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5. World alliance against antibiotic resistance: The WAAAR declaration against antibiotic resistance

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Carlet, J, Aaron, L, Abassi, M, Abbo, L, Aboderin, O, Abraham, E, Abroug, F, Acar, J, Achour, W, Adachi, J, Al-Abri, S, Al-Mousa, H, Albaya-Moreno, A, Alberti, C, Alfandari, S, Alnimr, A, Aranda, C, de Lerma, F, Amer, F, Andremont, A, Angoulvant, F, Anguill, M, Antonelli, M, Antoniadou, E, Arlet, G, Armaganidis, A, Arnera, A, Artigas, A, Attali, C, Auber, F, Aubert, J, Augereau, B, Aupee, M, Bahri, O, Ballereau, F, Bapt, G, Baquero, F, Barkhan, T, Barouti, O, Barthelemy, M, Barton, G, Bastoni, D, Baussier, M, Bavestrello, L, Beger, B, Benenson, S, Bensalem, F, Beraud, G, Bergheau, F, Bernard, G, Berthelot, P, Bertrand, X, Beuhorry-Sassus, F, Beuret, P, Billington, J, Birge, J, Biscardi, S, Blanch, L, Blanchard, H, Bleck, T, Blondeau, J, Blot, F, Borgey, F, Bousquet-Melou, A, Brami, J, Brard, C, Bretagne, S, Bretonniere, C, Brink, A, Brown, S, Bruant-Rodier, C, Brun-Buisson, C, Bruneel, F, de Carvalho, F, Buhot, C, Bukharie, H, Cabie, A, Calandra, T, Caniaux, I, Canica, M, Canton, R, Carenco, P, Carlet, C, Carlet, F, Carlet, R, Cars, O, Cassiano-Neves, M, Castan, B, Castellan, V, Cazenave-Roblot, F, Ceretti, A, Chakarian, J, Chalumeau-Lemoine, L, Chandy, J, Chanfreau, B, Chastre, J, Chausset, R, Chavanet, P, Cheadle, W, Chiche, J, Chidiac, C, Chosidow, O, Chueca, N, Cohen, J, Cohen, R, Collignon, P, Collot, F, Coloby, P, Conly, J, Cordero, C, Cordonnier, C, Corso, A, Cosgrove, S, Courcol, R, Crane, S, Craven, D, Crespin, A, Cyrillo, M, Danin, P, Waele, J, Dellamonica, P, Patchen Dellinger, E, Dellinger, P, Delmont, J, Denes, E, Dimopoulos, G, Drekonja, D, Mansilla, A, Druais, P, Dufour-Pierrat, S, Dumartin, C, Dunser, M, Dupont, M, Durlach, R, Dyar, O, Echaniz, G, Edelstein, P, Eggimann, P, Elghonemi, M, Elmdaghri, N, Elsaid, R, Elsokari, R, Engelhard, D, Fabry, J, Farmer, C, Fernandez, J, Finfer, S, Finn, P, Fjeldsted, K, Floret, D, Flozaro, F, Foegle, J, Forceville, X, Fournier, S, Frachon, I, Friedrich, A, Funuel, P, Gaillard, D, Gaillat, J, Galperine, T, Gambarotto, K, Garo, B, Garrouste-Orgeas, M, Gastemeier, P, Gauchot, J, Gauzit, R, Gavazzi, G, Gazagne, L, Gerberding, J, Ghafur, A, Giamarellos-Bourboulis, E, Giamarellou, E, Giard, M, Gilchrist, M, Gilquin, J, Gilsanz, F, Gniadkowski, M, Gogos, C, Goldman, D, Gordon, F, Gottlieb, T, Gould, I, Gouveia, J, Grant, J, Grason, L, Greder, A, Grundman, H, Guaguere, E, Gueroult-Locher, G, Guery, B, Guidet, B, Guignabert, C, Gupta, P, Gupta, S, Gurjar, M, Guzman, M, Hajjar, J, Hammad, N, Hammerum, A, Hanberger, H, Hanke, R, Harbarth, S, Harel, A, Heisbourg, E, Hermes, I, Hermet, J, Hirschel, B, Hoen, B, Hollis, A, Honghong, X, Hooper, D, Horcajada, J, Housset, B, Hryniewicz, W, Hsu, L, Huang, S, Hughes, J, Hunault, J, Jakobsen, L, Jalil, N, Jansens, H, Jarlier, V, Jarvis, W, Jean, D, Jereb, M, Johnson, J, Joly-Guillou, M, Jonquet, O, Kac, G, Kaddu-Mulindwa, D, Kaku, M, Kilani, B, Kim, E, Gazard, D, Klugman, K, Klutts, S, Kluytmans, J, Kollef, M, Koulenti, D, Kresken, M, Lacoin, F, Lajonchere, J, Landgraf, N, Larroussinie, G, Laterre, P, Lavenaire, A, Lavigne, T, Laxminarayan, R, Le, T, Leblanc-Jouffre, F, Lee, N, Lehiani, O, Lelouet, H, Lemanach-Kergueris, F, Lepape, A, Leroy, J, Lescure, X, Levy, M, Levy-Hara, G, Lin, L, Lipman, J, Livartowski, J, Looke, D, Cardozo, F, Medrano, F, Lotthe, A, Lucet, J, Lupande, D, Madec, J, Mainardi, J, Maiylagan, S, Mancebo, J, Mansour-Adeoti, F, Maravi, E, Marchou, B, Marciniuk, D, Marshall, J, Martin, C, Martin, D, Martinez-Martinez, L, Martinot, A, Maseda, E, Matamis, D, Matheron, S, Matos, R, Matthews, M, May, T, Mayet, T, Mcgowan, J, Mehtar, S, Teles, J, Mendelson, M, Michelet, C, Mifsud, A, Mikaszewska-Sokolewicz, M, Minion, J, Miquel, C, Mira, J, Miro, J, Misset, B, Monot, J, Montravers, P, Mootien, J, Moreno, R, Morris, A, Moulin, G, Mourlan, C, Mouthon, G, Mowafy, W, Muhl, E, Muruganathan, A, Mushira, E, N'Doye, B, Nana, A, Niederman, M, Nitenberg, G, Nordman, P, Novira, A, Nowak, C, Okeke, I, Olaechea, P, Omar, A, Opal, S, Leyba, C, Oudega, B, Oziol, E, Page, B, Paiva, J, Palmer, L, Palomar-Martinez, M, Parneix, P, de la Garanderie, D, Perencevich, E, Perl, T, Perronne, C, Peters, G, Peters, M, Peyramond, D, Philippart, F, Pittet, D, Pittet, J, Plesiat, P, Pletz, M, Ploy, M, Pospisil, F, Pouedras, P, Poulakou, G, Poursinoff, A, Pronovost, P, Pulcini, C, Puoti, M, Puvanendiram, S, Quintel, M, Rabaud, C, Rambaud, C, Ramos, H, Rassla, O, Raymond, J, Regnier, B, Reinhart, K, Condomines, J, Revil, J, Riche, A, Richman, P, Richmann, R, Rodriguez, V, Rodriguez-Bano, J, Romain, O, Romand, K, Rossines, E, Rothan-Tondeur, M, Rousselot, J, Rubinstein, E, Rudnov, V, Saini, N, Salmon, D, Salomao, R, Garcia, M, Santos-Bouza, A, Saux, M, Savey, A, Saxinger, L, Schlemmer, B, Schmit, J, Schneider, D, Schoemaker, J, Singh, S, Sole-Violan, J, Soto, S, Stahl, J, Stoclin, A, Tabah, A, Tabut, J, Tambyah, P, Tamion, F, Tarr, P, Tattevin, P, Tenover, F, Terzi, N, Lecompte, M, Theodore, J, Thevenin, D, Thevenot, P, Thiriet, L, Thompson, C, Thurn, J, Tillotson, G, Tiouiri, H, Torres, A, Tremolieres, F, Troadec, M, Umar, R, Upham, G, Urban, C, Vaarten, J, Valla, D, Van Der Mee-Marquet, N, Van der Meer, J, Van Der Poll, T, Vancel, J, Vanhems, P, Varin, R, Varon, E, Vaughan, D, Veilly, M, Vijayakumar, K, Villanueva, A, Vincent, J, Vitrat, V, Voss, A, Wachter, R, Walsh, T, Wark, P, Waterer, G, Wegener, H, Weinbreck, P, Weinstein, R, Weissman, S, Wiener-Kronish, J, Wilmer, A, Wyplosz, B, Yacoub-Agha, I, Young, M, Yusuf, I, Zein, E, Zhanel, G, Zinner, S, Zoungrana, J, Zubareva, N, Carlet