Investigations of carbapenem resistant and hypervirulent Klebsiella pneumoniae

Hypervirulent Klebsiella pneumoniae is an emerging pathogen that has gained attention due to its increased ability to cause infections even in healthy individuals. The aim of this study is to investigate virulence factors in K. pneumoniae strains isolated from clinical specimens and their association with carbapenem resistance. The study was conducted on 260 isolates identified between 2018 and 2023 at the Mohammed V Military Teaching Hospital in Rabat, Morocco. The isolates were categorized based on their susceptibility to antibiotics. The hypermucoviscosity was determined by a string test, while the presence of capsular serotypes and virulence genes were identified by PCR. Among our strains, 6.2% (n = 16) exhibited hypervirulent characteristics, 56% were resistant to carbapenem. Notably, 5.7% (n = 6) of carbapenem-resistant isolates expressed the hypermucoviscous phenotype, while 1.5% (n = 2) of carbapenem-susceptible K. pneumoniae isolates exhibited the same trait. In our study, we found that a total of 10 isolates (3.8%) had virulent capsular serotypes, with K2 being the most prevalent 40% (n = 4) and K20 in 30% (n = 3). Furthermore, we detected the presence of the Aerobactin gene in 1.5% (n = 4) of the isolates examined. Based on our findings, it appears that there was no correlation between the presence of virulence factors and carbapenem resistance. In conclusion, identifying hypervirulent K. pneumoniae in clinical specimens and assessing their antibiotic resistance profiles are crucial to ensure effective therapy and to prevent outbreaks.

Osteoarticular tuberculosis of the ankle, a rare localization: a case report

Tuberculosis poses a considerable public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3-5 % of all tuberculosis cases and 10-15 % of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report a case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and computed tomography scans of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.

A very rare case of bacteraemia in a 4-year-old girl with osteopetrosis with probable Leuconostoc lactis infection

Leuconostoc lactis (LLac) is a Gram-positive coccus of the family Leuconostocaceae . It can be found in a variety of vegetables and dairy products. LLac is an opportunistic pathogen with intrinsic resistance to vancomycin and teicoplanin. In this case report, we discuss a rare case of LLac-associated bacteraemia in a patient with osteopetrosis. A 4-year-old girl was admitted to the paediatric emergency department with acute fever without other signs. Blood culture revealed an infection with LLac. Using the streptococcus antibiogram, the isolate was resistant to vancomycin, teicoplanin, rifampicin and sulfamethoxazole-trimethoprim but sensitive to β-lactams, gentamicin, streptomycin, azithromycin, clarithromycin, lincomycin, clindamycin and erythromycin. The patient was treated with intravenous ceftriaxone and gentamicin, and subsequently with oral amoxicillin. After a favourable course, she was discharged from the hospital on the 10th day. The modes of transmission and physiopathology of LLac remain unknown. Factors associated with this infection include compromised immunity, previous antibiotic therapy especially with vancomycin, and application of a central venous catheter. In our patient, the risk factors for infection were pancytopenia and multiple transfusions used to treat bone marrow failure. The source of the bacteraemia could have been the cutaneous route, but it could also have been digestive due to the reservoir of the bacteria. LLac is known as an opportunistic bacterium. Further studies on its pathogenesis and other risk factors are needed to understand the true prevalence of this potentially fatal bacterium in compromised individuals, such as the case of our patient.

Prediction of the bacterial shape in urinary tract infections with the Sysmex UF-1000i analyser: technical note

Background

The aim of our study was to explore the utility of the Sysmex UF-1000i analyzer as a rapid screening tool for urinary tract infections (UTI) and its ability to predict bacterial shape in order to help physicians choose the appropriate empiric treatment.

Materials and methods

This is a retrospective study, including 1023 urine cytobacteriological examinations. Urines were processed according to the recommendations of the medical microbiology reference system (REMIC). Using the Sysmex Uf-1000i analyzer, the authors evaluated bacteria forward scatter (B_FSC) and fluorescent light scatter (B_FLH) in a preliminary discrimination step for UTI caused by bacilli or cocci bacteria.

Results

The authors got 1023 positive samples. Comparing baccili and cocci bacteria, the authors observed a statistically significant difference for B_FSC but not for B_FLH. The values of B_FLH are very close for the four categories of microorganisms compared (bacilli, cocci, bacilli-cocci association, and yeasts). For these same categories, tests show different values for the B_FSC. A separate analysis of the B_FSC values for bacilli shows that their distribution is relatively homogeneous and exhibits a peak between 20 and 30 ch.

Conclusion

Dimensional parameters of bacteria generated by UF-1000i could be a rapid and useful tool for predicting the bacterial shape causing UTI.

Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital

Introduction

Acinetobacter species are non-fermenting and ubiquitous Gram-negative coccobacilli, which in recent years have become the leading cause of healthcare-associated infections worldwide. Our objective here was to study the epidemiology and risk factors associated with Acinetobacter baumannii infections in the intensive care unit (ICU).

Methods

This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two ICUs of the Military Hospital of Instruction Mohammed V-Rabat over a 3 month period.

Results

We included 180 patients, of whom 60 had A. baumannii infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years [interquartile range (IQR) 59.5-77]. The median length of stay in the ICU before infection was 8.5 days (IQR 5-14). Multivariate logistic regression analysis identified the risk factors statistically associated with A. baumannii infection at the ICU level as follows: duration of invasive procedures >7 days [odds ratio (OR)=1.02], parenteral nutrition (OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin (OR=5.645), probabilistic antibiotic therapy >4 days (OR=9.063) and neoplastic pathology (OR=5.727).

Conclusion

Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices and optimizing antibiotic therapy could decrease the incidence of these infections.

The occurrence of a fatal tuberculous pancreatic abscess simulating a pancreatic tumor in an immunocompromised patient

Introduction

Tuberculosis is currently undergoing a worrying recovery in Morocco. It is becoming a tropical disease again and can take deceptive clinical forms and involve unusual localizations. We report a rare case of pancreatic abscess due to Mycobacterium tuberculosis in an immunocompromised patient.

Case report

The patient was 48 years old and was diagnosed with HIV infection 16 months previously during a systematic check-up. He had no notable pathological history, no notion of tuberculosis contagion and no signs of tuberculosis impregnation, and was admitted for the management of epigastric pain associated with an altered general condition. Abdominal CT scan showed a bulbar perforation and multiple deep necrotic adenopathies of infectious or tumoral origin. Direct examination of the pus with Ziehl Neelsen stain was positive (1-10 BAAR/field). Molecular study using the GeneXpert MTB/RIF technique revealed M. tuberculosis complex without rifampicin resistance. The patient was put on antibacillary treatment based on isoniazid, rifampicin, ethambutol and pyrazinamide. The patient died of septic shock with multiple organ failure.

Conclusions

The diagnosis of a tuberculous pancreatic abscess may be overlooked because of its rarity and its clinical state simulating a pancreatic tumor, so it should be considered especially in endemic countries like ours.

