Advertisement

High Prevalence of Multidrug-Resistant Bacteria in the Centre Hospitalier et Universitaire de la Mère et de l’Enfant Lagune (CHU-MEL) Reveals Implications of Poor Hygiene Practices in Healthcare

  • Victorien DougnonEmail author
  • Hornel Koudokpon
  • Yaovi M.G. Hounmanou
  • Simon Azonbakin
  • Kafayath Fabiyi
  • Alida Oussou
  • Ida Codjia
  • Angèle Ahoyo
  • Lamine Baba-Moussa
  • Honoré Bankolé
Medicine
  • 27 Downloads
Part of the following topical collections:
  1. Topical Collection on Medicine

Abstract

Healthcare-associated infections represent an emerging public health issue with serious impact among hospitalized patients, including cesarized women and children with catheter. The present study determined the implications of hygiene practices and the hospital environment in wound reinfection among cesarized women and the occurrence of catheter-induced infections in children. Bacteriological analyses were performed on 100 wound swabs from cesarized women, 40 swabs from the wound dressing room, and 83 catheter tips used in children. Isolated bacteria were tested for antimicrobial susceptibility. A comparison of the resistance profile between strains isolated from wounds and those isolated from the dressing room was conducted, whereas the hygiene practices observed from the personnel during catheter removal were recorded in the case of children. The results show that 85% of wound swabs, 63% of swabs from the dressing room, and 33.7% of catheter tips were positive for bacteriological analysis. The most isolated strains in wound and environmental swabs were Staphylococcus aureus (56%) and coagulase-negative Staphylococcus (44%), followed by Klebsiella pneumoniae (30%) and Enterobacter cloacae (32%) for wounds and Escherichia coli (43%) and Klebsiella pneumoniae (28%) for the environment. The catheter tips contained mostly Klebsiella pneumoniae (32%), coagulase-negative Staphylococcus (25%), and Enterobacter cloacae (14%). All strains showed resistance to penicillin and cephalosporin. The comparison of the resistance profiles suggests an implication of the environmental strains in the reinfection of wounds in cesarized women. However, a significant correlation was recorded between poor hygiene practices and the contamination of the catheter tips. These findings allowed the authorities of this hospital to reinforce the knowledge and improve the hygiene management, in order to still hold the good label of the structure.

Keywords

Healthcare-associated infections Hygiene practices Reinfection AMR 

Introduction

Healthcare-associated infections (HAIs) are known worldwide as a public health problem, which have led to a significant increase in mortality, morbidity, and cost of patient care due to longer stays [1]. Their frequency and severity are particularly high in the intensive care settings because of the pathologies presented by the patients, the associated comorbidities, and the density of the invasive techniques used [2, 3].

Healthcare-associated infections represent one of the most common nosocomial infections of public health concern due to high mortality and longer hospital stays despite the use of antibiotics, improvement of anesthesia techniques, and progress of preventive measures [4]. They account for about 25% of all nosocomial infections (NIBs) ranking second to UTIs [5]. According to the WHO, the rate of infection of the operating site varies from 0.5 to 1.5%. It exceeds 25% in some developing countries [6]. They are also responsible for an economic problem due to the extension of the hospital stay, absenteeism, and extra care costs [7]. Among the vulnerable groups, cesarized women are at two to three times more risk of healthcare-associated infections [8].

Catheter-related infections account for approximately 18 to 25% of nosocomial infections, with increased morbidity and mortality. Mortality due to catheter bacteremia is highly variable, but it could be as high as 60%. Catheter-related bloodstream infections are therefore of a serious public health concern. They are relatively common and are among the four most studied nosocomial infections [9] with the infection rate indicated in the literature between 1.8 and 5.2 cases per 1000 day-catheter [10, 11]. The catheter-associated bacteremia cases have the highest costs and the longest hospitalizations [12].

The present study aims to assess the implication of hygiene practices and the hospital environment in the bacterial infection of wounds in cesarized women and the occurrence of catheter infections in children.

