Résumé
L’isolement des patients porteurs ou infectés par une bactérie multirésistante (BMR) en réanimation est une politique habituelle promue par les sociétés savantes. Son objectif est de limiter et maîtriser la diffusion des BMR. Ces mesures sont néanmoins coûteuses et parfois difficilement applicables dans la situation endémique de la France. Elles ne doivent certainement pas être abandonnées, mais revues en fonction de l’épidémiologie, des moyens et surtout du niveau de respect des précautions standard de chaque unité. L’isolement complémentaire et le cohorting posent des problèmes éthiques et ont des conséquences multiples, dont certaines psychologiques, qui doivent être connues de chacun et prises en compte dans la balance risque collectif versus bénéfice individuel.
Abstract
Contact isolation of patients carrying or infected with multidrug-resistant bacteria in the intensive care unit is a routine policy, usually promoted by the scientific societies. Its purpose is to limit and control the spread of multidrugresistant bacteria. These measures are expensive and sometimes difficult to apply in the endemic situation of France. They should certainly not be abandoned but considered in regards to the local epidemiology and the level of compliance with standard precautions in each unit. There are numerous ethical problems, other psychological consequences, and adverse effects due to contact isolation and cohorting, which should be known and considered for the balance of collective risk versus individual benefit.
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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2012 dans la session : Maladies infectieuses transmissibles.
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Zahar, J.R., Mamzer, M.F. & Kouatchet, A. L’isolement en réanimation : intérêts, limites, perspectives. Réanimation 21 (Suppl 2), 494–502 (2012). https://doi.org/10.1007/s13546-011-0425-x
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DOI: https://doi.org/10.1007/s13546-011-0425-x