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Ayari I, Chebbi Y, Raddaoui A, Belloumi D, Frigui S, Werhni R, Ben Othmen T, Abedejlil N, Achour W. High rates of intestinal colonization with carbapenemase producing Enterobacteriaceae in hematopoietic stem cell transplant recipients. Acta Microbiol Immunol Hung 2024; 71:61-68. [PMID: 38381147 DOI: 10.1556/030.2024.02210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
Carbapenem resistant Enterobacteriaceae (CRE) are major human pathogens because, these cause high number of difficult-to-treat infections. Allogeneic hematopoietic stem cell transplant (AHSCT) recipients are highly exposed to these type of bacteria. The aim of our study was to investigate prevalence of CRE colonization in AHSCT patients and to determine genes encoding carbapenem resistance. A retrospective study conducted between January 2015 and December 2019, involved 55 patients colonized with CRE strains. We determined the rate of antibiotic resistance according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the carbapenem resistance genes by PCR assays for genes encoding most frequent β-lactamases namely, blaGES, blaKPC, blaIMI, blaNDM, blaVIM, blaIMP and blaOXA-48. Eighty-one episodes of CRE colonization were recorded in 55 patients, mainly suffering from acute leukaemia (30%) and aplastic anemia (26%). History of hospitalization was noted in 80 episodes. Prior antibiotic treatment, severe neutropenia and corticosteroid therapy were respectively found in 94%, 76% and 58% of cases. Among the 55 patients, six patients (11%) developed a CRE infection. The CRE responsible for colonization were carbapenemase producers in 90% of cases. They belonged mostly to Klebsiella pneumoniae (61/81) and Escherichia coli species (10/81). Antibiotic resistance rates were 100% for ertapenem, 53% for imipenem, 42% for amikacin, 88% for ciprofloxacin and 27% for fosfomycin. Molecular study showed that blaOXA-48 gene was the most frequent (60.5%), followed by blaNDM (58%). Thirty-five (43%) strains were co-producers of carbapenemases. In our study, we report a high rate of CRE intestinal colonization in AHSCT recipients of our center.
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Affiliation(s)
- Ikram Ayari
- 1Laboratory Department, National Bone Marrow Transplant Centre, 1006, Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006, Tunis, Tunisia
| | - Yosra Chebbi
- 1Laboratory Department, National Bone Marrow Transplant Centre, 1006, Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006, Tunis, Tunisia
| | - Anis Raddaoui
- 1Laboratory Department, National Bone Marrow Transplant Centre, 1006, Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006, Tunis, Tunisia
| | - Dorra Belloumi
- 3Department of Haematology, National Bone Marrow Transplantation, Tunis, Tunisia
| | - Siwar Frigui
- 1Laboratory Department, National Bone Marrow Transplant Centre, 1006, Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006, Tunis, Tunisia
| | - Rim Werhni
- 1Laboratory Department, National Bone Marrow Transplant Centre, 1006, Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006, Tunis, Tunisia
| | - Tarek Ben Othmen
- 3Department of Haematology, National Bone Marrow Transplantation, Tunis, Tunisia
| | - Nour Abedejlil
- 3Department of Haematology, National Bone Marrow Transplantation, Tunis, Tunisia
| | - Wafa Achour
- 1Laboratory Department, National Bone Marrow Transplant Centre, 1006, Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006, Tunis, Tunisia
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Raddaoui A, Mabrouk A, Chebbi Y, Frigui S, Al-Gallas N, Abbassi MS, Achour W. Outbreak caused by pandrug-resistant blaOXA-69/blaOXA-23/blaGES harboring Acinetobacter baumannii ST2 in an intensive care unit. Acta Microbiol Immunol Hung 2024; 71:37-42. [PMID: 38285075 DOI: 10.1556/030.2024.02202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Acinetobacter baumannii has emerged as a main nosocomial pathogen exhibiting high rates of resistance to clinically relevant antibiotics. Six pandrug-resistant A. baumannii (PDR-A. baumannii) were recovered from three patients in a Tunisian Intensive Care Unit (ICU) between 10th and 16th of May 2018 resulting in one fatal case and raising the possibility of an outbreak. On 18th of May environmental screening of ICU surfaces