Facteurs pronostiques des pneumopathies acquises sous ventilation mécanique en réanimation polyvalente du CHU d'Angre (RCI) / Prognostic factors for pneumopathy acquired under mechanical ventilation in multi-purpose resuscitation at the Angre CHU (RCI)

Objectifs : Identifier les facteurs de mauvais pronostic des pneumopathies acquises sous ventilation mécanique(PAVM) afin d'améliorer leur prise en charge.Patients et methode : Etude prospective, descriptive et analytique portant sur les patients admis en réanimation du CHU d'Angré du 1er novembre 2019 au 31 juillet 2021 et ayant présenté une PAVM.Resultats : Nous avons colligé 43 patients sur 625 admissions soit 6,88%. L'âge moyen était de 49,06 ans. Le sex ratio était de 0,38. Le principal motif d'admission était le coma avec 88,37%. L'HTA et le diabète étaient les principaux antécédents .Les PAVM précoces représentaient 53,49%. Le Klebsiella pneumoniae était le principal germe. Les patients intubés à l'admission représentaient 79,07%. La durée moyenne de ventilation était de 26,95 jours et la durée moyenne d'hospitalisation était de 30,8140 jours. Une antibiothérapie probabiliste a été réalisée chez 75,76% des patients. La mortalité était de 76,74%. Les facteurs de mortalité étaient une durée de ventilation mécanique supérieure à 15 jours et l'âge supérieur à 50 ans.Conclusion :La mortalité secondaire au PAVM demeure élevée. L'identification des deux facteurs pronostiques devrait améliorer la prise en charge ultérieure de tous nouveaux cas

Objectives: To identify the factors of poor prognosis of ventilator-associated lung disease (VAP) in order to improve their management. Patients and method: Prospective, descriptive and analytical study of patients admitted to intensive care at the Angré University Hospital from November 1, 2019 to July 31, 2021 and having presented VAP.Results: We collected 43 patients out of 625 admissions, i.e. 6.88%. The average age was 49.06 years. The sex ratio was 0.38. The main reason for admission was coma with 88.37%. Hypertension and diabetes were the main antecedents. Early VAP accounted for 53.49%. Klebsiella pneumoniae was the main germ. Patients intubated on admission accounted for 79.07%. The average duration of ventilation was 26.95 days and the average duration of hospitalization was 30.8140 days. Probabilistic antibiotic therapy was performed in 75.76% of patients. Mortality was 76.74%. The mortality factors were duration of mechanical ventilation greater than 15 days and age greater than 50 years.Conclusion:Secondary mortality from VAP remains high. The identification of the two prognostic factors should improve the subsequent management of all new cases.

Profiles of sugar fermenting bacteria of the oral cavity among children with dental caries attending stomatology services at Ruhengeri referral hospital in Musanze District, Northern Rwanda

Background: Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. Objective: This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. Materials and Methods: This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. Results: About 67.6% were male, while children of age 7­9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x2 = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901­0.5785), S. aureus (x2 = 34.59, P < 0.00001, 95% CI = 0.3541­0.6292), Enterobacter aerogenes (x2 = 13.5, P = 0.000239, 95% CI = 0.151­0.4622), Serratia marcescens (x2 = 11.64, P = 0.00645, 95% CI = 0.1275­0.4418) and Klebsiella pneumonia (x2 = 13.51, P = 0.000237, 95% CI = 0.1511­0.4623) were significantly associated with dental caries. Teeth loss (x2 = 51.04, P < 0.00001, 95% CI = 0.4757­0.7205), teeth pain (x2 = 5.05, P = 0.0246, 95% CI = 0.0249­0.33499), and infection (x2 = 4.73, P = 0.02964, 95% CI = 0.0186­0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Conclusion: Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

High prevalence of multi-drug resistant klebsiella pneumoniae in a tertiary teaching hospital in western Kenya

Introduction: Klebsiella pneumoniae is a gram negative enterobacteriaciae commonly associated with nosocomial infections. Multidrug resistant strains are increasingly being reported with corresponding increase in morbidity and mortality. The study outlines the epidemiology and antibiotic resistance pattern of K. pneumonia over a 10 year period in Moi Teaching and Referral Hospital; Eldoret; Kenya. Methodology and Study Design: This is a retrospective analysis of all the blood culture results for K. pneumoniae isolates in the hospital for the period 2002-2013. Results: K. pneumoniae accounted for 23% of the hospital isolates (231/1356) during the study period; of these; 82.6% were from the New Born Unit. Most of the isolates were multi drug resistant with highest resistance of over 80% to Penicillins; Cephalosporins; Macrolides; Tetracyclines; Sulphonamides; Lincosamides and Chloramphenicol. Aminoglycoside and Quinolone resistance was also high at 49.2% and 41.3% respectively. The lowest resistance rates were documented for Carbapenems (23.2%). For specific antibiotics; there was high resistance to commonly used antibiotics (over 80% for Ceftriaxone; Cefipime; Gentamycin and Ceftazidime). The antibiotics with least resistance were Amikacin and Meropenem (21% and 7 % respectively). Conclusion: There was a high prevalence of multidrug resistant K. pneumoniae isolates in the hospital; the majority originated from the New Born Unit. Resistance to third generation Cephalosporins and Gentamycin was high while Meropenem and Amikacin had the least resistance

Epidemiologie des souches de Klebsiella pneumoniae productrices de Beta-lactamases a spectre elargi dans un hopital universitaire au Senegal; 2011

