High rate of faecal carriage of extended-spectrum ß-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco.

Carbapenemase-producing Enterobacteriaceae isolates are being increasingly reported, particularly from countries surrounding the Mediterranean area. We aimed to quantify the prevalence of carbapenemase- and extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae in rectal swabs from hospitalized patients in a University hospital in Morocco, and to compare the performance of three screening media: ChromID ESBL (bioMérieux), Brilliance CRE (OXOID, Thermofisher) and SUPERCARBA (home made). Genetic detection and plasmid analysis were performed by PCR and sequencing. Strain comparison was performed by multi-locus sequence typing and the Diversilab technique (bioMérieux). The prevalence of multidrug-resistant Enterobacteriaceae was high, with 33 ESBL producers (42.85%, mainly CTX-M-15) and 10 OXA-48 producers (13%), corresponding to two major clones of K. pneumoniae (70%) and a clone of Enterobacter cloacae (30%). The three screening media showed the same sensitivity for detection of carbapenemase-producing Enterobacteriaceae, whereas the SUPERCARBA medium was more specific than the two other media. The average faecal carriage of ESBL or carbapenemase-producing Enterobacteriaceae varied from 1 × 10(2) to >1 × 10(8) CFU/g of stools. This study shows a high prevalence of multidrug-resistant Enterobacteriaceae, and particularly of OXA-48 producers. The new carbapenem-containing medium, SUPERCARBA, was as sensitive as Brilliance CRE and ChromID ESBL, and more specific for the detection of Enterobacteriaceae expressing those carbapenemases.

In Vitro Activities of Ertapenem and Imipenem against Clinical Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae Collected in Military Teaching Hospital Mohammed V of Rabat.

Objective. To study the sensitivity level of extended spectrum beta-lactamase-producing Enterobacteriaceae to Carbapenems (Imipenem, Ertapenem) marketed in Morocco and discusses the place of Ertapenem in the treatment of extended spectrum-beta-lactamase-producing. Materials and Methods. A retrospective study of 110 extended spectrum beta-lactamase-producing Enterobacteriaceae. Isolates obtained from blood cultures, superficial and deep pus, and catheters were conducted. The minimum inhibitory concentrations of Imipenem and Ertapenem were done by the E-test. The modified Hodge test was conducted for resistant or intermediate strains. Results. 99.1% of isolates were susceptible to Imipenem. For Ertapenem, 4 were resistant and 4 intermediate. The modified Hodge test was positive for all 08 isolates. A minimum inhibitory concentration comparison of K. pneumoniae, E. cloacae, and E. coli for Imipenem has noted a significant difference between E. cloacae on one hand and E. coli, K. pneumoniae on the other hand (P < 0.01). No significant difference was noted for minimum inhibitory concentration of Ertapenem. Conclusion. Our results confirm in vitro effectiveness of Ertapenem against extended spectrum beta-lactamase-producing Enterobacteriaceae as reported elsewhere. However, the emergence of resistance to Carbapenems revealed by production of carbapenemases in this study confirmed a necessary bacteriological documented infection before using Ertapenem.

First detection of oxacillinase-mediated resistance to carbapenems in Klebsiella pneumoniae from Morocco.

The frequency of carbapenem resistance due to class-D beta-lactamases (i.e. oxacillinases) among the world's Enterobacteriaceae is increasing. Recently, in Morocco, two isolates of carbapenem-resistant Klebsiella pneumoniae were recovered from the same patient, one harbouring plasmid-encoded bla-(OXA-48) and the other the bla-(OXA-1) gene. This represents the first evidence of bla(OXA-48)-mediated carbapenem-resistance in Enterobacteriaceae in Morocco.

[Baker Rosenbach erysipeloid appearing as a granulomatous cheilitis]. / Erysipéloïde de Baker-Rosenbach prenant l'aspect d'une chéilite granulomateuse.

BACKGROUND: Baker-Rosenbach's erysipeloid is a skin infection caused by Erysipelothrix rhusiopathiae. It occurs essentially in humans exposed to animals colonized with this germ such as swine. The typical skin lesion, an erythematous macule generally localized to inoculation site, frequently in the extremities, quickly resolves spontaneously. The lips are an atypical site of this infection. We describe a case of chronic granulomatosis cheilitis in a farmer caused by E. rhusiopathiae. CASE REPORT: A 40-year-old farmer, a wild-boar hunter and chronic smoker with no history of tuberculosis, injury or insect bites, presented at our dermatology unit with ulcerative macrocheilitis of the lower lip ongoing for 1 year. Its surface was purulent. A biopsy specimen showed non-caseating epithelioid granulomas. Laboratory and radiological screening for tuberculosis, sarcoidosis and Crohn's disease, and parasitological examination for Leishmaniasis proved negative. Bacteriological examination identified E. rhusiopathiae and labial Baker-Rosenbach's erysipeloid was diagnosed. The lesion healed after 15 days of treatment with parenteral penicillin G (12m IU/d), totally disappearing after 3 months. DISCUSSION: Swine erysipelas usually occurs in man as Baker-Rosenbach's erysipeloid. This localized form of infection with E. rhusiopathiae is the most frequent and the lesion typically observed is a violaceous plaque, less inflammatory with induration; spontaneous regression occurs after a mean 3 months. To our knowledge, this case is the first report of ulceration associated with macrocheilitis. Histologically, the granuloma directed our investigation towards the principal aetiologies of granulomatosis cheilitis, such as tuberculosis considering the epidemiological context, sarcoidosis or Crohn's disease. The diagnosis of erysipeloid was supported by epidemiological evidence (occupational exposure), isolation of the germ at the lesion and its regression on treatment with penicillin G. CONCLUSION: Diagnosis of E. rhusiopathiae infection was confirmed by bacteriology. However, the hypothesis concerning the pathogenesis of its chronic course in our patient remains a subject of discussion.