Predominance of OXA-48 Carbapenemase-Producing Enterobacterales in a Moroccan Hospital

Objective

The emergence of carbapenemase-producing Enterobacterales (CPE) is a major concern that is increasingly reported worldwide. Our study aimed at investigating the resistance of CPE isolates in a Moroccan teaching hospital using phenotypic and genotypic methods.

Methods

Enterobacterales strains from March to June 2018 were collected from different clinical samples. The Enterobacterales isolates resistant to third-generation cephalosporins (3GC) and/or carbapenems were subjected to the Carba NP test and an immunochromatographic test for phenotypic detection. Detection of extended-spectrum β-lactamases (ESBL) was also performed following standards. Molecular screening of carbapenemases genes (OXA-48, NDM, blaKPC, blaIMP, blaVIM, and blaOXA-24, blaOXA-23, OXA-51, OXA-58) using conventional multiplex PCR assays was also performed on 143 isolates.

Results

Enterobacterales represented 52.7% with a proportion of 21.8% of bacteria resistant to 3GC and/or carbapenems. Within 143 isolates MDR to 3GC, K. pneumoniae, E. coli, and E. cloacae represent 53.1%, 40.6%, and 6.3%, respectively. These strains were isolated mainly from urinary samples (74.8%) in patients admitted to emergency and surgical units. 81.1% of strains are producing ESBL and 29% are carbapenemase producers as confirmed by the Carba NP test, immunochromatographic test, and molecular testing. OXA-48 carriers represent 83.3% of these strains, followed by NDM with 16.7%. blaKPC, blaIMP, blaVIM, and blaOXA-24, blaOXA-23, OXA-51, OXA-58 were not detected in any of these bacteria.

Conclusions

A high rate of CPE carrying OXA-48 among Enterobacterales resistant to 3GC and/or carbapenems isolates was found. Strict observance of hospital hygiene measures and more rational use of antibiotics are mandatory. Implantation of carbapenemases detection should be encouraged in our hospital settings to estimate the true burden of the CPE.

Urinary tract infections older adults at Mohammed VI University Hospital of Oujda: case series

Due to its incidence, clinical polymorphism and severity, urinary tract infection is an important problem in elderly. The objectives of the authors' work were to establish the bacteriological profile of urinary tract infection and/or colonization in the elderly and then to study drug resistance of bacterial strains isolated.

Materials and methods

This is a 36 months retrospective study from 22 March 2016 to 11 May 2019. The study included urinary specimens of persons aged 65 years or over, hospitalized or consulting at the authors' hospital. Urines were processed according to the recommendations of the medical microbiology reference system and European Committee on Antimicrobial Susceptibility Testing.

Results

The authors collected 6552 requests for cytobacteriological examination of urine. Most of the specimens was collected in the middle stream (n=5503; 84%). Cultures were sterile in 49.77% of cases. Positive in 50.22% of cases. Among positive samples we had 53.41% polymorphic cultures, 32.75% urinary tract infection, and 13.82% urinary tract colonization. Gender distribution showed a sex ratio at 0.62. Gram-negative bacilli, with Escherichia coli as the main species, dominated the isolated bacteria. Resistance rates of E. coli strains that we isolated were 70% for amoxicillin, 36.31% for amoxicillin-clavulanate and 25% for ciprofloxacin. A high resistance rate was seen for third generation cephalosporins. Least resistance recorded to nitrofurantoin.

Conclusion

ITU in the elderly is diverse and significantly different from that of younger patients, through its high contamination rate, difficulty in acquiring clinical information, high rate of asymptomatic bacteriuria, and high proportion of multidrug resistant bacteria.

Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study

Introduction

Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections.

Methods

It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST).

Results

Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively.

Conclusion

Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy.

Value of hematological parameters for predicting patients with severe coronavirus disease 2019: a real-world cohort from Morocco

Objective

Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2. The clinical manifestations and the evolution of patients with COVID-19 are variable. In addition to respiratory involvement, COVID-19 leads to systemic involvement and can affect the hematopoietic system. This study aimed to evaluate the prognostic value of hematological and hemocytometric parameters in predicting the severity of patients with COVID-19.

Methods

We performed a retrospective study at Mohammed VI university Hospital from 1 March to 11 November 2020. We collected demographic characteristics and hematological findings of incident COVID-19 cases.

Results

A total of 245 patients were included in our study. We found that the rate of lymphopenia was significantly reduced in patients who were severely affected by COVID-19. Additionally, the rate of neutrophilia, the neutrophil side fluorescence light signal, monocyte fluorescent intensity, monocyte size, the neutrophil-to-lymphocyte ratio, the platelet-to-lymphocyte ratio, and the lymphocyte-to-monocyte ratio were significantly elevated in patients who were severely affected by COVID-19.

Conclusions

These results are consistent with the literature regarding the predictive value of these markers. A prospective validation in a large population with a longer follow-up is required.

Characterization of imipenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clinical isolates in a Moroccan hospital

Acinetobacter baumannii and Pseudomonas aeruginosa are two pathogens with an important power of adaptation to antibiotics thus, both pose a real public health problem. Our study investigated epidemiological characteristics, antibiotic sensitivity profile and resistance genes of imipenem resistant A. baumannii and P. aeruginosa. This was a retrospective study carried out in the bacteriology laboratory of Mohammed V military training hospital, spanning from January 2018 to April 2021. Antibiotic susceptibility was studied by Mueller Hilton agar diffusion method with OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST 2021. Carbapenemase detection was performed by CarbaNP-test®. The molecular study was performed using conventional PCR. During the study period, we collected 1,072 imipenem-resistant isolates namely, 820 A. baumannii and 252 P. aeruginosa. The molecular study showed that out of 108 A. baumannii isolates 102 carried the bla OXA-51 and 100 isolates carried the bla OXA-23 gene. The coexistence of bla OXA-23 and bla NDM genes was detected in only 4 isolates. Altogether 50% of P. aeruginosa strains carried bla VIM-2. All investigated A. baumannii and P. aeruginosa strains were colistin susceptible in this study. Multiresistant bacterial infections are associated with longer hospitalization, higher hospital costs and higher mortality rates. Therefore, a collective action including the different actors of the healthcare system is necessary.

Antibacterial and Antioxidant Activity of Dysphania ambrosioides (L.) Mosyakin and Clemants Essential Oils: Experimental and Computational Approaches

Dysphania ambrosioides (L.) Mosyakin and Clemants, also known as Mexican tea, and locally known as Mkhinza, is a polymorphic annual and perennial herb, and it is widely used in folk medicine to treat a broad range of illnesses in Morocco. The aim of this study was to determine the phytochemical content and the antioxidant and the antibacterial properties of essential oils isolated from D. ambrosioides aerial components, growing in Eastern Morocco (Figuig). Hydrodistillation was used to separate D. ambrosioides essential oils, and the abundance of each phytocompound was determined by using Gas Chromatography coupled with Mass Spectrometry (GC–MS). In vitro 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay and inhibition of β-carotene/linoleic acid bleaching assays were used to determine D. ambrosioides essential oils’ antioxidant activity. The findings revealed relative antioxidative power and modest radical scavenging. The antibacterial activity of the essential oils was broad-spectrum, with Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis as the most susceptible strains tested. To elucidate the physicochemical nature, drug-likeness, and the antioxidant and antibacterial action of the identified phytocomponents, computational techniques, such as ADMET analysis, and molecular docking were used.

