Faecal carriage of multi-drug resistant Enterobacteriaceae in hospitalized children at University Teaching Hospital Sylvanus Olympio of Lomé, Togo

Background: High prevalence of infections and associated antibiotherapy may put children at increased risk for development of multidrug-resistance (MDR), mostly to bacterial infections. The objective of this study therefore was to determine the prevalence of gastrointestinal carriage of MDR Enterobacteriaceae among hospitalized children in the Paediatric department of Sylvanus Olympio University Hospital, Lomé, Togo.Methodology: A descriptive cross-sectional study was carried out on randomly selected hospitalized children in the Paediatric wards of the hospital from November 03 to November 10, 2020, after obtaining informed consent from their parents/guardians. Rectal swabs and stool samples were collected from each participant and cultured for isolation of members of the family Enterobacteriaceae on Hektoen enteric agar containing 4 µg/L cefotaxime, which was incubated aerobically at 37oC for 24 hours. The isolates were identified using in-house biochemical tests. Antibiotic susceptibility test (AST) of each isolate to a panel of antibiotics including ertapenem and imipenem was done by the disc diffusion method and interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints version 2020 V.1.1. ESBL production was detected by the double-disc synergy test of amoxicillin and clavulanic acid, and resistance to carbapenem was inferred by resistance to ertapenem and imipenem discs in the AST. Multi-drug resistance (MDR) was defined as resistance to at least three families of antibiotics. Statistical analysis of data was carried out on Excel 2010 and EPI INFO 7.2 and p value < 0.05 was considered to be statistical significance. Results: A total of 70 hospitalized children during the study period were randomly recruited with an average age of 4 years 3 days and a range of 1 day to 18 years. The male gender was predominant (54.3%) with a M: F ratio of 1.2. Samples were culture positive in 85.7% (60/70) and a total of 72 species of Enterobacteriaceae were isolated in 93.3% (56/60) of these cultures. Escherichia coli was the most frequently isolated species(56.9%, 41/72). More than 90% (65/72) of the isolates were resistant to ampicillin, 58.3% (42/72) to third generation cephalosporins, 59.7% (43/72) to fourth generation cephalosporins, 43% (31/72) to aminoglycosides, 55.6% (40/72) were multi-drug resistant, 48.6% (35/72) were ESBL-producing strains, and 6.9% (5/72) were carbapenem resistant. Eighty-three percent (29/35) of ESBL-producing and all the carbapenem resistant isolates (5/5) were recovered from children on antibiotic therapy. The prevalence of ESBL-producing phenotypes among culture-positive children on antibiotic treatment (72.5%, 29/40) was significantly higher than among culture-positive children not on antibiotic treatment (20.0%, 4/20), indicating that antibiotic therapy was significantly associated with carriage of MDR isolates (OR=10.545, 95% CI=2.882-38.590, p=0.0002). Conclusion: The high faecal carriage rate of MDR Enterobacteriaceae, which are all ESBL-producing strains, in this study is worrying. There is urgent need to develop measures to monitor and limit the spread of these MDR organisms in children and the community in Togo

Assessment of the performance of six in vitro diagnostic kits for qualitative detection of hepatitis B virus surface antigen (HBsAg) in human serum or plasma in Lomé, Togo

