Prevalence of infectious multi-drug resistant bacteria isolated from immunocompromised patients in Tunisia

Objectives: A retrospective study was conducted in the Bone Marrow Transplant Center of Tunisia during a period of 10 years (from 2002 to 2011) in order to report the prevalence of infectious multi-drug resistant bacteria.Methods: Bacterial identification was carried on the basis of biochemical characteristics and API identification systems. Antibiotic susceptibility was tested by disc diffusion method on Muller-Hinton agar.Results: During the study period, 34.5% of 142 Klebsiella pneumoniae strains and 11.46% of 218 Escherichia coli strains were extended-spectrum beta-lactamase (ESBL) producers. Also, 32.8% of 210 strains of Pseudomonas aeruginosa were imipenem and/or ceftazidime resistant and 20.75% of 106 strains of Staphylococcus aureus were methicillin resistant. A rising trend was observed for the prevalence of the selected multidrug resistant bacteria.Conclusion: These findings may have important clinical implications in prophylaxis and selection of antibiotic treatment. Continuous surveillance is needed, especially for onco-hematological patients.Keywords: Infectious multi-drug resistant bacteria, immunocompromised patients, Tunisia

Molecular Epidemiology of Methicillin-Resistant Staphylococcus hominis (MRSHo): Low Clonality and Reservoirs of SCCmec Structural Elements

BACKGROUND: Methicillin resistant Staphylococcus hominis (MRSHo) are important human pathogens in immunocompromised patients. However, little is known regarding its population structure and staphylococcal chromosomal cassette mec (SCCmec) content. METHODOLOGY/PRINCIPAL FINDINGS: To assess the population structure and the SCCmec content of S. hominis, 34 MRSHo and 11 methicillin-susceptible S. hominis (MSSHo) from neutropenic patients collected over a 3-year period were studied. The genetic backgrounds of S. hominis isolates were analyzed by pulsed-field gel electrophoresis (PFGE) and SCCmec types were determined by PCR. Cassette chromosome recombinases (ccr) were characterized by PCR and ccrB sequencing. The 34 S. hominis isolates were classified into as many as 28 types and 32 subtypes (SID = 99.82%); clonal dissemination was occasionally observed. The main SCCmec structures identified were SCCmec type VI (4B) (20%), SCCmec VIII (4A) (15%), and a new SCCmec composed of mec complex A in association with ccrAB1 (38%); 27% of the isolates harbored non-typeable SCCmec. Overall, a high prevalence of mec complex A (73.5%), ccrAB1 (50%) and ccrAB4 (44%) were found. Importantly, ccrB1 and ccrB4 from both MRSHo and MSSHo showed a high nucleotide sequence homology with those found in S. aureus SCCmec I, VI and VIII respectively (>95%). CONCLUSIONS/SIGNIFICANCE: The S. hominis population showed a limited clonality and a low genetic diversity in the allotypes of ccr and classes of mec complex. Moreover, our data suggest that S. hominis might have been a privileged source of mec complex A, ccrB1 and ccrB4, for the assembly of primordial SCCmec types

Prevalence of infectious multi-drug resistant bacteria isolated from immunocompromised patients in Tunisia

Objectives: A retrospective study was conducted in the Bone Marrow Transplant Center of Tunisia during a period of 10 years (from 2002 to 2011) in order to report the prevalence of infectious multi-drug resistant bacteria. Methods: Bacterial identification was carried on the basis of biochemical characteristics and API identification systems. Antibiotic susceptibility was tested by disc diffusion method on Muller-Hinton agar. Results: During the study period, 34.5% of 142 Klebsiella pneumoniae strains and 11.46% of 218 Escherichia coli strains were extended-spectrum beta-lactamase (ESBL) producers. Also, 32.8% of 210 strains of Pseudomonas aeruginosa were imipenem and/or ceftazidime resistant and 20.75% of 106 strains of Staphylococcus aureus were methicillin resistant. A rising trend was observed for the prevalence of the selected multidrug resistant bacteria. Conclusion: These findings may have important clinical implications in prophylaxis and selection of antibiotic treatment. Continuous surveillance is needed, especially for onco-hematological patients. DOI: https://dx.doi.org/10.4314/ahs.v19i2.25 Cite as: Mechergui A, Achour W, Mathlouthi S, Hassen AB. Prevalence of infectious multi-drug resistant bacteria isolated from immunocompromised patients in Tunisia. Afri Health Sci.2019;19(2): 2021-2025. https://dx.doi.org/10.4314/ahs.v19i2.2

