[Community-acquired pleuropneumonia in children: bacteriological and therapeutic challenges]

Background: Community-acquired pleuropneumonia [CPP] is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality

Aim: To study clinical and paraclinical features of CPP in children and to establish a common therapeutic strategy

Methods: Our retrospective study included patients who were hospitalized for CPP between 2004 and 2012. All data were collected from patients' medical files. Statistical analysis was made by Epi-Info 6

Results: One hundred and sixty four patients were registered. The mean age was 32 months [15 days - 14.5 years]. The hospital incidence of CPP doubled between 2004 and 2012. The symptomatology was dominated by fever [93.9%], cough [56.7%] and dyspnea [48.1%]. The pleural effusion was frequently moderately abundant and loculated. Pleural sample, performed in 53.6% of cases, was the most beneficial bacteriological examination [p=10-6 ]. The bacteriological confirmation was attained in 44.5% of cases with the predominance of Staphylococcus aureus [59%] followed by Streptococcus pneumoniae [26%]. The S. aureus occurred basically in most young infants [p=0.04] and was responsible for the most severe cases [p=0.01]. The CPP management included heterogeneous intravenous antibiotics associated with a pleural drainage in 40% of cases. The quarter of our patients were transferred to an intensive care unit. Six patients died

Conclusion: The bacteriological confirmation is difficult. Pleural aspiration is the key tool. S. aureus is the first microorganism followed by S. pneumoniae. A therapeutic strategy is proposed based on large spectrum intravenous antibiotics. The pleural drainage indication is limited

Streptococcus pyogenes isolated in a Tunisian pediatric population: Emm types, T types, virulence factors and genes of resistance to macrolide and tetracycline

Aims: The aims of our study were to determine epidemiological markers of S. pyogenes isolates as well as the antimicrobial activities against these strains and we determined the macrolide and tetracycline resistance genes. Methodology and Results: We studied the epidemiological markers of 148 Streptococcus pyogenes isolates collected from children in Tunisia between October 2000 and December 2006. Antimicrobial susceptibility was performed according to the CA-SFM guidelines. T-serotypes were determined by slide agglutination. Virulence factor genes (pyrogenic exotoxin gene and superantigen gene) and macrolide and tetracycline resistance genes were revealed by PCR method. The emm types were determined by sequencing the variable 5’ end of the emm gene. The predominant markers were T3/12/13/B3264, emm22 and speB. All isolates were susceptible to β-lactam antibiotics (penicillin and amoxicillin). Resistance to tetracycline was observed in 65 isolates (43.9%), and strains harboured the tet(M) gene alone in 95.4% (62/65) or both tet(M) and tet(L) genes in 4.6% (3/65). Six strains (4%) were resistant to erythromycin among these; five were also resistant to clindamycin. Five strains of genotypes emm11, emm22, emm28, and emm76 expressed the constitutive MLSB phenotype with the presence of the ermB gene alone (3 strains) or in association with the mefA gene (2 strains). One emm4 strain expressed the M phenotype and harboured the mefA gene alone. Conclusion, Significance and Impact of Study: This work provided the molecular characteristics of paediatric S. pyogenes isolates in Tunisia. Our study affirmed that this micro-organism still susceptible to β-lactam antibiotics but showed an increase in macrolide resistance. We concluded that the epidemiology and the molecular characteristics of S. pyogenes strains were different around the world.

Management of purpura fulminans about 21 cases: diagnostic delay and therapeutic problems

To evaluate the diagnostic delay and therapeutic insufficiencies delay before the transfer in ICU of the children admitted in the ICU of the children's hospital of Tunis with a purpura fulminans [PF] A retrospective, descriptive study, of children with PF referred between January 2000 and January 2006 to a the paediatric intensive care unit [PICU] of the children's hospital of Tunis. The PF diagnosis was retained in any child presenting a feverish purpura and circulatory insufficiency signs. The optimal diagnostic and therapeutic charge taking was defined in three levels: parental, the first line doctors, and the hospital doctors. The symptoms' duration and the various treatments which were lavished to the patients were taken from the medical observations of the patients transferred in our PICU. Twenty one observations were collected. Twelve patients [57,1%] were addressed by a doctor exerting in a dispensary or by a free practicing doctor, 5 patients [23,8%] were transferred from a regional hospital and 4 children [19,1%] directly consulted the children hospital of Tunis urgencies .delayed parental recognitionoccured in 11 children. The PF diagnosis was not evoked by the first line doctor in 62%. Eleven [52,4%] of the children with meningococcal disease were seen but not admitted by a doctor in the 48 hours before admission. Apart from 2 patients [9,5%] who were hospitalized in reanimation directly of the urgencies, all the other patients forwarded by a general pediatry service. In general pediatry, the PF diagnosis was not evoked in 3 cases [15.8%], 31,6% of patients had unnecessary a lumbar punctures and shock was not recognised or treated in 26,3%. Twelve patients [52,2%] died. The duration of hospitalization in general pediatry is significantly higher among deceased patients [5,5 +/- 6,6 hours] than among the surviving patients [2,6 +/- 1,5 hours]; p<0,5. Suboptimal treatement in PF is due to failure of parents, general practioners and hospital doctors to recognise specific features of the illness. Improvement in outcome could be achieved by public education and better training of clinicians in recognition, resuscitation, and stabilisation of seriously ill children

Pseudomonas aeruginosa: etude multicentrique de la resistance aux antibiotiques [1999-2000]

A retrospective multicentric study was carried out over a period of 2 years [1999-2000]. 2659 strains of pseudomonas aeruginosa were collected from 4 university hospitals [charles Nicolle Hospital, pediatric Hospital and national center of Bone Marrow Transplantation in Tunis, Habib Bourguiba Hospital in Sfax]. Epidemiological profile and antibiotic susceptibility were analyesd. All bacteria were identified by conventional methods and antibiotic susceptibility tests were performed according to CA-SFM guidelines. The strains were recovered essrntially from surgical wards [33%] and intensive care units [22%]. Pseudomonas aeruginosa was isolated mainly from pus [36%] urine [32%]and respiratory samples [18%]. 25% of strains were resistant to ticarcilline, 18% to cefsulodine, 9% to ceftazidime, 14% to imipenem and amikacin and 25% to ciprofloxacin. Moreover, the resistance rates varied from hospital to hospital and from unit to another. The resistant strains were isolated particularly from urology and intensive care units: respectively 62% and 39% for ticarcilline; 26% and 13% for ceftazidime. The acquired resistance to b-lactams seems largely due to penicillinase production. The frequency of resistance to ceftazidime was the lowest and seem associated to chromosomal cephalosporinase over production

Profil epidemiologique des infections a H. influenzae en Tunisie

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

Identification biochimique des especes du genre enterococcus isolees en milieu hospitalier a Tunis, sensibilite aux antibiotiques

Conventional tests were used to determine the species identities of clinical isolates of 142 enterococci strains. The majority of strains [87,3%] were E. faecalis, while E. faecium accounted for 7.1%, the other species [E. durans, E. hirae, E. raffinosus, E. casseliflavus, E. avium] accounted for only 5,6% of our isolates. None of the clinical isolates was positive for beta-lactamase. The high-level gentamicin resistance was present in 25 [21%] of 142 E. faecalis strains tested and one strain of E. avium. All the strains were susceptible to vancomycin