{"id":1967,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/evaluation-de-la-qualite-de-la-prise-en-charge-hospitaliere-des-infections-a-clostridium-difficile-apres-une-epidemie-regionale-dans-un-centre-hospitalier-general\/"},"modified":"2018-10-20T18:40:08","modified_gmt":"2018-10-20T16:40:08","slug":"evaluation-de-la-qualite-de-la-prise-en-charge-hospitaliere-des-infections-a-clostridium-difficile-apres-une-epidemie-regionale-dans-un-centre-hospitalier-general","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/evaluation-de-la-qualite-de-la-prise-en-charge-hospitaliere-des-infections-a-clostridium-difficile-apres-une-epidemie-regionale-dans-un-centre-hospitalier-general\/","title":{"rendered":"Evaluation de la qualit\u00e9 de la prise en charge hospitali\u00e8re des infections \u00e0 Clostridium difficile apr\u00e8s une \u00e9pid\u00e9mie r\u00e9gionale dans un centre hospitalier g\u00e9n\u00e9ral."},"content":{"rendered":"

2012<\/strong><\/p>\n

Charlotte Mortier-Deswarte (1), Fr\u00e9d\u00e9rique Canis (1), Nicolas Ettahar (2), Marie-Charlotte Chopin (2) Rachida Leblanc (3), Arnaud Boruchowicz (3).
\n1) Laboratoire de Bact\u00e9riologie, 2) Unit\u00e9 d\u2019Infectiologie, 3) Service des Maladies de l\u2019Appareil Digestif, Centre Hospitalier de Valenciennes.<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02012-08-17 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Objectif: En 2006 une \u00e9pid\u00e9mie \u00e0 Clostridium difficile a \u00e9t\u00e9 observ\u00e9e dans les h\u00f4pitaux du nord de la France. Le but de notre travail a \u00e9t\u00e9 d\u2019\u00e9valuer la qualit\u00e9 de la prise en charge diagnostique et th\u00e9rapeutique des patients hospitalis\u00e9s pour une infection \u00e0 Clostridium difficile (ICD) au cours de 3 ann\u00e9es qui ont suivi l\u2019\u00e9pid\u00e9mie.
\nPatients et m\u00e9thodes: L\u2019\u00e9valuation, r\u00e9trospective, a port\u00e9 sur 157 dossiers de patients hospitalis\u00e9s entre 2008 et 2010 avec ICD. Nous avons \u00e9tudi\u00e9\u00a0: 1) Les motifs d\u2019hospitalisation et les services concern\u00e9s, 2) la s\u00e9v\u00e9rit\u00e9 des patients en fonction des recommandations fran\u00e7aises, europ\u00e9ennes, am\u00e9ricaines et en fonction du score ATLAS (a), 3) la dur\u00e9e d\u2019hospitalisation, 4) Le d\u00e9lai entre le d\u00e9but des signes cliniques, la recherche d\u2019ICD et la date du d\u00e9but du traitement en cas de recherche positive, 5) Le d\u00e9lai de la r\u00e9ponse au traitement et la date de la r\u00e9\u00e9valuation th\u00e9rapeutique en cas d\u2019\u00e9chec, 6) le taux de r\u00e9cidive et de recours \u00e0 la chirurgie, 7) la mortalit\u00e9 \u00e0 30 jours.
\nR\u00e9sultats: L\u2019\u00e2ge moyen des patients \u00e9tait de 75 ans (Ratio H\/F 0,78). Une alt\u00e9ration de l\u2019\u00e9tat g\u00e9n\u00e9ral, une chute, une maladie neurologique constituaient les principales causes d\u2019hospitalisation. Dans 25 % des cas une diarrh\u00e9e \u00e9tait le motif d\u2019entr\u00e9e. Dans les six semaines pr\u00e9c\u00e9dant l\u2019hospitalisation 85 % des patients avaient re\u00e7u un antibiotique. La prescription de la recherche de toxine a \u00e9t\u00e9 r\u00e9alis\u00e9e en moyenne 3,6 jours apr\u00e8s le d\u00e9but des sympt\u00f4mes et le traitement a \u00e9t\u00e9 instaur\u00e9 en moyenne 5,4 jours apr\u00e8s le d\u00e9but de la diarrh\u00e9e. Chez 22,9 % des patients trois pr\u00e9l\u00e8vements ont \u00e9t\u00e9 n\u00e9cessaires pour obtenir un r\u00e9sultat positif. Vingt trois patients \u00e9taient infect\u00e9s par une souche de ph\u00e9notype 027 (12,7 %). Un imidazol\u00e9 a \u00e9t\u00e9 prescrit par voie orale en premi\u00e8re intention dans 95% des cas. Une forme s\u00e9v\u00e8re selon les recommandations fran\u00e7aises, europ\u00e9ennes et am\u00e9ricaines a \u00e9t\u00e9 observ\u00e9e chez respectivement 46%, 45%, et 32% des patients. Le score ATLAS des patients \u00e9tait corr\u00e9l\u00e9 \u00e0 la mortalit\u00e9 (p<0,05).
\nLa r\u00e9ponse sous m\u00e9tronidazole \u00e9tait diminu\u00e9e en cas de signes de s\u00e9v\u00e9rit\u00e9 (p<0,05). Apr\u00e8s 5 j de traitement une absence de r\u00e9ponse \u00e9tait observ\u00e9e chez 63 patients. Vingt ont b\u00e9n\u00e9fici\u00e9 d\u2019une modification de traitement par vancomycine (31%). Deux colectomies totales ont \u00e9t\u00e9 n\u00e9cessaires pour perforation et colite s\u00e9v\u00e8re avec sepsis avec une \u00e9volution favorable. Dans les 30 jours apr\u00e8s le diagnostic 28% des patients \u00e9taient d\u00e9c\u00e9d\u00e9s. Parmi les patients non d\u00e9c\u00e9d\u00e9s \u00e0 J30 (n=116), 12 ont pr\u00e9sent\u00e9 une r\u00e9cidive et un deux r\u00e9cidives (11,2%). La dur\u00e9e moyenne de s\u00e9jour \u00e9tait de 56 jours.
\n\u00a0
\nConclusion\u00a0: Les infections \u00e0 Clostridium difficile \u00e0 l\u2019h\u00f4pital concernent une population \u00e2g\u00e9e avec comorbidit\u00e9s. Plusieurs pr\u00e9l\u00e8vements peuvent \u00eatre n\u00e9cessaires pour poser le diagnostic. Pr\u00e8s de la moiti\u00e9 des patients, dans cette \u00e9tude, pr\u00e9sentaient une forme s\u00e9v\u00e8re avec une mortalit\u00e9 de 28 %. Une am\u00e9lioration de la sensibilit\u00e9 des tests bact\u00e9riologiques, une meilleure \u00e9valuation clinique initiale de la s\u00e9v\u00e9rit\u00e9 par l\u2019utilisation de scores et une r\u00e9\u00e9valuation rapide de l\u2019efficacit\u00e9 du traitement pourraient permettre une am\u00e9lioration du pronostic.
\n(a) Miller M et al ICAAC 2010 (poster K-1692).
\n.<\/p>\n","protected":false},"excerpt":{"rendered":"

