Augmentation de la résistance aux antibiotiques des Entérobactéries isolées à l’Institut National d’Hygiène de Lomé de 2010 à 2017: Increase in antibiotic resistance of Enterobacteriaceae isolated at the National Institute of Hygiene of Lomé from 2010 to 2017

Introduction: La résistance des Entérobactéries aux antibiotiques est un problème d’importance croissante en pratique médicale. L’objectif de cette étude était de déterminer le profil de résistance aux antibiotiques des Entérobactéries isolées à l’institut national d’hygiène (INH) de Lomé et d’analyser son évolution dans le temps. Méthodes: Il s’agissait d’une analyse rétrospective, sur une période de huit ans (2010-2017), portant sur l’ensemble des souches d’Entérobactéries isolées des prélèvements pathologiques analysés au laboratoire de bactériologie de l’INH. Résultats: Au total, 5910 Entérobactéries ont été isolées majoritairement des urines (59,59%), avec une prédominance d’Escherichia coli (63,93%) suivie de Klebsiella spp (22,86%). Entre 2010 et 2017, le taux de résistance des souches d’Escherichia coli a augmenté significativement de 18,69% à 39,26% (p< 0,0001) à la Ceftazidime ; de 1,68% à 40,22% à la Ceftriaxone (p< 0,0001) et de 42,37% à 63,23% (p< 0,0001) à la Ciprofloxacine. La résistance des souches de Klebsiella spp à la Ceftazidime a augmenté significativement de 25,26% à 42,54% (p< 0,0001) et celle à la Ceftriaxone de 2,17% à 41,79% (p< 0,0001) respectivement de 2010 à 2017. Conclusion: L’augmentation de la résistance des Entérobactéries aux antibiotiques et surtout l’évolution des résistances aux Céphalosporines de 3e Génération et aux Fluoroquinolones est un phénomène réel. Ceci exposera à des difficultés de prise en charge thérapeutique et nécessite la mise en place des dispositions idoines. Background: Antibiotic resistance in Enterobacteriaceae is a growing problem in medical practice. The objective of this study was to determine the antibiotic resistance profile of Enterobacteriaceae isolated at the National Institute of Hygiene (INH) of Lomé and to analyse its evolution over time. Method: This was a retrospective analysis, over a period of eight years (2010-2017), of all strains of Enterobacteriaceae isolated from pathological samples analysed in the bacteriology laboratory of the INH. Results: A total of 5910 Enterobacteriaceae were isolated mainly from urine (59.59%), with a predominance of Escherichia coli (63.93%) followed by Klebsiella spp (22.86%). Between 2010 and 2017, the resistance rate of Escherichia coli strains increased significantly from 18.69% to 39.26% (p<0.0001) to Ceftazidime; from 1.68% to 40.22% to Ceftriaxone (p<0.0001) and from 42.37% to 63.23% (p<0.0001) to Ciprofloxacin. Resistance of Klebsiella spp strains to Ceftazidime increased significantly from 25.26% to 42.54% (p< 0.0001) and to Ceftriaxone from 2.17% to 41.79% (p< 0.0001) respectively from 2010 to 2017. Conclusion: The increase in antibiotic resistance in Enterobacteriaceae and especially the evolution of resistance to 3rd generation cephalosporins and fluoroquinolones is a real phenomenon. This will lead to difficulties in therapeutic management and requires the implementation of appropriate measures

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Gradual emergence followed by exponential spread of the SARS-CoV-2 Omicron variant in Africa.

The geographic and evolutionary origins of the SARS-CoV-2 Omicron variant (BA.1), which was first detected mid-November 2021 in Southern Africa, remain unknown. We tested 13,097 COVID-19 patients sampled between mid-2021 to early 2022 from 22 African countries for BA.1 by real-time RT-PCR. By November-December 2021, BA.1 had replaced the Delta variant in all African sub-regions following a South-North gradient, with a peak Rt of 4.1. Polymerase chain reaction and near-full genome sequencing data revealed genetically diverse Omicron ancestors already existed across Africa by August 2021. Mutations, altering viral tropism, replication and immune escape, gradually accumulated in the spike gene. Omicron ancestors were therefore present in several African countries months before Omicron dominated transmission. These data also indicate that travel bans are ineffective in the face of undetected and widespread infection

Retraction.

This is a retraction of 'Gradual emergence followed by exponential spread of the SARS-CoV-2 Omicron variant in Africa' 10.1126/science.add873