Background: Several in vitro diagnostic (IVD) test kits for hepatitis B surface antigen (HBsAg) are commercially available. The question is whether they are performing well for both screening and diagnosis or not? Thus, this study aimed to evaluate the performance of six commercially available HBsAg detection kits in Togo. Methods: This study was conducted at the National Reference Center for HIV/STI testing in Lomé (CNR-VIH/IST), Togo. Reference sera used for the assessment were collected from blood donors and patients with history of hepatitis B viral (HBV) infection between 2008 and 2014, and includes 200 non-reactive HBsAg and 150 reactive HBsAg sera that were confirmed with a reference method which consisted of the combination of an ELISA, a RDT, and a molecular test. Four ELISA kits (EKOlab ELISA-HBsAg; HEPALISA ULTRA; HEPALISA; Murex AgHBs Version 3) and two RDTs kits (ACON AgHBs and OnSite HBsAg Rapid Test-Cassette) were then evaluated using these serum samples. The EPI-INFO software version 7.2 was used to determine the 95% confidence interval and performed statistical analysis. Results: Reference serum samples were collected from the population with 65.0% under 40 years of age and 61.2% males. The sensitivity of the 4 ELISA tests compared to the reference method was 100%. Apart from the HEPALISA test with a specificity of 100.0%, the specificity of the other three ELISA tests (Murex HBsAg version 3, HEPALISA ULTRA and EKOlab ELISA-HBsAg) were 98.4%, 97.3% and 91.8% respectively. For the RDTs, the sensitivity of ACON HBsAg and OnSite HBsAg Rapid Test-Cassette was 70.0% and 95.6% respectively while the specificity was 100.0% for both. Conclusion: The ELISA tests evaluated were more sensitive than the RDTs, and HEPALISA test was the most efficient. Of the two RDTs, the OnSite HBsAg Rapid Test-Cassette was more sensitive. Our findings highlight the need for onsite verification of in vitro diagnostic kits for qualitative detection of hepatitis B surface antigen before their routine use in Togo. Keywords: HBV, HBsAg, Performance, IVD tes

High faecal carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) among hospitalized patients at Sylvanus Olympio Teaching Hospital, Lomé, Togo in 2019

Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) are a global health concern, associated with increased morbidity and mortality. Even in the absence of infections, colonization by these pathogens is still a great threat because of the risk of cross transfer among hospitalized patients. Faecal carriage of ESBL-PE remained poorly documented in Africa. This study aimed to determine faecal carriage rate of ESBL-PE, factors associated with carriage, and antimicrobial susceptibility of the strains among hospitalized patients at Sylvanus Olympio Teaching Hospitals (CHU SO) in Lomé, Togo. Methodology: This was a cross-sectional study of 105 randomly selected hospitalized patients between September and November 2019. Socio-demographic and clinical data as well as rectal swabs were collected after obtaining the consent of the selected participants. Rectal swabs were cultured on selective bromocresol purple (BCP) lactose agar containing 6µg/l ceftazidime, for isolation of Enterobacteriaceae. Identification of each isolate was performed using Uriselect 4 medium and API 20E. Antibiotic susceptibility of the bacterial isolates was performed by the Bauer-Kirby agar disc diffusion test and interpreted according to CASFM-EUCAST recommendations. Results: The faecal carriage rate of ESBL-PE among selected hospitalized patients was 80.9% (85/105). Escherichia coli was the most frequent bacteria 69.5% (73/105), followed by Klebsiella pneumoniae 22.8% (24/105). The antibiotic profile of ESBL producing Escherichia coli showed resistance to amoxycillin+clavulanic acid (72.6%), ticarcillin+clavulanic acid (82.2%), piperacillin+tazobactam (30.1%), cefoxitin (30.1%) ciprofloxacin (84.9%), levofloxacin (76.7%), nalidixic acid (83.6%), chloramphenicol (26.0%), gentamicin (49.3%), sulfamethoxazole-trimethoprim (86.3%), imipenem (5.5%), and ertapenem (21.9%). All (100%) isolates were sensitive to amikacin and fosfomycin. None of the characteristics or risk factors assessed was significantly associated with faecal carriage of ESBL-PE. Conclusion: Faecal carriage rate of ESBL-PE in these hospitalized patients was very high, but no factor was associated with carriage of ESBL-PE among the study population. Implementation of infection control measures, and surveillance are needed to limit the spread of these resistant pathogens within CHU SO healthcare facilities

Les Fractures De La Patella Chez L’adulte

Objectives: to determine the epidemiological aspects, the different techniques of surgical fixation of the patella fractures and the results. Patients and methods: this was a retrospective study from January 1, 2013 to December 31, 2017 and included the records of patients aged 15 years and older surgically treated for a patella fracture in our center. Results: The work involved 36 patients including 28 men (77.8%) and 8 women (22.2%) with a mean age of 35.9 years. High way trauma were the first cause of these fractures. Fractures were open in 44.4% of cases. Type II according to Ricard and Moulay classification was the most represented with 58.3% of cases. The majority of the patients, 80.5%, were treated by rigging. Five (5) cases of hematoma, one (1) postoperative infection, and three (3) cases of knee stiffness complicated the short- and medium-term follow-up. With an average follow-up of 2 years 6 months, radiologically, normal consolidation was achieved in 86.1% of cases. Two (2) cases of delayed consolidation and three (3) cases of nonunion have been noted. Three (3) cases of patellofemoral osteoarthritis appeared at two years. From the functional point of view, according to the Bosman score, 27.8% were excellent, 63.9% were good, 8.3% were bad, and the cable rigging seemed to give excellent and good results. Conclusion: the treatment of transverse fractures of the patella must be exclusively surgical. Guying is an osteosynthesis technique of choice. Nevertheless complications including knee stiffness, non-union and patellofemoral osteoarthritis are not uncommo

