R Baron

Publications (6)7.05 Total impact

• Article: Outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae in an intensive care unit (Brest).

  M Carpentier, V Appere, P Saliou, A de Tinteniac, H Floch, F Le Gall, M Cosse, M El Bouyousfi, R Baron, J-M Boles, S Jourdain, B Lejeune, B Nancy, G Prat, D Tande, M Virmaux, J-P Wargnier, R Garlantézec
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  ABSTRACT: INTRODUCTION: We had for aim to describe control and investigation of an outbreak caused by a strain of Extended spectrum beta-lactamase producing Klebsiella pneumoniae in intensive care units of the Brest teaching hospital. PATIENTS AND METHOD: The case definition was a patient infected by or carrying the epidemic strain. Control measures and investigations are presented. A case-control study was conducted in the surgical intensive care unit. Each case was matched with two controls based on admission times in the unit. The study focused on diagnostic and therapeutic procedures, and potential contacts with healthcare workers, in this context of cross transmission. RESULTS: Between February and May 2011, nine cases were reported in the surgical ICU and two in the medical ICU. Eighteen controls were matched with the nine surgical ICU cases. Several factors were found to be statistically associated with infection or colonization by the epidemic strain: the surgical block in which patients had been operated and the ward of first hospitalization; the number of trans-esophageal and trans-thoracic echocardiographies, of central venous catheter insertions, and of surgical operations; intubation. The total number of invasive procedures was also found to be statistically higher among cases. CONCLUSION: This study identified factors associated with colonization or infection by the epidemic strain. These factors might have been involved in the transmission tree, and be vulnerable elements for the prevention of nosocomial infections and colonisations, and their epidemic spread.
  Médecine et Maladies Infectieuses 09/2012; · 0.72 Impact Factor
• Article: Investigation and management of an imipenem-resistant oxa-23 Acinetobacter baumannii outbreak in an intensive care unit.

  R Garlantézec, C Bourigault, J-M Boles, G Prat, R Baron, J-M Tonnelier, M Cosse, M Lefevre, S Jourdain, G Lelay, L Daniel, M Virmaux, I Le Du, D Tande, A Renault, B Lejeune
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  ABSTRACT: The study objectives were to describe the investigation and management of an imipenem-resistant Acinetobacter baumannii outbreak that occurred in the 15-bed ICU of a tertiary care teaching hospital (Brest, France), during the summer 2008. Patients harboring an imipenem-resistant A. baumannii strain were defined as case patients. We described case occurrence and steps taken to control the outbreak: contact isolation, reinforcement of hygiene procedures, unit shutdown decision, unit disinfection, and reopening. We also made a case control study and a cost analysis of the outbreak management. During a 10-day period, five patients were positive for a single clone of imipenem-resistant oxa-23 A. baumannii. Four patients presented with ventilation-acquired pneumonia and one was asymptomatic. The first two patients died one day after the first swab which led to the identification of A. baumannii. No additional case was noted in the ICU or in other hospital units after deciding to close the ICU. The cost of outbreak management was estimated at 264,553 euros. The case control study identified several factors associated with infection or colonization: length of stay in the ICU, chronic respiratory disease, number of previous antibiotic classes used, duration of ventilation, prone position, echocardiography, and presence of a nasogastric tube. This outbreak occurred during the summer period requiring the shutdown of the ICU and inducing a considerable cost. Rapid reactions of the ICU staff during the outbreak enabled to limit the epidemic.
  Médecine et Maladies Infectieuses 06/2011; 41(8):430-6. · 0.72 Impact Factor
• Article: Cost-analysis of an intensive care unit closure due to an imipenem-resistant oxa-23 Acinetobacter baumannii outbreak.

  R Garlantézec, C Bourigault, J M Boles, G Prat, R Baron, J M Tonnelier, M Cosse, M Lefevre, S Jourdain, G Lelay, L Daniel, M Virmaux, I Le Du, D Tande, A Renault, B Lejeune
  The Journal of hospital infection 02/2011; 77(2):174-5. · 3.01 Impact Factor
• Article: [Microbiological investigation of endoscopes at Brest Hospital over a period from 2007 to 2009].