Evaluation of a Molecular Test for Detection of Mycobacterium tuberculosis Isolates Resistant to Rifampicin and Isoniazid

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) is increasing worldwide and is a major cause of death in many countries. It has become a major challenge for national tuberculosis control programs. Therefore, rapid identification of MDR strains of Mycobacterium tuberculosis and monitoring of their transmission could contribute significantly to the fight against tuberculosis. The GenoType MTBDRplus assay has been recommended by the World Health Organization to identify rifampicin (RIF)- and isoniazid (INH)-resistant M. Tuberculosis isolates. The objectives of this study were to evaluate the performance of the GenoType MTBDRplus test in the detection of rifampicin and isoniazid resistance of M. tuberculosis isolates in a Moroccan hospital and then to determine the frequency of mutations associated with resistance to these two major anti-tuberculosis drugs.

METHODS

This is a retrospective study conducted at the bacteriology department of the Mohammed V military hospital over a period of one year from 01/01/2018 to 12/31/2019. A total of 92 isolates of M. tuberculosis from pulmonary and extra-pulmonary specimens were evaluated for drug susceptibility by MGIT™ 960 AST system and compared to the GenoType MTBDRplus assay. The MGIT™ 960 AST system was used as the gold standard for the evaluation of the GenoType MTBDRplus assay.

RESULTS

Sensitivity and specificity of the GenoType MTBDRplus assay for the detection of RIF-resistant M. tuberculosis isolates were 83.33% and 100%, respectively. Its sensitivity and specificity for the detection of INH-resistant M. tuberculosis were 88.23% and 100% respectively. The concordances of the GenoType MTBDRplus assay and the MGIT™ 960 AST system for the detection of sensitivity to RIF and INH were 99% (1/92) and 98% (2/92), respectively. Among the five RIF-resistant isolates, the MUT3 mutation in the rpoB gene (codon S531L mutation) was present in 80% of isolates, whereas mutations in the rpoB MUT1 gene were present in only one (20%) RIF-resistant isolate. INH resistance was detected in 15 isolates, of which nine isolates (60%) had specific mutations of the katG gene (codon S315T1) and conferred a high level of resistance to INH.

CONCLUSIONS

The results of this study have shown that the GenoType MTBDRplus test has a high sensitivity and specificity for the detection of resistance to RIF and INH.

Multidrug-resistant community-acquired urinary tract infections in a northern region of Morocco: epidemiology and risk factors

INTRODUCTION

Urinary tract infection is very common and is the second most frequent reason for consultation in office-based practice. The incidence varies from one country to another. The diffusion of MDR in the community complicates therapeutic management. The objective of this study was to describe the bacterial epidemiology and to determine the risk factors for the acquisition of MDR in community urinary tract infections in our region.

METHODS

This was a retrospective case-control study conducted in the bacteriology laboratory of the Mohammed V Military Teaching Hospital over an 8-month period from 01 October 2015 to 31 May 2016. Cases were defined as patients with community-acquired urinary tract infection with MDR and controls were defined as patients with a urinary tract infection without MDR.

RESULTS

Out of 373 isolates, enterobacteria represented 80%. E. coli represented 59.2%, followed by K. pneumoniae at 15%. The rate of MDR represented 13.4% of which ESBL enterobacteria represented 12.1%. Univariate analysis showed a statistically significant association between male sex (p=0.001), age >65 years (p=0.007), urban origin (p=0.003), previous hospitalization within 3 months (p=0.001) and antibiotic therapy within 6 months (p=0.001) with MDR community-acquired urinary tract infection. On the other hand, multivariate analysis by logistic regression showed that age >65 years (OR=8.4, CI: 2.1-42), previous hospitalization within 3 months (OR=13.4, CI: 3.3-140.2) and antibiotic therapy within 6 months (OR=9.2, CI: 4.1-60.1) were significantly associated to MDR community-acquired urinary tract infection.

CONCLUSIONS

The increase in resistance to enterobacteria in the community prompts a review of the list of antibiotics prescribed for probabilistic management of these infections in our region.

Shewanella putrefaciens: a rare cause of purulent otorrhoea

Shewanella putrefaciens is a Gram-negative, non-fermenting, motile and oxidase-positive bacillus. Its incrimination in human pathology is very rare, although there has been a resurgence in Shewanella infections in recent years. We report the first case in Morocco of a purulent otorrhoea caused by S. putrefaciens , resistant to conventional treatment, occurring in a 25-year-old female, afebrile, without deterioration of the general state and possibly acquired during sea bathing. We also describe the bacteriological characteristics of and antibiotic susceptibility results for the isolate.

Breast tuberculosis: A forgotten diagnosis

Breast tuberculosis is a rare entity even in endemic countries. It is often considered as a diagnostic conundrum given the non-specific clinical and imaging characteristics. Therefore, the definitive diagnosis is based on the identification of bacilli by microbiological or histopathological examination. We report the case of a 52-year-old woman, with a 2-month history of a painful lump of the left breast. The imaging features were consistent with a breast abscess. The purulent collection was aspirated and a tuberculous mammary abscess was diagnosed by molecular biology (GeneXpert). Through this observation, we discuss the clinical, radiological and biological signs by highlighting the contribution of molecular biology in the rapid management of this rare pathology.

Leclercia adecarboxylata invasive infection in a patient with Hirschsprung disease: A case report

Introduction

Leclercia adecarboxylata is a ubiquitous aerobic, motile, gram-negative bacilli. The human gastro-intestinal tract is known to harbor this rarely opportunistic microorganism. We describe a rare case of invasive infection with a gastrointestinal starting point due to L. adecarboxylata in a patient with Hirschsprung disease.

Case report

It is about a newborn female who was admitted on the 3rd day of life to the neonatal intensive care unit for intestinal obstruction. On the 9th day of life, while managing the neonatal obstruction, the patient developed febrile peaks. Cytobacteriological examination of cerebrospinal fluid, blood cultures and culture of umbilical vein catheter allowed the exclusive isolation of Leclercia adecarboxylata. It was producing extended spectrum beta-lactamase and was treated with intravenous imipenem. After favourable evolution, the patient was transferred to the pediatric surgery department. There, she was diagnosed with Hirschsprung disease.

Discussion

Knowledge of the route of transmission of L. adecarboxylata is limited and the possible source of the infection is unclear. However, the authors describe three hypotheses of contamination of our propositus. In our patient, one or more of these routes of contamination would be possible. Indeed, bacteremia could occur as a result of a bacterial translocation across the mucosal barrier of the colon altered by Hirschsprung disease, antibiotic use and feeding practices.

