Les infections nosocomiales : bilan et perspectives.

Abstract

Tout patient hospitalisé est confronté à trois risques principaux d’infection nosocomiale (IN) : la présence d’autres patients (par transmission croisée directe ou indirecte), sa propre flore et, plus rarement, l’environnement hospitalier (air, eau, surfaces). L’exposition à ces risques varie, mais en moyenne 5 à 10 patients hospitalisés sur 100 sont victimes d’une IN. Les IN bactériennes sont souvent caractérisées par une résistance aux antibiotiques. Ainsi, chez l’espèce S. aureus, environ 40 % des souches à l’origine d’IN sont résistantes à des degrés divers. Afin de maîtriser ce problème, il est essentiel de parvenir à une meilleure gestion du patrimoine antibiotique, à son utilisation plus appropriée, ainsi qu’à la réduction de la transmission croisée des espèces, souvent manu-portée.

Between 5% and 10% of patients acquire an infection during an hospital stay. Although the overall prevalence does not appear to decline, nowadays, the exposed populations appear to be at higher risk because of patients increasing age, severe underlying disease and widespread use of more sophisticated invasive techniques and complex technologies. Progress may therefore be expected with the dissemination of non- or minimally invasive techniques. A major problem facing most developed countries is the development of antibacterial resistance among several clinically important species (S. aureus, enterococci, and gram-negative bacilli). This recurring challenge requires a global effort from clinicians, microbiologists, pharmacists, opinion leaders and administrative personnel to promote proper antibacterial prescribing through expert systems. The widespread diffusion of S. aureus has occurred in hospitals and in the community, and the early detection of carriers seems to be an important step to identify the hospital reservoir and prevent transmission. Control of cross-transmission can be improved via implementation of more accessible techniques to promote hand hygiene and disinfecting. Control of the environment, especially in high-risk areas housing compromised patients, remains also an important goal in infection control.