[Resistance to fluoroquinolones and third generation cephalosporin of Escherichia coli isolated from urines]. / Etude de la résistance des souches d'Escherichia coli isolées dans les urines aux fluoroquinolones et aux céphalosporines de troisième génération.

OBJECTIVES: This study had for objective to assess the frequency of resistance to fluoroquinolones and to third generation cephalosporin in E. coli isolated from urines of consulting and hospitalized patients and to detect the rate of multiresistant E. coli strains. DESIGN: A retrospective survey was made over 3 years (1(st) January 2005 to 31(st) December 2007). Eight hundred and nineteen patients presented with UTI confirmed in the Rabat Cheikh Zayd Teaching Hospital. RESULTS: E. coli was the etiologic agent in 57% of reported UTI. The frequency of E. coli resistance to fluoroquinolones was 27% with a higher rate among hospitalized patients. We found that ten E. coli strains were producing extended-spectrum beta-lactamase and resistant to aminosides and fluoroquinolones. CONCLUSIONS: The resistance of E. coli to fluoroquinolones is becoming worrying among consulting and hospitalized patients. Ten strains multiresistant to fluoroquinolones and third generation cephalosporins, probably because of plasmids, were isolated. This increasingly frequent resistance mechanism should lead to a more careful use of first line fluoroquinolones for UTI.

[Antibiotic susceptibility of Staphylococcus aureus strains isolated in two university hospitals in Rabat, Morocco]. / Sensibilité aux antibiotiques des souches de Staphylocoques aureus isolées dans deux hôpitaux universitaires à Rabat, Maroc.

OBJECTIVES: The aim of this study was to assess the in vitro activity of several antimicrobial agents against Staphylococcus aureus (S. aureus). METHOD: This 2 year study was made in two Moroccan teaching hospitals. Four hundred and sixty-one non-repetitive clinical S. aureus strains were isolated and collected from various samples collected in several units between March 2006 and March 2008. The susceptibility of strains was determined by the agar disk diffusion method. RESULTS: The rate of methicillin resistance was 19.3% for S. aureus isolates. 53.93% of S. aureus strains were resistant to gentamycin, and all strains were susceptible to glycopeptides. CONCLUSION: The rate of MRSA was high. Resistance to methicillin is often associated with resistance to gentamycin and fluoroquinolones. Vancomycin and teicoplanin were still effective on S. aureus in the two university hospitals.

Antimicrobial resistance of respiratory pathogens in North African countries.

This study reports the antimicrobial resistance of Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes isolated from patients in Algeria, Morocco and Tunisia. 672 non-duplicate isolates were recovered from May 2006 to May 2007. The minimum inhibitory concentrations (MICs) were determined using the E-test and interpreted according to EUCAST guidelines. Among 236 S. pneumoniae, 47% were penicillin non-susceptible (PNSP) with 3% of strains being highly resistant; 20.4% and 17.4% had decreased susceptibility to amoxicillin and cefotaxime, respectively. Dual resistance to penicillin and erythromycin was observed in 30.1%. All isolates were susceptible to levofloxacin except one. Among 262 H. influenzae, 13.3% were amoxicillin-resistant and beta-lactamase producers. Two isolates were beta-lactamase-positive and amoxicillin-clavulanate-resistant. All isolates were susceptible to cefixime, cefotaxime and levofloxacin. All S. pyogenes (174) were susceptible to beta-lactams with 5.7% resistant to erythromycin. Five had decreased susceptibility to levofloxacin. These data on respiratory tract pathogens indicate the high prevalence of PNSP in North African countries.

[Place of Streptococcus pyogenes in the throat infection in Morocco and overview of its susceptibility to antibiotics]. / Place de Streptococcus pyogenes dans les angines au Maroc et état actuel de sa sensibilité aux antibiotiques.