Conclusion

Infection with L. adecarboxylata revealed a wide range of infection. It has only recently been acknowledged as an emerging pathogen. Further studies of the pathogenesis and risk factors are required.

•

Leclercia adecarboxylata is Gram-negative bacillus as a member of the Enterobacteriaceae family.

•

Infection with this rarely pathogenic microorganism has been limited to a small number of case reports. Of these, only few reports implicate the gastrointestinal tract as the focus of infection.

•

Bacteremia could occur as a result of a bacterial translocation across the mucosal barrier of the colon altered by Hirschsprung disease, antibiotic use and feeding practices.

•

As the number of L. adecarboxylata infections continues to expand so does our insight into its pathogenicity and role in human clinical infections. Further studies of the pathogenesis and risk factors are required.

The occurrence of a multidrug-resistant tuberculous retropharyngeal abscess in an immunocompetent patient: A case report

Retropharyngeal abscess is an uncommon location of tuberculosis (TB). In this report, we describe a multidrug-resistant tuberculous retropharyngeal abscess in a 21-year-old female patient who was treated for lymph node TB for one year. CT scan revealed a large retropharyngeal abscess that was aspirated intraorally under local anesthesia. The diagnosis of TB was retained by molecular and histological study. GeneXpert MTB/ RIF (Cepheid, Sunnyvale, CA, USA),performed on the pus, showed rifampicin resistance and a first- and second-line drug resistance test using Genotype MTBDRplus VER.2 and MTBDRsl VER.1 (Hain Lifescience GmbH, Nehren, Germany) showed TB highly resistant to rifampicin, isoniazid, and aminoglycosides. Treatment is primarily medical as it combines specific antituberculous antibiotics, and aspiration for drainage of the abscess. Our patient was put on long-term 2nd line anti-TB treatment.

Update on the resistance of Escherichia coli isolated from urine specimens in a Moroccan hospital: a review of a 7-year period

Introduction

Escherichia coli is the most commonly isolated species in both community and healthcare-associated infections. Our study's purpose was to determine the rates of antibiotic resistance of E. coli isolates in hospital and community populations, track the kinetics of resistance rates of E. coli isolates to major antibiotics, particularly those prescribed for urinary tract infections and study the occurrence and evolution of multi-resistant phenotypes.

Methods

We conducted a retrospective study at the Bacteriological Department of the Mohammed V Military Hospital of Instruction, over a period of 7 years. All isolates of E. coli from inpatients and outpatients were included. Identification of bacterial isolates was based on culture, morphological and biochemical identification characteristics. Antibiotic susceptibility was studied using the Mueller Hilton agar diffusion method by using OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST/CA-SFM 2019.

Results

The rate of resistance of E. coli isolates to 3^rd generation cephalosporins, imipenem and fluoroquinolones was 12%, 1% and 34%, respectively. The difference between the resistance rates of inpatient and outpatient E. coli isolates was statistically significant for most antibiotics (p<0.05). The rate of extended-spectrum beta-lactamase phenotype (ESBL) was 6.73%. The carbapenemase phenotype was 1.25%. The ESBL phenotype rate increased from 3% in 2012 to 11.16% in 2018.

Conclusions

The progression of the ESBL phenotype in both hospital and community settings, due to the increase in the resistance rate to 3^rd generation cephalosporin, is prompting a review of the strategy for the therapeutic management of urinary tract infections with these molecules as probabilistic treatment.

A Case of Colonic Tuberculosis Revealed by Polymerase Chain Reaction

BACKGROUND

The authors report a case of tumor-like colonic tuberculosis revealed by PCR in a 32-year-old patient with a low-level peritoneal effusion on CT scan with negative histological study on colonic biopsy.

METHODS

The colonic biopsy received at the laboratory after grinding in a porcelain mortar, was the object of a molecular study by GeneXpert MT/RIF (Cepheid, Sunnyvale, CA, USA) using the automated real-time PCR technique and a conventional study based on Ziehl-Nielsen staining and culture on Lowenstein-Jensen® solid medium (LJ) and Mycobacteria Growth Indicator Tube (MGIT®) liquid medium.

RESULTS

The patient was a 32-year-old male without any personal or family history of tuberculosis and without signs of tuberculosis impregnation. He had a story of ingestion of non-pasteurized dairy products including milk and cheese. For 45 days he had constipation with abdominal pain and feeling of heaviness. Physical examination of the patient revealed abdominal tenderness without adenopathy. The laboratory workup showed a normal blood count, CRP, liver and kidney function tests. The HIV test was negative. Medical imaging revealed a low-level peritoneal effusion that could not be punctured. Colonoscopy showed a thickening of the colon. The colonic biopsy, after crushing and sonication, was searched for the Mycobacterium tuberculosis complex by both molecular biology and conventional methods. Molecular research by GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) using the automated real-time PCR technique, revealed the presence of the Mycobacterium tuberculosis complex without detection of rifampicin resistance. On the other hand, the direct examination after special Ziehl-Nielsen staining was positive (Figure 2) and the cultures on Lowenstein-Jensen® solid medium (LJ) and Mycobacteria Growth Indicator Tube (MGIT®) liquid medium were also positive after two and three weeks, confirming the molecular diagnosis. The histology study showed moderate non-specific chronic colitis with no histological arguments for tuberculosis or malignancy. The patient was placed on curative tuberculosis treatment according to the national protocol, with a favorable clinical-radiological course.

CONCLUSIONS

Colonic tuberculosis is a disease that may mimic many other diseases; therefore, a correct approach is necessary for the correct diagnosis and treatment.

Primary tuberculosis of the parotid gland: A forgotten diagnosis about a case!

The diagnosis of tuberculosis must be made in the face of any cervical swelling, and the treatment is essentially medical.

Infective endocarditis caused by Escherichia coli of a native mitral valve

Escherichia coli is a rare cause of infectious endocarditis. We report a clinical case of E. coli endocarditis of a native mitral valve in a young 26-year-old woman with a recurrent urinary tract infection who had a high fever for one week despite probabilistic treatment with amoxcillin-clavulanic acid 3 g per day. The patient was successfully treated with antibiotics and recovered without surgery.

Epidemiological profile of funguria in a university hospital in Oujda, Morocco

Background and Purpose

The presence of yeasts in the urine is not synonymous with urinary tract infection since it can result in simple colonization or contamination. Regarding this, it is required to further clarify the epidemiological profile of funguria. Accordingly, the present study was conducted to establish the epidemiology of funguria in the Mohammed VI Teaching Hospital of Oujda, Morocco.

Materials and Methods

This retrospective study was conducted on all urine samples sent for cytobacteriological examination to a microbiology laboratory over a period of 28 months (i.e., from March 2016 to June 2018). After the removal of duplicates, the urine samples were treated according to the recommendations of the medical microbiology standards.