PLoS One

CONCLUSION: This study showed the diversity of circulating HPV genotypes in Togo. Programs of HPV vaccination and early detection of benign or precancerous lesions should be implemented to reduce cancer-related comorbidities

Floating knee: epidemiology and results of treatment

Introduction: Floating Knee is the term applied to ipsilateral fractures of the femur and tibia. Management of this complex injury has been variously described in the literature. This retrospective study was designed to present our experience with treatment of this injury, its complications and the functional results of these patients. Material and Methods: Between January 2004 and December 2007, all floating knee injuries that were managed during the study period were included. The patients were divided according to Fraser's classification. Functional assessment and final outcome was measured using the Karlstrom and Olerud's criteria. Results: Our study included 43 patients with 43 floating knee injuries. There were 32 males and 11 females with a mean age of 37 years. All patients had sustained their injuries in motor vehicle accidents. Thirty nine associated injuries were noted in the 43 patients. According to Fraser's classification, there were 21 type I, 10 type IIa, 7 type IIb, and 5 type IIc. Most of the floating knee injuries were treated with antegrade intramedullary nailing for both the femur and tibia. The mean follow up was 24.8 months. All the fractures united within a reasonable time except for three femur and 14 tibias. The complications encountered were one case of fat embolism, eight case of knee stiffness, 10 cases of delayed union, nine cases of infections, and seven cases of nonunion. Assessment by the Karlstrom criteria revealed 12 excellent results, 19 good results, 4 acceptable results, and 8 poor results. Analysis showed that surgical results were significantly associated with Fraser type classification of floating knee injuries (p = 0.003), the severity of soft tissue injury in the leg (grade III opened fracture) (p = 0.008), and associate lesions (p = 0.001). Conclusion: In patients suffering from floating knees, early fixation is recommended since it has several advantages with few systemic complications. We found Floating knee injuries to be a group of complex injuries that needed careful assessment to detect poor prognostic factors. Combination of all these would determine the ultimate outcome of these patients.Key words: Floating knee, Intramedullary fixation, Associate lesions, Surgical treatment

