[Evaluation of carbapenem prescribing practices at the Mohammed VI University Hospital in Marrakech]

Carbapenems are antibiotics of last resort reserved for severe infections with resistant germs, and the abuse of which makes us fear the emergence of resistance to carbapenem. The objective of this survey is to evaluate the relevance of carbapenem prescriptions in the Mohammed VI CHU in Marrakech. This is a prospective evaluation performed on a given day in January 2017. Included were all hospitalization services at the Arrazi Hospital and the Mother Child Hospital of the Marrakech CHU Mohamed VI, including resuscitation services. The investigation concerned all hospitalized patients present in the department on the day of the survey and for whom a carbapenem prescription was made. During the study period, 30 patients were prescribed carbapenem, 63% in intensive care units and 37% in surgery. This carbapenem mainly concerned adults [57%] followed by newborns [33%]. The reason for introducing carbapenem antibiotics was mainly sepsis [46, 5%]. Carbapenems were prescribed as second-line therapy after initial clinical treatment [73, 5%]. The imipenem was the most frequently prescribed carbapenem [83, 5%]. 80% of the infections justifying this prescription were nosocomial. A prescription after microbiological documentation was only found in 9 cases. This evaluation helped to better understand the typology of carbapenem prescriptions in our context

[Epidemiology and susceptibility profile of blood culture isolates in a Moroccan university hospital center]

The antimicrobial therapy for the treatment of bacteremia is often empirical in the first 48 hours and based on the epidemiological knowledge of susceptibility profiles of the most common bacteria causing such infections. The aim of our study was to determine the epidemiological profile and the antibiotics susceptibility of bacteria identified in blood culture in a teaching hospital center, to improve the empirical antibiotherapy for the treatment of bacteremia. A retrospective study was carried out at the Microbiology laboratory of Mohammed VI hospital of Marrakech from January 2008 to June 2009. It included all the bacteria identified in blood culture. We collected 146 strains responsible for bacteremia. Gram-negative bacilli [BGN] represented 52.7%. The most frequently isolated species were Staphylococcus aureus [21.3%], Entrobacter cloacae [14%], Acinetobacter baumannii [12.3%] and Pseudomonas aeruginosa [8.9%]. The incidence of resistance to methicillin were 48.3% for Staphylococcus aureus. No resistance of glycopeptides was found among the enterococci and staphylococci isolates. 64.3% of enterobacteriaceae were resistant to third generation cephalosporins and had a broad-spectrum betalactamase phenotype. The proportion of non fermenting Gram negative bacilli resistant to imipenem was 49.9%. The resistance rate of Acinetobacter baumannii and Pseudomonas, aeruginosa was 49.9% for imipenem. To carry out an epidemiological control of bacteremic episodes occurring at every hospital, it is necessary to improve the empirical antibiotherapy

Nocardia brain abscess: a case report

Nocardiosis infections are rare, generally systemic, an occurring at the immuno compromised patient. The cerebral abscess with Nocardia is usually secondary to a pulmonary localization. Their bacteriological diagnosis and therapeutic management could be difficult. We report a case of cerebral abscess due to Nocardia in 47 years old patient treated with corticoids for a pulmonary confirmed sarcoidosis. He was hospitalized for a clinical feature in favour of an intra cranial expansive process. The diagnosis of Nocardiosis was suspected at direct examination of Gram stained smears and confirmed by the culture characteristics. The evolution was favorable after stereotaxic punction of the abscess and adapted antibiotherapy based on disc diffusion antibiogram. This observation emphasizes the interest of the bacteriological diagnosis for correct management of cerebral abscesses

[Clostriditm perfringens bacteraemia: a case report]

We report a case of resolutive bacteraemia due to Clostridium perfringens in an olderly patient with no predisposing factors or portal of entry. The patient presented a non specific infectious syndrome: high level CRP and fever; and was hospitalized for ischemic cardiopathy. Three cultures of peripheral blood have shown a growth in the first anaerobe one only, confirmed by the presence of Gram positive rods. Biochemical profile of the strain Api 20A [BioMerieux] allowed the identification of Clostridium perfringens at 99, 9%. The evolution under amoxicillin-clavulanic acid introduced before the second and the third blood culture permits a total recovering and disappearance of fever and pathologic levels of CRP