Results

A total of 15,165 urine samples were collected. Urinary colonization accounted for 4.94% (n=749) of cases. The infections of the urinary tract accounted for 5.35% (n=811) of cases. Microbial isolates (n=1,669) in colonization and urinary tract infections were dominated by bacteria (93.47%, n=1,560). Furthermore, the yeasts accounted for 6.53% (n=109) of the isolates. Candida albicans was isolated from 56.88% (n=62) of funguria cases. The risk factors for funguria in our series were essentially old age, admission to intensive care unit, and broad-spectrum antibiotic therapy.

Conclusion

The current level of knowledge about the clinical situations leading to funguria with the improvement and popularization of efficient identification techniques for yeasts other than C. albicans should redress the epidemiology of funguria. This should allow the knowledgeable societies to establish the rules of interpreting the cytobacteriological examination of the urine in case of funguria, as for bacteriuria.

Pancytopenia revealing acute brucellosis

Brucellosis is the most prevalent bacterial zoonosis worldwide. The WHO estimates that the infection is responsible for more than 500 000 cases per year across the world [1].

Hematological complications like mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia and thrombocytopenia are less frequently encountered [2]. We are reporting the case of a 73 year old male patient, with pancytopenia that revealed acute brucellosis. Following 6 weeks of antibiotic therapy, our patient showed favorable clinical outcome, and the complete blood count returned to normal. Acute brucellosis should be highly suspected in patients with pancytopenia.

[Prevalence of male infertility in a university hospital in Morocco]

INTRODUCTION

infertility in couples has become a public health problem in recent years. It can be related to a problem in the male, female or both. Men infertility accounts for 40% of cases. In Morocco, most studies have focused on the causes and risk factors for male infertility. The purpose of our study was to assess the prevalence of male infertility and semen parameters in infertile men or in men at high risk of developing infertility in a tertiary hospital in Rabat.

METHODS

we conducted an analysis of 482 patients referred for evaluation of infertility in the couple or as part of preoperative assessment of varicocele or testicular ectopia. Demographic data, risk factors for infertility, primary or secondary infertility were recorded for each patient. Semen parameters were assessed and interpreted according to WHO standards updated in 2010 based on studies of factors associated with their disturbance.

RESULTS

the average age of patients was 35.35±8.81 years. Primary infertility was found in 61.8% of cases. The most common risk factors for infertility were tobacco followed by varicocele and infection. Spermogram was altered in 53.1% of cases. The most common abnormality was sperm vitality issues (36.9%) followed by spermatic concentration (29.7%) and morphology (29.3%). Age was the unique factor which had a significant impact on spermogram (p=0.002). Abnormalities in mobility were detected in patients ≥31 years, sperm vitality issues in patients aged 34 years, abnormalities in morphology in patients aged 35 years and concentration in patients aged 37 years. Azoospermia was found in 16.4% of cases and was mainly associated with primary infertility. Oligo-astheno-teratozoospermia was the most common association (26.2%).

CONCLUSION

male infertility is common in our context. The major risk factor is age. Mobility is the earliest parameter achieved.

Septic arthritis of the ankle: Do not forget Pasteurella pneumotropica

Pasteurella pneumotropica is an important bacterial pathogen in both animals and humans. Most reported Pasteurella infections in humans involve skin and soft tissues, often after an animal bite, scratch, or lick to an open wound. We report a case of septic arthritis with Pasteurella pneumotropica in a diabetic and cardiopathic patient who was the victim of a rat bite in the street, with a good evolution after medical and surgical treatment.

Can the microbiota predict response to systemic cancer therapy, surgical outcomes, and survival? The answer is in the gut

INTRODUCTION

The gut microbiota seems to play a key role in tumorigenesis, across various hallmarks of cancer. Recent evidence suggests its potential use as a biomarker predicting drug response and adding prognostic information, generally in the context of immuno-oncology.

AREAS COVERED

In this review, we focus on the modulating effects of gut microbiota dysbiosis on various anticancer molecules used in practice, including cytotoxic and immune-modulating agents, primarily immune-checkpoint inhibitors (ICI). Pubmed/Medline-based literature search was conducted to find potential original studies that discuss gut microbiota as a prognostic and predictive biomarker for cancer therapy. We also looked at the US ClinicalTrials.gov website to find additional studies particularly ongoing human clinical trials.

EXPERT COMMENTARY

Sequencing of stool-derived materials and tissue samples from cancer patients and animal models has shown a significant enrichment of various bacteria such as Fusobacterium nucleatum and Bacteroides fragilis were associated with resistant disease and poorer outcomes. Gut microbiota was also found to be associated with surgical outcomes and seems to play a significant role in anastomotic leak (ATL) after surgery mainly by collagen breakdown. However, this research field is just at the beginning and the current findings are not yet ready to change clinical practice.

Cytological examination of cerebrospinal fluid: Sysmex UF-1000i versus optical microscopy

We evaluated the body fluid module on Sysmex UF-1000i (UF-1000i-BF) for analysis of white blood cell (WBC) and red blood cell (RBC) in cerebrospinal fluid. We collected 93 cerebrospinal fluid samples and compared the results of the UF-1000i-BF mode with the Fast-Read 102 disposable counting cell. Results shows a good correlation between the UF-1000i and the microscopic examination. The concordance percentage is 99.06% for white blood cells and 85.18% for red blood cells. The UF-1000i-BF mode offers rapid and reliable total WBC and RBC counts for initial screening of cerebrospinal fluid, and can improve the workflow in a routine laboratory.

Evaluation of GeneXpert MTB/RIF system performances in the diagnosis of extrapulmonary tuberculosis

Background

Tuberculosis represents a serious public health problem and a significant diagnostic and therapeutic challenge worldwide. Molecular diagnostic techniques are crucial in the World Health Organization’s new tuberculosis control strategy.

This study aims to evaluate the performance of GeneXpert MTB/RIF (Cepheid Sunnyvale, CA, United States) in diagnosis of extra-pulmonary tuberculosis then compare it’s performance in detecting Rifampicin resistance to GenoType MTBDRplus (HAIN Life Sciences, Nehren, Germany).

Methods

Samples from pulmonary and/or extra-pulmonary origins were analysed in a 21 months retrospective study. Samples were sent to the bacteriology laboratory for Mycobacterium tuberculosis detection using conventional bacteriological and molecular methods (GeneXpert MTB/RIF and MTBDRplus). Sensitivity and specificity were calculated for the stained smear and GeneXpert according to culture (Gold Standard) as well as for GeneXpert MTB/RIF in both negative and positive microscopy tuberculosis cases. Data’s statistical analysis was performed with SPSS13.0 software.