J., Aaron L., Abassi M. S., Abbo L., Aboderin O., Abraham E., Abroug F., Acar J., Achour W., Adachi J., Al-Abri S., Al-Mousa H., Albaya-Moreno A., Alberti C., Alfandari S., Alnimr A., Aranda C. A., de Lerma F. A., Amer F., Andremont A., Angoulvant F., Anguill M., Antonelli M., Antoniadou E., Arlet G., Armaganidis A., Arnera A., Artigas A., Attali C., Auber F., Aubert J. -P., Augereau B., Aupee M., Bahri O., Ballereau F., Bapt G., Baquero F., Barkhan T., Barouti O., Barthelemy M. -A., Barton G., Bastoni D., Baussier M., Bavestrello L., Beger B., Benenson S., Bensalem F., Beraud G., Bergheau F., Bernard G., Berthelot P., Bertrand X., Beuhorry-Sassus F., Beuret P., Billington J., Birge J., Biscardi S., Blanch L., Blanchard H., Bleck T., Blondeau J., Blot F., Borgey F., Bousquet-Melou A., Brami J., Brard C., Bretagne S., Bretonniere C., Brink A., Brown S., Bruant-Rodier C., Brun-Buisson C., Bruneel F., de Carvalho F. B., Buhot C., Bukharie H., Cabie A., Calandra T., Caniaux I., Canica M., Canton R., Carenco P., Carlet C., Carlet F., Carlet R., Cars O., Cassiano-Neves M., Castan B., Castellan V., Cazenave-Roblot F., Ceretti A. -M., Chakarian J. -C., Chalumeau-Lemoine L., Chandy J., Chanfreau B., Chastre J., Chausset R., Chavanet P., Cheadle W., Chiche J. -D., Chidiac C., Chosidow O., Chueca N., Cohen J., Cohen R., Collignon P., Collot F., Coloby P., Conly J., Cordero C., Cordonnier C., Corso A., Cosgrove S., Courcol R., Crane S., Craven D., Crespin A., Cyrillo M., Danin P. -E., Waele J. D., Dellamonica P., Patchen Dellinger E., Dellinger P., Delmont J., Denes E., Dimopoulos G., Drekonja D., Mansilla A. D., Druais P. -L., Dufour-Pierrat S., Dumartin C., Dunser M., Dupont M., Durlach R., Dyar O., Echaniz G., Edelstein P., Eggimann P., Elghonemi M., Elmdaghri N., Elsaid R., Elsokari R., Engelhard D., Fabry J., Farmer C., Fernandez J., Finfer S., Finn P., Fjeldsted K., Floret D., Flozaro F., Foegle J., Forceville X., Fournier S., Frachon I., Friedrich A., Funuel P., Gaillard D., Gaillat J., Galperine T., Gambarotto K., Garo B., Garrouste-Orgeas M., Gastemeier P., Gauchot J. -Y., Gauzit R., Gavazzi G., Gazagne L., Gerberding J., Ghafur A., Giamarellos-Bourboulis E., Giamarellou E., Giard M., Gilchrist M., Gilquin J., Gilsanz F., Gniadkowski M., Gogos C., Goldman D., Gordon F., Gottlieb T., Gould I., Gouveia J., Grant J., Grason L., Greder A., Grundman H., Guaguere E., Gueroult-Locher G., Guery B., Guidet B., Guignabert C., Gupta P., Gupta S., Gurjar M., Guzman M., Hajjar J., Hammad N., Hammerum A., Hanberger H., Hanke R., Harbarth S., Harel A., Heisbourg E., Hermes I., Hermet J. -P., Hirschel B., Hoen B., Hollis A., Honghong X., Hooper D., Horcajada J. P., Housset B., Hryniewicz W., Hsu L. Y., Huang S., Hughes J., Hunault J. -L., Jakobsen L., Jalil N., Jansens H., Jarlier V., Jarvis W., Jean D., Jereb M., Johnson J., Joly-Guillou M. -L., Jonquet O., Kac G., Kaddu-Mulindwa D., Kaku M., Kilani B., Kim E. -C., Gazard D. K., Klugman K., Klutts S., Kluytmans J., Kollef M., Koulenti D., Kresken M., Lacoin F., Lajonchere J. -P., Landgraf N., Larroussinie G., Laterre P. -F., Lavenaire A. -M., Lavigne T., Laxminarayan R., Le T. A. T., Leblanc-Jouffre F., Lee N. Y., Lehiani O., Lelouet H., Lemanach-Kergueris F., Lepape A., Leroy J., Lescure X., Levy M., Levy-Hara G., Lin L. M., Lipman J., Livartowski J., Looke D., Cardozo F. L. L., Medrano F. L., Lotthe A., Lucet J. C., Lupande D., Madec J. -Y., Mainardi J. -L., Maiylagan S., Mancebo J., Mansour-Adeoti F., Maravi E., Marchou B., Marciniuk D., Marshall J., Martin C., Martin D., Martinez-Martinez L., Martinot A., Maseda E., Matamis D., Matheron S., Matos R., Matthews M., May T., Mayet T., McGowan J., Mehtar S., Teles J. M. M., Mendelson M., Michelet C., Mifsud A., Mikaszewska-Sokolewicz M., Minion J., Miquel C., Mira J. -P., Miro J., Misset B., Monot J. -J., Montravers P., Mootien J., Moreno R., Morris A., Moulin G., Mourlan C., Mouthon G., Mowafy W., Muhl E., Muruganathan A., Mushira E., N'Doye B., Nana A., Niederman M., Nitenberg G., Nordman P., Novira A., Nowak C., Okeke I., Olaechea P. M., Omar A., Opal S., Leyba C. O., Oudega B., Oziol E., Page B., Paiva J. A., Palmer L., Palomar-Martinez M., Parneix P., de la Garanderie D. P., Perencevich E., Perl T., Perronne C., Peters G., Peters M., Peyramond D., Philippart F., Pittet D., Pittet J. -F., Plesiat P., Pletz M., Ploy M. -C., Pospisil F., Pouedras P., Poulakou G., Poursinoff A., Pronovost P., Pulcini C., Puoti M., Puvanendiram S., Quintel M., Rabaud C., Rambaud C., Ramos H., Rassla O., Raymond J., Regnier B., Reinhart K., Condomines J. R., Revil J. -C., Riche A., Richman P., Richmann R., Rodriguez V., Rodriguez-Bano J., Romain O., Romand K., Rossines E., Rothan-Tondeur M. I., Rousselot J. -F., Rubinstein E., Rudnov V., Saini N., Salmon D., Salomao R., Garcia M. S., Santos-Bouza A., Saux M. -C., Savey A., Saxinger L., Schlemmer B., Schmit J. -L., Schneider D., Schoemaker J., Singh S., Sole-Violan J., Soto S., Stahl J. -P., Stoclin A., Tabah A., Tabut J. -P., Tambyah P. A., Tamion F., Tarr P., Tattevin P., Tenover F., Terzi N., Lecompte M. T., Theodore J., Thevenin D., Thevenot P., Thiriet L., Thompson C., Thurn J., Tillotson G., Tiouiri H., Torres A., Tremolieres F., Troadec M., Umar R., Upham G., Urban C., Vaarten J., Valla D., Van Der Mee-Marquet N., Van der Meer J., Van Der Poll T., Vancel J., Vanhems P., Varin R., Varon E., Vaughan D., Veilly M., Vijayakumar K., Villanueva A., Vincent J. -L., Vitrat V., Voss A., Wachter R., Walsh T., Wark P., Waterer G., Wegener H. C., Weinbreck P., Weinstein R., Weissman S., Wiener-Kronish J., Wilmer A., Wyplosz