OBJECTIVE: In this study we report the prevalence of the throat infections to Streptococcus pyogenes in child and adult in Morocco, and the current antimicrobial susceptibility of the aminopenicillins and erythromycin. PATIENTS AND METHODS: A prospective surveillance study was made from March 2006 to February 2007 in four primary health care in Rabat and Sale cities. Six hundred and ninety-seven patients (494 children and 203 adults) were the object of samplings by throat cotton swab probe, for researching the group A Streptococcus (GAS). The patients were those proposed by their doctors for the treatment of throat infections. The antimicrobial susceptibility was realized by two methods: the disc-diffusion method on Mueller-Hinton agar plates and MICs were determined by E-test. The antibiotics tested were the penicillin G, the amoxicillin and the erythromycin. RESULTS: S. pyogenes was identified in 65 cases (9.3%): 45 strains in children (9.1%) and 20 strains in adults (9.9%). Two peaks of throat infections to S. pyogenes were recorded in children aged 12 to 15 years and in adults between 36 and 39 years old. All strains were susceptible to penicillin G and amoxicillin. One strain was resistant to erythromycin with a MIC greater than 256 microg/mL.

[Prevalence of hepatitis C virus infection in Morocco and serological tests assessment of detection for the viremia prediction]. / Prévalence de l'infection par le virus de l'hépatite-C au Maroc et évaluation des tests sérologiques de dépistage pour la prédiction de la virémie.

UNLABELLED: This study aims at assessing the prevalence of hepatitis C virus infection (HCV) in Moroccan general population and the efficacy of different virological tests in detection of the viral RNA in order to promote its screening. METHODS: From December 1st 2005 to April 30th 2007, the prevalence of the anti-HCV antibodies was determined for 8326 people. The mean age was 42.3+/-11.2 years (18 to 87 years) and sex ratio man/woman: 1.6. The determination of the anti-HCV antibodies in our sample has been achieved by the third generation ELISA. Among the detected cases as anti-HCV negative, 100 have been assessed by two other methods: AxSYM HCV and (Acon HCV): a fast test using immune chromatography on the membrane. Furthermore, the ELISA positive cases, 158 have been tested by the two previous techniques and submitted to viral RNA research by RT-PCR. The detection threshold has been fixed at 50 Ul/ml. RESULTS: The anti-HCV prevalence determined by ELISA was estimated at 1.93%. The mean age of the positive cases was 50.4 years. The viremia prevalence for positive anti HVC was 39%. The assessment of the methods AxSYM HCV, Acon and PCR compared to ELISA showed that the 100 anti negative VHC cases were also negative for the two other tests. For the 158 anti-VHC positive cases by ELlSA, 100 were also positive by AxSYM HCV, 78 by Acon HCV and 61 were RNA positives. The comparison of the anti-VHC positive results achieved by AxSYM HCV and Acon HCV methods with those related to the presence of viral RNA, showed that the AxSYM HCV method has a sensitivity=100%, a specificity=60%, a positive predictive value=61% and a negative predictive value of 100%. Whereas for the Acon HCV, the sensitivity was 99%, the specificity 87%, the positive predictive value 82% and the predictive negative=100%. CONCLUSION: The prevalence of anti-HCV obtained by ELISA has been overestimated. It is necessary to use more specific tests to reduce the risk to announce a false positive result to the patient and to reduce the expenses due to the realization of PCR in case of false positives.

Staphylococcus aureus : epidemiologie et prevalence des souches resistantes a la methicilline (sarm) au Maroc

Objectifs : Evaluer la place de S. aureus parmi les micro-organismes isoles au laboratoire de bacteriologie de l'hopital Cheikh Zaid (HCZ). Determiner la prevalence des SARM; a l'HCZ et a l'hopital militaire Mohammed V (HMMV) en vue d'instaurer une surveillance epidemiologique de ces derniers. Materiel et methodes: au cours d'une etude retrospective realisee sur deux ans (1/04/06 au 3/3/08); l'ecologie microbienne et la sensibilite de S. aureus aux antibiotiques ont ete analysees. Resultats : 1433 microorganismes ont ete isoles dans differents prelevements et services de l'HCZ parmi lesquels; il y avait 86 souches de S. aureus (6;7). Cette prevalence a atteint 10dans les services de reanimation. Dans les autres services; les frequences de S. aureus etaient plus faibles. La prevalence des S. aureus dependait; egalement; de la nature du prelevement : 19dans les pus; 10;7dans les hemocultures; 6;1pour les liquides de ponction; 4;6pour les prelevements distaux proteges (PDP); . Les deux etablissements; HCZ et HMMV; nous ont permis d'isoler 185 souches de S. aureus. Vingt cinq souches se sont revelees resistantes a la methicilline (SARM) soit 13;5. Ces souches provenaient essentiellement des services de reanimation (15/25) suivis des services de chirurgie (5/25) et de medicine (5/25). Les SARM donnaient des taux eleves de resistances a d'autres antibiotiques : entre 64 et 76pour l'erythromycine; la gentamicine; l'acide fusidique; les fluoroquinolones et le cotrimoxazole. Conclusion : La frequence des S. aureus et des SARM restent faibles au Maroc. Par contre; la resistance des SARM a d'autres antibiotiques est inquietante. Il est absolument necessaire de maitriser la diffusion de ces souches pour le controle des epidemies a germes multiresistants