Materials and Methods

Framework

The present study took place at the Centre Hospitalier et Universitaire de la Mère et de l’Enfant Lagune (CHU-MEL). With an annual budget of nearly 3 billion Francs CFA, more than 30 doctors, 70 midwives, and 90 nurses, CHU-MEL is a reference institution in Benin, located in Cotonou, and entirely dedicated to the mother and the child. This hospital used to receive patients not only from Cotonou, an urban and main populated city, but also from areas all over the country. Approximatively, CHU-MEL got 256 beds.

Study Population

Cesarized women were enrolled in this study. Similarly, all central venous catheters (CVC) posed in the study period, from July to October 2018, in newborns and children under 10 years, hospitalized at the CHU-MEL of Cotonou specifically in the Neonatology and Pediatric departments were included regardless of the pathology, pose pattern, and duration of the catheter operation.

Criteria of healthcare-associated infections used in the study were related to the type of surgery, duration of surgery, antimicrobial prophylaxis, duration of hospitalization before surgery and after, occurrence of symptoms, and swabbing for bacteriological exams [13, 14]. For venous catheter infection, the criterion used was a positive culture of 5 cm from the inner end of the catheter [15].

Collection of Samples

Swabs were collected from cesarean section wounds before they were dressed. Swabs were also taken from the wound dressing room (bench, bed, stool) and materials (tongs, bean, tray, compress, etc.) and placed in 3 ml of Tripcase soy broth [16, 17]. After 16 h of incubation, the broth was streaked onto agar plates for bacteriological analysis.

Catheter sample was taken according to Cleri et al. [18]. After disinfecting the hands and wearing sterile latex disposable gloves, the bandages and the catheters were removed without performing antisepsis. Five centimeters from the inner end of the catheter was then cut with sterile scissors and placed in a sterile vial containing 4 ml of Tripcase soy broth. All samples were sent to the laboratory and incubated at 37 °C for 16 h.

Bacteriological Examination and Data Analysis

The incubated broths were analyzed using standard bacteriology techniques described by [19]. Isolated strains were then tested for antimicrobial susceptibility according to the recommendations of the Antibiotic Committee of the French Microbiology Society [20]. Antibiotic discs tested are presented in Table 1.
Table 1

List of antibiotic discs tested

Discs

Concentrations (μg)

AMP (Ampicillin)

10

AMC (Amoxicillin + Clavulanic acid)

30

CRO (Ceftriaxone)

30

ERT (Ertapenem)

10

IPM (Imipenem)

10

CT (Colistin)

50

OX (Oxacillin)

5

FOX (Fosfomycin)

50

VAN (Vancomycin)

30

DA (Clindamycin)

15

E (Erythromycin)

15

GEN (Gentamicin)

15

A comparison of the resistance profiles between the strains isolated from the wounds and those isolated from the dressing room and materials served to assess the implication of the hospital strains in the postoperative infection of the wounds.

Hygiene practices observed by the personnel during catheterization and the presence of inflammation (thrombosis) were recorded as risk factors and analyzed along with bacteriological analyses of the catheter samples. The practices observed related to the contact time of the antiseptic with the skin (30 s) and the drying time (30 s) of the antiseptic before the installation of the catheter. Correlation between risk factors and the occurrence of catheter-related infections was determined with Chi2 test using the GraphPad 6 software.

Results

We identified eighty-five (85)-positive wound swabs out of the cent (100) and twenty-five (25)-positive swabs from the dressing room and materials out of forty (40) (Table 2). There was no significant statistical association between the hospitalization status and the occurrence of healthcare-associated infections (p = 0.084 > 0.05) (Table 3) nor between the appearance of the wounds and occurrence of infections (p = 0.759 > 0.05) (Table 4). However, a statistically significant association was noted between the number of dressings and the occurrence of healthcare-associated infections (p = 0.034 < 0.05) (Table 5). Ninety-six (96) bacterial strains were isolated from eighty-five (85)-positive wound swabs, and twenty-nine (29) bacterial strains were identified from twenty-five (25) environmental swabs. Staphylococcus aureus were the most isolated bacteria in both wound swabs and environmental swabs. It is followed by strains of coagulase-negative Staphylococci and Klebsiella pneumoniae in wound swabs, and coagulase-negative Staphylococci and Escherichia coli were predominant in samples of the environment (Figs. 1 and 2). The study of antibiotic susceptibility showed a strong resistance to betalactam antibiotics for both Gram-negative bacilli (Table 6) and Gram-positive cocci (Table 7) except for carbapenems. Similar resistance patterns were recorded in isolates obtained from wounds and those isolated from the hospital environment and materials from the wound dressing room (Table 8).
Table 2

