acquired strains in 67 patients. The same genotype I was observed for 58/81 (70%) of these strains issued from 47 patients, and a distinct genotype II affected two other patients (three strains). The last 20 strains were not genetically related. In a multivariate model, mechanical ventilation was associated with the acquisition of P. aeruginosa carriage. Antibiotics ineffective against P. aeruginosa significantly increased the risk of colonization or infection in ICU. Although several recent studies concluded that endogenous sources account for the majority of P. aeruginosa colonizations or infections, we conclude that epidemiology may vary according to the ICU, and that cross-colonization (i.e., exogenous source) may occur and warrant reinforced barrier precautions.

Actuarial Analysis↗
PubMed2002

[The importance of detecting methicillin-resistant Staphylococcus aureus in an intensive care setting].

In recent years, the fight against nosocomial infections has constituted a major public health challenge. Measures aimed at preventing the spread of multiresistant bacteria (MRB) through carriage combine the more or less systematic detection of carriers and precautions concerning isolation. In the light of published data, elements for the evaluation of a cost-efficiency ratio for measures concerning detection and isolation in intensive care are presented. The high levels of methicillin-resistant Staphylococcus aureus (MRSA) observed in hospitals constitute the principal target. Although isolation precautions appear to be effective, the value of detecting MRSA remains a subject of debate. Such detection has several objectives: the identification of carriers, assistance in the implementation of isolation precautions, the eradication of carriage and the evaluation of strategy. These different objectives are discussed.

Critical Care↗
PubMed2001

Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage.

To investigate persistent carriage of methicillin-resistant Staphylococcus aureus (MRSA), we conducted a prospective 10-month study of MRSA carriage in previous carriers who were readmitted to our hospital. Four screening specimens, 2 from the skin and 2 from the nares, were obtained within 3 days after admission, in addition to diagnostic specimens requested by physicians. Of the 78 patients included in our study, 31 (40%) were persistent carriers of MRSA, with an estimated median time of 8.5 months to MRSA clearance. In the multivariate analysis, the only factor significantly associated with persistent carriage was the presence of a break in the skin at readmission (odds ratio, 4.34; P=.004); however, a trend was found for admission from a chronic-care institution (odds ratio, 3.65; P=.06). Our data confirm that prolonged carriage of MRSA can occur after hospital discharge, support routine screening for MRSA at readmission of previously MRSA-positive patients, and suggest that a particularly high index of suspicion for MRSA carriage should be maintained if these patients have a break in the skin.

Adult↗
PubMed2001

Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure.

OBJECTIVES: To clarify the patterns of pulmonary tuberculosis (TB) that should result in a high index of suspicion, to increase the chances of early therapy and to identify predictors of 30-day mortality. PATIENTS AND METHODS: Retrospective, 7-year study in two medical intensive care units (ICUs). All patients admitted with pulmonary TB were enrolled. Clinical and laboratory data at admission and events within 48 h of admission were collected. Predictors of 30-day mortality were identified by univariate and multivariate analysis. RESULTS: The study included 99 patients with a median age of 41 years. Immunodeficiency was present in 60 patients, including 38 with AIDS. Fifty-nine patients had pulmonary TB alone, 22 also had extrapulmonary TB and 18 had miliary. All 99 patients were admitted for acute respiratory failure, some also with shock (20), neurologic disorders (18) or acute renal failure (10). Mechanical ventilation was needed in 50 patients; 22 patients met criteria for acute respiratory distress syndrome (ARDS). The 30-day mortality rate was 26.2%. Four factors independently predicted mortality: a time from symptom onset to treatment of more than 1 month (OR, 3.49; CI, 1.20-10.20), the number of organ failures (OR, 3.15; CI, 1.76-5.76), a serum albumin level above 20 g/l (OR, 3.96; CI, 1.04-15.10), and a larger number of lobes involved on chest radiograph (OR, 1.83; CI, 1.12-2.98). CONCLUSION: Delayed clinical suspicion and treatment of active pulmonary TB with respiratory failure may contribute to the persistently high mortality rates in ICU patients with these diseases.

Acute Disease↗
PubMed2001

An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients.

