[ role of neutrophils in the formation of peritoneal adhesion]

The use of antibiotics during peritonitis appears to decrease the formation of postoperative intra peritoneal adhesions and reduce their severity. The effect of this antibiotic is still controversial. To study the relationship between the decrease postoperative adhesions induced by rifamycin, and the number of neutrophils and the number of intraperitoneal bacteria. This is an experimental prospective, randomized single blind study performed on adult male rats. The product used for the peritoneal lavage was rifamycin s. The animals were randomized into three groups: Group S: intra peritoneal lavage with saline to 9%, R25 Group: intra peritoneal lavage with rifamycin at a dose of 25 mg / kg group and 12.5 R: intra peritoneal lavage with rifamycin at a dose of 12.5 mg / kg. Adhesions score was evaluated according to Zulkhé by the same operator. The adhesion score was significantly lower between groups S and R12.5 [p = 0.000] and group S and group R25 [P = 0.01]. However, the difference was not significant between the two groups R 25 and R12.5 compared to S group [p = 0.655]. The number of bacteria between the time of caecal resection [before peritoneal lavage] and the time of death or sacrifice was significantly decreased significantly in the groups R25, comparing the group S [p = 0.003]. However, there is no significant difference between groups S and R12, 5 [p = 0.106]. The number of neutrophils between the time of cecal resection [before peritoneal lavage] and the time of death or sacrifice decreased significantly in the groups R25 and R12, 5 in comparison to the group S. Between the group R25 and the S group, the difference is significant [p = 0.037] as well between the group R12, 5 and S [p = 0.026]. However, there is no significant difference between the two groups R 25 and R12, 5 [p = 0.712]. The action of rifamycin sodium on neutrophils seems to be independent of its antibacterial action. These findings deserve to be explored at the end to clarify the mechanism of neutropenia by intra peritoneal washing with rifamycin and the relationship between neutropenia and post-operative adhesions

Microbiological characteristics of catheter-related bacteremia in a Tunisian intensive care unit

Prevalence of catheter-related bacteremia in intensive care units is increasing as central venous catheters [CVC] are used more frequently. In the most of the published literature, Gram positive cocci are the leading cause of catheter-related bacteremia and the systemic empiric treatment recommended include the administration of glycopeptides. To search for the microbiological characteristics of catheterrelated bacteremia in a Tunisian ICU. Prospective observational cohort survey conducted in the ICU of the Habib Bourguiba university hospital, Tunisia [a 22 bed medical-surgical intensive care unit]. We had included all patients admitted to the unit over the study period [from August 1[st], 2001 to March 31[st], 2002], and who submitted to a central venous catheter for more than 24 hours. Catheter-tip specimens were cultured using a semiquantitative method. During the study period 218 central venous catheters [CVC] were assessed. The mean length of time the catheter was kept in place was 8 +/- 6.7 days [range; 2 and 46 days]. The CVC insertion site was the subclavian vein in 156 cases [71.6%], the jugular vein in 35 cases [16%], and the femoral vein in 27 cases [12.4%]. Seventy four catheters [33.9%] were removed because of suspicion of catheterrelated sepsis. The catheter-related bacteremia rate was 6.1 infections/1000 days-CVC. Unlike Gram-positive cocci which caused only one case of catheter-related bacteremia, Gram-negative rods, namely Klebsiella pneumoniae and Serratia marcescens were responsible for 91.7% of cases of catheter-related bacteremia. Our findings translate a specific microbiological flora in our Tunisian intensive care unit and highlight the importance of a treatment strategy based on local epidemiology in patients with catheter related bacteremia

[Psoas abscess of the adult: study of 38 cases]

Our aim is to report the clinical aspects, the etiologies, the treatment and the evolution of the psoas abscess in the adult. Our retrospective study concerns 38 cases of psoas abscesses collected in the Department of Infectious Diseases of Sfax [Tunisia], over a period of 16 years [January 1990 - December 2005]. The average age is 44 years [extremes: 16-76 years]. The sex-ratio is 1,4. Six patients were diabetics and one had a chronic renal injury at the stage of hemodialysis. The clinical manifestations were: a fever [76,4%], an abdomino-pelvic ache [84,2%] and a psoi'tis [34,2%]. All patients had a biologic inflammatory syndrome with a hyperleucocytosis in 28 cases. The abscess was one-sided in 29 cases and bilateral in 9 cases. After microbiological study and/or histological study, pathogens were identified in 31 patients, they were Staphylococcus aureus [10 cases], Staphylococcus lugdunensis [1 case], Streptococci [3 cases], Escherichia coli [2 cases], Bacteroides fragilis [1 case], Actinomyces [2 cases], Brucella [3 cases], Mycobacterium tuberculosis [8 cases] and Candida glabrata [1 case]. The psoas abscess was primary in 10 cases and secondary in 28 cases. All the patients received an antibiotherapy or an antifungal therapy adapted to the micro-organism in cause, with a drainage of the abscess in 25 cases [surgical in 9 cases and percutaneous in 16 cases]. The evolution was favourable in 36 cases. One patient presented recurrences and one patient died. The psoas abscess of the adult is characterized by a polymorphic clinical presentation. Germs in cause are very variable

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

non reponse a la vaccination antihepatitique chez le personnel soignant

The authors report the results of an investigation of witness cases realized in collaboration between occupational medecine service and immunology laboratory of hedi CHAKER university hospital SFAX during the year 2000. the purpose was to seartch the genetic control of the HLA class l system for the non response to hepatitis B vaccine and to evaluate the contribution of other favorite factors as tabac, sex age. Thus, in a population of 32 healthy agents found nonresponders to hepatitis B vaccine by the titers of anti HBs antibody, we have performed the HLA-A, -B phenotypes by the technique of complement dependent microcytotoxicity. The frequency of studied HLA class l antigens, was compared for the non responders group, to the frequency observed in witnesses group, done with 52 responders health agents. The rate of nonresponsiveness hepatitis B vaccine was evaluated up to 5%. Statistically significant difference was observed for HLA A1 and B44 markers showing frequencies which were considerably higher in the non responders than in witnesses

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