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The prevalence of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and carbapenemase-producing E. coli (CP-EC) is increasing worldwide. We investigated the epidemiology of ESBL-EC and CP-EC causing hospital-acquired (HA) infections in a large teaching hospital in Tunisia over the last two decades and compared it with a collection of 107 community-acquired (CA) ESBL-EC isolates. Between 2001 and 2019, the incidence of HA ESBL-EC increased significantly from 0.08 to 0.32 cases per 1,000 patient days, due entirely to the rapid emergence and expansion of ST131, which accounted for 42.3% (157/371) of HA ESBL-EC. Most ESBL-EC harbored the CTX-M type (92%) with a predominance of blaCTX-M-15. The C2/H30-Rx subclone ( n = 103, 65.6%) accounted for 90% of ST131 isolates between 2003 and 2012 and was exclusively associated with CTX-M-15, whereas cluster C1-M27, which was associated with CTX-M-27, emerged in 2013 and expanded gradually to 55% of ST131 in 2019. ST131 prevalence was higher among CA ESBL-EC than HA ESBL-EC (63.6% vs. 42.3%, P = 0.002). CA C2 subclone and non-ST131 isolates showed higher virulence scores than HA isolates. The incidence of CP-EC remained stable over the study period with a mean of 0.08 cases per 1,000 patient days. Among the 38 identified CP-EC isolates, only 16.2% belonged to the ST131 clone and 81.5% produced OXA-48-like carbapenemases. ST131 is the major driver of ESBL-EC spread in both hospital and community settings in Tunisia, mainly linked to the expansion of the CTX-M-15-C2 and CTX-M-27-C1 subclades. The emergence of CP-EC requires ongoing genomic surveillance., Importance: We aimed to investigate the microbiological features of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and carbapenemase-producing E. coli (CP-EC) causing hospital- and community-acquired infections in Tunisia over the last two decades. The study captured the emergence and expansion of the CTX-M-15-C2 ST131 subclade and successively the CTX-M-27-C1 ST131 subclade, which were responsible for the steady increase in the prevalence of ESBL-EC. However, the incidence of CP-EC remained stable over the study period with a highly diverse content in carbapenemase genes dominated by blaOXA-48-like. This is the first study to provide comprehensive data on the epidemiology of ESBL-EC and CP-EC in a North African country.

Aim: Histology is the most widely used test to detect H. pylori . PCR is less used but allows the detection of both infection and antibiotics' resistance. Methods: We conducted a monocentric cross-sectional study, collecting 97 symptomatic patients to assess the diagnostic performance of histology in the detection of H. pylori infection compared with PCR. Results: Sensitivity of histology in comparison with PCR was 81.5% and specificity was 56.3%. A history of anti- H. pylori therapy intake, as well as the density of the bacterium on the gastric sample and the presence of gastric atrophy, were significantly correlated to the PCR's result in terms of H. pylori detection. Conclusion: Thus, histology can be considered as an efficient test compared with PCR in H. pylori detection., Competing Interests: The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties., (© 2024 Manel Moalla.)

The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Mohamed Ben Jemaa et al.)

Klebsiella pneumoniae clinical isolates resistant to carbapenems were recovered from 11 patients in the hospital of Sfax, Tunisia. The isolates were closely related as shown by pulsed-field gel electrophoresis, and they produced VIM-4 metallo-enzyme, CTX-M-15 extended-spectrum beta-lactamase, and CMY-4 AmpC enzyme. The bla(VIM-4) gene is part of a class 1 integron.