was carried out. On 22nd of May a fourth patient was infected with PDR-A. baumannii and died. A second investigation was carried out for environmental screening and PDR-A. baumannii was isolated from the respirator. Antimicrobial susceptibility testing was performed according to EUCAST (2019) guidelines. MIC of colistin was determined by broth microdilution method. PCR was used to detect 14 beta-lactamases/carbapenemases and mcr (mcr-1 to mcr-5) genes. The genetic relatedness of PDR-A. baumannii isolates was determined by PFGE and MLST. Seven PDR-A. baumannii isolates were recovered from four patients, one MDR strain from wash basin, a PDR strain from hand sanitizer bottle and another PDR strain from respirator. All PDR-A. baumannii (n = 9) harbored blaOXA-69 gene and none carried mcr. Moreover, seven carried blaGES and blaOXA-23 genes. PFGE identified four pulsotypes (A, B, C, and D) with the pulsotype A gathering seven PDR-A. baumannii isolates: six from three patients and one from hygiene sample. MLST revealed that all PDR-A. baumannii isolates of pulsotype A belonged to the pandemic clone ST2. Systematic screening of MDR and PDR-A. baumannii is highly recommended to limit dissemination of such strains in ICUs.
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Affiliation(s)
- Anis Raddaoui
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Aymen Mabrouk
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Yosra Chebbi
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Siwar Frigui
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Nazek Al-Gallas
- 3Department of Biology, College of Science, University of Hafr Al Batin, Hafr AlBatin 31991, Saudi Arabia
- 4Water and Food Control Lab, National Center of Salmonella, Shigella, Vibrio-Enteropathogens, Pasteur Institute of Tunis, 1007 Tunis, Tunisia
| | - Mohamed Salah Abbassi
- 5Faculty of Medicine of Tunis, Laboratory of Antibiotic Resistance LR99ES09, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Wafa Achour
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- 2Faculty of Medicine of Tunis, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
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Raddaoui A, Mabrouk A, Chebbi Y, Frigui S, Salah Abbassi M, Achour W, Thabet L. Co-occurrence of blaNDM-1 and blaOXA-23 in carbapenemase-producing Acinetobacter baumannii belonging to high-risk lineages isolated from burn patients in Tunisia. J Appl Microbiol 2024; 135:lxae039. [PMID: 38346864 DOI: 10.1093/jambio/lxae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/10/2024] [Accepted: 02/09/2024] [Indexed: 03/21/2024]
Abstract
AIMS Carbapenem-resistant Acinetobacter baumannii (CR-Ab) is an important cause of infections in burn patients. This study aimed to characterize the antimicrobial susceptibility pattern of CR-Ab isolated from burns in Burn Intensive Care Unit (BICU) of the Trauma and Burn Centre of Ben Arous, to determine the prevalence of β-lactamase-encoding genes and to search eventual genetic relatedness of CR-Ab strains. METHODS AND RESULTS From 15 December 2016 to 2 April 2017, all nonduplicated CR-Ab isolated in burn patients in the BICU were screened by simplex Polymerase Chain Reaction (PCR) for the class A, B, C, and D β-lactamase genes. Sequencing was performed for NDM gene only. Genetic relatedness was determined by using pulsed field gel electrophoresis (PFGE) and by multilocus sequence typing. During the study period, 34 strains of CR-Ab were isolated in burns, mainly in blood culture (n = 14) and central vascular catheter (n = 10). CR-Ab strains were susceptible to colistin but resistant to amikacin (91%), ciprofloxacin (100%), rifampicin (97%), and trimethoprim-sulfamethoxazole (100%). All strains harbored blaOXA-51-like and blaOXA-23 genes, only or associated to blaGES (n = 26; 76%), blaADC (n = 20; 59%), blaPER-1 (n = 6; 18%) or/and blaNDM-1 (n = 3; 9%). PFGE identified 16 different clusters and revealed that most strains belonged to one major cluster A (n = 15; 44.1%). Among NDM-1 isolates, two were clonally related in PFGE and belonged to two single locus variant sequence type ST-6 and ST-85. CONCLUSIONS This is the first description of clonally related NDM-1 and OXA-23-producing A. baumannii strains in the largest Tunisian BICU associated with two single locus variant sequence types ST6 and ST85.
