Streptococcus pneumoniae carriage among febrile children at the time of PCV-10 immunization in pediatric emergencies at Mohammed VI University Hospital Centre in Marrakesh (Morocco).

OBJECTIVES: In Morocco, 13-valent pneumococcal conjugated vaccine (PCV) was introduced in the childhood immunization program in October 2010 and changed to PCV-10 in July 2012. The purpose of this study was firstly to determine the prevalence of pneumococcus carriage in a population of febrile infants in Marrakesh and secondly, to investigate the risk factors for carriage and the distribution of circulating serotypes. MATERIAL AND METHODS: This prospective study was conducted from February to June 2017, in the pediatric emergency department of the Mother and Child Hospital of Mohammed VI University Hospital Centre (UHC) in Marrakesh. At total of 183febrile infants, aged 2-18months, were enrolled in this study and were swabbed for nasopharyngeal carriage. Pneumococci were cultured, identified, serotyped, and tested for penicillin susceptibility. Demographic data and risk factors for carriage were collected. The statistical analyses performed were the following: the analysis of the risk factors using logistic regression, the estimation of serotype diversity with the Simpson index, and the Chi2 test to compare serotype distribution in the prevaccination (a cohort of 660 healthy children, less than 2years old, in the Marrakesh region, in 2008-2009) and postvaccination periods. RESULTS: The prevalence of Streptococcus pneumoniae carriage was 68.3%. Of the 183infants enrolled in this study, 111 had received at least one dose of PCV-10. Colonization by vaccine serotype among febrile children was related to incomplete vaccination status. In total, vaccine serotypes accounted for 6.4% (n=8): 19F (n=2), 1 (n=2) and one strain for each of the following serotypes: 14, 23F, 6B, and 9V. Non-vaccine and nontypeable strains presented 63.2% and 23.2%, respectively, with dominance of serotypes 6A (6.4%), 15A/15F (5.6%), 20, 22F/22A, 23B, and 11A/11D with a prevalence of 3.2%. The rate of pneumococcus strains with reduced susceptibility to penicillin was 33.6%, of which 90.2% were non-vaccine serotypes and nontypeable strains. Serotype diversity increased in the postvaccination period and the effectiveness of PCV-10 against vaccine serotypes was estimated at 89.6%. CONCLUSION: An important change in the distribution of vaccine and non-vaccine serotypes was observed after the introduction of the PCVs. In fact, the prevalence of vaccine serotypes decreased significantly while non-vaccine serotypes emerged. These results underscore the importance of maintaining close and prolonged surveillance of serotype distribution to monitor the dynamics of nasopharyngeal pneumococcal carriage.

[Actinomycosic mycetoma of the foot in Morocco due to Actinomycetes viscosus]. / Mycétome actinomycosique du pied à Actinomycetes viscosus au Maroc.

We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.

Epidemiological profile of invasive bacterial diseases in children in Casablanca, Morocco: antimicrobial susceptibilities and serotype distribution.

The aim of this prospective study in Morocco was to investigate the causes of invasive bacterial diseases in children in order to inform antibiotic therapy and vaccine choices. Of 238 children aged < or = 5 years admitted to the Children's Hospital of Casablanca for invasive diseases over a 12-month period, 185 were diagnosed with bacterial infection: 76 had chest-X-ray-confirmed pneumonia, 59 had meningitis and 50 had sepsis. Streptococcus pneumoniae was the most common pathogen identified (n = 24), followed by Neisseria meningitidis (n = 18, all group B) and Haemophilus influenzae (n = 11). The rate of penicillin non-susceptibility was 62.5% among Str. pneumoniae isolates and 11.1% among N. meningitidis and all isolates were ceftriaxone-susceptible. Of the 11 H. influenzae isolates, only 1 produced a beta-lactamase. The 5 predominant Str. pneumoniae serotypes were 19F, 14, 23F, 6B and 19A and the theoretical coverage of the 7, 10 and 13-valent pneumococcal conjugate vaccines was 60%, 78% and 91% respectively.