B., Yacoub-Agha I., Young M., Yusuf I., Zein E., Zhanel G., Zinner S., Zoungrana J., Zubareva N., Carlet, J, Aaron, L, Abassi, M, Abbo, L, Aboderin, O, Abraham, E, Abroug, F, Acar, J, Achour, W, Adachi, J, Al-Abri, S, Al-Mousa, H, Albaya-Moreno, A, Alberti, C, Alfandari, S, Alnimr, A, Aranda, C, de Lerma, F, Amer, F, Andremont, A, Angoulvant, F, Anguill, M, Antonelli, M, Antoniadou, E, Arlet, G, Armaganidis, A, Arnera, A, Artigas, A, Attali, C, Auber, F, Aubert, J, Augereau, B, Aupee, M, Bahri, O, Ballereau, F, Bapt, G, Baquero, F, Barkhan, T, Barouti, O, Barthelemy, M, Barton, G, Bastoni, D, Baussier, M, Bavestrello, L, Beger, B, Benenson, S, Bensalem, F, Beraud, G, Bergheau, F, Bernard, G, Berthelot, P, Bertrand, X, Beuhorry-Sassus, F, Beuret, P, Billington, J, Birge, J, Biscardi, S, Blanch, L, Blanchard, H, Bleck, T, Blondeau, J, Blot, F, Borgey, F, Bousquet-Melou, A, Brami, J, Brard, C, Bretagne, S, Bretonniere, C, Brink, A, Brown, S, Bruant-Rodier, C, Brun-Buisson, C, Bruneel, F, de Carvalho, F, Buhot, C, Bukharie, H, Cabie, A, Calandra, T, Caniaux, I, Canica, M, Canton, R, Carenco, P, Carlet, C, Carlet, F, Carlet, R, Cars, O, Cassiano-Neves, M, Castan, B, Castellan, V, Cazenave-Roblot, F, Ceretti, A, Chakarian, J, Chalumeau-Lemoine, L, Chandy, J, Chanfreau, B, Chastre, J, Chausset, R, Chavanet, P, Cheadle, W, Chiche, J, Chidiac, C, Chosidow, O, Chueca, N, Cohen, J, Cohen, R, Collignon, P, Collot, F, Coloby, P, Conly, J, Cordero, C, Cordonnier, C, Corso, A, Cosgrove, S, Courcol, R, Crane, S, Craven, D, Crespin, A, Cyrillo, M, Danin, P, Waele, J, Dellamonica, P, Patchen Dellinger, E, Dellinger, P, Delmont, J, Denes, E, Dimopoulos, G, Drekonja, D, Mansilla, A, Druais, P, Dufour-Pierrat, S, Dumartin, C, Dunser, M, Dupont, M, Durlach, R, Dyar, O, Echaniz, G, Edelstein, P, Eggimann, P, Elghonemi, M, Elmdaghri, N, Elsaid, R, Elsokari, R, Engelhard, D, Fabry, J, Farmer, C, Fernandez, J, Finfer, S, Finn, P, Fjeldsted, K, Floret, D, Flozaro, F, Foegle, J, Forceville, X, Fournier, S, Frachon, I, Friedrich, A, Funuel, P, Gaillard, D, Gaillat, J, Galperine, T, Gambarotto, K, Garo, B, Garrouste-Orgeas, M, Gastemeier, P, Gauchot, J, Gauzit, R, Gavazzi, G, Gazagne, L, Gerberding, J, Ghafur, A, Giamarellos-Bourboulis, E, Giamarellou, E, Giard, M, Gilchrist, M, Gilquin, J, Gilsanz, F, Gniadkowski, M, Gogos, C, Goldman, D, Gordon, F, Gottlieb, T, Gould, I, Gouveia, J, Grant, J, Grason, L, Greder, A, Grundman, H, Guaguere, E, Gueroult-Locher, G, Guery, B, Guidet, B, Guignabert, C, Gupta, P, Gupta, S, Gurjar, M, Guzman, M, Hajjar, J, Hammad, N, Hammerum, A, Hanberger, H, Hanke, R, Harbarth, S, Harel, A, Heisbourg, E, Hermes, I, Hermet, J, Hirschel, B, Hoen, B, Hollis, A, Honghong, X, Hooper, D, Horcajada, J, Housset, B, Hryniewicz, W, Hsu, L, Huang, S, Hughes, J, Hunault, J, Jakobsen, L, Jalil, N, Jansens, H, Jarlier, V, Jarvis, W, Jean, D, Jereb, M, Johnson, J, Joly-Guillou, M, Jonquet, O, Kac, G, Kaddu-Mulindwa, D, Kaku, M, Kilani, B, Kim, E, Gazard, D, Klugman, K, Klutts, S, Kluytmans, J, Kollef, M, Koulenti, D, Kresken, M, Lacoin, F, Lajonchere, J, Landgraf, N, Larroussinie, G, Laterre, P, Lavenaire, A, Lavigne, T, Laxminarayan, R, Le, T, Leblanc-Jouffre, F, Lee, N, Lehiani, O, Lelouet, H, Lemanach-Kergueris, F, Lepape, A, Leroy, J, Lescure, X, Levy, M, Levy-Hara, G, Lin, L, Lipman, J, Livartowski, J, Looke, D, Cardozo, F, Medrano, F, Lotthe, A, Lucet, J, Lupande, D, Madec, J, Mainardi, J, Maiylagan, S, Mancebo, J, Mansour-Adeoti, F, Maravi, E, Marchou, B, Marciniuk, D, Marshall, J, Martin, C, Martin, D, Martinez-Martinez, L, Martinot, A, Maseda, E, Matamis, D, Matheron, S, Matos, R, Matthews, M, May, T, Mayet, T, Mcgowan, J, Mehtar, S, Teles, J, Mendelson, M, Michelet, C, Mifsud, A, Mikaszewska-Sokolewicz, M, Minion, J, Miquel, C, Mira, J, Miro, J, Misset, B, Monot, J, Montravers, P, Mootien, J, Moreno, R, Morris, A, Moulin, G, Mourlan, C, Mouthon, G, Mowafy, W, Muhl, E, Muruganathan, A, Mushira, E, N'Doye, B, Nana, A, Niederman, M, Nitenberg, G, Nordman, P, Novira, A, Nowak, C, Okeke, I, Olaechea, P, Omar, A, Opal, S, Leyba, C, Oudega, B, Oziol, E, Page, B, Paiva, J, Palmer, L, Palomar-Martinez, M, Parneix, P, de la Garanderie, D, Perencevich, E, Perl, T, Perronne, C, Peters, G, Peters, M, Peyramond, D, Philippart, F, Pittet, D, Pittet, J, Plesiat, P, Pletz, M, Ploy, M, Pospisil, F, Pouedras, P, Poulakou, G, Poursinoff, A, Pronovost, P, Pulcini, C, Puoti, M, Puvanendiram, S, Quintel, M, Rabaud, C, Rambaud, C, Ramos, H, Rassla, O, Raymond, J, Regnier, B, Reinhart, K, Condomines, J, Revil, J, Riche, A, Richman, P, Richmann, R, Rodriguez, V, Rodriguez-Bano, J, Romain, O, Romand, K, Rossines, E, Rothan-Tondeur, M, Rousselot, J, Rubinstein, E, Rudnov, V, Saini, N, Salmon, D, Salomao, R, Garcia, M, Santos-Bouza, A, Saux, M, Savey, A, Saxinger, L, Schlemmer, B, Schmit, J, Schneider, D, Schoemaker, J, Singh, S, Sole-Violan, J, Soto, S, Stahl, J, Stoclin, A, Tabah, A, Tabut, J, Tambyah, P, Tamion, F, Tarr, P, Tattevin, P, Tenover, F, Terzi, N, Lecompte, M, Theodore, J, Thevenin, D, Thevenot, P, Thiriet, L, Thompson, C, Thurn, J, Tillotson, G, Tiouiri, H, Torres, A, Tremolieres, F, Troadec, M, Umar, R, Upham, G, Urban, C, Vaarten, J, Valla, D, Van Der Mee-Marquet, N, Van der Meer, J, Van Der Poll, T, Vancel, J, Vanhems, P, Varin, R, Varon, E, Vaughan, D, Veilly, M, Vijayakumar, K, Villanueva, A, Vincent, J, Vitrat, V, Voss, A, Wachter, R, Walsh, T, Wark, P, Waterer, G, Wegener, H, Weinbreck, P, Weinstein, R, Weissman, S, Wiener-Kronish, J, Wilmer, A, Wyplosz, B, Yacoub-Agha, I, Young, M, Yusuf, I, Zein, E, Zhanel, G, Zinner, S, Zoungrana, J, Zubareva, N, Carlet J., Aaron L., Abassi M. S., Abbo L., Aboderin