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Affiliation(s)
- Anis Raddaoui
- Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- Faculty of Medicine of Tunis, LR18ES39, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Aymen Mabrouk
- Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- Faculty of Medicine of Tunis, LR18ES39, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Yosra Chebbi
- Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- Faculty of Medicine of Tunis, LR18ES39, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Siwar Frigui
- Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- Faculty of Medicine of Tunis, LR18ES39, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Mohamed Salah Abbassi
- Faculty of Medicine of Tunis, Laboratory of Antibiotic Resistance LR99ES09, University of Tunis El Manar, 1006 Tunis, Tunisia
- Institute of Veterinary Research of Tunisia, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Wafa Achour
- Laboratory Ward, National Bone Marrow Transplant Center, 1006 Tunis, Tunisia
- Faculty of Medicine of Tunis, LR18ES39, University of Tunis El Manar, 1006 Tunis, Tunisia
| | - Lamia Thabet
- Laboratory Ward, Traumatology and Great Burned Center, 2074 Ben Arous, Tunisia
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Hmissi S, Raddaoui A, Frigui S, Abbassi MS, Achour W, Chebbi Y, Thabet L. Detection of carbapenem resistant Pseudomonas aeruginosa co-harboring blaVIM-2 and blaGES-5 in burn patients. Acta Microbiol Immunol Hung 2023; 70:199-205. [PMID: 37490366 DOI: 10.1556/030.2023.02089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
Pseudomonas aeruginosa is one of the major infectious agents in burn patients. Globally, high rates of antimicrobial resistance in P. aeruginosa have been reported, which is a cause of concern. The objective of this study was to determine the rate of resistance to carbapenems in P. aeruginosa isolates recovered from burn patients in Tunisia, to search genes encoding for carbapenemases and to determine their epidemiological markers (serotypes). A retrospective study was conducted in the Burn Intensive Care Unit (BICU) of the Trauma and Burn Centre of Ben Arous, Tunisia, and P. aeruginosa isolates collected from burn patients, from January to December 2018 were investigated. Carbapenemase screening was performed by Carbapenem Inactivation Method (CIM) and by EDTA-disk test for all carbapenem resistant isolates. Genes encoding carbapenemases (blaVIM, blaIMP, blaGES, blaNDM, and blaKPC) were investigated by PCR and selected carbapenemase genes were sequenced. During the study period, 104 non duplicated P. aeruginosa isolates were recovered. Most of them were isolated from skin samples (45.1%) and blood culture (22.1%) and belonged to O:11 (19.2%), O:12, and O:5 (12.5%, each) serotypes. High rates of resistance were observed for carbapenems (64.4%). Among the 67 carbapenem resistant isolates, 58 (86.5%) harbored blaVIM gene and 55 (82%) blaGES gene; in addition, 48 (71.6%) co-harbored blaVIM and blaGES genes. After sequencing, the blaVIM-2 and blaGES-5 gene variants were identified in seven randomly selected isolates. To the best of our knowledge, this is the first description of P. aeruginosa simultaneously harboring blaVIM-2 and blaGES-5 genes.
