title: Antibiotic consumption to detect epidemics of Pseudomonas aeruginosa in a burn centre: A paradigm shift in the epidemiological surveillance of Pseudomonas aeruginosa nosocomial infections.
abstract: OBJECTIVE
  The control of antibiotic resistance and nosocomial infections are major challenges for specialized burn centres. Early detection of those epidemic outbreaks is crucial to limit the human and financial burden. We hypothesize that data collected by antibiotic consumption medico-economic surveys could be used as warning signal to detect early nosocomial outbreaks.
  
  
  METHODS
  A retrospective analysis was conducted that included all burn patients staying >48h on the Lausanne BICU (Burn Intensive Care Unit) between January 2001 and October 2012 who received systemic therapeutic antibiotics. Infection episodes were characterized according to predefined criteria. Antibiotic consumption data, obtained from the quarterly surveillance of drug consumption surveys, were translated into defined daily doses (DDDs).
  
  
  RESULTS
  In total, 297 out of 414 burn patients stayed >48h, giving a total of 7458 'burn-days'. We identified 610 infection episodes (burn wound [32.0%], respiratory [31.1%], and catheter [21.8%]), from 774 microorganisms. Pseudomonas aeruginosa (26.2%), Staphylococcus aureus (11.5%), and Candida albicans (7.0%) were the main pathogens. We observed three distinct outbreaks of P. aeruginosa infections in 2002-2003, 2006, and 2009-2011. These outbreaks correlated with an increase in the DDDs of anti-Pseudomonas antibiotics.
  
  
  CONCLUSIONS
  Our data support a paradigm shift in the epidemiological surveillance of nosocomial P. aeruginosa epidemics in burn centres, using the rise in antibiotic consumption as an early trigger to initiate the molecular typing of P. aeruginosa strains and the reinforcement of standard infection control procedures.
authors.affiliation: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Fournier
authors.affiliation: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voirol
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Krähenbühl
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Claire-Lise
authors.initials: CL
authors.lastname: Bonnemain
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Camille
authors.initials: C
authors.lastname: Fournier
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pantet
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pagani
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Revelly
authors.affiliation: Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care, and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Research Center for Statistics, University of Geneva, Geneva, Switzerland.
authors.forename: Elise
authors.initials: E
authors.lastname: Dupuis-Lozeron
authors.affiliation: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Farshid
authors.initials: F
authors.lastname: Sadeghipour
authors.affiliation: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Pannatier
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.affiliation: Service of Adult Intensive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: yok-ai.que@chuv.ch.
authors.forename: Yok-Ai
authors.initials: YA
authors.lastname: Que
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002053:Burn Units; D002056:Burns / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D058872:Epidemics; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology*; D011550:Pseudomonas aeruginosa; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D014946:Wound Infection / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics consumption; Burn patients; Epidemic breakthroughs; P. aeruginosa infections