O., Abraham E., Abroug F., Acar J., Achour W., Adachi J., Al-Abri S., Al-Mousa H., Albaya-Moreno A., Alberti C., Alfandari S., Alnimr A., Aranda C. A., de Lerma F. A., Amer F., Andremont A., Angoulvant F., Anguill M., Antonelli M., Antoniadou E., Arlet G., Armaganidis A., Arnera A., Artigas A., Attali C., Auber F., Aubert J. -P., Augereau B., Aupee M., Bahri O., Ballereau F., Bapt G., Baquero F., Barkhan T., Barouti O., Barthelemy M. -A., Barton G., Bastoni D., Baussier M., Bavestrello L., Beger B., Benenson S., Bensalem F., Beraud G., Bergheau F., Bernard G., Berthelot P., Bertrand X., Beuhorry-Sassus F., Beuret P., Billington J., Birge J., Biscardi S., Blanch L., Blanchard H., Bleck T., Blondeau J., Blot F., Borgey F., Bousquet-Melou A., Brami J., Brard C., Bretagne S., Bretonniere C., Brink A., Brown S., Bruant-Rodier C., Brun-Buisson C., Bruneel F., de Carvalho F. B., Buhot C., Bukharie H., Cabie A., Calandra T., Caniaux I., Canica M., Canton R., Carenco P., Carlet C., Carlet F., Carlet R., Cars O., Cassiano-Neves M., Castan B., Castellan V., Cazenave-Roblot F., Ceretti A. -M., Chakarian J. -C., Chalumeau-Lemoine L., Chandy J., Chanfreau B., Chastre J., Chausset R., Chavanet P., Cheadle W., Chiche J. -D., Chidiac C., Chosidow O., Chueca N., Cohen J., Cohen R., Collignon P., Collot F., Coloby P., Conly J., Cordero C., Cordonnier C., Corso A., Cosgrove S., Courcol R., Crane S., Craven D., Crespin A., Cyrillo M., Danin P. -E., Waele J. D., Dellamonica P., Patchen Dellinger E., Dellinger P., Delmont J., Denes E., Dimopoulos G., Drekonja D., Mansilla A. D., Druais P. -L., Dufour-Pierrat S., Dumartin C., Dunser M., Dupont M., Durlach R., Dyar O., Echaniz G., Edelstein P., Eggimann P., Elghonemi M., Elmdaghri N., Elsaid R., Elsokari R., Engelhard D., Fabry J., Farmer C., Fernandez J., Finfer S., Finn P., Fjeldsted K., Floret D., Flozaro F., Foegle J., Forceville X., Fournier S., Frachon I., Friedrich A., Funuel P., Gaillard D., Gaillat J., Galperine T., Gambarotto K., Garo B., Garrouste-Orgeas M., Gastemeier P., Gauchot J. -Y., Gauzit R., Gavazzi G., Gazagne L., Gerberding J., Ghafur A., Giamarellos-Bourboulis E., Giamarellou E., Giard M., Gilchrist M., Gilquin J., Gilsanz F., Gniadkowski M., Gogos C., Goldman D., Gordon F., Gottlieb T., Gould I., Gouveia J., Grant J., Grason L., Greder A., Grundman H., Guaguere E., Gueroult-Locher G., Guery B., Guidet B., Guignabert C., Gupta P., Gupta S., Gurjar M., Guzman M., Hajjar J., Hammad N., Hammerum A., Hanberger H., Hanke R., Harbarth S., Harel A., Heisbourg E., Hermes I., Hermet J. -P., Hirschel B., Hoen B., Hollis A., Honghong X., Hooper D., Horcajada J. P., Housset B., Hryniewicz W., Hsu L. Y., Huang S., Hughes J., Hunault J. -L., Jakobsen L., Jalil N., Jansens H., Jarlier V., Jarvis W., Jean D., Jereb M., Johnson J., Joly-Guillou M. -L., Jonquet O., Kac G., Kaddu-Mulindwa D., Kaku M., Kilani B., Kim E. -C., Gazard D. K., Klugman K., Klutts S., Kluytmans J., Kollef M., Koulenti D., Kresken M., Lacoin F., Lajonchere J. -P., Landgraf N., Larroussinie G., Laterre P. -F., Lavenaire A. -M., Lavigne T., Laxminarayan R., Le T. A. T., Leblanc-Jouffre F., Lee N. Y., Lehiani O., Lelouet H., Lemanach-Kergueris F., Lepape A., Leroy J., Lescure X., Levy M., Levy-Hara G., Lin L. M., Lipman J., Livartowski J., Looke D., Cardozo F. L. L., Medrano F. L., Lotthe A., Lucet J. C., Lupande D., Madec J. -Y., Mainardi J. -L., Maiylagan S., Mancebo J., Mansour-Adeoti F., Maravi E., Marchou B., Marciniuk D., Marshall J., Martin C., Martin D., Martinez-Martinez L., Martinot A., Maseda E., Matamis D., Matheron S., Matos R., Matthews M., May T., Mayet T., McGowan J., Mehtar S., Teles J. M. M., Mendelson M., Michelet C., Mifsud A., Mikaszewska-Sokolewicz M., Minion J., Miquel C., Mira J. -P., Miro J., Misset B., Monot J. -J., Montravers P., Mootien J., Moreno R., Morris A., Moulin G., Mourlan C., Mouthon G., Mowafy W., Muhl E., Muruganathan A., Mushira E., N'Doye B., Nana A., Niederman M., Nitenberg G., Nordman P., Novira A., Nowak C., Okeke I., Olaechea P. M., Omar A., Opal S., Leyba C. O., Oudega B., Oziol E., Page B., Paiva J. A., Palmer L., Palomar-Martinez M., Parneix P., de la Garanderie D. P., Perencevich E., Perl T., Perronne C., Peters G., Peters M., Peyramond D., Philippart F., Pittet D., Pittet J. -F., Plesiat P., Pletz M., Ploy M. -C., Pospisil F., Pouedras P., Poulakou G., Poursinoff A., Pronovost P., Pulcini C., Puoti M., Puvanendiram S., Quintel M., Rabaud C., Rambaud C., Ramos H., Rassla O., Raymond J., Regnier B., Reinhart K., Condomines J. R., Revil J. -C., Riche A., Richman P., Richmann R., Rodriguez V., Rodriguez-Bano J., Romain O., Romand K., Rossines E., Rothan-Tondeur M. I., Rousselot J. -F., Rubinstein E., Rudnov V., Saini N., Salmon D., Salomao R., Garcia M. S., Santos-Bouza A., Saux M. -C., Savey A., Saxinger L., Schlemmer B., Schmit J. -L., Schneider D., Schoemaker J., Singh S., Sole-Violan J., Soto S., Stahl J. -P., Stoclin A., Tabah A., Tabut J. -P., Tambyah P. A., Tamion F., Tarr P., Tattevin P., Tenover F., Terzi N., Lecompte M. T., Theodore J., Thevenin D., Thevenot P., Thiriet L., Thompson C., Thurn J., Tillotson G., Tiouiri H., Torres A., Tremolieres F., Troadec M., Umar R., Upham G., Urban C., Vaarten J., Valla D., Van Der Mee-Marquet N., Van der Meer J., Van Der Poll T., Vancel J., Vanhems P., Varin R., Varon E., Vaughan D., Veilly M., Vijayakumar K., Villanueva A., Vincent J. -L., Vitrat V., Voss A., Wachter R., Walsh T., Wark P., Waterer G., Wegener H. C., Weinbreck P., Weinstein R., Weissman S., Wiener-Kronish J., Wilmer A., Wyplosz B., Yacoub-Agha I., Young M., Yusuf I., Zein E., Zhanel G., Zinner S., Zoungrana J., and Zubareva N.