Distribution of samples according to positivity

 

Wounds

Environment

Total

Sterile

15 (15%)

15 (37%)

21

Positive

85 (85%)

25 (63%)

89

Total

100 (100%)

40 (100%)

140

Table 3

Distribution of wound samples by patient status

 

Negative

Positive

Total

Chi2 test

Non-hospitalized

9 (9%)

23 (23%)

33 (33%)

0.084

Hospitalized

9 (9%)

59 (59%)

68 (68%)

Total

18 (18%)

82 (83%)

100 (100%)

 
Table 4

Distribution of wound samples according to the appearance of wounds

Aspect

Negative

Positive

Total

Chi2 test

Clean

10 (10%)

34 (34%)

44 (44%)

0.759

Bloody

3 (3%)

16 (16%)

20 (20%)

Suppurative

4 (4%)

23 (23%)

27 (27%)

Serosity

1 (1%)

9 (9%)

10 (10%)

Total

18 (18%)

82 (82%)

100 (100%)

 
Table 5

Distribution of wound samples according to the number of wound dressings

 

Negative

Positive

Total

Chi2 test

1 Wound dressings

4 (4%)

24 (24%)

28 (33%)

0.034

2 Wound dressings

5 (5%)

34 (34%)

39 (68%)

> 2 Wound dressings

9 (9%)

24 (24%)

33 (33%)

Total

18 (18%)

82 (83%)

100 (100%)

 
Fig. 1

Distribution of isolated bacteria

Fig. 2

Distribution of isolated bacteria

Table 6

Antibiotic sensitivity of Gram-negative bacillus strains

 

AMP

AMC

CTX

ATM

ERT

IPM

CT

 

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Escherichia coli

100

100

75

50

82

67

54.5

33

0

0

0

0

0

0

Klebsiella pneumoniae

100

100

75

50

62.5

50

37.5

50

0

0

0

0

0

0

Citrobacter freundii

50

50

50

50

0

0

0

Enterobacter cloacea

100

100

80

50

67

50

33

0

0

0

0

0

100

100

Proteus vulgaris

67

100

34

100

75

50

50

50

50

0

0

0

0

0

Pseudomonas aeruginosa

100

100

100

100

50

50

50

0

0

0

0

0

0

0

Klebsiella oxytoca

100

100

100

0

0

0

0

0

Table 7

Antibiotic susceptibility of Gram-positive cocci strains

 

AMP

OX

FOX

VAN

DA

E

GEN

 

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Wounds (%)

Env. (%)

