Etude de la flore bactérienne contaminant les téléphones mobiles avant et après la désinfection: comparaison entre les professionnels soignants de l’hôpital militaire d’instruction Mohammed V de Rabat et les témoins

Introduction: L'objectif de notre travail était évaluer la contamination microbienne des téléphones  mobiles utilisés par les personnels soignants des différents services de l'hôpital militaire d'instructions Mohammed V de Rabat et la comparer à celui d'une population témoin et aussi démontrer l'efficacité des solutions hydroalcoolique dans la désinfection de ces téléphones mobiles. Méthodes: Il s'agit d'une étude descriptive transversale réalisée sur une période de 9 mois entre  septembre 2010 et juin 2011, dans le service de bactériologie de l'hôpital militaire d'Instruction  Mohammed V. Résultats: L'étude bactériologique a été faite sur 240 téléphones mobiles dont 50%  provenaient de personnels de sante. Le taux de contamination bactérienne de tous les téléphones mobiles était de 100%. Les cultures des bactéries isolées au niveau des téléphones mobiles du personnel médical étaient plus polymorphes que celles de la population témoin (p=0,028). Parmi 437 bactéries isolées:  223(51%) provenaient de téléphones de personnels de santé et 214(49%) de téléphones de la population témoin avec une différence qui n'était pas statistiquement significative(p>0,05) sauf pour les isolats  deStaphylocoque à coagulase négative et Staphylococcus aureus. Les bactéries isolées étaient représentées par: Staphylocoque à coagulase (57,7%), Staphylococcus aureus (18,1%),   Corynebacterium sp (18,8%),Bacillus sp (2,3%) et autres (2,2%).La différence entre la prévalence des bactéries isolées selon les services et les fonctions des personnels de santé n'était pas statistiquementsignificative (p>0,05). La désinfection des téléphones portables par la solution hydroalcoolique a réduit à 99,5% le nombre des colonies.Conclusion: Ce travail montre que les téléphones portables pourraient jouer un rôle dans la transmission des infections nosocomiales et communautaires. Dans le cadre de prévention de ces risques, il faut  sensibiliser les utilisateurs des téléphones mobiles l'importance du lavage des mains et l'utilisation des solutions hydro alcoolique pour désinfecter aussi bien les téléphones portables que les mains

Aspects épidémiologiques, cliniques, cytologiques et immunophénotypiques des leucémies aiguës chez les enfants: expérience du laboratoire d’hématologie du Centre Hospitalier Universitaire IBN Sina

L’objectif de ce travail était de décrire les caractéristiques  épidémiologiques, cytologiques et immunophénotypiques des leucémies aigues (LA) chez les enfants diagnostiqués au Centre Hospitalo-universitaire (CHU) Ibn Sina et de déterminer aussi la concordance entre les résultats de la cytologie à ceux de l’immunophénotypage. Il s’agit d’une étude transversale réalisée au laboratoire d’hématologie du CHU Ibn Sina entre Juin 2012 et Mai 2014. Parmi 104 cas de LA diagnostiqués, 52% étaient des garçons avec un sex-ratio H/F= 1,32 et l’âge médian de 5,7 ans. La répartition des différents types de LA était : LA lymphoïde (LAL) (74%), LA myéloïde(LAM) (20,2%), LA biphénotypique(LAB) (65,8%). Parmi les LAL ,78% ont été classé LAL B et 22% comme LALT. Les signes cliniques étaient principalement présentés par le syndrome tumoral (73,1%),la fièvre (61%) et syndrome hémorragique (50%).Les anomalies de l’hémogrammeles plus fréquents étaient : thrombopénie (89,4%), anémie (86,5%), hyperleucocytose (79,8%).Le taux des blastes périphérique et médullaires était statistiquement élevé pour LAL que pour LAM et LAB (p<0,001). Le taux de rechute et de mortalité était respectivement de 21,2% et16, 3%.Le taux de concordance entre les résultats de la cytologie et ceux de l’immunophénotypage était de 92,7% pour LAL et de 82,6% pour LAM. Le diagnostic des LA se base toujours en premier sur la cytologie. L’immunophénotypage nous a permis de faire une meilleure distinction entre les leucémies aiguës. La prise en charge des LA pédiatriques est un problème majeur qui nécessite les centres spécialisés.Pan African Medical Journal 2016; 2

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

Comparaison de deux techniques d’antifongigramme en milieu gélosé sur Disque Bio-rad® et sur Comprimé Neo-sensitabs®

Introduction : Le but de notre étude est d’évaluer les performances des deux techniques d’antifongigramme en milieu gélosé par disques Bio-rad® et comprimés Neo-Sensitabs®. Matériels et méthodes : Une étude prospective menée au laboratoire de Parasitologie-Mycologie de l’HMIMV du 07 février au 07 août 2012.Dès la réception des hémocultures et des prélèvements des sites périphériques, l’identification des souches de Candidaest effectuée et la réalisation de l’antifongigramme est faite sur disque Bio-rad® et comprimé Neo-sensitabs®. Résultats : Au total 38 souches de Candida sp testées ; 39,5%(n=15) de C.albicans et 60,5%(n=23) de C.non albicans. La méthode Neo-sensitabs ®est comparée à celle de Bio-rad®, nous avons obtenu une concordance de 100% ; 100% ; 97,4% ; 94,7% ; 94,7% et 73% pour l’amphotéricine B, itraconazole, fluconazole, voriconazole, posaconazole et 5-fluorocytosine respectivement. Discussion : C.albicans est l’espèce prédominante. L’amphotéricine B est le plus efficace des antifongiques testés. Les résultats de cette étude montre une bonne corrélation entre la méthode Neo-sensitabs®et Bio-rad® pour l’amphotéricine B, itraconazole, fluconazole, voriconazole, posaconazole le voriconazole et tandis que pour 5-fluorocytosine, le pourcentage de concordance entre les deux méthodes est faible. Conclusion : Au vu de nos résultats, il semble que les deux méthodes d’antifongigramme testées obtiennent des résultats plus ou moins équivalents

