Pseudomonas aeruginosa : Epidémiologie et état actuel des résistances Etude retrospective sur trois ans

Objectifs : Ce travail a pour objectif, l’étude de l’épidémiologie locale des infections à P.aeruginosa, ainsi que  l’état actuel de sa résistance aux antibiotiques.Matériel et méthodes : C’est une étude rétrospective, descriptive, qui s’étalait sur 3ans (Avril 2012- Mars 2015), portant sur les isolats de P.aeruginosa colligés au niveau du laboratoire de bactériologie de l’H.M.I.M.V à Rabat.Résultats : Au total, 9868 bactéries ont été isolées durant la période d’étude, dont 730 P.aeruginosa (7,40%). les services sont représentés essentiellement par  la réanimation-soins intensifs  et les services de brulés (31,1%). Ces souches provenaient principalement des pus (27,1%) suivis des prélèvements broncho-pulmonaires (24,5%) et des urines (17 ,9%). Ces trois sites ont fourni 69,5% des isolats.Les molécules les plus actives étaient la ceftazidime 82%, le pipéracilline+ tazobactam 75,8%, l’imipénème 73,8%, céfepime 68,6%. La sensibilité aux aminosides était respectivement amikacine 80,8%, tobramycine 78,9%, gentamicine 70,5%. Celui de la ciprofloxacine est de 78,9%. Aucune souche n’était résistante à la colistine.La prévalence des isolats multi-résistants était de 8,4% enregistrée essentiellement en réanimation et dans le service des brulés.Conclusion : le taux de P.aeruginosa constitue toujours un problème de santé publique essentiellement au niveau des services de réanimation et de soins intensifs, vu sa fréquence et ses taux de résistances assez élevé, ainsi des mesures d’hygiènes associées à une optimisation de l’antibiothérapie sont nécessaires pour stopper sinon réduire l’évolution des taux de résistances

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.

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

Introduction: This study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat. Methods: This is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014. Results: During the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n=6352) and 9.6% of Gram negative rods (n=4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin. Conclusion: This paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.Pan African Medical Journal 2016; 2

Research Article Bacteraemia in Intensive Care Unit: Clinical, Bacteriological

Objectives. We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU) of Mohammed V Military Teaching Hospital of Rabat (Morocco). Methods. The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance. Results. During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases with Acinetobacter baumannii being the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and 100% of carbapenemase in Acinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases. Conclusions. Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality

Bee venom: a case of effectiveness on skin varicosities veins with review of its dermatological benefits

Bee venom is a very rich and varied biochemical complex, which explains the multitude of its physiological effects as well as its medical indications. In dermatology, apart from psoriasis, few studies have been conducted concerning its interest and effectiveness; however the preliminary results remain so promising and encouraging. We present a clinical case illustrating the efficacy of bee venom in cutaneous varicosities, with a review of the literature of its main dermatological indications

The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance

Pyoderma gangrenosum (PG) is a rare ulcerative skin condition. It can be associated with a number of systemic diseases. Association with monoclonal gammopathy of undetermined significance (MGUS) is uncommon, but prognosis may be different depending upon the type of MGUS. Cases of MGUS- related PG reported in the literature with data concerning evolution and treatment were identified through a PubMed search. A patient with recurrent PG in the setting of a MGUS-IgA-? in our department was also included. In total, 10 cases were identified. Only the two cases with Ig populations other than IgA improved without recurrence after treatment of the PG. All the patients with MGUS-IgA showed recurrences. Early multiple myeloma was proposed for three patients with MGUS-IgA-related PG. Second or third line treatments were necessary in some cases

Von Zumbusch’s pustular psoriasis associated with oral terbinafine

Adverse skin reactions have been reported in 2.7% of patients receiving oral terbinafine. Less common but life-threatening reactions include acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, toxic epidermal necrolysis, exacerbation or induction of psoriasis. We report a case of a 28 year-old woman with no history of psoriasis, the patient presented generalized pustular eruption, erythroderma, prolonged fever and altered general conditions, associated with initiation of oral terbinafine. The histological analysis of the cutaneous biopsy was compatible with pustular psoriasis. The intake of terbinafine was discontinued and treatment by acitretin 25 mg/day associated with emollient cream was started. The evolution was marked by resolution of skin eruption and disappearance of the fever in a few days. The complete remission was reached 2 months later. The diagnosis of severe generalized pustular psoriasis (GPP), type Von Zumbusch associated with initiation of oral terbinafine was made. The present case indicates that terbinafine is a drug that may be associated with the development of psoriasis de novo or its exacerbation

The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance

Pyoderma gangrenosum (PG) is a rare ulcerative skin condition. It can be associated with a number of systemic diseases. Association with monoclonal gammopathy of undetermined significance (MGUS) is uncommon, but prognosis may be different depending upon the type of MGUS. Cases of MGUS- related PG reported in the literature with data concerning evolution and treatment were identified through a PubMed search. A patient with recurrent PG in the setting of a MGUS-IgA-? in our department was also included. In total, 10 cases were identified. Only the two cases with Ig populations other than IgA improved without recurrence after treatment of the PG. All the patients with MGUS-IgA showed recurrences. Early multiple myeloma was proposed for three patients with MGUS-IgA-related PG. Second or third line treatments were necessary in some cases

Septicémie fatale due à une bactérie émergente: arcanobactrium hemolyticum

L’Arcanobactérium haemolyticum (A.haemolyticum) est un bacille à Gram positif. L’homme en est le principal réservoir. C’est un pathogène opportuniste essentiellement chez l’immunodéprimé, et qui peut être responsable d’infection au niveau de la peau et du pharynx chez les sujets sains, surtout chez les enfants et les adolescents. Il peut causer des surinfections des ulcères chroniques, et occasionnellement des infections invasives. Sa détection au niveau des cultures reste toujours difficile car il simule de nombreuses bactéries auxquelles il est souvent associé dans les produits pathologiques. Et Il n’existe pas de recommandations concernant l’étude sa sensibilité aux antibiotiques. Les bactériémies àArcanobactérium sont rares, à notre connaissance, seize cas ont été décrits dans la littérature. Nous rapportons, un autre cas de bactériémie à A.haemolyticum, secondaire à une surinfection d’escarres fessières.The Pan African Medical Journal 2016;2

Bacteriological aspects of chronic osteoarticular infections in adults: the influence of the osteosynthesis material

Abstract Background The aim of this study is to establish the bacterial epidemiology of chronic osteoarticular infections in adults, to study the susceptibility of the isolated strains to antibiotics and to demonstrate the influence of osteosynthesis material thereon. Patients and methods This is a retrospective study of 78 months, from January 2006 to June 2012, providing bacteriological samples from patients with osteitis and osteoarthritis in the Mohammed V military teaching hospital of Rabat. Isolation and identification of bacteria were made by bacteriological classical techniques. The antimicrobial susceptibility testing of the isolates was performed by disk diffusion agar method, as recommended by the Committee of the susceptibility of the French Society for Microbiology (CA-SFM). Results We collected 234 cases, 53% (n = 124) of patients without osteosynthesis material (group A) and 47% (n = 110) patients with osteosynthesis material (group B).We isolated 371 bacteria which 51.49 (n = 191) in group A and 48.51% (n = 180) in group B. Gram-positive cocci were the most frequent (n = 234), followed by the Gram-negative bacilli (n = 114) and the Gram-positive bacilli (n = 19). Our study shows that the rate of resistance to antibiotics in strains obtained from patients with osteosynthesis material is higher compared to those obtained from patients without osteosynthesis material. Conclusions Chronic OA infection in adults is difficult to diagnose and treat. Its good management must be multidisciplinary