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Affiliation(s)
- Souhir Hmissi
- 1Laboratory Ward, National Bone Marrow Transplant Center, Tunis 1006, Tunisia
- 2Faculty of Medicine of Tunis, Laboratory Ward, National Bone Marrow Transplant Center, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
- 6Faculty of Sciences of Bizerte, University of Carthage, 7021 Zarzouna, Bizerte, Tunisia
| | - Anis Raddaoui
- 1Laboratory Ward, National Bone Marrow Transplant Center, Tunis 1006, Tunisia
- 2Faculty of Medicine of Tunis, Laboratory Ward, National Bone Marrow Transplant Center, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Siwar Frigui
- 1Laboratory Ward, National Bone Marrow Transplant Center, Tunis 1006, Tunisia
- 2Faculty of Medicine of Tunis, Laboratory Ward, National Bone Marrow Transplant Center, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Mohamed Salah Abbassi
- 3Faculty of Medicine of Tunis, Laboratory of Antibiotic Resistance LR99ES09, University of Tunis El Manar, 1006 Tunis, Tunisia
- 4Institute of Veterinary Research of Tunisia, University of Tunis El Manar, Tunis 1006, Tunisia
| | - Wafa Achour
- 1Laboratory Ward, National Bone Marrow Transplant Center, Tunis 1006, Tunisia
- 2Faculty of Medicine of Tunis, Laboratory Ward, National Bone Marrow Transplant Center, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Yosra Chebbi
- 1Laboratory Ward, National Bone Marrow Transplant Center, Tunis 1006, Tunisia
- 2Faculty of Medicine of Tunis, Laboratory Ward, National Bone Marrow Transplant Center, University of Tunis El Manar, LR18ES39, 1006 Tunis, Tunisia
| | - Lamia Thabet
- 5Laboratory of Microbiology, Center of Traumatology and Major Burns, Ben Arous 2013, Tunisia
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Raddaoui A, Chebbi Y, Bouchami O, Frigui S, Messadi AA, Achour W, Thabet L. Dissemination of epidemic ST239/ST241-t037-agrI-SCCmecIII methicillin-resistant Staphylococcus aureus in a Tunisian trauma burn intensive care unit. Acta Microbiol Immunol Hung 2023; 70:52-60. [PMID: 36525058 DOI: 10.1556/030.2022.01884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/18/2022] [Indexed: 12/16/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen causing health care-infections in the world, especially in burns. The aim of this study was to assess the extent of dissemination of MRSA isolated from burn patients in Burn Intensive Care Unit in Tunisia and to evaluate the frequency of virulence and antibiotics resistance genes. Among the 72 S. aureus isolates analyzed in the study, 54% were MRSA. The majority of MRSA (94.8%) were multidrug resistant and they had a high resistance rates to kanamycin (94.8%), tobramycin (90%), tetracycline (94.8%) and ciprofloxacin and rifampicin (87%, each). The gene aac(6')-Ie-aph(2″)-Ia conferring resistance to kanamycine and tobtamycin were detected in all isolates and the aph(3')-Ia gene conferring resistance to gentamicin were detected in 2.8% of resistant isolates. Tetracycline resistance genes tet(M), tet(K) and tet(L) were detected in 100%, 10.8% and 2.8% of the isolates, respectively. The SCCmec type III and the agr type I were the most predominant (69.2% and 90%, respectively). The 27 SCCmecIII-agrI isolates were clustered into two PFGE types A and B. The two representative isolates of PFGE clusters A and B belonged to ST239-t037 and ST241-t037 respectively. As conclusion, our results showed a high prevalence of MRSA in trauma burn intensive care unit belonging to two multidrug resistant clones ST239/ST241-agrI-t037-SCCmecIII MRSA. We also demonstrated that MRSA was disseminated between burn patients.
