Profils de sensibilité des isolats de Staphylococcus aureus Etude rétrospective sur Huit ans dans un hôpital d’instruction

Les infections à S aureus en particulier, le Staphylococcus aureus résistant à la meticilline (SARM), pose un réel problème de santé publique.Elles sont responsables d’une morbidité et d’une mortalité importantes. Le but de ce travail consiste à déterminer le profil épidémiologique des SARM, et à décrire la cinétique des SARM. Entre Janvier 2007 et décembre 2014, nous avons colligé 1124 isolats reçus au laboratoire de bactériologie de L’Hôpital Militaire Mohammed Vde Rabat. La culture et l’identification ont été faites selon les techniques conventionnelles. Les tests de sensibilité ont été réalisés selon les recommandations de CA-SFM. L’étude de la sensibilité a révélé que 8,7% des isolats étaient résistants à la méticilline. Ces SARM ont été isolés majoritairement à partir des pus 51,3%, des hémocultures 13.3%. L’analyse de ces résultats a montré que l’antibiotique le plus actif reste les glycopeptides, suivi par la rifampicine 61,3%, Si le taux des SARM dans notre structure reste faible, le taux de résistance est élevé. Ces deux indicateurs pourraient être réduits, en renforçant les mesures d’hygiène et en maîtrisant l’utilisation des antibiotiques.

Septic arthritis of the ankle: Do not forget Pasteurella pneumotropica

Pasteurella pneumotropica is an important bacterial pathogen in both animals and humans. Most reported Pasteurella infections in humans involve skin and soft tissues, often after an animal bite, scratch, or lick to an open wound. We report a case of septic arthritis with Pasteurella pneumotropica in a diabetic and cardiopathic patient who was the victim of a rat bite in the street, with a good evolution after medical and surgical treatment

The individual, the government and the global community: Sharing responsibility for health post-2015 in Vanuatu, a small island developing state

Introduction: The end of 2015 will see the creation of the sustainable development goals - the new global framework for development. The process of creating universally relevant goals has involved community consultation throughout the world. Within this process it is vital that Pacific Island countries are included as they face particular development challenges due to their size and geographical location. As small island developing states, many Pacific Island countries struggle to overcome high rates of poverty and poor health outcomes. In order to include Pacific voices in the new health related sustainable development goals, Vanuatu was selected as a representative of the Pacific for this qualitative study. This paper presents the perspectives of communities throughout Vanuatu on their essential health needs and how best to meet them. Methods: This paper examines the perspectives of 102 individuals from throughout Vanuatu. Ten focus group discussions and 2 individual interviews were conducted within communities in September 2013. Discussions focused on community perceptions of health, essential health needs, and responsibility in achieving health needs. Discussions were audio recorded and transcribed. The transcripts were then analysed using a theoretical thematic approach in order to identify central themes and subthemes. Results: Individuals in this study demonstrated a comprehensive understanding of health, defining health in a holistic manner. Participants identified clear environmental and societal factors that impact upon health, and emphasized failures within the current health system as important barriers to attaining good health. Participants described the challenges faced in taking responsibility for one's health, and pointed to both the government and the international community as key players in meeting the essential health needs of communities. Conclusions: As a small island developing state, Vanuatu faces accentuated development challenges - particularly as globalisation and climate change progress. The individuals and communities in this study demonstrate a clear understanding of their needs, and show a strong desire for change. They point to both the government and the international community to assist in meeting health needs, and stress that respect for traditional governance and community involvement in decision-making are vital in this process. In order to ensure that the new health goals effectively meet local needs in Vanuatu such factors must be incorporated into policy and implementation decision-making

Serious phlegmonous lesion of the hand following an injury by vegetal thorn: Never forget Pasteurella multocida!

Pasteurella multocida can cause serious infections after dog or cat bite. We report here a rare case of hand infection caused by P. multocida consecutive to an injury by a thorn of the prickly pear. It caused an amputation of the distal phalanx of the thumb in a trisomic patient. It is about a 27-year-old man who was admitted to the hospital with swelling and intense pain of the left hand. He reported a sting by a thorn of prickly pear 15 days before. The patient was admitted to proceed with operative irrigation and debridement. The pus was collected for microbiological examination. Microscopic examination after Gram staining revealed small Gram-negative coccobacilli, associated to polymorphonuclear reaction. Culture have objectivated Pasteurella multocida. The isolated strain was susceptible to betalactamins. Patient was treated with ampicillin. Well-conducted antibiotics and repetitive local cares have not prevented local lesions from progressing to necrosis of the soft parts of the thumb and osteitis of the distal phalanx of the thumb. The patient underwent a necrosectomy and an amputation of the distal phalanx. Ampicillin was replaced by amoxicillin/clavulanic acid and after 15 days, progression was clinically and microbiologically favorable. In the case we report, since the patient does not report any exposure or contact with animals, the thorn prick is the source of infection. It was contaminated from the animal reservoir. Taking into account the monomicrobism of the infection, treatment with aminopenicillins was sufficient. Our propositus came to the hospital 15 days after the inoculation of the bacterium. This duration appears to be very late in relation to the acute character of pasteurellosis. This was probably the main reason why the local infection evolved towards osteoarticular complications. That's why, we should consider Pasteurella multocida in case of infection by inoculation, even in the absence of contact with the animals