Infection nosocomiale et certitude du caractère endogène

Hospitalisé le 27 juin 1998 au centre hospitalier régional d’Orléans à la suite d’un accident de la circulation, un patient y a subi le 17 juillet une intervention de chirurgie osseuse réparatrice du crâne. Dans les mois qui ont suivi, est apparue une suppuration de la cicatrice opératoire qui a justifié une nouvelle intervention, à l’occasion de laquelle a été diagnostiquée une atteinte infectieuse du volet frontal. Trois nouvelles interventions, ainsi qu’une antibiothérapie pendant deux ans, ont été nécessaires pour traiter l’infection, le patient présentant depuis lors une déformation du crâne.

Le tribunal administratif d’Orléans a, par jugement en date du 20 septembre 2007, condamné l’établissement public de santé à indemniser le patient des préjudices subis à raison de l’intervention initiale.

Par arrêt du 7 mai 2008, la cour administrative d’appel d’Orléans a annulé le jugement.

Le requérant s’est pourvu en cassation devant le Conseil d’État ((CE, 2 février 2011, X, n°320052 : AJDA 2011, p. 250.)) qui a estimé que :

« l’introduction accidentelle d’un germe microbien dans l’organisme lors d’une intervention chirurgicale révèle une faute dans l’organisation ou le fonctionnement du service hospitalier et engage la responsabilité de celui-ci envers la victime des conséquences dommageables de l’infection ; qu’il en va toutefois autrement lorsqu’il est certain que l’infection, si elle déclarée à la suite d’une intervention chirurgicale, résulte de germes déjà présents dans l’organisme du patient avant l’hospitalisation« .

Le Conseil d’État a ainsi relevé que :

« s’il ressortait des pièces du dossier soumis à la cour […], et notamment de l’expertise ordonnée avant dire droit par le tribunal […], que les germes à l’origine de l’infection […] étaient vraisemblablement endogènes, une telle constatation ne pouvait, à elle seule, permettre de tenir le caractère endogène de l’infection pour certain ; qu’en regardant néanmoins ce caractère comme établi et en écartant en conséquence la responsabilité du centre […], la cour a commis une erreur de droit ».

En substance, il faut donc retenir que, dans le cadre du régime de responsabilité antérieur à la loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé, que la responsabilité d’un hôpital ne peut être écartée qu’en cas de certitude sur le caractère endogène de l’infection nosocomiale contractée par le patient.

Cette jurisprudence poursuit l’assouplissement de sa position, antérieure à l’entrée en vigueur de la loi du 4 mars 2002, qui écartait la présomption de faute dans l’organisation ou le fonctionnement du service hospitalier dès lors que l’infection nosocomiale contractée par le patient résultait de germes déjà présents dans son organisme avant l’hospitalisation (CE, 27 septembre 2002, Mme N. c/ CHI de Créteil, n°211370, Lebon 315).

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