2012 Charlotte Mortier-Deswarte (1), Fr\u00e9d\u00e9rique Canis (1), Nicolas Ettahar (2), Marie-Charlotte Chopin (2) Rachida Leblanc (3), Arnaud Boruchowicz (3). 1) Laboratoire de Bact\u00e9riologie, 2) Unit\u00e9 d\u2019Infectiologie, 3) Service des Maladies de l\u2019Appareil Digestif, Centre Hospitalier de Valenciennes. Gastroent\u00e9rologie – \u00a02012-08-17 –\u00a0CO – ________________________________ Objectif: En 2006 une \u00e9pid\u00e9mie \u00e0 Clostridium difficile a \u00e9t\u00e9 observ\u00e9e dans […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[23],"class_list":["post-1967","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-23"],"yoast_head":"\nEvaluation de la qualit\u00e9 de la prise en charge hospitali\u00e8re des infections \u00e0 Clostridium difficile apr\u00e8s une \u00e9pid\u00e9mie r\u00e9gionale dans un centre hospitalier g\u00e9n\u00e9ral. - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/evaluation-de-la-qualite-de-la-prise-en-charge-hospitaliere-des-infections-a-clostridium-difficile-apres-une-epidemie-regionale-dans-un-centre-hospitalier-general\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evaluation de la qualit\u00e9 de la prise en charge hospitali\u00e8re des infections \u00e0 Clostridium difficile apr\u00e8s une \u00e9pid\u00e9mie r\u00e9gionale dans un centre hospitalier g\u00e9n\u00e9ral. - 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