L’impact de la PCR gastro-intestinale sur la prise en charge des infections gastro-intestinales chez les immunodéprimés

Introduction: Les infections gastro-intestinales sont une des premières causes de morbidité et de mortalité à travers le monde, notamment chez l’immunodéprimé. La PCR gastro-intestinale apparait comme une technique de choix pour établir le diagnostic moléculaire des agents gastro-intestinaux pathogènes.Le but de cette étude était de dresser le profil épidémiologique, clinique et évolutif des infections gastro-intestinales et étudier l’impact du diagnostic moléculaire sur le choix d’une thérapie ciblée.Matériel et méthodes: Il s’agit d’une étude rétrospective réalisée au sein du service de Microbiologie de l’hôpital Arrazi du Centre Hospitalier Universitaire Mohamed VI, incluant tous les patients immunodéprimés pris en charge pour une infection gastro-intestinale et ayant nécessité une hospitalisation, sur une durée de 15 mois. Résultats: Pendant la période étudiée, 124 patients ont été prélevés et 95,2% ont reçu une antibiothérapie probabiliste.L’infection gastro-intestinale a été documentée chez 57,26% des patients. Une étiologie bactérienne a été retrouvée chez 76,81% des patients. Une étiologie virale a été retrouvée chez 13,04% des patients et une étiologie parasitaire a été retrouvée chez 10,15% des patients. E.coli entéropathogène était l’agent infectieux le plus détecté (19,53%). Les coïnfections ont été retrouvées chez 29,84% patients. Après les résultats de la PCR, la prise en charge a été modifiée chez 70 patients (56,45%).Conclusion : le diagnostic des infections gastro-intestinales par la PCR multiplexe nous a permis une prise en charge optimale des patients. Des études ultérieures doivent être réalisées afin d’évaluer l’impact économique de la PCR multiplex

Common infections acquired in intensive care: Microbiological aspects and risk factors

Nosocomial infections are a serious health problem resulting in an enormous burden of morbidity and mortality rates, and high health care costs. The various microorganisms implicated in nosocomial infections were not known for causing recalcitrant nosocomial infections, they are opportunistic pathogens and hence pose a challenge to patients especially those with immunocompromised conditions. Patients at the intensive care unit are the most at risk of these hospital-acquired infections The infections usually encountered in intensive care unit (ICU) include urinary tract infection, pneumonia, tuberculosis, gastroenteritis. The main risk factors for these infections can be divided into three key groups: those related to patient characteristics and underlying diseases, those related to the acute disease process, and those related to the use of invasive diagnostic or therapeutic procedures. Incidence of ICU-acquired infections vary between hospitals and according to the type of population studied, being highest in burn units and surgical and trauma ICUs and lowest in coronary care units.The major preventive effort to reducing the risk of nosocomial infections should be focused on hospitals and other health care facilities. The responsible health authority should develop a national (or regional) programme to support hospitals. Such programmes must assess and promote good health care, appropriate isolation, sterilization, and other practices, staff training, and epidemiological surveillance should be developed

Vancomycin-resistant Enterococcus faecium in an Immunocompromised Patient

Over the last decades, Vancomycin-resistant Enterococcus, namely Enterococcus faecium, has emerged worldwide as a dreaded nosocomial pathogen, particularly in immunocompromised patients. Vancomycin-resistant Enterococcus infections remain rare but threatening, leading to high mortality rates, primarily because of limited treatment options.We once reported a case of nosocomial bacteremia caused by vancomycin-resistant Enterococcus faecium in a patient with acute myeloid leukemia. During his hospitalization for chemotherapy, the patient presented febrile neutropenic episodes, and his blood culture grew Enterococcus faecium that was resistant to vancomycin with a minimum inhibitory concentration > 256 mg/L by the E-test. The polymerase chaine reaction amplification revealed the presence of the VanA/VanB genes, and the resistance to both vancomycin and teicoplanin is consistent with the VanA phenotype. The patient died before starting appropriate antibiotic treatment.This case report highlights the importance of early diagnosis of Vancomycin-resistant Enterococcus infections, particularly in patients with impaired host defenses, in order to ensure a rapid infection management. It is the first case of Vancomycin-resistant Enterococcus reported in our microbiology laboratory. We also aim to emphasize the need of strict measures to control the spread of Vancomycin-resistant Enterococcus strains.

Changes in the Epidemiology of Respiratory Pathogens in Children during the COVID-19 Pandemic

Since the outbreak of the COVID-19 pandemic, a significant decrease in non-COVID-19 respiratory illnesses were observed, suggesting that the implementation of measures against COVID-19 affected the transmission of other respiratory pathogens. The aim of this study was to highlight the changes in the epidemiology of respiratory pathogens in children during the COVID-19 pandemic. All children with Severe Acute respiratory illness admitted to the pediatric departments between January 2018 and December 2021 with negative COVID-19 PCR, were enrolled. The detection of respiratory pathogens was made by the Film Array Respiratory Panel. A total of 902 respiratory specimens were tested. A significantly lower positivity rate during the COVID-19 period was found (p = 0.006), especially in infants under 6 months (p = 0.008). There was a substantial absence of detection of Respiratory Syncytial Virus and Influenza A during the winter season following the outbreak of the pandemic (p < 0.05; p = 0.002 respectively). An inter-seasonal resurgence of Respiratory Syncytial Virus was noted. Human Rhinovirus was detected throughout the year, and more prevalent in winter during COVID-19 (p = 0.0002). These changes could be explained by the impact of the implementation of preventive measures related to the COVID-19 pandemic on the transmission of respiratory pathogens in children