OBJECTIVE: To describe an outbreak of imipenem-resistant Acinetobacter baumannii (IR-Ab) and the measures for its control, and to investigate risk factors for IR-Ab acquisition. DESIGN: An observational and a case-control study. SETTING: A surgical intensive care unit (ICU) in a university tertiary care hospital. METHODS: After admission to the ICU of an IR-Ab-positive patient, patients were prospectively screened for IR-Ab carriage upon admission and then once a week. Environmental cleaning and barrier safety measures were used for IR-Ab carriers. A case-control study was performed to identify factors associated with IR-Ab acquisition. Cases were patients who acquired IR-Ab. Controls were patients who were hospitalized in the ICU at the same time as cases and were exposed to IR-Ab for a similar duration as cases. The following variables were investigated as potential risk factors: baseline characteristics, scores for severity of illness and therapeutic intervention, presence and duration of invasive procedures, and antimicrobial administration. RESULTS: Beginning in May 1996, the outbreak involved 17 patients over 9 months, of whom 12 acquired IR-Ab (cases), 4 had IR-Ab isolates on admission to the ICU, and 1 could not be classified. Genotypic analysis identified two different IR-Ab isolates, responsible for three clusters. Ten of the 12 nosocomial cases developed infection. Control measures included reinforcement of barrier safety measures, limitation of the number of admissions, and thorough environmental cleaning. No new case was identified after January 1997. Eleven of the 12 cases could be compared to 19 controls. After adjustment for severity of illness, a high individual therapeutic intervention score appeared to be a risk factor for IR-Ab acquisition. CONCLUSION: The outbreak ended after strict application of control measures. Our results suggest that high work load contributes to IR-Ab acquisition.

Acinetobacter↗
PubMed2001

Incidence and risk factors of bacteriuria after transurethral resection of the prostate.

INTRODUCTION: Postoperative bacteriuria is a frequent event after transurethral resection of the prostate, despite the use of prophylactic antibiotics. Certain risk factors have been clearly established (preoperative urinary catheter or bacteriuria, operating time), while others remain uncertain. MATERIALS AND METHODS: We conducted a prospective study in five urology centers, including non-catheterized patients with sterile preoperative urine undergoing transurethral resection of the prostate for benign prostatic hyperplasia. All received antibiotic prophylaxis with cefamandole. The incidence of bacteriuria and its risk factors were investigated. RESULTS: The postoperative bacteriuria rate was 26% (26/101), with 8% on removal of the catheter, 14% between the 7th and 10th postoperative days and 5% 1 month postoperatively. Factors associated with bacteriuria on univariate analysis were: operating time, disconnection of the closed urine drainage system and postoperative catheterization > or =3 days. Two variables were associated on multivariate analysis (logistic regression): operating time >52 min (odds ratio 9.0, 95% confidence interval 2.1-39.0) and disconnection of the closed urine drainage system (odds ratio 26.3, 95% confidence interval 6.1; 6.1-113). CONCLUSIONS: The postoperative bacteriuria rate after transurethral resection of the prostate was high in this study, raising the question of the choice and/or duration of prophylactic antibiotics. Prevention of postoperative bacteriuria must be based on careful hemostasis, prevention of postoperative catheter disconnections, and limitation of the duration of postoperative catheterization.

Aged↗
PubMed2001

[Evaluation of three testing strategies for detection of hepatitis C in a hospital medical consultation and in an HIV testing center].

AIMS: Testing for hepatitis C virus (HCV) is recommended. The purpose of this study was to evaluate the efficacy of HCV testing in a medical consultation without an appointment and in an HIV testing center based on three testing strategies: 1997 French Consensus Conference, "Lettre de la Direction Générale de la Santé" (January 1996), and extension to other risk factors. PATIENTS AND METHODS: For 6 months a free blood test was offered to any patient with a risk factor according to the literature. RESULTS: There were 1 736 new patients at the medical consultation and 1 616 at the testing center. The patients were younger at the testing center than at the medical consultation (31.1 vs 43.3 years; P<0.001). Acceptance of screening was better at the testing center (97.8% vs 75.2%; P<0.001). There were more patients exposed to one of the risk factors at the testing center (31.2% vs 13.9%; P<0.001). Tests were more efficient at the testing center: 30 HCV positive patients/1 616 (1.86%) vs 11/1 736 (0.63%, P<0.01). Tests based on the 1997 French Consensus Conference provided detection in 27/30 (90%) of HCV positive patients at the testing center but only 4/11 (36.3%) at the medical consultation (P<0.01). CONCLUSION: Testing was effective in both places but was more efficient at the testing center. Efficacy of the testing strategies differs significantly according to the place of screening. At the testing center, screening can be restricted to patients with a history of intravenous drug use and blood transfusion. At the medical consultation, screening should be extended to other risk factors.

Adult↗
PubMed2000

Microbiological evaluation of central venous catheter administration hubs.

We compared, in three intensive care units, colonization of hubs with hub protection boxes or hubs with needleless closed connectors; 137 central venous catheters and 451 hubs were randomized in two groups with similar characteristics. Catheter and hub colonization were not different between the two groups. Among 30 colonized catheters, the same isolate was found in only two hubs; hub contamination rarely is responsible for catheter colonization in short-term catheters. Further studies are required to evaluate the benefit of protected hubs compared with unprotected hubs.

Bacteremia↗
PubMed2000

Nosocomial bacteremia in HIV patients: the role of peripheral venous catheters.