Abstract

We must change how antibiotics are used and adopt proactive strategies, similar to those used to save endangered species. Preservation of the efficacy of antibiotics and to stabilization of antibiotic-susceptible bacterial ecosystems should be global goals. (C) 2014 Elsevier Espana, S.L.U. and SEMICYUC. All rights reserved.

Published
2015

6. PB2424: ORAL VERSUS INTRAVENOUS ANTI-CMV PREEMPTIVE THERAPY IN ALLOGENEIC STEM CELL TRANSPLANT PATIENTS WITH CMV REACTIVATION: EXPERIENCE FROM NATIONAL CENTER OF BONE MARROW TRANSPLANTATION, TUNISIA.

Author

Rimmel Yosra Kanoun, Nour Ben Adejlil, Jaied Rabeb, Roua Hsasna, Frigui Siwar, Sabrine Mekni, Lamia Torjemane, Ines Turki, Dorra Belloumi, Ouerghi Rihab, Insaf Ben Yaiche, Achour Wafa, Ladeb Saloua, and Tarek Ben Othman

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Published
2023
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9. [32nd National STPI Congress 2nd French-speaking Congress of Infectious Pathology and Clinical Microbiology 5 to 7 May 2023, Hammamet, Tunisia].

Author

Toumi A, Ben Brahim H, Berriche A, Hachfi W, Marrakchi C, Ammari L, Ben Lasfar N, Koubaa M, Aoun K, Neji S, Ben Abdallah R, Bouchekoua M, Mhalla S, Naïja H, Gargouri S, Hannachi N, Thabet L, Mnif B, Achour W, Marzouk M, Boutiba I, and Chippaux JP

Subjects
Humans, Tunisia epidemiology, Communicable Diseases
Published
2023
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10. Occurrence of High-Risk Clonal Lineages ST58, ST69, ST224, and ST410 among Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolated from Healthy Free-Range Chickens ( Gallus gallus domesticus ) in a Rural Region in Tunisia.

Author

Benlabidi S, Raddaoui A, Lengliz S, Cheriet S, Hynds P, Achour W, Ghrairi T, and Abbassi MS

Subjects
Animals, Multilocus Sequence Typing, Tunisia epidemiology, beta-Lactamases genetics, Clone Cells, Escherichia coli, Chickens genetics
Abstract

Antimicrobial-resistant Escherichia coli isolates have emerged in various ecologic compartments and evolved to spread globally. We sought to (1.) investigate the occurrence of ESBL-producing E. coli (ESBL-Ec) in feces from free-range chickens in a rural region and (2.) characterize the genetic background of antimicrobial resistance and the genetic relatedness of collected isolates. Ninety-five feces swabs from free-range chickens associated with two households (House 1/House 2) in a rural region in northern Tunisia were collected. Samples were screened to recover ESBL-Ec, and collected isolates were characterized for phenotype/genotype of antimicrobial resistance, integrons, and molecular typing (pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST)). Overall, 47 ESBL-Ec were identified, with the following genes detected: 35 bla CTX-M-1, 5 bla CTX-M-55 , 5 bla CTX-M-15 , 1 bla SHV-2, and 1 bla SHV-12 . Resistance to fluoroquinolones, tetracycline, sulfonamides, and colistin was encoded by aac(6') -Ib- cr ( n = 21), qnr B ( n = 1), and qnr S ( n = 2); tet A ( n = 17)/ tet B ( n = 26); sul 1 ( n = 29)/ sul 2 ( n = 18); and mcr -2 ( n = 2) genes, respectively. PFGE and MLST identified genetic homogeneity of isolates in House 1; however, isolates from House 2 were heterogeneous. Notably, among nine identified sequence types, ST58, ST69, ST224, and ST410 belong to pandemic high-risk clonal lineages associated with extrapathogenic E. coli . Minor clones belonging to ST410 and ST471 were shared by chickens from both households. The virulence genes fyuA, fimH, papGIII, and iutA were detected in 35, 47, 17, and 23 isolates, respectively. Findings indicate a high occurrence of ESBL-Ec in free-range chickens and highlight the occurrence of pandemic zoonotic clones.

Published
2023
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11. Tunisian Multicenter Study on the Prevalence of Colistin Resistance in Clinical Isolates of Gram Negative Bacilli: Emergence of Escherichia coli Harbouring the mcr-1 Gene.

Author

Ferjani S, Maamar E, Ferjani A, Meftah K, Battikh H, Mnif B, Hamdoun M, Chebbi Y, Kanzari L, Achour W, Bahri O, Hammami A, Zribi M, Smaoui H, and Boubaker IB

Abstract

Background: Actually, no data on the prevalence of plasmid colistin resistance in Tunisia are available among clinical bacteria., Objectives: This study aimed to investigate the current epidemiology of colistin resistance and the spread of the mcr gene in clinical Gram-negative bacteria (GNB) isolated from six Tunisian university hospitals., Methods: A total of 836 GNB strains were inoculated on COL-R agar plates with selective screening agar for the isolation of GNB resistant to colistin. For the selected isolates, mcr genes, beta-lactamases associated-resistance genes and molecular characterisation were screened by PCRs and sequencing., Results: Colistin-resistance was detected in 5.02% (42/836) of the isolates and colistin-resistant isolates harboured an ESBL ( bla CTX-M-15 ) and/or a carbapenemase ( bla OXA-48 , bla VIM ) encoding gene in 45.2% of the cases. The mcr -1 gene was detected in four E. coli isolates (0.59%) causing urinary tract infections and all these isolates also contained the bla TEM-1 gene. The bla CTX-M-15 gene was detected in three isolates that also carried the IncY and IncFIB replicons. The genetic environment surrounding the mcr -carrying plasmid indicated the presence of pap-2 gene upstream mcr -1 resistance marker with unusual missing of ISApl1 insertion sequence., The Conclusions: This study reports the first description of the mcr -1 gene among clinical E. coli isolates in Tunisia and provides an incentive to conduct routine colistin susceptibility testing in GNB clinical isolates.