Objectifs : Au cours de ces dix dernieres annees; la resistance bacterienne aux antibiotiques; particulierement par production de ?-lactamases a spectre elargi (BLSE); est devenue un probleme majeur de sante publique. L'objectif de cette etude est de determiner la prevalence des souches de Klebsiella pneumoniae BLSE au CHNU Le Dantec; Dakar; Senegal. Methodes : Il s'agit d'une etude retrospective sur une periode de 12 mois portant sur 139 souches de K. pneumoniae. La detection des BLSE a ete effectuee par la methode de diffusion par double disque. Resultats : Parmi les 139 souches de K. pneumoniae etudiees; 44 (31;7) etaient productrices de BLSE. Trente trois (75) de ces 44 souches etaient d'origine nosocomiale (p = 0;016). Ces souches etaient surtout isolees chez les patients hospitalises dans les unites de soins intensifs (USI : 45;4 ; p = 0;031) et provenaient principalement de prelevements d'urines (59) et de pus (25). Toutes les souches de K. pneumoniae etaient resistantes a l'Amoxicilline; a la Piperacilline et a la Cefalotine. La majorite des souches de K. pneumoniae BLSE avait en outre une resistance a l'association sulfamethoxazole/trimethoprime (95;2); a la Gentamicine (78;6); a la Ciprofloxacine (67;4) et a l'Amikacine (41). Par contre; elles demeurent tres sensibles a l'Imipeneme et a la Fosfomycine. Conclusion : La resistance des enterobacteries; notamment K. pneumoniae; aux fluoroquinolones par production de BLSE devient de plus en plus preoccupante. Ceci suggere une utilisation plus rationnelle des fluoroquinolones; en particulier dans les traitements de premiere intension des infections du tractus urinaire

Production of extended spectrum beta-lactamases of urinary isolates of Escherichia coli and Klesiella pneumoniae in Ahmadu Bello University Teaching Hospital; Zaria; Nigeria

Multidrug resistant strains of Klebsiella pneumoniae and Escherichia coli constitute a problem in many hospitals. The antibiotic susceptibility profile and the Production of Extended Spetrum Beta-Lactamase (ESBL) of the strains of Klebsiella pneumoniae and Escherichia coli were assessed by the Kirby-Bauer technique and the modified disc diffusion technique respectively. Out of a total of 65 urinary specimens submitted to the Medical Microbiology laboratory at the Ahmadu Bello University Teaching Hospital; Shika-Zaria; Nigeria; 50 isolates consisting of 33 (66) Escherichia coli and 17 (34) strains of Klebsiella pneumoniae were recovered from patients suspected to have Urinary Tract Infections (UTIs). Of these 50 isolates; 15(30) were ESBL producers; made up of 6/17 (35.3) ESBL-positive Klebsiella pneumoniae isolates and 9/33 (27.3) ESBL-positive E. coli isolates. The susceptibility of the ESBL-positive Klebsiella pneumoniae isolates to ciprofloxacin; ofloxacin and amikacin were 64.7; 82.4 and 82.4 respectively; while the susceptibility of the ESBL-positive E. coli isolates were: ciprofloxacin (57.6); ofloxacin (48.5) and amikacin (84.8). All (100) of the ESBL-positive E. coli isolates and 3/6 (50) of the ESBL-positive Klebsiella pneumoniae isolates had Multiple Antibiotic Resistance (MAR) index of greater than 0.3 which is an indication that they originated from an environment where antibiotics are frequently used. It is important to determine the prevalence and antibiotic susceptibility of ESBL-producing clinical isolates as a guide to clinicians for the chemotherapy and there should be effective infection control policies to curb their spread in the hospital setting

Antibiogram of Klebsiella Pneumoniae urinary isolates of apparently healthy individuals in Osogbo Metropolis; Nigeria

One thousand (1;000) urine samples from apparently healthy subjects were cultured for Klebsiella pneumoniae and its antibiotic susceptibility profile to commonly used antimicrobial drugs was determined. The study was conducted in two randomly selected local government areas within Osogbo metropolis. The occurrence rate of Klebsiella pneumoniae was 38 (3.8) and isolate were highly resistant to Tetracycline (92.1); Amoxyllin (76.3) and Co-trimoxazole (71.9). Resistance to gentamicin was moderate (63.2) while Ofloxacin; nitrofurantoin; ciprofloxacin; nalidixic acid and pefloxacin were very effective with 92.1; 84.2; 78.9and 76.3respectively sensitive to it and Cephalexin (57.9) was moderately sensitive. More females

Infections nosocomiales a Klebsiella pneumoniae au CHU de Fann; Dakar

18 souches de Klebsiella pneumoniae ont ete isolees de malades hospitalises au CHU de Fann a Dakar pour affections neurologiques (par hemocultures et ECBU) et a partir de mains de personnels soignants. 18 souches isolees de malades provenant d'autres services ont servi de temoins. Toutes les souches ont ete testees a differents antibiotiques par la methode de diffusion en gelose et une lecture interpretative realisee. Les souches responsables d'infections nosocomiales se sont averees plus resistantes : 57;14 pour cent de phenotype de resistance contre 16;67 pour cent pour les temoins (p=0;02 pour cent). Les phenotypes notes sont : la production de penicillinase a tres haut niveau (28;57 pour cent) et la production de B-lactamase a spectre elargi (28;57 pour cent). L'amikacine (87;5 pour cent) et la Ciprofloxacine (100 pour cent) sont les antibiotiques les plus efficaces; tandis que le cotrimoxazole (31;25 pour cent) reste le moins actif sur les souches. Le profil electrophoretique des ADN bacteriens montre une grande diversite de souches; ce qui fait penser a une contamination par des sources externes