Fractures Des Plateaux Tibiaux : Aspects Epidemiologiques Et Therapeutiques

Objectif : Déterminer les aspects épidémiologiques et thérapeutiques des fractures des plateaux tibiaux prises en charges dans le département de chirurgie orthopédique et traumatologique du CHU-TOKOIN de Lomé.Matériels et Méthodes : Il s’agissait d’une étude rétrospective qui s’est étendue sur une période de 5ans et a concerné 75 cas de fractures des plateaux tibiaux.Résultats : Les fractures des plateaux tibiaux ont représenté 2,5% des traumatismes et 8,5% des fractures du membre inférieur. L’age moyen était de 42,7ans avec une sex-ratio de 2,9 en faveur des hommes. Les accidents de la voie publique ont été les principales circonstances de survenue (84,0%). Le membre inférieur gauche a été concerné dans 39 cas, le droit dans 35 cas. Le plateau tibial latéral a été atteint dans 43 cas, le médial dans 12 cas et les deux plateaux dans 20 cas. La majorité des lésions élémentaires étaient des fractures enfoncement-séparation. Selon la classification de Duparc et Ficat, nous avons noté 29 cas de fractures uni-tubérositaires, 22 cas de fractures spino-tubérositaires et 24 cas de fractures bitubérositaires. Plusieurs modalités thérapeutiques ont été utilisées. Le traitement chirurgical a été réalisé dans 28 cas. Le recul moyen a été de 13 mois. La consolidation a été acquise dans 71 cas dans un délai moyen de 5,3 mois. Nous avons noté une dégradation de la qualité de la réduction (26 cas de très bonne et bonne qualité de la réduction). Le déficit de l’extension a été en moyenne de 8° avec un maximum de 24° chez deux patients. Le score moyen de Rasmussen a été de 19.Conclusion : Les fractures des plateaux tibiaux constituent un traumatisme peu fréquent (2,5%) avec une prédominance masculine. Le traitement non chirurgical a été d’indication fréquente. Mais ces résultats ont été décevants. Nous proposons donc un changement d’attitude dans la prise de ces fractures.Mots clés : Fracture, plateau tibial, épidémiologie, arthrose, chirurgie.ABSTRACTObjective: To determine the epidemiologic and therapeutic aspects of tibial plateau fractures treated in the department of orthopaedic surgery of Tokoin teaching hospital of Lome. Materials and Methods: It was a retrospective study which extended over a period of 5 years. Results: There were 75 cases of tibial plateau fracture. They represented 2.5% of the traumatisms and 8.5% of the fractures of the lower extremity. The Middle Age was of 42.7ans with a sex-ratio of 2.9 in favour of the men. The road traffic was the principal circumstances of occurred (84.0%). The left lower extremity was concerned in 39 cases, the right in 35 cases. The lateral plateau was reached in 43 cases, the medial in 12 cases and the two tibial plateaus in 20 cases. The majority of the elementary lesions were fractures depression-separation. According to the classification of Duparc and Ficat, we have noted 29 uni-tubérositaires fractures, 22 cases of fractures spino-tubérositaires and 24 cases of fractures Bi-tubérositaires. Several therapeutic methods were used. The surgical treatment was carried out in 28 cases. The follow-up was 13 month. The consolidation was acquired in 71 cases within 5.3 average month. We noted a deterioration of the quality of the reduction (26 cases of very good and good quality of the reduction). The deficit of the extension was on average 8° with a maximum of 24° among two patients. The average score of Rasmussen was of 19. Conclusion: Tibial plateau fractures are a frequent lesion (2.5%) with a male prevalence. The non surgical treatment was of frequent indication. But these results were disappointing. Therefore, we propose a change of attitude in the treatment of theses fractures.Key words: Tibial plateau, fracture, epidemiology, osteoarthritis, surgery

Agents bacteriens isoles lors de coprocultures realises de 2001 à 2011 au chu sylvanus olympio (ancien chu tokoin) de lome au Togo

Objectif: Faire le bilan de la coproculture sur 11ans au CHU Sylvanus OLYMPIO.Matériel et méthodes : Il s’agit d’une étude transversale descriptive à partir des registres archivés de coproculture de 2001 à 2011(11 ans).Les paramètres âge, sexe, motif de demande, service demandeur et le résultat de la coproculture ont été relevés. Les données ont été traitées avec Excel 2007.Résultats : Sur la période d’étude (11 ans), 2262 coprocultures ont été incluses et ont été analysées Elles avaient pour motif de demande : diarrhées (36,73%), suspicion de choléra (1,5%), syndrome infectieux (9,55%), fièvre typhoïde ou salmonelloses (8,67%) et autres (14,55%). Le sexe ration (M/F) était de 1, 26. Le taux de coprocultures positives étaient de 4%. Au sein des coprocultures positives, les prévalences des germes entéropathogènes étaient respectivement Vibrio cholerae (63%), Salmonella spp (26%), Escherichia coli (16%) et Shigella (15%).Les 34 souches de Vibrio cholerae isolées étaient du sérogroupe O1 dont 18 V.cholerae El Tor et 1 souche du sérotype Ogawa. Les 21 souches de Salmonella isolées étaient réparties en 7(33,33%) S. Typhimurium, 5(23,8%) Salmonella groupe C, 3(14,28%) Salmonella groupe B, (15,6%) Salmonella Enteritidis, 1(5,6%) Salmonella groupe A, 1(4,76%) Salmonella Typhi ; l’agglutination n’a pu être réalisée pour 3 souches (14,28%). Douze souches de Shigelles ont été isoléesdont 10 (83,3%) était S. flexneri, .Les Escherichia coli isolées chez des patients âgés de 8 mois à 27 mois étaient tous de sérotypes entéropathogènes (O55 B5, O111, O126, O119, O86, O128 B12, 026 B6, O124B17).Une souche de Shigella spp. était productrice de BLSE (Bêta Lactamase à Spectre Elargie), les souches d’entérobactéries était sensible aux céphalosporines, quinolones, aminosides, amoxicilline+ acide clavulanique et l’imipénème. Vibrio cholerae a été résistante à l’ampicilline, la colimycine et au chloramphenicol.Conclusion : Au Togo, Vibrio cholerae sérogroupe O1, Salmonella spp, Escherichia coli entéropathogènes, Shigella flexneri sont les principales bactéries retrouvées dans les gastroentérites lorsque la coproculture est positive.Mots clés : coproculture, bactéries, germes entéropathogènes, Lomé