Published
2022
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12. Dual Mechanism of Action of Curcumin in Experimental Models of Multiple Sclerosis.

Author

ELBini-Dhouib I, Manai M, Neili NE, Marzouki S, Sahraoui G, Ben Achour W, Zouaghi S, BenAhmed M, Doghri R, and Srairi-Abid N

Subjects
Animals, Anti-Inflammatory Agents pharmacology, Anti-Inflammatory Agents therapeutic use, Disease Models, Animal, Mice, Mice, Inbred C57BL, Models, Theoretical, Curcumin pharmacology, Curcumin therapeutic use, Encephalomyelitis, Autoimmune, Experimental, Multiple Sclerosis metabolism
Abstract

Background: Multiple sclerosis (MS) is characterized by a combination of inflammatory and demyelination processes in the spinal cord and brain. Conventional drugs generally target the autoimmune response, without any curative effect. For that reason, there is a great interest in identifying novel agents with anti-inflammatory and myelinating effects, to counter the inflammation and cell death distinctive of the disease., Methods and Results: An in vitro assay showed that curcumin (Cur) at 10 µM enhanced the proliferation of C8-D1A cells and modulated the production of Th1/Th2/Th17 cytokines in the cells stimulated by LPS. Furthermore, two in vivo pathophysiological experimental models were used to assess the effect of curcumin (100 mg/kg). The cuprizone model mimics the de/re-myelination aspect in MS, and the experimental autoimmune encephalomyelitis model (EAE) reflects immune-mediated events. We found that Cur alleviated the neurological symptomatology in EAE and modulated the expression of lymphocytes CD3 and CD4 in the spinal cord. Interestingly, Cur restored motor and behavioral deficiencies, as well as myelination, in demyelinated mice, as indicated by the higher index of luxol fast blue (LFB) and the myelin basic protein (MBP) intensity in the corpus callosum., Conclusions: Curcumin is a potential therapeutic agent that can diminish the MS neuroimmune imbalance and demyelination through its anti-inflammatory and antioxidant effects.

Published
2022
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13. Full Genome Characterization of Respiratory Syncytial Virus Causing a Fatal Infection in an Immunocompromised Patient in Tunisia.

Author

Curini V, Marcacci M, Abid S, Ouederni M, ElMoussi A, Charaa L, Achour W, Ouhichi R, Maazaoui L, Di Pasquale A, ElGhord H, Gzara A, Ripani A, Di Giallonardo F, Cammà C, Lorusso A, and Boubaker IB

Abstract

Human orthopneumovirus (HRSV) is a virus belonging to the Pneumovirus genus that causes lower respiratory tract infections (LRTI) in infants worldwide. In Tunisia, thousands of infants hospitalized for LRTI are found to be positive for HRSV but no whole genome sequences of HRSV strains circulating in this country are available thus far. In this study, five nasal swab samples collected at different time points from a three-month-old female baby with severe immunodeficiency that was hospitalized for acute bronchiolitis were investigated by next generation sequencing. The Tunisian sequences from this study originated from samples collected in 2021, belong to the ON1 genotype of HRSV-A, and are clustered with European sequences from 2019 and not from 2020 or 2021. This is most likely related to local region-specific transmission of different HRSV-A variants due to the COVID-19 related travel restrictions. Overall, this is the first report describing the whole genome sequence of HRSV from Tunisia. However, more sequence data is needed to better understand the genetic diversity and transmission dynamic of HRSV.

Published
2022
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14. An intermittent outbreak of Burkholderia cepacia contaminating hematopoietic stem cells resulting in infusate-related blood stream infections.

Author

Raddaoui A, Ben Tanfous F, Chebbi Y, Mabrouk A, and Achour W

Abstract

Microbial contamination of hematopoietic stem cells (HSC), used for autologous and allogenic transplantations, is rare but could cause serious blood stream infection in transplanted patients. These infections occur immediately, or later following the formation of biofilm on the catheter lumen. The present study describes an intermittent B. cepacia HSC contamination associated with nosocomial bacteremia: from October 2011 to April 2015, 17  B. cepacia strains were isolated in HSC bags ( n = 14) and blood cultures ( n = 3) in patients hospitalized in the National Bone Marrow Transplant Center. Two epidemiologic investigations in the National Blood Transfusion Center, allowing the isolation of three strains in hygiene samples, and four interventions in this institution were done. To identify the source of this contamination, a molecular investigation was done on 23  B. cepacia strains isolated in our center from 2007 to 2015. PFGE analysis revealed five clusters. The major cluster included 18 strains isolated from HSC bags ( n = 14), blood culture ( n = 1), and water cans and bath ( n = 3). The second cluster (B) including only two and the remaining clusters (C, D, and E) contained single strains isolated before the epidemic period. These findings confirmed that the origin of the outbreak was the contaminated water used in the water bath during the thawing step of HSC bags. Based on this result, new sterile water was used for every defrosting, but HSC bags contamination persisted. In May 2015, the water bath was replaced with a dry bath and no B. cepacia strain was isolated from that date to April 2020., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Published
2022
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15. Genetic characterization of ESBL/pAmpC-producing Escherichia coli isolated from forest, urban park and cereal culture soils.

Author

Benlabidi S, Raddaoui A, Achour W, Hassen B, Torres C, Abbassi MS, and Ghrairi T

Subjects
Animals, Anthropogenic Effects, Anti-Bacterial Agents pharmacology, Bacterial Proteins genetics, Edible Grain, Forests, Humans, Parks, Recreational, Plasmids, Soil, beta-Lactamases genetics, Escherichia coli genetics, Escherichia coli Infections
Abstract

Little is known about the role of forestland and non-fertilized agriculture soils as reservoirs of extended-spectrum beta-lactamase (ESBL) and plasmid-borne AmpC (pAmpC)-producing Escherichia coli isolates. Thus, in the present study, 210 soil samples from various origins (forest of Oued Zen (Ain Drahem), non-agriculture soils from different park gardens in Tunis City, cereal culture soils and home gardens) were investigated to characterize cefotaxime-resistant E. coli isolates. A total of 22 ESBL/pAmpC-producing E. coli were collected, and all harbored variants of the blaCTX-M gene (15 blaCTX-M-1, 5 blaCTX-M-55 and 2 blaCTX-M-15). A total of seven and two isolates harbored also blaEBC and blaDHA-like genes, respectively. Resistances to tetracycline, sulfonamides and fluoroquinolones were encoded by tetA (n = 4)/tetB (n = 12), sul1 (n = 17)/sul2 (n = 19) and aac(6')-Ib-cr (n = 2)/qnrA (n = 1)/qnrS (n = 1) genes, respectively. A total of seven isolates were able to transfer by conjugation cefotaxime-resistance in association or not with other resistance markers. PFGE showed that ten and two isolates were clonally related (pulsotypes P1 and P2). The 10 P1 isolates had been collected from forestland, cereal culture soils and an urban park garden in Tunis City, arguing for a large spread of clonal strains. Our findings highlight the occurrence of ESBL/pAmpC-E. coli isolates in soils under limited anthropogenic activities and the predominance of CTX-M enzymes that are largely disseminated in E. coli from humans and animals in Tunisia., (© The Author(s) 2021. Published by Oxford University Press on behalf of FEMS. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2021
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16. Granulomatous spondylodiscitis: A case series with focus on histopathological features.

