Cocci gram positive infection: regain registry

The Gram positive coccus infections were always preoccupying. In Tunisia, the epidemiological, clinics, therapeutic data concerning these infections remain insufficient. The main objective of this national epidemiological investigation achieved in 13 hospital units in Tunisia is to identify the criteria of choice of antibiotherapy and the profile of patients hospitalized for an infection to Gram positive cocci. This study included 450 patients with an average of 45.35 +/- 21.23 years of which 299 [66.4%] of men and 316 [70.2%] hospitalized in care unit. Two hundred fifty eight patients [62.2%] had one or several medical antecedents, and 145 [32.2%] one or several surgical antecedents. The diabetes [18%] and the chronic renal insufficiency [13.2%] were the two most frequent comorbidities. Signs of gravity to the admission were noted at least 14% of the patients and about 20% of the patients had presented a severe sepsis or a septic shock. The staphylococci [65.4%] were the most frequently the Gram positive cocci isolated follow-up by the streptococci [24.7%]. The resistance of the Gram positive cocci to glycopeptides concerned only one stump cf negative coagulase staphylococcus. Staphylococcus aureus is more frequently responsible for infections of skin and the soft cloths, bone and joint infections and severe sepsis. The rate of success clinic is more elevated in the infectious illness services [84.2% vs 55.3% p<0.0001], whereas mortality is more elevated the services of resuscitation [19.3% vs 3% p<0.0001]. The factors of bad prognosis are age>60 years, in the septic shock, the arterial hypotension to the admission, a score of Glasgow<8 to the admission and an infection to Staphylococcus aureus

[Implementation of antimicrobial resistance surveillance and antibiotic consumption in an intensive care burn department]

The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units. Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measures. The study was conducted during a 5 year period [1 January 2000 to 31 December 2004]. The average number of admissions was 204/ year and the mean number of hospitalization was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics: imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density [AD] which takes into account the quantity of antibiotics in Grams converted to daily defined dose [DDD] and number of hospitalization days. The daily defined dose [DDD] was proposed by WHO. The calculation of the AD for each molecule was carried out according to the following formula: AD = Quantity consumed in grams for the particular antimicrobial X 1000 divided by DDD for that antimicrobial X number of days hospitalizptions. There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae [rs =0.93; p=0.02] The use of ceftazidime was not significantly associated with resistance to this molecule in P.aeruginosa [rs =0.76; p=0.13].Concerning the fluoroquinolones, there was statistically significant relationship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P.aeruginosa [rs=0.89,P=0.043]. Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P.aeruginosa [rs = 0 .87, p= 0.05]. However, the consumption of imipenem was not significantly correlated to resistance of this drug in P.aeruginosa [rs=0.45; P=0,4]. The monitoring of both antibiotic consumption and antibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics

[ distally based posterolateral thigh fasciocutaneous flap a study of 6 cases]

The authors report a series of six patients who underwent couverage by the posterolateral thigh fasciocutaneous flap for cutaneous defects of the posterior surface of the knee. The defects were of various origin: post-traumatic in one case, post-infectious after excision of a phlegmon in a second case, and secondary to a release of a post bum retraction of the popliteal fossa in 4 cases. The majority of patients were men with an average age of 22 years. The patients were examined again about 2 years and a half later on average with results considered to be stable and of excellent quality on the cutaneous and functional level

[Disarticulation of the shoulder due to a high voltage electrical burn about 2 cases]

The high-voltage electrical bums cause an exceedingly high rate of morbidity resulting from the massive necrosis of deeper structures often necessitating major limb amputations. The authors report two rare cases of high-voltage electrical burns occurring accidentally, with a 49 and 19-year-old men, after an indirect contact with a high-voltage line. These high-voltage electrical burus caused massive necrosis and extended necrosis in the upper limb requiring the recourse to a disarticulation the shoulder. The indications and the operative techniques used are discussed