Infections urinaires communautaires et acquises au Centre Hospitalier Universitaire Campus de Lomé: bacteries en cause

Introduction: Les infections urinaires sont des infections communes généralement retrouvées chez tous les individus. D’apparences banales, elles peuvent se compliquer avec risque de mortalité importante.Objectifs: déterminer les germes responsables d’infections urinaires communautaires et celles acquises en milieu hospitalier.Matériel et Méthode: il s’agit d’une étude descriptive transversale à visée rétrospective allant d’août 2010 à janvier 2012 à l’unité de Bactériologie du Centre hospitalier Campus. Etaient considérés comme décrivant une infection communautaire tout patient non hospitalisé et ceux hospitalisés, une infection acquise à l’hôpital. Les prélèvements souillés n’ont pas été inclus. L’analyse des échantillons s’est fait selon les procédures standardisées nationales et les identifications ont été faites sur milieu chromogène et dans certains cas sur galerie API. Les résultats ont été analysés par tranche d’âge ≤15 ans, 16-25, 26-45 et >45 ans.Résultats: 1039 patients ont été inclus ; 77,96% (n=810) patients externes et 22,04%.(n= 229) patients internes. Le sex ratio H/F était de 1,03 pour les externes et de 1,20 pour les hospitalisés. Chez les externes, les bactéries ont été plus identifiés au sein de la tranche d’âge des 26-45 ans (42,31% ; n=33). Escherichia coli était la plus retrouvée avec 42,30% (n=33) suivie de Klebsiella 33,33% (n=26) et des Staphylocoques 15,38% (n=12). En infections communautaires, un fort taux de positivité a été retrouvé au sein des patients de plus de 45 ans avec 63,33% (n=19). Klebsiella spp. était identifiée chez 40% (n=12) et était suivi d’Escherichia coli 36,66% (n=11).Conclusion: les infections urinaires communautaires sont causées par Escherichia coli tandis que Klebsiella spp. est le germe le plus fréquent dans les infections nosocomiales. Une bonne stratégie de lutte contre les infections nosocomiales associée à une étude sur leur sensibilité est nécessaire.Mots clés: infections urinaires communautaires, nosocomiales, uropathogènes, LoméEnglish Title: Community-acquired and nosocomial urinary tract infections at University Hospital Center Lome Campus: bacteria involvedEnglish AbstractIntroduction: Urinary tract infections are infections commonly found in all individuals one time of their life. They are easy to treat but they can be complicated with a high risk of mortality.Objectives: to determine bacteria responsible for community-acquired urinary tract infections and those acquired in the hospital.Material and Method: This is a cross-sectional descriptive study retrospective from August 2010 to January 2012 at the Bacteriology Unit of the Campus Hospital Center. Hospitalized patients were considered to have hospital-acquired infection and a community-acquired infection was for any non-hospitalized patient. Samples which contained more than one bacterium were not included. The samples were analyzed according to the national standard procedures and the identifications are made on chromogenic medium and in some cases on API gallery. The results were analyzed by age group ≤15 years, 16-25, 26-45 and> 45 years old.Results: 1039 patients were included; 77.96% (n = 810) outpatients and 22.04% (n = 229) internal patients. The sex ratio H / F was 1.03 for the outpatients and 1.20 for the hospitalized. Among the externs, the bacteria were more identified in the 26-45 age group (42.31%, n = 33). Escherichia coli was the most recovered with 42.30% (n = 33) followed by Klebsiella 33.33% (n = 26) and Staphylococci 15.38% (n = 12). In community infections, a high rate of positivity was found in patients over 45 years of age with 63.33% (n = 19). Klebsiella spp. was identified in 40% (n = 12) followed by Escherichia coli 36.66% (n = 11).Conclusion: Escherichia coli dominates community infections and Klebsiella spp isfound in nosocomial infections. A good strategy to fight nosocomial infections associated with a study on their sensitivity is necessary.Keywords: urinary tract infections, nosocomials, community- acquired, uropathogenic, Lom

