Bacteriological and therapeutic profile of diabetic foot infection: a prospective study of 100 patients

Introduction: Identifying the infecting bacterial flora is one of the main rules to be followed to ensure the success of antibiotherapy in the treatment of the infected diabetic foot

The aim of the work was to define the bacteriological profile of the bacteria causing the infection of the diabetic foot at the surgery unit B of Charles Nicolle's hospital in Tunis and determine the prognostic factors of this condition

Methods: It was an open prospective study. It concerned 100 diabetic patients operated on for diabetic foot infection. All patients had bacteriological samples taken through deep scraping and swabing carried out in the operating room

Results: The average age of patients was 59,5 +/- 11 years, with a sex-ratio of 2,4. The foot infection was represented in 82 % of cases by a wet gangrene. The enterobacteria were the most frequently isolated bacteria [73%], followed by streptococcus [10%], Staphylococcus aureus [9%]. The rate of multidrug-resistant bacteria was of 9,5%. The empiric antibiotic therapy used [fusidic acid +amoxicillin/ clavulanic acid] was inactiveon 44,1% of the isolated bacteria. When we compared the group of patients with unfavourable development [who have been reoperated] and the group of patients with favourable development, we have found two poor prognosis factors: arteritis [p=0,018 ; OR=23,7] and presence of multidrug-resistant bacteria [p=0,027 ; OR=5,8]

Conclusion: The enterobacteria were the main bacteria causing the infection of diabetic foot. The prognostic factors found, arteritis and isolation of multidrug-resistant bacteria, outpoint the importance of multidisciplinary care

Detection of PER 1 extended-spectrum beta-lactamase among nosocomial providencia stuartii isolates in Tunisia

The Emergence of extended-spectrum beta-lactamases [ESBLs] in Enterobacteriace species imparting resistance to thirdgeneration cephalosporins is a growing concern worldwide. This study was undertaken to characterize ESBL producers from clinical isolates of Providencia stuartii in Tunisia. We analysed ten non-duplicate ESBL positive, P. stuartii isolates collected in intensive care units of military Hospital in Tunisia from blood specimens and presented an extended-spectrum resistance phenotype. the presence of the blaPER-1 encoding genes was confirmed by polymerase chain reaction. We detected PER-1 in three of ten isolates of P. stuartii. The gene coding for this enzyme was located on a 100 kb conjugative plasmid that encoded a beta-lactamase with a pI of 5.3. This study suggests the spreading of this gene among P. stuartii. clinical strains in the next year in Tunisia

[Pancreatic pseudocysts complicated by hemorrhage and infection]

The occurrence of bleeding complications secondary to the development of pancreatic pseudocysts is rare but associated with high mortality. To report a case of pancreatic pseudocyst complicated by hemorrhage and infection A 62 years old patient with history of severe acute pancreatitis two months ago consulted for abdominal pain associate with fever and internal bleeding. CT scan showed a heterogeneous PK complicated by hematoma of the ACE and hemoperitoneum. The emergency surgical treatment showed a PK superinfected with erosion of the splenic artery. It was directed by a left splenopancreatectomy Therapeutic management of hemorrhagic complications of pancreatic pseudo cysts is surgery despite the contribution of art‚rio-embolisation

[Posterior uretral valves, about a series of 44 cases]

To explore the physical symptoms and radiological findings for the diagnosis of posterior urethral valves [PUV], to point of the therapeutic snags depending on gravity and delay of lesions. We reviewed the records of 44 patients with PUV. Mean age: 2 years 1/2 [range 1 day-13 years]. More than 75% of patients were less than 2 years old. In utero diagnosis was made in 8 patients [14%]. After birth, the diagnosis was based on urological signs [as frequent as diagnosis is made belatedly] and extra urological signs. Cystourethrography [CUG] showed posterior urethral dilation in all cases. Ultrasonography [US] showed abnormalities in 30 cases and intravenous urography [IVU], made in 21 cases, was normal in appearance in 7 of them. At diagnosis, it was a renal failure in 36 patients and 8 of them had a terminal renal deficiency. Urethroscopy made in 40 patients, showed PUV in all cases. There were 29 types I valves, 3 type II valves, 5 type III and 3 unclassifiables cases. Treatment was endoscopic in 41 cases and by lamination in the 3 others. Mean follow up is 9 years [range16months-19 years] and 19 patients have terminal renal failure from which 3 are deceased. PUV are dangerous obstructive uropathies in boy whom end at terminal renal failure in more than 33% of cases. Precocious diagnosis and early ablation of PUV are able to limit the complications inherent to this pathology

[Uropathies and nephropathies in the Bardet-Biedl in child]

The Bardet-Biedl syndrome is an autosomal recessive disease, characterized by obesity, retinal degeneration, hypegenitalism in men, polydactylism and on often moderate mental retardation. With these cardinal features, others clinical findings [secondary features] including diabetes, congenital heart defects, hypertension or syndactyly can be seen. Renal involvement is almost constant, but varies from a moderate impairment of the tubular functions to chronic renal failure caused by malformative uropathy or glomerulopathy. Report a new cases. We report 6 patients with Bardet-Biedel syndrome who had renal involvement. Three patients had cystic dysplasia, one patient an increased fractional sodium excretion, one other a vesico-ureteral reflux and the last patient developed end-stage renal failure following acute post streptococcal glomerulonephritis. We insist on precocious diagnosis and multidisciplinary treatment of these renal lesions, to avoid or, at least, to slow down the evolution to the terminal renal failure, essential prognosis factor. Renal involvement, is considered as a major criteria predicting high morbidity and mortality during Bardet-Diedl disease

[Infective endocarditis on probe of pacemaker]

Infective endocarditis is an uncommon but potentially lethal complication of permanent cardiac pacing. Infection is mainly caused by local contamination during the implantation procedure. The most frequently detected causative microorganisms were staphylococci. The clinical presentation is often atypical causing prolonged diagnostic delay. Bacteriological data and visualisation of neostructures consistent with vegetations on transoesophageal echocardiography, strongly suggest pacemaker lead infection. Management is based on a combined approach using both prolonged antibiotic treatment and early complete device explantation. Percutaneous techniques are currently the method of choice for lead extraction but it is not without possible complications. Antibiotic prophylaxis in order to reduce infection risk related to pacemaker implantation is widely recommended