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Affiliation(s)
- Anis Raddaoui
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia.,2Faculty of Medicine of Tunis, Tunis El Manar University, LR18ES39, 1006, Tunis, Tunisia
| | - Yosra Chebbi
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia.,2Faculty of Medicine of Tunis, Tunis El Manar University, LR18ES39, 1006, Tunis, Tunisia
| | - Ons Bouchami
- 3Laboratory of Bacterial Evolutionand Molecular Epidemiology, Instituto de Tecnologia Química e Biológica (ITQB-NOVA) António Xavier, 2780-157, Oeiras, Portugal
| | - Siwar Frigui
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia.,2Faculty of Medicine of Tunis, Tunis El Manar University, LR18ES39, 1006, Tunis, Tunisia
| | - Amen Allah Messadi
- 4Burns Intensive Care Unit, Traumatology and Great Burned Center, 2074, Ben Arous, Tunisia
| | - Wafa Achour
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia.,2Faculty of Medicine of Tunis, Tunis El Manar University, LR18ES39, 1006, Tunis, Tunisia
| | - Lamia Thabet
- 5Laboratory Ward, Traumatology and Great Burned Center, 2074, Ben Arous, Tunisia
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Thabet L, Frigui S, Mellouli A, Gargouri M, Maamar B, Harzallal I, Boukadida J, Messadi A. [Not Available]. Ann Burns Fire Disasters 2021; 34:245-251. [PMID: 34744540 PMCID: PMC8534311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 06/13/2023]
Abstract
Antibiotics are one of the greatest advances in modern medicine. Antibiotic resistance is one of the most serious threats to global health, aggravating the prognosis of immunocompromised patients, especially burn patients. Our objective was to study the consumption of antibiotics of critical importance according to the WHO and the correlation between antibiotic resistance in Pseudomonas æruginosa and the consumption of these antibiotics. Our study took place in the Medical Laboratory in collaboration with the Trauma and Burn Center's Burn Unit in Tunisia. In our retrospective study, 1384 non-repetitive strains of Pseudomonas æruginosa responsible for colonization or infection were included, between January 2012 and December 2019. Pseudomonas æruginosa was the most isolated bacterial strain in the service, with an average rate of 15.9% of the service's bacterial ecology. The antibiotic resistance rates tested were high: 77.1% to piperacillin-tazobactam, 56% to ceftazidime, 74.9% to imipenem, 78.8% to amikacin, 54.7% to ciprofloxacin and 32.8% to fosfomycin. Among our strains, 81.8% were multi drug-resistant strains. The analysis of the correlation between the level of consumption of antibiotics and the antibiotic resistance levels in Pseudomonas æruginosa showed that the increased consumption of piperacillin-tazobactam increased resistance not only to piperacillin-tazobactam but also to imipenem and amikacin as well as multi drug resistance. Similarly, the increase in the consumption of fosfomycin correlates with resistance to piperacillin-tazobactam and imipenem.
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Affiliation(s)
- L. Thabet
- Laboratoire de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - S. Frigui
- Laboratoire de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - A. Mellouli
- Laboratoire de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - M. Gargouri
- Service de Pharmacie, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - B. Maamar
- Laboratoire de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - I. Harzallal
- Service de Pharmacie, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - J. Boukadida
- Service de Microbiologie, Hôpital Farhat Hachad, Sousse, Tunisie
| | - A.A. Messadi
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
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Chebbi Y, Frigui S, Raddaoui A, Belloumi D, Lakhal A, Torjemane L, Ben Abeljelil N, Ladeb S, Ben Othmen T, El Fatmi R, Achour W. Coagulase negative Staphylococcus bacteremia in hematopoietic stem cell transplant recipients: Clinical features and molecular characterization. Acta Microbiol Immunol Hung 2021; 68:73-79. [PMID: 33999858 DOI: 10.1556/030.2021.01315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/09/2020] [Indexed: 11/19/2022]
Abstract
The purpose of our study was to investigate the epidemiology of coagulase negative staphylococci (CoNS) responsible for bacteremia in hematopoietic stem cell transplant (HSCT) recipients and to determine the prevalence and the genetic background of methicillin resistance. The prevalence of CoNS bacteremia was 7.4% (54/728), higher in allograft (10.7%) than in autograft (4.7%) recipients. A sepsis or a septic shock were observed in 9% of cases. No deaths were attributable to CoNS bacteremia. The methicillin resistance rate was 81%. All MR-CoNS, harbored mecA gene and 90% were typeable with SCCmec typing using PCR amplification. The SCCmec type IV was the most frequent (44%). Clonal dissemination of MR- Staphylococcus epidermidis strains was limited. Our study showed a low prevalence and favorable outcome of CoNS bacteremia in HSCT recipients with limited clonal diffusion. However, they were associated with a significant rate of severe infections and a high rate of methicillin resistance, mediated by SCCmec IV element in most cases.