A retrospective case-control study compared 40 human immunodeficiency virus (HV)-infected patients with 43 nosocomial bacteremias (NB) to 77 HIV-infected patients without NB. Presence of a peripheral venous catheter (PVC) was associated with occurrence of NB and was significantly more frequent in NB without an identified source. PVCs probably are an underestimated source of NB in HIV-infected patients.

Adult↗
PubMed1999

Cost of antimicrobial treatment for nosocomial infections based on a French prevalence survey.

An estimate of the antibiotic cost of nosocomial infections (NI) was made in a university hospital group based on data collected in adult inpatients enrolled in the French national prevalence survey in 1996. Among the 6839 study patients, 636 (9.3%) presented with at least one NI, of these, data on antimicrobial treatment were available for 480. The overall daily antibiotic cost was estimated between FF 49,439 and 103,526, resulting in FF 103 to 216 per infected patient. The most expensive antibiotic treatment was prescribed in intensive care patients, for pneumonia for device-related NI, or for multi-resistant bacterial infections. Non-documented NI represented about 20% of the overall antibiotic cost. Beta-lactam antibiotics, especially third generation cephalosporins, and parenteral fluoroquinolones were the most expensive antimicrobial drugs. The cost of antibiotic treatment for NI represents a significant part of hospital expenditure that should be reduced by better control of highly expensive prescriptions.

Adolescent↗
PubMed1999

Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation to nasal colonization.

In the surgical intensive care unit of a university hospital, we investigated the frequency of and the risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) during postoperative intra-abdominal infection (pIAI). We conducted a prospective MRSA nasal screening and case evaluation for 17 months among 73 consecutive patients with having pIAI. MRSA pIAI was diagnosed when MRSA was obtained from culture of intraperitoneal fluids. The identity of nasal and peritoneal MRSA strains was assessed by genomic analysis. Twelve patients had MRSA pIAI, representing 21% of all MRSA infections acquired by the 73 patients. An organ system failure score of >/=1 and MRSA nasal carriage prior to pIAI were the independent risk factors for acquisition of MRSA pIAI. Patients with MRSA pIAI had a longer intensive care unit stay and more reoperations than did those free of MRSA pIAI. We conclude that MRSA may be a causative pathogen in pIAI and may be related to nasal colonization.

Adult↗
PubMed1999

Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) were isolated from clinical specimens from 130 to 140 patients/year in 1989-1991 in our hospital. In February 1992, a control program was initiated: screening tests in 3 intensive care units (ICUs) and contact-isolation precautions in all units. The septic surgical unit served as an isolation ward for surgical patients from whom ESBLPE was isolated. In 1992, the incidence of ESBLPE acquisition failed to decrease, and most acquisitions occurred in 3 ICUs. Critical evaluation of implementation of isolation procedures in these ICUs prompted corrective measures for barrier precautions. The incidence of acquired cases subsequently decreased, and a second evaluation determined that these measures had been correctly applied. The incidence of acquired cases in the septic surgical unit was lower than those in the other units. Decreases were also found in the incidence of acquisition of other hand-transmitted multidrug-resistant organisms. Barrier precautions, screening tests for ICU patients, and grouping of cohorts after ICU discharge are effective in controlling the spread of multidrug-resistant microorganisms by cross-contamination. The outbreak was effectively controlled without restricting antimicrobial use.

Anti-Bacterial Agents↗
PubMed1999

Risk factors for surgical wound infections in patients undergoing head and neck oncologic surgery.

Risk factors for surgical wound infection are difficult to establish in head and neck surgery. Flap reconstruction, which correlates with tumour size and surgical procedure, appears to be the main risk factor. Attempts should be made by the surgical staff to improve surgical procedures in terms of duration of surgery and choice of the procedure. The intraoperative choice between primary closure and flap reconstruction should be studied further. More subtle risk factors may appear in studies of large groups of patients and/or if a distinction is drawn between early and late SWI.

Antibiotic Prophylaxis↗
PubMed1998

[Control of multiple-resistant bacteria].

The number of multiply-resistant bacteria, especially methicillin-resistant Staphyloccoccus aureus, has reached an alarming level in France. This number reflects the inadequacy of efforts against nosocomial infections, and non-respect of hygiene rules by hospital staff. Two mechanisms lead to multiple resistance: the selection of multiply-resistant bacteria by antimicrobials; and, once resistance is acquired, bacterial dissemination by hand-mediated cross transmission. Controlling the spread of multiple resistance thus requires both judicious use of antimicrobials, and compliance with basic rules of hygiene, particularly handwashing. Although the hospital setting favors the emergence and spread of bacterial resistance, this is also increasing, albeit to a lesser extent, in the non-hospital environment. The same measures of careful antimicrobial use and good hygiene should be applied.

Cross Infection↗