Carole Loos-Ayav

Incidence de l’insuffisance rénale chronique en population générale, étude EPIRAN

AIMS To assess incidence of chronic kidney disease in general population and to describe baseline characteristics of incident patients. METHODS Between 1st/01/04 and 30/06/06 all incident cases of chronic kidney disease in the Nancy district were prospectively identified. New cases were identified from all medical laboratories in this area and determined by a persistently increased serum creatinine level (> or = 150micromol/l, or paediatric levels) for 3 months after the 1st/01/04, and by living in Nancy area. RESULTS The annual incidence rate of detected chronic kidney disease was 1 per thousand inhabitants (1,3 per thousand for men and 0,7 per thousand for women). Incidents patients were old (mean age: 77 years) and with numerous comorbidities (diabetes: 34 %, cardiac failure: 23 %). More than 30% of incident patients were diagnosed at sever stage of chronic kidney disease (<30ml/min/1,73m(2)). CONCLUSIONS The annual incidence of diagnosed chronic kidney disease is common: 10 times more than end-stage renal disease in France. Most of these patients are diagnosed in a severe stage of chronic kidney disease whereas they could be detected earlier and benefit from adequate, appropriate and multidisciplinary take care.

Effets sur la morbidité et les coûts des pneumopathies nosocomiales à Staphylococcus aureus résistant à la méthicilline en réanimation

OBJECTIVES Prevention of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections in the intensive care units (ICU) has been recommended for several years. However, the workload and the costs of these programs are to be weighed against the benefit obtained in terms of reduction of morbidity and costs induced by the infection. The purpose of this study was to evaluate the cost and the current morbidity of the infection with MRSA in the ICU. METHODS In a retrospective case-control study carried out in 2004, all patients of the 6 intensive care units of a teaching hospital having developed a MRSA nosocomial infection were included. They were paired with controls on the following criteria: department, Simplified Acute Physiology Score II (SAPSII), age (+/- 5 years), type of surgery (for the surgical intensive care units). The duration of hospitalization of the paired control had to be at least equal to the time from admission to infection of the infected patient. The costs were evaluated using the following parameters: scores omega 1, 2 and 3, duration of artificial ventilation, hemodialysis, length of ICU stay, radiological procedures, surgical procedures, total antibiotic cost and other expensive drugs. RESULTS Twenty-one patients with MRSA infection were included. All had nosocomial pneumonia. The 21 paired patients were similar with regard to both initial criteria and sex. Hospital mortality was not different between the 2 groups (cases=8; controls=6; p=0.41), as well as median duration of hospital stay (cases=41 days; controls=43 days; p=0.9). The duration of mechanical ventilation, number of hemodialysis or hemofiltration sessions, number of radiological procedures were similar in both groups. The total omega score was not significantly different between cases (median 435; IQR: 218-579) and controls (median 281, IQR: 231-419; p=0.55). The median duration of isolation was 12 days for cases and 0 day for controls (p=0.0007). The pharmaceutical expenditure was significantly higher in cases (median: 1414euro; IQR: 795-4349), by comparison with the controls (median: 877euro, IQR: 687-2496) (p=0.049). CONCLUSION In the ICU having set up a policy intended to reduce the risk of MRSA nosocomial infections, MRSA pneumonia does not seem to involve major additional morbidity, as compared to a control population matched for similar severity of illness. It increases modestly the use of the medical resources.

Conduite adoptée face à une épidémie à ERG (ERV) dans un établissement de santé

Resume Depuis fin 2004, la Lorraine est confrontee a une epidemie de colonisation digestive a enterocoques resistants aux glycopeptides (ERG). Elle a debute au centre hospitalier universitaire de Nancy ou elle a evolue en deux phases successives : une premiere bouffee a ete maitrisee en 2005 grâce a un renforcement de l’hygiene des mains et a des mesures de regroupement. Puis, apres une accalmie d’un an, seules des mesures de promotion exclusive de desinfection des mains par friction avec des produits hydro-alcooliques et de cohorting ont lentement permis de contenir cette seconde bouffee epidemique a la mi-2008. Mais l’epidemie a diffuse a partir de 2007 a d’autres etablissements de la region. Une mission regionale, diligentee par l’agence regionale d’hospitalisation, a alors edicte, sur la base des recommandations nationales, mais en tenant compte du caractere deja installe de l’epidemie et de la specificite de chaque etablissement confronte, une serie de procedures destinees a guider les soignants dans leurs prises en charge. Ainsi, une liste des services concernes par l’ERG est diffusee de facon hebdomadaire afin d’optimiser la politique de depistage et d’isolement probabiliste lors des transferts dans la region et une conduite a tenir pour la prise en charge specifique des patients colonises par l’ERG en service d’hemodialyse a ete proposee. L’ensemble de ces mesures a donne lieu a la creation d’un guide pratique pour la prise en charge d’une epidemie a ERG. Au total, plus de 900 cas de colonisations a ERG ont ete recenses en Lorraine entre 2004 et 2008. L’application des mesures decrites ci-dessus, au niveau du CHU mais aussi de la region, semble avoir permis le controle de l’epidemie.