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Affiliation(s)
- Yosra Chebbi
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- 2Tunis El Manar University, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia
| | - Siwar Frigui
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- 2Tunis El Manar University, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia
| | - Anis Raddaoui
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- 2Tunis El Manar University, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia
| | - Dorra Belloumi
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Amel Lakhal
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Lamia Torjemane
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Nour Ben Abeljelil
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Saloua Ladeb
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Tarek Ben Othmen
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Rym El Fatmi
- 3Hematology Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
| | - Wafa Achour
- 1Laboratory Ward, National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- 2Tunis El Manar University, Faculty of Medicine of Tunis, LR18ES39, 1006, Tunis, Tunisia
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Frigui S, Bourbiaa Y, Mokline A, Naija H, Messadi A, Thabet L. [Not Available]. Ann Burns Fire Disasters 2021; 34:10-17. [PMID: 34054382 PMCID: PMC8126372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 06/12/2023]
Abstract
Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019).
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Affiliation(s)
- S. Frigui
- Service de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés, Tunisie
| | - Y. Bourbiaa
- Service de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés, Tunisie
| | - A. Mokline
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - H. Naija
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Hôpital Militaire Principal d’Instruction de Tunis, Tunisie
| | - A.A. Messadi
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - L. Thabet
- Service de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
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Frigui S, Messadi A, Thabet L. [Not Available]. Ann Burns Fire Disasters 2020; 33:304-311. [PMID: 33708020 PMCID: PMC7894839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 06/12/2023]
Abstract
Pseudomonas æruginosa (PA) is among the major agents of infection in burns. Multidrug-resistant strains are commonly isolated, which hampers the management of these patients. Our purpose was to study the incidence density of PA colonization and PA infection and to investigate the antibiotic susceptibility of strains isolated in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia. It is a retrospective study including 1649 non-repetitive strains of PA during an 8-year period (2012- 2019). PA was the most common organism in TBC-BU bacterial ecology (15%). The incidence density of PA colonization and PA infection was 16.1‰ days of in-patient stay (DH) and 16.5‰ DH, respectively. A positive and statistically significant correlation was found between PA colonization and PA infection (rs=1; p=0,004). The colonization strains were mainly isolated from skin (25.1%) and central catheters (22.3%). Bacteremia was the most common infection (19.5%). The skin was the most common source of bacteremia (22.1%) followed by central catheters (18.3%). The highest rates of antibiotic resistance were found with piperacillin-tazobactam (72.4%), ceftazidime (49.4%), meropenem (74%), imipenem (70.5%), amikacin (74.6%), ciprofloxacin (56.5%) and fosfomycin (35.3%). We did not identify any colistin-resistant strain. The multidrug resistance rate was 78%. The metallo-carbapenemase-producing strains rate was 14.4%.
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Affiliation(s)
- S. Frigui
- Laboratoire de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
| | - A.A. Messadi
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
- Faculté de Médecine de Tunis, Tunisie
| | - L. Thabet
- Laboratoire de Biologie Médicale et Banque du Sang, Centre de Traumatologie et des Grands Brûlés de Ben Arous, Tunisie
- Faculté de Médecine de Tunis, Tunisie
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Ouanes W, Faiz M, Maaref K, Jemni S, Frioui S, Frigui S, Zaoui A, Khachnaoui F. Évaluation psycho-comportementale chez une population tunisienne de lombalgiques chroniques. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ouanes W, Faiz M, Maaref K, Jemni S, Frioui S, Frigui S, Zaoui A, Khachnaoui F. Psycho-behavioral assessment in a Tunisian population of chronic low back pain (LBP). Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zaoui A, Lazreg N, Hmida M, Frigui S, Guedria K, Benzarti H, Khachnaoui F, Rejeb N. Neurogenic heterotopic ossification of the hip complicated by rupture of an arterial pseudo-aneurysm, a case report. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zaoui A, Kanoun S, Hmida M, Lajili H, Bacha O, Frigui S, Maaraf K, Rejeb N. Rééducation d’une paraplégie secondaire a une diastématomyélie : à propos d’un cas. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zaoui A, Kanoun S, Hmida M, Lajili H, Bacha O, Frigui S, Maaraf K, Rejeb N. Rehabilitation of a secondary paraplegia due to diastematomyelia: Case report. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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