Results

Seven hundred fourteen patients’ samples were analysed; the average age was 47.21 ± 19.98 years with a male predominance (66.4%). Out of 714 samples: 285 were from pulmonary and 429 were from extra-pulmonary origins. The positivity rates for microscopy, GeneXpert MTB/RIF and culture were 12.88, 20.59 and 15.82%, respectively. These rates were 18.9, 23.85 and 20.35% for pulmonary samples and 9.71, 18.41 and 12.82% for extra-pulmonary samples, respectively. The sensitivity and specificity of GeneXpert MTB/RIF were almost the same in both pulmonary and extra-pulmonary samples (78.2 and 90.4%) and (79,3 and 90.3%) respectively.

Rifampicin resistance rate found by GeneXpert MTB/RIF was 0.84%. Comparison of Rifampicin resistance obtained by GeneXpert MTB/RIF and Genotype MTBDRplus, showed 100% agreement between the two techniques for studied samples.

Conclusions

This confirms GeneXpert MTB/RIF advantage for tuberculosis diagnosis, particularly extra-pulmonary tuberculosis with negatively stained smear. The performance of GeneXpert and Genotype MTBDRplus are similar in detection of Rifampicin resistance. However, variability of detection performance according to tuberculosis endemicity deserves more attention in the choice of screening techniques of Rifampicin resistance, hence the interest of conducting comparative studies of detection performance under low and medium endemicity on large samples of tuberculosis populations.

Assessment of surface cleaning and disinfection in neonatal intensive care unit

Background

Surveillance for healthcare-associated infections (HAI) is a priority in the neonatal intensive care unit (NICU), given the critical immune status of patients. The aim of this study was to assess surface bacterial contamination before and after improving cleaning and disinfection practices.

Materials and methods

This was a cross-sectional study conducted in March 2018. Surface samples were taken from the same areas in three steps: after cleaning, after "improved" cleaning, and after terminal disinfection using hydrogen peroxide vapor (VHP). Sampling and culture was carried out according to standard ISO14698-1: 2004. Results interpretation was based on the thresholds defined by good hospital pharmacy practice. Statistical analysis was performed by SPSS 21.0 and a P-value < 0.05 was considered to be significant.

Results

In total, 290 samples were taken from different zones: fixed equipment (69%), aseptic washbasins (12%), pneumatic system (9%), computer equipment (6%) and mobile equipment (4%). Prevalence of non-compliances after cleaning and disinfection was 75%, 10% after “improved” cleaning, and 0% after automated VHP (P < 0.0001). Median of CFU was 24[EI (0–625)] after standard cleaning, 2[EI (0–35)] after “improved” cleaning and 0 [EI (0–3)] after VHP (P < 0.0001). Isolated germs werecoagulase-negative Staphylococcus (31.2%), Acinetobacter baumannii (26%), Staphylococcus aureus (19.5%), Pseudomonas aeruginosa (9%), Klebsiella pneumoniae (9%), E. coli (4%) and Enterobacter sp (1.3%).

Conclusion

Improved cleaning and disinfection practices associated to VHP give microbiological satisfactory results. It is important to educate cleaning staff for effective surface cleaning and disinfection operations to control HAI.

[Prevalence and role of IgG anti-Chlamydia trachomatis in a population of infertile men in Morocco]

INTRODUCTION

Infertility is a global public health problem that affects 15% of couples of childbearing age. Male infertility is involved in 20 to 50% of cases. These figures are sharply increasing around the world. Several factors may be responsible for this infertility with especially hormonal, genetic, toxic or infectious factors. The latter are dominated mainly by Chlamydia infection. Among the most serious complications of this infection are infertility related to urethritis, epididymitis and irreversible total azoospermia in men and tubal obstructions and ectopic pregnancies in women.

STUDY OBJECTIVE

To determine the prevalence of IgG anti-Chlamydia trachomatis in men consulting for infertility and the association between previous contact with this bacterium and the impairment of sperm quality and sperm function.

MATERIAL AND METHODS

Prospective study over 26months of 143 patients referred to the service for infertility assessment of the couple. Demographic data, primary or secondary character of infertility, risk factors (tobacco, inguinal hernia, varicocele and history of urogenital infections), semen parameters (volume, mobility, pH, vitality and morphological abnormalities) were studied as well as the determination of the anti-C. trachomatis IgG titer. The prevalence of Chlamydia infection and the association of the infection and alteration of the various parameters of the semen were analyzed.

RESULTS

The average age of patients was 38.5±8.55. Infertility was primary in 72% of patients. Among the patients, 54.5% had an abnormal spermogram. Chlamydia IgG antibodies were positive in 37.1% of patients whose 58.5% had abnormal spermogram. Analysis of sperm parameters of patients with and without IgG C. trachomatis showed an altered vitality in Chlamydia positive patients with an OR at 2.41, P=0.02, (95% CI: 1.15-5.06).

CONCLUSION

The prevalence of Chlamydia infection is high in infertile male. C. trachomatis IgG antibodies may be associated with an alteration of spermatozoa vitality without significant impairment of other semen parameters.

LEVEL OF EVIDENCE

3.

Exceptional association of two species of bacteria causing mediastinitis: Haemophilus influenzae (H. influenzae) and Aggregatibacter aphrophilus (A. aphrophilus)

BACKGROUND

Post cardiac surgery mediastinitis is the major infectious complication, despite the development of surgical techniques and the application of strict preventive measures. The Haemophilus influenzae mediastinitis is very rare. The mediastinitis caused by the association between Haemophilus influenzae and Aggregatibacter aphrophilus has never been described to our knowledge.

CASE PRESENTATION

We report the case of an exceptional combination of Haemophilus influenzae and Aggregatibacter aphrophilus in a patient operated for single bypass which is complicated by mediastinitis the 10th day after the surgical act.

CONCLUSION

The conclusion to be drawn from this work is to think in unusual seeds in case of mediastinitis post cardiac surgery for the elaboration of recommendations for antibiotic prophylaxis.

Serious phlegmonous lesion of the hand following an injury by vegetal thorn: Never forget Pasteurella multocida!

Pasteurella multocida can cause serious infections after dog or cat bite. We report here a rare case of hand infection caused by P. multocida consecutive to an injury by a thorn of the prickly pear. It caused an amputation of the distal phalanx of the thumb in a trisomic patient.

It is about a 27-year-old man who was admitted to the hospital with swelling and intense pain of the left hand. He reported a sting by a thorn of prickly pear 15 days before. The patient was admitted to proceed with operative irrigation and debridement. The pus was collected for microbiological examination. Microscopic examination after Gram staining revealed small Gram-negative coccobacilli, associated to polymorphonuclear reaction. Culture have objectivated Pasteurella multocida. The isolated strain was susceptible to betalactamins. Patient was treated with ampicillin. Well-conducted antibiotics and repetitive local cares have not prevented local lesions from progressing to necrosis of the soft parts of the thumb and osteitis of the distal phalanx of the thumb. The patient underwent a necrosectomy and an amputation of the distal phalanx. Ampicillin was replaced by amoxicillin/clavulanic acid and after 15 days, progression was clinically and microbiologically favorable.

