Current research investigations
This study is a prospective pharmacoepidemiological investigation involving the establishment of a cohort of hospitalized individuals not initially colonized with S. aureus. We are surveying the acquisition of methicillin-susceptible and methicillin-resistant S. aureus infection. Subjects were recruited from patients with neurological diseases requiring long-term hospitalization from January 2008 to October 2010. Almost 7,800 rhinopharyngeal samples have been collected from the 451 patients recruited and about 2,000 antibiograms have already been performed. This program was funded by the 2006 regional PHRC (€350,000) and by Institut Pasteur.
The I-BIRD investigation provides innovative and unique data concerning the ability of methicillin-resistant Staphylococcus aureus (MRSA) and members of the Enterobacteriaceae resistant to third-generation cephalosporins (ER3GC) to disseminate within hospital clinical departments, based on the tracing of clonal dissemination, for MRSA and ER3GC, among hospitalized patients and health-care workers, and the assessment of contact dynamics within the hospital as a whole.
This specific epidemiological investigation began early in April 2009 and involved six months of systematic and standardized follow-up of hospitalized patients and health-care workers at Berck Hospital (AP-HP). The data collected concerned individual antibiotic use, the assessment of contacts with network sensors, individual control measures and serum samples from patients at admission and discharge. This investigation is funded in part by WP8 of the MOSAR project (€800,000) and its extension to enterobacteria through the 2009 PHRC (€500,000).
Enterobacteria and ßlactams in Intensive Care units, EßIC
This study is a prospective pharmacoepidemiological multicenter investigation with the primary objective of determining whether the initiation of β–lactam treatment modifies the risk of intestinal acquisition of ER3GC by the individual. The cohort included adult patients admitted to 10 medical or surgical ICUs in the Greater Paris area from November 2005 to February 2006. In total, 3,292 swab specimens have been collected from the 893 patients recruited. This program was funded by the 2004 regional PHRC (€300,000).
Public Health Impact of policies relating to the control of antibiotic resistance, PHI–CARE
Since 2002, we have been storing centrally reimbursement data for all the systemic antibiotics (class J01 of the Anatomical Therapeutic classification), antituberculosis drugs and vaccines against influenza and pneumococci prescribed to individuals from the French population. These data include: the location of the practitioner prescribing the medication, the unique code for the drug presentation, the number of boxes delivered, the delivery date, the sex and year of birth of the person for whom the drug was prescribed. This research program involves close collaboration with the French national health insurance agencies.
We have also gathered the following data relating to drug reimbursement for the French population:
– Numbers of invasive pneumococcal infections in hospitalized patients; data provided by the National Medical Information System;
– Number of cases of pneumococcal meningitis; data obtained through collaboration with the National Reference Center for Pneumococci.
Children, antibiotics, non steroidal anti-inflammatory drugs (NSAIDs) and childhood empyema, ChANCE
This investigation focuses specifically on evaluation of the association between the occurrence of empyema and NSAID exposure before the onset of pleuropulmonary symptoms after viral infection in children. This study is a prospective multicenter case-control study. In total, 309 children were invited to participate in the study, 168 of whom were eligible for inclusion (84 cases and 84 controls). This investigation was funded by the 2005 national PHRC (circa €300,000) and AFSSAPS.
Future research investigations
We aim to characterize and to follow up the intra-individual dynamics of co-infections with different HPV genotypes, taking into account both vaccination status and immunity to HPV 16 and 18. For this, we plan to set up a cohort of several thousand female students from the universities of Bordeaux and Versailles Saint Quentin. Follow-up will include the taking of genital and oral samples for the detection and genotyping of HPV, and completion of a questionnaire concerning sexual behavior, sociodemographic characteristics (including financial resources) and access to and the use of health-care services. This investigation is part of the iSHARE program funded by the “Investissement d’Avenir” cohort call.
In order to estimate the incidence of bacterial infections resistant to antibiotics in children, we will establish an epidemiological multicenter cohort of newborns who will be followed up until their second birthday. For this, live-birth registries will be established on the basis of data for mothers identified in a defined geographical area in each of the participating sites. This study will be carried out at several sites in the Institut Pasteur International Network (including Madagascar, Central African Republic, Cameroon, and Cambodia). The pilot phase of this program will be launched early in 2012 and this study is planned to run until the end of 2013. This investigation is funded by the Principality of Monaco (circa €800,000).