  P Saliou, R Garlantézec, R Baron, J-J Quiot, F Cholet, M-F Le Floch, B Lejeune
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  ABSTRACT: The aim of this study is to evaluate the quality of disinfection of endoscopes at Brest hospital over a period from 2007 to 2009. Retrospective study of microbiological investigations of endoscopes done at Brest hospital from 2007 to 2009. The interpretation of the microbiological investigations is based on the recommendations of the Comité technique national des infections nosocomiales et infections liées aux soins (CTINILS) of 2007. Most of the controls realized over the period deal with gastroenterological endoscopes (63.4 %) and bronchial endoscopes (21.8 %). Most of the controls (66.8 %) are conformed to the target level. Only 26.7 % of the controls get the level of action. Globally, the rate of level of action significantly increases (p=0.004) from 2007 (21.2 %) to 2009 (35.6 %). This increase is relatively important in gastroenterology endoscopy (46.8 % in 2009 versus 24.1 % in 2007) whereas the rate decreases in bronchial endoscopy (14.8 % in 2009 versus 25.9 % in 2007). In gastroenterological endoscopy, rates vary with the type of endoscopes and the context of controls, but there is no significant difference between manual disinfection and automated disinfection. The most frequent germ found in gastroenterological and bronchial endoscopies is Pseudomonas aeruginosa. Our results show that it is very difficult to insure a perfect disinfection of endoscopes. Difficulties met are certainly related with the complexity of the endoscopes and of the techniques of disinfection. Infections of patients are very infrequent in endoscopy, which takes the question of the pertinence of the threshold used for microbiological investigations.
  Pathologie Biologie 10/2010; 59(2):88-93. · 1.53 Impact Factor
• Article: [Results of a survey system for neurosurgical site infections, October 1998-January 2003].

  G Burnichon, C Liétard, D L'Azou, M-B Coutté, G Le Gall, R Baron, G Besson, B Lejeune
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  ABSTRACT: In the neurosurgery setting, incidence of surgical site infections (SSI) are considered as low to moderately low (1 to 10%). These infections are nevertheless a major problem because of the associated morbidity and mortality. A SSI survey system has been initiated in our neurosurgical unit. We report the incidence of SSI and identified SSI risk factors. Data collected included demographic and medical information recorded with the operating room computer system. Any SSI occurring during the patient's postsurgical hospital stay or observed at postoperative visits was notified using a standardized questionnaire. SSIs were registered using Centers for Disease Control criteria. A multiple logistic regression model was used to determine SSI incidence and evaluate risk factors for SSI. Results were reported to the neurosurgical team every three months. From October 1998 to January 2003, 7399 operative procedures were collected. One hundred and twenty-two SSIs were notified with a mean incidence per patient of 1.65% (95% CI [1.37-1.95]). Among the SSIs 42% were superficial, 58% were deep or organ-space. Risk factors significantly associated with SSI were operation site (higher risk with CSF shunt), operation modality (higher risk with postponed operation) and operation duration greater than 75th percentile. SSI are an important problem in neurosurgery. This SSI survey gave us fundamental information about SSI and risk factors. Complementary studies are now necessary about postponed operative procedures. Propositions are made to improve the system.
  Neurochirurgie 01/2008; 53(6):470-6. · 0.34 Impact Factor
• Article: [Outbreak of Enterobacter aerogenes in paediatric unit].

  G Burnichon, M F Le Floch, M Virmaux, R Baron, D Tandé, B Lejeune
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  ABSTRACT: Within the framework of breast milk control the hygiene laboratory of Brest hospital isolates, on 3 January 1996 a strain of Enterobacter aerogenes secretory of cephalosporinase in the breast milk of a mother whose child was hospitalized in neonatalogy. On 15 April 1996 a new strain of E. aerogenes is isolated from another mother's breast milk. Until 18 August 1997, 21 samples of breast milk were tested positive to this bacteria. During the same period, E. aerogenes was isolated in 26 children under 1 year of age, 11 of which were infected and 15 colonized. The breast milk did not correspond to those of the mothers of the infected or colonized children. All the strains presented the same antibioresistance. The pulsed-field gel electrophoresis showed that the children's strains, those colonized or infected as well as those isolated in breast milk had the same restriction profile. The epidemiological study concerned the biberonnery-lactarium. The biberonnery's staff is the same as the staff of the lactarium. A portage was searched for among the members of the staff of these units, but without success. The search for E. aerogenes in the environment and in baby-food, others than breast milk was negative. Finally, we did not find any source for these contagions. The only hypothesis we have retained is that of a common source from the biberonnery-lactarium, but without being able to bring any proof to it. Following this epidemic, we have revised all the working modalities and practices with the staff of the biberonnery-lactarium.
  Médecine et Maladies Infectieuses 05/2004; 34(4):166-70. · 0.72 Impact Factor