In the case we report, since the patient does not report any exposure or contact with animals, the thorn prick is the source of infection. It was contaminated from the animal reservoir. Taking into account the monomicrobism of the infection, treatment with aminopenicillins was sufficient. Our propositus came to the hospital 15 days after the inoculation of the bacterium. This duration appears to be very late in relation to the acute character of pasteurellosis. This was probably the main reason why the local infection evolved towards osteoarticular complications. That's why, we should consider Pasteurella multocida in case of infection by inoculation, even in the absence of contact with the animals.

Intensive care unit-acquired Acinetobacter baumannii infections in a Moroccan teaching hospital: epidemiology, risk factors and outcome

Introduction

The objective of this study was to examine the epidemiology, risk factors and outcome associated with Acinetobacter baumannii infections in the intensive care units (ICUs) in a Moroccan teaching hospital.

Methods

This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016.

Results

Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed A. baumannii infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired A. baumannii infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with A. baumannii infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with A. baumannii infection.

Conclusion

Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.

Bacteriological aspects of chronic osteoarticular infections in adults: the influence of the osteosynthesis material

Background

The aim of this study is to establish the bacterial epidemiology of chronic osteoarticular infections in adults, to study the susceptibility of the isolated strains to antibiotics and to demonstrate the influence of osteosynthesis material thereon.

Patients and methods

This is a retrospective study of 78 months, from January 2006 to June 2012, providing bacteriological samples from patients with osteitis and osteoarthritis in the Mohammed V military teaching hospital of Rabat. Isolation and identification of bacteria were made by bacteriological classical techniques. The antimicrobial susceptibility testing of the isolates was performed by disk diffusion agar method, as recommended by the Committee of the susceptibility of the French Society for Microbiology (CA-SFM).

Results

We collected 234 cases, 53% (n = 124) of patients without osteosynthesis material (group A) and 47% (n = 110) patients with osteosynthesis material (group B).We isolated 371 bacteria which 51.49 (n = 191) in group A and 48.51% (n = 180) in group B. Gram-positive cocci were the most frequent (n = 234), followed by the Gram-negative bacilli (n = 114) and the Gram-positive bacilli (n = 19). Our study shows that the rate of resistance to antibiotics in strains obtained from patients with osteosynthesis material is higher compared to those obtained from patients without osteosynthesis material.

Conclusions

Chronic OA infection in adults is difficult to diagnose and treat. Its good management must be multidisciplinary.

Brucellosis: A cause of meningitis not to neglect

Brucellosis is the most frequent bacteria zoonosis in the world, with more than half a million new cases each year [1]. It is also the most significant zoonos in the edge of the Mediterranean Sea [2]. This zoonosis is capable of affecting humans and cause polymorphic clinical manifestations. In Morocco, the southern regions are the main affected areas [3].

We are reporting the observation of a 17-year-old male patient, who presented a febrile meningeal syndrome for 9 months without sensitivo-motor deficit. Tuberculosis is frequently evoked in such clinical presentations because Morocco is an endemic country, brucellosis is therefore often forgotten. The results of lumbar puncture, magnetic resonance imaging (MRI) and especially serology aided to conclude to a neuro-brucellosis. The outcome was favourable with antibiotic therapy.

Clonal diversity and detection of carbapenem resistance encoding genes among multidrug-resistant Acinetobacter baumannii isolates recovered from patients and environment in two intensive care units in a Moroccan hospital

Background

Carbapenem-resistant Acinetobacter baumannii has recently been defined by the World Health Organization as a critical pathogen. The aim of this study was to compare clonal diversity and carbapenemase-encoding genes of A. baumannii isolates collected from colonized or infected patients and hospital environment in two intensive care units (ICUs) in Morocco.

Methods

The patient and environmental sampling was carried out in the medical and surgical ICUs of Mohammed V Military teaching hospital from March to August 2015. All A. baumannii isolates recovered from clinical and environmental samples, were identified using routine microbiological techniques and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Antimicrobial susceptibility testing was performed using disc diffusion method. The carbapenemase-encoding genes were screened for by PCR. Clonal relatedness was analyzed by digestion of the DNA with low frequency restriction enzymes and pulsed field gel electrophoresis (PFGE) and the multi locus sequence typing (MLST) was performed on two selected isolates from two major pulsotypes.

Results

A total of 83 multidrug-resistant A. baumannii isolates were collected: 47 clinical isolates and 36 environmental isolates. All isolates were positive for the bla_OXA51-like and bla_OXA23-like genes. The coexistence of bla_NDM-1/bla_OXA-23-like and bla_{OXA 24-like}/bla_OXA-23-like were detected in 27 (32.5%) and 2 (2.4%) of A. baumannii isolates, respectively. The environmental samples and the fecally-colonized patients were significantly identified (p < 0.05) as the most common sites of isolation of NDM-1-harboring isolates. PFGE grouped all isolates into 9 distinct clusters with two major groups (0007 and 0008) containing up to 59% of the isolates. The pulsotype 0008 corresponds to sequence type (ST) 195 while pulsotype 0007 corresponds to ST 1089.The genetic similarity between the clinical and environmental isolates was observed in 80/83 = 96.4% of all isolates, belonging to 7 pulsotypes.

Conclusion

This study shows that the clonal spread of environmental A. baumannii isolates is related to that of clinical isolates recovered from colonized or infected patients, being both associated with a high prevalence of the bla_OXA23-like and bla_NDM-1genes. These findings emphasize the need for prioritizing the bio-cleaning of the hospital environment to control and prevent the dissemination of A. baumannii clonal lineages.

Electronic supplementary material

The online version of this article (10.1186/s13756-017-0262-4) contains supplementary material, which is available to authorized users.

In vitro evaluation of the susceptibility of Acinetobacter baumannii isolates to antiseptics and disinfectants: comparison between clinical and environmental isolates

Background

This study aims to assess the susceptibility of Acinetobacter baumannii isolates to the antiseptics and disinfectants commonly used, and to the non-approved product.

Methods

This is a prospective study carried out from February to August 2015, in the Bacteriology department of Mohammed V Military Teaching hospital of Rabat on A.baumannii isolates collected from colonized and/or infected patients and environmental samples. The antiseptics and disinfectants susceptibility testing was assessed using the micromethod validated in our department. The antiseptics and disinfectants studied were: 70% ethyl alcohol, chlorhexidine, povidone-iodine, didecyldimethylammonium chloride and a commercial product which was presented as a hospital disinfectant (non-registered product).

Results

Povidone-iodine, 0.5% chlorhexidine digluconate, 70% ethyl alcohol and didecyl dimethyl ammonium chloride in combination with N- (3-aminopropyl) -N-dodecylpropane-1, 3-diamine were effective against all the 81 A.baumannii isolates tested, and their logarithmic reduction ≥ 5 were observed in 100% of the isolates in their undiluted form. The strains isolated from patients were more resistant than environmental strains: at a dilution of ½ for 70% ethyl alcohol (37.77% vs 11.11%, p = 0.007) and at a dilution of 1/10 (100% vs 69.44%, p < 0.001) for povidone iodine. The non-registered product was ineffective with a resistance rate of 96.29% at a dilution of 1/50, 45.67% at a dilution of 1/10 and 13.58% in its purest form.