Staphylococcus aureus

82

100

80

60

60

50

0

0

0

0

0

0

63

40

Coagulase-negative Staphylococcus

75

100

60

75

40

37.5

0

0

0

0

0

0

50

67

Table 8

Distribution of antibiotic resistance profiles

Species

Profiles

Wounds

Environment

Escherichia coli

AMP R AMC R CTX R ATM R ERT S IMP S CS S

AMP R AMC S CTX S ATM S ERT S IMP S CS S

3

2

1

1

Klebsiella pneumonia

AMP R AMC R CTX R ATM R ERT S IMP S CS S

AMP R AMC S CTX S ATM S ERT S IMP S CS S

7

3

1

1

Enterobacter cloacea

AMP R AMC R CTX R ATM R ERT S IMP S CS S

5

1

Pseudomonas aeruginosa

AMP R AMC R CTX R ATM R ERT S IMP S CS S

1

1

Staphylococcus aureus

AMP R OX R FOX R VAN S DA S E S GEN R

AMP R OX R FOX VAN R DA S E S GEN S

AMP R OX R FOX S VAN S DA S E S GEN R

4

2

1

2

1

1

Coagulase-negative Staphylococcus

AMP R OX R FOX R VAN S DA S E S GEN R

AMP R OX R FOX S VAN S DA S E S GEN R

3

3

1

2

Bacteriological analyses of catheter specimens showed twenty-eight (28)-positive catheter tips out of eighty three (83). We recorded forty-seven (47) cases of proper disinfection in the eighty-three (83) cases containing thirty-seven (37)-positive samples (44.6%) with a significant correlation (p = 0.01 < 0.05) (Table 9). The catheter was placed for more than 48 h in forty-nine (49) children of whom thirty-eight (38) were contaminated (43.4%). The duration of catheterization and catheter infection showed significant correlation (p = 0.037 < 0.05) (Table 10). Sixty-eight (68) children presented inflammation on the catheter site with 47 positive cases. The presence of inflammation was however not significantly correlated to catheter infections (p = 0.365) (Table 11).
Table 9

Distribution of samples according to the quality of the disinfection

 

Negative

Positive

Total

Chi2 test

Good disinfection

37 (44.6%)

10 (12%)

47 (56.6%)

0.010

Bad disinfection

18 (21.7%)

18 (21.7%)

36 (43.4%)

Total

55 (66.3%)

28 (33.7%)

83 (100%)

 
Table 10

Distribution of samples according to catheterization time

 

Negative

Positive

Total

Chi2 test

> 48 h

17 (20.5%)

17 (20.5%)

34 (41%)

0.037

< 48 h

38 (43.4%)

11 (15.7%)

49 (43.4%)

Total

55 (66.3%)

28 (33.7%)

83 (100%)

 
Table 11

Distribution of samples according to the presence of inflammation

 

Negative

Positive

Total

Chi2 test

Presence of inflammation

47 (56.6%)

21 (25.3%)

68 (41%)

0.365

Absence of inflammation

8 (9.6%)

7 (8.4%)

15 (18%)

Total

55 (66.3%)

28 (33.7%)

83 (100%)

 
All twenty-eight (28) bacterial-positive specimens of catheter tips were monomicrobial with predominance of Klebsiella pneumoniae (32%), coagulase-negative Staphylococci (25%), and Enterobacter cloacea (14%) (Fig. 1). Antimicrobial susceptibility tests show strong resistance to ampicillin. No resistance to carbapenem and colistin or glycopeptides was noted for Gram-positive cocci and Gram-negative bacilli, respectively (Tables 12 and 13).
Table 12

Antibiotic sensitivity of Gram-negative bacillus strains

 

AMP (%)

AMC (%)

CTX (%)

ATM (%)

ERT (%)

IPM (%)

CS (%)

Escherichia coli

100

100

0

0

0

0

0

Klebsiella pneumoniae

100

100

33

22

0

0

0

Enterobacter cloacea

50

0

50

25

0

0

0

Proteus vulgaris

50

50

50

0

0

0

100

Klebsiella oxytoca

100

100

0

0

0

0

0

Table 13

Antibiotic susceptibility of Gram-positive cocci strains

 

AMP (%)

OX (%)

FOX (%)

VAN (%)

DA (%)

E (%)

GEN (%)

Staphylococcus aureus

100

67

0

0

0

0

86

Coagulase-negative Staphylococcus

74

57

33

0

0

0

57

Discussion

Surgical operative sites and catheter infections are common nosocomial infections. Many studies reveal incidence of nosocomial infections in Benin, generally [21], and in hospitals, particularly [22]. The present study wanted to explore these two particular types of nosocomial infections in CHU MEL of Cotonou City.

