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

[Community bacterial meningitis of the adult. study of 70 cases]

Through a retrospective study of 70 cases of acute bacterial meningitidis which have occurred in adults admitted in a Tunisian military hospital, we propose to analyze the characteristics of these infections and to release from them the factors of bad forecast. Fifty seven men [including 26 young military recruits old of less than 25 years] and 13 women old on average 40 years are hospitalized during the period of study [1989-2005]. The average time of hospitalization is of two days. Fever and the meningeal syndrome are not constant [95.7% and 61.4% of the cases]. With the admission, half of the patients have disorders of the conscience. Six patients are allowed in a table of meningococcemia. The average value of the white cells in cerebrospinal fluid [CSF] is of 4900 cells/mm3. A raised prote‹norachie and a hypoglycorachie are found respectively only in 84.3% and 91.4% of the cases. The direct examination of the CSF and the research of the soluble antigens are positive only in 27.1% and 25.8% of the cases respectively. A germ is isolated in the CSF in 51.4% from the cases or blood in 14% from the cases. Neisseria meningitidis [23 cases], Streptococcus pneumoniae [13 cases] are the most frequent germs. The serotype B of N. meningitidis is most frequent [8 cases]. The serotype W135 is isolated in 3 cases. The sensitivity to principal antibiotics of the isolated germs is constant. The average period of antibiotherapy is 15.6 days. A corticotherapy is prescribed among 6 patients. Fourty nine patients [70%] presented at least a complication. The evolution is favorable among 42 patients [60%]. Nineteen patients [27.1%] kept after-effects. Nine patients [12.9%] died. The advanced age [. 60 years], pneumococcic etiology, the presence of a state of shock, the recourse to artificial ventilation, a positive blood culture, an initial leucocytorachie < 100 cells/mm3, an initial glycorachie < 20% of the glycemia, one duration of hyperthermia of more than 3 days under treatment and the hospitalization in an intensive care unit are factors bad forecast among our patients. In spite of the progress made in their assumptions of responsibility, acute bacterial meningitidis remain a major cause of morbi-mortality. In military medium N meningitidis is the most frequent germ and most serious. Introduction of antimeningococcal vaccine is necessary and effective in these communities