ABSTRACT
Introduction: Identifying the infecting bacterial flora is one of the main rules to be followed to ensure the success of antibiotherapy in the treatment of the infected diabetic foot
The aim of the work was to define the bacteriological profile of the bacteria causing the infection of the diabetic foot at the surgery unit B of Charles Nicolle's hospital in Tunis and determine the prognostic factors of this condition
Methods: It was an open prospective study. It concerned 100 diabetic patients operated on for diabetic foot infection. All patients had bacteriological samples taken through deep scraping and swabing carried out in the operating room
Results: The average age of patients was 59,5 +/- 11 years, with a sex-ratio of 2,4. The foot infection was represented in 82 % of cases by a wet gangrene. The enterobacteria were the most frequently isolated bacteria [73%], followed by streptococcus [10%], Staphylococcus aureus [9%]. The rate of multidrug-resistant bacteria was of 9,5%. The empiric antibiotic therapy used [fusidic acid +amoxicillin/ clavulanic acid] was inactiveon 44,1% of the isolated bacteria. When we compared the group of patients with unfavourable development [who have been reoperated] and the group of patients with favourable development, we have found two poor prognosis factors: arteritis [p=0,018 ; OR=23,7] and presence of multidrug-resistant bacteria [p=0,027 ; OR=5,8]
Conclusion: The enterobacteria were the main bacteria causing the infection of diabetic foot. The prognostic factors found, arteritis and isolation of multidrug-resistant bacteria, outpoint the importance of multidisciplinary care
ABSTRACT
Methicillin-resistant Staphylococcus aureus [MRSA] has become an increasingly important pathogen leading to hospital acquired infections. This study was done to confirm an outbreak of MRSA suspected at Charles Nicolle Hospital. From 26 April to 11 June 2002, six patients hospitalized in the dermatologic ward at Charles Nicolle hospital of Tunisia have developed infections caused by MRSA. An investigation of the outbreak has been detected a nasal carriage nurse. This carrier received topical mupirocin treatment to decolonize the anterior nares and the outbreak was stopped without further incident. Typing of the MRSA strains by pulsed field gel electrophoresis demonstrated the same pulsotype shared by all isolates showing that MRSA isolates belonged to a single clonal type responsible of outbreak. Colonized nurse was the source of MRSA dissemination. This report illustrates the risk of nosocomial outbreak linked to cares delivered by the staff personnel. More sensibilisation and the respect of strict hygienic measures should be emphasized
Subject(s)
Humans , Staphylococcal Infections/drug therapy , Disease Outbreaks , Hospitals , Health Personnel , Carrier State , Nose , Electrophoresis, Gel, Pulsed-FieldABSTRACT
Although non- diphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, they rarely account for clinical infections. Aim: we report a case of infection due to non- diphtherial corynebacteria, Corynebacterium propinquum. A Tunisian male patient of 67 years old was admitted to orthopedic surgery and traumatology ward of Charles Nicolle university hospital of Tunis [Tunisia] for a left elbow trauma. He was treated by osteosynthesis and received an antibioprophylactic therapy with amoxicilline-clavulanate and gentamicin association. No postoperative incident was noted. When he was readmitted a month later for the osteosynthesis material removal, clinical examination found a pus collection in the operated elbow. Specimen analysis showed a Gram positive stained bacilli identified as C.propinquum. The organism was resistant only to penicillin G and sulfamethoxazole-trimethoprim association. The patient was treated with ofloxacin [2g per day for 8 days] and gentamicin [160mg per day for 5 days] with clinical improvement. According to literature, infections due to C.propinquum are rare, occurring especially in patients with medical device or immunocompromised. Thus, this pathogen should be taken in consideration in such situations
Subject(s)
Humans , Male , Elbow/injuries , Suppuration , Fracture Fixation, Internal/adverse effectsABSTRACT
Haemophilus inluenzae, a commensal bacteria, is frequently incriminated in broncho pulmonary surinfections and severe diseases as meningitis, pneumonia and septic arthritis,particularly in young children. A multicenter study was conducted to establish the epidemiological profile of haemophilus influenzae, to determine the rate of antibiotics resistance for guide therapeutic and preventive strategies. The identification was based on the requirements for x and v factors, and the serotype b determined by agglutination. The betalactamase production was done by nitrocefin test. Antimicrobial susceptibility testing was determined on Muller Hinton chocolate agar with isovitalex. During the two year period, [January 1998 December 1999], 192 isolates of H. influenzae were collected, 61% were recovered from invasive infections [44 meninggitis, 8 bacteremia, 2 arthritis]. The serotype b was identified in 55.7% of cases, 67.3% were invasive strains. 24.5% of isolates were producing betalactamase particularly invasive serotype b strains. All isolates of H. influenzae were susceptible to cefotaxim and to ofloxacin. Resistance rates to other antibiotics were: erythromycin 56.2%, tetracycline 10.3%, rifampin 12%, chloramphenicol 1%, cotrimoxazole 16.5%, 11.5% amikacin and 20% gentamicin. The incidence of meningitis remained frequent in our country, involving the introducyion of the vaccination in offical calencedar. Nevertheless, the surveillance of H. influenzae invasives infections and the serotyping of isolates were necessary to evaluate the impact of the immunization