Sensibilite des souches d’Escherichia coli isolees sur deux annees (2009 -2010) aux β-lactamines et quinolones au laboratoire de microbiologie du CHU Campus de Lome

Introduction: Escherichia coli est une bactérie retrouvée à l’état commensal dans le système digestif des animaux et des hommes. Elle devient responsable d’infections intestinales par acquisition de facteurs de pathogénicité. Elle est aussi la première bactérie responsable d’infections urinaires. Les molécules utilisées dans le traitement des infections dues à cette bactérie, appartiennent à deux familles principalement : β-lactamines et quinolones.Objectifs: étudier la sensibilité des souches d’E. coli aux β-lactamines et quinolones.Matériel et méthode: C’est une étude descriptive analytique réalisée de février 2009 à Décembre 2010 sur les registres archivés d’antibiogramme au sein du Centre hospitalier Campus de Lomé en son unité de bactériologie des services des laboratoires.Résultats: Au cours de ces deux années, 79,7% de résistance à l’amoxicilline a été notée. Pour l’association amoxicilline+ acide clavulanique, 76,9% de résistance ; 18,9% de résistance à la ceftriaxone. Les phénotypes de résistances suivants ont été observés : pénicillinase haut niveau (PHN), pénicillinase résistante aux inhibiteurs (TRI), bêtalactamase à spectre élargie (BLSE). Ainsi 03 souches ont présenté le phénotype PHN en 2009 contre 47 souches en 2010 ; 16 en 2009 pour les TRI contre 29 en 2010. En 2009, 4 souches étaient BLSE contre 19 en 2010. 52,4% résistants à la ciprofloxacine. 7,7%. En 2009, 15 souches sur les 47 testées soit 31,9% étaient résistantes à la ciprofloxacine (ciproR), contre 42 ciproR sur les 85 souches testées en 2010 soit 49,4%.Conclusion: la résistance à ces molécules clés vont en croissant et donc reste alarmant.Mots clés: E. coli, susceptibilité aux β -lactamines et quinolones, LoméEnglish Title: Sensitivity of the strains of Escherichia coli isolated from 2009 to 2010 to β -lactamines and quinolons in the microbiology laboratory of CHU Campus de LoméEnglish AbstractIntroduction: Escherichia coli is a bacterium found in the commensal state in the digestive system of animals and humans. It becomes responsible for intestinal infections by acquisition of pathogenicity factors. It is also the first bacterium responsible for urinary  infections. The molecules used in the treatment of infections due to this bacterium belong to two families mainly: β-lactams and quinolons.Objectives: To study the susceptibility of E. coli strains to β-lactams and quinolons.Materials and methods: This is a descriptive analytical study carried out from february 2009 to December, 2010 on the archived antibiogram records in the Centre Hospitalier Campus of Lome in its bacteriology unit of laboratory services.Results: During these two years, 79.7% resistance to amoxicillin was noted. For the amoxicillin + clavulanic acid combination, 76.9% resistance; 18.9% resistance to ceftriaxone. The following resistance phenotypes were observed: high-level penicillinase (HLP), inhibitor-resistant penicillinase (IRT), expanded spectrum beta-lactamase (ESBL). Thus, 03 strains presented the phenotype PHN in 2009 against 47 strains in 2010; 16 in 2009 for IRT compared to 29 in 2010. In 2009, 4 strains were ESBL compared to 19 in 2010. 52.4% resistant to ciprofloxacin. 7.7%. In 2009, 15 of the 47 strains tested were 31.9% resistant to ciprofloxacin (ciproR), compared with 42 ciproR of the 85 strains tested in 2010, ie 49.4%.Conclusion: Resistance to these key molecules is increasing and therefore remains alarming.Keywords: E. coli, susceptibility to β-lactams and quinolones, Lom