We observed a prevalence of 33.7% of contaminated catheter. This result is above the 14% found in Morocco by [23, 24] for catheter-related bacteremia. In Algeria, [25] reported 26.6% for suspected patients and 2.2% for all patients aged 15 to 60 years. However, catheter-related bacteremia are more common in newborns and children [26] and in adults, which can be attributed to their poor immunity [26]. A significant correlation was reported between the occurrence of catheter-related bacteremia and the duration of catheterization. Many authors have come to the same conclusion for catheter-related bacteremias [25, 27, 28]. Merrer [27] explains this fact by the multiplication of potentially septic manipulations from the connector (faucets, infusions …). For Douard [29], the occurrence of catheter-related bacteremia remains constant during the period of hospitalization. It is therefore at the time of the catheter placement that the bacteria are inserted. This leads back to the second factor related to the occurrence of catheter-related bacteremia in our study: the quality of disinfection. This includes hand hygiene, the quality of the antiseptic used for hand hygiene, and the disinfection of the operation site [30, 31]. After bacteriological examination, the most isolated bacterial species from catheter tips are Klebsiella pneumoniae (32%), Staphylococci coagulase-negative (25%), and Enterobacter cloacea (14%). Numerous studies have shown the important role of coagulase-negative Staphylococci in nosocomial bacteremia [25, 32, 33]. Moreover, the antimicrobial susceptibility pattern of the strains reveals the presence of multidrug-resistant strains in these healthcare-associated infections.

On the other hand, wounds from cesarized women, the hospital environment, and materials used in the wound dressing were all infected by similar types of bacteria. These results are in agreement with those found by Kouchica [34] and Sossa [35] which show poor quality of material sterilization. Staphylococcus aureus were the most isolated bacteria in both wound swabs and environmental swabs, followed by coagulase-negative Staphylococci and Klebsiella pneumoniae in swabs of wounds, and coagulase-negative Staphylococci and Escherichia coli in samples from the environment. Studies have shown that Staphylococcus aureus remains the number 1 germ in all healthcare-associated infections, apart from abdominal surgery where Gram-negative bacilli prevail [36, 37, 38]. Considering the results with individual species, our results are also consistent with those of Coello and Guetarni [39, 40] who showed the prevalence of Staphylococcus aureus and negative-coagulase Staphylococci in abdominal healthcare-associated infections. These authors explain this fact by the presence of these species as commensals of the skin and mucous membranes, which are at high risk of contaminating the skin and mucous membranes during incision and manipulation. We moreover observed that higher number of wound dressing increases the level on wound infection, which supports the idea that the wounds are infected during dressing due to poor hygiene practices and poor sterilization of the materials. The strains found in the wounds were multidrug resistant with the same pattern as those found in the hospital environment, which further suggests an implication of the hospital environment in wound reinfection as previously described [41, 42].

Conclusion

Catheter-related bloodstream infections are major concern for the general population and children in particular. The results of the present study show the implication of the strains from the hospital environment and equipment in the occurrence of healthcare-associated infections in cesarized women. The bacteremia associated with catheters is related to the duration of catheterization and the quality of disinfection. The most isolated strains were Staphylococcus aureus, coagulase-negative Staphylococci, Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacea, which were all multidrug resistant. It is important that good hygiene practices be promoted to limit healthcare-associated infections for the betterment of health and well-being.

Limitations

Sequencing of Salmonella genome is not possible in Benin.

Notes

Acknowledgments

The authors thank the staff of the hospitals involved in the study.

Author Contributions

VD, HK, and L B-M wrote the protocol.

KF, AO, IC, VD, and HK processed the samples.

DV did the statistical analyses.

HK and DV wrote the draft of the manuscript.

DV, HK, and L B-M reviewed the manuscript.

Funding Information

This study was self-funded. The authors also thank Drs Jerrold AGBANKPE and Esther DEGUENON for their technical support. They are grateful to the whole staff from the Research unit in Applied Microbiology and Pharmacology of natural substances (University of Abomey-Calavi, Benin).

Compliance with Ethical Standards

Ethical Approval and Consent to Participate

The Benin National Ethical Committee for Health Research has reviewed and approved this study under No 65/MS/DC/SGM/DRFMT/CNERS/SA. A written approval was taken from each patient involved in the study.

Consent for Publication

All authors have read and gave their consent for publication. Written informed consent was obtained from the patients for publication of their individual details and accompanying images in this manuscript. However, the data submitted for this publication cannot permit to reveal their identity. The consent form is held by the authors’ institution (Polytechnic School of Abomey-Calavi) and is available for review by the Editor-in-Chief.

