Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up: Results of the French section of European Randomized Study of Screening for Prostate Cancer (ERSPC)

INTRODUCTION

European Randomized Study of Screening for Prostate Cancer (ERSPC) mortality results were reported for 7 European countries (excluding France) and showed a significant reduction in Prostate cancer (PCa) mortality. As those results have not been part of the global ERSPC results, it is of interest to report PCa mortality at a median follow-up of 9 years for French section of ERSPC.

MATERIAL AND METHODS

Two administrative departments were involved in the study. Only men after randomization in the screening group were invited by mail to be screened by PSA testing with two rounds at 4-6 year intervals. Biopsy was recommended if PSA>=3.0 ng/mL. No information other that the French Association of Urology recommandations on the use of PSA was offered to the control group (own decision of physicians and patients). Follow up was based on cancer registry database. Contamination defined as the receipt of PSA testing in control arm was measured. Poisson regression models were used to estimate the Rate Ratio (RR) of PCa mortality and incidence in the screening vs. control arm.

RESULTS

Starting from 2003, 80,696 men aged 55-69 years were included. The percentage of men in the screening arm with at least one PSA test (compliance) was 31%. Compared to the control arm, PCa incidence increased by 10% in the screening arm (RR=1.10; 95% CI=[1.04-1.16], P=0.001), but PCa mortality did not differ (0.222 and 0.215 deaths/1000 person-years; RR=1.03[0.75-1.42], P=0.9).

DISCUSSION

Limitations include low participation rate. PSA testing in the control arm was observed in 32% of men (contamination).

CONCLUSIONS

Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up.

LEVEL OF EVIDENCE

3.

[Infection control practices while performing prostate biopsies in France: A CIAFU survey]

In 2008, the French Public Health Committee admitted that associating ultrasound probe protection, and related precautions, and low-level disinfection would be equivalent to the intermediate level disinfection. In 2010, the French Urology Association (AFU) updated guidelines regarding trans-rectal prostate biopsies, namely preventive measures related to cross-transmission of infections. We report an evaluation of compliance to them, driven in 2016 by AFU's infection committee. Although not recommended, almost one third of the urologists still perform biopsies under general anesthesia, and two thirds of them ask for a urine culture before biopsies. Several improvements are still needed: sterilization of needle guide should always be done when not of single use, the ultrasonography gel should be sterile, probes protection should be EC labeled, and compliance to probe processing between two patients should increase. Most of urologists happened to experience blood or feces contamination of probes. Less than half of probes are entirely floodable, and when intermediate level disinfection is done, glutaraldehyde is still referred as disinfectant by one third of the urologists.

LEVEL OF EVIDENCE

4.

[Infection control in urology: standard and isolation precautions]

OBJECTIVES

To provide a structured review of good hygiene practices in infection control.

MATERIAL

A review of existing recommendations on standard precautions, isolation precautions and specific recommendations in infection control.

RESULTS

Isolation precautions complement standard precautions when a patient is identified as a carrier of bacteria showing resistance to antibiotics, virulence characteristics and/or epidemic potential. Full compliance with hand hygiene recommendations and standard precautions is mandatory as it optimizes safety when patient's viral and/or bacterial status is unknown. Acknowledging the routes of transmission, the value of individual protection equipment and good hygiene practices is therefore crucial in modern infection control. For specific micro-organisms, isolation precautions are needed against airborne, droplets and/or contact cross-contamination routes. Within isolation precautions, contact precautions are the most widely indicated as they control the risks of contamination from germs involved in cutaneous or enteric infections and of transmission of multi-resistant bacteria (MRB). In addition, specific recommendations have been defined for emerging resistant MRB.

CONCLUSION

MRB are becoming worldwide a major issue in public health. Reducing cross-contamination is, with lesser and better use of antibiotics, one of the main avenue in their control.

[Non-antibiotic anti-infectious treatments in urology]

OBJECTIVE

To define the terms of use of pesticides, antifungal, antiviral and antiseptic treatments in urology.

MATERIALS AND METHODS

A literature search was conducted on MEDLINE for all these treatments used in urology. The molecules were classified by family. Modes of action, indications in urology and adverse effects have been detailed. Authorisation files were consulted and then complemented by a literature analysis.

RESULTS

Although parasitic or viral diseases are uncommon in urology, their specific treatment deserves a thorough knowledge of pesticide and antiviral molecules. Antifungal treatments are regularly used in urology with special features to know to improve the efficacy/safety ratio. Antiseptics are used daily in urology and a better understanding of these molecules allows better use.

CONCLUSION

Beyond antibiotics, antiviral, antiparasitic and antifungal deserve a thorough knowledge. Antiseptic although used daily have features little known.

[Flexible cystoscopes: disinfection and microbiological surveillance practices among French urologists]

INTRODUCTION

According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing.

MATERIAL AND METHODS

The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists.

RESULTS

Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance.

CONCLUSION

Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.

Surgical-site infections and surgery of the salivary glands

OBJECTIVES

To determine the surgical-site infection (SSI) incidence rate targeted on salivary gland surgery over a 2-year period (from January 2007 to December 2008). Then identify any risk factors associated with SSI in all the patients operated with no antibiotic prophylaxis in accordance with French Anesthesiology Society guidelines.

POPULATION AND METHODS

Ninety-three patients were operated during the standard SSI surveillance period. A case-control (one case for five controls) study was then conducted aiming to identify risk factors.

RESULTS

The SSI incidence rate was 9.7%. The case-control study failed to identify any relevant risk factor with univariate analysis.