Successful treatment of fusarium solani ecthyma gangrenosum in a patient affected by leukocyte adhesion deficiency type 1 with granulocytes transfusions

<p>Abstract</p> <p>Background</p> <p>Ecthyma gangrenosum (EG) manifests as a skin lesion affecting patients suffering extreme neutropenia and is commonly associated with <it>Pseudomonas aeruginosa </it>in immunocompromised patients. Leukocyte adhesion deficiency I (LAD I) which count among primary immunodeficiency syndromes of the innate immunity, is an autosomal recessive disorder characterized in its severe phenotype by a complete defect in CD18 expression on neutrophils, delayed cord separation, chronic skin ulcers mainly due to recurrent bacterial and fungal infections, leucocytosis with high numbers of circulating neutrophils and an accumulation of abnormally low number of neutrophils at sites of infection.</p> <p>Case Presentation</p> <p>We report at our knowledge the first case of a child affected by LAD-1, who experienced during her disease course a multi-bacterial and fungal EG lesion caused by <it>fusarium solani</it>. Despite targeted antibiotics and anti-fungi therapy, the lesion extended for as long as 18 months and only massive granulocytes pockets transfusions in association with G-CSF had the capacity to cure this lesion.</p> <p>Conclusion</p> <p>We propose that granulocytes pockets transfusions will be beneficial to heal EG especially in severely immunocompromised patients.</p

rpoB Mutations in Streptococcus mitis Clinical Isolates Resistant to Rifampin

Activity of rifampin against 129 Streptococcus mitis isolates obtained from patients with hematologic cancer was investigated. One hundred twenty-five strains were susceptible to rifampin, and 4 were resistant (MIC = 32 to 64 μg/ml). Resistance to rifampin was related to mutations in the rpoB gene: His(526)Asn in three strains and His(526)Asp in one strain

Molecular typing of Neisseria perflava clinical isolates.

International audienceMultilocus sequence typing and pulsed-field gel electrophoresis were used to type 22 commensal isolates of Neisseria perflava collected by swabbing from neutropenic patients. High genetic diversity was found among our N. perflava clinical isolates

PFGE profiles after XhoI digestion of methicillin-resistant <i>S. hominis</i> isolates.

<p>The dendrogram showing the clustering of strains was performed by analysis of PFGE profiles with the Bionumerics software, with 1% tolerance and 0.8% optimization (this study). Clusters were defined at a cut-off value of 90%.</p

Phylogram (average distance) using the identity percentage for <i>ccrB</i>1 and <i>ccrB</i>4 carried by <i>S. hominis</i> isolates and <i>ccrB</i> prototype sequences available on 17 June 2010 at the ‘<i>ccrB</i> typing tool’ online resource.

<p>The tree was automatically drawn by the Java applet available through the ‘<i>ccrB</i> typing tool’ using the default parameters <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0021940#pone.0021940-Takeuchi1" target="_blank">[14]</a>. MRSHo and MSSHo isolates from this study are underlined. Control isolates were the following by order of appearance from top to bottom: ATCC12228, Methicillin-susceptible <i>S. epidermidis</i> (MSSE) strain; carrying the SCC<i>_pbp4</i>; HDE288, methicillin-resistant <i>S. aureus</i> (MRSA), carrying SCC<i>mec</i> VI; C10682, MRSA carrying SCC<i>mec</i> type VIII; H65, <i>S. fleuretti</i> isolate from database carrying <i>ccrAB4</i> from <i>ccrB</i> typing tool database; GIFU1223, MSSHo strain GIFU1223 (ATCC27844), carrying the SCC<i>₁₂₂₃</i>; SH-8-39, <i>S. hominis</i> isolate carrying <i>ccrAB1</i> from the database; D64, <i>S. haemolyticus</i> isolate carrying <i>ccrAB1</i> from the database; PER184, MRSA, carrying SCC<i>mec</i> I; COL, MRSA carrying SCC<i>mec</i> I; PL72, MRSA carrying SCC<i>mec</i> I; SE6-42, <i>S. epidermidis</i> isolate from the database, carrying <i>ccrAB1</i>; SH13-27, <i>S. hominis</i> from the database carrying <i>ccrAB1</i>; MSSA476, methicillin-susceptible <i>S. aureus</i> (MSSA), carrying SCC<i>_MSSA476</i>. SA, <i>S. aureus</i>; SE, <i>S. epidermidis</i>; SHo, <i>S. hominis</i>; SHa, <i>S. haemolyticus</i>; SF, <i>S. fleuretti</i>.</p