Competing Interests

All the authors declare that they have no competing interests.

References

  1. 1.
    Haque M, Sartelli M, Mckimm J, Abu BM. Infection and drug resistance DovepressHealth care-associated infections—an overview. Infect Drug Resist. 2018;11:2322–33.  https://doi.org/10.2147/IDR.S177247.CrossRefGoogle Scholar
  2. 2.
    Mitchell BG, Shaban RZ, MacBeth D, Wood C-J, Russo PL. The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature. Infect Dis Health. 2017;22:117–28.  https://doi.org/10.1016/j.idh.2017.07.001.CrossRefGoogle Scholar
  3. 3.
    Jia H, Li L, Li W, Hou T, Ma H, Yang Y, et al. Impact of healthcare-associated infections on length of stay: a study in 68 hospitals in China. Biomed Res Int. 2019; Article ID:1–7.Google Scholar
  4. 4.
    Traore BA. Les infections nosocomiales dans le service de chirurgie générale du CHU Gabriel Toure: Université de Bamako; 2008. http://www.keneya.net/fmpos/theses/2008/med/pdf/08M381.pdf. Accessed 19 Jun 2019
  5. 5.
    WHO. Prevention of hospital-acquired infections: A practical guide. 2nd edition. WHO/CDS/CSR/EPH/2002.12. World Health Organization. 2002.Google Scholar
  6. 6.
    Nejad SB, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011;89:757–65.  https://doi.org/10.2471/BLT.11.088179.CrossRefGoogle Scholar
  7. 7.
    Srun S, Sinath Y, Seng AT, Chea M, Borin M, Nhem S, et al. Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia. J Infect Dev Ctries. 2013;7:579–85.  https://doi.org/10.3855/jidc.2981.CrossRefPubMedGoogle Scholar
  8. 8.
    SF2H. Surveiller et prévenir les infections associées aux soins: recommandations. Rev Off la Société Française d’Hygiène Hosp. 2010;18:180p. www.hygienes.net. Accessed 19 Jun 2019.
  9. 9.
    Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:753–71.  https://doi.org/10.1086/676533.CrossRefPubMedGoogle Scholar
  10. 10.
    Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU Abstract. N Engl J Med. 2006;26:2725–33 www.nejm.org. Accessed 19 Jun 2019.CrossRefGoogle Scholar
  11. 11.
    Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81:1159–71.  https://doi.org/10.4065/81.9.1159.CrossRefPubMedGoogle Scholar
  12. 12.
    Gaynes R, Jacob JT. Intravascular catheter infection: epidemiology, pathogenesis, and microbiology—UpToDate. UpToDate. United Nation; 2019. https://www.uptodate.com/contents/intravascular-catheter-infection-epidemiology-pathogenesis-and-microbiology. Accessed 19 Jun 2019.
  13. 13.
    Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8 http://www.ncbi.nlm.nih.gov/pubmed/1334988. Accessed 2 Sep 2019.CrossRefGoogle Scholar
  14. 14.
    Kumar A, Rai A. Prevalence of surgical site infection in general surgery in a tertiary care centre in India. Int Surg J. 2017;4:3101–6 https://ijsurgery.com/index.php/isj/article/view/1696/1468. Accessed 2 Sep 2019.CrossRefGoogle Scholar
  15. 15.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.  https://doi.org/10.1086/599376.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lemmen SW, Häfner H, Zolldann D, Amedick G, Lutticken R. Comparison of two sampling methods for the detection of Gram-positive and Gram-negative bacteria in the environment: moistened swabs versus Rodac plates. Int J Hyg Environ Health. 2001;203:245–8.  https://doi.org/10.1078/S1438-4639(04)70035-8.CrossRefPubMedGoogle Scholar
  17. 17.