Epidemiological profile of invasive bacterial diseases in children in Casablanca, Morocco: antimicrobial susceptibilities and serotype distribution

The aim of this prospective study in Morocco was to investigate the causes of invasive bacterial diseases in children in order to inform antibiotic therapy and vaccine choices. Of 238 children aged </= 5 years admitted to the Children's Hospital of Casablanca for invasive diseases over a 12-month period, 185 were diagnosed with bacterial infection: 76 had chest-X-ray-confirmed pneumonia, 59 had meningitis and 50 had sepsis. Streptococcus pneumonia was the most common pathogen identified [n= 24], followed by Neisseria meningitides [n= 18, all group B] and Haemophilus influenza [n= 11]. The rate of penicillin non-susceptibility was 62.5% among Str. pneumoniae isolates and 11.1% among N. meningitidisand all isolates were ceftriaxone-susceptible. Of the 11 H. influenzae isolates, only 1 produced a beta-lactamase. The 5 predominant Str. pneumoniaeserotypes were 19F, 14, 23F, 6B and 19A and the theoretical coverage of the 7, 10 and 13-valent pneumococcal conjugate vaccines was 60%, 78% and 91% respectively

[Kluyvera bacteriemia: an epidemic in a Moroccan teaching hospital]. / Bactériémies à Kluyvera: à propos d'une épidémie dans un CHU au Maroc.

Kluyvera Spp is an enterobacterium rarely isolated in medical microbiology, an opportunistic pathogen the clinical significance of which remains unclear. Four strains of Kluyvera Spp were isolated for the first time in the Ibn Rochd Teaching Hospital microbiology laboratory. These strains were isolated in hemocultures of four patients hospitalized in the same medical ward, at the same time, and presenting with bacteriemia. An antibiotic susceptibility study allowed identifying the wild phenotype in the first isolate, the three next isolates had acquired resistance to trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ciprofloxacin, and produced broad-spectrum betalactamase. The epidemiological investigation in the patients' environment made after isolating the fourth strain was negative. The four patients evolved uneventfully without antibiotic treatment. This raises the question of the real pathogenic capacity of these strains, their epidemic power, and their ability to acquire resistance.

[Prevalence and in vitro antimicrobial susceptibility patterns of Acinetobacter baumannii strains in a Moroccan university hospital]. / Prévalence et état de sensibilité aux antibiotiques d'Acinetobacter baumannii dans un CHU marocain.

OBJECTIVE: The aim of this study was to identify the clinical presentations and the current antimicrobial susceptibility of Acinetobacter baumannii. RESULTS: We identified 754 strains especially from intensive care units (50.53%) between January 2003 and December 2005. Bronchial swabs and blood culture were prevalent. High-level resistance to betalactamines was noted: 91% to cefotaxime, 50.3% to ceftazidime, and 42.6% to imipenem. Aminoside resistance varied from 17.9% for netilmicine to 72.1% for gentamycin. The resistance rate to ciprofloxacine was 65.8%, and to trimethoprime-sulfamethoxazole 75.8%. In intensive care units, the antimicrobial resistance rate of A. baumannii was higher (p<0.05). CONCLUSION: The resistance of A. baumannii to current antibiotics is alarming especially in intensive care units. An effective strategy against nosocomial infection is still necessary.

Two-year surveillance of antibiotic resistance in Streptococcus pneumoniae in four African cities.

Worldwide spread of antibiotic resistance in Streptococcus pneumoniae is a major problem. However, data from West and North African countries are scarce. To study the level of resistance and compare the situations in different cities, a prospective study was conducted in Abidjan (Ivory Coast), Casablanca (Morocco), Dakar (Senegal), and Tunis (Tunisia), from 1996 to 1997. The resistances to eight antibiotics of 375 isolates were studied by E test, and the results were interpreted using the breakpoints recommended by the National Committee for Clinical Laboratory Standards. Overall, 30.4% of the isolates were nonsusceptible to penicillin G (25.6% were intermediate and 4.8% were resistant). Amoxicillin (96.3% were susceptible) and parenteral third-generation cephalosporins (92.7%) were highly active. Resistance to chloramphenicol was detected in 8.6% of the isolates. High levels of resistance were noted for erythromycin (28%), tetracycline (38.3%), and cotrimoxazole (36.4%). Resistance to rifampin was rare (2.1%). There were significant differences in resistance rates between individual countries. Multiple resistance was more frequent in penicillin-nonsusceptible isolates than in penicillin-susceptible isolates. Recommendations for treatment could be generated from these results in each participating country.

Serotypes and antimicrobial susceptibility of group B streptococcus isolated from neonates in Casablanca.

The serotypes and the levels of antibiotic resistance of 59 Streptococcus agalactiae isolates from neonates in Casablanca, from February 1992 to July 1997, were studied. Most of the isolates (86.4%) were recovered from early-onset disease. The serotype distribution was as follows: serotype III 39%; serotype Ia 32.2%; and serotype V 10.2%. All strains were susceptible to penicillin G, cefotaxime and ampicillin, whereas 1 strain was resistant to erythromycin. No high level of resistance to gentamicin was detected. A vaccine should comprise the most prevalent serotypes and also provide protection against serotype V disease. The antibiotic susceptibility patterns reported here support the recommended treatment and prophylaxis of invasive group B Streptococcal disease.