Author

Rammeh S, Romdhane E, Riahi H, Chebbi Y, Bouaziz MC, Achour W, Saidi LS, Benaissa HT, and Ladeb MF

Subjects
Female, Granuloma diagnosis, Granuloma etiology, Humans, Male, Discitis diagnosis, Sarcoidosis, Spinal Cord Injuries, Tuberculosis
Abstract

Objective: To report a series of Granulomatous Spondylodiscitis (GS) with focus on the histopathological features of the different forms of GS. Design: Case series. Setting: Pathology department of Charles Nicolle's Hospital of Tunisia Participants: This study included 57 patients diagnosed with GS. There were 44 (77.2%) female patients and 13 (22.8%) male patients (sex ratio = 0.28). Intervention: Not applicable. Outcome measures: Clinical, microbiological and histopathological features were assessed in this study. Results: Fifty-seven patients with GS were enrolled: 51 tuberculous spondylodiscitis (TS), 2 fungal spondylodiscitis (FS), 3 brucellar spondylodiscitis (BS) and 1 case of sarcoidosis. Granulomas with necrosis were seen in 38 (66.6%) cases: 36 TS and 2 FS, while granulomas without necrosis were observed in the remaining 19 cases: 15 TS, 3 BS and 1 sarcoidosis. In all cases of TS, granulomas were epithelioid type, associated with histiocytic type granulomas in 7 cases. Caseous necrosis was seen in 35 cases of TS and suppurative granuloma in one case. The 3 cases of BS exhibited non-necrotizing and histiocytic type granulomas. The 2 cases of FS showed histiocytic, epithelioid and necrotizing granulomas. Necrosis was mixed: suppurative and caseous in both cases of FS. Sarcoidosis was characterized with epithelioid type granulomas without necrosis. Conclusion: Granuloma with caseous necrosis is highly suggestive of TS but does not rule out FS. Certain fungi can exhibit this type of necrosis as do tuberculosis species. Suppurative inflammation, although rare in TS, does exist . Histiocytic type granuloma without necrosis is suggestive of brucellosis.

Published
2021
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17. Multidrug resistant bacteremia in hematopoietic stem cell transplant recipients.

Author

Mellouli A, Chebbi Y, El Fatmi R, Raddaoui A, Lakhal A, Torjmane L, Ben Abdeljelil N, Belloumi D, Ladeb S, Ben Othmen T, and Achour W

Subjects
Anti-Bacterial Agents therapeutic use, Drug Resistance, Multiple, Bacterial, Humans, Microbial Sensitivity Tests, Retrospective Studies, Bacteremia drug therapy, Bacteremia epidemiology, Hematopoietic Stem Cell Transplantation adverse effects, Methicillin-Resistant Staphylococcus aureus
Abstract

Background: Bacteremia become fearsome in hematopoietic stem cell transplant (HSCT) recipients with the emergence of multidrug-resistant (MDR) strains., Aim: Our purpose was to investigate the prevalence of MDR bacteremia in HSCT recipients at the Tunisian National Bone Marrow Transplant Center, associated factors and attributable mortality rate., Methods: Our retrospective study (January 2010-December 2017) included all MDR bacteremia in the Hematology department. MDR rods were: extended spectrum beta-lactamase producing Enterobacterales (ESBL-E), P. aeruginosa and A. baumannii resistant to at least three families of antibiotics, methicillin-resistant S. aureus (MRSA) and vancomycin resistant E. faecium (VRE)., Results: The prevalence of MDR bacteremia among HSCT recipients was 5.9% (48/816) with a stable trend over time (rs=0.18). Neutropenia, prior hospitalization, prior antibiotherapy and prior colonization with MDR pathogens were observed in 59%, 58%, 48% and 31% of cases, respectively. Imipenem was the most prescribed first-line antibiotic (50%). The attributable mortality rate was 13%. MDR bacteria (n=48) belonged to ESBL-E (60%), P. aeruginosa (19%), A. baumannii (13%), MRSA (4%) and VRE (4%). For ESBL-E and P. aeruginosa, the rates of antibiotic resistance were respectively, 17% and 44% to imipenem, 31% and 56% to amikacin and 15% and 0% to colistin. Strains of A. baumannii were susceptible only to colistin. The MRSA (n=2) were resistant to ciprofloxacin and gentamicin and susceptible to glycopeptides. The VRE (n=2) were susceptible to linezolid and tigecycline., Conclusion: Low prevalence of MDR bacteremia in HSCT recipients but high attributable mortality rate, requiring reinforcement of hygiene measures.

Published
2021

18. Prevalence of healthcare-associated infections at a Tunisian onco-hematology ward.

Author

Mellouli A, Chebbi Y, Belloumi D, Nouira M, Kallel K, Ladeb S, Ben Othmen T, and Achour W

Subjects
Delivery of Health Care, Hospitals, Humans, Prevalence, Cross Infection epidemiology, Hematology
Abstract

Introduction: Healthcare-associated infections (HAIs) are with high rates of mortality and an additional cost, in onco-hematology patients., Aim: To assess the prevalence trends of HAIs in the onco-hematology ward of the Tunisian National Bone Marrow Transplant Center (NBMTC), and to determine the principal associated risk factors., Methods: Six repeated point prevalence surveys were conducted, from May 2018 to March 2019, using a two months interval. All patients hospitalized in the day of the survey were included. Risk factors of HAIs were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). They were assessed using a logistic regression model., Results: Nineteen patients out of a total of 74 patients have been diagnosed with 19 HAIs, representing a prevalence of 25.7%. No significant downward or upward trend of prevalence was revealed over time (p=0.3). The most common HAI was respiratory tract infection (57.9%) with a prevalence of 14.9%. Multiple logistic regression analysis revealed that HAI was significantly associated with neutropenia (Adjusted OR: 14; 95% CI: 1.5-127; p=0.01) and duration of central venous catheter (Adjusted OR: 1.1; 95% CI: 1-1.2; p=0.005)., Conclusion: High prevalence of HAIs in our center with a high rate of mortality, requiring identifying potential problems in infection control practices.

Published
2021

19. Prevalence of infectious multi-drug resistant bacteria isolated from immunocompromised patients in Tunisia.

Author

Mechergui A, Achour W, Mathlouthi S, and Hassen AB

Subjects
Escherichia coli drug effects, Escherichia coli isolation & purification, Humans, Klebsiella pneumoniae drug effects, Klebsiella pneumoniae isolation & purification, Microbial Sensitivity Tests, Prevalence, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa isolation & purification, Retrospective Studies, Staphylococcus aureus drug effects, Staphylococcus aureus isolation & purification, Tunisia epidemiology, Anti-Bacterial Agents therapeutic use, Drug Resistance, Multiple, Bacterial, Immunocompromised Host, Stem Cell Transplantation
Abstract

Objectives: A retrospective study was conducted in the Bone Marrow Transplant Center of Tunisia during a period of 10 years (from 2002 to 2011) in order to report the prevalence of infectious multi-drug resistant bacteria., Methods: Bacterial identification was carried on the basis of biochemical characteristics and API identification systems. Antibiotic susceptibility was tested by disc diffusion method on Muller-Hinton agar., Results: During the study period, 34.5% of 142 Klebsiella pneumoniae strains and 11.46% of 218 Escherichia coli strains were extended-spectrum beta-lactamase (ESBL) producers. Also, 32.8% of 210 strains of Pseudomonas aeruginosa were imipenem and/or ceftazidime resistant and 20.75% of 106 strains of Staphylococcus aureus were methicillin resistant. A rising trend was observed for the prevalence of the selected multidrug resistant bacteria., Conclusion: These findings may have important clinical implications in prophylaxis and selection of antibiotic treatment. Continuous surveillance is needed, especially for onco-hematological patients., (© 2019 Mechergui et al.)

Published
2019
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20. A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis.