    Cavallo J, Antoniotti G, Baffoy N., Guignement-Coudrais S, Hajjar J, Horn C, et al. Surveillance microbiologique de l’environnement dans les établissements de santé. France; 2002. https://bdsp-ehesp.inist.fr/vibad/controllers/getNoticePDF.php?path=Ministere/Dgs/Publications/2002/recofin.pdf. Accessed 2 Sep 2019.
  18. 18.
    Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis. 1980;141:781–6.  https://doi.org/10.1093/infdis/141.6.781.CrossRefPubMedGoogle Scholar
  19. 19.
    Dougnon TV, Bankole HS, Johnson RC, Hounmanou G, Moussa Toure I, Houessou C, et al. Catheter-associated urinary tract infections at a hospital in Zinvie, Benin (West Africa). Int J Inf Secur. 2016;3:0–7.Google Scholar
  20. 20.
    CA SFM. Recommandations 2019 V.2.0 du Comité de l’antibiogramme de la Sociét é Française de Microbiologie. 1st edition. 2019. www.sfm-microbiologie.org. Accessed 19 Jun 2019.
  21. 21.
    Ahoyo T, Bankolé H, Adéoti F, Gbohoun A, Assavèdo S, Amoussou-Guénou M, et al. Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012. Antimicrob Resist Infect Control. 2014;3:17.  https://doi.org/10.1186/2047-2994-3-17.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Afle FCD, Quenum KJMK, Hessou S, Johnson RC. État des lieux des infections associées aux soins dans deux hôpitaux publics du sud Benin (Afrique de l’ouest): Centre Hospitalier Universitaire de Zone d’Abomey-Calavi/Sô-Ava et Centre Hospitalier de Zone de Cotonou 5. J Appl Biosci. 2018;121:12192.  https://doi.org/10.4314/jab.v121i1.9.CrossRefGoogle Scholar
  23. 23.
    Lemsanni M. Les infections nosocomiales en réanimation pédiatrique. Université CADI AYYAD; 2016. http://wd.fmpm.uca.ma/biblio/theses/annee-htm/FT/2016/these53-16.pdf. Accessed 19 Jun 2019.
  24. 24.
    Oubihi B. Epidémiologie des infections nosocomiales en milieu de réanimation. Université CADI AYYAD; 2015. http://wd.fmpm.uca.ma/biblio/theses/annee-htm/FT/2015/these79-15.pdf. Accessed 19 Jun 2019.
  25. 25.
    Zemmour H, Derbale FZ. Incidence des infections liées aux cathéters veineux centraux et périphériques et facteurs de risque attribuables au niveau du service de chirurgie générale «A» au CHU de Tlemcen. Universite Abou Bekr Belkaid Tlemcen; 2016. http://dspace.univ-tlemcen.dz/handle/112/9415?mode=full. Accessed 19 Jun 2019.
  26. 26.
    Soudée S, Schuffenecker I, Aberchih J, Josset L, Lina B, Baud O, et al. Infections néonatales à entérovirus en France en 2012. Arch Pédiatr. 2014;21:984–9.  https://doi.org/10.1016/j.arcped.2014.06.022.CrossRefPubMedGoogle Scholar
  27. 27.
    Merrer J. Épidémiologie des infections liées aux cathéters en réanimation. Ann Fr Anesth Reanim. 2005;24:278–81.  https://doi.org/10.1016/j.annfar.2004.12.015.CrossRefPubMedGoogle Scholar
  28. 28.
    Schoot RA, van Dalen EC, van Ommen CH, van de Wetering MD. Antibiotic and other lock treatments for tunnelled central venous catheter related infections in children with cancer. Cochrane Database Syst Rev. 2011;1:50.  https://doi.org/10.1002/14651858.CD008975.CrossRefGoogle Scholar
  29. 29.
    Douard MC, Clementi E, Arlet G, Marie O, Jacob L, Schremmer B, et al. Negative catheter-tip culture and diagnosis of catheter-related bacteremia. Nutrition. 10:397–404 http://www.ncbi.nlm.nih.gov/pubmed/7819651. Accessed 21 Jun 2019.
  30. 30.
    SF2H, HAS. Prévention des infections liées aux cathéters veineux périphériques Novembre 2005 Service des recommandations professionnelles. France; 2005. https://www.has-sante.fr/portail/upload/docs/application/pdf/Catheters_veineux_2005_rap.pdf. Accessed 19 Jun 2019.
