Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia

Objective: To assess the prevalence of ESBL producing and carbapenem resistant Klebsiella pneumoniae isolated from in-come and out-come patients at Sahloul-university hospital.Methods: A retrospective study over a 3 years period (January 2012 and December 2014) focused on 2160 strains of Klebsiella pneumoniae. Statistical analysis was carried out using SPSS program. ESBL detection was performed using a double disc diffusion method and carbapenemase detection was realized by Rosco-Disk kit.Results: A total of 2160 Klebsiella pneumoniae strains were isolated during the period of the study, 26.2% (n=566) were ESBL-producers and 15.8% (n=342) showed resistance to carbapenem. The wards most affected by these strains were basically urology and intensive care units. Eighty four percent of studied strains (203/241) were resistant to temocillin, which correlate with the production of a class D (OXA-48-like) carbapenemase and 7% (17/241) showed sensitivity to EDTA and dipicolinic acid, which indicate the production of metallo-enzyme. The rate of resistance to colistin remains low.Conclusion: Resistance of Enterobacteriaceae, including K. pneumoniae, to third generation cephalosporins (3rd GC) and carbapenem through the mechanism of ESBL and carbapenemases production is becoming increasingly worrying. This suggests a morerational use of antibiotics, as well as the rigorous application of hygiene measurement.Keywords: Klebsiella pneumoniae, epidemiology, ESBL, carbapenemase, phenotypic screening

Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia

Objective: To assess the prevalence of ESBL producing and carbapenem resistant Klebsiella pneumoniae isolated from in-come and out-come patients at Sahloul-university hospital. Methods: A retrospective study over a 3 years period (January 2012 and December 2014) focused on 2160 strains of Klebsiella pneumoniae. Statistical analysis was carried out using SPSS program. ESBL detection was performed using a double disc diffusion method and carbapenemase detection was realized by Rosco-Disk kit. Results: A total of 2160 Klebsiella pneumoniae strains were isolated during the period of the study, 26.2% (n=566) were ESBL-producers and 15.8% (n=342) showed resistance to carbapenem. The wards most affected by these strains were basically urology and intensive care units. Eighty four percent of studied strains (203/241) were resistant to temocillin, which correlate with the production of a class D (OXA-48-like) carbapenemase and 7% (17/241) showed sensitivity to EDTA and dipicolinic acid, which indicate the production of metallo-enzyme. The rate of resistance to colistin remains low. Conclusion: Resistance of Enterobacteriaceae, including K. pneumoniae, to third generation cephalosporins (3rd GC) and carbapenem through the mechanism of ESBL and carbapenemases production is becoming increasingly worrying. This suggests a more rational use of antibiotics, as well as the rigorous application of hygiene measurement. DOI: https://dx.doi.org/10.4314/ahs.v19i2.24 Cite as: Messaoudi A, Mansour W, Jaidane N, Chaouch C, Bouja\ue2far N, Bouall\ue8gue O. Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University hospital-Sousse, Tunisia. Afri Health Sci.2019;19(2): 2008-2020. https://dx.doi.org/10.4314/ahs.v19i2.2

Clinical characteristics and outcomes of critically ill COVID-19 patients in Sfax, Tunisia

Background Africa, like the rest of the world, has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. However, only a few studies covering this subject in Africa have been published. Methods We conducted a retrospective study of critically ill adult COVID-19 patients—all of whom had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection—admitted to the intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Results A total of 96 patients were admitted into our ICU for respiratory distress due to COVID-19 infection. Mean age was 62.4±12.8 years and median age was 64 years. Mean arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was 105±60 and ≤300 in all cases but one. Oxygen support was required for all patients (100%) and invasive mechanical ventilation for 38 (40%). Prone positioning was applied in 67 patients (70%). Within the study period, 47 of the 96 patients died (49%). Multivariate analysis showed that the factors associated with poor outcome were the development of acute renal failure (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.75–25.9), the use of mechanical ventilation (OR, 5.8; 95% CI, 1.54–22.0), and serum cholinesterase (SChE) activity lower than 5,000 UI/L (OR, 5.0; 95% CI, 1.34–19). Conclusions In this retrospective cohort study of critically ill patients admitted to the ICU in Sfax, Tunisia, for acute respiratory failure following COVID-19 infection, the mortality rate was high. The development of acute renal failure, the use of mechanical ventilation, and SChE activity lower than 5,000 UI/L were associated with a poor outcome

Self assembly of a novel Cu(II) complex, (C6H9N2)(2)[CuCl4]: experimental, computational, and molecular docking survey