Author

Ben Achour W, Bouaziz M, Mechri M, Zouari B, Bahlous A, Abdelmoula L, Laadhar L, Sellami M, Sahli H, and Cheour E

Subjects
Adult, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid diagnostic imaging, Biomarkers blood, Bone Resorption diagnostic imaging, Bone Resorption etiology, Cartilage diagnostic imaging, Cartilage metabolism, Cartilage Oligomeric Matrix Protein blood, Collagen Type I blood, Collagen Type II blood, Cross-Sectional Studies, Disease Progression, Female, Humans, Metacarpophalangeal Joint diagnostic imaging, Middle Aged, Osteocalcin blood, Peptide Fragments blood, Peptides blood, Phosphopeptides blood, Procollagen blood, Single-Blind Method, Tomography, X-Ray Computed statistics & numerical data, Wrist diagnostic imaging, Arthritis, Rheumatoid blood, Bone Resorption blood, Collagen blood
Abstract

The aim of our study was to assess the relationship between bone and cartilage remodeling biomarkers and joint damage in Rheumatoid Arthritis (RA), and to detect whether they have the capacity to predict the progression of joint disease assessment by computed tomography (CT) erosion score. We analyzed 65 female patients with established RA in our Rheumatology Department. Serum levels of bone and cartilage markers were measured: osteocalcin (OC), N-propeptide of type I collagen (PINP), collagen type I and II, C-telopeptide (CTX I, CTX-II) and cartilage oligomeric matrix protein (COMP). Radiography of both wrist and MCP joints were available. Two expert-readers independently scored articular damage and progression using the High-resolution low dose CT scan in a blinded fashion. 65 female patients with established RA with a median age of 44 years were included. The median disease-duration was two years and the median (Disease activity score) DAS 28 score at 4.46 [2.65-7.36]. The percentage of patient with low disease activity was 13.8%, while 55.4 and 30.8% for those with moderate and high disease activity respectively. The resorption bone markers were high in active versus non-active RA. Wrist and MCP erosion scores were also associated with RA activity. Our study shows that biomarkers of bone and cartilage collagen breakdown were related to specific joint erosion in RA and could predict subsequent radiographic damage in RA. Further larger scale longitudinal studies maybe needed to confirm our data.

Published
2018
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21. Genotyping of commensal Neisseria spp strains by pulsed-field gel electrophoresis and 16S rRNA gene sequencing.

Author

Mechergui A, Achour W, and Ben Hassen A

Subjects
DNA, Bacterial analysis, DNA, Bacterial genetics, Electrophoresis, Gel, Pulsed-Field, Genotyping Techniques, Humans, Neisseria classification, Neisseriaceae Infections microbiology, Polymerase Chain Reaction, Sequence Analysis, DNA, Molecular Typing methods, Neisseria genetics, RNA, Ribosomal, 16S genetics
Abstract

Background: We investigated the diversity of the primary sequences of the 16S rRNA genes among 46 commensal Neisseria strains and evaluated the use of this approach as a molecular typing tool in comparison with PFGE analysis., Methods: Identification to the genus was done using conventional methods and API NH (bio-Mérieux ® ). Identification to species level was based on 16S rRNA gene sequencing. PFGE analysis was done using SpeI., Results: Fourteen, two, three and fourteen 16S rRNA sequence types were found among twenty Neisseria flavescens, two Neisseria sicca, five Neisseria macacae and nineteen Neisseria mucosa clinical isolates. Forty-three different PFGE patterns were found among the tested strains., Conclusion: We demonstrated a high diversity among 16S rRNA genes which was reflected by PFGE analysis., (© 2017 Wiley Periodicals, Inc.)

Published
2018
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22. GES-14-Producing Acinetobacter baumannii Isolates in a Neonatal Intensive Care Unit in Tunisia Are Associated with a Typical Middle East Clone and a Transferable Plasmid.

Author

Mabrouk A, Grosso F, Botelho J, Achour W, Ben Hassen A, and Peixe L

Subjects
Acinetobacter Infections microbiology, Acinetobacter baumannii isolation & purification, Anti-Bacterial Agents pharmacology, Base Sequence, Carbapenems pharmacology, Disease Outbreaks, Humans, Intensive Care Units, Neonatal, Plasmids genetics, Sequence Analysis, DNA, Tunisia epidemiology, Acinetobacter Infections epidemiology, Acinetobacter baumannii drug effects, Acinetobacter baumannii genetics, Bacterial Proteins genetics, Drug Resistance, Bacterial genetics, beta-Lactamases genetics
Published
2017
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23. Serotype Distribution, Antibiotic Resistance and Clonality of Streptococcus pneumoniae Isolated from Immunocompromised Patients in Tunisia.

Author

Raddaoui A, Simões AS, Baaboura R, Félix S, Achour W, Ben Othman T, Béjaoui M, Sá-Leão R, and Ben Hassen A

Subjects
Adolescent, Adult, Aged, Anti-Infective Agents pharmacology, Child, Child, Preschool, Clone Cells, Female, Humans, Infant, Infant, Newborn, Male, Microbial Sensitivity Tests, Middle Aged, Multilocus Sequence Typing, Serogroup, Streptococcus pneumoniae drug effects, Tunisia, Young Adult, Drug Resistance, Microbial drug effects, Immunocompromised Host, Streptococcus pneumoniae classification, Streptococcus pneumoniae isolation & purification
Abstract

Background: Pneumococcal disease, a major cause of morbidity and mortality globally, has higher incidence among young children, the elderly and the immunocompromised of all ages. In Tunisia, pneumococcal conjugate vaccines (PCVs) are not included in the national immunization program. Also, few studies have described the epidemiology of S. pneumoniae in this country and, in particular, no molecular typing studies have been performed. The aim of this study was to evaluate serotype distribution, antimicrobial resistance and clonality of Streptococcus pneumoniae isolated from neutropenic patients in Tunisia., Methods: Fifty-nine S. pneumoniae were isolated from infection (n = 31) and colonization (n = 28) sites of patients (children and adults) attending the National Centre of Bone Marrow Transplantation in Tunis between 2005-2011. All isolates were characterized by serotype, antimicrobial resistance pattern and multilocus sequence typing (MLST)., Results: The majority (66.1%) of the isolates belonged to five serotypes all included in PCVs: 6B, 9V, 14, 19F and 23F. The potential coverage of the 10-valent and 13-valent PCV was of 71.2% and 76.3% respectively. Resistance rates were very high and 69.5% of the isolates were multidrug resistant: non-susceptibility rates to penicillin, amoxicillin and cefotaxime were 66.1%, 40.7% and 27.1%, respectively; resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole, were 69.5%, 61.0%, 37.3%, 22.0% and 67.8%, respectively. The most frequent serotypes had STs characteristic of multidrug resistant international clones known to be highly successful and important causes of pneumococcal infection: Spain 23F-ST81, France 9V/14-ST156, Spain 6B-ST90, 19F-ST320, and Portugal 19F-ST177., Conclusions: The majority of S. pneumoniae strains recovered from immunocompromised patients in Tunisia are representatives of multidrug resistant pandemic clones that express serotypes targeted by PCVs. To contain the burden of pneumococcal disease and improve treatment choices among Tunisian immunocompromised patients PCVs should be offered to all of them.

Published
2015
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24. rpoB mutations in Streptococcus mitis clinical isolates resistant to rifampin.

Author

Achour W, Guenni O, Fines M, Leclercq R, and Ben Hassen A

Subjects
DNA Primers, Drug Resistance, Bacterial, Humans, Microbial Sensitivity Tests, Mutation genetics, Neutropenia microbiology, Sequence Analysis, Protein, Antibiotics, Antitubercular pharmacology, DNA-Directed RNA Polymerases genetics, Rifampin pharmacology, Streptococcal Infections microbiology, Streptococcus mitis drug effects
Abstract

Activity of rifampin against 129 Streptococcus mitis isolates obtained from patients with hematologic cancer was investigated. One hundred twenty-five strains were susceptible to rifampin, and 4 were resistant (MIC = 32 to 64 microg/ml). Resistance to rifampin was related to mutations in the rpoB gene: His(526)Asn in three strains and His(526)Asp in one strain.

Published
2004
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