In vitro evaluation of the susceptibility of Acinetobacter baumannii isolates to antiseptics and disinfectants: comparison between clinical and environmental isolates

Abstract Background This study aims to assess the susceptibility of Acinetobacter baumannii isolates to the antiseptics and disinfectants commonly used, and to the non-approved product. Methods This is a prospective study carried out from February to August 2015, in the Bacteriology department of Mohammed V Military Teaching hospital of Rabat on A.baumannii isolates collected from colonized and/or infected patients and environmental samples. The antiseptics and disinfectants susceptibility testing was assessed using the micromethod validated in our department. The antiseptics and disinfectants studied were: 70% ethyl alcohol, chlorhexidine, povidone-iodine, didecyldimethylammonium chloride and a commercial product which was presented as a hospital disinfectant (non-registered product). Results Povidone-iodine, 0.5% chlorhexidine digluconate, 70% ethyl alcohol and didecyl dimethyl ammonium chloride in combination with N- (3-aminopropyl) -N-dodecylpropane-1, 3-diamine were effective against all the 81 A.baumannii isolates tested, and their logarithmic reduction ≥ 5 were observed in 100% of the isolates in their undiluted form. The strains isolated from patients were more resistant than environmental strains: at a dilution of ½ for 70% ethyl alcohol (37.77% vs 11.11%, p = 0.007) and at a dilution of 1/10 (100% vs 69.44%, p < 0.001) for povidone iodine. The non-registered product was ineffective with a resistance rate of 96.29% at a dilution of 1/50, 45.67% at a dilution of 1/10 and 13.58% in its purest form. Conclusion Our study revealed the effectiveness of the main disinfectants and antiseptics used in Morocco; three antiseptics tested were effective in their purest form against the 81 A.baumannii isolates. Regarding disinfectants, our results showed an efficacy of didecyl dimethyl ammonium at the recommended use concentration and in its purest form. This study emphasizes the need for using disinfectants and antiseptics in dilutions recommended by the manufacturer because the insufficient dilutions of these products are not effective. Our findings also demonstrated an inefficiency of the non-registered product against A.baumanii isolates. However, the non-registered products should be prohibited

Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda

Background: While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design: The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results: We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Conclusions: Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility readiness, and ensure consistency of facility capacity to provide quality care at the district level

Clonal diversity and detection of carbapenem resistance encoding genes among multidrug-resistant Acinetobacter baumannii isolates recovered from patients and environment in two intensive care units in a Moroccan hospital

Background Carbapenem-resistant Acinetobacter baumannii has recently been defined by the World Health Organization as a critical pathogen. The aim of this study was to compare clonal diversity and carbapenemase-encoding genes of A. baumannii isolates collected from colonized or infected patients and hospital environment in two intensive care units (ICUs) in Morocco. Methods The patient and environmental sampling was carried out in the medical and surgical ICUs of Mohammed V Military teaching hospital from March to August 2015. All A. baumannii isolates recovered from clinical and environmental samples, were identified using routine microbiological techniques and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Antimicrobial susceptibility testing was performed using disc diffusion method. The carbapenemase-encoding genes were screened for by PCR. Clonal relatedness was analyzed by digestion of the DNA with low frequency restriction enzymes and pulsed field gel electrophoresis (PFGE) and the multi locus sequence typing (MLST) was performed on two selected isolates from two major pulsotypes. Results A total of 83 multidrug-resistant A. baumannii isolates were collected: 47 clinical isolates and 36 environmental isolates. All isolates were positive for the bla OXA51-like and bla OXA23-like genes. The coexistence of bla NDM-1 /bla OXA-23-like and bla OXA 24-like /bla OXA-23-like were detected in 27 (32.5%) and 2 (2.4%) of A. baumannii isolates, respectively. The environmental samples and the fecally-colonized patients were significantly identified (p < 0.05) as the most common sites of isolation of NDM-1-harboring isolates. PFGE grouped all isolates into 9 distinct clusters with two major groups (0007 and 0008) containing up to 59% of the isolates. The pulsotype 0008 corresponds to sequence type (ST) 195 while pulsotype 0007 corresponds to ST 1089.The genetic similarity between the clinical and environmental isolates was observed in 80/83 = 96.4% of all isolates, belonging to 7 pulsotypes. Conclusion This study shows that the clonal spread of environmental A. baumannii isolates is related to that of clinical isolates recovered from colonized or infected patients, being both associated with a high prevalence of the bla OXA23-like and bla NDM-1genes. These findings emphasize the need for prioritizing the bio-cleaning of the hospital environment to control and prevent the dissemination of A. baumannii clonal lineages