International audienceIn the title salt complex (C6H9N2)(2)[CuCl4] symbolized along this work by (2A5PCuCl(4)), the Cu2+ cation is coordinated by four chloride anions and adopts a distorted tetrahedral geometry. This compound has been crystallized in the monoclinic space group C2/c and the following parameters obtained are a = 13.0244(19) angstrom, b = 8.3149(11) angstrom, c = 16.001(2) angstrom, beta = 93.730(6)degrees, Z = 4, V = 1729.2(4) angstrom(3) at 150 K. In the crystal structure, the atomic arrangement consists of isolated tetrahedral entities connected to the organic groups by weak hydrogen bonds N-H horizontal ellipsis Cl and C-H horizontal ellipsis Cl forming a three-dimensional network. The Hirshfeld surface analysis shows on two-dimensional fingerprints maps the great dominance of H horizontal ellipsis Cl and H horizontal ellipsis H contacts in the crystal packaging. The geometrical optimization, electronic, topological and biological properties of 2A5PCuCl(4) were theoretically studied using DFT. The HOMO and LUMO analysis are used to decide the charge transfer within the structure. Natural bond orbital analysis was carried out to study hyperconjugative interactions. Optical transmission measurements investigated by UV-visible and photoluminescence spectroscopy are carried out on a crystalline thin-film of 2A5PCuCl(4) show the detection of two absorption bands centered at 316 and 519 nm coherent with those observed in the perovskites based on CuCl4. Photoluminescence measurements showed two peaks at around 433 and 472 nm. The unaided-eye-detectable blue luminescence emission comes from the excitonic transition in the CuCl4 anions

Conservative management for acute renal rupture in blunt trauma

Renal injuries are commonly reported in blunt abdominal trauma and are usually associated to other abdominal injuries. Renal rupture may be misdiagnosed and its management, especially in severe lesions, is still controversial. We describe the case of renal rupture diagnosed in the Emergency Department and conservatively managed. The outcome was good thanks to the early diagnosis and the management of the renal trauma. Conservative management in renal rupture is possible in stable patients provided that the imaging is early done

Physical and Chemical Influences of Different Extraction Techniques for Essential Oil Recovery from Citrus sinensis Peels

International audienceThe orange tree (Citrus sinensis) is a species of fruit shrubs of the Rutaceae family. Essential oils from citrus peels are widely used in various agro-food and pharmaceutical preparations and hence they must be recovered using green extraction methods. In this study, we compare the efficiency of five extraction techniques (conventional hydro-distillation (HD), Salt-assisted extraction by HD (S-HD), Ultrasound-assisted extraction by HD (US-HD), Enzymes-assisted extraction by HD (E-HD), and Solvent-free microwave extraction (SFME)) for the extraction of essential oil from Citrus sinensis peels. The essential oils were compared with regard to their chemical compositions, light microscopy analysis, total energy consumption, and antioxidant activity. GC/MS analysis allowed the identification of 28 compounds in the different essential oils. The principal identified component was limonene (86.7 %, 87.9 %, 88.2 %, 88.3 %, 85.4 % for HD, S-HD, US-HD, E-HD, and SFME, respectively), followed by beta-pinene, sabinene, linalool and alpha-terpineol. The obtained essential oils were analyzed for their antioxidant activity using the 2,2-diphenyl-1-picrylhydrazyl radical scavenging method. Results indicated that essential oil extracted by SFME showed the highest antioxidant activity (IC50 = 0.0175 mg/ml) and extraction yield (3.58 % +/- 0.05) consuming lower energy (0.312 kW h(-1)) in a shorter extraction time (30 min) comparing with the other tested techniques. Hence, the SFME would be an interesting green method for the recovery of essential oil from C. sinensis peels useful in agro-food, cosmetic, and pharmaceutical preparations as an alternative for undesirable chemical additives

A rare case of acute poster ior reversible encephalopathy syndrome involving brainstem in a child

Posterior reversible encephalopathy syndrome (PRES) is a rare entity involving brainstem in very rare reported cases. We describe here the case of a boy who presented to the emergency department for headaches and strabismus. Diagnosis of PRES was retained by magnetic resonance imaging. The causes were blood pressure urgency and renal failure. Location of lesions was very rarely reported in literature and neurological troubles were persistent. Emergency physicians should evocate PRES each time there is a clinical context associated with neurological troubles by a normal brain CT scan. Early diagnosis is very important to treat its causes and improve prognosis

Synthesis, Characterization and Catalytic Studies of Chromium(III) Porphyrin Complex with axial cyanate ligands

International audienceWe report the synthesis and the spectroscopic, structural and electrochemical characterization of a new chromium(III) coordination compound namely the bis(cyanato-N)[meso-tetratolylporphyrinato]chromate(III) (cryptand-222)potassium dihydrate [K(crypt-222)][CrIII(TTP)(NCO)2]•2H2O (complex I). This compound crystallizes in the orthorhombic crystal system with the non-centrosymmetric space group C2221. The chromium and the potassium atoms are located at special positions in a two-fold axis. The crystal lattice of complex I is stabilized by O-H…O, C-H…O, C-H…N and C-H…pi intermolecular contacts involving the negatively charged [CrIII(TTP)(NCO)2]- species, the [K(crypt-222)]+ counterions and the two non-coordinated water molecules. Further insights on these weak intermolecular contacts are provided by the Hirshfeld surface analysis. Molecular electrostatic potential (MEP) theoretical calculation on [K(crypt-222)][CrIII(TTP)(NCO)2]•2H2O are reported. The new Cr(III) complex was efficient as a catalyst in the decomposition of Rhodamine B (RbH) dye by hydrogen peroxide. This coordination compound was also tested as photocatalyst of the photodecomposition of RbH dye by molecular oxygen