Carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-23 in Tunisia

To analyze the mechanisms of resistance to carbapenems among imipenem resistant A. baumannii recovered from different wards at Charles Nicolle Hospital. From January to December 2007, 50 carbapenem-resistant A. baumannii isolates were recovered from hospitalized patients. MICs were performed by agar dilution method and interpreted according to CLSI guidelines. Metallo-beta-lactamase production was evaluated using imipenem-EDTA disk synergy test. PCR and DNA sequencing targeting blaOXA genes were performed and pulsed field gel electrophoresis was used for epidemiologic study. Most of the isolates were obtained from patients hospitalized in surgery [62%] and Intensive Care Units [22%]. All strains showed high level of resistance to ticarcillin [MIC50 > 2048micro g/ml], ticarcillin-clavulanic acid [MIC50 >1024micro g/ml], aztreonam [MIC50 = 512micro g/ml], ceftazidim [MIC50 = 512micro g/ml], imipenem [MIC50 = 512micro g/ml], meropenem [MIC50 =128micro g/ml] and cefepime [MIC50 = 256micro g/ml]. Metallo-beta-lactamase production was negative for all isolates. The co-existence of blaOXA-51-like/ blaOXA-23-like was detected in 82% [n= 41]. The genes blaOXA- 24-like and blaOXA-58-like were not found in any isolate. All isolates harboured a blaOXA-51-like gene. Sequencing confirmed the presence of blaOXA-23 and blaOXA-69 genes. Eight distinct patterns were observed [A: 41 isolates, B: 1 isolate, C: 1 isolate, D: 1 isolate, E: 1 isolate, F: 2 isolates, G: 1 isolate, H: 2 isolates]. Production of OXA-23 was the important mechanism of resistance to carbapenem among A. baumannii. Strengthening of prevention measures are required to control further spread of carbapenemases in Tunisia

[Evaluation of hand hygiene in healthcare staff of Charles Nicolle hospital of Tunis by questionnaire]

Known to be reservoir of bacteria, hands are implicated in bacteria cross-transmission which enhances nosocomial-acquired infection rates [NI] and outbreaks. Hand washing is then considered the first mean with authentic efficiency to prevent NI. To describe the situation of the hand hygiene at Charles Nicolle hospital of Tunis in order to identify problems that can oppose to the good execution of this practice. A descriptive transverse study performed in October 2006 where 600 questionnaires were distributed to healthcare staff of the hospital. Only 434 questionnaires were responded [158 doctors and 276 nurses]. Analysis of data obtained showed that hand washing was essentially practiced after each contact presumed to be contaminant for the healthcare person himself [80%] and was principally done with water and soap [82%]. Hydro-alcoholic solutions were rarely mentioned [17.1%]. The main reasons evoked for the non observance were unavailability of the necessary means [84.8%] and default of awareness [61.3%]. So, these results show a poor perception of the healthcare staff of on the importance of hand hygiene which they share the responsibility with healthcare managers. Thus, implication of all healthcare actors is necessary to ensure the good practice and mainly the observance of hand hygiene

Corynebacterium propinquum isolated from a pus collection in a patient with an osteosynthesis of the elbow

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

[Community-acquired pneumonia due to panton-valentine producing staphylococcus aureus: first description in Tunisia]

Community-acquired pneumonia clue to Panton-Valentine producing S. aureus is a serious infection recently described. Many cases have been reported worldwide. We report here the first case in Tunisia. Our patient is a previously healthy fourteen-year-old girl hospitalized for bilateral hypoxemic pneumonia. The clinical course had violently deteriorated two hours later, marked by massive hemoptysis that lead to rapid degradation of her hemodynamic state and death. Toxicologic research and blood cultures were negatives. A post- mortem pleural specimen culture yielded a meticillin-resistant Staphylococcus aureus strain that carried the Panton-Valentine leucocidin genes. Community-acquired pneumonia due to Panton-Valentine producing Staphylococcus aureus is a serious affection unrecognized in our country. Thus, this pathogen must imperatively be included in the spectrum of those responsibles for pulmonary infections in children and young adults

[Prospective epidemiologic study of group B streptococcus vaginal colonization in pregnant woman]

Group B streptococcus is known to be the principal medium responsible of maternal and severe neonatal infection. Assessing the prevalence of group B streptococcus [GBS] in our population, emphasize risk factors of GBS vaginal colonization and main characteristics of isolated strains. Prospective study of GBS vaginal colonization at admission for delivery upper to 34 amenorrhea weeks. Two hundred and seven vaginal swabs were carried out. Prevalence of GBS was 13%. Primigravida represents a risk factor of GBS vaginal colonization regarded to multigravida. False negative rate was 1,6%, All isolated strains were susceptible to penicillin C and to ampicilin, 44,4%were resistant to erythromycin. Systematic screening of GBS must be introduced in our population. Per partum antibioprophylaxis must consider susceptibility of isolated strains to antibiotics

Particularites bacteriologiques des infections urinaires chez l'enfant dans la region de Sousse, Tunisie

Urinary tract infection [UTI] is frequent in childhood. Our purpose is to determine the bacterioiogic profile of UT1 in children through a retrospective study of 1281 urinary specimens analysed in the Laboratory of Microbiology of F. Hached University hospital of Sousse between 1 997 and 2002 [2000 except]. The most Frequent pathogens recovered were E. coli [71%], K. pneumoniae [10%] P. mirabilis [8%], Staphylococcus [1,6%], P, aeruginosa [1%] and others [2%]. E. coli susceptibility to antibiotics was characterised by the high resistance percentage to amoxicillin [60%], to amoxicilline- acid clavulanic [54%] and catrimoxazole [40%]. The resistance percentage to third generation cepha-losporins, to aminoglycosides and to nitrofurane remained very low, respectively of 1,5%, 1% and 1%. High resistance rates among K. pneumoniae strains towards to amoxicillin -acid clavulanic and Cefotaxim, respectively of 63 and 39% were noticed. The resistance percentages to amikacin and cotrimoxazole were respectively of 17 and 65%, but only of 4% to nitrofurane. 70% of P. mirabilis strains were resistant to amoxicillin, 63% of them remained susceptible to amoxicillin acid clovulonic. No resistance was shown to amikacin against 31% towards cotrimoxozole