CONCLUSION

As no risk factors could be identified, we suggest that surgical antibioprophylaxis could be relevant in salivary glands surgery and should be evaluated in this setting.

Epidemiological investigation of a Serratia liquefaciens outbreak in a neurosurgery department

Between February 2001 and March 2003, 17 patients from the neurosurgery department of the University Hospital of Rangueil (Toulouse, Southern France) developed Serratia liquefaciens infections. Due to the atypical antibiotype displayed by the clinical isolates (i.e. gentamicin resistance), an outbreak was suspected. Molecular analysis carried out by pulsed-field gel electrophoresis demonstrated a genetic link for all patients. Furthermore, the patient who introduced the epidemic Serratia strain was also identified and shown to be related to the two epidemic peaks observed during the outbreak period. Investigation failed to reveal a reservoir among the antiseptics and soaps, or among the mechanical ventilators used. However, when the colonization of patients was investigated, positive carriage was observed and could be considered as a potential risk for the spread of the epidemic strain. Due to the delay between antibiotherapy and S. liquefaciens colonization, a selection effect had to be considered. Finally, implementation of hygiene measures was accompanied by control of the outbreak.

Surveillance des infections de site opératoire sur prothèses mammaires en chirurgie esthétique

The results of long-term follow-up of surgical site infection (SSI) after aesthetical breast surgery are reported. 205 consecutive patients operated from 1/2000 to 3/2002 were followed for at least one year. Postoperative incidents were observed in 26 (12.7%) patients, including SSI in six (2.9%) patients. After surgery, the mean time to SSI was 113 days, with only two cases in the first postoperative month. In all SSI cases, no antibiotic prophylaxis had been given. The causative role of infectious agents in breast implant capsule occurrence is under investigation.

[Determination of nosocomial infection incidence in mothers and newborns during the early postpartum period]

BACKGROUND

We wished to determine the incidence of nosocomial infections in the mother and the newborn during the early postpartum period.

MATERIAL AND METHODS

Over a three-month period, the same investigator collected 50 different clinical and microbiological, standardized data related to infectious diseases in parturients and their newborns.

RESULTS

Data were collected on 804 deliveries. The overall rate of nosocomial infection was 2.9% (23/804). For vaginal deliveries, the rate was 1.9% (12/615) and for deliveries by Cesarean section, the rate was 5.8% (11/189). Of 745 newborns followed until discharge from hospital, 0.7% (5/745) had a nosocomial infection.

CONCLUSION

These results are in line with previously published rates of nosocomial infections, which varied between 0.2% to 2.3% for vaginal deliveries, 1.6% to 18.9% for Cesarean section, and 0.2 to 4% in newborns. Regular surveys of the incidence or the prevalence of nosocomial infections are necessary to monitor the effectiveness of educational programs, aimed to reduce hospital acquired infections.

Nosocomial outbreak of influenza virus A (H3N2) infection in a solid organ transplant department

BACKGROUND

There is a strong body of evidence in favor of influenza virus immunization in solid organ recipients. However, little attention has been devoted to other reservoirs, such as the patients' relatives and, at the time of hospital admission, to the healthcare workers.

METHODS

Analysis of the epidemiology of an outbreak of nosocomial influenza A in a solid organ transplant unit.

RESULTS

Four cases of influenza A virus infection were reported during a short 4-day outbreak in a 12 single-room transplant unit. None of the patients had been immunized against influenza. Three patients had not been visited by their relatives between admission and influenza infection. Three nurses, among the 27 healthcare workers, presented with clinical flu symptoms at times consistent with nosocomial transmission.

CONCLUSIONS

Because the prevention of influenza infection by vaccination warrants a global strategy to target the different reservoirs, we suggest that the modern policy of vaccinating solid organ patients should be extended both to their relatives and to the healthcare workers of transplant units.

[Infectious risk in medical offices: a reality to be fought]

The notion of nosocomial infection is intimately related with that of working or sejourning in a health care institution and would thus not concern the physician's office. Nevertheless, the risk of infection does exist in this setting, both for patients and personnel, and requires adequate preventive measures. The practitioner is called upon to care for patients who have community-acquired or possibly nosocomial infections following hospitalization and must therefore know the type of germ involved, its characteristics, particularly antibiotic sensitivity, the predominant modes of transmission and preventive measures against propagation, latrogenic infections such as abscess formation at a point of injection or septic arthritis after infiltration may also occur. Other more technical procedures (endoscopy, minor surgery) may also be a cause of contamination. The practitioner also produces wastes (needles, vaccine syringes, dressings) which must be disposed of in accordance with legal regulations. One must avoid contaminating oneself in order not to contaminate others. This requires adequate knowledge and application of elementary rules concerning hand washing, asepsis, antisepsis, and waste disposal, essential links in the chain of infection transmission.

[Vaccination against hepatitis B of Toulouse hospital personnel]

An enquiry by self-filled questionnaire was conducted among 834 employees of the Toulouse Hospital Centre. The 79.6 percent answer rate obtained made it possible to determine the prevalence of hepatitis B virus infection (11.1 percent), the proportion of immunized subjects (42.5 percent) and their distribution among the different professional categories, and the proportion of accidents that could carry a risk infection (64.3 percent). At present, the protective measures are insufficiently known and applied. The information needed should be precise and up-to-date, covering the various aspects of hepatitis B infection; it should be provided before any occupational exposure and thereafter recalled during routine activities.