Conclusion

Our study revealed the effectiveness of the main disinfectants and antiseptics used in Morocco; three antiseptics tested were effective in their purest form against the 81 A.baumannii isolates. Regarding disinfectants, our results showed an efficacy of didecyl dimethyl ammonium at the recommended use concentration and in its purest form. This study emphasizes the need for using disinfectants and antiseptics in dilutions recommended by the manufacturer because the insufficient dilutions of these products are not effective. Our findings also demonstrated an inefficiency of the non-registered product against A.baumanii isolates. However, the non-registered products should be prohibited.

[Saccharomyces cerevisiae invasive infection: The first reported case in Morocco]

Saccharomyces cerevisiae is a cosmopolitan yeast, widely used in agro-alimentary and pharmaceutical industry. Its impact in human pathology is rare, but maybe still underestimated compared to the real situation. This yeast is currently considered as an emerging and opportunistic pathogen. Risk factors are immunosuppression and intravascular device carrying. Fungemias are the most frequent clinical forms. We report the first case of S. cerevisiae invasive infection described in Morocco, and to propose a review of the literature cases of S. cerevisiae infections described worldwide. A 77-year-old patient, with no notable medical history, who was hospitalized for a upper gastrointestinal stenosis secondary to impassable metastatic gastric tumor. Its history was marked by the onset of septic shock, with S. cerevisiae in his urine and in his blood, with arguments for confirmation of invasion: the presence of several risk factors in the patient, positive direct microbiological examination, abundant and exclusive culture of S. cerevisiae from clinical samples. Species identification was confirmed by the study of biochemical characteristics of the isolated yeast. Confirmation of S. cerevisiae infection requires a clinical suspicion in patients with risk factors, but also a correct microbiological diagnosis.

[Fatal sepsis due to an emerging bacteria: Arcanobacterium hemolyticum]

Arcanobacterium hemolyticum (A.haemolyticum) is a gram-positive bacillus. Man is the primary environmental reservoir. It is essentially an opportunistic pathogen in immunocompromised patients and may be responsible for infections of the skin and pharynx in healthy subjects, especially in children and adolescents. It can cause superinfections of chronic ulcers, but occasionally it causes invasive infections. Its isolation from culture samples is always difficult because it simulates many bacteria to which it is often associated in pathological products. There are not recommendations concerning the study of its antibiotics sensitivity. Arcanobacterium Bacteremia are rare to our knowledge, only sixteen case reports have been described in the literature. We here report another case of a patient with A.haemolyticum bacteremia secondary to superinfection of gluteal eschars.

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

INTRODUCTION

This study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat.

METHODS

This is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014.

RESULTS

During the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n = 6352) and 9.6% of Gram negative rods (n = 4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin.

CONCLUSION

This paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.

Evaluation of antimicrobial susceptibility of Escherichia coli strains isolated in Rabat University Hospital (Morocco)

BACKGROUND

Escherichia coli (E. coli) is the most commonly isolated bacteria in human pathology. In Morocco the data concerning the nature and the rates of antibiotic resistance of E. coli in both hospitals and city environment remains relatively poor and needs further investigations.

METHODS

During a 16 months period, E. coli isolates were collected from different culture specimens received in the Bacteriology Department of the Military teaching Hospital Mohammed-V-Rabat for routine diagnostic purposes. E. coli isolates were identified and their antimicrobial susceptibility pattern was determined.

RESULTS

A total of 1369 E. coli isolates comprising 33% (1369/4110) of culture-positive samples were consecutively collected. Isolates of E. coli were, in 40.5% (554/1369) of cases from hospitalized patients and in 59.5% (815/1369) of cases from outpatients. Urine isolates represented 82% (1123/1369) of the cases. High rates of resistance were found for amoxicillin (42.5%), cefalotin (30.4%), norfoloxacin (29.9%) and sulfamethoxazole (37.7%). The detection rate of ESBL was 6.1% (85/1369). In hospitalized patients 11.9% of the isolates of E. coli (66/554) had an ESBL phenotype while in outpatients cases only 2.3% of isolates of E. coli (19/815) had this phenotype.

CONCLUSIONS

Our findings suggest that more judicious use of antibiotics is needed especially in probabilistic treatment. The emergence of ESBL in the Moroccan cities is an indicator of the severity of this problem that is not limited to health care facilities.

[Bacteriological aspects of catheter cultures: study over 24 months]

BACKGROUND

Catheter-related infections are the sixth leading cause of nosocomial infections with approximately 7% of cases.

AIM

The aim of this work was to establish the bacterial epidemiology of the catheter and TIC culture (totally implantable catheter) at the Mohamed V Military Teaching Hospital (MVHMI), and to study the antibiotic susceptibility of bacteria isolated.

METHODS

this is a retrospective study over 24 months, including the venous and arterial catheters as well as the TIC treated at the Microbiology laboratory of the MVHMI. The culture was realized by the quantitative Brun Buisson method. The antibiotic susceptibility was made according to the French Society guidelines.

RESULTS

We have collected 282 cases with 255 catheters and 27 TIC. The significant rate culture was 51,42% (n=145) for catheters and TIC, including 90,43% catheters and 9,57% TIC. These catheters and TIC with positive culture emanated primarily from hemodialysis (32,41%) and surgical intensive care unit (28,97%) services. The microorganisms distribution by species showed the prevalence of Staphylococcus aureus (15,91%) followed by Acinetobacter baumannii (14,77%) and Pseudomonas aeruginosa (7,39%). The meticilline resistance rate in Staphylococcus aureus was 7,14%. The Acinetobacter baumannii resistance rate was 64%, and 80,8% for imipenem and ceftazidime respectively. The rate of resistance of Pseudomonas aeruginosa to imipenem and ceftazidime was 69.23% for each.

CONCLUSION

The bacterial epidemiology of the catheters and TIC cultures is dominated by the potentially nosocomial bacteria. Multidrug resistance of A. baumannii and P. aeruginosa requires an improved catheters management and strengthening nosocomial infections prevention.

[Visceral leishmaniasis, pemphigus and immunosuppressive treatment: case report from Morocco]

Atypical forms of visceral leishmaniasis associated with immunosuppressive treatment are difficult to diagnose and cause high mortality. The purpose of this report is to describe a case involving a 42-year-old patient living in a leishmaniasis-endemic area, who was undergoing immunosuppressive treatment using corticosteroids and methotrexate for pemphigus. Despite clinical and laboratory findings consistent with visceral leishmaniasis, detection of Leishmania bodies was a coincidental finding of cytological examination of bone marrow during workup for pancytopenia and associated clinical signs. This case argues in favor of systematic screening for this opportunistic parasitic disease before undertaking immunosuppressive treatment in patients presenting risk factors and consistent clinical/laboratory findings.