  31. 31.
    SF2H, HAS. Avril 2Pose et entretien des cathéters veineux périphériques: Série de critères de qualité pour l’évaluation et l ’amélioration des pratiques professionnelles007. France; 2007. https://www.has-sante.fr/portail/upload/docs/application/pdf/2013-03/catheter_veineux_peripheriques_-_criteres_de_qualite.pdf. Accessed 19 Jun 2019.
  32. 32.
    Faye A, Bingen É. Place des infections nosocomiales en pédiatrie. Méd Thér/Pédiatrie. 2012;15:3–11.  https://doi.org/10.1684/MTP.2012.0448.CrossRefGoogle Scholar
  33. 33.
    Dachy A, Battisti O. Comment j’explore … les infections nosocomiales en néonatologie. Rev Med Liege. 2014;69:454–9 https://www.rmlg.ulg.ac.be/show.php. Accessed 19 Jun 2019.PubMedGoogle Scholar
  34. 34.
    Kouchica CE. Evaluation des bonnes pratiques d’hygiène au laboratoire de l’Antenne Départemental e pour la T ransfusion S anguine Atlantique-Littoral, CNHU-HKM, COTONOU. Benin; 2014. http://196.192.25.3/bitstream/handle/123456789/299/VERSIONGERALDOERIC.pdf?sequence=1&isAllowed=y. Accessed 19 Jun 2019.
  35. 35.
    Sossa CAM. Implication des germes de l’environement hospitalier dans la surinfection des plaies à l’Hopital de Menontin. Benin; 2018.Google Scholar
  36. 36.
    Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96:1–15.  https://doi.org/10.1016/j.jhin.2017.03.004.CrossRefPubMedGoogle Scholar
  37. 37.
    Sievert DM, Ricks P, Edwards JR, Mph AS, Patel J, Srinivasan A, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34:1–14.  https://doi.org/10.1086/668770.CrossRefPubMedGoogle Scholar
  38. 38.
    Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP, Finerty EA, Nguyen JT, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am. 2011;93:1627–33.  https://doi.org/10.2106/JBJS.J.00039.CrossRefPubMedGoogle Scholar
  39. 39.
    Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect. 2005;60:93–103.  https://doi.org/10.1016/j.jhin.2004.10.019.CrossRefPubMedGoogle Scholar
  40. 40.
    Guetarni N. Les Infections du Site Opératoire (ISO) au CHU d’Oran: Université d’Oran; 2014. https://theses.univ-oran1.dz/document/1012014009t.pdf. Accessed 19 Jun 2019
  41. 41.
    Feng W, Sun F, Wang Q, Xiong W, Qiu X, Dai X, et al. Epidemiology and resistance characteristics of Pseudomonas aeruginosa isolates from the respiratory department of a hospital in China. Integr Med Res. 2017;8:142–7.  https://doi.org/10.1016/j.jgar.2016.11.012.CrossRefGoogle Scholar
  42. 42.
    Nathwani D, Raman G, Sulham K, Gavaghan M, Menon V. Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2014;3:16p.  https://doi.org/10.1186/2047-2994-3-32.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Victorien Dougnon
    • 1
    Email author
  • Hornel Koudokpon
    • 1
  • Yaovi M.G. Hounmanou
    • 1
  • Simon Azonbakin
    • 2
  • Kafayath Fabiyi
    • 1
  • Alida Oussou
    • 1
  • Ida Codjia
    • 1
  • Angèle Ahoyo
    • 1
  • Lamine Baba-Moussa
    • 3
  • Honoré Bankolé
    • 1
  1. 1.Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-CalaviUniversity of Abomey-CalaviCotonouBenin
  2. 2.Laboratory of Histology, Biology of Reproduction, Cytogenetics and Medical Genetics, Faculty of Health SciencesUniversity of Abomey-CalaviCotonouBenin
  3. 3.Laboratory of Biology and Molecular Typing in Microbiology, Faculty of Science and TechnologyUniversity of Abomey-Calavi, UACCotonouBenin

Personalised recommendations